Influence of Posterior Tibial Slope on Clinical Outcomes and Survivorship after Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts: A Minimum of 10-Year Follow-up.
- 作者列表："Yoon KH","Park SY","Park JY","Kim EJ","Kim SJ","Kwon YB","Kim SG
PURPOSE:To investigate the influence of medial and lateral posterior tibial slope (PTS) on long-term clinical outcomes and survivorship after anterior cruciate ligament (ACL) reconstruction using hamstring autografts. METHODS:A total of 232 patients (mean age, 28.2 ± 8.9 years) who underwent primary ACL reconstruction from October 2002 to July 2007 were retrospectively reviewed. Patients with multiple ligament reconstruction, total meniscectomy, contralateral knee surgery before ACL reconstruction, open growth plate, and less than 10-year follow-up were excluded in the study. The medial and lateral PTS were measured from preoperative magnetic resonance imaging. Based on Li et al.'s previous study, the patients were divided into two groups according to their medial PTS (≤5.6° vs. >5.6°) and lateral PTS (≤3.8° vs. >3.8°), respectively. Clinical outcomes (clinical scores, stability tests and failure rate) were compared between the groups at the last follow-up. Furthermore, survival analysis was performed using the Kaplan-Meier method. RESULTS:All clinical scores (International Knee Documentation Committee subjective, Lysholm, and Tegner activity scores) and stability tests (physical examinations and side-to-side difference in Telos stress radiographs) were insignificantly different between the two groups classified based on medial or lateral PTS. However, the failure rate was significantly higher in patients with medial PTS >5.6° (16.1% vs. 5.1%, p=0.01) or lateral PTS >3.8° (14.5% vs. 4.7%; p=0.01). The odds ratios of graft failure due to increased medial and lateral PTS were 3.18 (95% confidence interval, 1.22-8.28; p=0.02) and 3.43 (95% confidence interval, 1.29-9.09; p=0.01), respectively. Additionally, the 10-year survivorship was significantly lower in patients with medial PTS >5.6° (83.9% vs. 94.9%, p=0.01) or lateral PTS >3.8° (85.5% vs. 96.0%; p=0.01). CONCLUSIONS:Increased medial (>5.6°) and lateral (>3.8°) PTS were associated with higher failure rate and lower survivorship at a minimum of 10-year follow-up after primary ACL reconstruction using hamstring autografts.
目的: 探讨胫骨内侧和外侧后倾角 (PTS) 对应用腘绳肌自体移植物重建前交叉韧带 (ACL) 后远期临床疗效和生存率的影响。 方法: 回顾性分析 2002 年 10 月至 2007 年 7 月接受 ACL 重建术的 232 例患者 (平均年龄 28.2 ± 8.9 岁)。研究中排除了多韧带重建、半月板全切除、 ACL 重建前对侧膝关节手术、开放生长板、随访不到 10 年的患者。从术前磁共振成像测量内侧和外侧 PTS。基于 Li 等人之前的研究，根据患者的内侧 PTS (≤ 5.6 ° vs. >5.6 °) 将患者分为两组和外侧 PTS (≤ 3.8 ° vs. >3.8 °)。比较末次随访时两组患者的临床结局 (临床评分、稳定性测试和失败率)。此外，使用 Kaplan-Meier 方法进行生存分析。 结果: 所有临床评分 (国际膝关节文献委员会主观、 Lysholm 和 Tegner 活动评分) 和稳定性测试 (体检和 Telos 应力 x 线片的侧对侧差异) 根据内侧或外侧 PTS 分类的两组之间无显著差异。然而，内侧 PTS >5.6 ° 的患者失败率显著较高 (16.1% vs. 5.1%，p = 0.01) 或侧位 PTS >3.8 ° (14.5% vs. 4.7%; p = 0.01)。内、外侧 PTS 增加导致移植失败的比值比分别为 3.18 (95% 置信区间，1.22-8.28; p = 0.02) 和 3.43 (95% 置信区间，1.29-9.09; p = 0.01)，分别。此外，内侧 PTS >5.6 ° 的患者 10 年生存率显著降低 (83.9% vs. 94.9%，p = 0.01) 或侧位 PTS >3.8 ° (85.5% vs. 96.0%; p = 0.01)。 结论: 内侧 (>5.6 °) 和外侧 (>3.8 °) 增加使用腘绳肌自体移植物进行初次 ACL 重建后，PTS 的失败率较高，存活率较低，至少随访 10 年。
METHODS:Purpose To determine outcomes of transphyseal ACL reconstruction using a living parental hamstring tendon allograft in a consecutive series of 100 children. Methods One hundred consecutive juveniles undergoing ACL reconstruction with a living parental hamstring allograft were recruited prospectively and reviewed 2 years after ACL reconstruction with IKDC Knee Ligament Evaluation, and KT1000 instrumented laxity testing. Skeletally immature participants obtained annual radiographs until skeletal maturity, and long leg alignment radiographs at 2 years. Radiographic Posterior tibial slope was recorded. Results Of 100 juveniles, the median age was 14 years (range 8–16) and 68% male. At surgery, 30 juveniles were graded Tanner 1 or 2, 21 were Tanner 3 and 49 were Tanner 4 or 5. There were no cases of iatrogenic physeal injury or leg length discrepancy on long leg radiographs at 2 years, despite a median increase in height of 8 cm. Twelve patients had an ACL graft rupture and 9 had a contralateral ACL injury. Of those without further ACL injury, 82% returned to competitive sports, IKDC ligament evaluation was normal in 52% and nearly normal in 48%. The median side to side difference on manual maximum testing with the KT1000 was 2 mm (range − 1 to 5). A radiographic PTS of 12° or more was observed in 49%. Conclusions ACL reconstruction in the juvenile with living parental hamstring tendon allograft is a viable procedure associated with excellent clinical stability, patient-reported outcomes and return to sport over 2 years. Further ACL injury to the reconstructed and the contralateral knee remains a significant risk, with identical prevalence observed between the reconstructed and contralateral ACL between 12 and 24 months after surgery. Level of evidence III (Cohort Study).
METHODS:Purpose The purpose of the study was to investigate the biomechanics of walking and of the knee joint in the acute phase of ACL injury. Methods We examined 18 patients with acute ACL injuries and 20 healthy adults as controls. The biomechanics of the knee joint and of walking was assessed by 5 inertial sensors fixed with special cuffs to the lower back, the lower third of the thigh, and the lower third of the shank of the right and left legs. The movements and temporal characteristics were recorded while the subject was walking 10 m at a comfortable pace. Based on the results of examination, the patients were divided into two groups: with severe function impairment (6 patients) and with moderate function impairment (12 patients). Results It was found that in the first days post-trauma, not only the knee function was reduced, but the function of the entire lower limb as well. This led to a functional asymmetry. The kinematics of movements in the joints changed in accordance with slower walking. The walking became not only slower, but it was also associated with a decreased impact load in the weight acceptance phase. At later dates, the functional impairments were less pronounced. The total range of flexion motion did not exceed 20 degrees in the first group and 55 degrees in the second one. The injured joint developed functional immobilization within the first days post-injury. This was a guarding response by additional muscle strain to prevent unusual and limit physiological movements in the knee joint. The movements in the knee joint while walking were of small amplitude, rocking, and occurred only under load. The amplitude of the main flexion in the swing phase was reduced. Conclusion The stage of an ACL injury should be assessed not only based on the time post-trauma, but also taking account of the functional parameter—the knee range of flexion while walking. According to our findings, the only factor that had influenced the functional condition of the KJ was the duration of joint immobilization after trauma.
METHODS:Purpose Numerous techniques have been described for the tibial-sided graft preparation in anterior cruciate ligament (ACL) reconstruction. The use of less suture material for graft preparation is thought to improve ingrowth and to reduce the risk for infection. At the same time, the suture construct should be strong enough to resist the surgeon’s pull during tensioning of the transplant. Methods In total, 39 fresh-frozen procine deep flexor tendons were used and prepared as four-strand grafts. In the three-suture group ( n = 19), graft preparation was performed using three tibial-sided sutures, with each tendon end sutured separately. In the one-suture group ( n = 20), a modified graft preparation using only one tibial-sided suture was applied. Each sample underwent load-to-failure testing ( N _max) after cyclic pre-loading. To estimate intraoperative tension forces acting on the tibial-sided suture constructs, the maximal tension force of 26 volunteers on such a construct was measured using a load cell. Results The biomechanical testing of the two different suture constructs showed a significantly higher load-to-failure for the three-suture group (711 N ± 91 N) compared to the one-suture group (347 N ± 24 N) ( p = 0.0001). In both groups, the mode of failure was a tear of the suture in all samples. A failure of the suture–tendon interface was not observed in any case. The median maximal tension force on the construct applied by the 26 volunteers was 134 N (range 73–182 N). Conclusion The presented single-suture tendon graft preparation resisted to smaller failure loads than the conventional three-suture technique. However, no failures in the suture–tendon interface were seen and the failure loads observed were far beyond the tension forces that can be expected intraoperatively. Hence, the single-suture graft preparation technique may be a valuable alternative to the conventional technique.