| 1. |
- Herman, Zachary J, et al.
(author)
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Outcomes of bone-patellar tendon-bone autograft and quadriceps tendon autograft for ACL reconstruction in an all-female soccer player cohort with mean 4.8-year follow up.
- 2024
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In: Journal of ISAKOS : joint disorders & orthopaedic sports medicine. - 2059-7762. ; 9:1, s. 34-38
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Journal article (peer-reviewed)abstract
- The purpose is to compare functional outcomes, return to soccer rates, and revision rates in an all-female soccer player cohort undergoing quadriceps tendon (QT) autograft ACLR versus bone-patellar tendon-bone (BPTB) autograft ACLR.Female soccer players who sustained an ACL rupture and underwent primary anatomic, single-bundle ACLR with BPTB autograft or QT autograft were included. Demographic and surgical characteristics were collected. Outcomes of interest included Tegner score, International Knee Documentation Committee (IKDC) score, Marx score, return to soccer rates, and failure rates.Data on 23 patients undergoing BPTB autograft ACLR and 14 undergoing QT autograft ACLR was available. Average age was 18.7 years, and average follow up was 4.8 years. Overall, 76% (28/37) returned to soccer and 5.4% (2/37) underwent revision ACLR. No major significant differences were found in demographic or surgical characteristics. No differences were found in postoperative IKDC scores, preoperative, postoperative, or change from pre-to postoperative Marx activity scores, or pre-and postoperative Tegner scores between the groups. QT autograft ACLR patients had significantly less change in Tegner scores pre-to postoperatively compared to the BTPB autograft ACLR group (0.6±1.2 versus 2.1±1.8; p=0.02). Both groups had similar rates of return to soccer [78% (18/23) BPTB autograft ACLR versus 71% (10/14) QT autograft ACLR; p=0.64] and rates of revision (8.7 % (2/23) BPTB autograft ACLR; 0 % (0/14) QT autograft ACLR.Results of this study suggest that BPTB autograft ACLR and QT autograft ACLR produce comparable, successful functional and return to soccer outcomes in this all-female soccer player cohort study. Larger, prospective studies are needed to improve the strength of conclusions and provide more information on the optimal graft choice for female soccer players. Surgeons can use the results of this study to counsel female soccer players on expected outcomes after ACLR.III.
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| 2. |
- Herman, Zachary J, et al.
(author)
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Overhead Athletes Have Comparable Intraoperative Injury Patterns and Clinical Outcomes to Nonoverhead Athletes Following Surgical Stabilization for First-Time Anterior Shoulder Instability at Average 6 Year Follow Up
- 2024
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In: Journal of shoulder and elbow surgery. - 1532-6500. ; 33:6, s. 1219-1227
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Journal article (peer-reviewed)abstract
- Anterior shoulder instability is a common problem affecting young, athletic populations that results in potential career-altering functional limitations. However, little is known regarding the differences in clinical outcomes after operative management of overhead versus nonoverhead athletes presenting with first-time anterior shoulder instability. We hypothesized that overhead athletes would have milder clinical presentations, similar surgical characteristics, and diminished postoperative outcomes when compared to nonoverhead athletes after surgical stabilization following first-time anterior shoulder instability episodes.Patients with first-time anterior shoulder instability events (subluxations and dislocations) undergoing operative management between 2013-2020 were included. Exclusion criteria included multiple dislocations and multidirectional shoulder instability. Baseline demographics, imaging, exam, and intraoperative findings were retrospectively collected. Patients were contacted to collect postoperative patient reported outcomes (PROs) including American Shoulder and Elbow Surgeons (ASES) score, Western Ontario Shoulder Instability (WOSI) score, Brophy activity index, Subjective Shoulder Value (SSV), in addition to return to work/sport rates, recurrent dislocation, and revision rates.A total of 256 patients met inclusion criteria, of which 178 (70%) patients were nonoverhead athletes. Mean age of the entire population was 23.1 years. There was no significant difference in concomitant shoulder pathology nor preoperative range of motion or strength between cohorts. A greater proportion of overhead athletes presented with instability events not requiring manual reduction (defined as subluxations; 64.1% vs. 50.6%; p < 0.001) and underwent arthroscopic surgery (97% vs. 76%, p < 0.001) compared to nonoverhead athletes. A smaller proportion of overhead athletes underwent open soft-tissue stabilization compared to nonoverhead athletes (1% vs. 19%, p < 0.001). Outcome data on 60 patients with average follow-up 6.7 years was available. No significant differences were found between groups with respect to recurrent postoperative instability event rate (13.0% overhead vs. 16.8% nonoverhead) or revision (13.0% overhead vs. 11.1% nonoverhead) rates, ASES, WOSI, BROPHY, SSV, or rates return to work/sport.Overhead athletes who underwent surgery after an initial instability event were more likely to present with subluxations compared to nonoverhead athletes. With limited follow-up subject to biases, this study found no differences in recurrence or revision rates, postoperative PROs, or return to work/sport rates between the overhead and nonoverhead athletes undergoing shoulder stabilization surgery following first-time instability events. While larger prospective studies are necessary to draw firmer conclusions, the findings of this study suggest that overhead athletes can be considered in the same treatment pathway for first-time dislocation as nonoverhead athletes.
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| 3. |
- Kaarre, Janina, 1996, et al.
(author)
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Metal interference screw fixation combinations show high revision rates in primary hamstring tendon ACL reconstruction
- 2024
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In: BMC Musculoskeletal Disorders. - 1471-2474. ; 25:1
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Journal article (peer-reviewed)abstract
- Background: Different fixation methods in anterior cruciate ligament reconstruction (ACLR) have been associated with different revision rates, specifically in the early postoperative period. However, most previous research has either grouped together different fixation types or evaluated femoral-sided fixation or tibial-sided fixation separately. Therefore, the purpose of this study was to determine ACL revision rates for specific combinations of femoral and tibial fixation methods within 2 years of primary hamstring tendon autograft ACLR based on data from the Swedish National Knee Ligament Registry (SNKLR). Methods: Patients that underwent primary hamstring tendon autograft ACLR between 2005 and 2018 in the SNKLR were included. The collected data included patient characteristics (age, sex, body mass index [BMI]), activity at time of injury, surgical information (concomitant injuries, time from injury to surgery, fixation types at the femur and tibia), and subsequent revision ACLR. Revision rate within 2 years of the index procedure was chosen, as ACLR fixation is most likely to contribute to ACLR revision within the first 2 years, during graft maturation. Results: Of the 23,238 included patients undergoing primary hamstring ACLR, 581 (2.5%) underwent revision ACLR within 2 years of the index procedure. Among the combinations used for > 300 patients, the femoral metal interference screw/tibial metal interference screw fixation combination had the highest revision rate followed by metal interference screw/resorbable screw and Endobutton/AO screw fixation combinations, with respective revision rates of 4.0, 3.0, and 3.0%. The lowest revision rate within 2 years of ACLR was found in the Endobutton/metal interference screw with backup Osteosuture fixation combination, used in 433 cases, with a failure rate of 0.9%. Conclusion: Different early ACL revision rates were found across different combinations of femoral and tibial fixation devices within 2 years of primary hamstring tendon autograft ACLR. Metal interference screw fixation, particularly when performed on both the femoral and tibial sides, most frequently resulted in revision ACLR. These findings may be helpful for surgeons in selecting appropriate fixation devices for hamstring ACLR. Level of evidence: IV.
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| 4. |
- Kaarre, Janina, 1996, et al.
(author)
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Strength symmetry after autograft anterior cruciate ligament reconstruction.
- 2024
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In: Journal of ISAKOS : joint disorders & orthopaedic sports medicine. - 2059-7762. ; 9:1, s. 3-8
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Journal article (peer-reviewed)abstract
- To compare postoperative isometric quadriceps strength indices (QI%) and hamstring strength limb symmetry indices (HI%) between partial thickness quadriceps tendon (pQT), full thickness quadriceps tendon (fQT), and bone-patellar-tendon bone (BPTB) autograft anterior cruciate ligament reconstruction (ACLR).Patients with primary ACLR with pQT, fQT, or BPTB autograft with the documentation of quantitative postoperative strength assessments between 2016 and 2021 were included. Isometric Biodex data, including QI% and HI% (calculated as the percentage of involved to uninvolved limb strength) were collected between 5 and 8 months and between 9 and 15 months postoperatively.In total, 124 and 51 patients had 5-8- and 9-15-month follow-up strength data, respectively. No significant difference was detected between groups for sex. However, patients undergoing fQT were found to be older than those undergoing BPTB (24.6±7 vs 20.2±5;p = 0.01). There were no significant differences in the number of concomitant meniscus repairs between the groups (pQT vs. fQT vs. BPTB). No significant differences were detected in median (min-max) QI% between pQT, fQT, and BPTB 5-8 months [87% (44%-130%), 84% (44%-110%), 82% (37%-110%) or 9-15 months [89% (50%-110%), 89% (67%-110%), and 90% (74%-140%)] postoperatively. Similarly, no differences were detected in median HI% between the groups 5-8 months or 9-15 months postoperatively.The study was unable to detect differences in the recovery of quadriceps strength between patients undergoing ACLR with pQT, fQT, and BPTB autografts at 5-8 months and 9-15-months postoperatively.III.
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| 5. |
- Zsidai, Balint, 1993, et al.
(author)
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Slope-Reducing High Tibial Osteotomy and Over-The-Top Anterior Cruciate Ligament Reconstruction With Achilles Tendon Allograft in Multiple Failed Anterior Cruciate Ligament Reconstruction
- 2022
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In: Arthroscopy Techniques. - : Elsevier BV. - 2212-6287. ; 11:11
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Journal article (peer-reviewed)abstract
- Graft failure is a challenging complication following anterior cruciate ligament reconstruction (ACL-R). Among the multiple anatomic and nonanatomic risk factors contributing to ACL-R failure, there is accumulating evidence that a posterior tibial slope of 12° or greater may predispose patients to graft failure of primary and revision ACL-R. In addition, previously malpositioned or widened tunnels, as well as limited autograft options, pose challenges in the setting of revision ACL-R. This Technical Note describes a technique to correct an increased posterior tibial slope using slope-reducing high tibial osteotomy, and single stage revision ACL-R with Achilles tendon allograft using the over-the-top route, in a single-stage procedure. The surgical technique involves an anterior approach to the proximal tibia, followed by tibial tubercle osteotomy and anterior closing-wedge osteotomy. The posterior cortical osteotomy hinge is left intact below the insertion of the posterior cruciate ligament. Over-the-top revision ACL-R is then performed using an Achilles tendon allograft passed around the posterior aspect of the lateral femoral condyle and fixed onto the lateral femur.
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