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- Setliff, J. C., et al.
(författare)
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Harvesting a second graft from the extensor mechanism for revision ACL reconstruction does not delay return of quadriceps function
- 2023
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 31:7, s. 2828-2835
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The purpose of this study was to evaluate whether harvesting a second graft from the ipsilateral extensor mechanism adversely affects clinical outcomes in revision anterior cruciate ligament (ACL) reconstruction. Methods A retrospective review of 34 patients undergoing revision anterior cruciate ligament (ACL) reconstruction with either quadriceps tendon (QT) autograft or bone-tendon-bone (BTB) autograft was conducted. Patients with two grafts (BTB+QT) from the extensor mechanism were matched based on age, laterality, and sex to patients who had primary reconstruction with hamstring (HS) autograft followed by revision with either BTB or QT autograft (HS+QT/BTB). Return of quadriceps function was assessed with time to return to jogging in a standardized rehab protocol or time to regain 80% quadriceps strength. Secondary outcomes included International Knee Documentation Committee (IKDC) and Marx scores at 12-month follow-up and return to sport. Results There were no significant differences in return to jogging or 80% quadriceps strength (HS 149.5 +/- 38.2 days, BTB+QT 131.7 +/- 40.1 days, n.s.), number able to return to sport (HS 62%, BTB+QT 93%, n.s.), months to return to sport (HS 10.6 +/- 1.4, BTB+QT 10.5 +/- 2.3, n.s.), return to pre-injury level of competition (HS 62%, BTB+QT 73%, n.s.), or IKDC (HS 77.2 +/- 16.4, BTB+QT 74.8 +/- 23.9, n.s.) and Marx scores (HS 9.2 +/- 5.3, BTB+QT 8.0 +/- 3.7, n.s.) at one-year follow-up. Conclusion The main finding of the present study was that outcomes for patients who underwent revision ACL reconstruction with a second extensor mechanism autograft were comparable to those seen for patients who underwent revision ACL reconstruction with extensor mechanism autograft after primary ACL reconstruction with hamstring autograft. By better understanding the consequences of harvesting a second graft from the extensor mechanism, surgeons can better decide what graft to use in revision ACL reconstruction.
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| 2. |
- Godshaw, B. M., et al.
(författare)
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Posterior tibial plateau impaction fractures are not associated with increased knee instability: a quantitative pivot shift analysis
- 2023
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose This study aimed to evaluate posterolateral tibial plateau impaction fractures and how they contribute to rotatory knee laxity using quantitative pivot shift analysis. It was hypothesised that neither the presence of nor the degree of involvement of the plateau would affect rotatory knee laxity in the ACL-deficient knee. Methods A retrospective review of prospectively collected data on 284 patients with complete anterior cruciate ligament (ACL) injuries was conducted. Posterolateral tibial plateau impaction fractures were identified on preoperative MRI. The patients were divided into two cohorts: "fractures" or "no fractures". The cohort with fractures was further categorised based on fracture morphology: "extra-articular", "articular-impaction", or "displaced-articular fragment". All data were collected during examination under anaesthesia performed immediately prior to ACL reconstruction. This included a standard pivot shift test graded by the examiner and quantitative data including anterior tibial translation (mm) via Rolimeter, quantitative pivot shift (QPS) examination ( mm) via PIVOT tablet technology, and acceleration (m/sec(2)) during the pivot shift test via accelerometer. Quantitative examinations were compared with the contralateral knee. Results There were 112 patients with posterolateral tibial plateau impaction fractures (112/284, 39%). Of these, 71/112 (63%) were "extra-articular", 28/112 (25%) "articular-impaction", and 13/112 ( 12%) "displaced-articular". Regarding the two groups with or without fractures, there was no difference in subjective pivot shift (2 +/- 0 vs 2 +/- 0, respectively, n.s.), QPS (2.4 +/- 1.6 mm vs 2.7 +/- 2.2 mm, respectively, n.s.), anterior tibial translation measurements (6 +/- 3 mm vs 5 +/- 3 mm, respectively, n.s.), or acceleration of the knee during the pivot (1.7 +/- 2.3 m/s(2) vs 1.8 +/- 3.1 m/s(2), respectively, n.s.). When the fractures were further subdivided, subgroup analysis revealed no significant differences noted in any of the measured examinations between the fracture subtypes. Conclusion This study showed that the posterolateral tibial plateau impaction fractures are commonly encountered in the setting of ACL tears; however, contrary to previous reports, they do not significantly increase rotatory knee laxity. This suggests that this type of concomitant injury may not need to be addressed at the time of ACL reconstruction.
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