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- Björnsson, Haukur, et al.
(author)
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A Randomized Controlled Trial With Mean 16-Year Follow-up Comparing Hamstring and Patellar Tendon Autografts in Anterior Cruciate Ligament Reconstruction
- 2016
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In: American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 44:9, s. 2304-2313
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Journal article (peer-reviewed)abstract
- Background: There is no consensus in the current literature on which surgical options render the best long-term results after anterior cruciate ligament (ACL) reconstruction in terms of clinical outcomes and the development of radiographic osteoarthritis (OA). Purpose: To investigate the long-term clinical and radiographic results after ACL reconstruction using either a patellar tendon (PT) autograft or a hamstring tendon (HT) autograft. Methods: This multicenter study was based on 2 previous randomized cohorts consisting of 193 patients who underwent unilateral primary ACL reconstruction using either a PT autograft or an HT autograft. The index surgical procedure was performed between September 1995 and January 2000. Clinical assessments, including knee laxity measurements, functional outcomes, patient-reported outcomes, and bilateral standing radiographs, were performed at the final follow-up examination. Results: At the long-term follow-up, 147 (76%) patients were examined: 61 in the PT group and 86 in the HT group. The mean (SD) follow-up time was 191.9 +/- 15.1 months for the HT group and 202.6 +/- 10.4 months for the PT group. Knee laxity measurements revealed significantly more patients with a normal pivot-shift test finding in the HT group compared with the PT group (71% vs 51%, respectively; P = .048); however, no significant differences were found in terms of the manual Lachman test or the KT-1000 arthrometer manual maximum test. The patients in the PT group had significantly more difficulty knee walking (P = .049). There were no significant differences between the study groups in terms of patient-reported outcomes or range of motion in the reconstructed knee. In both groups, significantly more signs of radiographic OA were found in the reconstructed knee than in the contralateral healthy knee. However, there were no significant differences between the groups in terms of radiographic OA. Conclusion: Only minor and mostly insignificant differences were found between the PT and HT autograft groups in this long-term randomized controlled trial. In both groups, significantly more signs of radiographic OA were found in the reconstructed knee than in the contralateral knee.
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- Desai, Neel
(author)
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Anatomic anterior cruciate ligament reconstruction - aspects of surgical technique
- 2016
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Doctoral thesis (other academic/artistic)abstract
- Anatomic anterior cruciate ligament (ACL) reconstruction is a concept that has gained in interest and it aims to more effectively restore native ACL anatomy and function. Despite extensive research on the topic, the optimal surgical technique to accomplish this is still the subject of debate. Study I is a meta-analysis to determine whether anatomic double-bundle (DB) reconstruction compared with anatomic single-bundle (SB) reconstruction more effectively restores knee laxity, and reduces rates of graft failure. A total of 15 studies were included for analysis. The results revealed significantly less antero-posterior (AP) laxity after anatomic DB reconstruction. No statistically significant differences were seen between anatomic DB and SB techniques in terms of the pivot-shift test, Lachman test, anterior drawer test, total knee rotation or graft failure rates. Study II is a systematic review including the implementation of the Anatomic Anterior Cruciate Ligament Reconstruction Scoring Checklist (AARSC) on studies comparing SB and DB reconstruction in order to evaluate the reporting of surgical details, and the degree to which these clinical studies fulfil the criteria of anatomic ACL reconstruction. Seventy-seven studies were included. Details of the surgical techniques used were more thoroughly reported for DB reconstructions than for SB reconstructions. There was substantial underreporting of surgical data for both the SB and DB groups in clinical studies. Study III is a prospective randomised clinical trial comparing the outcomes of the anatomic DB technique and anatomic SB technique using hamstrings tendon autograft. A total of 105 patients were randomised and underwent ACL reconstruction. At five-year follow-up, no statistically significant differences were found between the groups in terms of subjective or objective outcomes, or in terms of the presence of osteoarthritis (OA). Study IV is a cohort study with data from the Swedish National Knee Ligament Register with the focus on the risk of revision ACL surgery. A total of 17,682 patients were included. Surgical details pertaining to their primary ACL reconstruction were collected via an online questionnaire comprised of items from the AARSC, distributed to the surgeons. Non-anatomic bone tunnel placement via transtibial drilling resulted in the lowest risk of revision surgery. Non-anatomic surgical techniques in general were associated with a lower risk of revision. Anatomic techniques utilising several pertinent items from the AARSC were associated with a lower risk of revision compared with anatomic techniques utilising only some items.
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- Desai, Neel, et al.
(author)
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Anatomic single- versus double-bundle ACL reconstruction: a meta-analysis.
- 2014
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In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 22:5, s. 1009-1023
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Journal article (peer-reviewed)abstract
- To determine whether anatomic double-bundle anterior cruciate ligament (ACL) reconstruction compared to anatomic single-bundle ACL reconstruction more effectively restored antero-posterior (A-P) laxity, rotatory laxity and reduced frequency of graft rupture. Our hypothesis was that anatomic double-bundle ACL reconstruction results in superior rotational knee laxity and fewer graft ruptures due to its double-bundle tension pattern, compared with anatomic single-bundle ACL reconstruction.
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- Desai, Neel, et al.
(author)
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Outcomes after ACL reconstruction with focus on older patients: results from The Swedish National Anterior Cruciate Ligament Register.
- 2014
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In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 22:2, s. 379-86
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Journal article (peer-reviewed)abstract
- To investigate and analyse outcomes of patients over the age of 40 who had undergone anterior cruciate ligament (ACL) reconstruction and to compare them to their younger counterparts. We analysed patient-reported outcomes measured using the knee injury and osteoarthritis outcome score (KOOS) as well as aetiology of injury, concomitant intra-articular injuries and time from injury to surgery.
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- Desai, Neel, et al.
(author)
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Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17,682 patients from the Swedish National Knee Ligament Register
- 2017
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In: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 25:5, s. 1542-1554
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Journal article (peer-reviewed)abstract
- To investigate the association between surgical variables and the risk of revision surgery after ACL reconstruction in the Swedish National Knee Ligament Register. This cohort study was based on data from the Swedish National Knee Ligament Register. Patients who underwent primary single-bundle ACL reconstruction with hamstring tendon were included. Follow-up started with primary ACL reconstruction and ended with ACL revision surgery or on 31 December, 2014, whichever occurred first. Details on surgical technique were collected using an online questionnaire. All group comparisons were made in relation to an "anatomic" reference group, comprised of essential AARSC items, defined as utilization of accessory medial portal drilling, anatomic tunnel placement, visualization of insertion sites and pertinent landmarks. Study end-point was revision surgery. A total of 108 surgeons (61.7%) replied to the questionnaire. A total of 17,682 patients were included [n = 10,013 males (56.6%) and 7669 females (43.4%)]. The overall revision rate was 3.1%. Older age as well as cartilage injury evident at index surgery was associated with a decreased risk of revision surgery. The group using transtibial drilling and non-anatomic bone tunnel placement was associated with a lower risk of revision surgery [HR 0.694 (95% CI 0.490-0.984); P = 0.041] compared with the anatomic reference group. The anatomic reference group showed no difference in risk of revision surgery compared with the transtibial drilling groups with partial anatomic [HR 0.759 (95% CI 0.548-1.051), n.s.] and anatomic tunnel placement [HR 0.944 (95% CI 0.718-1.241), n.s.]. The anatomic reference group showed a decreased risk of revision surgery compared with the transportal drilling group with anatomic placement [HR 1.310 (95% CI 1.047-1.640); P = 0.018]. Non-anatomic bone tunnel placement via transtibial drilling resulted in the lowest risk of revision surgery after ACL reconstruction. The risk of revision surgery increased when using transportal drilling. Performing anatomic ACL reconstruction utilizing eight selected essential items from the AARSC lowered the risk of revision surgery associated with transportal drilling and anatomic bone tunnel placement. Detailed knowledge of surgical technique using the AARSC predicts the risk of ACL revision surgery.
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- Hamrin Senorski, Eric, 1989, et al.
(author)
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Increased odds of patient-reported success at 2years after anterior cruciate ligament reconstruction in patients without cartilage lesions: a cohort study from the Swedish National Knee Ligament Register.
- 2018
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In: Knee surgery, sports traumatology, arthroscopy. - : Springer Science and Business Media LLC. - 1433-7347 .- 0942-2056. ; 26:4, s. 1086-1095
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Journal article (peer-reviewed)abstract
- To investigate whether the surgical technique of single-bundle anterior cruciate ligament (ACL) reconstruction, the visualization of anatomic surgical factors and the presence or absence of concomitant injuries at primary ACL reconstruction are able to predict patient-reported success and failure. The hypothesis of this study was that anatomic single-bundle surgical procedures would be predictive of patient-reported success.This cohort study was based on data from the Swedish National Knee Ligament Register during the period of 1 January 2005 through 31 December 2014. Patients who underwent primary single-bundle ACL reconstruction with hamstring tendons were included. Details on surgical technique were collected using an online questionnaire comprising essential anatomic anterior cruciate ligament reconstruction scoring checklist items, defined as the utilization of accessory medial portal drilling, anatomic tunnel placement, the visualization of insertion sites and pertinent landmarks. A univariate logistic regression model adjusted for age and gender was used to determine predictors of patient-reported success and failure, i.e. 20th and 80th percentile, respectively, in the Knee injury and Osteoarthritis Outcome Score (KOOS), 2years after ACL reconstruction.In the 6889 included patients, the surgical technique used for single-bundle ACL reconstruction did not predict the predefined patient-reported success or patient-reported failure in the KOOS4. Patient-reported success was predicted by the absence of concomitant injury to the meniscus (OR=0.81 [95% CI, 0.72-0.92], p=0.001) and articular cartilage (OR=0.70 [95% CI, 0.61-0.81], p<0.001). Patient-reported failure was predicted by the presence of a concomitant injury to the articular cartilage (OR=1.27 [95% CI, 1.11-1.44], p<0.001).Surgical techniques used in primary single-bundle ACL reconstruction did not predict the KOOS 2years after the reconstruction. However, the absence of concomitant injuries at index surgery predicted patient-reported success in the KOOS. The results provide further evidence that concomitant injuries at ACL reconstruction affect subjective knee function and a detailed knowledge of the treatment of these concomitant injuries is needed.Retrospective cohort study, Level III.
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