Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Improving Care for Patients With ACL Injuries: A Team Approach 11 articles

Articles

Risk of Revision Was Not Reduced by a Double-bundle ACL Reconstruction Technique: Results From the Scandinavian Registers

Cathrine Aga MD, Jüri-Tomas Kartus MD, PhD, Martin Lind MD, PhD, Stein Håkon Låstad Lygre PhD, Lars-Petter Granan MD, PhD, Lars Engebretsen MD, PhD

Double-bundle anterior cruciate ligament (ACL) reconstruction has demonstrated improved biomechanical properties and moderately better objective outcomes compared with single-bundle reconstructions. This could make an impact on the rerupture rate and reduce the risk of revisions in patients undergoing double-bundle ACL reconstruction compared with patients reconstructed with a traditional single-bundle technique. The National Knee Ligament Registers in Scandinavia provide information that can be used to evaluate the revision outcome after ACL reconstructions.

What Is the Mid-term Failure Rate of Revision ACL Reconstruction? A Systematic Review

Alberto Grassi MD, Christopher Kim MD, Giulio Maria Marcheggiani Muccioli MD, Stefano Zaffagnini MD, Annunziato Amendola MD

When anterior cruciate ligament (ACL) reconstruction fails, a revision procedure may be performed to improve knee function, correct instability, and allow return to activities. The results of revision ACL reconstruction have been reported to produce good but inferior patient-reported and objective outcomes compared with primary ACL reconstruction, but the degree to which this is the case varies widely among published studies and may be influenced by heterogeneity of patients, techniques, and endpoints assessed. For those reasons, a systematic review may provide important insights.

High Interspecimen Variability in Engagement of the Anterolateral Ligament: An In Vitro Cadaveric Study

Robert N. Kent BSE, James F. Boorman-Padgett BS, Ran Thein MD, Jelle P. List MD, Danyal H. Nawabi MD, Thomas L. Wickiewicz MD, Carl W. Imhauser PhD, Andrew D. Pearle MD

Anterolateral ligament (ALL) reconstruction as an adjunct to anterior cruciate ligament (ACL) reconstruction remains a subject of clinical debate. This uncertainty may be driven in part by a lack of knowledge regarding where, within the range of knee motion, the ALL begins to carry force (engages).

Variations in Knee Kinematics After ACL Injury and After Reconstruction Are Correlated With Bone Shape Differences

Drew A. Lansdown MD, Valentina Pedoia PhD, Musa Zaid MD, Keiko Amano MD, Richard B. Souza PT, PhD, Xiaojuan Li PhD, C. Benjamin Ma MD

The factors that contribute to the abnormal knee kinematics after anterior cruciate ligament (ACL) injury and ACL reconstruction remain unclear. Bone shape has been implicated in the development of hip and knee osteoarthritis, although there is little knowledge about the effects of bone shape on knee kinematics after ACL injury and after ACL reconstruction.

Knee Abduction Affects Greater Magnitude of Change in ACL and MCL Strains Than Matched Internal Tibial Rotation In Vitro

Nathaniel A. Bates PhD, Rebecca J. Nesbitt PhD, Jason T. Shearn PhD, Gregory D. Myer PhD, Timothy E. Hewett PhD

Anterior cruciate ligament (ACL) injures incur over USD 2 billion in annual medical costs and prevention has become a topic of interest in biomechanics. However, literature conflicts persist over how knee rotations contribute to ACL strain and ligament injury. To maximize the efficacy of ACL injury prevention, the effects of underlying mechanics need to be better understood.

Rotational Laxity Control by the Anterolateral Ligament and the Lateral Meniscus Is Dependent on Knee Flexion Angle: A Cadaveric Biomechanical Study

Timothy Lording FRACS, Gillian Corbo BSc, Dianne Bryant PhD, Timothy A. Burkhart PhD, Alan Getgood MD

Injury to the anterolateral ligament (ALL) has been reported to contribute to high-grade anterolateral laxity after anterior cruciate ligament (ACL) injury. Failure to address ALL injury has been suggested as a cause of persistent rotational laxity after ACL reconstruction. Lateral meniscus posterior root (LMPR) tears have also been shown to cause increased internal rotation of the knee.

Does the FIFA 11+ Injury Prevention Program Reduce the Incidence of ACL Injury in Male Soccer Players?

Holly J. Silvers-Granelli MPT, Mario Bizzini PhD, MSC, PT, Amelia Arundale DPT, Bert R. Mandelbaum MD, Lynn Snyder-Mackler PT, ScD

The FIFA 11+ injury prevention program has been shown to decrease the risk of soccer injuries in men and women. The program has also been shown to decrease time loss resulting from injury. However, previous studies have not specifically investigated how the program might impact the rate of anterior cruciate ligament (ACL) injury in male soccer players.

What Factors Influence the Biomechanical Properties of Allograft Tissue for ACL Reconstruction? A Systematic Review

Drew A. Lansdown MD, Andrew J. Riff MD, Molly Meadows MD, Adam B. Yanke MD, Bernard R. Bach MD

Allograft tissue is used in 22% to 42% of anterior cruciate ligament (ACL) reconstructions. Clinical outcomes have been inconsistent with allograft tissue, with some series reporting no differences in outcomes and others reporting increased risk of failure. There are numerous variations in processing and preparation that may influence the eventual performance of allograft tissue in ACL reconstruction. We sought to perform a systematic review to summarize the factors that affect the biomechanical properties of allograft tissue for use in ACL reconstruction. Many factors might impact the biomechanical properties of allograft tissue, and these should be understood when considering using allograft tissue or when reporting outcomes from allograft reconstruction.

Report of the Clinical and Functional Primary Outcomes in Men of the ACL-SPORTS Trial: Similar Outcomes in Men Receiving Secondary Prevention With and Without Perturbation Training 1 and 2 Years After ACL Reconstruction

Amelia J. H. Arundale PT, DPT, Kathleen Cummer PT, DPT, Jacob J. Capin PT, DPT, MS, Ryan Zarzycki PT, DPT, Lynn Snyder-Mackler PT, ATC, ScD

Athletes often are cleared to return to activities 6 months after anterior cruciate ligament (ACL) reconstruction; however, knee function measures continue to improve up to 2 years after surgery. Interventions beyond standard care may facilitate successful return to preinjury activities and improve functional outcomes. Perturbation training has been used in nonoperative ACL injury and preoperative ACL reconstruction rehabilitation, but has not been examined in postoperative ACL reconstruction rehabilitation, specifically return to sport rehabilitation.

Report of the Primary Outcomes for Gait Mechanics in Men of the ACL-SPORTS Trial: Secondary Prevention With and Without Perturbation Training Does Not Restore Gait Symmetry in Men 1 or 2 Years After ACL Reconstruction

Jacob John Capin PT, DPT, MS, Ryan Zarzycki PT, DPT, Amelia Arundale PT, DPT, SCS, Kathleen Cummer PT, PhD, DPT, Lynn Snyder-Mackler PT, ScD, FAPTA

Movement asymmetries during walking are common after anterior cruciate ligament (ACL) injury and reconstruction and may influence the early development of posttraumatic osteoarthritis. Preoperative neuromuscular training (like perturbation training, which is neuromuscular training requiring selective muscle activation in response to surface perturbations) improves gait asymmetries and functional outcomes among people who are ACL-deficient, but the effect of postoperative perturbation training on gait mechanics after ACL reconstruction is unknown.

Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? A Meta-analysis of 47,613 Patients

Brian T. Samuelsen MD, MBA, Kate E. Webster PhD, Nick R. Johnson BS, Timothy E. Hewett PhD, Aaron J. Krych MD

Bone-patellar tendon-bone (bone-tendon-bone) and four-strand hamstring tendon grafts (hamstring) are the most commonly utilized autografts for primary anterior cruciate ligament (ACL) reconstruction. Existing clinical trials, registry studies, and meta-analyses offer conflicting opinions regarding the most favorable graft choice.