Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Autograft With Lateral Compartment Meniscectomy or Chondroplasty Does Not Lead to Decreased Return to Sport and Activity Compared With No Lateral Pathology
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PROVIDER: S-EPMC11240012 | biostudies-literature | 2024 Feb
REPOSITORIES: biostudies-literature
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Project description:Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft has long been considered the graft preference for young, active patients with anterior cruciate ligament injuries. The central-third of the native patellar tendon is a reliable graft and is the preferred option for competitive athletes given its excellent track record with high return-to-play rates and low failure rates. Disadvantages to using this graft include donor site morbidity and associated postoperative anterior knee pain, the risk of patellar fracture or patellar tendon tear, and the potential for graft-construct mismatch. In this Technical Note, we describe our preferred technique for bone-patellar tendon-bone autograft harvest and preparation for anterior cruciate ligament reconstruction.
| S-EPMC5621981 | biostudies-literature
Project description:Multiple surgical techniques for posterior cruciate ligament reconstruction have been described and subsequently scrutinized. We describe a surgical technique using full-thickness quadriceps tendon-patellar bone autograft in single-bundle, all-inside posterior cruciate ligament reconstruction that offers the following advantages over traditional technique: This technique mitigates the risk of tunnel widening and convergence while preserving bone stock, eliminating the killer turn, allowing for suspensory cortical fixation to optimize stabilization, and using a bone plug that allows for faster graft incorporation.
| S-EPMC10323692 | biostudies-literature
Project description:Knee arthroscopy is an important diagnostic and therapeutic tool in the management of disorders of the knee. In a series of 4 articles, the basics of knee arthroscopy are reviewed. In this article (part 4), the basics of operative knee arthroscopy are reviewed including chondroplasty and meniscectomy. Evaluation of the cruciate ligaments is also reviewed. Mastery of these techniques is critical for the treatment of the most common pathology encountered during knee arthroscopy.
| S-EPMC4040007 | biostudies-literature
Project description:The anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee, with injury usually occurring as a result of multidirectional sports. The incidence of ACL injury has continued to increase, with most patients opting for surgery to improve stability as well as permit a return to sport. Traditional methods of ACL reconstruction can achieve this but are not without their problems, including graft rupture, residual laxity, and donor-site morbidity. There is therefore a requirement for further research into newer, innovative surgical techniques to help improve complication rates. This article describes, with video illustration, ACL reconstruction using a reduced-size bone-patellar tendon-bone autograft with suture tape augmentation. The augmentation acts as a stabilizer during the early stages of graft incorporation while resisting against reinjury during an accelerated recovery. The ability to use a reduced-size graft decreases the donor-site burden, and retention of residual native ACL tissue, when possible, may help with proprioception.
| S-EPMC7917009 | biostudies-literature
Project description:ObjectiveGraft choices for athletes undergoing anterior cruciate ligament reconstruction (ACLR) include bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts and soft tissue allografts. The objective was to assess time to meet clinical milestones by graft type in athletes who completed a return-to-sport (RTS) program after ACLR.DesignRetrospective cohort study.MethodsSeventy-nine athletes enrolled after ACLR (allograft, n = 18; BPTB, n = 24; HT, n = 37). Time from surgery to meet (1) enrollment criteria (12 or more weeks post surgery, 80% or greater isometric quadriceps strength index, minimal effusion, and full knee range of motion), and (2) RTS criteria (90% or greater quadriceps strength index, hop testing limb symmetry, and patient-reported outcomes) was calculated. Quadriceps strength, hop performance, and patient-reported outcomes were measured before and after training, and at 1 year post surgery. Descriptive statistics, chi-square tests, and 1-way analyses of variance (α = .05) were used to analyze differences among graft types.ResultsOn average, the BPTB group (28.5 ± 7.6 weeks) took longer to meet enrollment milestones than the HT (22.5 ± 7.6 weeks, P = .007) and allograft (18.9 ± 5.8 weeks, P<.001) groups. The BPTB group (44.7 ± 15.8 weeks) took longer from surgery to meet RTS criteria than the HT (32.5 ± 9.9 weeks, P = .001) and allograft (29.3 ± 9.0 weeks, P<.001) groups. After training, the quadriceps strength index was lower in the BPTB group (86.1% ± 11.4%) than it was in the HT (96.1% ± 12.9%, P = .004) and allograft (96.9% ± 5.9%, P = .009) groups.ConclusionAthletes with a BPTB autograft may take longer than athletes with an HT autograft or a soft tissue allograft to complete postoperative rehabilitation, recover quadriceps strength, and meet RTS criteria. J Orthop Sports Phys Ther 2020;50(5):259-266. Epub 27 Nov 2019. doi:10.2519/jospt.2020.9111.
| S-EPMC7196003 | biostudies-literature
Project description:Anterior cruciate ligament (ACL) reconstruction is one of the most extensively studied surgical procedures in orthopaedics. The importance of this ligament for knee function and stability has been widely studied. For athletes who participate in activities involving cutting, twisting, and running, surgical reconstruction of the ACL has become the standard of care. However, there is much debate regarding the techniques involved in ACL reconstruction, including graft choice, technique of drilling the femoral tunnel, and single- versus double-bundle reconstruction. In recent studies, ACL femoral tunnel drilling via a medial parapatellar or accessory anteromedial portal provides a more anatomic graft placement than transtibial femoral drilling. Long-term outcomes of these techniques have not been widely studied. This article details our technique for ACL reconstruction with bone-patellar tendon-bone autograft and a medial parapatellar portal.
| S-EPMC5040198 | biostudies-literature
Project description:Anterior cruciate ligament ruptures are a relatively common injury in the athletic population, and surgical reconstruction is often indicated to restore knee stability. While hamstring tendon and patellar bone-tendon-bone autografts are a well-established graft choice in this population, there has been a growing body of literature supporting the benefits of quadriceps tendon autograft. Our technique illustrates a full-thickness quadriceps tendon-patellar bone autograft with dual tibial fixation using an interference screw and backup suspensory anchor fixation.
| S-EPMC8322283 | biostudies-literature
Project description:The bone-patellar tendon-bone has been widely used and considered a good graft source. The quadriceps tendon was introduced as a substitute graft source for bone-patellar tendon-bone. We compared the clinical outcomes of anterior cruciate ligament reconstructions using central quadriceps tendon-patellar bone and bone-patellar tendon-bone autografts. We selected 72 patients who underwent unilateral anterior cruciate ligament reconstruction using bone-patellar tendon-bone between 1994 and 2001 and matched for age and gender with 72 patients who underwent anterior cruciate ligament reconstruction using quadriceps tendon-patellar bone. All patients were followed up for more than 2 years. We assessed anterior laxity, knee function using the Lysholm and International Knee Documentation Committee scores, and quadriceps strength, the means of which were similar in the two groups. More patients (28 or 39%) in the bone-patellar tendon-bone group reported anterior knee pain than in the quadriceps tendon-patellar bone group (six patients or 8.3%). Anterior cruciate ligament reconstruction using the central quadriceps tendon-patellar bone graft showed clinical outcomes comparable to those of anterior cruciate ligament reconstruction using the patellar tendon graft, with anterior knee pain being less frequent in the former. Our data suggest the quadriceps tendon can be a good alternative graft choice.Level III Therapeutic study.
| S-EPMC2505304 | biostudies-other
Project description:Posterior cruciate ligament reconstruction using the transtibial technique provides successful clinical outcomes. However, a bone-patellar tendon-bone (BTB) autograft with the transtibial technique has not been used by some surgeons because of concerns with graft passage from the tibial to the femoral tunnels (sharp turn) that can damage graft fibers. In the present surgical technique, an arthroscopic, transtibial, single-bundle technique for posterior cruciate ligament reconstruction using the BTB autograft with an easy and effective technical tip to facilitate graft passage is presented. Once the BTB is harvested, the femoral bone block is divided into 2 equal-sized blocks providing an articulated structure while preserving the tendon component. This facilitates the passage of the BTB tendon once it is entered in the posterior tibia and the graft has to make a sharp turn to reach the femoral tunnel. This easy and effective technique tip may avoid graft damage during the sharp turn, while maintaining all the advantages of a BTB autograft (bone-to-bone healing, own tissue with fast incorporation, and strong fixation and stability).
| S-EPMC5850889 | biostudies-literature
Project description:IntroductionThe use of implant in anterior cruciate ligament (ACL) reconstruction has been associated with several drawbacks including graft injury, implant osteolysis, implant migration and soft tissue irritation. Implant-free ACL reconstruction surgery offers additional benefits of cost-effective, improved graft incorporation and ease of revision surgery. Our study aimed to compare the functional outcome of ACL reconstruction by using bone-patellar tendon autograft with press-fit fixation technique and hamstring autografts with implant.MethodsA prospective cohort study design was used. Between March 2013 and March 2014, 12 patients underwent patella tendon-bone graft fixated by press-fit fixation technique (implant-free), while 24 patients underwent ACL reconstruction using implant-fixated hamstring tendon graft. Objective functional outcome was measured by using rolimeter, and subjective functional outcome was measured according to the functional score of IKDC, Tegner-Lysholm and KOOS.ResultsBoth techniques have shown no significant difference in terms of functional outcome, whether assessed by rolimeter measurement, IKDC score, Tegner-Lysholm, KOOS score between implant group and implant-free group, preoperatively and postoperatively.DiscussionOur study results are in line with several other studies with various follow-up time and systematic review. With the right technique, graft harvesting of patella tendon-tibial tuberosity bone block can be successfully performed, and associated donor site morbidity can be avoided.ConclusionPatients who underwent ACL reconstruction using implant-free technique by press-fit fixation had comparable outcome with ACL reconstruction with implant, objectively and subjectively. This technique should be further revisited and reevaluated.
| S-EPMC7937666 | biostudies-literature