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Magnetic resonance imaging after anterior cruciate ligament reconstruction:A practical guide

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World Journal of Orthopedics 2016年第10期7卷 638-649页

作者： Alberto Grassi James R Bailey Cecilia Signorelli Giuseppe Carbone Andy Tchonang Wakam Gian Andrea Lucidi Stefano Zaffagnini Laboratorio di Biomeccanica ed Innovazione Tecnologica Istituto Ortopedico Rizzoli Department of Orthopaedic Surgery Duke Sports Sciences Institute Duke University Medical Center Unita’ Operativa di Ortopedia Dipartimento Rizzoli-Sicilia

Anterior cruciate ligament(ACL) reconstruction is one of the most common orthopedic procedures performed worldwide. In this regard, magnetic resonance imaging(MRI) represents a useful pre-operative tool to confirm a disruption of the ACL and to assess for potential associated injuries. However, MRI is also valuable postoperatively, as it is able to identify, in a non-invasive way, a number of aspects and situations that could suggest potential problems to clinicians. Graft signal and integrity, correct tunnel placement, tunnel widening, and problems with fixation devices or the donor site could all compromise the surgical outcomes and potentially predict the failure of the ACL reconstruction. Furthermore, several anatomical features of the knee could be associated to worst outcomes or higher risk of failure. This review provides a practical guide for the clinician to evaluate the post-surgical ACL through MRI, and to analyze all the parameters and features directly or indirectly related to ACL reconstruction, in order to assess for normal or pathologic conditions.

关键词： Anterior cruciate ligament reconstruction Magnetic resonance imaging Graft Tunnel Failures Complications Anatomic

Anterior cruciate ligament reconstruction using a double bundle hamstring autograft configuration in patients under 30 years

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World Journal of Orthopedics 2019年第12期10卷 446-453页

作者： Christopher Reece Lim Tamalee Henson Jay Ebert Peter Annear Department of Orthopaedics Sir Charles Gairdner HospitalWestern AustraliaNedlands 6009Australia Fiona Stanley Hospital Western AustraliaMurdoch 6150Australia School of Human Sciences(Exercise and Sport Science) University of Western AustraliaWestern AustraliaCrawley 6009Australia Perth Orthopaedic and Sports Medicine Centre Western AustraliaWest Perth 6005Australia

BACKGROUND Anterior cruciate ligament reconstruction(ACLR)has a high incidence of re-tear in younger patients.Despite comparable functional outcomes,the incidence of retear using single and double bundle ACLR methods has not been well reported.AIM To hypothesize that double bundle hamstring ACLR has a lower graft rupture rate compared with single bundle hamstring ACLR grafts in young patients.METHODS One hundred and twelve patients<30 years of age at the time of primary double bundle ACLR were eligible for study participation.91(81.3%)could be contacted,with a mean age of 20.4 years(range 13-29)and mean post-operative follow-up time of 59 mo(range 25-107).Telephone questionnaires evaluated the incidence(and timing)of subsequent re-tear and contralateral ACL tear,further surgeries,incidence and time to return to sport,and patient satisfaction.RESULTS Of the 91 patients,there were 6(6.6%,95%CI:1.4-11.7)ACL graft re-ruptures,with a mean time to re-rupture of 28 mo(range 12-84).Fourteen patients(15.4%)experienced a contralateral ACL rupture and 14 patients(15.4%)required further surgery to their ipsilateral knee.fifty patients(54.9%)returned to pre-injury level of sport.Of those<20 years(n=45),4 patients(8.9%,95%CI:0.4-17.3)experienced a re-rupture,with mean time to re-injury 15 mo(range 12-24).Comparative analysis with existing literature and revealed a non-significant Chisquared statistic of 2.348(P=0.125).CONCLUSION A trend existed toward lower graft rupture rates in young patients undergoing double bundle ACLR utilizing a hamstring autograft,compared with rates reported after single bundle ACLR.

关键词： Anterior cruciate ligament reconstruction Re-rupture Double bundle Young Knee function Clinical outcomes

Biomechanics of the anterior cruciate ligament:Physiology,rupture and reconstruction techniques

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World Journal of Orthopedics 2016年第2期7卷 82-93页

作者： Christoph Domnick Michael J Raschke Mirco Herbort Department of Trauma Hand and Reconstructive SurgeryWestphalian Wilhelms University Muenster

The influences and mechanisms of the physiology,rupture and reconstruction of the anterior cruciate ligament(ACL)on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades.The knee is a complex joint with shifting contact points,pressures and axes that are affected when a ligament is injured.The ACL,as one of the intra-articular ligaments,has a strong influence on the resulting kinematics.Often,other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes.Knowing the surgical options,anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome.

关键词： Biomechanics anterior cruciate ligament joint pressure anterior cruciate ligament rupture graft fixation anterior cruciate ligament reconstruction

Depression and psychiatric disease associated with outcomes after anterior cruciate ligament reconstruction

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World Journal of Orthopedics 2016年第11期7卷 709-717页

作者： Hao-Hua Wu Max Liu Joshua S Dines John D Kelly Grant H Garcia Perelman School of Medicine University of Pennsylvania Jordan Medical Education Center Stanford School of Medicine Hospital for Special Surger Department of Orthopaedic Surgery University of Pennsylvania

While most patients with an anterior cruciate ligament(ACL) injury indicate satisfaction with surgical intervention, a significant proportion still do not return to pre-injury level of function or sport. Psychiatric comorbidities, such as depression, have recently been associated with poor clinical outcomes after ACL reconstruction(ACLR). To date, no article has yet examined how depression affects ACLR outcomes and how potential screening and intervention for psychological distress may affect postoperative activity level. The purpose of this review is to delineate potential relationships between depression and ACLR outcome, discuss clinical implications and identify future directions for research.

关键词： Depression Preoperative evaluation Anxiety Anterior cruciate ligament reconstruction Patient reported outcome Orthopedic surgery

Allograft tissue irradiation and failure rate after anterior cruciate ligament reconstruction:A systematic review

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World Journal of Orthopedics 2016年第6期7卷 392-400页

作者： Jesse Dashe Robert L Parisien Antonio Cusano Emily J Curry Asheesh Bedi Xinning Li Depatment of Orthopaedic Surgery Boston University School of Medicine-Boston Medical Center Depatment of Orthopaedic Surgery University of Michigan School of Medicine

AIM:To evaluate whether anterior cruciate ligament(ACL) allograft irradiation is effective for sterility without compromising graft integrity and increasing failure rate.METHODS:A literature search was conducted using Pub Med,Cochrane,and Google.The following search terms were used:"Gamma irradiation AND anterior cruciate ligament AND allograft" with a return of 30 items.Filters used included:English language,years 1990-2015.There were 6 hits that were not reviewed,as there were only abstracts available.Another 5 hits were discarded,as they did not pertain to the topic of interest.There were 9 more articles that were excluded:Three studies were performed on animals and 6 studies were meta-analyses.Therefore,a total of 10 articles were applicable to review.RESULTS:There is a delicate dosing crossover where gamma irradiation is both effective for sterility without catastrophically compromising the structural integrity of the graft.Of note,low dose irradiation is considered less than 2.0 Mrad,moderate dose is between 2.1-2.4 Mrad,and high dose is greater than or equal to 2.5 Mrad.Based upon the results of the literature search,the optimal threshold for sterilization was found to be sterilization at less than 2.2 Mrad of gamma irradiation with the important caveat of being performed at low temperatures.The graft selection process also must include thorough donor screening and testing as well as harvesting the tissue in a sterile fashion.Utilization of higher dose(≥ 2.5 Mrad) of irradiation causes greater allograft tissue laxity that results in greater graft failure rate clinically in patients after ACL reconstruction.CONCLUSION:Allograft ACL graft gamma irradiatedwith less than 2.2 Mrad appears to be a reasonable alternative to autograft for patients above 25 years of age.

关键词： Anterior cruciate ligament reconstruction Graft choice Allograft Gamma irradiation Anterior cruciate ligament graft failure rate

Anterior cruciate ligament reconstruction and knee osteoarthritis

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World Journal of Orthopedics 2017年第3期8卷 212-217页

作者： Nikolaos K Paschos Department of Orthopaedic Surgery Penn Sports Medicine University of Pennsylvania Health System

Anterior cruciate ligament(ACL)injury is a traumatic event that can lead to significant functional impairment and inability to participate in high-level sports-related activities.ACL reconstruction is considered the treatment of choice for symptomatic ACL-deficient patients and can assist in full functional recovery.Furthermore,ACL reconstruction restores ligamentous stability to normal,and,therefore,can potentially fully reinstate kinematics of the knee joint.As a consequence,the natural history of ACL injury could be potentially reversed via ACL reconstruction.Evidence from the literature is controversial regarding the effectiveness of ACL reconstruction in preventing the development of knee cartilage degeneration.This editorial aims to present recent highlevel evidence in an attempt to answer whether ACL injury inevitably leads to osteoarthritis and whether ACL reconstruction can prevent this development or not.

关键词： Anterior cruciate ligament Osteoarthritis Anterior cruciate ligament reconstruction Prevention of osteoarthritis Meniscus tear Anterior cruciate ligament tear

Recurrent surgical site infection after anterior cruciate ligament reconstruction: A case report

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World Journal of Orthopedics 2019年第6期10卷 255-261页

作者： Don Koh Shi Ming Tan Andrew Hwee Chye Tan Department of Orthopaedic Surgery Singapore General Hospital

BACKGROUND Surgical site infections following anterior cruciate ligament(ACL)reconstruction are an uncommon but potentially devastating complication.In this study,we present an unusual case of recurrent infection of the knee after an ACL reconstruction,and discuss the importance of accurate diagnosis and appropriate management,including the issue of graft preservation versus removal.CASE SUMMARY A 33-year-old gentleman underwent ACL reconstruction using a hamstring tendon autograft with suspensory Endobutton fixation to the distal femur and an interference screw fixation to the proximal tibia.Four years after ACL reconstruction,he developed an abscess over the proximal tibia and underwent incision and drainage.Remnant suture material was found at the base of the abscess and was removed.Five years later,he re-presented with a lateral distal thigh abscess that encroached the femoral tunnel.He underwent incision and drainage of the abscess which was later complicated by a chronic discharging sinus.Repeated magnetic resonance imaging revealed a fistulous communication between the lateral thigh wound extending toward the femoral tunnel with suggestion of osteomyelitis.Decision was made for a second surgery and the patient was counselled about the need for graft removal should there be intraarticular involvement.Knee arthroscopy revealed the graft to be intact with no evidence of intra-articular involvement.As such,the decision was made to retain the ACL graft.Re-debridement,excision of the sinus tract and removal of Endobutton was also performed in the same setting.Joint fluid cultures did not grow bacteria.However,tissue cultures from the femoral tunnel abscess grew Enterobacter cloacae complex,similar to what grew in tissue cultures from the tibial abscess five years earlier.In view of the recurrent and indolent nature of the infection,antibiotic therapy was escalated from Clindamycin to Ertapenem.He completed a six-week course of intravenous antibiotics and has been well for six months since surgery,with excellent

关键词： Chronic surgical site infection Anterior cruciate ligament reconstruction Surgical site infection Graft preservation Enterobacter cloacae complex Septic arthritis Case report

Posttraumatic incarceration of medial collateral ligament into knee joint with anterior cruciate ligament injury

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Chinese Journal of Traumatology 2015年第6期18卷 367-369页

作者： Sunil Gurpur Kini Karel du Pre Warwick Bruce Department of Orthopaedics Concord Repatriation General Hospital Concord West NSW 2128 Australia

Medial collateral ligament of the knee is an important coronal stabiliser and often injured in isolation or as combination of injuries. The article reports a case of incarcerated medial collateral ligament （MCL） injury in combination with anterior cruciate ligament （ACL） injury in 20 year old male who presented to us 4 weeks after injury. Clinical examination and MRI was correlated to complete ACL tear with torn distal MCL and incarceration into the joint. Patient was taken up for ACL hamstring graft reconstruction with mini-arthrotomy and repair of the torn MCL. Patient was followed up with dedicated rehabilitation protocol with good functional results. At one year follow-up, patient exhibited full range of motion with negative Lachman, Pivot shift and valgus stress tests. This article highlights the rare pattern of MCL tear and also reviews the literature on this pattern of injury.

关键词： Medial collateral ligament Knee Anterior cruciate ligament Reconstruction Knee joint

Outcome of posterior wall blowout in anterior cruciate ligament (ACL) reconstruction via anteromedial portal approach: A retrospective research in 20 patients with 6 years follow-up

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Chinese Journal of Traumatology 2019年第1期22卷 24-28页

作者： Xu-Dong Jiang Han-Long Zheng Yu-Ping Yang Institute of Sports Medicine Peking University Third Hospital Beijing China Orthopaedic Department Beijing Jishuitan Hospital Beijing China

Purpose: To evaluate the clinical outcome in patients who received anterior cruciate ligament (ACL) rec on structi on via an teromedial portal with or without posterior wall blowout. Methods: Twenty patients w让h ruptured ACL, who have received ACL reconstruction via anteromedial portal between Apr 2012 and Oct 2013 were enrolled. According to the conditions of posterior wall, the patients were divided into 2 groups: posterior wall blowout group (10 patients) and posterior wall intact group (10 patients). The median follow up time were 63 (range 19-75) months and 60.5 (range 25—64) months in the 2 groups respectively. The clinical outcome was evaluated by knee joint physical examinati on, mag netic resonance imaging (MRI), the Inter national Knee Docume ntation Comm 让 tee (IKDC) 2000 subjective score, Lysholm score. Ten ger score, difference of thigh circumfere nee, KT-2000 and Biodex isokinetic dynamometer system. Results: No significant differences were found in terms of the IKDC score, Lysholm score, Tegner score, Lachman test positive rate or Pivot Shift test positive rate between the two groups. In KT-2000 and Biodex isokinetic dynamometer tests, the differenee of muscle strength between affected knees and unaffected knees in posterior wall blowout group was not significant less than that of posterior wall intact group (p > 0.05). In addition, there is no statistical difference between the two groups in signal/ noise quotient (SNQ) of the graft (p > 0.05) in post operative MRI. Conclusion: Blowout of posterior wall in ACL reconstruction via anteromedial portal does not affect the clinical outcome as long as reliable fixation has been taken intraoperatively.

关键词： Anterior cruciate ligament Arthroscopy Reconstruction Anteromedial portal Posterior wall blowout