Femoral Cortical Suspension Devices for Soft Tissue Anterior Cruciate Ligament Reconstruction: A Comparative Biomechanical Study.
Femoral Cortical Suspension Devices for Soft Tissue Anterior Cruciate Ligament Reconstruction: A Comparative Biomechanical Study.
Filed under: Rehab Centers
Am J Sports Med. 2012 Dec 20;
Petre BM, Smith SD, Jansson KS, de Meijer PP, Hackett TR, Laprade RF, Wijdicks CA
BACKGROUND:Optimization of anterior cruciate ligament (ACL) fixation is desired to improve graft healing. New soft tissue cortical suspension devices for femoral tunnel fixation should be biomechanically evaluated. HYPOTHESIS:All femoral fixation devices would prevent a clinically significant amount of displacement and support loads significantly larger than in situ forces experienced by the ACL during early rehabilitation. STUDY DESIGN:Controlled laboratory study. METHODS:Four cortical soft tissue ACL graft suspension devices were tested under cyclic and pull-to-failure loading conditions in both an isolated device-only setup and as a complete bone-device-tendon construct in porcine femurs using a tensile testing machine. RESULTS:There were significant differences in the ultimate failure loads among the devices. The highest ultimate failure loads when tested as a construct were observed for the XO Button (1748 N), followed by the Endobutton CL (1456 N), ToggleLoc with ZipLoop (1334 N), and TightRope RT (859 N). Cyclic displacement after 1000 cycles during isolated device testing was less than 1 mm for all devices. Cyclic displacements after 1000 cycles in the porcine construct were 1.88 mm, 2.74 mm, 3.34 mm, and 1.82 mm for the Endobutton, TightRope, ToggleLoc, and XO Button, respectively; all were significantly different from each other except when the Endobutton was compared with the XO Button. The ToggleLoc exceeded the 3.0-mm displacement threshold defined as a clinical failure. The most displacement occurred during the first cycle, especially for the adjustable-length loop devices. Stiffness reapproximated the native ACL stiffness for all constructs. CONCLUSION:The Endobutton, TightRope, and XO Button have the necessary biomechanical properties with regard to ultimate failure strength, displacement, and stiffness for initial fixation of soft tissue grafts in the femoral tunnel for ACL reconstruction. The ToggleLoc had sufficient ultimate failure strength but crossed our 3.0-mm clinical failure threshold for cyclic displacement. Although this study was not designed to compare fixed and adjustable-length loop devices, it was noted that both fixed-loop devices allowed less cyclic displacement and initial displacement. CLINICAL RELEVANCE:Adjustable-length loop devices may need to be retensioned after cycling the knee and fixing the tibial side to account for the increased initial displacement seen with these devices.
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Is postoperative exercise therapy necessary in patients with degenerative meniscus? A randomized controlled trial with one year follow-up.
Filed under: Rehab Centers
Knee Surg Sports Traumatol Arthrosc. 2012 Dec 23;
Osterås H, Osterås B, Torstensen TA
PURPOSE: There is no consensus on a postoperative rehabilitation regimen for patients who have undergone surgery for medial meniscus damage. The aim of this investigation was to evaluate two rehabilitation approaches after arthroscopic surgery in patients with degenerative meniscus: supervised medical exercise therapy versus no treatment. METHODS: A prospective randomized controlled clinical trial. Over 4 months, 70 participants were randomly assigned into either a medical exercise therapy group (n = 36) or a control group (n = 34). Pain was a composite score of a visual analogue scale (VAS), and function was measured with a functional assessment questionnaire (KOOS), while anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Function was also measured with tests of quadriceps femoris strength and a one-leg jump test. RESULTS: Prognostic variables were similar between the groups at baseline, with five (7 %) patients dropping out during the treatment period and another six (8 %) before the one-year follow-up. After 3 months, the medical exercise therapy group achieved significantly better outcome effects than the control group for pain and function. The results after the 12-month follow-up indicated the same results as at posttest, whereas Hospital Anxiety and Depression Scale, fiveRM and the one-leg hop test also demonstrated a significant difference between the groups from pre- to posttest to follow-up. CONCLUSION: In patients with surgery for degenerative meniscus damage, postoperative medical exercise therapy is an efficient treatment alternative compared to no treatment. LEVEL OF EVIDENCE: I.
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Evaluation of ACL mid-substance cross-sectional area for reconstructed autograft selection.
Filed under: Rehab Centers
Knee Surg Sports Traumatol Arthrosc. 2012 Dec 22;
Iriuchishima T, Yorifuji H, Aizawa S, Tajika Y, Murakami T, Fu FH
PURPOSE: The purpose of this study was to compare the size of the native ACL mid-substance cross-sectional area and the size of commonly used autografts. Hypothesis of this study was that the reconstructed graft size with autografts would be smaller than the native ACL size. METHODS: Twelve non-paired human cadaver knees were used. The ACL was carefully dissected, and the mid-substance of the ACL was cross-sectioned parallel to the articular surface of the femoral posterior condyles at 90 degrees of knee flexion. The size of the cross-sectional area of the ACL, and the femoral and tibial footprints were measured using Image J software (National Institute of Health). The semitendinosus tendon (ST) and the gracilis (G) tendon were harvested and prepared for ACL grafts. Simulating an ST graft, the ST was cut in half. The bigger half was regarded as the antero-medial (AM) bundle, and the remaining half was regarded as the postero-lateral (PL) bundle. Simulating an ST-G graft, the bigger half of the ST and G were regarded as the AM bundle, and the smaller half of the ST was regarded as the PL bundle. Each graft diameter was measured, and the graft area was calculated. Simulating a rectangular bone-patella tendon-bone (BPTB) graft, a 10-mm-wide BPTB graft was harvested and the area calculated. RESULTS: The sizes of the ACL mid-substance cross-sectional area, femoral and tibial ACL footprint were 46.9 ± 18.3, 60.1 ± 16.9 and 123.5 ± 12.5 mm(2), respectively. The average areas of the ST, ST-G, and BPTB grafts were 52.0 ± 3.8, 64.4 ± 6.2, and 40.8 ± 6.7 mm(2), respectively. The ST and BPTB grafts showed no significant difference in graft size when compared with the ACL cross-sectional area. CONCLUSION: ST and BPTB autografts were able to reproduce the native size of the ACL mid-substance cross-sectional area. The ST-G graft was significantly larger than the ACL cross-sectional area. For clinical relevance, ST and BPTB grafts are recommended in order to reproduce the native size of the ACL in anatomical ACL reconstruction with autograft.
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