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Does In Vivo Kinematics Following Acl Reconstruction With Or Without Lateral Extraarticular Tenodesis Correlate With Preoperative Quantitative Pivot Shift?

Christopher M. Gibbs, MD
UNITED STATES

Does In Vivo Kinematics Following Acl Reconstruction With Or Without Lateral Extraarticular Tenodesis Correlate With Preoperative Quantitative Pivot Shift?

Christopher M. Gibbs, MD, UNITED STATES Philipp Wilhelm Winkler, MD, AUSTRIA Jonathan D Hughes, MD, UNITED STATES Adam Popchak, DPT, PhD, UNITED STATES Daisuke Chiba, MD, PhD, JAPAN Bryson P. Lesniak, MD, UNITED STATES William Anderst, PhD, UNITED STATES Volker Musahl, MD, Prof., UNITED STATES

University of Pittsburgh, Pittsburgh, PA, UNITED STATES

2021 Congress Abstract Presentation 5 minutes Not yet rated

Anatomic Location

Knee

Anatomic Structure

Ligaments

Diagnosis / Condition

Instability

Treatment / Technique

Repair / Reconstruction

Ligaments

ACL

Sports Medicine

Biomechanics

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Summary: Preoperative quantitative pivot shift does not correlate with postoperative knee kinematics using a high-resolution in vivo analysis system.

Introduction

Following anterior cruciate ligament (ACL) injury, quantitative pivot shift (QPS) testing using the PIVOT technology can detect high- and low-grade rotatory instability.(1,2) Previously, preoperative rotatory knee laxity measured using an optical tracking system with manual load application was shown to predict postoperative rotatory knee laxity following ACL reconstruction (ACLR).(3) However, this study was performed with non-standardized external loads leading to potential error. To better inform treatment-decisions, we aimed to determine whether a correlation exists between preoperative QPS and postoperative knee kinematics during running at 6 and 12 months following ACLR with or without lateral extraarticular tenodesis (LET) using a highly precise in vivo analysis system.(4) A positive correlation between preoperative QPS and postoperative anterior-posterior tibial translation and internal-external tibial rotation at 6 and 12 months following ACLR with or without LET was hypothesized.

Methods

Twenty patients with an ACL injury (age 20.8 ± 6.8 years, 12 males) were randomized to undergo anatomic ACLR with or without LET using either bone-patellar tendon-bone or quadriceps tendon autograft as part of a prospective randomized trial (No. NCT0291340). To be included in this study, preoperative examination under anesthesia demonstrating high-grade rotatory instability (=3 mm of lateral compartment translation or a side-to-side difference =50% using PIVOT technology) was required.(2) At 6 and 12 months postoperatively, in vivo kinematic data was collected using dynamic biplanar radiography superimposed with high-resolution computed tomography scans of patients’ knees during downhill running at 2 m/s.(4) Total (maximum subtracted by minimum) anterior-posterior tibial translation and internal-external tibial rotation were calculated from foot-strike to mid-stance of the gait cycle. Spearman’s rho was calculated to evaluate for correlation between preoperative QPS and postoperative kinematics using SPSS statistics (IBM) with p<0.05.

Results

Preoperatively, all patients were confirmed to have high-grade rotatory knee instability with a QPS of 5.0 ± 1.6 mm. No statistically significant correlations were observed between preoperative QPS and total anterior-posterior tibial translation, or between preoperative QPS and total internal-external tibial rotation at 6 and 12 months postoperatively for combined ACLR and ACLR with LET patients as well as ACLR patients or ACLR with LET patients analyzed separately.

Discussion

The main finding of this study was that there were no significant correlations between preoperative QPS and postoperative in vivo kinematics at 6 and 12 months following ACLR with or without LET. These findings suggest that preoperative QPS does not correlate with postoperative rotatory knee stability following anatomic ACLR as there are likely other patient, injury, and surgical factors which play a role in determining postoperative knee kinematics. In addition, additional LET does not appear to be necessary in all cases of high-grade rotatory instability as other factors such as graft choice may be more important. In conclusion, additional LET does not appear to be required in all cases of high-grade rotatory instability as preoperative instability does not correlate with postoperative in vivo kinematics following ACLR with or without LET.

References: 1)Musahl. AJSM. 2016. 2)Hoshino. KSSTA. 2012. 3)Signorelli. Scand J Med Sci Sports. 2013. 4)Anderst. Med Engl Phys. 2009.

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Tunnel Position In Anterior Cruciate Ligament Reconstruction Varies Between High Volume And Low Volume Surgeons Abstract Presentation 6 minutes Jonathan D Hughes, MD, UNITED STATES Christopher M. Gibbs, MD, UNITED STATES Akere Atte, MD, PharmD, UNITED STATES Anmol Almast, BS, UNITED STATES Mikael Sansone, MD, PhD, SWEDEN Jon Karlsson, MD, PhD, Prof., SWEDEN Volker Musahl, MD, Prof., UNITED STATES
Analysis Of The Blood Supply To The Femoral Attachment Of The Anterior Cruciate Ligament After Acl Injury Abstract Presentation 4 minutes Jedrzej Jerzy Lesman, PhD MD, POLAND Marcin E. Domzalski, MD, Prof., POLAND Krzysztof Nowak, MD, PhD, POLAND Sebastian Zygmunt Żabierek, PhD, POLAND Radoslaw Grabowski, MD, POLAND Ilona Wagner-Olszewska, MD, POLAND
Tranexamic Acid Has No Effect On Post-Operative Hemarthrosis Or Pain Control Following Acl Reconstruction Using Bone Patella Tendon Bone Autograft: A Double-Blinded Randomized Control Trial Abstract Presentation 5 minutes Jordan W Fried, BM, UNITED STATES David Bloom, BA, UNITED STATES Eoghan T. Hurley, MB, BCh, MCh, IRELAND Samuel Baron, MD, UNITED STATES Kirk Anthony Campbell, MD, UNITED STATES Eric Jason Strauss, MD Laith M. Jazrawi, MD, UNITED STATES Michael J Alaia, MD, UNITED STATES
The Lateral Femoral Notch Sign Entails Increased Rotatory Laxity After Acl-Injury. Pivot Shift Quantification With Surgical Navigation System Abstract Presentation 5 minutes Gian Andrea Lucidi, MD, ITALY Piero Agostinone, MD, ITALY Stefano Di Paolo, Eng, ITALY Alberto Grassi, PhD, ITALY Luca Macchiarola, MD, ITALY Giacomo Dal Fabbro, MD, ITALY Nicola Pizza, MD, ITALY Stefano Zaffagnini, MD, Prof., ITALY
Return To Sports After Paediatric Anterior Cruciate Ligament Reconstruction (ACLR): Normal Population Vs An ACLR Cohort Abstract Presentation 6 minutes Alexander S. Nicholls, MSc, FRACS, AUSTRALIA Jillian Lee, BHB, MBChB, FRACS (Ortho), NEW ZEALAND Yoong Lim, BEng, PhD, AUSTRALIA Quang Dao, FRACS, AUSTRALIA
Return To Elite Sport After ACL Reconstruction In 376 'Professional' Athletes Abstract Presentation 5 minutes Kyle Borque, MD, UNITED STATES Mary Jones, Msc Grad Dip Phys, UNITED KINGDOM Ganesh Balendra, MBBS, AUSTRALIA Lukas Willinger, MD, GERMANY Vitor Hugo Pinheiro, MD, UNITED KINGDOM Andy Williams, MBBS, FRCS(Orth), FFSEM(UK), UNITED KINGDOM
Changes In Muscle Strength And Hop Performance After ACL Reconstruction. A Randomized Controlled Trial Comparing Patellar Tendon And Hamstring Tendon Autografts With Standard Or Accelerated Rehabilitation Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Christina Mikkelsen, PT, SWEDEN Peter Olov Wange, MD, SWEDEN Daniel Olsson, PhD, SWEDEN Anders Stalman, MD, PhD, associate professor, SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN
THE OUTCOME OF BALANCE EXERCISES AND AGILITY TRAINING FOR POST ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION: CLINICAL ASSESSMENT Abstract Presentation 7 minutes SITI MAIZATUL AKMAL ISMAIL, Medical Science (Orthopaedic Surgery Sports), MALAYSIA
Factors associated with anterior cruciate ligament (ACL) reconstruction among ACL injuries in Alberta, Canada ePoster Presentation Yuba Raj Paudel, MPH, CANADA Mark F. Sommerfeldt, MD, CANADA Donald C. Voaklander, PhD, CANADA
Risk Factors for Grade 3 Pivot Shift in Acute ACL-Injured Knees Abstract Presentation 5 minutes Adnan Saithna, MD, FRCS, UNITED STATES Edoardo Monaco, MD, ITALY Edoardo Gaj, MD, ITALY Valerio Andreozzi, ITALY Alessandro Annibaldi, MD, ITALY Alessandro Carrozzo, MD, ITALY Thais Dutra Vieira, MD, FRANCE Bertrand Sonnery-Cottet, MD, PhD, FRANCE Andrea Ferretti, Prof., ITALY
Value, Limitations And Recommendations For Use Of Metal-Reduction Knee MRI Sequences Following Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes Brandon Zhao, MD, CANADA Nabil Khan, MBChB, MMED, FCS Orth, CANADA Mark F. Sommerfeldt, MD, CANADA Anukul Panu, MD, CANADA Jacob L Jaremko, MD, PhD, CANADA Catherine May Ting Hui, MD, FRCSC, CANADA
Higher Return To Pre-Injury Activity Levels Following ACL Reconstruction With Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autograft In High Activity Patients: Results From The New Zealand ACL Registry Abstract Presentation 6 minutes Simon W. Young, MD, FRACS, NEW ZEALAND Richard Rahardja, MBChB, BMedSc(Hons), NEW ZEALAND Mark G. Clatworthy, FRACS, NEW ZEALAND Paul Monk, DPhil (Oxon), FRCS, NEW ZEALAND Hamish Love, FRACS, NEW ZEALAND

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Does In Vivo Kinematics Following Acl Reconstruction With Or Without Lateral Extraarticular Tenodesis Correlate With Preoperative Quantitative Pivot Shift?

Does In Vivo Kinematics Following Acl Reconstruction With Or Without Lateral Extraarticular Tenodesis Correlate With Preoperative Quantitative Pivot Shift?

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Does In Vivo Kinematics Following Acl Reconstruction With Or Without Lateral Extraarticular Tenodesis Correlate With Preoperative Quantitative Pivot Shift?

Does In Vivo Kinematics Following Acl Reconstruction With Or Without Lateral Extraarticular Tenodesis Correlate With Preoperative Quantitative Pivot Shift?

Introduction

Methods

Results

Discussion

More ISAKOS 2021: Global Content