Anterior Cruciate Ligament Preservation: Early Results of a Novel Arthroscopic Technique for Suture Anchor Primary Anterior Cruciate Ligament Repair

To propose a technique of arthroscopic suture anchor primary anterior cruciate ligament (ACL) preservation for patients with proximal avulsion ACL tears that maintain excellent tissue quality. We performed a retrospective review and early follow-up of 11 consecutive cases of ACL preservation. Patien...

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Vydáno v:	Arthroscopy Ročník 31; číslo 11; s. 2162
Hlavní autoři:	DiFelice, Gregory S, Villegas, Christine, Taylor, Samuel
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.11.2015
Témata:	Adolescent Adult Anterior Cruciate Ligament - surgery Anterior Cruciate Ligament Injuries Arthroscopy - methods Female Follow-Up Studies Humans Joint Instability - surgery Knee Joint - surgery Male Middle Aged Retrospective Studies Rupture Suture Anchors Suture Techniques - instrumentation Time Factors Young Adult
ISSN:	1526-3231, 1526-3231
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Abstract	To propose a technique of arthroscopic suture anchor primary anterior cruciate ligament (ACL) preservation for patients with proximal avulsion ACL tears that maintain excellent tissue quality. We performed a retrospective review and early follow-up of 11 consecutive cases of ACL preservation. Patients were included if they had a proximal avulsion tear and excellent tissue quality confirmed to be adequate for repair during arthroscopy. Patients were excluded if these criteria were not met or if patients had multiligamentous injury patterns or significant arthrosis. The ACL was reinforced with a No. 2 FiberWire (Arthrex, Naples, FL) and a No. 2 TigerWire (Arthrex) and was anchored to the femoral footprint by two 4.75-mm BioComposite SwiveLock suture anchors (Arthrex). The surgical procedures were performed at 3 different hospitals by a single surgeon. Anterior stability was determined with a KT-1000 arthrometer (MEDmetric, San Diego, CA). Clinical outcomes were measured using the Lysholm score, modified Cincinnati score, Tegner activity score, Single Assessment Numeric Evaluation, and subjective and objective International Knee Documentation Committee (IKDC) scores. Ten of eleven patients had good subjective and clinical outcomes after ACL preservation surgery at a minimum of 2 years' and mean of 3.5 years' follow-up. The mean Lysholm score was 93.2; the mean modified Cincinnati score was 91.5; the preoperative Tegner activity score was maintained postoperatively in 8 of 10 patients; the mean Single Assessment Numeric Evaluation score was 91.5; the mean subjective IKDC score was 86.4; and the objective IKDC score was A in 9 of 11 patients, B in 1 patient, and C in 1 patient. KT-1000 measurements were available in 8 of 11 patients, with 7 of 8 showing a side-to-side difference of less than 3 mm on maximum manual testing and 1 showing a 6-mm difference. Preservation of the native ACL using the described arthroscopic primary repair technique can achieve short-term clinical success in a carefully selected subset of patients with proximal avulsion-type tears and excellent tissue quality. Level IV, therapeutic case series.
AbstractList	To propose a technique of arthroscopic suture anchor primary anterior cruciate ligament (ACL) preservation for patients with proximal avulsion ACL tears that maintain excellent tissue quality.PURPOSETo propose a technique of arthroscopic suture anchor primary anterior cruciate ligament (ACL) preservation for patients with proximal avulsion ACL tears that maintain excellent tissue quality.We performed a retrospective review and early follow-up of 11 consecutive cases of ACL preservation. Patients were included if they had a proximal avulsion tear and excellent tissue quality confirmed to be adequate for repair during arthroscopy. Patients were excluded if these criteria were not met or if patients had multiligamentous injury patterns or significant arthrosis. The ACL was reinforced with a No. 2 FiberWire (Arthrex, Naples, FL) and a No. 2 TigerWire (Arthrex) and was anchored to the femoral footprint by two 4.75-mm BioComposite SwiveLock suture anchors (Arthrex). The surgical procedures were performed at 3 different hospitals by a single surgeon. Anterior stability was determined with a KT-1000 arthrometer (MEDmetric, San Diego, CA). Clinical outcomes were measured using the Lysholm score, modified Cincinnati score, Tegner activity score, Single Assessment Numeric Evaluation, and subjective and objective International Knee Documentation Committee (IKDC) scores.METHODSWe performed a retrospective review and early follow-up of 11 consecutive cases of ACL preservation. Patients were included if they had a proximal avulsion tear and excellent tissue quality confirmed to be adequate for repair during arthroscopy. Patients were excluded if these criteria were not met or if patients had multiligamentous injury patterns or significant arthrosis. The ACL was reinforced with a No. 2 FiberWire (Arthrex, Naples, FL) and a No. 2 TigerWire (Arthrex) and was anchored to the femoral footprint by two 4.75-mm BioComposite SwiveLock suture anchors (Arthrex). The surgical procedures were performed at 3 different hospitals by a single surgeon. Anterior stability was determined with a KT-1000 arthrometer (MEDmetric, San Diego, CA). Clinical outcomes were measured using the Lysholm score, modified Cincinnati score, Tegner activity score, Single Assessment Numeric Evaluation, and subjective and objective International Knee Documentation Committee (IKDC) scores.Ten of eleven patients had good subjective and clinical outcomes after ACL preservation surgery at a minimum of 2 years' and mean of 3.5 years' follow-up. The mean Lysholm score was 93.2; the mean modified Cincinnati score was 91.5; the preoperative Tegner activity score was maintained postoperatively in 8 of 10 patients; the mean Single Assessment Numeric Evaluation score was 91.5; the mean subjective IKDC score was 86.4; and the objective IKDC score was A in 9 of 11 patients, B in 1 patient, and C in 1 patient. KT-1000 measurements were available in 8 of 11 patients, with 7 of 8 showing a side-to-side difference of less than 3 mm on maximum manual testing and 1 showing a 6-mm difference.RESULTSTen of eleven patients had good subjective and clinical outcomes after ACL preservation surgery at a minimum of 2 years' and mean of 3.5 years' follow-up. The mean Lysholm score was 93.2; the mean modified Cincinnati score was 91.5; the preoperative Tegner activity score was maintained postoperatively in 8 of 10 patients; the mean Single Assessment Numeric Evaluation score was 91.5; the mean subjective IKDC score was 86.4; and the objective IKDC score was A in 9 of 11 patients, B in 1 patient, and C in 1 patient. KT-1000 measurements were available in 8 of 11 patients, with 7 of 8 showing a side-to-side difference of less than 3 mm on maximum manual testing and 1 showing a 6-mm difference.Preservation of the native ACL using the described arthroscopic primary repair technique can achieve short-term clinical success in a carefully selected subset of patients with proximal avulsion-type tears and excellent tissue quality.CONCLUSIONSPreservation of the native ACL using the described arthroscopic primary repair technique can achieve short-term clinical success in a carefully selected subset of patients with proximal avulsion-type tears and excellent tissue quality.Level IV, therapeutic case series.LEVEL OF EVIDENCELevel IV, therapeutic case series. To propose a technique of arthroscopic suture anchor primary anterior cruciate ligament (ACL) preservation for patients with proximal avulsion ACL tears that maintain excellent tissue quality. We performed a retrospective review and early follow-up of 11 consecutive cases of ACL preservation. Patients were included if they had a proximal avulsion tear and excellent tissue quality confirmed to be adequate for repair during arthroscopy. Patients were excluded if these criteria were not met or if patients had multiligamentous injury patterns or significant arthrosis. The ACL was reinforced with a No. 2 FiberWire (Arthrex, Naples, FL) and a No. 2 TigerWire (Arthrex) and was anchored to the femoral footprint by two 4.75-mm BioComposite SwiveLock suture anchors (Arthrex). The surgical procedures were performed at 3 different hospitals by a single surgeon. Anterior stability was determined with a KT-1000 arthrometer (MEDmetric, San Diego, CA). Clinical outcomes were measured using the Lysholm score, modified Cincinnati score, Tegner activity score, Single Assessment Numeric Evaluation, and subjective and objective International Knee Documentation Committee (IKDC) scores. Ten of eleven patients had good subjective and clinical outcomes after ACL preservation surgery at a minimum of 2 years' and mean of 3.5 years' follow-up. The mean Lysholm score was 93.2; the mean modified Cincinnati score was 91.5; the preoperative Tegner activity score was maintained postoperatively in 8 of 10 patients; the mean Single Assessment Numeric Evaluation score was 91.5; the mean subjective IKDC score was 86.4; and the objective IKDC score was A in 9 of 11 patients, B in 1 patient, and C in 1 patient. KT-1000 measurements were available in 8 of 11 patients, with 7 of 8 showing a side-to-side difference of less than 3 mm on maximum manual testing and 1 showing a 6-mm difference. Preservation of the native ACL using the described arthroscopic primary repair technique can achieve short-term clinical success in a carefully selected subset of patients with proximal avulsion-type tears and excellent tissue quality. Level IV, therapeutic case series.
Author	DiFelice, Gregory S Taylor, Samuel Villegas, Christine
Author_xml	– sequence: 1 givenname: Gregory S surname: DiFelice fullname: DiFelice, Gregory S email: difeliceg@hss.edu organization: Orthopaedic Trauma Service, Hospital for Special Surgery, New York, New York, U.S.A.; Orthopaedic Trauma Service, New York Presbyterian Hospital, New York, New York, U.S.A.. Electronic address: difeliceg@hss.edu – sequence: 2 givenname: Christine surname: Villegas fullname: Villegas, Christine organization: Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A – sequence: 3 givenname: Samuel surname: Taylor fullname: Taylor, Samuel organization: Sports Medicine Service, Hospital for Special Surgery, New York, New York, U.S.A
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/26542201$$D View this record in MEDLINE/PubMed
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SubjectTerms	Adolescent Adult Anterior Cruciate Ligament - surgery Anterior Cruciate Ligament Injuries Arthroscopy - methods Female Follow-Up Studies Humans Joint Instability - surgery Knee Joint - surgery Male Middle Aged Retrospective Studies Rupture Suture Anchors Suture Techniques - instrumentation Time Factors Young Adult
Title	Anterior Cruciate Ligament Preservation: Early Results of a Novel Arthroscopic Technique for Suture Anchor Primary Anterior Cruciate Ligament Repair
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