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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, Assoc. Prof., AUSTRIA Jonathan D Hughes, MD, PhD, UNITED STATES Adam J. 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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Lower Socioeconomic Status Adversely Affects Access To Care And The Rate Of Instability Events And Bucket Handle Meniscus Tears Following Anterior Cruciate Ligament Tears Abstract Presentation 6 minutes Edward S. Chang, MD, UNITED STATES Blake M. Bodendorfer, MD, UNITED STATES Andrew Curley, MD, UNITED STATES David X. Wang, MD, UNITED STATES Christine Conroy, MD, UNITED STATES Mark Hopkins, MD, UNITED STATES Brian McCormick, MD, UNITED STATES Caroline Fryar, MD, UNITED STATES
Same Knee, Different Goals: Patients and Surgeons have Different Priorities Related to ACL Reconstructions and Surgeons are Resistant to Changing Clinical Practice Abstract Presentation 4 minutes Hana Marmura, MPT, PhD, UNITED STATES Dianne M. Bryant, PhD, CANADA Trevor B. Birmingham, PT, PhD, CANADA Kurt Paul Spindler, MD, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES Tim Spalding, FRCS(Orth), UNITED KINGDOM Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
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
The Outcome Of Non-circular (Rectangle, Oval) Femoral Tunnel ACL Reconstruction, Does It Improve The Outcome Of ACL Reconstruction Surgery? Abstract Presentation 6 minutes S. Ali Ghasemi, MD, UNITED STATES Joseph McCahon, DO, UNITED STATES Arthur R Bartolozzi, MD, UNITED STATES
PSM: Pivot Shift Meter Cellphone Application for Classifying ACL Injuries Abstract Presentation 5 minutes Edmundo Berumen Nafarrate, PhD, Prof., MEXICO Carlos Alejandro Vega Najera, MD, MEXICO Joel Alejandro Cabral, MD, MEXICO Luis Sigala Gonzalez, Eng, MEXICO Ivan Ramos Moctezuma, Eng, MEXICO Carlos Leal, MD, Prof., COLOMBIA Jesus Javier Tonche, MD, MEXICO Avril Pérez Fontes, MD, MEXICO Fatima Quintana Trejo, Eng, MEXICO
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
MRI After ACL Reconstruction Demonstrates that Hamstring Grafts Heal and Integrate at Different Rates Abstract Presentation 6 minutes Sven Edward Putnis, MB ChB FRCS(Tr&Orth), UNITED KINGDOM Takeshi Oshima, MD, PhD, JAPAN Antonio Klasan, MD, PhD, EMBA, FRCS, AUSTRIA Samuel Grasso, PhD, B. Engineering (Mechanical), AUSTRALIA Thomas Neri, MD, PhD, Prof., FRANCE Myles R. J. Coolican, FRACS, AUSTRALIA Brett A. Fritsch, MBBS BSc(Med), FRACS, FAOrthA, AUSTRALIA David A. Parker, MBBS, BMedSc, FRACS, AUSTRALIA
Comparison of three different Quadriceps Tendon ACL graft to BTB and Semi-T grafts: A biomechanical study ePoster Presentation Marc Jacob Strauss, MD, NORWAY Jonathan Miles, M.S, UNITED STATES Mitchell Iung Kennedy, BS, UNITED STATES Gilbert Moatshe, MD, PhD, NORWAY Grant J Dornan, MS, UNITED STATES Martin Lind, MD, PhD, Prof., DENMARK Lars Engebretsen, MD, PhD, NORWAY Robert F. LaPrade, MD, PhD, UNITED STATES
Xenograft For Anterior Cruciate Ligament Reconstruction Was Associated With High Graft Processing Infection. Abstract Presentation 6 minutes Willem M. van der Merwe, MBChB, FCS(SA)Ortho, SOUTH AFRICA Martin Lind, MD, PhD, Prof., DENMARK Peter Faunoe, MD, DENMARK Kees van Egmond, MD, NETHERLANDS Stefano Zaffagnini, MD, Prof., ITALY Maurilio Marcacci, MD, ITALY Ramon Cugat Bertomeu, MD, PhD, SPAIN Rene E. Verdonk, Prof Em, MD, PhD, BELGIUM Ernique Ibanez, MD, PhD, SPAIN Giulio Maria Marcheggiani Muccioli, MD, PhD, Associate Professor, ITALY

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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