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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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Local Anaesthetic Infiltration (Lia) Is Equally Effective As Adductor Nerve Blocks For Pain Relief In Anterior Cruciate Ligament (Acl) Reconstructions. Abstract Presentation 8 minutes Mohammad Abou Salhab, MBChB, MSc, UNITED KINGDOM Sonal Sonwalkar , FRCA, UNITED KINGDOM Sanjeev Anand, MD, UNITED KINGDOM Martin Stone, MD, UNITED KINGDOM
High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury Abstract Presentation 5 minutes Ryan M Bell, BS, UNITED STATES Daniel P. Berthold, Association.-Prof., GERMANY Lukas Willinger, MD, GERMANY Matthew R. Levasseur, MD, UNITED STATES Daniel Marrero, MD, UNITED STATES Lukas Nawid Muench, MD, GERMANY Andreas B. Imhoff, MD, Prof. Emeritus, GERMANY Elmar Herbst, MD, PhD, GERMANY Mark P. Cote, PT, DPT, MSCTR, UNITED STATES Robert A. Arciero, MD, UNITED STATES Cory M. Edgar, MD, PhD, UNITED STATES
Ligamentous Laxity, Male Sex, Chronicity, Meniscus Injury And Posterior Tibial Slope Are Associated With A High-Grade Pre-Operative Pivot Shift: A Post Hoc Analysis Of The Stability Study Abstract Presentation 6 minutes Lachlan Batty, FRACS, AUSTRALIA Andrew Firth, PhD, CANADA Gilbert Moatshe, MD, PhD, NORWAY Dianne M. Bryant, PhD, CANADA S. Mark A. Heard, MD, FRCS, CANADA Robert G. McCormack, MD, CANADA Alex Rezansoff, MD, FRCSC, CANADA Devin Clarke Peterson, MD, FRCSC, Dip Sport Med, CANADA Davide Bardana, MD, CANADA Peter B. MacDonald, MD, FRCS, Dip Sport Med, CANADA Tim Spalding, FRCS(Orth), UNITED KINGDOM Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
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
Tunnel Position In Anterior Cruciate Ligament Reconstruction Varies Between High Volume And Low Volume Surgeons Abstract Presentation 6 minutes Jonathan D Hughes, MD, PhD, 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
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, Professor, SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN
Predicting Subjective Failure of ACL Reconstruction: A Machine Learning Analysis of the Norwegian Knee Ligament Register and Patient Reported Outcomes Award Winner 5 minutes R. Kyle Martin, MD, FRCSC, UNITED STATES Solvejg Wastvedt, BA, UNITED STATES Ayoosh Pareek, MD, UNITED STATES Andreas Persson, MD, PhD, NORWAY Havard Visnes, MD, PT, PhD, NORWAY Anne Marie Fenstad, MSc, NORWAY Gilbert Moatshe, MD, PhD, NORWAY Julian Wolfson, PhD, UNITED STATES Lars Engebretsen, MD, PhD, NORWAY
Acl Deficiency Influences Medio-Lateral Tibial Alignment And Knee Varus–Valgus During In Vivo Activities Abstract Presentation 3 minutes Piero Agostinone, MD, ITALY Stefano Di Paolo, Eng, PhD, ITALY Alberto Grassi, PhD, ITALY Marco Bontempi, PhD, ITALY Erika Pinelli, MsC, ITALY Laura Bragonzoni, Prof., ITALY Stefano Zaffagnini, MD, Prof., ITALY
Predicting Subsequent Revision ACL Reconstruction: A Machine Learning Analysis of the Norwegian Knee Ligament Register Abstract Presentation 5 minutes R. Kyle Martin, MD, FRCSC, UNITED STATES Solvejg Wastvedt, BA, UNITED STATES Ayoosh Pareek, MD, UNITED STATES Andreas Persson, MD, PhD, NORWAY Havard Visnes, MD, PT, PhD, NORWAY Anne Marie Fenstad, MSc, NORWAY Gilbert Moatshe, MD, PhD, NORWAY Julian Wolfson, PhD, UNITED STATES Lars Engebretsen, MD, PhD, NORWAY
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
Combined ACL and Anterolateral Ligament Reconstruction Confers Significantly Improved Long Term Outcomes when Compared to Isolated ACL Reconstruction: A Matched-Pair Analysis Abstract Presentation 5 minutes Adnan Saithna, MD, FRCS, UNITED STATES Ibrahim Haidar, MD, LEBANON Johnny Rayes, MD, MSc, FEBOT, CANADA Thomas Fradin, MD, FRANCE Cédric Ngbilo, MD, SWITZERLAND Benjamin Freychet, MD, FRANCE Thais Dutra Vieira, MD, FRANCE Herve Ouanezar, MD, UNITED ARAB EMIRATES Bertrand Sonnery-Cottet, MD, PhD, FRANCE
Negative Effects Of Delayed Anterior Cruciate Ligament Reconstruction On Associated Injuries And Knee Laxity Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Per-Mats Janarv, MD, PhD, Associate Prof., SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN Gunnar Edman, MD, PhD, Prof., SWEDEN Magnus Forssblad, SWEDEN Anders Stalman, MD, PhD, Professor, SWEDEN

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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