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Anterior Cruciate Ligament Injuries Management and Reconstruction
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Anterior Cruciate Ligament Injuries Management and Reconstruction

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Sports Medicine".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 11135

Special Issue Editor

Prof. Dr. Nikiforos Galanis

E-Mail Website
Guest Editor
1st Orthopaedic Department, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
Interests: sports medicine; knee arthroscopy; anterior cruciate ligament reconstruction

Special Issue Information

Dear Colleagues,

Anterior cruciate ligament (ACL) injury is one of the most common sports medicine injuries requiring reconstruction. Although several well-established concepts and surgical techniques have been widely used, open questions in the field of ACL reconstruction continue to arise. Problems such as rotatory instability, ACL graft failures, and long-term osteoarthritis still require scientific work on the subject.

The aim of this Special Issue is to describe the current techniques, the pros and cons of each method, and future theories. The topics include the indications, clinical and experimental results of the whole range of methods available, as well as the prehabilitation and postoperative rehabilitation programs. Recent topics requiring high-quality data are the addition of an anterolateral reconstruction/tenodesis, anteromedial and anterolateral instability, and long-term osteoarthritis. Graft choice, fixation techniques, or even early primary ACL repair are also evolving at present.

Therefore, researchers are encouraged to contribute to this Special Issue with both original research and review papers.


Prof. Dr. Nikiforos Galanis
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • anterior cruciate ligament
  • anterolateral ligament
  • rotatory instability
  • anteromedial instability
  • rehabilitation

Published Papers (5 papers)

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Research

Jump to: Review, Other

11 pages, 859 KiB  
Article
Manual and Device-Assisted Hamstring Autograft Tensioning Yield Similar Outcomes following ACL Reconstruction
by Andreas Piskopakis, Trifon Totlis, Vlasios Achlatis, Frantzeska Zampeli, Jim Dimitris Georgoulis, Michael Hantes, Nikolaos Piskopakis and Marios Vekris
J. Clin. Med. 2023, 12(14), 4623; https://doi.org/10.3390/jcm12144623 - 11 Jul 2023
Viewed by 1310
Abstract
The optimal initial graft tension during ACL reconstruction is still a matter of debate. Manual tension is commonly applied to the graft during tibial fixation. However, this has been associated with a greater graft failure rate than that associated with device-assisted tensioning. This [...] Read more.
The optimal initial graft tension during ACL reconstruction is still a matter of debate. Manual tension is commonly applied to the graft during tibial fixation. However, this has been associated with a greater graft failure rate than that associated with device-assisted tensioning. This study aims to compare the clinical outcomes between the application of manual tension and the use of the ConMed Linvatec SE™ Graft Tensioning System during graft fixation while performing anatomic single-bundle ACL reconstruction. Methods: A prospective comparative study was conducted between September 2015 and May 2017. Sixty-four patients (mean age 29.3 years, range 14–45) with isolated ACL injuries (and who would be subjected to ACL reconstruction with a quadruple hamstring tendon graft) were divided into two groups. In Group A (n = 29), common tension was applied manually to both grafts. In Group B (n = 35), specific tension was applied to the grafts with the use of a tensioner device (ConMed Linvatec SE™ (Stress Equalization) Graft Tensioning System). A total of 60 N was applied to the semitendinosus, and 40 N was applied to the gracilis. Clinical outcomes were assessed at 6, 12, and 24 months. Results: There were no significant differences between the baseline demographic and clinical data among the patients of the two groups (all p > 0.05). The patients were followed up for a minimum of 24 months (mean ± SD). There were no significant differences in the side-to-side anterior knee laxity, the IKDC, the Lysholm Knee, and the Tegner Activity Scale scores for up to 24 months after operation. The pivot shift test was negative in all cases, and no graft failure was reported at a 2-year follow-up. Conclusion: No significant differences were found with respect to postoperative anterior knee laxity, clinical outcomes, activity level, and patient satisfaction between the application of manual tension and the use of the graft-tensioning system during tibial fixation while performing anatomic single-bundle ACL reconstruction with a quadruple hamstring tendon graft. Further high-quality clinical studies are required to elucidate whether device-assisted tension is superior to manual tension. Full article
(This article belongs to the Special Issue Anterior Cruciate Ligament Injuries Management and Reconstruction)
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13 pages, 2741 KiB  
Article
Wrap It! Preventive Antimicrobial Treatment Shows No Negative Effects on Tenocytes and Tendons—A Comprehensive Approach
by Manuela Thierbach, Michelle Müller, Richard Stange, Daniel Kronenberg, Matthias Aurich and Britt Wildemann
J. Clin. Med. 2023, 12(12), 4104; https://doi.org/10.3390/jcm12124104 - 17 Jun 2023
Cited by 1 | Viewed by 966
Abstract
Although the rate of infection after the reconstruction of a ruptured anterior cruciate ligament (ACL) is low, prophylactic incubation of the graft with vancomycin (Vanco-wrap or vancomycin soaking) is routinely performed. A cytotoxic effect of vancomycin is reported for several cell types, and [...] Read more.
Although the rate of infection after the reconstruction of a ruptured anterior cruciate ligament (ACL) is low, prophylactic incubation of the graft with vancomycin (Vanco-wrap or vancomycin soaking) is routinely performed. A cytotoxic effect of vancomycin is reported for several cell types, and the prophylactic treatment might prevent infection but harm the tissue and cells. Aim: A comprehensive study was performed to investigate the effect of vancomycin on tendon tissue and isolated tenocytes using cell viability, molecular and mechanical analysis. Material and methods: Rat tendons or isolated tenocytes were incubated in increasing concentrations of vancomycin (0–10 mg/mL) for different times, and cell viability, gene expression, histology and Young’s modulus were analyzed. Results: The clinically used concentration of vancomycin (5 mg/mL for 20 min) had no negative effect on cell viability in the tendons or the isolated tenocytes, while incubation with the toxic control significantly reduced cell viability. Increasing the concentration and prolonging the incubation time had no negative effect on the cells. The expression of Col1a1, Col3a1 and the tenocyte markers mohawk, scleraxis and tenomodulin was not affected by the various vancomycin concentrations. The structural integrity as measured through histological and mechanical testing was not compromised. Conclusion: The results proved the safe application of the Vanco-wrap on tendon tissue. Level of evidence: IV. Full article
(This article belongs to the Special Issue Anterior Cruciate Ligament Injuries Management and Reconstruction)
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7 pages, 582 KiB  
Article
Functional Outcome of All-Soft-Tissue Quadriceps Tendon Autograft in ACL Reconstruction in Young and Athletic Patients at a Minimum Follow-Up of 1 Year
by Lorenz Pichler, Ludwig Pichler, Markus Liu, Stephan Payr, Harald Binder, Georg Kaiser, Marcus Hofbauer and Thomas Tiefenboeck
J. Clin. Med. 2022, 11(22), 6706; https://doi.org/10.3390/jcm11226706 - 12 Nov 2022
Cited by 2 | Viewed by 1500
Abstract
To investigate the functional outcome in young and athletic patients with ACL injuries, treated with an all-soft-tissue quadriceps tendon autograft at a minimum follow-up of 12 months. Methods: Patients who received a QT autograft ACL reconstruction between August 2018 and December 2020 were [...] Read more.
To investigate the functional outcome in young and athletic patients with ACL injuries, treated with an all-soft-tissue quadriceps tendon autograft at a minimum follow-up of 12 months. Methods: Patients who received a QT autograft ACL reconstruction between August 2018 and December 2020 were included in this study. Range of motion in the operated knee was described at 6 and 18 weeks after surgery and the functional outcome parameters (Lysholm score, IKDC score and Tegner activity scale) were calculated at 6 and ≥ 12 months after surgery. Results: Forty patients were included in this study, of which 29 identified as male and 11 as female. The average age was 31.3 years (range 16 to 57 years) and the mean follow-up time was 16.8 months (range 12 to 30 months). All functional outcome scores showed improvement over the course of the follow-up: Lysholm score 94.2 to 95.5 (n.s.), IKDC score 90.1 to 93.9 (n.s.), Tegner activity scale 3.7 to 5.0 (p > 0.001), all at six months and ≥12 months. No reruptures happened during the time of the follow-up. Conclusions: This study shows that the all-soft-tissue quadriceps tendon autograft technique can improve functional outcome in young and athletic patients with an ACL injury at short to intermediate follow-up. Full article
(This article belongs to the Special Issue Anterior Cruciate Ligament Injuries Management and Reconstruction)
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Review

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20 pages, 595 KiB  
Review
Clinical Research Progress of Internal Brace Ligament Augmentation Technique in Knee Ligament Injury Repair and Reconstruction: A Narrative Review
by Wenhao Lu, Zhenhan Deng, Anko Elijah Essien, Djandan Tadum Arthur Vithran, Michael Opoku, Yusheng Li and Wenfeng Xiao
J. Clin. Med. 2023, 12(5), 1999; https://doi.org/10.3390/jcm12051999 - 2 Mar 2023
Cited by 6 | Viewed by 3695
Abstract
Knee ligament injuries are most common in sports injuries. In general, ligament repair or reconstruction is necessary to restore the stability of the knee joint and prevent secondary injuries. Despite advances in ligament repair and reconstruction techniques, a number of patients still experience [...] Read more.
Knee ligament injuries are most common in sports injuries. In general, ligament repair or reconstruction is necessary to restore the stability of the knee joint and prevent secondary injuries. Despite advances in ligament repair and reconstruction techniques, a number of patients still experience re-rupture of the graft and suboptimal recovery of motor function. Since Dr. Mackay’s introduction of the internal brace technique, there has been continuous research in recent years using the internal brace ligament augmentation technique for knee ligament repair or reconstruction, particularly in the repair or reconstruction of the anterior cruciate ligament. This technique focuses on increasing the strength of autologous or allograft tendon grafts through the use of braided ultra-high-molecular-weight polyethylene suture tapes to facilitate postoperative rehabilitation and avoid re-rupture or failure. The purpose of this review is to present detailed research progress in the internal brace ligament enhancement technique of knee ligament injury repair as well as the reconstruction from biomechanical and histological research and clinical studies and to comprehensively assess the value of the application of this technique. Full article
(This article belongs to the Special Issue Anterior Cruciate Ligament Injuries Management and Reconstruction)
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Other

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17 pages, 5427 KiB  
Technical Note
All-Inside Anterior Cruciate Ligament Reconstruction Technique: Tips and Tricks
by Francesco Bosco, Fortunato Giustra, Alessandro Ghirri, Giorgio Cacciola, Alessandro Massè and Marcello Capella
J. Clin. Med. 2023, 12(18), 5793; https://doi.org/10.3390/jcm12185793 - 6 Sep 2023
Cited by 4 | Viewed by 2867
Abstract
The all-inside anterior cruciate ligament reconstruction (ACLR) technique was developed to improve patient outcomes by reducing the procedure’s invasiveness, minimizing complications and pain, and enabling faster postoperative recovery. This study presents a detailed description of the all-inside ACLR technique, which involves the use [...] Read more.
The all-inside anterior cruciate ligament reconstruction (ACLR) technique was developed to improve patient outcomes by reducing the procedure’s invasiveness, minimizing complications and pain, and enabling faster postoperative recovery. This study presents a detailed description of the all-inside ACLR technique, which involves the use of quadrupled semitendinosus (ST) graft and suspension devices at both tibial and femoral sites, as well as valuable tips for avoiding complications that may arise during the procedure. The surgical procedure employs retrograde drills to create bony sockets for graft passage, which are then fixed with suspension devices at both the tibial and femoral sites. This technique has no specific restrictions and may be applied to all patients with anterior cruciate ligament (ACL) injuries. The literature reports the advantages, good clinical outcomes, and medium- to long-term graft survival achieved with the all-inside ACLR technique. However, the complications and disadvantages associated with the technique must be considered. Full article
(This article belongs to the Special Issue Anterior Cruciate Ligament Injuries Management and Reconstruction)
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