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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-10-2011 | Knee

Will early reconstruction prevent abnormal kinematics after ACL injury? Two-year follow-up using dynamic radiostereometry in 14 patients operated with hamstring autografts

Authors: Jonas Isberg, Eva Faxén, Gauti Laxdal, Bengt I. Eriksson, Johan Kärrholm, Jon Karlsson

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2011

Abstract

Purpose

Previous studies have reported that Anterior Cruciate Ligament (ACL) reconstruction does not restore normal tibial rotation in patients with chronic instability and repeated episodes of giving way. We hypothesised that early ACL reconstruction, using quadruple hamstring autografts, before the pivoting episodes had occurred, would protect the knee joint from developing abnormal kinematics with increased external tibial rotation during flexion.

Methods

Fourteen consecutive patients (8 men, 6 women) with a median age of 24 years (18–43), with a complete, isolated unilateral ACL rupture and an intact contralateral knee, were studied. The operations were performed by one experienced surgeon, using quadruple hamstring autografts. We used dynamic radiostereometry (RSA) with tantalum markers inserted in both the injured and the intact contralateral knee to study the pattern of knee motion during active and weight-bearing knee extension. The patients were evaluated pre-operatively and followed for 2 years after the ACL reconstruction. The anterior-posterior laxity was measured using the KT-1000.

Results

Before surgical repair of the ACL, the internal/external tibial rotation or abduction/adduction did not differ significantly between the injured and intact knees (P = 0.27–0.91). Separate studies of the anterior-posterior translation of the medial and lateral femoral flexion facet centres (MFC and LFC) relative to a fixed tibia did not reveal any significant differences between the injured and intact knees (P = 0.21–0.59). Pre-operatively, the KT-1000 laxity measurements showed a side-to-side difference of 2.5 (1.0–5.5) mm. At 2 years, the laxity side-to-side difference was 0.5 (0–3.0) mm (P = 0.001), and there were still no significant differences between the injured and intact knees in terms of internal/external tibial rotation and abduction/adduction (P = 0.13–0.60). Nor did the anterior-posterior translation of the flexion facet centres differs (P = 0.27–0.97).

Conclusion

During the first 6–8 weeks after the ACL injury, before pivoting episodes had occurred, the kinematics of the injured knee were normal and did not differ from those of the intact contralateral knee. Reconstruction of the ACL within 10 weeks after injury using quadruple hamstring autografts resulted in unchanged knee kinematics for 2 years and no difference compared with the intact contralateral knee. Surgical repair during the early phase after the injury appears to protect the knee from developing abnormal knee motion after an ACL rupture.

Level of evidence

III.

Andriacchi TP, Dyrby CO (2005) Interactions between kinematics and loading during walking for the normal and ACL deficient knee. J Biomech 38:293–298PubMedCrossRef

Beynnon B, Johnson R, Abate J, Fleming B, Nichols C (2005) Treatment of Anterior cruciate ligament injuries, Part 1. Am J Sports Med 33:1579–1602PubMedCrossRef

Beynnon B, Johnson R, Abate J, Fleming B, Nichols C (2005) Treatment of Anterior cruciate ligament injuries, Part 2. Am J Sports Med 33:1751–1767PubMedCrossRef

Bragdon CR, Malchau H, Yuan X, Perinchief R, Karrholm J, Börlin N, Estok DM, Harris WH (2002) Experimental assessment of precision and accuracy of radiostereometric analysis for the determination of polyethylene wear in a total hip replacement model. J Orthop Res 20:688–695PubMedCrossRef

Brandsson S, Karlsson J, Eriksson BI, Kärrholm J (2001) Kinematics after tear in the anterior cruciate ligament. Dynamic bilateral radiostereometric studies in 11 patients. Acta Orthop Scand 72:372–378PubMedCrossRef

Brandsson S, Karlsson J, Swärd L, Kartus J, Eriksson BI, Kärrholm J (2002) Kinematics and Laxity of the Knee Joint after Anterior cruciate ligament reconstruction: pre- and postoperative radiostereometric studies. Am J Sports Med 30:361–367PubMed

Chouliaras V, Ristanis S, Moraiti C, Stergiou N, Georgoulis AD (2007) Effectiveness of reconstruction of the anterior cruciate ligament with quadrupled hamstrings and bone-patellar tendon-bone autografts. Am J Sports Med 35:189–196PubMedCrossRef

Fleming BC, Peura GD, Abate JA, Beynnon BD (2001) Accuracy and repeatability of Roentgen stereophotogrammetric analysis (RSA) for measuring knee laxity in longitudinal studies. J Biomech 34:1355–1359PubMedCrossRef

Hefti F, Müller W, Jakob RP, Stäubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234PubMedCrossRef

10.

Hunter RE, Mastrangelo J, Freeman JR, Purnell ML, Jones RH (1996) The impact of surgical timing on postoperative motion and stability following anterior cruciate ligament reconstruction. Arthroscopy 12:667–674PubMedCrossRef

11.

Isberg J, Faxén E, Brandsson S, Eriksson BI, Kärrholm J, Karlsson J (2006) Early active extension after Anterior Cruciate Ligament reconstruction does not result in increased laxity of the knee. Knee Surg Sports Traum Arthrosc 14:1108–1115CrossRef

12.

Iwaki H, Pinskerova V, Freeman MA (2000) Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Joint Surg Br 82:1189–1195PubMedCrossRef

13.

Jonsson H, Kärrholm J (1994) Three-dimensional knee joint movements during a step-up: Evaluation after anterior cruciate ligament rupture. J Orthop Res 12:769–779PubMedCrossRef

14.

Jonsson H, Kärrholm J, Elmqvist LG (1989) Kinematics of active knee extension after tear of the anterior cruciate ligament. Am J Sports Med 17:792–802

15.

Kärrholm J (1989) Roentgen stereophoto-grammetry. Review of orthopaedic applications. Acta Orthop Scand 60:491–503PubMedCrossRef

16.

Kärrholm J, Brandsson S, Freeman MAR. (2000) Tibiofemoral movement 4: changes of axial tibial rotation caused by forced rotation at the weight-bearing knee studied by RSA. J Bone and Joint Surg. 82-B:1201-1203

17.

Kärrholm J, Gill R, Valstar E (2006) The history and future of radiostereometric analysis. Clin Orthop Rel Res 448:10–21CrossRef

18.

Kärrholm J, Herberts P, Hultmark P, Malchau H, Nivbrant B, Thanner J (1997) Radiostereometry of hip prostheses. Review of methodology and clinical results. Clin Orthop Rel Res 344:94–110

19.

Kärrholm J, Selvik G, Elmqvist LG, Hansson LI (1988) Active knee motion after cruciate ligament rupture. Stereoradio-graphy. Acta Orthop Scand 59:158–164PubMed

20.

Kärrholm J, Elmqvist LG, Selvik G, Hansson LI (1989) Chronic anterolateral instability of the knee. A roentgen stereophotogrammetric evaluation. Am J Sports Med 17:555–563PubMedCrossRef

21.

Kärrholm J, Selvik G, Elmqvist LG, Hansson LI, Jonsson H (1988) Three-dimensional instability of the anterior cruciate deficient knee. J Bone Joint Surg 70-B:777–783

22.

Laxdal G, Kartus J, Hansson L, Heidvall M, Ejerhed L, Karlsson J (2005) A prospective randomized comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction. Arthroscopy 21:34–42PubMedCrossRef

23.

Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152PubMedCrossRef

24.

Mayr HO, Weig TG, Plitz W (2004) Arthrofibrosis following ACL reconstruction: reasons and outcomes. Arch Orthop Trauma Surg 124:518–522PubMedCrossRef

25.

Nilsson KG, Dahlén T. (1997) In vivo kinematics in knee replacements with fixed or mobile polyethylene bearings. Transactions of the 43rd Annual Meeting Orthopaedic Research Society. 22:261

26.

Nilsson KG, Kärrholm J, Gadegaard P (1991) Abnormal kinematics of the artificial knee, roentgen stereophotogrammetric analysis of 10 Miller-Galante and five New Jersey LCS knees. Acta Orthop Scand 62:440–446PubMedCrossRef

27.

Onsten I, Berzins A, Shott S, Sumner DR (2001) Accuracy and precision of radiostereo-metric analysis in the measurement of THR femoral component translations: human and canine in vitro models. J Orthop Res 19:1162–1167PubMedCrossRef

28.

Papannagari R, Gill TJ, Defrate LE, Moses JM, Petruska AJ, Li G (2006) In vivo kinematics of the knee after anterior cruciate ligament reconstruction: A clinical and functional evaluation. Am J Sports Med 34:2006–2012PubMedCrossRef

29.

Piazza SJ, Cavanagh PR (2000) Measurement of the screw-home motion of the knee is sensitive to errors in axis alignment. J Biomech 33:1029–1034PubMedCrossRef

30.

Raviraj A, Anand A, Kodikal G, Chandrashekar M, Pai S (2010) A comparison of early and delayed arthroscopically-assisted reconstruction of the anterior cruciate ligament using hamstring autograft. J Bone Joint Surg Br 92:521–526PubMedCrossRef

31.

Ristanis S, Stergiou N, Patras K, Tsepis E, Moraiti C, Georgoulis A (2006) Follow-up evaluation 2 years after ACL reconstruction with Bone-Patellar Tendon-Bone graft shows that excessive tibial rotation persists. Clin J Sports Med 16:111–116CrossRef

32.

Ristanis S, Stergiou N, Patras K, Vasiliadis H, Giakas G, Georgoulis A (2005) Excessive tibial rotation during high-demand activities is not restored by Anterior cruciate ligament reconstruction. Arthroscopy 21:1323–1329PubMedCrossRef

33.

Saari T, Carlsson L, Karlsson J, Kärrholm J (2005) Knee kinematics in medial arthrosis. Dynamic radiostereometry during active extension and weight-bearing. J Biomech 38:285–292PubMedCrossRef

34.

Selvik G (1989) Roentgen Stereophotogram-metry. A method for the study of the kinematics of the skeletal system. Acta Orthop Scand suppl 232:1–51

35.

Shelbourne KD, Patel DV (1996) Timing of surgery in anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc 3:148–156CrossRef

36.

Tegner Y, Lysholm J, Lysholm M, Gillquist J (1986) A performance test to monitor rehabilitation and evaluate anterior cruciate ligament injuries. Am J Sports Med 14:156–159PubMedCrossRef

37.

Uvehammer J, Kärrholm J, Brandsson S (2000) In vivo kinematics of total knee arthroplasty: concave versus posterior-stabilised tibial joint surface. J Bone Joint Surg 82B:499–505CrossRef

38.

Uvehammer J, Kärrholm J, Brandsson S, Herberts P, Carlsson L, Regner L (2000) In vivo kinematics of total knee arthroplasty: flat compared with concave tibial joint surfaces. J Orthop Res 18:856–864PubMedCrossRef

39.

van Dijk R, Huiskes R, Selvik G (1979) Roentgen stereophotogrammetric methods for the evaluation of the three dimensional kinematic behaviour and cruciate ligament length patterns of the human knee joint. J Biomech 12:727–731PubMedCrossRef

40.

Valstar ER, Gill R, Ryd L, Flivik G, Börlin N, Kärrholm J (2005) Guidelines for standardization of radiostereometry (RSA) of implants. Acta Orthop Scand 76:653–672

41.

von Porat A, Ross EM, Roos H (2004) High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis 63:269–273CrossRef

42.

Yoo JD, Papannagari R, Park SE, DeFrate LE, Gill TJ, Li G (2005) The effect of anterior cruciate ligament reconstruction on knee joint kinematics under simulated muscle loads. Am J Sports Med 33:240–246PubMedCrossRef

Title: Will early reconstruction prevent abnormal kinematics after ACL injury? Two-year follow-up using dynamic radiostereometry in 14 patients operated with hamstring autografts
Authors: Jonas Isberg
Eva Faxén
Gauti Laxdal
Bengt I. Eriksson
Johan Kärrholm
Jon Karlsson
Publication date: 01-10-2011
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2011
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-011-1399-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Will early reconstruction prevent abnormal kinematics after ACL injury? Two-year follow-up using dynamic radiostereometry in 14 patients operated with hamstring autografts

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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