PURPOSE OF THE STUDY: The aim of this retrospective study was to present a comprehensive overview of the causes of bone-tendon-bone (BTB) autograft failure after primary anterior cruciate ligament (ACL) reconstruction. MATERIAL AnD METHODS: Between 2003 and 2013, we performed revision ACL replacement in 47 patients who had undergone primary BTB autograft ACL reconstruction in other hospitals. The group consisted of 16 women (aged 25 to 48 years) and 31 men (25 to 46 years). Surgery was performed on the right knee in 26 and on the left knee in 21 patients. In each of the 47 patients, two different assessments were made: 1. Analysis of causes of failure based on surgical protocols and/or intra-operative video records taken during most of the procedures. 2. Evaluation of bone tunnel location on lateral knee radiograms, using the method described by Harner for femoral tunnels and that reported by Stäubli and Rauschning for tibial tunnels. RESULTS: The most frequent cause of knee instability, occurring in 51.1% of the patients, was new trauma to the knee. nontraumatic instability in the remaining 48.9% was due to insuffiiency of the graft, and resulted from an incorrect surgical technique (42.5%) or biological causes (6.4%). The most common surgical mistake found was incorrect bone tunnel placement in the tibia or femur, with a malpositioned femoral tunnel being most frequent. This was diagnosed in 32 patients (68.1% of all patients) and, in 17, was the main or major cause of BTB graft failure. DISCUSSION: Based on relevant literature data and our experience, principles for prevention of graft failure after ACL reconstruction can be summarised as follows: 1. harvest of a suffiiently strong BTB autograft 2. accurate anatomical bone tunnel placement 3. appropriate tension of the BTB autograft 4. preventing graft impingement 5. secure graft fiation 6. early functional rehabilitation with an accent on delaying full weight-bearing on the knee (6 to 9 months post-operatively) CONCLUSIONS: New trauma to the knee is the most frequent cause of BTB autograft failure after ACL reconstruction. This can be avoided by participating in a professionally guided rehabilitation programme and not returning to sports activities earlier than 9 months after ACL reconstruction. The most common technical error in ACL reconstruction is non-anatomical tunnel placement in the tibia and femur. Femoral tunnel malposition is most frequent while incorrect tibial tunnel placement, which does not inflence graft failure so much, is less common.
- MeSH
- dospělí MeSH
- femur radiografie MeSH
- kolenní kloub patologie radiografie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- ligamentum cruciatum anterius patologie radiografie chirurgie MeSH
- nestabilita kloubu radiografie MeSH
- reoperace metody MeSH
- retrospektivní studie MeSH
- štěp kost-čéškový vaz-kost metody MeSH
- terapie neúspěšná MeSH
- tibie radiografie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
BACKGROUND: Because there is limited information concerning the cruciate ligaments in proximal femoral focal deficiency, knee arthroscopy was used to identify the changes of cruciate ligaments and their relation to the different types of this deficiency. METHODS: Knee arthroscopy was performed in 21 consecutive patients with deficiency types III, IV, VII-IX using the Pappas classification. A new classification of the knee was created. It contains types I, II, III according to the findings of the anterior cruciate ligament (ACL) (type I: normal, type II: hypoplasia, type III: aplasia) and 3 subtypes A, B, C according to the findings of the posterior cruciate ligament (PCL) (type A: normal, type B: hypoplasia, type C: aplasia), respectively. Instrumented and radiologic drawer testing was provided additionally in 2010. RESULTS: The changes of the cruciate ligaments were found in all but 1 patient. Type I was found in only 2 patients. In 1, both cruciate ligaments were intact (type IA). In the other patient, the ACL was intact, but the PCL was absent (type IC). Hypoplastic ACLs (type II) were found in 4 patients, namely in 3 patients with normal PCLs (type IIA), whereas in 1 patient the PCL was absent (type IIC). In the majority of patients, the ACLs completely failed (type III, 15 patients). Absence of both cruciate ligaments was found in 8 patients (type IIIC). PCLs were intact in 4 patients (IIIA) or were hypoplastic in 3 patients (IIIB), respectively. Instrumental drawer testing was not reliable in patients of our group. Radiologic testing showed a posterior shift of the tibia in the majority of patients on the affected side. Anterior and posterior drawer tests were increased in a majority of patients, but did not directly correlate to the presence/absence of cruciate ligaments. CONCLUSIONS: Variable changes of the cruciate ligaments were found in all but 1 patient with proximal femoral focal deficiency. These changes were not related to the type of Pappas classification. Despite the lower clinical relevance of the changes in majority of patients, imaging of cruciate ligaments is recommend before lengthening of the extremity to avoid dislocation of the knee. LEVEL OF EVIDENCE: I - Testing of previously developed diagnostic criteria in series of consecutive patients.
- MeSH
- artroskopie metody MeSH
- dítě MeSH
- femur abnormality radiografie MeSH
- kolenní kloub patologie radiografie MeSH
- lidé MeSH
- ligamentum cruciatum anterius patologie radiografie MeSH
- ligamentum cruciatum posterius patologie radiografie MeSH
- mladiství MeSH
- předškolní dítě MeSH
- tibie abnormality MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Cíl práce: Cílem předkládané práce je radiologické hodnocení přesnosti umístění kostních kanálů u prvních rekonstrukcí předního zkříženého vazu (PZV) provedených s užitím navigačního systému. Metodika: Po artroskopické přípravě kloubního prostoru a registraci potřebných dat se cílí vodící dráty pro vrtání kanálů ve femuru a tibii pomocí navigačního systému. Štěp z lig. patellae je po té protažen a fixován interferenčními šrouby. Poloha kanálů byla hodnocena radiologicky metodami podle Bernarda-Hertela a Harnera. Výsledky: Korektní vyústění femorálního kanálu bylo nalezeno ve 13 (87 %) a tibiálního kanálu ve 14 (93 %) případech. Ideální poloha štěpu s ohledem na oba kostěné kanály byla zjištěna u 12 kolen (80 %). Závěry: Přesné cílení kostních kanálů je rozhodující pro dobrý výsledek rekonstrukce PZV. To je možné u standardních postupů jen v případě, že operatér provádí velký počet rekonstrukcí ročně. Ve skutečnosti je 70 % rekonstrukcí prováděno méně zkušenými ortopedy. První výsledky naznačují, že by navigační systém mohl být účinným pomocníkem operatérům, kteří nemají příležitost provádět tyto výkony příliš často.
Aim: The aim of this work is a radiological assessment of accuracy of the osseous channels location in initial reconstructions of the anterior crutiate ligament (PZV) conducted using a navigation system. Methodology: Following arthroscopic preparation of the joint space and registration of the essential data, conducting wires for channels in tibia and femur are navigated using the navigation system. The lig. patellae graft is then pulled-through and fixed using interference screws. The channels location was assessed using radiological methods according to Bernard-Hertel and Harner. Results: A correct emergence of the femoral channel was found in 13 (87%) and of the tibial channel in 14 (93%) cases. The optimum graft location with respect to the both osseous channels was detected in 12 knee joints (80%). Conclusions: Exact location of the osseous channels is a principal prerequisite for a good result of the anterior crutiate ligament reconstruction. In case of standard procedures, this may be possible only in case the operating surgeon conducts a large number of reconstructions every year. In daily practice, however, 70% of reconstructions are conducted by less experienced orthopaedic surgeons. Our initial results indicate that the navigation system could become an effective tool for the surgeons who do not have the opportunity for conducting the above procedures too often.
- MeSH
- chirurgie s pomocí počítače metody přístrojové vybavení MeSH
- kolenní kloub chirurgie radiografie MeSH
- ligamentum cruciatum anterius anatomie a histologie chirurgie radiografie MeSH
- ligamentum patellae chirurgie MeSH
- transplantáty MeSH
- zákroky plastické chirurgie metody přístrojové vybavení MeSH
