The REVision Using Imaging to Guide Staging and Evaluation (REVISE) in ACL Reconstruction Classification

J Knee Surg DOI: 10.1055/s-0039-1697902Revision anterior cruciate ligament (ACL) procedures are increasing in incidence and possess markedly inferior clinical outcomes (76% satisfaction) and return-to-sports (57%) rates than their primary counterparts. Given their complexity, a universal language is required to identify and communicate the technical challenges faced with revision procedures and guide treatment strategies. The proposed REVision using Imaging to guide Staging and Evaluation (REVISE) ACL (anterior cruciate ligament) Classification can serve as a foundation for this universal language that is feasible and practical with acceptable inter-rater agreement. A focus group of sports medicine fellowship-trained orthopaedic surgeons was assembled to develop a classification to assess femoral/tibial tunnel “usability” (placement, widening, overlap) and guide the revision reconstruction strategy (one-stage vs. two-stage) post–failed ACL reconstruction. Twelve board-certified sports medicine orthopaedic surgeons independently applied the classification to the de-identified computed tomographic (CT) scan data of 10 patients, randomly selected, who failed ACL reconstruction. An interclass correlation coefficient (ICC) was calculated (with 95% confidence intervals) to assess agreement among reviewers concerning the three major classifications of the proposed system. Across surgeons, and on an individual patient basis, there was high internal validity and obse...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research

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Publication date: Available online 26 September 2019Source: Arthroscopy TechniquesAuthor(s): Ravi Vaswani, Sean J. Meredith, Jayson Lian, Ryan Li, Michael Nickoli, Freddie H. Fu, Volker MusahlAbstractSmall intercondylar notch size is associated with increased risk of anterior cruciate ligament (ACL) injuries and increased difficulty of ACL reconstruction. When encountering a small notch during surgery, some surgeons may resort to a notchplasty, which has been shown to have associated morbidity. The ability to predict notch size on preoperative imaging could allow the orthopaedic surgeon to anticipate surgical difficulty su...
Source: Arthroscopy Techniques - Category: Surgery Source Type: research
ConclusionsAnatomic ACL reconstruction could restore not only the normal anterior knee laxity, but also the normal tibiofemoral relationship even under an anterior tibial load.
Source: Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology - Category: Sports Medicine Source Type: research
AbstractPurposeTo compare tunnel widening and clinical outcome after anterior cruciate ligament reconstruction (ACLR) with interference screw fixation and all-inside reconstruction using button fixation.MethodsTunnel widening was assessed using tunnel volume and diameter measurements on computed tomography (CT) scans after surgery and 6  months and 2 years later, and compared between the two groups. The clinical outcome was assessed after 2 years with instrumented tibial anteroposterior translation measurements, hop testing and International Knee Documentation Committee (IKDC), Lysholm and Tegner activity sc...
Source: Knee Surgery, Sports Traumatology, Arthroscopy - Category: Orthopaedics Source Type: research
This study aimed to clarify the influence of variation in the Blumensaat’s line on the accuracy of the quadrant method measurements.MethodsA retrospective review of the radiological records of patients aged 18 –30 years who underwent computed tomography (CT) scanning of the knee joint was conducted. The Blumensaat’s line inclination angle (BIA), along with the most posterior point of the posterior condyle (point P) position using the quadrant method and morphology of the Blumensaat’s line were meas ured on true lateral transparent three-dimensional CT images of the distal femoral condyle in 147...
Source: Knee Surgery, Sports Traumatology, Arthroscopy - Category: Orthopaedics Source Type: research
Abstract BACKGROUND: Previous studies showed that compared with single-bundle (SB) precedures, double-bundle (DB) anterior cruciate ligament (ACL) reconstruction perform better. OBJECTIVE: To make assurance that distance of TT-TG may be altered along with ACL rupture and reconstruction. METHODS: Imaging study of 201 patients's related cases by MRI and CT scans. RESULTS: Compared with the intact knee's overall mean TT-TG value, the mean overall pre/postoperative TT-TG values showed a significant difference. For SB reconstruction, the mean pre/postoperative TT-TG values were 15.67± 2.46 mm and ...
Source: Technology and Health Care - Category: Medical Devices Authors: Tags: Technol Health Care Source Type: research
AbstractPurposeThe purpose of this study was to evaluate whether a flattened bone tunnel has a positive effect on the tendon –bone healing (TBH) process in the early period after anterior cruciate ligament (ACL) reconstruction.MethodsSeventy-two New Zealand White rabbits were randomly allocated into two groups, the flattened tunnel (FT) group and the conventional round tunnel (RT) group. We compared the cross-sectional areas and diameters of the bone tunnels between the two groups through computed tomography (CT) scanning. TBH results between the two groups were assessed by histological analysis, micro-CT scanning an...
Source: Knee Surgery, Sports Traumatology, Arthroscopy - Category: Orthopaedics Source Type: research
ConclusionFemoral tunnel widening after hamstring graft was not significantly different between Endobutton and Double Cross-Pin fixation techniques.
Source: Journal of Clinical Orthopaedics and Trauma - Category: Orthopaedics Source Type: research
ConclusionsWhen performing simultaneous ACL and ALL ligament reconstruction, the ALL femoral tunnel should be drilled with an angle of 30 ° anterior in the axial plane and 30° proximal in the coronal plane. Tunnels with an angle of 0° in the axial plane showed high risk of contact and disruption of the posterior femoral cortex; thus, these angles should be avoided. The clinical relevance of this work is that an ALL anatomical recon struction does not represent a risk when performing a simultaneous ACL reconstruction as long as the ALL tunnel is reamed with a proximal and anterior angulation.
Source: Knee Surgery, Sports Traumatology, Arthroscopy - Category: Orthopaedics Source Type: research
Authors: Liu Z, Hu X, Zhang X, Jiang Y, Wang J, Ao Y Abstract The purpose of this article was to demonstrate an adjustable oval bone tunnel ACLR technique. Aim of this technique was to fit the direction and shape of the footprint and tendon-bone healing passage (TBHP) which was defined as the passage of the normal ACL insertion embedded in the bone as closely as possible. 30 fresh-frozen human cadaveric knees were used to do the ACL anatomical insertions research. 20 patients underwent adjustable oval bone tunnel surgery and 20 patients were in round tunnel group. The tunnel of the presented technique was first dri...
Source: American Journal of Translational Research - Category: Research Tags: Am J Transl Res Source Type: research
AbstractPurposeRecent studies have emphasized the importance of anatomical ACL reconstruction to restore normal knee kinematics and stability. Aim of this study is to evaluate and compare the ability of the anteromedial (AM) and transtibial (TT) techniques for ACL reconstruction to achieve anatomical placement of the femoral and tibial tunnel within the native ACL footprint and to determine forces within the graft during functional motion. As the AM technique is nowadays the technique of choice, the hypothesis is that there are significant differences in tunnel features, reaction forces and/or moments within the graft when...
Source: Knee Surgery, Sports Traumatology, Arthroscopy - Category: Orthopaedics Source Type: research
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