- Email: [email protected]
Minimum Two-Year Outcomes of ACL Reconstruction Associated with Bimeniscal Repair
2017 ISAKOS ABSTRACTS
sensitivity and specificity were calculated for each parameters. P-value < 0.05 was considered statistically significant. Results: Significant differences between healthy and injured side were observed in acceleration parameter in both KiRA and EMS (KiRA: 2.0 1.3, 4.4 2.9 m/s2; P < 0.01, EMS: 0.93 0.58, 2.2 1.3 m/s2; P < 0.01). KiRA demonstrated moderate correlation with EMS for the acceleration parameter (r ¼ 0.54; P < 0.01). AUC, sensitivity and specificity of acceleration were 0.76, 59%, 82% in KiRA, and 0.84, 77%, 82% in EMS when the cutoff levels were 3.0 and 1.5 m/s2, respectively. There was a statistically significant side-to-side difference in tibial translation measured by both iPad and EMS (iPad: 0.7 0.6, 1.7 1.5 m/s2; P < 0.01, EMS: 3.0 2.0, 13.0 5.0 mm; P < 0.01). iPad demonstrated poor correlation with EMS for the translation parameter (r ¼ 0.28; P < 0.01). AUC, sensitivity and specificity of translation were 0.77, 71%, 71% in iPad, and 0.96, 79%, 91% in EMS when the cutoff levels were 0.73 and 9.0 mm, respectively. Conclusion: The electromagnetic measurement system has the advantage of comprehensive evaluation of the pivot shift test by evaluating both tibial acceleration and translation. KiRA and iPad measurements could provide clinically acceptable evaluation in a much simpler way than EMS, but clinical usability of KiRA and iPad was somewhat inferior to that of EMS.
Category: Knee - ACL Paper #82: ACL Graft Metabolic Activity Assessed by 18FDG PET-MRI ROBERT A. MAGNUSSEN, MD, MPH, UNITED STATES KATHERINE BINZEL, PHD, UNITED STATES JUN ZHANG, PHD, UNITED STATES WENBO WEI, PHD, UNITED STATES MELANIE U. KNOPP, UNITED STATES DAVID C. FLANIGAN, MD, UNITED STATES TIMOTHY E. HEWETT, PHD, UNITED STATES CHRISTOPHER C. KAEDING, MD, UNITED STATES MICHAEL V. KNOPP, MD, PHD, UNITED STATES The Ohio State University, Columbus, OH, UNITED STATES
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Hypothesis: 18FDG PET signal intensity decreases with time from ACL reconstruction. Study design: Case Series. Methods: Twenty-one knees with intact ACL grafts in 19 patients at multiple time points following ACL reconstruction were recruited to participate. PET-MRI imaging was performed using a custom device to place the knees in the same position for both studies and images were co-registered for quantification of the 18FDG-PET standardized uptake value (SUV) for specific structures within the knee. Signal in the proximal, middle, and distal ACL and extraarticular muscle tissue was quantified and signal from each location was compared based on the time each was knee from ACL reconstruction (less than 6 months, 6 to 12 months, 12 to 24 months, or greater than 24 months). Results: Significant differences in 18FDG PET SUV between the 4 time points were observed in the proximal (p¼0.02), middle (p¼0.004), and distal (p¼0.007) portions of the ACL graft. The greater than 24 months group was noted to be different from other groups in each case. No difference in PET 18FDG SUV was noted in the extraarticular muscle in the index knee in each time group (p¼0.61). Conclusion: 18FDG PET-MRI imaging has been demonstrated to assess the metabolic activity of ACL grafts in vivo. Metabolic activity was noted to be significantly lower in grafts that were imaged greater than 2 years postreconstruction relative to those grafts that had been in place for shorter periods of time. Clinical Relevance: 18FDG PET-MRI can provide insight into the process of graft ligamentization in patients following ACL reconstruction. A better understanding of this process may impact graft selection and return to play decisions that could influence graft tear risk. Category: Knee - Meniscus Paper #83: Minimum Two-Year Outcomes of ACL Reconstruction Associated with Bimeniscal Repair PHILIPPE BOISRENOULT, MD, FRANCE NICOLAS PUJOL, MD, FRANCE PHILIPPE BEAUFILS, MD, FRANCE Centre Hospitalier de Versailles, Le Chesnay, FRANCE
SUMMARY Metabolic activity of ACL grafts as assessed with PETMRI was significantly lower in grafts greater than two years post-reconstruction relative to those grafts in place for shorter periods of time.
SUMMARY The prognosis for the ACL reconstruction associated with bimeniscal repair is bad with a higher risk of graft rupture, despite a good initial control of the anterior laxity.
ABSTRACT DATA Background: For an ACL graft to function in the longterm, it must undergo ligamentization. The rate at which this process occurs in humans is not well delineated and difficult to assess in vivo. Combined 18F-Fluorodeoxyglucose positron emission tomography (PET) - magnetic resonance imaging (MRI) imaging has the capability to quantify tissue metabolic activity with sufficient resolution to evaluate a healing ACL graft.
ABSTRACT DATA Purpose: To evaluate comparative results of ACL reconstructions with either bimeniscal repair, meniscal repair, or no meniscal surgery. The hypothesis was that functional results are worse in the bimeniscal repair group. Material and methods: This is a retrospective comparative study of patients undergoing ACL reconstruction with bone-patellar tendon-bone autograft included between May 2009 and May 2013. Among 469 consecutive ACL reconstructions, 15 patients had a bimeniscal repair.
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2017 ISAKOS ABSTRACTS
All of them were matched with 30 patients with ACL reconstruction and one meniscal repair, and 30 patients with ACL reconstruction without meniscal surgery. These three subgroups were comparable concerning age, sex, type of sport, Tegner score, time between injury and surgery, BMI. At a minimum of 2 years of follow-up (2-5), patients were clinically evaluated by KOOS, Lysholm and IKDC scores, side-to-side anterior knee translation (Telos and GNRB). Results: The incidence of bimeniscal repair with concomitant ACL reconstruction was 3,2%. ACL rerupture was 6 times greater in the bimeniscal repair group (20%, 3 patients), when compared with the other groups (3.3% in each, p¼0.06). Postoperative functional scores (KOOS, Lysholm, IKDC) were as follows: 81.9, 82.3 and 71.3 in the isolated ACL reconstruction group, 86.7, 89.3, 84 in the group with one meniscal repair, 85.8, 84.3, 78 in the ACL+bimeniscal repair (ns). Mean injured to non-injured difference in anterior laxity by Telos was 3.3mm (SD 2.2) in the bimeniscal repair group, 2.0mm (SD 1.5) in the meniscal repair group, 1.5mm (SD 2.0) in the isolated ACL reconstruction group (ns). There were 2 secondary meniscectomies after failed meniscal repair in the group of meniscal repair (6.7%), none in the other groups. Conclusions: ACL lesion in association with repairable lesions of the two menisci is a rare entity. The prognosis for the ACL reconstruction associated with bimeniscal repair is bad with a higher risk of graft rupture, despite a good initial control of the anterior laxity. The meniscal prognosis is good (low rate of reoperations for meniscectomies). Return to sports activities should be done with caution in these patients.
Category: Knee - ACL Paper #84: Utility of a New Developed Motion Capture with Infrared Camera System in ACL-Insufficient Knees by the Comparison with the Validated Navigation System EIICHI NAKAMURA, MD, PHD, JAPAN NOBUKAZU OKAMOTO, MD, PHD, JAPAN SOICHIRO YAMABE, MD, PHD, JAPAN TETSUROU MASUDA, MD, PHD, JAPAN DAISUKE SHIRAISHI, MD, PHD, JAPAN HIROSHI MIZUTA, MD, PHD, JAPAN Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto-City, Kumamoto, JAPAN
SUMMARY Based on the quantification of a dynamic rotatory knee laxity reproduced and evaluated by the pivot-shift test, our newly developed noninvasive system (MCICS) could be as accurate as the validated navigation system, particularly within range of knee flexion during the pivot-shift
test, which could be useful in diagnosis of ACL pathology and the postoperative evaluation of surgical reconstruction. ABSTRACT DATA Purpose: Development of more objective clinical evaluation of the rotational instability in the ACL - insufficient knee is critical to evaluate its function extensively and to improve the outcome in the ACL reconstructive surgery. However, there are few available quantitative methods for the rotational instability in a clinical use. We have developed a new noninvasive motion capture with infrared camera system (MCICS; Anima Co. Ltd.,Tokyo, Japan) for analysis of in vivo three-dimensional kinematics of the knee. The purpose of this study are to compare our MCICS with the standard validated commercial navigation system in terms of reliability and repeatability of the rotational kinematics in the ACL-insufficient knee, and to validate the utility of our MCICS. Patients and Methods: Thirteen unilateral ACL injured patients (mean age 18 y.o.) were enrolled in this study. The injured knees in all patients were evaluated during the pivot shift test by a single surgeon (E.N.) before reconstruction under anesthesia using two imaging equipment; one is a commercial image-free navigation system (Brain Lab, ACL 2.0, Heirnstettern, Germany) with trackers secured by bone screws (Navi), and the other is our MCICS. During the pivot-shift test, the starting angle of the pivot-shift phenomenon (SA; ), and tibial rotational angle defined as the amount of rotational angle when an anterior subluxation and a subsequent reduction in the tibial plateau from the femoral condyle(TRA; ), were extracted from the kinematics data recorded by both system. The verification of the MCICS was analyzed using the interclass correlation coefficient (ICC) for those values between both system. A p-value less than 0.05 were considered to be statistically significant. Results: The pivot-shift phenomenon in all patients was determined as a sudden tibial external rotational movements in both system (Figure 1 and 2). The averaged SA in the MCICS and Navi was 12.5 (range; 5 to 30 ) and 11.0 (range; 4.2 to 18.4 ), respectively, showing the great consistency (ICC 0.808, p<0.001). The averaged TRA in the MCICS and Navi was 7.7 (range; 4.5 to 15 ) and 6.2 (range; 2.7 to 9.1 ), respectively, also showing the great consistency (ICC 0.840, p<0.001). Discussion and Conclusions: These results indicate that based on the quantification of a dynamic rotatory knee laxity reproduced and evaluated by the pivot-shift test, our newly developed noninvasive system (MCICS) could be as accurate as the validated navigation system, particularly within range of knee flexion during the pivotshift test. Our MCICS also has some advantages such as no limitation of the measurement location or an examining room, and capability of the analysis on the performance at high speed, which could be useful in diagnosis of ACL pathology and the postoperative evaluation of surgical reconstruction.
sensitivity and specificity were calculated for each parameters. P-value < 0.05 was considered statistically significant. Results: Significant differences between healthy and injured side were observed in acceleration parameter in both KiRA and EMS (KiRA: 2.0 1.3, 4.4 2.9 m/s2; P < 0.01, EMS: 0.93 0.58, 2.2 1.3 m/s2; P < 0.01). KiRA demonstrated moderate correlation with EMS for the acceleration parameter (r ¼ 0.54; P < 0.01). AUC, sensitivity and specificity of acceleration were 0.76, 59%, 82% in KiRA, and 0.84, 77%, 82% in EMS when the cutoff levels were 3.0 and 1.5 m/s2, respectively. There was a statistically significant side-to-side difference in tibial translation measured by both iPad and EMS (iPad: 0.7 0.6, 1.7 1.5 m/s2; P < 0.01, EMS: 3.0 2.0, 13.0 5.0 mm; P < 0.01). iPad demonstrated poor correlation with EMS for the translation parameter (r ¼ 0.28; P < 0.01). AUC, sensitivity and specificity of translation were 0.77, 71%, 71% in iPad, and 0.96, 79%, 91% in EMS when the cutoff levels were 0.73 and 9.0 mm, respectively. Conclusion: The electromagnetic measurement system has the advantage of comprehensive evaluation of the pivot shift test by evaluating both tibial acceleration and translation. KiRA and iPad measurements could provide clinically acceptable evaluation in a much simpler way than EMS, but clinical usability of KiRA and iPad was somewhat inferior to that of EMS.
Category: Knee - ACL Paper #82: ACL Graft Metabolic Activity Assessed by 18FDG PET-MRI ROBERT A. MAGNUSSEN, MD, MPH, UNITED STATES KATHERINE BINZEL, PHD, UNITED STATES JUN ZHANG, PHD, UNITED STATES WENBO WEI, PHD, UNITED STATES MELANIE U. KNOPP, UNITED STATES DAVID C. FLANIGAN, MD, UNITED STATES TIMOTHY E. HEWETT, PHD, UNITED STATES CHRISTOPHER C. KAEDING, MD, UNITED STATES MICHAEL V. KNOPP, MD, PHD, UNITED STATES The Ohio State University, Columbus, OH, UNITED STATES
e79
Hypothesis: 18FDG PET signal intensity decreases with time from ACL reconstruction. Study design: Case Series. Methods: Twenty-one knees with intact ACL grafts in 19 patients at multiple time points following ACL reconstruction were recruited to participate. PET-MRI imaging was performed using a custom device to place the knees in the same position for both studies and images were co-registered for quantification of the 18FDG-PET standardized uptake value (SUV) for specific structures within the knee. Signal in the proximal, middle, and distal ACL and extraarticular muscle tissue was quantified and signal from each location was compared based on the time each was knee from ACL reconstruction (less than 6 months, 6 to 12 months, 12 to 24 months, or greater than 24 months). Results: Significant differences in 18FDG PET SUV between the 4 time points were observed in the proximal (p¼0.02), middle (p¼0.004), and distal (p¼0.007) portions of the ACL graft. The greater than 24 months group was noted to be different from other groups in each case. No difference in PET 18FDG SUV was noted in the extraarticular muscle in the index knee in each time group (p¼0.61). Conclusion: 18FDG PET-MRI imaging has been demonstrated to assess the metabolic activity of ACL grafts in vivo. Metabolic activity was noted to be significantly lower in grafts that were imaged greater than 2 years postreconstruction relative to those grafts that had been in place for shorter periods of time. Clinical Relevance: 18FDG PET-MRI can provide insight into the process of graft ligamentization in patients following ACL reconstruction. A better understanding of this process may impact graft selection and return to play decisions that could influence graft tear risk. Category: Knee - Meniscus Paper #83: Minimum Two-Year Outcomes of ACL Reconstruction Associated with Bimeniscal Repair PHILIPPE BOISRENOULT, MD, FRANCE NICOLAS PUJOL, MD, FRANCE PHILIPPE BEAUFILS, MD, FRANCE Centre Hospitalier de Versailles, Le Chesnay, FRANCE
SUMMARY Metabolic activity of ACL grafts as assessed with PETMRI was significantly lower in grafts greater than two years post-reconstruction relative to those grafts in place for shorter periods of time.
SUMMARY The prognosis for the ACL reconstruction associated with bimeniscal repair is bad with a higher risk of graft rupture, despite a good initial control of the anterior laxity.
ABSTRACT DATA Background: For an ACL graft to function in the longterm, it must undergo ligamentization. The rate at which this process occurs in humans is not well delineated and difficult to assess in vivo. Combined 18F-Fluorodeoxyglucose positron emission tomography (PET) - magnetic resonance imaging (MRI) imaging has the capability to quantify tissue metabolic activity with sufficient resolution to evaluate a healing ACL graft.
ABSTRACT DATA Purpose: To evaluate comparative results of ACL reconstructions with either bimeniscal repair, meniscal repair, or no meniscal surgery. The hypothesis was that functional results are worse in the bimeniscal repair group. Material and methods: This is a retrospective comparative study of patients undergoing ACL reconstruction with bone-patellar tendon-bone autograft included between May 2009 and May 2013. Among 469 consecutive ACL reconstructions, 15 patients had a bimeniscal repair.
e80
2017 ISAKOS ABSTRACTS
All of them were matched with 30 patients with ACL reconstruction and one meniscal repair, and 30 patients with ACL reconstruction without meniscal surgery. These three subgroups were comparable concerning age, sex, type of sport, Tegner score, time between injury and surgery, BMI. At a minimum of 2 years of follow-up (2-5), patients were clinically evaluated by KOOS, Lysholm and IKDC scores, side-to-side anterior knee translation (Telos and GNRB). Results: The incidence of bimeniscal repair with concomitant ACL reconstruction was 3,2%. ACL rerupture was 6 times greater in the bimeniscal repair group (20%, 3 patients), when compared with the other groups (3.3% in each, p¼0.06). Postoperative functional scores (KOOS, Lysholm, IKDC) were as follows: 81.9, 82.3 and 71.3 in the isolated ACL reconstruction group, 86.7, 89.3, 84 in the group with one meniscal repair, 85.8, 84.3, 78 in the ACL+bimeniscal repair (ns). Mean injured to non-injured difference in anterior laxity by Telos was 3.3mm (SD 2.2) in the bimeniscal repair group, 2.0mm (SD 1.5) in the meniscal repair group, 1.5mm (SD 2.0) in the isolated ACL reconstruction group (ns). There were 2 secondary meniscectomies after failed meniscal repair in the group of meniscal repair (6.7%), none in the other groups. Conclusions: ACL lesion in association with repairable lesions of the two menisci is a rare entity. The prognosis for the ACL reconstruction associated with bimeniscal repair is bad with a higher risk of graft rupture, despite a good initial control of the anterior laxity. The meniscal prognosis is good (low rate of reoperations for meniscectomies). Return to sports activities should be done with caution in these patients.
Category: Knee - ACL Paper #84: Utility of a New Developed Motion Capture with Infrared Camera System in ACL-Insufficient Knees by the Comparison with the Validated Navigation System EIICHI NAKAMURA, MD, PHD, JAPAN NOBUKAZU OKAMOTO, MD, PHD, JAPAN SOICHIRO YAMABE, MD, PHD, JAPAN TETSUROU MASUDA, MD, PHD, JAPAN DAISUKE SHIRAISHI, MD, PHD, JAPAN HIROSHI MIZUTA, MD, PHD, JAPAN Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto-City, Kumamoto, JAPAN
SUMMARY Based on the quantification of a dynamic rotatory knee laxity reproduced and evaluated by the pivot-shift test, our newly developed noninvasive system (MCICS) could be as accurate as the validated navigation system, particularly within range of knee flexion during the pivot-shift
test, which could be useful in diagnosis of ACL pathology and the postoperative evaluation of surgical reconstruction. ABSTRACT DATA Purpose: Development of more objective clinical evaluation of the rotational instability in the ACL - insufficient knee is critical to evaluate its function extensively and to improve the outcome in the ACL reconstructive surgery. However, there are few available quantitative methods for the rotational instability in a clinical use. We have developed a new noninvasive motion capture with infrared camera system (MCICS; Anima Co. Ltd.,Tokyo, Japan) for analysis of in vivo three-dimensional kinematics of the knee. The purpose of this study are to compare our MCICS with the standard validated commercial navigation system in terms of reliability and repeatability of the rotational kinematics in the ACL-insufficient knee, and to validate the utility of our MCICS. Patients and Methods: Thirteen unilateral ACL injured patients (mean age 18 y.o.) were enrolled in this study. The injured knees in all patients were evaluated during the pivot shift test by a single surgeon (E.N.) before reconstruction under anesthesia using two imaging equipment; one is a commercial image-free navigation system (Brain Lab, ACL 2.0, Heirnstettern, Germany) with trackers secured by bone screws (Navi), and the other is our MCICS. During the pivot-shift test, the starting angle of the pivot-shift phenomenon (SA; ), and tibial rotational angle defined as the amount of rotational angle when an anterior subluxation and a subsequent reduction in the tibial plateau from the femoral condyle(TRA; ), were extracted from the kinematics data recorded by both system. The verification of the MCICS was analyzed using the interclass correlation coefficient (ICC) for those values between both system. A p-value less than 0.05 were considered to be statistically significant. Results: The pivot-shift phenomenon in all patients was determined as a sudden tibial external rotational movements in both system (Figure 1 and 2). The averaged SA in the MCICS and Navi was 12.5 (range; 5 to 30 ) and 11.0 (range; 4.2 to 18.4 ), respectively, showing the great consistency (ICC 0.808, p<0.001). The averaged TRA in the MCICS and Navi was 7.7 (range; 4.5 to 15 ) and 6.2 (range; 2.7 to 9.1 ), respectively, also showing the great consistency (ICC 0.840, p<0.001). Discussion and Conclusions: These results indicate that based on the quantification of a dynamic rotatory knee laxity reproduced and evaluated by the pivot-shift test, our newly developed noninvasive system (MCICS) could be as accurate as the validated navigation system, particularly within range of knee flexion during the pivotshift test. Our MCICS also has some advantages such as no limitation of the measurement location or an examining room, and capability of the analysis on the performance at high speed, which could be useful in diagnosis of ACL pathology and the postoperative evaluation of surgical reconstruction.