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The Effectiveness of Anterior Cruciate Ligament Reconstruction on the Patellofemoral Stability and Patellar Height

Yıl 2023, Cilt: 4 Sayı: 2, 94 - 101, 31.05.2023
https://doi.org/10.47482/acmr.1261764

Öz

Background: Considering the critical role the anterior cruciate ligament (ACL) plays in knee biomechanics, it is a logical hypothesis that ACL reconstruction (ACLR) will have positive effects on knee kinematics, and stability. Our objective was to investigate the effect of single-bundle ACLR on patellar height, and patellofemoral balance radiologically and clinically.
Methods: In this prospective study, 87 patients operated with hamstring autograft-used single-bundle ACLR were analyzed. History of dislocation, stability-related physical examination findings, Tegner-Lysholm Knee Scoring Scale, and Kujala Anterior Knee Pain Scale were used for functional assessment. All patients underwent pre-and post-operative magnetic resonance imaging and Insall-Salvati (IS) Index, Caton Deschamps Index, Blackburne-Peel Index, and Patella-patellar tendon (P-PT) angles were measured on T1-weighted sagittal section images.
Results: A total of 79 patients (90.8%) achieved excellent or good result, according to Tegner-Lysholm Knee Scoring Scale, and the patients' postoperative 1st year mean Kujala Anterior Knee Pain Score was calculated as 90.4 (Range: 79.1 – 96.4). On physical examination, increased passive patellar translation was observed in 2 patients (2.3%), but the J sign was appeared to be negative in all the patients. While all patellar height indices decreased after reconstruction, only the decrease in IS index was statistically significant (p=0.007). Moreover, the P-PT angle was found to be significantly lower after ACLR (p<0.001).
Conclusion: Our study is an essential step in demonstrating the relationship between anterior cruciate ligament reconstruction and patellar height. With single-bundle ACLR, sagittal balance improves, patellar height indices decrease, and patients' susceptibility to patellofemoral instability may reduce.

Kaynakça

  • Igoumenou VG, Dimopoulos L, Mavrogenis AF. Patellar Height Assessment Methods: An Update. JBJS Rev. 2019;7(1):e4.
  • Thompson P, Metcalfe AJ. Current concepts in the surgical management of patellar instability. Knee. 2019;26(6):1171-81.
  • Hiemstra LA, Page JL,Kerslake S. Patient-Reported Outcome Measures for Patellofemoral Instability: a Critical Review. Curr Rev Musculoskelet Med. 2019;12(2):124-37.
  • Salem KH,Sheth MR. Variables affecting patellar height in patients undergoing primary total knee replacement. Int Orthop. 2021;45(6):1477-82.
  • Vampertzis T,Barmpagianni C,Nitis G,Papastergiou S. A study of the possible effect of abnormal patella height on meniscal tears. J Orthop. 2020;22:170-2.
  • Kaeding CC, Léger-St-Jean B, Magnussen RA. Epidemiology and Diagnosis of Anterior Cruciate Ligament Injuries. Clin Sports Med. 2017;36(1):1-8.
  • Doğan Ö, Çalışkan E, Gencer B. Clinical Results of Single Bundle Anterior Cruciate Ligament Reconstruction with Hamstring Autograft. Akdeniz Med J. 2019;5(3):504-9.
  • Noyes FR,Huser LE, Levy MS. The Effect of an ACL Reconstruction in Controlling Rotational Knee Stability in Knees with Intact and Physiologic Laxity of Secondary Restraints as Defined by Tibiofemoral Compartment Translations and Graft Forces. J Bone Joint Surg Am. 2018;100(7):586-97.
  • Ntagiopoulos PG, Bonin N,Sonnery-Cottet B,Badet R,Dejour D. The incidence of trochlear dysplasia in anterior cruciate ligament tears. Int Orthop. 2014;38(6):1269-75.
  • Cristiani R,Viheriävaara S,Janarv PM, Edman G,Forssblad M,Stålman A. Knee laxity and functional knee outcome after contralateral ACLR are comparable to those after primary ACLR. Knee Surg Sports TraumatolArthrosc. 2021;29(11):3864-70.
  • Filbay SR,Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019;33(1):33-47.
  • Cai WS, Li HH, Konno SI,Numazaki H, Zhou SQ, Zhang YB, et al. Patellofemoral MRI Alterations Following Single Bundle ACL Reconstruction with Hamstring Autografts Are Associated with Quadriceps Femoris Atrophy. Curr Med Sci. 2019;39(6):1029-36.
  • Straume-Næsheim TM,Randsborg PH, Mikaelsen JR, Sivertsen EA, Devitt B,Granan LP, et al. Recurrent lateral patella dislocation affects knee function as much as ACL deficiency - however patients wait five times longer for treatment. BMC MusculoskeletDisord. 2019;20(1):318.
  • Shelbourne KD, Rubinstein RA Jr, Braeckel CJ, Butler JP. Assessment of patellar height after autogenous patellar tendon anterior cruciate ligament reconstruction. Orthopedics. 1995;18(11):1073-7.
  • Parker MC, Lang SD, Lakehomer H, O'Neil S, Crall TS, Gilmer BB. Harvest of All-Soft Tissue Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction with or Without Closure of Resulting Defect Has No Effect on Patellar Height. Arthrosc Sports Med Rehabil. 2023;5(1):e143-e150.
  • Tegner Y,Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin OrthopRelat Res. 1985;(198):43-9.
  • Mitsou A,Vallianatos P,Piskopakis N,Maheras S. Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty. J Bone Joint Surg Br. 1990;72(3):398-404.
  • Kuru T,Dereli EE,Yaliman A. Validity of the Turkish version of the Kujala patellofemoral score in patellofemoral pain syndrome. Acta OrthopTraumatolTurc. 2010;44(2):152-6.
  • Thompson K,Kramarchuk M,Yagnatovsky M,Kunichoff D,Zacchilli M, Campbell KA, et al. Pain catastrophizing is associated with increased physical disability in patients with anterior knee pain. J Orthop. 2020;21:283-6.
  • Ozcan C, Turkmen I,Sokucu S. Comparison of three different approaches for anterior knee pain after tibia intramedullary nailing. Eur J Trauma Emerg Surg. 2020;46(1):99-105.
  • Phatama KY,Mustamsir E, Jaya AO,Pradana AS, Putra DP,Hidayat M. Patellofemoral functional outcome of gracilis sparing compared to gracilis sacrificing ACL reconstruction. Ann Med Surg (Lond). 2022;84:104940.
  • Wang D, Jones MH,Khair MM,Miniaci A. Patient-reported outcome measures for the knee. J Knee Surg. 2010;23(3):137-151.
  • StatPearls Publishing. Wolfe S,Varacallo M, Thomas JD, Carroll JJ,Kahwaji CI. Patellar Instability. 2022. Available at https://www.ncbi.nlm.nih.gov/books/NBK482427/. Accessed March 10,2023.
  • Verhulst FV, van Sambeeck JDP,Olthuis GS, van der Ree J,Koëter S. Patellar height measurements: Insall-Salvati ratio is most reliable method. Knee Surg Sports TraumatolArthrosc. 2020;28(3):869-75.
  • Yılmaz B,Ozdemir G, Sirin E,Cicek ED,Anıl BS,Bulbun G. Evaluation of patella alta using MRI measurements in adolescents. Indian J Radiol Imaging. 2017;27(2):181-6.
  • Aksahin E, Yilmaz S,Karasoy I, Duran S,Yuksel HY, Dogan O, et al. Sagittal patellar tilt and concomitant quadriceps hypotrophy after tibial nailing. Knee Surg Sports TraumatolArthrosc. 2016;24(9):2878-83.
  • Aksahin E,Aktekin CN,Kocadal O, Duran S,Gunay C, Kaya D, et al. Sagittal plane tilting deformity of the patellofemoral joint: a new concept in patients with chondromalacia patella. Knee Surg Sports TraumatolArthrosc. 2016;25(10):3038-45.
  • Flandry F,Hommel G. Normal anatomy and biomechanics of the knee. Sports Med Arthrosc Rev. 2011;19(2):82-92.
  • Hao K, Niu Y, Kong L, Wang F. The patient with patellar instability has a stenotic intercondylar notch and a thin anterior cruciate ligament: a retrospective comparative study. J Orthop Surg Res. 2023;18(1):144.
  • Cai WS, Li HH, Konno SI, Numazaki H, Zhou SQ, Zhang YB, et al. Patellofemoral MRI Alterations Following Single Bundle ACL Reconstruction with Hamstring Autografts Are Associated with Quadriceps Femoris Atrophy. Curr Med Sci. 2019;39(6):1029-36.
  • Güven N,Özkan S,Turkozu T,Yokus A,Adanas C,Gokalp MA, et al. Insall-Salvati index is associated with anterior cruciate ligament tears in men: A Case-controlled study. J Orthop Surg (Hong Kong). 2022;30(1):23094990211069692.
  • Gobbi RG,Videira LD, Dos Santos AA,Saruhashi MB, Lucarini BR, Fernandes RJR, et al. Anatomical Risk Factors for Anterior Cruciate Ligament Injury Are Not Important As Patellar Instability Risk Factors in Patients with Acute Knee Injury. J Knee Surg. 2022;35(6):676-83.
  • Ahmad CS, Clark AM,Heilmann N,Schoeb JS, Gardner TR, et al. Effect of gender and maturity on quadriceps-to-hamstring strength ratio and anterior cruciate ligament laxity. Am J Sports Med. 2006;34(3):370-4.
  • Birchmeier T,Lisee C, Kane K, Brazier B, Triplett A,Kuenze C. Quadriceps Muscle Size Following ACL Injury and Reconstruction: A Systematic Review. J Orthop Res. 2020;38(3):598-608.
  • Lavagnino M,Arnoczky SP, Elvin N,Dodds J. Patellar tendon strain is increased at the site of the jumper's knee lesion during knee flexion and tendon loading: results and cadaveric testing of a computational model. Am J Sports Med. 2008;36(11):2110-18.
Yıl 2023, Cilt: 4 Sayı: 2, 94 - 101, 31.05.2023
https://doi.org/10.47482/acmr.1261764

Öz

Kaynakça

  • Igoumenou VG, Dimopoulos L, Mavrogenis AF. Patellar Height Assessment Methods: An Update. JBJS Rev. 2019;7(1):e4.
  • Thompson P, Metcalfe AJ. Current concepts in the surgical management of patellar instability. Knee. 2019;26(6):1171-81.
  • Hiemstra LA, Page JL,Kerslake S. Patient-Reported Outcome Measures for Patellofemoral Instability: a Critical Review. Curr Rev Musculoskelet Med. 2019;12(2):124-37.
  • Salem KH,Sheth MR. Variables affecting patellar height in patients undergoing primary total knee replacement. Int Orthop. 2021;45(6):1477-82.
  • Vampertzis T,Barmpagianni C,Nitis G,Papastergiou S. A study of the possible effect of abnormal patella height on meniscal tears. J Orthop. 2020;22:170-2.
  • Kaeding CC, Léger-St-Jean B, Magnussen RA. Epidemiology and Diagnosis of Anterior Cruciate Ligament Injuries. Clin Sports Med. 2017;36(1):1-8.
  • Doğan Ö, Çalışkan E, Gencer B. Clinical Results of Single Bundle Anterior Cruciate Ligament Reconstruction with Hamstring Autograft. Akdeniz Med J. 2019;5(3):504-9.
  • Noyes FR,Huser LE, Levy MS. The Effect of an ACL Reconstruction in Controlling Rotational Knee Stability in Knees with Intact and Physiologic Laxity of Secondary Restraints as Defined by Tibiofemoral Compartment Translations and Graft Forces. J Bone Joint Surg Am. 2018;100(7):586-97.
  • Ntagiopoulos PG, Bonin N,Sonnery-Cottet B,Badet R,Dejour D. The incidence of trochlear dysplasia in anterior cruciate ligament tears. Int Orthop. 2014;38(6):1269-75.
  • Cristiani R,Viheriävaara S,Janarv PM, Edman G,Forssblad M,Stålman A. Knee laxity and functional knee outcome after contralateral ACLR are comparable to those after primary ACLR. Knee Surg Sports TraumatolArthrosc. 2021;29(11):3864-70.
  • Filbay SR,Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019;33(1):33-47.
  • Cai WS, Li HH, Konno SI,Numazaki H, Zhou SQ, Zhang YB, et al. Patellofemoral MRI Alterations Following Single Bundle ACL Reconstruction with Hamstring Autografts Are Associated with Quadriceps Femoris Atrophy. Curr Med Sci. 2019;39(6):1029-36.
  • Straume-Næsheim TM,Randsborg PH, Mikaelsen JR, Sivertsen EA, Devitt B,Granan LP, et al. Recurrent lateral patella dislocation affects knee function as much as ACL deficiency - however patients wait five times longer for treatment. BMC MusculoskeletDisord. 2019;20(1):318.
  • Shelbourne KD, Rubinstein RA Jr, Braeckel CJ, Butler JP. Assessment of patellar height after autogenous patellar tendon anterior cruciate ligament reconstruction. Orthopedics. 1995;18(11):1073-7.
  • Parker MC, Lang SD, Lakehomer H, O'Neil S, Crall TS, Gilmer BB. Harvest of All-Soft Tissue Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction with or Without Closure of Resulting Defect Has No Effect on Patellar Height. Arthrosc Sports Med Rehabil. 2023;5(1):e143-e150.
  • Tegner Y,Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin OrthopRelat Res. 1985;(198):43-9.
  • Mitsou A,Vallianatos P,Piskopakis N,Maheras S. Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty. J Bone Joint Surg Br. 1990;72(3):398-404.
  • Kuru T,Dereli EE,Yaliman A. Validity of the Turkish version of the Kujala patellofemoral score in patellofemoral pain syndrome. Acta OrthopTraumatolTurc. 2010;44(2):152-6.
  • Thompson K,Kramarchuk M,Yagnatovsky M,Kunichoff D,Zacchilli M, Campbell KA, et al. Pain catastrophizing is associated with increased physical disability in patients with anterior knee pain. J Orthop. 2020;21:283-6.
  • Ozcan C, Turkmen I,Sokucu S. Comparison of three different approaches for anterior knee pain after tibia intramedullary nailing. Eur J Trauma Emerg Surg. 2020;46(1):99-105.
  • Phatama KY,Mustamsir E, Jaya AO,Pradana AS, Putra DP,Hidayat M. Patellofemoral functional outcome of gracilis sparing compared to gracilis sacrificing ACL reconstruction. Ann Med Surg (Lond). 2022;84:104940.
  • Wang D, Jones MH,Khair MM,Miniaci A. Patient-reported outcome measures for the knee. J Knee Surg. 2010;23(3):137-151.
  • StatPearls Publishing. Wolfe S,Varacallo M, Thomas JD, Carroll JJ,Kahwaji CI. Patellar Instability. 2022. Available at https://www.ncbi.nlm.nih.gov/books/NBK482427/. Accessed March 10,2023.
  • Verhulst FV, van Sambeeck JDP,Olthuis GS, van der Ree J,Koëter S. Patellar height measurements: Insall-Salvati ratio is most reliable method. Knee Surg Sports TraumatolArthrosc. 2020;28(3):869-75.
  • Yılmaz B,Ozdemir G, Sirin E,Cicek ED,Anıl BS,Bulbun G. Evaluation of patella alta using MRI measurements in adolescents. Indian J Radiol Imaging. 2017;27(2):181-6.
  • Aksahin E, Yilmaz S,Karasoy I, Duran S,Yuksel HY, Dogan O, et al. Sagittal patellar tilt and concomitant quadriceps hypotrophy after tibial nailing. Knee Surg Sports TraumatolArthrosc. 2016;24(9):2878-83.
  • Aksahin E,Aktekin CN,Kocadal O, Duran S,Gunay C, Kaya D, et al. Sagittal plane tilting deformity of the patellofemoral joint: a new concept in patients with chondromalacia patella. Knee Surg Sports TraumatolArthrosc. 2016;25(10):3038-45.
  • Flandry F,Hommel G. Normal anatomy and biomechanics of the knee. Sports Med Arthrosc Rev. 2011;19(2):82-92.
  • Hao K, Niu Y, Kong L, Wang F. The patient with patellar instability has a stenotic intercondylar notch and a thin anterior cruciate ligament: a retrospective comparative study. J Orthop Surg Res. 2023;18(1):144.
  • Cai WS, Li HH, Konno SI, Numazaki H, Zhou SQ, Zhang YB, et al. Patellofemoral MRI Alterations Following Single Bundle ACL Reconstruction with Hamstring Autografts Are Associated with Quadriceps Femoris Atrophy. Curr Med Sci. 2019;39(6):1029-36.
  • Güven N,Özkan S,Turkozu T,Yokus A,Adanas C,Gokalp MA, et al. Insall-Salvati index is associated with anterior cruciate ligament tears in men: A Case-controlled study. J Orthop Surg (Hong Kong). 2022;30(1):23094990211069692.
  • Gobbi RG,Videira LD, Dos Santos AA,Saruhashi MB, Lucarini BR, Fernandes RJR, et al. Anatomical Risk Factors for Anterior Cruciate Ligament Injury Are Not Important As Patellar Instability Risk Factors in Patients with Acute Knee Injury. J Knee Surg. 2022;35(6):676-83.
  • Ahmad CS, Clark AM,Heilmann N,Schoeb JS, Gardner TR, et al. Effect of gender and maturity on quadriceps-to-hamstring strength ratio and anterior cruciate ligament laxity. Am J Sports Med. 2006;34(3):370-4.
  • Birchmeier T,Lisee C, Kane K, Brazier B, Triplett A,Kuenze C. Quadriceps Muscle Size Following ACL Injury and Reconstruction: A Systematic Review. J Orthop Res. 2020;38(3):598-608.
  • Lavagnino M,Arnoczky SP, Elvin N,Dodds J. Patellar tendon strain is increased at the site of the jumper's knee lesion during knee flexion and tendon loading: results and cadaveric testing of a computational model. Am J Sports Med. 2008;36(11):2110-18.
Toplam 35 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm ORIGINAL ARTICLE
Yazarlar

Özgür Doğan 0000-0002-5913-0411

Batuhan Gencer 0000-0003-0041-7378

İhsaniye Süer Doğan 0000-0002-7586-0537

Yayımlanma Tarihi 31 Mayıs 2023
Gönderilme Tarihi 7 Mart 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 4 Sayı: 2

Kaynak Göster

APA Doğan, Ö., Gencer, B., & Süer Doğan, İ. (2023). The Effectiveness of Anterior Cruciate Ligament Reconstruction on the Patellofemoral Stability and Patellar Height. Archives of Current Medical Research, 4(2), 94-101. https://doi.org/10.47482/acmr.1261764

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