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Objective:To investigate the short-term clinical outcomes of patients who received combined anterior closing-wedge high tibial osteotomy (ACW-HTO) and anterior cruciate ligament (ACL) reconstruction in treating chronic ACL injury with increased posterior tibial slope (PTS).Methods:From January 2017 to June 2018, a total of 54 patients (46 males and 8 females, mean age 30.8±3.9 years, range from 20 to 42 years) with chronic (time from injury to surgery was more than 6 months) ACL injury and increased PTS (>17°) were retrospectively analyzed. Eighteen of them received combined ACW-HTO and ACL reconstruction (ACW-HTO+ACL reconstruction group), while the remaining 36 received isolated ACL reconstruction (ACL reconstruction group). The demographic data, pre-operative and post-operative anterior tibial translation, pivot-shift result, KT-1000 side-to-side difference, subjective Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) objective grading system were collected and compared between the two groups.Results:There were no significant differences between the two groups in terms of age, sex, body mass index, time from injury to surgery and proportion of patients with concomitant medial or lateral meniscus tear ( P>0.05). At 2-year's follow-up, the anterior tibial translation in the ACW-HTO+ACL reconstruction group was 0.9±0.4 mm, which was significantly smaller than that in the ACL reconstruction group 7.3±1.5 mm ( t=10.049, P<0.001). Moreover, there was significant difference in the pivot-shift result between the two groups (ACW-HTO+ACL reconstruction group: 18 low-grade vs. ACL reconstruction group: 31 low-grade, 5 high-grade) (χ 2=16.071, P<0.001). The KT-1000 side-to-side difference in the ACW-HTO+ACL reconstruction group was 1.5±0.6 mm, which was significantly smaller than that in the ACL reconstruction group 4.4±1.2 mm ( t=13.858, P<0.001). In addition, the subjective Lysholm score in the ACW-HTO+ACL reconstruction group was 93.3±4.3, which was significantly higher than that in the ACL reconstruction group 80.3±6.3 ( t=12.176, P<0.001). The Tegner activity score in the ACW-HTO+ACL reconstruction group was 7.3±0.9, which was significantly higher than that in the ACL reconstruction group 6.8±0.6 ( t=6.356, P=0.043). There was significant difference in terms of the IKDC objective grading system between the two groups (ACW-HTO+ACL reconstruction group: 17 grade A, 1 grade B vs. ACL reconstruction group: 29 grade A, 5 grade B, 2 grade C) (χ 2=12.351, P<0.001). Conclusion:The combined ACW-HTO and ACL reconstruction showed superior short-term knee stability and functional scores compared with the isolated ACL reconstruction in treating chronic ACL injury with increased PTS.
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Objective:To explore the risk factors of primary anterior cruciate ligament (ACL) reconstruction failure.Methods:From November 2015 to May 2017, a total of 178 consecutive patients with clinically diagnosed non-contact ACL injury were treated and followed-up more than 2 years. Twenty-five patients (post-operative failure group) who underwent completely ruptured ACL graft confirmed by MRI, positive pivot-shift test, more than 5 mm side-to-side difference (SSD) measured by KT-1000 arthrometer, more than 5 mm static anterior tibial translation (ATT) measured on MRI were determined to be ACL reconstruction failure. They were matched in a 1∶2 fashion to 50 non-failure patients (post-operative non-failure group), who showed intact ACL graft 2 years after ACL reconstruction. The sex, age, body mass index (BMI), affected side, meniscal injury side, time from injury to surgery, KT-1000 SSD, pivot shift test under anesthesia, follow-up duration, posterior tibial slope (PTS) and ATT measured on the pre-operative weight-bearing whole leg radiographs between the two groups were compared using univariate analysis. Moreover, the predictors of ACL reconstruction failure were assessed by multivariable conditional Logistic regression analysis.Results:Post-operative failure group had a significantly higher PTS and ATT values than those in the post-operative non-failure group (17.21°±2.20° vs 14.36°±2.72°, t=4.395, P<0.001; 8.29±3.42 mm vs 4.09±3.06 mm, t=5.504, P<0.001). The sex, age, BMI, affected side, meniscal injury side, time from injury to surgery, KT-1000 SSD, pivot shift test under anesthesia, follow-up duration between the two groups showed no significant difference ( P>0.05). Multivariable Logistic regressions indicated that PTS≥17° ( OR=15.62, P=0.002) and ATT≥6 mm ( OR=9.91, P=0.006) were independent risk factors for primary ACL reconstruction failure. However, sex, age, BMI, meniscal lesions, degree of pivot shift test, KT-1000 SSD were not the independent risk factors. Conclusion:PTS≥17° and ATT≥6 mm could increase the risk of primary ACL reconstruction failure.
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Objective:To evaluate the clinical, radiological and arthroscopic outcomes after surgical repair for chronic lateral meniscus posterior root (LMPR) avulsion combined with anterior cruciate ligament (ACL) reconstruction.Methods:From July 2015 to June 2017, a total of 33 patients who underwent transtibial pull-out suture repair for chronic LMPR avulsion combined with anatomic single-bundle ACL reconstruction with hamstring graft were retrospectively reviewed. There were 30 males and 3 females with an average age of 27.7±7.5 years (range 17-45 years) and a mean BMI of 25.2±3.7 kg/m 2 (range 19.4-36.7 kg/m 2). All patients were available for at least two years of follow-up. A second-look arthroscopy was performed to evaluate the healing status of the repaired meniscus. Subjective knee function was assessed through Lysholm and Tegner scores. Objective knee stability was evaluated using KT-1000 arthrometer side-to-side difference (SSD) and pivot shift test under anesthesia. The tibiofemoral relationship was evaluated by anterior tibial subluxation (ATS) measured on axial MRI. Between patients with preoperative ATS ≥6 mm (18 patients in the ATS positive group) and <6 mm (15 patients in the ATS negative group), the postoperative ATS and the reduction of ATS was also compared. Results:After a mean follow-up of 27.5±4.0 months (range 24-39 months), the LMPR avulsion completely healed in 23 (70%) cases, partially healed in 9 (27%) cases, failed to heal in 1 (3%) case on second-look arthroscopy. The Lysholm score was increased from 60.4±13.6 to 82.7±11.1 at 1 year and to 91.4±9.1 at 2 years operatively ( F=155.996, P<0.001). The Tegner score was increased from 3(2, 5) to 4(3, 5) at 1 year and 6(4, 6) at 2 years postoperatively (χ 2=47.791, P<0.001). The KT-1000 SSD was decreased from 9.1±3.3 mm to 2.0±1.7 mm ( t=11.197, P<0.001). The result of pivot shift test was also improved (10 grade I, 20 grade II, 3 grade III, preoperatively vs 30 grade 0, 3 grade I, postoperatively, U=5.161, P<0.001). The ATS was reduced from 5.7±3.9 mm to 3.5±3.2 mm ( t=3.530, P=0.001). However, there was no statistically significant decrease in the ATS of the ATS negative group ( t=0.400, P=0.695). The ATS of the ATS positive group was reduced from 8.7±1.8 mm to 5.0±3.3 mm ( t=4.765, P<0.001), and the ATS reduction of the ATS positive group was greater than that of the ATS negative group (3.7±3.3 mm vs 0.3±2.8 mm, t=3.115, P=0.004). Conclusion:In patients undergoing ACL reconstruction, the transtibial pull-out suture repair for chronic LMPR avulsion yielded meniscus healing rate of 97% with improved subjective knee function and objective knee stability and better restored the tibiofemoral relationship for patients with excessive ATS.