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Tibial slope, remnant preservation, and graft size are the most important factors affecting graft healing after ACL reconstruction
Purpose The aim of this study was to determine the anatomic, operative and biological factors that influenced graft healing after single-bundle anterior cruciate ligament (ACL) reconstruction. Methods One hundred fourteen consecutive patients who underwent anatomic single-bundle ACL reconstruction w...
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| Published in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2022-05, Vol.30 (5), p.1584-1593 |
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| creator | Okutan, Ahmet Emin Kalkışım, Muhammet Gürün, Enes Ayas, Muhammet Salih Aynacı, Osman |
| description | Purpose
The aim of this study was to determine the anatomic, operative and biological factors that influenced graft healing after single-bundle anterior cruciate ligament (ACL) reconstruction.
Methods
One hundred fourteen consecutive patients who underwent anatomic single-bundle ACL reconstruction with quadrupled hamstring tendon autografts between 2016 and 2019 were retrospectively analyzed. Ninety-four patients met the inclusion criteria with minimum follow-up of 12 months. Patients were evaluated with multiple clinical measurements, including International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Lyshom Scores, and Marx activity scale. To evaluate graft healing, the signal-to-noise quotient (SNQ) was measured at intra-articular graft and intra-tunnel integration were evaluated on magnetic resonance imaging (MRI) at one year after surgery. Potential factors affecting graft healing, including age, sex, body mass index, time from injury to surgery, posterior tibial slope, lateral femoral condyle ratio, notch width index, meniscal injury, remnant preservation, tunnel aperture locations, graft size, graft bending angle, graft/remaining notch volume ratio were evaluated for their association with graft SNQ value by stepwise regression analysis.
Results
A total of 94 patients were evaluated with mean follow-up 28.5 ± 9 months. Univariate regression analysis showed that posterior tibial slope, notch width index, remnant preserving procedure, high femoral tunnel, anterior tibial tunnel, graft bending angle, and graft/remaining notch volume ratio significantly associated with graft SNQ values. Multivariate regression analysis showed that lateral tibial slope, remnant preservation, and graft/remaining notch volume ratio were independent factors correlated with graft SNQ values. Also, the graft SNQ values was weakly correlated with femoral tunnel integration and Marx activity scale at one year. There was no correlation between graft SNQ values and IKDC-SKF and Lysholm scores. There was no correlation between graft SNQ values and International Knee Documentation Committee and Lysholm scores.
Conclusions
Tibial slope, remnant preservation and graft/remaining notch volume ratio were significant independent associated factors of graft SNQ value at one year. The graft SNQ values were also weakly correlated with femoral tunnel integration and the Marx activity scale. These factors should be taken into account for ensuring the ideal graft healing and |
| doi_str_mv | 10.1007/s00167-021-06660-2 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2550264136</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2550264136</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-24d2f9a1f060fea40bbc4014f83802c91d0a8ef957d6c09cba66a497542bdde13</originalsourceid><addsrcrecordid>eNp9kc1u1DAURi1ERaeFF2CBLLFh0ZTr30yW1QgK0kjdtGvLca6nqRI72A4SLHlyEmYAiQUrX8vn-66lQ8hrBtcMoH6fAZiuK-CsAq01VPwZ2TApRFULWT8nG2gkrzgofU4ucn4CWEbZvCDnQnKpBDQb8uO-b3s70DzECa9owjHYUOiUMGP6aksfwxW1oaOHZH2huf-O1Cak5RHpGHOh_TjFVNaMt67ElKn1Hl3pw-GUeUQ7rLdlxkRvdvtli4shlzS7tf8lOfN2yPjqdF6Sh48f7nefqv3d7efdzb5yolal4rLjvrHMgwaPVkLbOglM-q3YAncN68Bu0Teq7rSDxrVWayubWknedh0ycUneHXunFL_MmIsZ--xwGGzAOGfDlQKuJRN6Qd_-gz7FOYXld4ZrJSRTuuYLxY-USzHnhN5MqR9t-mYYmNWQORoyiyHzy5BZQ29O1XM7Yvcn8lvJAogjkJencMD0d_d_an8CczadGg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2653415672</pqid></control><display><type>article</type><title>Tibial slope, remnant preservation, and graft size are the most important factors affecting graft healing after ACL reconstruction</title><source>Springer Link</source><source>SPORTDiscus with Full Text</source><creator>Okutan, Ahmet Emin ; Kalkışım, Muhammet ; Gürün, Enes ; Ayas, Muhammet Salih ; Aynacı, Osman</creator><creatorcontrib>Okutan, Ahmet Emin ; Kalkışım, Muhammet ; Gürün, Enes ; Ayas, Muhammet Salih ; Aynacı, Osman</creatorcontrib><description>Purpose
The aim of this study was to determine the anatomic, operative and biological factors that influenced graft healing after single-bundle anterior cruciate ligament (ACL) reconstruction.
Methods
One hundred fourteen consecutive patients who underwent anatomic single-bundle ACL reconstruction with quadrupled hamstring tendon autografts between 2016 and 2019 were retrospectively analyzed. Ninety-four patients met the inclusion criteria with minimum follow-up of 12 months. Patients were evaluated with multiple clinical measurements, including International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Lyshom Scores, and Marx activity scale. To evaluate graft healing, the signal-to-noise quotient (SNQ) was measured at intra-articular graft and intra-tunnel integration were evaluated on magnetic resonance imaging (MRI) at one year after surgery. Potential factors affecting graft healing, including age, sex, body mass index, time from injury to surgery, posterior tibial slope, lateral femoral condyle ratio, notch width index, meniscal injury, remnant preservation, tunnel aperture locations, graft size, graft bending angle, graft/remaining notch volume ratio were evaluated for their association with graft SNQ value by stepwise regression analysis.
Results
A total of 94 patients were evaluated with mean follow-up 28.5 ± 9 months. Univariate regression analysis showed that posterior tibial slope, notch width index, remnant preserving procedure, high femoral tunnel, anterior tibial tunnel, graft bending angle, and graft/remaining notch volume ratio significantly associated with graft SNQ values. Multivariate regression analysis showed that lateral tibial slope, remnant preservation, and graft/remaining notch volume ratio were independent factors correlated with graft SNQ values. Also, the graft SNQ values was weakly correlated with femoral tunnel integration and Marx activity scale at one year. There was no correlation between graft SNQ values and IKDC-SKF and Lysholm scores. There was no correlation between graft SNQ values and International Knee Documentation Committee and Lysholm scores.
Conclusions
Tibial slope, remnant preservation and graft/remaining notch volume ratio were significant independent associated factors of graft SNQ value at one year. The graft SNQ values were also weakly correlated with femoral tunnel integration and the Marx activity scale. These factors should be taken into account for ensuring the ideal graft healing and for the return to sport decision-making.
Level of evidence
Level IV.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-021-06660-2</identifier><identifier>PMID: 34245309</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Anterior cruciate ligament ; Autografts ; Body mass ; Body mass index ; Body size ; Decision making ; Documentation ; Evaluation ; Femur ; Grafting ; Healing ; Integration ; Knee ; Magnetic resonance imaging ; Medicine ; Medicine & Public Health ; Meniscus ; Orthopedics ; Patients ; Preservation ; Quotients ; Regression analysis ; Sports Medicine ; Surgery ; Tunnels</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022-05, Vol.30 (5), p.1584-1593</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2021</rights><rights>2021. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).</rights><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-24d2f9a1f060fea40bbc4014f83802c91d0a8ef957d6c09cba66a497542bdde13</citedby><cites>FETCH-LOGICAL-c375t-24d2f9a1f060fea40bbc4014f83802c91d0a8ef957d6c09cba66a497542bdde13</cites><orcidid>0000-0003-1818-9422</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34245309$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Okutan, Ahmet Emin</creatorcontrib><creatorcontrib>Kalkışım, Muhammet</creatorcontrib><creatorcontrib>Gürün, Enes</creatorcontrib><creatorcontrib>Ayas, Muhammet Salih</creatorcontrib><creatorcontrib>Aynacı, Osman</creatorcontrib><title>Tibial slope, remnant preservation, and graft size are the most important factors affecting graft healing after ACL reconstruction</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
The aim of this study was to determine the anatomic, operative and biological factors that influenced graft healing after single-bundle anterior cruciate ligament (ACL) reconstruction.
Methods
One hundred fourteen consecutive patients who underwent anatomic single-bundle ACL reconstruction with quadrupled hamstring tendon autografts between 2016 and 2019 were retrospectively analyzed. Ninety-four patients met the inclusion criteria with minimum follow-up of 12 months. Patients were evaluated with multiple clinical measurements, including International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Lyshom Scores, and Marx activity scale. To evaluate graft healing, the signal-to-noise quotient (SNQ) was measured at intra-articular graft and intra-tunnel integration were evaluated on magnetic resonance imaging (MRI) at one year after surgery. Potential factors affecting graft healing, including age, sex, body mass index, time from injury to surgery, posterior tibial slope, lateral femoral condyle ratio, notch width index, meniscal injury, remnant preservation, tunnel aperture locations, graft size, graft bending angle, graft/remaining notch volume ratio were evaluated for their association with graft SNQ value by stepwise regression analysis.
Results
A total of 94 patients were evaluated with mean follow-up 28.5 ± 9 months. Univariate regression analysis showed that posterior tibial slope, notch width index, remnant preserving procedure, high femoral tunnel, anterior tibial tunnel, graft bending angle, and graft/remaining notch volume ratio significantly associated with graft SNQ values. Multivariate regression analysis showed that lateral tibial slope, remnant preservation, and graft/remaining notch volume ratio were independent factors correlated with graft SNQ values. Also, the graft SNQ values was weakly correlated with femoral tunnel integration and Marx activity scale at one year. There was no correlation between graft SNQ values and IKDC-SKF and Lysholm scores. There was no correlation between graft SNQ values and International Knee Documentation Committee and Lysholm scores.
Conclusions
Tibial slope, remnant preservation and graft/remaining notch volume ratio were significant independent associated factors of graft SNQ value at one year. The graft SNQ values were also weakly correlated with femoral tunnel integration and the Marx activity scale. These factors should be taken into account for ensuring the ideal graft healing and for the return to sport decision-making.
Level of evidence
Level IV.</description><subject>Anterior cruciate ligament</subject><subject>Autografts</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Decision making</subject><subject>Documentation</subject><subject>Evaluation</subject><subject>Femur</subject><subject>Grafting</subject><subject>Healing</subject><subject>Integration</subject><subject>Knee</subject><subject>Magnetic resonance imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meniscus</subject><subject>Orthopedics</subject><subject>Patients</subject><subject>Preservation</subject><subject>Quotients</subject><subject>Regression analysis</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Tunnels</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kc1u1DAURi1ERaeFF2CBLLFh0ZTr30yW1QgK0kjdtGvLca6nqRI72A4SLHlyEmYAiQUrX8vn-66lQ8hrBtcMoH6fAZiuK-CsAq01VPwZ2TApRFULWT8nG2gkrzgofU4ucn4CWEbZvCDnQnKpBDQb8uO-b3s70DzECa9owjHYUOiUMGP6aksfwxW1oaOHZH2huf-O1Cak5RHpGHOh_TjFVNaMt67ElKn1Hl3pw-GUeUQ7rLdlxkRvdvtli4shlzS7tf8lOfN2yPjqdF6Sh48f7nefqv3d7efdzb5yolal4rLjvrHMgwaPVkLbOglM-q3YAncN68Bu0Teq7rSDxrVWayubWknedh0ycUneHXunFL_MmIsZ--xwGGzAOGfDlQKuJRN6Qd_-gz7FOYXld4ZrJSRTuuYLxY-USzHnhN5MqR9t-mYYmNWQORoyiyHzy5BZQ29O1XM7Yvcn8lvJAogjkJencMD0d_d_an8CczadGg</recordid><startdate>20220501</startdate><enddate>20220501</enddate><creator>Okutan, Ahmet Emin</creator><creator>Kalkışım, Muhammet</creator><creator>Gürün, Enes</creator><creator>Ayas, Muhammet Salih</creator><creator>Aynacı, Osman</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1818-9422</orcidid></search><sort><creationdate>20220501</creationdate><title>Tibial slope, remnant preservation, and graft size are the most important factors affecting graft healing after ACL reconstruction</title><author>Okutan, Ahmet Emin ; Kalkışım, Muhammet ; Gürün, Enes ; Ayas, Muhammet Salih ; Aynacı, Osman</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-24d2f9a1f060fea40bbc4014f83802c91d0a8ef957d6c09cba66a497542bdde13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Anterior cruciate ligament</topic><topic>Autografts</topic><topic>Body mass</topic><topic>Body mass index</topic><topic>Body size</topic><topic>Decision making</topic><topic>Documentation</topic><topic>Evaluation</topic><topic>Femur</topic><topic>Grafting</topic><topic>Healing</topic><topic>Integration</topic><topic>Knee</topic><topic>Magnetic resonance imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meniscus</topic><topic>Orthopedics</topic><topic>Patients</topic><topic>Preservation</topic><topic>Quotients</topic><topic>Regression analysis</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Tunnels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Okutan, Ahmet Emin</creatorcontrib><creatorcontrib>Kalkışım, Muhammet</creatorcontrib><creatorcontrib>Gürün, Enes</creatorcontrib><creatorcontrib>Ayas, Muhammet Salih</creatorcontrib><creatorcontrib>Aynacı, Osman</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database (ProQuest)</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Okutan, Ahmet Emin</au><au>Kalkışım, Muhammet</au><au>Gürün, Enes</au><au>Ayas, Muhammet Salih</au><au>Aynacı, Osman</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tibial slope, remnant preservation, and graft size are the most important factors affecting graft healing after ACL reconstruction</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2022-05-01</date><risdate>2022</risdate><volume>30</volume><issue>5</issue><spage>1584</spage><epage>1593</epage><pages>1584-1593</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Purpose
The aim of this study was to determine the anatomic, operative and biological factors that influenced graft healing after single-bundle anterior cruciate ligament (ACL) reconstruction.
Methods
One hundred fourteen consecutive patients who underwent anatomic single-bundle ACL reconstruction with quadrupled hamstring tendon autografts between 2016 and 2019 were retrospectively analyzed. Ninety-four patients met the inclusion criteria with minimum follow-up of 12 months. Patients were evaluated with multiple clinical measurements, including International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Lyshom Scores, and Marx activity scale. To evaluate graft healing, the signal-to-noise quotient (SNQ) was measured at intra-articular graft and intra-tunnel integration were evaluated on magnetic resonance imaging (MRI) at one year after surgery. Potential factors affecting graft healing, including age, sex, body mass index, time from injury to surgery, posterior tibial slope, lateral femoral condyle ratio, notch width index, meniscal injury, remnant preservation, tunnel aperture locations, graft size, graft bending angle, graft/remaining notch volume ratio were evaluated for their association with graft SNQ value by stepwise regression analysis.
Results
A total of 94 patients were evaluated with mean follow-up 28.5 ± 9 months. Univariate regression analysis showed that posterior tibial slope, notch width index, remnant preserving procedure, high femoral tunnel, anterior tibial tunnel, graft bending angle, and graft/remaining notch volume ratio significantly associated with graft SNQ values. Multivariate regression analysis showed that lateral tibial slope, remnant preservation, and graft/remaining notch volume ratio were independent factors correlated with graft SNQ values. Also, the graft SNQ values was weakly correlated with femoral tunnel integration and Marx activity scale at one year. There was no correlation between graft SNQ values and IKDC-SKF and Lysholm scores. There was no correlation between graft SNQ values and International Knee Documentation Committee and Lysholm scores.
Conclusions
Tibial slope, remnant preservation and graft/remaining notch volume ratio were significant independent associated factors of graft SNQ value at one year. The graft SNQ values were also weakly correlated with femoral tunnel integration and the Marx activity scale. These factors should be taken into account for ensuring the ideal graft healing and for the return to sport decision-making.
Level of evidence
Level IV.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>34245309</pmid><doi>10.1007/s00167-021-06660-2</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-1818-9422</orcidid></addata></record> |
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| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022-05, Vol.30 (5), p.1584-1593 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2550264136 |
| source | Springer Link; SPORTDiscus with Full Text |
| subjects | Anterior cruciate ligament Autografts Body mass Body mass index Body size Decision making Documentation Evaluation Femur Grafting Healing Integration Knee Magnetic resonance imaging Medicine Medicine & Public Health Meniscus Orthopedics Patients Preservation Quotients Regression analysis Sports Medicine Surgery Tunnels |
| title | Tibial slope, remnant preservation, and graft size are the most important factors affecting graft healing after ACL reconstruction |
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