Atesch Ateschrang1, Anna Janine Schreiner1, Sufian S Ahmad2, Steffen Schröter1, Michael T Hirschmann3,4, Daniel Körner1, Sandro Kohl5, Ulrich Stöckle1, Marc-Daniel Ahrend1,6. 1. BG Trauma Center Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany. 2. BG Trauma Center Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany. sufian@ahmadortho.com. 3. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland. 4. University of Basel, Basel, Switzerland. 5. Trauma Center Hirslanden Klinik, Zurich, Switzerland. 6. AO Research Institute Davos, Davos, Switzerland.
Abstract
PURPOSE: It was the aim to assess the influence of synovial sheath disruption on early failure of primary anterior cruciate ligament (ACL) repair. It was hypothesized that more-part ACL tears with disruption of the synovial sheath are associated with a higher risk of failure after primary ACL repair. METHODS: A cohort study was conducted comprising patients with primal ACL tears undergoing primary ACL repair and dynamic intraligamentary stabilization (DIS). The patients were stratified into three groups: A-one-part rupture with intact synovial membrane (n = 50), B-two-part ruptures resultant to separation of the ACL into two main bundles with synovial membrane tearing (n = 52) and C-more parts involving multilacerated ruptures with membrane disruption (n = 22). Failure was defined as a retear or residual laxity (anterior posterior translation > 5 mm compared to healthy knee). Adjustment for potential risk factors was performed using a multivariate logistic-regression model. RESULTS: The overall failure rate was 17.7% throughout the mean follow-up period of 2.3 ± 0.8 years. The failure rate in patients with one-part ACL tears with an intact synovial membrane was 4% (n = 2) (Group A), which was significantly lower than the failure rates in groups B and C, 26.9% (n = 14) (p = 0.001) and 27.3% (n = 6) (p = 0.003), respectively. Disruption of the synovial sheath in two- or more-part tears was identified as an independent factor influencing treatment failure in primary ACL repair (OR 8.9; 95% CI 2.0-40.0). CONCLUSION: The integrity of the ACL bundles and synovial sheath is a factor that influences the success of ACL repair. This needs to be considered intra-operatively when deciding about repair. LEVEL OF EVIDENCE: IV.
PURPOSE: It was the aim to assess the influence of synovial sheath disruption on early failure of primary anterior cruciate ligament (ACL) repair. It was hypothesized that more-part ACL tears with disruption of the synovial sheath are associated with a higher risk of failure after primary ACL repair. METHODS: A cohort study was conducted comprising patients with primal ACL tears undergoing primary ACL repair and dynamic intraligamentary stabilization (DIS). The patients were stratified into three groups: A-one-part rupture with intact synovial membrane (n = 50), B-two-part ruptures resultant to separation of the ACL into two main bundles with synovial membrane tearing (n = 52) and C-more parts involving multilacerated ruptures with membrane disruption (n = 22). Failure was defined as a retear or residual laxity (anterior posterior translation > 5 mm compared to healthy knee). Adjustment for potential risk factors was performed using a multivariate logistic-regression model. RESULTS: The overall failure rate was 17.7% throughout the mean follow-up period of 2.3 ± 0.8 years. The failure rate in patients with one-part ACL tears with an intact synovial membrane was 4% (n = 2) (Group A), which was significantly lower than the failure rates in groups B and C, 26.9% (n = 14) (p = 0.001) and 27.3% (n = 6) (p = 0.003), respectively. Disruption of the synovial sheath in two- or more-part tears was identified as an independent factor influencing treatment failure in primary ACL repair (OR 8.9; 95% CI 2.0-40.0). CONCLUSION: The integrity of the ACL bundles and synovial sheath is a factor that influences the success of ACL repair. This needs to be considered intra-operatively when deciding about repair. LEVEL OF EVIDENCE: IV.
Authors: Sufian S Ahmad; Gregory S Difelice; Jelle P van der List; Atesch Ateschrang; Michael T Hirschmann Journal: Knee Surg Sports Traumatol Arthrosc Date: 2018-12-07 Impact factor: 4.342
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Authors: Samuel Bachmaier; Gregory S DiFelice; Bertrand Sonnery-Cottet; Wiemi A Douoguih; Patrick A Smith; Lee J Pace; Daniel Ritter; Coen A Wijdicks Journal: Orthop J Sports Med Date: 2020-01-28