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Changes in gait pattern and early functional results after ACL repair are comparable to those of ACL reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Dynamic intraligamentary stabilization (DIS) has been introduced as a new technique to repair the torn anterior cruciate ligament (ACL) and to restore knee joint kinematics after an acute ACL tear. Aim of the present study was to compare the early post-operative activity, restoration of gait pattern and functional results after DIS in comparison with primary ACL reconstruction (ACLR) for acute ACL tears. It was hypothesized that functional results, post-operative activity and changes in gait pattern after DIS are comparable to those after ACLR.

Methods

Sixty patients with acute ACL tears were included in this study and underwent either DIS or ACLR with an anatomic semitendinosus autograft in a randomized manner. Patients were equipped with an accelerometric step counter for the first 6 weeks after surgery in order to monitor their early post-operative activity. 3D gait analysis was performed at 6 weeks and 6 months after surgery. Temporal-spatial, kinematic and kinetic parameters were extracted and averaged for each subject. Functional results were recorded at 6 weeks, 6 months and 12 months after surgery using the Tegner activity scale, International Knee Documentation Committee score and Lysholm score.

Results

Patients who underwent DIS showed an increased early post-operative activity with significant differences at week 2 and 3 (p = 0.0241 and 0.0220). No significant differences between groups were found for knee kinematic and kinetic parameters or the functional scores at any time of the follow-up. Furthermore, the difference in anterior tibial translation was not significantly different between the two groups (n.s.).

Conclusion

Early functional results and changes in gait pattern after DIS are comparable to those of primary ACLR. Therefore, ACL repair may be an alternative to ACLR in this cohort of patients.

Level of evidence

I.

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References

  1. Andernord D, Desai N, Bjornsson H, Ylander M, Karlsson J, Samuelsson K (2015) Patient predictors of early revision surgery after anterior cruciate ligament reconstruction: a cohort study of 16,930 patients with 2-year follow-up. Am J Sports Med 43(1):121–127

    Article  PubMed  Google Scholar 

  2. Bourke HE, Salmon LJ, Waller A, Patterson V, Pinczewski LA (2012) Survival of the anterior cruciate ligament graft and the contralateral ACL at a minimum of 15 years. Am J Sports Med 40(9):1985–1992

    Article  PubMed  Google Scholar 

  3. Eggli S, Kohlhof H, Zumstein M, Henle P, Hartel M, Evangelopoulos DS, Bonel H, Kohl S (2014) Dynamic intraligamentary stabilization: novel technique for preserving the ruptured ACL. Knee Surg Sports Traumatol Arthrosc 23(4):1215–1221

    Article  PubMed  PubMed Central  Google Scholar 

  4. Eggli S, Roder C, Perler G, Henle P (2016) Five year results of the first ten ACL patients treated with dynamic intraligamentary stabilisation. BMC Musculoskelet Disord 17:105

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fältström A, Hagglund M, Magnusson H, Forssblad M, Kvist J (2016) Predictors for additional anterior cruciate ligament reconstruction: data from the Swedish national ACL register. Knee Surg Sports Traumatol Arthrosc 24(3):885–894

    Article  PubMed  Google Scholar 

  6. Gokeler A, Benjaminse A, van Eck CF, Webster KE, Schot L, Otten E (2013) Return of normal gait as an outcome measurement in acl reconstructed patients. A systematic review. Int J Sports. Phys Ther 8(4):441–451

    CAS  Google Scholar 

  7. Hart HF, Culvenor AG, Collins NJ, Ackland DC, Cowan SM, Machotka Z, Crossley KM (2016) Knee kinematics and joint moments during gait following anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Br J Sports Med 50(10):597–612

    Article  PubMed  Google Scholar 

  8. Heitmann M, Dratzidis A, Jagodzinski M, Wohlmuth P, Hurschler C, Puschel K, Giannakos A, Preiss A, Frosch KH (2014) Ligament bracing–augmented cruciate ligament sutures: biomechanical studies of a new treatment concept. Unfallchirurg 117(7):650–657

    Article  CAS  PubMed  Google Scholar 

  9. Heitmann M, Gerau M, Hotzel J, Giannakos A, Frosch KH, Preiss A (2014) Ligament bracing–augmented primary suture repair in multiligamentous knee injuries. Oper Orthop Traumatol 26(1):19–29

    Article  CAS  PubMed  Google Scholar 

  10. Henle P, Roder C, Perler G, Heitkemper S, Eggli S (2015) Dynamic intraligamentary stabilization (DIS) for treatment of acute anterior cruciate ligament ruptures: case series experience of the first three years. BMC Musculoskelet Disord 16:27

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kösters C, Herbort M, Schliemann B, Raschke MJ, Lenschow S (2015) Dynamic intraligamentary stabilization of the anterior cruciate ligament. Operative technique and short-term clinical results. Unfallchirurg 118(4):364–371

    Article  PubMed  Google Scholar 

  12. Leblanc MC, Kowalczuk M, Andruszkiewicz N, Simunovic N, Farrokhyar F, Turnbull TL, Debski RE, Ayeni OR (2015) Diagnostic accuracy of physical examination for anterior knee instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 23(10):2805–2813

    Article  PubMed  Google Scholar 

  13. Lubowitz JH (2014) Anatomic ACL reconstruction produces greater graft length change during knee range-of-motion than transtibial technique. Knee Surg Sports Traumatol Arthrosc 22(5):1190–1195

    Article  PubMed  Google Scholar 

  14. Marshall JL, Warren RF, Wickiewicz TL (1982) Primary surgical treatment of anterior cruciate ligament lesions. Am J Sports Med 10(2):103–107

    Article  CAS  PubMed  Google Scholar 

  15. Marshall JL, Warren RF, Wickiewicz TL, Reider B (1979) The anterior cruciate ligament: a technique of repair and reconstruction. Clin Orthop Relat Res 143:97–106

    Google Scholar 

  16. Mulligan EP, McGuffie DQ, Coyner K, Khazzam M (2015) The reliability and diagnostic accuracy of assessing the translation endpoint during the lachman test. Int J Sports Phys Ther 10(1):52–61

    PubMed  PubMed Central  Google Scholar 

  17. Paessler HH, Deneke J, Dahners LE (1992) Augmented repair and early mobilization of acute anterior cruciate ligament injuries. Am J Sports Med 20(6):667–674

    Article  CAS  PubMed  Google Scholar 

  18. Petersen W, Forkel P, Achtnich A, Metzlaff S, Zantop T (2013) Anatomic reconstruction of the anterior cruciate ligament in single bundle technique. Oper Orthop Traumatol 25(2):185–204

    Article  CAS  PubMed  Google Scholar 

  19. Roewer BD, Di Stasi SL, Snyder-Mackler L (2011) Quadriceps strength and weight acceptance strategies continue to improve two years after anterior cruciate ligament reconstruction. J Biomech 44(10):1948–1953

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sandberg R, Balkfors B, Nilsson B, Westlin N (1987) Operative versus non-operative treatment of recent injuries to the ligaments of the knee. A prospective randomized study. J Bone Joint Surg Am 69(8):1120–1126

    Article  CAS  PubMed  Google Scholar 

  21. Sanders TL, Pareek A, Hewett TE, Levy BA, Dahm DL, Stuart MJ, Krych AJ (2017) Long-term rate of graft failure after ACL reconstruction: a geographic population cohort analysis. Knee Surg Sports Traumatol Arthrosc 25(1):222–228

    Article  PubMed  Google Scholar 

  22. Schliemann B, Lenschow S, Domnick C, Herbort M, Haberli J, Schulze M, Wahnert D, Raschke MJ, Kösters C (2015) Knee joint kinematics after dynamic intraligamentary stabilization: cadaveric study on a novel anterior cruciate ligament repair technique. Knee Surg Sports Traumatol Arthrosc 25(4):1184–1190

    Article  PubMed  Google Scholar 

  23. Spindler KP, Kuhn JE, Freedman KB, Matthews CE, Dittus RS, Harrell FE Jr (2004) Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring: does it really matter? A systematic review. Am J Sports Med 32(8):1986–1995

    Article  PubMed  Google Scholar 

  24. Webster KE, Feller JA (2011) Alterations in joint kinematics during walking following hamstring and patellar tendon anterior cruciate ligament reconstruction surgery. Clin Biomech 26(2):175–180

    Article  Google Scholar 

  25. Webster KE, Wittwer JE, O'Brien J, Feller JA (2005) Gait patterns after anterior cruciate ligament reconstruction are related to graft type. Am J Sports Med 33(2):247–254

    Article  PubMed  Google Scholar 

  26. Wilson WT, Hopper GP, Byrne PA, MacKay GM (2016) Anterior cruciate ligament repair with internal brace ligament augmentation. Surg Technol Int XXIX:273–278

    PubMed  Google Scholar 

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Acknowledgements

A native speaker prior to submission edited the manuscript. We thank MAD for their help with the statistical analyses.

Author information

Author notes

  1. Benedikt Schliemann and Johannes Glasbrenner have contributed equally to this study.

Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany

    Benedikt Schliemann, Johannes Glasbrenner, Katharina Lammers, Mirco Herbort, Christoph Domnick, Michael J. Raschke & Clemens Kösters

  2. Movement Analysis Lab, Institute for Experimental Musculoskeletal Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building D3, 48149, Münster, Germany

    Dieter Rosenbaum

Authors
  1. Benedikt Schliemann
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  2. Johannes Glasbrenner
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  4. Katharina Lammers
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  5. Mirco Herbort
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  8. Clemens Kösters
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Corresponding author

Correspondence to Benedikt Schliemann.

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Conflict of interest

BS, MH and CK are consultants for the Mathys Medical AG. MH is a consultant for Medacta and Karl Storz. All other authors declare that they have no conflict of interest.

Funding

No funding was received.

Ethical approval

IRB approval was obtained prior to the study by the Ethics Board of the University of Münster (2013-414-f-S).

Informed consent

Informed consent was obtained from all patients included in the study.

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Schliemann, B., Glasbrenner, J., Rosenbaum, D. et al. Changes in gait pattern and early functional results after ACL repair are comparable to those of ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 26, 374–380 (2018). https://doi.org/10.1007/s00167-017-4618-3

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  • DOI: https://doi.org/10.1007/s00167-017-4618-3

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