Ochsner Sports Medicine InsCtute New Orleans, Lousiana

Transcription

1 Anterior Cruciate Ligament with Bone Patellar Tendon Bone Technique Does Not Cause Functional Anterior Knee Pain Brian Godshaw MD, Connor Ojard MD, Art Villarreal MD, Kian Setayash MD, Gerard Williams MD, Michael Nammour MD, Michael Wong BS, Misty Suri MD Ochsner Sports Medicine InsCtute New Orleans, Lousiana

2 Disclosure All authors have no relevant disclosures See Mobile MeeCng Guide for all disclosures

3 Introduction Anterior Cruciate Ligament (ACL) rupture is one of the most common injuries in orthopaedics Most common ligament injury EsCmated Incidence: 81/100,000 persons Common in: Running, jumping, cuqng, pivocng Female : Male = 2-4:1 Treatment ConservaCve ACL reconstruccon

4 Introduction Bone Patellar Tendon Bone (BPTB) Gold Standard Pro: Faster and stronger incorporacon Bone-to-bone healing Rigid fixacon Superior Lachman Greater return to sport Con: Anterior knee pain Patella fracture Hamstring Pro: Strongest Smaller/fewer incisions Lower risk anterior knee pain Lower risk DJD Con: Hamstring weakness Gra^ laxity So^ Cssue fixacon

5 Introduction: Anterior Knee Pain BPTB: Donor site origin / scar Cssue formacon Kartus et al: 40-60% BPTB pacents have donor site morbidity Xie et al: Meta analysis: Anterior knee pain 1.71x higher BPTB (p<0.01); kneeling pain 2.05x higher (p<0.01) Hamstring: Kanamoto et al: 6 month follow up of 57 hamstring ACL reconstrucions 56.1% with anterior knee pain

6 Purpose Hypothesis To invescgate if ACL reconstruccon with BPTB autogra^ results in funcconal anterior knee pain ACL reconstruccon with BPTP autogra^ does not cause funcconal anterior knee pain FuncConal = accvity limicng

7 Methods IRB approved retrospeccve review BPTB ALC reconstruccon 3/2013 5/2017 Minimum 1 year follow up Outcomes: Pain: Visual Analogue Scale (VAS) Presence vs absence anterior knee pain Range of mocon (ROM) Data: Pre-operaCve Post-operaCve: 2wk, 6wk, 3mo, 6mo, 1yr 130 pacents with BPTB ACL reconstruccon and >1yr follow up Demographics Male (%) 76 (58.5%) Female (%) 54 (41.5%) BMI (range) 26.5 ( ) kg/m 2 Age (range) 26.7 (13 75) years

8 Results: VAS Pain and ROM VAS Pain Score Range of MoFon Arc VAS SCORE DEGREES WEEKS POST-OPERATIVE WEEKS POST-OPERATIVE

9 Results: Anterior Knee Pain PaFents with Anterior Knee Pain NUMBER OF PATIENTS % 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% WEEKS POST-OPERATIVE 0.00% Number of PaCents Percentage of PaCents

10 Results: Anterior Knee Pain 14 Peristence of Anterior Knee Pain PAIN AT 2WKS PAIN AT 6WKS PAIN AT 3MOS PAIN AT 6MOS PAIN AT 1YR Pain at 2wks Pain at 6wks Pain at 3mos Pain at 6mos Pain at 1yr

11 Discussion Niki et al: 56 BPTB vs 71 semitendinosus vs 44 semitendinosus + gracilis Anterior knee pain: 3 month: 42.0% overall, significantly greater in BPTB (p=0.001) PredisposiCon: knee extension deficit (OR 2.76, p=0.004) 2 year: 11.1% overall, no difference between gra^ opcons 95% of which also reported anterior knee pain at 3 months Feller et al: 31 BPTB vs 34 Hamstring autogra^s (randomized) BPTB with more anterior knee pain (97% vs 68% p<0.01) at 2weeks Non-significant discrepancy at 8weeks (87% vs 77%) or 4months (81% vs 70%) High incidence of anterior knee pain Pain levels ( on VAS) no clinically different

12 Conclusion BPTB is effeccve for reducing pain in pacents with ACL tears BPTB has low incidence of anterior knee pain Peak of 10% at 6 months post operacvely 92.3% resolucon of anterior knee pain between 6 months and 1 year post-operacve

13 References 1. J. H. Ahn, J. G. Kim, J. H. Wang, C. H. Jung, H. C. Lim, Long-term results of anterior cruciate ligament reconstruccon using bone-patellar tendon-bone: an analysis of the factors affeccng the development of osteoarthrics. Arthroscopy 28, (2012). 2. J. C. Christensen, L. R. Goldfine, T. Barker, D. S. Collingridge, What can the first 2 months tell us about outcomes a^er anterior cruciate ligament reconstruccon? J Athl Train 50, (2015). 3. W. R. Dunn et al., Which preoperacve factors, including bone bruise, are associated with knee pain/symptoms at index anterior cruciate ligament reconstruccon (ACLR)? A MulCcenter Orthopaedic Outcomes Network (MOON) ACLR Cohort Study. Am J Sports Med 38, (2010). 4. W. R. Dunn, K. P. Spindler, M. ConsorCum, Predictors of accvity level 2 years a^er anterior cruciate ligament reconstruccon (ACLR): a MulCcenter Orthopaedic Outcomes Network (MOON) ACLR cohort study. Am J Sports Med 38, (2010). 5. J. A. Feller, K. E. Webster, B. Gavin, Early post-operacve morbidity following anterior cruciate ligament reconstruccon: patellar tendon versus hamstring gra^. Knee Surg Sports Traumatol Arthrosc 9, (2001). 6. T. Järvelä, P. Kannus, M. Järvinen, Anterior knee pain 7 years a^er an anterior cruciate ligament reconstruccon with a bone-patellar tendon-bone autogra^. Scand J Med Sci Sports 10, (2000). 7. T. Kanamoto et al., Anterior knee symptoms a^er double-bundle ACL reconstruccon with hamstring tendon autogra^s: an ultrasonographic and power Doppler invescgacon. Knee Surg Sports Traumatol Arthrosc 23, (2015). 8. A. E. Kleipool, T. van Loon, R. K. MarC, Pain a^er use of the central third of the patellar tendon for cruciate ligament reconstruccon. 33 pacents followed 2-3 years. Acta Orthop Scand 65, (1994). 9. L. S. Lohmander, A. Ostenberg, M. Englund, H. Roos, High prevalence of knee osteoarthrics, pain, and funcconal limitacons in female soccer players twelve years a^er anterior cruciate ligament injury. Arthri<s Rheum 50, (2004). 10. B. Lund, T. Nielsen, P. Faunø, S. E. ChrisCansen, M. Lind, Is quadriceps tendon a beser gra^ choice than patellar tendon? a prospeccve randomized study. Arthroscopy 30, (2014). 11. A. Matsumoto et al., A comparison of bone-patellar tendon-bone and bone-hamstring tendon-bone autogra^s for anterior cruciate ligament reconstruccon. Am J Sports Med 34, (2006). 12. Y. Niki et al., Factors affeccng anterior knee pain following anatomic double-bundle anterior cruciate ligament reconstruccon. Knee Surg Sports Traumatol Arthrosc 20, (2012). 13. Y. Niki et al., Anatomic double-bundle anterior cruciate ligament reconstruccon using bone-patellar tendon-bone and gracilis tendon gra^: a comparacve study with 2-year follow-up results of semitendinosus tendon gra^s alone or semitendinosus-gracilis tendon gra^s. Arthroscopy 27, (2011). 14. L. Rahr-Wagner, T. M. Thillemann, A. B. Pedersen, M. Lind, Comparison of hamstring tendon and patellar tendon gra^s in anterior cruciate ligament reconstruccon in a naconwide populacon-based cohort study: results from the danish registry of knee ligament reconstruccon. Am J Sports Med 42, (2014). 15. X. Xie et al., A meta-analysis of bone-patellar tendon-bone autogra^ versus four-strand hamstring tendon autogra^ for anterior cruciate ligament reconstruccon. Knee 22, (2015).