Evidence map›Paper›PMID 31980844›Full record

ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2020

ACL reconstruction combined with lateral monoloop tenodesis can restore intact knee laxity.

Koen C Lagae, Joris Robberecht, Kiron K Athwal, Peter C M Verdonk, Andrew A Amis

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed
4.3field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 32 citations in OpenAlex.

  1. Review
  2. Article
  3. Review
  4. Article
  5. Review
  6. Article
  7. Article
  8. Article
  9. Article
  10. Review
  11. Article
  12. Article
  13. Article
  14. Article
  15. Review
  16. Article
  17. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 3 countries.

Koen C LagaeAntwerp Orthopaedic Centre Monica Hospitals, Antwerp, Belgium.
Joris RobberechtDepartment of Orthopaedic Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium.
Kiron K AthwalBiomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ, UK.
Peter C M VerdonkAntwerp Orthopaedic Centre Monica Hospitals, Antwerp, Belgium.
Andrew A AmisBiomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ, UK. a.amis@imperial.ac.uk.ORCID http://orcid.org/0000-0002-4489-1381
Antwerp University Hospital · BECharing Cross Hospital · GBImperial College London · GB

Funding

Smith and Nephew Co. none
6 · The paper itself

Abstract

purposeAn anterior cruciate ligament (ACL) injury is often combined with injury to the lateral extra-articular structures, which may cause a combined anterior and rotational laxity. It was hypothesised that addition of a 'monoloop' lateral extra-articular tenodesis (mLET) to an ACL reconstruction would restore anteroposterior, internal rotation and pivot-shift laxities better than isolated ACL reconstruction in combined injuries.

methodTwelve cadaveric knees were tested, using an optical tracking system to record the kinematics through 0°-100° of knee flexion with no load, anterior and posterior translational forces (90 N), internal and external rotational torques (5 Nm), and a combination of an anterior translational (90 N) plus internal rotational load (5 Nm). They were tested intact, after sectioning the ACL, sectioning anterolateral ligament (ALL), iliotibial band (ITB) graft harvest, releasing deep ITB fibres, hamstrings tendon ACL reconstruction, mLET combined with ACL reconstruction, and isolated mLET. Two-way repeated-measures ANOVA compared laxity data across knee states and flexion angles. When differences were found, paired t tests with Bonferroni correction were performed.

resultsIn the ACL-deficient knee, cutting the ALL significantly increased anterior laxity only at 20°-30°, and only significantly increased internal rotation at 50°. Additional deep ITB release significantly increased anterior laxity at 40°-90° and caused a large increase of internal rotation at 20°-100°. Isolated ACL reconstruction restored anterior drawer, but significant differences remained in internal rotation at 30°-100°. After adding an mLET there were no remaining differences with anterior translation or internal rotation compared to the intact knee. With the combined injury, isolated mLET allowed abnormal anterior translation and rotation to persist.

conclusionsCutting the deep fibres of the ITB caused large increases in tibial internal rotation laxity across the range of knee flexion, while cutting the ALL alone did not. With ACL deficiency combined with anterolateral deficiency, ACL reconstruction alone was insufficient to restore native knee rotational laxity. However, combining a 'monoloop' lateral extra-articular tenodesis with ACL reconstruction did restore native knee laxity.

Indexed as

AgedAnterior Cruciate Ligament InjuriesAnterior Cruciate Ligament ReconstructionBiomechanical PhenomenaCadaverFemaleHumansJoint InstabilityKneeMaleMiddle AgedRange of Motion, ArticularRotationTenodesisTorqueACL reconstructionAnterolateral rotational instabilityBiomechanicsKnee laxityLateral extra-articular tenodesisMonoloop

Identifiers

PMID31980844
PMCPMC7148266
OpenAlexW3002479668

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.