None listed
Conditions
Brief summary
Anterior Cruciate Ligament (ACL) reconstruction is an ever evolving subject. Significant improvements have been seen for this procedure over the past few decades, yet we still have high complication rates in the general population. Loss of extension post reconstruction has been reported as having an incidence as high as 59%. A loss of more than five degrees of extension can cause significant gait abnormalities, patellofemoral pain (pain behind the knee-cap) and quadriceps weakness. This in turn can affect the patient's confidence in returning to full activities. There are several causes of loss of extension post ACL reconstruction. The factor that will be assessed in this project will be the angle of the knee during graft fixation intra-operatively. Traditional orthopaedic teaching dictates tensioning the graft with the knee positioned between 20-30 degrees. There has been increasing evidence (mainly in biomechanical studies conducted in cadavers) that demonstrates over-constrained knees when the graft is tensioned in a flexed knee instead of a fully extended knee. This study aims to quantify the loss of extension associated with tensioning the ACL graft in a flexed knee. Patients that are undergoing ACL reconstructions will be included. In these patients we will assess their range of motion in both knees before the operation. During the operation the range of motion of the operative knee will be re-assessed using Computer Navigation for accuracy and reproducibility, The graft will be fixed on the femoral side and temporarily locked on the tibial side whilst the knee is in flexion. Then the knee will go through a full range of motion arc and measurements will be recorded. The graft will then be permanently fixed whilst the knee is in extension and the same motions and measurements will be undertaken. The anterior-posterior and rotational laxity of the knee will also be measured at the end of the operation.
Interventions
Two orthopaedic surgeons with over 20 years of clinical experience will carry out anterior cruciate ligament (ACL) reconstructions on patients with deficient ACLs. This will occur in the surgical theatre of a private hospital. The patients were to have this surgery regardless of participation in the study. During the ACL reconstruction, a hamstring graft will be tensioned first in flexion and then in extension. Using computer navigation, baseline measurement of anisometricity, extension range an
Two orthopaedic surgeons with over 20 years of clinical experience will carry out anterior cruciate ligament (ACL) reconstructions on patients with deficient ACLs. This will occur in the surgical theatre of a private hospital. The patients were to have this surgery regardless of participation in the study. During the ACL reconstruction, a hamstring graft will be tensioned first in flexion and then in extension. Using computer navigation, baseline measurement of anisometricity, extension range and tibial rotation will be recorded. The graft will be tensioned and provisionally fixed with the knee flexed beyond is anisometric point and the extension range will be recorded. Following this first set of measures, the graft will be fixed in full extension and range as well as tibial rotation will be recorded. The difference in range of motion between tensioning in flexion versus tensioning in full extension will be compared. This will be compared with the range of motion and laxity of the non-operative knee. The rest of the surgery will then follow as per the standard ACL reconstruction technique by this surgeon. There will be no changes to post-operative care or rehabilitation. Data collected on day of surgery will be used for the analysis to test hypothesis. The additional measures adds 10 minutes to the standard procedure.
Sponsors
Orthopaedic Research Institute of Queensland
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
Patients scheduled to undergo Anterior Cruciate Ligament Reconstructions under the care of the investigating surgeons Patients with an isolated ACL injury Male and female Age 16 - 90 Able to provide informed consent Patients with BMI < 40
Exclusion criteria
Patients with ligament injuries other than ACL injury (determined from magnetic resonance imaging and clinical review) Patients with previous knee surgery in operative knee Patients with BMI > 40 Patients who are pregnant or planning to become pregnant during the course of the study Patients unable to provide informed consent
Outcome results
None listed