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Tibial slope and medial menisectomy significantly influence short-term knee laxity following ACL reconstruction
Author(s):
Valoroso M. (Italy)
,
Valoroso M. (Italy)
Affiliations:
Pungitore M.
,
Pungitore M.
Affiliations:
La Barbera G.
,
La Barbera G.
Affiliations:
Pasqualotto S.
,
Pasqualotto S.
Affiliations:
Valluy J.
,
Valluy J.
Affiliations:
Saffarini M.
,
Saffarini M.
Affiliations:
Demey G.
,
Demey G.
Affiliations:
Dejour D.
Dejour D.
Affiliations:
ESSKA Academy. Valoroso M. 05/09/18; 209487; P06-1970 Topic: Knee
Dr. Marco Valoroso
Dr. Marco Valoroso
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Abstract
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Objectives: Background: Elevated knee laxity following ACL reconstruction often compromises functional outcomes and increases risks of graft rupture. The causes of such knee laxity remain controversial and stronger evidence is necessary to help surgeons prescribe adjuvant procedures and rehabilitation protocols, as well as estimate risks of resuming particular sports.
Purpose: To determine demographic, anatomic and surgical factors associated with side-to-side (SSD) differential laxity and anterior tibial translation (ATT) x-ray measurements 6 to 12 months following ACL reconstruction. The hypothesis was that both SSD and ATT would be associated with excessive tibial slope (>8°) and medial meniscal lesions.

Methods: The authors prospectively evaluated all patients that underwent primary ACL reconstruction in 2014 at our center. The inclusion criteria were patients aged over 16 years, full clinical and radiographic evaluation at 8 post-operative months, including SSD differential laxity (measured using Telos device with 150N load) and ATT (measured on x-rays in monopodal stance), tibial slope (measured on true sagittal view x-rays) and pivot-shift test, as well as strict adherence to the standard rehabilitation protocol. The exclusion criteria were previous surgery or fractures in either knee, concomitant neuromuscular pathologies, and other conditions that could alter tissue laxity. Uni- and multi-variable linear regressions were performed to determine significant associations between laximetry values (SSD and ATT) and demographic and anatomic factors (gender, age, BMI, tibial slope, medial and/or lateral meniscal lesions).

Results: A total of 171 patients (69% men) met the criteria, aged 30.4±10.3 years (range, 16-60). Their mean BMI was 24.6±3.5 (range, 18.6-35.3) and tibial slope was 9.9°±2.5° (range, 4°-16°). Patellar tendon (PT) grafts were used in 40 (23%) while hamstrings tendon grafts (HT) were used in 131 (77%). Medial meniscal sutures or partial menisectomies were performed in 44 (26%) and 24 (14%), respectively. Lateral meniscal sutures or partial menisectomies were performed in 31 (18%) and 29 (17%), respectively. The post-operative SSD was 2.2±3.7 mm (range, -12.7-10.4) and ATT was 2.8±3.6 mm (range, -4.2-17.8). Multi-variable regression confirmed significant associations
between ATT and tibial slope over 8° (p<0.01), medial menisectomies (p<0.001), and medial meniscal sutures (p<0.05), but revealed no significant associations between SSD and any variables.

Conclusions: Increased laxity observed in some patients following ACL reconstruction could be attributed to graft elongation due to excessive bony and/or effective tibial slopes leading to an excessive stress. The congenital factors and injury patterns should therefore be considered when prescribing weight-bearing and/or post-operative rehabilitation to protect the graft and prevent from a biological failure.

Keywords:
Knee - ACL - Laxity
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