Researchers identify technique that improves ACL surgery

July 09, 2009

Surgeons from Hospital for Special Surgery in New York have identified a drilling technique that improves the outcome of surgery to reconstruct the anterior cruciate ligament (ACL). The news will be presented during the annual meeting of the American Orthopedic Society for Sports Medicine, June 9-12, in Keystone. Colo.

"We found that the anatomy was better reproduced with the anteromedial portal drilling technique compared to the transtibial technique," said Asheesh Bedi, M.D., a fellow in sports medicine and shoulder surgery at Hospital for Special Surgery who was involved with the study.

In recent years, an improved understanding of the anatomy of the ACL has allowed surgeons to refine techniques to reconstruct the ACL. Investigators at Hospital for Special Surgery (HSS) set out to compare the outcomes of surgeries using two common techniques. "The goal in repairing the ACL is to recreate the normal anatomy, and there are a variety of different techniques to prepare tunnels for ACL reconstruction that have evolved over time," said Dr. Bedi. "The focus of the study was to compare two very common techniques in terms of their ability to reproduce the native ligament anatomy and restore the stability of the knee after reconstruction in a cadaveric model."

The investigators used ten matched cadaveric knees to directly compare the transtibial and anteromedial portal drilling technique. The researchers found that the transtibial technique could not reproduce the position of the ACL, whereas the anteromedial portal drilling technique could better restore the native anatomy. The transtibial technique also presented additional concerns. "In preparing the femoral tunnel using the transtibial technique, the tibial tunnel is inadvertently re-reamed as much as 30 percent and can lead to significant time-zero tunnel expansion," Dr. Bedi said. The transtibial reconstruction also performed inferiorly to the medial portal on a number of biomechanical parameters of stability assessed with computer navigation.

"This study clearly demonstrates that restoring the anatomy of the ACL and the stability of the knee is far superior when the femoral socket is reamed through the anteromedial portal rather than the tibial tunnel, as has been traditionally done by most surgeons," said David W. Altchek, M.D., attending orthopedic surgeon and co-chief of the Sports Medicine and Shoulder Service at HSS. "HSS is an international leader in this innovative solution toward further improving patient outcomes in ACL surgery."

According to Dr. Bedi, the work has translated into modified techniques in the operating room at HSS, where more than 800 ACL surgeries are performed each year. Tears of the ACL are quite common, with between 70,000 and 80,000 reported each year in the United States.
-end-
Other researchers involved in the study are Volker Musahl, M.D., Volker Steuber, M.D., Daniel Kendoff, M.D., Answorth A. Allen, M.D., and Andrew D. Pearle, M.D., all with the Sports Medicine and Shoulder Service at HSS.

About Hospital for Special Surgery

Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics and No. 4 in rheumatology by U.S. News & World Report (2008), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In 2008 and 2007, HSS was a recipient of the HealthGrades Joint Replacement Excellence Award. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Cornell Medical College. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.

For more information contact:
Phyllis Fisher
212-606-1197
FisherP@hss.edu

Tracy Hickenbottom
212-606-1197
HickenbottomT@hss.edu

Hospital for Special Surgery

Related Anterior Cruciate Ligament Articles from Brightsurf:

Study points way to possible new treatment for ligament injuries
A new exosomes study released in STEM CELLS may lead to future treatment for ligament injuries.

Researchers develop synthetic scaffolds to heal injured tendons and ligaments
Top biomedical engineering researcher develops synthetic scaffolds for tendon and ligament regeneration.

Anterior insula activation restores prosocial behavior in animal model of opioid addiction
Researchers in the Arizona State University Department of Psychology have shown that chemogenetic activation of the anterior insula restores prosocial behavior in an animal model of opioid addiction and empathy.

Simple computational models can help predict post-traumatic osteoarthritis
Researchers from the University of Eastern Finland, in collaboration with the University of California in San Francisco, Cleveland Clinic, the University of Queensland, the University of Oulu and Kuopio University Hospital, have developed a method to predict post-traumatic osteoarthritis in patients with ligament ruptures using a simplified computational model.

Does autograft choice in ACL reconstruction affect recurrent ACL revision rates
Young athletes who have anterior cruciate ligament surgery are more likely to need an additional surgery if they received a hamstring graft compared to a bone-patellar tendon-bone graft, according to research presented today at the American Orthopedic Society for Sports Medicine Annual Meeting.

Lateral extra-articular tenodesis reduces hamstring autograft
The addition of lateral extra-articular tenodesis to a hamstring autograft in knee surgery in young active patients significantly reduces graft failure and persistent anterolateral rotatory laxity at two years post operatively.

Mini 'magic' MRI scanner could diagnose knee injuries more accurately
Researchers at Imperial College London have developed a prototype mini MRI scanner that fits around a patient's leg.

Study looks at opioid use after knee surgery
A small study looked at whether reducing the number of opioid tablets prescribed after knee surgery would reduce postoperative use and if preoperative opioid-use education would reduce it even more.

Does stimulation of the brain's dorsal anterior insula trigger ecstasy?
The epileptic 'aura' is a subjective phenomenon that sometimes precedes the visible clinical features of a seizure.

Researchers explore augmented ACL reconstruction procedure
An innovative procedure that explores the use of amnion, bone marrow concentrate and suture tape in ACL reconstruction may result in earlier return to play protocols for athletes, suggests a new study from the Marshall University Joan C.

Read More: Anterior Cruciate Ligament News and Anterior Cruciate Ligament Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.