caa a22 4500 605458294 CHVBK 20210128100228.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s00167-015-3772-8 doi (NATIONALLICENCE)springer-10.1007/s00167-015-3772-8 Single-bundle ACL reconstruction with and without extra-articular reconstruction: evaluation with robotic lower leg rotation testing and patient satisfaction scores [Elektronische Daten] [Thomas Branch, Frédéric Lavoie, Christian Guier, Eric Branch, Timothy Lording, Shaun Stinton, Philippe Neyret] Purpose: The purpose of this study was to compare the biomechanical characteristics and patient outcomes after either isolated intraarticular ACL reconstruction or intraarticular reconstruction with lateral extra-articular tenodesis. In addition, we aimed to evaluate biomechanical parameters of the entire uninjured, contralateral knee as a baseline during the analysis. Methods: Eighteen patients were evaluated at an average of 9.3years after ACL reconstruction. Twelve patients had an intraarticular reconstruction (BTB), and six had an additional lateral extraarticular procedure (BTB/EAR). Patients were selected for the additional procedure by the operating surgeon based on clinical and radiological criteria. At the time of review, each patient was assessed using subjective patient questionnaires, manual laxity testing, and instrumented laxity testing. Each knee was also evaluated using a robotic lower leg axial rotation testing system. This system measured maximum internal and external rotations at 5.65Nm of applied torque and generated load deformation curves and compliance data. Pointwise statistical comparisons within each group and between groups were performed using the appropriate paired or unpaired t test. Features were extracted from each load deformation curve for comparative analysis. Results: There were no significant differences between the two groups with respect to the patient satisfaction scores or to laxity testing (manual or instrumented). Robotic testing results for within-group comparisons demonstrated a significant reduction in maximum external rotation (8.77°) in the reconstructed leg when compared to the healthy leg (p<0.05) in the BTB/EAR group, with a non-significant change in internal rotation. The slope of the curve at maximum internal rotation was also significantly greater in the reconstructed legs for the BTB/EAR group (p<0.05), indicating reduced endpoint compliance or a harder endpoint. Finally, the leg that received the extra-articular tenodesis had a trend towards a reduced total leg axial rotation. Conversely, patients in the BTB group demonstrated no significant differences between their legs. For between-group comparisons, there was a significant increase in maximum internal rotation in the healthy legs in the BTB/EAR group compared with the healthy legs in the BTB group (p<0.05). If the injured/reconstructed legs were compared, the significant difference at maximum internal rotation disappeared (p<0.10). Similarly, the healthy legs in patients in the BTB/EAR group had a significantly more compliant or softer endpoint in internal rotation, greater maximum internal rotation, and more internal rotation at torque 0 in their healthy legs compared with the healthy legs in the BTB group (p<0.05). These same differences were not noted in the reconstructed knees. The only identifiable significant difference between the injured/reconstructed legs was rotation at 0 torque (p<0.05). Conclusions: In this group of patients who were at an average of 9years from surgery, the addition of a lateral extra-articular reconstruction to a standard bone-tendon-bone intraarticular ACL reconstruction does reduces internal rotation of the tibia with respect to the femur when compared to intraarticular reconstruction alone. It appears that the selection process for inclusion into the BTB/EAR group included an increase in total axial rotation of the healthy knee during the examination along with a decrease in endpoint stiffness at maximum internal rotation. Level of evidence: II. The Author(s), 2015 Rotational laxity nationallicence Robotic knee testing nationallicence Extra-articular augmentation nationallicence ACL reconstruction nationallicence Knee laxity nationallicence Branch Thomas University Orthopedics, Decatur, GA, USA aut Lavoie Frédéric Department of Orthopedic Surgery, Hôpital Notre-Dame, CHUM, Montréal, QC, Canada aut Guier Christian Private Practice, Jacksonhole, WY, USA aut Branch Eric Miami, FL, USA aut Lording Timothy Frankston Hospital, Frankston, VIC, Australia aut Stinton Shaun ArthroMetrix LLC, 441 Armour Place NE, 30324, Atlanta, GA, USA aut Neyret Philippe Department of Orthopaedic Surgery, Centre Albert-Trillat, Hôpital de la Croix-Rousse, Lyon, France aut Knee Surgery, Sports Traumatology, Arthroscopy Springer Berlin Heidelberg 23/10(2015-10-01), 2882-2891 0942-2056 23:10<2882 2015 23 167 https://doi.org/10.1007/s00167-015-3772-8 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00167-015-3772-8 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Branch Thomas University Orthopedics, Decatur, GA, USA aut NATIONALLICENCE 700 1- Lavoie Frédéric Department of Orthopedic Surgery, Hôpital Notre-Dame, CHUM, Montréal, QC, Canada aut NATIONALLICENCE 700 1- Guier Christian Private Practice, Jacksonhole, WY, USA aut NATIONALLICENCE 700 1- Branch Eric Miami, FL, USA aut NATIONALLICENCE 700 1- Lording Timothy Frankston Hospital, Frankston, VIC, Australia aut NATIONALLICENCE 700 1- Stinton Shaun ArthroMetrix LLC, 441 Armour Place NE, 30324, Atlanta, GA, USA aut NATIONALLICENCE 700 1- Neyret Philippe Department of Orthopaedic Surgery, Centre Albert-Trillat, Hôpital de la Croix-Rousse, Lyon, France aut NATIONALLICENCE 773 0- Knee Surgery, Sports Traumatology, Arthroscopy Springer Berlin Heidelberg 23/10(2015-10-01), 2882-2891 0942-2056 23:10<2882 2015 23 167