This case series evaluates whether patients with an anterior cruciate ligament (ACL) repair have better outcome if the anterolateral ligament (ALL) was repaired or not considering the ultrasound (US) pre-surgical recommendation.
In this case series, the surgeon will decide which patient will have ACL only or ACL and ALL surgery on the basis on multiple parameters. All patient will undergo detailed pre-clinical evaluation, including an ultrasonographic evaluation of the integrity of the ALL. Two subgroups will be compared for the primary outcome (International Knee Documentation Committee score at 8 months of follow-up). In subgroup 1, the surgeon will follow the ultrasonographic evaluation of the ALL considering the ALL repair (i.e. : ALL intact on the ultrasound, ACL repair only; ALL broken on ultrasound; ACL and ALL repair). In subgroup 2, the surgeon will not follow the ultrasonographic evaluation of the ALL considering the ALL repair. Secondary outcomes of interest will be evaluated with multivariate regression analysis. Sample size calculation: The chosen parameter of interest for the primary outcome evaluation is a continuous response variable (IKDC score) from two independent subgroups (ultrasonographic evaluation of the ALL followed or not for the surgical repair), considering a ratio of 1:3 between the two subgroups. In a previous study (AJSM Sonnery-Cottet 2017) the response within each subject group was normally distributed with standard deviation 13.1. If the true difference between the group means is the published minimal clinically important difference of 9 (AJSM Nwachukwu 2017), we will need to study 30 experimental subjects and 90 control subjects to be able to reject the null hypothesis that the population means of the experimental and control groups are equal with probability (power) 0.9. The Type I error probability associated with this test of this null hypothesis is 0.05.
Study Type
OBSERVATIONAL
Enrollment
120
Surgical repair of the ACL using semitendinous autograft
Surgical repair of the ACL using semitendinous autograft, and surgical repair of the ALL using an allograft (Arthrex, Extra-Articular Augmentation device)
Hôpital de la Providence
Neuchâtel, Switzerland
RECRUITINGIKDC score
Self-reported IKDC (International Knee Documentation Committee Subjective Knee Form) score, scaled between 0 and 100 (100 = good function)
Time frame: Month 8
IKDC score
Self-reported IKDC (International Knee Documentation Committee Subjective Knee Form) score, scaled between 0 and 100 (100 = good function)
Time frame: Months 0, 2, 5, 12
Lysholm score
The Lysholm score is a 100-point scoring system for examining a patient's knee-specific symptoms including mechanical locking, instability, pain, swelling, stair climbing, and squatting, scaled between 0 and 100 (100 = good function)
Time frame: Months 0, 2, 5, 8, 12
SANE score
The Single Numeric Assessment Evaluation is a subjective percentage of the knee functionality, scaled between 0% and 100% (100% = good function)
Time frame: Months 0, 2, 5, 8, 12
Return-to-play
Timing when return-to-play to full sports activities is possible
Time frame: Months 5, 8, 12
Clinical evaluation: reverse pivot shift test
Described as "Clunk absent", "Clunk present", or "Clunk present with shake"
Time frame: Months 0, 2, 5, 8, 12
Clinical evaluation: anterior drawer test
Described as "Hard stop", "Soft stop", or "Soft stop and increased course"
Time frame: Months 0, 2, 5, 8, 12
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Clinical evaluation: Lachman test
Described as "Hard stop", "Soft stop", or "Soft stop and increased course"
Time frame: Months 0, 2, 5, 8, 12
Clinical evaluation: thigh circumference 10 cm proximal to the patella
measure in cm
Time frame: Months 0, 2, 5, 8, 12
Clinical evaluation: thigh circumference 15 cm proximal to the patella
measure in cm
Time frame: Months 0, 2, 5, 8, 12
Clinical evaluation: knee extension
Measured in °. Negative values associated with bad outcome
Time frame: Months 0, 2, 5, 8, 12
Isokinetic test: knee extensors concentric strength
Measured in absolute value and comparative value with controlateral limb
Time frame: Months 5 & 8
Isokinetic test: knee flexors concentric strength
Measured in absolute value and comparative value with controlateral limb
Time frame: Months 5 & 8
Isokinetic test: knee flexors eccentric strength
Measured in absolute value and comparative value with controlateral limb
Time frame: Months 5 & 8
Rerupture rate
Patients will be evaluated by phone at 3 years of follow-up. Rerupture of the ACL graft (yes-no) will be recorded.
Time frame: Year 3