Combined ACL Research Articles

Impact of surgical timing on the outcome of anterior cruciate ligament reconstruction

The purpose of the present study is the comparison of acute ACL reconstruction with or without meniscus repair within 48h after injury and a delayed surgery during the inflammation-free interval. It was hypothesized that acute ACL reconstruction results in inferior patient reported outcomes and higher frequency of range of motion deficits. The effect of acute (within 48h) and delayed (during the inflammation-free interval) ACL surgery was prospectively studied on 160 consecutive patients with ACL injury between January 2010 and December 2011. Subgroup analyses were performed to evaluate patients with an additional meniscus repair separately from isolated ACL surgeries. During the study period, partial meniscectomies were recorded to evaluate time dependent meniscus reparability. Patient reported outcomes, objective IKDC and manual stability measurements were documented during the 24-month follow-up period. The Pearson Chi-squared test was used to evaluate objective outcome measures. The Mann-Whitney U test was performed to analyse the results of patient reported outcomes. Statistical significance was set at p<0.05. For patients who underwent isolated ACL reconstruction, no statistical significant difference was observed at any time point regarding objective and subjective outcome measures. Significantly fewer patients who underwent acute combined ACL reconstruction and meniscus repair had an extension deficit between 3° and 5° at 12months following surgery (3.7 vs. 22.2%, p<0.05). No difference regarding cyclops removal, re-injury of ACL or meniscus was found between the two surgical timing groups. Further, surgical timing did not influence the reparability of the meniscus. An acute ACL reconstruction within 48h is preferable in highly active patients or competitive athletes. Prospective cohort study, Level II.

Prospective study of the anterior cruciate ligament reconstruction associated with high tibial opening wedge osteotomy in knee arthritis associated with instability.

Chronic ACL insufficiency with associated varus malalignment due to knee osteoarthritis (OA) is challenging to treat surgically. A combined ACL reconstruction (ACLR) with medial open wedge high tibial osteotomy (HTO) without using any metallic implant for HTO is an effective technique. All the patients attending the outpatient department ACL injury and with associated medial compartment OA (Kellegren's grade 2 and grade 3) were considered for inclusion in the study. Forty patients who met inclusion criteria were included in the study. Simultaneous ACLR (single bundle of quadrupled hamstring graft fixed with Endobutton on femoral side and biointerference screw on the tibial side) along with medial opening wedge osteotomy (with tricalcium phosphate wedge) was done. The patients were assessed with IKDC, KOOS scores and any change in anterior tibial translation was also checked. The combined procedure showed mean varus angle correction of 9° (10.5-1.5°), and the mechanical axis of the knee was restored from an average of 172-181.5°. There was a significant improvement in knee score (KOOS and IKDC) after the surgery (p<0.05). The average time for the radiological union of the osteotomy was 3.56 months. The anterior tibial translation was improved. No intraoperative complications and slippage of the synthetic graft were noted in any case. Combined ACLR with HTO (using TCP wedge, without any hardware) is a reliable method that prevents rapid progression of OA. It reliably corrects varus deformity and obviates the use of any hardware.

Kinematic characteristics of anterior cruciate ligament deficient knees with concomitant meniscus deficiency during ascending stairs

ABSTRACTIt is commonly believed that a torn ACL or a damaged meniscus may be associated with altered knee joint movements. The purpose of this study was to measure the tibiofemoral kinematics of ACL deficiency with concomitant meniscus deficiency. Unilateral knees of 28 ACL deficient participants were studied while ascending stairs. Among these patients, 6 had isolated ACL injuries (group I), 8 had combined ACL and medial meniscus injuries (group II), 8 had combined ACL and lateral meniscus injuries (group III) and 6 had combined ACL and medial-lateral meniscus injuries (group IV). Both knees were then scanned during a stair climb activity using single fluoroscopic image system. Knee kinematics were measured at 0°, 5°, 10°, 15°, 30° and 60° of flexion during ascending stairs. At 0°, 15° and 30° flexion of the knee, the tibia rotated externally by 13.9 ± 6.1°,13.8 ± 9.5° and 15.9 ± 9.8° in Group I. Group II and III exhibited decreased external rotation from 60° to full extension. Statistical differences were found in 0°, 15°and 30° of flexion for the 2 groups compared with Group I. In general, the tibia showed anterior translation with respect to the femur during ascending stairs. It was further determined that Group III had larger anterior translation compared with Group IV at 0° and 5° of flexion (−6.9 ± 1.7 mm vs. 6.2 ± 11.3 mm, P = 0.041; −9.0 ± 1.8 mm vs. 8.1 ± 13.4 mm, P = 0.044). During ascending stairs the ACL deficient knee with different deficiencies in the meniscus will show significantly different kinematics compared with that of uninjured contralateral knee. Considering the varying effect of meniscus injuries on knee joint kinematics, future studies should concentrate on specific treatment of patients with combined ACL and meniscus injuries to protect the joint from abnormal kinematics and subsequent postoperative degeneration.

Outcome of Simultaneous Arthroscopic Anterior Cruciate Ligament and Posterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: A Multicenter Prospective Study.

Background:Multiligamentous injuries of knee are a complex problem in orthopaedics. Combined ACL-PCL injuries are uncommon, usually associated with knee dislocations. Extremity vascular status is essential because of possible arterio-venous compromise. These complex injuries require a systematic evaluation and treatment. Single setting simultaneous arthroscopic ACL and PCL reconstruction or a staged approach can be adopted to treat these cases.Objectives:To evaluate functional outcome of simultaneous arthroscopic ACL and PCL reconstruction with hamstring tendon autograft in multiligamentous knee injuries.Patients and Methods:This prospective study was performed on 20 patients with combined ACL-PCL injuries who underwent simultaneous arthroscopic ACL-PCL reconstruction with hamstring tendon. Evaluation of functional outcome was by IKDC and Lysholm-Tegner scores.Results:In 20 patients, mean age 34 years, return to full-time work and to full sports was 8 weeks and 6.2 months respectively. All patients had full range of motion except 2 patients with < 5 degrees flexion loss; 90% had negative Lachmann test; 95% had negative pivot shift and 10% patients had mild posterior drawer at 90 degrees (1+) at final follow up. Mean IKDC score was 90 (range 81 - 94); mean Tegner activity score was 7 and mean Lysholm knee score was 89. 85% returned to preinjury activity level and a 90% satisfaction rate.Conclusions:Simultaneous arthroscopic ACL and PCL reconstructions using hamstring tendon for combined ACL and PCL injuries is a clinically effective, safe, time saving and cost-effective procedure with better patient compliance and reproducible for a timely return of motion, strength, and function with favorable outcome.

Effects of maturation on combined female muscle strength and ACL structural factors.

Relations between lower limb muscle strength and female ACL injury risk are well documented. How these relations combine with key ACL geometries however, is unknown. Identifying how these combined factors are impacted by maturation would benefit current risk screening and prevention efforts. This study compared hamstrings and quadriceps strength and ACL cross sectional area (CSA) indices across three maturation groups. Cross-sectional human experimental. MRI scans of the dominant knee were collected in 35 females stratified into early (9.7±0.8yrs), middle (12.9±1.7yrs), and late (14.8±0.6yrs) maturation groups. Hamstring and quadriceps muscle volumes and ACL CSA measures were obtained. Isokinetic strength data were quantified for dominant knee flexors and extensors. Peak hamstring and quadriceps concentric and eccentric strength per unit volume magnitudes (QCSPV, HCSPV, QESPV, HESPV) were determined. Metrics and select ratios were submitted to a one way ANOVA to determine the main effect of maturation. Significant decreases occurred in HESPV (N/cm(3)) and ACL CSA (cm(2)/kgm), respectively, from early (0.188±0.023N/cm(3), 0.007±0.002cm(2)/kgm) to middle (0.157±0.029N/cm(3), 0.005±0.002cm(2)/kgm, p=0.034, p=0.029), and middle to late (0.132±0.031N/cm(3), 0.003±0.001cm(2)/kgm, p=0.044, p=0.018) maturation. A significant decrease in HESPV:QCSPV occurred between early (1.795±0.496) and middle (1.362±0.277, p=0.018) maturation. ACL CSA was significantly greater in late (37.26±13.35) compared to middle (25.81±9.17, p=0.021) maturation. Key ratios between female knee quadriceps and hamstring strength and ACL size parameters, which may directly impact ACL injury risk, are substantially different among three maturation states. The results are potentially hazardous strength mismatches in mid-pubertal females, where a smaller (weaker) ACL may be unable to stabilize quadriceps dominated loading strategies.

Arthroscopic Transtibial Tunnel Posterior Cruciate Ligament Reconstruction

The goals leading to successful posterior cruciate ligament (PCL) reconstruction surgery include identification and treatment of associated pathology such as posterolateral instability, posteromedial instability, and lower extremity malalignment. The use of strong graft material, properly placed tunnels to as closely as possible approximate the posterior cruciate ligament insertion sites, and the minimization of graft bending also enhance the probability of the PCL reconstruction success. In addition, mechanical graft tensioning, primary and backup PCL graft fixation, and the appropriate postoperative rehabilitation program are also necessary ingredients for PCL reconstruction success. Both single- and double-bundle PCL reconstruction surgical techniques are successful when evaluated with stress radiography, KT-1000 arthrometer measurements, and knee ligament rating scales. Indications for double-bundle PCL reconstruction as of this writing include severe hyperextension of the knee and revision PCL reconstruction. About 2–18-year postsurgical results in combined PCL, ACL, and medial- and lateral-side knee injuries (global laxity) revealed very successful PCL reconstruction using the arthroscopic transtibial tunnel surgical technique. The purpose of this chapter is to describe the arthroscopic transtibial tunnel PCL reconstruction surgical technique and present results with this surgical procedure.

Biomechanical effect of posterolateral corner sectioning after ACL injury and reconstruction.

Posterolateral corner structures functionally interact with the ACL. The aim of this study was to investigate the capability of an isolated ACL reconstruction control laxity parameters in a knee with combined ACL and PLC and the increase in terms of laxity produced by the resection of the PC in an ACL-deficient knee. An in vitro cadaveric study was performed on seven knees. The joints were analysed in the following conditions: intact, after ACL resection, after popliteus complex resection, after ACL reconstruction and after LCL. Testing laxity parameters were recorded with an intra-operative navigation system and defined as: AP displacement at 30° and 90° of flexion (AP30 and AP90) applying a 130N load and IE at 30° and 90° of knee flexion with a 5N load. Sectioning the ACL significantly increased the AP30 at 30° and 90° of knee flexion (p<0.05). At 90° of knee flexion, the resection of the LCL determined a significant increase in terms of AP laxity (p<0.05). At 90° has been found a significant difference for the IE laxity (p<0.05) after PC resection. Sectioning the LCL produced a significant increase in IE laxity at 30° and 90° of knee flexion (p<0.05). Isolated ACL reconstruction is able to control the AP laxity with a combined complete lesion of the PLC at 30° of knee flexion, but not at higher angle of knee flexion. Considering the IE rotations, the reconstruction was not sufficient not even to control a partial lesion of the PLC. These findings suggest that additional surgical procedures should be considerate even when facing combined PLC lesion.

Outcomes of Meniscal Allograft Transplantation in the Pediatric Athlete

Objectives:Meniscal allograft transplantation (MAT) has a successful clinical track record in adults. The results of MAT in children have not been reported. The goal of this study was to report the results of MAT with minimum 2-year follow-up in this unique population.Methods:After IRB approval, all patients under the age of 16 undergoing MAT between 1999 and 2011 and having > 2 year clinical follow-up were identified from a prospectively collected database. Demographic data including age, height, weight, BMI and prior surgery were collected. Functional outcome scores were collected pre-operatively and at 6 months, 1 year, 2 years and final follow up. Differences between scores at each time point were compared using a mixed model repeated measures ANOVA. All re-operations were documented.Results:17 patients met inclusion criteria. Mean age was 14.9 +/- 1.4 years (range 11 - 16). 10/17 patients had undergone prior knee surgery. 59% were female and 41% were male. The average BMI was 23.4 +/- 5.9. Concomitant procedures included 7 ACI, 1 ACI biopsy and one ACL reconstruction. All patients were available for follow-up at an average of 38 +/- 30 months (range 24 - 122). Surgery resulted in significant improvements in KOOS pain, KOOS ADL, KOOS sport and KOOS QOL scores (Figure 1). Similar improvements were seen in Lysholm, IKDC subjective, WOMAC pain, WOMAC function, and SF-12 physical scores. 3/17 (18%) patients underwent subsequent surgical intervention, however only one (6%) required a graft meniscectomy. One patient required a plica excision, and the other a combined ACL reconstruction and ACI. No complications were found in this population.Conclusion:MAT results in predictable improvements in functional outcomes in the pediatric athlete. Most of these improvements were sustained at an average follow up of 38 months. The meniscal re-operation rate was low (6%) and no complications were reported.

Long-term clinical outcomes of combined BPTB ACL reconstruction and popliteus tendon plasty.

A deficiency of posterolateral structures significantly increases the varus load on the ACL, while a chronic ACL lesion, the increased tibial rotation and the repetitive non-physiological knee motion, could affect and damage the integrity of the popliteus tendon. Therefore, the aim of the present study was to report the very long clinical outcomes of a combined single-bundle BPTB ACL reconstruction and popliteus plasty according to Bousquets technique, for the treatment of combined chronic anterior and posterolateral laxities. Fifteen patients that underwent combined ACL reconstruction and popliteal plasty according to Bousquets technique were available at mean 26.8±1.0years (range 25.4-28.0years). All the patients were evaluated clinically and 13 by means of KT-1000 Arthrometer as well. Subjective evaluation was performed with the subjective IKDC, WOMAC and a 0-10 VAS for pain scales. At clinical evaluation, 10 patients (67%) presented a negative anterior drawer test; Lachman test was negative in nine patients (60%); the varus stress test was negative in eight (53%); and the dial test was negative in all but one patient (93%). Only two patients (15%) presented a side-to-side difference >5mm at the instrumented laxity evaluation. The combined single-bundle BPTB ACL reconstruction and popliteal plasty according to Bousquets technique were able to produce very good long-term results, in terms of knee stability, subjective outcomes, functional results and return to sport activity, in case of chronic anterior and posterolateral laxities. Retrospective case series, Level IV.

Management of Chronic Combined ACL Medial Posteromedial Instability of the Knee

The medial collateral ligament is the most commonly injured ligament in the knee. High-grade medial collateral injuries are associated with injuries to the posteromedial structures of the knee. Chronic medial-sided instability is rare due to the intrinsic capacity of the medial ligamentous structures to heal. However, when combined with anterior cruciate ligament deficiency, significant anterior, valgus, and rotatory laxity of the knee occurs. In this review, we discuss the important biomechanical, clinical, and surgical considerations in the management of chronic combined anterior cruciate ligament, medial, and posteromedial instability of the knee.

Anterior cruciate ligament reconstruction-rehabilitation research methodological quality: a systematic review with world region comparisons.

A systematic review and world region comparison of combined ACL reconstruction-rehabilitation studies was performed. Studies that combined ACL surgical-rehabilitative management published between January 1990 and June 2014 were evaluated. The combined terms "rehabilitation" and "anterior cruciate ligament reconstruction" or "ACL reconstruction" were used to search the CINAHL Plus, Cochrane Library, MEDLINE, PEDro, and PubMed databases. A total of 5920 studies were initially identified. Inclusion criteria reduced this total to 299 studies that underwent abstract review. Following this, 155 studies underwent full text review and 109 met all inclusion criteria for Modified Coleman Methodology Score (MCMS) evaluation. Overall, MCMS were 74.0±17 (mean±standard deviation). Europe had slightly greater MCMS than North America (P=0.041). Specific MCMS components that displayed significant world region differences included use of an independent investigator (Europe>North America and Asia; P=0.047), including a patient-completed written assessment (Europe>North America and Asia; P=0.009), allowing the patient to complete the assessment without medical, surgical, or rehabilitation personnel intervention (Europe>North America and Asia; P=0.009), and use of well-described subject selection or inclusion criteria (Europe>North America and Asia; P=0.004). Tegner Activity Scale (P=0.042) and VAS-Pain Scale (P=0.007) use was greater in Europe compared with other world regions. Primary rehabilitation theme frequency was comparable between world regions (n.s.). Regional research methodological quality differences were observed. Europe displayed a slightly greater MCMS for combined ACL reconstruction-rehabilitation studies. With this information, research groups can design better team-based approaches to ensure that study findings provide sufficient significance to foster meaningful patient care improvements. Systematic review, Level III.

Diagnostic value of the clinical investigation in acute meniscal tears combined with anterior cruciate ligament injury using arthroscopic findings as golden standard.

The main purpose of our study was to evaluate the accuracy of clinical investigation for meniscal tears associated with ACL injuries. We hypothesized that combined ACL injury can decrease the accuracy of clinical examination in acute onset. One hundred and thirty-seven patients with a mean age of 28.5 years (from 12 to 55) were prospectively examined for acute combined ACL and meniscal injuries, between March and November 2012 at our department. For meniscal tears, clinical examination was performed using McMurray test, Apley test and medial and lateral joint line tenderness. The diagnoses of ACL tear were made using Lachman test, jerk test and pivot-shift test, anterior drawer test and KT-2000 side-to-side difference. Each patient was examined using X-ray and MRI. All the patients underwent arthroscopic surgery performed by the same surgeon within 6 weeks after the injury. Finally, using the arthroscopic findings as gold standard, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of clinical investigation and MRI were evaluated. The specificity of clinical investigation was 63.5 and 46.0 % and the sensitivity was 74.4 and 77.3 % for the medial meniscus and the lateral meniscus, respectively. Overall, the accuracy of the clinical investigation was 70.3 % for the MM and 65.5 % for the lateral meniscus. The accuracy of MRI investigation was 76.4 and 69.5 % for medial and lateral meniscus, respectively. In combined acute ACL injury and meniscal tears, we have found a decreased accuracy of the clinical investigation. The remnants of the torn ACL and the synovitis increased the rate of false positives, and it could simulate meniscal tears. However, clinical investigation can provide sufficient information for the treatment decision and MRI can be avoided as a routine diagnostic tool. Level II, prospective study.

Isolated PCL and ACL Avulsion Fractures of the Knee

Objectives:Isolated combined PCL and ACL avulsion fractures is a rare condition. A 40 year old woman had both PCL and ACL avulsion fracture due to a car accident. These fractures often have a subtle appearance at conventional radiography. Advanced imaging modalities, particularly CT and MRI are helpful to diagnose correctly and define the extent of damage. The aim of the study was point out this rare injury. We diagnosed this patient who had both PCL and ACL avulsion fractures. In the literature only a few case have been reported. We think that these fractures may be missed in the Emergency Department. If a patient is brought to the ED with high-velocity trauma, careful evaluation of bone and soft tissues followed by advanced imaging modalities should be performed.Methods:The PCL avulsion fracture was fixed with a cancellous screw via posterior approach and ACL avulsion fracture was fixed with arthroscopically assisted pull-out sutures 10 days after the traumatic event. The knee was immobilized in 20° flexion. Isometric knee, hip and ankle exercises were started immediately. Six weeks later after the operation active range of motion exercises and partial weight-bearing were allowed. In the third month full weight bearing was allowed and full range of motion was achieved.Results:Both PCL and ACL avulsion fractures healed uneventfully.Conclusion:Although knee injuries are frequent, simultaneous PCL and ACL avulsion fractures are rare . The clinician should have a high index of suspicion for these injuries. Careful physical examination and radiological imaging, especially magnetic resonance imagination is helpful in the diagnosis. Early surgical repair and appropriate rehabilitation are the keys to a good outcome in these injuries.

Long-term followup of surgically treated knee dislocations: stability restored, but arthritis is common.

Surgical treatment of knee dislocations is intended to correct the anatomic injury and restore knee stability and patient function. Several studies have shown successful results with surgical treatment of knee dislocations with up to 10 years of followup, but longer-term studies are uncommon. We evaluated patients treated surgically for knee dislocations at 10-year followup to assess (1) knee stability; (2) return to preinjury level of function; (3) development of arthrosis; and (4) range of motion (ROM) loss. This study was a retrospective review of 127 combined PCL, ACL, and medial and/or lateral side reconstructions performed by a single surgeon (GCF) between 1990 and 2008. Of these, 44 were available for clinical and functional evaluation (35%) at a minimum 5-year followup. Inclusion criteria were combined PCL/ACL plus medial and/or lateral side reconstruction. Evaluation methods included arthrometer measurements, stress radiography, knee ligament rating and activity scales (Lysholm and Tegner), plain radiographs with osteoarthritic assessment, and physical examination. Of the 44 patients, there were nine ACL/PCL medial, 22 ACL/PCL lateral, and 13 ACL/PCL mediolateral reconstructions. Followup was at a minimum of 5 years (mean, 10 years; range, 5-22 years). The mean age at the time of injury was 31 years with a range of 13 to 65 years. The mean arthrometer-measured side-to-side differences were as follows: PCL screen, 1.9 mm; corrected posterior, 2.4 mm; corrected anterior, 0.8 mm; and anterior displacement at 30° of knee flexion, 1.7 mm. Stress radiographic measurements at 90° of knee flexion revealed a mean side-to-side difference of 1.9 mm. Mean Lysholm, and Tegner scores were 84 of 100 and 4.1 of 9, respectively. Ninety-three percent (41 of 44) of patients returned to their preinjury level of activity or one Tegner grade lower. Ten of the 44 knees (23%) developed degenerative joint disease. The mean flexion loss was 12.5°, and flexion contractures were not seen in any of the patients. We found that a high proportion of patients treated for these severe injuries achieved static and functional stability, allowing the return to physically demanding work and recreational activities, but that nearly one-fourth of them will develop arthritis at a mean of 10 years. We cannot extrapolate our results to an elite athlete population, but our results probably apply well to working class populations. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Surgical Treatment of Knee Dislocations: 5 to 22 Year Results

The purpose of this paper is to present the results of surgical treatment of knee dislocations with 5 to 22 year follow up in 44 patients in this retrospective case series. Inclusion criteria are a combined PCL ACL plus medial and or lateral side reconstruction in patients with 5 to 22 year follow up. The surgery was performed by one surgeon for all patients. The mean follow up was 9.8 years with a range of 5 to 22 years. The patient age at the time of surgery was 30.9 years, with an age range of 13 to 65 years. The diagnosis were 9 ACL PCL medial (20.5%), 22 ACL PCL lateral (50.0%), and 13 ACL PCL medial lateral (29.5%). Mechanisms of injury included 26 motor vehicle related (59.1%), 9 sports injuries (20.5%), 6 industrial/farming (13.6%), and 3 pedestrian automobile encounters (6.8%). Evaluation methods included KT 1000 arthrometer measurements, stress radiography, knee ligament rating scales, physical examination, and plain radiographs. The KT 1000 arthrometer mean side to side difference measured in millimeters are: PCL screen 1.9 mm, corrected posterior 2.4 mm, corrected anterior 0.8 mm, and the anterior displacement at 30 degrees of knee flexion 1.7 mm. The combined mean side to side difference measurement for all parameters was 1.7 mm. Stress radiographic measurements at 90 degrees of knee flexion to evaluate the PCL reconstruction revealed a mean 1.9 mm side to side difference. Mean Lysholm knee ligament score was 84.4/100. Mean Hospital for Special Surgery score was 82.8/100. Mean Tegner score was 4.1/9. 65.1% of patients returned to their pre-injury level of activity, and 92.8% of postoperative patients returned to their pre-injury level of activity or one Tegner grade lower level of function. Post reconstruction physical examination for the PCL revealed 97.8% of knees had symmetrical or less than grade one posterior drawer (43 of 44 knees). Post ACL reconstruction 39 knees had symmetrical Lachman test (86.6%) and 40 knees had symmetrical (negative) pivot shift (90.9%). Symmetrical varus was present in 41 knees (93.2%), and symmetrical valgus was present in 43 knees (97.7%). Axial rotation was symmetrical to the normal knee in 38 knees (86.4%) and tighter than the normal knee in 6 (13.6%). There were 10 of the 44 knees developed degenerative joint disease (22.7%), and 3 of the 44 knees required total knee replacement (6.8%). There was no loss of terminal extension in any of the knees, but the mean flexion loss was 12.5 degrees compared to the normal knee. Static stability is achieved and documented with KT 1000 arthrometer measurements (mean 1.7 mm side to side difference), and stress radiography (1.9 mm side to side difference), and these results do not deteriorate with time. Functional stability is achieved with 92.8% of patients returning to physically demanding work and/or recreational activities. Post traumatic degenerative joint disease occurs in 22.7% of the knees in this series, and the incidence increases as the time from injury increases.

Gait biomechanics pre and post combined high tibial osteotomy and acl reconstruction

Gait biomechanics pre and post combined high tibial osteotomy and acl reconstruction

Paper 78: Range of Motion and Quadriceps Muscle Power After the Early Surgical Treatment of Acute Combined ACL and Grade III MCL Injuries: A Prospective Randomized Study of 47 Patients

Early operative treatment of combined ACL and MCL injuries have led to frequent motion complications and slow quadriceps muscle power gains. The purpose of this study is to evaluate the effect of early operative or nonoperative treatments of the concomitant MCL injury on knee range of motion and quadriceps muscle strength in combined ACL/MCL injuries. We also wanted to determine the ability of the rehabilitation program to restore normal knee motion after early operative intervention.

Paper 15: MCL Rupture Need Not be Treated Operatively in Acute Combined ACL and Grade III MCL Injuries. A Prospective Randomized Study

Paper 15: MCL Rupture Need Not be Treated Operatively in Acute Combined ACL and Grade III MCL Injuries. A Prospective Randomized Study

Surgical management of multiple knee ligament injuries

To summarize our experience and mid-term results of reconstruction with Iliotibial tract grafts for multiple ligament injuries. Between July 1997 and December 2003, multiple ligament injuries of 15 patients were reconstructed with Iliotibial tract grafts in arthroscopy. There were 5 women and 10 men. The mean age at the time of the surgery was 30.5years (range 25-43years). There were 7 cases who were injured with combined ACL rupture and the PCL, and 8 cases were with disruption of both the ACL and the PCL, combined with damage of the medial collateral ligament. Fifteen patients were followed up for a mean of 7.5years (range 6-12years). The overall mean postoperative Lysholm score was 84.3±5.7. At final IKDC qualification, 60.0% of the knees were normal or nearly normal. The overall average Tegner activity score decreased significantly at the re-examination compared to the activity score before accident (3.6±0.5 vs. 5.1±0.6). Reconstruction with Iliotibial tract grafts in arthroscopy was a reliable treatment for multiple ligament injuries.

Surgical Technique: Does Mini-invasive Medial Collateral Ligament and Posterior Oblique Ligament Repair Restore Knee Stability in Combined Chronic Medial and ACL Injuries?

Residual laxity remains after ACL reconstruction in patients with combined chronic ACL and medial instability. The question arises whether to correct medial capsular and ligament injuries when Grade II and III medial laxity is present. We developed a mini-invasive medial ligament plasty to repair the medial collateral ligament to correct residual medial valgus and rotatory laxity after ACL reconstruction. We prospectively followed 36 patients with an ACL deficiency combined with chronic Grade II or III valgus and rotatory medial instability. The mean age was 37 years (range, 15-70 years). For all patients, we obtained preoperative and postoperative Knee Injury and Osteoarthritis Outcome, International Knee Documentation Committee, Lysholm, and Tegner Activity Level Scores. The minimum followup was 2 years (median, 3 years; range, 2-7 years). The mean subjective International Knee Documentation Committee score improved from 36 preoperatively to 94 at the last followup. While all patients had an International Knee Documentation Committee score of Grade C or D preoperatively, no patient did postoperatively. The mean Knee Injury and Osteoarthritis Outcome Score improved from 45 preoperatively to 93 postoperatively. Valgus and external rotatory tests were negative in all patients. The mean Tegner activity level decreased from 7 preinjury to 6 postoperatively, and the mean Lysholm score improved from 40 preoperatively to 93 at last followup. This simple technique restored medial stability and knee function to normal or nearly normal in all patients. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.