Complete ACL Tear Research Articles

Deep learning-based automated detection and segmentation of bone and traumatic bone marrow lesions from MRI following an acute ACL tear

IntroductionTraumatic bone marrow lesions (BML) are frequently identified on knee MRI scans in patients following an acute full-thickness, complete ACL tear. BMLs coincide with regions of elevated localized bone loss, and studies suggest these may act as a precursor to the development of post-traumatic osteoarthritis. This study addresses the labour-intensive manual assessment of BMLs by using a 3D U-Net for automated identification and segmentation from MRI scans. MethodsA multi-task learning approach was used to segment both bone and BML from T2 fat‐suppressed (FS) fast spin echo (FSE) MRI sequences for BML assessment. Training and testing utilized datasets from individuals with complete ACL tears, employing a five-fold cross-validation approach and pre-processing involved image intensity normalization and data augmentation. A post-processing algorithm was developed to improve segmentation and remove outliers. Training and testing datasets were acquired from different studies with similar imaging protocol to assess the model's performance robustness across different populations and acquisition conditions. ResultsThe 3D U-Net model exhibited effectiveness in semantic segmentation, while post-processing enhanced segmentation accuracy and precision through morphological operations. The trained model with post-processing achieved a Dice similarity coefficient (DSC) of 0.75 ± 0.08 (mean ± std) and a precision of 0.87 ± 0.07 for BML segmentation on testing data. Additionally, the trained model with post-processing achieved a DSC of 0.93 ± 0.02 and a precision of 0.92 ± 0.02 for bone segmentation on testing data. This demonstrates the approach's high accuracy for capturing true positives and effectively minimizing false positives in the identification and segmentation of bone structures. ConclusionAutomated segmentation methods are a valuable tool for clinicians and researchers, streamlining the assessment of BMLs and allowing for longitudinal assessments. This study presents a model with promising clinical efficacy and provides a quantitative approach for bone-related pathology research and diagnostics.

Role of MRI in evaluation of a tear in the anterior cruciate ligament

Magnetic resonance imaging is one of the most crucial procedures used to diagnose and follow up several orthopedic approaches and interventions. This study aimed to assess and evaluate the efficacy of MRI in diagnosing ACL among different patients who attend the radiology department. A case series correlational study was conducted among randomly selected patients with AC in different stages for 11 months of study correlations. The results revealed that among 40 patients with partial or complete ACL tears and assessing the MRI approaches with evaluating its accuracy, specificity, and sensitivity with selected cases under radiograph.This study concluded that MRI is main radiological procedure used to assess and evaluate the degree of bone and tendons injuries, specially, ACL tears.

Paper 27: Preoperative Risk Factors of Subsequent Ipsilateral ACL Revision Surgery following an ACL Restoration Procedure

Objectives: To identify the preoperative risk factors for revision ACL surgery within the first two years after BEAR ACL repair procedure. Methods: Data from the prospective BEAR I, II, and III trials were used to determine preoperative risk factors for ACL revision surgery. All subjects with a complete ACL tear (ages between 13-47 years, depending on the trial), who passed all other inclusion/exclusion trial criteria, and underwent a primary BEAR procedure within 30-50 days from injury (dependent on trial) were included. Demographic data (age, sex, BMI), baseline patient-reported outcomes (IKDC Subjective Score, Marx Activity score), pre-operative imaging characteristics (ACL stump length, notch size, tibial slopes), and intraoperative findings (knee hyperextension, meniscal tear status) were evaluated to determine their contribution to ipsilateral revision ACL surgery risk. Results: 123 subjects, median age 17.6 years (IQR 16-23), including 67 (54%) females, met study criteria. 18 (15%) patients required revision ACL surgery in the first two years following the BEAR procedure. In bivariate analyses, younger age (p=.011), having a contact injury at the time of the initial tear (p=.048), and increased medial tibial slope (p=.029) were associated with a higher risk of ipsilateral revision surgery. Multivariable logistic regression analyses identified two independent predictors of revision: patient age and medial tibial slope. The odds of an ipsilateral revision surgery were decreased by 32% for each one-year increase in age (OR=0.684, 95% CI = 0.517 to 0.905, p=.008), and increased by 28% per each degree of increase in medial tibial slope (OR=1.280, 95% CI =1.024 to 1.601, p=.030). Sex, baseline IKDC or Marx score, knee hyperextension, or meniscus status were not significant predictors of revision. Conclusions: Younger age and higher medial tibial slope were predictors of increased odds of ipsilateral ACL revision surgery after the BEAR procedure. Younger patients with higher tibial slopes should be aware of the increased risk for revision surgery when deciding to undergo ACL restoration surgery.

Pediatric ACL Injuries

Background or Purpose: Managing ACL tears in the skeletally immature patient is a complicated and at times challenging undertaking. As such, it should be undertaken only by a surgeon with experience treating pediatric and adolescent injuries of this nature. Methods: Two basic choices exist: (1) conservative management with or without delayed reconstruction or (2) early reconstruction. While data can be found to support both modes of care, an overwhelming preponderance of the literature supports early operative intervention for complete ACL tears in this population. Results and Conclusions: Operative intervention has consistently been shown to increase knee stability and decrease the risk of further damage to the meniscus and articular cartilage with minimal risk of growth disturbance. Conservative or delayed operative care should only be considered in the most compliant patients with uncomplicated injuries. As there is little data supporting one surgical technique as superior, patient age and surgeon familiarity and comfort should guide the choice. This paper aims to address the natural course of ACL injuries in the skeletally immature patient, treatment options with associated complications, and current preventative strategies

Hidden Meniscus Problems: Ramp Lesion and Posterior Meniscus Medial Root Tear

Ramp lesion (RL) is a peripheral tear affecting the posterior horn of the medial meniscus in the setting of ACL tears. Posterior meniscus medial root tear (PMMRT) is defined as an avulsion of the attachment, or a complete radial tear within 1 cm of the posterior tibial attachments of the meniscus. Both are not uncommonly found. The prevalence of RL existing in conjunction with ACL tears ranges from 9 to 42%. On the other hand, PMMRT contributes up to 10 to 21% of all meniscus tears. Both RL and PMMRT have significant consequences. RT increases anterior tibia translation and internal rotation after ACL reconstruction which may increase graft failure. PMMRT may accelerate the progress of medial knee osteoarthritis. Unfortunately, both conditions are frequently overlooked from physical examination, MRI reading, and arthroscopy procedures, due to the low sensitivity, unfamiliarity, and hidden location of the lesions. Posteromedial tibia edema finding on MRI images in a complete ACL tear in young patients increases the risks of RL. Ghost sign and medial femorotibial edema found on MRI may indicate PMMRT. RL and PMMRT may not be identifiable from the standard arthroscopic view. The trochlear view may be needed for RL and MCL trephination is almost always needed for PMMRT. The stability of both lesions should be assessed by meniscus probing, and repair is the gold standard for unstable lesions. RL can be repaired with sutures from the anterior or posterior. PMMRT is usually repaired using the transtibial pull-out suture technique.

Assessment of femoral notch morphology in male patients with anterior cruciate ligament injury: an MRI study

Aim: The objective of the present study was to evaluate the femoral notch type, notch width index (NWI), notch angle (NA) and α angle in patients with ACL injury and compare with nonathletic male population, using magnetic resonance imaging (MRI).Methods: 79 patients with complete ACL tear and 80 patients as control group (aged 19-43 years) who had knee MRI were evaluated. NWI, NA measurements and notch shape were evaluated on axial fat-saturated proton-weighted sequences. Femoral notch shape was classified as A, U and W types.Results: A statistically significant association was found between notch type, NWI, NA and ACL injury (p<0,001). Type A notch in the ACL-injured group (79.75 %) was significantly higher than the control group (24%). NWI was lower in patients with ACL-injured group than in control group (0.249 ± 0.020 vs 0.281 ± 0.022) Notch angle was lower in patients with ACL-injured group than in control group (47.15 º ± 5.63 º vs 50.73 º ± 5.44º). A significant association between stenotic notch type A and NWI (p <0,001). The α angle was lower in patients with ACL-injured group than in control group but it was not statistically different (41.9 º ±2.79 ºvs 42.06 º ±2.53 º; p= 0.978).Conclusion: This study showed that however low NWI, NA values are a risk factor for ACL injury, the strongest predictive factor was stenotic femoral notch type A. α angle had no significant correlation in ACL injury.

A COMPARATIVE STUDY BETWEEN SUSPENSORY AND APERATURE FIXATION METHOD IN ARTHROSCOPIC SINGLE BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Purpose: To compare the functional outcome of suspensory and aperture fixation method in arthoscopic single bundle anterior cruciate ligament. Method: 30 patient (mean age grp ,35yr)underwent arthroscopic ACL repair with 15 got suspensory and another 15 got aperture fixation in random selection. Similar implant were use to nullify the error.We taken patient with MRI finding of isolated ACL (23)and ACL with medial meniscus tear(7) in our study. No multiligamentous injury were taken.The functional outcome measure with lachman test,Lysholm score ,IKDC score.Post op rehabilitation of early mobilization was done. Inclusion Criteria: Patient given their consent , Age 20-60 years ,Confirmed Complete ACL Tear in MRI Exclusion Criteria: Patients refusing for consent,Patient not ambulatory ,Multiligament knee injury ,Chronic ACL insufficiency with osteoarthritis ,Contradiction to Arthroscopy Result: Patient were followed up in 3week,6week,3month,6month and 1 year.Lysholm score of suspensory were 65.3%, 81.6%,84.5%, 85.1%,97.2%.Aperture fixation scores were 63.7%,76.8%,80.6%,82.13%,95.9%. The IKDC score is 57%, 62.1%,65%,66.6%,77.7% in suspensory fixation and 58.6%,61.6%,63.8%,65.4%,75.1% in aperture fixation. Conclusion: Lysholm score ad IKDC score show no much difference between these two after 3 week,6 week,3 months,6 months of post operation.But after 1 year somehow suspensory had a better result than aperture fixation method.

Right sciatic nerve schwannoma with complete ACL tear: A rare presentation

Right sciatic nerve schwannoma with complete ACL tear: A rare presentation

Poster 262: Correlation of Tanner Stage and Hypermobility with Meniscal and Articular Cartilage Injury in the Pluto Cohort

Objectives:To determine whether the relationship between hypermobility and meniscal and/or articular cartilage injury varies by stage of pubertal development. Patients with hypermobility will have a lower risk of meniscal and articular cartilage injury than patients with normal laxity.Methods:At 10 geographically diverse institutions in the United States, consecutive skeletally immature patients diagnosed with complete ACL tears between January 2016 and April 2020 were enrolled. Beighton score was collected at the preoperative physical exam; bone age was determined from a hand/wrist radiograph; and the presence of meniscal tears and articular cartilage injuries was collected from the surgical assessment. Tanner stage was documented at time of surgery. Univariable and multivariable logistic regression analysis was used to assess the effect of Tanner stage and Beighton score on the likelihood of cartilage injury and meniscal tear.Results:Seven hundred forty-seven skeletally immature patients with complete ACL tears were analyzed with an average age at surgery of 12.3 years; the cohort was 62% male.Eighty-five patients had documented cartilage injuries for an event rate of 11.4%. Bivariate analysis found that those with cartilage injuries had a slightly higher bone age (13.9 versus 13.1 years; p=0.001) and a higher Tanner stage (p=0.009). For each additional Tanner stage, the odds of cartilage injury increased by approximately 1.6 (p<0.001). No association was detected between hypermobility and the likelihood of a cartilage injury.Four hundred twenty-three patients had documented meniscal tears for an event rate of 56.6%. Bivariate analysis found that those with meniscal tears were slightly older (12.6 versus 12.0 years; p<0.001), had a slightly higher bone age (13.5 versus 12.8 years; p<0.001) and a higher Tanner stage (p=0.002). For each additional Tanner stage, the odds of a meniscal tear increased by approximately 1.3 times (p<0.001). No association was detected between hypermobility and the likelihood of a meniscal tear.Conclusions:There is a high rate of concomitant articular cartilage and meniscal injuries in skeletally immature patients who sustain ACL tears. The risk of concurrent injury is associated with increasing bone age and Tanner score. There was no association between these concurrent injuries and hypermobility.Figure 1.Distribution of Tanner stage by cartilage injury groups.Figure 2.Distribution of Tanner stage by meniscal tear groups.

No differences found in long-term outcomes of a randomized controlled trial comparing ipsilateral versus contralateral hamstring graft in ACL reconstruction.

Contralateral graft harvest in primary ACL reconstruction is relatively uncommon and the long-term comparative of this approach relative to ipsilateral harvest has not been described. The purpose of this study was to evaluate ACL graft and contralateral rupture following ipsilateral or contralateral semitendinosus and gracilis (STG) graft harvest at follow-up of a minimum 10years post-reconstruction in the treatment of a complete ACL tear. Patients from a previous randomized trial were evaluated. The primary outcome measures were ipsilateral and contralateral reinjury as well as the International Knee Documentation Committee (IKDC) knee assessment form, the ACL Quality of Life questionnaire (ACL-QoL) and the Tegner activity scale. Participants completed four different single-leg hop tests and concentric knee flexion and extension strength were assessed on an isokinetic dynamometer. Of the original 100 patients, 50 patients (41.3 ± 9.5years of age, 31 males, 19 females) reported on re-injury at 12.6 ± 1.4years post-operative. Thirty-eight patients returned for full assessment and 12 responded by mail or phone survey. There were no differences between groups for graft rupture, contralateral injury, ACL-QoL score, IKDC categorization, or anterior tibial translation, though both groups experienced a reduction in the Tegner Activity Scale from their preinjury scores. There was no difference in knee flexor and extensor isokinetic concentric strength, or single leg hop test performance. Knee flexor strength limb symmetry index was reduced when measured in the supine relative to the seated position in both groups, indicating persistent deficits in knee flexor strength when measured in the supine position. Contralateral hamstring harvest does not put patients at an increased risk of a contralateral ACL tear and long-term outcomes of ACL reconstruction do not differ based on the side of graft harvest. Contralateral STG harvest may provide a safe alternative surgical option for select patients. Level II.

Descriptive Epidemiology of Complete ACL Tears in the Skeletally Immature Population: A Multicenter Investigation of the Pluto Study

Background:ACL injuries are being seen with increased frequency in pediatric and adolescent patients. Understanding patient and injury characteristics as well as treatment strategies are important to help guide future surgical decisions in the care of these young patients.Hypothesis/Purpose:To report the demographic characteristics and descriptive epidemiology of a large cohort of skeletally immature patients with complete ACL tears through a prospective, multicenter study.Methods:At 10 geographically diverse institutions in the United States, consecutive skeletally immature patients diagnosed with complete ACL tears between January 2016 and April 2020 were enrolled. Treatment was provided by one of 23 participating orthopedic surgeons. Patient demographics, including chronological and skeletal age, sex, race, ethnicity, as well as anthropometric measures, mechanism of injury, and ACL treatment type were collected.Results:748 skeletally immature patients were included in the final cohort; the mean chronological age was 12.3 years, and 62.3% were male. Mean skeletal age (13.2 years) was on average 0.9 years higher than mean chronological age (p<0.001). The median BMI percentile for the cohort was 71st (IQR, 45-88), and 10.8% were classified as obese (≥95th percentile). 5.3% reported a previous ipsilateral knee injury, and 32.5% had a family history of ACL injuries. Sport was the predominant mechanism of injury (89.4%), with non-contact injuries the most common (61.5%). When stratified by sex, non-contact injury was significantly higher in females (68.3%) than males (57.4%) (p=0.005). The most common sport resulting in an ACL tear among males was football (41.2%) and among females was soccer (44.2%) (p<0.001). 99.9% percent of skeletally immature patients were treated surgically by one of four reconstruction techniques: transphyseal (52.7%), partial transphyseal (7.1%), all-epiphyseal (13.1%), and the physeal sparing iliotibial band (ITB) technique (27.0%). One patient underwent non-operative treatment. The most common surgical techniques for patients with a bone age younger than 13 years were physeal sparing with ITB (56.7%) and all-epiphyseal (21.8%), while in patients with a bone age of 13 years and older, transphyseal (71.1%) and physeal sparing with ITB (11.9%) were most common (p<0.001).Conclusion:This multicenter, prospective study is the first to describe the characteristics of an exclusively skeletally immature cohort with complete ACL tears. Almost all patients were injured during sports, surgical treatment was overwhelmingly the treatment of choice, and preferred surgical techniques varied based on skeletal age.

Correlation of Tanner Stage and Hypermobility with Meniscal and Articular Cartilage Injury in the Pluto Cohort

Background:ACL injuries in adults are frequently accompanied by meniscal and articular cartilage damage. However, little is known regarding the correlation of Tanner stage and hypermobility in ACL-deficient skeletally immature patients and the risk of these associated injuries.Hypothesis/Purpose:The relationship between hypermobility and meniscal and/or articular cartilage injury varies by stage of pubertal development. Patients with hypermobility will have a lower risk of meniscal and articular cartilage injury than patients with normal laxity.Methods:At 10 geographically diverse institutions in the United States, consecutive skeletally immature patients diagnosed with complete ACL tears between January 2016 and April 2020 were enrolled. Beighton score was collected at the preoperative physical exam; bone age was determined from a hand/wrist radiograph; and the presence of meniscal tears and articular cartilage injuries was collected from the surgical assessment. Tanner stage was documented at time of surgery. Univariable and multivariable logistic regression analysis was used to assess the effect of Tanner stage and Beighton score on the likelihood of cartilage injury and meniscal tear.Results:Seven hundred forty-seven skeletally immature patients with complete ACL tears were analyzed with an average age at surgery of 12.3 years; the cohort was 62% male. Eighty-five patients had documented cartilage injuries for an event rate of 11.4%. Bivariate analysis found that those with cartilage injuries had a slightly higher bone age (13.9 versus 13.1 years; p=0.001) and a higher Tanner stage (p=0.009). For each additional Tanner stage, the odds of cartilage injury increased by approximately 1.6 (p<0.001). No association was detected between hypermobility and the likelihood of a cartilage injury. Four hundred twenty-three patients had documented meniscal tears for an event rate of 56.6%. Bivariate analysis found that those with meniscal tears were slightly older (12.6 versus 12.0 years; p<0.001), had a slightly higher bone age (13.5 versus 12.8 years; p<0.001) and a higher Tanner stage (p=0.002). For each additional Tanner stage, the odds of a meniscal tear increased by approximately 1.3 times (p<0.001). No association was detected between hypermobility and the likelihood of a meniscal tear.Conclusion:There is a high rate of concomitant articular cartilage and meniscal injuries in skeletally immature patients who sustain ACL tears. The risk of concurrent injury is associated with increasing bone age and Tanner score. There was no association between these concurrent injuries and hypermobility.Figure 1.Distribution of Tanner stage by cartilage injury groups.Figure 2.Distribution of Tanner stage by meniscal tear groups.

Influence of tibial plateau morphometric risk factors on ACL injury: A retrospective case control study

Background: ACL injuries lead to significant disability among the injured, often requiring surgical reconstruction. Anatomical morphometric analysis helps us identify individuals who are more susceptible to incurring an ACL injury, despite activity modifications, thereby improving quality of life and decreasing the economic burden posed by a potential ACL injury. We explore the relation between morphometric variations in Tibial plateau measured by Medial Tibial plateau slope (MTS), lateral Tibial plateau slope (LTS), Medial Tibial plateau depth (MTD), Tibial eminence height (TEH), Tibial eminence width (TEW) on MRI in association with an ACL tear. Methods: We retrospectively evaluated 269 patients who underwent knee MRI and clinical examination for suspected ACL pathology. Participants were divided into two groups – cases (ACL-injured) and controls (ACL-uninjured) based on MRI and clinical findings suggestive of a complete ACL tear. In both groups, MTS, LTS, MTD, TEH, TEW were calculated. Results: Patients with steeper MTS and LTS and shallower MTD had increased chances of sustaining an ACL injury (p&lt;0.05). Variations in the Tibial eminence morphometrics, however, didn't show any significant association towards increased chances of an ACL injury. Apart from MTD (p&lt;0.05), gender variations in Tibial morphometrics leading to ACL injury were insignificant.

Femur-tibia angle and patella-tibia angle: new indicators for diagnosing anterior cruciate ligament tears in magnetic resonance imaging

BackgroundFemur-tibia angle (FTA) and patella-tibia angle (PTA) are two MRI measurements that reflect the rotation of the knee joint. The purposes of this study were to assess whether FTA and PTA are associated with ACL tear and to explore their roles in ACL tear diagnosis.MethodsFTA, PTA, ACL angle and anterior tibial subluxation were compared between the two matched groups: ACL tear group and control group (each n = 20). Diagnostic performance was evaluated in a consecutive 120-patient cohort who underwent MR imaging of the knee and subsequently had arthroscopy. Different measurements were assessed by area under the curve (AUC) of receiver operating characteristic (ROC) curve.ResultsFTA and PTA increased significantly in ACL tears group when compared to the control group (4.79 and 7.36 degrees, respectively, p < 0.05). In distinguishing complete ACL tear, ACL angle had the highest AUC of 0.906 while AUC of PTA and FTA were 0.849 and 0.809. The cutoff of FTA was 80 degrees with a sensitivity of 82% and specificity of 68%, while the cutoff of PTA was 91 degrees with a sensitivity of 82% and specificity of 74%. In distinguishing partial ACL tear, FTA and PTA had the highest AUCs of 0.847 and 0.813, respectively. The calculated cutoff of FTA was 84 degrees with a sensitivity of 90% and specificity of 81%, while the cutoff of PTA was 92 degrees with a sensitivity of 80% and specificity of 77%.ConclusionFTA and PTA increased when ACL tears and they might be valuable in diagnosing ACL tears, especially in distinguishing partial ACL tear from intact ACL.

Diagnostic Performance of Multi-Direction Adjusted Multi-Planar Reconstruction with Helical CT for Evaluating Continuity of the Anterior Cruciate Ligament

To analyze the diagnostic performance of MDA-MPR with CT for evaluating ACL structural continuity. A total of 145 patients with highly suspected ACL injury admitted to our hospital between January 2016 and May 2021 were retrospectively enrolled. All patients had undergone examination with MRI, CT, and arthroscopy. Taking arthroscopy results as the gold standard, the diagnostic accuracy for identifying ACL rupture by MRI and MDA-MPR with CT were compared. The receiver operator characteristic curves demonstrated that both MRI and MDA-MPR with CT performed well in the diagnosis of ACL tears. The sensitivities of MRI and MDA-MPR with CT for diagnosing complete ACL tears were 95.16% (59/62) and 90.32% (56/62), respectively. Their specificities in this regard were 77.11% (64/83) and 84.34% (70/83), respectively. MRI had a higher sensitivity but MDA-MPR with CT had a higher specificity for detecting complete ACL tears, and the differences were statistically significant (p <.05). The sensitivities of diagnosing partial ACL tears using MRI and MDA-MPR with CT were 78.79% (26/33) and 75.76% (25/33), respectively, while the specificities were 86.61% (97/112) and 90.18% (101/112), respectively. These differences were non-significant (p >.05). MDA-MPR with CT has high diagnostic efficiency for ACL injuries, especially in the diagnosis of complete ACL tears.

Strong association of meniscus tears with complete Anterior Cruciate Ligament (ACL) injuries relative to partial ACL injuries

BackgroundAnterior Cruciate Ligament (ACL) injuries are often associated with meniscus tears. These meniscus tears in long term may affect the functional outcomes after ACL reconstruction. The present study aims to identify the incidence and relative association of meniscus injuries in complete and partial ACL injuries. MethodsThis was a retrospective study. Patients were divided into 2 groups; group I: partial ACL tear and group 2: complete ACL tear. Both groups were assessed for meniscal tears; either isolated medial/lateral or combined and odds ratio was measured between two groups. ResultsA total of 43 and 219 patients were enrolled in group I and II respectively. The mean age (years) in group I and II were 25.32 ± 7.12 and 28.64 ± 10.84 respectively. There were a total of 5 and 28 females in group I and II respectively. Mean pre-injury Tegner score in group I and II was 7.02 ± 2.87 and 6.82 ± 3.14 respectively. Mean time from injury to surgery (months) in group I and II was 8.04 ± 6.43 and 7.62 ± 4.83 respectively. In group 1 There were a total of 6 with lateral meniscus tears, 9 with medial meniscus tears And 3 with combined meniscal tears in group 1 while in group 2, 47 had lateral meniscal tears, 71 had medial meniscal tears and 71 had combined tears. Group II patients had stronger association for isolated meniscal tears compared to group I, with an odds ratio of 5.05(p < 0.05). Combined meniscal tears had non-significant relation in two groups (p = 0.58). ConclusionPartial ACL injuries present with less risk of acquiring isolated meniscus tears, compared to complete ACL injuries.

Functional outcome of arthroscopic anterior cruciate ligament reconstruction with autologous hamstring graft

Introduction: The ligamentous injuries of the knee are increasing owing to the increasing participation in the sports activities. Anterior cruciate ligament is the most commonly injured ligament in the knee joint. A number of procedures have been recounted for reconstruction of a broken ACL ranging from open to arthroscopic technique. In this study, we have used hamstring autograft for ACL reconstruction and fixed it with endobutton on the femoral end and with interference screw at the tibial end and in addition to this, cancellous screws or suture wheel was used if required. Materials and Methods: A total of 15 cases of complete ACL tear were taken for the study. All patients underwent arthroscopic ACL reconstruction with hamstring graft. All operated patients took Lysholm knee scoring questionnaire and were reviewed at 6 weeks, 3 months, 6 months and 1 year for assessment. Results: At the end of 1 year by Lysholm knee scoring, a total of 27% cases reported excellent results, 53% were good, 13% were fair and 7% obtained poor results. The functional restoration to pre-injury level was seen in 67% of patients. Conclusion: We conclude that the usage of hamstring graft for reconstruction of a torn ACL gives an excellent to good outcome, keeping in mind proper patient selection and an immense role of the physiotherapy. Keywords: Anterior cruciate ligament, Hamstring, Endobutton, Arthroscopy.

In Complete ACL Tears, Bridge-Enhanced ACL Repair Was Noninferior to ACL Reconstruction for Symptoms and Functioning and Knee Laxity at 2 Years.

In Complete ACL Tears, Bridge-Enhanced ACL Repair Was Noninferior to ACL Reconstruction for Symptoms and Functioning and Knee Laxity at 2 Years.

The Effect of Increasing Rehabilitation Program Using Electric Stimulation On Rehabilitating Knee Joint Working Muscles Due to ACL Tear In Athletes

The research aimed at designing a rehabilitation program using electric stimulation for rehabilitating knee joint working muscles as a result of ACL tear using an apparatus developed by the researchers that stimulate the muscle vibration and work as well as the ability to rehabilitate the join in shorter periods. In addition to that, it aimed at identifying the effect of this program on rehabilitating the knee joint working muscles. The researchers used the experimental method on Baghdad clubs’ players who suffer from complete knee joint ACL tear aged (19 – 24) years old. The results showed that the training program developed the working muscles significantly achieving normal levels of activity.

A comparative study of functional outcome of transtibial and transportal femoral tunneling techniques for arthroscopic ACL reconstruction

Introduction:Acl reconstruction has revolutionarised the sports medicine world lately. Various methods of reconstruction have been advocated in the literature recently. ACL injury results in severe morbidity to an athletes career. The aim for anatomical reconstruction is to harvest the ACL graft at a more anatomical location on both the tibia and the femur. The purpose of this study is to compare the functional outcomes of the two methods of the graft harvestis to compare the functional outcomes of the two methods of the graft harvestHypotheses:60 patients were included in the study with complete ACL tear and were assessed at 3 6 and 9 months on the basis of various scores and relevant elements.Methods:All patients who were planned for arthroscopic ACL reconstruction surgery from the OPD, who were willing and fit the inclusion criteria were included in the study. They were then examined clinically with special tests i.e. Lachman’s test, anterior drawer test, pivot shift test and McMurray’s test and the findings were recorded including any associated meniscal injuries. They were then evaluated using 3 different evaluation systems i.e. IKDC, Lysholm and pain VAS.Results:Average mean age of the patients undergoing ACL reconstruction was (26%) in Transtibial and 23.3%. 90% of them were males. Majority of them were males (58%). The average IKDC score of transportal patients was significantly higher than transtibial patients at 6 months followup [P=0.001]. The average Lysholm knee score of transportal patients was significantly higher than the transtibial patients [P=0.047].The average pain on VAS score of transportal group was significantly lower than transtibial at 6 months followup [P<0.001].Complication of instability was more common in transtibial patients, 11(36.7%), when compared to transportal patients, 9(30%), however this difference was not significant [P=0.58].Conclusion:Our study clearly stated that the transportal technique for acl reconstruction fetched superior results as compared to the transtibial technique in terms of knee instability, pain and other domains.