Complete Anterior Cruciate Ligament Research Articles

Patellar Tendon Versus Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction

Background Controversy remains over the most appropriate graft for anterior cruciate ligament reconstruction. Hypothesis There is no significant difference in outcomes after 4-strand hamstring and patellar tendon autograft anterior cruciate ligament reconstructions using similar fixation techniques. Study Design Randomized controlled trial; Level of evidence, 1. Methods Between August 2000 and May 2003, 64 Keller Army Hospital patients with complete anterior cruciate ligament tears were randomized to hamstring (n = 32) or patellar tendon (n = 32) autograft anterior cruciate ligament reconstruction. Operative graft fixation and rehabilitative techniques were the same for both groups. Follow-up assessments included the Single Assessment Numeric Evaluation score, Lysholm score, International Knee Documentation Committee score, and Knee Injury and Osteoarthritis Outcome Score. Postoperative radiographs were analyzed for tunnel location and orientation. Results Eleven women and 53 men were randomized. Eighty-three percent of the patients (53 of 64) had follow-up of greater than 2 years, or to the point of graft rupture or removal (average follow-up, 36 months). Four hamstring grafts (12.5%) and three patellar tendon grafts (9.4%) (P = .71) ruptured. One deep infection in a hamstring graft patient necessitated graft removal. Forty-five of the 56 patients with intact grafts had greater than 2-year follow-up. Patients with patellar tendon grafts had greater Tegner activity scores (P = .04). Single Assessment Numeric Evaluation scores were 88.5 (95% confidence interval: 83.1, 93.8) and 90.1 (95% confidence interval: 85.2, 96.1) for the hamstring and patellar tendon groups, respectively (P = .53). Lysholm scores were 90.3 (95% confidence interval: 84.4, 96.1) and 90.4 (95% confidence interval: 84.5, 96.3) for the hamstring and patellar tendon groups, respectively (P = .97). There were no significant differences in knee laxity, kneeling pain, isokinetic peak torque, International Knee Documentation Committee score, or Knee Injury and Osteoarthritis Outcome Scores. Postoperative graft rupture correlated with more horizontal tibial tunnel orientation. Conclusion Hamstring and patellar tendon autografts provide similar objective, subjective, and functional outcomes when assessed at least 2 years after anterior cruciate ligament reconstruction.

Anterior cruciate ligament rupture secondary to a ‘heel hook’: a dangerous martial arts technique

The 'heel hook' is a type of knee lock used in some forms of martial arts to stress the knee and cause opponent to concede defeat. While the knee is in a flexed and valgus disposition, an internal rotation force is applied to the tibia. Reports are lacking on serious knee trauma as a result of this technique. We report the case of a 32-year-old Mixed Martial Arts exponent who sustained complete anterior cruciate ligament rupture and an medial collateral ligament injury from the use of a 'heel hook'.

Salter Harris III Medial Femoral Condyle Fracture with Concomitant Complete Anterior Cruciate Ligament Tear. A Case Report and Review of the Literature

Several reports in the literature detail a Salter-Harris III medial femoral condyle fracture caused by valgus stress. Many report delayed medial meniscal tears, early degenerative changes, and subsequent need for medial menisectomy. This may indicate that ACL injury in these patients goes unrecognized. This case report describes successful closed treatment of a Salter-Harris III medial femoral condyle fracture and a delayed ACL reconstruction, where all others in the literature advocate surgical treatment of the fracture. The indications for surgical management of the fracture and the literature on this combined injury are reviewed. Index of suspicion should remain high for the possibility of ligamentous instability associated with fractures about the knee in skeletally immature patients. The potential for further injury can be avoided by performing a thorough exam. Magnetic resonance imaging confirms situations where provocative ligament exams are limited by guarding and pain.

Ist die konservative Behandlung der partiellen oder kompletten vorderen Kreuzbandruptur noch gerechtfertigt?

In a review of the recent literature after conservative treatment of the complete anterior cruciate ligament (acl) rupture good results were found in an average (av) of 56% (12-80%) of all cases. In comparison the conservative treatment of partial tears showed in 84% (60-100%) of all cases good results. 79% (32-100%) of the patients with complete acl ruptures and 90% (66-100%) of the cases with partial acl tears were able to continue their sport activities. Secondary acl replacement or meniscus surgery were later necessary in 20% and 14% of the cases (av) with complete acl ruptures and in only 6% and 5% (av) of the cases with partial tears. Most of the patients who were operated later were young and ambitiously engaged in sports. The results of the mostly retrospective studies display a high variability. For this reason it is necessary to perform more prospective, controlled and randomized studies to verify the preventive effect of an early operative treatment to protect the joint form osteoarthritis and progressive instability. Arthrocopy is essential for all cases of acute hemartrosis. Partial acl tears are predominantly treated conservatively, while complete acl ruptures should be treated following an individual decision regimen. A tree for decision making of the treatment of acute acl-injuries is proposed.

Complete anterior cruciate ligament tear and the risk for cartilage loss and progression of symptoms in men and women with knee osteoarthritis

To determine whether a complete anterior cruciate ligament (ACL) tear, a frequent incidental finding on magnetic resonance imagings (MRIs) of individuals with established knee osteoarthritis (OA), increases the risk for further knee OA progression. We examined 265 participants (43% women) with symptomatic knee OA in a 30-month, prospective, natural history study of knee OA. The more symptomatic knee was imaged using MRI at baseline, 15 and 30 months. Cartilage was scored at the medial and lateral tibiofemoral joint and at the patellofemoral joint using the Whole-Organ MRI Score (WORMS) semi-quantitative method. Complete ACL tear was determined on baseline MRI. At each visit, knee pain was assessed using a knee-specific visual analog scale and physical function was assessed using the Western Ontario and McMaster Universities (WOMAC) physical function subscale. There were 49 participants (19%) with complete ACL tear at baseline. Adjusting for age, body mass index, gender and baseline cartilage scores, complete ACL tear increased the risk for cartilage loss at the medial tibiofemoral compartment [odds ratio (OR): 1.8, 95% confidence interval (CI): 1.1, 3.2]. However, following adjustment for the presence of medial meniscal tears, no increased risk for cartilage loss was further seen (OR: 1.1, 95% CI: 0.6, 1.8). Knee pain and physical function were similar over follow-up between those with and without a complete ACL tear. Individuals with knee OA and incidental complete ACL tear have an increased risk for cartilage loss that appears to be mediated by concurrent meniscal pathology. The presence of a complete ACL tear did not influence the level of knee pain or physical function over short-term follow-up.

Gender Differences in Anterior Cruciate Ligament Injury vary with Activity

Background Previous studies have shown that women involved in similar activities as men are at increased risk for anterior cruciate ligament injuries. Hypothesis The incidence rate of complete anterior cruciate ligament tears for men and women in our athletic, college-aged population is similar. Study Design Descriptive epidemiology study. Methods Students graduating in class years 1994 to 2003 at our institution who sustained complete anterior cruciate ligament tears were assessed for mechanism of injury and type of sport played at time of injury. We calculated the incidence proportion, an estimation of risk, by gender and class year, and the incidence proportion ratio comparing men and women by class year. We also calculated incidence rates by gender and type of sport played and incidence rate ratios comparing men and women. Results There were 353 anterior cruciate ligament injuries in the 10 classes studied. We found an overall, 4-year incidence proportion of 3.24 per 100 (95% confidence interval, 2.89-3.63) for men and 3.51 (95% confidence interval, 2.65-4.65) for women (incidence proportion ratio, 1.09 [95% confidence interval, 0.80-1.47]). The overall anterior cruciate ligament injury rate, excluding male-only sports, was significantly greater in women (incidence rate ratio, 1.51 [95% confidence interval, 1.03-2.21]). We found significantly greater injury rates among women in a gymnastics course (incidence rate ratio, 5.67 [95% confidence interval, 1.99-16.16]), indoor obstacle course test (incidence rate ratio, 3.72 [95% confidence interval, 1.25-11.10]), and basketball (incidence rate ratio, 2.42 [95% confidence interval, 1.05-5.59]). Conclusion We found little gender difference in the overall risk of an anterior cruciate ligament tear; however, there were gender differences in injury rates when specific sports and activities were compared and when male-only sports were removed from the overall rate assessment.

Perturbation Training Improves Knee Kinematics and Reduces Muscle Co-contraction After Complete Unilateral Anterior Cruciate Ligament Rupture

Dynamic knee stabilization strategies of people who successfully compensate for the absence of an anterior cruciate ligament (ACL) ("copers") are different from those of people who do not compensate well for the injury ("noncopers"). Early after injury, certain patients ("potential copers") can increase the likelihood of successfully compensating for the injury by participating in 10 sessions of perturbation training. The purpose of this study was to determine how perturbation training alters muscle co-contraction and knee kinematics in potential copers. Seventeen individuals with acute, unilateral ACL rupture who were categorized as potential copers and 17 subjects without injuries who were matched by age, sex, and activity level were recruited for this study. Motion analysis and electromyographic data were collected as subjects walked across a stationary or moving platform (horizontal translation) before and after perturbation training. Before training, potential copers had higher co-contraction indexes and lower peak knee flexion angles than subjects without injuries. After training, potential copers' movement patterns more closely resembled those of subjects without injuries (ie, they showed reduced co-contraction indexes and increased peak knee flexion angles during stance). Perturbation training reduced quadriceps femoris-hamstring muscle and quadriceps femoris-gastrocnemius muscle co-contractions and normalized knee kinematics in individuals with ACL rupture who were classified as potential copers. Findings from this study provide evidence for a mechanism by which perturbation training acts as an effective intervention for promoting coordinated muscle activity in a select population of people with ACL rupture.

A prospective analysis of incidence and severity of quadriceps inhibition in a consecutive sample of 100 patients with complete acute anterior cruciate ligament rupture

Background: Weakness of the quadriceps femoris muscle after anterior cruciate ligament (ACL) injury and reconstruction has been attributed to incomplete voluntary activation of the muscle. The literature is conflicting on the incidence of incomplete voluntary quadriceps activation after ACL injury because of differences in testing methods and population biases. The purpose of this study was to systematically examine the incidence and severity of quadriceps voluntary activation failure in both lower extremities after acute ACL injury. We hypothesized that the incidence of quadriceps inhibition would be higher in the ACL‐injured limbs than the uninvolved limbs, that the incidence of inhibition in the ACL‐deficient limbs would be larger than in our historical sample of healthy young individuals tested in the same manner and that there would be no difference in inhibition by gender.Study Design: Prospective, descriptive.Methods: One hundred consecutive patients with acute ACL rupture (39 women and 61 men) were tested when range of motion was restored and effusion resolved, an average of 6 weeks after injury. A burst superimposition technique was used to assess quadriceps muscle activation and strength in all patients. Dependent t‐tests were used to compare side‐to‐side differences in quadriceps strength. Independent t‐tests were used to compare incidence of activation failure by gender and make comparisons to historical data on young, active individuals.Results: The average involved side quadriceps activation was 0.92, and ranged from 0.60 to 1.00. The incidence of incomplete activation in the involved side quadriceps was 33 percent and in the uninvolved side quadriceps was 31 percent after acute ACL rupture. The incidence of incomplete activation bilaterally was 21 percent. There was no difference in incidence of quadriceps inhibition by gender.Conclusion: The incidence of voluntary quadriceps inhibition on the involved side was three times that of uninjured, active young subjects, but the magnitude was not large. The incidence of quadriceps inhibition on the uninjured side was similar to the injured side.Clinical relevance: Both the incidence and magnitude of quadriceps inhibition after ACL rupture are lower than have previously been reported. The conventional wisdom, therefore, that quadriceps inhibition is a significant problem in this population is challenged by the results of this study. Differences between this study and others include sufficient practice to ensure a maximal effort contraction and rigorous inclusion criteria. The findings have implications for strength testing as well as rehabilitation. The quadriceps index, an assessment of the injured side quadriceps strength deficit, may be affected by the presence of voluntary activation failure in the uninvolved side.

Single-bundle anterior cruciate ligament reconstruction using the medial portal technique

Complete anterior cruciate ligament (ACL) ruptures can lead to recurrent knee instability, meniscal tears, and articular cartilage degeneration. ACL reconstruction typically has been performed using a single-bundle reconstruction technique that attempts to recreate the normal biomechanical properties of the native ACL. A critical review of the literature reveals that the success rates of single-bundle ACL reconstruction vary between 69% and 95%. The variability of the results may be attributed to the different techniques and styles of the individual surgeon, as there is variability in operative technique, fixation method, graft choice, and rehabilitation protocol. Our technique uses the medial portal technique and intraoperative radiographic analysis to more accurately recreate the anatomic insertion sites of the ACL femoral and tibial tunnels, respectively. Advantages of using the medial portal technique include the following: (1) femoral tunnel and tibial tunnels are placed independently of each other; (2) femoral tunnel is placed more anatomically on the ACL femoral insertion; (3) allows for easy preservation of any remaining ACL fibers (augmentation); and (4) tunnel placement is independent of graft type, fixation devices, or tunnel guides. We present our current technique for anatomic arthroscopic ACL reconstruction using a single-bundle graft.

A prospective analysis of incidence and severity of quadriceps inhibition in a consecutive sample of 100 patients with complete acute anterior cruciate ligament rupture

Background: Weakness of the quadriceps femoris muscle after anterior cruciate ligament injury and reconstruction has been attributed to incomplete voluntary activation of the muscle. The literature is conflicting on the incidence of incomplete voluntary quadriceps activation after anterior cruciate ligament injury because of differences in testing methods and population biases. The purpose of this study was to systematically examine the incidence and severity of quadriceps voluntary activation failure in both lower extremities after acute anterior cruciate ligament injury. We hypothesized that the incidence of quadriceps inhibition would be higher in the anterior cruciate ligament injured limbs than the uninvolved limbs, that the incidence of inhibition in the anterior cruciate ligament deficient limbs would be larger than in our historical sample of healthy young individuals tested in the same manner and that there would be no difference in inhibition by gender. Study design: Prospective, descriptive. Methods: One hundred consecutive patients with acute anterior cruciate ligament rupture (39 women and 61 men) were tested when range of motion was restored and effusion resolved, an average of 6 weeks after injury. A burst superimposition technique was used to assess quadriceps muscle activation and strength in all patients. Dependent t-tests were used to compare side-to-side differences in quadriceps strength. Independent t-tests were used to compare incidence of activation failure by gender and make comparisons to historical data on young, active individuals. Results: The average involved side quadriceps activation was 0.92, and ranged from 0.60 to 1.00. The incidence of incomplete activation in the involved side quadriceps was 33 per cent and uninvolved side quadriceps was 31 per cent after acute anterior cruciate ligament rupture. The incidence of incomplete activation bilaterally was 21 per cent. There was no difference in incidence of quadriceps inhibition by gender. Conclusion: The incidence of voluntary quadriceps inhibition on the involved side was three times that of uninjured, active young subjects, but the magnitude was not large. The incidence of quadriceps inhibition on the uninjured side was similar to the injured side. Clinical relevance: Both the incidence and magnitude of quadriceps inhibition after ACL rupture are lower than have previously been reported. The conventional wisdom, therefore, that quadriceps inhibition is a significant problem in this population is challenged by the results of this study. Differences between this study and others include sufficient practice to ensure a maximal effort contraction and rigorous inclusion criteria. The findings have implications for strength testing as well as rehabilitation. The quadriceps index, an assessment of the injured side quadriceps strength deficit may be affected by the presence of voluntary activation failure in the uninvolved side.

Anterior rim tibial plateau fractures and posterolateral corner knee injury.

The aim of this study was to review MRI findings of clinically suspected posterolateral corner knee injuries and their associated internal derangements. Sixteen knees in 15 patients who had evidence of a posterolateral corner knee injury on the physical exam underwent MRI to evaluate the posterolateral corner of the knee and to look for associated injuries. Two musculoskeletal radiologists reviewed the scans. Surgery was performed on 10 of the knees. Tibial plateau fractures were present in 6 knees; 5 of the fractures were anteromedial rim tibial plateau fractures. The popliteus muscle was injured in 13 knees and the biceps femoris in 6 knees. The lateral collateral ligament was ruptured in 12 knees. The posterior cruciate ligament was completely ruptured in 7 knees and avulsed from its tibial attachment in 1 knee. Eleven knees had a complete anterior cruciate ligament rupture. The anterior cruciate ligament was edematous without complete disruption of all fibers in 3 knees. There was excellent correlation between the MRI results and operative results in regard to the presence of a posterolateral corner injury of the knee (9 of the 10 knees had a posterolateral corner injury). In our study MRI readily detected posterolateral corner injuries. Posterolateral corner injuries of the knee are frequently associated with a variety of significant injuries, including cruciate ligament tears, meniscus tears, and fractures. Fractures of the peripheral anteromedial tibial plateau are not common; however, given their relatively common occurrence in this study, they may be an indicator of a posterolateral corner injury to the knee.

The effect of insufficient quadriceps strength on gait after anterior cruciate ligament reconstruction

Objective. To determine the effect of quadriceps strength and joint stability on gait patterns after anterior cruciate ligament injury and reconstruction. Design. Cross-sectional comparative study in which four groups underwent motion analysis with surface electromyography. Background. Individuals following anterior cruciate ligament rupture often demonstrate reduced knee angles and moments during the early stance phase of gait. Alterations in gait can neither be ascribed to instability nor to quadriceps weakness alone when both are present. Methods. Twenty-eight individuals with complete anterior cruciate ligament rupture (10 patients with acute rupture, 8 patients following reconstruction with quadriceps strength >90% of the uninvolved side [strong-anterior cruciate ligament reconstructed group], and 10 patients after reconstruction with quadriceps strength <80% of the uninvolved side [weak-anterior cruciate ligament reconstructed group]), and 10 uninjured subjects underwent an examination of their lower extremity to collect kinematics, kinetics, and electromyography during walking and jogging. Anterior cruciate ligament reconstruction was arthroscopically assisted and a double loop semitendinosis-gracilis autograft or allograft was used as a graft source. All reconstructed subjects had stable knees, full range of motion, and no effusion or pain at the time of testing (more than three months after surgery). Results. Knee angles and moments of the strong group were indistinguishable from the uninjured group during early stance of both walking and jogging. The weak subjects had reduced knee angles and moments during walking, and jogged similarly to the deficient subjects. Regression analysis revealed a significant effect between early stance phase knee angles and moments and quadriceps strength during both walking and jogging. Conclusion. Inadequate quadriceps strength contributes to altered gait patterns following anterior cruciate ligament reconstruction. Relevance Rapid strengthening following anterior cruciate ligament injury or reconstruction may contribute to a safe return to high-level activities.

Biomechanical evidence supporting a differential response to acute ACL injury

Objective. To describe movement patterns in people with complete anterior cruciate ligament rupture objectively identified as good candidates for non-operative management of the injury. Design. Involved side kinematics and kinetics were compared to the uninvolved side and to uninjured subjects. Background. High-level athletes with anterior cruciate ligament rupture and poor dynamic stability (non-copers) have movement alterations, including less knee flexion and a decreased internal knee extensor moment during loading response, that are not seen in those with excellent knee stability (copers). Our screening exam can identify people with good rehabilitation potential for non-operative management of anterior cruciate ligament injury (potential copers), but the movement strategies of these individuals are unknown. Methods. Sagittal plane kinematics and kinetics during the stance phase of walking and jogging were collected from 11 subjects who had an acute anterior cruciate ligament rupture and met the criteria of the screening exam, and were compared to 10 uninjured subjects, who we studied previously. Variables were those in which non-copers differed from uninjured subjects. Results. The potential copers flexed their involved knee less than uninjured subjects and their uninvolved side during walking. Potential copers, compared to uninjured subjects, also had a lower vertical ground reaction force during loading response, a lower knee support moment, and an increased ankle support moment during walking. In jogging, the involved knee angle at initial contact was more extended compared to uninjured subjects, and the amount of knee flexion was less than the uninvolved side. No differences in kinetics were present during jogging. Conclusions. This study provides evidence that the potential copers identified by the screening examination have movement patterns that are consistent with people who have more knee stability than non-copers. Relevance Although potential copers have developed some characteristics of a successful stabilization strategy, the presence of kinematic alterations indicates that they may benefit from training programs designed to enhance dynamic knee stability.

Long-term results of non-operative treatment of anterior cruciate ligament injury

We retrospectively reviewed the record of 89 patients with complete anterior cruciate ligament injury, documented by arthroscopic examination to investigate the long-term results in relation to the generation of osteoarthritis. The mean age of the patients was 34.9 years at follow-up and the mean duration of follow-up was 12.0 years. The mean Lysholm score was 89 points at follow-up. The mean Tegner activity score was 5.7 points before injury and 4.5 points at follow-up. Plain radiographs revealed 63% of osteoarthritis and 37% of which had joint space narrowing. The age of the patients, the level of sports activity, the history of meniscectomy, obesity and the osteoarthritis of the contralateral knee were found to be significant risk factors in osteoarthritis after anterior cruciate ligament injury. The most influential factor for osteoarthritis was considered meniscectomy, in combination with the risk factors of primary osteoarthritis. It should also be noted that modification of sports activity level was the most important factor for avoiding the combined injury of meniscus and osteoarthritis.

Assessment of functional knee bracing: an in vivo three-dimensional kinematic analysis of the anterior cruciate deficient knee

Objective. To describe three-dimensional tibial and femoral movements in vivo and examine the effect of a brace on knee kinematics during moderate to intense activity. Design. Skeletal kinematics of anterior cruciate ligament deficient knees was measured with and without braces during moderate to intense activity. Background. Invasive markers implanted into the tibia and femur are the most accurate means to directly measure skeletal motion and may provide a more sensitive measure of the differences between brace conditions. Methods. Steinmann traction pins were implanted into the femur and tibia of four subjects having a partial or complete anterior cruciate ligament rupture. Non-braced and braced conditions were randomly assigned and subjects jumped for maximal horizontal distance to sufficiently stress the anterior cruciate ligament. Results. Intra-subject peak vertical force and posterior shear force were generally consistent between conditions. Intra-subject kinematics was repeatable but linear displacements between brace conditions were small. Differences in angular and linear skeletal motion were observed across subjects. Bracing the anterior cruciate ligament deficient knee resulted in only minor kinematic changes in tibiofemoral joint motion. Conclusion. In this study, no consistent reductions in anterior tibial translations were observed as a function of the knee brace tested. Relevance Investigations have reported that knee braces fail when high loads are encountered or when load is applied in an unpredictable manner. Questions remain regarding tibiofemoral joint motion, in particular linear displacements. The pin technique is a means for direct skeletal measurement and may provide a more sensitive measure of the differences between brace conditions.

Strength and function before and after anterior cruciate ligament reconstruction.

Rehabilitation of patients with anterior cruciate ligament injury is a topic of interest among clinicians. Although numerous studies report the deficits after anterior cruciate ligament reconstruction, there are no data available on the changes in strength and functional performance before and 6 months after reconstruction surgery. This is when most patients are returning to sports activities. In the current study 31 patients with complete unilateral anterior cruciate ligament ruptures followed a controlled rehabilitation program emphasizing early range of motion after surgery and quadriceps strengthening before and after undergoing bone-patellar tendon-bone reconstruction. Strength of the hamstrings and quadriceps and five functional activities were assessed at 1 week before and 6 months after surgery. Preoperative strength assessments using a Cybex II dynamometer showed a 12% quadriceps deficit at 60 degrees per second and 9% deficit at 120 degrees per second with no hamstring deficit in the injured leg compared with the uninjured leg. Despite intensive quadriceps training, the postoperative quadriceps deficit increased to 28% at 60 degrees per second and 22% at 120 degrees per second in comparison with the uninjured leg. There was no change in hamstring strength in the injured leg. Most functional measures improved after surgery. The shuttle run improved by 10%, the side step test results improved by 17%, and the carioca test results improved by 23%. No significant difference was found in the results of the hop test. This study highlights the extent of the quadriceps deficits despite functional improvement and the difficulty in restoring quadriceps strength after bone-patellar tendon-bone reconstruction. It also questions the relationship of current functional tests to quadriceps strength and the role of maximum strength testing as a predictor of function and of safe sporting performance.

Wear Patterns on Tibial Plateaus From Varus and Valgus Osteoarthritic Knees

The size and location of articular cartilage wear was assessed on 106 varus and 37 valgus osteoarthritic tibial plateaus resected during total knee arthroplasty. Anterior cruciate ligament integrity was assessed intraoperatively, and calibrated digital images were used to measure the wear patterns. Complete anterior cruciate ligament deficiency was seen in 25% of the varus and 24% of the valgus knees. Wear patterns on anterior cruciate ligament intact and attenuated varus tibial plateaus occurred in the middle to anterior aspect of the medial plateau. Anterior cruciate ligament deficient varus plateaus had significantly larger wear areas located more posterior on the medial plateau. In contrast, anterior cruciate ligament intact and deficient valgus tibial plateaus had wear located posterior to the center of the lateral plateau. Anterior cruciate ligament integrity is a discrete feature of advanced osteoarthritis that strongly influences the articular wear patterns. The anterior cruciate ligament deficient wear patterns show a wear mechanism that is consistent with the posterior femoral subluxation and posterior tibiofemoral contact observed after acute anterior cruciate ligament rupture. These observations provide insight into the altered knee mechanics that exist in osteoarthritic knees and the resulting mechanical factors that contribute to degenerative changes.

Incidence of Associated Knee Lesions with Torn Anterior Cruciate Ligament: Retrospective Cohort Assessment

The records of 141 consecutive patients with confirmed complete anterior cruciate ligament injuries were reviewed retrospectively. One hundred and sixty-two associated injuries were divided into 25 injury complexes. Isolated injuries to the anterior cruciate ligament occurred in 40 cases (28.4%). Injuries of the medial meniscus occurred in 62 cases (38.2%), while injuries of the lateral meniscus occurred in 37 cases (22.8%). Injuries to the medial collateral ligament complex occurred in 42 cases (25.9%). Injuries to the lateral collateral ligament, posterior deep popliteus-arcuate ligament complex, and posterior cruciate ligament were found to be positively correlated (rho = .81, p = .001, and rho = .77, p = .001, N = 141, respectively). Injuries to the medial collateral ligament and the posterior oblique ligament were likewise positively correlated (rho = .45, p = .001, N = 141).

Observations on the injury mechanism of anterior cruciate ligament tears in skiers.

The purpose of this study was to demonstrate the uniqueness of the injury mechanism for acute complete tears of the anterior cruciate ligament in recreational alpine skiers by using patterns of osseous injury as detected by magnetic resonance imaging. We treated 42 patients (average age, 32 years) who met the following criteria: 1) acute complete anterior cruciate ligament tear incurred during skiing, 2) no history of knee injury, 3) magnetic resonance imaging within 30 days of injury, and 4) arthroscopy and anterior cruciate ligament reconstruction or both for documentation of all intraarticular injury. An osseous injury detected by magnetic resonance imaging was seen in the lateral femoral condyle in 17 (40%) of the patients and was located over the terminal sulcus in 15 of these patients; only 1 had arthroscopic evidence of chondral injury. Four (10%) of the 42 patients had a bone bruise on the medial femoral condyle; all were located at the extreme posterior margin. Thirty-four patients (81%) had a bone bruise on the lateral tibial plateau; 33 were located at the extreme posterior margin and 27 of these were at the posterolateral tibial rim. Twelve patients (29%) had a bone bruise on the medial tibial plateau; all were located on the posterior margin.

Management of complete traumatic anterior cruciate ligament tears in the skeletally immature patient: Current concepts and review of the literature

Once considered extremely rare, complete traumatic tears of the anterior cruciate ligament (ACL) in skeletally immature patients with open physes are now being diagnosed with increasing frequency. Concomitant subsequent meniscal injuries develop in a significant number of these patients. Nonoperative treatment, primary surgical repair of the torn ACL, or extraarticular stabilization procedures have not been reported to restore dynamic knee stability or prevent further meniscal damage. Transphyseal bone plugs from a patellar tendon graft fixed with suture or interference screws have not been reported in patients with significant growth potential and cannot be recommended. Soft-tissue autografts placed through transphyseal tunnels have been reported to give good functional results and minimize potential for growth disturbance.