Cruciate Ligament Injury Research Articles

Implementing ACL Injury Prevention in Daily Sports Practice\u2014It\u2019s Not Just the Program: Let\u2019s Build Together, Involve the Context, and Improve the Content

Although the benefits of current anterior cruciate ligament (ACL) injury prevention programmes have been demonstrated in efficacy studies, they, unfortunately, have had limited public health impact to date. For example, the incidence of ACL injuries continues to rise in adolescent athletes. Raising awareness and educating coaches and athletes is not enough to facilitate the widespread, sustained use of these programmes in the real-world setting. Considering the profound burden of ACL injuries, it is necessary to continue to improve the current ACL injury prevention programmes through co-creation. First, the uptake of the programmes should be optimized by a better appreciation and understanding of the individual, socio-cultural and environmental context (i.e., community). Second, the content of the programmes should be optimized to better reflect the demands of the sport by creating more ownership and increasing motivation (incorporating challenging, sport-specific and fun elements) with the end-users. In addition, implicit motor learning, random practice and differential learning are concepts that should be integrated when practising to obtain the most optimal results when learning or finetuning skills.

A 2D qualitative movement assessment of a deceleration task detects football players with high knee joint loading

PurposeThe deceleration (pressing) is a common situational pattern leading to anterior cruciate ligament (ACL) injury in football. Although mainly assessed for performance purposes, a stronger focus on movement quality might support the screening of at-risk athletes. The aim of the present study was to describe a 2D scoring system for the assessment of the deceleration task and to associate it with the knee joint loading (knee abduction moment) evaluated through the gold standard 3D motion capture. The hypothesis was that lower 2D scores would be associated with higher knee joint loading.MethodsThirty-four competitive football (soccer) players (age 22.8 ± 4.1, 16 females) performed a series of deceleration tasks. 3D motion analysis was recorded using ten stereophotogrammetric cameras, a force platform, and three high-speed cameras. The 2D qualitative assessment was performed via a scoring system based on the video analysis of frontal and lateral planes joint kinematics for five scoring criteria. The intra- and inter-rater reliabilities were calculated for each 2D scoring criteria. The peak knee abduction moment was extracted and grouped according to the results of the 2D evaluation.ResultsAn ICC > 0.94 was found for all the 2D scoring criteria, both for intra-rater and inter-rater reliability. The players with low 2D frontal plane scores and low total scores (0–4) showed significantly higher peak knee abduction moment values (p < 0.001). A significant negative rank correlation was found between the total score and the peak knee abduction moment (ρ = − 0.25, p < 0.001).ConclusionsThe qualitative 2D scoring system described successfully discerned between athletes with high and low knee joint loading during a deceleration task. The application of this qualitative movement assessment based on a detailed and accurate scoring system is suitable to identify players and patients with high knee joint loading (high knee abduction moments) and target additional training in the scenario of the primary and secondary ACL injury risk reduction.Level of evidenceLevel IV.

Comprehensive Rehabilitation After Reconstruction of the Anterior Cruciate Ligament

Introduction: The knee joint is the second most frequently injured joint. Anterior cruciate ligament (ACL) injury is a relatively common injury to the inner part of the knee joint, mainly related to contact sports. Its rupture leads to instability of the entire joint. Two treatment options are possible: operative or conservative. Each of them is related to an appropriate rehabilitation process. The aim of this study was to define a comprehensive rehabilitation plan in patients after ACL rupture and meniscal suturing.Materials and methods: The work was written based on the medical history of the patient who was diagnosed with complete rupture of ACL, and then reconstruction was performed with the harvesting of a semitendinous and slender muscle graft.Results: The rehabilitation process can be divided into two stages: hospital and post-hospital. Rehabilitation in hospital conditions begins on the zero day after arthroscopy. The main goals of rehabilitation include: increasing the range of mobility, no myofascial dysfunctions, no thromboembolic complications, and the ability to self-service.Conclusion: Rehabilitation is an indispensable element of the treatment of patients after ACL reconstruction. Early initiation of rehabilitation brings tangible benefits during treatment and return to full physical fitness.

Analysis of the effect of stent-assisted embolization for low-grade subarachnoid hemorrhage caused by V4 segment dissecting aneurysm of vertebral artery

Objective: To investigate the efficacy and safety of different stents assisted embolization in the treatment of subarachnoid hemorrhage(SAH) caused by V4 dissecting aneurysm of vertebral artery. Methods: The clinical data of 39 patients with spontaneous SAH V4 dissecting aneurysm treated at the Department of Neurosurgery, the Northern Theater General Hospital from January 2016 to June 2019 were analyzed retrospectively.There were 21 males and 18 females, aged (48±17) years(range:35 to 68 years).There were 24 cases of HUNT-HESS grade Ⅰ and 15 cases of grade Ⅱ.Among them, 20 cases were treated with single stent-assisted embolization, 9 cases with multi-stent-assisted embolization, 9 cases with semi-dense mesh-assisted embolization, and 1 case with dense-mesh stent-assisted embolization.The perioperative and postoperative complications, postoperative recurrence were collected. Results: Intraoperative complications included 2 cases of aneurysm rupture and 2 cases of acute thrombosis.All aneurysms were densely packed according to the angiography performed immediately after operation.Postoperative complications included 3 cases of long-term responsible vascular ischemia(modified Rankin score<2). The patients were followed up for 15.1 months(range: 12 to 29 months). At the last follow-up, aneurysms recurrence occured in 10 cases, the recurrence rate was 25.6%(10/39). There were 6 cases of recurrence and 2 cases of complications in 20 cases with single stent-assisted embolization, 3 cases of recurrence and 4 cases of complications in 9 cases with multi-stent-assisted embolization, 1 case of recurrence and 1 case of complications in 9 cases with semi-dense mesh stent. Conclusion: Endovascular treatment is feasible for patients with vertebral artery dissecting aneurysm, and the appropriate surgical method should be selected according to the vascular structure and the location of the aneurysm.

Numerical Analysis of the ACL, with Sprains of Different Degrees after Trauma.

Nowadays, cruciate ligament injuries have increased in incidence, since practicing a sport or physical activity has become a trend in current societies. Although this lifestyle generates multiple benefits, as a consequence, injury has also increased. Due to its nature and complexity, the ligaments of the knee are those that are most frequently affected, mainly the ACL (anterior cruciate ligament). This tissue reacts to overexertion or movements out of range, either caused by the exercise itself or caused by trauma caused by the practice of physical activity, causing various degrees of sprain. Whatever the etiology of these injuries, they will require a therapy indicated for each degree of injury. This therapy initially entails immobilization of the affected area and later; physical therapy will be required to a lesser or greater degree. Commonly, in the physiotherapy of these injuries, rehabilitation exercises are prescribed, where the physiotherapist asks a patient to use equipment with an estimated weight. However, the effectiveness of a generalized therapy in this way does not always give the expected results. This is related to the fact that these therapies are standardized and do not consider some factors such as the remaining muscle fibres that are not directly affected by the sprain, which does not mean that they should not be considered. Therefore, in the present work, a biomodel of a human knee has been developed and used to evaluate numerically how the ACL acts under an external load, when there are different degrees of injuries, caused by trauma. Four case studies were considered: Case 1 (control case) where the ACL is healthy, Case 2 where the ACL presents a 1st-degree sprain, Case 3 where the ACL presents a 2nd-degree sprain, and finally Case 4 where the ACL presents a 3rd-sprain grade. After performing the analyses, in the control case, it was found that it presents a balance between tensile and compressive stresses. While in the 4th case, the most critical tensile stress decreases while compression stresses increase. This shows that the ligament, having considerable damage, no longer works as it should and can eventually damage the collateral structures. It was found that, when there was a sprain, where the continuity of the ligament is compromised, a second torsional moment occurs in the ACL which causes the tissue fibres not to act according to their normal physiology or in a healthy state. The results obtained from the present study provide the possibility of predicting where the following injuries will occur by considering the von Mises failure criterion. Likewise, they will allow to improve the therapeutic procedures considering not only the injured structure but also the system as a whole.

Reconstruction of the Posterolateral Corner of the Knee Using LaPrade and Modified Larson Technique: A Prospective Study.

Posterolateral corner (PLC) injuries of the knee are often overlooked for its complex anatomy, and frequent association with cruciate ligament injuries. Overlooked injuries lead to reconstruction failure of cruciate ligaments, chronic knee pain and early arthritic changes. Many reconstruction methods are described, but the best treatment still remains elusive. In this study, we have treated grade-III PLC injuries by the 'anatomic LaPrade' technique and the 'fibula-based Modified Larson' technique, and evaluated their outcomes. Our hypothesis was that both the groups will have similar improvements after surgery. An open-label prospective comparative study was done with a total of 28 patients from August 2013 to July 2019. Patients were treated alternatively by LaPrade or Modified Larson technique using hamstring autografts. Follow-up visits were done at sixth week and subsequently at 3, 6, 12, 18 and 24months postoperatively. Outcomes were measured by Dial Test, side-to-side difference in lateral opening on varus stress radiographs, Lysholm score and IKDC subjective score. During analysis, we considered 25 patients only as three patients were lost to follow-up. Both the groups had comparable improvements in rotational stability, lateral opening on varus stress, Lysholm score and IKDC subjective score. Both LaPrade and Modified Larson technique showed good clinical results in restoring varus and rotational stability of knee in grade-III posterolateral corner injury of the knee. II (prospective, comparative study).

Multiplanar reformation improves identification of the anterolateral ligament with MRI of the knee

The anterolateral ligament (ALL) is subject of the current debate concerning rotational stability in case of anterior cruciate ligament (ACL) injuries. Today, reliable anatomical and biomechanical evidence for its existence and course is available. Some radiologic studies claim to be able to identify the ALL on standard coronal plane MRI sections. In the experience of the authors, however, ALL identification on standard MRI sequences frequently fails and is prone to errors. The reason for this mainly lies in the fact, that the entire ALL often cannot be identified on a single MRI image. This study aimed to establish an MRI evaluation protocol improving the visualization of the ALL, using multiplanar reformation (MPR) with the goal to be able to evaluate the ALL on one MRI image. A total of 47 knee MRIs performed due to atraumatic knee pain between 2018 and 2019 without any pathology were analyzed. Identification of the ALL was performed twice by an orthopedic surgeon and a radiologist on standard coronal plane and after MPR. For the latter axial and coronal alignment was obtained with the femoral condyles as a reference. Then the coronal plane was adjusted to the course of the ALL with the lateral epicondyle as proximal reference. Visualization of the ALL was rated as “complete” (continuous ligamentous structure with a tibial and femoral insertion visible on one coronal image), “partial” (only parts of the ALL like the tibial insertion were visible) and “not visible”. The distances of its tibial insertion to the bony joint line, Gerdy’s tubercle and the tip of the fibular head were measured. On standard coronal images the ALL was fully visible in 17/47, partially visible in 27/47, and not visible in 3/47 cases. With MPR the ALL was fully visible in 44/47 and not visible in 3/47 cases. The median distance of its tibial insertion to the bony joint line, Gerdy’s tubercle and the tip of the fibular head were 9, 21 and 25 mm, respectively. The inter- (ICC: 0.612; 0.645; 0.757) and intraobserver (ICC: 0.632; 0.823; 0.857) reliability was good to excellent. Complete visualization of the ALL on a single MRI image is critical for its identification and evaluation. Applying multiplanar reformation achieved reliable full-length visualization of the ALL in 94% of cases. The described MPR technique can be applied easily and fast in clinical routine. It is a reliable tool to improve the assessment of the ALL.

Association between Intercondylar Notch Dimensions and Morphometry of Anterior Cruciate Ligament – A Cadaveric Study

Introduction: Injuries to the anterior cruciate ligament (ACL) are commonly encountered in day-to-day practice. The morphology of the intercondylar notch (ICN), in particular, the width, and shape of the notch are of anatomic interest predisposing to ligament injuries. The previous literature points to contradicting views on the association between ICN dimensions and cruciate ligament injuries. Aim of the study: This study aims to study the morphometry of the ACL and ICN in 32 prosected lower limbs and to see if any association exists between the two. Objectives The objectives of the study were to estimate the dimensions of ACL (maximum length and width) in 32 prosected lower limbs, estimate the dimensions of ICN (ICN width and depth) along with intercondylar (IC) width in 32 prosected lower limbs, and test the strength of association between the dimensions of ICN with the dimensions of ACL. Materials and Methods: The study was done in the Department of Anatomy of MVJ Medical College and Research Hospital, Bengaluru. Thirty-two prosected lower limbs from the department of anatomy were used for the study. Results: It was observed that IC width correlated positively with ACL length as well as ACL width. A strong positive correlation was also observed between IC width with ICN width. Femoral notch width index also correlated positively with ACL width. Conclusions: The above study provides valuable data on the morphometry of ACL and its association with all dimensions of IC fossa unlike previous studies which have correlated the dimensions of IC fossa only with the thickness of ACL.

ANALYSIS OF DIFFERENT INJURIES OF BASKETBALL PLAYERS BASED ON SURFACE ELECTROMYOGRAPHY

ABSTRACT Assessing the performance of basketball players is very important in the implementation of technical training programs. The application of electromyography (EMG) in basketball players is still relatively small. The evaluation of athletes’ muscle state index by EMG can guide sports training. This study used surface electromyography to test and compare EMG data, analyze muscle discharge timing, contribution rate and integral EMG value of the turning movement, aiming to explore the prevention mechanism of different types of injury affecting basketball players. The synchronous measurement model of EMG signal and plantar pressure curve in jump shot process of basketball players is established to deepen coaches’ understanding of jump shot movement rules and guide athletes to conduct scientific jump shot training. The research shows that the incidence of knee joint injury is relatively high in basketball players. Patella strain and softening, knee meniscus injury and cruciate ligament injury are the main types of injury, and there is no difference between genders.

Femur originated genu varum in a patient with symptomatic ACL deficiency: a case report and review of literature

BackgroundAnterior cruciate ligament (ACL) injury may be associated with genu varum. There are a few indications in which the varus deformity can be corrected at the time of ACL reconstruction. However, as the genu varum originates mostly from the tibia and the simultaneous presence of ACL deficiency and femur originated genu varum is uncommon, only a few papers have described their management for ACL deficient patients with femur originated genu varum.Case presentationA young patient visited our clinic with a complaint of right knee pain and giving way. Further work up revealed a full mid substance ACL tear, mild medial knee osteoarthritis and femur originated genu varum of his right knee. He was managed with simultaneous ACL reconstruction and distal femoral valgus osteotomy.ConclusionsAny corrective osteotomy for genu varum should be performed at center of rotation angle. Isolated ACL reconstruction in patients with simultaneous ACL deficiency and genu varum may hasten the knee degeneration.Level of evidenceIV

Effect of Cognitive Loading on Single-Leg Jump Landing Biomechanics of Elite Male Volleyball Players

Anterior cruciate ligament (ACL) injury is prevalent during the single-leg jump landing in various sports. The effects of cognitive loading and how it affects risk of ACL injury are not well understood. The purpose of this study is to examine how landing kinetics change in the presence of cognitive loading during a volleyball block. Cognitive loading decreased activations in vastus lateralis and rectus femoris, and increased activation in biceps femoris and medial gastrocnemius muscles. During landing, the first and second peaks of ground reaction forces were 13% and 11% lower under cognitive loading, suggesting that cognitive loading alters landing biomechanics and muscle activations.

Outcomes of simultaneous anterior cruciate ligament and medial collateral ligament reconstruction

Multiligamentous knee injuries (MLKI) are rare orthopedic injuries with involvement of two or more ligaments in the knee. There are variety of combinations of MLKI and one such relatively common and important injury pattern is anterior cruciate ligament (ACL) plus medial collateral ligament (MCL) injury. Though MCL grade 1 and 2 does not warrant surgical management, grade 3 defintely needs reconstruction or repair according to past studies so as to avoid valgus instability. A retrospective study was conducted evaluating the outcomes of combined ACL and MCL injuries in 22 patients at our centre. Road traffic accidents (RTA) accounted for 45.5% of the total cases as the most common mechanism of injury. Out of 22 patients operated with simultaneous ACL and MCL reconstruction, 14 (63.6%) had good results based on Lyscholm scoring system, 5 (22.8%) had excellent results, and 3(13.6%) had fair result and none of our patients had poor results. Simultaneous single stage management of ACL and MCL injury has advantages like early rehabilitation, reduced number of hospital stay as well as absence of necessity for getting admitted and operated for each ligament separately which also brings down the cost to the patient. Keywords: Reconstruction, ACL, MCL, Lyscholm.

Simultaneous arthroscopic reconstruction of anterior cruciate ligament and posterior cruciate ligament: An outcome analysis

Introduction: Combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injury is relatively a rare entity and it is extremely important to manage these injuries with great accuracy, as this may involve damage to neurovascular structures associated with knee dislocation and also carries the risk of accelerated joint degeneration if left untreated. There are many issues that are topic of debate even today like timing of surgery, graft of choice and single stage versus staged reconstruction. Materials and Methods: A prospective study for evaluating the outcomes of combined ACL and PCL injuries in 20 patients was conducted at our centre, who were managed arthroscopically. Preoperative and post-operative Lyscholm scores and IKDC scores were assessed to evaluate the patients outcomes. Results: Out of 20 patients operated for ACL and PCL injury, 14(70%) of them had excellent to good results and the rest 6(30%) had fair results with none of the patients reporting poor results. Conclusion: Simultaneous ACL and PCL reconstruction using arthroscopic technique is an effective and safe procedure irrespective of the time since injury and also this is more helpful to achieve early rehabilitation. Keywords: PCL, Lyscholm score, IKDC.

The effect of gender, age, and body mass index on the\xa0medial and lateral posterior tibial slopes: a magnetic resonance imaging study

BackgroundThe posterior tibial slope (PTS) is crucial in knee joint stability and in maintaining the natural movement of the knee. An increase in the PTS is associated with various knee pathologic conditions, such as anterior cruciate ligament (ACL) injury and anterior tibial translation (ATT). In the present study, we aimed to establish native medial and lateral PTS values for adult Saudis and to identify any association between PTS and gender, age, and body mass index (BMI).Materials and methodsA total of 285 consecutive, normal, magnetic resonance imaging (MRI) studies of the knee were included in the study. The PTS was measured using the proximal anatomical axis of the tibia. The Kruskal-Wallis test was used to compare the medial and lateral PTS angles between age groups. The difference between the medial and lateral posterior tibial slopes was assessed using the Wilcoxon signed-rank test. The Mann-Whitney U test was performed to compare the medial and lateral PTS angles between men and women. Age, gender, and BMI were analyzed by multivariate linear regression to determine whether they positively predict the medial and lateral PTS angles.ResultsThe mean physiological medial PTS was 5.86 ± 3.0° and 6.61 ± 3.32°, and the lateral PTS was 4.41 ± 3.35° and 4.63 ± 2.85° in men and women, respectively. This difference showed no statistically significant gender dimorphism (p > 0.05). The medial PTS was significantly larger than the lateral PTS (p < 0.0001). There was no statistically significant difference in the medial and lateral PTS angles between age groups (p > 0.05). Higher BMI was significantly associated with a steeper medial PTS (p = 0.001).ConclusionsThis study provided native values for medial and lateral PTS angles in Saudis, which can assist surgeons in maintaining normal knee PTS during surgery. The PTS was not influenced by age. The medial PTS was significantly larger than the lateral PTS in men and women. The PTS showed no significant gender dimorphism. BMI was significantly associated with the medial PTS.

A comparative study between laprade and Larson’s technique for posterolateral corner [PLC] Injury of knee

In the last few decades, injuries to the knee joint are common because of knee pivoting sports. The mechanism of injury to the PLC is due to direct varus stress, hyperextension, or twisting of the knee. These injuries are commonly associated with cruciate ligament tears, but PLC injury are usually overlooked or misdiagnosed. If Left untreated, it can cause chronic pain and residual instability. PLC reconstruction is normally advocated for grade 2 or 3 lesions, as it is superior to conservative treatment. This study is to compare larson’s and laparde techinque. In Larson’s technique there is reconstruction of the fibular collateral ligament and popliteo fibular ligament. In LaPrade technique popliteus graft is reinforced to the PLC. This is a prospective study conducted in 40 patients between April 2016 to January 2018 in Deccan Medical College and Hospitals, to compare the clinical outcome of Laprade and Larson’s techniques in terms of best post-operative stability and function of an isolated PLC injury. Inclusion criteria:age ranging from 18 to 40 years, Posterio lateral corner injury, No previous surgery or damage in the affected knee or the contralateral knee. Exclusion criteria: Patients with medial collateral ligament injury, cruciate ligament injury, generalized ligamentous laxity and arthritis knee. Methods and analysis of results: it is randomized study between Larson’s technique and Laprade’s technique. Postoperative evaluation: is by Lysholm score, IKDC scores and Postoperative complications. In conclusion it revealed that both methods are significant, and equally good at postoperative outcomes.

Influence of hip strength on acl injury related biomechanics during the cutting maneuver in preadolescent students (practical implication for physical education teachers and sports pedagogues)

Anterior cruciate ligament (ACL) injuries are one of the most serious injuries of the lower limb and can result in a relatively low rate of return to sport and decreased quality of life in later years, as well as to the psychological attitude towards sports among young people. Previous research has investigated the interaction between the hip muscles and knee valgus moments where some studies have concluded that decreased hip abductor and external rotator strength is a risk factor for ACL injury, but no research has been conducted on preadolescent population. Data from 271 students (174 girls), age 9-12 where collected while performing cutting manoeuvre and the isometric maximal voluntary contraction of hip external rotators and abductors. Our results show that no significant correlation where found between the hip strength does not influence the knee VM during the cutting manoeuvre in this age group which is in line with many previous studies conducted on older population.

Stronger Subjects Select a Movement Pattern That May Reduce Anterior Cruciate Ligament Loading During Cutting.

Davies, WT, Ryu, JH, Graham-Smith, P, Goodwin, JE, and Cleather, DJ. Stronger subjects select a movement pattern that may reduce anterior cruciate ligament loading during cutting. J Strength Cond Res 36(7): 1853-1859, 2022-Increased strength has been suggested to reduce the incidence of anterior cruciate ligament (ACL) injury as part of wider neuromuscular training programs; however, the mechanism of this is not clear. Cutting is a high-risk maneuver for ACL injury, but limited research exists as to how strength affects sagittal plane biomechanics during this movement. Sixteen subjects were split into a stronger and weaker group based on their relative peak isometric strength in a unilateral squat (stronger: 29.0 ± 3.4 N·kg-1 and weaker: 18.3 ± 4.1 N·kg-1). Subjects performed 45° cuts with maximal intent 3 times, at 3 different approach velocities (2, 4, and 6 m·s-1). Kinematics and ground reaction forces were collected using optical motion capture and a force platform. The stronger group had lower knee extensor moments, larger hip extensor moments, and a greater peak knee flexion angle than the weaker group (p < 0.05). There was a trend for greater knee flexion at initial contact in the stronger group. There were no differences in resultant ground reaction forces between groups. The stronger group relied more on the hip than the knee during cutting and reached greater knee flexion angles. This could decrease ACL loading by reducing the extensor moment required at the knee during weight acceptance. Similarly, the greater knee flexion angle during weight acceptance is likely to be protective of the ACL.

Influence of the site of injury on the spontaneous healing response in a rat model of total rupture of the anterior cruciate ligament

ABSTRACT Aim The healing ability of the anterior cruciate ligament (ACL) injury is very poor; however, it has recently been shown to undergo self-healing with conservative treatments. In this study, we evaluated the influence of the site of injury on the healing process after complete transverse tear of ACL using a rat model. Materials and Methods A total of 58 skeletally mature Wistar rats were randomly assigned to various ACL injury groups: controlled abnormal movement-mid-portion (CAM-MP), controlled abnormal movement-femoral side (CAM-FS), ACL transection-mid-portion (ACLT-MP), or ACL transection-femoral side (ACLT-FS) injury groups. The ACL was completely transected in the mid-portion in the ACLT-MP and CAM-MP groups, and on the femoral side in the ACLT-FS and CAM-FS groups. Both CAM groups underwent extra-articular braking to control for abnormal tibial translation. The animals were allowed full cage activity until sacrifice postoperatively for histological and biomechanical assessment. Results Significant differences were found in the ratios of residual ligament lengths between the CAM-MP and CAM-FS groups, demonstrating the validity of each model. Spontaneous healing of the injured ACL was observed in the CAM-MP and CAM-FS groups but not in the ACLT-MP and ACLT-FS groups. The mechanical strength of the healing ACL did not differ between the CAM-MP and CAM-FS groups 8 weeks after injury; however, the former had better mechanical strength than the latter 12 weeks after the injury. Conclusion ACL injuries in the mid-portion and on the femoral side may be treated with conservative therapy for spontaneous healing.

Imaging Review of the Posterior Cruciate Ligament.

Posterior cruciate ligament (PCL) injuries can often be missed on physical examination, especially in multiligament knee injuries. Therefore, a comprehensive approach to imaging the PCL should be implemented whenever history and examination findings indicate relative risk. Radiography, including a posterior-stress view, and magnetic resonance imaging, when available, provide consistently accurate diagnosis of PCL pathology and common knee comorbidities. Computed tomography and ultrasonography can be useful modalities with potential advantages with respect to availability and access, specific comorbidities, and/or cost-effectiveness.

When can total knee arthroplasty be safely performed following prior arthroscopy?

BackgroundThe optimal timing to perform a total knee arthroplasty (TKA) after knee arthroscopy (KA) was controversial in the literature. We aimed to 1) explore the effect of prior KA on the subsequent TKA; 2) identify who were not suitable for TKA in patients with prior KA, and 3) determine the timing of TKA following prior KA.MethodsWe retrospectively reviewed 87 TKAs with prior KA and 174 controls using propensity score matching in our institution. The minimum follow-up was 2 years. Postoperative clinical outcomes were compared between groups. Kaplan-Meier curves were created with reoperation as an endpoint. Multivariate Cox proportional hazards regressions were performed to identify risk factors of severe complications in the KA group. The two-piecewise linear regression analysis was performed to examine the optimal timing of TKA following prior KA.ResultsThe all-cause reoperation, revision, and complication rates of the KA group were significantly higher than those of the control group (p < 0.05). The survivorship of the KA group and control group was 92.0 and 99.4% at the 2-year follow-up (p = 0.002), respectively. Male (Hazards ratio [HR] = 3.2) and prior KA for anterior cruciate ligament (ACL) injury (HR = 4.4) were associated with postoperative complications in the KA group. There was a non-linear relationship between time from prior KA to TKA and postoperative complications with the turning point at 9.4 months.ConclusionPrior KA is associated with worse outcomes following subsequent TKA, especially male patients and those with prior KA for ACL injury. There is an increased risk of postoperative complications when TKA is performed within nine months of KA. Surgeons should keep these findings in mind when treating patients who are scheduled to undergo TKA with prior KA.