Difference In Lysholm Score Research Articles

Bone marrow lesion and medial meniscus extrusion width changes following arthroscopic partial meniscectomy for medial meniscal flap tears

BackgroundThe current literature evaluating meniscectomy outcomes often mixes various tear patterns, failing to elucidate the impact of specific tear types on procedure results. Flap tears, which are prone to causing mechanical symptoms, require targeted research. This study aims to examine Lysholm scores following a meniscectomy for medial meniscus flap tears, to determine if extensive resections lead to poorer one-year outcomes, and to assess their impact on postoperative bone marrow lesion (BML) risk and medial meniscus extrusion (MME) width.MethodsPatients undergoing arthroscopic meniscectomy for medial meniscal flap tears were classified into three groups: minimum resection, single leaf resection, and subtotal resection. Lysholm scores and medial joint space (MJS) width on Rosenberg view radiographs were measured preoperatively and one year postoperatively. BMLs and MMEs were assessed via MRI preoperatively and at 1, 3, 6, and 12 months postoperatively.ResultsFifty patients (mean age 60 ± 13 years) underwent meniscectomy: minimum resection in 21 (42%), single leaf in 23 (46%), and subtotal in 6 (12%). The Lysholm scores improved significantly, from 65.5 ± 17.6 to 93.4 ± 16.5 (n = 50) at 12 months in patients overall (p < 0.001), while MJS width decreased from 3.9 ± 0.7 mm to 3.5 ± 0.8 mm (p < 0.001). There were no significant differences in Lysholm scores or MJS widths among the three resection patterns. The occurrence rate of BMLs in the medial femoral condyle and tibial plateau increased post-surgery, peaking at 1 month, but then improved to near-baseline by 12 months. The occurrence rate of BMLs was higher in the single leaf and subtotal meniscectomy groups post-surgery, but declined across all groups by 12 months. Among the three groups with different resection patterns, MME width at 12 months was 2.7 ± 1.8 mm in the subtotal resection group, which was significantly larger than in the other groups.ConclusionsArthroscopic partial meniscectomy for flap tears yielded favorable 12-month outcomes. Larger resections were associated with greater BML incidence and greater MME width.

A Retrospective Study on Arthroscopic Debridement Alone Versus Combined with Microfracture in Patients with Knee Osteoarthritis

ObjectiveTo compare the clinical outcomes between arthroscopic debridement alone and arthroscopic debridement combined with microfracture in treating knee osteoarthritis, providing evidence for clinical treatment selection. MethodsClinical data of 103 knee osteoarthritis patients treated at our hospital from January 2022 to December 2023 were retrospectively analyzed. Patients were divided into observation group (arthroscopic debridement combined with microfracture, n=51) and control group (arthroscopic debridement alone, n=52) based on surgical approach. Lysholm scores, VAS scores, ROM, SF-36 scores, and complications were compared between groups before surgery and 6 months postoperatively. ResultsBoth groups showed significant improvement in Lysholm scores, VAS scores, ROM, and SF-36 scores at 6 months postoperatively compared to preoperative values (P<0.001). Compared with the control group, the observation group showed statistically significant differences in Lysholm scores [(76.12±2.45) vs (68.19±2.77)], VAS scores [(2.61±0.49) vs (3.13±0.77)], ROM [(126.20±2.42)° vs (115.02±2.08)°], and SF-36 scores [(77.47±2.08) vs (64.15±1.71)] at 6 months postoperatively (all P<0.001). The total complication rate in the observation group (11.76%) was significantly lower than in the control group (30.77%) (P<0.05). ConclusionArthroscopic debridement combined with microfracture shows significant advantages over arthroscopic debridement alone in improving clinical symptoms, joint function, and quality of life in knee osteoarthritis patients, with a lower complication rate, representing a safe and effective treatment option.

Comparative study of I.D.E.A.L. technique and transtibial technique in anterior cruciate ligament reconstruction

To compare the effectiveness of I.D.E.A.L technique and transtibial (TT) technique in anterior cruciate ligament (ACL) reconstruction. A clinical data of 60 patients with ACL injury, who were admitted and met the selection criteria between January 2020 and September 2022, was retrospectively analyzed. All patients underwent arthroscopic ACL reconstruction with autologous tendon. During operation, the femoral tunnel was prepared by using I.D.E.A.L technique in 30 cases (I.D.E.A.L group) and using TT technique in 30 cases (TT group). There was no significant difference in baseline data such as age, gender, body mass index, cause of injury, injured side, interval from injury to operation, constituent ratio of combined cartilage and meniscus injury, and preoperative Lysholm score, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) score, anterior tibial translation difference, and Blumensaat angle between the two groups ( P>0.05). The length of hospital stay and the occurrence of early and late complications were recorded. During follow-up, the Lysholm score, IKDC score, and VAS score were used to evaluate knee joint function and pain degree, and the anterior tibial translation difference was measured. MRI reexamination was performed to observe the healing of the graft, and the signal to noise quotient (SNQ) values of the femoral end, middle section, and tibial end of the graft, as well as the Blumensaat angle of the knee joint were measured. The differences in tibial anterior translation difference and Blumensaat angle before and after operation (change values) were calculated and compared between the two groups. The incisions in both groups healed by first intention after operation, and there was no significant difference in the length of hospital stay between the two groups ( P>0.05). All patients were followed up 12-18 months, with an average of 14.9 months. The Lysholm score and IKDC score of the knee joint in both groups after operation increased when compared with those before operation, and the VAS score decreased. Compared to preoperative scores, except for the VAS score of the TT group at 1 week after operation ( P>0.05), there were significant differences in all scores at different time points postoperatively in the two groups ( P<0.05). The above scores in both groups showed a further improvement trend with the prolongation of time after operation. There were significant differences in Lysholm score and VAS score among 1 week, 1 month, 3 months, 6 months, and 12 months after operation in the two groups ( P<0.05). The IKDC score of both groups at 1 month after operation was significantly different from that at 1 week after operation ( P<0.05). At 1 week after operation, the Lysholm score and IKDC score in the I.D.E.A.L group were significantly higher than those in the TT group ( P<0.05), and the VAS score was significantly lower ( P<0.05); there was no significant difference between the two groups at 1, 3, 6, and 12 months after operation ( P>0.05). At 12 months after operation, the anterior tibial translation differences in both groups were significantly lower than those before operation ( P<0.05); and the change value in the I.D.E.A.L group was significantly higher than that in the TT group ( P<0.05). The incidences of early and late complications in the I.D.E.A.L group were significantly lower than those in the TT group ( P<0.05). At 12 months after operation, MRI examination showed that the grafts of the knee joint in both groups survived well, and the Blumensaat angles of both groups were significantly smaller than those before operation ( P<0.05). The change value of the Blumensaat angle in the I.D.E.A.L group was significantly higher than that in the TT group ( P<0.05). The SNQ values of the femoral end, middle section, and tibial end of the graft in the I.D.E.A.L group were significantly higher than those in the TT group ( P<0.05). The early effectiveness of ACL reconstruction by using the I.D.E.A.L technique is better, the knee joint is more stable, and the incidence of postoperative complication is lower. However, the maturity of the graft after reconstruction using the TT technique is higher.

Results of medial patellofemoral ligament reconstruction with and without tibial tubercle osteotomy in patellar instability: a systematic review and single-arm meta-analysis

PurposeTo confirm which method provides lower rate of recurrent instability and superior clinical outcomes.MethodWe searched PubMed, Embase and Web of Science for the trials involving one intervention or both for patellar instability: medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle osteotomy (TTO). The postoperative Kujala score, Lysholm score, Tegner scores and the rate of recurrent instability (dislocation or subluxation) were analyzed as the primary clinical outcome parameters in a random or fixed effects meta-analysis.ResultsIn total, 43 articles met inclusion criteria after full-text review. A total of 2046 patients were analyzed. The overall mean age was 20.3 years (range, 9.5–60.0 years), with a mean follow-up time of 3.2 years (range, 1–8 years). The mean Kujala scores in MPFLR and MPFLR + TTO were 89.04 and 84.44, respectively. There was significant difference in Kujala scores between MPFLR and MPFLR + TTO (MD = 4.60, 95%CI: 1.07–8.13; P = 0.01). The mean Lysholm scores in MPFLR and MPFLR + TTO were 90.59 and 88.14, respectively. There was no significant difference in Lysholm scores between MPFLR and MPFLR + TTO (MD = 2.45, 95%CI: -3.20-8.10; P = 0.40). The mean Tegner scores in MPFLR and MPFLR + TTO were 5.30 and 4.88, respectively. There was no significant difference in Tegner scores between MPFLR and MPFLR + TTO (MD = 0.42, 95%CI: -0.39-1.23; P = 0.31). At final follow-up, the rates of recurrent instability in MPFLR and MPFLR + TTO were 3% and 4%, respectively. There was no significant difference in the rates between MPFLR and MPFLR + TTO (OR = 0.99, 95%CI: 0.96–1.02; P = 0.4848).ConclusionMPFLR and MPFLR + TTO are effective and reliable treatments in the setting of patellofemoral instability. MPFLR seems to show a better performance in functional outcomes than MPFLR + TTO. Moreover, their rates of recurrent instability are very low, and no significant difference exists.

Clinical outcomes following transtibial medial meniscal root repair are maintained at long-term follow-up.

To evaluate long-term outcomes of patients treated with posterior medial meniscal root tear (PMMRT) repair through assessment of functional outcome scores and to identify patient surgical and magnetic resonance imaging (MRI) characteristics associated with improved outcomes. This was a single-centre, retrospective study evaluating patients who had undergone a PMMR repair using a transtibial suture pullout technique with two locking cinch sutures. This was performed as a follow-up to previously published 2-year and 5-year outcome studies, using the same cohort. All patients from the prior short-term and midterm studies were invited to participate. Patient-reported outcome (PROs) scores, including the International Knee Documentation Committee (IKDC) and Lysholm scores, were collected. Previously collected demographic data were updated based on review of the electronic medical record. Patient outcomes were assessed preoperatively, as well as at 2-year, 5-yearand 8-yearpostoperatively. MRI outcome measurements were assessed at 2-year and 5-year follow-ups. All statistical analysis was performed using SPSS version 26. Seventeen patients of the original 18 patients (94.4%) were included in the final analysis. Additionally, three patients who had additional ipsilateral surgery were excluded from the analysis of PROs. The IKDC score significantly increased from 44.7 ± 11.6 at preoperative baseline to 71.2 ± 21.3 at 8-yearpost-operation (p = 0.001). There were no significant differences in IKDC score between 2-year and 8-year follow-ups (p = n.s.) or 5-year and 8-year follow-ups (p = n.s.). The Lysholm score significantly increased from 49.6 ± 7.3 at preoperative baseline to 76.4 ± 17.2 at 8-year follow-up (p < 0.001). There was no significant difference in Lysholm scores between 2-year and 8-year follow-ups (p = n.s.) or 5-year and 8-year follow-ups (p = n.s.). A linear regression analysis found that 5-year IKDC scores were significantly correlated with 8-year IKDC scores (β = 0.681, p = 0.038). At 8-year follow-up, four (23.5%) patients required additional procedures on their operative knee (one total knee arthroplasty conversion). Patients treated with repair of PMMRT had maintenance of clinical outcome improvements at long-term follow-up despite worsening MRI outcomes at short-term and medium-term follow-ups. While a high proportion of patients required additional procedures on their operative knee at 8-yearfollow-up, few of these patient's additional procedures were related to failure of their primary surgery. Providers and patients may expect durable clinical outcomes following the repair of PMMRT, irrespective of radiographic appearance. Level IV.

Early-term effectiveness comparison of suture hook suture via double posteromedial approaches and Fast-Fix total internal suture in treatment of Ramp lesions

To compare the short-term effectiveness of suture hook suture via double posteromedial approaches and Fast-Fix total internal suture in treatment of Ramp lesions. A clinical data of 56 patients with anterior cruciate ligament rupture combined with Ramp lesions, who met the selection criteria and admitted between December 2021 and February 2023, was retrospectively analyzed. The Ramp lesions were sutured using suture hook via double posteromedial approaches under arthroscopy in 28 cases (group A) and treated with Fast-Fix total internal suture under arthroscopy in 28 cases (group B). There was no significant difference in age, gender, cause of injury, type of injury, time from injury to operation, side of injury, body mass index, and preoperative Lysholm score, visual analogue scale (VAS) score, and Tegner score between the two groups ( P>0.05). The patients were followed up regularly after operation, and the clinical and imaging healing of the Ramp lesion was evaluated according to the Barrett clinical healing standard and the MRI evaluation standard. Lysholm score, VAS score, and Tegner score were used to evaluate the function and pain degree of knee joint, and the results were compared with those before operation. The incisions of the two groups healed by first intention. All patients were followed up 12-18 months (mean, 14.9 months). Postoperative McMurray tests were negative in both groups. The clinical healing rates of group A and group B were 71.4% (20/28) and 64.3% (18/28) at 6 months after operation, and 92.9% (26/28) and 82.1% (23/28) at 12 months after operation, respectively. The differences between the two groups was not significant ( χ 2=0.327, P=0.567; χ 2=0.469, P=0.225). There was no significant difference in Lysholm score, VAS score, and Tegner score between the two groups at each time point after operation ( P>0.05). The postoperative scores in the two groups significantly improved when compared with those before operation, and the scores at 12 months after operation further improved when compared with those at 6 months after operation, showing significant differences between the different time points in the two groups ( P<0.05). At last follow-up, MRI examination of the knee joint showed that there were 26 (92.9%), 2 (7.1%), and 0 (0) cases of complete healing, partial healing, and nonunion in the Ramp lesion of group A, and 25 (89.3%), 1 (3.6%), and 2 (7.1%) cases in group B, respectively. There was no significant difference between the two groups ( Z=-0.530, P=0.596). Suture hook suture via double posteromedial approaches and Fast-Fix total internal suture under arthroscopy are safe and reliable in the treatment of Ramp lesion, and the knee joint function significantly improves after operation.

Efficacy of Intraoperative Platelet-Rich Plasma After Meniscal Repair: Systematic Review and Meta-analysis.

Meniscal injuries frequently require surgical intervention to restore knee joint function and stability. Intraoperative platelet-rich plasma (PRP) injection has emerged as a potential adjunctive therapy to enhance tissue healing post-meniscal repair. This systematic review and meta-analysis aimed to evaluate the efficacy of PRP in terms of pain relief, functional recovery, and overall success rates in patients undergoing meniscal repair procedures. A comprehensive search strategy was employed to identify relevant studies across Scopus, PubMed, Embase, and the Cochrane Library databases. The inclusion criteria encompassed human studies, including randomized controlled trials (RCTs), cohorts, and case-control studies, focusing on intraoperative platelet-rich plasma (PRP) use post-meniscal repair and reporting outcomes related to pain, functionality, and cure rates. Exclusion criteria comprised animal studies, non-English publications, studies lacking relevant outcome measures, and those with insufficient data. Two reviewers independently screened titles and abstracts, resolving disagreements through consensus or consultation with a third reviewer, followed by a full-text assessment for potentially eligible studies. Data extraction was conducted independently by two reviewers using a standardized form. The reliability of observational studies was evaluated using the Newcastle-Ottawa Scale. Subgroup analyses and pooled effect estimates for main outcomes were computed using RevMan 5.3, a meta-analysis tool. The demographic analysis revealed that the PRP group had an average age of 41.39years, while the control group had an average age of 42.1years. In terms of gender distribution, the PRP group consisted of 61 men and 29 women, while the control group had 62 men and 34 women. Pain ratings showed a preference for PRP with a mean difference of 4.83 (p = 0.13). However, there was no significant difference in Lysholm scores (mean difference: - 0.44, p = 0.91) or IKDC scores (mean difference: 2.80, p = 0.14) between the PRP and control groups. Similarly, ROM measures did not show a statistically significant difference, with a mean difference of 2.80 (p = 0.18). Additionally, there was no significant distinction in failure rates between the PRP and control groups, as indicated by a weighted mean difference of 0.71 (p = 0.52). These findings suggest that while PRP may offer some benefits in pain relief, its impact on functional recovery, range of motion, and failure rates following meniscal repair procedures is inconclusive. The current evidence regarding the effect of intraoperative platelet-rich plasma (PRP) injection on patients undergoing meniscal repair remains inconclusive. While some studies suggest potential benefits in terms of pain relief and functional recovery, others show no significant differences compared to control groups. The impact of PRP therapy on overall success rates, including rates of re-tear and revision surgery, is also uncertain. Further well-designed randomized controlled trials with larger sample sizes are needed to provide more robust evidence and guide clinical practice in orthopedic surgery.

Effects of preoperative anxiety level on pain level and joint functions after total knee arthroplasty

This study examined the effect of preoperative anxiety level on postoperative pain, opioid and nonopioid analgesic use requirements and joint function in patients undergoing primary knee arthroplasty for knee osteoarthritis. 106 patients were included in the study. Situational anxiety score (STAI-S) and trait anxiety score (STAI-T) were divided into two groups as below and above 40. Visual analog scale (VAS), Lysholm scores, and anxiety levels were assessed preoperatively, at the third and sixth month postoperatively to investigate their effects on the use of opioid and non-opioid drugs during the postoperative period. For those with low situational and trait anxiety scores, the median duration of hospital stays was significantly shorter compared to those with high anxiety scores. In groups where anxiety levels were initially low, the median anxiety levels at the postoperative 3rd month were also observed to be lower compared to the other group. In the same groups, the median VAS values and the median Lysholm knee scores were significantly better both preoperatively and at the postoperative 3rd month compared to the other group. There was no significant difference in Lysholm score between the two groups at the 6th postoperative month. Similarly, in the preoperative period, groups with low anxiety levels had a significantly lower median usage of both opioids and non-opioids compared to the other group. These findings suggest that high preoperative anxiety may have a negative effect on functional outcomes in the early postoperative period, but this effect disappeared at 6 months. It can be concluded that reducing preoperative anxiety may have a positive effect on early outcomes. We believe that preoperative psychological evaluation and treatment can increase the satisfaction level in patients undergoing total knee arthroplasty (TKA).

The degree of fracture reduction does not compromise the clinical efficacy of arthroscopic reduction and fixation of tibial posterior cruciate ligament avulsion fractures: A retrospective study.

This study aimed to explore the postoperative outcomes of patients who underwent arthroscopic internal fixation with repositioning sutures for the treatment of posterior cruciate ligament (PCL) avulsion fractures with poorly reduced fracture fragments. It was hypothesized that improperly repositioned fracture fragments might not influence the postoperative clinical outcomes in patients with PCL avulsion fractures treated by arthroscopic sutures. From January 2020 to December 2021, patients admitted to our hospital with PCL avulsion fractures were evaluated. Our inclusion criteria were as follows: diagnosis of PCL avulsion fracture as Meyers & McKeever Type II or Type III; underwent arthroscopic double tunnel suture fixation; and age below 70. Of the patients meeting these criteria, data from 34 individuals were collected by a designated follow-up officer. Based on postoperative imaging, the patients were divided into 2 groups: well fracture reduction and poor fracture reduction groups. Prior to the surgery, the Lysholm score, knee mobility, and international knee documentation committee (IKDC score) were recorded for both groups. At the 3-month post-surgery mark, CT-3D reconstruction was performed. Statistical analysis was conducted on the collected data. For data that conformed to a normal distribution, the t test was applied. For data that didn't conform, we used a non-parametric test. Both groups achieved successful wound healing without encountering any adverse events, such as fracture nonunion infection. Fracture healing was observed in both groups at the 3-month postoperative mark. The average follow-up duration was 13.24 ± 6.18 months. There were no significant differences in Lysholm score, IKDC score, or knee mobility between the well- and poorly-reduced groups at the final follow-up (P > .05). Postoperatively, both groups demonstrated significant improvements in knee function compared to the preoperative scores, with statistically significant differences observed in Lysholm score, IKDC score, and knee mobility (P < .05). Arthroscopic fixation with double-tunnel sutures proved to be a highly effective treatment approach for PCL avulsion fractures, even in cases where the fractures were poorly reduced. Remarkably, there were no significant differences observed in postoperative knee function between the well- and poorly-reduced groups, indicating that both groups achieved favorable outcomes.

Brace-Free Rehabilitation after Isolated Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft Is Not Inferior to Brace-Based Rehabilitation-A Randomised Controlled Trial.

The postoperative use of a rehabilitative knee brace after isolated primary anterior cruciate ligament (ACL) reconstruction (ACLR) using a hamstring tendon (HT) autograft is controversial. A knee brace may provide subjective safety but can cause damage if applied incorrectly. The aim of this study is to evaluate the effect of a knee brace on clinical outcomes following isolated ACLR using HT autograft. In this prospective randomised trial, 114 adults (32.4 ± 11.5 years, 35.1% women) underwent isolated ACLR using HT autograft after primary ACL rupture. Patients were randomly assigned to wear either a knee brace (n = 58) or no brace (n = 56) for 6 weeks postoperatively. An initial examination was performed preoperatively, and at 6 weeks and 4, 6, and 12 months. The primary endpoint was the subjective International Knee Documentation Committee (IKDC) score to measure participants' subjective perceptions. Secondary endpoints included objective knee function assessed by IKDC, instrumented knee laxity measurements, isokinetic strength tests of the knee extensors and flexors, Lysholm Knee Score, Tegner Activity Score, Anterior Cruciate Ligament-Return to Sport after Injury Score, and quality of life determined by Short Form-36 (SF36). There were no statistically significant or clinically meaningful differences in IKDC scores between the two study groups (3.29, 95% confidence interval (CI) -1.39 to 7.97, p = 0.03 for evidence of non-inferiority of brace-free compared with brace-based rehabilitation). The difference in Lysholm score was 3.20 (95% CI -2.47 to 8.87); the difference in SF36 physical component score 0.09 (95% CI -1.93 to 3.03). In addition, isokinetic testing did not reveal any clinically relevant differences between the groups (n.s.). Brace-free rehabilitation is non-inferior to a brace-based protocol regarding physical recovery 1 year after isolated ACLR using HT autograft. Consequently, the use of a knee brace might be avoided after such a procedure. Level I, therapeutic study.

A Randomized Trial of Autologous Chondrocyte Implantation Versus Alternative Forms of Surgical Cartilage Management in Patients With a Failed Primary Treatment for Chondral or Osteochondral Defects in the Knee

Background: There are limited randomized controlled trials with long-term outcomes comparing autologous chondrocyte implantation (ACI) versus alternative forms of surgical cartilage management within the knee. Purpose: To determine at 5 years after surgery whether ACI was superior to alternative forms of cartilage management in patients after a failed previous treatment for chondral or osteochondral defects in the knee. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In total, 390 participants were randomly assigned to receive either ACI or alternative management. Patients aged 18 to 55 years with one or two symptomatic cartilage defects who had failed 1 previous therapeutic surgical procedure in excess of 6 months prior were included. Dual primary outcome measures were used: (1) patient-completed Lysholm knee score and (2) time from surgery to cessation of treatment benefit. Secondary outcome measures included International Knee Documentation Committee and Cincinnati Knee Rating System scores, as well as number of serious adverse events. Analysis was performed on an intention-to-treat basis. Results: Lysholm scores were improved by 1 year in both groups (15.4 points [95% CI, 11.9 to 18.8] and 15.2 points [95% CI, 11.6 to 18.9]) for ACI and alternative, with this improvement sustained over the duration of the trial. However, no evidence of a difference was found between the groups at 5 years (2.9 points; 95% CI, −1.8 to 7.5; P = .46). Approximately half of the participants (55%; 95% CI, 47% to 64% with ACI) were still experiencing benefit at 5 years, with time to cessation of treatment benefit similar in both groups (hazard ratio, 0.97; 95% CI, 0.72 to 1.32; P > .99). There was a differential effect on Lysholm scores in patients without previous marrow stimulation compared with those with marrow stimulation (P = .03; 6.4 points in favor of ACI; 95% CI, −0.4 to 13.1). More participants experienced a serious adverse event with ACI (P = .02). Conclusion: Over 5 years, there was no evidence of a difference in Lysholm scores between ACI and alternative management in patients who had previously failed treatment. Previous marrow stimulation had a detrimental effect on the outcome of ACI. Registration: International Standard Randomised Controlled Trial Number: 48911177

Comparison of Autografts vs Allografts for Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Current Perspective

Objective: To describe the outcomes of autografts and allografts in anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction with respect to instrumented laxity measurements, patient-reported outcome scores, complications, and graft failure risk. Methods: We searched PubMed, Cochrane Library, and EMBASE for published randomized controlled trials (RCT) and case controlled trials (CCTs) to compare the outcomes of the autografts versus allografts after cruciate ligament reconstruction. Data analyses were performed using Cochrane Collaboration RevMan 5.0. Results: Nine studies were identified from the literature review. Of these studies, three studies compared the results of bone–patellar tendon–bone (BPTB) and ligament augmentation and reconstruction system (LARS), while six studies compared the results of four-strand hamstring tendon graft (4SHG) and LARS. The comparative study showed no difference in Lysholm score and failure risk between autografts and synthetics. Discussion: The combined results of the meta-analysis indicated that there was a significantly lower rate of side-to-side difference &gt; 3 mm (Odds Ratio [OR] 2.46, 95% confidence intervals [CI] 1.44–4.22, P = 0.001), overall IKDC (OR 0.40, 95% CI 0.19–0.83, P = 0.01), complications (OR 2.54, 95% CI 1.26–5.14, P = 0.009), and Tegner score (OR −0.31, 95% CI −0.52–0.10, P = 0.004) in the allografts group than in the autografts group. Conclusion: This systematic review comparing long-term outcomes after cruciate ligament reconstruction with either autograft or allografts suggests no significant differences in failure risk. Autografts were inferior to allografts with respect to restoring knee joint stability and patient-reported outcome scores, and were also associated with more postoperative complications.

Combined Anterior Cruciate Ligament Reconstruction (ACLR) and Lateral Extraarticular Tenodesis Using Modified Lemaire Technique versus ACLR alone : A Meta-Analysis of Clinical Outcomes

Introduction: Anterior cruciate ligament (ACL) rupture was the most common injury that occurred in the knee. Reconstruction was the most common operative management used. After primary ACL reconstruction, a rerupture can be devastating. Several extraarticular procedures have been proposed to resolve rotatory instability, such as tenodesis. We determined to conduct a meta-analysis comparing ACL reconstruction (ACLR) with lateral extraarticular tenodesis (LET) using the modified Lemaire technique and evaluated the risk of failure or re-rupture rate and the outcome. Method: We conducted a meta-analysis based on The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The search was conducted in June 2022 on several databases: PubMed, EBSCOHost, Scopus, ScienceDirect, and WileyOnline using Boolean operators focusing on PICO (Population, Intervention, Control, Outcome). Included studies will be extracted for characteristics such as author and study year, location, design, sample characteristics, failure (graft or clinical failure), and outcome (KOOS score, functional outcome, clinical outcome). Studies will be qualitatively and quantitatively evaluated using Review Manager 5.4 or equivalent. Result: Search was conducted and resulted in the five final studies with 797 patients. ACLR + LET has a lower risk of failure or re-rupture ratio than ACLR alone (RR= 0.44; 95% CI 0.26 – 0.75; I2=9%; p= 0.003). There were differences in the KOOS pain score, ADL score, sports score and QOL score with mean difference of 0.20 (95% CI 0.10, 0.30; I2=0%; p &lt;0.0001), -0.20 (95% CI -0.26, -0.13; I2=0%; p &lt;0.00001), 0.20 (95% CI 0.02, 0.38; I2=0%; p= 0.03), and 0.50 (95% CI 0.29, 0.71; I2=0%; p&lt; 0.00001) respectively. Furthermore, there was a significant mean difference in the International Knee Documentation Committee score of 0.70 (95% CI 0.57, 0.83; I2=0%; p &lt;0.000001). However, there were no significant differences in Lysholm score, and Tegner score between groups. Conclusion: LET was considered adequate in adjunction to ACLR, to minimize rerupture rate, and to improve stability and laxity of the knee to improve clinical outcome

A comparison of functional knee outcomes post-arthroscopic anterior cruciate ligament (ACL) reconstruction using hamstring and peroneus longus (PL) autograft

Background: Hamstring autograft (HA) is the most common graft used in ACL reconstruction procedures. However, harvesting HA could weaken the secondary stabilizer of the knee joint. Peroneus longus grafts (PL) is a novel option secondary to hamstring graft with less morbidity at the knee joint. We intended to determine whether peroneus longus autograft (PL) is a comparable alternative to hamstring autograft for ACL Reconstruction. Methods: 84 patients were grouped into "hamstring" (n = 51) and "peroneus longus" (n = 33) groups, with a mean age of 26.2 ± 5.9 in the Hamstring group and a mean age of 26.4 ± 6.6 in peroneus group. We obtain secondary data from the medical records of several hospitals in Makassar. Results: There was a significant difference in Lysholm score (p&lt;0.05) in the hamstring group with peroneus at 6 months and 12 months postoperatively for IKDC score, anterior translation, Power Grading Flexi-Extension, ROM on flexion, and extension. In addition, in muscle atrophy, the Hamstring group compared to the peroneus group also showed a significant difference (p=0.001). Conclusion: The study's results did not show significant differences between the hamstring and peroneus groups other than atrophy of thigh muscles in the hamstring group. Based on the results of this study, we conclude peroneus longus graft is one of the graft options in ACL reconstruction surgery.

Synovial Fluid Cytokine Profile at the Time of Arthroscopy Explains Intermediate-Term Functional Outcomes

Background: The intra-articular immune response after ligamentous, meniscal, or focal chondral knee injuries likely plays a role in intra-articular healing and the onset and progression of posttraumatic osteoarthritis. Purpose: To evaluate the association of synovial fluid cytokine concentrations measured at the time of knee arthroscopy with intermediate-term functional outcomes after knee arthroscopy based on the Lysholm score. Study Design: Cohort study; Level of evidence, 2. Methods: This was a prospective cohort study of patients undergoing arthroscopic knee surgery. Synovial fluid was aspirated from the injured knee immediately before surgical incision, and the concentrations of 10 cytokines were analyzed using immunoassay. Principal component regression was used to create a model to predict patient-reported Lysholm score at a minimum of 5 years postoperatively. Hierarchical clustering was performed to identify groups of patients with similar synovial fluid inflammatory phenotypes. Lysholm scores and cytokine concentrations were compared between clusters. Results: A total of 26 patients (mean age, 40.33 ± 16.40 years) were included in the analysis. The mean duration between surgery and follow-up was 6.69 ± 0.72 years. A model consisting of 2 principal components (PC1, PC2) explained 62.48% of the variance in the cytokine data and 52.03% of the variance in intermediate-term Lysholm score. Hierarchical clustering resulted in 3 patient clusters based on the principal components used in the regression model. Despite no baseline differences in Lysholm score, cluster 3 demonstrated significantly greater intermediate-term Lysholm score compared with cluster 2 (94.33 vs 76.09, respectively; 95% CI, 5.96-30.52; P = .006) and cluster 1 (94.33 vs 52.33, respectively; 95% CI, 24.09-59.91; P = .003). Cluster 3, when compared with the overall means, was characterized by greater PC1 value (1.01 vs 0.00, respectively; P = .030) and greater PC2 value (0.86 vs 0.00, respectively; P = .002). Conclusion: The concentrations of select synovial fluid cytokines assessed at the time of knee arthroscopy can be used to explain more than half of the variance in intermediate-term functional outcomes.

Functional Outcome of Anterior Cruciate Ligament Reconstruction by Tibial Attachment Preserving versus Sacrificing Hamstring Graft Technique- A Prospective Interventional Study

Introduction: Anterior Cruciate Ligament (ACL) is a stout, short intra-articular, extra synovial structure. For a knee with the deficiency of ACL, the ligament reconstruction using an autograft, either a free bone patellar tendon bone graft or a Semi Tendinosus and Gracilis (STG) tendon free hamstring graft, is the most common surgical treatment. Tibial fixation region of the graft is presumed to be a delicate point in arthroscopic ACL reconstruction. There, can be a chance of graft pull out from the tibial tunnel before actual healing of the graft– tunnel can occur. To avoid this problem, the technique of tibial attachment preserved hamstring graft can be used instead of free hamstring graft. Aim: To evaluate and compare the functional outcome of patients who underwent ACL reconstruction with either a free hamstring graft or by tibial attachment preserving hamstring graft. Materials and Methods: A prospective interventional study was conducted in the Department of Orthopaedics, Swami Rama Himalayan University Hospital, Dehradun, Uttarakhand, India, over a period of one year (July 2019-July 2020). A total 52 patients were included and they were divided into two groups. Group A (tibial attachment preserving hamstring graft) and Group B (tibial attachment sacrificing hamstring graft) with each group comprised 26 patients. Patients were assessed with Lysholm score at 6, 12 and 24 weeks of follow-up. For determining the statistical difference between the two groups Independent Student’s t-test was used, whereas for more than two groups Analysis of Variance (ANOVA) test was used and a p-value &lt;0.05 was considered to be significant. Results: The mean age of patients in group A was 30.73±10.02 years whereas in group B it was 29.54±9.84 years. For group A, mean Lysholm score at 6 weeks was 73.23±8.37, at 12 week score was 86.85±5.93 and at 24 week score was 95.58±4.91. For group B, mean Lysholm score at 6 weeks was 74.15±5.82, at 12 weeks score was 87.46±5.95 and at 24 weeks score was 96.92±3.61. Post-hoc analysis showed that there was a significant difference in mean Lysholm score {between preoperative and other time points (p&lt;0.001, respectively)} for both the groups but there was no significant difference in Lysholm score at 6 weeks (p=0.646), 12 weeks (p=0.710) and 24 weeks (p=0.265) when compared between the two groups. Conclusion: ACL reconstruction using hamstring autograft with preserved tibial insertion resulted in no statistically significant difference in functional outcome as compared with free autograft.

Arthroscopic surgery combined with platelet-rich plasma for meniscus injury:a Meta analysis

To evaluate clinical efficacy of arthroscopic with platelet-rich plasma (PRP) in treating meniscus injury. From January 2015 to December 2019, clinical control study on repair meniscus injury by arthroscopic with PRP between arthroscopic were searched by PubMed, Science Direct, Cochrane library, Chinese Journal Full-text Database, Wanfang and VIP database. Literature screening, data extraction and quality evaluation according to inclusion and exclusion criteria. Visual analogue scale(VAS) of knee joint and Lysholm score at 1, 6 and 12 months after opertaion between two groups were compared, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) at 3, 6 and 12 months after opertaion between twogroups were also compared. Totally 9 literatures and 329 patients with meniscal injuries were screened, include 146 patients treated by arthroscopic with PRP and 183 patients treated by arthroscopic. There were no statistical differences in VAS between two groups at 1, 6 and 12 months after opertaion. There were differences in Lysholm score at 1 and 6 months after operation between two groups [MD=3.85, 95%CI (1.25, 6.44), P<0.05], [MD=2.88, 95%CI (0.13, 5.63), P<0.05];while there was no difference at 12 months[MD=5.88, 95%CI(-8.72, 20.48), P=0.43]. There were differneces in WOMAC score at 3 and 6 months after operation between two groups[MD=-8.07, 95%CI(-11.17, -4.89), P<0.000 01], [MD=-7.96, 95%CI(-11.44, -4.48), P<0.000 01];and no difference at 12 months after operation[MD=-6.61, 95%CI (-16.64, 3.41), P>0.05]. Arthroscopic with PRP for repair meniscus injury has short term efficacy of knee function and delay arthritis, while has similar effect in long term clinical efficacy and relieve pain.

The clinical outcome of minimally invasive popliteal tendon recess procedure is comparable to arthroscopic popliteal tendon reconstruction in patients with type A posterolateral rotational instability.

To compare the objective and subjective clinical outcome of minimally invasive popliteal tendon (PT) recess procedure versus arthroscopic PT reconstruction, combined with posterior cruciate ligament reconstruction in patients with Type A posterolateral rotational instability (PLRI). The hypothesis was that the two techniques had comparable clinical outcomes. Between 2012 and 2017, patients who were eligible for inclusion in this study if they (1) had Type A PLRI according to Fanelli's classification with posterior tibial translation > 12mm on stress radiography and side-to-side difference of dial test external rotation > 10°, (2) PT peel-off lesion or laxity with structural integrity (3) were followed for a minimum of 2years with examination under anesthesia (EUA) and stress radiograph results. Evaluation included subjective scoring, knee stability examinations and second-look arthroscopic lateral gutter drive-through (LGDT) test. Patients who underwent PT recess procedure were designated as Group A, while patients who underwent arthroscopic PT reconstruction were labelled as Group B. The differences between the two groups were analyzed. A total of 61 eligible patients with a minimum follow-up time of 2years were evaluated in the present study. At the final follow-up, there were no significant inter-group differences in Lysholm scores (Group A: 69.0 ± 16.5, Group B: 75.8 ± 14.6, ns), Tegner scores [Group A: 2 (1-4), Group B: 3 (1-5), ns], or IKDC subjective scores (Group A: 70.5 ± 13.5, Group B: 71.1 ± 9.1, ns). No significant difference in side-to-side difference on posterior stress radiography (Group A: 4.3 ± 3.8mm, Group B: 4.7 ± 4.6mm, P = 0.701), dial test result (Group A: 0.9 ± 4.4°, Group B: 1.6 ± 4.9°, ns) or LGDT test positive rate (Group A: 2/34, 5.9%, Group B: 2/27, 7.7%, ns) was observed. Both minimally invasive PT recess procedure and arthroscopic PT reconstruction significantly improved the knee stability and subjective outcome comparing with preoperative value. In a comparison with arthroscopic PT reconstruction, the recess procedure demonstrated comparable subjective and objective clinical outcome. When both PT reconstruction and PT recess procedure are indicated, the minimally invasive and graft-free recess procedure can be a viable option. III.

The comparative efficacies of intravenous administration and intra-articular injection of tranexamic acid during anterior cruciate ligament reconstruction for reducing postoperative hemarthrosis: a prospective randomized study

BackgroundHemarthrosis after anterior cruciate ligament (ACL) reconstruction can create many adverse joint effects. Tranexamic acid (TXA) can be used to minimize hemarthrosis and associated pain after ACL reconstruction. We aimed to compare the efficacies of intravenous (IV) administration and intra-articular (IA) injection of TXA during ACL reconstruction for reducing postoperative hemarthrosis.MethodsA total of 120 patients who underwent arthroscopic ACL reconstruction were included in this prospective and randomized study. All patients were randomized into three groups: IV group, IA group and placebo group. Patients in the IV group received intravenously administered TXA (15 mg/kg in 100 mL of saline solution) 10 min before tourniquet release; patients in the IA group received intra-articular TXA (15 mg/kg in 100 mL of saline solution) injected via the drainage tube; and patients in the placebo group received an equivalent volume of normal saline administered into the knee joint cavity and intravenously. Drainage tubes were removed 24 h after surgery, and all enrolled patients experienced a 4-week follow-up period. The drain output volume, visual analogue scale (VAS) score, patellar circumference, hemarthrosis grade and Lysholm score of all patients were recorded.ResultsBoth the IV group and the IA group had significantly lower drain output volumes at day 1, lower VAS scores at weeks 1 and 2, smaller patellar circumferences at weeks 1 and 2, and lower hemarthrosis grades at weeks 1 and 2 than the placebo group (p < 0.05). There were no significant differences in drain output volume, VAS score, patellar circumference or hemarthrosis grade between the IV group and the IA group at any time point (p > 0.05). No obvious differences in Lysholm score were observed between any pair of groups at week 4 (p > 0.05)). Neither infection nor deep vein thrombosis occurred in any group.ConclusionsBoth intravenous administration and intra-articular injection can reduce intra-articular hemarthrosis, joint pain and swelling during ACL reconstruction. No significant difference in the efficacies of reducing hemarthrosis, joint pain and swelling was found between intravenous administration and intra-articular injection.Trial registrationThe study was registered by the Chinese Clinical Trial Registry (The comparative efficacies of intravenous administration and intra-articular injection of tranexamic acid during anterior cruciate ligament reconstruction; ChiCTR-INR-17012217; August 1, 2017).

Low-Energy Multiligament Knee Injuries Are Associated With Higher Postoperative Activity Scores Compared With High-Energy Multiligament Knee Injuries: A Systematic Review and Meta-analysis of the Literature

Background: Multiligament knee injuries (MLKIs) can result from high-energy injury mechanisms such as motor vehicle accidents or low-energy injury mechanisms such as activities of daily living or sports. Purpose/Hypothesis: The purpose was to conduct a systematic review on postoperative patient-reported outcomes after MLKIs and to conduct a meta-analysis of comparable outcome variables based upon high- versus low-energy injury mechanisms. It was hypothesized that MLKIs with low-energy injury mechanisms would demonstrate significantly improved subjective clinical outcome scores compared with high-energy injuries. Study design: Meta-analysis and systematic review. Methods: A systematic review was performed with the inclusion criteria of postoperative MLKI outcomes based upon high-versus low-energy mechanisms of injury with a minimum 2-year follow-up. Outcome scores included were the Lysholm knee scoring scale, Tegner activity scale, and the International Knee Documentation Committee (IKDC) score. High-energy mechanisms included motor vehicle accidents or falls from a height >5 feet; low-energy mechanisms included sports-related injuries, activities of daily living, or falls from <5 feet. A meta-analysis was performed comparing the outcome scores of high- versus low-energy mechanisms of MLKIs. Results: Overall, 1214 studies were identified, 15 of which were included in the systematic review and meta-analysis. Thirteen studies included surgical reconstructions of all injured ligaments. A total of 641 patients with 275 high-energy and 366 low-energy injuries were grouped for comparison in the meta-analysis. No significant differences in Lysholm scale (78.6 vs 78.0) or IKDC scores (69.0 vs 68.4) were found between high- and low-energy groups at a minimum of 2 years (range, 2-10 years) postoperatively (P > .05). The low-energy injury group demonstrated significantly higher Tegner activity scale scores (5.0 vs 3.9; P = .03). There was no significant difference in failure rates between groups (3.5% vs 2.0%; P = .23). Conclusion: We found in this systematic review and meta-analysis that patients with low-energy mechanisms of MLKI surgery had improved postoperative Tegner activity scores compared with those patients with high-energy mechanisms after MLKI surgery. However, there were no differences in Lysholm score, IKDC score, or failure rates between high- and low-energy MLKI patients at an average of 5.3 years postoperatively.