IKDC Scale Research Articles

Évolution naturelle à long terme d’une lésion de la rampe non réparée : analyse rétrospective de 28 patients suivis pendant au moins 20 ans

Ramp lesion is a specific type of injury, located in the posterior horn of the medial meniscus. The purpose of the study was to evaluate the complications for meniscal ramp lesions left in situ during ACL reconstruction, after more than 20 of follow-up. All patients who underwent arthroscopic ACLRs between January 1998 and December 2000 were evaluated retrospectively. Surgery was performed by the same surgeon. In case of a stable vertical tear, i.e. without instability, lesion was left in situ, without suture or debridement. The following parameters were studied: demographics; history and clinical findings including time from injury to surgery, side-to-side laxity, pivot shift; knee and activity function by Lysholm score, subjective IKDC, KOOS and Tegner activity scale; and evolution to bucket handle. We defined two groups: bucket handle group versus no bucket handle group. A total of 716 patients underwent a primary ACLR during this period. The overall incidence of ramp lesions in the study population was 5.4% (39 ramp lesions in 716 patients). Mean follow-up time was 262.1 (± 10.5) months. The occurrence of medial meniscus bucket handle represented 21.4% of our population, with an average delay of 99 (± 50) months, and a concentration of this injury between 96 and 156 months. The postoperative scores were significantly improved for the whole population at more than 20 years of follow-up ( P < 0.0001), except for the Tegner score ( P = 0.3424). Functional scores and side-to-side laxity was the same for the two groups. No risk factors were identified. There is a high incidence of bucket-handle injury after ACL surgery with a ramp lesion left in place (21.4%). This high rate is only found in series with a long follow-up, since these lesions appear between 8 and 12 years after the first surgery.

Repairing Complete Radial Tears of the Lateral Meniscus: Arthroscopic All-Inside Double Vertical Cross-Suture Technique Is Effective and Safe With 2-Year Minimum Follow-Up

To assess the failure rate and clinical outcomes of the all-inside, double-vertical, cross-suture technique in repairing complete radial tears of the lateral meniscus. We retrospectively reviewed records of patients with this injury on whom the present technique was employed at our institution between 2011 and 2018, with at least 24 months of follow-up. Six months postoperatively, the meniscus healing and extrusion status were evaluated through magnetic resonance imaging. Preoperative and postoperative knee function, measured through IKDC, Lysholm knee, and Tegner activity scale scores, were compared. In total, 27 patients underwent the procedure. The preoperative mean (standard deviation) IKDC score, Lysholm knee score, and Tegner activity scale scores were 53.4 ± 5.3, 63.2 ± 9.3, and 4± .7, respectively. At the last follow-up (≥24 months postoperatively), these scores increased to 92.1 ± 2.6, 90.8 ± 4.2, and 6.1 ± 1.3, respectively (all P < .05). Complete healing of the meniscus was observed in 23 patients, and 4 patients had meniscus retear or nonhealing. The overall retear or nonhealing rate was 14.8%. Healing rates between those with isolated radial tears (87.5%) and those with combined anterior cruciate ligament rupture (84.2%; P= .826) were comparable. No difference was observed in the progression of coronal and sagittal meniscus extrusion (P= .133 and .797, respectively). In patients with complete radial tears of the lateral meniscus, the arthroscopic all-inside double vertical cross-suture repair technique resulted in an 85.2% healing rate, improvements in functional outcomes and activity levels, and no identifiable progression of meniscus extrusion. The all-inside double vertical cross-suture technique is effective and safe for the repair of radial tears of the meniscus. Level IV, retrospective case series.

ADVANTAGES AND FEATURES OF ARTHROSCOPIC REINSERTION OF THE ANTERIOR CRUCIATE LIGAMENT OF THE KNEE JOINT WITH INTERNAL SPLINTING (internal brace technology)

Background. Despite the annual increase in the number of patients with knee injuries, there is no gen-erally accepted algorithm for treating patients with anterior cruciate ligament injury (ACL). Conservative treatment is ineffective, as in 75-87% gives chronic anterior medial instability, increases the risk of post-traumatic arthritis by 51,2%. There is a considerable interest in arthroscopic primary recovery of ACL. The aim of the study is to evaluate the results of treatment of patients with ACL rapture and to develop a differentiated approach in its treatment. Materials and methods. The results of treatment of patients with ACl rupture who underwent ligament reinsertion (n = 40) and ACL reconstruction (n = 50) were analyzed. The assessment was performed on the scale of VAS for 2 days, VAS and IKDC 2-6-12 weeks after surgery Results. On the second day after the ligament reinsertion, patients had less pain compared to their post-reconstruction sensations: VAS 4,1 versus 5,3. In the group of patients after reinsertion of ACL in the period of 2-6 weeks there were lower rates of pain, namely 2,25 compared with 3,4 in the group of ACL reconstruction. At 2 weeks after reinsertion, patients reported moderate pain and an activity level of 66,4 ± 3,5 compared with the 61,3 ± 2,6 ligament reconstruction group on the IKDC scale. At 6 weeks, the positive dynamics persists, 80,2 ± 2,8 and 76,9 ± 3,1 IKDC, respectively. In 12 weeks, patients in both groups recover almost completely and return to daily activity, 93,9 ± 3,6 and 91,7 ± 2,4 on the IKDC scale, respectively. Conclusions. Primary recovery for proximal ACL ruptures shows good results and may be an alternative to ACL reconstruction. Success is based on the location of the ligament rupture and the tissues quality. The possibility of the initial ACL recovery is solved during surgery. If there is any doubt about the suitability of tissues for recovery, it is recommended to perform a standard reconstruction of ACL.

Platelet-Rich Plasma in Anterior Cruciate Ligament Quadriceps Tendon Bone Reconstruction—Impact of PRP Administration on Pain, Range of Motion Restoration, Knee Stability, Tibial Tunnel Widening and Functional Results

Background: Using Platetet-Rich Plasma (PRP) in anterior cruciate ligament reconstruction (ACLR) has been suggested to improve patient outcomes. The aim of this study was to assess the impact of PRP administration on pain, range of motion (ROM) restoration and the functional results of ACLR performed with quadriceps tendon bone (QTB) autografts. Methods: A total of 106 patients were included in this multicenter study. Fifty-two patients underwent single-bundle QTB ACLR and 54 patients underwent the same procedure with additional PRP administration. Results: Mean time of need for on-demand analgesia was 8 days in the PRP group and 11 days in no-PRP group. Symmetric full extension was restored in a mean of 40 days in the PRP group and 53 days in the no-PRP group. Ninety degrees of flexion was restored at a mean of 21 days in the PRP group and 25 days in the no-PRP group. At 18 months postoperatively, the mean side-to-side difference in anterior tibial translation with the use of an arthrometer (Rolimeter, Aircast Europa) was 1.3 mm in the PRP group vs. 2.7 mm in the no-PRP group. Mean tibial tunnel widening was 1.4 mm in the PRP group vs. 2.1 mm in the no-PRP group. The mean score in the pain section of the KOOS scale was 93 in the PRP group vs. 89 in the no-PRP group. For the IKDC scale, 53 patients in the PRP group graded A or B and 1 patient graded C. In the no-PRP group, 48 patients graded A or B and 4 patients graded C or D. Conclusions: The use of PRP in QTB ACLR may decrease the need for on-demand analgesia and accelerate ROM restoration as well as improve knee stability, lessen the extent of tibial tunnel widening and potentially diminish pain at 18 months postoperatively. Further studies will be needed to confirm all authors’ conclusions.

Remnant preserving ACL reconstruction with a functional remnant is related to improved laxity but not to improved clinical outcomes in comparison to a nonfunctional remnant

The Anterior cruciate ligament (ACL) remnant has been pointed out as a ligamentization enhancer. Nonetheless, the remaining tissue can be functional if it still provides some stability or nonfunctional. This study intends to compare the clinical results and knee stability of functional vs. nonfunctional remnant preservation ACL reconstruction (ACLR). One hundred and seventy-five patients with ACL injuries were included and underwent remnant preservation ACLR. They were divided into two groups accordingly to remnant tissue functionality: functional (Group F) and nonfunctional (Group NF). Primary outcome was defined as patient reported outcomes measured with Lysholm, IKDC and Tegner continuous scales and improvements. Secondary outcomes comprised of Lachman test, anterior drawer test, pivot shift test, extension and flexion deficit, graft coverage by remnant preserved tissue and failure rate (persistent instability or new ACL lesion). Menisci lesions, cartilage lesions and time to surgery were also recorded for each group. One hundred and forty-four patients were available at a mean of 30.2 ± 10.1months: 69 Functional and 75 Nonfunctional. Lysholm, IKDC and Tegner functional outcomes demonstrated no difference between the groups, Functional compared to Nonfunctional: 88.4 ± 10.5 vs. 92.2 ± 4.9, n.s. and 83.2 ± 11.3 vs. 87 ± 5.3, n.s. and 6 (5-10) vs. 6 (5-9), n.s., respectively. Lysholm and IKDC functional outcomes improvements demonstrated differences between the groups: Functional compared to Nonfunctional (39.3 ± 9.4 vs. 42.3 ± 7.4, p = 0.014 and 37.7 ± 10 vs. 41.0 ± 6.6, p = 0.032); however, they were not clinically significant. Functional group showed more stability on physical examination pre- and post-operatively (p < 0.001, p < 0.001). There was no difference regarding extension deficit (n.s.); however, functional group had more flexion deficit (p = 0.02). Nonfunctional group had better graft coverage (p = 0.001). There was no difference regarding failure rate: 4% vs. 9%, (n.s.). Both remnant preservation ACLR techniques were able to achieve satisfactory functional outcomes. A functional remnant was not related to improved functional outcomes in comparison to a nonfunctional remnant; however, it was related to less laxity pre and postoperatively and inferior graft coverage. II.

Evaluation of the \u2018Spaarne soft tissue procedure\u2019 as a treatment for recurrent patellar dislocations: a four-in-one technique

PurposeThe ‘Spaarne soft tissue procedure’, is a 4-in-1 soft tissue procedure that treats recurrent patellar dislocations in the young and active population. The procedure has not yet described elsewhere. The purpose of this study is to analyse the redislocation rate and to evaluate the postoperative knee function and patient satisfaction.MethodsTwenty-seven patients (34 knees) underwent the four-in-one SST-procedure. The 4-step technique required a minor change in 2010, including the use of a smaller strip of the patellar tendon for transposition. After a median follow-up of 10.4 years, the redislocation rate was evaluated as the primary outcome measure. Secondary outcome measures were functional outcome (IKDC, Kujala, Lysholm and Tegner activity scale) and Numeric Rating Scales for satisfaction and pain.ResultsRedislocation occurred in 8 cases (23.5%) and subluxation occurred in 13 cases (38.2%) post-surgery. A significant higher number of redislocations and subluxations were seen before 2010 (p = 0.04, p = 0.03). The median postoperative IKDC, Lysholm and Kujala scores for the total group were 54, 76 and 81 respectively. Pre- and postoperative Tegner activity scale were both level 3. Median NRS scores during rest, walking and sports were 1, 3 and 5 respectively. Satisfaction with the procedure was reported as ‘excellent’ or ‘good’ by 79% of the patients.ConclusionDespite the high overall redislocation rate and increased pain scores, the SST-procedure shows to be a safe procedure in patients with recurrent patellar dislocations based on the cases after 2010. Mid- and long-term results show moderate to good functional outcomes and satisfaction.Level of evidenceTherapeutic retrospective cohort study, LEVEL III

The results of polypropylene mesh application at anterior cruciate ligament reconstruction

Anterior cruciate ligament (ACL) repair remains one of the most common surgeries in orthopedics and traumatology. The evolution of the ACL repair technique continues, new fixators appear, and the position of the graft, its shape and size are modified. Semi-tendon and gracilis muscle (STG) grafts are the most common used due to low-trauma and technically simple method of obtaining. Its disadvantage is a long period of intratunnel incorporation, one of the ways of this acceleration is the implantation of a polypropylene mesh. In an experiment on rabbits, we proved its positive effect. Objective. To develop a method of improving the intratunnel incorporation of STG-graft at ACL repair of the knee joint using polypropylene mesh. Methods. Results of 75 patients were analyzed. The study group consisted of 35 patients who underwent surgery during 2018–2019 using polypropylene mesh, comparative group — 40 patients who had surgical treatment in 2017. Evaluated demographic data, pre-operation period, recovery functions, complications rate, data of KOOS and IKDC scales. Results. Non-specific data of the inflammatory process (CRP and ESR) did not change significantly in patients with inserted polypropylene mesh. They did not have more pronounced pain after surgery, there were less cases of reactive synovitis with significantly minimized the number of the knee joint punctures. Restorationof knee function was faster, and early weight bearing of the leg allowed up to 6 months. Better results by the KOOS and IKDC scales received after surgery. Conclusions. Implantation of polypropylene mesh around the intratunnel part of STG-graft at ACL repair surgery did not increase the complications rate and allowed to improve the dynamics of limb function recovery up to 6 months after surgery.

Clinical and Functional Effects of Surgical Technique After Repair of Bucket Handle Meniscus Tears

All-inside meniscus repair has recently been explored as an alternative to inside-out meniscus repair of bucket handle meniscus tears. Current evidence suggests there are comparable outcomes between inside-out and all-inside repairs for bucket handle meniscus tears. However, there are limited data that directly compares all-inside with inside-out repairs, particularly with relatively long term follow up of functional outcomes. The aim of the current study was to determine if there are clinical and functional differences between all-inside and inside-out repairs of bucket-handle meniscus tears. All patients who underwent repair for bucket handle meniscus tears at a single institution from 2007 to 2017 were eligible for inclusion in the study (n = 77). Failure rates for this cohort were evaluated through chart review and confirmed via phone. Of this cohort, 9 patients who underwent all-inside meniscus repair were able to be contacted for functional assessment. These patients were then double matched by concomitant procedure (ACLR, chondroplasty, and/or microfracture) with patients who underwent inside-out repairs (n = 18). The patients were called and assessed for repeat surgery, as well as administered the KOOS, IKDC, and Marx activity scale to assess patients functionally. The mean age for the cohort was 27.42 (SD = 9.49) years with a mean follow-up of 6.19 (SD = 2.96) years. Of the patients who underwent All-inside (AI) repair (n=19), 15.78% had repeat surgery (n = 3), and 20.69% (n = 12) of patients who underwent inside-out (IO) repair (n = 58) underwent repeat surgery. Of the matched patients (n = 27), those who underwent all-inside meniscal repair had lower mean KOOS scores than patients with inside-out repairs in each sub-category (means and standard deviations are listed all-inside; inside-out): KOOS – Pain: mean = 78.08 (SD = 22.37); 87.74 (9.67), KOOS – Sports: 64.44 (25.67); 75.29 (22.8), KOOS – Symptoms: 78.97 (11.90); 81.09 (12.54), KOOS – QOL: 43.06 (33.7), 65.44 (22.32), KOOS – ADL: 81.37 (24.2); 94.55 (8.13). All-inside patients had a lower mean IKDC score (AI: mean = 66.4, SD = 27.64; IO: mean = 77.96, SD = 16.77) as well as lower Marx activity scores (AI: mean = 5, SD = 5.83; IO: mean = 7.05, SD = 5.03). The current study suggests that patients who undergo all-inside meniscus repair have worse functional outcomes but a slightly lower failure rate than those who undergo inside-out repair.

High Valging Tibial Osteotomy in the Complex Treatment of Anterior Cruciate ligament Ruptures in Patients With Varus Gonarthrosis of the Knee

MATERIALS AND METHODS. We observed 164 patients from 2013 to 2019 (mean age 39.8 ± 5.1 years) who underwent anatomical antegrade ACLR ВТВ autograft . Group 1 (43 people, 31.1%) and Group 2 (48 patients, 29.3%) included patients with isolated medial GA of 2-3 degree and/or varus deformity of at least 5º. Group 3 (73 people or 44.5%) included patients with normal articular cartilage and the correct axis of the limb. In Group 1, ACLR was supplemented with an “open wedge” HVTO. The assessment was carried out according to Lysholm Knee Scoring Scale, 2000 IKDC, KOOS.RESULTS. The simultaneous performance of HVTO and ACLR shows good clinical and radiological results in 93% in the first year, and three years after surgery keeps it in 88.4%. The results of treatment of patients of Group 1 turned out to be significantly better in comparison with Group 2 (p&lt;0.01). In Group 1, the anteroposterior and rotational hypermobility of the knee joint was 16.3%, less commonly we observed pain, synovitis, atrophy of the muscles of the thigh and contracture (p &lt;0.01), some dysfunctions (C according 2000 IKDC scale) were determined in 11.6% (p&lt;0.05), and significant impairment of the knee joint function (D according to 2000 IKDC scale) were not observed (p&lt;0.001). In the first 5 years after surgery, a much larger number of patients of the 1st group were able to fully return to their work, domestic and sports activities, compared with Group 2 (p&lt;0.05).CONCLUSION. The combined ACLR and HVTO allow reliable technology in the treatment of anterior instability in patients with GA (p&lt; 0.05%). This approach is effective in young active middle-aged patients, with anterior instability of the knee joint and varus GA or prerequisites for its development, as well as with revision ACLR, posterior tibial plateau tilt of more than 12º. Performing HVTO simultaneously with ACLR is not practical for patients with valgus deviation of the lower leg, failure of the posterolateral capsular ligamentous complex, or changes in the external joint.

Meniscus repairs in the adolescent population-safe and reliable outcomes: a systematic review.

The purpose of this study was to determine the outcomes of meniscus repair in the adolescent population, including: (1) failure and reoperation rates, (2) clinical and functional results, and (3) activity-related outcomes including return to sport. Two authors independently searched MEDLINE, Cochrane Central Register of Controlled Trials & Cochrane Library, and CINHAL databases for literature related to meniscus repair in an adolescent population according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No meta-analysis was performed in this qualitative systematic review. Thirteen studies, including no Level I, one Level II, one Level III, and eleven Level IV studies yielded 466 patients with 503 meniscus repairs. All defined meniscal re-tear as a primary endpoint, with a reported failure rate ranging from 0 to 42% at a follow-up ranging from 22 to 211months. There were a total of 93 failed repairs. IKDC scores were reported in four studies with a mean improvement ranging from 24 to 42 (P < 0.001). Mean post-operative Lysholm scores were reported in seven studies, ranging from 85 to 96. Additionally, four of those studies provided mean pre-operative Lysholm scores, ranging from 56 to 79, with statistically significant mean score improvements ranging from 17 to 31. Mean post-operative Tegner Activity scores were reported in nine studies, with mean values ranging from 6.2 to 8. This systematic review demonstrates that both subjective and clinical outcomes, including failure rate, Lysholm, IKDC, and Tegner activity scale scores, are good to excellent following meniscal repair in the adolescent population. Further investigations should aim to isolate tear type, location, surgical technique, concomitant procedures, and rehabilitation protocols to overall rate of failure and clinical and functional outcomes. IV.

Psychometric properties of the 12-item Knee injury and Osteoarthritis Outcome Score (KOOS-12) Spanish version for people with knee osteoarthritis.

To evaluate the validity, reliability, and responsiveness to change of the 12-item Knee injury and Osteoarthritis Outcome Score (KOOS) Spanish version questionnaire. This study was based on a questionnaire validation design. A cross-sectional survey of 199 patients with knee osteoarthritis (KOA) and ten healthy controls was studied to evaluate the validity and reliability of KOOS-12. One hundred and sixteen patients were assessed for test-retest reliability, and 38 patients were included for a responsiveness assessment. Structural validity was assessed by the confirmatory factor analysis (CFA). Item response theory-based methods were used to determine the performance of the items. Internal consistency reliability was appropriate for all scales (Cronbach's alpha = 0.85-0.94). The intra-class correlation coefficient of KOOS-12 scales ranged from 0.60 to 0.71. The CFA and generalized partial credit model showed that KOOS-12 scales presented a good overall model fit. No differential item functioning was found. Convergent validity was demonstrated by strong correlations (Spearman's rho ≥ 0.70) with KOOS, International Knee Documentation Committee subjective knee evaluation form (IKDC), and Knee Intermittent and Constant Osteoarthritis Pain (ICOAP). Known-groups validity showed that KOOS-12 well discriminated subgroups of patients (radiographic severity and nutritional status). Standardized response means for KOOS-12 scales were ≥ 0.75. Changes in KOOS-12 scales had a moderate to strong correlation (Pearson's r ≥ 0.40) with the changes in the KOOS, ICOAP, and IKDC scales. The KOOS-12 Spanish version is a valid, reliable, and responsiveness to change questionnaire to measure patients' opinions about their knee and associated problems in Mexican subjects with KOA. Key Points • KOOS-12 is a short self-reported measure that assesses patient's opinions about the difficulties they experience due to problems with their knee and also covers aspects of pain, functional limitations, and knee-related quality of life. • The Spanish version of KOOS-12 questionnaire is a valid instrument for measuring the patients' opinions about their knee and associated problems, and is both reliable and responsiveness to change.

Intra-articular platelet-rich plasma vs corticosteroids in the treatment of moderate knee osteoarthritis: a single-center prospective randomized controlled study with a 1-year follow up

BackgroundOsteoarthritis is the most prevalent type of arthritis, which significantly impacts the patient’s mobility and quality of life. Pharmacological treatments for osteoarthritis, such as corticosteroids, produce an immediate reduction of the patient’s pain as well as an improvement in the patient’s mobility and quality of life, but with a limited long-term efficacy. In this context, platelet-rich plasma (PRP) infiltrations represent a therapeutic tool due to its trophic properties and its ability to control inflammatory processes, especially in musculoskeletal applications. The aim of this study is to evaluate and compare the clinical benefits of PRP when injected intra-articularly vs a commonly used corticosteroid (CS, triamcinolone acetonide, Kenalog®) in patients affected by mild to moderate symptomatic knee osteoarthritis.MethodsForty patients affected by symptomatic radiologically confirmed knee osteoarthritis (Kellgren-Lawrence grades II–III) were enrolled in this randomized study. Patients randomized in the PRP group (n = 20) received an intra-articular injection of PRP (8 mL) while patients randomized in the CS group (n = 20) received an intra-articular injection of triamcinolone acetonide (1 mL of 40 mg/mL) plus lidocaine (5 mL of 2%). The pain and function of the target knee were evaluated by the VAS, IKDC, and KSS scales at the baseline (V1), 1 week (V2), 5 weeks (V3), 15 weeks (V4), 30 weeks (V5), and 1 year (V6) after treatment.ResultsNo serious adverse effects were observed during the follow-up period. A mild synovitis was registered in 15 patients (75%) in the PRP group within the first week after treatment which resolved spontaneously. Both treatments were effective in relieving pain and improving the knee function in the very short-term follow-up visit (1 week). A high improvement of the subjective scores was observed for both groups up to 5 weeks, with no significative differences between the groups for the VAS, IKDC, or KSS. After 15 weeks of follow-up, the PRP group showed significative improvements in all scores when compared to the CS group. Overall, the patients who received PRP treatment had better outcomes in a longer follow-up visit (up to 1 year) than those who received CS.ConclusionsA single PRP or CS intra-articular injection is safe and improves the short-term scores of pain and the knee function in patients affected by mild to moderate symptomatic knee OA (with no significant differences between the groups). PRP demonstrated a statistically significant improvement over CS in a 1-year follow-up. This study was registered at ISRCTN with the ID ISRCTN46024618.

The Use of a Corrugated Suture for Cortical Fixation of a Semitendinosus Tendon Autograft in Anterior Cruciate Ligament Reconstruction: Clinical Results

The study purpose — to evaluate the clinical results and the condition of bone tunnels after anterior cruciate ligament reconstruction with a semitendinosus tendon graft using cortical fixation and corrugated sutures.Materials and Methods. The results anterior cruciate ligament reconstruction with a semitendinosus tendon autograft were analyzed in 57 patients aged 18 to 53 years. The patients of the first group (n = 27) underwent anterior cruciate ligament reconstruction with a semitendinosus tendon graft using cortical fixation on the femur and tibia in combination with corrugated sutures at the proximal and distal ends of the graft. The patients of the second group (n = 30) underwent anterior cruciate ligament reconstruction in a similar way, but without the use of corrugated sutures. Clinical results were assessed using the Lysholm and IKDC scales. The degree of bone tunnels widening was evaluated by CT data in 6 months after the surgery.Results. In the first group, the degree of postoperative bone tunnels widening was significantly lower (for the femoral tunnel by 18% and tibial — by 17%) compared with the second group (for the femoral tunnel by 30% and tibial — by 31%). Scores by the IKDC 2000 and Lysholm scales were higher in the corrugated sutured group. Although, the treatment outcome was interpreted as equally good for both groups. The time for graft preparation was on average 6 minutes longer in the first group. This slightly increased the duration of the surgery.Conclusion. The anterior cruciate ligament reconstruction with a semitendinosus tendon graft using cortical fixation on the femur and tibia in combination with corrugated sutures ensured the tight contact of the tendon inside the bone tunnels without additional implants and reduced the degree of tunnels widening. This is important for a possible re-grafting. The proposed method does not significantly affect the clinical outcomes.

Who passes return to sport tests and which tests are most associated with a return to play after anterior cruciate ligament reconstruction?

Objectives:Although return to sport (RTS) testing has become popular following anterior cruciate ligament (ACL) reconstruction surgery, its utility is still questioned. The purpose of this study was to determine if there are age, sex and activity level differences between patients who pass a battery of self-report and functional tests at 6 months following surgery and to determine which tests are associated with a return to competition sport at 12 months.Methods:This was a prospective longitudinal study in which 450 patients who had undergone a primary ACL reconstruction were assessed at 6- and 12-months following surgery. Patients with a prior contralateral ACL injury, or who did not regularly participate in sport prior to injury were not included. There were 176 females and 274 males with a mean age of 25 (SD = 4) years. Six return to sport tests were conducted at 6 months and included two patient self-report measures: IKDC subjective knee form to measure symptoms and function and the ACL-RSI scale to measure psychological readiness to RTS; and four functional measures: single and triple hop for distance and isokinetic quadriceps strength measured at 60 and 180 deg/sec. Limb symmetry index scores of ≥90 for functional tests and IKDC scores of ≥85 and ACL-RSI scores ≥65 were considered indicators of satisfactory recovery. Proportional statistics and contingency analysis were used to determine associations between age (<21 vs. ≥21 years), sex, sport level (Level I vs. Levels II/III sports) and meeting test criteria and return to sport.Results:Only 13 (3%) patients met all 6 of the test criteria at 6 months following ACL reconstruction surgery and 83 (18%) patients did not pass any of the tests. A significantly greater proportion of younger patients passed all the functional tests (p<0.01). A greater proportion of males passed the IKDC threshold for symptoms and function (30% vs. 21% p=0.03) but there were no other sex differences. Patients who had played Level I sports before injury had the same pass rates as those who played Level II or III sports. Patients who passed the threshold for the IKDC and ACL-RSI scales had 4 (95% CI 3-6) times the odds of returning to competition sport at 12 months (p<0.0001). Conversely, meeting the threshold for either quadriceps strength test or either hop test at 6 months was not associated with a return to sport at 12 months.Conclusion:Few patients pass all the thresholds of common tests which are used to assess the ability to return to sport at 6 months following ACL reconstruction surgery although younger patients have higher rates of passing functional tests. This has implications for the utility of such testing and when patients should be cleared to return to sport. Patients may base their decision to return to sport on self-perceived symptoms and psychological readiness more than physical performance and muscle strength. These findings have implications for how return to sport testing may be used to facilitate a return to sport following this surgery.

Autogenous Osteochondral Grafting for Treatment of Knee Osteochondritis Dissecans: A Case Series Study.

Although some surgical techniques have been described for the operative treatment of unstable Osteochondritis dissecans (OCD) of the knee, outcomes are variable and are not satisfying totally. The aim of the present study is to evaluate the outcomes of autogenous osteochondral grafting for OCD of the knee. In a case series study, from June 2014 to July 2015, 16 patients with stage II-IV OCD (International Cartilage Repair Society (ICRS)) of the femoral condyle were investigated. Surgical intervention considered in cases of stage III (4 cases) and IV (2 cases) and in stage II (10 cases) ones that were nonresponsive to conservative treatment. At the initial and final visits, the IKDC, Lysholm score and Tegner activity scale were evaluated. The mean preoperative IKDC score (53.4) increased significantly following surgery (84.3) (P<0.001). Based on the IKDC grading system, before the operation, the knee status was graded as nearly normal, abnormal, and severely abnormal in 4, 10, and 2 patients, respectively. At final post-surgical follow up, 15 normal and 1 abnormal knee were documented (P<0.001). The mean Lysholm score increased from 44.3 per operatively to 86.3 (P<0.001).Tegner activity score improved from 2.8±1 pre operatively to 5.6±2 (P<0.001). Surgical treatment of unstable OCD using autogenous osteochondral graft shows successful outcomes. In addition to reliable fixation, it can enhance healing and convert an uncontained lesion to contained one appropriate for autogenous osteochondral grafting with healthy cartilage.

Non-treatment of stable ramp lesions does not degrade clinical outcomes in the setting of primary ACL reconstruction.

The purpose of this study was to evaluate the clinical outcomes of various methods of treatment of stable and unstable ramp lesions compared to patients with no meniscal pathology at the time of primary ACL reconstruction. All patients with a preoperative MRI performed at our facility who were enrolled in an institutional ACL registry and 1-year clinical follow-up were identified. A musculoskeletal radiologist reviewed preoperative MRI scans for evidence of a ramp lesion. Ramp lesions were classified as stable if a peripheral tear of the posterior horn of the medial meniscus was identified by MRI, but did not displace into the medial compartment with anteriorly directed probing at the time of surgery. Ramp lesions were classified as unstable if a tear was identified by preoperative MRI at the meniscocapsular junction and the meniscus was displaceable into the medial compartment with probing. Reoperation rates for ACL graft failure or recurrent medial meniscus pathology were collected. Patient-reported outcome scores (IKDC, SF12 PCS, SF12 MCS, and Marx Activity scale) were recorded at baseline and final follow-up. A total of 162 patients were included in the analysis with median 2-year (range 1-5years) clinical follow-up. Patients with a repaired unstable ramp lesion had a significantly higher likelihood of reoperation for recurrent medial meniscus pathology than patients without meniscal pathology at the time of index surgery. Patients with an untreated stable ramp lesion had a similar rate of reoperation when compared to patients without meniscal pathology. At final follow-up, there was no difference between groups in IKDC score, SF12 PCS/MCS, or Marx activity score or change in any score. Patients with untreated stable ramp lesions have similar clinical outcomes at median 2-year (range 1-5years) follow-up when compared to patients without a ramp lesion. Treatment of stable ramp lesions at the time of ACL reconstruction does not have clinical benefit. III.

Repair of large condylar osteochondral defects of the knee by collagen scaffold. Minimum two-year outcomes

IntroductionCollagen scaffolds are a good surgical option for covering large focal osteochondral defects in the knee. In the recent literature there is a wide range of patient profiles and chondral defect treatments (chondral and osteochondral defects, associated procedures, etc.). The aim of the present study was to evaluate clinical and imaging outcomes with collagen scaffolds and to assess any correlation between medium-term clinical outcome and MRI features. The hypothesis was that there is no correlation between clinical outcome and MRI after 2 years postoperatively. Material and methodsA single-center retrospective observational study included all patients receiving a MaioRegen® scaffold for large painful focal osteochondral defect of the femoral condyle. There were 17 patients, with a mean age of 28±9 years. Defect locations comprised 12 medial femoral condyles, 4 lateral femoral condyles and 1 lateral tibial plateau. Mean defect area was 4.5±1.4cm2. All patients were evaluated clinically and on KOOS and objective and subjective IKDC scales, with MRI at last follow-up. ResultsAt a mean follow-up of 46±17 months, mean subjective IKDC was 67.8±23; KOOS scores were: symptoms, 78±22; pain, 78±23; function, 85±20; sports, 66±27; and activities of daily living, 59±25. MRI MOCART score revealed incomplete scaffold healing in 21.4% of cases, with variable signal intensity within regenerated tissue. Functional scores did not correlate with reconstruction aspect on MRI. Discussion/Conclusion3D collagen scaffolds yield good medium-term clinical outcomes in large osteochondral defects of the knee. There is, however, a discrepancy between MRI features of the recipient site and objective and subjective clinical scores. These scaffolds may be a good option for treating large focal osteochondral defects in knees of young patients, but MRI does not provide satisfactory medium-term assessment.

Mid-Term Results of Simultaneous Reconstruction of Anterior Cruciate and Anterolateral Ligaments in Athletes

Relevance. Today, there exist a large number of methods for arthroscopic reconstruction of the anterior cruciate ligament, however, the return to the competitive level among athletes remains quite low. It is believed that the functional state depends on the restoration of the rotational and anteroposterior stability of the knee. Such data facilitate the search of techniques for additional stabilization of the knee, one of which is the reconstruction of the anterolateral ligament of the knee. The goal of the study was to assess the medium-term results of combined one-stage arthroscopic reconstruction of the anterior cruciate and anterolateral ligaments of the knee in athletes and the probability of their return to the competitive level. Material and Methods. In the period from 2014 to 2015, 50 patients underwent surgery. They were divided into 2 groups. Group 1 (main) consisted of 20 patients, including 10 professional athletes, who underwent the arthroscopic reconstruction of the anterior cruciate ligament, supplemented by reconstruction of the anterolateral ligament. Group 2 (control) included 30 patients (of which 10 were the professional athletes) who underwent the arthroscopic reconstruction only of the anterior cruciate ligament. Results. Group 1. 2 years after surgical treatment, 100% of patients were able to return to the preoperative competitive levels of activity. The average Tegner Lysholm score before the operation was 72.60±6.45 points, after the operation — 97.40±1.18 points. The average value on the IKDC scale before surgery was 63.1±4.8%, after surgery — 96.3±1.8%. Group 2. Of 30 patients, 2 years after surgery, 20 patients returned to the preoperative and competitive levels (66.7%). Of the professional athletes, 5 out of 10 patients (50%) returned to the competitive level, among amateur athletes — 15 out of 20 patients (75%). The average Tegner Lysholm score before surgery was 69.6±3.5 points, after — 92.1±3.9 points. The average value on the IKDC scale before surgery was 73.4±3.2%, after — 90.3±3.7%. Conclusion. Medium-term results of the study showed that the onestage restoration of the anterior cruciate and anterolateral ligaments, compared with arthroscopic reconstruction of only the anterior cruciate ligament, increased the probability that the patients with high functional requirements and professional athletes would return to sports.

Transportal single bundle ACL reconstruction with quadruple hamstring graft using suspensory femoral and hybrid tibial fixation: A prospective study

Objectives: The aim of the study was to evaluate the functional outcome of transportal single bundle ACL reconstruction with Quadruple Hamstring Graft using suspensory femoral and hybrid tibial fixation for restoration of joint stability, patient satisfaction and for any complications. Design: Prospective Study Design. Methods: Patients admitted to the department of Orthopaedics, Bhagat Phool Singh Government medical college, Khanpur Kalan, Sonipat and fulfilling the inclusion criteria of age group 20-45 years without pre-existing arthritis and clinical and radiological evidence of anterior cruciate ligament tear were included in the study who were followed upto six months. Preoperatively Lysholm score and IKDC score was evaluated of each patient and post operatively Lysholm score and IKDC score were calculated at 2 weeks, 8 weeks, 12 weeks and 24 weeks. Results and conclusion: All patients were taken for single bundle ACL reconstruction using suspensory femoral and hybrid tibial fixation. The Lysholm and Knee Scoring Scale consists of eight parameters for evaluation. The individual parameters were allotted specific scores depending on the patient’s functional ability. The maximum possible knee score was 100. Based on the outcome scores they were divided into Excellent, Good, Fair and Poor. The Subjective IKDC scale was evaluated by summing the scores for the individual items and then transforming the score to a scale that ranges from 0 to 100. The patients were followed up in OPD and their functional outcomes were measured by Lysholm scoring and IKDC scoring at 2 weeks, 8 weeks, 12 weeks, 24 weeks. There were 20 (83.3%) male patients and 4 (16.7%) female patients. The right side was more commonly injured (54.2%) than the left side (45.8%). The most common mode of injury in our study was Road Traffic Accidents (58.3%) followed by sports (20.8%). Most of the patients (41.7%) presented 4 to 6 months after injury. The most common symptom at presentation was knee pain (37.5%) followed by instability (29.2%). Both knee pain and instability were present in 16.7% of patients. There was associated meniscal injury in 75.0% of patients. The most commonly injured was medial meniscus (50%) followed by injury to both medial and lateral menisci (16.7%). Isolated ACL tear was present in 25% of the patients. In our study, 83.3% had excellent functional outcome while 16.7% patients had good outcome on the basis of Lysholm Scoring. In our study the mean pre-operative IKDC score was 55.60 whereas the post-operative score after 24 weeks was 86.13. There was significant improvement in post-operative IKDC score when compared with preoperative score. In young active adults, anatomic single bundle reconstruction with quadrupled hamstring graft gives good functional results. Endobutton on the femoral side and Bioabsorbable interference screw and suture disc on the tibial end is a good mechanical and strong suspensory type of fixation device for ACL reconstruction. This technique offers an excellent knee function, knee stability and restoration of preoperative functional status with minimal complication. The patients undergoing hybrid method of fixation return to preinjury level of activity early.

Lateral meniscal cysts: long-term clinical and radiological results of a partial meniscectomy and percutaneous decompressive needling.

The aim of this study was to describe clinical and radiological long-term results of an arthroscopic partial meniscectomy associated with an outside-in decompressive needling of the cyst for lateral parameniscal cyst. Eighteen patients with symptomatic parameniscal cysts treated between April 2002 and September 2009 were retrospectively included in the study. All patients underwent arthroscopic partial meniscectomy (preserving peripheral rim) and needling of the cyst using a 20-gauge needle. Pre- and post-operative IKDC, Tegner, and Lysholm scores were used to evaluate clinical results. Radiological results were obtained from pre- and post-operative radiographies and post-operative MRI scans. Both supine and weight bearing MRI examinations were performed. Kellgren-Lawrence and WORMS scales were used to evaluate osteoarthritis development of the knee. The mean follow-up period was 11.6 ± 2.6 years (range 7-15). Horizontal lesions were found in 56% of patients. All patients fully recovered. Mean Lysholm scores passed from mean pre-operative value 52 ± 16.9 to post-operative 85 ± 11.9 (P < 0.01) and mean IKDC scale score changed from 49.5 ± 14.7 to 67 ± 23.5 (P < 0.01). Mean Tegner scores did not change significantly. Post-operative radiographies showed a Kellgren-Lawrence scale grade 0 in six patients (33%), a grade I in eight (44%), a grade II in three (17%), and a grade III in one patient (6%). No patients were found with a Kellgren-Lawrence scale grade IV. No significant differences with pre-operative radiographies were found (chi-square = 1.867; df = 3; P = 0.60) in osteoarthritis development of the knee. Reported WORMS scores had an average of 12.4 ± 5.1. No recurrence of any cysts was observed. Different treatments for lateral meniscal cysts have been proposed, but proper management of the cyst is still controversial. The results of this study suggest that the outside-in needling of the cyst associated with partial meniscectomy is a highly effective, simple, and repeatable technique. Excellent clinical outcomes were reported at a mean follow-up of 11.6 ± 2.6 years (range 7-15). Imaging evaluation showed no significant evolution to osteoarthritis of the knee. Partial arthroscopic meniscectomy associated with percutaneous decompressive needling of the cyst wall under arthroscopic visualization showed positive clinical and radiological long-term results. Neither traditional radiographies nor innovative standing MRIs showed findings of osteoarthritis.