International Knee Documentation Committee Score Research Articles

Evaluation of the peroneus longus tendon as an autologous graft in knee surgery

Our hypothesis is that the peroneus longus (PL) is a great option for ligament reconstruction in the knee, and therefore the objective of the study is to determine if the use of this graft is safe and does not cause secondary damage to the harvested area. A prospective study was conducted between April 2019 and September 2022. Patients who underwent any type of knee ligament reconstruction using the PL or just the anterior half (AHPL) as grafts were followed up. These patients were evaluated according to the Tegner–Lysholm score and the International Knee Documentation Committee (IKDC) guidelines for functional evaluation of the knee and the American Orthopedic Foot and Ankle Score (AOFAS) and the Foot and Ankle Disability Index (FADI) for the functional evaluation of the ankle. Most patients had an increase in the IKDC score, Tegner–Lysholm score, AOFAS and FADI regardless of the graft used in the surgical procedure, with mean values at the 24-month follow-up of, respectively, 99.02± 0.02, 98.69± 0.08, 99.92± 0.07, and 99.92± 0.07 for those with PL grafts and 99.31± 0.54, 98.88± 0.95, 100± 0.00, and 100± 0.00 for those with AHPL grafts. The differences in the scores between the two graft groups during each of the follow-up periods were significant (P = 0.001). The use of the peroneus longus tendon as a graft in knee surgeries was shown to be adequate for achieving good knee functional results.

Clinical efficacy of arthroscopic single-bundle versus double-bundle reconstruction of the posterior cruciate ligament: a retrospective study.

To compare the functional and clinical outcomes of knee joints in patients over a 10-year period following posterior cruciate ligament (PCL) reconstruction with single-bundle versus double-bundle. Patients who underwent PCL reconstruction were retrospectively analyzed. Based on the surgical approach, they were divided into the single-bundle reconstruction group and the double-bundle reconstruction group. Preoperative and postoperative Lysholm score, International Knee Documentation Committee (IKCD) score, and Tegner activity score were evaluated, and the stability of the joints was assessed using KT-2000 arthrometer. Radiographs were taken at the final follow-up to evaluate the progression of osteoarthritis. A total of 61 patients were included in the analysis: 26 in the double-bundle group and 35 in the single-bundle group. Baseline data were comparable between the two groups (P > 0.05). There were no significant differences between the two groups in preoperative Lysholm, IKDC score, and Tegner activity score. Postoperatively, these scores were significantly higher at two and ten years follow-up (P < 0.05), with no significant difference between the groups (P > 0.05). There was no significant difference in side-to-side differences (SSD) at 30° and 90° of knee flexion preoperatively between the groups (P > 0.05). Postoperatively, SSD decreased significantly at the two year and ten year follow-up (P < 0.05), with no significant difference between the groups (P > 0.05). For osteoarthritis progression, there were four cases of Kellgren-Lawrence grade ≥ II in the single-bundle group and three cases in the double-bundle group, with no significant difference in the progression of osteoarthritis between the groups (P > 0.05). Both single-bundle and double-bundle reconstructions for PCL result in good joint stability and mobility, with similar progression of osteoarthritis in long-term follow-up. Level III.

Comparison of blood flow restriction training rehabilitation and general rehabilitation exercise after anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials.

Blood flow restriction training (BFRT) has been found to reduce quadriceps atrophy and weakness after anterior cruciate ligament (ACL) surgery. However, the clinical benefit of BFRT as compared to general rehabilitation exercise (GRE) alone remains uncertain. This study aimed to compare the effects of BFRT and GRE on ACL reconstruction rehabilitation through a meta-analysis of randomized controlled trials. PubMed, Web of Science, EMBASE, Elsevier and Biosis were searched for randomized controlled trials comparing BFRT and GRE following ACL reconstruction. Primary outcomes included muscle strength (extensor and flexor muscle general strength), Lysholm score, the International Knee Documentation Committee (IKDC) score, extensor muscle torque (peak torque and average torque) and muscle cross-sectional area (CSA). The secondary outcomes included a range of motion (ROM), pain, Y-balance and the Patient-Reported Outcomes Measurement Information System (PROMIS). Thirteen randomized controlled trials involving 376 participants were included. The change in muscle strength (Mean difference, MD: 12.96, 95% confidence interval, [95% CI]: 7.02-18.91, heterogeneity, I2 = 39%), Lysholm score (MD: 9.41, 95% CI: 8.93-9.88, I2 = 40%) and IKDC score (MD: 9.88, 95% CI: 0.57-19.19, I2 = 87%) of the BFRT group were superior to that of the GRE group at the time of last follow-up. However, no significant difference was found between the BFRT and the GRE groups regarding the change in muscle CSA, ROM, extensor muscle torque, pain score, Y-balance and PROMIS. BFRT seems to perform better than GRE in terms of functional improvement and muscle strength following ACL reconstruction, but there seems to be no significant difference between them in terms of joint mobility, pain relief, stability improvement and patient's perception of their disease and treatment. Level II.

Musculoskeletal Tissue Asymmetries Following Anterior Cruciate Ligament Reconstruction

OBJECTIVE: To compare musculoskeletal tissue asymmetries between those who had undergone ACLR and non-surgical controls, and to evaluate the influence of sex on asymmetries and perceptions of knee function in ACLR patients. DESIGN: Cross-sectional cohort analysis. METHODS: Individuals (female n=11, male n=11) with a history of ACLR and matched controls (female n=10, male n=9) completed Dual-energy X-ray Absorptiometry (DXA) scans to measure lower-body bone mineral content (BMC), Fat%, and lean mass (LM). Perceptions of knee function were captured via the International Knee Documentation Committee (IKDC) instrument and inter-limb asymmetry indices (AI%) were calculated for each DXA outcome. Surgical groups and sexes were compared using independent t-tests ( p&lt;0.05) and Cohen’s effect sizes ( d). Additionally, Pearson’s Correlation Coefficients evaluated the association between AI% and IKDC scores. RESULTS: The ACLR group showed greater lower-body asymmetries, specifically less BMC and LM and greater Fat% in the ACLR limb ( p≤0.044; d=0.63–0.87). ACLR group sex comparisons found that females had lower IKDC scores, greater asymmetries for BMC and LM ( p≤0.027, d=0.40–0.74), and these asymmetries were negatively correlated with IKDC scores (all r≥0.755; p≤0.007) while males demonstrated no such correlations. CONCLUSIONS: Individuals with a history of ACLR had persistent musculoskeletal tissue asymmetries that favored the non-surgical leg. The asymmetries were greater in female versus male patients and were associated with lower perceptions of knee function. Thus, musculoskeletal imaging may provide complementary information to the current standard of care during ACLR rehabilitation.

Acellular Particulated Costal Allocartilage Improves Cartilage Regeneration in High Tibial Osteotomy: Data From a Randomized Controlled Trial.

This study aimed to compare short-term arthroscopic and clinical outcomes between microfractures with (treatment group) and without (control group) acellular particulated costal allocartilage in patients undergoing concurrent high tibial osteotomy (HTO). This retrospective cohort study enrolled 19 and 21 patients in the treatment and control groups, respectively, and reviewed them at a minimum 2-year follow-up after HTO. Cartilage regeneration status was evaluated according to the International Cartilage Repair Society-Cartilage Repair Assessment (ICRS-CRA) grading and Koshino's macroscopic staging systems during medial locked plate removal. Patient-reported measures, including the visual analog scale pain score, Knee Injury and Osteoarthritis Outcome Score, and International Knee Documentation Committee score, assessed clinical outcomes. The total points of the ICRS-CRA grading system were significantly higher in the treatment group than in the control group (7.7 ± 3.8 vs 4.2 ± 3.0, respectively; P = 0.007). Likewise, the cartilage status according to Koshino's macroscopic staging system was better in the treatment group (P = 0.022). Patient-reported functional outcomes significantly improved postoperatively but were equivalent between the study groups at the final follow-up. Microfractures augmented with acellular particulated costal allocartilage resulted in better repair quality than microfractures alone at a minimum 2-year follow-up after HTO, but functional outcomes improved similarly for both treatment approaches.

Survivorship and Outcomes of Meniscal Ramp Lesions Repaired Through a Posteromedial Portal During Anterior Cruciate Ligament Reconstruction: Outcome Study With a Minimum 10-Year Follow-up.

Several studies have demonstrated suture repair of ramp lesions of the medial meniscus via a posteromedial approach was associated with a significantly lower rate of secondary meniscectomy. However, these studies are not long-term and highlight the need for extended follow-up research to better understand the outcomes over a more extended period. To evaluate the long-term results and reoperation rate for the failure of arthroscopic all-inside suture repair of ramp lesions of the medial meniscus via a posteromedial approach during anterior cruciate ligament (ACL) reconstruction. Case series; Level of evidence, 4. All patients who underwent all-inside suture repair of the posterior segment of the medial meniscus (ramp lesion) via a posteromedial approach during ACL reconstruction at a minimum follow-up of 10 years were included in the study. Side-to-side anterior laxity was assessed preoperatively and postoperatively. Pre- and postoperative functional assessment was based on the subjective International Knee Documentation Committee score for activities of daily living and the Tegner activity scale for sporting ability. Reinterventions for meniscal repair failure and other complications were also recorded at the last follow-up. A total of 81 patients met the inclusion criteria for this study. Two patients had an ACL graft rupture with a new ramp lesion and were excluded from the analysis. Additionally, 15 patients were lost to follow-up, leaving a total of 64 patients in the final analysis. The mean follow-up was 124.8 months (range, 122.4-128.4 months). Mean side-to-side difference in anterior laxity significantly improved from 7.4 ± 1.5 mm (range, 5-12 mm) to 0.4 ± 1.3 mm (range, -3 to 4 mm) (P = .01). The mean subjective International Knee Documentation Committee score increased from 64.3 ± 13.4 (range, 34-92) before the operation to 91.1 ± 10.1 (range, 49-100) at the last follow-up (P = .001). The Tegner activity scale score at the last follow-up (6.3 ± 1.6) was lower than that before the trauma (7.1 ± 1.6) (P = .02). Fourteen patients (21.9%) had a failed meniscal repair and were reoperated. The mean time from initial repair to reoperation was 64.5 months (range, 13-126 months), and the median was 60.6 months. The multivariate analysis, including parameters such as lateral tenodesis (hazard ratio [HR], 1.62; P = .50), preoperative Tegner score (HR, 1.66; P = .41), preoperative laxity (HR, 1.75; P = .35), age at surgery (HR, 1.02; P = .97), and number of sutures (HR, 2.38; P = .19), did not reveal any factors associated with suture failure. The results show that arthroscopic repair of ramp lesions of the medial meniscus during ACL reconstruction using a posteromedial approach has a high failure rate at the 10-year follow-up, with half of these suture failures occurring within 5 years after the initial repair.

Graft Maturity Assessment by Magnetic Resonance Imaging and its Relation with Functional Scores after Anterior Cruciate Ligament Reconstruction with Hamstring Graft

Abstract Background/Objectives: Anterior cruciate ligament (ACL) reconstruction is a common procedure performed in orthopedic surgery. There are many methods to evaluate the functional outcome postoperatively, but no single reliable method exists to assess graft maturity. The purpose of this research is to evaluate graft maturity by magnetic resonance imaging (MRI) and its relation with functional outcome at the end of 6 months and 12 months. Materials and Methods: MRIs were performed on 32 patients who underwent ACL reconstruction at 6 and 12 months following surgery. The measurements were made of the background, posterior cruciate ligament, and signal intensity of the graft. The calculation of the signal noise quotient (SNQ) was done. The correlations between the international knee documentation committee (IKDC) at 6 and 12 months and the SNQ values at 6 and 12 months were assessed. Results: After 6 months, the mean SNQ value was 3.8953 ± 2.6561, and after 12 months, it was 2.6013 ± 1.7337. In addition, the mean IKDC was 43.3 preoperatively, 52.8125 ± 9.24728 at 6 months’ follow-up and 70.6875 ± 8.32578 at 12 months’ follow-up. The 12-month SNQ values showed a significant decrease, according to RMANOVA (F[1,62] = 6.50871, P = 0.01316). Conversely, the IKDC scores at 12 months demonstrated a statistically significant rise (F[1,62] = 66.03667, P &lt; 0.001). Conclusion: MRI is a reliable investigation to assess the graft maturity. In our study, hamstring graft demonstrated superior maturity at 12 months as compared to 6 months’ postsurgery. There was a noteworthy inverse relationship between graft SNQ and IKDC scoring. MRI assessment at 6 months and 12 months is desirable to know graft’s maturity and helps to modify the rehabilitation protocol.

Long-term Prognosis of Patellar Tendinopathy (Jumper's Knee) in Young, Elite Volleyball Players: Tendon Changes 11 Years After Baseline.

The long-term prognosis of jumper's knee and whether structural changes in the patellar tendon persist is unknown. To investigate whether limitations in knee function and structural changes persisted beyond the athletic career of young elite volleyball players. Cohort study; Level of evidence, 2. Volleyball players (mean ± SD age, 18 ± 0.8 years) enrolled in 2006-2011 in a prospective cohort study were invited in 2020-2022 to a follow-up study. Participants rated their knee function with the Victorian Institute of Sport Assessment-Patellar Tendon (VISA-P) score (baseline and follow-up) and the International Knee Documentation Committee (IKDC) score (follow-up) and reported if jumper's knee had influenced their decision to retire from sport. Tendon thickness and structural changes were assessed with ultrasound (baseline) and magnetic resonance imaging (MRI) (follow-up) of both patellar tendons. We included 138 of 143 former athletes (97%) 11.4 ± 1.6 years after their baseline examination. At baseline, 37 persons (52 knees) had developed jumper's knee. At follow-up, participants reported lower knee function scores in knees diagnosed with jumper's knee at baseline than healthy knees (VISA-P scores: jumper's knee, 81 [95% CI, 70-92]; healthy, 90 [95% CI, 86-94]; P < .001; IKDC scores: jumper's knee, 82 [95% CI, 75-89]; healthy, 92 [95% CI, 91-95]; P < .001). Jumper's knee problems directly caused 7 of the 37 athletes (19%) with jumper's knee at baseline to retire from competitive volleyball. Of the 138 players included, 97 (70%) completed a bilateral MRI examination (194 knees). At follow-up, 38 of the 54 abnormal tendons (70%) had no structural changes (P < .001 vs baseline) while 22 of the 140 normal tendons (16%) had developed structural changes. Clinical symptoms were not correlated with tendon structure at follow-up (VISA-P scores for normal tendons: 85 [95% CI, 73-87]; abnormal: 89 [95% CI, 85-92]; P = .48). Jumper's knee is not a self-limiting condition; volleyball players who had developed jumper's knee during adolescence reported persistent reductions in knee function 11 years later, leading one-fifth to retire from competitive volleyball. Although approximately 70% of tendons with structural changes at baseline were normal at follow-up, there was no clear relationship between structure and function.

The Effect and Long-term Prognosis of Different Suturing Methods for Meniscus Repair Under Knee Arthroscopy.

This study aims to evaluate the efficacy and long-term prognosis of all-inside and outside-in suturing methods for meniscus repair under knee arthroscopy. A retrospective analysis was conducted on 120 patients with meniscus injuries who underwent surgical treatment at Yuhuan People's Hospital, Department of Joint Surgery, from January 2019 to March 2021. Based on the suturing method, patients were assigned into two groups: Group A (64 cases, all-inside suturing) and Group B (56 cases, outside-in suturing). Surgical indicators and adverse events were recorded for both cohorts. The variances in proprioception before and after surgery, International Knee Documentation Committee (IKDC) scores, Lysholm scores, knee range of motion (ROM), and Visual Analogue Scale (VAS) pain scores were compared between the two groups. Group A had significantly shorter operative time, postoperative immobilization, and hospital stay compared to Group B (p < 0.05). The overall incidence of adverse events was 12.50% in Group A and 16.07% in Group B, with no significant difference between the groups (p > 0.05). There were no substantial differences in preoperative knee proprioception difference values, IKDC scores, Lysholm scores, VAS scores, and knee ROM between the two groups (p > 0.05). At three months postoperatively, Group A exhibited lower proprioception difference values at 15°C, 45°C, and 75°C angles compared to Group B (p < 0.05). Additionally, at three months and three years postoperatively, Group A showed higher IKDC scores, Lysholm scores, and ROM and lower VAS scores compared to Group B (p < 0.05). Compared to the outside-in suturing approach, the all-inside suturing method for treating meniscus damage is more effective. It attenuates operative time, postoperative immobilization time, and hospital stay, ameliorates knee proprioception, promotes knee function recovery, alleviates pain, and is safe and reliable.

Comparison of a full tibial tunnel or an all-inside technique for anterior cruciate ligament reconstruction: An observational study.

This study aims to compare the effectiveness of anterior cruciate ligament (ACL) reconstruction performed with either a full tibial tunnel technique or an all-inside technique. Data from patients with ACL rupture who underwent ACL reconstruction using autogenous hamstring tendon grafts between January 2019 and July 2021 were retrospectively reviewed. Patients were followed up for a minimum of 24 months. Preoperative and postoperative International Knee Documentation Committee scores, Lysholm knee scores, visual analog scale pain scores, Tegner activity scale scores, C-reactive protein levels, erythrocyte sedimentation rate, white blood cell (WBC) count, D-dimer levels, and neutrophils were recorded. At the final follow-up, side-to-side differences were assessed with the pivot shift test, Lachman test, anterior drawer test, and a knee laxity-testing device. This study included 135 patients with ACL rupture, with 62 patients (43 males and 19 females, mean age: 34.42 ± 12.79 years) undergoing the full tibial tunnel technique, and 73 patients (58 males and 15 females, mean age: 32.41 ± 11.01 years) undergoing the all-inside techniques (AITs). There were no significant differences in postoperative International Knee Documentation Committee scores, Lysholm knee scores, or Tegner activity scale scores, except at postoperative 6 months. visual analog scale pain scores showed significant improvement in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 week, 2 weeks, and 1 month; however, there were no significant differences at postoperative 3, 6, 12, 18, and 24 months. C-reactive protein levels, erythrocyte sedimentation rate, WBC count, D-dimer levels, and neutrophils were significantly lower in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 month, but there were no other significant differences in these outcome measures, except for WBC count at postoperative 3 months. There was no significant difference in knee stability at the last follow-up. In ACL reconstruction, functional outcomes following the AIT are satisfactory and similar to the total tibial tunnel technique, but patients experience less pain and a reduced early postoperative inflammatory response. These results highlight the promising potential of AITs in the clinical management of ACL rupture and advocate for their widespread adoption.

Evaluating Synergistic Effects of Hyaluronic Acid, Human Umbilical Cord-Derived Mesenchymal Stem Cells, and Growth Hormones in Knee Osteoarthritis: A Multi-Arm Randomized Trial.

Knee osteoarthritis (OA) significantly affects quality of life and imposes economic burdens due to its prevalence and the disability it causes. The efficacy of current treatments is limited to alleviating the symptoms, and they cannot be used for regenerative purposes. This study aims to evaluate the efficacy and safety of combining hyaluronic acid (HA), human umbilical cord-derived mesenchymal stem cells (hUC-MSCs), and synthetic human growth hormone (somatotropin) in the treatment of knee OA, assessing pain relief, functional improvement, and cartilage regeneration. A four-arm, double-blind randomized trial was conducted with 51 knees from 28 subjects aged ≥50 with primary knee OA. The treatments involved were HA alone, HA with hUC-MSCs, HA with somatotropin, and a combination of all three. Efficacy was measured through the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog score (VAS), and MRI T2 mapping of cartilage was conducted on pre-implantation at the 6th and 12th month. All treatment arms showed improvements in the VAS and WOMAC scores over 12 months, suggesting some pain relief and functional improvement. However, MRI T2 mapping showed no significant cartilage regeneration across the groups. While the combined use of HA, hUC-MSCs, and somatotropin improved symptoms of knee OA, it did not enhance cartilage regeneration significantly. This study highlights the potential of these combinations for symptom management but underscores the need for further research to optimize these therapies for regenerative outcomes.

Management of Multiligament Knee Injuries Using Anatomic Autograft Reconstructions: A Case Series.

While proven effective management of multiligament knee injury (MLKI) using allograft is often reported, it has shown an increased risk for graft failure compared with autograft and raises availability and cost issues. Osseous stock preservation and tunnel convergence avoidance led us to develop a compromise innovative surgical procedure using only ipsilateral autograft for anatomic reconstruction of Schenck III-L or higher MLKI. We report the description and early outcomes of our initial experience. Our strategy consisted of an anatomic single-bundle posterior cruciate ligament reconstruction with quadriceps tendon autograft and a "Versailles" reconstruction for the posterolateral corner, which we modified to reconstruct the anterolateral ligament in case of anteromedial rotatory instability, called "full lateral." A second-stage surgery was planned for anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft. Outcomes were Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores for functional status, Short Form 12 (SF-12) for quality of life, and visual analog scale (VAS) for pain. Complications, full weight-bearing, return to work, and sport were also computed. Between March 2019 and August 2020, 10 patients were included. At follow-up, light pain was found in nine patients with a mean VAS of 1.2 ± 2.16 during the day. The mean Lysholm, Tegner, and subjective IKDC scores were good, with 61.2 ± 20.6, 2.8 ± 2.1, and 52.6 ± 20.4, respectively. However, quality of life was altered with poor SF-12 scores. In our first 10 patients with Schenck III-L or higher MLKI, our procedure using only ipsilateral autograft enabled correct daily knee functional activities while preserving osseous stock.

Superior Biological Healing of Hamstring Autografts Compared with Tibialis Allografts after Anterior Cruciate Ligament Reconstruction: A Propensity Score Matching Analysis Based on Second-Look Arthroscopy.

Background and Objectives: Remodeling and healing of the graft are crucial processes for long-term graft survival after anterior cruciate ligament reconstruction (ACLR). However, few studies have objectively evaluated the differences in graft healing between autografts and allografts. This study aimed to compare the status of the anterior cruciate ligament (ACL) grafts between hamstring tendon (HT) autografts and tibialis anterior tendon (TAT) allografts using second-look arthroscopy. Materials and Methods: The outcomes of 193 consecutive patients (153 males and 40 females, with an average age of 30.38 and BMI of 25.43 kg/m2) who underwent second-look arthroscopy following primary ACLR were retrospectively reviewed. Prior to participating in this study, all patients provided written informed consent. The patients were divided into two groups: those with HT autografts and those with TAT allografts. Confounding factors were matched between the two groups using propensity score matching (PSM). ACL graft status was assessed during second-look arthroscopy using a numeric scale system based on the degree of four parameters: graft tension, continuity, synovium coverage, and vascular marking. Clinical outcomes were assessed using the Lysholm and International Knee Documentation Committee (IKDC) scores. Graft status and clinical outcomes were compared between the two groups. Additionally, a subgroup analysis based on the timing of the second-look arthroscopy (12-24 months vs. >24 months after the initial ACLR) was conducted. Results: After PSM, 62 patients were included in each group. The second-look arthroscopy was conducted at 23.6 ± 6.6 months for the HT group and at 24.0 ± 7.9 months for the TAT group (p = 0.749). The continuity and tension of the ACL graft were not significantly different between the two groups (p = 0.146 and 0.075, respectively). However, the TAT group exhibited significantly inferior synovial coverage and vascular marking of the ACL graft compared with the HT group (p = 0.021 and 0.007, respectively). These findings were consistent regardless of the timing of the second-look arthroscopy. Clinical outcomes, according to the Lysholm and IKDC scores, significantly improved in both groups with no significant differences (p = 0.386 and 0.733, respectively). Conclusions: Although there were no differences in graft tension and continuity between HT autografts and TAT allografts, the biological healing of ACL grafts, in terms of synovialization and vascularization, was superior in HT autografts compared to TAT allografts.

Outcomes of Trochleoplasty vs Tibial Tubercle Osteotomy for Treatment of Patellar Instability Associated with Trochlear Dysplasia; A Systematic Review and Meta-analysis.

To compare the outcomes of tibial tubercle osteotomy (TTO) and trochleoplasty for the treatment of patellar instability associated with trochlear dysplasia Methods: This was a systematic review of the literature including published articles that describe either trochleoplasty or TTO in addition to medial patellofemoral ligament reconstruction for the surgical treatment of patellar instability associated with trochleoplasty. Main outcomes assessed were Kujala and international knee documentation committee (IKDC) scores, in addition to recurrent instability and complications. Outcome measures reported were provided in a table format and a subjective analysis was performed. Ten studies were included with a total of 362 knees including 132 in the trochleoplasty group and 230 in the TTO group. Mean follow up ranged from 27.6 to 61.3 months. At the final follow up, both Kujala and IKDC scores improved significantly in all studies that reported both preoperative and postoperative scores in both groups. There was a total of 3 instability events in the trochleoplasty group as opposed to 21 in the TTO group. Both procedures, trochleoplasty and TTO may provide satisfactory functional improvement in patients with patellar instability associated with trochlear dysplasia. However, trochleoplasty may be a better option to minimize the risk of recurrent instability.

Effectiveness of In-Home, Augmented Reality-Based Telerehabilitation After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.

New digital technology-based rehabilitation may be a viable option for patients after anterior cruciate ligament reconstruction (ACLR), with advantages such as easy access to treatment and learning as well as cost-effectiveness. To investigate the effects of an augmented reality (AR)-based, telerehabilitation system in patients after ACLR compared with a brochure-based rehabilitation program in terms of patient-reported outcomes and functional performance measures. Randomized controlled trial; Level of evidence, 2. This was a multicenter, assessor-blinded study. Enrolled participants were allocated randomly to either the intervention group, who underwent AR-based telerehabilitation system, or to the control group, who underwent a brochure-based rehabilitation program with a self-log. Both groups performed the same postoperative rehabilitation exercise protocol. Subjective knee function was assessed using the International Knee Documentation Committee (IKDC) as the primary outcome; secondary outcomes were a numeric rating scale for pain, the EuroQol 5-Dimension 5-Level, isometric knee strength, range of motion, and the single-leg hop test. The intervention group also completed a satisfaction survey. Follow-up was conducted at 2, 6, 12, and 24 weeks postoperatively. A total of 28 patients were enrolled in each group; 1 patient in the control group was lost to follow-up. Patients in both groups demonstrated improvement on all outcomes over time. There were no significant between-group differences in the IKDC score from baseline to 12 weeks postoperatively. The intervention group saw a greater increase in the relative isometric strength of the quadriceps on the involved limb at 6, 12, and 24 weeks postoperatively (P < .05 for all). No significant group differences were observed in the remaining secondary outcomes. Study findings indicated that patients who underwent AR-based telerehabilitation in the early rehabilitation phase after ACLR demonstrated similar improvements as those who followed a brochure-based rehabilitation program and had a quicker recovery of knee extensor strength. NCT04513327 (ClinicalTrials.gov identifier).

Successful ACL repair by dynamic intraligamentary stabilisation is non-inferior in functional performance and worse in proprioception compared to healthy controls in a case-matched study.

The primary aim of this study was to assess non-inferiority in functional performance of the knee after dynamic intraligamentary stabilisation (DIS) surgery at a minimal follow-up of 1 year compared to healthy controls, based on limb symmetry index (LSI) of the single leg hop test (SLH). Additionally, functional performance based on the single leg triple hop test (SLTH) and side hop test (SH), proprioception and subjective outcome were evaluated. A total of 45 DIS patients were 1-to-1 matched to a healthy control. Functional performance was evaluated by LSI and absolute values on the SLH, SLTH and SH. Proprioception was assessed by joint position sense (JPS) test and International Knee Documentation Committee (IKDC) scores were obtained. Non-inferiority in functional performance after DIS compared to healthy controls was confirmed based on the mean LSI of the SLH and SLTH (97.6% vs. 99.6% and 97.5% vs. 100.6%, respectively) and non-confirmed on the SH (98.8% vs. 100.0%, respectively). No significant differences were found in absolute value of the SLH and SLTH and a significantly higher absolute value of the SH was found in the DIS group (p = 0.01). JPS absolute angular error was significantly higher in the DIS group compared to the control group (p = 0.01). The median IKDC score of the DIS group was significantly lower (92, IQR 85-95) than the control group (100, IQR 99-100), p < 0.001. In conclusion, functional performance after DIS was confirmed non-inferior compared to healthy controls based on the SLH and SLTH, although non-confirmed on the SH. Level III.

Anatomic physeal-sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24-month follow-up.

Recurrent patellar dislocation is a prevalent orthopaedic issue among active paediatric and adolescent populations. Bony surgical procedures are not recommended in growing patients; therefore, the focus of surgery is on restoring the medial patellar ligaments, with different reconstructive techniques available. This retrospective case series focuses on the 2-year outcomes of medial patellofemoral ligament (MPFL) reconstruction in skeletally immature patients with open physis. Twenty-four consecutive patients with patellofemoral instability and open growth plates underwent anatomic MPFL reconstruction with a physeal-sparing technique. All subjects have had more than three episodes of true patellar dislocations. Preoperative radiographic examination included anteroposterior and lateral views to assess patella alta and limb alignment. Magnetic resonance imaging was performed to evaluate trochlear dysplasia and tibial tubercle-trochlear groove (TT-TG) distance. The patients were questioned regarding complications and clinical outcomes using the visual analogue scale (VAS), Kujala and Paediatric International Knee Documentation Committee (Pedi-IKDC) score. Variables were evaluated using paired t test with significance at p < 0.05. The mean age at the time of operation was 13.04 years (9-16 years). The cohort was followed for a mean duration of 38.66 months (24-86 months). The mean time from injury to surgery was 50.45 days (16-80 days). No growth arrest, limb-length discrepancies or angular deformities were observed post-operatively during the whole follow-up period. No patellar re-dislocations were recorded throughout the study period. The VAS score improved significantly from 5.67 (4-8) to 1.88 (0-4) (p < 0.01). The Kujala score improved significantly from 64.67 (44-81) preoperatively to 87.58 (77-100) post-operatively (p < 0.01). The Pedi-IKDC also increased significantly from 58.81 (34.80-77.70) preoperatively to 90.64 (70.70-100) post-operatively (p < 0.01). The vast majority of patients (87.5%) returned to their pre-injury activity level. Boys scored better than girls in VAS, Pedi-IKDC and Kujala score post-operatively, but these differences were not statistically significant. Physeal-sparing MPFL reconstruction in children and adolescents yields excellent midterm results and allows patients to return to sports without redislocation of the patella. Boys scored better than girls in VAS, Pedi-IKDC and Kujala score post-operatively, but these differences were not statistically significant. IV: case series with no comparative group.

Resorption characteristics of an open architecture biocomposite interference screw after ACL reconstruction.

Absorbable interference screws for anterior cruciate ligament reconstruction (ACLR) can lead to tunnel widening and cyst formation. The Biosure Regenesorb interference screw (Smith & Nephew). has been developed with an optimised calcium phosphate/polymer composition to promote bone formation during resorption. The present study aims to investigate screw resorption, new bone formation, and tunnel geometry following ACLR with Biosure Regenesorb screw tibial fixation. The study is a prospective single-centre case series of 12 patients with ACL lesions and treated with ACLR using hamstring tendon autograft with Biosure Regenesorb interference screw tibial fixation with a two-year follow-up period. The Biosure Regenesorb consists of 65% polylactide-glycolic acid poly. 20% calcium sulphate and 15% tricalcium phosphate. Primary endpoint: Tunnel volume. implant volume and new bone formation in the tibial tunnel is evaluated by quantitative computed tomography (CT) scanning. Secondary endpoints: Arthrometric knee laxity, International Knee Documentation Committee (IKDC) and Knee Osteoarthritis and Injury Outcome Scores (KOOS) and Tegner activity scale. Screw volume decreased to 44% within the two-year follow-up period while tunnel volume remained unchanged. Only a minor amount (<1% of tunnel volume) of new bone formation in the screw remnants was observed. Sagittal knee laxity at one year was 0.9 mm. The IKDC score increased by 15 points and the KOOS sport and KOOS quality of life scores increased by 25 and 26 points. respectively. ACLR using Biosure Regenesorb interference screw does not result in tunnel widening. showing a screw resorption of 44% after two years and minor new bone formation. Knee stability and subjective outcome improvements are as expected after other ACLR methods. IV.

Outcomes After Osteochondral Allograft Transplantation of the Medial Femoral Condyle in Patients With Varus and Nonvarus Alignment

Background: Fresh osteochondral allograft (OCA) transplantation is an effective technique for the treatment of focal chondral and osteochondral defects in the knee. Coronal-plane malalignment leads to increased contact forces within a compartment and subsequently the cartilage repair site and may lead to higher failure rates. However, the magnitude of the effect of coronal-plane malalignment on graft survivorship and clinical outcomes has not been well characterized. Purpose: To evaluate how varus malalignment affects graft survival and patient-reported outcomes after isolated OCA transplantation of the medial femoral condyle (MFC). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 70 patients (74 knees) who underwent primary OCA transplantation of the MFC between 2005 and 2019 were identified from a prospectively collected single-surgeon cartilage registry with a minimum 2-year follow-up. Coronal-plane alignment was evaluated utilizing standing hip-to-ankle radiographs. OCA failure, defined as removal of the graft or conversion to arthroplasty, and reoperations were recorded. Patient-reported outcomes were obtained preoperatively and postoperatively using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, modified Merle d’Aubigné–Postel score, and overall patient satisfaction score. Results: The mean mechanical tibiofemoral angle for patients with varus alignment was 3.9° of varus (range, 1.1° to 8.9°) and for patients with nonvarus alignment it was 0.02° of valgus (range, 3.6° varus to 4.6° valgus). Graft survivorship was 95.3% in the varus group and 95.8% in the nonvarus group (P = .918) at 5 years postoperatively. Reoperations after OCA transplantation occurred in 14.0% of the varus group and 22.6% of the nonvarus group (P = .336). The mean International Knee Documentation Committee total score improved from 45.2 preoperatively to 74.8 at latest follow-up in the varus group and from 40.5 preoperatively to 72.3 at latest follow-up in the nonvarus group. Patient satisfaction was >85%. Conclusion: Patients undergoing isolated OCA transplantation of the MFC had high rates (>90%) of graft survivorship and significant improvements in pain and function. Patients with mild preexisting varus malalignment were found to have no difference in the failure rate or clinical outcomes compared with patients with nonvarus alignment.

Peroneus Longus vs Hamstring Tendon Autografts in ACL Reconstruction: A Comparative Study of 106 Patients' Outcomes.

BACKGROUND Anterior cruciate ligament (ACL) reconstruction commonly uses a hamstring tendon autograft, but the peroneus longus tendon can also be used. This study aimed to compare outcomes of anterior cruciate ligament reconstruction in 106 patients using peroneus longus tendon and hamstring tendon autografts. MATERIAL AND METHODS ACL repair was performed on 54 patients using a hamstring tendon autograft and 52 patients with a peroneus longus tendon autograft. Knee function was assessed using the International Knee Documentation Committee (IKDC) and Lysholm scores, while the ankle was evaluated using the American Orthopedic Foot and Ankle Score (AOFAS) and the Foot &amp; Ankle Disability Index (FADI) scores. Donor-site morbidity and graft characteristics were compared. RESULTS There was no difference between the 2 groups in terms of knee IKDC and Lysholm scores (p=0.49, p=0.68, respectively). The diameter of the peroneus longus tendon graft (8.56±0.93) was significantly larger than the hamstring tendon (7.44±0.6) (p<0.001). The peroneus graft harvesting time was significantly shorter (p<0.001). Thigh hypotrophy and donor-site morbidity were significantly higher in the hamstring group (p<0.001 and p=0.006). The donor ankle AOFAS score was 93.46±3.8, and the FADI score was 93.48±4.6. No morbidity associated with the peroneus longus graft was observed. CONCLUSIONS Patients who underwent ACL reconstruction using the peroneus longus tendon experienced faster knee rehabilitation and less donor-site morbidity, such as thigh hypotrophy and knee pain. The peroneus longus tendon, with its larger diameter, fewer graft-related complications, and similar knee scores compared to the hamstring group, is considered a suitable alternative graft source.