Knee Ligament Research Articles

Non-operative Management of Acute Knee Injuries.

Acute knee injuries are commonly encountered in both the clinical and sideline setting and may be treated operatively or non-operatively. This article describes an evidence-based approach to non-operative acute knee injury. This includes history, physical exam, imaging, and initial management. In addition, the non-operative management of three such injuries-ligament injury, meniscus injury, and patellar dislocation injury-will be discussed via a case-based practical approach. Aside from grade III ACL tears, most acute knee ligament injuries, especially in the absence of other concurrent injuries, can be treated non-operatively. There is new evidence that acute traumatic meniscus tears in those younger than 40 can be successfully treated non-operatively and can do equally, as well as those that undergo surgery, at 1year out from injury. Based on the current literature, a short period of knee bracing in extension with progression to weightbearing to tolerance is recommended after initial patellar dislocation. Many of the most common acute knee injuries, including MCL tears, meniscus tears, and patellar dislocations, can be managed non-operatively. A detailed systemic approach to initial evaluation, including pertinent history, physical exam, and appropriate imaging, is essential and complementary to the subsequent non-operative treatment algorithm.

Magnetic Resonance Imaging in diagnosing anterior and posterior cruciate ligament injury of knee joint with arthroscopic correlation

Anterior and posterior cruciate ligaments are the most injured of the major knee ligaments. Magnetic Resonance Imaging (MRI) knee is routinely used to diagnose or support clinical diagnosis for cruciate ligament tear before arthroscopic treatment. MRI of the knee has been regarded as the non-invasive alternative to diagnostic arthroscopy, which is regarded as the gold standard for the diagnosis of traumatic intra-articular knee injuries. A cross-sectional study was carried out in the Department of Radiology in collaboration with Orthopedics among 55 patients with clinically suspected anterior and posterior cruciate ligament injury using the purposive sampling method. MRI diagnosis of anterior and posterior cruciate ligaments tear correlated significantly well with arthroscopic diagnosis as shown by the higher validity test results with 90.91% sensitivity, 97.73% specificity, 96.36% accuracy, 90.91% positive predictive value, and 97.73% negative predictive value. The study also revealed that there is no statistically significant difference (p =0.62) between MRI and arthroscopy in the evaluation of cruciate ligament tears. Therefore, MRI is a reliable tool and non-invasive diagnostic modality in the evaluation of anterior and posterior cruciate ligament tears before surgical management of these cases.

EXTRA-ARTICULAR KNEE LIGAMENT RECONSTRUCTIONS USING LIGAMENT AUGMENTATION AND RECONSTRUCTION SYSTEM (LARS) SYNTHETIC GRAFTS IN ELITE ATHLETES

IntroductionTo determine if elite athletes can return to professional sport after MCL or posterolateral (PLC) reconstruction using LARS ligaments. The secondary aims are to demonstrate the safety and efficacy of LARS by reporting sport longevity, subsequent surgeries, and complications.MethodsA retrospective review of all extra-articular knee ligament reconstructions, utilising a LARS synthetic ligament, by 3 sports knee surgeons between 2013 and 2020 was undertaken. All elite athletes aged over 16 years and a minimum of 2 years post reconstruction were included. No LARS were used for ACL reconstructions, and they were excluded if a LARS ligament was used for a PCL reconstruction. Return to play (RTP) was defined as competing at professional level or national/ international level in amateur sport.ResultsSixty-four (84.2%) MCL reconstructions and 12 (15.8%) PLC reconstructions were included. 52 (68.4%) underwent concomitant autograft cruciate(s) reconstruction including 6 (7.8%) bicruciate reconstructions. The mean age was 25.1 years (SD +/− 4.50). 35 (46.1%) were footballers and 35 (46.1%) were rugby players. Sixty-seven athletes (88.2%) returned to elite sport, 7 (9.2%) did not RTP and RTP status was unknown for 2 (2.6%) (Figure 1). 65 out of 67 (97.0%) RTP at the same/higher Tegner level. 56 (83.6%) and 20 (57.1%) were still playing at 2- and 5-years post-surgery Six (7.9%) players required further surgery due to irritation from the metal fixation implants. One had an inflammation adjacent to the synthetic material at the femoral end and the other cases involved the tibial staples. All six cases were able to RTP. One athlete, following bicruciate /MCL surgery had the LARS removed due to laxity. There was one MCL re-rupture, sustained while jumping, 4 years after returning to football.ConclusionsUtilising LARS in extra-articular knee ligament reconstructions allows 88.2% of athletes with a variety of knee ligament injuries to return to elite sport. The results compare well regarding RTP, complication, and revision rates with the published evidence for other types of MCL and PLC grafts. This, coupled with 57% of athletes still playing 5 years post-surgery suggests the LARS is safe and effective in these cases.For any figures or tables, please contact authors directly.

Knee Function of Four Alpine and One Freestyle World Cup Skiers 30 Years after Serious Knee Injuries

Objective: Serious knee injuries have ruined many skiing careers. The purpose of this study is to report the knee function of five Norwegian world cup skiers 30 years after a serious knee injury. Methods: The five skiers with anterior cruciate ligament (ACL) and concomitant serious knee injuries were treated at Oslo University Hospital in the period 1989-92. The median age at the time of injury was 25 (19-26) years. Three of the alpine skiers regained their world cup ranking. About 30 years after their injuries, the skiers were asked about later injuries, competition activity and evaluated by Tegner activity scale and the knee injury and osteoarthritis outcome score (KOOS). Results: The skiers participated in median 4 (0-5) world cup seasons after their knee injuries and did not suffer new acute knee injuries. Thirty years after the knee injury the tegner score was higher (more activity) and the KOOS score was lower (more symptoms) than those of a normal population of corresponding age group. Conclusion: Thirty years after a serious knee knee injury the five world cup skiers are still living an active life with higher tegner and lower KOOS scores than the normal population. Functional knee scores should therefore be related to the degree of activity.

Comparison of Improvement in Patient-Reported Knee Function After Revision and Multiple-Revision ACL Reconstruction Compared With Primary ACL Reconstruction.

Graft failure after anterior cruciate ligament reconstruction (ACLR) is a debilitating complication often requiring revision surgery. It is widely agreed upon that functional knee outcomes after revision ACLR (r-ACLR) are inferior compared with those after primary reconstruction. However, data are scarce on outcomes after multiple-revision ACLR (mr-ACLR). To compare patient-reported knee function in terms of Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and 1-year postoperatively after primary ACLR, r-ACLR, and mr-ACLR and evaluate the pre- to postoperative improvement in KOOS scores for each procedure. Cohort study; Level of evidence, 3. Patients from the Swedish National Knee Ligament Registry who underwent their index ACLR between 2005 and 2020 with a minimum age of 15 years at the time of surgery were included in this study. All patients had pre- and postoperative KOOS data. The 1-year postoperative KOOS and the pre- to postoperative changes in KOOS were assessed between patients who underwent primary ACLR and those who underwent subsequent r-ACLR and mr-ACLR. Of 20,542 included patients, 19,769 (96.2%) underwent primary ACLR, 760 (3.7%) underwent r-ACLR, and 13 (0.06%) underwent mr-ACLR. Patients who underwent r-ACLR had significantly smaller pre- to postoperative changes on all KOOS subscales compared with patients undergoing primary ACLR (P < .0001 for all). Furthermore, patients in the mr-ACLR group had significantly smaller changes in the KOOS-Pain subscale compared with patients in the r-ACLR group (-9 ± 23.3 vs 2.5 ± 18; P = .024). The study results indicated that while improvement is seen after primary ACLR, r-ACLR, and mr-ACLR, the greatest improvement in functional outcomes is observed after primary ACLR. Patients who underwent at least 1 r-ACLR, specifically mr-ACLR, had lower postoperative outcome scores, indicating that primary ACLR may provide the best chance for recovery after ACL injury.

The effects of knee ligament load using simulated hip abductor and hamstring muscle strengthening during cutting maneuver.

This study aimed to analyze knee ligament of load and joint moment to simulate the strengthening of the hip abductor and hamstring muscles using musculoskeletal modeling, thereby contributing to decrease of knee ligament load. Forty participants (age: 21.85 ± 1.90 years; height: 1.76 ± 0.06 m; body mass: 68.5 ± 7.06 kg) were instructed to run at 4.5 ± 0.2 m/s from a 5 m distance posterior to the force plate, land their feet on the force plate, and perform the cutting maneuver on the left. In the musculoskeletal modeling, the hip abductor and hamstring muscles were targeted to construct a model with a 30% increase in the contraction force of the hip abductor, hamstring, and both 2 muscles. The variables were the ligament force and knee joint moment. One-way repeated measure ANOVA and Bonferroni test were used to compare the abductor/hamstring, abductor, hamstring and control models. There were significant differences in anterior bundle of the anterior cruciate ligament (ACL) (P = .001), inferior bundle of the superficial layer of the medial collateral ligament (MCL) (P = .016), and posterior bundle of the superficial layer of the MCL (P = .022) force. The post hoc showed that the hamstring model had lower anterior bundle of the ACL and inferior bundle of the superficial layer of the MCL than the abductor/hamstring and abductor models (P < .05) and lower posterior bundle of the superficial layer of the MCL than the abductor and control models (P < .05). There was a significant difference in the adduction (P = .028) and internal rotation moments (P = .014). The post hoc showed that both moments were lower in the hamstring model than in the other models (P < .05). The hamstring strengthening may contribute significantly to preventing ACL or MCL injury by reducing knee ligament load.

Ligamentous Knee Joint Instability: Association with Chronic Conditions of the Knee and Treatment with Prolotherapy

Ligamentous knee joint instability and other conditions associated with knee dysfunction are common musculoskeletal complaints that affect a large percentage of the global population. A healthy knee has normal joint mechanics and can maintain its stability as it responds to the forces placed upon it. Once undue forces, whether from injury, wear and tear, or overuse, cause the soft tissue structures of the knee to stretch beyond their normal range of motion, they can become lax, elongated, damaged, or torn, especially the ligaments. This condition, known as ligamentous knee instability, causes destructive joint forces to occur, which results in the development of other pathophysiologic conditions related to knee dysfunction, including osteoarthritis, patellar pain syndromes, tendinopathies, meniscus tears, and osteochondral defects. Traditional treatments address the consequences of joint instability, such as synovitis and joint swelling, but do not address the underlying ligament and/or disease that led to the joint instability. Prolotherapy promotes the repair of injured or degenerated tissues, such as ligaments, tendons, and menisci, by stimulating the physiological healing process of the joint. This process corrects the underlying joint instability, reduces associated pain, improves knee function, and has the potential to slow the degenerative process.

Minimally Invasive Harvesting of Triple-Fold Superficial Layer Quadriceps Autograft for Knee Ligament Reconstruction

Graft selection plays a critical role in anterior cruciate ligament reconstruction. Autograft options, including hamstrings, bone–patellar tendon–bone, and quadriceps, offer distinct advantages and disadvantages. Soft tissue quadriceps tendon autografts are increasingly favored due to their strength, size compatibility, and potential for enhanced graft healing. This technique offers minimal skin incision, a longer graft, and reduced morbidity, as it specifically targets the superficial band of the quadriceps tendon.

Graft failure within 2years of isolated anterior cruciate ligament reconstruction is associated with increased risk of secondary meniscus tears.

A debilitating complication following anterior cruciate ligament reconstruction is a secondary meniscus tear. Currently, the literature is mixed regarding the risk factors associated with the incidence of secondary meniscus tears. The aim of this study was to investigate risk factors associated with meniscus tears following an isolated primary anterior cruciate ligament reconstruction. ACL graft failure was hypothesized to be the strongest risk factor for secondary meniscal injury occurrence. A retrospective cohort analysis was performed using the PearlDiver Database. Patients with a primary anterior cruciate ligament reconstruction were identified in the database. Patients with concomitant knee ligament injury or meniscus injury present at the time the index procedure were excluded. Patients were grouped to those who had a secondary meniscus tear within 2years following anterior cruciate ligament reconstruction and those who did not. Univariate analysis and multivariable regression analysis was conducted to identify significant risk factors for a secondary meniscus tear. There were 25,622 patients meeting criteria for inclusion in this study. Within 2years from the primary anterior cruciate ligament reconstruction, there were 1,781 patients (7.0%) that experienced a meniscus tear. Graft failure had the highest odds of having a postoperative meniscus tear within 2years (OR: 4.1; CI 3.5-4.8; p < 0.002). Additional significant risk factors included tobacco use (OR: 2.0; CI 1.0-3.1; p < 0.001), increased Charlson Comorbidity Index (OR: 1.2; CI 1.1-1.4), male gender (OR: 1.1; CI 1.1-1.2; p < 0.001), obesity (OR: 1.1; CI 1.1-1.2; p < 0.001), delayed surgery (OR:1.1; CI 1.1-1.2; p < 0.002), and patients age 30 and older (OR: 1.0; CI 1.0-1.0; p < 0.001). This study found that anterior cruciate ligament graft failure is the strongest predictor of post-operative meniscus tears. Other risk factors, including tobacco use, increased CCI, male gender, obesity, delayed surgery, and age 30 and older, were established, with several being modifiable. Therefore, targeted preoperative optimization of modifiable risk factors and postoperative protocols may reduce the risk of secondary meniscus tears. Level III, prognostic trial.

THE ROLE OF AUTOLOGOUS HAMSTRING GRAFT IN IMPROVING FUNCTIONAL OUTCOME AFTER ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: PROSPECTIVE STUDY AT GGH, KURNOOL

Objectives: The prevalence of knee ligament injuries is on the rise due to increasing engagement in sports activities. Among the various ligaments present in the knee joint, the anterior cruciate ligament (ACL) is the most commonly injured. Several procedures have been described for the reconstruction of a torn ACL, ranging from open to arthroscopic techniques. In this particular study, we utilized an autograft from the hamstring muscle for ACL reconstruction. The graft was secured with an Endobutton on the femoral end and an interference screw at the tibial end. If necessary, cancellous screws or a suture wheel was used as well. Methods: This is a 2-year prospective study conducted between April 2021 and March 2023 at GGH, Kurnool, which included 20 cases of complete ACL tear. All patients underwent arthroscopic ACL reconstruction using a hamstring graft. Following the procedure, all patients were assessed using the lysholm knee scoring questionnaire and were monitored at specific intervals, including 3 months, 6 months, and 1 year, to evaluate their progress. Results: After 1 year, the lysholm knee scoring questionnaire was used to evaluate the results of the ACL reconstruction with the hamstring graft. The findings revealed that 30% (6 cases) of the cases reported excellent results, 50% (10 cases) of the cases showed good results, 15% (3 cases) of the cases showed fair results, and 5% (1 case) of the cases obtained poor results. In addition, 80% of patients achieved functional restoration to their pre-injury level. At 1-year follow-up, our study found that the average pre-operative lysholm score was 63.24, while the average post-operative score was 91.98, which showed a statistically significant improvement in the post-operative lysholm score compared to the pre-operative score (p&lt;0.05). Conclusions: Our study suggests that the use of a hamstring graft for the reconstruction of a torn ACL can result in excellent to good outcomes. However, it should be noted that proper patient selection and physiotherapy play a significant role in achieving favorable results.

Reference standards for stress radiography measurements in knee ligament injury and instability: a systematic review

AbstractPurposeStress radiographs are an easily accessible, cost‐effective tool in the evaluation of acute and chronic ligament knee injuries. Stress radiographs provide an objective, quantifiable, and functional assessment of the injured ligament and can be a useful adjunct when planning surgical management and to objectively assess postoperative outcomes. This study aimed to review the literature reporting on stress radiographic techniques in evaluating knee ligament injury and instability and propose thresholds for interpreting stress radiography techniques.MethodsThe following three databases, OVID MEDLINE, the EMBASE library, and the Cochrane Controlled Trials Register, were systematically searched on January 23, 2023, for studies published from January 1970 to January 2023. The search extended to the reference lists of all relevant studies and orthopedic journals. Included studies were those that described a stress technique for the diagnosis of knee ligament injury; studies that reported a description or comparison of the accuracy and/or reliability of one or several stress radiography techniques, or studies that reported a comparison with alternative diagnostic modalities.ResultsSixteen stress radiography techniques were reported for assessing the ACL with stress applied in the anterior plane, 10 techniques for assessing the PCL with stress applied in the posterior plane, 3 techniques for valgus stress, and 4 techniques for varus stress. The Telos device was the most commonly used stress device in the ACL and PCL studies. There was no consensus on the accuracy and reliability of stress radiography techniques for the diagnosis of any knee ligament injury. Stress radiography techniques were compared with alternative diagnostic techniques including instrumented arthrometry, MRI, and physical examination in 18 studies, with variability in the advantages and disadvantages of stress radiography techniques and alternatives. Analysis of results pooled from different studies demonstrated average delta gapping in knees with a completely injured ligament compared to the normal contralateral knee as per the following: for the ACL 4.9 ± 1.4 mm; PCL 8.1 ± 2.5 mm; MCL 2.3 ± 0.05 mm; and the FCL 3.4 ± 0.2 mm.ConclusionDespite heterogeneity in the available literature with regard to stress examination techniques and device utilization, the data support that stress radiography techniques were accurate and reliable when compared to numerous alternatives in the diagnosis of acute and chronic knee ligament injuries. The present study also provides average increased ipsilateral compartment gapping/translation for specific knee ligament injuries based on the best available data. These values provide a reference standard for the interpretation of stress radiography techniques, help to guide surgical decision‐making, and provide benchmark values for future investigations.Level of evidenceIII.

Comparison of knee kinematics and ligament forces in single and multi-radius cruciate-retaining total knee arthroplasty: A computer simulation study

BackgroundThe single-radius design in total knee arthroplasty has been designed to develop a more fixed flexion–extension axis without mid-flexion instability compared with the multi-radius design. It remains unclear whether differences between the multi-radius and single-radius designs can affect kinematics and collateral ligament forces. This study aimed to simulate knee kinematics and kinetics between single-radius and multi-radius models using a musculoskeletal computer model. MethodsThe single-radius and multi-radius femoral components were virtually implanted in a computer simulation using the same tibial insert. The effects of implant design on kinematics and medial collateral ligament forces during squatting and gait activities were analyzed. ResultsDuring squatting, the multi-radius model exhibited paradoxical anterior translation on both the medial and lateral flexion facet center where peak anterior translation was 2.4 mm for medial flexion facet center and 2.2 mm for the lateral flexion facet center, while the peak anterior translation of the single-radius model was less than 1 mm at early flexion. A rapid decrease in medial collateral ligament tension was observed in the early flexion phase in the multi-radius model, which occurred simultaneously with paradoxical anterior translation, whereas the relatively constant medial collateral ligament tension was observed in the single-radius model. During gait activity, the single-radius model exhibited a more posterior position than the multi-radius model. ConclusionThese suggest that abrupt changes in the medial collateral ligament force influence anterior sliding of the femur, and that the single-radius design is a reasonable choice for prevention of mid-flexion instability.

Comparing the Balance, Strength, and Range of Motion of Hip and Ankle Joints in Volleyball Players With and Without Dynamic Knee Valgus

Background and Aims Dynamic knee valgus (DKV) is an abnormal pattern of movement or abnormal alignment of the lower limb that causes changes in lower limb function in the frontal plane and absorption of excessive reaction force by the knee ligaments during sports activities, which can increase the risk of anterior cruciate ligament injury. This study aims to compare the balance, strength, and range of motion (ROM) of hip and ankle joints in volleyball players with and without DKV. Methods This is a quasi-experimental and causal-comparative study. Participants were 60 volleyball players (30 with DKV and 30 without DKV). The tuck jump test was used to evaluate their DKV. The ROM of knee and ankle joints was measured using a goniometer, while the isometric strength of the hip and ankle muscles was determined using a hand dynamometer. Then static and dynamic balances were evaluated by the Stork test and the Y balance test, respectively. Independent t-test was used to compare the means of variables between the two groups in SPSS software, version 24. Results The results showed a significant difference in static balance (P=0.005), dynamic balance (P≤0.05), hip abduction strength (P=0.03), hip external rotation strength (P=0.01), and ROM of ankle dorsiflexion (P=0.03) between the two groups, where those without DKV performed better. The difference in other variables was not significant between the two groups. Conclusion The results indicate the importance of improving hip abduction and hip external rotation strength as well as the ROM of ankle dorsiflexion for reducing the DKV, which should be considered in designing training protocols.

Tissue Augmentation Techniques in the Management of Ligamentous Knee Injuries.

Despite early reports of high failure rates in knee ligament repair techniques resulting in favor of reconstruction, newer advances in surgical technology have shifted the attention back to repair with the addition of various tissue augmentation techniques. Ligament repair preserves proprioceptors in the native ligament and avoids autograft tendon harvest, minimizing the complications associated with donor site ruptures in reconstruction techniques. Tissue augmentation has been successfully used in knee ligamentous and tendon repair procedures, as well as in some upper extremity procedures. This study provides a clinical update on the surgical techniques, biomechanics, and outcomes with the application of various tissue augmentation techniques in the ligaments surrounding the knee joint.

A Soft Tissue Technique for Treating Knee Hyperextension or Recurvatum: Posterior Oblique Ligament Advancement

Background: Genu recurvatum is a challenging disorder and can negatively affect knee biomechanics, as reflected in its role as a risk factor for knee ligament injury and poor outcomes following ligament reconstruction or arthroplasty. Indication: Pathological recurvatum should be addressed in the presence of a causative correctible structural abnormality, whether due to decreased posterior tibial slope or due to multiligament injury. We described a posterior oblique ligament (POL) advancement technique for the treatment of knee recurvatum. Technique Description: After completion of all concomitant procedures such as ligament reconstructions, the procedure is initiated with a medial approach. The POL is isolated with an inverted L-shaped dissection and mobilized. Mattress sutures are passed through the resulting POL flap, and are re-tensioned and fixed anteriorly and distally, with the knee close to extension, in order for the imbrication to restrain hyperextension. Results: Anecdotal evidence points to satisfactory control of knee recurvatum postoperatively, which can potentially avoid its deleterious effects in surgical outcomes. Discussion/Conclusion: We present a promising option in the treatment of pathological recurvatum, with favorable cost-efficacy, low morbidity relative to slope-altering osteotomy or posterolateral soft tissue procedures, and focused on the biomechanically demonstrated main restrictors to knee hyperextension. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Reconstruction of the Posterior Cruciate Ligament and Medial Collateral Ligament With a Single Combined Femoral Tunnel

Background: Lesions of the medial collateral ligament (MCL) are the most common knee ligament injuries and, when they occur in isolation, they often progress with satisfactory outcomes using conservative treatment. However, MCL lesions associated with anterior cruciate ligament or posterior cruciate ligament (PCL) injuries in knee dislocations should be reconstructed to prevent failure of the central pivot. In knees with combined injuries involving the PCL and the MCL, the confluence of tunnels in the medial femoral condyle can be a potential problem during reconstruction surgery. Indications: The indication of this technique is the combined injury of the PCL and the MCL. Technique Description: The technique consists in the reconstruction of the PCL and the MCL with an Achilles tendon allograft. The bone plug of the graft is fixed on the tibial bed with the inlay technique. The graft passes through a single femoral tunnel drilled in the medial femoral condyle, with entrance point on the footprint of the PCL on the inner wall of the condyle and exit on the origin of the native MCL, near to the medial epicondyle. The graft is fixed in the femoral tunnel with an interference screw and continues to the isometric point of the anatomic insertion of the MCL in the tibia, where an interference screw is used to fix it. Results: Results from our group using this technique have shown good clinical outcomes, with complications and failure rates similar to other series in the literature. Discussion/Conclusion: This technique is an excellent option for surgeons, when an Achilles tendon allograft is available, to avoid confluence of tunnels in the medial femoral condyle. It presents good results and acceptable complication rates, compatible with the severity of this lesion. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

All-Inside Posterior Cruciate Ligament Reconstruction Using Autologous Quadriceps Tendon–Bone Block

Posterior cruciate ligament ruptures account for nearly 20% of knee ligament lesions. These may be either isolated or occur as part of multiligament injuries. In most of the cases, conservative treatment is recommended, but when operative treatment is required, this is technically demanding. Several posterior cruciate ligament reconstructive techniques have been described, but some concerns still remain regarding graft choice, tunnels position, visualization of the posterior compartment and graft fixation. We describe an arthroscopic all-inside technique using a single-bundle autologous quadriceps tendon with patellar bone block.

The Addition of the Gracilis Tendon to a Semitendinosus Tendon Autograft Is Not Associated With Knee Muscle Strength, Subjective Knee Function, or Revision Surgery After Anterior Cruciate Ligament Reconstruction

PurposeTo evaluate and compare isokinetic knee muscle (extension and flexion) strength, single-leg-hop (SLH) test performance, anterior knee laxity, subjective knee function and the 2-year revision surgery risk between patients who underwent anterior cruciate ligament (ACL) reconstruction (ACLR) with a semitendinosus tendon autograft (ST) or a semitendinosus and gracilis tendon autograft (ST+G). MethodsPatients aged 16 years or older who underwent primary ACLR with a hamstring tendon autograft at our institution from January 2005 to December 2020, with no associated ligament injuries, were identified. Isokinetic knee muscle strength and SLH test performance were assessed 6 months postoperatively. Anterior knee laxity (KT-1000 arthrometer, 134-N) was assessed preoperatively and 6 months postoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and 1 and 2 years postoperatively. Patients who underwent revision ACLR at any institution in the country within 2 years of primary surgery were identified through the Swedish National Knee Ligament Registry. ResultsA total of 6,974 patients (5,479 ST and 1,495 ST+G) were included. There were no significant differences in extension and flexion strength or SLH test performance between the groups. Preoperatively, there was no significant difference in knee laxity between the ST and ST+G groups. Postoperatively, the ST+G group had a significantly increased mean side-to-side (STS) laxity (2.1 ± 2.3 mm vs 1.7 ± 2.2 mm; P <.001) and showed a trend towards an increased STS laxity according to the IKDC form, with significantly fewer patients with an STS laxity of ≤ 2 mm (58.4% vs 65.8%) and significantly more patients with an STS laxity of between 3 and 5 mm (35.0% vs 29.9%) or > 5 mm (6.6% vs 4.3%) (P < .001). The only significant difference in subjective knee function was for the KOOS Quality of Life score in favor of the ST group preoperatively (37.3 ± 21.4 vs 35.1 ± 19.9; P = .001). No other significant differences between the groups were found preoperatively and 1 and 2 years postoperatively for any of the KOOS subscales. The overall revision ACLR rate within 2 years of primary surgery was 2.0% (138/6,974). The revision ACLR risk for the ST+G group (1.7%; 25/1,495) was not significantly different from that of the ST group (2.1%; 113/5,479) (Hazard Ratio [HR] 0.80; 95%, CI, 0.50-1.24; P = .32). ConclusionThe addition of the gracilis tendon to an ST autograft was not associated with knee muscle strength, SLH test performance, subjective knee function or the risk of revision surgery after ACLR. Level of EvidenceLevel III, retrospective comparative study

Pattern in Simultaneous Rupture of the Medial Collateral Ligament and Anterior Cruciate Ligament Assessed by Magnetic Resonance Imaging

Background: Determining the exact details of complex traumatic injuries such as knee ligament rupture will be a crucial point in planning the surgical approach, which is determined through accurate imaging techniques such as magnetic resonance imaging (MRI). We aimed to evaluate the pattern of medial collateral ligament (MCL) rupture in patients who presented with simultaneous rupture of the anterior cruciate ligament (ACL) and MCL.&#x0D; Methods: We evaluated knee MRI in 44 patients (25 women and 19 men, mean age: 38.6 ± 5.4 years) who suffered from clinically acute simultaneous ACL and MCL injuries. Meniscus status, MCL rupture patterns, and pivot bone bruise were analyzed.&#x0D; Results: Concerning ACL rupture, 38.6% had a partial ACL rupture, and 61.4% had a complete rupture. The meniscus ruptured in 61.4%. The most common site of the meniscus rupture was related to the medial posterior horn (37.0%). The vertical type rupture was the most common (37.0%), followed by the horizontal rupture (29.6%). MCL rupture was present in all patients with grade 2 rupture revealed in 52.3%. Regarding the location of MCL ligament rupture, the highest ratio was found in the femoral site (65.9%). Semimembranosus rupture was observed in 2.3%. Pivot bone bruise was positive in 34.1%. Medial patellofemoral ligament (MPFL) rupture was also revealed in 68.2%. There was a significant relationship between the grade of rupture in the MCL and the presence of pivot bone bruise (P &lt; 0.001).&#x0D; Conclusion: Femoral detachment of MCL and posterior horn of medial meniscus (PHMM) are the most common sites of MCL injury and meniscus rupture in the context of ACL rupture. Besides, our results show a relevant influence of the extent of bone bruise on the grade of MCL rupture.

Outcome Analysis of Posterior Cruciate Ligament Injuries: A Narrative Review.

The primary posterior stabilizer of the knee is the posterior cruciate ligament (PCL), the largest intra-articular ligament in the human knee. One of the four primary ligaments of the knee joint, the PCL, serves to support the tibia on the femur. An extreme force applied anteriorly to the proximal tibia of the flexed knee results in trauma to the PCL. Dashboard injuries, which occur when the knee is driven into the dashboard after a collision with a motor vehicle, are frequent causes. Grade 1 and 2 acute injuries are often addressed conservatively due to the PCL's natural capacity for mending. If a grade 3 injury occurs, a cautious trial can be conducted on elderly or low-demand patients. When standard treatment for isolated grade 3 injuries has failed, surgery is advised. Single-bundle or double-bundle techniques using either transtibial tunnel or tibial inlay techniques are among the reconstruction approaches. Restoring the natural kinematics of the knee and forestalling persistent posterior and mixed rotatory knee laxity are the ultimate goals of treating PCL injuries through a personalized strategy. These injuries may become more common in the future as more people participate in sports. As a result of ongoing instability, discomfort, diminished function, and the emergence of inflammatory and degenerative disorders of joints, PCL rips are becoming more well-acknowledged as a cause of morbidity and decreased function.