Kujala Score Research Articles

Single Versus Double Tunnel Fixation in Medial Patellofemoral Ligament Reconstruction: A Meta-Analysis.

The purpose of this meta-analysis was to conduct a comparative analysis of clinical scores and complication rates among patients experiencing recurrent patellar dislocation who underwent medial patellofemoral ligament (MPFL) reconstruction using both single and double tunnel techniques. A comprehensive search was conducted across electronic databases including PubMed, the Cochrane Library, Web of Science, and Google Scholar to retrieve articles relevant to MPFL reconstruction utilising the tunnel technique. Subsequently, meta-analyses were undertaken to assess complication rates and changes in clinical scores before and after surgery. Following this, sensitivity analysis and meta-regression analysis were performed to scrutinise potential confounding variables. A total of thirty-two studies were included in the analysis, comprising twenty-seven non-comparative studies and five comparative studies. The findings revealed a similarity in postoperative complication rates between the single and double tunnel fixation techniques: [9.0% (95%CI, 4.0%-15.6%) versus 8.9% (95%CI, 4.7%-14.1%, p = 0.844)]. Likewise, no statistically significant differences were observed in Lysholm scores [34.1 (95%CI, 26.7-41.5) versus 33.8 (95%CI, 27.7-40.0, p = 0.956)], Kujala scores [29.4 (95%CI, 22.3-36.4) versus 27.3 (95%CI, 22.3-32.3, p = 0.637)], and Tegner score change [1.1 (95%CI, 0.8-1.4) versus 0.7 (95%CI, -0.2-1.6, p = 0.429)] before and after MPFL reconstruction, respectively, using these two techniques. In conclusion, the authors found that the clinical functional improvement and complication rates in MPFL reconstruction using the single tunnel fixation technique are comparable to those achieved with the double tunnel fixation approach. However, to further advance the understanding in this field, additional randomised controlled studies must be conducted to provide further insights. Key Words: MPFL reconstruction, Bone tunnel, Patellar dislocation, Meta-analysis.

Surgical treatment of patellar tendon rupture after total knee arthroplasty with a double-row repair method using the hamstring tendons: A novel technique with functional results.

Patellar tendon rupture (PTR) is extremely rare but serious complication after primary or revision total knee arthroplasty. Due to the serious failure rates of end-to-end repair techniques, various augmentation techniques have been described. In this study, the results of patients with PTR after reconstruction using our own technique with semitendinosus (ST) and gracilis tendons taken from the affected side were evaluated retrospectively. A total of 14 patients, whose diagnosis was made based on physical examination and clinical findings, and supported radiologically (ultrasonography), were included in the study. In these patients, reconstruction was performed using double-row repair technique with the ST and gracilis tendons. Active-passive knee joint range of motion, active knee extension loss, and the Caton-Deschamps index at preoperative and final follow-up visits were compared. Tegner-Lysholm knee score and Kujala score were used to evaluate functional results. In 14 patients (8 women and 6 men) with a mean age of 68.1 years, the median time between injury and surgery was 6.6 weeks. In all patients, the rupture was in the distal part of the patellar tendon. While the median preoperative Caton-Deschamps index was 1.8, the postoperative median value was found to be 1.25 after an average follow-up of 3.8 years (P = .014). The median preoperative knee extension loss decreased from 25° to 5° postoperatively. Tegner-Lysholm knee score and Kujala score of the patients at their last follow-up were significantly increased (P < .01). For PTR developing after total knee arthroplasty, the double-row reconstruction technique with ST and gracilis tendons is effective.

Outcomes of surgical treatment of patellar instability in children with Down syndrome

Backgroundpatellar instability is a relatively frequent musculoskeletal disorder in children with Down syndrome (DS). However, such a condition has seldom been studied in the literature, even less its surgical treatment. Different techniques have been offered for this condition; the evidence for surgical options is scarce and primarily based on case reports or case series with few patients and heterogeneous techniques. Given this background, we aimed to evaluate the outcomes of a uniform kind of surgical procedure for such a condition that combined lateral soft tissue release, medial patellofemoral ligament (MPFL) reconstruction (using a partial-thickness quadriceps tendon autograft), the Roux-Goldthwait procedure, and V-Y quadricepsplasty (if needed).Materials and methodsThis retrospective study involved 11 skeletally immature patients (12 knees; 9 males and 2 females), 5.5 to 14.1 years of age, with DS who had patellofemoral instability (PFI) and were managed by this technique between October 2018 and March 2020. Preoperative radiography, CT scan, and MRI were performed to evaluate the physis status, lower limb alignment, patellar height, trochlear morphology, and any associated knee pathology. A functional knee assessment was done by using the Kujala score and the modified Lysholm score.ResultsThe mean time of follow-up (± SD) was 47.7 ± 5.8 months (range: 39–56). Pre-operatively, the Kujala score (± SD) was 52.6 ± 14.3 (range: (31–74), and at final follow-up, it was 92.2 ± 4.4 (range: (88–98), showing a significant improvement (P < 0.001). The preoperative modified Lysholm score (± SD) was 54.3 ± 8.1 (range: 39–62), and at final follow-up it was 92.4 ± 5.3 (range: 82–96), showing a significant improvement (P < 0.001). All patients had a stable patella without a recurrence of instability and regained full ROM. There was no incidence of a patellar fracture or femoral physis injury.ConclusionsOur proposed technique of combined soft tissue procedures, including lateral soft tissue release, MPFL reconstruction (using a partial-thickness quadriceps tendon autograft), the Roux-Goldthwait procedure, and V-Y quadricepsplasty, was an effective method for treating patellar instability in children with DS while avoiding physeal injury and patellar fracture. Functional scores and radiological outcomes were improved.Level of evidenceIV; retrospective case series.

Association Between Knee Pain and Patellofemoral Syndrome (PFS) In Football Players

Background: Knee pain and patellofemoral syndrome (PFS) are common among athletes, particularly in sports requiring extensive lower limb use such as football. These conditions can significantly impair performance and quality of life. Objective: This study aimed to investigate the prevalence and severity of knee pain and patellofemoral syndrome among football players, and to explore the association between these conditions. Methods: The study was conducted with 145 football players who provided informed consent, in alignment with the Declaration of Helsinki. Data were collected using structured surveys that included the Numeric Pain Rating Scale and the Kujala Scoring questionnaire. The analysis utilized SPSS software (version 25) to conduct descriptive and inferential statistics. Qualitative data were assessed by frequencies and percentages, while quantitative data analysis involved computing means and standard deviations. The association between knee pain and PFS was examined using a Pearson Chi-Square test. Results: The average age of participants was 22.95 years (SD = 2.83), ranging from 19 to 28 years. Regarding knee pain, 8.3% reported no pain, 26.2% mild pain, 32.4% moderate pain, and 33.1% severe pain. For PFS symptoms, 10.3% of players had no symptoms, 27.6% mild, 31.7% moderate, and 30.3% severe symptoms. The Pearson Chi-Square test yielded a p-value of less than 0.05, indicating a significant association between knee pain and the presence of PFS. Conclusion: The study confirmed a significant correlation between knee pain and PFS among football players, highlighting the need for targeted preventive and therapeutic strategies in sports settings to enhance player health and performance.

Performance of medial pivot, posterior stabilized and rotating platform total knee arthroplasty based on anteroposterior stability and patient-reported outcome measures; a multicentre double-blinded randomized controlled trial of 210 knees.

Despite advancements in total knee arthroplasty (TKA), 10-20% of patients remain dissatisfied after surgery. Improved anteroposterior (AP) stability provided by medial pivot (MP) implants may theoretically lead to higher patient satisfaction. AP stability and patient-reported outcome measures (PROMs) at one-year postsurgery were compared between patients who underwent TKA with MP- (n = 121), posterior stabilized (PS; n = 53) and rotating platform (RP; n = 57) implants in a double-blind multicentre randomized controlled trial (Dutch Trial Register: NL6856, 21-02-2018). AP stability was assessed at 30°, 60° and 90° of knee flexion using a KT-2000 arthrometer. PROMs were measured preoperative and one-year postsurgery. MP-TKA provided significant better AP stability at early flexion (30°) compared to PS- and RP-TKA (median [IQR]; 1.79 [1.14-2.77] mm vs. 3.31 [2.51-4.08] mm vs. 2.82 [1.80-4.03] mm, p < 0.001). Additionally, MP-TKA provided significant better AP stability at mid-flexion (60°) compared to PS-TKA (1.75 [1.23-2.36] mm vs. 2.14 [1.49-2.83] mm, p = 0.014). PROM improvements were comparable between implant designs. AP laxity of ≥ 4mm at early flexion was independently of implant design associated with significantly worse Kujala scores. The incidence of ≥ 4mm AP laxity at any knee angle was however not significantly different between implant designs. MP-, PS- and RP-TKA all provide excellent and comparable results. Although MP-TKA provided better AP stability at early flexion compared to PS- and RP-TKA, this was found to be unrelated to improved PROMs in favour of MP-TKA. More studies focusing on early and mid-flexion performance based differences between MP and other TKA designs are required to confirm our findings. Other non-implant related factors may play a more important role in the performance of TKA and are potentially worthwhile examining.

Clinical Outcome of Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autograft versus Tibialis Tendon Allograft Allograft

Abstract: Objectives: The present study aimed to examine the clinical outcome of anterior cruciate Ligament (ACL) reconstruction using hamstring tendon autograft versus tibialis tendon Allograft. Materials/Patients and Methods: Local institutional review board approval (Code number 930971) was obtained before the commencement of the study. Thereafter, the patients who had undergone anatomical arthroscopic ACL reconstruction with hamstring tendon autograft and allograft tibialis were retrospectively reviewed. A number of 82 eligible Patients in autograft and 100 patients in the allograft group who met inclusion criteria were examined regarding knee stability by clinical examinations and KT-2000 arthrometer from 2008-2014. Results: Anterior drawer test was reported negative in 23.18% of patients in autograft and 23% of patients in the allograft group which was not statistically meaningful (P=0.870). The mean follow-up time was reported as 36.34 and 38.34 months in autograft and allograft groups, respectively. Final score of Knee Injury and Osteoarthritis Outcome Score (KOOS) in autograft and allograft groups was measured at 70.87±19.76 and 71.83%, respectively. In addition, the mean Lysholm score in autograft And allograft groups was reported to be 90±4.77 and 3.3±92, respectively. Moreover, Mean International Knee Documentation Committee (IKDC) score in the autograft and Allograft groups was estimated as 85±14.11 and 7.03±9, respectively. Furthermore, the Mean Kujala score in autograft and allograft groups was measured at 79±3.07 and 3.75±81, respectively. Conclusions: Apart from the mainstay treatment which is the surgical technique, the Use of quadrupled hamstring tendon autograft and tibialis allograft would yield dramatic Results in ACL reconstruction both subjectively and objectively. Moreover, the use of Hamstring tendon autograft and tibialis allograft is reported to have similar medical Results.

Indications of Arthroscopy in the Treatment of Patellar Instability in Children.

Purpose Understanding the relevant risk factors for patellar instability and the clinical and radiographic testsnecessary to determine optimal treatment. This case series intends to evaluate arthroscopic indications in the treatment of patellar instability in children. Methods From 2013 to 2021, 33 patients (seven to 16 years of age) with 35 knees sustaining first-time dislocation with loose bodies, recurrent dislocation or subluxation, and habitual dislocation were arthroscopically operated on according to the flow chart. Periods of follow-up were two to 10 years (avg. 5.5 years). Follow-up assessment included the recurrence, complications (joint stiffness and excessive reduction), and the final function outcomes by using the Kujala score. Results Among 35 knees, there were two (5.7%) first dislocations, 30 (85.7%) recurrent dislocations, and three (8.6%) habitual dislocations, lateral release 27/35 (77.1%), medial reefing 23/35 (65.7%), reconstruction of the medial patellofemoral ligament(MPFL) 12/35 (34.3%). The major complication was a knee of extensive stiffness after medial reefing and lateral release. Recurrence was in 4/35 (11.4%) of knees, not correlated to lateral release (p=0.21), medial reefing, or reconstruction of MPFL (p=0.07); in about 23 knees of medial reefing, recurrence was significantly correlated to number of knots (p=0.045). The final functional results according to Kujala were 88-100 (avg. 95.5). Conclusions This study showed the role of arthroscopy in both medial reefing and reconstruction of MPFL in children by low recurrence rate and high Kujala score at final follow-up. There was no significant correlation between recurrence and the procedures as arthroscopic indications counted on the flow chart.

Autologous matrix-induced chondrogenesis versus osteochondral autograft transfer system in patellar chondral lesions: a comparative study with a 2-year follow-up

IntroductionFocal patellofemoral chondral lesions are clinically challenging, with unfavorable surgical results in the medium- and long-term; Although there is no golden standard technique to treat patellofemoral lesions, several patellar cartilage repair procedures are used with variable postoperative results. ObjectivesTo compare functional outcomes between patients who had undergone surgical treatment with osteochondral autograft transfer system (OATS) or autologous matrix-induced chondrogenesis (AMIC) for patellar chondral lesions preoperatively and after a 2-year follow-up. MethodsForty-six patients who underwent AMIC (n = 12) or OATS (n = 34), participated in this retrospective study. Outcome measures, including the Lysholm, Kujala, Fulkerson, and Tegner scores, were collected before surgery and 2 years after surgery. ResultsSex, age, laterality, or location of the patellar lesion were not significantly different between groups. The mean lesion size was greater in the AMIC group (2.18 cm2) than in the OATS group (1.13 cm2) (P < .001). There was no difference between groups in Lysholm, Fulkerson, and Kujala scores preoperatively, although the OATS group showed a more favorable Tegner score compared to the AMIC group (6.59 vs 3.45, P < .001). Postoperatively, the AMIC group had a higher mean Lysholm score than the OATS group, (88.3 vs 79.5, P = .025). Mean values of almost all clinical tests significantly increased at the end of the 2-year follow-up, in both groups, except for the Tegner score in the OATS group, which showed a mean reduction from 6.59 preoperatively to 5.47 postoperatively (P = .006). ConclusionOATS and AMIC are effective treatments for patellar chondral lesions, with sustainable results after a minimum follow-up period of 2 years. Patients who underwent AMIC had better clinical and functional outcomes than patients who underwent OATS for patellar chondral lesions during the follow-up period.

Inferior patellar mobility before and after knee arthroplasty: A comparison with healthy knees.

The aim of this study was to evaluate patellar mobility in patients before and after knee arthroplasty (KA) and compare it with that of healthy subjects. It was hypothesisedthat patellar mobility is diminished in patients with osteoarthritis (OA) and remains unchanged after KA. A total of 101 patients (59 females and 42 males) with a mean age of 70.9 ± 9.9 years underwent KA and were compared with 25 healthy individuals (seven females and 18 males) with a mean age of 32.3 ± 9.3 years. Mediolateral patellar displacement was measured by applying a force of 10 N, and the medial and lateral patellar shifts were recorded separately using a validated novel patellostabilometer. Patients were examined preoperatively and at 3 months postoperatively, assessing the range of knee motion and the clinical and functional status based on the Oxford Knee Score (OKS), Kujala Score, subjective Knee Society Score (sKSS), Forgotten Joint Score (FJS)and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Total patellar displacement was 42.1 ± 6 mm for healthy subjects, 31 ± 6 mm before surgeryand 32.8 ± 7.8 mm after surgery in osteoarthritic patients (p < 0.01). The mean lateral patellar shift differed significantly between healthy individuals (17.9 ± 4 mm) and osteoarthritic patients (15.1 ± 6 mm) (p < 0.01). The mean medial patellar mobility of healthy individuals (24.2 ± 7 mm) was significantly greater than that of osteoarthritic patients (15.8 ± 4.8 mm) (p < 0.01). All scores improved significantly postoperatively. No correlation was found between patellar mobility and OKS, Kujala Score, sKSS, FJSand WOMAC (r = -0.11). Improvement in patellar mobility also showed no correlation with clinical outcomes according to OKS, Kujala Score, sKSS, FJSand WOMAC (r = 0.08). This study has demonstrated reduced patellar mobility in patients with OA. While patellar mobility significantly improved after KA, it may not hold clinical significance (p = 0.04). No impact on clinical outcome can be expected when the presurgical patella mobility is preserved in KA. Level IV.

Evaluation of the Results of Reconstruction of Medial Patellofemoral Ligament in the Treatment of Recurrent Patellar Instability Using Hamstring Autograft by Dual Patella Docking Technique

Abstract Background: Recurrent patellar instability can significantly affect a patient’s life quality. This study evaluated the results of medial patellofemoral ligament (MPFL) reconstruction in the recurrent patellar instability treatment using hamstring autograft by dual patellar docking technique. Materials and Methods: This prospective study was performed on 20 recurrent patellar instability patients. Magnetic resonance imaging and computed tomography scans were performed to confirm MPFL tear and assess the tibial tubercle-trochlear groove distance. Various clinical and radiographic evaluations were performed preoperatively. The surgical technique involved diagnostic arthroscopy, graft preparation, patellar preparation, graft passage, femoral tunnel preparation, and graft fixation. Results: Postoperatively, a substantial progression was observed in the International Knee Documentation Committee score, Kujala score, Cincinnati score, and Lysholm score compared to preoperative values (P &lt; 0.001). In addition, the postoperative measurements of patellar tilt angle and patellar congruence angle were significantly lower than their respective preoperative values (P &lt; 0.001). All 20 (100%) patients had negative findings in the postapprehension test, indicating improved stability. In the postcompression test, 3 (15%) patients showed positive results, whereas 17 (85%) patients had negative results. In terms of complications, 2 (10%) patients experienced patellofemoral pain, 1 (5%) patient had residual patellar translation without dislocation, 1 (5%) patient had limited flexion, and the majority of patients (16, 80%) had no complications. Conclusions: MPFL reconstruction with patellar docking yielded good results with Kujala and Lysholm, as well as adequate, satisfactory congruence angles for most patients. This procedure has exhibited a high success rate in addressing patellofemoral instability.

No significant difference in thick versus thin osteochondral flap trochleoplasty in the treatment of trochlear dysplasia: A systematic review.

Trochleoplasty has become increasingly utilised to address patellar instability in the setting of severe trochlear dysplasia. There remains a paucity of literature on the outcomes of 'thick'- versus 'thin'-osteochondral flap trochleoplasty. The purpose of this study is to compare clinical and radiographic outcomes between patients with patellar instability with symptomatic trochlear dysplasia treated using a 'thick' versus 'thin' osteochondral flap trochleoplasty. A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using a PRISMA checklist. Quality assessment of final articles was conducted by two blinded reviewers. Articles were separated based on the use of a 'thick' versus 'thin' flap trochleoplasty. Data collection consisted of recording the following variables: patient demographics, indications for trochleoplasty, mean follow-up time, additional procedures performed during trochleoplasty, patient-reported outcome measures (PROMs), radiographic outcomes (tibial tubercle-trochlear groove [TT-TG] distance, Caton-Deschamps Index [CDI] and sulcus angle [SA])and the incidence of any postoperative complications and patellar redislocation rates. A total of 24 studies, consisting of 927 patients, were identified as meeting inclusion criteria. A total of five papers described a 'thick' flap technique, while 19 papers described the use of a 'thin' flap technique. No significant difference in the mean improvement of Kujala scores was appreciated when comparing 'thick' versus 'thin' techniques (p > 0.05). Improvements in mean radiographic outcomes based on TT-TG, CDI and SA were observed in both 'thick' and 'thin' flap trochleoplasty groups. The overall redislocation rate was 0.35%. No significant difference in Kujala scores was observedin patients undergoing trochleoplasty utilising 'thick' versus 'thin' technique, while improvements in mean TT-TG, CDIand SA were noted in both technique groups, with an overall redislocation rate of 0.35%. Level IV.

Medial quadriceps tendon femoral ligament reconstruction and medial patellofemoral ligament reconstruction have no significant differences in clinical outcomes for treatment of lateral patellar instability: a matched-cohort study

ObjectivesThe purpose of this study was to compare clinical outcomes of medial quadriceps tendon-femoral ligament reconstruction (MQTFLR) and medial patellofemoral ligament reconstruction (MPFLR) among patients with recurrent lateral patellar instability. MethodsA retrospective matched-cohort study was conducted involving patients who underwent MQTFLR or MPFLR with or without tibial tubercle osteotomy (TTO) from 2019 to 2021. Subjects were matched 1:1 on age, concomitant osteochondral allograft (OCA), concomitant TTO, and follow-up time. Measured outcomes included 90-day complications, Visual Analog Scale (VAS) knee pain, return to sport/work, Kujala score, Tegner score, and MPFL-Return to Sport after Injury (MPFL-RSI) score. Outcomes were compared between groups using Mann–Whitney U-test for continuous variables and Fisher's exact test for categorical variables. P-values <0.05 were considered significant. ResultsTen MQTFLR patients (mean age 28.7 years, 80% female, mean follow-up 19.7 months) and ten MPFLR patients (mean age 29.1 years, 90% female, mean follow-up 28.3 months) were included in the study. One MQTFLR patient (10%) and three MPFLR patients (30%) underwent reoperation for postoperative arthrofibrosis. Postoperative VAS resting pain was not significantly different between the groups (MQTFLR mean 1.1, MPFLR mean 0.6, p ​= ​0.31). There were no significant differences in rates of recurrent subluxations (MQTFLR 20%, MPFLR 0%, p ​= ​0.47), return to sport (MQTFLR 50%, MPFLR 75%, p ​= ​0.61), return to work (MQTFLR 100%, MPFLR 88%, p ​= ​1.00), or MPFL-RSI pass rate (MQTFLR 75% vs. MPFLR 38%, p ​= ​0.31). ConclusionThere were no significant differences in knee pain and function, return to work, and rates of recurrent patellar instability between patients who underwent MQTFLR versus MPFLR, though these results should be interpreted with caution given the small sample size and potential selection bias. Level of EvidenceIII.

Anterior knee pain patients without structural knee abnormalities and normal lower limb skeletal alignment have a higher prevalence of cam-femoroacetabular impingement syndrome than the general population

ObjectivesThis study aimed to ascertain the prevalence of cam femoroacetabular impingement syndrome (cam-FAIS) in anterior knee pain (AKP) patients devoid of both structural patellofemoral joint abnormalities and lower limb skeletal malalignment. A secondary objective was to examine pain and disability differences between AKP patients with and without cam-FAIS. MethodsA total of 209 AKP patients were screened for eligibility. Inclusion criteria were normal imaging studies and normal lower limb alignment, and exclusion criteria were previous knee surgery and knee and/or hip osteoarthritis. Of those, 49 (23.4%) were eligible and this number matched a previous power analysis to detect statistically significant differences in prevalence of cam-FAIS in a population of AKP patients. The first step in the study sequence was to ask the patient whether they had groin pain. If so, the impingement test was done. Then, the femoral cam morphology defined by an alpha angle greater than or equal to 55° in a 45° Dunn axial view of the hip was ruled out. Additionally, patients completed Kujala and International Knee Documentation Committee (IKDC) functional knee scores for disability assessment. General population control group was obtained from literature. ResultsThe study included 9 males and 40 females, with an average age of 36 (20–50, ±SD 8.03) years. Groin pain and positive impingement test were found in 26/49 patients (53%). An alpha angle ≥55° was observed in 35/49 patients (71%). A combination of groin pain, positive impingement test and an alpha angle ≥55° was seen in 18/49 patients (37%). The AKP patients with groin pain, a positive impingement test and an alpha angle ≥55° exhibited statistically similar pain and disability levels as AKP patients without cam-FAIS. ConclusionThe results of this study suggest that AKP patients without structural abnormalities in the patellofemoral joint and without lower limbs malalignment have a statistically significantly higher prevalence of cam-FAIS than the general population. Moreover, AKP patients with cam-FAIS have a statistically similar degree of pain and disability than AKP patients without it. Study designCross-sectional study. Level of EvidenceIV.

Ultrasound-guided electrocoagulation of neovascularisation for persistent patellar tendinopathy in athletes: a cohort study of 25 patients with a mean follow-up of 5 years from the SANTI Study Group

BackgroundPatellar tendinopathy (PT) is a common condition characterised by persistent patellar tendon pain and dysfunction, particularly in athletes. Neovascularisation is frequently observed in the PT and is associated with increased...

Clinical and Radiological Outcomes After Combined ACL and MPFL Reconstruction Versus Isolated ACL Reconstruction for ACL Injury With Patellar Instability

Background: An anterior cruciate ligament (ACL) injury accompanied by patellar instability (PI) is a topic that has gained orthopaedic surgeons’ attention recently. Untreated PI is reportedly associated with worse clinical outcomes after isolated ACL reconstruction (ACLR) in patients after an ACL injury with PI. Nevertheless, the appropriate surgical approach and its long-term therapeutic effects in these patients remain unclear. Purpose: (1) To compare the clinical and radiological outcomes between isolated ACLR (iACLR) and combined ACLR and medial patellofemoral ligament reconstruction (cAMR) in patients after an ACL injury with PI and (2) to explore the correlations between these 2 procedures and clinical and radiological outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 106 patients diagnosed with an ACL injury accompanied by PI between January 2016 and April 2021 were analyzed in this study. There were 34 patients excluded because of missing postoperative radiological data. Among the remaining 72 patients, 34 patients underwent iACLR, while 38 patients underwent cAMR. Demographic characteristics, intraoperative findings, and patient-reported outcomes (Lysholm score, subjective International Knee Documentation Committee score, and Tegner activity score) were prospectively collected. Patellar alignment parameters and worsening patellofemoral osteoarthritis (PFOA) features (evaluated with the modified Whole-Organ Magnetic Resonance Imaging Score) were analyzed longitudinally on magnetic resonance imaging. The Kujala score was used to evaluate the functional recovery of the patellofemoral joint, and redislocations of the patella were prospectively recorded. Finally, multivariate logistic regression analysis was used to explore the correlations between these 2 procedures and clinical (not achieving the minimal detectable change [MDC] for the Lysholm score) and radiological (worsening PFOA features) outcomes. Results: The mean follow-up duration was 28.9 ± 6.2 and 27.1 ± 6.8 months for the iACLR and cAMR groups, respectively (P = .231). Significantly higher Lysholm scores (88.3 ± 9.9 vs 82.1 ± 11.1, respectively; P = .016) and subjective International Knee Documentation Committee scores (83.6 ± 11.9 vs 78.3 ± 10.2, respectively; P = .046) were detected in the cAMR group compared with the iACLR group postoperatively. The rates of return to preinjury sports were 20.6% and 44.7% in the iACLR and cAMR groups, respectively (difference, 24.1% [95% CI, 3.3%-45.0%]; P = .030). Moreover, the rates of worsening PFOA features were 44.1% and 18.4% in the iACLR and cAMR groups, respectively (difference, 25.7% [95% CI, 4.9%-46.4%]; P = .018). In addition, significantly higher Kujala scores (87.9 ± 11.3 vs 80.1 ± 12.0, respectively; P = .006), lower redislocation rates (0.0% vs 11.8%, respectively; difference, 11.8% [95% CI, 0.9%-22.6%]; P = .045), and significantly better patellar alignment were detected in the cAMR group compared with the iACLR group postoperatively. Furthermore, multivariate logistic regression analysis determined that iACLR and partial lateral meniscectomy were significantly correlated with not achieving the MDC for the Lysholm score and worsening PFOA features in our study population. Conclusion: In patients after an ACL injury with PI, cAMR yielded better clinical and radiological outcomes compared with iACLR, with better patellar stability and a lower proportion of worsening PFOA features. Furthermore, not achieving the MDC for the Lysholm score and worsening PFOA features were significantly correlated with iACLR and partial lateral meniscectomy. Our study suggests that cAMR may be a more appropriate procedure for patients after an ACL injury with PI, which warrants further high-level clinical evidence.

A Suprapatellar approach, when compared to an Infrapatellar approach, yields less Anterior Knee Pain and better patellofemoral joint Function, for intramedullary nailing of diaphyseal tibial fractures. Results of a Randomised Controlled Trial.

To assess if a suprapatellar (SP) approach, when compared to an infrapatellar (IP) approach, yielded less patient reported anterior knee pain and higher patellofemoral joint function at 6 weeks and 12 months post operatively, when treating tibial fractures with intramedullary nailing. Prospective, parallel group randomized control trial. Tertiary level one trauma care centre, Brisbane, Australia. Skeletally mature patients with an acute diaphyseal tibial fracture (AO/OTA 41A2/3, 42 A1- 43A3) amenable to an IMN were included. Exclusion criteria were peri-prosthetic fractures, nonunions, and presence of a contralateral injury that would restrict weightbearing. Anterior knee pain, through the visual analogue scale (VAS) and patellofemoral function using the Kujala scale at 6-weeks and 12-months were compared between those treated with a SP and IP approach. 95 tibia fractures were included in the randomized trial, with complete follow-up data for 44 and 46 tibia fractures in the SP and IP groups, respectively. The SP cohort exhibited better patella-femoral knee function at both 6 weeks post operatively (Kajula 53.0 for SP vs 43.2 for IP, p<0.01)) and 12 months (Kujala 92.0 for SP vs 81.3 for IP (p<0.01)), and a reduction in anterior knee pain at 12-months post-operatively (VAS 0.7 SP vs 2.9 IP, p<0.01). This randomized trial demonstrated clinically meaningful differences in patellofemoral function, for a suprapatellar versus infrapatellar approach, with a greater than 10 point discrepancy in Kujala score at both 6 weeks and 12 months. Additionally, there was a clinically important difference in VAS knee pain scores for patients at 12 months, but not at 6 weeks, post operatively. These results contribute to the growing body of evidence demonstrating the functional and clinical benefits of the suprapatellar approach.

Less risk of patellofemoral degeneration without significant clinical and survivorship difference for distal tibial tuberosity high tibial osteotomy compared to biplanar high tibial osteotomy over a mid-term follow-up.

This study aims to compare the mid-term radiographic, clinical results and survivorship between distal tibial tuberosity high tibial osteotomy (DTT-HTO) and conventional biplanar medial open-wedge high tibial osteotomy (cOW-HTO). The weight-bearing line ratio (WBL%) and medial proximal tibial angle (MPTA) were evaluated using a standing anteroposterior view of lower extremity. The posterior tibial slope (PTS), Caton-Deschamps index (CDI), tilting angle (TT) and lateral shift ratio (LSR) were evaluated using the lateral views and Merchant views. The Knee Society (KS) knee and function score, Lysholm score, and Anterior Knee Pain Scale (Kujala score) were were used to evaluate the functional outcomes. All parameters were evaluated preoperatively and at the final follow-up. The postoperative complications and survivorship for both groups were also evaluated during the follow-up period. The WBL% and MPTA exhibited no significant differences between the two groups preoperatively and at the final follow-up. The postoperative CDI and TT in the cOW group decreased significantly compared with the DTT group (p = .037 and .041, respectively). The PF grade showed a significant increase after DTT-HTO and cOW-HTO (p = .036 and <0.001, respectively). Furthermore, the postoperative PF grade of cOW group was significantly higher than that of DTT group (p = .039). The KS knee and function score, Lysholm score, and Kujala score for both groups improved similarly at the final follow-up. The survivorship free of revision was 92.7 % in the DTT group and 94.2% in the OW group. Despite observing a lower risk of PF joint progression in DTT-HTO compared to cOW-HTO, the clinical outcomes and survivorship after DTT-HTO and cOWHTO were comparable over a mid-term follow-up.

Relationship between Anterior Cruciate Ligament Injury and Flat-Foot among Volleyball Players of Lahore, Pakistan

Background: A person with flat feet experiences a decrease in their medial arch when they bear weight. Players of volleyball are more vulnerable to ACL problems. Playing volley-ball increases the risk of ACL damage because of the repeated jumping and falling on the ground. Aim: To find relationship between anterior cruciate ligament injury and flat-feet among volleyball players of Lahore, Pakistan Methodology: This cross-sectional study included volley-ball players and was conducted on 158players. Participants were selected by non-probability sampling. Their age was in range between20 to30 years and only males were included. For collection of data KUJALA score (anterior knee pain scale) was used to assess anterior cruciate ligament injury and Clarke’s angle was used to measure flat-foot. Data was collected from training academies in Lahore. Written consent was taken from the participants and the significance of the study were explained before filling the questionnaires. Results: In present study the mean age was 23.14. The mean of KUJALA score and Clarke’s angle for right knee and flat foot was 77.78 and 9.57 respectively. The mean of KUJALA score and Clarke’s angle for left knee and flat foot was 71.90 and 9.09 respectively. The Pearson’s correlation showed negative correlation between KUJALA score and Clarke’s angle. Practical Implications: This research will be very beneficial to society it will help to make a correct and beneficial rehabilitation plan for flat foot patients having ligamentous injury. It will also help athletes to decrease pain management for patients having ACL injury in flat foot patients. Conclusion: The present study concluded that there is negative correlation between anterior cruciate ligament injury and flat foot which means reduction in medial longitudinal arch can increase knee pain followed by anterior cruciate ligament injury. Keywords: Anterior cruciate ligament, Athletes, Flat foot, Volleyball players

Combination of tibial tubercle transfer, medial patellofemoral ligament reconstruction, trochleoplasty and lateral release for patellofemoral instability provides good middle- to long-term outcomes in adolescents.

There are limited studies that have reported the middle- to long-term outcomes of combined procedures consisting of more than two procedures for patellofemoral instability. The current study aims to investigate and report the middle- to long-term outcomes of a combination procedure of tibial tubercle transfer, medial patellofemoral ligament reconstruction, trochleoplasty and lateral release for patellofemoral instability in patients aged 18 years and below. In the cohort study, all patients aged 18 years old or younger who underwent a combination procedure of tibial tubercle transfer, medial patellofemoral ligament reconstruction, trochleoplasty and lateral release for recurrent patellofemoral instability were included. A total of 21 patients were included in the study. All patients had no further patellofemoral dislocation, pain and apprehension following the 4-in-1 surgery (p < 0.01). There was a significant improvement in the Kujala score from 36.1 (SD 12.9) pre-operatively to 93.1 (SD 3.6) post-operatively (p < 0.001). The patients also had a statistically significant improvement in their radiological factors, including the patellar tilt angle (p < 0.001), sulcus angle (p = 0.001), trochlear groove depth (p = 0.041), tibial tubercle-trochlear groove distance (p < 0.001) and Caton-Deschamps index (p = 0.001). A combination procedure of tibial tubercle transfer, medial patellofemoral ligament reconstruction, trochleoplasty and lateral release leads to good middle- to long-term subjective, functional and radiographic outcomes for patients with recurrent patellofemoral instability and underlying predisposing factors of increased TT-TG distance of more than 20mm, Dejour B or D trochlear dysplasia and medial patellofemoral ligament rupture. IV.

Çocuklarda Patellar Dislokasyon Sonrası Osteokondral Kırık Fiksasyonu ile Eşzamanlı Medial Patellofemoral Ligament Rekonstrüksiyonunun Sonuçları.

ABSTRACT&#x0D; AIM&#x0D; The aim of this study was to evaluate the outcomes of the patients who underwent OCF fixation and simultaneous MPFL reconstruction after patellar dislocation in children.&#x0D; MATERIAL AND METHOD&#x0D; A total of 12 patients who underwent OCF fixation and simultaneous MPFL reconstruction between 2018 and 2021 were retrospectively evaluated. Demographic information, surgical specifics, and clinical follow-up data were gathered. Postoperative clinical assessments were conducted utilizing Kujala and Lysholm scores.&#x0D; RESULTS&#x0D; The mean age at surgery was 10.4 years (range, 7-15 years). The mean period of follow-up was 36.5 months(range, 24-58). One (8%) patient required a second surgery on the ipsilateral knee. The mean surface area of the fragments was 2.5 cm² (SD: 1.4). Preoperatively, the Kujala score and the Lysholm score were 38.2 (SD: 13.3) and 44.1 (SD: 10.4), respectively. These scores exhibited significant improvement postoperatively, reaching 87.6 (SD: 11) and 88.2 (SD: 10.3) at the latest follow-up. Radiological examinations, including X-ray and MRI, indicated favorable healing of the OCFs.&#x0D; CONCLUSION&#x0D; Osteochondral fracture fixation in children with patellofemoral instability can be effectively managed through fixation combined with simultaneous medial patellofemoral ligament reconstruction. The mid-term results have demonstrated satisfactory outcomes.