Ligament Reconstruction In Athletes Research Articles

Arthroscopic Posterior Capsular Release Improves Range of Motion and Outcomes for Flexion Contracture After Anterior Cruciate Ligament Reconstruction in Athletes

To assess outcomes of arthroscopic posterior capsular release among athletes for loss of terminal extension following anterior cruciate ligament (ACL) reconstruction. A retrospective review of prospectively collected data was performed for patients undergoing arthroscopic posterior capsular release for knee extension loss following ACL reconstruction between January 2014 and December 2019. Procedure indications included extension loss greater than 10° at least 3 months after ACL reconstruction that was refractory to physical therapy. Patients were included if they were involved in either high school or college athletics, had complete outcomes of interest, and had at least 2 years of follow-up. Prospectively collected outcomes included preoperative and postoperative measurement of knee extension, International Knee Documentation Committee score, Lysholm score, return to sport data, and complications. Eighteen athletes with minimum 2 years of follow-up who underwent posterior capsular release following ACL reconstruction performed by a single surgeon were included in the analysis. Patients underwent surgery at an average of 16 weeks after ACL reconstruction. Knee extension improved an average of 13.8° at 2 years' follow-up (prerelease mean extension deficit 15.1°, postrelease mean extension deficit 1.3°, P < .005). Improvements in the International Knee Documentation Committee score averaged 21.7 at 6 months and 35.0 at 24 months, both of which were statistically significant (P < .001). Similarly, differences in Lysholm included a significant improvement of 23.0 and 34.2 at 6 months and 2 years, respectively (P < .001). In total, 77.8% returned to sport at an average of 9.8 months from their primary ACL surgery and 6.5 months following posterior capsular release surgery. No infections or neurovascular complications were observed. One patient required secondary release to achieve adequate extension. For athletes with persistent knee extension loss after ACL reconstruction, knee extension was significantly improved at 2 years following arthroscopic posterior capsular release. Substantial improvements in patient-reported outcomes also were seen. In addition, subjects demonstrated a high rate of return to sport and return to preinjury performance levels. Level IV, therapeutic case series.

Rectus femoris and vastus intermedius thickness measurement by ultrasound before and after anterior cruciate ligament reconstruction in athletes

BackgroundMost anterior cruciate ligament (ACL) injuries which are common in violent sports require anterior cruciate ligament reconstruction (ACLR) to restore knee joint stabilization. Rectus femoris (RF) and vastus intermedius (VI) weakness are among the notable changes after ACLR. This weakness can be hazardous to the patient as it could decrease functional activity and thus increases the chances of re-injury. The objectives of the current study were to measure the (RF) thickness, (VI) thickness and the total (RF + VI) thickness on (ACL) reconstructed limb and the non-reconstructed limb of athletes using ultrasound and to compare the results pre-operatively and 6–8 months post-operative.ResultsThe reconstructed limb showed a significant decrease in (RF), (VI) and the total thickness in the 1st, 2nd and 3rd measurements compared to that of non- reconstructed limb post-operatively. In both limbs, the decrease of (VI) thickness was significantly higher than (RF) thickness in the 1st, 2nd and 3rd measurements (p < 0.001, p < 0.001 and p < 0.001 respectively).ConclusionsUltrasound can be used to assess quadriceps atrophy (including the individual muscles) found after ACLR. Ultrasound is an affordable and easily available modality as compared to MRI and CT scans for the assessment of RF and VI muscle weakness in athletes with ACLR during the rehabilitation period and can guide selective rehabilitation protocols if wasting is identified early.

Assessment of functional prognosis of anterior cruciate ligament reconstruction in athletes based on a body shape index.

A healthy body shape is essential to maintain athletes' sports level. At present, little is known about the effect of athletes' body shape on anterior cruciate ligament reconstruction (ACLR). Moreover, the relationship between body shape and variables such as knee joint function after operation and return to the field has not been well studied. To verify the relationship between a body shape index (ABSI) and the functional prognosis of the knee after ACLR in athletes with ACL injuries. We reviewed 76 athletes with unilateral ACL ruptures who underwent ACLR surgery in the First Hospital of Shanxi Medical University between 2017 and 2020, with a follow-up period of more than 24 mo. First, all populations were divided into a High-ABSI group (ABSI > 0.835, n = 38) and a Low-ABSI group (ABSI < 0.835, n = 38) based on the arithmetic median (0.835) of ABSI values. The primary exposure factor was ABSI, and the outcome indicators were knee function scores as well as postoperative complications. The correlation between ABSI and postoperative knee function scores and postoperative complications after ACLR were analyzed using multifactorial logistic regression. The preoperative knee function scores of the two groups were similar. The surgery and postoperative rehabilitation exercises, range of motion (ROM) compliance rate, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score of the two groups gradually increased, whereas the quadriceps atrophy index gradually decreased. The knee function scores were higher in the Low-ABSI group than in the High-ABSI group at the 24-mo postoperative follow-up (P < 0.05). In multifactorial logistic regression, ABSI was a risk factor of low knee joint function score after surgery, specifically low ROM scores (odds ratio [OR] = 1.31, 95% confidence interval [CI] [1.10-1.44]; P < 0.001), low quadriceps atrophy index (OR = 1.11, 95%CI [0.97-1.29]; P < 0.05), low Lysholm scores (OR = 2.34, 95%CI [1.78-2.94]; P < 0.001), low symptoms (OR = 1.14, 95%CI [1.02-1.34]; P < 0.05), low activity of daily living (OR = 1.34, 95%CI [1.18-1.65]; P < 0.05), low sports (OR = 2.47, 95%CI [1.78-2.84]; P < 0.001), and low quality of life (OR = 3.34, 95%CI [2.88-3.94]; P < 0.001). ABSI was also a risk factor for deep vein thrombosis of the lower limb (OR = 2.14, 95%CI [1.88-2.36], P < 0.05] and ACL recurrent rupture (OR = 1.24, 95%CI [0.98-1.44], P < 0.05) after ACLR. ABSI is a risk factor for the poor prognosis of knee function in ACL athletes after ACLR, and the risk of poor knee function after ACLR, deep vein thrombosis of lower limb, and ACL recurrent rupture gradually increases with the rise of ABSI.

Knee valgus and patellofemoral instability after pediatric anterior cruciate ligament reconstruction: a case report and review of the literature

BackgroundPediatric athletes who undergo anterior cruciate ligament reconstruction are at risk for a growth deformity if the surgery violates the physes.CaseA 12-year-old African American boy underwent anterior cruciate ligament reconstruction using a hamstring autograft. The procedure violated the distal femoral growth plate and the perichondrial ring of LaCroix, resulting in a distal femoral lateral physeal growth arrest. Three years later, he had developed a 15° valgus deformity, an increased quadriceps angle and patellofemoral instability. He was able to return to sports after undergoing a distal femoral osteotomy to correct the valgus and medial patellofemoral ligament reconstruction to stabilize the patella.ConclusionAnterior cruciate ligament reconstruction in athletes with open physes has the potential to cause distal femoral valgus deformity, an increased quadriceps angle, and subsequent patellofemoral instability.

Morphometric MRI Evaluation of Three Autografts Used in Anterior Cruciate Ligament Reconstruction in Athletes

The purpose of the present study was to quantify the morphometric characteristics of three tendon autografts (hamstring tendons (HT), quadriceps tendon (QT), and patellar tendon (PT)) used in anterior cruciate ligament (ACL) reconstruction. For this purpose, knee magnetic resonance imaging (MRI) was obtained in 100 consecutive patients (50 males and 50 females) with an acute, isolated ACL tear without any other knee pathology were used. The level of the physical activity of the participants was determined using the Tegner scale. Measurements of the tendons' dimensions (PT and QT tendon length, perimeter, cross-sectional area (CSA), and maximum mediolateral and anteroposterior dimensions) were performed perpendicular to their long axes. Higher values were recorded as regards the mean perimeter and CSA of the QT in comparison with the PT and the HT (perimeter QT: 96.52 ± 30.43 mm vs. PT: 63.87 ± 8.45 mm, HT: 28.01 ± 3.73 mm, F = 404.629, p < 0.001; CSA QT: 231.88 ± 92.82 mm2 vs. PT: 108.35 ± 28.98 mm2, HT: 26.42 ± 7.15 mm2, F = 342.415, p < 0.001). The length of the PT was shorter in comparison with the QT (53.1 ± 7.8 vs. 71.7 ± 8.6 mm, respectively, t = -11.243, p < 0.001). The three tendons showed significant differences in relation to sex, tendon type, and position as regards the perimeter, CSA, and the mediolateral dimensions but not for the maximum anteroposterior dimension.

All-Soft Tissue Quadriceps Tendon Autograft in Revision Anterior Cruciate Ligament Reconstruction in Athletes: Comparison to Bone-Patellar Tendon-Bone Autograft With at Least a 2-Year Follow-up

Background: Revision anterior cruciate ligament (ACL) reconstruction is being performed at an increasing rate. Previous literature has suggested that autograft ACL reconstruction is a better option than allograft in revision surgery, although the optimal autograft choice remains unknown. The all–soft tissue quadriceps tendon (ASTQT) autograft has been found to be an effective option for primary ACL reconstruction. However, few studies have evaluated ASTQT autograft in revision ACL reconstruction. Purpose/Hypothesis: The purpose of this study was to evaluate the ASTQT autograft in revision ACL reconstruction in athletes compared with bone–patellar tendon–bone (BTB) autograft. We hypothesized that the ASTQT autograft would lead to similar return to play, time to return to play, retear rate, and patient-reported outcomes compared with BTB autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was performed on all athletes undergoing revision ACL reconstruction between August 2013 and December 2019 at a single institution. Patients participating in high school or college athletics undergoing first-time revision with either ASTQT or BTB autograft with ≥2 years of follow-up were included. Demographic variables, complications, return to sports, and outcome scores including the International Knee Documentation Committee (IKDC) and Lysholm were collected and compared between the 2 cohorts. Results: A total of 58 revision ACL reconstructions were included, with 32 in the ASTQT cohort and 26 in the BTB cohort. Return to sports at the same level occurred in 62.5% of the ASTQT group and 53.8% of the BTB group. The ASTQT group returned to sports significantly faster than the BTB group (8.9 vs 10.3 months; P = .020). There was no difference in retear rates (3.1%, ASTQT; 7.7%, BTB) or other complications between the 2 groups. The IKDC scores were significantly higher at the 6- and 12-month follow-up for the ASTQT autograft group compared with the BTB group (6 months: ASTQT, 71.3; BTB, 61.7, P = .001; 12 months: ASTQT, 82.7; BTB, 78.6; P = .021). Lysholm scores were also greater in the ASTQT cohort at these time points (6 months: ASTQT, 75.1; BTB, 63.6; P < .001; 12 months: ASTQT, 82.0; BTB, 74.5; P < .001). However, IKDC and Lysholm scores were similar between both groups at final follow-up (IKDC: ASTQT, 82.9; BTB, 81.7; P = .344; Lysholm: ASTQT, 83.0; BTB, 81.0; P = .104) There was no significant clinical difference in the absolute difference in scores or rate of achieving clinical thresholds between the 2 cohorts. Conclusion: ASTQT autograft for revision ACL in athletes has similar outcomes compared with BTB autograft. However, the ASTQT may possibly afford quicker return to sports and better early improvements in patient-reported outcomes that normalize by 1 year. The soft tissue quadriceps autograft should be considered a viable graft option in revision ACL reconstruction in athletes.

Validity and reproducibility of the PPLP score in the follow-up of anterior cruciate ligament reconstruction in athletes

Objectives:In a context where psychological scores appear to have an increasing influence on the resumption of sports, it would also appear to be essential to evaluate the relevance of global scores with multiple criteria. The PPLP score (Psychological Physical Ligament Predictive score) enables an analysis of subjective, clinical and isokinetic muscle assessment items.Methods:We prospectively followed anterior cruciate ligament (ACL) reconstructions in several series for which we analyzed the validity of the score (763 patients), the reproducibility, the sensitivity to change, the relevance in the follow-up of ligamentoplasty (3,296 ligamentoplasties followed postoperatively) as well as the predictive nature in the resumption of sports (258 patients). The PPLP score has two parts: one (PPLP1) based on 100 points for postoperative follow-up and the other also based on 100 points (PPLP2) which is added to the first score for follow-up at a certain period of time after surgery to determine a new score of 200 points. We also tried to identify correlations with other scores in the literature (OAK, Lysholm, Tegner, KOOS, Arpeggio, IKDC Subjective and the Psychovitality Test).Results:We demonstrated the distinction of the items (r coefficient of 0.20) for construct validity. Intra-examiner and extra-examiner reproducibility was excellent, ranging from 0.92 to 1. The PPLP score changed in a statistically significant way during hospitalization and according to the operating lead time with phases of higher variation. Complicated clinical changes manifested in a low score, in particular neuro-algodystrophies (1.9%) with a mean PPLP1 of 80.33 while changes without complications (80.8%) had a mean score of 94.28 with a significant difference (p < 0.0001). The PPLP2 score correlated significantly with the resumption of competition (p = 0.012). A high score was associated with faster recovery. The optimal cut-off score was 176 (sensitivity 79.7% and specificity 49.3%). The results of the PPLP score were correlated with the other scores.Conclusion:The PPLP score was validated in terms of construction, reproducibility, and sensitivity in the follow-up of ACL ligamentoplasties. It provides indications on the quality of change and the possibilities of resuming sports. It is the only score that incorporates isokinetic assessments.

Commentary: Comparison of an Innovative Rehabilitation, Combining Reduced Conventional Rehabilitation With Balneotherapy, and a Conventional Rehabilitation After Anterior Cruciate Ligament Reconstruction in Athletes.

Commentary: Comparison of an Innovative Rehabilitation, Combining Reduced Conventional Rehabilitation With Balneotherapy, and a Conventional Rehabilitation After Anterior Cruciate Ligament Reconstruction in Athletes.

Asymmetry of muscle strength values during the basic period of rehabilitation after anterior cruciate ligament reconstruction in athletes

Objective: to specify the features of muscle strength imbalance values as the criteria defining intensity and progress of rehabilitation after anterior cruciate ligament (ACL) reconstruction in athletes. The study involved 46 athletes having ACL injury. All the injured were young people under 44 years of age according to the current WHO classification. The control group, or experimental group consisted of 23 patients, and there were 25 patient s in the main one. Physical rehabilitation program for the patients of the CG and MG included therapeutic exercises, massage, and electrical myostimulation. Physical rehabilitation program for the MG patients was aimed at the priority recovery of tone, strength and mass of hamstrings.&#x0D; The article evaluates the effect of the developed physical rehabilitation program on the relation of strength values of the injured and intact limbs during the basic period of rehabilitation. The CG patients showed positive changes only according to EMG (asymmetry index of the mean amplitude of the rectus femoris and vastus medialis (р &lt;0,05), and the MG patients significantly restored the balance between muscle strength values according to dynamometry results (moment of hip flexors and extensors strength, р&lt;0,01; asymmetry index of hip flexors and extensors strength, р&lt;0,05), and EMG (asymmetry index of the mean amplitude of the rectus femoris and vastus medialis, р&lt;0,05). The study found that physical therapy program which additionally included electrical myostimulation and special exercises for hamstrings has significant effect on the relation of strength values of the injured and intact limbs during the basic period of rehabilitation.

Anterolateral ligament reconstruction improves the clinical and functional outcomes of anterior cruciate ligament reconstruction in athletes.

To compare the outcomes of anterior cruciate ligament (ACL) reconstruction with those of combined ACL and anterolateral ligament (ALL) reconstruction in ACL-deficient knees. The objective of this study wasto improve knowledge regarding the treatment of ACL-deficient knees with combined ACL and ALL reconstruction. Combined ACL and ALL reconstruction has been hypothesized to result in better clinical and functional outcomes than isolated ACL reconstruction (ACLR). One-hundred and seven adult male athletes with ACL tears and high-grade pivot shifts were randomized into two groups. Those in group A (n = 54) underwent ACLR, while those in group B (n = 53) underwent combined ACL and ALL reconstruction. The median age was 26 (18-40) and 24 (18-33) years in groups A and B, respectively, and the median follow-up was 60 (55-65) months. Physical examination findings, instrumented knee laxity tested using a KT-1000 arthrometer, and International Knee Documentation Committee Scale (IKDC) scores were used to evaluate the outcomes. One-hundred and two patients were available for follow-up: 52 in group A and 50 in group B. Postoperatively, the pivot shift was normal in 43 (82.7%) and 48 (96%) patients in groups A and B, respectively (p < 0.001). The median instrumented knee laxity was 2.5 ± 0.7 (1.2-6.1) mm in patients in group A and 1.2 ± 0.7 (1.2-3.2) mm in patients in group B (p < 0.001). Additionally, 44 (84.6%) patients in group A had normal IKDC scores and 3 (5.8%) had nearly normal scores, while 48 (96.0%) patients in group B had normal IKDC scores and 2 (4%) had nearly normal scores (p < 0.001). Combined ACL and ALL reconstruction, compared with isolated ACLR resulted in favourable clinical and functional outcomes, as demonstrated by decreased rotational instability and instrumented knee laxity, a lower graft rupture rate and better postoperative IKDC scores. 1.

Ulnar collateral ligament reconstruction in athletes using a cortical button suspension technique

A variety of techniques currently exist for ulnar collateral ligament (UCL) reconstruction in symptomatic overhead athletes, all with the potential complication of fracture about the humeral or ulnar tunnels. Far cortical button fixation is a reproducible, biomechanically attractive option; however, no clinical series has been published on this technique to date. This study reports the clinical outcomes, with minimum 2-year follow-up, of a dual far cortical button suspension technique for UCL reconstruction in athletes. A retrospective evaluation was performed of 23 consecutive athletes who underwent UCL reconstruction with the use of ulnar and humeral-sided far cortical button fixation with minimum 2 years of follow-up. Data were collected from electronic medical records and patient telephone calls. The primary outcome was return to sport. Secondary outcomes included Disabilities of the Arm, Shoulder and Hand score, range of motion, and complications. We included 23 athletes with a mean follow-up of 47.2 months (range, 24-81 months). Autograft was used in 22 patients (16 palmaris, 6 gracilis, 1 semitendinosus, and 1 gracilis allograft). Overall, 82.6% (19 of 23) of patients returned to sport. At final follow-up, the average Disabilities of the Arm, Shoulder and Hand score was 3.8, and range of motion averaged 0° to 140°, with 87% (20 of 23) of patients achieving full motion. The visual analog scale score improved from 3.8 preoperatively to 0.2 at the final follow-up (P < .0001). There was 1 reconstruction failure. The humeral and ulnar far cortical button suspension technique provides a new UCL fixation option with theoretically lower concern for tunnel fracture and with predictable return to sport and good functional outcomes.

Comparison of an Innovative Rehabilitation, Combining Reduced Conventional Rehabilitation with Balneotherapy, and a Conventional Rehabilitation after Anterior Cruciate Ligament Reconstruction in Athletes.

Instability of the knee, related to anterior cruciate ligament injury, is treated by surgical reconstruction. During recovery, a loss of proprioceptive input can have a significant impact. Few studies have evaluated the benefits of rehabilitation of the knee in aquatic environment on functional outcomes. This study aimed to compare an innovative rehabilitation protocol combining reduced conventional rehabilitation with aquatic rehabilitation, with a conventional rehabilitation, according to the National French Health Authority, in terms of kinetics, development of proprioceptive skills, and functional improvement of the knee. 67 patients, who were amateur or professional athletes, were randomized into two groups: 35 patients followed the conventional rehabilitation protocol (Gr1) and 32 patients followed the innovative rehabilitation protocol (Gr2). Patients were evaluated before surgery, and at 2 weeks, 1, 2, and 6 months after surgery using posturography, and evaluation of muscular strength, walking performance and proprioception. This study is multicenter, prospective, randomized, and controlled with a group of patients following conventional rehabilitation (level of evidence I). For the same quality of postural control, Gr2 relied more on somesthesia than Gr1 at 6 months. The affected side had an impact on postural control and in particular on the preoperative lateralization, at 2 weeks and at 1 month. Lateralization depended on the affected knee, with less important lateralization in Gr2 preoperatively and at 1 month. The quadriceps muscular strength was higher in Gr2 than in Gr1 at 2 and 6 months and muscle strength of the external hamstring was greater in Gr2 than in Gr1 at 6 months. The isokinetic test showed a greater quadriceps muscular strength in Gr2. Gr2 showed a greater walking distance than Gr1 at one month. Gr2 showed an improvement in the proprioceptive capacities of the operated limb in flexion for the first 2 months. The effectiveness of the innovative rehabilitation program permits faster recovery, allowing for an earlier return to social, sporting, and professional activities. Faster retrieval of knee function following aquatic rehabilitation would prevent both short-term risk of lesions of the contralateral limb due to overcompensation and long-term risk of surgery due to osteoarthritis. NCT02225613.

Single-Leg Hop Test Performance and Isokinetic Knee Strength After Anterior Cruciate Ligament Reconstruction in Athletes.

Background:Isokinetic strength and hop tests are commonly used to assess athletes’ readiness to return to sport after knee surgery.Purpose/Hypothesis:The purpose of this study was to investigate the results of single-leg hop and isokinetic knee strength testing in athletes who underwent anterior cruciate ligament reconstruction (ACLR) upon returning to sport participation as well as to study the correlation between these 2 test batteries. The secondary purpose was to compare the test results by graft type (patellar tendon or hamstring). It was hypothesized that there would be no statistically significant limb difference in either isokinetic knee strength or single-leg hop tests, that there would be a moderate to strong correlation between the 2 test batteries, and that there would be no significant difference between graft types.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Twenty-nine high school and collegiate athletes who underwent ACLR participated in this study. At the time of return to full sport participation, a series of hop tests and knee extension/flexion isokinetic strength measurements were conducted. The results were analyzed using analysis of variance and Pearson correlation (r).Results:The timed 6-m hop test was the only hop test that showed a significant difference between the involved and uninvolved limbs (2.3 and 2.2 seconds, respectively; P = .02). A significant difference between limbs in knee strength was found for flexion peak torque/body weight at 180 deg/s (P = .03), flexion total work/body weight at 180 deg/s (P = .04), and flexion peak torque/body weight at 300 deg/s (P = .03). The strongest correlation between the hop tests and knee strength was found between the total distance of the hop tests and flexion total work/body weight at 300 deg/s (r = 0.69) and between the timed 6-m hop test and flexion peak torque/body weight at 300 deg/s (r = –0.54). There was no statistically significant difference in hop test performance or isokinetic knee strength between graft types.Conclusion:The single-leg hop tests and isokinetic strength measurements were both useful for a bilateral comparison of knee functional performance and strength. Knee flexion strength deficits and flexion-to-extension ratios seemed to be correlated with single-leg hop test performance. There was no difference in postoperative hop test performance or knee strength according to graft type.

Glucosamine Supplementation after Anterior Cruciate Ligament Reconstruction in Athletes: A Randomized Placebo-controlled Trial

Although glucosamine is commonly consumed by athletes, its effectiveness in sports injuries is still under debate. We aimed to investigate the effects of glucosamine to the rehabilitation outcomes of anterior cruciate ligament (ACL) reconstructed athletes. Glucosamine-sulfate (1000 mg daily, for 8 weeks) was administered to half of the cohort of 30 male athletes, the other half used a placebo. Both groups received the same rehabilitation protocol. Knee pain and functions were evaluated by a visual analogue scale (VAS), International Knee Documentation Committee (IKDC) and Lysholm scores before and after oral administration. Additionally, an isokinetic test was performed after the administration period. The scores revealed significant improvements in both groups after 8 weeks, but no significant difference was detected between groups in any of the parameters. Glucosamine supplementation did not improve the rehabilitation outcomes of athletes after ACL reconstruction. This is the first study investigating this topic. Further studies will help to obtain clear evidence about glucosamine efficacy on ACL injured or ACL reconstructed athletes.

Bicruciate Ligament Reconstruction in a Professional Rugby Player: Clinical Presentation and Literature Review.

The association of an anterior cruciate ligament (ACL) tear and a posterior cruciate ligament (PCL) injury is rare in athletes, and to our knowledge it has never been described in a professional rugby player. We report the case of a 27-year-old international professional rugby player who presented with an ACL tear associated with chronic posterior laxity on a former PCL tear. The procedure associated arthroscopic ACL and PCL reconstruction in a one-stage operation with two autografts, bone-patellar tendon-bone and hamstring tendon, respectively. At 7 months postoperatively, the patient had returned to playing rugby at the same level of play. The therapeutic strategy successfully met the established goals of returning to sports at the same level of play with excellent functional results after 2 years of follow-up. A literature review was performed via PubMed. The inclusion criteria were the studies in English language, assessing the return-to-sport after bicruciate ligament reconstruction in athletes. Eight studies were included in analysis. Only one study has focused on the return-to-sport in 24 competitive athletes and two other studies have included 1 professional athlete each. The overall rate of the return-to-sport after bicruciate reconstruction varied between 100% and 50%.

Erratum to: Primary anterior cruciate ligament reconstruction in athletes: a 5-year follow up comparing patellar tendon versus hamstring tendon autograft

Erratum to: Primary anterior cruciate ligament reconstruction in athletes: a 5-year follow up comparing patellar tendon versus hamstring tendon autograft

Paper 255: The Influence of Locally Applied Platelet Derived Growth Factor on Free Tendon Graft Remodeling After Anterior Cruciate Ligament Reconstruction in Athletes

Paper 255: The Influence of Locally Applied Platelet Derived Growth Factor on Free Tendon Graft Remodeling After Anterior Cruciate Ligament Reconstruction in Athletes

Why autologous hamstring tendon reconstruction should now be considered the gold standard for anterior cruciate ligament reconstruction in athletes

The aim of anterior cruciate ligament (ACL) reconstructive surgery is to provide the patient with a timely return to sport allowing them to participate without any further meniscal damage and...

Techniques for ulnar collateral ligament reconstruction in athletes

The ulnar collateral ligament (UCL) is the primary restraint to valgus stress of the elbow. Symptomatic valgus instability secondary to ligament insufficiency is seen almost exclusively in overhead throwing athletes, particularly baseball pitchers. The valgus forces on the elbow during the late cocking and early acceleration phases of throwing are tremendous. Valgus loading of the medial elbow is transmitted mainly to the UCL, and may exceed its tensile strength. Instability resulting from UCL insufficiency alters the joint biomechanics, hinders the ability to throw, and may lead to secondary elbow pathology. Most overhead athletes who fail nonoperative measures require reconstruction of the ligament. The initial technique of UCL reconstruction resulted in moderate clinical success, but had a relatively high rate of complications, mainly involving the ulnar nerve. Modifications of the surgical technique in subsequent years have yielded more predictable results and fewer complications.

Ulnar collateral ligament reconstruction in athletes: Muscle-splitting approach without transposition of the ulnar nerve

Eighty-three athletes with medial elbow instability underwent reconstruction of the anterior band of the ulnar collateral ligament with a muscle-splitting approach without transposition of the ulnar nerve. The purposes of this study were to describe postoperative neurologic outcomes in all 83 athletes and to describe the 2-year follow-up in 33 athletes. Postoperatively, 5% of this group had transient ulnar nerve symptoms, all of which resolved with nonoperative management. There were no reoperations for nerve dysfunction and no permanent nerve problems. At 2- to 4-year follow-ups, 93% of the highly competitive athletes who had not had a prior surgical procedure had an excellent result. All athletes, regardless of whether they had a prior procedure, were able to return to their sport. These surgical modifications to the ulnar collateral ligament reconstruction yielded a decreased postoperative complication rate and improved outcomes compared with the results of prior procedures. (J Shoulder Elbow Surg 2001;10:152-7.)