Ligament Surgery Research Articles

Readability and Quality of Online Patient Education Materials Concerning Posterior Cruciate Ligament Reconstruction.

Objective This study aimed to assess the quality of online patient educational materials regarding posterior cruciate ligament (PCL) reconstruction. Methods We performed a search of the top-50 results on Google® (terms: "posterior cruciate ligament reconstruction,""PCL reconstruction,""posterior cruciate ligament surgery," and "PCL surgery") and subsequently filtered to rule out duplicated/inaccessible websites or those containing only videos (67 websites included). Readability was assessed using six formulas: Flesch-Kincaid Reading Ease (FRE), Flesch-Kincaid Grade Level (FKG), Gunning Fog Score (GF), Simple Measure of Gobbledygook (SMOG) Index, Coleman-Liau Index (CLI), Automated Readability Index (ARI); quality was assessed using the JAMA benchmark criteria and recording the presence of the HONcode seal. Results The mean FRE was 49.3 (SD 11.2) and the mean FKG level was 8.09. These results were confirmed by the other readability formulae (average: GF 8.9; SMOG Index 7.3; CLI 14.7; ARI 6.5). A HONcode seal was available for 7.4 % of websites. The average JAMA score was 1.3. Conclusion The reading level of online patient materials concerning PCL reconstruction is too high for the average reader, requiring high comprehension skills. Practice implications Online medical information has been shown to influence patient healthcare decision processes. Patient-oriented educational materials should be clear and easy to understand.

Isokinetic Testing: Why it is More Important Today than Ever.

Isokinetics is a proven method to train and objectively assess the capability of muscle groups, particularly at the knee. The current re-injury rates and less than optimal return to sport percentages seen following anterior cruciate ligament surgery highlights the need for greater focus on what tests and methods are used to make these critical decisions. Isokinetics remains the best single method to objectively determine dynamic muscle strength, power, rate of force development and endurance. These factors make it well-suited to play a crucial role in influencing the appropriate patient progression through a rehabilitation program and assisting in determining return to play readiness following injury or surgery. In this article we will discuss why we believe isokinetics is a useful and necessary testing method, and elucidate testing parameters and goals used during knee extension/flexion assessment.

Psychological aspects associated with ACL rehabilitation and recurrence in football players: a systematic review

Although most football players recover good physical function after anterior cruciate ligament (ACL) surgery, some do not return to their sport or to the same pre-injury level, and there is a risk of recurrence. Therefore, this study aimed to examine research on psychological aspects of ACL rehabilitation and Return to Play (RTP), as well as their influence on possible recurrence in football and futsal players. The search was conducted using the Scopus, PubMed, WoS, CENTRAL databases, and grey literature sources DART-Europe and OpenGrey. A total of nine studies met the inclusion criteria. The results indicated as the most evaluated psychological factor the psychological readiness to RTP through the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI). Likewise, psychological interventions in ACL-injured football players have positive effects on mood states, reduces pain perception, and fear reinjury, among others. Risk profiles for recurrence included vulnerability to stress and high psychological readiness to RTP. Therefore, psychological interventions should be incorporated into the rehabilitation process and screening to identify players at risk for poor outcomes or recurrences. Additional research would help to understand the influence of other variables or optimal levels of psychological readiness to RTP. Keywords: anterior cruciate ligament; RTP; sports injury; psychology; rehabilitation.

Current methods of perioperative analgesia for arthroscopic anterior cruciate ligament reconstruction: a literature review

Arthroscopic knee joint surgery is becoming routine in modern orthopedics. Its advantages include minimal invasiveness, lower infection risk, and early rehabilitation. Despite the minimized surgical trauma, the postoperative period after some arthroscopic operations involving cruciate ligament surgery occurs with relatively severe pain syndrome. This warrants the search for novel pain relief methods for patients that meet all modern trends. This review presents data from randomized clinical studies and meta-analyses on the use of various anesthesias in arthroscopic cruciate ligament repair and discusses methods of prolonged postoperative analgesia. The limited number of studies on this issue and lack of systematic recommendations require prospective studies.

The Effect of Rehabilitative Exercises in Improving (the range of motion, muscle strength, and the degree of pain) for Football Players After ACL Surgery

Objective: This study aims to prepare rehabilitative exercises for football players following anterior cruciate ligament surgery and to determine the impact of such exercises on the functional ability of the anterior cruciate ligament (muscle strength, range of motion, and level of pain) in advanced football players following surgery. Method: A sample of (6) injured, from Al-Kut club, (age = 27.33 ± 1.98 years, height = 174.7 ± 2.99 cm, mass 60.6 0.68 kg) participated in the study. The participants in the experimental group (n=6) completed pre-tests and post-tests. Results: The results of the experimental sample show that there was a significant improvement in the mean scores for Muscular strength on the post-test compared to the pre-test. The mean score for muscular strength increased from 18.50 to 33.33, p<0.001), the mean score for the range of motion increased (extension) from 163.50 to 177.33, (flexion) 68.83 to 21, p<0.001), and the mean score for pain decreased from 7.125 to 1.12, p<0.001). conclusion: following surgery, rehabilitation exercises improve the strength of the muscles that operate on the knee joint, increase the range of motion of the knee joint, and decrease pain degree.

Building large-scale registries from unstructured clinical notes using a low-resource natural language processing pipeline

Building clinical registries is an important step in clinical research and improvement of patient care quality. Natural Language Processing (NLP) methods have shown promising results in extracting valuable information from unstructured clinical notes. However, the structure and nature of clinical notes are very different from regular text that state-of-the-art NLP models are trained and tested on, and they have their own set of challenges. In this study, we propose Sentence Extractor with Keywords (SE-K), an efficient and interpretable classification approach for extracting information from clinical notes and show that it outperforms more computationally expensive methods in text classification. Following the Institutional Review Board (IRB) approval, we used SE-K and two embedding based NLP approaches (Sentence Extractor with Embeddings (SE-E) and Bidirectional Encoder Representations from Transformers (BERT)) to develop comprehensive registry of anterior cruciate ligament surgeries from 20 years of unstructured clinical data at a multi-site tertiary-care regional children's hospital. The low-resource approach (SE-K) had better performance (average AUROC of 0.94 ± 0.04) than the embedding-based approaches (SE-E: 0.93 ± 0.04 and BERT: 0.87 ± 0.09) for out of sample validation, in addition to minimum performance drop between test and out-of-sample validation. Moreover, the SE-K approach was at least six times faster (on CPU) than SE-E (on CPU) and BERT (on GPU) and provides interpretability. Our proposed approach, SE-K, can be effectively used to extract relevant variables from clinic notes to build large-scale registries, with consistently better performance compared to the more resource-intensive approaches (e.g., BERT). Such approaches can facilitate information extraction from unstructured notes for registry building, quality improvement and adverse event monitoring.

Peracetic acid sterilized tendon and ligament allografts for knee reconstruction : For anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) and complex knee surgery.

The use of allografts and autografts has been met with mixed views on whether allografts are asuitable alternative to autografts. We aimed to investigate if chemically sterilized allografts show similar rerupture rates to those reported in the literature for allografts and autografts in anterior (ACL) and posterior cruciate ligaments (PCL) and complex knee surgery. Retrospective data on knee reconstructions performed between 2011 and 2015 with tendon/ligamnet allografts sterilized with peracetic acid were collected in the form of aquestionnaire. The inclusion criteria of 2years for each patient were met by 38patients, representing 22ACL reconstructions, 5PCL reconstructions, 3OTHER surgeries, including the Larson technique and medial patellofemoral ligament (MPFL) reconstruction and 8COMPLEX surgeries. The main endpoints were rerupture and complication rate. Secondary endpoints included stability of the knee (Lachman test, Pivot shift test) and the range of motion. The rerupture rate was 7.9% (3grafts). Reruptures only occurred in the ACL group. No reruptures were observed in the PCL, OTHER and COMPLEX surgery groups. Stability improved significantly after surgery and the range of motion returned to values similar to that of healthy knees. Tendon allografts sterilized with peracetic acid show promising low rerupture rates and good clinical scores and the results are comparable to the literature on autografts and other allografts.

PERBEDAAN PENGARUH OPEN KINETIC CHAIN EXERCISE DAN CLOSE KINETIC CHAIN EXERCISE TERHADAP KEKUATAN OTOT QUADRICEPS FEMORIS PASCA OPERASI ANTERIOR CRUCIATE LIGAMEN DITINJAU DARI USIA

This research is an experimental research. The sample is post-Anterior Cruciate Ligament surgery patients at the Solo Sport Physiotherapy Clinic as many as 16 people including Open and Close exercise categories and based on adolescent and adult age categories. Samples were taken using purposive sampling technique. The variables in this study include: 1) Quadriceps Femoris Muscle Strength (Y); 2) Open Exercise (a1); 3) Close Exercise (a2); and 4) Age (b). Research data were obtained from measurements using an Electromyograph. Hypothesis testing using two-way Anova test and t test. Conclusion, (1) There is a difference in the effect of quadriceps femoris muscle strength after being given open kinetic chain and close kinetic chain exercises in ACL postoperative patients. Which means that close kinetic chain training has a better improvement than open kinetic chain in ACL postoperative patients. (2) There are differences in the effect of quadriceps femoris muscle strength in adolescent and adult athletes. Which means that adult athletes have a better increase in quadriceps femoris muscle strength compared to adolescent athletes. (3) There is no interaction between open kinetic chain and close kinetic chain training methods with adolescent and adult age on increasing quadriceps muscle strength.

Environmental and genetic risk factors associated with total knee arthroplasty following cruciate ligament surgery.

The purpose of this study is to determine an individual's age-specific prevalence of total knee arthroplasty (TKA) after cruciate ligament surgery, and to identify clinical and genetic risk factors associated with undergoing TKA. This study was a retrospective case-control study using the UK Biobank to identify individuals reporting a history of cruciate ligament surgery. Data from verbal history and procedural codes recorded through the NHS were used to identify instances of TKA. Patient clinical and genetic data were used to identify risk factors for progression from cruciate ligament surgery to TKA. Individuals without a history of cruciate ligament reconstruction were used for comparison. A total of 2,576 individuals with a history of cruciate ligament surgery were identified, with 290 (11.25%) undergoing TKA. In patients with prior cruciate ligament surgery, prevalence of TKA was 0.75% at age 45 years, 9.10% at age 65 years, and 20.43% at age 80 years. Patients with prior cruciate ligament surgery were 4.6 times more likely to have undergone TKA by age 55 years than individuals without prior cruciate ligament surgery. In the cruciate ligament surgery cohort, BMI > 30 kg/m2 (odds ratio (OR) 4.01 (95% confidence interval (CI) 2.74 to 5.87)), a job that always involved heavy manual or physical labour (OR 2.72 (95% CI 1.57 to 4.71)), or a job that always involved walking and standing (OR 2.58 (95% CI 1.58 to 4.20)) were associated with greater TKA odds. No single-nucleotide polymorphism (SNP) was associated with risk of TKA following cruciate ligament surgery. Patients with a history of prior cruciate ligament surgery have substantially higher risk of TKA and undergo arthroplasty at a relatively younger age than individuals without a history of prior cruciate ligament surgery. Physically demanding work and obesity were associated with higher odds of TKA after cruciate ligament surgery, but no SNP was associated with risk of TKA.

Increased risk for early revision with quadriceps graft compared with patellar tendon graft in primary ACL reconstructions.

Bone patella-tendon bone (BPTB) and hamstring tendon (HT) autografts are the most used grafts in primary anterior cruciate ligament (ACL) reconstructions (ACLR) in Norway. Quadriceps tendon (QT) autograft has gained more popularity during the past years. The purpose of this study is to compare revision rates and patient-reported outcomes of primary QT with BPTB and HT autograft ACL reconstructions in Norway at 2-year follow-up. It was hypothesized that there would be no difference in 2-year revision rates between all three autografts. Data included primary ACLR without concomitant ligament surgeries, registered in the Norwegian Knee Ligament Register from 2004 through 2021. Revision rates at 2 years were calculated using Kaplan-Meier analysis. Hazard ratios (HR) for revision were estimated using multivariable Cox regression analysis with revision within 2 years as endpoint. Mean change in patient-reported outcome was recordedpreoperatively and at 2 years through the Knee Injury and Osteoarthritis Outcome Score (KOOS) subcategories 'Sport' and 'Quality of Life' was measured for patients that were not revised and analysed with multiple linear regression. A total of 24,790 primary ACLRs were identified, 10,924 with BPTB, 13,263 with HT and 603 with a QT graft. Patients in the QT group were younger (23.5 years), more of them were women (58.2%) and over 50% had surgery <3 months after injury. The QT group had the highest prevalence of meniscal injuries (61.9%). Revision estimates at 2-years were 3.6%, 2.5% and 1.2% for QT, HT and BPTB, respectively (p < 0.001). In a Cox regression analysis with QT as reference, BPTB had a lower risk of revision (HR 0.4, 95% Cl 0.2-0.7, p < 0.001). No significant difference was observed in the revision risk between QT and HT (HR 1.1, 95% Cl 0.7-1.8, n.s.). The two most common reported reasons for revision were: traumatic graft rupture and nontraumatic graft failure. There were no differences between the groups in change of KOOS in subcategories 'Sport' and 'Quality of Life' at 2-years follow-up. The 2-year risk of revision after ACLR with QT was higher than BPTB and similar to HT. No difference was found between the groups in patient-reported outcomes. This study provides valuable insights for both surgeons and patients when making decisions about the choice of autografts in primary ACL reconstructions. Level II.

Performance-Based Outcomes after Revision Ulnar Collateral Ligament Surgery in Professional Pitchers.

To compare performance in baseball pitchers before and after revision ulnar collateral ligament (UCL) surgery using performance metrics. Case series. Public online database. Players who underwent revision UCL surgery between 2015 and 2021 were identified. Players were included if they were Minor League (MiLB) or Major League (Major League baseball [MLB]) pitchers. Players were excluded if they were not pitchers, if they underwent their revision surgery as an amateur, or if there is no record of their primary reconstruction surgery. Revision UCL surgery (repair or reconstruction). Return to sport (RTS) rate, RTS time, pitch velocity, and pitch spin rate. Sixty-five pitchers underwent revision UCL surgery. MiLB pitchers had a shorter RTS time after their primary surgery (15.62 vs 20.77 months, P < 0.01) compared with MLB pitchers but similar RTS times after their revision reconstruction (19.64 vs 18.48 months, P = 0.44). There was also no difference in return to play (RTP) rate overall after primary versus revision reconstruction ( P = 1.00). Major League baseball pitchers also had decreased RTS time after primary compared with revision reconstruction (15.62 vs 19.64 months, P < 0.01) but similar RTP rates ( P = 0.28). Finally, MLB pitchers had similar pitch breakdowns, velocities, and spin rates before and after their primary and revision repair or reconstruction. Both revision UCL repair and reconstruction can return pitchers to preinjury performance levels. Pitchers and teams should be properly counseled on realistic RTP times and postsurgery performance when discussing revision UCL surgeries.

Objectively evaluated physical activity among individuals following anterior cruciate ligament reconstruction: a systematic review and meta-analysis

ObjectiveTo compare time spent in moderate-to-vigorous physical activity (MVPA) per week, MVPA per day, and steps per day between individuals that were subjected to the anterior cruciate ligament reconstruction (ACLR)...

Effectiveness of Blood Flow Restriction Training on Increasing Strength in Post Surgery Rehabilitation of Anterior Cruciate Ligament (ACL) Compared with Traditional ACL Rehabilitation Protocol

Background: Patients who have anterior cruciate ligament restoration surgery endure a severe loss of strength intheir lower limbs as a result of muscle atrophy and arthrogenic inhibition. A relatively novel method for eitherpreventing muscle atrophy or maybe inducing muscular growth is blood flow restriction (BFR) training.Purpose: The Purpose of the study is to determine effectiveness of blood flow restriction training in post-surgeryrehabilitation of anterior cruciate ligament compared with traditional ACL rehabilitation protocol.Materials and Methods: Total of 50 samples was selected based on inclusion and exclusion criteria. The subjectswere separated as Group A and Group B where group A (n=25) is provided with blood flow restriction trainingand group B (n=25) is provided with strengthening exercise. Results were statistically analysed and tabulated.Result: The study found that there is significant improvement on anterior cruciate ligament surgery in post rehabusing NPRS and Range of motion. The results concluded that the improvement in blood flow restriction trainingwas extremely statistically significant.Conclusion: Blood flow restriction training was found to be more effective than strengthening exercise for thetreatment of post rehabilitation of anterior cruciate ligament surgery.

Review on Causes and Management of Ganglion Cyst after Anterior Cruciate Ligament Reconstruction

The gelatinous fluid within a ganglion is rich in hyaluronic acid and other mucopolysaccharides, and the lesion itself is surrounded by a dense network of collagen fibres and fibrocytes. By restoring knee stability, the procedure aims to enhance the patient’s quality of life. Historically, individuals who underwent anterior cruciate ligament (ACL) surgery were able to resume their prior level of athletic involvement in 75%–90% of cases. ACL ganglion cysts are associated with serious clinical symptoms. Some people’s discomfort and stiffness from immobility due to large ganglia prohibit them from fully extending. Such individuals should have an arthroscopy or a computed tomography (CT) scan to decompress the ganglion, which offers immediate relief. ACL surgeries are becoming more and more common, and ganglion cysts may be present in individuals who have pain at the extremes of both flexion and extension has a clinical history. Radiologists must be conversant with these therapies and the adverse effects that go with them. While arthroscopic treatment offers quick discomfort alleviation without compromising ligament integrity, when it comes to radiological diagnostics, nothing beats magnetic resonance imaging (MRI). With an MRI, any other relevant intraarticular abnormalities may be ruled out. Safe CT scan-guided suction was used to successfully cure this patient’s ACL ganglion cyst symptoms.

Prevalence and Predictors of Concomitant Meniscal and Ligamentous Injuries Associated With ACL Surgery: An Analysis of 20 Years of ACL Reconstruction at a Tertiary Care Children’s Hospital

Background: There is an increasing rate of procedures being performed for concomitant injuries during anterior cruciate ligament (ACL) surgery. Few studies have examined risk factors for these associated injuries in young patients. Hypothesis: There are patient-related factors predictive of concomitant knee pathology that differ between age-based cohorts. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Natural language processing was used to extract clinical variables from available notes of patients undergoing ACL surgery between 2000 and 2020 at a single institution (5174 ACL surgeries; mean age, 17 ± 4 years; 53.1% female; accuracy, >98%). Patients were stratified to pediatric (5-13 years), adolescent (14-19 years), and young adult (20-35 years) cohorts. Logistic regression was used to determine predictors of concomitant injury to the menisci, medial collateral ligament (MCL), posterolateral corner (PLC), and posterior cruciate ligament (PCL). Results: Between 2000 and 2020, 54% of pediatric, 71% of adolescent, and 70% of adult patients had ≥1 concomitant soft tissue injury. In children and adolescents, increased age was consistently predictive of sustaining a concomitant injury (P < .02). Female children had increased odds of concomitant medial meniscal injury, while female adults had decreased odds (P≤ .046). Adolescent and adult female patients had decreased odds of concomitant lateral meniscal injury (P≤ .027). Female children had increased odds of injury to the MCL (P = .015), whereas female children and adolescents had decreased odds of PCL injury (P≤ .044). Adolescents undergoing revision ACL surgery had increased odds of meniscal injury (P≤ .001) and decreased odds of concomitant MCL injury (P = .028). Increased body mass index (BMI) was associated with increased odds of concomitant medial meniscal injury in all cohorts (P≤ .041), lateral meniscal injury in adults (P = .045), and PLC injury in children (P = .016). Contact injuries were associated with increased odds of MCL injury in adolescents (P = .017) and PLC injury in adolescents and adults (P < .014). Conclusion: These findings support the hypothesis, as there were multiple factors that significantly affected the risk of concomitant injuries that differed between cohorts. Increased age, BMI, and contact injury history were generally associated with increased odds of sustaining a concomitant injury, whereas female sex and revision ACL surgery had mixed effects. Further studies are essential to investigate the sex-based differences in risk for concomitant injuries and to develop tailored treatment plans that minimize the risk of secondary ACL injury.

"Lost in Translation: The Readability Discrepancy of Online Patient Educational Materials for PCL Surgery".

While the internet provides accessible medical information, often times it does not cater to the average patient's ability to understand medical text at a 6th and 8th grade reading level, per American Medical Association (AMA)/National Institute of Health (NIH) recommendations. This study looks to analyze current online materials relating to posterior cruciate ligament (PCL) surgery and their readability, understandability, and actionability. The top 100 Google searchs for "PCL surgery" were compiled. Research papers, procedural protocols, advertisements, and videos were excluded from the data collection. The readability was examined using 7 algorithms: the Flesch Reading Ease Score, Gunning Fog, Flesch-Kincaid Grade Level, Coleman-Liau Index, SMOG index, Automated Readability Index and the Linsear Write Formula. Two evaluators assessed Understandability and Actionability of the results with the Patient Educational Materials Assessment Tool (PEMAT). Outcome measures included Reading Grade Level, Reader's age minimum and maximum, Understandability, and Actionability. Of the 100 results, 16 were excluded based on the exclusion criteria. There was a statistically significant difference between the readability of the results from all algorithms and the current recommendation by AMA and NIH. Subgroup analysis demonstrated that there was no difference in readability as it pertained to which page they appeared on Google search. There was also no difference in readability between individual websites versus organizational websites (hospital and non-hospital educational websites). Three articles were at the 8th grade recommended reading level, and all three were from healthcare institutes. There is a discrepancy in readability between the recommendation of AMA/NIH and online educational materials regarding PCL surgeries, regardless of where they appear on Google and across different forums. The understandability and actionability were equally poor. Future research can focus on the readability and validity of video and social media as they are becoming increasingly popular sources of medical information.

Long-term Outcomes After Surgical Reconstruction of Multiligamentous Knee Injuries: Results at Minimum 10-Year Follow-up.

Multiligamentous knee injuries (MLKIs) are devastating injuries with concomitant injuries that complicate treatment and recovery. Short-term studies have shown satisfactory patient outcomes after surgical treatment; however, evaluations of long-term outcomes remain scarce. To evaluate long-term outcomes after surgically reconstructed MLKIs and further investigate the relationship between patient age on clinical outcomes. Case series; Level of evidence, 4. A total of 55 knees (age, 36 ± 11 years; 24% female subjects) who underwent surgical reconstruction for MLKI between 1992 and 2013 met the study inclusion criteria and were evaluated with postoperative patient-reported outcomes (PROs) including International Knee Documentation Committee (IKDC) score, Lysholm score, visual analog scale (VAS) for pain, Forgotten Joint Score, subjective improvement ratings and surgery satisfaction, and Tegner activity scores. PRO scores, revision, and conversion to arthroplasty were analyzed using descriptive statistics, linear regression, Wilcoxon rank-sum, and Fisher exact tests. At final follow-up (mean, 15 ± 5 years; range, 10-31 years), 67% of the cohort reported subjective improvement in their knee, and 82% reported satisfaction with their surgery. Compared with preoperative scores, there were significant improvements in postoperative VAS pain at rest in the full cohort, age ≤30-year cohort, and age >30-year cohort (4 ± 1 vs 2 ± 2; 4 ± 1 vs 2 ± 3; 4 ± 1 vs 1 ± 2, respectively; P≤ .029 for all) but significant reductions in Tegner scores (6 ± 3 vs 4 ± 2; 7 ± 2 vs 5 ± 2; 5 ± 2 vs 3 ± 1; P≤ .003 for all). Younger patients had higher postoperative Tegner scores than older patients (5 ± 2 vs 3 ± 1, respectively; P = .003), but no other differences in PROs were observed based on age. At a mean 15-year follow-up, 3.6% of the cohort underwent revision ligament surgery and 10.9% required arthroplasty. The majority of the cohort reported modest subjective improvement and were satisfied with their surgery. Gradual but expected age-related decreases in Tegner scores were observed, and some patients demonstrated continued symptomatic and functional limitations, but mean PRO scores remained satisfactory. Revision surgery and conversion to arthroplasty were not commonly required.

Adverse Events After Isolated Posterior Cruciate Ligament Reconstruction: A National Database Study.

Optimal management after posterior cruciate ligament (PCL) injury remains an active area of research, as reconstruction is technically challenging and poses unique risks in the posterior knee. Studies have reported variable rates of complications. To describe the rates of readmission, emergency department (ED) visits, and postoperative complications within 90 days of isolated PCL reconstruction (PCLR) in a large, national cohort to better understand the perioperative variables that influence a practitioner's decision of whether to pursue operative versus nonoperative management. Descriptive epidemiology study. PCLRs from January 1, 2010, through August 31, 2020, were identified in PearlDiver, a national administrative database. Patients with concomitant ligament surgery and those with fewer than 90 days of postoperative database activity were excluded. Deep vein thromboses, pulmonary embolisms, surgical site infections, compartment syndrome, and vascular events within 90 days of surgery were identified, as were 90-day readmissions and ED visits. Logistic regression models were built in PearlDiver to calculate odds ratios (ORs) for ED utilization. The final cohort consisted of 1154 patients with isolated PCLR (mean age, 34 ± 16 years; 62% male). Most patients were located in the Southern United States (n = 417; 36.1%), and most had commercial insurance (n = 992; 86%). The 90-day rates of adverse events were as follows: deep vein thrombosis (13; 1.1%), pulmonary embolism (19; 1.6%), surgical site infection (<11; <1%), compartment syndrome (<11; <1%), vascular event (<11; <1%), readmission (13, 1.1%), and ED utilization (99; 8.6%). The majority of emergency department visits (52%) occurred in the first 2 weeks postoperatively. Predictive factors for ED utilization included Elixhauser Comorbidity Index score (OR = 1.31 per 2-point increase) and Medicaid insurance (OR = 2.03 relative to commercial insurance). The current study reported rates of adverse events after isolated PCLR in a large, national cohort. The results provide important context for decisions about optimal management of PCL injury.

Location and Progression of Chondral Injuries at the Time of Revision Anterior Cruciate Ligament Surgery Varies by Sex

To quantify progression of chondral and meniscal injuries between primary and revision anterior cruciate ligament (ACL) surgery. Patients who underwent both index and revision ACL reconstruction between 2000 and 2020 at our institution were identified, and dates of injury and surgery, demographics, and clinical data were obtained from operative reports. Outerbridge grade was recorded in each compartment, along with presence and location of meniscal injury. The frequency of each injury between first and second cases was calculated. Differences in injury and progression were compared over time as well as between patient sex and age. The study included 189 patients (96 female, 93 male). Age at first surgery was 31.7 ± 13.2 years. Mean time to second injury was 3.3 ± 3.0 years. In total, 116 patients had a new or previous chondral injury (odds ratio, 1.6; 95% CI, 1.2-2.1). The medial femoral condyle (31%) and the patella (21%) accounted for the highest proportion of new injury to articular surfaces, whereas new injury to menisci was comparable between the medial (25%) and lateral (23%) meniscus. At the time of revision ACL reconstruction, females had a high prevalence of chondral injuries to the lateral compartment, whereas males had a high prevalence of chondral injury to the medial femoral condyle. The prevalence of new chondral injuries was comparable between sexes, with males having a slightly higher proportion. While time between surgeries, sex, and age had graphical evidence of moderating risk, the effects were small and imprecise. Revision ACL reconstruction carried a 1.6 increase in the odds for new or progressive chondral lesions in our cohort. At the time of revision, females had a relatively higher proportion of lateral-sided chondral injuries, whereas males had a relatively higher proportion of medial femoral condyle injuries. The greatest increase in the prevalence of new and progressive lesions was observed in the medial femoral condyle and trochlea. This progression appeared to be moderated by time between surgeries, patient sex, and age; however, the differences were small and imprecise. Level IV, therapeutic case series.

Epidemiology of cruciate ligament surgery in Japan: A repeated cross-sectional study from 2014 to 2021.

Understanding the incidence and trends of cruciate ligament (CL) surgeries in Japan is crucial for providing effective healthcare services. This study aimed to use open data available from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) to analyze changes in CL surgeries over time and the characteristics of the Japanese population by sex and age. We retrospectively identified CL surgeries of the knee joint registered from April 2014 to March 2022 using the NDB open data. Data on sex, age, and practice were extracted to determine the number of cases per 100,000 population. Trends in the annual incidence of CL surgeries were evaluated using Poisson regression analysis. A total of 142,931 CL surgeries were performed from 2014 to 2021, with arthroscopic ligament reconstruction accounting for 98% of cases. The number of surgeries significantly increased from 16,975 in 2014 to 19,735 in 2019 (P<0.001). CL surgeries were most common in the 15-19 and 20-29 years age groups, with variations between males and females. The incidence of CL surgery in Japan has increased, with characteristics varying by sex and age, including middle-aged and older patients. Further investigation of general patterns in CL surgery in Japan would be valuable.