Mean International Knee Documentation Committee Score Research Articles

Arthroscopic M-shaped suture fixation for tibia avulsion fracture of posterior cruciate ligament: A modified technique and case series.

Tibial avulsion fractures of the posterior cruciate ligament (PCL) are challenging to treat and compromise knee stability and function. Traditional open surgery often requires extensive soft tissue dissection, which may increase the risk of morbidity. In response to these concerns, arthroscopic techniques have been evolving. The aim of this study was to introduce a modified arthroscopic technique utilizing an M-shaped suture fixation method for the treatment of tibial avulsion fractures of the PCL and to evaluate its outcomes through a case series. To evaluate the effects of arthroscopic M-shaped suture fixation on treating tibia avulsion fractures of the PCL. We developed a modified arthroscopic M-shaped suture fixation technique for tibia avulsion fractures of the PCL. This case series included 18 patients who underwent the procedure between January 2021 and December 2022. The patients were assessed for range of motion (ROM), Lysholm score and International knee documentation committee (IKDC) score. Postoperative complications were also recorded. The patients were followed for a mean of 13.83 ± 2.33 months. All patients showed radiographic union. At the final follow-up, all patients had full ROM and a negative posterior drawer test. The mean Lysholm score significantly improved from 45.28 ± 8.92 preoperatively to 91.83 ± 4.18 at the final follow-up (P < 0.001), and the mean IKDC score improved from 41.98 ± 6.06 preoperatively to 90.89 ± 5.32 at the final follow-up (P < 0.001). The modified arthroscopic M-shaped suture fixation technique is a reliable and effective treatment for tibia avulsion fractures of the PCL, with excellent fracture healing and functional recovery.

Good clinical outcomes of anterior cruciate ligament reconstruction in patients over 60 years of age.

To evaluate the clinical outcomes following arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) in patients over 60 years and to investigate the potential impact of preoperative osteoarthritis (OA) on these outcomes. A retrospective study included ACL-injured patients over 60 years who underwent primary arthroscopic ACLR between 2010 and 2020. The Lysholm score and the International Knee Documentation Committee (IKDC) score were assessed preoperatively and at the final follow-up. The Tegner activity scale was performed to evaluate patients' activity levels. Data on return to sports, patient satisfaction, subsequent injuriesand complications were collected. Preoperative radiographs were used to grade OA according to the Kellgrene-Lawrenceclassification. Correlation analysis between OA and clinical outcomes was performed. The rates of achieving the minimal clinically significant differenceand patient-acceptable symptoms statewere documented. A total of 37 patients were included in this study. The mean age at surgery was 62.3 ± 2.3 years, with a mean follow-up of 6.3 ± 3.2 years (range: 2.1-12.4). Patients showed statistically significant (all p < 0.001) improvements in the mean IKDC (38.9 ± 9.4-66.8 ± 12.5), Lysholm (48.8 ± 15.4-83.0 ± 12.8)and Tegner (1-3) scores. Fourteen patients (37.8%) returned to sports. No correlation was observed between the degree of preoperative OA and clinical outcomes (n.s.). Patients over 60 years with symptomatic ACL-deficient knees could benefit from ACLR, even when mild to moderate OA is present preoperatively. Level IV.

Comparison of Efficacy and Safety Profile of Conservative Versus Surgical Management of Meniscal Injuries

Background: Surgical management of meniscal tear carries financial implications in resource limited settings like ours. Conservative management could address this issue, if its safety and efficacy profile is better understood. Objectives: The objective of this study was to compare the efficacy and safety of conservative and surgical management of patients with meniscal tear with conservative management.Material and Methods: Descriptive comparative study of 80 patients with meniscal tear, recruited through non-probability convenient sampling technique, was carried out at Orthopedic unit MMC MTI Mardan, during 1st August 2022 and 31st July 2023. Patients were assigned to surgical and conservative group. International Knee Documentation Committee (IKDC) score at baseline and 3 months after treatment were compared for efficacy. Treatment related complications were noted.Results: A total of 80 patients were enrolled with 40 patients in each group (surgical versus conservative). The mean baseline and IKDC score at week 12 in surgical versus conservative group were 45.069±13.301 versus 51.873±17.90 and 79.52±7.40 versus 73.92±11.67 respectively. Surgical group showed treatment response in 37 patients (92.5%) versus 31 (77.5%) in conservative approach (p value 0.060). Surgical site infection was observed in 5 patients (12.5%) in surgical group. Medication related adverse effects were observed in 3 patients (7.5%) in conservative group.Conclusion: No appreciable differences in the clinical results, such as pain reduction or better knee function, between patients who received meniscal surgery and those who underwent conservative treatment for meniscal tears.Keywords: Conservative Approach, Meniscal Injury, Surgical Approach, Treatment Outcomes

Technique and Outcomes of Posterior Cruciate Ligament Repair With Augmentation.

Posterior cruciate ligament (PCL) injuries to the knee are uncommon, and ideal surgical management of these injuries is unclear. Current surgical techniques include PCL reconstruction with remnant debridement, remnant-preserving techniques, and primary PCL repair. Augmentation of PCL repairs and reconstructions has been proposed to protect repairs or grafts in the postoperative period. To describe PCL repair with the hamstring autograft augmentation technique and examine our preliminary midterm outcomes from a sequential cohort of patients. Case series; Level of evidence, 4. The authors identified patients at their institution who underwent remnant-preserving primary PCL repair with hamstring autograft augmentation for both isolated tears and tears associated with multiligament knee injury (MLKI). Patient-reported outcomes were evaluated at a minimum 2-year follow-up using the International Knee Documentation Committee (IKDC) subjective knee form, the 12-item Short Form Survey, and a custom return-to-play questionnaire. Patient-reported outcomes data were summarized, and the predictors of outcomes from the descriptive data and clinical measures were further examined. A total of 23 patients with a mean follow-up of 5.3 years met the inclusion criteria. Of these patients, 87% were associated with MLKI. The mean IKDC score was 87.7. Approximately 83% of patients were able to successfully return to their sport or occupation. Among 19 athletes, only 2 reported being unable to return to their preinjury level of sport because of limitations from their PCL surgery. Patient-reported outcome scores and return to sport or occupation did not have a statistically significant association with age, sex, body mass index, time from injury to surgery, or follow-up time. Outcomes of our cohort with remnant-preserving primary PCL repairs with hamstring autograft augmentation demonstrated comparable clinical outcomes to previously published PCL data. The advantages of remnant preservation, primary repair, and augmentation with an independent hamstring autograft reconstruction are combined within this technique.

An observational retrospective study on safety and functional outcomes of arthroscopic anterior cruciate ligament reconstruction using Sironix suture button and interference screw

Background: Anterior cruciate ligament (ACL) injury is a persistent orthopaedic condition that affects a wide spectrum of people. ACL reconstruction (ACL-R) stands out as the primary treatment option. Graft fixation with suture buttons and interference screws has proven to be a highly successful and reliable method for ACL-R. In this context, our research aims to assess the safety and functional outcomes of patients who underwent arthroscopic ACL-R using the Sironix suture button and interference screw. Methods: This was a retrospective observational study. Patients who underwent arthroscopic ACL-R using Sironix suture button and interference screw (January 2018-March 2022) were included in the study. Functional outcomes of patients were evaluated using the international knee documentation committee (IKDC) assessment, the Tegner activity scale (TAS), the Lysholm knee scoring scale, the modified knee injury and osteoarthritis outcome score (KOOS) quality of life subscale, and the single assessment numerical evaluation (SANE) score. Adverse events, if any, were recorded. Results: All patients achieved excellent outcome measures for IKDC, Tegner, Lysholm, KOOS, and SANE scores. The mean (SD) IKDC score was 88.76 (7.16), Tegner activity score was 5.9 (1.13), while the Lysholm score was 96.9 (6.56). The overall KOOS score was 93.7 (7.52), and the overall SANE score for the affected joint was 94.5 (7.22). Conclusions: Arthroscopic ACL-R using Sironix implants (Helysis titanium interference screw, Helysis PLDLA+β-TCP interference screw, Infiloop fixed loop UHMWPE suture titanium button, Proloop adjustable loop UHMWPE suture Titanium button, and Titanium suture disc) demonstrated safety and good functional outcomes.

A Comparative Study of Anterior Cruciate Ligament Reconstruction Versus Conservative Treatment.

Background The anterior cruciate ligament (ACL) rupture is a common injury with an incidence of 68.6 in 100,000 patients per year. Despite extensive research on ACL rupture, there are insufficient high-quality studies to determine clear treatment strategies for adults lacking the ACL. This study aims to examine the functional differences between surgical and conservative treatment based on the quality of the surgical process. Methodology In this prospective, comparative study, a total of 136 patients aged between 18 and 35 years were enrolled per inclusion and exclusion criteria. Using the lottery system, patients were dividedinto the following two groups: group A (n = 71) and group B (n = 65). Group A was treated with arthroscopic ACL reconstruction and rehabilitation, whereas group B was treated conservatively (rehabilitation). Patient data, including age, sex, body mass index, International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Level (TAL) score, and complications were recorded and compared. Results The demographic data were comparable, where males had dominancy in both groups. The mean IKDC and KOOS scores were higher in group A at all follow-ups compared to group B. The scores gradually increased at every follow-up till six months. At the final follow-up, the IKDC and KOOS scores were higher in group A than in group B, and a significant difference was observed among both groups. The TAL score also gradually increased at every follow-up till 6 months. At the final follow-up, the TAL score was higher in group A than in group B, with a significant difference between the two groups (p = 0.0032). Complications in both groups were comparable. Conclusions This study showed that both the conservatively treated group and the rebuilt group had identical outcomes, with the exception of the conservative group having greater objectively quantifiable instability. However, at the final follow-up, patients reported feeling just as satisfied with their knee without surgery, demonstrating no subjective difference in activity levels or functional outcomes. Therefore, non-athletes with an ACL-insufficient knee should still choose conservative treatment.

Medial opening-wedge high tibial osteotomy with microfracture in treatment of varus medial compartmental knee osteoarthritis: clinical outcomes and second-look arthroscopic results.

Objective: This study aimed to investigate the clinical outcomes of medial opening high tibial osteotomy (MOWHTO) combined with arthroscopic microfracture in the treatment of varus medial compartmental knee osteoarthritis and to assess cartilage regeneration using second-look arthroscopy. Methods: This study involved 86 patients (86 knees) who underwent MOWHTO and microfracture from August 2016 to August 2020, including 15 men and 71 women with an average age of 55.3 ± 7.6years (range, 42-71years). The patients underwent a second-look arthroscopy to evaluate the status of cartilage regeneration at the time of plate removal, an average of 2years after the initial osteotomy. Clinical and radiological examinations were performed preoperatively and at the final follow-up visit. The radiologic evaluation included the weight-bearing line ratio (WBL ratio), mechanical femorotibial angle (FTA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTS) and Kellgren-Lawrence (KL) grade. Clinical outcomes were assessed using the Knee Society score (KSS) and International Knee Documentation Committee (IKDC) scores. Arthroscopic findings were assessed by macroscopic evaluation of cartilage repair according to the International Cartilage Repair Society (ICRS) grading system. Results: The mean KSS and IKDC scores significantly improved at the final follow-up compared to the scores obtained preoperatively (p < 0.05). At the time of plate removal, a second-look arthroscopic examination showed that the ICRS grade of the medial femoral condyle was as follows: grade I -11 cases, grade II -56, grade III-12, and grade IV-7, and cartilage regeneration was seen in 85% of knees (73/86). The ICRS grade of medial tibial plateau was grade I-12 cases, grade II-44, grade III-22, and grade IV-8, and cartilage regeneration was seen in 63% of knees (54/86). Significant differences were observed between cartilage regeneration and clinical outcomes (p < 0.05). Clinical results were better in the good cartilage regeneration group (grades I and II) than were in the poor cartilage regeneration group (grades III and IV). Conclusion: MOWHTO combined with arthroscopic microfracture can effectively improve clinical outcomes in the treatment of varus medial compartmental knee osteoarthritis. Cartilage regeneration can be promoted by correcting varus deformities, which affect clinical outcomes.

Post-Operative Modified All-Inside ACL Reconstruction Technique's Clinical Outcomes and Isokinetic Strength Assessments.

Anterior cruciate ligament (ACL) injuries are very common among the athletic population. ACL reconstruction (ACLR) performed because of these injuries is one of the procedures performed by orthopedic surgeons using different grafting methods. This study aims to compare the data related to post-operative 6-month isokinetic strength values, strength-related asymmetry rates, time parameters, and joint angle in athletes who underwent ACLR with the Modified All-inside (4ST) technique, on both the healthy knee (HK) and the ACLR-applied sides. A total of 20 athletes from various sports on whom the 4ST ACLR technique had been applied by the same surgeon were evaluated retrospectively. Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores of the patients were obtained pre-operative and at 6 months post-operative. Isokinetic knee extension (Ex) and flexion (Flx) strengths on the HK and ACLR sides of the patients were evaluated with a series of four different angular velocities (60, 180, 240, and 300°/s). In addition to peak torque (PT) and hamstring/quadriceps ratio (H/Q) parameters, the findings were also evaluated with additional parameters such as joint angle at peak torque (JAPT), time to peak torque (TPT), reciprocal delay (RD), and endurance ratio (ER). There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores after surgery compared with pre-operative levels (p < 0.05). As for PT values, there were significant differences in favor of the HK in the 60, 180, and 300°/s Ex phases (p < 0.05). In terms of the H/Q and (hamstring/hamstring)/(quadriceps/quadriceps) (HH/QQ) ratios, there were significant differences at 300°/s (p < 0.05). In terms of JAPT, there were significant differences in the 300°/s Ex and 180°/s Flx phases (p < 0.05). In terms of TPT, there were significant differences in the 300°/s Ex phase (p < 0.05). In terms of RD and ER, no significant difference was observed between the HK and ACLR sides at any angular velocity. Although differences were observed in PT values, particularly in the Ex phase, this did not cause a significant change in H/Q ratios. Similar results were observed for additional parameters such as JAPT, TPT, RD, and ER. The results show that this ACLR technique can be used in athletes in view of strength gain and a return to sports.

Mid-term outcomes of temporary medial distal femoral hemiepiphysiodesis with and without medial patellofemoral ligament repair for recurrent patellar instability in skeletally immature patients with genu valgum.

Genu valgum contributes to patellar instability, though outcomes following temporary hemiepiphysiodesis via eight plating are less understood. The purpose of this study was to evaluate the outcomes and need for additional procedures following temporary hemiepiphysiodesis for the treatment of pediatric genu valgum and patellar instability, as well as evaluating the utility of a concurrent medial patellofemoral ligament (MPFL) repair. Patients who underwent medial distal femoral epiphysiodesis for the treatment of genu valgum and recurrent patellar instability were identified. Inclusion criteria were minimum 1-year follow-up and lack of concurrent ligamentous reconstruction. Patients were contacted to complete a questionnaire which included the International Knee Documentation Committee (IKDC) form and questions pertaining to knee function and patient satisfaction. Thirty-one patients aged 12.0 ± 1.9 years underwent 47 guided growth procedures and were included in final analysis. Seventeen knees (36%) required subsequent surgery for patellar instability. All patients requiring subsequent surgery were female, compared with 70% of patients not requiring subsequent surgery ( P = 0.017). The MPFL repair group underwent fewer subsequent procedures to address instability, though this difference was NS (17 vs. 46%, P = 0.318). Mean IKDC score at 5.3 years follow-up among 18 survey respondents was 78.6. Medial distal femoral hemiepiphysiodesis may partially address recurrent patellar instability in skeletally immature patients with genu valgum. Concurrent MPFL repair may minimize the need for subsequent procedures to address recurrent instability. While correcting alignment may be helpful, patients should be aware of the potential need for further patellar instability surgery. Level of evidence: IV, case series.

A prospective randomized controlled study of hamstring and bone-free quadriceps tendons autografts in arthroscopic ACL reconstruction.

Anterior cruciate ligament (ACL) reconstruction is one of the most common surgical procedures worldwide. However, the ideal graft source is still debatable. This study compared hamstring (HT) and bone-free quadriceps (QT) tendon autografts in terms of muscle strength and patient-reported outcomes. Between June 2018 and December 2019, 46 patients were enrolled in the study and randomly assigned to one of two groups for the ACL reconstruction surgery-the HT autograft group or the QT autograft group. An experienced examiner performed preoperative and postoperative examinations. The HUMAC NORM isokinetic machine (Computer Sports Medicine International-CSMI, 2004) was used to assess flexor and extensor thigh muscle strength. Both groups received the same surgical technique and fixation method. All patients were examined after three, six, nine, and 12months. The final evaluations were performed at the 24-month follow-up. Patients' scores on the International Knee Documentation Committee (IKDC) evaluation form and the Lysholm Knee Scoring Scale were used to evaluate patient-reported outcomes. The two groups were also compared in terms of postoperative complications and activity levels. The difference between preoperative and postoperative knee flexor peak torques (FPT) was lower in the QT group than in the HT group. The average difference between preoperative and postoperative knee extensor peak torque (EPT) was higher in the QT group than in the HT group. As a result, the HT group had a lower postoperative H/Q ratio (flexor strength normalized to body mass divided by extensor strength normalized to body mass) than the QT group (p < 0.001). The mean IKDC scores for the HT and QT groups were 90.13 ± 6.99 and 87.12 ± 6.61, respectively. The scores of the two groups postoperatively were close, and both groups showed significant improvement. The average graft size in the QT group was significantly greater than that in the HT group. Saphenous nerve palsy was the most common complication in the HT group (22%). Thigh hematomas were observed in two patients in the QT group and required urgent intervention (12%). After ACL reconstruction, we found a significant decrease in strength at the donor sites in both techniques, with similar patient-reported measures and stability outcomes. The H/Q strength ratio was higher in the QT group postoperatively, which may have a protective effect on the reconstructed ligament. Level of Evidence I It is a randomized controlled trial.

Nonoperative Management of Degenerative Medial Meniscus Posterior Root Tears: Poor Outcomes at a Minimum 10-Year Follow-up.

Medial meniscus posterior root tears (MMPRTs) cause pain and dysfunction and are associated with poor clinical outcomes with nonoperative management at short-term follow-up. However, little is known about the long-term natural history of these tears. The purpose of this study was to (1) provide an update to a previous minimum 2-year study on the natural progression of these tears and (2) evaluate long-term patient-reported and radiographic outcomes. Case series (prognosis); Level of evidence, 4. A retrospective review was performed on a cohort of patients with untreated MMPRTs, diagnosed between 2005 and 2013, who were followed clinically using International Knee Documentation Committee (IKDC), visual analog scale for pain, and Tegner activity scores as well as radiographically at a minimum 10-year follow-up. Failure was defined as conversion to arthroplasty or a severely abnormal subjective IKDC score <75.4. Overall, 5 (10%) of the original 52 patients with minimum 2-year outcomes were subsequently lost to follow-up. The remaining 47 patients (21 male, 26 female) were followed for a mean of 14 ± 2 years (range, 11-18 years). At final follow-up, 25 patients (53%) had progressed to total knee arthroplasty, 8 (17%) were deceased, and 14 (30%) had not progressed to total knee arthroplasty. The mean IKDC and Tegner activity scores for the 14 patients with remaining MMPRTs were 51.6 ± 22.2 and 3.1 ± 1.1, respectively, and the mean visual analog scale score was 4.4 ± 3.0. Radiographically, the mean Kellgren-Lawrence grade progressed from 1.2 ± 0.7 at baseline to 2.6 ± 0.5 at final follow-up (P < .001). At a minimum 10-year follow-up, 37 of 39 living patients (95%) had failed nonoperative treatment. Poor clinical and radiographic outcomes were associated with the nonoperative treatment of degenerative MMPRTs at long-term follow-up. This study provides a valuable update on the natural history and long-term prognosis of nonoperatively treated MMPRTs.

Poster 252: BMAC Augmentation of Allograft Anterior Cruciate Ligament Reconstruction Improves Patient Reported Outcomes in the Presence of Intra-articular Pathology

Objectives: A randomized control trial demonstrated evidence of earlier graft remodeling and improved 9-month International Knee Documentation Committee (IKDC) scores when anterior cruciate ligament reconstruction (ACLR) with bone-tendon-bone allograft was augmented with an intra-graft injection of bone marrow aspirate concentrate (BMAC). While these results are promising, the mechanism by which BMAC may affect patient reported outcome measures (PROMs) following ACLR is unclear. Methods: This was a sub-analysis of patients enrolled to date in an IRB-approved, double-blinded, randomized control trial comparing patients undergoing ACLR with BTB allograft ± BMAC. Only patients who had completed at least 9 months follow-up were included. Patients were stratified by 1) treatment arm (BMAC versus control) and 2) presence of concurrent meniscus or cartilage pathology, as noted on diagnostic arthroscopy). The primary outcome was the Tegner activity scale and International Knee Documentation Committee (IKDC) at 9 months. A secondary sub-analysis assessed differences in MRI characteristics (signal intensity ratio [SIR], graft volume) by group. Results: The final study cohort included 44 BMAC patients – 19 (43%) without and 25 (57%) with concurrent cartilage or meniscus pathology – and 39 control group patients - 16 (41%) without and 23 (59%) with concurrent cartilage or meniscus pathology. 24 patients in the BMAC group had a meniscus lesion, 13 of which were treated via meniscectomy (54%) and 11 by meniscus repair (46%). By comparison, 21 patients in the control group had a meniscus lesion (P=0.57), 11 who were treated with meniscectomy (52%, P=0.88) and 11 who had a meniscus repair (P=1.00). 5 patients with BMAC (20%) and 6 control patients (25%) had a cartilage injury noted intraoperatively (P=0.94); chondroplasty was performed in 2 patients in the BMAC group (8.0%) and 4 patients in the control group (16.7%). Tegner score at 9 months did not differ by BMAC treatment or presence of concurrent meniscus/cartilage pathology (P=0.816). If a patient had a concurrent meniscus and/or cartilage lesion, the group treated with BMAC had a greater mean IKDC at 9 months (81.7 [SD=10.2] vs. 74.3 [SD=14.6], P=0.039). If a patient had no concurrent pathology, there was no difference in IKDC scores by treatment group (P=0.80). Change in Tegner (P=0.99) and IKDC (P=0.31) did not differ by groups. At 3 months, patients with BMAC and concurrent pathology had the highest mean SIR in the inferior 1/3 of the graft (3.00), followed by patients with BMAC but no concurrent pathology (2.60), controls without concurrent pathology (1.95), and controls with concurrent pathology (1.83, P=0.041). There were no significant differences in SIR at 9 months or graft volume, in this comparative cohort study. Conclusions: Amongst patients with concurrent meniscus and/or cartilage lesions, patients with BMAC had an 8-point higher mean IKDC score than controls at 9 months postoperatively. However, there was no difference in mean IKDC score between BMAC and control groups if no concurrent pathology was present. Thus, improved IKDC amongst patients with BMAC may be mediated by improved healing of repaired tissue or through an undefined anti-inflammatory or nociceptive pathway. Further investigation will be required to delineate a physiologic mechanism of action associated with BMAC during the recovery process when utilized at the time of ACL allograft reconstruction. [Table: see text][Table: see text][Table: see text]

Poster 346: Revision Anterior Cruciate Ligament Reconstruction with an All-Soft Tissue Quadriceps Tendon Autograft Produces Similar Outcomes to Index Surgery

Objectives: Anterior cruciate ligament reconstruction (ACLR) using all-soft tissue quadriceps tendon (QT) autograft has not yet been studied as a viable revision option in the pediatric population. This study aimed to compare short- to mid-term outcomes between patients undergoing revision ACLR and primary ACLR using all-soft tissue QT autograft. Methods: A retrospective review of prospectively collected data included patients aged 8-18 years old who underwent revision ACLR using an all-soft tissue QT autograft over a ten-year period (2011-2021). One-to-two matching by age and gender was performed to select a control group of patients who underwent primary ACLR utilizing all-soft tissue QT autograft during the same period. All procedures were performed by a single surgeon using a minimally invasive graft harvest technique and suspensory fixation. Subjective assessment of knee function was obtained pre- and postoperatively with the International Knee Documentation Committee (IKDC) survey. Postoperative knee laxity was measured with a KT1000 arthrometer at 6 weeks, 3 months, and 6 months. Isokinetic quadriceps strength at 60° and 180° was collected at 6 months and 12 months. Complications, including hematomas, infections, graft failures, and the need for subsequent surgery were recorded. To determine clinical significance ( p≤0.05), outcomes were compared using two-sided Student t-tests and Pearson’s chi-squared tests. Results: Thirty-nine patients underwent revision ALCR (59% female; 15.67±1.6 years old; BMI 23.7±4.6) and 78 underwent primary ACLR (59% female; 15.73±1.46 years old; BMI 23.5±3.9) with all-soft tissue QT autograft ( p=1.00 for gender; p=0.83 for age; p=0.82 for BMI). Length of follow up was 20.9 months (revision) and 23.4 months (primary) ( p=0.543). Mean IKDC scores improved significantly in both groups (Revision: 59.17±16.4 vs. 85.87±10.57, p&lt;0.001; Index: 55.85±16.8 vs. 88.38±14.2 p&lt;0.001). Mean time to postoperative IKDC for revision and primary ACLR was 14.67±5.7 months and 15.22±6.5 months, respectively ( p=0.865). There were no significant differences in mean pre- or postoperative IKDC scores between the index and revision groups (Table 1, p&gt;0.05). However, postoperative knee laxity was significantly greater after revision surgery at 6 weeks ( p=0.006) and 6 months ( p=0.009) (Table1). Contrarily, patients undergoing primary surgery had a greater isokinetic quadriceps strength deficit during both time points at 60° and 180°, which was statistically significant at full extension at 12 months postoperatively ( p&lt;0.039) (Table 1). Finally, although patients undergoing revision surgery exhibited fewer complications, this difference was not statistically significant (Table 2). Conclusions: Patient reported outcomes after ACLR revision surgery using all-soft tissue QT autograft in the paediatric population is equivocal to those undergoing primary reconstruction. Despite minor differences in the progression of postoperative isokinetic strength and knee laxity, a history of previously failed ACLR does not seem to portend inferior outcomes or increased risk for complications in pediatric patients undergoing revision surgery with all-soft tissue QT autograft. [Table: see text][Table: see text]

A Single-Centre, Retrospective, Observational Study to Assess Safety and Functional Outcomes of Arthroscopic Meniscal Repair Using Surestitch All Inside Implant.

Introduction The meniscus plays a vital role in maintaining knee stability. It acts as a shock absorber and knee filler. The incidence of meniscal tears is estimated to be 60 per 100,000 people. Due to lack of awareness among patients, only 10% of the meniscus tears were treated through partial or total meniscectomy. Recently, the concept of meniscus preservation surgery has emerged to preserve early degeneration of the knee joint. In the current retrospective study, safety and functional outcomes of arthroscopic meniscal repair surgery using SurestitchAll inside implants (Sironix Arthroscopy Solutions, Healthium Medtech Limited, Bengalaru, India) were assessed. Methods Fifty-two patients who underwent arthroscopic meniscal repair surgery between January 2019 to July 2022 at Epic Hospital in Gujarat, India, were enrolled in the study. Retrospective data including demographics, injury details, surgery details, and post-surgery complications were collected from the medical records of the patients. Then, the patients were followed up telephonically to document safety and functional outcomes using patient-reported instruments such as International Knee Documentation Committee (IKDC) score, Single Assessment Numeric Evaluation (SANE) score, Tegner activity level, and Lysholm knee score. Results The recruited patients had the mean age, height, and weight of 37.56 ± 12.52 years, 167.61 ± 7.28 cm, and 75.87 ± 10.7 kgs, respectively. Seventy-one percent of patients were male and 29% were female. Majority of the patients had the routine of doing mild exercise. During pre-surgery representations, medial meniscal tear was observed in majority of patients. The mean length of the tear was 1.32 ± 0.84 cm. In addition, patients were also diagnosed with anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) tears, and osteochondral defects. Surgeries for meniscal repair were performed using Surestitch All inside implant. In patient-reported outcomes, the mean IKDC, SANE, and Lysholm scores were 81.72 ± 14.23, 94.02 ± 13.79, and 93.32 ± 14.63, respectively. When the mean Tegner scores of pre-injury and post-surgery periods were compared, this resulted in no significant difference (p>0.05) in the activity levels of the patients. Conclusion Based on our findings, arthroscopic meniscal repair with Surestitch All inside meniscal repair implant provides satisfactory and favorable functional outcomes with no remarkable adverse events.

Functional outcomes after Medial Patellofemoral Ligament Reconstruction show inverted J-shaped relation with Body Mass Index.

Medial patellofemoral ligament reconstruction (MPFL-R) is a recognised surgical procedure for the treatment of recurrent patellofemoral instability with excellent outcomes reported. The aim of this study is to determine if body mass index can influence these outcomes. This is a single-centre retrospective analysis of a longitudinal patellofemoral database. Patients with recurrent patellar instability, without patellar alta or severe trochlear dysplasia were treated using a MPFL-R between 2015 and 2019 at The Robert Jones & Agnes Hunt Orthopaedic Hospital. The clinical efficacy following surgery was assessed by Kujula, International Knee Documentation Committee Score (IKDC), and EuroQol-5 score (EQ-5D) at baseline and up to 26months post-operatively; their safety assessed by complication rate and requirement for further surgery. The effect of Body Mass Index (BMI) on clinical outcome was analysed using linear, curvilinear, and segmented models following propensity score weighting. A total of 97 patients (97 Knees, mean age 25y) were analysed. Of these, 61 patients had a BMI < 30kg/m2 (mean age 23y, mean BMI 24) of which 7 patients (12.3%) required additional surgery. A further 36 patients had a BMI > 30kg/m2 (mean age 27y, mean BMI 36) of which 2 patients (5.6%) required additional surgery. The re-dislocation rate was 0% in each BMI group. Both groups had a significantly improved mean outcome following surgery, with improvements in mean IKDC above the minimum clinical important differences (MCID) of 20.5. BMI had an inverted J-shaped association with functional outcome, showing peak outcomes at BMI of 20.5 (95% CI 18.5 to 22.4; IKDC and Kujala) or BMI of 28 (EQ-5D index). No evidence for an association between BMI and complication risk was found. BMI influences the functional outcomes in MPFL-R with an inverted J-shaped relation, without evidence it affected the complication or re-dislocation rate. In the absence of patella alta and severe trochlear dysplasia, an isolated MPFL reconstruction is a safe and effective procedure to treat patellar instability, with the best functional outcome in patients with a BMI around 20 to 21. Level III.

Functional Outcomes of Anterior Cruciate Ligament Reconstruction Using Titanium Adjustable Loop Button and Poly-L-co-DL-Lactic Acid-Beta Tricalcium Phosphate (PLDLA-bTCP) Interference Screws: A Single-Center, Retrospective, Observational Study.

Background The anterior cruciate ligament (ACL) reconstruction is a standard surgery in patients with instability of the knee caused by ACL insufficiency. Several differential procedures using grafts and implants such as loops, buttons, and screws have been described. This study aimed to assess the functional outcomes of ACL reconstruction surgery using titanium adjustable loop buttons and poly-L-co-DL-lactic acid-beta tricalcium phosphate (PLDLA-bTCP) interference screws. Methodology This was a retrospective, observational, single-center, and clinical study. A total of 42 patients who underwent ACL reconstruction at a tertiary trauma center in northern India between 2018 and 2022 were recruited. Data including demographics, details of the injury, surgery, implants, and surgical outcomes were collected from the patients' medical records. Further, post-surgery details such as re-injury, adverse events, International Knee Documentation Committee (IKDC)profiles, and Lysholm knee score were recorded from the enrolled patients through a telephonic follow-up. Pain score and Tegner activity scale were used to compare the knee status before and after surgery. Results At the time of surgery, the mean age of the recruited patients was 31.1 ± 8.8 years, with a male preponderance of 93%. About 57% of patients had left knee injuries. The common symptoms were instability (67%), pain (62%), swelling (14%), and giving away (5%). During surgery, titanium adjustable loop button and PLDLA-bTCPinterference screw implants were used in all patients. The mean follow-up time was 21.2 ± 14.2 months. Based on patient responses, the mean IKDC and Lysholm scores were found to be 54.02 ± 5.93 and 94.4 ± 4.73, respectively. Further, the proportion of patients reporting pain decreased from 62% before surgery to 21% after surgery. The mean Tegner score revealed a significant increase in the activity levels of the patients post-surgery compared to pre-surgery (p < 0.05). Lastly, no adverse events or re-injuries were reported in any of the patients during follow-up. Conclusions Our findings revealed a significant improvement in Tegner activity levels and pain scores after surgery. In addition, patient-reported IKDC and Lysholm scores fell under the category of good knee status and function, suggesting a satisfactory functional outcome of ACL reconstruction. Hence, titanium adjustable loop and PLDLA-bTCP interference screws may be a good choice of implants for successful ACL reconstruction surgery.

3D-printed individualized navigation template versus the fluoroscopic guide to defining the femoral tunnel for medial patellofemoral ligament reconstruction: A retrospective study.

During medial patellofemoral ligament (MPFL) reconstruction, fluoroscopic determination of the femoral tunnel point is the most common method. However, there is a decrease in tunnel position accuracy due to rotation of the femur during fluoroscopy, as well as the damage to the operator from multiple fluoroscopies, whereas the 3D-printed individualized navigation template is not affected by this factor. This study focuses on the accuracy and early clinical efficacy of 2 different ways to determine the femoral tunnel (Schöttle point) for double-bundle isometric MPFL reconstruction. This is a retrospective study, conducted between 2016 and 2019, in which 60 patients with recurrent patellar dislocation were divided into 2 groups: 30 with MPFL reconstruction at the Schöttle point determined by 3D-printed individualized navigation template (group A) and 30 with MPFL reconstruction at the Schöttle point determined by fluoroscopic guidance (group B). The changes in patella congruence angle and patella tilt angle before and after surgery were assessed using computed tomography scans of the knee, knee function was assessed using the Kujala knee score and the international knee documentation committee (IKDC) score, and the 2 approaches were compared for the intraoperative establishment of the femoral tunnel position at a distance from Schöttle point. At a minimum of 3 years follow-up, patella tilt angle and patella congruence angle returned to normal levels and were statistically different from the preoperative range, with no significant differences between the 2 groups at the same period, and Kujala and IKDC scores of knee function were significantly improved in both groups after surgery. The mean Kujala and IKDC scores were statistically different between groups A and B at 3 and 6 months postoperatively. No statistically significant differences were seen between the 2 groups at the final follow-up. Both femoral tunnel localization approaches for double-bundle isometric MPFL reconstruction resulted in good knee function. At no < 3 years of follow-up, the use of a 3D-printed individualized navigation template did result in more accurate isometric points and higher knee function scores in the early postoperative period.

Relationships between Jumping Performance and Psychological Readiness to Return to Sport 6 Months Following Anterior Cruciate Ligament Reconstruction: A Cross-Sectional Study.

Investigating the relationship between functional capacity and psychological readiness is of paramount importance when planning sport resumption following knee surgery. The aim of this study was to prospectively assess clinical and functional outcomes in athletes 6 months after primary anterior cruciate ligament (ACL) reconstruction and to evaluate whether jumping ability is related to psychological readiness to return to sport following ACL surgery. Patients who underwent ACL reconstruction were prospectively enrolled and evaluated pre-operatively and 6 months after surgery. Assessment included Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level, and the ACL-Return to Sport after Injury (ACL-RSI) scale. Jumping ability was instrumentally assessed by an infrared optical acquisition system using a test battery including mono- and bipodalic vertical jump and a side hop test. Patients were dichotomized by ACL-RSI into two groups: group A (ACL-RSI &gt; 60), and group B (ACL-RSI &lt; 60). Overall, 29 males and two females from the original study group of 37 patients (84%) were available for clinical evaluation. Mean age at surgery was 34.2 years (SD 11.3). Mean body mass index (BMI) was 25.4 (SD 3.7). Mean overall Lysholm, IKDC, and ACL-RSI scores increased from pre-operatively (p &lt; 0.001). No differences in Tegner score were reported (p = 0.161). Similarly, improvement in most variables regarding jumping ability were observed at follow-up (p &lt; 0.05). According to ACL-RSI, 20 subjects were allocated in group A (ACL-RSI &gt; 60), while 11 were allocated in group B (ACL-RSI &lt; 60). A statistically significant difference in favor of patients in group A was recorded for the post-operative Lysholm and Tegner score, as well as Side Hop test LSI level (p &lt; 0.05), while a trend for IKDC was observed without statistical significance (p = 0.065). Patients with higher values of ACL-RSI scores showed better functional and clinical outcomes as well as improved performance 6 months after ACL reconstruction.

Mid-Term Results following Traumatic Knee Joint Dislocation

Although treatment strategies of knee joint dislocations have evolved, there is still no consensus on the best method and timing. New therapeutic concepts suggest that early one-stage treatment, including suturing and bracing of the cruciate ligaments in acute knee joint dislocation, are leading to improved functional results. This study aimed to evaluate the midterm functional outcome following traumatic knee joint dislocation and to determine whether the outcome is influenced by the surgical management, patient habitus or concomitant injuries. In this retrospective single center study, 38 patients with acute Schenck type II to IV knee dislocations were treated over an eight-year period in a level I trauma center. At follow-up, various clinical scores, such as the International Knee Documentation Committee (IKDC) Score, Lysholm Score, and Tegner Activity Scale (TAS), and individual questions about rehabilitation and activity levels of 38 patients were evaluated. Mean follow-up was 5.5 ± 2.7 years. The mean IKDC Score was 65.6 ± 15.7 points, the average Lysholm Score was 70.5 ± 16.4 points and the median TAS was 4 (0-7), resulting in a loss of activity of 2 (range 0-6) points. There was no significant difference between a one-stage treatment compared to a two-stage approach. Ligament reconstruction of the ACL in a two-stage approach was required in only 33.3%. Further operations (early and late) were performed in 37% of cases. Being overweight was associated with more complications and worse outcomes, and external fixation with arthrofibrosis. Knee dislocation is a severe trauma that often leads to a prolonged loss of function and increased knee pain over years, affecting the patient's activity. Clinical outcome is influenced significantly by concomitant injuries. Severe cases with initial external fixation are associated with a higher risk of knee stiffness and should be considered during rehabilitation. Obese patients present a challenge due to higher complication rates and lower postoperative knee function. Retrospective single center study, level III.

One-Stage Arthroscopic Multiple Ligament Reconstruction for Schenck IV Knee Dislocation.

Schenck IV knee dislocation patients have dissatisfactory knee function and return-to-sport rate with the existing treatment methods. The purpose of this study was to illustrate a one-stage arthroscopic multiple ligament reconstruction method for treating Schenck IV knee dislocations. A retrospective case series study was performed. All patients with a history of Schenck IV knee dislocation who underwent one-stage arthroscopic multi-ligament reconstruction from 2010 to 2018 were followed for 24months. The outcomes, including general patient data, Lysholm scores, International Knee Documentation Committee (IKDC) scores, visual analog scale (VAS) pain scores, knee active range of motion, and complications, were reviewed. The data was analyzed with paired-samples t-test. A total of 12 patients, comprising nine males and three females, were followed up and reviewed. The mean age at the time of the surgical procedure was 40.3 ± 9.0 (22-57) years. The mean body mass index (BMI) was 24.6 ± 4.9 (15.2-32.5) kg/m2 . The mean IKDC score and Lysholm score before surgery were 30.4 ± 6.1 (21-42) and 28.2 ± 6.2 (22-39), respectively. The average operation time was 121.8 minutes. The mean IKDC score and Lysholm score at the 24-month follow-up were 80.6 ± 6.5 (68-92) and 82.0 ± 7.5 (72-95), respectively. There were significant differences in the IKDC and Lysholm scores between the preoperative and 24-month postoperative time points (p < 0.01). The mean knee range of motion was 124.6° ± 6.6° (115°-135°) at the 24-month follow-up. No major complications occurred. The results of this retrospective study suggest that the new arthroscopic one-stage multi-ligament reconstruction technique is an effective way to treat Schenck IV knee dislocation with satisfactory postoperative knee function.