Negative Pivot Shift Research Articles

Double-bundle ACL combined with ALL reconstruction for patients at high risk of ACL failure: clinical and radiological results

BackgroundWe investigated whether double-bundle (DB) anterior cruciate ligament (ACL) reconstruction (ACLR) combined with anterolateral ligament reconstruction (ALLR) improved clinical and radiological outcomes in patients at high risk of ACL failure. The primary outcome was graft failure, and secondary outcomes included knee stability and patient-reported outcome measures (PROMs).Patients and methodsFifty-two patients who underwent DB ACLR combined with ALLR were included in this retrospective cohort study. Preoperative risk factors, including femorotibial angle (FTA), lateral tibial slope (LTS), medial tibial slope (MTS), and meniscal tears, were assessed using X-ray and magnetic resonance imaging (MRI). The grade of post-operative pivot shift, Lysholm score, and Tegner activity score were used to assess clinical outcomes. The minimum follow up duration was 2 years.ResultsThe cohort (mean age, 26.1 ± 9.4 years; 51.9% male) had a mean follow-up duration of 28.9 ± 3.4 months. Preoperatively, 57.8% had lateral meniscus (LM) tears, and 61.0% had a grade 2–3 pivot shift. Postoperatively, no graft failures or revision cases occurred during follow-up. Approximately 90.4% of the patients exhibited a negative pivot shift (p < 0.001), with Lysholm and Tegner activity scores of 92.5 ± 6.1 and 5.1 ± 2.0. The medial meniscus (MM) tear group had a significantly smaller FTA than the intact group (p = 0.043). No significant differences in PROMs were found between the LM tear and intact LM groups or between the high and low MTS or LTS groups (p = n.s.).ConclusionDB ACLR combined with ALLR had satisfactory clinical outcomes in patients at high risk of ACL failure, with no graft failures observed during a mean follow-up duration of 2.4 years. The technique effectively reduced the postoperative pivot shift, regardless of preoperative risk factors.Study designLevel IV, retrospective therapeutic case-series.Trail registrationethical approval number, 202300134B0; ethical committee, the Institutional Review Board of Chang Gung Medical Foundation.

Clinical outcome of trans-portal anatomic anterior cruciate ligament reconstruction with quadrupled semitendinosus graft

Introduction: The anterior cruciate ligament (ACL) injury is one of the most common injuries of knee. Arthroscopic reconstruction of ACL is standard approach, but controversy still remains regarding choice of graft. Objective: The objective of study is to see clinical outcome of quadrupled semitendinosus graft for ACL reconstruction. Methodology: This was a prospective clinical study of patients undergone single bundle ACL reconstruction with quadrupled semitendinosus autograft between February 2021 to July 2022 in our orthopedic department. All eligible patients who met inclusion criteria were evaluated in terms of knee stability subjectively and objectively before operation and at one year after operation. Results: There was total 33 patients, out of which 27 were male and 6 were female. The mean age was 27.5±8.2 years and most common mode of injury was RTA in 14 patients (43%) followed by sporting activities in 13 patients (39%) and fall from height in 6 patients (18%). The average diameter of graft was 8.03±0.35mm. The mean Lysholm score was 92.3±5.1 (range 79–99). Seventy percent patients returned to preinjury activity level whereas 30% decreased their activity level. In our study 31 patients (94%) had negative pivot shift test which indicates very high rate of knee stability. Conclusion: The quadrupled semitendinosus graft shows excellent result for ACL reconstruction both subjectively and clinically in our study. This method helps to save Gracilis tendon and also increases graft diameter.

The posterolateral ligament of the elbow: anatomy and clinical relevance

The posterolateral capsule was recognized in the past as an important structure for elbow stability but was later disregarded. Two recent biomechanical studies demonstrated its role in preventing posterolateral instability, and thus it should be identified as a distinct ligament: the posterolateral ligament (PLL). This study includes 2 parts: an anatomic study of the PLL's footprint and a collection of 5 cases of pathologic lesions of the PLL. Six cadaveric upper limbs were assessed. The attachments of the PLL were dissected, the footprints were marked and photographed, and the 2-dimensional area and length were measured. The mean proximal attachment dimensions were a length of 13 mm and an area of 101 mm2, and the mean distal attachment dimensions were 19 mm and 111 mm2, respectively. There were 2 cases of posterolateral elbow pain in professional cricket bowlers, diagnosed radiographically as enthesopathy of the PLL's proximal attachment on the posterior capitellum, probably due to repeated forced hyperextension of the elbow. Both patients were treated by débridement of the posterior capitellum and reattachment of the PLL, with complete resolution of symptoms. In addition, there were 3 cases of clinical posterolateral rotatory instability in young patients. Two athletes had an isolated acute tear of the PLL, and on physical examination, both had positive posterior draw test results but negative pivot-shift test results. Both underwent elbow arthroscopy and repair of the PLL with resolution of symptoms. The third patient had long-standing recurrent elbow instability, following a failed lateral ulnar collateral ligament reconstruction, in the presence of an Osborne-Cotterill lesion. He underwent revision lateral ulnar collateral ligament reconstruction, bone grafting of the bony lesion, and reattachment of the PLL, with complete resolution of symptomatic posterolateral rotatory instability. The PLL of the elbow has a significant role in the elbow's posterolateral stability. Its footprints were described, and its clinical significance was demonstrated in cases of elbow instability caused by acute ligament tears and elbow pain due to ligament enthesopathy. Surgeons should be aware of this structure and potential pathology related to its injury.

An isolated rupture of the anterolateral ligament of the knee: A case report.

The anterolateral ligament (ALL) is a controversial ligament in the knee that may play a significant role in knee stability. It is difficult to identify on magnetic resonance imaging (MRI) imaging and is often injured in conjunction with other ligaments, such as the anterior cruciate ligament (ACL) and medial collateral ligament. This is a unique case of an isolated ALL tear in a 48-year-old woman who presented with severe left knee pain, swelling, and inability to bear weight during a yoga session. Physical examination showed swelling and tenderness at the lateral aspect of the femoral condyle, with increased pain on varus stress testing. Radiographs revealed normal osseous structures with the absence of traumatic bone lesions. MRI revealed an intact meniscus, cruciate, and collateral ligaments, but a rupture of the ALL at its femoral origin. Diagnosis of isolated ALL rupture of the left knee was made, and the patient was treated conservatively with icing, rest, and non-steroidal anti-inflammatory drugs. Physiotherapy was started 2 weeks post-injury, and return to sports was allowed at the sixth week. Upon last follow-up, the patient had excellent functional outcomes and was satisfied with the treatment. Physical examination showed a stable knee with negative Lachman and pivot shift tests. To the best of the authors' knowledge, this is the first case of isolated ALL rupture to be reported. The paper highlights the rarity of isolated ALL injuries and the difficulty in diagnosing them. Conservative treatment can be successful for isolated ALL injuries, with physiotherapy playing an essential role in rehabilitation.In conclusion, isolated ALL injuries are rare and can be challenging to diagnose. Conservative treatment with physiotherapy can lead to successful outcomes. Further research is needed to understand the role of the ALL in knee stability and to determine optimal treatment options.

Anterior Cruciate Ligament Arthroscopic Ligamentoplasty Using the Four-Strand Hamstring Technique.

In this study, we looked at the clinical outcomes of individuals who had a symptomatic torn anterior cruciate ligament and had their anterior cruciate ligament repaired using a four-strand hamstring (4SHS) tendon autograft at least two years later. This is a retrospective study of 34 cases of anterior cruciate ligament arthroscopic reconstruction using the four-strand hamstring graft, collected from Traumatology and Orthopedics at Cheikh Khalifa Hospital in Casablanca, Morocco between January 2017 and January 2021. Different surgeons performed the operations. Physical findings and functional scores were recorded before the follow-up physical examination and surgery; thus, knee radiographs have been evaluated. A six-month rehabilitation program was devised following surgery. The average age of the patients was 30 years, with a male predominance of 94%. Thirty patients (88%) reported negative pivot shift tests and the Lachman test. The average Lysholm score enhanced from 59.3before surgery to 85.29at the time of the assessment. Three patients (8.82%)with a positive pivot shift test had no background of extra knee damage. In comparison to the appearance on the preoperative radiographs, no proof of progressive degenerative deterioration was found on the follow-up radiographs. All of the patients, however, had tunnel extension. The tibial tunnel grew on average by 18%, while the femoral tunnel grew on average by 30%. In 88% of patients assessed at least two years after surgery, ligamentoplasty of the anterior cruciate ligament using the four-strand hamstring graft eradicated anterior tibial subluxation. The failure rate was overall 10%. The functional knee scores had greatly improved at the time of the follow-up.

Posterolateral stabilization of the elbow by autologous ligament reconstruction to limit long-term development of osteoarthritis.

Posterolateral instability is the most frequent form of both acute and chronic elbow instability. Joint incongruity due to posterolateral unlocking leads to shear and compression stress of the internal aspect of the humeroulnar joint. We carried out long-term analysis of patients with posterolateral elbow instability in order to determine whether, in addition to improving their symptoms, reconstruction of the lateral collateral ligament complex may play a protective role against the development of post-traumatic osteoarthritis. We hypothesized that ligament reconstruction according to the technique of O'Driscoll stabilizes the elbow and also limits the development of osteoarthritis in the long term. Patients with symptomatic posterolateral instability of the elbow and who underwent ligament reconstruction according to the technique of O'Driscoll from January 1995 to December 2010 were identified and retrospectively included for 2 follow-up evaluations at a mean of 5 and 14years. Fourteen elbows in 14 patients were included. All had a negative lateral pivot shift test and none reported a new episode of instability. Two patients (14%) had osteoarthritis. The 2 radiographic evaluations showed no progression of osteoarthritis. Osteoarthritis developed in 33% of patients with intra-articular fracture. In simple dislocations, pre-existing osteoarthritic lesions were stabilized and there were no new cases of osteoarthritis. Elbow ligament reconstruction according to the technique of O'Driscoll gives effective posterolateral stabilization and appears to protect against progression to osteoarthritic degeneration in the long term. In the absence of associated lesions, it prevents the development of osteoarthritis or the worsening of pre-existing osteoarthritis.

A STUDY OF FUNCTIONAL OUTCOME OF ACL RECONSTRUCTION WITH ANATOMICAL HAMSTRING TENDON AUTOGRAFT

Background: The Anterior Cruciate ligament (ACL) is the primary stabilizer of the knee and prevents the knee against anterior translation. It is also important in counteracting rotational and valgus stress. Anterior Cruciate Ligament (ACL) reconstruction is an established and widely practiced surgical procedure with proven efcacy and a low morbidity prole. The arthroscopically aided approach has the advantages of smaller skin and capsular incisions, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion, and easier rehabilitation. The advantages with anatomical hamstring grafts are availability of a greater sectional area and unaffected integrity of the extensor mechanism. Moreover tensile strength of quadrupled anatomical hamstring is found to be even better than a normal ACL. The rate of complications like extension loss, anterior knee pain and surgical site infections was also lower than other procedures. Cortical suspension devices have the necessary biomechanical properties with regard to ultimate failure strength, displacement, and stiffness for initial xation of soft tissue in the femoral tunnel for ACL reconstruction. The aperture xation methods like the interference screws allows for early rm xation and heal with tight bone-tendon interface. To evalua Objectives: te functional outcome of arthroscopy assisted ACL reconstruction with anatomical hamstring tendon graft using Endobutton and Bioabsorbable interference screw and tibial disc. The Methodology: study results included 30 patients admitted with clinical and radiological deciency of ACL during October 2021 to December 2022, in Department of Orthopaedics, SMIMER Hospital, Surat. Study aims to assess the functional outcome of arthroscopy assisted anterior cruciate ligament reconstruction with anatomical hamstring tendon graft using Endobutton and Bioabsorbable interference screw and tibial disc in terms of range of motion, postoperative knee stability, graft site morbidity, subjective knee functions and prospective assessment of functional outcome using Tegner Lysholm knee scoring system. All the patients included in the s Results: tudy were 23 male and 2 female patient. The analysis of the studied cases revealed that the most common affected age group was between 18 to 24 years .. Majority of patients were operated more than 6 months after injury. Sports/BPET (Battle Physical Efciency Test) injuries was the most common mode of injury. The mean size of graft used was 8.2±0.39.Post-operatively at 3, 6, 12month follow up,1 case (4%) had a positive Pivot shift test with a "Glide" (Grade-I), whereas remaining 24 cases (96%) had a negative Pivot shift test. None of the patients had grade III laxity. The mean postoperative Lysholm score improved from preoperative score of 66±5.2 to 88.70±5.54. The overall satisfactory result (excellent + good) at follow up was 95%. All the patients had returned to preinjury level of activity. ACL injuries are common in younger age group individuals. S Conclusion: ports related injury and RTA are the most common modes of injury. Arthroscopy assisted ACL reconstruction using Anatomical hamstring tendon autograft provides a stable knee, reduces postoperative morbidity and enables early rehabilitation. Graft xation using endobutton and and Bioabsorbable interference screw will help the graft to facilitate graft tunnel healing and also maintain its strength until there is a good graft to bone healing occurs. It allows the patients to return to preinjury level of activity, allows the patient to squat, sit crossed leg and climb stairs without difculty. Degeneration of the articular surfaces rarely occurs and the re-operation rates are minimal.

Outcomes of Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction According to GNRB Arthrometer Measurement

Background and Objectives: To investigate the prognosis of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction, we used a GNRB (Genourob, Laval, France) arthrometer to measure surgical outcomes. Materials and Methods: This retrospective study reviewed patients who underwent combined ACL and ALL reconstruction and had a minimum follow-up of 2 years. Subjective outcomes, namely the International Knee Documentation Committee (IKDC) evaluation form scale scores and Lysholm scores, were evaluated preoperatively and postoperatively. We used a GNRB arthrometer to test the side-to-side laxity under pressures of 134 and 200 N, and we calculated the differential of the slope of the curves. We also recorded complications. Results: Our study examined 18 patients (mean age: 30.56 ± 8.9 years, range: 19-53) with a mean follow-up of 27.37 ± 3.4 months (range: 24-36). Both Lysholm and IKDC scores were significantly improved following the operation. The GNRB arthrometer measured mean anteroposterior laxity side-to-side as 0.76 ± 0.78 mm and 0.82 ± 0.8 mm under pressures of 134 and 200 N, respectively. The mean side-to-side differential slope under 200 N was 3.52 ± 2.17 μm/N. These values indicated that patients displayed no graft tear or low functional knee instability. All patients had a grade 3 pivot shift preoperatively; only two patients had a grade 1 pivot shift postoperatively, with the rest having a negative pivot shift. Conclusions: Our study revealed that combined ACL and ALL reconstruction has an excellent prognosis. GNRB measurement demonstrated excellent stability, and most patients had no residual pivot shift.

FUNCTIONAL OUTCOMES OF PERONEUS LONGUS TENDON AUTOGRAFT ARTHROSCOPIC RESTORATION OF AN ANTERIOR CRUCIATE LIGAMENT TEAR

The study was conducted to assess the functional outcome of arthroscopic reconstruction of anterior cruciate ligament tear by using peroneus longus tendon autograft. A prospective study was conducted in the Orthopaedics Department of Bakhtawar Amin Memorial Trust, Multan from 22 June 2021-22 June 2022. A total of 24 patients from the out-patient department were included in the study. Patients were clinically examined, and MRI was performed to confirm the presence of tear. Arthroscopic reconstruction was done. IKDC was used to assess the final outcome after 6 months, MRC was used to evaluate ankle stability with normal side as control. IKDC was normal in 22 patients (91.6%) and abnormal in only 2 patients (20%). The average IKDC score was 82.44. Lachman test showed normal results in 17 (70.8%)patients, 1+ laxity in 4 (16.6%), 2+laxity in (8.3%) and 3+laxity in 1 (4.1%)patient. 14 (58.3%) patients had negative pivot shift and 10 (41.6%)had positive glide. Peroneus longus tendon autograft is an effective option for anterior cruciate ligament reconstruction with less complications and maintains ankle function.

Quadriceps tendon vs hamstring autograft in primary ACL reconstruction - a comparative study with minimum two-year follow-up.

Recently there has been growing interest in the quadriceps tendon (QUAD) as a valid option for reconstruction of the anterior cruciate ligament (ACLR). The aims of the study is to compare the outcomes achieved in anatomic ACLR involving QUAD vs. Hamstring (HT) autografts. A total of 52 consecutive patients underwent an ACLR, 25 patients with QUAD graft and 27 with HT graft. The same surgical technique, fixation method and postoperative protocol were used in both groups. The following parameters were evaluated: functional status (Lysholm, Tegner, subjective IKDC scores), joint stability (Lachman and pivot shift tests), surgical reoperation rate, complications, degree of satisfaction and return to previous level of activity. Descriptive statistics were analysed using the Student's t-test. Forty four patients were evaluated (20 QUAD, 24 HT), with a mean follow-up of 27.4 months. Two patients were re-operated in the QUAD group (including one ACL revision), and one patient in the HT group required an ACL revision. There were no significant differences between the two groups in postoperative scores: Lysholm (96.05 vs. 96.05), IKDC (86.2 vs. 91.2) and Tegner (6 vs. 5) scales. The percentage of negative Lachman and pivot shift tests was similar in the two groups (45% vs. 50% and 40% vs. 45.8%, respectively). There were no significant differences between the groups in the degree of satisfaction (95.8% vs. 80%, p = .16) or in the percentage who returned to their previous level of activity (62.5% vs. 45%, p = .17). The use of a QUAD graft in ACL reconstruction leads to similar clinical and functional outcomes to those obtained with HT.

Outcomes of Combined Lateral Meniscus Posterior Root Repair and Anterior Cruciate Ligament Reconstruction.

Background:Lateral meniscus posterior root tears (LMPRTs) almost always occur in association with anterior cruciate ligament (ACL) tears. Their repair is advocated to restore the stabilizing and load-sharing functions of the meniscus.Purpose:To study the functional outcomes of combined arthroscopic repair of LMPRTs and ACL reconstruction (ACLR).Study Design:Case series; Level of evidence, 4.Methods:The authors evaluated patients who underwent simultaneous arthroscopic ACLR and LMPRT repair. All patients had chronic injuries, with a mean time since ACL rupture of 7.9 months. Patient characteristics, Lachman and pivot-shift test results, type of LMPRT, associated injuries, and surgery details were documented. Pre- and postoperative functional status was assessed using the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. An independent single-tunnel transtibial repair using 2 SutureTapes was performed for Forkel type 1 and 3 tear root avulsions, while side-to-side suture repair was performed for type 2 radial/oblique tears. The Wilcoxon signed rank test and minimal clinically important difference (MCID) of the IKDC score were used for statistical analysis.Results:Included were 25 patients with a mean age of 29.6 ± 6.5 years. Of these, 22 patients (88%; 95% CI, 73.1%-100%) had a high-grade (grade 2 or 3) preoperative pivot shift. Diagnosis of the LMPRT on magnetic resonance imaging (MRI) scans was possible only in 5 patients (20%). At final evaluation, performed at 37.4 ± 7.1 months postoperatively, all functional scores had improved significantly from preoperatively: IKDC score, from 47.6 ± 9.5 to 81.8 ± 11.5; KOOS, from 45.5 ± 10.9 to 86.5 ± 10.3, and Lysholm score, from 49.0 ± 11.5 to 88.8 ± 7.6 (P < .001 for all). Twenty-four patients (96%) achieved the MCID for the IKDC score. All knees had a negative pivot shift at final analysis, and no patient underwent revision ACLR or LMPRT repair.Conclusion:LMPRT repair combined with ACLR led to good short-term clinical outcomes in this study. An LMPRT may frequently go undetected on preoperative MRI scans, but a high-grade pivot shift is present in a large majority of these patients.

A prospective randomized study of arthroscopic ACL reconstruction with adjustable- versus fixed-loop device for femoral side fixation

PurposeSuspensory devices are extensively used in the management of anterior cruciate ligament (ACL) tear. They include fixed- and adjustable-loop devices. There are only a few studies comparing the efficacy of these two devices in the available literature. Therefore, the aim of this study is to compare clinical outcomes between the adjustable-loop device (group I) and fixed-loop device (group II).Materials and methodsThis was a prospective randomized study. Both groups were equivalent in demographic, preoperative, and intraoperative variables. Twenty-three patients underwent femoral side graft fixation with adjustable-loop and 20 with fixed-loop devices. Four patients were lost to follow-up. Assessment of clinical outcome was done with International Knee Documentation Committee (IKDC) score, Lysholm score, and knee stability tests (Lachman test and pivot shift test). Patient evaluation was performed preoperatively and finally postoperatively 2 years after surgery.ResultsPostoperative IKDC scores of group I and II were 91.9 ± 3.6 and 91.5 ± 3.6, respectively, and Lysholm scores were 91.0 ± 3.6 and 91.4 ± 3.5, respectively, after 2 years; however, the difference in the outcomes was statistically insignificant (p > 0.05). Twenty patients (87%) in group I and 17 patients (85%) in group II had a negative Lachman test (p = 0.8). Twenty-two patients (95.7%) in group I and 19 patients (95%) in group II had a negative pivot shift test (p = 0.9).ConclusionACL reconstruction with fixed- and adjustable-loop suspensory devices for graft fixation gives equivalent and satisfactory clinical results.Level of evidence1.

Interlinked Hamstrings for Combined Anterolateral and Anterior Cruciate Ligament Reconstruction: A Novel Technique for ALL.

Anterolateral ligament (ALL) reconstruction provides rotational stability in patients undergoing anterior cruciate ligament (ACL) reconstruction. The aim of this study was to assess the outcome of patients who underwent combined ACL and ALL reconstruction with a novel anatomic technique using hamstring tendon autograft and fixed loop suspensory device. From 2016 to 2018, 25 patients who underwent combined reconstruction of ACL and ALL in our Institution were evaluated retrospectively. International Knee Documentation Committee (IKDC) Score, Tegner Lysholm Knee Score, grade of pivot shift was assessed at a final follow-up. Mean follow-up was 31.5months (28-42). Mean IKDC (81.5) and Tegner Lysholm (82.8) Knee Scores improved significantly at a final follow-up, with all knees demonstrating negative pivot shift. All patients had good outcomes at 2years follow-up with no graft failure and with no residual instability. ACL and ALL reconstruction using this technique described for the anterolateral instability of the knee was satisfactory in our patients. This technique is simple, easily reproducible and avoids additional implants for ALL in the tibia. IV.

ACL Repair of Femoral Osseous Avulsion in a 13-Year-Old Using Suture Pullout Technique

Background: The incidence of pediatric anterior cruciate ligament (ACL) injuries has been increasing over the past 20 years, with the majority comprised of mid substance tears or tibial eminence avulsion fractures. Pediatric femoral sided osseous avulsion is rarely reported in orthopedic literature and specific surgical indications and contraindications, as well as recommended surgical techniques and postoperative rehabilitation protocols, are underdefined. Indications: The surgical indications for femoral-sided repair of ACL osseous avulsion includes a displaced osseous fragment and ligamentous laxity on physical examination. There was no concomitant midsubstance tear necessitating reconstruction. Technique Description: Two sutures piercing the proximal ligamentous bony junction of the ACL were fed through 2.4-mm transphyseal tunnels and secured with cortical button and backup fixation with a 3.9-mm swivel lock anchor in the proximal lateral femoral metaphysis. The patient was immobilized in a hinged-knee brace locked in extension during ambulation and limited to 90 degrees of flexion while nonweightbearing for the first 6 weeks after surgery. Standard ACL protocol was followed thereafter. Results: Successful fixation and restoration of ligamentous tension and impingement-free range of motion were achieved without complication. There was stable Lachman, negative pivot shift, 125 degrees of knee flexion, and evidence of early healing at 3 months follow-up. Discussion/Conclusion: This report demonstrates successful reduction and fixation of proximal bony avulsion of the ACL. Although this patient exhibits stable physical examination and undisturbed growth at early follow-up, more research is required to establish treatment and rehabilitation guidelines for this rare injury.

Anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft through transtibial tunnel: Functional results after 7 years of follow-up

Background: The anterior cruciate ligament (ACL) reconstruction is conducted to improve the stability and function of the knee. Bone-patellar tendon-bone (BPTB) graft is still considered as one of the best grafts for ACL reconstruction. The purpose of this paper was to assess outcomes of BPTB ACL reconstruction at 7 years of follow-up. Materials and Methods: This was a retrospective study in which records of 26 patients, who had ACL reconstruction using BPTB graft from 2013 to 2015, were done and the outcomes of results were analyzed by clinical Tegner activity levels and Lysholm score at 6–8 years of follow-up. Results: The follow-up study has revealed excellent long-term results. Approximately 87% of 26 patients had negative pivot shift examination with the remaining 13% having grade 1 ligament laxity. Tegner activity levels were similar to preinjury levels and Lysholm score was 91. All patients were satisfied with the procedure. Conclusion: BPTB ACL reconstruction using transtibial tunnel provides a satisfactory mid-term follow-up outcome.

The Effect of Combined Anterolateral and Anterior Cruciate Ligament Reconstruction on Reducing Pivot Shift Rate and Clinical Outcomes: A Meta-analysis

To determine whether combined anterior cruciate ligament reconstruction (ACLR) and anterolateral ligament reconstruction (ALLR) result in better knee rotatory stability and postoperative clinical outcomes than ACLR alone. A computer literature search was conducted of Medline (1982 to April 2020), Embase (1982 to April 2020), OVID (1982 to April 2020), and the Cochrane Library (1982 to April 2020) to screen all therapeutic trials on combined ACLR and ALLR versus isolated ACLR. Only level of evidence I and II clinical studies were included. The outcome measures included (1) objective knee stability examination such as anterior drawer test, Lachman test, KT-arthrometer measurement, and pivot shift test; (2) patient-reported outcomes such as International Knee Documentation Committee (IKDC), Tegner activity score, and Lysholm score; (3) return to play; and (4) graft rupture rate. Data were extracted, pooled, and analyzed to compare the 2 groups. A total of 890 studies were screened, and 884 were excluded. Six clinical trials with 828 subjects were included in the final meta-analysis. In comparison to patients received combined ACLR and ALLR, patients who received isolated ACLR had a significantly lower negative pivot shift test rate (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.23 to 0.92, I2= 0%, P= .03, 95% prediction interval [PrI] 1.00 to 2.26), Lysholm score (mean difference -2.79, 95 % CI -4.68 to -0.91, I2= 77 %, P= .004, 95% PrI -10.81 to 5.42), Tegner score (mean difference -0.57, 95% CI -1.12 to -0.02, I2= 90 %, P= .04, 95% PrI -3.12 to 1.93). Combined ALLR and ACLR could effectively augment knee rotatory stability by reducing pivot shift rate and moderately improve patients' clinical outcomes. However, the effect of ALLR on overall graft rupture rate cannot be confirmed. II, meta-analysis of level I and II studies.

Arthroscopic Primary Repair for Partial Proximal Anterior Cruciate Ligament Tear in Military Personnel.

To evaluate the short-term clinical outcomes of arthroscopic primary repair for partial proximal anterior cruciate ligament (ACL) tear in a young, active duty military population. Retrospective cohort study. A national tertiary-level medical and academic institution. Nineteen active duty military patients with partial proximal ACL tears and excellent tissue quality were included and 18 were finally analyzed. All patients underwent arthroscopic primary repair using a suture anchor technique between March 2014 and June 2016. Clinical outcomes were evaluated using anterior drawer test (ADT), Lachman test, pivot shift test, 3-km run test, 10 m × 5 shuttle run test, physical readiness test (PRT) score, Tegner activity score, Lysholm score, modified Cincinnati score, International Knee Documentation Committee (IKDC) subjective score, and magnetic resonance imaging. At final follow-up, 17 patients had negative ADT, Lachman, and pivot shift examination findings, and 1 patient had a 1+ ADT, negative Lachman, and pivot shift result. Mean 3-km run time at final follow-up was not statistically different from that preinjury (12:55 vs 12:39, P = 0.071), nor were the 10 m × 5 shuttle run time (23.4 vs 22.9, P = 0.235), PRT score (82.5 vs 85.1, P = 0.086), and Tegner activity score (7.8 vs 7.9, P = 0.083). Mean Lysholm score at final follow-up was significantly improved compared with that preoperative (93.1 vs 70.7, P < 0.001), so were the modified Cincinnati score (90.4 vs 58.6, P < 0.001) and IKDC subjective score (88.3 vs 67.4, P < 0.001). Arthroscopic primary repair can achieve short-term clinical success in high-demand military patients with partial proximal ACL tears and excellent tissue quality.

Evaluation of Anterolateral Ligament Healing After Anatomic Anterior Cruciate Ligament Reconstruction

Background: Few studies have reported the healing process of anterolateral ligament (ALL) injuries. Purpose/Hypothesis: This study investigated the healing status of ALL injuries after primary anterior cruciate ligament (ACL) reconstruction (ACLR). Additionally, we investigated the association between the healing status of ALL injuries and associated lesions such as osseous lesions and meniscal tears occurring at the time of an ACL rupture. We hypothesized that acute ALL injuries show a high rate (more than two-thirds) of healing at the 1-year follow-up after ACLR and that concomitant lesions observed at the time of an ACL rupture affect the healing status of the ALL. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively investigated patients with ALL injuries who underwent primary ACLR between March 2015 and February 2017. Using magnetic resonance imaging (MRI), we evaluated the features of ALL injuries and concomitant lesions, and MRI was performed at the 1-year follow-up to assess the healing status of the ALL. We investigated the association between the healing status of the ALL and concomitant lesions observed at the time of an ACL rupture. A subjective assessment was performed using the Lysholm score, International Knee Documentation Committee subjective score, and Tegner activity scale. Objective tests included an isokinetic strength assessment and functional performance testing. Results: With respect to the severity of ALL injuries, of 54 patients, a complete rupture occurred in 16 (29.6%) of the 54 patients and a partial rupture in 38 (70%). A significant association was observed between the severity of ALL injuries and bone contusions (lateral tibial plateau and medial tibial plateau [MTP]) and meniscus ramp lesions (Fisher exact test: P = .023, .012, and .023, respectively). Good and partial healing of the ALL occurred in 16 (29.6%) and 23 (42.6%) of 54 patients, respectively. Scar formation occurred in 12 (22.2%), and nonvisualization of the ALL was observed in 3 (5.6%) of 54 patients. Poor healing of the ALL was associated with preoperative MTP bone contusions and a high-grade pivot shift. Multivariate analysis showed that an MTP bone contusion was an independent risk factor associated with poor healing of the ALL. Among the functional tests performed, significant differences were observed between the good and poor healing groups with respect to the carioca test (P = .039). The good healing group (n = 16) showed a negative pivot shift at the last follow-up, whereas 5 (13.2%) of the patients from the poor healing group (n = 38) showed a positive pivot shift, including 2 (5.3%) with a high-grade pivot shift. Conclusion: Approximately 70% of acute ALL injuries showed poor healing at the 1-year follow-up. Poor healing of ALL injuries was significantly associated with preoperative MTP bone contusions and a high-grade pivot shift. Therefore, a careful assessment of posteromedial bone contusions at the time of an ACL rupture is warranted, particularly in patients with a high-grade pivot shift.

Pediatric tibial eminence fracture treatment: A case series using a bioabsorbable screw

BackgroundPediatric tibial eminence fractures constitute a complex injury with multiple treatment options. We have described a technique that combines direct visualization through an open approach and stable fixation using a bioabsorbable screw. The purpose of this study is to describe our surgical technique for tibial eminence fractures and to compare the radiographic and functional outcomes to previous open or arthroscopic methods. MethodsWe retrospectively reviewed a series of five pediatric patients who underwent open reduction and internal fixation of a tibial eminence fracture with a headless, bioabsorbable poly-L lactic acid (PLLA) screw (Bio-Compression screw, Arthrex Inc, Naples, FL) from 2016 to 2017. The surgical technique involves an open approach, direct fracture reduction, and fixation with a PLLA screw without violating the epiphyseal plate. Postoperative assessment was quantified using the Lysholm knee score (LKS), knee arc of motion (AOM), presence of a pivot shift or Lachman, and knee radiographs with an average of 18.4 months of follow-up. ResultsFive patients (average age of 11.3 years) were treated with a biobsorbable screw and followed for an average of 18.4 months. Average LKS was 99.6, AOM was 98.4%, all patients had negative pivot shift and Lachman exams, and all patients went on to radiographic union. No patients required re-operation or implant removal. ConclusionsThe goals of tibial eminence fracture management are fracture union, restoring knee stability, and regaining normal knee motion and kinematics. Our study demonstrates that open treatment with a bioabsorbable screw is an excellent alternative surgical method as it reliably results in rigid fixation, fracture union, excellent knee function scores, and it mitigates the possible need for hardware removal. Level of evidenceTherapeutic Level IV – Case series.

An interventional study on functional outcome of combined anterior cruciate ligament and anterolateral ligament reconstruction

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The anterolateral ligament (ALL) is an important structure for rotational stability of knee joint after anterior cruciate ligament (ACL) rupture. Outcome of combined ACL and ALL reconstruction will change view of high demanding ACL tear cases.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A hospital based prospective interventional study was done in Department of Orthopaedics, SMS Medical College, Jaipur to find the functional outcome of combined anterior cruciate ligament and anterolateral ligament reconstruction. A total of 45 patients underwent ACL and ALL reconstruction. Indications for a combined procedure were associated grade 3 pivot shifts, high level of sporting activity and pivoting sports. Patients were assessed pre- and post-operatively with objective and subjective International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean follow up time was around 5 months. Two patients lost to follow up. Leaving 45 patients for final evaluation. At the last follow-up, all patients had full range of motion. The Lysholm, subjective IKDC, and objective IKDC scores were significantly improved (all p&amp;lt;0.0001). Pre-operatively, 38 patients had a grade 3 pivot shifts and 7 had a grade 2 according to the IKDC criteria. Post-operatively, 42 patients had a negative pivot shift (grade 0), and 3 patients were grade 1 (p&amp;lt;0.0001).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study demonstrates that a combined reconstruction can be an effective procedure without specific complications at a minimum follow-up of 6 months. Longer follow up is required to know any long term complications and functional outcome.&lt;/p&gt;