Partial Anterior Cruciate Ligament Research Articles

Early degenerative changes are different between partial and complete anterior cruciate ligament injury and associate with joint instability in a skeletally immature porcine model

ObjectiveAnterior cruciate ligament (ACL) injuries are a major problem in the pediatric and adolescent populations. Some of these injuries are only partial; yet, there is limited data to inform clinical treatment of such partial tears. It is unknown how injury partial injury impacts long-term degenerative changes in the joint relative to complete injury. In this study, we hypothesized that partial (anteromedial (AM) or posterolateral (PL) bundle) tears would result in small levels of instability and degeneration relative to complete ACL tears and that the degree of degeneration would associate with joint instability. DesignPartial (isolated AM or PL bundle) or complete ACL injury was arthroscopically created in 3-month-old juvenile pigs. The contralateral limb served as a sham-operated control. Six months after injury, joint biomechanics was assessed along with cartilage and meniscus degeneration (via MRI, gross imaging, and histology). ResultsJoint laxity increases were minimal after PL bundle injury (difference relative to controls (confidence interval): 0.5 (-1.2-2.2) mm), minor after AM bundle injury (3.7 (2.0-5.4) mm), and major after ACL injury (15.8 (13.7-17.8) mm). Cartilage MRI T1ρ relaxation times increased minimally after PL bundle injury (-0.9 (-5.1-3.3) ms for lateral tibia), moderately after AM bundle injury (6.6 (1.7-11.4) ms), and substantially after ACL injury (10.8 (2.1-19.5) ms). Changes in meniscus volume followed a similar rank order. Degeneration was associated with the extent of joint destabilization. ConclusionsThese findings suggest that cartilage and meniscus degeneration in the skeletally immature joint are associated with joint laxity after partial and complete ACL injuries.

Comparison between a Novel Knee Arthrometer and Simultaneous Stress Radiography for the Diagnosis of Complete and Partial Acute Anterior Cruciate Ligament Tears.

The type of ligamentous tear and the degree of knee laxity have important guiding significancefor the diagnosis and management of anterior cruciate ligament (ACL) tears. Instrumental measurement is necessary for ACL tears since physical examination and magnetic resonance imaging (MRI) cannot provide an objective and quantitative assessment of knee laxity. This study aimed to compare the application of a novel knee arthrometer and simultaneous stress radiography in differentiating between complete and partial acute ACL tears, and further assess the correlation between the two measurements. A total of 106 patients with complete acute ACL tears and 52 patients with partial acute ACL tears were included in the study. Preoperative arthrometry and simultaneous stress radiography were performed using the Ligs arthrometer at 90, 120, and 150 N to assess side-to-side difference (SSD) in anterior knee laxity. The optimal threshold was determined using the receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) was used to assess the diagnostic value of the measurement. Pearson's correlation coefficient was used to assess the correlation between the two measurements. The optimal differential SSD thresholds in the Ligs arthrometer were 2.7 mm at 90 N, 3.8 mm at 120 N, and 4.6 mm at 150 N. Similarly, the optimal differential SSD thresholds in simultaneous stress radiography were 3.8 mm at 90 N, 5.1 mm at 120 N, and 5.6 mm at 150 N. The AUC analysis revealed that the Ligs arthrometer was fairly informative at 90 N (AUC = 0.851), 120 N (AUC = 0.878), and 150 N (AUC = 0.884), and simultaneous stress radiography was highly informative at 90 N (AUC = 0.910), 120 N (AUC = 0.925), and 150 N (AUC = 0.948). Moreover, the AUC of the combined measurements was 0.914 at 90 N, 0.931 at 120 N, and 0.951 at 150 N. A significantly strong correlation was found between the two measurements at 90 N (r = 0.743, p < 0.001), 120 N (r = 0.802, p < 0.001), and 150 N (r = 0.823, p < 0.001). The Ligs arthrometer and simultaneous stress radiography proved to be valid diagnostic tools to differentiate between complete and partial acute ACL tears, with a strong correlation between the two measurements in SSD values. Compared with single instrumental measurement, the combination of the two measurements can further improve the diagnostic value in this regard.

The angle of the lower portion of the posterior cruciate ligament assists in the diagnosis of partial anterior cruciate ligament tears.

To compare the difference of angle of the lower portion of the posterior cruciate ligament (PCL) measured via magnetic resonance imaging (MRI) in patients with and without partial anterior cruciate ligament (ACL) tears and to investigate the effectiveness of the angle of the lower portion of the PCL in diagnosing partial ACL tears. From January 2022 to December 2022, a cohort of consecutive patients presenting with ACL tears who underwent ACL reconstruction and patients with isolated meniscus tears undergoing arthroscopic surgery were enroled for this study. The angle of the inferior portion of the PCL comprises α and β angles, and the posterior offset of the lateral condyle were measured on the MRI and compared between the partial ACL tear and control groups. Receiver operating characteristic curves, the areas under the curve (AUCs) and the 95% confidence intervals (CIs) were calculated to identify cutoff values for diagnosing partial ACL injuries. Following an assessment of cohort eligibility and matching for age and sex, 100 patients were included in this study. The mean age of the cohort was 46.1 ± 10.3 years. The AUC for the α angle was 0.88 (95% CI, 0.82-0.94), with a sensitivity of 0.74 and specificity of 0.84 for predicting partial ACL ruptures; the α angle cutoff value was 73.6° (diagnostic odds ratio (OR), 14.10; 95% CI, 5.33-37.28). The AUC for the β angle was 0.86 (95% CI, 0.79-0.93), with a sensitivity of 0.64 and a specificity of 0.92 for predicting partial ACL ruptures; the β angle cutoff value was 73.3° (diagnostic OR, 14.54; 95% CI, 5.76-36.68). A small α angle and a large β angle were associated with partial ACL tears. The angle of the distal portion of the PCL was simple to measure and reproducible, enhancing the diagnosis of partial ACL tears. Level III.

The potential of posterior cruciate ligament buckling phenomenon as a sign for partial anterior cruciate ligament tears.

Diagnosis of a partial tear of the anterior cruciate ligament (ACL) can be challenging with physical examination and imaging techniques. Although magnetic resonance imaging (MRI) has high sensitivity and specificity for diagnosing complete ACL tears, its effectiveness may be limited when it is used to diagnose for partial tears. The hypothesis of the present study is that the posterior cruciate ligament (PCL) buckling phenomenon, which is a secondary sign of complete ACL tears on MRI, may be a useful method for diagnosing partial ACL tears. The data of 239 patients who underwent knee arthroscopy in a single institution between 2016 and 2022 were analyzed retrospectively. Patients were divided into three groups based on the condition of their ligaments: partial tears, complete tears and intact ligaments. To evaluate the buckling phenomenon on sagittal T2-weighted MRI, measurements of the posterior cruciate ligament angle (PCLA) and the posterior cruciate ligament-posterior cortex angle (PCL-PCA) were conducted in each group. Subsequently, the ability of these two measurement methods to distinguish partial tears from the other groups was assessed. Both methods provided significantly different results in all three groups. Partial tears could be distinguished from intact ligaments with 86.8% sensitivity, 89.9% specificity when PCLA < 123.13° and 94.5% sensitivity, 93.2% specificity when PCL-PCA < 23.77°. Partial tears could be distinguished from complete tears with 79.5% sensitivity, 78.4% specificity when PCLA > 113.88° and with 86.1% sensitivity, 85.3% specificity when PCL-PCA > 16.39°. The main finding of the present study is that the PCLA and PCL-PCA methods are useful on MRI for diagnosing partial ACL tears. PCLA value between 113°-123° and PCL-PCA value between 16°-24° could indicate a partial ACL tear. With these methods, it is possible to distinguish partial tears from healthy knees and reduce missed diagnoses. In addition, the differentiation of partial and complete tears by these methods may prevent unnecessary surgical interventions. Level III.

Nonoperative Treatment for Traumatic Partial Graft Rupture After Anterior Cruciate Ligament Reconstruction: A 2-Year Follow-up Study.

There are no studies on the nonoperative treatment of traumatic partial anterior cruciate ligament (ACL) graft rupture. The purpose of this study was to compare the clinical and radiological outcomes and failure rates between nonoperative treatment and revision ACL reconstruction for traumatic partial ACL graft rupture. We hypothesized that the outcomes and failure rates would be comparable and that nonoperative treatment of traumatic partial ACL graft rupture can produce satisfactory outcomes. Cohort study; Level of evidence, 3. We retrospectively evaluated 2114 patients treated for isolated ACL rupture between January 2000 and June 2020. Patients with traumatic partial graft rupture after ACL reconstruction with minimum 2-year follow-up data were included. Patients who met all the following conditions were candidates for nonoperative treatment: (1) Lachman or pivot-shift grade 0 or 1 at 6 months after ACL reconstruction, (2) ACL graft with low to intermediate signal intensity on 1-year postoperative magnetic resonance imaging (MRI), and (3) MRI after reinjury showing definite evidence of trauma, some fibers remaining in continuity of the ACL graft, and no anterior tibial subluxation in the sagittal plane. The patients were divided into 2 groups according to treatment method: nonoperative treatment (group A) and revision ACL reconstruction (group B). Clinical scores, laxity test results, radiological outcomes, and graft failures were compared between the groups. In total, 47 patients had traumatic partial graft rupture (group A, n = 10; group B, n = 37). There were no significant differences between the 2 groups in terms of clinical scores, laxity tests, radiological outcomes, or graft failure. The clinical and radiological outcomes of nonoperative treatment of traumatic partial graft rupture after ACL reconstruction were comparable with those of revision ACL reconstruction. Nonoperative treatment of traumatic partial ACL graft rupture can produce satisfactory outcomes in selected patients.

GNRB® laximeter with magnetic resonance imaging in clinical practice for complete and partial anterior cruciate ligament tears detection: A prospective diagnostic study with arthroscopic validation on 214 patients

BackgroundAccurate diagnosis of anterior cruciate ligament (ACL) injury is not always obtained with magnetic resonance imaging (MRI). Other tools, such as the GNRB® arthrometer, help to accurately identify the type of ACL tear. The aim of this study was to show that the GNRB® could be a relevant complementary solution to MRI in ACL injuries detection. MethodsA prospective study performed between 2016 and 2020 included 214 patients who had undergone knee surgery. The study compared sensitivity/specificity pairs of MRI and the GNRB® at 134 N to detect healthy ACL, partial and complete ACL tears. Arthroscopies were the ‘gold standard’. Forty-six patients had a healthy ACL with associated knee lesions, 168 patients had ACL tears where 107 were complete tears and 61 were partial tears. ResultsFor healthy ACL, MRI scored 100% for sensitivity (SE) and 95% for specificity (SP), and the GNRB® scored SE 95.65% and SP 97.5% at 134 N. For complete ACL tears, MRI scored 80.81% for sensitivity (SE) and 64.49% for specificity (SP), and the GNRB® scored SE 77.78% and SP 85.98% at 134 N. For partial tears, MRI scored SE 29.51% and SP 88.97%, and the GNRB® scored SE 73.77% and SP 85.52% at 134 N. ConclusionGNRB® sensitivity and specificity were equivalent to those of MRI for healthy ACL and complete ACL tear detection. However, MRI had some difficulty in detecting partial ACL tears compared with the GNRB® which showed better sensitivity.

Regeneration of Partial Anterior Cruciate Ligament Tears Using the Technique of Biologic Augmentation with Bone Marrow Concentrate and Platelet-Rich Plasma Under Arthroscopic Visualization

To present clinical outcomes in a preliminary patient cohort using a biologic augmentation technique consisting of intra-ligamentous and intra-articular infiltration of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) under arthroscopic visualization for treatment of isolated and acute partial anterior cruciate ligament (ACL) tears. Athletes with an acute symptomatic partial ACL injury with clinical examination findings of increased anterior tibial translation without rotational instability were treated with the biologic augmentation technique. Patients were followed for 2 years postoperatively. The Lysholm Knee Questionnaire, IKDC Objective score, physical examination findings, MRI, and the KT-1000 arthrometer were used to assess clinical outcomes. Five patients were included in the analysis with a median age of 22. All patients were determined to have a healed ACL on MRI 8 months postoperatively. The median Lysholm Score at the final follow-up of 99 was significantly increased from the median pre-operative score (p = 0.042). In addition, the objective IKDC score improved in all patients postoperatively, and no clinical examination findings of knee instability were identified at the final follow-up. The median side-to-side difference in KT-1000 arthrometer testing was 3 mm pre-operatively and 0 mm at the last follow-up (p = 0.038). The treatment of appropriately indicated partial ACL injuries in this study has demonstrated that restoration of ligamentous structure and function may be achieved by a biologic augmentation technique using intra-ligamentous and intra-articular infiltration of BMAC and PRP. This technique is performed with minimal technical difficulty, leading to excellent 2-year clinical outcomes in this preliminary series of patients.

Reliability and assessment of partial or complete anterior cruciate ligament injuries with diagnostic arthroscopy

Background: Partial tears of anterior cruciate ligament (ACL) were more commonly identified in young group with knee twisting. Partial tears are characterized by tear involvement of less than 50% of the ligament is torn. The arthroscopic evaluation is considered as gold standard in diagnostic evaluation. The comparison of findings between partial and complete tears in magnetic resonance imaging (MRI) and arthroscopy helps in finding out reliability of diagnostic modalities and consider the surgeon to establish the plan of treatment. Methods: 2-year prospective study at the department of orthopedics, RRMCH, Bangalore, India. 40 consecutive patients with suspicion of cruciate injuries of knee were selected for the study from July 2018 to May 2021. The MR imaging of knee in selected cases were performed and the findings were obtained. The descriptive statistical analysis was prepared which includes spectrum of MRI findings in cruciate injuries of knee that were correlated with arthroscopy findings in determining the accuracy. Results: Total 40 patients, we obtained 100% sensitivity and 66.67% specificity, 93.75% accuracy of MRI with arthroscopy in diagnosing complete ACL tears. We obtained 90.91% sensitivity and 80% specificity, 87.50% accuracy of MRI with arthroscopy in diagnosing partial ACL tears. Conclusions: The partial tears can be missed or can be over diagnosed on MRI. These misinterpretations are more likely to happen due to intra-substance signal abnormality. Description of the status of ACL ligament in arthroscopy helped the orthopaedic surgeons in decision making as conservative approach in partial tears and reconstruction in a complete tear.

Results of following selective bundle reconstruction in partial anterior cruciate ligament tears by All-inside technique

Objectives: To evaluate the outcome of selective reconstructive anterior cruciate ligament (ACL) surgery using the All-inside technique with a four-strand semitendinosus or gracilis autograft tendon. Subject and methods: 34 patients were diagnosed with a partial tear of the ACL and underwent selective reconstructive surgery at the Orthopedic Center, Military Hospital 103 from November 2018 to September 2020. Lysholm knee scale and IKDC class were used to access post-operatively clinical outcomes. Stability was evaluated using the anterior drawer test, the Lachman test, the Pivot shift test, and the Rolimeter measure at 20o of knee flexion. Results: The pre-operative and post-operative Lysholm scores were 49.5 ± 18.4 and 94.47 ± 6.81, respectively (p &lt; 0.001). Pre-operatively, most patients were classified as C and on the IKDC score. At the final follow-up, IKDC scores included 22 class A, 10 class B, 2 class C (p &lt; 0.001). The pre- and post-operative laxity measured by Rolimeter were 5.15 ± 1.5 mm and 1.74 ± 1.34 mm, respectively (p &lt; 0.001). Pre-operatively and post-operatively, the Pivot-shift was absent in all cases. Conclusion: Selective reconstruction of the injured ACL bundle restores knee stability and function. All-inside technique can be used to reconstruct the rupture ACL bundle with many advantages. Longer follow-up is needed to fully evaluate clinical outcomes after selective reconstruction in partial ACL tears.&#x0D; * Keywords: All-inside; Partial tear; Selective reconstruction.

Influences of Partial Anterior Cruciate Ligament Injury on Anterior Cruciate Ligament Tensional Force and Kinematic Stability During Walking.

Injuries in the anterior cruciate ligament (ACL), including partial tear and lengthening of the ACL, change the dynamic function of the knee. However, there is a lack of information on the effect of ACL partial tear on knee kinematics during walking. This study aimed to investigate the effects of different levels of ACL injuries on knee stability and ACL tensional force to identify the critical injury level. Motion data of five normal subjects were acquired along with the ground reaction force. A knee model with 14 ligaments was developed using cadaveric specimen data. The initial length and stiffness of the ACL were changed to develop ACL-injured knee models. Musculoskeletal simulations of the knee models were performed using the measured gait data. The average tibial anterior translation increased significantly by 2.6 ± 0.7 mm when the ACL stiffness decreased to 25% of its original stiffness. The average tibial anterior translation increased significantly by 2.6 ± 0.3 mm at an increase in initial length of 10%. The knee with partial ACL tear had a nonlinear decrease in ACL forces owing to the increase in the level of ACL injury, while the knee with ACL lengthening had linear decreased ACL forces. The partial tear of the ACL caused translational instability, while the complete tear caused both rotational and translational instabilities during the musculoskeletal walking simulation. This study presents the effects of partial ACL injuries on joint kinematics and ACL tensional force during the dynamic motion of walking.

Effectiveness of ultrasound guided platelet rich plasma injection in comparison with standard conservative treatment on improving pain and function among the athletes with partial anterior cruciate ligament injury of knee: a randomized controlled trial

Background: Anterior cruciate ligament (ACL) injuries are one of the most common ligamentous injuries of knee. Treatment options for partial ACL tear range from conservative treatment up to partial reconstruction. PRP may have enhancing effect on ACL cell viability and promotion of cell proliferation in partial tear of ACL. Thus, the purpose of this study is to determine the role of PRP on partial ACL tear.Methods: A RCT was done among athletes with partial ACL injury who visited department of Sports Medicine, RIMS, Imphal during June 2019-December 2020. Patients with MRI diagnosed grade 1 and 2 ACL injury (n=48) randomized into PRP injection plus rehabilitation, (n=24) and rehabilitation alone, (n=24) groups. The outcomes were compared using International Knee Documentation Committee (IKDC) score, Lysholm score and VAS at baseline, 1st month, 4th month, 8th month and 12th month respectively.Results: Baseline characteristics were not statistically significant. At the end of 1st month, there were statistically significant improvement in both mean difference of IKDC score (.001), Lysholm score (0.001) and VAS (0.007). At the end of 4th month, there were statistically significant improvement in both mean difference of IKDC score (0.001), Lysholm score (0.026) and VAS (0.001). At the end of 8th and 12th month, improvement in mean difference of IKDC score, Lysholm score, VAS were observed however not statistically significant.Conclusions: Ultrasound guided PRP injection along with conservative rehabilitation program might be a treatment choice for ACL partial tear.

Outcomes, Including Graft Tears, Contralateral Anterior Cruciate Ligament Tears, and All-Cause Ipsilateral Knee Operations, are Similar for Adult-type, Transphyseal, and Partial Transphyseal Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft in Pediatric and Adolescent Patients

PurposeTo compare hamstring autograft primary anterior cruciate ligament reconstruction (ACLR) techniques including adult-type/anatomic, transphyseal, and transphyseal techniques by (1) ACL graft tear, (2) contralateral ACL tear, and (3) all-cause ipsilateral reoperation.MethodsA retrospective, single-surgeon review was performed including all ACLR with hamstring autograft in pediatric and adolescent patients from 2011 to 2019. Minimum 2-year follow-up was required for patients unless a tear or reoperation was sustained before that time point. Data collected included demographics and baseline surgical variables, type of reconstruction, sporting activity, and deviations from rehabilitation protocols. Comparisons were made among hamstring autograft reconstruction groups (adult-type/anatomic, transphyseal, and partial transphyseal) for primary outcomes of graft tear, contralateral ACL tears, and all-cause ipsilateral knee reoperations, including hardware removal. Secondary surgeries performed with different surgeons were noted.ResultsIn total, 214 patients of age 15.2 ± 2.0 years with 4.1 ± 1.7-year follow-up were included. Overall graft tear rate was 11.7% (11.0% adult-type vs 19.1% transphyseal vs 5.6% partial transphyseal; P = .18). On univariate analyses, all-cause ipsilateral reoperation did not differ by technique (21.3% vs 31.0% vs 33.3%; P = .20), and neither did contralateral ACL tear (8.1% vs 9.5% vs 0%; P = .17). 21.7% of ipsilateral revision ACLRs (all adult-type) and 16.7% of patients with any reoperations had subsequent procedures performed with a different surgeon.ConclusionsThe graft tear rates in primary hamstring autograft ACLRs in the adolescent population did not significantly differ by technique (11.0% vs 19.1% vs 5.6% in adult-type, transphyseal, and partial transphyseal reconstructions, respectively). Furthermore, contralateral ACL tears (8.1% vs 9.5% vs 0%) and all-cause (including > 1/4 hardware removal) ipsilateral knee reoperations (21.3% vs 31.0% vs 33.3%) did not statistically differ. Higher powered studies may detect statistical significance in the observed differences in this study.Level of evidenceLevel IV, therapeutic case series.

Magnetic Resonance Imaging (MRI) Based Diagnosis of Anterior Cruciate Ligament (ACL) TEARS in Patients with Internal Derangements of Knee

Objective: To assess the role of magnetic resonance imaging (MRI) in diagnosing anterior cruciate ligament (ACL) tears in patients with knee internal derangements.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Department of Radiology, Combined Military Hospital, Kharian Pakistan, from Sep 2019 Aug 2020.&#x0D; Methodology: 40 patients of any age and gender were part of the study with painful or unstable knee joints. A clinical examination was performed after recording demographic data. In addition, MRI was performed, and primary and secondary signs were noted for each case.&#x0D; Results: The range of patients was 15 to 63, with a mean age of 36.3 ± 12.62 years. Most of the patients were male (n=29; 72.5%), whereas only 11 (27.5%) were females. In total, 27 (67.5%) complete and 13 (32.5%) partial Anterior cruciate ligament (ACL) tears were present. Blumensaat’s angle&gt; 15 degree was present in 10 (37.03%) complete tear cases and 2 (15.38 %) partial tear cases. Anterior tibial displacement was evident in 4 (14.81%) complete tear cases and 3 (23.07 %) partial tear cases. Posterior cruciate line (PCL) angle was apparent in 21 (77.77%) complete tear cases and 12 (92.30 %) partial tear cases.&#x0D; Conclusion: The use of MRI is advocated for diagnosing Anterior cruciate ligament (ACL) tears in patients with knee internal derangements.

Outpatient-based diagnostic criteria for partial ACL injury: clinical outcomes of non-operative treatment and radiographic predictor.

This study aimed to (1) evaluate the short-term clinical outcomes of patients who underwent non-operative treatment for partial anterior cruciate ligament (ACL) tears diagnosed using the outpatient-based diagnostic criteria and (2) investigate the radiographic predictors distinguishing patients at risk of non-operative treatment failure. From 2010 to 2019, patients diagnosed with partial ACL tears and treated with non-operative treatment were reviewed retrospectively. Patients were then classified into two groups: those who successfully responded to non-operative treatment (group S) and those who failed to respond to non-operative treatment and required surgical reconstruction within 6months after injury (group F). ACL laxity, patient-reported outcomes (PROs), and several radiographic parameters were analyzed. To identify radiographic predictors related to clinical outcomes, radiographic parameters were compared between the groups, which were statistically matched for potential confounders (age and activity level) using inverse probability of treatment weighting. A total of 44 patients were analyzed (mean age, 28.7 ± 8.7years; 31 men), and classified into two groups (group S, 23 patients; group F, 21 patients). There were no significant differences in ACL laxity and PROs between the groups at 1year after either non-operative treatmentor surgical reconstruction. Acomparison of radiographic parametersbetween the groups revealed significant differences in several parameters related to secondary signs of ACL injury. Subsequent regression analyses revealed that anterior tibial translation and extent of bone bruises were radiographic predictors related to clinical outcomes. Non-operative treatment for partial ACL tears diagnosed using the outpatient-based diagnostic criteria can provide successful short-term clinical outcomes in selective patients. Secondary signs of ACL injuries, particularly the amount of anterior tibial translation and the extent of bone bruises, are radiographic predictors that could differentiate patients at risk of non-operative treatment failure. Retrospective cohort study, III.

Selective bundle reconstruction for symptomatic partial anterior cruciate ligament tears demonstrates good functional scores, high return to sport rates and a low re-tear rate

BackgroundThe treatment of symptomatic partial anterior cruciate ligament (ACL) tears remains controversial. This study investigated the clinical and functional outcome of patients undergoing selective posterolateral (PLB) or anteromedial (AMB) bundle reconstruction. Methods55 consecutive patients underwent partial bundle reconstruction, of which 45 (AMB = 17, PLB = 28) were included in the current analysis (62% male, mean age of 29.1 years). Patients were assessed at 12 and 24 months with patient-reported outcome measures (PROMs), graft laxity (KT-1000), knee extensor and flexor torque and a 4-hop battery. Limb Symmetry Indices (LSIs) were calculated. Return to sport (RTS) rates, re-operations and re-injuries were evaluated. ResultsHigh scoring PROMs were evident, with 62% and 84% of patients participating in pivoting sports at 12 and 24 months, respectively. Overall, 98% of patients demonstrated ‘normal’ knee laxity at 24 months. Mean LSIs for all hop tests were ≥ 90% at 12 and 24 months, with 76–87% of patients demonstrating LSIs ≥ 90% on the four hop tests employed at 12 months, which was 89–93% of patients at 24 months. A mean knee extensor torque LSI of 89% and 97% was observed at 12 and 24 months. Two ipsilateral re-tears (2/55, 3.6%, AMB = 1, PLB = 1) were observed over the 24-month period, with no contralateral ACL tears. ConclusionsHigh levels of physical function and RTS were observed in patients following partial bundle reconstruction, higher than that reported in the literature in patients undergoing ACLR, without evidence of instability and a low re-injury rate.

Image Guided Injection of Anterior Cruciate Ligament Tears with Autologous Bone Marrow Concentrate and Platelets: Midterm Analysis from A Randomized Controlled Trial

Background: There has been a recent emergence in the use of orthobiologics, including platelet-rich plasma (PRP) and bone marrow concentrate (BMC), in the treatment of various musculoskeletal conditions. The goal of this study was to determine if injection of BMC and platelet products into partial and full-thickness anterior cruciate ligament (ACL) tears can facilitate primary ligament healing in patients failing conservative care, resulting in improved outcomes compared to exercise therapy.Methods: Patients were randomized to either exercise therapy or percutaneous injection of autologous BMC with PRP and platelet lysate into the ACL under fluoroscopic guidance. Pain and function were assessed at baseline and at 1, 3, 6, 12, and 24 months. Baseline and 6-month post-treatment magnetic resonance imaging (MRI) were obtained to evaluate interval healing. Laxity was assessed using the Telos device.Results: There was significant improvement in functional outcomes in the BMC group, compared to base-line for LEFS at time points 3 up to 24 months s = 0.000000005), and significant improvement in pain in the BMC group at 6 (p = 0.00054), 12 (p = 0.00127), and 24 months (p = 0.002). There was no significant improvement in pain or function at any time point in the exercise therapy group. There was significant improvement in ACL MRI ImageJ quantitative assessment in the BMC group (p = 0.001) and no difference in the exercise group (p &gt; 0.05). No serious adverse events were reported.Conclusion: Autologous BMC and platelet product injection into ACL tears improved patient function compared to exercise, observed through 24 months. Patients treated with BMC demonstrated quantitative improvements in post-treatment MRI scans suggestive of interval ligament healing.

Age- and Sex-Specific Joint Biomechanics in Response to Partial and Complete Anterior Cruciate Ligament Injury in the Porcine Model.

Pediatric anterior cruciate ligament (ACL) injury rates are increasing and are highest in female adolescents. Complete ACL tears are typically surgically reconstructed, but few guidelines and very limited data exist regarding the need for surgical reconstruction or rehabilitation for partial ACL tears in skeletally immature patients. To evaluate the effects of partial (anteromedial bundle) and complete ACL transection on joint laxity and tissue forces under anterior and rotational loads in male and female stifle joints throughout skeletal growth in the porcine model. Descriptive laboratory study. Laboratory. We studied 60 male and female Yorkshire crossbreed pigs aged 1.5, 3, 4.5, 6, and 18 months (n = 6 pigs per age per sex). Joint laxity was measured in intact, anteromedial bundle-transected, and ACL-transected joints under applied anterior-posterior drawer and varus-valgus torque using a robotic testing system. Loading of the soft tissues in the stifle joint was measured under each condition. Anterior-posterior joint laxity increased by 13% to 50% (P < .05) after anteromedial bundle transection and 75% to 178% (P < .05) after ACL transection. Destabilization after anteromedial bundle transection increased with age (P < .05) and was greater in late female than late male adolescents (P < .05). In anteromedial bundle-transected joints, the posterolateral bundle resisted the anterior load. In ACL-transected joints, the medial collateral ligament (MCL) contribution was largest, followed by the medial meniscus. The MCL contribution was larger and the medial meniscus contribution was smaller in male versus female specimens. Partial ACL transection resulted in moderate increases in joint laxity, with the remaining bundle performing the primary ACL function. Destabilization due to partial ACL transection (anteromedial bundle) was largest in late adolescent joints, indicating that operative treatment should be considered in active, late-adolescent patients with this injury. Increased forces on the MCL and medial meniscus after ACL transection suggested that rehabilitation protocols may need to focus on protecting these tissues.

Is Remnant Preserving Single Bundle Reconstruction Surgery an Effective Method in Partial Anterior Cruciate Ligament Rupture?

Is Remnant Preserving Single Bundle Reconstruction Surgery an Effective Method in Partial Anterior Cruciate Ligament Rupture?

The importance of continuous remnant preservation in anterior cruciate ligament reconstruction.

Selective anteromedial or posterolateral bundle reconstruction is recognized as a treatment modality in partial anterior cruciate ligament (ACL) reconstruction (ACLR) with a biomechanically sufficient ACL remnant. However, there is paucity in literature investigating clinical outcomes of standard ACLR with preservation of residual continuous but biomechanically insufficient ACL tissue. The aim of this study was to investigate the influence of preservation of residual continuous but biomechanical insufficient ACL tissue in standard ACLR on complication and repeat surgery rate, and patient reported and clinical outcome. The retrospective cohort comprised 134 patients (age 23 ± 7years; Tegner 6 ± 3) with an isolated acute ACL tear. In 67 patients, residual continuous but biomechanically insufficient ACL tissue was present and preserved based on visual inspection, probing of the ACL tissue and Lachman test under arthroscopic view (standard reconstruction with tissue preservation; SRTP). These patients were matched to 67 patients that underwent ACLR where no residual ACL tissue could be preserved (standard reconstruction; SR) based on gender, age and chondral and/or meniscal status. Clinical failure (recurrent instability, pathological ACL graft laxity and/or ACL graft discontinuity), other complication and repeat-surgery rate within index surgery and 1-year and within index surgery and 2-year follow-up, and patient reported and clinical outcomes at 1-year and at 2-year follow-up were compared. A statistically significant lower clinical failure rate within index surgery and 1-year (SRTP, 3%; SR, 13%; P = 0.028) and within index surgery and 2-year follow-up (SRTP, 3%; SR, 23%; P = 0.001), and revision ACL surgery rate within index surgery and 1-year (SRTP, 2%; ST, 10%; P = 0.029) and within index surgery and 2-year follow-up (SRTP, 2%; SR, 18%; P = 0.001) was found in the SRTP group. No statistically significant differences were found for other investigated outcomes in patients that were without clinical failure. This study shows that in ACLR surgery, preservation of residual continuous but biomechanical insufficient ACL tissue might lead to lower clinical failure rate and ACL revision surgery rate within index surgery and 1-year, and within index surgery and 2-year follow-up compared to standard ACLR where no residual continuous ACL tissue could be preserved. III.

Comparison of the Use of Magnetic Resonance Imaging of Partial Anterior Cruciate Ligament Tears Using Maximum Knee Flexion in the Lateral Decubitus Position with Routine Knee Positioning

BackgroundThis study assessed magnetic resonance imaging (MRI) of acute and chronic partial anterior cruciate ligament (ACL) tears using maximum knee flexion in the lateral decubitus position compared with routine knee positioning in 204 patients at a single center.Material/MethodsBased on the time interval from injury to MRI examination, the 204 patients in this study were divided into 3 groups: subacute (6 weeks to 3 months), intermediate (3 months to 1 year), and chronic (>1 year). All patients received both routine MRI (MRI R) and maximum knee flexion in the lateral decubitus position MRI (MRI S) examination, followed by knee arthroscopy. Three radiologists blinded to patient groups evaluated the MRI scans and made a diagnosis. Results of knee arthroscopy were referenced as the criterion standard. The sensitivity and specificity of MRI R and MRI S groups were calculated and compared.ResultsThe MRI S diagnostic rate was comparable to that of knee arthroscopy. MRI S had significantly higher sensitivity than MRI R for partial ACL tears, especially in the intermediate group (P<0.01).ConclusionsMRI of partial ACL tears using maximum knee flexion in the lateral decubitus position improved the diagnostic rate relative to routine MRI examination, particularly in patients in the intermediate group.