Primary Arthroscopic Anterior Cruciate Ligament Reconstruction Research Articles

Both Hamstring and Quadriceps Tendon Autografts Offer Similar Functional Outcomes After Arthroscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 50 Years or Older

PurposeThe purpose of this study was to compare the outcomes of hamstring tendon (HT) and quadriceps tendon (QT) autografts for anterior cruciate ligament (ACL) reconstruction in patients older than 50 years in terms of patient-reported functional outcomes, graft failure rates, complications, return to sports activity and the preference for sports. MethodsBetween 2010 and 2022, prospectively collected data were obtained from an institutional database. Patients older than 50 years with primary arthroscopic ACL reconstruction using either HT or QT autograft and a minimum of 2 years of follow-up were included. Patients with concomitant meniscus, cartilage and MCL injury were also included. Patients undergoing a revision ACL reconstruction or undergoing a primary ACL reconstruction using a graft other than HT or QT autograft, and patients with a contralateral knee injury or ipsilateral osteoarthritis (Ahlback stage 2 or higher) were excluded. Patients were evaluated for pre-injury and 2-year follow-up Lysholm knee score, Tegner activity level, Visual Analog Scale (VAS) for pain, graft failure, quadriceps tendon rupture, and return to sport. Mann-Whitney test was used for unpaired samples, whereas the Friedman test was used for analyzing variables over time. The chi-square statistic test was used to determine differences in categorical data between groups ResultsThe number of patients in the QT and HT groups was 85 and 143 respectively. The mean age was 54.4 [50-65] and 56.4 [50-65] for the QT and HT groups respectively, 49% and 51% were males in the QT and HT groups respectively. The two groups did not differ significantly in terms of age, gender, time from injury to surgery and concomitant injuries. No significant differences were found in the pre-injury patient-reported outcome scores (PROMs) as Lysholm, Tegner activity level and VAS for pain between the two groups (p>0.05). At the 2-year follow-up, Lysholm knee score, Tegner activity level and VAS for pain improved to pre-injury level and no significant difference was noted between pre-injury and 2-year follow-up functional scores between the two groups (p>0.05).Furthermore, at the 2-year follow-up, Lysholm score, and VAS didn't show significant differences between QT and HT groups. (p=.390; p= .131). Similarly, no differences have been reported in Tegner activity level scores between HT and QT groups at 2 years of follow-up. No significant differences in terms of minimal clinically important difference (MCID) have been detected between the two groups for Lysholm and Tegner activity scores (p = 0.410 and p = 0.420 for Lysholm score and Tegner activity level score respectively).The two groups did not differ in terms of patient’s percentage of sports participation at baseline, and 2 years of follow-up (p>0.05). A significant decrease (p=0.01) in skiing/snowboarding was reported in the HT group at a 2-year follow-up compared to baseline [116 (81%) vs 98 (69%)]. No case of graft failures and quadriceps tendon rupture was reported in either of the groups. ConclusionArthroscopic ACL reconstruction by using HT or QT autograft in athletically active older than 50 years patients provide satisfactory patient-reported functional outcomes and allows recovery of the pre-injury level of activity.

Functional and clinical outcome of arthroscopic primary single bundle anterior cruciate ligament reconstruction using peroneus longus autograft

Background: Peroneus longus tendon (PLT) autograft has emerged as one of the primary graft options for arthroscopic anterior cruciate ligament reconstruction (ACLR). We aimed to study whether PLT autograft could be used as primary graft for arthroscopic single bundle ACLR, without compromising stability of donor ankle. Materials and Methods: A prospective observational study of 120 patients, who underwent single bundle arthroscopic ACLR with ipsilateral PLT autograft was done. Functional outcome of patients were evaluated with international knee documentation (IKDC) and Lysholm knee scores after one year. The donor ankle morbidity was assessed using American orthopedic foot and ankle score (AOFAS) and foot and ankle disability index (FADI) scores. Results: The mean IKDC pre-op subjective score was 55.3 ± 10.7 and after one year follow-up was 91.4 ± 5.86. The mean difference of IKDC score between pre-op and post-op evaluation was 33.1 ± 11.4, with a p-value of <0.001. The pre-operative mean Lysholm score was 67.6 ± 10.8 and on follow-up after 1 year was 93.6 ± 6.3. The mean difference of Lysholm score was 25.1± 10.4, and p-value <0.001. The mean AOFAS score was 98.14 ± 3.16 and the mean FADI score was 98.37 ± 2.71 on one year follow-up. Conclusion: The significant improvements in IKDC and Lysholm knee scores after using PLT autograft, makes it one of the graft choices for ACLR. The apprehension of donor ankle instability is mitigated by excellent AOFAS and FADI scores reported in the study. PLT is an ideal graft choice for arthroscopic primary single bundle ACLR. Keywords: anterior cruciate ligament; peroneus longus tendon; autograft; arthroscopy; ACL reconstruction

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.

Histological and clinical analysis of knee cyclops lesions.

Cyclops Syndrome, first described by Jackson and Schaefer in 1990, is known as a complication of anterior cruciate ligament reconstruction (ACLR). However further researches have demonstrated that cyclops can be present even without symptoms and/or in absence of ACLR, simply configuring itself as a lesion in patients with rupture of the native ligament. This is a retrospective cohort study in which we report our experience of 13 cyclops lesions found between 126 patients during a primary arthroscopic ACLR. Preoperative examination with tests of joint stability and range of movement measurement was performed and recorded. Accurate joint examination was performed during arthroscopy and the cyclops lesions found were removed and analyzed with haematoxylin-eosin coloration. Post-operative clinical examination was performed until 6 months of follow-up. Histological analysis showed proliferation of dense fibroelastic polypoid nodules with a macroscopically histological aspects of a "blue eye", hence the name Cyclops. At 6 months of follow-up after surgery, none of the patients reported pain at terminal extension or instability and they were all able to resume their previous activities. Our study confirmed that surgical reconstruction of the ACL is not the only condition in which the Cyclops Syndrome develops; in fact our histological analysis indicate that the Cyclops lesions develop like a reactive fibroproliferative process following the rupture of the native ACL fibers, as scar reaction to the trauma: for this reason an accurate arthroscopic detection of these Cyclops lesions is crucial during primary ACL reconstruction in order to obtain the best surgical outcomes.

PATIENT-REPORTED OUTCOMES AND REVISION RATES AFTER PRIMARY ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITHOUT CONCOMITANT KNEE INJURY: A COMPARISON OF QUADRICEPS, HAMSTRING, AND BONE-PATELLA-TENDON-BONE AUTOGRAFTS WITH MINIMUM TWO-YEAR FOLLOW-UP

Most previous studies investigating autograft options (quadriceps, hamstring, bone-patella-tendon-bone) in primary anterior cruciate ligament (ACL) reconstruction are confounded by concomitant knee injuries. This study aims to investigate the differences in patient reported outcome measures and revision rates for quadriceps tendon in comparison with hamstring tendon and bone-patella-tendon-bone autografts. We use a cohort of patients who have had primary ACL reconstruction without concomitant knee injuries.All patients from the New Zealand ACL Registry who underwent a primary arthroscopic ACL reconstruction with minimum 2 year follow-up were considered for the study. Patients who had associated ipsilateral knee injuries, previous knee surgery, or open procedures were excluded. The primary outcome was Knee Injury and Osteoarthritis Outcome Score (KOOS) and MARX scores at 2 years post-surgery. Secondary outcomes were all-cause revision and time to revision with a total follow-up period of 8 years (time since inception of the registry).2581 patients were included in the study; 1917 hamstring tendon, 557 bone-patella-tendon-bone, and 107 quadriceps tendon. At 2 years, no significant difference in MARX scores were found between the three groups (2y mean score; 7.36 hamstring, 7.85 bone-patella-tendon-bone, 8.05 quadriceps, P = 0.195). Further, no significant difference in KOOS scores were found between the three groups; with the exception of hamstring performing better than bone-patella-tendon-bone in the KOOS sports and recreation sub-score (2y mean score; 79.2 hamstring, 73.9 bone-patella-tendon-bone, P &lt; 0.001). Similar revision rates were reported between all autograft groups (mean revision rate per 100 component years; 1.05 hamstring, 0.80 bone-patella-tendon-bone, 1.68 quadriceps, P = 0.083). Autograft revision rates were independent of age and gender variables.Quadriceps tendon is a comparable autograft choice to the status quo for primary ACL reconstruction without concomitant knee injury. Further research is required to quantify the long-term outcomes for quadriceps tendon use.

Functional Outcomes of Quadriceps Tendon versus Hamstring Tendon Autograft using Suspensory Fixation at Femoral and Tibial Sites for Primary Anterior Cruciate Ligament Reconstruction: A Randomised Controlled Study

Introduction: Arthroscopic Anterior Cruciate Ligament (ACL) reconstruction using hamstring tendon autografts is commonly used in day-to-day practice. Recently, the quadriceps tendon has been considered as a graft choice for primary ACL reconstruction due to its reliable graft size and resistance to rupture. The available literature comparing Quadriceps and Hamstring autografts in ACL reconstruction is limited. Therefore, the present study was conducted to compare the functional outcomes of these autografts using suspensory fixation at the femoral and tibial sites. Aim: To compare the functional outcomes of quadriceps tendon versus hamstring tendon autografts for primary ACL reconstruction. Materials and Methods: A randomised controlled study was conducted at Department of Orthopaedics, BLDE’s Shri BM Patil Medical College and Research Centre, Vijayapur, Karnataka, India, from January 2021 to April 2023. Thirty-four patients were included in the study and randomised into two groups: one group was operated with a quadriceps tendon graft, and the other group used a hamstring tendon autograft. Both groups underwent surgery using suspensory fixation, and postoperative rehabilitation was similar. Functional outcomes (assessed using Lysholm and International Knee Documentation Committee (IKDC) scores), return to preinjury activity, and complications were evaluated. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0. The Mann-Whitney U test was applied to compare pre- and postoperative functional outcomes (Lysholm and IKDC scores) at 6, 12, and 24 months, with a significance level of p&lt;0.05. Results: Out of 34 patients, 27 (79%) were male and 7 (21%) were female. The follow-up period ranged from a minimum of 24 months to a maximum of 26 months. The mean Lysholm score in the hamstring group increased from 47 preoperatively to 92 at six months postoperatively, while in the quadriceps group, it increased from 46 preoperatively to 90 at six months postoperatively. The reliability and validity of the IKDC score for the hamstring group also increased from 46 preoperatively to 79 at six months, and for the quadriceps group, it increased from 44 preoperatively to 78 at six months. A total 31 of the cases (91%) returned to their preinjury activity, while 3 patients (9%) (2 from the hamstring group and 1 from the quadriceps group) experienced knee stiffness, which restricted their ability to squat and sit cross-legged. There were no significant differences in Lysholm and IKDC scores between the hamstring and quadriceps tendon autografts at 6, 12, and 24 months postoperatively. Conclusion: Patients undergoing single bundle ACL reconstruction have comparable functional outcomes with either hamstring or quadriceps grafts at the end of the 2-year follow-up period, with no specific graft site complications. The soft tissue quadriceps tendon autograft can be considered as an equally viable option for graft selection.

Comparison of Clinical and Radiographic Outcomes According to the Presence or Absence of a Posterior Draw Force during Graft Fixation in Anterior Cruciate Ligament Reconstruction.

Background and Objectives: A reduction forced toward the posterior side during graft fixation may help to lessen anterior tibial translation after ACL reconstruction. The purpose was to compare the clinical and radiological outcomes of graft fixation when a posterior draw was used and when it was not used during anterior cruciate ligament (ACL) reconstruction surgery. Materials and Methods: Of 110 patients who had undergone primary arthroscopic ACL reconstruction between January 2017 and August 2020, in all, 76 patients had been operated on without a posterior draw (non-draw group), and 34 patients had received surgery with a posterior draw (draw group). The results of the Lachman test and the pivot-shift test, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) indexes, the Lysholm scores, the International Knee Documentation Committee (IKDC) subjective scores, and side-to-side difference (STSD) on stress radiography were compared between the two groups. Results: The postoperative WOMAC indexes, Lysholm scores, and IKDC subjective scores were similar across both groups. Postoperative STSD (2.4 ± 2.2 for the non-draw group vs. 2.0 ± 2.2 for the draw group; p = 0.319) and change in STSD (3.5 ± 3.5 for preoperative STSD vs. 4.3 ± 4.4 for postoperative STSD; p = 0.295) were not superior in the draw group. Conclusions: The take-home message is that graft fixation with a posterior draw during ACL reconstruction did not result in significantly better postoperative stability. The postoperative clinical outcomes were similar between both groups.

Comparison of Fixed- and Variable-Loop Button Fixation in Arthroscopic Anterior Cruciate Ligament Reconstruction.

IntroductionWith the advent of fixed- and variable-loop suspensory fixation devices for arthroscopic anterior cruciate ligament (ACL) reconstruction, a maximum number of grafts can be placed within the femoral tunnel. Although several biomechanical studies have been conducted comparing these two devices, only a few comparative clinical studies are available. This study was conducted to compare the functional outcomes of arthroscopic ACL reconstruction using fixed-loop devices with those of variable-loop devices by determining their effect on graft laxity clinical assessment and patient-reported outcome scores.MethodologyOut of 32 patients (27 males and five females) who underwent primary ACL reconstruction using tripled hamstring autograft, fixed- and variable-loop devices were used for 13 and 19 patients, respectively. Thirteen patients in each group were evaluated over a period of one year using the Lysholm knee score. Six patients in the variable-loop group had only six months of follow-up. Anterior drawer and Lachman tests were performed at six-month and one-year follow-ups, respectively.ResultsThe mean ages of patients in the fixed- and variable-loop groups were 34.5pm11 and 34.1pm9.1 years, respectively. The Lysholm knee score at six weeks was fair in 7.7% of the patients in the fixed-loop group when compared to 52.6% of those in the variable-loop group (p<0.05). All the other parameters were comparable between the two groups. One patient in each group had ligament laxity at six-month and one-year follow-up, respectively.ConclusionThis study showed no statistically significant difference in graft laxity or functional outcomes of arthroscopic ACL reconstruction with fixed- and variable-loop devices, except for a better patient-reported outcome score in the variable-loop group at six weeks of follow-up. Hence, there is a need for more comparative studies in this direction.

No difference in postoperative efficacy and safety between autograft and allograft in anterior cruciate ligament reconstruction: a retrospective cohort study in 112 patients.

BackgroundArthroscopic anterior cruciate ligament reconstruction (ACLR) is the best treatment choice for returning to pre-injury activities following ACL rupture. Although allografts are considered an effective alternative to autografts, there is still controversy regarding the safety and effectiveness of this procedure, especially concerning the risk of postoperative infection and disease transmission. The purpose of this study was to compare the efficacy outcomes and safety between allografts and autografts in primary ACLR.MethodsThe retrospective analysis involved 112 patients (58 patients received allogeneic tendons and 54 patients received autologous hamstring tendons) who underwent primary ACLR. All patients were followed up and evaluated on admission and at 1 week, 3 months, 6 months, and 1 year postoperatively. The efficacy outcome of the ACLR was evaluated by International Knee Documentation Committee (IKDC) score and physical examinations (Lachman test, anterior drawer test, and pivot shift test). The safety outcome of allografts and autografts was compared by investigating the occurrence of postoperative complications, including postoperative inflammation and potential disease transmission. The benefits of each operation for surgeons and patients were also analyzed, including the length of surgical incision and operative time.ResultsThere was no significant difference in the demographic and clinical characteristics between the allograft and autograft groups. The two cohorts proved to be similar in terms of the acute or chronic nature of the cruciate ligament and the incidence of concomitant meniscal surgery. Arthroscopic ACLR was performed in all patients. The physical examinations were all positive before surgery and negative immediately after the operation. The KT-1000 and IKDC scores of two groups significantly decreased than pre-operative ones (P<0.05), but the difference between the two groups was not statistically significant (P>0.05). At final follow-up, all patients had returned to their pre-injury activities. Allografts showed no increased risk for postoperative infection or potential disease transmission relative to autografts.ConclusionsThe outcomes of reconstructed ACL with allografts were similar to those of autographs. Moreover, the safety of allografts showed to be comparable to that of autografts, especially concerning postoperative infection and disease transmission. Therefore, the surgical option should be chosen wisely according to the patient’s condition.

Failure rate analysis and clinical outcomes of two different femoral tunnel positions using anteromedial portal technique in anterior cruciate ligament reconstruction

AimTo analyze two different femoral tunnel positions and to evaluate their correlation with clinical, functional outcomes and surgical revision rate in patients who underwent primary arthroscopic anterior cruciate ligament (ACL) reconstruction with anteromedial (AM) portal technique. MethodsFrom January 2015 to October 2018, we recruited 244 patients that underwent primary single-bundle ACL reconstruction, using four strand-semitendinosus graft and AM portal technique for femoral tunnel placement. Patients were divided into two groups based on the different femoral tunnel positions: 117 patients of group A had ACL footprint center femoral tunnel position compared with 127 patients of group B, with femoral tunnel placement close to the AM bundle footprint. Preoperatively and at last follow up, all patients were assessed subjectively by Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores, while Lachman, Pivot-shift, and KT-1000 tests were performed to evaluate knee joint stability. ResultsGroup B patients showed significantly better results in Lysholm, objective, and subjective IKDC scores compared with patients of group A (P < 0.001). A significantly higher surgical failure rate was found in group A than in group B (10.26% vs. 2.3%; P < 0.001). A higher anterior knee laxity was recorded in patients of group A than in patients of group B (1.9 ± 1.1 vs. 1.3 ± 1 mm; P < 0.001); a reduction in mean anterior tibial translation from preoperative to final follow up was found in group B compared with group A (3.5 ± 1.2 vs. 2.7 ± 1.1 mm; P < 0.001). No significant differences in the Tegner scale were found between the two groups. ConclusionACL reconstruction performed using the AM portal technique showed better and more satisfactory clinical and functional outcomes associated with a lower failure rate when the femoral tunnel had been placed more eccentrically in the footprint, in the AM bundle center position.

Incidence of venous thromboembolism in Asian patients undergoing anterior cruciate ligament reconstruction without the use of mechanical or chemical prophylaxis

Background:Venous thromboembolism (VTE) is a clinically relevant complication of major orthopedic surgeries. The prevalence of VTE and the indications for VTE thromboprophylaxis in Asian patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction are not clear. This study aims to evaluate the prevalence of clinically significant venous thromboembolic events (VTE) in Asian patients undergoing arthroscopic ACL reconstruction without mechanical or chemical thromboprophylaxis.Methods:All patients who underwent ACL reconstruction by a single surgeon from 2006 to 2018 in a single tertiary institution were reviewed. The inclusion criteria for the study included Asian patients of common ethnic groups in Singapore (Chinese, Malay, Indian) and underwent primary or revision ACL reconstruction, or ACL reconstruction combined with meniscal surgery. The exclusion criteria were patients with incomplete medical records, pre-existing anticoagulant treatment within 1 year prior to the surgery and additional procedures that altered the standard rehabilitation protocol, less than 6 months of follow-up duration. All patients received general anesthesia. The single-bundle ACL technique with autologous hamstring tendon reconstruction was performed. No chemical DVT prophylaxis was given. The patients were screened for clinically for VTE. Symptomatic patients were referred for ultrasonography.Results:Of the 581 patients reviewed, 3 patients had a clinical suspicion of deep vein thrombosis, but subsequent ultrasonography showed no thrombosis. Hence, the prevalence of clinically significant VTE was 0%.Conclusion:Given the low prevalence of clinically significant VTE, there is no need for routine mechanical or chemical thromboprophylaxis or radiologic screening in Asian patients undergoing arthroscopic ACL reconstruction.

Graft diameter as a predictor for functional outcome following arthroscopic anterior cruciate ligament reconstruction: A prospective study

Background: The purpose of the study was to find the effect of autologous hamstring tendon graft size on patient reported outcome (PRO) measures following Arthroscopic Anterior cruciate ligament (ACL) reconstruction. Materials and Methods: A review of prospectively collected cohort data of 90 patients who had undergone primary ACL reconstruction using hamstring tendon autograft was evaluated. Patient's age, sex, graft diameter at the time of surgery, and minimum of 2 years postoperative functional outcome were assessed using PRO measures, i.e. Tegner Lysholm Knee (TLK) Scoring Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee score. Mean of the three scores was calculated along with that of graft diameter, and Pearson correlation coefficient was calculated to find the relation between graft diameter and the three-PRO measure scores independently. Two-tailed test was used to compute the statistical significance of parameter inferred from the data sheet. Results: There was a positive linear correlation between the graft diameter and three PRO measures independently; however, two-tailed tests for statistical significance were significant only for TLK Score and KOOS. Conclusion: We conclude that hamstring autograft diameter is one of the important predictor for postoperative functional outcome, and hence, a thicker diameter graft is desirable.

The Effectiveness of Autograft Used in Anterior Cruciate Ligament Reconstruction of the Knee: Surgical Records for the New Generations of Orthopedic Surgeons and Synthetic Graft Revisit.

ObjectiveIn this article, we aim to revisit the synthetic graft and review the advantages and disadvantages between different types of grafts for patients who underwent anterior cruciate ligament (ACL) reconstruction in a tertiary medical institute for the new generations of surgeons.Patients and MethodsRetrospectively, we identified 115 patients who underwent arthroscopic ACL reconstruction between 2006 and 2009. We were able to retrieve 74 patients from them. The 74 patients were divided into 32 patients who underwent primary arthroscopic ACL reconstruction with hamstring and patellar tendon autograft and 42 cases with an active biosynthetic composite (ABC) ligament. The mean the follow-up period for both groups was 7 years. The following information was obtained: standard demographic information (age, sex), clinical presentation, presence of trauma, associated injuries, types of grafts (autograft versus synthetic graft) and postoperative complications. Moreover, functional and clinical outcomes in addition to the satisfaction of patients using the international knee documentation committee (IKDC) score and knee injury and osteoarthritis outcome score (KOOS) were measured.ResultsWe found that the natural (autograft) was better in terms of clinical and functional outcome than the synthetic one (the scores of KOOS and IKDC were better in natural grafts). Furthermore, the immediate postoperative results for the pivot and Lachman tests were better in natural grafts. On the other hand, the rate of re-rupture was similar for both groups. However, the long-term inflammatory changes and stiffness that is attributed to the immunological reactions were more in the synthetic grafts.ConclusionThis study revisited the synthetic graft and provided evidence that the natural grafts are more beneficial with less complications, as they had better immediate and long-term postoperative clinical and functional outcomes. We recommend the utilization of autograft as first choice and the synthetic not to be used given the current criteria.

Prospective study to assess functional outcomes in patients undergoing single bundle arthroscopic reconstruction of primary anterior cruciate ligament tear comparing with bone quadriceps tendon versus hamstring tendon autograft

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Anterior cruciate ligament (ACL) injuries are one of the most common ligament injuries of knee. Arthroscopic ACL reconstruction has become the standard of care for ACL injuries in the active patient. In present study good bone quadriceps tendon (BQT) autograft and hamstring tendon (HT) autograft will be used for primary arthroscopic ACL reconstruction and its data regarding clinical and functional results will be evaluated and compared.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Sixty patients underwent isolated ACL reconstruction. 30 underwent ACL reconstruction with the BQT and 30 with the HT. The same surgical technique, fixation method and postoperative protocol were used in both groups. Functional outcome in terms of International Knee Documentation Committee (IKDC) score, joint stability (anterior drawer, Lachman, pivot shift), anterior knee pain and isokinetic strength was evaluated.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; IKDC score in bone quadriceps tendon and hamstring tendon group after 9 months follow up showing no statistical significance. The negative Lachman component was higher in the BQT group than in the HT group. There was no difference between groups in terms of isokinetic strength.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study shows no statistically significant difference between both groups.&lt;/p&gt;

The 90-day Readmission Rate after Single-Bundle ACL Reconstruction Plus LET: Analysis of 2,559 Consecutive Cases from a Single Institution.

The aim of the present study is to examine the readmission rate within 90 days of a cohort of patients, who underwent an arthroscopic anterior cruciate ligament (ACL) reconstruction with a lateral extraarticular tenodesis, from a single highly specialized sports traumatology department. From our institutional database, we identified 2,559 patients (78.5% males and 21.5% females, with a mean age at surgery of 30.9 ± 11.5 years) who underwent primary ACL reconstruction with the same "over-the-top" technique plus lateral extraarticular tenodesis (LET) from January 2010 to December 2017. From this count, we extracted all patients who were readmitted within 90 days and focused on causes of readmission and reoperation rate. Moreover, a multivariate logistic regression was performed to identify possible variables, such as gender, age, and concomitant meniscus surgery, which could predict the risk of early readmission. From the aforementioned cohort, 58 patients (2.27%) were readmitted within 90 days from surgery after a mean time of 31 ± 23 days. The most common cause of readmission was fever and knee swelling (0.78%), followed by superficial infection (0.63%), deep infection (0.55%), and joint stiffness (0.23%). The patients' age and meniscal lesions requiring concomitant arthroscopic treatment were found to be correlated to an increased risk of early readmission. Superficial infections were more common in female patients (odds ratio [OR] = 3.01), whereas the meniscal treatment was also a significant risk factor specifically for deep infections (OR = 3.56). In conclusion, this technique of arthroscopic ACL reconstruction with LET showed a low readmission rate within 90 days from surgery. However, patients and physicians should be aware of the risk of serious complications, such as deep and superficial infections, mostly in female patients and in cases of concurrent meniscal treatments. This is a Level IV, retrospective case series study.

Effect of autograph used in anterior cruciate ligament reconstruction surgery on postoperative infection rate

Purpose: The aim of this study was to investigate effect of autograft selection on the infection risk following arthroscopic anterior cruciate ligament (ACL) reconstruction surgery. Materials and Methods: Between June 2004 and October 2018, 840 consecutive patients who underwent primary arthroscopic ACL reconstruction with either a hamstring tendon autograft or a bone patellar tendon bone (BTB) autograft were reviewed retrospectively. Patients were assigned into two groups based on the type of graft used: First group was bone-patellar tendon-bone (BTB) autograft group (n=354) and second group was hamstring tendon autograft group (n=466). These two groups were compared statistically in terms of demographic characteristic and postoperative infection status. After primary ACL reconstruction, local and systemic clinical findings of infection (knee effusion, systemic fever, nausea, weakness) supported by laboratory findings (C-Reactive Protein (CRP), Erytrocyt Sedimentation Rate (ESR)) were defined as infection.Results: There was a statistically increased risk of infection with hamstring tendon autograft compared to BTB autograft. While the infection rate in the first group (BTB) was 0.3 % (n=1), the infection rate in the second group (Hamstring tendon) was 4.7 % (n=22).Conclusion: In this study, a higher infection rate was found in primary ACL cases treated with hamstring tendon autograft compared to those using BTB autografts. Orthopedic surgeons should be aware of the increased risk of infection when hamstring autograft is used in ACL reconstruction surgery and should prefer BTB autograft over hamstring autograft in appropriate indication.

Mid-term effectiveness of arthroscopic anterior cruciate ligament reconstruction combined with meniscus allograft transplantation

To summarize the mid-term effectiveness of arthroscopic anterior cruciate ligament (ACL) reconstruction combined with meniscus allograft transplantation. A clinical data of 21 patients treated with arthroscopic ACL reconstruction and meniscus allograft transplantation and followed up more than 5 years between February 2007 and December 2014 was retrospectively analyzed. There were 12 males and 9 females, aged from 18 to 45 years, with an average age of 23.5 years. The cause of injury was sport sprain in 15 cases, falling in 4 cases, and traffic accident in 2 cases. The time from injury to operation ranged from 2 to 36 months, with an average of 12 months. Among them, 15 patients underwent previous meniscectomy, with an average interval of 1.6 years (range, 3 months to 6.5 years). All patients were primary ACL reconstruction. Preoperative anterior drawer test, Lachman test, and pivot shift test were positive. Lysholm score was 43.6±10.2. International Knee Documentation Committee (IKDC) score was 60.50±14.06. Of the 21 patients, 10 were gradeⅠ-Ⅱcartilage injuries and 11 were grade Ⅲ cartilage injuries according to MRI. All patients were followed up 5.1-7.8 years, with an average of 5.5 years. There were 2 cases of numbness of lower extremity, 3 cases of slight exudation of incision, 2 cases of articular movement bounce, 5 cases of mild joint swelling and pain after exercise. At last follow-up, Lachman tests were negative in 18 cases and positive in 3 cases; anterior drawer tests were negative in 19 cases and positive in 2 cases; pivot shift tests were negative in all cases. Lysholm score was 84.5±16.5 and IKDC score was 85.25±4.60, which were significantly higher than those before operation ( P<0.01). The flexion and extension of the affected knee joint were (128±13) and (3±7)°, respectively, which were smaller than those of the healthy knee joint [(133±15), (0±5)°] ( P<0.01). The results of KT-1000 test showed that when knee flexion was 30 and 90°, tibial anterior displacement of affected side [(2.35±1.20), (1.60±1.15) mm] were not significantly different from those of healthy side [(1.20±1.10), (1.10±1.03) mm] ( P>0.01). MRI showed that the ACL graft was in normal position and meniscus survived well. Cartilage injuries were gradeⅠ-Ⅱ in 18 cases and grade Ⅲ in 3 cases. For patients with severe meniscus injury and ACL rupture, ACL reconstruction combined with meniscus allograft transplantation can restore the stability of the joint, recover the meniscus function which is conducive to the protection of articular cartilage and obtain satisfactory mid-term effectiveness.

Procedure length is independently associated with overnight hospital stay and 30-day readmission following anterior cruciate ligament reconstruction.

The purpose was to characterize the independent effect of procedure length on the rates of 30-day perioperative complications, hospital readmissions, and overnight hospital stay in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). We hypothesized that longer procedure length in primary ACLR increases the risk for post-operative complications. Primary ACLR cases from 2005 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program registry. Patients were categorized into two cohorts based on procedure length, either less than or greater than 90min. Two equal-sized propensity-matched cohorts were generated to account for differences in baseline and operative characteristics. Thirty-day clinical outcomes were compared using bivariate analyses between propensity-matched groups that controlled for patient-specific factors and concurrent meniscal repair. Multivariate logistic regression models were used to identify independent predictors of hospital readmission and overnight hospital stay. In total, 12,077 ACLR cases were identified. The rate of any 30-day complication was increased in longer procedures relative to shorter procedures (1.6% vs 0.9%, p = 0.006), as were the rates of returning to the operating room (0.6% vs 0.3%, p = 0.03), hospital readmission (1.0% vs 0.3%, p = 0.001), and overnight hospital stay (16.2% vs 6.0%, p < 0.001). Obesity was a risk factor for both hospital readmission and overnight hospital stay, while hypertension, diabetes, chronic obstructive pulmonary disease, and a smoking history were associated with increased rates of overnight hospital stay. The most common reasons for hospital readmission were deep vein thrombosis or pulmonary embolism (25.0% of all readmitted patients), surgical site infection (25.0%), and post-operative pain (14.1%). In this propensity-matched analysis adjusting for baseline patient characteristics and operative factors, procedure length of greater than or equal to 90min in ACLR was independently associated with an increased risk of hospital readmission and overnight hospital stay. As a surrogate measure of surgical complexity, operative time may be a useful perioperative variable for post-operative risk stratification and patient counseling. III.

Delayed ACL Reconstruction in Patients ≥40 Years of Age Is Associated With Increased Risk of Medial Meniscal Injury at 1 Year

Background: Anterior cruciate ligament (ACL) tears in the pediatric and young adult ACL-deficient knee are often associated with meniscal or chondral injury with delayed time to surgery. The incidence of ACL reconstruction performed in patients aged ≥40 years is rising, and it is unclear if delayed surgery in this cohort similarly affects the health of the meniscus and cartilage. Purpose: To evaluate whether delayed reconstruction in a cohort of patients aged ≥40 years is associated with an increased risk of meniscal or chondral injury. Study Design: Cohort study; Level of evidence, 3. Methods: Records of patients aged ≥40 years who underwent primary arthroscopic ACL reconstruction between 2012 and 2016 at an academic hospital were retrospectively reviewed. Patient characteristic data and time to surgery were recorded. Operative reports were analyzed for meniscal and chondral injuries as well as treatment. Patients were grouped according to time to surgery, defined as early (<90 days) or delayed (≥90 days). Logistic regression modeling was used to form associations between elapsed time to surgery and patient characteristics to meniscal and chondral damage. Additionally, risks for meniscal and chondral injury were analyzed at time points of 180 days and 1 year from injury to surgery. Results: A total of 227 patients met the study criteria: 106 patients underwent early surgery, and 121 underwent delayed surgery. The authors identified 127 medial meniscal tears and 106 lateral meniscal tears. Medial, lateral, and patellofemoral compartment chondral injury was reported in 127, 82, and 130 patients, respectively. Delayed surgery (≥90 days) was not associated with increased risk of medial or lateral meniscal tears or any chondral injury at 90 days. Each year of increased age was associated with an increased odds ratio: 1.09 (P = .001) for medial meniscal tears, 1.06 (P = .014) for lateral meniscal tears, 1.10 (P = .001) for medial compartment chondral injuries, and 1.07 (P = .007) for patellofemoral compartment chondral injuries. Additionally, each unit of increased body mass index was associated with an increased odds ratio: 1.09 (P = .039) for medial meniscal tears and 1.14 (P = .003) for medial compartment cartilage injury. Analysis of 180-day and 1-year time points revealed an increased risk (odds ratio, 3.47; 95% CI, 1.55-7.77; P = .002) for medial meniscal injury when surgery was delayed for >1 year. Conclusion: Delayed ACL reconstruction (≥90 days) among patients aged ≥40 years was not associated with an increased risk of meniscal or chondral injury. Increasing age and body mass index were associated with higher risks of meniscal and chondral injuries in this cohort. Delay in surgery for >1 year was associated with increased risk of medial meniscal tear.

Clinical Outcomes, Return to Sports, and Patient Satisfaction After Anterior Cruciate Ligament Reconstruction in Young and Middle-Aged Patients in an Asian Population—A 2-Year Follow-up Study

To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction in young and middle-aged Asians. A retrospective study was performed using prospectively collected data from a tertiary institution ACL registry. All Asian patients with ACL tears who underwent primary arthroscopic ACL reconstruction by a single surgeon between 2008 and 2014, with minimum 2-year follow-up, were included. Patients with previous knee surgery or multiligamentous knee injuries were excluded. Two groups were formed: young patients (YP) (age <30) and middle-aged patients (MP) (age >40). They were compared preoperatively and 6months, 1year, and 2years postoperatively for demographics, knee range of motion, anterior laxity, Tegner level, Lysholm and International Knee Documentation Committee grade, ability to return to preinjury level of activity, and patient satisfaction. YP (n=84) and MP (n= 22) had differences in mean age (YP= 23.1years, range 18-29years; MP= 46.4years, range 41-59years, P < .001), preinjury Tegner level (YP= 7.4, MP= 6.4, P= .005), and preoperative Lysholm scores (YP=65.3, MP= 53.0, P= .034). The incidence of meniscal and chondral injuries was similar. Two years postoperatively, both groups had comparable knee range of motion and anterior laxity. The Tegner score was different (YP= 6.3, MP=5.2, P= .028), but the proportion of patients returning to preinjury Tegner level (YP= 45.2%, MP= 46.9%, P=.812), Lysholm scores (YP= 92.5, MP= 93.8, P= .794), proportion of patients with knees rated International Knee Documentation Committee A/B (YP= 77.4%, MP= 81.8%, P= .777), and satisfaction levels (YP= 98.5%, MP= 94.1%, P= .370) were similar. There were no graft ruptures or reoperations. In an Asian, predominantly male population, the clinical outcomes of arthroscopic ACL reconstruction in YP and MP are equally good at 2-year follow-up. MP can benefit as much as younger patients from ACL reconstruction in terms of restoration of knee function and return to preinjury activity level, are equally satisfied with outcomes, and should not be excluded from surgery on the basis of age alone. Level III, retrospective comparative study.