Ligament Reconstruction Research Articles

Comparison between early and late weight bearing after anterior cruciate ligament reconstruction surgery.

The anterior cruciate ligament (ACL) is a strip of dense connective tissue that runs from the femur to the tibia with a relatively poor blood supply. It prevents the femoral condyles from rolling posteriorly. ACL is commonly injured in any knee trauma, ranging from a little sprain to a total rupture. The arthroscope is the gold standard approach for identifying ACL tears, which may be treated conservatively or surgically. To assess the efficiency of immediate and delayed weight bearing after arthroscopic ACL reconstruction. Cohort longitudinal study carried through 6years from 2017 to 2023 et al.-kindy Teaching, Ulamaa, and Almuktar hospitals 186 patients, the patients were divided randomly into 2 groups, group A (n = 93) with immediate (after 10days) weight bearing and group B (n = 93) with delayed (after 1month) weight bearing following ACL reconstruction. any patients with chondral lesions, aged less than 19 or more than 40years, knee osteoarthritis, ligament damage, and deformity in lower extremities were excluded. Patients from both groups A and B had complete ACL tears and underwent arthroscopic ACL reconstruction follow-up for 6months duration regarding stiffness, infection, giving up pain, swelling, and quadriceps muscle atrophy. In group A, there were 93 patients,70 male and 23 female, and meniscal injury was 89 patients. While in group B (93 patients) 57 male and 36 female, meniscal injury in group B was 91. There is a statistically significant difference regarding knee swelling. (80.6% in group A, and 10.8% in group B), and knee pain in which (79.6% in group A patients and only 7.5% in group B). There is no significant value between the two groups about the knee getting given up, infection, stiffness, and quadriceps muscle atrophy. Delay weight bearing after ACL reconstruction makes the patients less prone to knee pain and effusion but more prone to quadriceps muscle atrophy.

Relationship between peroneus longus tendon graft thickness and anthropometric variables: a radiographic study using ultrasonography

BackgroundThis study aimed to evaluate the predictive value of anthropometric measurements for two-stranded peroneus longus tendon (PLT) graft thickness using ultrasonographyMaterials and methodsA prospective study was conducted on 204 healthy volunteers (102 males and 102 females) aged 18–40 years. Anthropometric measurements were recorded, including height, weight, body mass index (BMI), fibular length, calf circumference, and ankle circumference. The Tegner Activity Scale (TAS) was used to assess activity levels. PLT cross-sectional area (CSA) was measured using ultrasonography. Two-stranded PLT graft thickness was calculated using the previously reported formula by Luo et al. A thickness of less than 8 mm of PLT graft was accepted as an insufficient autograft for anterior cruciate ligament reconstruction (ACLR). Correlation and regression analyses were performed to identify predictors of two-stranded PLT graft thickness. Receiver operating characteristic (ROC) analysis was performed to establish the best threshold values.ResultsMales had a significantly greater PLT CSA (0.17 ± 0.03 cm2) and predicted two-stranded PLT graft thickness (8.1 ± 0.6 mm) compared with females (0.15 ± 0.03 cm2 and 7.5 ± 0.6 mm, respectively; p < 0.001 for both). Correlation analysis revealed that two-stranded PLT graft thickness positively correlated with height, weight, BMI, fibular length, calf circumference, ankle circumference, and Tegner Activity Scale in both genders, with stronger correlations observed in females. The logistic regression model identified height and calf circumference as significant predictors of sufficient two-stranded PLT graft thickness (≥ 8 mm) in males, while calf circumference and the TAS were significant predictors in females. ROC analysis demonstrated that calf circumference and the TAS had acceptable discriminatory abilities in females, with 36.25 cm and ≥ 4 cutoff points, respectively. However, no anthropometric variables in males exhibited strong discriminatory abilities for predicting two-stranded PLT graft thicknessConclusionsCalf circumference and the TAS are significant predictors for two-stranded PLT autograft thickness in females. However, no anthropometric variables in males could be used strongly for prediction. These anthropometric measurements can assist in preoperative planning and decision-making, potentially improving ACLR outcomes by ensuring adequate graft thickness in females.Level of evidence: Level II prospective study

Comparison of clinical efficacy between reconstruction of the superior acromioclavicular ligament with acellular dermal allografts and clavicular hook plate in acromioclavicular dislocations

Purposes: We aimed to compare the clinical efficacy of superior acromioclavicular ligament reconstruction (SALR) using acellular dermal allograft with that of clavicular hook plate fixation (HP) in patients with acromioclavicular (AC) dislocations. We hypothesized that the SALR could provide more stability than hook plate. Methods: Twenty-two cases of acute AC joint dislocation between November 2021 to December 2023 were retrospectively reviewed. All patients were divided into 2 groups based on the treatment with SALR (12 cases) or HP (10 cases). Patients were evaluated radiologically and clinically using coracoclavicular distance and ratio, pain visual analogue scale (PVAS), Single Assessment Numerical Evaluation (SANE), and American Shoulder and Elbow Surgeons (ASES) at postoperative 3 months and 1 year. We evaluated whether patient achieve MCID of PVAS at the last visit, based on the minimal clinically important differences (MCIDs) of PVAS. Results: The SALR group showed a lower rate of reduction loss (8.3 % vs. 40.0 %) and similar clinical outcomes compared to the hook plate group. Initial SANE score was statistically significantly lower in SALR group (SANE: SALR, 45.8 ± 20.7; HP, 68.0 ± 15.5, p = 0.009), but there were no significant differences in final clinical outcomes, including PVAS, ASES, and SANE scores. Conclusion: SALR with acellular dermal allograft demonstrates comparable clinical outcomes to hook plate fixation and may offer a viable alternative, especially in complicated cases. Study Design: Case series; Level of evidence, 4.

Anterior and coracoid base tunnel location combined with single -or double clavicular tunnel techniques using double-button fixation for coracoclavicular ligament reconstruction both restore horizontal stability. A biomechanical cadaver study

BackgroundThe placement of clavicle tunnels in coracoclavicular ligament reconstruction is well established, but the optimal position of the coracoid tunnel remains unclear. This study aimed to investigate how the coracoid tunnel's position affects horizontal stability during coracoclavicular ligament reconstruction using a double-button technique. MethodsFifteen fresh frozen shoulder cadaver specimens were tested under various conditions: intact coracoclavicular ligaments, disrupted ligaments, and reconstructions with a single coracoid and clavicle tunnel or double clavicle tunnels. The coracoid tunnel was positioned at the coracoid base 1/9, and 1/5 anterior to the base. Specimens underwent displacement-controlled loading, with 2D motion analysis conducted on captured digital images using TEMA motion analysis. FindingsMean displacement for intact coracoclavicular ligaments was 1.61 ± 0.92 mm, and 3.69 ± 1.09 mm for disrupted ligaments. For reconstructed conditions, displacements were as follows: Single-Tunnel Base (1.87 ± 0.64 mm), Single-Tunnel 1/9 (2.54 ± 1.13 mm), Single-Tunnel 1/5 (2.62 ± 1.17 mm), Double-Tunnel Base (1.25 ± 0.73 mm), Double-Tunnel 1/9 (2.03 ± 1.22 mm), and Double-Tunnel 1/5 (1.88 ± 1.20 mm). Differences among intact, reconstructed, and disrupted states were statistically significant (p = 0.01–0.0001), with all reconstruction techniques restoring horizontal displacement near the intact state. InterpretationAt point zero both single coracoid tunnel and single- and double-clavicle tunnel restored horizontal displacement to its intact state. Coracoid tunnel placement anterior to the base of the coracoid did not influence horizontal displacement but single coracoid at the coracoid base and single clavicle tunnel resulted in the most anatomic reconstruction. Single coracoid tunnel at the base and double-clavicle resulted in the most stable reconstruction.

Ligament reconstruction for distal radioulnar joint instability with the biomechanical analysis: A case report.

The aim of the study is to evaluate the clinical effects and feasibility on chronic distal radioulnar unstable joint (DRUJ) under wrist arthroscope triangular fibrocartilage complex (TFCC) repair and reconstruction. The biomechanical characteristics of the recovery process after treatment were analyzed using finite element modeling. A patient with chronic DRUJ instability was treated with reconstruction of the distal radioulnar ligament using the Adams Berger method. Piano sign and forearm rotation tests were used to evaluate the function of the DRUJ. Grip power, range of motion, and visual analog scale scores were recorded at the last follow-up. Joint function was evaluated by the disability of the arm, shoulder, and hand score. A geometric model for the surgical repair of TFCC damage, meshing in finite element simulation, and stress distribution of the repaired ligament during forearm rotation were analyzed by finite element simulation. The diagnosis was confirmed as chronic DRUJ instability. The patient had no postoperative complications and was followed-up for 6 months. Stability was achieved in all patients. The results of the stress and forearm rotation tests are negative. At the last follow-up, the grip power, disability of the arm, shoulder, and hand score, visual analog scale score, and range of motion of the wrist were significantly improved compared with the preoperative values (P < .05). TFCC repair and reconstruction under wrist arthroscopy can effectively treat chronic DRUJ and improve wrist function. Our study established a three-dimensional finite element model of the entire DRUJ, which provided a digital visual platform for simulating the biomechanical features of the TFCC, DRUJ, and other structures in different states. This study demonstrated that the rotation angle of the wrist joint should be confined within 75° for a short period after surgery to avoid tearing the tendon as a result of excessive force. It also provides an intuitive simulation tool for the design of TFCC repair and the evaluation of curative effects.

Comparison of Results in ACL Reconstruction in Women under 30 Years Old at a Minimum of 2 Years’ Follow-Up between a Bone–Tendon–Bone (BTB) Technique with the Patellar Tendon and a Hamstring Technique Combined with Anterolateral Ligament Reconstruction

Background: Anterior cruciate ligament (ACL) rupture is a frequent injury among athletes, particularly women. Various techniques have shown effectiveness, but their impact on laxity and clinical outcomes varies. This study aims to compare the rupture rates of patellar tendon (PT) reconstruction versus hamstring reconstruction (HR) combined with anterolateral ligament reconstruction (ALLR) in young women. The secondary objectives include comparing functional ACL-RSI and subjective IKDC scores, as well as the Tegner scale, between these two groups. The hypothesis is that adding ALLR to HR will result in rupture rates and functional scores similar to those of PT reconstruction. Methods: Between 2015 and 2019, 96 patients were treated at two facilities, with 70 having an average follow-up of 44 ± 14.5 months: 35 underwent PT reconstruction, and 35 had HR combined with ALLR. Patients were re-evaluated remotely after at least 2 years using a standardised questionnaire and assessing subjective IKDC, ACL-RSI, and Tegner scores. Results: Rupture rates were 5.7% in both groups. The mean subjective IKDC score was 81% for the HR + ALLR group versus 80.8% for the PT group (p = 0.09). The mean ACL-RSI score was 66% for HR + ALLR versus 68% for PT (p = 0.78). The HR + ALLR group lost an average of 0.4 points on the Tegner scale postoperatively, while the PT group lost an average of 0.77 points (p = 0.09). Conclusions: Hamstring surgery combined with anterolateral surgery provides subjective results, as assessed by patients using subjective scales and questionnaires, that are as good as those obtained with PT surgery in young women. Notwithstanding, the results are not corroborated by clinical or radiological examination.

Management of Multiligament Knee Injuries Using Anatomic Autograft Reconstructions: A Case Series.

While proven effective management of multiligament knee injury (MLKI) using allograft is often reported, it has shown an increased risk for graft failure compared with autograft and raises availability and cost issues. Osseous stock preservation and tunnel convergence avoidance led us to develop a compromise innovative surgical procedure using only ipsilateral autograft for anatomic reconstruction of Schenck III-L or higher MLKI. We report the description and early outcomes of our initial experience. Our strategy consisted of an anatomic single-bundle posterior cruciate ligament reconstruction with quadriceps tendon autograft and a "Versailles" reconstruction for the posterolateral corner, which we modified to reconstruct the anterolateral ligament in case of anteromedial rotatory instability, called "full lateral." A second-stage surgery was planned for anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft. Outcomes were Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores for functional status, Short Form 12 (SF-12) for quality of life, and visual analog scale (VAS) for pain. Complications, full weight-bearing, return to work, and sport were also computed. Between March 2019 and August 2020, 10 patients were included. At follow-up, light pain was found in nine patients with a mean VAS of 1.2 ± 2.16 during the day. The mean Lysholm, Tegner, and subjective IKDC scores were good, with 61.2 ± 20.6, 2.8 ± 2.1, and 52.6 ± 20.4, respectively. However, quality of life was altered with poor SF-12 scores. In our first 10 patients with Schenck III-L or higher MLKI, our procedure using only ipsilateral autograft enabled correct daily knee functional activities while preserving osseous stock.

Right knee ACL, PCL and MCL reconstruction with sports-related anxiety

Introduction: JM, a 20-year-old male professional ice hockey player, presented with a 2-week history of lack of range of motion, weakness, and pain in his right knee, after a 2-year post-medical collateral ligament repair of the right knee and 3 year-post anterior cruciate ligament, posterior cruciate ligament and medial collateral ligament reconstruction of the right knee. Case Description: In the course of history taken, it was revealed that 5 months prior to admission the patient had been informed by a psychiatrist that he had sport-related anxiety. With an unremarkable psychiatric history prior to age 18, the competitive nature of his sports career in addition to financial pressure may have contributed to his sports-related anxiety. His examination findings were consistent with a diagnosis of complete tears of the right anterior cruciate ligament and posterior cruciate ligament along with grade III medial collateral ligament injury. Discussion: The biopsychosocial model was used to explicate JM's case. JM's current injuries prompted reconstruction of the anterior cruciate, posterior cruciate, and medial collateral ligaments. Psychologically, JM's sports-related anxiety is not a rare phenomenon as recent studies have discovered an increased risk of sports-related anxiety amongst young professional athletes. Sports-related anxiety, along with competitive trait anxiety, may be factors that contribute to sports injury occurrence. Other psychological stressors can add to sports-related or competitive trait anxiety, further increasing the risk of sports injury reoccurrence. Summary: JM was admitted for a right knee open medial collateral ligament repair with internal bracing, anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction, and platelet rich plasma injection. As part of a holistic patient-centered treatment plan, a referral to psychiatry was made to address JM's sports-related anxiety with the goal of decreasing future risk of sports injury. Patient's Consent Obtained: Yes

Evaluation of retear rates following transtibial anterior cruciate ligament reconstruction: Functional outcomes and GNRB assessment with a mean 6.3-year follow-up

The method of reconstruction of the anterior cruciate ligament (ACL) using the tibia-dependent femoral tunnel technique is highly criticized. It would not allow anatomical placement of the graft and would therefore lead to a high rate of retear. This retrospective study aimed to evaluate the rate of retear in ACL reconstructions using the transtibial tunnel (TT) technique and assess functional outcomes. The study included 148 patients (153 knees) who underwent ACL reconstruction with a minimum two-year follow-up period. Patients underwent clinical examinations, completed functional questionnaires (KOOS, Lysholm, ACL-RSI), and underwent laximetry measurements with GNRB at 134 N and 200 N. Two patients had retears detected on MRI and underwent revision surgery prior to the study, leaving 151 knees for evaluation. The retear rate was 6.6 %, with an overall rate of 7.8 % when including revision cases. Laxity measurements obtained with GNRB showed a strong correlation with functional scores, indicating worse scores with greater laxity differences (p < 0.0001). The retear rate observed in this study was at the higher end of those reported in the literature. The study indications for TT ACL reconstructions must be defined more specifically to reduce failure rates.Level of evidence: III (retrospective cohort study).

Which technique provides more benefits in return to sports and clinical outcomes after anterior cruciate ligament reconstruction: Double-bundle or single-bundle? A randomized controlled study.

The achievement of an optimal return to sport (RTS) has remained a key goal after sports-related injuries, with the ongoing debate on the effectiveness of different surgical approaches for anterior cruciate ligament (ACL) rupture. This study aims to assess clinical outcomes and RTS across various surgical methods, such as anatomical single-bundle reconstruction (ASBR), central-axial single-bundle reconstruction (CASBR), and double-bundle reconstruction (DBR). A randomized clinical trial was conducted, comprising 191 patients who underwent ACL rupture. These patients were divided into three groups based on the ACL reconstruction techniques they received (ASBR, CASBR, DBR). Over the 2-year follow-up period, the study assessed RTS through four single-hop tests, isokinetic extension tests, and limb asymmetry indices. Postoperative graft status was determined using the signal-to-noise quotient (SNQ), while knee function was evaluated using the International Knee Documentation Committee 2000 (IKDC-2000) score, Lysholm score, Tegner score, and degree of knee laxity. A binary logistic regression model was developed to forecast the factors influencing ideal RTS. DBR (67.63%) and CASBR (58.00%) exhibited higher RTS passing rates compared to ASBR (30.39%; χ2=19.57, P<0.05). Quadriceps strength symmetry in the lower limbs was identified as the key determinant of RTS (χ2=17.08, P<0.05). The RTS rate was influenced by SNQs of the graft's tibial site (odds ratio: 0.544) and quadriceps strength of the reconstructed knee joint at 60°/s (odds ratio: 6.346). Notably, the DBR group showed enhanced knee stability, evidenced by superior results in the Lachman test (χ2=13.49, P<0.01), objective IKDC-2000 (χ2=27.02, P=0.002), and anterior instability test (χ2=9.46, P <0.01). Furthermore, DBR demonstrated superior clinical outcomes based on the Lysholm score (DBR: 89.57±7.72, CASBR: 83.00±12.71, ASBR: 83.21±11.95; F=10.452, P<0.01) and IKDC-2000score (DBR: 90.95±7.00, CASBR: 84.64±12.68, ASBR: 83.63±11.41; F=11.78, P<0.01). For patients with ACL rupture, more ideal RTS rate and clinical outcomes were shown in the DBR group than in the ASBR and CASBR groups. Autograft status and quadriceps strength are postively related to RTS. ClinicalTrials.gov (NCT05400460).

Tale of quadriceps and hamstring muscle strength after ACL reconstruction: a systematic review with longitudinal and multivariate meta-analysis

ObjectiveThis study aimed to investigate how knee extensor and flexor strength change over time after anterior cruciate ligament reconstruction (ACLR).DesignSystematic review with longitudinal meta-analysis.Data sourcesMedline, Embase, CINAHL, Scopus, Cochrane CENTRAL...

Osteoarthritis After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Contributing Factors and Potential Treatments

Osteoarthritis After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Contributing Factors and Potential Treatments

Return to play after UCL injury in gymnasts

ABSTRACT Background Injuries to the ulnar collateral ligament (UCL) are commonly reported in traditional overhead sports. Conversely, there is a lack of evidence outlining management and return to play (RTP) outcomes for gymnasts. This study aimed to evaluate RTP and patient reported outcomes (PROs) in gymnasts after operative and non-operative treatment of UCL injuries. Methods Gymnasts who presented with UCL injury and underwent operative and non-operative treatment were evaluated. Patient reported outcomes were collected via telephone: Conway-Jobe Scale, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC) Score, Mayo Elbow Performance (MEP) Score, quick DASH (qDASH) and Timmerman-Andrews (TA) Elbow Score. Results Nine patients met inclusion criteria and were available for follow-up. Five were initially treated operatively and 4 were initially treated non-operatively. The operative group initially consisted of 3 ulnar collateral ligament reconstructions (UCLR) and 2 UCL repairs with internal bracing. One patient crossed over to the operative group after failing non-operative treatment and underwent UCLR 4 months post injury. Overall, 66.7% and 100% of operatively and non-operatively treated gymnasts were able to return to play, respectively. At final follow-up, the operative groups’ mean KJOC, MEP, TA and qDASH scores were: 68.4 ± 7.7, 97.5 ± 2.7, 90.8 ± 10.7 and 1.9 ± 3.0, respectively. For the non-operative group, the mean scores were 67.4 ± 9.0, 71.7 ± 5.8, 71.7 ± 14.4 and 11.4 ± 9.9, respectively. Treatment satisfaction for the operative group was 81.7 ± 27.5 compared to 80.6 ± 34.5 in the non-operative group. Odds ratios indicated no differences between groups. Conclusion Both operative and non-operative interventions for UCL injuries in gymnasts can provide favorable outcomes with respect to return to play and subjective patient-reported outcomes. Further research is warranted to determine optimal treatment, especially regarding indications for operative vs. nonoperative treatment, of UCL injury based on injury severity and location in gymnasts. Level of Evidence Level III

Favorable change in patient-reported outcomes following peroneus longus to brevis tendon transfer and lateral ankle ligament reconstruction

BackgroundA peroneus longus to brevis tendon transfer is recommended for a severely torn peroneus tendon, but there is little research on the outcome. We conducted a prospective cohort study to examine patient-reported outcomes after this procedure. MethodsThirty-two patients underwent a peroneus longus to brevis tendon transfer and lateral ankle ligament reconstruction, 11 had an additional calcaneal osteotomy. The Foot and Ankle Outcome Score (FAOS) and Short Form-36 (SF-36) were assessed preoperatively, six and 12 months after surgery. ResultsPreoperative mean FAOS was 51.7 (SD 17.8) compared with 72.7 (SD 21.2) at 12 months, an improvement of 21 (95 % CI 12.7–28.0) (p < 0.0001). SF-36 improved significantly in the three domains involving physical function and bodily pain (p < 0.007). ConclusionPatient-reported outcomes improved significantly through peroneus longus to brevis tendon transfer. This procedure is worth considering for patients with a severely damaged peroneus tendon. Level of evidenceLevel II: Prospective cohort study

Superior Biological Healing of Hamstring Autografts Compared with Tibialis Allografts after Anterior Cruciate Ligament Reconstruction: A Propensity Score Matching Analysis Based on Second-Look Arthroscopy.

Background and Objectives: Remodeling and healing of the graft are crucial processes for long-term graft survival after anterior cruciate ligament reconstruction (ACLR). However, few studies have objectively evaluated the differences in graft healing between autografts and allografts. This study aimed to compare the status of the anterior cruciate ligament (ACL) grafts between hamstring tendon (HT) autografts and tibialis anterior tendon (TAT) allografts using second-look arthroscopy. Materials and Methods: The outcomes of 193 consecutive patients (153 males and 40 females, with an average age of 30.38 and BMI of 25.43 kg/m2) who underwent second-look arthroscopy following primary ACLR were retrospectively reviewed. Prior to participating in this study, all patients provided written informed consent. The patients were divided into two groups: those with HT autografts and those with TAT allografts. Confounding factors were matched between the two groups using propensity score matching (PSM). ACL graft status was assessed during second-look arthroscopy using a numeric scale system based on the degree of four parameters: graft tension, continuity, synovium coverage, and vascular marking. Clinical outcomes were assessed using the Lysholm and International Knee Documentation Committee (IKDC) scores. Graft status and clinical outcomes were compared between the two groups. Additionally, a subgroup analysis based on the timing of the second-look arthroscopy (12-24 months vs. >24 months after the initial ACLR) was conducted. Results: After PSM, 62 patients were included in each group. The second-look arthroscopy was conducted at 23.6 ± 6.6 months for the HT group and at 24.0 ± 7.9 months for the TAT group (p = 0.749). The continuity and tension of the ACL graft were not significantly different between the two groups (p = 0.146 and 0.075, respectively). However, the TAT group exhibited significantly inferior synovial coverage and vascular marking of the ACL graft compared with the HT group (p = 0.021 and 0.007, respectively). These findings were consistent regardless of the timing of the second-look arthroscopy. Clinical outcomes, according to the Lysholm and IKDC scores, significantly improved in both groups with no significant differences (p = 0.386 and 0.733, respectively). Conclusions: Although there were no differences in graft tension and continuity between HT autografts and TAT allografts, the biological healing of ACL grafts, in terms of synovialization and vascularization, was superior in HT autografts compared to TAT allografts.

Functional Outcome in Posterior Cruciate Ligament Reconstruction with Posterolateral Corner Reconstruction: A Prospective Clinical Study

Functional Outcome in Posterior Cruciate Ligament Reconstruction with Posterolateral Corner Reconstruction: A Prospective Clinical Study

Surface Electromyography and Gait Features in Patients after Anterior Cruciate Ligament Reconstruction.

An important reason for the poor recovery of anterior cruciate ligament (ACL) injuries is the poor recovery of muscle function. Therefore, we used surface electromyography (sEMG) and gait analysis to explore the muscle activation patterns and gait characteristics between lower limbs under different exercise states in patients, following anterior cruciate ligament reconstruction (ACLR). Forty-one adults with unilateral ACL injuries in Binzhou Medical University Hospital from October 2022 to June 2023 were allocated to three groups according to the time after ACL reconstruction: group A (≤3 months, 16), group B (3 months-1 year, 13), and group C (>1 year, 12). Patients were tested by sEMG and gait, while straight leg raising (SLR), walking at normal speed, fast walking, and walking up and down the stairs. Two related sample tests were performed for the normalized root mean square (RMS) values and gait parameters. Muscle function changes varied in different training tasks. The RMS value of the involved side was more than the uninvolved side in biceps femoris and semitendinosus of group A (p < 0.010), and for the bilateral rectus femoris (RS), vastus medialis (VM), and vastus lateralis in group B, only the comparison of the RS was significant in group C during fast walking and going up and down the stairs. The ground impact (0.90 [0.63, 1.33] vs. 0.71 [0.43, 1.02], p = 0.035) of the uninvolved side was significantly decreased compared to those of the involved side in patients with ACLR when going down the stairs. Different muscles need to be focused on at different stages of the postoperative period. sEMG and gait analysis can guide the development of a rehabilitation program.

Rates of Early Recovery Following Thumb Carpometacarpal Arthroplasty: Comparing Ligament Reconstruction and Tendon Interposition, Abductor Pollicis Longus Suspensionplasty, and Suture Button Suspensionplasty

Abstract Background Several techniques have been previously described for the treatment of thumb carpometacarpal (CMC) arthritis, including trapeziectomy with ligament reconstruction and tendon interposition (LRTI), abductor pollicis longus suspensionplasty (APLS), or suture button suspensionplasty (SBS). It remains unclear whether a specific method produces faster recovery and more rapid return to function. The purpose of this study was to evaluate early clinical outcomes in patients undergoing thumb CMC arthroplasty stratified by method of treatment. Methods This study was conducted using a registry of patients undergoing thumb CMC arthroplasty using LRTI, APLS, or SBS. Patients were grouped by technique for comparison. Patient-reported outcomes were measured using Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity, Pain Interference, and Pain Intensity scores and compared across cohorts using analysis of variance. Regression analysis was used to determine factors associated with early clinical outcomes. Results Note that 150 out of 201 patients met inclusion criteria for this study. Univariate regression demonstrated no difference between technique and achievement of minimal clinically important difference (MCID) by 1 year or ∆PROMIS scores at 1 and 3 months postoperatively. Stepwise multivariate regression analysis also found that technique did not contribute significantly to postoperative outcomes. Increased baseline PROMIS Upper Extremity scores were associated with lower odds of achieving MCID (odds ratio 0.80, p &lt; 0.001). Baseline PROMIS scores were also associated with ∆PROMIS scores at 1 and 3 months postoperatively. Conclusion Patients undergoing thumb CMC arthroplasty via LRTI, APLS, or SBS can expect to experience similar improvements from baseline in the early postoperative period regardless of technique choice.

A Flat Reconstruction of the Medial Collateral Ligament and Anteromedial Structures Restores Native Knee Kinematics: A Biomechanical Robotic Investigation.

Injuries of the superficial medial collateral ligament (sMCL) and anteromedial structures of the knee result in excess valgus rotation and external tibial rotation (ER) as well as tibial translation. To evaluate a flat reconstruction of the sMCL and anteromedial structures in restoring knee kinematics in the combined MCL- and anteromedial-deficient knee. Controlled laboratory study. Eight cadaveric knee specimens were tested in a 6 degrees of freedom robotic test setup. Force-controlled clinical laxity tests were performed with 200 N of axial compression in 0°, 30°, 60°, and 90° of flexion: 8 N·m valgus torque, 5 N·m ER torque, 89 N anterior tibial translation (ATT) force, and an anteromedial drawer test consisting of 89 N ATT force under 5 N·m ER torque. After determining the native knee kinematics, we transected the sMCL, followed by the deep medial collateral ligament (dMCL). Subsequently, a flat reconstruction of the sMCL with anteromedial limb, mimicking the function of the anteromedial corner, was performed. Mixed linear models were used for statistical analysis (P < .05). Cutting of the sMCL led to statistically significant increases in laxity regarding valgus rotation, ER, and anteromedial translation in all tested flexion angles (P < .05). ATT was significantly increased in all flexion angles but not at 60° after cutting of the sMCL. A combined instability of the sMCL and dMCL led to further increased knee laxity in all tested kinematics and flexion angles (P < .05). After reconstruction, the knee kinematics were not significantly different from those of the native state. Insufficiency of the sMCL and dMCL led to excess valgus rotation, ER, ATT, and anteromedial tibial translation. A combined flat reconstruction of the sMCL and the anteromedial aspect restored this excess laxity to values not significantly different from those of the native knee. The presented reconstruction might lead to favorable results for patients with MCL and anteromedial injuries with an anteromedial rotatory knee instability.

Revision ACL reconstruction, but not bilateral ACL reconstruction, is associated with clinically relevant inferior subjective knee function compared with primary ACL reconstruction: A comparative analysis of 6831 patients.

To evaluate and compare the subjective knee function in patients undergoing revision and bilateral anterior cruciate ligament (ACL) reconstruction (ACLR) with those undergoing primary ACLR in a large cohort. Patients without concomitant ligament injuries who underwent primary, revision or bilateral ACLR at the Capio Artro Clinic, Stockholm, Sweden, between 2005 and 2018 were identified. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1, 2 and 5 years postoperatively from the Swedish National Knee Ligament Registry. Patients who underwent revision and bilateral ACLR were compared with those who underwent primary ACLR (control group) using Student's t test. A total of 6831 patients (6102 with primary ACLRs, 343 with revision ACLRs and 386 with bilateral ACLRs) were included. Preoperatively, there were significant but nonclinically relevant differences in favour of the revision ACLR group for KOOS Symptoms, Pain, Activities of Daily Living (ADL) and Sport/Rec subscale scores compared with the primary ACLR group. Postoperatively, except for the 1-year Symptoms and ADL subscales, the revision ACLR group reported significantly lower scores on all KOOS subscales than the primary ACLR group, with clinically relevant differences (>8-10 points) for the 1-, 2- and 5-year Sport/Rec and Quality of Life (QOL) subscales. The bilateral ACLR group reported significantly, but not clinically relevant, inferior scores on the 1-year Symptoms and QOL subscales and the 5-year Sport/Rec and QOL subscales compared with the primary ACLR group. Revision ACLR, but not bilateral ACLR, was associated with clinically relevant inferior subjective knee function compared with primary ACLR. It is important to counsel patients regarding their future subjective knee function after repeated ACLR. Compared to primary ACLR, inferior subjective results should be expected after revision ACLR, but not after bilateral ACLR. Level III.