Secondary Meniscal Injury Research Articles

Conservative Treatment Using Platelet-Rich Plasma for Acute Anterior Cruciate Ligament Injuries in Highly Active Patients: A Retrospective Survey.

Background The recommended treatment for anterior cruciate ligament (ACL) injuries in active, sports-oriented patients is reconstructive surgery in order to regain stability and prevent secondary meniscal injuries. However, ACL reconstruction requires a long recovery period and poses issues such as decreased muscle strength due to tendon harvesting and postoperative osteoarthritis (OA) progression, thereby raising significant expectations for the advancement of conservative treatments. Recent studies have shown that platelet-rich plasma (PRP) therapy, which utilizes the tissue repair-promoting property of platelets, is effective for ACL injuries. Methods We administered PRP therapy within six weeks after ACL injury in patients who expressed the desire for an early return to sports through conservative care. After the treatment, patients wore a simple brace that limited deep flexion but placed no restrictions on weight bearing. Four months was the standard goal established for returning to pre-injury condition, and, depending on the target level, timing, and knee condition, we adjusted the additional PRP treatments and rehabilitation approach, gradually authorizing the patients' return to sport. We assessed the ligament repair status by magnetic resonance imaging (MRI) just before the full return to sports.A retrospective survey was conducted to evaluate the status of ligament repair and the condition of return-to-sport in patients with ACLinjuries who underwent conservative treatment using PRP. Results The average patient age was 32.7 years and the average treatment was 2.8 PRP sessions. MRI evaluations confirmed that ligament continuity was regained in all cases. All the patients returned to their pre-injury level (Tegner Activity Scale 7.0) in an average of 139.5 days, but there was one instance of re-rupture following the return to sports. Conclusion All patients with ACL injury who underwent PRP therapy regained ligament continuity and returned to sport successfully with only one case of re-rupture.

Graft failure within 2years of isolated anterior cruciate ligament reconstruction is associated with increased risk of secondary meniscus tears.

A debilitating complication following anterior cruciate ligament reconstruction is a secondary meniscus tear. Currently, the literature is mixed regarding the risk factors associated with the incidence of secondary meniscus tears. The aim of this study was to investigate risk factors associated with meniscus tears following an isolated primary anterior cruciate ligament reconstruction. ACL graft failure was hypothesized to be the strongest risk factor for secondary meniscal injury occurrence. A retrospective cohort analysis was performed using the PearlDiver Database. Patients with a primary anterior cruciate ligament reconstruction were identified in the database. Patients with concomitant knee ligament injury or meniscus injury present at the time the index procedure were excluded. Patients were grouped to those who had a secondary meniscus tear within 2years following anterior cruciate ligament reconstruction and those who did not. Univariate analysis and multivariable regression analysis was conducted to identify significant risk factors for a secondary meniscus tear. There were 25,622 patients meeting criteria for inclusion in this study. Within 2years from the primary anterior cruciate ligament reconstruction, there were 1,781 patients (7.0%) that experienced a meniscus tear. Graft failure had the highest odds of having a postoperative meniscus tear within 2years (OR: 4.1; CI 3.5-4.8; p < 0.002). Additional significant risk factors included tobacco use (OR: 2.0; CI 1.0-3.1; p < 0.001), increased Charlson Comorbidity Index (OR: 1.2; CI 1.1-1.4), male gender (OR: 1.1; CI 1.1-1.2; p < 0.001), obesity (OR: 1.1; CI 1.1-1.2; p < 0.001), delayed surgery (OR:1.1; CI 1.1-1.2; p < 0.002), and patients age 30 and older (OR: 1.0; CI 1.0-1.0; p < 0.001). This study found that anterior cruciate ligament graft failure is the strongest predictor of post-operative meniscus tears. Other risk factors, including tobacco use, increased CCI, male gender, obesity, delayed surgery, and age 30 and older, were established, with several being modifiable. Therefore, targeted preoperative optimization of modifiable risk factors and postoperative protocols may reduce the risk of secondary meniscus tears. Level III, prognostic trial.

Early ACLR and Risk and Timing of Secondary Meniscal Injury Compared With Delayed ACLR or Nonoperative Treatment: A Time-to-Event Analysis Using Machine Learning

Background: Surgical and nonoperative management of anterior cruciate ligament (ACL) injuries seek to mitigate the risk of knee instability and secondary meniscal injury. However, the associated risk and timing of secondary meniscal tears have not been completely elucidated. Purpose: To compare risk and timing of secondary meniscal injury between patients receiving nonoperative management, delayed ACL reconstruction (ACLR), and early ACLR using a machine learning survival analysis. Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database was used to identify and review records of patients with a diagnosis of ACL rupture between 1990 and 2016 with minimum 2-year follow-up. Patients undergoing ACLR were matched 1:1 with nonoperatively treated controls. Rate and time to secondary meniscal tear were compared using random survival forest algorithms; independent models were developed and internally validated for predicting injury-free duration in both cohorts. Performance was measured using out-of-bag c-statistic, calibration, and Brier score. Model interpretability was enhanced using global variable importance and partial dependence curves. Results: The study included 1369 patients who underwent ACLR and 294 patients who had nonoperative treatment. After matching, no significant differences in rates of secondary meniscal tear were found (P = .09); subgroup analysis revealed the shortest periods of meniscal survival in patients undergoing delayed ACLR. The random survival forest algorithm achieved excellent predictive performance for the ACLR cohort, with an out-of-bag c-statistic of 0.80 and a Brier score of 0.11. Significant variables for risk of meniscal tear for the ACLR cohort included time to return to sports or activity ≤350 days, time to surgery ≥50 days, age at injury ≤40 years, and high-impact or rotational landing sports, whereas those in the nonoperative cohort model included time to RTS ≤200 days, visual analog scale pain score >3 at consultation, hypermobility, and noncontact sports. Conclusion: Delayed ACLR demonstrated the greatest long-term risk of meniscal injury compared with nonoperative treatment or early ACLR. Risk factors for decreased meniscal survival after ACLR included increased time to surgery, shorter time to return to sports or activity, older age at injury, and involvement in high-impact or rotational landing sports. Pending careful external validation, these models may be deployed in the clinical space to provide real-time insights and enhance decision making.

Combined ACL and ALL reconstruction reduces the rate of reoperation for graft failure or secondary meniscal lesions in young athletes.

Graft failure and secondary meniscal tears are major concerns after anterior cruciate ligament (ACL) reconstruction in young athletes. The aim was to evaluate the link between ACL reconstruction with and without anterolateral ligament (ALL) reconstruction and outcomes in young patients participating in pivoting sports. This was a retrospective study of data collected prospectively. Patients less than 20years, involved in pivoting sports and undergoing primary ACL reconstruction with a quadruple hamstring tendon (4HT) graft or 4HT graft combined with anterolateral ligament reconstruction (4HT + ALL) were included. Survival analysis was performed to identify the prognostic indicators for reoperation due to graft failure or secondary meniscal lesions. Knee laxity was assessed and patient reported outcome measures (PROMs) were collected. A total of 203 patients (mean (± SD) age: 16.3 ± 2years) with a mean follow-up of 4.8 ± 0.9 (range: 3.3‒6.8) years were included. There were 101 4HT and 102 4HT + ALL grafts. Graft rupture rates were 11.9% for 4HT grafts and 5.8% for 4HT + ALL grafts (n.s.). There were 9.9% secondary meniscal procedures for 4HT grafts vs. 1.9% for 4HT + ALL grafts (p = 0.02). With reoperation for graft failure or secondary meniscal lesions at final follow-up as the endpoint, survival was better in the 4HT + ALL group (91.4% vs. 77.8%, respectively; p = 0.03). Absence of ALL reconstruction (HR = 4.9 [95%CI: 1.4-17.9]; p = 0.01) and preoperative side-to-side laxity > 3mm (HR = 3.1 [95%CI: 1.03-9.1]; p = 0.04) were independently associated with an increased rate of reoperations. Mean (± SD) side-to-side laxity was 1.3 ± 1.3mm (range: -2 to 5) for 4HT grafts vs. 0.9 ± 1.3mm (range: -6 to 4.8) for 4HT + ALL grafts (n.s.) 6months post-surgery. The rate of return to the same sport at the same level was 42.2% for 4HT grafts vs. 52% for 4HT + ALL grafts (n.s.). There was no significant difference in subjective outcomes including PROMs between the two groups. Combined ALL + ACL reconstruction reduced the rate of graft failure and secondary meniscal injury in young athletes when compared to ACL reconstruction alone. Subjective results were comparable, with a similar rate of complications. Combined reconstruction should be preferred in this young population. Level IV.

Re-rupture rate and the post-surgical meniscal injury after anterior cruciate ligament reconstruction with the Press-Fit-Hybrid®-technique in comparison to the interference screw technique: a retrospective analysis of 200 patients with at least 3 years follow-up

BackgroundThere is currently no consensus regarding the preferred surgical procedure for the reconstruction of anterior cruciate ligament (ACL). The interference screw technique is widely used, but has been associated with a risk of graft damage. The Press-Fit-Hybrid®-technique is one of the alternatives for biological ACL-reconstruction with minimal implant requirements. The hypothesis of this retrospective analysis is, that the Press-Fit-Hybrid®-technique leads to better results with respect to re-rupture rate and secondary meniscal lesion than the interference-screw-technique.MethodsTo compare the re-rupture rate of the interference-screw-technique (IF) used until 2015 with the currently used Press-Fit-Hybrid®-technique (PFH), the last 100 patients of the IF-group and the first 100 patients of the PFH-group were retrospectively analyzed. Primary outcomes were re-rupture rate, complications and secondary meniscal injury. Additionally, laxity, Lachman and Pivot-shift and range of motion were evaluated.ResultsA mean follow-up of 4.2 and 5.3 years revealed 4% and 9% re-rupture rates and 1% and 2% complication rates in the PFH- and IF-group, respectively. In the PFH-group there were no re-ruptures in patients older than 23 years. Secondary meniscal injury post-surgery was 6% and 9% for the PFH and IF-group, respectively. Knee stability was similar in both groups. Range of motion was significantly better in the PFH-group, with 136° of flexion, 6 months after surgery.ConclusionFor ACL-reconstruction the Press-Fit-Hybrid®-technique is an alternative new method. Low level of secondary meniscal lesions after surgery and high stability, is known to prevent later arthrosis of the knee. The encouraging observed trend of the reduction of the re-rupture rate in revision surgery and in young patients using the Press-Fit-Hybrid®-technique in comparison to the interference-screw-technique must be confirmed with further studies.Level of evidenceTherapeutic Level III, retrospective cohort study.

Incidence and Risk Factors for Residual High-Grade Pivot Shift After ACL Reconstruction With or Without a Lateral Extra-articular Tenodesis.

Background:Residual rotatory knee laxity at midterm follow-up after isolated anterior cruciate ligament reconstruction (ACLR) versus ACLR with lateral extra-articular tenodesis (LET) remains an issue.Purpose/Hypothesis:To evaluate the outcomes of ACLR with or without additional LET at a minimum 2-year follow-up in patients with preoperative high-grade pivot shift (PS). Our hypothesis was that the addition of LET would decrease the risk of secondary meniscal injury and the presence of residual high-grade PS at follow-up.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective analysis performed at 3 sports medicine centers identified 266 study patients; all had a high-grade PS (grade 2 or 3) preoperatively and underwent isolated ACLR with or without LET. Four different ACLR techniques were used: single-strand quadrupled semitendinosus (ST4) ACLR without LET (ST4 group; n = 55), ST4 with anatomic LET (ST4+LET group; n = 77), bone–patellar tendon and modified Lemaire LET (BTB+LET group; n = 43), and quadriceps tendon and modified Lemaire LET (QT+LET group; n = 91). At follow-up, we evaluated for the presence of high-grade (grade ≥2) PS. Preoperative meniscal tears and their treatment were recorded.Results:Overall, 185 (69.5%) patients had at least 1 meniscal tear at index surgery. The mean follow-up period was 44.3 months; 47 (17.7%) patients had a new meniscal tear and 64 (24%) patients had a high-grade PS at follow-up. Compared with meniscal repair, significant predictors for high-grade PS at follow-up were meniscectomy (odds ratio [OR] = 2.65 [95% CI, 1.19-5.63]; P = .02) and nonrepair of preoperative meniscal tear (OR = 3.26 [95% CI, 1.27-9.43]; P = .007). The appearance of a new symptomatic meniscal tear was the strongest significant predictor of high-grade PS at follow-up (OR = 4.31 [95% CI, 2.31-8.06]; P < .001). No significant correlation was observed between the addition of LET and the presence of high-grade PS at follow-up.Conclusion:In the current study, 1 in 4 patients with high-grade PS before ACLR with or without LET was at risk of residual rotatory knee laxity at mean 44-month follow-up, regardless of the technique used. Repairing a pre-existing meniscal lesion was more effective than performing LET to decrease the presence of a high-grade PS at follow-up.

Does Anterior Cruciate Ligament Reconstruction Protect the Meniscus and Its Repair? A Systematic Review

Background:Anterior cruciate ligament (ACL) tear and meniscal injury often co-occur. The protective effect of early ACL reconstruction (ACLR) on meniscal injury and its repair is not clear. Critical literature review can support or change clinical strategies and identify gaps in the available evidence.Purpose:To assess the protective effect of ACLR on the meniscus and provide clinical guidelines for managing ACL tears and subsequent meniscal injury. We aimed to answer the following questions: (1) Does ACLR protect the meniscus from subsequent injury? (2) Does early ACLR reduce secondary meniscal injury compared with delayed ACLR? (3) Does ACLR protect the repaired meniscus?Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review was performed through use of MEDLINE and Embase electronic databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms included ACL, reconstruction, and meniscus. Studies describing primary ACLR and nonoperative treatment in adult patients were included, as well as studies indicating timing of ACLR. The included articles were assessed individually for risk of bias through use of the modified Cochrane Risk of Bias and MINORS (Methodological Index for Nonrandomized Studies) tools.Results:One level 2 randomized controlled trial and several level 3 and 4 studies indicated a protective effect of ACLR on meniscal injury compared with nonoperative treatment. There was weak (level 3) evidence of the protective effect of early ACLR on the meniscus. Meniscal repair failure was less frequent in patients with ACL reconstruction than in patients with ACL deficiency (level 4).Conclusion:The evidence collected in this review suggests a protective effect of ACLR for subsequent meniscal injury (level 2 evidence). ACLR should be performed within 3 months of injury (level 3 evidence). Meniscal injury requiring surgical repair in the ACL-deficient knee should be treated with repair accompanied by ACLR (level 3 evidence). The paucity of level 2 studies prevents the formation of guidelines based on level 1 evidence. There is a strong clinical need for randomized or prospective trials to provide guidelines on timing of ACLR and meniscal repair.

Loss of anterior cruciate ligament integrity and the risk of secondary meniscal injury and bone marrow lesions: data from the osteoarthritis initiative

Loss of anterior cruciate ligament integrity and the risk of secondary meniscal injury and bone marrow lesions: data from the osteoarthritis initiative

Is Anterior Cruciate Ligament Reconstruction Effective in Preventing Secondary Meniscal Tears and Osteoarthritis?

Background: Reconstruction of anterior cruciate ligament (ACL) tears may potentially prevent the development of secondary meniscal injuries and arthritis. Purpose/Hypothesis: The purpose of this study was to (1) evaluate the protective benefit of ACL reconstruction (ACLR) in preventing subsequent meniscal tears or arthritis, (2) determine if earlier ACLR (<1 year after injury) offers greater protective benefits than delayed reconstruction (≥1 year after injury), and (3) evaluate factors predictive of long-term sequelae after ACLR. The hypothesis was that the incidence of secondary meniscal tears, arthritis, and total knee arthroplasty (TKA) would be higher in patients treated nonoperatively after ACL tears than patients treated with surgical reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included a population-based incidence cohort of 964 patients with new-onset, isolated ACL tears between 1990 and 2000 as well as an age- and sex-matched cohort of 964 patients without ACL tears. A chart review was performed to collect information related to the initial injury, treatment, and outcomes. A total of 509 patients were treated with early ACLR, 91 with delayed ACLR, and 364 nonoperatively. All patients were retrospectively followed (range, 2 months to 25 years) to determine the development of subsequent meniscal tears, arthritis, or TKA. Results: At a mean follow-up of 13.7 years, patients treated nonoperatively after ACL tears had a significantly higher likelihood of developing a secondary meniscal tear (hazard ratio [HR], 5.4; 95% CI, 3.8-7.6), being diagnosed with arthritis (HR, 6.0; 95% CI, 4.3-8.4), and undergoing TKA (HR, 16.7; 95% CI, 5.0-55.2) compared with patients treated with ACLR. Similarly, patients treated with delayed ACLR had a higher likelihood of developing a secondary meniscal tear (HR, 3.9; 95% CI, 2.2-6.9) and being diagnosed with arthritis (HR, 6.2; 95% CI, 3.4-11.4) compared with patients treated with early ACLR. Age >21 years at the time of injury, articular cartilage damage, and medial/lateral meniscal tears were predictive of arthritis after ACLR. Conclusion: Patients treated with ACLR have a significantly lower risk of secondary meniscal tears, symptomatic arthritis, and TKA when compared with patients treated nonoperatively after ACL tears. Similarly, early ACLR significantly reduces the risk of subsequent meniscal tears and arthritis compared with delayed ACLR.

Three-dimensional invivo dynamic motion analysis of anterior cruciate ligament-deficient knees during squatting using geometric center axis of the femur.

Anterior cruciate ligament (ACL) injury often leads to symptoms of instability, which may cause meniscus injury, osteochondral lesions, and degenerative changes. For thorough evaluation of the effects of abnormal motion of ACL-deficient (ACLD) knees on the meniscus and articular cartilage, it is necessary to assess tibiofemoral motion in the medial and lateral compartments separately. Our aim was to determine if invivo three-dimensional (3D) dynamic motion of ACLD knees differs from that of contralateral uninjured knees by assessing knee motion in the medial and lateral compartments respectively. A total of 22 patients with an isolated ACL-injured knee were examined. 3D to two-dimensional registration was used to determine 3D knee motion during squatting from full knee extension to full flexion for both ACLD and contralateral uninjured knees. The knee motion was evaluated by the movement of the geometric center axis of the femur projected onto the tibial axial plane. In ACLD knees the lateral femoral condyle was located significantly more posteriorly during nearly full extension than in contralateral uninjured knees. The range of anteroposterior translation of the medial femoral condyle was significantly greater than those of contralateral uninjured knees. Almost all of the contralateral uninjured knees demonstrated medial pivot motion, while the ACLD knees showed higher variance. The ACLD knees exhibited a motion pattern different from those of contralateral uninjured knees with higher variance. During nearly full extension of the ACLD knees, the lateral femoral condyle translated posteriorly and the screw-home movement seemed to be impaired. The ACL might have an important role in maintaining normal knee function, especially during the early flexion phase. The larger range of anteroposterior translation of the medial femoral condyle in ACLD knees may be associated with a risk of secondary meniscal injury and degenerative change in the articular cartilage. Level IV.

Patellofemoral osteoarthritis 15 years after anterior cruciate ligament injury – a prospective cohort study

Prevalence and clinical relevance of patellofemoral (PF) osteoarthritis (OA) after anterior cruciate ligament (ACL) injury. Prospectively we studied 94 out of 100 consecutive patients 15 years after acute ACL injury. ACL reconstructions were only performed late if recurrent "give way" persisted or a secondary meniscal injury suitable for repair occurred. The subjects, mean age 42 years, had knee radiographs including skyline PF view taken, which were graded according to the atlas of the Osteoarthritis Research Society International. Knee-related symptoms and function were assessed by questionnaires. PF OA was present in 12/75 knees (16%). Of 94 patients 22 (23%) have had their ACL reconstructed during follow-up. Meniscal injury and ACL reconstruction had occurred more often in knees with PF OA than in knees without PF OA (P=0.004 and P=0.002, respectively). Seven of 15 ACL reconstructed knees showed radiographic PF OA at follow-up. Knees with PF OA had more extension and flexion deficit than knees without PF OA. Subjects with PF OA maintained a higher activity level from injury to follow-up, but did not differ significantly from those without PF OA regarding patient-relevant symptoms and knee function. However, there was a trend for worse outcome in subjects with PF OA. We found a relatively low prevalence of mild PF OA after ACL injury treated non-operatively, and it had limited impact on knee symptoms and patient-relevant knee function. At follow-up PF OA was associated with higher activity level, meniscal injury, extension and flexion deficit, and ACL reconstruction.

15-Year Follow-up of Neuromuscular Function in Patients with Unilateral Nonreconstructed Anterior Cruciate Ligament Injury Initially Treated with Rehabilitation and Activity Modification

Background It has been suggested that neuromuscular function is of importance in the overall outcome after anterior cruciate ligament (ACL) injury. Hypothesis Good neuromuscular function can be achieved and maintained over time in subjects with ACL injury treated with rehabilitation and activity modification but without reconstructive surgery. Study Design Case series; Level of evidence, 4. Methods One hundred consecutive patients (42 women and 58 men) with acute ACL injury at a nonprofessional, recreational or competitive activity level were assessed 1, 3, and 15 years after injury. Their mean age at inclusion was 26 years (range, 15-43 years). All patients initially underwent rehabilitation and were advised to modify their activity level, especially by avoiding contact sports. Patients with recurrent giving-way episodes or secondary meniscal injuries that required fixation were subsequently excluded and underwent reconstruction of the ACL. Sixty-seven patients (71% of those available for follow-up) with unilateral nonreconstructed injury remained at the 15-year follow-up. Fifty-six of these 67 patients were examined with the single-legged hop test for distance and knee muscle strength. The limb symmetry index (LSI), calculated by dividing the result for the injured leg by that of the uninjured leg and multiplying by 100, was used for comparisons over time (paired t test). Results The LSI for the single-legged hop test was higher at the 3-year follow-up (mean, 98.5%; standard deviation [SD], 7.6%) than at the 15-year follow-up (mean, 94.8%; SD, 10.5%) (mean difference, —3.7%; 95% confidence interval [CI], —6.1% to —1.2%; P = .004). The LSI for isometric extension was higher at the 15-year follow-up (mean, 97.2%; SD, 13.7%) than at the 1-year follow-up (mean, 88.2%; SD, 15.4%) (mean difference, 9.0%; 95% CI, 3.7% to 14.4%; P = .001). At the 15-year follow-up, between 69% and 85% of the patients had an LSI ≥90%. Conclusions Good functional performance and knee muscle strength can be achieved and maintained over time in the majority of patients with ACL injury treated with rehabilitation and early activity modification but without reconstructive surgery.

Activity Level and Subjective Knee Function 15 Years after Anterior Cruciate Ligament Injury

Background The activity level and subjective knee function after an anterior cruciate ligament (ACL) injury treated without reconstruction have not been well elucidated. Hypothesis Patients with ACL injury can achieve good knee function and satisfactory long-term activity level when treated by early activity modification combined with rehabilitation. Study Design Cohort study (prognosis); Level of evidence, 2. Materials and Methods One hundred patients with an acute total ACL injury were observed for 15 years. All patients initially underwent arthroscopic surgery and a rehabilitation program. They were advised to modify their activity level, especially by avoiding contact sports. Patients with recurrent giving-way episodes and/or secondary meniscal injuries that required fixation (n = 6) were subsequently excluded and underwent reconstruction (n = 22). Sixty-seven patients with unilateral nonreconstructed ACL injury remained at the 15-year follow-up. The Lysholm knee score, Tegner activity level, and a visual analog score for global knee function were recorded at regular intervals. At the final follow-up, patients were further evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) subjective knee evaluation form. Results Forty patients resumed their preinjury activity level or higher within 3 years. The median activity level 15 years after injury had decreased from 7 to 4 according to Tegner activity scale (P < .001). The mean Lysholm knee score was 96 and 95, 1 and 3 years after injury, respectively, but declined to 86 after 15 years (P < .001). Forty-nine patients had good/excellent results, and 14 had fair (n = 6) or poor function (n = 8) at 15 years. Patients injured in contact sports scored lower in the quality of life sub-scale of KOOS than those injured in noncontact sports (P < .05). Thirteen of the 67 patients (19%) were reoperated with an arthroscopic procedure because of knee symptoms. Conclusion Early activity modification and neuromuscular rehabilitation resulted in a good knee function and an acceptable activity level in the majority of the nonreconstructed patients. The decline in activity level of patients engaged in contact sports at the time of injury affected their subjective quality of life more than patients involved in noncontact sports.

Augmentation of Acute Rupture of the Anterior Cruciate Ligament

Acute repair and augmentation of anterior cruciate ligament rupture is indicated in the active individual who is going to place excessive demands on the knee. Repair of any other ligament injury with the addition of augmentation of the anterior cruciate ligament repair provides a better chance for functional stability and lessens the incidence of secondary meniscal injury.