Single-bundle Anterior Cruciate Ligament Reconstruction Research Articles

Subjective Functional Outcomes of Single-Bundle Anterior Cruciate Ligament Reconstruction With Different Femoral Tunnel Positions via Arthroscopy.

Objective To compare the five-year subjective functional outcomes of single-bundle anterior cruciate ligament reconstruction (ACLR) with three different femoral tunnel positions under arthroscopic guidance. Methods A retrospective study was conducted on the clinical data of 165 patients who underwent ACLR at the Department of Sports Traumatology,Sports Hospital,National Institute of Sports Medicine,General Administration of Sport of China from January 2012 to December 2017.According to femoral tunnel positions,the patients were assigned into three groups of low centre (LC)section (n=53),high centre (HC) section (n=45),and high anterior medial (HAM) section (n=67).The three groups were compared before and 5 years after surgery regarding the following items:international knee documentation committee(IKDC) score,Lysholm score,and ACL-return to sport after injury (ACL-RSI) scale score. Results All patients were followed up for 57-64 months [(60.2±1.52) months].The IKDC scores in the LC,HC,and HAM groups 5 years after surgery were 80.80±10.82,77.36±14.36,and 85.33±7.42,respectively,and the scores were higher than those before surgery (all P=0.002).The HAM group had higher IKDC score than the LC and HC groups 5 years after surgery (P=0.022,P=0.008).The Lysholm scores in the LC,HC,and HAM groups 5 years after surgery were 80.87±10.83,77.67±15.23,and 86.10±7.68,respectively,which were higher than those before surgery (all P=0.002).Moreover,the HAM group had higher Lysholm score than the LC and HC groups (P=0.020,P=0.022).The ACL-RSI scores in the LC,HC,and HAM groups 5 years after surgery were 70.39±17.26,73.58±16.81,and 83.73±11.10,respectively,and the score was higher in the HAM group than in the LC and HC groups (P=0.014,P=0.038). Conclusions The ACL patients treated by ACLR with the HAM section had better rotational stability and subjective function 5 years after surgery.Therefore,we recommend the HAM section as the preferred femoral tunnel position in ACL reconstruction.

Oval Tunnel Shows Better Rotational Stability Than Round Tunnel in Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction: Biomechanical Study in a Porcine Model.

To compare knee laxity between the conventional round tunnel and oval tunnel techniques in primary anterior cruciate ligament (ACL) reconstruction in a porcine knee model. Twenty porcine knees were used for evaluating laxity in terms of anterior translation and anterolateral rotation. The study determined porcine knee kinematics on the Instron instruments under simulated Lachman (89 N anterior tibial load) at 15°, 30°, and 60° of flexion and a simulated pivot shift test (89 N anterior tibial load, 10 Nm valgus, and 4 Nm internal tibial torque) at 30° of flexion. Kinematics were recorded for intact (n = 10), ACL-deficient (n = 10), and conventional round (n = 10) or oval tunnel (n = 10) techniques. All measurements were repeated twice, and the average was used for comparison. Under the Lachman test, the conventional round tunnel and oval tunnel both showed significantly larger anterior tibial translation (ATT) at 30° and 60° compared to the intact knee (p < 0.05), but smaller ATT compared to the ACL-deficient knees (p < 0.05). However, there were no differences in ATT between the conventional round tunnel and oval tunnel techniques (p > 0.05). Under simulated pivot shift at 30° flexion, there was a significant difference between the conventional round tunnel and oval tunnel techniques (round vs. oval: 4.27 ± 0.87 mm vs. 3.52 ± 0.49 mm, p = 0.028). Both conventional round tunnel and oval tunnel techniques reduced ATT compared to ACL-deficient knees but failed to restore normal knee stability. However, the oval tunnel technique showed better rotational stability at 30° than the round tunnel technique. These findings suggest that the oval tunnel technique would be a reasonable option in anatomical single-bundle ACL reconstruction.

Joint Effusion at 3 Months After Anterior Cruciate Ligament Reconstruction: Its Risk Factors and Association With Subsequent Muscle Strength and Graft Remodeling.

Joint effusion at 3 months after anterior cruciate ligament (ACL) reconstruction is a risk factor for ACL reinjury. However, factors associated with joint effusion at 3 months postoperatively and the effect of joint effusion on subsequent quadriceps muscle strength and graft remodeling remain unknown. To identify factors associated with joint effusion and investigate the association between joint effusion and quadriceps muscle strength and graft remodeling in the postoperative period. Case-control study; Level of evidence, 3. In this retrospective multicenter study, the medical records of patients who underwent single-bundle ACL reconstruction between 2015 and 2021 were reviewed. The study included the data of 174 patients (mean age, 23.5 ± 10.6 years). Demographic data, including sex, age at surgery, time from injury to surgery in months, body mass index, preinjury Tegner activity score, presence of meniscus, and chondral injuries, were collected. Magnetic resonance imaging was performed 3 months postoperatively. Joint effusion was defined as grade 3 (range of grades, 0-3) according to the ACL Osteoarthritis Score. Isokinetic strength testing was performed at 60 deg/s, while the limb symmetry index (LSI) of quadriceps strength was evaluated at 6 months postoperatively. Moreover, graft remodeling was evaluated using magnetic resonance imaging-derived signal intensity ratio (SIR) measures at 1 year postoperatively. The authors used multivariate logistic and linear regression analyses to identify the factors influencing joint effusion at 3 months and those associated with postoperative quadriceps strength LSI and SIR values, respectively. Greater preinjury Tegner activity scores (odds ratio, 1.59; 95% CI, 1.08 to 2.34; P = .02) increased the odds of joint effusion at 3 months postoperatively. Multivariable linear regression analysis revealed that joint effusion (β = -23.8; 95% CI, -36.0 to -11.7; P < .001) was an independent factor associated with LSI of the quadriceps. Furthermore, joint effusion (β = 1.33; 95% CI, 0.53 to 2.14; P = .001) was associated with a higher SIR value of the reconstructed graft. The preinjury Tegner activity score was a factor associated with joint effusion at 3 months postoperatively, and joint effusion was associated with subsequent muscle weakness and delayed graft remodeling.

Modifiable and non-modifiable risk factors affecting surgical failure after revision ACL reconstruction: a cohort study

BackgroundResearch on factors influencing the outcomes of revision anterior cruciate ligament (ACL) reconstruction is relatively scarce and mostly relies even on reports from a single group. Understanding the factors contributing to the failure of revision ACL reconstruction can provide valuable information for achieving better clinical outcomes and assist in patient counseling before surgery. Therefore, this study aimed to analyze the factors contributing to surgical failure after revision ACL reconstruction.MethodsThe medical records of consecutive patients who underwent single-bundle revision ACL reconstruction using the transportal technique between 2010 and 2020 and had a minimum follow-up of 2 years were retrospectively reviewed. Eligible patients were classified into two groups on the basis of the presence of surgical failure during the follow-up period (group NF, patients who did not experience surgical failure; group F, patients who experienced surgical failure). In this study, surgical failure after revision ACL reconstruction was defined as meeting any of the following conditions during follow-up: the presence of graft re-tear confirmed by magnetic resonance imaging (MRI), anterior–posterior laxity graded ≥ 2, or rotational laxity graded ≥ 2. A comparative analysis was conducted on demographic data, as well as peri-, intra-, and postoperative data between the groups. Additionally, a regression analysis was performed to investigate factors influencing surgical failure after revision ACL reconstruction.ResultsA total of 58 patients were included (group NF, 40 patients; group F, 18 patients). In between-group comparisons of demographic, peri-, and intra-operative data, group F exhibited a higher frequency of multiple revision surgeries (P = 0.001), increased preoperative osteoarthritis grade (P = 0.001), and shallower femoral tunnel depth (P = 0.002) compared with group NF. At the final follow-up, group F demonstrated relatively poor clinical outcomes, both subjectively and objectively. Multivariate regression analysis revealed that all variables that showed differences in the preceding comparisons were independent factors affecting surgical failure after revision ACL reconstruction.ConclusionsSurgical failure after revision ACL reconstruction can occur in a substantial number of patients, influenced by non-modifiable factors, such as cases corresponding to multiple revision surgery and preoperative osteoarthritis grade, and modifiable factors, such as femoral tunnel depth.

Optimal angles for independent femoral tunnel drillings to prevent damage to anatomic structures in single-bundle anterior cruciate ligament reconstruction

PurposeTo determine the optimal angles for independent femoral tunnel drillings in single-bundle anterior cruciate ligament reconstruction (ACLR) in different races and genders with the aim of preventing damage to lateral femoral anatomic structures (LFAS), posterior cortex and medial femoral condyle.MethodsThis study included 180 volunteers, including 90 Caucasian and 90 matched Chinese. Magnetic resonance imaging (MRI) was used to scan the knees to create three-dimensional bone models, the ACL femoral footprint centre and the LFAS. In each femur model, femoral tunnels were established using a set of 16 distinct angular combinations: 15°, 30°, 45°, and 60° in the axial plane, as well as 15°, 30°, 45°, and 60° in the coronal plane. The minimum distance from the tunnel exit to the LFAS was evaluated, and the tunnel length, posterior cortex damage and medial femoral condyle injury were assessed.ResultsAmong the 180 patients with simulated ACL femoral tunnels, there was damage to the anatomical structure in parts of the model. According to the Cochran Q test results (P < 0.001), the percentage of safe tunnels varied significantly among the 16 different drilling angle combinations. The overall occurrence of the tunnel exit causing injury to LFAS were 8.3% and 8.1% in Chinese and Caucasian groups (P = 0.786). The means for tunnel length in Caucasians was 40.1 ± 7.9 mm, respectively; for Chinese, the results was 38.8 ± 6.6 mm (P < 0.001). Females had significantly shorter femoral tunnels than males in both Chinese and Caucasian (P < 0.001). The overall invasion rate of the posterior cortex and medial femoral condyle were 32.6% and 7.4% for Chinese; 31.0% and 7.4% for Caucasians, respectively.ConclusionTo reduce risks of injury to anatomical structures, such as the LFAS, posterior cortex and medial femoral condyle, specific angle combinations of 30°/45°, 45°/30°, 45°/45°, 45°/60°, 60°/30°, 60°/45° and 60°/60° should be used when creating the femoral tunnel in single-bundle ACLR. The selected drilling angles are critical for optimizing femoral tunnel placement.

No difference in osteoarthritis, but less graft failures after 5 years, comparing anatomic double-bundle to anatomic single-bundle ACL reconstruction.

The purpose of this study was to compare the incidence of knee osteoarthritis (OA) between the anatomic single-bundle (SB) and anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction technique after 5-year follow-up (FU). Secondary objectives were to compare patient-reported outcome measures (PROMs), clinical examination, activity level, functional tests and graft failures between the two groups. The study was a secondary analysis after 5-year FU of a randomized controlled trial (RCT) (Clinical Trials NCT01033188). One hundred and twenty patients between 18 and 40 years were randomized to either anatomic SB or anatomic DB reconstruction. The Kellgren-Lawrence (KL) classification grade ≥2 and the Osteoarthritis Research Society International (OARSI) atlas criteria score ≥2 were used for defining OA. Additionally, PROMs were obtained and clinical examinations of the knees were performed. Finally, the number of patients experiencing graft failure in each group was recorded. Radiographic imaging was performed in 39 patients in the SB group and in 37 patients in the DB group. Four patients (10%) in the SB group and two (5%) in the DB group developed osteoarthritis according to the KL classification (p = 0.28). Five (13%) in the SB group and three (8%) in the DB group developed osteoarthritis according to the OARSI atlas criteria (p = 0.59; difference 5.0% [95% confidence interval, CI: -0.10 to 0.20]). There were no significant differences in the PROMs, clinical examinations, activity levels, or functional tests when comparing the two groups. Of initially 62 SB patients, 14 (23%) experienced graft failure compared to 4 (7%) of the 58 DB patients (p = 0.015; difference 0.016 [95% CI: 0.03-0.29]). At 5-year FU, there were no significant differences in the incidence of OA, PROMS, or other clinical findings comparing the anatomic DB to anatomic SB ACL reconstructed patients. There were fewer graft failures among patients treated with anatomic DB ACL reconstruction. II.

Determining Maximal Outcome Improvement Thresholds for Patient-Reported Outcome Measures After Primary ACL Reconstruction: A Mid-Term Follow-up Study Using the Anchor Method.

The clinical interpretation of patient-reported outcome measures (PROMs) after anterior cruciate ligament (ACL) reconstruction (ACLR) can be challenging. This study aimed to establish the clinical relevance of PROMs by determining maximal outcome improvement (MOI) thresholds at mid-term follow-up after primary ACLR. A total of 343 patients who underwent primary single-bundle ACLR using hamstring tendon autograft at our institute were included. Patients were queried with a 2-option anchor question regarding satisfaction with their current knee symptom state. The MOI of a PROM was calculated for each patient as the percentage of improvement normalized by the maximal possible improvement. The MOI threshold for each PROM was determined as the optimal cutoff value for predicting patient satisfaction based on receiver operating characteristic curve analysis. Multivariable logistic regression analyses were performed to identify predictors of achieving these thresholds. Subgroup analyses that stratified the time from injury to surgery within the cohort were performed, and MOI thresholds were recalculated within each of these subgroups. The PROMs evaluated in this study were the modified Lysholm Knee Score and the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) score. The calculated MOI threshold was 35.1% for the Lysholm score and 46.7% for the IKDC score. A longer time from injury to surgery reduced the odds of achieving the MOI threshold for the Lysholm score (odds ratio [OR] per time bracket = 0.7114, p < 0.0001) and IKDC score (OR = 0.8038, p = 0.0003). Male sex was associated with higher odds of achieving the MOI threshold for the IKDC score (OR = 1.9645, p = 0.0143). For patients with chronicity of ≤6 months, the MOI threshold was 35.1% for the Lysholm score and 57.9% for the IKDC score, and for patients with chronicity of >6 months, the thresholds were 24.5% and 27.1%, respectively. The calculated MOI thresholds for the Lysholm and IKDC scores at mid-term follow-up after primary ACLR were 35.1% and 46.7%, respectively. Greater chronicity of the ACL injury was associated with lower odds of achieving the MOI thresholds for the PROMs at mid-term follow-up. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Outcomes of combined single-bundle anterior cruciate ligament reconstruction and anterolateral structure reconstruction through a modified single femoral tunnel.

To explore the clinical outcomes of combining anterior cruciate ligament (ACL) reconstruction and anterolateral structure (ALS) reconstruction through a modified single femoral tunnel in patients with high risk of clinical failure. From December 2018 to August 2022, a total of 62 patients with ACL injury in our institution were enrolled in this study. All patients were associated with high risk of clinical failure, meeting the indications of ALS reconstruction. All patients accepted arthroscopic single-bundle ACL reconstruction and ALS reconstruction using hamstring autograft through a modified single femoral tunnel. Perioperative clinical outcome measurements consisted of functions, stability and safety evaluation at different time points (preoperative, postoperative threemonth, sixmonth, oneyear, twoyear, threeyear and more). Functional evaluation included Lysholm score, Tegner activity scale, subjective and objective International Knee Documentation Committee (IKDC) score. All patients, including 47 males and 15 females, aged 16-52years with an average age of 29.3 ± 9.2years, were followed up for 12-58months. At the last follow-up, the Lysholm, subjective IKDC and Tegner activity scale (93.8 ± 7.0, 88.8 ± 10.7 and 5.8 ± 1.4 respectively) were significantly higher than those before surgery (65.0 ± 20.8, 51.2 ± 21.1 and 2.3 ± 1.3 respectively)(P < 0.05). Postoperative pivot shift and Lachman test were markedly improved (P < 0.05). One patient still had grade II pivot shift, defined as clinical failure. During follow-up, no graftruptureoccurred according to magnetic resonance imaging and physical examination, no lateral compartment osteoarthritis were found in all patients. Combined single bundle ACL reconstruction and ALS reconstruction through a modified single femoral tunnel could significantly improve knee function and stability with low related risk in patients with high risk of failure in ACL injury.

Outcomes of All-Inside Arthroscopic ACL Reconstruction with Lateral Extra-Articular Tenodesis (ACLR + LET).

Anatomic single-bundle ACL reconstruction (ACLR) produces good results when the graft and tunnel are positioned in the anatomic footprint on the femoral and tibial insertion sites in a more oblique orientation. The Anterolateral Complex of the knee and its biomechanical role in controlling rotational laxity, internal rotation, and pivot shift has led to adding adjunctive procedures like extra-articular augmentation and lateral extra-articular tenodesis (LET) to decrease rotational laxity. We prospectively analyzed young adults with rotational instability and generalized laxity undergoing an arthroscopic single bundle ACLR with an additional LET procedure. 42 patients, aged between 20 and 50, undergoing all-inside ACLR augmented with concomitant lateral extra-articular tenodesis between November 2020 and October 2021 were included. All patients were followed up for one year and functional assessment comprised of the International Knee Documentation Committee [IKDC] score, visual analogue score [VAS], and Lysholm Knee Scoring Scale at 6months and 1year. Return to activity was assessed using the Tegner Activity Score. The Lysholm score, IKDC score, and VAS showed significant improvements at 6months after ACLR + LET (p < 0.0001) and further improved significantly at 1year. The patients had a significant decline in the Tegner Activity Scale at 6months but returned to the near pre-injury level (5.98 ± 0.924) at 1year (5.67 ± 0.816) which was insignificant (p = 0.1067). Three patients sustained mild complications. 93% were satisfied with the surgery, 66% returned to sports and no patient underwent re-operation. Combination of LET with ACLR produces good functional outcomes, high rates of return to sports activities, and no graft failure in young patients at high risk of failure.

Effect of Graft Choice for ACL Reconstruction on Clinical Outcomes in Combined ACL and MCL Injuries: Comparison Between Bone-Patellar Tendon-Bone and Hamstring Autografts.

Background/Objectives: The optimal graft, particularly in combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries, remains controversial. We evaluated the influence of graft choice between bone-patellar tendon-bone (BPTB) and hamstring autografts on clinical outcomes in combined ACL and MCL injuries. Methods: This retrospective analysis included patients with concurrent ACL and MCL injuries who underwent single-bundle ACL reconstruction with BPTB (group B) or hamstring (group H) grafts, between 2010 and 2019, with a ≥2-year follow-up. Patients were classified based on the MCL injury grade (I, II, or III). Clinical outcomes were assessed through knee stability evaluations using valgus stress radiographs and the KT-2000 arthrometer, patient-reported outcomes using the International Knee Documentation Committee (IKDC) subjective score and Lysholm score, and radiologic outcomes using the IKDC radiographic grade. Results: The study included 169 patients (group B, 92; group H, 77). No significant between-group differences in knee stability or functional outcomes were found after follow-up. Within the same MCL injury grade, particularly in high-grade MCL injuries, BPTB grafts resulted in significantly better medial stability (side-to-side difference in medial joint opening on valgus stress radiographs: grade II, p = 0.006; grade III, p = 0.039) and functional outcomes (IKDC subjective score: grade II, p = 0.045; grade III, p = 0.038) than hamstring grafts. In the hamstring group, higher-grade MCL injuries were associated with worse outcomes (Lysholm knee score, p = 0.009; IKDC subjective score, p = 0.015). Conclusions: Graft choice in ACL reconstruction with concomitant MCL injuries may affect clinical outcomes, particularly in high-grade MCL injuries. Although both graft types performed similarly overall, BPTB grafts provided superior medial stability and functional results in higher-grade MCL injuries. However, caution is needed when interpreting these results due to limitations such as the small sample size and the lack of randomization in graft selection.

Comparison of Clinical Results Using Hamstring Versus Quadriceps Tendon Graft Versus Bone Patella Tendon in Anterior Cruciate Ligament Reconstruction Surgery: A Randomized Clinical Trial.

Anterior cruciate ligament (ACL) reconstruction is pivotal for restoring knee stability and function in individuals with ACL injuries. While bone-patellar tendon-bone (PT), hamstring tendon (HT), and quadriceps tendon (QT) autografts are commonly employed, their comparative effectiveness remains a subject of ongoing research. This study aims to comprehensively compare the functional outcomes, knee stability, revision rates, and incidence of anterior knee pain associated with these autografts. In this randomized clinical trial, adult male participants undergoing primary single-bundle ACL reconstruction were randomized into three groups (PT, HT, QT) using a computer-generated sequence with allocation concealment. Blinded assessments were conducted at 2-, 6-, and 12-months post-surgery to evaluate knee function, stability, and patient satisfaction. The rehabilitation protocol was standardized across groups, including specific exercises and cryotherapy, to minimize postoperative swelling and pain. A total of 75 participants were followed for 12 months post-surgery. While significant improvements in knee function and stability were observed across all groups, there were no statistically significant differences between the autograft types in terms of revision rates or the incidence of anterior knee pain. Detailed statistical analysis revealed effect sizes and confidence intervals, substantiating the clinical relevance of the findings. PT, HT, and QT autografts each provide favorable outcomes for ACL reconstruction without significant differences in efficacy up to one year postoperatively.Level of Evidence: Level 2 (Randomized Clinical Trial).

Prospective comparative study between peroneus longus tendon autograft and hamstring tendons autograft in single bundle ACL reconstruction

ABSTRACT Background ACL reconstruction is often regarded as the most effective approach of restoring knee stability. Several graft possibilities are available, including (BPTB), four-strand hamstring autografts, quadriceps tendon, and peroneus longus tendon. Each has both advantages and cons. This study compares the effectiveness of peroneus longus and hamstring tendon autografts for single bundle ACL restoration. Patients and Methods The study involved 60 patients. Thirty of them had their torn anterior cruciate ligaments reconstructed arthroscopically using hamstring tendons, while the other 30 had their ACLs managed arthroscopically with peroneus longus tendon. The follow-up period lasted at least 12 months. Patients were assessed using IKDC score and Lysholm score. Ankle function was assessed using AOFAS score. Results There was a statistically significant difference in preoperative and postoperative range of motion improvement in each group as an IKDC score item. However, no statistically significant difference existed between both groups. A statistically significant change in Lysholm scores preoperatively and postoperatively in each group was detected, but there was no statistical difference between groups 1 and 2, either in terms of improvement or percentage improvement. The AOFAS score was used also to assess for any donor site morbidity. No significant difference was detected between both ankles range of motion and no ankle joint dysfunction or problems with sports activities. Conclusion The current study found that the PL tendon autograft might be considered a safe, effective and a technically easy graft option for ACLR. The research shows no substantial difference in postoperative knee stability or graft failure rate between hamstring and peroneus tendons.

Single Bundle vs. Double Bundle ACL Reconstruction: Is there any difference in Joint Stability and Subjectivity?

Single Bundle vs. Double Bundle ACL Reconstruction: Is there any difference in Joint Stability and Subjectivity?

Factors Associated With a Successful Return to Performance After Anterior Cruciate Ligament Reconstruction: A Multiparametric Evaluation in Soccer Players.

Anterior cruciate ligament reconstruction (ACLR) is highly recommended in patients with ACL deficiency who must perform at a high physical level. A combination of functional and psychological outcome measures is necessary to provide a comprehensive evaluation of functional status after successful return to sport after ACLR. To identify factors associated with higher functional outcomes among soccer players who had returned to full sports participation after ACLR. Cohort study; Level of evidence, 3. A total of 168 out of 231 patients who underwent primary unilateral arthroscopic anatomic single-bundle ACLR were available at follow-up. Postoperatively, knee function, generic health outcomes, and psychological impact were assessed using the International Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm Knee Scoring Scale, the 12-item Short Form Health Survey (SF-12), and the ACL-Return to Sport after Injury scale. After a mean follow-up of 35.5 ± 22.6 months, 85% of soccer players returned to performance. Midfielder position was associated with a better SF-12 Physical Component Summary (PCS) score (P = .013), IKDC (P = .003), total KOOS (P < .001), KOOS Symptoms (P = .004), KOOS Pain (P = .029), KOOS Activities of Daily Living (ADL) (P = .044), KOOS Sport and Recreation (Sport/Rec) (P = .001), KOOS Quality of Life (QoL) (P < .001), and Lysholm score (P = .008). Playing only on natural grass was associated with lower SF-12 PCS scores (P = .003), total KOOS (P = .001), and KOOS Sport/Rec (P = .011). Playing only on artificial turf was associated with lower Lysholm score (P = .018) and total KOOS (P = .014). The contact mechanism was associated with higher IKDC (P = .044) and KOOS QoL (P = .048), and injury affecting the dominant limb was associated with lower SF-12 Mental Component Summary scores (P = .012). Playing at a nonprofessional level was associated with lower total KOOS (P = .028), KOOS Symptoms (P = .002), KOOS ADL (P = .033), and KOOS Sport/Rec (P = .016). Professional soccer players and the midfielder position are associated with better functional scores upon returning to the sport. A history of noncontact ACL injury and playing on a single type of surface are associated with lower functional outcomes upon returning to the sport. Lower mental health scores can be expected after injury of the dominant limb.

Radiographic Tibial Tunnel Assessment After Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autografts and Biocomposite Screws: A Prospective Study With 10-Year Follow-up.

Biocomposite screws reportedly provide equivalent graft fixation in anterior cruciate ligament reconstruction (ACLR) to metallic screws while simplifying subsequent imaging and surgery. One purported complication of biocomposite screws is paradoxical tunnel widening. Previous studies on beta-tricalcium phosphate screws have only reported outcomes at short- and midterm follow-up. To radiographically assess the tibial tunnel 10 years after ACLR using hamstring tendon autografts and biocomposite interference screws in anatomic single-bundle (SB) and double-bundle (DB) methods. Case series; Level of evidence, 4. Of the 105 initially recruited patients, 61 (58%) completed all follow-up evaluations for inclusion in this long-term study. A total of 26 patients received anatomic SB ACLR and 35 patients received DB ACLR with biocomposite interference screws containing beta-tricalcium phosphate in the tibia. Weightbearing anteroposterior and lateral radiographs of the index knee were taken in the early postoperative period and at 2, 5, and 10 years postoperatively; computed tomography (CT) imaging was performed at 10-year follow-up. Subjective and objective clinical assessments were recorded preoperatively and at 10-year follow-up. The mean follow-up period was 122 months. In 76% of radiographs in the SB group, the width of the tibial tunnel had not increased at 10 years compared with the early postoperative period. The mean tibial tunnel volume on CT in the SB group was 2.04 cm3 (± 0.85 cm3). In the DB group, the posterolateral tunnel width had not increased in 69% of radiographs; the same was found in 63% of radiographs for the anteromedial tunnel at 10-year follow-up. The mean posterolateral tunnel volume on CT was 2.04 cm3 (±1.92 cm3) and the mean anteromedial tunnel volume was 1.38 cm3 (±0.54 cm3). There was no correlation between tunnel widths and KT-1000 arthrometer assessments. There was a moderate but statistically significant correlation between SB tibial tunnel volume on CT imaging and KT-1000 arthrometer anterior 134 N side-to-side difference (r = 0.45; P = .039). Most patients' tibial tunnels had not increased on 1 or both radiographic views at 10-year follow-up compared with the early postoperative period after ACLR using biocomposite interference screws, with no obvious negative effect on outcomes. However, the tunnels were still visible in most patients at 10 years on standard radiographs and CT imaging.

Arthroscopic Reconstruction of an Anterior Cruciate Ligament Tear Using the Anatomic Single-Bundle Technique: A Clinical and Functional Outcome Evaluation.

The anterior cruciate ligament (ACL) consists of an anteromedial bundle and a posterolateral bundle giving anteroposterior and rotational stability to the knee. An ACL tear might lead to secondary changes in the knee joint if not operated in time. The aim of the study was to evaluate the clinical and functional results in patients with ACL tears treated by arthroscopic reconstruction using the anatomic single-bundle technique. This was a prospective study conducted between June 2015 and December2017 at a teaching institute in Kolkata, India, on patients who underwent single-bundle arthroscopic reconstruction of an ACL tear. A minimum follow-up of nine months was considered for all patients. The functional outcome was assessed via the Lysholm knee score. A total of 45 patients were included in this study, of which 34 (75.56%) and eight (17.78%) patients showed excellent and good results, respectively, at the final follow-up. The mean age in this study was 29.88±9.02 years. No complication was seen in 95.6% of patients. The mean Lysholm score by the end of nine months was 95.31±6.55. At the time of the final follow-up, all the patients returned to their same activity status prior to injury. Arthroscopic anatomic single-bundle ACL reconstruction using hamstring autograft is an effective treatment modality for ACL injuries. It restores the stability of the knee and is associated with good recovery of joint function with an early return to active lifestyle and sports activities. This procedure achieves excellent clinical and functional outcomes without any long-term disability.

A Single-Surgeon 35-Year Experience With ACL Reconstruction Using Patellar Tendon Auto- and Allografts With the Transtibial Technique.

Long-term follow-up for anterior cruciate ligament reconstruction (ACLR) is limited due to heterogeneity in the number of techniques utilized, the number of surgeons included, and attrition bias. To analyze a single surgeon's 35-year experience with ACLR using the transtibial technique, with an emphasis on temporal trends in graft selection and subanalyses on rates of revision surgery, contralateral ACLR, and nonrevision reoperation among different demographic cohorts of patients. Case series; Level of evidence, 4. All patients who underwent arthroscopically assisted single-bundle ACLR between 1986 and 2021 were identified from a prospectively maintained single-surgeon registry. Outcomes of interest included revision, reoperation, and contralateral rupture rates. A total of 2915 ACLRs were performed during the senior surgeon's career. The mean age for primary ACLR was 29.4 ± 14.8 years. During primary ACLR, 98.4% of patients received a central-third bone-patellar tendon-bone (BPTB) graft. Increasing patient age was associated with increasing allograft usage (P < .01), with a significant temporal increase in allograft usage over the senior surgeon's career (P < .01). There was a higher revision rate among younger patients (P < .01), female patients aged 21 to 25 years (P = .01), and patients who received an allograft during the primary procedure (P = .04). The contralateral rupture rate showed no difference between sexes (P = .34); however, patients who underwent ACLR with autograft had a greater rate of contralateral injury compared with those with allograft (P < .01). The contralateral rupture rate was greater than the revision rate (P < .01). The most common causes of nonrevision reoperation were failed meniscal repair, new meniscal tears, arthrofibrosis, and painful hardware removal. The findings of this single-surgeon registry reveal temporal trends in ACLR over a 35-year career. There was a trend toward increasing BPTB allograft use in ACLR, especially in older patients and revision cases. A greater revision rate was observed among younger patients, female patients, and those receiving allografts during primary surgery. Contralateral ACLR was more common than revision surgery.

Single-bundle ACL combined with ALL reconstruction yields comparable outcomes in patients with varied anatomical risk factors for ACL graft failure

BackgroundAnterior cruciate ligament (ACL) graft failure is influenced by factors such as meniscal tears and tibial plateau slope. Combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction has reduced failure rates; however, its efficacy in high-risk patients remains unclear. This study hypothesized that combined ACL and ALL reconstruction would yield similar clinical outcomes in patients with varying risks of ACL failure.Patients and methodsA total of 76 patients who underwent primary single-bundle ACL reconstruction combined with ALL reconstruction between June 2018 and June 2021 were included. The medial tibial slope (MTS), lateral tibial slope (LTS), and anterior tibial translation (ATT) were measured using magnetic resonance imaging and plain radiography of the knee joint. The meniscal lesions were assessed during surgery. Preoperative clinical assessments and final follow-up were conducted using patient-reported outcome measurements (PROMs), including the International Knee Documentation Committee (IKDC) evaluation, Lysholm knee scoring scale, and Tegner Activity scale. PROMs were collected at least two years postoperatively.ResultsThe average follow-up was 32.5 ± 7.4 months. There were no significant differences in postoperative IKDC score, Lysholm score, or Tegner activity score between patients with or without medial meniscus injury (p = 0.155, 0.914, and 0.042, respectively), with or without lateral meniscus injury (p = 0.737, 0.569, and 0.942, respectively), medial tibial slope > 12° or ≤ 12° (p = 0.290, 0.496, and 0.988, respectively), or lateral tibial slope > 7.4° or ≤ 7.4° (p = 0.213, 0.625, and 0.922, respectively). No significant correlations were found between anterior tibial translation and postoperative IKDC (R = -0.058, p = 0.365), Lysholm (R = -0.017, p = 0.459), or Tegner activity scores (R = -0.147, p = 0.189).ConclusionOur study demonstrates that single-bundle ACL reconstruction combined with ALL reconstruction provides reliable and comparable clinical outcomes in patients with high-risk factors for ACL graft failure, such as increased tibial slope or meniscal injury. Our results suggest that the indications for ALL reconstruction may be expanded to include patients with a high tibial slope or meniscal injury, because these factors have been shown to contribute to increased rotational instability and high rates of ACL graft failure. Future prospective randomized controlled trials with large patient cohorts and long follow-up periods are needed to validate these findings and establish clear guidelines for patient selection and surgical decision-making.Level of evidenceLevel 3.

Comparison of the quadrant method measuring four points and bernard method in femoral tunnel position evaluation on 3-dimensional reconstructed computed tomography after anatomical single-bundle anterior cruciate ligament reconstruction

PurposeThis prospective study aimed to compare the postoperative evaluation of the quadrant method measuring four points and Bernard method in femoral tunnel position evaluation on 3-Dimensional (3D) reconstructed computed tomography (CT) following the arthroscopic single-bundle anterior cruciate ligament (ACL) reconstruction.MethodsThirty-eight patients with ACL tears that were reconstructed using single-bundle ACL reconstruction between May 2021 and March 2023 were included in this study. Postoperative 3D CT images were obtained after the operation. The femoral tunnel position was measured by use of the quadrant method measuring four points and Bernard method.ResultsAverage mean position of the femoral tunnel insertion center on the 3D CT image was at 26.16 ± 6.27% in the x-coordinate and at 24.36 ± 5.52% in the y-coordinate according to the Bernard method. Meanwhile, the position of the femoral insertion of the ACL measured by the quadrant method measuring four points was 24.2% ± 6.86% in the x-coordinate and 21.16% ± 5.14% in the y-coordinate.ConclusionsBoth the quadrant method measuring four points and Bernard method were effective in femoral tunnel position evaluation on 3D reconstructed CT. Application of the quadrant method measuring four points on 3D CT showed the advantage that measurement can be taken regardless of the shape of the bone tunnel.

CT evalution of tibial tunnel widening and clinical outcome in single bundle ACL reconstruction with hamstring attachment sparing technique

CT evalution of tibial tunnel widening and clinical outcome in single bundle ACL reconstruction with hamstring attachment sparing technique