Single-bundle Reconstruction Research Articles

The effect of the position of the femoral endobutton on knee function in the posterior cruciate ligament reconstruction: a retrospective study

BackgroundTo investigate the effect of the position of the femoral endobutton on knee function in the posterior cruciate ligament reconstruction (PCLR).MethodsA retrospective study was conducted to analyze 96 patients who underwent single-bundle reconstruction of posterior cruciate ligament (PCL) in our hospital from January 2020 to June 2023. The patients were divided into three groups according to the position of the endobutton on the lateral knee radiography. The first group is the position of endobutton in front of the lateral cortex of the femur, the second group is the position of endobutton in back of the lateral cortex of the femur, and the third group is the position of endobutton behind the femur. Knee Lysholm score, International Knee Documentation Committee (IKDC) Evaluation, Tegner Activity Scale, knee flexion angle and postoperative complication rate of the three groups were compared to evaluate whether there were statistical differences among the three groups.ResultsThere were 39 patients in group 1, 46 patients in group 2, and 11 patients in group 3. The mean Lysholm Knee Scores of the group 1 was 91.77, 92.17 in group 2, and 90.36 in group 3. The mean IKDC Evaluation of group 1 was 90.48, 92.41 in group 2, and 93.00 in group 3. Tegner Activity Level was 5.69 in group 1, 5.72 in group 2, and 5.45 in group 3. The mean flexion degree was found as 125° in patients in group1, 127° in group 2, and 122° in group 3. There was no statistically significant difference between Lysholm Knee Scores (p = 0.434), IKDC (p = 0.068), Tegner Activity Level (p = 0.797), and knee flexion angle (p = 0.135). There was also no significant difference in the incidence of complications among the three groups (p > 0.05).ConclusionThere were not statistically differences in clinical functional results when comparing patients’ endobutton location on femur. This indicates that it does not need to adjust the orientation of the exit hole of the femur whether it is forward or backward during the PCLR.

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.

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.

Clinical efficacy of arthroscopic single-bundle versus double-bundle reconstruction of the posterior cruciate ligament: a retrospective study.

To compare the functional and clinical outcomes of knee joints in patients over a 10-year period following posterior cruciate ligament (PCL) reconstruction with single-bundle versus double-bundle. Patients who underwent PCL reconstruction were retrospectively analyzed. Based on the surgical approach, they were divided into the single-bundle reconstruction group and the double-bundle reconstruction group. Preoperative and postoperative Lysholm score, International Knee Documentation Committee (IKCD) score, and Tegner activity score were evaluated, and the stability of the joints was assessed using KT-2000 arthrometer. Radiographs were taken at the final follow-up to evaluate the progression of osteoarthritis. A total of 61 patients were included in the analysis: 26 in the double-bundle group and 35 in the single-bundle group. Baseline data were comparable between the two groups (P > 0.05). There were no significant differences between the two groups in preoperative Lysholm, IKDC score, and Tegner activity score. Postoperatively, these scores were significantly higher at two and ten years follow-up (P < 0.05), with no significant difference between the groups (P > 0.05). There was no significant difference in side-to-side differences (SSD) at 30° and 90° of knee flexion preoperatively between the groups (P > 0.05). Postoperatively, SSD decreased significantly at the two year and ten year follow-up (P < 0.05), with no significant difference between the groups (P > 0.05). For osteoarthritis progression, there were four cases of Kellgren-Lawrence grade ≥ II in the single-bundle group and three cases in the double-bundle group, with no significant difference in the progression of osteoarthritis between the groups (P > 0.05). Both single-bundle and double-bundle reconstructions for PCL result in good joint stability and mobility, with similar progression of osteoarthritis in long-term follow-up. Level III.

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.

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.

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).

Double-bundle versus single-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocation: A meta-analysis.

To compare the clinical efficacy of single-bundle versus double-bundle reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar dislocation (RPD) regarding knee function scores, postoperative complications, and imaging assessments. A computerized search of PubMed, Cochrane Library, Embase, China Biomedical Literature Database (CBM), China National Knowledge Network (CNKI), and VIP Database was performed for single-bundle versus double-bundle reconstruction of the medial patellofemoral ligament for treatment of RPD. Randomized controlled trials (RCTs) were evaluated for quality using the risk-of-bias evaluation tool recommended by the Cochrane Collaboration Network, and Cohort studies (CSs) were assessed using the Newcastle-Ottawa Scale (NOS) scale. Meta-analysis was performed using RevMan 5.3 software and STATA 16.0. Thirteen studies were included, four randomized controlled studies, and nine cohort studies. The level of evidence for the four randomized controlled studies was Ⅰ, and the nine cohort studies were Ⅲ. A total of 862 (891 knees) patients were included, of which 448 (465 knees) underwent double-bundle MPFL reconstruction and 414 (426 knees) underwent single-bundle MPFL reconstruction. Kujala score (MD = 2.06, 95% confidence interval [CI] [0.11, 4.01], p < 0.05), Tegner score (MD = 0.39, 95% CI [0.11, 0.68], p < 0.05), International Knee Documentation Committee (IKDC) score (MD = 4.88, 95% CI [1.46, 8.31], p < 0.05), and postoperative recurrence instability (odds ratio [OR] = 0.12, 95% CI [0.04, 0.44], p < 0.05) were better in the double-bundle group than in the single-bundle group. Lysholm score (MD = 0.86, 95% CI [-0.76, 2.48], p = n.s), patellar tilt angle (MD = -0.22, 95% CI [-0.54, 0.10], p = n.s), patellar lateral shift rate (MD = -0.16, 95% CI [-0.41, 0.09], p = n.s), congruence angle (MD = 0.06, 95% CI [-0.41, 0.52], p = n.s), postoperative knee pain (OR = 0.39, 95% CI [0.14, 1.11], p = n.s), and additional postoperative surgical treatment (OR = 0.20, 95% CI [0.01-6.25], p = n.s) had no statistically significant differences. Double-bundle reconstruction of the medial patellofemoral ligament for RPD was superior to single-bundle reconstruction in both knee function scores and postoperative recurrent patellar instability, and double-bundle reconstruction of the medial patellofemoral ligament for RPD had better clinical outcomes. Level Ⅲ, Ⅰ and Ⅲ studies.

Posterior Cruciate Ligament Reconstruction Using a Trans-septal Approach With Preserved Hamstrings Tibial Insertion

Posterior cruciate ligament reconstruction is a challenging procedure and requires a safe approach that provides a proper visualization of the tibial footprint while avoiding neurovascular damage and facilitating graft passage. Recent studies have shown that the preservation of the hamstring tibial attachment improves fixation and vascularization in the setting of anterior cruciate ligament reconstruction. This Technical Note reports an effective and reproducible arthroscopic single-bundle posterior cruciate ligament reconstruction through a trans-septal approach wit preserved hamstring tibial insertion.

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 Comprehensive Review of Graft Choices and Surgical Techniques in Primary Anterior Cruciate Ligament Reconstruction: An Outcome Analysis.

Anterior cruciate ligament (ACL) injuries are among the most prevalent knee injuries, particularly in athletes engaged in high-impact sports. ACL reconstruction is a widely performed surgical procedure to restore knee stability, prevent further knee damage, and enable patients to return to their previous physical activity levels. However, the success of ACL reconstruction is influenced by various factors, including the choice of graft and the surgical technique employed. This comprehensive review explores the outcomes of different graft options - autografts, allografts, and synthetic grafts - and various surgical techniques such as single-bundle versus double-bundle reconstruction and anatomic versus non-anatomic tunnel placement. The review analyzes the short- and long-term outcomes, including functional recovery, return to sports, complication rates, and the impact of patient-specific factors such as age, activity level, and comorbidities. Additionally, the review discusses the role of rehabilitation protocols in optimizing surgical outcomes. By synthesizing current evidence, this review aims to provide clinicians with insights into the most effective graft choices and surgical techniques for primary ACL reconstruction, ultimately guiding the optimization of patient outcomes and highlighting areas for future research.

Nonanatomic Posterolateral Tenodesis for Posterior Ligament Reconstruction Augmentation

A successful posterior cruciate ligament (PCL) reconstruction depends on multiple factors. Various techniques have been described for PCL reconstruction. Despite the constant evolution of reconstructive techniques, 26% of residual laxity cases with grade I and II positive posterior drawer tests have been reported in the literature in patients undergoing PCL reconstruction. Part of these failures is associated with the lack of control of the posterior translation of the tibia and the increase in external tibial rotation. We describe a surgical technique in which a posterolateral tenodesis augmentation associated with a single-bundle reconstruction of the PCL is performed. It is proposed for use in isolated reconstructions of the PCL in cases of grade III ruptures associated with or unassociated with low-grade posterolateral corner injuries.

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.

Tendon Groove Technique: A Double-Bundle Footprint Technique for Anterior Cruciate Ligament Reconstruction

Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction has biomechanical advantages over single-bundle reconstruction. However, most studies perform the DB reconstruction with 2 femoral tunnels, which fails to provide an entire femoral footprint for ACL reconstruction. In this study, we describe a femoral double-bundle footprint technique for ACL reconstruction, named the tendon groove technique. This technique modifies the DB femoral tunnels through connecting 2 inner orifices of the anteromedial bundle and the posterolateral bundle tunnels, creating a groove to ensure an entire ACL footprint. This modified technique achieves an anatomic and double-bundle ACL reconstruction with a native footprint, which increases the tendon-bone interface area and theoretically promotes tendon-bone healing in ACL reconstruction.

Is Partial ACL Tear a Cause of Painful Swollen Knees?

Abstract Study Design: Retrospective case series. Objective: In this study, we will identify if partial ACL tear is a common hidden cause of chronic pain and swelling of the knee in adults. And we will evaluate the effectiveness of arthroscopic selective bundle reconstruction in the management of this condition. Background: The Anterior Cruciate Ligament (ACL) has two anatomical bundles, the anteromedial (AM) and the posterolateral (PL), each bundle was named according to the site of its tibial insertion.[1] Partial ACL tear is evident and symptomatic when the percentage of the torn fibers is more than 50% of ligament fibers. AM bundle is more liable to injury than PL.[2] Symptomps of partial ACL tear may be giving way and instability but persistent knee pain and swelling is often present as the main presenting symptom of the patient due to micro-instability of the knee, The primary complication of longstanding partial ACL tears is early knee degeneration.[3] Patients and Methods: 37 patients with chronic knee pain and swelling, related to activity and resistant to non-operative treatment, underwent diagnostic knee arthroscopy. In 3 cases diagnostic arthroscopy revealed osteochondral ulcers of the medial compartment of the knee managed by drilling and 4 cases showed non-specific synovitis managed by arthroscopic synovectomy. 30 of these patients, who were included in this study, were found to suffer from partial ACL tear and underwent single bundle reconstruction, 18 of them underwent selective AM bundle reconstruction while preserving PL bundle. Twelve patients underwent selective PL bundle reconstruction with AM bundle preservation. Semitendinosus tendon graft was utilized for all reconstructions. The femoral side was always fixed with an adjustable loop (Zimmer), and the tibial side with a biodegradable interference screw. Lysholm score[4] was used to assess the outcomes. Patients with severe degenerative disorders, lower limb mal-alignment and multiple ligamentous injuries of the knee were excluded from our study. Results: Marked decrease in the knee pain and swelling postoperatively. The preoperative score had a mean value of 66.17±10.39. At 2 years, the postoperative score was 96.1±6.71, indicating a highly statistically significant improvement (P value 0.001). Hypothesis: Partial ACL tears are the commonest hidden cause of pain and swelling of the knee among young adults. Conclusion: Arthroscopic selective bundle reconstruction diminishes knee pain and swelling with a very satisfactory postoperative clinical outcomes.

No difference was found between double-bundle and single-bundle anterior cruciate ligament reconstructions in terms of osteoarthritis at 15-year follow-up.

The purpose of the study was to determine whether the grade of osteoarthritis (OA) is higher with single-bundle (SB) or double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. The hypothesis was that there will be no difference in the grade of OA between the techniques. This study was a randomised controlled trial (RCT) with a follow-up period of 15 years. Patients were randomly assigned to either the SB group (n = 78) or the DB group (n = 75). Surgical techniques were anatomic, and the rehabilitation protocol was standardised. Evaluation included Kellgren-Lawrence (KL) difference and absolute OA results. OA was defined as a KL grade of at least 2. At 15-year follow-up, information was available on 101 patients (66%), of whom 56 (37%) were accepted in the final statistical analysis. No difference was found between the SB and DB techniques in terms of KL difference or absolute OA results. Significantly less OA was found in the contralateral knee (21%) than in the reconstructed knee (59%) (p < 0.001). Patients with meniscal tears who underwent partial meniscal resection during ACL reconstruction had a significantly higher rate of OA changes (82%) compared with patients with isolated ACL tears (33%) (p < 0.001). A longer delay between initial injury and surgery did not appear to affect the severity of the KL classification. At 15-year follow-up, no difference was found between the DB and SB techniques in terms of OA. Level I.

Anterior cruciate ligament femoral side retained stump technique reduces enlargement of the femoral bone tunnel after anterior cruciate ligament reconstruction

BackgroundEnlargement of the bone tunnel has become an unavoidable early complication after anterior cruciate ligament (ACL) reconstruction, whether it is a single or double-bundle ACL reconstruction. Preservation of the ACL stump in ACL reconstruction reduces enlargement of the bone tunnel. The purpose of this study was to investigate the question of whether single-bundle ACL reconstruction using the ACL femoral side retained stump technique reduces enlargement of the femoral tunnel.MethodsForty patients who underwent single-bundle reconstruction of the ACL were included in this study. The patients were categorized into a Remnant preservation group (Group R) and the Non-remnant preservation group (Group N). In the Remnant preservation group, a high-flexion femoral side retained stump technique was used intraoperatively for the establishment of the femoral side bone tunnel, and in the Non-remnant preservation group, the conventional femoral positioning method was used (we used a femoral positioning drill for localization and drilling of the femoral bone tunnel), and MRI of the operated knee joints was performed at 6 months postoperatively. We measured the internal diameter of the femoral bone tunnel at 5 mm from the intra-articular outlet of the femoral bone tunnel on an MRI scan image perpendicular to the femoral bone tunnel. The size of the tunnel was compared between the intraoperative drilling of the bone tunnel and the size of the bone tunnel at 6 months postoperatively. Postoperative clinical assessment was Lysholm score.ResultsAfter a 6-month follow-up of 40 patients, the diameter of the femoral tunnel at a distance of 5 mm from the inner opening of the femoral tunnel was 10.96 ± 0.67 mm and 10.11 ± 0.62 mm in patients of group N and group R, respectively, and the difference was statistically significant (P < 0.05).The diameter of the femoral tunnel at 6 months postoperatively in group N and group R compared to the intraoperative bone tunnel increased by 2.58 ± 0.24 mm and 1.94 ± 0.31 mm, and the difference was statistically significant (P < 0.05).The femoral tunnel enlargement rates of group N and group R were 30.94 ± 3.00% and 24.02 ± 5.10%, respectively, and the differences were significant (P < 0.05).ConclusionACL femoral side retained stump technique does not sacrifice the ideal location of the femoral tunnel and is able to preserve the possible benefits of the ACL stump: reduced femoral tunnel enlargement.

Medial Quadriceps Tendon Femoral Ligament Reconstruction for Anatomic Reconstruction of the Medial Patellofemoral Complex

The medial patellofemoral complex (MPFC) refers to the primary static restraint to lateral patellar translation. Originally thought of as the medial patellofemoral ligament, anatomic studies over the past 10 years have identified the additional fibers that attach to the quadriceps tendon, which some have termed the medial quadriceps tendon femoral ligament. Anatomic studies have demonstrated that the MPFC midpoint is at the junction of the medial border of the quadriceps tendon and the articular surface of the patella, indicating that fixation can be on either structure. This technique describes a single-bundle reconstruction technique with anatomic fixation on the quadriceps tendon at the MPFC midpoint that involves fixation on the extensor mechanism first.

Functional Outcome of Single-Bundle Arthroscopic Anterior Cruciate Ligament Reconstruction using Peroneus Longus Graft and Hamstring Graft: An Open-Label, Randomized, Comparative Study.

Background This study investigates the functional outcomes of single-bundle arthroscopic anterior cruciate ligament (ACL) reconstruction, comparing the use of two distinct graft sources: peroneus longus (PL) graft and hamstring graft. The choice of graft material in ACL reconstruction is crucial for optimal postoperative results, and this study aims to contribute valuable insights into the comparative efficacy of these two graft types. Method This open-label randomized comparative study involved a carefully selected cohort of patients undergoing single-bundle arthroscopic ACL reconstruction. Participants were randomly assigned to either the PLgraft group or the hamstring graft group. Surgical procedures were conducted using standardized techniques, and postoperative rehabilitation protocols were closely monitored. Functional outcomes, including range of motion, stability, and patient-reported measures, were assessed at predefined intervals to ensure comprehensive data collection. Results The study underscores significant demographic and clinical factors in ACL reconstruction outcomes. Participants were predominantly aged 17-30 years (58.33%) with a mean age of 29.27 years and exhibited a male predominance (80.56%). Common complaints included knee pain and instability, primarily due to falls from bikes (55.56%) or sports-related trauma (44.44%). Notably, PL grafts demonstrated advantages over hamstring grafts, with longer mean length (10.11 mm vs. 8.77 mm, p=0.0001) and shorter operation times. Visual analog scale (VAS), International Knee Documentation Committee(IKDC), and Tegner Lysholm scores show no significant differences between grafts over the period of time. There is no notable foot eversion weakness or significant donor site morbidity after the PL graft harvest.Hamstring graft cases exhibit a higher incidence of altered sensation and muscle atrophy, suggesting the potential benefits of PL grafts for improved surgical outcomes. Conclusions Graft comparisonsfavored PL grafts due to longer length, and functional outcome assessments between the two graft types. However, foot and anklestrength assessments revealed fluctuations in strength recovery with PL grafts, highlighting the need for tailored rehabilitation. Thigh circumference variations suggested potentialmuscle atrophy in the hamstring graft group, along with reported paresthesia in theipsilateral proximal leg. In conclusion, PL grafts offer potential advantages for ACL surgery, but ongoing monitoring and specialized rehabilitation are crucial.