Tegner Activity Level Research Articles

Cell-free osteochondral scaffolds provide a substantial clinical benefit in the treatment of osteochondral defects at a minimum follow-up of 5\u2009years

PurposeThe treatment of osteochondral lesions is challenging and no consensus has been established about the best option for restoring both cartilage and subchondral bone. Multilayer collagen-hydroxyapatite scaffolds have shown promising clinical results, but the outcome at a follow-up longer than 5 years still has to be proved. The aim was to evaluate the clinical outcome of patients with a knee isolated osteochondral lesion treated with a biomimetic three-layered scaffold at a minimum 5 years of follow-up.MethodsTwenty-nine patients (23 males and 6 females, mean age 31.5 ± 11.4 years) were evaluated retrospectively before surgery, at 1 and 2 years and at last follow-up (FU). Visual Analog Scale (VAS) for pain, International Knee Documentation Committee (IKDC) Subjective Score, Tegner-Lysholm Knee Scoring Scale and Tegner Activity Level Scale were collected. Mean FU was 7.8 ± 2.0 years (min 5.1 - max 11.3). The etiology of the defect was Osteochondritis Dissecans or osteonecrosis (17 vs 12 cases).ResultsAt 12 months FU the IKDC score improved from 51.1 ± 21.7 to 80.1 ± 17.9 (p < 0.01), Tegner Lysholm Score from 59.9 ± 17.3 to 92.5 ± 9.0 (p < 0.01), VAS from 6.1 ± 2.1 to 1.7 ± 2.3 (p < 0.01) and Tegner Activity Level Scale from 1.6 ± 0.5 to 4.9 ± 1.7 (p < 0.01). The results remained stable at 24 months, while at last FU a statistically significant decrease in IKDC, Tegner Lysholm and Tegner Activity Scale was recorded, though not clinically relevant. Patients under 35 achieved statistically better outcomes.ConclusionsThe use of a cell-free collagen-hydroxyapatite osteochondral scaffold provides substantial clinical benefits in the treatment of knee osteochondral lesions at a minimum follow-up of 5 years, especially in patients younger than 35 years.Level of evidenceLevel IV.

A Comparison of Two-Year Anterior Cruciate Ligament Reconstruction Clinical Outcomes Using All-Soft Tissue Quadriceps Tendon Autograft With Femoral/Tibial Cortical Suspensory Fixation Versus Tibial Interference Screw Fixation

To contribute to future quadriceps tendon harvest and fixation guidelines in the setting of anterior cruciate ligament reconstruction by comparing 2-year patient-reported subjective knee outcome scores and incidence of graft-related complications between the shorter harvest all-inside tibial-femoral suspensory fixation (TFSF) approach versus the longer harvest standard tibial interference screw fixation technique. Patients who underwent primary anterior cruciate ligament reconstruction with all soft tissue quadriceps tendon autograft from January 2017 to May 2019 were identified for inclusion. Patients were matched into 2 cohorts of 62 based on reconstruction technique. All patients completed baseline and minimum 2-year International Knee Documentation Committee, Tegner Activity Level, and Lysholm questionnaires and were queried regarding subsequent procedures and complications to the operative knee. Average graft length for the all-inside TFSF was 69.55 (95% confidence interval 68.99-70.19) mm versus 79.27 (95% confidence interval 77.21-81.34) mm in the tibial screw fixation cohort (P= .00001). Two-year Lysholm scores were greater in the TFSF cohort (P= .04) but were not clinically significant. There was no difference in 2-year International Knee Documentation Committee (P= .09) or Tegner (P= .69) scores between cohorts, but more patients in the TFSF cohort returned to or exceeded their baseline activity level compared with the tibial screw fixation cohort (73% vs 61%, P= .25). Seven patients in the TFSF cohort versus 13 in the tibial screw fixation cohort reported anterior knee pain or kneeling difficulty (P= .22). There were no differences in reported complications. All-inside soft-tissue quadriceps tendon autograft with TFSF resulted in clinically comparable subjective outcome scores at 2 years to tibial screw fixation. There were also no differences in complications or reports of anterior knee pain or kneeling difficulty. All-inside TFSF can be a viable alternative to tibial screw fixation for all-soft tissue quadriceps autograft. III, comparative therapeutic trial.

Sport activity levels following ankle fusion

Ankle arthrodesis (AA) is frequently employed in the treatment of end-stage ankle arthritis, which is common following trauma and athletic injuries. While AA remains a popular therapeutic option, little data exists about activity and sporting capacity following AA. The objective of this research was to determine functional outcomes and sporting activity levels in patients following Ankle Arthrodesis. Validated questionnaires were emailed to 35 patients with a history of AA at an average follow-up of 52months. Functional outcomes were assessed using the Foot and Ankle Disability Index (FADI), as well as the associated FADI-Sport. Responses were compared to those from a control population of RESULTS: 24 patients scheduled for AA, at an average pre-operative visit of three months. Activity levels were assessed prior to injury as well as pre- and post-operatively using the Tegner activity level scale. Average Tegner scores of the 35 surgical patients decreased from 3.82 ± 0.38 before their injury, to 1.15 ± 0.19 immediately pre-op, with recovery to 2.67 ± 0.26 following fusion. Average post arthrodesis FADI and FADI-sport scores in our patients were 76.5 ± 3.19% and 33.8 ± 23.06%. For the pre-operative control population, corresponding scores were 47.41 ± 2.61% and 22.24 ± 1.03%. Following AA, we found that patients improved upon their pre-op Tegner score, although they did not return to their pre-injury level of sporting participation. Additionally, patients reported that they had no current dysfunction with their lower leg. Patients undergoing Ankle Arthrodesis should expect improved lower leg function, though will not likely return to their pre-injury level of activity.

Comparison of Function- and Activity-Related Outcomes After Anterior Talofibular Ligament Repair With 1 Versus 2 Suture Anchors.

Background:Few studies have compared the clinical outcomes of using 1 versus 2 suture anchors for anterior talofibular ligament (ATFL) repair.Purpose:To compare the function and activity-related outcomes of arthroscopic ATFL repair using 1 versus 2 suture anchors.Study Design:Cohort study; Level of evidence, 3.Methods:This retrospective study involved 46 patients (22 patients in the 1-anchor group, 24 patients in the 2-anchor group) who underwent ATFL repair between January 2015 and December 2017. American Orthopaedic Foot & Ankle Society score, Karlsson and Peterson score, and Tegner activity level were evaluated preoperatively and ≥2.5 years postoperatively. At follow-up, patients were also asked about time to return to sport as well as level and intensity of physical fitness. Satisfaction was evaluated with the Sefton grading system.Results:After ≥2.5 years of follow-up (30 months in the 1-anchor group, 33 months in the 2-anchor group), patients in the 2-anchor group had a higher Tegner activity level than those in the 1-anchor group (mean ± SD, 4.75 ± 1.07 vs 4.05 ± 1.17; P = .039). As compared with patients in the 2-anchor group, fewer patients in the 1-anchor group returned to their preoperative activity level (54.2% vs 22.9%; P = .029); the rate of activity at the same or higher intensity as preinjury was also lower in the 1-anchor group (50% vs 79.2%; P = .038). However, there were no differences between the groups in terms of American Orthopaedic Foot & Ankle Society and Karlsson and Peterson scores, time to return to work/sport, duration of activity participation, level of physical fitness, or satisfaction according to Sefton grading.Conclusion:Arthroscopic ATFL repair appears to be an effective treatment regardless of whether 1 or 2 suture anchors are used. The techniques had similar functional outcome scores, but 1-anchor repair produced inferior activity-related outcomes.

Comparison of Doubled Semitendinosus and Gracilis Autograft Versus Bone-Patellar Tendon-Bone Autograft for Reconstruction of the Anterior Cruciate Ligament

Background: The choice of graft for anterior cruciate ligament (ACL) reconstruction is a matter of debate with hamstring and bone-patellar tendon-bone being the most popular autologous graft options. Objective: The objective of this study was to conduct a prospective randomized control trial comparing doubled semitendinosus and gracilis graft versus bone-patellar tendon-bone graft. Materials and Methods: Sixty patients with chronic unilateral rupture of ACL underwent arthroscopically assisted ACL reconstruction using quadrupled hamstring and bone-tendon-bone graft after randomization. Both groups were comparable with demographic data, preoperative activity level, mechanism of injury, the interval between injury and operation, and preoperative laxity of the knee. The same well-proved surgical technique and aggressive rehabilitation were used in all cases. The outcome assessment was done using the visual analog scale, Lysholm score, Tegner activity level, and International Knee Documentation Committee (IKDC) evaluation system. Results: At 2-year follow-up, we found that results within the same groups showed statistically significant improvement as assessed by IKDC, Tegner’s, and Lysholm operative scores. There was also a significant correlation between the manual Lachman test and stress laxometry findings. There was no statistically significant difference between the scores of the two groups (hamstring and bone patella tendon). In the hamstring group, we recorded a higher incidence of femoral tunnel widening, and in the bone-patellar tendon-bone group the higher incidence of kneeling discomfort and increased area of decreased sensation in the skin. Conclusions: Arthroscopic ACL reconstruction by either hamstring tendon graft or bone-patellar tendon-bone graft gives equally satisfactory results.

EARLY OUTCOMES AFTER SUTURE TAPE REINFORCEMENT OF QUADRICEPS TENDON AUTOGRAFT ACL RECONSTRUCTION IN ADOLESCENT ATHLETES

Background:Recently, anterior cruciate ligament reconstruction (ACLR) with suture-tape reinforcement has been popularized for protection of the graft during the revascularization and remodeling phase of incorporation. To date, there are limited short-term data regarding the outcomes of suture tape reinforcement to ACLR. Furthermore, its use with quadriceps tendon autograft (QT) ACLR is limited.Purpose:The purpose of this study was to review the early, preliminary results of ACLR in adolescent patients using QT autograft with suture tape reinforcement (QT-SR).Methods:A retrospective review was performed of skeletally mature adolescent patients who underwent primary ACLR with all-soft tissue QT-SR since 2018. Surgeries were performed by a single surgeon using an all-inside technique. All patients followed the same standardized rehabilitation protocol. Twelve-month patient-reported outcome measures (PROMs) and complications were analyzed. PROMs included the Pediatric International knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form, Lysholm knee scoring scale, and the Tegner activity level scale. Psychological readiness was assessed with the ACL-Return to Sport after Injury (ACL-RSI) scale.Results:39 patients (24 girls, 15 boys) were identified. The mean age at the time of surgery was 15.7 ± 1.3 years (range, 13-18 years). 82% of patients were high school athletes. Soccer was the primary sport for 48.7% of patients. The mean graft diameter was 9.5 ± 0.4 mm. 51.3% of patients had concomitant meniscus repairs. The mean time to return-to-sport clearance was 10.1 ± 1.4 months. At 12 months, the mean postoperative Pedi-IKDC was 95.6 ± 4.0, the mean Lysholm score was 97.6 ± 3.9, and the mean Tegner score was 8.8 ± 0.9. All PROMs improved significantly compared to the preoperative scores (Pedi-IKDC: p = 0.003, Lysholm: p = 0.006, Tegner: p = 0.003). The mean ACL-RSI was 93.4 ± 4.7. Complications included return to surgery due to postoperative stiffness in two patients. There were no cases of postoperative instability, graft rupture, or contralateral ACL injury.Conclusion:QT-SR ACLR results in excellent clinical and patient-reported outcomes in adolescent athletes at 12 months follow-up. The long-term effect of QT-SR remains to be investigated.

Has platelet-rich plasma any role in partial tears of the anterior cruciate ligament? Prospective comparative study.

BACKGROUNDPartial tears of the anterior cruciate ligament (ACL) are frequent, and there is still considerable controversy surrounding their diagnosis, natural history and treatment. AIMTo examine patient-reported outcomes, physical examination and magnetic resonance imaging (MRI) findings of partial ACL tears treated with an intraarticular injection of platelet-rich plasma (PRP) compared to a control group. METHODSFrom January 2015 to November 2017, consecutive patients from a single institution with partial ACL tears treated nonoperatively were prospectively evaluated. Partial tears were defined as a positive Lachman test with a clear end-point, a negative pivot-shift and less than 3 mm of side-to-side difference using the KT1000 arthrometer. Patients in group 1 were treated with one intraarticular injection of PRP and specific physical therapy protocol. Control group consisted of patients treated only with physical therapy. Prospective analyzed data included physical examination, Tegner activity level and Lysholm and International Knee Documentation Committee scores. Baseline MRI findings and at 6 mo follow-up were reviewed. Failure was defined as those patients with clinical instability at follow-up that required a subsequent ACL reconstruction. RESULTSA total of 40 patients where included, 21 treated with PRP injection with a mean follow-up of 25 mo [standard deviation (SD): 3.6] and 19 in the control group with a mean follow-up of 25 mo (SD: 5.68). Overall failure rate was 32.0% (n = 13). No significant differences were observed between groups regarding subjective outcomes, return to sport and failure rate. MRI findings revealed an improvement in the ACL signal in half of the patients of both groups. However, we did not find a significant relationship between MRI findings and clinical outcomes.CONCLUSIONOverall, 95.0% of patients returned to sports at a mean follow-up of 25 mo. Mean time to return to sports was 4 mo. Out of these patients, almost 30.0% in each group had a new episode of instability and required surgery at a median time of 5 mo in group 1 and 8 mo in group 2. The addition of PRP alone was not sufficient to enhance any of the outcome measures evaluated, including MRI images, clinical evaluation and failure rate.

Use of the forgotten joint score (FJS)-12 to evaluate knee awareness after isolated anterior cruciate ligament reconstruction with and without meniscus repair or partial meniscectomy.

The aim of this study was to compare knee awareness, based on the FJS-12 score, among three patient groups: Anterior cruciate ligament reconstruction (ACLR), ACLR + meniscus repair and ACLR + partial meniscectomy. The relationship between FJS-12 scores and scores on other instruments (Lysholm Knee Scoring Scale, Tegner Activity Level Scale, KOOS and WOMAC) was also evaluated. Forty-three patients were divided into group A (isolated ACLR) group B (ACLR + meniscectomy) and group C (ACLR + meniscus repair). Graft thickness, femoral tunnel width, tibial tunnel width, tibial screw thickness and follow-up time were evaluated in all three groups. The subjective knee scores (KOOS, WOMAC, Lysholm Knee Scoring Scale, Tegner Activity Level Scale and FJS-12) of the groups were then compared. FJS-12 scores of 43 patients were evaluated. The mean age was 26.1 ± 6.5years (range: 18-40years). Group A: 23; group B: 9 and group C include 11 patients. The mean FJS-12 score of group B (median: 100 [range: 98-100]) was higher than that the others. Spearman's rho test showed that the FJS-12 is highly compatible with the other scores. According to this study, FJS-12 and the other scoring systems showed that ACLR with partial meniscectomy is the most effective surgical method to restore normal sensation in the knee.

Minimum 10-Year Clinical Outcome of Lateral Collagen Meniscal Implants for the Replacement of Partial Lateral Meniscal Defects: Further Results From a Prospective Multicenter Study.

Background:The collagen meniscal implant (CMI) is a biologic scaffold aimed at replacing partial meniscal defects. The long-term results of lateral meniscal replacement have never been investigated.Purpose:To document the clinical outcomes and failures of lateral CMI implantation for partial lateral meniscal defect at a minimum 10-year follow-up.Study Design:Case series; Level of evidence, 4,Methods:This study included 24 consecutive patients who underwent lateral CMI implantation for partial lateral meniscal defects between April 2006 and September 2009 and who were part of a previous study with a 2-year follow-up. Outcome measures at the latest follow-up included the Lysholm score, Knee injury and Osteoarthritis Outcome Score, visual analog scale (VAS) for pain, Tegner activity level, and EuroQol 5-Dimensions score. Data regarding complications and failures were collected, and patients were asked about their satisfaction with the procedure.Results:Included in the final analysis were 19 patients (16 male, 3 female) with a mean age at surgery of 37.1 ± 12.6 years and a mean follow-up of 12.4 ± 1.5 years (range, 10-14 years). Five failures (26%) were reported: 1 CMI removal because of implant breakage and 4 joint replacements (2 unicompartmental knee arthroplasties and 2 total knee arthroplasties). The implant survival rate was 96% at 2 years, 85% at 5 years, 85% at 10 years, 77% at 12 years, and 64% at 14 years. Lysholm scores at the final follow-up were rated as “excellent” in 36% (5 of 14 nonfailures), “good” in 43% (6 of 14), and “fair” in 21% (3 of 14). The VAS score was 3.1 ± 3.1, with only 16% (3 of 19 patients) reporting that they were pain-free; the median Tegner score was 3 (interquartile range, 2-5). All clinical scores decreased from the 2-year follow-up; however, with the exception of the Tegner score, they remained significantly higher compared with the preoperative status. Overall, 79% of patients were willing to undergo the same procedure.Conclusion:Lateral CMI implantation for partial lateral meniscal defects provided good long-term results, with a 10-year survival rate of 85% and a 14-year survival rate of 64%. At the final follow-up, 58% of the patients had “good” or “excellent” Lysholm scores. However, there was a general decrease in outcome scores between the short- and the long-term follow-up.

All-inside repair of bucket handle meniscus tears – Mid-term outcomes with postoperative magnetic resonance imaging

PurposeThe purpose of this study was to evaluate our results of bucket handle meniscus tear (BHMT) repairs with an all-inside repair technique using postoperative radiological imaging to evaluate meniscus reduction and healing and use them as criteria for evaluation of repair success. MethodsProspective recruitment of 20 patients with 21 BHMT repairs performed with an all-inside techniqueover a period from 2013 to 2015. All patients had an International Knee Documentation Committee (IKDC) Subjective Knee Form (SKF), Lysholm Score, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner Activity Level Scale obtained pre-operatively and at a minimum of 24 months after surgery. All patients had postoperative knee magnetic resonance imaging (MRI) performed between 18 and 24 months after surgery to assess the stability or failure of their repairs.At 5 years after surgery, the patients were assessed with regard to whether they had undergone repeat surgery or not. ResultsAt 2 years, the mean postoperative SKF, Lysholm and KOOS grand scores were 78.9, 88.5 and 86.8, respectively. The mean pre-injury Tegner Activity Scale was 7.6 and postoperatively it was 6.0. There was a significant difference in all pre- and postoperative outcome scores (P < 0.01).The postoperative MRIs showed that 19 of the 21 BHMT repairs had stable reduction of the tear fragment and two patients had displacement of the torn bucket handle fragment. At 5 years, one patient had undergone revision surgery. ConclusionBHMTs can be repaired with all-inside techniques with good results and successful outcomes.

Arthroscopic management of tibial eminence fracture: a review of treatment outcome

&lt;p class="abstract"&gt;In this study outcomes of arthroscopic management of tibial eminence fracture have been described. We conducted a study of 15 patients of ACL avulsion fractures especially Meyer and Mckeever type II and III treated arthroscopically by pull through sutures. Outcome measures were assessed through International Knee Documentation Committee (IKDC) form, Tenger Activity scale and Lysholm knee score. The study group consisted of 15 patients who met the inclusion criteria, of which 9 were male and 6 were female. The range of patient age consisted of 13-37 years and the average patient age was 20.6 years. The average male age was 22.11 years and the average female age was 18.33 years. The fracture classification showed 7 being type II while 8 were type III. Tegner Activity level at follow up ranged from 5-8 and the mean score was 6.4. On follow-up evaluation, the mean Lysholm score was 92.8 (ranging from 76-100). 6 patients who had inter-meniscal interposition was retracted or resected showed no difference in functional outcome. We found that displaced tibial eminence fractures could be successfully treated using arthroscopic pull through sutures, with most patients returning to their previous activity level. Complications were avoided by anatomic reduction of fracture fragments and early post-operative rehabilitation.&lt;/p&gt;

Posterior knee arthroscopy facilitates the safe and effective all-inside repair of locked bucket-handle medial meniscal tear using a suture hook technique.

This study reported the outcomes of locked bucket-handle medial meniscal tear (BHMMT) repairs using an arthroscopic posterior approach during anterior cruciate ligament (ACL) reconstruction. Between 2011 and 2014, 48 patients with BHMMTs and ACL tears who met the eligibility criteria were enrolled in the present study. BHMMTs were assessed using a posterolateral transseptal portal and repaired using a posteromedial portal. Transportal ACL reconstruction was performed using hamstrings autograft. Patients were assessed based on their IKDC and Lysholm scores and Tegner activity level. Meniscal healing was clinically evaluated based on the absence of swelling, joint line tenderness, locking, and catching; McMurray test results; and the need for meniscectomy. According to follow-up assessments, the average IKDC and Lysholm scores improved significantly after 3-5years (P < 0.001) CONCLUSION: Excellent clinical outcomes were obtained when locked BHMMTs were repaired using an all-inside suture technique that employed posteromedial and posterolateral transseptal portals. IV.

L’ajout d’une ténodèse extra-articulaire au facia lata permet un meilleur contrôle de la stabilité rotatoire par rapport à une plastie isolée aux ischio-jambiers prélevés sur le genou controlatéral pour la chirurgie de révision des ruptures du ligament croisé antérieur

BackgroundRecent years have seen a resurgence of interest about lateral extra-articular procedures performed in association with anterior cruciate ligament (ACL) surgery, as they can reduce the positivity to pivot shift test by acting on rotational instability. The purpose of the present study is to compare the postoperative functional outcomes of ACL revision surgery using contralateral hamstring tendon autografts with or without extra-articular tenodesis. HypothesisThe hypothesis is that combined extra-articular tenodesis gives better rotational stability with revision ACL surgery. Patients and methodsTwenty-four patients who underwent ACL revision surgery were retrospectively reviewed at an average follow-up of 4.5 years; 12 underwent contralateral hamstring tendon autografts reconstruction (group A) while in 12 extra-articular tenodesis was associated (group B). Assessment included Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level and objective evaluation (range of motion, Lachman test, pivot-shift test and KT-1000 instrumented laxity testing). ResultsFollow-up examination showed that there were no statistically significant differences in Lysholm, IKDC and Tegner scores between the groups (p=n.s.). Similarly, no differences concerning anterior tibial translation as measured with KT-1000 arthrometer were reported between the groups (p=n.s.); the percentage of positivity to pivot shift test was significantly higher in patients in group A (p<0.05). ConclusionsThe association of extra-articular tenodesis restores rotational stability more effectively compared to contralateral hamstring tendon autografts ACL revision surgery alone. Level of evidenceIII.

Clinical and radiographic results after arthroscopic repair of lateral meniscus tear in lateral-depression tibial plateau fracture.

To evaluate the clinical and radiographic results of AR/IF and meniscus repair for treating lateral meniscus (LM) tears associated with lateral tibial plateau fractures and to identify the factors associated with LM tear. Forty-two patients with lateral plateau fractures (Schatzker types II and III) treated by AR/IF were included retrospectively. Radiographic evaluations using the Rasmussen system and computerized tomography (CT) were performed. Clinical evaluations were also conducted at final follow-up. Second-look arthroscopy was applied during metal removal. All fractures were healed after 46.3months of follow-up. The mean Tegner activity level was not decreased significantly, going from 7.1 ± 2.1 pre-injury to 6.6 ± 2.3 at final follow-up (p = 0.301). However, the amount of depression noted on CT imaging was significantly decreased from 8.9mm ± 4.4 to 1.2mm ± 1.3 (p = 0.000). The mean Rasmussen radiologic score at final follow-up was 14.5 ± 5.3 points. Osteoarthritis was progressed in six patients (14.3%). Twenty-five patients had concomitant LM tear, with 18 cases treated by repair and the remaining ones treated by partial meniscectomy. Preoperative joint depression (> 11mm) was significantly associated with the risk of LM tear (p = 0.024; odds ratio (OR): 9.0, 95% confidence interval (CI): 1.018-79.545) and most of those lesions could be repaired (p = 0.001). Postoperatively, 16 repaired patients were evaluated by second-look arthroscopy; 15 had healed completely and one had healed partially. LM tears are frequently combined with lateral tibial plateau fracture, especially in correlation with more than 11mm of joint depression, though most of those lesions can be repaired at the time of fracture fixation. AR/IF with arthroscopic meniscus repair could achieve good clinical and radiographic outcomes when treating Schatzker types II and III tibial plateau fractures. Level IV retrospective cohort study.

Age, time from injury to surgery and quadriceps strength affect the risk of revision surgery after primary ACL reconstruction

PurposeTo identify preoperative, intraoperative and postoperative factors associated with revision anterior cruciate ligament reconstruction (ACLR) within 2 years of primary ACLR.MethodsPatients who underwent primary ACLR at our institution, from January 2005 to March 2017, were identified. The primary outcome was the occurrence of revision ACLR within 2 years of primary ACLR. Univariate and multivariate logistic regression analyses were used to evaluate preoperative [age, gender, body mass index (BMI), time from injury to surgery, pre-injury Tegner activity level], intraoperative [graft type, graft diameter, medial meniscus (MM) and lateral meniscus (LM) resection or repair, cartilage injury] and postoperative [side-to-side (STS) anterior laxity, limb symmetry index (LSI) for quadriceps and hamstring strength and single-leg-hop test performance at 6 months] risk factors for revision ACLR.ResultsA total of 6,510 primary ACLRs were included. The overall incidence of revision ACLR within 2 years was 2.5%. Univariate analysis showed that age < 25 years, BMI < 25 kg/m2, time from injury to surgery < 12 months, pre-injury Tegner activity level ≥ 6, LM repair, STS laxity > 5 mm, quadriceps strength and single-leg-hop test LSI of ≥ 90% increased the odds; whereas, MM resection and the presence of a cartilage injury reduced the odds of revision ACLR. Multivariate analysis revealed that revision ACLR was significantly related only to age < 25 years (OR 6.25; 95% CI 3.57–11.11; P < 0.001), time from injury to surgery < 12 months (OR 2.27; 95% CI 1.25–4.17; P = 0.007) and quadriceps strength LSI of ≥ 90% (OR 1.70; 95% CI 1.16–2.49; P = 0.006).ConclusionAge < 25 years, time from injury to surgery < 12 months and 6-month quadriceps strength LSI of ≥ 90% increased the odds of revision ACLR within 2 years of primary ACLR. Understanding the risk factors for revision ACLR has important implications when it comes to the appropriate counseling for primary ACLR. In this study, a large spectrum of potential risk factors for revision ACLR was analyzed in a large cohort. Advising patients regarding the results of an ACLR should also include potential risk factors for revision surgery.Level of evidence III.

Magnetic Resonance Imaging 1 Year After Hamstring Autograft Anterior Cruciate Ligament Reconstruction Can Identify Those at Higher Risk of Graft Failure: An Analysis of 250 Cases

Background: There is currently no analysis of 1-year postoperative magnetic resonance imaging (MRI) that reproducibly evaluates the graft of a hamstring autograft anterior cruciate ligament reconstruction (ACLR) and helps to identify who is at a higher risk of graft rupture upon return to pivoting sports. Purpose: To ascertain whether a novel MRI analysis of ACLR at 1 year postoperatively can be used to predict graft rupture, sporting level, and clinical outcome at a 1-year and minimum 2-year follow-up. Study Design: Case-control study; Level of evidence, 3. Methods: Graft healing and integration after hamstring autograft ACLR were evaluated using the MRI signal intensity ratio at multiple areas using oblique reconstructions both parallel and perpendicular to the graft and tunnel apertures. Clinical outcomes were assessment of side-to-side laxity and International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm, and Tegner activity level scores at 1 year. Repeat outcome measures and detection of graft rupture were evaluated at a minimum of 2 years. Results: A total of 250 patients (42.4% female) underwent MRI analysis at 1 year, and assessment of 211 patients between 1 year and the final follow-up (range, 24-36 months) detected 9 graft ruptures (4.3%; 5 in female patients). A significant predictor for graft rupture was a high signal parallel to the proximal intra-articular graft and perpendicular to the femoral tunnel aperture (P = .032 and P = .049, respectively), with each proximal graft signal intensity ratio (SIR) increase by 1 corresponding to a 40% increased risk of graft rupture. A cutoff SIR of 4 had a sensitivity and specificity of 66% and 77%, respectively, in the proximal graft and 88% and 60% in the femoral aperture. In all patients, graft signal adjacent to and within the tibial tunnel aperture, and in the mid intra-articular portion, was significantly lower than that for the femoral aperture (P < .001). A significant correlation was seen between the appearance of higher graft signal on MRI and those patients achieving top sporting levels by 1 year. Conclusion: ACLR graft rupture after 1 year is associated with MRI appearances of high graft signal adjacent to and within the femoral tunnel aperture. Patients with aspirations of quickly returning to a high sporting level may benefit from MRI analysis of graft signal. Graft signal was highest at the femoral tunnel aperture, adding further radiographic evidence that the rate-limiting step to graft healing occurs proximally.

Effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon ruptures and defects

To investigate the effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon rupture and defects. The clinical data of 11 patients with chronic patellar tendon rupture and defects admitted between January 2015 and August 2018 were retrospectively analyzed. The patient were treated with inverted U-shaped reconstruction technique using hamstring autografts, in which 2 bone tunnels were created at the level of 1/2 and lower 3/4 of the patella, and 1 bone tunnel was created beneath the tibial tuberosity. There were 8 males and 3 females with an average age of 30.1 years (range, 10-61 years). The average interval from the primary injury to the operation was 9.5 months (range, 2-36 months). According to Yousef classification, there were 7 cases of type A2, 3 cases of type B2, and 1 case of type C2. The length of the patella tendon defect was measured when the patella was reducted intraoperatively with an average of 4.5 cm (range, 2.7-7.1 cm). Subjective function scores [including International Knee Documentation Committee (IKDC) subjective score, Tegner activity level, and Lysholm score] were evaluated before operation and at last follow-up. The loss of knee extension, Caton index, and thigh circumference difference at 15 cm above the patella between bilateral limbs were also measured. All patients were followed up 24-66 months (mean, 34.2 months). All incisions were primary healing, and there were no complications such as wound infection, venous thrombosis of the lower extremities, stiffness of the knee joint, graft failure, neurovascular injury, etc. No second revision surgery was performed during the follow-up. At last follow-up, the subjective function scores (IKDC subjective score, Tegner activity level, Lysholm score), loss of knee extension, thigh circumference difference, and Caton index were significantly improved when compared with those before operation ( P<0.05). Two patients still had patella alta, with Caton indexes of 1.29 and 1.32, respectively. In the treatment of chronic patellar tendon ruptures and defects, the modified patellar tendon reconstruction using hamstring autograft can significantly improve the postoperative knee function, restore the normal range of knee extension, enhance the extensor and correct the patella alta.

Failed meniscal repair increases the risk for osteoarthritis and poor knee function at an average of 9 years follow-up

PurposeThe purpose of this study was to determine the effect of meniscal repair on OA in the knee joint and patient-related outcomes.MethodsThree-hundred and sixteen meniscal repairs performed between 1999 and 2011 were analysed. Patient-related outcome measures were assessed through mailed questionnaires including KOOS, Lysholm score and Tegner activity level. Patients answering the questionnaires were encouraged to perform a radiographic evaluation with Rosenberg views, assessed according to Kellgren–Lawrence (KL) classification. The primary endpoint was to determine the effect of meniscal repair on the development of radiographic OA defined as a KL grade 2 or more.ResultsMean follow-up time was 9.3 years (SD 3.6), 162 (51%) patients answered the questionnaires, and 86 patients completed the X-ray. The odds ratio for OA with a failed meniscus repair was 5.1 (p = 0.007) adjusted for gender and age at time of follow-up. KOOS showed a clinically important difference in the sport and recreation subscale (p = 0.041).ConclusionsThere was an increased risk for OA in the affected compartment with a failed meniscus fixation. This supports the fact that the meniscus is an important protector of the cartilage in the knee. The meniscus injury affects the long-term health-related quality of life according to KOOS and in light of this study we recommend repair of a torn meniscus whenever possible.Level of evidenceIII.

Comparable Clinical and Radiologic Outcomes Between an Anatomic Tunnel and a Low Tibial Tunnel in Remnant-Preserving Posterior Cruciate Ligament Reconstruction.

Background:There is currently no consensus on the optimal placement of the tibial tunnel for remnant-preserving posterior cruciate ligament (PCL) reconstruction.Purpose/Hypothesis:The purpose of this study was to compare the clinical and radiologic outcomes of remnant-preserving PCL reconstruction using anatomic versus low tibial tunnels. We hypothesized that the outcomes of low tibial tunnel placement would be superior to those of anatomic tibial tunnel placement at the 2-year follow-up after remnant-preserving PCL reconstruction.Study Design:Cohort study; Level of evidence, 3.Methods:We retrospectively reviewed the data for patients who underwent remnant-preserving PCL reconstruction between March 2011 and January 2018 with a minimum follow-up of 2 years (N = 63). On the basis of the tibial tunnel position on postoperative computed tomography, the patients were divided into those with anatomic placement (group A; n = 31) and those with low tunnel placement (group L; n = 32). Clinical scores (International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity level), range of motion, complications, and stability test outcomes at follow-up were compared between the 2 groups. Graft signal on 1-year follow-up magnetic resonance imaging scans was compared between 22 patients in group A and 17 patients in group L.Results:There were no significant differences between groups regarding clinical scores or incidence of complications, no between-group differences in posterior drawer test results, and no side-to-side difference on Telos stress radiographs (5.2 ± 2.9 mm in group A vs 5.1 ± 2.8 mm in group L; P = .900). Postoperative 1-year follow-up magnetic resonance imaging scans showed excellent graft healing in both groups, with no significant difference between them.Conclusion:The clinical and radiologic outcomes and complication rate were comparable between anatomic tunnel placement and low tibial tunnel placement at 2-year follow-up after remnant-preserving PCL reconstruction. The findings of this study suggest that both tibial tunnel positions are clinically feasible for remnant-preserving PCL reconstruction.

Outcomes of one-stage reconstruction for chronic multiligament injuries of knee

PurposeThis article aims to evaluate patterns of chronic multiligament injuries and outcomes of treatment with single-stage reconstruction using autografts.MethodsAll patients with clinicoradiologically diagnosed multiligament knee injury (MKI) were included in this prospective observational study. As the time since injury was more than 6 weeks in all of the patients, they were categorized as having chronic MKI. Patients were assessed clinically for laxity, and the diagnosis was confirmed radiologically. Ipsilateral hamstring tendons were used for medial collateral ligament (MCL) or posterolateral corner reconstruction in a patient with Schenck knee dislocation (KD) type III. In these cases, the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) were reconstructed by using the peroneus longus and contralateral hamstring tendons respectively. Ipsilateral hamstring tendons were used for ACL reconstruction and an ipsilateral peroneus longus tendon graft was used for reconstruction of the PCL in a KD type II injury. In two cases of KD type IV injury, the lateral laxity was only grade II and was managed conservatively; the rest of the ligaments were addressed like a KD type III injury. Outcome evaluation was done using a visual analogue scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity level, preoperatively and postoperatively at 2 years’ follow-up.ResultsA total of 27 patients of mean age 33.48 ± 9.9 years with MKI were included in the study. The patients were classified as eight KD type II, 17 KD type III, and two KD type IV. The majority of the patients had associated meniscal (59.2%) or chondral (40.7%) injuries. At the 2 years’ follow-up visit, there were significant improvements in VAS score (p = 0.0001) IKDC score (p = 0.0001), Lysholm score (p = 0.0001), and range of motion (p = 0.001). None of the patients had residual laxity on clinical examination of the knee joint at the 2 years’ follow-up. All but two of the patients went back to their previous activity level. These two patients had progressive knee arthritis and needed knee arthroplasty.ConclusionSingle-stage surgical reconstruction for chronic MKI has favourable functional outcomes.Level of evidenceLevel IV, case series.