Tegner Score Research Articles

Chitosan based scaffold applied in patellar cartilage lesions showed positive clinical and MRI results at minimum 2 years of follow up.

New scaffold-based cartilage regeneration techniques have been developed to improve the results of microfractures also in complex locations like the patello-femoral joint. The aim of this study was to analyse the results obtained in patellar lesions treated with a bioscaffold, a mixture composed by a chitosan solution, a buffer, and the patient's whole blood which forms a stable clot into the lesion. Fifteen patients with ICRS grade 3-4 cartilage lesions of the patellar surface were treated with a chitosan bioscaffold. Fourteen patients were clinically and radiologically evaluated prospectively for a minimum follow-up of 2years with IKDC, KOOS, Tegner score, and MRI.The mean age of patients at the time of surgery was31.8 ± 11.9and nine patients presented degenerative aetiology, four patients with previous trauma, and 1 patient with osteochondritis dissecans. RESULTS: The IKDC subjective score improved from 46.2 ± 19.3 preoperatively to 69.5 ± 20.3 (p < 0.05) and74.1 ± 23.2(p < 0.05) at 12 and 24months, respectively. Also KOOS Pain, KOOS Sport/Rec and KOOS QOLshowed a significant improvement from baseline to 12months and to the final follow-up.MRI evaluation showed a complete filling of the cartilage defect at the final follow-up in 70% of the lesions, obtaining a total MOCART 2.0 score of 71.5 ± 13.6 at 24months after surgery. Chondral patellar lesions represent a complex pathology, with lower results compared to other sites. This bioscaffold representsa safe surgical treatment providing a significant clinical improvement at 24months in the treatment of patellar cartilage lesions. IV.

Arthroscopic Posterior Capsular Release Effectively Reduces Pain and Restores Terminal Knee Extension in Cases of Recalcitrant Flexion Contracture

PurposeTo 1) evaluate the clinical efficacy of arthroscopic posterior capsular release for improving range of motion (ROM) in cases of recalcitrant flexion contracture and 2) determine patient-reported outcomes (PROs) postoperatively.MethodsRetrospective chart review was performed to identify patients who underwent arthroscopic posterior capsular release due to persistent extension deficit of the knee despite comprehensive nonoperative physical therapy between 2008 and 2021. Knee ROM and PROs (International Knee Documentation Committee [IKDC], Tegner, and visual analog scale [VAS]) were collected at final follow-up.ResultsOverall, 22 patients were included with a median age of 37 years (interquartile range [IQR]: 20.5-44.3). Of these, 8 (36%) were male and 14 (64%) were female, and average follow-up was 3.7 ± 3.3 years. The most common etiology was knee flexion contracture after anterior cruciate ligament (ACL) reconstruction (59%). All patients failed a minimum of 3 months of nonoperative management. Prior to operative intervention, 100% of patients received physical therapy, 64% received extension knee bracing or casting, and 36% received corticosteroid injection. Median preoperative extension was 15° (IQR: 10-25) compared to 2° (IQR: 0-5) postoperatively (P < .001). At final follow-up, median extension was 0° (IQR: 0-3.5). Postoperative VAS pain scores at rest (2 vs 0; P = .001) and with use (5 vs 1.8; P = .017) improved at final contact, and most (94%) patients reported maintaining their extension ROM. Patients with ACL-related extension deficit reported better IKDC (81 vs 51.3; P = .008), Tegner (5.8 vs 3.6; P = .007), and VAS pain scores (rest: 0.2 vs 1.8; P = .008; use: 1.3 vs 5; P = .004) compared to other etiologies.ConclusionArthroscopic posterior capsular release for recalcitrant flexion contracture provides an effective means for reducing pain and restoring terminal extension. The improvement in extension postoperatively was maintained for most (94%) patients at final follow-up with a 14% reoperation rate.

Double-Tunnel Technique Was Similar to Single-Tunnel Technique in Clinical, Imaging and Functional Outcomes for Medial Patellofemoral Ligament Reconstruction: A Randomized Clinical Trial

This study aimed to compare the clinical, functional, and imaging outcomes of single-tunnel (ST) and double-tunnel (DT) techniques for medial patellofemoral ligament (MPFL) reconstruction. Ninety-four patients with recurrent patellar instability were randomly divided into 2 groups, receiving either ST or DT MPFL reconstruction. Lateral reticulum release (LRR) and tibial tuberosity (TT) transfer were performed as combined procedures when necessary. Preoperative and postoperative clinical characteristics (symptoms and episodes of redislocation), functional outcomes (Kujala, Lysholm, Tegner, IKDC, and KOOS score), and radiological measurements (congruence angle, patellar tilt angle, lateral patellar angle, and lateral patellar translation) were analyzed. The analysis included data from 90 patients with 48 patients in the ST group and 42 patients in the DT group. Patients were followed up for a mean period of 37.8 (range: 27-50) months in the ST group and 38.6 (range: 25-53) months in the DT group. Forty-three patients in the ST group and 40 patients in the DT group received combined TT transfer, and all patients underwent LRR. At thelatestfollow-up, 1 patient in ST group experienced redislocation, while no patient in the DT group sustained clinical failure (P= .347). Imaging measurements decreased significantly to the normal range postoperatively. No significant difference was noted between the postoperative radiological results of the 2 groups. All clinical scores significantly improvedpostoperatively,and no significant difference was observed between the 2 groups except for the higher Lysholm score (P= .031), KOOS symptoms score (P= .021) and KOOS knee-related quality of life score (P= .043) in the DT group. Both techniques could equally mitigate the patellar lateral translation or redislocation. Our results demonstrate several significant differences in functional outcomes that favored DT MPFL reconstruction but no difference in clinical failure rates and radiological results between ST and DT MPFL reconstruction. Level I, randomized clinical trial.

Complex Repair and Cruciate Ligament Reconstruction in KDs III and IV Multiligamentous Knee Injuries-Results of Mid-Term Follow-up.

The purpose of the present study was to describe the longitudinal outcomes of acute repair of extra-articular structure and anatomical reconstruction of cruciate ligament for knee dislocations (KDs) III and IV multiligamentous knee injuries. Forty-seven patients with an acute KD III or IV were treated with one-stage management within 9.2 days. Forty-five KDs III and IV with a follow-up at a mean of 53.2 months were evaluated. The mean International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score were 81.5 ± 0.7, 89.6 ± 1.2, and 6.8 ± 0.5, respectively. Comparing preoperative data with those at the latest follow-up, significant improvements in IKDC score (p < 0.01), Lysholm score (p < 0.01), and Tegner score (p < 0.01) were noted in all groups. Comparing contralateral knee stability, no statistical differences were found including the varus/valgus (0 degree/30 degrees) and Telos stress radiography. So, acute repair of extra-articular structure and anatomical reconstruction of cruciate ligament resulted in satisfactory outcomes for KDs III and IV multiligamentous knee injuries.

Single-stage repair of displaced bucket-handle meniscal tears with anterior cruciate ligament reconstruction leads to good meniscal survivorship : a retrospective cohort study.

The best surgical strategy for the management of displaced bucket-handle (BH) meniscal tears in an anterior cruciate ligament (ACL)-deficient knee is unclear. Combining meniscal repair with ACL reconstruction (ACLR) is thought to improve meniscal healing rates; however, patients with displaced BH meniscal tears may lack extension. This leads some to advocate staged surgery to avoid postoperative stiffness and loss of range of motion (ROM) following ACLR. We reviewed the data for a consecutive series of 88 patients (mean age 27.1 years (15 to 49); 65 male (74%) and 23 female (26%)) who underwent single-stage repair of a displaced BH meniscal tear (67 medial (76%) and 21 lateral (24%)) with concomitant hamstring autograft ACLR. The patient-reported outcome measures (PROMs) EuroQol visual analogue scale (EQ-VAS), EuroQol five-dimension health questionnaire (EQ-5D), Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee score (IKDC), and Tegner score were recorded at final follow-up. A Kaplan-Meier survival analysis was performed to estimate meniscal repair survivorship. Analyses were performed with different cut-offs for meniscal and ACL injury-to-surgery time (within three weeks, three to ten weeks, and more than ten weeks). Meniscal repair survivorship at a median final follow-up of 55 months (interquartile range (IQR) 24 to 91) was 82% (95% confidence interval 70 to 89). A total of 13 meniscus repairs failed (12 requiring meniscectomy and one requiring a further meniscal repair). At final follow-up, median PROMs were: EQ-VAS 85 (IQR 75 to 90), EQ-5D Index 0.84 (IQR 0.74 to 1.00), KOOS Pain 89 (IQR 80 to 94), KOOS Symptoms 82 (IQR 71 to 93), KOOS Activities of Daily Living 97 (IQR 91 to 100), KOOS Sport and Recreation 80 (IQR 65 to 90), KOOS Quality of Life 69 (IQR 53 to 86), IKDC 82.8 (IQR 67.8 to 90.8), and Tegner 6 (IQR 4 to 7). Two patients underwent revision ACLR following further injuries. One patient had an arthroscopic washout for infection at 11 days post-BH meniscal repair/ACLR. Four patients (4.5%) required a further procedure for stiffness, reduced ROM, and pain, and all were operated on within three weeks of meniscal injury. There was no difference in the interval between meniscal injury and surgery between repairs that failed and those that survived. These data suggest that concomitant ACLR with repair of displaced BH meniscal tears, even if they have been displaced for some time, appears to afford satisfactory PROMs and good survivorship. Repairs within three weeks of meniscal injury may be associated with higher rates of postoperative reintervention for stiffness. Cite this article: Bone Joint J2022;104-B(6):680-686.

Two cases of contact athletes with anterior cruciate ligament injuries who returned to competition early after conservative treatment with PRP therapy

IntroductionAnterior cruciate ligament (ACL) injuries in high-impact contact sports athletes are often treated through surgery. Recently, conservative treatment of ACL injuries in athletes using autologous biotherapy such as platelet-rich plasma (PRP) has been reported. We report two cases of aggressive conservative treatment with PRP therapy for contact athletes.Presentation of caseCase 1. A 23-year-old male rugby player with a preinjury Tegner score of 9 underwent three PRP treatments following an ACL injury and returned to preinjury levels of play 4 months postinjury. The pivot shift test had improved to grade 0 at the last follow-up. Case 2. A 34-year-old male mixed martial arts fighter with a preinjury Tegner score of 9 underwent five PRP treatments following an ACL injury and returned to his preinjury play level 3.5 months postinjury. Both contact athletes returned to competition early and continued to compete without losing stability at the final follow-up. Moreover, their functional score exceeded the median score for athletes after ACL reconstruction, suggesting satisfactory performance.DiscussionAntiinflammatory cytokines and growth factors in PRP may promote graft maturation and alter the natural history of remodeling, resulting in earlier and firmer graft maturation, improving both the duration and quality of the healing process.ConclusionTwo high-impact sports athletes with ACL injuries were treated with aggressive conservative therapy using PRP and returned early to their preinjury play level.

Posterior cruciate ligament reconstruction with independent internal brace reinforcement: surgical technique and clinical outcomes with a minimum two year follow-up

PurposeWe developed an augmentation technique for PCL reconstruction with independent internal brace reinforcement and evaluated the functional outcome after PCL reconstruction employing autologous hamstrings augmented with an internal brace system for patients with isolated or combined grade 3 posterior instability who were treated with this technique.MethodsFrom January 2016 to January 2018, patients with isolated or combined grade 3 PCL tears who underwent single-bundle PCL reconstruction using autologous hamstrings augmented with independent internal braces were studied. The function of the operated knee was evaluated according to the International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity score. The patients were asked the level of returned to their previous sport. Posterior knee laxity was examined with a KT-1000 arthrometer, and data on range of motion (ROM), re-operation, and other complications were collected.ResultsA total of 33 consecutive patients who received single-bundle PCL reconstruction using autologous hamstrings augmented with independent internal braces with a minimum two years follow-up were included in this study. Two patients had undergone this procedure during the study period and were not included in this study (one had combined bone fractures, and one patient had previous meniscus surgery). Thirty-one patients were available for final analysis. The mean follow-up was 45.35 ± 10.88 months (range 29–66 months). The average IKDC subjective knee evaluation scores from 51.65 ± 12.35 to 84.52 ± 6.42, the Lysholm score from 53.90 ± 11.86 to 85.68 ± 4.99, and the Tegner score from 2.81 ± 0.79 to 6.71 ± 1.83 (P < 0.05 for all). The mean total posterior side-to-side difference in knee laxity, assessed using a KT-1000 arthrometer, decreased from 12.13 ± 2.66 mm pre-operatively to 1.87 ± 0.56 mm post-operatively at 70° (P < 0.05). Most patients (29/31) had normal or near normal knee ROM post-operatively; two patients revealed a 6–15° loss of knee flexion compared with the contralateral knee. Twenty-nine patients (93.55%) returned to a normal daily exercise level. Twenty-three patients (74.19%) returned to competitive sports with high-level sports (Tegner score of 6 or above; eleven patients (35.48%) reported to be on the same level as well as the Tegner level); six patients (19.35%) returned to recreational sports (Tegner score of 4 or 5). Two patients had Tegner scores of 2 and 3, indicating poor function level. No patient needed PCL revision surgery during the follow-up period.ConclusionSingle-bundle PCL reconstruction with internal brace augmentation for PCL injury exhibited satisfactory posterior stability and clinical outcomes in patients with isolated or combined grade 3 PCL injuries at a minimum two year follow-up.

The promotive effect of grafts with the double-stranded peroneus longus tendon and with the four-stranded hamstring tendon on reconstruction of the posterior cruciate ligament injury

IntroductionPosterior cruciate ligament (PCL) injury hampers the rotational stability and stability front to back of the knee joint, seriously affecting the quality of life of patients. Some studies have reported that the peroneus longus tendon (PLT) has sufficient length and strength. HypothesisWe hypothesized that the PLT can be used as a novel appropriate material for PCL reconstruction therapy. Materials and methods: Herein, we systematically analysed the clinical effect of the double-stranded PLT and the four-stranded hamstring tendon in the reconstruction of the PCL and compared the effectiveness and safety of these two surgical approaches in the reconstruction of PCL injury. A total of 48 patients with complete rupture of the PCL were divided into Group A (reconstructed with the double-stranded PLT, 25 cases) and Group B (reconstructed with the four-stranded hamstring tendon, 23 cases). ResultsThe patients were followed up for more than 1 year. The intraoperative time for tendon extraction was significantly shorter in Group A than Group B. Twenty-four months after operation, patients in the two groups showed the alleviated tibial posterior displacement and the increased IKDC score, Lysholm score and Tegner score. Nevertheless, these scores showed no significant differences between the two groups. Additionally, compared with the therapy using the four-stranded hamstring tendon, therapy using the double-stranded PLT is simpler and safer. DiscussionBoth surgical methods are effective in the treatment of PCL injury. The PLT could be a good choice for PCL injury reconstruction material, especially when the four-stranded hamstring tendon is accidentally damaged or ineffective. Our study may provide guidance for the clinical treatment of PCL injury. Level of EvidenceIII, retrospective study.

Long-term (10-25 years) outcomes of knee osteochondral autologous transplantation in soccer players

ObjectiveOsteochondral lesions in the knee can occur in a high percentage of soccer players. Untreated, symptomatic osteochondral lesions can lead to reduced athletic performance, early career-ending, and the premature onset of knee osteoarthritis. One of the treatment options is osteochondral autologous transplantation with the mosaicplasty technique. The study aims to investigate the long-term outcomes of the procedure in the athletic population. DesignIn a single-center retrospective study, the long-term outcomes of knee mosaicplasty procedures in soccer players between 1992 and 2011 were investigated. Using International Knee Documentation Committee and Bandi score to evaluate the knee function, Tegner score to measure activity, and MOCART 2.0 score to describe cartilage surface. Players' skill level was divided into professional, competitive, and recreational groups. ResultsFifty-five out of 73 soccer players were included; 25 had MRI at the last follow-up control. The average follow-up time was 17,54 years (10,32-24,91). The mean International Knee Documentation Committee score was 68.52 ± 16.01 (33-87), MOCART was 70.8 ± 18.12 (25-95), and 80% of the patient had a good Bandi score. The mean size of the defects was 2,08 cm2 ± 1,19 (1-5 cm2) and overall return to sport time was 7,78 ± 2,96 (4-12) months. ConclusionThe knee mosaicplasty procedure has a good long-term result, with no significant decrease in functional scores compared to other studies even after 20 years from the surgery. Therefore, osteochondral autologous transplantation is a reasonable option for soccer players with small to medium-sized osteochondral lesions in the knee.

Surgical Repair of Stener-like Injuries of the Medial Collateral Ligament of the Knee in Professional Athletes

Background: A “Stener-like” lesion of the knee is defined as a distal avulsion of the superficial medial collateral ligament (sMCL) with interposition of the pes anserinus between the ligament and its tibial insertion—a displacement impeding anatomic healing. Because of the scarcity of these injuries, the literature is limited to case reports and small case series. Purpose: To assess the effect of surgical repair of acute Stener-like lesions of the sMCL on the following outcomes: return to preinjury level of sporting function; time to return to preinjury level of sporting function; functional performance; injury recurrence; and any other complications. Study Design: Case series: Level of evidence, 4. Methods: This prospective single–surgeon study included 23 elite athletes with a mean age of 27.2 years (range, 19-37 years). Of the participants, 20 were men (87%) and 3 were women (13%). The mean body mass index was 23.1 ± 2.3. A total of 16 athletes were soccer players (70%) and 7 were rugby players (30%), with isolated acute, traumatic Stener-like lesions of the sMCL of the knee confirmed on preoperative magnetic resonance imaging. Surgical repair was undertaken with primary suture anchor repair with ligament repair or reconstruction system (LARS) augmentation. Predefined outcomes were recorded at regular intervals after surgery. The minimum follow–up time was 24 months (range, 24-108 months) from the date of surgery. Results: The mean time from injury to surgical intervention was 9 days (range, 3-28 days). Overall, 15 (65%) athletes had isolated distal sMCL injuries requiring anatomic suture anchor repair at the distal tibial insertion site only, and 8 (35%) athletes had concomitant injuries of the proximal and distal sMCL and required anatomic suture anchor repair at the proximal and distal attachment sites. Ten athletes required LARS augmentation at the time of the index operation. All study patients returned to their preinjury level of sporting activity in professional soccer or rugby. The mean time from surgical intervention to return to full sporting activity was 16.8 ± 2.7 weeks. At 6 and 24 months’ follow–up, all patients had Tegner scores of 10. At a 2–year follow–up, all study patients were still participating at their preinjury level of sporting activity. Three patients developed complications around the LARS that required further surgery to remove synthetic material; however, this did not affect function. Conclusion: Surgical repair of acute Stener-like lesions of the sMCL is associated with a high return to preinjury level of sporting function, excellent functional performance, and a low risk of recurrence at short–term follow-up in elite athletes.

Effect of Anterolateral Structure Augmentation on Graft Maturity After Anterior Cruciate Ligament Reconstruction: A Clinical and MRI Follow-up of 2 Years

Background: Anterolateral structure augmentation (ALSA) has been applied to prevent residual rotatory instability and lower clinical failure rates after anterior cruciate ligament (ACL) reconstruction (ACLR); however, the effect of combined ALSA on the maturity of ACL grafts remains unknown. Purpose: To evaluate the graft maturity and patient–reported outcomes in patients who underwent double–bundle ACLR with or without ALSA. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 92 patients who underwent double–bundle ACLR between January 2016 and July 2019 were included in the present study—44 patients with isolated ACLR (ACLR group) and 48 patients with combined ACLR and ALSA (ALSA group). Demographic characteristics, intraoperative findings, and patient–reported outcomes were prospectively collected. On postoperative magnetic resonance imaging at the 2–year follow–up, the signal–to–noise quotient (SNQ) values were separately calculated for 6 sections of the ACL graft, including the femoral intratunnel graft (FTG), intra–articular graft (IAG), and tibial intratunnel graft (TTG) of the anteromedial bundle (AMB) and the posterolateral bundle (PLB). Superior graft maturity was usually indicated by lower SNQ values. Results: The rates of return to preinjury sports were 47.9% and 27.3% in the ALSA and ACLR groups, respectively (difference, 20.6% [95% CI, 1.3%-40%]; P = .042). The AMB demonstrated significantly lower SNQ values in the ALSA group than in the ACLR group (FTG, 7.04 ± 3.65 vs 9.44 ± 4.51 [P = .006]; IAG, 6.62 ± 4.19 vs 8.77 ± 5.92 [P = .046]; TTG, 6.93 ± 3.82 vs 8.75 ± 4.55 [P = .040]). The SNQ values were significantly lower in the ALSA group for 2 of the 3 sections of the PLB (IAG, 7.73 ± 4.61 vs 9.88 ± 5.61 [P = .047]; TTG, 5.88 ± 3.10 vs 8.57 ± 4.32 [P = .001]). Partial lateral meniscectomy was correlated with higher SNQ values of the TTG in the AMB (β = 0.27; P = .009) and the PLB (β = 0.25; P = .008), with both groups pooled. Higher body mass index, smaller ACL graft–Blumensaat line angles, larger AMB graft diameters, and lower postoperative Tegner scores were also associated with inferior maturity in specific regions of the ACL graft. Conclusion: A combination of ACLR and ALSA is a desirable option to improve the maturity of ACL grafts for patients who are young or expected to return to pivoting sports. Meanwhile, further investigations with higher levels of evidence and longer periods of follow–up are warranted.

Simultaneous Treatment of Osteochondral Lesion Does Not Affect the Mid- to Long-Term Outcomes of Ligament Repair for Acute Ankle Sprain: A Retrospective Comparative Study with a 3-11-Year Follow-up.

PurposeThis study aims to evaluate the mid- to long-term outcome of concurrent arthroscopic treatment of osteochondral lesion (OCL) and open anatomical repair of lateral ankle ligaments for severe acute ankle sprain patients and compare them to the outcome of those without OCL.MethodsA total of 166 patients with grade III acute lateral ankle ligament injuries underwent concurrent ankle arthroscopy and open anatomic ligament repair. Forty-three patients (group A) with OCL underwent arthroscopic treatment followed by open ligament repair. A total of 105 patients (group B) without OCL were followed up as the control. The evaluation parameters included sports recovery, postoperative visual analog scale (VAS) pain score, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner score, sprain recurrence, satisfaction, and range of motion. Patients in group A were then subgroup-analyzed according to age, sex, body mass index, injury side, OCL location, and stage (Ferkel and Cheng’s staging system).ResultsThe postoperative exercise level of the two groups recovered to more than 90% of the normal level (91.2% ± 11.2% in group A and 90.9% ± 13.3% in group B, n.s.). The average time of group A and group B to return to preinjury sports activity was respectively 4.4 ± 1.0 months and 4.4 ± 1.2 months with no significant difference (p = 0.716). No significant differences were found in the preoperation VAS pain score, AOFAS score, and Tegner score between the two groups. The postoperative VAS pain score in group A was significantly higher than that in group B (0.8 ± 1.7 vs. 0.3 ± 0.8, p = 0.027), but the difference was not clinically important. The postoperative VAS pain score of patients with stage D–F lesions was significantly higher than that of patients with stage B–C lesions (1.3 ± 2.1 vs. 0.3 ± 0.9, p = 0.038).ConclusionsFor the severe acute ankle sprain combined with OCL, the simultaneous arthroscopic treatment and open lateral ankle ligament repair achieved good mid- to long-term outcomes. Except that the pain was more pronounced than in the control group, there were no differences in other outcomes. Postoperative pain was positively correlated with the grade of OCL.

Long-term outcomes of talus osteochondral autologous transplantation in soccer players: 24 mosaicplasty with more than 10 years of follow-up

ObjectiveAround 17% to 40% of professional soccer players' joint injuries affect the ankle. Although their incidence rate is relatively low, it is necessary to treat the cartilage and osteochondral talus injury in most cases, particularly in athletes. According to the latest International Consensus Meeting on Cartilage Repair of the Ankle implicates that there is not enough evidence to make a proper guideline; therefore, the study aims to investigate the long-term outcomes of talar mosaicplasty. MathodsIn a single-center retrospective study, the long-term outcomes of talus mosaicplasty procedures in soccer players between 1997 and 2011 were investigated. A combination of scores was used: the FAOS (Foot and Ankle Outcome Score) and Bandi score in order to evaluate the ankle and donor site function, the Tegner scores to measure activity, and the MOCART 2.0 (Magnetic Resonance Observation of Cartilage Repair Tissue) score to describe cartilage surface. Players' skill level was divided into professional, competitive, and recreational groups. ResultsTwenty-four soccer players were included; 13 had MRI at the last follow-up control. The average follow-up time was 13.84 ± 3.65 (10.22-22.82) years. The mean FAOS score was 86.16 ± 16.05 (24-99), MOCART was 50.76 ± 12.55 (25-70), and 87% of the patients had a good to excellent Bandi score. The overall return to sport was 11.4 ± 4.8 (3.6-24) months. ConclusionMosaicplasty has a good long-term functional outcome score and proved to be a reliable treatment option for the athletic population.

Outcomes After Repair of Quadriceps Tendon Rupture in Patients Aged 40 Years and Younger.

Background:Injury to the quadriceps tendon is rare and most commonly occurs in middle-aged men. Few reports are available regarding outcomes after quadriceps tendon rupture in younger patients.Purpose/Hypothesis:To review the clinical outcomes of patients who underwent quadriceps tendon repair at age ≤40 years. We hypothesized that this cohort would experience better clinical outcomes in comparison to historical older controls.Study Design:Case series; Level of evidence, 4.Methods:Using an institutional database, we retrospectively identified patients who underwent quadriceps tendon repair between January 2009 and December 2017. Patients were included in the study if they were aged ≤40 years at the time of surgery and had sustained an isolated, complete tendon rupture. Patient and injury characteristics were recorded. Patients were contacted to complete a custom survey, the 2000 International Knee Documentation Committee (IKDC) form, the Lysholm scale, and the Tegner scale.Results:Included were 38 patients (86.8% male; mean age, 32.0 ± 6.9 years; age range, 15-40 years), with a mean follow-up of 5.9 ± 2.3 years (range, 2.4-11.3 years). At final follow-up, the mean IKDC score was 74.1 ± 22.6 (range, 26.4-100.0), and the mean Lysholm score was 85.4 ± 20.0 (range, 30-100), which were similar if not inferior to historical controls of patients >40 years. Only 16 patients (42.1%) had unchanged or higher Tegner scores after surgery, whereas 22 patients (57.9%) reported lower postoperative activity level. Overall, 91.2% (31/34) of workers returned at a mean 3.9 months after surgery, whereas 63% (12/19) of athletes were able to return to play at 8.8 months. At final follow-up, 12 patients (31.6%) reported persistent pain and stiffness in their knees. Additionally, 3 patients (7.9%) reported pain without stiffness, and 4 (10.5%) reported stiffness without pain. Patients reporting pain or stiffness had significantly lower IKDC scores, Lysholm scores, postoperative Tegner scores, and change in their Tegner score at final follow-up in comparison to those who did not report pain or stiffness.Conclusion:Although patients aged ≤40 years had satisfactory outcomes after quadriceps tendon repair, this injury resulted in significant long-term sequelae in a substantial percentage of patients, despite their youth. Further, this group did not have better outcomes compared with historical controls aged > 40 years.

Return to Sport Testing After Arthroscopic Shoulder Surgery in Adolescent Patients

Background:Readiness for return to sport (RTS) after surgery can be assessed using strength and functional performance testing. However, data regarding RTS testing after arthroscopic shoulder stabilization in adolescent patients is limited.Purpose:To investigate the results of strength and functional RTS testing following arthroscopic stabilization in adolescent patients with shoulder instability.Methods:A retrospective review of medical records was performed to identify adolescent patients who underwent arthroscopic shoulder stabilization and subsequent RTS testing between April 2017 and April 2020. Surgeries were performed by a single sports medicine fellowship-trained surgeon; RTS assessments were performed at the primary institution’s sports rehabilitation clinic by a licensed physical therapist. Patient demographics, operative details, patient-reported outcome measures (PROMs) (VAS, Tegner, ASES, QuickDASH), and RTS testing results were collected. PROMs were obtained at the time of the RTS test. The recovery of muscle strength was defined by a limb symmetry index (LSI) ≥90%. Differences between the involved and uninvolved limbs were analyzed. Correlations between RTS testing results and PROMs were examined.Results:24 patients (62.5% male) were identified with mean age of 15.5 years (range, 13-21 years). Football was the most common primary sport played (33.3%). 58.3% of patients underwent surgery on their dominant shoulder. 21 patients had isolated anterior repairs, two had combined anterior/posterior repairs, and one had an isolated posterior repair. RTS testing was performed at a mean of 6.02 ± 0.64 months postoperatively. All PROMs improved significantly from pre-operative to the time of RTS testing (p<0.0001). All patients (n=24) failed at least one component of the RTS testing (Table 1). Pre-operative Tegner scores were positively correlated with involved isokinetic external rotation symmetry (r=0.383, p<0.05) and with closed kinetic chain upper extremity stability test (CKCUEST) performance (r=0.577, p<0.005). Post-operative Tegner and ASES scores were positively correlated with involved isometric internal rotation LSI (r=0.418, p<0.05) and CKCUEST performance (r=0.383, p<0.05), respectively. Isometric External Rotation LSI was positively correlated with the Isokinetic External Rotation LSI at 180°/sec for the surgical limb (r=0.57, p<0.01).Conclusion:At 6-months postoperative, shoulder strength and stability deficits persist in the surgical limb of adolescent patients. PROMs improve significantly from pre-operative to time of RTS testing. Tegner and ASES scores may be associated with objective shoulder strength and stability measurements.Table 1.Return-to-Sport Pass Criteria and Percentage of Patients Who Passed

Determining the Substantial Clinical Benefit Values for Patient-Reported Outcome Scores After Primary ACL Reconstruction.

Background:Little is known about the threshold of patient-reported outcomes (PROs) at which patients perceive to have attained a substantial clinical benefit (SCB) after anterior cruciate ligament reconstruction (ACLR).Purpose:To determine the SCB value of PROs 1 year after ACLR in the general population and to determine factors that predict SCB attainment.Study Design:Case series; Level of evidence, 4.Methods:The Lysholm, International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF), Tegner, and Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scores were examined postoperatively in 88 patients who underwent ACLR. At the 12-month follow-up visit, the patients answered 2 independent anchor questions about daily discomfort and functional recovery. Receiver operating characteristic (ROC) curve analysis was used to differentiate PRO scores between patients who responded as having no difficulty versus some difficulty with daily knee discomfort (anchor question 1) and between patients with substantial recovery versus nonsubstantial recovery of knee function (anchor question 2). The area under the ROC curve (AUC) was calculated to assess reliability, and the differences between the AUC values were compared. Multivariate logistic regression analyses were performed to determine predictors affecting SCB attainment.Results:There were 76 patients enrolled in this study. The 12-month Lysholm, IKDC-SKF, Tegner, and ACL-RSI scores that corresponded to the SCB were 88.0, 85.1, 6.5, and 64.2 for anchor question 1 and 84.5, 77.7, 5.5, and 57.1 for anchor question 2, respectively. The AUC values obtained from the ROC curve analyses showed acceptable to excellent reliability (anchor question 1: Lysholm, 0.90; IKDC-SKF, 0.86; Tegner, 0.71; ACL-RSI, 0.92; anchor question 2: Lysholm, 0.80; IKDC-SKF, 0.90; Tegner, 0.82; ACL-RSI, 0.82) and were all statistically significant (P < .001 to P = .028). For all PROs, younger age (Odds Ratio (OR), 0.88-0.94; P < .001 to P = .027) and greater muscle strength (OR, 1.03-1.07; P < .001 to P = .023) were predictive factors of SCB attainment.Conclusion:The postoperative Lysholm, IKDC-SKF, Tegner, and ACL-RSI scores showed acceptable to excellent reliability in predicting the SCB after ACLR in the general population. Age at surgery and thigh muscle strength influenced SCB attainment for all PROs.

Outcomes of Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years and Younger Than 30 Years

Background:Few studies have compared the outcomes of anterior cruciate ligament (ACL) reconstruction between older patients and younger patients.Purpose:To evaluate the clinical and functional outcomes of ACL reconstruction with autologous hamstring tendon in patients >50 years and <30 years. It was hypothesized that the outcomes would be comparable between these age groups.Study Design:Cohort study; Level of evidence, 3.Methods:Patients >50 years (older group) or <30 years (younger group) who underwent ACL reconstruction surgery with autologous hamstring tendon between 2012 and 2015 at the authors’ hospital were retrospectively enrolled in this study. All patients had a minimum of 2 years of follow-up. Intraoperative findings, including cartilage and meniscal injury, were recorded, and clinical and functional outcomes were evaluated using the International Knee Documentation Committee (IKDC), Lysholm, and Tegner activity scores. We used the paired-samples t test for statistical analysis between the 2 age groups.Results:A total of 67 patients and 459 patients were included in the older and younger groups, respectively. Both groups achieved significant preoperative to postoperative improvement in IKDC (older group, from 41.4 to 88.9; younger group, from 49 to 91.2), Lysholm (older group, from 49.8 to 86.1; younger group, from 50.2 to 91.8), and Tegner (older group, from 2.7 to 4.4; younger group, from 4.6 to 6.9) (P < .05 for all) scores. The change in Tegner score from preinjury to postoperatively was not statistically significant in the older group (from 4.5 to 4.4; P = .471), although it was significant in the younger group (from 7.5 to 6.9; P < .05). No between-group differences were noted in preoperative or postoperative IKDC or Lysholm scores. Both age groups reached a high rate of return to sports activity, and no major complications or ACL retears were noted in either group.Conclusion:Comparable results after ACL reconstruction were achieved in patients >50 years compared with patients <30 years, with a high rate of return to sports activity and a low rate of complications at the 2-year follow-up. The younger group returned to a higher Tegner score, while the older group did not.

The Impact of Concomitant Meniscus Repair on Functional and Patient Reported Outcomes at Return to Activity in Paediatric Patients Undergoing ACL Reconstruction

Background:Paediatric patients undergoing Anterior Cruciate Ligament (ACL) reconstruction often present with a repairable meniscus tear. When a conservative early post-operative rehabilitation protocol is used to protect the meniscus repair, some have wondered whether this has an effect on functional and subjective outcomes, or time required, at return to activity.Purpose:The goal of this study was to compare the quantitative lower limb functional measures and subjective patient reported outcome scores at Return to Activity (RTA) in paediatric patients undergoing ACL reconstruction, with or without meniscus repair.Methods:This study was performed as a retrospective comparative cohort analysis of prospectively collected data in paediatric patients undergoing ACL reconstruction. Inclusion criteria for this study included a full data set and a visit to our biomechanics lab post-operatively, after being cleared for RTA by their attending surgeon. If a repairable meniscus injury was present, it was repaired concurrently with ACL reconstruction. Patients with a meniscus repair were provided rehabilitation guidelines that included partial weightbearing and limited range of motion (ROM) for six weeks, whereas full weightbearing and unrestricted ROM was recommended for the non-meniscal repair group. Postoperative quantitative knee functional outcome variables (drop vertical jump ground reaction forces, isometric knee extension/flexion strength, and hip abduction strength) were expressed as limb symmetry indices (LSIs; reconstructed limb/uninjured limb). Patient reported subjective knee outcome scores (Tegner and HSS Pedi-FABS) were also obtained. Differences in outcome measures were assessed using Mann-Whitney U-test and independent T-tests.Results:Twenty-four paediatric ACL reconstruction patients met criteria for inclusion in this study. Thirteen patients had a meniscus repair (median age 15 (13-17)) and 11 patients did not (median age 15.8 (14-17)). The median days between surgery and follow-up was 267 (168-460) days for the meniscus repair group and 251 (167-435) days for the non-meniscus repair group. There were no differences between the groups for the postoperative drop vertical jump test (p=0.21), knee extension/flexion strength (p=0.88/0.46) and hip abduction strength (p=0.46). Both groups also displayed similar Tegner (6.1/6.2) and Pedi-FABS (12.5/12.8) scores.Conclusion:Despite conservative weight-bearing and range of motion restrictions, repair of the meniscus in combination with ACL reconstruction in pediatric patients does not appear to induce a meaningful strength deficit at the return-to-activity evaluation phase, and is therefore not expected to influence return to activity in comparison with non-meniscus repair patients. This is important guidance for paediatric patients, families, and rehabilitation professionals involved in the care of young athletes.Table 1.Patient characteristicsTable 2.Post-operative patient reported outcome scores

A Return to Sport Test Battery does not Predict Second Injury After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes

Background:There is mixed evidence on the effectiveness of return to sport test (RTST) batteries and their ability to predict second Anterior Cruciate Ligament (ACL) injury. The majority of tests in the literature include objective measures of strength, hop test distance, knee range of motion and laxity, and measures of psychological readiness to return. Few RTST batteries include movement quality assessments.Purpose:To determine the effectiveness of a RTST test battery, including qualitative movement assessments, to predict second ACL injury in adolescent athletes after primary Anterior Cruciate Ligament Reconstruction (ACLR).Methods:A retrospective chart review of 77 adolescent athletes who underwent primary ACLR between 2014 and 2018 (55 males, age at surgery 16 + 2 years, BMI 25 ± 5) was conducted. All athletes completed a RTST battery consisting of psychological assessment with the Tampa Scale of Kinesiophobia (TSK-11), lateral step down test (LSDT), Tuck jump assessment (TJA), single leg hop testing (SLHT) including the single, triple, and triple crossover hop for distance, and an evaluation of cutting performance. The LSDT, SLHT’s and cutting task were evaluated using a qualitative movement assessment checklist, which awarded a point for each movement fault identified. Athletes passed the RTST if they scored <19 on the TSK-11, <2 on the LSDT, <3 on all SLHT’s with a Limb Symmetry index > 95%, < 5 on the TJA and, < 2 on the cutting assessment. All variables were analyzed descriptively. For continuous variables, median and interquartile ranges (IQR) were reported and Wilcoxon rank sum test was used to assess the differences. For categorical variables, frequency and proportion were reported and chi-square or Fisher’s exact test was used to assess differences between “no second ACL injury” and “second ACL injury” groups.Results:Overall, 14.2% of athletes (N=11) suffered a second ACL injury (81.8% males). Median Tegner score in both groups was 7 (IQR: 7-9). Median time to RTS clearance was significantly different between the no second ACL injury and second ACL injury groups (10 [IQR: 8-12] vs 8[IQR:8-9] months; p=0.017). A total of 66.2% of athletes (N= 51) passed the RTST. Of those who suffered a second ACL injury, 63.6% passed the RTS. There was no statistically significant difference between those who passed the RTST and those that did not on the occurrence of second ACL injury.Conclusion:A RTST battery including qualitative movement assessments does not predict second ACL injury in adolescent athletes after ACLR.

The immediate meniscal allograft transplantation achieved better chondroprotection and less meniscus degeneration than the conventional delayed transplantation in the long-term.

The purpose of this study was to compare the long-term clinical and radiological outcomes between the immediate and delayed meniscus allograft transplantation (MAT). Nine menisci were transplanted immediately after total meniscectomy (immediate group, IM), and 10 menisci were delayed transplanted in patients with the median of 35months (range 9-92months) after total meniscectomy (delayed group, DE). Patient's subjective clinical outcomes including VAS, IKDC, Lysholm and Tegner scores as well as muscle strength measures were compared. Joint degeneration was evaluated by both radiographs to assess joint space width narrowing, Kellegren-Lawrence (KL) grade and MRI with T2 mapping sequences to quantitatively analyze both cartilage and meniscal allograft degeneration. The median follow-up time was 10.8years (range 10-14years). The IKDC (IM vs DE, 89.8 vs 80.9, n.s.) and Lysholm scores (IM vs DE, 87.7 vs 78.0, n.s.) were close in two groups, while the IM group showed slightly lower VAS (IM vs DE, 0.2 vs 1.5, p = 0.031), higher Tegner score (IM vs DE, 7 vs 3.5 p = 0.021) and better quadriceps muscle strength. The IM group had less joint space narrowing (IM vs DE, 0.35mm vs 0.71mm, n.s.), less KL grade progression (IM vs DE, 0.6 vs 1.7, p = 0.041) on radiographs and less chondral lesions development on MRIs (Cartilage Degeneration Index, IM vs DE, 252 vs 2038, p = 0.025). All meniscal grafts exhibited degeneration by showing grade 3 signal on MRI, and 4 (4/9) in the IM group and 8 (8/10) cases in the DE group. The T2 value of cartilage and meniscal allograft in the IM group was close to that of the healthy control and was significantly lower than that of the DE group. Compared to the conventional delayed MAT, the immediate MAT achieved better cartilage and meniscus protection in the long-term, while its superiority in patient-reported outcomes was limited. IV.