Underwent Anterior Cruciate Ligament Reconstruction Research Articles

Comparison of anterior lateral ligament reconstruction and anterior lateral complex repair in the treatment of anterior cruciate ligament combined with anterior lateral ligament injury with high-grade pivot shift

To retrospectively analyze the clinical efficacy of anterior cruciate ligament (ACL) reconstruction combined with anterolateral complex repair and ACL reconstruction combined with ALL reconstruction in the treatment of anterior cruciate ligament injuries with high-grade pivot shift. From January 2018 to June 2022, 49 patients combined ACL and ALL injuries with high-grade pivot shift were retrospectively studied from three hospitals, 29 of them underwent ACL reconstruction with anterolateral complex repair (repair group), including 23 males and 6 females with an average age of (27.5±4.8) years old, ranged from 20 to 37 years old;the injured sides were 13 on the left and 16 on the right, and 11 patients were suffered with meniscus injury. The other 20 patients underwent ACL and ALL reconstruction (reconstruction group) including 17 males and 3 females with the mean age of (27.1±4.5) years old, ranged from 20 to 38 years old;the injured sides were 8 on the left and 12 on the right, and 6 patients were suffered with meniscus injury. Knee stability (pivot shift test, KT-2000), range of motion, knee function (Lysholm scoring scale, Cincinnati sports activity scale (CSAS) scoring scale, and Tegner activity level score between two groups were compared. A total of 49 patients were followed up, the repair group receiving 13 to 20(15.3±1.8) months and the reconstruction group receiving 12 to 21(16.0±2.2) months. There was no statistically significant difference in the preoperative pivot shift test grading distribution between two groups (P>0.05). At the last postoperative follow-up, there were 24 patients with grade 0 and 5 patients with grade 1 in the repair group, and there were 18 patients with grade 0 and 2 patients with grade 1 in the reconstruction group, there is no significant difference in the distribution of axial shift test grading between two groups(P>0.05). The preoperative KT-2000 tibial displacement of two groups were (9.39±0.77) mm (repair group) and (9.14±0.78) mm (reconstruction group) respectively, with no statistically significant difference (P>0.05). At the final postoperative follow-up, there were 24 patients with KT-2000 tibial displacement <3 mm and 5 patients with 3 to 5 mm in the repair group, while 18 patients with <3 mm and 2 patients with 3 to 5 mm in the reconstruction group, KT-2000 tibial displacement distribution of two groups was no significant difference (P>0.05), but the KT-2000 tibial displacement in the reconstruction group (1.30±0.86) mm was significantly smaller than that in the repair group (1.99±1.11) mm (P<0.05). The final postoperative follow-up range of motion of the contralateral side knee between two groups was no significant difference (P>0.05). The range of motion of the suffering knee in the repair group was less than that in the reconstruction group (P<0.05). There was no significant difference in preoperative Lysholm and CSAS scores between two groups (P>0.05). At the final postoperative follow-up, both groups showed significant improvement in Lysholm and CSAS scores, while the Lysholm and CSAS scores of the reconstruction group were better than those of the repair group, and the difference was statistically significant (P<0.05). Significant differences was found in Tegner scores between two groups, which 16 patients in the repair group returned to their pre-injury activity level, and 17 patients in the reconstruction group returned to their pre-injury level (P<0.05). Compared to anterolateral complex repair, combined ACL and ALL reconstruction in the treatment of ACL injuries with high-grade pivot shift results in better knee joint function and stability. This is advantageous in reducing the risk of ACL reconstruction failure.

Higher Posterior Tibial Slope and Lower Medial Proximal Tibial Angle of the Knee Are Associated with Delayed Graft Maturation after ACL Reconstruction Surgery with Hamstring Autograft

PurposeThis study aims to relate bone shape with anterior cruciate ligament (ACL) graft maturation, as evaluated by quantitative magnetic resonance imaging (MRI). MethodsWe retrospectively evaluated patients aged 18-60 years who underwent ACL reconstruction with a hamstring autograft with doubled semitendinosus and gracilis at our institution between 2018 and 2020 with isolated ACL injuries. All patients had a minimum follow-up period of 2 years. To evaluate alignment, radiographs of the knee were taken preoperatively. Postoperative 3T magnetic resonance imaging (MRI) and patient-reported outcomes (PRO) scores were acquired at 2 years after surgery. A combined T1ρ/T2 quantification sequence and a 3D multi-echo ultrashort echo-time (UTE) Cones sequence were obtained in a sagittal-oblique plane for better assessment of the ACL graft. After acquiring images, a manual segmentation for ACL graft was performed to assess T1ρ, T2 and UTE T2* relaxation times. Correlations between radiographic parameters or PRO scores and T1ρ, T2 and UTE T2* values were tested with Pearson correlation coefficients. Significance was defined as p<0.05. ResultsSubjects were 28 patients (12 males and 16 females) and had an average age of 34.3 years (SD=8.5 years) and a BMI of 24.4 kg/m2 (SD=4.5 kg/m2). A significant correlation was found between the preoperative PTS and the T1ρ, T2 and UTE T2* relaxation times (r=0.41; p=0.033, r =0.47; p=0.014 and r =0.41; p=0.030), indicating inferior graft maturation in patients with higher PTS. Furthermore, a negative correlation was identified between the preoperative MPTA and the T1ρ, T2 and UTE T2* relaxation times (r=-0.39; p=0.039, r =-0.46; p=0.018 and r =-0.43; p=0.024), indicating inferior graft maturation in patients with greater varus knee alignment. ConclusionThe study findings suggest that an increased PTS and lower MPTA are associated with inferior graft maturation as per T1ρ, T2 and UTE T2* imaging at 2 years post-ACL reconstruction. Level of EvidenceLevel IV retrospective case series

Diagnostic Accuracy of Magnetic Resonance Imaging in the 120° Flexed-Knee Position for Detecting and Classifying Meniscal Ramp Lesion

Background: Detection of meniscal ramp lesions concomitant with anterior cruciate ligament (ACL) injury using conventional magnetic resonance imaging (MRI) has low sensitivity, and these lesions are currently difficult to diagnose preoperatively. Purpose/Hypothesis: The purpose of this study was to assess the accuracy of MRI in detecting the presence of meniscal ramp lesions in the 120° flexed-knee position compared with that in the near–extended-knee position. It was hypothesized that the diagnostic performance of MRI in the 120° flexed-knee position would be better than that in the extended-knee position. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: This retrospective study of prospectively collected data between February 2019 and January 2024 included 154 consecutive patients undergoing ACL reconstruction. All patients underwent 3-T MRI examination in the near extended- and 120° flexed-knee positions preoperatively. The presence and Thaunat classification of ramp lesions were separately detected on each MRI scan and confirmed via arthroscopy during ACL reconstruction. Diagnostic sensitivity, specificity, and conditional relative odds ratios for detecting ramp lesions and the classification accuracy were compared between 2 MRI modalities. The accuracies of these MRI scans in acute and chronic cases were also evaluated. Results: This study included 154 patients (79 male and 75 female; mean age, 29.0 ± 14.2 years). A total of 62 ramp lesions (40.3%) were observed on arthroscopy. The sensitivity and specificity of MRI in near extension were 69.4% and 77.2%, respectively, and those in flexion were 91.9% and 94.6%, respectively, with significant superiority in MRI at knee flexion (P = .003 and P < .001, respectively). The conditional relative odds ratio between the MRI examinations at these 2 positions was 10.3 (95% CI, 4.82-21.8). The classification accuracy of MRI in flexion was significantly higher than that of MRI in near extension (accuracy, 49 vs 11; P < .001). The diagnostic accuracy of MRI in the 120° flexed-knee position was significantly higher than that in the near–extended-knee position in the acute cases (P < .05); however, no significant differences were observed in the chronic cases. Conclusion: The diagnostic accuracy of MRI in the 120° flexed-knee position for detecting and classifying meniscal ramp lesions was superior to that of MRI in the near–extended-knee position.

Youth Soccer Players Undergoing Anterior Cruciate Ligament Reconstruction Demonstrate High Rates of Continuation of Sport and Progression to Professional Level Soccer: A Seven Season Analysis in Twenty-Nine Brazilian Professional Soccer Teams

Objectives To evaluate the progression of youth male soccer athletes who undergo ACL reconstruction and track their progression from youth up to professional level play Methods 163 male players from 29 soccer teams underwent ACL reconstruction and were followed from 2015 to 2023. They were evaluated regarding category progression (under-13 to professional), type of graft used, presence of re- rupture, and return to sport/continuation of sport. Results Most injuries occurred in players in the under-17 (31.3%) and under-20 (47.2%) categories. A total of 111 patients continued playing after ligament reconstruction (68.1%), and 52 patients discontinued their careers (31.9%). Of the 163 athletes who underwent ACL reconstruction, 40 still play professionally (24.5%) and 71 are continuing participation in youth soccer and may still become professionals (43.6%). Among the professionals, 8 underwent an ACL revision reconstruction. The graft of choice in 77.3% of the reconstructions were the hamstring tendons. Conclusion Athletes from professional soccer teams who underwent ACL reconstruction while still playing in the youth teams of their clubs demonstrated a return to sport rate of 68.1%. Among players who returned to sport and became adult league professionals, 40 (83.3%) continued to play at the adult professional level, and 8 (16.7%) have discontinued their careers.

Early versus delayed start of weight-bearing after arthroscopic anterior cruciate ligament reconstruction with hamstring tendons.

The aim of this prospective randomized clinical study was to compare the clinical and second-look arthroscopic outcomes of early weight-bearing and delayed weight-bearing rehabilitation protocols following anterior cruciate ligament (ACL) reconstruction with hamstring tendons. This prospective study involved 90 patients who underwent ACL reconstruction with hamstring tendons. The patients were randomly assigned to either perform weight-bearing exercises at three weeks postoperatively (group A) or at one week postoperatively (group B). Evaluation of the patients was conducted at 3, 6, and 12 months postoperatively, focusing on knee range of motion, thigh circumference, and knee function assessed using the International Knee Documentation Committee (IKDC) form and Lysholm knee score. Graft evaluation was performed based on tension, tear, and synovial coverage via second-look arthroscopy at least one year after reconstruction. Group B exhibited significantly greater knee extension and flexion angles at 3 and 6 months compared to group A. IKDC and Lysholm scores were significantly higher in group B at 3 and 6 months. Additionally, the difference in thigh circumference between groups A and B was smaller at all evaluation periods, indicating less muscle atrophy in group B. Furthermore, there was no significant difference in synovial coverage, graft tear, or tension between the two groups based on second-look arthroscopy findings. This study demonstrates that an early weight-bearing protocol leads to faster recovery of knee joint function and muscle strength, facilitating a quicker return to sports activities. Additionally, there was no significant difference in graft morphology observed at second-look arthroscopy between the two groups at one year postoperative. Therefore, clinicians are encouraged to develop suitable early weight-bearing rehabilitation protocols for patients who have undergone ACL surgery.

Return to sport at pre-injury level following anterior cruciate ligament reconstruction is influenced by patients' perceived knee status and psychological readiness and does not correlate with functional ability.

ObjectivesThe purposes of this study were to (1) prospectively evaluate clinical and functional outcomes of athletes following anterior cruciate ligament (ACL) reconstruction up to 12 months after surgery, (2) to identify the correlations between functional and subjective tests, and (3) to determine which factors influence patients’ capability to resume sports at pre-injury level. MethodsPatients who underwent ACL reconstruction using doubled autologous hamstring graft were prospectively assessed pre-operatively, 6, and 12 months after surgery using International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level, and ACL–Return to Sport after Injury (ACL-RSI) scale. Jumping ability was instrumentally assessed using a test battery including bipodalic squat jump (SJ), bipodalic countermovement jump (CMJ), monopodalic CMJ, and monopodalic side-hop test. ResultsThirty-three patients were available for clinical evaluation at 12-months follow-up. Average age was 34.0 years (SD 11.5, range 19-50). Male/female ratio was 31:2. Mean overall IKDC, and ACL-RSI scores increased from 52.5 and 47.1 preoperatively, to 89.9 (SD: 12.2, range 36.8-100) and 81.3 (SD 21.7, range 10-98.3), respectively at last follow-up (p<0.001). Monopodalic jump tests showed improvements at 12-month evaluation compared to 6-month follow-up (p<0.01). No statistically significant correlation was reported for ACL-RSI and jump limb symmetry index (LSI) (p=0.08 vs. CMJ; p=0.07 vs. side-hop test). No differences were observed in terms of jump LSI between patients who returned to pre-injury activity level and those who did not (p=0.11 for CMJ, p=0.09 for side-hop test). A significantly higher IKDC score at 6 months was observed in patients who did not return to pre-injury levels (p=0.009). Patients who did not return to pre-injury activity reported lower ACL-RSI scores at 12-months follow-up (p=0.007). ConclusionsOne year after ACL reconstruction, an improvement in jumping ability was observed, while a persistence of lower limbs asymmetries when performing jump tests was noted at 6-months follow-up. The ability to perform vertical jumps was not influenced by psychological outcomes 12 months following surgery. Higher values of subjective knee score and psychological readiness weakly correlated to return to sport at preinjury level, while no correlation was reported concerning jumping performance.

Incidence of Meniscal Ramp Lesions in Anterior Cruciate Ligament Reconstructions players

Objectives To evaluate the incidence and epidemiological aspects of meniscal ramp injuries in patients undergoing anterior cruciate ligament (ACL) reconstruction, and determine the related risk factors. Methods 824 patients who underwent ACL reconstruction were retrospectively analyzed. Patients who presented medial meniscal instability underwent evaluation of the posteromedial compartment of the knee. In case of injury, surgical repair was performed. Potential risk factors associated with injuries were analyzed. Results The overall incidence of ramp injuries in the study was 10.6% (87 injuries in 824 patients). Multivariate analysis using the Chi-Square test demonstrated that the presence of meniscal ramp injuries was significantly associated with the following risk factors: right laterality and chronic injuries. Sex, age and sporting activity were not statistically significant. Football was the most frequent cause of sports-related ramp injuries, accounting for 78.2% of cases. However, it did not prove to be a risk factor. The annual incidence ranged from 4.0% to 20.6%. Conclusion The incidence of meniscal ramp lesions was 10.6% in ACL reconstruction, being more frequent in chronic injuries. The increasing annual incidence ranged from 4.0% in 2014 to 20.6% in 2019.

Transtibial Femoral Tunnel Technique in ACL Reconstruction and Osteoarthritis Incidence

Objectives Evaluate osteoarthritis incidence in patients that undergone ACL reconstruction using the transtibial technique, with a minimum of 5 years of follow up, with isolated ACL injury. Methods Patients from a private clinic who underwent to ACL reconstruction by transtibial technique, with hamstrings graft, and with at least 5 years of follow-up, without any associated injury to the operated knee at the day of the surgery, were selected. All patients were operated on by the same surgeon. The patients were invited to perform X-Ray images of the operated knee to assess the presence of osteoarthritis. The Kellgren &amp; Lawrence radiographic osteoarthritis classification was used. The grade I classification was already considered as the presence of osteoarthritis. The obtained results were analyzed by simple descriptive statistics, ie, obtaining the percentage of patients with osteoarthritis among those analyzed. Patients were also divided into 2 groups: between 5 and 10 of surgery, and with more than 10 years. The obtained data were evaluated by descriptive statistics. Results Forty-two patients (44 knees) were evaluated, with a mean age of 31 years old (SD: 8), being 23 right knees and 28 male patients. Mean time from surgery to imaging evaluation was 94.1 months (ranging from 60 to 154 months; SD: 28). Of the evaluated knees, 37 did not have osteoarthritis (83.3%) and 7 had (16.7%). Conclusion The ACL reconstruction performing the femoral tunnel through the transtibial technique in patients without another associated injuries to the operated knee, using quadruple hamstring graft, with a minimum of 5 years of follow up, showed an osteoarthritis incidence of 16.7% with a mean follow-up of 94.1 months.

Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury

PurposeTo investigate the influence of the timing of ACL reconstruction (ACLR) on patient-reported outcomes, comparing those with and without concomitant medial collateral ligament (MCL) injury. MethodsThis study included patients who underwent ACLR between September 2015 and October 2020. Inclusion criteria required patients to have preoperative and postoperative patient-reported outcome measures (PROMs) and a follow-up period of at least 2 years. Patients who sustained a grade 2 or 3 MCL injury with an ACL tear were compared to patients with no MCL injury as a control. All patients underwent ACL reconstruction using either bone-tendon-bone (BTB) autograft or BTB Allograft. Patient-reported outcomes (International Knee Documentation Committee (IKDC), Lysholm, and Knee Osteoarthritis and Score (KOOS)) were recorded, and outcomes were analyzed by sex and time from index injury. A stratified linear mixed-effects regression analysis was conducted. ResultsA total of 253 eligible patients with 2-year outcomes were enrolled. Combined ACL/MCL injury had lower IKDC (β=-6.1 vs β=-8.3, p=0.003), KOOS QOL (β=-9.3 vs β=-11, p=0.004), and KOOS Sport (β=-12 vs β=-13 , p=0.08) if performed after 6 weeks from index injury. Isolated ACL injuries showed lower KOOS ADL (β=-2.4, p=0.045) if surgery performed between 3-6 months. For combined ACL/MCL injury, autograft (compared to allograft) was found to have worse IKDC (β=-11 (-18, -4.2), p=0.002), Lysholm (β=-9.2 (-15, -3.1), p=0.004), KOOS QOL(β=-11 (-20, -1.6), p=0.023), KOOS Pain (β=-5.1 (-10, -0.03), p=0.049), KOOS Symptoms (β=-7.6 (-10, -0.03), p=0.02), and KOOS Sports (β=-21 (-32, -10), p=<0.001). ConclusionPatients undergoing ACL reconstruction with a grade 2 or 3 MCL injury have improved patient-reported outcomes if surgery is performed within 6 weeks from the time of injury. In this cohort, allografts resulted in better outcome scores compared with autografts. Level of EvidenceLevel III Retrospective Cohort Study

A New Algorithm for Extra-Articular Reinforcement in ACL Injury Based on Rotational Instability

Background: The results of surgical reconstructions of the anterior cruciate ligament (ACL) are improving with the association of extra-articular reinforcements, such as anterolateral ligament reconstruction and Lemaire tenodesis. However, ACL injury can occur through various mechanisms, and when there are valgus and external rotation of the tibia, anteromedial rotational instability (AMRI) may develop. Articular reinforcement in the anteromedial quadrant, in the topography of the anterior oblique ligament (AOL), can be an important tool for patients with ACL injury and external rotation instability. Indications: The physical examination under anesthesia in patients undergoing ACL reconstruction who are candidates for extra-articular reinforcements provides important information about rotational instability. Patients with instability in external rotation may benefit from anteromedial reinforcement in the AOL’s topography. Technique Description: We propose an algorithm to be followed in patients with ACL injury and indication for extra-articular reinforcement. Patients with a positive pivot shift, indicating internal rotation instability of the knee, should undergo anterolateral reinforcements, as well as those patients with joint hyperlaxity. The algorithm suggests performing the anterior drawer in external rotation (ADER) test. When positive in isolation, anteromedial reinforcement is indicated. When the physical examination shows both positive ADER and pivot shift, both medial and lateral extra-articular reinforcement could be performed. Results: This new type of extra-articular reinforcement, in the AOL’s topography, appears to be an important tool for improving surgical outcomes in ACL reconstructions. AMRI is a risk factor for central pivot reconstruction failure and should be investigated and treated, as proposed by the algorithm. Conclusions: Clinical examination of the ACL-injured knee, preferably under anesthesia, should include internal rotational and external rotational examination (pivot-shift and ADER tests). AMRI, when detected, should be treated, and the AOL reconstruction seems to be a good alternative. We propose a new algorithm based on rotational instability to make our extra-articular reinforcement in ACL patients. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

MCL augmentation using a peroneus longus split tendon autograft satisfactorily restores knee stability with no impairment in foot function and with a low failure rate for concurrent ACL reconstruction.

Addressing grade 2 and 3 medial-sided instabilities during anterior cruciate ligament (ACL) reconstruction is crucial to reduce the risk of ACL graft failure. This study introduced a minimally invasive, medial collateral ligament (MCL) augmentation technique using a peroneus longus split tendon autograft, which was fixed to the femoral deep MCL insertion and tibial superficial MCL insertion. This prospective, longitudinal, single-centre case series included patients who underwent MCL augmentation concurrent with primary or revision ACL reconstruction due to anteromedial instability. Preoperatively and at 1-year follow-up, clinical examinations, such as rolimeter test of anterior tibial translation and medial instability, knee (International Knee Documentation Committee subjective knee form [IKDC], Lsyholm, Knee Injury and Osteoarthritis Outcome Score [KOOS]) and foot function scores (American Orthopaedic Foot and Ankle Society score [AOFAS]) and complications, were analyzed. Thirty-one patients with a mean follow-up of 13.5 ± 2.6 months and a mean age of 27.8 ± 9.6 years were included. The side-to-side difference for anterior tibial translation significantly improved from preoperative to 1-year follow-up with an ACL reconstruction failure rate of 6.5%. No patient retained a grade 2 or 3 medial instability on valgus stress testing with 30° flexion. Significant improvements from preoperative to 1-year postoperative follow-up were observed in knee function scores: IKDC (48.9 ± 26.9- 71.3 ± 11.5, p < 0.001) and Lysholm (59.9 ± 28.5-80.5 ± 11.2, p = 0.002) as well as KOOS pain, ADL, sport and QoL, each reaching the respective minimal clinically important difference values. The foot function score AOFAS showed no significant impairment (100 ± 0-99.3 ± 2.5, p = 0.250). Complications included cyclops lesions of ACL reconstruction in three patients. At 1-year follow-up, MCL augmentation using a peroneus longus split tendon autograft for patients simultaneously undergoing ACL reconstruction satisfactorily restores knee stability, has a low ACL reconstruction failure rate and does not significantly impair foot function. Level IV therapeutic study; case series.

Functional Assessment of Anterior Cruciate Ligament Reconstruction Using Peroneus Longus vs. Hamstring Tendon at 6, 12, And 24 Months Follow Up: A Meta-Analysis

Background: Anterior cruciate ligament (ACL) tear occurs between 29 to 38 cases per 100.000 people annually with more than half of cases requiring an ACL reconstruction. Peroneus longus tendon (PLT) has growing popularity as an autograft for ACL reconstruction providing comparable outcomes with proper graft diameter size, lack of donor site morbidity and uncomplicated harvesting technique. Unfortunately, certain studies did not agree with the superiority of PLT to the standard hamstring tendon (HT). Objective: The aim of study is to compare the knee functional outcome of an ACL reconstruction using peroneus longus and hamstring tendon according to recent publications. Methods: This study conducted a thorough systematic search for relevant scientific reports on multiple medical databases, including PubMed, Embase, and Google Scholar, using a combination of keywords such as "peroneus longus," “hamstring tendon,” "ACL reconstruction," “IKDC,” and “Lysholm”. The search was performed in April 2013-2023, resulting in 1567 studies. Two reviewers (RR, WA) independently screened the abstracts and reference lists, with any discrepancies resolved through consensus, concluding 5 included studies. Results: Five studies are included with a total of 538 patients consisting of 267 patients who underwent ACL reconstruction with PLT and 271 patients who underwent ACL reconstruction with HT. Up to 24 months follow-up, there are equally balanced satisfactory functional outcomes between ACL reconstruction using peroneus longus and hamstring tendon, in terms of IKDC (I2 = 74%; SMD = 0.08 95%CI, -0.21 to 0.38; p = 0.57) and Lysholm score (I2 = 75%; SMD = 0.06 95%CI, -0.27 to 0.39; p = 0.73). Conclusion: ACL reconstruction using the peroneus longus tendon is a safe and effective procedure with excellent short to long term functional outcome of the knee. Keywords: Anterior Cruciate Ligament Reconstruction, Functional Outcome, Hamstring tendon, Human, Peroneus Longus Tendon Keywords: Anterior Cruciate Ligament Reconstruction, Functional Outcome, Hamstring tendon, Human, Peroneus Longus Tendon.

Anthropometric predictors of hamstring graft size in anterior cruciate ligament reconstruction

Background: The anterior cruciate ligament (ACL) is commonly injured in the knee joint, necessitating surgical reconstruction where quadrupled hamstring tendon autografts are frequently utilized for their favourable outcomes. Predicting the appropriate dimensions of these grafts is essential for surgical success. This study aims to investigate whether simple anthropometric measurements-height, weight, body mass index (BMI), thigh length, and circumference-can predict the length and diameter of quadrupled hamstring tendons used in ACL reconstruction. Methods: This cross-sectional study included 45 patients undergoing ACL reconstruction with quadrupled hamstring autografts at department of orthopaedics, Renai Medicity Kerala, India. Preoperative anthropometric measurements were correlated with intraop graft dimensions using Pearson correlation and SPSS statistical software (version 22). Results: Taller patients exhibited a positive correlation with graft diameter (p=0.028). Height and thigh length correlated positively with both gracilis and semitendinosus tendon lengths (p&lt;0.001). Thigh circumference correlated positively with semitendinosus length (p=0.005), while weight, BMI, and other measures did not significantly correlate with graft dimensions. Conclusions: Anthropometric measurements, particularly height and thigh length, serve as valuable predictors for hamstring graft dimensions in ACL reconstruction. These findings may assist surgeons in selecting appropriate grafts and optimizing surgical outcomes.

Graft Maturity Assessment by Magnetic Resonance Imaging and its Relation with Functional Scores after Anterior Cruciate Ligament Reconstruction with Hamstring Graft

Abstract Background/Objectives: Anterior cruciate ligament (ACL) reconstruction is a common procedure performed in orthopedic surgery. There are many methods to evaluate the functional outcome postoperatively, but no single reliable method exists to assess graft maturity. The purpose of this research is to evaluate graft maturity by magnetic resonance imaging (MRI) and its relation with functional outcome at the end of 6 months and 12 months. Materials and Methods: MRIs were performed on 32 patients who underwent ACL reconstruction at 6 and 12 months following surgery. The measurements were made of the background, posterior cruciate ligament, and signal intensity of the graft. The calculation of the signal noise quotient (SNQ) was done. The correlations between the international knee documentation committee (IKDC) at 6 and 12 months and the SNQ values at 6 and 12 months were assessed. Results: After 6 months, the mean SNQ value was 3.8953 ± 2.6561, and after 12 months, it was 2.6013 ± 1.7337. In addition, the mean IKDC was 43.3 preoperatively, 52.8125 ± 9.24728 at 6 months’ follow-up and 70.6875 ± 8.32578 at 12 months’ follow-up. The 12-month SNQ values showed a significant decrease, according to RMANOVA (F[1,62] = 6.50871, P = 0.01316). Conversely, the IKDC scores at 12 months demonstrated a statistically significant rise (F[1,62] = 66.03667, P &lt; 0.001). Conclusion: MRI is a reliable investigation to assess the graft maturity. In our study, hamstring graft demonstrated superior maturity at 12 months as compared to 6 months’ postsurgery. There was a noteworthy inverse relationship between graft SNQ and IKDC scoring. MRI assessment at 6 months and 12 months is desirable to know graft’s maturity and helps to modify the rehabilitation protocol.

Comparison of a full tibial tunnel or an all-inside technique for anterior cruciate ligament reconstruction: An observational study.

This study aims to compare the effectiveness of anterior cruciate ligament (ACL) reconstruction performed with either a full tibial tunnel technique or an all-inside technique. Data from patients with ACL rupture who underwent ACL reconstruction using autogenous hamstring tendon grafts between January 2019 and July 2021 were retrospectively reviewed. Patients were followed up for a minimum of 24 months. Preoperative and postoperative International Knee Documentation Committee scores, Lysholm knee scores, visual analog scale pain scores, Tegner activity scale scores, C-reactive protein levels, erythrocyte sedimentation rate, white blood cell (WBC) count, D-dimer levels, and neutrophils were recorded. At the final follow-up, side-to-side differences were assessed with the pivot shift test, Lachman test, anterior drawer test, and a knee laxity-testing device. This study included 135 patients with ACL rupture, with 62 patients (43 males and 19 females, mean age: 34.42 ± 12.79 years) undergoing the full tibial tunnel technique, and 73 patients (58 males and 15 females, mean age: 32.41 ± 11.01 years) undergoing the all-inside techniques (AITs). There were no significant differences in postoperative International Knee Documentation Committee scores, Lysholm knee scores, or Tegner activity scale scores, except at postoperative 6 months. visual analog scale pain scores showed significant improvement in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 week, 2 weeks, and 1 month; however, there were no significant differences at postoperative 3, 6, 12, 18, and 24 months. C-reactive protein levels, erythrocyte sedimentation rate, WBC count, D-dimer levels, and neutrophils were significantly lower in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 month, but there were no other significant differences in these outcome measures, except for WBC count at postoperative 3 months. There was no significant difference in knee stability at the last follow-up. In ACL reconstruction, functional outcomes following the AIT are satisfactory and similar to the total tibial tunnel technique, but patients experience less pain and a reduced early postoperative inflammatory response. These results highlight the promising potential of AITs in the clinical management of ACL rupture and advocate for their widespread adoption.

Impact of anterior cruciate ligament injury on functional capacity and pain: an analysis differentiated by age and gender

Anterior cruciate ligament (ACL) injuries significantly impact knee function, particularly in active populations. This study explores functional capacity and pain post-ACL reconstruction in relation to age, gender, and physical activity. A total of 41 participants who underwent ACL reconstruction were analyzed. Data were collected on age, sex, physical activity level, and pain frequency/intensity. The sample included 56.10% women (n=23) with an average age of 30.27 ± 10.18 years. Among the participants, 19.51% engaged in light activity, 26.83% in moderate, 7.32% in vigorous, 24.39% in very vigorous, and 21.95% were unable to perform any activity. Significant age differences were observed in moderate activity (p = 0.017), with older women more likely to engage in moderate activity. Logistic regression revealed age as a key factor affecting activity level (p &lt; 0.05), and sex had marginal significance (p ≈ 0.054), suggesting men may perform more intense activities. Pain frequency and intensity showed weak correlations with age (p &gt; 0.05), but women reported higher pain levels than men. The average functional ability dropped from 8.73 before the injury to 5.80 post-surgery. Men reported more pain than women, although t-tests showed no statistically significant differences between genders in functional capacity before or after surgery. ACL reconstruction reduces knee function across genders, with men reporting higher pain intensity. Age significantly impacts activity level, emphasizing the need for targeted rehabilitation strategies. Post-surgical recovery programs should consider individual differences in age and sex to optimize outcomes and enhance recovery.

Evaluation of retear rates following transtibial anterior cruciate ligament reconstruction: Functional outcomes and GNRB assessment with a mean 6.3-year follow-up

The method of reconstruction of the anterior cruciate ligament (ACL) using the tibia-dependent femoral tunnel technique is highly criticized. It would not allow anatomical placement of the graft and would therefore lead to a high rate of retear. This retrospective study aimed to evaluate the rate of retear in ACL reconstructions using the transtibial tunnel (TT) technique and assess functional outcomes. The study included 148 patients (153 knees) who underwent ACL reconstruction with a minimum two-year follow-up period. Patients underwent clinical examinations, completed functional questionnaires (KOOS, Lysholm, ACL-RSI), and underwent laximetry measurements with GNRB at 134 N and 200 N. Two patients had retears detected on MRI and underwent revision surgery prior to the study, leaving 151 knees for evaluation. The retear rate was 6.6 %, with an overall rate of 7.8 % when including revision cases. Laxity measurements obtained with GNRB showed a strong correlation with functional scores, indicating worse scores with greater laxity differences (p < 0.0001). The retear rate observed in this study was at the higher end of those reported in the literature. The study indications for TT ACL reconstructions must be defined more specifically to reduce failure rates.Level of evidence: III (retrospective cohort study).

The Association between the Duration of Anterior Cruciate Ligament Rupture-reconstruction with Meniscal Lesions and Knee Functional Outcomes

Background: Given the controversial correlation between the duration of anterior cruciate ligament (ACL) rupture-reconstruction and knee functional outcomes reported in previous studies, this study aimed to investigate the correlation between the duration of ACL rupture-reconstruction with knee meniscal lesions and functional outcomes. Patients and Methods: This retrospective cohort study was conducted on 221 patients with ACL rupture who underwent ACL reconstruction at a referral hospital in Tehran, Iran, from April 2021 to May 2023. Demographic characteristics and data about the duration of ACL rupture reconstruction were collected using the patients’ clinical documents. The status of knee meniscal lesions had been evaluated using magnetic resonance imaging report or operation note. After that, knee functional outcomes had been assed using Osteoarthritis Outcome Score scale. The correlation between the duration of ACL rupture-reconstruction with knee meniscal lesions and functional outcomes was evaluated using the multivariate regression test. Results: Most patients were male, with a mean age of 28.38 ± 7.33 years. The correlation between the duration of ACL rupture-reconstruction and knee meniscal lesions was statistically significant (P = 0.026); however, the correlation between the duration of ACL rupture-reconstruction with the KOOS questionnaire scale score and all its dimensions as a scale for assessing knee outcomes was not significant (P &gt; 0.05). Conclusion: Although early ACL reconstruction is accompanied by reduced knee meniscal lesions, this cannot improve knee functional outcomes.

Longer time between anterior cruciate ligament injury and reconstruction is associated with a greater risk of medial meniscus injury.

To evaluate the impact of delaying reconstruction following anterior cruciate ligament (ACL) injury on the risk of meniscal injury and subsequent meniscectomy, the study was carried out. This constitutes the first study of its kind to be conducted in China. This study collected data on patients who had undergone ACL reconstruction surgery at Peking University First Hospital between 2010 and 2022. Patient's injury details, including the time and cause of ACL injury, surgery date and meniscal injury details, were recorded. Patients were stratified into distinct cohorts based on the duration between injury and reconstruction. Logistic regression analysis was used to evaluate the impact of a delayed reconstruction time on the risk of meniscal injury and meniscectomy. The study involved patients with an average age of 34.1 ± 11.3 years. Nearly half of the patients (49.74%) had meniscal injuries. Univariate logistic regression analysis showed that gender and the time from ACL trauma to surgery were significantly associated with meniscus injury (p < 0.01). Men have a higher risk of meniscus damage than women (p < 0.01, odds ratio: 1.94, 95% confidence interval: 1.23-3.05). Patients who had surgery 12 months after injury had a significantly increased risk of meniscus injury compared to those who had surgery within 3 months after injury (p < 0.01). The time from ACL injury to operation was significantly correlated with medial meniscus injury (p < 0.001). There was no significant correlation between time to ACL reconstruction and lateral meniscus injury (p > 0.05). Age was significantly associated with the risk of medial meniscectomy (p > 0.05). Time from injury to surgery was not significantly associated with the risk of lateral meniscectomy (p > 0.05). Delayed reconstruction beyond 12 months after ACL rupture increases the risk of medial meniscus injury. The risk of meniscus injury after ACL injury is higher in men than in women, and the risk of medial meniscectomy increases with age. Level III.

The Role of Biomarkers in Predicting Outcomes of Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Anterior cruciate ligament (ACL) injury is frequently associated with injuries to other parts of the knee, including the menisci and articular cartilage. After ACL injury and reconstruction, there may be progressive chondral degradation. Biomarkers in blood, urine, and synovial fluid can be measured after ACL injury and reconstruction and have been proposed as a means of measuring the associated cellular changes occurring in the knee. To systematically review the literature regarding biomarkers in urine, serum, or synovial fluid that have been associated with an outcome measure after ACL reconstruction. Systematic review; Level of evidence, 3. This review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The MEDLINE, Embase, CINAHL, and Web of Science databases were searched to identify studies published before September 2023 that reported on patients undergoing ACL reconstruction where a biomarker was measured and related to an outcome variable. Of 9360 results, 16 studies comprising 492 patients were included. Findings were reported as descriptive summaries synthesizing the available literature. A total of 45 unique biomarkers or biomarker ratios were investigated (12 serum, 3 urine, and 38 synovial fluid; 8 biomarkers were measured from >1 source). Nineteen different outcome measures were identified, including the International Knee Documentation Committee Subjective Knee Form, Knee injury and Osteoarthritis Outcome Score, numeric pain scores, radiological outcomes (magnetic resonance imaging and radiography), rates of arthrofibrosis and cyclops lesions, and gait biomechanics. Across the included studies, 17 biomarkers were found to have a statistically significant association (P < .05) with an outcome variable. Serum interleukin 6 (s-IL-6), serum and synovial fluid matrix metalloproteinase-3 (s-MMP-3 and sf-MMP-3), urinary and synovial fluid C-terminal telopeptide of type 2 collagen (u-CTX-II and sf-CTX-II), and serum collagen type 2 cleavage product (s-C2C) showed promise in predicting outcomes after ACL reconstruction, specifically regarding patient-reported outcome measures (s-IL-6 and u-CTX-II), gait biomechanical parameters (s-IL-6, sf-MMP-3, s-MMP-3, and s-C2C), pain (s-IL-6 and u-CTX-II), and radiological osteoarthritis (ratio of u-CTX-II to serum procollagen 2 C-propeptide). The results highlight several biomarkers that have been associated with clinically important postoperative outcome measures and may warrant further research to understand if they can provide meaningful information in the clinical environment.