Underwent Anterior Cruciate Ligament Reconstruction Research Articles

Enhanced reliability and time efficiency of deep learning-based posterior tibial slope measurement over manual techniques.

Multifaceted factors contribute to inferior outcomes following anterior cruciate ligament (ACL) reconstruction surgery. A particular focus is placed on the posterior tibial slope (PTS). This study introduces the integration of machine learning and artificial intelligence (AI) for efficient measurements of tibial slopes on magnetic resonance imaging images as a promising solution. This advancement aims to enhance risk stratification, diagnostic insights, intervention prognosisand surgical planning for ACL injuries. Images and demographic information from 120 patients who underwent ACL reconstruction surgery were used for this study. An AI-driven model was developed to measure the posterior lateral tibial slope using the YOLOv8 algorithm. The accuracy of the lateral tibial slope, medial tibial slopeand tibial longitudinal axis measurements was assessed, and the results reached high levels of reliability. This study employed machine learning and AI techniques to provide objective, consistentand efficient measurements of tibial slopes on MR images. Three distinct models were developed to derive AI-based measurements. The study results revealed a substantial correlation between the measurements obtained from the AI models and those obtained by the orthopaedic surgeon across three parameters: lateral tibial slope, medial tibial slopeand tibial longitudinal axis. Specifically, the Pearson correlation coefficients were 0.673, 0.850and 0.839, respectively. The Spearman rank correlation coefficients were 0.736, 0.861and 0.738, respectively. Additionally, the interclass correlation coefficients were 0.63, 0.84and 0.84, respectively. This study establishes that the deep learning-based method for measuring posterior tibial slopes strongly correlates with the evaluations of expert orthopaedic surgeons. The time efficiency and consistency of this technique suggest its utility in clinical practice, promising to enhance workflow, risk assessmentand the customization of patient treatment plans. Level III, cross-sectional diagnostic study.

Modified Implant Fixation Technique Is an Alternative for Patients with an Anterior Cruciate Ligament Tear in Limited Resource Settings: A Comparison Functional Outcome Study with Polyether Ether Ketone and Bioabsorbable Screws.

Background: Anterior cruciate ligament (ACL) injury is one of the most prevalent factors contributing to knee instability worldwide. This study aimed to evaluate modified metal fixation techniques for ACL reconstruction compared to factory-made implants, such as polyether ether ketone (PEEK) screws, bioabsorbable screws, and modified metal implants. Methods: A retrospective cohort analysis was conducted to assess the functional outcomes of ACL using various fixation methods. Patients who underwent arthroscopic ACL reconstruction at several healthcare facilities were included in the study. The functional outcomes were evaluated using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score questionnaire at 6- and 12 months post-surgery. Statistical analyses, including the Shapiro-Wilk test and analysis of variance, were performed to compare outcomes among the fixation groups. Results: Thirty-three patients who underwent ACL reconstruction surgery with varying distributions across the three fixation groups (modified metal implants, PEEK screws, and bioabsorbable screws) were included in the study. As measured by the Lysholm and IKDC scores at 6- and 12 months post-surgery, the PEEK group demonstrated the highest average scores. Nevertheless, these functional outcomes were not significantly different between the groups (p = 0.140, 0.770, 0.150, and 0.200). These findings align with those of meta-analyses comparing different fixation methods for ACL reconstruction. Conclusions: While acknowledging the small sample size as a limitation, this study suggests that modified metal implants represent viable options for ACL reconstruction. The selection of fixation methods should consider patient characteristics and preferences, emphasizing biomechanical stability and long-term outcomes. Further research is needed to validate these findings and explore their biomechanical properties and cost-effectiveness.

Periosteal wrapping of the hamstring tendon autograft improves graft healing and prevents tunnel widening after anterior cruciate ligament anatomic reconstruction.

The periosteum is a readily available tissue at the hamstring harvest site that could be utilized to enhance graft healing and prevent tunnel widening without additional cost or morbidity. This study aimed to compare graft healing using magnetic resonance imaging (MRI) and functional clinical outcome scores in a matched cohort of patients who underwent anterior cruciate ligament (ACL) reconstruction with hamstring autografts with or without periosteal augmentation. Forty-eight patients who underwent ACL reconstruction (ACLR) were prospectively enrolled: 25 with standard ACLR (ST-ACLR) and 23 with periosteal augmented grafts (PA-ACLR). The same surgical techniques, fixation methods, and postoperative protocol were used in both groups. Signal-to-noise quotient (SNQ), graft healing at the bone-graft interface, graft signal according to the Howell scale, and femoral tunnel widening were evaluated using MRI after 1 year of follow-up. International knee documentation score (IKDC), Lysholm, Tegner activity scale, and visual analog scale for pain were used for functional evaluation at a minimum of 2years postoperative. The mean SNQ of the proximal part of the graft was 9.6 ± 9.2 and 2.9 ± 3.3 for the ST-ACLR and PA-ACLR groups, respectively (P = 0.005). The mean femoral tunnel widening was 30.3% ± 18.3 and 2.3% ± 9.9 for the ST-ACLR, PA-ACLR groups, respectively (P < 0.001). Complete graft tunnel healing was observed in 65% and 28% of cases in the PA-ACLR and ST-ACLR groups, respectively. Both groups showed marked improvements in functional scores, with no statistically significant differences. Periosteal wrapping of hamstring tendon autografts is associated with better graft healing and maturation and lower incidence of femoral tunnel widening based on MRI analysis 1year after ACL reconstruction. However, patient-reported outcomes and measured laxity were similar between the two groups at 2years follow up. Trail registration number: PACTR202308594339018, date of registration: 1/5/2023, retrospectively registered at the Pan African Clinical Trial Registry (pactr.samrc.ac.za) database.

SAFETY AND EFFICACY OF INTRAOSSEOUS ROPIVACAINE IN LOWER EXTREMITY (SORE) STUDY

IntroductionDay stay surgery for anterior cruciate ligament (ACL) reconstructions is an increasingly common practice and has driven clinicians to come up with postoperative pain regimes that allow same day mobilisation and a safe and timely discharge. There is a paucity of literature surrounding the use of intraosseous (IO) ropivacaine used as a Bier's block to provide both intraoperative and postoperative analgesia in lower limb surgery.MethodsThis patient blinded, pilot study randomised 15 patients undergoing ACL reconstruction to receive either IO ropivacaine 1.5 or 2.0 mg/kg; or 300 mg of ropivacaine as local infiltration (standard of care). Toxic plasma levels of ropivacaine have been defined in the literature and therefore the primary outcome for this study was arterial plasma concentration of ropivacaine as a means to determine its safety profile. Samples were taken via an arterial line at prespecified times after tourniquet deflation. Secondary outcomes that we were interested in included immediate postoperative pain scores using the visual analogue scale (VAS) and perioperative opioid equivalent consumption.ResultsParticipants had a mean age of 27.8 (SD 9.2) years and 87% (13/15) were male. All patients in the intervention group receiving IO ropivacaine had plasma concentrations well below the threshold for central nervous system (CNS) toxicity (0.60 µg/ml). The highest plasma concentration was achieved in the intervention group receiving 1.5 mg/kg dose of ropivacaine reaching 3.59 mg/ml. This would equate to 0.22 µg/ml of free plasma ropivacaine. There were no differences across the three groups regarding pain scores or perioperative opioid consumption.ConclusionsThis study demonstrates that IO administration of 0.2% ropivacaine is both safe and effective in reducing perioperative pain in patients undergoing ACL reconstruction. There may be scope to increase the IO dose further or utilise other analgesics via the IO regional route to improve perioperative pain relief.

Bridge-Enhanced Anterior Cruciate Ligament Restoration: Surgical Technique

Background: Anterior cruciate ligament (ACL) repair has historically had poor outcomes and fell out of favor in the 1980s with the majority of surgeons opting to do an ACL reconstruction instead due to the high failure rate. The Bridge-Enhanced ACL Restoration or BEAR technique utilizes a de-cellularized, bovine-derived, type I collagen implant to aid in the ACL repair. The device is implanted to augment the healing of the ACL. Indications: The BEAR technique is indicated to augment ACL repair in cases of complete rupture where there is a residual tibial stump of sufficient length and good tissue quality. Results: In our experience to date, patients undergoing an ACL repair with BEAR recover range of motion quickly and have less quadriceps atrophy and less postoperative swelling than those undergoing ACL reconstruction requiring autograft harvest. We will continue to follow up our patient cohort to assess for re-rupture rate as they return to sport. Conclusion: The BEAR technique is a promising development that enables ACL repair as an alternative option to reconstruction. This article describes our approach including tips and tricks to successfully perform this procedure. 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.

‘It’s just my knee’: a qualitative study investigating the process of reframing and young athletes’ perceived quality of life between anterior cruciate ligament injury and surgery

ObjectivesTo understand the factors influencing young athletes’ perceptions of quality of life (QOL) following an anterior cruciate ligament (ACL) rupture, prior to reconstructive surgery.DesignQualitative descriptive study using semi-structured interviews and...

Anterior Cruciate Ligament Rupture Combined with Complete Radial Tear of the Posterior Horn of the Lateral Meniscus: Suture or Resection?

Anterior cruciate ligament (ACL) rupture often presents with a tear of the posterior horn of the lateral meniscus. There is no clear preference between ACL reconstruction with suture and resection of the meniscus. We aimed to compare the clinical efficacy of ACL reconstruction with suture versus resection in patients presenting with arthroscopic ACL rupture and radial complete tear of the posterior corner of the lateral meniscus. We retrospectively analyzed 157 patients with ACL rupture and complete radial tear of the posterior horn of the lateral meniscus. Between May 2010 and April 2015, 86 of 157 patients underwent ACL reconstruction and meniscus suture (study group, 54.78%) and 71 of 157 patients underwent ACL reconstruction and meniscus resection (control group, 45.22%) in our department. All patients were monitored over the 12 to 72-month follow-up period. The primary evaluation indices were the Lysholm scores, the International Knee Documentation Committee (IKDC) scores, pivot shift test, the Barret criteria, and magnetic resonance imaging (MRI) findings of meniscal healing. The majority of 157 patients were relatively young men (29.64 ± 7.79 years) with low body mass index (BMI) (23.79 ± 2.74). The postoperative Lysholm and IKDC scores of the two groups were significantly improved over the corresponding preoperative scores (p < 0.05). The clinical results and excellent and good rates were significantly better for the study group than for the control group (both, p < 0.05). MRI showed that the meniscal healed rate of the study group was 96.51%. There was no significant difference in BMI between subgroups for any functional outcome. For patients with ACL rupture and complete radial tear of the posterior horn of the lateral meniscus, ACL reconstruction and both simultaneous suture and resection of the posterior horn of the lateral meniscus were found to be safe and effective. There was no association between outcomes and BMI. However, the former was associated with a superior long-term clinical effect and may restore the integrity of the meniscus and is particularly recommended for young patients.

ANALYSIS OF CAUSES AND POSTOPERATIVE RECOVERY OF ANTERIOR CRUCIATE LIGAMENT INJURY CAUSED BY AEROBICS IN KNEE JOINTS

Background: During the process of aerobic exercise, there are a lot of jumping and split movements, which can easily cause anterior cruciate ligament (ACL) injury in the knee joint. After undergoing ACL reconstruction (ACLR) surgery, postoperative recovery is crucial. Currently, many methods have been applied, but research on water exercise is still limited. Purpose: This paper aims to understand the role of water exercise in the recovery of athletic ability after ACLR and provide guidance for athletes’ postoperative rehabilitation. Methods: Forty athletes with ACL injuries caused by aerobics practice or competition and undergoing surgery were randomly assigned to either group A or group B. The former received six weeks of a conventional postoperative recovery program, and the latter received six weeks of a water exercise postoperative recovery program. Knee joint range of motion (ROM), swelling value, visual analog scale (VAS) score, knee joint function score, and passive angle reproduction (PAR) were measured before and after the experiment. Results: After six weeks of recovery, the knee ROM was [Formula: see text], the swelling value was [Formula: see text][Formula: see text]cm, the VAS score was [Formula: see text], the Lysholm score was [Formula: see text], and the International Knee Documentation Committee (IKDC) score was [Formula: see text] in group B, which were significantly lower than those before recovery and those in group A ([Formula: see text]). After recovery, the PAR of the affected side was still different from that of the healthy side in the two groups ([Formula: see text]), but the PAR of group B was better than that of group A ([Formula: see text]). Conclusion: Compared to the conventional program, the water exercise-based postoperative recovery program demonstrates better performance in improving knee joint ROM, functionality, and proprioception, and can be used for practical post-ACLR rehabilitation.

Risk factors and prevalence of ramp lesions in ACL ruptures: An analysis from the registry of the Francophone Arthroscopic Society.

The study aimed to estimate the prevalence of ramp lesions among patients undergoing anterior cruciate ligament (ACL) reconstruction and identify risk factors associated with these lesions. A retrospective, multicentre cohort study was conducted using data from the Francophone Arthroscopic Society's registry, including 5359 patients who underwent ACL reconstruction (ACLR) from June 2020 to June 2023. Potential risk factors for ramp lesion such as patient demographics, revision surgery, pivot shift, side-to-side anteroposterior laxity, medial collateral ligament (MCL) injury, lateral meniscal tear and the volume of ligament remnant were evaluated using multivariate regression analyses. BMI and delay to surgery were also assessed. Ramp lesions were identified in 822 patients (15.3%). Univariate analysis identified male sex, younger age, revision surgery, lateral meniscal injury, percentage of ACL remnant (all p < 0.0001)and pivot shift (p = 0.0103) as significant risk factors. MCL injury was associated with a lower risk (p < 0.0001). In multivariate analysis, male sex, younger age, revision surgery, lateral meniscal injuryand percentage of ACL remnants remained significant risk factors, while MCL injury remained a protective factor. The anteroposterior laxity wasn't a significant predictor in either analysis. In subgroup analysis, there were differences concerning body mass index(n.s) and the delay to surgery (n.s). The study identified male sex, younger age, revision surgery, lateral meniscal injuryand pourcentage of ACL remnant as significant risk factors for ramp lesions, with MCL injury acting as a protective factor. This will help regarding the suspicion and identification of ramp lesions. Level III.

Patients’ under 25 subjective readiness to return to sport after ACL reconstruction with bone-patellar-bone grafts: Autograft vs. allograft

PurposeTo assess the difference in perceived readiness to return to sport (RTS) within the first year postoperative period between individuals undergoing anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BTB) autografts or allografts. MethodsThis was a prospective cohort study of patients undergoing primary ACL reconstruction done either with BTB autograft or allograft from 2010 to 2018. Skeletally mature patients aged 14 to 25 were eligible for inclusion. Patients completed the Marx Activity Rating Scale (MARS) questionnaire postoperatively evaluating perceived ability to perform various activities to compare subjective ability to RTS. Those patients who were outside outlined cohort age, failed to complete a single post-operative survey, underwent revision procedures, or underwent simultaneous or staged additional ligament surgery were excluded. ResultsFifty-nine patients (20.1 ± 3.19 years, 57.6 % Male) were included in the study. Sixteen patients underwent ACL reconstruction with allograft (19.8 ± 3.43 years) while 43 patients received autograft (20.2 ± 3.13). At 3 months autograft recipients reported higher perceived ability to cut (P = .003). At 6-months, allograft recipients reported higher perceived ability to run (P = .033), cut (P = .048), and decelerate (P = .008) as well as a higher overall perceived ability to RTS (P = .032). At all other times, there was no significant difference between cohorts’ subjective readiness to perform activities. ConclusionThe results of this study indicate that at times within the first year of recovery following ACL reconstruction, patients who receive allografts and autografts may have significantly different perceived ability to perform activities or RTS. However, while present at various times throughout the first year of recovery, any difference in perceived ability to perform activities or in overall RTS is no longer present at 12 months. Level of evidenceLevel II, Prospective cohort study.

Anterior Cruciate Ligament Reconstruction in Tibial Eminence Avulsion Fracture: A Case Series

Introduction: Ruptures of the anterior cruciate ligament (ACL) are common orthopedic injuries, especially among patients participating in sports. Anterior cruciate ligament (ACL) avulsion fracture or tibial eminence avulsion fracture is a type of avulsion fracture of the knee. This article describes several cases of ACL rupture management with eminence avulsion. Case report: This case series describes 3 cases of ACL tear with eminence avulsion. The first patient was a 31-year-old female with right knee pain since 6 months ago after a traumatic fall from a motorcycle. The second patient, a 16-year-old girl with a history of bending her legs inward during exercise. The third patient is a 49-year-old female with a history of accidents and complaints of knee pain. All three patients found ACL tear accompanied by an avulsion fracture on the tibial eminence and then undergo ACL reconstruction. Discussion: The most common mechanism of trauma, which leads to a disruption of ACL, is a trauma forcing the knee in hyperextension combined with valgus-external rotation. At times, these lesions can occur in adults; in this instance, the main cause is high-energy trauma, such as road accidents. Based on case reports and previous research, the management approach in this case is still debatable in children and adults and requires a specific approach in each case. Conclusion: The management of ACL reconstruction in patients with tibial eminence avulsion involvement is still a challenge for orthopedic surgeon. Given the rarer cases, a different approach is needed in young and adult cases. Each case requires proper management to improve the patient's functional outcome and their quality of life. Keywords: anterior cruciate ligament reconstruction, avulsion fracture, tibial eminence avulsion

Clinical Outcomes in Patients Undergoing Anterior Cruciate Ligament Reconstruction With Controlled Accelerated Rehabilitation.

Background An anterior cruciate ligament (ACL) tear is one of the most common sports injuries in the knee region. Currently, anatomical ACL reconstruction with quadrupled hamstring tendon autograft and controlled accelerated rehabilitation is a frequently used treatment approach. This study aims to add to the literature the early and mid-term clinical results of the controlled accelerated rehabilitation program we implemented in our clinic to enable patients to return to their daily activities faster after ACL reconstruction. Methodology In this retrospective study, 51 patients (50 males, 1 female) diagnosed with ACL tear and undergoing ACL reconstruction with quadrupled hamstring tendon graft were included in our study.In the femoral fixation of the graft, the transfix method was used in 22 patients and the Endobutton-CL method was used in 29 patients. A controlled accelerated rehabilitation program developed by Shelbourne was employed with some modifications to the patients. Clinical evaluation of patients was performed using Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee (IKDC) scoring systems. Results The mean postoperative follow-up period was 18.7 months (range = 6-36 months). During the physical examination, Lachman, anterior drawer, and pivot shift, 49 (96%) patients achieved excellent or good results, while only two (5%) patients experienced fair clinical outcomes. On clinical assessment using the Lysholm and IKDC scoring systems, 50 (98%) patients demonstrated excellent or good results, whereas only one (2%) patient showed fair results. Excellent and good outcomes were observed in all patients using the Cincinnati scoring system. We found a significant decrease in Tegner activity score pre-surgery, which significantly increased post-surgery. Conclusions The combination of Endobutton and cross-pin for femoral fixation and staples and interference screw for tibial fixation is thought to be safe in patients undergoing controlled accelerated rehabilitation after ACL reconstruction. The implementation of controlled accelerated rehabilitation enables patients to return to their social lives earlier without resulting in clinically poor outcomes in grafts and implants applied in the early and middle stages.

Return to Sport, Re-injury and Performance After the Anterior Cruciate Ligament Reconstruction: Evaluating the Role of International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) Scoring Systems.

Introduction Anterior cruciate ligament (ACL) tears are common injuries that can considerably impact an individual's quality of life and athletic performance. In these cases, surgical reconstruction of the ligament can be considered to restore stability to the knee. This study aims to investigate the time taken for individuals to return to sport post-ACL reconstruction, assess the rate of re-injuryand evaluate the reliability of the International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scoring systems in predicting a return to sport at the pre-injury level. Methods In this retrospective study, a total of 104 patients who underwent ACL reconstruction between January 2016 and December 2022 by one surgical team at Mater Dei Hospital, Malta were evaluated using a self-administered questionnaire. The questionnaire was based on different components including the sport practised at the time of injury, sport engagement classification, return to sport, the ability to return to pre-injury levels of performanceand re-injury. The participants then had to fill in IKDC and KOOS evaluation forms. Results In this study, 73% (n=76) of individuals successfully returned to sport after ACL reconstruction, with no significant difference being found between professional and recreational athletes (Chi-squared=0.00455, p=0.95). After reconstruction, 31.7% (n=33) of participants experienced an ipsilateral or contralateral ACL tear, with those returning to sport within six months showing a fivefold increase in re-injury risk compared to individuals who returned at eight or 12 months, suggesting a significant association between return duration and re-injury. The relationship between scoring systems and return to sport at the pre-injury level of performance was analysed using binary logistic regression, revealing that achieving scores of 85.6 or higher in IKDC or 89 or higher in KOOS meant having a 95% probability of returning to sport at the pre-injury level. Conclusions By considering these scoring systems with other post-operative criteria, clinicians can offer a more customised rehabilitation plan tailored to each patient who undergoes ACL reconstruction.

MRI Accurately Predicts Quadrupled Semitendinosus Autograft Size Using Posterior Hamstring Harvest for ACL Reconstruction

To determine the effectiveness of preoperative magnetic resonance imaging (MRI) measurements of the cross-sectional area (CSA) of the semitendinosus tendon in predicting the intraoperative quadrupled semitendinosus graft diameter of a posteriorly harvested hamstring autograft for anterior cruciate ligament (ACL) reconstruction. Aretrospective review of patients who underwent ACL reconstruction with autograft using a posterior hamstring harvest was performed. Patient demographics and operative reports were reviewed, and measurements of the CSA of the semitendinosus on MRI were performed. Multiple linear regression was used to analyze the predictors for graft diameter. A P value < .05 was considered statistically significant. Interrater and intrarater reliability were calculated. 280 patients were included. Patient height (P < .0001), and CSA of the semitendinosus (P < .0001) were significant predictors. Patients shorter than 63 inches had an average graft diameter of 7.89 mm compared to 8.69 mm for patients above 63 in (P < .001). The formula for the model is as follows: Graft diameter (mm2)= 2.74+ .067·Height (in)+ .00009 · Weight (lbs)+ .0018 · Age (years)+.12·Gender (1 if M, 0 if F) + 8.56 · CSA (cm2). The R2 for the model (0.5620), was greater than models using only height (R2= .4092) or only CSA Semitendinosus (R2= .3932). None of the interaction terms between covariates (e.g.,height, weight, age, gender) were significant. Age (P=.6400), weight (P=.9970), and gender (P= .6700) were not significant predictors. Both intraclass (ICC= 0.864, 95% CI=[0.791, 0.912]) and interclass correlation (ICC=0.827, 95% CI=[0.715, 0.894]) showed good reliability. CSA semitendinosus tendon and patient height independently perform similarly as predictors of graft diameter. When used together, CSA and height accurately predict the graft diameter. In particular, for patients under 63 in tall who demonstrated an average graft diameter below the minimum 8 mm, as suggested by the literature, this may be a useful tool for preoperative planning of patients intending to undergo ACLreconstruction with posterior hamstring harvest. Level III, diagnostic: retrospective cohort study.

Young men undergoing anterior cruciate ligament reconstruction with patellar tendon autograft and anteromedial drilling outperform at 5- to 10-year follow-up in terms of graft stability and activity levels compared to those undergoing reconstruction with hamstring autograft and transtibial drilling

ObjectiveTo compare 5- to 10-year outcomes of anterior cruciate ligament (ACL) reconstruction in young men performed with bone-patellar tendon bone (BPTB) autograft and anteromedial portal to reconstruction with hamstring autograft and transtibial technique. It was hypothesised that in young adult men, at 5- to 10-year follow-up, superior restoration of knee laxity and activity levels would be demonstrated using BPTB autograft and anteromedial portal technique. MethodsNinety-four men who had ACL reconstruction with BPTB autograft and anteromedial portal were eligible for comparison to 106 men who had reconstruction with hamstring autograft and transtibial technique. Inclusion criteria were: (1) age 18–35 years, (2) ACL tear caused by sports trauma only, (3) no concomitant ligament reconstruction and (4) 5- to 10-year follow-up. Outcome measures compared between the two groups included Lachman and pivot shift tests, KT side-to-side difference, Tegner and Marx scores, International Knee Documentation Committee (IKDC)-subjective score, Knee Osteoarthritis Outcome Scale (KOOS), Short Form (SF)-36, and single hop test for distance. P value ​< ​0.05 indicated statistical significance. ResultsForty-five patients with BPTB and 55 patients with hamstring ACL reconstruction were available for in-person assessment at 5–10 years after surgery. Outcomes in the BPTB group compared to the hamstring group showed KT difference 1.4 ​± ​1.9 mm vs. 2.8 ​± ​2.3 mm (p ​< ​0.01), pivot shift grade 2–3 in 4% vs. 34% (p ​< ​0.01), return to preinjury Tegner level in 51% vs. 36% (p ​= 0.1) and to preinjury Marx score in 29% vs. 11% (p ​= 0.02), and IKDC-subjective 88 ​± ​10 vs. 82 ​± ​13 vs (p ​< ​0.01), respectively. Statistically significant inter-relationships were found between KT side-to-side difference and the Tegner, Marx and IKDC-subjective scores at follow-up (r ​= ​−0.314, p ​< ​0.01; r ​= ​−0.263, p ​< ​0.01; r ​= ​−0.218, p ​= ​0.03, respectively). ConclusionYoung men undergoing ACL reconstruction with patellar tendon autograft and anteromedial drilling outperform at 5- to 10-year follow-up in terms of graft stability and activity levels compared to young men undergoing reconstruction with hamstring autograft and transtibial drilling. Level of EvidenceIII (Retrospective cross-sectional comparative study).

Tibial Tubercle Trochlear Groove Distance Does Not Correlate With Patellar Tendon Length in Patients Who Underwent Anterior Cruciate Ligament Reconstruction

To examine the relationship between tibial tubercle-trochlear groove (TT-TG) distance and patellar tendon length. All healthy athletes who underwent anterior cruciate ligament reconstruction who had a magnetic resonance imaging (MRI) study of the knee on file between July 2018 and June 2019 at a single institution were retrospectively reviewed. Exclusion criteria included patients without an MRI study of the knee on file or with an MRI of insufficient quality precluding reliable calculation of TT-TG and patellar tendon length. MRIs were reviewed to calculate TT-TG, patellar tendon length, and Caton-Deschamps Index (CDI). Patient charts were reviewed to obtain anthropometric characteristics including sex, concomitant injuries, and previous knee procedures as well as age at time of MRI. Spearman correlations were used to assess the relationship between TT-TG, patellar tendon length, and CDI, with regression analysis performed to assess for relationships between TT-TG, patellar tendon length, and patient-specific factors. Overall, 235 patients (99 female [42.1%], 136 male [57.9%]; mean age: 30.0 years [23.0; 40.0]) were included. Inter-rater reliability between the 2 reviewers was 0.888 for TT-TG, 0.804 for patellar tendon length, and 0.748 for CDI, indicating strong agreement. The correlation between TT-TG and patellar tendon length was 0.021, indicating no true relationship. The correlation between TT-TG and CDI was -0.048 and that of patellar tendon length and CDI was 0.411, indicating a weak positive relationship. Regression analysis found that male sex is strongly correlated with a longer patellar tendon length (odds ratio 2.65, 95% confidence interval 1.33-3.97, P < .001). In this study, no correlation was found between TT-TG and patellar tendon length or CDI. Male sex was correlated with a longer patellar length. Level III.

Functional Outcome of ACL Reconstruction Following Pre-reconstruction Rehabilitation vs. None Rehabilitation: A Systematic Review and Meta-analysis.

Objective The aim of this study is to analyse the needs for pre-operative rehabilitation in patients undergoing ACL reconstruction. Methods The database reports were searched within 2018 to 2023, using PubMed, Cochrane library database, Medline, and other published trials. A statistical analysis was made from Review Manager. Results Pre-operative rehabilitation group shows significantly higher 2 years post-operative KOOS score in all subscore and the total mean of the score, pain (p < 0. 0001), symptoms (p < 0. 0001), ADL (p < 0. 0001), sports and recreations (p < 0. 0001), QoL (p < 0. 0001), and the total mean of the KOOS score (p < 0.0001). In contrary, pre-operative rehabilitation group shows insignificantly higher score on 3 months post-operative Lysholm score (p = 0.12). Conclusion This meta-analysis conclude pre-operative rehabilitation may provide better long-term post-operative outcome, however it may not provide much of a short-term outcome. It is recommended to add pre-operative rehabilitation as a guideline for ACL injury management to improve long-term outcome of patients with ACL injury undergoing ACL reconstruction procedure.

Segond Fractures Can Be Identified With Excellent Accuracy Utilizing Deep Learning on Anteroposterior Knee Radiographs

PurposeTo 1) develop a deep learning model for detection of Segond fractures on AP knee radiographs and 2) to compare model performance to that of trained human experts. MethodsAP knee radiographs were retrieved from the Hospital for Special Surgery ACL Registry, which enrolled patients between 2009 and 2013. All images corresponded to patients who underwent ACL reconstruction by one of 23 surgeons included in the registry data. Images were categorized into one of two classes based on radiographic evidence of a Segond fracture and manually annotated. Seventy percent of the images were used to populate the training set, while 20% and 10% were reserved for the validation and test sets, respectively. Images from the test set were used to compare model performance to that of expert human observers, including an orthopedic surgery sports medicine fellow and a fellowship-trained orthopedic sports medicine surgeon with over 10 years of experience. ResultsA total of 324 AP knee radiographs were retrieved, of which 34 (10.4%) images demonstrated evidence of a Segond fracture. The overall mean average precision (mAP) was 0.985, and this was maintained on the Segond fracture class (mAP = 0.978, precision = 0.844, recall = 1). The model demonstrated 100% accuracy with perfect sensitivity and specificity when applied to the independent testing set and the ability to meet or exceed human sensitivity and specificity in all cases. Compared to an orthopedic surgery sports medicine fellow, the model required 0.3% of the total time needed to evaluate and classify images in the independent test set. ConclusionA deep learning model was developed and internally validated for Segond fracture detection on AP radiographs and demonstrated perfect accuracy, sensitivity and specificity on a small test set of radiographs with and without Segond fractures. The model demonstrated superior performance compared to expert human observers. Clinical RelevanceDeep learning can be used for automated Segond fracture identification on radiographs, leading to improved diagnosis of easily missed concomitant injuries, including lateral meniscus tears. Automated identification of Segond fractures can also enable large-scale studies on the incidence and clinical significance of these fractures, which may lead to improved management and outcomes for patients with knee injuries.

Impacts of Segond Fractures on Anterior Cruciate Ligament Reconstruction Outcomes.

Segond fractures, characterized by avulsion injuries at the lateral tibial condyle's anterolateral structure (ALS) attachment, often coincide with anterior cruciate ligament (ACL) injuries, potentially leading to knee instability. However, the influence of Segond fractures on knee stability after ACL reconstruction remains uncertain. Despite documented ALS reconstructions, there is a lack of consensus regarding the assessment of ALS failure and the criteria for surgical interventions. This study aimed to determine if Segond fracture presence impacts ACL reconstruction outcomes, utilizing patient-reported subjective assessments and healthcare providers' objective evaluations. This retrospective study encompassed 639 patients (328 males, 311 females; mean age 26.9 years) who underwent ACL reconstruction, with a follow-up of at least one year. Subjects were divided into two groups: Segond fractures diagnosed through radiographic findings (Group S+, n = 17) and no Segond fractures (Group S-, n = 622). Clinical evaluation included the 36-item Short Form Survey (SF-36), Lysholm score, visual analog scale (VAS) for knee pain, knee injury and osteoarthritis outcome score (KOOS), and knee instability assessment via Telos SE (Telos Japan, Tokyo, Japan). Statistical comparisons were performed between the two groups. At the final follow-up, all SF-36 subscales improved in all eight subscales compared to before surgery, reaching national standard scores; no significant inter-group differences were evident. Lysholm scores were 93.0 ± 12.1 (Group S+) and 91.7 ± 10.9 (Group S-) (P = 0.62), VAS for knee pain was 10.0 ± 18.0 (Group S+) and 11.9 ± 16.9 (Group S-) (P = 0.62), total KOOS was 89.0 ± 17.4 (Group S+) and 90.7 ± 9.9 (Group S-) (P = 0.39), and anterior tibial translation differences were 2.8 ± 3.0 mm (Group S+) and 2.7 ± 2.9 mm (Group S-) (P = 0.73). All these values represent postoperative measurements. No significant discrepancies existed between groups across evaluation methods. This study's results suggest that Segond fractures have minimal impact on clinical ACL reconstruction outcomes, as assessed through both patient-reported subjective evaluations and objective healthcare provider evaluations. Segond fractures' significance in postoperative outcomes questions the necessity of ALS reconstruction.

Influence of strength and balance ability on functional performance in the involved and uninvolved sides after anterior cruciate ligament reconstruction.

The restoration and management of the uninvolved side have been emphasized to prevent a second anterior cruciate ligament (ACL) injury and to ensure that athletes return to sports after ACL reconstruction. To determine the factors influencing the single leg hop test (SLHT) and single leg vertical jump test (SLVJT) at 1 year postoperatively after ACL reconstruction in both the involved and uninvolved sides. Ninety-four patients who underwent ACL reconstruction were assessed at 1 year postoperatively. Multiple regression models included eight independent variables with two dependent variables (SLHT and SLVJT.), each on the involved and uninvolved side. On the involved side, the Y balance test (YBT), extensor peak torque per body weight (PT/BW), Biodex balance system anteroposterior index (BBS-API), and sex accounted for 53.9% of the variance in SLHT (P= 0.002), and extensor PT/BW and YBT accounted for 26.3% of the variance in SLVJT (P= 0.027). On the uninvolved side, YBT, sex, age, BBS-API, and flexor PT/BW accounted for 47.0% of the variance in SLHT (P= 0.046), and flexor PT/BW, YBT, and age accounted for 44.9% of the variance in SLVJT (P= 0.002). Knee extensor strength on the involved side and flexor strength on the uninvolved side influence the two functional performance tests. The YBT was an important factor in the two functional performance tests in both sides. Anteroposterior stability was the only factor that influenced the SLHT bilaterally.