Both Adjustable and Fixed Loop Hamstring Tendon Graft Fixation Have Similar Clinical and Patient-Reported Outcomes in Anterior Cruciate Ligament Reconstruction.

Purpose: This study aims to compare the outcomes of fixed-loop device (FLD) vs adjustable-loop device (ALD) graft fixation with up to 2-year follow-up in patients undergoing primary anterior cruciate ligament reconstruction (ACLR) in a predominantly Asian setting. Methods: Prospectively collected outcome measures as well as clinical records of patients who underwent primary ACLR using either FLD or ALD fixation of hamstring tendon autograft performed by a single surgeon were reviewed. The surgeon in this study used a fixed-loop device from 2018 to 2019 and then changed to adjustable loop from 2019 to 2020. Suspensory fixation was performed on the femoral side, and aperture (interference screw) fixation was performed on the tibial side. Outcome measures included knee range of motion, KT-1000 arthrometer testing, Lysholm knee score, and Tegner activity scale. Patients were assessed preoperatively and postoperatively at regular intervals of 6, 12, and 24 months. Results: A total of 105 patients were identified. Forty-six were excluded due to incomplete follow-up data, so 59 patients with full 2-year follow-up were included in the final study group. Both groups (FLD vs ALD) were similar in demographics except for age (P = .042). Out of 105, there were 59 patients remaining in the study group with 2-year follow-up data. No significant differences were observed between the 2 groups at all respective testing intervals. Conclusions: FLDs and ALDs for suspensory fixation of hamstring tendon autograft in ACLR had similar clinical outcomes with a minimum of 2-year follow up. There is no evidence of graft loosening from loop lengthening. Level of Evidence: Level III, retrospective comparative trial.

Single-Stage Arthroscopic Cartilage Repair With Injectable Scaffold and BMAC.

Injectable scaffold augmentation is a promising modality for single-stage cartilage repair. According to published studies, cartilage repair with scaffold augmentation has improved clinical outcomes, radiological fill, and histological repair compared with microfracture alone. Injectable scaffolds have the versatility to be used in large and irregularly shaped lesions. With correct preparation, they can be applied to lesions on the femoral condyle that may be vertical, or even inverted lesions such as those in the patella. They can be combined with bone marrow aspirate concentrate (BMAC) to provide mesenchymal stem cells (MSCs), thereby avoiding the need for microfracture. This protects the subchondral plate, preventing biomechanical alteration and potentially resulting in improved long-term outcomes. In this article, we demonstrate the utility of injectable scaffolds and their combination with BMAC.

Large Infected Femoral Cystic Swelling after Anterior Cruciate Ligament Reconstruction through Transportal Technique.

INTRODUCTION: Large cystic swellings in the knee are a rare complication of anterior cruciate ligament (ACL) reconstruction surgery. Most cystic swellings in the literature arise from the tibia; femoral cystic swellings which are clinically significant and infected are thus extremely rare. Little is known about the etiology of such cystic swellings post-ACL reconstruction, and there are no standardized protocols for their treatment. CASE PRESENTATION: Our patient presented 6 months post-ACL reconstruction, with a large swelling over the lateral aspect of the femur in the operated knee. His presentation presented a clinical dilemma: On the one hand, he presented with a large cystic swelling adjacent to the knee, but had only vague knee pain with no significant joint effusion and no fever or other constitutional symptoms; while on the other, his swelling was significantly large and his imaging findings were worrisome. This cystic swelling turned out to be an infected cyst arising from the tissue adjacent to the femoral tunnel. We present a rare complication of ACL reconstruction and discuss the possible causes of such large cystic swellings. We also discuss the management of large infected cysts post-ACL reconstruction. CONCLUSION: Large, infected femoral cyst post-ACL reconstruction is rare and requires appropriate clinical assessment and management. It is important to ascertain whether they are associated with intra-articular infections/septic arthritis. If there is no septic arthritis, these swellings can be treated with simple surgical debridement and antibiotics and retention of ACL graft. The long-term outcomes of graft retention in these patients are excellent.