Posterior tibial slope angle in contact versus non-contact anterior cruciate ligament injuries.

BACKGROUND: Increased Posterior Tibial Slope (PTS) angle has been reported to be a risk factor for primary anterior cruciate ligament (ACL) tears. However, it is unknown whether increased PTS has an associated increased risk for non-contact versus contact ACL injury. PURPOSE: The purpose of this study is to determine whether patients with non-contact ACL injury have a higher PTS angle than those with contact ACL injury. METHODS: A total of 1700 patients who underwent primary ACL reconstruction between January 2011 and June 2023 at a single academic institution were initially included. Electronic medical records were reviewed for demographic information as well as evidence that the patient sustained a contact or non-contact ACL injury. Patients in the contact cohort were propensity score matched to patients in the non-contact cohort by age, sex and BMI. Additionally, patients in the contact cohort were then propensity score matched to a control group of patients with intact ACLs also by age, sex and BMI. RESULTS: One hundred and two patients with contact injury were initially identified and 1598 patients with non-contact injuries were identified. Of the 102, 67 had knee X-rays that were suitable for measurement. These 67 contact injury patients were propensity score matched to 67 noncontact patient and 67 patients with intact ACLs based on age, sex and BMI. There were no significant differences between contact and non-contact cohorts in age (28.7±6.3 vs. 27.1±6.5, p = 0.147), sex (Female: 36.0% vs. 34.3%, p = 0.858), or BMI (26.7±5.6 vs 26.1±3.4, p = 0.475). There was no significant difference in PTS angle between contact versus non-contact ACL injury patients (11.6±3.0 vs.11.6±2.8, p = 0.894). There was a significant difference in PTS between the contact ACL injury and the intact cohort (11.6±3.0 vs. 10.0±3.9, p = 0.010) and the non-contact ACL injury and the intact cohort (11.6±2.8 vs. 10.0±3.9, p = 0.010). CONCLUSION: There was no significant difference in the degree of PTS between patients who sustained contact versus non-contact ACL injuries. Additionally, there was a significantly increased PTS in both the contact and non-contact ACL injury cohorts compared to patients with intact ACLs.

Revision ACL reconstruction, but not bilateral ACL reconstruction, is associated with clinically relevant inferior subjective knee function compared with primary ACL reconstruction: A comparative analysis of 6831 patients.

PURPOSE: To evaluate and compare the subjective knee function in patients undergoing revision and bilateral anterior cruciate ligament (ACL) reconstruction (ACLR) with those undergoing primary ACLR in a large cohort. METHODS: Patients without concomitant ligament injuries who underwent primary, revision or bilateral ACLR at the Capio Artro Clinic, Stockholm, Sweden, between 2005 and 2018 were identified. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1, 2 and 5 years postoperatively from the Swedish National Knee Ligament Registry. Patients who underwent revision and bilateral ACLR were compared with those who underwent primary ACLR (control group) using Student's t test. RESULTS: A total of 6831 patients (6102 with primary ACLRs, 343 with revision ACLRs and 386 with bilateral ACLRs) were included. Preoperatively, there were significant but nonclinically relevant differences in favour of the revision ACLR group for KOOS Symptoms, Pain, Activities of Daily Living (ADL) and Sport/Rec subscale scores compared with the primary ACLR group. Postoperatively, except for the 1-year Symptoms and ADL subscales, the revision ACLR group reported significantly lower scores on all KOOS subscales than the primary ACLR group, with clinically relevant differences (>8-10 points) for the 1-, 2- and 5-year Sport/Rec and Quality of Life (QOL) subscales. The bilateral ACLR group reported significantly, but not clinically relevant, inferior scores on the 1-year Symptoms and QOL subscales and the 5-year Sport/Rec and QOL subscales compared with the primary ACLR group. CONCLUSIONS: Revision ACLR, but not bilateral ACLR, was associated with clinically relevant inferior subjective knee function compared with primary ACLR. It is important to counsel patients regarding their future subjective knee function after repeated ACLR. Compared to primary ACLR, inferior subjective results should be expected after revision ACLR, but not after bilateral ACLR. LEVEL OF EVIDENCE: Level III.

No significant difference in skin contamination during anterior cruciate ligament reconstruction with and without preoperative skin cleaning.

PURPOSE: This prospective study aimed to assess whether preoperative antiseptic skin cleansing reduces bacterial contamination and surgical site infections (SSI) following anterior cruciate ligament reconstruction (ACLR). We hypothesized that antiseptic cleaning would lower bacterial load, reducing contamination and early infections. METHODS: One hundred and nineteen patients scheduled for ACLR were included in this prospective, nonrandomized study. Individuals were divided into two groups. Patients in the intervention group applied octenisan® wash lotion daily for three days before surgery and used the wash solution instead of their usual shower gel. Additionally, they swiped their leg with octenisan® soaked gloves on the morning of the operation. The control group followed their usual wash routine with no specific instructions. Fluid samples were taken before surgery from the irrigation bag and at 15-min intervals from the reservoir of the sterile surgical drape during the procedure. Suture material used for the ACL graft and meniscus repair were also collected for testing. The samples were subjected to a 14-day incubation period. Follow-up included outpatient visits at 6 weeks, 12 weeks and 6 months with a final evaluation at 12 months. RESULTS: Contamination rates showed no significant difference between the control and intervention groups. The mean contamination rate in the control group was 6.4% (n = 22) and 6.6% (n = 24) in the intervention group (p = 0.28). At 12-month follow-up, 110 out of 119 participants were included (52 control, 58 intervention). T tests for age (p = 0.19), BMI (p = 0.66), and surgery duration (p = 0.38) showed no significant differences. No early SSI were observed in either group postoperatively. CONCLUSION: Our results indicate that the use of antiseptic wash lotion and gloves does not influence the risk of bacterial contamination during surgery. LEVEL OF EVIDENCE: Level III.

Perturbation Training in Anterior Cruciate Ligament Graft Tear and Posterolateral Corner Injury: A Case Report of a Combined Injury.

This case study illustrates how rehabilitation for combination injuries necessitates a thorough, customized strategy that includes perturbation training to address complicated biomechanical impairments because of the complex relationship between the anterior cruciate ligament (ACL) and the posterolateral corner (PCL). An 18-year-old female basketball player visited the Sports Rehab Outpatient Department with a complaint of pain in the posterior aspect of her knee, difficulty fully flexing her right knee joint, and intermittent instability one month after an injury. Her grade 2 ACL tear was accompanied by thinning of the lateral collateral ligament and strain of the popliteofibular ligament as per the MRI findings before the ACL reconstruction surgery. She underwent a knee graft sprain and ACL re-injury. The decision was made to manage the injury conservatively by implementing a rehabilitation program focused on perturbations to improve neuromuscular control and functional stability of the knee. This case report highlights the significance of a multidisciplinary approach, evidence-based interventions (such as the Lysholm score, International Knee Documentation Committee-Subjective Knee Form, and Tempa Scale of Kinesiophobia as outcome measures), and patient-centered care. This study intends to make a significant contribution to sports medicine and orthopedic rehabilitation by clarifying the complexities of rehabilitation in such complicated circumstances.

A Comprehensive Review of Graft Choices and Surgical Techniques in Primary Anterior Cruciate Ligament Reconstruction: An Outcome Analysis.

Anterior cruciate ligament (ACL) injuries are among the most prevalent knee injuries, particularly in athletes engaged in high-impact sports. ACL reconstruction is a widely performed surgical procedure to restore knee stability, prevent further knee damage, and enable patients to return to their previous physical activity levels. However, the success of ACL reconstruction is influenced by various factors, including the choice of graft and the surgical technique employed. This comprehensive review explores the outcomes of different graft options - autografts, allografts, and synthetic grafts - and various surgical techniques such as single-bundle versus double-bundle reconstruction and anatomic versus non-anatomic tunnel placement. The review analyzes the short- and long-term outcomes, including functional recovery, return to sports, complication rates, and the impact of patient-specific factors such as age, activity level, and comorbidities. Additionally, the review discusses the role of rehabilitation protocols in optimizing surgical outcomes. By synthesizing current evidence, this review aims to provide clinicians with insights into the most effective graft choices and surgical techniques for primary ACL reconstruction, ultimately guiding the optimization of patient outcomes and highlighting areas for future research.

Enhancing Recovery and Performance Through Plyometric Training for a Badminton Athlete After Anterior Cruciate Ligament (ACL) Reconstruction: A Case Report.

Anterior cruciate ligament (ACL) injuries are widespread, particularly in sports that involve rapid changes in direction, such as badminton, and it incapacitates an athlete severely and for a long time. ACL reconstruction followed by a structured rehabilitation program is essential for returning to peak performance. Plyometric training, known for enhancing explosive power and agility, is increasingly incorporated in post-ACL reconstruction rehabilitation for athletes. This case report presents the rehabilitation of a 19-year-old female badminton player operated for ACL reconstruction through the inculcation of plyometric training in the later phase to optimize better performance outcomes. The athlete demonstrated significant improvements in knee stability, strength, and functional performance. Plyometric exercises played a crucial role in restoring explosive power and agility, essential for competitive badminton, thereby facilitating a successful return to sport.

Similar two-year improvement in patient-reported outcomes in patients 40 years and older with outerbridge grade III and IV lesions following ACL reconstruction.

PURPOSE: This study aims to evaluate clinical and patient-reported outcome measures (PROMs) of patients 40 years and older that underwent anterior cruciate ligament reconstruction (ACLR) and determine the influence of preexisting arthritis and chondral wear on ACLR outcomes. We hypothesized that patients aged 40+ with ACLR would have excellent clinical outcomes and PROMs regardless of preexisting arthritic changes. METHODS: A total of 118 patients were included. Patients aged 40 years and older who underwent ACLR in a single healthcare system between 2009 and 2016 were eligible. Outcomes assessed include Knee Injury and Osteoarthritis Outcome Scores (KOOS), Single Assessment Numeric Evaluation (SANE) scores, intraoperative Outerbridge grading, preoperative Kellgren-Lawrence (KL) grading and postoperative complication rates over a 2-year period. RESULTS: Average increase in KOOS and SANE scores were 21.2 ± $\pm $ 19.9 and 23.5 ± $\pm $ 31.3, respectively. Patients with Outerbridge grade III and IV lesions in weight-bearing compartments had lower baseline SANE and KOOS scores than those without (47.1 ± 22.0 vs. 64.5 ± 23.6 baseline SANE and 43.1 ± 18.1 vs. 63.5 ± 15.9 baseline KOOS; p = 0.002 and p < 0.001, respectively) with no significant difference in the amount of change in SANE or KOOS scores (p = 0.111 and p = 0.165 respectively). Patients with KL-grade 2+ osteoarthritis experienced similar changes in KOOS and SANE over the 2-year period to their counterparts (p = 0.598 and p = 0.643, respectively). CONCLUSION: There is no correlation between preexisting osteoarthritic changes or chondral defects and PROs. KOOS and SANE scores both increased postoperatively. When treating older patients with an ACL tear, surgeons should consider the activity level and desires of the patient as they determine appropriate treatment. Preexisting osteoarthritis does not correlate with patient-reported outcomes for ACLR. LEVEL OF EVIDENCE: Level IV.

Reviving Movement and Stability: A Case Series on Different Innovative Rehabilitation Strategies Post-anterior Cruciate Ligament Reconstruction.

Injuries to the anterior cruciate ligament (ACL) are frequent and can seriously impair stability and mobility. This study examines rehabilitation outcomes in four patients following ligament reconstruction. Four patients who underwent ACL reconstruction and received different physiotherapy protocols, namely, "Oxford Knee Services," "Mass General Brigham," "Fowler Kennedy Sports Medicine," and "Schlechter Protocol of Youth Sports and Ortho," were included. The study aimed to identify the most effective rehabilitation approach. Demographic data, injury details, clinical examinations, and preoperative investigations were presented. Outcome measures included pain scores, range of motion (ROM), muscle strength, and functional assessments. All the patients showed improvements, but the rate of progress varied. Patient 3 achieved the best results in the ROM, muscle strength, and functional measures. This suggests that individual factors and rehabilitation protocols might influence outcomes. This study highlights the varying impacts of different rehabilitation protocols on the recovery outcomes of the patients' post-ACL reconstruction. Despite all patients showing improvements in pain reduction, ROM, muscle strength, and functional capabilities, the rate of progress and the degree of improvement differed notably among them.

A Qualitative Study of Factors Perceived to Influence Physical Activity among Young Athletes after ACL Reconstruction.

Background: Despite evidence of alarming declines in physical activity levels after anterior cruciate ligament reconstruction (ACLR), very little is known about how young athletes perceive their experiences with engagement in sports and physical activity in the years following ACLR. Hypothesis/Purpose: The purpose of this study was to answer the research question, "what are the lived experiences and perceptions of factors that facilitate or hinder physical activity among young athletes following ACLR?". Study Design: Qualitative Study. Methods: Ten participants were included in this qualitative study at a median of 5.9 (4.3-10.2) years after adolescent ACLR. Using an interpretive phenomenological methodology, semi-structured interviews were conducted with each participant. Data collection focused on participants' lived experiences related to physical activity participation in the years after ACLR. Iterative coding with two independent coders and a peer debriefing process were used to identify themes from the data. Results: Factors perceived to influence physical activity after ACLR spanned all levels of the socioecological framework. Three overarching themes were generated during thematic analysis: 1) navigation of barriers (common obstacles, injury-related limitations, unique adaptations), 2) movement motives (ingrained desire to move, external motivators, internal motivation), and 3) movement mindset (envisions for future physical activity, perceived impact of injury, belief in the power of sports). Conclusion: The themes identified in this study indicate that the adolescent ACLR experience has the potential to significantly influence one's physical activity into young adulthood, both positively and negatively. These findings serve as an important foundation for future studies to explore the psychological and environmental factors identified as important to one's physical activity participation in the years following adolescent ACLR. Level of Evidence: Level 3.

Predicting the Recovery of Isokinetic Knee Strength 6 Months After Anterior Cruciate Ligament Reconstruction.

Background: The limb symmetry index (LSI) is a metric of strength restoration. It is key to successfully return to sports after anterior cruciate ligament (ACL) reconstruction. The threshold for return to sports is generally considered an LSI of ≥85%. Purpose: To develop a statistical model for predicting the recovery of knee extension and flexion strength (with LSI ≥85%) at 6 months after ACL reconstruction. Study Design: Case-control study; Level of evidence: 3. Methods: Patients who underwent arthroscopic ACL reconstruction between November 2015 and December 2020 were included. The patients were classified into 2 groups: "pass" if the LSI at 6 months postoperatively was ≥85% and "fail" if the LSI was <85%. Factors in 25 categories with 74 levels, including patient characteristics, periarticular procedures, intra-articular lesions and treatment, and perioperative management, were collected. A multivariable logistic regression combined with backward variable elimination was used to determine the predictive parameters for recovery of knee extension and flexion strength. Results: A total of 948 patients were included. Graft site, preoperative isokinetic strength, treatment of meniscal injury, and injured side (left vs right) were identified as general predictors for both knee extension and flexion strength. For knee extension strength, age at injury and partial weightbearing duration were identified as additional predictors. For knee flexion strength, type of meniscal injury, surgeon volume, cartilage procedures, and periarticular procedures were identified as additional predictors. The Nagelkerke R 2 of the final model was 0.178, and the c-statistic was 0.716 (95% CI, 0.676-0.754). The Hosmer-Lemeshow test indicated good calibration (P = .879). Conclusion: Several factors including preoperative isokinetic strength, treatment of meniscal injuries, left vs. right side and graft site were found to predict recovery of ≥85% LSI in knee extension and flexion strength. Despite the numerous factors that were analyzed, the predictive power was moderate (c-statistic = 0.716), indicating there were other nonincluded factors that significantly influence strength performance at 6 months postoperatively.

All-soft tissue quadriceps tendon autograft and bone-patellar tendon-bone autograft demonstrate no significant ACL tunnel widening: An MRI comparison.

PURPOSE: This study sought to quantify the tunnel widening associated with quadriceps tendon (QT) autograft after anterior cruciate ligament reconstruction (ACLR) and compare it to bone-patellar tendon-bone (BTB) autografts. METHODS: A retrospective review of each ACLR performed at a single academic institution from 2011 to 2021 were reviewed. Subjects with repeat ipsilateral knee magnetic resonance imaging (MRI) studies performed after ACLR were included. Two reviewers independently measured the maximum diameter of the femoral and tibial tunnels 1 cm from the aperture. Tunnel widening was calculated as the difference between the initial drilled diameter and the measured diameters. RESULTS: Seventy-five patients (38 BTB and 37 QT autografts) were identified including 42 females and 33 males. With respect to graft type (QT vs. BTB), there was no statistically significant difference in median patient age (19.0 (16.0-31.5) years vs. 20.0 (16.8-30.0) years respectively; p = n.s.) or median time to MRI (12.0 [9.0-19.5] months vs. 13.0 [7.0-43.3] months respectively, p = n.s.). Mean tunnel diameter changes or widening was statistically significantly greater for QT autografts than BTB autografts at the tibial tunnel: (0.4 [±0.6] mm] vs. -0.4 [±1.1 mm; p < 0.001). Similarly, the mean tunnel diameter change was also significantly greater at the femoral tunnel for QT compared to BTB. (0.2 [±0.6] mm vs. -0.4 [±0.8] mm; p < 0.001) However, no patients with QT grafts demonstrated tibial or femoral tunnel diameters >12 mm. CONCLUSION: Although QT autografts had a statistically significant greater amount of tunnel widening compared to BTB autografts; the mean tibial and femoral net widening of 0.4 mm and 0.2 mm, respectively, does not meet previously reported clinically significant values. Thus, the tunnel widening presented in this study is unlikely to affect clinical outcomes and should not preclude the use of either graft. LEVEL OF EVIDENCE: Level III (Retrospective comparative study).

No difference in clinical outcome between quadriceps tendon anterior cruciate ligament reconstruction with and without bone block: Results from the Danish Knee Ligament Registry.

PURPOSE: The quadriceps tendon (QT) has recently gained increasing interest as an anterior cruciate ligament reconstruction (ACLR) graft due to minimally invasive harvesting techniques and low donor site morbidity. QT grafts can be used both with a patella bone block and as complete soft tissue grafts. However, it is unknown whether the QT graft type affects clinical outcomes. This study used data from the Danish Knee Ligament Reconstruction Registry (DKRR) to compare revision rates, knee stability and subjective clinical outcomes in patients who underwent ACLR with QT graft with bone block (QT-B) or soft tissue only (QT-S). METHODS: Patients who underwent primary ACL reconstruction with QT autografts documented in the DKRR were included and divided into the QT-B (n = 925) and QT-S (n = 659) groups. The clinical outcome was evaluated using objective-instrumented knee stability, pivot shift test, knee injury osteoarthritis outcome score (KOOS) and Tegner activity scores for the two cohorts performed at the 1-year follow-up. The overall revision rates were determined as well. RESULTS: Revision rates at 2 years were equally low in both graft groups at 2.8%. Similarly, post-operative knee laxity was equal at 1.5 (1.4) and 1.6 (1.4) mm side-to-side laxity, respectively. However, QT-B exhibited a reduced post-operative positive pivot shift of 22% compared with 31% for QT-S. Although the subjective outcomes were equal for the KOOS and Tegner activity scale scores at the 1-year follow-up, reduced improvements in KOOS were observed for QT-B compared to QT-S. CONCLUSION: ACL with a QT autograft harvested either with a bone block or as a soft tissue graft exhibited comparable revision rates and sagittal knee stability. Furthermore, ACL reconstruction using a QT graft with a bone block achieved better rotational stability with less pivot shift than ACL reconstruction using complete soft tissue QT grafts. LEVEL OF EVIDENCE: Level III.

ACL reconstruction demonstrates better stability compared to ACL repair for patients with Schenck III and IV knee dislocations.

PURPOSE: This study compared mid-term outcomes of two anterior cruciate ligament (ACL) restoration techniques within an early total surgical care of acute knee dislocation: repair with additional internal bracing (ACLIB) and reconstruction with autograft (ACLR). Initial results at 12 months demonstrated that ACLR offered superior stability compared to ACLIB. METHODS: Retrospective clinical study of patients with acute type III or IV KD. ACLIB or ACLR procedures were performed accompanied by simultaneous suture and internal bracing of the posterior cruciate ligament (PCL) and repair with lateral augmentation of the medial and lateral complex injuries utilizing Arciero's reconstruction technique. Patient-reported outcome measurements (PROMs), instrumental stability assessment via the Rolimeter-Test, and stress radiographs were analyzed. RESULTS: The study involved 20 patients (5 IIIM, 5 IIIL, and 10 IV injuries) with an average follow-up of 35.2 ± 7.4 months. Notable differences in anterior tibial translation on stress radiography favouring ACLR persisted at 24-month follow-up in side-to-side difference (SSD) (ACLIB 2.8 ± 2.5 mm vs. ACLR 0.3 ± 2.6 mm; p = 0.0487), but Rolimeter test variance diminished (SSD ACLIB 2.5 ± 0.9 mm vs. ACLR 1.8 ± 1.7 mm). Both groups showed excellent PROMs (Lysholm Score: ACLIB 84.4 ± 15.8 vs. ACLR 89.9 ± 9.0; IKDC Score: ACLIB 77.1 ± 16.2 vs. ACLR 77.7 ± 8.6). CONCLUSION: Our results indicate improved anterior stability at 12 months, which persisted at 24 months after ACL reconstruction compared with ACL repair by stress radiography. Both groups showed favourable patient-reported outcomes throughout the follow-up period. Notable rates of postoperative knee stiffness were observed in both groups. These were successfully managed with early, one-time arthroscopic arthrolysis within the first seven months of treatment, resulting in no major range of motion limitations at the 24-month follow-up. LEVEL OF EVIDENCE: Retrospective cohort study, III.

Does the timing of anterior cruciate ligament reconstruction surgery affect flexion contracture formation in rats?

BACKGROUND: Anterior cruciate ligament injuries are commonly treated with ligament reconstruction surgery, but post-operative joint contracture is a major complication. The optimal timing for anterior cruciate ligament reconstruction remains controversial, with some clinical studies suggesting that early surgery may increase the risk of joint contractures, while others have found no such association. To clarify this, we investigated the effects of the timing of reconstruction surgery on contracture formation using a rat model. METHODS: Anterior cruciate ligament-transected rats were divided into groups based on the timing of reconstruction: immediate, early, and delayed (1, 14, and 28 days after transection, respectively). Some anterior cruciate ligament-transected rats did not receive reconstruction surgery. Untreated rats served as controls. At 56 days after ligament transection, we assessed knee extension range of motion before (including both myogenic and arthrogenic factors) and after myotomy (arthrogenic factor only), as well as fibrotic changes in the joint capsule. FINDING: Anterior cruciate ligament transection alone significantly decreased range of motion before myotomy, but not after myotomy. In all reconstructed groups, both range of motions before and after myotomy were significantly reduced compared to the control, indicating the induction of arthrogenic contracture by reconstruction surgery. Fibrotic changes in the joint capsule were observed in all reconstructed groups, contributing to arthrogenic contracture formation. However, the timing of reconstruction had no effect on range of motions and fibrotic changes in the joint capsule. INTERPRETATION: Our findings may help guide clinical decision-making regarding the timing of anterior cruciate ligament reconstruction surgery.

Navigating Post-operative Challenges: A Comprehensive Review of Complications Following Anterior Cruciate Ligament (ACL) Tear Surgery.

Anterior cruciate ligament (ACL) injuries are among the most common and debilitating sports-related injuries, often necessitating surgical intervention to restore knee stability and function. ACL reconstruction surgery, which has evolved significantly over the years, aims to enable patients, particularly those who are young and physically active, to return to their pre-injury activity levels. However, despite advancements in surgical techniques and rehabilitation protocols, post-operative complications remain a significant concern that can adversely affect patient outcomes. This comprehensive review explores the spectrum of complications that can arise following ACL tear surgery, ranging from common issues such as infection, graft failure, and knee stiffness to less frequent but clinically significant complications like osteoarthritis and neurological injuries. The review also delves into the various factors influencing the likelihood of these complications, including patient-related variables, surgical techniques, and the effectiveness of rehabilitation protocols. By providing an in-depth analysis of these post-operative challenges, this review aims to enhance the understanding of ACL reconstruction outcomes and guide healthcare professionals in implementing preventive strategies and optimizing patient care. Through a multidisciplinary approach, the goal is to minimize the risk of complications, improve surgical outcomes, and ultimately enhance the quality of life for patients undergoing ACL reconstruction.

Late (≥60 years old) and middle adulthood (40-59 years old) patients achieve similar improvement in patient-reported outcomes following ACL reconstruction.

PURPOSE: This study aimed to compare the range of motion (ROM), surgical outcomes, and patient-reported outcome measures (PROMs) following anterior cruciate ligament (ACL) reconstruction outcomes in patients 60 years or older at the time of surgery to 40- to 59-year-old patients. METHODS: In this retrospective cohort study from 2015 to 2022, a 3:1 propensity match was performed to match late adulthood patients (≥60 years old) undergoing ACL reconstruction with middle adulthood (40-59 years old) ACL reconstruction patients. Patients were matched based on sex, ACL graft utilized and concomitant procedures performed during ACL reconstruction. Statistical analysis compared demographics, preoperative injury management, surgical outcomes, PROMs, and minimal clinical important difference (MCID) and substantial clinical benefit (SCB) achievement rates for all ACL reconstruction patients included. RESULTS: Twenty late adulthood and 60 middle adulthood patients who underwent ACL reconstruction were included in the final cohort. Patients who were 60 years or older experienced no difference in reoperation rate (n.s.), incidence of retears (n.s.) or ROM (n.s.) at 1 year post-operatively. There were also no differences in International Knee Documentation Committee (ΔIKDC) (31.3 ± 19.1 vs. 34.2 ± 18.2, n.s.) or ΔPCS-12 (12.4 ± 9.8 vs. 12.9 ± 10.8, n.s.) scores at 1 year post-operatively. Furthermore, the younger and older patient cohorts demonstrated similar rates of achieving the MCID (80.0% vs. 83.3%, n.s.) and SCB (50.0% vs. 61.7%, n.s.) scores for IKDC. CONCLUSION: Patients 60 years or older and 40- to 59-year-old patients demonstrated similar outcomes after undergoing ACL reconstruction with allograft. This study concludes that ACL reconstruction in late adulthood can still be a successful treatment option and should allow surgeons to feel more comfortable when performing indicated surgical intervention for older patients who experience an ACL tear. LEVEL OF EVIDENCE: Level III, Therapeutic III, retrospective cohort study.

One-Year Changes in Collagen Type in Semitendinosus Tendons: A Case Study Using Tissues Obtained From a Growing Patient.

Recently, there have been concerns about the high postoperative re-injury rate associated with the use of the semitendinosus tendon (ST) as an autograft for anterior cruciate ligament reconstruction in adolescent patients before the closure of the epiphyseal line. Our previous studies showed that this high re-injury is related to the histological and mechanical immaturity of ST in adolescent patients. Moreover, the overall structure of collagen fibers is strengthened with the application of traction force to tendon tissue. Therefore, it is assumed that, in vivo, bone growth and increased height increase the traction force applied to tendon tissue and the percentage of type I collagen, which has a remarkable physical strength. The present study aimed to investigate the changes in the content of ST's type I collagen in an adolescent patient over one year. The patient was an 11-year-old male with bilateral patellar dislocations. The orthopedic surgeon performed medial patellofemoral ligament reconstruction on the left knee using an ST graft, followed by a similar procedure on the right knee one year later. ST tissue that would have been discarded during each procedure was harvested and used. The bone of the patient's legs grew approximately 8 cm during the one-year period. The obtained tissues were immunostained and microscopically observed to evaluate the area content of type I and III collagen. The area content of type I collagen in STs collected from the patient was 66%. The area content of type I collagen increased rapidly to 95% one year later. A comparison of the two STs obtained from the patient in the first half of their 10th year showed that the type I collagen content of the STs increased rapidly over one year. This fact may provide a preliminary insight into the prevention of re-injury when selecting the autograft for anterior cruciate ligament (ACL) reconstruction in adolescent patients.

Anterior Cruciate Ligament Rupture: Evidence-Based Concepts on Reconstruction, Repair and Future Developments.

The anterior cruciate ligament (ACL) is a vital but frequently injured structure. An ACL injury can result in dysfunction, meniscal injuries, and the early onset of osteoarthritis. This article aims to discuss favourable reconstruction techniques through a literature review with consideration for novel methods in order to identify superior methods that provide a patient's return to function. Current surgical options include reconstruction using different types of autografts and allografts.

Development and validation of a novel method for assessing physical activity profiles after anterior cruciate ligament reconstruction: The Sports and Physical Activity scale.

OBJECTIVES: To describe and evaluate the preliminary validity of a novel scoring system for assessing the physical activity of patients after anterior cruciate ligament (ACL) reconstruction. METHODS: The Sports and Physical Activity (SPA) scale consists of thirty options of sports and physical activities, followed by four frequency options for each option selected. Factors used to develop the scoring system were frequency of participation and intensity of the sports or physical activities. Possible scores ranged from a low of 0 to a high of 24. The scale was assessed for validity and responsiveness. RESULTS: The study cohort included 418 primary ACL reconstructed patients 2 years after surgery, and a subgroup of 183 patient 5 years after surgery. The mean and median SPA scores for the cohort were 12.35 ( â€‹± â€‹6.95) and 12, respectively. There was no statistically significant difference between the scores of men and women (U â€‹= â€‹21,541.0, p â€‹= â€‹0.921). The SPA scale had a small but statistically significant inverse correlation with age (rs â€‹= â€‹-0.2, p = <0.001), indicating divergent validity. Patients who had returned to sport had a statistically significantly higher score (U â€‹= â€‹21593.5, p = <0.001), and there was a statistically significant difference between scores of the three current sports status groups (H â€‹= â€‹19.99, p value = <0.001) indicating convergent validity. Construct validity was indicated with a statistically significant correlation with the Marx scale (rs â€‹= â€‹0.422, p value= <0.001). In a subgroup (n â€‹= â€‹183) of the patient sample, comparison between scores at 2-years (13.27 â€‹± â€‹7.02) and 5-years (12.11 â€‹± â€‹7.88) found a statistically significant decline (p= <0.001). However, this decline was smaller than the decline seen in the Marx score between 2 and 5 years (11.11 â€‹± â€‹4.07 and 9.30 â€‹± â€‹4.52 p= <0.001). CONCLUSION: Preliminary validity was found for the SPA scale. Women and men were found to be participating in a similar amount of activity 2 years post ACL reconstruction, despite return to sport differences between men and women being well documented. The scores of the SPA scale showed a statistically significant decrease over time with a negligible effect size. LEVEL OF EVIDENCE: III.

In the medium term, more than half of males report kinesiophobia after anterior cruciate ligament reconstruction.

OBJECTIVES: Anterior cruciate ligament rupture is a serious trauma with long-term consequences for the patient. Psychological and physiological factors may negatively affect patient recovery after anterior cruciate ligament reconstruction (ACLR), and development of kinesiophobia is possible. The aim of this study was to examine the presence of kinesiophobia and lower-leg muscle strength recovery in both sexes after ACLR. METHODS: 140 ACLR patients agreed to participate in the study. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK). The Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS) and Tegner Activity Scale (TAS) were used for patient-related outcome measurements. In both legs quadriceps and hamstring muscle strength at 60°/s and 180°/s were measured with an isokinetic dynamometer. For dynamic balance and leg function, the Y-balance test and single-leg hop test were used. RESULTS: 100 (71%) males and 40 (29%) females-mean age 32.5 (±8.3)-were examined 5.5 (±1.25) years after ACLR. 68/140 patients (48.6%) reported a TSK kinesiophobia score equal to or higher than 37 points: 54/100 (54%) males and 14/40 (35%) females (p â€‹= â€‹0.04). Patients with kinesiophobia had significantly lower KOOS values (p â€‹< â€‹0.001). In terms of the TAS no significant differences were found between those with or without kinesiophobia. Knee strength deficiency at 180°/sec and 60°/sec was significantly higher in the kinesiophobia group in knee extension in males (p â€‹= â€‹0.009) and knee flexion in females (p â€‹= â€‹0.001). Normalized body weight isokinetic average peak torque strength tests were significantly better in males compared to females in both groups (p â€‹< â€‹0.001). CONCLUSION: Both sexes reported high rates of kinesiophobia, but males are at higher risk of developing kinesiophobia than females in the medium term after ACLR. Furthermore, patients with kinesiophobia have significantly lower total KOOS scores, and females were significantly weaker than males in knee flexion and extension according to normalized body weight muscle strength tests. Also, a longer time from injury to surgery increases the risk of kinesiophobia in females. LEVEL OF EVIDENCE: Level IV. TYPE OF STUDY: Retrospective case series study. CLINICAL TRIAL REGISTRATION: Trial registration in ClinicalTrials.gov. Identifier: NCT05762809.