Two-year postoperative MRI appearances of anterior cruciate ligament hamstrings autografts are not correlated with functional outcomes, anterior laxity, or patient age.

AIMS: MRI has been suggested as an objective method of assessing anterior crucate ligament (ACL) graft "ligamentization" after reconstruction. It has been proposed that the MRI appearances could be used as an indicator of graft maturity and used as part of a return-to-sport assessment. The aim of this study was to evaluate the correlation between MRI graft signal and postoperative functional scores, anterior knee laxity, and patient age at operation. METHODS: A consecutive cohort of 149 patients who had undergone semitendinosus autograft ACL reconstruction, using femoral and tibial adjustable loop fixations, were evaluated retrospectively postoperatively at two years. All underwent MRI analysis of the ACL graft, performed using signal-to-noise quotient (SNQ) and the Howell score. Functional outcome scores (Lysholm, Tegner, International Knee Documentation Committee (IKDC) subjective, and IKDC objective) were obtained and all patients underwent instrumented side-to-side anterior laxity differential laxity testing. RESULTS: Two-year postoperative mean outcome scores were: Tegner 6.5 (2 to 10); Lysholm 89.8 (SD 10.4; 52 to 100); and IKDC subjective 86.8 (SD 11.8; 51 to 100). The objective IKDC score was 86% A (128 patients), 13% B (19 patients), and 1% C (two patients). Mean side-to-side anterior laxity difference (134 N force) was 0.6 mm (SD 1.8; -4.1 to 5.6). Mean graft SNQ was 2.0 (SD 3.5; -14 to 17). Graft Howell scores were I (61%, 91 patients), II (25%, 37 patients), III (13%, 19 patients), and IV (1%, two patients). There was no correlation between either Howell score or SNQ with instrumented anterior or Lysholm, Tegner, and IKDC scores, nor was any correlation found between patient age and ACL graft SNQ or Howell score. CONCLUSION: The two-year postoperative MRI appearances of four-strand, semitendinosus ACL autografts (as measured by SNQ and Howell score) do not appear to have a relationship with postoperative functional scores, instrumented anterior laxity, or patient age at surgery. Other tools for analysis of graft maturity should be developed. Cite this article: Bone Jt Open 2021;2(8):569-575.

Navigated intra-articular ACL reconstruction with additional extra-articular tenodesis using the same hamstring graft.

PURPOSE: In some complex cases, standard anterior cruciate ligament reconstruction is not enough and could lead to a new failure. Lateral extra-articular reconstruction should be added. We describe a new mini-invasive technique using the same hamstring graft for intra-articular reconstruction and lateral tenodesis, optimized with navigation. METHOD: This arthroscopic technique is precisely described, different graft setting are possible, four strands graft inside the joint and two strands for the tenodesis or two strands graft for all the whole graft. As the lateral tenodesis is not anatomic, tunnel placement could be tricky. The use of navigation system is a real advantage for this technique with optimal tunnels placement. RESULTS: No results are given. CONCLUSION: This technique is comparable to others reported previously, showing a clinical advantage and no increasing of osteoarthritis. The use of the same graft avoids collateral damages, and navigation improves the graft placement.

Computer-assisted, anatomic, double-bundle anterior cruciate ligament reconstruction.

Accurate placement of the separate anteromedial bundle and posterolateral bundle bone tunnels required for anatomic, double-bundle anterior cruciate ligament reconstruction remains a concern, and the advantages the technique confers, in terms of laxity control, may be lost with incorrect tunnel positioning. We present an image-free, computer-assisted, double-bundle reconstruction technique using specifically designed software. This assists tunnel positioning and allows the behavior of virtual anteromedial and posterolateral bundle grafts to be modeled. Data on graft length change, obliquity, and possible notch impingement are fed back to the surgeon via the interactive, touch-screen navigation display. Tunnel length and obliquity may also be determined. In addition, the software allows preoperative and postoperative navigated laxity analysis, which includes objective measurement of pivot shift.