Primary Versus Revision ACL Reconstruction Using Quadriceps Autograft: A Matched-Control Cohort Study.

Background: The incidence of anterior cruciate ligament (ACL) reconstruction is increasing, and quadriceps tendon (QT) autograft is gaining popularity for both primary and revision ACL reconstruction. Purpose: To evaluate the differences in the patient-reported functional outcomes, concomitant injuries, and graft failure in primary versus revision ACL surgery using QT autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 376 patients with primary ACL reconstruction and 138 patients with revision ACL reconstruction were retrospectively retrieved from a prospectively collected ACL registry. A minimally invasive technique was used for QT autograft harvesting. The surgical procedure and rehabilitation protocol were identical in both groups. To maintain a homogeneous cohort for the study, the groups were matched by age, sex, and preinjury outcome scores (Lysholm knee score, Tegner activity level, and visual analog scale [VAS] for pain). Initial baseline assessments of outcome scores were compared with scores collected at the 2-year postoperative mark. Results: The mean age of the primary group and revision group was 32.9 ± 10.2 years (range, 18-55 years) and 32.3 ± 9.9 years (range, 19-55 years) respectively. Significant preinjury to postoperative improvements were noted in Lysholm (88.2 ± 16.4 vs 83.5 ± 15.0; P = .007) and VAS pain (0.9 ± 1.3 vs 1.5 ± 1.6; P = .001) scores after primary ACL reconstruction compared with revision reconstruction. However, no significant difference was found in Tegner activity level (6.7 ± 1.8 vs 5.9 ± 1.8; P > .430). Primary ACL injury was associated with significantly higher concomitant medial collateral ligament injuries (P = .019), while the revision group was associated with significantly higher concomitant cartilage (P = .001) and meniscal (P = .003) injuries. A significantly higher graft failure rate was noted in the revision group compared with the primary ACL reconstruction group (13.0% vs 5.6%; P = .005). Conclusion: Both primary and revision ACL reconstruction with QT autograft had acceptable functional outcomes. The primary group had better outcomes than the revision group, possibly due to the lower prevalence of meniscal and cartilage injuries in the primary group compared with the revision group. The revision group was associated with higher graft failure than the primary group. QT autograft is a viable graft choice for both primary and revision ACL reconstruction.

Quadriceps autograft is a viable graft choice for arthroscopic ACL reconstruction in patients over 50 years of age.

PURPOSE: The purpose of this study was to evaluate the patient-reported outcomes, graft failure, quadriceps rupture and sports preference after arthroscopic ACL reconstruction in patients older than 50 years who underwent arthroscopic ACL reconstruction with a quadriceps tendon (QT) autograft. METHODS: Between 2010 and 2020, prospectively collected data were obtained from an institutional database. Patients older than 50 years with primary arthroscopic ACL reconstruction and a minimum of 2 years of follow-up were included. Patients undergoing a revision ACL reconstruction or undergoing a primary ACL reconstruction using a graft other than a QT autograft, and patients with a contralateral knee injury or osteoarthritis (Ahlbäck stage 2 or higher) were excluded. A minimally invasive technique was used for QT autograft harvesting. Patients were evaluated for pre-injury and 2-year follow-up Lysholm knee score, Tegner activity level, Visual Analog Scale (VAS) for pain, graft failure, quadriceps tendon rupture, and return to sport. RESULTS: A total of 57 patients were included in the study. The mean age of the cohort was 54.9 ± 5.2 (range 50-75). Of the 57 reconstructions, 16 (28%) were isolated ACL reconstructions, while 41 (72%) were complex reconstructions (concomitant meniscus, cartilage and/or collateral ligament injuries). At the 2-year follow-up Lysholm knee score, Tegner activity level and VAS for pain improved to pre-injury level and no significant difference was noted between pre-injury and 2-year follow-up functional scores (n.s.). No case of graft failure or quadriceps tendon rupture was reported. No significant difference was noted in the pre-injury and postoperative sports preference (n.s.) and all patients return to their desired sports activity. CONCLUSION: Arthroscopic ACL reconstruction by using QT autograft in highly active older patients provides satisfactory patient-reported functional outcomes and allows recovery of the pre-injury level of activity. QT autograft is a good graft option in patients older than 50 years. LEVEL OF EVIDENCE: Level IV.

Total knee arthroplasty improves sports activity and the patient-reported functional outcome at mid-term follow-up.

PURPOSE: The purpose of this study was to assess (1) sports participation and preference for the type of sports activity after TKA, (2) mid-term functional outcome and activity level, (3) correlation of different age groups with activity level and functional outcomes, and (4) mid-term survivorship of the prosthesis. METHODS: A retrospective review of prospectively collected data was performed. 182 patients were included who underwent primary TKA between January 2010 and December 2016. Inclusion criteria were symptomatic knee osteoarthritis, age 50-90 years, and with a minimum of 5-year follow-up after TKA. Patients with rheumatoid arthritis and revision TKA were excluded. Sports participation and sports preference, Oxford Knee Score (OKS), Tegner Activity Level, and Visual Analogue Scale (VAS) for pain were recorded pre- and postoperatively at 6 months, 1 year, 2 years, and 5 years. The patient cohort was subdivided according to age groups; activity levels, patient-reported outcomes, and improvement in knee pain were correlated with these age groups. Kaplan-Meier curves were used to investigate survivorship at a minimum of 5 years. RESULTS: The mean age of the cohort was 75.6 ± 7.2 years (range 52-89). Significant improvement was noted in sports participation (p < 0.003). After TKA, there was no change in the preference for sports and none of the patients had to discontinue their sporting activity. OKS improved significantly at all follow-up time points compared to the preoperative score (p < .0001). Patients' sports and physical activity improved significantly at 1 year compared to the preoperative activity level (p < 0.001). Although the Tegner activity level improved over time, this improvement was not significant (NS), while it was significantly higher in males than in females (p < 0.004). Significant improvement was found in the VAS for pain at all follow-up time points compared to the preoperative score (p < .0001). Survivorship was found to be 100% at a 5-year follow-up. CONCLUSION: After TKA, patients can be able to return to sporting activity or even perform better than before surgery. Maximum improvement was noted in the first post-operative year. The male and younger groups perform better than the female and older groups. Sports and physical activity do not negatively impact survivorship of the knee prosthesis at mid-term follow-up and all patients are encouraged to take up sports participation after their TKA. LEVEL OF EVIDENCE: Level 3.

Revision ACL reconstruction using quadriceps, hamstring and patellar tendon autografts leads to similar functional outcomes but hamstring graft has a higher tendency of graft failure.

PURPOSE: The purpose of this study was to evaluate the differences in the patient-reported functional outcomes, and graft failure in revision ACL reconstruction using quadriceps tendon (QT), Hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts. METHODS: Between 2010 and 2020, 97 patients who underwent revision ACL reconstruction (40 patients received a QT, 26 an HT and 31 a BPTB graft) met the inclusion criteria. Pre-injury and at 2-year postoperatively patients were evaluated for patient-reported functional outcomes; Lysholm knee score, Tegner activity level and VAS (visual analogue scale) for pain; and graft failure. Patient-reported outcomes and graft failure were compared between the QT, HT and BPTB groups. The patients with graft failure were not included for outcome analysis at 2-years of follow-up. RESULTS: All three revision groups with QT, HT and BPTB autograft did not differ significantly in terms of age, sex, time from injury to surgery, concomitant injuries and single-stage or double-stage procedures (n.s.). No significant difference was found in the pre-injury patient-reported outcome; Lysholm knee score, Tegner activity and VAS for pain (n.s.) between the three groups. At the 2-year follow-up functional outcomes improved in all three groups and all the patients returned to pre-injury activity level; however, no significant difference was found in functional outcomes at the 2-year follow-up between the three groups (n.s.). Graft failure occurred in 4 (10%), 5 (19%) and 3 (10%) patients of QT, HT and BPTB groups, respectively. However, the rate of failure did not differ significantly between groups. CONCLUSION: All three autografts (QT, HT and BPTB) demonstrated satisfactory patient-reported outcomes in revision ACL reconstruction. Compared with QT and BPTB grafts, HT graft showed a higher tendency for failure rates. With the increasing incidence of revision ACL reconstruction, surgeons should be aware of all the available graft options. The findings of this study will assist the surgeons in the graft selection for revision ACL reconstruction. LEVEL OF EVIDENCE: Level III.

No difference in sports participation and patient-reported functional outcomes between total knee arthroplasty and unicompartmental knee arthroplasty at minimum 2-year follow-up in a matched control study.

PURPOSE: The purpose of this study was to compare (1) sports participation and type of sports activity between TKA and UKA patients; (2) functional outcome and activity level between TKA and UKA; and (3) survivorship of the prosthesis in both the groups. METHODS: Prospectively collected data were obtained from an arthroplasty database to identify patients who underwent primary TKA and UKA. Both the cohorts of TKA and UKA were matched, controlling for age, sex, BMI and preoperative patient-reported outcomes, which include Oxford Knee Score (OKS), Tegner activity level, and visual analog scale (VAS) for pain score. After matching the two groups, 287 TKA and 69 UKA cases were available to be included in the study. Patients were evaluated pre- and postoperatively at 2 years for sports participation and sports preference, patient-reported outcomes, activity levels, and improvement in knee pain. RESULTS: The mean age of the TKA and UKA groups were 75.7 ± 8.1 and 74.2 ± 8.8, respectively. There was no significant difference between the two groups concerning the demographic variables. Significant improvement was noted in the weekly sports participation at the final follow-up compared to preoperative sports participation in both the TKA and UKA groups (p < 0.05). All patients were able to return to their desired sporting activity. No significant difference was noted between the two groups in sports participation preoperatively and postoperatively (p > 0.05). OKS, Tegner activity level and VAS for pain demonstrated a significant improvement from preoperative to 2 years postoperatively (p < 0.05). However, preoperative and postoperative patient-reported outcomes did not differ significantly between the TKA and UKA groups (p > 0.05). No case of revision surgery was found at a 2-year follow-up in both groups. CONCLUSION: Traditionally, in isolated medial compartment osteoarthritis, UKA has been considered to be the procedure with better functional outcomes, but the current study demonstrates that when confounding factors are controlled, both TKA and UKA are effective, and offer similar functional outcomes and result in similar improvement in sports participation. These findings will be helpful to counsel the patients to choose the best suitable operative procedure between UKA and TKA. LEVEL OF EVIDENCE: Level 3.

Health literacy and clinical outcomes in patients with total knee arthroplasty in different rehabilitation settings: An exploratory prospective observational study.

BACKGROUND: Limited health literacy is associated with negative clinical outcomes. Although research on health literacy has increased in recent years, there is still a lack of evidence for orthopaedic patients undergoing joint replacement and in the rehabilitation sector. OBJECTIVES: The aims of this study were to assess health literacy of patients undergoing total knee arthroplasty (TKA) and to observe its course during rehabilitation. Furthermore, we aimed to investigate associations between health literacy and clinical outcomes as well as differences regarding rehabilitation settings. METHODS: In this prospective observational study, data about (n = 92) patients' health literacy and clinical outcomes were collected. Baseline assessments were conducted preoperatively (T0) and followed-up after three (T1) and six (T2) months. Health literacy was assessed with the European Health Literacy Questionnaire, pain scores, functional restrictions and activity levels with standardised patient-reported outcome measures (PROMs). Subgroup analyses were conducted regarding inpatient and outpatient rehabilitation. RESULTS: Out of 92 patients, 77 completed postoperative rehabilitation between T0 and T1. Health literacy improved from T0 to T1 (p < 0.001) and subsequently remained constant until T2. Although the study showed an average improvement in health literacy scores in post-discharge rehabilitation, subgroup analyses indicated that patients did not achieve higher levels of health literacy. Pain scores were higher in patients undergoing outpatient rehabilitation (p = 0.022). No differences were found in other outcomes regarding rehabilitation settings and health literacy. CONCLUSIONS: Based on our results, there seems to be no association between health literacy and clinical outcomes. Furthermore, the results regarding health literacy over the rehabilitation period indicated a need for enhancement of educational strategies to strengthen health literacy in the context of inpatient and outpatient orthopaedic rehabilitation.

Return to Sports after Anterior Cruciate Ligament Injury: a Matched-Pair Analysis of Repair with Internal Brace and Reconstruction Using Hamstring or Quadriceps Tendons.

PURPOSE: The purpose of this study was to evaluate sports activity before anterior cruciate ligament (ACL) injury and after surgical treatment of ACL rupture comparing ACL repair with an Internal Brace to ACL reconstruction using either a hamstring (HT) or quadriceps tendon (QT) autograft. METHODS: Between 12/2015 and 10/2016, we recruited 69 patients with a mean age of 33.4 years for a matched-pair analysis. Twenty-four patients who underwent Internal Brace reconstruction were matched according to age (±â€Š5 years), gender, Tegner activity scale (±â€Š1), BMI (±â€Š1) and concomitant injuries with 25 patients who had undergone HT reconstruction and 20 patients who had undergone QT reconstruction. The minimum follow-up was 12 months. RESULTS: Overall, the return-to-sports rate was 91.3 %. There were no significant differences (p ≥ 0.05) in the number of sports disciplines and the time before return to sports within or among the groups. Overall and within the groups, the level of sports participation did not change significantly (p ≥ 0.05) postoperatively. The patients' sense of well-being was excellent after either ACL repair with an Internal Brace or ACL reconstruction with autologous HT or QT. CONCLUSION: At short-term follow-up, ACL repair using an Internal Brace enables sports activity and provides a sense of well-being similar to that of classic ACL reconstruction using hamstring or quadriceps tendon autografts in a selected patient population. LEVEL OF EVIDENCE: Level III Retrospective comparative study.

Sonographic evaluation of lateral meniscal extrusion: implementation and validation.

INTRODUCTION: Meniscal extrusion (ME) is an important indicator of and prognostic factor for various knee pathologies. To date, no standardized protocol for the ultrasound-based examination of lateral ME exists. The purpose of the present study was to test the reliability and validity of lateral ME measurements using a standardized ultrasound-based examination protocol. MATERIALS AND METHODS: A group consisting of 11 healthy volunteers (Group I, male and female, 18-45 years) as well as a group of 10 consecutive patients who had undergone all-inside lateral meniscal radial tear repair were included (Group II, male and female, 23-43 years). Lateral ME, the main outcome parameter, was measured by ultrasound (US; both groups) and magnetic resonance imaging (MRI; Group II only). Both knees of all subjects were examined in an unloaded state and under axial compression of the knee (50% of body weight). Repeated measurements obtained in Group I by 2 observers were used for reliability testing, and the validity of US was assessed through comparison with MRI data (Group II). RESULTS: A total of 66 US images of Group I, obtained by each observer, were analyzed for reliability testing. Forty US and MR images of Group II were assessed for validation. Results showed good interrater (ICC = 0.904) and excellent intrarater (ICC = 0.942) reliability of US-based measurements of lateral ME. Agreement with MRI results was poor (ICC = 0.439), with US systematically overestimating results by 1.1 mm on average. CONCLUSIONS: Ultrasound is a reliable, quick and cost-effective technique for lateral ME measurement, but results are not readily comparable with MRI. TRIAL REGISTRATION: The study was registered in the European Union Clinical Trials Register (EudraCT-Number: 2017-005037-24).

Anterior Cruciate Ligament Reconstructions With Quadriceps Tendon Autograft Result in Lower Graft Rupture Rates but Similar Patient-Reported Outcomes as Compared With Hamstring Tendon Autograft: A Comparison of 875 Patients.

BACKGROUND: Graft rupture is a devastating outcome after anterior cruciate ligament (ACL) reconstruction (ACLR). Little is known about graft rupture rates as well as clinical and functional outcomes after ACLR with quadriceps tendon (QT) autografts. PURPOSE: To compare QT with hamstring tendon (HT) autografts in terms of the rates of graft and contralateral ACL rupture as well as patient-reported outcome measures. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: All primary ACLRs performed between 2010 and 2016 were followed prospectively for 24 months through the recording of graft ruptures and contralateral ACL injuries as well as patient-administered questionnaires. RESULTS: A total of 875 patients were included in the study. Three factors-graft type, age group, and activity level-had a significant value in predicting the need for revision surgery. The odds of revision surgery were 5.5 times greater in children younger than 15 years than in adults older than 45 years, 3.6 times greater in patients with high activity levels than low activity levels, and 2.7 times greater in patients receiving an HT autograft as compared with a QT autograft. A significantly higher rate of ipsilateral graft ruptures versus contralateral ACL injuries was observed in the HT group (4.9% vs 2.3%; odds ratio, 2.1; P = .01) but not in the QT group (2.8% vs 2.3%). The difference in the ratios of graft and contralateral ACL ruptures was even more pronounced in highly active patients treated with HT autografts (11.1% vs 4.2%; odds ratio, 2.6; P = .01) as compared with QT autografts (5.0% vs 2.8%; P = .48). Two-year measures of Lysholm scores (mean ± SD: QT, 86.0 ± 22.3; HT, 89.4 ± 16.4) and Tegner activity scores (QT, 6.1 ± 2.0; HT, 5.7 ± 1.9) as well as visual analog scale pain (QT, 0.8 ± 1.3; HT, 0.7 ± 1.1) did not differ between grafts. CONCLUSION: Graft choice does not influence clinical and functional outcomes 2 years after ACLR. However, 3 factors-graft type, age group, and activity level-have a significant value in predicting the need for revision surgery. Patients treated with HT autografts have a significantly higher, activity-dependent risk of revision surgery and experience more ipsilateral graft ruptures than subsequent contralateral ACL injuries when compared with patients treated with QT autografts. Young age and high activity level are significant predictors for ACL revision surgery.

Quantitative Evaluation of Dynamic Lateral Meniscal Extrusion After Radial Tear Repair.

BACKGROUND: Radial tears of the lateral meniscus frequently accompany acute anterior cruciate ligament (ACL) injuries and lead to increased joint stress and pathological meniscal extrusion (ME). The dynamic behavior of the lateral meniscus after radial tear repair with respect to ME has not been described. PURPOSE: To quantitatively assess dynamic lateral ME after all-inside radial tear repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients who underwent ACL reconstruction and all-inside radial tear repair of the lateral meniscus and had no history of contralateral knee injuries were included. Magnetic resonance imaging scans were acquired in loaded (50% of body weight) and unloaded conditions of both the injured and noninjured knees. A custom-made pneumatically driven knee brace was used for standardized knee positioning in 10° of flexion and with axial load application. Quantitative measures included the absolute lateral ME, meniscal body extrusion ratio, and Δ extrusion. Preoperative and postoperative unloaded extrusion data were compared by paired t tests. For postoperative data, the concomitant influence of the factors "leg" and "condition" were assessed through factorial analyses of variance. RESULTS: A total of 10 patients with a mean follow-up of 47.9 months were enrolled. The intraclass correlation coefficient (ICC) confirmed good interrater reliability (ICC, 0.898) and excellent intrarater reliability (ICC, 0.976). In the unloaded injured leg, all-inside repair reduced ME from 3.15 ± 1.07 mm to 2.13 ± 0.61 mm (-32.4%; P = .033). Overall, load application led to a significant increase in ME (+0.34 mm [+21.8%]; P = .029). Significantly greater ME was observed in the injured knee (+1.10 mm [+93.2%]; P = .001) than in the noninjured knee. The condition × leg interaction was not significant (P = .795), suggesting that the compression-associated increase in ME did not differ significantly between the injured and noninjured knees. CONCLUSION: Lateral ME depends on the knee status and loading condition. All-inside repair of radial meniscal tears led to a reduction of extrusion with no alteration in dynamic lateral ME. Meniscus-preserving therapy is recommended in the case of a radial lateral meniscal tear to preserve its dynamic behavior.

Injuries in Austrian football players: Are they an issue?

PURPOSE AND HYPOTHESIS: With its load characteristics, the team sport of football places high physical demands on players and thus is associated with a high risk of injury. Therefore, the purpose of this study was to collect information about injuries suffered by football players in Austria during training or matches to enable participating clubs to learn about injuries. METHODS: One hundred and forty-five players from seven teams with age ranging from 16 to 38 years participated in this prospective study during the 2015/16 season. Injury surveillance was conducted according to the consensus statement of Fuller et al. (2006). RESULTS: During the period of study, a total of 83 injuries were recorded, which represents an overall incidence of 4.5 injuries/1000 hours (2.3 injuries/1000 hours in training and 14.2 injuries/1000 hours of match play). There was a significant difference for older age in injured players compared to non-injured players (p = 0.019). No differences in BMI were detected (p = 0.427). Ninety-four percent of all injuries occurred in the lower extremity, with the thigh (25.8 %), ankle (19.3 %) and knee (13.3 %) being the major locations of injuries. Muscle tendon injuries were the most common non-contact injuries (78.9 %). CONCLUSION: Lower extremity injuries are the most common injury in Austrian football. The incidence of muscle injuries is high, especially injuries of the posterior thigh. There are promising preventive strategies for the most common injury types. The implementation of these strategies is essential in order to reduce the incidence or recurrence of these football injuries.

Sports activity is maintained or increased following total knee arthroplasty.

PURPOSE: The purpose of this study was to investigate sports activities and functional abilities in patients following total knee arthroplasty (TKA). It was hypothesized that patients who had undergone TKA would return to a higher activity level as that experienced preoperatively. METHODS: Two hundred patients were included in this prospective single-cohort study. All the patients completed subjective questionnaires (Tegner Activity Level, Oxford Knee Score, Visual Analog Scale for pain) prior to surgery as well as at 6, 12, and 24 months postoperatively. Additionally, sports behaviour was evaluated. Sports frequency was divided into four categories: more than 5 times a week, 2-3 times a week, occasionally, and no sports activities. Additionally, the patients were asked to state their three favourite summer and winter sports. RESULTS: All patient-reported outcome scores improved significantly over time (p ≤ 0.005). The Tegner Activity Level increased significantly from the preoperative state to 24 months postsurgery (p = 0.005). Six months after surgery, 43% of the patients returned to the same and 35% to a higher Tegner Activity Level than prior to surgery. Gender-related differences were observed for the Tegner Activity Level showing a higher activity level for the male than for the female patients. Overall, 24 months postsurgery 83% of the patients practiced sports in comparison with 79% prior to surgery. CONCLUSIONS: Following TKA, the patients were able to increase sports performance, while pain was reduced. Therefore, patients who want to continue their desired sports may safely consider TKA. LEVEL OF EVIDENCE: II.

There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study.

PURPOSE: Graft choice for anterior cruciate ligament (ACL) reconstruction is crucial, however the optimal graft source remains a topic of controversy. The purpose of this study is to compare subjective and functional patient-reported outcomes (PRO) after single-bundle ACL reconstruction using quadriceps tendon (QT) or hamstring tendon (HT) autografts for single-bundle ACL reconstruction. We hypothesize that there is no difference in patient-reported functional outcomes after ACL reconstruction using either HT- or QT autograft. METHODS: All data were extracted from a prospectively collected ACL registry. A total of 80 patients with at least 2-year follow-up were included in this study. A total of 40 patients with primary ACL reconstruction using a QT autograft harvested via a minimally invasive technique were matched by sex, age and pre-injury Tegner and Lysholm score to 40 patients who received HT autografts. Subjective and functional PRO scores including Lysholm score, Tegner activity level and visual analogue scale for pain were obtained at 6, 12 and 24 months after index surgery. RESULTS: No significant difference between the QT and the HT group was seen at any follow-up in regard to any of the PRO scores for function or pain. 24 months post-surgery the mean Tegner activity score of the HT group was significantly (p = 0.04) lower compared to the pre-injury status. At final follow-up, 27 patients (67.5%) in the QT group and 32 patients (80.0%) in the HT returned to their pre-injury activity level (n.s.). A total of 37 patients (92.5%) of the QT cohort and 35 patients (87.5%) of the HT cohort reported "good" or "excellent" results according to the Lysholm score (n.s.). "No pain" or "slight pain" during severe exertion was reported by 33 patients (82.5%) with QT autograft and 28 patients (82.4%) with HT autograft (n.s.). CONCLUSION: There is no significant difference between PRO 2 years post-operative using either QT or HT autografts. Both QT and HT grafts show acceptable and comparable PRO scores making the QT a reliable graft alternative to HT for primary ACL reconstruction. LEVEL OF EVIDENCE: III.

Higher hamstring-to-quadriceps isokinetic strength ratio during the first post-operative months in patients with quadriceps tendon compared to hamstring tendon graft following ACL reconstruction.

PURPOSE: The aim of this study was to compare isokinetic quadriceps and hamstring muscle strength in patients following anterior cruciate ligament (ACL) reconstruction who received either hamstring (HT) or quadriceps (QT) tendon autografts at two time intervals within the first year after surgery. METHODS: One hundred twenty-four patients, 81 males (age 22.0 ± 6.2 years) and 43 females (age 20.9 ± 8.7 years), participated in this study. ACL reconstruction was performed with either quadriceps tendon autografts (QT; n = 61) or hamstring tendon autografts (HT; n = 63). Two isokinetic muscle strength tests (t1: 5.5 ± 1.2 months; t2: 7.6 ± 1.6 months) were performed at an angular velocity of 60°/s in both the injured and contralateral knees. An independent t test as well as a two-factor analysis of variance with repeated measurements was used. The significance level was set at p < 0.05. RESULTS: A statistically significant lower knee extensor strength was observed in the QT group within one year after surgery (p < 0.001). Additionally, data showed a significant higher H/Q ratio in QT patients compared to the HT group at t1 (p < 0.001) and t2 (p = 0.001) as well as a significant effect over time (p < 0.001) and interaction effect of time and graft (p = 0.007). Side-to-side values for extensor muscle strength were significantly (p < 0.001) greater in HT graft patients, while QT patients showed significantly (p < 0.001) greater values for flexor muscle strength at both time points of isokinetic testing, respectively. CONCLUSION: The results of this study indicate that graft choice has an impact on extensor strength in the first months after ACL reconstruction; however, there is no impact on flexor strength. The finding of a higher H/Q ratio in patients with QT grafts within the first months following surgery is possibly of clinical relevance. This may potentially be associated with lower stress on the maturing ACL graft. Furthermore, normal thigh strength can be restored over time. LEVEL OF EVIDENCE: III.

Impact of surgical timing on the outcome of anterior cruciate ligament reconstruction.

PURPOSE: The purpose of the present study is the comparison of acute ACL reconstruction with or without meniscus repair within 48 h after injury and a delayed surgery during the inflammation-free interval. It was hypothesized that acute ACL reconstruction results in inferior patient reported outcomes and higher frequency of range of motion deficits. METHODS: The effect of acute (within 48 h) and delayed (during the inflammation-free interval) ACL surgery was prospectively studied on 160 consecutive patients with ACL injury between January 2010 and December 2011. Subgroup analyses were performed to evaluate patients with an additional meniscus repair separately from isolated ACL surgeries. During the study period, partial meniscectomies were recorded to evaluate time dependent meniscus reparability. Patient reported outcomes, objective IKDC and manual stability measurements were documented during the 24-month follow-up period. The Pearson Chi-squared test was used to evaluate objective outcome measures. The Mann-Whitney U test was performed to analyse the results of patient reported outcomes. Statistical significance was set at p < 0.05. RESULTS: For patients who underwent isolated ACL reconstruction, no statistical significant difference was observed at any time point regarding objective and subjective outcome measures. Significantly fewer patients who underwent acute combined ACL reconstruction and meniscus repair had an extension deficit between 3° and 5° at 12 months following surgery (3.7 vs. 22.2 %, p < 0.05). No difference regarding cyclops removal, re-injury of ACL or meniscus was found between the two surgical timing groups. Further, surgical timing did not influence the reparability of the meniscus. CONCLUSION: An acute ACL reconstruction within 48 h is preferable in highly active patients or competitive athletes. LEVEL OF EVIDENCE: Prospective cohort study, Level II.

The effects of a 3-month controlled hiking programme on the functional abilities of patients following total knee arthroplasty: a prospective, randomized trial.

PURPOSE AND HYPOTHESIS: Improvements in pain, function and sports activity are the main goals of patients following total knee arthroplasty (TKA). Participation in sports has become an increasingly important contributor to patients' quality of life (QoL). Hiking is one of the most popular summer activities among elderly people in alpine regions. Consequently, this randomized controlled trial investigates the impact of a 3-month guided hiking programme on patients' functional abilities and QoL following TKA. It was hypothesized that patients who participate in this programme would demonstrate improvements in functional and QoL parameters compared with a control group. METHODS: Forty-eight TKA patients were included and randomized into either the intervention group (IG; n = 25) or the control group (CG; n = 23). The IG participated in a 3-month hiking programme (2-3 times a week), whereas the CG performed activities of daily living. The stair climb test (SCT), QoL questionnaires and isokinetic force measurements were completed at three time points (i.e. pre-test, post-test, retention-test). ANOVAs for repeated measurements were conducted for the SCT results. The Friedman test and the Mann-Whitney U test were performed for the QoL parameters. RESULTS: After the 3-month hiking programme, the IG achieved faster overall walking times on the SCT. The time decreased from 4.3 ± 0.6 s (pre-test) to 3.6 ± 0.4 s (post-test) for the stair ascent (p = 0.060) and from 3.6 ± 0.6 s (pre-test) to 3.2 ± 0.5 s (post-test) for the stair descent (p = 0.036). The IG showed significant improvement on some of the subscales of the Knee Injury and Osteoarthritis Outcome Score from pre-test to retention-test (p < 0.01). In the CG, no significant changes were observed (n.s.). CONCLUSIONS: The results indicate moderate improvement in the functional abilities and QoL of TKA patients who participated in a 3-month guided hiking programme compared with the patients in the CG. Hiking did not have any acute detrimental effects on the TKA patients during this study period. LEVEL OF EVIDENCE: II.