Search

Background: Bony morphology is central to the pathomechanism of femoroacetabular impingement syndrome (FAIS), however isolated radiographic measures poorly predict symptom onset and severity. More comprehensive morphology measurement considered together with patient factors may better predict symptom presentation. This study aimed to determine the morphological parameter(s) and patient factor(s) associated with symptom age of onset and severity in FAIS. Methods: 99 participants (age 32.9 ± 10.5 years; body mass index (BMI 24.3 ± 3.1 kg/m2; 42% females) diagnosed with FAIS received standardised plain radiographs and magnetic resonance scans. Alpha angle in four radial planes (superior to anterior), acetabular version (AV), femoral torsion, lateral centre-edge, anterior centre-edge (ACEA) and femoral neck-shaft angles were measured. Age of symptom onset (age at presentation minus duration of symptoms), international Hip Outcome Tool-33 (iHOT-33) and modified UCLA activity scores were recorded. Backward stepwise regression assessed morphological parameters and patient factors (age, sex, BMI, symptom duration, annual income, private/public healthcare system accessed) to determine variables independently associated with onset age and iHOT-33 score. Results: Earlier symptom onset was associated with larger superoanterior alpha angle (p = 0.007), smaller AV (p = 0.023), lower BMI (p = 0.010) and public healthcare system access (p = 0.041) (r2 = 0.320). Worse iHOT-33 score was associated with smaller ACEA (p = 0.034), female sex (p = 0.040), worse modified UCLA activity score (p = 0.010) and public healthcare system access (p < 0.001) (r2 = 0.340). Conclusions: Age of symptom onset was chiefly predicted by femoral and acetabular bony morphology measures, whereas symptom severity predominantly by patient factors. Factors measured explained a small amount of variance in the data; additional unmeasured factors may be more influential. [ABSTRACT FROM AUTHOR]

Background: Although randomized controlled trials comparing hip arthroscopy with physical therapy for the treatment of femoroacetabular impingement (FAI) syndrome have emerged, no studies have investigated potential moderators or mediators of change in hip-related quality of life. Purpose: To explore potential moderators, mediators, and prognostic indicators of the effect of hip arthroscopy and physical therapy on change in 33-item international Hip Outcome Tool (iHOT-33) score for FAI syndrome. Study Design: Cohort study; Level of evidence, 2. Methods: Overall, 99 participants were recruited from the clinics of orthopaedic surgeons and randomly allocated to treatment with hip arthroscopy or physical therapy. Change in iHOT-33 score from baseline to 12 months was the dependent outcome for analyses of moderators, mediators, and prognostic indicators. Variables investigated as potential moderators/prognostic indicators were demographic variables, symptom duration, alpha angle, lateral center-edge angle (LCEA), Hip Osteoarthritis MRI Scoring System (HOAMS) for selected magnetic resonance imaging (MRI) features, and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) score. Potential mediators investigated were change in chosen bony morphology measures, HOAMS, and dGEMRIC score from baseline to 12 months. For hip arthroscopy, intraoperative procedures performed (femoral ostectomy ± acetabular ostectomy ± labral repair ± ligamentum teres debridement) and quality of surgery graded by a blinded surgical review panel were investigated for potential association with iHOT-33 change. For physical therapy, fidelity to the physical therapy program was investigated for potential association with iHOT-33 change. Results: A total of 81 participants were included in the final moderator/prognostic indicator analysis and 85 participants in the final mediator analysis after exclusion of those with missing data. No significant moderators or mediators of change in iHOT-33 score from baseline to 12 months were identified. Patients with smaller baseline LCEA (β = −0.82; P =.034), access to private health care (β = 12.91; P =.013), and worse baseline iHOT-33 score (β = −0.48; P <.001) had greater iHOT-33 improvement from baseline to 12 months, irrespective of treatment allocation, and thus were prognostic indicators of treatment response. Unsatisfactory treatment fidelity was associated with worse treatment response (β = −24.27; P =.013) for physical therapy. The quality of surgery and procedures performed were not associated with iHOT-33 change for hip arthroscopy (P =.460-.665 and P =.096-.824, respectively). Conclusion: No moderators or mediators of change in hip-related quality of life were identified for treatment of FAI syndrome with hip arthroscopy or physical therapy in these exploratory analyses. Patients who accessed the Australian private health care system, had smaller LCEAs, and had worse baseline iHOT-33 scores, experienced greater iHOT-33 improvement, irrespective of treatment allocation. [ABSTRACT FROM AUTHOR]

Background: Graft fixation with interference screws for anterior cruciate ligament (ACL) reconstruction is a highly successful technique. Polyether ether ketone (PEEK) is a novel thermoplastic polymer with high biocompatibility and mechanical properties that mimic native bone, and it can be imaged on computed tomography or magnetic resonance imaging (MRI) without signal flare. Purpose: To compare the clinical performance of ACL reconstruction with PEEK and titanium interference screws at 2 years and to evaluate a novel method of measuring tunnel volume. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 133 patients underwent arthroscopic ACL reconstruction with 4-strand hamstring autografts and were randomized to have titanium or PEEK interference screws for femoral and tibial tunnel fixation. At 2 years, subjective Lysholm and International Knee Documentation Committee scores were assessed and clinical examination performed. At 12 months, MRI was performed to assess graft incorporation and cyst formation, and a novel technique was employed to measure tunnel volumes. Results: There were no significant differences in graft rerupture rate, contralateral ACL rupture rate, subjective outcomes, or objective outcomes. In the titanium and PEEK groups, MRI demonstrated high overall rates of graft integration (96%-100% and 90%-93%, respectively) and ligamentization (89% and 84%) and low rates of synovitis (22% and 10%) and cyst formation (0%-18% and 13%-15%). There was a higher proportion of patients with incomplete graft integration within the femoral tunnel in the PEEK group as compared with the titanium group (10% vs 0%, P =.03); however, the authors suggest that metal artifact precluded proper assessment of the graft in the titanium group by MRI. Tunnel volumes also appeared to be equivalent in the 2 groups and were measured with a novel technique that was highly reproducible in the PEEK group secondary to the absence of flare. Conclusion: Two-year clinical analysis of PEEK interference screws for femoral and tibial fixation of ACL reconstructions showed equivalent clinical performance to titanium interference screws. Given the excellent mechanical characteristics, biological compatibility, and absence of metal artifact on MRI, PEEK has become our material of choice for interference screw fixation in ACL reconstruction. [ABSTRACT FROM AUTHOR]

Background: No standardized methodology and objective criteria currently exist to accurately and objectively assess tunnel placement and consequent graft orientation in anterior cruciate ligament (ACL) reconstruction (ACLR) through a single imaging modality. Advances in magnetic resonance imaging (MRI) technology have enabled the use of volumetric high spatial and contrast resolution proton density–weighted sequencing, which allows precise delineation of graft orientation, tunnel position, and quantitative assessment of tunnel position relationship to adjacent reproducible anatomic landmarks. Purpose: To establish an MRI protocol that would provide an accurate alternative to 3-dimensional computed tomography (3D-CT) for standardized assessment of bone tunnel placement in ACLR, as a component of assessing ACLR outcomes and to assist in presurgical planning for revision ACLR. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Twenty-four participants diagnosed with a failed ACLR underwent MRI and 3D-CT per the imaging protocols of the Sydney Orthopaedic Research Institute, in which the acquired data were converted to 3D models. The bone tunnels of the previous ACLR were then intraoperatively digitized at the tunnel aperture and along the length of the tunnel (barrel) and used as the reference standard to evaluate the accuracy of high-resolution MRI and 3D-CT. Differences in geometry between the image-based model and the reference point cloud were calculated through point-to-point comparison. Results: At the tunnel apertures, no significant differences were detected between the MRI and 3D-CT models versus the reference models for the femur (P = .9472) and tibia (P = .5779). Mean ± SD tunnel barrel deviations between MRI and 3D-CT were 0.48 ± 0.28 mm (femur) and 0.46 ± 0.27 mm (tibia). No significant differences were detected between the MRI and 3D-CT models versus the reference models for the femoral (P = .5730) and tibial (P = .3002) tunnel barrels. Conclusion: This study demonstrated that, in addition to being the optimum modality for assessment of soft tissue injury of the knee, a high-resolution 3D turbo spin echo proton density sequence can provide an accurate assessment of tunnel placement, without the use of ionizing radiation. Therefore, this protocol provides the foundation for an objective standardized platform to quantitatively evaluate the location of ACL bone tunnels and graft orientation for routine postoperative assessment, presurgical planning, and evaluation of clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: No well-controlled studies have compared the long-term outcome of anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft between adolescents and adults. Increased posterior tibial slopes (PTSs) have been reported in the ACL-injured versus controls, but the effect of PTS on the outcome after reconstruction is relatively unexplored. Purpose: To compare the prospective longitudinal outcome of “isolated” ACL ruptures treated with anatomic endoscopic ACL reconstruction using hamstring tendon autograft over 20 years in adolescent and adult cohorts and to examine factors for repeat ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: A single-surgeon series of 200 consecutive patients undergoing isolated primary ACL reconstruction with hamstring tendon autograft were prospectively studied. Subjects were assessed preoperatively and at 2, 7, 15, and 20 years postoperatively. Outcomes included International Knee Documentation Committee (IKDC) Knee Evaluation, IKDC subjective scores, KT-1000 instrumented laxity testing, and radiological evaluation of degenerative change and medial tibial slope. Twenty-year outcomes were compared between those who underwent surgery at the age of 18 years or younger (adolescent group, n = 39) and those who underwent surgery when older than 18 years (adult group, n = 161). Results: At 20 years, 179 of 200 subjects were reviewed (89.5%). ACL graft rupture occurred in 37 subjects and contralateral ACL injury in 22 subjects. Of those with intact ACL grafts at 20 years, outcomes were not statistically different between adolescents and adults for the variables of IKDC subjective score (P = .29), return to preinjury activity level (P = .84), current activity level (P = .69), or degree of radiological degenerative change at 20 years (P = .51). The adolescent group had a higher proportion of grade 1 ligamentous laxity testing compared with the adult group (P = .003). Overall, ACL graft survival at 20 years was 86% for adults and 61% for adolescents (hazard ration, 3.3; P = .001). The hazard for ACL graft rupture was increased by 4.8 in adolescent males and 2.5 in adolescent females compared with adults. At 20 years, the ACL survival for adolescents with a PTS of ≥12° was 22%. The hazard for ACL graft rupture was increased by 11 in adolescents with a PTS of ≥12° (P = .001) compared with adults with a PTS <12°. Conclusion: Repeat ACL injury after isolated ACL reconstruction is common, occurring in 1 in 3 over 20 years. In the absence of further injury, isolated ACL reconstruction using this technique was associated with good long-term outcomes with respect to patient-reported outcomes and return to sports, regardless of age. However, mild ligament laxity and ACL graft rupture after ACL reconstruction are significantly more common in adolescents, especially adolescent males, compared with adults. PTS of 12° or more is the strongest predictor of repeat ACL injury, and its negative effect is most pronounced in adolescents. [ABSTRACT FROM AUTHOR]

Background: Talar osteochondral lesions represent challenging clinical entities, particularly in high-demand athletes. Surgical treatment of large lesions often requires a 2-step procedure, or the use of osteotomy in the case of autologous osteochondral transfer, which can delay return to sport.Methods: A professional rugby league player underwent surgery for a complex injury to the ankle. A talar osteochondral lesion with a maximal diameter of 15 mm was treated in an arthroscopic fashion using the cartilage taken from the completely displaced osteochondral fragment. Cartilage was cut into chips and combined with bone graft product containing platelet-derived growth factor and a porous collagen scaffold. Autologous cartilage was then reimplanted arthroscopically. The patient was allowed full ankle motion from 2 weeks postoperatively, and weightbearing was commenced at 6 weeks. Follow-up imaging and functional outcomes, including return to sport, were assessed at regular intervals.Results: The patient was able to return to professional rugby league by 23 weeks postoperatively. Magnetic resonance imaging at 16 months postoperatively showed restoration of the subchondral plate and osseous infill. At final follow-up, the patient remained pain free and was playing at preinjury level.Conclusion: This report describes good outcomes using a novel, 1-step cartilage repair technique to treat a large talar osteochondral lesion in a professional athlete.Levels Of Evidence: Level V: Expert opinion. [ABSTRACT FROM AUTHOR]

Background: Long-term prospective studies of isolated endoscopic anterior cruciate ligament (ACL) reconstruction are limited and may include confounding factors. Purpose: This study aimed to compare the outcomes of isolated ACL reconstruction using the patellar tendon (PT) autograft and the hamstring (HT) autograft in 180 patients over 20 years. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 180 participants undergoing isolated ACL reconstruction between 1993 and 1994 were prospectively recruited. Evaluation was performed at 1, 2, 5, 7, 10, 15, and 20 years after surgery and included the International Knee Documentation Committee (IKDC) knee ligament evaluation with radiographic evaluation, KT-1000 arthrometer side-to-side difference, and subjective scores. Results: Over 20 years, there were 16 patients (18%) and 9 patients (10%) with an ACL graft rupture in the HT and PT groups, respectively (P = .13). ACL graft rupture was associated with male sex (odds ratio [OR], 3.9; P = .007), nonideal tunnel position (OR, 3.6; P = .019), and age <18 years at the time of surgery (OR, 4.6; P = .003). The odds of a contralateral ACL rupture were increased in patients with the PT graft compared with patients with the HT graft (OR, 2.2; P = .02) and those aged <18 years at the time of surgery (OR, 3.4; P = .001). The mean IKDC scores at 20-year follow-up were 86 and 89 for the PT and HT groups, respectively (P = .18). At 20 years, 53% and 57% of the PT and HT groups participated in strenuous or very strenuous activities (P = .55), kneeling pain was present in 63% and 20% of the PT and HT groups (P = .018), and radiographic osteoarthritic change was found in 61% and 41% of the PT and HT groups (P = .008), respectively. Conclusion: Compared with patients who received the HT graft, patients who received the PT graft had significantly worse outcomes with regard to radiologically detectable osteoarthritis, kneeling pain, and contralateral ACL injury. At 20-year follow-up, both HT and PT autografts continued to provide good subjective outcomes and objective stability. However, further ACL injury is common, particularly in male individuals, younger patients, and those with tunnel malposition. [ABSTRACT FROM AUTHOR]

Background: Long-term prospective follow-up studies of single-incision endoscopic anterior cruciate ligament (ACL) reconstruction are limited and may include confounding factors. Purpose: This longitudinal prospective study reports the outcomes of isolated ACL reconstruction using middle-third patellar tendon autografts in 90 patients over 20 years. Study Design: Case series; Level of evidence, 4. Methods: Between January 1993 and April 1994, a total of 90 patients met study inclusion criteria: evaluation at 1, 2, 3, 4, 5, 7, 10, 15, and 20 years after surgery. Exclusion criteria were associated ligamentous injuries requiring surgery, previous meniscectomy or meniscal injuries requiring more than one-third meniscectomy, chondral injuries, and an abnormal contralateral knee. Results: At 20 years, 32 (36%) patients had sustained another ACL injury: 8 (9%) to the index limb and 27 (30%) to the contralateral limb (3 injuring both knees). The mean International Knee Documentation Committee (IKDC) score was 86. Of the patients, 50% participated in strenuous/very strenuous activities, and kneeling pain was present in 63%. Radiographic degenerative change was found in 61%; 20% had IKDC grade C, and 0% had grade D. The IKDC clinical examination revealed that 95% had a normal/nearly normal knee. Significant sex differences existed: when compared with male patients, female patients were less likely to reinjure the reconstructed ACL (18% vs 2%, respectively; P = .01), reported poorer IKDC subjective scores (90 vs 83, respectively; P = .03), had more activity-related pain (20% vs 57%, respectively; P = .02), and were less likely to participate in strenuous activities (66% vs 35%, respectively; P = .009). ACL graft survival was not related to age. Patients <18 years old had an increased odds ratio (3.2) for rupturing the contralateral ACL. A coronal graft angle <17° increased the risk of failure compared with an angle >17° (77% vs 96% survival, respectively) by a factor of 8.5. Conclusion: Injuries more commonly occurred in the contralateral ACL than in the reconstructed ACL graft, and the most significant predictor of a contralateral ACL injury was age <18 years. The most significant predictor of an ACL graft rupture was a coronal graft angle <17°. Female patients had lower rerupture rates, poorer subjective scores, and decreased participation in strenuous activities, putting the graft at a lower risk of failure. Kneeling pain remained persistent over 20 years. Radiographic osteoarthritis was evident in 61% of patients, but symptomatic osteoarthritic symptoms were rarely reported. [ABSTRACT FROM AUTHOR]

Background:Longer-term results of bioabsorbable screws for anterior cruciate ligament reconstruction (ACLR) have been reported, but results are specific to the exact screw material and design. Titanium and poly-L-lactic acid with hydroxyapatite (PLLA-HA) screw outcomes have been compared only to 2 years.Purpose/Hypothesis:The purpose of this study was to compare the clinical and radiologic outcomes of the PLLA-HA screw versus titanium screw for hamstring tendon ACLR over a 5-year follow-up period. The hypothesis was that there are no differences in clinical scores or tunnel widening between the PLLA-HA and the titanium screws and that the PLLA-HA screw as seen on magnetic resonance imaging (MRI) should show high-grade resorption and ossification response over 5 years.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 40 patients undergoing ACLR were randomized to receive either a PLLA-HA screw (PLLA-HA group) or a titanium screw (titanium group) for ACL fixation. Blinded evaluation was performed at 2 and 5 years with the International Knee Documentation Committee and Lysholm knee score, KT-1000 arthrometer, single-legged hop test, and MRI to evaluate tunnel and screw volumes, periscrew ossification, graft integration, and cyst formation.Results:There was no difference in any clinical outcome measure at 2- or 5-year follow-up between the 2 groups. At 2 years, the femoral tunnel in the PLLA-HA group was smaller than that in the titanium group (P = .02); at 5 years, there was no difference. At 2 years, the femoral PLLA-HA screw was a mean 76% of its original volume, and by 5 years, it was 36%. At 2 years, the tibial PLLA-HA screw mean volume was 68% of its original volume, and by 5 years, it was 46%. At 5 years in the PLLA-HA group, 88% of femoral tunnels and 56% of tibial tunnels demonstrated a significant ossification response. There was no increase in cyst formation in the PLLA-HA group and no screw breakages.Conclusion:There were equivalent clinical results between the PLLA-HA and titanium groups at 2- and 5-year follow-ups. The PLLA-HA screw was not associated with increased tunnel widening or cyst formation when compared with the titanium screw. The PLLA-HA screw demonstrated progressive screw resorption and gradual but incomplete ossification over 5 years. [ABSTRACT FROM AUTHOR]

The article describes the case of a 16-year-old gymnast who underwent operative fixation after suffering an inversion injury to her right foot while running backward during training. Topics discussed include findings on her physical examination on resumption of training, the characteristics of coboid syndrome or subluxation, and the effectiveness of direct anatomical imbrication as a reconstructive technique.

Background: There is a lack of prospective studies comparing the long-term outcome of endoscopic anterior cruciate ligament (ACL) reconstruction with either a patellar tendon or hamstring tendon autograft.Purpose: This prospective longitudinal study compared the results of isolated endoscopic ACL reconstruction utilizing a 4-strand hamstring tendon (HT) or patellar tendon (PT) autograft over a 15-year period with respect to reinjury, clinical outcomes, and the development of osteoarthritis.Study Design: Cohort study; Level of evidence, 2.Methods: Ninety consecutive patients with isolated ACL rupture were reconstructed with a PT autograft, and 90 patients received an HT autograft, with an identical surgical technique. Patients were assessed at 2, 5, 7, 10, and 15 years. Assessment included the International Knee Documentation Committee (IKDC) knee ligament evaluation including radiographic evaluation, KT-1000 arthrometer testing, and Lysholm knee score.Results: Patients who received the PT graft had significantly worse outcomes compared with those who received the HT graft at 15 years for the variables of radiologically detectable osteoarthritis (grade A: 46% in PT and 69% in HT; P = .04), motion loss (extension deficit <3°: 79% in PT and 94% in HT; P = .03), single-legged hop test (grade A: 65% in PT and 92% in HT; P = .001), participation in strenuous activity (very strenuous or strenuous: 62% of PT and 77% of HT; P = .04), and kneeling pain (moderate or greater pain: 42% of PT and 26% of HT; P = .04). There was no significant difference between the HT and PT groups in overall IKDC grade (grade A: 47% of PT and 57% of HT; P = .35). An ACL graft rupture occurred in 17% of the HT group and 8% of the PT group (P = .07). An ACL graft rupture was associated with nonideal tunnel position (odds ratio [OR], 5.0) and male sex (OR, 3.2). Contralateral ACL rupture occurred in significantly more PT patients (26%) than HT patients (12%) (P = .02) and was associated with age ≤18 years (OR, 4.1) and the PT graft (OR, 2.6).Conclusion: Anterior cruciate ligament reconstruction using ipsilateral autograft continues to show excellent results in terms of patient satisfaction, symptoms, function, activity level, and stability. The use of HT autograft does, however, show better outcomes than the PT autograft in all of these outcome measures. Additionally, at 15 years, the HT graft–reconstructed ACLs have shown a lower rate of radiological osteoarthritis. [ABSTRACT FROM PUBLISHER]

Background: Few studies report the long-term results of anterior cruciate ligament rupture and single-incision endoscopic reconstructive surgery. Outcomes are often clouded by concomitant meniscal, chondral, or ligament injuries.Purpose: To determine the 15-year outcomes of anterior cruciate ligament ruptures treated with endoscopic anterior cruciate ligament reconstruction using middle-third patellar tendon autograft.Study Design: Case series; Level of evidence, 4.Methods: Between January 1993 and April 1994, 333 consecutive patients underwent anterior cruciate ligament reconstruction. Patients with associated ligamentous injury requiring surgery, previous meniscectomy, or meniscal injury requiring more than one-third meniscectomy; chondral injury diagnosed at arthroscopy; and an abnormal contralateral knee were excluded. Ninety patients met the inclusion criteria. Outcomes included range of motion, Lachman and pivot-shift tests, instrumented ligament testing, single-legged hop test, Lysholm Knee Score, the International Knee Documentation Committee evaluation, and radiographic assessment.Results: Thirty percent of patients had further anterior cruciate ligament injury. Twenty-four percent of patients (n = 22) sustained contralateral anterior cruciate ligament ruptures, and 8% (n = 7) ruptured the graft (P = .009). Graft rupture was associated with a graft inclination angle <17° (P = .02). Contralateral anterior cruciate ligament rupture was associated with age <18 years at time of primary injury (P = .001). All patients had normal or nearly normal (International Knee Documentation Committee evaluation) Lachman and instrumented testing, and 91% had a negative pivot-shift result. Seventy percent of patients had kneeling pain. Median subjective International Knee Documentation Committee evaluation was 91 of 100. Fifty-one percent of patients had radiographic evidence of osteoarthritis (41% grade B; 10% grade C).Conclusion: Good results are maintained at 15 years after surgery with respect to ligamentous stability, subjective outcomes, and range of motion. Kneeling pain remains a significant problem. Concern remains regarding the incidence of further anterior cruciate ligament injury and the increasing number of patients with radiographic and clinical signs of osteoarthritis despite surgical stabilization. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 16-year-old right-hand dominant male student with glenoid fracture. The patient was examined two days after the rugby injury wherein he felt his shoulder give away while driving into an opponent. His radiography showed a displaced anterosuperior glenoid fracture. He accordingly underwent a surgery with arthroscopic fixation of the superior glenoid fragment with concurrent labral repair. It discusses that scapular fracture represents 0.5 - 1.0 of all fractures.

Background: There are no controlled, prospective studies comparing the 10-year outcomes of anterior cruciate ligament (ACL) reconstruction using patellar tendon (PT) and 4-strand hamstring tendon (HT) autografts. Hypothesis: Comparable results are possible with HT and PT autografts. Study Design: Cohort study; Level of evidence, 2. Methods: One hundred eighty ACL-deficient knees that met inclusion criteria underwent ACL reconstruction (90 HT autograft, 90 PT autograft) by one surgeon and were treated with an accelerated rehabilitation program. All knees were observed in a prospective fashion with subjective, objective, and radiographic evaluation at 2, 5, 7, and 10-year intervals. Results: At 10 years, there were no differences in graft rupture rates (7/90 PT vs. 12/90 HT, P = .24). There were 20 contralateral ACL ruptures in the PT group, compared with 9 in the HT group (P = .02). In all patients, graft rupture was associated with instrumented laxity >2 mm at 2 years (P = .001). Normal or near-normal function of the knee was reported in 97% of patients in both groups. In the PT group, harvest-site symptoms (P = .001) and kneeling pain (P = .01) were more common than in the HT group. More patients reported pain with strenuous activities in PT knees than in HT knees (P = .05). Radiographic osteoarthritis was more common in PT knees than the HT-reconstructed knees (P = .04). The difference, however, was composed of patients with mild osteoarthritis. Other predictors of radiographic osteoarthritis were <90% single-legged hop test at 1 year and the need for further knee surgery. An "ideal" outcome, defined as an overall International Knee Documentation Committee grade of A or B and a radiographic grade of A at 10 years after ACL reconstruction, was associated with <3 mm of instrumented laxity at 2 years, the absence of additional surgery in the knee, and HT grafts. Conclusions: It is possible to obtain excellent results with both HT and PT autografts. We recommend HT reconstructions to our patients because of decreased harvest-site symptoms and radiographic osteoarthritis. [ABSTRACT FROM AUTHOR]

Background: It is now well documented that women are more likely to suffer anterior cruciate ligament injuries than are men. A few studies have examined gender differences in the outcome of anterior cruciate ligament reconstruction with patellar tendon graft and hamstring tendon with EndoButton fixation, but no well-controlled studies have specifically compared men and women after anterior cruciate ligament reconstruction with hamstring tendon graft and interference screw fixation. Hypothesis: There is no difference in outcome between men and women after anterior cruciate ligament reconstruction with hamstring tendon autograft and interference screw fixation. Study Design: Cohort study; Level of evidence, 3. Methods: There were 100 men and 100 women who underwent isolated anterior cruciate ligament reconstruction by a single surgeon. Patients were assessed preoperatively and at 1,2, and 7 years after surgery. Variables were compared between female and male patients. Results: Laxity on physical evaluation was greater in women than in men on Lachman (P = .04), pivot-shift (P = .05), and mean manual maximum testing (P = .05) at 7 years. However, the magnitude of this difference was small. No patient had a greater than grade 1 Lachman or pivot-shift test result, and the mean difference between men and women was 0.6 mm on instrumented testing. Anterior cruciate ligament graft rupture occurred in 11 men and 10 women. There was no difference between male and female patients for self-reported knee function or symptoms of instability or radiologic examination. Conclusion: Anterior cruciate ligament reconstruction using hamstring tendon autograft affords excellent self-reported and objective results in both men and women after 7 years. Although significantly greater laxity on physical examination was present in female patients than in male patients, the magnitude of this difference was small and had no effect on activity level, graft failure, or subjective or functional assessment. [ABSTRACT FROM AUTHOR]