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Clinical Scenario: Delay in surgery for anterior cruciate ligament (ACL) injuries increases the risk of complications including secondary injuries. Previous research has shown individuals with public insurance have greater delays in care for a variety of health conditions. Clinical Question: In pediatric patients with ACL injuries, is the time from injury to surgery longer for patients with public insurance than patients with private insurance? Summary of Key Findings: Four studies met the inclusion criteria. All studies reported a greater wait time for surgery in pediatric patients with public insurance. Clinical Bottom Line: There is moderate evidence indicating that there is a delay in ACL surgery for pediatric patients with public insurance compared to those with private insurance. Strength of Recommendation: Grade B evidence exists that there is a delay in surgery for ACL injuries in pediatric patients with public insurance compared to those with private insurance. [ABSTRACT FROM AUTHOR]

Background: In ACL reconstruction, it is desirable to assess preoperatively whether a sufficient graft diameter can be achieved with the planned tendon graft. The present study investigated the effect of the location of the cross-sectional area (CSA) measurement of the hamstring tendons in preoperative MRI on the correlation of the CSA with the intraoperative graft diameter. In addition, we analyzed whether the measurement results of examiners with different skill levels were comparable. Methods: A total of 32 subjects undergoing a single bundle ACL reconstruction using an autologous ipsilateral quadrupled hamstring graft (STGT) were included. The CSA of the semitendinosus and gracilis tendon was determined in preoperative MRI on six defined levels by three examiners. The intraclass correlation coefficient between the measurements of these observers was determined. The correlation between the sum of the CSA of both tendons (CSA STGT) and the graft diameter was investigated. Results: The interrater reliability was excellent on most of the investigated levels. A significant correlation between CSA STGT and the graft diameter was seen on all levels. The strongest correlation was found on the level 10 mm above the joint line. Conclusions: The measurement of the CSA STGT in the preoperative MRI 10 mm above the joint line enabled a good assessment of the achievable graft diameter in ACL reconstruction, independent of the examiners' training level. [ABSTRACT FROM AUTHOR]

Objective: This study aims to prepare rehabilitative exercises for football players following anterior cruciate ligament surgery and to determine the impact of such exercises on the functional ability of the anterior cruciate ligament (muscle strength, range of motion, and level of pain) in advanced football players following surgery. Method: A sample of (6) injured, from Al-Kut club, (age = 27.33 ± 1.98 years, height = 174.7 ± 2.99 cm, mass 60.6 0.68 kg) participated in the study. The participants in the experimental group (n=6) completed pre-tests and post-tests. Results: The results of the experimental sample show that there was a significant improvement in the mean scores for Muscular strength on the post-test compared to the pre-test. The mean score for muscular strength increased from 18.50 to 33.33, p<0.001), the mean score for the range of motion increased (extension) from 163.50 to 177.33, (flexion) 68.83 to 21, p<0.001), and the mean score for pain decreased from 7.125 to 1.12, p<0.001). conclusion: following surgery, rehabilitation exercises improve the strength of the muscles that operate on the knee joint, increase the range of motion of the knee joint, and decrease pain degree. [ABSTRACT FROM AUTHOR]

Background: Quality of life (QoL) is affected up to 5 years after an anterior cruciate ligament (ACL) injury. Knee impairment and osteoarthritis (OA) development increase over time, and this may affect QoL at a long-term follow-up. Purpose: To investigate changes in health- and knee-related QoL between 20 and 35 years after ACL injury and compare it between patients treated with or without ACL surgery, as well as to study how symptomatic OA (SOA) is associated with change in QoL. Study Design: Cohort study; Level of evidence, 2. Methods: Between 1980 and 1983, 139 patients with acute ACL rupture were allocated to surgical or nonsurgical treatment of the ACL. Both groups completed a structured rehabilitation program. Of those patients, 59 were followed for 20 and 35 years after ACL rupture. After 10 crossovers, 33 patients were treated with primary repair or ACL reconstruction, and 26 were treated without ACL surgery. Combined radiographic OA and knee symptoms at 35 years was defined as SOA. QoL was assessed at 20 and 35 years after injury with the Knee injury and Osteoarthritis Outcome Score QoL (KOOS-QoL) subscale (range, 1-100), ACL-QoL questionnaire (total score and 5 subscales; range, 1-100), European QoL–5 Dimensions Questionnaire, and visual analog scale. Results were analyzed with paired and independent-sample t tests and chi-square tests. Results: Knee-related QoL was impaired at both 20 and 35 years after ACL injury, and differences were dependent on the measurement outcome. In the total cohort, KOOS-QoL did not change but both total ACL-QoL score (7.1 points; 95% CI, 2.2-11.9) and 4 of 5 subscales (5-10 points) decreased (P <.05). No differences were found between treatment groups. QoL decreased overall in patients with SOA, with a 21-point difference within-group change in KOOS-QoL (SOA or non-SOA) between 20 and 35 years of follow-up (P =.001; Cohen d = 1.0). Conclusion: An ACL injury impairs knee-related QoL for up to 35 years, with no difference between treatment approaches (initial repair or later reconstruction compared with nonsurgical treatment). The deterioration decreases with longer follow-up. Clinicians should be aware of differences in QoL depending on the measurement outcome. [ABSTRACT FROM AUTHOR]

Background: Arthrogenic muscle inhibition (AMI) is a complex neurological phenomenon that is actually very common. AMI can appear following a knee injury or knee surgery. If it is not addressed, the patient's function can be negatively affected. There is currently no specific tool for the diagnosis and treatment of AMI. Indications: Following surgery or injury to the knee, AMI causes defective activation of the quadriceps, sometimes combined with a knee extension deficit. A clinical classification of AMI has been proposed recently to help with making the diagnosis and to guide treatment. In this article, we describe how biofeedback and surface electromyography (EMG) can be used in the early diagnosis and treatment of knee AMI. Technique Description: Biofeedback is based on transformation of physiological variables into a visual or auditory signal. This allows the patient to learn how to control physical and bodily functions, which were previously considered as involuntary processes. This technique requires the use of a specific device that transforms the measured physiological signals—neuromuscular activation in this instance—into visual signals. This tool incorporates surface EMG, with electrodes connected to a measuring unit. This unit is connected to a screen that shows the neuromuscular activation in real time. Thus, EMG biofeedback can be used to help clinicians make a diagnosis and to specifically treat the AMI. Results: We have used biofeedback in patients who have a knee injury or who have undergone knee surgery. Both the therapist and patient were able to objectively see the presence of AMI using the biofeedback device. For treatment, the therapist works with a patient by providing clear instructions and increasingly more challenging goals. We show examples of how patients were able to eliminate their AMI by using biofeedback. Discussion/Conclusion: EMG biofeedback is a promising tool for the diagnosis and treatment of AMI after an anterior cruciate ligament (ACL) tear and ACL reconstruction surgery. The next steps are to define thresholds and a rehabilitation protocol that will be used in a clinical trial. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. [ABSTRACT FROM AUTHOR]

Purpose: It is essential to obtain rotational stability of the knee after anterior cruciate ligament reconstruction (ACL-R) and it is suggested that a supplementary reconstruction of the antero-lateral ligament (ALL-R) may supports this. Theoretically, ALL-R may be particularly advantageous to support revision of failed ACL-Rs. It was hypothesized that ACL revision combined with ALL-R will result in superior outcome compared to isolated ACL revision. Methods: The study was designed as a randomized controlled trial. Patients eligible for first time ACL revision were randomized to either isolated ACL revision (− ALL group) or ACL revision combined with a single-stranded allograft ALL-reconstruction (+ ALL group). Patient reported outcomes and function were evaluated at two-year follow-up by KNEES-ACL, KOOS, and Tegner activity scale. Objective knee laxity was evaluated at one-year follow-up using an instrumented Rolimeter test, the pivot shift test, and a manual Lachman test. Results: A total of 103 patients were enrolled with 49 patients randomized to the + ALL group and 54 patients in the − ALL group. There were no differences at baseline between groups regarding age, gender, body mass index, preoperative patient reported outcome scores and concomitant meniscus or cartilage injury. The ACL revision was performed with an allograft in 10 patients (20%) in the + ALL group and 8 patients (15%) in the -ALL group. At follow-up there was no significant difference between the groups in patient reported outcome scores and clinical knee laxity. Conclusion: Supplementary ALL-R does not improve subjective outcome of first time ACL revision at two-years and clinical knee stability at one-year follow-up compared to isolated ACL revision. Level of evidence: Level I. [ABSTRACT FROM AUTHOR]

Background: In ACL reconstruction, it is desirable to assess preoperatively whether a sufficient graft diameter can be achieved with the planned tendon graft. The present study investigated the effect of the location of the cross-sectional area (CSA) measurement of the hamstring tendons in preoperative MRI on the correlation of the CSA with the intraoperative graft diameter. In addition, we analyzed whether the measurement results of examiners with different skill levels were comparable. Methods: A total of 32 subjects undergoing a single bundle ACL reconstruction using an autologous ipsilateral quadrupled hamstring graft (STGT) were included. The CSA of the semitendinosus and gracilis tendon was determined in preoperative MRI on six defined levels by three examiners. The intraclass correlation coefficient between the measurements of these observers was determined. The correlation between the sum of the CSA of both tendons (CSA STGT) and the graft diameter was investigated. Results: The interrater reliability was excellent on most of the investigated levels. A significant correlation between CSA STGT and the graft diameter was seen on all levels. The strongest correlation was found on the level 10 mm above the joint line. Conclusions: The measurement of the CSA STGT in the preoperative MRI 10 mm above the joint line enabled a good assessment of the achievable graft diameter in ACL reconstruction, independent of the examiners’ training level.

Background: Recently, interest in anterior cruciate ligament (ACL) preservation and repair after proximal ACL tears has been resurrected. Although good clinical outcomes have been reported in the literature with adequate patient selection, to date detailed scientific evidence for the functional benefit of primary ACL repair with ligament augmentation is scarce. Purpose: To compare patient-reported, clinical, and functional outcomes in patients 2 years after ACL repair and InternalBrace augmentation (ACL-IB) with age- and sex-matched patients 2 years after ACL reconstruction (ACL-R) and with matched healthy controls. Study Design: Cohort study; Level of evidence, 3. Methods: In total, 29 patients 2 years after ACL-IB, 27 sex- and age- matched patients 2 years after ACL-R (hamstring autografts), and 29 matched healthy controls were included. Patient-reported outcomes were assessed using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, EQ-5D-5L, Tegner Activity Scale, and Anterior Cruciate Ligament Return to Sports after Injury scale. Surgery time was recorded. For clinical outcomes, range of motion and thigh and shank circumference were measured, and passive anterior translation was determined using the Rolimeter. Isokinetic muscle strength was measured using a Biodex dynamometer. The limb symmetry index (operated/contralateral or nondominant/dominant × 100), side-to-side differences (operated – contralateral, nondominant – dominant), and hamstring-quadriceps ratios were calculated for functional parameters. Failure and reoperation rates were not compared. Results: Two years after surgery, patients treated with ACL-IB showed good to excellent patient-reported outcomes comparable with those of patients after ACL-R. Surgery time, including concomitant surgeries, was significantly shorter in the ACL-IB group (mean, 81 minutes) compared with the ACL-R group (mean, 97 minutes) (P =.024). Isokinetic muscle strength was comparable between patient groups without significant differences in extensor and flexor strength or in hamstring-quadriceps ratios. Conclusion: These results suggest that ACL-IB achieves comparable patient-reported, clinical, and functional outcomes with ACL-R at 2 years postoperatively and, after careful patient selection, should be considered as a valuable early treatment alternative for proximal ACL tears. Registration: NCT04429165 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: The emergence of artificial intelligence (AI) has allowed users to have access to large sources of information in a chat-like manner. Thereby, we sought to evaluate ChatGPT-4 response's accuracy to the 10 patient most frequently asked questions (FAQs) regarding anterior cruciate ligament (ACL) surgery., Methods: A list of the top 10 FAQs pertaining to ACL surgery was created after conducting a search through all Sports Medicine Fellowship Institutions listed on the Arthroscopy Association of North America (AANA) and American Orthopaedic Society of Sports Medicine (AOSSM) websites. A Likert scale was used to grade response accuracy by two sports medicine fellowship-trained surgeons. Cohen's kappa was used to assess inter-rater agreement. Reproducibility of the responses over time was also assessed., Results: Five of the 10 responses received a 'completely accurate' grade by two-fellowship trained surgeons with three additional replies receiving a 'completely accurate' status by at least one. Moreover, inter-rater reliability accuracy assessment revealed a moderate agreement between fellowship-trained attending physicians (weighted kappa = 0.57, 95% confidence interval 0.15-0.99). Additionally, 80% of the responses were reproducible over time., Conclusion: ChatGPT can be considered an accurate additional tool to answer general patient questions regarding ACL surgery. None the less, patient-surgeon interaction should not be deferred and must continue to be the driving force for information retrieval. Thus, the general recommendation is to address any questions in the presence of a qualified specialist., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘J.C. reports a relationship with American Orthopaedic Society for Sports Medicine that includes board membership, a relationship with Arthrex Inc that includes consulting or advisory, a relationship with Arthroscopy Association of North America that includes board membership, a relationship with CONMED Corp that includes consulting or advisory, a relationship with International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine that includes board membership, a relationship with Ossur Americas that includes consulting or advisory, a relationship with Smith and Nephew Inc that includes consulting or advisory and speaking and lecture fees. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.’., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Patients undergoing elective procedures often utilize online educational materials to familiarize themselves with the surgical procedure and expected postoperative recovery. While the Internet is easily accessible and ubiquitous today, the ability of patients to read, understand, and act on these materials is unknown. Purpose: To evaluate online resources about anterior cruciate ligament (ACL) surgery utilizing measures of readability, understandability, and actionability. Study Design: Cross-sectional study; Level of evidence, 4. Methods: Using the term "ACL surgery," 2 independent searches were performed utilizing a public search engine (Google.com). Patient education materials were identified from the top 50 results. Audiovisual materials, news articles, materials intended for advertising or medical professionals, and materials unrelated to ACL surgery were excluded. Readability was quantified using the Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Coleman-Liau Index, Automated Readability Index, and Gunning Fog Index. The Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) was utilized to assess the actionability and understandability of materials. For each online source, the relationship between its Google search rank (from first to last) and its readability, understandability, and actionability was calculated utilizing the Spearman rank correlation coefficient (ρS). Results: Overall, we identified 68 unique websites, of which 39 met inclusion criteria. The mean Flesch-Kincaid Grade Level was 10.08 ± 2.34, with no website scoring at or below the 6th-grade level. Mean understandability and actionability scores were 59.18 ± 10.86 (range, 33.64-79.17) and 34.41 ± 22.31 (range, 0.00-81.67), respectively. Only 5 (12.82%) and 1 (2.56%) resource scored above the 70% adequate PEMAT-P threshold mark for understandability and actionability, respectively. Readability (lowest P value =.103), understandability (ρS = –0.13; P =.441), and actionability (ρS = 0.28; P =.096) scores were not associated with Google rank. Conclusion: Patient education materials on ACL surgery scored poorly with respect to readability, understandability, and actionability. No online resource scored at the recommended reading level of the American Medical Association or National Institutes of Health. Only 5 resources scored above the proven threshold for understandability, and only 1 resource scored above it for actionability. [ABSTRACT FROM AUTHOR]

Patient-reported knee-related rating scores and scales are widely used in reporting the clinical outcomes of anterior cruciate ligament (ACL) surgery. Understanding the psychometric properties of such measures is vital to recognizing the limitations that such measures may confer. The aim of this study was to review the available evidence as to the psychometric properties of patient-reported outcome measures (PROMs) used in ACL surgery. Eleven studies were identified, the majority being prospective cohort studies. Eight English, ACL-specific patient-reported outcome measures were identified and evaluated: Lysholm score, Tegner Activity Scale (TAS), Cincinnati score, ACL-Quality of Life (QOL) score, International Knee Documentation Committee (IKDC) Subjective Knee Form (SKF), Knee Injury and Osteoarthritis Outcome Score (KOOS)-ACL score, and ACL-Return to Sport Injury (RSI) scale. Only the Lysholm score, ACL-QOL, IKDC SKF, and ACL-RSI were evaluated for internal consistency, having an acceptable Cronbach's α (α>0.70). Most of the scoring systems were assessed for test-retest reliability, with four of them (Lysholm score, TAS, Cincinnati score, and IKDC SKF) having acceptable intraclass correlation coefficient (ICC) values (ICC > 0.70). Criterion validity was assessed for most measures with a good correlation with the IKDC. Effect sizes and standardized response means were large for three instruments that measured responsiveness (Lysholm score, TAS, and Cincinnati score) and moderate for one (ACL-QOL). Evidence is stronger and more robust for the Lysholm score, TAS, ACL-QOL, and IKDC SKF. However, there is variation in their psychometric properties as well as the aspect of knee-related health they are assessing. Hence, none can be universally applicable to all patients with ACL injuries. Recognizing these parameters is vital when choosing which instrument to use in reporting the outcomes of ACL injury or ACL surgery studies., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Prodromidis et al.)

Objectives: To investigate whether intensive supervised rehabilitation following ACL reconstruction leads to superior self-reported function and sports participation compared to less supervised rehabilitation.Design: Systematic review and meta-analysis.Methods: We included randomised controlled trials (RCTs) comparing supervised rehabilitation to rehabilitation with a similar protocol that used less supervised sessions for athletes following ACL reconstruction. Two reviewers independently screened studies and extracted data. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate methodological quality and GRADE to evaluate overall quality of evidence. Self-reported function and sports participation were the primary outcomes. Data were pooled using random effects meta-analyses.Results: Our search retrieved 4075 articles. Seven articles reporting on six RCTs were included (n=353). Very-low to low-certainty evidence suggests intensive supervised rehabilitation is not superior to less supervised rehabilitation following ACL reconstruction for improving self-reported function, sports participation, knee flexor and extensor strength, range of motion, sagittal plane knee laxity, single leg hop performance, or quality of life.Conclusion: Based on uncertain evidence, intensive supervised rehabilitation is not superior to less supervised rehabilitation for athletes following ACL reconstruction. Although high-quality RCTs are needed to provide more certain evidence, clinicians should engage athletes in shared decision making to ensure athletes' rehabilitation decisions align with current evidence on supervised rehabilitation as well as their preferences and values. [ABSTRACT FROM AUTHOR]

Background: The long-term prevalence of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is unknown, especially in patients without a history of ACL surgery. Purpose: To (1) describe the prevalence of radiographic OA, symptomatic OA, and knee replacement surgery 32 to 37 years after acute ACL injury and to (2) compare the prevalence of radiographic OA, symptomatic OA, and knee symptoms between patients allocated to early ACL surgery or no ACL surgery and patients who crossed over to ACL surgery. Study Design: Cohort study; Level of evidence, 2. Methods: Participants aged 15 to 40 years at the time of ACL injury were allocated to surgical (augmented or nonaugmented ACL repair) or nonsurgical ACL treatment within 14 days of injury. At 32 to 37 years after the initial injury, 153 participants were followed up with plain weightbearing radiographs and completed 4 subscales from the Knee injury and Osteoarthritis Outcome Score (KOOS). Radiographic OA was defined as Kellgren and Lawrence grade 2 or higher. Symptomatic OA was defined as radiographic OA plus knee symptoms measured with the KOOS. Results: Participants allocated to ACL surgery (n = 64) underwent surgery at a mean ± SD of 5 ± 4 days (range, 0-11 days) after injury. Of the 89 participants allocated to no ACL surgery, 53 remained nonsurgically treated, 27 had ACL surgery within 2 years, and 9 had ACL surgery between 3 and 21 years after injury. In the total sample, 95 participants (62%) had radiographic tibiofemoral OA, including 11 (7%) who had knee replacement. The prevalence of radiographic tibiofemoral OA was lower in the group allocated to ACL surgery compared with the group who never had ACL surgery (50% vs 75%; P =.005). The prevalence of symptomatic OA (50% in the total sample) and patellofemoral radiographic OA (35% in the total sample) was similar between groups. Conclusion: Patients allocated to early ACL surgery, performed a mean 5 days after injury, had a lower prevalence of tibiofemoral radiographic OA at 32 to 37 years after injury compared with patients who never had ACL surgery. The prevalences of symptomatic OA, radiographic patellofemoral OA, and knee symptoms were similar irrespective of ACL treatment. Overall, the prevalence of OA after ACL injury was high. Registration: NCT03182647 (ClinicalTrials.gov identifier) [ABSTRACT FROM AUTHOR]

As the incidence of anterior cruciate ligament (ACL) reconstruction continues to increase, the rate of revision surgery continues to climb. Revision surgery has inherent challenges that must be addressed to achieve successful results. The cause of the primary ACL reconstruction failure should be determined and careful preoperative planning should be performed to address the cause(s) of failure. Each patient undergoing revision surgery should undergo a thorough history and physical examination, receive full-length alignment radiographs, lateral radiographs, 45° flexion weight-bearing posteroanterior radiographs, and patellofemoral radiographs. The 3-dimensional computed tomography scan should be performed to assess tunnel position and widening. Magnetic resonance imaging should be used to assess for intra-articular soft tissue pathology. Meniscal tears, meniscal deficiency, anterolateral capsule injuries, bony morphology, age, activity level, connective tissue diseases, infection, graft choice, and tunnel position can all affect the success of ACL reconstruction surgery. Meniscal lesions should be repaired, and in cases of persistent rotatory instability, extra-articular procedures may be indicated. Furthermore, osteotomies may be needed to correct malalignment or excess posterior tibial slope. Depending on the placement and condition of the original femoral and tibial tunnels, revision surgery may be performed in a single procedure or in a staged manner. In most cases, the surgery can be performed in one procedure. Regardless, the surgeon must communicate with the patient openly regarding the implications of revision ACL surgery, and the treatment plan should be developed in a shared fashion between the surgeon and the patient. [ABSTRACT FROM AUTHOR]

Background: Pain in the immediate post-operative period after anterior cruciate ligament (ACL) surgery, apart from an unpleasant experience for the patient, can act as a barrier for static quadriceps contractions and optimum execution of the initial rehabilitation protocol resulting in slow recovery and a later return to full function for a sportsperson. There is no report in the literature comparing pain in the immediate post-operative period after using the two most widely used autografts, bone patellar tendon bone (BPTB) graft and hamstring graft. Methods: The present study compared the visual analogue scale (VAS) pain score in the immediate post-operative period after arthroscopic ACL reconstruction with the BPTB and hamstring autografts. Both groups consisted of 50 patients each. The mean age of the BPTB and hamstring cohorts was 26.9 ± 7.3 years (age range 18-59 years) and 26.7 ± 9.0 years (age range 17-52 years), respectively. Unpaired t test was applied to compare pain scores between the BPTB and hamstring cohorts. Results: In the present study, patients in the BPTB cohort showed higher mean pain scores across all the post-operative time intervals except at 6 h. However, the difference in the mean VAS pain score at post-operative 6,12,18, 24, 36 and 48 h in the two groups was statistically not significant (p value of 1, 0.665, 0.798, 0.377, 0.651 and 0.215 at 6,12,18, 24, 36 and 48 h, respectively). Conclusions: Our study concludes that the arthroscopic ACL reconstruction with BPTB autograft and hamstring autograft is associated with similar pain in the immediate post-operative period. As a result, aggressive physiotherapy regime is not affected by the type of graft being used for ACL reconstruction, as the pain scores in the immediate post-operative period are similar for both techniques. [ABSTRACT FROM AUTHOR]

The article discusses allograft anterior cruciate ligament reconstruction. According to the article, several relative indications where many surgeons believe allografts are beneficial include revision reconstruction where ipsilateral and contralateral autografts have previously been harvested and a prior history of hamstring or patellar surgery. The Bone-Patellar Tendon-Bone (BPTB) graft and interference screw fixation was the surgical technique used for allograft ACL reconstruction.

Abstract: The incidence of IBSN injury to the infrapatellar branch of the saphenous nerve (IBSN) in ACL surgery using the hamstrings technique has been reported to be between 30 and 59%. The purpose of this study was to evaluate the incidence of IBSN injury in ACL surgery with the hamstrings technique through clinical and electrophysiological evaluation, and also to evaluate potential risk factors of IBSN injury related to the surgical incision. Between November 2003–September 2004, 21 consecutive patients (22 knees) with an acute ACL rupture suitable for reconstruction were included. Patients with previous surgeries or scars around the knee and those with any degree of osteoarthritis were excluded. Clinical and electrophysiological evaluations were performed in all the cases. Hypoesthesia of the IBSN territory was found in 17 knees (77%) with an average area of 36 cm2 (1–120 cm2). Injury to the IBSN was electrophysiologically detected in 15 knees (68%). Two patients also had an injury to the saphenous nerve (9%). The presence of sensory loss associated with damage to the IBSN did not correlate with the size of the incision or the distance to the tibial tubercle. This injury probably occurs during tendon harvesting as found by an injury to the saphenous nerve in two of our patients. However the sensory loss does not impair normal daily activities in these patients. [Copyright &y& Elsevier]

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Objectives: Examine subjective pain descriptors following arthroscopically assisted ACL surgery and determine aspects of postoperative pain experience that may be most common in athletes. Also, investigate effects of gender, age, pain medication consumption and affective distress for unique contributions to pain.Method: Using the McGill Pain Questionnaire for subjective pain descriptions, 54 athletes were assessed at 24 and 48-h postoperatively following ACL surgery. Measures included anxiety, depression and medication consumption drawn from hospital charts at discharge.Results: Twenty-four-hour pain descriptors show a restricted sensory experience of moderate to high intensity reflecting two levels, a deeper/somatic level (i.e., throbbing) and one more superficial (i.e., sharp). Forty-eight-hour descriptors also show a sensory experience of moderate to high intensity, but reveal a deeper pain as reflected by “pulling”. There were no significant pain differences by gender for 24 or 48-h assessments. Regression analyses show anxiety as the lone significant predictor of pain at 24-h postoperative. No variables provided significant prediction of pain at 48-h.Conclusions: These data suggest a pattern of acute subjective postoperative pain experience following ACL surgery. This study is the first such empirical report and may be utilized for preoperative information interventions or as directing postoperative pain research in ACL injured athletes. These pain reports are not influenced by gender across assessments but were significantly predicted by anxiety assessed at 24-h postoperative. Limitations and implications for future research are discussed. [Copyright &y& Elsevier]

Patellar tendon donor defect (PTDD) healing after patellar tendon autograft (PTA), was evaluated in 12 lambs (24 knees), by means of conventional histology, immunohistochemistry and image analysis. The results of this study indicate that the PTDD is replaced by a tissue that does not assume the histological characteristics of a normal patellar tendon. Both the Hoffa fat pad (HFP) and the paratenon play an important role in the healing process, although qualitative and quantitative chronological differences were found, which supports the concept of a “two-time process”. The HFP initiates the repair process, and is the main active proliferative tissue compartment during the first week. Once the process is established, the paratenon and, in particular, its synovial lining, starts proliferative activity and virtually substitutes that of the HFP, which rapidly loses activity in a few days. Moreover, donor-site morbidity after PTA could be the result of histological changes in the patellar tendon and environs in only a few cases. We have found inflammatory and neural changes in the refilled PTDD that could explain the anterior knee pain after PTA. Likewise, we have observed loss of Golgi corpuscles in the refilled PTDD, which could lead to proprioceptive loss after ACL reconstruction with PTA. Finally, we have observed shrinkage of the PTDD scar that could contribute to the etiopathogenia of a patella infera. [ABSTRACT FROM AUTHOR]

The knee radiographs of 77 patients were examined by two physicians not involved in the operation a mean of 41.2 months after implantation of a synthetic ligament (Trevira hochfest). They evaluated the increase of degenerative osteoarthritis on a five-grade scale (0-4) by Jonasch and Mohing as modified by Holz, and using the IKDC score. Fifty patients with acute rupture had the synthetic ligament implanted for protection of anterior cruciate repair. Twenty-seven patients had a salvage procedure with the alloplastic ligament functioning as a prosthesis. Both examiners found a statistically significant increase of degenerative arthritis. Patients with acute anterior cruciate tears had a lower degree of osteoarthritis on the day of surgery compared to the patients with chronic insufficiency, but the postoperative increase was identical in both groups. Statistical analysis revealed correlations between osteoarthric changes and several factors such as concomitant meniscus or posterior cruciate injury and demonstrated no correlation to the grade of postoperative stability or injuries to the medial or lateral collateral ligaments or capsule. [ABSTRACT FROM AUTHOR]

Introduction: Anterior cruciate ligament (ACL) reconstructive surgery is one of the most common ligament-related surgeries performed in France. The French Society of Anesthesia & Intensive Care Medicine (SFAR) recommends the systematic use of low-molecular weight heparin postoperatively to prevent venous thromboembolisms (VTE). However, these recommendations differ from one country to another; several national societies do not recommend them. To specify the benefits of such a treatment, we did a retrospective case-control study to evaluate the incidence of symptomatic VTE after ACL reconstruction. Hypothesis We hypothesized that the rate of symptomatic VTE would be the same, whether a course of postoperative anticoagulants is prescribed or not., Methods: This was a retrospective, multicenter, multi-surgeon study. Of the four participating surgeons, two never prescribed thromboprophylaxis after surgery while the other two always prescribed a 10-day course of low-molecular weight heparin. All patients who underwent primary ACL reconstruction using an autologous graft between the 1st of January 2019 and the 15th of February 2020 were included. The 535 patients who had undergone ACL reconstruction were divided into two groups: (Group 1) 279 patients in the group without anticoagulants; 96% received a four-strand semi-tendinosus graft (ST4) and 4% received a quadriceps tendon (QT) graft; the mean age of these patients was 30 years (14-58); 41% of them were women and 22% of them were smokers; the mean body mass index was 24.4 (18-37); the mean tourniquet time was 37minutes. (Group 2) 256 patients in the group with anticoagulants; 81% received a semi-tendinosus/gracilis graft, 15% received a ST4 and 4% a QT; the mean age of these patients was 29 years (14-60); 38% of them were women and 21% of them were smokers; the mean body mass index was 25.0 (18-38); the mean tourniquet time was 34minutes. The two groups were comparable in all respects except for the type of graft used. All patients were contacted at a minimum interval of 3 months after their surgery, by telephone. Doppler ultrasonography was done solely when a VTE was suspected., Results: In the group without anticoagulants, 249 of 279 patients were contacted, while in the group with anticoagulants, 221 of 256 were contacted. The two groups were comparable in terms of age, gender ratio, tourniquet time, body mass index and proportion of smokers. Two cases of deep vein thrombosis (all in the calf region) were found in each group with no associated pulmonary embolism. There was no difference between groups in the VTE rate., Discussion: Our hypothesis was confirmed since the incidence of symptomatic VTE was the same whether postoperative anticoagulants were prescribed or not. The incidence of symptomatic VTE after ACL reconstruction was identical whether thromboprophylaxis was used or not. This casts doubt on the need for postoperative thromboprophylaxis, especially in younger patients who do not have risk factors, and brings into question whether the recommendations in France should be changed., Level of Evidence: III (retrospective case-control study)., (Copyright © 2021. Published by Elsevier Masson SAS.)

Injuries involving the anterior cruciate ligament are among the most common athletic injuries, and are the most common involving the knee. The anterior cruciate ligament is a key translational and rotational stabilizer of the knee joint during pivoting and cutting activities. Traditionally, surgical intervention in the form of anterior cruciate ligament reconstruction has been recommended for those who sustain an anterior cruciate ligament rupture and wish to remain active and return to sport. The intra-articular environment of the anterior cruciate ligament makes achieving successful healing following repair challenging. Historically, results following repair were poor, and anterior cruciate ligament reconstruction emerged as the gold-standard for treatment. While earlier literature reported high rates of return to play, the results of more recent studies with longer follow-up have suggested that anterior cruciate ligament reconstruction may not be as successful as once thought: fewer athletes are able to return to sport at their preinjury level, and many still go on to develop osteoarthritis of the knee at a relatively younger age. The four principles of tissue engineering (cells, growth factors, scaffolds, and mechanical stimuli) combined in various methods of bioaugmentation have been increasingly explored in an effort to improve outcomes following surgical treatment of anterior cruciate ligament injuries. Newer technologies have also led to the re-emergence of anterior cruciate ligament repair as an option for select patients. The different biological challenges associated with anterior cruciate ligament repair and reconstruction each present unique opportunities for targeted bioaugmentation strategies that may eventually lead to better outcomes with better return-to-play rates and fewer revisions., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Study Design: Prospective case series., Background: After surgical reconstruction of the anterior cruciate ligament, recovery to pre-injury levels of knee function is challenging. Postoperative edema and muscle atrophy are common roadblocks to full function and are evident in changes to the surface morphology of the knee. There are currently few accessible objective tools to accurately track these morphological changes., Objectives: We aimed to determine if 3D surface scanning can be used to monitor changes in the external shape of the knee after surgery and throughout the rehabilitation process., Methods: Thirty participants had 3D surface scans taken of their knee, along with questionnaire-based functional outcomes prior to surgery (baseline), and at two-week, six-week, 12-week, and 26-week timepoints post-surgery. Volumetric changes relative to pre-op were assessed using generalized linear growth models for key anatomical regions and correlated with functional outcomes., Results: Significant swelling of the patella region compared to baseline was evident immediately after surgery (14%, p < 0.001), before returning to pre-operative levels. Changes in volume at this region were significantly associated with patient-reported functional outcomes. Reductions in volume of the regions corresponding to the vastus medialis and lateralis muscles were significant at 12 weeks post-surgery (p = 0.018 and 0.01 respectively) but returned to baseline levels at six months., Conclusion: We demonstrate the use of 3D surface scanning as a method for capturing detailed measurements of knee surface morphology after surgery. Significant changes in external morphology are evident during the rehabilitation process., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest relating to the material presented in this article., (Copyright © 2019 Elsevier B.V. All rights reserved.)