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The state of the ACL injured knee and how this impacts on quality of life (QOL) more than 30 years after ACL injury, remains unclear. Additionally, the impact of surgical or non-surgical ACL treatment on outcome beyond 30 years of injury is uncertain. This study aimed to: i. Evaluate patient-reported outcomes (PROs) 32-37 years following acute ACL injury ii. Assess whether ACL treatment (surgical or non-surgical), baseline meniscus injury and knee function at mid-term follow-up were related to differences in PROs at 32-37 year follow-up

The impact of the anterior cruciate ligament (ACL)-injured knee on quality of life (QOL) and knee function more than 30 years after ACL injury is unclear. Additionally, comparison in outcome following football and non-football related ACL injury, and the impact of meniscus injury, ACL treatment and knee function on patient-report outcomes (PROs) 32-37 years following injury has not been investigated. This study aimed to: i. Evaluate PROs 32-37 years following football compared with non-football related ACL injury; ii. Assess the relationship between ACL treatment, baseline meniscus injury and mid-term knee function with PROs, 32-37 years following football compared with non-football related ACL injury

Background: The resurgence in recent attention given to the Anterolateral Ligament has fuelled debate regarding its potential role in knee kinematics, injury, and the need for repair or reconstruction. Surgeons have long recognised that a laterally based extra-articular reconstruction (LEAR) offers a powerful tool to control rotation of the knee. The principle subsequently emerged that combining extra- and intra-articular reconstructions was less likely to fail than either technique performed in isolation. Although successful in reducing anterolateral instability, LEAR fell out of favour when reports emerged about its unpredictability and unsatisfactory results in some cases. Aim: The purpose of this study was to systematically review the current literature on the clinical outcomes following primary anterior cruciate ligament reconstruction (ACLR) with a LEAR. A secondary aim was to compare the clinical outcomes of combined ACLR and LEAR with ACLR alone. Methodology: Systematic Review. Relevant articles were identified by two independent reviewers following a search of seven electronic databases. The inclusion criteria was all published peer-reviewed studies including randomized controlled trials, nonrandomized comparative studies, cohort studies, and case series (> 10 patients) with outcome data following primary ACLR with a LEAR with more than two years follow-up. The exclusion criteria included extra-articular procedures performed in isolation, synthetic ACLR or LEAR, cases with greater than two surgically treated knee ligaments or combined alignment knee surgery, ACL repair, reports on guidelines, technical notes, reviews or systematic reviews. Methodological quality assessment was performed using the MINORS criteria. Data was obtained using a data-extraction form developed specifically for this review. The outcomes of interest included postoperative clinical examination, objective, subjective, functional and radiographic evaluation. A meta-analysis was performed using a random effects model on available data. Results: The literature search yielded 363 articles. After titles and abstracts were reviewed, 125 articles were selected for full-text review, of which 32 studies met the inclusion criteria (11 comparative studies 21 non-comparative studies). Of the 11 comparative studies, 5 recommended a combined LEAR and ACLR, 5 were in favour of the ACLR alone, and 1 was equivocal. Meta-analysis demonstrated a statistically significant difference for the pivot-shift test in favour of a combined LEAR and ACLR. All but 2 of the non-comparative groups reported a satisfactory outcome with combined ACLR and LEAR at a minimum of two years. Three long-term studies (>10 years) found there was no increased rate of lateral compartment osteoarthrosis with LEAR. Conclusions: A meta-analysis of data acquired from studies comparing ACLR to a combined ACLR with a LEAR, revealed a significantly reduced the post-operative pivot shift with LEAR. Review of the recommendations of 11 comparatives studies reached an equivocal verdict as to effectiveness of a LEAR in conjunction with ACLR. A number of studies advocated that a LEAR was not necessary when treating an acutely rupture ACLR in the primary setting, however, in the chronic setting it may have greater utility. Based on the available radiographic data, long term follow-up of ACLR with LEAR, there was no evidence of an increased incidence of lateral compartment osteoarthrosis.

Psychological factors may be a hindrance for returning to sport after an anterior cruciate ligament (ACL) reconstruction. The ACL-Return to Sport after Injury scale (ACL-RSI) measures athletes emotions, confidence in performance, and risk appraisal in relation to return to sport. The aim of this study was to translate the ACL-RSI scale from English to Swedish and to examine some of the measurement properties of the Swedish version. The ACL-RSI was translated and culturally adapted. A professional expert group and five patients evaluated face validity. One hundred and eighty-two patients completed the translated ACL-RSI, a project-specific questionnaire, the Tampa Scale of Kinesiophobia (TSK), the Knee-Self-Efficacy Scale (K-SES), the Multidimensional Health Locus of Control (MHLC-C), the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Anterior Cruciate Ligament-Quality of Life (ACL-QoL) questionnaires. Fifty-three patients answered the ACL-RSI twice to examine reproducibility. The ACL-RSI showed good face validity, internal consistency (Cronbachs alpha=0.948), low floor and ceiling effects and high construct validity when evaluated against the TSK, K-SES, MHLC-C, KOOS, and ACL-QoL scales. The reproducibility was also high (intra-class correlation=0.893). Therefore, the ACL-RSI can be used to evaluate psychological factors relevant to returning to sport after ACL reconstruction surgery. Funding Agencies|Swedish National Centre for Research in Sports (CIF)||R&D-centre Sormland||Linkoping University

Diabetes Care, 2009, Dec.;32(12): 2297-9.