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Importance Distal biceps rupture is a debilitating injury that is increasing in incidence. A subset of patient experiences this injury on both sides, simultaneously or at separated times. Previous studies have evaluated the incidence and risk factors of unilateral distal biceps rupture. However, little is known about the risk factors for bilateral distal biceps rupture. Aims This aims of this study were to determine risk factors for bilateral distal biceps rupture and to compare these to the known risk factors for unilateral rupture. Evidence review A systematic review of literature was conducted using five databases, producing a total of 1183 papers. After the review process, 31 papers with data bilateral distal biceps tendon ruptures were included. Findings The 31 papers included a total of 2234 patients with 2366 ruptures. Patients with a bilateral rupture were younger than patients with unilateral ruptures (45.8 vs 48.8 years old). Women made up a larger percentage of patients with bilateral ruptures (6.8% vs 4.0%). Bilateral injuries occurred most commonly during heavy lifting or falls, whereas forced extension of the arm was the most frequently reported injury mechanism reported with unilateral ruptures. Tobacco used was more common in patients with bilateral ruptures (24.4% vs 6.8%). Labour-intensive occupations and anabolic steroid use did not appear to increase the risk of a bilateral rupture. Pooling of the data was not possible due to heterogeneity of the included studies. Conclusions While differences in risk factors between patients with unilateral and bilateral ruptures were observed, there was too great of a degree of heterogeneity among the studies to perform a meta-analysis of the data. Level of evidence Systematic review; level III evidence.

Medial collateral ligament (MCL) injury is very common and surgical repair is sometimes necessary. Especially in the setting of simultaneous anterior cruciate ligament reconstruction (ACLR) as the ACL is the secondary restraint against valgus stress. The goal of this study was to evaluate knee biomechanics after suture repair of the MCL augmented with suture tape, as compared to MCL repair alone, in the setting of concomitant ACL reconstruction (ACLR). Fifteen fresh-frozen human cadaveric knees were tested using a six-degrees-of-freedom robotic system under four loadings: (a) an 89.0 N anterior tibial load, (b) a 5.0 Nm internal and external rotation torque, (c) a 10.0 Nm valgus load, (d) a 7.0 Nm valgus load combined with 5.0 Nm internal rotation torque as a static simulated pivot-shift. The tested conditions were ACLR with the following states: (1) MCL intact, (2) MCL deficient, (3) MCL Repair, and (4) MCL repair augmented with suture tape (MCL Repair + ST). Under the different knee loadings, the tibial displacement, and the force in either the intact MCL, suture repaired MCL or repaired MCL-suture tape complex was measured. While neither the MCL Repair nor the MCL Repair + ST restored valgus rotation to the MCL intact state, displacement was significantly smaller after MCL Repair + ST (p

Female athletes represent a unique challenge for sports medicine providers. Care for skeletally mature female athletes requires an understanding of the distinct physiology, risk factors and injury patterns that have been described in this population. Anterior cruciate ligament (ACL) injuries are commonly observed in female athletes, especially in high-risk sports such as soccer, basketball, lacrosse and volleyball. Women have been shown to be at a higher risk for ACL injury compared with their male peers, even competing in the same sport. Several factors must be considered when discussing the increased risk of ACL injuries in women. Anatomic factors and altered landing mechanics alignment contribute to increased forces seen at the ACL. A variety of other factors including altered neuromuscular profiles, hormonal factors and genetic factors may all play a role in increased predisposition towards ACL injury. Prevention strategies for ACL such as proprioceptive training may be helpful, especially for at-risk activities such as landing and cutting drills. Optimal surgical management including graft choice is an area of debate. Postoperatively, return to sport protocols are not well standardised for female athletes. Women have a lower return to sport frequency, and psychological factors such as fear of reinjury are often cited as a predominant factor. Overall, the influence of female gender on ACL injury treatment has been an area of heavy research recently. However, more research is needed to elicit the reasons for physical and psychological differences between men and women in order to clarify optimal postoperative management.

Background: Anterior cruciate ligament (ACL) repair is an alternative to reconstruction; however, suture tape support may be necessary to achieve adequate outcomes. Purposes: To investigate the influence of suture tape augmentation (STA) of proximal ACL repair on knee kinematics and to evaluate the effect of the 2 flexion angles of suture tape fixation. Study Design: Controlled laboratory study. Methods: Fourteen cadaveric knees were tested using a 6 degrees of freedom robotic testing system under anterior tibial (AT) load, simulated pivot-shift (PS) load, and internal rotation (IR) and external rotation loads. Kinematics and in situ tissue forces were evaluated. Knee states tested were (1) ACL intact, (2) ACL cut, (3) ACL repair with suture only, (4) ACL repair with STA fixed at 0° of knee flexion, and (5) ACL repair with STA fixed at 20° of knee flexion. Results: ACL repair alone did not restore the intact ACL AT translation at 0°, 15°, 30°, or 60° of flexion. Adding suture tape to the repair significantly decreased AT translation at 0°, 15°, and 30° of knee flexion but not to the level of the intact ACL. With PS and IR loadings, only ACL repair with STA fixed at 20° of flexion was not significantly different from the intact state at all knee flexion angles. ACL suture repair had significantly lower in situ forces than the intact ACL with AT, PS, and IR loadings. With AT, PS, and IR loadings, adding suture tape significantly increased the in situ force in the repaired ACL at all knee flexion angles to become closer to that of the intact ACL state. Conclusion: For complete proximal ACL tears, suture repair alone did not restore normal knee laxity or normal ACL in situ force. However, adding suture tape to augment the repair resulted in knee laxity closer to that of the intact ACL. STA with fixation at 20° of knee flexion was superior to fixation with the knee in full extension. Clinical Relevance: The study findings suggest that ACL repair with STA fixed at 20° could be considered in the treatment of femoral sided ACL tears in the appropriate patient population.

The aims of this study were (1) to study the biomechanics of single-bundle anatomic ACL reconstructed knees with and without notchplasty using a robotic testing system and (2) to determine if there would be a difference between performing a small or large notchplasty. Fifteen fresh-frozen specimens were used in this study. The ACL reconstruction (ACL-R) was performed using an anatomic single-bundle technique with the 8 mm soft tissue graft fixed at 30° with suspensory fixation on the femoral side and a screw and washer on the tibial side. The notchplasty was then created with a burr. The following knee states were compared: (1) ACL-R, (2) ACL-R with a small (3 mm) notchplasty, and (3) ACL-R with a large (6 mm) notchplasty. Four loading conditions were applied: (1) an anterior drawer with an 89 N anterior tibial load, (2) simulated pivot-shift loading, (3) a 5 Nm internal rotational moment, and (4) a 5 Nm external rotational moment. Under anterior tibial loading, anterior tibial translation increased, and graft force decreased significantly after ACL-R + 3 mm notchplasty and ACLR + 6 mm notchplasty compared to ACL-R alone at FE, 15° and 30° of knee flexion. There were no changes in either anterior tibial translation or graft force under simulated pivot-shift loading, internal rotational moment, or external rotational moment. When added to anatomic ACL reconstruction, notchplasty increased anterior tibial translation and decreased graft forces during low knee flexion angles. There was no difference between a small and large notchplasty. The findings of this study are clinically relevant as the purpose of anatomic ACL reconstruction is to restore normal knee laxity, and while notchplasty may be helpful in avoiding graft impingement and improving visualization, removing even 3 mm of bone leads to biomechanical changes.

Misnaming low-grade lipomatous tumors poses a clinical and medicolegal challenge, potentially subjecting patients to expensive and unnecessary surgeries. The terms atypical lipomatous tumor (ALT) and "well-differentiated" liposarcoma (WDL) have been used interchangeably in pathology reports, scholarly works and consensus recommendations, creating vagaries between low-virulence extremity tumors and retroperitoneal disease with metastatic potential.A systematic review was performed on all studies that reported on the local recurrence rate and metastasis of ALTs and WDLs in living human subjects. Local recurrence and metastases were compared using Fisher's Exact Test.In total, 20 studies evaluated ALTs (n=936), whereas 13 studied WDLs (n=626). Mean follow-up was 6.6±2.0 years (median, 7.0 y). No metastatic disease was observed among ALTs, whereas 15 patients with WDLs (2.7%, P0.0001) had metastases. The local recurrence rate of ALTs was significantly lower than WDLs after both marginal (15.1%, 141/936 vs. 46.0%, 288/626, P0.0001) and wide excisions (3.3%, 2/59 in ALT vs. 17.4%, 19/109, P=0.007).ALT should be reserved for extremity lesions meeting appropriate histopathologic criteria that represent nonmetastatic disease, reducing over-diagnosis, over-treatment, and patient risk.

Objectives In patients undergoing arthroscopic knee surgery, it is not uncommon to complain of pain in both the ipsilateral and the contralateral knee. The primary aim of the present study was to evaluate the prevalence of contralateral knee pain in patients undergoing arthroscopic knee surgery. The secondary aim was to identify risk factors for contralateral knee pain in this population. Methods All patient who underwent arthroscopic knee surgery between 2015 and 2017 were included. The prevalence of pain in the contralateral knee prior to and at the final follow-up after ipsilateral knee surgery was assessed. The following potential risk factors for contralateral knee pain were evaluated: age, gender, worker comp status, duration of symptoms, pre-operative diagnosis, activity level, history of a fall, use of a walking aid and findings during surgery. Results A total of 142 patients met the inclusion criteria. The average age was 45±11 years, 104 patients (73%) were men. Prior to the surgery on the ipsilateral knee, only 1 patient ( Conclusion Pain in the contralateral knee is uncommon prior to arthroscopic knee surgery, but common after. The risk for the development of contralateral knee pain is increased if the index injury was workers compensation related. Level of evidence Level IV case series.

Purpose To investigate the occurrence of heat-related complications from radiofrequency and electrocautery devices in patients undergoing arthroscopic surgery. Methods A systematic review was performed using the PubMed/Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies reporting complications after arthroscopy using electrosurgery devices were included. Only English- and Dutch-language articles were included. Basic science/nonclinical studies/human cadaveric studies and animal studies were excluded. Article selection was performed by 2 separate reviewers. Interobserver agreement of the selection procedure was determined by Cohen’s kappa. All included articles were critically appraised using an adapted version of the ROBINS-I tool. Results Twenty-five studies were included in this systematic review. A total of 309 cases of heat-related complications were identified. Chondrolysis was present in 45 cases and dermal burns in 15 cases. Axillary nerve injuries were reported in 197 cases of arthroscopic adhesive capsulitis release. However, it was unclear whether these injuries were directly related to the overheating of the arthroscopic fluid. No one specific risk factor for thermal complications was identified, but related factors included the leakage of the arthroscopy fluid, use of a thermal device continuously for a long period of time, proximity of the thermal device to the tissue, intra-articular local anesthetic injection or the use of intra-articular pain pumps, and certain surgical procedures, such as thermal capsulorrhaphy, capsular release, and synovectomy. Conclusions The most common heat-related complications in arthroscopy are dermal burns and chondrolysis. Risk factors include leakage of arthroscopy fluid, use of a thermal device, intra-articular anesthetics/pain pumps, and performing specific surgical procedures. Level of Evidence Systematic review of level III-IV studies.

Medial collateral ligament (MCL) injury is very common and surgical repair is sometimes necessary. Especially in the setting of simultaneous anterior cruciate ligament reconstruction (ACLR) as the ACL is the secondary restraint against valgus stress. The goal of this study was to evaluate knee biomechanics after suture repair of the MCL augmented with suture tape, as compared to MCL repair alone, in the setting of concomitant ACL reconstruction (ACLR).Fifteen fresh-frozen human cadaveric knees were tested using a six-degrees-of-freedom robotic system under four loadings: (a) an 89.0 N anterior tibial load, (b) a 5.0 Nm internal and external rotation torque, (c) a 10.0 Nm valgus load, (d) a 7.0 Nm valgus load combined with 5.0 Nm internal rotation torque as a static simulated pivot-shift. The tested conditions were ACLR with the following states: (1) MCL intact, (2) MCL deficient, (3) MCL Repair, and (4) MCL repair augmented with suture tape (MCL Repair + ST). Under the different knee loadings, the tibial displacement, and the force in either the intact MCL, suture repaired MCL or repaired MCL-suture tape complex was measured.While neither the MCL Repair nor the MCL Repair + ST restored valgus rotation to the MCL intact state, displacement was significantly smaller after MCL Repair + ST (p 0.05). The knee rotation under external rotation torque in MCL Repair + ST did not differ MCL intact (n.s.), while with MCL Repair the rotation was significantly greater (p 0.05). MCL Repair + ST did not cause an over-constraint of the knee in any of the tested loading conditions.In a combined ACL-reconstruction-MCL-repair model, MCL Repair augmented with suture tape improved valgus and external rotation laxity when compared to MCL suture repair alone. Suture tape augmentation may provide this additional means of stabilization and can be added at the time of surgical repair of the MCL. Clinically this may result in lower failure rates and less residual laxity after MCL repair, as well as shorter immobilization times and faster return to play.

Background:A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sport and their previous activity level.Purpose:The aim of the Panther Symposium ACL Injury Return to Sport Consensus Group was to provide a clear definition of RTS after ACL injury and a description of the RTS continuum as well as provide clinical guidance on RTS testing and decision-making.Study Design:Consensus statement.Methods:An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence.Results:Key points include that RTS is characterized by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS and, ultimately, return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum, with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors, and concomitant injuries.Conclusion:The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing, and methods for the biological assessment of healing and recovery.

The aim of the present study was to evaluate and compare the effectiveness of the silver-zinc bioelectric dressing as compared with skin preparation with 2% chlorhexidine or 4% chlorhexidine in reducing the bacterial count on the knee.Three groups consisting of 48 healthy volunteers were included. Age range was 23 to 54 years old and 60% of participants were male. Each subject had 1 knee serve as the test and the contralateral as the control. The test site was prepared with either 2% chlorhexidine, 4% chlorhexidine, or a silver-zinc bioelectric dressing and after 24 hours skin cultures were taken and examined for bacterial growth.In the 2% chlorhexidine group 23 of 48 unprepped knees had positive cultures, compared with 9 of 48 prepped knees (P = .003; risk reduction, 4.0 times). In the 4% chlorhexidine group 25 of 48 unprepped knees had positive cultures, compared with 14 of 48 prepped knees (P = .027; risk reduction, 2.6 times). In the silver-zinc bioelectric dressing group 29 of 48 unprepped knees had positive cultures, compared with 7 of 48 prepped knees (P.001; risk reduction, 8.9 times). There was no difference in the positive skin culture rate between the 3 methods.Application of the silver-zinc bioelectric dressing was equally effective at reducing skin bacterial load when compared with skin preparation with 2% chlorhexidine or 4% chlorhexidine in healthy volunteers.Basic Science - Microbiology.The findings of this study indicate that the use of a bioelectric dressing after knee surgery can match the standard of care of preparing the skin with an antiseptic before surgery.

Infection is a concern after all orthopedic procedures, including shoulder surgery. This systematic review of literature aimed to determine risk factors for infection as well as the availability and effectiveness of measures utilized to prevent infection after elective shoulder surgery. An electronic database search was performed using MEDLINE (1950–October 2017), EMBASE (1980–October 2017), CINAHL (1982–October 2017), and the Cochrane database to identify studies reporting a risk factor or preventive measure for infection after shoulder surgery. Fifty-one studies were eligible for inclusion. Risk factors identified for infection were male sex, the presence of hair, receiving an intra-articular cortisone injection within the 3 months prior to surgery, smoking, obesity, and several comorbidities. The only preventive measure with level I evidence was for the use of chlorhexidine wipes for cleansing the skin in the days prior to surgery and for the use of ChloraPrep or DuraPrep over povodine and iodine to prep the skin at the time of surgery. Level II–IV evidence was found for other infection prevention methods such as intravenous antibiotic prophylaxis. There are many risk factors associated with developing an infection after elective shoulder surgery. Many preventive measures have been described which may decrease the risk of infection; however, most lack a high level evidence to support them. The findings of this systematic review are clinically relevant as it has been shown that infection after shoulder surgery results in poor patient-reported outcomes and pose a significant financial burden. As surgeons the goal should be to prevent infections to avoid the morbidity for patients and the increased cost for society. IV systematic review of literature.

Background: Anterior cruciate ligament (ACL) tears are one of the most devastating injuries seen in the National Basketball Association (NBA). No previous studies have examined the economic impact of ACL tears in the NBA. Purpose/Hypothesis: The purpose of this study was to examine the economic impact of ACL tears on NBA players and teams by calculating the costs of recovery (COR) and classifying players based on preinjury success level (All-Star or equivalent, starter, or reserve) and salary (in US$ million: 4 per season). It was hypothesized that players with a lower preinjury salary or primarily a reserve role would have decreased costs, lower rates of return to play (RTP), and shorter careers. Study Design: Descriptive epidemiology study. Methods: We reviewed the publicly available records of NBA players treated with ACL reconstruction from 2000 to 2015. Data collected included player demographics, player salaries, statistical performance using player efficiency rating (PER), and specifics regarding time missed and RTP rate. Results: A total of 35 players met the study inclusion criteria. The cumulative economic loss from ACL injuries in the NBA from 2000 to 2015 was $99 million. The average COR was $2.9 million per player. RTP rate was 91% overall, with 70% retention at 3 years. Players that made a salary of less than $1.5 million per season before the injury had a significant drop in PER (difference of –7), RTP rate of 63%, and only 37% retention at 3 years. Conversely, recovering All-Star players also had a significant drop in PER (–6.2), and no players repeated as All-Stars in the season after ACL reconstruction (0%), although they did have a 100% RTP rate and an average career length of 5.6 seasons postinjury. Conclusion: While the RTP rate in NBA athletes remained high, ACL reconstruction can result in decreased statistical performance and/or inability to return to prior levels of play. Players who made less than $1.5 million preinjury or played primarily in a reserve role were associated with lower RTP and retention in the NBA at 3 years.

Study DesignRetrospective clinical study.PurposeThe purpose of this study was to determine what percentage of patients who underwent nonoperative management of unilateral non-displaced or minimally displaced facet fractures progressed radiographically and to determine what percentage of patients required surgical intervention and to identify risk factors for failure of conservative management.Overview of LiteratureAccording to most commonly used classification systems, unilateral, non-and minimally displaced facet fractures are be amendable to nonoperative management.MethodsA retrospective review of the Trauma Registry of a Level I trauma center was performed to identify all patients diagnosed with a non- or minimally displaced unilateral facet fracture which was managed nonoperatively. Several demographic variables and clinical outcomes were recorded. Using computed tomography scanning and plain radiographs, fracture pattern, listhesis, displacement, angle and percentage of the facet that included the fracture were determined. Radiographic progression was defined as the occurrence of listhesis of more than 10% of the anterior-posterior dimensions of the inferior vertebral body during radiographic follow-up. Failure of conservative management was defined as a patient requiring surgical intervention after initially being managed nonoperatively.ResultsSeventy-four patients were included. Fifteen patients (20%) progressed radiographically. However, only 2 developed radicular symptoms and none developed myelopathy or other catastrophic cord related symptoms. Seven patients (9%) underwent surgery. Indications for surgery included significant radiographic progression and/or radicular symptoms. Risk factors for failure of conservative management included presence of radiculopathy at the time of presentation, a higher body mass index, increased Injury Severity Score, greater initial fracture displacement and more than 2 mm of listhesis.ConclusionsPatients with non-displaced or minimally displaced facet fractures who do not have neurological symptoms at the time of presentation can safely be managed conservatively with careful observation and follow-up.

This study evaluates the ability of a Glass Reinforced Hydroxyapatite Composite (GRHC), in a new microporous pellet formulation with autologous bone marrow concentrate (BMC), to enhance bone regeneration and new bone formation. Ninety non-critical sized bone defects were created in the femurs of nine Merino breed sheep and randomly left unfilled (group A), filled with GRHC pellets alone (group B) or filled with GRHC pellets combined with BMC (group C). The sheep were sacrificed at 3 weeks (three sheep), 6 weeks (three sheep) and 12 weeks (three sheep) and histological analysis (Light Microscopy-LM), scanning electron microscopy (SEM) and histomorphometric analysis (HM) were performed. At 3, 6, and 12 weeks, HM revealed an average percentage of new bone of 48, 72, 83%; 25, 73, 80%, and 16, 38, 78% for Groups C, B and A respectively (significantly different only at 3 weeks p < 0.05). LM and SEM evaluation revealed earlier formation of well-organized mature lamellar bone in Group C. This study demonstrates that the addition of a bone marrow concentrate to a glass reinforced hydroxyapatite composite in a pellet formulation promotes early bone healing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1176-1182, 2017.

The intercondylar notch and anterior cruciate ligament (ACL) are closely related. Literature suggests that patients with a narrow intercondylar notch may be predisposed to ACL injury. However, the notch is also important during ACL reconstruction surgery. A narrow notch or A-shaped notch may make it difficult to drill the femoral tunnel from the medial portal and may not be able to accommodate a double-bundle technique. However, if these considerations are taken into account, a narrow notch does not predispose to ACL graft rupture. This article provides a historic overview of the research performed on the intercondylar notch as it related to ACL injury risk. In addition, it provides guidelines for intraoperative decision-making.

Anterior cruciate ligament (ACL) rupture is a common injury particularly among young active individuals. ACL injury leads to increased knee laxity and abnormal knee biomechanics that may prevent return to sports and predispose to early onset degenerative changes in the joint. Therefore, optimizing ACL injury treatment is of great interest to the sports medicine field. ACL reconstruction (ACLR) is considered the treatment of choice for most patients, especially in those involved in cutting and pivoting activities, often allowing them to return sports. ACLR has been based traditionally on standardized techniques that neglected the individual anatomy of the patient. Individualized anatomical ACLR is considered a new concept that is based on tailoring the ACL surgery to the individual patient. It uses preoperative measurements on plain radiographs and magnetic resonance imaging as well as intraoperative measurement of the patients’ native ACL and knee anatomy to precisely determine the variations in the size of femoral and tibial insertion site and size and morphology of the intercondylar notch. The ultimate goal of individualized anatomical ACL reconstruction is to restore the ACL to its native dimensions, collagen orientation, and insertion site to replicate the individual anatomy as closely as possible. In this concept, the choice to perform a single- or double-bundle reconstruction or augmentation depends on aforementioned variations in the anatomy of the ACL and the knee joint.

Turf toe is a common injury in a variety of different athletes, especially those involved in contact sports played on rigid surfaces. It is caused by a hyperextension injury to the hallux metatarsophalangeal joint resulting in attenuation or tearing of the plantar capsular ligamentous complex. Treatment generally consists of nonoperative measures such as rest, ice, nonsteroidal anti-inflammatory drugs, taping, a stiff-sole shoe, walking boot, or casting. There has been a recent increase in the use of biologics, such as platelet-rich plasma and autologous conditioned plasma for the treatment of a variety of orthopaedic conditions. This study reports on 2 cases of turf toe treated with a combination of Toradol and autologous conditioned plasma. These case presentations are followed by a literature review on the use of biologics in the treatment of sports injuries.

In the management of common orthopaedic pathology involving tendons, ligaments, bone, and articular cartilage, the application of small molecules and biologic compounds has expanded greatly in the past decade. In particular, the use of platelet-rich plasma (PRP) and stem cells has gained significant attention for potential therapeutic augmentation of healing, modulation of inflammatory cascades, and pain modulation. Despite the increase in clinical application and interest, there has been a paucity of high level of evidence studies supporting the use of these biologic agents. This article examines the current state for the clinical use of stem cells and PRP, with review of the most recent clinical studies involving the treatment of tendon, ligament, bone, and cartilage injury. Current evidence regarding safety profile, therapeutic effect, and validated outcome scores are reported. Though plagued by inconsistency in experimental testing and low numbers of large, multicenter randomized controlled trials, the use of stem cells and PRP appears to have a positive clinical effect with minimal systemic side effects or complications. Further study is needed to elucidate the specific therapeutic indications, dosing regimen, and efficacy of treatment in short and long follow-ups is needed to document the role and effectiveness of these treatments in clinical practice.

Sports participation has never been more popular. The number of kids participating in organized athletics continues to increase each and every year.

Multi-ligament knee injuries present a wide spectrum of pathology involving a combination of the cruciate(s) and collateral(s). This chapter will focus on one specific injury pattern: combined posterior cruciate ligament and posterolateral corner injury. It will briefly discuss the anatomy and function, history, physical exam, and diagnostic tests that should be considered. The remainder of the chapter will discuss the management of these injuries. The authors’ preferred surgical technique will be outlined in a concise, step-by-step approach with picture illustrations.

Poster presentations are a key component of any scientific conference. They are an excellent platform for a researcher to present their study to a large audience. Therefore, it is important to prepare the presentation in a way that catches the eye of the people attending the meeting while presenting the key data in an easy to interpret format. This will encourage the audience to engage in an academic discussion, which is vital for the researcher to obtain feedback on their study. This chapter aims to help orthopedic researchers in preparation and presentation of a scientific poster. After reading this chapter, the reader should know the various different types of poster presentation, be familiar with the technical aspect of how to make their own poster, and understand what to do at the scientific meeting to get the most out of presenting their research in poster format.

The most common statistical error in orthopedic research is a type II (or “beta”) error. This occurs when a study incorrectly concludes that there is “no difference” between the test and control treatment. Finding no difference does not always mean there is no difference. This chapter will review the different causes of type II errors and provide tips for avoiding these errors when conducting research and interpreting the literature. The prevalence of type II errors in orthopedic research underscores the necessity of more objective outcome measurements and randomized studies with large numbers of patients.

This study presents a method to measure the size of quadriceps, patellar tendon and hamstring autografts using preoperative magnetic resonance imaging (MRI). Sixty-two subjects with a mean age of 25 ± 10 years who underwent ACL surgery between 2011 and 2014 were included. Patient anthropometric data were recorded for all subjects. During surgery, the respective autograft was harvested and measured using commercially available graft sizers. MRI measurements were performed by two raters, who were blinded to the intra-operative measurements. The inter- and intra-rater reliability was ≥0.8 for all MRI measurements. The intra-class correlation coefficient between the MRI measurement of the graft and the actual size of the harvested graft was 0.639. There were significant correlations between quadriceps tendon thickness and height (r = 0.3, p

Anterior cruciate ligament (ACL) injuries are often seen in young participants in sports such as soccer, football, and basketball. Treatment options include conservative management as well as surgical intervention, with the goal of enabling the patient to return to cutting and pivoting sports and activities. Individualized anatomic ACL reconstruction is a surgical technique that tailors the procedure to the individual patient using preoperative measurements on plain radiographs and magnetic resonance imaging and intraoperative measurement to map the patients' native ACL anatomy in order to replicate it as closely as possible. Anatomic ACL reconstruction, therefore, is defined as reconstruction of the ACL to its native dimensions, collagen orientation, and insertion site. The surgical reconstruction is followed by a specific rehabilitation protocol that is designed to enable the patient to regain muscle strength and proprioception while facilitating healing of the reconstructed ACL prior to the patient's returning to sports activities.

Background A large number of surgical techniques have been described to treat acromioclavicular (AC) joint separations. Despite the high success rates with double-tunnel reconstruction, this method has been associated with the risk of coracoid and clavicle fractures. This study aimed to evaluate the outcomes of the first cohort of patients who underwent single-tunnel AC and coracoclavicular (CC) ligament reconstruction. It was hypothesized that this technique would result in maintenance of reduction and a minimal risk of fracture of the coracoid and clavicle. Methods All patients who underwent single-tunnel AC joint reconstruction between 2012 and 2015 via the technique with 2-year follow-up were included. Objective outcomes recorded were maintenance of reduction as measured by the CC distance on radiographs, shoulder range of motion, strength, return to sports, and complications. Subjective outcomes included maintenance of reduction on visual inspection and various patient-reported outcomes. Results Seventeen patients were included with a mean age of 41 ± 12 years. Separation types included types III, IV, and V. The mean follow-up period was 29 ± 9 months (range, 16-45 months). The CC distance improved from 37.4 to 30.0 mm on plain radiographs (P = .006), the American Shoulder and Elbow Surgeons score improved from 67.0 to 90.1 (P = .094), and the Single Assessment Numeric Evaluation score improved from 30.5 to 91.1 (P = .025). Reduction on visual inspection was maintained in 16 patients (94.1%). Regarding sports participation, 14 patients (82.4%) returned to their preinjury level. The most common complication was a prominent suture knot stack, occurring in 3 patients (17.6%), which was removed in all 3 in a second procedure. There were no clavicle or coracoid fractures. Conclusion The described technique results in satisfactory objective and patient-reported outcomes and return to sports while avoiding coracoid and clavicle fractures.

Background: Renewed interest has arisen in arthroscopic anterior cruciate ligament (ACL) repair techniques. Hypothesis: ACL repair with or without some form of internal bracing could lead to good outcomes in a carefully selected subset of patients. Study Design: Systematic review. Methods: An electronic database search was performed to identify 89 papers describing preclinical and clinical studies on the outcome of ACL repair. Results: Proximal ACL tear patterns showed a better healing potential with primary repair than distal or midsubstance tears. Some form of internal bracing increased the success rate of ACL repair. Improvement in the biological characteristics of the repair was obtained by bone marrow access by drilling tunnels or microfracture. Augmentation with platelet-rich plasma was beneficial only in combination with a structural scaffold. Skeletally immature patients had the best outcomes. Acute repair offered improved outcomes with regard to load, stiffness, laxity, and rerupture. Conclusion: ACL repair may be a viable option in young patients with acute, proximal ACL tears. The use of internal bracing, biological augmentation, and scaffold tissue may increase the success rate of repair.

Acromioclavicular (AC) joint separation is a common injury seen in the young adult athletic population. Both the indications for surgical management and the best operative technique remain controversial. One of the most popular reconstruction techniques is the anatomic double-tunnel coracoclavicular (CC) ligament reconstruction. However, there have been several case reports of clavicle fractures with this technique. This article presents a single-tunnel reconstruction technique that aims to restore both the CC and AC ligament function, while minimizing fracture risk.

Overhead athletes, such as baseball players, have been shown to have adaptive changes in the shoulder range of motion (ROM) of their dominant arm. Professional handball players are a unique subtype of overhead athletes with very different demands from baseball players. The aim of this study was to determine if professional handball players demonstrate differences in shoulder ROM between their dominant and non-dominant arm and try to relate them with new variables.Fifty professional male handball players were included and completed a questionnaire regarding age at which they started to play, number of hours they practice a week, field position and arm dominance. ROM measurements were performed including forward flexion (FF), external rotation with the shoulder in abduction (ABER) and with adducted arm (ADER) and internal rotation with shoulder in abduction (IR). Statistical analysis was performed to determine differences in ROM between the dominant and non-dominant shoulder and if there is a relationship between these differences and shoulder load or field position.The dominant arm showed decreased internal rotation (47 vs. 56 degrees, p 0.001) and increased external rotation both with the arm abducted (99 vs. 88 degrees, p 0.001) and at the side (62 vs 57 degrees, p = 0.001). This was not correlated with shoulder load for any movement (FF, p = 0.980; ABER, p = 0.741; ADER, p = 0.803; IR, p = 0.085) but was dependent on field position with first line players showing the highest internal rotation deficit (13 degrees vs. 6-7 degrees in the other field positions, p = 0.013).This study showed that professional male handball players with a first line position have a significant risk for developing a glenohumeral internal rotation deficit, similar to the phenomenon seen in baseball pitchers.

Level iii retrospective cohort study. Objective The aim of this study was to determine the rate of revision surgery and the occurrence of adjacent segment disease of patients undergoing ACDF for cervical radiculopathy and myelopathy using more modern-day instrumentation techniques. Summary of background data Anterior cervical discectomy and fusion (ACDF) has long been the preferred treatment for cervical radiculopathy and myelopathy. Methods All patients undergoing ACDF between January of 2000 and December of 2010 were included. Age, sex, height, weight, body mass index, symptoms at presentation, number of levels fused, graft type, and smoking status were recorded. Outcomes included revision rate, reason for revision surgery, time to revision surgery, presence and grade of adjacent segment disease, distance from the instrumentation to the cranial and caudal endplate (plate-to-disc distance), and reporting of symptoms of adjacent segment disease at the final follow-up. Results A total of 672 patients were included in this study. The average duration of follow-up was 31 months. One hundred one (15%) patients underwent revision surgery. The reason for revision surgery was adjacent segment disease in 47 (47.5%), pseudarthrosis in 45 (45.5%) and a new problem at a nonadjacent level in 7 (7.1%) of those patients. The need for revision surgery was not affected by patient age, sex, body mass index, smoking status, symptoms at presentation, number of levels fused, plate-to-disc distance or graft type. Conclusion The revision rate after ACDF is 15%. Most revisions were done for either adjacent segment disease or pseudarthrosis. No specific risk factors for revision surgery were identified in this study. Level of evidence 3.

Injury to the anterior cruciate ligament (ACL) of the knee is potentially devastating for the patient and can result in both acute and long-term clinical problems. Consequently, the ACL has always been and continues to be of great interest to orthopaedic scientists and clinicians worldwide. Major advancements in ACL surgery have been made in the past few years. ACL reconstruction has shifted from an open to arthroscopic procedure, in which a two- and later one-incision technique was applied. Studies have found that traditional, transtibial arthroscopic single-bundle reconstruction does not fully restore rotational stability of the knee joint, and as such, a more anatomic approach to ACL reconstruction has emerged. The goal of anatomic ACL reconstruction is to replicate the knee's normal anatomy and restore its normal kinematics, all while protecting long-term knee health. This manuscript describes the research that has changed the paradigm of ACL reconstruction from traditional techniques to present day anatomic and individualized concepts.

Introduction. Intertrochanteric hip fractures occur in the proximal femur. They are very common in the elderly and are responsible for high rates of morbidity and mortality. The authors hypothesized that adding an autologous bone marrow stem cells concentrate (ABMC) to a hydroxyapatite scaffold and placing it in the fracture site would improve the outcome after surgical fixation of intertrochanteric hip fractures.Material and Methods. 30 patients were randomly selected and divided into 2 groups of 15 patients, to receive either the scaffold enriched with the ABMC (Group A) during the surgical procedure, or fracture fixation alone (Group B).Results. There was a statistically significant difference in favor of group A at days 30, 60, and 90 for Harris Hip Scores (HHS), at days 30 and 60 for VAS pain scales, for bedridden period and time taken to start partial and total weight bearing (P<0.05).Discussion. These results show a significant benefit of adding a bone marrow enriched scaffold to surgical fixation in intertrochanteric hip fractures, which can significantly reduce the associated morbidity and mortality rates.Conclusion. Bone marrow stem cells added to a hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures.

The neuromuscular disorder–affected child with severe hip subluxation presents a difficult challenge for the pediatric orthopaedic surgeon. Surgical correction is often necessary and can range from soft tissue releases to bony procedures including proximal femoral osteotomy, proximal femoral resection, arthrodesis, arthroplasty, and pelvic osteotomy. In this article, the indications and surgical techniques for these procedures are discussed. In addition, some general considerations for the care for the child with neuromuscular disorder are considered.

The topic of deep vein thrombosis (DVT) prophylaxis in anterior cruciate ligament (ACL) surgery has become an important topic as the frequency of arthroscopic ACL reconstruction continues to increase. The reported incidence of symptomatic DVT following ACL surgery is approximately 0.3 %, and the incidence of pulmonary embolism (PE) is 0.18 %. Several diagnostic tests exist, but ultrasound is most commonly used to diagnose DVT, whereas CT scan is used most frequently to diagnose a PE. Multiple risk factors, both patient and procedure specific, may affect a patient’s overall risk for developing VTE. Patient-specific risk factors include age, gender, previous history of VTE, oral contraceptives or hormone replacement therapy, varicose veins, smoking, obesity, history of malignancy, pregnancy, and an inherited or acquired thrombophilia. Procedure-specific factors include tourniquet time and type of anesthesia. The decision for the right form of thromboprophylaxis for a specific patient starts with proper risk assessment. Commonly used prophylaxis include: sequential compression devices, compression stockings, aspirin, low-molecular-weight heparin, and warfarin. Various guidelines for the selection of appropriate thromboprophylaxis exist, with the most frequently referenced being provided by the American College of Chest Physicians (ACCP). This chapter evaluates the topic of anticoagulation after ACL reconstruction. It will discuss the incidence and diagnosis of DVT, risk factors, and available thromboprophylaxis and highlight available scientific evidence, as well as national and international guidelines.

The aims of this meta-analysis were to determine the sensitivity and specificity of the KT 1000 Arthrometer, Stryker Knee Laxity Tester and Genucom Knee Analysis System for ACL rupture. It was hypothesized that the KT 1000 test is the most sensitive and specific. Secondly, it was hypothesized that the sensitivity and specificity of the KT 1000 arthrometer increase when the amount of Newton force is increased. An electronic database search was performed using MEDLINE and EMBASE. All cross-sectional and cohort studies comparing one or more instrumented examination tests for diagnosing acute complete ACL rupture in living human subjects to an accepted reference standard such as arthroscopy, arthrotomy and MRI were included. The sensitivity of the KT 1000 Arthrometer with 69 N was 0.54. With 89 N, the sensitivity was 0.78 and the specificity 0.92, and with maximum manual force, the sensitivity was 0.93 and the specificity 0.93. For the Stryker Knee Laxity Tester, the sensitivity was 0.82 and the specificity 0.90. And for the Genucom Knee Analysis System, the sensitivity was 0.74 and the specificity 0.82. The KT Arthrometer performed with maximum manual force has the highest sensitivity, specificity, accuracy and positive predictive value for diagnosing ACL rupture. Meta-analysis, Level I.

Background: There are conflicting reports regarding the role of osseous morphologic characteristics such as an increased tibial slope as associated with an anterior cruciate ligament (ACL) injury. Few studies have analyzed the role of a combination of osseous morphologic characteristics in matched case control studies. The aim of this study was to determine if there is an association between osseous morphologic characteristics and ACL injury in male college American-football players. Methods: Ninety male U.S. National Collegiate Athletic Association (NCAA) Division-I college football players who underwent magnetic resonance imaging (MRI) for a knee injury between 2005 and 2014 were included. Subjects with an ACL injury (ACL-injured group) were matched for age, height, weight, and body mass index to subjects without an ACL injury (control group). Several osseous morphologic characteristics including medial and lateral condylar width, medial and lateral plateau width, notch width, bicondylar width, notch width index, and medial and lateral tibial slopes were measured and were compared between groups. Conditional logistic regression was used to analyze the data. Significance was set at p < 0.05. Results: According to univariable analysis, a narrower lateral femoral condyle (odds ratio, 0.82 [95% confidence interval (95% CI), 0.68 to 0.97]), increased medial tibial plateau slope (odds ratio, 1.42 [95% CI, 1.09 to 1.85]), and increased lateral tibial plateau slope (odds ratio, 1.43 [95% CI, 1.15 to 1.78]) were significantly associated with ACL injury. Multivariable analysis revealed that increased lateral tibial slope (odds ratio, 1.32 [95% CI, 1.03 to 1.70]) was the sole independent predictor of ACL injury. Conclusions: Based on this study, osseous morphology, specifically increased lateral tibial slope, is associated with ACL injury in male college football players. These data might help to improve prevention strategies to lower ACL injury. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: There have been numerous studies on anterior cruciate ligament (ACL) reconstruction. Considering the vast number of studies, a quick assessment reveals rather few with a high level of evidence. Purpose: The primary aim was to categorize the study type and level of evidence of studies on primary ACL reconstruction by applying the level of evidence rating system proposed by the Oxford Centre for Evidence-Based Medicine. The secondary aims were to correlate the level of evidence with the impact factor of the journal, to evaluate the level of evidence over time, and to evaluate the geographic distribution of the included studies. Study Design: Systematic review. Methods: An electronic search was performed using the databases PubMed, EMBASE, and Cochrane Library. Studies published from January 1995 to August 2011 were included. Therapeutic studies written in English that report on isolated primary ACL reconstruction with clinical outcome measurements related to the reconstruction were included. Categorization and implementation of the level of evidence were performed. Correlation between the level of evidence and the impact factor of the journal was analyzed together with linear regression models to reveal any significant trends over time. Results: A total of 7154 studies were analyzed, of which 1510 were included. Analysis of the study types revealed that case series (n = 494; 32.7%) was the most frequent study type. Randomized controlled trials represented 9.2% (n = 139) of the sample, whereas meta-analyses were rare. Single-bundle studies were the most common studies (n = 1333; 88.3%), followed by double-bundle (n = 98; 6.5%) and single- versus double-bundle (n = 79; 5.2%). The journals Arthroscopy, Knee Surgery Sports Traumatology Arthroscopy (KSSTA), and American Journal of Sports Medicine (AJSM) represented 43.5% (n = 657) of the included studies. Arthroscopy had the highest number of publications in general and in level 4 and 5 studies, whereas AJSM had the lowest number of the 3. AJSM had the highest number of level 1 and 2 studies in general. The mean level of evidence calculated without level 5 studies was 3.15 for Arthroscopy, 3.20 for KSSTA, and 2.9 for AJSM. There was a significant correlation ( P < .05) between the impact factor of the journal and mean level of evidence of the journal and the proportion high level of evidence studies (levels 1 and 2). There was a significant ( P < .05) trend toward higher mean level of evidence over time. Conclusion: Most therapeutic studies on primary ACL reconstruction were of low level of evidence, and there was a positive correlation between the journal’s impact factor and the mean level of evidence and the proportion of high level of evidence studies. There was significant trend toward higher mean level of evidence over time.

Growing interest in double-bundle anterior cruciate ligament (ACL) reconstruction has sparked tremendous research, yielding a better understanding of normal ACL anatomy, kinematics, and function. Recent studies have more accurately defined the size and orientation of the femoral and tibial insertion sites of the anteromedial and posterolateral bundles. At our institution, we have identified specific osseous landmarks to better guide tunnel placement. The goal of anatomic ACL is to use these discoveries, refine technique, and reconstruct the ACL in a manner that most closely mimics normal anatomy. Logically, we believe that anatomic ACL reconstruction will lead to more favorable kinematics and, in turn, improved patient outcomes. This article summarizes our experiences and details our systematic approach to anatomic ACL reconstruction. Finally, we highlight multiple issues with conventional ACL reconstruction to better illustrate the concept of anatomic ACL reconstruction.

Background: Three different techniques of anterior cruciate ligament (ACL) reconstruction—conventional (transtibial) single bundle (CSB), anatomic single bundle (ASB), and anatomic double bundle (ADB)—have been described. Purpose: To determine if double-bundle reconstruction is needed to restore rotational stability or if anatomic placement of a single bundle can yield similar results. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: From December 2005 to December 2007, 320 patients were prospectively randomized into 3 groups: ADB, ASB, and CSB reconstruction. The average follow-up was 51.15 months (range, 39-63 months). At the final follow-up, 281 patients were available. In all groups, hamstring tendons were used with suspensory fixation on the femoral side and bioabsorbable interference screw fixation on the tibial side. The outcomes were evaluated by an independent blinded observer using the Lysholm score and subjective International Knee Documentation Committee (IKDC) form. The KT-1000 arthrometer was used to evaluate anteroposterior stability, and the pivot-shift test was used to determine rotational stability. Results: Anatomic single-bundle reconstruction resulted in better anteroposterior and rotational stability than CSB reconstruction (average side-to-side difference for anterior tibial translation was 1.6 mm in the ASB group vs 2.0 mm in the CSB group; P = .002). Negative pivot shift was 66.7% vs 41.7% ( P = .003). In other parameters, the differences between groups were not statistically significant. The results of the ADB group were also superior to the ASB group for anteroposterior and rotational stability (average side-to-side difference for anterior tibial translation was 1.2 mm in the ADB group vs 1.6 mm in the ASB group; P = .002). Negative pivot shift was 93.1% vs 66.7%, respectively ( P < .001), and range of motion was also significantly different ( P = .005). The Lysholm score was 90.9, 91.8, and 93.0 in the CSB, ASB, and ADB groups, respectively. The difference was significant only when we compared ADB and CSB ( P = .025). Subjective IKDC scores were 90.2, 90.6, and 92.1 in the CSB, ASB, and ADB groups, respectively. The difference was not significant. Conclusion: Anatomic double-bundle ACL reconstruction is significantly superior to conventional single-bundle ACL reconstruction and better than anatomic single-bundle reconstruction. Anatomic single-bundle reconstruction was superior to conventional single-bundle reconstruction. However, these differences are small and may not be clinically relevant.

The aims of this study were (1) to evaluate the femoral tunnel position after anatomic double-bundle and nonanatomic single-bundle reconstruction; (2) to evaluate the influence of rotation of the femur caused by limb malalignment on measurements of the position of the femoral ACL tunnel aperture relative to Blumensaat's line. 3D CT scans were performed in 5 patients after anatomic double-bundle reconstruction and 5 patients after nonanatomic single-bundle reconstruction. Digitally reconstructed lateral radiographs were generated from the 3D CT scans to determine the tunnel position on the femur along and perpendicular to Blumensaat's line. The femur was then rotated to simulate internal/external and varus/valgus rotations from 0A degrees to 15A degrees in 5A degrees increments. At each rotated bone position, tunnel position relative to Blumensaat's line was calculated and the difference from the lateral radiograph was calculated. After double-bundle reconstruction, the AM tunnel was located at 31.5 (+/- 5.0) % along Blumensaat's line and 29.7 (+/- 13.6) % perpendicular to Blumensaat's line, and the PL tunnel at 36.2 (+/- 12.9) % along Blumensaat's line and 34.2 (+/- 7.6) % perpendicular to Blumensaat's line. Valgus greater than 10A degrees significantly affected the assessment of tunnel position (P = 0.043). After nonanatomic single-bundle reconstruction, the tunnel position was 35.4 (+/- 15.0) % along Blumensaat's line and -2.7 (+/- 19.4) % perpendicular to Blumensaat's line. Internal rotation of more than 10A degrees significantly affected the assessment of tunnel position (P = 0.043). Tunnel position after anatomic double-bundle reconstruction and nonanatomic single-bundle reconstruction can be determined on lateral radiographs. However, valgus and internal rotation of more than 10A degrees can introduce significant errors in tunnel position estimates. Case series, Level IV

Purpose To assess the ability of a transtibial aimer with a 7-mm off-set in a standardized position to reach the center of the ACL footprint on the femur through the AM portal. Methods Nineteen cadaveric knees were dissected, and the perimeter of the femoral ACL footprint was marked. The aimer was placed just superior to the medial joint line close to the medial condyle through the AM portal. The guide was rested upon the posterior cortex and placed in three different positions: (A) at zero degrees in frontal plane and 60° in axial plane, (B) at 45° in frontal and 45° in axial, and (C) at the center of the ACL insertion site under direct visualization. A digital camera was used to take pictures on the axial plane, and Image J software was used for angle measurement. Aluminum beads were used to mark the three positions indicated by the aimer, and CT scans were performed. The distances from the true center of the ACL to each point were determined. Results Position A resulted in femoral tunnel placement furthest from the center of the ACL footprint (8.6 mm). Position B was at a distance of 3.2 mm, and position C was the most accurate, with an average distance of 2.0 mm. The angles required by Position C varied with an average of 54° ± 11° in the frontal plane and an average of 44° ± 6° in the axial plane. Conclusion The 7-mm transtibial aimer was unable to reach the center of ACL footprint at a fixed orientation.

The primary purpose of this study was as follows: (1) to compare bony morphology in subjects with and without ACL injury. The secondary purposes were the following: (2) to compare bony morphology between men and women and (3) to determine whether MRI measurements of the notch correlate with intra-operative measurements. MRI measurements of NW, bicondylar width, medial condyle size and lateral condyle size, and medial-to-lateral condyle ratio (M:L) were taken from 45 subjects with ACL injury and 44 subjects without ACL injury, by two independent observers. In addition, notch width measurements were taken arthroscopically in the 45 injured subjects. Knee morphometrics were compared between men and women. Additionally, values of ACL-injured and non-injured subjects were compared for male and female subjects separately. Correlations between notch measurements taken from MRI and measured arthroscopically were determined. Reliability of the MRI measurements was calculated. Significant differences were found for bicondylar width (P = 0.001), medial condyle width (P = 0.002), and lateral condyle width (P = 0.002) between male and female subjects. When bony morphology was compared between ACL-injured and non-injured subjects, the male subjects showed significant differences for bicondylar width (P = 0.002) and medial condyle width (P = 0.008). For the female subjects, significant differences were found for bicondylar width (P = 0.009) and lateral condyle width (P = 0.002). There was no correlation between notch width measured on the MRI’s and NW measured intra-operatively. The intra- and inter-observer reliability of the MRI measurements was satisfactory. There were differences in bony morphology between men and women and between subjects with and without ACL injury. The bony morphology that was different between ACL-injured and non-injured subjects varied between male and female subjects. Case–control study, Level III.