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Purpose: To confirm which method provides lower rate of recurrent instability and superior clinical outcomes. Method: We searched PubMed, Embase and Web of Science for the trials involving one intervention or both for patellar instability: medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle osteotomy (TTO). The postoperative Kujala score, Lysholm score, Tegner scores and the rate of recurrent instability (dislocation or subluxation) were analyzed as the primary clinical outcome parameters in a random or fixed effects meta-analysis. Results: In total, 43 articles met inclusion criteria after full-text review. A total of 2046 patients were analyzed. The overall mean age was 20.3 years (range, 9.5–60.0 years), with a mean follow-up time of 3.2 years (range, 1–8 years). The mean Kujala scores in MPFLR and MPFLR + TTO were 89.04 and 84.44, respectively. There was significant difference in Kujala scores between MPFLR and MPFLR + TTO (MD = 4.60, 95%CI: 1.07–8.13; P = 0.01). The mean Lysholm scores in MPFLR and MPFLR + TTO were 90.59 and 88.14, respectively. There was no significant difference in Lysholm scores between MPFLR and MPFLR + TTO (MD = 2.45, 95%CI: -3.20-8.10; P = 0.40). The mean Tegner scores in MPFLR and MPFLR + TTO were 5.30 and 4.88, respectively. There was no significant difference in Tegner scores between MPFLR and MPFLR + TTO (MD = 0.42, 95%CI: -0.39-1.23; P = 0.31). At final follow-up, the rates of recurrent instability in MPFLR and MPFLR + TTO were 3% and 4%, respectively. There was no significant difference in the rates between MPFLR and MPFLR + TTO (OR = 0.99, 95%CI: 0.96–1.02; P = 0.4848). Conclusion: MPFLR and MPFLR + TTO are effective and reliable treatments in the setting of patellofemoral instability. MPFLR seems to show a better performance in functional outcomes than MPFLR + TTO. Moreover, their rates of recurrent instability are very low, and no significant difference exists. [ABSTRACT FROM AUTHOR]

Abstract Purpose To confirm which method provides lower rate of recurrent instability and superior clinical outcomes. Method We searched PubMed, Embase and Web of Science for the trials involving one intervention or both for patellar instability: medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle osteotomy (TTO). The postoperative Kujala score, Lysholm score, Tegner scores and the rate of recurrent instability (dislocation or subluxation) were analyzed as the primary clinical outcome parameters in a random or fixed effects meta-analysis. Results In total, 43 articles met inclusion criteria after full-text review. A total of 2046 patients were analyzed. The overall mean age was 20.3 years (range, 9.5–60.0 years), with a mean follow-up time of 3.2 years (range, 1–8 years). The mean Kujala scores in MPFLR and MPFLR + TTO were 89.04 and 84.44, respectively. There was significant difference in Kujala scores between MPFLR and MPFLR + TTO (MD = 4.60, 95%CI: 1.07–8.13; P = 0.01). The mean Lysholm scores in MPFLR and MPFLR + TTO were 90.59 and 88.14, respectively. There was no significant difference in Lysholm scores between MPFLR and MPFLR + TTO (MD = 2.45, 95%CI: -3.20-8.10; P = 0.40). The mean Tegner scores in MPFLR and MPFLR + TTO were 5.30 and 4.88, respectively. There was no significant difference in Tegner scores between MPFLR and MPFLR + TTO (MD = 0.42, 95%CI: -0.39-1.23; P = 0.31). At final follow-up, the rates of recurrent instability in MPFLR and MPFLR + TTO were 3% and 4%, respectively. There was no significant difference in the rates between MPFLR and MPFLR + TTO (OR = 0.99, 95%CI: 0.96–1.02; P = 0.4848). Conclusion MPFLR and MPFLR + TTO are effective and reliable treatments in the setting of patellofemoral instability. MPFLR seems to show a better performance in functional outcomes than MPFLR + TTO. Moreover, their rates of recurrent instability are very low, and no significant difference exists.

Introduction: The tendon graft option in revision surgery for anterior cruciate ligament re-tear still represents a debatable subject, regarding which is the best. As a primary option, the peroneus longus tendon (PLT) auto graft used in the reconstruction of the anterior cruciate ligament has been reported with success in many studies, but there are few reports about the uses of PLT in revision surgeries. This study aimed to assess the functional result of PLT autograft in revision ACL surgeries. Methods: A retrospective study was done on 16 young male patients, who underwent revision surgeries for ACL re-tear, using double or triple folded full thickness peroneus longus tendon autograft graft, functional results of the knee and ankle using Lysholm score and American orthopaedic foot and ankle disability index, evaluated after two years of surgeries. Results: After two years of surgery, the Lysholm score was good – an excellent result in 11 patients (73.33%), fair-good in 3 patients (20%) and poor in one patient only (6.66%). American foot and ankle score was 100 in 14 patients and 95 only in one patient. Conclusion: It has been concluded that PLT auto graft, represents a good graft option in revision ACL surgeries with no or little donor site morbidity.

Ligamentization is a complex process and effect of preservation of hamstring tendon graft insertion on this process is not well studied. Present study was conducted to analyze and compare the ligamentization of semitendinosus gracilis graft with preserved tibial insertion (STGPI) and bone-patellar tendon-bone (BPTB) autografts. A total of 50 sportspeople who underwent ACL reconstruction using either BPTB (group A; n = 25) or STGPI (group B; n = 25) autografts were included in the study. Contrast enhanced MRI was done at 8 months and 14 months post-ACL reconstruction to evaluate the ligamentization using Signal noise quotient (SNQ), graft intensity and enhancement index. Clinical outcomes (Lysholm score) and knee laxity were also assessed at 8 months and 14 months. 18/23 (78%) patients in group A and 14/23 (61%) patients in group B had hyperintense graft signal at 8 months (n.s.) and at 14 months, 1/23 patients in group A and none of the patients in group B had hyperintense graft. SNQ at 8 months was 3.6 ± 2 and 3.7 ± 2 in group A and B respectively (n.s.) and at 14 months, SNQ was 2.5 ± 1.5 in group A and 2.4 ± 1.3 in group B (n.s.). Enhancement index at 8 months was 1.5 ± 0.3 and 1.2 ± 0.3 in group A and B respectively (p = 0.0001). Enhancement index at 14 months was 1.21 ± 0.2 in group A and 1.07 ± 0.2 in group B (p = 0.003). Functional outcomes and knee laxity were comparable in both the groups at 8 and 14 months (n.s.). Both the grafts i.e. BPTB and STGPI are similar in terms of rate and extent of ligamentization. Clinical outcomes and knee laxity are also comparable between two grafts. [ABSTRACT FROM AUTHOR]

Background: Tibial spine anterior cruciate ligament (ACL) avulsion injuries are uncommon injuries and are less accompanied with tear or rupture of ligaments. Posterior cruciate ligament (PCL) avulsions are significantly associated with concomitant injuries. Methods: Thirteen patients with tibial avulsion fractures were studied (7 with anterior cruciate and 6 with posterior cruciate ligament avulsion fractures). All patients were operated with open reduction and internal fixation with metallic stainless steel or titanium implants and were followed up for 12-24 months. Functional and clinical outcomes were observed with Lysholm knee score and GH SF36 score at 6 months, 1 year and at final visit. Results: Mean radiological union was 11.6 weeks in both cruciate avulsion fractures. Of the 13 cases, 11 were treated with cannulated screws and 2 were treated with 3.5 mm stainless steel plate. We had observed mean motion of knee to be 131.42° in ACL avulsion fractures and 143.33° in PCL avulsion fractures. Mean Lysholm score at final visit was 87.38 and mean SF36 general health score was 85.41. Conclusion: In regards of cruciate ligaments tibial avulsion fractures, metallic implants are coveted choice of fixation with charismatic experience of learning and expertise. Metallic implants impose a definite functional outcome with sure and reliable union rate and secure activity of daily living without any implant related adverse issues.

(1) Background: The aim of this study was to investigate how a medial meniscus injury accompanying an anterior cruciate ligament rupture affects the clinical outcome 10 years after ACL reconstruction. (2) Methods: A total of 37 patients who received anterior cruciate ligament reconstruction (ACLR) were included in this retrospective study. Two groups were analyzed at a single follow-up of 10 years: (i) "isolated (ACLR)" (n = 20) and (ii) "ACLR with medial meniscal injury" (n = 17). The following clinical scores were recorded: International Knee Documentation Committee (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Score and Tegner Activity Score. To determine the degree of osteoarthritis the Kellgren–Lawrence score was used. (3) Results: The "isolated ACLR" study group scored significantly higher (p < 0.05) on the IKDC subjective questionnaire (mean: 88.4) than the "ACLR with medial meniscus injury" group (mean: 81). The KOOS category "activities of daily living" showed significantly better results in the isolated ACLR group (p < 0.05). The "ACLR with medial meniscus injury" group had significantly higher degree of osteoarthritis (p < 0.05). No significant differences were found in all the other clinical scores. (4) Conclusions: The results of this study further indicate that patients with a concomitant medial meniscus injury have slightly more discomfort in everyday life and increased risk of developing osteoarthritis 10 years after surgery. [ABSTRACT FROM AUTHOR]

Introduction: The tendon graft option in revision surgery for anterior cruciate ligament re-tear still represents a debatable subject, regarding which is the best. As a primary option, the peroneus longus tendon (PLT) auto graft used in the reconstruction of the anterior cruciate ligament has been reported with success in many studies, but there are few reports about the uses of PLT in revision surgeries. This study aimed to assess the functional result of PLT autograft in revision ACL surgeries. Methods: A retrospective study was done on 16 young male patients, who underwent revision surgeries for ACL re-tear, using double or triple folded full thickness peroneus longus tendon autograft graft, functional results of the knee and ankle using Lysholm score and American orthopaedic foot and ankle disability index, evaluated after two years of surgeries. Results: After two years of surgery, the Lysholm score was good – an excellent result in 11 patients (73.33%), fair-good in 3 patients (20%) and poor in one patient only (6.66%). American foot and ankle score was 100 in 14 patients and 95 only in one patient. Conclusion: It has been concluded that PLT auto graft, represents a good graft option in revision ACL surgeries with no or little donor site morbidity. [ABSTRACT FROM AUTHOR]

Background: The graft tunnel mismatch is a well-known complication of bone–patellar tendon–bone (BPTB) graft in anterior cruciate ligament reconstruction (ACLR) surgery. In the present study, graft rotation technique is used to tackle this problem. Aim: The present study was conducted to study the effect of this technique on functional outcomes and graft failure rate. Methods: Ninety-nine patients who underwent ACL reconstruction using BPTB graft were enrolled in the study and depending upon the graft length these patients were divided into two groups. Group A-patients had no graft tunnel mismatch (n = 67) and group B-patients had graft tunnel mismatch (n = 32). In group B patients, the graft was rotated inside the tibial tunnel to manage the graft tunnel mismatch problem. Functional outcomes (Lysholm score and return to sports), knee laxity (KT-1000 difference), and graft rupture rate were compared between two groups. Results: The mean KT-1000 difference in group A was 2.11 mm and in group B was 2.03 mm (n.s.). There was no significant difference in mean Lysholm score (97 vs. 97.3; p > 0.05). 78% (49/67) of patients in group B and 73% (25/32) of patients in group A returned to the same or above level of pre-injury activity (n.s.). The graft failure rate was 6% (4/67) in group A and 3% (1/32) in group B. Conclusions: Rotation of graft inside the tibial tunnel is an effective way to deal with graft tunnel mismatch. [ABSTRACT FROM AUTHOR]

The optimal surgical intervention for lateral patellar instability remains a topic of controversy despite satisfactory clinical outcomes and low re‐dislocation rates reported in numerous studies following medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle transfer (TTT). The purpose of this systematic review and meta‐analysis is to investigate the hypothesis that combining MPFLR with TTT provides reduced complication rates and improved clinical outcomes to isolated MPFLR in patients with lateral patellar instability. We conducted a comprehensive systematic review and meta‐analysis of comparative trials involving MPFLR with and without TTT, sourcing data from PubMed, the Cochrane Library, Embase, and Web of Science. The primary clinical outcomes analyzed included the Kujala score, the Lysholm score, complication rates, and the Caton–Deschamps index (CDI). Random or fixed effects were used for the meta‐analysis. Postoperatively, there were no significant differences observed in the Kujala and Lysholm scores between MPFLR and MPFLR + TTT (p = 0.053). At the final follow‐up, the CDI had decreased 0.015 (95% CI −0.044, 0.013; p = 0.289) points in the MPFLR group, with no statistical significance. In contrast, the MPFLR + TTT group demonstrated a significant decrease of 0.207 (95% CI −0.240, −0.174; p = 0.000) points in CDI. Notably, the complication rate was higher in the MPFLR + TTT group compared to the MPFLR‐only group (RR = 2.472; 95% CI 1.638, 3.731; p = 0.000). Both MPFLR and MPFLR + TTT procedures yield significant improvements in the Kujala and Lysholm scores. However, the MPFLR + TTT approach results in an apparent improvement in CDI and corrects patellar maltracking, particularly in cases involving high tibial tuberosity‐trochlear groove (TT‐TG) (>20 mm) or patella alta (CDI > 1.2), while MPFLR alone cannot. It is essential to consider the higher complication rate of MPFLR + TTT, which suggests that MPFLR alone may be sufficient for patients without high TT‐TG or patella alta.

Background: Tibial spine anterior cruciate ligament (ACL) avulsion injuries are uncommon injuries and are less accompanied with tear or rupture of ligaments. Posterior cruciate ligament (PCL) avulsions are significantly associated with concomitant injuries. Methods: Thirteen patients with tibial avulsion fractures were studied (7 with anterior cruciate and 6 with posterior cruciate ligament avulsion fractures). All patients were operated with open reduction and internal fixation with metallic stainless steel or titanium implants and were followed up for 12-24 months. Functional and clinical outcomes were observed with Lysholm knee score and GH SF36 score at 6 months, 1 year and at final visit. Results: Mean radiological union was 11.6 weeks in both cruciate avulsion fractures. Of the 13 cases, 11 were treated with cannulated screws and 2 were treated with 3.5 mm stainless steel plate. We had observed mean motion of knee to be 131.42° in ACL avulsion fractures and 143.33° in PCL avulsion fractures. Mean Lysholm score at final visit was 87.38 and mean SF36 general health score was 85.41. Conclusion: In regards of cruciate ligaments tibial avulsion fractures, metallic implants are coveted choice of fixation with charismatic experience of learning and expertise. Metallic implants impose a definite functional outcome with sure and reliable union rate and secure activity of daily living without any implant related adverse issues. [ABSTRACT FROM AUTHOR]

The optimal surgical intervention for lateral patellar instability remains a topic of controversy despite satisfactory clinical outcomes and low re‐dislocation rates reported in numerous studies following medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle transfer (TTT). The purpose of this systematic review and meta‐analysis is to investigate the hypothesis that combining MPFLR with TTT provides reduced complication rates and improved clinical outcomes to isolated MPFLR in patients with lateral patellar instability. We conducted a comprehensive systematic review and meta‐analysis of comparative trials involving MPFLR with and without TTT, sourcing data from PubMed, the Cochrane Library, Embase, and Web of Science. The primary clinical outcomes analyzed included the Kujala score, the Lysholm score, complication rates, and the Caton–Deschamps index (CDI). Random or fixed effects were used for the meta‐analysis. Postoperatively, there were no significant differences observed in the Kujala and Lysholm scores between MPFLR and MPFLR + TTT (p = 0.053). At the final follow‐up, the CDI had decreased 0.015 (95% CI −0.044, 0.013; p = 0.289) points in the MPFLR group, with no statistical significance. In contrast, the MPFLR + TTT group demonstrated a significant decrease of 0.207 (95% CI −0.240, −0.174; p = 0.000) points in CDI. Notably, the complication rate was higher in the MPFLR + TTT group compared to the MPFLR‐only group (RR = 2.472; 95% CI 1.638, 3.731; p = 0.000). Both MPFLR and MPFLR + TTT procedures yield significant improvements in the Kujala and Lysholm scores. However, the MPFLR + TTT approach results in an apparent improvement in CDI and corrects patellar maltracking, particularly in cases involving high tibial tuberosity‐trochlear groove (TT‐TG) (>20 mm) or patella alta (CDI > 1.2), while MPFLR alone cannot. It is essential to consider the higher complication rate of MPFLR + TTT, which suggests that MPFLR alone may be sufficient for patients without high TT‐TG or patella alta. [ABSTRACT FROM AUTHOR]

Objective: To assess the mean Lysholm score after arthroscopic anterior cruciate ligament Anterior Cruciate Ligament (ACL) reconstruction with a bone-patellar tendon-bone graft. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Orthopaedic, Combined Military Hospital, Peshawar Pakistan, from Oct 2020 to Apr 2021. Methodology: Arthroscopic anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft was performed in 70 patients. Baseline characteristics were recorded, and patients were followed up for six months. Functional outcome was determined using the Lysholm score. Results: The mean age of patients was 32.38±11.83 years. The majority, 59(84.3%) of the patients were males. Of the 70 patients, 36(51.4%) had a right knee involved. The mean Lysholm score at baseline was 50.46±6.93. At six months, a Lysholm score of 85.49±9.05 was recorded, and the mean difference was found to be statistically significant (p

ObjectivesMedial patellofemoral ligament (MPFL) reconstruction is an important surgical therapy for recurrent patellar dislocation. However, few studies have focused on exercise therapy after MPFL reconstruction. Therefore, the first purpose was to compare the active and traditional postoperative exercise therapies on the recovery of knee joint function and reduction of muscle atrophy after MPFL reconstruction, and the second purpose was to compare the active and traditional postoperative exercise therapies on the patellar stability after MPFL reconstruction.MethodsThe cases of 31 patients with recurrent patellar dislocation treated with patella double semi-tunnel anatomical MPFL reconstruction from February 2016 and February 2019 were retrospectively reviewed. The clinical outcomes, including the patellar tilt angle (PTA), lateral patellofemoral angle (LPFA), thigh circumference reduction, Kujala score, and Lysholm score, were compared between two groups (i.e., active exercise and traditional exercise groups) preoperatively, 3 months postoperatively, 6 months postoperatively, 12 months postoperatively, and 24 months postoperatively.ResultsThe Kujala score was significantly higher in the active exercise group than traditional exercise group 3 months postoperatively (80.06 vs. 74.80, P 0.05) or LPFA postoperatively (P > 0.05).ConclusionsOur results suggested that active exercise therapy might benefit the early recovery of knee joint function and reduction of muscle atrophy in patients with recurrent patellar dislocation after MPFL reconstruction.

BACKGROUND: Multiple ligament injuries of the knee are a complicated problem, which is prone to vascular and nerve damage, leading to severe dysfunction. However, for the current surgical treatment of knee dislocation and multiple ligament injuries, there is a lack of effective evaluation on the timing of surgery and postoperative gait. OBJECTIVE: To investigate the clinical effect of stage I arthroscopic repair and reconstruction in patients with multiple ligament injuries of the knee joint, and provide a reference for clinical guidance of functional exercises after multiple ligament injuries of the knee joint through a three-dimensional gait analysis. METHODS: The clinical data of 15 patients with multiple ligament injury of knee dislocation who were treated in the First Affiliated Hospital of Kunming Medical University from September 2014 to August 2018 were collected. All the cases were single knee injury, including 11 males and 4 females. Their age ranged from 18 to 40 years old, with an average of (28±8) years old. The time from injury to operation was 10-18 days, with an average of 14 days. At admission, the anterior and posterior drawer tests and the Lachman test were positive in all the patients. The knee varus stress test was positive in eight patients, and the knee valgus stress test was positive in five patients. Lysholm knee joint function score was (27.85±5.98) points, and joint range of motion was (49.15±13.47)°. Under arthroscopy, autologous hamstring tendons were taken to reconstruct the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and other injured knee joint structures. The range of knee joint motion and Lysholm score were evaluated, and three-dimensional gait analysis was conducted postoperatively. RESULTS AND CONCLUSION: Grade I/A healing was found in 15 patients. All patients were followed up for 11-24 months. During the postoperative followup, all patients had negative results in the anterior and posterior drawer tests and in the knee varus and valgus stress tests. Lysholm knee function score and joint range of motion of the affected limb were significantly improved at the last follow-up after repair, which were (85.3±6.65) points and (122.83±9.27)°, respectively, significantly different from the preoperative levels (t=24.879, P=0.000; t=17.452, P=0.000). Results of kinematic analysis showed that there were no significant differences in varus and valgus angles, internal and external displacements, internal and external rotations, flexion and extension angles, up and down displacements, and anteroposterior displacements between the healthy and affected limbs in the gait analysis at the last follow-up (P > 0.05). All these findings indicate that stage I arthroscopic repair of multiple ligament injuries of the knee joint can restore the stability of the knee joint, which is a safe, reliable, and effective treatment. [ABSTRACT FROM AUTHOR]

Background: The anterior cruciate ligament (ACL) consists of an anteromedial bundle and a posterolateral bundle giving anteroposterior and rotational stability to the knee. An ACL tear might lead to secondary changes in the knee joint if not operated in time. The aim of the study was to evaluate the clinical and functional results in patients with ACL tears treated by arthroscopic reconstruction using the anatomic single-bundle technique., Methods: This was a prospective study conducted between June 2015 and December2017 at a teaching institute in Kolkata, India, on patients who underwent single-bundle arthroscopic reconstruction of an ACL tear. A minimum follow-up of nine months was considered for all patients. The functional outcome was assessed via the Lysholm knee score., Results: A total of 45 patients were included in this study, of which 34 (75.56%) and eight (17.78%) patients showed excellent and good results, respectively, at the final follow-up. The mean age in this study was 29.88±9.02 years. No complication was seen in 95.6% of patients. The mean Lysholm score by the end of nine months was 95.31±6.55. At the time of the final follow-up, all the patients returned to their same activity status prior to injury., Conclusion: Arthroscopic anatomic single-bundle ACL reconstruction using hamstring autograft is an effective treatment modality for ACL injuries. It restores the stability of the knee and is associated with good recovery of joint function with an early return to active lifestyle and sports activities. This procedure achieves excellent clinical and functional outcomes without any long-term disability., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Clinical Research Ethics Committee of Medica Superspecialty Hospital issued approval CREC/2015/July/07. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. 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, Baid et al.)

Background: Arthroscopically aided anterior cruciate ligament reconstruction using hamstring graft can be fixed to femoral condyle by suspensory and aperture fixation methods. Objectives: To investigate functional outcomes with these fixation methods as measured by the Lysholm knee score of Hamstring autografts. Methods: 50 patients of clinically and radiologically diagnosed ACL tear fulfilling the inclusion and exclusion criteria were randomized into two groups to undergo arthroscopic ACL reconstruction using quadrupled hamstring graft with suspensory (n=25) and aperture (n=25) fixation methods on femoral side. They were compared post operatively with Lysholm score, clinical laxity tests and percentage of tunnel enlargement using computed tomograms at 01 year. Results: At the end of 6 months there was no much difference in Lysholm score between both the groups (P =0.63) and at the end of 01 year aperture group had slightly better outcome. However, the difference was not statistically significant (p =0.13). There were more tunnels widening in the suspensory group especially of the femoral tunnel in the coronal plane. However, the amount of tunnel widening in both the groups was not significant statistically (P =0.071 and P =0.963). Conclusions: Aperture and Suspensory fixation methods of hamstring graft at femoral condyle in ACL reconstruction are comparable clinically and there is no advantage of one particular method over other. [ABSTRACT FROM AUTHOR]

Objective: To verify the reliability and validity of Chinese versions of the Lysholm score and the Tegner activity scale for knee arthroplasty. Methods: Sixty-four patients undergoing total knee arthroplasty and 28 healthy volunteers were included in this study. Participants were divided into 4 groups: a pre-operation group; a 3 months post-operation group; a 1-year post-operation group; and a control group of healthy volunteers. Participants completed the Lysholm score and Tegner activity scale twice over a period of 3–7 days. Results: The intraclass correlation coefficients of the Lysholm score and Tegner scale were both relatively high, at 0.99 and 0.97, respectively. Moreover, the Cronbach’s alpha of the Lysholm score was 0.71. The items “locking” and “instability” differed slightly between groups (Kruskal–Wallis: for locking, χ2 (p) = 13.48, p = 0.0037; for instability, χ2 (p) = 4.32, p = 0.2292). Conclusion: The simplified-Chinese versions of the Lysholm score and the Tegner scale are applicable for use with patients undergoing total knee arthroplasty, and have relatively high validity and reliability. The items “locking” and “instability” should be combined with clinical data to make the Lysholm score more suitable for assessment of total knee arthroplasty. LAY ABSTRACT The aim of this study was to verify the reliability and validity of Chinese versions of the Lysholm score and the Tegner activity scale for assessment of knee arthroplasty. A total of 64 patients undergoing total knee arthroplasty (TKA) and 28 healthy volunteers were included in the study. Participants were divided into 4 groups: a pre-operation group; a 3 months post-operation group; a 1-year post-operation group; and a control group of healthy volunteers. Study participants completed the Lysholm score and Tegner activity scale score twice for over a period of 3–7 days, and the results analysed. The simplified-Chinese versions of the Lysholm score and the Tegner scale were found to be applicable for use with total knee arthroplasty patients, and to have relatively high validity and reliability. Furthermore, the items “locking” and “instability” should be combined with clinical data to make the Lysholm score more suitable for assessment of total knee arthroplasty.

The gastrocnemius-semimembranous bursa of the knee, which connects to the posterior region of the joint capsule, becomes distended in a Baker's (popliteal) cyst. In adults, it is nearly always secondary to pathological changes in the knee joint that cause an effusion. Baker cysts are mostly asymptomatic, but they may have presentations ranging from mild swelling, a picture similar to infective arthritis, to massive swelling leading to rupture and causing lower limb ischemia. We have presented these cases of post-tubercular baker cysts and evaluated their post-treatment outcomes. Between September 2018 and September 2021, 12 patients with post-tuberculous baker cysts who presented to the outpatient department or emergency department of our institute were treated with conservative or open excision and followed up for 12 months at regular intervals. The functional assessment was done by VAS pain scoring and Lysholm knee scoring at the start of treatment, 1, 6 and 12 months after the surgery or conservative treatment. 8 patients with post-tubercular Baker cysts were managed conservatively with aspirations and medications. Four patients with large multiloculated post-tubercular baker cysts were managed operatively. The mean age of patients with complicated post-tuberculosis Baker cyst was 44.92 ± 5.07 years. VAS The scoring of all the patients improved with each visit and 1-year follow-up. The Lysholm Knee score of patients also improved with each visit. All patients had excellent scores, with 3 patients having a score of 100 at 1-year follow-up. Complicated Baker's cysts with multiloculated post-tubercular cysts need surgical management in most cases. Excellent to good functional outcomes can be achieved in these unusual cases with prompt intervention, detailed work-up, and medications. [ABSTRACT FROM AUTHOR]

Introduction: Anterior Cruciate Ligament (ACL) is a stout, short intra-articular, extra synovial structure. For a knee with the deficiency of ACL, the ligament reconstruction using an autograft, either a free bone patellar tendon bone graft or a Semi Tendinosus and Gracilis (STG) tendon free hamstring graft, is the most common surgical treatment. Tibial fixation region of the graft is presumed to be a delicate point in arthroscopic ACL reconstruction. There, can be a chance of graft pull out from the tibial tunnel before actual healing of the graft-tunnel can occur. To avoid this problem, the technique of tibial attachment preserved hamstring graft can be used instead of free hamstring graft. Aim: To evaluate and compare the functional outcome of patients who underwent ACL reconstruction with either a free hamstring graft or by tibial attachment preserving hamstring graft. Materials and Methods: A prospective interventional study was conducted in the Department of Orthopaedics, Swami Rama Himalayan University Hospital, Dehradun, Uttarakhand, India, over a period of one year (July 2019-July 2020). A total 52 patients were included and they were divided into two groups. Group A (tibial attachment preserving hamstring graft) and Group B (tibial attachment sacrificing hamstring graft) with each group comprised 26 patients. Patients were assessed with Lysholm score at 6, 12 and 24 weeks of follow-up. For determining the statistical difference between the two groups Independent Student's t-test was used, whereas for more than two groups Analysis of Variance (ANOVA) test was used and a p-value <0.05 was considered to be significant. Results: The mean age of patients in group A was 30.73±10.02 years whereas in group B it was 29.54±9.84 years. For group A, mean Lysholm score at 6 weeks was 73.23±8.37, at 12 week score was 86.85±5.93 and at 24 week score was 95.58±4.91. For group B, mean Lysholm score at 6 weeks was 74.15±5.82, at 12 weeks score was 87.46±5.95 and at 24 weeks score was 96.92±3.61. Post-hoc analysis showed that there was a significant difference in mean Lysholm score {between preoperative and other time points (p<0.001, respectively)} for both the groups but there was no significant difference in Lysholm score at 6 weeks (p=0.646), 12 weeks (p=0.710) and 24 weeks (p=0.265) when compared between the two groups. Conclusion: The ACL reconstruction using hamstring autograft with preserved tibial insertion resulted in no statistically significant difference in functional outcome as compared with free autograft. [ABSTRACT FROM AUTHOR]

Background: Accurate direction of tibial and femoral tunnel has significant effect on functional outcome after anterior cruciate ligament reconstruction (ACLR). A vertical tunnel position high in the intercondylar notch near the 12-o'clock position has been shown to provide stability in the anteroposterior plane but does not restore rotational stability. Postoperative CT scan provide a reliable and valid way for the assessment of anatomical tunnel position and obliquity after ACLR. Materials and Methods: 31 patients with complete ACL tear with or without the meniscal injury are treated with single bundle arthroscopic reconstruction using hamstring graft tendon. With common post-operative rehabilitation protocol all patient are followed up clinically and radiological for next 12 months. Tibia and femoral tunnel obliquity were measured interpreted with the clinical parameters. Radiological parameters were summarized as mean standard deviation and proportions as applicable. Results: Total no of patients with the age averaged 27.13± 5.89, pre op lysholm score averaged 64.26± 8.93. At 1 year follow up. Femur tunnel coronal angle average of 37.520 ± 5.040 the coronal tibia tunnel was angle averaged of 72.230 ± 2.440.32.2% and 35.5% of patients showed grade 1 anterior drawer and Lachman test positive respectively. And mean lysholm score averaged to be 86.58±5.32. Conclusion: Statistical analysis of our data showed negative significant correlation between femoral tunnel obliquity with lysholm score. [ABSTRACT FROM AUTHOR]

Background: Arthroscopically assisted ligament reconstruction with hamstring and bonepatellar tendon-bone (BPTB) auto graft in multi ligamentous knee injuries is an accepted procedure. Hence; the present study was undertaken for evaluating functional outcome of arthroscopic assisted ligament reconstruction with both hamstring and bone-patellar tendonbone (BPTB) auto graft in multiligamentous knee injuries. Materials and methods: This study conducted for a follow up of 6 months of time period between June 26 th2018 to 31st December of 2018, after approval from ethical committee. 15 patients with Ligament injuries which include ACL/PCL/PLC/MCL/LCL were treated with arthroscopic reconstruction using hamstring tendon graft and bone-patellar tendon-bone graft. With common post-operative rehabilitation protocol, all patients were subjectively evaluated with Lysholm knee scoring scale and Tegner activity scale. Results: A total number of 15 patients with average age 36.2± 9.2 with Multiligamentous injuries to the ACL, PCL, or collateral ligaments were included in the study. Postoperative physical examination revealed normal posterior drawer /tibial step off in 46% knees . Normal Lachman and pivot shift test results were found in 94% knees. Posterolateral stability was restored to normal in 24% knees and tighter than normal knee results were found in 76% knees evaluated with external rotation thigh foot angle test. Postoperative Lysholm, Tegner mean values were 85.3, 5.3 respectively showing statistically significant improvement from preoperative status (p<0.001).Postoperative complications included surgical site infection (1.2%), joint stiffness (1%). Conclusion: Arthroscopic assisted reconstruction of multiligament knee injuries with use of autograft can restore ligament function with good patient compliance and without significant surgical complications. [ABSTRACT FROM AUTHOR]

Introduction: Anterior Cruciate Ligament (ACL) is a stout, short intra-articular, extra synovial structure. For a knee with the deficiency of ACL, the ligament reconstruction using an autograft, either a free bone patellar tendon bone graft or a Semi Tendinosus and Gracilis (STG) tendon free hamstring graft, is the most common surgical treatment. Tibial fixation region of the graft is presumed to be a delicate point in arthroscopic ACL reconstruction. There, can be a chance of graft pull out from the tibial tunnel before actual healing of the graft– tunnel can occur. To avoid this problem, the technique of tibial attachment preserved hamstring graft can be used instead of free hamstring graft. Aim: To evaluate and compare the functional outcome of patients who underwent ACL reconstruction with either a free hamstring graft or by tibial attachment preserving hamstring graft. Materials and Methods: A prospective interventional study was conducted in the Department of Orthopaedics, Swami Rama Himalayan University Hospital, Dehradun, Uttarakhand, India, over a period of one year (July 2019-July 2020). A total 52 patients were included and they were divided into two groups. Group A (tibial attachment preserving hamstring graft) and Group B (tibial attachment sacrificing hamstring graft) with each group comprised 26 patients. Patients were assessed with Lysholm score at 6, 12 and 24 weeks of follow-up. For determining the statistical difference between the two groups Independent Student’s t-test was used, whereas for more than two groups Analysis of Variance (ANOVA) test was used and a p-value

Background: Many surgeons are still hesitant to do arthroscopic anterior cruciate ligament reconstruction (ACL) in patients above 40 years old. Purpose: The effect of ACL reconstruction on functional outcomes in patients above 40 years of age. Materials and methods: Patients of age > 40 years who underwent ACL reconstruction were enrolled in the study. Functional outcomes (Lysholm, WOMAC score, and Tegner activity scale), pain (VAS score), and knee stability (KT-1000) were assessed at final follow-up and compared with pre-operative scores. All patients were followed up for a minimum of 2 years. Results: A total of 112 patients were included in the study. Eighty-eight were males and 24 were females. The mean age at the time of surgery was 44.8 ± 5.6 years (40–63 years). The mean Lysholm score was improved from 64.1 ± 11.7 to 87.2 ± 5.9 (p = 0.0001). Similarly, the WOMAC score was also improved from 8.8 ± 6.9 to 2.3 ± 1.9 (p = 0.0001). The mean side-to-side difference (KT-1000) also improved from 6.65 ± 2.25 mm to 2.32 ± 1.45 mm (p = 0.0001). More than 70% of the patients had excellent or good outcomes. Median pre-injury Tegner activity scale was 5 (3–8) and the median post-ACLR Tegner activity scale was 5 (3–7; p = 1). Conclusion: ACL reconstruction in patients > 40 years of age results in good functional outcomes and knee stability. [ABSTRACT FROM AUTHOR]

This study compares recurrence rates and functional outcomes of patients who underwent anterior arthroscopic synovectomy versus combined anterior arthroscopic/posterior open synovectomy for diffuse pigmented villonodular synovitis (DPVNS). 41 patients were grouped by initial procedure and tracked for disease recurrence and functional outcomes (Lysholm Scale). 24 patients (58.5%) had disease recurrence [16 (57.1%) arthroscopic, 8 (61.5%) combined, chi-square test p = 0.81]. The combined procedure mean Lysholm Score (75.4) exceeded the arthroscopic (68.1) (two-sample t -test p = 0.25). There is no statistical evidence that the combined procedure harms functionality more than arthroscopic only or that recurrence rates differ between treatment methods. [ABSTRACT FROM AUTHOR]

Objective: To evaluate arthroscopic assisted Anterior Cruciate Ligament (ACL) reconstruction using Bone-Patellar Tendon-Bone (BPTB) graft using anteromedial approach to drill the femoral tunnel followed by accelerated ACL rehabilitation protocol in terms of Lysholm score. Study Design: Prospective comparative study. Place and Duration of Study: The study was conducted in Combined Military Hospital (CMH) Rawalpindi and Combined Military Hospital Malir, Pakistan, from Nov 2013 to Dec 2015. Methodology: This study was an analysis of prospectively collected data of patients who had undergone Anterior Cruciate Ligament reconstruction. All patients below the age of 35 years presenting with Anterior Cruciate Ligament Grade 3 tear were assessed objectively and subjectively using Lysholm score pre and post operatively. Manual laxity of knee was assessed with anterior drawer and Lachman test; and being compared with normal contralateral knee. Rotational instability was assessed by pivot shift test. Results: Nineteen patients, all males, were included in this study with the mean age of 26.7 ± 4.68 years. All patients underwent arthroscopic assisted Anterior Cruciate Ligament reconstruction with uneventful recovery. Every patient had his pre and post-operative Lysholm scoring done. Mean pre-operative Lysholm score was 53.89 ± 3.81. Patients were followed up at 5 months and at 9 months and their mean Lysholm scores were 84.74 ± 6.31and 92.47 ± 3.04 respectively with the p-value of

Background Meniscal tears are a common injury in the adult population. With the advent of newer devices, the adoption of the all-inside repair technique has been expanding substantially because of its feasibility and reduced risk to surrounding neurovascular structures. This study was conducted in a lower middle-income country to assess the functional outcome of the arthroscopic all-inside technique and to identify the potential factors that may affect the functional outcome that will eventually influence the future management of these patients. Method This study is a retrospective case series conducted at the Department of Orthopedic Surgery, Aga Khan University Hospital, Karachi, Pakistan. Patients presenting to the outpatient clinics with meniscal tears who underwent arthroscopic all-inside repair from January 2015 to December 2021 were included in this study. The exclusion criteria included patients who had associated fractures and patients with meniscal tears greater than six months ago. Results A total of 29 patients underwent all-inside meniscal repair for meniscus tears. The mean age of our patients was 26.31 years (SD = 7.11 years), ranging from 17 years to 48 years. Of these patients, 26 were males and three were females, accounting for 89.7% and 10.3%, respectively. The most frequent mechanism of injury was twisting while playing sports, accounting for 51.7%, followed by falling while playing sports and road traffic accidents (RTAs), accounting for 13.8% and 20.7%, respectively. Of the 29 patients, 16 (55.2%) had lateral meniscal injuries, 10 (34.5%) were diagnosed with medial meniscus injuries, and three (10.3%) had injuries to both menisci. The most common type of tear that was observed in our sample size was bucket handle tears, which were found in 14 patients, accounting for a total of 48.3%, followed by complex tears in seven patients (24.1%). The majority of the patients, i.e., 19 out of 29 patients (65.5%), had an acute course of injury, i.e., less than six weeks. For the functional outcome, the Lysholm score was calculated at 12 months and was found to be excellent in 17 patients, good in six patients, and fair in six patients, accounting for 58.6%, 20.7%, and 20.7%, respectively. The mean Lysholm score was 90.03 ± 8.85 points. Of the 29 patients, 27 (93.2%) had no complaints at the regular 12-month follow-up, whereas one patient (3.4%) experienced rotatory instability and one patient (3.4%) experienced stiffness at the knee joint. None of the patients had to undergo a reoperation. The mean Lysholm score in the 25 patients who had an associated anterior cruciate ligament tear was 89.64 ± 9.442 points, whereas the four patients who had an isolated meniscal tear had a mean score of 92.50 ± 2.887 points, which was not significantly different (p-value = 0.831). Conclusion All-inside meniscal repair for treating meniscal tears has become the new treatment paradigm as it not only renders excellent functional outcomes with minimal complications but also prevents damage to the surrounding neurovasculature and the soft tissue envelope as it is a minimally invasive technique., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Review Committee, Aga Khan University Hospital issued approval 2022-8035-22952. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. 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, Ali et al.)

Objective To investigate the detection rate of musculoskeletal ultrasonography in patients with rheumatic knee arthritis and its correlation with knee function. Methods A total of 118 patients with rheumatic knee arthritis (all patients with one knee affected) from May 1, 2019 to March 1, 2020 were selected as the subjects. All patients were confirmed by clinical manifestations combined with X-ray examination. Before diagnosis, all patients were planned to undergo musculoskeletal ultrasound examination, and the results of musculoskeletal ultrasound examination and X-ray examination were compared to analyze the detection rate of musculoskeletal ultrasound in patients with rheumatic knee arthritis. Lysholm score was used to evaluate the knee function of the affected and unaffected limbs. Pearson correlation analysis was used to analyze the correlation between musculoskeletal ultrasound results and knee function. Results The detection rate of synovium thickening, articular cartilage degeneration, suprapatellar sac effusion, medial meniscus injury and degeneration, popliteal cyst, ligament injury and subchondral bone destruction in musculoskeletal ultrasound was higher than that in X-ray (P < 0.05). The detection rates of subchondral bone destruction, joint space narrowing, osteoporosis and bone hyperplasia in musculoskeletal ultrasound were lower than those of X-ray (P < 0.05). The claudication, supporting, stair-climbing, squatting and standing up, pain, joint swelling and pain and total scores of the affected side of rheumatoid knee arthritis patients were lower than those of the healthy side (P < 0.05). Pearson correlation analysis results showed that knee function in patients with rheumatic knee arthritis was negatively correlated with synovial thickening, articular cartilage degeneration, suprapatellar sac effusion, medial meniscus injury and degeneration, popliteal fossa cyst, ligament injury, subchondral bone destruction and osteogenesis, and articular space narrowing (P < 0.05). Conclusion Musculoskeletal ultrasound has a high detection rate in patients with rheumatic knee arthritis, and there is correlation between the detection results and knee function. [ABSTRACT FROM AUTHOR]

Introduction: Anterior Cruciate Ligament (ACL) is requisite for knee stability. Reconstruction in ACL tear is gold standard mode of treatment. Anatomical placement of graft is determined by precise drilling of femoral and tibial tunnels. Aim: To study the precision of placement of bony tunnel in single bundle arthroscopic anterior cruciate ligament reconstruction and to correlate functional outcome. Materials and methods: A hospital based longitudinal prospective study was conducted at a tertiary care hospital. We included 37 patients who underwent ACL reconstruction. Radiographic analysis of knee was done to assess the position of tunnels. The position of tunnels was compared with ideal placement of tunnels and functional outcomes were documented. Lysholm score at 3 and 6 months was used for comparison. Statistical analysis was done by SPSS Ver. 17.0. Results: At the end of 6 months, 56.75% cases had good to excellent functional outcome. There was inverse correlation of deviation in femoral tunnel and tibial tunnel with Lysholm score at three months. There was inverse correlation of deviation in femoral tunnel with Lysholm score at 6 months. Conclusion: Following an ACL reconstruction, tunnels placement is very important to gain a successful outcome. Placement of femoral tunnel is especially important in this regard. [ABSTRACT FROM AUTHOR]

The editor comments on four studies from the 1970s and 1980s on anterior cruciate ligament (ACL) injury. The editor discusses a study on the conflicting views of the ACL among orthopaedic surgeons due to the inadequacy of the anterior drawer and Lachman tests, and a related study on ACL reconstruction. The editor reviews research on knee ligament surgery that used scoring scale and a related study on KT-100 arthometer device for evaluating anterior knee laxity in ACL patients.

Introduction The knee joint, an extraordinary feat of biomechanics, is prone to injuries, with the anterior cruciate ligament (ACL) often being a common victim. The intricate coordination of joint movements relies heavily on the ACL's screw-home mechanism, a crucial element for synchronizing knee movement with neighboring joints. Despite its indispensable role, the ACL is susceptible to injury, necessitating surgical intervention. While many patients experience positive outcomes following ACL reconstruction surgeries, a significant proportion face the challenge of procedure failure. The key to success lies in the healing process within the tibial and femoral bone tunnels. The post-ACL reconstruction phase introduces its own set of challenges, particularly in the context of returning to sports (RTS), underscoring the importance of reinstating neuromuscular and motor function. The trajectory of rehabilitation is influenced by factors such as graft healing, patient age, gender, pain levels, and concurrent injuries. Materials and methods This prospective observational study spanned 2.5 years, enrolling 71 patients with diagnosed ACL injuries. Arthroscopic reconstruction utilized hamstring autografts and peroneus longus autografts. A nine-month post-surgery follow-up employed the Lysholm scoring system for comprehensive evaluations. Results Over 2.5 years, 87.3% of male and 12.6% of female participants underwent arthroscopic reconstruction. Lysholm scores revealed 28.1% excellent, 45.0% good, and 26.7% fair outcomes, with no participants in the unsatisfactory range. Lysholm scores demonstrated positive outcomes, indicating the efficacy of arthroscopic reconstruction in enhancing knee function. Findings align with existing literature, emphasizing positive results from ACL reconstruction techniques and specific implants. Comparisons with related studies highlight challenges in standardized return-to-sport guidelines and underscore the need for outcome measure standardization. Conclusion The study contributes nuanced insights into ACL reconstruction outcomes, emphasizing positive functional recovery trends at the nine-month follow-up. Lysholm scores indicate favorable outcomes, supporting the procedure's effectiveness. Consideration of specific implants adds practical value. Despite limitations, this study enriches ACL reconstruction research, promoting advancements in patient care and outcomes. Ongoing research with extended follow-ups and larger cohorts will enhance understanding and refine ACL reconstruction strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Soni et al.)

Anterior Knee Pain(AKP) has been quoted as the main disadvantage of Bone Patellar Tendon Bone (BPTB)graft in Anterior Cruciate Ligament Reconstruction (ACLR). We overcome the problem by harvesting BPTB graft by mini-open mobile window technique. To investigate postoperative incidence of AKP with BPTB graft in comparison with hamstring graft during primary ACLR. Total of 1737 patients underwent ACLR in the study period of which 1250 met eligibility criteria (622-BPTB graft, , 628-Hamstring graft). Incidence of AKP, Lysholm score and IKDC score were analysed and found no statistically significant difference at 18-month followup. BPTB graft harvested by mini-open mobile window technique has a low incidence of AKP as of hamstring graft. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical outcome of fixation of anterior cruciate ligament avulsion injuries in Military Soldiers. Study Design: Descriptive case series. Place and Duration of Study: Orthopedic department, Combined Military Hospital (CMH) Rawalpindi, from Jun 2015 to Jun 2016. Material and Methods: Open reduction and screw fixation was done in 30 soldiers presenting with McKeever type III and IV avulsion fractures of anterior cruciate ligament. Outcome evaluation was carried out at 3 and 6 months. Lachman test was used for stability. Standard AP and Lateralx-rayswere taken to monitor bony healing. Lysholm score was used for functional evaluation. Results: All 30 patients showed complete healing at 3 months. Three patients revealed residual laxity. Mean extension loss was 5 degrees. Lysholm score improved from pre-operative mean of 29.97 (SD ± 5.46) to postoperative mean of 95.67 (SD ± 1.47). Conclusion: This study demonstrated operative fixation of Grade III and IV anterior cruciate ligament avulsion injuries as a successful surgical option in Military soldiers.

Background: There are numerous subjective rating scales available to evaluate outcomes of total knee arthroplasty (TKA). Single Assessment Numerical Evaluation (SANE) score was developed to reduce the burden of patients or clinicians to evaluate patients' status by asking patients to simply rate the current status of their injured body part on a scale of 0-100. The purpose of this study is to investigate the correlation between SANE score and Lysholm score in patients who underwent primary TKA. Methods: Forty-nine patients who underwent primary TKA participated. Patients who underwent bilateral TKA or revision TKA were excluded from this study. They were asked to respond to SANE and Lysholm scores. Regression analysis was used to evaluate the correlation between 2 scores. Bilateral isometric quadriceps strength and limb symmetry index were also measured and recorded. Results: There were a total of 49 patients in the study. The mean age of the subjects was 73.04 ± 6.63 years. The mean height and body weight were 153.37 ± 8.81 cm and 55.51 ± 8.61 kg, respectively. The mean scores for SNAE and Lysholm scores were 66.08 ± 16.77 and 71.0 ± 17.55, respectively. Pearson r correlation coefficient between SANE and Lysholm scores was 0.38 (P = .003). Regression analysis showed statistically significant correlation between 2 scores with r2 of 0.15 (P = .005). The average time from surgery was 16.02 weeks. The mean isometric quadriceps strength was 26.76 ± 11.30 kgf for the involved knee and 40.58 ± 11.55 kgf for the non-involved knee. The limb symmetry index was 66.10% ± 21.51%. Conclusions: The results of the investigation showed that there was a statistically significant, however relatively weak, correlation between SANE score and Lysholm score. SANE score may serve as an alternative method to assess TKA patients' subjective post-operative outcomes to Lysholm score.

To find clinical outcome of in-vivo standard 80 N tensioning of quadrupled hamstring graft during arthroscopic single bundle ACL reconstruction in comparison to traditional graft tensioning. Sixty cases of isolated ACL tears were included in this study. All cases underwent Arthroscopic ACL reconstruction with Tibial attachment sparing quadrupled hamstring graft. Cases were divided into group I and group II (30 cases each). Graft Tensioning in group 1 was conventional one-handed unmeasured pull and in group II it was measured tension of 80 N with tensionometer during graft fixation. Pre-operative and post-operative (12 months) Anterior tibial translation (ATT) was measured with KT-1000 arthrometer. Clinical outcome was measured using Lysholm knee scoring system at 6weeks, 3months, 6months, 12 months and compared statistically among both groups. The mean pre-op ATT of 10.6 ± 2.04 mm (group I) & 10.83 ± 2 mm (group II) improved to 3.63 ± 1.16 mm (group I) & 3.63 ± 0.92 (group II) respectively at one year without significant difference (p value 1). The mean pre-op Lysholm score was 46.73 ± 6.77 (group I) and 45.97 ± 8.68 (group II). The mean Lysholm score at 6 weeks was 91.5 ± 2.78 (group I) and 93.43 ± 3.02 (group II) with significant difference (p value 0.014). At 3 months it was 95.4 ± 2.99 (group I) and 97.07 ± 2.07 (group II) with significant difference (p value 0.025). At 6 months it was 95.53 ± 2.46 (group I) and 97.5 ± 1.2 (group II) with significant difference (p value 0.0002). At 1 year it was 95.73 ± 2.22 (group I) and 97.8 ± 0.979 (group II) with significance (p value 0.0001). The clinical score of ACL reconstruction is better when in-vivo 80 N tension is applied using tensionometer during graft fixation in comparison to conventional manual tensioning but there is no difference in ATT. [ABSTRACT FROM AUTHOR]

Background: Single-tunnel double-bundle anterior cruciate ligament reconstruction (ACLR) with anatomical placement of hamstring tendon graft can closely restore the anterior knee instability when compared with single bundle reconstruction. Aim: Evaluation of the clinical and functional outcomes of ACLR using femoral intra-fix and tibial interference screw. Methods: This is a prospective study held on 40 patients who underwent autologous hamstring graft ACLR using femoral intra-fix and tibial interference screw. After a median follow up of one year the clinical (Lysholm score), functional outcome (International Knee Documentation Committee, IKDC) and Joint laxity (assessed with KT-1000 arthrometer - MEDmetric, San Diego, CA) were evaluated. Results: As regard IKDC 36 patients (90%) had normal or nearly normal knees postoperatively in comparison to 100% had abnormal and severely abnormal knees pre-operatively (P value < 0.001). The mean Lysholm score was higher in the postoperative follow up than preoperative (91.40±7.3 Vs 53.35±13.55) with statistically significant (P value < 0.001). The mean anterior translation of tibia improved from 7.55 mm preoperatively to 2.1 mm after one year of ACLR. Conclusion: ACLR using femoral intra-fix and tibial interference screw provide secure graft fixation and allow early rehabilitation. The clinical and functional outcome of this fixation technique is rewarding. [ABSTRACT FROM AUTHOR]

Multi-ligamentous knee injuries have been a grey area due to unavailability of large scale control trials with a long term follow up. Several studies have documented good results with different protocols of management regarding time of treatment, repair versus reconstruction, choice of graft and sequence of repair. The author wishes to put forward long-term results of early (<6 weeks) single-stage surgery in multi ligamentous injuries. The prospective trial included 29 patients diagnosed with three or more ligaments involved. Patients having fractures involving proximal tibia, distal femur, patella, patients with history of compound trauma to knee, osteochondral lesions, associated neuro-vascular injury & poly-trauma patients were excluded from the study. The patients also underwent AP, lateral & stress skiagrams in addition to a standard 3T MR scan for pre-operative planning and confirmation of diagnosis. The pre & post-operative outcomes were assessed using KSS & Lysholm score. The patients were followed up for two years with clinical examination and stress skiagrams. The mean increase in knee scores was statistically significant at both 12 months and 24 months (p < 0.05) with mean ROM of 132.8° at final follow-up. Three patients required manipulation under anaesthesia. All patients could carry out their activities of daily living at mean period of 8.2 months. Osteoarthritis was most common complication at 2 years follow-up. The most important aspect of a single stage reconstruction lies in earlier restoration of function with a tremendous decrease in loss of medical expenses, improvement of quality of life and early & improved function in terms of both physical and psychological factors. Better restoration of kinematics from early rehabilitation is probably the factor responsible for the results. Osteoarthritis remains an important follow-up finding. [ABSTRACT FROM AUTHOR]

to assess twenty two cases of isolated PCL avulsion fractures from tibial insertion, arthroscopically treated with suture pull technique, and to evaluate achieved clinical outcomes in terms of radiographic laxometry (objective) and Lysholm scale (subjective). Study includes 22 cases operated between April 2014 and March 2017. Patients less than 18 years old, presentation after 3 weeks of injury, concomitant injury in the same limb, with open wounds or with comminuted avulsed fragment were excluded from the study. All cases were MRI proven. All arthroscopic suture fixation technique was used in all cases. Follow up was done at 3 weeks, 6 weeks, 3 months, 6 months and 12 months. Mean follow up was one year. Subjective complaints, Knee flexion, Lysholm score and stress radiographs were noted. Average Lysholm score was 96.3. Seventeen patients had excellent results and Five had good results based on Lysholm scores. In two patients, grade 2 laxity (5–10 mm) was present on stress radiographs but there were no clinical complaints. All patients achieved osseous union and had no functional limitation. Three Patients developed arthrofibrosis initially but gained functional range later. Arthroscopic suture fixation method for PCL avulsion fracture from tibia is a good and safe method of choice for fixation. [ABSTRACT FROM AUTHOR]

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Purpose: It has been quoted that the graft is more prone to injury in the early stages of ligamentization between 3 and 6 months when the muscles are weak and compliance with post-op protocol is waning. Purpose of this study was to evaluate the functional outcome of avoiding postoperative bracing following ACL reconstruction and early enhanced recovery protocol on the reinjuries of graft. Methods: Thirty-two consecutive patients who underwent arthroscopic ACL reconstruction by a single surgeon in the same specialist center between October 2015 and May 2017 were included in the study. All the patients were educated regarding rehabilitation before the index surgery and preoperative quadriceps exercises had been initiated. Rehabilitation was undertaken as per a standard protocol with emphasis on early mobilization. No brace was used. Patients were followed up between 3 months and 1 year. Lysholm knee scores were evaluated at 6 and 12 months postoperatively. Results: No failures were noted (failure defined as instability, stiffness or persistent pain). The average Lysholm knee score at 6 months was 88 and at 12 months period was 91. No statistical significance (P > 0.00001) was noted in the scores between braced and unbraced at 1 year. Conclusion: ACL rehabilitation without a knee brace can indirectly prevent rerupture and is a cheaper as well as a safer method with better outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate arthroscopic assisted Anterior Cruciate Ligament (ACL) reconstruction using Bone-Patellar Tendon-Bone (BPTB) graft using anteromedial approach to drill the femoral tunnel followed by accelerated ACL rehabilitation protocol in terms of Lysholm score. Study Design: Prospective comparative study. Place and Duration of Study: The study was conducted in Combined Military Hospital (CMH) Rawalpindi and Combined Military Hospital Malir, Pakistan, from Nov 2013 to Dec 2015. Methodology: This study was an analysis of prospectively collected data of patients who had undergone Anterior Cruciate Ligament reconstruction. All patients below the age of 35 years presenting with Anterior Cruciate Ligament Grade 3 tear were assessed objectively and subjectively using Lysholm score pre and post operatively. Manual laxity of knee was assessed with anterior drawer and Lachman test; and being compared with normal contralateral knee. Rotational instability was assessed by pivot shift test. Results: Nineteen patients, all males, were included in this study with the mean age of 26.7 ± 4.68 years. All patients underwent arthroscopic assisted Anterior Cruciate Ligament reconstruction with uneventful recovery. Every patient had his pre and post-operative Lysholm scoring done. Mean pre-operative Lysholm score was 53.89 ± 3.81. Patients were followed up at 5 months and at 9 months and their mean Lysholm scores were 84.74 ± 6.31and 92.47 ± 3.04 respectively with the p-value of <0.001. Only 2 patients had residual Grade I Lachman laxity and none of the patients had any rotational instability. Conclusion: Arthroscopic assisted Anterior Cruciate Ligament reconstruction using Bone-Patellar Tendon-Bone graft followed by accelerated Anterior Cruciate Ligament rehabilitation protocol led to significant improvement of Lysholm score. [ABSTRACT FROM AUTHOR]

Background: Injuries to the lateral collateral ligament (LCL) are most commonly associated with anterior cruciate ligament (ACL) injury than with posterior cruciate ligament (PCL) injury. There is currently a paucity in the literature in regards to treatment and outcomes of such lesions. Methods: 30 patients underwent surgical treatment of concomitant LCL and ACL injury or concomitant LCL and PCL injury with follow-up postoperative period of two years. The Lysholm score and varus stress radiographs was calculated and analysed before and at 6, 12, and 24 months postoperatively. Results: There was a significant increase in scores between two timepoints over the follow-up period for both groups: before surgery and after 6 months, and between 6 and 12 months (p < 0.05). The lateral joint opening measured on the varus stress radiographs was greater in group 2 than in group 1 before surgery (p = 0.04). When assessing each group separately, the lateral joint opening decreased at each timepoint in the first year for both groups (p < 0.05). Conclusion: Patients diagnosed with combined LCL and PCL injuries were shown to have a higher degree of lateral opening at the time of injury when compared to patients with combined LCL and ACL injuries. However, there was no difference in lateral joint opening on stress radiography after 12 months postoperatively in either group. Finally Lysholm scores for both groups significantly increased between the preoperative period and 6 months postoperatively, as well as between 6 months and 12 months postoperatively. Level of evidence: III [ABSTRACT FROM AUTHOR]