Return to sports and re-rupture rate following anterior cruciate ligament reconstruction in amateur sportsman: long-term outcomes

Single-bundle ACL combined with ALL reconstruction yields comparable outcomes in patients with varied anatomical risk factors for ACL graft failure

BACKGROUND

Anterior cruciate ligament (ACL) graft failure is influenced by factors such as meniscal tears and tibial plateau slope. Combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction has reduced failure rates; however, its efficacy in high-risk patients remains unclear. This study hypothesized that combined ACL and ALL reconstruction would yield similar clinical outcomes in patients with varying risks of ACL failure.

PATIENTS AND METHODS

A total of 76 patients who underwent primary single-bundle ACL reconstruction combined with ALL reconstruction between June 2018 and June 2021 were included. The medial tibial slope (MTS), lateral tibial slope (LTS), and anterior tibial translation (ATT) were measured using magnetic resonance imaging and plain radiography of the knee joint. The meniscal lesions were assessed during surgery. Preoperative clinical assessments and final follow-up were conducted using patient-reported outcome measurements (PROMs), including the International Knee Documentation Committee (IKDC) evaluation, Lysholm knee scoring scale, and Tegner Activity scale. PROMs were collected at least two years postoperatively.

RESULTS

The average follow-up was 32.5 ± 7.4 months. There were no significant differences in postoperative IKDC score, Lysholm score, or Tegner activity score between patients with or without medial meniscus injury (p = 0.155, 0.914, and 0.042, respectively), with or without lateral meniscus injury (p = 0.737, 0.569, and 0.942, respectively), medial tibial slope > 12° or ≤ 12° (p = 0.290, 0.496, and 0.988, respectively), or lateral tibial slope > 7.4° or ≤ 7.4° (p = 0.213, 0.625, and 0.922, respectively). No significant correlations were found between anterior tibial translation and postoperative IKDC (R = -0.058, p = 0.365), Lysholm (R = -0.017, p = 0.459), or Tegner activity scores (R = -0.147, p = 0.189).

CONCLUSION

Our study demonstrates that single-bundle ACL reconstruction combined with ALL reconstruction provides reliable and comparable clinical outcomes in patients with high-risk factors for ACL graft failure, such as increased tibial slope or meniscal injury. Our results suggest that the indications for ALL reconstruction may be expanded to include patients with a high tibial slope or meniscal injury, because these factors have been shown to contribute to increased rotational instability and high rates of ACL graft failure. Future prospective randomized controlled trials with large patient cohorts and long follow-up periods are needed to validate these findings and establish clear guidelines for patient selection and surgical decision-making.

LEVEL OF EVIDENCE

Level 3.

Return to Play and Performance After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Systematic Review of Recent Evidence

BACKGROUND

The available literature referring to the return to play (RTP) and performance after anterior cruciate ligament reconstruction (ACLR) has already been comprehensively summarized in team sports such as basketball or American Football. Therefore, in this sense, it is necessary to synthesize evidence relating to the mentioned parameters in soccer players who underwent ACLR.

OBJECTIVE

The aim of this systematic review was to examine RTP and the performance of soccer players after ACLR.

METHODS

Three electronic databases, Web of Science, Scopus, and PubMed, have been comprehensively searched to identify relevant articles. The following inclusion criteria were applied: (1) the sample of respondents consisted of soccer players irrespective of their age, sex, or level of competition; (2) athletes experienced anterior cruciate ligament injury and underwent ACLR; (3) outcomes estimated referred to the RTP, RTP at the preinjury level of competition, RTP time, performance, and career duration of soccer players; (4) studies were written in the English language. The methodological quality of the research was evaluated using the Methodological Index for Non-Randomized Studies (MINORS).

RESULTS

Databases searched yielded a total of 694 studies, of which 17 fulfilled the eligibility criteria and were included in the final analysis. These included 3657 soccer players, 2845 males and 812 females, who underwent ACLR and most commonly competed at the elite, national, amateur, and recreational levels. The results obtained indicated that 72% of soccer players successfully RTP and 53% RTP at the preinjury level of participation after ACLR. In addition, recent evidence provided in this literature review demonstrated that mean RTP time was 264 days or 8.7 months. Moreover, the majority of the studies unambiguously suggested that performance related to statistical aspects noticeably deteriorated compared with both the preinjury period and noninjured athletes. The mean career length of soccer players following ACL surgery was approximately between 4 and 5 years.

CONCLUSION

Although a high percentage of athletes RTP after a relatively short period of absence from the sports field compared with other sports closely related to soccer, ACLR negatively impacts soccer players' performance and career duration.

Limb asymmetries persist 6 months after anterior cruciate ligament reconstruction according to the results of a jump test battery

Objectives

Test batteries used to assess a patient's return-to-sports (RTS) following anterior cruciate ligament reconstruction (ACLR) are currently undergoing continual development, although no consensus exist on tests to be administered to athletes before allowing return to play. A simple standardized jump test battery was developed to objectively evaluate knee function following ACLR, thereby aiding in RTS decision-making.

Methods

Thirty-three patients who underwent ACLR were prospectively assessed pre-operatively, 6, and 12 months after surgery. Knee function was assessed using a device for optical detection using a test battery consisting of three jump tests: monopodalic countermovement jump (CMJ), drop jump, and monopodalic side-hop. Limb symmetry index (LSI) was reported for all tests at all time points. LSI ≥90% was defined as RTS criteria.

Results

At 12-month evaluation, mean LSI significantly improved compared to 6-month follow up (p < 0.01), and also compared to baseline (p < 0.01), reporting a mean value of 92.6% for CMJ, 90.6 for drop jump and 96.9% for side hop test. Most patients fulfilled the RTS criteria 12 months after surgery (LSI ≥90%). The percentages of patients demonstrating LSI ≥90% at 6 months was 7/33 (21.2%) for CMJ, 12/33 (36.4%) for drop jump, and 11/33 (33.3%) for side-hop test. One year after surgery, percentages grew up to 66.6% (22/33), 63.6% (21/33), and 81.8% (27/33) respectively.

Conclusion

Six months after ACLR, knee functional performance was unsatisfactory in most patients, whereas a significantly higher percentage of patients met RTS criteria 1 year after surgery. The results of the jump test battery proposed in this study support the idea that timing for resumption of cutting and pivoting sports should be delayed later than 6 months, as still limb asymmetries persist at this time point.

One-stage anterior cruciate ligament revision surgery after primary failed double-bundle reconstruction: a systematic review

INTRODUCTION

Anterior cruciate ligament (ACL) revision surgery after failed double-bundle (DB) reconstruction is a challenging procedure. This study aimed to systematically review the research on ACL revision surgery following failed DB reconstruction, providing an overview on indications, surgical techniques, clinical outcomes and potential pitfalls occurring while performing this therapeutic approach.

MATERIALS AND METHODS

Literature published from exception to February 2023 was searched in the Pubmed/MEDLINE, Embase and CINAHL databases. Studies in English reporting on patients who underwent ACL revision surgery after prior failed DB reconstruction were considered. Review articles and expert opinion or editorial pieces were excluded. Outcomes of interest included indications and pre-operative planning, surgical technique and associated procedures, type of revision surgery (either one- or two-stage), graft choice, clinical and functional outcomes, rate of complications, failure rate.

RESULTS

Overall, 4 studies met all the inclusion criteria for this review. All were published between 2007 and 2020. The search resulted in two retrospective comparative studies, one case series, and one case report. Average follow-up periods ranged from 24 to 45 months. From these studies, 66 patients (66 knees) were identified. One-stage revision surgery was performed in 64 on 66 patients (97%) with pathologic laxity following DB ACL reconstruction. Most frequently reported outcome was Lysholm score in five studies: average postoperative Lysholm score ranged from 90.5 to 91.0 while Tegner activity level ranged from 5.6 to 7.0. In 4 patients (6%) re-revision surgery was performed due to graft re-rupture.

CONCLUSIONS

One-stage ACL revision surgery following DB ACL reconstruction appears feasible providing satisfying outcomes and limited complications. The literature on this subject is limited and further comparative studies reporting long-term outcomes are needed, as high-level studies on this topic are still lacking.

Synthetic grafts for anterior cruciate ligament reconstructive surgery

The quest for a good and durable substitute to anterior cruciate ligament (ACL) is driving scientists to explore new promising areas of research. Autologous and allogenic ligament reconstruction bring satisfactory results in managing ACL surgery although their use is associated with significant drawbacks. To overcome the limitations of biologic grafts, many artificial devices have been developed and implanted as a substitute to the native ACL over the past decades. Although many synthetic grafts used in the past have been withdrawn from the market due to early mechanical failures ultimately leading to synovitis and osteoarthritis, there is recently a resurgence of interest in the use of synthetic ligaments for ACL reconstruction. However, this new generation of artificial ligaments, despite promising initial results, have shown to produce serious side effects such as high rupture rates, insufficient tendon-bone healing and loosening. For these reasons, recent advancements in biomedical engineering are focusing on improving technical features of artificial ligaments combining mechanical properties to biocompatibility. Bioactive coatings and surface modification methods have been proposed to enhance synthetic ligament biocompatibility and promote osseointegration. The path to the development of a safe and effective artificial ligament is still full of challenges, however recent advancements are leading the way towards a tissue-engineered substitute to the native ACL.

Drop Jump Performance Improves One Year Following Anterior Cruciate Ligament Reconstruction in Sportsmen Irrespectively of Psychological Patient Reported Outcomes

Our study aims to prospectively report the functional outcomes of 31 sportsmen following anterior cruciate ligament (ACL) reconstruction, up to 12 months after surgery, with regards to subjective tests and drop jump performance, and to investigate the correlations between these variables, to be used for determining the return to sports after ACL reconstruction. Lysholm score, Tegner activity level, and the ACL-Return to Sport after Injury (ACL-RSI) scale were evaluated preoperatively, at 6 months, and at 12 months after surgery. Drop vertical jump was recorded using an infrared optical acquisition system. Lysholm and ACL-RSI scores significantly improved at the 12-month follow-up compared to the baseline and 6-month evaluations (p < 0.001). Concerning Tegner activity level, no statistically significant differences were reported between pre- and post-operative status (p = 0.179). Drop jump limb symmetry index significantly improved at 12 months, with the mean value improving from 76.6% (SD: 32,4) pre-operatively to 90.2% (SD: 14.7; p < 0.001) at follow-up. Scarce positive correlation was reported between the ability to perform drop jumps and activity level in athletes one year after ACL reconstruction. In addition, subjective knee score and psychological readiness were not related to jumping performance.

Quadriceps strength is an early indicator of return to competitive sports 1 year after anterior cruciate ligament reconstruction in adult amateur athletes

BACKGROUND

Return to sports is one of the important reasons why athletes with an anterior cruciate ligament (ACL) injury undergo surgery. There are few reports on return to sports among adult amateur athletes (individuals older than the college age who participate in competitive sports). This study aimed to investigate the return of adult amateur athletes to competitive sports 1 year after ACL reconstruction and to identify the indicators for return to competitive sports.

METHODS

Between January 2015 and December 2017, adult amateur athletes who underwent primary ACL reconstruction were retrospectively investigated. The rate of return to competitive sports 1 year after surgery was evaluated. The patients were categorized into two groups: return to sports group (R group) and non-return to sports group (N group). Pre- and postoperative range of motion, pivot-shift test, anteroposterior laxity, quadriceps strength, Lysholm score, and the International Knee Documentation Committee score were compared between the groups.

RESULTS

This study included 78 patients (48 men, 30 women; age range, 22-53 years). Five months after ACL reconstruction, quadriceps strength was significantly lower in the N group than in the R group, denoting muscle weakness in the N group at that time. No significant differences were found in the other items between the groups preoperatively and 1 year after surgery.

CONCLUSION

In this study, the rate of return to competitive sports of adult amateur athletes 1 year after ACL reconstruction was 76.9%. Quadriceps strength may be an early indicator of return to competitive sports 1 year after reconstruction.

Relationships between Jumping Performance and Psychological Readiness to Return to Sport 6 Months Following Anterior Cruciate Ligament Reconstruction: A Cross-Sectional Study

Background: Investigating the relationship between functional capacity and psychological readiness is of paramount importance when planning sport resumption following knee surgery. The aim of this study was to prospectively assess clinical and functional outcomes in athletes 6 months after primary anterior cruciate ligament (ACL) reconstruction and to evaluate whether jumping ability is related to psychological readiness to return to sport following ACL surgery. Methods: Patients who underwent ACL reconstruction were prospectively enrolled and evaluated pre-operatively and 6 months after surgery. Assessment included Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level, and the ACL−Return to Sport after Injury (ACL-RSI) scale. Jumping ability was instrumentally assessed by an infrared optical acquisition system using a test battery including mono- and bipodalic vertical jump and a side hop test. Patients were dichotomized by ACL-RSI into two groups: group A (ACL-RSI > 60), and group B (ACL-RSI < 60). Results: Overall, 29 males and two females from the original study group of 37 patients (84%) were available for clinical evaluation. Mean age at surgery was 34.2 years (SD 11.3). Mean body mass index (BMI) was 25.4 (SD 3.7). Mean overall Lysholm, IKDC, and ACL-RSI scores increased from pre-operatively (p < 0.001). No differences in Tegner score were reported (p = 0.161). Similarly, improvement in most variables regarding jumping ability were observed at follow-up (p < 0.05). According to ACL-RSI, 20 subjects were allocated in group A (ACL-RSI > 60), while 11 were allocated in group B (ACL-RSI < 60). A statistically significant difference in favor of patients in group A was recorded for the post-operative Lysholm and Tegner score, as well as Side Hop test LSI level (p < 0.05), while a trend for IKDC was observed without statistical significance (p = 0.065). Conclusions: Patients with higher values of ACL-RSI scores showed better functional and clinical outcomes as well as improved performance 6 months after ACL reconstruction

Reliable ligamentous stability and high return-to-sport rates after arthroscopic reduction and internal fixation of tibial eminence fractures

PURPOSE

To investigate functional and clinical outcomes, and physical activity after arthroscopic suture fixation of tibial eminence fractures with regard to postoperative stability, range of motion (ROM), complications, and return to sports.

METHODS

Patients undergoing arthroscopic reduction and internal fixation (ARIF) of tibial eminence fractures using a suture fixation technique were included. Outcome was evaluated retrospectively after a minimum follow-up of 24 months using KT-1000 arthrometer measurements, clinical examination, outcome scores (Lysholm score, Tegner Activity Scale), and a questionnaire about sport activities.

RESULTS

A total of 23 patients (44% male, 57% female) with a mean age of 25 ± 15 years were included. Mean follow-up was 57 ± 25 months. KT-1000 arthrometer measurements of anterior tibial translation revealed a mean side-to-side difference of 0.9 ± 1.0 mm. Clinical examination showed 100% normal or nearly normal anterior translation of the tibia. Two patients (9%) received an ACL reconstruction due to traumatic ACL re-instability and were, therefore, considered as failures. An extension deficit concerning hyperextension occurred in 29% of patients postoperatively. Further postoperative complications occurred in 14% of patients and included postoperative stiffness with ROM limitations and secondary dislocation of a fragment. Mean postoperative Lysholm score was 89 ± 14. Comparing pre- and postoperative values, no significant change of the Tegner Activity Scale was observed. All patients (failures excluded) returned to high impact sports activities after ARIF.

CONCLUSION

Excellent reliable ligamentous stability and high rates of return to high impact sports can be expected after ARIF using a suture fixation technique for type II-IV tibial eminence fractures. Complications, such as limitations in ROM, commonly occur in up to 30% after ARIF. Therefore, regular follow-up examinations remain important in this usually young patient cohort.

LEVEL OF EVIDENCE

Level IV.

Epidemiological profile of anterior cruciate ligament injuries in a tertiary referral trauma center of Nepal

Background

Sports related injuries are the leading cause of Anterior Cruciate Ligament (ACL) tear in the Western world. Although professional and recreational sporting activities are increasing in Nepal, they are not as common and prevalent in comparison to western world. In contrast, Road Traffic Accident (RTA) is a very common cause of knee injuries in Nepal. Although there are some studies from Nepal mentioning Road Traffic Accidents (RTAs) as the most common cause of ACL injury, no specific studies have primarily investigated the epidemiological and demographic profile of ACL injured patients from this region. we aimed to understand the epidemiological and demographic profile of ACL injured patients and evaluate the mode of injury in a tertiary referral trauma center of Nepal.

Methods

This was a retrospective descriptive study of a hospital cohort conducted from February 2018 to January 2020. Electronic details were retrieved, telephone interviews conducted and data analysis was done using descriptive analysis on the patients from the fore mentioned dates to complete demographic and epidemiological information.

Results

A total of 237 patients were enrolled in this study. Among these, 120 patients (50.6%) fell into the age group of 15–30 years with a male to female ratio of 2.7:1. A RTA was the most common cause of ACL injury (38.8%), followed by sports-related injuries in 33.3% and falls in 16.5% of patients. The most common mode of RTA was a two-wheeler accident, and football was the most common sport causing ACL injuries. Sports injury was more common in patients below 30 years of age (OR = 3.5, 95% CI [2.2, 5.7]), whereas RTA was more common in patients above 30 years of age. Sports was the cause of ACL injury in 55.5% of students and RTAs was the commonest cause of ACL injury in office workers.

Conclusion

Overall males were more frequently injured than females. Road traffic accidents were the most common cause of ACL injury in our subset of patients. Two-wheeler riders were the most commonly injured patients. Sport was the commonest cause of ACL injury in patients below 30 years, and RTA was common in patients above 30 years of age. Sports were the commonest cause of ACL injury in students, while RTA was the most common cause in office workers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05551-y.

Functional outcomes and return to sport following anterior cruciate ligament reconstruction in recreational athletes: A systematic review

INTRODUCTION

Outcomes of anterior cruciate ligament reconstruction (ACLR) are well reported in athletic populations, however surprisingly little information is available for the recreational athletes that make up the majority of cases. The aim was therefore to assess post-operative outcome and return-to-sport in recreational athletes following ACLR.

METHODS

A systematic search was conducted in Ovid MEDLINE, CINAHL, AMED and the grey literature according to PRISMA guidelines. Studies involving a clear definition of recreational athletes who underwent ACLR and recorded postoperative outcomes were included. Publication quality was assessed using Newcastle-Ottawa Scale.

RESULTS

107 studies were identified, 19 full-text records reviewed and 13 included, reflecting 1342 patients with an average age of 31.7 (SD 9.8) years. Mean follow-up was 43.6 (SD 42.8) months. Activity change post-surgery was reported in 92% (12/13) papers. Outcomes were assessed with the Tegner score in seven studies, four of which reported pre-injury scores, which worsened from 5.4 to 4.3 at final follow-up (76.5 months). 54% (7/13) studies reported return to pre-injury level of sport. In these, 59% (n = 327/555) achieved pre-injury level at a mean follow-up of 33.7 months (SD 38.6). The return-to-sports rate increased with length of follow-up. Methodological quality was moderate.

CONCLUSION

Substantial variation in the timeframes and outcomes assessed restricts pooled analysis of change in function. Based on seven studies, 59% of recreational athletes return to pre-injury level of sport following ACLR. The link between return rate and post-operative review timeframe suggests that longer follow-up may be required to capture return-to-sport rates in this population.

Restoring rotational stability following anterior cruciate ligament surgery: single-bundle reconstruction combined with lateral extra-articular tenodesis versus double-bundle reconstruction

Aim: To compare the outcomes of patients who underwent single-bundle (SB) anterior cruciate ligament (ACL) reconstruction combined with lateral extra-articular tenodesis (LET) with the outcomes of those who underwent double-bundle (DB) ACL reconstruction. Methods: 16 patients who underwent ACL hamstring SB reconstruction combined with LET (Coker-Arnold modification of the MacIntosh procedure) were retrospectively compared with 20 patients who underwent hamstring DB reconstruction at an average follow-up of 6.2 years. Assessment included Lysholm and International Knee Documentation Committee scores, objective examination and instrumented laxity test. Results: No complications were reported. Mean Lysholm and International Knee Documentation Committee scores significantly increased from preoperatively (p < 0.05). No differences were reported between the two groups with regard to point scales, anterior tibial translation and pivot-shift test (p = not significant). Conclusions: Both DB ACL reconstruction and combined LET and autologous hamstring SB ACL reconstruction are effective at providing satisfying functional outcomes and restoring rotational stability.

Similar outcomes and satisfaction after transtibial versus transportal femoral drilling for anterior cruciate ligament reconstruction in young adult recreational athletes

PURPOSE

Controversy continues regarding whether the transtibial (TT) and transportal (TP) methods for anterior cruciate ligament (ACL) reconstruction provide similar or different outcomes, and the evidence on patient satisfaction is very limited. The objective of this study was to compare functional outcomes and patient satisfaction in young adult recreational athletes who underwent arthroscopic hamstring ACL reconstruction using either the TT or the TP femoral tunnel drilling method.

METHODS

A nonrandomized prospective study was designed to compare the outcomes of arthroscopic hamstring ACL reconstruction using TT or TP method. Functional outcome was assessed with the Lyshom score, and patient satisfaction with a 5-point Likert scale. Knee stability was measured with the KT-1000 arthrometer.

RESULTS

42 patients in the TT group and 41 in TP group, with age ranged 18-40 years, were compared with a mean follow-up of 42 (range 24-60) months. There were no significant differences between groups in the Lysholm score (n.s.), sport return rate (n.s.) or patient satisfaction with the surgery (n.s.). Satisfaction was only significantly associated with the Lysholm score (OR 1.3; IC 95% 1.06-1.6; p = 0.012), but not with the return to sports (n.s.) or knee anterior laxity (n.s.).

CONCLUSION

This study showed no statistical differences between the TT and the TP method in functional outcomes or patient satisfaction in young adult recreational athletes. In those patients, satisfaction with the surgery was not influenced by the return to sport activities. This study can guide surgeons in the decision-making for ACL reconstruction in recreational athletes.

LEVEL OF EVIDENCE

Level II.

The top 100 highly cited articles on anterior cruciate ligament from 2000 to 2019: A bibliometric and visualized analysis

INTRODUCTION

Bibliometrics can trace the overall research trend in a specific field. To our knowledge, there has been no comprehensive bibliometric analysis of all anterior cruciate ligament (ACL) research from 2000-2019. We provided a bibliometric and visualized analysis of the top 100 highly-cited articles on ACL indexed by the Web of Science (WoS) to provide researchers with the present research status and the potential direction of ACL research.

HYPOTHESIS

A bibliometric and visualized analysis of the top 100 highly-cited articles on ACL may identify the research trends, popular journals, core countries, influential institutions and authors in this field.

MATERIAL AND METHODS

We obtained data from the WoS Core Collection on February 20, 2020. Qualitative and quantitative analyses were conducted based on the WoS. Collaboration and keywords analysis was performed using the VOSviewer software.

RESULTS

The top 100 highly-cited literatures included 88 articles and 12 reviews. The average total citations was 325 (ranging 197 to 1,423). The article with 1432 citations published by Hewett TE et al. in 2005 was the most influential reference. Sixteen cohort studies and 14 clinical randomized controlled trials were included among the 100 literatures. Twenty-three journals published the top 100 literatures. The American Journal of Sports Medicine published 44 papers with 15,665 citations. The USA published 65 highly-cited articles. The University of Pittsburgh published 13 literatures with 3,966 citations. Hewett TE published 11 papers with 4,806 citations. Extensive collaboration existed worldwide. Reconstruction, kinematics, posterolateral bundle, in-situ forces, neuromuscular control, long-term follow-up, tunnel placement, and prevention were the most common keywords.

DISCUSSION

In this field, The American Journal of Sports Medicine was the most influential journal. The USA was the most productive and influential country. Researchers and institutions from North America and Europe contributed the most. Regarding the treatments for ACL injuries, we do need well-reported and good-quality enduring randomized trials to assess the effectiveness and cost-effectiveness of current treatments.

LEVEL OF PROOF

IV; retrospective analysis.

Effect of suspension training on neuromuscular function, postural control, and knee kinematics in anterior cruciate ligament reconstruction patients

BACKGROUND

Suspension training (SET) is a method of neuromuscular training that enables the body to carry out active training under unstable support through a suspension therapy system. However, there have been few reports in the literature on the application of SET to anterior cruciate ligament reconstruction (ACLR) patients. It is not clear what aspects of the patient's function are improved after SET.

AIM

To investigate the effect of SET on the neuromuscular function, postural control, and knee kinematics of patients after ACLR surgery.

METHODS

Forty participants were randomized to an SET group or a control group. The SET group subjects participated in a SET protocol over 6 wk. The control group subjects participated in a traditional training protocol over 6 wk. Isokinetic muscle strength of the quadriceps and hamstrings, static and dynamic posture stability test, and relative translation of the injured knee were assessed before and after training.

RESULTS

The relative peak torque of the quadriceps and hamstrings in both groups increased significantly (P < 0.001), and the SET group increased by a higher percentage than those in the control group (quadriceps: P = 0.004; hamstrings: P = 0.011). After training, both groups showed significant improvements in static and dynamic posture stability (P < 0.01), and the SET group had a greater change than the control group (P < 0.05). No significant improvement on the relative translation of the injured knee was observed after training in either group (P > 0.05).

CONCLUSION

Our findings show that SET promotes great responses in quadriceps and hamstring muscle strength and balance function in ACLR patients.

The association of extra-articular tenodesis restores rotational stability more effectively compared to contralateral hamstring tendon autografts ACL reconstruction alone in patients undergoing ACL revision surgery

BACKGROUND

Recent years have seen a resurgence of interest about lateral extra-articular procedures performed in association with anterior cruciate ligament (ACL) surgery, as they can reduce the positivity to pivot shift test by acting on rotational instability. The purpose of the present study is to compare the postoperative functional outcomes of ACL revision surgery using contralateral hamstring tendon autografts with or without extra-articular tenodesis.

HYPOTHESIS

The hypothesis is that combined extra-articular tenodesis gives better rotational stability following revision ACL surgery.

PATIENTS AND METHODS

Twenty-four patients who underwent ACL revision surgery were retrospectively reviewed at an average follow-up of 4.5 years; 12 underwent contralateral hamstring tendon autografts reconstruction (group A) while in 12 extra-articular tenodesis was associated (group B). Assessment included Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level and objective evaluation (range of motion, Lachman test, pivot-shift test and KT-1000 instrumented laxity testing).

RESULTS

Follow-up examination showed that there were no statistically significant differences in Lysholm, IKDC and Tegner scores between the groups (p=n.s.). Similarly, no differences concerning anterior tibial translation as measured with KT-1000 arthrometer were reported between the groups (p=n.s.); the percentage of positivity to pivot shift test was significantly higher in patients in group A (p<0.05).

CONCLUSIONS

The association of extra-articular tenodesis restores rotational stability more effectively compared to contralateral hamstring tendon autografts ACL revision surgery alone.

LEVEL OF EVIDENCE

III.

Ten-Year Survivorship, Patient-Reported Outcome Measures, and Patient Acceptable Symptom State After Over-the-Top Hamstring Anterior Cruciate Ligament Reconstruction With a Lateral Extra-articular Reconstruction: Analysis of 267 Consecutive Cases

BACKGROUND

Long-term patient-reported outcome measures (PROMs) and predictors of success or failure after anterior cruciate ligament (ACL) reconstruction are not fully understood, especially when combined with a lateral extra-articular reconstruction.

PURPOSE

To assess the long-term PROMs, revision rate, and predictors of success or failure after ACL reconstructions using an over-the-top surgical technique with single-bundle hamstring tendon autografts and a lateral extra-articular reconstruction.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

The study cohort consisted of 267 consecutive patients (mean age, 30.7 years) who underwent ACL reconstruction with an over-the-top surgical technique with single-bundle hamstring tendon autografts and a lateral extra-articular augmentation between November 2007 and May 2009. The number of subsequent ACL revisions and reoperations were recorded. Subjective clinical status was assessed with PROMs-specifically, the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner, and visual analog scale for pain-at a minimum follow-up of 10 years.

RESULTS

Overall, 3% of patients underwent ACL revision, with a 10-year survival rate of 96.3%. High sport activity (hazard ratio, 6.9; P = .285) and concomitant meniscal lesion (hazard ratio, 2.6; P = .0487) were predictors of ACL revision or new meniscectomy. The mean ± SD Lysholm score was 94.1 ± 10.8, while that for the visual analog scale for pain was 0.2 ± 0.9 at rest and 2.1 ± 2.6 during activity. KOOS subscale scores were as follows: 95.7 ± 8.1 for Pain, 92.5 ± 10.5 for Symptoms, 98.4 ± 7.4 for Activities of Daily Living, 90.7 ± 17.2 for Sport, and 91.2 ± 17.1 for Quality of Life; respectively, 88%, 99%, 81%, 89%, and 91% of patients achieved the Patient Acceptable Symptom State. Female sex and chondropathy with Outerbridge grade ≥2 were predictors of worse KOOS subscales. Overall, 82% of patients returned to sport, and 57% were still participating at the 10-year evaluation.

CONCLUSION

ACL reconstruction with an over-the-top surgical technique with single-bundle hamstring autografts and a lateral extra-articular reconstruction provided satisfactory results in terms of function, symptoms, sports, and quality of life in 80% to 90% of patients after 10 years. Long-term survivorship was 96%. Sport participation declined from 82% postoperatively to 57% at long-term follow-up. A concomitant medial meniscal lesion was a predictor of higher risk of ACL failure or new meniscal lesion, while advanced chondropathy and female sex were predictors of higher pain, lower function, and poor quality of life scores.

Clinical and radiological outcome after anterior cruciate ligament reconstruction using the T-lock Osteotrans resorbable tendon anchor: early experience and midterm follow-up

PURPOSE

Reconstruction of the Anterior cruciate ligament (ACL) using tendon grafting is an established method for restoring knee function and stability. Multiple methods are established for graft fixation. Several involve anchoring the autograft distant to the joint with hardware that remains implanted. This study reports the first early to midterm results in patients who received ACL reconstruction (ACLR) using the T-Lock Osteotrans femoral near joint fixation method with a tibial fixation using the BioactIF Osteotrans interference screw.

METHODS

This consecutive prospective series included 20 Patients (14 Male, 6 Female) with a primary ACL rupture. All patients were treated with an ACLR using a semitendinosus autograft fixated with the T-Lock Osteotrans and were followed-up postoperatively. The following parameters were assessed: Side-to-side difference of the posterior-anterior translation measured using the KT-1000 arthrometer, Tegner activity score, Lysholm score, IKDC subjective knee evaluation form. Magnetic resonance imaging (MRI) was done to assess tunnel enlargement and integrity of the anchoring device.

RESULTS

The average follow-up duration was 2 years (range 1-4.2 years). One patient was lost to follow-up. Two Patients suffered a traumatic ACL re-rupture 2 years postoperatively and received a 2-stage revision ACLR. Difference in the posterior-anterior translation was 1.8 mm (range 0-5). The median Tegner score was 6 (range 4-10) and 9 patients (45%) returned to their preinjury level of activity. The mean IKDC subjective knee evaluation form scored 91 points (range 77-100). The mean Lysholm score was 86 points (74-96). All mentioned scores were significantly better compared to preoperative values. No relevant tunnel enlargement was seen on MRI. The anchoring device was evaluated to be intact in all patients.

CONCLUSION

ACLR with the aforementioned procedure leads to good clinical and radiological outcome.

Innovative rehabilitative bracing with applied resistance improves walking pattern recovery in the early stages of rehabilitation after ACL reconstruction: a preliminary investigation

BACKGROUND

The use of knee braces early after anterior cruciate ligament (ACL) reconstruction is a controversial issue. The study preliminarily compares the effect of a traditional brace blocked in knee extension and a new functional brace equipped with a spring resistance on walking and strength performance early after ACL reconstruction performed in the acute/subacute stage.

METHODS

14 ACL-reconstructed patients wore either a traditional (Control group: CG, 7 subjects) or a new functional brace (Experimental group: EG 7 subjects) until the 30th post-operative day. All patients were tested before surgery (T0), 15, 30, and 60 days after surgery (T1, T2, and T3, respectively). Knee angular displacement and ground reaction forces (GRF) during the stance phase of the gait cycle were analyzed at each session and, at T3, maximal voluntary isometric contraction (MVIC) for knee flexor/extensor muscles was performed. Limb symmetry indexes (LSI) of GRF and MVIC parameters were calculated.

RESULTS

At T3, EG showed greater peak knee flexion angle of injured limb compared to CG (41 ± 2° vs 32 ± 1°, p < 0.001). During weight acceptance, a significant increase of anteroposterior GRF peak and vertical impulse from T1 to T3 was observed in the injured limb in EG (p < 0.05) but not in CG (p > 0.05). EG showed a greater side-to-side LSI of weight acceptance peak of anteroposterior GRF at T2 (113 ± 23% vs 69 ± 11%, p < 0.05) and T3 (112 ± 23% vs 84 ± 10%, p < 0.05).

CONCLUSIONS

The preliminary findings from this study indicate that the new functional brace did help in improving gait biomechanical pattern in the first two months after ACL reconstruction compared to a traditional brace locked in knee extension.

A retrospective study to compare the clinical effects of individualized anatomic single- and double-bundle anterior cruciate ligament reconstruction surgery

To evaluate the clinical efficacy of single- and double- bundle individualized anatomic anterior cruciate ligament (ACL) reconstruction, we retrospectively analyzed the data and charts of 920 patients with ACL rupture who received individualized anatomic ACL reconstruction surgery at our center. All of the patients underwent arthroscopic ACL reconstruction with autologous hamstring tendons. The patients were divided into two groups: the single-bundle individualized anatomic reconstruction group (N = 539), and the double-bundle individualized anatomic reconstruction group (N = 381). The IKDC, Lysholm and Tegner scores were used to subjectively evaluate the function of the knee joint during the postoperative follow-up. The Lachman test, pivot shift test and KT-3000 were used to objectively evaluate the stability of the knee. All 920 patients participated in clinical follow-up (average duration: 27.91 ± 3.61 months) achieved satisfied outcomes with few complications. The postoperative IKDC, Lysholm and Tegner scores, and the objective evaluation of knee joint stability were significantly improved compared to the preoperative status in both groups (P < 0.05). No statistically significant difference was observed between the two groups at the final follow-up (P > 0.05). Therefore, no difference in terms of the IKDC, Lysholm and Tegner score, or KT-3000 was observed between the individualized anatomic single- and double-bundle ACL reconstruction techniques. Both techniques can be used to restore the stability and functionality of the knee joint with satisfactory short-term efficacy.

ACL reconstruction using a bone patellar tendon bone (BPTB) allograft or a hamstring tendon autograft (GST): a single-center comparative study

Background and aim of the work: There is still debate on which graft is better indicated for anterior cruciate ligament (ACL) surgical reconstruction. The objective of this study was to evaluate the medium-term clinical outcomes of ACL reconstruction comparing patients managed with bone patellar tendon bone allograft (BPTB) versus patients treated with hamstring autograft (GST). Methods: Patients enrolled during the period 2013-2016 underwent a personal interview with the use of specific evaluation questionnaires (Tegner e Lyshom, Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee), a clinical evaluation with the use of objective functional tests (Lachman test, pivot-shift) and a physical examination of the knee. Results: In this study 43 patients were enrolled: 21 patients were treated by autograft and 22 patients by allograft. Patients who received allograft ACL reconstruction returned to normal sport activity earlier than patients operated on using autograft (11.7±10.3 vs 17.9±14.6 weeks, p<0.05). Data obtained with subjective tests, clinical and physical examination were positive overall, with no differences observed between the two groups. Finally, 15 allograft patients and 12 autograft patients accepted to perform the proprioceptive tests: no difference was found between the two groups. Conclusions: At follow-up evaluation after ACL reconstruction, both BPTB allograft and GST autograft patient groups showed similar results at subjective, objective clinical evaluation and proprioceptive properties of the limb. In particular, the use of allogenic BPTB allowed the patients to return earlier to normal activities of daily-living and sport activity. (www.actabiomedica.it)