Anterior cruciate ligament (ACL) injuries are among the most common and debilitating knee injuries in professional athletes with an incidence in females up to eight-times higher than their male counterparts. ACL injuries can be career-threatening and are associated with increased risk of developing knee osteoarthritis in future life. The increased risk of ACL injury in females has been attributed to various anatomical, developmental, neuromuscular, and hormonal factors. Anatomical and hormonal factors have been identified and investigated as significant contributors including osseous anatomy, ligament laxity, and hamstring muscular recruitment. Postural stability and impact absorption are associated with the stabilizing effort and stress on the ACL during sport activity, increasing the risk of noncontact pivot injury. Female patients have smaller diameter hamstring autografts than males, which may predispose to increased risk of re-rupture following ACL reconstruction and to an increased risk of chondral and meniscal injuries. The addition of an extra-articular tenodesis can reduce the risk of failure; therefore, it should routinely be considered in young elite athletes. Prevention programs target key aspects of training including plyometrics, strengthening, balance, endurance and stability, and neuromuscular training, reducing the risk of ACL injuries in female athletes by up to 90%. Sex disparities in access to training facilities may also play an important role in the risk of ACL injuries between males and females. Similarly, football boots, pitches quality, and football size and weight should be considered and tailored around females’ characteristics. Finally, high levels of personal and sport-related stress have been shown to increase the risk of ACL injury which may be related to alterations in attention and coordination, together with increased muscular tension, and compromise the return to sport after ACL injury. Further investigations are still necessary to better understand and address the risk factors involved in ACL injuries in female athletes. Cite this article:
The purpose of this study was to determine the incidence of graft-tunnel mismatch (GTM) when performing anatomic anterior cruciate ligament reconstruction (ACLR) using bone-patella tendon-bone (BPTB) grafts and anteromedial portal drilling. Beginning in November 2018, 100 consecutive patients who underwent ACLR by two sports fellowship-trained, orthopedic surgeons using
This study investigated the biomechanical performance of decellularized porcine superflexor tendon (pSFT) grafts of varying diameters when utilized in conjunction with contemporary ACL graft fixation systems. This aimed to produce a range of ‘off-the-shelf’ products with predictable mechanical performance, depending on the individual requirements of the patient. Decellularized pSFTs were prepared to create double-bundle grafts of 7 mm, 8 mm, and 9 mm diameter. Femoral and tibial fixation systems were simulated utilizing Arthrex suspension devices and interference screws in bovine bone, respectively. Dynamic stiffness and creep were measured, followed by ramp to failure from which linear stiffness and load at failure were measured. The mechanisms of failure were also recorded.Objectives
Methods
Aims. Our aim was to perform a meta-analysis of the outcomes of revision
anterior cruciate ligament (ACL) reconstruction, comparing the use
of different types of graft. Materials and Methods. A search was performed of Medline and Pubmed using the terms
“Anterior Cruciate Ligament” and “ACL” combined with “revision”,
“re-operation” and “failure”. Only studies that reported the outcome
at a minimum follow-up of two years were included. Two authors reviewed
the papers, and outcomes were subdivided into autograft and allograft. Autograft
was subdivided into hamstring (HS) and bone-patellar tendon-bone
(BPTB). Subjective and objective outcome measures were analysed
and odds ratios with confidence intervals were calculated. Results. A total of 32 studies met the inclusion criteria. Five studies
used HS autografts, eight reported using
We examined the association of graft type with
the risk of early revision of primary anterior cruciate ligament reconstruction
(ACLR) in a community-based sample. A retrospective analysis of
a cohort of 9817 ACLRs recorded in an ACLR Registry was performed.
Patients were included if they underwent primary ACLR with bone–patellar tendon–bone
autograft, hamstring tendon autograft or allograft tissue. Aseptic
failure was the main endpoint of the study. After adjusting for
age, gender, ethnicity, and body mass index, allografts had a
3.02 times (95% confidence interval (CI) 1.93 to 4.72) higher risk
of aseptic revision than bone–patellar tendon–bone autografts (p
<
0.001). Hamstring tendon autografts had a 1.82 times (95% CI
1.10 to 3.00) higher risk of revision compared with bone–patellar
tendon–bone autografts (p = 0.019). For each year increase in age,
the risk of revision decreased by 7% (95% CI 5 to 9). In gender-specific
analyses a 2.26 times (95% CI 1.15 to 4.44) increased risk of hamstring
tendon autograft revision in females was observed compared with
bone–patellar tendon–bone autograft. We conclude that allograft
tissue, hamstring tendon autografts, and younger age may all increase
the risk of early revision surgery after ACLR. Cite this article:
Injuries to the infra-patella branch of the saphenous nerve on harvesting Bone-Patella Tendon-Bone (BPB) autograft commonly cause anterior knee pain. The purpose of this study is to investigate the possibility of harvesting a good BPB graft without injury to the nerve by using double mini-incision. Twelve adult cadaveric knees, with two vertical incisions of 25mm, one over the inferior pole of the patella, and the other over the tibial tuberosity were prepared. The tibial bone block was harvested, with preservation of the para-tendon, making a subcutaneous tunnel proximally and stripped to dissect the middle 1/3 of the patella tendon. The graft was then detached after harvesting the patella bone block, and examined for size and quality. The knees were finally dissected to check the relationship of the incisions with the infra-patella branch, and see if it was injured. All BPB grafts were found to have good tendon qualities of average 9.5mm in width. The tibial bone plug is of average 25mm in length and 10mm in width, while the patella bone plug is of average 22mm in length & 9mm in width. All 12 knees have 2 infra-patella branches, with the proximal branch running at averaged distance of 23mm distal to the proximal incision, while the distal branch lying at averaged distance of 11mm proximal to the distal incision. 2 out of the 12 distal branches were injured by the distal incision. Double-mini incision allows harvesting of a consistently good quality BPB graft with preservation of the infra-patella branch of the saphenous nerve.
Introduction: This biomechanical study evaluates the consequences of a mid-third BPTB-autograft excision on patellofemoral biomechanics and knee kinematics. Of particular interest was the potential role of a BPTB-autograft excision on postoperative anterior knee pain in ACL replacement surgery. Methods: Isokinetic knee extension from 120 of flexion to full extension was simulated on 9 human knee cadaver specimens (5 male, 4 female, average age at death 43 years). Joint kinematics was evaluated by ultrasound sensors (CMS 100TM, Zebris, Isny, Germany), and retro-patellar contact pressure was measured using a thin-film resistive ink pressure system (K-ScanTM 4000, Tekscan, Boston). All data were taken before and after excision of a mid-third BPTB-autograft. Results: Following excision of a mid-third patella tendon autograft we found a significant (p<
0.05) proximalization of the patella (average: 0.5 mm) and a significant decrease of patella flexion in the sagittal plane (average: 1). Patella tilt, -rotation (frontal plane), -translation (medial/lateral) and tibiarotation (external-/internal), -axis (varus-/valgus position) remained unchanged. Patellofemoral contact pressure and -area decreased significantly near knee extension (p<
0.05). Conclusions: We conclude that an excision of a mid-third patella tendon autograft results in a lengthening of the tendon with a proximalization of the patella. As the patellofemoral pressure decreases and the patella remains centralized, postoperative anterior knee pain following ACL-replacement using a
The choice of graft for anterior cruciate ligament reconstruction remains controversial. A systematic review was performed to compare bone-patella tendon-bone and 4-strand hamstring grafts. Medline (1966 onwards), EMBASE (1980 onwards) and the Cochrane database were searched retrieving 6312 possible articles but only 6 studies fulfilled all the inclusion criteria. To be included, the study had to be prospective, randomised or quasi-randomised, comparing 4SHS and central third
The choice of graft for anterior cruciate ligament reconstruction remains controversial. A systematic review was performed to compare bone-patella tendon-bone and 4-strand hamstring grafts. Medline (1966 onwards), EMBASE (1980 onwards) and the Cochrane database were searched retrieving 6312 possible articles but only 6 studies fulfilled all the inclusion criteria. To be included, the study had to be prospective, randomised or quasirandomised, comparing 4SHS and central third
Aim: To confirm previous studies and reports of tunnel widening following anterior cruciate ligament (ACL) reconstruction. To report the medium term behaviour and the effect of tunnel widening on the clinical results. Methods: A retrospective analysis of the ACL database comparing