The management of symptomatic single bundle Anterior Cruciate Ligament (ACL) ruptures is still a surgical dilemma. Preservation of the intact fibres of the ACL bundle is considered to be a possible source of reinnervation of the ACL autograft which reflects on better proprioceptive knee control after major ligament reconstruction. Results of a prospective study of 67 patients who had a double stranded but single bundle
Purpose: To determine if patients randomized to a knee immobilizer following a primary hamstring tendon
ACL deficiency can have detrimental pathological effects on the menisci in the knee. A database review in Quebec over a three-year period was previously reported (Canadian Academy of Sport Medicine, Winnipeg, 2003), which examined the relationship between waiting times for ACL surgery and the requirement of a meniscal procedure. The purpose of this study is to determine if the length of time between an index injury and ACL reconstruction (ACLR) surgery correlates with the incidence of meniscal repair and meniscectomy in Alberta, and to compare the results to those of the Quebec study. Retrospective study, using procedure and billing codes to search the Alberta Health and Wellness databases for knees undergoing primary ACLR surgery between 2002–2005. Inclusion: Patients sixteen years or older at time of reconstruction. Exclusion: Revision ACLR, duplicate billing and coding, and insufficient database information. For each reconstructed knee, databases were searched for initial injury evaluation date with primary care physician, dates of meniscectomy or meniscal repair procedures, and date of ACLR. Over a three-year period, there were 3382 primary ACL reconstructions performed in Alberta, 3812 ACLR in Quebec. Of these patients, 2583 in Alberta (76%) and 1722 in Quebec (45%) required a meniscal procedure. On average, Albertans waited 1389 days from injury to ACLR compared to 422 days in Quebec. In Alberta, patients not requiring a meniscal procedure waited 1212 days, patients requiring meniscal repair waited 1143 days, and patients requiring meniscectomy waited 1519 days, compared to 251, 413 and 676 days in Quebec, respectively. Three percent of patients in Alberta had ACLR <
three months after injury (114 patients), with 45% requiring meniscectomy. Overall, 61% of patients in Alberta required a meniscectomy for significant meniscal injury, compared to 48% of patients in Quebec. The proportions for each province were statistically significant. Compared to Quebec, patients in Alberta are waiting longer for ACLR, with only a small proportion of cases being treated acutely. The proportion of patients requiring surgery for significant meniscal injury is also greater in Alberta. The higher proportion of patients in Alberta requiring meniscectomy may be due to the delay in ACLR.
Anterior knee instability associated with rupture of ACL is a disabling clinical problem, especially in the athletic individual. The gracilis and semitendinosus tendon (T4) represent an alternative autograft donor material for reconstruction of the ACL. The aim of our study was to elaborate a CPG to assist physiotherapists in decision making and to improve the efficacy and uniformity of care for patients with ACL reconstruction with T4. The CPG was developed according to international methods of guideline development. To identify “best evidence” a structured search was performed. When no evidence was available, consensus between experts (physiotherapist and orthopaedic surgeons) was achieved to develop the guideline. To identify “best clinical experience” and “physiopathology reasoning” focus group of practicing physiotherapists was used. They reviewed the clinical applicability and feasibility of the guideline, and their comments were used to improve it. CPG include three phases determined from the evidence, physiopathology reasoning and the biological process of autograft (weeks after the surgery: 2a–6a, 6a–10a and 10a–16a). The recommendations included: In postoperative weeks (2a–6a) physiotherapy focused on early range of motion of the knee; manual therapy (passive range of motion (PROM) 0–120° and miofascial techniques), pulsed ultrasound of low intensity with a power of 0.3w/cm2 (1MHz) during 10min/day in tibial tunnel, early active hamstring beginning with static weight bearing co-contractions (closed-kinetic-chain) and adductors, partial weight bearing with crutches, exercises in the swimming pool and cryotherapy to pain control (30 mi/4 hours). In weeks 6 to 10, full weight bearing, manual therapy (PROM 0–140° and miofascial techniques), hamstring strengthening progress complexity and repetitions of co-contractions, electrotherapy hamstring and quadriceps co-contractions. Starting at week 10, progress to more dynamic activities/movements, proprioceptive work, open-kinetic-chain, stationary bike and Theraband squats. In week 12, progress jogging program and plyometric type activities. The patients performed sports-specific exercises by about 3½ months postoperative.
Aims. To verify whether secretory leucocyte protease inhibitor (SLPI) can promote early tendon-to-bone healing after
Aims. The aim of this study was to compare the preinjury functional scores with the postinjury preoperative score and postoperative outcome scores following
Aims. Patient dissatisfaction following primary total knee arthroplasty (TKA) with manual jig-based instruments has been reported to be as high as 30%. Robotic-assisted total knee arthroplasty (RA-TKA) has been increasingly used in an effort to improve patient outcomes, however there is a paucity of literature examining patient satisfaction after RA-TKA. This study aims to identify the incidence of patients who were not satisfied following RA-TKA and to determine factors associated with higher levels of dissatisfaction. Methods. This was a retrospective review of 674 patients who underwent primary TKA between October 2016 and September 2020 with a minimum two-year follow-up. A five-point Likert satisfaction score was used to place patients into two groups: Group A were those who were very dissatisfied, dissatisfied, or neutral (Likert score 1 to 3) and Group B were those who were satisfied or very satisfied (Likert score 4 to 5). Patient demographic data, as well as preoperative and postoperative patient-reported outcome measures, were compared between groups. Results. Overall, 45 patients (6.7%) were in Group A and 629 (93.3%) were in Group B. Group A (vs Group B) had a higher proportion of male sex (p = 0.008), preoperative chronic opioid use (p < 0.001), preoperative psychotropic medication use (p = 0.01), prior
Cite this article:
The effects of remnant preservation on the anterior cruciate ligament (ACL) and its relationship with the tendon graft remain unclear. We hypothesized that the co-culture of remnant cells and bone marrow stromal cells (BMSCs) decreases apoptosis and enhances the activity of the hamstring tendons and tenocytes, thus aiding ACL reconstruction. The ACL remnant, bone marrow, and hamstring tendons were surgically harvested from rabbits. The apoptosis rate, cell proliferation, and expression of types I and III collagen, transforming growth factor-β (Aims
Methods
The best surgical strategy for the management of displaced bucket-handle (BH) meniscal tears in an anterior cruciate ligament (ACL)-deficient knee is unclear. Combining meniscal repair with ACL reconstruction (ACLR) is thought to improve meniscal healing rates; however, patients with displaced BH meniscal tears may lack extension. This leads some to advocate staged surgery to avoid postoperative stiffness and loss of range of motion (ROM) following ACLR. We reviewed the data for a consecutive series of 88 patients (mean age 27.1 years (15 to 49); 65 male (74%) and 23 female (26%)) who underwent single-stage repair of a displaced BH meniscal tear (67 medial (76%) and 21 lateral (24%)) with concomitant hamstring autograft ACLR. The patient-reported outcome measures (PROMs) EuroQol visual analogue scale (EQ-VAS), EuroQol five-dimension health questionnaire (EQ-5D), Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee score (IKDC), and Tegner score were recorded at final follow-up. A Kaplan-Meier survival analysis was performed to estimate meniscal repair survivorship. Analyses were performed with different cut-offs for meniscal and ACL injury-to-surgery time (within three weeks, three to ten weeks, and more than ten weeks).Aims
Methods
There is limited information on outcomes of revision ACL reconstruction (rACLR) in soccer (association football) athletes, particularly on return to sport and the rate of additional knee surgery. The purpose of this study was to report return to soccer after rACLR, and to test the hypothesis that patient sex and graft choice are associated with return to play and the likelihood of future knee surgery in soccer players undergoing rACLR. Soccer athletes enrolled in a prospective multicentre cohort were contacted to collect ancillary data on their participation in soccer and their return to play following rACLR. Information regarding if and when they returned to play and their current playing status was recorded. If they were not currently playing soccer, they were asked the primary reason they stopped playing. Information on any subsequent knee surgery following their index rACLR was also collected. Player demographic data and graft choice were collected from their baseline enrolment data at rACLR.Aims
Methods
MRI has been suggested as an objective method of assessing anterior crucate ligament (ACL) graft “ligamentization” after reconstruction. It has been proposed that the MRI appearances could be used as an indicator of graft maturity and used as part of a return-to-sport assessment. The aim of this study was to evaluate the correlation between MRI graft signal and postoperative functional scores, anterior knee laxity, and patient age at operation. A consecutive cohort of 149 patients who had undergone semitendinosus autograft ACL reconstruction, using femoral and tibial adjustable loop fixations, were evaluated retrospectively postoperatively at two years. All underwent MRI analysis of the ACL graft, performed using signal-to-noise quotient (SNQ) and the Howell score. Functional outcome scores (Lysholm, Tegner, International Knee Documentation Committee (IKDC) subjective, and IKDC objective) were obtained and all patients underwent instrumented side-to-side anterior laxity differential laxity testing.Aims
Methods
Aims. To evaluate graft healing of decellularized porcine superflexor tendon (pSFT) xenograft in an ovine
Despite extensive research aimed at improving surgical outcomes of enthesis injuries, re-tears remain a common problem, as the repairs often lead to fibrovascular scar as opposed to a zonal enthesis. Zonal enthesis formation involves anchoring collagen fibers, synthesizing proteoglycan-rich fibrocartilage, and mineralizing this fibrocartilage [1]. During development, the hedgehog signaling pathway promotes the formation and maturation of fibrocartilage within the zonal tendon-to-bone enthesis [1-4]. However, whether this pathway has a similar role in adult zonal tendon-to-bone repair is not known. Therefore, we developed a murine
To address the current challenge of
The principal of “function priority, early rehabilitation, and return to sports” is now the goal for sports injury rehabilitation. Neuromuscular electrical stimulation for
Abstract. Introduction. The aim of this study was to determine the factors affecting return to sport (RTS) and career longevity of elite athletes after microfracture of the knee. Methods. A retrospective review of a consecutive series of elite athletes with chondral injuries in the knee treated with microfracture was undertaken. RTS was defined as competing in at least one event at professional level or national/ international level in amateur sport. Demographic, pre, intra and post operative factors affecting RTS were analysed. Results. Fifty six athletes, including 35 (62.5%) footballers and 14 (25.0 %) rugby players, with a mean age 24.8 (+/− 3.9) years, were included. 18 (32.1 %) of chondral injuries were secondary to trauma, 20 (35.7 %) post meniscectomy, 9 (16.1%) post
The bone-patellar tendon-bone (BTB) autograft is associated with difficulty kneeling following
The optimal method of tibial fixation when using a hamstring tendon autograft in
Although autografts represent the gold standard for
Introduction. Day stay surgery for
Successful
Most previous studies investigating autograft options (quadriceps, hamstring, bone-patella-tendon-bone) in primary
Aims. Adenosine, lidocaine, and Mg. 2+. (ALM) therapy exerts differential immuno-inflammatory responses in males and females early after
Meniscal repairs are commonly performed during
Abstract. Introduction. All-tissue quadriceps tendon (QT) is becoming an increasingly popular alternative to hamstrings tendon (HT) and bone-tendon-bone (BTB) autograft for
Arthrofibrosis is a less common complication following
Screw fixation is an established method for
Background.
Anterior cruciate ligament (ACL) injuries have been increasing, especially amongst adolescents. These injuries can increase the risk for early-onset knee osteoarthritis (OA). The consequences of late-stage knee OA include structural joint change, functional limitations and persistent pain. Interleukin-6 (IL-6) is a pro-inflammatory biomarker reflecting knee joint healing, and increasing evidence suggests that IL-6 may play a critical role in the development of pathological pain. The purpose of this study was to determine the relationship between subjective knee joint pain and function, and synovial fluid concentrations of the pro-inflammatory cytokine IL-6, in adolescents undergoing anterior cruciate ligament reconstruction surgery. Seven youth (12-17 yrs.) undergoing
Increasing expectations from arthroscopic
External validation of machine learning predictive models is achieved through evaluation of model performance on different groups of patients than were used for algorithm development. This important step is uncommonly performed, inhibiting clinical translation of newly developed models. Recently, machine learning was used to develop a tool that can quantify revision risk for a patient undergoing primary
Aims. The aim of this study was to investigate the incidence, risk factors, and outcome of venous thromboembolism (VTE) following
The June 2015 Knee Roundup360 looks at: Cruciate substituting versus retaining knee replacement; What’s behind the psychology of
To describe our experience with computer assisted combined
Revision
Introduction and Objective. Osteoarthristis (OA) has been associated with many genes and yet the genetic basis for this disease has never formally been established. Recent realization that epigenetic changes could be the underlying pathological mechanisms has helped to explain many complex multifactorial diseases with no clear genetic cause. We therefore asked whether epigenetics could also play a role in OA. We have previously shown that the DNA epigenetic modification, specifically the hydroxymethylation on cytosine (5hmC), undergoes a fivefold increase on OA-associated genes which are activated at OA onset. In this study, we further uncovered a set of 5hmC-mediated gene targets and their mechanistic link to OA progression. Materials and Methods. We surgically induced OA on 4 to 6 months old Tet1−/− mice (Tet1tm1.1Jae, the Jackson laboratory) and wild-type littermates by performing destabilization of the medial meniscus (DMM) surgery. Joints were collected for histological assessment through blinded grading with the OARSI scoring system. Human articular chondrocytes were harvested from OA cartilage samples obtained during total knee arthroplasty or from grossly normal cartilage pieces obtained during notchplasty or debridement from patients undergoing
Objectives. To compare the effect of femoral bone tunnel configuration on tendon-bone healing in an
The use of platelet-rich plasma (PRP) as an adjuvant
to tissue repair is gaining favour in orthopaedic surgery. Tunnel widening
after
Due to unsatisfactory results and reported drawbacks of
Between 1993 and 1994, 891 patients underwent
primary
Surgery performed in low-volume centres has been associated with longer operating time, longer hospital stays, lower functional outcomes, and higher rates of revision surgery, complications, and mortality. This has been reported consistently in the arthroplasty literature, but there is a paucity of data regarding the relationship between surgical volume and outcome following
The treatment of medial knee osteoarthritis (OA) in conjunction with anterior knee laxity is an issue of debate. Current treatment options include knee joint distraction, unicompartmental knee replacement (UKR) or high tibial osteotomy with
The aim of an
The primary purpose of this study was to assess whether patients presenting with clinical graft laxity following primary anatomic
The concept of decellularised xenografts as a basis for
There is increasing interest in the placement of the femoral and tibial tunnels for
We reviewed 87 patients who underwent revision
Hamstring tendons are commonly used for
We report the clinical outcome and findings at
second-look arthroscopy of 216 patients (mean age 25 years (11 to 58))
who underwent
Introduction. Anatomical reconstruction of the
Background:. The Lateral Intercondylar Ridge (LIR) gained notoriety with arthroscopic trans-tibial
This study evaluated the results of a physeal-sparing technique of intra-articular
The aim of an
Review of 133 cases of
Introduction/aims.
Introduction. Anatomical reconstruction of the
To determine the prevalence of osteoarthritis in the knee in the long term after
This prospective study was undertaken to compare the clinical and radiological results and the in vivo stabilities of anteromedial (AM) and posterolateral (PL) bundle augmentation during
The goal of this prospective study was to evaluate the results of arthroscopic meniscal repair with the FasT-Fix repair system. Type of study: Prospective case series. Methods: 83 meniscal repairs with the FasT-Fix meniscal repair system in 80 patients with a mean age of 29 years were performed between 2004 and 2008. Concurrent
To evaluate in-vivo the effectiveness of the double bundle technique for
Introduction. Unlike the NJR, no surgeon driven national database currently exists for ligament surgery in the UK and therefore information on outcome and adverse event is limited to case series. Methods. Prospectively collected Hospital episode statistics (HES) data for England was analysed so as to determine national rates of 90-day symptomatic deep venous thrombosis (DVT), pulmonary thromboembolism (PTE) rate, significant wound infection and 30-day readmission rates with cause following
This study was performed to evaluate the results of transphyseal
Knee ligament injury is one of the most frequent sport injuries and ligament reconstruction has been used to restore the structural stability of the joint. Cycling exercises have been shown to be safe for
Aim: To assess pain control, functional outcome and patient satisfaction following day surgery ACL reconstruction. We report the results of 60 consecutive primary
Purpose of the study: The debate continues on the appropriate tendon to use for
The study was established to assess the long-term results and differences between autogenous and synthetic
Purpose of Study: To prospectively evaluate the outcome of single surgeon endoscopic
Background: This study was carried out to record and compare the opinions of junior and senior orthopaedic surgeons with regards to the amount of training necessary to achieve competency in knee arthroscopy. Methods: At a recent international orthopaedic conference a questionnaire was given to 50 orthopaedic residents and 40 consultants. Consultants were also asked if they performed regular knee arthroscopy (>
50/year). Competency for this study was deWned as the ability to perform the procedure without supervision. Participants were asked to estimate the number of times a trainee needs to do the following procedures to achieve competency: diagnostic scope, partial medial meniscectomy, partial lateral meniscectomy, and
Purpose: The goal of this prospective study was to evaluate the results of arthroscopic meniscal repair with the FasT-Fix repair system. Type of study: Prospective case series. Methods: 83 meniscal repairs with the FasT-Fix meniscal repair system in 80 patients with a mean age of 29 years were performed between 2001 and 2004. Concurrent
The study was established to assess the long-term results and differences between autogenous and synthetic
There is little evidence examining the relationship between anatomical landmarks, radiological placement of the tunnels and long-term clinical outcomes following
AIM. Failure of a primary
Purpose of study. To determine whether cycles of pivot shift testing prior to
Septic arthritis after arthroscopic
The purpose to prospectively compare two types of tibial fixation in a series of 160
Tibial and femoral bone tunnel widening (TW) has been observed following
Purpose. To assess whether
A review of the outcome, safety, practicality and cost effectiveness of day surgery
Introduction Cold therapy is known to reduce pain and swelling after surgical procedures on the knee. We hypothesised that if cold therapy is started earlier, then there would be a reduction in pain and swelling in patients undergoing arthroscopic
Introduction: The most critical step in the ACL reconstruction is placement of the femoral and tibial tunnels into which the graft is secured. The purpose of this prospective randomised study was to assess biomechanical, radiographic and functional results after single-bundle
Most people have not returned to their pre-injury level of sports participation 12 months following
Purpose: To evaluate the differencies in graft orientation between transtibial and anteromedial portal technique using magnetic resonance imaging (MRI) in
To compare the early functional and clinical results, between single (SB) and double-bundle (DB) of
Previous
Introduction: The technique of double bundle
A recurrence of objectively measured knee laxity after
Aims: The aims of this study were to evaluate the biomechanical properties and mode of failure of a technique of
Aims: The aims of this study were to evaluate the biomechanical properties and mode of failure of a technique of
The aim was to demonstrate that day case