Introduction. Anterior Cruciate Ligament (ACL) injury prevention programs can reduce injury risk in various sports. The perception of ACL injury prevention programs amongst professional netball players and coaches has not been studied. The purpose of the study was to determine (1) level of awareness and experience of ACL injury prevention programs; (2) use of ACL injury prevention programs; and (3) barriers and potential facilitators to implementing a sustainable ACL injury prevention program in netball. Methods. This cross-sectional observational study was undertaken using the CHERRIES checklist. Female netball players representing Welsh senior and under-21 teams and elite and amateur coaches were invited electronically to participate in this web-based study between 1st May – 31st July 2021. Information on ACL injury susceptibility and seriousness, knowledge, experience, and implementation of ACL injury prevention programs were ascertained. Results. Twenty-eight players (77.8%) and 29 coaches (13.2%) completed the questionnaire. Seventeen (60.7%) players and 15 (51.7%) coaches reported female athletes were at greater risk for sustaining ACL injuries. Over 90% of respondents identified netball as high-risk, whilst 89% of players and 76% of coaches reported these injuries to be preventable. Only two (7.1%) players and 6 (20.7%) coaches utilised an ACL injury prevention program with lack of time and engagement from coaches and players identified. Majority of respondents indicated that their club has neither promoted, advocated the use nor demonstrated exercises for ACL injury prevention. Over 90% of respondents would utilise an ACL injury prevention program if it minimised players risk with appropriate information and demonstration of exercises. Conclusion. This study highlights limited knowledge of female athletes' increased susceptibility of ACL injuries amongst players and coaches with lack of communication and education of ACL injury prevention programs between sporting associations, coaches, and players. However, the results demonstrate willingness amongst both players and coaches to implement an ACL injury prevention program in netball

Patellar dislocation is a common presentation with a clear management pathway. Sometimes, however, what a patient experiences as the patella dislocating may, in fact, be ACL insufficiency. We reviewed case notes and imaging of 315 consecutive ACL reconstructions, collecting data on the date and mechanism of injury, time to MRI, and reconstruction. We noted cases initially diagnosed as patellar dislocation. 25 of 315 (7.9%) patients were initially diagnosed with a patellar dislocation. Subsequently, however, MRI scans revealed no evidence of patellar dislocation and instead showed ACL rupture with pathognomonic pivot-shift bony oedema. The false patella dislocation group were 32% female and had an average age of 25; the rest of the group average age was 27.1 and there were a lower proportion of females; 21%. The false patella instability patients had a median waiting time of 412 days from injury to operation (range: 70-2445 days), compared to 392 days (range: 9 – 4212 days) for rest of the patients. 5 of the remaining 290 had MRIs showing patella oedema with medial patello-femoral ligament injury in addition to their ACL rupture. From our literature search this is a new finding which shows that ACL rupture can present with symptoms suggestive of patellar dislocation. These findings raise the risk that there are a group of people who have been diagnosed with patellar instability who instead have ACL insufficiency and so are at risk of meniscal and chondral damage. Further research should analyse those diagnosed with patellar instability to quantify missed ACL injuries

Introduction. Anterior tibial translation (ATT) is assessed in the acutely injured knee to investigate for ligamentous injury and rotational laxity. Specifically, there is a growing recognition of the significance of anterior medial rotary laxity (AMRI) as a crucial element in assessing knee stability. Anterior cruciate ligament (ACL) injuries are often accompanied with medial collateral ligament (MCL) damage. It has been suggested that Deep MCL (dMCL) fibres are a primary restraint in rotational displacement. This research aims to quantify the difference in rotational laxity of patients with ACL and MCL injuries to deem if the Feagin-Thomas test can robustly capture metrics of AMRI. 2. Methods. AMRI was assessed using the Feagin-Thomas test in 7 isolated ACL (iACL) injured participants, 3 combined ACL and superficial fibre MCL (sMCL) injuries, 5 combined ACL and deep fibre MCL injuries, and 21 healthy controls. Displacement values were recorded using an optical motion capture (OMC) system and bespoke processing pipeline which map and model the knee's anterior displacement values relative to the medial compartment. Since absolute values (mm) of rotational laxity vary dependant on the person, values were recorded as a proportion of the rotational laxity obtained from the subject's contralateral leg. Values were compared between each patient group using an ANOVA test and Tukey's honesty significant difference post hoc test. 3. Results. The healthy control group had a median proportion of 0.97 (3SF), whilst the iACL was 1.12 (3SF), a 12% increase in rotational laxity in the injured leg. The sMCL group yielded a result of 1.64 (3SF), a 64% increase in rotational laxity in the injured leg; finally, dMCL resulted in a proportion of rotational laxity of 1.90 (3SF), a 90% increase in rotational laxity [table 1]. Whilst all groups showed differences in the increase of rotational laxity, dMCL was significantly different from the healthy control group (P value 0.0041). 4. Conclusion. ACL injuries with MCL involvement led to an increase in anterior medial rotary laxity and this is more evident in patients where deep MCL fibres are involved. The Feagin-Thomas test appears to be sensitive in detecting differences in AMRI and should be considered when performing comprehensive clinical knee examination. For any figures or tables, please contact authors directly

Background. The mechanical disadvantage and detrimental effect to articular cartilage following meniscectomy has been well documented in the literature. Meniscal repair in the avascular (white on white zone) is controversial and would be deemed inappropriate by many. Methods. Prospective data collection on all meniscal repairs between 1999 and 2008. 423 patients underwent meniscal repair at our unit during this time. We identified 88 patients who underwent a meniscal repair of a non peripheral tear (white on white zone) where there was no co-existent ACL injury or instability. There were 74 males and 14 females with a mean age of 26 years (13-54). There were 50 medial meniscal tears and 38 lateral tears, all in the non peripheral area of the meniscus. The criterion for failure was any reoperation on the same meniscus requiring excision or re fixation. Results. The mean follow up was 44 months (5–106). Twenty nine patients required further surgery on their repaired meniscus. There were nine re-repairs and twenty partial menisectomies. Of the nine re-repairs only one has gone on to have a further procedure with meniscectomy. This represents a success rate of 67% (59/88). The mean pre-operative Lysholm score was 61 (4-88) which rose to 75 (12-100) postoperatively, (p=0.002). The mean pre-operative Tegner score was 6 (3-10) and this did not change significantly post operatively, mean 6 (0-10) (p=0.4). Conclusions. Isolated white on white avascular meniscal tears can be successfully repaired in the majority of cases with a good clinical and functional result

Background. Injury to the ACL is a significant problem and can cause further damage to the internal structures of the knee. ACL injury is associated with injuries to other structures in the knee such as the meniscus and chondral cartilage. Such intra articular injuries pre-dispose the knee to develop arthritis. This injury is usually seen in young and active people usually related to sporting injuries. There is a paucity of literature on the influence of anthropometric features on the hamstring graft obtained in ACL reconstruction, although there are studies on the sex based differences affecting the hamstring graft. This study was undertaken to assess the influence of anthropometric measurements on the graft thickness obtained at ACL reconstruction surgery within the UK population. Objective. This study was undertaken to assess the influence of anthropometric measurements (body mass index (BMI), height and weight) on the graft thickness obtained at anterior cruciate ligament reconstruction surgery. Materials and methods. Data from 121 consecutive patients who had undergone ACL reconstruction by the same surgeon using quadrupled hamstring grafts were analysed. The body mass index, height and weight of these patients were correlated with the graft thickness obtained during surgery. Regression analysis was undertaken to assess the influence of individual anthropometric variables on the graft thickness. Results. Of the 121 patients there were 108 males and 13 females. Average age of the cohort was 32 years (14–55). There was a statistically significant positive correlation between the height and graft size (r=0.38, p < 0.01) as well as between the body weight and graft size (r=0.29, p < 0.01). However, when body mass index was calculated, the correlation was not statistically significant (r=0.08, p > 0.1). Regression analysis confirmed that BMI was not statistically significant as a predictor of hamstring graft diameter whereas height was statistically the most important predictor (F=20.1; p < 0.01) and yielded the predictive equation from regression analysis. Graft diameter=4.5 + 0.02 × Ht. (in cms) suggesting that people with height less than 125 cms (4′1″) are at greatest risk of a quadrupled graft size of less than 7 mm. Conclusion. Our findings suggest that although body mass index did not significantly correlate, individual anthropometric variables (height and weight) do influence the size of graft thickness in ACL reconstruction and give pre operative information. This may allow surgeons to plan for alternative graft options, if they could predict the possibility of inadequate graft size prior to ACL reconstruction surgery

INTRODUCTION. This study aimed to intra-operatively quantify the improvements in knee stability given both by anatomic double-bundle (ADB) and single-bundle with additional lateral plasty (SBLP) ACL reconstruction using a navigation system. MATERIALS AND METHODS. We prospectively included 35 consecutive patients, with an isolated anterior cruciate ligament injury, that underwent both ADB and SBLP ACL reconstruction (15 ADB, 20 SBLP). The testing protocol included anterior/posterior displacement at 30° and 90° of flexion (AP30–AP90), internal/external rotation at 30° and 90° of flexion (IE 30–IE90) and varus/valgus test at 0° and 30° of flexion (VV0–VV30); pivot-shift (PS) test was used to determine dynamic laxity. The tests were manually performed before and after the ACL reconstruction and the data were acquired by means a surgical navigation system (BLU-IGS, Orthokey, USA). Comparisons of pre- and post-reconstruction laxities were made using paired Student t-test (P=0.05) within the same group; comparison between ADB and SBLP groups was indeed performed using independent Student t-test (P=0.05), analysing both starting pre-operative condition and post-operative one. RESULTS. Statistically significant reduction of the global amount of laxity and global displacement was observed for both reconstructions (p<0.05) in all the performed clinical tests. Statistical differences was found between the two reconstruction considering the recovery (pre-post laxities) due to the each reconstruction, in VV0 (SBLP: 3.7±0.2° and ADB: 2.3±0.5°, p<0.0001) and in IE90 (SBLP: 9.2±3.1° and ADB: 5.0±2.8°, p=0.0022). Statistical differences were also found between the two reconstruction considering the recovery of global displacement, in particular for the lateral compartment during AP90 SBLP: 8.8±1.0 mm, ADB: 6.4±0.4 mm, p<0.0001), for the maximal lateral joint opening during VV0 (SBLP: 4.5±1.2 mm, ADB: 1.2±1.1 mm, p<0.0001) and VV30 (SBLP 3.5±1.3 mm, ADB 1.8±0.1 mm, p=0.0013) and both for the medial and lateral AP displacement during IE90 (in in medial compartment SBLP:5.6±0.6 mm, ADB: 2.7±0.7 mm, p<0.0001, in lateral compartment SBLP:8.2±1.0 mm, ADB: 3.9±0.8 mm, p<0.0001). During PS test ADB patients revealed less “hysteresis” after reconstruction (p=0.0005). Moreover SBLP patients presented more acceleration after the reconstruction compared to ADB and more evident displacement (p=0.0009). DISCUSSION. Both the reconstructions worked similarly for what concerns knee static laxity. The considered extra-articular procedure plays an important role in better controlling lateral tibial compartment displacement in drawer test and in controlling maximal lateral joint opening both at 0° and 30° of flexion. On the other hand the ADB reconstruction better restores the dynamic behaviour of the joint under PS test

Aims

This study describes the use of the Masquelet technique to treat segmental tibial bone loss in 12 patients.