Anterior cruciate ligament reconstruction (ACLR) can be performed with a number of different autografts including all soft tissue quadriceps autograft. (QT). QT has several advantages including decreased donor site morbidity, reduced anterior knee pain and comparable revision rates compared to other autografts. The primary aim of this review was to assess all complications of QT in adult population. A systematic review of the literature was conducted on in accordance with the PRISMA guidelines using the online databases Medline and EMBASE. Clinical studies or reporting on soft tissue QT were included and appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool.Abstract
Introduction
Methodology
The aim of this study was to compare patient-reported outcomes (PROMs) following isolated anterior cruciate ligament reconstruction (ACLR), with those following ACLR and concomitant meniscal resection or repair. We reviewed prospectively collected data from the UK National Ligament Registry for patients who underwent primary ACLR between January 2013 and December 2022. Patients were categorized into five groups: isolated ACLR, ACLR with medial meniscus (MM) repair, ACLR with MM resection, ACLR with lateral meniscus (LM) repair, and ACLR with LM resection. Linear regression analysis, with isolated ACLR as the reference, was performed after adjusting for confounders.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
The study aims were to demonstrate rates, level, and time taken to RTP in elite sports after ACL reconstruction (ACL-R) and compare football and rugby. A retrospective review of a consecutive series of ACL-R between 2005 and 2019 was undertaken. Patients were included if they were elite athletes and were a minimum of 2 years post primary autograft ACL-R. The outcomes measured were return to play (RTP), (defined as participation in a professional match or in national/ international level amateur competition), time to RTP after surgery, and RTP level (Tegner score).Abstract
Introduction
Methods
Abstract. Introduction. Anterolateral procedures can reduce the risk of re-rupture after ACL reconstruction in high risk patients however, this effectiveness has never been evaluated in elite athletes. The purpose of this study was to evaluate the effectiveness of lateral extra-articular tenodesis in reducing revision rates in ACL reconstructions in elite athletes. Methodology. A consecutive cohort of elite athletes between 2005 and 2018 undergoing ACLR reconstruction with or without modified Lemaire lateral extra-articular tenodesis were analysed. A minimum of 2 years of follow-up was required. The association between the use of LET and ACL graft failure was evaluated with univariate and multivariate logistic regression models. Results. 455 elite athletes (83% male; 22.5±4.7 years) underwent
Abstract. Methodology. Prospective single-surgeon case-series evaluating patients undergoing surgery by this technique. 76 cases (mean age of 33.2 years) who had
Abstract. Purpose. Since arthroscopic reconstruction of the anterior cruciate ligament (ACL) started, the use of peroneus longus grafts for
The outcome following arthroscopic anterior cruciate (ACL) reconstruction is dependant on a combination of surgical and non-surgical factors. Technical error is the commonest cause for graft failure, with poor tunnel placement accounting for over 80% of those errors. A routine audit of femoral and tibial tunnel positions following single bundle hamstring arthroscopic ACL reconstruction identified apparent inconsistent positioning of the tibial tunnel in the sagittal plane. Intra-operative fluoroscopy was therefore introduced (when available) to verify tibial guide wire position prior to tunnel reaming. This paper reports a comparison of tibial interference screw position measured on post-operative radiographs with known tunnel position as shown on intra-operative fluoroscopic images in 20 patients undergoing routine
Purpose. The aim of the present study was to investigate the relationship between generalised ligament laxity and requirement for revision ACL reconstruction. Materials and methods. 126 patients undergoing
Aims. Wales in collaboration with the Welsh Assembly Government, has attempted to start a national ligament register. Introduction. Norway is the lead in Europe for running a successful national quality knee ligament registry. As yet there is no UK wide registry encompassing all forms of knee ligament surgery. The issue has been discussed at previous society meetings, but no consensus has been reached. Method. A pilot study covering three NHS Trusts in South Wales was run between April 2010 and September 2010. Data is gathered prospectively on non-operatively treated and surgically treated knee ligament injuries performed in the regions. This data is recorded on the WKLR form which is then sent to the WKLR centre and entered onto a secure database. Four knee surgeons agreed to take part in the study, from three NHS Health Boards. The data is recorded at the time of the operation on a tick box form akin to that used by the NJR. The prospectively gathered data is stored at the central registry office in Princess of Wales Hospital Bridgend. Results. A total of 68 forms were returned to the registry, 58 Males and 10 Females, average age 30 and 35 years respectively. Four per cent of ACL ruptures were treated non-operatively. Sixty two (96%) ACL ruptures were reconstructed; 57 primary reconstructions; 3 revisions; 2 were multi-ligament injuries. The most common mechanisms of injury in females were basketball and football. Rugby was the most common mechanism for males. Six PCL injuries were reported, half (3) were reconstructed, all using allograft Achilles tendon. Of the fifty seven
Anterior cruciate ligament (ACL) and multiligament knee (MLK) injuries increase the risk of development of knee osteoarthritis and eventual need for total knee arthroplasty (TKA). There are limited data regarding implant use and outcomes in these patients. The aim of this study was to compare the use of constrained implants and outcomes among patients undergoing TKA with a history of prior knee ligament reconstruction (PKLR) Patients with a history of ACL or MLK reconstruction who underwent TKA between 2007 and 2017 were identified in a single-institution registry. There were 223 patients who met inclusion criteria (188 ACL reconstruction patients, 35 MLK reconstruction patients). A matched cohort, also of 223 patients, was identified based on patient age, body mass index (BMI), sex, and year of surgery. There were 144 male patients and 79 female patients in both cohorts. Mean age at the time of TKA was 57.2 years (31 to 88). Mean BMI was 29.7 kg/m2 (19.5 to 55.7).Aims
Patients and Methods
The aim of this study was to investigate the long-term clinical
and radiological outcome of patients who suffer recurrent injuries
to the anterior cruciate ligament (ACL) after reconstruction and
require revision surgery. From a consecutive series of 200 patients who underwent primary
reconstruction following rupture of the ACL, we identified 36 who
sustained a further rupture, 29 of whom underwent revision surgery.
Patients were reviewed prospectively at one, two, seven, 15 and
about 20 years after their original surgery. Primary outcome measures
were the number of further ruptures, the posterior tibial slope
(PTS), and functional and radiological outcomes. These were compared
with a gender and age matched cohort of patients who underwent primary
ACL reconstruction only.Aims
Patients and Methods
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. 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.Aims
Materials and Methods
Aims. The aim of this study was to investigate the incidence, risk factors, and outcome of venous thromboembolism (VTE) following anterior cruciate ligament (ACL) reconstruction in a nationwide cohort. Patients and Methods. All
To investigate the risk factors for progression of articular
cartilage damage after anatomical anterior cruciate ligament (ACL)
reconstruction. A total of 174 patients who underwent second-look arthroscopic
evaluation after anatomical ACL reconstruction were enrolled in
this study. The graded condition of the articular cartilage at the
time of ACL reconstruction was compared with that at second-look
arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction
technique, meniscal conditions, and other variables were assessed
by regression analysis as risk factors for progression of damage
to the articular cartilage.Aims
Patients and Methods
To examine the rates of hamstring graft salvage with arthroscopic
debridement of infected anterior cruciate ligament (ACL) reconstruction
as reported in the literature and discuss functional outcomes. A search was performed without language restriction on PubMed,
EMBASE, Ovid, CINAHL and Cochrane Register of Controlled Trials
(CENTRAL) databases from their inception to April 2015. We identified
147 infected hamstring grafts across 16 included studies. Meta-analysis
was performed using a random-effects model to estimate the overall
graft salvage rate, incorporating two different definitions of graft
salvage.Aims
Materials and Methods
We reviewed 87 patients who underwent revision reconstruction of the anterior cruciate ligament. The incidence of meniscal tears and degenerative change was assessed and related to the interval between failure of the primary graft and revision reconstruction. Patients were divided into two groups: early revision surgery within six months of graft failure, and delayed revision. Degenerative change was scored using the French Society of Arthroscopy system. There was a significantly higher incidence of articular cartilage degeneration in the delayed group (Mann-Whitney U-test, 53.2% We conclude that revision reconstruction should be carried out within six months of primary graft failure, in order to minimise the risk of degenerative change.
We report the clinical outcome and findings at
second-look arthroscopy of 216 patients (mean age 25 years (11 to 58))
who underwent anterior cruciate ligament (ACL) reconstruction or
augmentation. There were 73 single-bundle ACL augmentations (44
female, 29 male), 82 double-bundle ACL reconstructions (35 female,
47 male), and 61 single-bundle ACL reconstructions (34 female, 27
male). In 94 of the 216 patients, proprioceptive function of the knee
was evaluated before and 12 months after surgery using the threshold
to detect passive motion test. Second-look arthroscopy showed significantly better synovial
coverage of the graft in the augmentation group (good: 60 (82%),
fair: 10 (14%), poor: 3 (4%)) than in the other groups (p = 0.039).
The mean side-to-side difference measured with a KT-2000 arthrometer
was 0.4 mm (-3.3 to 2.9) in the augmentation group, 0.9 mm (-3.2
to 3.5) in the double-bundle group, and 1.3 mm (-2.7 to 3.9) in
the single-bundle group: the result differed significantly between
the augmentation and single-bundle groups (p = 0 .013). No significant
difference in the Lysholm score or pivot-shift test was seen between
the three groups (p = 0.09 and 0.65, respectively). In patients
with good synovial coverage, three of the four measurements used
revealed significant improvement in proprioceptive function (p = 0.177,
0.020, 0.034, and 0.026). We conclude that ACL augmentation is a reasonable treatment option
for patients with favourable ACL remnants. Cite this article:
The purpose of this study was to report the outcome
of ‘isolated’ anterior cruciate ligament (ACL) ruptures treated with
anatomical endoscopic reconstruction using hamstring tendon autograft
at a mean of 15 years (14.25 to 16.9). A total of 100 consecutive
men and 100 consecutive women with ‘isolated’ ACL rupture underwent
four-strand hamstring tendon reconstruction with anteromedial portal
femoral tunnel drilling and interference screw fixation by a single
surgeon. Details were recorded pre-operatively and at one, two,
seven and 15 years post-operatively. Outcomes included clinical
examination, subjective and objective scoring systems, and radiological
assessment. At 15 years only eight of 118 patients (7%) had moderate
or severe osteo-arthritic changes (International Knee Documentation
Committee Grades C and D), and 79 of 152 patients (52%) still performed
very strenuous activities. Overall graft survival at 15 years was
83% (1.1% failure per year). Patients aged <
18 years at the
time of surgery and patients with >
2 mm of laxity at one year had
a threefold increase in the risk of suffering a rupture of the graft
(p = 0.002 and p = 0.001, respectively). There was no increase in
laxity of the graft over time. ACL reconstructive surgery in patients with an ‘isolated’ rupture
using this technique shows good results 15 years post-operatively
with respect to ligamentous stability, objective and subjective
outcomes, and does not appear to cause osteoarthritis.
Between 1993 and 1994, 891 patients underwent
primary anterior cruciate ligament (ACL) reconstruction. A total
of 48 patients had undergone bilateral ACL reconstruction and
42 were available for review. These patients were matched to a unilateral
ACL reconstruction control group for gender, age, sport of primary
injury, meniscal status and graft type. At 15-year follow-up a telephone
interview with patients in both groups was performed. The incidence
of further ACL injury was identified through structured questions
and the two groups were compared for the variables of graft rupture
or further ACL injury, family history of ACL injury, International
Knee Documentation Committee (IKDC) subjective score and activity
level. There were 28 male and 14 female patients with a mean age of
25 years (13 to 42) at the time of first ACL injury. Subsequent
further ACL injury was identified in ten patients (24%) in the bilateral
ACL reconstruction study group and in nine patients (21%) in the
unilateral ACL reconstruction control group (p = 0.794). The mean
time from bilateral ACL reconstruction to further ACL injury was
54 months (6 to 103). There was no significant difference between
the bilateral ACL reconstruction study group and the matched unilateral
ACL reconstruction control group in incidence of further ACL injury
(p = 0.794), family history of ACL injury (p = 0.595), IKDC activity
level (p = 0.514), or IKDC subjective score (p = 0.824). After bilateral ACL reconstruction the incidence of graft rupture
and subjective outcomes were equivalent to that after unilateral
ACL reconstructions. Cite this article: