Introduction. Anterior cruciate ligament (ACL) injuries are one of the most common knee injuries amongst elite athletes and usually require an ACL reconstruction (ACLR) to enable return to sport. Secondary surgery can result in a longer rehabilitation period and often a. significant time away from sport which can have implications to the athlete including contract obligations and sponsorship. Advances in ACLR techniques and meniscal repair techniques as well as an awareness of meniscal root lesions, ramp lesions and lateral extraarticular procedures (LEAPs) during ACL surgery has improved outcomes. The purpose of this study was to evaluate the rates of secondary surgery following the introduction of a systematic arthroscopic evaluation of the knee, improved meniscal repair techniques and the addition of a concomitant LEAP This systematic approach was introduced after October 2012 (10/2012). Methods. Professional athletes who underwent primary ACLR with a minimum follow-up of 2 years were identified from the (blinded for review). Those who had undergone major concomitant procedures such as multi-ligament reconstruction or osteotomy were excluded. Analysis of the database and review of medical records identified athletes who had underwent secondary surgery procedures. Results. A total of 342 athletes with a mean follow-up of 100.2 +/− 51.9 months (range, 24–215 months) were analysed. 130 athletes underwent surgery before 10/2012 and 212 athletes underwent surgery after 10/2012. Overall, 74 patients (21.6%) underwent secondary surgery. 39 patients (30.0% including 13.1% for graft rupture) before 10/2012 and 35 patients (16.5% including 6.6% for graft rupture) after 10/2012. A multivariate analysis was performed using the Cox model and demonstrated that athletes undergoing ACLR before10/2012 were at almost 2-fold risk of secondary surgery (hazard ratio (HR), 1.768(1.103;2.836), p=0.0256) when compared with those undergoing ACLR after 10/2012. (Figure 1). Conclusion. Professional athletes undergoing ACLR with a systematic arthroscopic evaluation with the use of advanced meniscal repair techniques and the combination with a LEAP result in a significantly lower rate of secondary surgery. For any figures or tables, please contact authors directly

Introduction. It has been contentious whether an anatomic double-bundle technique for anterior cruciate ligament reconstruction (ACLR)is superior to that of a single-bundle technique. It has been hypothesized in the literature that the double-bundle technique could provide function closer to that of the anatomical knee joint. The purpose of this study was to compare the long-term clinical outcomes after single-bundle ACLR versus double-bundle ACLR. We hypothesized that the double-bundle technique would not be superior to the single-bundle technique. Methods. A retrospective, non-randomized, matched-paired comparative study was performed. Patients undergoing primary anterior cruciate ligament reconstruction, using either a double-bundle or single-bundle technique, between 2003 and 2008 were included and matched 1:1. Matching included age, sex, BMI, time from injury to surgery, side of injury and type of sport. Patients who underwent revision procedures, multiligament reconstruction or other ACLR techniques were excluded. Patients were subsequently followed up, noting occurrence of graft rupture and any other complications. Results. A total of 1377 ACLRs were performed during the study period. Seven hundred and fifty-six patients were excluded, leaving 396patients to be included in the matching (198 matched pairs). Mean follow-up time was 176.7 +/− 7.7 months (range, 166–211 months). Overall, 40 patients (10.1%) suffered from a graft rupture which consisted of 22 patients (11.1%) in the single-bundle group and 18patients (9.1%) in the double-bundle group. A multivariate analysis was performed using the Cox model and demonstrated that graft failure had no significant association with the surgical technique (hazard ratio (HR), 0.857(0.457;1.609), p=0.6313). (Figure 1) Five patients (2.5%) in the single-bundle group and 7 patients (3.5%) in the double-bundle group underwent secondary surgery for cyclops syndrome(p=0.5637). Three patients (1.5%) in the single-bundle group and 2 patients (1.0%) in the double-bundle group underwent arthrolysis(p=0.6547). Seven patients (3.5%) in the single-bundle group underwent secondary meniscectomy compared to 6 patients (3.0%) in the double-bundle group (p=0.7630). Conclusion. Double-bundle ACLR is not superior to single-bundle ACLR at long-term follow up. Therefore, orthopaedic surgeons do not need to use a double-bundle technique when performing ACL reconstruction. For any figures or tables, please contact authors directly

Correct femoral tunnel position in anterior cruciate ligament reconstruction (ACLR) is critical in obtaining good clinical outcomes. We aimed to delineate whether any difference exists between the anteromedial (AM) and trans-tibial (TT) portal femoral tunnel placement techniques on the primary outcome of ACLR graft rupture. Adult patients (>18year old) who underwent primary ACLR between January 2011 – January 2018 were identified and divided based on portal technique (AM v TT). The primary outcome measure was graft rupture. Univariate analysis was used to delineate association between independent variables and outcome. Binary logistic regression was utilised to delineate odds ratios of significant variables. 473 patients were analysed. Median age at surgery was 27 years old (range 18–70). A total of 152/473, (32.1%) patients were AM group compared to 321/473 (67.9%) TT. Twenty-five patients (25/473, 5.3%) sustained graft rupture. Median time to graft rupture was 12 months (IQR 9). A higher odds for graft rupture was associated with the AM group, which trended towards significance (OR 2.03; 95% CI 0.90 – 4.56, p=0.081). Older age at time of surgery was associated with a lower odds of rupture (OR 0.92, 95% CI 0.86 – 0.98, p=0.014). There is no statistically significant difference in ACLR graft rupture rates when comparing anteromedial and trans-tibial portal technique for femoral tunnel placement. There was a trend towards higher rupture rates in the anteromedial portal group