Aims

To investigate the risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament (ACL) reconstruction.

Aims

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.

The June 2015 Research Roundup360 looks at: Tranexamic acid: just give it – it’s not important how!; The anterolateral ligament re-examined; Warfarin a poor post-operative agent; Passive exoskeleton the orthosis of the future?; Musculoskeletal medicine: a dark art to UK medical students?; Alendronic acid and bone density post arthroplasty; Apples with oranges? Knee functional scores revisited

The April 2015 Knee Roundup360 looks at: Genetic determinants of ACL strength; TKA outcomes influenced by prosthesis; Single- or two-stage revision for infected TKA?; Arthroscopic meniscectomy: a problem that just won’t go away!; Failure in arthroscopic ACL reconstruction; ACL reconstruction in the over 50s?; Knee arthroplasty for early osteoarthritis; All inside meniscal repair; Steroids, thrombogenic markers and TKA

Hypermobility is an acknowledged risk factor for patellar instability. In this case control study the influence of hypermobility on clinical outcome following medial patellofemoral ligament (MPFL) reconstruction for patellar instability was studied.

A total of 25 patients with hypermobility as determined by the Beighton criteria were assessed and compared with a control group of 50 patients who were matched for age, gender, indication for surgery and degree of trochlear dysplasia. The patients with hypermobility had a Beighton Score of ≥ 6; the control patients had a score of < 4. All patients underwent MPFL reconstruction performed using semitendinosus autograft and a standardised arthroscopically controlled technique. The mean age of the patients was 25 years (17 to 49) and the mean follow-up was 15 months (6 to 30).

Patients with hypermobility had a significant improvement in function following surgery, with reasonable rates of satisfaction, perceived improvement, willingness to repeat and likelihood of recommendation. Functional improvements were significantly less than in control patients (p < 0.01).

Joint hypermobility is not a contraindication to MPFL reconstruction although caution is recommended in managing the expectations of patients with hypermobility before consideration of surgery.

This study evaluated the results of a physeal-sparing technique of intra-articular anterior cruciate ligament (ACL) reconstruction in skeletally immature patients, with particular reference to growth disturbance. Between 1992 and 2007, 57 children with a mean age of 12.2 years (6.8 to 14.5) underwent ACL reconstruction using the same technique. At a mean of 5.5 years (2 to 14) after surgery, 56 patients underwent clinical and radiological evaluation. At that time, 49 patients (87.5%) had reached bony maturity and 53 (95%) achieved A or B according to the IKDC 2000 classification. Four patients had stopped participation in sports because of knee symptoms, and three patients (5.4%) had a subsequent recurrent ACL injury. There was no clinical or radiological evidence of growth disturbance after a mean growth in stature of 20.0 cm (3 to 38).

This study demonstrates that ACL reconstruction sparing the physes in children is a safe technique protecting against meniscal tears and giving better results than reconstruction in adults, without causing significant growth disturbance.

The effect of weight-bearing on the height of the patellar using four radiological indices was studied in 25 healthy men using lateral radiographs of the knee in 30° of flexion non-weight-bearing and weight-bearing. The position of the patella was quantified using the Insall-Salvati, the modified Insall-Salvati, the Blackburne-Peel and the Caton indices. The contraction of the quadriceps on weight-bearing resulted in statistically significant proximal displacement of the patella with all four indices studied. The mean Insall-Salvati index was 0.919 (sd 0.063) before and 1.109 (sd 0.042) after weight-bearing (p = 0.001), while the mean modified Insall-Salvati index was 0.734 (sd 0.039) before and 0.896 (sd 0.029) after weight-bearing (p = 0.041). Similarly, the Blackburne-Peel index was 0.691 (sd 0.09) before and 0.807 (sd 0.137) after weight-bearing (p = 0.012). The mean Caton index was 0.861 (sd 0.09) before and 0.976 (sd 0.144) after weight-bearing (p = 0.023).

The effect of quadriceps contraction should be considered in clinical studies where the patellar position indices are reported.

This prospective study used magnetic resonance imaging to record sagittal plane tibiofemoral kinematics before and after anterior cruciate ligament reconstruction using autologous hamstring graft. Twenty patients with anterior cruciate ligament injuries, performed a closed-chain leg-press while relaxed and against a 150 N load. The tibiofemoral contact patterns between 0° to 90° of knee flexion were recorded by magnetic resonance scans. All measurements were performed pre-operatively and repeated at 12 weeks and two years.

Following reconstruction there was a mean passive anterior laxity of 2.1 mm (sd 2.3), as measured using a KT 1000 arthrometer, and the mean Cincinnati score was 90 (sd 11) of 100. Pre-operatively, the medial and lateral contact patterns of the injured knees were located posteriorly on the tibial plateau compared with the healthy contralateral knees (p = 0.014), but were no longer different at 12 weeks (p = 0.117) or two years postoperatively (p = 0.909). However, both reconstructed and healthy contralateral knees showed altered kinematics over time. At two years, the contact pattern showed less posterior translation of the lateral femoral condyle during flexion (p < 0.01).