Career Length After Surgically Treated ACL Plus Collateral Ligament Injury in Elite Athletes.

BACKGROUND: Limited data are available regarding career length and competition level after combined anterior cruciate ligament (ACL) and medial- or lateral-sided surgeries in elite athletes. PURPOSE: To evaluate career length after surgical treatment of combined ACL plus medial collateral ligament (MCL) and ACL plus posterolateral corner (PLC) injuries in elite athletes and, in a subgroup analysis of male professional soccer players, to compare career length and competition level after combined ACL+MCL or ACL+PLC surgeries with a cohort who underwent isolated ACL reconstruction (ACLR). STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A consecutive cohort of elite athletes undergoing combined ACL+MCL and ACL+PLC surgery was analyzed between February 2001 and October 2019. A subgroup of male elite soccer players from this population was compared with a previously identified cohort having had isolated primary ACLR without other ligament surgery. A minimum 2-year follow-up was required. Outcome measures were career length and competition level. RESULTS: A total of 98 elite athletes met the inclusion criteria, comprising 50 ACL+PLC and 48 ACL+MCL surgeries. The mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Return-to-play (RTP) time was significantly longer for ACL+PLC injuries (12.8 months; P = .019) than for ACL+MCL injuries (10.9 months). In the subgroup analysis of soccer players, a significantly lower number of players with combined ACL+PLC surgery were able to RTP (88%; P = .003) compared with 100% for ACL+MCL surgery and 97% for isolated ACLR, as well as requiring an almost 3 months longer RTP timeline (12.9 months; P = .002) when compared with the isolated ACL (10.2 months) and combined ACL+MCL (10.0 months) groups. However, career length and competition level were not significantly different between groups. CONCLUSION: Among elite athletes, the mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Professional soccer players with combined ACL+PLC surgery returned at a lower rate and required a longer RTP time when compared with the players with isolated ACL or combined ACL+MCL injuries. However, those who did RTP had the same career longevity and competition level.

Rising rates of anterior cruciate ligament reconstruction in Australian adults: An analysis of Australian Medicare Benefits Schedule database.

PURPOSE: Anterior cruciate ligament (ACL) reconstruction is an evolving field, though there remains sparse epidemiological data on the treatment of ACL ruptures. The objective of this study is to analyse the trends in the rate of ACL reconstruction (ACLR) in adult patients over the past two decades in the Australian population. METHODS: The incidence of ACLR between 2001 and 2020 in patients 15 years and over was analysed using the Australian Medicare Benefits Schedule (MBS) database. The data reflect patients with private health coverage (45% of the Australian population). An offset term was introduced using national population data to account for population changes over the study period. RESULTS: A total of 160,353 ACLRs were performed in Australia under the MBS in the 20-year period from 2001 to 2020. An annual increase in the total volume and per capita rate of ACLRs was found (p < 0.05). The annual volume of cases increased by 82%, from 5512 in 2001 to a peak of 10,011 in 2017. This increase was seen across all age groups (p < 0.05) and both sexes (p < 0.05), with a greater proportion of reconstructions performed on males (n = 102,357, 64%) than females (n = 57,996, 36%). In 2020, the rate of adult ACLRs decreased to a level last seen in 2004, likely due to the effects of COVID-19. CONCLUSIONS: The incidence of ACLR in adult patients has increased in Australia over the 20-year study period. The trends noted provide information that can be used to guide resource allocation and health provision in the future. LEVEL OF EVIDENCE: Level IV.

Does concomitant meniscus repair and meniscectomy show different efficacy in anterior cruciate ligament reconstruction? A systematic review and meta-analysis.

Aims: Currently, it is advised to perform meniscal repair instead of meniscectomy in certain cases of primary anterior cruciate ligament reconstruction (ACLR). However, the level of evidence is low. Therefore, this study aimed to compare the effectiveness of meniscectomy and meniscus repair in addition to ACLR. Methods: The systematic search was conducted in three online databases (EMBASE, MEDLINE, and Cochrane) from inception until October 2021 for the literature on primary ACLR and concomitant meniscal surgery. Eligible studies compared the following outcomes between meniscal repair and meniscectomy groups: the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, International Knee Documentation Committee (IKDC) score, and KT-arthrometer examinations. Lastly, we calculated pooled mean differences (MDs) with 95 % confidence intervals (CIs) from the change between pre- and post-intervention values. Results: Of 10,565 studies, 22 met the inclusion criteria, with a follow-up between 6 and 43 months. We found no difference when comparing the KOOS subscale changes-only in the KOOS pain subscale (MD = -1.6; CI: -2.48, -0.72). However, these results were not clinically significant. We analyzed the lateral and media meniscal injuries separately and concluded the same results regarding KOOS changes. We found no significant differences in the Lysholm score change (MD = -2.61; CI: -5.51, 0.29), changes in IKDC score (MD = 1.08; CI: -4.05, 6.21) or the change for the KT-arthrometer side-to-side difference (MD = -0.50; CI: -1.06, 0.06). Conclusion: Based on our result, we did not find a clinically significant difference between meniscus repair and meniscectomy during primary ACLR regarding patient-reported outcomes in a short-term follow-up. Translational potential: Our research supports the prompt integration of findings into clinical practice for treating meniscus injuries during ACL reconstruction. We recommend considering both meniscus repair and meniscectomy, as the available data indicate their effectiveness. Further studies are necessary to assess the long-term impacts, particularly on osteoarthritis, and to identify patient subgroups that may benefit most from each technique.

A Comparative Study on Correlation between Magnetic Resonance Imaging and Arthroscopic Findings in the Knee Joint Injuries.

Introduction: The knee joint primarily allows for flexion and extension and is essentially a hinge joint. The knee joint, like all hinge joints, is strengthened by collateral ligaments - one on each side of the joint. Objective: Our study sought to investigate potential correlations between arthroscopy and magnetic resonance imaging (MRl) examination in the diagnosis of traumatic diseases of the knee. Methods and Materials: A prospective study was conducted on 30 persons who showed signs of having traumatic knee disease. Following a comprehensive evaluation of the patient s medical history and current state of health, we opted to undergo an arthroscopic evaluation and knee MRL. Results: The sensitivity of the MRI was 93.87%, the specificity was 91.54%, the accuracy was 92.50%, and the negative predictive value was 95.58% when compared to arthroscopic inspection as the gold standard. Conclusion: This study demonstrates that MRIs frequently misdiagnose individuals with multiple knee injuries or fail to detect a lesion while doing a diagnostic evaluation. Therefore, if the MRI comes out normal, there is no reason to deny the patient arthroscopy. Due to this MRI flaw, researchers have determined that arthroscopy can be performed following a comprehensive clinical assessment without the need for an MRI.

Anterior cruciate ligament injury and age affect knee cartilage T2 but not thickness.

OBJECTIVE: To investigate the effect of unilateral anterior cruciate ligament (ACL) injury on cartilage thickness and composition, specifically laminar transverse relaxation time (T2) by magnetic resonance imaging (MRI), in younger and older participants and to compare within-person side differences in these parameters between ACL-injured and healthy controls. DESIGN: Quantitative double-echo steady-state 3 Tesla MRI-sequences were acquired in both knees of 85 participants in four groups: 20-30 years: healthy, HEA20-30, n = 24; ACL-injured, ACL20-30, n = 23; 40-60 years: healthy, HEA40-60, n = 24; ACL-injured, ACL40-60, n = 14 (ACL injury 2-10 years prior to study inclusion). Weight-bearing femorotibial cartilages were manually segmented; cartilage T2 and thickness were computed using custom software. Mean and side differences in subregional cartilage thickness, superficial and deep cartilage T2 were compared within and between groups using non-parametric statistics. RESULTS: Cartilage thickness did not differ within or between groups. Only the side difference in medial femorotibial cartilage thickness was greater in ACL20-30 than in HEA20-30. Deep zone T2 was longer in the ACL-injured than in the contralateral uninjured knees and than in healthy controls, especially in the lateral compartment. Most ACL-injured participants had side differences in femorotibial deep zone T2 above the threshold derived from controls. CONCLUSION: In the ACL-injured knee, early compositional differences in femorotibial cartilage (T2) appear to occur in the deep zone and precede cartilage thickness loss. These results suggest that monitoring laminar T2 after ACL injury may be useful in diagnosing and monitoring early articular cartilage changes.

Association of tibial slope alterations with anterior cruciate ligament (ACL) injury and mucoid degeneration.

OBJECTIVE: To compare radiographic measurements of lateral tibial slope (LTS), medial TS (MTS), and coronal TS (CTS) in MRI-defined intact, injured, and mucoid-degenerated native ACL knees and determine inter-reader reliability. MATERIALS AND METHODS: Patient records from 2 years at tertiary care hospitals were reviewed for individuals aged 18-100 undergoing 3-Tesla knee MRI and radiographs. Two randomly selected cohorts, control, and pathologic ACLs on MRI with 86 patients each, were age, gender, and BMI-matched. A fellowship-trained musculoskeletal radiologist reevaluated curated images, characterizing ACL status. Two trained medical students independently collected clinical data and measured slopes on blinded radiographs. ICC, Cohen's kappa, and case-control matching were performed using SPSS statistical package, with ICC and ANOVA used for comparisons. RESULTS: Among 172 patients with 172 MRIs and radiographs, there were 86 controls and 86 ACL lesions. There were 108/172 (62.79%) males and 64/172 (37.21%) females. ICCs were 0.966 for MTS, 0.975 for LTS, and 0.978 for CTS. Mucoid degeneration patients had a higher BMI and were older than control (p < .05) or completely torn (p < .001) ACL patients. There was no difference in TS between normal and pathologic ACLs; however, LTS-MTS differences were larger with partial tears (2.5 ± 4.9) than normal ACLs by 4.5° (± 1.2, p < .001), complete tears by 4.5° (± 1.3, p < .001), and mucoid degeneration by 4.9° (± 1.5, p = .001). CONCLUSION: Various TS measurements are reliable. LTS-MTS differences are associated with different ACL lesions compared to normal ACLs.

Management of Meniscus Pathology with Concomitant Anterior Cruciate Ligament Injury.

PURPOSE OF REVIEW: The purpose of this review is to summarize current clinical knowledge on the prevalence and types of meniscus pathology seen with concomitant anterior cruciate ligament (ACL) injury, as well as surgical techniques, clinical outcomes, and rehabilitation following operative management of these pathologies. RECENT FINDINGS: Meniscus pathology with concomitant ACL injury is relatively common, with reports of meniscus pathology identified in 21-64% of operative ACL injuries. These concomitant injuries have been associated with increased age and body mass index. Lateral meniscus pathology is more common in acute ACL injury, while medial meniscus pathology is more typical in chronic ACL deficiency. Meniscus tear patterns associated with concomitant ACL injury include meniscus root tears, lateral meniscus oblique radial tears of the posterior horn (14%), and ramp lesions of the medial meniscus (8-24%). These meniscal pathologies with concomitant ACL injury are associated with increased rotational laxity and meniscal extrusion. There is a paucity of comparative studies to determine the optimal meniscus repair technique, as well as rehabilitation protocol, depending on specific tear pattern, location, and ACL reconstruction technique. There has been a substantial increase in recent publications demonstrating the importance of meniscus repair at the time of ACL repair or reconstruction to restore knee biomechanics and reduce the risk of progressive osteoarthritic degeneration. Through these studies, there has been a growing understanding of the meniscus tear patterns commonly identified or nearly missed during ACL reconstruction. Surgical management of meniscal pathology with concomitant ACL injury implements the same principles as utilized in the setting of isolated meniscus repair alone: anatomic reduction, biologic preparation and augmentation, and circumferential compression. Advances in repair techniques have demonstrated promising clinical outcomes, and the ability to restore and preserve the meniscus in pathologies previously deemed irreparable. Further research to determine the optimal surgical technique for specific tear patterns, as well as rehabilitation protocols for meniscus pathology with concomitant ACL injury, is warranted.

Analysis of the Swedish Knee Ligament Register: Concomitant injuries, revision surgery and smoking render worse results.

PURPOSE: To analyse the 52,199 patients in the Swedish Knee Ligament Register (SKLR) preoperatively, and the patients reaching 5- and 10-year follow-ups who underwent anterior cruciate ligament reconstruction (ACLR), revision ACLR and ACLR on the contralateral side (CACLR). The main hypothesis was that patients undergoing revision ACLR would have worse patient-reported outcome measurements (PROMs) than the primary ACLR group at 10 years and that smoking and concomitant injuries would result in poorer outcomes for all groups. METHODS: Data from 2005 to 2021 were extracted from the SKLR. Only patients whose ACLR surgery was registered in the SKLR were included for revision ACLR and CACLR. The PROMs consist of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the knee-specific PROM (EQ-5D-3L). PROMs were analysed as a whole and in subgroups based on sex, smoking, graft choice and concomitant injuries. RESULTS: Poorer KOOS were seen for revisions compared with primary ACLRs at both the 5- and 10-year follow-ups (p = 0.003). Smokers had significantly poorer KOOS than nonsmokers (p < 0.001) preoperatively in all groups, however only in the primary ACLR group at 5 and 10 years. At 10 years, patients who had undergone CACLR had lower KOOS than primary ACLRs (p = 0.03). Concomitant injuries resulted in statistically, significantly poorer KOOS for both primary ACLRs and CACLRs preoperatively and at the follow-ups. CONCLUSION: The PROMs for revision ACLRs have worse KOOS scores at 10 years compared with the primary ACLRs. The presence of concomitant meniscal or cartilage injuries at the time of ACLR or CACLR were associated with worse PROMs. LEVEL OF EVIDENCE: Level III.

Biomechanical mechanisms of anterior cruciate ligament injury in the jerk dip phase of clean and jerk: A case study of an injury event captured on-site.

Background: Weightlifting exposes athletes to significant loads, potentially placing the knee joint in an abnormal mechanical environment and leading to anterior cruciate ligament (ACL) injuries. Once an ACL injury occurs, it can affect athletes' competitive ability to varying degrees and even prematurely end their career. Understanding the biomechanical mechanisms of ACL injuries in weightlifters helps in comprehensively understanding the stress patterns and degrees on ACL during human movement, and identifying potential injury-causing factors, thereby enabling the implementation of appropriate preventive measures to reduce the occurrence of injuries. This study aimed to explore the biomechanical mechanisms of ACL injuries during the jerk dip phase of clean and jerk in weightlifters, providing a theoretical basis for the prevention of ACL injuries in weightlifting sports. Methods: This study utilized the German SIMI Motion 10.2 movement analysis system and the AnyBody simulation system to analyze the kinematic and dynamic parameters of a 109 kg + class weightlifter (height: 191 cm, age: 22 years, weight: 148 kg, athletic level: elite) performing a 205 kg clean and jerk (non-injured) and a 210 kg clean and jerk (ACL injury occurred). The differences in kinematic and dynamic indicators of lower limb joints under injured and non-injured jerk dip conditions were investigated. Results: Knee joint torque during non-injured clean and jerk was consistently positive (i.e., external rotation) but turned from positive to negative (i.e., from external rotation to internal rotation) during injured clean and jerk and reached a maximum internal rotation torque of 21.34 Nm at the moment of injury. At every moment, the muscle activation and simulated muscle force of the quadriceps and gastrocnemius during the injured clean and jerk were higher than those during the non-injured clean and jerk. By contrast, the muscle activation and simulated muscle force of the semitendinosus, semimembranosus, biceps femoris, and soleus during non-injured clean and jerk were higher than those during injured clean and jerk. The knee joint internal rotation angle during injured clean and jerk first increased and then declined, reaching a peak at 46.93° at the moment of injury, whereas it gradually increased during non-injured clean and jerk. The proximal tibia on the left side during the injured clean and jerk moved forward faster by 0.76 m/s compared with that during the non-injured clean and jerk. Conclusions: The small muscle activation and simulated muscle force of the hamstring and soleus could not resist timely and effectively the large muscle activation and simulated muscle force of the quadriceps (especially the medial quad) and gastrocnemius. As such, the force applied to the ACL could exceed its ultimate load-bearing capacity. Kinematic indicators in the athlete's injured lift demonstrated certain disparities from those in their non-injured lift. Knee internal rotation and tibial anterior translation during the jerk dip phase of weightlifting might be the kinematic characteristics of ACL injuries.

Associations of collagen type 1 α1 gene polymorphisms and musculoskeletal soft tissue injuries: a meta-analysis with trial sequential analysis.

Numerous studies have investigated the role of collagen type 1 α1 (COL1A1) polymorphisms in musculoskeletal soft tissue injuries (MSTIs), yielding conflicting results. This study was designed to synthesize existing evidence and clarify the relationship between COL1A1 polymorphisms and MSTI susceptibility. We conducted a comprehensive literature search using PubMed, Cochrane Library, Web of Science, EMBASE, and Wanfang databases. Associations were assessed using odds ratios (ORs) with 95% confidence intervals (95% CIs) across five genetic models. Subgroup analyses were performed based on ethnicity and injury type. Additionally, trial sequential analysis (TSA) was utilized to assess information size and statistical power. We analyzed a total of 16 articles from 358 retrieved studies, encompassing 2094 MSTI cases and 4105 controls. Our pooled data revealed that individuals with the TT genotype of the rs1800012 polymorphism had a significantly reduced risk of MSTIs (TT vs. GG, OR = 0.53, 95% CI 0.35-0.82, P = 0.004; TT vs. TG + GG, OR = 0.54, 95% CI 0.36-0.80, P = 0.002). Ethnicity-based stratification showed a significant association in Caucasians but not Asians. However, no significant association was observed between the rs1107946 polymorphism and MSTIs, regardless of ethnicity or injury type. TSA indicated that the sample sizes may have been insufficient to yield conclusive results. In conclusion, our study supports the protective effect of the TT genotype of the rs1800012 polymorphism against MSTIs, particularly among Caucasians. However, the rs1107946 polymorphism does not appear to influence MSTI susceptibility.

Impacts of Segond Fractures on Anterior Cruciate Ligament Reconstruction Outcomes.

INTRODUCTION: Segond fractures, characterized by avulsion injuries at the lateral tibial condyle's anterolateral structure (ALS) attachment, often coincide with anterior cruciate ligament (ACL) injuries, potentially leading to knee instability. However, the influence of Segond fractures on knee stability after ACL reconstruction remains uncertain. Despite documented ALS reconstructions, there is a lack of consensus regarding the assessment of ALS failure and the criteria for surgical interventions. This study aimed to determine if Segond fracture presence impacts ACL reconstruction outcomes, utilizing patient-reported subjective assessments and healthcare providers' objective evaluations. MATERIALS AND METHODS: This retrospective study encompassed 639 patients (328 males, 311 females; mean age 26.9 years) who underwent ACL reconstruction, with a follow-up of at least one year. Subjects were divided into two groups: Segond fractures diagnosed through radiographic findings (Group S+, n = 17) and no Segond fractures (Group S-, n = 622). Clinical evaluation included the 36-item Short Form Survey (SF-36), Lysholm score, visual analog scale (VAS) for knee pain, knee injury and osteoarthritis outcome score (KOOS), and knee instability assessment via Telos SE (Telos Japan, Tokyo, Japan). Statistical comparisons were performed between the two groups. RESULTS: At the final follow-up, all SF-36 subscales improved in all eight subscales compared to before surgery, reaching national standard scores; no significant inter-group differences were evident. Lysholm scores were 93.0 ± 12.1 (Group S+) and 91.7 ± 10.9 (Group S-) (P = 0.62), VAS for knee pain was 10.0 ± 18.0 (Group S+) and 11.9 ± 16.9 (Group S-) (P = 0.62), total KOOS was 89.0 ± 17.4 (Group S+) and 90.7 ± 9.9 (Group S-) (P = 0.39), and anterior tibial translation differences were 2.8 ± 3.0 mm (Group S+) and 2.7 ± 2.9 mm (Group S-) (P = 0.73). All these values represent postoperative measurements. No significant discrepancies existed between groups across evaluation methods. CONCLUSIONS: This study's results suggest that Segond fractures have minimal impact on clinical ACL reconstruction outcomes, as assessed through both patient-reported subjective evaluations and objective healthcare provider evaluations. Segond fractures' significance in postoperative outcomes questions the necessity of ALS reconstruction.

Conservative vs Surgical Treatment of Anterior Cruciate Ligament Rupture: A Systematic Review.

Anterior cruciate ligament (ACL) injury is very common, especially in young athletic individuals who injure themselves during sports involving pivoting actions. Management options include conservative management, which involves progressive physical therapy, educating the patient on how to prevent instability, and the use of a hinged knee brace. Surgical management involves reconstruction of the torn ligament using an autograft or an allograft and ACL repair where the torn ligament is affixed back to the tibia or femur. The choice of management depends on the severity of the injury, other injuries in associated structures, the level of fitness, and the athletic goals of the patient. Many studies exist on the management choice of ACL injury, but no clear consensus prevails. This study will examine the effectiveness of conservative versus surgical management. A literature review will be performed to identify appropriate papers which compare and evaluate the two approaches. A literature search for randomized controlled trials (RCTs) and cohort studies comparing the conservative to surgical management of ACL injury was conducted on PubMed, Scopus, and Web of Science. Patient eligibility criteria included individuals older than 15 with an isolated, recent ACL injury diagnosis via an appropriate clinical test, MRI, or arthroscopy. Studies were eligible if they were using appropriate surgical or conservative methods, as mentioned previously, and measuring results via appropriate scores, tools, and methods that will be presented below. The follow-up timeline would be from presentation time until at least two years. Five papers were found to be eligible. Overall, these papers included 462 patients. Two studies measuring overall knee symptoms, function, and sports activities using the International Knee Documentation Committee Subjective Knee Form (IKDC) score found that the operated group had a significantly higher score. The other two studies measured overall knee function and health using the Tegner & Lysholm and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores. In both papers, no significant difference was found between the two groups. Regarding Tegner's activity score, only one paper had significant findings. A significantly longer period to return to sports activities was observed in the operative group. Stability was significantly higher in all papers in the operated group. Osteoarthritis was measured using different tools in each paper. Only one paper found a significantly higher risk in the operated group. Only one paper indicated significantly more complications in the operated group regarding side effects. Overall, very few differences were observed between the two treatment groups. The most significant differences observed were the higher stability and the longer recovery period in patients undergoing surgery. Large RCTs following patients for enough time are needed to prove if surgical treatment offers significant benefits over conservative treatment.

A 2D video-based assessment is associated with 3D biomechanical contributors to dynamic knee valgus in the coronal plane.

Introduction: Adolescent athletes involved in sports that involve cutting and landing maneuvers have an increased risk of anterior cruciate ligament (ACL) tears, highlighting the importance of identifying risky movement patterns such as dynamic knee valgus (DKV). Qualitative movement screenings have explored two-dimensional (2D) scoring criteria for DKV, however, there remains limited data on the validity of these screening tools. Determining a 2D scoring criterion for DKV that closely aligns with three-dimensional (3D) biomechanical measures will allow for the identification of poor knee position in adolescent athletes on a broad scale. The purpose of this study was to establish a 2D scoring criterion that corresponds to 3D biomechanical measures of DKV. Methods: A total of 41 adolescent female club volleyball athletes performed a three-task movement screen consisting of a single-leg squat (SLS), single-leg drop landing (SLDL), and double-leg vertical jump (DLVJ). A single rater scored 2D videos of each task using four criteria for poor knee position. A motion capture system was used to calculate 3D joint angles, including pelvic obliquity, hip adduction, knee abduction, ankle eversion, and foot progression angle. Receiver operating characteristic curves were created for each 2D scoring criterion to determine cut points for the presence of movement faults, and areas under the curve (AUC) were computed to describe the accuracy of each 2D criterion compared to 3D biomechanical data. Results: 3D measures indicated knee abduction angles between 2.4°-4.6° (SD 4.1°-4.3°) at the time point when the center of the knee joint was most medial during the three tasks. AUCs were between 0.62 and 0.93 across scoring items. The MEDIAL scoring item, defined as the knee joint positioned inside the medial border of the shoe, demonstrated the greatest association to components of DKV, with AUCs ranging from 0.67 to 0.93. Conclusion: The MEDIAL scoring criterion demonstrated the best performance in distinguishing components of DKV, specifically pelvic obliquity, hip adduction, ankle eversion, and foot progression. Along with the previously published scoring definitions for trunk-specific risk factors, the authors suggest that the MEDIAL criterion may be the most indicative of DKV, given an association with 3D biomechanical risk factors.

Association Between Psychological Readiness to Return to Sports at 3 Months Postoperatively and Risk of Second ACL Injury.

Background: Psychological readiness to return to sports (RTS) has been associated with second anterior cruciate ligament (ACL) injury. However, this relationship is controversial because covariates such as anatomic and knee function characteristics have not been adequately considered. Purpose/Hypothesis: To investigate whether psychological readiness in the early postoperative period can predict the occurrence of a second ACL injury within 24 months after primary ACL reconstruction (ACLR) using propensity score analysis. It was hypothesized that patients with high ACL-RSI after injury (ACL-RSI) scores at 3 months postoperatively would have a second ACL injury within the projected postoperative period. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 169 patients who underwent primary ACLR using hamstring tendon autografts between November 2017 and July 2021 and also underwent knee functional assessments at 3 months postoperatively. The ACL-RSI scale was used to assess psychological readiness for RTS. A second ACL injury was defined if ipsilateral or contralateral ACL injury was confirmed by examination within 24 months postoperatively. Based on a previous study showing that 65 was the highest cutoff value for the ACL-RSI score for RTS, we classified patients into 2 groups: those with high ACL-RSI scores (≥65; group H) and those with low ACL-RSI scores (<65; group L). We generated 1-to-1 matched pairs using propensity score analysis and used log-rank testing to compare the rate of second ACL injury between the 2 groups. Results: More patients returned to any sports activities within 12 months in group H than in group L (90% vs 73%; P = .03). A second ACL injury within 24 months postoperatively was identified in 7% of patients (13/169). The rate of second ACL injury was significantly higher in group H than in group L (17.6% vs 3.4%; P = .001). In 43 matched pairs extracted using propensity scoring, the rate of second ACL injury was also higher in group H than in group L (18.6% vs 4.7%; P = .04). Conclusion: Patients with a higher ACL-RSI score at 3 months exhibited a significantly higher incidence of second ACL injury within 24 months after primary ACLR.

Comparison of Partial Meniscectomy With Meniscal Repair With Respect to Functional Outcome.

Introduction Meniscus tear is a commonly encountered sports-related injury requiring surgical intervention due to knee mobility dysfunction and discomfort. Previously, it has been thought that these are non-functional vestigial structures and they used to be excised commonly. Recent studies have shown that meniscal repair gives superior results when compared with partial meniscectomy. Methods This quasi-experimental study was conducted at the Orthopedics Department, Khyber Teaching Hospital, Peshawar, Pakistan. A total of 92 patients of both genders with meniscal injuries were included. Forty-six of them underwent meniscal repair (Group A), and 46 underwent partial meniscectomy (Group B). Functional outcome was noted after 12 weeks and recorded. Results The age range was from 18 to 50 years with a mean of 28.630±6.64 years in Group A and 29.630±8.12 years in Group B. Functional outcome was excellent in 44 (95.7%) patients who underwent meniscal repair as compared to 23 (50%) patients who underwent partial meniscectomy (P= 0.000). Conclusion It is concluded that meniscal repair should be pursued over partial meniscectomy when surgically treating meniscal tears.

Identifying Anterior Cruciate Ligament Injuries Through Automated Video Analysis of In-Game Motion Patterns.

Background: Failure to diagnose anterior cruciate ligament (ACL) injury during a game can delay adequate treatment and increase the risk of further injuries. Artificial intelligence (AI) has the potential to be an accurate, cost-efficient, and readily available diagnostic tool for ACL injury in in-game situations. Purpose: To develop an automated video analysis system that uses AI to identify biomechanical patterns associated with ACL injury and to evaluate whether the system can enhance the ability of orthopaedic and sports medicine specialists to identify ACL injuries on video. Study Design: Descriptive laboratory study. Methods: A total of 91 ACL injury and 38 control movement scenes from online available match recordings were analyzed. The videos were processed to identify and track athletes and to estimate their 3-dimensional (3D) poses. Geometric features, including knee flexion, knee and hip abduction, and foot and hip rotation, were extracted from the athletes' 3D poses. A recurrent neural network algorithm was trained to classify ACL injury, using these engineered features as its input. Analysis by 2 orthopaedic surgeons examined whether providing clinical experts with the reconstructed 3D poses and their derived signals could increase their diagnostic accuracy. Results: All AI models performed significantly better than chance. The best model, which used the long short-term memory network with engineered features, demonstrated decision interpretability and good performance (F1 score = 0.63 ± 0.01, area under the receiver operating characteristic curve = 0.88 ± 0.01). The analysis by the 2 orthopaedic surgeons demonstrated improved diagnostic accuracy for ACL injury recognition when provided with system data, resulting in a 0.08 increase in combined F1 scores. Conclusion: Our approach successfully reconstructed the 3D motion of athletes from a single-camera view and derived geometry-based biomechanical features from pose sequences. Our trained AI model was able to automatically detect ACL injuries with relatively good performance and prelabel and highlight regions of interest in video footage. Clinical Relevance: This study demonstrated the feasibility of using AI to automatically evaluate in-game video footage and identify dangerous motion patterns. Further research can explore the full potential of the biomechanical markers and use of the system by nonspecialists, potentially diminishing the rate of missed diagnosis and the detrimental outcomes that follow.

Arthroscopic Transphyseal ACL Reconstruction With Lateral Extraarticular Tenodesis With Unusual Arthroscopic Meniscal Findings in a Case of an Adolescent Girl Previously Diagnosed With Amniotic Band Syndrome.

Amniotic band syndrome (ABS) constriction rings in the lower limb are common. Despite this, there is insufficient literature on anatomical abnormalities in the knee joints of children with ABS. There is an increasing incidence of paediatric anterior cruciate ligament (ACL) injuries recently. ACL reconstruction in this population has an extra dilemma of sparing the physis to prevent growth disturbances. Treating both these conditions simultaneously is a challenge that is rarely encountered. In our literature review, we found no case such as this. As such a case is being described for the first time, we also found certain meniscal anatomical variations on diagnostic arthroscopy. A 12-year-old adolescent Indian girl presented with an ACL tear in her left leg after a school sports injury. She had a known case of ABS constriction bands in both her lower limbs. Her distal femoral and proximal femoral physis was fused on radiographs, so we went ahead with a transphyseal ACL soft-tissue graft reconstruction. On the diagnostic round, we found an anatomical variation of the menisci, which was previously not described since arthroscopy of the knee in an adolescent kid with ABS has not been published in the literature as of yet. These kinds of clinical presentations can become common in the future as more and more kids with ABS take part in recreational sports. In such a scenario, having knowledge about common anatomical variations in the knee of such syndromic patients is essential. While performing ACL reconstructions in this population, we have to be aware of the risk of growth deformities along with vascular and neurological complications, which are added risks with constriction bands around the lower limb.

Alteration of knee joint moment after anterior cruciate ligament reconstruction conditions in subjects with and without meniscal pathology.

BACKGROUND: The effects of anterior cruciate ligament (ACL) reconstruction on postoperative gait biomechanics remain controversial, and the influence of meniscus pathology on pre- and post-ACL reconstruction biomechanical changes has not yet been studied. Here, we aimed to clarify the difference in knee joint moment between pre- and post-ACL reconstruction conditions in subjects with and without meniscal pathology. METHODS: Twenty-four subjects with unilateral ACL reconstruction injuries participated in this study. A total of 13 of the subjects had concomitant meniscus injuries. Gait analysis was performed preoperatively and at 11 months postoperatively. Three-dimensional knee joint angles and moments were calculated based on motion-capture data. The total joint moment and contribution of individual moments during the stance phase were assessed. For statistical analysis, we compared pre- and postoperative alterations, and differences were assessed in subjects with and without meniscal pathology. RESULTS: Tibial rotation excursion was lower in subjects with meniscal pathology than in those with intact menisci postoperatively. An significant increase in the contribution of the knee flexion moment and a significant decrease in the contribution of the knee adduction moment postoperatively were observed in subjects with intact menisci. CONCLUSIONS: Patients with ACL injury showed different postoperative alterations in joint moments depending on the concomitant meniscal injury.

Decreased sagittal slope of the medial tibial spine and deep concavity of the lateral tibial spine are risk factors for noncontact anterior cruciate ligament injury.

PURPOSE: This study aimed to assess the relationship between the geometric features of tibial eminence and susceptibility to noncontact anterior cruciate ligament (ACL) injuries. METHODS: Patients with unilateral noncontact knee injuries between 2015 and 2021 were consecutively enroled in this study. Based on knee magnetic resonance imaging (MRI) and arthroscopic visualisation, patients were categorised into the case group (ACL rupture) and control group (ACL intact). Using MRI, the geometric features of tibial eminence were characterised by measuring the sagittal slopes, depth of concavity and coronal slopes of the inclined surfaces of the tibial spines. Univariate and multivariate logistic regressions were conducted to explore independent associations between quantified geometric indices of tibial eminence and the risk of noncontact ACL injuries. RESULTS: This study included 187 cases and 199 controls. A decreased sagittal slope of the medial tibial spine (MTSSS) (combined group: odds ratio [OR]: 0.87 [0.82, 0.92], p < 0.001; females: OR: 0.88 [0.80, 0.98], p = 0.020; males: OR: 0.87 [0.81, 0.93], p < 0.001) and an increased depth of concavity in the lateral tibial spine (LTSD) (combined group: OR: 1.51 [1.24, 1.85], p < 0.001; females: OR: 1.65 [1.12, 2.43], p = 0.012; males: OR: 1.44 [1.11, 1.89], p = 0.007) were independent risk factors for noncontact ACL injuries. Moreover, a steeper coronal slope of the inclined surface of the medial tibial spine was a significant predictor of noncontact ACL injuries for males (MTSCS: OR: 1.04 [1.01, 1.08], p = 0.015) but not for females. CONCLUSION: Geometric features of tibial eminence, particularly a decreased MTSSS and an increased LTSD, were identified as independent risk factors for noncontact ACL injuries. These findings will help clinicians identify individuals at high risk of ACL injury and facilitate the development of targeted prevention strategies. LEVEL OF EVIDENCE: Level III.