Contralateral and siblings' knees are at higher risk of ACL tear for patients with a positive history of ACL tear.

PURPOSE: Recent studies have shown that several genetic factors can cause susceptibility to anterior cruciate ligament (ACL) rupture. The aim of the present study was to evaluate certain underlying factors that increase the risk of ACL rupture. METHODS: Eight hundred thirty-six patients with ACL rupture who underwent ACL reconstructive surgery from 2010 to 2013 at an academic center completed a minimum of 5 years post-operation follow-up. The collected variables included sex, age, height, weight, exercise level, time interval between ACL rupture in the first knee and contralateral ACL rupture, dominant leg, side of the involved knee and sibling history of ACL rupture. RESULTS: The median follow-up duration was 6.5 (range: 5-8) years. Eighty-three patients (9.9%) had a contralateral ACL rupture, and 155 patients (18.5%) had siblings with a history of ACL rupture. The rate of contralateral ACL rupture was three times higher in women than in men and in patients with siblings with a history of ACL rupture than in those without such history. In addition, the risk of contralateral ACL rupture was higher in those younger than 30 years of age, those with a BMI of 20-25 kg/m2 and those who participated in regular sports activity. However, whether the involved knee was on the dominant or nondominant side had no effect on the incidence of contralateral ACL rupture. The results of the study showed that 69 (83.1%) of the contralateral ACL ruptures occurred within the first 2 years after the primary operation. CONCLUSION: In a 5- to 8-year follow-up, one out of every ten patients had a contralateral ACL rupture, and two out of every ten patients had siblings with a history of ACL rupture. The findings suggest that having a sibling with a history of ACL rupture and being female are important risk factors for ACL rupture of the contralateral knee. LEVEL OF EVIDENCE: III.

Is gabapentin effective on pain management after arthroscopic anterior cruciate ligament reconstruction? A triple blinded randomized controlled trial.

BACKGROUND: Acute pain is common after arthroscopic surgeries and it is one of the most important causes of patient dissatisfaction, admission time and increased morbidity . Gabapentin with anti-hyperalgesic effects can play a critical role in pre-emptive analgesia methods. The aim of this study was to assess the efficacy of gabapentin in pain management after surgery and the rate of drug consumption in patients who are candidate for anterior cruciate ligament (ACL) reconstruction arthroscopic surgery. METHODS: In this randomized, triple blind clinical trial, 114 patients who were candidate for arthroscopic ACL reconstruction were divided into two groups of gabapentin (G) and placebo (p), with 57 patients in each group. The intervention group received gabapentin 600 mg and a placebo was administered in control group. Patients received on-demand pethedine for pain management. The primary outcome was pain intensity according to the visual analogue scale (VAS) and the secondary outcome was the amount of opioid consumption and incidence of side effects (including: dizziness, sedation, nausea and vomiting) at 6 and 24 h visits. RESULTS: The mean pain intensity in G group at both the 6 and 24 hour visits was significantly lower than the control group (Both P<0.001). Also, patients in the gabapentin group consumed less opioid at both visits in comparison to the placebo group (p<0.001, P=0.032). The incidence rate of sedation, dizziness, nausea and vomiting was similar in both groups. CONCLUSION: In arthroscopic ACL reconstruction, administering a preoperative single dose of 600mg gabapentin may decrease both pain intensity and opioid consumption.