Allograft Augmentation of Hamstring Autograft in Anterior Cruciate Ligament Reconstruction Results in Equivalent Outcomes to Autograft Alone.

PURPOSE: To examine allograft augmentation of undersized hamstring (HS) autograft tendons at the time of anterior cruciate ligament (ACL) reconstruction, compared with un-augmented autograft HS ACL reconstruction. METHODS: Patients who underwent ACL reconstruction at our institution between 2005 and 2015 were reviewed. Inclusion criteria included patients who underwent (1) primary ACL reconstruction, (2) use of a hybrid HS autograft with allograft augmentation, and (3) had a minimum 2-year postoperative follow-up. Patients with revision ACL, multiligamentous injuries, all-epiphyseal fixation techniques, or additional procedures beyond chondroplasty or meniscal repair/debridement were excluded. Data collected included demographics, graft size, concomitant procedures, revision operation, revision ACL reconstruction, and patient-reported outcomes. RESULTS: In total, 59 patients met criteria for inclusion into the hybrid group, and 80 patients were eligible for inclusion into the control group. The average age of the cohort was 22.9 (interquartile range Q1:17, Q3: 38.3), and 51.8% of the patients were female. Seven patients (11.9%) in the hybrid ACL group underwent revision ACL surgery versus 15 (18.8%) in the control group (P = .27). There was no difference in patient-reported outcomes between groups. CONCLUSIONS: Augmenting an HS ACL autograft that is 8 mm or less with allograft tissue to increase the overall size of the ACL graft shows no difference in overall reoperation or revision of ACL failure. The hybrid autograft/allograft ACL reconstruction patients showed no clinically important difference between groups in patient-reported outcome measures. LEVEL OF EVIDENCE: Level III, case-control comparative analysis.

Recurrent Anterior Cruciate Ligament Tears in the National Football League: A Case-Control Study.

BACKGROUND: Anterior cruciate ligament (ACL) injuries are common in American football players. The risk of subsequent ACL reinjury to either the ipsilateral or the contralateral knee in National Football League (NFL) draftees with a history of successful ACL reconstruction before entering the NFL remains unknown. HYPOTHESIS: NFL athletes with a history of successful ACL reconstruction before being drafted will likely demonstrate increased risk of subsequent ACL injury when compared with a control cohort consisting of players of similar positions and draft class. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Detailed orthopaedic evaluations of NFL Combine participants from 2006 to 2012 were obtained to identify players entering the NFL draft with a history of successful ACL reconstruction. A control cohort was created in a 2:1 ratio, consisting of players matched by position and draft class. RESULTS: Of the 2016 players invited to the NFL Combine during the study period, 100 met the inclusion criteria. A total of 26 subsequent ACL reinjuries (12 ipsilateral, 14 contralateral) occurred in 25 players (25%) while playing in the NFL, with injuries occurring at a mean of 22.1 months after the NFL draft. In comparison, 18 of the 200 (9%) carefully matched cohort players without history of prior ACL injury sustained a new ACL injury during this time period (P < .001). CONCLUSION: NFL athletes with a history of successful ACL reconstruction before being drafted into the NFL have a significantly higher rate of subsequent ACL reinjury while playing in the NFL when compared with a carefully matched cohort of players without a history of prior ACL injury.

Complex Primary Total Knee Arthroplasty: Long-Term Outcomes.

BACKGROUND: Total knee arthroplasty in patients with severe preoperative deformity, ligamentous instability, and/or marked bone loss occasionally requires a varus and valgus constrained or rotating-hinge design prosthesis. The purpose of this study was to compare patient populations that underwent primary total knee arthroplasty with constrained or unconstrained total knee arthroplasty implants to determine patient demographic characteristics, long-term survival, and reasons for reoperation and revision for each group. METHODS: We identified 28,667 primary total knee arthroplasties performed from 1979 to 2013 at our institution. A total of 427 knees had a varus and valgus constrained design and 246 knees underwent rotating-hinge total knee arthroplasties. Patient demographic information and preoperative diagnoses were analyzed by implant type. A multivariate analysis was performed to account for age, sex, and body mass index (BMI). Kaplan-Meier survival rates for each complication leading to reoperation or component revision were determined at 10 and 20 years. Adjusted hazard ratios were determined for the most common causes for reoperation and revision compared with a routine total knee arthroplasty control group. RESULTS: Patient demographic characteristics were significantly different (p < 0.05) between all groups for age, sex, and BMI. The varus and valgus constrained and rotating-hinge groups had decreased survival free of all-cause reoperation at 10 and 20 years compared with the unconstrained total knee arthroplasty group, with a hazard ratio of 1.74 (95% confidence interval [95% CI], 1.36 to 2.23) for the valgus and varus constrained group and 2.07 (95% CI, 1.58 to 2.70) for the rotating-hinge group. The adjusted hazard ratio for all-cause revision was significantly higher for the varus and valgus constrained group at 1.65 (p = 0.007) but not for the rotating-hinge group at 1.48 (p = 0.054) compared with the unconstrained total knee arthroplasty group. Wear and osteolysis, infection, and fracture were the most common reasons for component revision in both groups. CONCLUSIONS: We found increased reoperation and revision rates associated with the use of constrained implants at the time of index total knee arthroplasty. The rate of component revision for any reason at 10 years was >2 times higher in the constrained total knee arthroplasty groups compared with the unconstrained total knee arthroplasty group. At 20 years postoperatively, the component revision rate was >3 times higher. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Current Concepts and the Role of Surgery in the Treatment of Jumper's Knee.

Jumper's knee is a common cause of anterior knee pain among athletes and active populations. Numerous treatments have been described with variable results. To better delineate this, the authors reviewed all articles from 2000 to 2014 pertaining to the treatment of patellar tendinopathy, focusing namely on treatment of recalcitrant cases. Open and arthroscopic techniques were found to achieve similar satisfactory results in 81% (range, 45%-100%) and 91% (range, 86%-96%) of patients, respectively. Average time to return to play was 5.6 months and 5 months, respectively. A recently described technique, percutaneous ultrasonic tenotomy, potentially represents an attractive alternative option for definitive intervention. [Orthopedics. 2016; 39(6):e1028-e1035.].