Results of medial patellofemoral ligament reconstruction with and without tibial tubercle osteotomy in patellar instability: a systematic review and single-arm meta-analysis.

PURPOSE: To confirm which method provides lower rate of recurrent instability and superior clinical outcomes. METHOD: We searched PubMed, Embase and Web of Science for the trials involving one intervention or both for patellar instability: medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle osteotomy (TTO). The postoperative Kujala score, Lysholm score, Tegner scores and the rate of recurrent instability (dislocation or subluxation) were analyzed as the primary clinical outcome parameters in a random or fixed effects meta-analysis. RESULTS: In total, 43 articles met inclusion criteria after full-text review. A total of 2046 patients were analyzed. The overall mean age was 20.3 years (range, 9.5-60.0 years), with a mean follow-up time of 3.2 years (range, 1-8 years). The mean Kujala scores in MPFLR and MPFLR + TTO were 89.04 and 84.44, respectively. There was significant difference in Kujala scores between MPFLR and MPFLR + TTO (MD = 4.60, 95%CI: 1.07-8.13; P = 0.01). The mean Lysholm scores in MPFLR and MPFLR + TTO were 90.59 and 88.14, respectively. There was no significant difference in Lysholm scores between MPFLR and MPFLR + TTO (MD = 2.45, 95%CI: -3.20-8.10; P = 0.40). The mean Tegner scores in MPFLR and MPFLR + TTO were 5.30 and 4.88, respectively. There was no significant difference in Tegner scores between MPFLR and MPFLR + TTO (MD = 0.42, 95%CI: -0.39-1.23; P = 0.31). At final follow-up, the rates of recurrent instability in MPFLR and MPFLR + TTO were 3% and 4%, respectively. There was no significant difference in the rates between MPFLR and MPFLR + TTO (OR = 0.99, 95%CI: 0.96-1.02; P = 0.4848). CONCLUSION: MPFLR and MPFLR + TTO are effective and reliable treatments in the setting of patellofemoral instability. MPFLR seems to show a better performance in functional outcomes than MPFLR + TTO. Moreover, their rates of recurrent instability are very low, and no significant difference exists.

Use of the forgotten joint score (FJS)-12 to evaluate knee awareness after quadriceps tendon reconstruction.

BACKGROUND: Quadriceps tendon rupture (QTR) is a severe injury of the knee extensor apparatus. The study aims to validate the use of forgotten joint score (FJS-12) for functional outcome assessing after surgical treatment of QTR. METHODS: Fifty-seven patients who underwent surgery for QTR with transosseous suture reconstruction in a single orthopaedic surgery and traumatology center between 2015 and 2020 were eligible for enrolment in this retrospective case series. The demographic data and other pre-operative details such as age, gender, comorbidities and medication use also were extracted from the medical records. Patient reported outcome measures (PROMs) were gathered in the form of Western Ontario and McMaster Universities Arthritis Index Score (WOMAC), Tegner Activity Score (TAS), Lysholm Score and FJS-12 at a mean follow-up time of 49.84 months ± 20.64 months. The FJS-12 was validated by correlation with WOMAC, TAS and Lysholm Score. RESULTS: The mean age of all patients were 69.2 ± 13.6 years with 51 (89.5%) males and 6 (10.5%) females. The mean time from injury to surgery was 3.39 ± 5.46 days. All patients reported satisfactory functional outcomes after surgery on FJS-12, WOMAC and Lysholm scores, except the TAS, which decreased slightly from pre-operative level. There was a high negative correlation between WOMAC and FJS-12, but moderate positive correlations between FJS-12 and TAS and Lysholm scores. The Cronbach's alpha value was 0.96 for 12 items in FJS-12. CONCLUSION: This study has found that FJS-12 is a reliable and easy to assess tool for functional outcomes after QTR reconstruction. It has shown moderate to strong correlation with other commonly used outcome measures (WOMAC, TAS and Lysholm).

Medial patellofemoral ligament reconstruction for recurrent patellar dislocation allows a good rate to return to sport.

PURPOSE: Recurrent patellar dislocation is a frequent knee disorders in young, active patients. Medial patellofemoral ligament reconstruction (MPFLR) can restore knee stability and function, but the rate of return to sports is less clear. The aim of this study was to evaluate rate of return to sport following treatment of recurrent patellar dislocation with isolated MPFLR. METHODS: Between 2011 and 2018, 113 patients with recurrent patellar dislocation were treated with isolated MPFLR at an academic center. Pre-injury sports participation and Tegner score, pre-operative subjective IKDC score, time to return to sports, and post-operative Tegner and subjective IKDC scores were collected, with a minimum of follow-up of 2 years. RESULTS: One hundred and three patients (91%) were evaluated at a mean of 4.5 ± 2.5-year post-operative. 92 patients (89%) participated in sports prior to onset of patellar instability. At final follow-up, 84 of these 92 patients (91%) were able to return to sports. The mean time from surgery to return to sports was 10.4 ± 8.6 months (range: 2-48 months). 62 patients (67%) returned to the same (50 patients) or higher (12 patients) level. 22 patients (26%) returned at a lower level. 19 of these patients attributed this decreased participation to ongoing knee problems. The median Tegner score was noted to decrease from 5 pre-injury to 4 post-operatively (p = 0.02). CONCLUSION: Isolated MPFL reconstruction allowed return to pre-injury sports in 91% of patients, with 67% of patients returning to the same or higher level than pre-injury. Mean time to return to sports was 10 months and post-operative Tegner score was noted to be modestly decreased from pre-injury level. LEVEL OF EVIDENCE: IV.

A Pilot Clinical Study of Hyperacute Serum Treatment in Osteoarthritic Knee Joint: Cytokine Changes and Clinical Effects.

The serum fraction of platelet-rich fibrin (hyperacute serum) has been shown to improve cartilage cell proliferation in in vitro osteoarthritic knee joint models. We hypothesize that hyperacute serum may be a potential regenerative therapeutic for osteoarthritic knees. In this study, the cytokine milieu at the synovial fluid of osteoarthritic knee joints exposed to hyperacute serum intraarticular injections was investigated. Patients with knee osteoarthritis received three injections of autologous hyperacute serum; synovial fluid was harvested before each injection and clinical monitoring was followed-up for 6 months. Forty osteoarthritic-related cytokines, growth factors and structural proteins from synovial fluid were quantified and analysed by Multivariate Factor Analysis. Hyperacute serum provided symptomatic relief regarding pain and joint stability for OA patients. Both patients "with" and "without effusion knees" had improved VAS, KOOS and Lysholm-Tegner scores 6 months after of hyperacute serum treatment. Synovial fluid analysis revealed two main clusters of proteins reacting together as a group, showing strong and significant correlations with their fluctuation patterns after hyperacute serum treatment. In conclusion, hyperacute serum has a positive effect in alleviating symptoms of osteoarthritic knees. Moreover, identified protein clusters may allow the prediction of protein expression, reducing the number of investigated proteins in future studies.

Tegner level is predictive for successful return to sport 2 years after anterior cruciate ligament reconstruction.

PURPOSE: For a successful return to sport (RTS) after an anterior cruciate ligament reconstruction (ACLR), patients are recommended to attend a comprehensive rehabilitation program, followed by an RTS assessment, that is a combination of tests. The purpose of this study was to predict a successful return to sport using the results of the RTS assessment and self-reported questionnaires at minimum 2 years after ACLR. METHODS: A total of 123 consecutive ACLR patients undertook an intensive rehabilitation program followed by a comprehensive RTS assessment that included an established combination of balance and strength tests, the ACL-return to sport after Injury scale (ACL-RSI) questionnaire and a KT1000 laximetry test. Preinjury and expected Tegner and Lysholm were collected at baseline, at RTS and prospectively collected at minimum 2-year follow-up. The patients were asked if they returned to their previous sport and at which level. All variables were included in a regression analysis predicting a successful return to previous sport, return to the same level of sport as well as the Tegner level at 2 years. RESULTS: Sixty-two patients (50%) returned to their previous sport by the 2-year follow-up, without a difference in preinjury Tegner between these two groups (n.s.). Expected preoperative Tegner was the only significant predictor of a successful return to previous sport (p = 0.042; OR 1.300, 95% CI 1.010-1.672). Out of the 62 patients returning to their previous sport, 38 (61%) reported to be on the same or higher level. The only predictive variable for returning to the same level was the higher preinjury Tegner level (p = 0.048; OR 1.522). Multivariate regression analysis of Tegner level at 2 years found younger age to be the only predictive value. From the RTS assessment tests, the ACL-RSI questionnaire and the posterolateral balance test were predictive variables for Tegner at 2-year follow-up, albeit in the univariate regression analysis. CONCLUSIONS: Preoperative Tegner and expected Tegner level collected prior to an ACL reconstruction can aid in the objective prediction of patients' return to sport after 2 years. High-level athletes are more likely to return to their previous sport and to the previous level. Younger patients achieve a higher Tegner level at 2 years. LEVEL OF EVIDENCE: Level III study.

Patient Reported Outcome Measures in the Foot and Ankle: Normative Values Do Not Reflect 100% Full Function.

PURPOSE: The primary purpose of this study was to determine normative values for foot and ankle ability measure (FAAM), activities of daily living (ADL), FAAM/foot and ankle disability (FADI) Sport, Tegner activity scale, SF-12 physical component summary (PCS) and mental component summary (MCS) in individuals who are representative of the "normal" adult population in the United States. The secondary purpose was to perform a confirmatory factor analysis (CFA) of ankle functional ability to provide evidence of reliability and validity of commonly used orthopaedic outcome scores. Our hypothesis was that normative values will differ based on patient characteristics and demographics, and that the selected commonly used foot and ankle outcomes scores will demonstrate acceptable reliability and validity estimates. METHODS: There were 271 persons in this study (101 women, 170 men, average age = 31.4 (SD = 15.1) years, average BMI = 25.9 (SD = 5.9)). Age, sex and BMI were documented. Comparisons of outcome scores were made between cohorts. CFA was performed to test factor structure of ankle functional ability. RESULTS: There was no significant difference in FAAM ADL between women and men (n.s.) or FAAM Sport (n.s.). Women had significantly higher SF-12 PCS (P = 0.001). Men had significantly higher SF-12 MCS (P < 0.001) and Tegner (P = 0.024). FAAM ADL, FAAM Sport and SF-12 PCS scores were significantly higher in people who did not have previous ankle surgery. Younger people and those with lower BMI had significantly higher ankle function. Reliability was excellent, and the CFA had excellent model fit demonstrating evidence of validity. CONCLUSIONS: This study revealed that normative values of foot and ankle outcome measures did not reflect 100% function and differed by sex, previous ankle surgery status, age and BMI. Individuals who did not have previous ankle surgery were younger, and had lower BMI and higher functional levels. Reliability was excellent, and the CFA model demonstrated excellent fit, providing evidence for validity, and lending support to use aggregated outcome measures as one scale. This study is unique in that it provides surgeons with normative ankle values in commonly reported outcome measures including the FAAM, FADI SF-12 and Tegner activity scale, in the normal population, based on BMI, age, gender and previous ankle surgery status. This information can be a very useful tool in the clinical setting for patient expectations counseling. In addition, surgeons and clinicians can feel confident using these outcome scores to assess their patients' progress through the continuum of care. LEVEL OF EVIDENCE: Level II.

Ongoing MRI remodeling 3-7 years after collagen meniscus implantation in stable knees.

PURPOSE: The purpose of the present study was to evaluate the clinical and radiological 3-7 years outcomes of patients who underwent collagen meniscus implantation in stable or stabilized knees. It was the hypothesis that using the collagen meniscus (CMI) good clinical 3-7 years outcomes with low pain levels are achieved. METHODS: Thirty-nine patients (male:female = 30:9, mean age 34 ± 10 years) underwent arthroscopic CMI after subtotal medial (n = 32) or lateral meniscectomy (n = 7). A 7-mm CMI was performed due to prophylactic (n = 25) or therapeutic indication (n = 14). IKDC score, Tegner score preinjury, preoperatively and at follow-up, Lysholm score and visual analogue scale for pain and satisfaction (follow-up rate 90%) were assessed. MRI scans were analyzed according to the Genovese criteria (n = 19). Implant failure was defined as infection or mechanical failure of the device. The minimum follow-up time was 36 months (range 36-84 months). RESULTS: The mean VAS satisfaction preoperatively and at follow-up was 4.0 ± 0 and 1.6 ± 1.0. The mean VAS pain was 4.3 ± 3.2 preoperatively and at last follow-up 2.1 ± 1.7. The median Tegner score preinjury was 7 (range 3-10), it decreased preoperatively to median 3.5 (range 1-8) and nearly reached the preinjury level at last follow-up 6 (range 3-10). The mean Lysholm score before surgery was 66 ± 20 and 91 ± 8 at last follow-up. Seven patients (38.9%) had a normal total IKDC score (A), 10 patients were nearly normal (B) and 1 patient slightly abnormal (C). In MRI the CMI was entirely resorbed in 4 patients (21%) and partially resorbed in 15 (79%). In 4 patients (21%) the CMI was isointense, in 14 (74%) slightly hyperintense and in 1 (5%) highly hyperintense. Ten patients (53%) showed marked signs of bone marrow edema. In 13 patients (68%) an extrusion of the meniscus > 3 mm at last follow-up was found. CONCLUSIONS: Meniscal substitution with the CMI showed good to excellent clinical 3-7 results. The CMI shows an ongoing remodelling with decreased signal intensity and decreased size. However, as meniscus extrusion remained at the same level and bone marrow edema decreased from 1 year to longer term follow-up, it appears that the remodeling comes to an end at about 5 years after CMI. LEVEL OF EVIDENCE: IV.

Combined reconstruction of the medial patellofemoral and medial patellotibial ligaments: outcomes and prognostic factors.

PURPOSE: To report outcomes after combined medial patellofemoral ligament (MPFL) and medial patellotibial ligament (MPTL) reconstruction and test associations between prognostic factors and clinical outcomes. It was hypothesised that combined MPFL and MPTL reconstruction would result in significant improvement in function, and that outcomes would be associated with age, sex, Beighton score, concomitant articular lesions, and preoperative function. METHODS: All combined reconstructions of MPFL and MPTL were reviewed. Inclusion criterion was minimum 2-year follow-up. Exclusion criteria were age at surgery ≥ 35 years and concomitant osteotomies. Kujala, Tegner and Marx scores were completed prospectively. Patients were evaluated at a minimum 2-year follow-up. Associations between potential prognostic factors and Kujala and Tegner scores were tested using bivariate analyses followed by multivariate regression models. RESULTS: Of 22 patients (26 knees), 19 (23 knees) met inclusion criteria, and 16 (20 knees) were available for follow-up. Mean age at surgery was 18 years (range 14.5-23). Mean follow-up was 43 months (range 24-73). Postoperative Kujala score significantly improved compared to before surgery (86.4 ± 12.5 vs. 54.9 ± 15.2, p < 0.01). Postoperative Tegner score was nonsignificantly higher compared to before surgery (4.8 ± 2.4 vs. 4 ± 3, p = ns) and lower compared to before first patella dislocation (4.8 ± 2.4 vs. 5.9 ± 1.2, p < 0.01). Postoperative Kujala score was associated with male sex (p = 0.02), with medial patellofemoral chondral lesions (p = 0.01) and with preoperative Kujala score (p = 0.05). Postoperative Tegner score was associated with male sex (p < 0.01), with preoperative Tegner level (p < 0.01), and with Beighton score (p < 0.01). Patella apprehension was recorded in two knees (10%) in two patients. CONCLUSION: Combined MPFL and MPTL reconstruction in young adults results in significant improvement in subjective knee function with minimal risks, although preinjury activity levels are not consistently restored. Associated factors of improved outcome include higher preoperative knee scores and activity levels, medial patellofemoral chondral lesions, decreased Beighton scores, and male sex. This supports the advisability of the procedure and can also assist in setting realistic goals for specific groups of patients. LEVEL OF EVIDENCE: Case series, Level IV.

The Degree of Shoulder Involvement in Sports (DOSIS) scale is a valid and responsive instrumentation for shoulder assessment in patients after surgery for anterior instability.

PURPOSE: The purpose of this study was to evaluate validity and responsiveness of the Degree of Shoulder Involvement in Sport (DOSIS) scale. METHODS: A web-based survey was developed to test the construct validity of the DOSIS scale. Fifty-three patients with a median age of 33 years (range 17-59) were included in the study. Convergent validity was evaluated by external correlation (Spearman's rank correlation coefficient, r) of the DOSIS with the Brophy-Marx and Tegner activity scales, the Western Ontario shoulder instability index (WOSI), the Simple Shoulder Test (SST), and the Short-Form 36 (SF-36). Responsiveness was analysed by relative efficiency calculation of the DOSIS versus the Brophy-Marx and Tegner activity scales. RESULTS: The DOSIS showed strong correlation with the Brophy-Marx and Tegner activity scales, a moderate correlation with the WOSI and SST scores, and a moderate correlation with the physical functioning, role physical and role emotional subscores of the SF-36. The distribution of the DOSIS scores had no serious ceiling or floor effects. The DOSIS demonstrated lesser responsiveness when compared to the Brophy-Marx and Tegner activity scales. CONCLUSION: The DOSIS showed an adequate validity and responsiveness. The clinical relevance of this study is that the DOSIS scale can be used for sport-specific shoulder assessment in patients after surgery for anterior instability. LEVEL OF EVIDENCE: III.

Sport-specific outcomes after isolated meniscal repair: a systematic review.

PURPOSE: The purpose of this systematic review was to assess sport-specific outcomes after repair of isolated meniscal tears. METHODS: A systematic electronic search of the MEDLINE and Cochrane database was performed in May 2016 to identify studies that reported sport-specific outcomes after isolated meniscal repair. Included studies were abstracted regarding study characteristics, patient demographics, surgical technique, rehabilitation, and outcome measures. The methodological quality of the included studies was assessed with the Coleman Methodology Score (CMS). RESULTS: Twenty-eight studies with a total of 664 patients met the inclusion criteria. The methodological quality of the included studies was moderate, with a mean CMS of 69.7 ± 8.3. The mean patient age was 26 ± 7.2 years and 71% of patients were male. Mean preoperative Tegner score improved from 3.5 ± 0.3 to 6.2 ± 0.8 postoperatively. Comparing preinjury and postoperative Tegner scores, comparable values were observed (6.3 ± 1.1 and 5.7 ± 0.8, respectively). Return to sports on the preinjury level was achieved in 89%. Mixed-level populations returned to their preinjury activity level in 90% and professional athletes in 86%. Mean delay of return to sports varied between 4.3 and 6.5 months, with comparable results between professional and mixed-level athletes. The pooled failure rate was 21%. The failure rate was lower in professional athletes compared to mixed-level athletes (9% vs. 22%). CONCLUSION: This systematic review suggests that isolated repair of meniscal tears results in good to excellent sport-specific outcomes and a high return to sports rate in both recreational and professional athletes. The failure rate is comparable to systematic reviews not focusing on sportive patients. LEVEL OF EVIDENCE: Level IV systematic review of Level I to Level IV studies.

Sports activity is maintained or increased following total knee arthroplasty.

PURPOSE: The purpose of this study was to investigate sports activities and functional abilities in patients following total knee arthroplasty (TKA). It was hypothesized that patients who had undergone TKA would return to a higher activity level as that experienced preoperatively. METHODS: Two hundred patients were included in this prospective single-cohort study. All the patients completed subjective questionnaires (Tegner Activity Level, Oxford Knee Score, Visual Analog Scale for pain) prior to surgery as well as at 6, 12, and 24 months postoperatively. Additionally, sports behaviour was evaluated. Sports frequency was divided into four categories: more than 5 times a week, 2-3 times a week, occasionally, and no sports activities. Additionally, the patients were asked to state their three favourite summer and winter sports. RESULTS: All patient-reported outcome scores improved significantly over time (p ≤ 0.005). The Tegner Activity Level increased significantly from the preoperative state to 24 months postsurgery (p = 0.005). Six months after surgery, 43% of the patients returned to the same and 35% to a higher Tegner Activity Level than prior to surgery. Gender-related differences were observed for the Tegner Activity Level showing a higher activity level for the male than for the female patients. Overall, 24 months postsurgery 83% of the patients practiced sports in comparison with 79% prior to surgery. CONCLUSIONS: Following TKA, the patients were able to increase sports performance, while pain was reduced. Therefore, patients who want to continue their desired sports may safely consider TKA. LEVEL OF EVIDENCE: II.

Surgical excision of symptomatic mature posttraumatic myositis ossificans: characteristics and outcomes in 32 athletes.

PURPOSE: The purpose of this study was to report characteristics and outcomes of surgical excision of symptomatic mature posttraumatic myositis ossificans in adult athletes. The hypothesis was that surgical excision of the ossified mass in these circumstances can effectively relief symptoms and result in return to high-level sports with minimal postoperative complications. METHODS: All operations involving excision of posttraumatic heterotopic ossifications performed between 1987 and 2015 were reviewed. Included cases had isolated excision of posttraumatic myositis ossificans, whereas excluded cases had: (1) concomitant reattachment of tendon to bone; (2) chronic overuse injuries which preceded the development of the heterotopic mass or large calcifications which were excised from tendon-to-bone insertions; and (3) excision of heterotopic ossification from a ligament, capsule, or tendon insertion following avulsion injury without tendon-to-bone repair. After surgery, return to sports was allowed at 4-6 weeks. RESULTS: Of 57 athletes undergoing excision of heterotopic ossifications, 32 were eligible as isolated excision of posttraumatic myositis ossificans. Twenty-four (75%) were ice hockey or soccer players. Median age was 23 years. Prior to surgery, patients were unable to continue their sports. At surgery, the ossification was excised from a thigh muscle in 27 (84%) cases. Median follow-up was 2 years (range 1-20 years). Outcome was Good/Excellent in 26 (81%) patients, corresponding to return to preinjury sports with minimal symptoms at sports activities. Preinjury Tegner activity level was resumed after surgery in 30 of 32 (94%) athletes, of whom 28 (94%) were involved in high-level sports corresponding to Tegner levels 8-10. No postoperative complications were recorded other than minimal insensitive areas at the periphery of skin incisions. CONCLUSION: In high-level athletes who present chronic disabling mature posttraumatic myositis ossificans that interferes with their sports career, surgical excision of the heterotopic mass results in effective clinical improvement with return to sports and minimal postoperative risks. LEVEL OF EVIDENCE: Case series, Level IV.

Return to prelesional Tegner level after anatomic anterior cruciate ligament reconstruction.

INTRODUCTION: Injury and surgery of the anterior cruciate ligament (ACL) are very frequent within the sports environment. The purpose of the present study is to assess the level at which a group of athletes were able to return to play (RTP) after ACL reconstruction, and most importantly, the time for RTP. MATERIALS AND METHODS: A prospective study with patients who presented an ACL injury and underwent ligament reconstruction surgery; a bone-tendon-bone reconstruction and a minimum follow-up of 24 months. The rates of RTP as well as correlations with IKDC and KT-1000 were collected. RESULTS: 42 patients were included (mean age 31.7 years old). Mean Tegner level was 6.7. 9.5 % of patients returned to sports 6 months after surgery, 52.3 % at 1 year, and 73.8 % at 2 years after ACL reconstruction. 11 patients did not achieve their preoperative Tegner level after 2 years of follow-up. Levels of KT-1000 of the operated side were normal, and IKDC levels reached 90 % of total. CONCLUSIONS: Fear to a new injury, psychological factors, personality, type of life, and sports level previous to the injury are factors that influence when it comes to RTP after an ACL surgery. Level of evidence Level II descriptive analysis.

A Long-term Comparison of Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Bioabsorbable Interference Screw and Endobutton on Femur.

Introduction: Arthroscopic anterior cruciate ligament (ACL) reconstruction is a very commonly done procedure in recent times. There is a need for a long-term outcome study of ACL reconstruction with a comparison between different types of fixation techniques. The graft fixation methods vary from aperture fixation (interference screws) to suspensory fixation methods (endobutton). Failure of graft incorporation and the development of tunnel widening (TW) after ACL reconstruction have been frequently reported in the long term in present literature. TW especially complicates revision ACL surgery. This is a prospective non-randomized clinical study of arthroscopic ACL reconstruction comparing the functional results between aperture fixation and suspensory fixation. Materials and Methods: Two groups of 14 patients who underwent autogenous hamstring ACL reconstruction with a minimum of 2-year follow-up evaluation were included in the study. The first group underwent aperture fixation with bioabsorbable interference screw at tibial and femoral side. The second group underwent suspensory fixation with endobutton fixation on the femoral side and biointerference screw on the tibial side. Both group patients were examined clinically before surgery, and at 3 months, 6 months, 1 year, and at 2 years. They were compared for functional outcome with Tegner Lysholm knee score. Observation and Results: There was a significant improvement in functional outcome in both the groups for base and at 3 months, also for 3 months and 6 months but for 6 months-1 year. Group 2 is almost significant. This improvement in outcome in Group 2 is consistent from 1 year to 2 years. Conclusion: In our prospective study comparing the outcomes of functional outcomes of ACL reconstruction with aperture fixation versus suspensory fixation on the femur, which was evaluated using Tegner Lysholm knee score over a period of 2 years, suspensory fixation was found to be better. However, further studies involving a larger series of cases are required for a better evaluation of the outcome.

Electromyographic Analysis of Large Muscle Activity in Progressive Collapsing Foot Deformity.

BACKGROUND: There are various deformities described in the spectrum of Progressive Collapsing Foot Deformity (PCFD) which not only have adverse effects on the foot but also on the entire lower limb. Early lower limb muscular fatigue and pain during exertion is the most common complaint of patients with PCFD. Surface electromyography (sEMG) provides an accurate assessment of muscle activity. In this study, we aim to compare the activities of quadriceps, hamstrings, and gastrosoleus muscle groups of adult patients with PCFD with normal lower limbs and correlate the radiological parameters and functional effects of PCFD with the activities. METHODS: Thirty patients with bilateral PCFD and 30 controls underwent weight-bearing anteroposterior (AP), lateral, and hindfoot alignment radiographs of the foot. Radiographic parameters of PCFD were assessed. Surface electromyography was used to assess the quadriceps, hamstrings, and gastrosoleus activities, and this was compared between the 2 groups and correlated with radiological measurements of PCFD. Tegner activity questionnaire was used to assess the functional effects of collapsed arch. RESULTS: Electrical activities of all muscle groups were significantly higher in cases than controls. Meary's angle and hindfoot moment arm had significant correlations with hamstring activity (P = .013) and gastrosoleus activity (P = .027), respectively. Tegner scores of cases were significantly lower than those of controls (P = .041). CONCLUSIONS: The PCFD causes an increase in activity of large muscles of the affected lower limb which act on joints other than those in the foot. This finding may be due to several compensatory mechanisms that counteract the deforming forces. This may be a cause for the frequent complaint, early fatigue, and hence functional impairment. However, most radiological parameters did not correlate with muscle activities and larger study size may be required for further association. LEVELS OF EVIDENCE: Diagnostic: Level 3.

The Effectiveness of Treating Osgood-Schlatter Disease (OSD) with Leukocyte-Rich Platelet-Rich Plasma (LR-PRP) Depending on the Duration of the Disease.

Background: Osgood-Schlatter disease (OSD) occurs mainly in physically active adolescents, causing significant physical activity restrictions. The aim of this study is to compare the effectiveness of treating OSD with leukocyte-rich platelet-rich plasma (LR-PRP) depending on the duration of the disease and to attempt to develop an alternative treatment method to the currently used conservative therapy. Methods: Treatment efficacy was evaluated using the VAS, Tegner, Lysholm, and KOOS scales. Subject satisfaction, return to sports activity, potential adverse effects, and X-ray evaluation were likewise used to assess the success of the procedure. Results: Analysis across all scales showed statistically significant treatment effectiveness with LR-PRP in both groups of patients. When comparing the two groups, significantly better treatment outcomes were achieved in the acute phase of OSD. Treatment satisfaction in the acute OSD group was 95%, compared to 64% in the chronic group. The MCID value after LR-PRP injection in acute OSD compared to chronic OSD reached 100% vs. 81% on the VAS scale, 95.5% vs. 55% on the Tegner scale, 95% vs. 47% on the Lysholm scale and 91% vs. 27% on the KOOS scale. No adverse effects were recorded in either group. Conclusions: The high efficacy of LR-PRP treatment in patients with acute OSD, in correlation with high safety, as well as rapid and lasting results, can be an effective and beneficial alternative to conservative treatment. This single procedure seems particularly justified in a group of young professional athletes, where absence from training can lead to serious consequences.

Analysis of the Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using the Central Quadriceps Tendon Graft.

INTRODUCTION: Anterior cruciate ligament (ACL) injuries are common, particularly among athletes, and often result in knee instability and decreased functionality. Arthroscopic ACL reconstruction is the standard treatment, typically using a patellar tendon bone graft (PTBG) or hamstring tendon graft (HTG). The central quadriceps tendon graft (QTG) has been proposed as a superior alternative due to its structural properties. METHODOLOGY: This study involved patients undergoing ACL reconstruction using the central quadriceps tendon graft. Functional outcomes were assessed using the Tegner Lysholm knee score were assessed at preoperative and postoperative intervals of two weeks, three months, and six months. Statistical analysis compared these scores over time. RESULTS: Among the subjects, 90.6% were male and 9.4% were female. Injuries primarily resulted from sports activities and road traffic accidents (46.9% each). Right-side injuries were more prevalent (65.6%). The mean time from injury to surgery was 9.37 months. The mean graft size was 8.75 mm, and the mean tourniquet time was 105.94 minutes. Preoperative tests showed positive results for anterior drawer, Lachman, and pivot shift tests in most patients, which were negative postoperatively. Significant improvements in knee flexion and Lysholm knee scores were observed. Preoperative knee flexion ranged from 0-100° to 0-120°, improving to 0-120° to 0-130° six months postoperatively. The mean Lysholm knee score improved from 47.06 preoperatively to 93.16 at six months. Excellent outcomes were seen in 78.1% of the patients, with 21.9% achieving good outcomes. CONCLUSION: The central quadriceps tendon graft is an effective option for ACL reconstruction, offering excellent functional outcomes and low complication rates. It shows promise as a better alternative to traditional graft types, although further research is necessary to confirm these findings.

Physical Activity Levels in Persons With Patellofemoral Pain: A Systematic Review and Meta-analysis.

CONTEXT: Pain and symptoms of patellofemoral pain (PFP) are often exacerbated during daily activities, which may result in reduced overall physical activity levels. OBJECTIVE: To summarize the evidence for physical activity levels among persons with PFP compared with pain-free controls. DATA SOURCES: PubMed, Embase, CINHAL, Cochrane Library, and SPORTDiscus were searched from January 1, 2000 to February 22, 2024. STUDY SELECTION: Peer-reviewed studies published in English that measured physical activity subjectively or objectively in persons with PFP and pain-free controls. STUDY DESIGN: Systematic review with meta-analysis. LEVEL OF EVIDENCE: Level 1. DATA EXTRACTION: Standardized mean difference (SMD) with 95% CI are reported based on Hedges' g effect sizes. RESULTS: From 23,745 records, 41 studies met the eligibility criteria. There was high-to-moderate-certainty evidence that persons with PFP reported higher physical activity levels compared with pain-free controls using the International Physical Activity Questionnaire (SMD, 0.27; 95% CI 0.03, 0.51), whereas lower physical activity levels compared with pain-free controls using the Tegner Activity Scale (SMD, -0.31; 95% CI -0.57, -0.04). There was low-to-moderate-certainty evidence that there was no group difference in physical activity levels using the Baecke Physical Activity Questionnaire (SMD, 0.17; 95% CI -0.09, 0.44) or self-reported sports participation duration (SMD, -0.46; 95% CI -0.98, 0.05). There was high-certainty evidence that runners with PFP reported shorter running distances compared with pain-free runners (SMD, -0.36, 95% CI -0.57, -0.14). No data pooling was possible for objectively measured physical activity levels due to device heterogeneity (ie, different algorithms used to quantify the intensity of physical activity). CONCLUSION: Self-reported physical activity levels among persons with PFP were inconsistent depending on the physical activity measurement tool used or which specific physical activity was measured. Clinicians should integrate multiple physical activity assessment tools to determine the extent to which PFP influences physical activity levels. TRIAL REGISTRATION: PROSPERO #CRD42022314598.

Do octogenarian patients undergoing total knee replacement return to physical activity? / ¿Los pacientes octogenarios sometidos a reemplazo total de rodilla regresan a la actividad física?

BACKGROUND AND OBJECTIVES: It has been shown that total knee replacement improves functional capacity and physical activity; however, the influence of age remains unclear. The objective is evaluate the pre and postoperative physical activity measured with the Knee Society Score (KSS) score and the Tegner score. MATERIALS AND METHODS: A retrospective cohort analysis was conducted on patients who underwent total knee replacement (TKR) between January 2016 and December 2019 at our institution. Demographic variables (age, sex, and body mass index), activities of daily living, age-adjusted Charlson Comorbidity Index, American Society of Anesthesiologists score, the Knee Society Score (KSS) in its clinical (KSSc) and functional (KSSf) subscales, the Tegner functional scale, activity variables from the 2011 KSS version, and pain assessment using the visual analog scale were collected. Differences in these variables were analyzed between two age groups: group A (between 65 and 79 years old) and group B (80 years or older). RESULTS: A total of 450 patients were evaluated (group A=245, group B=167). Group A showed a Tegner improvement of 1.19 (95% CI: 1.06-1.31), whereas group B averaged 0.61 (95% CI: 0.43-0.80) (P<.001). Age >80 was an independent risk factor for less Tegner improvement. In KSSc, group A improved by 43 points (95% CI: 40.82-46.14), while group B showed a greater increase of 53 points (95% CI: 49.74-57.80). Adjusted for confounders, those>80 showed significantly higher KSSc improvement (12.8 points). For KSSf, group A improved by 33.91 points (95% CI: 31.07-36.75), and group B by 15.57 points (95% CI: 11.78-19.35). Adjusted for confounders, patients >80 had less improvement than those <80 (19 points). CONCLUSIONS: Patients who underwent TKR experienced improvements in physical and functional activity parameters. While these improvements were seen in the entire population, they were most notable in patients younger than 80 years.

Influence of a Concomitant Medial Meniscus Injury on Knee Joint Function and Osteoarthritis Presence after Anterior Cruciate Ligament Reconstruction.

(1) Background: The aim of this study was to investigate how a medial meniscus injury accompanying an anterior cruciate ligament rupture affects the clinical outcome 10 years after ACL reconstruction. (2) Methods: A total of 37 patients who received anterior cruciate ligament reconstruction (ACLR) were included in this retrospective study. Two groups were analyzed at a single follow-up of 10 years: (i) "isolated (ACLR)" (n = 20) and (ii) "ACLR with medial meniscal injury" (n = 17). The following clinical scores were recorded: International Knee Documentation Committee (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Score and Tegner Activity Score. To determine the degree of osteoarthritis the Kellgren-Lawrence score was used. (3) Results: The "isolated ACLR" study group scored significantly higher (p < 0.05) on the IKDC subjective questionnaire (mean: 88.4) than the "ACLR with medial meniscus injury" group (mean: 81). The KOOS category "activities of daily living" showed significantly better results in the isolated ACLR group (p < 0.05). The "ACLR with medial meniscus injury" group had significantly higher degree of osteoarthritis (p < 0.05). No significant differences were found in all the other clinical scores. (4) Conclusions: The results of this study further indicate that patients with a concomitant medial meniscus injury have slightly more discomfort in everyday life and increased risk of developing osteoarthritis 10 years after surgery.