Search Results (42)

Background and Objectives: Atelocollagen, a purified collagen derivative, has demonstrated potential benefits in various orthopedic applications; however, its role in anterior cruciate ligament (ACL) reconstruction remains unclear. This study aimed to compare magnetic resonance imaging (MRI) graft signal following ACL reconstruction with and without atelocollagen interposition and to evaluate its effects on knee joint laxity and clinical outcomes. Materials and Methods: A retrospective review was conducted on patients who underwent primary ACL reconstruction using hamstring autografts between March 2015 and July 2023. Patients were divided into two groups: without atelocollagen (Group N) and with atelocollagen interposition (Group C). The primary outcome was ACL graft signal intensity (intra-articular and intra-tunnel) on 1-year postoperative MRI. Secondary outcomes included tunnel widening, knee joint laxity, and patient-reported outcome measures (PROMs). Results: A total of 57 patients (Group N: 34; Group C: 23) were analyzed. Baseline characteristics were comparable between groups. Group C had a higher proportion of thicker graft constructs (quintuple/sextuple: 73% vs. 17.6%, p < 0.001) and more frequent concomitant anterolateral ligament reconstruction (78.3% vs. 8.8%, p < 0.001). No significant difference in intra-articular graft signal was observed. However, femoral intra-tunnel graft signal was significantly lower in Group C (p = 0.018), accompanied by reduced femoral tunnel widening (p < 0.001). Tibial tunnel widening, knee joint laxity, and PROMs did not differ significantly at 1 and 2 years. In multivariable analysis, atelocollagen interposition was associated with reduced femoral tunnel widening (B = −1.1, p = 0.025). Conclusions: Atelocollagen interposition during ACL reconstruction was associated with more favorable intra-tunnel graft healing signals and reduced femoral tunnel widening, although it did not appear to influence short-term clinical outcomes. Full article

The available literature provides limited and inadequate data regarding the association between intraoperative knee kinematics, long-term clinical outcomes and survivorship after total knee arthroplasty (TKA). This study aimed to examine the potential relationship between specific intraoperative kinematics laxity assessment, acquired with a computer navigation system, and the long-term clinical outcomes and survivorship in patients undergoing TKA. This study consists of a retrospective cohort analysis of consecutive TKA procedures, in which a surgical navigation system was utilized to intra-operatively assess bone resections, implant positioning and gap balancing. The intraoperative kinematic parameters included varus-valgus laxity at 0° (VV 0) and 30° of flexion (VV 30), anterior–posterior displacement at 90° of flexion (AP 90), and passive range of motion (ROM). Different prosthesis designs were used, with a predominance of the posterior stabilized (PS)-type implant. The Knee Injury and Osteo-arthritis Outcome Score (KOOS) was used to investigate patients’ clinical and functional status. Survival was analyzed with the Kaplan–Meier method. Between-group comparisons were performed using the Mann–Whitney U test. A univariate logistic regression analysis was conducted to identify factors associated with clinical failure. Of 165 eligible patients, 120 were included in the final analysis, with a mean follow-up of 7.7 ± 2.8 years. Revision surgery was required in seven cases, representing surgical failure and an overall survival rate of 94.2%, with survival probabilities of 98.8%, 97.4%, and 93.6% at 6, 8, and 10 years, respectively. Clinical failure (KOOS < 70 in three domains) occurred in 23 patients. No intra-operative surgical parameters, including Hip-Knee-Ankle angle, Preoperative KL grade, prostheses design, VV 0, VV 30, AP 90 and ROM, or demographic variables, were found to be statistically correlated with clinical failure at follow-up. Although, in this navigated TKA cohort, survivorship was acceptable and consistent with previously reported benchmarks, it was not possible to reliably predict survival probability based solely on the intra-operative laxity parameters measured. Nevertheless, the use of surgical navigation can help surgeons accurately assess bone resections and the balance of prosthetic components. Full article

Background/Objectives: Anterior cruciate ligament (ACL) reconstruction remains the accepted standard of care for ACL ruptures in physically active individuals. Various surgical techniques have been developed to achieve anatomic reconstruction and optimize functional outcomes. The aim of this study was to descriptively report the early functional outcomes of anatomic ACL reconstruction performed using retrograde femoral socket drilling using a FlipCutter through a far anteromedial portal combined with a conventional antegrade tibial tunnel, without claiming superiority over alternative techniques. Methods: This single-center, single-arm retrospective cohort study included 33 consecutive male patients with ACL rupture who underwent arthroscopic ACL reconstruction using hamstring tendon autograft between 2021 and 2022 at a tertiary academic medical center. The surgical technique employed retrograde drilling of the femoral socket using a FlipCutter device introduced through a far anteromedial portal; the tibial tunnel was created with a standard outside-in aiming guide. The pre-specified primary outcome was the change in the Tegner–Lysholm score from baseline to 12 months; secondary outcomes were the Modified Cincinnati and International Knee Documentation Committee (IKDC) subjective scores and clinical stability tests. Functional outcomes were assessed preoperatively and at 6 weeks, 3 months, and 12 months postoperatively using repeated-measures testing with the Friedman test and post hoc Wilcoxon signed-rank tests with Bonferroni correction. Reporting followed the STROBE recommendations for observational studies. Results: All 33 patients (100% male) completed the 12-month follow-up. The mean age was 28 years (range: 18–44), and sports-related injuries accounted for 84.8% of cases. Significant improvements were observed in all functional scores from preoperative to 12-month postoperative assessments (p < 0.001). The mean Tegner-Lysholm score improved from 46.8 ± 17.3 preoperatively to 83.7 ± 10.5 at 12 months (mean change +36.9, 95% CI 30.3 to 43.5; matched-pairs effect size r = 0.87). The mean IKDC score increased from 36.3 ± 14.4 to 68.4 ± 15.1 (mean change +32.1, 95% CI 25.3 to 38.9; r = 0.84), and the Cincinnati score improved from 41.3 ± 15.9 to 80.2 ± 10.9 (mean change +38.9, 95% CI 32.6 to 45.2; r = 0.86). All observed mean changes exceeded the minimal clinically important difference (MCID) reported for these instruments in ACL populations. Postoperative stability assessment demonstrated restoration of knee stability in the majority of patients, with 66.7% showing a negative anterior drawer test at final follow-up. Conclusions: Anatomic ACL reconstruction utilizing retrograde femoral socket drilling using a FlipCutter through a far anteromedial portal combined with a conventional antegrade tibial tunnel was associated with satisfactory early functional outcomes in a small, all-male cohort, comparable to those reported for contemporary anatomic ACL reconstruction techniques. Given the retrospective, single-arm design, modest sample size, homogeneous all-male cohort, absence of instrumented laxity or return-to-sport data, and absence of multivariable adjustment, any suggestion of technique-specific advantages should be regarded as hypothesis-generating. Comparative effectiveness against other anatomic techniques remains to be established in prospective, controlled studies with longer follow-up. Full article

Background: The necessity of cyclic graft loading during anterior cruciate ligament (ACL) reconstruction remains debated. This study aimed to compare clinical outcomes between patients undergoing ACL reconstruction with and without cyclic graft loading. Methods: A retrospective comparative study was conducted involving 216 patients who underwent ACL reconstruction between 2021 and 2022. Patients were divided into two groups: those whose grafts were cyclically loaded intraoperatively (n = 104) and those who did not undergo cyclic loading (n = 112). All surgeries used hamstring autografts and similar fixation techniques. Outcomes, including graft re-rupture rates, knee laxity (measured by arthrometer, Rolimeter^®), and patient-reported outcomes, were evaluated at a minimum follow-up of two years. Results: The demographics of both groups were comparable. Re-rupture rates were 2.5% in the cyclic loading group and 2.9% in the non-cyclic loading group (p = 0.78). Mean side-to-side laxity difference in anterior tibial translation measured by Rolimeter^® was 1.1 mm ± 0.6 in the cyclic loading group and 1.2 mm ± 0.7 in the non-cyclic loading group (p = 0.39). No significant differences in Lysholm or IKDC scores were observed between groups. Conclusion: In this retrospective, non-randomized cohort, no statistically significant differences were detected between ACL reconstruction performed with or without cyclic graft loading. These findings should be interpreted with caution, given the potential for temporal confounding. Further prospective, randomized studies are required to confirm these results. Full article

Background and Clinical Significance: Multiligamentous knee injuries (MLKIs) are uncommon but severe injuries associated with instability, neurovascular compromise, and long-term functional impairment. Irreducible knee dislocations are a distinct subgroup requiring urgent intervention because soft-tissue interposition may prevent closed reduction and place the limb at risk of skin necrosis and vascular compromise. This report reviews current concepts in MLKI management and presents a complex KD-IV irreducible knee dislocation treated with a staged surgical strategy. Case Presentation: A 56-year-old woman presented 24 h after a skiing injury with a grossly deformed knee, multidirectional instability, and an anteromedial “pucker sign”. Magnetic resonance imaging demonstrated a KD-IV injury with complete rupture of the anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament, associated with capsular disruption and intra-articular soft-tissue interposition causing irreducibility. Urgent open reduction was performed. The first stage included reduction of the incarcerated capsule, capsular repair, and reconstruction of the posteromedial corner and medial collateral ligament using a semitendinosus autograft. Delayed reassessment at 6 months demonstrated satisfactory stability, minimal residual anterior laxity, and no subjective instability; therefore, anterior cruciate ligament reconstruction was not performed. At final follow-up, the patient had near-full range of motion, no significant valgus instability, and no arthrofibrosis or vascular complications. Conclusions: Management of MLKIs should be individualized according to reducibility, soft-tissue condition, neurovascular status, and functional demands. Irreducible KD-IV dislocations with a pucker sign require urgent open reduction. In selected patients, staged reconstruction may reduce postoperative stiffness and allow selective omission of cruciate ligament reconstruction when satisfactory functional stability is achieved. Full article

Purpose: To critically evaluate the role or effect of platelet-rich plasma (PRP) in anterior cruciate ligament (ACL) reconstruction in terms of clinical and radiological outcomes. Method: We conducted a systematic search of PubMed, Embase, the Cochrane Library, and Web of Science to identify relevant studies. Clinical outcomes included the Visual Analogue Scale (VAS), International Knee Documentation Committee (IKDC) subjective and objective evaluations, Lysholm score, Tegner score, anterior knee laxity, Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala score, Victorian Institute of Sport Assessment (VISA) scale, proprioception, isokinetic strength, and physical examination tests (anterior drawer, Lachman, and pivot-shift tests). Radiological outcomes encompassed measures obtained via magnetic resonance imaging (MRI), computed tomography (CT), X-ray, and ultrasound. Statistical significance was defined as a p value < 0.05, and all analyses were performed using R software (version 4.1.3). Results: A total of 23 studies, including 19 randomized controlled trials, met the inclusion criteria, encompassing 1072 patients overall. The meta-analysis showed significant differences between PRP group and non-PRP group with regard to VAS score at 6- and 12-month follow-up, Lysholm score at 6-month follow-up, and Tegner score at 6-month follow-up. Meta-regression showed that the two group differences in VAS score changed significantly with follow-up time (p < 0.01). In terms of radiological findings, about half of the assessments favored PRP to facilitate the graft maturation and integration at 6-month follow-up. Conclusions: PRP application in ACL reconstruction compared with non-PRP, may produce short-term but not long-term clinical outcomes such as VAS score, Lysholm score and Tegner score. While some short-term statistical differences exist, their magnitude and durability do not yet justify routine clinical adoption of PRP in ACL reconstruction. Larger samples and higher-quality studies are needed to support our results and further explore the advantages of PRP in other aspects. Level of evidence: Level II. Full article

Background/Objectives: The aim of this study was to report first experiences with dynamic intraligamentary stabilization (DIS) technique for anterior cruciate ligament (ACL) rupture in children and adolescents. Methods: A case series of 22 children and adolescents with a mean age of 13.3 years underwent primary repair of an ACL rupture using the DIS technique as an off-label use in skeletally immature patients. Patients were evaluated for laxity, strength, range of motion (ROM), and functional tests, as well as Tegner, Lysholm, International Knee Documentation Committee (IKDC), and PedsQL scores after 3 years. A follow up after 11 years was conducted to analyze long-term results, rerupture rates and reinterventions. Results: Three years after surgery, there was no significant difference in laxity, strength, ROM, and in the functional tests comparing the injured to the contralateral knee. The Tegner Index after surgery showed a slight drop of 0.8 points, from 7.1 preoperatively to 6.3. Mean IKDC, Lysholm, and peds-QL scores were 91.17 (range 62.64–98.85, median 94.25), 88.27 (range 58–100, median 93), and 88.78 (range 58.15–100, median 91.30). Overall failure rate of the DIS-repaired knees was 55% (12 of 22 patients). In ten patients, reruptures happened at an average time of 3.2 years after initial surgery; additionally, two patients with chronic instability had to undergo revision ACL reconstruction. Conclusions: DIS repair might help ACL healing with satisfactory functional outcomes. However, given the high failure and reintervention rates, further studies need to show non-inferiority of the DIS technique in children and adolescents before being considered a valid treatment option. Full article

Objectives: This study aimed to perform matched comparisons of the surgical outcomes of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction with those of isolated ACL reconstruction, in which allografts were used for the ACL. Methods: Patients who underwent anatomical ACL reconstruction with or without additional ALL reconstruction between 2017 and 2023 and had a minimum follow-up of 2 years were included and grouped according to whether an additional ALL reconstruction was performed. The cohorts were statistically adjusted using an inverse probability of treatment weighting (IPTW) to control for potential confounders related to surgical indication, including age, activity level, sex, rotational knee laxity, and preoperative osteoarthritic grade. Between-group comparisons were conducted for baseline characteristics, clinical outcomes, knee laxity, and radiologic parameters. Results: Fifty-nine patients were included (Group 1: 39 isolated ACL reconstructions; Group 2: 20 combined ACL and ALL reconstructions). Before IPTW adjustment, a significant difference was observed in the preoperative pivot-shift test (p = 0.008), which was no longer significant after weighting. Postoperative functional outcomes and knee stability were comparable between groups; however, the incidence of surgical failure was significantly lower in Group 2 both before and after IPTW adjustment (p = 0.044 and p = 0.049, respectively). Regarding radiologic parameters, the signal-to-noise quotient of the ACL graft was also significantly lower in Group 2, both before and after IPTW adjustment (p = 0.046 and p = 0.038, respectively). Conclusions: In ACL reconstruction using allografts, the addition of ALL reconstruction resulted in more favorable clinical and radiologic outcomes—particularly a lower incidence of surgical failure and greater postoperative graft maturity—compared with isolated ACL reconstruction. Full article

Background/Objectives: Anterior cruciate ligament (ACL) reconstruction stabilizes the knee and treats associated lesions. Control of rotational laxity can be optimized by an extra-articular plasty, historically known as the Lemaire plasty or tenodesis at the fascia lata. The risk of iterative rupture is reduced, by stabilising anterior translation and tibial internal rotation. In the literature, many different technical details are described, for example regarding the position and the method of femoral fixation. Although these parameters are fundamental to achieving graft isometry and avoiding overconstraint, no consensus or standardized recommendations have yet been established. The aim of the study was to summarize the position of fixation of a lateral tenodesis to the fascia lata, the degrees of flexion and rotation during fixation, its mode of fixation and its passage in relation to the lateral collateral ligament (LCL). Methods: In April 2024, a systematic review was conducted by two independent authors to identify studies describing lateral tenodesis with fascia lata with details about femoral fixation position, method of fixation, the graft’s passage relative to the lateral collateral ligament and flexion/rotation during fixation. From 111 records initially identified, 22 studies met the inclusion criteria. Results: Most authors described passing the graft beneath the LCL to achieve controlled anisometry. The preferred femoral fixation point was proximal and posterior to the lateral epicondyle, with fixation performed at approximately 30° of flexion and neutral tibial rotation. Various fixation methods have been reported, including staples, screws, cortical buttons, and anchors, but no biomechanical evidence demonstrated the superiority of one technique over another. Conclusions: Lateral tenodesis at the fascia lata is a well-established adjunct to ACL reconstruction, providing additional control of rotational laxity. While consistent trends are emerging regarding graft passage and femoral fixation landmarks, technical heterogeneity persists, and no definitive guidelines currently exist. Standardization of these parameters through high-level clinical and biomechanical studies is warranted to optimize outcomes and reduce variability in surgical practice. Full article

Background and Objectives: Revision anterior cruciate ligament reconstruction (ACLR) is demanding and yields inferior outcomes compared with primary procedures. The quadriceps tendon (QT) autograft with bone block has biomechanical and biological advantages though clinical evidence in revision remains limited. This study evaluated the clinical and radiological outcomes of revision ACLR using bone-block QT autograft in young, active patients. Materials and Methods: A case series with a level of evidence of 4. Thirty-four patients (28 men, 6 women; mean age, 27.2 ± 5.8 years) who underwent revision ACLR with a bone-block QT autograft between 2021 and 2023 were retrospectively reviewed. The mean follow-up was 37.4 ± 3.2 months. Clinical assessments included the Lysholm, International Knee Documentation Committee (IKDC) subjective, and Tegner activity scores, along with isokinetic strength testing. Objective stability was evaluated using pivot shift grading and Telos stress radiography. Radiological analyses included 3D computed tomography for tunnel positioning and magnetic resonance imaging for tunnel widening. Perioperative and postoperative complications were recorded. Results: All clinical outcomes improved significantly from baseline to 2-year follow-up: Lysholm (62.7 ± 9.6 to 87.1 ± 10.3), IKDC (59.0 ± 10.8 to 79.5 ± 11.1), and Tegner (3.5 ± 1.2 to 5.6 ± 1.3; all p < 0.001). However, the Tegner score remained lower than the pre-injury level (6.1 ± 1.4; p = 0.035). At the final follow-up, 91.2% of the patients had returned to sports, with 59% resuming sports at their pre-injury level or higher. Side-to-side anterior laxity decreased from 8.5 ± 1.7 mm to 1.4 ± 1.1 mm on Telos stress radiography (p < 0.001). Preoperatively, 82% of patients demonstrated high grade pivot shift (≥grade 2), which improved to 91% graded as negative or grade 1 at final follow-up (p < 0.001). Isokinetic evaluation showed improvements in quadriceps (28.7% ± 12.5% to 12.4% ± 8.1%) and hamstring (18.3% ± 9.7% to 8.9% ± 6.5%) deficit (both p < 0.001). MRI demonstrated minimal tunnel widening (tibia, +1.3 ± 0.9 mm, p = 0.012; femur, +0.3 ± 0.6 mm, p = 0.148). Three complications (8.8%) were observed: one cyclops lesion, one transient extension deficit, and one graft rupture. No patellar fractures, septic arthritis, or revision procedures occurred during the follow-up period. Conclusions: Bone-block QT autografts provide a reliable option for revision ACLR, yielding functional improvement, restored stability, and minimal donor-site morbidity, with low complications. These findings support their consideration as the preferred graft choice for young active patients needing revision reconstruction. Full article

Background/Objectives: All-inside ACL reconstruction has emerged as a minimally invasive alternative to conventional techniques, with potential advantages in graft configuration and reduced surgical trauma. This study aimed to compare the clinical outcomes of all-inside and full tibial tunnel ACL reconstruction, focusing on graft diameter, postoperative stability, and functional recovery. We hypothesized that the all-inside technique would allow for thicker grafts and yield superior postoperative knee stability and functional outcomes, with postoperative anterior laxity as a major outcome of interest. Methods: This retrospective comparative study reviewed patients who underwent ACL reconstruction between January 2020 and February 2024. From January 2020 to September 2022, a four-strand hamstring autograft with full tibial tunnel technique (FT-4) was used, while from September 2022, a six-strand hamstring autograft with the all-inside technique (AI-6) was adopted to enable thicker grafts and optimize fixation. Among a total of 103 patients, 1:1 propensity score matching (PSM) was performed based on age, sex, BMI, laterality, ALL reconstruction, meniscal lesion, and preoperative anterior laxity (SSD). Graft diameter and clinical outcomes, including knee stability and functional scores, were compared between the matched groups. Results: After PSM, two comparable groups of 29 patients each were established. Graft diameter was significantly larger in the AI-6 group (9.5 ± 0.7 mm) compared to the FT-4 group (7.8 ± 0.8 mm, p < 0.001), while other baseline characteristics remained well balanced between the groups. At the final follow-up, both groups exhibited significant improvements in anterior laxity, functional scores, and pivot shift grades (all p < 0.001). The AI-6 group demonstrated superior outcomes with a significantly higher Lysholm score (82.2 ± 6.7 vs. 75.6 ± 8.9, p = 0.002), lower WOMAC score (8.0 ± 4.3 vs. 12.9 ± 10.5, p = 0.023), and reduced anterior laxity (1.6 ± 1.1 mm vs. 2.5 ± 1.4 mm, p = 0.005) compared to the FT-4 group, whereas no significant differences were observed in the IKDC, Tegner, Korean knee score, or pivot shift test results. A simple linear regression revealed a significant negative correlation between graft diameter and postoperative anterior laxity (B = −0.398, p = 0.048). Conclusions: The present study demonstrated that the use of a six-strand hamstring graft configuration in the AI-6 technique resulted in significantly thicker grafts and was associated with reduced postoperative anterior knee laxity compared to the FT-4 technique. While interpretation of these findings requires caution in light of MCID thresholds, the AI-6 group showed favorable outcomes in anterior laxity and selected functional scores, such as the Lysholm and WOMAC. This technique may offer practical clinical value, particularly in populations prone to smaller graft diameters, as it facilitates adequate graft thickness through multifold preparation, with the all-inside approach accommodating the inherent graft shortening. Full article

Background: Arthrogenic muscle inhibition (AMI), anterior knee laxity, and kinesiophobia are key barriers to recovery after anterior cruciate ligament reconstruction (ACLR). While each has been independently studied, their interrelationships during the early postoperative phase remain unclear. Methods: This cross-sectional study included 56 patients (mean age: 26.5 ± 5.7 years) who underwent ACLR using hamstring autografts. Clinical AMI grading, GNRB^® arthrometer measurements of anterior tibial translation, and the Tampa Scale for Kinesiophobia-11 (TSK-11) were used to assess neuromuscular inhibition, mechanical laxity, and psychological fear, respectively. All evaluations were performed at 34.9 ± 4.2 postoperative days. Statistical analyses included one-way ANOVA, Kruskal–Wallis, and Spearman correlation. Results: No significant differences in TSK-11 scores were observed across AMI grades (p = 0.327). Similarly, anterior laxity did not differ significantly between AMI groups (p = 0.182). Correlation between GNRB measurements and TSK-11 scores was non-significant (rho = −0.220, p = 0.103). Conclusions: In the early phase following ACLR, AMI, anterior laxity, and kinesiophobia appear to be independent domains. These findings suggest that early postoperative rehabilitation should address each dimension individually. Further longitudinal studies are needed to explore their potential interactions over time. Full article

Background/Objectives: Types I, V, and XI collagen gene variants have been reported to associate with measurements of knee joint laxity and/or absolute knee ligament length changes. Type XII collagen and tenascin C are also ligament structural proteins whose expression is regulated by mechanical loading. This study investigated whether COL12A1 and TNC variants are associated with knee laxity and/or ligament length changes. Methods: Genu recurvatum, anterior–posterior tibial translation, external–internal tibial rotation, and ligament length changes were measured in 128 healthy participants. They were genotyped for COL12A1 (rs970547) and TNC (rs1061494, rs2104772, rs1138545). Results: Both the COL12A1 AA and TNC rs1061494 TT genotypes were associated with decreased external (p = 0.007, p = 0.010) and internal (p = 0.025, p = 0.002) rotation, as well as slack (p = 0.033, p = 0.014), in the dominant leg. Both genotypes, together with sex, weight, and/or COL1A1 genotypes, explained 26% and 32% of the variance in external and internal rotation, respectively. The TNC genotype, sex, and BMI explained 23% of the variance in slack. The COL12A1 AA and the TNC rs1061494 TT genotypes were associated with smaller changes in the MCL (aMCL: COL12A1 p = 0.009, TNC p = 0.045; iMCL: COL12A1 p = 0.004, TNC p = 0.043; pMCL: COL12A1 p = 0.003, TNC p = 0.067; aDMCL: COL12A1 p = 0.007, TNC p = 0.020; pDMCL: COL12A1 p = 0.007, TNC p = 0.023) and/or LCL (COL12A1 p = 0.652, TNC p = 0.049) lengths within the dominant knee. The TNC rs1061494 CC genotype was associated with larger changes in the non-dominant anterior (p = 0.021) and posterior (p < 0.001) ACL bundle lengths. Conclusions: These findings suggest that COL12A1 and TNC variants are associated with internal–external tibial rotation and knee ligament length changes in healthy individuals. Full article

Background/Objectives: Lateral extraarticular tenodesis (LET) has been advocated in revision anterior cruciate ligament reconstruction (ACLR) to improve knee stability and furthermore, decrease failure rates. The aim of this study was to compare clinical outcomes, knee laxity, and failure rates after revision ACLR with LET (ACLR + LET) versus without LET. It was hypothesized that ACLR + LET improves clinical outcomes and reduces the failure rate. Methods: A retrospective analysis of prospectively collected data was conducted to examine patients who underwent revision ACLR with and without LET between 2017 and 2021 with a minimum follow-up of 24 months. Patients with coronal malalignment (>5°), posterior tibial slope >12°, and concomitant injuries to collateral ligaments were excluded. Patient reported outcome measures (PROMs) included the International Knee Documentation Committee (IKDC) subjective knee score, the Lysholm score, and the Tegner activity scale (TAS). Anterior knee laxity was measured with a Rolimeter and side-to-side difference (SSD) was determined. Revision ACLR failure was defined as ACL revision surgery and SSD > 5 mm. Group comparisons were performed using chi-square-, independent-samples students t-test or Mann–Whitney–U tests. Results: Of 56 eligible patients, 45 (80%, follow up, 23 isolated rACLR vs. 22 rACLR + LET) were included with a mean follow-up of 45.6 ± 15.8 months. Postoperative PROMs were not statistically different between rACLR and rACLR + LET groups (IKDC: 73.0 ± 18.9 vs. 68.7 ± 16.6, n.s.; Lysholm: 84.8 ± 12.3 vs. 77.7 ± 16.2, n.s.). Both groups showed similar TAS (rACLR vs. rACLR +LET (5; range 4–6 vs. 4; range 3–5; n.s.). Anterior knee laxity SSD was 2.4 ± 1.3 mm in the rACLR group and 1.8 ± 1.8 mm in the rACLR + LET group (n.s.). The failure rate was 13% in the rACLR group compared to 4.5% in the rACLR + LET group (n.s.). Conclusions: Isolated revision ACLR showed comparable postoperative patient-reported outcome measures and anterior knee laxity compared to ACLR + LET at mid-term follow up. The addition of a LET demonstrated a lower, though non-significant, failure rate after revision surgery. However, future studies with a prospective, randomized design and an increased number of patients are needed to clearly identify the exact indication for the use of additional LET. Full article

Current surgical practices in total knee arthroplasty (TKA) have advanced and include significant changes and improvements in alignment philosophies, femorotibial implant conformities, and ligament management to replicate in vivo knee kinematics. While corrective measures have emphasized sagittal plane alignment to restore normal flexion–extension (F–E) motion and coronal plane ligament balance, internal–external (I–E) rotation kinematics in the axial plane have been largely neglected. Recent in vivo evidence indicates that the combination of factors necessary to closely restore native tibial rotation as the knee flexes and extends is kinematic alignment (KA), which resurfaces the patient’s pre-arthritic knee without releasing ligaments, an insert with medial 1:1 ball-in-socket conformity and a lateral flat surface, and posterior cruciate ligament (PCL) retention. However, the inherent anterior–posterior (A–P) stability provided by the medial 1:1 ball-in-socket limits the surgeon’s ability to select the correct insert thickness using manual laxity testing. Accordingly, this review presents the design and validation of an instrument called an insert goniometer that measures I–E tibial rotation for inserts that differ in thickness by 1 mm and uses rotation limits at extension and 90° flexion to select the optimal insert thickness. The optimal thickness is the one that provides the greatest external tibial orientation in extension and internal tibial orientation at 90° flexion without lift-off of the insert. Full article