Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA最新文献

{"title":"Surgical treatment of posterior cruciate ligament lesions does not cause growth disturbances in pediatric patients.","authors":"Helmut Wegmann,&nbsp;Sophie Janout,&nbsp;Michael Novak,&nbsp;Tanja Kraus,&nbsp;Christoph Castellani,&nbsp;Georg Singer,&nbsp;Holger Till","doi":"10.1007/s00167-018-5308-5","DOIUrl":"https://doi.org/10.1007/s00167-018-5308-5","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of the present study was to describe epidemiology, management and outcome of pediatric and adolescent patients with posterior cruciate ligament (PCL) injuries.</p><p><strong>Methods: </strong>Sixteen patients of less than 18 years of age with 7 PCL avulsion fractures and 9 PCL tears were included over a 10-year period. Trauma mechanism, additional injuries and treatment methods were analyzed. Follow-up examination included range of motion and ability to perform squats. Pedi-IKDC and Lysholm score were obtained and posterior shift was measured in kneeling view radiographs and compared to the contralateral side. Patients were grouped into pediatric patients with open physes at the time surgery and adolescent patients with closing or closed physes. In case of open physes, growth disturbances were assessed.</p><p><strong>Results: </strong>Six of the treated patients (median age 12.5 years, range 10-13) had open physes at time of surgery. Five of those sustained avulsion fractures and treatment consisted of open reduction and screw fixation in four cases and graft reconstruction in one case. One patient sustained a PCL tear and underwent graft reconstruction. Follow-up at a median of 71.5 months (range 62-100) did not reveal any growth disturbances. Median Pedi-IKDC was 71.9 (range 51.7-92.1), median Lysholm score was 81.5 (range 66-88) and median posterior shift difference was 2.5 mm (range 0-11). The remaining 10 patients (median age 16 years, range 14-17) had closing/closed physis at the time of operation. Two patients presented with avulsion fractures treated with open reduction and screw fixation and 8 patients sustained PCL tears treated with graft reconstruction. At a median follow-up of 69.5 months (range 11-112), median Pedi-IKDC was 86.8 (range 36.8-97.7), median Lysholm score was 84.0 (range 45-95) and median posterior shift difference was 4 mm (range 0-15).</p><p><strong>Conclusions: </strong>In our small number of pediatric patients with PCL injuries, open reduction and epiphyseal screw fixation of displaced avulsed fractures and steep tunnel drilling in case of PCL reconstruction did not cause growth disturbances. Nevertheless, long-term functional impairment should be expected and close follow-up has to be recommended.</p><p><strong>Level of evidence: </strong>Therapeutic, Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2704-2709"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5308-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36696340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical rectangular tunnels identified with the arthroscopic landmarks result in excellent outcomes in ACL reconstruction with a BTB graft.","authors":"Yuta Tachibana,&nbsp;Konsei Shino,&nbsp;Tatsuo Mae,&nbsp;Ryo Iuchi,&nbsp;Yasuhiro Take,&nbsp;Shigeto Nakagawa","doi":"10.1007/s00167-018-5300-0","DOIUrl":"https://doi.org/10.1007/s00167-018-5300-0","url":null,"abstract":"<p><strong>Purpose: </strong>To elucidate tunnel locations and clinical outcomes after anatomic rectangular tunnel (ART) anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone (BTB) graft.</p><p><strong>Methods: </strong>Sixty-one patients with a primary unilateral ACL injury were included. Tunnels were created inside the ACL attachment areas after carefully removing the ACL remnant and clearly identifying the bony landmarks. Using 3-dimensional computed tomography (3-D CT) images, the proportion of the tunnel apertures to the anatomical attachment areas was evaluated at 3 weeks. The clinical outcomes were evaluated at 2 years postoperatively.</p><p><strong>Results: </strong>Geographically, the 3-D CT evaluation showed the entire femoral tunnel aperture; at least 75% of the entire tibial tunnel aperture area was consistently located inside the anatomical attachment areas surrounded by the bony landmarks. In the International Knee Documentation Committee (IKDC) subjective assessment, all patients were classified as 'normal' or 'nearly normal'. The Lachman test and pivot-shift test were negative in 98.4% and 95.1% of patients, respectively. The mean side-to-side difference of the anterior laxity at the maximum manual force with a KT- 1000 Knee Arthrometer was 0.2 ± 0.9 mm, with 95.1% of patients ranging from - 1 to + 2 mm.</p><p><strong>Conclusion: </strong>By identifying arthroscopic landmarks, the entire femoral tunnel aperture and at least 75% of the entire tibial tunnel aperture area were consistently located inside the anatomical attachment areas. With properly created tunnels inside the anatomical attachment areas, the ART ACLR using a BTB graft could provide satisfactory outcomes both subjectively and objectively in more than 95% of patients.</p><p><strong>Level of evidence: </strong>Case series, Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2680-2690"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5300-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36701897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Recognition of evolving medial patellofemoral anatomy provides insight for reconstruction.","authors":"Miho J Tanaka,&nbsp;Jorge Chahla,&nbsp;Jack Farr,&nbsp;Robert F LaPrade,&nbsp;Elizabeth A Arendt,&nbsp;Vicente Sanchis-Alfonso,&nbsp;William R Post,&nbsp;John P Fulkerson","doi":"10.1007/s00167-018-5304-9","DOIUrl":"https://doi.org/10.1007/s00167-018-5304-9","url":null,"abstract":"<p><p>Unfortunately, the middle name of author was incorrectly published as Jorge A. Chahla instead of Jorge Chahla in the original article.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2551"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5304-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36702020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior cruciate ligament reconstruction is associated with greater tibial tunnel widening when using a bioabsorbable screw compared to an all-inside technique with suspensory fixation.","authors":"Edoardo Monaco,&nbsp;Mattia Fabbri,&nbsp;Andrea Redler,&nbsp;Edoardo Gaj,&nbsp;Angelo De Carli,&nbsp;Giuseppe Argento,&nbsp;Adnan Saithna,&nbsp;Andrea Ferretti","doi":"10.1007/s00167-018-5275-x","DOIUrl":"https://doi.org/10.1007/s00167-018-5275-x","url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical outcomes and tunnel widening following anterior cruciate ligament reconstruction (ACLR) performed with an all-inside technique (Group A) or with a bioabsorbable tibial screw and suspensory femoral fixation (Group B).</p><p><strong>Methods: </strong>Tunnel widening was assessed using computed tomography (CT) and a previously validated analytical best fit cylinder technique at approximately 1-year following ACLR. Clinical follow-up comprised evaluation with IKDC, KSS, Tegner, Lysholm scores, and knee laxity assessment.</p><p><strong>Results: </strong>The study population comprised 22 patients in each group with a median clinical follow-up of 24 months (range 21-27 months). The median duration between ACLR and CT was 13 months (range 12-14 months). There were no significant differences in clinical outcome measures between groups. There were no differences between groups with respect to femoral tunnel widening. However, there was a significantly larger increase in tibial tunnel widening, at the middle portion, in Group B (2.4 ± 1.5 mm) compared to Group A (0.8 ± 0.4 mm) (p = 0.027), and also at the articular portion in Group B (1.5 ± 0.8 mm) compared to Group A (0.8 ± 0.8 mm) (p = 0.027).</p><p><strong>Conclusion: </strong>Tibial tunnel widening after ACLR using hamstring tendon autograft is significantly greater with suspensory femoral fixation and a bioabsorbable tibial interference screw when compared to an all-inside technique at a median follow-up of 2 years. The clinical relevance of this work lies in the rebuttal of concerns arising from biomechanical studies regarding the possibility of increased tunnel widening with an all-inside technique.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2577-2584"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5275-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36704991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synovitis following anterior cruciate ligament reconstruction using the LARS device.","authors":"Scott John Tulloch,&nbsp;Brian Meldan Devitt,&nbsp;Cameron John Norsworthy,&nbsp;Chris Mow","doi":"10.1007/s00167-018-5280-0","DOIUrl":"https://doi.org/10.1007/s00167-018-5280-0","url":null,"abstract":"<p><strong>Purpose: </strong>The Ligament Augmentation and Reconstruction System (LARS^®) has been at the forefront of a recent revival in the use of synthetic ligaments for ACL reconstruction. However, despite promising short-to-mid-term results its role has been approached with caution due to a high number of major complications in previous synthetic graft designs including mechanical failures, synovitis and osteoarthritis. This study aims to report on the incidence of synovitis in a series of patients undergoing second-look surgery following LARS ACL reconstruction.</p><p><strong>Methods: </strong>A retrospective analysis was performed of a single surgeon's series of 12 patients that underwent second-look arthroscopic surgery following primary LARS ACL surgery for indications including mechanical symptoms (meniscal tears/cyclops lesions/chondral flaps) and/or symptomatic instability secondary to LARS failure. In all cases an examination under anaesthesia (EUA) was performed, and a qualitative assessment of the synovium was carried out and graded as normal, reactive or inflammatory. A synovial biopsy was performed in all knees with visible evidence of synovitis and in all cases of LARS failure.</p><p><strong>Results: </strong>The second-look arthroscopy was performed at a mean of 23 months (7-66) after the index surgery. In 6 (50%) knees the LARS device had failed necessitating removal and revision ACL reconstruction, while in the remaining 6 knees the LARS was still intact. Arthroscopic evaluation of the synovium revealed a normal appearance in 8 knees (67%) and reactive synovitis in 4 knees (23%); of these 4 knees, one had an intact LARS device and 3 had failed LARS. Histological examination from these 4 knees and the 3 knees with graft failures without visible synovitis revealed chronic hypertrophic synovitis (moderate 2, mild 5) in all cases with rare giant cells, consistent with a reaction to foreign body material.</p><p><strong>Conclusions: </strong>Foreign body synovitis is a common finding in our series of patients undergoing a repeat arthroscopy following a LARS ACL reconstruction. The histological diagnosis of synovitis was more frequently encountered than an arthroscopic appearance of synovitis. Whilst the results of this case series cannot support a direct causative link between LARS failure and the development of synovitis, this study highlights the need to remain vigilant about the risk of reactive synovitis following LARS ACL reconstruction due to exposure of the knee to foreign body material.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2592-2598"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5280-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36658514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steep lateral tibial slope and lateral-to-medial slope asymmetry are risk factors for concomitant posterolateral meniscus root tears in anterior cruciate ligament injuries.","authors":"Rainer Kolbe,&nbsp;Andrés Schmidt-Hebbel,&nbsp;Philipp Forkel,&nbsp;Jonas Pogorzelski,&nbsp;Andreas B Imhoff,&nbsp;Matthias J Feucht","doi":"10.1007/s00167-018-5279-6","DOIUrl":"https://doi.org/10.1007/s00167-018-5279-6","url":null,"abstract":"<p><strong>Purpose: </strong>To compare sagittal and coronal tibial slopes between anterior cruciate ligament (ACL) injured subjects with and without posterolateral meniscus root tear (PLRT).</p><p><strong>Methods: </strong>A chart review was conducted to identify patients with isolated ACL tears and patients with an associated PLRT. Patients with other concomitant injuries and patients who underwent surgery > 6 months after the injury were excluded. Magnetic resonance image data were used to compare the medial and lateral sagittal tibial slope (MTS and LTS), lateral-to-medial slope asymmetry (LTS-MTS), and coronal slope of the tibial plateau between both groups. Mean LTS and standard deviation (SD) of the control group were calculated, and a value of > mean + 1 SD was considered an abnormal LTS. Interobserver reproducibility was assessed by calculating interclass correlation coefficients (ICCs) of measurements independently obtained by two reviewers.</p><p><strong>Results: </strong>Fifty-nine patients met the in- and exclusion criteria. Thirty nine (66%) had an isolated ACL tear and 20 (34%) had an associated PLRT. Interrater ICCs for LTS, MTS, and coronal slope were 0.930, 0.884 and 0.825, respectively, representing good to excellent interobserver reproducibility. Patients with a PLRT had significantly steeper LTS (8.0 ± 3.2 vs. 4.0 ± 2.0; p < 0.001) and significantly greater difference of LTS-MTS (3.7 ± 2.9 vs. - 0.6 ± 2.0; p < 0.001). Furthermore, patients with abnormal LTS were significantly overrepresented among patients with PLRT (70% vs. 18%; p < 0.001). No significant difference between both groups was found for MTS and coronal slope.</p><p><strong>Conclusion: </strong>A steep lateral tibial slope and lateral-to-medial slope asymmetry are risk factors for concomitant PLRT in ACL-injured subjects.</p><p><strong>Level of evidence: </strong>IV, retrospective cohort study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2585-2591"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5279-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36691280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alignment factors affecting the medial meniscus extrusion increases the risk of osteoarthritis development.","authors":"Norio Goto,&nbsp;Ken Okazaki,&nbsp;Takenori Akiyama,&nbsp;Yukio Akasaki,&nbsp;Hideki Mizu-Uchi,&nbsp;Satoshi Hamai,&nbsp;Shunsuke Nakamura,&nbsp;Yasuharu Nakashima","doi":"10.1007/s00167-018-5286-7","DOIUrl":"https://doi.org/10.1007/s00167-018-5286-7","url":null,"abstract":"<p><strong>Purpose: </strong>Varus alignment is known as one of the major causes of medial compartment osteoarthritis (OA). Medial meniscus extrusion also plays a critical role in the in the development of OA. However, studies on the exact relationship between alignment parameters and medial meniscus extrusion are limited. Therefore, this study aimed to investigate this relationship in patients with knee OA.</p><p><strong>Methods: </strong>Based on a retrospective analysis of the outpatient magnetic resonance imaging (MRI) database, 190 knees were identified to be examined using weight-bearing, whole-leg radiographs and MRIs within 3 months from the first consultation. Subsequently, various parameters of lower leg alignment were measured, which affected the knee varus in radiographs. Finally, a statistical analysis was performed to assess the relationships between the OA grade, distance of medial meniscus extrusion (MME), and alignment parameters; hip-knee-ankle angle (HKAA), percentage of mechanical axis (% MA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA). The subjects were divided according to the presence or absence of MME (Group A: MME distance below 3 mm, Group B: MME distance 3 mm and above) to assess the differences in each alignment parameter correlated with MME distance between the groups.</p><p><strong>Results: </strong>MME distance significantly increased with OA grade progression. HKAA, % MA, MPTA, and JLCA significantly correlated with medial meniscus extrusion distance (r = - 0.21, - 0.23, - 0.16, 0.3, respectively). Multiple regression analysis of each significant alignment combined with age, sex, and body mass index revealed that HKAA, % MA, MPTA, and JLCA were significant independent factors of MME distance (P = 0.008, 0.0026, 0.011, 0.0001, respectively). These significant findings were reinforced in group B. In contrast, the correlation between alignment parameters and medial meniscus extrusion distance was not significant in group A.</p><p><strong>Conclusion: </strong>Varus alignment factors are related to MME distance especially in extruded meniscus knees, as the OA grade progressed. Therefore, the coexistence of varus alignment and MME can be the risk factors for OA progression. As the low MPTA was an independent alignment factor for generating varus alignment, patients with osteoarthritis of the knee with both, low MPTA and MME could be the appropriate candidates for early intervention by high tibial osteotomy.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2617-2623"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5286-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36699363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midbody of the medial meniscus as a reference of preservation in partial meniscectomy for complete discoid lateral meniscus.","authors":"Seong Hwan Kim,&nbsp;JungTae Ahn,&nbsp;Tae Wook Kim,&nbsp;Kang-Il Kim,&nbsp;Sang Hak Lee","doi":"10.1007/s00167-018-5268-9","DOIUrl":"https://doi.org/10.1007/s00167-018-5268-9","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the postoperative size of discoid lateral meniscus using magnetic resonance imaging (MRI) after partial meniscectomy relative to the size of medial meniscus midbody.</p><p><strong>Methods: </strong>This study included 48 patients who underwent arthroscopic partial meniscectomy with or without repair for symptomatic complete discoid meniscus. The intraoperative size of midbody of medial meniscus was used as a reference for partial meniscectomy. MRIs were performed pre- and postoperatively. Quantitative evaluations of the height, width, extrusion of the meniscus, and relative percentage of extrusion in the coronal and sagittal planes were completed. Demographic data, preoperative shift, type of shift, and operative technique were analyzed while considering the remaining meniscus. Logistic regression analyses were used.</p><p><strong>Results: </strong>The mean remaining discoid meniscal width in the coronal plane of MRI was not significantly different from the width of midbody of medial meniscus (9.1 ± 4.2 mm vs. 9.4 ± 1.4 mm, n.s.) Absolute meniscal extrusion and relative percentage of extrusion in the coronal plane and the ratio of t meniscus in sagittal plane of the final MRI were significantly increased as compared with the preoperative MRI. Preoperative shift was a risk factor for the reduction of remaining meniscal width (odds ratio 11.997, p = 0.016, 95% CI 1.586-90.737).</p><p><strong>Conclusion: </strong>The size of midbody of medial meniscus could be a reference for partial meniscectomy in symptomatic complete discoid meniscus. Preoperative shift represents a risk factor for decreased remaining meniscal width. These findings could be helpful in ensuring appropriate surgical planning and explaining poor prognostic factors.</p><p><strong>Level of evidence: </strong>Prospective cohort study, Level II.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2558-2567"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5268-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36704990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased risk of ACL revision with non-surgical treatment of a concomitant medial collateral ligament injury: a study on 19,457 patients from the Swedish National Knee Ligament Registry.","authors":"Eleonor Svantesson,&nbsp;Eric Hamrin Senorski,&nbsp;Eduard Alentorn-Geli,&nbsp;Olof Westin,&nbsp;David Sundemo,&nbsp;Alberto Grassi,&nbsp;Svemir Čustović,&nbsp;Kristian Samuelsson","doi":"10.1007/s00167-018-5237-3","DOIUrl":"https://doi.org/10.1007/s00167-018-5237-3","url":null,"abstract":"<p><strong>Purpose: </strong>To determine how concomitant medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries affect outcome after anterior cruciate ligament (ACL) reconstruction.</p><p><strong>Methods: </strong>Patients aged > 15 years who were registered in the Swedish National Knee Ligament Registry for primary ACL reconstruction between 2005 and 2016 were eligible for inclusion. Patients with a concomitant MCL or LCL injury were stratified according to collateral ligament treatment (non-surgical, repair or reconstruction), and one isolated ACL reconstruction group was created. The outcomes were ACL revision and the 2-year Knee Injury and Osteoarthritis Outcome Score (KOOS), which were analyzed using univariable and multivariable Cox regression and an analysis of covariance, respectively.</p><p><strong>Results: </strong>A total of 19,457 patients (mean age 27.9 years, 59.4% males) met the inclusion criteria. An isolated ACL reconstruction implied a lower risk of ACL revision compared with presence of a non-surgically treated MCL injury (HR = 0.61 [95% CI 0.41-0.89], p = 0.0097) but not compared with MCL repair or reconstruction. A concomitant LCL injury did not impact the risk of ACL revision. Patients with a concomitant MCL or LCL injury reported inferior 2-year KOOS compared with isolated ACL reconstruction. The largest difference was found in the sports and recreation subscale across all groups, with MCL reconstruction resulting in the maximum difference (14.1 points [95% CI 4.3-23.9], p = 0.005).</p><p><strong>Conclusion: </strong>Non-surgical treatment of a concomitant MCL injury in the setting of an ACL reconstruction may increase the risk of ACL revision. However, surgical treatment of the MCL injury was associated with a worse two-year patient-reported knee function. A concomitant LCL injury does not impact the risk of ACL revision compared with an isolated ACL reconstruction.</p><p><strong>Level of evidence: </strong>Cohort study, Level III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2450-2459"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5237-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36675186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial patellofemoral ligament (MPFL) reconstruction using quadriceps tendon autograft provides good clinical, functional and patient-reported outcome measurements (PROM): a 2-year prospective study.","authors":"Gföller Peter,&nbsp;Christian Hoser,&nbsp;Armin Runer,&nbsp;Elisabeth Abermann,&nbsp;Guido Wierer,&nbsp;Christian Fink","doi":"10.1007/s00167-018-5226-6","DOIUrl":"https://doi.org/10.1007/s00167-018-5226-6","url":null,"abstract":"<p><strong>Purpose: </strong>The medial patellofemoral ligament (MPFL) is the most important ligamentous stabilizer preventing lateral patella dislocation. Numerous surgical procedures for MPFL reconstruction have been described in the literature. The aim of this study was to investigate the clinical, functional and patient-reported (PROM) outcomes 2 years after minimally invasive MPFL reconstruction performed using an autologous strip of the quadriceps tendon.</p><p><strong>Methods: </strong>Thirty-six patients (38 knees) were included in the study. For MPFL reconstruction, a partial thickness autologous quadriceps tendon graft was used. All patients were evaluated clinically and with patient-reported outcome questionnaires including the Tegner, Lysholm and Kujala scores as well as a visual analogue scale (VAS) for pain preoperatively and at 6, 12 and 24 months postoperatively. A functional Back-in-Action (BIA) test battery, including a total of seven stability, agility and jumping tests, was performed on 19 (50%) patients at the final follow-up. One patient was lost to follow-up at 24 months.</p><p><strong>Results: </strong>The mean age at the time of operation was 25.2 ± 6.1 years. No redislocations occurred during the period of investigation. The mean Lysholm score improved significantly from 79.3 ± 16.1 preoperatively to 83.2 ± 14.4 at 6 months, 88.1 ± 11.3 at 12 months and to 90.0 ± 9.6 at 24 months follow-up. No change throughout the study period was observed for the median Tegner Activity Score (median 6). The mean Kujala score increased from a preoperative value of 82.0 ± 12.4, to 84.5 ± 8.4 at 6 months, and 88.2 ± 5.8 at 12 months up to 88.7 ± 4.5 at 24 months follow-up. A total of 77.8% of the performed functional BIA tests were equal to or above the norm for patients of the corresponding ages and activity levels.</p><p><strong>Conclusions: </strong>Minimally invasive MPFL reconstruction with a partial thickness strip of quadriceps tendon is a safe and effective treatment for patellofemoral instability. Good clinical, functional and subjective results were observed at the 2-year follow-up.</p><p><strong>Level of evidence: </strong>Prospective cohort study, non-randomized, Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2426-2432"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5226-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36675189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}