Evaluation of Factors Associated With Short-term Failure After Primary Isolated PCL Reconstruction: A Study of Patients From the Swedish and Norwegian Knee Ligament Registries.

Background: The rate of subjective failure after isolated primary posterior cruciate ligament reconstruction (PCL-R) is relatively high, requiring an improved understanding of factors associated with inferior outcomes.

Purpose: To determine the association between patient and injury-related factors and total (surgical and clinical) failure at 2 years after PCL-R based on data from the Swedish National Knee Ligament Registry (SNKLR) and the Norwegian Knee Ligament Registry (NKLR).

Study Design: Cohort study; Level of evidence, 3.

Meniscal forces and knee kinematics are affected by tibial slope modifying high tibial osteotomy.

Purpose: To quantify the effect of increasing the posterior tibial slope (PTS) on knee kinematics and the resultant medial and lateral meniscal forces.

Methods: In this controlled laboratory study, a 6 degrees of freedom (DOF) robotic testing system was used to apply external loading conditions to seven fresh-frozen human cadaveric knees: (1) 200-N axial compressive load, (2) 5-N m internal tibial +10-N m valgus torque and (3) 5-N m external tibial + 10-N m varus torque. Knee kinematics and the resultant medial and lateral meniscal forces were acquired for two PTS states: (1) native PTS and (2) increased PTS.

Controversies in Timing of Surgery and Rehabilitation for Multiligamentous Knee Injuries.

With an estimated incidence of 0.02% to 0.2%, multiligamentous knee injuries are rare, often devastating injuries that can occur with concomitant vascular or neurologic involvement.

Technical Tips and Tricks for Knee Osteotomy.

Osteotomies around the knee have a variety of indications, including pain reduction, functional improvement, knee joint stabilization, and articular cartilage preservation. Thorough preoperative planning is essential, including a determination of the precise location of any deformity (proximal tibia, distal femur, or both). High tibial osteotomies and distal femoral osteotomies can be performed in isolation, or jointly in the form of a double-level osteotomy, for correction of coronal and/or sagittal deformity of the knee.

A simple, subjective, knee self-evaluation using a single question can be used for a quick assessment of patients undergoing knee surgery.

Purpose: The use of patient-reported outcome measures (PROMS) is the cornerstone of clinical research for surgical disciplines, but the use in daily routine can be challenging. One of the most widespread PROMS in knee surgery is the International Knee Documentation Committee (IKDC) questionnaire. The purpose of the present study was to investigate the potential correlation of the IKDC score with a patient's subjective assessment of the knee using a single question.

How Can the Environmental Impact of Orthopaedic Surgery Be Measured and Reduced? Using Anterior Cruciate Ligament Reconstruction as a Test Case.

Background: The healthcare sector in the United States has increased its greenhouse gas emissions by 6% since 2010 and today has the highest per capita greenhouse gas emissions globally. Assessing the environmental impact and material use through the methods of life cycle assessment (LCA) and material flow analysis (MFA) of healthcare procedures, products, and processes can aid in developing impactful strategies for reductions, yet such assessments have not been performed in orthopaedic surgery. We conducted an LCA and an MFA on an ACL reconstruction (ACLR).

Functional knee bracing provides protection to the anterior cruciate ligament in response to rotatory loads.

Background: The aim of the study was to quantify the effect of functional knee bracing on native knee kinematics and the in-situ force in the ACL in response to external loading.

Methods: A robotic testing system was used to apply three external loads from full extension to 60° of flexion to eight fresh frozen human cadaveric knees: 1) a 134 N anterior load, 2) a combined 5-Nm internal rotation +5-Nm valgus torque, and 3) a combined 5-Nm external rotation +5-Nm valgus torque. For native and braced states, kinematics were recorded and the in-situ force in the ACL was determined.

Primary Anterior Cruciate Ligament Injury: Extrinsic and Intrinsic Risk Factors.

Anterior cruciate ligament (ACL) injuries continue to increase in incidence despite extensive research into prevention strategies. Many extrinsic and intrinsic risk factors for sustaining ACL injuries have been identified and continue to be investigated. Extrinsic risk factors for ACL injury relate to the athlete's environment, such as the shoe-surface interaction, weather conditions, and sport played.

Demographic and surgical characteristics in patients who do not achieve minimal important change in the KOOS Sport/Rec and QoL after ACL reconstruction: a comparative study from the Swedish National Knee Ligament Registry.

Objectives: This study aimed to compare demographic and surgical characteristics between patients who do and do not achieve minimal important change (MIC) in the Knee injury and Osteoarthritis Outcome Score (KOOS) Sports and Recreation (Sport/Rec) and Quality of Life (QoL) subscales 1 year after anterior cruciate ligament reconstruction.

Design: Comparative cross-sectional.

Setting: The MIC for the KOOS Sport/Rec subscale was ≥12.

Multiligament knee injury (MLKI): an expert consensus statement on nomenclature, diagnosis, treatment and rehabilitation.

Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study.

Increased rate of surgery for loss of motion following anterior cruciate ligament reconstruction during COVID-19.

Objectives: To investigate the incidence and risk factors associated with loss of motion after anterior cruciate ligament reconstruction (ACLR) during the coronavirus disease 2019 pandemic (COVID-19).

Methods: A retrospective review of patients undergoing primary ACLR between March 2017 and November 2022 by a senior high-volume orthopaedic surgeon was performed. Exclusion criteria included revision ACLR, multiligamentous knee surgery, and age <14 years.

Timing of Surgery & Rehabilitation After Multiligamentous Knee Reconstruction.

Purpose Of Review: To provide an overview of the current evidence of the timing of surgery and rehabilitation after multiligamentous knee injuries (MLKIs) and offer insights into the ongoing multi-center randomized controlled study, the 'STaR trial'.

Recent Findings: Due to the complexity of the MKLIs, they are usually treated surgically with the goal of either repairing or reconstructing the injured ligaments. Although the current literature on MLKIs is relatively extensive, the consensus on the timing of surgery or rehabilitation following surgery for MLKIs is still lacking.

Association of Smaller Intercondylar Notch Size With Graft Failure After Anterior Cruciate Ligament Reconstruction.

Background: Smaller intercondylar notch sizes have been consistently associated with a predisposition for primary anterior cruciate ligament tears.

Purpose: To evaluate the association between intercondylar notch size, graft size, and postoperative complications, including knee stiffness and return to the operating room, after primary anatomic anterior cruciate ligament reconstruction (ACLR).

Study Design: Case-control study; Level of evidence, 3.

Quadriceps tendon size does not affect postoperative strength recovery following quadriceps tendon anterior cruciate ligament reconstruction.

Objective: The influence of quadriceps tendon (QT) size on postoperative quadriceps strength following QT anterior cruciate ligament reconstruction (ACLR) is unclear. Therefore, this study aimed to determine the relationship between QT morphology and postoperative quadriceps strength recovery following primary ACLR using a QT autograft.

Methods: Patients who underwent primary ACLR using QT autograft from 2014 to 2022 followed by a postoperative isometric strength measurement between 5 and 8 months were retrospectively reviewed.

Registry-based cohort study comparing percentages of patients reaching PASS for knee function outcomes after revision ACLR compared to primary ACLR.

Objectives: Reaching the Patient-Acceptable Symptom State (PASS) threshold for the Knee injury and Osteoarthritis Outcome Score (KOOS) has previously been reported to successfully identify individuals experiencing clinical success after anterior cruciate ligament reconstruction (ACLR). Thus, the objectives of this study were to examine and compare the percentages of patients meeting PASS thresholds for the different KOOS subscales 1 year postoperatively after primary ACLR compared with revision ACLR (rACLR) and multiply revised ACLR (mrACLR), and second, to examine the predictors for reaching PASS for KOOS Quality of Life (QoL) and Function in Sport and Recreation (Sport/Rec) after mrACLR.

Design: Prospective observational registry study.

Outcomes After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon in Adolescent Athletes at Mean Follow-up of 4 Years.

Background: Despite increasing use of quadriceps tendon (QT) autograft in anterior cruciate ligament (ACL) reconstruction (ACLR), limited data exist regarding its outcomes in high-risk adolescent athletes.

Purpose: To (1) report the outcomes after QT ACLR in adolescent athletes and (2) identify patient-related and surgery-related factors that may influence failure rates after QT ACLR.

Study Design: Case series; Level of evidence, 4.

Slope Osteotomies in the Setting of Anterior Cruciate Ligament Deficiency.

➤ Posterior tibial slope (PTS) of ≥12° represents an important risk factor for both anterior cruciate ligament (ACL) injury and ACL reconstruction failure.➤ PTS measurements can significantly differ on the basis of the imaging modality and the measurement technique used. PTS should be measured on strictly lateral radiographs, with a recommended proximal tibial length of 15 cm in the image.

Reliability and changes in knee cartilage T2 relaxation time from 6 to 24 months after anatomic anterior cruciate ligament reconstruction.

The objectives of this study were to evaluate the reliability of cartilage T2 relaxation time measurements and to identify focal changes in T2 relaxation on the affected knee from 6 to 24 months after anatomic anterior cruciate ligament reconstruction (ACLR). Data from 41 patients who received anatomic ACLR were analyzed. A bilateral 3.

Effect of the Material Properties and Knee Position to the Bone Bruise Pattern in Skeletally Mature and Immature Subjects.

A bone bruise is generated by a bony collision that could occur when the anterior cruciate ligament (ACL) is injured, and its pattern reflects the injury mechanism and skeletal maturity. Thus, the bone bruise pattern is useful to predict a subject-specific injury mechanism, although the sensitivity and/or effect of the material property and the knee position at injury is still unclear. The objective of the present study was to determine the effect of the material property and knee position on the bone bruise pattern in skeletally mature and immature subjects using finite element analysis.