Range of Motion, Strength, and Function After ACL Reconstruction Using a Contralateral Patellar Tendon Graft.

Background: Regaining preinjury levels of activity and progressing rehabilitation factors after anterior cruciate ligament (ACL) reconstruction have shown mixed results.

Purpose: To evaluate the timing and rate of return for knee range of motion (ROM), stability, strength, and subjective scores after ACL reconstruction with contralateral patellar tendon graft (PTG).

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

Posterior Tibial Slope in Patients Undergoing Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft: Analysis of Subsequent ACL Graft Tear or Contralateral ACL Tear.

Background: Reports on greater posterior tibial slope (PTS) and its relationship to subsequent anterior cruciate ligament (ACL) injury show conflicting results; it has not been studied much in patients after ACL reconstruction with patellar tendon autograft (PTG).

Hypothesis: Patients who suffered a subsequent ACL injury would have a larger PTS than patients who did not suffer a subsequent injury after primary or revision ACL reconstruction.

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

Knee Osteoarthritis: Alternative Range of Motion Treatment.

The number of total knee arthroplasty (TKA) surgeries is expected to soar, and an effective nonoperative rehabilitation program is needed. We began treating patients with knee osteoarthritis with a range-of-motion (ROM) -based rehabilitation program that was delivered systematically, starting with ROM exercises for knee extension, followed by exercises for flexion and swelling reduction, before starting a strengthening program. In a group of 396 patients, significant improvements were made in knee extension, flexion, and KOOS subjective scores for pain, symptoms, activities of daily living, sport, and quality of life.

A Novel Skin Closure Device for Total Knee Arthroplasty: Randomized Controlled Trial versus Staples.

Twenty-five patients undergoing simultaneous, bilateral total knee arthroplasty (TKA) were randomized to receive skin closure with Zip device on one knee and staples on the other. Patients' pain and scar appearance were rated from 0 (best) to 10 (worst). Knee arc of motion was measured by a physical therapist.

Results of Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autografts: Objective Factors Associated With the Development of Osteoarthritis at 20 to 33 Years After Surgery.

Background: Few studies exist that report objective radiographic and physical examination results at >20 years after anterior cruciate ligament (ACL) reconstruction.

Hypothesis: The risk of osteoarthritis (OA) at >20 years after surgery would be statistically significantly higher if an increased severity of factors was present.

Study Design: Cohort study; Level of evidence, 2.

Continuous Infusion Ketorolac for Postoperative Analgesia Following Unilateral Total Knee Arthroplasty.

Background: Previous clinical trials have demonstrated benefit with the addition of continuous infusion (CI) ketorolac to a multimodal pain regimen in surgical patients. Data following major orthopedic surgery are minimal and conflicting.

Objectives: To evaluate CI ketorolac use following unilateral total knee arthroplasty (TKA) through assessment of patient-reported pain scores, opioid consumption, and safety outcomes.

Optimal management of posterior cruciate ligament injuries: current perspectives.

Background: The optimal management of posterior cruciate ligament (PCL) injuries is debated by orthopedic surgeons. A natural history study (NHS) of acute, isolated PCL tears in patients with a mean follow-up of 14.3 years was previously published.

The Degree of Knee Extension Does Not Affect Postoperative Stability or Subsequent Graft Tear Rate After Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft.

Background: There is concern that high degrees of hyperextension may lead to an increase in graft laxity or graft failure after anterior cruciate ligament (ACL) reconstruction.

Hypothesis: Patients with a high degree of hyperextension will have a higher rate of graft tear/failure and lower subjective scores after surgery compared with patients with less knee extension.

Study Design: Cohort study, Level of evidence, 2.

Evaluation of Peripheral Vertical Nondegenerative Medial Meniscus Tears Treated With Trephination Alone at the Time of Anterior Cruciate Ligament Reconstruction.

Purpose: To determine (1) subjective results and incidence of symptomatic medial meniscus tears (MMTs) in patients treated with trephination alone compared with a control group without meniscus tears and (2) if trephination treatment resulted in a higher incidence of knee arthritis compared with controls with intact menisci.

Methods: Between 1997 and 2010, 419 patients met the inclusion criteria of having an isolated anterior cruciate ligament (ACL) tear, peripheral vertical nondegenerative MMT treated with trephination alone, no lateral meniscus tears, normal radiographs before surgery, and no bilateral knee involvement. A control group of 462 patients included patients who met the same criteria but without MMT.

Total knee replacement in young, active patients: long-term follow-up and functional outcome: a concise follow-up of a previous report.

Concern exists regarding the long-term durability and effectiveness of total knee arthroplasty in young patients. We reviewed our experience with total knee arthroplasty in patients fifty-five years old and younger with severe osteoarthritis to determine the long-term outcomes. One hundred and fourteen total knee arthroplasties were performed in eighty-eight patients at an average patient age of fifty-one years.

Return to Sports and Subsequent Injury Rates After Revision Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft.

Background: The return-to-sport and reinjury rates are not well defined after revision anterior cruciate ligament (ACL) reconstruction.

Hypothesis: School-age athletes would have a higher rate of return to sports and reinjury to either knee after revision ACL surgery compared with college or recreational athletes.

Study Design: Cohort study; Level of evidence, 2.

Nonoperative management of a partial patellar tendon rupture after bone-patellar tendon-bone graft harvest for ACL reconstruction.

This is a case report of a young athlete who sustained a partial tear of the patellar tendon after anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone (BPTB) autograft. The injury, diagnostic workup, and decision-making process that lead to the choice of nonsurgical treatment are described. Furthermore, the rehabilitation process is described in detail.

Tear patterns, surgical repair, and clinical outcomes of patellar tendon ruptures after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft.

Background: Patellar tendon ruptures are rare after graft harvest for anterior cruciate ligament (ACL) reconstruction. Few reports are available in the literature.

Purpose: To report the common tear patterns and results of treatment with tendon repair and cable augmentation.

How does TKA kinematics vary with transverse plane alignment changes in a contemporary implant?

Background: Assessment of patient function after TKA often focuses on implant alignment and daily activity capabilities, but the functional results and kinematics of the TKA are not easily predicted by some of these parameters during surgery.

Questions/purposes: We asked whether differences in implant alignment in the transverse plane may affect fluorokinematics and be one of the many variables that help explain the discrepancies in fluorokinematic results.

Methods: We utilized a computer model (LifeMOD™/KneeSIM; LifeModeler, Inc, San Clemente, CA, USA) to show variability in polyethylene contact patterns.

Infections and patellar tendon ruptures after anterior cruciate ligament reconstruction: a comparison of ipsilateral and contralateral patellar tendon autografts.

Background: No studies document the incidence or results of infections and patellar tendon ruptures after anterior cruciate ligament reconstruction with a contralateral patellar tendon autograft.

Purpose: To determine the results of patients who have infections and patellar tendon ruptures after anterior cruciate ligament reconstruction with a patellar tendon autograft and compare the results between ipsilateral and contralateral grafts.

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

Correlation of joint line tenderness and meniscus pathology in patients with subacute and chronic anterior cruciate ligament injuries.

We evaluated joint line tenderness (JLT) as a test for meniscus pathology in 3531 patients who underwent anterior cruciate ligament (ACL) reconstruction >30 days postinjury. If the patient had no additional giving-way episode after the index ACL injury, the injury was considered subacute; otherwise, it was considered chronic. Immediately before surgery, the presence or absence of medial or lateral JLT was evaluated.

Isolated anterior cruciate ligament reconstruction in the chronic ACL-deficient knee with degenerative medial arthrosis.

Isolated anterior cruciate ligament (ACL) reconstruction may provide long-term symptom relief and improved function in patients with medial knee arthrosis and ACL-deficiency, while delaying or possibly eliminating the need for further surgical intervention. Fifty-three patients who had medial unicompartmental arthrosis and chronic ACL-deficient knees underwent ACL reconstruction alone. Subjective evaluation at mean 10 years postoperatively indicated statistically significant improvement compared to preoperative evaluation and better scores for patients who obtained normal knee range of motion.

Intercondylar notch width measurement differences between African American and white men and women with intact anterior cruciate ligament knees.

Background: A recent report of professional women's basketball found that white European American female players were 6.5 times more likely to tear their anterior cruciate ligament than their nonwhite European American counterparts. African Americans accounted for 95% of the nonwhite European American group.