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.

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.

Editorial Commentary: Meniscus Tears Seen at the Time of Anterior Cruciate Ligament Reconstruction Are Overtreated.

Meniscus tears seen at the time of anterior cruciate ligament reconstruction are usually asymptomatic, and treatment varies greatly between surgeons, with meniscus repair being used for tears that could be left in situ. Recent outcome studies of most types of lateral meniscus tears show that leaving the tears in situ can give equal or superior results. Meniscus repair being performed for degenerative medial meniscus tears does not give better results than removing the tears.

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.

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.

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.

Anterior cruciate ligament reconstruction with contralateral autogenous patellar tendon graft: evaluation of donor site strength and subjective results.

Background: Few surgeons use a contralateral patellar tendon autograft for primary anterior cruciate ligament (ACL) reconstruction because of concern for donor site morbidity.

Hypothesis: There will be no difference in quadriceps muscle strength or International Knee Documentation Committee (IKDC) subjective scores in patients with contralateral grafts compared with patients with ipsilateral grafts.

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

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.

Evaluation of Joint Space Width and Narrowing After Isolated Partial Medial Meniscectomy for Degenerative Medial Meniscus Tears.

Background: Few studies have evaluated the effect of existing articular cartilage damage and sex on joint space measurements after isolated degenerative medial meniscus tears.

Purpose: To determine what factors affected joint space width and narrowing in patients after removal of isolated degenerative medial meniscus tears.

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

Minimum 10-year follow-up of patients after an acute, isolated posterior cruciate ligament injury treated nonoperatively.

Background: Few studies report long-term subjective or objective results for acute, isolated posterior cruciate ligament (PCL) injuries in patients followed prospectively.

Hypothesis: Subjective or objective results will not differ based on PCL laxity.

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

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.

Results of medial retinacular imbrication in patients with unilateral patellar dislocation.

Many surgical methods are used for treating malaligned patella after patellar dislocation, but one surgical method may not be appropriate for all patients. The purpose of this study was to determine the radiographic and subjective outcomes of patients who underwent imbrication of redundant medial structures. A total of 42 patients met the inclusion criteria of suffering a traumatic, unilateral patellar dislocation and had no J-sign, no patella alta, asymmetry on Merchant view radiograph with normal patella alignment on the noninvolved side, and MRI showing injury to the medial retinaculum.

Osteoarthritis after anterior cruciate ligament reconstruction: the importance of regaining and maintaining full range of motion.

Context: Several factors have been associated with the development of osteoarthritis after anterior cruciate ligament (ACL) reconstruction, yet little attention has been given to the association between range of motion (ROM) and osteoarthritis after ACL reconstruction. Several studies have shown a link between ROM loss and a higher incidence of osteoarthritis.

Evidence Acquisition: A search was performed with PubMed (MEDLINE) for English-language level I-IV studies involving the long-term evaluation of ROM and osteoarthritis after ACL reconstruction.

Correlation of a single assessment numeric evaluation (SANE) rating with modified Cincinnati knee rating system and IKDC subjective total scores for patients after ACL reconstruction or knee arthroscopy.

Background: Limited studies exist regarding how well a single assessment numeric evaluation (SANE) rating correlates with validated knee surveys.

Purpose: To determine whether a SANE rating correlates positively with the International Knee Documentation Committee (IKDC) and the modified Cincinnati Knee Rating System (CKRS) total scores after knee surgery.

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

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.

Meniscus tears that can be left in situ, with or without trephination or synovial abrasion to stimulate healing.

To determine which meniscus tears to leave in situ, the clinician must know whether the meniscus tear is degenerative or nondegenerative, stable or unstable, in an anterior cruciate ligament (ACL)-stable or ACL-unstable knee, and whether it is in the medial or lateral compartment. Symptomatic medial meniscus tears in ACL-intact knees are almost always degenerative in nature and should be removed. Generally, the only type of medial meniscus that can be left in situ is a peripheral, vertical, nondegenerative tear, but these tears are not displaceable, are asymptomatic, and are usually seen in a patient with an ACL tear.

Loss of normal knee motion after anterior cruciate ligament reconstruction is associated with radiographic arthritic changes after surgery.

Background: Meniscectomy and articular cartilage damage have been found to increase the prevalence of osteoarthritis after anterior cruciate ligament reconstruction, but the effect of knee range of motion has not been extensively studied.

Hypothesis: The prevalence of osteoarthritis as observed on radiographs would be higher in patients who had abnormal knee range of motion compared with patients with normal knee motion, even when grouped for like meniscal or articular cartilage lesions.

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

Outcomes after arthroscopic excision of the bony prominence in the treatment of tibial spine avulsion fractures.

Purpose: The purpose of this study was to determine the outcomes after arthroscopic excision of the bony prominence after a tibial spine avulsion fracture.

Methods: This study included 7 subjects (5 female and 2 male subjects; mean age, 21.4 years).

Rehabilitation following knee dislocation with lateral side injury: implementation of the knee symmetry model.

Rehabilitation following lateral side knee ligament repair or reconstruction has traditionally utilized a conservative approach. An article outlining a new concept in rehabilitation following ACL reconstruction called the Knee Symmetry Model was recently published(13). The Knee Symmetry Model can also be applied to rehabilitation of other knee pathologies including a knee dislocation with a lateral side injury.