To evaluate the anatomic geometry of the posterior intercondylar eminence and its association with PCL injury risk.Patients who underwent primary PCL reconstruction from 2015 to 2018 were retrospectively analyzed. The control group included inpatients diagnosed with ACL rupture because of a sports-related accident during the same period, matched by age, gender, height, weight, and side of injury. Measurements of the height of the apex of the posterior intercondylar eminence (HPIE), the slope length (SLPIE) and the slope angle (SAPIE) of the posterior intercondylar eminence were performed using conventional MRI scans assessed by 2 blinded, independent raters. Intraclass correlation coefficients (ICCs) was used to evaluate the consistency of measurement results. Independent sample t tests, Chi-square tests, and logistic analyses were used to compare the two group, with P < 0.05 considered statistically significant.Fifty-five patients with PCL rupture met the inclusion criteria and 55 PCL-intact matched controls were included. There were no significant differences between the groups in gender (P = 1.000), limb side (P = 0.848), age (P = 0.291), BMI (P = 0.444) or height (P = 0.290). Inter-observer reproducibility was excellent agreement in HPIE, SLPIE and SAPIE of case and control groups (ICC: HPIE = 0.81, SLPIE = 0.77, SAPIE = 0.85). Patients with PCL rupture had significantly greater HPIE, SAPIE (both P < 0.001), and SLPIE (P < 0.05) than PCL-intact patients. The multivariable analysis showed that HPIE (OR, 1.62 [95% CI, 1.24-2.11], P < 0.001) and SAPIE (OR, 1.17 [95% CI, 1.05-1.31], P < 0.001) were independent factors associated with PCL rupture.Through this retrospective observational study, we found that patients with PCL rupture may have a higher posterior intercondylar eminence compared to PCL-intact patients.III.
Patients with simultaneous ruptures of the patellar tendon (PT) and anterior cruciate ligament (ACL) underwent PT repair and ACL reconstruction in a single or staged surgery. However, due to the limited cases, the design of previous studies was mostly case report with varying conclusions regarding recommended surgical strategy selection, the optimal surgical strategy remains a subject of debate. We conducted a retrospective case series and literature review, including 10 cases from local institution and 27 cases from 17 studies. Demographic information, injury causes, surgical strategies, combined injuries, whether to return to (pre-injury level) sports, postoperative complications, Lysholm score and International Knee Documentation Committee (IKDC) score were identified retrospectively or reviewed from previous studies. The Fisher's exact test was used to compare the incidence of postoperative complications between different surgical strategy groups, and linear logistic regression was used to analyze factors influencing postoperative knee function scores. Of the 37 patients, 15 patients (40.5%) underwent single surgery and 22 patients (59.5%) underwent staged surgery. Postoperative complications occurred in 5 (33.3%) patients after single surgery and in none after staged surgery, with the former being significantly more frequent than the latter (P = 0.007). Linear regression of postoperative knee function scores showed that surgical strategy did not significantly affect postoperative Lysholm and IKDC scores (P = 0.327 and P = 0.348, respectively). This study demonstrates that staged surgery significantly reduces postoperative complications compared to single surgery in patients with simultaneous PT and ACL ruptures and should be considered the preferred approach, especially when an expedited return to sports is not a priority.
To translate the English version of Tegner Activity Score into a Simplified-Chinese version (Tegner-C) and evaluate its psychometric properties.Tegner-C was cross-culturally adapted according to established guidelines. The validity and reliability of Tegner-C were assessed in 78 participants, with 19-20 participants in each of the four groups: before anterior cruciate ligament reconstruction (pre-ACLR) group, 2-3 months after ACLR group, 3-12 months after ACLR group, and healthy control group. Each participant was asked to complete the Tegner-C and Chinese version of International Knee Documentation Committee Subjective Knee Form (IKDC-SKF-C) twice, with an interval of 5±2 days. Intra-class correlation coefficient (ICC2, 1) was used to assess the reliability and Spearman's rank correlation was used for construct validity.The ICC2,1 was higher than 0.90 for all groups except in the pre-ACLR group, for which the ICC2,1 was 0.71 (0.41, 0.87) (All with p<0.001). The absolute reliability as evaluated by the smallest detectable change was 0.43, 2.12, 0.89, and 0.44 for the healthy control group, pre-ACLR group, 2-3 months after ACLR group, and 3-12 months after ACLR group, respectively. Neither a ceiling effect nor a floor effect was observed for any group. Significant difference was observed for both Tegner-C and IKDC-SKF-C scores between the control and the other three groups (all with p<0.001), and between pre-ACLR and the 2-3 months after ACLR group (p<0.001).Tegner-C demonstrated comparable psychometric properties to the original English version and thus is reliable and valid for Chinese-speaking patients with ACL injury.
Background: Nonanatomic transtibial single-bundle anterior cruciate ligament reconstruction (SB-ACLR) with a bone–patellar tendon–bone (BPTB) allograft has been used for a long time and has shown the same satisfactory clinical results as an autograft; however, it has not been reported if a double-bundle ACLR (DB-ACLR) could be performed with a BPTB allograft and achieve even better results. Hypothesis: The DB-ACLR with a BPTB allograft is technically feasible and will be superior to the SB technique in restoring better anterior and rotating stability. Study Design: Cohort study; Level of evidence, 2. Methods: The study was performed with 56 patients, and 52 (25 in the DB group and 27 in the SB group) of them were followed up at 2 to 5 years. With an irradiated deep-frozen BPTB allograft, a standard single-incision arthroscopic technique was used, and the graft was fixed with bioabsorbable interference screws on both the femoral and tibial sides. Outcome assessment at final follow-up included International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores; side-to-side difference by conventional KT-2000 arthrometer; total anteroposterior (AP) laxity by the back-pushing KT-2000 arthrometer; pivot shift (0, +, ++); range of motion (ROM); and isokinetic muscle strength evaluation. Results: Mean follow-up was 47.3 ± 11.5 and 58.2 ± 6.6 months for the DB group and SB group, respectively. A statistically significant difference in favor of the DB group was found with the total AP laxity at 30° ( P < .05). The overall incidence of pivot shift in the DB group (4% ++) was significantly lower than that in the SB group (26%: 19% + and 7% ++; P = .029). No significant differences were found between the 2 groups in terms of IKDC score, Lysholm score, Tegner score, conventional KT-2000 arthrometer anterior laxity, ROM, and muscle strength. Conclusion: A DB-ACLR with a BPTB allograft is feasible and achieved more satisfactory results than the transtibial SB technique in terms of total AP stability and rotational stability in spite of no significant differences among other clinical parameters.
Purpose The anterior flange height of the current femoral component increases with an increasing distal femoral anteroposterior dimension. During total knee arthroplasty (TKA), we have observed that a large femur may have a thinner anterior condyle, whereas a small femur may have a thicker anterior condyle. The first purpose of this study was to examine whether the femoral anterior condyle height decreases as the distal femoral anteroposterior size increases and whether gender differences exist in anterior condyle height. Methods A total of 1218 knees undergoing TKA intraoperative and computed tomography scans from 303 healthy knees were used to measure the anterior lateral condylar height (ALCH), anterior medial condylar height (AMCH), and the lateral anteroposterior (LAP) and medial anteroposterior (MAP) dimensions of distal femurs. The LAP and MAP measurements were used for adjustments to determine whether gender differences exist in anterior condyle heights. Linear regression analysis was performed to determine correlations between ALCH and LAP or between AMCH and MAP. Results There were significant differences between males and females in ALCH in both the CT and TKA groups and AMCH in the CT group (all P<0.01). After adjusting for LAP and MAP, there were significant gender differences in the lateral and medial condylar heights in both groups (P<0.01). There were significant negative correlations between ALCH and LAP values and between AMCH and MAP values in both CT and TKA measurements, with the LAP and MAP values increasing as ALCH and AMCH decreased. Conclusions The results demonstrate that femoral anterior condylar height decreased with increasing anteroposterior dimension in both the medial and lateral condyle. In addition, this study also showed that anterior condylar heights are highly variable, with gender differences. The data may provide an important reference for designing femoral anterior flange thickness to precisely match the natural anterior condylar anatomy.
Background: The incidence of the patellofemoral joint chondral lesions after anterior cruciate ligament reconstruction (ACLR) is disturbingly high. Few studies have assessed the factors affecting patellofemoral joint chondral lesions postoperatively. Hypothesis: The recovery of quadriceps strength after ACLR could be associated with patellofemoral joint cartilage damage. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 88 patients who underwent arthroscopic anatomic double-bundle ACLR with hamstring autografts received second-look arthroscopy at the time of metal staple removal at an average of 24.1 months (range, 12-51 months) postoperatively. All patients underwent standardized isokinetic strength testing for bilateral quadriceps and hamstrings 1 to 2 days before second-look arthroscopy. The patients were divided into 2 groups: Patients in group 1 had a ≥20% deficit on the peak torque measures for quadriceps compared with that of the contralateral knee, whereas those in group 2 had a <20% deficit on peak torque. Cartilage status at the patellofemoral joint and tibiofemoral joint were evaluated by second-look arthroscopy and the Outerbridge classification. Other assessments included the International Knee Documentation Committee (IKDC) score, Tegner and Lysholm scores, side-to-side difference on KT-2000 arthrometer, and range of motion. Results: There were 42 patients included in group 1 and 46 patients in group 2. The mean postoperative quadriceps peak torque of the involved knee compared with the contralateral knee was 70% (range, 57%-80%) in group 1 and 95% (range, 81%-116%) in group 2. For all patients, a significant worsening was seen in the patellar and trochlear cartilage ( P = .030 and <.001, respectively) but not at the medial or lateral tibiofemoral joint after ACLR. A significant worsening in the status of both patellar and trochlear cartilage was seen after ACLR in group 1 ( P = .013 and =.011, respectively) and of trochlear cartilage in group 2 ( P = .006). Significantly fewer severe chondral lesions of the patella were found in group 2 than in group 1 (proportion of patients whose cartilage grade worsened: 26% vs 48%, P < .05; difference in cartilage grade: 0.09 vs 0.62, P < .05). There was no significant difference for trochlear chondral worsening between the 2 groups. No significant differences were detected between the 2 groups in terms of hamstring strength; Lysholm, Tegner, and IKDC scores; KT-2000 arthrometer anterior laxity; or range of motion. Conclusion: Greater than 80% recovery of quadriceps strength after ACLR is associated with less severe patellar cartilage damage at short-term follow-up.
Background: Double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) has been reported to yield better joint stability than single-bundle (SB) reconstruction. Few studies have compared the 2 techniques with regard to postoperative articular cartilage changes. Hypothesis: Less cartilage damage should occur in the short term after DB ACLR than after SB ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: The study included 52 patients (27 in the DB group and 25 in the SB group) with no chondral or meniscus injury at primary ACLR, as confirmed under arthroscopy. Four-strand and 6- to 8-strand hamstring autografts, respectively, were used for transtibial SB and 4-tunnel DB reconstruction. Each graft was fixed with an EndoButton bioabsorbable interference screw and a staple. Cartilage status at 6 identified regions was evaluated by second-look arthroscopy and the Outerbridge classification. Other assessments at final follow-up included International Knee Documentation Committee (IKDC) score, Tegner and Lysholm scores, side-to-side difference on KT-2000 arthrometer, and range of motion. Results: The mean time from reconstruction to second-look arthroscopy was 18.2 and 17.3 months for the DB and SB groups, respectively. Both groups had cartilage lesions at the patellofemoral joint (patella, 9 vs 13; trochlea, 5 vs 12) and the medial compartment (1 vs 2). Significantly less severe lesions were found in the DB group than in the SB group (mean grade, 0.33 vs 0.96; P < .05). No significant differences were found between the 2 groups in terms of cartilage status at other regions, IKDC score, Lysholm score, Tegner score, KT-2000 arthrometer anterior laxity, or range of motion. Conclusion: Chondral lesions were found postoperatively in both DB and SB ACLR groups with hamstring autograft. The DB ALCR led to less cartilage damage at the femoral trochlea at short-term follow-up.
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