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9 pages, 405 KiB

Open AccessArticle

Anterior Cruciate Ligament Reconstruction with LARS Synthetic Ligament: Outcomes and Failures

by Lorenzo Moretti, Raffaele Garofalo, Giuseppe D. Cassano, Alessandro Geronimo, Nicola Reggente, Fabrizio Piacquadio, Davide Bizzoca and Giuseppe Solarino

J. Clin. Med. 2025, 14(1), 32; https://doi.org/10.3390/jcm14010032 - 25 Dec 2024

Viewed by 1477

Abstract

Background: Anterior cruciate ligament (ACL) injuries are common in athletes, but their prevalence has also increased among adults. ACL reconstruction (ACLR) is a key treatment option, with graft choice playing a critical role in recovery. The study evaluates the clinical and functional outcomes [...] Read more.

Background: Anterior cruciate ligament (ACL) injuries are common in athletes, but their prevalence has also increased among adults. ACL reconstruction (ACLR) is a key treatment option, with graft choice playing a critical role in recovery. The study evaluates the clinical and functional outcomes of ACLR using the Ligament Augmentation and Reconstruction System (LARS) in patients over 35 years old. It assesses implant survival, failure rate, and revision rate, and measures quality of life and subjective outcomes. Methods: Fifty-three patients were finally included in this retrospective two-center study. The study assessed quality of life (QoL) and subjective outcomes using IKDC and Lysholm scores, evaluated implant survival and revision rates, and assessed the difference in activity levels between the two years before ACL injury and at follow-up. Results: The study found high Lysholm (90.61) and IKDC (80.25) scores, indicating positive clinical results. However, about 40% of patients did not return to their pre-injury activity levels. The graft failure rate was low at 3.8%, with no cases of infection or implant rejection. Conclusions: The study concluded that LARS ACLR is an effective option for middle-aged patients, offering faster recovery and fewer complications. However, it may not be suitable for younger, professional athletes due to its mechanical limitations. Further research with larger sample sizes and longer follow-up is recommended. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament Reconstruction: Clinical Advances and Prognosis)

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13 pages, 6674 KiB

Open AccessArticle

Anterior Cruciate Ligament Reconstruction Utilizing Double Adjustable-Loop Suspensory Fixation Devices Provides Good Clinical Outcomes in Patients under the Age of 40 Years at Two-Year Follow-Up

by Theofylaktos Kyriakidis, Alexandros Tzaveas, Ioannes Melas, Kosmas Petras, Artemis-Maria Iosifidou and Michael Iosifidis

J. Clin. Med. 2024, 13(18), 5436; https://doi.org/10.3390/jcm13185436 - 13 Sep 2024

Cited by 1 | Viewed by 1464

Abstract

Background: Anterior cruciate ligament reconstruction (ACLR) using double adjustable fixation gained popularity in the last decade due to its minimally invasive technique. However, suspensory fixation devices could be related to recurrent instability, poor clinical outcomes, and patient dissatisfaction. The present study aims to [...] Read more.

Background: Anterior cruciate ligament reconstruction (ACLR) using double adjustable fixation gained popularity in the last decade due to its minimally invasive technique. However, suspensory fixation devices could be related to recurrent instability, poor clinical outcomes, and patient dissatisfaction. The present study aims to evaluate the clinical outcomes following ACLR using double adjustable-loop suspensory fixation devices in the demanding population of young patients. Methods: Between 2019 and 2022, 95 patients with knee post-traumatic anterior cruciate ligament insufficiency were treated with primary ACLR using semitendinosus quadrupled graft and double adjustable-loop suspensory fixation devices and followed for at least two years. Concomitant lesions were also treated at the same surgical time. The knee examination form of the International Knee Documentation Committee (IKDC) was used to assess clinical evaluation, and the return to physical activities using the Tegner Activity Scale was recorded. Patient-reported objective measures (PROMs) were also evaluated, including the IKDC subjective and Lysholm scores. Results: Sixty-six males and twenty-nine females with a mean age of 23.8 (range 18–37) and a mean BMI of 24.9 (SD ± 2.42) kg/m² were included in this study. All patients were evaluated clinically as normal or nearly normal at the final follow-up. PROMs also significantly improved postoperatively (p < 0.05) compared to the preoperative values. The Tegner Activity Scale increased from 2 to 7, the IKDC mean score improved from 43.9 (±8.9) to 93.3 (±12.3), and the modified Lysholm from 47.3 (±11.1) to 92.9 (±16.6). No complications or adverse events were recorded. Conclusions: Anterior cruciate ligament reconstruction utilizing double adjustable-loop suspensory fixation devices provides good clinical and functional outcomes in young patients at a two-year follow-up. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament Reconstruction: Clinical Advances and Prognosis)

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14 pages, 1278 KiB

Open AccessArticle

Reliability and Validity of Temporal Parameters during the Side Hop Test in Patients after Anterior Cruciate Ligament Reconstruction

by Anna Stitelmann, Lara Allet, Stéphane Armand and Philippe Tscholl

J. Clin. Med. 2024, 13(12), 3407; https://doi.org/10.3390/jcm13123407 - 11 Jun 2024

Viewed by 1745

Abstract

Background: The side hop test (SHT) measures the number of jumps performed over 30 s. Although this measure has demonstrated its value in clinical practice, the temporal parameters of the SHT allow for a deeper analysis of the execution strategy. The aim of [...] Read more.

Background: The side hop test (SHT) measures the number of jumps performed over 30 s. Although this measure has demonstrated its value in clinical practice, the temporal parameters of the SHT allow for a deeper analysis of the execution strategy. The aim of this study is to assess the reliability and construct validity of contact time parameters during the SHT recorded by a video analysis system in anterior cruciate ligament reconstructed (ACLR) patients. Methods: We investigated the reliability (intra-rater, standard error of measurement (SEM), and minimum detectable change (MDC)), discriminant validity (operated (OP) versus non-operated (NOP) side), and convergent validity (relationship with strength and psychological readiness) of SHT contact time parameters, number of valid hops and limb symmetry index (LSI) in 38 ACLR patients. Contact time parameters are presented as mean, standard deviation (SD), and coefficient of variation (CV) of contact time. Results: Intra-tester reliability was good to excellent for all contact time parameters. For discriminant validity, the mean and SD contact times of the OP leg were significantly longer than those of the NOP leg, although the difference was smaller than the SEM and MDC values. The number of valid jumps and CV contact time parameters were not significantly different. Isokinetic quadriceps strength (60°/s) was strongly correlated with mean contact time for both legs. However, psychological readiness was not correlated with any of the contact time parameters. Conclusions: Temporal parameters of the SHT measured on video analysis are valid and reliable parameters to assess the performance strategy of the SHT. The results should be interpreted with caution regarding the SEM and MDC values. Further studies are needed to measure criterion validity, inter-rater reliability, and responsiveness. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament Reconstruction: Clinical Advances and Prognosis)

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14 pages, 993 KiB

Open AccessArticle

Impact of Surgical Timing on Functional Outcomes after Anterior Cruciate Ligament Reconstruction

by Tatsuhiro Kawashima, Hirotaka Mutsuzaki, Arata Watanabe, Kotaro Ikeda, Yuki Yamanashi and Tomonori Kinugasa

J. Clin. Med. 2024, 13(10), 2994; https://doi.org/10.3390/jcm13102994 - 20 May 2024

Cited by 3 | Viewed by 2064

Abstract

Objectives: Although acute anterior cruciate ligament reconstruction (ACLR) is often avoided because of postoperative joint stiffness, delayed ACLR can lead to a longer recovery time and can have a negative impact on physical function due to detraining. This study aimed to determine [...] Read more.

Objectives: Although acute anterior cruciate ligament reconstruction (ACLR) is often avoided because of postoperative joint stiffness, delayed ACLR can lead to a longer recovery time and can have a negative impact on physical function due to detraining. This study aimed to determine the effects of acute ACLR on postoperative outcomes, including muscle strength, performance, and return to sports. Methods: A total of 110 patients who underwent anatomical ACLR using hamstring autografts were included in this study and were divided into three groups: acute (ACLR performed within 2 weeks after ACL injury), 2–6 weeks (ACLR performed between 2 and 6 weeks after injury), and 6–12 weeks (ACLR performed between 6 and 12 weeks after injury). Several parameters were evaluated, including range of motion, knee joint stability, isokinetic knee strength, performance, and return to sports. Results: No significant differences were found in the range of motion or knee joint stability between the groups. The acute group exhibited significantly greater quadriceps strength at 3 months postoperatively than the other groups (p < 0.05). The single-leg hop test showed that 66.7%, 38.7%, and 33.3% of the patients in the acute, 2–6 weeks, and 6–12 weeks groups, respectively, recovered to an LSI of 90% or greater (p = 0.09, Cramer’s V = 0.27). All patients in the acute group were able to return to sports (p = 0.14; Cramer’s V = 0.28). Conclusions: Acute ACLR is advantageous for the early recovery of strength and performance without adverse events. Acute ACLR may shorten the time spent away from sports activities. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament Reconstruction: Clinical Advances and Prognosis)

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10 pages, 843 KiB

Open AccessArticle

Influence of a Concomitant Medial Meniscus Injury on Knee Joint Function and Osteoarthritis Presence after Anterior Cruciate Ligament Reconstruction

by Darian Bayerl, Lukas B. Moser, Markus Neubauer, Johannes Neugebauer, Dietmar Dammerer, Markus Winnisch and Rudolf Schabus

J. Clin. Med. 2024, 13(8), 2433; https://doi.org/10.3390/jcm13082433 - 22 Apr 2024

Cited by 1 | Viewed by 1681

Abstract

(1) Background: The aim of this study was to investigate how a medial meniscus injury accompanying an anterior cruciate ligament rupture affects the clinical outcome 10 years after ACL reconstruction. (2) Methods: A total of 37 patients who received anterior cruciate ligament reconstruction [...] Read more.

(1) Background: The aim of this study was to investigate how a medial meniscus injury accompanying an anterior cruciate ligament rupture affects the clinical outcome 10 years after ACL reconstruction. (2) Methods: A total of 37 patients who received anterior cruciate ligament reconstruction (ACLR) were included in this retrospective study. Two groups were analyzed at a single follow-up of 10 years: (i) “isolated (ACLR)” (n = 20) and (ii) “ACLR with medial meniscal injury” (n = 17). The following clinical scores were recorded: International Knee Documentation Committee (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Score and Tegner Activity Score. To determine the degree of osteoarthritis the Kellgren–Lawrence score was used. (3) Results: The “isolated ACLR” study group scored significantly higher (p < 0.05) on the IKDC subjective questionnaire (mean: 88.4) than the “ACLR with medial meniscus injury” group (mean: 81). The KOOS category “activities of daily living” showed significantly better results in the isolated ACLR group (p < 0.05). The “ACLR with medial meniscus injury” group had significantly higher degree of osteoarthritis (p < 0.05). No significant differences were found in all the other clinical scores. (4) Conclusions: The results of this study further indicate that patients with a concomitant medial meniscus injury have slightly more discomfort in everyday life and increased risk of developing osteoarthritis 10 years after surgery. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament Reconstruction: Clinical Advances and Prognosis)

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Review

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15 pages, 288 KiB

Open AccessReview

The Double-Edged Sword: Anterior Cruciate Ligament Reconstructions on Adolescent Patients—Growth Plate Surgical Challenges and Future Considerations

by Alexandria Mallinos and Kerwyn Jones

J. Clin. Med. 2024, 13(24), 7522; https://doi.org/10.3390/jcm13247522 - 11 Dec 2024

Cited by 1 | Viewed by 1013

Abstract

The management of anterior cruciate ligament (ACL) injuries in pediatric patients presents unique challenges due to the presence of open growth plates in the proximal tibia and distal femur. Delaying ACL reconstruction until skeletal maturity may protect the physes but increases the risk [...] Read more.

The management of anterior cruciate ligament (ACL) injuries in pediatric patients presents unique challenges due to the presence of open growth plates in the proximal tibia and distal femur. Delaying ACL reconstruction until skeletal maturity may protect the physes but increases the risk of secondary injuries, such as meniscal tears and chondral damage, due to prolonged joint instability. Conversely, early surgical intervention restores knee stability but raises concerns about potential growth disturbances, including leg-length discrepancies and angular deformities. This narrative review examines current approaches to pediatric ACL management, highlighting the risks and benefits of both conservative and surgical treatments. Additionally, it explores the role of finite element modeling (FEM) as an innovative tool for pre-surgical planning. FEM offers a non-invasive method to optimize surgical techniques, minimize iatrogenic damage to growth plates, and improve patient outcomes. Despite its potential, FEM remains underutilized in clinical practice. This review underscores the need to integrate FEM into pediatric ACL care to enhance surgical precision, reduce complications, and improve long-term quality of life for young patients. By synthesizing available evidence, this review aims to provide clinicians with a comprehensive framework for decision-making and identify future directions for research in pediatric ACL reconstruction. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament Reconstruction: Clinical Advances and Prognosis)

14 pages, 508 KiB

Open AccessReview

Anterior Cruciate Ligament Tear: Individualized Indications for Non-Operative Management

by George A. Komnos, Michael H. Hantes, Georgios Kalifis, Nifon K. Gkekas, Artemis Hante and Jacques Menetrey

J. Clin. Med. 2024, 13(20), 6233; https://doi.org/10.3390/jcm13206233 - 18 Oct 2024

Cited by 2 | Viewed by 2583

Abstract

Anterior cruciate ligament (ACL) rupture represents a common sports injury that is mostly managed operatively. However, non-operative treatment can also play a role, despite the limited high-quality published data on ACL tear management. Both methods have shown favorable outcomes, but clear guidelines based [...] Read more.

Anterior cruciate ligament (ACL) rupture represents a common sports injury that is mostly managed operatively. However, non-operative treatment can also play a role, despite the limited high-quality published data on ACL tear management. Both methods have shown favorable outcomes, but clear guidelines based on high-quality research are lacking. Several factors should be considered and discussed with the patient before deciding on the best treatment method. These include patient characteristics and expectations, concomitant injuries, and clinical evaluation, with laxity or/and instability being one of the most essential parameters examined. This should eventually lead to an individualized approach for each patient to ensure the best possible outcome. This review aims to delve into all parameters that are related to ACL rupture and guide physicians in choosing the most appropriate treatment method for each patient. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament Reconstruction: Clinical Advances and Prognosis)

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12 pages, 2278 KiB

Open AccessEditor’s ChoiceReview

Management of Medial Femorotibial Knee Osteoarthritis in Conjunction with Anterior Cruciate Ligament Deficiency: Technical Note and Literature Review

by Claudio Legnani, Alberto Ventura, Laura Mangiavini, Nicola Maffulli and Giuseppe M. Peretti

J. Clin. Med. 2024, 13(11), 3143; https://doi.org/10.3390/jcm13113143 - 27 May 2024

Cited by 5 | Viewed by 1499

Abstract

In recent years, there has been increased interest in the management of medial femorotibial knee osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency. Traditional treatment modalities included conservative therapy, high tibial osteotomy with or without ACL reconstruction, and total knee replacement. [...] Read more.

In recent years, there has been increased interest in the management of medial femorotibial knee osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency. Traditional treatment modalities included conservative therapy, high tibial osteotomy with or without ACL reconstruction, and total knee replacement. Since younger patients with higher physical demands are more likely to suffer from this pathological condition, reduced invasiveness, faster recovery time, and improved knee kinematics are preferred to allow for satisfying clinical and functional outcomes. Thus, a new surgical strategy combining medial unicompartmental knee replacement (UKR) and ACL reconstruction has been proposed to allow bone stock preservation, to reduce surgical morbidity and recovery time, and ultimately to improve joint kinematics and clinical outcomes. Based on the data present in the literature, in the setting of unicompartmental OA in association with ACL deficiency, UKR combined with ACL reconstruction provided encouraging early results. Studies evaluating the outcomes of combined ACL reconstruction and UKR demonstrate promising results in select patient populations. Improved knee stability, pain relief, functional recovery, and patient satisfaction improved after surgery. Moreover, the combined approach offered advantages such as reduced surgical trauma, faster rehabilitation, and preservation of native knee anatomy compared with traditional treatment strategies. However, still, high-level studies on this topic are lacking; therefore, more comparative studies reporting long-term outcomes are needed to support the potential of this combined procedure to become mainstream. In this paper, we discuss the relevant features and rationale behind the indications and technique of this combined surgical procedure, to help surgeons choose the correct therapeutic approach for a patient with concomitant medial OA and ACL insufficiency. Continued advancements in surgical techniques, patient selection criteria, and rehabilitation strategies will further enhance the success of this combined approach, offering hope to individuals with concomitant ACL injuries and unicompartmental knee OA. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament Reconstruction: Clinical Advances and Prognosis)

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