Search Results (151)

Introduction: Patellofemoral instability (PFI) is most prevalent in adolescents aged 10–17 years, yet disease-specific functional assessment tools validated for pediatric populations are limited. The Banff Patellofemoral Instability Instrument (BPII) 2.0 and the Norwich Patellar Instability (NPI) scores are disease-specific tools that have previously been validated in adults. The purpose of this study was to translate, culturally adapt, and validate the BPII 2.0 and NPI scores for Polish-speaking pediatric patients with PFI. Methods: The Polish versions of the BPII 2.0 and NPI were developed following Beaton’s cross-cultural adaptation guidelines. Patients aged 12–18 years with surgically treated recurrent patellofemoral joint instability completed the BPII 2.0, NPI, Anterior Knee Pain Scale (Kujala), Lysholm Knee Score, and Pedi-IKDC at a clinic visit and again 7–14 days later. The following psychometric properties were assessed: face validity, floor and ceiling effects, test–retest reliability (ICC), internal consistency (Cronbach’s α), and construct validity (Spearman Correlation Coefficients). Results: A total of 57 postoperative patients (19 males, 38 females; median age 16 years, range 12.25–18 years) participated 24–36 months after surgical stabilization. No floor or ceiling effects were observed. The test–retest reliability was excellent (ICC = 0.988 for BPII 2.0 (95% CI 0.977–0.994, p < 0.001); ICC = 0.997 for NPI (95% CI 0.995–0.998, p < 0.001)). Both instruments demonstrated excellent internal consistency (Cronbach’s α = 0.95 for BPII 2.0; α = 0.93 for NPI). The BPII 2.0 showed moderate to strong positive correlations with Lysholm (ρ = 0.69), Kujala (ρ = 0.69), and Pedi-IKDC (ρ = 0.57) and moderate negative correlation with NPI (ρ = −0.62), all of which were statistically significant (p < 0.001). Conclusion: The Polish versions of the BPII 2.0 and NPI scores demonstrated excellent reliability (ICC = 0.988 and 0.997, respectively), internal consistency (Cronbach’s α = 0.95 and 0.93, respectively), and construct validity in Polish-speaking adolescent patients with surgically treated recurrent patellofemoral instability. This is the first validation of the NPI in an exclusively pediatric population. These tools are suitable for clinical assessment and research in this specific population. Limitations include the postoperative-only cohort and absence of structural validity assessment. Full article

Background/Objectives: Differential learning (DL) amplifies natural fluctuations in movement execution and, in its more extreme forms, facilitates repetition-free training with minimal external feedback. While increasingly recognized in the field of skill acquisition, its application in anterior cruciate ligament (ACL) rehabilitation remains underexplored. Methods: This study examined the application of DL in the rehabilitation of an 18-year-old trained basketball player following left-ACL reconstruction. The athlete completed a 42-week rehabilitation program in which DL principles were incorporated throughout the pre-operative, early, mid-, and late phases, culminating in return to sport. Training included differential mobility work, motor control, plyometric exercises, and sport-specific drills. Functional recovery was evaluated using single-leg hop tests, change-of-direction tasks, and sprint performance, while self-reported knee function was monitored via the International Knee Documentation Committee (IKDC) questionnaire. Results: Results indicated substantial improvements in both functional performance and psychological readiness. The IKDC score increased from 13.8% at baseline to 95.4% postoperatively, reaching the normal functional range. An ACL-RSI score of 85.2%, and inter-limb asymmetries were reduced to below 10%. Strength, agility, and sprint performance exceeded pre-injury levels. Conclusions: DL again shows potential as an effective approach to facilitating recovery and return to sport after ACL reconstruction, but larger controlled studies are needed for validation. Full article

Introduction: This case report presents the multifactorial surgical management and long-term outcome of a permanent patellar dislocation in a 16-year-old female patient. Case presentation: A 16-year-old female with permanent patellar dislocation of the left knee complained of progressive pain and functional limitations. Physical examination revealed a 20-degree passive flexion contracture, significant muscle weakness in knee extension, and a permanently laterally dislocated patella that could not be manually repositioned. Imaging studies revealed a complex knee deformity characterised by femoral valgus, tibial varus, posterior tibial slope, and trochlear dysplasia. The patient underwent a comprehensive surgical approach addressing all deformities, including femoral and tibial osteotomies, trochleoplasty, medial patellofemoral ligament (MPFL) plasty, and quadriceps muscle balancing. Results: At the eight-year follow-up, the patient demonstrated a full range of motion and adequate stability, and experienced mild pain only rarely. Outcomes improved significantly: the International Knee Documentation Committee (IKDC) score increased from 10.3% to 75.9%, the Lysholm score rose from 24 to 72, the Kujala score improved from 22 to 67, and the BPII score increased from 14.9 to 55.4. Conclusions: Comprehensive surgical correction of all predisposing factors achieved sustained functional improvement over eight years, demonstrating that systematic treatment of anatomical and functional abnormalities is essential for the successful management of permanent patellar dislocation. Level of evidence: V. Full article

Background: Persistent rotational instability and graft failure remain major challenges following anterior cruciate ligament reconstruction (ACLR). The addition of anterolateral ligament reconstruction (ALLR) and suture tape augmentation may enhance graft protection and early stability. This study aimed to assess the short-term clinical outcomes of combined ACLR and ALLR with suture tape augmentation, hypothesizing that this technique would yield favorable results in patients with ACL injury. Methods: Twenty-four patients (16 males, 8 females; mean age 30.8 years) with high grade pivot shift who underwent combined ACLR and ALLR with suture tape augmentation between 2022 and 2024 were retrospectively reviewed. Objective assessments included pivot-shift grading and anterior tibial translation (ATT) using a GNRB arthrometer. Patient-reported outcome measures (PROMs) comprised the International Knee Documentation Committee (IKDC), Marx activity score, and Single Assessment Numeric Evaluation (SANE) scores. Subgroup analysis compared graft diameters < 8 mm versus ≥8 mm. Results: The mean follow-up period was 23.4 months. Significant improvements were observed postoperatively in IKDC (45.9→83.7), Marx (4.4→9.9), SANE (49.2→85.2), and ATT (4.7→1.1 mm) (all p < 0.001). Full range of motion was regained at a mean of 3.2 months. Twenty-one patients presented no pivot shift and three with grade one postoperatively. No significant differences were found between the small (<8 mm) and large (≥8 mm) graft groups. MRI at one year showed intact grafts without adverse reactions. Conclusions: Combined ACL and anterolateral ligament reconstruction with suture tape augmentation demonstrated promising short-term stability and functional recovery without significant complications. This technique may enhance biomechanical reinforcement of both ACL and ALL grafts and represents a viable option for patients with smaller graft diameters. Full article

Background: It is known that meniscus root tears affect the biomechanics of the knee in a way that is equivalent to a total meniscectomy. Therefore, repair is increasingly favored for meniscal root tears. In our study, we aimed to investigate the clinical and radiological outcomes of meniscal root repairs with suture anchors. Materials and Methods: Patients who had undergone surgery for medial meniscus posterior root tear (MMPRT) using suture-anchors between 2018 and 2023 were retrospectively analyzed. Patients were excluded if they had a previous infection, a fracture and an operation on the same knee, or osteoarthritis and a follow-up period under one year. The MMPRTs were classified according to the LaPrade classification system. For the functional classification, the range of motion (ROM), the Visual Analog Scale (VAS), the Lysholm Knee Score (LKS), and the International Knee Documentation Committee (IKDC) Subjective Knee Form were used for the postoperative functional assessments. The radiological assessment was performed by measuring the medial meniscus extrusion (MME) and evaluating the signal changes in the magnetic resonance imaging (MRI) of the knee, which was recorded during the last follow-up examination. Results: Thirty-two patients (6M/26F) were included in the study. The mean age was 49.9 ± 5.4 years old, and the follow-up period was 29.6 ± 24.1 months. The LKS improved from 53.7 ± 6.9 to 83.6 ± 5.2 and the IKDC improved from 46.1 ± 6.9 to 83.0 ± 5.5 at the final follow-up control (p < 0.001 and p < 0.001). The VAS score decreased from 8.4 ± 0.5 to 2.5 ± 0.9 (p < 0.001). The MRI scan of the knee performed at the last follow-up examination showed no improvement in only one patient. While the MME before surgery was 5.0 ± 2.1 mm, it was 4.6 ± 2.1 mm at the last follow-up examination (p = 0.178). An increase in the Kellgren–Lawrence stage was observed in 4 of our patients (from stage 1 to stage 2 in one patient, from stage 0 to stage 1 in 3 patients). Conclusions: The results of this study suggest that repairing MMPRTs using suture-anchors is a valid solution for treatment and prevention in patients with poor prognoses in order to achieve positive results in reducing pain, restoring mobility, improving functional outcomes and avoiding a significant increase in progression to arthrosis. Full article

Background: We sought to compare the anatomical accuracy and clinical outcomes of two intraoperative landmarks, the anterior cruciate ligament (ACL) tibial remnant and the anterior horn of the lateral meniscus (LMAH), for tibial tunnel placement in single-bundle ACL reconstruction. Methods: This retrospective comparative study included 74 patients who underwent single-bundle ACL reconstruction using either the ACL tibial remnant (Group 1, n = 35) or the LMAH (Group 2, n = 39) as the primary intraoperative landmark. Tunnel positioning was evaluated using post-operative MRI. Clinical outcomes included the Lysholm score, subjective IKDC, Tegner activity scale, Lachman and pivot-shift tests, KT-2000 arthrometer measurements, and return-to-sports status. Results: Group 1 demonstrated slightly more anterior sagittal tunnel placement (44.57%) compared to Group 2 (46.87%) (p = 0.036). Coronal tunnel positioning did not differ significantly between the groups (p = 0.215). Functional scores, stability tests, and return-to-sports rates were similar across groups. MRI-based tunnel measurements in sagittal and coronal planes had excellent inter- and intraobserver reliability. Conclusions: Both the ACL tibial remnant and LMAH are reliable landmarks for tibial tunnel placement in ACL reconstruction. Although minor variations in sagittal tunnel positioning were identified, they did not affect functional or stability outcomes. Full article

Background/Objectives: Focal cartilage defects of the knee are a common cause of pain and functional impairment. While several patient-reported outcome measures (PROMs) and objective scores have been developed to assess clinical knee status and functional impairment, the correlation between subjective PROMs and objective clinical findings after cartilage repair surgery remains unclear. A better understanding of this relationship could enhance the interpretation of registry data and improve clinical decision-making. Methods: This study analyzed 52 patients from the German Cartilage Registry (KnorpelRegister DGOU) who underwent cartilage repair surgery of the knee at a single orthopedic university center in Germany. All patients were re-evaluated in a standardized follow-up examination. PROMs from either the registry or the follow-up examination and objective findings, summarized using a modified objective International Cartilage Repair Society [ICRS] score, derived from the International Knee Documentation Committee (IKDC) 2000 knee examination form, were correlated using Spearman’s rank correlation coefficient. Results: Moderate and statistically significant negative correlations were observed between the objective ICRS score and Knee Injury and Osteoarthritis Outcome Score (KOOS) Symptoms (ρ = −0.420, p = 0.005), KOOS Quality of Life (QoL) (ρ = −0.377, p = 0.013), and the subjective IKDC score (ρ = −0.305, p = 0.028) The subjective IKDC score (IKDC–Subjective Knee Form) was also moderately and significantly correlated with the objective ICRS score (ρ = –0.305, p = 0.028). Other KOOS subscales (Pain, Activities of Daily Living (ADL), Sport) did not show statistically significant correlations with the objective ICRS score. Conclusions: PROMs provide valuable insights into patients’ perceived outcomes after cartilage repair surgery, but do not fully reflect objective functional recovery, underlining the importance of combining them with clinical assessments. Level of Evidence: III. Full article

Background/Objectives: While arthroscopic repair is established for the treatment of medial meniscus posterior root tears (MMPRT), the relationship between physiotherapy (PT) exposure, meniscal extrusion (ME), and structural healing remains unclear. The aim of this study was to evaluate short-term functional and structural results after transtibial pull-out (TPO) repair of isolated MMPRT and to explore the influence of patient age and postoperative physiotherapy volume. Methods: A retrospective single-center case series with 14 adults (64% women, age 59 years, body mass index (BMI) 31.0 kg/m²) who underwent TPO repair (April 2022–June 2024). Mean follow-up was 18.4 months. Outcomes included range of motion (ROM), pain levels using visual analog scale (VAS), International Knee Documentation Committee (IKDC), the Western Ontario Meniscal Evaluation Tool (WOMET), the 36-Item Short Form Survey (SF-36), and MRI-based ME, cartilage grade, and root-healing status. Postoperative PT volume was assessed with a self-developed, custom questionnaire. Correlations and subgroup analyses (<60 vs. ≥60 years) were performed. Results: Mean postoperative ROM was 121° and IKDC 63.4. Median PT exposure was 25.9 h, and the mean duration from symptom to repair was 215 days. MRI demonstrated complete healing in 70% of cases. A positive correlation was observed between postoperative ME and ROM (p = 0.008), while higher PT volume was associated with greater pain scores. Conclusions: TPO repair appears to be a viable treatment option for selected patients with MMPRT, showing acceptable early outcomes, even in older individuals with higher BMIs or delayed repair. Meniscal healing was frequent, although extrusion progression remained common and may influence the function. The observed links between ME, ROM, and PT-related pain highlight the need for standardized rehabilitation assessment. Larger, prospective studies are warranted to validate these exploratory findings and refine postoperative management. Full article

Background/Objectives: This study aimed to compare clinical and functional outcomes of anterior cruciate ligament reconstruction (ACLR) using peroneus longus tendon (PLT) versus hamstring tendon (HT) autografts in matched cohorts. Materials and Methods: A retrospective matched cohort study with 1:1 nearest-neighbor matching without replacement on sex (exact), age (±3 years), and time to last follow-up (closest match) was performed on consecutive primary single-bundle ACLR cases. After exclusions and follow-up completion, 77 PLT patients were matched 1:1 with 82 HT patients based on age, sex, and follow-up. Outcomes included the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm Knee Score, Tegner Activity Scale, Tampa Scale for Kinesiophobia, knee range of motion, manual strength testing, stability tests, limb circumferences, and the Single-Leg Hop test. Additionally, ankle-specific function in the PLT group was assessed using the AOFAS and FADI scores. Results: Graft diameter was larger with PLT (8.5 ± 0.6 mm) than with HT (8.1 ± 0.7 mm; p = 0.003). Both groups demonstrated significant improvement from the preoperative to the postoperative period on the IKDC, Lysholm, and Tegner scores (all p < 0.001). Between groups, postoperative IKDC and Lysholm scores were comparable (both p > 0.05), and Tegner scores did not differ significantly (p > 0.05). Knee flexion loss was less frequent (9.1% vs. 68.3%; p = 0.001), and knee flexion strength was higher (4.7 ± 0.5 vs. 4.0 ± 0.8; p = 0.001) in PLT. Stability tests, LSI, extension strength, and limb circumferences were similar (all p > 0.05). Saphenous nerve symptoms were less frequent with PLT (13.0% vs. 29.3%; p = 0.010). Ankle function in PLT was preserved (AOFAS 96.9 ± 7.9; FADI 97.4 ± 8.5) with mild eversion limitation in 3 patients (3.9%). Re-rupture rates were low and did not differ significantly between groups (p > 0.05). Infections occurred only after HT, yielding a between-group difference (p = 0.030). Conclusions: PLT autografts provide clinical and functional outcomes comparable to those of HT, with advantages including a larger graft diameter, better preservation of knee flexion function, fewer symptoms related to the saphenous nerve, and excellent ankle outcomes. PLT is a safe and effective alternative for primary ACLR. Full article

Background: Arthrofibrosis requiring arthrolysis is a relevant complication after anterior cruciate ligament (ACL) reconstruction. It has been suggested that intercondylar notch impingement may contribute to this outcome. The aim of this study was to evaluate whether systematic notchplasty during primary ACL reconstruction with hamstring autografts reduces the rate of secondary arthrolysis. Methods: Two groups of patients undergoing primary ACL reconstruction were compared: 149 patients without notchplasty and 140 patients with notchplasty, each with a minimum follow-up of 2 years. The incidence of arthrolysis and other complications, functional outcome scores, and return-to-sport data were analyzed. Results: No significant difference was observed in the rate of arthrolysis: Seven patients (4.7%) were in the non-notchplasty group, with seven patients (5.0%) in the notchplasty group (p = n.s.). Functional outcomes were comparable between groups, with mean subjective IKDC of 86.5, KOOS of 87.5, and Lysholm of 90.9. Return-to-sport rates were similar, and over 90% of patients in both groups reported being satisfied or very satisfied with their outcome. Conclusions: Systematic notchplasty during primary ACL reconstruction with hamstring autografts did not reduce the rate of secondary arthrolysis in this underpowered cohort. Arthrofibrosis is multifactorial, and larger studies are needed to clarify whether notchplasty has an independent effect. Full article

Background and Objectives: This study aimed to evaluate whether delayed intra-articular application of injectable platelet-rich fibrin (i-PRF) improves clinical and radiologic outcomes compared to nanofracture alone. Materials and Methods: A total of 76 patients with ICRS Grade III–IV femoral condyle or trochlear cartilage defects larger than 2 cm² were enrolled in this prospective controlled study. Patients were allocated into two groups: Group 1 (n = 40) underwent nanofracture followed by delayed intra-articular i-PRF injection at three weeks postoperatively, while Group 2 (n = 36) underwent nanofracture alone. Preoperative MRI was evaluated using the AMADEUS grading system. Clinical outcomes—including WOMAC and IKDC scores—were assessed at baseline and at 6, 12, and 24 months postoperatively. MOCART 2.0 scoring was used to evaluate cartilage repair at ≥12 months follow-up. Results: Both groups demonstrated significant functional improvement according to the IKDC and WOMAC scores. However, Group 1 showed a significantly greater improvement in WOMAC total score at final follow-up (Group 1: 20.1 ± 4.3 vs. control: 23.2 ± 3.4; p = 0.0008). No statistically significant differences were found between groups in IKDC score (p = 0.238), Tegner score (p = 0.776), or time to return to daily activities (p = 0.401). Baseline demographic, radiological, and intraoperative variables were comparable between groups (p > 0.05 for all). Radiologic outcomes based on the mean MOCART 2.0 scores were 57.1 and 50, respectively, in group 1 and group 2 (p = 0.0316). These results showed significantly improved results in group 1 according to the MRI evaluation. Conclusions: In patients with large chondral defects (>2 cm²), delayed intra-articular i-PRF injection following nanofracture may improve mid-term functional and radiological outcomes, particularly in pain and symptom relief. This regenerative strategy enhances cartilage repair potential during the early healing phase without adding surgical complexity. Full article

Background and Objectives: Revision anterior cruciate ligament reconstruction (ACLR) is demanding and yields inferior outcomes compared with primary procedures. The quadriceps tendon (QT) autograft with bone block has biomechanical and biological advantages though clinical evidence in revision remains limited. This study evaluated the clinical and radiological outcomes of revision ACLR using bone-block QT autograft in young, active patients. Materials and Methods: A case series with a level of evidence of 4. Thirty-four patients (28 men, 6 women; mean age, 27.2 ± 5.8 years) who underwent revision ACLR with a bone-block QT autograft between 2021 and 2023 were retrospectively reviewed. The mean follow-up was 37.4 ± 3.2 months. Clinical assessments included the Lysholm, International Knee Documentation Committee (IKDC) subjective, and Tegner activity scores, along with isokinetic strength testing. Objective stability was evaluated using pivot shift grading and Telos stress radiography. Radiological analyses included 3D computed tomography for tunnel positioning and magnetic resonance imaging for tunnel widening. Perioperative and postoperative complications were recorded. Results: All clinical outcomes improved significantly from baseline to 2-year follow-up: Lysholm (62.7 ± 9.6 to 87.1 ± 10.3), IKDC (59.0 ± 10.8 to 79.5 ± 11.1), and Tegner (3.5 ± 1.2 to 5.6 ± 1.3; all p < 0.001). However, the Tegner score remained lower than the pre-injury level (6.1 ± 1.4; p = 0.035). At the final follow-up, 91.2% of the patients had returned to sports, with 59% resuming sports at their pre-injury level or higher. Side-to-side anterior laxity decreased from 8.5 ± 1.7 mm to 1.4 ± 1.1 mm on Telos stress radiography (p < 0.001). Preoperatively, 82% of patients demonstrated high grade pivot shift (≥grade 2), which improved to 91% graded as negative or grade 1 at final follow-up (p < 0.001). Isokinetic evaluation showed improvements in quadriceps (28.7% ± 12.5% to 12.4% ± 8.1%) and hamstring (18.3% ± 9.7% to 8.9% ± 6.5%) deficit (both p < 0.001). MRI demonstrated minimal tunnel widening (tibia, +1.3 ± 0.9 mm, p = 0.012; femur, +0.3 ± 0.6 mm, p = 0.148). Three complications (8.8%) were observed: one cyclops lesion, one transient extension deficit, and one graft rupture. No patellar fractures, septic arthritis, or revision procedures occurred during the follow-up period. Conclusions: Bone-block QT autografts provide a reliable option for revision ACLR, yielding functional improvement, restored stability, and minimal donor-site morbidity, with low complications. These findings support their consideration as the preferred graft choice for young active patients needing revision reconstruction. Full article

Background and Objectives: The menisci are crucial fibrocartilaginous structures of the knee joint and have to be repaired in case of a tear. However, not all meniscal tears heal, even in young patients. Fibrin clot (FC) started to be used to reduce the failure rates following meniscus repair. The purpose of this study is to evaluate and compare outcomes after isolated arthroscopic meniscal repair augmented with FC versus without FC. Materials and Methods: Fifty-nine patients aged under 19 with isolated meniscal tears were randomized into two groups: one group underwent the meniscal repair with FC (FC-augmented), and the other group did not receive FC (control). The evaluation and comparison between the groups based on FC augmentation included secondary arthroscopy rates, patient-reported outcome measures (Pedi-IKDC, Lysholm, and Tegner), and clinical and radiological (MRI) assessments at a median follow-up of 12 months. Results: No statistically significant difference was observed between FC-augmented and control groups in Pedi-IKDC, Lysholm, and TAG scores, or following clinical and radiological (MRI) evaluation. Patients in the FC-augmented group reported fewer clinical symptoms at the final follow-up across unstable and demanding (bucket-handle and complex) tear type subgroups (p = 0.012 and 0.041, respectively). Overall, nine revision arthroscopies occurred in both groups (2 and 7, respectively), all across bucket-handle and complex tears with no significant difference between the FC-augmented and control groups (p = 0.072). Conclusions: This pilot study found that FC usage during meniscal repair reduces clinical symptoms for patients with unstable, bucket-handle, or complex meniscal tears at the final follow-up of 12 months postoperatively. Nonetheless, no statistically significant differences were observed within the other outcome measures between the FC-augmented and control groups and subgroups based on meniscal tear types. Level of evidence: Level II. Full article

Background/Objectives: All-inside ACL reconstruction has emerged as a minimally invasive alternative to conventional techniques, with potential advantages in graft configuration and reduced surgical trauma. This study aimed to compare the clinical outcomes of all-inside and full tibial tunnel ACL reconstruction, focusing on graft diameter, postoperative stability, and functional recovery. We hypothesized that the all-inside technique would allow for thicker grafts and yield superior postoperative knee stability and functional outcomes, with postoperative anterior laxity as a major outcome of interest. Methods: This retrospective comparative study reviewed patients who underwent ACL reconstruction between January 2020 and February 2024. From January 2020 to September 2022, a four-strand hamstring autograft with full tibial tunnel technique (FT-4) was used, while from September 2022, a six-strand hamstring autograft with the all-inside technique (AI-6) was adopted to enable thicker grafts and optimize fixation. Among a total of 103 patients, 1:1 propensity score matching (PSM) was performed based on age, sex, BMI, laterality, ALL reconstruction, meniscal lesion, and preoperative anterior laxity (SSD). Graft diameter and clinical outcomes, including knee stability and functional scores, were compared between the matched groups. Results: After PSM, two comparable groups of 29 patients each were established. Graft diameter was significantly larger in the AI-6 group (9.5 ± 0.7 mm) compared to the FT-4 group (7.8 ± 0.8 mm, p < 0.001), while other baseline characteristics remained well balanced between the groups. At the final follow-up, both groups exhibited significant improvements in anterior laxity, functional scores, and pivot shift grades (all p < 0.001). The AI-6 group demonstrated superior outcomes with a significantly higher Lysholm score (82.2 ± 6.7 vs. 75.6 ± 8.9, p = 0.002), lower WOMAC score (8.0 ± 4.3 vs. 12.9 ± 10.5, p = 0.023), and reduced anterior laxity (1.6 ± 1.1 mm vs. 2.5 ± 1.4 mm, p = 0.005) compared to the FT-4 group, whereas no significant differences were observed in the IKDC, Tegner, Korean knee score, or pivot shift test results. A simple linear regression revealed a significant negative correlation between graft diameter and postoperative anterior laxity (B = −0.398, p = 0.048). Conclusions: The present study demonstrated that the use of a six-strand hamstring graft configuration in the AI-6 technique resulted in significantly thicker grafts and was associated with reduced postoperative anterior knee laxity compared to the FT-4 technique. While interpretation of these findings requires caution in light of MCID thresholds, the AI-6 group showed favorable outcomes in anterior laxity and selected functional scores, such as the Lysholm and WOMAC. This technique may offer practical clinical value, particularly in populations prone to smaller graft diameters, as it facilitates adequate graft thickness through multifold preparation, with the all-inside approach accommodating the inherent graft shortening. Full article

Purpose: To evaluate the prevalence of undiagnosed ligamentous knee injuries in patients surgically treated for high-energy pelvic ring or acetabular fractures and propose a mechanism to diagnose these briefly post-hospital discharge. Methods: A retrospective case series (level of evidence IV) was conducted at Italy’s largest trauma center. Medical records from 2018 to 2023 were reviewed to identify patients who underwent surgical treatment for pelvic or acetabular fractures. Eligible patients were contacted for a structured telephone interview, which included a questionnaire on knee symptoms and the International Knee Documentation Committee (IKDC) score. Associations between demographic factors, trauma mechanism, and knee outcomes were statistically analyzed. Results: Fifty-nine patients (mean age 55 years, 72.9% male) were enrolled. Undiagnosed knee ligament injuries were present in 11.9%, with an additional 8.5% reporting persistent knee symptoms. The average time to diagnosis was 6.4 months post-discharge. Patients involved in road traffic accidents showed a significantly higher incidence of knee injuries (34.8%) compared to those who fell from a height (3.9%) (p = 0.049). Patients who had undergone ligament reconstruction had significantly lower IKDC scores (62.0 ± 8.2) than non-surgical cases (82.4 ± 12.1, p = 0.0002). No association was found with age or sex. Conclusions: Ligamentous knee injuries are frequently overlooked in the acute management of high-energy pelvic fractures, particularly in road traffic accidents. A systematic knee assessment before discharge or early outpatient imaging should be considered to improve detection and outcomes. Full article