Purpose: During the pivot shift mechanism of an ACL tear, an impaction fracture of the lateral femoral condyle, also known as “lateral femoral Notch” (LFN), can occur. The aim of this study is to verify if the morphology of the LFN has an impact on the risk of recurrence of ACL tear. Methods: This is a retrospective study on 730 patients operated for ACL reconstruction between 2008 and 2019, with minimum 2-years follow up. Clinical data such as age, sex, stability (Lachman, Pivot Shift), graft size, and concomitant meniscal tear were collected. Radiological data, including depth, length, and LFN position (from the Blumensaat line), were collected from both X-Ray and MRI. Descriptive analysis and comparison of clinical and radiological data between stable and unstable groups (confirmed re-rupture, revision, Lachman ≥2, Pivot Shift ≥2) were performed. Results: Of the 730 patients, 75 were classified as unstable and were matched using a 3:1 ratio to stable knees based on sex, age and graft diameter. Radiologic data analysis failed to show differences between the two groups for LFN morphology, including depth (p= 0.746), length (p= 0.781) and position from Bluemensaat line (p= 0.989). Conclusion: Despite its retrospective design, this study's clinical significance primarily stems from the scarcity of prior research on the subject and its statistical power. No difference between knee stability after ACL reconstruction and LFN lesion severity (in terms of depth, length, and position) was shown, weakening the relevance of treating this impaction fracture.

Aims: This study presents clinical outcomes and functional results after anterior cruciate ligament (ACL) reconstruction using quadruple hamstring tendon autograft or peroneus longus tendon autograft. Methods: Between February 2018 and July 2019, patients who underwent ACL reconstruction were randomly assigned to two groups: hamstring and peroneus longus. The functional outcomes and pain intensity were evaluated using IKDC, Lysholm and visual analogue scores at 3 and 6 months, 1, 2, and 5 years after the surgery. At the 5-year follow-up, anterior stability was tested using the 3D printable Knee Arthrometer. In addition, in the peroneus longus group, ankle functional assessment was performed using the American foot and ankle score. Results: Sixty patients, with 30 in each group, were included in the study. After five years of follow-up, there was no significant difference in functional assessment scores (IKDC and Lysholm) between the two groups (P-value > 0.05). The mean Arthrometer testing measurements (AMT) for the operated knees in the hamstring and peroneus longus groups were 5.85 ± 1.83 and 5 ± 1.13. There was a statistically significant difference in AMT measurements between the two groups at five years follow-up (P-value 0.04). In the peroneus longus group, the mean postoperative foot and ankle score was 98.63±3.8 that showed excellent ankle function after harvesting. Conclusions: Peroneus longus tendon autograft for arthroscopic ACL reconstruction is a feasible alternative. The graft diameter is sufficient, and the results regarding laxity and functional outcomes are like those achieved with hamstring tendon autografts.

ACL reconstruction is a widespread sports medicine surgery, varying studies on single vs. double bundles techniques. This study investigates outcomes between the two techniques.Method: A retrospective cohort study was undertaken, identifying individuals aged 15 to 65 with an ACL tear in Taiwan's Chang Gung Research Database (CGRD) spanning January 2001 to December 2020. The study drew upon the CGRD, utilizing diagnostic registrations initially coded under the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) system, and transitioning to ICD-10 codes post-2016. Additional insights into the CGRD have been previously disseminated. For further analysis, clinical characteristics (age, sex, BMI, etc.), surgical interventions (single or double bundle reconstruction), and outcomes (osteoarthritis, knee arthroplasty, meniscectomy, graft failure) were retrospectively collected.
Result:The study initially included 1884 patients in the single-bundle ACL reconstruction and 454 in the double-bundle group. After propensity score matching (PSM), 453 patients for both single and double-bundle. Post-inverse probability of treatment weighting (IPTW), the groups comprised 1879 and 438 patients, respectively. The double-bundle group showed a higher likelihood of graft failure (HR 1.922 - 8.02, 95% CI) and meniscectomy (HR 1.727 - 4.077, 95% CI) compared to the single-bundle group.Discussion:The choice between single or double-bundle depends on surgeon preference and patient characteristics. The double-bundle approach may be recommended for specific cases.Conclusions:Single bundle technique may be more optimal than double bundle technique for anterior cruciate ligament reconstruction due to less graft failure and meniscectomy possibility.

Posterior cruciate ligament injuries are very uncommon and PCL avulsion fractures are an extremely rare variant of PCL injuries. Conventionally these injuries were treated with open reduction and internal fixation but newer arthroscopic techniques have now gained popularity over recent times
Objective: The main objective of our study is to report the clinical, radiological, and functional outcomes of posterior cruciate ligament tibial avulsion fracture using the Endobutton technique.Materials and methods: All the consecutive patients aged between 18-50 years with PCL avulsion fractures who underwent arthroscopic fixation via Endobutton device were included in this study. The clinical and Functional outcome was recorded at 1 year by evaluating the range of motion of the knee joint, stability, and Lysholm score along with post-operative complications. Results: Excellent outcome was recorded in all six of the patients with full range of motion and no posterior tibial sagging. All of them returned to their routine activities within two weeks and no postoperative complications were recorded. Conclusion: Previous literature has shown that the utilization of the Endobutton technique has not only achieved excellent clinical outcomes but has also resulted in fewer complications as compared to the traditional treatment modality, the only long-term complication that was observed was the development of arthrofibrosis. In our cases, the intramuscular septum was not breached hence none of the patients experienced arthrofibrosis.
keywords: Arthroscopic, Avulsion fracture, Endobutton, Posterior cruciate ligament

Purpose: The goal of this study was to assess the effectiveness of remote fixation with endobutton & screw and aperture fixation with bioabsorbable interference screw (BIS) for hamstring anterior cruciate ligament (ACL) reconstruction. Type of Study: Retrospective comparative study. Methods: This included two groups of 25 patients each who had autogenous hamstring ACL reconstruction at least 18months follow-up. The BIS group underwent interference screw fixation at both femoral and tibial tunnels and the ENDO group underwent endobutton fixation on the femoral side and screw fixation on the tibial side. The International Knee Documentation Committee (IKDC) and athrometer measurements were part of clinical evaluation. MRI and radiography were used to assess tunnel enlargement, screw integrity, graft integrity, and graft-tunnel interface. Statistical analyses were performed using the Student t test. Results: Revision rates were reviewed. Patients in both groups had functionally normal or near-normal IKDC scores. The average IKDC subjective knee form scores were 85 +/- 11 versus 81 +/- 17 (BIS v ENDO) For both groups, tunnel enlargement was present on radiographs at both femoral and tibial sides (36% to 77%), more significant on the femoral side. The grafts had full or partial integration at every tunnel for both groups. Measurements of tunnel expansion obtained from MRI closely match those obtained from radiography. Conclusions: At 18 to 24 months of follow-up evaluation, the ENDO and BIS showed similar clinical outcomes. The femoral side had statistically significant tunnel enlargement. MRI scans revealed that even two years after surgery, BIS had not degraded.

Anterior cruciate ligament rupture is one of the most common causes of ending the professional career of an athlete. The loss of one of the main knee stabilizers makes it impossible to play sports at a high level and significantly complicates daily physical activity. Considering the impaired quality of life and lack of biological regenerative capacity of LCA, arthroscopic reconstruction is currently the best approach. When going with reconstruction, the most important factor is appropriate graft selection. There are several choices regarding grafts: autografts or allografts, soft tissue grafts or grafts with bone block. Among arthroscopic surgeons, the most popular grafts are semitendinosus-gracillis (ST-G) and bone-patellar tendon-bone (BTB) grafts, with now increasing popularity of quadriceps tendon (QT) grafts, while Achilles tendon (TA), peroneus longus tendon (PLT), and iliotibial band (ITB) grafts are less used in everyday practice. The optimal graft should have histological structure and biomechanical characteristics as similar as possible to the native ligament, to restore structure and kinetics of the knee joint. This review aims to investigate recent literature and point out the advantages and disadvantages of currently used grafts in primary and revision reconstructions. Apart from biomechanical characteristics, donor site morbidity and postoperative results, the graft selection decision should also be included a patient’s level of physical activity and postoperative expectations.

Keywords: LCA rupture, LCA reconstruction, graft choice

Anterior cruciate ligament(ACL) injuries pose a significant problem frequently encountered by active individuals. Many questions arise from patient perspective regarding this injury, often leaving them without access to professional healthcare providers for answers. Consequently, alternative avenues for solutions are sought. The era once dominated by Dr.Google has now given way to artificial intelligence technologies. This study aims to address the questions frequently asked by patients about ACL injuries through an artificial intelligence-based model, ChatGPT, and to evaluate responses by sports surgeons. Using Google, ten most commonly asked questions by patients regarding ACL injuries were identified. These questions were automatically answered by the ChatGPT 3.5. Subsequently, the responses were compiled into a survey. Ten sports surgeons were asked to evaluate the responses. A four-point scoring system was utilized (excellent response, satisfactory requiring minimal clarification, satisfactory requiring moderate clarification, unsatisfactory).In the evaluation of responses provided by ChatGPT, none were deemed unsatisfactory. Five questions were predominantly rated as excellent responses. The remaining five questions were mostly categorized as satisfactory requiring minimal clarification. However, in three questions, some evaluators marked the option of satisfactory requiring moderate clarification.This study demonstrates that the information provided by ChatGPT is generally understandable. However, in some cases, there may be deficiencies or the need for clarification in the responses. This study highlights the potential of artificial intelligence-based models in meeting the information needs of patients regarding ACL injuries. Nevertheless, the use of these models should be supported by expert evaluation and current clinical knowledge.

Background: Many studies have documented the use of platelet-rich plasma (PRP) alongside anterior cruciate ligament (ACL) reconstruction (ACLR) in the management of ACL injury, but evidence on the benefits of PRP in improving the outcomes of ACLR is inconsistent. Purpose: To help in our understanding, we undertook this study that evaluated the effects of PRP on patient-reported functional scores, complications and return to work time. Method: After thorough search in literature, we found that the most useful outcome evaluating methods assessing the effects of PRP on ACLR were visual analog scale (VAS) for pain, International Knee Documentation Committee (IKDC) scores and pivot-shift test. We designed our study based on two groups of 20 ACLR patients. The first group that received PRP injections at 2,6,12 weeks post ACLR. The other group that did not receive any injections. Both groups were followed up at 2,4,6,10,12 and 24 weeks postoperatively. Results: There were a significant improvement in the first group in comparison to the second group in IKDC score (P< 0.0001). While the VAS score showed a significant improvement between the two groups (P<0.0001). Pivot shift test results and complications showed no differences in both groups. The mean return to work time in the second group was 8 months while in the first group it was 5 months. Which shows a significant value. Conclusion: PRP applied post ACLR could reduce postoperative pain, improve knee function and hassle the return to work time. PRP does not improve knee stability.

Background: Suspension devices are the standard femoral fixation device for arthroscopic ACL reconstruction. It is important to determine whether its two variants -fixed and adjustable provide comparable results in clinical settings. Aims: to compare clinical outcomes between patients who underwent ACL reconstruction with fixed loop device (group I) versus adjustable-loop device (group II).Methods: Patients were divided into two groups of sixteen patients each. Both groups were equivalent in demographic, preoperative, and intra-operative variables. Clinical outcome assessment was done with IKDC score, Lysholm Score and knee stability tests at preoperatively, 6 months after surgery and finally at 1 year post-operatively. Results: Mean pre-operative IKDC score were 61.4 ± 4.2 and 59.4± 4.4. Mean Post-operative IKDC scores of groups I and II were 72.2 ± 4.8 and 70.3 ± 5.2 at 6 months and, 85.8 ± 5.3 and 84.5 ± 5.8 after 1 year . Mean Lysholm scores were 54.6±4.8 and 56.1±3.9 pre-operatively and 78.7±3.6 and 77.6±3.5 after 6 months and 86.8±2.9 and 88.1±3.1 at 1 year. The groups were compared based on scores and difference in the outcomes was statistically insignificant (p > 0.05). All patients showed improvement in pre-operative and the post-operative results in all three tests at 6 months and at 1 year. Conclusion: No significant difference in outcomes was found between the two groups. Hence both suspensory devices are efficient for fixing femoral side grafts in arthroscopic ACL reconstruction. This study showed that lengthening associated with adjustable-loop devices in biomechanical studies may not be relevant in clinical settings.

INTRODUCTION : ACL tear and its reconstruction has been increasing in numbers due to increased sports injuries and road traffic accidents. Internal bracing is the augmentation of a ligament with high strength suture tape, which reinforces the ligament and acts as a secondary stabilizer to share the load of the ACL graft especially in the ligamentization phase, which in theory due to its structural support can help to reduce the re-tear rate and improve the knee function during the early stages of healing. In our study, we want to compare the outcome of both the techniques. METHODS : We had two groups each of 50 patients.
Both the groups underwent ACL reconstruction with hamstring graft, with suspensory fixation on femoral side and screw on tibial side. In cases with fiber tape, the anchorage was done separately in the tibia with help of bioanchor, with knee at zero degree extension. Both IKDC and Lysholm score was used for assessment. The results of both the groups was comparable, but patients with augmentation were mobilised faster and were weaned off the knee brace earlier than the other group. The group with internal bracing were back to the sports activity earlier than the other group. DISCUSSION: Younger patients with high levels of physical activity whom requires an earlier and more secure rehabilitation, application of internal bracing has been found more beneficial.

Home-based (HB) rehabilitation is an alternative method of physiotherapy after ACL reconstruction to regain the pre-injury state level. This study aims to assess the effectiveness of a new modified home-based physiotherapy program for chronic anterior cruciate ligament (ACL) deficient patients. 34 ACL patients were randomly allocated before surgery to either supervised physiotherapy (SP) or HB group. 27 patients completed rehabilitation (15 in SP;12 in HB). Patients were given an instructional video CD and equipments to perform rehabilitation at home. They were reviewed at 6-week, 3-month and 6-month to evaluate knee motion, muscle strength and power, knee stability, and functional outcomes. Only 1 patient in SP group did not achieve the targeted motion. Functional outcome scores improved at 6 months, but were statistically insignificant (P value 0.652 at 3-month and 0.323 at 6-month). Knee laxity did not show any significant difference at 6 months (p: 0.371) as well as muscle strengths and power were measured at 2 speeds (180° and 300°/s). Our modified HB rehabilitation protocol is based on principle as the available regime that could be as effective as SP regime that is similar to previous studies in term of functional outcome, knee motion, graft laxity, muscle power and muscle strength. Evaluation of both flexion and extension power can elucidate the balance of knee function that reflect on the knee stability. A structured HB rehabilitation was as effective as SP in achieving acceptable short-term outcomes post ACL reconstruction and improving patient compliance in rehabilitation and reducing healthcare cost and burden