In children, it is necessary to perform ACL plastic surgery regardless of age. But what if the ACL rupture is partial?
During the period June 2019 - December 2020 25 children with injuries of the ACL were treated in our hospital. 10 of them with partial ACL rupture and all of them underwent plasty with preservation of the ACL stump using the SAMBBA technique. Knee MRI was performe at 6 months, knee X-rays - 12 months after surgery.
SAMBBA technology allows maintaining its own proprioception and vascularization, and the remaining synovial membrane of the ligament accelerates and improves graft engraftment. The use of the SAMBBA technique makes it possible to locate the attachment points isometrically, taking into account the individual footprint of the ACL.
Results: All children operated on with the use of the technique with the preservation of the remainder of the ACL achieved a good functional and cosmetic result. None of the children had muscle hypotrophy and the rehabilitation of movements in the knee joint was faster. In all children, the control MRI determines the satisfactory position of the graft and its preserved integrity.
Conclusion: performing tendon plastics with preservation of the remainder of the ligament in case of partial ACL injuries in children can increase the survival rate of the graft, accelerate rehabilitation and improve the functional parameters of the knee joint after surgery. This improves the quality of life, eliminating chronic instability of the knee joint, which leads to secondary damage to the menisci and cartilage

Anterior cruciate ligament (ACL) reconstruction (ACLR) failure rates until 15% have been reported and errors in surgical technique related to tunnel placement or graft malposition are an important cause of recurrent instability. Current ACLR procedures focus on intra-articular graft placement but many bad results are related with persistent anterolateral rotatory instability and recent works advocate an horizontalized graft placement in order to control this kind of instability - Lateral Extra-articular Tenodesis (LET) is an alternative and simple technique that provides additional knee stability for solving these complex problems. Case-report exams showed malposition of the tunnels with a vertical ligament orientation and small bone tunnel enlargement that provided rotational instability. A modified Lemaire LET augmentation was performed and, after proper rehabilitation, an excellent functional and radiological outcome was reached. The aim of adding LET to ACLR is to reduce the strain on the graft, reduce the pivot shift prevalence and potentially reduce the rate of ACLR graft failure. In our case, with anterolateral rotational instability associated with a verticalized plasty and tunnels enlargement, the solution would classically be to review the ACLR, however, with the widening of the tunnels there are several difficulties for the revision and two procedures would be necessary. Thus, considering that we have a plasty that, although inadequate in the control of rotation, is effective in controlling the anterior translation, and the role of anterolateral structures, our option proved to be a good one, restoring knee stability with clear functional gain, without great additional morbidity.

Introduction: Anterior cruciate ligament reconstruction with hamstring graft is the commonly performed surgery. We have designed a new technique where the hamstring tibial insertion is preserved. This technique eliminates the need for a tibial side fixation implant. The aim of this paper is to evaluate the functional outcome following arthroscopic ACL reconstruction with tibial attachment preserving quadrupled hamstring autograft without implant on the tibial side. Methodology: 85 patients with complete ACL tear were operated using above mentioned technique between July 2017 and July 2019 at Manipal hospital, Bangalore, India, out of which 42 were male and 10 were female with mean age of 33 years. Patients were followed up at 4, 6, 12 weeks, 6 months and 9 months following surgery. The functional outcome was assessed at regular follow ups using IKDC, tegner and lysholm score. Results: Functional outcome was good to excellent in our study group in 78.9 % of patients as per lysholm score, very few complications were observed, post-operative IKDC score is 81.6 compared to pre-operative score 35.8, post-operative tegner score is 5.2 compared to pre injury score 5.7, post-operative lysholm score is 88.3 compared to pre injury score 97.9. Conclusion: The main finding of this preliminary study is that tibial attachment preserving hamstring graft without a tibial implant is a simple, time saving, cost effective technique that provides a consistently satisfactory outcome with no complications like bio-screw reaction, graft loosening and laxity. Majority of the patients are return to their pre-injury level of activity.

Background: Patients undergoing ACL reconstruction aim to regain preoperative functions and to return to sports (RTS). A wide range of clinical test has been used, but still prediction of RTS have been non-homogenous. Looking at the limitation of individual test in predicting a return to a sport we want to propose the combination of physical plyometric tests and psychological assessment to improve the predictive value. Aims and objectives: To determine if the combination of single-leg plyometric tests and psychological assessment better predict a return to sports after ACL reconstruction. Methods A prospective study on retrospectively operated 51 athletes (18 professional+ 33 recreational players) with ACL deficient knee from a single tertiary care centre in northern India was carried out. Use of psychological scales (ACL-RSI and Tampa’s kinesophobia) and simple non-invasive and non-expensive single-leg plyometric tests (single hop, triple hop, crossover hop and vertical hop) were carried out to see if they correlated with return to sports after ACL reconstruction retrospectively. Results ACL-RSI (PPV=73.53) and Tampas Kinesophobia score (PPV=72.97) correlated significantly with the return to sports retrospectively (P<0.05). All the plyometric test (Avg PPV=77.6) correlated significantly with the return to sports (p<0.05) except the vertical hop test. Conclusion: We recommend the use of the combined test as a screening tool for return to sports after ACL reconstruction. Physical rehabilitation and psychological counselling are required for overall improvement in the RTS. The combination of both gives us a broader understanding of RTS and addresses any shortcomings to achieve the same.

Purpose: The objective of this systematic review is to evaluate the safety and efficacy of intraarticular (IA) hyaluronic acid (HA) instillation following anterior cruciate ligament reconstruction (ACLR).
Methods: A literature search of electronic databases and manual search of studies reporting clinical effectiveness of IA HA following ACLR was performed on 1st March 2021. The methodology quality and risk of bias were assessed using Cochrane Collaboration Risk of Bias Tool and Newcastle-Ottawa scale for randomized-controlled trial and prospective cohort studies, respectively.
Results: Of 324 studies retrieved, four studies (3 RCTs and one prospective) with low to moderate risks of bias were found to be eligible for this review. There were 182 patients in HA group and 121 patients in the control group. Three studies injected HA within 1-2 days of surgery, and one study injected it after 4 weeks. Multiple doses were used in two studies, and single injection was used in the remaining two studies. All studies reported significant improvement in pain, range of motion, knee circumference, and functional score within 1-2 months following the IA HA administration; however, clinical benefit at 6-12 months follow up was not different between the groups. Only one study reported a persistent long term clinical benefit where they injected HA at 8 weeks or later.
Conclusions: IA HA instillation following ACLR has short term effects in minimizing pain and knee swelling, causing better ROM and functional recovery. The heterogeneity of the studies with different doses and HA-formulation are the major limitations for this conclusion.

Introduction:This study aim to establishment of a new safety therapeutic and rehabilitation model include: modified the surgical technique, accelerate the rehabilitation process and promote the anterior cruciate ligament(ACL) injury patients walking with partial weight bearing within 24 hours of anterior cruciate ligament reconstruction.Methods:A total of 65 patients underwent ACL reconstruction. 35 patients underwent the standard procedure (group A),the remaining 30 patients underwent the modified ERAS procedure (group B).Group B ERAS procedure include four parts: in the surgical management part, use of a 3D-printed navigation template for femoral anatomical positioning and use of an original ACL tension-relieving autograft hamstring tendon which we developed; in the pain management part, use of perioperative multi-modal analgesia and intra-articular"Cocktail therapy" after surgery; in the rehabilitation management part, establishing standardized rehabilitation management procedures and use of an inclination pillow and special ice pack, both of which were developed by our group; in the nutrition management part: improved perioperative diet plan for ACL patients. Results:After the new serial safety therapeutic and rehabilitation model application, Group B compared to group A the postoperative within 24 hours partial weight bearing rate was increased by 89.1%, the incidence of moderate and severe pain after surgery was decreased by 64.1%, rehabilitation pathway enrollment rate was increased by 54%, the incidence of hunger and thirst decreased by 30.2% and 18.8% respectively, patient satisfaction rate increased by 45.3%(p＜0.001).Conclusion: The application of new serial therapeutic and rehabilitation model was safety and effectivity.

Introduction: A nonsteroidal anti-inflammatory drug(NSAID) is normally used to relieve pain in post-operative anterior cruciate ligament(ACL) reconstruction, but most patients continue to have moderate to severe pain that disturbs their rehabilitation. Some orthopedists prefer to use intravenous(IV) parecoxib for post-operative pain control, as some studies have reported better pain control with this method. Hypothesis/purpose: To compare the efficacy of IV parecoxib and oral diclofenac for post-operative pain control in ACL reconstruction. Methods: This study was a retrospective review. Each patient was given either IV parecoxib twice a day or oral diclofenac three times a day and all patients received paracetamol six times per day. If the patient complained of moderate or severe pain(VAS≥3) after the surgery, 3 mg of morphine would be given intravenously every three hours and 1 mg of morphine as a rescue analgesic every 1 hour for one day. VAS and morphine consumption were recorded at 0,4,8,12,16,20 and 24 hours, post-operatively. Results: 161 patients were included in this study, of whom 47 and 114 patients received IV parecoxib or oral diclofenac, respectively. The IV parecoxib group had significantly lower average post-operative pain scores than the oral diclofenac group at 4 and 8 hours(p-value<0.05), and the cumulative morphine consumption in the IV parecoxib group was significantly lower than the oral diclofenac group at all time points except 4 hours post-operatively(p- value<0.05). Conclusion: This study found that IV parecoxib was more effective than oral diclofenac in controlling post-operative pain and also resulted in lower post-operative morphine consumption.

Background: Clinical registries are an important aspect of orthopaedic research in assessing outcomes of surgical intervention and tracking medical devices. However, patient follow-up rates in registries are often low potentially leading to attrition bias. Traditional guidelines recommend a follow-up rate of at least 80% in survey studies. This study aimed to explore methodology available to account for patients lost to follow-up (LTFU) in studies related to arthroscopic intervention. Methods: A scoping review was performed. Literature for studies from nine arthroscopy registries were identified on EMBASE, MEDLINE, and the annual reports of each registry. Inclusion criteria included the study having information on patient reported outcome measures and being based on the nine national registries. Exclusion criteria included review articles, conference abstracts, and studies not based on registry data. Studies were then divided into categories based on what method of LTFU analysis was used. Results: Thirty-six articles were identified for final analysis. The categories for LTFU analysis included dropout analyses (n=10), referencing validation studies (n=12), contacting non-responders (n=4), and sensitivity analyses (n=1). Referencing validation studies was most common (n=12). Majority (n=35) of the studies exceeded the recommended maximum rates for LTFU. Conclusions: There is no standardised guideline for minimising the impact of LTFU in arthroscopy studies. The validation studies used by several studies have limitations when assessing the effect of LTFU on the data obtained from the registries. We therefore propose that a consensus study using experts in the field of registries to determine a universal method for accounting for patient LTFU.