Purpose: The aim of the study was to analyze the failure of primary ACLR (Anterior Cruciate Ligament Reconstruction). The primary purpose was to evaluate the influence of tibial slope in failure. The secondary purpose was to evaluate the femoral and tibial tunnel positions in failed ACLR.
Materials and Methods: We identified One hundred and two patients who underwent ACLR revision at our center and reviewed their clinical and radiological records. Two Radiologists reviewed the clinical MRI (Magnetic Resonance Imaging) prior to the revision surgery, measured the lateral tibial slope, and graded the tunnel position.
Results: The radiological grading and measurements of Eighty-six MRI scans were achieved after exclusion with a good agreement of interobserver and intra-observer coefficients for two radiologists.
The incidence of the anatomically placed tunnels was 38.37% (33) with anatomical femoral tunnels 51.1% (44) and similarly, the tibial tunnel was 72.09% (62). The traumatic cause of failure was 61.11% (56) and the rest were non-traumatic.
The mean lateral tibial slope of 8.37 degrees with a Standard deviation (SD) of 3.21. We found a significantly higher lateral tibial slope in failed ACLR with anatomical tunnels. We further noted a significantly higher tibial slope in patients with failure because of trauma.
Conclusion: Our learning points are the incidence of Traumatic failure of ACLR is high in our study. Lateral Tibial slope needs to be evaluated and addressed in traumatic failed ACLR with anatomical tunnels.


Purpose: To assess the functional outcome of revision ACLR with autografts in a population with kneeling customs and evaluating the factors influencing the failure.
Materials and methods: We evaluated One hundred and two patients who underwent revision ACL reconstruction with a minimum follow-up of 2-years (range 2-5years). We compared the functional outcome of different autografts using the Kruskal-Wallis test.
Results: 70.23% of the patients post revision ACLR reported excellent to good results on the Tegner-Lysholm scoring. Autografts used for revision were Semitendinosus-Gracilis graft (40.47%), Bone patella tendon-bone graft (36.9%), and Quadriceps tendon graft (22.61%) with no autograft found superior to others in the kneeling population The grade of the medial articular cartilage represented a non-significant trend with poorer functional outcome. The cause of primary failure was trauma (58.33%), technical failure (22.61%), and non-traumatic (19.04%).
Conclusion: Our study shows the outcome of revision ACLR to be good to excellent results with autografts. We found no autograft to be superior to others in the kneeling population. The chondral status and autograft choice had no significant impact on the functional outcome. Trauma was the major cause of failure in our study population.


Introduction
Correct femoral tunnel position in anterior cruciate ligament reconstruction (ACLR) is critical in obtaining good clinical outcomes. We aimed to delineate whether any difference exists between the anteromedial (AM) and trans-tibial (TT) portal femoral tunnel placement techniques on the primary outcome of ACLR graft rupture.

Methods
Adult patients (>18 years old) who underwent primary ACLR between January 2011 - January 2018 were identified and divided based on portal technique (AM v TT). The primary outcome measure was graft rupture. Univariate analysis was used to delineate association between independent variables and outcome. Binary logistic regression was utilised to delineate odds ratios of significant variables.

Results
473 patients were analysed. Median age at surgery was 27 years old (range 18-70). A total of 152/473 (32.1%) patients were AM group compared to 321/473 (67.9%) TT. Twenty-five patients (5.3%) sustained graft rupture. Median time to graft rupture was 12 months (IQR 9). A higher odds for graft rupture was associated with the AM group, which trended towards significance (OR 2.03; 95% CI 0.90 - 4.56, p=0.081). Older age at time of surgery was associated with a lower odds of rupture (OR 0.92, 95% CI 0.86 - 0.98, p=0.014).

Conclusion
There is no statistically significant difference in ACLR graft rupture rates when comparing anteromedial and trans-tibial portal technique for femoral tunnel placement. There was a trend towards higher rupture rates in the anteromedial portal group.

Introduction: The gold standard treatment for Anterior Cruciate Ligament injury is reconstruction(ACL-R). Graft failure is the concern and ensuring a durable initial graft with rapid integration is crucial. Graft augmentation with suture tape (internal brace) are techniques purported to reduce the risk of rupture and hasten recovery. Few studies have examined these techniques, in
particular when compared to non-augmented grafts.

Aims: To assess the short-term outcome of ACL-R using fibre tape augmented and non-augmented hamstring tendon grafts.

Methods: This was a retrospective comparative clinical study looking at augmented and non- augmented ACL-R. All procedures were performed by or under the supervision of a single surgeon in
a single centre using the same technique. The Knee injury and Osteoarthritis Outcome Score [KOOS] was used to assess patient reported outcomes.

Results:  There were 72 patients in the augmented and 132 patients in the control group. Confounding factors were comparable in both groups. Mean graft diameter in the augmented group was 8.81mm
versus 8.01mm in the non-augmented. Six strand graft was achievable in 71% of the augmented group compared to 62.5% in the non-augmented group. Two graft failures reported in the non-augmented group and none in the augmented group. The average 14-month postoperative KOOS in the augmented group was 90.5 compared to average 30-month score of 82.5 in the non augmented group,which is statistically significant.

Conclusion: Augmented ACL-R demonstrate statistically significant better patient reported outcomes compared to nonaugmented group. Graft failure rates may also be lower in augmented ACL-R.

Optimum femoral and tibial tunnel positioning is paramount to a successful clinical outcome in ACL reconstruction procedures. However, some margin of error remains with placement of these tunnels, based on surgeon, patient and anatomy. This study evaluated a large series (116 patients) who underwent successful ACL reconstruction at out centre. All procedures were performed by the principal author. Patients were divided into three groups: Optimum (101), posterior tunnel(3) and anterior tunnel(12) based on placement of tibial tunnel in lateral view X Ray. Patients who appeared to have relative posterior and anterior tunnels were further evaluated by repeat MRI to check for graft impingement, roof impingement, and tunnel position. All patients were followed up for mean average of 11 months. This study evaluates the clinical results in all three patient groups, with focus on reasons for non-optimal tunnel placement, especially as all cases were performed by same surgeon. The study also evaluates the clinical results and return to sports in all three patient populations.

ACL reconstruction is one of the most common orthopaedic procedures. The aim of this study was to retrospectively evaluate the radiological progression to knee osteoarthritis (OA) after arthroscopic ACL reconstruction with semitendinous and gracilis (STG) or bone-patellar tendon-bone (BPTB) grafts.
A retrospective revision of all patients submitted to anterior cruciate ligament (ACL) reconstruction, between 2006 and 2012, with more than 8 years follow-up, was made. Progression to radiographic Knee OA was assessed according to Felson et al. and symptomatic patients were identified. Degree and location of OA were evaluated according to Kellgren and Laurence classification. Tegner activity scale, KOOScore, and VAScale were used to evaluate patient symptoms and function.
38 patients with a mean follow-up time of 9.86 years were evaluated. 22 submitted to STG and 16 to BPTB. Radiographic OA was present in 20 (52.6%) patients, with 17 (44.7%) symptomatic. OA of the medial compartment was the most frequent, present in 26 (68.4%) patients. A significant difference was found in progression to radiographic OA in BPTP and STG groups: 12/16 (75%) and 8/22 (36.4%) respectively; as well as in symptomatic OA, 11/17 (64.7%) and 6/17 (35.3%) respectively. Similarly, the results of function and satisfaction levels were superior in STG group (KOOS 86.05, Tegner 5, VAS 8.1) than in BPTB group (KOOS 64.38, Tegner 4, VAS 6.3).
In our series ACL reconstruction did not prevent secondary OA at 8 years of follow-up. The graft type can also influence the risk of radiographic and symptomatic progression to OA.