Background:The impact of anterior cruciate ligament (ACL) injury and Achilles' tendon (AT) rupture on football players' careers has not been extensively investigated. This descriptive epidemiology study aimed to compare the return-to-play (RTP) rate, career survival, athletes' performance and market values in the first three postoperative seasons after surgery for ACL or AT injury in male football players. Methods:Authors investigated professional football players in the top 8 European Football leagues who suffered an ACL tear or AT rupture. Data were retrieved from publicly available online sources. Outcomes were evaluated based on age, position, affected side, and league. Results:Overall, 178 players sustained an ACL injury and 71 an AT rupture. The mean age was 25.6 for ACL and 28.5 for AT (p<0.001); the BMI was lower in ACL (22.81) than in AT (23.20) (p=0.046). No difference was found in position or dominant side. The RTP rate after was 98.3% for ACL and 100.0% for AT (p=0.271), with a mean RTP time of 238.3 days for ACL and 216.2 for AT (p=0.156). Within the third season, 73.8% of players in the ACL group and 69.8% in AT group competed in a top-level league, and respectively 17.8% and 18.3% ended their careers (p=0.754). Re-ruptures occurred in 4.5% of the ACL group and 2.8% of the AT group. The market value decreased similarly in both groups after surgery (p=0.271). Conclusions:Although ACL injury occurred in younger players than AT rupture, the outcomes considered in this study did not show a difference between the two groups.

Anterior cruciate ligament (ACL) tibial avulsion occurs predominantly in children and young adults.ACL avulsion is associated with severe restriction of knee range of motion, instability and pain.ACL avulsion from the tibial side has been treated by methods ranging from conservative to a variety of operative procedures. The already described techniques have drawbacks of unstable fixation, anterior beaking and re operation. They require experience hands and exhaustive resources making these techniques challenging. To overcome these drawbacks, we have come up with a novel technique for ACL tibial avulsion repair. The technique is applicable for Meyers-McKeever type II, III, and IV ACL avulsions that uses regular antero-lateral, antero-medial along with an additional trans-patellar tendon portal. The posterior wall of tibial crater bed of the avulsed fragment is cleared and utilized to insert a 5.5mm double loaded anchor. The sutures from the anchor are passed through the base of ACL stump above the bony fragment from posterior to anterior. This unique configuration of fibre-wires buttress the avulsed fragment completely. Ultimately, these fibre-wires are passed through a knotless 5.5mm anchor and is fixed within the intra articular portion of the proximal tibia to give a stable and comprehensive fixation. As the fixation does not cross the physis, it can prove to be the best in skeletally immature. This technique is performed arthroscopically in an all inside manner, addresses the avulsed fragments without harming the physis, can be easily mastered by the beginners in arthroscopy and avoids the drawbacks of open and conventional arthroscopic procedures.

Objectives: To investigate the effectiveness of continuous cold flow and compression device versus traditional icing regimen and without icing following anterior cruciate ligament reconstruction.
Methodology: All patients undergoing ACL reconstruction from June 2021 to August 2021 were enrolled in this study. All patients were randomly allocated in to three groups: A control group (n=10) with no ice regimen post-operatively, a second control group (n=10) with ice bag and third group (n=10) with continuous cold flow and compression device (physiolab). All patients who had isolated ACL tear evident on magnetic resonance imaging were included. Pain intensity was measured by using visual analogue score at pre-operative, 24 hours, 2, 6 and 12 weeks post-operatively. The secondary outcomes were limb girth, oxford knee score and 12-item survey form.
Results: The mean age for icing, non-icing and physiolab was 26.60±3.40, 27.40±3.59 and 27.30±3.23 respectively. There was significant difference found between pain scores in all groups at 2 and 6 weeks follow up with P-value of 0.004 and 0.01. The test of between subject effect showed significant difference in (P= 0.007) limb girth between groups. According to profile plot, physiolab reduced immediate swelling after 24 hours of surgery. The SF-12 and oxford score improved at each follow-up in all groups with no statistical difference between groups.
Conclusion: Cold and compression device can be used to reduce swelling immediately after ACL reconstruction. However, there is no such effect of cold and compression therapy in improving outcomes after surgery.

" the Lelli test : a new clinical test for the diagnosis of ACL lesion "
A.LELLI
DEPARTEMENT OF ORTHOPEDY ,VILLA REGINA HOSPITAL,BOLOGNA ,ITALY

The Lelli test is a new clinical examination tool to diagnose ACL lesion.Preliminary results suggest almost 100% sensivity and specificity to diagnose acute and chronic complete ACL tears and clinically significant partial tears as compared with MRI

Methods : this study includes 800 patients :clinical history detail clinical assessment of knee instability including anterior drawer test, pivot shift test, and lelli test

conclusions : in general ,chronic, complete tears were mostsuccessfully diagnosed but acute and partial tears were least successfully diagnosed .The lelli test is more sensitive to correctly diagnose both acute and partial tears of the ACL compared wit other common tests

Background: Knee pain is one of the commonest symptoms in patients who attend the Orthopaedic outpatient clinics. Chondral defects result in a painful knee. Incidence of chondral defect is reported to be between 5 and 10% over the age of 40. It is well documented that chondral defects can lead to osteoarthritis. Early detection of these lesions and cartilage repair surgery can delay the onset of osteoarthritis. The purpose of this study is to highlight the incidence, associations and correlations between opposing cartilage defects in patients who present to the knee clinic with pain. Methods: A retrospective analysis was carried out on patients who had Magnetic Resonance Imaging scans for painful knees between June 2017 and May 2019. About 227 consecutive knees were studied for the incidence of chondral defects, number of lesions, grade and size of lesion, geographical location and associated pathology in the knee. Results: All the 227 patients had chondral lesions. Most patients had 2–3 lesions (66.1%) with patellar lesions (76.6%) being the commonest followed by medial femoral condyle (59.9%). Significant correlation was found in grade and size between opposing surface lesions in patella-trochlea, Medial Femoral Condyle-Medial Tibial Plateau and Lateral Femoral Condyle-Lateral Tibial Plateau. Females were more predisposed to patella lesions. Significance between age and lesions were established. Conclusion: Incidence of cartilage defects in the knee is very high. Kissing lesions must be considered when treating cartilage lesions. Volume index could be a promising method to quantify lesions. Keywords: Cartilage defects, Chondral defects, Epidemiology

Objectives: Concomitant anterolateral complex (ALC) injury may contribute to persistent rotatory knee instability following anterior cruciate ligament (ACL) reconstruction. There is no consensus on how to best identify concomitant ALC injury preoperatively, nor how well ALC injury identified on imaging modalities correlates with clinical examination of knee instability. The purpose of this retrospective study was to determine the incidence of concomitant ALC injury in ACL-injured knees, as determined by arthroscopy, and in comparison to, preoperative imaging modalities. Methods: 117 patients with unilateral primary ACL injury who underwent individualized anatomic ACLR between June 2016 and May 2019 were enrolled. Preoperative imaging modalities (x-ray, ultrasound, MRI) were evaluated for concomitant ALC injury. Clinical examination under anesthesia (anterior drawer, Lachman, pivot shift tests) were performed. Anterolateral capsule injury, as defined by hemorrhage and/or capsular tearing on diagnostic arthroscopy, was also determined. Correlative analyses of ALC injury incidence and severity were performed across imaging modalities and against clinical examination grades. Results: ALC injury incidence across imaging modalities was as follows: x-ray (3%), arthroscopy (19%), MRI (53%), and US (63%). The ALC injury rate on arthroscopy was significantly less than MRI (p<0.001) or ultrasound (p<0.001). ALC injury incidence and severity were significantly correlated between MRI and US grading scales (p=0.02) but no correlations among other imaging modalities were found. No imaging modality meaningfully correlated with physical examination maneuvers. Conclusion: The incidence of ALC injury varies across imaging modalities. Increasing ALC injury severity grades on imaging does not predict increasing anterolateral knee laxity on clinical examination.

This paper aimed to compare, in patients who suffered from an acute ACL injury associated with preoperative ALRI(Anterolateral rotatory Instability), the clinical outcomes of ACL+anterolateral complex (ALC) repair versus combined ACL reconstruction(ACLR) + lateral-extrarticular Tenodesis(LET).
The hypothesis was that patients treated with ACL+ALC repair would have non-inferior clinical and radiological outcomes compared with patients undergoing ACLR+LET at a 2-year minimum follow-up.
Methods:
Consecutive patients presenting with an acute knee injury, with clinical and radiological evidence of ACL rupture associated with ALRI were considered for eligibility in this prospective study. Surgical procedures were performed within 15 days of injury. The decision to perform an ACL+ALC repair or an ACLR+LET was taken after assessing the repairability of the ACL during arthroscopy.
Results:
The final study population was composed by 44 patients who received an ACL+ALC Repair and 40 an ACLR+LET.
At 2 years, there were not significant differences in the ACL+ALL repair group compared to the ACLR+LET group in terms of the IKDC Score (P=.089). At the 1-year post-op MRIs there were no significant differences in terms of SNQ comparing the ACL+ALC repair group to the ACLR+LET group (P=.39). The non-inferiority was proven for both clinical and radiological outcomes. Two patients experienced graft failure in the ACL+ALC Repair group and one patient in the ACLR+LET group, with no significant difference.
Conclusions:
In acute ALRI occurring as a result of a combined ACL and ALC tears, ACL+ALC repair has non-inferior clinical and radiological outcomes compared with patients undergoing ACLR+LET.

Introduction: Optimal graft size for anterior cruciate ligament (ACL) reconstruction is a key factor for successful surgery. Studies showed that small graft size(<8mm) increased risk of failure while large graft size caused impingement to intercondylar roof, posterior cruciate ligament and harmed the root area of lateral meniscus. Hence, graft size need to be customized for optimal result rather than 1 size fit all. The purposes of this study are to evaluate diameter of ACL at mid-portion, length & width of femoral insertion and tibial insertion of ACL and their correlation with anthropometric parameters ( height, thigh length, leg length, anterio-posterior (AP) & mediolateral (ML) diameter of tibia plateau, femoral inter-epicondylar distance, femoral intercondylar notch distance, AP diameter of medial & lateral femoral condyle) that allow us to estimate native ACL size prior customizing the graft size for each individual. Method: A total of 24 cadaveric knees were included. Result: Diameter of ACL at mid-portion was 7.4mm±1.2(5.8-10.5mm). Length and width of tibial insertion of ACL were 17.7mm±2.6 (11.3-22.3mm) and 12.0mm±2.1(7.3-15.8mm) respectively. Length and width of femoral insertion of ACL were 17.0mm±3.3 (9.2-26.5mm) and 10.8mm±1.9(7.3-15.4mm) respectively. The diameter of ACL at mid-portion had strongest association with thigh length (r:0.566, p:0.004). Length and width of tibial insertion of ACL had strongest association with leg length (r:0.753, p<0.001; r:0.714, p<0.001). Length of femoral insertion of ACL had strongest association with ML diameter tibia plateau (r:0.664, p<0.001). Based on these associations, following linear regression formulas were developed: Diameter of ACL at mid-portion(mm) =-4.22+0.24 (thigh length(cm))...

BACKGROUND Recent outcomes of arthroscopic primary repair of proximal anterior cruciate ligament (ACL) tears have been promising in recent past. The purpose of this study was to assess outcomes of arthroscopic ACL repair and to assess the role of additional augmentation. METHODS Total of 26 patients underwent arthroscopic ACL repair were examined at minimum 2-year follow-up. All 26 patients were included (100% follow-up). Single Anchor technique was utilized and no internal brace was used. However, patients were given 3-4 sessions of PRP in their first 6 months of Follow up. Mean age at surgery was 24.5 ± 10.3 years (89% male) and mean follow-up 2.2 ± 1.6 years. Clinical examination was performed using the objective International Knee Documentation Committee (IKDC) form. Subjective outcomes were obtained using the Lysholm, and subjective IKDC scores. Patients were given brace free rehabilitation. RESULTS 3 repairs (11.5%) failed and were treated with ACL Reconstruction using relevant Autografts. Objective IKDC scores were A in 17 (65%), B in 8 (19%) and C/D in 6 (7%) patients. Mean Lysholm score was 96 ± 8.6, and subjective IKDC 93 ± 1.9. Failures rates were 11.5 % . 3 (11.5 %) patients were re-operated for Meniscal injuries and anchor related problems. 13 patients (50%) Returned To Sports. CONCLUSION Arthroscopic primary repair has resulted in good objective and subjective outcomes at 2-year follow-up in a carefully selected population. The role of additional internal bracing is possibly helpful, but larger groups are needed to assess this

Peroneus longus graft use for primary ACL reconstruction was never thought of with a very few literature present. So, our study aims to compare the results of ACL injury managed by arthroscopic single bundle reconstruction with peroneus longus verses hamstrings as an auto-graft. Adults of age 16-50 years of either gender presenting with symptomatic ACL deficiency were admitted ,operated and observed. Functional scores (International knee documentation committee , Lysholm score), clinical knee evaluation (anterior drawer, Lachman and pivot shift test), donor site morbidity (American Orthopaedic Foot and Ankle Society ankle hindfoot score), time and thickness of graft retrieval, and improvement in thigh circumference were recorded at 1 year post-operative.In 40 patients who met the inclusion criteria there were no significant differences between the 1 year postoperative evaluation of hamstring and peroneus longus groups in the IKDC (p=0.356) ,Lysholm knee (p=0.289) and AOFAS scores. The peroneus longus graft diameter (8.92 ± 0.30 mm) was significantly larger than the hamstring diameter (8.28 ± 0.32 mm) (p < 0.001). There was significant improvement in thigh muscle wasting among peroneus group at final follow up (p < 0.001). We observed similar knee stability, functional outcome and no obvious donor site morbidity among both the groups but getting much thicker graft with significantly less graft harvesting time and a better response in thigh muscle wasting in peroneus group. So, we recommend that peroneus longus graft can be a safe, viable and effective option for arthroscopic single bundle ACL reconstruction.

Introduction ACL reconstruction is one of the most commonly performed arthroscopic knee surgery. The most widely used autograft sources are Hamstring, Bone-Patellar Tendon-Bone (BPTB), Quadriceps tendon, Fascia Lata and Iliotibial Band. BPTB graft has the best tensile strength and bone union with bone, but the complications of anterior knee pain are also quite common (5-55%). The loss of Hamstring tendons also causes a decrease in muscle strength.In female patients hamstring graft length and thickness in a major concern. The aim of this study was to evaluate the clinical outcome and donor site morbidity of ACL reconstruction with PLT ( Peroneus longus tendon ) autografts in patients with an ACL injury. Material and methods ACL reconstruction was performed using ipsilateral PLT in 20 female patients. Functional scores (IKDC and Lysholm scores) were recorded preoperatively and postoperatively till 1 year after surgery. Donor site morbidities were assessed with VAS-FA and ankle scoring with the AOFS and FADI score Results- The mean of peroneus longus graft diameter was (8.9 ± 0.4 mm) There were significant differences between Pre and postoperative lysholm score that was (50.1+20.2) and improved to (84.0.+14.1) postoperatively. Preoperative IKDC score was (73.4+8.3) that was improved to (52.0+6.2 The mean for AOFAS was 97.3 ± 4.2 and for the FADI 98 ± 3.4 Conclusions PLT with advantages of larger graft diameter, less thigh hypotrophy and excellent ankle function based on AOFAS and FADI scoring is recommended for ACL reconstruction

Introduction: The quadriceps tendon (QT) is an emerging autograft option in primary anterior cruciate ligament reconstruction (ACLR). Limited studies have been performed to measure its functional outcomes. This study evaluates differences in patient reported outcome measure (PROM) scores and revision rates for QT in comparison with hamstring tendon (HT) and bone-patella-tendon-bone (BPTB) autografts in isolated primary ACLR.

Methods: All patients who underwent primary arthroscopic ACLR recorded on the New Zealand Anterior Cruciate Ligament Registry were considered for the study. Importantly, patients who had associated knee injuries or previous knee surgery were excluded. The primary outcome was PROM scores (MARX and KOOS scores) at 2 years post-surgery. Secondary outcomes were revision rates, time to revision, and all cause for revision.

Results: 2019 patients were included in the study; 1570 HT, 384 BPTB, and 65 QT; all with comparable baseline characteristics. At 2 years, no significant difference in MARX score was found between QT and HT (mean 5.69 vs. 5.98, P = 0.618). However, a statistically significant difference was found between QT and BPTB (mean 5.69 vs. 6.91, P = 0.047), and HT and BPTB (mean 5.98 vs. 6.91, P < 0.001). KOOS score for pain and quality of life were similar between groups. There were no revisions for the QT and BPTB groups, and 4 revisions for the HT group.

Conclusions: Similar functional outcomes were observed at 2 years between all autograft choices for primary arthroscopic ACLR. These results suggests QT is a comparable autograft choice to the status quo.

Background: Meniscus ramp lesions associated with anterior cruciate ligament (ACL) injuries are being increasingly reported in the literature. This study was carried out to know the incidence of ramp lesions in ACL injured patients and study the characteristics of these patients in our population. Methods: 75 patients who underwent ACL reconstruction from Jan 2021 to Dec 2021 were prospectively studied. Patients with multi-ligament injuries or a history of previous knee surgery were excluded. All patients were examined clinically and underwent MRI examination. The findings of arthroscopy during ACL reconstruction were recorded and analyzed. Result: Seventeen patients had ramp lesion with an incidence of 22.67%. Eight were isolated ramp lesion and 9 had other meniscus injuries. Preoperative MRI was 41.18% sensitive in identifying the ramp lesion. Thirteen out of 17 patients with ramp lesions had increased mobility of the posterior horn of the medial meniscus on anterior probing. The duration from injury to surgery was significantly more in patients with ramp lesions as compared to patients without ramp lesions. Conclusion: Ramp lesion is not an uncommon lesion in ACL injuries and can occur as an isolated meniscus lesion or in association with other meniscus lesions. An active effort should be made to look for ramp lesions in the posteromedial compartment of the knee in all cases undergoing ACL reconstruction.

Introduction: The peroneus longus tendon has been explored as the ideal graft choice for ACL (anterior cruciate ligament) reconstructions and has shown equal functional results comparable to the use of conventional autografts around knee. The study aimed to quantify the possible morbidity if any in the donor ankle and establish Peroneus Longus as a good alternative for graft source selection. Method: In this prospective study, military athletes diagnosed with ACL injury, underwent reconstructive surgery using ipsilateral peroneus longus tendon autograft in tertiary care set up. Exclusion criteria were multiligamentous injuries, previous foot and ankle injury. The AOFOS (American Orthopaedic Foot and Ankle Society) and FADI (Foot and Ankle Disability Index) scores of the graft-donor foot and ankle were documented and compared with contralateral foot and ankle at six months post-operatively. Results: A total of 20 male patients were included in the study. The mean age was 28.7± 6.1 yrs. The average operative time was 65± 6.8 mins. There was no post-op ankle pain or instability clinically. The mean AOFOS and FADI scores of the donor foot and ankle were 98.1± 0.7 and 99.2 ± 1 respectively and comparable to that of contralateral foot and ankle (99 ± 0.6 and 100 ± 0.8 respectively). Conclusion: Harvesting Peroneus longus autograft is a safe procedure with excellent outcome in view of negligible donor site morbidity and Peroneus longus autograft can be recommended as a primary and alternative source of graft in ligament reconstruction procedures.

Purpose: To evaluate the clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with meniscal allograft transplantation (MAT) through systematic review of current available evidence. Methods: A systematic database search of PubMed, Embase, Web of Science and CINAHL was performed in December 2021 in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Follow-up studies (inception cohort studies/non-randomized controlled trials/retrospective cohort studies) and case series that had more than 10 people published in English, which involved patients who underwent a combination of ACLR and MAT were included. Systematic review of International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores were conducted. Results: Eight studies involving 387 patients were included. All studies used the Lysholm Knee Scoring system to report clinical outcomes, while three studies and four studies used the IKDC Questionnaire and Tegner activity scale respectively to measure clinical outcomes post-operatively. Comparing postoperative to pre-operative scores, we found an improvement above the MCID for the Lysholm (MD range= 16.00 to 29.70) and Tegner activity scores (MD range = 1.30 to 2.00). All but one study reported an increase above the MCID for IKDC scores post-op (MD range= 5.60 to 23.00). Conclusions: Combined ACLR with MAT have good long term clinical outcomes and is an optimal procedure for patients with concurrent ACL and irreparable meniscus injuries. More prospective studies and studies evaluating outcome differences between concurrent ACLR with MAT and staged ACLR with MAT should be conducted. Level of evidence: III

Introduction: Posterior Cruciate Ligament (PCL) reconstruction is a complex surgical procedure and often challenging. The newer posterior trans-septal portal technique is thought to make tibial tunnel preparation easier with better visualization of the tibial attachment site. It is also perceived to lower the risk of neurovascular injuries. The aim of this study is to evaluate the functional and clinical outcomes of patients who underwent arthroscopic all-inside PCL reconstruction using the posterior trans-septal portal at our institute.
Methods: This was a retrospective study with prospectively collected data between 2016 - 2020. Results: A total of 36 patients (26 males and 10 females) were identified. The mean age was 35.2 years. Mean time from injury to surgery was 17 months. Mean follow-up was 41.2 months (range, 13-72 months). Nineteen cases involved multiligament injuries and another 17 patients had isolated PCL injury. Eighteen PCLs were reconstructed using autograft and 18 were allograft. Result: Post-operative posterior drawer test grade improved from 2.7 to 0.7 (p<0.001). Knee ROM was 116.3 degrees pre-operatively and 115.6 degrees postoperatively (p=0.814). Lysholm knee scoring scale improved from 50.9 to 91.0 (p<0.001). KOOS score improved from 65.1 to 77.2 (p=0.196). One patient required a manipulation under anaesthesia for stiffness. No patients needed any additional surgical procedures. All PCLs were clinically intact at final follow-up.
Conclusion: Arthroscopic all inside PCL reconstruction using the posterior trans-septal portal technique is a safe, reliable and reproducible procedure. From our study it shows that clinical and functional outcomes improved significantly post operatively.