scholarly journals The “Apple-Bite-Fracture”: ACL rupture combined with posterolateral tibia plateau fracture

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0024
Author(s):  
Leif Menzdorf ◽  
Tobias Drenck ◽  
Achim Preiss ◽  
Ralph Akoto ◽  
Matthias Krause ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Statistical Power ◽  
Cruciate Ligament ◽  
Bone Bruise ◽  
Acl Tear ◽  
Therapy Strategy ◽  
Small Patient Number ◽  
Patient Reported ◽  
Ikdc Score ◽  
Tibia Plateau

Aims and Objectives: Anterior cruciate ligament (ACL) ruptures are often concomitated by posterolateral bone bruise in the MRI. This is caused by a ventral subluxation of the tibia and impact of the femur in the posterolateral tibia plateau. In some cases, this impact causes a fracture of the posterolateral tibia plateau, the so-called Apple-Bite-Fracture. The increased posterior slope can cause additional instability and has to be considered as a risk factor for ACL failure. In this study we investigated the short term clinical outcomes of patients with this combined injury. Materials and Methods: Retrospective study of 14 patients (mean age 46 ± 12,3) (8 male, 6 female) with a mean follow up of 23,75 months. Different treatment strategies were analyzed. The clinical evaluation included visual analog score (VAS) increasing from 0-10 for Pain, IKDC Score, Rasmussen score as well as a clinical evaluation. Results: First analysis of the treatment options revealed a non-uniformed therapy strategy. In three patients the ACL tear was treated nonsurgical. In 11 patients the ACL tear was addressed surgical: six times the ACL was reconstructed with hamstring tendon graft, two times the ACL was sutured. Two patients treated with a non-reconstructive technique to promote healing (“healing response”). In one patient a tibial eminence fracture was fixated with a screw. The fracture of the posterolateral tibia plateau was in nine cases minimally invasive reduced and fixated with a screw osteosynthesis in jail technique. Two patients needed posterior buttress plate. Three times the large bone defect has been augmented with autologous bone graft from the pelvis. The postoperative clinical testing did not reveal any persisting knee instabilities. All patient had a non-limited ROM. No significant differences in ROM in comparison to the contralateral knee was seen. One patient reported persisting knee pain (VAS 3). All other patients reported no pain (VAS 0). Subjective IKDC score was 78,18 (71,3 - 83,9; ± 5,68). Clinical Rasmussen scores ranged from 27 to 30 (mean 27, ± 3,0). Rasmussen radiological results ranged from 16 to 18, mean 16,67 (± 1,15). Conclusion: Despite a very small patient number and leck of statistical power the new patient-spedific mini-metal implant seems to be a good options fort he treatment of middle-aged patients who already underwent frustane cartilage surgery. In these relatively rare caes early unicompartimental arthroplasty can be prevented. Further clinical studies with larger patient collectives have to prove the effectiveness of this new technique.

Is Treatment of Segond Fracture Necessary With Combined Anterior Cruciate Ligament Reconstruction?

2017 ◽  
Vol 46 (4) ◽  
pp. 832-838 ◽  
Author(s):  
Heath P. Melugin ◽  
Nick R. Johnson ◽  
Isabella T. Wu ◽  
Bruce A. Levy ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Control Group ◽  
Study Group ◽  
Activity Levels ◽  
Segond Fracture ◽  
Acl Tear ◽  
Significant Difference ◽  
Ikdc Score ◽  
Grade 3

Background: There is a paucity of clinical information to guide the treatment of a combined anterior cruciate ligament (ACL) tear and Segond fracture. Purpose: To compare clinical outcomes, graft failure rates, and activity levels between patients undergoing ACL reconstruction (ACLR) with and without an untreated Segond fracture at a minimum 2-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: This study included a group of patients with a combined ACL tear/untreated Segond fracture that was matched based on age, sex, body mass index, and graft type to a control group of patients with an ACL tear and no Segond fracture. All patients were treated with ACLR alone between the years of 2000 and 2015. The diagnosis of a Segond fracture, or bony avulsion of the anterolateral complex, was made by radiographic analysis. Data regarding the initial injury, surgical intervention, and physical examination findings were recorded. Clinical and functional outcomes were obtained using physical examination results, International Knee Documentation Committee (IKDC) subjective scores, and Tegner activity levels. Results: Twenty patients (16 male, 4 female) with a combined ACL tear/untreated Segond fracture with a mean age of 26.3 years (range, 13-44 years) were matched to a control group of 40 patients (32 male, 8 female) with an ACL tear and no Segond fracture with a mean age of 26.4 years (range, 13-47 years). The study group was followed for a mean of 59.1 months (range, 24-180 months) and the control group for a mean of 55.5 months (range, 24-120 months). The mean IKDC score was 86.5 (range, 54-100) for the study group compared with 93.0 (range, 54-100) for the control group ( P = .03). The graft rupture rate was 10% for both groups ( P = .97). The mean time to rupture was 33.0 months (range, 21-45 months) in the study group and 63.5 months (range, 39-88 months) in the control group ( P = .24). Patients in the study group had significantly more anteroposterior instability by preoperative Lachman testing than those in the control group (control group: 0 normal, 3 grade 1+, 37 grade 2+, 0 grade 3+; study group: 0 normal, 1 grade 1+, 10 grade 2+, 9 grade 3+; P = .0001). There was no significant difference between the 2 groups in regard to postoperative Lachman testing (control group: 35 normal, 3 grade 1+, 2 grade 2+, 0 grade 3+; study group: 17 normal, 3 grade 1+, 0 grade 2+, 0 grade 3+; P = .31). Patients in the study group had significantly more instability by preoperative pivot-shift testing than those in the control group (control group: 0 normal, 7 grade 1+, 33 grade 2+, 0 grade 3+; study group: 1 normal, 1 grade 1+, 11 grade 2+, 7 grade 3+; P = .0003). No significant difference was found between the 2 groups for postoperative pivot-shift testing (control group: 36 normal, 2 grade 1+, 2 grade 2+, 0 grade 3+; study group: 18 normal, 1 grade 1+, 1 grade 2+, 0 grade 3+; P = .61) or final Tegner activity level (median, 6). Conclusion: At midterm follow-up, patients undergoing ACLR with and without a Segond fracture had similar pivot-shift test results, graft failure rates, and activity levels. The IKDC score was statistically worse in the patients with a combined ACL tear/untreated Segond fracture, but the difference was less than the minimal clinically important difference for the IKDC score. These findings suggest that patients with a combined ACL tear/untreated Segond fracture can have comparable outcomes to patients with an ACL tear and no Segond fracture when treated with ACLR alone.

Midterm Outcomes following Acute Repair of Grade III Distal MCL Avulsions in Multiligamentous Knee Injuries

2019 ◽  
Vol 33 (08) ◽  
pp. 785-791 ◽  
Author(s):  
Vishal S. Desai ◽  
Isabella T. Wu ◽  
Christopher L. Camp ◽  
Bruce A. Levy ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Surgical Repair ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
International Knee Documentation Committee ◽  
Activity Score ◽  
Patient Reported ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Grade Iii

AbstractThere is limited evidence guiding management of medial collateral ligament (MCL) avulsions or functional disruptions distal to the medial joint line. This study aims to determine outcomes of a series of patients with grade III distal MCL injuries managed with acute surgical repair. Patients with grade III, distal MCL injuries, with or without multiligament involvement were identified. Demographic, clinical examination, and midterm patient-reported outcomes (PRO) data were collected. Clinical follow-up included physical examination and ligamentous stress testing at a minimum of 6 months. PROs included Lysholm's knee scoring scale, Tegner's activity score, and subjective International Knee Documentation Committee (IKDC) scores at minimum of 2 years follow-up. Of the 24 eligible patients, outcomes data were available for 20 (83%). Of the 20 included patients, 16 had a concomitant anterior cruciate ligament (ACL) injury, 3 had ACL and posterior cruciate ligament (PCL) injuries, and 1 had an isolated MCL injury. Mean time from injury to surgery was 5 weeks. At mean clinical follow-up of 20.3 months, all patients showed valgus stability and satisfactory range of motion (ROM). Anteroposterior stability was normal in all but one patient who demonstrated a 2+ posterior drawer but with firm end points. At a mean follow-up of 5.7 years for PROs, mean Lysholm's score was 91.5 (standard deviation [SD] = 12.2), median Tegner's activity score was 7 (range, 4–9), and mean subjective IKDC score was 88.8 (SD: 9.9). The surgical repair of grade III distal MCL injuries delivered satisfactory clinical and functional outcomes. Future comparative studies with larger patient samples are needed.

scholarly journals Longitudinal Assessment of Quadriceps Muscle Morphology Before and After Anterior Cruciate Ligament Reconstruction and Its Associations With Patient-Reported Outcomes

2020 ◽  
Vol 12 (3) ◽  
pp. 271-278
Author(s):  
Steven A. Garcia ◽  
Michael T. Curran ◽  
Riann M. Palmieri-Smith
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Rectus Femoris ◽  
Quadriceps Muscle ◽  
Muscle Quality ◽  
Muscle Size ◽  
Muscle Morphology ◽  
Patient Reported ◽  
Ikdc Score ◽  
Anterior Cruciate

Background: Reductions in muscle size are common after anterior cruciate ligament reconstruction (ACLR) and may contribute to suboptimal patient outcomes. However, few studies have quantified postoperative alterations in muscle quality and evaluated its associations with patient-reported function. Hypotheses: Rectus femoris cross-sectional area (CSA) will decrease postoperatively but improve at return to activity (RTA), rectus femoris muscle quality (percentage fat [PF]) will increase postoperatively and be greater at RTA compared with preoperative values, and rectus femoris CSA and PF will be associated with International Knee Documentation Committee (IKDC) scores at both postoperative time points. Study Design: Case series. Level of Evidence: Level 4. Methods: A total of 26 individuals who sustained an ACL injury and underwent reconstructive surgery were evaluated preoperatively (T0), 9 weeks post-ACLR (T1), and at RTA. Rectus femoris CSA and PF were evaluated bilaterally via ultrasound imaging, and patient-reported function was assessed using the IKDC score. Results: Bilateral reductions in rectus femoris CSA were noted from T0 to T1 ( P < 0.01). Only the uninvolved limb returned to preoperative CSA ( P = 0.80), as the involved limb failed to return to preoperative levels at RTA ( P = 0.04). No significant changes in rectus femoris PF were observed across time points ( P > 0.05). Lesser PF ( P < 0.01) but not CSA ( P = 0.75) was associated with higher IKDC score at T1. Lesser PF ( P = 0.04) and greater CSA ( P = 0.05) was associated with higher IKDC score at RTA. Conclusion: Substantial atrophy occurs bilaterally after ACLR, and the involved limb does not return to preoperative muscle size despite the patient completing rehabilitation. Quadriceps muscle morphology is associated with patient-reported function and may be an important rehabilitation target after ACLR. Clinical Relevance: Quadriceps atrophy and poor muscle quality may contribute to suboptimal patient functioning and quadriceps dysfunction and may be important in RTA decision making. Assessing muscle morphology using ultrasound may be a feasible and clinically beneficial tool in patients after ACLR.

scholarly journals Poor Associations Between Radiographic Tibiofemoral Osteoarthritis and Patient-Reported Outcomes at 16 Years After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712095117
Author(s):  
Fredrik Identeg ◽  
Eric Hamrin Senorski ◽  
Eleonor Svantesson ◽  
Kristian Samuelsson ◽  
Ninni Sernert ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Grade 3

Background: Radiographic tibiofemoral (TF) osteoarthritis (OA) is common in patients after anterior cruciate ligament (ACL) reconstruction at long-term follow-up. The association between radiographic OA and patient-reported outcomes has not been thoroughly investigated. Purpose: To determine the association between radiographic TF OA and patient-reported outcome measure (PROM) scores at 16 years after ACL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: This study was based on 2 randomized controlled studies comprising 193 patients who underwent unilateral ACL reconstruction. A long-term follow-up was carried out at 16.4 ± 1.7 years after surgery and included a radiographic examination of the knee and recording of PROM scores. Correlation analyses were performed between radiographic OA (Kellgren-Lawrence [K-L], Ahlbäck, and cumulative Fairbank grades) and the PROMs of the International Knee Documentation Committee (IKDC) subjective knee form, Lysholm score, and Tegner activity scale. A linear univariable regression model was used to assess how the IKDC score differed with each grade of radiographic OA. Results: Of 193 patients at baseline, 147 attended the long-term follow-up. At long-term follow-up, 44.2% of the patients had a K-L grade of ≥2 in the injured leg, compared with 6.8% in the uninjured leg. The mean IKDC score at follow-up was 71.2 ± 19.9. Higher grades of radiographic OA were significantly correlated with lower IKDC and Lysholm scores ( r = –0.36 to –0.22). Patients with a K-L grade of 3 to 4 had significantly lower IKDC scores compared with patients without radiographic OA (K-L grade 0-1). Adjusted beta values were –15.7 (95% CI, –27.5 to –4.0; P = .0093; R 2 = 0.09) for K-L grade 3 and –25.2 (95% CI, –41.7 to –8.6; P = .0033; R 2 = 0.09) for K-L grade 4. Conclusion: There was a poor but significant correlation between radiographic TF OA and more knee-related limitations, as measured by the IKDC form and the Lysholm score. Patients with high grades of radiographic TF OA (K-L grade 3-4) had a statistically significant decrease in IKDC scores compared with patients without radiographic TF OA at 16 years after ACL reconstruction. No associations were found between radiographic TF OA and the Tegner activity level.

scholarly journals Outcomes and Complications After All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769360 ◽  
Author(s):  
Eric J. Wall ◽  
Paul J. Ghattas ◽  
Emily A. Eismann ◽  
Gregory D. Myer ◽  
Preston Carr
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Case Series ◽  
Reconstruction Technique ◽  
Skeletally Immature ◽  
Patient Reported ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Bone Tunnels

Background: The safest and most effective technique for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients is currently unknown. Purpose: To evaluate the functional and patient-reported outcomes of a specific all-epiphyseal ACL reconstruction technique in which the graft, bone tunnels, and fixation do not cross the knee growth plates. Study Design: Case series; Level of evidence, 4. Methods: Twenty-seven patients (23 boys, 4 girls; mean age, 11 years; range, 8-15 years) underwent an all-epiphyseal ACL reconstruction with a single femoral transverse epiphyseal tunnel and primarily split tibial epiphyseal tunnels. Outcomes were evaluated in terms of the manual Lachman test, range of motion, pain, return to activity, angular or leg-length deformity on imaging, and International Knee Documentation Committee (IKDC) or Pedi-IKDC score an average of 3.8 years postoperatively, with a minimum 2-year follow-up. Results: The mean IKDC score was 94 ± 11. There were no growth arrests, but 3 patients had knee overgrowth, and 2 required a subsequent guided growth procedure. The ACL graft failed in 4 patients (15%), and 2 patients had contralateral ACL tears (7%). There were 5 subsequent ipsilateral meniscal tears, 4 of which were retears of a repaired meniscus. Ipsilateral knee reinjury significantly correlated with the number of associated injuries at the time of index surgery ( P = .040) and the number of sports played ( P = .029). Conclusion: All-epiphyseal ACL reconstruction resulted in excellent long-term functional outcomes, despite a high rate of complications (48%) and secondary procedures (37%) in this highly active cohort. The incidence of graft failure was similar to other standard ACL reconstruction techniques for patients younger than 20 years.

scholarly journals A Comparison of Psychological Readiness and Patient-Reported Function Between Sexes After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Author(s):  
Christopher Kuenze ◽  
David Robert Bell ◽  
Terry L. Grindstaff ◽  
Caroline Michele Lisee ◽  
Thomas Birchmeier ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Young Men ◽  
Return To Sport ◽  
Men And Women ◽  
Cruciate Ligament Reconstruction ◽  
Patient Reported ◽  
Ikdc Score ◽  
Anterior Cruciate

Context Postoperative functional and return-to-sport outcomes after anterior cruciate ligament reconstruction (ACLR) differ by sex. However, whether sex disparities are observed in patient-reported outcome measures (PROMS) before return to sport after ACLR is unclear. Objectives To compare common PROMS between young men and women who had not yet returned to sport after ACLR. Design Cross-sectional study. Setting University laboratory. Main Outcome Measure(s) Forty-five young men (age = 18.7 ± 2.7 years, time since surgery = 6.8 ± 1.4 months) and 45 matched for age (±1 year) and time since surgery (±1 month; age = 18.8 ± 2.8 years, time since surgery = 6.9 ± 1.4 months) with ACLR participated. Participants completed the Tegner Activity Scale, ACL Return to Sport After Injury scale, Tampa Scale of Kinesiophobia, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). The PROMS were compared between men and women using Mann-Whitney U tests. Odds ratios were calculated to evaluate the odds of a male reporting a PROM value above the previously established normative value as compared with a female. Results Sex differences were present for the IKDC score (P = .01) and KOOS Pain score (P = .04) but not for the Tegner activity level (P = .22), ACL Return to Sport after Injury scale score (P = .78), Tampa Scale of Kinesiophobia score (P = .64), or other KOOS subscales (P values = .40 to .52). The odds of reporting values above normative levels differed only for the IKDC score (odds ratio = 2.72, 95% confidence level = 1.16, 6.38). Conclusions After ACLR, young men and women reported similar levels of knee-related function, fear of movement, and readiness for return to sport and were equally likely to meet clinically meaningful normative values before return to sport. Overreliance on patient reports or objective functional outcomes in evaluating patient progress and readiness for return to sport after ACLR may limit clinicians in their ability to comprehensively evaluate and develop individualized interventional approaches that optimize patient outcomes.

scholarly journals Evaluation of functional outcome of arthroscopic anterior cruciate ligament reconstruction by modified AMP technique

2019 ◽  
Vol 5 (5) ◽  
pp. 824
Author(s):  
Saurabh Gupta ◽  
Meenakshi Garg ◽  
Raj Singh
Keyword(s):  
Anterior Cruciate Ligament ◽  
Femoral Tunnel ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Rotational Instability ◽  
Tunnel Length ◽  
Acl Tear ◽  
Starting Point ◽  
Ikdc Score ◽  
Anterior Cruciate

<p class="abstract"><strong>Background:</strong> In anterior cruciate ligament (ACL) reconstruction, transtibial (TT) drilling of the femoral tunnel has been criticized for its vertical and less anatomical tunnel, which accompanied rotational instability of knee. Antero medial portal (AMP) drilling technique creates more oblique and anatomic femoral tunnel. However, recent researches show that oblique tunnel is related to risks of too short femoral tunnel, blowout of back wall, and posterolateral structures injury. Modified AMP technique creates vertical tunnel with anatomical FSP (femoral starting point).</p><p class="abstract"><strong>Methods:</strong> In our study we have functionally evaluated 30 patients of ACL tear who underwent reconstruction by modified AMP technique. Modified AMP technique creates vertical tunnel with anatomical FSP.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean postoperative Lysholm score is 94.4±1.22 and mean postoperative subjective IKDC score is 93.308. All the cases of ACL tear reported their knees as normal or near normal according to objective IKDC score after reconstruction. Mean coronal angle is 51.112±6.3 and mean femoral tunnel length is 41.8±3.55 mm while posterior wall blowout of lateral femoral condyle and postero lateral structure injury has not been observed.</p><p class="abstract"><strong>Conclusions:</strong> The modified AMP technique provides an anatomic and safe mode with vertical tunnel and oblique graft, by reduces the risks involved in the AMP technique.</p>

scholarly journals Towards Improving the Identification of Anterior Cruciate Ligament Tears in Primary Point-of-Care Settings

2020 ◽  
Author(s):  
Jackie L Whittaker ◽  
Michelle Chan ◽  
Bo Pan ◽  
Imran Hassan ◽  
Terry Defreitas ◽  
...  
Keyword(s):  
Point Of Care ◽  
Cruciate Ligament ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Support Tool ◽  
Acl Tear ◽  
Patient Reported ◽  
History Of ◽  
Clinical Decision Support Tool ◽  
Anterior Cruciate

Abstract Background: Only a small proportion of anterior cruciate ligament (ACL) tears are diagnosed on initial healthcare consultation. Current clinical guidelines do not acknowledge that primary point-of-care practitioners rely more heavily on a clinical history than special clinical tests for diagnosis of an ACL tear. This research will assess the accuracy of combinations of patient-reported variables alone, and in combination with clinician-generated variables to identify an ACL tear as a preliminary step to designing a primary point-of-care clinical decision support tool.Methods: Electronic medical records (EMRs) of individuals aged 15-45 years, with ICD-9 codes corresponding to a knee condition, and confirmed (ACL+) or denied (ACL-) first-time ACL tear seen at a University-based Clinic between 2014 and 2016 were eligible for inclusion. Demographics, relevant diagnostic indicators and ACL status based on orthopaedic surgeon assessment and/or MRI reports were manually extracted. Descriptive statistics calculated for all variables by ACL status. Univariate between group comparisons, clinician surveys (n=17), availability of data and univariable logistic regression (95%CI) were used to select variables for inclusion into multivariable logistic regression models that assessed the odds (95%CI) of an ACL-tear based on patient-reported variables alone (consistent with primary point-of-care practice), or in combination with clinician-generated variables. Model performance was assessed by accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (95%CI).Results: Of 1,512 potentially relevant EMRs, 725 were included. Participant median age was 26 years (range 15-45), 48% were female and 60% had an ACL tear. A combination of patient-reported (age, sport-related injury, immediate swelling, family history of ACL tear) and clinician-generated variables (Lachman test result) were superior for ACL tear diagnosis [accuracy; 0.95 (90,98), sensitivity; 0.97 (0.88,0.98), specificity; 0.95 (0.82,0.99)] compared to the patient-reported variables alone [accuracy; 84% (77,89), sensitivity; 0.60 (0.44,0.74), specificity; 0.95 (0.89,0.98)].Conclusions: A high proportion of individuals without an ACL tear can be accurately identified by considering patient-reported age, injury setting, immediate swelling and family history of ACL tear. These findings directly inform the development of a clinical decision support tool to facilitate timely and accurate ACL tear diagnosis in primary care settings.

scholarly journals Towards Improving the Identification of Anterior Cruciate Ligament Tears in Primary Point-of-Care Settings

2019 ◽  
Author(s):  
Jackie L Whittaker ◽  
Michelle Chan ◽  
Bo Pan ◽  
Imran Hassan ◽  
Terry Defreitas ◽  
...  
Keyword(s):  
Point Of Care ◽  
Cruciate Ligament ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Support Tool ◽  
Acl Tear ◽  
Patient Reported ◽  
History Of ◽  
Clinical Decision Support Tool ◽  
Anterior Cruciate

Abstract BackgroundOnly a small proportion of anterior cruciate ligament (ACL) tears are diagnosed on initial healthcare consultation. Current clinical guidelines do not acknowledge that primary point-of-care practitioners rely more heavily on a clinical history than special clinical tests for diagnosis of an ACL tear. This research will assess the accuracy of combinations of patient-reported variables alone, and in combination with clinician-generated variables to identify an ACL tear as a preliminary step to designing a primary point-of-care care clinical decision support tool.MethodsElectronic medical records (EMRs) of individuals aged 15-45 years, with ICD-9 codes corresponding to a knee condition, and confirmed (ACL+) or denied (ACL-) first-time ACL tear seen at a University-based Clinic between 2014 and 2016 were eligible for inclusion. Demographics, relevant diagnostic indicators and ACL status based on orthopaedic surgeon assessment and/or MRI reports were manually extracted. Descriptive statistics calculated for all variables by ACL status. Univariate between group comparisons, clinician surveys (n=17), availability of data and univariable logistic regression (95%CI) were used to select variables for inclusion into multivariable logistic regression models that assessed the odds (95%CI) of an ACL-tear based on patient-reported variables alone (consistent with primary point-of-care practice), or in combination with clinician-generated variables. Model performance was assessed by accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (95%CI).ResultsOf 1,512 potentially relevant EMRs, 725 were included. Participant median age was 26 years (range 15-45), 48% were female and 60% had an ACL tear. A combination of patient-reported (age, sport-related injury, immediate swelling, family history of ACL tear) and clinician-generated variables (Lachman test result) were superior for ACL tear diagnosis [accuracy; 95%CI (90,98), sensitivity; 0.97 (0.88,0.98), specificity; 0.95 (0.82,0.99)] compared to the patient-reported variables alone [accuracy; 84% (77,89), sensitivity; 0.60 (0.44,0.74), specificity; 0.95 (0.89,0.98)].ConclusionsA high proportion of individuals without an ACL tear can be accurately identified by considering patient-reported age, injury setting, immediate swelling and family history of ACL tear. These findings directly inform the development of a clinical decision support tool to facilitate timely and accurate ACL tear diagnosis in primary care settings.

scholarly journals Femoral and Tibial Tunnel Diameter and Bioabsorbable Screw Findings After Double-Bundle ACL Reconstruction in 5-Year Clinical and MRI Follow-up

2017 ◽  
Vol 5 (2) ◽  
pp. 232596711668552 ◽  
Author(s):  
Tommi Kiekara ◽  
Antti Paakkala ◽  
Piia Suomalainen ◽  
Heini Huhtala ◽  
Timo Järvelä
Keyword(s):  
Clinical Evaluation ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Case Series ◽  
Knee Laxity ◽  
Double Bundle ◽  
Tunnel Enlargement ◽  
Patient Reported ◽  
Double Bundle Acl Reconstruction

Background: Tunnel enlargement is frequently seen in short-term follow-up after anterior cruciate ligament reconstruction (ACLR). According to new evidence, tunnel enlargement may be followed by tunnel narrowing, but the long-term evolution of the tunnels is currently unknown. Hypothesis/Purpose: The hypothesis was that tunnel enlargement is followed by tunnel narrowing caused by ossification as seen in follow-up using magnetic resonance imaging (MRI). The purpose of this study was to evaluate the ossification pattern of the tunnels, the communication of the 2 femoral and 2 tibial tunnels, and screw absorption findings in MRI. Study Design: Case series; Level of evidence, 4. Methods: Thirty-one patients underwent anatomic double-bundle ACLR with hamstring grafts and bioabsorbable interference screw fixation and were followed with MRI and clinical evaluation at 2 and 5 years postoperatively. Results: The mean tunnel enlargement at 2 years was 58% and reduced to 46% at 5 years. Tunnel ossification resulted in evenly narrowed tunnels in 44%, in conical tunnels in 48%, and fully ossified tunnels in 8%. Tunnel communication increased from 13% to 23% in the femur and from 19% to 23% in the tibia between 2 and 5 years and was not associated with knee laxity. At 5 years, 54% of the screws were not visible, with 35% of the screws replaced by a cyst and 19% fully ossified. Tunnel cysts were not associated with worse patient-reported outcomes or knee laxity. Patients with a tibial anteromedial tunnel cyst had higher Lysholm scores than patients without a cyst (93 and 84, P = .03). Conclusion: Tunnel enlargement was followed by tunnel narrowing in 5-year follow-up after double-bundle ACLR. Tunnel communication and tunnel cysts were frequent MRI findings and not associated with adverse clinical evaluation results.

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