Anterior Knee Endoscopy

Background: The acute effects of exercise on anterior knee laxity (AKL) and anterior knee stiffness (AKS) have been documented in healthy participants, but only limited evidence has been provided for athletes cleared to return to sports after anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose/Hypothesis: The purpose was to determine if 45 minutes of a soccer match simulation lead to acute changes in AKL and AKS in soccer players returning to sport within 12 months after ACLR. We hypothesized that the reconstructed knee of the ACLR group would exhibit an altered response to sport-specific exercise. Study Design: Controlled laboratory study. Methods: A total of 13 soccer players cleared to return to sport after ACLR and 13 healthy control soccer players matched for age, physical activity level, limb dominance, and anthropometric characteristics were recruited. To assess the effects of a standardized soccer match simulation (Soccer Aerobic Field Test [SAFT45]) on AKL and AKS, an arthrometric evaluation was carried out bilaterally before and immediately after SAFT45. To conduct a comprehensive examination of the force-displacement curve, the absolute and side-to-side difference (SSD) values of both AKL and AKS were extracted at 67, 134, and 200 N. Results: The ACLR and control groups showed similar AKL and AKS at baseline ( P > .05). In response to SAFT45, laxity increased bilaterally at all force levels by 14% to 17% only in the control group ( P < .025). Similarly, AKS at 134 and 200 N decreased in response to SAFT45 only in the control group (10.5% and 20.5%, respectively; P < .025). After SAFT45, the ACLR group had 1.9 and 2.5 times higher SSDs of AKS at 67 and 134 N compared with the control group, respectively ( P < .025), as well as a 1.9 times higher SSD of AKS at 134 N compared with baseline ( P = .014). Conclusion: Soccer players at the time of return to sport after ACLR showed an altered mechanical response to a sport-specific match simulation consisting of bilaterally unchanged AKL and AKS. Clinical Relevance: Soccer players showing altered AKL and AKS in response to exercise after ACLR may not be ready to sustain their preinjury levels of sport, thus potentially increasing the risk of second ACL injuries.

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Influence of patellar denervation on anterior knee pain and knee function following total knee replacement: A systematic review and meta‐analysis

ANZ Journal of Surgery ◽

10.1111/ans.17078 ◽

2021 ◽

Author(s):

Yongzhi Qin ◽

Chuancheng Pu ◽

Yong Zhou ◽

Jiang Yu ◽

Jing Tang

Keyword(s):

Systematic Review ◽

Total Knee Replacement ◽

Knee Pain ◽

Knee Replacement ◽

Anterior Knee Pain ◽

Meta Analysis ◽

Knee Function ◽

Total Knee ◽

Anterior Knee

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120 Genicular Nerve Radio-Frequency Ablation in The Treatment of Anterior Knee Pain in Patients with Osteoarthritis of The Knee Joint: Systematic Review

British Journal of Surgery ◽

10.1093/bjs/znab134.532 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Farrugia ◽

C Tinning

Keyword(s):

Knee Pain ◽

Anterior Knee Pain ◽

Comparative Studies ◽

Primary Outcome ◽

Final Analysis ◽

Primary Outcome Measure ◽

Sensory Innervation ◽

Osteoarthritis Of The Knee ◽

Pain Scores ◽

Anterior Knee

Abstract Anterior knee pain is one of the main symptoms in osteoarthritis, resulting from the rich sensory innervation of its capsule. Pain control can be difficult to achieve, with non-responders to conservative and medical therapy often requiring a total knee replacement. Radiofrequency ablation (RFA) is a novel technique that could be beneficial in managing anterior knee pain by targeting the genicular nerves around the knee; however, its routine use is not included in current guidelines. A literature search identified fifty-two results, which underwent screening using a study protocol and the final literature sources, of varying levels of evidence, underwent critical appraisal and analysis. The primary outcome included the significant improvement of pain scores from baseline, against their respective control treatments. The ten studies included in the final analysis consisted of seven comparative studies and three non-comparative studies. Literature showed significant improvement in their mean pain scores, all meeting the primary outcome measure. Most studies also showed significant improvement from the control treatments used. Current literature shows evidence that genicular nerve RFA is an effective and safe treatment modality in the management of anterior knee pain secondary to osteoarthritis. However, the literature available is limited and further comparative studies are required.

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HP0018 The development of an integrated care pathway for the management of anterior knee pain in cornwall

10.1136/annrheumdis-2001.1293 ◽

2001 ◽

Author(s):

PJ Pender

Keyword(s):

Integrated Care ◽

Knee Pain ◽

Anterior Knee Pain ◽

Care Pathway ◽

Integrated Care Pathway ◽

Anterior Knee

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Effect of Tibial Tunnel Placement Using the Lateral Meniscus as a Landmark on Clinical Outcomes of Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction

The American Journal of Sports Medicine ◽

10.1177/0363546521999672 ◽

2021 ◽

pp. 036354652199967

Author(s):

Kadir Büyükdoğan ◽

Michael S. Laidlaw ◽

Michael A. Fox ◽

Michelle E. Kew ◽

Mark D. Miller

Keyword(s):

Tibial Plateau ◽

Cruciate Ligament ◽

Tibial Tunnel ◽

Lateral Meniscus ◽

Knee Laxity ◽

Pivot Shift Test ◽

Anterior Knee Laxity ◽

Posterior Group ◽

Kt 1000 ◽

Anterior Knee

Background: It remains unclear if use of the lateral meniscus anterior horn (LMAH) as a landmark will produce consistent tunnel positions in the anteroposterior (AP) distance across the tibial plateau. Purpose: To evaluate the AP location of anterior cruciate ligament (ACL) reconstruction tibial tunnels utilizing the LMAH as an intra-articular landmark and to examine how tunnel placement affects knee stability and clinical outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was conducted of 98 patients who underwent primary ACL reconstruction with quadrupled hamstring tendon autografts between March 2013 and June 2017. Patients with unilateral ACL injuries and a minimum follow-up of 2 years were included in the study. All guide pins for the tibial tunnel were placed using the posterior border of the LMAH as an intra-articular landmark. Guide pins were evaluated with the Bernard-Hertel grid in the femur and the Stäubli-Rauschning method in the tibia. Patients were divided by the radiographic location of the articular entry point of the guide pin with relation to the anterior 40% of the tibial plateau. Outcomes were evaluated by the Marx Activity Scale and International Knee Documentation Committee (IKDC) form. Anterior knee laxity was evaluated using a KT-1000 arthrometer and graded with the objective portion of the IKDC form. Rotational stability was evaluated using the pivot-shift test. Results: A total of 60 patients were available for follow-up at a mean 28.6 months. The overall percentage of AP placement of the tibial tunnel was 39.3% ± 3.8% (mean ± SD; range, 31%-47%). Side-to-side difference of anterior knee laxity was significantly lower in the anterior group than the posterior group (1.2 ± 1.1 mm vs 2.5 ± 1.3 mm; P < .001; r = 0.51). The percentage of AP placement of the tibial tunnel demonstrated a positive medium correlation with side-to-side difference of anterior knee laxity as measured by a KT-1000 arthrometer ( r = 0.430; P < .001). The anterior group reported significantly better distribution of IKDC grading as compared with the posterior group (26 grade A and 6 grade B vs 15 grade A and 13 grade B; P = .043; V = 0.297). The pivot-shift test results and outcome scores showed no significant differences between the groups. Conclusion: Using the posterior border of the LMAH as an intraoperative landmark yields a wide range of tibial tunnel locations along the tibial plateau, with anterior placement of the tibial tunnel leading toward improved anterior knee stability.

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Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120961082 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712096108

Author(s):

Fabiano da Silva Marques ◽

Pedro Henrique Borges Barbosa ◽

Pedro Rodrigues Alves ◽

Sandro Zelada ◽

Rodrigo Pereira da Silva Nunes ◽

...

Keyword(s):

Patellar Tendon ◽

Knee Pain ◽

Anterior Knee Pain ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Hamstring Tendon ◽

Tendon Graft ◽

Extension Deficit ◽

Anterior Cruciate ◽

Anterior Knee

Background: Anterior knee pain is a frequent condition after anterior cruciate ligament reconstruction (ACLR), but its origin remains uncertain. Studies have suggested that donor site morbidity in autologous bone–patellar tendon–bone reconstructions may contribute to patellofemoral pain, but this does not explain why hamstring tendon reconstructions may also present with anterior pain. Purpose: To evaluate the prevalence of anterior knee pain after ACLR and its predisposing factors. Study Design: Case-control study; Level of evidence, 3. Methods: We evaluated the records of all patients who underwent ACLR between 2000 and 2016 at a private facility. The prevalence of anterior knee pain after surgery was assessed, and possible risk factors (graft type, patient sex, surgical technique, range of motion) were evaluated. Results: The records of 438 patients (mean age, 30 years) who underwent ACLR were analyzed. Anterior knee pain was found in 6.2% of the patients. We found an increased prevalence of anterior knee pain with patellar tendon graft, with an odds ratio of 3.4 ( P = .011). Patients who experienced extension deficit in the postoperative period had an odds ratio of 5.3 of having anterior pain ( P < .001). Anterior knee pain was not correlated with patient sex or surgical technique. Conclusion: The chance of having anterior knee pain after ACLR was higher when patellar tendon autograft was used compared with hamstring tendon graft, as well as in patients who experienced extension deficit in the postoperative period.

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