Epidemiology of surgically managed anterior cruciate ligament ruptures in a sports surgery practice

Introduction: Anterior cruciate ligament (ACL) tears are common knee injuries, especially among sportsmen and sportswomen. The aim of this study is to better understand the epidemiology of surgically managed ACL tears sustained in our institution. Methods: All patients who underwent arthroscopic ACL reconstruction by the senior author of this article in Singapore from 2008 to 2013 were studied. Patients who were diagnosed clinically and/or radiologically to have a complete tear of the ACL and subsequently underwent arthroscopic ACL reconstruction were included. Patients who suffered from traumatic knee dislocation were excluded. Two hundred and ninety-two patients were available for analysis. All patients were operated on by the senior author. Results: 83.9% of patients were male. 60.5, 23.0, 8.46, and 8.11% were of Chinese, Malay, Indian and other origins, respectively. 69.6 and 28.7% were in white-collared and blue-collared jobs, respectively, while 1.69% were unemployed. Mean age at operation was 29.4 years. Mean body mass index was 25.3 kg/m2. 82.4 and 17.6% of ACL tears were sports (contact—27.5%; non-contact—72.5%) and non-sports injuries (activities of daily living—94.2%, road traffic accidents—5.77%), respectively. The top four sporting activities causing ACL tears were soccer, basketball, racquet games and volleyball. 56.2% of ACL tears presented with concomitant knee injuries (medial meniscus—63.4%; lateral meniscus—31.1%; posterior cruciate ligament—5.49%). 84.5% were primary tears. Conclusions: In this epidemiological review of ACL injuries, we found that ACL injuries tend to cluster within certain population subgroups. Patterns of mechanisms of injuries have been observed. These findings may lead to better preventive and treatment strategies in the management of ACL tears.

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EFFECT OF SKELETAL MATURITY ON INCIDENCE OF ASSOCIATED MENISCAL AND CHONDRAL INJURIES IN ANTERIOR CRUCIATE LIGAMENT INJURED KNEES

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00105 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0010

Author(s):

Brett Heldt ◽

Elsayed Attia ◽

Raymond Guo ◽

Indranil Kushare ◽

Theodore Shybut

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Medial Meniscus ◽

Skeletal Maturity ◽

Cruciate Ligament ◽

Demographic Data ◽

Meniscal Tear ◽

Lateral Meniscus ◽

Meniscus Tears ◽

Anterior Cruciate

Background: Acute anterior cruciate ligament(ACL) rupture is associated with a significant incidence of concomitant meniscal and chondral injuries. However, to our knowledge, the incidence of these concomitant injuries in skeletally immature(SI) versus skeletally mature(SM) patients has not been directly compared. SI patients are a unique subset of ACL patients because surgical considerations are different, and subsequent re-tear rates are high. However, it is unclear if the rates and types of meniscal and chondral injuries differ. Purpose: The purpose of this study is to compare associated meniscal and chondral injury patterns between SI and SM patients under age 21, treated with ACL reconstruction for an acute ACL tear. We hypothesized that no significant differences would be seen. Methods: We performed a single-center retrospective review of primary ACL reconstructions performed from January 2012 to April 2020. Patients were stratified by skeletal maturity status based on a review of records and imaging. Demographic data was recorded, including age, sex, and BMI. Associated intra-articular meniscal injury, including laterality, location, configuration, and treatment were determined. Articular cartilage injury location, grade, and treatments were determined. Revision rates, non-ACL reoperation rates, and time to surgery were also compared between the two groups. Results: 785 SM and 208 SI patients met inclusion criteria. Mean BMI and mean age were significantly different between groups. Meniscal tear rates were significantly greater in SM versus SI patients in medial meniscus tears(P<.001), medial posterior horn tears(P=.001), medial longitudinal tears configuration(P=.007), lateral Radial configuration(P=.002), and lateral complex tears(P=.011). Medial repairs(P<.001) and lateral partial meniscectomies(P=.004) were more likely in the SM group. There was a significantly greater number of chondral injuries in the SM versus SI groups in the Lateral(p=.007) and medial compartments(P<.001). SM patients had a significantly increased number of outerbridge grade 1 and 2 in the Lateral(P<.001) and Medial Compartments(P=.013). ACL revisions(P=.019) and Non-ACL reoperations(P=.002) were significantly greater in the SI patients compared to SM. No other significant differences were noted. Conclusion: SM ACL injured patients have a significantly higher rate of medial meniscus tears and medial longitudinal configurations treated with repair, and a significantly higher rate of radial and/or complex lateral meniscus tears treated with partial meniscectomy compared to the SI group. We also found a significantly higher rate of both medial and lateral compartment chondral injuries, mainly grades 1 and 2, in SM compared to SI patients. Conversely, SI ACL reconstruction patients had higher revision and subsequent non-ACL surgery rates.

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Anterolateral ligament of the knee: back to the future in anterior cruciate ligament reconstruction

Orthopedic Reviews ◽

10.4081/or.2015.5773 ◽

2015 ◽

Vol 7 (2) ◽

Cited By ~ 12

Author(s):

Davide Edoardo Bonasia ◽

Andrea D'Amelio ◽

Pietro Pellegrino ◽

Federica Rosso ◽

Roberto Rossi

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Double Bundle ◽

Anterolateral Ligament ◽

Rotational Instability ◽

Small Subset ◽

Acl Injuries ◽

Anterior Cruciate ◽

Double Bundle Acl Reconstruction

Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes.

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Effects of a Prophylactic Knee Sleeve on Anterior Cruciate Ligament Loading During Sport-Specific Movements

Journal of Sport Rehabilitation ◽

10.1123/jsr.2017-0079 ◽

2019 ◽

Vol 28 (1) ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Jonathan Sinclair ◽

Paul J. Taylor

Keyword(s):

Anterior Cruciate Ligament ◽

Repeated Measures ◽

Cruciate Ligament ◽

Knee Injuries ◽

Musculoskeletal Modeling ◽

Acl Injuries ◽

Recreational Athletes ◽

Load Rate ◽

Anterior Cruciate ◽

3D Motion Capture

Context: Prophylactic knee bracing is extensively utilized in athletic populations to reduce the high risk from knee injuries, but its role in the attenuation of anterior cruciate ligament (ACL) pathologies is not well understood. Objective: The aim of this investigation was to explore the effects of a prophylactic knee sleeve on ACL loading parameters linked to the etiology of injury in recreational athletes. Setting: Laboratory. Design: Repeated measures. Participants: Thirteen healthy male recreational athletes. Intervention: Participants performed run, cut, and single-leg hop movements under 2 conditions; prophylactic knee sleeve and no sleeve. Main Outcome Measures: Biomechanical data were captured using an 8-camera 3D motion capture system and a force platform. Peak ACL force, average ACL load rate, and instantaneous ACL load rate were quantified using a musculoskeletal modeling approach. Results: The results showed that both average and instantaneous ACL load rates were significantly reduced when wearing the knee sleeve in the hop (sleeve = 612.45/1286.39 N/kg/s and no sleeve = 743.91/1471.42 N/kg/s) and cut (sleeve = 222.55/1058.02 N/kg/s and no sleeve = 377.38/1183.01 N/kg/s) movements. Conclusions: Given the biomechanical association between ACL loading and the etiology of ACL injuries, it is proposed that athletes may be able to attenuate their risk from injury during cut and hop movements through utilization of a prophylactic knee sleeve.

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The Role of Patient Characteristics in the Success of Nonoperative Treatment of Anterior Cruciate Ligament Injuries

The American Journal of Sports Medicine ◽

10.1177/0363546520917386 ◽

2020 ◽

Vol 48 (7) ◽

pp. 1657-1664 ◽

Cited By ~ 1

Author(s):

Jelle P. van der List ◽

Frans J.A. Hagemans ◽

Dirk Jan Hofstee ◽

Freerk J. Jonkers

Keyword(s):

Anterior Cruciate Ligament ◽

Multivariate Analysis ◽

Physical Therapy ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Patient Characteristics ◽

Nonoperative Treatment ◽

Activity Level ◽

Acl Injuries ◽

Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears can either be treated nonoperatively with physical therapy and then treated operatively if persistent instability is present, or be directly treated operatively. Advantages of early ACL reconstruction surgery include shorter time from injury to surgery and potentially fewer meniscal injuries, but performing early ACL reconstruction in all patients results in surgery in patients who might not need ACL reconstruction. It is important to assess in which patients nonoperative treatment is successful and which patients will require ACL reconstruction and thus might be better treated surgically in an earlier phase. Purpose: To identify patient characteristics that predict the success of nonoperative treatment. Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: All patients with complete ACL injuries who were evaluated between 2014 and 2017 at our clinic were included. The minimum follow-up was 2 years. The initial treatment and ultimate ACL reconstruction were reviewed. Univariate analysis was performed using Mann-Whitney U tests and chi-square tests and multivariate analysis using binary logistic regression. Results: A total of 448 patients were included with a median age of 26 years and median Tegner level of 7 and mean Tegner level of 6.4. At initial consultation, 210 patients (47%) were treated nonoperatively with physical therapy and 126 of these patients (60%) ultimately required ACL reconstruction. Nonoperative treatment failed in 88.9% of patients <25 years of age, 56.0% of patients 25 to 40 years, and 32.9% of patients >40 years ( P < .001); and 41.9% of patients with Tegner level 3 to 6, and 82.8% of patients with Tegner level 7 to 10. Age <25 years (odds ratio [OR], 7.4; P < .001) and higher Tegner levels (OR, 4.2; P < .001) were predictive of failing nonoperative treatment in multivariate analysis. Patients in the failed nonoperative group had longer time from diagnosis to surgery than the direct reconstruction group (6.2 vs 2.2 months; P < .001), and more frequently had new meniscal injuries (17.4% vs 3.1%; P < .001) at surgery. Conclusion: Nonoperative treatment of ACL injuries failed in 60% of patients and was highly correlated with age and activity level. In patients aged 25 years or younger or participating in higher-impact sports, early ACL reconstruction should be considered to prevent longer delay between injury and surgery, as well as new meniscal injuries.

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Secondary Meniscal Tears in Patients With Anterior Cruciate Ligament Injury: Relationship Among Operative Management, Osteoarthritis, and Arthroplasty at 18-Year Mean Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546519844481 ◽

2019 ◽

Vol 47 (7) ◽

pp. 1583-1590 ◽

Cited By ~ 4

Author(s):

Michella H. Hagmeijer ◽

Mario Hevesi ◽

Vishal S. Desai ◽

Thomas L. Sanders ◽

Christopher L. Camp ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Meniscal Tear ◽

Acl Injury ◽

Nonoperative Treatment ◽

Meniscal Tears ◽

Acl Injuries ◽

Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injury is one of the most frequent orthopaedic injuries and reasons for time loss in sports and carries significant implications, including posttraumatic osteoarthritis (OA). Instability associated with ACL injury has been linked to the development of secondary meniscal tears (defined as tears that develop after the initial ACL injury). To date, no study has examined secondary meniscal tears after ACL injury and their effect on OA and arthroplasty risk. Purpose: To describe the rates and natural history of secondary meniscal tears after ACL injury and to determine the effect of meniscal tear treatment on the development of OA and conversion to total knee arthroplasty (TKA). Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database of >500,000 patients was reviewed to identify patients with primary ACL injuries between January 1, 1990, and December 31, 2005. Information was collected with regard to ACL injury treatment, rates/characteristics of the secondary meniscal tears, and outcomes, including development of OA and conversion to TKA. Kaplan-Meier and adjusted multivariate survival analyses were performed to test for the effect of meniscal treatment on survivorship free of OA and TKA. Results: Of 1398 primary ACL injuries, the overall rate of secondary meniscal tears was 16%. Significantly lower rates of secondary meniscal tears were noted among patients undergoing acute ACL reconstruction within 6 months (7%) as compared with patients with delayed ACL reconstruction (33%, P < .01) and nonoperative ACL management (19%, P < .01). Of the 235 secondary meniscal tears identified (196 patients), 11.5% underwent repair, 73% partial meniscectomy, and 16% were treated nonoperatively. Tears were most often medial in location (77%) and complex in morphology (56% of medial tears, 54% of lateral tears). At the time of final follow-up, no patient undergoing repair of a secondary meniscal tear (0%) underwent TKA, as opposed to 10.9% undergoing meniscectomy and 6.1% receiving nonoperative treatment ( P = .28). Conclusion: Secondary meniscal tears after ACL injury are most common among patients undergoing delayed surgical or nonoperative treatment of their primary ACL injuries. Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy.

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DIAGNOSING ANTERIOR CRUCIATE LIGAMENT INJURIES USING A KNEE ARTHROMETER: DESIGN, FABRICATION, AND CLINICAL EVALUATION

Biomedical Engineering Applications Basis and Communications ◽

10.4015/s1016237211002517 ◽

2011 ◽

Vol 23 (03) ◽

pp. 181-192

Author(s):

Damoon Soudbakhsh ◽

Elham Sahraei ◽

Mehdi Bostan Shirin ◽

Farzam Farahmand ◽

Mohammad Naghi Tahmasebi ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Knee Injuries ◽

Knee Laxity ◽

Ligament Injuries ◽

Acl Injuries ◽

Anterior Cruciate Ligament Injuries ◽

Specificity And Sensitivity ◽

Anterior Cruciate ◽

The Right

Every year many people suffer from knee injuries. Previous studies on patients with knee injuries have shown that about 40% of knee injuries are Ligament injuries, and about 50% of the ligament injuries are the Anterior Cruciate Ligament (ACL) injuries. Along with other methods, knee arthrometers are widely used to diagnose ACL injuries. In the current research, a knee arthrometer was designed and developed to provide a reliable and repeatable measurement of knee laxity under anterior–posterior applied loads. Test–retest configurations to examine repeatability of the device resulted in less than 1.5-mm difference for more than 97% of tests under applied loads of up to 90 N. These tests included 166 tests on the left knees and 147 tests on the right knees of 37 healthy subjects. Also, this device was tested on 27 confirmed ACL ruptured patients, and the results were analyzed to find a better criterion than standard criteria to diagnose ACL rupture using knee arthrometers by finding specificity and sensitivity of the device using those criteria. Among the 20 criteria evaluated, a combination of side-to-side difference under 150 N of applied load, and CI@90-60 (compliance index calculated between 90 N, and 60 N) resulted in the best sensitivity (96.4%) and specificity (100%).

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Evaluating Different Criteria to Diagnose ACL Rupture Using a Knee Arthrometer

ASME 2009 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2009-206427 ◽

2009 ◽

Author(s):

Damoon Soudbakhsh ◽

Mohammad-Naghi Tahmasebi ◽

Mohamad Parnianpour

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Knee Injuries ◽

Acl Rupture ◽

Ligament Injuries ◽

Acl Injuries ◽

Anterior Laxity ◽

Anterior Cruciate

Every year many people suffer from knee injuries. Previous studies on patients with knee injuries has shown that about 40% percent of knee injuries are ligament injuries, and about 50% of the ligament injuries are the Anterior Cruciate Ligament (ACL) injuries [1–2]. Knee arthrometers are widely used to diagnose ACL injuries, along with other methods [3–4]. In the current research, a knee arthrometer which was developed to provide an accurate measurement of AP displacement of the knee [5] was used to measure anterior laxity of the knees of 20 subjects, and the results were analyzed to find better criteria to diagnose ACL rupture using knee arthrometers.

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Incidence of Second Anterior Cruciate Ligament Tears (1990-2000) and Associated Factors in a Specific Geographic Locale

The American Journal of Sports Medicine ◽

10.1177/0363546517694026 ◽

2017 ◽

Vol 45 (7) ◽

pp. 1567-1573 ◽

Cited By ~ 22

Author(s):

Nathan D. Schilaty ◽

Nathaniel A. Bates ◽

Thomas L. Sanders ◽

Aaron J. Krych ◽

Michael J. Stuart ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Patellar Tendon ◽

Cruciate Ligament ◽

Population Based ◽

Contralateral Side ◽

Activity Level ◽

Acl Injuries ◽

Acl Tear ◽

Anterior Cruciate

Background: Second anterior cruciate ligament (ACL) tears after reconstruction occur at a reported rate of 20% to 30%. This high frequency indicates that there may be factors that predispose an athlete to graft failure and ACL tears of the contralateral knee. Purpose: To determine the incidence of second ACL injuries in a geographic population-based cohort over a 10-year observation period. Study Design: Descriptive epidemiological study. Methods: International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACL reconstruction were searched across the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 1990 and 2000. This cohort of patients was tracked for subsequent ACL injuries through December 31, 2015. The authors identified 1041 patients with acute, isolated ACL tears. These patients were stratified by primary and secondary tears, sex, age, activity level, side of injury, sex by side of injury, and graft type. Results: Of the 1041 unique patients with a diagnosed ACL tear in Olmsted County, Minnesota, from 1990 to 2000, there were 66 (6.0%) second ACL tears; 66.7% of these tears occurred on the contralateral side. A second ACL injury was influenced by graft type ( P < .0001), election of ACL reconstruction ( P = .0060), and sex by side of injury ( P = .0072). Nonparametric analysis of graft disruption by graft type demonstrated a higher prevalence of second ACL tears with allografts compared with hamstring ( P = .0499) or patellar tendon autografts ( P = .0012). Conclusion: The incidence of second ACL tears in this population-based cohort was 6.0%, with 66.7% of these tears occurring on the contralateral side from the original injury. There was a high population incidence of second ACL injuries in female patients younger than age 20 years. The utilization of patellar tendon autografts significantly reduced the risk of second ACL injuries compared with allografts or hamstring autografts in this cohort.

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Results of meniscectomy and meniscal repair in anterior cruciate ligament reconstruction

Joints ◽

10.11138/jts/2015.3.3.151 ◽

2015 ◽

Vol 03 (03) ◽

pp. 151-157 ◽

Cited By ~ 5

Author(s):

Davide Deledda ◽

Federica Rosso ◽

Umberto Cottino ◽

Davide Bonasia ◽

Roberto Rossi

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Ligament Reconstruction ◽

Medial Meniscus ◽

Cruciate Ligament ◽

Meniscal Repair ◽

Meniscal Tears ◽

Acl Injuries ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

Meniscal tears are commonly associated with anterior cruciate ligament (ACL) injuries. A deficient medial meniscus results in knee instability and could lead to higher stress forces on the ACL reconstruction.Comparison of results in meniscectomy and meniscal repairs revealed worse clinical outcomes in meniscectomy, but higher re-operation rates in meniscal repairs. Our aim was to review the results of ACL reconstruction associated with meniscectomy or meniscal repair.

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Failure and Reoperation Rates Following Arthroscopic Primary Repair Versus Reconstruction of the Anterior Cruciate Ligament

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00297 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0029

Author(s):

Jelle P. van der List ◽

Anne Jonkergouw ◽

Gregory S. DiFelice

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Primary Repair ◽

Cruciate Ligament ◽

Treatment Algorithm ◽

Acl Injuries ◽

Graft Rupture ◽

Anterior Cruciate ◽

Reoperation Rates

Objectives: To compare the failure and reoperation rates of arthroscopic primary repair versus reconstruction of the anterior cruciate ligament (ACL). Methods: This study retrospectively reviewed all patients with ACL injury operatively treated between April 2008 and May 2016 by one surgeon. All patients with proximal tears were treated with primary repair using suture anchors, or otherwise underwent standard reconstruction. Patients were included if minimum two-year follow-up was present, and were excluded for multiligamentous injuries. Charts were reviewed and patients were contacted to assess failure (instability, graft rupture or revision), reoperation (other than revision), complications and contralateral failure. Results: 154 patients were included of which 56 underwent primary repair (36.4%). Mean age was 30 years (range 14-57), 70% was male and mean follow-up was 3 years (range 2-9). Patients undergoing ACL reconstruction were younger (28 vs. 33, p=0.002) and were more often male (77% vs. 59%, p=0.02). Failure rates were lower following primary repair (10.7%) than ACL reconstruction (12.2%) but this was not statistically significant (p=0.776). Also, no clinical relevant or statistical significant differences were found between repair and reconstruction in reoperations (7.1% each group), complications (1.8% vs. 3.1%, respectively) and contralateral failures (3.6% vs. 4.1%, respectively) (all p>0.99). With revision surgery, no complications were noted following primary repair revision (primary reconstruction; 0%) but 25% of revision reconstructions failed and 1 needed reoperation (8%). Conclusion: This study is the first study to compare the failure and reoperation rates following arthroscopic primary repair versus reconstruction in a large cohort of patients. With the treatment algorithm of primary repair for proximal avulsion tears and reconstruction of midsubstance tears, equivalent outcomes were noted between both treatments. Arthroscopic primary repair is a safe and good treatment for ACL injuries and has similar failure and reoperation rates when compared to the gold standard of ACL reconstruction.

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