scholarly journals Spontaneous Healing in complete ACL ruptures: results at eight-year mean follow-up

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0018
Author(s):  
Matias Costa-Paz ◽  
Ignacio Garcia-Mansilla ◽  
Miguel Ayerza ◽  
D. Luis Muscolo
Keyword(s):  
Cruciate Ligament ◽  
Sport Activity ◽  
Scar Tissue ◽  
Long Term Results ◽  
Return To Sports ◽  
Spontaneous Healing ◽  
Initial Evolution ◽  
Anterior Cruciate ◽  
Tissue Rupture

Objectives: The injured anterior cruciate ligament (ACL) has a limited healing capacity leading to persisting instability. Although several studies have reported spontaneous healing of torn ACLs, it is difficult to determine its healing potential and whether patients will be able to return to sports activities. In 2011, we published a series of 14 patients with spontaneous healing following a complete ACL rupture, the mean follow up was 30 months (range 25-36 months). The purpose of this study was to evaluate the long-term results of spontaneous healing in complete ACL ruptures in the same group of patients. Methods: We retrospectively reviewed a cohort of 14 patients with acute ACL injury established by physical examination and MRI (proximal third in eight patients and the midligament in six). Twelve patients were male and average age at injury was 31 years (range, 23-41 years), All patients were athletically active before the injury and suffered the lesion during a sport activity. Surgery was indicated in all patients, but it was postponed for different reasons, including related labor problems, need to travel, illnesses, planned holidays, and the patient’s personal decision not to undergo surgery. Most of the patients let the injury run its course with no bracing and unspecific rehabilitation protocol. The primary outcomes of this study were rerupture rate and time between injury and surgery. Results: Twelve patients out of 14 were reevaluated (86%), with a mean follow up of 8 years (3-14). Ten were men, with a mean age of 38 years (range, 25-51 years). Five patients had an ACL reconstruction during follow-up, with a mean time between injury and surgery of 5 years (range 3-14). Initial injury was located in the proximal third in two patients and in the midligament in three. Conclusion: Although favorable initial evolution at 30 months after a complete ACL lesion, our series show a re-rupture rate or “scar tissue” rupture of 40% at a mean follow-up of 8 years.

scholarly journals Retorno Deportivo Luego de Reconstrucción Primaria de Ligamento Cruzado Anterior con Injerto Hueso-Tendón Patelar-Hueso Autólogo: Análisis de Factores Relacionados

2020 ◽  
Vol 61 (01) ◽  
pp. 002-010
Author(s):  
A. Pakuts ◽  
L. Martin ◽  
J. Contador
Keyword(s):  
Cruciate Ligament ◽  
Activity Level ◽  
Return To Sports ◽  
Questionnaire Response ◽  
Self Assessment ◽  
Related Factors ◽  
Chondral Injury ◽  
Anterior Cruciate ◽  
Positive Return

Abstract Objective Analyze return to sports and related factors after primary anterior cruciate ligament reconstruction. Methods Observational descriptive study. 173 patients operated by the same surgeon and standardized technique (patellar autograft) who answered a questionnaire at least 12 months post procedure were included. Questionnaire included Subjective IKDC, Tegner activity level (Pre and Postoperative) and questions elaborated by the group. Results Mean age was 30.8 years, 85% were men, 73% practiced soccer and median postoperative IKDC was 71. Follow up until questionnaire response was 28 months. Males had a better return to sports than females (70% vs 48%, p = 0.037). Tegner pre-injury level was 5 vs 4.3 postoperative, (p < 0.001). Return to sports was 67% according to Tegner scale and 66% by self-assessment. Return to similar previous activity level was 57% by Tegner scale but 24% by direct questions. Of those patients, 51% have fear of re-injury and 26% by reasons other than knee or surgery. We didn't find association between meniscal injuries and return to sports rate. Patients with chondral injuries had lower rates in return to sports (35% vs 60%, p = 0.002). Subjects that returned to sports had higher IKDC scores (73.5 vs 64.3, p < 0.001). Conclusions We found 67% return to sports and 57% to the preinjury level. Positive return to sports factors were male sex, absence of chondral injury and better functional outcome. Psychological factors such as fear of injury is frequent in patients who don't achieve previous levels of activity.

scholarly journals Patients return to sports and to work after successful treatment of septic arthritis following anterior cruciate ligament reconstruction

2021 ◽  
Author(s):  
Alexander Themessl ◽  
Felix Mayr ◽  
Kate Hatter ◽  
Marco-Christopher Rupp ◽  
Jonas Pogorzelski ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Septic Arthritis ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sports ◽  
Cruciate Ligament Reconstruction ◽  
Ikdc Score ◽  
Anterior Cruciate

Abstract Purpose To determine specific return to sports (RTS) and return to work (RTW) rates of patients with septic arthritis following anterior cruciate ligament reconstruction (ACLR), and to assess for factors associated with a diminished postoperative return to physical activity after successful eradication of the infection. Methods In this study, patients who were treated for postoperative septic arthritis of the knee following anterior cruciate ligament reconstruction between 2006 and 2018 were evaluated at a minimum follow-up (FU) of 2 years. Patients’ outcomes were retrospectively analyzed using standardized patient-reported outcome scores including the Lysholm score and the subjective IKDC score, as well as return to sports and return to work questionnaires to assess for the types, number, and frequency of sports performed pre- and postoperatively and to evaluate for potential occupational changes due to septic arthritis following ACLR. To assess for the signifiance of the graft at follow-up, outcomes were compared between patients with a functioning graft at FU and those without, as well as between patients with initial graft retention and those with graft removal and consecutive revision ACLR. Results Out of 44 patients eligible for inclusion, 38 (86%) patients at a mean age of 36.2 ± 10.3 years were enrolled in this study. At a mean follow-up of 60.3 ± 39.9 months, the Lysholm score and the subjective IKDC score reached 80.0 ± 15.1 and 78.2 ± 16.6 points, respectively. The presence of a graft at FU yielded statistically superior results only on the IKDC score (p = 0.014). There were no statistically significant differences on the Lysholm score (n.s.) or on the IKDC score (n.s.) between patients with initial graft retention and those with initial removal who had undergone revision ACLR. All of the included 38 patients were able to return to sports at a median time of 8 (6–16) months after their last surgical intervention. Among patients who performed pivoting sports prior to their injury, 23 (62.2%) returned to at least one pivoting sport postoperatively. Overall, ten patients (26.3%) returned to all their previous sports at their previous frequency. The presence of a graft at FU resulted in a significantly higher RTS rate (p = 0.010). Comparing patients with initial graft retention and those with graft removal and consecutive revision ACLR, there was no statistically significant difference concerning the RTS rate (n.s.). Thirty-one patients (83.8%) were able to return to their previous work. Conclusion Successful eradication of septic arthritis following anterior cruciate ligament reconstruction allows for a postoperative return to sports and a return to work particularly among patients with ACL-sufficient knees. However, the patients’ expectations should be managed carefully, as overall return rates at the pre-injury frequency are relatively low. Level of evidence IV.

Differences in Baseline Characteristics and Outcome Among Responders, Late Responders, and Never-Responders After Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110478
Author(s):  
Per-Henrik Randsborg ◽  
Dakota Adamec ◽  
Nicholas A. Cepeda ◽  
Andrew Pearle ◽  
Anil Ranawat
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Patient Characteristics ◽  
International Knee Documentation Committee ◽  
Patient Reported Outcome Measures ◽  
Return To Sports ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Anterior Cruciate

Background: Loss to follow-up in registry studies might affect generalizability and interpretation of results. Purpose: To evaluate the effect of nonresponder bias in our anterior cruciate ligament (ACL) registry. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 2042 patients with ACL reconstruction in the Hospital for Special Surgery ACL Registry between 2009 and 2013 were included in the study. Patients who completed the patient-reported outcome measures at 2 or 5 years were considered responders (n = 808). Baseline data and patient characteristics were compared between responders and nonresponders (n = 1234). Both responders and nonresponders were contacted and invited to complete the International Knee Documentation Committee (IKDC) and Marx scores electronically and respond to questions regarding return to sports and subsequent surgeries. Nonresponders who completed the questionnaires after reminders were considered late responders. The remaining nonresponders were considered never-responders. The late responders (n = 367) completed the questionnaires after a mean follow-up of 7.8 years (range, 6.7-9.6 years), while follow-up for the responders was 6.8 years (range, 5.0-9.7 years). Responders and late responders were then compared in terms of differences in IKDC and Marx scores from baseline to final follow-up. Results: Nonresponders were younger (28.5 vs 31.5 years; P < .001) and more often male (60% vs 53%; P = .003) compared with responders. Responders had a higher level of education and were more likely to be White (79% vs 74%; P = .04). There were no substantial differences in patient characteristics or baseline IKDC and Marx scores between the late responders and never-responders. There were no statistically significant differences in patient-reported outcomes, return to sports, or subsequent surgeries between responders and late responders at a mean follow-up time of 8.8 years (range, 6.7-9.7 years). Repeat email reminders and telephone calls increased response rate by 18% (from 40% to 58%). Conclusion: There was no difference in clinical outcome as evaluated using IKDC and Marx scores between responders and late responders.

Outcome after Combined Lateral Extra-articular Tenodesis and Anterior Cruciate Ligament Revision in Professional Soccer Players

2018 ◽  
Vol 32 (09) ◽  
pp. 906-910 ◽  
Author(s):  
Mattia Alessio-Mazzola ◽  
Matteo Formica ◽  
Antonio Russo ◽  
Francesca Sanguineti ◽  
Andrea Giorgio Capello ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Lysholm Score ◽  
Rate Of Return ◽  
Soccer Players ◽  
Return To Sports ◽  
Professional Soccer ◽  
The Mean ◽  
Anterior Cruciate

AbstractWe report the functional outcome after combined anterior cruciate ligament (ACL) reconstruction and lateral extra-articular tenodesis (LET) for ACL re-rupture and high-grade pivot shift in professional soccer players. For this retrospective review, the medical records of 24 professional soccer players were analyzed. The mean age at surgery was 23.8 ± 4.2 years and the mean follow-up was 42.2 ± 16.9 months. Pre- and postoperative assessment included the KT-1000 Lachman test, pivot shift test, International Knee Documentation Committee (IKDC) subjective knee evaluation, Tegner activity scale (TAS), and Lysholm score. The rate of return to sports and the level of play at final follow-up were recorded. ACL revision was performed with an autologous bone–patellar tendon–bone autograft or a hamstring graft. LET was performed using an extra-articular MacIntosh procedure as modified by Arnold–Coker. Anterior–posterior laxity was significantly reduced at the final clinical assessment (p < 0.0001): 22 patients (91.7%) had a negative pivot shift and 2 (8.3%) had residual glide (+), with significant improvement (p < 0.0001). The mean subjective IKDC and Lysholm score improved from 69.5 ± 11.1 (range: 56–90) to 88.4 ± 8.9 (range: 62.1–100) and from 58.1 ± 11.7 (range: 33–72) to 97.4 ± 3.2 (range: 88–100), respectively, with significant improvement (p < 0.0001) over preoperative values. The overall failure rate was 8.3%. There were no differences between mean preinjury and final TAS scores (p > 0.05). The rate of return to sports at the same level was 91.7% and the mean time to return to sports was 9.2 ± 2.2 months. Mid-term functional outcome after combined extra-articular reconstruction and ACL revision surgery was satisfactory, with a reduction in residual postoperative rotatory instability and degree of pivot shift.

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