Limited evidence for graft selection in pediatric ACL reconstruction: a narrative review

Anterior cruciate ligament reconstruction is the preferred treatment to anterior cruciate ligament injury. With the increase in anterior cruciate ligament injuries in both adults and skeletally immature patients comes the need for individualized anterior cruciate ligament reconstruction graft selection whether it is the type of graft (auto vs. allograft) or the harvesting site (hamstrings, iliotibial band, quadriceps, patella). Several factors need to be considered preoperatively in order to optimize the patients’ recovery and restore anterior cruciate ligament strength and function. These include age and bone maturity, preoperative knee flexor/extensor strength, sport participation, patient’s needs and anatomical characteristics. This paper aims at bringing evidence supporting the use of a personalized approach in graft selection for faster and more efficient return to sport and propose a theoretical framework to support the approach.

Ankle-Injury Patients Perform More Microadjustments during Walking: Evidence from Velocity Profiles in Gait Analysis

Introduction. We evaluated the velocity profiles of patients with lateral collateral ligament (LCL) injuries of the ankle with a goal of understanding the control mechanism involved in walking. Methods. We tracked motions of patients’ legs and feet in 30 gait cycles recorded from patients with LCL injuries of the ankle and compared them to 50 gait cycles taken from normal control subjects. Seventeen markers were placed on the foot following the Heidelberg foot measurement model. Velocity profiles and microadjustments of the knee, ankle, and foot were calculated during different gait phases and compared between the patient and control groups. Results. Patients had a smaller first rocker percentage and larger second rocker percentage in the gait cycle compared to controls. Patients also displayed shorter stride length and slower strides and performed more microadjustments in the second rocker phase than in other rocker/swing phases. Patients’ mean velocities of the knee, ankle, and foot in the second rocker phase were also significantly higher than that in control subjects. Discussion. Evidence from velocity profiles suggested that patients with ligament injury necessitated more musculoskeletal microadjustments to maintain body balance, but these may also be due to secondary injury. Precise descriptions of the spatiotemporal gait characteristics are therefore crucial for our understanding of movement control during locomotion.

Do Clinical Outcomes and Failure Rates Differ in Patients With Combined ACL and Grade 2 MCL Tears Versus Isolated ACL Tears?: A Prospective Study With 14-Year Follow-up

Background: A combined injury to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) is a common injury pattern encountered during clinical practice. Recent systematic reviews have found no consensus on the optimal method of managing this combined ligament injury pattern, and no long-term studies with modern techniques are available in the literature. Purpose: To compare 2 groups of patients who underwent isolated ACL reconstruction in terms of failures and clinical scores at long-term follow-up. In the first group were patients with isolated ACL tears (ACL group), while the second was composed of patients with combined ACL and MCL grade 2 tears (ACL + MCL group). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 57 patients (37 in the ACL group and 20 in the ACL + MCL group) underwent isolated ACL reconstruction with a double-bundle technique between January and December 2005. Patients were contacted for scores on the International Knee Documentation Committee subjective form, Western Ontario and McMaster Universities Osteoarthritis Index, and Tegner activity scale as well as data regarding ipsilateral or contralateral revision ACL surgery. A 2-way analysis of variance for repeated measures was used to statistically assess the differences between the groups. Results: Overall, 49 patients (86%) completed the survey and were therefore included in the study. The minimum follow-up was 14.6 years (range, 14.1-15.2 years). There was a significant reduction in both groups of all the outcome scores between the intermediate and final-follow-up. The number of failures was 3 of 31 (9.7%) in the ACL group and 1 of 18 (5.5%) in the ACL + MCL group; this difference was not significant. Moreover, there were no clinical differences between the groups in terms of graft failures, contralateral lesions, and clinical scores. Conclusion: At 14-year follow-up, no clinical difference or increased failure rate was observed between the study groups, suggesting that isolated ACL reconstruction could represent an appropriate treatment for a combined ACL and MCL grade 2 lesion.

In Different Gender Groups, What Is the Impact of the Fibular Notch on The Severity of High Ankle Sprain: A Retrospective Study of 240 Cases

Background: The function of the distal tibiofibular ligament on the ankle in the occurrence of high ankle sprain (HAS) has been widely studied. Then, in different genders, the effect of the anatomical morphology of fibular notch (FN) on HAS is unclear. Therefore, on the basis of excluding the anatomical differences caused by gender, we explore the impact of different types of FN on the severity of HAS.Methods: We selected 120 patients and further classified these 120 patients into four HAS groups according to FN depth with deep concave type FN ≥ four mm and shallow flat type FN < four mm. A further 120 normal individuals were served as a control group. FN morphological indicators, tibiofibular distance (TFD), and ankle mortise indexes were measured and compared between patients and control groups.Results: In males with shallow flat type, the Anterior tibiofibular distance (aTFD), Middle tibiofibular distance (mTFD), Posterior tibiofibular distance (pTFD), Front tibial width (FTiW), Middle tibial width (MTiW), Posterior tibial width (PTiW) and Depth of ankle mortise (DOAM) of HAS group were higher than those in normal group (P < 0.05). In males with deep concave type, the aTFD, mTFD and DOAM of patients were significantly higher (P < 0.05). Among females with shallow flat type, the aTFD, mTFD, pTFD, FTiW and MTiW in HAS group were greater than those in normal group (P < 0.05). Among the females with deep concave type, the mTFD and pTFD of patients were higher (P < 0.05).Conclusions: After analyzing the morphological indicators of FN, it is found that in both males and females, HAS patients have significant differences in TFD and certain ankle mortise indexes compared with normal people. But more importantly, the above abnormalities are often more common in HAS patients with shallow flat FN, indicating that shallow flat FN may be related to more serious distal tibiofibular ligament injury and ankle mortise widening, resulting in a worse prognosis.Level of evidence: Level III, retrospective comparative study.