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Am J Sports Med 2021 Jun 4:3635465211015682. Epub 2021 Jun 4.

Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.

Background: Injuries to the Kaplan fiber complex (KFC) are not routinely assessed for in the anterior cruciate ligament (ACL)-deficient knee during preoperative magnetic resonance imaging (MRI). As injuries to the KFC lead to anterolateral rotatory instability (ALRI) in the ACL-deficient knee, preoperative detection of these injuries on MRI scans may help surgeons to individualize treatment and improve outcomes, as well as to reduce failure rates.

Purpose: To retrospectively determine the rate of initially overlooked KFC injuries on routine MRI in knees with isolated primary ACL deficiency. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 May;35(5):556-561

Department of Knee Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China.

Objective: To investigate the short-term effectiveness of arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon for posterior cruciate ligament (PCL) injuries.

Methods: A clinical data of 30 patients with PCL injury, who were admitted between December 2015 and September 2018 and met the selection criteria, was retrospectively analyzed. All patients were treated with arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon and TightRope technique. Read More

BMC Musculoskelet Disord 2021 May 13;22(1):434. Epub 2021 May 13.

Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.

Background: A functionally deficient anterior cruciate ligament (ACL) is considered one of the contraindications in unicompartmental knee arthroplasty (UKA). But there is still a lack of standardized and reproducible methods to assess ACL functional integrity in patients with advanced anteromedial osteoarthritis of the knee (AMOA). This study explores the value of passive anterior tibial subluxation (PATS) on axial MRI in evaluating ACL status in this population. Read More

Knee Surg Sports Traumatol Arthrosc 2021 May 7. Epub 2021 May 7.

Human Movement Analysis Laboratory, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark.

Purpose: To identify modifiable biomechanical and neuromuscular anterior cruciate ligament (ACL) injury risk factors for first-time ACL injury in adolescent female elite football and team handball players.

Methods: Adolescent female elite football and handball players with no previous ACL injury participated in the present study. At baseline, players were tested during side-cutting manoeuvres performed in a 3-dimensional motion analysis laboratory with concomitant electromyography (EMG) measurements. Read More

Orthop J Sports Med 2021 Apr 16;9(4):2325967121998310. Epub 2021 Apr 16.

Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Québec, Canada.

Background: The mechanism for traumatic ruptures of the native anterior cruciate ligament (ACL) is frequently a noncontact injury involving a valgus moment with internal rotation of the tibia. The abnormal rotation and translation of the lateral femoral condyle posteroinferiorly relative to the lateral tibial plateau is thought to be related to the geometry of the tibial plateau.

Purpose/hypothesis: The purpose of the study was to mathematically model the posterior tibial plateau geometry in patients with ACL injuries and compare it with that of matched controls. Read More

J Knee Surg 2021 Apr 30. Epub 2021 Apr 30.

Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago, Chicago, Illinois.

The purpose of this study was to define the diagnostic value of magnetic resonance imaging (MRI) and plain radiographs (X-ray [XR]) in identifying an osteochondral defect or loose body in patients undergoing operative treatment for patellar instability. A total of 87 patients treated operatively for patellar instability with medial patellofemoral ligament (MPFL) reconstruction between 2015 and 2019 were identified. Inclusion criteria were evidence of clinical patellar instability, preoperative XR and MRI studies, and concomitant diagnostic knee arthroscopy and MPFL reconstruction performed to address patellar instability. Read More

Am J Sports Med 2021 Jun 30;49(7):1822-1826. Epub 2021 Apr 30.

Department of Orthopaedics, Children's Hospital, CHU de Toulouse, Toulouse, France.

Background: Anterior cruciate ligament (ACL) tears represent 13% of knee injuries in children. Medial meniscal tears are commonly associated with ACL ruptures. Ramp lesions correspond to posterior meniscocapsular tears of the medial meniscus. Read More

Arthroscopy 2021 05;37(5):1544-1546

Steadman Philippon Research Institute.

Femoral intercondylar notch size and volume are some of the many morphometric knee measures that have been associated with increased risk of anterior cruciate ligament (ACL) injury. The merits of relatively simple measures such as notch width versus more complex 3-dimensional notch volume have been debated, and there is some evidence suggesting that volumetric measures may have a stronger association with injury risk. The application for this information is, however, unclear. Read More

Arthroscopy 2021 05;37(5):1378-1380

Twin Cities Orthopedics, Edina-Crosstown. Edina, Minnesota, U.S.A.. Electronic address:

Patients with multiligament knee injuries require a thorough examination (Lachman, posterior-drawer, varus, valgus, and rotational testing). Diagnoses are confirmed with magnetic resonance imaging as well as stress radiographs (posterior, varus, and valgus) when indicated. Multiple systematic reviews have reported that early (<3 weeks after injury) single-stage surgery and early knee motion improves patient-reported outcomes. Read More

Knee 2021 Apr 21;30:113-124. Epub 2021 Apr 21.

Department of Orthopaedic Surgery, HanYang University Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea. Electronic address:

Background: This study aimed to compare anterolateral ligament (ALL) injuries in anterior cruciate ligament (ACL) ruptures, as well as ALL healing and clinical outcomes following ACL reconstruction between adolescents and adults.

Methods: This retrospective study involved 98 patients who underwent ACL reconstruction. They were divided into two groups according to age: group A (adolescents, 16-20 years of age; n = 49) and group B (adults, 21-45 years of age; n = 49). Read More

Morphologie 2021 Apr 15. Epub 2021 Apr 15.

Department of Physiology and Medical Clinic of the Lusíada Foundation-UNILUS, Santos - SP, Brazil.

We report a case of a 49-year-old patient presenting an anteromedial meniscofemoral ligament (AMMFL) on both knees with a tear of this ligament in the left knee associated to a normal anterior cruciate ligament (ACL). The AMMFL is a relatively rare anatomic structure that may correspond to a variant of the ACL type anterior root insertion of the medial meniscus. The findings reported in the literature were in most part results of incidental situations. Read More

Am J Sports Med 2021 05 16;49(6):1470-1481. Epub 2021 Apr 16.

Department of Rehabilitation Sciences, Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium.

Background: Rates of reinjury, return to play (RTP) at the preinjury level, and hamstring strain injuries in male soccer players after anterior cruciate ligament reconstruction (ACLR) remain unsatisfactory, due to multifactorial causes. Recent insights on intramuscular hamstring coordination revealed the semitendinosus (ST) to be of crucial importance for hamstring functioning, especially during heavy eccentric hamstring loading. Scientific evidence on the consequences of ST tendon harvest for ACLR is scarce and inconsistent. Read More

Knee Surg Sports Traumatol Arthrosc 2021 Apr 1. Epub 2021 Apr 1.

Fortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK.

Purpose: The anterolateral soft tissue envelope of the knee is frequently injured at the time of ACL rupture. This study aims to investigate the MRI injury patterns to the Anterolateral complex and their associations in patients with acute 'isolated ligament' ACL ruptures.

Methods: Professional athletes who underwent ACL reconstruction for complete ACL rupture between 2015 and 2019 were included in this study. Read More

Orthop J Sports Med 2021 Mar 17;9(3):2325967121989678. Epub 2021 Mar 17.

Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China.

Background: Clinical outcomes of surgical repairs for tears of the lateral meniscus posterior root (LMPR) in patients undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) have not been comprehensively investigated.

Purpose: To systematically review the clinical, radiographic, and arthroscopic results of surgical repairs for tears of the LMPR in patients undergoing ACLR.

Study Design: Systematic review; Level of evidence, 4. Read More

Pediatr Radiol 2021 Mar 30. Epub 2021 Mar 30.

Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

Background: Literature regarding medial collateral ligament (MCL) injuries is focused on adults with superficial MCL disruptions. However, children follow different injury patterns, with avulsion fractures at ligament attachment sites occurring commonly. Such avulsions have not been characterized for pediatric MCL injuries. Read More

Knee Surg Sports Traumatol Arthrosc 2021 Mar 27. Epub 2021 Mar 27.

Faculty of Medicine, Research Centre for Movement Sciences, The University of Iceland, Sæmundargata 2, 102, Reykjavík, Iceland.

Purpose: Anterior cruciate ligament (ACL) tears have a major impact on the individual and society. Long term effects may be mediated by injuries that occur concurrently to the ACL tear. The purpose of this study was to describe in a nationwide cohort the traumatic meniscal injuries and bone marrow lesions concomitant to ACL tears, their age and sex distribution and the rate any association with ACL reconstruction. Read More

Knee Surg Sports Traumatol Arthrosc 2021 Mar 26. Epub 2021 Mar 26.

Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.

Purpose: To determine the accuracy of detection, injury rate and inter- and intrarater reproducibility in visualizing lesions to the anterolateral ligament (ALL) and the deep portion of the iliotibial tract (dITT) in anterior cruciate ligament (ACL) deficient knees.

Methods: Ninety-one consecutive patients, out of those 25 children (age 14.3 ± 3. Read More

Orthop J Sports Med 2021 Feb 22;9(2):2325967120973192. Epub 2021 Feb 22.

Twin Cities Orthopedics, Edina, Minnesota, USA.

Background: The anterior meniscofemoral ligament (aMFL) of Humphrey is an anatomically variable fibrous band of connective tissue that attaches between the lateral aspect of the medial femoral condyle and posterior horn of the lateral meniscus, running posterior to the anterior cruciate ligament and anterior to the posterior cruciate ligament (PCL). The presence of an intact aMFL may contribute to stabilization of the lateral compartment of the knee joint.

Purpose: The original magnetic resonance imaging (MRI) arm of this study aimed to assess the aMFL incidence among Polish patients. Read More

Open Access J Sports Med 2021 8;12:23-32. Epub 2021 Mar 8.

Department of Radiology, Boston University School of Medicine, Boston, MA, USA.

Purpose: Describe the frequency and severity of knee ligament sprains diagnosed by MRI in athletes participating at the 2016 Summer Olympic Games, their association with certain sports and assess correlations with additional knee structural injury.

Patients And Methods: All knee MRIs performed in the Olympic Village and polyclinics during the 2016 Olympics were retrospectively, blindly reviewed for ligament sprains and associated knee injuries. In addition to the absence or presence of these abnormalities, athletes were stratified by age, gender and sport. Read More

Am J Sports Med 2021 04 15;49(5):1262-1269. Epub 2021 Mar 15.

OrthoSport Victoria, Richmond, Australia.

Background: Biomechanical studies have suggested that the Kaplan fibers (KFs) of the iliotibial band play a role in controlling anterolateral rotation of the knee. There is a paucity of clinical information on whether injury to the KF in the setting of anterior cruciate ligament (ACL) rupture contributes to increased rotatory laxity of the knee.

Purpose/hypothesis: The purpose was to evaluate the association among radiological evidence of KF injury, intraoperative arthroscopic findings, and grade of pivot shift at the time of ACL reconstruction (ACLR). Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 Mar;35(3):337-342

Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China.

Objective: To investigate the effectiveness of partial anterior cruciate ligament (ACL) suture repair with wide awake local anesthesia no tourniquet (WALANT) technique.

Methods: Between July 2017 and July 2019, 18 patients with partial ACL injury were admitted. There were 10 males and 8 females, with an average age of 40. Read More

Orthop J Sports Med 2021 Feb 25;9(2):2325967120979986. Epub 2021 Feb 25.

Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.

Background: High anterior knee laxity (AKL) has been prospectively identified as a risk factor for anterior cruciate ligament (ACL) injuries. Given that ACL morphometry and structural composition have the potential to influence ligamentous strength, understanding how these factors are associated with greater AKL is warranted.

Hypothesis: Smaller ACL volumes combined with longer T2* relaxation times would collectively predict greater AKL. Read More

J Clin Orthop Trauma 2021 Jun 27;17:5-10. Epub 2021 Jan 27.

Department of Orthopedics, Vydehi Institute of Medical Sciences, Whitefield, Bangalore, Karnataka, India.

Background: ACL injuries are infamously known for disability in young adults and require surgical reconstruction. The need of time is to predict predisposing factors and prevent ACL injuries.The incidence of ACL injuries has been associated with various factors related to the morphology of distal femur and proximal tibia. Read More

Am J Sports Med 2021 04 8;49(5):1244-1250. Epub 2021 Mar 8.

Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway.

Background: Increased lateral posterior tibial slope (LPTS) is associated with increased rates of anterior cruciate ligament (ACL) injury and failure of ACL reconstruction. It is unknown if ACL deficiency influences the developing proximal tibial physis and slope in skeletally immature patients through anterior tibial subluxation and abnormal force transmission.

Purpose: To assess the natural history of LPTS in skeletally immature patients with an ACL-injured knee. Read More

Arthroscopy 2021 03;37(3):985-988

Magnetic resonance imaging of the torn anterior lateral ligament (ALL) is inconsistent and subject to significant intra- and interobserver variability. Like that of an anterior cruciate ligament (ACL), an ALL tear can vary in degree (first, second, or third) and location (tibial or femoral side). These variations may impact the appropriate surgical intervention. Read More

Knee Surg Sports Traumatol Arthrosc 2021 Mar 4. Epub 2021 Mar 4.

Fortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK.

Purpose: In anterior cruciate ligament (ACL) injuries, concomitant damage to peripheral soft tissues is associated with increased rotatory instability of the knee. The purpose of this study was to investigate the incidence and patterns of medial collateral ligament complex injuries in patients with clinically 'isolated' ACL ruptures.

Methods: Patients who underwent ACL reconstruction for complete 'presumed isolated' ACL rupture between 2015 and 2019 were retrospectively included in this study. Read More

Am J Sports Med 2021 04 3;49(5):1279-1285. Epub 2021 Mar 3.

Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Background: Previous studies have stated that closely matching the size of the anterior cruciate ligament (ACL) insertion site footprint is important for biomechanical function and clinical stability after ACL reconstruction. However, the ACL varies widely regarding the area of femoral insertion, tibial insertion, and midsubstance of ACL, and reconstructing the insertion site area with a uniform diameter graft can result in a cross-sectional area that is greater than that of the midsubstance of the native ACL. Therefore, understanding the effect of relative graft size in ACL reconstruction on knee biomechanics is important for surgical planning. Read More

Am J Sports Med 2021 04 25;49(5):1270-1278. Epub 2021 Feb 25.

Sydney Orthopaedic Research Institute, Sydney, Australia.

Background: There is currently no analysis of 1-year postoperative magnetic resonance imaging (MRI) that reproducibly evaluates the graft of a hamstring autograft anterior cruciate ligament reconstruction (ACLR) and helps to identify who is at a higher risk of graft rupture upon return to pivoting sports.

Purpose: To ascertain whether a novel MRI analysis of ACLR at 1 year postoperatively can be used to predict graft rupture, sporting level, and clinical outcome at a 1-year and minimum 2-year follow-up.

Study Design: Case-control study; Level of evidence, 3. Read More

Am J Sports Med 2021 03 22;49(4):928-934. Epub 2021 Feb 22.

Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA.

Background: Incompetence of the anterior cruciate ligament (ACL) confers knee laxity in the sagittal and axial planes that is measurable with clinical examination and diagnostic imaging.

Hypothesis: An ACL-deficient knee will produce a more vertical orientation of the lateral collateral ligament (LCL), allowing for the entire length of the LCL to be visualized on a single coronal slice (coronal LCL sign) on magnetic resonance imaging.

Study Design: Cohort study (diagnosis); Level of evidence, 3. Read More

Am J Sports Med 2021 03 22;49(4):935-940. Epub 2021 Feb 22.

Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA.

Background: The coronal lateral collateral ligament (LCL) sign is the presence of the full length of the LCL visualized on a single coronal magnetic resonance imaging (MRI) slice at the posterolateral corner of the knee. The coronal LCL sign has been shown to be associated with elevated measures of anterior tibial translation and internal rotation in the setting of anterior cruciate ligament (ACL) tear.

Hypothesis: The coronal LCL sign (with greater anterior translation, internal rotation, and posterior slope of the tibia) will indicate a greater risk for graft failure after ACL reconstructive surgery. Read More