Anterior cruciate ligament (ACL) reconstruction is presently evolving rapidly. In order to monitor the developments in surgical methods and clinical outcome, a national clinical database for knee ligament reconstructions was established in 2005 in Denmark. This study presents the first data with 2 year follow-up from the Danish ACL registry. All orthopaedic departments performing ACL reconstructions in Denmark, including private clinics, report to the registry. The database includes both surgery- and patient-related data. The surgeon reports anamnestic, objective knee laxity and operative data including graft and implant choices. At 1 year control, complications, reoperations, and objective knee laxity are recorded. The patient registers the Knee injury and Osteoarthritis Outcome Score (KOOS) and Tegner function score preoperatively and at 1, 5 and 10 years follow-up. During the first 30 months, 5,872 knee-ligament reconstructions were registered. A total of 4,972 were primary ACL reconstructions, 443 were ACL revisions and 457 multiligament reconstructions. A total of 85% of all knee ligament reconstruction were reported to the database. A total of 71% of primary ACL reconstruction used hamstring tendon grafts and 21% used patella tendon graft. Meniscus injuries were treated in 35% of all patients. A total of 17% had significant cartilage lesions. At 2 years follow-up 3% of primary reconstructions were revised. Follow-up KOOS demonstrated specific differences between primary ACL, revision ACL, and multiligament reconstructions. Sports/recreation score were 40, 32, 28 and quality of life score were 40, 32, 33 for the respective groups. This study presents the first follow-up data from a national ACL registry. These data will become new international reference materials for outcome measures before and after ACL surgery. The database will enable future monitoring of ACL reconstruction techniques and outcome.

Background and purpose No prospective surveillance systems have been available for monitoring the outcome of cruciate ligament surgery in Scandinavia (Denmark, Norway, and Sweden). In the present paper we describe the Scandinavian ACL registries including their main function, similarities, and preliminary baseline results.Methods The Scandinavian registries were established in 2004 (Norway) and 2005 (Denmark and Sweden). The Danish and Swedish registries were originally based on the Norwegian registry, and there is no overriding difference between the three. In Denmark, all hospitals and clinics are legally bound to report to an approved national database. In Norway and Sweden, the registries are based on voluntarily reporting by surgeons.Results The annual incidence of primary ACL reconstructions is higher in Denmark than in Norway, except in females younger than 20 years. Among Scandinavian surgeons, there is a similar approach to the patients. Differences do, however, exist regarding choice of grafts, choice of implants, and choice of treatment of simultaneous meniscal and cartilage injuries; the proportion of ACL reconstructions performed as outpatient surgery; and the use of prophylactic anticoagulation. Clinically, the preoperative KOOS scores are not significantly different between the Scandinavian registries, except that Denmark reports more symptoms both pre- and postoperatively.Interpretation The Scandinavian national ACL registries will generate new data about ACL reconstructions. They will contribute important knowledge regarding ACL epidemiology. They will be the only source of data on the performance of a wide range of different implants and techniques. In addition, they will hopefully have an impact on the selection of methods for ACL reconstructions in Scandinavia and elsewhere.

Acceptable clinical results with the MCL reconstruction technique were achieved in patients suffering from chronic valgus instability.

Purpose of this paper is to provide an overview of the latest research on the anterolateral ligament (ALL) and present the consensus of the ALL Expert Group on the anatomy, radiographic landmarks, biomechanics, clinical and radiographic diagnosis, lesion classification, surgical technique and clinical outcomes. A consensus on controversial subjects surrounding the ALL and anterolateral knee instability has been established based on the opinion of experts, the latest publications on the subject and an exchange of experiences during the ALL Experts Meeting (November 2015, Lyon, France). The ALL is found deep to the iliotibial band. The femoral origin is just posterior and proximal to the lateral epicondyle; the tibial attachment is 21.6 mm posterior to Gerdy’s tubercle and 4–10 mm below the tibial joint line. On a lateral radiographic view the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary consensus on all studied features of the ALL. The findings warrant future research in order to further test these early observations, with the ultimate goal of improving the long-term outcomes of ACL-injured patients. Level of evidence Level V—Expert opinion.