No abstract

Background: Biomechanical studies have shown excellent anteroposterior and rotatory laxity control after double-bundle (DB) anterior cruciate ligament (ACL) reconstruction, but no clinical studies have compared midterm (>5-year) residual laxity between the DB and single-bundle (SB) techniques. Purpose: To clinically compare sagittal and rotatory laxities and residual sagittal laxity on the KT-1000 arthrometer between patients treated with an SB ACL reconstruction and those treated with a DB ACL reconstruction at the 7-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 110 patients were included between January 2006 and December 2007. The patients were randomly assigned into 2 groups: those treated with SB ACL reconstruction (n = 63) and those treated with the DB technique (n = 47). All patients were then reviewed at a minimum of 7 years of follow-up; patients with ACL rerupture (n = 3 in the SB group and n = 2 in the DB group) were excluded from the postoperative comparative analysis. Residual anterior laxity (Lachman test), rotatory laxity (pivot-shift test), and sagittal laxity (KT-1000 arthrometer side-to-side difference) were measured and compared between the 2 groups. Results: The mean age at surgery was 23.0 ± 5.1 years for the DB group and 28.1 ± 7.0 years for the SB group, and the mean follow-up was 7.4 ± 0.8 years. No statistically significant differences were found between the 2 groups in terms of age, sex, preoperative laxity on KT-1000, preoperative Tegner score, or concomitant meniscal lesions. Residual postoperative laxity via Lachman testing ( P < .01), pivot-shift testing ( P = .042), and the KT-1000 arthrometer ( P < .01) was statistically significantly in favor of DB reconstruction. Conclusion: DB ACL reconstruction allowed better control of anterior stability during the evaluation via the Lachman test and via objective measurement on the KT-1000, as well as rotatory stability at a minimum of 7 years of follow-up.

Objectives: Although they may be related to ACL tears in adults, there are few publications on meniscal injuries after intercondylar eminence fractures in children. Methods: The main objective of this systematic review of the literature was to measure the incidence of meniscal injuries as well as concomitant tissue involvement in tibial eminence fractures (TEF) in children. The secondary objectives were to determine a diagnostic and therapeutic strategy to anticipate difficulties in reduction and to treat associated meniscal tears. The PubMed and Scopus database subject search included MeSH indexing terms: "intercondylar tibial fracture*" OR "tibial spine fracture*" OR “tibial spinal fracture” OR "tibial eminence fracture*" OR "intercondylar eminence fracture*". Only series of pediatric tibial eminence fractures with the presence of data on possible meniscal damage were selected. Case reports, mixed adult and child series and duplicates were excluded. Results: 789 references were chosen with 91 eligible articles. Only 26 articles reported on the rates of meniscal tears and entrapment after these fractures. Of a total of 997 cases, 227 (22.8%) had a concomitant injury (osteochondral, ACL, PCL and/or meniscal), including 180 cases of meniscal tears (18.1%). Meniscal or intermeniscal ligament entrapment was present in 20.1% (n = 201) of the patients. 2 groups of diagnostic analyses of these injuries were compared: during the arthroscopy, or previously on MRI imaging. Meniscal tears were present in 20.9% of the patients in the arthroscopy group, compared with 26.1% in the group with a prior MRI (p = .06), and the proportion of meniscal tears was 18.6% in the arthroscopy group alone compared to 17.1% in the MRI group (p = .55). However, statistically, the proportion of entrapment noted was significantly higher in the arthroscopy group (17.8% vs 6.2%; p <.0001). Conclusion: This review of the literature reports a high incidence of meniscal tears and tissue entrapment in children. Although it would appear that MRI tends to improve the assessment of associated injuries, the rate of meniscal or intermeniscal ligament entrapment is low compared to the rate reported by arthroscopic diagnosis.

No abstract