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Purpose The primary purpose of this study was to evaluate the second-look arthroscopic indings 1 year postoperatively and magnetic resonance imaging (MRI) indings 2 years after anterior cruciate ligament reconstruction (ACLR) using bonepatellar tendon-bone autograft (BTB) or hamstring tendon autograft (HT). Secondary purpose included clinical results from physical examination, including range of motion, Lachman test, pivot shift test, and knee anterior laxity evaluation, and the clinical score for subjective evaluations at 2 years after surgery. Methods Between 2015 and 2018, 75 patients with primary ACL injuries were divided into either the BTB group (n = 30) or HT group (n = 45). When using HT, an anatomical double-bundle ACLR was performed. BTB was indicated for athletes with suicient motivation to return to sporting activity. Graft maturation on second-look arthroscopy was scored in terms of synovial coverage and revascularization. All participants underwent postoperative MRI evaluation 2 years postoperatively. The signal intensity (SI) characteristics of the reconstructed graft were evaluated using oblique axial proton density-weighted MR imaging (PDWI) perpendicular to the grafts. The signal/noise quotient (SNQ) was calculated to quantitatively determine the normalized SI. For clinical evaluation, the Lachman test, pivot shift test, KT-2000 evaluation, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS) were used. Results Arthroscopic indings showed that the graft maturation score in the BTB group (3.6 ± 0.7) was signiicantly greater than that in the anteromedial bundle (AMB; 2.9 ± 0.2, p = 0.02) and posterolateral bundle (PLB; 2.0 ± 0.9, p = 0.001) in the HT group. The mean MRI-SNQs were as follows: BTB, 2.3 ± 0.5; AMB, 2.9 ± 0.9; and PLB, 4.1 ± 1.1. There were signiicant diferences between BTB, AMB, and PLB (BTB and AMB: p = 0.04, BTB and PLB: p = 0.003, AMB and PLB: p = 0.03). Second-look arthroscopic maturation score and MRI-SNQ value signiicantly correlated for BTB, AMB, and PLB. No signiicant diferences were detected in clinical scores. There was a signiicant diference (p = 0.02) in the knee laxity evaluation (BTB: 0.9 ± 1.1 mm; HT: 2.0 ± 1.9 mm). Conclusion BTB maturation is superior to that of double-bundle HT based on morphological and MRI evaluations following anatomical ACLR, although no signiicant diferences were found in clinical scores. Regarding clinical relevance, the advantages of BTB may help clinicians decide on using the autograft option for athletes with higher motivation to return to sporting activity because signiicant diferences were observed in morphological evaluation, MRI assessment, and knee anterior laxity evaluation between BTB and double-bundle HT. Level of evidence Level IV.

Objective:We aimed to investigate the effect and safety of extracorporeal shock wave therapy (ESWT) on ischial apophysitis (IA) in young high-level gymnasts. We hypothesized that ESWT would be safe and effective in alleviating pain.Design:Retrospective case series.Setting:Funabashi Orthopedic Hospital.Patients:The subjects were 18 high-level gymnasts (mean age of 13 years) with a chief complain of chronic buttock pain diagnosed with IA.Interventions:Ten patients received only physiotherapy (PT), whereas 8 received both PT and ESWT to the ischial tuberosity. The basic protocol for ESWT was to use an energy dose of 0.20 mJ/mm2 or less with 3000 shots per session at 4-week intervals.Main Outcome Measures:We investigated whether PT and ESWT relieved the pain and allowed the patient to return fully to gymnastics. Based on radiographs at the last observation, we examined whether early closure of the apophyseal line of the ischium and around hip joint on the affected side occurred.Results:In the PT group, pain was relieved in 2 of 10 patients. In the ESWT group, pain was relieved and full return to gymnastics was possible in all 8 patients. None of the patients showed early closure of the apophyseal line.Conclusions:Extracorporeal shock wave therapy can be a safe and effective treatment option for IA in young high-level gymnasts.

Purpose This study aimed to assess the risk factors for prolonged joint efusion in patients undergoing double-bundle anterior cruciate ligament reconstruction (ACLR). Methods In total, 160 patients who underwent primary ACLR using autograft hamstring between 2015 and 2018 were retrospectively reviewed. Joint efusion was deined as any grade ≥ 2 (range, 0-3) according to the MRI Osteoarthritis Knee Score (MOAKS). Univariate and multivariate logistic regression analyses were performed. ResultsThe median age of the patients was 25 years (range 14-68 years) at the time of the surgery; there were 89 women and 71 men. At 1 year, 46 (28.8%) patients experienced knee joint efusion, as deined by the MOAKS. Univariate analysis revealed that age, preoperative Kellgren-Lawrence (K-L) grade, and joint efusion at 6 months were signiicantly associated with joint efusion at 1 year. In the multivariate analysis, joint efusion at 6 months was signiicantly associated with joint efusion at 1 year (odds ratio, 68.0; 95% conidence interval, 22.1-209.4). No signiicant diference in the Lysholm scores was observed between patients with and without joint efusion at 1 year (n.s.). Conclusions Joint efusion at 6 months was signiicantly associated with joint efusion 1 year after ACLR. Level of evidence III.