Background: A valgus lower limb alignment has been noted during noncontact anterior cruciate ligament injuries. A video dropjump test can indicate an athlete's ability to control lower limb axial alignment in the coronal plane. Hypotheses: Female athletes have decreased knee separation distances on landing and acceleration; male athletes have a neutrally aligned lower limb position. A neuromuscular training program will significantly increase knee separation distance in female athletes. Study Design: Cohort study; Level of evidence, 2. Methods: The authors tested 325 female and 130 male athletes aged 11 to 19 years. The distance between the hips, knees, and ankles was measured during a drop-jump test. The separation distance between the knees and ankles was normalized by the hip separation distance. A neuromuscular training program (Sportsmetrics) was completed by 62 female athletes, and their jump-landing characteristics were reexamined. Results: A marked decrease in knee separation distance was found on takeoff in 80% of female athletes and in 72% of male athletes. There was no difference between male and female athletes in the normalized knee and ankle separation distance during the landing and takeoff phases. The knee separation distance on landing was 23 ± 9 cm in the female athletes and 22 ± 8 cm in the male athletes. The normalized knee separation distance was 51% ± 19% in the female athletes and 51% ± 15% in the male athletes. After training, statistically significant increases were found in the female athletes in the knee separation distance on landing (29 ± 8 cm, P<. 0001) and in the normalized knee separation distance (68% ± 18%, P<. 0001). The trained female athletes had significantly greater knee separation distance and normalized knee separation distance than did the males (P<. 0001). Conclusions: The majority of untrained female and male athletes demonstrated a valgus alignment appearance on the video test. After neuromuscular training, female athletes had improved knee separation distances and a more neutral lower limb alignment on landing and takeoff.

Objective: To review anterior cruciate ligament (ACL) clinical studies to assess the objective functional criteria used to determine when patients can return to athletics postoperatively, and to determine the rates of reinjury to either knee when these criteria are applied. Methods: A literature search was conducted using the Medline database. The inclusionary criteria were the English language, publication between April 2001 and April 2011, original clinical trials, all levels of evidence, primary ACL reconstruction, skeletal maturity, minimum 2 years of follow-up, and ≥1 objective test used to allow release to sports activities. The exclusionary criteria were revision ACL reconstructions or dislocated knees; studies that specifically excluded patients with ACL graft failure or reinjuries; major concomitant procedures such as high tibial osteotomy, meniscus allograft, other knee ligament reconstructions; and case reports, abstracts, review articles, and technical notes. Results: Three objective c...

Background: Posterior cruciate ligament reconstructions have not shown uniformly predictable results in restoration of normal posterior tibial translation. The authors are unaware of any study that has assessed the causes of failure of these operations, and they investigated 52 prior unsuccessful posterior cruciate ligament procedures to determine the factors that contributed to failure of the operations. Study Design: Case series; Level of evidence, 4. Methods: The authors studied 52 prior failed posterior cruciate ligament surgeries that had been done in 41 knees (40 patients). Graft reconstructions had been done in 31 cases, primary repairs in 14, synthetic replacements in 4, and thermoplasties in 3. Medical records, operative notes, radiographs, and magnetic resonance imaging scans were reviewed, and a comprehensive knee examination was conducted. Results: A single factor that caused the operations to fail was identified in 23 (44%) of 52 operations, and multiple factors were identified in 29 (56%). The most common probable causes of failure were associated posterolateral ligament deficiency (40%), improper graft tunnel placement (33%), associated varus malalignment (31%), and primary suture repair (25%). Sixteen of 21 (76%) prior posterolateral ligament procedures had failed, as had 9 of 19 (47%) prior anterior cruciate ligament reconstructions. Twenty-nine knees (71%) presented with pain with activities of daily living. Thirty-four knees (83%) had compounding problems of joint arthritis, prior meniscectomy, associated ligament deficiencies, or varus malalignment. Posterior cruciate revision surgery was done in 22 knees (54%). Eleven knees (27%) had severe joint damage that contraindicated revision, and 8 (19%) declined further operations. Conclusions: Failure to restore associated ligament instabilities and incorrect tunnel placement were major factors contributing to surgical failure. The results suggest the need for greater emphasis on the initial reconstruction in graft tunnel placement, correction of associated ligament instabilities, and correction of varus osseous malalignment. Failure of concurrent posterolateral ligament reconstructions was frequently encountered, suggesting the need for higher strength augmentation procedures or anatomical graft replacement.

Anterior cruciate ligament (ACL) reconstruction (ACLR) is frequently performed in patients younger than 20 years whose goal is to return to sport (RTS). Varying reinjury rates have been reported, and the factors responsible are unclear. Studies differ with regard to age, graft type, surgical techniques, postoperative rehabilitation, RTS guidelines, and methods used to determine ACL failures. To determine RTS rates; the effect of participation in high-risk sports, sex, and graft type on ACL reinjury rates; and whether objective test criteria before RTS correlate with lower reinjury rates. A systematic review of the literature from inception to May 31, 2019, was conducted using the PubMed and Cochrane databases. Studies on transphyseal ACLR in athletes <20 years old with a minimum mean follow-up of 2 years that reported reinjury rates, the number that RTS, and detailed the type of sport were included. Systematic review. Level 4. A total of 1239 patients in 8 studies were included; 87% returned to sport and 80% resumed high-risk activities. Of the patients, 18% reinjured the ACL graft and/or the contralateral ACL. Nine percent of patellar tendon autografts and 15% of hamstring autografts failed (odds ratio [OR], 0.52; P = 0.002). Of reinjuries, 90% occurred during high-risk sports. Male patients had a significantly higher rate of ACL graft failure than female patients (OR, 1.64; P = 0.01). There was no sex-based effect on contralateral ACL injuries. Only 1 study cited objective criteria for RTS. A high percentage of athletes returned to sport, but 1 in 5 suffered reinjuries to either knee. Male patients were more likely to reinjure the ACL graft. Objective criteria for RTS were rarely mentioned or not detailed. The need for testing of knee stability, strength, neuromuscular control, agility, and psychological measures before RTS remains paramount in young athletes.

Background: The purpose of this study was to prospectively evaluate the results of meniscal transplantation in a consecutive series of younger patients treated for pain in the tibiofemoral compartment following a previous meniscectomy.