We examined the arthroscopic appearance of the anterior cruciate ligament (ACL) attachment site on the femur in five fresh-frozen cadaver knees. First, the ACL was cut out, leaving a footprint of ligament-fibers with a length of 2 mm intact. The ACL was consistently found to insert on the lateral wall of the notch. No fibers were found to attach high in the roof of the notch at the 12 o'clock position. Secondly, we tried to reach the anatomical attachment site with a femoral aiming guide through a correctly placed tibial tunnel. This proved to be impossible. The closest position that could be reached was at the margin of the anatomical attachment site. Investigation of the distal femur after complete dissection confirmed these arthroscopic findings. Femoral aiming devices for use through the tibial tunnel aim for an isometric placement of the femoral tunnel, they do not aim for an anatomical position of the graft.

This study investigates if the mechanical/anatomical alignment influences the intensity values as well as the distribution pattern of SPECT/CT tracer uptake. Eighty-five knees (mean age 48 AE 16) undergoing 99mTc-HDP-SPECT/CT due to pain were prospectively included. SPECT/CTs were analyzed using a previously validated localization method. The maximum intensities in each femoral, tibial, and patellar joint compartment (medial, lateral, central, superior, and inferior) were noted using a color-coded grading scale (0-10). The Kellgren-Lawrence osteoarthritis score (KL) was assessed on standardized radiographs. Long leg radiographs were used to assess the mechanical/anatomical leg alignment, which was classified as varus, valgus, or neutral. The alignment and KL was correlated with the intensity of tracer uptake in each area of interest (p < 0.05). The intensity of SPECT/CT tracer uptake in the medial and lateral knee compartment significantly correlated with varus or valgus alignment of the knee. A higher degree of osteoarthritis was significantly related to higher tracer uptake in the corresponding joint compartments. SPECT/CT reflects the specific loading pattern of the knee with regard to its alignment. It is also related to the degree of osteoarthritis. Hence, SPECT/CT should be considered for follow-up of patients after realignment treatments, osteotomies, deloader devices, or insoles. ß

Objective To establish the clinical relevance of proprioceptive defi cits reported after anterior cruciate ligament (ACL) injury. Material and methods A literature search was done in electronic databases from

A varus alignment in an anterior cruciate ligament-deficient knee does not necessarily lead to a varus thrust and therefore does not always need operative varus alignment correction. However, in an unstable anterior cruciate ligament-deficient knee with a varus thrust, it might be safer to perform a high valgus tibial osteotomy to minimize the risk of an anterior cruciate ligament reconstruction failure.

Purpose Anterior cruciate ligament reconstruction (ACLR) aims to restore knee function and stability, allowing patients to return to the activities they enjoy and minimize further injury to the meniscus and cartilage and their ultimate progression to osteoarthritis. This study aims to present the evolution of graft choice over the last three decades according to members of the ACL Study Group (SG). Methods Prior to the January 2020 ACL SG biannual meeting, a survey was administered consisting of 87 questions and 16 categories, including ACLR graft choice. A similar questionnaire has been administered prior to each meeting and survey results from the past 14 meetings (1992 through 2020, excluding 1994) are included in this work. Survey responses are reported as frequencies in percentages to quantify changes in practice over the surgery period. Results In 1992, the most frequent graft choice for primary ACLR was bone-patellar tendon-bone (BTB) autograft, at nearly 90%. Hamstring tendon (HT) autografts have increased in popularity, currently over 50%, followed by just under 40% BTB autograft. Recently, quadriceps tendon (QT) autograft has increased in popularity since 2014. Conclusion Autograft (HT, BTB, QT) is an overwhelming favorite for primary ACLR over allograft. The preference for HT autograft increased over the study period relative to BTB autograft, with QT autograft gaining in popularity in recent years. Graft selection should be individualized for each patient and understanding the global trends in graft choice can help orthopaedic surgeons discuss graft options with their patients and determine the appropriate graft for each case. Level of evidence Level V, Expert Opinion.

Retrospective case series, Level IV.

Integrated hybrid single photon emission computerized tomography (SPECT)/computer tomography (CT) is a promising new diagnostic imaging modality for orthopedic patients. A high diagnostic yield is available from combining the detection of abnormal bone metabolism with SPECT, to the precise anatomical detail available in high resolution CT. With this review, we endeavor to illustrate the clinical value and future perspectives of SPECT/CT in sports medicine.

Prospective therapeutic study, Level IV.