We report a prospective series evaluating the incidence and degree of tunnel widening in a well-matched series of patients receiving a hamstring or patella tendon graft for anterior cruciate ligament (ACL) deficiency. We correlated tunnel widening with clinical factors, knee scores, KT-1000 and isokinetic muscle strength to determine the clinical significance of this finding. Seventy-three patients at least 12 months post-ACL reconstruction were evaluated. Thirty-eight patients had received a doubled semitendinous and gracilis graft and 35 a bone-patella tendon-bone graft. All patients underwent a similar endoscopic procedure and accelerated postoperative rehabilitation. Tunnel widening was determined using standardized anteroposterior (AP) and lateral X-rays adjusted for magnification. A limited series of MRIs was performed to validate these measurements. There was a significant difference in the degree of tunnel widening between the two groups. The mean increase in femoral tunnel area in the hamstring group was 100.4% compared with a decrease of 25% in the patella tendon group (P = < 0.0001). In the tibial tunnel the mean increase in the hamstring group was 73.9% compared with a decrease of 2.1% in the patella tendon group (P = < 0.0001). The MRIs validated the plain film measurements. Tunnel widening did not correlate with the clinical findings, knee scores, KT-1000 or isokinetic muscle strength. Tunnel widening is marked in the hamstring group. Tunnel widening does not correlate with instability or a poor clinical outcome in the short term. The long-term implications of this finding are still to be determined.

Animal studies have shown that implanted anterior cruciate ligament (ACL) grafts initially undergo a process of revascularisation prior to remodelling, ultimately increasing mechanical strength. We investigated whether minimal debridement of the intercondylar notch and the residual stump of the ruptured ACL leads to earlier revascularisation in ACL reconstruction in humans. We undertook a randomised controlled clinical trial in which 49 patients underwent ACL reconstruction using autologous four-strand hamstring tendon grafts. Randomised by the use of sealed envelopes, 25 patients had a conventional clearance of the intercondylar notch and 24 had a minimal debridement method. Three patients were excluded from the study. All patients underwent MR scanning postoperatively at 2, 6 and 12 months, together with clinical assessment using a KT-1000 arthrometer and International Knee Documentation Committee (IKDC) evaluation. All observations were made by investigators blinded to the surgical technique. Signal intensity was measured in 4 mm diameter regions of interest along the ACL graft and the mid-substance of the posterior cruciate ligament. Our results indicate that minimal debridement leads to earlier revascularisation within the mid-substance of the ACL graft at two months (paired t-test, p = 0.002). There was a significant reduction of mid-substance signal six months after the minimal debridement technique (paired t-test, p = 0.00007). No statistically significant differences were found in tunnel placement, incidence of Cyclops lesions, blood loss, IKDC scores, range of movement or Lachman test between the two groups.

The action of fast bowling in the game of cricket is known to cause injuries to the lumbar spine. We studied a group of 16-to 18-year-old fast bowlers, selected for special fraining in Western Australia. All 24 had MR scans of the spine, 22 had radiographs and CI' scans; in 20 the bowling technique was analysed biomechanically.There was a high incidence of back pain and this was always associated with a radiological abnormality.Pars interarticularis defects were diagnosed in 54% and intervertebral disc degeneration in 63%. Bowling actions which involved counter-rotation were associated with a higher incidence ofboth injuries.

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The authors suggest that this relatively simple procedure can be of significant benefit to those athletes wishing to return to their previous levels of physical activity when more nonoperative measures have proven unsuccessful.

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Background:Preventing and mitigating the risk of reinjury after anterior cruciate ligament reconstruction (ACLR) rest on variables including age, surgical restoration of knee stability, adequate physical function, and thorough and complete postoperative rehabilitation, but to what degree these factors influence return to sport is unclear.Purpose:To investigate factors predictive of return to sport 12 months after ACLR. The factors specifically evaluated were strength, hop function, self-reported knee function, patient age, and quality of postoperative rehabilitation.Study Design:Case-control study; Level of evidence, 3.Methods:This study evaluated 113 patients approximately 12 months after ACLR using a rehabilitation grading tool, the subjective International Knee Documentation Committee (IKDC) form, and a return-to-sport battery consisting of maximal isokinetic quadriceps and hamstring strength and 4 functional hop tests. Mann-Whitney U tests and chi-square analyses were used to determine differences between patients who had or had not returned to sport. A subsequent binary logistic hierarchical regression determined the factors predictive of a patient’s return to sport. In those patients who had returned to sport, relationships between either age or level of rehabilitation and passing the return-to-sport battery were also investigated.Results:Complete rehabilitation (adjusted odds ratio [OR], 7.95; P = .009), age ≤25 years (adjusted OR, 3.84; P = .024), and higher IKDC scores (P < .001) were predictive of return to sport at 12 months. In participants who had returned to sport, 21% passed the return-to-sport battery compared with only 5% who did not. Of those who had returned to sport, 37% who underwent complete rehabilitation passed the return-to-sport battery as opposed to 5% who underwent incomplete rehabilitation. In patients aged ≤25 years, only 48% underwent complete rehabilitation, despite having returned to sport. Additionally, in this group of patients, 40% underwent complete rehabilitation and passed the physical performance battery as opposed to only 4% who did not undergo complete rehabilitation.Conclusion:Younger patients and higher subjective IKDC scores were predictive of return to sport. Patients who completed 6 months of rehabilitation incorporating jumping and agility tasks had a higher rate of return to sport, suggesting that postoperative rehabilitation is important in predicting return to sport. Specialists and physical therapists alike should stress the importance of thorough postoperative rehabilitation and adequate neuromuscular strength and function to patients whose goals are to return to sport.