Severe trochlear dysplasia is the most important predictor of residual patellofemoral instability after isolated MPFL reconstruction. In addition, an increased TT-TG distance affected the outcomes in patients with type D trochlea. Additional patellar stabilization procedures should be considered for patients with severe trochlear dysplasia and an increased TT-TG distance.

The CSA of the femoral tunnel aperture enlarged, and the tunnel aperture migrated anteriorly with time after MPFL reconstruction. Risk factors for patellar dislocation other than patella alta did not influence morphological changes of the femoral tunnel.

Purpose In animal studies after ACL reconstruction (ACL‐R) using the bone‐patellar tendon‐bone (BTB), the graft‐healing pattern was found to depend on the relationship between bone plug and the tunnel wall. This difference of graft‐healing pattern could influence the postoperative morphological changes of the tunnel. However, no study has assessed the relationship between bone plug position and the change of tunnel morphology. Therefore, the main purpose of this study was to investigate the relationship between the bone plug position within femoral or tibial tunnel and morphological changes of each tunnel aperture in ACL‐R using computed tomography. Methods Subjects were 30 consecutive patients (six females and 24 males; mean age, 20.4 ± 5.4 years) who underwent primary ACL‐R using BTB. The distance from the tunnel aperture to the tendon‐bone junction (TBJ) at 2 weeks postoperatively, and tunnel aperture enlargement and tunnel wall migration from 2 weeks to 6 months postoperatively, were evaluated. Results The distance from the femoral tunnel aperture to the TBJ in most cases was less than 2 mm, whereas the TBJ was located within the tibial tunnel. Femoral tunnel aperture was significantly enlarged (17.0 ± 11.7%) distally, and the tibial tunnel aperture was significantly enlarged (19.6 ± 12.5%) posterolaterally. Only the position at distal portion of femoral bone plug was correlated with femoral tunnel aperture enlargement (r = 0.454, p = 0.0015). Conclusion Both femoral and tibial tunnel aperture were significantly enlarged distally and posterolaterally 6 months postoperatively. Only correlation between the position at distal portion of femoral bone plug and femoral tunnel enlargement were found, suggesting the deep plug position in the tunnel is a risk factor for femoral tunnel enlargement, highlighting the importance of accurately locating the TBJ just at the femoral tunnel aperture. Another option is to deviate the harvest site in the patellar tendon to match the shape of the TBJ and the tunnel aperture. Level of evidence 4 (case series).

Background:It remains unclear whether the tibiofemoral relationship in the sagittal plane is restored after anatomic anterior cruciate ligament (ACL) reconstruction, particularly in cases of chronic ACL deficiency (ACLD).Hypothesis:Patients with long-term ACLD will exhibit an anteriorly subluxed tibia both preoperatively and immediately postoperatively, even after anatomic reconstruction.Study Design:Cohort study; Level of evidence, 2.Methods:In total, 358 patients who had undergone anatomic ACL reconstruction with autologous semitendinosus grafts were divided into 5 groups based on chronicity of ACLD: (1) 0 to 6 months, (2) 6 months to 1 year, (3) 1 to 2 years, (4) 2 to 5 years, and (5) longer than 5 years. Preoperatively and immediately postoperatively, all patients underwent lateral radiography in extension to evaluate the tibiofemoral relationship, specifically with regard to anterior tibial subluxation (ATS), space for the ACL (sACL), and extension angle. Demographic and radiographic factors were compared among the 5 groups.Results:Preoperative ATS values in groups 4 (mean ± SD, 2.9 ± 2.1 mm) and 5 (2.6 ± 1.9 mm) were significantly greater than in group 1 (1.6 ± 1.9 mm). Postoperatively, the tibia was posteriorly overconstrained in all groups, and there was no difference in immediately postoperative ATS among the 5 groups. Further evaluation of the tibiofemoral relationship in the sagittal plane revealed that the mean preoperative side-to-side difference in sACL (sACL-SSD) was greater in groups 4 (2.5 ± 1.6 mm) and 5 (2.2 ± 1.7 mm) than in group 1 (1.2 ± 1.5 mm). Immediately after ACL reconstruction, however, there were no group-dependent differences in sACL-SSD. No significant group-dependent differences were found for extension deficit.Conclusion:Chronicity of ACLD had an effect on the preoperative tibiofemoral relationship in the sagittal plane, including ATS and sACL-SSD, especially in patients with ACLD longer than 2 years. However, preoperative extension deficit was not influenced by chronicity. Immediately postoperatively, chronicity did not affect the ability of anatomic ACL reconstruction to reduce subluxation.

Context:Yoga improves physical and respiratory functions in healthy inactive middle-aged people.Aim:This study aimed to assess the effects of 8 weeks of asana and asana with pranayama lessons in order to clarify the influence of two different combinations of yoga practice on physical and respiratory functions in healthy inactive middle-aged people.Subjects and Methods:A total of 28 participants (mean age: 52.7 years) were divided into a yoga asana (YA) group and YA with pranayama (YAP) group. Participants attended a 70-min session once a week for 8 weeks. The YA group practiced basic asana without specific breathing instructions, while the YAP group practiced basic asana with specific breathing instructions (pranayama). Respiratory function was measured with an autospirometer. Physical function assessments included the 30-s chair stand test and upper and lower extremity flexibility. All tests were assessed at baseline and after 8 weeks of intervention.Statistical Analysis:Changes in scores were analyzed with the paired t-test for each group. Pre-post results were compared for all the measured values. P < 0.05 was considered statistically significant.Results:Both groups showed significant improvements in physical and overall respiratory functions after the 8-week yoga intervention. However, the maximal inspiratory pressure and lower extremity flexibility improved only in the YAP group.Conclusions:The 8-week yoga intervention for healthy inactive middle-aged people improved the overall respiratory and physical functions, and the inclusion of pranayama had the added benefit of improving inspiratory muscle strength and global body flexibility.