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Purpose: To determine if preoperative magnetic resonance imaging (MRI) measurements of semitendinosus and gracilis tendon cross-sectional area (CSA) could be used in predicting the intraoperative diameter of a 5-strand hamstring autograft. Methods: A retrospective review was performed of patients who underwent anterior cruciate ligament (ACL) reconstruction with a 5-strand hamstring autograft. All patients undergoing a 5-strand hamstring autograft ACL reconstruction from a single surgeon between 2018 and 2021 were included in this analysis. CSA of both the semitendinosus (CSAst) and gracilis (CSAgr) tendons were measured on preoperative MRI. Demographic and operative data were recorded via chart review. Analyses of within-rater and between-rater reliability were performed. Multiple linear regression was used to analyze the predictors of graft diameter. Results: A total of 45 ACLs were included in this study. An initial multiple linear regression model included multiple patient-independent variables (R2 = 0.62, P < .001), but CSAst was the only significant predictor of graft diameter. Accordingly, a second multiple linear regression model was created using CSAst and CSAgr (R2 = 0.61, P < .001). Both CSAst and CSAgr were significant predictors of graft diameter. The resulting equation for determining the graft diameter based on CSAst and CSAgr is as follows: [Graft Diameter (mm)] = 5.324 + 0.124 ∗ [CSAst (mm2)] + 0.183 ∗ [CSAgr (mm2)]. Conclusions: CSA measurements of the semitendinosus and gracilis tendons on preoperative MRI axial imaging, measured at the level for which the femoral condyle was the widest, may be used to predict the intraoperative graft diameter for ACL reconstruction using the 5-strand autograft technique. Clinical Relevance: Predicting ACL autograft size on preoperative MRI can aid in preoperative planning, including choice of graft.

Purpose: To systematically review the literature and provide a detailed summary of the current treatments and outcomes for arthrofibrosis following knee arthroscopy and anterior cruciate ligament reconstruction (ACLR) and to compare the treatment strategies in pediatric and adult populations. Methods: A systematic review was performed in March 2022 using PubMed, EMBASE, and Cochrane Library Databases per Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Search terms consisted of variations of the following: (“arthrofibrosis” OR “stiffness” OR “stiff” OR “complications”) AND (“arthroscopy” OR “arthroscop” OR “ACL” OR “anterior cruciate”) AND (“treat” OR “care” OR “management” AND “knee”). The inclusion criteria were studies that were written in English, were published since 2000, and that reported outcomes of knee arthroscopy or ACLR for treatment of arthrofibrosis of the knee. The study quality was assessed, and data about the patients and treatments were recorded. Treatments were compared between pediatric and adult patients. Results: A total of 1,208 articles were identified in the initial search, 42 (3.48%) of which met eligibility criteria, involving treatment regimens for arthrofibrosis following knee arthroscopy or ACLR. Of the 42 studies included, 29 (69.0%) were reported data for adults and 13 (31.0%) reported data for pediatric patients. Thirty-nine studies (92.8%) discussed manipulation under anesthesia and/or lysis of adhesions (LOA) as treatment for arthrofibrosis of the knee, whereas 2 (4.8%) described the use of medications. Conclusions: Within orthopaedic sports medicine literature, there is variability in the reported treatment options for arthrofibrosis of the knee. Most studies identified manipulation under anesthesia and/or LOA as the treatment among both adult and pediatric patients. Other variants include notchplasty, open posterior arthrolysis, total graft resection, removal of hardware with LOA, dynamic splinting, casting in extension, bracing, and medications. Level of Evidence: Level IV, systematic review of Level I-IV studies.

Purpose: To conduct a literature review to assess the definitions of anterior cruciate ligament reconstruction (ACLR) failure used throughout the orthopaedic literature. Methods: A systematic search of Embase, Ovid Medline, SPORTDiscus, and Web of Science was conducted by a university librarian to identity level I-IV clinical studies on ACLR failure. Inclusion criteria consisted of patients who underwent ACLR and included a definition of failure of ACLR. Patients who underwent anterior cruciate ligament (ACL) repairs, animal/cadaver studies, review studies, non-English language articles, and non-full text articles were excluded. Failure data were extracted from each study and categorized. Other data that were extracted included follow-up time after ACLR, failure reoperation rate, and failure reoperation procedure. Descriptive statistics was used to analyze the data. Results: Out of 2,775 studies, 104 (3.75%) met inclusion criteria and were analyzed in this review. The most common definition of ACLR failure included the use of a physical examination, specifically Lachman’s test (21/104 [20.2%]), anterior laxity assessment, or a Pivot-Shift test (24/104 [35.2%]) or undergoing or requiring revision ACLR (39/104 [37.5%]). Although some studies used quantitative tests or imaging to help define “failure,” others simply defined it as graft rerupture that was otherwise not defined (22/104 [22.5%]). Other common definitions included: the use of imaging (magnetic resonance imaging/radiographs) to confirm graft re-rupture (37/104 [35.6%]), patient-reported outcomes (recurrent instability)/patient reported outcomes measures (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner) (18/104 [17.3%]), and the use of an arthrometer (KT-1000/2000, Rollimeter, or Kneelax) (17/104 [16.3%]). The least common definitions included graft failure or rerupture confirmed by arthroscopy (13/104 [12.5%]) and nonrevision surgery (2/104 [1.0%]). The failure rate of this procedure ranged from 0% to 100% depending on the definition of “failure.” Conclusions: In this study, we found that a variety of definitions of failure are used among studies published in the orthopaedic literature. The most common criteria for failure of ACLR were the results of physical examination tests (35%), the need for undergoing a revision ACLR (36%), and the use of imaging to diagnose the failure (34%). About 17% of studies included in this review used patient-reported outcomes, specifically recurrent instability, or PROMs (IKDC, KOOS, Tegner) in their assessment of failure of ACLR. The least used definitions of “failure” of ACLR included nonrevision ACLR surgery (2%). Although some studies used similar tests or categories in their definition of failure, there were a variety of score and grade cutoff points between them. Level of Evidence: Level IV, systematic review of Level II-IV studies.