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Objectives: To determine whether dual-energy CT (DECT) can be used to accurately and reliably detect anterior cruciate ligament (ACL) rupture., Materials and Methods: Participants with unilateral ACL rupture were prospectively enrolled, and the bilateral knees were scanned by DECT. A tissue-specific mapping algorithm was applied to improve the visualization of the ACLs. The 80-keV CT value, mixed-keV CT value, electron density (Rho), and effective atomic number (Z eff ) were measured to quantitatively differentiate torn ACLs from normal ACLs. MRI and arthroscopy served as the reference standards., Results: Fifty-one participants (mean age, 27.0 ± 8.7 years; 31 men) were enrolled. Intact and torn ACLs were explicitly differentiated on color-coded DECT images. The 80-keV CT value, mixed-keV CT value, and Rho were significantly lower for the torn ACLs than for the intact ACLs (p < 0.001). The optimal cutoff values were an 80-keV CT value of 61.8 HU, a mixed-keV CT value of 60.9 HU, and a Rho of 51.8 HU, with AUCs of 98.0% (95% CI: 97.0-98.9%), 99.2% (95% CI: 98.6-99.7%), and 99.8% (95% CI: 99.6-100.0%), respectively. Overall, DECT had almost perfect reliability and validity in detecting ACL integrity (sensitivity = 97.1% [95% CI: 88.1-99.8%]; specificity = 98.0% [95% CI: 89.5-99.9%]; PPV = 98.0% [95% CI: 93.0-99.8%]; NPV = 97.1% [95% CI: 91.7-99.4%]; accuracy = 97.5% [95% CI: 94.3-99.2%]). There was no evidence of a difference between MRI and DECT in the diagnostic performance (p > 0.99)., Conclusion: DECT has excellent diagnostic accuracy and reliability in qualitatively and quantitatively diagnosing ACL rupture., Clinical Relevance Statement: DECT could validly and reliably diagnose ACL rupture using both qualitative and quantitative methods, which may become a promising substitute for MRI to evaluate the integrity of injured ACLs and the maturity of postoperative ACL autografts., Key Points: • On color-coded DECT images, an uncolored ACL was a reliable sign for qualitatively diagnosing ACL rupture. • The 80-keV CT value, mixed-keV CT value, and Rho were significantly lower for the torn ACLs than for the intact ACLs, which contributed to the quantitative diagnosis of ACL rupture. • DECT had an almost perfect diagnostic performance for ACL rupture, and diagnostic capability was comparable between MRI and DECT., (© 2023. The Author(s).)

Purpose: To evaluate the extent of tunnel widening after anterior cruciate ligament reconstruction (ACLR) using the all-inside technique and to establish its correlation with patient-reported clinical outcomes and femoral graft bending angle (GBA)., Methods: Tunnel widening was evaluated using computed tomography (CT)-based three-dimensional (3D) models, and the femoral GBA was directly measured on CT images using the Picture Archiving and Communication System (PACS) software. Clinical follow-up was routine procedure, and patient-reported clinical outcomes mainly included International Knee Documentation Committee (IKDC), Lysholm, and Knee Injury and Osteoarthritis Outcome Scores (KOOS) scores, and subjective knee stability assessment., Results: Fifty-two patients received standard all-inside ACLR, with a median follow-up of 6 months. Reconstructed anterior cruciate ligaments (ACLs) were scanned during the first 3 days and 6 months after surgery. On both the femoral and tibial sides, bone tunnels were most significantly enlarged at the articular aperture segment; the femoral tunnel was 9.2 ± 1.3 mm postoperatively and was significantly enlarged by 32% to a mean tunnel diameter of 12.1 ± 2.0 mm at 6 months after surgery. Moreover, the extent of tunnel enlargement gradually decreased as the measured levels approached those of the bone cortex. The femoral tunnel center was shifted into the anterior and distal direction, and the tibial tunnel center was shifted into the posterior and lateral direction. Additionally, the mean femoral GBA was 105.9° ± 8.1° at the 6-month follow-up. Tunnel enlargement and GBA were not significantly correlated with patient-reported outcomes., Conclusions: Femoral and tibial tunnels were significantly greater and eccentrically shifted at the 6-month follow-up after all-side ACLR. However, the extent of tunnel widening does not markedly affect the short-term clinical outcomes. Meanwhile, the femoral GBA was not significantly correlated with femoral tunnel widening or patient-reported outcomes. Although the tunnel widening following all-inside ACLR was not associated with clinical outcomes, it potentially caused difficulties in revision ACLR., Level of Evidence: Level IV., (© 2022. The Author(s).)

Anterior cruciate ligament (ACL) injury is a common disease in orthopedics and mostly occurs as a noncontact injury in athletes. Patients' knee joint stability, which is crucial to their athletic ability, cannot be restored through conservative treatment; it can only be restored through ACLR (ACL reconstruction) surgery. The surgical techniques of ACLR are constantly evolving, from bone tendon bone (BTB) grafting combined with interface screw fixation to hamstring tendon autograft or allogeneic tendon and of suspension device constructs. In particular, the currently prevalent all-inside technique featuring good cosmetic results and quick recovery of early functions not only ensures the stable fixation of grafts but also reduces surgical trauma. This review compares the advantages and disadvantages of different aspects of all-inside ACLR, including graft selection and preparation, bone socket reconstruction, fixation methods, and surgical technique effects and limitations. It has been found that the all-inside technique excels both anatomically and clinically but still requires further development. Besides, it has some limitations, and high-quality randomized controlled trials are still required to compare the long-term effects of the all-inside technique and other ACLR techniques., Competing Interests: The authors declare no conflict of interest. YSL is serving as the guest editor of this journal. We declare that YSL had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Emerito Carlos Rodriguez-Merchan and Viviana di Giacomo., (© 2022 The Author(s). Published by IMR Press.)

Purpose: The purpose of this meta-analysis was (1) to examine the effect of the tibial plateau slopes (medial and lateral) on anterior cruciate ligament (ACL) injury and (2) to investigate gender differences between ACL-injured subjects and gender-matched controls., Methods: The PubMed database was searched through to 1 November 2011 to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Two authors independently extracted information on the designs of the studies, the characteristics of the study participants, exposure and outcome assessments, and control for potential confounding factors. A meta-analysis was conducted, and either a fixed- or a random-effects model was used to calculate the overall weighted mean difference (WMD)., Results: Twelve studies (n = 1,871: 923 patients in the ACL-injured group and 938 patients in the control group) were included. The medial tibial plateau slope in the ACL group ranged from 1.8° ± 3.7° to 12.1° ± 3.3° while it ranged from 2.9° ± 2.8° to 9.5° ± 3° among the controls. The lateral tibial plateau slope in the ACL ranged from 1.8° ± 3.2° to 11.5° ± 3.5° and 0.3° ± 3.6° to 9° ± 4° in the control group. Statistically significant increased angles were observed in ACL-injured group compared to control group for medial tibial plateau slope (WMD, 1.1°; 95 % confidence interval, 0.5°-1.7°) and lateral tibial plateau slope (WMD, 1.8°; 95 % confidence interval, 1.3°-2.3°). Sensitivity analysis and subgroup analysis proved this to be a reliable result., Conclusions: The current meta-analysis suggests that both, increased medial and lateral tibial plateau slopes, are associated with increased susceptibility to ACL injury regardless of gender. In addition, this study indicates a stronger evidence for lateral tibial plateau slope to be associated with ACL injury compared with medial tibial plateau slope due to the larger increased angle value and on the basis of consistency among the included studies.

Objective: To assess the clinical results of the remnant‐preserving and I.D.E.A.L. femoral tunnel technique in the arthroscopic treatment of anterior cruciate ligament (ACL) injuries. Methods: This was a retrospective single‐center, single‐surgeon study reviewing data from November 2016 to March 2019. Based on our inclusion/exclusion criteria, a total of 31 patients (18 males, 13 females; mean age, 23.6 years) who underwent arthroscopic ACL reconstruction with the remnant preservation and I.D.E.A.L. femoral tunnel technique were recruited and had a minimum follow‐up of 12 months. Clinical data and status of knee stability were recorded. The International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale were collected both preoperatively and at a minimum of 1‐year follow‐up. Results: Statistically significant differences were detected between the preoperative and postoperative values for Lachman test and pivot‐shift test (P < 0.01). The mean postoperative Lysholm score was 89.6 ± 9.4, whereas the mean preoperative Lysholm score was 47.3 ± 12.8 (P < 0.01). The mean Tegner activity score was significantly higher at postoperative evaluation than at preoperative evaluation (6.5 ± 2.1 vs 2.6 ± 1.8; P < 0.01). The mean IKDC score was significantly improved from 49.5 ± 10.6 preoperatively to 88.2 ± 10.7 postoperatively (P < 0.01). No case of infection was reported. No radiograph showed any joint space narrowing or degenerative change at the last postsurgical follow‐up. Conclusion: The anatomical remnant‐preserving and I.D.E.A.L. femoral tunnel technique achieves a satisfactory clinical outcome and provides an effective option for the treatment of ACL injuries. [ABSTRACT FROM AUTHOR]