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  • Kapalı Erişim
    Yayın
    Durable patellar stability and high patient‐reported success at minimum 5‐year follow‐up after isolated suture tape MPFL reconstruction
    (Wiley, 2026) Erden, Tunay; Ağır, Muzaffer; Kayaalp, Mahmut Enes; Toker, Berkin; Taşer, Ömer
    Purpose: To evaluate the mid‐to‐ long‐term clinical and radiological out comes of isolated medial patellofemoral ligament reconstruction (MPFL‐R) using a high‐strength suture tape (HSST) construct in patients with recur rent patellar instability and no major osseous risk factors. Methods: Patients treated with isolated MPFL‐R using HSST and a single knotless femoral anchor between 2015 and 2021 were retrospectively re viewed. Inclusion criteria were recurrent lateral patellar instability (≥2 disloca tions or symptomatic subluxations) refractory to nonoperative treatment and a minimum postoperative follow‐up of 60 months. Patients requiring concomitant bony realignment or presenting with major anatomic risk factors (e.g., high grade trochlear dysplasia, severe patella alta, tibial tubercle–trochlear groove distance >20mm) were excluded. Clinical outcomes were assessed with the International Knee Documentation Committee (IKDC) subjective score, Kujala score and visual analogue scale (VAS) for pain. Patellar tilt was mea sured on axial magnetic resonance imaging (MRI). Postoperative instability events, complications and reoperations were recorded. Clinically meaningful improvements were assessed using minimal clinically important difference (MCID) and patient‐acceptable symptomatic state (PASS) thresholds. Kaplan Meier survival analysis was performed to estimate 5‐year survivorship free from redislocation (primary endpoint) and any postoperative instability (secondary endpoint). Postoperative instability was defined as clinically docu mented redislocation or symptomatic subluxation. Results: Eighty‐one patients (mean age 20.8 years; 31.4% female) were included. At a mean follow‐up of 79.4±14.3 months, one redislocation (1.2%) and two subluxations (2.5%) occurred. Five‐year survivorship free from redislocation was 98.8% (95% confidence interval [CI], 96.4%–100%), and survivorship free from any postoperative instability was 96.3% (95% CI, 92.2%–100%). All patient‐reported outcome measures improved signifi cantly from baseline to final follow‐up (all p<0.001). Ninety‐six percent of patients achieved the PASS threshold for IKDC (95% CI, 89.7%–98.7%), whereas PASS attainment for the Kujala score ranged from 74% to 86% depending on the applied cut‐off. Radiologically, patellar tilt improved substantially on MRI (p<0.001). Postoperative complications were infrequent and manageable, including five cases of arthrofibrosis (requiring manipulation under anaesthesia), one deep infection (treated with arthro scopic debridement) and three cases of implant‐related bursitis at the femoral fixation site. Conclusion: Isolated MPFL reconstruction using an HSST construct pro vided durable patellar stability and significant functional improvement at a minimum 5‐year follow‐up. This technique represents a reliable mid‐to long‐term option for isolated MPFL‐R in appropriately selected patients, especially when graft harvest morbidity and patellar bone preservation are concerns.
  • Küçük Resim
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    Increased residual anterior knee laxity at one year is associated with a dose‐dependent increase in graft re‐rupture risk following hamstring autograft ACL reconstruction in athletes
    (Wiley, 2026) Erden, Tunay; Ağır, Muzaffer; Kayaalp, Mahmut Enes; Toker, Berkin; Taşer, Ömer
    Purpose: Residual anterior knee laxity following anterior cruciate ligament reconstruction (ACLR) has been associated with inferior subjective out comes and an increased risk of revision surgery; however, its prognostic value for predicting subsequent graft re‐rupture remains unclear. This study aimed to assess the association between KT‐1000–measured 1‐year post operative anterior knee laxity and graft re‐rupture after ACLR. We hy pothesised that increased residual anterior knee laxity at 1 year post operatively would be associated with a higher risk of graft re‐rupture in a dose‐dependent manner. Methods: This retrospective cohort study included 1011 amateur and pro fessional athletes who underwent primary ACLR with hamstring tendon autograft (HTA) between 2005 and 2024 by a single surgeon using a standardised surgical technique. Patients undergoing revision ACLR, mul tiligament reconstruction, or any lateral extra‐articular augmentation pro cedure were excluded. Anterior knee laxity was quantified using the KT 1000 arthrometer at a mean of 12.1±1.3 months post‐operatively. A landmark time‐to‐event design was applied, with follow‐up starting from the KT‐1000 assessment to minimise immortal time bias and to focus on anterior knee laxity after biological graft maturation. The primary exposure was KT‐1000 side‐to‐side difference (SSD), analysed as both a continuous variable and using clinically relevant thresholds (<3mm, 3–5mm, and >5mm). Associations between post‐operative laxity and graft re‐rupture, adjusting for demographic, surgical, and activity‐related factors were assessed using a multivariable Cox proportional hazards model. Secondary analyses evaluated the relationship between KT‐1000 laxity, return‐to‐play status, and post‐operative activity level. Results: Patients who experienced graft re‐rupture had significantly greater post‐operative KT‐1000 SSD compared with those without re‐rupture (3.5 ± 1.3mm vs. 2.1±0.9mm; p<0.001). Increased KT‐1000 SSD was independently associated with higher graft re‐rupture risk (adjusted hazard ratio, 2.97 per 1‐mm increase; 95% confidence interval [CI], 2.5–3.5). Higher laxity categories were associated with progressively increased re‐rupture risk with adjusted hazard ratios of 1.76 (95% CI, 1.3–2.3; p<0.001) for 3–5mm and 8.85 (95% CI, 4.7–16.4; p<0.001) for >5mm compared with <3mm. Post‐operative 1‐year KT‐1000 anterior knee laxity was not significantly associated with return‐to‐play status (odds ratio, 0.84 per 1‐mm increase; 95% CI, 0.6–1.1; p=0.28), but was modestly associ ated with lower post‐operative Tegner activity level (p<0.001). Conclusion: KT‐1000–measured post‐operative anterior knee laxity at 1 year post‐operatively was independently associated with the risk of sub sequent graft re‐rupture after HTA ACLR in athletic patients. These findings suggest that residual laxity may serve as a useful risk stratification tool, rather than a deterministic predictor of failure, and should be interpreted in the context of overall clinical and biomechanical assessment. Level of Evidence: Level III.
  • Küçük Resim
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    Radiographic medial posterior tibial slope ≥16° predicts multiple revisions after anterior cruciate ligament reconstruction
    (Wiley, 2026) Kayaalp, Mahmut Enes; Inoue, Jumpei; Konstantinou, Efstathios; Kahraman, Hamit Çağlayan; Erden, Tunay; Musahl, Volker
    Purpose: An increased posterior tibial slope (PTS) has been implicated as a risk factor for anterior cruciate ligament (ACL) graft failure. This matched case–control study aimed to compare radiographic and magnetic reso nance imaging (MRI)‐based PTS measurements between patients under going multiple revision anterior cruciate ligament reconstruction (ACLR) and those with successful primary ACLR and to identify thresholds predictive of high revision risk. Methods: In this matched case–control study, 156 patients were analysed: 78 patients undergoing multiple revision ACLR and 78 patients with suc cessful primary ACLR. Medial PTS was measured on radiographs, while medial, lateral and PTS difference (PTS asymmetry) were measured on MRI. Group differences were assessed using independent t tests and χ2 tests. Receiver operating characteristic (ROC) analysis identified optimal thresholds, and logistic regression quantified odds ratios (ORs) for multiple revisions per 1° increase in radiographic medial PTS, adjusting for body mass index (BMI), sex, side, height and weight. Results: Radiographic medial PTS was significantly higher in the multiple‐ revision group (12.5 ± 3.5° vs. 11.2 ± 3.0°, p = 0.016). ROC analysis identi fied an optimal medial PTS cutoff of 13° (area under the curve = 0.58, sensitivity = 0.49, specificity = 0.65), but only a PTS ≥ 16° was significantly associated with increased multiple revision risk (OR = 3.10, 95% confidence interval [CI]: 1.14–8.40; p = 0.037; specificity = 0.91; positive predictive value [PPV] = 0.70). MRI‐based medial and lateral PTSs, as well as PTS asymmetry, did not differ significantly between groups. Univariate logistic regression demonstrated a 10% increase in odds per 1° increase in radio graphic PTS (OR = 1.10, 95% CI: 1.00–1.22, p = 0.049), remaining signifi cant after adjustment for BMI, sex, side, height and weight (adjusted OR = 1.11, 95% CI: 1.01–1.23, p = 0.034). Radiographic medial PTS cor related moderately with MRI‐based medial PTS (r = 0.49, p < 0.001), but not with lateral PTS (p: n.s.). Conclusion: Radiographic medial PTS showed the strongest differentiation between successful primary ACLR and multiple‐revision ACLR. A PTS ≥ 16° identifies patients at significantly higher risk of multiple revisions, whereas MRI‐based medial PTS, lateral PTS and PTS asymmetry provide no addi tional discriminatory value. Radiographic medial PTS appears practical for preoperative risk stratification, whereas MRI‐based measures do not show similar utility. Level of Evidence: Level III.