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Article ; Online: Editorial Commentary: So Your Knee Has a Big Pivot Shift Before Anterior Cruciate Ligament Surgery-Why Does that Matter???

Magnussen, Robert A

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

2020 Volume 36, Issue 5, Page(s) 1407–1408

Abstract: Control of anterolateral knee laxity has always been a major goal of anterior cruciate ligament (ACL) reconstruction. The recent focus on the anatomy of the anterolateral knee and new studies demonstrating decreased graft failure risk with the additional ...

Abstract	Control of anterolateral knee laxity has always been a major goal of anterior cruciate ligament (ACL) reconstruction. The recent focus on the anatomy of the anterolateral knee and new studies demonstrating decreased graft failure risk with the additional of lateral procedures to intra-articular ACL reconstruction have given these procedures new relevance. A key question that drives indications is which patients benefit the most from these procedures. Those patients with increased rotational knee laxity, particularly in the absence of a repairable meniscus injury, may be good candidates. ACL injury chronicity, bony anatomy, concomitant anterolateral injury, and other factors all contribute to increased anterolateral knee laxity. This high laxity population is ideal for evaluation of the effectiveness of new methods to control knee laxity and improve outcomes of isolated intra-articular ACL reconstruction.
MeSH term(s)	Anterior Cruciate Ligament ; Anterior Cruciate Ligament Injuries ; Electromagnetic Phenomena ; Humans ; Joint Instability ; Knee Joint ; Meniscus ; Range of Motion, Articular
Language	English
Publishing date	2020-05-01
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	632528-2
ISSN	1526-3231 ; 0749-8063
ISSN (online)	1526-3231
ISSN	0749-8063
DOI	10.1016/j.arthro.2020.02.009
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Article ; Online: Patella Alta Sees You, Do You See It?

Magnussen, Robert A

American journal of orthopedics (Belle Mead, N.J.)

2017 Volume 46, Issue 5, Page(s) 229–231

Abstract: Numerous anatomic factors have been shown to contribute to patellar instability. Patellar height remains a critical, yet underappreciated contributor to instability that is amenable to surgical correction through the performance of a tibial tubercle ... ...

Abstract	Numerous anatomic factors have been shown to contribute to patellar instability. Patellar height remains a critical, yet underappreciated contributor to instability that is amenable to surgical correction through the performance of a tibial tubercle distalization osteotomy (TTDO). The indications for a distalizing tibial tubercle osteotomy are not completely clear and depend on multiple factors. One must consider patient factors and physical examination findings in addition to radiographic measures. In general, the addition of a TTDO to medial patellofemoral ligament reconstruction should be considered when the degree of patella alta exceeds a Caton-Deschamps Index (CDI) of 1.4. The presence of trochlear dysplasia, patellar maltracking (J-sign), lateral patellar apprehension that persists at higher flexion angles, and decreased patellotrochlear articular cartilage contact on sagittal magnetic resonance imaging may drive the decision to proceed with distalization when the CDI is lower. Complications of distalization osteotomies are frequent and careful attention to surgical technique is critical to obtain good outcomes.
MeSH term(s)	Humans ; Joint Instability/surgery ; Ligaments, Articular/surgery ; Orthopedic Procedures/methods ; Osteotomy/methods ; Patella/surgery ; Patellar Dislocation/surgery ; Reconstructive Surgical Procedures/methods
Language	English
Publishing date	2017-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2365753-4
ISSN	1934-3418 ; 1078-4519
ISSN (online)	1934-3418
ISSN	1078-4519
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Article ; Online: What Happened to My Quad? Commentary on an article by Brian Noehren, PT, PhD, et al.: "Cellular and Morphological Alterations in the Vastus Lateralis Muscle as the Result of ACL Injury and Reconstruction".

Magnussen, Robert A

The Journal of bone and joint surgery. American volume

2016 Volume 98, Issue 18, Page(s) e79

MeSH term(s)	Anterior Cruciate Ligament/surgery ; Anterior Cruciate Ligament Injuries ; Anterior Cruciate Ligament Reconstruction ; Electromyography ; Humans ; Muscle, Skeletal ; Quadriceps Muscle
Language	English
Publishing date	2016--21
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	220625-0
ISSN	1535-1386 ; 0021-9355
ISSN (online)	1535-1386
ISSN	0021-9355
DOI	10.2106/JBJS.16.00635
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Article ; Online: Elevated Posterior Tibial Slope Is Associated With Anterior Cruciate Ligament Reconstruction Failures: A Systematic Review and Meta-analysis.

Duerr, Robert / Ormseth, Benjamin / Adelstein, Jeremy / Garrone, Andrew / DiBartola, Alex / Kaeding, Christopher / Flanigan, David / Siston, Robert / Magnussen, Robert

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

2023 Volume 39, Issue 5, Page(s) 1299–1309.e6

Abstract: Purpose: To evaluate the association of posterior tibial slope (PTS) with anterior cruciate ligament (ACL) reinjury following primary ACL reconstruction.: Methods: PubMed, Scopus, Embase, and CINAHL databases were searched from inception through ... ...

Abstract	Purpose: To evaluate the association of posterior tibial slope (PTS) with anterior cruciate ligament (ACL) reinjury following primary ACL reconstruction. Methods: PubMed, Scopus, Embase, and CINAHL databases were searched from inception through March 1, 2021, to retrieve relevant studies. Comparative studies reporting PTS measurements in a cohort of patients experiencing ACL graft failure versus patients with intact primary ACL reconstruction or studies comparing patients undergoing revision ACL reconstruction versus primary ACL reconstruction were included for analysis. A random-effects model was used to calculate the overall standardized mean difference (SMD) between groups. The following inclusion criteria were used: English language; full text available; Level I, II, or III evidence; studies in humans; and skeletally mature patients. Results: After we systematically screened 1,912 studies, 15 studies met the inclusion/exclusion criteria. Radiographic measurements were used in 6 studies reporting medial PTS in 411 ACL failures versus 2808 controls. Patients with ACL failure had significantly greater medial PTS compared with controls (SMD 0.50; 95% confidence interval [CI] 0.23-0.77; P < .001). Magnetic resonance imaging (MRI) was used in 9 studies reporting lateral PTS measurements in 641 patients with a failed ACL reconstruction compared with 705 controls. Seven of the MRI studies also measured medial PTS in 552 failures versus 641 controls. Patients with ACL failure had significantly greater lateral PTS on MRI (SMD 0.58; 95% CI 0.13-1.03; P = .012) and medial PTS on MRI (SMD 0.59; 95% CI 0.23-0.96; P = .001) compared with controls. Conclusions: The present meta-analysis demonstrated that patients with elevated PTS on radiographs and MRI are at increased risk for ACL graft failure after primary ACL reconstruction. Level of evidence: Level III, meta-analysis of Level III studies.
MeSH term(s)	Humans ; Knee Joint/surgery ; Anterior Cruciate Ligament Injuries/surgery ; Anterior Cruciate Ligament/surgery ; Tibia/surgery ; Magnetic Resonance Imaging ; Anterior Cruciate Ligament Reconstruction/methods ; Retrospective Studies
Language	English
Publishing date	2023-01-21
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	632528-2
ISSN	1526-3231 ; 0749-8063
ISSN (online)	1526-3231
ISSN	0749-8063
DOI	10.1016/j.arthro.2022.12.034
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Article ; Online: Patella alta and increased TT-TG distance do not adversely affect patient-reported outcomes following isolated MPFL reconstruction: A systematic review.

Pappa, Nicholas / Good, Logan / DiBartola, Alex / Martin, Kyle / Flanigan, David C / Magnussen, Robert A

Journal of ISAKOS : joint disorders & orthopaedic sports medicine

2023 Volume 8, Issue 5, Page(s) 352–363

Abstract: Objectives: To analyze the effect of patellofemoral anatomical variations (patella alta, increased tibial tubercle-trochlear groove [TT-TG] distance, and trochlear dysplasia) on clinical outcomes after isolated medial patellofemoral ligament (MPFL) ... ...

Abstract	Objectives: To analyze the effect of patellofemoral anatomical variations (patella alta, increased tibial tubercle-trochlear groove [TT-TG] distance, and trochlear dysplasia) on clinical outcomes after isolated medial patellofemoral ligament (MPFL) reconstruction. Methods: A comprehensive search from PubMed, Embase, and the Cochrane Library databases was conducted to identify studies that compared outcomes based on the presence or absence of patella alta, elevated tibial tubercle-trochlear groove (TT-TG) distance, and/or trochlear dysplasia. Exclusion criteria included reviews and meta-analyses, studies that included patients who underwent associated bony procedures, and those reporting outcomes after isolated MPFL reconstruction with no comparison between varying anatomical groups. Results: After application of selection criteria, 19 studies were included. Patella alta was not predictive of failure or poorer outcomes among 13 studies; however, 2 studies demonstrated poorer patient-reported outcome scores and/or higher failure rates with increasing patellar height. Increasing TT-TG distance demonstrated a statistically significant correlation with poorer outcomes in only one study, whereas 12 other studies showed no association. Trochlear dysplasia resulted in worse outcomes and greater failure rates in 6 studies, while 10 studies showed no statistically significant correlation between trochlear dysplasia and postoperative outcomes. Conclusion: Patella alta and increased TT-TG distance did not adversely affect outcomes following isolated MPFL reconstruction in the preponderance of reviewed studies. Data are mixed regarding the impact of trochlear dysplasia on the outcomes of isolated MPFL reconstruction. Level of evidence: IV.
MeSH term(s)	Humans ; Patellar Dislocation/surgery ; Patellofemoral Joint/surgery ; Patella/surgery ; Joint Instability/surgery ; Recurrence ; Patient Reported Outcome Measures
Language	English
Publishing date	2023-08-09
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review
ISSN	2059-7762
ISSN (online)	2059-7762
DOI	10.1016/j.jisako.2023.08.001
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Article ; Online: Qualitative visual assessment of the J-sign demonstrates high inter-rater reliability.

Walla, Nicholas / Moore, Toren / Harangody, Sarah / Fitzpatrick, Sean / Flanigan, David C / Duerr, Robert A / Siston, Robert / Magnussen, Robert A

Journal of ISAKOS : joint disorders & orthopaedic sports medicine

2023 Volume 8, Issue 6, Page(s) 420–424

Abstract: Objectives: To assess the inter- and intra-rater reliability of the classification of the J-sign as "large" versus "small or none" as compared to another two-level system ("present" versus "absent") and a three-level system ("large," "small," or "none") ...

Abstract	Objectives: To assess the inter- and intra-rater reliability of the classification of the J-sign as "large" versus "small or none" as compared to another two-level system ("present" versus "absent") and a three-level system ("large," "small," or "none") and to identify anatomical and patient factors associated with the presence of a large J-sign. Methods: Forty patients (40 knees) with recurrent patellar instability were prospectively enrolled and recorded on video actively extending their knee while seating. Four raters classified patellar tracking on two separate occasions using three systems: 1) two groups: J-sign versus no J-sign; 2) three groups: large J-sign, small J-sign, or no J-sign; and 3) two groups: large J-sign versus small or no J-sign. The intra- and inter-rater reliability of each system was assessed using kappa statistics. Anatomical (trochlear dysplasia, tibial tubercle-trochlear groove (TT-TG) distance, patellar height) and patient (Beighton score) factors as well as Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales were compared between patients with a large J-sign and patients with a small or no J-sign. Results: Inter- and intra-rater reliability were found to be highest with the two-level classification system of a large J-sign versus a small or no J-sign (inter-rater kappa = 0.76, intra-rater kappa = 0.75). Patients with a large J-sign had more severe trochlear dysplasia as assessed with the sulcus angle (p = 0.042) and were more likely to have a tight lateral retinaculum (p = 0.032) and an elevated Beighton score (p = 0.009). No significant differences in KOOS subscales were noted based on the presence of a large J-sign versus a small J-sign or no J-sign. Conclusion: Qualitative visual assessment of patellar tracking with the J-sign demonstrates substantial inter- and intra-rater reliability, particularly when utilizing a two-group classification system to identify knees with a large J-sign. Patients with a large J-sign demonstrate an increased incidence of a tight lateral retinaculum, generalized ligamentous laxity, and trochlear dysplasia. Level of evidence: Level III - cross-sectional study.
MeSH term(s)	Humans ; Patellar Dislocation/complications ; Patellofemoral Joint ; Joint Instability/diagnosis ; Reproducibility of Results ; Cross-Sectional Studies
Language	English
Publishing date	2023-07-26
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7762
ISSN (online)	2059-7762
DOI	10.1016/j.jisako.2023.07.006
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Microfragmented Adipose Tissue Is Equivalent to Platelet-Rich Plasma for Knee Osteoarthritis at 12 Months Posttreatment: A Randomized Controlled Trial.

Baria, Michael / Barker, Tyler / Durgam, Sushmitha / Pedroza, Angela / Flanigan, David / Jia, Liuqing / Kaeding, Christopher / Magnussen, Robert

Orthopaedic journal of sports medicine

2024 Volume 12, Issue 3, Page(s) 23259671241233916

Abstract: Background: Platelet-rich plasma (PRP) is an effective treatment for knee osteoarthritis (OA). Microfragmented adipose tissue (MFAT) is another orthobiologic that holds promise, but data supporting its use are limited. Previous studies showed that MFAT ... ...

Abstract	Background: Platelet-rich plasma (PRP) is an effective treatment for knee osteoarthritis (OA). Microfragmented adipose tissue (MFAT) is another orthobiologic that holds promise, but data supporting its use are limited. Previous studies showed that MFAT created using the Lipogems device was equivalent to PRP created via noncommercial laboratory-based processes. Purpose: To perform a comparison of commercially available MFAT and PRP systems for treatment of knee OA. Study design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 71 patients with symptomatic knee OA (Kellgren-Lawrence grades 1-4) were randomized to receive a single injection of either leukocyte-rich PRP (Angel; Arthrex) or MFAT (Lipogems) under ultrasound guidance. Patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS], visual analog scale for pain with activities of daily living [VAS pain], and Tegner activity level) were recorded at baseline and at 1, 3, 6, and 12 months after injection. The primary outcome was the KOOS-Pain subscale score at 12 months after injection. Results: Overall, 49 patients completed their 12-month follow-up (PRP group, n = 23; MFAT group, n = 26). All demographic features were similar between groups, except that more men were randomized to the PRP group and more women to the MFAT group. At 12 months posttreatment, KOOS-Pain scores improved in both groups, with no significant group difference (PRP, 78 ± 17.9 vs MFAT, 77.8 ± 19.3; Conclusion: Both PRP and MFAT injections for knee OA resulted in improved patient-reported outcomes at 12 months posttreatment, with no differences found between treatments. Registration: NCT04351087 (ClinicalTrials.gov identifier).
Language	English
Publishing date	2024-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2706251-X
ISSN	2325-9671
ISSN	2325-9671
DOI	10.1177/23259671241233916
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Article: Arthroscopic Bone Graft Technique for Two-Stage Revision Anterior Cruciate Ligament Reconstruction.

Welder, Eric / Magnussen, Robert A / Fitzpatrick, Sean / Duerr, Robert A / Kaeding, Christopher C / Flanigan, David C

Arthroscopy techniques

2022 Volume 11, Issue 10, Page(s) e1667–e1674

Abstract: Revision anterior cruciate ligament reconstruction is an increasingly common procedure, with 2-stage surgery often required to address large bone defects and malpositioned tunnels. The arthroscopic bone grafting technique described herein uses morselized ...

Abstract	Revision anterior cruciate ligament reconstruction is an increasingly common procedure, with 2-stage surgery often required to address large bone defects and malpositioned tunnels. The arthroscopic bone grafting technique described herein uses morselized allograft bone to provide reproducible fill of asymmetrical bone defects without autograft harvest or additional loss of native bone. The second stage of the anterior cruciate ligament reconstruction can typically proceed 6 months following bone grafting.
Language	English
Publishing date	2022-09-17
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2653101-X
ISSN	2212-6287
ISSN	2212-6287
DOI	10.1016/j.eats.2022.05.014
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Article ; Online: Editorial Commentary: The Trend to Blend: Should We Be Using Hybrid Grafts in Adult Anterior Cruciate Ligament Reconstructions?

Flanigan, David C / Magnussen, Robert A

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

2019 Volume 35, Issue 6, Page(s) 1914–1916

Abstract: Hybrid anterior cruciate ligament grafts augmenting a small-diameter hamstring tendon autograft with nonirradiated allografts can be used with good results in adults. In teens, however, outcomes of hybrid grafts have not been well defined, and other ... ...

Abstract	Hybrid anterior cruciate ligament grafts augmenting a small-diameter hamstring tendon autograft with nonirradiated allografts can be used with good results in adults. In teens, however, outcomes of hybrid grafts have not been well defined, and other solutions to small hamstring grafts including graft folding, contralateral autograft augmentation, or selection of a different autograft source could be considered.
MeSH term(s)	Adolescent ; Adult ; Anterior Cruciate Ligament/surgery ; Anterior Cruciate Ligament Injuries/surgery ; Anterior Cruciate Ligament Reconstruction ; Autografts ; Hamstring Muscles ; Hamstring Tendons ; Humans ; Transplantation, Autologous
Language	English
Publishing date	2019-06-04
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	632528-2
ISSN	1526-3231 ; 0749-8063
ISSN (online)	1526-3231
ISSN	0749-8063
DOI	10.1016/j.arthro.2019.02.040
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Zs.A 2046: Show issues

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Article ; Online: Increased Body Mass Index is Associated with Worse Mid- To Long-Term Patient Outcomes after Surgical Repair of Multiligamentous Knee Injuries.

Tan, Danny / Ferrante, Stephanie / DiBartola, Alex / Magnussen, Robert / Welder, Eric / Crouser, Nisha / Kaeding, Christopher / Flanigan, David / Duerr, Robert A

The journal of knee surgery

2023

Abstract: We evaluated the relationship between elevated body mass index (BMI) and mid- to long-term outcomes after surgical treatment of multiligamentous knee injury (MLKI). Records identified patients treated surgically for MLKI at a single institution. ... ...

Abstract	We evaluated the relationship between elevated body mass index (BMI) and mid- to long-term outcomes after surgical treatment of multiligamentous knee injury (MLKI). Records identified patients treated surgically for MLKI at a single institution. Inclusion criteria: minimum 2 years since surgery, complete demographics, surgical data, sustained injuries to two or more ligaments in one or both knees, and available for follow-up. Patients were contacted to complete patient-reported outcomes assessments and were classified according to mechanism of injury. Multivariate logistic regression analysis was used to predict the impact of BMI on outcome scores. A total of 77 patients (72.7% male) were included with a mean age at the time of injury of 29.4 ± 11.0 years and a mean BMI of 30.5 ± 9.4 kg/m
Language	English
Publishing date	2023-11-28
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2075354-8
ISSN	1938-2480 ; 1538-8506 ; 0899-7403
ISSN (online)	1938-2480
ISSN	1538-8506 ; 0899-7403
DOI	10.1055/a-2198-8068
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