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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: 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
Database	MEDical Literature Analysis and Retrieval System OnLINE

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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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Article ; Online: Who's at risk?: Commentary on an article by Timothy Leroux, MD, MEd, et al.: "The risk of knee arthroplasty following cruciate ligament reconstruction. A population-based matched cohort study".

Magnussen, Robert A

The Journal of bone and joint surgery. American volume

2014 Volume 96, Issue 1, Page(s) e7

MeSH term(s)	Anterior Cruciate Ligament Reconstruction/statistics & numerical data ; Arthroplasty, Replacement, Knee/statistics & numerical data ; Female ; Humans ; Male ; Osteoarthritis, Knee/epidemiology
Language	English
Publishing date	2014-01-01
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	220625-0
ISSN	1535-1386 ; 0021-9355
ISSN (online)	1535-1386
ISSN	0021-9355
DOI	10.2106/JBJS.M.01357
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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: 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 ; Online: Horizontal Cleavage Meniscus Tears: Biomechanics, Indications, Techniques, and Outcomes.

Mallory, Noah / Qin, Charles / Gibbs, David / Milliron, Eric / Cavendish, Parker / Magnussen, Robert A / Flanigan, David C

JBJS reviews

2023 Volume 11, Issue 8

Abstract: Accounting for up to 24% of all meniscus tears, horizontal cleavage tears (HCTs) are a common pathology orthopaedic practitioners should be comfortable managing.» Historically, HCTs were treated with partial meniscectomy; however, recent studies have ... ...

Abstract	» Accounting for up to 24% of all meniscus tears, horizontal cleavage tears (HCTs) are a common pathology orthopaedic practitioners should be comfortable managing.» Historically, HCTs were treated with partial meniscectomy; however, recent studies have demonstrated that these procedures have an adverse biomechanical effect, while HCT repairs restore the knee's natural biomechanics.» Indications for the surgical repair of HCTs remain disputed, but surgery is generally considered for young, active patients and older patients without significant concomitant osteoarthritis.» Early clinical findings surrounding HCT repair are promising. They suggest that this treatment adequately restores meniscus mechanics, leads to good knee functional outcomes, and results in a high likelihood of return to preinjury activity levels.
MeSH term(s)	Humans ; Menisci, Tibial/surgery ; Biomechanical Phenomena ; Tibial Meniscus Injuries/surgery ; Knee Joint/surgery ; Meniscus/surgery
Language	English
Publishing date	2023-08-10
Publishing country	United States
Document type	Journal Article
ISSN	2329-9185
ISSN (online)	2329-9185
DOI	e23.00042
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Article ; Online: Incidence, Common Pathogens, and Risk Factors for Infection after Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Schneider, Justine G / Ormseth, Benjamin / DiBartola, Alex C / Magnussen, Robert A / Duerr, Robert A / Stoodley, Paul / Flanigan, David C

The journal of knee surgery

2023 Volume 37, Issue 6, Page(s) 470–481

Abstract: We sought to assess the current literature to present a comprehensive summary of the incidence, common pathogens, and risk factors for infection after anterior cruciate ligament (ACL) reconstruction. PubMed, CINAHL, EMBASE, and Scopus databases were ... ...

Abstract	We sought to assess the current literature to present a comprehensive summary of the incidence, common pathogens, and risk factors for infection after anterior cruciate ligament (ACL) reconstruction. PubMed, CINAHL, EMBASE, and Scopus databases were searched for relevant studies reporting on infection after ACL reconstruction. Two reviewers independently screened the extracted studies for adherence to inclusion and exclusion criteria. Studies were selected if they reported on the incidence of infection, pathogens cultured from infected knees, or risk factors for infection after primary ACL reconstruction. Exclusion criteria consisted of studies with fewer than 100 patients or studies that included revision ACL reconstruction. Fifty studies met the inclusion and exclusion criteria, reporting on a total of 316,214 ACL reconstructions. Included studies evaluated between 123 and 104,255 patients. The overall incidence of infection was 0.60% (0.15-2.44%). The most common pathogens were
MeSH term(s)	Humans ; Male ; Incidence ; Anterior Cruciate Ligament Injuries/epidemiology ; Anterior Cruciate Ligament Injuries/surgery ; Anterior Cruciate Ligament Injuries/etiology ; Anterior Cruciate Ligament Reconstruction/adverse effects ; Knee Joint/surgery ; Risk Factors
Language	English
Publishing date	2023-09-21
Publishing country	Germany
Document type	Systematic Review ; 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-2179-3678
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