Sofia Lindqvist Bueneman

Purpose: To evaluate the inter‐rater reliability and sensitivity of the GNRB arthrometer compared with the KT1000 and clinical examination with the Lachman test for patients with an anterior cruciate ligament (ACL) injury. Methods: Patients with ACL injury were examined preoperatively and postoperatively by 2 examiners. One examiner also performed a clinical examination and an examination with the KT1000. Side‐to‐side difference of ≥3 mm was classified as an ACL injury for both the GNRB and the KT1000. The interclass correlation was used to evaluate inter‐reliability, and a paired t‐test was used to identify differences between examiners. The sensitivity was calculated preoperatively. Results: A total of 20 patients underwent preoperative assessment with the GNRB, whereas 17 were available postoperatively. The GNRB diagnosed 12/20 and 13/20 for the 2 examiners, respectively, as having ACL injuries preoperatively, whereas the KT1000 diagnosed 19/20. Postoperatively, 5/17 and 4/17, respectively, had a side‐to‐side difference of ≥3 mm with the GNRB versus 7/17 for the KT1000, hence indicating an ACL injury or insufficient reconstruction. Clinical examination concluded that 15/17 had a manual Lachman of ≤+1. The interclass correlations between examiners were 0.80 for the involved side preoperatively and 0.84 postoperatively, considered moderate to good. Sensitivity for the GNRB was 60% and 65% for examiners 1 and 2, respectively. For the KT1000, it was 95%. Conclusions: In this study, the GNRB had a high inter‐rater reliability, even with limited experience with the device. However, it was inferior to the KT1000 in correctly identifying ACL deficiency preoperatively in patients with ACL injury. Level of Evidence: Level III, prospective comparative study.

Purpose: To analyse the 52,199 patients in the Swedish Knee Ligament Register (SKLR) preoperatively, and the patients reaching 5‐ and 10‐year follow‐ups who underwent anterior cruciate ligament reconstruction (ACLR), revision ACLR and ACLR on the contralateral side (CACLR). The main hypothesis was that patients undergoing revision ACLR would have worse patient‐reported outcome measurements (PROMs) than the primary ACLR group at 10 years and that smoking and concomitant injuries would result in poorer outcomes for all groups. Methods: Data from 2005 to 2021 were extracted from the SKLR. Only patients whose ACLR surgery was registered in the SKLR were included for revision ACLR and CACLR. The PROMs consist of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the knee‐specific PROM (EQ‐5D‐3L). PROMs were analysed as a whole and in subgroups based on sex, smoking, graft choice and concomitant injuries. Results: Poorer KOOS were seen for revisions compared with primary ACLRs at both the 5‐ and 10‐year follow‐ups ( p = 0.003). Smokers had significantly poorer KOOS than nonsmokers ( p < 0.001) preoperatively in all groups, however only in the primary ACLR group at 5 and 10 years. At 10 years, patients who had undergone CACLR had lower KOOS than primary ACLRs ( p = 0.03). Concomitant injuries resulted in statistically, significantly poorer KOOS for both primary ACLRs and CACLRs preoperatively and at the follow‐ups. Conclusion: The PROMs for revision ACLRs have worse KOOS scores at 10 years compared with the primary ACLRs. The presence of concomitant meniscal or cartilage injuries at the time of ACLR or CACLR were associated with worse PROMs. Level of Evidence: Level III.