Gilbert Moatshe

• Tollefson, Luke V.; Kennedy, Nicholas I.; Banovetz, Mark T.; Homan, Morgan D.; Engebretsen, Lars & Moatshe, Gilbert [Show all 9 contributors for this article] (2024). Supratubercle Anterior Closing Wedge Osteotomy: No Changes in Patellar Height and Significant Decreases in Anterior Tibial Translation at 6 Months Postoperatively. American Journal of Sports Medicine. ISSN 0363-5465. doi: 10.1177/03635465241252982.
• Familiari, Filippo; Chahla, Jorge; Compagnoni, Riccardo; DePhillipo, Nicholas; Moatshe, Gilbert & LaPrade, Robert F. (2024). Meniscal extrusion consensus statement: A collaborative survey within the Meniscus International Network (MenIN) Study Group. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. p. 1–9. doi: 10.1002/ksa.12183.
• Geeslin, Andrew G.; Moatshe, Gilbert; Engebretsen, Lars; Lind, Martin; Hansson, Frida & Stalman, Anders [Show all 8 contributors for this article] (2024). Functional anterior cruciate ligament braces may have a role in select patient groups although there is presently limited evidence supporting or refuting their routine use: A scoping review of clinical practice guidelines and an updated bracing classification. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. doi: 10.1002/ksa.12203.
• Moatshe, Gilbert; LaPrade, Christopher M.; Fenstad, Anne Marie; Persson, Andreas; LaPrade, Matthew D. & Martin, Richard Kyle [Show all 8 contributors for this article] (2024). Rates of Subjective Failure After Both Isolated and Combined Posterior Cruciate Ligament Reconstruction: A Study From the Norwegian Knee Ligament Registry 2004-2021. American Journal of Sports Medicine. ISSN 0363-5465. doi: 10.1177/03635465241238461.
• Tollefson, Luke V.; Kennedy, Mitchell I.; Tagliero, Adam J.; Malinowski, Konrad; Chahla, Jorge & Moatshe, Gilbert [Show all 9 contributors for this article] (2024). Inflammatory synovial biomarkers and state of the tibiofemoral joint in the post-surgical settings: a narrative review. Annals of Joint. ISSN 2415-6809. 9, p. 1–11. doi: 10.21037/aoj-23-56.
• Zegzdryn, Marek; Moatshe, Gilbert; Engebretsen, Lars; Drogset, Jon Olav; Lygre, Stein Håkon Låstad & Visnes, Håvard [Show all 7 contributors for this article] (2024). Increased risk for early revision with quadriceps graft compared with patellar tendon graft in primary ACL reconstructions. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 32(3), p. 656–665. doi: 10.1002/ksa.12081.
• Martin, Richard Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 10 contributors for this article] (2024). Unsupervised Machine Learning of the Combined Danish and Norwegian Knee Ligament Registers: Identification of 5 Distinct Patient Groups With Differing ACL Revision Rates. American Journal of Sports Medicine. ISSN 0363-5465. 52(4). doi: 10.1177/03635465231225215.
• Moatshe, Gilbert & Engebretsen, Lars (2024). Knee dislocations with vascular injuries – a review article. Danish Medical Journal. ISSN 2245-1919. 71(3). doi: 10.61409/A08230529.
• Martin, Richard Kyle; Marmura, Hana; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas & Moatshe, Gilbert [Show all 10 contributors for this article] (2024). External validation of the Norwegian anterior cruciate ligament reconstruction revision prediction model using patients from the STABILITY 1 Trial. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 32(2), p. 206–213. doi: 10.1002/ksa.12031.
• Makaram, Navnit S.; Murray, Iain R.; Geeslin, Andrew G.; Chahla, Jorge; Moatshe, Gilbert & LaPrade, Robert F. (2023). Diagnosis and treatment strategies of the multiligament injured knee: a scoping review. British Journal of Sports Medicine. ISSN 0306-3674. 57(9), p. 543–550. doi: 10.1136/bjsports-2022-106425. Show summary

  Objective: To map the current literature evaluating the diagnosis and treatment of multiligament knee injuries (MLKIs). Design: Scoping review. Data sources: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and Arksey and O’Malley frameworks were followed. A three-step search strategy identified relevant published literature comprising studies reporting on at least one aspect in the diagnosis or treatment of MLKI in adults. Data were synthesised to form a descriptive analysis and thematic summary. Results: Overall, 417 studies were included. There was a substantial chronological increase in the number of studies published per year, with 70% published in the last 12 years. Of included studies, 128 (31%) were narrative reviews, editorials or technical notes with no original data. The majority of studies (n=239, 57%) originated from the USA; only 4 studies (1%) were of level I evidence. Consistent themes of contention included clinical assessment, imaging, operative strategy, timing of surgery and rehabilitation. There was a lack of gender and ethnic diversity reported within patient groups. Conclusions: There remains insufficient high-level evidence to support definitive management strategies for MLKI. There is considerable heterogeneity in outcome reporting in current MLKI literature, precluding robust comparison, interpretation and pooling of data. Further research priorities include the development of expert consensus relating to the investigation, surgical management and rehabilitation of MLKI. There is a need for minimum reporting standards for clinical studies evaluating MLKI.

• Toyooka, Seikai; Persson, Andreas; LaPrade, Robert F.; Engebretsen, Lars & Moatshe, Gilbert (2023). Injury Patterns in Posterolateral Corner Knee Injury. Orthopaedic Journal of Sports Medicine (OJSM). ISSN 2325-9671. 11(8). doi: 10.1177/23259671231184468. Full text in Research Archive Show summary

  Background: Posterolateral corner (PLC) knee injuries associated with different injury mechanisms are not well known. Purpose/Hypothesis: This study sought to assess the patterns of associated injuries in the setting of PLC injury. The hypothesis was that there are recognizable injury patterns in PLC injuries that may correlate with injury mechanism. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients who sustained a multiligament knee injury were retrospectively reviewed. Patients who sustained an acute grade 3 PLC injury and underwent surgery were enrolled in this study. A description of the PLC injury (location of the injury of the fibular collateral ligament [FCL], popliteus tendon, and/or popliteofibular ligament) and reported concomitant injuries (biceps femoris tendon or meniscal tears, cartilage pathology and/or peroneal nerve palsy, or bone bruises) were collected and classified based on intraoperative and magnetic resonance imaging (MRI) findings. Results: Of 135 patients reviewed, 83 did not have PLC involvement and 13 were excluded due to insufficient MRI scans available. Thus, 39 patients were included in this study. For both the anterior cruciate ligament (ACL)–PLC and ACL–posterior cruciate ligament–PLC injury patterns, the most frequent injury pattern entailed a bone bruise of the anteromedial (AM) femur and tibia, an FCL tear from the fibular head, the popliteus tendon avulsed off the femur, a biceps femoris tendon torn off the fibular head, and a common peroneal nerve palsy. Conversely, when no bone bruise occurred on the AM femur and tibia, the FCL was injured on the femoral side and the popliteus tendon, biceps femoris, and peroneal nerve were not injured. Conclusion: AM bone bruise was associated with a peroneal nerve injury in almost half of the patients, and peroneal nerve injury was not seen if there was no AM bone bruise.

• Oeding, Jacob F.; Pareek, Ayoosh; Nieboer, Micah J.; Rhodes, Nicholas G.; Tiegs-Heiden, Christin A. & Camp, Christopher L. [Show all 10 contributors for this article] (2023). A Machine Learning Model Demonstrates Excellent Performance in Predicting Subscapularis Tears Based on Pre-Operative Imaging Parameters Alone. Arthroscopy: The Journal of Arthroscopy And Related. ISSN 0749-8063. doi: 10.1016/j.arthro.2023.08.084.
• Corsi, Matthew P.; Thompson, Adam B.; Kennedy, Nicholas I.; LaPrade, Robert F. & Moatshe, Gilbert (2023). Multiligament knee injuries in winter sports athletes. Journal of Cartilage & Joint Preservation. ISSN 2667-2545. 3(3). doi: 10.1016/j.jcjp.2023.100143. Show summary

  Multiligament knee injuries (MLKIs) are severe injuries that involve complete or partial tear to multiple ligaments of the knee, such as the cruciate ligaments, collateral ligaments, as well as structures such as the posteromedial and posterolateral corners. These injuries often occur as a result of high-energy trauma in motor vehicle accidents, but can also occur during sports activities such as a fall or collision while skiing or snowboarding. Diagnosis of an MLKI can be challenging due to the multifaceted nature of these injuries, and a comprehensive evaluation, including a thorough history, physical examination, and imaging studies, is necessary. Imaging methods, such as plain and stress radiographs and magnetic resonance imaging, are often used to confirm the diagnosis and assist in the establishment of a treatment plan. Treatment of MLKIs commonly involves surgical repair or reconstruction of torn ligaments and capsular structures, followed by lengthy rehabilitation focused on mobility, strength, and improving knee function. Return to sport is a concern, especially for those with many ligaments torn and those involving both cruciate ligaments and/or those involving the posterolateral corner. Prevention of MLKIs in skiing and snowboarding is important, and proper technique, equipment, risk awareness, and strengthening exercises can help reduce the risk of injury. While much is known about knee injuries in skiers, further research is needed to better understand MLKIs in ski and snowboard athletes, including the incidence, optimal management, and return to sport rates.

• Engseth, Lars; Grønsund, Jørgen; Aunan, Eirik; Brattgjerd, Jan Egil; Schulz, Anselm & Moatshe, Gilbert [Show all 7 contributors for this article] (2023). A novel instrument for ligament balancing: a biomechanical study in human cadaveric knees. Journal of Experimental Orthopaedics. ISSN 2197-1153. 10(1). doi: 10.1186/s40634-023-00643-7. Full text in Research Archive Show summary

  Purpose: Ligament balancing is a prerequisite for good function and survival in total knee arthroplasty (TKA). Various balancing techniques exist, but none have shown superior results. The pie-crusting technique by Bellemans of the medial collateral ligament is commonly utilized; however, it can be difficult to achieve repeatable ligament lengthening with this technique. Therefore, we invented a novel instrument to standardize the pie-crusting technique of the superficial and deep medial collateral ligament (hereafter MCL). The purpose was to examine if pie-crusting with the instrument could produce repeatable ligament lengthening. Methods: The MCL was isolated in 16 human cadaveric knees, and subjected to axial tension. The instrument was composed of a specific grid of holes in rows, used to guide sequential pie-crusting puncturing of the MCL with a Ø1.6 mm end-cutting cannula. Ligament lengthening was measured after each row of punctures. Regression analysis was performed on the results. Results: Mean lengthening ± SD in human cadaveric MCL for puncturing of row 1 in the instrument was 0.06 ± 0.09 mm, 0.06 ± 0.04 mm for row 2, 0.09 ± 0.08 mm for row 3, 0.06 ± 0.05 mm for row 4 and 0.06 ± 0.04 mm for row 5, giving a mean total lengthening of 0.33 ± 0.20 mm. Linear regression revealed that MCLs were repeatably lengthened by 0.07 mm per row when punctured using the instrument. Conclusions: MCLs showed linear lengthening in human cadavers for subsequent use of the instrument. Our instrument shows promising results for repeatable ligament lengthening.

• Martinez-Cano, Juan Pablo; Familiari, Filippo; Vinagre, Gustavo; Moatshe, Gilbert; Gomez-Sierra, Maria Antonia & Marín Fermín, Theodorakys (2023). Instrument-based anterolateral rotatory laxity assessment of the knee has a high intra-observer and inter-observer reliability: a systematic review. Journal of ISAKOS: Joint Disorders & Orthapaedic Sports Medicine. ISSN 2059-7754. doi: 10.1016/j.jisako.2023.07.007. Full text in Research Archive
• Ellis, Henry B.; Zak, Taylor K.; Jamnik, Adam; Lind, Dane R.G.; Dabis, Jessica & Losito, Michael [Show all 8 contributors for this article] (2023). Management of Pediatric Anterior Cruciate Ligament Injuries: A Critical Analysis. Journal of bone and joint surgery reviews (JBJS Reviews). ISSN 2329-9185. 11(8). doi: 10.2106/JBJS.RVW.22.00223.
• Martin, R. Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 10 contributors for this article] (2023). Ceiling Effect of the Combined Norwegian and Danish Knee Ligament Registers Limits Anterior Cruciate Ligament Reconstruction Outcome Prediction. American Journal of Sports Medicine. ISSN 0363-5465. 51(9), p. 2324–2332. doi: 10.1177/03635465231177905. Full text in Research Archive Show summary

  Background: Clinical tools based on machine learning analysis now exist for outcome prediction after primary anterior cruciate ligament reconstruction (ACLR). Relying partly on data volume, the general principle is that more data may lead to improved model accuracy. Purpose/Hypothesis: The purpose was to apply machine learning to a combined data set from the Norwegian and Danish knee ligament registers (NKLR and DKRR, respectively), with the aim of producing an algorithm that can predict revision surgery with improved accuracy relative to a previously published model developed using only the NKLR. The hypothesis was that the additional patient data would result in an algorithm that is more accurate. Study Design: Cohort study; Level of evidence, 3. Methods: Machine learning analysis was performed on combined data from the NKLR and DKRR. The primary outcome was the probability of revision ACLR within 1, 2, and 5 years. Data were split randomly into training sets (75%) and test sets (25%). There were 4 machine learning models examined: Cox lasso, random survival forest, gradient boosting, and super learner. Concordance and calibration were calculated for all 4 models. Results: The data set included 62,955 patients in which 5% underwent a revision surgical procedure with a mean follow-up of 7.6 ± 4.5 years. The 3 nonparametric models (random survival forest, gradient boosting, and super learner) performed best, demonstrating moderate concordance (0.67 [95% CI, 0.64-0.70]), and were well calibrated at 1 and 2 years. Model performance was similar to that of the previously published model (NKLR-only model: concordance, 0.67-0.69; well calibrated). Conclusion: Machine learning analysis of the combined NKLR and DKRR enabled prediction of the revision ACLR risk with moderate accuracy. However, the resulting algorithms were less user-friendly and did not demonstrate superior accuracy in comparison with the previously developed model based on patients from the NKLR alone, despite the analysis of nearly 63,000 patients. This ceiling effect suggests that simply adding more patients to current national knee ligament registers is unlikely to improve predictive capability and may prompt future changes to increase variable inclusion.

• Banovetz, Mark T.; Kennedy, Nicholas I.; LaPrade, Robert F.; Engebretsen, Lars & Moatshe, Gilbert (2023). Biomechanical considerations for graft choice in anterior cruciate ligament reconstruction. Annals of Joint. ISSN 2415-6809. 8. doi: 10.21037/aoj-22-50.
• Familiari, Filippo; Madonna, Vincenzo; Mercurio, Michele; Cinque, Mark E.; Gasparini, Giorgio & Galasso, Olimpio [Show all 7 contributors for this article] (2023). Outcomes and complications of inlay versus onlay patellofemoral arthroplasty: A systematic review. Knee (Oxford). ISSN 0968-0160. 41, p. 124–136. doi: 10.1016/j.knee.2023.01.001. Show summary

  Purpose: The purpose of this systematic review was to evaluate outcomes and complications rates between inlay and onlay patellofemoral arthroplasty (PFA). Methods: According to the PRISMA statement, 42 studies with 2552 patients were included. Data considered for quantitative analysis consisted of the Knee Society Score (KSS), the range of motion (ROM), the visual analogue score (VAS), and the Western Ontario and McMaster Universities questionnaire (WOMAC). Complications and revision surgery were considered. Results: Data on postoperative KSS showed no differences between the groups. The ROM was evaluated in 8 studies for 70 and 331 inlay and onlay PFA, respectively. Onlay group was favorable in terms of postoperative ROM. Postoperative VAS was available for 64 inlay and 110 onlay and no differences were found. Data on postoperative WOMAC were available for 49 inlay and 527 onlay PFA and inlay group showed better scores. A statistically significant higher rate of instability, persistent pain, malposition, stiffness, deep infection, disease progression, and wear of the patellar component were noted in the inlay group. A higher rate of lateral release was noted in the onlay group. A higher number of manipulations under anesthesia was noted in the inlay group. The revision to total knee arthroplasty was reported more frequently in the inlay group. Conclusion: A higher rate of conversion to total knee arthroplasty and complication rates after inlay technique was found. The potential of achieving better WOMAC scores with the inlay technique should be weighed against the higher complication and revision rates compared to the onlay technique.

• Toyooka, Seikai; Moatshe, Gilbert; Persson, Andreas & Engebretsen, Lars (2023). Return to Pivoting Sports after Cartilage Repair Surgery of the Knee: A Scoping Review. Cartilage. ISSN 1947-6035. doi: 10.1177/19476035221141416. Full text in Research Archive Show summary

  Objective. to perform a scoping literature review evaluating and reporting on outcomes and return to pivoting sports after cartilage procedures. For this review, the following cartilage procedures were evaluated: microfracture, osteochondral autograft transplantation (Oat), osteochondral allograft transplantation (OCa), and autologous chondrocyte implantation (aCi). Design. the scoping review incorporated articles identified using PubMed (MeDliNe), CiNaHl, and Cochrane Central register of Controlled trials. Screening of reference lists of included studies and forward citation tracking were performed to identify additional studies. reported on return to pivoting sports after cartilage surgery written in english language. Results. Sixteen studies fulfilled the inclusion criteria. the return to sports (rtS) rates after microfracture ranged from 44% to 83%, and to preinjury level from 25% to 75%. the rtS rates after Oat ranged from 87% to 100%, and to preinjury level from 67% to 93%. the rtS rates after OCa ranged from 77% to 80%, and to preinjury level 64%. the rtS rates after aCi ranged from 33% to 96%, and to preinjury level from 26% to 67%. Conclusions. there was a high heterogeneity and range in rates of rtS in athletes participating in pivoting sports. Most studies reported high rates of rtS; however, return to preinjury level was lower. these data may be important to clinicians in shared decision making on the type of procedure to be performed and counseling pivoting sports athletes on prognosis and expected rtS rates.

• Alfaraidy, Moaad; Alraiyes, Thamer; Moatshe, Gilbert; Litchfield, Robert & LeBel, Marie-Eve (2022). Low rates of serious complications after open Latarjet procedure at short-term follow-up. Journal of shoulder and elbow surgery. ISSN 1058-2746. p. 1–9. doi: 10.1016/j.jse.2022.06.004.
• Familiari, Filippo; Compagnoni, Riccardo; Bait, Corrado; Grassi, Alberto; Pieroni, Arianna & Moatshe, Gilbert [Show all 8 contributors for this article] (2022). International cooperation needed to improve national anterior cruciate ligament registries. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 31(1), p. 235–247. doi: 10.1007/s00167-022-07091-3. Show summary

  Purpose: The aim of this study is to illustrate an overview of the registries currently operative in many countries to support the introduction of new prospective registries in other countries. Methods: The authors carried out a systematic web research in July 2021 to identify national ACL registries’ annual reports and scientific literature on national ACL registries. The latest annual public registry reports were collected and analyzed in this study. Results: There are currently established national ACL registries in Norway, Denmark, Sweden, Luxembourg, New Zealand, the United Kingdom (UK), and the Kaiser Permanente National Anterior Cruciate Ligament Reconstruction Registry in the United States (US). Some differences can be found among the various registries due to the local healthcare system structure, data management rules, and general national laws. Conclusion: It is possible to develop accessible, cost-effective and entirely web-based ACL registries—as demonstrated by the Danish and Swedish registries—respecting the national legislation of different countries. This study supports the introduction of new ACL prospective registries in other countries to obtain valuable information for implementing daily clinical practice.

• Familiari, Filippo; Palco, Michelangelo; Russo, Raffaella; Moatshe, Gilbert & Simonetta, Roberto (2022). Arthroscopic Repair of Posterior Root Tears of the Lateral Meniscus with All-Suture Anchor. Arthroscopy Techniques. ISSN 2212-6287. 11(5), p. e781–e787. doi: 10.1016/j.eats.2021.12.037. Full text in Research Archive
• Bøe, Berte Marie Grimsmo; Støen, Ragnhild Øydna; Blich, Ingvild; Moatshe, Gilbert & Ludvigsen, Tom C (2022). Learning Curve for Arthroscopic Shoulder Latarjet Procedure Shows Shorter Operating Time and Fewer Complications with Experience. Arthroscopy: The Journal of Arthroscopy And Related. ISSN 0749-8063. 38(8), p. 2391–2398. doi: 10.1016/j.arthro.2022.01.042. Full text in Research Archive Show summary

  Purpose: To evaluate the learning curve of the arthroscopic Latarjet procedure in a consecutive series of 103 shoulders in 102 patients by comparing the early clinical and radiologic outcomes and complications of the first 25 patients with the latter 25 patients. Our hypothesis was that the studied parameters would be enhanced over time. Methods: A consecutive cohort of 103 shoulders in 102 patients treated with arthroscopic Latarjet procedure was prospectively registered from December 2014 until November 2019. Patients in this cohort represent the first cases of arthroscopic Latarjet for the 2 shoulder surgeons. All patients had a double screw fixation technique. The Western Ontario Shoulder Instability Index (WOSI) score preoperatively and at 1-year follow-up and 3-dimensional computed tomography scans preoperatively, postoperatively, and at 1-year follow-up were prospectively registered. Patient demographics, intraoperative data, complications, and reoperations were all recorded. In total, 85 of 103 shoulders (83%) had complete data sets. Patient demographics, WOSI scores, operating time, complications, satisfaction rate, and radiology scores in the first and last 25 patients were compared to evaluate learning curve. Results: There was longer operating time in the early group compared with the latter (130 vs 105 minutes, P = .001) and number of complications was reduced with experience (16 vs 4, P = .0005). Serious complications requiring a reoperation were 4 (16%) in the early group compared to 1 (4%) in the latter group (P = .157). Clinical results were good with major improvement in WOSI scores and 84 % satisfaction rates in both groups. Conclusions: Arthroscopic Latarjet was associated with a learning curve where the early group had longer operating time and greater rates of complications. This is a procedure with few serious complications, acceptable surgery time and learning curve.

• Rodriguez, Ariel N.; Lundeen, Anna; Liechti, Daniel; Moatshe, Gilbert & Engebretsen, Lars (2022). Role of Osteotomy and Tunnel Bone Grafting in Chronic Medial and Lateral Knee Injuries. Operative techniques in sports medicine. ISSN 1060-1872. 30(2). doi: 10.1016/j.otsm.2022.150913. Show summary

  Coronal plane alignment deformities of the lower extremity are often neglected in the evaluation and treatment of chronic posteromedial (PMC) and posterolateral corner (PLC) injuries. Genu varus, valgum, and recurvatum deformities can increase the likelihood of graft failure following knee ligament reconstruction. Abnormal and excessive vector forces act across the grafts if these deformities remain undiagnosed, resulting in stretching and failure of the grafts. A thorough evaluation should include a complete physical exam and radiographic imaging protocol that includes long limb alignment and stress radiographs of the knee. Correction of these deformities requires extensive preoperative planning to determine in which planes and how much correction needs to be performed via an osteotomy. A distal femoral opening wedge osteotomy is recommended to treat genu valgus deformity. A medial opening wedge osteotomy is recommended to correct genu varus deformity. In cases of combined superficial medial collateral ligament (sMCL) and PLC deficiencies, a biplanar opening wedge anterolateral opening wedge osteotomy may be indicated. These procedures should all be performed using a combination of preoperative planning and intraoperative fluoroscopy to minimize the risk of complications. In the setting of failed primary reconstructions due to an undiagnosed alignment deformity, an osteotomy and tunnel bone grafting procedure should be performed as part of a staged procedure. Early outcome studies on osteotomies for recurrent ligament instability are promising, but more data and long-term outcomes are needed to support early findings.

• Martin, Richard Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 9 contributors for this article] (2022). Predicting subjective failure of ACL reconstruction: a machine learning analysis of the Norwegian Knee Ligament Register and patient reported outcomes. Journal of ISAKOS: Joint Disorders & Orthapaedic Sports Medicine. ISSN 2059-7754. 7(3). doi: 10.1016/j.jisako.2021.12.005. Full text in Research Archive Show summary

  Objectives: Accurate prediction of outcome following anterior cruciate ligament (ACL) reconstruction is challenging, and machine learning has the potential to improve our predictive capability. The purpose of this study was to determine if machine learning analysis of the Norwegian Knee Ligament Register (NKLR) can (1) identify the most important risk factors associated with subjective failure of ACL reconstruction and (2) develop a clinically meaningful calculator for predicting the probability of subjective failure following ACL reconstruction. Methods: Machine learning analysis was performed on the NKLR. All patients with 2-year follow-up data were included. The primary outcome was the probability of subjective failure 2 years following primary surgery, defined as a Knee Injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscale score of <44. Data were split randomly into training (75%) and test (25%) sets. Four models intended for this type of data were tested: Lasso logistic regression, random forest, generalized additive model (GAM), and gradient boosted regression (GBM). These four models represent a range of approaches to statistical details like variable selection and model complexity. Model performance was assessed by calculating calibration and area under the curve (AUC). Results: Of the 20,818 patients who met the inclusion criteria, 11,630 (56%) completed the 2-year follow-up KOOS QoL questionnaire. Of those with complete KOOS data, 22% reported subjective failure. The lasso logistic regression, GBM, and GAM all demonstrated AUC in the moderate range (0.67–0.68), with the GAM performing best (0.68; 95% CI 0.64–0.71). Lasso logistic regression, GBM, and the GAM were well-calibrated, while the random forest showed evidence of mis-calibration. The GAM was selected to create an in-clinic calculator to predict subjective failure risk at a patient-specific level (https://swastvedt.shinyapps.io/calculator_koosqol/). Conclusion: Machine learning analysis of the NKLR can predict subjective failure risk following ACL reconstruction with fair accuracy. This algorithm supports the creation of an easy-to-use in-clinic calculator for point-of-care risk stratification. Clinicians can use this calculator to estimate subjective failure risk at a patient-specific level when discussing outcome expectations preoperatively.

• Vivacqua, Thiago; Vakili, Samira; Willing, Ryan; Moatshe, Gilbert; Degen, Ryan & Getgood, Alan M. (2022). Biomechanical Assessment of Knee Laxity After a Novel Posterolateral Corner Reconstruction Technique. American Journal of Sports Medicine. ISSN 0363-5465. 50(4), p. 962–967. doi: 10.1177/03635465211070553. Show summary

  Background: Different techniques to restore knee stability after posterolateral corner (PLC) injury have been described. The original anatomic PLC reconstruction uses 2 separate allografts to reconstruct the PLC. Access to allograft tissue continues to be a significant limitation of this technique, which led to the development of a modified anatomic approach utilizing a single autologous semitendinosus graft fixed on the tibia with an adjustable suspensory loop to enable differential tensioning of the PLC components. Purpose/Hypothesis: The purpose of this study was to compare the modified anatomic technique with the original anatomic reconstruction in terms of varus and external rotatory laxity in a cadaveric biomechanical model. The hypothesis was that both techniques would restore varus and external rotatory laxity after a simulated complete PLC injury. Study Design: Controlled laboratory study. Methods: Eight pairs of fresh-frozen cadaveric knee specimens were tested to compare the 2 techniques. Varus and external tibial rotation laxity of the knee were measured while applying 10-N·m varus and 5-N·m external rotatory torques at 0°, 30°, 60°, and 90° of flexion. These measurements were tested under 3 conditions: (1) intact fibular collateral ligament, popliteal tendon, and popliteofibular ligament; (2) complete transection of the fibular collateral ligament, popliteal tendon, and popliteofibular ligament; (3) after PLC reconstruction with either the modified (n = 8) or the original (n = 8) technique. Results: After PLC reconstruction, varus laxity was restored with no statistically significant differences from the intact condition after both reconstruction techniques. Similar outcomes were observed for external rotation in extension; however, in terms of the external rotation limit with respect to the intact joint, significant reductions of mean ± SD 4.1°± 6.3° (P = .036) and 5.1°± 6.6° (P = .016) were recorded with the modified technique at 60° and 90° of flexion, respectively. No significant effect was observed on the neutral flexion kinematics from 0° to 90° of flexion, and no significant differences were observed between reconstructions (P = .222). Conclusion: Both PLC reconstruction techniques restored the normal native varus as compared with the intact knee. Although the modified technique constrained end-range external rotation at 60° and 90° of flexion, no differences were noted with neutral flexion kinematics. Care should be taken when tensioning in the modified technique so that the tibia is in a neutral position to avoid overconstraining the knee.

• Martin, Richard Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 10 contributors for this article] (2022). Machine learning algorithm to predict anterior cruciate ligament revision demonstrates external validity. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 30(2), p. 368–375. doi: 10.1007/s00167-021-06828-w. Full text in Research Archive Show summary

  Purpose: External validation of machine learning predictive models is achieved through evaluation of model performance on different groups of patients than were used for algorithm development. This important step is uncommonly performed, inhibiting clinical translation of newly developed models. Machine learning analysis of the Norwegian Knee Ligament Register (NKLR) recently led to the development of a tool capable of estimating the risk of anterior cruciate ligament (ACL) revision (https://swastvedt.shinyapps.io/calculator_rev/). The purpose of this study was to determine the external validity of the NKLR model by assessing algorithm performance when applied to patients from the Danish Knee Ligament Registry (DKLR). Methods: The primary outcome measure of the NKLR model was probability of revision ACL reconstruction within 1, 2, and/or 5 years. For external validation, all DKLR patients with complete data for the five variables required for NKLR prediction were included. The five variables included graft choice, femur fixation device, KOOS QOL score at surgery, years from injury to surgery, and age at surgery. Predicted revision probabilities were calculated for all DKLR patients. The model performance was assessed using the same metrics as the NKLR study: concordance and calibration. Results: In total, 10,922 DKLR patients were included for analysis. Average follow-up time or time-to-revision was 8.4 (± 4.3) years and overall revision rate was 6.9%. Surgical technique trends (i.e., graft choice and fixation devices) and injury characteristics (i.e., concomitant meniscus and cartilage pathology) were dissimilar between registries. The model produced similar concordance when applied to the DKLR population compared to the original NKLR test data (DKLR: 0.68; NKLR: 0.68–0.69). Calibration was poorer for the DKLR population at one and five years post primary surgery but similar to the NKLR at two years. Conclusion: The NKLR machine learning algorithm demonstrated similar performance when applied to patients from the DKLR, suggesting that it is valid for application outside of the initial patient population. This represents the first machine learning model for predicting revision ACL reconstruction that has been externally validated. Clinicians can use this in-clinic calculator to estimate revision risk at a patient specific level when discussing outcome expectations pre-operatively. While encouraging, it should be noted that the performance of the model on patients undergoing ACL reconstruction outside of Scandinavia remains unknown.

• Persson, Andreas; Moatshe, Gilbert & Engebretsen, Lars (2022). The Evidence Regarding ACL Repair. In Nakamura, Norimasa; Marx, Robert G.; Musahl, Volker; Getgood, Alan; Sherman, Seth L. & Verdonk, Peter (Ed.), Advances in Knee Ligament and Knee Preservation Surgery. Springer. ISSN 978-3-030-84747-0. p. 61–69. doi: 10.1007/978-3-030-84748-7_7.
• Uddin, Fares; Moatshe, Gilbert & Getgood, Alan (2022). Evidenced-Based Approach for Anterolateral Surgery for ACL Reconstruction. In Nakamura, Norimasa; Marx, Robert G.; Musahl, Volker; Getgood, Alan; Sherman, Seth L. & Verdonk, Peter (Ed.), Advances in Knee Ligament and Knee Preservation Surgery. Springer. ISSN 978-3-030-84747-0. p. 43–56. doi: 10.1007/978-3-030-84748-7_5.
• Batty, Lachlan M.; Firth, Andrew; Moatshe, Gilbert; Bryant, Dianne M.; Heard, Mark & McCormack, Robert G. [Show all 13 contributors for this article] (2021). Association of ligamentous laxity, male sex, chronicity, meniscal injury, and posterior tibial slope with a high-grade preoperative pivot shift: A post hoc analysis of the STABILITY study. Orthopaedic Journal of Sports Medicine (OJSM). ISSN 2325-9671. 9, p. 1–10. doi: 10.1177/23259671211000038. Full text in Research Archive
• Ludvigsen, Tom C; Bøe, Berte; Blich, Ingvild; Støen, Ragnhild Øydna & Moatshe, Gilbert (2021). Fra åpen til artroskopisk latarjet - en evaluering av lærekurven ved de første 103 inngrepene. In Hansen, Ann Kristin (Eds.), Høstmøteboka 2021. Norsk Ortopedisk Forening. ISSN 978-82-994275-3-1.
• Martin, Richard Kyle; Persson, Andreas; Moatshe, Gilbert; Fenstad, Anne Marie; Engebretsen, Lars & Drogset, Jon Olav [Show all 7 contributors for this article] (2021). Low annual hospital volume of anterior cruciate ligament reconstruction is not associated with higher revision rates. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. doi: 10.1007/s00167-021-06655-z. Show summary

  Purpose: Surgery performed in low-volume centres has been associated with longer operating time, longer hospital stays, lower functional outcomes, and higher rates of revision surgery, complications and mortality. This has been reported consistently in the arthroplasty literature, but there is a paucity of data regarding the relationship between surgical volume and outcome following anterior cruciate ligament (ACL) reconstruction. The purpose was to compare ACL reconstruction failure rates between hospitals performing different annual surgical volumes. Methods: All patients from the Norwegian Knee Ligament Register having primary autograft ACL reconstruction between 2004 and 2016 were included. Hospital volume was divided into quintiles based on the number of ACL reconstructions performed annually, defined arbitrarily as: 1–12 (V1), 13–24 (V2), 25–49 (V3), 50–99 (V4) and ≥ 100 (V5) annual procedures. Kaplan–Meier estimated survival curves and survival percentages were calculated with revision ACL reconstruction as the end point. Secondary outcome measures included (1) mean change in Knee Injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) and Sport subsections from pre-operative to 5-year follow-up and (2) subjective failure defined as KOOS QoL < 44. Results: Twenty thousand eight hundred and fifty patients met the inclusion criteria and 1195 (5.7%) underwent subsequent revision ACL reconstruction over the study period. Revision rates were lower in the lower volume hospitals compared with the higher volume hospitals (p < 0.001). There was no clinically significant difference in improvement between pre-operative and 5-year follow-up KOOS scores between hospital volume categories, but a higher proportion of patients having surgery at lower volume hospitals reported a subjective failure. Patients in the lower volume categories (V1-3) were more often male and older compared to the higher volume hospitals (V4-5). Concomitant meniscal injuries and participation in pivoting sports were most common in V5 compared with V1 (p < 0.001). Median operative time decreased as hospital volume increased, ranging from 90 min at V1 hospitals to 56 min at V5 hospitals (p < 0.001). Conclusion: Patients having ACL reconstruction at lower volume hospitals had a lower rate of subsequent revision surgery relative to higher volume hospitals. However, complications occurred more frequently, operative duration was longer, and the number of patients reporting a subjective failure of ACL reconstruction was highest at these lower volume hospitals.

• Martin, Richard Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 9 contributors for this article] (2021). Predicting Anterior Cruciate Ligament Reconstruction Revision : A Machine Learning Analysis Utilizing the Norwegian Knee Ligament Register. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. doi: 10.2106/JBJS.21.00113. Full text in Research Archive Show summary

  Background: Several factors are associated with an increased risk of anterior cruciate ligament (ACL) reconstruction revision. However, the ability to accurately translate these factors into a quantifiable risk of revision at a patient-specific level has remained elusive. We sought to determine if machine learning analysis of the Norwegian Knee Ligament Register (NKLR) can identify the most important risk factors associated with subsequent revision of primary ACL reconstruction and develop a clinically meaningful calculator for predicting revision of primary ACL reconstruction. Methods: Machine learning analysis was performed on the NKLR data set. The primary outcome was the probability of revision ACL reconstruction within 1, 2, and/or 5 years. Data were split randomly into training sets (75%) and test sets (25%). Four machine learning models were tested: Cox Lasso, survival random forest, generalized additive model, and gradient boosted regression. Concordance and calibration were calculated for all 4 models. Results: The data set included 24,935 patients, and 4.9% underwent a revision surgical procedure during a mean follow-up (and standard deviation) of 8.1 ± 4.1 years. All 4 models were well-calibrated, with moderate concordance (0.67 to 0.69). The Cox Lasso model required only 5 variables for outcome prediction. The other models either used more variables without an appreciable improvement in accuracy or had slightly lower accuracy overall. An in-clinic calculator was developed that can estimate the risk of ACL revision (Revision Risk Calculator). This calculator can quantify risk at a patient-specific level, with a plausible range from near 0% for low-risk patients to 20% for high-risk patients at 5 years. Conclusions: Machine learning analysis of a national knee ligament registry can predict the risk of ACL reconstruction revision with moderate accuracy. This algorithm supports the creation of an in-clinic calculator for point-of-care risk stratification based on the input of only 5 variables. Similar analysis using a larger or more comprehensive data set may improve the accuracy of risk prediction, and future studies incorporating patients who have experienced failure of ACL reconstruction but have not undergone subsequent revision may better predict the true risk of ACL reconstruction failure.

• Katthagen, J. Christoph; Nolte, Philip-C.; Moatshe, Gilbert; Dornan, Grant J. & Millett, Peter J. (2021). Influence of Radiographic Parameters on Reduction of the Critical Shoulder Angle With Arthroscopic Lateral Acromioplasty— A Mathematical Model. Arthroscopy, Sports Medicine, and Rehabilitation (ASMAR). ISSN 2666-061X. 3(3), p. e799–e805. doi: 10.1016/j.asmr.2021.01.021. Full text in Research Archive Show summary

  Objectives: To develop a mathematical model for the preoperative planning of arthroscopic lateral acromioplasty (ALA) and to evaluate the role of radiographic parameters with regards to the critical shoulder angle (CSA). Methods: Anteroposterior (AP) radiographs of patients who underwent rotator cuff surgery were screened to identify true AP radiographs. Radiographs were assessed for (1) native CSA, (2) CSA after simulated resection of a spur if present, (3) amount of ALA necessary to achieve a CSA of 34°, (4) CSA after 5-mm ALA, (5) lateral acromion angle, (6) acromion index, and (7) sclerosis of the greater tuberosity. Results: A total of 1191 radiographs were screened. Of the 124 patients included, the native CSA was large (≥35°) in 56 patients (45%). In 30 patients (24%), a subacromial spur was detected and resection reduced the CSA by a median of 2°. Spur resection alone reduced the CSA to ≤34° in 19 patients (15.3%). Mean amount of ALA to achieve a CSA of 34° was 3.9 ± 1.8 mm, and this value strongly correlated with the CSA before ALA (R = 0.88, P < .001). The linear regression model to determine the amount of ALA to achieve a CSA of 34° was as follows: The multiple R2 for this model was 0.777. Mean reduction of CSA by 5-mm ALA was 3.8 ± 0.8° and 75% of large CSAs were reduced to a CSA of 30-34°. The acromion index had no significant independent influence on the model (P = .427), whereas lateral acromion angle was an independently significant predictor of required ALA to achieve a CSA of 34° (P = .019). Sclerosis of the greater tuberosity was significantly associated with a CSA of 35° or greater (P = .003). Conclusions: The amount of ALA needed to reduce a large CSA to 34° correlates with the CSA before ALA and can preoperatively be planned with the use of a simple equation.

• Abdelrahman, Taher; Moatshe, Gilbert; Arendt, Elizabeth; Feller, Julian & Getgood, Alan (2021). Combined Medial Patellofemoral Ligament and Medial Patellotibial Ligament Reconstruction for Recurrent Lateral Patellar Dislocation in Flexion. Arthroscopy Techniques. ISSN 2212-6287. 10(2), p. e385–e395. doi: 10.1016/j.eats.2020.10.017. Full text in Research Archive Show summary

  Recurrent lateral patellar dislocation can be a challenging entity to manage. It results from an imbalance between the restraints to lateralization of the patella and the forces applied to the patella within the biomechanical environment of the knee. The medial patellofemoral ligament has been recognized as the most important static soft-tissue restraint. However, the medial patellotibial ligament and medial patellomeniscal ligament are important for patellar stability at higher degrees of knee flexion. Lateral patellar dislocation in flexion poses a particularly challenging clinical entity with a combination of unique characteristics that need to be addressed to achieve optimal patellar tracking and stability. In this technical note, we describe a combined medial patellofemoral ligament and medial patellotibial ligament reconstruction technique to address lateral patellar dislocation in flexion.

• DePhillipo, Nicholas; Aman, Zachary S.; Dekker, Travis J.; Moatshe, Gilbert; Chahla, Jorge & LaPrade, Robert F. (2021). Preventative and Disease-Modifying Investigations for Osteoarthritis Management Are Significantly Under-represented in the Clinical Trial Pipeline: A 2020 Review. Arthroscopy: The Journal of Arthroscopy And Related. ISSN 0749-8063. 37(8), p. 2627–2639. doi: 10.1016/j.arthro.2021.03.050. Full text in Research Archive Show summary

  Purpose: To conduct a review of active United States–based clinical trials investigating preventative, symptom resolution, and disease-modifying therapies for osteoarthritis (OA). Methods: We conducted a review of currently active clinical trials for OA using data obtained from the ClinicalTrials.gov database as of August 2020. The inclusion criteria were active studies registered in the United States that involved the prevention, symptom resolution, or disease modification of OA. Descriptive statistics were recorded and summarized. Results: A total of 3,859 clinical trials were identified, and 310 were included in the final analysis. Of the currently active trials, 89% (n = 275) targeted symptom resolution in patients with existing OA, 6% (n = 19) targeted OA disease-modifying therapeutics, and 5% (n = 16) targeted the prevention of OA in high-risk patients (P < .001). Primary interventions included medical devices (44%, n = 137), pharmaceutical drugs (14%, n = 42), surgical procedures (14%, n = 42), cellular biologics (13%, n = 41), and behavioral therapies (13%, n = 41). There was a significantly higher number of disease-modifying therapeutics for cellular biologics than pharmaceutical drugs (30% vs 14%) (P = .015). Most trials targeted the knee joint (63%, P = .042), with 38% of all trials evaluating joint arthroplasty. There were no significant differences between private sector and government funding sources (43% and 49%, respectively) (P = .288), yet there was a significantly lower rate of funding from industry (8%) (P = .026). Conclusions: There was a significantly higher number of clinical trials investigating symptomatic resolution therapy (89%) for existing OA in comparison to preventative (5%) and disease-modifying (6%) therapies. The most common interventions involved medical devices and joint replacement surgery, with the knee joint accounting for more than 60% of the current clinical trials for OA. There was a significantly higher number of disease-modifying therapeutics for cellular biologics than pharmaceutical drugs. Funding of clinical trials was split between the private sector and government, with a low rate of reported funding from industry partners.

• Strauss, Marc Jacob; Miles, Jon W.; Kennedy, Mitchell L.; Dornan, Grant J.; Moatshe, Gilbert & Lind, Martin [Show all 8 contributors for this article] (2021). Full thickness quadriceps tendon grafts with bone had similar material properties to bone‑patellar tendon‑bone and a four‑strand semitendinosus grafts: a biomechanical study. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. doi: 10.1007/s00167-021-06738-x. Show summary

  Purpose: Despite increasing interest in utilizing quadriceps tendon (QT) grafts in anterior cruciate ligament reconstruction (ACLR), data on the optimal quadriceps graft thickness are limited. The purpose of this study was to characterize the mechanical properties for the quadriceps tendon, comparing full-thickness (FT) QT grafts with and without bone to a partial-thickness (PT) QT graft, and comparing the three QT grafts to four-stranded semitendinosus (4-SST) and bone-patellar tendon-bone (BTB) grafts and one experimental graft, the two-stranded rectus femoris (RF). Methods: Forty-eight (n = 48) young cadaveric grafts (mean age 32 ± 6 years) were utilized for testing with N = 8 specimens in each of the following groups; (1) FT QT with bone, (2) FT QT without bone, (3) PT QT without bone, (4) BTB, (5) RF, and (6) 4-SST. Each specimen was harvested and rigidly fixed in custom clamps to a dynamic tensile testing machine for biomechanical evaluation. Graft ultimate load and stiffness were recorded. Independent groups one-factor ANOVAs and Tukey’s pairwise comparisons were performed for statistical analyses. Results: FT QT with bone and 4-SST grafts demonstrated similar ultimate loads to BTB grafts (both n.s), whereas PT QT demonstrate statistically significantly lower ultimate loads to BTB grafts (n.s) and 4-SST grafts (n.s). Furthermore, no statistically significant differences were observed between the ultimate loads of FT QT vs. PT QT grafts without bone (n.s) or between FT QT with vs. without bone (n.s). FT QT grafts with bone did not demonstrate statistically significantly greater ultimate loads than PT QT grafts without bone (n.s). The RF graft demonstrated statistically significantly lower ultimate loads to BTB grafts (p < 0.005) and 4-SST grafts (p < 0.014). Conclusions: Full thickness QT grafts with bone had similar material properties to BTB and a 4-SST grafts, while Partial thickness QT graft without bone had significantly lower material properties than BTB and 4-SST, in a biomechanical setting.

• Strauss, Marc Jacob; Kennedy, Mitchell L.; Brady, Alex W.; Moatshe, Gilbert; Chahla, Jorge & LaPrade, Robert F. [Show all 8 contributors for this article] (2021). Qualitative and Quantitative Anatomy of the Human Quadriceps Tendon in Young Cadaveric Specimens. Orthopaedic Journal of Sports Medicine (OJSM). ISSN 2325-9671. 9(9), p. 1–8. doi: 10.1177/23259671211037305. Full text in Research Archive Show summary

  Background: A detailed understanding of the anatomy of the quadriceps tendon (QT) is clinically relevant, owing to its increased use as a graft in anterior cruciate ligament reconstruction. Purpose: To qualitatively and quantitatively describe the anatomy of the QT in younger adult specimens. Study Design: Descriptive laboratory study. Methods: A total of 18 nonpaired cadaveric knees with a mean age of 30.1 years (range, 18-38 years) were utilized for this study. A 3-dimensional coordinate measuring system was used to assess the structural relationships between the different layers of the QT and their attachments to the patella, and QT thickness was measured medially, centrally, and laterally at 2-cm intervals from the patellar eminence line (PEL; defined as a straight line between the medial and lateral patellar eminences) and proximally. Results: In all specimens, 3 distinct layers formed the QT. The first (superficial) layer was formed by the rectus femoris, which was fused to the second layer with an unclearly defined direct attachment to the patella. The median length of the QT was 86.9 mm (range, 68.4-98.9 mm). The second (middle) layer consisted of the vastus medialis and vastus lateralis and was found to have fibers running in an oblique direction that attached on the patella. A “fuse point,” where the proximal part of the rectus femoris started to merge to the second layer, was identified at a median of 48.7 mm (range, 27.9-62.6 mm) from the PEL. The third (deep) layer consisted of the vastus intermedius. The median thickness of the graft centrally at 20, 40, 60, 80, and 100 mm from the PEL was 8.5, 7.2, 7.5, 6.5, and 5.4 mm, respectively. Conclusion: Overall, 3 different layers of the QT were consistently found in all specimens. The first layer was fused with the second layer, and the direction of the fibers of the second layer or the vastus medialis and vastus lateralis was oblique. The median length of the QT was 86.9 mm, and the thickness of the tendon diminished proximally.

• Midtgaard, Kaare S.; Bøe, Berte Marie Grimsmo; Lundgreen, Kirsten; Wünsche, Bernd & Moatshe, Gilbert (2021). Fremre skulderluksasjon – utredning og behandling. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 141(11), p. 1–7. doi: 10.4045/tidsskr.20.0826. Show summary

  Fremre skulderluksasjon kan oppstå i forbindelse med et traume eller som følge av anatomisk disponerende forhold. En traumatisk luksasjon medfører skader på stabiliserende strukturer som kan disponere for gjentatte luksasjoner. Spesielt utsatt for dette er personer under 30 år og utøvere av kontaktidrett, som da kan få ytterligere svekkelse av de stabiliserende strukturene. Pasienter i disse kategoriene kan vurderes for tidlig operativ behandling.

• Moatshe, G.; Floyd, E.R.; Martin, Richard Kyle; Engebretsen, L. & LaPrade, Robert F. (2021). Emerging Topics in ACL Graft Selection: Best Evidence for the Use of Quadriceps Tendon Graft. Operative techniques in sports medicine. ISSN 1060-1872. 29(2). doi: 10.1016/j.otsm.2021.150835. Show summary

  Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures in orthopaedic sports medicine. Despite this, graft selection remains controversial with various regional, institutional, and individual preferences and trends. The traditional autograft options for reconstruction have been hamstring tendon and bone-patellar tendon-bone (BTB) autografts. Recently, quadriceps tendon (QT) autografts have garnered significant interest and appear promising because of their biomechanical properties and stability on clinical outcomes, and have less donor site morbidity compared with BTB. In this review, recent developments in QT autograft research are discussed and future directions which may clarify the appropriate role of quadriceps grafts in ACL reconstruction are explored.

• Grasso, Mackenzie; O'Neill, Conor; Constantinescu, David; Moatshe, Gilbert & Vap, Alexander R. (2021). Reconstruction of Chronic Proximal Hamstring Tear: Description of a Surgical Technique. Arthroscopy Techniques. ISSN 2212-6287. 10(5), p. e1307–e1313. doi: 10.1016/j.eats.2021.01.028.
• Martin, Richard Kyle; Ekås, Guri R.; Saltyte Benth, Jurate; Kennedy, Nicholas I.; Moatshe, Gilbert & Krych, Aaron J. [Show all 7 contributors for this article] (2021). Change in Posterior Tibial Slope in Skeletally Immature Patients With Anterior Cruciate Ligament Injury: A Case Series With a Mean 9 Years’ Follow-up. American Journal of Sports Medicine. ISSN 0363-5465. 49(5), p. 1244–1250. doi: 10.1177/0363546521997097. Show summary

  Background: Increased lateral posterior tibial slope (LPTS) is associated with increased rates of anterior cruciate ligament (ACL) injury and failure of ACL reconstruction. It is unknown if ACL deficiency influences the developing proximal tibial physis and slope in skeletally immature patients through anterior tibial subluxation and abnormal force transmission. Purpose: To assess the natural history of LPTS in skeletally immature patients with an ACL-injured knee. Study Design: Case series; Level of evidence, 4. Methods: A total of 38 participants from a previous study on nonoperative management of ACL injury in skeletally immature patients were included. During the initial study, bilateral knee magnetic resonance imaging (MRI) was performed within 1 year of enrollment and again at final follow-up. All patients were younger than 13 years at the time of enrollment, and final follow-up occurred a mean 10 years after the injury. MRI scans were retrospectively reviewed by 2 reviewers to determine bilateral LPTS for each patient and each time point. Linear mixed models were used to assess LPTS differences between knees, change over time, and association with operational status. Subgroup analyses were performed for patients who remained nonoperated throughout the study. Results: A total of 22 patients had ACL reconstruction before final follow-up and 16 remained nonoperated. In the entire study population, the mean LPTS was higher in the injured knee than in the contralateral knee at final follow-up by 2.0° (P < .001; 95% CI, 1.3°–2.6°). The mean LPTS increased significantly in the injured knee by 0.9° (P = .042; 95% CI, 0.03°–1.7°), while the mean LPTS decreased in the contralateral knee by 0.4° (P = .363; 95% CI, –0.8° to 0.4°). A significant difference in LPTS was also observed in the nonoperated subgroup. No significant association was observed between LPTS and operational status. Conclusion: Lateral posterior tibial slope increased more in the ACL-injured knee than in the contralateral uninjured knee in a group of skeletally immature patients. Lateral posterior tibial slope at baseline was not associated with the need for surgical reconstruction over the study period.

• Cinque, Mark E.; Kunze, Kyle N.; Williams, Brady T.; Moatshe, Gilbert; LaPrade, Robert F. & Chahla, Jorge (2021). Higher Incidence of Radiographic Posttraumatic Osteoarthritis With Transtibial Femoral Tunnel Positioning Compared With Anteromedial Femoral Tunnel Positioning During Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. American Journal of Sports Medicine. ISSN 0363-5465. p. 1–9. doi: 10.1177/0363546521993818. Show summary

  Background: Anteromedial (AM) femoral tunnel positioning in anterior cruciate ligament reconstruction (ACLR) has been reported by some authors to yield superior clinical and functional outcomes compared with the transtibial (TT) approach; however, differences in the subsequent rates of posttraumatic osteoarthritis (PTOA) are not clear. Purpose: To perform a systematic review and meta-analysis of the literature to evaluate the influence of femoral tunnel positioning during primary ACLR on the development of radiographic PTOA. Study Design: Systematic review and Meta-analysis. Methods: The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2019), and MEDLINE (1980-2019) were queried for all studies describing the development of PTOA after TT or AM ACLR. Data pertaining to patient demographics, ACLR technique, and radiographic PTOA were extracted. A meta-analysis utilizing the DerSimonian-Laird method for random effects was used to compare the weighted proportion of PTOA after ACLR between the TT and AM approaches. Results: There were 16 studies identified for inclusion with a total of 1546 patients. The mean follow-up across all studies was 10.9 years (range, 5.4-17.8 years). The mean follow-up in the AM and TT groups was 10.8 years (range, 5.4-17 years) and 11.4 years (range, 6-17.8 years), respectively. A total of 783 (50.6%) patients underwent TT ACLR. Of these patients, 401 (weighted mean, 49.3%) developed radiographic PTOA. A total of 763 (49.4%) patients underwent AM ACLR. Of these patients, 166 (mean, 21.8%) went on to develop radiographic PTOA. The meta-analysis demonstrated a significantly greater rate of PTOA after ACLR using a TT technique compared with an AM technique overall (49.3% vs 25.4%, respectively; P < .001) and when studies were stratified by 5- to 10-year (53.7% vs 14.2%, respectively; P < .001) and greater than 10-year (45.6% vs 31.2%, respectively; P < .0001) follow-up. Conclusion: TT ACLR was associated with higher overall rates of radiographic PTOA compared with the AM ACLR approach. The rates of radiographic PTOA after ACLR with a TT approach were also significantly higher than using an AM approach when stratified by length of follow-up (5- to 10-year and >10-year follow-up).

• Tornetta, Paul; Della Rocca, Gregory J.; Morshed, Saam; Jones, Clifford; Heels-Ansdell, Diane & Sprague, Sheila [Show all 437 contributors for this article] (2020). Risk Factors Associated With Infection in Open Fractures of the Upper and Lower Extremities. JAAOS: Global Research & Reviews. ISSN 2474-7661. 4(12). doi: 10.5435/JAAOSGlobal-D-20-00188.
• Pache, Santiago; Del Castillo, Juan; Moatshe, Gilbert & LaPrade, Robert F. (2020). Anterior cruciate ligament reconstruction failure and revision surgery: Current concepts. Journal of ISAKOS: Joint Disorders & Orthapaedic Sports Medicine. ISSN 2059-7754. 5(6), p. 351–358. doi: 10.1136/jisakos-2020-000457.

View all works in Cristin

• Berge, Tea; Blich, Ingvild; Stølen, Ragnhild Øydna; Moatshe, Gilbert; Ludvigsen, Tom C & Bøe, Berte Marie Grimsmo (2023). Minimum five years follow-up after arthroscopic latarjet at Oslo University Hospital.
• Uddin, Fares; Alfaraidy, Moaad; Moatshe, Gilbert & Getgood, Alan (2023). Outcomes and complications following medial patellofemoral ligament reconstruction utilizing a single converging patella tunnel technique with gracilis tendon autograft - minimum 2-year followup.
• Moatshe, Gilbert (2023). Epidemiology and assessment of multiligament knee injury.
• Moatshe, Gilbert (2023). The posterior cruciate ligament rReconstruction - how do I get it tight and how do I get it right? My Way.
• Moatshe, Gilbert (2023). Osteotomies for the treatment of insufficiency of the collaterals (MCL/LCL).
• Toyooka, Seikai; Moatshe, Gilbert; Persson, Andreas & Engebretsen, Lars (2023). Return to pivoting sports after cartilage repair surgery of the knee - a scoping review.
• Martin, Richard Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 10 contributors for this article] (2023). Ceiling effect of the combined Norwegian and Danish Knee Ligament Registers limits anterior cruciate ligament reconstruction outcome prediction.
• Martin, Richard Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 10 contributors for this article] (2023). Unsupervised machine learning of the combined Danish and Norwegian Knee Ligament Registers identifies five discrete patient groups with differing ACL revision rates.
• Moatshe, Gilbert; Lind, Martin & Engebretsen, Lars (2023). Panel discussion - MLKI cases.
• Moatshe, Gilbert (2023). Optimizing knee dislocation treatment - single stage, anatomic reconstructions with early PT and ROM.
• Moatshe, Gilbert & Chahla, Jorge (2023). Live demo - Order and tensioning of grafts and fixation in a MLKI case.
• Moatshe, Gilbert; Lind, Martin; Larson, Christopher; Hiemstra, Laurie; Harlem, Thomas & Tjong, Vehniah (2023). Panel debate - Acute ACL-MCL case.
• Rodriguez, Ariel N.; Falaas, Kari L.; Monson, Jill; Moatshe, Gilbert; Engebretsen, Lars & LaPrade, Robert F. (2023). Management of Posterolateral Corner Injury in the Multiligament Injured Knee. In Sherman, Seth L.; Chahla, Jorge; Rodeo, Scott & LaPrade, Robert F. (Ed.), Knee Arthroscopy and Knee Preservation Surgery. Springer. ISSN 978-3-030-82869-1. doi: 10.1007/978-3-030-82869-1_41-1.
• Moatshe, Gilbert (2023). Multi-ligament knee injuries in athletes.
• Moatshe, Gilbert (2023). Practical examination - knee.
• Pache, Santiago; Vázquez, José María; Chahla, Jorge; Moatshe, Gilbert & LaPrade, Robert F. (2023). Irreducible Posterolateral Knee Dislocation: A Case Report. JBJS Case Connector. ISSN 2160-3251. 13(1). doi: 10.2106/JBJS.CC.22.00792.
• Løken, Sverre Bertrand; Persson, Andreas & Moatshe, Gilbert (2022). Kirurgiske behandlingsmetoder ved kneluksasjoner. Kirurgen. ISSN 1504-8888. p. 206–209.
• Moatshe, Gilbert & Engebretsen, Lars (2022). Knee dislocations with vascular injuries. Kirurgen. ISSN 1504-8888. p. 202–205.
• Persson, Andreas; Løken, Sverre Bertrand; Engebretsen, Lars & Moatshe, Gilbert (2022). Kneluksasjon - diagnostikk og initial behandling. Kirurgen. ISSN 1504-8888. 4, p. 198–201.
• Grønsund, Jørgen; Aunan, Eirik; Brattgjerd, Jan Egil; Schulz, Anselm; Moatshe, Gilbert & Röhrl, Stephan Maximilian Herbert (2022). A novel instrument for ligament balancing in Total Knee Arthroplasty – a biomechanical study in porcine tissue.
• Aunan, Eirik; Schulz, Anselm; Moatshe, Gilbert; Brattgjerd, Jan Egil; Grønsund, Jørgen & Röhrl, Stephan Maximilian Herbert (2022). A novel instrument for ligament balancing in Total Knee Arthroplasty – a biomechanical study in porcine and human tissue.
• LaPrade, Robert F.; Geeslin, Andrew G.; Chahla, Jorge; Cohen, Moises; Engebretsen, Lars & Faucett, Scott C. [Show all 20 contributors for this article] (2022). Posterior Lateral Meniscal Root and Oblique Radial Tears: The Biomechanical Evidence Supports Repair of These Tears, Although Long-Term Clinical Studies Are Necessary. Arthroscopy: The Journal of Arthroscopy And Related. ISSN 0749-8063. 38(12), p. 3095–3101. doi: 10.1016/j.arthro.2022.09.015.
• Martin, Richard Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 10 contributors for this article] (2022). Predicting anterior cruciate ligament reconstruction revision - external validation of a machine learning algorithm.
• Martin, Richard Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 10 contributors for this article] (2022). Predicting subjective failure of anterior cruciate ligament reconstruction - a machine learning analysis of a national knee ligament registry.
• Martin, Richard Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 10 contributors for this article] (2022). Unsupervised Machine learning of the combined Danish and Norwegian knee ligament registers for ACL revision rates.
• Martin, Richard Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 10 contributors for this article] (2022). Ceiling effect of the combined Norwegian and Danish Knee Ligament Registers limits ACL outcome prediction.
• Moatshe, Gilbert (2022). Hamstringsskader i idrett - kirurgisk behandling .
• Nyland, John; Moatshe, Gilbert & Martin, Robin (2022). Combined ACL and anterolateral ligament reconstruction: time to pivot and shift the focus? Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. doi: 10.1007/s00167-022-07072-6.
• Moatshe, Gilbert (2022). Classic Laprade Technique.
• Moatshe, Gilbert (2022). What should we do when the postero-lateral corner fails?
• Moatshe, Gilbert (2022). Return to Alpine skiing after ACL injury.
• Moatshe, Gilbert (2022). Outcomes and OA.
• Moatshe, Gilbert (2022). Multilig knee injuries and sports.
• Martin, R. Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 9 contributors for this article] (2022). Machine learning algorithm to predict anterior cruciate ligament revision demonstrates external validity.
• Martin, R. Kyle; Pareek, Ayoosh; Wastvedt, Solvejg; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 9 contributors for this article] (2022). Predicting subjective failure of ACL reconstruction - a machine learning analysis of the Norwegian Knee Ligament Register and patient reported outcomes.
• Martin, Richard Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 9 contributors for this article] (2021). Predicting subjective failure of ACL reconstruction - a machine learning analysis of the Norwegian Knee Ligament Register and patient reported outcomes.
• Moatshe, Gilbert (2021). Managing knee dislocations and proper sequence in multi-ligament graft tensioning.
• Martin, R. Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 9 contributors for this article] (2021). Predicting subsequent revision ACL reconstruction a machine learning analysis of the Norwegian knee ligament register.
• DePhillipo, Nicholas; Dekker, Travis J.; Moatshe, Gilbert; Chahla, Jorge & LaPrade, Robert F. (2021). Osteoarthritis therapies in the clinical trial pPipeline - a 2020 Review.
• Moatshe, Gilbert (2021). HTO, Indications and Limitations.
• Ludvigsen, Tom C; Bøe, Berte Marie Grimsmo; Blich, Ingvild; Støen, Ragnhild & Moatshe, Gilbert (2021). Fra åpen til artroskopisk latarjet - en evaluering av lærekurven ved de første 103 inngrepene.
• Martin, Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 10 contributors for this article] (2021). Predicting anterior cruciate ligament reconstruction revision - external validation of a machine learning algorithm. In Hansen, Ann Kristin (Eds.), Høstmøteboka 2021. Norsk Ortopedisk Forening. ISSN 978-82-994275-3-1.
• Martin, Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 10 contributors for this article] (2021). Predicting anterior cruciate ligament reconstruction revision - external validation of a machine learning algorithm.
• Martin, Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 9 contributors for this article] (2021). Predicting subjective failure of anterior cruciate ligament reconstruction using a machine learning analysis. In Hansen, Ann Kristin (Eds.), Høstmøteboka 2021. Norsk Ortopedisk Forening. ISSN 978-82-994275-3-1.
• Martin, Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 9 contributors for this article] (2021). Predicting subjective failure of anterior cruciate ligament reconstruction using a machine learning analysis.
• Martin, Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 9 contributors for this article] (2021). Predicting anterior cruciate ligament reconstruction revision using a machine learning analysis. In Hansen, Ann Kristin (Eds.), Høstmøteboka 2021. Norsk Ortopedisk Forening. ISSN 978-82-994275-3-1.
• Martin, Kyle; Wastvedt, Solvejg; Pareek, Ayoosh; Persson, Andreas; Visnes, Håvard & Fenstad, Anne Marie [Show all 8 contributors for this article] (2021). Predicting anterior cruciate ligament reconstruction revision using a machine learning analysis.
• Moatshe, Gilbert (2021). Stem cell therapy in orthopedics.
• Moatshe, Gilbert; Kweon, Christopher Y.; Gee, Albert O. & Engebretsen, Lars (2021). Anterior cruciate ligament reconstruction is not for all - A need for improved patient selection. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2021-104304.
• DePhillipo, Nicholas & Moatshe, Gilbert (2021). Meniscal ramp lesions. In LaPrade, Robert F. & Chahla, Jorge (Ed.), Evidence-Based Management of Complex Knee Injuries : Restoring the Anatomy to Achieve Best Outcomes. Elsevier. ISSN 978-0-323-71310-8. p. 216–223.
• Moatshe, Gilbert; Getgood, Alan & Engebretsen, Lars (2021). Multiligament knee injuries. In LaPrade, Robert F. & Chahla, Jorge (Ed.), Evidence-Based Management of Complex Knee Injuries : Restoring the Anatomy to Achieve Best Outcomes. Elsevier. ISSN 978-0-323-71310-8. p. 135 –143.
• Engebretsen, Lars & Moatshe, Gilbert (2020). Arthroscopic partial meniscectomy for degenerative meniscus tears in middle age patients: Why surgeons should change their approach. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2020-103330.
• Martin, Kyle; Ekås, Guri Ranum; Benth, Jūratė Šaltytė; Kennedy, Nicholas; Moatshe, Gilbert & Krych, Aaron J. [Show all 7 contributors for this article] (2020). The relationship between ACL deficiency and posterior tibial slope in skeletally immature patients. In Hansen, Ann Kristin (Eds.), Høstmøteboka 2020. Norsk Ortopedisk Forening. ISSN 978-82-994275-2-4.
• Moatshe, Gilbert; Bøe, Berte Marie Grimsmo & LaPrade, Robert F. (2020). Editorial Commentary: Early Surgery and Restricted Rehabilitation Are Recommended for High-Grade Acromioclavicular Joint Dislocation. Arthroscopy: The Journal of Arthroscopy And Related. ISSN 0749-8063. 36(10), p. 2642–2644. doi: 10.1016/j.arthro.2020.07.039.

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