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Aga, C., Trøan, I., Heir, S., Risberg, M.A., Rana, T., Johansen, S., Fagerland, M.W. and Engebretsen, L. (2025) No Difference in Osteoarthritis, but Less Graft Failures after 5 Years, Comparing Anatomic Double-Bundle to Anatomic Single-Bundle ACL Reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 33, 2781-2792.
https://doi.org/10.1002/ksa.12528

has been cited by the following article:

• TITLE: The Association of Quadriceps Femoris Atrophy with Patellofemoral Magnetic Resonance Imaging Alterations after Hamstring Autografts for Single-Bundle Anterior Cruciate Ligament Reconstruction

  AUTHORS: Daniel Gululi, Kembone Johanes, Patrick Mgweno

  KEYWORDS: Patellofemoral Pain, Patellofemoral Osteoarthritis, Quadriceps Atrophy, Merchant Congruence Angle, Lateral Patellar Tilt, Anterior Cruciate Ligament Reconstruction

  JOURNAL NAME: Open Access Library Journal, Vol.13 No.4, April 23, 2026

  ABSTRACT: Objective: To ascertain the association of congruence instability of patellofemoral joint and quadriceps femoris strength deficits after hamstring tendon harvest and Anterior Cruciate ligament-Reconstruction (ACL-R), and to propose a new index to clarify the likely significant influence on patellofemoral pain and early onset of patellofemoral joint osteoarthritis after ACL-R surgery. Methods: 20 patients underwent Magnetic Resonance Imaging (MRI) scan before anterior cruciate ligament reconstruction and at every two weeks after surgery, and every two weeks until 12 weeks. Merchant’s patellar congruence angle, lateral inclination angle, and quadriceps femoris muscle cross-sectional area were measured, and multiple regression analysis was used to analyze the relationship between merchant’s patellar congruence angle, lateral inclination angle and the ratio of quadriceps femoris atrophy. Results: The merchant’s patellar congruence angle and lateral inclination angle significantly changed after surgery and the alterations of the following angles were significantly corrected with the quadriceps femoris atrophy ratio. Conclusion: These findings show that the choice of hamstring autografts for ACL reconstruction can reduce patellofemoral joint dysfunction to a certain extent. However Post operative time period the unbalanced atrophy of quadriceps femoris does disturb the stability and congruence of the patellofemoral joint, which is thought to be one among the causes of patellofemoral pain and early osteoarthritis. Rehabilitation training for quadriceps femoris muscle especially the Vastus medialis is therefore not unconnected with post-surgery (ACL-reconstruction) approaches.