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The article focuses on outcomes of anterior cruciate ligament (ACL) treatment during the first five years after clinical trial. Topics discussed include occurrence of osteoarthritis after normal and delayed ACL reconstruction with rehabilitation, knee stability and radiographic differences among randomized ACL trial patients.

Low scores on psychological patient-reported outcomes measures, including the Anterior Cruciate Ligament—Return to Sport After Injury (ACL-RSI) and Injury-Psychological Readiness to Return to Sport (I-PRRS), after anterior cruciate ligament reconstruction (ACLR) have been associated with a maladaptive psychological response to injury and poor prognosis. To assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores and generate normative reference curves. Case series. Outpatient sports medicine and orthopaedic clinic. A total of 507 patients (age at ACLR, 17.9 ± 3.0 years) who had undergone primary ACLR and completed ACL-RSI or I-PRRS assessments ≥1 times (n = 796) between 0 and 1 year post-ACLR. An honest broker provided anonymous data from our institution's knee-injury clinical database. Generalized additive models for location, scale, and shape and generalized least-squares analyses were used to assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores. The ACL-RSI and I-PRRS scores increased over time post-ACLR. Males had higher scores than females until approximately 5 months post-ACLR, with scores converging thereafter. Males reported higher ACL-RSI and I-PRRS scores than females in the initial stages of rehabilitation, but scores converged between sexes at times associated with return to play post-ACLR. Normative reference curves can be used to objectively appraise ACL-RSI and I-PRRS scores at any time post-ACLR. This may lead to timely recognition of patients with a maladaptive psychological response to injury and a higher likelihood of a poor prognosis, optimizing ACLR outcomes. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) injury has multifactorial causes encompassing mechanical, hormonal, exposure, and anatomical factors. Alterations in the central nervous system also play a role, but their influence after injury, recovery, and recurrent injury remain unknown. Modern neuroimaging techniques can be used to elucidate the underlying functional and structural alterations of the brain that predicate the neuromuscular control adaptations associated with ACL injury. This knowledge will further our understanding of the neural adaptations after ACL injury and rehabilitation and in relation to injury risk. In this paper, we describe the measurement of brain activation during knee extension-flexion after ACL injury and reconstruction and 26 days before a contralateral ACL injury. Methods: Brain functional magnetic resonance imaging data for an ACL-injured participant and a matched control participant were collected and contrasted. Results: Relative to the matched control participant, the ACL-injured participant exhibited increased activation of motorplanning, sensory-processing, and visual-motor control areas. A similar activation pattern was present for the contralateral knee that sustained a subsequent injury. Conclusions: Bilateral neuroplasticity after ACL injury may contribute to the risk of second injury, or aspects of neurophysiology may be predisposing factors to primary injury. Clinical Implications: Sensory-visual-motor function and motor-learning adaptations may provide targets for rehabilitation. [ABSTRACT FROM AUTHOR]

To critically assess the literature focused on sex-specific trajectories in physical characteristics associated with anterior cruciate ligament (ACL) injury risk by age and maturational stage. PubMed, CINAHL, Scopus, and SPORTDiscus databases were searched through December 2021. Longitudinal and cross-sectional studies of healthy 8- to 18-year-olds, stratified by sex and age or maturation on ≥1 measure of body composition, lower extremity strength, ACL size, joint laxity, knee-joint geometry, lower extremity alignment, balance, or lower extremity biomechanics were included. Extracted data included study design, participant characteristics, maturational metrics, and outcome measures. We used random-effects meta-analyses to examine sex differences in trajectory over time. For each variable, standardized differences in means between sexes were calculated. The search yielded 216 primary and 22 secondary articles. Less fat-free mass, leg strength, and power and greater general joint laxity were evident in girls by 8 to 10 years of age and Tanner stage I. Sex differences in body composition, strength, power, general joint laxity, and balance were more evident by 11 to 13 years of age and when transitioning from the prepubertal to pubertal stages. Sex differences in ACL size (smaller in girls), anterior knee laxity and tibiofemoral angle (greater in girls), and higher-risk biomechanics (in girls) were observed at later ages and when transitioning from the pubertal to postpubertal stages. Inconsistent study designs and data reporting limited the number of included studies. Critical gaps remain in our knowledge and highlight the need to improve our understanding of the relative timing and tempo of ACL risk factor development. [ABSTRACT FROM AUTHOR]

Context: Fear has been cited as the primary barrier to return to sport (RTS) by athletes after anterior cruciate ligament reconstruction (ACLR). Understanding the neural factors that contribute to fear after ACLR may help us to identify interventions for this population. Objective: To characterize the underlying neural substrate of injury-related fear in patients after ACLR versus healthy matched control individuals during a picture imagination task (PIT) consisting of sport-specific images and images of activities of daily living (ADL). Design: Case-control study. Setting: Research laboratory. Patients or Other Participants: A total of 24 right-hand– dominant participants (12 with left-sided ACLR and 12 control individuals) were enrolled. Participants underwent full-brain functional magnetic resonance imaging. Main Outcome Measure(s): Functional data were acquired using blood oxygen level–dependent (BOLD) echoplanar imaging. Independent t tests were conducted to identify between-groups differences in BOLD signal changes during all images of the PIT. Paired t tests were computed to examine differences in BOLD signal change between sport-specific and ADL images in the ACLR group. Results: Increased activation in the inferior parietal lobule and the mediodorsal thalamus was observed during PIT in the ACLR group. An inability to suppress the default mode network in the ACLR group was noted. The ACLR group exhibited increased activation in the cerebellum and inferior occipital regions during the sport-specific images versus the ADL images, but no other regions of interest demonstrated differences. Conclusion: After ACLR, patients may be more predisposed to fear, anxiety, and pain during sport-specific activities and ADLs. Psychosocial interventions may be warranted after ACLR to reduce injury-related fear and mitigate potentially maladaptive neuroplasticity. [ABSTRACT FROM AUTHOR]

Objective: To evaluate sex differences in incidence rates (IRs) of anterior cruciate ligament (ACL) injury by sport type (collision, contact, limited contact, and noncontact). Data Sources: A systematic review was performed using the electronic databases PubMed (1969-January 20, 2017) and EBSCOhost (CINAHL, SPORTDiscus; 1969-January 20, 2017) and the search terms anterior cruciate ligament AND injury AND (incidence OR prevalence OR epidemiology). Study Selection: Studies were included if they provided the number of ACL injuries and the number of athlete-exposures (AEs) by sex or enough information to allow the number of ACL injuries by sex to be calculated. Studies were excluded if they were analyses of previously reported data or were not written in English. Data Extraction: Data on sport classification, number of ACL injuries by sex, person-time in AEs for each sex, year of publication, sport, sport type, and level of play were extracted for analysis. Data Synthesis: We conducted IR and IR ratio (IRR) metaanalyses, weighted for study size and calculated. Female and male athletes had similar ACL injury IRs for the following sport types: collision (2.10/10 000 versus 1.12/10 000 AEs, IRR = 1.14, P = .63), limited contact (0.71/10 000 versus 0.29/10 000 AEs, IRR = 1.21, P = .77), and noncontact (0.36/10 000 versus 0.21/10 000 AEs, IRR = 1.49, P = .22) sports. For contact sports, female athletes had a greater risk of injury than male athletes did (1.88/ 10 000 versus 0.87/10 000 AEs, IRR = 3.00, P < .001). Gymnastics and obstacle-course races were outliers with respect to IR, so we created a sport category of fixed-object, high-impact rotational landing (HIRL). For this sport type, female athletes had a greater risk of ACL injury than male athletes did (4.80/10 000 versus 1.75/10 000 AEs, IRR=5.51, P < .001), and the overall IRs of ACL injury were greater than all IRs in all other sport categories. Conclusions: Fixed-object HIRL sports had the highest IRs of ACL injury for both sexes. Female athletes were at greater risk of ACL injury than male athletes in contact and fixed-object HIRL sports. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses the various topics within the issue, including pediatric anterior cruciate ligament (ACL) injuries, evidence-based screening, and the maturation-specific interventions to optimize function and lifelong joint health.

The article discusses the methodological approaches used in the referenced manuscript1 do not comply with contemporary standards of statistical analyses and reporting for functional magnetic resonance imaging (fMRI), studies to reinforce the concept that minimum analytic standards applied if task-based fMRI data are to inform and innovate sports medicine practice. It also discusses the increased activity in response to a manipulation or stimulus relative to a control or rest condition.

The article presents abstracts on athletic training which include the neuromuscular risk factors for anterior cruciate ligament (ACL) injury, the abnormal movement patterns at the knee, hip and trunk with non-contact ACL injuries and the genetic risk factors in ACL tear.

The article presents a descriptive laboratory study which clusters participants based on combinations of lower extremity alignment (LEA) variables, and compares clusters in kinematics and kinetics of hip and knee joints during the landing phase of a drop-jump task. The context of the study, the participants, and main outcome measures are outlined. The results indicate that three clusters were identified according to their static LEAs.

The article discusses the anterior cruciate ligament (ACL) sixth retreat that was held on March 22-24, 2012, in Greensboro, North Carolina. Keynote speakers at the meeting included Ajit Chaudhari, Malcolm Collins and Tron Kraushaug. Topics discussed at the meeting included technical biomechanical modeling, knee-joint geometry and risk factors associated with ACL.

Context: A dynamic postural-control task that has gained notoriety in the clinical and research settings is the Star Excursion Balance Test (SEBT). Researchers have suggested that, with appropriate instruction and practice by the individual and normalization of the reaching distances, the SEBT can be used to provide objective measures to differentiate deficits and improvements in dynamic postural-control related to lower extremity injury and induced fatigue, and it has the potential to predict lower extremity injury. However, no one has reviewed this body of literature to determine the usefulness of the SEBT in clinical applications. Objective: To provide a narrative review of the SEBT and its implementation and the known contributions to task performance and to systematically review the associated literature to address the SEBT's usefulness as a clinical tool for the quantification of dynamic postural-control deficits from lower extremity impairment. Data Sources: Databases used to locate peer-reviewed articles published from 1980 and 2010 included Derwent Innovations Index, BIOSIS Previews, Journal Citation Reports, and MEDLINE. Study Selection: The criteria for article selection were (1) The study was original research. (2) The study was written in English. (3) The SEBT was used as a measurement tool. Data Extraction: Specific data extracted from the articles included the ability of the SEBT to differentiate pathologic conditions of the lower extremity, the effects of external influences and interventions, and outcomes from exercise intervention and to predict lower extremity injury. Data Synthesis: More than a decade of research findings has established a comprehensive portfolio of validity for the SEBT, and it should be considered a highly representative, noninstru- mented dynamic balance test for physically active individuals. The SEBT has been shown to be a reliable measure and has validity as a dynamic test to predict risk of lower extremity injury, to identify dynamic balance deficits in patients with a variety of lower extremity conditions, and to be responsive to training programs in both healthy people and people with injuries to the lower extremity. Clinicians and researchers should be confident in employing the SEBT as a lower extremity functional test. [ABSTRACT FROM AUTHOR]