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Purpose: Multiligamentous injury to the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) is an uncommon but debilitating event. Patients with combined ligament injuries typically complain of painful, debilitating knee instability that restricts their sports and daily activities. The purpose of this retrospective study was to evaluate functional and clinical outcomes of patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot., Methods: Medical records of 20 consecutive patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot were retrospectively reviewed. All patients had received either an allograft (group A) or a semitendinosus-gracilis graft for ACL repair and a bone-patellar tibial-bone graft for PCL repair (group B). Functional outcomes, after the initial follow-up period at 24-month FU, were assessed with concentric isokinetic knee extensor-flexor testing at 60 and 180°/s. The secondary aim was to compare long-term clinical recovery by the administration of the IKDC (International Knee Document Committee) Knee Ligament Evaluation Form, the Lysholm Knee Scoring Scale and the Cincinnati Knee Rating Scale., Results: The mean per cent quadriceps strength deficit in the operated as compared to the healthy knee was 13.5 % in group A and 15 % in group B (angular velocity 60°/s) and 13.5 % in group A and 9.4 % in group B (angular velocity 180°/s). The mean per cent flexor strength deficit in the operated as compared to the healthy knee was 10.4 % in group A and 12.3 % in group B (angular velocity 60°/s) and 12.2 % in group A and 9 % in group B (angular velocity of 180°/s). The flexor-quadriceps ratio was 49.4 % in group A and 48.8 % in group B in the healthy knee and 53.2 % in group A and 53.8 % in group B in the operated knee (angular velocity 60°/s) and 63.9 % in group A and 60.7 % in group B in the healthy knee and 65 % in group A and 64.9 % in group B in the operated knee (angular velocity 180°/s). Lysholm outcome was 93.9 ± 3.9 in group A and 89.1 ± 7.6 in group B (n.s). Cincinnati score was 89.6 ± 7.3 in group A and 91.0 ± 6.9 in group B (p = 0.791). IKDC results were group A in six patients (60 %), group B in three patients (30 %) and group C in one patient (10 %) in the allograft group and group A in seven patients (70 %) and group B in three patients (30 %) for autologous group., Conclusions: The results of this study suggest that one-stage arthroscopic bicruciate ligament reconstruction can restore good knee joint function. Surgical treatment should be followed by a comprehensive rehabilitation programme with specific goals, objectives and strategies, including pain management and assessment of progress in recovery of joint function and perception of knee stability., Level of Evidence: Retrospective case series, Level IV.

We analyzed muscle injuries collected from an Italian major-league soccer team during the period 1995-2000. We considered all the muscle accidents that had required a player to stand down for three or more days. Among the overall injuries, muscle accidents were the most frequent, representing 30% (103 cases), followed by contusions (28%), sprains (17%) and tendinopathies (9%). There was one recurrence involving the hamstring. Lack of training was one of the causes of such injuries; in fact the training/match ratio of those seasons (3.6 to 1) show that there was little time for training compared to the number of matches.

To evaluate the effects of a rehabilitation brace locked in extension for the first week on the recovery of full extension after ACL reconstruction we compared two groups of subjects who underwent ACL bone-patellar tendon-bone reconstruction. The brace was unlocked twice a day for assisted physiotherapy. In Group A, 18 male subjects wore a post-operative brace locked from 0 degrees to 90 degrees. In Group B, 18 male subjects wore the same post-op brace locked in full extension for the first week. In both groups the brace was unlocked (0 degrees -120 degrees ) at the beginning of the second postoperative week, and then removed at the beginning of the third week. All the subjects followed the same rigorous, accelerated rehabilitation protocol. Each subject was evaluated pre and post-operatively (at second, fourth and eighth week) with bubble-level heel height difference (HHD) measurements and KT 1000 arthrometric assessment at the fourth postoperative month. Preoperative bubble-level HHD measurements of the two groups were statistically similar (Group A 0.6 cm, Group B 1 cm; not significant, n.s.). At the fourth week (Group A 2.2 cm, Group B 0.6 cm) and eighth week (Group A 1.6 cm, Group B 0.1 cm) follow-ups, bubble-level HHD measurements showed that the extension of the operated knees of Group B was significantly greater than in Group A. KT 1000 arthrometric scores showed no difference between the two groups (Group A 1.8 mm, Group B 1.5; n.s.).