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Background: Anterior cruciate ligament injuries are commonly treated with ligament reconstruction surgery, but post-operative joint contracture is a major complication. The optimal timing for anterior cruciate ligament reconstruction remains controversial, with some clinical studies suggesting that early surgery may increase the risk of joint contractures, while others have found no such association. To clarify this, we investigated the effects of the timing of reconstruction surgery on contracture formation using a rat model., Methods: Anterior cruciate ligament-transected rats were divided into groups based on the timing of reconstruction: immediate, early, and delayed (1, 14, and 28 days after transection, respectively). Some anterior cruciate ligament-transected rats did not receive reconstruction surgery. Untreated rats served as controls. At 56 days after ligament transection, we assessed knee extension range of motion before (including both myogenic and arthrogenic factors) and after myotomy (arthrogenic factor only), as well as fibrotic changes in the joint capsule., Finding: Anterior cruciate ligament transection alone significantly decreased range of motion before myotomy, but not after myotomy. In all reconstructed groups, both range of motions before and after myotomy were significantly reduced compared to the control, indicating the induction of arthrogenic contracture by reconstruction surgery. Fibrotic changes in the joint capsule were observed in all reconstructed groups, contributing to arthrogenic contracture formation. However, the timing of reconstruction had no effect on range of motions and fibrotic changes in the joint capsule., Interpretation: Our findings may help guide clinical decision-making regarding the timing of anterior cruciate ligament reconstruction surgery., Competing Interests: Declaration of competing interest The authors report no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Anterior cruciate ligament (ACL) injury is a common knee ligament injury among young, active adults; however, little is known about its impact on the viscoelastic properties of the knee joint's collateral ligaments. This study aimed to characterize and compare the viscoelastic properties of rabbit collateral ligaments in healthy control knees, injured knees, and knees contralateral to the injured knees. Unilateral anterior cruciate ligament transection was performed on six New Zealand white rabbits to create an ACL injury model. Medial and lateral collateral ligaments (MCL and LCL) were collected from the injured and contralateral knees eight weeks after ACL transection. Ligaments were also harvested from both knees of four unoperated rabbits. The ligaments underwent tensile stress-relaxation testing at strain levels of 2, 4, 6, and 8 %, and a sinusoidal loading test at 8 % strain with 0.5 % strain amplitude using frequencies of 0.01, 0.05, 0.1, 0.5, 1, and 2 Hz. The results showed that collateral ligaments of ACL-transected knees relaxed slower compared to control knees. Sinusoidal testing revealed that contralateral knee LCLs had significantly higher storage and loss modulus across all test frequencies. The results indicate that contralateral knee LCLs become stiffer compared to LCLs from control and ACL-transected knees, while LCLs from ACL-transected knees become less viscous compared to LCLs from control and contralateral knees. This study suggests that knee ligaments undergo adaptations following an ACL injury that may affect the mechanics of the ACL-transected knee, which should be considered in biomechanical and rehabilitation studies of patients with an ACL injury., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To evaluate knee biomechanics of patients about 12 months after anterior cruciate ligament (ACL) reconstruction during cutting and determine the abnormal biomechanical characteristics., Methods: Sixteen males about 12 months after ACL reconstruction were recruited for this study. Three-dimensional kinematic and kinetic data were collected during cutting movement. Knee joint angles and moments were calculated. Paired t -tests were used to compare the differences in knee biomechanics between the surgical leg and nonsurgical leg., Results: The peak posterior ground reaction force (surgical leg: 0.380±0.071; nonsurgical leg: 0.427±0.069, P = 0.003) and vertical ground reaction force (surgical leg: 1.996±0.202, nonsurgical leg: 2.110±0.182, P = 0.001) were significantly smaller in the surgical leg than in the nonsurgical leg. When compared with the uninjured leg, the surgical leg demonstrated a smaller knee flexion angle (surgical leg: 38.3°± 7.4°; nonsurgical leg: 42.8°± 7.9°, P < 0.001) and larger external rotation angle (surgical leg: 10.3°± 2.4°; nonsurgical leg: 7.7°± 2.1°, P = 0.008). The surgical leg also demonstrated a smaller peak knee extension moment (surgical leg: 0.092 ± 0.031; nonsurgical leg: 0.133 ± 0.024, P < 0.001) and peak knee external rotation moment (surgical leg: 0.005 ± 0.004; nonsurgical leg: 0.008 ± 0.004, P = 0.015) when compared with the nonsurgical leg., Conclusion: The individuals with ACL reconstruction mainly showed asymmetrical movements in the sagittal and horizontal planes. The surgical leg demonstrated a smaller peak knee flexion angle, knee extension moment, and knee external rotation moment, with greater knee external rotation angle.

Background: Strength and neuromuscular decrements following knee musculoskeletal injury may accelerate knee osteoarthritis development. This study assessed isometric knee extensor and flexor strength and steadiness between individuals with knee injury, i.e., ligament reconstruction, and knee osteoarthritis to healthy age-matched controls., Methods: Four cohorts (1: knee injury and 2: age-matched controls, and 3: radiographic knee osteoarthritis and 4: age-matched controls) were recruited. Participants performed maximal voluntary isometric knee extensor and flexor contractions. Then, strength (e.g., peak and rate of torque development) and steadiness (e.g., peak power, mean, and median frequency) were derived from each raw torque-time curve and associated power spectral density. A Kruskal-Wallis H test and Spearman's rho correlation analysis assessed cohort differences and association between knee extensor and flexor strength and steadiness., Findings: The young adult control and knee injury cohorts exhibited greater knee extensor and flexor strength than the older, knee osteoarthritis cohort (p < 0.043). The knee injury cohort, despite being as strong as their healthy counterparts, were significantly less steady with a 92% increase in peak power frequency (p = 0.046). The osteoarthritis cohort exhibited 157% less total power compared to the knee injury and young control cohorts (p < 0.019). Knee extensor and flexor peak torque, rate of torque development, and mean torque exhibit a significant, positive relation with total power (p < 0.018)., Interpretation: Individuals with knee injury and disease may exhibit weaker or less steady knee musculature, predisposing them to degenerative joint disease. Clinicians may need to restore knee extensor and flexor steadiness to facilitate better joint neuromuscular control., Competing Interests: Declaration of competing interest None of the authors demonstrate any conflict of interest regarding this submission., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Knee extension range of motion (ROM) measurement is important in patients with anterior cruciate ligament (ACL) injury. The main objective is to evaluate the reliability and the minimal detectable change (MDC) of three methods of measuring knee extension ROM in ACL patients. The three common goniometric devices were a universal goniometer, an inclinometer, and a smartphone app. During a single-visit, knee extension ROM was measured in both knees of 92 ACL-injured or -reconstructed patients by two testers blinded to the other's measures. Intrarater, interrater, and test-retest intraclass correlation coefficients (ICC 2,1 ) were calculated. Intrarater ICC 2,1 was excellent for the three devices ranging from 0.92 to 0.94, with the inclinometer yielding the best results (ICC 2,1  = 0.94 [95% confidence interval, CI: 0.91-0.96]). Interrater ICC 2,1 , however, varied from 0.36 to 0.80. The inclinometer and the smartphone app yielded similar results 0.80 (95% CI: 0.71-0.86) and 0.79 (95% CI: 0.70-0.86), respectively, whereas the universal goniometer was 0.36 (95% CI: 0.17-0.53). Test-retest ICC 2,1 for the inclinometer was 0.89 (95% CI: 0.84-0.93), 0.86 (95% CI: 0.79-0.91) for the app, and 0.83 (95% CI:0.74-0.89) for the goniometer. The intrarater, interrater, and test-retest MDC 95 values ranged from 2.0 to 3.5, 3.7 to 10.4, and 2.6 to 5.4 degrees, respectively. The goniometer was the least reliable. The inclinometer is the recommended device due to its highest ICC scores among the three devices and ease of use., Competing Interests: None declared., (Thieme. All rights reserved.)

The purpose of this work was to provide a simple method to determine reactive strength during the 6-meter timed hop test (6mTH) and evaluate its association with isokinetic peak torque in patients following anterior cruciate ligament reconstruction (ACLR). Twenty-nine ACLR patients who were at least four months from surgery were included in this analysis. Participants were brought into the laboratory on one occasion to complete functional testing. Quadriceps and hamstring isokinetic testing was completed bilaterally at 60, 180, and 300 deg∙s-1, using extension peak torque from each speed as the outcome measure. The 6mTH was completed bilaterally using a marker-based motion capture system, and reactive strength ratio (RSR) was calculated from the vertical velocity of the pelvis during the test. An adjustment in RSR was made using the velocity of the 6mTH test to account for different strategies employed across participants. Repeated measures correlations were used to determine associations among isokinetic and hop testing variables. A two-way mixed analysis of variance was used to determine differences in isokinetic and hop testing variables between operated and non-operated legs and across male and female participants. Moderate positive associations were found between RSR (and adjusted RSR) and isokinetic peak torque at all speeds (r = .527 to .577). Mean comparisons showed significant main effects for leg and sex. Patients showed significant deficits in their operated versus non-operated legs in all isokinetic and hop testing variables, yet only isokinetic peak torque and timed hop time showed significant differences across male and female groups. Preliminary results are promising but further development is needed to validate other accessible technologies available to calculate reactive strength during functional testing after ACLR. Pending these developments, the effects of movement strategies, demographics, and levels of participation on RSR can then be explored to translate this simple method to clinical environments., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ripic et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: The objective of this study was to investigate the initial stability of different screw placements in arthroscopic anterior cruciate ligament (ACL) tibial avulsion fracture fixation., Methods: A three-dimensional knee model at 90° flexion was utilized to simulate type III ACL tibial avulsion fracture and arthroscopic screw fixation through different portals, namely the central transpatellar tendon portal (CTP), anterolateral portal (ALP), anteromedial portal (AMP), lateral parapatellar portal (LPP), medial parapatellar portal (MPP), lateral suprapatellar portal (LSP), medial suprapatellar portal (MSP). A shear force of 450 N was applied to the finite element models at 30° flexion to simulate the failure condition. The displacement of the bony fragment and the volume of the bone above 25,000 µ-strain (damaged bone volume) were calculated around the screw path., Results: When the screw was implanted through CTP, the displacement of the bony fragment reached the maximum displacement which was 1.10 mm and the maximum damaged bone volume around the screw path was 148.70 mm 3 . On the other hand, the minimum displacement of the bony fragment was 0.45 mm when the screw was implanted through LSP and MSP. The minimum damaged bone volume was 14.54 mm 3 around the screw path when the screw was implanted through MSP., Conclusion: Screws implanted through a higher medial portal generated less displacement of the bony fragment and a minimum detrimental strain around the screw path. The findings are clinically relevant as they provide biomechanical evidence on optimizing screw placement in arthroscopic ACL tibial avulsion fracture fixation., (© 2024. The Author(s).)

Background: Those who undergo ACL reconstruction are at an increased risk of suffering a second ACL injury. A suggested rationale for the increased injury risk is sensory reweighting to the visual system to compensate for a lack of somatosensory information from the knee. Understanding this proposed visual reliance may help clinicians improve return to sport outcomes and reduce the risk of a subsequent ACL injury., Methods: Thirteen ACL reconstructed individuals and thirteen matched controls completed two common static postural control assessments under three different visual conditions; eyes open, low visual disruption, and high visual disruption. Center of pressure data was collected for 30 s using force plates. Static postural stability was evaluated using the following: 1) root mean square distance, 2) mean velocity, 3) sway area, and 4) mean frequency., Findings: No significant interactions between group and vision were observed. Significant differences between groups were observed for mean frequency in the double-limb stance (p < .05). Additionally, significant differences were observed for visual conditions in both double-limb (mean velocity; p < .05) and single-limb stances (root mean square distance, mean velocity, sway area, and mean frequency; p < .05)., Interpretation: The findings of the current study suggest that ACL reconstructed individuals, who are at least two years removed from surgery, do not rely on visual information to a greater extent than controls during static postural stability assessments. Stroboscopic glasses may be a cost-effective alternative for rehabilitation purposes compared to the traditional binary eyes open vs. eyes closed methods., Competing Interests: Declaration of competing interest Nathan Robey reports financial support was provided by University of Northern Colorado. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Background: Injuries to the deep medial collateral ligament (dMCL) and partial superficial MCL (psMCL) can cause anteromedial rotatory instability; however, the contribution of each these injuries in restraining anteromedial rotatory instability and the effect on the anterior cruciate ligament (ACL) load remain unknown., Purpose: To investigate the contributions of the different MCL structures in restraining tibiofemoral motion and to evaluate the load through the ACL after MCL injury, especially after combined dMCL/psMCL injury., Study Design: Controlled laboratory study., Methods: Sixteen fresh-frozen human cadaveric knees were tested using a 6 degrees of freedom robotic simulator. Tibiofemoral kinematic parameters were recorded at 0°, 30°, 60°, and 90° of knee flexion for the following measurements: 8-N·m valgus rotation, 4-N·m external tibial rotation (ER), 4-N·m internal tibial rotation, and a combined 89-N anterior tibial translation and 4-N·m ER for both anteromedial rotation (AMR) and anteromedial translation (AMT). The kinematic parameters of the 3 different MCL injuries (dMCL; dMCL/psMCL; dMCL/superficial MCL (sMCL)) were recorded and reapplied either in an ACL-deficient joint (load sharing) or before and after cutting the ACL (ACL load). The loads were calculated by applying the principle of superposition., Results: The dMCL had the largest effect on reducing the force/torque during ER, AMR, and AMT in extension and the psMCL injury at 30° to 90° of knee flexion ( P < .05). In a comparison of the load through the ACL when the MCL was intact, the ACL load increased by 46% and 127% after dMCL injury and combined dMCL/psMCL injury, respectively, at 30° of knee flexion during ER. In valgus rotation, a significant increase in ACL load was seen only at 90° of knee flexion., Conclusion: The psMCL injury made the largest contribution to the reduction of net force/torque during AMR/AMT at 30° to 90° of flexion. Concomitant dMCL/psMCL injury increased the ACL load, mainly during ER., Clinical Relevance: If a surgical procedure is being considered to treat anteromedial rotatory instability, then the procedure should focus on restoring sMCL function, as injury to this structure causes a major loss of the knee joint's capacity to restrain AMR/AMT., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by Smith & Nephew, in the form of a research grant that funded the presented research; Ossur, in the form of an educational grant for our research fellowship position; the Natural Sciences and Engineering Research Council Discovery: RGPIN-2018-05693; the Ontario Early Researcher Award ER18-14-197; and the Canadian Foundation for Innovation JELF and Ontario Research Fund–Research Infrastructure, 38141. A.G. has received consulting fees from Smith & Nephew; is on the advisory board and holds stock in Spring Loaded Technology; and holds stock in Precision OS, LinkX Robotics, and Ostesys Robotics. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Background: Up to 20% of patients remain unsatisfied after total knee arthroplasty (TKA), prompting the development of new implants. Bi-Cruciate Retaining (BCR) TKA preserves both the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), with the ACL beneficial for its proprioceptive qualities. The Bi-Cruciate Stabilised (BCS) TKA substitutes the ACL and PCL with a unique dual cam-post mechanism. Robotics improve accuracy and facilitate technically demanding TKA., Methods: This was a retrospective case-control study recruited from two centres. Measured outcomes included kinematic analysis, proprioception, and functional outcomes., Results: There was a significantly larger maximum flexion angle and range of flexion to extension in sit-to-stand and stairs in BCR when compared to BCS. Further analysis revealed more similarities between BCR and normal native knees. Proprioception and functional scores did not have any statistical difference., Conclusion: BCR TKA demonstrated better knee flexion in weight-bearing active range of motion and showed similarities with normal knee kinematics., (© 2024 The Author(s). The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons Ltd.)

Purpose: The pivot-shift test is used to clinically assess knee instability in patients with anterior cruciate ligament (ACL) lesions; however, it has low interobserver reliability. Dynamic radiostereometry (dRSA) is a highly precise and noninvasive method for the objective evaluation of joint kinematics. The purpose of this study was to quantify precise knee kinematics during a pivot-shift test using dRSA imaging., Method: Eight human donor legs, including hemipelvises, were evaluated. Arthroscopic intervention was performed inducing ligament lesions in the ACL, and anterolateral ligament (ALL) section was performed as a capsular incision. The pivot-shift test was recorded with dRSA on knees with intact ligaments, ACL-deficient and ACL + ALL-deficient knees., Results: A pivot-shift pattern was identifiable after ligament lesion, as a change in tibial posterior drawer velocity from 7.8 mm/s (95% CI: 3.7; 11.9) in ligament intact knees to 30.4 mm/s (95% CI 23.0; 38.8) after ACL lesion to 35.1 mm/s (95% CI 23.4; 46.7) after combined ACL-ALL lesion. The anterior-posterior drawer excursion increased from 2.8 mm (95% CI 2.1; 3.4) in ligament intact knees to 7.2 mm (95% CI 5.5; 8.9) after ACL lesion to 7.6 mm (95% CI 5.5; 9.8) after combined lesion. A statistically significant increase in tibial external rotation towards the end of the pivot-shift motion was observed when progressing from intact to ACL + ALL-deficient knees (p < 0.023)., Conclusion: This experimental study demonstrates the feasibility of dRSA to objectively quantify the kinematic laxity patterns of the knee during the pivot-shift test. The dynamic parameters obtained through dRSA revealed the kinematic changes from ACL to combined ACL-ALL ligament lesion., Level of Evidence: Not applicable., (© 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

This study aimed to compare functional outcomes sequentially up to 1 year after combined anterior cruciate ligament reconstruction (ACLR) and anterolateral ligament reconstruction (ALLR) and isolated ACLR. Fifty patients who underwent ACLR with versus without ALLR were analyzed at four different time points (preoperatively and 3, 6, and 12 months postoperatively). For the functional outcomes, muscle strength and acceleration time (AT) were measured using an isokinetic dynamometer. Proprioception was evaluated using joint position sense and dynamic postural stability. Patient-reported outcomes were measured using the Tampa Scale for Kinesiophobia (TSK-11) scores. Functional performance was assessed using single-leg hop distance (SLHD) and Limb Symmetry Index. In the operated knees, quadriceps (at 6 months postoperatively, p = 0.003) and hamstring (at 6 and 12 months postoperatively, p < 0.001) strength were significantly higher in the combined ACLR and ALLR group than the isolated ACLR group. The TSK-11 (at 6 and 12 months postoperatively, p < 0.001) was significantly lower in the combined ACLR and ALLR group than the isolated ACLR group. SLHD was significantly higher in the combined ACLR and ALLR group than the isolated ACLR group (at 6 months, p = 0.022 and at 12 months, p = 0.024). The addition of ALLR to primary ACLR yielded better muscle performance, fear of movement, and functional performance than isolated ACLR., (© 2024. The Author(s).)

Introduction: The escalating incidence of anterior cruciate ligament (ACL) injuries, particularly among adolescents, is a pressing concern. The study of ACL biomechanics in this demographic presents challenges due to the scarcity of cadaveric specimens. This research endeavors to validate the adolescent porcine stifle joint as a fitting model for ACL studies., Methods: We conducted experiments on 30 fresh porcine stifle knee joints. (Breed: Yorkshire, Weight: avg 90 lbs, Age Range: 2-4 months). They were stored at - 22 °C and a subsequent 24-h thaw at room temperature before being prepared for the experiment. These joints were randomly assigned to three groups. The first group served as a control and underwent only the load-to-failure test. The remaining two groups were subjected to 100 cycles, with forces of 300N and 520N, respectively. The load values of 300N and 520N correspond to three and five times the body weight (BW) of our juvenile porcine, respectively., Result: The 520N force demonstrated a higher strain than the 300N, indicating a direct correlation between ACL strain and augmented loads. A significant difference in load-to-failure (p = 0.014) was observed between non-cyclically loaded ACLs and those subjected to 100 cycles at 520N. Three of the ten samples in the 520N group failed before completing 100 cycles. The ruptured ACLs from these tests closely resembled adolescent ACL injuries in detachment patterns. ACL stiffness was also measured post-cyclical loading by applying force and pulling the ACL at a rate of 1 mm per sec. Moreover, ACL stiffness measurements decreased from 152.46 N/mm in the control group to 129.42 N/mm after 100 cycles at 300N and a more significant drop to 86.90 N/mm after 100 cycles at 520N. A one-way analysis of variance (ANOVA) and t-test were chosen for statistical analysis., Conclusions: The porcine stifle joint is an appropriate model for understanding ACL biomechanics in the skeletally immature demographic. The results emphasize the ligament's susceptibility to injury under high-impact loads pertinent to sports activities. The study advocates for further research into different loading scenarios and the protective role of muscle co-activation in ACL injury prevention., (© 2024. The Author(s).)

Background: Rupturing the anterior cruciate ligament is an orthopedic injury that results in neuromuscular impairments affecting sensory input to the central nervous system. Traditional physical therapy after anterior cruciate ligament reconstruction aims to rehabilitate orthopedic impairments but fails to address asymmetric gait mechanics that are present post-operatively and are linked to the development of post-traumatic osteoarthritis. A first step towards developing gait interventions is understanding if individuals after anterior cruciate ligament reconstruction have the capacity to learn new walking mechanics., Methods: The split-belt treadmill offers a task-specific approach to examine neuromuscular adaptations in patients after injury. The potential for changing spatiotemporal gait mechanics via split-belt treadmill adaptation has not been tested early after anterior cruciate ligament reconstruction; nor has the ability to retain and transfer newly learned gait mechanics. Therefore, we used a split-belt treadmill paradigm to compare gait adaptation, retention, and transfer to overground walking between 15 individuals 3-9 months after anterior cruciate ligament reconstruction and 15 matched control individuals., Findings: Results suggested individuals after anterior cruciate ligament reconstruction were able to adapt and retain step length symmetry changes as well as controls. There was also evidence of partial transfer to overground walking, similar to controls., Interpretation: Despite disruption in afferent feedback from the joint, individuals early after anterior cruciate ligament reconstruction can learn a new gait pattern using sensorimotor adaptation, retain, and partially transfer the learned gait pattern. This may be a critical time to intervene with gait-specific interventions targeting post-operative gait asymmetries., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Elanna K. Arhos reports financial support was provided by National Institutes of Health. Elanna K. Arhos reports financial support was provided by Foundation for Physical Therapy. Karin G Silbernagel reports financial support was provided by National Institutes of Health. Susanne M. Morton reports financial support was provided by National Institutes of Health. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Individuals with a recent anterior cruciate ligament reconstruction may demonstrate an altered movement strategy for protecting the knee and maintaining stability. Altered knee movement might lead to abnormal intra-articular load, potentially contributing to early knee osteoarthritis onset. A protective strategy may be particularly evident during active tasks that induce a pivot-shift manoeuvre, such as a step-down and cross-over task. In this study, we investigated whether knee joint mechanics and muscle activity differed between participants early (∼3 months) following reconstruction (n = 35) to uninjured controls (n = 35) during a step-down and cross-over task with a 45° change-of-direction., Methods: We used motion capture, force plates and surface electromyography to compare time-normalised curves of sagittal and transverse-plane knee mechanics and muscle activity during the cross-over phase between groups using functional t-tests. We also compared knee mechanics between sides within the injured group and compared discrete outcomes describing the cross-over phase between groups., Findings: Compared to controls, the injured participants had greater knee flexion angle and moment, lower internal rotation moment, more preparatory foot rotation of the pivoting leg, a smaller cross-over angle, and a longer cross-over phase for both the injured and uninjured sides. The injured leg also had greater biceps femoris and vastus medialis muscle activity compared to controls and different knee mechanics than the uninjured leg., Interpretation: Individuals with anterior cruciate ligament reconstruction showed a knee-stabilising and pivot-shift avoidance strategy for both legs early in rehabilitation. These results may reflect an altered motor representation and motivate considerations early in rehabilitation., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Charlotte K Häger reports financial support was provided by Swedish Research Council (2017–00892; 2022–00774). Charlotte K Häger reports financial support was provided by Region Västerbotten (Cutting Edge funding Grant No RV966109; ALF funding RV 967112; VLL838421; Strategic funding VLL358901, Project No. 7002795; ALF funding 2022–2024; Cutting Edge Funding 2022–2024). Charlotte K Häger reports financial support was provided by The Swedish Research Council for Sports Science (P2020–0035; P2021–0061; 2022/10 P2023–0030). Charlotte K Häger reports financial support was provided by Umeå University Foundation for Medical Research 2019–2023. Charlotte K Häger reports financial support was provided by King Gustaf V and Queen Victoria's Foundation of Freemasons. Charlotte K Häger reports financial support was provided by Umeå university Strategic research area health care science, SFOV. All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Background: The aims of this study were to describe a lateral extra-articular tenodesis (LET) using no additional hardware and compare the tibiofemoral kinematics of anterior cruciate ligament (ACL) reconstruction augmented with either the LET or a standard anatomic anterolateral ligament (ALL) reconstruction using intra-tunnel fixation., Methods: Ten cadaveric knees were mounted on a robotic testing system and underwent a kinematic assessment of anterior tibial translation and internal tibial rotation under a simulated pivot-shift in the following states: ACL-intact, ACL-sectioned, ACL-sectioned/anterolateral complex (ALC)-sectioned, ACL-reconstructed/ALC-sectioned, ACL-reconstructed/ALL-reconstructed, and ACL-reconstructed/LET. For the LET, an iliotibial autograft was passed under the fibular collateral ligament and secured to the femur with the pull sutures of the ACL reconstruction femoral cortical suspensory fixation device, positioned at the distal ridge of Kaplan's fibers., Results: Anterior tibial translation was restored to normal by ACL reconstruction without meaningful benefit of augmentation with LET or ALL. ACL reconstruction restored internal tibial rotation close to normal between 0° and 30°, but increased internal tibial rotation persisted between 45° and 90°. Augmentation of ACL reconstruction with the LET reduced internal rotation close to normal between 45° and 90°, whereas increased internal rotation persisted after ALL reconstruction., Conclusion: ACL reconstruction and LET are complementary in controlling tibiofemoral kinematics of knees with a combined ACL and ALC injury: ACL reconstruction restored native tibiofemoral kinematics except for internal rotation at flexion greater than 30°. The increased internal rotation at flexion greater than 30° was restored to normal with an LET, but not with an ALL reconstruction., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The ten fresh-frozen human cadaveric knees and the equipment and disposables for the all-inside ACL reconstruction were provided by Arthrex. This study was funded in part by the Departments of Orthopaedics and Sports Medicine of the University of Washington School of Medicine and Seattle Children’s Hospital. Dr. Schmale has received grants from SIGN Fracture Care Int and Arthrex, outside the submitted work. For the remaining authors none were declared., (Copyright © 2024 Elsevier B.V. All rights reserved.)