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Purpose of this paper is to provide an overview of the latest research on the anterolateral ligament (ALL) and present the consensus of the ALL Expert Group on the anatomy, radiographic landmarks, biomechanics, clinical and radiographic diagnosis, lesion classification, surgical technique and clinical outcomes. A consensus on controversial subjects surrounding the ALL and anterolateral knee instability has been established based on the opinion of experts, the latest publications on the subject and an exchange of experiences during the ALL Experts Meeting (November 2015, Lyon, France). The ALL is found deep to the iliotibial band. The femoral origin is just posterior and proximal to the lateral epicondyle; the tibial attachment is 21.6 mm posterior to Gerdy's tubercle and 4-10 mm below the tibial joint line. On a lateral radiographic view the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary consensus on all studied features of the ALL. The findings warrant future research in order to further test these early observations, with the ultimate goal of improving the long-term outcomes of ACL-injured patients. Level of evidence Level V-Expert opinion.

Reference/citation: Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013;346:F232., Clinical Question: Does early anterior cruciate ligament (ACL) reconstruction with rehabilitation lead to better patient-reported outcomes and a lower incidence of osteoarthritis at 5 years postinjury compared with delayed ACL reconstruction with rehabilitation?, Study Selection: This randomized controlled trial with extended follow-up at 5 years postrandomization was conducted in 2 Swedish orthopaedic departments., Data Extraction: The authors studied a total of 121 moderately active adults (age = 18-35 years) with an acute ACL rupture in a knee with no other history of trauma. Excluded were patients with a collateral ligament rupture, full-thickness cartilage defect, or extensive meniscal fixation. One patient assigned to the early ACL-reconstruction group did not attend the 5-year follow-up visit. Patients were randomly assigned to (1) an early ACL reconstruction plus structured rehabilitation group (n = 62, surgery within 10 weeks of injury) or (2) optional-delayed ACL reconstruction plus structured rehabilitation group (n = 59). The primary outcome measure was change in the average of 4 out of 5 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS). The authors also assessed crude KOOS (combined 4 subscales), KOOS subscale scores, general physical and mental health (Short-Form 36), activity level (Tegner Activity Scale), mechanical knee stability (Lachman and pivot shift tests), meniscal surgery status, and presence of knee osteoarthritis on radiographs., Main Results: Among patients randomized to the optional-delayed ACL-reconstruction group, 30 (51%) opted for an ACL reconstruction. The treatment groups had comparable 5-year patient-reported outcomes and changes in patient-reported outcomes (eg, knee pain, knee symptoms, activities of daily living, sport and recreational levels, knee-related quality of life, general physical health, and general mental health). Patients in the optional-delayed ACL-reconstruction group had greater mechanical knee instability than patients who received early ACL reconstruction; however, this was primarily among the patients opting for conservative management alone. In the overall sample, 61 knees (51%) required meniscal surgery over 5 years, regardless of treatment group. At 5 years, radiographs were available for 113 patients (93%). Overall, 29 patients (26%) had knee osteoarthritis at 5 years. Specifically, 13 patients (12%) developed tibiofemoral radiographic osteoarthritis (9 patients [16%] in the early ACL-reconstruction group, 4 [7%] in the optional-delayed ACL-reconstruction group) and 22 (19%) developed patellofemoral osteoarthritis (14 patients [24%] in the early ACL-reconstruction group, 8 [15%] in the optional-delayed ACL-reconstruction group). Patients with patellar tendon grafts (n = 40) had a greater incidence of ipsilateral patellofemoral osteoarthritis than patients with hamstrings tendon grafts (n = 51), but the 2 groups had similar incidences of ipsilateral tibiofemoral osteoarthritis. Six knees (5%) had both tibiofemoral and patellofemoral osteoarthritis., Conclusions: Early ACL reconstruction plus rehabilitation did not provide better results at 5 years compared with optional-delayed ACL reconstruction plus rehabilitation. Furthermore, the authors found no radiographic differences among patients with early ACL reconstruction, delayed ACL reconstruction, or no ACL reconstruction (rehabilitation alone).

Objectives: Posterior tibial slope (PTS) is a known anatomical factor in the biomechanical function of the anterior cruciate ligament. However, when PTS is typically measured on a lateral radiograph, this does not consider potential differences between the lateral and medial tibial plateau. The difference between medial posterior tibial slope (MPTS) and lateral posterior tibial slope (LPTS) in a knee is largely unknown. Generally, computed tomography (CT) is the gold standard for 3-dimensional osseus imaging but very few studies to date have attempted to quantify the medial and lateral PTS in the same knee using CT. Clinically, it is debated whether an elevated MPTS or the LPTS is critical for anterior cruciate ligament injury and reinjury. The objective of this study was to quantify the variation in the difference between MPTS and LPTS using full tibial CT scans. Methods: At our institution, CT-assisted preoperative planning is frequently used for osteotomies. Ninety-seven patients with clinically acquired CT scans went through the preoperative planning process (Bodycad, Quebec City, Canada) from Jan 2016 to Nov 2022. This includes patients undergoing coronal, sagittal or biplanar high tibial and distal femoral osteotomies. This process is semi-automated meaning that the user can intervene with the measurements and adjust the initial landmarks and best-fit. Distally, the software will find the center of the tibiotalar joint to provide a point for the tibial axis. The user may adjust that landmark if needed. To measure the tibial slope, the software finds the best fit tibial plateau in 3D and determines the slope angle medially and laterally. The software measures the MPTS and LPTS independently. The slope measurements were compiled and quantitatively analyzed including mean, median, range as well as the difference between the MPTS and LPTS. Patients were defined to have undergone a sagittal or coronal correction if there was more than 2 degrees of change in the sagittal plane or more than 5% change in the coronal plane weight bearing line. Patients were defined as having a biplanar correction when both conditions were met. The slopes were analyzed with respect to sex and laterality. Additionally, patients undergoing an osteotomy in conjunction with an ACL reconstruction (either single or two-staged) were compared to the other patients. Results: There are differences in the MPTS and LPTS within the same knee. When analyzing the whole group, the average absolute difference is 2.76⁰ with a standard deviation of 2.49. As shown in Table 1, 40% of knees had greater than a 2.5⁰ difference in MPTS and LPTS, 19% of knees had greater than a 5⁰ difference in MPTS and LPTS, 5% of knees had greater than a 7.5⁰ difference in MPTS and LPTS and 2% of knees had greater than a 10⁰ difference in MPTS and LPTS. The magnitude of the LPTS is greater than the MPTS 52% of the time. There is no significant difference in the average, standard deviation, mean or the 10th, 25th, 75th and 90th percentiles of the MPTS and LPTS as shown in Table 2. One hundred percent of the sagittal corrections and 84% of the biplanar corrections also underwent an ACL reconstruction in addition to an osteotomy. Characteristics of these groups of patients are shown in table 3. The sagittal and coronal osteotomy patients have a higher MPTS and LPTS than the patients undergoing a coronal osteotomy. Conclusions: The most important finding in this study is that the medial and lateral PTS can be very different within the same knee. There can be up to 11.62-degree difference in this population. Sixteen out of 97 patients had a difference of more than 5⁰ with 2 patients having a difference of greater than 10⁰. The data presented here has uncovered a description of the medial and lateral posterior tibial slope anatomy that was not evident with conventional lateral knee x-rays previously. We do not know the clinical significance of a large difference in the medial and lateral PTS and it brings forth an interesting set of clinical questions. 1) Which posterior tibial slope, medial or lateral, is most important for knee biomechanics, specifically regarding ACL stresses and function? 2) When performing a slope correcting osteotomy, is it the medial, lateral or average slope that should be the target for correction? 3) Should an intercondylar correction which only modifies one slope be considered? Further clinical studies should focus on investigating the relationship of differential PTS to native knee biomechanics as well as its implication for corrective osteotomy procedures and ACL reconstruction. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to radiographically assess changes in 1) patellar height, 2) anterior tibial translation (ATT), and 3) posterior tibial slope following supratubercle ACW-PTO and to compare changes in patellar height to a cohort of medial opening proximal tibial osteotomies (MOW-PTO). Methods: Patients who underwent supratubercle ACW-PTO by a single surgeon from July 2019-February 2023 were included. Institutional Review Board approval was obtained for this study. Radiographic assessment at four time points (preoperative, postoperative day 1, 3 months and 6 months) of patellar height (via the Caton Dechamps and Insall Salvati ratios), posterior tibial slope, and anterior tibial translation of the lateral tibial plateau relative to the lateral femoral condyle was completed. A comparison cohort of patients undergoing MOW-PTO was included for comparison of patellar height. Results: Patellar height averages (n =16) after ACW-PTO using the Caton-Deschamps ratio (Figure 1) demonstrated a significant increase in patellar height on postoperative day 1 (p= 0.004), but were not significantly different at 3 and 6 months postoperatively (Table 2). Conversely, averages of patellar height after MOW-PTO (n =28) demonstrated no difference on postoperative day 1, but then was significantly decreased by 6 months postoperatively (p= 0.005) (Table 1). There was a significant difference between the closing and opening-wedge cohorts when comparing the difference in patellar height using the CD ratio between preoperative and 6 months (p= 0.011). Anterior tibial translation in the ACW-PTO cohort was significantly decreased by an average of 9.0 mm from preoperative to postoperative values (p <<0.001) (Figure 2). Posterior tibial slope in the ACW-PTO cohort was significantly decreased by an average of 11.8° from preoperative to postoperative values (p <<0.001). Conclusions: Supratubercle ACW-PTO performed for ACL failure in the setting of increased tibial slope did not induce significant changes in patellar height postoperatively. Furthermore, following ACW-PTO there was a significant decrease in anterior tibial translation and posterior tibial slope. [ABSTRACT FROM AUTHOR]

Introduction: Voluntary Response Index (VRI) is used as a measure of motor control to study abnormalities of voluntary movements. This study aimed to evaluate the reliability of voluntary response index analysis in subjects with Anterior Cruciate Ligament Reconstruction (ACLR). Materials and Methods: Using surface electromyography, the VRI components of both groups of 15 ACLR and 15 healthy controls were assessed during the functional task (sit-stand-sit). The outcome variables of VRI included the magnitude and similarity index. Results: In sit to stand phase, high reliability was found (ICC=0.80-0.89) for the magnitude and similarity index in both groups. In the standing phase, high to very high reliability was found for the magnitude and similarity index in both groups (ICC=0.75-0.91). In stand to sit phase, high to very high reliability was found (ICC=0.78-0.92) for the magnitude and similarity index in both groups. Conclusion: Surface electromyographic measurements of VRI analysis demonstrated high to very high reliability in athletes with ACLR during the functional task (sit-stand-sit). The results of the current study showed that the VRI analysis in athletes after ACLR was a reliable method and can be used to evaluate motor control before and after ligament injury in these patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Understanding the impact of orthopaedic scientific research is vital in identifying facilitators and barriers to its implementation in clinical practice. A meta‐analysis was carried out which showed that presoaking hamstring (HT) autografts in vancomycin was associated with a 10‐fold reduction in infection rate in anterior cruciate ligament (ACL) reconstruction. Our aim was to determine the practice of orthopaedic surgeons with regards to vancomycin presoaking and explore whether they would adopt the findings of this meta‐analysis. Methods: A paper questionnaire survey was administered to attendees of an annual EFORT podium presentation of the meta‐analysis findings. Descriptive statistics were used to summarize the characteristics of respondents and their responses. Results: A total of 29 senior surgeons/subspecialists performing a median of 40 ACL reconstructions per year completed the survey of whom 7 (24.1%) had encountered an ACL graft infection in the previous 2 years and 14 (48.3%) in the previous 5 years. Only 3 (10.3%) presoaked the ACL graft with an antibiotic. About 1/4 of those who up to then did not pre‐soak the graft (6/26, 23.1%) would consider changing their practice to pre‐soaking with vancomycin, with similar findings (5/20, 25.0%) in those that used a HT autograft as their first choice. Conclusions: Orthopaedic surgeons are receptive to the findings of a meta‐analysis reporting on the effectiveness of vancomycin graft presoaking in ACL reconstruction, which can thus have a substantial impact upon clinical care. Addressing concerns about vancomycin induced graft toxicity and comparing the pre‐soaking effect to that of specific intravenous antibiotic regimens may further enhance the uptake of this practice. [ABSTRACT FROM AUTHOR]

Background: Revision ACL reconstruction is a complex topic with many controversies and not-easy-to-make decisions. The authors' aim is to provide some feasible advice that can be applied in daily clinical practice with the goal of facilitating the decision-making process and improving the outcomes of patients subjected to revision ACL reconstruction., Methods: A national survey with seven questions about the most controversial topics in revision ACL reconstruction was emailed to members of two societies: SIOT and SIAGASCOT. The participants' answers were collected, the most recent literature was analyzed, and a consensus was created by the authors, according to their long-term surgical experience., Conclusions: The decision-making process in revision ACL reconstruction starts with a standardized imaging protocol (weight-bearing radiographs, CT scan, and MRI). One-stage surgery is indicated in almost all cases (exceptions are severe tunnel enlargement and infection), while the choice of graft depends on the previously used graft and the dimensions of the tunnels, with better clinical outcomes obtained for autografts. Additional procedures such as lateral extra-articular tenodesis in high-grade pivot-shift knees, biplanar HTO in the case of severe coronal malalignment, and meniscal suture improve the clinical outcome and should be considered case by case., Level of Evidence: V (Expert opinion)., (© 2022. The Author(s).)

Objectives: Short-term follow-up of anterior cruciate ligament (ACL) primary repair (ACLPR) presented increased failure risk (37%) in patients ≤21 years of age (y/o), however low rates in patients >21 y/o (3.5%). Mid- and long-term clinical evidence for contemporary anterior cruciate ligament primary repair (ACLPR) is lacking, whereas outcomes of historical ACL repair were shown to deteriorate at midterm follow-up after initial good short-term outcomes. This study evaluates age-differentiated survival rates of ACLPR at 5-year FU to assess whether the previously presented rates at 2-year FU can be maintained at 5-year FU. Methods: The first 113 consecutive patients with proximal ACL tears undergoing ACLPR by a single surgeon, from 04/2008 to 09/2017, were prospectively followed up. Indication for ACLPR was determined if a proximal type I or II tear and good to excellent tissue quality was present. Failure and re-operation rates, patient reported outcome measurements (PROMs) (IKDC score, Lysholm score, Forgotten Joint score, ACL-RSI score, and Tegner Activity Scale Difference) and instrumented anterior-tibial translation side-to-side difference (ATT-SSD) were recorded at minimum 5-year FU. Results: A total of 96 patients (85%) with a mean final FU of 7.2 ±2.3 (5.0 – 12.8) years were evaluated. Ipsilateral reinjury rates for patients ≤21 y/o, from 2- to 5-year FU, remained stable (40.0%) with no additional failure recorded. Six additional re-injuries were detected in patients >21 y/o, leading to a failure rate of 9.8% at 5-year FU. Mean time to failure following surgery was 17 ±11 months in patients ≤21 y/o versus 26 ±16 months in patients >21 y/o. Re-operation rates for patients ≤21- and >21 y/o were 0.0% and 4.0% respectively. PROMs showed no significant differences as compared to outcomes at 2-year FU (p <.001) and 5-year ATT-SSD was 0.75 ±1.2 mm. Conclusions: ACLPR is correlated with a high risk of early failure (40.0% at 17 ±11 months) in patients < 21 y/o, however no additional subsequent re-injuries were reported at minimum final 5-year FU. In contrast, patients >21 y/o demonstrate low failure rates at 2- (3.5%) and 5-year FU (9.8%). [ABSTRACT FROM AUTHOR]

Objectives: Lateral meniscus oblique radial tears (LMORTs) commonly occur in the setting of anterior cruciate ligament (ACL) rupture. Despite publications pertaining to the prevalence, biomechanics, and surgical repair techniques of LMORTs, studies reporting outcomes following LMORT repair are lacking. The purpose of this study was to examine clinical and patient-reported outcomes following the surgical repair of LMORTs during ACL reconstruction. Methods: A retrospective chart review was conducted on 845 patients that underwent a meniscus repair at a single institution between 2017 and 2019. Operative reports, procedure notes, and operative images were manually reviewed to identify LMORTs. Subsequent knee surgery, meniscus repair failure, and postoperative complications were also extracted during the chart review. Postoperative complications were defined as reinjury, pain, stiffness, recurrent swelling, weakness, instability, or superficial wound infections. Patients were contacted postoperatively for evaluation of patient reported outcomes including the Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale (MARS), and Visual Analog Scale (VAS). Results: Twenty-five patients (68% male) were identified who underwent repair of an LMORT in the same setting as an ACL reconstruction during the study period. Mean age was 21.1 ± 4.6 years old, and the mean body mass index was 26.9 ± 5.1 kg/m2. Mean follow-up was 33.1 ± 25.7 months. There were no reported failures of the LMORT repair. Postoperative complications were reported in 9 patients (36%). Seven of these patients underwent repeat arthroscopy of the index knee for stiffness, pain, and/or repeat injury. However, of the patients who had repeat arthroscopy at the same institution (6 patients), all demonstrated complete healing of the LMORT repair site during arthroscopic evaluation. For patients completing patient-reported outcome measures, there was a minimum follow-up period of 43 months from the initial date of surgery. The mean KOOS, MARS, and VAS were 86.3 ± 8.1, 6.7 ± 4.2, and 2.0 ± 1.3, respectively. Conclusions: Surgical repair of LMORTs results in low failure risk, low complication rates, and favorable patient-reported outcome measures. Further work is needed to evaluate for differences in outcomes between meniscus repair versus partial meniscectomy versus observation of these LMORT lesions. [ABSTRACT FROM AUTHOR]

Purpose: History of an anterior cruciate ligament reconstruction (ACLR) and high body mass index (BMI) are strong independent risk factors for knee osteoarthritis (KOA) onset. The combination of these risk factors may further negatively affect joint loading and KOA risk. We sought to determine the combined influence of BMI and ACLR on walking speed and gait biomechanics that are hypothesized to influence KOA onset., Methods: Walking speed and gait biomechanics (peak vertical ground reaction force [vGRF], peak vGRF instantaneous loading rate [vGRF-LR], peak knee flexion angle, knee flexion excursion [KFE], peak internal knee extension moment [KEM], and peak internal knee abduction moment [KAM]) were collected in 196 individuals with unilateral ACLR and 106 uninjured controls. KFE was measured throughout stance phase, whereas all other gait biomechanics were analyzed during the first 50% of stance phase. A 2 × 2 ANOVA was performed to evaluate the interaction between BMI and ACLR and main effects for both BMI and ACLR on walking speed and gait biomechanics between four cohorts (high BMI ACLR, normal BMI ACLR, high BMI controls, and normal BMI controls)., Results: History of an ACLR and high BMI influenced slower walking speed (F1,298 = 7.34, P = 0.007), and history of an ACLR and normal BMI influenced greater peak vGRF-LR (F1,298 = 6.56, P = 0.011). When evaluating main effects, individuals with an ACLR demonstrated lesser KFE (F1,298 = 7.85, P = 0.005) and lesser peak KEM (F1,298 = 6.31, P = 0.013), and individuals with high BMI demonstrated lesser peak KAM (F1,297 = 5.83, P = 0.016)., Conclusion: BMI and history of ACLR together influence walking speed and peak vGRF-LR. History of an ACLR influences KFE and peak KEM, whereas BMI influences peak KAM. BMI may need to be considered when designing interventions aimed at restoring gait biomechanics post-ACLR.

Objectives: Few studies have examined the viability of the quadriceps tendon autograft as a revision graft option following failed primary bone-patellar tendon-bone (PT) autograft reconstruction. Potential concerns include further disruption to the knee extensor mechanism, inhibition of the quadriceps muscle, and increased complication and reinjury rates. The purpose of this study was to assess knee extension strength, functional outcomes, patient reported outcomes, and return to play after revision ACL reconstruction using free quadriceps tendon autograft after a failed primary reconstruction using bone-patellar tendon-bone (PT) autograft. Methods: A retrospective case series was conducted in accordance with Strengthening the Reporting of OBservational Studies in Epidemiology (STROBE) guidelines using a prospective single surgeon ACL database (n = 1,514) that included 48 patients receiving revision ACL reconstruction using free QT autograft after failure of primary PT autograft ACL reconstruction from 2015-2019. Exclusion criteria are listed in Figure 1, and included ages <15 years or > 55 years, bi-cruciate ligament injuries, and meniscal allograft transplant. Baseline patient demographics and surgical variables were collected and included preinjury level of function (Marx Score). Functional and self-reported outcomes were obtained at the time of return to play and consisted of: single-leg squat symmetry, hip abduction strength, single-leg hop tests, agility testing, and isokinetic knee extension strength (60°, 180°, and 300°/sec). Self-reported outcomes at the time of return to play included the International Knee Disability Committee (IKDC-2000) scale and Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) psychological readiness survey. Return to play was defined as the time (mo) required to reach a threshold of 90% limb symmetry on objective functional testing compared to the contralateral extremity and ultimately, the surgeon's discretion. Injury and complication surveillance was conducted for 2-years postoperatively, and patients were contacted via email or phone survey at 24-months to obtain functional status and single answer numeric evaluation (SANE) scores. Descriptive statistics were calculated using SPSS (version 26, IBM Inc, NY, USA). Results: Baseline patient demographics are listed in Table 1 for the 48 patients (mean age 23.9 ±9.5 years; 14/34 female/male) enrolled in the study. Isokinetic knee extension strength was 84.3 ±17.1% at 60°/sec, 88.6 ±16.4% at 180°/sec, and 92.0 ±19.5% at 300°/sec. The mean knee function SANE score at 2-years was 88.9 ±12.2%. All patients went through return to play testing prior to returning to sport. The mean time to return to play was 8.9 ±1.8 mo, and the mean 24-month assessment was conducted at 24.6 ±2.3 mo. Limb symmetry index scores ranged from 94.1%-102.6% across all objective functional tests (Table 2), and self-reported knee function via the IKDC-2000 was 86.3±16.8. Three patients were lost to follow up (6.3%) at 2-years, and of the 45 patients remaining in the study, 3 sustained graft reinjuries (6.7%). Two-year complications are listed in Table 3, and included meniscal tear (2.2%), DVT (4.4%), loss of motion requiring surgical lysis of adhesions (4.4%), anterior knee pain (11.1%), and symptomatic removal of hardware (2.2%). Conclusions: Free quadriceps tendon autograft is a viable autograft option for revision ACL reconstruction for failed PT autograft allowing return to high function without compromising knee extension strength with a low failure and complication rate. Two-year graft reinjury rates for revision ACL reconstruction with free QT autograft are similar or favorable to other autograft options previously reported in the literature in a revision setting. Additionally, functional outcomes are comparable to revision reconstructions using PT autograft and good to excellent outcomes can be obtained Table 1. Patient Demographics Fig 1. Study Design Table 2. Level of Return to Sport Table 3. Return to Play Functional Performance Outcomes [ABSTRACT FROM AUTHOR]

Purpose: Compared with other sports, soccer is an activity with a relatively high incidence of injury. To decrease the number of injuries, prevent early retirement, and provide a healthy and safe environment for players, preventive programs are highly recommended. This study aimed to investigate the effect of Sportsmetrics Soccer Training (SMST) on Landing Error Scoring Systems (LESS) and dynamic balance in soccer players. Methods: This study was a randomized controlled trial with pretest-posttest design and training (TG) and control (CG) groups. The statistical population comprised young soccer players over 18 years old recruited from Zulfaqarnasab Soccer Academy in Sanandaj City, Iran. The study participants were 29 soccer players with three years of experience in soccer clubs. The subjects were randomly assigned into TG (n=14, mean±SD age=18.40±0.5 years, mean±SD height=180.40±6.86 cm, mean±SD weight=70.47±9.62 kg) and CG (n=15, mean±SD age=18.64±0.08 years, mean±SD height=179.57±6.72 cm, mean±SD weight=64.64±6.61 kg). The TG group performed SMST three times a week for six weeks (each session lasted 35 to 45 minutes). The CG did not receive any intervention. The LESS (intraclass correlation [ICC]=0.82- 0.99) and the Y-balance (ICC=0.91-0.99) were used for assessing landing errors and dynamic balance. The obtained data were analyzed using the Analysis of Covariance (ANCOVA) (P≤0.05) in SPSS (version 24). Results: The TG showed a significant improvement in scores of LESS (F=48.23, P=0.0001), anterior reach (F=18.26, P=0.0001), posteromedial reach (F=21.15, P=0.0001), and posterolateral reach (F=17.94, P=0.0001) in posttest compared to their baseline results. Conclusion: The present study results showed that SMST could improve LESS score and Y-balance, so we recommend that soccer coaches use SMST to prevent injury. [ABSTRACT FROM AUTHOR]

Objectives: Anterior cruciate ligament rupture is a serious trauma with long-term consequences for the patient. Psychological and physiological factors may negatively affect patient recovery after anterior cruciate ligament reconstruction (ACLR), and development of kinesiophobia is possible. The aim of this study was to examine the presence of kinesiophobia and lower-leg muscle strength recovery in both sexes after ACLR., Methods: 140 ACLR patients agreed to participate in the study. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK). The Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS) and Tegner Activity Scale (TAS) were used for patient-related outcome measurements. In both legs quadriceps and hamstring muscle strength at 60°/s and 180°/s were measured with an isokinetic dynamometer. For dynamic balance and leg function, the Y-balance test and single-leg hop test were used., Results: 100 (71%) males and 40 (29%) females-mean age 32.5 (±8.3)-were examined 5.5 (±1.25) years after ACLR. 68/140 patients (48.6%) reported a TSK kinesiophobia score equal to or higher than 37 points: 54/100 (54%) males and 14/40 (35%) females (p ​= ​0.04). Patients with kinesiophobia had significantly lower KOOS values (p ​< ​0.001). In terms of the TAS no significant differences were found between those with or without kinesiophobia. Knee strength deficiency at 180°/sec and 60°/sec was significantly higher in the kinesiophobia group in knee extension in males (p ​= ​0.009) and knee flexion in females (p ​= ​0.001). Normalized body weight isokinetic average peak torque strength tests were significantly better in males compared to females in both groups (p ​< ​0.001)., Conclusion: Both sexes reported high rates of kinesiophobia, but males are at higher risk of developing kinesiophobia than females in the medium term after ACLR. Furthermore, patients with kinesiophobia have significantly lower total KOOS scores, and females were significantly weaker than males in knee flexion and extension according to normalized body weight muscle strength tests. Also, a longer time from injury to surgery increases the risk of kinesiophobia in females., Level of Evidence: Level IV., Type of Study: Retrospective case series study., Clinical Trial Registration: Trial registration in ClinicalTrials.gov. Identifier: NCT05762809., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Leho Rips reports financial support and article publishing charges were provided by Tartu University Hospital. Juri Toomas Kartus reports a relationship with CONMED Corp that includes: speaking and lecture fees. 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 Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Dynamic knee valgus (DKV) is a risk factor for non-contact anterior cruciate ligament (ACL) injuries. Understanding the changes in the electromyographic activity of the lower extremity muscles in individuals with DKV helps trainers design ACL injury prevention exercises. Therefore, the present meta-analysis aimed to investigate the muscle activation of the lower limb muscles in individuals with DKV during single-leg and overhead squats., Methods: Articles with titles, abstracts, and full texts were searched and screened independently by two reviewers in the Web of Science, Scopus, PubMed, and Google Scholar databases, without restrictions on publication date and in English using specified keywords from their inception to January 5, 2024. The quality of articles was evaluated using a modified version of the Downs and Black quality checklist. This meta-analysis used mean difference (MD) to compare the muscle activity patterns between individual with DKV and healthy individuals. Heterogeneity was detected using I-square (I 2 ) test., Results: In total, four papers with 130 participants were included in the study. Evidence showed a significant difference between the DKV group and the healthy group regarding the activities of the adductor magnus (MD: 6.25, P < 0.001), vastus medialis (MD: 13.23, P = 0.002), vastus lateralis (MD: 11.71, P = 0.004), biceps femoris (MD: 3.06, P = 0.003), and tibialis anterior muscles (MD: 8.21, P = 0.02). Additionally, muscle activity in the DKV group was higher than that in the healthy group., Conclusions: This meta-analysis reveals distinct muscle activation patterns in individuals with dynamic knee valgus (DKV), with increased activity in key muscles suggesting compensatory responses. These findings underscore the need for targeted rehabilitation to address muscle imbalances and improve knee stability., (© 2024. The Author(s).)

Importance: Bibliometric research is a statistical analysis of publications to measure the scientific output in a specific field in order to highlight medical developments or knowledge gaps and to direct future scientific research. The quantity of orthopedic papers on the internet is astounding and is steadily growing as a result of recent advancements in technology and medicine. This is why choosing the right information is essential., Aim: The purpose of this study was to analyze the current literature for trends in publications regarding quadriceps tendon (QT) grafting of the anterior cruciate ligament (ACL)., Evidence Review: PubMed was searched on August 28, 2023. References were collected from PubMed, and trends were analyzed using this information. This search retrieved 405 articles regarding human and animal studies. We analyzed the top 10 authors and journals in terms of publication numbers, citation numbers, and citations per year. The PubMed-by-year feature was used to compare the number of publications regarding ACL reconstruction by quadriceps grafting with all publications in PubMed., Findings: The number of yearly publications averaged 10 or less up to 2018, starting from 1982 when the first paper on the QT was published. However, the number of publications increased from 2018. While the total number of publications on this topic was 405, 260 were published from 2018 alone. The number of citations was 8262 in total overall years. It is expected that the last five years' publications, especially those for the last year, will be low in number, as it takes time for citations to accrue. The journal Arthroscopy published the most articles on this topic, with 57 papers and 1884 citations, followed by the American Journal of Sports Medicine, with 39 articles and 1576 citations. The top three journals on this topic were Arthroscopy, AmericanJournalofSportsMedicine, and KneeSurgery, SportsTraumatology, Arthroscopy. The most published author was Musahl V (with 24 articles), and the most cited author was Xerogeanes JW (with 570 citations)., Conclusions and Relevance: Global trend analysis suggests that research on anterior cruciate ligament reconstruction with the quadriceps has significantly increased in the last 5 years and that the number of papers on this topic is increasing steadily. We found that the publications and citations are exhibiting a rising trend, Arthroscopy is the most impactful journal, and Musahl V is the most impactful author on the topic. Xerogeanes JW is the author with the most citations on the topic. The promising clinical results of anterior cruciate ligament reconstruction with the QT have attracted the most research interest., Level of Evidence: Level IV., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: This article aims to assess for clinically important differences in patient-reported outcome measures (PROMs) at one and two years post anterior cruciate ligament reconstruction (ACLR)., Methods: A retrospective comparison of prospectively collected PROMs for a single cohort who underwent a primary ACLR with or without associated meniscal surgery from 2016 to 2020 was assessed. Six externally validated PROMs were collected preoperatively and at standardized times postoperatively. Descriptive statistics and paired equivalence testing of PROMs at one and two years after surgery was completed using previously published or calculated minimal clinically important differences as upper and lower equivalence limits. A repeated measures analysis of PROMs that were not clinically equivalent at one and two years after surgery was completed to assess for a clinically significant difference. Subgroup analyses based on sex, age and associated meniscal injury were completed., Results: One-hundred and forty-five participants with a mean age of 28.7 years (standard deviation: 9.9 years) were included in the final analysis. All PROMs were clinically equivalent at two years compared to one year after ACLR except the quality of life and sport and recreation domains of the Knee Injury and Osteoarthritis Outcome Score (KOOS). The quality of life (mean difference (MD):12.3, P ​< ​0.01, effect size (η 2 ): 0.65) and sport and recreation (MD: 8.78, P ​< ​0.01, η 2 : 0.50) domains of the KOOS were clinically different at two years compared to one year postoperatively. No major differences were found in the subgroup analyses compared to the entire included sample., Conclusion: While most PROMs were equivalent at two years compared to one year after ACLR, the quality of life and sport and recreation domains of the KOOS, which reflect knee performance during higher demand activities, exhibited a clinically significant difference., Level of Evidence: IV., 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 Inc. All rights reserved.)

In athletes, a mismatch between caloric intake and energy expended in exercise can eventually lead to Relative Energy Deficiency in Sport (REDs), where the athlete suffers from physiological derangements and decreased sport performance. The prevalence of REDs is higher in females than males. Females are already at a higher risk of knee injuries, which has been attributed to a multitude of factors such as hormonal influences, differences in musculoskeletal anatomy and neuromuscular control compared to males. The literature demonstrates an even higher risk of knee injuries in female athletes with symptoms of REDs. We propose the various factors that influence this risk. A reduction in anabolic hormones can affect muscle development and tendon repair. A relationship between poor neuromuscular control and knee injury has been established, and this can be further worsened in patients with menstrual dysfunction. Chronic deficiency in nutrients such as collagen and vitamin D can result in poorer recovery from microtrauma in tendons and ligaments. All these factors may contribute to increasing the risk of knee injuries, which may include anterior cruciate ligament tears, patella tendinopathy and patellofemoral pain syndrome. This review aims to educate sports clinicians to have a high index of suspicion when treating knee injuries in females; to screen and then manage for REDs if present, for holistic patient care., 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 Inc. All rights reserved.)

Importance: Patients with excessive posterior tibial slope (PTS) may have higher risks of anterior cruciate ligament (ACL) reconstruction (ACL-R) failure, and clinical outcomes after revision of ACL-R procedures are typically poor., Objective: This study aimed to perform a systematic review of the literature summarizing the clinical and radiological outcomes of the surgical treatment of ACL insufficiency in the setting of excessive PTS using a tibial deflexion osteotomy combined with ACL-R., Evidence Review: A systematic review of the literature was performed using PubMed, Cochrane Library, and OVID Medline databases from 1990 to present. Inclusion criteria were studies of outcomes of isolated tibial deflexion osteotomies performed with primary or revision ACL-R in the English language. Data extracted included study demographic information, type of tibial deflexion osteotomy and concomitant procedures, radiological outcomes, patient-reported outcome scores, and postoperative complications., Findings: Six studies, with 133 knees were identified. All included studies were retrospective case series, with a weighted mean follow-up of 3.39 years. In 106 of 133 (79.7%) knees, tibial deflexion osteotomy was performed concomitantly with an ACL-R, whereas in 27 of 133 (20.3%) knees, the procedures were staged. 22, 45, and 66 of 133 knees (16.5%, 33.8%, and 49.6%) underwent primary, first revision, and second or greater revision ACL-R, respectively. Three of 133 (2.25%) knees demonstrated recurrent ACL graft failure at the final follow-up. On average, PTS decreased from 15.2° preoperatively to 7.1° postoperatively. The mean International Knee Documentation Committee, Lysholm, and Tegner scores increased from 42.5, 46.4, and 4.2 preoperatively to 71.8, 89.0, and 6.7 postoperatively., Conclusions: The results of this review suggest that combined ACL-R and tibial deflexion osteotomy may be effective in decreasing PTS and improving knee function and stability., Study Design: Systematic Review; Level of evidence 4., 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 Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To compare 5- to 10-year outcomes of anterior cruciate ligament (ACL) reconstruction in young men performed with bone-patellar tendon bone (BPTB) autograft and anteromedial portal to reconstruction with hamstring autograft and transtibial technique. It was hypothesised that in young adult men, at 5- to 10-year follow-up, superior restoration of knee laxity and activity levels would be demonstrated using BPTB autograft and anteromedial portal technique., Methods: Ninety-four men who had ACL reconstruction with BPTB autograft and anteromedial portal were eligible for comparison to 106 men who had reconstruction with hamstring autograft and transtibial technique. Inclusion criteria were: (1) age 18-35 years, (2) ACL tear caused by sports trauma only, (3) no concomitant ligament reconstruction and (4) 5- to 10-year follow-up. Outcome measures compared between the two groups included Lachman and pivot shift tests, KT side-to-side difference, Tegner and Marx scores, International Knee Documentation Committee (IKDC)-subjective score, Knee Osteoarthritis Outcome Scale (KOOS), Short Form (SF)-36, and single hop test for distance. P value ​< ​0.05 indicated statistical significance., Results: Forty-five patients with BPTB and 55 patients with hamstring ACL reconstruction were available for in-person assessment at 5-10 years after surgery. Outcomes in the BPTB group compared to the hamstring group showed KT difference 1.4 ​± ​1.9 mm vs. 2.8 ​± ​2.3 mm (p ​< ​0.01), pivot shift grade 2-3 in 4% vs. 34% (p ​< ​0.01), return to preinjury Tegner level in 51% vs. 36% (p ​= 0.1) and to preinjury Marx score in 29% vs. 11% (p ​= 0.02), and IKDC-subjective 88 ​± ​10 vs. 82 ​± ​13 vs (p ​< ​0.01), respectively. Statistically significant inter-relationships were found between KT side-to-side difference and the Tegner, Marx and IKDC-subjective scores at follow-up (r ​= ​-0.314, p ​< ​0.01; r ​= ​-0.263, p ​< ​0.01; r ​= ​-0.218, p ​= ​0.03, respectively)., Conclusion: Young men undergoing ACL reconstruction with patellar tendon autograft and anteromedial drilling outperform at 5- to 10-year follow-up in terms of graft stability and activity levels compared to young men undergoing reconstruction with hamstring autograft and transtibial drilling., Level of Evidence: III (Retrospective cross-sectional comparative study)., 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 Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: The anterior cruciate ligament is probably one of the ligaments with the lowest healing potential. Many authors have reported cases of spontaneous healing but nowadays it is difficult to predict successful healing of an anterior cruciate ligament rupture and, even more, residual functionality and capability to return to sport. The aim of this study was to investigate cases of spontaneous healing in a population that received non-surgical treatment after anterior cruciate ligament rupture and to perform an updated review of contemporary literature. Methods: The authors retrospectively reviewed patients who suffered from an acute complete anterior cruciate ligament rupture and underwent non-surgical treatment. No specific rehabilitation protocol was prescribed. A new magnetic resonance imaging study was conducted 6 months after the injury for all patients. A literature review was conducted regarding spontaneous healing of the anterior cruciate ligament. The papers included in the analysis were reports of any level of evidence, written in English, Italian, or French languages; articles were excluded if they reported non-human studies, histological studies, studies conducted without magnetic resonance imaging or arthroscopic second look, or partial anterior cruciate ligament tear. Results: Case series: Six patients were enrolled in the study. All patients had a proximal anterior cruciate ligament lesion. The minimum follow-up was 13 months (range 6–20 months). At the last follow-up the mean score on the Lysholm scale was 97, the mean IKDC score was 94, and the mean KOOS score was 96. All patients returned to their own sport activities; no one reported significant differences. The magnetic resonance imaging study at 6 months revealed an end-to-end continuous anterior cruciate ligament with homogeneous signal. No one had any new knee injury at last follow-up. Literature review: A search of comprehensive databases retrieved 1057 articles; 8 full-text articles met the eligibility criteria. The studies were heterogeneous regarding the populations analysed, sport activity level, treatment applied, healing definition, and follow-up. The failure rate of non-surgical management ranged among the papers from 0 to 73%. Conclusions: The study findings show that spontaneous anterior cruciate ligament healing is possible and there are chances of clinical recovery for patients not suitable for surgery. However, there is still a lack of evidence about predictors, clinical outcomes, and adequate rehabilitation protocols. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this paper is to conduct a bibliometric analysis to examine the research status and development trend of anterior cruciate ligament injury and reconstruction in children and adolescents over the past 20 years., Design: Descriptive Research., Methods: This study obtained information regarding studies on Anterior Cruciate Ligament Reconstruction in Children and Adolescents from the Web of Science Core Collection database. Visual and bibliometric analysis were conducted using VOSviewer, Origin 2022, Pajek64 5.18and Excel 2019. These analytic tools facilitated the analysis of various aspects, including countries/regions, institutions, authors, journals and keywords related to the research., Results: From 2003 to 2023, a total of 1328 articles were retrieved in WOS, and 637 articles were selected by two authors. The most productive institutions are Childrens Hosp Philadelphia, Kocher, ms. Their articles have the highest number of publications and citations. The American journal of sports medicine is the most frequently cited journal for articles on anterior cruciate ligament reconstruction in children and adolescents. The most common keywords used in these articles were "anterior cruciate ligament reconstruction", "injury, children, adolescent", and "skeletally immature patients"., Conclusions: This study provides valuable insights into the research focus of anterior cruciate ligament reconstruction in children and adolescents. In recent years, there has been significant attention paid to areas of "the return to sport, re-repture rate and functional recovery after anterior cruciate ligament reconstruction" in this specific population. These aspects have emerged as key directions for future research in this field., (© 2024. The Author(s).)

Importance: Return to sport (RTS) is considered an indicator of successful recovery after anterior cruciate ligament reconstruction (ACLR). In recent years, there has been major interest in documenting RTS following anterior cruciate ligament (ACL) injury. Despite women being at increased risk for ACL injuries and a global increase in women's participation in sports, research has not adequately focused on female athletes., Objective: The purpose of this study is to conduct a systematic review and meta-analysis evaluating the RTS rate in female athletes after ACLR. We hypothesize that most of the female athletes can RTS., Evidence Review: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic databases (PubMed, Embase, and Epistemonikos) were searched for articles reporting RTS rates and contextual data in female athletes. The following search terms were used: "anterior cruciate ligament reconstruction" OR "ACL reconstruction" AND "female" OR "women" AND "return to sports" OR "return to play" to retrieve all relevant articles published between 2003 and 2023. A quality assessment of the included studies was conducted., Findings: Fifteen articles were included, reporting on 1456 female athletes participating in pivoting sports. The included studies comprised 9 cohorts, 1 case-control study, 2 case series, 2 descriptive epidemiology studies, and 1 observational study. Eight out of fifteen studies focused solely on elite-level athletes. The participants had a mean age of 23.13 years. Soccer was the most prevalent sport among the participants, accounting for 49.7% of all athletes included. All 15 studies reported an RTS rate, yielding a meta-proportion of 69% [95% CI, 58-80%] for RTS. Nine articles reported the average time to RTS, which was 10.8 months [95% CI, 8.7-12.8 months]., Conclusions: This systematic review demonstrates that a majority of female athletes (69 ​%) can RTS participation at an average of 10.8 months, however, the available information is insufficient, and quantitative data and reasons for not returning to play are lacking. Future studies should establish return-to-play criteria in this population and determine reasons for not returning to play., Level of Evidence: III., 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 Inc. All rights reserved.)

This paper focuses on different types of backbone networks for machine learning architectures which perform classification of knee Magnetic Resonance Imaging (MRI) images. This paper aims to compare different types of feature extraction networks for the same classification task, in terms of accuracy and performance. Multiple variations of machine learning models were trained based on the MRNet architecture, choosing AlexNet, ResNet, VGG-11, VGG-16, and Efficientnet as the backbone. The models were evaluated on the MRNet validation dataset, computing Area Under the Receiver Operating Characteristics Curve (ROC-AUC), accuracy, f1 score, and Cohen's Kappa as evaluation metrics. The MRNet-VGG16 model variant shows the best results for Anterior Cruciate Ligament (ACL) tear detection. For general abnormality detection, MRNet-VGG16 is dominated by MRNet-Resnet in confidence between 0.5 and 0.75 and by MRNet-VGG11 for confidence more than 0.8. Due to the non-uniform nature of backbone network performance on different MRI planes, it is advisable to use an LR ensemble of: VGG16 on a coronal plane for all classification tasks; on an axial plane for abnormality and ACL tear detection; Alexnet on a sagittal plane for abnormality detection, and an axial plane for meniscal tear detection; and VGG11 on a sagittal plane for ACL tear detection. The results also indicate that the Cohen's Kappa metric is valuable in model evaluation for the MRNet dataset, as it provides deeper insights on classification decisions. [ABSTRACT FROM AUTHOR]

Objectives: Renewed interest in ACL repair is supported by promising early results from case series. However, comparative studies are currently lacking. The purpose of this study was to compare the clinical and functional outcomes of ACL repair versus ACL reconstruction, at a minimum follow-up of two years. Methods: A retrospective analysis of prospectively collected data was undertaken. Patients who underwent ACL repair were propensity matched (based on variables including age, gender, BMI, time between injury and surgery, knee laxity parameters, the presence of meniscal lesions, pre-operative activity level and sports participation) in a 1:1 ratio, to those who underwent ACL reconstruction during the same period. Isokinetic testing was used to evaluate strength deficits compared to the contralateral limb at 6 months post-operatively. At final follow-up, knee laxity parameters, return to sport, and outcome measures including Lysholm, Tegner, IKDC, ACL-RSI, and the Forgotten Joint Score-12 (FJS) were recorded. Results: 75 matched pairs were evaluated. The ACL repair group had significantly better mean hamstring muscle strength (+1.7% ± 12.8, compared to contralateral limb) when compared to their counterparts who underwent ACL reconstruction (-10.0% ± 12.8, compared to contralateral limb) (p<0.0001) (Table 1). At a mean final follow-up of 30 ± 4.8 months, the ACL repair group had significantly better FJS (82.0 ± 15.1) compared to the reconstruction group (74.2 ± 21.7) (p=0.017). No significant differences were demonstrated between groups with respect to Lysholm, Tegner, and ACL-RSI scores (Table 2). Non-inferiority criteria were met for the ACL repair group, when compared to ACL reconstruction with respect to subjective IKDC scores and knee laxity parameters (side to side antero-posterior laxity difference and pivot shift). There were no significant differences in the rate of return to the pre-injury level of sport (repair group 74.7% vs reconstruction group 60%, p=0.078). However, a significant difference was observed regarding the occurrence of ACL re-rupture (failure rates: ACL repair, 5,3%; ACL reconstruction, 0%; p=0.045). Patients experiencing failure of ACL repair were significantly younger than those that did not (26.8 years vs 40.7 years, p=0.013). There was no significant difference in rupture rates between groups when only patients aged over 22 years were considered (age >22, failure rates: ACL repair 2.8%; ACL reconstruction 0%, p=0.157) Conclusions: ACL repair was associated with significantly better isokinetic strength tests at 6 months, better FJS at final follow-up, and non-inferior IKDC, Lysholm, Tegner, ACL-RSI and knee laxity parameters. However, the rate of re-rupture was significantly higher when compared to ACL reconstruction and younger patients were particularly at risk Table 1. Isokinetic strength at 6 months post-operatively [ABSTRACT FROM AUTHOR]

Objectives: The administration of return to sport assessments have become common in patients following Anterior Cruciate Ligament Reconstruction (ACLR). However, they are often administered after the time of clinical supervision which may leave patients without access to clinical personnel to appropriately address the functional deficits identified. It is currently unknown if patient outcomes would benefit from interim functional assessments while under clinical supervision. The purpose of this study is to compare patient outcomes at the time of return to sport (RTS) progression between those with a prior interim assessment and those without. We hypothesize that patients with prior interim assessments will demonstrate stronger and more symmetric quadriceps strength, greater hopping performance, and higher subjective function. Methods: Patients following ACLR were retrospectively identified through an ongoing RTS assessment program where patients were referred from a sports medicine subspecialist orthopedic clinic to complete a battery of functional assessments This program assessed knee extensor and flexor strength (Nm/kg) and symmetry (%) and patient reported outcomes. Patients were stratified into "Single Test": first assessment between 6- and 9-months post-ACLR and "Repeat Test": prior assessment performed at least 2-months before RTS assessment between 6- and 9-months post-ACLR (Figure 1). Patients were matched based on time post-surgery, age, pre-injury activity level, and graft type. Results: A total of 392 patients were included (Single Test n=303, Repeat Test n=89.) Once matched, 169 patients (21.1±7.0 years, 7.3±.9 mo. post-ACLR) were analyzed (n=69 per group, Figure 2.) Controlling for age, activity level, graft type, and time of the assessment, Repeat Test patients demonstrated higher measures of subjective function (P =.028) and greater knee flexion symmetry (P =.006) compared to Single Test patients. There were no differences in quadriceps strength (P =.82) and symmetry (P =.18) between groups. Conclusions: Patients that received interim functional assessments reported better subjective function and higher hamstring symmetry at the time of return to sport progression compared to patients that completed their first and only assessment at this time-point. Interim referral for functional assessments may identify limitations which medical provides can address prior to the time of RT progression. [ABSTRACT FROM AUTHOR]

After an ACL injury, rehabilitation consists of multiple phases, and progress between these phases is guided by subjective visual assessments of activities such as running, hopping, jump landing, etc. Estimation of objective kinetic measures like knee joint moments and GRF during assessment can help physiotherapists gain insights on knee loading and tailor rehabilitation protocols. Conventional methods deployed to estimate kinetics require complex, expensive systems and are limited to laboratory settings. Alternatively, multiple algorithms have been proposed in the literature to estimate kinetics from kinematics measured using only IMUs. However, the knowledge about their accuracy and generalizability for patient populations is still limited. Therefore, this article aims to identify the available algorithms for the estimation of kinetic parameters using kinematics measured only from IMUs and to evaluate their applicability in ACL rehabilitation through a comprehensive systematic review. The papers identified through the search were categorized based on the modelling techniques and kinetic parameters of interest, and subsequently compared based on the accuracies achieved and applicability for ACL patients during rehabilitation. IMUs have exhibited potential in estimating kinetic parameters with good accuracy, particularly for sagittal movements in healthy cohorts. However, several shortcomings were identified and future directions for improvement have been proposed, including extension of proposed algorithms to accommodate multiplanar movements and validation of the proposed techniques in diverse patient populations and in particular the ACL population.

Purpose: The study's objective was to determine the optimal window for anterior cruciate ligament (ACL) reconstruction with respect to quadriceps atrophies and clinical outcome., Methods: For this retrospective, comparative study, 115 patients aged under 35 were included, who received an ACL reconstruction between 2011 and 2016. They were divided into four groups, depending on the time to surgery, to determine the optimal window for reconstruction: (group 1: ≤21 d, group 2: <21d-56d≥, group 3: >56d-100d≥, group 4: >100d). Follow-up was performed one month postoperatively, after a mean of 4.9 (±5.3) months, and after a mean of 3.5 (±1.4) years. Primary endpoints included quadriceps muscle status, range of motion (ROM), pain, swelling, the International Knee Documentation Committee Subjective Knee Form (IKDC), the Lysholm-Score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tegner-Activity-Scale (TAS)., Results: Significantly more quadriceps atrophies were observed in group 1 and group 4, representing reconstructions earlier than 21 and later than 100 days (29% and 41% vs. 9%; p = 0.032). The measurements of knee extension (p = 0.082) and ROM (p = 0.123) were comparable in all groups. Group 1 showed the least pain (0% vs. 15%; p = 0.285) and swelling (0% vs. 23%; p = 0.077) compared to all other groups one month postoperatively. A comparison of postoperative clinical scores revealed no significant differences, with group 1 exhibiting the lowest TAS levels., Conclusion: In patients who underwent ACL reconstruction within three weeks or after more than 100 days, a significantly higher incidence of quadriceps atrophy was observed, possibly attributable to the initial inflammatory phase or the delayed reconstruction affecting quadriceps function. However, this impairment may not be observable in elite athletes who undergo reconstruction within hours of the injury., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Patrick Sadoghi receives industry grants from Depuy Synthes, Alphamed Medizintechnik Fischer GmbH, and Medacta International SA not related to the submitted work. All other authors declare that there are no potential conflicts of interest related to the study authors and corresponding organizations, and publication of the paper. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Widhalm 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.)

Objectives: There is no clear consensus so far on which fixation method is most favorable for the tibial tunnel in anterior cruciate ligament reconstruction (ACLR). The purpose of this paper is to investigate the outcome of RigidFix cross pins fixation in the tibial tunnel and to explore the advantages of RigidFix applied both in the femoral and tibial tunnel with hamstring tendon graft in anterior cruciate ligament reconstruction., Methods: This retrospective study included 53 patients (male/female, 45/8) who underwent anterior cruciate ligament reconstruction using autologous hamstring tendons between January 2013 and December 2017 at our institute. The participants in group A (n = 36) received anterior cruciate ligament reconstruction with RigidFix cross pins fixation in both femoral and tibial tunnels, while those in group B (n = 17) with RigidFix cross pins fixation in the femoral tunnel and Interference screw fixation in the tibial tunnel. The visual analogue scale (VAS) score, International Knee Documentation Committee subjective knee form 2000 (IKDC2000) score, Lysholm knee scoring scale, Tegner activity score and the side-to-side difference were compared at 2 and 5 years postoperatively. The graft diameter, number of strands in graft and the average diameter of each strand were also compared between the two groups. The categorical parameters were analyzed by chi-square test and the continuous variables conforming to a normal distribution were analyzed by Student's t-test., Results: At 2 years postoperation, the VAS score (1.61 ± 0.55), side-to-side difference (1.50 ± 0.58) in group A were significantly lower than that in group B, and the IKDC2000 score (88.81 ± 3.88), Tegner activity score (6.14 ± 0.60) in group A were significantly higher than that in group B. At 5 years postoperation, the VAS score (1.64 ± 0.68), side-to-side difference (1.73 ± 0.63) in group A were significantly lower than that in group B, and the IKDC2000 score (89.09 ± 3.85), Tegner activity score (6.58 ± 0.94) in group A were slso significantly higher than that in group B. There was statistical difference in the change of the side-to-side difference between the two groups (group A vs. B, 0.22 ± 0.08 vs. 0.34 ± 0.11, p < 0.001). There were also statistical differences in the graft diameter (group A vs. B, 7.83 ± 0.74 vs. 7.41 ± 0.51, p = 0,038), number of strands in graft (5.67 ± 0.72 vs. 4.00 ± 0.00, p < 0.001) and the average diameter of each strand (1.41 ± 0.22 vs. 1.85 ± 0.13, p < 0.001) between the two groups., Conclusion: RigidFix cross pins fixation in the tibial tunnel for anterior cruciate ligament reconstruction can achieve better 5-year results when compared with the interference screw, and the hamstring tendon can be folded into a thicker graft when RigidFix cross pins were applied in both femoral and tibial tunnels., (© 2023 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

(1) Background: The objective of this systematic review was to collect relevant data in the available contemporary studies about sports injuries of basketball players and explain differences in sports injuries relative to gender, location, sport, and position on the court; (2) Methods: The papers were searched digitally using PubMed, MEDLINE, ERIC, Google Scholar, and ScienceDirect databases, from 1990 to 2024; (3) Results: The most frequent severe injuries for both genders are knee and ankle injuries and the most frequent forms of injury are ankle sprain and ligament strain. The most frequent injuries occur during running and after contact with the ball. Shooting guards sustain the highest injury rate followed by centers and point guards, while guards have the highest rate of adductor muscle injury; and (4) Conclusions: Studies indicate that ankle and knee injuries are prevalent among basketball players, with ankle sprains being particularly prevalent. Knee injuries are more common in female basketball players, including ACL injuries. Various factors contribute to injuries, including the biomechanics of jumping, landing, sudden changes in direction, and the physical demands placed on the body during the game. [ABSTRACT FROM AUTHOR]

Soccer is a sport with a high incidence of injuries. The most common injury occurs when the anterior cruciate ligament of the knee has undergone a sprain, strain, or partial or total rupture. Besides fitness factors (e.g., proprioception, balance and strength capabilities), a principal cause of ACL injuries is sport shoes and playing surfaces. Especially with the emergence of artificial surfaces (rubbers, turfs, concrete, asphalt, red turf), the ACL injuries dramatically increase. The cost of ACL injuries is high both in terms of career termination and in social and economic costs. Thus, it is necessary to understand the impact of sport shoes and playing surfaces on the ACL and how it can be mitigated. The present literature review followed the PRISMA methodology to identify the major biomechanical factors influencing the behavior of surfaces and shoes in relation to the ACL damage. Fifty-eight papers were identified. After reviewing the mechanism of injuries, we identified several distinct factors: type of outsole and mechanical arrangement of the outsoles; shear forces; characteristics of artificial turf surfaces; effect of weather on artificial surface aging and change in mechanical characteristics; outsole/ground interface; and the frictional, tractional and rotational forces in the pathogenesis of ACL injuries in soccer. [ABSTRACT FROM AUTHOR]

Infection is an uncommon side effect of arthroscopic surgery, and this percentage is higher in anterior cruciate ligament reconstruction (ACLR) surgery, where graft and fixation devices are used. Infections can not only lead to high re-admission rates and poor functional recovery of the knee but can also have a significant negative impact on the patient's psychological and economic health, especially in athletes, as it can affect their sports career. It is important to be aware of the many risk factors, especially the manifestation of symptoms. These may sometimes be non-specific to the infectious pathology and common to other situations, such as the presence of a significant intra-articular hematoma. Septic arthritis after ACLR can occur at any time after surgery but typically presents acutely, while late manifestation is relatively rare. Diagnosis of infection is based on patient history, physical examination, laboratory parameters, and analysis of synovial fluid after joint aspiration, which is the gold standard for diagnosing post-operative infection. Once symptoms appear and the diagnosis seems certain, it is necessary to intervene quickly with arthroscopic debridement and long-term antibiotic treatment to try to save the graft and resolve the infectious situation to avoid graft failure and arthrofibrotic sequelae. The aim of this paper is to provide an overview of the epidemiology, pathogenesis, risk factors, clinical presentation, diagnostic evaluation, and current treatment guidelines of septic arthritis after ACLR surgery by analyzing recent literature, in particular meta-analyses and systematic reviews. [ABSTRACT FROM AUTHOR]

Objectives: To develop and validate a short form, disease-specific version of the KOOS appropriate for the young active ACL deficient population: the KOOS-ACL. Methods: A baseline dataset of 605 young patients (< 25 years) with ACL tears was divided into a development and validation sample. Exploratory factor analyses were conducted in the development sample to identify the underlying factor structure and reduce the number of KOOS items based on statistical and conceptual indicators. Confirmatory factor analyses were conducted to check fit indices of the proposed KOOS-ACL model in both samples. Structural validity, reliability, and responsiveness to change were assessed in the full sample at five timepoints: baseline and 3 months, 6 months, 12 months and 24 months post-operatively. Results: Two factors were deemed most appropriate for the KOOS-ACL: Functionality and Sport. Fifteen items were removed from the full length KOOS based on discriminant validity (i.e., lack of distinctiveness between some proposed constructs) and another fifteen items were removed for repetitive content. The final KOOS-ACL model showed acceptable structural validity (CFI and TLI > 0.9, RMSEA and SRMR < 0.08), internal consistency reliability (a > 0.8), and responsiveness to change (effect size > 0.8) at all five timepoints in the dataset. The KOOS-ACL showed strong and significant correlations to the original KOOS and IKDC at all timepoints (r > 0.7). Conclusions: The new KOOS-ACL questionnaire contains 12 items and two subscales relevant to young active ACL patients. The KOOS-ACL would reduce patient burden by more than two thirds and provides improved structural validity compared to the full length KOOS while maintaining adequate psychometric properties and relatedness to other popular outcome measures currently used following ACL injuries. The KOOS-ACL may be a more relevant outcome to use with young active ACL patients within the two years of surgery. [ABSTRACT FROM AUTHOR]

In the era of big data, text-based medical data, such as electronic health records (EHR) and electronic medical records (EMR), are growing rapidly. EHR and EMR are collected from patients to record their basic information, lab tests, vital signs, clinical notes, and reports. EHR and EMR contain the helpful information to assist oncologists in computer-aided diagnosis and decision making. However, it is time consuming for doctors to extract the valuable information they need and analyze the information from the EHR and EMR data. Recently, more and more research works have applied natural language processing (NLP) techniques, i.e., rule-based, machine learning-based, and deep learning-based techniques, on the EHR and EMR data for computer-aided diagnosis in oncology. The objective of this review is to narratively review the recent progress in the area of NLP applications for computer-aided diagnosis in oncology. Moreover, we intend to reduce the research gap between artificial intelligence (AI) experts and clinical specialists to design better NLP applications. We originally identified 295 articles from the three electronic databases: PubMed, Google Scholar, and ACL Anthology; then, we removed the duplicated papers and manually screened the irrelevant papers based on the content of the abstract; finally, we included a total of 23 articles after the screening process of the literature review. Furthermore, we provided an in-depth analysis and categorized these studies into seven cancer types: breast cancer, lung cancer, liver cancer, prostate cancer, pancreatic cancer, colorectal cancer, and brain tumors. Additionally, we identified the current limitations of NLP applications on supporting the clinical practices and we suggest some promising future research directions in this paper. [ABSTRACT FROM AUTHOR]

This paper presents the development of a robust control algorithm to be applied in a knee and ankle joint exoskeleton designed for rehabilitation of flexion/extension movements. The goal of the control law is to follow the trajectory of a straight leg extension routine in a sitting position. This routine is commonly used to rehabilitate an injury on an Anterior Cruciate Ligament (ACL) and it is applied to the knee and ankle joints. Moreover, the paper presents the development and implementation of the robotic structure of the ankle joint to integrate it into an exoskeleton for gait rehabilitation. The development of the dynamic model and the implementation of the control algorithm in simulation and experimental tests are presented, showing that the proposed control guarantees the convergence of the tracking error. [ABSTRACT FROM AUTHOR]