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Background: A disadvantage of using hamstring tendon autograft consisting of the semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction is pain from tendon harvesting and persistent hamstring weakness. In the tendon-sparing all-inside technique, a quadrupled semitendinosus graft and adjustable-loop cortical fixation are suggested to give less postoperative flexion deficits while displaying overall similar clinical results to the traditional hamstring technique. However, there are a limited number of high-quality studies comparing these techniques with inconsistent results. Purpose: To investigate differences between the all-inside (quadrupled semitendinosus) and traditional hamstring (double-stranded semitendinosus and gracilis) technique regarding (1) self-reported function, (2) hamstring strength, and (3) knee laxity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 98 patients were randomized to either the all-inside or the traditional hamstring technique. Perioperatively, duration of surgery and graft size were obtained. The International Knee Documentation Committee 2000 Subjective Knee Form score, Knee injury and Osteoarthritis Outcome Score, Tegner Activity Scale score, knee laxity (KT-1000 arthrometer side-to-side difference and pivot shift), range of motion, isokinetic knee strength, and hop test score were collected preoperatively and 2 years postoperatively. Return-to-sport readiness was evaluated 9 months postoperatively. Results: A total of 89 patients completed 2-year follow-up, 45 patients with the all-inside technique and 44 patients with the traditional hamstring technique. There were no significant differences between groups in any of the outcome measures 2 years after surgery, but there was a tendency in the all-inside group toward having increased anterior translation (mean, 3.6 mm vs 2.7 mm), a higher number of revision surgeries (5 patients vs 2 patients), and more patients having +1 and +2 pivot-shift values (29 vs 18 patients) when compared with the traditional group. Conclusion: The all-inside technique yields equivalent results to the traditional hamstring technique 2 years after surgery and should be considered a reliable technique to use for ACL reconstruction. Sparing the gracilis tendon does not lead to less persistent hamstring weakness. Long-term follow-up is needed to further determine whether the tendency of increased anterior translation seen at 2 years postoperatively will lead to a higher risk of graft failure. [ABSTRACT FROM AUTHOR]

The Stability Study was a multicenter, pragmatic, parallel groups, randomized clinical trial comparing hamstring tendon autograft anterior cruciate ligament reconstruction with or without the addition of lateral extra-articular tenodesis in young patients at high risk of graft failure. Having recruited 618 patients with a 5% loss to follow up, we were able to demonstrate a clinically and statistically significant reduction in clinical failure and graft rupture at 2 years postoperative. No differences in patient-reported outcomes (PROs) were demonstrated between groups; however, patients who experienced an adverse event had significantly worse PROs than those who did not. [ABSTRACT FROM AUTHOR]

* BACKGROUND: Anterior cruciate ligament tear is a serious knee injury with implications for central nervous system (CNS) plasticity. To perform simple knee movements, people with a history of anterior cruciate ligament reconstruction (ACL-R) engage cross-modal brain regions, and when challenged with cognitive-motor dual tasks, physical performance deteriorates. Therefore, people with ACL-R may increase visual-cognitive neural processes for motor control. * CLINICAL QUESTION: What components of CNS plasticity should the rehabilitation practitioner target with interventions, and how can practitioners augment rehabilitation exercises to target injury associated plasticity? * KEY RESULTS: This clinical commentary (1) describes the neurophysiological foundation for visual-cognitive compensation after ACL-R, (2) provides a theoretical rationale for implementing visual-cognitive challenges throughout the return-tosport continuum, and (3) presents a framework for implementing visual-cognitive challenges from the acute phases of rehabilitation. The Visual-Cognitive Control Chaos Continuum (VC-CCC) framework consists of five training difficulties that progress visual-cognitive challenges from high control to high chaos to better represent the demands of sport. * CLINICAL APPLICATION: The VC-CCC framework augments traditional rehabilitation so that each exercise can progress to increase difficulty and promote sensorimotor and visual-cognitive adaptation after ACL-R. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of untreated medial meniscal ramp lesions (MMRLs) on the tendon graft after anterior cruciate ligament (ACL) reconstruction and histological findings of medial meniscus (MM) in a porcine a model. Methods: A total of 17 pigs were divided into two groups: (1) the untreated MMRL group (UM group, n = 9) and (2) intact MM group (n = 8) and euthanized 12 weeks after surgery. The specimens were then tested cyclically and loaded to failure. Side‐to‐side differences (SSDs) in translation under cyclic loading and structural properties were analyzed. Histological evaluation of the MM was also performed. Results: No significant differences in the SSD in translation during the cyclic testing (UM group, 0.3 ± 0.4 mm; intact MM group, 0.1 ± 1.4 mm), upper yield load (UM group, 476.3 ± 399.9 N; intact MM group, 643.2 ± 302.9 N), maximum load (UM group, 539.5 ± 265.8 N; intact MM group, 705.8 ± 282.6 N), linear stiffness (UM group, 63.5 ± 39.0 N/mm; intact MM group, 73.7 ± 60.1 N/mm) and elongation at failure (UM group, −4.6 ± 16.3 mm; intact MM group, 2.3 ± 6.6 mm) were observed. However, the UM group had significantly worse Modified Mankin's histological grading scores (1.8 ± 0.4 [1–2] vs. 0 ± 0 [0]; p < 0.001) and Modified Copenhaver classification scores (6.6 ± 2.4 [2–9] vs. 0.7 ± 1.1 [0–3]; p < 0.001) than did the intact MM group. Conclusion: Untreated MMRLs showed postoperative histological deterioration. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to compare results of suture‐tape augmented anterior cruciate ligament (ACL) repair (internal bracing [IB]) and ACL reconstruction (ACLR) with hamstring autograft in terms of laxity, proprioception and neuromuscular control. The hypothesis was that with strict indications IB may provide better results in proprioception and neuromuscular control. Methods: Patients with unilateral ACL injury treated with IB or ACLR with hamstring autograft were enroled in this retrospective study. Anterior tibial translation (ATT) in 30° and 90° of flexion was measured with Rolimeter. The joint position sense (JPS) test was performed in 30° and 60° of flexion using Biodex System 4Pro. The time‐synchronized motion capture system and surface electromyography set were used during dynamic tasks to assess knee valgus and semitendinosus (ST) and biceps femoris (BF) activities. Comparisons between both techniques and operated versus contralateral healthy knees were performed. Results: The study groups involved 28 patients after ACLR (21.8 ± 4.8 years) and 20 patients after IB (25.8 ± 10.5 years) with the average follow‐up 30 ± 18 and 28 ± 15 months, respectively. The ATT did not differ significantly between operated groups. In 30° of flexion ATT for ACLR was significantly higher in operated than in contralateral knee (5.8 ± 2.4 mm vs. 4.3 ± 1.3 mm, p < 0.001). The JPS test and dynamic knee valgus presented no significant differences. The ACLR group presented significantly higher ST (p = 0.048) and BF (p = 0.012) activity comparing operated to contralateral knee in dynamic tasks. Conclusion: Suture‐tape augmented ACL repair and ACLR with hamstring autograft yield similar results in terms of laxity, proprioception and neuromuscular control. Level of Evidence: Level III: Retrospective comparative study. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate if the operated knee environment remains abnormal in patients successfully treated with anterior cruciate ligament reconstruction (ACL‐R). Methods: Thirty asymptomatic patients were enrolled (28 men, 2 women, age 28.6 ± 6.54 years, body mass index: 24.9 ± 3.0 kg/m2) and evaluated at 42.2 ± 12.5 months after surgery. Patients were assessed with patient‐reported outcome measurements and with a triaxial accelerometer. The temperature of the knees as well as four regions of interest were evaluated with an infrared thermographic camera FLIR T1020 (FLIR® Systems) according to a standardised protocol including a baseline evaluation and further evaluations immediately after exercise and after 5, 10 and 20 min. The temperature of the ACL‐R knee was compared to that of the contralateral healthy knee for the purpose of the study. Results: The mean temperature of the knee was higher (p = 0.010) for the ACL‐R knees (31.4 ± 1.4°C) compared to the healthy knees (31.1 ± 1.6°C), as well as for the patellar area (p = 0.005), the lateral area (p = 0.016) and the medial area (p = 0.014). The analysis of the response to the exercises of the ACL‐R knees showed similar trends to the healthy knees but higher temperature values at all time points (p < 0.05). Patients who underwent ACL‐R with concomitant meniscal treatment showed higher knee temperatures compared to ACL‐R knees without concomitant meniscal treatment after 5 (p = 0.047), 10 (p = 0.027) and 20 min (p = 0.048). Conclusions: The temperature of asymptomatic knees previously treated with ACL‐R is higher than the contralateral healthy knee, both at rest and after exercise, with a further increase in knees that underwent both ACL‐R and meniscal treatment. These results suggest an inflammatory state persisting years after the surgery, which could predispose to the early onset of knee degeneration. Level of Evidence: III, Case–control study. [ABSTRACT FROM AUTHOR]

Background: Delayed anterior cruciate ligament (ACL) reconstruction often causes residual anterolateral rotatory instability (ALRI) and consequent knee osteoarthritis, warranting the recommendation of early ACL reconstruction within 6 months after injury. Nonetheless, some cases show notable instability, even shortly after injury. The purpose of this study was to identify risk factors for an increase in quantitatively measured pivot shift in patients with ACL‐deficient knees within 6 months after injury. Methods: Patients with primary ACL reconstruction within 6 months after injury and quantitative triaxial accelerometer measurements of preoperative pivot shift were included. Descriptive statistics were calculated for 11 independent variables (age, gender, time from injury to surgery, KT‐1000, knee extension angle, lateral and medial posterior tibial slope angle, medial and lateral meniscus tears, ramp lesion and Tegner active scale). A single regression analysis was performed on the 11 items and acceleration during the pivot shift, and a multiple regression analysis was performed for items with p value less than 0.1. Results: Overall, 111 patients met the inclusion criteria. Single regression analysis showed that medial posterior tibial slope angle, medial meniscus tear and ramp lesion were significantly correlated with acceleration during the pivot shift (p < 0.001, p = 0.04 and p = 0.001). Multiple regression analysis identified medial posterior tibial slope angles and ramp lesions as independent factors for increased preoperative pivot shift (p = 0.005 and 0.01). Conclusion: A steep medial posterior tibial slope angle and ramp lesion were independent risk factors for increased quantitatively measured pivot shift in patients with ACL‐deficient knees. Level of Evidence: Level IV, case series study. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate mid‐ to long‐term clinical outcomes after arthroscopic bucket‐handle meniscal tear (BHMT) repair and to assess the impact of concurrent anterior cruciate ligament reconstruction (ACLR). Methods: A comparative retrospective case series with blinded outcome assessment was conducted. All consecutive patients treated with arthroscopic BHMT repair with or without concurrent ACLR between 2001 and 2021 were eligible for inclusion. Fifty‐five patients with an average follow‐up of 7.3 ± 3.4 years were included in the analysis. Outcome measures comprised post‐operative IKDC Subjective Knee Form, Lysholm Score, Tegner Activity Scale, KOOS, and visual analogue scale (VAS) for satisfaction. Additionally, failure and reoperation rates were assessed. Results: The failure rate was 9%. Medial BHMT repair showed superior post‐operative IKDC scores compared to lateral meniscus repair (p = 0.038). Concurrent ACLR did not demonstrate any impact on post‐operative KOOS, IKDC, Tegner or patient satisfaction. The mean IKDC score at final follow‐up across both groups was 80.4 ± 17.8. The mean Lysholm score was 86.9 ± 16.7. Mean KOOS scores were (i) symptoms: 83.6 ± 18.3, (ii) pain: 90.2 ± 14.4, (iii) activities of daily living: 93.6 ± 15.1, (iv) sports: 78.3 ± 26.0 and (v) quality of life: 70.5 ± 24.5. Mean patient satisfaction (VAS) was 7.9 ± 2.5. The mean Tegner score was 4.9 ± 1.9. A consistent positive correlation between the number of sutures used and post‐operative outcome measures was observed but did not reach statistical significance for most items. Conclusion: Arthroscopic BHMT repair achieved good clinical outcomes and an acceptable failure rate of 9% at a mean follow‐up of 7 years, supporting the clinical value of meniscal repair, including large BHMTs. Concurrent ACLR showed no impact on clinical outcomes. Level of Evidence: Level IV (retrospective case series). [ABSTRACT FROM AUTHOR]

Purpose: Establishing zonal tendon‐to‐bone attachment could accelerate the anterior cruciate ligament reconstruction (ACLR) rehabilitation schedule and facilitate an earlier return to sports. KI24RGDS is a self‐assembling peptide hydrogel scaffold (SAPS) with the RGDS amino acid sequence. This study aimed to elucidate the therapeutic potential of KI24RGDS in facilitating zonal tendon‐to‐bone attachment after ACLR. Methods: Sixty‐four C57BL/6 mice were divided into the ACLR + SAPS and ACLR groups. ACLR was performed using the tail tendon. To assess the maturation of tendon‐to‐bone attachment, we quantified the area of mineralized fibrocartilage (MFC) in the tendon graft with demeclocycline. Immunofluorescence staining of α‐smooth muscle actin (α‐SMA) was performed to evaluate progenitor cell proliferation. The strength of tendon‐to‐bone attachment was evaluated using a pull‐out test. Results: The MFC and maximum failure load in the ACLR + SAPS group were remarkably higher than in the ACLR group on Day 14. However, no significant difference was observed between the two groups on Day 28. The number of α‐SMA‐positive cells in the tendon graft was highest on Day 7 after ACLR in both the groups and was significantly higher in the ACLR + SAPS group than in the ACLR group. Conclusion: This study highlighted the latent healing potential of KI24RGDS in facilitating early‐stage zonal attachment of tendon grafts and bone tunnels post‐ACLR. These findings may expedite rehabilitation protocols and shorten the timeline for returning to sports. Level of Evidence: Not applicable. [ABSTRACT FROM AUTHOR]

Background: After anterior cruciate ligament reconstruction (ACLR), single-leg horizontal hop distance limb symmetry index (LSI) >90% is recommended as a cutoff point for safe return to sport (RTS). However, athletes after ACLR have abnormal lower limb biomechanics despite an adequate single-leg hop distance LSI, implying that athletes are at high risk of reinjury. Symmetry of single-leg vertical jump height appears to be more difficult to achieve and can be a better representation of knee function than single-leg horizontal hop distance. Hypothesis: Athletes after ACLR with single-leg jump height LSI >90% had similar biomechanical characteristics to healthy athletes. Study Design: Controlled laboratory study. Level of Evidence: Level 3. Methods: A total of 46 athletes after ACLR were divided into low jump height (LJH, jump height LSI <90%, n = 23) and high jump height (HJH, jump height LSI >90%, n = 23) groups according to symmetry of single-leg vertical jump height, while 24 healthy athletes acted as a control (CONT) group. One-way analysis of variance was used to compare the kinematic and kinetic characteristics of the LJH, HJH, and CONT groups during single-leg vertical jump. Results: Both the LJH and HJH groups demonstrated greater limb asymmetry (lower LSI) during landing compared with the CONT group in knee extension moment (P < 0.05), peak knee flexion angle (P < 0.05), and knee power (P < 0.05). Conclusion: Symmetry in single-leg vertical jump height does not represent normal lower limb biomechanics in athletes after ACLR. Clinical Relevance: Symmetrical jump height may not signify ideal biomechanical or RTS readiness, but single-leg vertical jump test can be used as a supplement to horizontal hop test or other functional tests to reduce the likelihood of false-negative results in the absence of detailed biomechanical evaluation. [ABSTRACT FROM AUTHOR]

Expansion-type anchors have been developed as an alternative to conventional fixation devices, such as screw-type and button-type anchors, for anterior cruciate ligament (ACL) reconstruction. Here, we present novel expansion-type anchors that minimize damage to both bone tissue and the transplanted ligament during surgery, potentially leading to improved postoperative outcomes for patients. The biomechanical performance of two different expansion-type ACL anchors, the 2 expansion directions type anchor (2EDA) and the 4 expansion directions type anchor (4EDA), was evaluated through finite element analysis. The required force for complete retraction, as well as the stress distribution of the device during the retraction and expansion procedures, was precisely evaluated. Subsequently, we assessed displacement distance and the applied maximum force on bone models under conditions of vertical and oblique force application. The results revealed that both 2EDA and 4EDA for ACL reconstruction have clinical potential, providing sufficient fixation ability under a maximum loading force of 500 N. In this study, we confirmed that ACL reconstruction using the modified expansion-type anchors is a promising approach to enhancing artificial ligament fixation and reducing the risk of postoperative complications. Notably, both 2EDA and 4EDA anchors demonstrated clinical potential, while the 2EDA exhibited improved performance in terms of displacement distance, applied stress, and stress distribution within the bone tunnel. [ABSTRACT FROM AUTHOR]

BACKGROUND: Grafts are often used to reconstruct the anterior cruciate ligament in clinical practice, while different types of grafts affect postoperative knee function and the development of rehabilitation programs. OBJECTIVE: To retrospectively analyze the effects of different graft types on muscle strength, joint stability, functional activities, and return to sports in patients after anterior cruciate ligament reconstruction. METHODS: Related studies were searched through PubMed, Web of Science, Cochrane, CNKI, and WANFANG databases. The Chinese and English key words were “anterior cruciate ligament reconstruction, autografts, allografts, artificial ligaments, bone-patellatendon-bone, quadriceps tendon autograft, hamstring tendon autograft, peroneus longus tendon autograft, rehabilitation, exercise, protocol, return to sport”. RESULTS AND CONCLUSION: Patients with bone-patellar tendon-bone grafts should strengthen centrifugal contraction exercises of quadriceps muscle, and pay attention to the recovery of quadriceps muscle endurance and explosive power in the later stage of rehabilitation. Compared with bone-patellar tendon-bone grafts and hamstring tendon grafts, significantly fewer patients with quadriceps tendon grafts met regression criteria within 5-8 months, and a longer training plan should be developed, with the training cycle lasting as long as possible to more than 3 years. The selection of hamstring tendon grafts should strengthen the hamstring muscle strength training under multiple angles, especially the cycle of bending the knee above 60° until at least 18 weeks after surgery. Patients who choose peroneus longus tendon graft should strengthen the muscle strength around the ankle, mainly the plantar muscle strength. In the selection of allograft, attention should be paid to the reduction of tension resistance of 20% after the graft is disinfected by low-dose radiation, so attention should be paid to knee stability training. Patients who choose artificial ligament grafts can gradually enhance quadriceps and hamstring muscle strength training within 3-6 weeks, pay attention to early proprioceptive exercises, and conduct targeted training on balance, jumping, and flexibility. [ABSTRACT FROM AUTHOR]

BACKGROUND: The type of graft selected during anterior cruciate ligament revision is considered one of the main factors affecting the postoperative outcome, but there are few reports on the comparison between different graft materials. OBJECTIVE: To explore the medium-to-long-term clinical efficacy after anterior cruciate ligament revision with autologous ligament, allogeneic ligament, and LARS artificial ligament. METHODS: A total of 67 patients with the first anterior cruciate ligament revision admitted to the Department of Joint and Sports Medicine, The Second Hospital of Tangshan from May 2011 to May 2020 were selected, including 41 males and 26 females, with a mean age of (45.83±7.39) years. They were divided into three groups according to different grafts used: autologous ligament group (n=24), allogeneic ligament group (n=22), and LARS artificial ligament group (n=21). Follow-up for more than 36 months after revision was performed to evaluate the effect of revision. RESULTS AND CONCLUSION: (1) International Knee Documentation Committee (IKDC) score, Lysholm knee score, and Tegner motor score 1 year after surgery and at the last follow-up in the three groups were higher than those before surgery (P < 0.05). There were no significant differences in IKDC score, Lysholm knee score, and Tegner motor score among the three groups 1 year after surgery and the last follow-up (P > 0.05). (2) The lateral differences of KT-1000 at 1 year after surgery and the last follow-up among the three groups were lower than those before surgery (P < 0.05). The lateral difference of KT-1000 and the positive rate of the axial shift test in the last follow-up of the LARS artificial ligament group were higher than those in the autologous ligament group and allogeneic ligament group (P < 0.05). (3) At the last follow-up, X-ray films showed no obvious enlargement of the reconstructed bone tunnel and no obvious failure of the graft fixation device. There was no obvious aggravation of osteoarthritis, but bone density decreased significantly in some elderly patients. (4) These findings suggest that anterior cruciate ligament revision with LARS artificial ligaments can obtain good initial stability, but with the extension of time, the stability of partial cases tends to decrease, even with reconstructed ligament failure. Both allogeneic and autogenous ligaments can obtain good clinical efficacy in anterior cruciate ligament revision. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the feasibility and precision of using a 3D-printed template for femoral tunnel placement in guiding the optimal positioning of the Internal anatomical stop and Low tension maintenance (IDEAL) bone tunnel during single-bundle anterior cruciate ligament (ACL) reconstruction. Methods: A retrospective analysis was conducted on 40 patients who underwent arthroscopic single-bundle ACL reconstruction at our hospital between April 2021 and November 2021. In the direct vision group, the IDEAL bone tunnel was positioned using radiofrequency localization directly visualized at the stump. In the 3D-printed positioning group, preoperative CT scans and Digital Imaging and Communications in Medicine (DICOM) data were employed. Following the Quadrant method by Bernard, the femoral tunnel's depth was set at 25% and its height at 29%. Postoperative plain CT scans enabled the reconstruction of 3D models for both groups. The accuracy of femoral tunnel placement was then compared. Results: The central locations of the bone tunnels in the direct vision group were at a mean depth of 25.74 ± 1.84% and a height of 29.22 ± 2.97%. In the 3D printing localization group, these values were 25.39 ± 2.98% for depth and 28.89 ± 2.50% for height, respectively. No significant differences were found in tunnel positioning between the groups. Both groups demonstrated statistically significant improvements in International Knee Documentation Committee Subjective Knee Form (IKDC) and Lysholm scores postoperatively, with no significant differences observed 12 months post-surgery. Conclusion: The findings of this study suggest that 3D printing-assisted arthroscopic IDEAL point femoral tunnel positioning and conventional arthroscopic positioning are feasible and effective for ACL reconstruction. Using 3D printing technology to design femoral anchor points in ACL reconstruction allows for the customization of anterior fork reconstruction and precise bone tunnel positioning, supporting the goal of individualized and accurate reconstruction. [ABSTRACT FROM AUTHOR]

Background: Biomechanical changes and neuromuscular adaptations have been suggested as risk factors of secondary injury in individuals after anterior cruciate ligament reconstruction (ACLr). To achieve a better understanding of preventive mechanisms, movement quality is an important factor of consideration. Few studies have explored time-series analysis during landing alongside clinical performance in injured and non-injured individuals. The purpose of the study was to investigate the biomechanical risks of recurrent injury by comparing clinical and jump-landing performance assessments between athletes with ACLr and healthy controls. Method: This study was observational study. Sixteen athletes with and without ACLr voluntarily participated in clinical and laboratory measurements. Single-leg hop distance, isokinetic tests, landing error score, and limb symmetry index (LSI) were included in clinical report. Lower limb movements were recorded to measure joint biomechanics during multi-directional landings in motion analysis laboratory. Hip-knee angle and angular velocity were explored using discrete time-point analysis, and a two-way mixed analysis of variance (2 × 4, group × jump-landing direction) was used for statistical analysis. Time series and hip-knee coordination analyses were performed using statistical parametric mapping and descriptive techniques. Results: Significantly lower single-leg hop distance was noted in ACLr group (158.10 cm) compared to control group (178.38 cm). Although the hip and knee moments showed significant differences between four directions (p < 0.01), no group effect was observed (p > 0.05). Statistical parametric mapping showed significant differences (p ≤ 0.05) between groups for hip abduction and coordinate plot of hip and knee joints. Athletes with ACLr demonstrated a higher velocity of hip adduction. Time-series analysis revealed differences in coordination between groups for frontal hip and knee motion. Conclusions: Athletes with ACLr landed with poor hip adduction control and stiffer knee on the involved side. Multi-directions landing should be considered over the entire time series, which may facilitate improved movement quality and return to sports in athletes with ACLr. [ABSTRACT FROM AUTHOR]

Clinical trials focused on anterior cruciate ligament reconstruction (ACLR) use multiple assessment methods to determine the effectiveness of the interventions; however, the tests used depend on the authors' criteria. The purpose of this study was to determine the assessment tools used in ACLR with autograft or allograft clinical trials. A search of the Cochrane, Scielo, Pubmed, Epistemonikos and PEDro databases was performed until May 10, 2024. Inclusion criteria focused on systematic reviews or meta-analyses from the last five years that specified the type of graft, included follow-up details, and were in English or Spanish. Exclusion criteria contained studies without population numbers, description of sex or no available access. There are post-surgical follow-up times to assess strength that exceed 24 months. The evaluation instruments used included the Limb Symmetry Index (LSI), isokinetic and isometric strength tests; clinical tests such as Lachman, Pivot Shift Test. Functional assessments such as Sigle leg Hop Test; Ccestionaries associated with surgery and function such as the IKDC, Lysholm, Tegner, Shellbourne Trumper; and finally, subjective assessments such as anterior knee pain, pain on kneeling, Active Join Position Sense Assessment. Numerous assessment tools are available after ACL reconstruction, but it is essential to identify the most effective ones in clinical settings. [ABSTRACT FROM AUTHOR]

Purpose: Anterior cruciate ligament reconstruction (ACLR) in children is indicated to reduce recurrent knee instability and further damage to the joint. Postoperative modified gait pattern was reported in the adult population after ACLR. The aim of this study was to analyse gait abnormalities, and especially knee and ankle adaptations during gait in children after ACLR. Methods: A prospective study was performed between 2018 and 2022 on 50 children, aged nine to 15 years with unilateral ACL deficiency. Changes in gait pattern were evaluated by gait analysis before surgery and at the latest follow-up of 24 months. Kinematic data of ACL-deficient limb were compared to contralateral limb and to those of a matched control group of healthy children. Results: Compared to control group, knee flexion was decreased for both ACL-deficient and contralateral knee before surgery. Decreased knee flexion during gait cycle persisted at latest follow-up. Ankle kinematics showed decreased dorsal flexion for both ACL-deficient and contralateral limb before surgery. At latest follow-up, ankle kinematics were modified for ACL-reconstructed limbs only at initial contact and showed no significant difference for contralateral limb compared to the control group. Conclusion: In children with ACL injury, abnormal gait patterns persist two years after ligament reconstruction, in spite of extensive rehabilitation and no clinical complaints. These findings might guide neuromuscular training to improve clinical outcomes and reduce the rerupture rate. [ABSTRACT FROM AUTHOR]

Objective: Peroneus Longus Tendon (PLT), a viable anterior cruciate ligament (ACL) graft, shares similar biomechanics, making it suitable for reconstruction. Controversy exists over whether PLT transplants affects the donor ankle joint. The purpose of this study was to examine the recovery of knee joint function following arthroscopic ACL restoration using autologous PLT and its influence on the donor ankle joint. Methods: A retrospective analysis was conducted on 65 patients with ACL rupture who underwent PLT graft reconstruction in our hospital from January 2016 to December 2021. A three‐dimensional gait analysis of the bilateral knee and ankle joints was performed postoperatively using an Opti_Knee three‐dimensional motion measurement and analysis system—Yidong Medical Infrared Motion Gait Analyzer. Knee function scores and changes in the range of motion of the bilateral knee and ankle joints were collected. The analysis of preoperative and postoperative joint function scores, bilateral knee and ankle mobility was performed by t‐tests. Results: One year after surgery, the patients' International Knee Documentation Committee (IKDC) scores, Knee Injury and Osteoarthritis Outcome Scores (KOOSs), and Lysholm scores were significantly improved compared to preoperative scores, with statistically significant differences (p < 0.05). There was no statistical difference in the American Orthopedic Foot and Ankle Society (AOFAS) score of the donor ankle joint before and after surgery (p > 0.05). During different gait cycles, there was no statistical difference in knee joint mobility between the affected and healthy sides (p > 0.05), but there was a statistical difference in the inversion and eversion angle of the donor ankle joint during the support phase (p < 0.05). Conclusion: ACL reconstruction using the PLT can yield satisfactory knee joint function. However, it does affect inversion and eversion in the donor ankle joint, necessitating postoperative exercises. Similar subjective function ratings for both operated and non‐operated feet, despite increased inversion‐eversion motion in the operated foot, may be influenced by the subjective nature and margin of error in the AOFAS Ankle‐hindfoot score, along with the relatively small variation in ankle inversion‐eversion angles. [ABSTRACT FROM AUTHOR]

Background: The addition of an iliotibial band–based lateral extra-articular tenodesis (LET) to anterior cruciate ligament (ACL) reconstruction (ACLR) has been shown to reduce failure rates. However, there are concerns as to the potential overconstraint of tibiofemoral kinematics that may increase the risk of cartilage degradation. To date, no clinical study has investigated the effect of LET on patellofemoral joint articular cartilage health. Hypothesis: It was hypothesized that at 2 years postoperatively, (1) the addition of LET at the time of ACLR would have no effect on cartilage health on magnetic resonance imaging (MRI), and (2) higher cartilage relaxation values would be associated with worse patient-reported and functional outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A subset of patients from the STABILITY 1 randomized controlled trial were included. All patients underwent primary ACLR with a hamstring autograft. Patients were randomized to either LET augmentation or not. Cartilage status in the patellofemoral joint between the ACLR group and ACLR+LET group was compared using 2-year postoperative quantitative MRI and the ACL osteoarthritis scores of both the surgical and the contralateral nonsurgical knees. Objective functional outcomes and patient-reported outcome measures (PROMs) were attained. Results: A total of 92 patients (43 patients in the ACLR group; mean age, 18.9 ± 3.2 years; 60.5% female; and 49 patients in the ACLR+LET group; mean age, 18.7 ± 3.2 years, 63.3% female) were included. No significant differences were seen in the mean values (ms) for adjusted T1ρ/T2 relaxation times in the medial patella (47.8/42.2 vs 47.3/43.2), central patella (45.5/42.5 vs 44.1/42.7), lateral patella (48.2/43.5 vs 47.3/43.0), medial trochlea (54.7/50.9 vs 56.4/50.9), central trochlea (53.3/51.1 vs 53.1/52.0), and lateral trochlea (54.9/52.1 vs 53.9/52.6) between the ACLR and ACLR+LET groups. No difference in overall ACL osteoarthritis scores was observed (P =.99). An increase in medial patellar T2 relaxation times was associated with a decreasing International Knee Documentation Committee score (P =.046), Knee injury and Osteoarthritis Outcome Score (KOOS) Symptoms subscale score (P =.01), and total KOOS (P =.01). Conclusion: There was no statistical difference in patellofemoral cartilage health between knees 2 years after primary ACLR with hamstring tendon autograft with or without LET. Statistically significant correlations were found between quantitative MRI relaxation times, functional outcome scores, and PROMs; however, the correlations were weak and the clinical significance is unknown. Registration: NCT02018354 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: The vancomycin presoaking technique (wherein grafts are treated with a vancomycin solution [VS] for anterior cruciate ligament reconstruction [ACLR]) reduces the infection rate after ACLR. However, the effects of this technique on graft-bone healing have not been fully elucidated. Purpose: To investigate the effects of vancomycin presoaking on graft-bone healing in a rat ACLR model. Study Design: Controlled laboratory study. Methods: Long flexor digitorum longus tendons were obtained from 9 Wistar rats, and each was randomly allocated to the normal saline (NS) or VS groups. The grafts were immersed in sterile saline for 30 minutes in the NS group and in a 5-mg/mL VS in the VS group. The presence of time-zero graft bacterial contamination was confirmed, and the grafts were incubated in Fluidised Thioglycollate Broth for 2 weeks. ACLR was performed on the right knees of 65 male Wistar rats using the flexor digitorum longus tendons. Each graft was similarly treated. Biomechanical testing, micro–computed tomography, and histological evaluations were performed 4 and 12 weeks postoperatively. Results: The VS group showed significantly reduced graft contamination at time zero (P =.02). The mean maximum loads to failure were 13.7 ± 8.2 N and 11.6 ± 4.8 N in the NS and VS groups, respectively, at 4 weeks (P =.95); and 23.2 ± 13.2 N and 30.4 ± 18.0 N in the NS and VS groups, respectively, at 12 weeks (P =.35). Regarding micro–computed tomography, the mean bone tunnel volumes were 3.76 ± 0.48 mm3 and 4.40 ± 0.58 mm3 in the NS and VS groups, respectively, at 4 weeks (P =.41); and 3.51 ± 0.38 mm3 and 3.67 ± 0.35 mm3 in the NS and VS groups, respectively, at 12 weeks (P =.54). Histological semiquantitative examination revealed no clear between-group differences at any time point. Conclusion: Presoaking grafts in vancomycin in a rat ACLR model demonstrated no discernible adverse effects on short- and midterm biomechanical, radiological, and histological investigations. Clinical Relevance: The findings provide guidance for surgeons when considering this technique. [ABSTRACT FROM AUTHOR]

Background: The optimal timing of anterior cruciate ligament (ACL) reconstruction (ACLR) remains a controversial topic. Previous reviews have demonstrated that there are no differences between early and delayed ACLR; however, these studies have been limited by heterogeneous definitions of acute ACL injury. Purpose: To evaluate postoperative patient functional outcomes and risk for arthrofibrosis after acute arthroscopic ACLR performed ≤10 days after injury. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using multiple medical databases. Inclusion criteria were studies that evaluated postoperative range of motion outcomes for patients undergoing ACLR ≤10 days after initial ACL injury. For included comparative studies comparing patient groups undergoing ACLR ≤10 days and patients undergoing "delayed" ACLR after ≥3 weeks of initial injury, quantitative analysis was performed to assess for differences in postoperative arthrofibrosis, reoperation rates, and patient-reported outcomes between groups. DerSimonian-Laird binary random-effects models were constructed to quantitatively describe the association between the ACLR time period and patient outcomes by generating effect estimates in the form of odds ratios with 95% CIs. Qualitative analysis was performed to describe variably reported patient outcomes and the risk of arthrofibrosis after ACLR for noncomparative studies. Results: Screening yielded 6 full-text articles with 448 patients who underwent ACLR (296 ACLR <10 days, 152 ACLR >3 weeks), with a pooled mean age of 28.1 years. For studies amenable to quantitative analysis, there were no significant differences between ACLR performed ≤10 days and ACLR performed at the 3-week point or after in terms of postoperative stiffness (3 studies; odds ratio, 1.27; P =.508), Tegner scores (2 studies; mean difference, –0.056; P =.155), or reoperation for stiffness (3 studies; odds ratio, 0.869; P =.462). The overall incidence of postoperative arthrofibrosis after 12 months of follow-up was 11 of 296 (3.7%) for ACLRs performed ≤10 days versus 6 of 152 (3.9%) for those performed at the 3-week point or after. Conclusion: ACLR performed ≤10 days after the inciting injury does not increase the risk of postoperative arthrofibrosis and demonstrates similar patient-reported outcomes compared with ACLR performed at the 3-week point or after. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) rupture is a frequently encountered injury among athletes, often requiring surgical intervention to restore knee stability. Magnetic resonance imaging (MRI) after ACL reconstruction is common, especially in the evaluation of clinical complications leading to knee instability, decreased range of motion, or pain. This article provides a detailed overview of normal and abnormal postoperative findings including a practical step-by-step guide for MRI assessment. MRI findings must be correlated with surgical technique, time interval from surgery to imaging, and clinical examination. [ABSTRACT FROM AUTHOR]

Purpose: Risk factors for the development of symptomatic cyclops lesion after anterior cruciate ligament reconstruction (ACLR) surgery are not entirely identified yet. This study aimed to investigate whether the choice of hamstring graft (semitendinosus‐gracilis; STG vs. semitendinosus; ST) affects the risk of developing a symptomatic cyclops lesion after ACLR. Methods: This retrospective cohort study included 1416 patients receiving either an ST graft (n = 1209) or an STG graft (n = 207) ACLR with a follow‐up of at least 2 years. A persisting extension limitation was clinically determined, and cyclops lesions were confirmed by magnetic resonance imaging (MRI) and second‐look arthroscopy. Graft‐specific incidence of cyclops lesions was examined with χ2 test and combined with the factors number of graft bundles, graft diameter and sex evaluated with a binominal logistic regression model. Results: In total, 46 patients developed symptomatic cyclops lesions (3.2%), with 36 having ACLR with an ST graft (3.0%) and 10 with an STG graft (4.8%) (n.s). The mean time from ACLR to the second‐look arthroscopy for cyclops removal was 1.1 ± 0.6 years. Female patients were 2.5 times more likely to develop a cyclops lesion than male patients. Patients with an STG graft and larger graft diameters did not have a higher risk of developing cyclops lesions. Patients who received an STG graft with both tendons folded four times (double‐quadruple) had significantly higher risk of developing a cyclops compared with all other numbers of graft bundles combined (8.3%, respectively 3.0%; p = 0.014). Conclusion: This study could not prove an increased risk of developing a symptomatic cyclops lesion for patients with an STG graft compared with an ST graft used for ACLR. However, patients with a double‐quadruple ACLR had a higher percentage of cyclops lesions compared with all other numbers of graft bundles. Female sex was associated with an increased risk of developing cyclops lesions. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

The extent to which knee functions improve after anterior cruciate ligament reconstruction (ACLR) varies. This study aimed to determine the factors that affect lower knee function improvement after two years of ACLR. The study included 159 patients who underwent ACLR in the Indonesian ACL community between August 2018 and April 2020. The concomitant injury and graft types of ACLR were determined using patients' pre-surgical MRI and medical records. The five subscales of the knee injury and osteoarthritis outcome score (KOOS) were used to evaluate the patient at baseline, first year, and second year following ACLR. A linear mixed-effect model (LMEM) was used to predict the longitudinal improvement models for the five-subscales KOOS score after ACLR. The LMEM predicted lower KOOS subscales scores improvements by 0.5 for QOL, 0.1 for symptom, ADL, and QOL, and 0.2 for sports/recreation, respectively, for a one score increase of age and time from injury to surgery. Male patients had higher KOOS subscale scores with the improvement of pain, symptom, and ADL by 5.7, 5.9, and 6.3 compared to female patients, respectively, while patients with patellar tendon grafts had lower improvement of KOOS score pain by 6.5 compared to hamstring tendon grafts. As the age and time from injury to surgery increased, the KOOS subscales scores of QOL and symptoms, ADL, sports/recreation, and QOL decreased. Male patients reported higher KOOS subscales scores for pain, symptoms, and ADL, while patients with patella tendon grafts had a lower improvement in pain score. [ABSTRACT FROM AUTHOR]

tOBJECTIVE: To synthesize and present reference values for double-leg and single-leg jump tests in healthy athletes who play pivoting sports, and athletes with anterior cruciate ligament reconstruction (ACLR) who play pivoting sports. tDESIGN: Scoping review. tLITERATURE SEARCH: We searched PubMed, the Cochrane Library, MEDLINE, Embase, and Web of Science until April 7, 2023. tSTUDY SELECTION CRITERIA: We included reference values in 2 different categories: (1) double-leg and/or single-leg jump test outcomes in pivoting-sport athletes with ACLR at a specific time point during rehabilitation, and (2) double-leg and/or single-leg jump test outcomes in healthy pivoting-sport athletes. tDATA SYNTHESIS: We performed data synthesis for reference values from double-leg jump tests (squat jump and countermovement jump) and single-leg jump tests (vertical hop, single hop for distance, triple hop for distance, crossover hop for distance, medial triple hop for distance, lateral triple hop for distance, 6-m timed hop, side hop, drop jump, and 10-second repeated hop) that were performed according to a standardized test description. We summarized the data for type of sport, sex, sport participation level, and age group. tRESULTS: Of the 27 included studies, nine reported reference values from healthy soccer players, six from healthy basketball players, and eleven from other healthy pivoting-sport athletes. LSI dominant/ nondominant (LSI-D/ND) ranged between 97% and 106% for healthy soccer players, and between 99% and 120% for healthy basketball players. Four studies reported reference values from pivoting-sport athletes with ACLR from 7 to 10 months postsurgery. tCONCLUSION: This scoping review summarizes double-leg and single-leg jump test reference values for athletes who play common pivoting sports, [ABSTRACT FROM AUTHOR]

Background: The Quality of Patient-Surgeon Relationship (QPASREL) is an 11-item questionnaire developed and validated to assess the relationship between practitioners and patients on recovery and return to work after surgery. Purpose: To evaluate the association of patient-surgeon relationship (PSR) and patient-physical therapist relationship (PPR), as measured by QPASREL, with a patient's return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). Study Design: Case-control study; Level of evidence, 3. Methods: This study targeted patients who underwent primary ACLR at a specialized sports surgery referral center between January and May 2021. Patients who had revision surgery, multiligamentous knee injury, and sedentary status were excluded from the study. Patients were grouped based on ability to RTS at the preinjury level 1 year postoperatively (RTS group and no-RTS group). The primary outcome was rate of RTS at 1 year postoperatively, and the primary dependent variables were the quality of PSR and PPR as measured by QPASREL scores at 6-month intervals. Secondary outcomes were the correlation and discriminative capacity of the QPASREL compared with the Anterior Cruciate Ligament–Return to Sport After Injury (ACL-RSI) scores (collected at 6-month intervals). Results: The study included 243 patients. Patients in the RTS group exhibited a higher mean PPR QPASREL score (36.6 ± 5.1) compared with no-RTS patients (34.8 ± 5.2; P =.01) as well as a higher mean PSR score (35.7 ± 5.1) compared with no-RTS patients (33.8 ± 5.9; P =.01). Multivariate analysis showed that every 5-point increase in the QPASREL scores for PPR and PSR resulted in a 39% (odds ratio [OR] = 1.39; P = 0.014) and 35% (OR = 1.35, P = 0.021) increased odds of RTS, respectively. A weak yet positive correlation was found between QPASREL and ACL-RSI. The predictive capacity of the QPASREL (area under the curve [AUC] = 0.60 for PPR and 0.61 for PSR), although significant, was less powerful compared with that of the ACL-RSI (AUC = 0.73). Conclusion: The quality of the PPR and PSR, as measured by QPASREL scores, demonstrated a significant association with RTS rates at 1 year after ACLR. A weak yet positive correlation was found between QPASREL and ACL-RSI. [ABSTRACT FROM AUTHOR]

Background: Socket-tunnel overlap during meniscal allograft transplantation (MAT) combined with anterior cruciate ligament reconstruction (ACLR) may compromise graft integrity and lead to impaired fixation and treatment failure. Purpose/Hypothesis: The purpose of this study was to determine optimal socket-tunnel drilling parameters for medial and lateral MAT with concurrent ACLR using artificial tibias and computed tomography (CT) scans for 3-dimensional (3D) modeling. It was hypothesized that clinically relevant socket tunnels could be created to allow for concurrent medial or lateral MAT and ACLR without significant risk for overlap at varying tunnel guide angles. Study Design: Descriptive laboratory study. Methods: A total of 27 artificial right tibias (3 per subgroup) were allocated to 9 experimental groups based on the inclination of the socket tunnels (55°, 60°, and 65°) created for simulating medial and lateral MAT and ACLR. Five standardized socket tunnels were created for each tibia using arthroscopic guides: one for the ACL tibial insertion and one for each meniscus root insertion. CT scans were performed for all specimens and sequentially processed using computer software to produce 3D models for quantitative assessment of socket-tunnel overlap risk. Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney U tests. Results: No subgroup consistently presented significantly safer distances than other subgroups for all distances measured. Three cases (11%) and 24 cases (~90%) of tunnel overlap occurred between the ACL tunnel and tunnels for medial and lateral MAT, respectively. Most socket-tunnel overlap (25 of 27; 92.6%) occurred between sockets at depths ranging between 6.3 and 10 mm from the articular surface. For ACLR and posterior root of the lateral meniscus setting, the guide set at 65° increased socket-tunnel distances. Conclusion: When combined ACLR and MAT using socket tunnels for graft fixation is performed, the highest risk for tibial socket-tunnel overlap involves the ACLR tibial socket and the lateral meniscus anterior root socket at a depth of 6 to 10 mm from the tibial articular surface. Clinical Relevance: Setting tibial guides at 65° to the tibial articular surface with the tunnel entry point anteromedial and socket aperture location within the designated anatomic "footprint" will minimize the risk for socket-tunnel overlap. [ABSTRACT FROM AUTHOR]

Background: A novel hybrid transtibial (HTT) approach to femoral tunnel drilling in anterior cruciate ligament reconstruction (ACLR) has been developed that circumvents the need for knee hyperflexion and orients the graft in the most anatomic position without sacrificing the tunnel length or aperture. Hypothesis: Patients who underwent ACLR utilizing the HTT technique would achieve excellent patient-reported outcome scores and experience low rates of graft failure and reoperations. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent primary ACLR at a single institution between 2005 and 2020 were retrospectively reviewed. Patients treated with the HTT, anteromedial portal (AMP), and transtibial (TT) approaches were matched based on age, sex, and body mass index ±3 kg/m2. Demographic and surgical data as well as femoral tunnel angle measurements on anteroposterior and lateral radiographs were collected for the 3 groups. However, clinical outcomes were only reported for the HTT group because of concerns of graft heterogeneity. Results: A total of 170 patients (median age, 26.5 years [interquartile range (IQR), 18.0-35.0 years]) who underwent ACLR using the HTT approach were included. The median coronal- and sagittal-plane femoral tunnel angles were 47° (IQR, 42°-53°) and 40° (IQR, 34°-46°), respectively. The sagittal-plane femoral tunnel angles in the HTT group were significantly more horizontal compared with those in the TT group (P <.0001), whereas the coronal-plane femoral tunnel angles in the HTT group were found to be significantly more vertical compared with those in the AMP group (P =.001) and more horizontal compared with those in the TT group (P <.0001). The graft failure and reoperation rates in the HTT group at a minimum 2-year follow-up were 1.8% (3/170) and 4.7% (8/170), respectively. The complication rate was 6.5% (11/170), with the most common complication being subjective stiffness in 7 patients. The median Lysholm score was 89.5 (IQR, 79.0-98.0); the median International Knee Documentation Committee score was 83.9 (IQR, 65.5-90.8); and the median Veterans RAND 12-Item Health Survey physical and mental component summary scores were 55.0 (IQR, 52.6-55.9) and 56.2 (IQR, 49.1-59.3), respectively. Conclusion: ACLR using the HTT technique was associated with low graft retear and revision surgery rates and good patient-reported outcome scores at medium-term follow-up and demonstrated femoral tunnel obliquity on postoperative radiographs that correlated with optimal parameters previously reported in cadaveric and biomechanical studies. [ABSTRACT FROM AUTHOR]

Objective: To determine the effects of plyometric training programs on neuromuscular and knee functions during the late phase rehabilitation following anterior cruciate ligament (ACL) reconstruction. Materials and Methods: Thirty participants, post-ACL reconstruction, were randomly assigned at their 6-month follow-up visit into two groups: 15 participants in each group (resistance or plyometric training group). Each group underwent two training sessions weekly for 8 weeks. The participants were assessed at baseline and after completed the training period for the single leg 6-meter timed hop, knee joint position sense, static and dynamic balance, isokinetic muscle strength and the International Knee Documentation Committee Subjective Knee Form. Results: Post an 8-week training period, both groups showed improvements in the single leg 6-meter timed hop. Notably, the limb symmetry index for this hop in the plyometric group was significantly higher than the resistance group {18.2% (10.2, 26.1) vs 6.2% (-2.0, 14.5) respectively}. The plyometric group also demonstrated significantly better knee joint position sense {-3.1° (-4.3, -1.9) vs -0.8° (-2.0, 0.4) respectively}and the unipedal stance on a stable surface with eyes closed {13.9 sec (2.7, 25.2) vs -2.6 sec (-14.3, 9.1) respectively} than the resistance group. Conclusion: Plyometric training in the late phase of ACL rehabilitation program has proven to be a suitable and effective approach for enhancing neuromuscular and knee functions. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

BACKGROUND: Internal tension-reduction technique is to reconstruct the anterior cruciate ligament through high-strength suture system combined with tendon. It can effectively reduce graft relaxation and frets by sharing the internal load of the knee joint, and has achieved good biomechanical results and clinical efficacy. However, whether it can reduce cartilage degeneration after anterior cruciate ligament reconstruction through stress sharing reduction has not been studied. OBJECTIVE: To investigate the effect of internal tension-reduction technique on articular cartilage degeneration in southern Yunnan small-ear pigs undergoing anterior cruciate ligament reconstruction. METHODS: Ten adult female Yunnan small-ear pigs were selected, and the ipsilateral knee Achilles tendon was taken from the left knee joint for anterior cruciate ligament reconstruction (normal group, n=10), and the ipsilateral knee Achilles tendon from the right knee joint combined with internal tension)reduction and augmentation system for anterior cruciate ligament reconstruction (tension-reduction group, n=10). One year after surgery, the experimental pigs were sacrificed, and the left and right knee cartilage was taken for hematoxylin-eosin staining, Safranin O-fast green staining, Osteoarthritis Research Society International scoring, and immunohistochemistry staining of type II collagen, interleukin-1β, and tumor necrosis factor-alpha in the cartilage. RESULTS AND CONCLUSION: Hematoxylin-eosin staining showed that in the tension-reduction group, there were mild pathologic changes of osteoarthritis, with a low number of empty bone lacunae and no obvious pathological changes such as fibrosis or cell layer breakage; in the normal group, more severe cartilage damage, with an increased number of empty bone lacunae, loss of chondrocytes near the bone and even the formation of fissures. Safranin O-fast green staining indicated that the tension-reduction group had normal cartilage tissue thickness, flat cartilage surface, a neat cell arrangement in a polar pattern, and no swelling or apoptosis, while in the normal group, the thickness of cartilage tissue was obviously thinner, the cell arrangement was disordered with no polarity, the number of cells was reduced, obvious cartilage fractures and cartilage vacuoles formed, and the absence of cells near the central bone was obvious. The Osteoarthritis Research Society International score was significantly lower in the tension-reduction group than in the normal group (P < 0.05). Immunohistochemical findings showed that the protein expression of type II collagen in cartilage tissue of the tension-reducing group was higher than that of the normal group (P < 0.05), and the protein expression of interleukin 1β and tumor necrosis factor ɑ in cartilage tissue was lower than that of normal group (P < 0.05). To conclude, internal tension-reduction technique can delay the degeneration of articular cartilage in Yunnan small-eared pigs following anterior cruciate ligament reconstruction. [ABSTRACT FROM AUTHOR]

BACKGROUND: At present, postoperative timing or subjective criteria by clinicians are commonly employed to determine the return-to-sport timing for patients undergoing anterior cruciate ligament reconstruction. Unfortunately, these criteria do not adequately consider the biomechanical deficits in patients following anterior cruciate ligament reconstruction. OBJECTIVE: To explore the lower extremity kinematic and kinetic characteristics of athletes after anterior cruciate ligament reconstruction during bilateral vertical jumping. METHODS: Twenty athletes undergoing anterior cruciate ligament reconstruction and twenty healthy athletes, aged 20-24 years, were recruited in Wuhan Sports University from December 2021 to December 2022. All the 40 subjects underwent a bilateral vertical jumping test. The kinematic and dynamic characteristics of the lower limbs at propulsion phase, initial landing time and peak vertical ground reaction force moment. RESULTS AND CONCLUSION: At the initial landing time, the athletes undergoing anterior cruciate ligament reconstruction showed higher hip flexion angle (P=0.031) and lower ankle plantar flexion angle (P=0.018) on the operated side compared with the healthy athletes. At the peak vertical ground reaction force moment, the athletes undergoing anterior cruciate ligament reconstruction had higher hip flexion angle (P=0.016), lower hip abduction angle (P=0.019), lower knee flexion angle (P=0.025), higher knee external rotation angle (P=0.030), and higher ankle external rotation angle (P=0.042) on the operated side compared with the healthy athletes. At the peak vertical ground reaction force moment, the athletes undergoing anterior cruciate ligament reconstruction showed lower knee extension moment (P=0.036), lower knee internal rotation moment (P=0.016), lower hip abduction moment (P=0.004), higher hip extension moment (P=0.040), and higher hip external rotation moment (P=0.005) on the operated side compared with the healthy athletes. To conclude, the athletes undergoing anterior cruciate ligament reconstruction exhibit a stiff landing pattern, in which the knee load on the operated side tends to shift to the hip joint, and show inadequate control of lower limb rotational stability. Therefore, detection and correction of abnormal biomechanical characteristics should be part of the rehabilitation after anterior cruciate ligament reconstruction. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) injury is one of the most prevalent factors contributing to knee instability worldwide. This study aimed to evaluate modified metal fixation techniques for ACL reconstruction compared to factory-made implants, such as polyether ether ketone (PEEK) screws, bioabsorbable screws, and modified metal implants. Methods: A retrospective cohort analysis was conducted to assess the functional outcomes of ACL using various fixation methods. Patients who underwent arthroscopic ACL reconstruction at several healthcare facilities were included in the study. The functional outcomes were evaluated using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score questionnaire at 6- and 12 months post-surgery. Statistical analyses, including the Shapiro–Wilk test and analysis of variance, were performed to compare outcomes among the fixation groups. Results: Thirty-three patients who underwent ACL reconstruction surgery with varying distributions across the three fixation groups (modified metal implants, PEEK screws, and bioabsorbable screws) were included in the study. As measured by the Lysholm and IKDC scores at 6- and 12 months post-surgery, the PEEK group demonstrated the highest average scores. Nevertheless, these functional outcomes were not significantly different between the groups (p = 0.140, 0.770, 0.150, and 0.200). These findings align with those of meta-analyses comparing different fixation methods for ACL reconstruction. Conclusions: While acknowledging the small sample size as a limitation, this study suggests that modified metal implants represent viable options for ACL reconstruction. The selection of fixation methods should consider patient characteristics and preferences, emphasizing biomechanical stability and long-term outcomes. Further research is needed to validate these findings and explore their biomechanical properties and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Purpose: As a therapeutic intervention for several musculoskeletal illnesses, the benefits and effectiveness of Kinesio taping (KT) are currently unclear. This systematic review and meta-analysis's (MA) goal is to evaluate the effectiveness of KT for anterior cruciate ligament (ACL) reconstruction and its impact on clinical outcomes. Methods: A comprehensive search of online databases was done to discover relevant studies. Inclusion criteria included controlled or randomized clinical trials that were published in English. Changes in pain, flexion strength, and extension strength were among the outcomes of interest. RevMan 5.4 was used to extract and analyze data. Results: After satisfying the inclusion requirements, five studies were included in the MA. Pooled analysis showed that, in comparison with the intervention group, the control group had a statistically significant improvement in flexion strength (Standardized mean difference (SMD) = 0.44, 95% Confidence interval (CI) [0.01, 0.87], p = 0.04). Extension strength and pain, however, did not significantly differ between the intervention and control groups (SMD = 30, 95% CI [− 0.12, 0.72], p = 0.16), (SMD = 0.26, 95% CI [− 0.14, 0.66], p = 0.20), respectively. Conclusions: This analysis suggests limited to no benefits of KA post-ACL reconstruction. While the control group surprisingly showed better improvement in flexion strength, no significant differences were found in extension strength and pain. Further rigorous trials are needed to confirm its utility in rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction Anterior cruciate ligament (ACL) rupture is frequently encountered in athletes as well as in military personnel. In civilian population, many studies have looked at the return to sport, but return to duty in Army is a topic that requires further research. The purpose of this study was to determine through annual military fitness tests in real conditions, the return to sport in soldiers after ACL reconstruction and factors influencing failure. Materials and Methods This was a retrospective comparative study. Patients were all soldiers and had followed up in a Military Hospital. The SUCCESS group was military personnel who obtained a result of the specific aptitude test greater than or equal to this same test carried out before reconstruction of the ACL, the FAILURE group comprised the others. Results of the annual specific aerobic fitness tests were collected before and after ACL reconstruction. Preoperative epidemiological data, intraoperative information, and isokinetic test results were collected. Results One hundred forty four soldiers were included between January 2011 and December 2017 (94.9% of men with a median age of 27.6 years); 40.3% obtained a result greater than or equal to the preoperative fitness test after ACL reconstruction. Among the soldiers who did not regain their performance, 24.3% were declared unfit or discharged. In the FAILURE group, we found patients with a higher body mass index (25.5 vs. 24.4; P  = .04), less patients with isokinetic deficit < 30% on the knee flexors and extensors (26.6% vs. 62.9%; P  < .01), more long sick leave (39.5% vs. 13.7%; P  < .01), and late resumption of military activities (10.5 vs. 8.9 months; P  < .01). Conclusion Rupture of ACL has a significant impact on the operational capacity of the French army. The proportion of return to the same level in annual specific fitness tests after ACL reconstruction is 40% among soldiers. Several variables are important to consider in the follow-up of these patients to optimize their recovery of sports performance and therefore their operational capacity. [ABSTRACT FROM AUTHOR]

Background and Aims: Genicular nerve block (GNB) is beneficial in early ambulation and faster patient discharge since it selectively blocks articular branches and is motor‑sparing. This study aimed to compare the analgesic efficacy of ultrasound (US)‑guided GNB with adductor canal block (ACB) in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). Methods: This randomised, double‑blind study was conducted on 38 adults undergoing arthroscopic ACLR. Patients in Group GNB (n = 19) received US‑guided GNB with 3 ml of 0.25% bupivacaine and 2 mg dexamethasone. Patients in Group ACB (n = 19) received US‑guided ACB with 20 ml of 0.25% bupivacaine with 6 mg dexamethasone. Postoperative rescue analgesia was provided by intravenous Patient Controlled Analgesia (PCA) with morphine. The primary outcome was Numerical Rating Scale (NRS) pain scores over 24 h. The secondary outcome was the duration of analgesia and 24‑h morphine consumption. The Chi‑square test was used to test the statistical significance between categorical variables. Independent t‑test or Mann–Whitney U test was used to compare continuous variables. Results: NRS scores at rest and physical activity at 24 h were similar in both the groups (P = 0.429 and P = 0.101, respectively). The mean time to rescue analgesia was comparable in both groups (Group GNB: 820.79 [483.65] min [95% confidence interval {CI}: 603.31–1038.27] and Group ACB: 858.95 [460.06] min [95% CI: 652.08, 1065.82], P = 0.805), and the mean 24‑h morphine consumption was also comparable in both groups (P = 1.000). Conclusion: US‑guided GNB has an analgesic efficacy similar to US‑guided ACB for patients undergoing arthroscopic ACLR. [ABSTRACT FROM AUTHOR]

This study aimed to compare functional outcomes including knee muscle strength in the quadriceps and hamstrings, and proprioception, assessed through dynamic postural stability (overall stability index [OSI]) and self-reported outcomes in the operated and non-operated knees between anterior cruciate ligament reconstruction (ACLR) with meniscal repair for unstable (root and radial tears) and stable (longitudinal, horizontal, and bucket handle tears) meniscal tears. A total of 76 patients were randomly selected (41 with ACLR with meniscal repair for unstable meniscal tears and 35 with ACLR with meniscal repair for stable meniscal tears) at three different time points (preoperative, 6 months, and 12 months). Repeated measures analysis of variance was used to investigate the differences in outcomes for between-subject and within-subject factors. In the operated knees, there were no significant differences for functional outcomes between the two groups (all p > 0.05). In the non-operated knees, a significant difference was observed for the OSI between the two groups, which was significantly higher in ACLR with meniscal repair for unstable meniscal tears than for stable meniscal tears at 6 months (p < 0.001). Multiple linear regression analysis showed that age (p = 0.027), preoperative OSI in the operated knees (p = 0.005), and postoperative OSI in the operated knees at 6 months (p = 0.002) were significant and independent predictors for OSI in the non-operated knees at 6 months postoperatively. Therefore, while no differences were observed in functional outcomes between the two groups in the operated knees, dynamic postural stability was poorer at 6 months postoperatively in the non-operated knees of patients with ACLR with meniscal repair for unstable meniscal tears. Furthermore, a significant correlation was observed between preoperative/postoperative dynamic postural stability in the operated knees and postoperative dynamic postural stability in the non-operated knees. Hence, we recommend incorporating balance exercises for both knees in post-surgical rehabilitation, particularly for patients with unstable meniscal tears. [ABSTRACT FROM AUTHOR]

Copyright of Japanese Journal of Clinical Sports Medicine / Nihon Rinsho Supotsu is the property of Japanese Society of Clinical Sports Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A successful return to sports (RTS) after an anterior cruciate ligament reconstruction (ACLR) is multifactorial, and therefore difficult and challenging. Unfortunately, low percentages of patients RTS, and for those who succeed, one-fifth of patients will sustain a second ACL injury. Over the past years, test batteries were developed to assess whether patients can RTS with a low risk for a second ACL injury risk. Low rates of patients who meet RTS criteria were found, coupled with the insufficiency of current RTS test batteries in predicting second ACL injuries suggesting poor sensitivity. The result of an RTS test is likely to reflect the content of a rehabilitation program, raising critical questions regarding what we are offering patients within the rehabilitation programme. Are we preparing our patients well enough for the high demands of complex situations within pivoting team sports? This narrative review offers insights from key lessons of the last 15 years on 1) RTS testing, 2) the content of rehabilitation, and 3) the RTS continuum, all from a "helicopter perspective". • Current RTS tests fail in predicting second ACL injury risk. • RTS after ACLR is not a static moment in time, but a continuum. • RTS after ACLR is a dynamic and individual process and therefore complex. [ABSTRACT FROM AUTHOR]

Assess the validity of hand-held dynamometry (HHD) and the Tindeq Progressor (TP) in assessing peak isometric knee extension torque and limb symmetry index (LSI) versus isokinetic dynamometer (IKD). Prospective cross-sectional study. Laboratory. 31 individuals with unilateral knee disorders (21 female; 28.3 ± 11 years). Peak isometric knee extension torque; Knee extension LSI. Strong to almost perfect (p < 0.001) correlations (Cohen's Kappa k) with IKD were found for both devices for peak torque of the uninvolved limb (HHD [ k = 0.84], TP [ k = 0.91]) and involved limb (HHD [ k = 0.93], TP [ k = 0.98]). For LSI, moderate to strong (p < 0.001) correlations with IKD were found for HHD (k = 0.79) and TP (k = 0.89). Mean bias errors were equivalent for determining LSI (HHD = 0.02%; TP = 0.03%). Both HHD and TP were highly sensitive (96.2–100.0%) and specific (100.0%) at the 70% LSI threshold. TP showed higher sensitivity and specificity at the 90% LSI threshold. HHD and TP are valid in measuring isometric knee extension torque with the reference standard IKD. TP showed superior validity in identifying LSI. TP also shows greater specificity in identifying the 90% LSI threshold. • Both hand-held dynamometry and the Tindeq Progressor are valid in assessing isometric knee extension torque and LSI. • Tindeq Progressor overestimated peak torque. • The Tindeq Progressor was superior to HHD in assessing LSI at the 90% LSI threshold. [ABSTRACT FROM AUTHOR]

To investigate the current clinical practice regarding pre- and post-surgical rehabilitation and return to sport (RTS) criteria following anterior cruciate ligament reconstruction (ACLR). Cross-sectional design. Online survey. Survey platform. Argentinian physical therapists (PTs). The survey consisted of a combination of 39 open- and closed-ended questions, divided across 3 sections: (1) demographic and professional information, (2) clinical practice and rehabilitation strategies, and (3) return-to-running (RTR) and RTS. A total of 619 PTs completed the survey. Considerable variability was observed in preoperative rehabilitation, criteria used for rehabilitation progression and RTS decision-making criteria used by PTs. From the total surveyed, 336 (54.3%) carried out RTS assessment in their clinical practice. Most of PTs (53.3%) use visual estimation to assess knee range of motion. Only 20% of the PTs reported incorporating patient-reported outcome measures in their decision-making. From PTs who use strength assessment as a criterion of RTS (68.8%), 16.6% extrapolate this from jump tests and 15.3% use manual muscle testing. Less than the 50% of the PTs recommended nine months or more to allow patients to RTS. Current rehabilitation practices of Argentinian PTs following ACLR are largely variable and not aligned with current evidence and scientific guidelines. To achieve better rehabilitation and RTS practices better knowledge dissemination and implementation are required. • Current ACLR rehabilitation practices are largely not aligned with contemporary evidence and scientific guidelines. • Less than 30% of PTs don't use strength measures as a criterion to RTS. • Less than 20% of PTs use PROMS associated with aspects of ACLR rehabilitation progression and RTS. [ABSTRACT FROM AUTHOR]

After anterior cruciate ligament reconstruction (ACLR), return to sprint is poorly documented in the literature. In soccer, return to sprint is an essential component of return to play and performance after ACLR. The characteristics of running in soccer are specific (velocity differences, nonlinear, intensity). It is important to address these particularities, such as curvilinear running, acceleration, deceleration, changes of direction, and variations in velocity, in the patient's rehabilitation program. Force, velocity, and acceleration capacities are key elements to sprint performance. Velocity-based training (VBT) has gained much interest in recent years and may have a role to play in optimizing return to play and return to sprint after ACLR. Force, velocity, and acceleration can be assessed using force-velocity-power and acceleration-speed profiles, which should inform rehabilitation. The purpose of this commentary is to describe a velocity-based return to sprint program which can be used during ACLR rehabilitation. [ABSTRACT FROM AUTHOR]

Copyright of Japanese Journal of Clinical Sports Medicine / Nihon Rinsho Supotsu is the property of Japanese Society of Clinical Sports Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

PUSPOSE OF THE STUDY Many studies have investigated the efficacy of peroneus longus tendon (PLT) in anterior cruciate ligament (ACL) reconstruction, and donor site morbidity has not been adequately studied. MATERIAL AND METHODS Fifty patients who underwent ACL reconstruction using PLT were included. Ankle strengths of the patients evaluated with an analog dynamometer. Ankle range of motion (ROM) was measured with a smart phone inclonometer application. RESULTS There was no significant difference between the postoperative ankle strength(eversion, plantar flexion) in the donor area and the preoperative period (p=0.6 and p=0.7, respectively) and contralateral healthy side (p=0.6, p=0.6, respectively). Ankle ROM angles (dorsiflexion, plantar flexion, eversion, inversion) were significantly lower in the post-operative period compared to the preoperative period and contralateral healthy side (p<0.05, p<0.05, p<0.05, p<0.05, respectively). There was no significant difference between pre-operative and post-operative AOFAS scores (p=0.2). CONCLUSIONS Although PLT can affect ROM angles, it is a promising alternative for ACL reconstructions without causing functional morbidity. [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]

Anterior cruciate ligament (ACL) injuries of the knee are one of the most common and serious athletic injuries. The widely used cortical suspension fixation buttons for ligament reconstruction are permanent implants, particularly those made from conventional steel or titanium alloys. In this study, a biodegradable Zn–0.45Mn–0.2Mg (ZMM42) alloy with the yield strength of 300.4 MPa and tensile strength of 329.8 MPa was prepared through hot extrusion. The use of zinc alloys in the preparation of cortical suspension fixation buttons was proposed for the first time. After 35 d of immersion in simulated body fluids, the ZMM42 alloy fixation buttons were degraded at a rate of 44 µm/a, and the fixation strength was retained (379.55 N) in the traction loops. Simultaneously, the ZMM42 alloy fixation buttons exhibited an increase in MC3T3-E1 cell viability and high antibacterial activity against Escherichia coli and Staphylococcus aureus. These results reveal the potential of biodegradable zinc alloys for use as ligament reconstruction materials and for developing diverse zinc alloy cortical suspension fixation devices. [ABSTRACT FROM AUTHOR]

Background: Blood flow restriction training (BFRT) is a safe and potentially effective adjunctive therapeutic modality for postoperative rehabilitation related to various knee pathologies. However, there is a paucity of literature surrounding BFRT in high-performance athletes after anterior cruciate ligament reconstruction (ACLR). Purpose: To (1) compare the overall time to return to sports (RTS) in a cohort of National Collegiate Athletic Association (NCAA) Division I athletes who underwent a standardized rehabilitation program either with or without BFRT after ACLR and (2) identify a postoperative time interval for which BFRT has the maximum therapeutic benefit. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 55 student-athletes who underwent ACLR between 2000 and 2023 while participating in NCAA Division I sports at a single institution were included in this study. Athletes were allocated to 1 of 2 groups based on whether they participated in a standardized postoperative rehabilitation program augmented with BFRT (BFRT group; n = 22) or completed the standardized protocol alone (non-BFRT group [control]; n = 33). Our primary outcome measure was time to RTS. The secondary outcome measure was handheld dynamometry quadriceps strength testing at various postoperative time points, converted to a limb symmetry index (LSI). Quadriceps strength was not tested between the BFRT and non-BFRT groups because of the limited amount of data on the control group. Results: The mean age at the date of surgery was 18.59 ± 1.10 years for the BFRT group and 19.45 ± 1.30 years for the non-BFRT group (P =.011), and the mean RTS time was 409 ± 134 days from surgery for the BFRT group and 332 ± 100 days for the non-BFRT cohort (P =.047). For the BFRT group, the mean quadriceps strength LSI increased by 0.67% (95% CI, 0.53%-0.81%) for every week of rehabilitation, and there was a significantly positive rate of change in quadriceps strength in weeks 13-16 compared with weeks 9-12 (ΔLSI, 8.22%; P <.001). Conclusion: In elite NCAA Division I athletes, a statistically significant delay was observed in RTS with BFRT compared with standardized physical therapy alone after undergoing ACLR. There also appeared to be an early window during the rehabilitation period where BFRT had a beneficial impact on quadriceps strength. [ABSTRACT FROM AUTHOR]

Background: The relationship between graft maturity on magnetic resonance imaging (MRI) and return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction is unclear. Purpose: To compare signal-to-noise quotient (SNQ) values and ACL graft T2* (gradient echo) values between patients who did RTS and those who did not RTS (NRTS) after ACL reconstruction and to evaluate the predictive value of T2* mapping for RTS after ACL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: At a minimum of 9 months after arthroscopic single-bundle ACL reconstruction with autologous hamstring tendon graft, 82 patients underwent RTS assessment as well as MRI evaluation. The patients were classified into RTS (n = 53) and NRTS (n = 29) groups based on the results of the assessment. The SNQ values in the proximal, middle, and distal regions of the graft and the T2* values of the graft were measured on MRI. The correlation between T2* values and RTS was assessed using Spearman correlation analysis. Receiver operating characteristic curves were constructed to compare the diagnostic performance, and the optimal T2* cutoff value for detecting RTS was determined based on the maximum Youden index. Results: At 9 months after ACL reconstruction, the proximal, middle, and mean SNQ values in the RTS group were significantly lower than those in the NRTS group (proximal: 17.15 ± 4.85 vs 19.55 ± 5.05, P =.038; middle: 13.45 ± 5.15 vs. 17.75 ± 5.75, P =.001; mean: 12.37 ± 2.74 vs 15.07 ± 3.32, P <.001). The T2* values were lower in the RTS group (14.92 ± 2.28 vs 17.69 ± 2.48; P <.001) and were correlated with RTS (r = −0.41; P =.02). The area under the curve of T2* was 0.79 (95% CI, 0.75-0.83), and the optimal cutoff value for T2* was 16.65, with a sensitivity and specificity for predicting failure to RTS of 67.9% and 88.2%, respectively. Conclusion: Study findings indicated that the SNQs (mean, proximal, and middle) and the T2* values of the graft in the RTS group were significantly lower than those in NRTS group. A T2* value of 16.65 was calculated to predict patients who failed RTS tests with a sensitivity of 67.9% and specificity of 88.2%. [ABSTRACT FROM AUTHOR]

Background: During anterior cruciate ligament (ACL) reconstruction, there are various autograft options. Donor-site morbidity is an important consideration while deciding the type of the autograft. Gracilis and semitendinosus autografts are commonly used in ACL reconstruction, resulting in weakness of the hamstring muscle. Hypothesis: We hypothesized that if we preserved the tibial insertion site of the sartorial fascia (SF) during hamstring tendon harvest, there would be better recovery of knee flexor strength. Study Design: Case-control study; Level of evidence, 3. Methods: In this retrospective study, 34 patients (aged 20-59 years) underwent ACL reconstruction using hamstring tendon autograft with 2 different incision techniques on the SF. The tibial attachment site of the SF was preserved in 17 patients. The insertion site of the muscle was incised transversely in 17 patients. The follow-up duration was ≥2 years. Patients were recalled to the institute for examination and muscle strength assessment. The results were compared between the groups in terms of flexor and extensor knee isokinetic muscle strength at 60 and 180 deg/s. Results: There was no statistical difference between the groups in terms of age, sex, or body mass index. When compared with patients whose SF attachment site was incised, patients with a preserved SF tibial insertion were found to have a higher flexion peak torque at the angular speed of 180 deg/s (P < 002). No statistically significant difference was noted at 60 deg/s. Conclusion: During collection of gracilis and semitendinosus autografts, preserving the SF tibial attachment site was associated with better knee flexion peak torque. [ABSTRACT FROM AUTHOR]

Background: Postoperative laxity correlates with negative clinical outcomes after anterior cruciate ligament reconstruction (ACLR). The influence of lateral extra-articular tenodesis (LET) on anteroposterior translation is unclear. Purpose/Hypothesis: This study aimed to evaluate the reduction in radiographic static anterior tibial translation (SATT) and dynamic anterior tibial translation (DATT) after LET as an adjunctive procedure to ACLR. It was hypothesized that adding a LET procedure would have no effect on postoperative SATT and DATT. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary ACLR with hamstring tendon autografts between 2020 and 2022 were reviewed, and those who underwent ACLR and LET as an anterolateral associate procedure were paired 1 to 1 with those who underwent isolated ACLR (control) based on age, sex, preoperative SATT, and posterior tibial slope (PTS). The indications for LET were age <18 years and anterolateral rotary instability (grade ≥2 pivot shift). A previously validated technique was used to measure SATT, DATT, and PTS on lateral weightbearing and lateral stress knee radiographs. Preoperative and 9-month postoperative radiographs were compared between the 2 groups. Results: A total of 72 patients were included in the analysis (n = 36 patients in each group). The inter- and intraobserver reliability of the SATT, DATT, and PTS measurements was excellent (intraclass correlation coefficients, 0.88-0.99). The mean pre- and postoperative SATT in the ACLR+LET group was 2.44 ± 2.90 mm and 2.44 ± 2.38 mm, respectively, compared with 2.60 ± 2.99 mm and 2.12 ± 2.74 mm, respectively, in the control group. The mean pre- and postoperative reduction in side-to-side DATT in the ACLR+LET group was 5.44 ± 4.65 mm and 1.13 ± 2.95 mm, respectively, compared with 5.03 ± 3.66 mm and 2 ± 3.12 mm, respectively, in the control group. There was no pre- to postoperative difference in SATT (P =.51). However, the side-to-side DATT was reduced by 3.66 ± 3.37 mm postoperatively (P <.001), without significant differences between groups (P =.24). Conclusion: Including a LET procedure for patients undergoing ACLR did not reduce SATT; that is, it did not decrease the amount of tibial translation due to physiological axial load. [ABSTRACT FROM AUTHOR]