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BACKGROUND: Anterior cruciate ligament (ACL) injury often leads to posttraumatic osteoarthritis (PTOA), despite ACL reconstruction (ACLR). Medial meniscal extrusion (MME) is implicated in PTOA progression but remains understudied after ACL injury and ACLR. HYPOTHESIS/PURPOSE: It was hypothesized that MME would increase longitudinally after ACL injury and ACLR, with greater changes in the ipsilateral knee compared with the contralateral knee, leading to cartilage degeneration. The study aimed to assess MME 3 years after ACLR and its relationship with magnetic resonance imaging (MRI) T1ρ and T2 as cartilage degeneration markers. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: MME and relative percentage of extrusion (RPE) were measured on 3 coronal slices of 3-dimensional fast spin-echo images and the mean values were used. T1ρ and T2 sequences were obtained and cartilage compositional measurements were performed using in-house developed software with MATLAB. Mixed models were used to assess the longitudinal changes and linear regression was used to assess the relationships between RPE and T1ρ and T2 values. RESULTS: A total of 54 participants with unilateral ACL injuries underwent preoperative bilateral knee MRI. A total of 36 participants completed MR scans at 6 months and 3 years after ACLR. MME and RPE measurements demonstrated high reliability (ICC > 0.88 and > 0.91, respectively). The predicted values of MME and RPE from the mixed models showed that the ipsilateral side had significantly greater MME and RPE than the contralateral side at all 3 time points (P = .023 for MME; P = .013 for RPE at baseline; and P < .001 at 6 months and P < .001 at 3 years for both MME and RPE). The rate of change of MME and RPE on the ipsilateral side was significantly greater than that on the contralateral side (P < .001). Postoperative RPE was associated with T1ρ and T2 values in the posterior medial femoral condyle. CONCLUSION: MME and RPE obtained pre- and postoperatively after ACLR on the ipsilateral side were significantly greater than those on the contralateral side, and the longitudinal increases on the ipsilateral side were greater than those on the contralateral side. Postoperative RPE was significantly associated with cartilage degeneration in the posterior medial femoral condyle.

Context: Anterior cruciate ligament (ACL) injuries are prevalent in sports and often require surgical intervention followed by rehabilitation. Several rehabilitation methods have been used for patients after ACL surgery. Objective: This study aimed to assess the overall efficacy of exercise therapy in improving outcomes for patients following ACL surgery using a systematic review and meta-analysis of randomized controlled trials (RCTs). Data sources: PubMed, Web of Science, Embase, and the Cochrane Library were searched for randomized controlled trials published from 1 January 2000 to 30 August 2024. Study quality was assessed using the Cochrane Risk-of-Bias tool. Study selection: A total of 11 randomized controlled trials (whole-body vibration training = 4, core-stability training = 2, strength training = 3, blood flow restriction training = 1, and aquatic training = 1) involving 552 anterior cruciate ligament surgery patients were included. Data extraction: Two researchers individually screened the key information for each eligible study and evaluated the quality of the studies. Any dispute was discussed by a third researcher. Results: Compared with conventional therapy, exercise therapy significantly reduced pain scores (mean difference: −0.53, 95% CI: −0.82 to −0.24, and p < 0.001) and improved muscle strength (flexion: 13.76 and extension: 12.46) and knee function (effect size: 2.06 and p = 0.001). Secondary outcomes, although less pronounced, also demonstrated improvement. Limitation: The sources of heterogeneity among the included studies were not fully identified, particularly concerning variations in exercise protocols or patient characteristics. Additionally, the therapeutic effects of specific exercise modalities (e.g., strength training versus aquatic training) were not directly compared. Conclusion: Exercise therapy is effective in reducing pain, enhancing muscle strength, and improving knee function in ACL surgery patients. These findings underscore the importance of integrating tailored exercise therapies into rehabilitation programs. Systematic review registration number: https://www.crd.york.ac.uk/PROSPERO/, identifier registration number. CRD42023476653. [ABSTRACT FROM AUTHOR]

Background: Injury to the anterior cruciate ligament is one of the most common knee injuries. Following anterior cruciate ligament reconstruction, strength deficits and reduced quadriceps and hamstring muscle mass are common. Traditional strengthening protocols recommend the use of heavy loads. However, following surgery, heavy-load exercises are contraindicated to protect the joint and graft. Blood flow restriction resistance training is an alternative that optimizes muscle recovery. The aim of this study was to evaluate the effects of blood flow restriction resistance training on muscle mass and strength after ACLR. Methods: The Pubmed, Cochrane Library, and PEDro databases were used to constitute the corpus of this systematic review. The methodological quality of the studies was assessed with the Cochrane Collaboration's analysis grid. Results: Thirty-four articles were identified in the initial search, and five randomized controlled trials were included in this review. Not all studies reported significant results regarding strength and muscle mass. Two of these studies observed a significant improvement in strength associated with blood flow restriction resistance training compared with the control group. A significant increase in muscle mass was observed in one study. Conclusions: The blood flow restriction resistance training method shows superior efficacy to training without occlusion, yet this device has not been shown to be more effective than heavy-load resistance training in terms of muscular strength and muscle mass. Blood flow restriction resistance training shows superior efficacy in both these variables when used with low loads. However, there are still few random controlled trials on this subject, and this review presents their limitations and biases. Future research is needed on guidelines for the application of blood flow restriction resistance training in clinical populations. [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcome (PROs) instruments of knee function quality of life are routinely administered to patients after anterior cruciate ligament reconstruction (ACLR). The Patient Acceptable Symptom State (PASS), an evidence-based threshold defining perceived outcomes, may be a useful indicator of strength and functional performance. Purpose: To compare strength and functional performance between patients recovering from ACLR who did and did not meet PASS thresholds on associated PROs. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 223 patients who had undergone ACLR (106 women, 117 men; 7.62 ± 1.71 months after ACLR) completed isokinetic knee extensor and flexor strength at 90 deg/s, hop performance (single-limb hop for distance [SLHD], triple hop for distance [THD], 6-m timed hop [6MH]), and PROs (International Knee Documentation Committee Subjective Form [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], and Anterior Cruciate Ligament Return to Sport After Injury [ACL-RSI]) assessments in a controlled laboratory setting at an academic institution. Independent-samples t tests compared strength and hop measures between patients who did and did not achieve a PASS on the PROs. Limb symmetry index (LSI) was calculated as (ACLR Limb ÷ Contralateral Limb) × 100%. Strength and hop performance LSI outcomes were converted into indicator variables, categorized as either a "pass" or "fail" based on the operational definition of having an LSI value ≥90%. Chi-square tests compared strength and hop LSI PASS status measures to PRO PASS status. Results: Patients who achieved IKDCPASS were significantly stronger and had more symmetric limbs than those who did not achieve IKDCPASS. Values for IKDCPASS were as follows: knee extension ACLR limb 1.72 ± 0.47 N·m/kg, contralateral limb 2.40 ± 0.45 N·m/kg, LSI 71.64% ± 15.23%; knee flexion ACLR limb 1.04 ± 0.29 N·m/kg, contralateral limb 1.05 ± 0.26 N·m/kg, LSI 99.12% ± 17.22%. Values for IKDCFAIL were knee extension ACLR limb 1.47 ± 0.52 N·m/kg, contralateral limb 2.25 ± 0.47 N·m/kg, LSI 64.66% ± 17.07%; knee flexion ACLR limb 0.88 ± 0.28 N·m/kg, contralateral limb 0.97 ± 0.28 N·m/kg, LSI 90.46% ± 17.41%. Effect sizes ranged from small to moderate (P <.001; d = 0.3-0.55). IKDCPASS status was significantly associated with an LSI ≥90% for knee flexion peak torque (χ2 = 9.66; P =.002), SLHD (χ2 = 9.61; P =.002), and THD (χ2 = 3.97; P =.02), with a moderate effect size (P <.05; d = 0.41-0.73). Significant relationships were found with KOOSPASS (Pain, Activities of Daily Living [ADL], and Sport) and LSI ≥90% for peak knee flexion torque with a moderate effect size (Pain and ADL, P <.001; Sport, P =.04; d = 0.59-0.72) and SLHD with a strong effect size for the Symptom subscale (Symptom, P <.01, d = 1.21; Pain, P =.003; ADL, P =.04; Sport, P =.001). No differences were found in strength outcomes for patients who achieved ACL-RSIPASS versus those who did not (P >.05). Patients who achieved ACL-RSIPASS had more symmetric SLHD and THD LSI scores and jumped farther on their contralateral limb for the THD compared with ACL-RSIFAIL patients (P <.05; d = 0.50-0.64). Conclusion: Patients meeting thresholds for the IKDCPASS and KOOSPASS (Pain, ADL, and Sport subscales) demonstrated greater knee strength bilaterally, and hopped farther and more symmetrically, compared with patients who scored below the PASS threshold on the same PROs. Using PASS thresholds for PROs can aid clinicians when considering when patients can safely return to activities after ACLR. [ABSTRACT FROM AUTHOR]

Deep learning approaches such as DeepACSA enable automated segmentation of muscle ultrasound cross-sectional area (CSA). Although they provide fast and accurate results, most are developed using data from healthy populations. The changes in muscle size and quality following anterior cruciate ligament (ACL) injury challenges the validity of these automated approaches in the ACL population. Quadriceps muscle CSA is an important outcome following ACL injury; therefore, our aim was to validate DeepACSA, a convolutional neural network (CNN) approach for ACL injury. Quadriceps panoramic CSA ultrasound images (vastus lateralis [VL] n = 430, rectus femoris [RF] n = 349, and vastus medialis [VM] n = 723) from 124 participants with an ACL injury (age 22.8 ± 7.9 y, 61 females) were used to train CNN models. For VL and RF, combined models included extra images from healthy participants (n = 153, age 38.2, range 13–78) that the DeepACSA was developed from. All models were tested on unseen external validation images (n = 100) from ACL-injured participants. Model predicted CSA results were compared to manual segmentation results. All models showed good comparability (ICC > 0.81, < 14.1% standard error of measurement, mean differences of <1.56 cm2) to manual segmentation. Removal of the erroneous predictions resulted in excellent comparability (ICC > 0.94, < 7.40% standard error of measurement, mean differences of <0.57 cm2). Erroneous predictions were 17% for combined VL, 11% for combined RF, and 20% for ACL-only VM models. The new CNN models provided can be used in ACL-injured populations to measure CSA of VL, RF, and VM muscles automatically. The models yield high comparability to manual segmentation results and reduce the burden of manual segmentation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hamstrings and quadriceps strength recovery and restoration of the hamstrings-to-quadriceps ratio (H/Q ratio) is a major concern after anterior cruciate ligament reconstruction (ACLR). Recently, moment-angle profiles and angle-specific H/Q ratios are receiving increasing interest. PURPOSE: The first objective of this study was to investigate moment-angle profiles and angle-specific H/Q ratio profiles in athletes with ACLR at the time of RTS. The second objective of this study was to assess whether strength asymmetries identified at the time of RTS, persist after six months. STUDY DESIGN: Case-Control study METHODS: Twenty athletes who had undergone ACLR performed isokinetic strength tests for concentric knee flexion and extension (60°/s) at RTS, and three and six months later. Twenty controls were tested once. T-tests were used to compare strength differences between 1) ACLR athletes and controls and 2) the injured and uninjured leg of the ACLR athletes. Finally, to assess strength deficits over time, two-way ANOVAs were used. RESULTS: Angle-specific analyses and peak moments showed lower hamstrings strength in the injured leg of ACLR athletes compared to their uninjured leg at RTS. Furthermore, angle-specific analyses showed a lower hamstrings strength and H/Q ratio in the injured leg compared to controls at larger knee flexion angles. The latter deficit was not identified with a peak-based analysis. The asymmetries identified at RTS did not change over the six months following RTS. CONCLUSIONS: Athletes with ACLR show strength deficits and asymmetries that persist even six months after RTS. As some asymmetries may go undetected by peak-based analyses, angle-specific analyses are recommended. LEVEL OF EVIDENCE: Level 3b [ABSTRACT FROM AUTHOR]

Purpose: Graft rupture is a significant cause of graft failure in anterior cruciate ligament reconstruction (ACLR). To address this issue, clinicians have combined the internal tension relieving technique (ITRT) with ACLR to improve graft stiffness, aiming to reduce the risk of graft failure. The purpose of this study is to compare the graft failure rates and clinical functional outcomes between ITRT-assisted ACLR and conventional ACLR. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search was conducted in databases including Ovid, PubMed, Web of Science, Embase, Cochrane Library, Wanfang Data, CNKI, and VIP Medical Database for clinical controlled trials comparing the ITRT combined with ACLR to conventional ACLR. The search period spanned from the establishment of the databases to September 2024. Studies meeting the inclusion and exclusion criteria were selected, with two independent reviewers conducting literature screening, quality assessment, and data extraction. Data analysis was performed using RevMan 5.4 software. The evaluated outcomes included graft failure rate, Lysholm Knee Scoring Scale, Tegner activity score, Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, Visual Analog Scale (VAS) score, Single Assessment Numeric Evaluation (SANE), return to sport (RTS) rate, and knee joint laxity. Results: A total of 11 studies were included in the final analysis, with 1,339 patients (592 patients with ITRT-assisted ACLR and 747 patients with conventional ACLR). The combined analysis results indicated that, compared to conventional ACLR, ITRT-assisted ACLR showed significant advantages in reducing graft failure rates (RR = 0.44; 95% CI: 0.23, 0.83; P = 0.01), increasing return-to-sport rates (MD = 1.75; 95% CI: 1.05, 2.91; P = 0.03), and improving knee scores (including KOOS score and Tegner activity score) (all P values < 0.05). However, no significant differences were observed between the two approaches in terms of Lysholm knee score, VAS score, IKDC score, and knee joint laxity. Conclusions: This meta-analysis highlighted the significance and superiority of combining ITRT with ACLR compared to conventional ACLR, particularly in reducing graft failure rate and improving knee function outcomes. The ITRT-assisted ACLR procedure may represent the optimal approach for minimizing graft failure. However, given the limitations of short-term follow-up and reliance on retrospective studies, more randomized controlled trials and longer follow-up periods are needed to further evaluate the long-term graft failure rates and functional outcomes. [ABSTRACT FROM AUTHOR]

Background: The incidence of knee osteoarthritis after anterior cruciate ligament reconstruction (ACLR) is high to 57%, and the biomechanical abnormality during walking is one of the reasons. The purpose of this study was to investigate the effect of 12 weeks of knee extension constraint training on walking biomechanics during the stance phase of injured side after ACLR. Methods: Forty-five patients were randomly assigned to three groups based on different brace conditions from 13 weeks to 24 weeks after ACLR: experimental (brace with knee extension constraint), placebo (brace without knee extension constraint), and control (no brace). Gait analysis was performed 3 and 6 months after ACLR. The peak for knee flexion angle (KFA), knee extension moment (KEM), and vertical ground reaction force (vGRF) were compared by 2 (time) x 3 (group) repeated-measures analysis of covariance (ANCOVA), and pairwise comparisons were conducted.. Results: There was a significant time x group interaction for the peak KFA (p = 0.047), and there was no significant time x group interaction for the peak KEM and peak vGRF. The pairwise comparisons showed that there were no statistical differences among the groups both the pre-intervention and post-intervention in the peak KFA, peak KEM, and peak vGRF. Compared with pre-intervention, the peak vGRF in the experimental group was significantly greater (p = 0.009) and the peak KFA in the control group was significantly lower (p = 0.041) post-intervention. There were not significantly different in the placebo group between pre-intervention and post-intervention. Conclusion: 12 weeks of knee extension constraint training can increase lower extremity loading on the injured side, may be a potential therapeutic adjunct to improve abnormal gait after ACLR. [ABSTRACT FROM AUTHOR]

The anterior cruciate ligament (ACL) is one of the most injured ligaments, with approximately 100,000 ACL reconstructions taking place annually in the United States. In order to successfully manage ACL rupture, it is of the utmost importance to understand the anatomy, unique physiology, and biomechanics of the ACL, as well as the injury mechanisms and healing capacity. Currently, the "gold standard" for the treatment of ACL ruptures is surgical reconstruction, particularly for young patients or athletes expecting to return to pivoting sports. Although ACL reconstruction boasts a high success rate, patients may face different, serious post-operative complications, depending on the type of graft and technique used in each one of them. Tissue engineering is a multidisciplinary field that could contribute to the formation of a tissue-engineered ACL graft manufactured by a combination of the appropriate stem-cell type, a suitable scaffold, and specific growth factors, combined with mechanical stimuli. In this review, we discuss the aspects that constitute the creation of a successful tissue-engineered graft while also underlining the current drawbacks that arise for each issue. Finally, we highlight the benefits of incorporating new technologies like artificial intelligence and machine learning that could revolutionize tissue engineering. [ABSTRACT FROM AUTHOR]

Purpose: Biological augmentation of anterior cruciate ligament (ACL) reconstruction with bone marrow aspirate concentrate (BMAC) is gaining attention for its theoretical potential to enhance postoperative healing and recovery. However, its clinical benefits remain uncertain, and its high cost raises questions about efficacy. Hence, we systematically reviewed randomised controlled trials (RCTs) to evaluate the effectiveness of BMAC in ACL reconstruction. Methods: Our search included Cochrane, EMBASE, OVID, PubMed, and Scopus databases for RCTs evaluating the use of BMAC in ACL reconstruction. Primary outcomes focused on International Knee Documentation Committee (IKDC) scores and Lysholm scores. Secondary outcomes included MRI-related outcomes and postoperative complications. Statistical analysis was conducted using Review Manager 5.4 (Cochrane Collaboration), with heterogeneity assessed using Cochrane's Q test and I2 statistics. Results: 221 patients from five RCTs were included, with 109 (49.3%) receiving BMAC augmentation. Follow-up ranged from 11.05 to 24 months. No significant differences were found in postoperative IKDC scores between the BMAC and control groups at, three, six and 12 months. The BMAC group had significantly higher IKDC scores at 24 months; however, this difference was unlikely to be clinically significant. No significant differences were observed in postoperative Lysholm scores at 12 or 24 months. MRI-related outcomes suggested potential graft recovery improvement with BMAC, and complication rates were comparable between groups. Conclusion: In summary, biological augmentation with BMAC in ACL reconstruction does not significantly improve early patient-reported outcomes but offers potential benefits in graft recovery without increasing complication rates. [ABSTRACT FROM AUTHOR]

Background: Anatomic single-bundle ACL reconstruction (ACLR) produces good results when the graft and tunnel are positioned in the anatomic footprint on the femoral and tibial insertion sites in a more oblique orientation. The Anterolateral Complex of the knee and its biomechanical role in controlling rotational laxity, internal rotation, and pivot shift has led to adding adjunctive procedures like extra-articular augmentation and lateral extra-articular tenodesis (LET) to decrease rotational laxity. We prospectively analyzed young adults with rotational instability and generalized laxity undergoing an arthroscopic single bundle ACLR with an additional LET procedure. Methods: 42 patients, aged between 20 and 50, undergoing all-inside ACLR augmented with concomitant lateral extra-articular tenodesis between November 2020 and October 2021 were included. All patients were followed up for one year and functional assessment comprised of the International Knee Documentation Committee [IKDC] score, visual analogue score [VAS], and Lysholm Knee Scoring Scale at 6 months and 1 year. Return to activity was assessed using the Tegner Activity Score. Results: The Lysholm score, IKDC score, and VAS showed significant improvements at 6 months after ACLR + LET (p < 0.0001) and further improved significantly at 1 year. The patients had a significant decline in the Tegner Activity Scale at 6 months but returned to the near pre-injury level (5.98 ± 0.924) at 1 year (5.67 ± 0.816) which was insignificant (p = 0.1067). Three patients sustained mild complications. 93% were satisfied with the surgery, 66% returned to sports and no patient underwent re-operation. Conclusions: Combination of LET with ACLR produces good functional outcomes, high rates of return to sports activities, and no graft failure in young patients at high risk of failure. [ABSTRACT FROM AUTHOR]

Background/Objectives: Anterior cruciate ligament (ACL) reconstruction is a common procedure performed in orthopedic surgery. There are many methods to evaluate the functional outcome postoperatively, but no single reliable method exists to assess graft maturity. The purpose of this research is to evaluate graft maturity by magnetic resonance imaging (MRI) and its relation with functional outcome at the end of 6 months and 12 months. Materials and Methods: MRIs were performed on 32 patients who underwent ACL reconstruction at 6 and 12 months following surgery. The measurements were made of the background, posterior cruciate ligament, and signal intensity of the graft. The calculation of the signal noise quotient (SNQ) was done. The correlations between the international knee documentation committee (IKDC) at 6 and 12 months and the SNQ values at 6 and 12 months were assessed. Results: After 6 months, the mean SNQ value was 3.8953 ± 2.6561, and after 12 months, it was 2.6013 ± 1.7337. In addition, the mean IKDC was 43.3 preoperatively, 52.8125 ± 9.24728 at 6 months' follow-up and 70.6875 ± 8.32578 at 12 months' follow-up. The 12-month SNQ values showed a significant decrease, according to RMANOVA (F [1,62] = 6.50871, P = 0.01316). Conversely, the IKDC scores at 12 months demonstrated a statistically significant rise (F [1,62] = 66.03667, P < 0.001). Conclusion: MRI is a reliable investigation to assess the graft maturity. In our study, hamstring graft demonstrated superior maturity at 12 months as compared to 6 months' postsurgery. There was a noteworthy inverse relationship between graft SNQ and IKDC scoring. MRI assessment at 6 months and 12 months is desirable to know graft's maturity and helps to modify the rehabilitation protocol. [ABSTRACT FROM AUTHOR]

Background: The incidence of anterior cruciate ligament reconstruction (ACLR) graft failure is inversely related to the diameter of the ACLR graft. When the diameter of a 4-stranded hamstring tendon graft with a doubled semitendinosus and doubled gracilis tendon (ST×2 + G×2) configuration is <8 mm, the gracilis tendon is often thin. Hypothesis: (1) The diameter of the doubled semitendinosus tendon (ST×2) alone would be able to predict the probability of a 4-stranded ACLR graft having a diameter of ≥8 mm, and (2) there would be a specific cutoff value for the ST×2 diameter such that the addition of a doubled gracilis tendon (G×2) will not result in a 4-stranded graft with a ≥8-mm diameter. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were patients who had undergone 4-stranded hamstring ACLR between 2008 and 2018. Patients were excluded if the diameter measurements of the tendons or ACLR graft were missing. A receiver operating characteristic (ROC) analysis was performed to assess the predictability of ST×2 on an ACLR graft with a diameter of ≥8 mm. The effect of including G×2 on the final graft size was reported. Results: A total of 314 patients were included, and the mean diameters of ST×2 and G×2 were 6.5 ± 0.8 mm and 5.0 ± 0.7 mm, respectively. There was a moderate to strong correlation between the diameter of ST×2 and that of G×2 (men: r = 0.678; women: r = 0.654; P <.001 for both). An ST×2 with a diameter <6 mm predicted a 4-stranded ACLR graft of <8 mm (area under the ROC = 0.917; P <.001). When ST×2 was <6 mm, the addition of a G×2 did not result in the ACLR graft's having a diameter of ≥8 mm, regardless of patient sex or G×2 diameter. Conclusion: When the diameter of the doubled semitendinosus was <6 mm, the addition of the doubled gracilis was unlikely to produce a 4-stranded ACLR graft with a diameter of ≥8 mm. Surgeons should consider alternative methods such as tripling or quadrupling the semitendinosus tendon to increase the size of the ACLR graft, rather than routinely harvesting the gracilis tendon. [ABSTRACT FROM AUTHOR]

Background: This study aimed to describe the arthroscopic superlateral capsule pathway technique for spotting femoral fixation device deployment, and to compare the results with normal procedure. Methods: A total of 69 patients underwent ACLR (Anterior Cruciate Ligament Reconstruction) with or without the SCP (superolateral capsule pathway) during procedure were retrospectively selected and evaluated. A total of 36 patients underwent SCP and 33 patients underwent ACLR without SCP. Mean follow-up was 6 months after surgery. All patient noted joint fluid, underwent VAS and Lysholm score at follow-up, and statistical analysis was performed. Results: No statistically significant differences were found in patient demographics, ACLR duration time (p = 0.076) and Lysholm score (p = 0.296). Significantly less postoperation pain was reported in the SCP group (p = 0.000), and fluid volume in SCP group was significantly lower (p = 0.001). The postoperative complications were rare in both group. Conclusions: The superolateral capsule pathway approach is a minimally invasive and safe technique that can be used to accurately locate and implant suture button-based femoral fixation devices in anterior cruciate ligament reconstruction. [ABSTRACT FROM AUTHOR]

The difficulties of rehabilitation after anterior cruciate ligament (ACL) injuries, subsequent return-to-sport (RTS) let alone achieving pre-injury performance, are well known. Isokinetic testing is often used to assess strength capacities during that process. The aim of the present machine learning (ML) approach was to examine which isokinetic data differentiates athletes post ACL reconstruction (ACLR) and healthy controls. Two Random Forest models were trained from data of unilateral concentric and eccentric knee flexor and extensor tests (30°/s, 150°/s) of 366 male (63 post ACLR) as well as 183 female (72 post ACLR) athletes. Via a cross-validation predictive performance was evaluated and the Random Forest showed outstanding results for male (AUC = 0.90, sensitivity = 0.76, specificity = 0.88) and female (AUC = 0.92, sensitivity = 0.85, specificity = 0.89) athletes. The Accumulated Local Effects plot was used to determine the impact of single features on the predictive likelihood. For both male and female athletes, the ten most impactful features either referred to the disadvantageous (injured, non-dominant in control group) leg or to lateral differences. The eccentric hamstring work at 150°/s was identified as the most impactful single parameter. We see potential for improving the RTS process by incorporating and combining measures, which focus on hamstring strength, leg symmetry and contractional work. [ABSTRACT FROM AUTHOR]

Background: Quadriceps tendon (QT), bone–patellar tendon–bone (BPTB), and hamstring tendon (HT) autografts are widely used for anterior cruciate ligament reconstruction (ACLR), but the optimal autograft choice remains controversial. This study assessed the treatment effects of QT versus BPTB and HT autografts for ACLR. Methods: The PubMed, Embase, and Cochrane Library databases were systematically searched for eligible studies published from inception until July 2022. Effect estimates were presented as odds ratios (OR) and weighted mean differences (WMD) with 95% confidence intervals (CI) for categorical and continuous variables, respectively. All pooled analyses were performed using a random-effects model. Results: Twenty-one studies (3 randomized controlled trials [RCTs], 3 prospective studies, and 15 retrospective studies) involving 2964 patients with ACLR were selected for meta-analysis. Compared with the HT autograft, the QT autograft was associated with a reduced risk of graft failure (OR: 0.46; 95% CI: 0.23–0.93; P = 0.031). Compared with the BPTB autograft, the QT autograft was associated with a reduced risk of donor site pain (OR: 0.16; 95% CI: 0.10–0.24; P < 0.001). Moreover, the QT autograft was associated with a lower side-to-side difference than that observed with the HT autograft (WMD: − 0.74; 95% CI: − 1.47 to − 0.01; P = 0.048). Finally, compared with the BPTB autograft, the QT autograft was associated with a reduced risk of moderate-to-severe kneecap symptoms during sports and work activities (OR: 0.14; 95% CI: 0.05–0.37; P < 0.001). Conclusions: The findings of this study suggest that the QT autograft can be defined as a safe and effective alternative choice for ACLR, but its superiority is yet to be proven by RCTs and prospective studies. Level of evidence Level III. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) injury rates are on the rise, despite improved surgical techniques and prevention programs. While traditional rehabilitation emphasizes the restoration of motion, strength, and physical performance, emerging research highlights the importance of addressing neurocognitive deficits that can persist after injury. These deficits, including altered proprioception, impaired motor control and muscle recruitment, as well as heightened reliance on visual feedback, can significantly increase the risk of re-injury and impede return to sport. The purpose of this clinical commentary is to outline a proposed comprehensive approach to rehabilitation that challenges the neurocognitive system to optimize rehabilitation outcomes and reduce reinjury risk. Thus, this clinical commentary discusses the rationale for integrating neurocognitive training into all phases of ACLR rehabilitation, from initial injury to eight weeks post-surgery. It details the neurophysiological changes caused by ACL injury and presents evidence supporting the use of exercises that challenge visual attention, decision-making, and motor planning. A comprehensive rehabilitation framework incorporating both physical and neurocognitive components is proposed, aiming to improve long-term outcomes and reduce re-injury risk. Level of Evidence: 5 [ABSTRACT FROM AUTHOR]

Background: After anterior cruciate ligament reconstruction (ACLR), asymmetry is likely to persist in single-leg (SL) vertical jump and drop jump performance than in SL hop distance. However, its relationship with the return to sport (RTS) remains unclear. Hypothesis/Purpose: This study aimed to determine the association between vertical jump performance after primary ACLR using hamstring tendon autograft and RTS at a pre-injury competitive level. Study design: Cross-sectional study Methods: Patients who underwent primary ACLR using hamstring tendon autograft were recruited for this study. Participants who returned to pre-injury competition after ACLR were recruited at least eight months postoperatively. Knee condition was assessed, including joint laxity, range of motion, muscle strength, and knee pain intensity during sports activities. Performance variables were also assessed, including SL hop distance, jump height in SL vertical jump, and reactive strength index (RSI; jump height/contact time) in SL drop jump. Participants were asked to subjectively report whether they had returned to the same level of competition as pre-injury and their perceived sport performance intensity. Those who answered "Yes" to the dichotomous question and had a postoperative subjective athletic performance of > 80% were categorized into the Yes-RTS group. The primary outcome was the ability to achieve RTS at the preinjury level. Results: Sixty-five patients (female, 35; male, 30) at 13.0 (13.0) [median (interquartile)] months after ACLR participated in this study. Thirty-nine (60%) were assigned to the Yes-RTS group. Regarding knee conditions, the No-RTS group had a significantly higher knee pain intensity, as assessed using a numerical rating scale (p<0.001, effect size -0.45). In the performance tests, the No-RTS group exhibited a significantly lower limb symmetry index of RSI during the SL drop jump compared to the Yes-RTS group (p=0.002, effect size 0.81). Conclusion: Patients unable to achieve RTS after primary ACLR using hamstring grafts are more likely to exhibit asymmetric performance during the SL drop jump test, suggesting the significance of assessing jump symmetry when evaluating post-ACLR rehabilitation success. Level of Evidence: 3c [ABSTRACT FROM AUTHOR]

BACKGROUND: The maximum muscle strength is typically used for evaluating the recovery of muscle function after anterior cruciate ligament reconstruction. Recent studies have suggested that neuromuscular function should also be considered, such as rate of force development, which measures the slope of the force time curve at different time intervals under conditions of isometric muscle contraction. OBJECTIVE: To elaborate on the current research status and shortcomings of muscle isometric rate of force development in patients undergoing anterior cruciate ligament reconstruction surgery, and analyze the degree of defects in quadriceps femoris and hamstring isometric rate of force development at different times after surgery; to analyze the effect of isometric rate of force development on postoperative functional performance, thereby providing important information for optimizing postoperative rehabilitation following anterior cruciate ligament reconstruction, reducing secondary injury to patients, and reducing the incidence of knee osteoarthritis. METHODS: Literature retrieval of CNKI, VIP, WanFang and PubMed was performed using “anterior cruciate ligament, rate of force development” as Chinese search terms and “anterior cruciate ligament, rate of force development, rate of torque development” as English search terms. Finally, 69 articles were included according to inclusion and exclusion criteria. RESULTS AND CONCLUSION: Most studies have found defects in bilateral muscle isometric rate of force development in patients undergoing anterior cruciate ligament reconstruction within 6 months. Early isometric rate of force development of the bilateral hamstring muscles (i.e. the slope of the force time curve at any time interval during muscle contraction of 100 ms) showed significant improvement after 6 months. However, long-term defects in early isometric rate of force development of the bilateral quadriceps indicate long-term damage to the neuromuscular function of the quadriceps after surgery. There is limited research on late isometric rate of force development (the slope of the force time curve at any time interval after 100 ms of muscle contraction), and conclusions cannot be drawn. Regarding landing exercises (jumping to the ground, lateral cutting, etc.) and daily activities (walking, running), early isometric rate of force development of the quadriceps is more correlated with isometric peak torque. Abnormal biomechanical changes during exercise are considered an important risk factor for secondary injury and traumatic knee osteoarthritis in patients. Actively improving early isometric rate of force development of the quadriceps may reduce the incidence of secondary injury and traumatic knee osteoarthritis. Currently, there is limited evidence to suggest that wholebody vibration training can improve early isometric rate of force development of the quadriceps femoris in patients undergoing anterior cruciate ligament reconstruction. It is recommended to use neuromuscular electrical stimulation to intervene in the quadriceps and hamstring in the early postoperative stage and implement explosive force and high resistance training in the late postoperative stage, which may improve the isometric rate of force development in patients. Generating sufficient muscle strength in a short period of time is necessary to effectively protect the anterior cruciate ligament, while the relationship between isometric rate of force development in the hamstring muscle and functional performance is still unclear, which may provide information on preventing secondary injury in patients. It is recommended to use the isometric rate of force development as one of the evaluation indicators for guiding rehabilitation and restoring movement. In addition to focusing on improving symmetry and differences from normal individuals, the hamstring to quadriceps strength ratio should also be considered. An appropriate range of ratios can ensure the balance of muscles during rapid muscle exertion, which may reduce the occurrence of secondary injuries. However, the normal range of ratios is not yet clear. Future research should consider the effects of graft type and knee flexion angle on isometric rate of force development, in order to identify neuromuscular dysfunction in patients as much as possible and help them recover better. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions The influence of the graft sagittal inclination angle (SIA) on knee stability, biomechanics, and graft maturity has been elucidated. However, no study has comprehensively described the effects of SIA on the aforementioned postoperative prognostic indicators. So, we aimed to determine whether the sagittal inclination angle (SIA) of a graft is associated with postoperative graft maturity, joint stability, and joint function after anterior cruciate ligament (ACL) reconstruction.Patients who had undergone ACL reconstruction between April 2019 and February 2022 and those with intact ACL were eligible. Using magnetic resonance imaging, graft maturity was evaluated as the mean signal‐to‐noise quotient (SNQ) measured in three regions. Anterior tibial translation (ATT) was used to evaluate knee stability. Correlation analysis was conducted for the SIA, ATT, and clinical outcome scores. Multivariate stepwise regression analysis was used on the SIA and potential risk factors to determine their association with the graft SNQ. The SIA threshold of knee instability was calculated by receiver‐operating characteristic curves.Sixty‐three postoperative patients were enrolled. The SIA was significantly negatively associated with graft SNQ value. A multivariate stepwise regression analysis showed that SIA and body mass index were significant influencing factors associated with the graft SNQ. Correlations between the SIA and medial and lateral ATT were statistically significant. A larger SIA resulted in a decreased probability of medial and lateral ATT ≥ 5 mm. The SIA threshold of an increased risk of lateral ATT ≥ 5 mm was < 44.4°. A positive correlation was observed between SIA and subjective symptom subscales in the KOOS.A low SIA is not conducive to graft maturation after ACL reconstruction. A larger graft SIA was correlated with better postoperative knee stability. However, the effect of the SIA on joint function was only significant in terms of symptoms. Therefore, these new findings provide new ideas for preoperative assessment and intraoperative determination of the ideal graft inclination. [ABSTRACT FROM AUTHOR]

The pilot study aimed to determine whether the time from injury to surgery influences on postoperative knee biomechanics during walking in patients with anterior cruciate ligament reconstruction (ACLR). Thirty-two patients with unilateral ACLR (early, 10 patients; delayed, 22 patients) and 30 control subjects participated in this study. All examinations for patients with ACLR were performed preoperatively and at 12 months postoperatively and comprised passive knee joint laxity, knee muscle strength, and knee kinematics and kinetics during walking. At both time points, there were no significant differences in passive knee joint laxity and knee muscle strength between the early ACLR and delayed ACLR groups. Preoperatively, both the early ACLR and delayed ACLR patients exhibited significantly reduced knee extension movement from midstance to terminal stance compared to the control subjects. Moreover, the delayed ACLR patients exhibited significantly decreased peak external knee flexion moment compared to the control subjects. At 12 months postoperatively, the early ACLR patients showed significant improvement in knee extension movement from midstance to terminal stance compared to pre-ACLR, while the delayed ACLR patients did not show significant improvement in this knee extension movement. It can be concluded that early ACLR may be more beneficial to improve knee biomechanics during walking. [ABSTRACT FROM AUTHOR]

The objectives of this study were to evaluate the reliability of cartilage T2 relaxation time measurements and to identify focal changes in T2 relaxation on the affected knee from 6 to 24 months after anatomic anterior cruciate ligament reconstruction (ACLR). Data from 41 patients who received anatomic ACLR were analyzed. A bilateral 3.0‐T MRI was acquired 6 and 24 months after ACLR. T2 relaxation time was measured in subregions of the femoral condyle and the tibial plateau. The root‐mean‐square coefficient of variation (RMSCV) was calculated to evaluate the reliability of T2 relaxation time in the contralateral knee. Subregion changes in the affected knee T2 relaxation time were identified using the contralateral knee as a reference. The superficial and full thickness layers of the central and inner regions showed good reliability. Conversely, the outer regions on the femoral side and regions in the deep layers showed poor reliability. T2 relaxation time increased in only 3 regions on the affected knee when controlling for changes in the contralateral knee, while changes in T2 relaxation time were identified in 14 regions when not using the contralateral knee as a reference. In conclusion, evaluation of cartilage degeneration by T2 relaxation time after ACLR is most reliable for central and inner cartilage regions. Cartilage degeneration occurs in the central and outer regions of the lateral femoral condyle from 6 to 24 months after anatomic ACLR. [ABSTRACT FROM AUTHOR]

Background: ACL reconstruction is often regarded as the most effective approach of restoring knee stability. Several graft possibilities are available, including (BPTB), four-strand hamstring autografts, quadriceps tendon, and peroneus longus tendon. Each has both advantages and cons. This study compares the effectiveness of peroneus longus and hamstring tendon autografts for single bundle ACL restoration. Patients and Methods: The study involved 60 patients. Thirty of them had their torn anterior cruciate ligaments reconstructed arthroscopically using hamstring tendons, while the other 30 had their ACLs managed arthroscopically with peroneus longus tendon. The follow-up period lasted at least 12 months. Patients were assessed using IKDC score and Lysholm score. Ankle function was assessed using AOFAS score. Results: There was a statistically significant difference in preoperative and postoperative range of motion improvement in each group as an IKDC score item. However, no statistically significant difference existed between both groups. A statistically significant change in Lysholm scores preoperatively and postoperatively in each group was detected, but there was no statistical difference between groups 1 and 2, either in terms of improvement or percentage improvement. The AOFAS score was used also to assess for any donor site morbidity. No significant difference was detected between both ankles range of motion and no ankle joint dysfunction or problems with sports activities. Conclusion: The current study found that the PL tendon autograft might be considered a safe, effective and a technically easy graft option for ACLR. The research shows no substantial difference in postoperative knee stability or graft failure rate between hamstring and peroneus tendons. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) injuries are common in sports and often require surgical intervention, e.g., ACL reconstruction (ACLR), aimed at restoring knee stability and enabling a return to pre-injury activity levels. The choice of graft is crucial, impacting biomechanical properties, clinical outcomes, and complication rates, and is especially important in revision surgeries after graft failure. Over the past 30 years, trends in graft selection have evolved towards more individualized approaches, considering factors such as patient activity level, prior injuries, and tissue availability. In Europe, autografts like hamstring tendon (HT), bone-patellar tendon-bone (BTB), and quadriceps tendon (QT) are preferred, with the increasing use of QT grafts. This review synthesizes the current literature on graft selection and its influence on ACLR outcomes. [ABSTRACT FROM AUTHOR]

Return from sport-related injury requires interprofessional collaboration to progress the athlete through a multistage rehabilitation continuum and successfully re-establish a performance level at or above the preinjury level. To achieve an optimal rehabilitation outcome, evidence-based exercise prescription must be considered throughout the entire continuum alongside typical milestones and testing outcomes. This prescription must also use match-play external load data within a multisystems program. This applied article focuses on the physical characteristics and training aspects after anterior cruciate ligament reconstruction and throughout the full rehabilitation continuum which includes 3 general phases: return to activity, sport, and performance. A 5 step framework is provided for the strength and conditioning specialist to effectively transition elite soccer athletes from return to sport to return to performance. This framework includes an expanded definition of the role of the strength and conditioning specialist during rehabilitation and outlines exercise prescription across the entire rehabilitation continuum. Improved interprofessional collaboration, decision making, and load management throughout transitions can aid in optimizing long-term outcomes for the athlete, including reduced risk of reinjury or new injury. [ABSTRACT FROM AUTHOR]

Background: After anterior cruciate ligament (ACL) reconstruction (ACLR), the function and strength of the quadriceps muscle are essential for a successful recovery. Low-load blood flow restriction training (LL-BFRT) is believed to reduce muscle atrophy and restore muscle function. Purpose: To systematically analyze the evidence on the effectiveness of LL-BFRT in early rehabilitation after ACLR. Study Design: Systematic review; Level of evidence, 1. Methods: A systematic review and meta-analysis were conducted consistent with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Comprehensive literature searches were performed in several electronic databases—including Cochrane Library (trials), PubMed, Embase, Web of Science, China National Knowledge Infrastructure, WanFang, China Science and Technology Journal Database, and Sinomed—from inception to October 1, 2023. Included were randomized controlled trials in Chinese and English comparing LL-BFRT within 6 weeks after ACLR with conventional rehabilitation training. Bias risk was assessed using the Cochrane Risk-of-Bias 2 tool. The outcomes measured were quadriceps muscle size, knee joint functional scores, balance function, and complications. The effects of LL-BFRT versus conventional rehabilitation were analyzed using standardized mean differences (SMDs) or weighted mean differences (WMDs). Results: A total of 362 studies were initially identified, and 8 were included for analysis. LL-BFRT was significantly more effective in improving quadriceps muscle volume (SMD, 0.37 [95% CI, 0.08 to 0.66]; P =.01) and Lysholm scores (SMD, 0.74 [95% CI, 0.43 to 1.05]; P <.0001) compared with conventional rehabilitation training. However, no significant improvements were observed in the 3 directions of the Y-balance test: anterior (WMD, 0.55 [95% CI, –6.37 to 7.46]; P =.88), posteromedial (WMD, –2.24 [95% CI, –8.76 to 4.29]; P =.50), and posterolateral (WMD, 0.02 [95% CI, –13 to 13.03]; P = 1.0). No complications were reported in any of the included studies. Conclusion: The results of this meta-analysis suggested that LL-BFRT within 6 weeks after ACLR has a more pronounced effect on increasing quadriceps muscle volume and improving Lysholm scores compared with conventional rehabilitation training, with no apparent complications. [ABSTRACT FROM AUTHOR]

Background: Postoperative knee arthrofibrosis after arthroscopic ligament reconstruction is a serious complication. Among adolescents, risk factors for postoperative arthrofibrosis are not well characterized and the effectiveness of early manipulation under anesthesia (MUA) is not well established. Purposes: To identify risk factors for arthrofibrosis after arthroscopic knee ligament reconstruction in adolescent patients and to evaluate the safety and effectiveness of early MUA. Study Design: Case-control study; Level of evidence, 3. Methods: The charts of all adolescent patients (<19 years of age) who underwent early MUA (<3 months) for knee stiffness after anterior cruciate ligament (ACL) or medial patellofemoral ligament (MPFL) reconstructions between 2008 and 2021 were retrospectively reviewed. Patients were matched 2:1 with patients without MUA from the same study period. The primary outcome was the final range of motion (ROM) after MUA. Logistic regression analysis was performed to identify predictors of MUA. Results: A total of 25 patients (10 with ACL reconstruction and 15 with MPFL reconstruction) with a mean age of 14.8 ± 2.6 years were included for analysis. Overall, 44% were skeletally immature. Patients underwent MUA at a mean of 63.3 ± 19.5 days after the index surgery. The mean ROM improved significantly from 96.3°± 20.5° to 135°± 9.7° after MUA after a median follow-up of 8.1 months (interquartile range, 5.4-15.0 months). There were no complications associated with MUA, but 2 patients (8.0%) had MUA treatment failure. There were no differences in body mass index, type and frequency of associated procedures, or patellar height on lateral radiographs between the cohorts. The MUA cohort had statistically significant increased operative time, decreased preoperative motion, decreased ROM at 6 weeks postoperatively, and increased pain at 6 weeks postoperatively when compared with the non-MUA cohort. Regression analysis demonstrated that ROM at 6 weeks (OR: 0.83, 95% CI, 0.69-0.98, p =.034) was significantly associated with the need for MUA. Conclusion: The findings of this study suggest that early (<3 months) MUA is safe and effective in treating knee arthrofibrosis in adolescent patients. MUA is a treatment alternative for patients with restricted ROM at 6 weeks that may help them recover full ROM. [ABSTRACT FROM AUTHOR]

Abstract Background Anterior cruciate ligament (ACL) injuries are one of the most common sports injuries, accounting for approximately 50% of knee-related injuries. Extracorporeal shockwave therapy (ESWT), in the form of the radial (R-SWT) or focused shockwave (F-SWT), has been shown effective in treating various orthopaedic conditions. Recently, studies have investigated whether ESWT combined with standard rehabilitation may improve outcomes following anterior cruciate ligament reconstruction (ACLR). Therefore, this study aimed to determine whether ESWT can improve clinical outcomes following ACLR. Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched PubMed, Embase, and Web of Science and included studies involving ESWT treatment following ACLR, which consisted of randomized controlled trials (RCTs) and cohort studies. Two authors independently extracted the outcome measurements and used a revised Cochrane risk-of-bias tool (RoB 2) for RCTs and the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) for a cohort study to assess the risk of bias. A random effects pairwise meta-analysis was used to compare patient-reported outcomes between ESWT and controlled treatments. Results Five studies (Level I: 4; Level II: 1) with 242 participants (male: 167; female: 75) were included. Regarding the patient-reported outcomes, the risk of bias for all RCTs was ‘high’ and ‘serious’ for a non-randomized study. The meta-analysis demonstrated that the Lysholm scores were significantly higher in ESWT groups than those of controls at 12 months (Weighted mean difference [WMD]: 7.037, 95% confidence interval [CI]: 6.172–7.902, I2: 0%) and 24 months (WMD: 5.463, 95% CI: 2.870–8.056, I2: 0%). Furthermore, the International Knee Documentation Committee (IKDC) scores were also significantly higher in the ESWT group than that of the control at 12 months (WMD: 6.371, 95% CI: 3.397–9.344, I2: 68.8%). However, the WMDs for these outcomes between the two groups did not exceed the minimal clinically important difference (MCID). Conclusion Based on the meta-analyses performed with a few studies, ESWT combined with standard rehabilitation may potentially lead to better patient-reported outcomes. However, these differences may not be clinically significant. Further high-quality studies are needed to confirm our review’s findings.

Objective An important reason for the poor recovery of anterior cruciate ligament (ACL) injuries is the poor recovery of muscle function. Therefore, we used surface electromyography (sEMG) and gait analysis to explore the muscle activation patterns and gait characteristics between lower limbs under different exercise states in patients, following anterior cruciate ligament reconstruction (ACLR). Methods Forty‐one adults with unilateral ACL injuries in Binzhou Medical University Hospital from October 2022 to June 2023 were allocated to three groups according to the time after ACL reconstruction: group A (≤3 months, 16), group B (3 months–1 year, 13), and group C (>1 year, 12). Patients were tested by sEMG and gait, while straight leg raising (SLR), walking at normal speed, fast walking, and walking up and down the stairs. Two related sample tests were performed for the normalized root mean square (RMS) values and gait parameters. Results Muscle function changes varied in different training tasks. The RMS value of the involved side was more than the uninvolved side in biceps femoris and semitendinosus of group A (p

Background: Anterior cruciate ligament reconstruction (ACLR) involves surgically restoring the injured ACL through the placement of graft material. The selection of graft material plays a crucial role in ensuring optimal knee stability postsurgery. Using autografts of the hamstring, bone-patellar tendon-bone (BPTP), quadriceps, and peroneus longus tendon (PLT), the current systematic study aimed to assess the clinical and functional results of patients undergoing ACLR. Methods: Literature search exploration was conducted using databases such as PubMed, Medline, Web of Science, and Cochrane Library, supplemented by additional resources such as Google Scholar and clinical trials.gov, spanning from 2014 to 2024. The two-part tool was employed to analyze five distinct domains. For evaluation of the quality of diagnostic accuracy studies, a quality assessment tool was implemented. Results: Seventeen studies were incorporated. Most studies indicated considerable enhancements in clinical function, postsurgical knee stability, and osteoarthritis alterations. Nonetheless, these autografts present a reduced risk of certain complications including anterior knee pain, discomfort during kneeling, and extension loss. The assessment of risks in the study revealed that 50% were categorized as having a low risk, whereas 32% had an unclear risk and 18% of cases were classified as not applicable. Conclusion: The present systematic review highlights the survival rates and joint stability across various graft options including BPTP, hamstring, quadricep, and especially PLT. These autografts are safe, reliable, and versatile choices deserving of attention in forthcoming ACL reconstruction investigations.

Abstract Background Septic arthritis is a rare but devastating complication after anterior cruciate ligament reconstruction (ACLR). While early treatment can prevent significant graft complications, outcomes are often inferior to those in uncomplicated ACLR. Furthermore, whether to retain or remove the graft after infection remains debatable. Therefore, we sought to compare the outcomes of septic arthritis post ACLR with uncomplicated ACLR and evaluate graft retention versus removal in infected patients. Methods We conducted a systematic review and meta-analysis in which PubMed, Embase, and Cochrane Library databases were searched. Clinical studies were included if they compared patient-reported, clinician-reported, or radiographic outcomes (minimum follow-up of 12 months) between patients with post-ACLR septic arthritis and those with uncomplicated ACLR or that compared graft retention and removal in patients with post-ACLR septic arthritis. Results Thirteen studies were retrieved. Patients with post-ACLR septic arthritis reported inferior Lysholm Knee Scoring Scale scores (mean difference (MD) 7.53; 95% confidence interval (CI) 3.20–11.86; P = 0.0006), Tegner Activity Scale scores (MD, 1.42; 95% CI 1.07–1.76; P

Background ACL reconstruction is often regarded as the most effective approach of restoring knee stability. Several graft possibilities are available, including (BPTB), four-strand hamstring autografts, quadriceps tendon, and peroneus longus tendon. Each has both advantages and cons. This study compares the effectiveness of peroneus longus and hamstring tendon autografts for single bundle ACL restoration.Patients and Methods The study involved 60 patients. Thirty of them had their torn anterior cruciate ligaments reconstructed arthroscopically using hamstring tendons, while the other 30 had their ACLs managed arthroscopically with peroneus longus tendon. The follow-up period lasted at least 12 months. Patients were assessed using IKDC score and Lysholm score. Ankle function was assessed using AOFAS score.Results There was a statistically significant difference in preoperative and postoperative range of motion improvement in each group as an IKDC score item. However, no statistically significant difference existed between both groups. A statistically significant change in Lysholm scores preoperatively and postoperatively in each group was detected, but there was no statistical difference between groups 1 and 2, either in terms of improvement or percentage improvement. The AOFAS score was used also to assess for any donor site morbidity. No significant difference was detected between both ankles range of motion and no ankle joint dysfunction or problems with sports activities.Conclusion The current study found that the PL tendon autograft might be considered a safe, effective and a technically easy graft option for ACLR. The research shows no substantial difference in postoperative knee stability or graft failure rate between hamstring and peroneus tendons.