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Background: This study aimed to investigate the expression of vascular endothelial growth factor (VEGF) in cruciate ligaments from patients with osteoarthritis (OA). It was hypothesized that the expression level of VEGF is associated with the extent of degeneration of the cruciate ligaments. Methods: Remnants of anterior cruciate ligaments (ACLs) from patients with acute ACL injury due to trauma, and ACLs and posterior cruciate ligaments (PCLs) from patients with primary OA were assessed histologically. Samples were immunohistochemically stained with VEGF and tenomodulin, and immunopositive cells were quantitatively assessed by the histological grades of ligament degeneration. Results: Histological analysis showed significant degeneration of the ACLs from OA patients compared with trauma patients, with increased expression of VEGF correlating with higher grades of degeneration. Conversely, tenomodulin expression was lower in more degenerated cruciate ligaments. The percentage of VEGF-positive cells was correlated inversely with that of tenomodulin-positive cells. Conclusions: Increased VEGF expression is associated with degeneration of cruciate ligaments in patients with osteoarthritis of the knee. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to investigate the expression of vascular endothelial growth factor (VEGF) in cruciate ligaments from patients with osteoarthritis (OA). It was hypothesized that the expression level of VEGF is associated with the extent of degeneration of the cruciate ligaments. Methods Remnants of anterior cruciate ligaments (ACLs) from patients with acute ACL injury due to trauma, and ACLs and posterior cruciate ligaments (PCLs) from patients with primary OA were assessed histologically. Samples were immunohistochemically stained with VEGF and tenomodulin, and immunopositive cells were quantitatively assessed by the histological grades of ligament degeneration. Results Histological analysis showed significant degeneration of the ACLs from OA patients compared with trauma patients, with increased expression of VEGF correlating with higher grades of degeneration. Conversely, tenomodulin expression was lower in more degenerated cruciate ligaments. The percentage of VEGF-positive cells was correlated inversely with that of tenomodulin-positive cells. Conclusions Increased VEGF expression is associated with degeneration of cruciate ligaments in patients with osteoarthritis of the knee.

The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are important structures to maintain knee stability. The present study aimed to further enrich understandings of the morphology of the cruciate ligaments and explore the relationship between the diameter of ACL and PCL.

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In the surgery of knee cruciate ligament repair, how to accurately and personalized obtain cruciate ligament insertion centers is the key issue and a great challenge for surgeons. Current artificial judgment is often with deviation, which increases the risk of surgical failure, complications, and the need for a second surgery. Surgical failure can cause imbalanced force on the knee joint (even limping). In this paper, we propose a personalized preoperative positioning method framework of cruciate ligament insertion centers. We focus on locating the insertion centers and verifying the accuracy of the results. The main steps of the method are as follows. First, we propose a new network model W-UNet to better segment accurate bone regions and small ligament regions from MRI. Second, based on RANSAC algorithm and ICP algorithm, MRI bone model and CT bone model are registered. Third, based on the extracted bone and ligament models, we propose an accurate and personalized method for locating the insertion centers. Fourth, we propose a method based on the principle of calculus, using broken lines instead of curves, to solve the problem of ligament reconstruction blocked by intercondylar protrusions. Finally, the length of cruciate ligament with different flexion angles verifies the accuracy of insertion centers. Preoperative personalized insertion centers preoperative positioning can be performed according to the patient's MRI and CT images. Validation experiments proved the accuracy and robustness of this method. Surgeons can use this framework to accurately obtain personalized preoperative insertion centers location for target patients. This framework provides a reasonable and feasible technical means for locating and marking cruciate ligament insertion centers. It effectively solves the problem of difficult ligament centers localization in clinical surgery and reduces the risk of surgical failure. [ABSTRACT FROM AUTHOR]

Introduction and aim of the work: The rupture of the cranial cruciate ligament (CrCL) is among the most common causes of pelvic limb lameness in dogs. The objective of this study was to investigate the histological changes in dogs with cranial cruciate ligament rupture and to compare the result using three different score systems Materials and Methods: The study cohort comprised of 30 dogs of various breeds, ages, genders and body weights with spontaneous cranial cruciate ligament rupture divided into 3 groups (1 week, 2 weeks and 3 weeks’ post-rupture). All tissue samples from CrCL were collected after open medial or lateral arthrotomy and histology slides were prepared and stained with hematoxylin-eosin. Three different score systems were used for grading the histological changes-synovitis score modified Bonar and modified Vasseur score. Results: Our results showed that no inflammatory cells were observed in groups II and III and a very limited number in group I. We also found the highest erythrocytes deposition and larger lumen of blood vessels, uneven arrangement of the collagen fibers as well as fibrocytes transformation into chondrocytes in group I. In group II multiple blood vessel were also filled with erythrocytes and the number of chondrocytes is increased in comparison to group I. In group III blood vessels size and number were reduced in comparison to group I and II and many sections of the collagen fibers showed hyalinization. Conclusion: In summary, degenerative changes were seen in all samples examined of cranial cruciate ligaments with different grades of chondroid metaplasia, increased cellularity and vascularity. Inflammatory changes were rarely detected by lymphoplasmacytic infiltrates with or without lymphoid aggregate deposition. No correlation was noted between age and all histological scores.

This summary provides an overview of eight studies that investigated the relationship between gonadectomy (spaying or neutering) and the risk of cranial cruciate ligament disease (CCLD) in dogs. The studies varied in design and sample size, and the results were mixed. Some studies found a significant increase in the risk of CCLD in certain breeds or when gonadectomy was performed at a young age, while others did not find a significant association. It is important to note that these studies have limitations, such as small sample sizes and potential biases. Further research is needed to fully understand the relationship between gonadectomy and CCLD in dogs. [Extracted from the article]

The aim of the research is to design a rehabilitation program and to identify how it affects the improvement of the muscle force and balance on volleyball players with the crusader bond. The researcher used the experimental approach to adapt it to the nature of the research and to the application of tribal and telemetry as a pilot design for a single set to which the proposed rehabilitation program would apply. Application of the proposed rehabilitation program: The rehabilitation program was implemented in the period from 1 January 2022 to 30 June 2023 by (14) weeks with ( 3 ) units, bringing the number of rehabilitation units to ( 42 ). The average time of the rehabilitation unit was set at (40) minutes. The sample of the search was young volleyball players registered by the Egyptian Fleet Federation for the 2022th sports season, 2023th, and they The (6) players were divided into (5) players for the application of program ( 1) players for the reconnaissance experiment.. During the course of the training program, the researcher took into account the following: 1. Standardization of the location of the training of the samplers. 2- Individual application of the experiment to take into account individual differences in the sample and the extent of the injury. 3. Fever performance to prepare the body for action and raise the body temperature to prepare for the main part. 4. Attention to tidal exercises during the program to restore muscle strength. 5. Attention to the final part and the exercise of calm in order to reduce the degree of pain. The most important conclusions were the impact of the proposed and implemented rehabilitation program on improving some of the physical abilities (motivated force and balance) of volleyball players with a cross strand and also contributed to the return of players to exercise sports activity. The researcher recommended that the content of the proposed rehabilitation program should be guided by the rehabilitation of those affected by the crusade and the need to take care of the period of physical preparation prior to the start of the sports season in order to prevent sports injuries. She also recommended that the balance should be struck in the development of the muscle strength of the front muscles and the back muscles of the knee shaft in order to avoid injury as a result of the imbalance. The researcher also recommended the use of long and balanced exercises and their significant use in the rehabilitation program for knee injuries in general. imbalance. The researcher also recommended the use of long and balanced exercises and their significant use in the rehabilitation program for knee injuries in general. [ABSTRACT FROM AUTHOR]

Introduction and aim of the work: The rupture of the cranial cruciate ligament (CrCL) is among the most common causes of pelvic limb lameness in dogs. The objective of this study was to investigate the histological changes in dogs with cranial cruciate ligament rupture and to compare the result using three different score systems Materials and Methods: The study cohort comprised of 30 dogs of various breeds, ages, genders and body weights with spontaneous cranial cruciate ligament rupture divided into 3 groups (1 week, 2 weeks and 3 weeks' post-rupture). All tissue samples from CrCL were collected after open medial or lateral arthrotomy and histology slides were prepared and stained with hematoxylin-eosin. Three different score systems were used for grading the histological changes-synovitis score modified Bonar and modified Vasseur score. Results: Our results showed that no inflammatory cells were observed in groups II and III and a very limited number in group I. We also found the highest erythrocytes deposition and larger lumen of blood vessels, uneven arrangement of the collagen fibers as well as fibrocytes transformation into chondrocytes in group I. In group II multiple blood vessel were also filled with erythrocytes and the number of chondrocytes is increased in comparison to group I. In group III blood vessels size and number were reduced in comparison to group I and II and many sections of the collagen fibers showed hyalinization. Conclusion: In summary, degenerative changes were seen in all samples examined of cranial cruciate ligaments with different grades of chondroid metaplasia, increased cellularity and vascularity. Inflammatory changes were rarely detected by lymphoplasmacytic infiltrates with or without lymphoid aggregate deposition. No correlation was noted between age and all histological scores. [ABSTRACT FROM AUTHOR]

Objective of the research This study aimed to manufacture an innovative device that enables the player to walk after the operation and improves functional efficiency through improvement in the range of motion as well as improvement in the size of the muscles working on the knee joint Imposing research There are statistically significant differences between the pre and posttests of the experimental and control groups, there are Statistically significant differences between the post-tests between the experimental group and the control group in favor of the experimental group of the research sample. The researchers used the experimental approach by designing the control and experimental groups with a test (pre-post) for the suitability of the approach to the research problem. The study population consisted of players with severed anterior cruciate ligaments for advanced soccer players, and the number of the research sample was (5) injured for the control sample and (5) for the experimental sample. The researchers concluded that the use of the innovative device showed good results in accelerating the rehabilitation process, and the development of body parts was In line with the progress of bending and stretching in the innovative device. There is no delay for one part of the body at the expense of another part, the most important recommendations. The necessity of using partial movement braces in the rehabilitation of the anterior cruciate ligament injury of the knee in advanced soccer players, the use of the number of walking steps and the pressure applied to the ground as a criterion for the progress of rehabilitation and recovery, the researcher recommends using the device early after the operation. [ABSTRACT FROM AUTHOR]

PICO Question In bitches, does gonadectomy before 1 year of age compared to gonadectomy at 1 year of age or older, increase the risk of cranial cruciate ligament disease during their life? Clinical bottom line Category of research Risk. Number and type of study designs reviewed Eight studies were reviewed, four of which were retrospective cohort studies, two of which were prospective longitudinal cohort studies, one of which was a retrospective case-control study and one of which was a prospective case-control study. Strength of evidence Moderate. Outcomes reported The evidence was mixed, but overall was suggestive that gonadectomy before 1 year of age increased the risk of cranial cruciate ligament disease in bitches. Gonadectomy before 1 year of age was found to increase the risk of cranial cruciate ligament disease in seven of eight studies. Most studies assessed a narrow range of breeds and the generalisability of these results to all dogs is thus limited. The one study which assessed a range of 35 breeds noted an increase in risk of cranial cruciate ligament disease in 6 of 35 breeds associated with gonadectomy before 1 year of age. Direct comparison of studies is limited by the varying age stratifications, breed analyses, and study methodologies. Conclusion Gonadectomy before 1 year of age in Golden Retriever, German Shepherd, and Rottweiler bitches may increase the risk of cranial cruciate ligament disease. In other breeds, limited evidence is available to draw conclusions. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Objective of the research This study aimed to manufacture an innovative device that enables the player to walk after the operation and improves functional efficiency through improvement in the range of motion as well as improvement in the size of the muscles working on the knee joint Imposing research There are statistically significant differences between the pre and posttests of the experimental and control groups, there are Statistically significant differences between the post-tests between the experimental group and the control group in favor of the experimental group of the research sample. The researchers used the experimental approach by designing the control and experimental groups with a test (pre-post) for the suitability of the approach to the research problem. The study population consisted of players with severed anterior cruciate ligaments for advanced soccer players, and the number of the research sample was (5) injured for the control sample and (5) for the experimental sample. The researchers concluded that the use of the innovative device showed good results in accelerating the rehabilitation process, and the development of body parts was In line with the progress of bending and stretching in the innovative device. There is no delay for one part of the body at the expense of another part, the most important recommendations. The necessity of using partial movement braces in the rehabilitation of the anterior cruciate ligament injury of the knee in advanced soccer players, the use of the number of walking steps and the pressure applied to the ground as a criterion for the progress of rehabilitation and recovery, the researcher recommends using the device early after the operation.

IntroductionTo investigate the epidemiological features and prevalence of cruciate ligament injuries (CLI) in children and adolescents, and to examine the potential risk factors associated with concomitant meniscal tear (MT) among this population.MethodsThe demographic data and injury details of children and adolescents with CLI from Southeast China were analyzed to describe their distribution characteristics, alongside an analysis of the prevalence of MTs, the most frequent complication. In addition, binary logistic analysis was employed to ascertain the risk factors linked to MT in individuals suffering from CLI.ResultsA total of 203 patients with CLI (n = 206) met the inclusion criteria, with a male-to-female ratio of 2.3:1. Notably, a higher proportion of females were aged ≤16 years old compared to males, who predominated in patients aged >16 years (P = 0.001). Among children and adolescents, anterior cruciate ligament (ACL) injuries were the primary type of CLI, accounting for 88.18% (179/203) of all cases. The majority of cases (132/203, 65.02%) were sustained during sports activities, and sprains were the predominant mechanism of injury (176/203, 86.7%). Additionally, the most common associated injury was an MT (157/203, 77.34%). The posterior horn is the most frequently affected site for both medial MT (62.93% out of 73 cases) and lateral MT (70.19% out of 73 cases). Moreover, vertical tears constituted the majority of medial MTs (59.48% out of 116 cases). Furthermore, patients with a higher BMI faced an increased risk of associated MT in comparison to non-overweight patients (88% vs. 73.86%; P = 0.038). Each increase in BMI unit was linked with a 14% higher probability of associated MT occurrence in children and adolescents with CLI (OR = 1.140; P = 0.036).DiscussionACL injuries are a common form of knee ligament injury among children and adolescents, especially those over the age of 16, and are often the result of a sprain. Meniscal posterior horn injury is the most commonly associated injury of youth with CLI. Additionally, overweight or obese people with CLI are at a greater risk of developing MT.

Background: Cranial cruciate ligament disease is one of the leading causes of pelvic limb claudication in canines and osteoarthritis in the stifle joint. Historically, studies have focused on surgical options to improve the stability of the stifle joint, although none of the techniques described in the literature prevents the development of osteoarthritis. Aim: This study aimed at proving the presence of osteoarthritis at the time of diagnosis of cranial cruciate ligament rupture, as well as evaluating the benefits of administering diacerein or chondroprotective coadjuvants to the extracapsular fabelo-tibial technique. Methods: Seventeen dogs aged between 2 and 8, weighing more than 25 kg, with no predilection for breed or sex, were operated on using this technique. These were divided into three groups: Diacerein (DAR), Chondroprotector (CP), and Control. The animals were treated for 90 days and controlled clinically, radiologically, and using multidimensional scales for pain and quality of life. The statistical analysis used was descriptive and through non-parametric tests. Results: All patients had some degree of osteoarthritis at the beginning of the study associated with the presence of pain. The treated groups improved the claudication scores; however, the changes were significant for the diacerein group. The pain score improved in all animals, including those in the Control group; however, the differences were significant only in the treated groups. On the other hand, no significant differences were detected in the radiological studies, so it would be convenient to perform this study over more than 90 days. Conclusion: The surgical treatment accompanied by drugs that act on the degradation of articular cartilage has better clinical results. [Open Vet J 2023; 13(3.000): 297-306]

The purpose of this study was to develop injury risk functions (IRFs) for the anterior and posterior cruciate ligaments (ACL and PCL, respectively) and the medial and lateral collateral ligaments (MCL and LCL, respectively) in the knee joint. The IRFs were based on post-mortem human subjects (PMHSs). Available specimen-specific failure strains were supplemented with statistically generated failure strains (virtual values) to accommodate for unprovided detailed experimental data in the literature. The virtual values were derived from the reported mean and standard deviation in the experimental studies. All virtual and specimen-specific values were thereafter categorized into groups of static and dynamic rates, respectively, and tested for the best fitting theoretical distribution to derive a ligament-specific IRF. A total of 10 IRFs were derived (three for ACL, two for PCL, two for MCL, and three for LCL). ACL, MCL, and LCL received IRFs in both dynamic and static tensile rates, while a sufficient dataset was achieved only for dynamic rates of the PCL. The log-logistic and Weibull distributions had the best fit (p-values: >0.9, RMSE: 2.3%–4.7%) to the empirical datasets for all the ligaments. These IRFs are, to the best of the authors’ knowledge, the first attempt to generate injury prediction tools based on PMHS data for the four knee ligaments. The study has summarized all the relevant literature on PHMS experimental tensile tests on the knee ligaments and utilized the available empirical data to create the IRFs. Future improvements require upcoming experiments to provide comparable testing and strain measurements. Furthermore, emphasis on a clear definition of failure and transparent reporting of each specimen-specific result is necessary.

Background: Cranial cruciate ligament disease is one of the leading causes of pelvic limb claudication in canines and osteoarthritis in the stifle joint. Historically, studies have focused on surgical options to improve the stability of the stifle joint, although none of the techniques described in the literature prevents the development of osteoarthritis. Aim: This study aimed at proving the presence of osteoarthritis at the time of diagnosis of cranial cruciate ligament rupture, as well as evaluating the benefits of administering diacerein (DAR) or chondroprotective coadjuvants to the extracapsular fabelo-tibial technique. Methods: Seventeen dogs aged between 2 and 8, weighing more than 25 kg, with no predilection for breed or sex, were operated on using this technique. These were divided into three groups: DAR, Chondroprotector (CP), and Control. The animals were treated for 90 days and controlled clinically, radiologically, and using multidimensional scales for pain and quality of life. The statistical analysis used was descriptive and through non-parametric tests. Results: All patients had some degree of osteoarthritis at the beginning of the study associated with the presence of pain. The treated groups improved the claudication scores; however, the changes were significant for the DAR group. The pain score improved in all animals, including those in the Control group; however, the differences were significant only in the treated groups. On the other hand, no significant differences were detected in the radiological studies, so it would be convenient to perform this study over more than 90 days. Conclusion: The surgical treatment accompanied by drugs that act on the degradation of articular cartilage has better clinical results. [ABSTRACT FROM AUTHOR]

Aims: A functional anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) has been assumed to be required for patients undergoing unicompartmental knee arthroplasty (UKA). However, this assumption has not been thoroughly tested. Therefore, this study aimed to assess the biomechanical effects exerted by cruciate ligament-deficient knees with medial UKAs regarding different posterior tibial slopes. Methods: ACL- or PCL-deficient models with posterior tibial slopes of 1°, 3°, 5°, 7°, and 9° were developed and compared to intact models. The kinematics and contact stresses on the tibiofemoral joint were evaluated under gait cycle loading conditions. Results: Anterior translation increased in ACL-deficient UKA cases compared with intact models. In contrast, posterior translation increased in PCL-deficient UKA cases compared with intact models. As the posterior tibial slope increased, anterior translation of ACL-deficient UKA increased significantly in the stance phase, and posterior translation of PCL-deficient UKA increased significantly in the swing phase. Furthermore, as the posterior tibial slope increased, contact stress on the other compartment increased in cruciate ligament-deficient UKAs compared with intact UKAs. Conclusion: Fixed-bearing medial UKA is a viable treatment option for patients with cruciate ligament deficiency, providing a less invasive procedure and allowing patient-specific kinematics to adjust posterior tibial slope. Patient selection is important, and while AP kinematics can be compensated for by posterior tibial slope adjustment, rotational stability is a prerequisite for this approach. ACL- or PCL-deficient UKA that adjusts the posterior tibial slope might be an alternative treatment option for a skilled surgeon. Cite this article: Bone Joint Res 2022;11(7):494–502.

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Copyright of Der Unfallchirurg is the property of Springer Nature 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.)

Projectile legform tests are used to evaluate pedestrian lower extremity injury risk, including risk of injury to the cruciate and collateral ligaments. However, it has been suggested that cruciate ligament injuries rarely occur without collateral ligament injuries, making a cruciate ligament injury requirement unnecessary in pedestrian test procedures. Therefore, the current study examines cruciate ligament injuries among U.S. pedestrians with and without other injuries that are evaluated in pedestrian test procedures. Injury data for pedestrians treated in U.S. trauma centers from 2007 to 2017 were drawn from the National Trauma Data Bank (NTDB) Research Data Set (RDS) and from its successor, the Trauma Quality Program (TQP) Participant User Files (PUF). Crash and demographic details for individual cases with documented knee ligament injuries were obtained from the Pedestrian Crash Data Study (PCDS). Among pedestrians aged 16 and older with knee ligament injuries, 38% had only collateral injuries, 31% had only cruciate injuries and 31% were documented with injuries to both. Younger pedestrians also sustained cruciate injuries without collateral injuries, with 36% of the 0–15 year-old pedestrians diagnosed with knee ligament injuries having isolated cruciate injuries. Given that injuries to the left and right knee could not be distinguished in NTDB cases, these estimates of isolated ligament injuries are likely conservative, so that at least 31% of pedestrians aged 16 and older and at least 36% of younger pedestrians sustained cruciate ligament injuries without collateral ligament injuries in the same knee. A PCDS case study illustrated how cruciate injury can occur without collateral injury in a lateral bumper impact below the knee. Cruciate ligament injuries can occur in pedestrian crashes, with or without other injuries that are evaluated in pedestrian test procedures. Isolated cruciate injuries may be more likely in impacts above or below the knee and in impacts with a component of anterior-posterior loading. The frequency of cruciate injury in the absence of collateral injury in lateral and non-lateral impact supports inclusion of injury measures correlating to cruciate injury risk in pedestrian legform test procedures. [ABSTRACT FROM AUTHOR]

Purpose: It has been proven that a steep tibial slope (TS) is a risk factor for anterior cruciate ligament (ACL) injury and graft insufficiency after ACL reconstruction (ACLR). Recently, there is an increasing number of case series on slope decreasing osteotomies after failed ACLR utilizing different techniques and strategies. Goal of the present study is to report on early experiences with slope decreasing osteotomies in ACL deficient knees with special emphasis on the amount of slope correction, technical details, and complications; and to further analyze differences of slope corrections between sole sagittal as well as combined coronal and sagittal realignment procedures. In addition, we wanted to study if sole sagittal corrections change the coronal alignment. Methods: Seventy-six patients with a minimum follow-up of 6 months were identified, who underwent a sole sagittal correction (anterior closed-wedge high tibial osteotomy (ACW-HTO)) or a combined procedure with an additional coronal realignment (medial open-wedge high tibial osteotomy (MOW-HTO)). In ACW-HTO, either infratuberosity or supratuberosity approaches were used. The medial TS was measured on lateral radiographs and the anatomical medial proximal tibial angle (aMPTA) was measured on anterior–posterior radiographs. Technical details and specific complications were recorded. Results: Fifty-eight ACW-HTO and 18 MOW-HTO were performed. Regarding ACW-HTO, an infratuberosity (N = 48) or a supratuberosity (N = 10) approach was chosen. Sixty-seven patients had at least 1 previous ACLR. Mean TS changed from 14.5 ± 2.2° to 6.8 ± 1.9° (P < 0.0001). Mean TS of ACW-HTO was significantly reduced (14.6 ± 2.3° vs. 6.5 ± 1.9°; P < 0.0001), whereas in combined coronal and sagittal realignments, from 14.1 ± 1.9° to 7.6 ± 1.9° (P < 0.0001). The TS reduction in sole sagittal corrections was significantly higher compared to combined procedures (8.1 ± 1.6 vs. 6.4 ± 1.6°; P = 0.0002). Mean aMPTA in ACW-HTO changed from 87.1 ± 2.1° to 87.4 ± 2.8 (n.s.). However, there was a significant inverse correlation between the amount of sagittal correction and coronal alteration (r = − 0.29; P = 0.028). There was one late implant infection, which occurred 5.5 months after the index surgery. Conclusions: ACW-HTO and MOW-HTO facilitate significant slope reduction with a low-risk profile in patients with ACL insufficiency and a high tibial slope. AOW-HTO does not significantly alter coronal alignment in the majority of patients. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Bone-patellar tendon-bone (BPTB) and semitendinosus–gracilis (STG) are the commonest grafts used for ACL reconstruction. However even after having been debated for years, there is no consensus about the ideal graft. Moreover, the literature is deficient about STG graft with preserved tibial insertion (STGPI) which preserves the proprioception. Our aim is to compare the outcome of BPTB, free STG and STGPI grafts after ACL reconstruction in professional sports persons. We compared the outcome in terms of mechanical stability, functional outcome, return to sports activity and degenerative changes. MATERIALS AND METHODS: Professional sports persons aged between 16-50 years operated for ACL tear using BPTB, free STG and STGPI grafts with minimum follow-up of two years were identified from hospital records. Patients with associated knee injuries were excluded. Patients, divided in three groups according to graft used, were compared in terms of mechanical stability (arthrometric examination KT-1000 score), functional outcome (Lysholm Score), return to sports activity (Tegner score and difference in thigh circumference) and degenerative changes (KL grading). RESULTS: BPTB graft group was found to be better than free STG and STGPI graft groups in terms of KT-1000 score. There was no statistically significant difference among the groups in terms of Lysholm score, Tegner score, difference in thigh circumference and KL grading. CONCLUSION: BPTB graft is better than free STG and STGPI grafts in terms of knee stability. When compared for patient reported outcome, return to sports activity, osteoarthritic changes and graft failure there is no significant difference among the three types of grafts.

BackgroundCranial cruciate ligament (CCL) disease is a well-known pathology that generates both rotational and translational instability of the stifle joint that leads to osteoarthritis in dogs. Tibial tuberosity advancement (TTA) is a common surgical technique used to dynamically neutralize the tibiofemoral shear forces to achieve stifle joint stability. However, significant persistent instability has been documented in clinical cases. The purpose of this study was to evaluate the effect of increasing quadriceps load, increasing tibial tuberosity advancement, and increasing joint flexion angle on the cranial translation of the tibia relative to the femur in the cranial cruciate ligament deficient stifle joint.Methods and ResultsSix cadaveric hind limbs were collected from six healthy mixed breed dogs of medium build and prepared for biomechanical testing. The specimen was placed into a custom-made joint testing machine, and translation of the tibia relative to the femur was measured at stifle angles of 135°, 120°, and 105°. Cranial tibial thrust was generated by applying a vertical load to the metatarsal pad and the quadriceps muscle was simulated with loads of 0, 5, and 10 kg applied to the patella via a system of weights and pulleys. All specimens were tested with the CCL intact and cut, both of which served as controls. The tibial tuberosity was then advanced using both 6 mm and 9 mm cages, and the specimen was tested using the identical technique. Each specimen was loaded to failure by increasing the load applied to the pes until the sudden marked cranial translation of the tibia. Tibial tuberosity advancement with an applied quadriceps load was successful in limiting cranial tibial translation in 54/62 tests. Under similar loading conditions, TTA failed to limit cranial translation in 8 tests. The failures occurred at all angles of flexion examined. In the cases that failed cranial translation could be limited by either increasing the quadriceps load or increasing the amount of tibial tuberosity advancement.ConclusionThis study showed that TTA with an applied quadriceps load is effective at decreasing cranial tibial translation at functional joint angles.

Introduction: Osteoarthritis (OA) is a leading cause of disability in older adults. The majority of cruciate ligament injuries progress to OA through numerous mechanisms. The aim of this study was to identify the histological changes of cruciate ligaments in OA knees from patients undergoing total knee arthroplasty (TKA) as well as possible correlations with coronal plate deformities and patients' characteristics. Methods: A total of 50 consecutive patients with knee OA undergoing TKA with posterior stabilized prosthesis were included in the study. Demographics, preoperative range of flexion, the flexion contracture, Visual Analogue Scale (VAS) score, coronal plane deformity, Kellgren and Lawrence radiological degree of OA and Beguin-Locker classification of intraoperative degree of OA were recorded. The histopathological changes evaluated in specimens from both cruciate ligaments included myxoid and mucoid degeneration, chondroid metaplasia and orientation of collagen fibers. Results: A total of 24 males (48%) and 26 females (52%) with a mean age of 71 years (SD 5.93) participated in our study. The mean preoperative duration of pain was 3.62 years (SD 2.2). The K-L scale mean score was 2.60 (SD 0.64) and the mean VAS score 6.38 (SD 1.1). The mean varus deformity was 10.14 degrees (SD 3.7). Knee flexion/flexion contracture were recorded at 95.76±6.183 and 16.14±4.914 degrees, respectively. Intraoperatively, the B-L scale mean score was 2.02 (SD 0.77). Mucoid degeneration in ACL was the most common histopathological feature (15.7%) (SD 12.9), followed by chondroid metaplasia in both ACL and PCL [14.3% (SD12.5) and 14.3% (SD 13.2), respectively]. A negative correlation between BMI and myxoid ACL (p=0.01) as well as between varus deformity and mucoid ACL (p=0.05) was found, while a negative correlation between height and myxoid ACL (p=0.05) has been also revealed. Conclusions: Degeneration of cruciate ligaments is associated with degenerative joint disease and OA should be considered a disease involving the whole joint including ligaments, menisci, synovium and joint capsule. However, the correlation between degeneration of cruciate ligaments and OA is not yet fully understood and more research is needed. [ABSTRACT FROM AUTHOR]

Background: Irreducible knee dislocation (IKD) is a very rare but serious type of knee dislocation; it can lead to soft tissue necrosis due to incarceration of the medial structures and faces great difficulty in the postoperative rehabilitation, too. IKD needs careful pre-operative planning. There is no universal agreement about the appropriate surgical strategy for IKD. The purpose of this study was to investigate the clinical efficacy, safety, and outcome of the two-staged operation in treatment of IKD.Methods: IKD patients were included from June 1, 2016 to May 31, 2020. In the stage-1 surgery, acute reduction and extra-articular structure repair were performed. Following an intermediate rehabilitation, delayed cruciate ligament reconstructions were performed in stage-2. Physical examination, CT, MRI, and X-ray were performed during the pre-operative period. Knee function, joint stability, ligament laxity, knee range of motion (ROM), and alignment were accessed at follow-ups. The minimum and maximum follow-up times were 0.5 years and 1 year, respectively.Results: In total, 17 IKD patients were included. There were three subjects (17.65%) missing at the 1 year follow-up and the average follow-up was 11.18 ± 2.53 months. After stage-1, normal alignment and superior valgus/varus stability were restored in most subjects; however, a notable anterior–posterior instability still existed in most patients. The intermediate rehabilitation processed smoothly (6.94 ± 1.20 weeks), and all patients achieved knee ROM of 0–120° finally. At 0.5 years and 1 year follow-up after stage-2, all subjects had achieved normal knee stability, ROM, and satisfying joint function. No infection or DVT was observed.Conclusions: The two-staged operation for IKD has superior efficacy on knee stability and function, and it can facilitate the rehabilitation and achieve satisfactory short-term outcome.

To describe the outcomes of autografts and synthetics in anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction with respect to instrumented laxity measurements, patient‐reported outcome scores, complications, and graft failure risk. We searched PubMed, Cochrane Library, and EMBASE for published randomized controlled trials (RCT) and case controlled trials (CCTs) to compare the outcomes of the autografts versus synthetics after cruciate ligament reconstruction. Data analyses were performed using Cochrane Collaboration RevMan 5.0. Nine studies were identified from the literature review. Of these studies, three studies compared the results of bone–patellar tendon–bone (BPTB) and ligament augmentation and reconstruction system (LARS), while six studies compared the results of four‐strand hamstring tendon graft (4SHG) and LARS. The comparative study showed no difference in Lysholm score and failure risk between autografts and synthetics. The combined results of the meta‐analysis indicated that there was a significantly lower rate of side‐to‐side difference > 3 mm (Odds Ratio [OR] 2.46, 95% confidence intervals [CI] 1.44–4.22, P = 0.001), overall IKDC (OR 0.40, 95% CI 0.19–0.83, P = 0.01), complications (OR 2.54, 95% CI 1.26–5.14, P = 0.009), and Tegner score (OR −0.31, 95% CI −0.52–0.10, P = 0.004) in the synthetics group than in the autografts group. This systematic review comparing long‐term outcomes after cruciate ligament reconstruction with either autograft or synthetics suggests no significant differences in failure risk. Autografts were inferior to synthetics with respect to restoring knee joint stability and patient‐reported outcome scores, and were also associated with more postoperative complications.

Purpose: The associated damage to articular cartilage in anterior cruciate ligament (ACL) injured patients is a well-recognized phenomenon; however, there is a relative paucity in the literature regarding the different treatment techniques and outcomes. The purpose of this systematic review was to identify patients treated for acute ACL rupture and associated cartilage injury, with interest in the surgical management of these chondral injuries and any difference in patient-reported outcome measures (PROMs) differing techniques., Methods: A systematic review was performed looking for treatment or management of International Cartilage Repair Society grade 3 or 4 articular cartilage injury at the time of ACL reconstruction., Results: Seventeen studies fit the criteria, a total of 892 patients were included, 64.6% were male with a mean age of 33.7 and the average time to follow-up was 41.7 months. 68.2% of the lesions were on the medial femoral condyle (MFC) with a mean lesion size of 3.9 cm 2 . Six different operative methods of dealing with chondral lesions were identified, there was no significant difference in PROMs between the techniques, although there was a significant difference between the preoperative and postoperative outcome measures., Conclusions: The systematic review found that chondral defects on the MFC are more common in concomitant ACL injuries, despite the pattern of bone bruising being more common on the lateral femoral condyle as reported in the literature. It also found no significant difference in the PROMs between the six different techniques identified for the concomitant management of ACL reconstruction and chondral defects., Level of Evidence: Level II., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Posterolateral rotational knee instability is one of the insufficiently studied problems of modern orthopedics. Complexity of anatomy, difficulties of diagnosis together with a small number of such injuries did not allow to formulate a clear concept and algorithm for the treatment of such patients. Only in the last 10 years, this problem has been given attention. The paper describes a new minimally invasive technique of posterolateral corner reconstruction under arthroscopic control. Objective. To analyze the long-term results of minimally invasive posterolateral corner reconstruction under arthroscopic control. Methods. The results of treatment of 58 patients were presented, 26 of them formed a study group and 32 -- comparison. The dynamics of the pain syndrome, the nature of range of motion restoration, as well as tests of rotational stability were assessed. Results. Statistical analysis of long-term results showed that pain syndrome after minimally invasive technique is significantly lower, and the function of the knee in dynamics recovers faster. The results of knee lateral stability were better in the study group. The main classification of posterolateral corner injuries by Fanelli and Larson is mostly consistent with clinical practice. However, it does not take into account clinical cases of anterior cruciate ligament ruptures combined with injuries of the posterolateral corner. Conclusions. The use of the proposed method of minimally invasive knee posterolateral corner reconstruction with arthroscopic grafting of the popliteal tendon provided positive short-term and long-term results of treatment of patients, reduction of pain intensity after surgery and earlier recovery of range of motion in the knee. An increase complications and deterioration of function was not detected in any case. [ABSTRACT FROM AUTHOR]

Introduction: Reconstruction of the anterior cruciate ligament attempts to reproduce the native ligament; make independent tunnels optimize the entry points and eff ectiveness the anatomy. Perform radiographic measurements of the knee, identify position of femoral and tibial tunnels in patients operated for reconstruction of anterior cruciate ligament with anatomical technique. Material and methods: Patients were identified in the period January 2018 to December 2019. 98 patients were retrospectively evaluated. Radiographic measurements in the femur, the inclination angle of the tunnel, the insertion site with respect to the Blumensaat line and the transosseous distance were determined. In tibia, the location in percentage of the tibial plateau location in anteroposterior and lateral view, tibial tunnel angle. Results: Postoperative patients were 98. (75.5%) male, female (24.5%). Postoperative in 2018 (57.15%) and 2019 (42.85%) Age range: aff ected group was 21-25 years, right side aff ected in 57.15%; Radiographic measurements in femur, the angle of inclination of the tunnel was 45°, percentage in the Blumensaat line was 20%, and the transosseous distance was 3.43 cm. In tibia the percentage distance in anteroposterior projection was 44%, and lateral 28%, The angle in tibial tunnel anteroposterior projection of 73 degrees, and lateral 114. Conclusion: The anatomical technique is a good option to perform tunnels with an optimal anatomical position. By making independent tunnels it allows to improve coverage of normal antomic footprint. Increases degrees and inclination of tunnels, causes added injuries. [ABSTRACT FROM AUTHOR]

Background. Knee ligaments are not only recognized as mechanical stabilizers, but also as sensorimotor components contributing to the proprioceptive feedback mechanisms and neuromuscular stabilization of knee joint. The study investigated the influence of isolated and bicruciate ligament injury of cruciate ligaments on postural stability in male individuals prior to reconstruction surgery. Materials and methods. An individual case, control study design was used. Thirty-six patients were categorized into three groups depending on a history of a recent knee joint: ACL group with an anterior cruciate ligament injury, BCL group with an anterior and posterior cruciate ligament injury and control group with no knee injury and no lower limb injury during last 12 months. Postural stability was expressed by body sways (angular degrees, º) in the antero-posterior (AP-Shift), latero-medial (LM-Shift) and in both planes (2D-Shift) assessed with a Delos Postural System in standing one leg position with and without visual control. Non-parametric Kruskal-Wallis and Mann-Whitney U tests were used to assess changes between studied variables. Results. There was statistical difference between individuals with BCL who had higher body sways with closed eyes in all examined planes while standing on the affected limb compared to control and their own unaffected limbs (p < 0.05). Additionally, AP-Shift and 2D-shift were higher in BCL group than in the ACL injured group with eyes closed (p < 0.05). The ratio of body sways between closed and open eyes was greater in the BCL group in all planes for both limbs than in the healthy men (p < 0.05). In BCL and ACL groups the ratio of body sway distribution during stability tests was two times higher in the injured limb than in the uninjured one (p < 0.05). There was statistical difference in AP-Shift between participants with ACL and BCL injury in affected and unaffected limb (p < 0.05). The only changed detected in the ACL group was increased body sway for all studied planes when standing on the injured limb with closed eyes as compared to standing with open eyes (p < 0.05). Conclusions. Under lack of visual cues, body sway increases in BCL but not ACL knee injured individuals suggesting a substantial decline in proprioceptive input after the bicruciate ligament rupture. [ABSTRACT FROM AUTHOR]

With the rapid improvement of magnetic resonance imaging (MRI), mucoid degeneration (MD) of the anterior cruciate ligament (MD-ACL) has become an established disease entity and mechanical factors, such as increased posterior tibial tilt and intercondylar notch impingement, have been proposed. However, symptomatic MD of the posterior cruciate ligament (MD-PCL) remains an orphan disease without any established etiology. A man in his 60s exhibited restricted range of motion with knee pain. MRI revealed PCL enlargement with high-signal intensity and tram-track appearance on T2-weighted sagittal images and lipoma arborescens (LA) in the suprapatellar pouch. On gadolinium-enhanced MRI, the distal PCL was not contrasted. Arthroscopy revealed an almost normal expanded appearance with partial loss of the envelope synovium. Debulking operation was performed. Pathological findings revealed intravascular thrombus formation in early lesions of MD, and intraligamentous vascular degeneration and severity of MD were proportional. ACL is susceptible to mechanical external forces from surrounding tissues because of its anatomical features that induce protease expression, resulting in MD-ACL with denatured large aggregating proteoglycans deposition. Conversely, occlusion of nutrient vessels within the ligament was observed in this case of MD-PCL. Coexisting LA likely provoked an inflammatory response with hypercoagulability, resulting in thromboembolism of the envelope synovial nutrient vessel. MD-CL is a disease entity comprising multiple pathologies. Although symptomatic MD-ACL is mainly caused by mechanical factors with a relatively high morbidity rate, nutrient vessel dysfunction can contribute to symptomatic MD-PCL with coexisting LA in middle-aged adults with an extremely low morbidity rate. • Mucoid degeneration (MD) of cruciate ligament comprises multiple pathologies. • Nutrient vessel dysfunction can contribute to symptomatic MD of the posterior cruciate ligament. • Lipoma arborescens likely provoked thromboembolism of the nutrient vessel in this case. [ABSTRACT FROM AUTHOR]

Abstract Background A retrospective case–control study was conducted to estimate breed predisposition for common orthopaedic conditions in 12 popular dog breeds in Norway and Sweden. Orthopaedic conditions investigated were elbow dysplasia (ED); cranial cruciate ligament disease (CCLD); medial patellar luxation (MPL); and fractures of the radius and ulna. Dogs surgically treated for the conditions above at the Swedish and Norwegian University Animal Hospitals between the years 2011 and 2015 were compared with a geographically adjusted control group calculated from the national ID-registries. Logistic regression analyses (stratified for clinic and combined) were used to calculate odds ratios (OR) and 95% confidence intervals. Mixed breed dogs were used as reference. Results Breeds found at-risk for ED were the Labrador retriever (OR = 5.73), the Rottweiler (OR = 5.63), the German shepherd dog (OR = 3.31) and the Staffordshire bull terrier (OR = 3.08). The Chihuahua was the only breed where an increased risk for MPL (OR = 2.80) was identified. While the Rottweiler was the only breed predisposed for CCLD (OR = 3.96), the results were conflicting for the Labrador retriever (OR = 0.44 in Sweden, 2.85 in Norway); the overall risk was identical to mixed-breed dogs. Conclusions Most results are in concordance with earlier studies. However, an increased risk of CCLD was not identified for the Labrador retriever, the Staffordshire bull terrier was found to have an increased risk of ED and some country-specific differences were noted. These results highlight the importance of utilising large caseloads and appropriate control groups when breed susceptibility is reported.

Anterior cruciate ligament (ACL) rupture is a common condition that disproportionately affects young people, 50% of whom will develop knee osteoarthritis (OA) within 10 years of rupture. ACL rupture exhibits both hereditary and environmental risk factors, but the genetic basis of the disease remains unexplained. Spontaneous ACL rupture in the dog has a similar disease presentation and progression, making it a valuable genomic model for ACL rupture. We leveraged the dog model with Bayesian mixture model (BMM) analysis (BayesRC) to identify novel and relevant genetic variants associated with ACL rupture. We performed RNA sequencing of ACL and synovial tissue and assigned single nucleotide polymorphisms (SNPs) within differentially expressed genes to biological prior classes. SNPs with the largest effects were on chromosomes 3, 5, 7, 9, and 24. Selection signature analysis identified several regions under selection in ACL rupture cases compared to controls. These selection signatures overlapped with genome-wide associations with ACL rupture as well as morphological traits. Notable findings include differentially expressed ACSF3 with MC1R (coat color) and an association on chromosome 7 that overlaps the boundaries of SMAD2 (weight and body size). Smaller effect associations were within or near genes associated with regulation of the actin cytoskeleton and the extracellular matrix, including several collagen genes. The results of the current analysis are consistent with previous work published by our laboratory and others, and also highlight new genes in biological pathways that have not previously been associated with ACL rupture. The genetic associations identified in this study mirror those found in human beings, which lays the groundwork for development of disease-modifying therapies for both species.

Anterior cruciate ligament (ACL) rupture is a common condition that disproportionately affects young people, 50% of whom will develop knee osteoarthritis (OA) within 10 years of rupture. ACL rupture exhibits both hereditary and environmental risk factors, but the genetic basis of the disease remains unexplained. Spontaneous ACL rupture in the dog has a similar disease presentation and progression, making it a valuable genomic model for ACL rupture. We leveraged the dog model with Bayesian mixture model (BMM) analysis (BayesRC) to identify novel and relevant genetic variants associated with ACL rupture. We performed RNA sequencing of ACL and synovial tissue and assigned single nucleotide polymorphisms (SNPs) within differentially expressed genes to biological prior classes. SNPs with the largest effects were on chromosomes 3, 5, 7, 9, and 24. Selection signature analysis identified several regions under selection in ACL rupture cases compared to controls. These selection signatures overlapped with genome-wide associations with ACL rupture as well as morphological traits. Notable findings include differentially expressed ACSF3 with MC1R (coat color) and an association on chromosome 7 that overlaps the boundaries of SMAD2 (weight and body size). Smaller effect associations were within or near genes associated with regulation of the actin cytoskeleton and the extracellular matrix, including several collagen genes. The results of the current analysis are consistent with previous work published by our laboratory and others, and also highlight new genes in biological pathways that have not previously been associated with ACL rupture. The genetic associations identified in this study mirror those found in human beings, which lays the groundwork for development of disease-modifying therapies for both species. [ABSTRACT FROM AUTHOR]

Introduction: The diagnosis of ACL injury is established with the physical examination that includes the Lachman maneuver and the pivot-shift test since it has the highest positive predictive value. Imaging tests such as MRI are still used for confirmation of the same; so the quantification of clinical maneuvers is sought. Material and methods: Prospective clinical study in which the maneuvers of pivot-shift and Lachman are quantified for later classification. Results: Of 36 patients, 64% found a range between 0 and 3 mm when subtracting the value of the affected knee from the value of the healthy knee. It was found that 28% of the patients recorded values of KT-1000 ranging between 4 and 6 mm of displacement. In 8% of the total patients, values of KT-1000 were found that exceeded 7 mm of displacement. The data obtained are normalized and classified into 3 degrees of injury: grade 1 with partial injury; grade 2 with complete anteromedial and partial injury in posterolateral bundle; grade 3 with complete injury of both bundles. Conclusion: A classification is proposed for the degrees of ACL injury with future application to a more personalized reconstruction. [ABSTRACT FROM AUTHOR]

Introduction: To investigate the epidemiological features and prevalence of cruciate ligament injuries (CLI) in children and adolescents, and to examine the potential risk factors associated with concomitant meniscal tear (MT) among this population., Methods: The demographic data and injury details of children and adolescents with CLI from Southeast China were analyzed to describe their distribution characteristics, alongside an analysis of the prevalence of MTs, the most frequent complication. In addition, binary logistic analysis was employed to ascertain the risk factors linked to MT in individuals suffering from CLI., Results: A total of 203 patients with CLI ( n  = 206) met the inclusion criteria, with a male-to-female ratio of 2.3:1. Notably, a higher proportion of females were aged ≤16 years old compared to males, who predominated in patients aged >16 years ( P  = 0.001). Among children and adolescents, anterior cruciate ligament (ACL) injuries were the primary type of CLI, accounting for 88.18% (179/203) of all cases. The majority of cases (132/203, 65.02%) were sustained during sports activities, and sprains were the predominant mechanism of injury (176/203, 86.7%). Additionally, the most common associated injury was an MT (157/203, 77.34%). The posterior horn is the most frequently affected site for both medial MT (62.93% out of 73 cases) and lateral MT (70.19% out of 73 cases). Moreover, vertical tears constituted the majority of medial MTs (59.48% out of 116 cases). Furthermore, patients with a higher BMI faced an increased risk of associated MT in comparison to non-overweight patients (88% vs. 73.86%; P  = 0.038). Each increase in BMI unit was linked with a 14% higher probability of associated MT occurrence in children and adolescents with CLI (OR = 1.140; P  = 0.036)., Discussion: ACL injuries are a common form of knee ligament injury among children and adolescents, especially those over the age of 16, and are often the result of a sprain. Meniscal posterior horn injury is the most commonly associated injury of youth with CLI. Additionally, overweight or obese people with CLI are at a greater risk of developing MT., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Zhi, Wen, Zhang, Lai, Ye, Wu, Li, Shao, Canavese, Zeng and Xu.)

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Background: Cruciate ligament (CL) and patellar tendon (PT) are important elements of the knee joint, uniting femur, patella, and tibia into a single functional unit. So far, knowledge on the developmental mechanism of CL, PT, and patella falls far behind other skeletal tissues. Results: Here, employing various lineage tracing strategies we investigate the cellular sources and dynamics that drive CL, PT, and patella formation during mouse embryonic development. We show that Gdf5 and Gli1 are generally expressed in the same cell population that only contributes to CL, but not PT or patella development. In addition, Col2 is expressed in two independent cell populations before and after joint cavitation, where the former contributes to the CL and the dorsal part of the PT and the latter contributes to the patella. Moreover, Prrx1 is always expressed in CL and PT progenitors, but not patella progenitors where it is switched off after joint cavitation. Finally, we reveal that patella development employs different cellular dynamics before and after joint cavitation. Conclusions: Our findings delineate the expression changes of several skeletogenesis‐related genes before and after joint cavitation, and provide an indication on the cellular dynamics underlying ligament, tendon, and sesamoid bone formation during embryogenesis. Key Findings: Cellular dynamics underlying ligament, tendon and sesamoid bone formation during embryogenesis. [ABSTRACT FROM AUTHOR]

Partial ACL tears are increasingly recognized in young active patients. They can evolve into complete tears. Controversy exists regarding the need to spare intact ACL bundle as it has its advantages considering biomechanical strength, blood supply and proprioception. The current study determined the challenges in partial ACL tear management and assessed the functional outcomes. Twenty consecutive patients with partial ACL tears were studied. Inclusion criteria were: age 16–45yrs and patients operated for partial ACL tear. Exclusion criteria were: combined ACL-PCL injuries, associated collateral injuries, complete ACL tear, chondral defect or bony malalignment and patients with radiographic signs of arthritis. 'Partial' tear was defined as continuous fibers from native tibial ACL footprint to native femoral ACL footprint in arthroscopy. Clinical and radiological assessment was done to evaluate anteromedial(AM) or posterolateral(PL) bundle tears. We used the term "ACL-augmentation" without disturbing the intact bundle or preserving the intact fibers as much as possible. Functional scoring was done using Lysholm score. Standard post-operative protocols were followed. Statistical analysis was done using SPSS software. Mean age of patients was 31.2 years. Physically active age group (<30yrs) included 62.5% patients. Males were 87.5%. Pain and instability were the presenting complaints in 75% and 70% respectively. Average duration of presentation since injury was 4.2 months. Sports activities were the most common mode of injury (45%) followed by road traffic accidents (37.5%). Anterior drawer test was positive in 40%, pivot shift in 35% and Lachman test was positive in 65%. On arthroscopy, 65% had AM bundle tears and 35% had PL bundle tears. The intact bundle was found lax in 13% cases. Associated meniscal tear was present in 28% patients. Stiff knee was the most common post-operative complaint. Preoperative Lysholm knee score of 74.5 improved to 87.7 at 12months (p < 0.001). Around 97.5% of the patients reported outcomes as good and fair. The treatment strategy needs to be individualized. The ACL augmentation needs more systematic and accurate placement of portals while sparing the intact ACL fibers. For AM bundle, tibial tunnel entry point is about 1–2 cm medial to tibial tuberosity. For PL bundle, it is about 3–4 cm medial to tibial tuberosity to protect the AM bundle. Long term studies with greater number of subjects are required. [ABSTRACT FROM AUTHOR]