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After an anterior cruciate ligament (ACL) injury, people need secondary prevention strategies to identify osteoarthritis at its earliest stages so that interventions can be implemented to halt or slow the progression toward its long-term burden. The Osteoarthritis Action Alliance formed an interdisciplinary Secondary Prevention Task Group to develop a consensus on recommendations to provide clinicians with secondary prevention strategies that are intended to reduce the risk of osteoarthritis after a person has an ACL injury. The group achieved consensus on 15 out of 16 recommendations that address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. We hope this statement raises awareness among clinicians and researchers on the importance of taking steps to mitigate the risk of osteoarthritis after an ACL injury.

Context Rehabilitation after anterior cruciate ligament reconstruction (ACLR) is challenging for adolescent patients concurrently experiencing growth and development, changes in attitudes and social interactions, and a gradual shift toward independence. Objective To examine the perceptions of information sharing and interpersonal communication among adolescent patients going through ACLR, their parents, and physical therapists (PTs) treating adolescent patients with ACLR. Design Cross-sectional study. Setting University-affiliated sports medicine clinic. Patients or Other Participants Nine adolescent patients who had recently completed physical rehabilitation after ACLR, one of their parents, and PTs who treated adolescent patients with ACLR were recruited and enrolled. Main Outcome Measure(s) Participants completed semistructured interviews. The interview scripts for patients, parents, and PTs intentionally addressed the same topics, with only minor modifications in wording as appropriate for each role. All interviews were recorded, transcribed verbatim, and analyzed using a hybrid of deductive and inductive coding by trained members of the study team. Results Patients, parents, and PTs perceived that interpersonal dynamics (eg, communication, external motivation) and stakeholder knowledge (eg, understanding of the psychological consequences of injury) influenced intrapersonal experiences (eg, emotional response, intrinsic motivation) during rehabilitation after ACLR. Additionally, patients and parents indicated that a lack of information about the rehabilitation process hindered their ability to obtain additional information from the PT and surgeon. Conclusions Participants from all stakeholder groups reported that orthopaedic surgeons and other members of the health care team may consider being more consistent when setting expectations, physical restrictions, and recovery timelines.

Background: Physical activity (PA) participation can moderate weight status and body mass index (BMI), with reduced PA being associated with weight gain and elevated BMI. Previous studies have observed lower PA engagement among individuals with a history of anterior cruciate ligament reconstruction (ACLR) when compared to their uninjured peers. This reduction in PA may be due to activity limitations during rehabilitation and failure of some patients to return to sport. Limited evidence has also shown an increase in body weight and BMI following surgery that may remain elevated in adolescent patients up to 2 years post-ACLR. Overall, body weight and BMI changes from pre-surgery to post-ACLR for adolescents and adults are not well-understood. Purpose: The purpose of this study was to assess change in body weight and BMI from pre-surgery to 6 months post-ACLR in adolescent and adult patients. Methods: A retrospective chart review was conducted including adult (age ≥20) and adolescent (ages 13-19) patients who underwent primary, unilateral ACLR and were previously enrolled in a prospective cohort study. BMI was calculated [weight (kg)/ height (m2)] for all adult participants and BMI percentile was calculated for all participants under the age of 20 to account for changes in growth and maturation during adolescence. Pre-surgery to 6-months post-ACLR values for body mass, absolute BMI, and BMI percentile were compared using paired sample t-tests. Statistical significance was established a priori as α≤0.05. Results: One hundred and 16 adolescents with ACLR (67 female; age= 16.7 ± 1.6yrs, months since surgery= 6.2 ± 0.7) and 63 adults (29 female; age= 27.2 ± 7.4yrs, months since surgery= 6.4 ± 0.7) participated. Adolescent participants experienced a significant increase in body mass (pre-ACLR= 70.1 ± 15.1kg, post-ACLR= 72.4 ± 16.9kg; p2, post-ACLR= 26.7 ± 4.9kg/m2; p=0.006). Conclusion: Adults and adolescents experienced an increase in body weight and BMI in the 6 months following ACLR. Revising rehabilitation to extend beyond traditional musculoskeletal strengthening to include focus on incorporation and maintenance of healthy lifestyle behaviors related to diet and PA should be considered to help patients with ACLR to minimize the potential for negative long-term effects of weight gain following surgery.

It remains unclear what role reduced volume and cross-section area (CSA) of individual quadriceps muscles may play in persistent quadriceps weakness and more global dysfunction following ACL reconstruction (ACLR). The purpose of this investigation was to establish the relationship between cross-sectional area of the quadriceps muscle group and measures of knee related and quadriceps function following ACLR. Thirty participants with a history of primary, unilateral ACLR experiencing persistent quadriceps activation failure participated in this cohort study. Clinical factors including International Knee Documentation Committee (IKDC) score, normalized knee extension MVIC torque (Nm/kg) and quadriceps central activation ratio (CAR, %) were assessed in addition to CSA. Quadriceps CSA was measured via magnetic resonance imaging (MRI; Siemens Avanto 1.5T). Quadriceps CSA (cm(2) ) and quadriceps volume (cm(3) ) as well as individual muscle estimates were identified within a 10 cm mid-thigh capture area. Pearson's product-moment correlation coefficients (r) established relationships between CSA and all other variables. Stepwise linear regression established which CSA factors were able to successfully predict clinical factors. Knee extension MVIC torque was strongly correlated with Vastus Intermedius (VI; r = 0.857, p 0.001) CSA as well as partial VI (r = 0.849, p 0.001) and quadriceps (r = 0.830, p 0.001) volume. Partial VI (r = 0.365, p = 0.047) volume was weakly correlated with IKDC score. Knee extension MVIC torque was strongly predicted using VI CSA alone (R(2) = 0.725) or in combination with Vastus Medialis CSA (VM; R(2) = 0.756). Statement of Clinical Significance: Atrophy of the VI and VM muscles negatively impacts knee extension strength following ACLR. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1656-1662, 2016.

The purpose of this study was to compare knee extension torque variability in patients with ACL reconstructed knees before and after exercise. Thirty two patients with an ACL reconstructed knee (ACL-R group) and 32 healthy controls (control group) completed measures of maximal isometric knee extension torque (90° flexion) at baseline and following a 30-min exercise protocol (post-exercise). Exercise included 30-min of repeated cycles of inclined treadmill walking and hopping tasks. Dependent variables were the coefficient of variation (CV) and raw-change in CV (ΔCV): CV = (torque standard deviation/torque mean x 100), ΔCV = (post-exercise - baseline). There was a group-by-time interaction (p = 0.03) on CV. The ACL-R group demonstrated greater CV than the control group at baseline (ACL-R = 1.07 ± 0.55, control = 0.79 ± 0.42, p = 0.03) and post-exercise (ACL-R = 1.60 ± 0.91, control = 0.94 ± 0.41, p = 0.001). ΔCV was greater (p = 0.03) in the ACL-R group (0.52 ± 0.82) than control group (0.15 ± 0.46). CV significantly increased from baseline to post-exercise (p = 0.001) in the ACL-R group, while the control group did not (p = 0.06). The ACL-R group demonstrated greater knee extension torque variability than the control group. Exercise increased torque variability more in the ACL-R group than control group.