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A 13-year-old boy was referred to orthopedic surgery for chronic intermittent pain and swelling of the left knee. Initial imaging was consistent with osteochondritis dissecans of the femoral condyle. Follow-up imaging demonstrated unexpected progression, with a mass extending into the notch, replacing the anterior cruciate ligament, and eroding the femoral and tibial condyles. Subsequent surgical biopsy and resection revealed tumoral calcinosis, with an ultimate diagnosis of autosomal recessive familial tumoral calcinosis. This case report highlights the radiographic appearance and progression of a rare disease in this unusual location and the differential diagnosis. KEY POINTS: Tumoral calcinosis (TC) is a rare disease that typically presents in the periarticular soft tissues along extensor surfaces of large joints in adolescents and young adults, with greater frequency in African-descent populations.1,2 TC may cause pain, swelling, and loss of range of motion of the nearby joint.1 On imaging, TC is typically superficial with calcified lobular masses, layering milk of calcium and/or hemorrhage in cysts on magnetic resonance imaging, and only septal enhancement. Atypical features include bone involvement, intra-articular/extrasynovial joint space involvement, and lack of cysts.1,3–5 Hyperphosphatemic TC, normophosphatemic TC, and secondary causes can usually be discerned with history and biochemical analysis (serum calcium, phosphorus, calcitriol, parathyroid hormone, and renal function tests). If the serum calcium and phosphorus are normal, connective tissue disease should be excluded with a negative antinuclear, anti-Smith, anti-centromere, and anti-scleroderma antibody profile.1,6 [ABSTRACT FROM AUTHOR]

Background: Person-centered care is a concept in healthcare that aims to promote the patient's health and adapt resources and interventions based on the patient's needs and wishes. Knowledge on what person-centered physiotherapy is for patients who rehabilitate after an anterior cruciate ligament (ACL) reconstruction, and how patients experience it within the context of sports injury rehabilitation, is lacking. Purpose: The aim of this study was to explore how patients who were in a late rehabilitation stage (8-12 months) after ACL reconstruction experienced their rehabilitation from a person-centered perspective. Study Design: Qualitative interview study. Methods: Fourteen patients (57% females), aged 18-57, treated with ACL reconstruction, were interviewed with semi-structured interviews 8-12 months after ACL reconstruction. Interviews were recorded, transcribed and analyzed with qualitative content analysis. Results: One theme: all lights on me; be seen and heard, a cornerstone for patients, supported by three main categories: 1) rehabilitation: a roller coaster of physical and psychological challenges; 2) patient involvement; 3) the physiotherapist – stronger together; emerged from the collected data. Conclusion: Patients in a late rehabilitation stage (8-12 months) after ACL reconstruction experienced that the rehabilitation process was person-centered when they felt to be the focus and were allowed to participate via open and constructive communication with the physiotherapists. [ABSTRACT FROM AUTHOR]

Background: In basketball, changing direction is one of the primary mechanisms of anterior cruciate ligament (ACL) injury, often occurring within complex game situations with high cognitive demands. It is unknown how visual attention affects sidestep cutting kinematics during the entire energy absorption phase of the cut in an ecologically valid environment. Purpose: The purpose of this research was to study the effect of added cognitive load, in the form of increased visual attentional demands, on sidestep cutting kinematics during the energy absorption phase of the cut in an ecologically valid environment. Study Design: Crossover Study Methods: Fifteen male basketball players (aged 22.1 ± 2.3) performed ten sidestep cutting movements without (BASE) and with (VIS) a visual attention dual task. 3D kinematics of the hip, knee and ankle were recorded utilizing Xsens IMU motion capture. Temporal kinematics were analyzed using Statistical Parametric Mapping. Discrete time point kinematics were additionally analyzed at initial contact (IC) and at peak knee flexion utilizing paired t-tests. Effect sizes were calculated. Results: Hip flexion was significantly reduced in the VIS condition compared to the BASE condition (p<0.01), including at IC (VIS 35.0° ± 7.2°, BASE 40.7° ± 4.9°, p=0.02, d=0.92) and peak (VIS 37.8° ± 9.7°, BASE 45.5° ± 6.9°, p=0.001, d=0.90). Knee flexion was significantly reduced in the VIS condition, in comparison to the BASE condition (p<0.01), at peak (VIS 59.9° ± 7.5°, BASE 64.1° ± 7.4°, p=0.001, d=0.55). Conclusion: The addition of visual attention during sidestep cutting altered lower limb kinematics, which may increase ACL injury risk. It is suggested that ACL injury risk screening and prevention should include sidestep cutting with visual attentional demands, in order to mimic the cognitive demands of the sports environment. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background: Changes in cortical activation patterns after rupture of the anterior cruciate ligament (ACL) have been described. However, evidence of these consequences in the early stages following the incident and through longitudinal monitoring is scarce. Further insights could prove valuable in informing evidence-based rehabilitation practices. Purpose: To analyze the angular accuracy, neuromuscular, and cortical activity during a knee joint position sense (JPS) test over the initial six months following ACL reconstruction. Study design: Cohort Study Methods: Twenty participants with ACL reconstruction performed a JPS test with both limbs. The measurement time points were approximately 1.5, 3-4 and 6 months after surgery, while 20 healthy controls were examined on a single occasion. The active JPS test was performed seated with a target angle of 50° for two blocks of continuous angular reproduction (three minutes per block). The reproduced angles were recorded simultaneously by an electrogoniometer. Neuromuscular activity of the quadriceps muscles during extension to the target angle was measured with surface electromyography. Spectral power for theta, alpha-2, beta-1 and beta-2 frequency bands were determined from electroencephalographic recordings. Linear mixed models were performed with group (ACL or controls), the measurement time point, and respective limb as fixed effect and each grouping per subject combination as random effect with random intercept. Results: Significantly higher beta-2 power over the frontal region of interest was observed at the first measurement time point in the non-involved limb of the ACL group in comparison to the control group (p = 0.03). Despite individual variation, no other statistically significant differences were identified for JPS error, neuromuscular, or other cortical activity. Conclusion: Variation in cortical activity between the ACL and control group were present, which is consistent with published results in later stages of rehabilitation. Both indicate the importance of a neuromuscular and neurocognitive focus in the rehabilitation. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background: Athletes at risk for anterior cruciate ligament (ACL) injury have concurrent deficits in visuocognitive function and sensorimotor brain functional connectivity. Purpose: This study aimed to determine whether visual perturbation neuromuscular training (VPNT, using stroboscopic glasses and external visual focus feedback) increases physical and cognitive training demand, improves landing mechanics, and reduces neural activity for knee motor control. Design: Controlled laboratory study. Methods: Eight right leg dominant healthy female athletes (20.4±1.1yrs; 1.6±0.1m; 64.4±7.0kg) participated in four VPNT sessions. Before and after VPNT, real-time landing mechanics were assessed with the Landing Error Scoring System (LESS) and neural activity was assessed with functional magnetic resonance imaging during a unilateral right knee flexion/extension task. Physical and cognitive demand after each VPNT session was assessed with Borg's Rating of Perceived Exertion (RPE) for both physical and cognitive perceived exertion and the NASA Task Load Index. Descriptives and effect sizes were calculated. Results: Following VPNT, LESS scores decreased by 1.5 ± 1.69 errors with a large effect size (0.78), indicating improved mechanics, and reductions in BOLD signal were observed in two clusters: 1) left supramarginal gyrus, inferior parietal lobule, secondary somatosensory cortex (p=.012, z=4.5); 2) right superior frontal gyrus, supplementary motor cortex (p<.01, z=5.3). There was a moderate magnitude increase of cognitive RPE between the first and last VPNT sessions. Conclusion: VPNT provides a clinically feasible means to perturbate visual processing during training that improves athletes' real-time landing mechanics and promotes neural efficiency for lower extremity movement, providing the exploratory groundwork for future randomized controlled trials. Level of evidence: Level 3 [ABSTRACT FROM AUTHOR]

Introduction: Elective orthopaedic service has been reduced during the COVID-19 pandemic, and sports activities of the population have been minimised due to the social distancing strategies. This study aimed to quantify the change in sports medicine operations and its distributions during the COVID-19 pandemic, which could be useful for healthcare providers and policymakers plan in terms of resource planning in case of another severe infection outbreak in the future. Methods: Data, including age and gender of the patients and the types of operation, of all the surgeries performed by the Division of Sports and Arthroscopic Surgery in our institution from September 2017 to June 2022 was retrieved. The first 29 months of the 58 months period were classified as pre-COVID-19. Result: During the COVID-19 pandemic, there was a 20.9% reduction in the total number of sports and arthroscopic surgeries performed, from 10.1 to 8.0 per month (p = 0.042). The number of shoulder operations was significantly reduced by 32% (p = 0.029), with rotator cuff surgery reduced by 42% (p = 0.022). The number of knee operations decreased by 15% (p = 0.278), with anterior cruciate ligament (ACL) surgery reduced by 20% (p = 0.093). Notably, the relative proportion of knee and shoulder operations, as well as the patient demographics, remained similar during the COVID-19 pandemic. Conclusion: The reduction in the number of ACL and rotator cuff surgeries could be related to the reduced sports activity and manual labour activity during the lockdown periods of the pandemic. This study provides information and insight into the demand for sports medicine-related operations during the pandemic. It may be practical to limit elective operation sessions for sports and arthroscopic surgery during the pandemic, especially when resources are scarce. However, it is essential to strike a good balance between providing necessary care for patients who require these surgeries, while also taking appropriate measures to combat the pandemic. [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]

Introduction Anterior Cruciate Ligament (ACL) injuries continue to be a major source of morbidity in gymnastics. The gold standard is to perform an ACL Reconstruction (ACLR). However, injuries to the proximal femoral attachment of the ACL have demonstrated an ability to regenerate. An alternative surgical intervention to the ACLR in this ACL tear subgroup is an ACL repair. The purpose of this case report is to provide a rehabilitation progression for a female gymnast after an ACL repair with Internal Brace Ligament Augmentation (IBLA). Case Description The subject was a 16-year-old female who presented with a Sherman Type 1 proximal avulsion of her ACL. She underwent an ACL repair with IBLA. Physical therapy interventions followed a sequential and multi-phased approach based on time for tissue physiologic healing and individual progression. Patient reported outcomes including the International Knee Documentation Committee (IKDC), the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) and the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) were assessed in conjunction with isokinetic strength and hop performance testing to determine return to sport readiness. Outcomes The subject completed 42 sessions over the course of 26 weeks in addition to a home exercise program. At return to sport, clinically meaningful improvement was observed in patient reported outcomes including the IKDC, ACL-RSI, and OSPRO-YF. Additionally, strength and hop performance surpassed established thresholds of clinical significance. The subject returned to sport at six months post-operatively. Conclusion The subject in this case report returned to full participation in gymnastics six months after an ACL repair with internal bracing following a sequential and multi-phased rehabilitation. The primary ACL repair with IBLA appeared beneficial to this patient and could benefit from additional study in other athletes and athletic populations. Level of Evidence Level 5 [ABSTRACT FROM AUTHOR]

Background Muscular strength deficits are common after ACL injury. While the Limb Symmetry Index (LSI), using the uninvolved limb as a reference, is widely used, negative strength adaptations may affect both limbs post-injury. It is uncertain how the strength of the uninvolved limb in those with an ACL injury compares to uninjured individuals, making it unclear whether it is appropriate as a benchmark for determining sufficient strength. Purpose To compare the strength of key lower extremity muscles of the uninvolved limb in those with history of ACL injury (ACL-I) to the dominant limb in individuals with no history of ACL injury (control). Study Design Cross-sectional study. Methods: A total of 5,727 military cadets were examined, with 82 females and 126 males in the ACL-I group and 2,146 females and 3,373 males in the control group. Maximum isometric strength was assessed for six muscle groups measured with a hand-held dynamometer. Separate two-way ANOVAs with limb and sex were performed for each muscle group. Results Significant main effects for limb were observed with the uninvolved limb in the ACL-I group displaying greater strength compared to the dominant limb in the control group for the quadriceps, hamstrings, and gluteus medius, but effect sizes were small (Cohen's d <0.25). Significant main effects for sex were observed with greater male muscular strength in all six muscle groups with small to large effect sizes (Cohen's d 0.49-1.46). No limb-by-sex interactions were observed. Conclusions There was no evidence of reduced strength in the uninvolved limb in those with a history of ACL injury compared to the dominant limb in those with no prior ACL injury. This finding suggests that, after clearance to return to activities, the uninvolved limb can be used as a standard for comparison of sufficient strength, including when using the LSI. Level of Evidence: Level 3 [ABSTRACT FROM AUTHOR]

The unilateral anterior cruciate ligament reconstruction can create asymmetry in vertical ground reaction force and muscle activities, which could be amplified by pronated feet. The study compared plantar pressure variables, amplitude, and muscular frequency in individuals with pronated feet and anterior cruciate ligament reconstruction (PF/ACLR) versus control during running. As part of a cross-sectional study, 15 individuals with PF/ACLR (aged 23.2 ± 4.5 years) and 15 healthy control participants (aged 22.9 ± 4.1 years) ran barefoot at a speed of 3.3 m/s±5% on an 18-m runway. During running, a foot scan and electromyography systems were used to record the peak plantar pressure variables and electromyography activity of the main lower limb muscles, respectively. Results demonstrated lower peak plantar pressure values at the Toe 1 region (p < 0.001, d = 1.83) for the PF/ACLR group. The PF/ACLR group had larger peak plantar pressure values at toes second to fifth (p = 0.013, d = 1.15), fourth (p = 0.026, d = 0.97), fifth (p < 0.001, d = 1.74) metatarsal, and medial (p = 0.002, d = 1.41), and lateral (p = 0.001, d = 1.51) heel regions. The PF/ACLR group presented larger tibialis anterior (p = 0.003, d = 1.15), vastus lateralis (p = 0.001, d = 1.27), and gluteus medius (p = 0.009, d = 0.60) amplitude at the loading phase. At the mid-stance phase, larger tibialis anterior (p = 0.039, d = 0.99) and vastus lateralis (p = 0.00.024, d = 1.52) amplitudes were observed. For the push-off phase, the PF/ACLR group presented larger vastus medialis (p = 0.037, d = 0.82), biceps femoris (p = 0.004, d = 1.14), and semitendinosus (p = 0.001, d = 0.96) amplitudes. Our results demonstrated that pronated feet and anterior cruciate ligament reconstruction significantly impact plantar pressure variables and muscular amplitude in the lower limb during running. [ABSTRACT FROM AUTHOR]

To determine whether clinical screening tests can predict lower limb joint kinematics and kinetics outcomes eliciting anterior cruciate ligament (ACL) injury risk in single-leg landings. Cross-sectional study. Laboratory research. Twenty-six professional male futsal athletes. Participants completed the Modified Star Excursion Balance Test (mSEBT), Lateral Step Down (LSD), Lunge, Hop tests, and isometric strength tests for clinical screening of lower extremity injury risk and performed single-leg landings to assess lower extremity 3D kinematics and kinetics outcomes. mSEBT, LSD, and isometric strength were the more important tests when constructing the prediction models. The predictive power of clinical tests for screening injury risk significantly increases when combined with strength measurements (p = 0.005, f2 = 0.595). We discerned 11 biomechanical predictions, six explicitly related to the sagittal plane's biomechanics. Some predictions were leg-dependent, with muscle strength tests predominantly predicting biomechanical outcomes of the preferred leg. Combining clinical screening tests with strength measures enhances ACL injury risk factors prediction during single-leg landings. Clustering at least two tests improves prediction accuracy, aiding injury prevention planning and decision-making. • Clinical and strength tests predict frontal and sagittal plane biomechanics in single-leg landing. • A single clinical test poorly predicts injury risk, but combining tests enhances predictions. • Clustering strength and clinical tests improve single-leg landing biomechanics predictions. • Knee strength outcomes strongly predict impact forces. [ABSTRACT FROM AUTHOR]

Sufficient evidence within the past two decades have shown that osteoarthritis (OA) has a sex-specific component. However, efforts to reveal the biological causes of this disparity have emerged more gradually. In this narrative review, we discuss anatomical differences within the knee, incidence of injuries in youth sports, and metabolic factors that present early in life (childhood and early adulthood) that can contribute to a higher risk of OA in females. We compiled clinical data from multiple tissues within the knee joint—since OA is a whole joint disorder—aiming to reveal relevant factors behind the sex differences from different perspectives. The data gathered in this review indicate that sex differences in articular cartilage, meniscus, and anterior cruciate ligament are detected as early as childhood and are not only explained by sex hormones. Aiming to unveil the biological causes of the uneven sex-specific risks for knee OA, we review the current knowledge of sex differences mostly in young, but also including old populations, from the perspective of (i) human anatomy in both healthy and pathological conditions, (ii) physical activity and response to injury, and (iii) metabolic signatures. We propose that to close the gap in health disparities, and specifically regarding OA, we should address sex-specific anatomic, biologic, and metabolic factors at early stages in life, as a way to prevent the higher severity and incidence of OA in women later in life. [ABSTRACT FROM AUTHOR]

To determine the relative contribution of each of the following aspects: demographics, physical function, and patient-reported outcome measures (PROMs), including both physical and psychological constructs, to return to sport (RTS) (any level) one-year post anterior cruciate ligament reconstruction (ACLR). Cross-sectional cohort study. We included data for 143 participants (73 women, mean (SD) age 24 (5.8) years) ∼ one-year post-ACLR. Data comprised demographics, physical function (hop performance, hip and knee peak torque) and PROMs (Knee Osteoarthritis Outcome Score subscales, perceived stress, and ACL Return to Sport after Injury scale (ACL-RSI)). We then used a Z-normalized multivariable logistic regression model to establish the relative contribution of factors associated with RTS. Sixty-four (45%) of the participants had returned to sport at one year post-ACLR. In the regression model, greater hip abduction peak torque (OR = 1.70, 95% CI; 1.01 to 2.84) and greater psychological readiness to RTS (OR = 2.32, 95% CI; 1.30 to 4.12) were the only variables associated with RTS (R2 = 0.352). The significant contribution of hip abduction strength and psychological readiness to RTS was still relatively small, suggesting other potential factors explaining RTS which may not be captured by common RTS criteria. • Sixty-four (45%) of the participants had returned to sport at one-year post-ACLR. • Hip abduction strength and psychological readiness were associated with RTS. • Factors not captured by common RTS criteria may be relevant for RTS status. [ABSTRACT FROM AUTHOR]

To compare the timeline for post-operative quadriceps and hamstrings strength recovery following anterior cruciate ligament reconstruction (ACLR) using either a quadriceps tendon (QT) or hamstring tendon (HT) autograft. Patients (≤18 years) who underwent ACLR using autograft QT or HT were included. Isokinetic strength was extracted at 3, 6, and 12 months post-operatively. Effects of time and graft type on quadriceps or hamstring limb symmetry index (qLSI/hLSI) was assessed with two-way repeated measures ANOVA. Between group differences at each time point were assessed with unpaired t-tests. Chi-square and Kaplan-Meir analysis analyzed the proportions of subjects able to achieve ≥90% LSI. A total of 75 subjects (QT n = 38 HT n = 37,15.8 years) were included. There were significant differences in qLSI, with greater symmetry within the HT group at all time points. A higher proportion of subjects with HT grafts were able to achieve ≥90% qLSI within 12 months of surgery (81% vs 45%, p = 0.001). Compared to those with HT autografts, adolescents with QT autografts demonstrate a prolonged timeline for quadriceps recovery. While mean strength values above 90% are achieved, a significantly lower percentage of QT patients are able to achieve 90% qLSI by 12 months post-op. • Patients who have quadriceps tendon autografts take longer to recover quad strength. • Fewer patients with quadriceps tendon autografts achieve 90% limb symmetry index. • Patients with hamstring tendon autografts are slower to recover hamstring strength. [ABSTRACT FROM AUTHOR]

Measurement of success following anterior cruciate ligament reconstruction (ACLR) hinges on the appropriate use of high quality and meaningful outcome measures. We identified and categorized over 100 outcome measures for ACLR using the International Classification of Functioning, Disability and Health (ICF) model. The ICF model is a useful framework to facilitate decisions about outcome selection and describe recovery following ACL injury. We outline key considerations when selecting outcome measures during study design (purpose, measurement properties, sample size, global assessment) or evaluating reported outcomes (measurement properties, sample size, magnitude/precision, clinical relevance, applicability), and discuss challenges in outcome measurement following ACLR. [ABSTRACT FROM AUTHOR]

Precision anterior cruciate ligament reconstruction (ACLR) refers to the individualized approach to prerehabilitation, surgery (including anatomy, bony morphology, and repair/reconstruction of concomitant injuries), postrehabilitation, and functional recovery. This individualized approach is poised to revolutionize orthopedic sports medicine, aiming to improve patient outcomes. The purpose of this article is to provide a summary of precision ACLR, from the time of diagnosis to the time of return to play, with additional insight into the future of ACLR. [ABSTRACT FROM AUTHOR]

This article outlines the key points in the nonoperative treatment of an anterior cruciate ligament (ACL) injury. Initial evaluation and treatment of an acute knee injury, often performed by a physician with limited experience in the treatment of an ACL injury, follow the basic diagnostic workup that lead to the diagnosis. The principles of rehabilitation after ACL injury have changed from time based to criteria based, and the different phases based on physical criteria are described. [ABSTRACT FROM AUTHOR]

This narrative review examines the current literature for the influence of the surgical timing in the setting of anterior cruciate ligament (ACL) reconstruction on various outcomes. Although the exact definition of early and delayed ACL reconstruction (ACLR) is a subject of controversy, surgical timing influences arthrofibrosis and postoperative stiffness, quadriceps strength, postoperative knee function, and the incidence of intra-articular injuries to the menisci and cartilage. Additionally, there is a shortage of evidence regarding the role of ACLR timing in the setting of multiligament knee injury and when concurrent procedures are performed during the operative treatment of the ACL-injured knee. [ABSTRACT FROM AUTHOR]

To compare physical therapy (PT) utilization, timing of return-to-sport (RTS) test and hop test performance by age and between sexes in youth after anterior cruciate ligament reconstruction (ACLR). Multicenter retrospective cohort. A retrospective review of adolescents after primary ACLR was conducted. Participants completed return-to-sport (RTS) tests including single-legged hop testing. PT frequency, average weekly visits, and timing of RTS test were calculated. T-tests assessed the effect of age and sex on average weekly PT visits and multivariable logistic regressions assessed odds of passing hop tests. 289 participants were included (15.7 ± 1.9 years). There was no difference in average weekly PT visits (p = 0.321) or time to RTS test (p = 0.162) by age. There were significant differences in average weekly PT visits (p = 0.047) and mean time from surgery to RTS test (p = 0.048) between sexes with small effect sizes (d = 0.24 and d = 0.21, respectively). Age and sex had no effect on odds of passing hop tests (OR, 1.29; 95% CI, 0.71–2.35 and OR, 0.79; 95%CI, 0.43–1.45, respectively). In a youth cohort, age and sex may have no clinically important effect on PT visit utilization, timing of RTS test or hop test performance. • Age had no effect on physical therapy visit utilization or time of RTS test completion. • Age and sex had no effect on the odds of passing single legged hop tests. • Sex had a significant but small effect on physical therapy utilization and timing of RTS test completion. • In a youth cohort, sex may not have a clinically important effect on physical therapy utilization. [ABSTRACT FROM AUTHOR]

To determine the association between change in physical activity level, as defined as the change from pre-to post-operative Tegner Activity Scale, and quality of life (QOL) after anterior cruciate ligament reconstruction (ACLR), before patients are cleared for return to sport. 1198 participants (42.9% male; 18.7 ± 3.6 years; 7.1 ± 3.7 months post-ACLR). Surveys included Knee Injury and Osteoarthritis Outcome Score QOL (KOOS-QOL) subscale and Tegner Activity Scale. KOOS-QOL score ≥62.5 is considered as meeting a previously established patient acceptable symptom state. The acceptable KOOS-QOL group reported a significantly smaller decrease in activity level from pre-injury to time of data collection (median: 2.00, IQR: 2.00) than the unacceptable KOOS-QOL group (median: 3.00, IQR: 3.00). Across the full cohort, for every one-point larger decrease in Tegner score from pre-to post-ACLR, there is a 52% increase in the odds of having an unacceptable KOOS-QOL score. For adolescents, the odds increase to 60% while the odds for adults were lower at 39%. Following ACLR, greater decreases in physical activity level are associated with poorer QOL for both adolescents and adults at short-term follow-up, and this effect is larger amongst adolescents. • Decreased physical activity is associated with worse quality of life after ACLR. • This effect is greater in adolescents than in adults. • Returning to physical activity is important for short-term quality of life. [ABSTRACT FROM AUTHOR]

To determine return to running criteria currently used by physiotherapists following anterior cruciate ligament (ACL) injury. Self-reported online international survey. An online survey of physiotherapists across Australia, the Netherlands and France. A total of 476 respondants participated in the survey across Australia (n = 153), the Netherlands (n = 162), and France (n = 161). For return to running criteria following a non-operative approach, the majority of respondents chose swelling (40.55%, n = 193/476), pain (38.24%, n = 182/476), knee extensor strength (34.34%, n = 163/476), single leg squat (31.93%, n = 152/476) and knee flexor strength (29.83%, n = 142/476). After ACL reconstruction, the highest responses were also swelling (41.18%, n = 196/476), pain (37.18%, n = 177/476), knee extensor strength (37.18%, n = 177/476) and single leg squat (33.19%, n = 158/476). From the identified themes the most common cutoff variables were pain between 0 and 3/10, swelling < grade 1+ and limb symmetry on strength and hop tests >70 %. Physiotherapists in Australia, France, and the Netherlands use many different return to running criteria and most of them use more than one criterion. Despite this, there was little consensus on the cut-off physiotherapists use to apply these criteria. • Swelling, strength, pain and single leg squat assessment were the most common responses for return to running. • There is no consensus between countries on cut-off criteria for return to running. • Further research is needed for specific cut off criteria for safe return to running. [ABSTRACT FROM AUTHOR]

Two mature, large breed dogs presented with chronic lameness and discomfort localised to the stifle. No hindlimb deformities were present on physical examination or radiographic evaluation. No stifle instability was present. Arthroscopy revealed severe (grade 5/5 modified Outerbridge score) cartilage erosion in the lateral compartment (femorotibial), marked degeneration of the lateral meniscus and early cranial cruciate ligament disease in both patients. Medial-closing, medially translating, centre-of-rotation-of-angulation-based, levelling osteotomy (mcmtCBLO) was performed in both patients. The procedure aims to shift the pelvic limb's mechanical axis medially to reduce pressure in the lateral compartment while also reducing craniocaudal shear forces by lowering the tibial plateau angle. Eight weeks after surgery one patient's lameness had resolved while the other had improved significantly. Second-look arthroscopy performed at this time revealed fibrocartilage formation in the lateral compartment without progression of cruciate disease in both cases. At long-term follow-up (approximately 3 and 5 years), favourable outcomes (no or minimal lameness, mild or moderate osteoarthritis) were identified on the long-term owner survey, lameness examination and radiographs. mcmtCBLO reduced or eliminated short- and long-term lameness in these two cases afflicted by concurrent lateral compartment and early cranial cruciate ligament disease. [ABSTRACT FROM AUTHOR]

To examine the effectiveness of different exercise-based interventions to mitigate the risk of anterior cruciate ligament injury in football players, and to determine which is the most appropriate for them, specifically for female football players. Four databases were accessed in July 2023 using the keywords football, soccer, athletic injuries, anterior cruciate ligament, knee injuries, injury prevention, exercise-based programme, and risk factor. Randomised controlled trials that evaluated any exercise-based injury prevention intervention compared with a control group on the prevention of anterior cruciate ligament injury in football players were included. Eleven studies were included. Data were presented as logarithm hazard ratio, credible intervals and standard deviation. FIFA 11+ was the most effective in reducing anterior cruciate ligament injury risk in football players (logarithm hazard ratio = –1.23 [95% credible intervals: –2.20, –0.35]; SD = 0.47), followed by the Knäkontroll programme (logarithm hazard ratio = –0.76 [95% credible intervals: –1.60, –0.03]; standard deviation = 0.42). For females, only Knäkontroll had a significant impact on reducing the risk of anterior cruciate ligament injury (logarithm hazard ratio = –0.62 [95% credible intervals: –1.71, 0.62]; standard deviation = 0.58). Our results support the use of FIFA 11+ and Knäkontroll to mitigate injury incidence at overall level. However, the effectiveness of these interventions changed when adjusting for females. Knäkontroll is postulated as the programme with the greatest preventive nature, although these results should be interpreted with caution due to the lack of the sample. [ABSTRACT FROM AUTHOR]

Cranial cruciate ligament rupture (CCLR) is a common cause of stifle joint pain in dogs. This study assessed the short-term outcomes in the management of CCLR, with or without concurrent medial patellar luxation (MPL), in small-breed dogs, comparing surgical intervention using tibial plateau leveling osteotomy (TPLO) with non-surgical approaches. Dogs weighing less than 10 kg and suffering from CCLR were divided into two groups: surgical and non-surgical (nine stifles per group). Both groups followed the same rehabilitation protocol. Measurements were taken on days 0, 14, 28, 42, 56, 70, and 84. These measurements included the mean difference in orthopedic assessment score (diffOAS) and thigh muscle circumference (TMC) assessed by veterinarians, as well as the Canine Brief Pain Inventory score (CBPI) evaluated by the owners. Six stifles had concurrent MPL in the surgical group and five in the non-surgical group. No significant differences were observed in diffOAS (P=0.685), TMC (P=0.557), CBPI pain severity score (P=0.062), and CBPI pain interference score (P=0.29) between the two groups. However, both groups showed a significant decrease (P<0.05) in diffOAS and CBPI. The TMC remained relatively stable in the non-surgical group (P>0.05), but it significantly increased in the surgical group (P<0.05). Both groups demonstrated improved clinical outcomes in the short term, with no significant differences. However, cautious consideration should be given to a conservative treatment in small-breed dogs, particularly when considering the exclusive improvement observed in TMC within the TPLO group. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) injury is one of the main injuries in professional and amateur athletes of different sports. Hundreds of thousands of ACL ruptures occurs annually, and only 55% of the athletes return to competitive level, with a 15 times higher chance of suffering a second injury. 60% of these injuries occur without physical contact and since they occur in the acute process, they can cause joint effusion, muscle weakness and functional incapacity. In the long term, they can contribute to a premature process of osteoarthritis. This narrative review is of particular interest for clinicians, practitioners, coaches and athletes to understand the main factors that contribute to an injury and/or re-injury and thus, to optimize their training to reduce and/or prevent the risk of injury and/or reinjury of ACL. Therefore, we aimed reports a narrative overview of the literature surrounding communication and explore through a theoretical review, the main risk factors for an ACL injury and/or re-injury, as well as bringing practical and correct methods of training applications. The lack of theoretical/practical knowledge on the part of rehabilitation and/or training professionals may impair the treatment of an athlete and/or student. High-quality research that can testing different training methods approaches in randomized controlled trials is needed. [ABSTRACT FROM AUTHOR]

After anterior cruciate ligament (ACL) reconstruction, determining readiness to return to participation is challenging. The understanding of which neuromuscular performance parameters are associated with limb symmetry and self-reported symptoms may be useful to improve monitoring the rehabilitation towards adequate decision-making to return. To compare the ACL-operated and injury-free lower limbs regarding functional performance; and to investigate whether lower limb strength and functional performance are associated with self-reported symptoms and functional lower limb symmetry. Thirty-four participants were included. Functional performance was assessed by using the Y-Balance test, Single-leg Hop, and Functional Movement Screen. An isokinetic dynamometer was used to evaluate the strength levels in open and closed kinetic chains. The functional lower limb symmetry was calculated considering the single-leg hop test results for each lower limb. There were no differences in dynamic balance (Y-Balance) between the operated and injury-free limbs. The operated limb presented a worst performance in the single-leg hop. Self-reported symptoms prevalence and lower limb symmetry were associated with knee extension strength and functional performance (Y-Balance). Individuals submitted to ACL-reconstruction presented worse functional performance in the operated limb compared to the injury-free limb. Both knee strength and dynamic balance were associated with limb symmetry and self-reported symptoms. [ABSTRACT FROM AUTHOR]

Comparison of knee flexor strength limb symmetry index (LSI) between the NordBord-test and the Biodex-test, and to determine the relationship between knee flexor strength and function in patients 2 and 5 years after anterior cruciate ligament reconstruction (ACL-R) with hamstring tendon (HT) autografts. Observational registry study. Primary care. Cross-sectional data from 96 patients (55% women) participating in a rehabilitation-registry after ACL-R with HT autografts. Comparison of knee flexor strength symmetry between the Biodex-test and the NordBord-test. Secondly, the relationship between knee flexor strength test and perceived knee function, activity level, and hop performance. The NordBord-test demonstrated greater strength deficits compared to the Biodex-test with a mean difference of 12.5% ± 15.1% 95 % CI [8.1; 16.9%] at 2 years, and 11.1% ± 11.9% 95 % CI [7.7; 14.6 %] at 5 years after ACL-R. Relative concentric knee flexor strength (Nm/kg) in the Biodex demonstrated significant weak-to-moderate correlations with activity level and hop performance (r = 0.33–0.67) at 2 and 5 years. The NordBord-test identified deficits in knee flexor strength LSI not seen with the Biodex-test at 2 and 5 years after ACL-R. No significant correlations were found between the persistent knee flexor strength asymmetry and perceived function, activity level or hop performance. • Knee flexor strength deficits persists in the NordBord-test at 2 and 5 years. • Knee flexor strength LSI displayed weak relationships with knee function. • Relative knee flexor strength in the Biodex appears more relevant for function. [ABSTRACT FROM AUTHOR]

To assess whether tibial tuberosity avulsion injury and subsequent surgical repair in skeletally immature dogs are associated with changes in tibial plateau angle (TPA) at skeletal maturity. Skeletally mature (> 18 months of age) dogs that had previously undergone unilateral surgery when 4–8 months of age to repair tibial tuberosity avulsion were enrolled. Bilateral, mediolateral stifle radiographs were taken. TPA was measured digitally from the radiographs independently by two readers and compared between sides within dogs. As the number of dogs that would be enrolled for the main part of the study was unknown, to understand how the variation between left and right stifles within dogs would affect the power of the main study, 29 client-owned, skeletally mature dogs without stifle pathology were recruited prior to the main study for bilateral, mediolateral projection stifle radiographs. Variation in the differences in TPA between left and right stifles was used to estimate the likely power of the major part of the study for different numbers of enrolled dogs. From 29 dogs enrolled in the power assessment, the SD of the differences between left and right stifles was 2.1°. With 10 dogs (20 stifles) enrolled within the main part of the study, and if the SD of the differences between operated and non-operated stifles within a dog was the same as the SD of the differences between non-operated stifles within a dog (2.1°), the study would have power ≥ 0.8 if the mean difference in TPA between operated and non-operated stifles was ≥ 2.1°. Ten dogs were enrolled in phase II of the study. In 8/10 of these dogs, the TPA in the operated stifle was less than in the non-operated stifle. The mean TPA on the operated stifle was 6.4° less than on the non-operated stifle (95% CI = 2.4–10.3° less; p = 0.002). For surgery between 4 and 8 months of age, TPA at maturity increased by 2.7° (95% CI = 1.1–4.3°; p = 0.001) for each additional month of age at surgery. Based on this study, surgical repair of tibial tuberosity avulsion in skeletally immature dogs is associated with a smaller TPA at skeletal maturity. However, causality cannot be established from this cross-sectional study, and this association may be because stifles with a smaller TPA are predisposed to tibial tuberosity avulsion. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the time to return to sport (RTS) between patients who did and did not suffer a second anterior cruciate ligament (ACL) injury after ACL reconstruction. DESIGN: Etiology systematic review with meta-analysis. LITERATURE SEARCH: Cochrane Library, Embase, Medline, AMED, and PEDro databases were searched in August 2021 and again in November 2022. STUDY SELECTION CRITERIA: Clinical studies reporting time to RTS after ACL reconstruction and second ACL injury were eligible. DATA SYNTHESIS: We pooled continuous data (time [months] and proportions [%]), with random-effects meta-analyses. Pooled estimates were summarized in forest plots. A qualitative data synthesis was also performed. RESULTS: Twenty-one studies were included in the meta-analysis and 33 in the qualitative synthesis. Pooled incidence of second ACL injury was 16.9% (95% confidence interval [CI]: 12.8, 21.6). Patients who suffered a second ACL injury returned to sport significantly earlier (25 days; 95% CI: 9.5, 40.4) than those who did not suffer another injury. There was no difference in time to RTS for professional athletes who suffered a second ACL injury and those who did not. The certainty of evidence was very low. CONCLUSION: There was very low-certainty evidence that patients who suffered a second ACL injury had returned to sport 25 days earlier than patients who did not have another injury. For professional athletes, there was no difference in time to RTS between athletes who suffered a second ACL injury and athletes who did not. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) injuries are devastating injuries for athletes. Prior studies have shown increased ACL injury rates on non-natural surfaces versus natural grass in several sports. The purpose of this study is to calculate the prevalence of ACL injuries in the NFL on natural versus non-natural surfaces to determine if there is a significant increase on non-natural surfaces. Accessing publicly available data for NFL seasons beginning with the 2017–2018 season through 2021–2022 seasons, all ACL injuries with publicly available data concerning timing and playing surface were recorded and categorized according to playing surface. Practice injuries or those without an identifiable playing surface were excluded. Incidence rates, defined as ACL ruptures per game, were calculated. ACL injuries were recorded for each playing surface, as well as the combined category of non-natural grass surface. Odds ratio was calculated to compare the risk of ACL rupture on non-natural surfaces vs natural grass. During the 2017–2021 NFL seasons, 173 ACL ruptures were identified with known surfaces. Injury rate for non-natural surfaces was 0.134 compared to 0.097 for grass. Injury rate ratio for non-natural vs natural grass surfaces was 1.211, a 21.1% increased risk of ACL injury in the NFL on non-natural surfaces vs natural grass. OR for non-natural surfaces 1.239 (95% CI 0.900–1.704). Based on these findings there is a trend toward increased risk of ACL injury on non natural grass surfaces, however this did not reach statistical significance. Numerous published studies show trends toward increasing rates of ACL injuries on non-natural playing surfaces vs natural grass. Based on our findings the difference is not statistically significant, however it does trend toward increased risk of ACL injury with non-natural surfaces. Further studies should be performed with larger sample sizes in order to further determine the risk of non-natural surfaces. [ABSTRACT FROM AUTHOR]

*BACKGROUND: Restoring quadriceps strength is essential for successful rehabilitation of knee injuries, but many athletes return to their previous activity with persisting muscle weakness. Strong evidence supports using neuromuscular electrical stimulation (NMES) to improve quadriceps strength; however, there is a lack of widespread clinical implementation. We believe there is a critical need to provide clinical approaches that promote using NMES to improve patients' quadriceps strength and ensuring clinicians provide high-value rehabilitation care. *CLINICAL QUESTION: What is best practice when using NMES to facilitate strength after injury, what are barriers to its use, and how can they be addressed? *KEY RESULTS: We discuss the low clinical implementation of NMES, perceived barriers to using NMES, and provide recommendations for setup and dosage parameters for effective use of NMES. *CLINICAL APPLICATION: We aim for this commentary, with accompanying videos, to serve as a resource for clinicians who are using commercially available NMES units in clinical practice. [ABSTRACT FROM AUTHOR]

The Star Excursion Balance Test (SEBT) and its modification(mSEBT) as dynamic tests have been shown to have high reliability and validity for the prediction of lower extremities injuries including ACL ones. No previous study has compared mSEBT performance measures in different hormonal statuses of the menstrual cycle in naturally menstruating women. So aim of the study was comparison of mSEBT performance measures in days of the menstruation cycle with the peak of estrogen and progesterone hormones in naturally menstruating women. After a pilot study for estimation of sample size, mSEBT performance measures in a sample of 18 healthy women with regular menstrual cycles were compared two times in their cycles, first in the peak of estrogen (mid-cycle) and second in time of peak of progesterone (one week later). The test was performed 2 times using either the right or left leg as the stance and reach limb. No significant difference between days with estrogen and progesterone peaks with right or left reach limb was seen for the percentage of reach in any direction or the composite reach on the mSEBT performance. It seems that there is the same risk for lower extremities injuries in estradiol and progesterone peak days of normal menstruating women. • Use of the modified Star Excursion Balance Test as a valid and dynamic test. • No difference in balance performance between estradiol and progesterone days. • The same risk of leg injuries in estradiol and progesterone days. [ABSTRACT FROM AUTHOR]

• High formability Mg-Zn-Gd wire improve the formability of the wire during the anterior cruciate ligament reconstructive surgery. • Mg-Zn-Gd wire directly activate multiple pathways in the early healing stage to promote osteogenesis, and indirectly maintain the fibrocartilage formation environment after degradation. • Mg-Zn-Gd wire degradation can promote the aggregation of calcium phosphate crystals and then stimulate osteogenesis via the Wnt3a pathway. After reconstructing the anterior cruciate ligament (ACL), unsatisfactory bone tendon interface healing may often induce tunnel enlargement at the early healing stage. With good biological features and high formability, Magnesium-Zinc-Gadolinium (ZG21) wires are developed to bunch the tendon graft for matching the bone tunnel during transplantation. Microstructure, tensile strength, degradation, and cytotoxicity of ZG21 wire are evaluated. The rabbit model is used for assessing the biological effects of ZG21 wire by Micro-CT, histology, and mechanical test. The SEM/EDS, immunochemistry, and in vitro assessments are performed to investigate the underlying mechanism. Material tests demonstrate the high formability of ZG21 wire as surgical suture. Micro-CT shows ZG21 wire degradation accelerates tunnel bone formation, and histologically with earlier and more fibrocartilage regeneration at the healing interface. The mechanical test shows higher ultimate load in the ZG21 group. The SEM/EDS presents ZG21 wire degradation triggered calcium phosphate (Ca-P) deposition. IHC results demonstrate upregulation of Wnt3a, BMP2, and VEGF at the early phase and TGFβ3 and Type II collagen at the late phase of healing. In vitro tests also confirmed the Ca-P in the metal extract could elevate the expression of W nt3a, β catenin , ocn and opn to stimulate osteogenesis. Ex vivo tests of clinical samples indicated suturing with ZG21 wire did not weaken the ultimate loading of human tendon tissue. In conclusion, the ZG21 wire is feasible for tendon graft bunching. Its degradation products accelerated intra-tunnel endochondral ossification at the early healing stage and therefore enhanced bone-tendon interface healing in ACL reconstruction. [ABSTRACT FROM AUTHOR]

Background Sensorimotor dysfunction is thought to occur following anterior cruciate ligament (ACL) injury which may have implications on future reinjury risk. Dysfunction has been demonstrated within the efferent component of the sensorimotor system. However, no reviews have examined the two main components of the afferent system: the visual and somatosensory systems. Hypothesis/Purpose This study aimed to report differences in function (central processing and local processing) within the (1) somatosensory and (2) visual systems between individuals following anterior cruciate ligament reconstruction (ACLR) and healthy controls (between-subject). The study also aimed to report differences in function within the two systems between the two limbs of an individual following ACLR (within-subject). Study Design Scoping review Methods A search was conducted in PubMed, SPORTDiscus, CINAHL, Medline and Embase up until September 2021. Level I-IV studies assessing somatosensory and visual systems were included if they compared ACLR limbs to the uninjured contralateral limb (within-subject) or a healthy control limb (between-group). The function of somatosensory and visual systems was assessed across both central processing (processing of information in the central cortex) and local processing (all other assessments outside of central processing of information). Results Seventy studies were identified (52 somatosensory, 18 visual). Studies examining somatosensory central processing demonstrated significant differences; 66% of studies exhibited within-subject differences and 100% of the studies exhibited between-group differences. Studies examining local somatosensory processing had mixed findings; 40% of the 'joint position sense (JPS)' and 'threshold to detect motion (TTDM)' studies showed significant within-subject differences (JPS=0.8°-3.8° and TTDPM=0.2°-1.4°) and 42% demonstrated significant between-group differences (JPS=0.4°-5° and TTDPM=0.3°-2.8°). Eighty-three percent of visual central processing studies demonstrated significant dysfunction between-groups with no studies assessing within-subject differences. Fifty percent of the studies examining local visual processing demonstrated a significant between-group difference. Conclusion Significant differences in central processing exist within somatosensory and visual systems following ACLR. There is mixed evidence regarding local somatosensory and visual processing. Increased compensation by the visual system and local visual processing dysfunction may occur in conjunction with somatosensory dysfunction. [ABSTRACT FROM AUTHOR]

Medical records from a single referral hospital (Animal Referral Hospital, Sinnamon Park, Australia) of dogs treated with modified triple tibial osteotomy (TTO) for management of cranial cruciate ligament (CrCL) disease from June 2017 to June 2020 were reviewed. Modifications to the originally described TTO procedure included a modified wedge angle calculation and performing the tibial osteotomies without the use of pre-drilled guide holes. A total of 253 dogs met the inclusion criteria. Two dogs were excluded, leaving 251 dogs that had undergone 309 procedures for assessment, and data from these, including complications, were reviewed. Complete, partial competent, and partial incompetent rupture of the cranial cruciate ligament was identified in 202/309 (65.4%), 79/309 (25.6%), and 28/309 (9.1%) stifles, respectively. Medial meniscal injury was identified in 207/309 (67.0%) stifles at the time of initial surgery. Fifty-eight dogs had bilateral procedures, including both single-session and staged surgeries, and 48 of these were available for analyses. The modifications to the TTO procedure described herein resulted in a median wedge angle of 21° and a median post-operative tibial plateau angle of 5.8°. Tibial compression testing following surgery indicated elimination of cranial tibial thrust in all stifles in this series. The most common intra-operative complication was tibial tuberosity fracture (15/309; 4.9%). Minor post-operative complications occurred in 37/309 (12.0%) procedures, with infection being the most common (27/309; 8.7%). Major post-operative complications occurred in 9/309 (2.9%) procedures. The intra- and post-operative complication rates for dogs undergoing bilateral single-session TTO were both 8.3% (2/24). The intra- and post-operative complication rates for dogs undergoing bilateral staged TTO were both 4.2% (1/24). The low number of complications for both the bilateral single-session and bilateral staged TTO groups precluded statistical analysis. All complications resolved uneventfully as determined by the attending surgeon. The modified TTO technique described here was safe and effective for the management of canine CrCL disease in the dogs included in the case series. Findings of this study suggest that, with careful case selection, the modified TTO may be performed as a bilateral single-session procedure in dogs with concurrent bilateral cranial cruciate ligament disease. Future studies analysing the effects of these modifications on stifle biomechanics would be beneficial. CrCL: Cranial cruciate ligament; SSI: Surgical site infection; TPA: Tibial plateau angle; TPLO: Tibial plateau levelling osteotomy; TTA: Tibial tuberosity advancement; TTO: Triple tibial osteotomy [ABSTRACT FROM AUTHOR]

This study aimed to clarify the relationship between the transition of kinesiophobia and knee joint function from the preoperative period to three months postoperative, the time to resume running, six months post-ACLR, and the goal time to resume sports. 54 patients who underwent initial ACLR were included in this study. The Tampa Scale for Kinesiophobia-11 (TSK-11) was used to assess kinesiophobia. One-way ANOVA was performed for the preoperative, three-month postoperative, and six-month postoperative endpoints. To examine changes in knee function associated with changes in TSK-11, we calculated correlations between the differences at each time point. TSK-11 decreased significantly at both three and six months postoperatively compared with the preoperative level, but there was no significant change between three months and six months postoperatively. Similar to the decrease in TSK-11 from preoperatively to three and six months postoperatively, there was an improvement in flexion ROM, Pain, Subjective knee function, but none of these changed significantly from three to six months postoperatively. There may be significant improvements in knee function associated with TSK-11 reduction up to three months postoperatively. • Kinesiophobia decreased from preoperative to 3 and 6 months postoperative. • Flexion ROM, pain, and subjective knee function improved with decreased kinesiophobia. • Kinesiophobia is associated with changes in knee function to 3 months postoperatively. [ABSTRACT FROM AUTHOR]

Introduction: Anterior cruciate ligament injury is an injury that occurs in both sexes and in the population of all ages. The anterior cruciate ligament (ACL) is a very strong internal ligament of the knee, whose injuries occur frequently in athletes (professional and recreational) and after which the recovery is very long and complicated. The aim of this study is to determine the effectiveness of a standardized rehabilitation program after anterior cruciate ligament reconstruction based on the time required for rehabilitation in athletes and recreational athletes. Methods: Research is designed as prospective study. The research was conducted in Polyclinic FM Sarajevo over a period of 10 months, starting in June 2018 and ending in March 2019. The collection of data required for the study was carried out using a form prepared for the analysis of patients included in the study. Results: Thirty-six people participated in the study, divided into two groups. In the first group, 52.8% belonged to recreational athletes, while in the second group, 47.2% belonged to athletes. At the end of the study, the flexion value in both studied groups was 120º. At the end of the study, the percentage of subjects with correct extension of the injured limb was 94.7% of recreational athletes and 64.7% of athletes. Of the total number of respondents included in this study, 33% were soccer players, 14% were basketball players, and 53% were recreational athletes. Conclusion: Based on the research results, it was confirmed that early rehabilitation after the established rehabilitation treatment program is shorter in recreational athletes than in professional athletes. [ABSTRACT FROM AUTHOR]

Anterior Cruciate Ligament (ACL) injuries are common in the active population of the Armed Forces. Symptomatic instability prompts individuals to seek a cure or a sheltered appointment. Despite the increasing numbers of ACL reconstructions performed, the outcomes have not been so spectacular with only a meager percentage of our patients returning to preinjury levels of activity. With the premise that an all-inside ACL reconstruction is likely to result in better functional outcomes, the aim of this study was to compare the short-term functional outcomes of a large consecutive series of patients undergoing ACL reconstruction using the translateral all-inside ACL reconstruction technique (AI) and standard anteromedial portal technique (AM) with a minimum follow-up of one year. A total of 240 patients with isolated ACL tear underwent ACL reconstruction via the AI or AM technique. Their preoperative and postoperative scores were compared to look for any significant differences in functional outcomes. The two groups were matched for age, BMI, mechanism of injury, and interval from injury to surgery. There was no difference in their preoperative scores. Postoperatively, although there were significant improvements across both groups, there was no significant difference between the groups at any point of time. The AI technique has garnered interest in recent literature in addressing ACL injuries. This study found no discernible benefit of the AI technique when compared to the AM technique in terms of functionality following an ACL reconstruction at any point of time up to 1 year following surgery. [ABSTRACT FROM AUTHOR]

Entheses are complex attachments that translate load between elastic-ligaments and stiff-bone via organizational and compositional gradients. Neither natural healing, repair, nor engineered replacements restore these gradients, contributing to high re-tear rates. Previously, we developed a culture system which guides ligament fibroblasts in high-density collagen gels to develop early postnatal-like entheses, however further maturation is needed. Mechanical cues, including slow growth elongation and cyclic muscle activity, are critical to enthesis development in vivo but these cues have not been widely explored in engineered entheses and their individual contribution to maturation is largely unknown. Our objective here was to investigate how slow stretch, mimicking ACL growth rates, and intermittent cyclic loading, mimicking muscle activity, individually drive enthesis maturation in our system so to shed light on the cues governing enthesis development, while further developing our tissue engineered replacements. Interestingly, we found these loads differentially drive organizational maturation, with slow stretch driving improvements in the interface/enthesis region, and cyclic load improving the ligament region. However, despite differentially affecting organization, both loads produced improvements to interface mechanics and zonal composition. This study provides insight into how mechanical cues differentially affect enthesis development, while producing some of the most organized engineered enthesis to date. Entheses attach ligaments to bone and are critical to load transfer; however, entheses do not regenerate with repair or replacement, contributing to high re-tear rates. Mechanical cues are critical to enthesis development in vivo but their individual contribution to maturation is largely unknown and they have not been widely explored in engineered replacements. Here, using a novel culture system, we provide new insight into how slow stretch, mimicking ACL growth rates, and intermittent cyclic loading, mimicking muscle activity, differentially affect enthesis maturation in engineered ligament-to-bone tissues, ultimately producing some of the most organized entheses to date. This system is a promising platform to explore cues regulating enthesis formation so to produce functional engineered replacements and better drive regeneration following repair. [Display omitted] [ABSTRACT FROM AUTHOR]

The somatosensory system fulfils a critical role in functional knee joint stability (FKJS) by providing afferent feedback necessary for neuromuscular control. Individuals with anterior cruciate ligament reconstruction (ACLr) have altered somatosensory function. Somatosensory characteristics are assessed by proprioception and quantitative sensory testing. The purpose of the study was to examine intra-rater and inter-rater reliability of methods used to assess somatosensory characteristics and FKJS in amateur adult athletes with unilateral ACLr. Repeated measures. University. 8 female, 4 male with unilateral autogenous ACLr. Bilateral measurements at 5 lower extremity locations and the anterior forearm: light touch (LT), vibration sense (VS), pressure pain threshold (PPT); knee active joint position sense (AJPS); adapted crossover hop for distance (ACHD). Intraclass correlation coefficients (ICC) determined reliability, defined as: poor (<0.50), moderate (0.50–0.75), good (0.75–0.90). ACLr-side intra-rater/inter-rater ICCs ranged: LT, −0.27-0.80/-0.01-0.84; VS, 0.12–0.90/0.25–0.90; PPT, 0.49–0.98/0.86–0.99; AJPS, 0.15–0.79/0.55–0.87; ACHD, 0.98/0.99. Uninjured-side intra-rater/inter-rater ICCs ranged: LT, 0.12–0.66/-0.09-0.64; VS, 0.35–0.89/0.05–0.81; PPT, 0.65–0.99/0.45–0.95; AJPS, 0.07–0.81/0.37–0.99; ACHD, 0.99/0.98. Intra-rater and inter-rater reliability was poor to good for both limbs. Overall, PPT and the ACHD demonstrated the highest ICCs. Some somatosensory assessments can be employed with confidence, while others should be used with caution. • Light touch rater ICC: Intra (−0.27-0.80), Inter (−0.01-0.84). • Vibration sense rater ICC: Intra (0.12–0.90), Inter (0.05–0.90). • Pressure pain threshold rater ICC: Intra (0.49–0.99), Inter (0.45–0.99). • Active joint position sense rater ICC: Intra (0.07–0.81), Inter (0.37–0.99). • Adapted crossover hop for distance rater ICC: Intra (0.98–0.99), Inter (0.98–0.99). [ABSTRACT FROM AUTHOR]

Background Restoration of quadriceps strength after anterior ligament reconstruction (ACLR) is a persistent challenge for patients and clinicians. Inadequate recovery of quadriceps strength has been linked to increase risk of re-injury. Developing methods of early identification of strength deficits is essential to allow clinicians to provide more individualized interventions early in the rehabilitation process. Purpose To determine whether 3-month isometric quadriceps strength, the Y-Balance Test (YBT), and the anterior step-down test are predictive of isokinetic quadriceps strength at six months in adolescents after ACLR. Design Retrospective cohort Methods Thirty-six adolescent patients with primary ACLR (58% female, 36% with concomitant meniscal repair, age: 15.7 ± 1.6 years). At three months post-operative, isometric quadriceps strength via isokinetic dynamometer, YBT-Lower Quarter, and anterior step-down tests were completed. At six months post-operative, an isokinetic knee strength assessment was completed. Regression analysis was used to evaluate the predictive relationship between 3-month isometric tests and 6-month isokinetic knee extension tests. Results Three-month post operative isometric quadriceps peak torque predicted isokinetic quadriceps peak torque at 6 months, F(1,34) = 19.61, p <0.001. Three-month isometric quadriceps peak torque accounted for 36.6% of the variance in normalized isokinetic quadriceps peak torque at 6 months with adjusted R2 = 34.7%. Including YBT anterior reach (β = 0.157, p = 0.318) in regression added 1.9% of variance when predicting 6-month isokinetic quadriceps peak torque, F (2,33) = 10.32, p <0.001, R² = 0.385, ΔR2 = 0.019. Conclusion At three months post-ACLR, isometric strength testing appears more optimal than other functional tests in predicting isokinetic quadriceps peak torque in later stages of rehabilitation for adolescents. Clinicians should use tests at three months that measure quadriceps strength if aiming to predict isokinetic quadriceps peak torque at six months post-ACLR, rather than using functional tests such as the YBT-LQ or anterior step-down. Level of Evidence Level 3 [ABSTRACT FROM AUTHOR]

Introduction: A rupture of the anterior cruciate ligament (ACL) is a common knee injury in athletes, often followed by surgical reconstruction. A high percentage returns to high-impact sports, however, up to 25% of those athletes sustain an ACL reinjury.1 Objectives: To summarize evidence-based training modalities as secondary prevention measures after ACL recon- struction Study design: Evidence summary based on a systematic literature review. Methods: Systematic literature search in the databases PubMED and Web of Science with the keywords «ACL, anterior cruciate ligament, reconstruction, reinjury, second injury, rerupture, secondary, prevention, sports» from 2013 to May 2023. Two authors screened the hits independently for title and abstract, followed by full-text reading. Predefined inclusion (adults, professional and amateur athletes after ACL reconstruction), and exclusion criteria (conservative treatment, ACL suture, concomitant or secondary injuries, cadaver or animal study) were used. Injury of the contralateral side, rerupture of the reconstructed ACL and modification of risk factors for ACL reinjury were chosen as outcomes. The final study selection was made by consensus. Included studies were assessed for risk of bias by using the Critical Appraisal Skills Programme checklist.2 Results: From 923 hits, seven studies with a total of 560 athletes, one systematic literature review, three randomized controlled trials and three cohort studies were included for qualitative analysis. The included literature showed moderate to high quality. Secondary prevention programs with neuromuscular training, eccentric training and plyometric exercises and core strenghtening showed a positive impact on spine, knee and hip joint biomechanics, functional and clinical outcomes in patients after ACL reconstruction. Conclusions: The interventions in the included literature were shown to reduce various risk factors for ACL reinjury. However, the included studies were heterogeneous regarding interventions and outcomes. As ACL reinjury is multifactorial, it is recommended not to focus on one specific risk factor or outcome. [ABSTRACT FROM AUTHOR]

Introduction: After anterior cruciate ligament reconstruction (ACLR), studies have demonstrated early use of OKC did not seem to affect the graft healing process and laxity. Objective: The main objective was to determine whether quadriceps and hamstring strengthening in a rehabilita- tion program involving early open kinetic chain (OKC) and/or closed kinetic chain (CKC) knee joint exercises had an influence on graft laxity at 1, 3 and 6 after ACLR. The secondary objective was to assess whether the early use of OKC exercise affects intrinsic graft laxity between 1 and 6 months postoperatively. Design: Non randomized, single blinded, prospective case control study Methods: This study included 53 patients following a ACLR with hamstring graft. Participants were retrieved from 2 rehabilitation centers that followed different ACLR rehabilitation programs with regards the use of OKC exercises; the intervention group (n= 25) that performed OKC and CKC exercises in combination and the control group (n=28) that performed only CKC exercises. (1;2) Anterior knee laxity was measured using the GNRB device on the operated limb, and compared to the contralateral control limb. Three evaluations were performed at 1, 3 and 6 months after the ACLR. The difference between both limbs was calculated and used to determine the variation in anterior laxity throughout the first 6 months after surgery. (1;3) Results: No differences were observed in knee laxity at 1 (p = 0.263), 3 (p = 0.263) and 6 months (p = 0.256) follow up between intervention group and control group. No differences were observed in within-group graft laxity between 1 and 6 months after ACLR in intervention group (p = 0.155) and control group (p = 0.690). Conclusion: The initiation of OKC exercises doesn't seem to increase the ACLR graft laxity as compared to the rehabilitation program with only CKC exercises. [ABSTRACT FROM AUTHOR]

Introduction: Noncontact anterior cruciate ligament (ACL) injuries occur frequently during change-of-direction/landing tasks when eccentric muscle performance is required to decelerate momentum and shock-absorb forces away from noncontractile tissues. Therefore, assessment of knee eccentric muscle performance is prudent in noncontact ACL injury prevention screening, but reliable measurement procedures are scarce in the literature. Objective: To assess critical psychometric properties of a new knee isokinetic eccentric muscle performance assessment procedure linked closely to noncontact ACL injury mechanisms and using a specific knee range-of-motion and velocity-of-motion (specificity of testing.1,2 It was hypothesised that procedures would demonstrate good intra-rater reliability (intraclass correlation coefficient [ICC] ≥0.75). Study design: Between-day (D1/D2) repeated measures. Setting: biomechanics laboratory. Study population: 12 agility-sport athletes volunteered (male n=7, female n=5, age 23.5±4.6yr; height 170.0±10.1cm; mass 75.7±12.3kg). Assessment: athletes were seated on an isokinetic dynamometer set to eccentric mode. For specificity of testing, dynamometer configuration was knee flexion/extension range-of-motion 0-60° and velocity-of-motion 240°/second. Five maximal-effort knee flexion (eccentric quadriceps) and extension (eccentric hamstrings) trials were performed. Peak torque (PT; Newton-metres [Nm]) and time-to-peak torque (TTPT; milliseconds [ms]) were measured. Limb order was randomised for D1, the order repeated for D2. Main outcome measurements: relative reliability (ICC 2,1), absolute reliability (standard error of measurement [SEM]). Results: For eccentric quadriceps PT ICC/SEM: right 0.76/22.8Nm, left 0.78/19.0Nm. For eccentric quadriceps TTPT ICC/SEM: right 0.07/213.0ms, left 0.13/316.3ms. For eccentric hamstrings PT ICC/SEM: right 0.92/13.7Nm, left 0.96/8.0Nm. For eccentric hamstrings TTPT ICC/SEM: right 0.74/12.5ms, left 0.41/16.6ms. Conclusion: For both eccentric quadriceps and hamstrings, PT consistently demonstrated good relative reliability (ICC>0.75) but TTPT did not (ICC<0.75). Interestingly, right and left eccentric hamstring TTPT absolute reliability (SEM) were <17.0ms. These new knee isokinetic eccentric PT assessment procedures possess critical psychometric properties that qualify them for use in ACL injury prevention screening systems with adult agility-sport athletes. [ABSTRACT FROM AUTHOR]

This article, titled "Where are the broken needle fragments? Are they intra-articular or not? Case report," discusses a rare case of foreign body penetration in a child's knee. The authors present a case where two foreign bodies were detected in the knee and removed through arthroscopic intervention. The article emphasizes the importance of multidimensional thinking and detailed examination when dealing with a limping child, and suggests that diagnostic arthroscopy is a safe and minimally invasive procedure for cases where the location of foreign bodies cannot be fully determined. The authors hope that presenting this case will aid in the differential diagnosis and treatment of similar cases. [Extracted from the article]

Fatigue can significantly affect the biomechanics of the anterior cruciate ligament (ACL) during single-legged jumping, and these changes are closely related to ACL injuries. Unfortunately, there is no convenient way to accurately and quickly track these changes. This present study aimed to develop such a method based on video capture and inverse dynamics simulation.Are our method's results accurate and reliable? Fifteen participants performed sing-legged jumping before and after the fatigue protocol, and their actions were videotaped. The videos were processed and converted to marked motion data, used to drive the mannequin model in AnyBody Modelling System (AMS) for the inverse dynamics simulations. The ACL segment was also constructed based on one participant's MRI data and added the mannequin model.Our results were similar to the findings from previous studies. Neuromuscular fatigue decreased the peak flexion angles and increased the low-the-limb muscle strength and activation. These alterations might contribute to ACL tears and ruptures. In addition, the simulation showed that the ACL force significantly (p < 0.05) increased as a result of fatigue during single-legged jumping. Our study provides a facile and reliable method to study the effects of neuromuscular fatigue on lower-the-limb biomechanics. Such a method can be applied to investigate other risk factors on ACL injuries and assist in developing workable plans for athlete training in the future. [ABSTRACT FROM AUTHOR]

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Background: Most anterior cruciate ligament (ACL) injuries which are common in violent sports require anterior cruciate ligament reconstruction (ACLR) to restore knee joint stabilization. Rectus femoris (RF) and vastus intermedius (VI) weakness are among the notable changes after ACLR. This weakness can be hazardous to the patient as it could decrease functional activity and thus increases the chances of re-injury. The objectives of the current study were to measure the (RF) thickness, (VI) thickness and the total (RF + VI) thickness on (ACL) reconstructed limb and the non-reconstructed limb of athletes using ultrasound and to compare the results pre-operatively and 6–8 months post-operative. Results: The reconstructed limb showed a significant decrease in (RF), (VI) and the total thickness in the 1st, 2nd and 3rd measurements compared to that of non- reconstructed limb post-operatively. In both limbs, the decrease of (VI) thickness was significantly higher than (RF) thickness in the 1st, 2nd and 3rd measurements (p < 0.001, p < 0.001 and p < 0.001 respectively). Conclusions: Ultrasound can be used to assess quadriceps atrophy (including the individual muscles) found after ACLR. Ultrasound is an affordable and easily available modality as compared to MRI and CT scans for the assessment of RF and VI muscle weakness in athletes with ACLR during the rehabilitation period and can guide selective rehabilitation protocols if wasting is identified early. [ABSTRACT FROM AUTHOR]