Search

Objective: To culturally adapt and validate the Italian version of the Shoulder Instability—Return to Sport after Injury (SI-RSI-I) scale. Methods: The SI-RSI-I was developed by adapting the Anterior Cruciate Ligament—Return to Sport Index—Italian version and replacing the term "knee" with "shoulder." Subsequently, it underwent validation following COSMIN recommendations. The study involved athletic participants who experienced SI. They completed the SI-RSI-I together with other measurement instruments: Western Ontario Shoulder Instability Index, Kerlan-Jobe Orthopedic Clinic Score, EuroQol-5D-5L, and Numeric Pain Rating Scale. The following psychometric properties were investigated: structural validity, internal consistency, test–retest reliability, measurement error, and construct validity. Results: The study included 101 participants (age mean [SD] 28.5 [7.4] y; 83 males, 18 females). The SI-RSI-I showed a single-factor structure, excellent internal consistency (α =.935), and excellent test–retest reliability (ICC =.926; 95% CI,.853–.964). The standard error of measurement was 6.1 points, and the minimal detectable change was 17.0 points. Furthermore, SI-RSI-I demonstrated moderate to strong correlations with all reference scales, confirming 8 out of 9 (88.0%) hypotheses, thus establishing satisfactory construct validity. Conclusion: The SI-RSI-I has demonstrated robust internal consistency, reliability, validity, and feasibility as a valuable scale for assessing psychological readiness to return to sport in Italian athletes with SI. [ABSTRACT FROM AUTHOR]

Context : In March 2020, public health concerns resulted in school closure throughout the United States . The prolonged sport cessation may affect knee injury risk in high school athletes. The purpose of this study was to describe and compare risk of knee injuries in high school athletes during 2019-2020 and 2020-2021 academic years, and stratify by gender, severity, mechanism of injury, injury type, and knee anatomic region . Design : Historical-prospective cohort study . Methods : This historical- prospective cohort study included 176 schools in 6 states matched by sport participation in control and COVID years from July 1, 2019 to June 30,2021. Injury rates per 1000 athletes per year were calculated with 95% confidence intervals. A negative binomial regression was performed to assess potential differences in knee injuries between academic years . Results: 94, 847 and 72,521 high school athletes participated in the 2019-2020(19-20) and 2020-2021 (20-21) seasons. Knee injury risk was higher in the 20-21 season (19-20: 28.89% [27.82-29.96-]; 20-21: 33.82% [32.50-35.14]). Risk increased for male athletes from 2019- 2020 to 2020-2021 (19-20: 29.42% [28.01-30.83]; 20-21 : 40.32% [38.89-41.75]). Female knee injury risk was similar between years (19-20: 25.78% [24.29-27.27]; 20-21: 26.03% [24.31-27.75]). Knee injuries increased by a ratio of 1.2 ([95% CI, 1.1- 1.3], P <.001) during 2020-2021. Conclusions,· Knee injury risk and relative risk increased among males in 2020-2021. Results indicate changes in knee injury risk following return from COVID shelter in place among high school athletes and implicate potential negative downstream effects of interrupted sports training and participation on high school injury risk. [ABSTRACT FROM AUTHOR]

Prior studies have explored the relationship between knee valgus and musculoskeletal variables to formulate injury prevention programs, primarily for females. Nonetheless, there is insufficient evidence pertaining to professional male soccer players. Here, the aim was to test the correlation of lateral trunk inclination, hip adduction, hip internal rotation, ankle dorsiflexion range of motion, and hip isometric strength with knee valgus during the single-leg vertical jump test. Twenty-four professional male soccer players performed a single-leg vertical hop test, hip strength assessments, and an ankle dorsiflexion range of motion test. A motion analysis system was employed for kinematic analysis. Maximal isometric hip strength and ankle dorsiflexion range of motion were tested using a handheld dynamometer and a digital inclinometer, respectively. The correlation of peak knee valgus with peak lateral trunk inclination was.43 during the landing phase (P =.04) and with peak hip internal rotation was −.68 (P <.001). For knee valgus angular displacement, only peak lateral trunk inclination presented a moderate positive correlation (r =.40, P =.05). This study showed that trunk and hip kinematics are associated with knee valgus, which could consequently lead to increased knee overload in male professional soccer players following a unilateral vertical landing test. [ABSTRACT FROM AUTHOR]

The hamstring plays an important role in reducing loads born by the anterior cruciate ligament. As anterior cruciate ligament injuries occur rapidly after ground contact, how the hamstring is activated prior to landing can influence injury risk. The purpose was to determine sex-related differences in hamstring activation immediately before landing and the effect of fatigue on "preactivation." Twenty-four participants (13 males and 11 females, age = 24.3 [6.5] y, mass = 72.2 [19.3] kg, height = 169 [9.7] cm) participated in this study. Participants completed a drop-vertical jump protocol before and after a lower body fatigue protocol. Hamstring electromyography (EMG) amplitude at 5 periods prior to landing, peak vertical ground reactions forces (in newtons/body weight), rate of loading (in body weight/second), and landing error scoring system were measured. Females had higher EMG amplitude before and after fatigue (P <.024), with decreased EMG amplitude for both sexes after fatigue (P =.025). There was no change on vertical ground reaction force, rate of loading, or landing error scoring system. Males and females demonstrated similar landing performance before and after fatigue but have different hamstring neuromuscular coordination strategies. The acute reduction in hamstring EMG amplitude following fatigue may increase loading on the anterior cruciate ligament. [ABSTRACT FROM AUTHOR]

Backgrounds: Osteoarthritis (OA) significantly impacts the elderly, leading to disability and decreased quality of life. While hyaluronic acid (HA) and chondroitin sulfate (CS) are recognized for their therapeutic potential in OA, their effects on extracellular matrix (ECM) degradation are not well understood. This study investigates the impact of HA and CS, individually and combined, on ECM degradation in OA and the underlying mechanisms. Methods: OA was modeled in rats through anterior cruciate ligament transection and in cells using IL-1β pretreatment. Treatments included HA and CS, alone or combined, with and without PMA (an NF-κB pathway activator). Cartilage tissue was analyzed using HE and Saffron O-fast green staining, with degradation assessed via the OARSI score. Inflammatory factors were measured by ELISA, and ECM-related proteins were detected by immunohistochemistry, immunofluorescence, and Western blotting. Chondrocyte viability was assessed using CCK8. Results: HA and CS treatments significantly reduced cartilage damage, decreased inflammatory factor release, alleviated ECM degradation, and inhibited NF-κB pathway activation compared to the OA group (P < 0.05). The combination of HA and CS further enhanced these therapeutic effects (P < 0.05). However, these benefits were reversed when PMA was introduced (P < 0.05). Conclusion: HA and CS, whether used alone or in combination, mitigate ECM degradation in osteoarthritis by inhibiting the NF-κB pathway, offering potential therapeutic benefits for OA management. [ABSTRACT FROM AUTHOR]

Background: To summarize the statistical performance of machine learning in predicting revision, secondary knee injury, or reoperations following anterior cruciate ligament reconstruction (ACLR), and to provide a general overview of the statistical performance of these models. Methods: Three online databases (PubMed, MEDLINE, EMBASE) were searched from database inception to February 6, 2024, to identify literature on the use of machine learning to predict revision, secondary knee injury (e.g. anterior cruciate ligament (ACL) or meniscus), or reoperation in ACLR. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Demographic data and machine learning specifics were recorded. Model performance was recorded using discrimination, area under the curve (AUC), concordance, calibration, and Brier score. Factors deemed predictive for revision, secondary injury or reoperation were also extracted. The MINORS criteria were used for methodological quality assessment. Results: Nine studies comprising 125,427 patients with a mean follow-up of 5.82 (0.08–12.3) years were included in this review. Two of nine (22.2%) studies served as external validation analyses. Five (55.6%) studies reported on mean AUC (strongest model range 0.77–0.997). Four (44.4%) studies reported mean concordance (strongest model range: 0.67–0.713). Two studies reported on Brier score, calibration intercept, and calibration slope, with values ranging from 0.10 to 0.18, 0.0051–0.006, and 0.96–0.97 amongst highest performing models, respectively. Four studies reported calibration error, with all four studies demonstrating significant miscalibration at either two or five-year follow-ups amongst 10 of 14 models assessed. Conclusion: Machine learning models designed to predict the risk of revision or secondary knee injury demonstrate variable discriminatory performance when evaluated with AUC or concordance metrics. Furthermore, there is variable calibration, with several models demonstrating evidence of miscalibration at two or five-year marks. The lack of external validation of existing models limits the generalizability of these findings. Future research should focus on validating current models in addition to developing new multimodal neural networks to improve accuracy and reliability. [ABSTRACT FROM AUTHOR]

Purpose: To explore the clinical outcomes of combining anterior cruciate ligament (ACL) reconstruction and anterolateral structure (ALS) reconstruction through a modified single femoral tunnel in patients with high risk of clinical failure. Methods: From December 2018 to August 2022, a total of 62 patients with ACL injury in our institution were enrolled in this study. All patients were associated with high risk of clinical failure, meeting the indications of ALS reconstruction. All patients accepted arthroscopic single-bundle ACL reconstruction and ALS reconstruction using hamstring autograft through a modified single femoral tunnel. Perioperative clinical outcome measurements consisted of functions, stability and safety evaluation at different time points (preoperative, postoperative three month, six month, one year, two year, three year and more). Functional evaluation included Lysholm score, Tegner activity scale, subjective and objective International Knee Documentation Committee (IKDC) score. Results: All patients, including 47 males and 15 females, aged 16–52 years with an average age of 29.3 ± 9.2 years, were followed up for 12–58 months. At the last follow-up, the Lysholm, subjective IKDC and Tegner activity scale (93.8 ± 7.0, 88.8 ± 10.7 and 5.8 ± 1.4 respectively) were significantly higher than those before surgery (65.0 ± 20.8, 51.2 ± 21.1 and 2.3 ± 1.3 respectively)(P < 0.05). Postoperative pivot shift and Lachman test were markedly improved (P < 0.05). One patient still had grade II pivot shift, defined as clinical failure. During follow-up, no graft rupture occurred according to magnetic resonance imaging and physical examination, no lateral compartment osteoarthritis were found in all patients. Conclusions: Combined single bundle ACL reconstruction and ALS reconstruction through a modified single femoral tunnel could significantly improve knee function and stability with low related risk in patients with high risk of failure in ACL injury. [ABSTRACT FROM AUTHOR]

Post-traumatic osteoarthritis (PTOA) is a painful joint disease characterized by the degradation of bone, cartilage, and other connective tissues in the joint. PTOA is initiated by trauma to joint-stabilizing tissues, such as the anterior cruciate ligament, medial meniscus, or by intra-articular fractures. In humans, ~50% of joint injuries progress to PTOA, while the rest spontaneously resolve. To better understand molecular programs contributing to PTOA development or resolution, we examined injury-induced fluctuations in immune cell populations and transcriptional shifts by single-cell RNA sequencing of synovial joints in PTOA-susceptible C57BL/6J (B6) and PTOA-resistant MRL/MpJ (MRL) mice. We identified significant differences in monocyte and macrophage subpopulations between MRL and B6 joints. A potent myeloid-driven anti-inflammatory response was observed in MRL injured joints that significantly contrasted the pro-inflammatory signaling seen in B6 joints. Multiple CD206+ macrophage populations classically described as M2 were found enriched in MRL injured joints. These CD206+ macrophages also robustly expressed Trem2, a receptor involved in inflammation and myeloid cell activation. These data suggest that the PTOA resistant MRL mouse strain displays an enhanced capacity of clearing debris and apoptotic cells induced by inflammation after injury due to an increase in activated M2 macrophages within the synovial tissue and joint space. [ABSTRACT FROM AUTHOR]

Background: The co-occurrence of anterior cruciate ligament (ACL) rupture with medial collateral ligament (MCL) rupture is a compound injury that can be associated with meniscal tears. Purpose: To report the characteristics of meniscal tears in knees with isolated ACL versus combined ACL and MCL injuries, analyzing their frequency, distribution by site, and lesion type. Study Design: Cross-sectional study; Level of evidence, 3. Method: This prospective, multicenter, case-control study, conducted across 10 hospitals in France as part of a symposium of the national French Society of Arthroscopy, compared patients undergoing ACL reconstruction with and without MCL injury. The 2 groups were matched by sex, age (±3 years), and body mass index (±3) to minimize imbalances between groups. All operations were performed by senior surgeons, who systematically explored for ramp, root, and other types of meniscal lesions as well as corner injuries. The primary outcome focused on meniscal injury frequency, with secondary outcomes examining lesion sites and types. A subgroup analysis was performed to compare these outcomes depending on the injury chronicity. Acute ACL injuries were those treated within 3 months of injury, and chronic lesions were those treated after this period. Results: A total of 722 patients were included, with a mean age of 30.32 ± 10.78 years. Meniscal injuries were observed more frequently in the ACL+MCL group, with 217 of 408 patients (53.2%) affected, compared with 130 of 314 patients (41.4%) in the isolated ACL group (P =.001). Lateral meniscal lesions were significantly more common in the ACL+MCL group at 41.9% compared with 20.8% in the isolated ACL group (P <.001). The same pattern was found independent of chronicity. Medial meniscal lesions were significantly more common in the isolated ACL group regardless of chronicity status. In terms of types of medial lesions, the ACL+MCL group primarily experienced longitudinal (45.9%) and ramp lesions (28.7%), whereas the isolated ACL group experienced mostly ramp lesion (58.3%; P <.001). No significant difference was observed in the distribution of lateral meniscal injury types. Conclusion: This study demonstrated a higher prevalence of meniscal injuries associated with ACL+MCL injuries compared with isolated ACL injuries, with lateral meniscal lesions particularly more frequent, independent of chronicity status. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) injury is one of the most severe injuries for athletes. It is important to identify risk factors because a better understanding of injury causation can help inform athletes about risk and increase their understanding of and motivation for injury prevention. Purpose: To investigate the relationship between anatomic factors and risk for future noncontact ACL injuries. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 870, excluding 9 players with a new contact ACL injury and a player with a new noncontact ACL injury just before the testing, female elite handball and soccer players—86 of whom had a history of ACL injury—underwent measurements of anthropometrics, alignment, joint laxity, and mobility, including leg length, knee alignment, knee anteroposterior laxity, generalized joint hypermobility, genu recurvatum, and hip anteversion. All ACL injuries among the tested players were recorded prospectively. Welch t tests and chi-square tests were used for comparison between the groups (new injury group, which sustained a new ACL injury in the follow-up period, and no new injury group). Results: An overall 64 new noncontact ACL injuries were registered. No differences were found between athletes with and without a new ACL injury among most of the measured variables. However, static knee valgus was significantly higher in the new injury group than in the no new injury group among all players (mean difference [MD], 0.9°; P =.007), and this tendency was greater in players with a previous ACL injury (MD, 2.1°; P =.002). Players with secondary injury also had a higher degree of knee hyperextension when compared with those previously injured who did not have a secondary injury (MD, 1.6°; P =.007). Conclusion: The anatomic factors that we investigated had a weak or no association with risk for an index noncontact ACL injury. Increased static knee valgus was associated with an increased risk for noncontact ACL injury, in particular for secondary injury. Furthermore, hyperextension of the knee was a risk factor for secondary ACL injury. [ABSTRACT FROM AUTHOR]

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

Introduction: Isolated patellar tendon (PT) or anterior cruciate ligament (ACL) ruptures are common injuries, yet the co-occurrence of both presents a rare challenge for clinicians. The objectives of the study are to document diagnostic and therapeutic approaches, outcomes, and complications of combined PT and ACL injuries and to develop an algorithm to guide clinicians in decision-making. Methods: The systematic review und metanalysis was conducted according to the PRISMA guidelines. Studies reporting on simultaneous PT and ACL ruptures were included. Meta-analysis was performed to compare different diagnostic modalities and treatment strategies. Results: Thirty-six studies reporting on 56 Patients were included. 88% of patients had a concomitant injury (apart from PT and ACL) to the ipsilateral knee. Part of the diagnosis was missed in 23% of the cases. Performance of MRI significantly reduced the risk of missing a part of the injury (5% with MRI vs 69% without MRI, p < 0.001). Surgical treatment was used only for the PT in 21% of the cases and for the PT and ACL in 77% of the cases (48% one-stage, 52% two-stage surgical treatment). Conclusion: Combined ACL and PT rupture is rare, and recognizing its full extent is crucial for successful management. Performing an MRI in PT rupture from high-energy trauma and diagnostic arthroscopy/arthrotomy when MRI is not done is essential. PT ruptures should be treated surgically. For ACL rupture, conservative and operative treatment, one- or two-stage surgery are possible based on the patient's profile and concomitant injuries. Based on the limited available literature, this systematic review provides a diagnostic and therapeutic algorithm to assist in clinical decision-making. [ABSTRACT FROM AUTHOR]

Introduction: Aberrant knee mechanics during gait 6 months after anterior cruciate ligament reconstruction (ACLR) are associated with markers of knee cartilage degeneration. The purpose of this study was to compare loading during walking gait in quadriceps tendon, bone–patellar tendon–bone (BPTB), and hamstring tendon autograft patients 6 months post-ACLR using loadsol single sensor insoles, and to evaluate associations between loading and patient-reported outcomes. Methods: Seventy-two patients (13 to 40 yr) who underwent unilateral, primary ACLR with BPTB, quadriceps tendon, or hamstring tendon autograft completed treadmill gait assessment, the International Knee Documentation Committee (IKDC) survey, and the ACL-Return to Sport after Injury (ACL-RSI) survey 6 ± 1 months post-ACLR. Ground reaction forces were collected using loadsols. Limb symmetry indices (LSI) for peak impact force (PIF), loading response instantaneous loading rate (ILR), and loading response average loading rate (ALR) were compared between groups using separate analyses of covariance. Survey scores were compared between groups using one-way ANOVAs. The relationships between IKDC, ACL-RSI, and LSI were compared using Pearson's product moment correlation coefficients. Results: There were no significant differences between graft sources for LSI in PIF, ILR, ALR, or impulse. Patient-reported knee function was significantly different between graft source groups with the BPTB group reporting the highest IKDC scores; however, there was no significant difference between groups for ACL-RSI score. There were no significant associations between IKDC score, ACL-RSI score, and biomechanical symmetry among any of the graft source groups. Conclusions: Autograft type does not influence PIF, ILR, ALR, or impulse during walking 6 months post-ACLR. Limb symmetry during gait is not strongly associated with patient-reported outcomes regardless of graft source. Loadsols appear to be a suitable tool for use in the clinical rehabilitation setting. [ABSTRACT FROM AUTHOR]

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: Postural control deficits and persistent joint stability issues are prevalent in population with anterior cruciate ligament (ACL) injuries or reconstructions. Postural control is typically assessed using the center of pressure (CoP) parameters during the static single-leg stance with a force plate. However, previous studies have reported unclear definitions and descriptions of the CoP parameters, causing inconsistent results of postural control deficits in a specific population. Objective: To 1) summarize CoP parameters commonly used to evaluate postural control deficits in ACL injured or reconstructed population, and 2) identify the differences in CoP parameters with opened and closed eyes during the single-leg stance between ACL injured or reconstructed and control groups. Methods: PubMed, Embase, Cochrane Library, CINAHL, Scopus, Web of Science, and SPORTDiscus databases were searched up to July 2023. Data were obtained from the selected articles and underwent quality and risk of bias assessment and meta-analysis using random-effect models. Subgroup analysis within ACL injured or reconstructed group were also performed. Results: A total of 14 articles were included in the analysis after screening. The injured knee of the ACL injured or reconstructed group differed insignificantly in sway amplitude, sway area, and sway velocity during static singleleg stance under opened and closed eyes when compared with the control group. In the subgroup analysis, we found that there was only significant difference in sway velocity with open eyes (SMD ¼ 0.47, p ¼ 0.001) between ACL reconstructed group and control group. Conclusion: This study summarized the common CoP parameters used to evaluate postural control in ACL injured or reconstructed population. The results only showed weak difference in sway velocity between ACL reconstructed population and healthy individuals with opened eyes during the static single-leg stance. [ABSTRACT FROM AUTHOR]

Background: Traditional examinations of anterior cruciate ligament (ACL) injuries focus primarily on static assessments and lack the ability to evaluate dynamic knee stability. Hence, a dynamic scoring system for knee function is needed in clinical settings. This study aimed to propose a dynamic scoring system based on a large sample of normative six-degree-of-freedom (6-DOF) knee kinematics during gait, and validate its correlation with conventional outcome measurements in assessing ACL-injured knees. Methods: A total of 500 healthy Chinese participants were enrolled to establish a large dataset. The 6-DOF kinematics of both knees during gait were recorded using an infrared navigation three-dimensional portable knee motion analysis system. Based on the large sample dataset, a novel 6-DOF scoring system was developed using the dynamic time warping algorithm. To further validate the scoring system, an additional 83 patients with ACL injuries were included, and their preoperative dynamic knee kinematics assessment and patient-reported outcome measurements (PROMs) were recorded. Spearman's correlation coefficient (ρ) was used to determine the correlations between the 6-DOF score and the Lysholm score, International Knee Documentation Committee (IKDC) subjective score, and Tegner activity scale. Results: The mean values of adduction/abduction, internal/external rotation, flexion/extension, anterior/posterior translation, proximal/distal translation, and medial/lateral translation in the 500 healthy participants were 10.07 ± 4.04°, 15.13 ± 4.85°, 60.56 ± 6.07°, 1.79 ± 0.75 cm, 1.58 ± 0.54 cm, and 1.10 ± 0.42 cm, respectively. The mean preoperative 6-DOF score, Lysholm score, IKDC subjective score, and Tegner activity scale of the 83 ACL-injured patients were 74.29 ± 7.23, 70.26 ± 17.55, 66.78 ± 15.79, and 2.28 ± 1.56, respectively. The 6-DOF score was significantly correlated with the Lysholm score (ρ = 0.375, P < 0.001) and Tegner activity scale (ρ = 0.273, P = 0.016) for the ACL-injured patients. No significant correlation was found between the 6-DOF score and the IKDC subjective score (ρ = 0.145, P = 0.208). Conclusion: This study proposed a normative 6-DOF knee kinematic reference range for the Chinese population based on a large sample dataset. The 6-DOF dynamic score was developed accordingly and proven to be significantly correlated with the Lysholm score and the Tegner activity scale, showing the potential to provide comprehensive and meaningful information on dynamic knee function and stability for patients with ACL injuries in the future. [ABSTRACT FROM AUTHOR]

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

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]

Key points Knee osteoarthritis contributes substantially to worldwide disability. Post‐traumatic osteoarthritis (PTOA) develops secondary to joint injury, such as ligament rupture, and there is increasing evidence suggesting a key role for inflammation in the aetiology of PTOA and associated functional deficits. Colony stimulating factor 1 receptor (CSF1‐R) has been implicated in the pathogenesis of musculoskeletal degeneration following anterior cruciate ligament (ACL) injury. We sought to assess the efficacy of CSF1‐R inhibition to mitigate muscle and joint pathology in a mouse model of PTOA. Four‐month‐old mice were randomized to receive a CSF1‐R inhibitor and studied for 7 or 28 days after joint injury. Additionally, we profiled synovial fluid samples for CSF1‐R from patients with injury to their ACL. Transcriptomic analysis of quadriceps muscle and articular cartilage in CSF1‐R inhibitor‐treated animals at 7 days after injury revealed elevated chondrocyte differentiation within articular cartilage and enhanced metabolic and contractile gene expression within skeletal muscle. At 28 days post‐injury, CSF1‐R inhibition attenuated PTOA severity and mitigated skeletal muscle atrophy. Patient synovial fluid CSF1‐R levels correlated with matrix metalloproteinase 13, a prognostic marker and molecular effector of PTOA. Our findings support an opportunity for CSF1‐R targeting to mitigate the severity of PTOA and muscle atrophy after joint injury. Posttraumatic osteoarthritis (PTOA) of the knee commonly results from direct injury to the joint, which is characterized by pain, weakness, and disability. Induction of colony stimulating factor one receptor (CSF1‐R) is positively associated with knee trauma severity, and the initial acute inflammatory state suppresses muscle recovery and degrades articular cartilage. Skeletal muscle and articular cartilage transcriptomic response following direct joint injury in a murine model of PTOA is rescued by pharmacological inhibition of CSF1‐R. CSF1‐R inhibition mitigated skeletal muscle atrophy and attenuated PTOA severity and synovitis. Patient synovial fluid CSF1‐R levels correlated with matrix metalloproteinase 13, a prognostic marker and molecular effector of PTOA, offering further evidence for CSF1‐R as a therapeutic target across musculoskeletal tissues after injury. [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]

Background: Ruptures of the anterior cruciate ligament (ACL) are common injuries. Reconstruction using autologous grafts is recommended to prevent further damage and functional impairment. Grafts are usually prepared with stabilizing sutures. The aim of this study was to evaluate if a 4-strand semitendinosus autograft preparation technique is non-inferior to conventional preparation techniques with regard to maximum tensile strength threshold. Methods: Fresh porcine flexor tendons were used as specimens in this study. Four different preparation techniques for quadruple-folded tendons were compared. Group 1 three suture FiberWire® (n = 20) and Group 2 one suture FiberWire® (n = 20) using Krakow stitches, Group 3 (n = 10) using SPEEDTRAP® and piercing the autograft and 4 (n = 9) using SPEEDTRAP® without piercing the autograft for preparation. Biomechanical tensile testing included 50 sinusoidal cycles of preloading between 50 and 150 N at 1 Hz and load-to-failure was measured at 20 mm/min. Results: Failure at the maximum load occurred at the filament for all samples, whereas failure of the suture/tendon interface was not observed. Load-to-failure was significantly higher in Group 1 (711 ± 91 N) than in all other groups. When comparing groups 2–4 load-to-failure was significantly higher in Group 2 (347 ± 24 N) than in Group 3 (258 ± 25 N, p < 0.02) but not than in Group 4 (325 ± 26N). Conclusion: In all 4 Groups the load to failure was higher than the maximum tension force on the construct that will be applied by hand (182N). Therefore, the needleless preparation technique seems to be a valuable alternative to conventional techniques for the insertion of the graft into the joint during joint-near tibial fixation technique. [ABSTRACT FROM AUTHOR]

Deep learning is a powerful branch of machine learning, which presents a promising new approach for diagnose diseases. However, the deep learning for detecting anterior cruciate ligament still limits to the evaluation of whether there are injuries. The accuracy of the deep learning model is not high, and the parameters are complex. In this study, we have developed a deep learning model based on ResNet-18 to detect ACL conditions. The results suggest that there is no significant difference between our proposed model and two orthopaedic surgeons and radiologists in diagnosing ACL conditions. [ABSTRACT FROM AUTHOR]

Background: The use of a tourniquet is common during anterior cruciate ligament (ACL) reconstruction, offering convenience for the surgical procedure. However, the potential adverse effects of tourniquet use have gained increasing attention from clinical researchers. We conducted this systematic review and meta-analysis to compare the clinical outcomes of tourniquet application versus non-tourniquet approach during arthroscopic ACL reconstruction. Methods: A comprehensive search of PubMed, Web of Science, Embase, and Cochrane Library databases, was performed through March 2023 to identify controlled clinical trials. The main outcomes assessed included post-operative drain output, post-operative pain using a visual analogue scale (VAS), operation time, calf girth, and thigh girth. A random-effects meta-analysis was performed to account for heterogeneity, with weighted mean difference (WMD) and 95% confidence intervals (CI) used as pooled estimates for clinical outcomes. Results: Of the nine potentially related studies, seven eligible studies (sufficient quantitative data) were included in the meta-analysis. Postoperative drain output in the tourniquet group was on average 100 ml higher than in the non-tourniquet group (95% CI: 36 to 168). Pain, measured by the VAS at 24 h postoperatively, was 0.42 points higher in the tourniquet group (95% CI: 0.08 to 0.76), with the increase persisting at 48 h, averaging 0.40 points (95% CI: 0.12 to 0.69). Thigh girth in the tourniquet group was reduced by 1.8 cm (95% CI: -2.7 to -0.94). No significant differences were observed for calf girth and the operation time. Conclusion: Our meta-analysis indicates that tourniquet use during arthroscopic ACL reconstruction is associated with higher pain levels, increased postoperative drain output, and reduced thigh girth. However, performing the surgery without a tourniquet does not significantly extend the operation time. Trial registration: The protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42023417604). [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence The significance of the posterior tibial slope (PTS) has increasingly come into focus in anterior cruciate ligament (ACL) reconstruction being a risk factor for ACL graft failure. Nevertheless, inconsistent data on the critical value of the PTS exist. The purpose of this study was to define a cut‐off value for the PTS in ACL surgery.In a retrospective cohort study, 350 revision ACL reconstructions (ACL‐RR) with a failed ACL hamstring graft and 350 primary ACL reconstructions (ACL‐R) were matched according to age, gender, concomitant injuries and graft characteristics and compared to a healthy control group. Using the proximal anatomic axis, lateral knee radiographs were evaluated for the PTS, interrater reliability was defined, ROC curves, Fischer's exact test and Baptista–Pike method were applied to define specificity and the odds ratio for a critical PTS value.Radiographic evaluation proved excellent interrater reliability (intraclass correlation coefficient 0.969). Evaluation of the PTS revealed 10.0 ± 2.2 (5–15) degrees in the ACL‐RR group, 7.8 ± 1.8 (4.2–13) degrees in the ACL‐R group and 6.6 ± 1.9 (3.6–12) degrees in the control group with significant differences between the groups (p < 0.001). A PTS value of 10.1 degrees proved a specificity of 98% for the prediction of an ACL graft failure and indicated an 11‐fold risk for a retear of the ACL.A PTS exceeding 10.1 degrees carries an 11‐fold risk for ACL graft failure and, therefore, should be considered in ACL reconstruction. These findings might serve as a cut‐off value for the indication of a slope‐reducing high tibial osteotomy in ACL surgery.Level III. [ABSTRACT FROM AUTHOR]

Objectives: Evaluation of ultrasound-guided (USG) adductor canal block (ACB) or femoral nerve block (FNB) for enhanced recovery in arthroscopic anterior cruciate ligament (ACL) repair, and their analgesic efficacy postoperatively. Background: USG ACB and USG FNB are getting more consideration for enhanced recovery in arthroscopic ACL repair. Methods: A prospective randomized double-blind work was performed on eighty adult individuals assigned into two equal groups scheduled for elective arthroscopic ACL repair using spinal anesthesia. Group A (n=40): obtained USG ACB with bupivacaine 0.125% in total volume of 20 ml. Group B (n=40): received USG FNB with bupivacaine 0.125 in total volume of 20 ml. The role of those blocks in enhanced recovery after arthroscopic (ACL) repair is assessed by the length of the patient's hospital stay as a primary outcome. The analgesic efficacy of those blocks was assessed by visual analog scale (VAS), time for the postoperative first analgesic requirement, total opioid consumption as post-operative additional analgesia, and post-operative hemodynamics (mean blood pressure and heart rate) as a secondary outcome. Results: Hospital stay was substantially decreased in group A contrasted to in group B (P value = 0.001). VAS score was decreased in group A contrasted to group B with statistical significance on 4, 8, and 12 hours postoperatively with P value = 0.001, 0.026, 0.031 respectively. It was statistically insignificantly between both groups on admission at the post-anesthesia care unit (PACU), 16, 20, and 24 hours postoperatively with P values = 0.254, 0.074, 0.114, and 0.725 respectively. Time to first analgesic request was substantially prolonged in group A contrasted to group B (P value <0.001). Total consumption of morphine was substantially decreased in group A contrasted to group B (P value < 0.001). Conclusion: Our findings revealed that USG ACB provides better postoperative enhanced recovery as shown by a lower hospital stay and superior post-operative analgesic effects via lower VAS score, time for the postoperative first analgesic requirement, total opioid consumption, patients' vital parameters and satisfaction in first 24h post-operative than USG FNB in arthroscopic ACL repair. [ABSTRACT FROM AUTHOR]

Background: Segond fracture is considered a component of the anterolateral complex (ALC) injury, yet the underlying cause and clinical outcomes of this bony avulsion remain subjects of debate. Additionally, MRI measurements of altered tibiofemoral position in anterior cruciate ligament (ACL)-injured patients with a Segond fracture have not been reported. The purpose of this study is to measure the rotational tibiofemoral position on MRI in ACL-injured patients with a Segond fracture. Methods: A total of 44 patients with a primary ACL injury and a concomitant Segond fracture were included in the Segond fracture group, with the time from injury to MRI within 3 months. Avulsion was confirmed via preoperative computed tomography (CT) scans. The control group comprised 44 matched patients with primary ACL injury and an MRI-determined ALC injury but without a Segond fracture, also with the time from injury to MRI within 3 months. The MRI-determined ALC injury included injuries to the anterolateral ligament, Kaplan fibers, and anterolateral joint capsule, as identified based on previous studies. Sex, age, and BMI were matched between the two groups using propensity score matching (PSM). Arthroscopic findings, concomitant collateral ligament injuries, and preoperative MRI measurements were compared between the two groups. Results: The Segond fracture group demonstrated a higher frequency of concomitant patellar and femoral trochlear injuries (p = 0.0110) and lateral collateral ligament injuries (p = 0.0121) compared to the control group. Additionally, significantly increased internal rotational tibial subluxation (IRTS) (p = 0.0095) and axial internal tibial rotation (ITRa) (p = 0.0306) were observed in the Segond fracture group. A strong positive correlation was found between IRTS and ITRa (rp = 0.8201), indicating that these two tibial rotation measurement methods were correlated. No significant differences were observed in the measurements of anteroposterior tibiofemoral position and posterior tibial slope (PTS) between the two groups. Conclusion: The presence of a Segond fracture was associated with significantly increased internal tibial rotation measured on MRIs, suggesting that this bony avulsion may represent a more severe form of ALC injury in ACL-injured patients and should be managed with caution. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the anatomical features of the femoral tunnel in anatomical and isometric single-bundle ACL reconstruction. Method: Thirty-two 3-dimensional knee models were reconstructed based on CT scan (average age: 26.5 ± 6.7 years, 18 males and 14 females, 17 left and 15 right). Multiple anatomical landmarks were identified. Virtual femoral tunnels were created at the deep and high portion of ACL footprint, close to the lateral intercondylar ridge to achieve best anatomy and isometry, simulating an anteromedial portal reconstruction. Anatomical features of the femoral tunnels were analyzed. The position of the femoral tunnel was quantified by the distance to anatomical landmarks and using quadrant methods. The spatial angles, length and outer opening of the femoral tunnels were also evaluated. Results: Acceptable tunnels were created in all models. The center of femoral tunnel was slightly higher than the apex of deep cartilage, near the deep one-third point across the shallow-deep dimension of the lateral femoral condyle. Using the quadrant method, the tunnel was located at 28.4% ± 2.2% and 22.2% ± 3.6%, parallel and perpendicular to the Blumensaat line, respectively. The spatial angles of the tunnel were 40°, 33.5° ± 4.1° and 38.2° ± 4.4° on the sagittal, transverse, and coronal planes, respectively. The average tunnel length was 34.8 mm ± 3.8 mm. The outer opening of the tunnels was located at the posterior one-third of the femoral metaphysis. Conclusion: The anatomical and isometric positioning of the femoral tunnel can be achieved through anteromedial portal with satisfied tunnel characteristics. The apex of deep cartilage may be used as an anatomical reference for tunnel positioning. When drilled at appropriate orientation, favorable tunnel length, integrity and position of the outer opening can be obtained. [ABSTRACT FROM AUTHOR]

Background/Objectives: After anterior cruciate ligament reconstruction (ACLR), a 6-month composite test is recommended during rehabilitation before the return to sport, and the influence of a meniscal tear is not known. The hypothesis was that the location and treatment of meniscus injuries could influence the results of the composite test. Methods: A retrospective single-center study was carried out of prospectively collected data involving 504 patients who performed a composite test 6 months after ACLR. Isolated ACLR was compared to ACLR with medial meniscus injuries (MM), lateral meniscus injuries (LM), and bimeniscal injuries (BM) using a composite test including a single-leg squat (SLS), a single-leg landing (SLL), a single hop for distance (SHD), a triple hop for distance (THD) and a side-hop test (Side-HT), isokinetic strength tests, and an assessment of the anterior cruciate ligament—return to sport after injury (ACL-RSI). Results: Compared with isolated ACLR, MM injury was associated with a quadricipital deficit at a velocity of 240°/s (14% ± 14% vs. 18% ± 18%, p = 0.02), hamstring deficit at 30°/s (14% ± 18% vs. 18% ± 18%, p = 0.02) and an increase in the hamstring/quadricipital ratio at 240°/s (68% ± 27% vs. 80% ± 67% p = 0.02). Furthermore, ACLR + MM or ML injuries in the operated knee generated an increase in the dynamic valgus frequency detected by the SLS, respectively (40% ± 49% vs. 51% ± 50%, p = 0. 05) and (40% ± 49% vs. 54% ± 50%, p = 0.02). Meniscal repair and meniscectomies showed no differences. Conclusions: These results show that meniscal injuries lead to muscle imbalance for MM injuries and impaired neuromuscular control for MM and LM injuries and suggest that meniscal repairs should be done. Moreover, rehabilitation must be adapted to meniscus injuries. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) tears have become an increasingly prevalent problem in pediatric patients due to increased youth sports participation and early sports specialization. A high index of suspicion should be utilized for any young patient with an acute knee injury and an associated effusion or difficulty bearing weight. A thorough work-up should be performed that includes a careful assessment of growth remaining and concomitant injuries. While nonoperative management may be a consideration for select cases, most patients will benefit from early surgical management. ACL deficiency or delayed reconstruction can lead to early chondral degeneration and risk for further injury to the cartilage and menisci. The goal of ACL reconstruction is to create a stable knee and prevent secondary chondral or meniscal injury. Physeal-sparing and physeal-respecting transphyseal techniques have been developed that allow for safe and successful ligament reconstruction while minimizing the risk of growth arrest. Younger patients have a higher risk of reinjury and require a longer recovery period for a full return to sports than their older counterparts. Even though there have been advances in the safe and successful treatment of ACL tears in pediatric patients, it remains a devastating physical and psychological injury, and increased efforts should be made at prevention. Injury prevention programs have been shown to reduce the risk of ACL tears, and it is important to increase awareness and utilization of prevention strategies. [ABSTRACT FROM AUTHOR]

Chronic inflammation significantly contributes to the progression of osteoarthritis (OA), and an anti‐inflammatory small molecule derived from medicinal herbs could be a potential drug candidate for OA. Herein, we investigated the function and mechanism of Evodiamine (EAE), the active ingredient from Evodia rutaecarpa, in chondrocytes and macrophages in vitro and in vivo. The cytotoxicity of EAE was determined using an MTT assay. And the anti‐inflammatory and anti‐extracellular matrix (ECM) degradation effects of EAE were investigated using qRT‐PCR, western blot (WB), immunofluorescence (IF). Inductively Coupled Plasma Atomic Emission Spectrometry (ICP‐AES), Fluo‐4 AM, IF and AutoDock were used to elucidate the molecular mechanisms and signalling pathways of the reducing‐inflammatory properties of EAE on chondrocytes in vitro. Moreover, the effect of EAE on macrophage polarization was detected by IF and flow cytometry (FC). Ultimately, we explored the in vivo therapeutic efficacy of EAE in an anterior cruciate ligament transection (ACLT)‐induced OA model. The finding demonstrated that EAE blocked the phosphorylation of IKBα and Ca2+ influx, thereby curbing inflammation and ECM degradation. Additionally, EAE can prevent the polarization towards the M1 phenotype. Thus, our findings suggest that EAE has great potential as a therapeutic drug for the treatment of OA. [ABSTRACT FROM AUTHOR]

Objectives: The type of ligamentous tear and the degree of knee laxity have important guiding significance for the diagnosis and management of anterior cruciate ligament (ACL) tears. Instrumental measurement is necessary for ACL tears since physical examination and magnetic resonance imaging (MRI) cannot provide an objective and quantitative assessment of knee laxity. This study aimed to compare the application of a novel knee arthrometer and simultaneous stress radiography in differentiating between complete and partial acute ACL tears, and further assess the correlation between the two measurements. Methods: A total of 106 patients with complete acute ACL tears and 52 patients with partial acute ACL tears were included in the study. Preoperative arthrometry and simultaneous stress radiography were performed using the Ligs arthrometer at 90, 120, and 150 N to assess side‐to‐side difference (SSD) in anterior knee laxity. The optimal threshold was determined using the receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) was used to assess the diagnostic value of the measurement. Pearson's correlation coefficient was used to assess the correlation between the two measurements. Results: The optimal differential SSD thresholds in the Ligs arthrometer were 2.7 mm at 90 N, 3.8 mm at 120 N, and 4.6 mm at 150 N. Similarly, the optimal differential SSD thresholds in simultaneous stress radiography were 3.8 mm at 90 N, 5.1 mm at 120 N, and 5.6 mm at 150 N. The AUC analysis revealed that the Ligs arthrometer was fairly informative at 90 N (AUC = 0.851), 120 N (AUC = 0.878), and 150 N (AUC = 0.884), and simultaneous stress radiography was highly informative at 90 N (AUC = 0.910), 120 N (AUC = 0.925), and 150 N (AUC = 0.948). Moreover, the AUC of the combined measurements was 0.914 at 90 N, 0.931 at 120 N, and 0.951 at 150 N. A significantly strong correlation was found between the two measurements at 90 N (r = 0.743, p < 0.001), 120 N (r = 0.802, p < 0.001), and 150 N (r = 0.823, p < 0.001). Conclusions: The Ligs arthrometer and simultaneous stress radiography proved to be valid diagnostic tools to differentiate between complete and partial acute ACL tears, with a strong correlation between the two measurements in SSD values. Compared with single instrumental measurement, the combination of the two measurements can further improve the diagnostic value in this regard. [ABSTRACT FROM AUTHOR]

Background: Previous studies have examined the relationship between patient resilience and functional outcome scores after anterior cruciate ligament reconstruction (ACLR). However, past studies have failed to explore the longitudinal relationship between preoperative resilience and functional outcomes 2 years after ACLR. Purpose: To evaluate the relationship between preoperative patient resilience and functional outcomes 2 years after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were identified who underwent ACLR for anterior cruciate ligament tears between January and June 2020 at a single institution. Those who completed the Brief Resilience Scale preoperatively as part of routine patient questionnaires were considered for inclusion. Patients were contacted a minimum of 2 years after ACLR to complete the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR), Single Assessment Numeric Evaluation (SANE), International Knee Documentation Committee (IKDC) Subjective Knee Form, and visual analog scale (VAS). Outcomes were compared among patients with low resilience (LR), normal resilience (NR), and high resilience (HR), as defined in a previous study.23 Results: A total of 81 patients were included in the final analysis, with 14 patients in the low preoperative resilience group, 54 in normal, and 13 in high. The mean age of the cohort was 32.0 years, and there were no significant differences in age, sex, race, graft type, or psychiatric comorbidities among the resilience groups. Significantly increased postoperative KOOS-JR scores were observed in patients in the HR group as compared with those in the NR and LR groups (94.8, 86.7, and 79.6, respectively; P =.031). There were also significantly increased postoperative SANE scores in patients in the HR group versus those in the NR and LR groups (92.3, 83.5, and 69.2; P =.012). Patients with high preoperative resilience achieved the IKDC Patient Acceptable Symptom State at significantly higher rates (P =.003). No significant differences were observed in postoperative VAS (P =.364), IKDC (P =.072), or change in IKDC (P =.448) over time among resilience groups. Postoperatively, 30 patients (37.0%) changed resilience groups, with 13 moving down and 17 moving up in category (low, n = 12; normal, n = 55; high, n = 14). Conclusion: Preoperative resilience correlated with KOOS-JR and SANE scores 2 years after ACLR but did not correlate with VAS, IKDC, or change in IKDC over the same period. Resilience was not static, with changes in resilience observed from initial to final evaluations. Resilience is not a strong predictor of postoperative patient-reported outcomes after ACLR. [ABSTRACT FROM AUTHOR]

Background: Detection of meniscal ramp lesions concomitant with anterior cruciate ligament (ACL) injury using conventional magnetic resonance imaging (MRI) has low sensitivity, and these lesions are currently difficult to diagnose preoperatively. Purpose/Hypothesis: The purpose of this study was to assess the accuracy of MRI in detecting the presence of meniscal ramp lesions in the 120° flexed-knee position compared with that in the near–extended-knee position. It was hypothesized that the diagnostic performance of MRI in the 120° flexed-knee position would be better than that in the extended-knee position. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: This retrospective study of prospectively collected data between February 2019 and January 2024 included 154 consecutive patients undergoing ACL reconstruction. All patients underwent 3-T MRI examination in the near extended- and 120° flexed-knee positions preoperatively. The presence and Thaunat classification of ramp lesions were separately detected on each MRI scan and confirmed via arthroscopy during ACL reconstruction. Diagnostic sensitivity, specificity, and conditional relative odds ratios for detecting ramp lesions and the classification accuracy were compared between 2 MRI modalities. The accuracies of these MRI scans in acute and chronic cases were also evaluated. Results: This study included 154 patients (79 male and 75 female; mean age, 29.0 ± 14.2 years). A total of 62 ramp lesions (40.3%) were observed on arthroscopy. The sensitivity and specificity of MRI in near extension were 69.4% and 77.2%, respectively, and those in flexion were 91.9% and 94.6%, respectively, with significant superiority in MRI at knee flexion (P =.003 and P <.001, respectively). The conditional relative odds ratio between the MRI examinations at these 2 positions was 10.3 (95% CI, 4.82-21.8). The classification accuracy of MRI in flexion was significantly higher than that of MRI in near extension (accuracy, 49 vs 11; P <.001). The diagnostic accuracy of MRI in the 120° flexed-knee position was significantly higher than that in the near–extended-knee position in the acute cases (P <.05); however, no significant differences were observed in the chronic cases. Conclusion: The diagnostic accuracy of MRI in the 120° flexed-knee position for detecting and classifying meniscal ramp lesions was superior to that of MRI in the near–extended-knee position. [ABSTRACT FROM AUTHOR]

Background: The utilization of lateral extra-articular tenodesis (LET) augmentation for anterior cruciate ligament reconstruction has increased. Various fixation points have been recommended based on tactile and anatomic landmarks; however, there is limited reporting of the accuracy or precision of these techniques in clinical practice. Purpose/Hypothesis: The purpose of this study was to evaluate whether LET fixation points identified using anatomic landmarks and tactile techniques would fall within a predefined radiographic zone. It was hypothesized that the majority of LET fixation points would be inside the radiographic zone. Study Design: Cross-sectional study; Level of evidence, 4. Methods: Postoperative lateral knee radiographs of patients who underwent anterior cruciate ligament reconstruction with LET using a landmark-based technique without fluoroscopy between January 2018 and September 2023 were reviewed. Fixation points were measured by 2 raters based on their distance from an extension of the posterior femoral cortex line (PFCL) distally and a line perpendicular to the PFCL at the posterior condylar flare (PCF). Patients were excluded if the tunnel position could not be identified or if postoperative radiographs were malrotated. The mean LET position and percentage of points within the radiographic isometric zone, defined as 4 ± 4 mm posterior and 4 ± 3 mm anterior to the PFCL and 6 ± 4 mm distal and 20 ± 5 mm proximal to the PCF were calculated. Results: Complete data sets were obtained for 47 cases. The mean LET position was 6.4 ± 7.1 mm (range, –9 to 27.3 mm) anterior to the PFCL and 1.8 ± 7.6 mm (range, –16.7 to 12.6 mm) proximal to the PCF. Overall, 53% of LET fixation points were within the predefined radiographic zone. Of the malpositioned tunnels (n = 22), their locations relative to the radiographic zone were anterior (n = 18), posterior (n = 2), proximal (n = 1), and anterior and distal (n = 1). Conclusion: This study found large variation in the location of LET fixation points, and almost half of fixation points were outside the predefined radiographic zone. Accurate and precise tunnel placement is one of multiple factors that may be important to minimize the risk of lateral compartment overconstraint, anterior cruciate ligament graft failure, and anisometry leading to LET graft loosening. [ABSTRACT FROM AUTHOR]

Background: Blood flow restriction training (BFR-t) data are heterogeneous. It is unclear whether rehabilitation with BFR-t after an anterior cruciate ligament (ACL) injury is more effective in improving muscle strength and muscle size than standard rehabilitation. Purpose: To review outcomes after an ACL injury and subsequent reconstruction in studies comparing rehabilitation with and without BFR-t. Study Design: Systematic review. Level of evidence, 3. Methods: A search of English-language human clinical studies published in the past 20 years (2002-2022) was carried out in 5 health sciences databases, involving participants aged 18-65 undergoing rehabilitation for an ACL injury. Outcomes associated with muscle strength, muscle size, and knee-specific patient-reported outcome measures (PROMs) were extracted from studies meeting inclusion criteria and compared. Results: The literature search identified 279 studies, of which 5 met the selection criteria. Two studies suggested that BFR-t rehabilitation after an ACL injury improved knee or thigh muscle strength and muscle size compared with rehabilitation consisting of comparable and higher load resistance training, with two studies suggesting the opposite. The single study measuring PROMs showed improvement compared to traditional rehabilitation, with no difference in muscle strength or size. Conclusion: BFR-t after an ACL injury seems to benefit muscle strength, muscle size, and PROM scores compared with standard rehabilitation alone. However, only 1 large study included all these outcomes, which has yet to be replicated in other settings. Further studies utilizing similar methods with a common set of outcome measures are required to confirm the effects of BFR-t on ACL rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed procedures in sports medicine, and undesirable outcomes still may range from 3-18%. One technique that has been explored to improve outcomes is preservation of the ACL remnant tibial stump, as opposed to stump debridement, at the time of reconstruction. Purpose: To review current high-level evidence and compare remnant-preserving anterior cruciate ligament reconstruction (ACLR) versus standard ACLR in terms of clinical outcomes and measures of knee stability. Hypothesis: ACLR with remnant preservation would result in improved clinical outcomes and knee stability measures. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic review of randomized controlled trials (RCTs) and cohort studies comparing remnant-preserving ACLR with standard ACLR with a minimum level of evidence of 2 was performed. Extracted data were summarized as general information, surgical characteristics, postoperative clinical outcomes, knee stability, graft evaluation, tunnel assessment, and postoperative complications. When feasible, a meta-analysis was performed. Results: Seven RCTs and 5 cohort studies met the inclusion criteria. In total, 518 patients underwent remnant-preserving ACLR and 604 patients underwent standard ACLR. Ten studies performed the reconstruction with hamstring tendon (HT) autografts, 1 study with HT and bone–patellar tendon–bone autografts, and 1 study with HT and tibialis anterior allografts. On meta-analysis, remnant-preserving ACLR provided comparable outcomes with respect to International Knee Documentation Committee grades or Tegner scores. Even though there was a significant improvement in Lysholm scores (mean difference, −1.9; 95% CI, −2.89 to −0.91; P =.0002) with the remnant-preserving technique, this did not exceed previously reported minimal clinically important difference values. Remnant-preserving ACLR demonstrated superior knee stability in terms of patients achieving negative pivot shift when compared with the control group (88.89% vs 79.92%; P =.006). Although there was a significant improvement in the side-to-side difference in anterior tibial translation favoring remnant preservation (P =.004), the mean difference was 0.51 mm. Conclusion: Remnant-preserving ACLR, primarily with HT autografts, results in comparable clinical outcome scores and significantly improved knee stability relative to standard ACLR without remnant preservation without increasing the complication rate. Further studies will help clarify if remnant-preserving ACLR also has benefits in terms of enhancing graft integration and maturation, improving proprioception, limiting tunnel enlargement, and reducing complications. [ABSTRACT FROM AUTHOR]

Globally, osteoarthritis (OA) is the most prevalent joint disease and is characterized by infiltration of M1 macrophages in the synovium, anabolic–catabolic imbalance of the extracellular matrix (ECM), increased articular shear force and overproduction of reactive oxygen species (ROS). Disease-modifying OA drugs are not yet available, and treatments for OA focus solely on reducing pain and inflammation and have limited therapeutic effect. Herein, we developed an injectable self-lubricating poly(N-acryloyl alaninamide) (PNAAA) hydrogel loaded with platelet lysate (PL) (termed "PNAAA@PL") for treating OA. Tribological and drug release tests revealed suitable lubrication properties and sustained release of bioactive factors in PNAAA@PL. In vitro experiments showed that PNAAA@PL alleviated interleukin-1β (IL-1β)-induced anabolic–catabolic imbalance of chondrocytes and repolarized pro-inflammatory M1 macrophages to the anti-inflammatory M2 phenotype via intracellular ROS scavenging. Additionally, the PNAAA@PL hydrogel enhanced the migratory capacity and chemotaxis ability of stem cells, which are essential for chondrogenesis. In vivo , the functionalized PNAAA@PL hydrogel acted like synovial fluid following intra-articular injection into a rat OA model with anterior cruciate ligament transection, ultimately attenuating cartilage degeneration and synovitis. According to molecular mechanism studies, PNAAA@PL repairs cartilage in the OA model by inhibiting the NF-ĸB pathway. Overall, this self-lubricating PNAAA@PL hydrogel offers a comprehensive strategy for preventing OA progression by engineering a biophysiochemical microenvironment to generate high-quality hyaline cartilage. [Display omitted] • Loading platelet lysate on hydrogels can delay the release of bioactive factors. • PNAAA@PL hydrogel attenuated joint degeneration by remodeling joint microenvironment. • Differentially expressed genes contributed to anti-OA abilities of PNAAA@PL hydrogel. • The synergy of lubrication and sustained bioactive factors delivery help treat OA. [ABSTRACT FROM AUTHOR]