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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]

• tRFs and tiRNAs profiles of NA ACL cells and OA ACL cells has been shown. • tRF-3031B knockdown enhanced cellular apoptosis, while its overexpression inhibited IL-1β induced cell apoptosis. • tRF-3031B regulating cell proliferation and survival depends on cellular RELA expression. tRNA-derived fragments (tRFs) are novel short noncoding RNAs that play pivotal roles in cell proliferation and survival. However, knowledge of the biological roles of tRFs in anterior cruciate ligament (ACL) cells is limited. Here, we intended to investigate the function of tRF-3031B in ACL cell. We used the tRF and tiRNA array to analyze tRF and tiRNA expression profiles in osteoarthritis (OA) ACL cells and normal ACL cells, and qRT-PCR and fluorescence in situ hybridization (FISH) were used to determine tRF-3031B expression. The results showed that tRF-3031B was expressed at low levels in OA ACL and Interleukin-1β (IL-1β) treated ACL cells. We found that RELA was the target of tRF-3031B. When ACL cells were transfected with tRF-3031B mimics, RELA expression was suppressed, whereas transfection with tRF-3031B inhibitors had the opposite effect. The rescue and dual-luciferase reporter assays showed that tRF-3031B silenced the RELA expression by binding to its untranslated region (3′-UTR). Hence, this study showed the novel function of tRF-3031B in regulating ACL cell proliferation and survival by targeting RELA, and these findings may offer a new direction for the study of ACL degeneration and pathophysiological of OA. [ABSTRACT FROM AUTHOR]

Abnormal gait dynamics are an important risk factor responsible for the high incidence of traumatic knee osteoarthritis in patients undergoing anterior cruciate ligament (ACL) reconstruction.To evaluate the effect of neuromuscular electrical stimulation (NMES) superimposed quadriceps training on gait dynamics.A total of 32 postoperative patients were randomly allocated to the NMES and conventional training (CT) groups, with 16 patients per group. Patients in the CT group received the standardized conventional training for 60 min per day, 3 days per week for 6 weeks, while those in the NMES group received the same conventional training, but with NMES superimposed on the conventional open chain training of the quadriceps. The amount of time for training was equal between the two groups. Patients were evaluated at 8 and 14 weeks after surgery. The outcome measurements were maximum voluntary isometric contraction (MVIC) of the quadriceps used to assess the quadriceps strength, Lysholm score used to assess knee function and peak vertical ground reaction force (PvGRF), heel medial (HM) peak pressure and heel lateral (HL) peak pressure used to assess gait dynamics.Compared to the CT group, the NMES group had greater improvements in quadriceps strength (p<0.001, effect size = 2.93), knee function (p = 0.049, effect size = 2.06), and gait loading (including HL peak pressure (P = 0.007, effect size = 0.89) and PvGRF (P = 0.019, effect size = 0.62)). After the intervention, participants in both groups had a significantly lower rearfoot impulse and significantly higher forefoot impulse.The NMES superimposed on conventional quadriceps open chain training has shown additional improvements in gait loading in patients after ACL reconstruction, which suggests it may contribute to delaying the onset of early postoperative traumatic knee osteoarthritis. In addition, changes in foot impulse may suggest a progressive trend in quadriceps avoidance gait in the early postoperative period. [ABSTRACT FROM AUTHOR]

A lateral extra-articular tenodesis (LET) is increasingly being utilized to augment an anterior cruciate ligament reconstruction because it has been shown to reduce the risk of postreconstruction graft failure or recurrent rotatory instability. Various femoral fixation techniques are available, including the use of an interference screw, staple, or suture anchor.To determine and compare the biomechanical properties of an LET graft when using an interference screw, staple, or suture anchor for the femoral fixation for a modified Lemaire LET.Controlled laboratory study.Eighteen fresh-frozen cadaveric knees were obtained and randomly assigned via a random group generator to undergo a modified Lemaire LET using either an interference screw, a staple, or a suture anchor for femoral fixation. The specimen underwent load-to-failure testing at 20 mm/min until graft failure. The maximum failure load, stiffness, and failure mode for each specimen were recorded.The mean failure load was highest for the interference screw (252.7 ± 131.2 N), followed by the staple (151.8 ± 34.1 N) and the suture anchor (105.7 ± 16.4 N). There was a significant difference in failure load between the interference screw and the suture anchor (P = .015). There was no significant difference between the staple and the interference screw (P = .101) or the suture anchor (P = .577). There was no significant difference in graft stiffness across all fixation methods (P = .089).All 3 femoral fixation methods achieved adequate failure loads, although the interference screw had a greater failure load than the suture anchor and there was no significant difference between these implants and the staple. There were no significant differences in stiffness between the fixation methods.The maximum failure load occurred with an interference screw for femoral fixation of a modified Lemaire LET; however, because of socket size, this implant may be at greater risk of anterior cruciate ligament reconstruction tunnel collision compared to a smaller-diameter suture anchor drill hole. The failure load of the suture anchor was the lowest; however, it appears sufficient for stable fixation based on the force experienced by an LET graft reported in the literature. [ABSTRACT FROM AUTHOR]

Tobacco use is a known modifiable risk factor for postoperative complications and revision surgery after anterior cruciate ligament reconstruction (ACLR). Previous studies focus on tobacco as a broad categorization of traditional smoking, smokeless tobacco, and other forms of nicotine use. It is unclear if differences in the type of nicotine used lead to similar adverse outcomes after ACLR.To (1) assess the incidence of postoperative complications among ACLR patients who use smokeless tobacco and (2) compare these outcomes with those of patients who do not use tobacco and those who smoke tobacco.Cohort study; Level of evidence, 3.A retrospective cohort study utilizing the PearlDiver database was conducted. Patients undergoing primary ACLR with a minimum 2-year follow-up were included. Smokeless tobacco users (n = 898), cigarette smokers (n= 22,062), and non–tobacco users (n= 207,462) were matched based on patient variables and comorbidities. Postoperative complications within 90 days of surgery and subsequent knee surgery within 2 years were compared among groups. Multivariable logistic regressions were used to control for confounding variables.Compared with nonusers, smokeless tobacco users demonstrated an increased risk of pneumonia (odds ratio [OR], 3.36; 95% CI, 1.41-7.90), acute kidney injury (OR, 12.7; 95% CI, 3.77-52.8), and emergency department (ED) utilization (OR, 6.29; 95% CI, 3.70-10.9) within 90 days of the ACLR. Additionally, smokeless tobacco users had an increased risk of ACLR (OR, 4.75; 95% CI, 3.60-6.26) and meniscal surgery (OR, 2.89; 95% CI, 2.23-3.73) within 2 years. When compared with cigarette smokers, smokeless tobacco users showed an increased risk of pneumonia (OR, 3.25; 95% CI, 1.33-7.78), acute kidney injury (OR, 7.63; 95% CI, 2.72-22.5), and ED visits (OR, 1.55; 95% CI, 1.26-1.90) within 90 days and subsequent ACLR (OR, 4.81; 95% CI, 3.58-6.47) and meniscal surgery (OR, 3.23; 95% CI, 2.45-4.26) within 2 years.Smokeless tobacco use was associated with an increased risk of medical complications, ED utilization, and subsequent procedures compared with nonuser controls and traditional smokers. These findings highlight the importance of considering specific forms of tobacco use in preoperative screening for patients undergoing ACLR. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) stress techniques—including single-leg stress radiographs, Telos, and KT-1000 arthrometer—are highly accessible and can provide additional diagnostic information to assess ACL and ACL graft integrity. The degree of anterior tibial translation (ATT) may be useful in guiding treatment when a diagnosis on magnetic resonance imaging is not conclusive or for judging if additional treatments, such as anterolateral complex augmentation, may be necessary.The purpose of this study was to evaluate the effect of increasing posterior tibial slope (PTS) on baseline tibial position (BTP) and side-to-side differences (SSD) in ATT. A secondary purpose was to perform a subgroup analysis of SSD in ATT for patients with a PTS of ≥12° versus <12°, as well as for acute (<6 weeks from injury) versus chronic (≥6 weeks from injury or ACL graft tear) ACL tears. It was hypothesized that the BTP in normal intact knees would increase linearly with the PTS and there would be an increased SSD in ATT when comparing ACL-injured and ACL-intact knees.Case-control study; Level of evidence, 3.Bilateral ACL stress radiographs were assessed from patients with primary ACL and ACL graft tears between March 2023 and March 2024. Bilateral stress views were obtained by single-leg full-length lateral weightbearing radiograph in 20° of knee flexion. The BTP and ATT were measured using a perpendicular line drawn between the posterior position of the lateral femoral condyle and the lateral tibial plateau. PTS measurements were assessed by the anatomic tibial axis. Statistical analysis using linear regression—r > 0.6 was considered strong, r between 0.4 and 0.6 moderate, and r < 0.4 weak—and t tests were used to compare the PTS with BTP and SSD in ATT.A total of 72 patients were analyzed using ACL stress radiographs. The results found a significant positive correlation between increased PTS and increased BTP for the ACL-intact knees (P < .001; r = 0.476). A significant increase was found in the SSD in ATT of 1.73 mm with a positive correlation between increased PTS and increased SSD in ATT of ACL-deficient knees (P < .001; r = 0.397). A subgroup analysis reported significant increases in SSD in ATT for both ACL-injured knees with a PTS ≥12° (P = .008) and for chronic ACL tears (P < .001) and no significant differences in SSD in ATT for ACL-injured knees with a PTS of <12° (P = .650) and for acute ACL tears (P = .745).This study found a significant positive correlation between PTS and the BTP in ACL-intact knees and for the SSD in ATT between ACL-injured and ACL-intact knees. Moreover, the SSD in ATT was significantly increased for ACL-injured knees with a PTS of ≥12° and for chronic ACL tears. No significant difference in SSD in ATT was found for ACL-injured knees with a PTS of <12° and for acute ACL tears. [ABSTRACT FROM AUTHOR]

While allografts are commonly used for anterior cruciate ligament reconstruction (ACLR), evidence to guide specific allograft selection is lacking.To compare clinical and graft failure rates after ACLR using soft tissue–only allografts and bone–soft tissue allografts in adults.Systematic review and meta-analysis; Level of evidence, 4.English-language studies with clinical outcome data on primary and revision ACLR in adults with nonirradiated soft tissue–only and bone–soft tissue grafts were identified in the search. Data extracted included allograft type, patient characteristics, follow-up time, and failure rates. The cumulative failure rate was defined as International Knee Documentation Committee grade C/D, graft retear, grade ≥2+ Lachman, grade ≥2+ pivot shift, and/or side-to-side KT-1000 laxity of >5 mm. The graft rupture rate was defined solely by the proportion of patients who had a graft rupture. Meta-analyses using the inverse variance method were used to estimate the pooled rates with 95% CIs. Subgroup analysis was conducted to compare allograft types and determine whether age, sex, and follow-up time influenced the estimates.A total of 14 studies met the inclusion criteria: 7 investigated bone–soft tissue allografts, 6 investigated soft tissue–only allografts, and 1 investigated both. The comparative study showed a difference in the cumulative failure rate between bone–patellar tendon–bone and soft tissue–only allografts. The pooled cumulative failure rates for bone–soft tissue and soft tissue–only allografts were 11% (95% CI, 7-17) and 20% (95% CI, 14-29), respectively (P = .05). The pooled graft rupture rates for bone–soft tissue and soft tissue–only allografts were 6% (95% CI, 4-9) and 13% (95% CI, 7-23), respectively (P = .07).The meta-analysis results showed that bone–soft tissue allografts have lower cumulative failure rates than soft tissue–only allografts. Bone–soft tissue allografts may be the preferred allograft choices for ACLR. [ABSTRACT FROM AUTHOR]

Collagen XI is ubiquitous in tissues such as joint cartilage, cancellous bone, muscles, and tendons and is an important contributor during a crucial part in fibrillogenesis. The COL11A1 gene encodes one of three alpha chains of collagen XI. The present study elucidates the role of collagen XI in the establishment of mechanical properties of tendons and ligaments. We investigated the mechanical response of three tendons and one ligament tissues from wild type and a targeted mouse model null for collagen XI: Achilles tendon (ACH), the flexor digitorum longus tendon (FDL), the supraspinatus tendon (SST), and the anterior cruciate ligament (ACL). Area was substantially lower in Col11a1ΔTen/ΔTen ACH, FDL, and SST. Maximum load and maximum stress were significantly lower in Col11a1ΔTen/ΔTen ACH and FDL. Stiffness was lower in Col11a1ΔTen/ΔTen ACH, FDL, and SST. Modulus was reduced in Col11a1ΔTen/ΔTen FDL and SST (both insertion site and midsubstance). Collagen fiber distributions were more aligned under load in both wild type group and Col11a1ΔTen/ΔTen groups. Results also revealed that the effect of collagen XI knockout on collagen fiber realignment is tendon-dependent and location-dependent (insertion versus midsubstance). In summary, this study clearly shows that the regulatory role of collagen XI on tendon and ligament is tissue specific and that joint hypermobility in type II Stickler's Syndrome may in part be due to suboptimal mechanical response of the soft tissues surrounding joints. [ABSTRACT FROM AUTHOR]

Background: Patellar luxation is one of the common diseases in small breed dogs, especially Pomeranian dogs. This disease causes pain and lameness of hind-limbs the affected animal. Accurate diagnosis of this disease is of great importance in order to effectively intervene in it. Radiography is one of the simple yet accurate tools that help for evaluating and grading of this disease. The purpose of this study was to identify the size of the Quadriceps Angle (Q angle) and Femoral Varus Angle (FVA) in Pomeranian dogs with different grades of Medial Patellar Luxation (MPL). Materials and Methods: This study was conducted on Pomeranian dogs, whose MPL was clinically confirmed, and Putnam (1968) classification was used in its conduct. Each MPL, grade 1, grade 2, grade 3 and grade 4, 4 hind-limb from 11 Pomeranian dog were considered and two angles Q and FVA were measured in them. The Q angle is the result of the intersection of two lines, one of which connects the center of the patella bone to the tibial tuberosity and the other line that connects the anterior cruciate ligament to the center of the patella bone (Kaiser et al., 1997). The FVA angle is also the result of the intersection of two lines, one connecting the center of the patella to the proximal center of the femur, and the other one that connecting the center of the patella to the center of the tibia (Hauptman et al., 1985). In the process of studying the angles were measured and the average of each parameter was recorded separately for samples. Results: The results of this study showed that the mean Q angle in dogs with I, II, III and IV patellar luxation is 11, 16, 22 and 36 degrees, respectively. It was also found that the difference between the mean Q angle in different grades of luxation is statistically significant. The mean of FVA angle in dogs with I, II, III and IV patellar luxation were 28, 23, 22 and 16 degrees, respectively, These means were not statistically significantly different from each other. Conclusion: According to the findings of this study, measuring the Q angle and FVA angle can be helpful in prognosis of disease and degree of progressivity of luxation situation and changing the grade of disease in patient and making an acceptable descition for conservative or surgical treatments. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to predict intraoperative graft diameter with our new method by evaluating the cross-sectional areas (CSAs) of the hamstrings in axial sections of MRI., Methods: This study included 78 patients who underwent single-bundle ACLR between 2022 and 2023. MRIs of the patients were evaulated preoperatively and four CSAs of the hamstring tendons were measured in two different regions by two participants. CSA measurements were calculated manually and the total area was measured by adding up these cross-sectional areas separately. This value was considered as the area of a single circle and the radius was calculated using the area formula of the circle (A = πr 2 ) RESULTS: For participant I, perfect agreement was found in semitendinosus measurement (κ = 0.849), moderate agreement was detected at the medial condyle level (κ = 0.520). For participant II, perfect agreement was found in the medial condyle region (κ = 0.849), substantial agreement was obtained at the joint level (0.631). In the gracilis tendon evaluation of both participants, substantial and moderate agreement was found at the joint level and at the medial condyle level, respectively. CSA of hamstring tendons measured at the joint level by both participants were found to be positively correlated with the intraoperative graft diameter (r = 0.51) (P < 0.05) CONCLUSIONS: Preoperative MRI assesment could be a effective tool for determing preliminary information about the hamstring graft diameters. Moreover, it is observed that quadruple hamstring graft sizes were more correlated with MRI measurements at the joint level than medial condyle level by using circle area formula., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: Medial meniscus ramp lesions (MMRLs), lateral meniscus posterior root tears (LMPRTs), and anterolateral complex injuries (ALCIs) are major secondary stabiliser injuries associated with anterior cruciate ligament (ACL) injuries. This study aimed to investigate the effect of the number of secondary stabiliser injuries on knee instability in ACL injuries., Methods: Patients who underwent primary ACL reconstruction between January 2017 and May 2023 were enroled in this study. Exclusion criteria encompassed patients with other ligament injuries, a history of contralateral knee injury, hyperextension, flexion contracture and meniscus injuries other than MMRL or LMPRT. Ultimately, 158 patients (mean age: 25.3 years; 81 males and 77 females) were included in this study, and the presence of MMRL, LMPRT and ALCI was investigated. Patients were categorised into four groups based on the number of ACL and secondary stabiliser injuries: single (isolated ACL injury), dual, triad and tetrad. Subsequently, the groups were compared regarding pivot shift grade, quantitative rotational instability measured using an inertial sensor, and anterior tibial translation (ATT)., Results: Secondary stabiliser injuries identified included ALCI 85 (53.8%), MMRL 58 (36.7%) and LMPRT 23 (14.6%). The distribution of patients in the single, dual, triad and tetrad groups was 45 (28.5%), 68 (43.0%), 37 (23.4%) and 8 (5.1%), respectively. High-grade pivot shifts were observed in 33.3% (15 out of 45) of the single group, 63.2% (43 out of 68) of the dual group, 67.6% (25 out of 37) of the triad group, and 100% (8 out of 8) of the tetrad group. Quantitative evaluations using the inertial sensor revealed significantly lower acceleration in the isolated ACL injury group compared to the other groups (p < 0.05). No significant difference was observed in ATT measurements (n.s.)., Conclusion: The combination of secondary stabiliser injuries led to higher instability. Therefore, it is important to carefully diagnose these injuries and devise appropriate treatment plans, particularly in cases of high knee instability., Level of Evidence: Level III diagnostic., (© 2025 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: To investigate if hip and knee alignment assessed 2 years after anterior cruciate ligament (ACL) injury is associated with compartment-specific radiographic knee osteoarthritis (OA) 3 years later., Methods: An exploratory analysis was conducted in the knee ACL, nonsurgical versus surgical treatment (KANON) trial (ISRCTN84752559); 115 subjects with acute ACL injury were assessed at the 2-year follow-up; full-limb images of the injured leg were acquired, and the neck-shaft angle (NSA) and hip-knee-ankle angle (HKA) were measured. At the 5-year follow-up, weight-bearing tibiofemoral and patellofemoral radiographs were obtained. Radiographs were graded according to the OA Research Society International Atlas and Radiographic OA was defined as approximating Kellgren & Lawrence grade 2 or worse. Analysis of covariance adjusting for sex, age, body mass index, randomization and partial meniscectomy recorded at the 2-year follow-up was performed., Results: In patients who had developed medial tibiofemoral OA at the 5-year follow-up, the NSA and the HKA at the 2-year follow-up were smaller (NSA, mean difference = -4.6° [95% confidence interval {CI} -7.9° to -1.1°]; HKA, mean difference = -2.3° [95% CI -4.2° to -0.4°]). No association was observed between the NSA or HKA at the 2-year follow-up and lateral tibiofemoral OA, nor patellofemoral OA at the 5-year follow-up., Conclusion: A smaller NSA and HKA angle of the ACL injured leg (i.e., more varus hip and varus knee alignment) 2 years after the injury was associated with medial tibiofemoral radiographic OA 3 years later., Level of Evidence: Level II exploratory post hoc analysis of an RCT., Competing Interests: The authors declare no conflicts of interest., (© 2025 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Basketball is an intense, fast-paced game that is physically, highly demanding. Certain aspects of the game, such as the quick pivoting and cutting movements, predispose the players to serious knee injuries, including anterior cruciate ligament (ACL) tears. While an ACL tear can be a devastating condition for players, multidisciplinary management of the injury can provide the players with a reasonable chance to return to play at the pre-injury level. This article aims to review the general principles and guidelines for the management of ACL injury in basketball players. The diagnosis, surgical treatment, rehabilitation and return to sports are discussed from European and North American perspectives. With a comprehensive and multidisciplinary approach to this condition, medical professionals can provide injured basketball players with a favourable prognosis for returning to play at the pre-injury level. To return to normal life and basketball after ACL reconstruction, the proposed approach includes (1) the selection of the appropriate surgical graft and technique, (2) maintaining a healthy and persistent mental state during rehabilitation, and (3) following a scientific rehabilitation programme based on personalized recovery. LEVEL OF EVIDENCE: Level V., (© 2025 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: In this study, ultrasonography was used to measure medial meniscus (MM) extrusion under weight-bearing and nonweight-bearing conditions in both anterior cruciate ligament (ACL)-deficient and ACL-intact knee groups. This study aimed to determine the possible differences between these groups with an eventual impact on meniscal tears in ACL-deficient knees., Methods: A total of 107 patients who underwent ACL reconstructive surgery between June 2022 and April 2023 were enroled. After applying exclusion criteria, 37 patients met the conditions for inclusion in the study and formed the ACL deficiency group (Group D). Of the 141 patients presenting to an outpatient clinic who agreed to have ultrasonography conducted on their nondiscomforting contralateral knee, 37 patients matched for age, sex, hip-knee-ankle angle and body mass index with Group D patients were selected for the ACL intact group (Group I). Ultrasonography was used to measure MM extrusion in weight-bearing and nonweight-bearing conditions for all participants., Results: Seventy-four patients were included in the study (n = 37 per group). The supine position showed an MM extrusion of 1.2 ± 0.7 mm in Group I and 1.2 ± 0.7 mm in Group D (not significant). In the standing position, MM extrusion measured 2.0 ± 0.6 mm in Group I and 1.3 ± 0.8 mm in Group D. The difference in extrusion (Δextrusion) between the two positions was 0.8 ± 0.6 in Group I and 0.1 ± 0.2 in Group D, with statistical significance (p < 0.01). A consistent reduction in MM extrusion during weight-bearing was observed in patients with ACL deficiency, irrespective of the duration of ACL deficiency, age, sex and BMI., Conclusion: ACL deficiency did not significantly impact MM extrusion during nonweight-bearing conditions; however, less MM extrusion was observed in response to axial loading conditions. These findings indicate altered MM biomechanics due to increased anterior-posterior meniscal motion and rotational instability after ACL injury., Level of Evidence: Level III., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: Multifaceted factors contribute to inferior outcomes following anterior cruciate ligament (ACL) reconstruction surgery. A particular focus is placed on the posterior tibial slope (PTS). This study introduces the integration of machine learning and artificial intelligence (AI) for efficient measurements of tibial slopes on magnetic resonance imaging images as a promising solution. This advancement aims to enhance risk stratification, diagnostic insights, intervention prognosis and surgical planning for ACL injuries., Methods: Images and demographic information from 120 patients who underwent ACL reconstruction surgery were used for this study. An AI-driven model was developed to measure the posterior lateral tibial slope using the YOLOv8 algorithm. The accuracy of the lateral tibial slope, medial tibial slope and tibial longitudinal axis measurements was assessed, and the results reached high levels of reliability. This study employed machine learning and AI techniques to provide objective, consistent and efficient measurements of tibial slopes on MR images., Results: Three distinct models were developed to derive AI-based measurements. The study results revealed a substantial correlation between the measurements obtained from the AI models and those obtained by the orthopaedic surgeon across three parameters: lateral tibial slope, medial tibial slope and tibial longitudinal axis. Specifically, the Pearson correlation coefficients were 0.673, 0.850 and 0.839, respectively. The Spearman rank correlation coefficients were 0.736, 0.861 and 0.738, respectively. Additionally, the interclass correlation coefficients were 0.63, 0.84 and 0.84, respectively., Conclusion: This study establishes that the deep learning-based method for measuring posterior tibial slopes strongly correlates with the evaluations of expert orthopaedic surgeons. The time efficiency and consistency of this technique suggest its utility in clinical practice, promising to enhance workflow, risk assessment and the customization of patient treatment plans., Level of Evidence: Level III, cross-sectional diagnostic study., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)