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Context: Anterior cruciate ligament (ACL) injuries, prevalent in athletic contexts have profound physical and psychological impacts. Despite extensive research on the physiological aspects of ACL recovery, the psychological dimensions of this process have gained increased attention. This scoping review delves into the intricate landscape of psychological factors influencing ACL rehabilitation. Design: Scoping review. Methods: A literature search across multiple databases was conducted to identify relevant published studies that provide insight into the psychological aspects of ACL recovery. This search spanned various study designs, enabling a nuanced understanding of the psychological intricacies surrounding ACL recovery. Overall, a total of 1830 unique articles were screened, of which 66 were included in this review. Our findings are further contextualized through alignment with insights from prior reviews on similar themes. Through a comprehensive analysis of diverse literature, we explore 3 key themes: psychological challenges, current rehabilitation programs, and the integration of psychological support. Results: Psychological challenges emerged as a pervasive aspect of ACL rehabilitation, encompassing fear, anxiety, motivation, and depression. The nuanced emotional responses, particularly the fear of reinjury, impact treatment adherence and overall well-being. Contemporary rehabilitation programs revealed inconsistencies in incorporating psychological support, emphasizing the need for standardized, multidisciplinary approaches. The alignment with prior reviews in the literature reinforced the importance of psychological traits, such as knee self-efficacy, in predicting positive outcomes. Conclusion: This scoping review provides a comprehensive overview of psychological factors within ACL rehabilitation, highlighting the importance of tailored interventions and standardized approaches. The integration of multidisciplinary expertise emerges as crucial for optimizing patient outcomes. Our findings not only contribute to a nuanced understanding of psychological nuances in ACL rehabilitation but also offer valuable implications for clinical practice and policy development. [ABSTRACT FROM AUTHOR]

Following anterior cruciate ligament reconstruction (ACLR), patients exhibit abnormal walking mechanics and quadriceps dysfunction. Quadriceps dysfunction has been largely attributed to muscle atrophy and weakness. While important, these factors do not capture intrinsic properties of muscle that govern its ability to generate force and withstand load. While fascicle abnormalities after ACLR have been documented in early stages of recovery (<12 mo), long-term effects of ACLR on fascicle mechanics remain unexplored. We evaluated quadriceps fascicle mechanics during walking 3 years post-ACLR and examined the relationship with knee mechanics. Participants included 24 individuals with ACLR and 24 Controls. Linear mixed models compared the ACLR, Contralateral, and Controls limbs for (1) quadriceps strength, (2) fascicle architecture and mechanics, and (3) knee mechanics. No difference in strength or overall fascicle length excursions was found between limbs. The ACLR limb exhibited longer fascicles at heel strike and peak knee extension moment (P <.001–.004), and smaller fascicle angles at heel strike, peak knee extension moment, and overall suppressed fascicle angle excursions (P <.001–.049) relative to the Contralateral and/or Control limb. This indicates an abnormality in fascicle architecture and mechanics following ACLR and suggests abnormalities in contractile function that cannot be explained by muscle weakness and may contribute to long-term gait irregularities. [ABSTRACT FROM AUTHOR]

Context: The persistence and the recurrence of posterior medial knee pain (PKP) after anterior cruciate ligament reconstruction (ACLR) using hamstring tendon graft are often overlooked during rehabilitation. Design: Cross-sectional observational study. Methods: The study aimed (1) to evaluate the prevalence of these types of PKP before 4 months post-ACLR, (2) to measure their consequences on the knee flexors strength, and (3) to evaluate the role of the type of ACLR. From a cohort of patients operated on with hamstring tendon procedures, the persistent and the recurrent PKP were sought at 4 months post-ACLR. The evolution of isokinetic muscle strength recovery in PKP subjects was compared with those of nonpainful subjects. The functional deficit was measured at 6/7 months post-ACLR by a hop test. Results: Three hundred seventeen subjects (25.8 [6.0] y) were included. At 4 months post-ACLR, 2 populations were identified based on the recurrent onset of PKP (PKP+, n = 40) or the absence of knee pain (PKP−, n = 277). The prevalence of PKP was 8.3%. At the fourth month post-ACLR, the PKP+ group had a higher flexor strength deficit compared with the PKP− group (limb symmetry index at 60°/s: 67.2% [12.4%] vs 84.3% [12.6%]; P <.05). At 6/7 months, the loss of strength persisted (limb symmetry index at 60°/s: 82.3% [13.4%] vs 87.7% [12.8%]; P <.05). The hop test deficit was comparable, and no difference was shown according to the type of graft. Conclusions: Persistent and recurrent PKP during the rehabilitation period were not uncommon and were associated with a worsening of flexors strength loss on the ACLR side. [ABSTRACT FROM AUTHOR]

Purpose: To determine between-limbs differences in isometric rate of force development (RFD) measured during open- (OKC) and closed-kinetic-chain (CKC) strength testing and establish which method had the strongest relationship to single-leg vertical-jump performance and knee mechanics after anterior cruciate ligament (ACL) reconstruction. Methods: Subjects (n = 19) 1 to 5 years from ACL reconstruction performed isometric knee extensions (OKC), unilateral isometric midthigh pulls (CKC), and single-leg vertical jumps on the ACL-involved and -noninvolved limbs. Between-limbs differences were assessed using paired t tests, and the relationship between RFD, jump performance, and knee mechanics was assessed using correlation coefficients (r; P ≤.05). Results: There were significant between-limbs differences in OKC RFD (P =.008, d = −0.69) but not CKC RFD. OKC RFD in the ACL-involved limb had a strong association with jump height (r =.64, P =.003), knee-joint power (r =.72, P <.001), and peak knee-flexion angle (r =.72, P =.001). CKC RFD in the ACL-involved limb had a strong association with jump height (r =.65, P =.004) and knee-joint power (r =.67, P =.002) but not peak knee-flexion angle (r =.40, P =.09). Conclusions: While both OKC and CKC RFD were strongly related to jump performance and knee-joint power, OKC RFD was able to detect between-limbs RFD asymmetries and was strongly related to knee-joint kinematics. These findings indicate that isometric knee extension may be optimal for assessing RFD after ACL reconstruction. [ABSTRACT FROM AUTHOR]

Objective: The primary aim of this study was to investigate the immediate and delayed effects of kinesiotape (KT) on postural control and patient-reported outcome measures under challenging conditions in individuals with anterior cruciate ligament reconstructions. Methods: Thirty-two anterior cruciate ligament-reconstructed patients for whom 6 months had passed since their operation were randomly assigned to either the KT (n = 16, aged 21.8 [5.5] y) or the placebo KT (n = 16, aged 24.0 [5.1] y) groups. Initially, both groups stood barefoot on a force platform while performing postural tasks in 4 randomized conditions (eyes open, eyes closed, cognitive task, and foam). Before the experiment, patients would bring the 4 conditions, which were written on folded papers, one by one, and in this way, the order of conditions for the examiners was determined. The patients' evaluations were conducted immediately and 48 hours after KT application. Postural control measures, with area and displacement of the center of pressure (CoP) in anterior--posterior and medial--lateral directions, and mean total velocity displacement of CoP (MVELO CoP) served as dependent variables. In addition, the International Knee Documentation Committee score was measured pretreatment and 48 hours posttreatment. Results: Significant group-by-time interactions were observed for displacement of COP in medial--lateral direction (P = .002) and MVELO CoP (P = .034). MVELO CoP significantly decreased (mean difference = 0.60, P = .009) immediately after KT application compared with preapplication measures. In the placebo group, a statistically significant decrease in MVELO CoP (mean difference = 0.869, P = .001) was observed at 48 hours post-KT compared with preapplication values. International Knee Documentation Committee scores significantly improved at 48 hours post-KT application in both groups (P < .05). Conclusions: Though observed at different time points, both KT (immediately after the intervention) and placebo KT (48 h after the intervention) were found to improve postural control measures. It appears that the changes in postural control may be more related to proprioceptive enhancement due to KT rather than the specific KT pattern. [ABSTRACT FROM AUTHOR]

Context: Injury-related fear and quadriceps strength are independently associated with secondary anterior cruciate ligament (ACL) injury risk. It is not known whether injury-related fear and quadriceps strength are associated, despite their individual predictive capabilities of secondary ACL injury. The purpose of this study was to examine the association between injury-related fear and quadriceps strength in individuals at least 1 year after ACL reconstruction (ACLR). Design: Cross-sectional study. Methods: Forty participants between the ages of 18 and 35 years at least 1 year post unilateral primary ACLR. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) and a standard isokinetic quadriceps strength assessment using the Biodex Isokinetic Dynamometer. Pearson Product-Moment correlations were used to examine the linear association between the TSK-11 scores and peak torque (in nanometers per kilogram) for each limb and between the TSK-11 scores and limb symmetry indices for each limb. Pearson Product-Moment correlation coefficients (r) were interpreted as very high (.90--1.00), high (.70--.90), moderate (.50--.70), low (.30--.50), and no correlation (.00--.30). Results: The average TSK-11 score was 18.2 (5.3), average ACLR peak quadriceps torque was 1.9 (0.50) N·m/kg, average contralateral peak quadriceps torque was 2.3 (0.48) N·m/kg, and average limb symmetry index was 85.3% (12.6%). There was no statistically significant correlation between the TSK-11 and peak quadriceps torque on the ACLR limb (r = .12, P = .46), the TSK-11 and contralateral limb (r = .29, P = .07), or the TSK-11 and limb symmetry index (r = -.18, P = .27). Conclusions: There was no association between kinesiophobia and peak isokinetic quadriceps strength in individuals at least 1 year post-ACLR. Both factors, independently, have been shown to influence risk of secondary injury in patients after ACLR. [ABSTRACT FROM AUTHOR]

Context: A reduced knee extensor moment (KEM) in the involved limb and asymmetry in the KEM during landing tasks are observed after anterior cruciate ligament reconstruction (ACLR). There is limited information about the association of kinetic and kinematic parameters with the KEM during landing after ACLR. This study investigated the association of the anterior--posterior center of pressure (AP-COP) position, vertical ground reaction force (VGRF), and lower limb joint angles with the KEM during landing in female athletes following ACLR. Design: Cross-sectional study. Methods: Twenty-two female athletes who underwent ACLR performed a drop vertical jump at 7.9 (1.7) months after surgery. We evaluated the KEM, AP-COP position, VGRF, and sagittal plane hip, knee, and ankle angles using a 3-dimensional motion analysis system with force plates. Results: The peak KEM in the involved limb was significantly smaller than that in the uninvolved limb during landing (1.43 [0.33] N·m/kg/m vs 1.84 [0.41] Nm/kg/m, P = .001). The VGRF in the involved limb was significantly smaller than that in the uninvolved limb (11.9 [2.3] N/kg vs 14.6 [3.5] N/kg, P = .005). The limb symmetry index of the KEM was predicted by that of the VGRF (P < .001, R² = .621, β = 0.800). The KEM was predicted by the AP-COP position in the involved limb (P = .015, R² = .227, β = 0.513) and by the VGRF in the uninvolved limb (P = .018, R² = .213, β = 0.500). No significant correlation was noted between the KEM and the lower limb joint angles. Conclusions: The AP-COP position and VGRF were associated with the KEM during landing. Evaluating the VGRF and AP-COP position, not the lower limb joint angles, may contribute to understanding the KEM during double-leg landing after ACLR in the clinical setting. [ABSTRACT FROM AUTHOR]

Context: Decreased trunk neuromuscular control is a risk factor for both upper- and lower-extremity injuries, yet there are few reliable and valid clinical tests to identify deficits. Objective: The purpose of this study was to determine the reliability and known-groups validity of a novel clinical test, the seated trunk control test (STCT). Design: Cross-sectional reliability and known-groups validity study. Setting: Laboratory. Participants: 89 unique participants: 34 were 3 months postoperative anterior cruciate ligament reconstruction (ACLR) and 55 healthy controls. Methods: For the STCT, participants sat on a balance board with their eyes closed for three 30-second trials while investigators counted balance errors. Intraclass correlations (ICCs) were used to assess interrater reliability (N = 20) and test–retest reliability (N = 40). To assess known-groups validity, independent t tests were used to compare STCT errors at 3 months post-ACLR with healthy matched controls (N = 34/group). Area under a receiver operating characteristic curve identified an optimal cutoff for distinguishing between groups. Results: The STCT had perfect interrater reliability (ICC2,3 = 1.00) and good test–retest reliability (ICC3,3 =.79; 95% confidence interval =.61–.89). The ACLR group made significantly more errors on the STCT (mean [SD] = 15.5 [5.4]) than controls (mean [SD] = 8.2 [4.1]; P <.001, Cohen d = 1.52). The STCT's ability to distinguish between groups was excellent (area under a ROC curve = 0.86). A cutoff of 12 errors maximized sensitivity (76%) and specificity (85%). Conclusions: The STCT is reliable between raters and across days. It also has excellent ability to distinguish between individuals with a recent ACLR and healthy matched controls, which provides initial evidence to suggest that the STCT may be clinically useful for identifying deficits in trunk neuromuscular control. [ABSTRACT FROM AUTHOR]

Context: Among many unanticipated changes, access to rehabilitation was disrupted during the onset of the COVID-19 pandemic. It is unclear how the timing of late-stage rehabilitation following anterior cruciate ligament with surgical reconstruction (ACLR) during the initial months of the pandemic affected outcomes. The purpose of this study was to compare physical performance outcome measures in patients following ACLR prior to and following COVID-19-related restrictions. Design: Retrospective cohort study. Methods: Data from patients who underwent return-to-sport testing following ACLR were analyzed based on date. December 2018 through March of 2020 (n = 66) was defined as the baseline period, and June through October 2020 (n = 27) was defined as the surveillance period. Outcome measures included single leg hop, triple hop, single leg vertical jump, and the lower-extremity functional test (LEFT). Linear mixed models were used to compare outcome measures before and after the onset of pandemic-related restrictions, clustered by sex and sport. A 1-way analysis of variance was performed to analyze the association between the number of virtual rehabilitation visits and outcome measures for subjects in the surveillance period. Results: Subjects in the surveillance period performed significantly worse in the LEFT (+7.88 s; 95% confidence interval, 1.11 to 14.66; P =.02) and single leg vertical jump on the unaffected side (−4.32 cm; 95% confidence interval, −7.44 to −1.19, P <.01), and performed better with single leg vertical jump symmetry (+6.3%; 95% confidence interval, 1.0% to 11.5%; P =.02). There were no other statistically significant differences. There was no significant association between having virtual rehabilitation visits and any of the performance outcomes. Conclusions: There was a decline in physical performance outcome measures in patients following ACLR who did not attend regular in-person physical therapy sessions in the late-stage rehabilitation due to COVID-19-related restrictions. Other factors during this unique time period, such as access to training facilities or psychosocial stressors, may have also influenced outcomes. [ABSTRACT FROM AUTHOR]

Context: With the high prevalence of anterior cruciate ligament rupture among young and active individuals, rehabilitation after the injury and surgery should meet the current evidence-based recommendations to restore knee function and reduce the risk of further injury. This study aimed to investigate the current rehabilitation practices and return to sports (RTS) criteria after anterior cruciate ligament reconstruction (ACLR) among physical therapists in Saudi Arabia. Design: Online cross-sectional survey-based study. Methods: A total of 177 physical therapists in Saudi Arabia participated in this survey. The survey included questions about the preferred postoperative timing and frequency of rehabilitation, current views on the importance of preoperative and postoperative rehabilitation to the overall outcomes, the timeframe of RTS, and the decision-making process to RTS. Results: Most therapists (96.6%) believed preoperative rehabilitation was essential/important to postoperative outcomes. Two-thirds encouraged patients to start rehabilitation program within 1 to 4 days immediately post-ACLR. RTS was permitted 6 to 9 months post-ACLR by 60% of therapists if satisfied with patient progress and capacity. Factors considered before RTS included knee strength (72.9%), functional capacity (86.4%), lower limb and trunk mechanics (62.7%), and psychological readiness (42.2%). Knee strength was assessed by manual muscle testing (39%), handheld dynamometry (15.3%), and isokinetic dynamometer (13.6%). While 60% of the therapists used single-limbed hop for distance for evaluating functional capacity, only 27.1% used a hop test battery. Conclusions: The surveyed physical therapists in Saudi Arabia demonstrated variations in the current rehabilitation practices and RTS criteria post-ACLR. Over half of the surveyed therapists considered preoperative rehabilitation essential to postoperative outcomes. However, the therapists should update their perspective with current evidence-based practice regarding the RTS timeframe, psychological readiness assessment for RTS, and knee strength evaluation using objective measurements. [ABSTRACT FROM AUTHOR]

Objective: To rate athletes' functional ability and return to sport (RTS) success at the end of their individual, formal, medically prescribed rehabilitation after anterior anterior cruciate ligament (ACL) reconstruction. Methods: In our prospective multicenter cohort study, 88 (42 females) adults aged 18-35 years after acute unilateral ACL rupture and subsequent hamstring grafting were included. All patients were prospectively monitored during their rehabilitation and RTS process until the end of their formal rehabilitation and RTS release. As outcome measures, functional hop and jump tests (front hop, balance hops, and drop jump screening test) and self-report outcomes (Knee Injury and Osteoarthritis Outcome Score, ACL-RTS after injury) were assessed. Literature-based cut-off values were selected to rate each performance as fulfilled or not. Results: At 7.5 months (SD 2.3 months) after surgery, the percentage of participants meeting the functional thresholds ranged from 4% (Knee Injury and Osteoarthritis Outcome Score SPORT) and over 44% (ACL-RTS after injury sum score) to 59% (Knee Injury and Osteoarthritis Outcome Score activities of all daily living) in the self-report and from 29% (Balance side hop) to 69% (normalized knee separation distance) in performance testing. Only 4% fulfilled all the cut-offs, while 45% returned to the same type and level of sport. Participants who successfully returned to their previous sport (type and level) were more likely to be "over-cut-off-performers." Conclusions: The low share of the athletes who fulfilled the functional RTS criteria highlights the importance of continuing the rehabilitation measures after the formal completion to assess the need for and success of, inter alia, secondary-preventive therapies. [ABSTRACT FROM AUTHOR]

Context: The purpose of this study was to compare short-term clinical outcomes between meniscus procedures performed with anterior cruciate ligament reconstruction (ACLR), ACLR (ACLR-only), ACLR with meniscectomy/resection (ACLR-resect), and ACLR with meniscal repair (ACLR-repair) for bone patellar tendon bone grafts (BPTB) and hamstring tendon grafts, separately. Design: This was a cross-sectional study conducted in a controlled laboratory setting as part of a large point-of-care collaborative research program. Methods: This study included 314 participants (168 females; mean [SD]: age, 19.7 [4.8]) with primary unilateral ACLR with a BPTB or hamstring tendon. Patients were divided into 3 groups depending on meniscal procedure (ACLR-only, ACLR-resect, and ACLR-repair). Postsurgical testing included: isokinetic assessment of knee extension and flexion, single-leg hop tests, and patient-reported outcomes. Multivariate analysis of covariance compared differences between meniscal procedures on the battery of tests, and for each statistically significant variable an analysis of covariance assessed the effect of meniscal procedure within each graft type. Chi-square analysis assessed the influence of meniscal procedure on tests' pass rates defined as 90% of limb symmetry index. Results: BPTB: ACLR-only had greater hamstring strength than ACLR-resect (P = .05) and ACLR-repair (P = .005). ACLR-only had the highest proportion of participants to pass the hamstring strength test (P=.02). amstring tendon: ACLR-only (P=.03) and ACLR-resect (P=.003) had higher International Knee Documentation Committee scale scores than ACLR-repair. There was a significant difference in the proportion of participants who scored >90% limb symmetry index on the timed hop test (P = .05). Conclusions: The influence of meniscal repair on clinical outcomes is dependent on the graft choice. Following an ACLR with BPTB and a meniscal procedure, hamstring function should be more closely monitored for optimal short-term recovery. [ABSTRACT FROM AUTHOR]

Context: The long duration and high cost of anterior cruciate ligament reconstruction (ACLR) rehabilitation can pose barriers to completing rehabilitation, the latter stages of which progress to demanding sport-specific exercises critical for a safe return to sport. A staged approach shifting in-person physiotherapy sessions to later months of recovery may ensure patients undergo the sport-specific portion of ACLR rehabilitation. Design/Objective: To compare postoperative outcomes of knee function in patients participating in a staged ACLR physiotherapy program to patients participating in usual care physiotherapy through a randomized controlled trial. Methods: One hundred sixty-two patients were randomized to participate in staged (n = 80) or usual care physiotherapy (n = 82) following ACLR and assessed preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months. The staged group completed the ACLR rehabilitation protocol at home for the first 3 months, followed by usual care in- person sessions. The usual care group completed in-person sessions for their entire rehabilitation. Outcome measures included the Lower Extremity Functional Scale, International Knee Documentation Committee Questionnaire, pain, range of motion, strength, and hop testing. Results: There were no statistically significant between-group differences in measures of knee function at 6 months postoperative. Patients in the usual care group reported significantly higher International Knee Documentation Committee scores at 3 months postoperative (mean difference = 5.8; 95% confidence interval, 1.3 to 10.4; P = .01). Conclusion: A staged approach to ACLR rehabilitation does not appear to impede knee function at 6 months postoperative but may result in worse patient reported outcomes at early follow-ups. [ABSTRACT FROM AUTHOR]

Purpose: After anterior cruciate ligament reconstruction (ACL-R), knee muscle strength symmetry is used as part of the return-to-sport criteria. However, little is known about the changes in the force–velocity (F–V) relationship, which could affect athletic performance. This study investigated the F–V relationship of knee muscles at 4 and 8 months after ACL-R, using the 2-point method tested by isokinetic dynamometry. Methods: A total of 103 physically trained individuals (24.6 [9.3] y, 59.2% male) who underwent primary ACL-R were included. Demographic information and surgery characteristics were collected at 6 weeks postoperatively. Isokinetic knee flexors' and extensors' peak torques were measured at 60° and 240° per second in the concentric mode at 4 and 8 months postoperative. Peak torques and angular velocities were converted to force and linear velocity for calculating maximum isometric force (F0) and the slope of the regression line (F–V slope). Results: At 4 and 8 months postoperative, F0 was significantly lower and F–V slope was significantly less steep (less negative) on the operated leg compared with the nonoperated leg for knee extensors (P <.001) and flexors (P <.001–.002). The limb symmetry index calculated using F0 was lower than the limb symmetry indexes assessed at 60° and 240° per second, especially for knee flexors (P <.001). The use of patellar tendon grafts was associated with lower F0 and a less steep F–V slope compared with hamstring tendon grafts (P <.010). Conclusion: The isokinetic 2-point model assessing the F–V relationship provides additional and relevant insight for evaluating knee muscle strength after ACL-R. [ABSTRACT FROM AUTHOR]

The first article discusses a study on the long-term effects of a behavior change intervention called BEAT Cancer on breast cancer survivors. The intervention included counseling and exercise sessions, and participants reported improved health outcomes and quality of life. However, objective measures of physical activity did not show a difference between the intervention and control groups. The second article explores the impact of self-monitoring prompts on physical activity among young adults. The study found that daily step counts were positively associated with the frequency of self-monitoring prompts. The third article focuses on team flow among firefighters and its relationship with teamwork stressors and resources. The study found that effective communication, support, and coordination were associated with team flow, while ineffective support, leadership, and coordination were negatively associated. The fourth article examines how elite athletes reflect on sport injury narratives. The study found that athletes challenged dominant narratives and used different narrative techniques to reconceptualize time lost due to injury. The fifth article critically examines the use of SMART goals in sport and exercise psychology, finding that there is little evidence to support the effectiveness of specific goal parameters. The final article explores the role of coaches in communicating about body image among female athletes, emphasizing the need for cultural considerations in addressing body image concerns. [Extracted from the article]

Background Limitations exist with current ACLR functional testing assessments that may be mitigated by including single-leg multi-directional testing. Hypothesis/Purpose To compare Anterior Cruciate Ligament-Return to Sport after Injury Scale (ACL-RSI) scores, limb symmetry index (LSI) of the single-leg vertical jump (SLVJ), single-leg medial rotation hop (SLMRH), single-leg lateral hop (SLLH), and isokinetic quadriceps strength between participants with an ACLR and healthy controls and assess predictors of quadriceps strength asymmetry. It was hypothesized that ACL-RSI scores and LSIs for all tests would differ between ACLR and healthy control groups and within the ACLR group a strong correlation would exist between all outcome measures and quadriceps strength. Study Design Cross-Sectional Study Methods Twenty-six participants with an ACLR (median 13 months after surgery) and twenty-six matched healthy controls were recruited to participate in this study. Performance was assessed via SLVJ, SLMRH, SLLH, and isokinetic quadriceps strength. Between-group comparisons were made with independent t-tests and Mann-Whitney U test. Within the ACLR group, bivariate correlation and multivariate regression analysis were performed to assess the relationship between the outcome measures and quadriceps strength asymmetry. Results Significant between-limb differences were only identified in the ACLR group (p< 0.05): SLVJ LSI: 88.5%, SLMRH LSI: 93.6%, SLLH LSI: 92.7%, quadriceps strength LSI 80.9% - 83.9%, which were significantly lower (p <0.05) than the healthy control group. Within the ACLR group, a moderate-strong significant (p < 0.05) correlations existed with quadriceps strength and SLVJ (r=0.44-0.65), SLMRH (r =0.43-0.83), and SLLH (r=0.54-0.63); while ACL-RSI had a weak non-significant (p > 0.05) correlation with quadriceps strength (r= 0.12-0.30). Conclusion Single-leg multidirectional test LSIs were less in ACLR participants than matched healthy controls and all were directly related to quadriceps strength. Psychological readiness to return to sport was not related to quadriceps strength. [ABSTRACT FROM AUTHOR]

Arthrogenic Muscle Inhibition (AMI) is a phenomenon observed in individuals with joint injury or pathology, characterized by a reflexive inhibition of surrounding musculature, altered neuromuscular control, and compromised functional performance. After anterior cruciate ligament reconstruction (ACLR) one of the most obvious consequences of AMI is the lack of quadriceps activation and strength. Understanding the underlying mechanisms of AMI is crucial for developing effective therapeutic interventions. The surgical procedure needed to reconstruct the ACL has biochemical et physiological consequences such as inflammation, pain, and altered proprioception. These alterations contribute to the development of AMI. Therapeutic interventions aimed at addressing AMI encompass a multidimensional approach targeting pain reduction, inflammation management, proprioceptive training, and quadriceps activation. Early management focusing on pain modulation through modalities like ice, compression, and pharmacological agents help mitigate the inflammatory response and alleviate pain, thereby reducing the reflexive inhibition of quadriceps. Quadriceps activation techniques such as neuromuscular electrical stimulation (NMES) and biofeedback training aid in overcoming muscle inhibition and restoring muscle strength. NMES elicits muscle contractions through electrical stimulation, bypassing the inhibitory mechanisms associated with AMI, thus facilitating muscle activation and strength gains. Comprehensive rehabilitation programs tailored to individual needs and stage of recovery are essential for optimizing outcomes in AMI. The objective of this clinical viewpoint is to delineate the significance of adopting a multimodal approach for the effective management of AMI, emphasizing the integration of pain modulation, proprioceptive training, muscle activation techniques, and manual therapy interventions. Highlighting the critical role of early intervention and targeted rehabilitation programs, this article aims to underscore their importance in restoring optimal function and mitigating long-term complications associated with AMI. [ABSTRACT FROM AUTHOR]

Alpine skiing poses significant risks for anterior cruciate ligament (ACL) injury at both recreational and professional levels, which is compounded by high rates of re-injury. Despite the existence of return to sport (RTS) and return to snow protocols, the frequency of ACL re-injury has not been mitigated, raising doubts about protocol effectiveness. Current RTS protocols primarily focus on biomechanical and neuromuscular factors in isolation, neglecting the important perceptual-motor-cognitive changes associated with ACL injuries and the high cognitive demands of skiing. The purpose of this clinical commentary is to address the perceptual-motor-cognitive demands specific to alpine skiing, evaluate RTS testing for skiers, and propose updated standards for testing and return to snow progressions that incorporate these considerations. [ABSTRACT FROM AUTHOR]

Background: There have been emerging clinical trials investigating the efficacy of synthetic-graft-augmented autografts in anterior cruciate ligament reconstruction (ACLR) in recent years. Hamstring tendon and Ligament Augmentation and Reconstruction System (LARS) are both widely discussed graft choices for ACLR. Purpose: To compare the clinical efficacy of hamstring tendon grafts with LARS-augmented hamstring tendon grafts in ACLR. Study Design: Systematic review and meta-analysis. Method: A systematic literature search was performed in PubMed, Embase and the Cochrane Library to identify primary evidence related to the comparison of ACLR with a hamstring tendon (HT) versus a hamstring tendon with LARS (HT + LARS). Quality assessment of the included studies was conducted using Newcastle–Ottawa Scale for non-RCTs. Quantitative analysis was conducted with Reviewer Manager 5.4. The primary outcomes compared were the Lysholm scale, Tegnar activity scale, International Knee Documentation Committee (IKDC) evaluation, KT-1000-based laxity, complication/retear rate and rate of return-to-sports. The secondary outcomes were the Knee Injury and Osteoarthritis Outcomes Score (KOOS), Global Rating of Change (GRC) scale, hop tests, isokinetic knee strength tests and radiographic and arthroscopic evaluations. Results: Six cohort studies with 710 participants were included in this study. Compared with the HT group, the HT + LARS group had better Lysholm scores at the 1-year follow-up (P = 0.0007) and at the final follow-up (P = 0.04). HT + LARS group had better IKDC scores at the 1-year follow-up (P = 0.003). The HT + LARS group had a better return-to-sports rate in short term. No significant difference in complications or re-surgery was observed. The secondary results revealed superior or non-inferior outcomes in the HT + LARS group. Conclusions: As grafts for ACLR, the use of hamstring tendons with LARS augmentation, compared with the use of hamstring tendons alone, in the short term, has significantly superior overall functional results and better early sports participation and non-inferior results in other comparisons. In the long term, the use of hamstring tendon with LARS augmentation demonstrated non-inferior results in terms of functional scores, knee stability, knee strength, complications and re-tear rate, etc. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament reconstruction (ACLR) is one of the more common procedures performed worldwide and perhaps the most widely studied construct in orthopedic literature. Interference screws are reliable and frequently used for ligament reconstruction, providing rigid fixation and facilitates graft incorporation allowing for the physiologic loads of early rehabilitation. The purpose of this study was to determine the bio-integration profile and quality of soft tissue graft when using mineral fiber-reinforced screws in an ACLR interference model. Nine sheep underwent ACLR using harvested autologous tendon graft fixated with 4.75 mm screws made of continuous mineral fibers. Histopathology and imaging evaluation at 28, 52, 104, 132-weeks (W) demonstrated mesenchymal tissue ingrowth into implant wall at 28 W, which increased at 52 W and peaked at 104 W. At 132 W, implants fully replaced by newly remodeled bone. Graft cellularity was evident at 28 W and continued to increase through 132 W as the tendon ossified at sites of bone contact. Pro-healing M2-macrophages and giant cells remained infrequent, with minor increases between 52 W and 104 W, attributed to expected phagocytic response. Pro-inflammatory cells (i.e., M1-macrophages, polymorphonuclears) were absent through the entire study course. In conclusion, bio-integrative screws provide secure soft tissue fixation with replacement by bone demonstrating graft cellularization over time. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence To compare graft failure, nonrevision reoperation, complication, patient‐reported outcome measures (PROMs) and return to sports (RTS) between patients who underwent anterior cruciate ligament reconstruction (ACLR) with and without suture augmentation (SA).A systematic search was performed on PubMed, Cochrane, Embase and Web of Science databases from the inception of databases to 18 April 2024, according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Studies comparing clinical outcomes of SA‐ and standard ACLR with a minimum 2‐year follow‐up were included. Data extraction and quality appraisal were performed by two researchers independently.Eight retrospective cohort studies were included, with a total of 408 patients receiving SA‐ACLR and 443 patients receiving standard ACLR. A meta‐analysis of graft failure demonstrated a 62% relative risk reduction (RR [risk ratio], 0.38 [95% confidence interval {CI}, 0.19–0.73]; p = .004) in those receiving SA‐ACLR compared with standard ACLR. An age‐related heterogeneity in graft failure reduction was detected in the subgroup analysis, which was more pronounced in studies with mean ages of <20 years compared with ≥20 years (p = .05; I2 = 73.9%). No significant difference was observed in nonrevision reoperation or complication rates. No clinically relevant difference was observed in PROMs. SA‐ACLR was associated with a significantly higher RTS rate compared with the standard ACLR (RR, 1.12 [95% CI, 1.00–1.24]; p = .04), whereas no significant difference was observed in time to RTS.SA‐ACLR is associated with a reduced graft failure rate and increased RTS rate compared with standard ACLR without additional reoperations or complications. However, confidence in the evidence is limited by substantial heterogeneity. Future studies with a higher level of evidence are warranted to validate the benefit of SA and to determine the indication for different risk populations.Level III. [ABSTRACT FROM AUTHOR]

Individuals with anterior cruciate ligament reconstruction (ACLR) exhibit less knee kinematic variability while walking than uninjured controls, associated with deleterious changes in cartilage composition linked to an increased risk for early knee osteoarthritis (KOA). It is unknown whether less knee kinematic variability is also associated with worse knee-related patient-reported outcomes (PROs) consistent with KOA development. This study examined associations between kinematic variability during gait and PROs in individuals post-ACLR. Gait kinematics and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected from 45 participants 6-months post-ACLR (67% Females; 21.45 ± 4.56 years). Overground gait biomechanics using 3D motion capture were collected, and knee kinematics were extracted for post-processing. Sample entropy (SampEn) was used to calculate knee kinematic variability. Pearson’s product-moment correlations were conducted to determine the associations between SampEn and KOOS sub-scores. Additionally, independent samples t-tests were performed to evaluate potential differences in SampEn outcomes between individuals with and without clinically relevant symptoms (defined in the introduction). Less sagittal plane kinematic variability is associated with greater pain (r = 0.37, p = 0.01) and symptoms (r = 0.32, p = 0.03). Symptomatic participants demonstrated less sagittal plane knee kinematic variability compared to asymptomatic participants (p = 0.01). The findings suggest less variable gait patterns 6-months post-ACLR may be linked to KOA-related symptoms. [ABSTRACT FROM AUTHOR]

Background: Manipulation under anesthesia (MUA) has been recommended for refractory arthrofibrosis after anterior cruciate ligament (ACL) reconstruction. However, the effectiveness of MUA to restore normal kinematics of the arthrofibrotic knee is still unclear. The objective of this study was to evaluate tibiofemoral and patellofemoral kinematics in six degrees-of-freedom (6DOF) in patients with arthrofibrosis before and after MUA. Methods: Computed tomography and dual fluoroscopic imaging system were used to assess in vivo knee kinematics. Ten patients (6 women and 4 men; 32.6 ± 6.5y, 168.4 ± 7.8 cm, 61.8 ± 13.2 kg) were included in this study. The tibiofemoral and patellofemoral kinematics in 6DOF were collected before and one year after MUA. A simple analysis of variance was used to evaluate kinematic data of preoperative arthrofibrotic knee, postoperative arthrofibrotic knee, and the contralateral knee. Results: The patella in the postoperative arthrofibrotic knee shifted significantly more inferiorly compared to the preoperative knee at 45° (P = 0.010), 60° (P = 0.008), and 75° (P = 0.049) of flexion. The patellar flexion in the postoperative arthrofibrotic knee significantly increased at 45° (P = 0.048), 60° (P = 0.037), and 75° (P = 0.006) of flexion compared to the preoperative arthrofibrotic knee. The patellar tilt was significantly decreased at 60° (P = 0.006) and at 75° (P = 0.037) of knee flexion in the postoperative arthrofibrotic knee compared to the contralateral knee. MUA significantly increased tibial internal rotation angle in the arthrofibrotic knee at 45° (P = 0.047), at 60° (P = 0.033), and at 75° (P = 0.021) of knee flexion. Conclusions: MUA could restore normal patellar inferior shift, flexion, and tibial rotation compared to the contralateral side. However, the MUA could not restore normal patellar tilt of the arthrofibrotic knee. This indicated that improvement of patellar tilt should be emphasized in postoperative rehabilitation. Highlights: The abnormal knee kinematics has been thought to be an important factor contributing to the associated joint degeneration in patients with arthrofibrosis after ACL reconstruction. Despite the effectiveness of MUA in the ROM gains for patients with knee arthrofibrosis, the effectiveness of MUA to restore normal knee kinematics in patients with arthrofibrosis after ACL reconstruction is still unclear. The MUA could restore normal patellar inferior shift, flexion, and tibial rotation. The MUA could not restore normal patellar tilt of the arthrofibrotic knee, indicating that improvement of patellar tilt should be emphasized in postoperative rehabilitation. [ABSTRACT FROM AUTHOR]

Background: The health-care sector and particularly the surgical sector are major contributors to the exacerbation of the global climate crisis. Little is known about the carbon emissions caused by surgical procedures. Therefore, the aim of this study was to estimate the carbon footprint associated with common orthopaedic surgical procedures. Methods: Eight surgical procedures (total hip arthroplasty, total knee arthroplasty, knee arthroscopy, anterior cruciate ligament reconstruction, shoulder arthroscopy, elective foot surgery, revision hip arthroplasty, and revision knee arthroplasty) were selected for analysis. The inventory process was performed according to the Greenhouse Gas Protocol for all activity occurring in the operating room. Results: The carbon footprint (in CO2 equivalents, CO2e) ranged between 53.5 kg for knee arthroscopy and 125.9 kg for revision knee arthroplasty. Energy consumption accounted for 57.5% of all emissions, followed by other indirect emissions (38.8%) and direct emissions (3.7%). The largest single contributors were the supply chain (34.6%) and energy consumption for ventilation, heating, and air conditioning (32.7%). Conclusions: Orthopaedic surgical procedures produce considerable amounts of CO2. Reduction in and greening of energy consumption, as well as the decarbonization of the supply chain, would have the greatest impact in reducing the carbon footprint of orthopaedic surgical procedures. Clinical Relevance: Orthopaedic surgical procedures contribute to the climate crisis by emitting relevant amounts of CO2. It should therefore be imperative for all orthopaedic surgeons to endeavor to find solutions to mitigate the environmental impact of their practice. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence To assess the incidence of ramp lesions in anterior cruciate ligament (ACL) injuries and to compare preoperative knee laxity between the patients with and without ramp lesions by using an electromagnetic measurement system (EMS).Two hundred six patients who underwent primary ACL reconstruction with preoperative EMS measurements were retrospectively enrolled in the present study. The diagnoses of the ramp lesions were made by arthroscopic inspections. The patients with ramp lesions and no other meniscal lesions were allocated to ‘ramp group’, and the patients without any meniscal lesions were allocated to ‘control group’. Before ACL reconstruction under general anaesthesia, the side‐to‐side difference (SSD) in anterior tibial translation (ATT) during Lachman test (mm) and tibial acceleration (m/s2) of posterior tibial reduction during the pivot‐shift test was measured using the EMS. The SSD in tibial internal/external rotation angle (°) at 30, 60 and 90 were further measured using the EMS. The SSD in ATT using KT‐2000 was also measured. Knee laxity measurements were compared between two groups using unpaired Student's t test.Ramp lesions were observed in 30 patients (14.7%). Subsequently, 17 patients were allocated to ‘ramp group’ and 77 patients to ‘control group’, and there were no statistical differences with regard to background demographics. ATT‐SSD during Lachman test was significantly greater in ‘ramp group’ (9.1 [95% confidence interval, CI: 5.7–12.5] mm vs. 6.2 [95% CI: 5.1–7.3] mm, p = 0.037). However, SSD in ATT with KT‐2000, tibial acceleration during pivot‐shift test, and SSD in tibial rotational angles were not significantly different between the two groups.Presence of ramp lesion was associated with increased anterior knee laxity during Lachman test, suggesting ramp lesions may need to be addressed at the time of ACL reconstruction.IV. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence The purpose of this study was to compare the incidence of knee osteoarthritis (OA) between the anatomic single‐bundle (SB) and anatomic double‐bundle (DB) anterior cruciate ligament (ACL) reconstruction technique after 5‐year follow‐up (FU). Secondary objectives were to compare patient‐reported outcome measures (PROMs), clinical examination, activity level, functional tests and graft failures between the two groups.The study was a secondary analysis after 5‐year FU of a randomized controlled trial (RCT) (Clinical Trials NCT01033188). One hundred and twenty patients between 18 and 40 years were randomized to either anatomic SB or anatomic DB reconstruction. The Kellgren–Lawrence (KL) classification grade ≥2 and the Osteoarthritis Research Society International (OARSI) atlas criteria score ≥2 were used for defining OA. Additionally, PROMs were obtained and clinical examinations of the knees were performed. Finally, the number of patients experiencing graft failure in each group was recorded.Radiographic imaging was performed in 39 patients in the SB group and in 37 patients in the DB group. Four patients (10%) in the SB group and two (5%) in the DB group developed osteoarthritis according to the KL classification (p = 0.28). Five (13%) in the SB group and three (8%) in the DB group developed osteoarthritis according to the OARSI atlas criteria (p = 0.59; difference 5.0% [95% confidence interval, CI: −0.10 to 0.20]). There were no significant differences in the PROMs, clinical examinations, activity levels, or functional tests when comparing the two groups. Of initially 62 SB patients, 14 (23%) experienced graft failure compared to 4 (7%) of the 58 DB patients (p = 0.015; difference 0.016 [95% CI: 0.03–0.29]).At 5‐year FU, there were no significant differences in the incidence of OA, PROMS, or other clinical findings comparing the anatomic DB to anatomic SB ACL reconstructed patients. There were fewer graft failures among patients treated with anatomic DB ACL reconstruction.II. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence To evaluate the infection rate following anterior cruciate ligament reconstruction (ACLR) using all‐soft tissue quadriceps tendon (ASTQT) autograft.All primary ASTQT autograft ACLRs within a single surgeon's prospectively collected database from 2011 to 2021 were retrospectively reviewed. No topical antibiotics were administered and no graft‐soaking with antibiotics was performed during the study period. Patients who underwent multiligament knee reconstruction or a cartilage restoration procedure were excluded. Patients who underwent a subsequent procedure, including irrigation and debridement (I&D) of the knee joint, were included. Case‐specific data, including fluid culture analysis, antibiotics (type, route of administration and duration), time to debridement and method of debridement, were collected. Descriptive statistics were utilized to analyze demographics, incidence and possible association between the need for I&D and concomitant meniscus surgery.Out of 1053 cases (mean age: 20.2 ± 6.3, 44.6% female), four patients (0.38%) (mean age: 18.5 ± 4.0, 25% female) underwent subsequent I&D (arthroscopic I&D only [n = 1], graft harvest site I&D only [n = 1], combined graft harvest site and arthroscopic I&D [n = 1] and tibia wound and arthroscopic I&D [n = 1]). There was no significant difference with regard to demographics. No joint fluid cultures returned positive; one wound culture returned positive for Methicillin‐susceptible Staphylococcus aureus from their graft harvest site. The time to I&D ranged from 18 to 23 days. Concomitant meniscectomy or meniscal repair was not associated with requiring surgical I&D. All patients who underwent I&D were prescribed antibiotics for a minimum of 10 days and a maximum of 31 days (mean: 16.25 days). Three patients (75%) who underwent I&D ultimately returned to sport. One patient was lost to follow‐up. ACL grafts were retained in all patients.The incidence of culture‐positive septic arthritis following ASTQT autograft ACLR is 0%, while the overall need for I&D of 0.38% is low and not related to concomitant meniscal procedures or patient‐specific factors.Level IV. [ABSTRACT FROM AUTHOR]

The procedure of anterior cruciate ligament (ACL) allograft preparation can be divided into fresh-frozen method (FF-allograft) or freeze-dried method (FD-allograft). This study aims to biomechanically and histologically compare the graft to bone tunnel integration between the two allografts. In-vitro results indicated that FF-allograft and FD-allograft showed excellent biocompatibility and biomechanics, while FD-allograft showed a denser collagen fiber arrangement than FF-allograft and autograft. Then, in-vivo preformation of the FF-allograft, FD-allograft, and autograft on bone tunnel integration was evaluated via a canine ACL reconstruction model. In-vivo results indicated that no signs of infection or osteoarthritis were shown in the femur-graft-tibia complexes, but more vascularity and synovitis formed around the implanted FF-allograft. Micro-computed tomography showed that peri-graft bone in the FF-allograft group was significantly increased and remodeled compared with the FD-allograft group; Histologically, the FF-allograft group exhibited similar graft-bone tunnel healing to the FD-allograft group. Tartrate-resistant acid phosphatase (TRAP) staining showed significantly more osteoclasts presented in the FD-allograft group compared to the FF-allograft group. Meanwhile, a significantly higher failure load was shown in the FF-allograft group when compared with the FD-allograft group (P < 0.05). In conclusion, the FF-allograft integrated more firmly into the bone tunnel than the FD-allograft when used in ACL reconstruction. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence To determine the statistical fragility of randomized controlled trials (RCTs) which compare the use of quadriceps tendon (QT) autografts to either hamstring tendon (HT) or bone‐patellar tendon‐bone (BPTB) autografts in anterior cruciate ligament reconstruction (ACLR).A search was conducted across PubMed, MEDLINE and EMBASE databases for RCTs comparing QT autografts to HT or BPTB autografts in ACLR from inception to 21 April 2024. Studies that reported ≥1 statistically significant continuous outcome, statistically significant dichotomous outcome and/or nonsignificant dichotomous outcome were included for analysis. The fragility index (FI), continuous fragility index (CFI) and reverse fragility index (RFI) were calculated for significant dichotomous outcomes, significant continuous outcomes and nonsignificant dichotomous outcomes, respectively.A total of 11 RCTs comprising 716 patients were included. The mean sample size was 65.8 patients. The median FI among nine outcomes from four studies was 1.0 (interquartile range [IQR], 0.5; 95% confidence interval [CI], 0.6–1.4; range 0.5–1.5). The number of patients lost to follow‐up at the final follow‐up period was more than the study‐specific FI in three (75%) studies. The median CFI among 30 outcomes from six studies was 4.9 (IQR, 10.1, 95% CI, 3.9–8.2; range 0–18.2). The number of patients lost to follow‐up at the final follow‐up period was more than the study‐specific CFI in four (66.7%) studies. The median RFI among 10 outcomes from five studies was 5.0 (IQR, 3.5; 95% CI, 3.4–6.6; range 1.0–9.0). The number of patients lost to follow‐up at the final follow‐up period was more than the study‐specific RFI in four (80%) studies.This systematic review revealed that regardless of the metric used, RCTs comparing QT autografts to HT or BPTB autograft options in ACLR are statistically fragile. While the indices of statistical fragility evaluated in this study are important metrics of robustness to consider, their application in research and clinical practice needs to be further elucidated.Level I. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to compare the interlimb biomechanical differences in patients who had undergone anterior cruciate ligament reconstruction (ACLR) in either dominant (ACLR-D) or nondominant (ACLR-ND) limbs and healthy controls (CON) during drop vertical jump (DVJ) task. To investigate whether the dominant or nondominant limb influences the risk of re-injury in ACLR patients. Methods: Thirty-three ACLR patients were divided into ACLR-D and ACLR-ND groups according to whether the surgical limb was dominant or nondominant. Seventeen healthy individuals were selected as the CON group. Three-dimensional kinematic data, ground reaction force (GRF) data, and surface electromyographic (EMG) data from the bilateral lower limbs of all participants were collected during the DVJ task. Two-way repeated-measures ANOVAs (limb × group) were performed on the variables of interest to examine the main effects of limb (dominant vs. nondominant) and group (ACLR-D, ACLR-ND, and CON), as well as the interaction between limb and group. Results: The nonsurgical limbs of ACLR group had significantly greater knee valgus angles, knee extension and valgus moments, peak posterior GRF (PPGRF), and peak vertical GRF (PVGRF) compared to the surgical limbs. The nonsurgical limbs of ACLR-ND patients demonstrated significantly greater knee extension and valgus moments, greater PPGRF and PVGRF, and reduced muscle activity in the vastus medialis and vastus lateralis compared to the CON group. The ACLR patients had reduced muscle activity in the quadriceps of the surgical limb and the hamstrings of the bilateral limbs compared to controls. Conclusion: The nonsurgical limbs of ACLR patients may suffer an increased risk of ACL injury due to altered landing mechanics and neuromuscular control strategies compared to the surgical limbs. Additionally, limb dominance influences movement patterns and neuromuscular control during DVJ task, the nonsurgical limbs of the ACLR-ND might be at higher risk of ACL injury compared to the ACLR-D group. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to compare the interlimb biomechanical differences in patients who had undergone anterior cruciate ligament reconstruction (ACLR) in either dominant (ACLR-D) or nondominant (ACLR-ND) limbs and healthy controls (CON) during drop vertical jump (DVJ) task. To investigate whether the dominant or nondominant limb influences the risk of re-injury in ACLR patients. Methods: Thirty-three ACLR patients were divided into ACLR-D and ACLR-ND groups according to whether the surgical limb was dominant or nondominant. Seventeen healthy individuals were selected as the CON group. Threedimensional kinematic data, ground reaction force (GRF) data, and surface electromyographic (EMG) data from the bilateral lower limbs of all participants were collected during the DVJ task. Two-way repeated-measures ANOVAs (limb × group) were performed on the variables of interest to examine the main effects of limb (dominant vs. nondominant) and group (ACLR-D, ACLR-ND, and CON), as well as the interaction between limb and group. Results: The nonsurgical limbs of ACLR group had significantly greater knee valgus angles, knee extension and valgus moments, peak posterior GRF (PPGRF), and peak vertical GRF (PVGRF) compared to the surgical limbs. The nonsurgical limbs of ACLR-ND patients demonstrated significantly greater knee extension and valgus moments, greater PPGRF and PVGRF, and reduced muscle activity in the vastus medialis and vastus lateralis compared to the CON group. The ACLR patients had reduced muscle activity in the quadriceps of the surgical limb and the hamstrings of the bilateral limbs compared to controls. Conclusion: The nonsurgical limbs of ACLR patients may suffer an increased risk of ACL injury due to altered landing mechanics and neuromuscular control strategies compared to the surgical limbs. Additionally, limb dominance influences movement patterns and neuromuscular control during DVJ task, the nonsurgical limbs of the ACLR-ND might be at higher risk of ACL injury compared to the ACLR-D group. [ABSTRACT FROM AUTHOR]

Background: Considering the low rate of qualitative studies on athletes with anterior cruciate ligament reconstruction (ACLR), aiming to access in-depth data, we thought that the utilization of the qualitative method would allow us to collect the appropriate and sufficient data to yield novel findings and achieve sound conclusions. The study's aim was to investigate anterior cruciate ligament (ACL) injury experience processes in athletes who had undergone isolated ACLR, reveal the clinically related milestones, and highlight the necessary gaps. Methods: Semi-structured interview techniques, in-depth follow-up questions, and thematic analysis were used to explore the experiences of participants with isolated ACL injuries 1–3 years after surgical treatment. The study was conducted in the Orthopaedics and Traumatology outpatient clinic of the Adana City Training and Research Hospital and included 14 male athletes who had undergone isolated primary ACLR. The study group's demographic and qualitative data were collected in the first week of September 2023. The member checking process was completed in the third following week. A thematic analysis checklist was used to ensure the reliability of the thematic analysis. The Consolidated Criteria for Reporting of Qualitative Research (COREQ) guidelines were followed. Results: The experiences of 14 patients (22.78 ± 3.76 years, all males) were summarized into four themes that emerged from the data analysis process: 'The Distinctions in the Participants' Experiences Regarding the Moment of Injury,' 'Gathering Information about the ACL Injury,' 'Factors That Facilitate The Treatment Process and Reinforce Positive Experiences,' and 'Desperate Plight: Main Points of Patients' Negative Experiences.' Based on the main themes, there were 14 subthemes. Conclusions: Our study revealed that varying perceptions of ACL injury presented by the participants, which were caused by all stakeholders, including themselves, the professional environment, family members, social network, and the healthcare staff, showed that the physical and psychological impacts of the injury were observed in different severity levels at each stage of the process. We believe that an extensive guide for athletes with ACL injuries that includes all components of well-being and displays the required details for the sports club/coach, family/companion, and physician. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) injury is a common sports injury, and ACL reconstruction is an effective surgery for this trauma. Most cases gain good recovery after surgery, while some patients may experience knee stiffness, which is characterized by joint fibrosis, leading to reduced joint mobility, pain, and dysfunction. Currently, various research studies have been conducted to unveil the mechanisms underlying this condition, identifying pre-, intra-, and post-operative risk factors, and testify the efficacy of different therapeutic methods against it. In this review, we summarize the current progress regarding the advancements in knee fibrosis after ACL reconstruction. The risk factors associated with knee fibrosis are systematically delineated, accompanied by an evaluation of the efficacy of various treatment modalities for both the prevention and mitigation of fibrosis. Furthermore, recommendations for future research directions are proposed, offering a foundational basis for subsequent investigations. [ABSTRACT FROM AUTHOR]

Objectives: Rupture of the anterior cruciate ligament (ACL) is a severe injury common in sports. It also has a high rate of re-injury. The aim of this work was to assess hamstring muscle fatigue in active football players after ACL reconstruction who were cleared to play and to determine symmetry between the lateral and medial hamstring muscles. Methods: In professional football players post ACL reconstruction (n = 25) and non-injured players (n = 26), the bioelectrical activity of the medial (biceps femoris—BF) and lateral (semimembranosus and semitendinosus—SEM) hamstring muscles was measured during 60 s of isometric contraction. The fatigue variables were calculated using the Continuous Wavelet Transform (CWT) tool. Results: The football players following ACL reconstruction demonstrated significant asymmetry in fatigue of the lateral and medial hamstring muscles, with greater fatigue in the SEM compared to the BF muscle. Moreover, in those after reconstruction, the changes are more pronounced, with higher muscle fatigue in both limbs (they have lower MDF than non-injured players) and more severe SEM muscle insufficiency (noted in both limbs but with greater intensity in the non-operated one). Conclusions: The higher SEM muscle fatigue observed in this study influenced the lateral-to-medial activation ratio within the hamstring muscle, which may be a probable cause of this muscle's insufficiency in laterally stabilizing the knee in the frontal and transverse plane. Furthermore, the hamstring muscles after reconstruction were more fatigued in both limbs, which may be another risk factor for ACL graft rupture. Therefore, increased fatigue in specific hamstring muscles may indicate the direction in which knee stabilization is compromised due to ACL overload. A muscle that becomes fatigued and inefficient more quickly also becomes ineffective in performing its function sooner, which can lead to increased overloading forces acting on the ACL graft. [ABSTRACT FROM AUTHOR]

Background/Objectives: The Achilles tendon is a popular allograft option for anterior cruciate ligament (ACL) reconstruction. Structurally, the tendon is known to have a 90-degree rotational fiber track. Preparation techniques, with this consideration, may influence the strength of the graft. This study aims to assess the tensile strength of a novel Achilles tendon allograft harvest procedure following the rotational fiber track. Methods: Both Achilles tendons were harvested from formalin-embalmed cadavers [(n = 20), male n = 13, female n = 7, average age = 70]. Ten cadavers had the right Achilles as the control and the left Achilles as the fiber track sample; 10 cadavers had the opposing designation. Tensile strength was tested utilizing a Bose machine. An unpaired t-test was used to compare data across groups. Results: The average ultimate load for the control group was 874.17 N, with an average elastic stiffness of 76.01 N/mm. The ultimate load for the fiber track group was 807.84 N, with an average elastic stiffness of 64.75 N/mm. No statistically significant difference (p = 0.21) was determined between the average ultimate loads or elastic loads (p = 0.18) across groups. Conclusions: These data suggest that the rotational fiber track method of Achilles allograft has consistent tensile strength and elastic stiffness as compared to the common harvest procedure. The rotational fiber track method for ACL harvesting is a viable alternative option to the common harvest procedure for usage in an ACL reconstruction. [ABSTRACT FROM AUTHOR]

Background/Objectives: The optimal graft, particularly in combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries, remains controversial. We evaluated the influence of graft choice between bone-patellar tendon-bone (BPTB) and hamstring autografts on clinical outcomes in combined ACL and MCL injuries. Methods: This retrospective analysis included patients with concurrent ACL and MCL injuries who underwent single-bundle ACL reconstruction with BPTB (group B) or hamstring (group H) grafts, between 2010 and 2019, with a ≥2-year follow-up. Patients were classified based on the MCL injury grade (I, II, or III). Clinical outcomes were assessed through knee stability evaluations using valgus stress radiographs and the KT-2000 arthrometer, patient-reported outcomes using the International Knee Documentation Committee (IKDC) subjective score and Lysholm score, and radiologic outcomes using the IKDC radiographic grade. Results: The study included 169 patients (group B, 92; group H, 77). No significant between-group differences in knee stability or functional outcomes were found after follow-up. Within the same MCL injury grade, particularly in high-grade MCL injuries, BPTB grafts resulted in significantly better medial stability (side-to-side difference in medial joint opening on valgus stress radiographs: grade II, p = 0.006; grade III, p = 0.039) and functional outcomes (IKDC subjective score: grade II, p = 0.045; grade III, p = 0.038) than hamstring grafts. In the hamstring group, higher-grade MCL injuries were associated with worse outcomes (Lysholm knee score, p = 0.009; IKDC subjective score, p = 0.015). Conclusions: Graft choice in ACL reconstruction with concomitant MCL injuries may affect clinical outcomes, particularly in high-grade MCL injuries. Although both graft types performed similarly overall, BPTB grafts provided superior medial stability and functional results in higher-grade MCL injuries. However, caution is needed when interpreting these results due to limitations such as the small sample size and the lack of randomization in graft selection. [ABSTRACT FROM AUTHOR]

A sport-related musculoskeletal injury carries substantial consequences. It is essential to individualize management of these injuries with a model optimizing goal-oriented rehabilitation. A major challenge is to link a patient's goal for returning to sport with the restoration of performance assessed through the rehabilitation process. Even more challenging is that the demanded movement competence is a moving target based on the type of sport and level of competition the athlete seeks to return to. Currently, no single standardized test battery can elucidate a patient's readiness to return to their desired sport at their desired level. We propose a clinical framework to link the assessed capacity (AC) of patients and the demanded competence (DC) of a sport/recreational activity to develop a readiness score (the AC-DC score). The AC-DC score provides a starting point for exploring the critical elements in the decision-making process surrounding the return-to-sport continuum. [ABSTRACT FROM AUTHOR]

Background: Several studies have demonstrated suture repair of ramp lesions of the medial meniscus via a posteromedial approach was associated with a significantly lower rate of secondary meniscectomy. However, these studies are not long-term and highlight the need for extended follow-up research to better understand the outcomes over a more extended period. Purpose: To evaluate the long-term results and reoperation rate for the failure of arthroscopic all-inside suture repair of ramp lesions of the medial meniscus via a posteromedial approach during anterior cruciate ligament (ACL) reconstruction. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent all-inside suture repair of the posterior segment of the medial meniscus (ramp lesion) via a posteromedial approach during ACL reconstruction at a minimum follow-up of 10 years were included in the study. Side-to-side anterior laxity was assessed preoperatively and postoperatively. Pre- and postoperative functional assessment was based on the subjective International Knee Documentation Committee score for activities of daily living and the Tegner activity scale for sporting ability. Reinterventions for meniscal repair failure and other complications were also recorded at the last follow-up. Results: A total of 81 patients met the inclusion criteria for this study. Two patients had an ACL graft rupture with a new ramp lesion and were excluded from the analysis. Additionally, 15 patients were lost to follow-up, leaving a total of 64 patients in the final analysis. The mean follow-up was 124.8 months (range, 122.4-128.4 months). Mean side-to-side difference in anterior laxity significantly improved from 7.4 ± 1.5 mm (range, 5-12 mm) to 0.4 ± 1.3 mm (range, –3 to 4 mm) (P =.01). The mean subjective International Knee Documentation Committee score increased from 64.3 ± 13.4 (range, 34-92) before the operation to 91.1 ± 10.1 (range, 49-100) at the last follow-up (P =.001). The Tegner activity scale score at the last follow-up (6.3 ± 1.6) was lower than that before the trauma (7.1 ± 1.6) (P =.02). Fourteen patients (21.9%) had a failed meniscal repair and were reoperated. The mean time from initial repair to reoperation was 64.5 months (range, 13-126 months), and the median was 60.6 months. The multivariate analysis, including parameters such as lateral tenodesis (hazard ratio [HR], 1.62; P =.50), preoperative Tegner score (HR, 1.66; P =.41), preoperative laxity (HR, 1.75; P =.35), age at surgery (HR, 1.02; P =.97), and number of sutures (HR, 2.38; P =.19), did not reveal any factors associated with suture failure. Conclusion: The results show that arthroscopic repair of ramp lesions of the medial meniscus during ACL reconstruction using a posteromedial approach has a high failure rate at the 10-year follow-up, with half of these suture failures occurring within 5 years after the initial repair. [ABSTRACT FROM AUTHOR]

Background: Revision anterior cruciate ligament (ACL) reconstruction has been documented to have inferior outcomes compared with primary ACL reconstruction. The reasons why remain unknown. Purpose: To determine whether surgical factors performed at the time of revision ACL reconstruction can influence a patient's outcome at 6-year follow-up. Study Design: Cohort study; Level of evidence, 2. Methods: Patients who underwent revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline patient characteristics, surgical technique and pathology, and a series of validated patient-reported outcome instruments: Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) subjective form, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx activity rating score. Patients were followed up for 6 years and asked to complete the identical set of outcome instruments. Regression analysis was used to control for baseline patient characteristics and surgical variables to assess the surgical risk factors for clinical outcomes 6 years after surgery. Results: A total of 1234 patients were enrolled (716 men, 58%; median age, 26 years), and 6-year follow-up was obtained on 79% of patients (980/1234). Using an interference screw for femoral fixation compared with a cross-pin resulted in significantly better outcomes in 6-year IKDC scores (odds ratio [OR], 2.2; 95% CI, 1.2-3.9; P =.008) and KOOS sports/recreation and quality of life subscale scores (OR range, 2.2-2.7; 95% CI, 1.2-4.8; P <.01). Use of an interference screw compared with a cross-pin resulted in a 2.6 times less likely chance of having a subsequent surgery within 6 years. Use of an interference screw for tibial fixation compared with any combination of tibial fixation techniques resulted in significantly improved scores for IKDC (OR, 1.96; 95% CI, 1.3-2.9; P =.001); KOOS pain, activities of daily living, and sports/recreation subscales (OR range, 1.5-1.6; 95% CI, 1.0-2.4; P <.05); and WOMAC pain and activities of daily living subscales (OR range, 1.5-1.8; 95% CI, 1.0-2.7; P <.05). Use of a transtibial surgical approach compared with an anteromedial portal approach resulted in significantly improved KOOS pain and quality of life subscale scores at 6 years (OR, 1.5; 95% CI, 1.02-2.2; P ≤.04). Conclusion: There are surgical variables at the time of ACL revision that can modify clinical outcomes at 6 years. Opting for a transtibial surgical approach and choosing an interference screw for femoral and tibial fixation improved patients' odds of having a significantly better 6-year clinical outcome in this cohort. [ABSTRACT FROM AUTHOR]

Background: Both high body mass index (BMI) and anterior cruciate ligament reconstruction (ACLR) independently influence knee osteoarthritis risk. Preliminary evidence shows the combination of these risk factors leads to poorer recovery and altered biomechanical outcomes after ACLR, but few studies have directly evaluated early changes in cartilage health between normal-BMI and high-BMI groups in this population. Purpose: To evaluate ultrasound-based measures of cartilage strain and compositional changes (via echo-intensity [EI]) in response to an incline walking stress test between normal-BMI and high-BMI individuals with ACLR. A secondary evaluation was conducted of associations between habitual walking biomechanics (ie, ground-reaction forces, sagittal knee kinetics and kinematics) and cartilage strain and EI outcomes. Study Design: Controlled laboratory study. Methods: Gait biomechanics and femoral trochlear ultrasound analyses were evaluated in 64 participants with ACLR who had normal BMI (BMI < 27.0; n = 40) and high BMI (BMI ≥ 27.0; n = 24). Ultrasound images were collected bilaterally before and after an incline treadmill walk, and medial and lateral trochlear strain and EI changes pre-post exercise were used to compare BMI groups and limbs. Gait outcomes included ground-reaction forces, peak sagittal plane knee moments, angles, and excursions and were used to determine associations with cartilage outcomes in the entire cohort. Results: High-BMI individuals with ACLR exhibited greater medial trochlear cartilage strain in the ACLR limb compared with normal-BMI individuals (approximately 6%; P <.01). In those with high BMI, the ACLR limb exhibited greater medial trochlear strain relative to non-ACLR limbs (approximately 4%; P <.05), but between-limb differences were not observed in the normal-BMI group (P >.05). Medial trochlear EI changes were greater bilaterally in those with high BMI compared with normal-BMI ACLR counterparts (approximately 10%; P <.01). Last, individuals who walked with greater peak knee flexion angles exhibited less medial cartilage strain (Δ R 2 = 0.06; P =.025). Conclusion: The data suggested that high BMI affects cartilage functional properties after ACLR, whereas smaller knee flexion angles were associated with larger medial cartilage strain. Clinical Relevance: High-BMI individuals with ACLR may represent a subset of patients exhibiting earlier declines in cartilage functional integrity in response to loading, necessitating additional or more targeted interventions to mitigate disease development. [ABSTRACT FROM AUTHOR]

Purpose: Meniscal allograft transplantation (MAT) is a valuable option for postmeniscectomy syndrome in young and active patients, which can successfully improve symptoms, function and quality of life. This study aimed to report outcomes and complications in patients treated with isolated MAT or MAT combined with revision anterior cruciate ligament reconstruction (ACLR) and lateral extra‐articular tenodesis (LET). Methods: In total, 18 patients who were treated with MAT using a soft tissue fixation technique were retrospectively analysed. Patients were allocated into two groups, the isolated MAT group and the MAT plus revision ACLR + LET group (MAT+ group). Both groups were assessed using the following Patient‐Reported Outcome Measures (PROMs): Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), Tegner Activity Scale, Lysholm score, EuroQol 5‐Dimension 5‐level (EQ‐5D‐5L) questionnaire and a patient acceptable symptom state (PASS) statement. Results: The mean follow‐up was 3.2 years and the mean age of patients was 29 (±7.6) years. Ten patients were treated with isolated MAT and eight patients were treated with MAT combined with revision ACLR and LET. No complications and no reoperations were reported. In both groups, all PROMs significantly improved postoperatively (p < 0.05), except for the Tegner score in the MAT+ group, which did not reach statistical significance (not significant [n.s.]). No significant difference was found postoperatively in PROMs between the MAT and the MAT+ group; however, differences in the KOOS Symptoms, Sports and Quality‐of‐life subscales reached the minimal clinically important threshold. Mean values were: IKDC 61.2 (±13.9) versus 64.7 (±23.2), KOOS Total 72.8 (±14.9) versus 68.0 (±16.7), Lysholm score 83.2 (±11) versus 84.2 (±8.7) and EQ‐5D‐5L 71.8 (±14.9) versus 72.2 (±22.4). Median values for the Tegner Activity Scale were 4 versus 3. PASS statement was negative in 37.5% of the MAT+ group in comparison to 20% of the MAT group (n.s.). Conclusion: In terms of patient‐reported outcomes, MAT is an effective and safe procedure, even when combined with revision ACLR + LET. Compared to the preoperative assessment, a significant improvement of the postoperative PROMs can be expected either when MAT is performed isolated or in combination with ACLR + LET. However, clinically important differences between the two groups can be noted in favour of the isolated MAT procedure, especially regarding symptoms and sporting activity. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: To compare the difference of angle of the lower portion of the posterior cruciate ligament (PCL) measured via magnetic resonance imaging (MRI) in patients with and without partial anterior cruciate ligament (ACL) tears and to investigate the effectiveness of the angle of the lower portion of the PCL in diagnosing partial ACL tears. Methods: From January 2022 to December 2022, a cohort of consecutive patients presenting with ACL tears who underwent ACL reconstruction and patients with isolated meniscus tears undergoing arthroscopic surgery were enroled for this study. The angle of the inferior portion of the PCL comprises α and β angles, and the posterior offset of the lateral condyle were measured on the MRI and compared between the partial ACL tear and control groups. Receiver operating characteristic curves, the areas under the curve (AUCs) and the 95% confidence intervals (CIs) were calculated to identify cutoff values for diagnosing partial ACL injuries. Results: Following an assessment of cohort eligibility and matching for age and sex, 100 patients were included in this study. The mean age of the cohort was 46.1 ± 10.3 years. The AUC for the α angle was 0.88 (95% CI, 0.82–0.94), with a sensitivity of 0.74 and specificity of 0.84 for predicting partial ACL ruptures; the α angle cutoff value was 73.6° (diagnostic odds ratio (OR), 14.10; 95% CI, 5.33–37.28). The AUC for the β angle was 0.86 (95% CI, 0.79–0.93), with a sensitivity of 0.64 and a specificity of 0.92 for predicting partial ACL ruptures; the β angle cutoff value was 73.3° (diagnostic OR, 14.54; 95% CI, 5.76–36.68). Conclusions: A small α angle and a large β angle were associated with partial ACL tears. The angle of the distal portion of the PCL was simple to measure and reproducible, enhancing the diagnosis of partial ACL tears. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to compare 45° and 60° of sagittal femoral tunnel angles in terms of anterior tibial translation (ATT), valgus angle and graft in situ force following anterior cruciate ligament reconstruction (ACLR). Methods: Ten porcine knees were subjected to the following loading conditions: (1) 89 N anterior tibial load at 35° (full extension), 60° and 90° of knee flexion and (2) 5 N m valgus tibial moment at 35° and 45° of knee flexion. ATT and graft in situ force of the intact anterior cruciate ligament (ACL) and ACLR were collected using a robotic universal force/moment sensor (UFS) testing system for (1) ACL intact, (2) ACL‐deficient (ACLD) and (3) two different ACLR using different sagittal femoral tunnel angles (coronal 45°/sagittal 45° and coronal 45°/sagittal 60°). Results: During the anterior tibial load, the femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° and 60° had significantly higher ATT than that of the ACL‐intact knees at 60° of knee flexion (p < 0.05). The femoral tunnel angle of ACLR knees at coronal 45°/sagittal 60° had significantly lower graft in situ force than that of the ACL‐intact knees at 60° and 90° of knee flexion (p < 0.05). During the valgus tibial moment, the femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° and 60° had significantly lower graft in situ force than that of the ACL‐intact knees at all knee flexions (p < 0.05). Conclusions: The femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° provided similar ATT, valgus angle and graft in situ force to that of ACLR knees at coronal 45°/sagittal 60°. Therefore, both femoral tunnel angles could be used in ACLR, as the sagittal femoral tunnel angle does not appear to be relevant in post‐operative knee stability. Level of Evidence: Not applicable. [ABSTRACT FROM AUTHOR]

Purpose: The study hypothesized that the addition of lateral extra‐articular tenodesis (LEAT) in anterior cruciate ligament reconstruction (ACLR) had a significant effect on ACL graft healing. Methods: A total of 80 patients were divided into two cohorts matched for gender, age, body mass index, time from surgery to post‐operative MRI and graft diameter. Forty patients underwent ACL reconstruction alone, while 40 underwent ACLR in addition to LEAT. Patients underwent a magnetic resonance imaging scan at 12 months post‐surgery; tunnel apertures were measured using multiplanar reformation, graft healing was assessed using signal‐to‐noise quotient (SNQ) in three regions of interest and finally graft maturity and integration were classified using the Howell and Ge scale, respectively. In addition, clinical evaluation and patient‐reported outcome measures were collected. Results: The mean femoral tunnel widening at 12 months post‐surgery was 39.8 ± 14.0% in the ACLR + LEAT group and 55.2 ± 12.7% in the ACLR alone group (p < 0.05). The mean tibial tunnel widening was 29.3 ± 12.7% in the ACLR + LEAT group and 44.4 ± 12.1% in the ACLR group (p < 0.05). The mean adjusted graft SNQ was 9.0 ± 14.9 in the ACLR + LEAT group and 9.5 ± 11.4 in the ACLR group (n.s.). Conclusion: At 1 year post‐operatively, we noted significantly less femoral and tibial tunnel widening in the ACLR + LEAT group. LEAT did not result in a statistically significant effect on graft healing. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: To analyse the 52,199 patients in the Swedish Knee Ligament Register (SKLR) preoperatively, and the patients reaching 5‐ and 10‐year follow‐ups who underwent anterior cruciate ligament reconstruction (ACLR), revision ACLR and ACLR on the contralateral side (CACLR). The main hypothesis was that patients undergoing revision ACLR would have worse patient‐reported outcome measurements (PROMs) than the primary ACLR group at 10 years and that smoking and concomitant injuries would result in poorer outcomes for all groups. Methods: Data from 2005 to 2021 were extracted from the SKLR. Only patients whose ACLR surgery was registered in the SKLR were included for revision ACLR and CACLR. The PROMs consist of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the knee‐specific PROM (EQ‐5D‐3L). PROMs were analysed as a whole and in subgroups based on sex, smoking, graft choice and concomitant injuries. Results: Poorer KOOS were seen for revisions compared with primary ACLRs at both the 5‐ and 10‐year follow‐ups (p = 0.003). Smokers had significantly poorer KOOS than nonsmokers (p < 0.001) preoperatively in all groups, however only in the primary ACLR group at 5 and 10 years. At 10 years, patients who had undergone CACLR had lower KOOS than primary ACLRs (p = 0.03). Concomitant injuries resulted in statistically, significantly poorer KOOS for both primary ACLRs and CACLRs preoperatively and at the follow‐ups. Conclusion: The PROMs for revision ACLRs have worse KOOS scores at 10 years compared with the primary ACLRs. The presence of concomitant meniscal or cartilage injuries at the time of ACLR or CACLR were associated with worse PROMs. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to determine whether the grade of osteoarthritis (OA) is higher with single‐bundle (SB) or double‐bundle (DB) anterior cruciate ligament (ACL) reconstruction. The hypothesis was that there will be no difference in the grade of OA between the techniques. Methods: This study was a randomised controlled trial (RCT) with a follow‐up period of 15 years. Patients were randomly assigned to either the SB group (n = 78) or the DB group (n = 75). Surgical techniques were anatomic, and the rehabilitation protocol was standardised. Evaluation included Kellgren–Lawrence (KL) difference and absolute OA results. OA was defined as a KL grade of at least 2. Results: At 15‐year follow‐up, information was available on 101 patients (66%), of whom 56 (37%) were accepted in the final statistical analysis. No difference was found between the SB and DB techniques in terms of KL difference or absolute OA results. Significantly less OA was found in the contralateral knee (21%) than in the reconstructed knee (59%) (p < 0.001). Patients with meniscal tears who underwent partial meniscal resection during ACL reconstruction had a significantly higher rate of OA changes (82%) compared with patients with isolated ACL tears (33%) (p < 0.001). A longer delay between initial injury and surgery did not appear to affect the severity of the KL classification. Conclusion: At 15‐year follow‐up, no difference was found between the DB and SB techniques in terms of OA. Level of Evidence: Level I. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify risk factors for subsequent meniscal surgery following anterior cruciate ligament (ACL) reconstruction (ACLR) in patients without recurrent ACL injury. Methods: Patients aged ≥14 years who underwent primary ACLR with minimum 1‐year follow‐up and without recurrent ACL injury were retrospectively reviewed. Patient demographics and surgical data at the time of ACLR were collected. Postoperative radiographs were used to measure femoral and tibial tunnel position, and posterior tibial slope. Univariate and multivariate analyses were performed to identify risk factors for subsequent meniscal surgery. Results: Of 629 ACLRs that fulfilled the inclusion criteria, subsequent meniscal surgery was performed in 65 [10.3%] patients. Multivariate analysis revealed that medial meniscal repair at the time of ACLR, younger age, anterior femoral tunnel position and distal femoral tunnel position were significantly associated with subsequent meniscal surgery (p < 0.001, p = 0.016, p = 0.015, p = 0.035, respectively). The frequency of femoral tunnel placement >10% outside of the literature‐established anatomic position was significantly higher in those who underwent subsequent meniscal surgery compared to those who did not (38.3% vs. 20.3%, p = 0.006). Posterior tibial slope and ACL graft type were not significantly associated with subsequent meniscal surgery. Conclusion: Medial meniscal repair at the time of ACLR, younger age and nonanatomic femoral tunnel placement were risk factors for subsequent meniscal surgery in patients without recurrent ACL injury. Femoral tunnel placement <10% outside of the native anatomic position is important to reduce the risk of subsequent meniscal surgery. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the postoperative outcomes of the all‐inside technique in arthroscopic anterior cruciate ligament reconstruction (ACLR). Methods: Patients who underwent ACLR using the all‐inside technique between 2018 and 2021 were retrospectively assessed. All patients were followed up for at least 2 years. Functional recovery and pain relief were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS). Instrumented laxity was assessed via side‐to‐side difference using the Kneelax3 arthrometer. Graft maturity was estimated using the signal‐to‐noise quotient value based on magnetic resonance imaging (MRI). Adverse events during and after the surgery were recorded. Results: A total of 78 patients were included in this study, with a mean age of 28.1 ± 7.6 years. The IKDC (p < 0.001), Lysholm (p < 0.001) and KOOS (p < 0.001 for all subgroups) scores at the final follow‐up were significantly higher than those before the surgery. The VAS scores (p < 0.05) were significantly lower than those before surgery. The side‐to‐side difference results indicated that 50 patients had a difference of less than 3 mm, indicating a tight graft, whereas only 1 patient had a difference of >5 mm, indicating a loose graft. The median signal‐to‐noise quotient of the graft on MRI was 1.4 (P25, P75: 1.0, 2.0). No intraoperative adverse events were observed. Postoperative adverse events included three cases of infection, three cases of graft rerupture, two cases of cyclops lesion and one case of surgical intervention for a meniscal tear. Conclusion: ACLR using the all‐inside technique offers promising results in patients with ACL rupture. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: To validate the New Zealand Anterior Cruciate Ligament (ACL) Registry's capture rate of revisions by cross‐referencing Registry data with reoperations data recorded by the Accident Compensation Corporation (ACC) and identify risk factors for all‐cause reoperation. Methods: Primary ACL reconstructions performed between April 2014 and September 2019 were individually matched on a record‐by‐record basis between the two databases. The ACC database was used to identify patients who underwent a reoperation with manual review of operation notes to identify whether a revision or other procedure was performed. This was combined with the number of revisions separately recorded in the New Zealand ACL Registry, which was used as the denominator value to calculate the Registry's capture rate of revisions. Patient and surgical data recorded in the Registry were analysed to identify independent predictors for all‐cause reoperation. Results: A total of 8046 primary ACL reconstructions were matched between the New Zealand ACL Registry and the ACC databases. The reoperation rate was 8.9% (n = 715) at a mean follow‐up of 2.5 years. Meniscal‐related procedures were the most common reoperation (n = 299, 3.7%), followed by revision ACL reconstruction (n = 219, 2.7%), arthrofibrosis (n = 185, 2.3%), cartilage (n = 56, 0.7%) and implants (n = 32, 0.4%). The New Zealand ACL Registry captured 96% of revisions. Younger age (hazard ratio [HR] > 1.4, p < 0.001), earlier surgery (HR > 1.3, p = 0.05), concurrent meniscal repair (medial meniscus HR = 1.9, p < 0.001 and lateral meniscus HR = 1.3, p = 0.022) and hamstring tendon autografts (HR = 1.4, p = 0.001) were associated with a higher risk of reoperation. Conclusion: The New Zealand ACL Registry captured 96% of revisions. Risk factors for all‐cause reoperation included younger age, earlier surgery, meniscal repair and hamstring tendon autografts. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]