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Anterior cruciate ligament (ACR) rupture is a frequent injury in professional sports players. We conducted a retrospective cohort study, including 41 professional female handball players, undergoing ACR reconstruction surgery, using a Ligament Advanced Reinforcement System (LARS) graft (n = 12) or a Soft Tissue (ST) graft (n = 29). After return-to-play, the patients were asked to take a survey, reporting subjective and objective performance indexes before the injury and after return-to-play. Time from surgery to first practice and to return-to-play were significantly shorter in the LARS group (3.92 ± 1.14 vs. 6.93 ± 2.19 months, p < 0.001 and 4.71 ± 1.2 vs. 8.81 ± 2.9, respectively). While there was no difference between postoperative mean time on court, number of goals/match, number of matches played at 6 months return-to-play and 50 m, 100 m and gate-to-gate sprint times, there was a significantly greater increase in preoperative times in the ST group than in the LARS group (1.45 ± 1.05 s vs. 0.21 ± 0.58 s slower than preoperatively, p < 0.001 for 50 m; 1.09 ± 0.95 s vs. 0.08 ± 1 s, p = 0.01 for 100 m; 1.66 ± 1 s vs. 0.21 ± 0.66 s for gate-to-gate). In conclusion, LARS grafts provide a faster recovery time and better functional outcome, significantly impacting the performance of professional handball players. [ABSTRACT FROM AUTHOR]

Background and Objectives: An effective post-injury training program is essential to regain performance and fulfill criteria for return to sport for team sport athletes following anterior cruciate ligament (ACL) reconstruction. The aim of this study was to compare the effects of 6 weeks of eccentric-oriented strength training vs. traditional strength training during the late-stage ACL-rehab phase on leg strength and vertical and horizontal jumping performance in professional team sport athletes. Materials and Methods: Twenty-two subjects (14 males, 8 females, age 19.9 ± 4.4 years, mass 77.4 ± 15.6 kg, height 182.4 ± 11.7 cm) (mean ± SD) with a unilateral reconstructed ACL (BTB graft) were included in the study. All participants enrolled in the same rehabilitation protocol prior to the training study. Players were randomly assigned to an experimental (ECC: n = 11, age 21.8 ± 4.6 years, mass 82.7 ± 16.6 kg, height 185.4 ± 12.2 cm), and a control group (CON: n = 11, age 19.1 ± 2.1 years, mass 76.6 ± 16.5 kg, height 182.5 ± 10.2 cm). Both groups underwent an equivolumed rehabilitation program, with the only difference being in strength training, which consisted of flywheel training vs. traditional strength training for the experimental and control groups, respectively. Testing was organized before and after the 6-week training programs and included isometric semi-squat tests (ISOSI-injured and ISOSU-uninjured legs), vertical jump tests (CMJ), single-leg vertical jump tests (SLJI-injured and SLJU-uninjured legs), single-leg hop tests (SLHI-injured and SLHU-uninjured legs), and triple hop tests (TLHI-injured and TLHU-uninjured legs). In addition, limb symmetry indexes were calculated for the isometric semi-squat (ISOSLSI) test, the single-leg vertical jump (SLJLSI), and the hop (SLHLSI) tests, as well as the triple-leg hop (THLLSI) test. Results: Main effects of time across training were observed for all dependent variables (posttest > pretest, p < 0.05). Significant group-by-time interactions were found for ISOSU (p < 0.05, ES = 2.51, very large), ISOSI (p < 0.05, ES = 1.78, large), CMJ (p < 0.05, ES = 2.23, very large), SLJI (p < 0.05, ES = 1.48, large), SLHI (p < 0.05, ES = 1.83, large), and TLHI (p < 0.05, ES = 1.83, large). Conclusions: This study suggests that eccentric-oriented strength training in late-stage ACL recovery, undertaken twice or three times weekly for 6 weeks, results in better outcomes than traditional strength training in leg strength, vertical jump ability, and single and triple hop tests with injured legs in professional team sport athletes. It seems that flywheel strength training can be recommended in late-stage ACL recovery for professional team sport athletes in order to regain recommended performance outcome levels faster. [ABSTRACT FROM AUTHOR]

Introduction: Tibiotalar arthrodesis was traditionally the treatment of choice for degenerative, inflammatory, or post-traumatic ankle arthrosis. Although ankle arthroplasty emerged as a potential option, initial implants had high failure rates. However, second-generation implants featuring mobile bearings have shown promise in treating young and active patients. Case Report: We present a 27-year-old male with severe ankle dysfunction, characterized by pain, swelling, difficult gait, and permanent equinus, following a complex open distal tibia fracture and three surgical interventions: open reduction and internal fixation (ORIF) with plates and screws, secondary removal due to infection, and subsequent joint debridement. The physical examination revealed a markedly reduced range of motion, local inflammation, and an American Orthopedic Foot and Ankle Society (AOFAS) score of 35. Diagnostic imaging included standard and weight- bearing X-rays, and a CT scan assessed the joint and bone quality of the talus. Diagnosed with severe tibiotalar arthritis, the patient opted for ankle arthroplasty over surgical fusion. Pre-operative planning excluded malalignment and instability, and the sizing of the tibial and talar components was determined using templates of the selected Alpha Ankle Arthroplasty implant. This uncemented implant, with a range-of-motion (ROM) of 50 degrees, semi-constrained design, and porous titanium construction, enhances osteointegration. The surgery involved a supine position with a pneumatic tourniquet and tranexamic acid for blood loss control. Procedures included a longitudinal incision, alignment guide assembly, X-ray-controlled alignment, tibial and talar resection and milling, and component insertion, followed by skin closure. Post-operative management entailed stabilizing orthosis for 6 weeks, weight bearing at 3 weeks, and a rehabilitation program after 6 weeks. Clinical and radiological evaluations at 6 and 12 weeks post- surgery confirmed successful primary fixation and osteointegration, with significant pain reduction and functional improvement, reflected in an AOFAS score of 88. Discussions : Second-generation total ankle replacements, predominantly semi-constrained, cementless, requiring minimal bone resection, and designed for bone ingrowth, have shown improved outcomes. Advances in materials, design, and surgical techniques have established these implants as viable alternatives to arthrodesis. Conclusions: For young, active patients seeking to preserve joint motion and refusing tibiotalar fusion, ankle replacement offers a viable option. However, it is a complex procedure with potential complications, necessitating careful consideration and patient selection. [ABSTRACT FROM AUTHOR]