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Background: Increased Posterior Tibial Slope (PTS) angle has been reported to be a risk factor for primary anterior cruciate ligament (ACL) tears. However, it is unknown whether increased PTS has an associated increased risk for non-contact versus contact ACL injury., Purpose: The purpose of this study is to determine whether patients with non-contact ACL injury have a higher PTS angle than those with contact ACL injury., Methods: A total of 1700 patients who underwent primary ACL reconstruction between January 2011 and June 2023 at a single academic institution were initially included. Electronic medical records were reviewed for demographic information as well as evidence that the patient sustained a contact or non-contact ACL injury. Patients in the contact cohort were propensity score matched to patients in the non-contact cohort by age, sex and BMI. Additionally, patients in the contact cohort were then propensity score matched to a control group of patients with intact ACLs also by age, sex and BMI., Results: One hundred and two patients with contact injury were initially identified and 1598 patients with non-contact injuries were identified. Of the 102, 67 had knee X-rays that were suitable for measurement. These 67 contact injury patients were propensity score matched to 67 noncontact patient and 67 patients with intact ACLs based on age, sex and BMI. There were no significant differences between contact and non-contact cohorts in age (28.7±6.3 vs. 27.1±6.5, p = 0.147), sex (Female: 36.0% vs. 34.3%, p = 0.858), or BMI (26.7±5.6 vs 26.1±3.4, p = 0.475). There was no significant difference in PTS angle between contact versus non-contact ACL injury patients (11.6±3.0 vs.11.6±2.8, p = 0.894). There was a significant difference in PTS between the contact ACL injury and the intact cohort (11.6±3.0 vs. 10.0±3.9, p = 0.010) and the non-contact ACL injury and the intact cohort (11.6±2.8 vs. 10.0±3.9, p = 0.010)., Conclusion: There was no significant difference in the degree of PTS between patients who sustained contact versus non-contact ACL injuries. Additionally, there was a significantly increased PTS in both the contact and non-contact ACL injury cohorts compared to patients with intact ACLs., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Purpose: Badminton requires fast and pivoting movements, putting athletes at risk of sustaining an anterior cruciate ligament (ACL) injury. The primary purpose is to investigate the return to sport (RTS) and the return to performance (RTP) after an ACL injury in elite badminton athletes. The secondary purpose is to describe ACL injury mechanisms in elite badminton players., Methods: Athletes within the top 200 of the Badminton World Federation World Ranking who sustained an ACL injury between January 2001 and December 2021 were retrospectively included. An anonymous online survey was created in eight languages. RTS, RTP and contributing factors were analysed among athletes aiming to RTP. The injury mechanism was analysed in all participants., Results: Sixty-six athletes from 32 countries were included. Fifty-seven athletes (86.4%) aimed to RTP. Forty-eight out of 57 (84.2%) did RTS. Twenty-nine (50.9%) managed to successfully RTP. Forty-nine (74.2%) of ACL injuries occurred during a competition, 14 (21.2%) occured during training. Thirty-one (49.2%) occurred in the rear court backhand side and 47 (74.6%) occurred during landing after a jump., Conclusion: Forty-eight out of 57 (84.2%) athletes managed to RTS. Half of the athletes managed to successfully RTP. Most of the ACL injuries occurred during competition, in the rear court backhand side and during landing after a jump., Level of Evidence: Level III., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background: Traditional examinations of anterior cruciate ligament (ACL) injuries focus primarily on static assessments and lack the ability to evaluate dynamic knee stability. Hence, a dynamic scoring system for knee function is needed in clinical settings. This study aimed to propose a dynamic scoring system based on a large sample of normative six-degree-of-freedom (6-DOF) knee kinematics during gait, and validate its correlation with conventional outcome measurements in assessing ACL-injured knees., Methods: A total of 500 healthy Chinese participants were enrolled to establish a large dataset. The 6-DOF kinematics of both knees during gait were recorded using an infrared navigation three-dimensional portable knee motion analysis system. Based on the large sample dataset, a novel 6-DOF scoring system was developed using the dynamic time warping algorithm. To further validate the scoring system, an additional 83 patients with ACL injuries were included, and their preoperative dynamic knee kinematics assessment and patient-reported outcome measurements (PROMs) were recorded. Spearman's correlation coefficient (ρ) was used to determine the correlations between the 6-DOF score and the Lysholm score, International Knee Documentation Committee (IKDC) subjective score, and Tegner activity scale., Results: The mean values of adduction/abduction, internal/external rotation, flexion/extension, anterior/posterior translation, proximal/distal translation, and medial/lateral translation in the 500 healthy participants were 10.07 ± 4.04°, 15.13 ± 4.85°, 60.56 ± 6.07°, 1.79 ± 0.75 cm, 1.58 ± 0.54 cm, and 1.10 ± 0.42 cm, respectively. The mean preoperative 6-DOF score, Lysholm score, IKDC subjective score, and Tegner activity scale of the 83 ACL-injured patients were 74.29 ± 7.23, 70.26 ± 17.55, 66.78 ± 15.79, and 2.28 ± 1.56, respectively. The 6-DOF score was significantly correlated with the Lysholm score (ρ = 0.375, P < 0.001) and Tegner activity scale (ρ = 0.273, P = 0.016) for the ACL-injured patients. No significant correlation was found between the 6-DOF score and the IKDC subjective score (ρ = 0.145, P = 0.208)., Conclusion: This study proposed a normative 6-DOF knee kinematic reference range for the Chinese population based on a large sample dataset. The 6-DOF dynamic score was developed accordingly and proven to be significantly correlated with the Lysholm score and the Tegner activity scale, showing the potential to provide comprehensive and meaningful information on dynamic knee function and stability for patients with ACL injuries in the future., Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. The study protocol was reviewed and approved by the Ethics Committee on Biomedical Research, West China Hospital of Sichuan University (No. 2016-99). The patients/participants provided their written informed consent to participate in this study. Clinical trial number: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Current literature offers scant insights into Schatzker IV tibial plateau fractures (TPFs) that affect the posterolateral (PL) column. This study seeks to elucidate the prevalence of meniscal and ligamentous injuries in the knee, as well as the clinical outcomes, in Schatzker IV TPF cases, both with and without PL column involvement., Methods: We conducted a retrospective analysis of clinical and imaging data from patients with Schatzker IV TPFs who received surgical treatment at our institution between January 2018 and January 2022. Patient demographics and surgical details were meticulously documented. The study participants were categorized into two groups based on the involvement of the PL column in the Schatzker IV TPF. Group A comprised patients without PL column fractures, whereas Group B included those with such fractures. We compared soft tissue injuries affecting knee stability, namely meniscal and ligamentous injuries, between two groups using Magnetic Resonance Imaging (MRI) and surgical records. Further, Group B was divided into subgroups based on the presence or absence of knee subluxation. Within Group B, we measured the lateral plateau depression (LPD) and lateral plateau widening (LPW). Additionally, we investigated the frequency of meniscus entrapment in patients with PL column fractures. Clinical outcomes were assessed using The American Hospital for Special Surgery (HSS) and Rasmussen scores., Results: The study comprised 66 patients with Schatzker IV TPFs. Of these, 12 patients had no PL column fracture, while 54 had a PL column fracture. Group B demonstrated a 57.4 % and 64.8 % incidence of lateral meniscus (LM) and anterior cruciate ligament (ACL) injuries, respectively, significantly higher than that in Group A (25 %, 8.3 %) (p = 0.044, p < 0.001). Within Group B, those with knee subluxation showed a marked increase in LPD (14.5 ± 5.3 mm) and LPW (9.3 ± 4.9 mm), correlating with a higher rate of meniscus entrapment (76.0 %) (p < 0.001). Patients in Group B had lower HSS and Rasmussen scores compared to Group A (p = 0.048, p = 0.006)., Conclusion: This investigation reveals that Schatzker IV TPFs involving the PL column are highly associated with increased rates of LM and ACL injuries. Additionally, these fractures correlate with a greater likelihood of knee subluxation and meniscus entrapment, ultimately leading to poorer prognostic outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the benefits and harms of injury prevention programmes on anterior cruciate ligament injuries., (Copyright © 2024 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.)

The increased participation of females in sports has been accompanied by an increase in the rate of anterior cruciate ligament (ACL) injuries. The literature has identified risk factors for noncontact ACL injuries in female athletes, including anatomic, hormonal, biomechanical, neuromuscular, and environmental factors. This review will provide an overview of sex-specific considerations when managing female athletes with ACL injuries. A discussion of sex-specific surgical and rehabilitative treatment strategies with the goal of optimizing return to sport after ACL reconstruction will be emphasized., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mary Mulcahey reports a relationship with Arthrex Inc that includes: consulting or advisory. Mary Mulcahey reports a relationship with Ruth Jackson Orthopaedic Society that includes: board membership. Mary Mulcahey reports a relationship with American Association of Orthopaedic Surgeons that includes: board membership. Mary Mulcahey reports a relationship with American Orthopaedic Society for Sports Medicine that includes: board membership. Mary Mulcahey reports a relationship with Arthroscopy Association of North America that includes: board membership. Mary Mulcahey reports a relationship with International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine that includes: board membership. Mary Mulcahey reports a relationship with Orthoinfo that includes: board membership. Mary Mulcahey reports a relationship with AJSM that includes: board membership., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Anterior cruciate ligament (ACL) injury is a concerning problem in the paediatric population, impacting joint health and longevity. Moreover, ACL injury hampers physical activity, which is important for children's social network and general well-being. Recent data demonstrates a rise in paediatric ACL reconstructions, affecting both girls and boys. However, it is unclear whether this rise reflects a higher injury rate or a more proactive approach towards surgery, as information on nonoperated patients is lacking. Regarding gender differences, increasing evidence implies that girls engaged in pivoting sports experience a higher incidence of ACL injuries and reinjuries compared to boys. Furthermore, data suggest that girls have inferior outcomes and lower return-to-sport rates than boys. The social context in which girls compete in sports is likely a significant contributing factor to the risk of serious knee injuries. Lack of attention and insufficient data on gender-based differences in ACL injuries, outcomes and evidence-based treatment guidelines highlight the need for further research on this topic. LEVEL OF EVIDENCE: Level IV., (© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: Research surrounding the biomechanics and video analysis of anterior cruciate ligament (ACL) injuries at the professional level has emerged in recent years as a tool to screen athletes for potential biomechanical deficits. The purpose of this study was to analyze and discuss the most common mechanism, body position, and activity at the time of ACL injury among NBA players., Methods: Anterior cruciate ligament injuries over 10 consecutive NBA seasons (2009-2010 to 2019-2020) were reviewed from publicly available sources. A 10-question survey was developed and utilized to analyze each video clip. These questions were divided into three categories: 1. contact mechanism, 2. activity at the time of injury, and 3. position of the involved lower extremity at the time of injury. Two reviewers analyzed the videos individually, and differing answers were resolved via consensus review, with a senior author arbitrating in the case of any discrepancies., Results: Overall, 23 ACL ruptures were included. The most common injury mechanism was indirect contact with another player without knee contact (56.5%), and no patients had an ACL rupture as a result of direct knee contact with another player. The most common action at the time of injury was pivoting (47%), and the most common basketball action was dribbling (43.5%). Additionally, the vast majority of patients were injured while on offense (91.3%). The most common knee positions were early flexion (73.9%) and abduction (95.7%). The most common foot positions were abduction relative to the knee (82.6%), in eversion (73.9%), and dorsiflexion (56.5%). The most common hip position was early flexion (87%), and all hips were abducted (100%)., Conclusion: Our study found that the majority of ACL ruptures occurred during offensive play and over half were secondary to contact with an opposing player (but without a direct blow to the injured knee), indicating that such perturbations may alter the kinematics of the players' movement. Additionally, a large majority of ACL injuries occurred while the hip was abducted with the knee in abduction relative to the hip and while the knee was in early flexion from 0° to 45°.

Introduction: Several studies have proven that ultrasound (US) can improve the efficiency of early diagnostics of anterior cruciate ligament (ACL) injuries. ACL US is mainly performed by sonologists or radiologists. We have very little data on how effective these tests are if they are performed by an orthopaedic surgeon. We also have no information on the applicability of ACL US in children and adolescents. In this retrospective study, we analysed the results of point of care ultrasound (POCUS), which were performed by orthopaedic surgeons on children with suspected ACL injury., Materials and Methods: We reviewed the data of children and adolescents who were examined with ultrasound between 2018 and 2021 for suspected ACL injury. ACL POCUS was done immediately after the physical examination, according to a standard technique. The tests were performed by an orthopaedic resident and young and a senior orthopaedic surgeon. The inclusion criteria were as follows: the child's age is between 0-15 years, the growth zones are open, the child later underwent MRI and/or arthroscopy, which confirmed or excluded the fact of an ACL injury. We excluded patients with incomplete recordings and documentation., Results: 119 children met the above criteria. The children were between 8 and 15 years old (mean = 13.29). Positive findings were found in 47, negative findings in 72 children with ACL POCUS. During the subsequent treatment, 57 children underwent only MRI examination, 11 children only arthroscopy, and 51 children both MRI and arthroscopy. The specificity of the test was measured as 0.958 and the sensitivity as 0.917 for complete ACL rupture. Regarding all ACL injuries (complete + partial), we found the sensitivity to be 83.019 and the specificity to be 95.45. The interrater agreement between radiologist and clinicians was 94.957 %. (Cohen's k: 0.8945)., Conclusions: POCUS can indicate functional insufficiency caused by ACL injury in children and adolescents. The biggest advantage of the test is that it is quick and simple, non-invasive. Further prospective diagnostic tests and standardized examination protocols can confirm our favourable experiences., Competing Interests: Declaration of competing interest The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The Knee Numeric-Entity Evaluation Score (KNEES-ACL) is a 41-item condition-specific patient-reported outcome measure (PROM) that was developed for patients with an anterior cruciate ligament (ACL) deficiency and patients after ACL reconstruction. This measure is intended to be used for longitudinal clinical studies. The KNEES-ACL has demonstrated face and content validity and superior responsiveness compared with other PROMs commonly used in patients with an ACL injury. However, this PROM was developed in Danish and has not been appropriately translated and culturally adapted into North American English., Purpose: To translate and culturally adapt the KNEES-ACL from Danish to North American English., Study Design: Cross-sectional study., Methods: Translation from Danish to English and cultural adaptation to a North American context were performed according to the dual panel method. First, the Danish KNEES-ACL was translated by a bilingual panel, which provided multiple English wording options for each item. Second, an English lay panel focus group was formed to determine the wording for each item that best reflected everyday spoken language. Finally, individual think-aloud cognitive interviews were conducted with patients after an ACL injury to evaluate the relevance, comprehensiveness, and comprehensibility of the PROM content and questions. Repeated modifications and testing were performed until a final English version of the KNEES-ACL was constructed., Results: Participants in the lay panel focus group were able to reach unanimous decisions for each of the 41 items. Further changes to 17 items were made after 8 think-aloud interviews with patients with ACL injuries at various time points to ensure that items were relevant and being interpreted consistently among different types of patients. The final KNEES-ACL consisted of 6 domains: Problems with Daily Activities, Mental Impact, Stability, Strength and Control, Pain, and Sport and Physical Activity., Conclusion: The English KNEES-ACL for patients with ACL injuries has undergone appropriate translation and cultural adaptation using established dual panel and cognitive interviewing methods in the population of interest. The psychometric properties of the English KNEES-ACL will likely mirror those established with the Danish version. However, direct validation of the psychometric properties of the English version would be beneficial before widespread use., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: H.M. has received research support from the Bone and Joint Institute of Western University and the Canadian Institutes of Health Research. A.M.J.G. has received research support from the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, the National Institutes of Health, the Canadian Institutes of Health Research, the Department of Defense, Smith+Nephew, Ossur, and B. Braun Aesculap; has received royalties from Smith+Nephew; has received consulting fees from Smith+Nephew, PrecisionOS, Graymont, and Xiros; and holds stock options for PrecisionOS and Spring Loaded Technology. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Objectives: To describe the epidemiology of injuries in sub-elite female Australian Football (AF)., Design: Prospective cohort., Methods: 424 athletes were tracked across a 12-match season. Injury characteristics (location, severity, mechanism) were reported. Injury incidence (injuries per 1000 h) and injury burden (days absent per 1000 h) were calculated. Severity was considered as the number of days missed between injury onset and return to full training. Incidence was compared using incidence rate ratios, and severity using a Mann-Whitney U test., Results: Total injury incidence was 10.8 (95 % confidence interval [CI] = 9.0, 12.8) injuries per 1000 h. Match incidence was 34.6 (95 % CI = 28.0, 42.4) injuries per 1000 h. Ankle sprain injuries (2.2 per 1000 h, 95 % CI = 1.4, 3.1) and concussion (1.6 per 1000 h, 95 % CI = 1.0, 2.5) injuries were the most frequent, followed by anterior cruciate ligament (ACL) injuries (0.9 per 1000 h, 95 % CI = 0.4, 1.6). ACL (40.4 days per 1000 h, 95 % CI = 36.9, 44.1), ankle sprain injuries (31.4 per 1000 h, 95 % CI =28.4, 34.7), and concussion (19.9 per 1000 h, 95 % CI = 17.5, 22.5) injuries were also the most burdensome. There were 78 mild, 34 moderate, and 21 severe injuries. ACL injuries were the most severe injury (56.0 [77.0] in-season days missed)., Conclusions: This research describes the first large-scale injury profile of sub-elite female AF, reporting time-loss measures of incidence and burden for many injury types. Ankle sprain injuries, concussions, and ACL injuries are common and burdensome, and should be prioritised for prevention., Competing Interests: Declaration of interest statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The American Academy of Orthopaedic Surgeons (AAOS) has developed a clinical practice guideline (CPG) for management of anterior cruciate ligament (ACL) injuries. Primary studies such as randomized controlled trials (RCTs) are cited as evidence for the guidelines. Given the influence that these trials have on patient care, adherence to standardized protocols for conducting and reporting RCTs is essential., Purpose: To evaluate the CONSORT (Consolidated Standards of Reporting Trials) Extension for Harms-related reporting of RCTs cited as supporting evidence for the AAOS CPG on the management of ACL tears., Study Design: Cross-sectional study., Methods: The reference section of the AAOS guideline for ACL tears was first screened for RCTs cited in the CPG. Next, each RCT was evaluated for adherence to the CONSORT Extension for Harms checklist. Both identification of RCTs and assessment of adherence were performed in a masked and duplicate process. Descriptive statistics were used to summarize adherence to CONSORT Extension for Harms items. A Pearson correlation test was conducted to assess the relationship between the year of publication and adherence to CONSORT harms reporting., Results: The sample included 113 RCTs, of which 16 (14.2%) were published before the CONSORT Extension for Harms was implemented in 2004. Sample sizes ranged from 24 to 4564 participants, with a mean of 228. None of the included RCTs included all 18 items in the CONSORT Extension for Harms checklist. The mean number of checklist items reported was 4 (of 18; 22.2%). A moderate, positive, and statistically significant correlation was found between the RCT publication year and the adherence with reporting of the CONSORT Extension for Harms ( t 111 = 3.54; P < .001) ( r = 0.32; 95% CI, 0.14-0.47)., Conclusion: Harms were infrequently reported in RCTs cited as supporting evidence in the AAOS CPG for the management of ACL tears. One encouraging finding was the positive correlation between the year when RCTs were published and how well they adhered to reporting harms. Efforts to improve adverse event reporting are warranted, as RCTs are commonly used to make clinical decisions in orthopaedic surgery., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: C.H. has received support for education from Pylant, consulting fees from Endeavor, and hospitality payments from Stryker. M.H. has received support for education from CDC Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Background: The understanding of noncontact anterior cruciate ligament (ACL) injury causation in soccer has improved over the past decades. Bidimensional video analyses have significantly augmented our awareness, representing to date the only practical method to describe injury biomechanics. However, the extent of the problem continues to raise serious concerns., Purpose: To advance our understanding of the causal pathways leading to ACL injury with a large-scale reconstruction of 3-dimensional (3D) whole-body joint kinematics of injuries that occurred to male elite soccer players, as well as to compare the joint angle time course among situational patterns., Study Design: Descriptive laboratory study., Methods: A total of 33 consecutive noncontact and indirect contact ACL injuries that occurred in 6 national and 2 international professional leagues (seasons 2020-2021 to 2022-2023 until December 2022) were analyzed: (1) multiview noncoaxial television images were inspected; (2) multiple camera views were taken from 400 ms before the initial ground contact to 200 ms after the injury frame; (3) a size-matched pitch was modeled and used to calibrate cameras; (4) a 3D skeletal model was adjusted to fit the player's pose in each frame/view; and (5) poses were interpolated, and Euler joint angles were extracted., Results: The authors reconstructed the 3D lower limb joint kinematic curves preceding and during ACL injuries in 33 cases; notably, a sudden external (up to 5°) and then internal knee rotation was observed after the initial contact and before the injury frame. The overall kinematics at injury were knee moderately flexed (45.9°± 21.7°), abducted (4.3°± 5.1°), and externally rotated (3.0°± 6.4°); trunk shallowly flexed (17.4°± 12.5°) and rotated and tilted toward the injured side; and hip flexed (32.0°± 18.7°), abducted (31.1°± 12.0°), and slightly internally rotated (6.6°± 12.2°). Variable behaviors were observed at the ankle level., Conclusion: Via reconstruction of the sequence of whole-body joint motion leading to injury, we confirmed the accepted gross biomechanics (dynamic valgus trend). This study significantly enriches the current knowledge on multiplanar kinematic features (transverse and coronal plane rotations). Furthermore, it was shown that ACL injuries in male professional soccer players manifest through distinct biomechanical footprints related to the concurrent game situation., Clinical Relevance: Interventions aimed at reducing ACL injuries in soccer should consider that environmental features (ie, situational patterns) affect injury mechanics., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

BACKGROUND: Patient-reported outcome measures (PROMs) have been adopted as a way to measure patient self-rated physical function and health status for patients with anterior cruciate ligament (ACL) injuries. Although multiple PROMs exist and have been translated into various languages, the cross-cultural adaptation and validity of these PROMs for Spanish-speaking patients is unknown. PURPOSE: To evaluate the adaptation quality and psychometric properties of Spanish-language adaptations of PROMs for patients with ACL injuries. STUDY DESIGN: Scoping review; Level of evidence, 3. METHODS: Under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we reviewed published studies related to adaptation quality and psychometric properties of Spanish PROMs in patients with ACL injuries. The methodological quality of the included studies was assessed using the Guidelines for the Process of Cross-Cultural Adaptation of Self-Reported Measures, the Quality Criteria for Psychometric Properties of Health Status Questionnaires, and the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The level of evidence for each PROM was determined based on the number of studies, methodological quality, consistency of results, and sample size. RESULTS: The initial search strategy identified 5687 articles. After removal of duplicates, 1882 titles were screened, and 114 articles were assessed for eligibility. Six articles were selected for final review, comprising 4 PROMs: the Lysholm knee score, the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI), the Lower Extremity Functional Scale, and the Lower Limb Functional Index. Three studies followed all 6 processes for cross-cultural adaptation. None of the studies demonstrated all 14 domains required for cross-cultural validity (eg, description of translator expertise). The ACL-RSI achieved the highest level of evidence, with 3 of 9 domains demonstrating moderate evidence. CONCLUSION: This review identified 4 instruments that have been translated for Spanish-speaking patients with ACL injuries, none of which demonstrated appropriate adaptation or robust psychometric properties. The study highlights the need for improvement in PROMs for Spanish-speaking patients and the potential for mismeasurement and inappropriate application of PROM results in patients with ACL injuries.

Background: Sports-related ACL (anterior cruciate ligament) injuries are frequent. Successful management requires early diagnosis and treatment. One of the clinical tests used to identify ACL damage is the lever sign test. This meta-analysis aimed to assess the lever sign test's diagnostic efficacy for ACL injuries., Methods: An extensive investigation of the Cochrane Library, Embase, and PubMed databases was conducted until April 2023. Studies assessing the lever sign test's diagnostic efficacy for ACL injuries were also included. A bivariate random-effects model was employed to acquire the pooled estimates of diagnostic odds ratios, specificity, positive and negative likelihood ratios, sensitivity, and curves of the summary receiver operating characteristic (SROC)., Results: The meta-analysis comprised twelve investigations with a total of 1365 individuals. The lever sign test's combined sensitivity and specificity for the purpose of diagnosing injuries to the ACL were 0.810 (95% confidence interval [CI] 0.686-0.893) and 0.784 (95% CI 0.583-0.904), respectively. The positive and negative likelihood ratios were 3.148 (95% CI 1.784-5.553) and 0.210 (95% CI 0.084-0.528), respectively. The study revealed a diagnostic odds ratio of 17.656, with a 95% CI ranging from 4.800 to 64.951. The SROC curve's area was determined to be 0.912 (95% CI 0.857-0.967)., Conclusion: With high specificity and sensitivity, the lever sign test is a reliable diagnostic modality for ACL injuries. However, the test should be used in combination with other diagnostic tests to increase the accuracy of the diagnosis. Further investigations are warranted to assess the clinical practicability of the lever sign test in various populations and settings., (© 2024. The Author(s).)

Purpose: To identify MRI-detected anatomical risk factors for non-contact anterior cruciate ligament (ACL) injuries across genders., Methods: A retrospective analysis was performed on 141 ACL-reconstructed patients (35 females, 106 males) and 142 controls (37 females, 105 males) from January 2020 to April 2022. Inclusion criteria were primary non-contact ACL injuries. The tibial plateau slope, lateral femoral condyle index, Insall-Salvati index, and patellar tendon angle were measured, using binary logistic regression for gender-specific risk evaluation., Results: Increased lateral tibial plateau slope, reduced intercondylar notch width index, lateral femoral condyle index, and patellar tendon angle correlated with ACL injuries in both genders. The Insall-Salvati index was a significant risk factor in females but not in males., Conclusion: This study identifies the lateral tibial plateau slope, notch width index, lateral femoral condyle index, and patellar tendon angle at near-extension as risk factors for ACL injuries in both genders, with the Insall-Salvati index also implicated in females., (© 2024. The Author(s).)

Background: It is unclear how anterior cruciate ligament (ACL) reconstruction (ACLR) affects the development of osteoarthritis (OA). This uncertainty is partly caused by the lack of long-term studies on ACL injuries treated primarily without reconstruction and the underreporting of symptomatic OA., Purpose: To determine (1) the knee function, symptoms, and activity level, as well as the presence of radiographic and symptomatic OA; (2) how these clinical outcomes have changed over time; and (3) the frequency of subsequent knee surgeries after the index ACL injury in a cohort of patients with ACL injuries treated primarily without reconstruction., Study Design: Case series; Level of evidence, 4., Methods: A total of 100 patients underwent initial nonoperative treatment >30 years ago (mean, 33.2 ± 1.4 years). Of these, 81 patients (mean age, 59 ± 8 years) completed the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Scoring Scale, and Tegner Activity Scale. Seventy-three patients underwent radiography to evaluate tibiofemoral and patellofemoral OA in the ACL-injured knee. Patients only underwent late ACLR if they experienced insufficient knee stability., Results: At 33 years after the ACL injury, the KOOS Activities of Daily Living subscore was better than population-based reference values, but scores were similar for the remaining KOOS subscales. Furthermore, 65% of patients had a good or excellent Lysholm score (≥84 points). The Tegner score decreased 4 points from before the injury to 33-year follow-up ( P < .001). Most patients (75%) had evidence of radiographic tibiofemoral and/or patellofemoral OA, but only 38% were classified as having symptomatic OA (defined as radiographic OA in combination with a symptomatic knee according to cutoffs on the KOOS). Approximately 50% underwent meniscal surgery, and 29% subsequently underwent ACLR for recurrent instability. There were 2 patients who underwent total knee replacement., Conclusion: Despite a high prevalence of radiographic OA, patients achieved acceptable subjective knee function and had a relatively low prevalence of symptomatic OA at >30 years after an ACL injury when an initial nonoperative treatment strategy was employed., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was financed by Swedish governmental funding of clinical research (ALF) and the Greta and Johan Kock Foundation. C.H. has received ALF funding for medical residents at Lund University in 2022; funding is allocated from the government to the health care system for clinicians to be able to perform clinical research for their doctoral thesis and was not provided for this article specifically. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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

Background: The Knee Outcome Survey – Activities of Daily Living Scale (KOS-ADLS) is a patient-reported outcome measure (PROM) developed to assess symptoms and functional limitations in patients with various knee disorders. The aim of this study was to translate and culturally adapt the KOS-ADLS to Danish and to evaluate the psychometric properties of the Danish version (KOS-ADLS-DK) in patients with anterior cruciate ligament (ACL) injury. Methods: The KOS-ADLS was translated and culturally adapted to Danish in accordance with recommended guidelines. To evaluate psychometric properties in a test-retest design 115 Danish patients with ACL injury completed KOS-ADLS-DK and other knee specific PROMs at baseline and after 14 days. A sub-population of 79 patients completed the KOS-ADLS-DK before and after 3 months of rehabilitation. Structural validity (factor analysis), Internal consistency (Cronbach's alpha), construct validity (hypothesis testing), test-retest reliability (Intraclass Correlation Coefficient [ICC]), test-retest agreement (Bland-Altman plots with 95% Limits of Agreement), Standard Error of Measurement (SEM), Smallest Detectable Chance (SDC), responsiveness (construct approach with hypothesis testing) and floor/ceiling effects were assessed. Results: No major problems were revealed in the cross-cultural adaptation process. The KOS-ADLS-DK was uni-dimensional and showed a high internal consistency (Chronbach's alpha = 0.90). Construct validity was not perfect as only five of seven hypotheses were confirmed, but there was a good reliability (ICC = 0.88) and test-retest agreement showed equal distribution of measurement error across the scale and the SEM was 4.9% and SDC was 13.6%. However, hypotheses testing on change scores revealed the KOS-ADLS-DK to be responsive and there were no floor/ceiling effects. Conclusion: Overall, the Danish version of KOS-ADLS is considered a valid, reliable and responsive PROM for assessing symptoms and functional limitations in patients with ACL injury but may show some limitations in its construct validity. [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]

Introduction: Anterior cruciate ligament (ACL) injuries are known to have a high rate of occurrence among athletes. The growing prevalence of these injuries demands research in this field to determine clinically reliable diagnostic techniques. Aims: The goal of this study was to compare the diagnostic accuracy of the lever sign test with other frequently used manual tests, such as the anterior drawer and Lachman test, and to evaluate the sensitivity and specificity of the lever sign test in the diagnosis of ACL injuries. Study Design: The study was conducted for a period of 1 year, from November 2021 to November 2022, among 100 patients presenting to orthopedic outpatient department in a tertiary care center with complaints of acute knee pain after a trauma to the knee. Materials and Methods: A thorough history, physical examination, and three manual tests for diagnosing an ACL tear were performed by an intern, orthopedic resident, and consultant after obtaining consent. Arthroscopy of the injured knee was taken as the reference standard. Results: Of 100 patients, 53 were surgical and 67 were nonsurgical; the mean patient age was 33 years (range, 16 + 6.38 years). The overall accuracy of the lever sign test was 83% (85% sensitivity and 81% specificity); the accuracy was almost similar at arrival and under anesthesia (at arrival 86%, under anesthesia 80%), when performed by interns, postgraduates, and consultants. Conclusion: The lever sign test is easier to perform, equally efficacious, and reliable in diagnosing ACL injuries when compared to the other conventionally used manual tests. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to develop a neural network model for predicting second anterior cruciate ligament (ACL) injury risk following ACL reconstruction using patient features from medical records., Methods: Of 486 consecutive patients who underwent primary unilateral ACL reconstruction, 386 patients (198 women, 188 men) with a mean age of 25.1 ± 11.6 years were included in this study. Fifty-eight features, including demographic data, surgical, preoperative and postoperative data, were retrospectively collected from medical records, and features with an incidence of less than 5% were excluded. Finally, 14 features were used for the analysis. The multilayer perceptron was composed of four hidden layers with a rectified linear unit as activation and was trained to maximise the area under the receiver-operating characteristic curve (auROC). Subsequently, validation was carried out through a rigorous threefold cross-validation process. To ascertain the most efficacious combination of features with the highest auROC, a single feature with the least impact on auROC maximisation was systematically eliminated from the comprehensive variable set, ultimately resulting in the retention of a mere two variables., Results: The median follow-up period was 50.5 (24-142) months. Fifty-seven knees had a second ACL injury, with a graft rupture rate of 7.7% and a contralateral injury rate of 6.9%. The maximum auROC for predicting graft rupture was 0.81 with two features: young age and hamstring graft. Meanwhile, the maximum auROC for predicting contralateral ACL injury was 0.74 with seven features, including young age, presence of medial meniscus tear, small body mass index, hamstring graft, female sex and medial meniscus repair or treatment., Conclusion: A neural network model with patient features from medical records detected graft ruptures and contralateral ACL injuries with acceptable accuracy. This model can serve as a new, useful tool in clinical practice to inform decisions about ACL reconstruction and retuning to sports postoperatively., Level of Evidence: Level IV., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: In recent years, anterior cruciate ligament (ACL) injuries have been frequently observed in ski jumping. However, available data in this discipline are very scarce. Therefore, the purpose of this study was to investigate whether an ACL injury in elite-level ski jumping limits the performance level after ACL reconstruction (ACLR)., Methods: Both male and female elite-level ski jumpers from five national A-teams who suffered an ACL injury were identified retrospectively by searching available media reports and Fédération Internationale de Ski (FIS) database. World Cup (WC) results and time-out-of-competition before ACL injury and after ACLR were compared. Only athletes who suffered the injury during or after the 2009-2010 season and who participated in at least one WC competition before the injury were included in this study. The level of athletes' performance from two full seasons before until three seasons after the injury was compared., Results: Eighteen elite-level ski jumpers (11 males/seven females) were eligible for the study. All male and four female athletes returned to professional competition after ACLR. One female athlete ended her career due to prolonged recovery and two have not yet recovered due to a recent injury. The mean return-to-competition (RTC) time was 14.6 months in males and 13.5 months in females. The mean WC placement decreased after the ACL injury: two seasons before injury the mean position was 17.9 ± 11.0 (n = 12), one season before it was 22.4 ± 12.8 (n = 15). After recovery, the mean placement in seasons 1-3 was: 26.4 ± 8.9 (n = 7), 25.7 ± 10.3 (n = 13), 33.6 ± 12.2 (n = 10) (p = 0.008). Among the athletes returning to competition, only six males and three females reached their preinjury level and only one male and one female (compared to seven males and three females preinjury) reached an individual top-3 placement after ACLR, accounting for less than 10% of podiums compared to preinjury., Conclusion: Only 60% of the professional ski jumpers reached the preinjury level and less than 15% reached a top-3 placement after the ACL injury. These results support the fact that ACL tear during a ski jumping career may be a significant factor limiting high-level performance. In terms of clinical relevance, the findings implicate the need to analyse the reasons of these very low rates of return to elite-level performance, to analyse ACL injury and RTC rates at lower levels of performance and to develop specific prevention strategies in order to reduce the number of ACL injuries in this sport., Level of Evidence: Level IV., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Context: Evidence is emerging that core neurocognitive functions such as working memory and inhibitory control (ie, motor-response and attentional inhibition) are linked to the anterior cruciate ligament (ACL) injury risk. Research has been conducted in laboratory settings, but the contribution of neurocognition to actual ACL injuries under real-world conditions is unknown., Objective: To describe the possible neurocognitive errors involved in noncontact ACL injury mechanisms., Design: Case series., Setting: Soccer matches., Patients or Other Participants: A total of 47 professional male soccer players., Main Outcome Measure(s): Three independent reviewers evaluated 47 videos of players sustaining noncontact ACL injuries. Neurocognitive errors in inhibitory control were operationalized as follows: (1) motor-response inhibition was scored when a player demonstrated poor decision-making and approached the opponent with high speed that reduced the ability to stop or change the intended action and (2) an attentional error was scored when a player shifted his selective attention away from the relevant task to irrelevant stimuli., Results: Of 47 noncontact ACL injuries, 26 (55%) were related to a pressing-type injury, 19 (73%) of which involved a deceiving action made by the opponent, suggesting poor inhibitory control of the defender. Of the remaining 21 noncontact ACL injuries (45%), 16 (76%) could be attributed to attentional errors. Agreement among the 3 raters was very good for all items except poor decision-making, which showed fair to good agreement (Fleiss κ = 0.71). Interrater reliability was excellent (intraclass correlation coefficient = 0.99-1.00)., Conclusions: Errors in motor-response inhibitory control and attentional inhibition were common during noncontact ACL injury events in professional male soccer players. The interrater agreement in detecting neurocognitive errors in general was very good., (© by the National Athletic Trainers’ Association, Inc.)

Purpose: Injuries of the anterior cruciate ligament (ACL) are common knee injuries among active and younger patients. The Lever Sign Test (LST) is a relatively newer test, of which the accuracy is disputed in the existing literature. The aim of this study was to assess the accuracy with and without anesthesia of the Lever Sign test in the literature., Methods: PRISMA guidelines were followed, studies were identified using PubMed, EMBASE and Google Scholar. All studies that reported accuracy of LST performed by a clinical professional were included. Integrity of ACL was confirmed using magnetic resonance imaging or arthroscopy. Sensitivity and specificity were calculated using uni- and bivariate methods., Results: After inclusion, 3299 observations in 2516 patients were included from 23 studies. Mean age was 31.8 years and 64.2% were male. Without anesthesia, sensitivity was 79.2% (95% CI 68.7-86.9) and specificity was 92.0% (95% CI 82.2-96.6). An area under the curve (AUC) of 86.1% was found. With anesthesia, sensitivity was 86.6% (95% CI 68.0-95.2), specificity was 93.4% (95% CI 84.5-97.3) and the AUC was 91.6%., Conclusion: The Lever Sign test shows very good to excellent accuracy for ACL injury, and is a useful tool for clinical practice., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The effect of trunk stability and dynamic balance warm-up exercises on physical functional improvement remains unelucidated. This study examined whether exercises could prevent anterior cruciate ligament (ACL) injury and improve trunk muscle activation and dynamic balance in gymnasts., Methods: This comparison study, involving gymnastics practice sessions, included 31 university gymnasts and was conducted in two periods: 1 year of observation followed by 2 years of intervention. Participants performed a trunk and dynamic balance warm-up exercise program during the intervention. The effect of exercise on the incidence of ACL injury was evaluated. In addition, the paired t-test was used to compare the Y-balance distance and the changes in muscle thickness associated with trunk muscle activation at rest and during plank., Results: ACL injury risk during the intervention was significantly lower, with a relative risk of 0.23 (P=0.02, 95% CI: 0.06-0.88). Changes in muscle thickness with activation of the transversus abdominis (P<0.01, mean difference 4.1, 95% CI: 9.97-28.07, Cohen's d=0.52), internal oblique (P<0.01, mean difference 5.2, 95% CI: 9.72-21.55, Cohen's d=0.65), and external oblique (P<0.01, mean difference 5.5, 95% CI: 20.44-39.09, Cohen's d=0.71) muscles were significantly higher during the intervention. The Y-balance distance was also significantly greater in the posterior medial reach (P<0.01, mean difference 3.3, 95% CI: 1.56-6.26, Cohen's d=0.46) during the intervention., Conclusions: Exercise-based warm-up programs may decrease ACL injuries. It can improve physical functions, such as the rate of change in trunk muscle thickness and the posterior medial distance during Y balance.

Background: Arthrogenic muscle inhibition (AMI) is a process in which neural inhibition after injury or surgery to the knee results in quadriceps activation failure and knee extension deficit., Purpose: To determine the incidence and spectrum of the severity of AMI after acute anterior cruciate ligament (ACL) injury using the Sonnery-Cottet classification, to determine the interobserver reliability of the classification system, and to investigate potential important factors associated with AMI after ACL injury., Study Design: Case-control study; Level of evidence, 3., Methods: Consecutive patients who had an acute ACL injury between October 2021 and February 2022 were considered for study inclusion. Eligible patients underwent a standardized physical examination at their first outpatient appointment. This included an assessment of quadriceps inhibition, identification of any extension deficits, and grading of AMI and its reversibility according to the Sonnery-Cottet classification., Results: A total of 300 consecutive patients with acute ACL ruptures were prospectively enrolled in the study. Of them, 170 patients (56.7%) had AMI. Patients evaluated with AMI showed a significantly inferior Lysholm score, International Knee Documentation Committee score, Simple Knee Value, and Knee injury and Osteoarthritis Outcome Score than patients without AMI ( P < .0001). Multivariate analysis revealed that the presence of effusion, concomitant injuries, and high pain scores were associated with a significantly greater risk of AMI. Additional associations with the presence of AMI included a short duration between injury and evaluation, the use of crutches, and using a pillow as a support at night. In contrast, a previous ACL injury was associated with significantly lower odds of developing AMI (OR, 0.025; 95% CI, 0-0.2; P = .014). Among the 170 patients with AMI, 135 patients (79%) showed a resolution of their inhibition at the end of the consultation after application of simple exercises; the remaining 35 patients required specific rehabilitation. Interobserver reliability of the classification system was almost perfect (95% CI, 0.86-0.99)., Conclusion: AMI occurs in over half of patients with acute ACL injuries. When it occurs, it is easily reversible in the majority of patients with simple exercises targeted at abolishing AMI. The presence of "red flags" should increase the index of suspicion for the presence of AMI, and these include the presence of an effusion, high pain scores, a short time between injury and evaluation, multiligament injuries, the use of crutches, and using a pillow as a support at night. Patients with a history of ipsilateral or contralateral ACL injury are at a significantly lower risk of AMI than those with a first-time ACL injury., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.S.C. has received consulting fees and royalties from Arthrex. J.M.F. is consultant for Arthrex and New Clip Technics. M.T. is a consultant for Arthrex. E.C. is a consultant for Arthrex. G.P.H. has received a fellowship grant from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Context: Deficits in perceptual-motor function, like visuomotor reaction time (VMRT), are risk factors for primary and secondary anterior cruciate ligament (ACL) injury. Noncontact ACL injuries have been associated with slower reaction time, but whether this association exists for patients with contact ACL injuries is unknown. Exploring differences in VMRT among individuals with contact versus noncontact ACL injuries may provide a more comprehensive understanding of modifiable risk factors., Objective: To compare lower extremity VMRT (LEVMRT) in individuals with contact or noncontact ACL injuries after ACL reconstruction (ACLR)., Design: Cross-sectional study., Setting: Research laboratory., Patients or Other Participants: A total of 36 participants with primary, unilateral ACLR completed an LEVMRT assessment (contact ACL injury = 20 [56%], noncontact ACL injury = 16 [44%])., Main Outcome Measure(s): The LEVMRT was assessed bilaterally and collected using a series of wireless light discs deactivated by individuals with their feet. The ACLR-active LEVMRT (ie, ACLR limb is deactivating lights) and ACLR-stable LEVMRT were compared using separate analyses of covariance to determine the association with contact or noncontact injury using time since surgery as a covariate., Results: After controlling for time since surgery, a difference and large effect size between groups was found for the ACLR-stable LEVMRT (P = .010; η2 = 0.250) but not for the ACLR-active (P = .340; η2 = 0.065) condition. The contact group exhibited slower ACLR-stable LEVMRT (521.7 ± 59.3 milliseconds) than the noncontact group (483.4 ± 83.9 milliseconds)., Conclusions: Individuals with contact ACL injury demonstrated a slower LEVMRT while their ACLR limb was stabilizing. The group differences during the ACLR-stable LEVMRT task might indicate deficits in perceptual-motor function when the surgical limb maintains postural control during a reaction time task. After ACLR, individuals with contact injuries may need additional motor learning interventions to enhance perceptual-motor functioning., (© by the National Athletic Trainers’ Association, Inc.)

Objective: Anterior cruciate ligament (ACL) tears are exceedingly common among the athletic population and are seen with higher incidence in females. Observational studies have noted peak ACL tear rates in the luteal phase of the menstrual cycle, a time in which the hormone relaxin peaks in serum concentration., Methods: A systematic review of the literature was performed. Inclusion criteria specified all prospective and retrospective studies which included the role of relaxin in the pathogenesis of ACL tears., Results: Six studies met inclusion criteria yielding 189 subjects from clinical studies and 51 in vitro samples. Included studies found that ACL samples exhibit selective relaxin binding. When pre-treated with estrogen prior to relaxin exposure, female ACL tissue samples exhibit increased expression of collagen degrading receptors., Conclusion: Relaxin displays binding specificity to the female ACL and increased serum concentrations are correlated with increased ACL tear rates in female athletes. Further research is needed in this area., Level of Evidence: V., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Objectives: Perform a comprehensive video analysis of all anterior cruciate ligament (ACL) injuries in National Basketball Association (NBA) athletes from 2006 to 2022 to determine the associated biomechanics, injury mechanism and game situation., Methods: NBA players diagnosed with an ACL tear from 2006 to 2022 were identified and videos of each injury evaluated by two reviewers. Visual evaluation included assessment of joint kinematics at three time points: initial contact of the injured leg with the ground (IC), 33 milliseconds later (IC+33) and 66 milliseconds later (IC+66). Game situation was assessed qualitatively., Results: Videos of 38 out of 47 (80.9%) ACL tears were obtained. 9 injuries were non-contact, while 29 involved indirect contact. Between IC and IC+33, average knee valgus increased from 5.1° to 12.0° and knee flexion increased from 12.6° to 32.6°. At all time points, the majority of injuries involved trunk tilt and rotation towards the injured leg, hip abduction and neutral foot rotation. The most common game situations for injury included the first step when attacking the basket following picking up the ball (n=13), landing following contact in the air (n=11) and jump stop (n=5)., Conclusion: Three major mechanisms predominate ACL tears in NBA players: the first step following picking up the ball when attacking, landing and jump stops. None of the injuries reviewed demonstrated direct contact to the knee, emphasising the importance of body kinematics in this injury pattern. The increase in knee valgus and knee flexion between IC and IC+33 should be noted as a possible precipitant to injury., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

The anterior cruciate ligament (ACL) is frequently injured in elite athletes, with females up to eight times more likely to suffer an ACL tear than males. Biomechanical and hormonal factors have been thoroughly investigated; however, there remain unknown factors that need investigation. The mechanism of injury differs between males and females, and anatomical differences contribute significantly to the increased risk in females. Hormonal factors, both endogenous and exogenous, play a role in ACL laxity and may modify the risk of injury. However, data are still limited, and research involving oral contraceptives is potentially associated with methodological and ethical problems. Such characteristics can also influence the outcome after ACL reconstruction, with higher failure rates in females linked to a smaller diameter of the graft, especially in athletes aged < 21 years. The addition of a lateral extra-articular tenodesis can improve the outcomes after ACL reconstruction and reduce the risk of failure, and it should be routinely considered in young elite athletes. Sex-specific environmental differences can also contribute to the increased risk of injury, with more limited access to and availablility of advanced training facilities for female athletes. In addition, football kits are designed for male players, and increased attention should be focused on improving the quality of pitches, as female leagues usually play the day after male leagues. The kit, including boots, the length of studs, and the footballs themselves, should be tailored to the needs and body shapes of female athletes. Specific physiotherapy programmes and training protocols have yielded remarkable results in reducing the risk of injury, and these should be extended to school-age athletes. Finally, psychological factors should not be overlooked, with females' greater fear of re-injury and lack of confidence in their knee compromising their return to sport after ACL injury. Both intrinsic and extrinsic factors should be recognized and addressed to optimize the training programmes which are designed to prevent injury, and improve our understanding of these injuries., Competing Interests: F. S. Haddad reports multiple research grants from Stryker, Smith & Nephew, Corin, NIHR, and the International Olympic Committee, royalties from Stryker, Smith & Nephew, Corin, and MatOrtho, consulting fees from Stryker, speaker payments from Stryker, Smith & Nephew, Zimmer, and AO Recon, support for attending meetings and/or travel from Stryker, Smith & Nephew, AO Recon, and The Bone & Joint Journal, all of which are unrelated to this article. F. S. Haddad is also a Trustee of the British Orthopaedic Association and sits on the BOSTAA Executive Committee., (© 2023 The British Editorial Society of Bone & Joint Surgery.)

» Overall evidence for the treatment of an anterior cruciate ligament (ACL) injury in a pediatric or skeletally immature patient remains lows.» An ACL reconstruction is recommended with concomitant repairable chondral and meniscus injury or with symptoms of persistent instability despite high-quality rehabilitation.» Treatment decision for pediatric ACL reconstruction should use a shared decision-making model weighing the risks and benefits of both a nonoperative vs. surgical treatment., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A988)., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

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

Objective: Over the past few years, histopathological studies have demonstrated that the ligamentum mucosum (LM) contains neural and vascular structures. These findings suggest that LM can be used for proprioception and revascularization in the repair of anterior cruciate ligament (ACL). The aim of this study was to evaluate the LM structure in knees with ACL injuries. Methods: The data of patients who underwent knee arthroscopy at our clinic between 2017 and 2022 were retrospectively analyzed. Three groups were included in the study; acute ACL tears (n=89), chronic ACL tears (n=111) and intact ACLs (n=101). The arthroscopic video records of all patients were evaluated retrospectively. LM was defined in three different forms: (1) Intact, (2) ruptured, and (3) non-presence. Results: The non-presence of the LM was significantly more common in chronic ACL tears compared to the other groups (p=0.021), while the presence of the LM (either intact or ruptured) was similar between acute ACL tears and intact ACLs. In acute tears, the number of intact LM was significantly lower than that of intact ACLs (p<0.001). However, it was significantly greater than that of chronic tears (p=0.001). Conclusion: According to the present study, the likelihood of intact LM in chronic ACL tears is quite low. In this regard, we suggest that performing surgery in the acute phase of ACL injury will increase the chances of using the LM as a neurovascular source. In addition, because of the possible effect of the LM on proprioception, we recommend preserving the structure during knee arthroscopy procedures if a healthy LM is present. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) injuries are prevalent and can have debilitating consequences, with various factors potentially influencing their occurrence. This multicentric study aimed to comprehensively analyze the epidemiological characteristics of ACL injuries. We hypothesized that specific patient characteristics, such as age, sex, body mass index (BMI), and sports involvement, would be associated with distinct injury patterns and risk profiles. Methods: This cross-sectional study analyzed the medical records of 712 patients aged 15–60 diagnosed with ACL rupture. Data on demographics, injury mechanisms, associated injuries, graft type, and sports involvement were collected. Results: The majority of patients were male (93.1%), aged 15–30 years (80.2%), and overweight (66.7%). Autografts were the predominant graft choice (96.07%). Associated injuries were present in 79.5% of cases, with medial meniscus ruptures being the most common (37.36%). Sports-related (49.3%) and non-sports-related (50.7%) injuries were nearly equal, with non-contact injuries more prevalent (71.1%). In the sports-related subgroup, associated injuries emerged as a significant risk factor for ACL rupture (p = 0.014, OR = 1.596, 95% CI: 1.101–2.314), whereas non-contact mechanisms showed borderline significance (OR = 0.75, p = 0.09). Moreover, younger athletes were more susceptible to sports-related injuries (p = 0.024), with football being the primary sport involved. Conclusions: This study identified a high prevalence of concomitant injuries with ACL injury, which increased the risk of ACL injury, particularly in sports-related cases. Age-related differences in injury patterns highlight the need for age-appropriate preventive measures, especially for younger athletes participating in high-risk sports. This underscores the need for comprehensive injury assessment, targeted prevention strategies, and optimized clinical management approaches tailored to different populations' specific characteristics and risks. [ABSTRACT FROM AUTHOR]

Objective: To critically evaluate the efficacy and safety of early versus delayed anterior cruciate ligament reconstruction (ACLR) for anterior cruciate ligament (ACL) injuries based on the different cut-off values of the timing of operation., Methods: PubMed, Medline, Embase, Cochrane library, China National Knowledge Infrastructure, Chinese Biomedical Literature, and Wanfang Digital Periodical database were searched from inception to November 2022 without language restrictions. Randomized controlled trials (RCTs) and cohort studies (CSs) comparing early ACLR with delayed ACLR for ACL injuries were included., Results: Twenty-four studies (10 RCTs and 14 CSs) were included. According to the information from included studies, 3 weeks, 4 weeks, 6 weeks, 6 months, and 12 months after ACL injuries were considered as the cut-off values of early and delayed ACLR. When 4 weeks were considered as the cut-off value, early ACLR could significantly improve Lysholm score, IKDC score and VAS score at 6 and 12 months postoperatively and decrease the incidence of adverse events compared with delayed ACLR (P < 0.05). However, no statistically significant difference in positive rate of Lachman test and incidence of meniscus injuries and chondral lesions between the two groups when 3 weeks, 6 weeks, 6 months or 12 months after ACL injuries were considered as the cut-off values of early and delayed ACLR (P > 0.05)., Conclusion: The present study suggests that early ACLR, especially conducted within 3-4 weeks after ACL injuries, may be more effective for improving knee function and relieving pain compared with delayed ACLR. More high-quality RCTs are warranted., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ai-Feng Liu reports financial support was provided by National Natural Science Foundation of China. Ai-Feng Liu reports financial support was provided by Basic Scientific Research Project of Public Welfare on Central Level of Chinese Academy of Medical Sciences. The authors declare that there are no conflicts of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Introduction:  Second anterior cruciate ligament (SACL) injuries are a devastating complication following return to sport (RTS). Appropriate and safe RTS criteria that reduce the risk of SACL injuries are needed. The goal of this study was to investigate the relationship between functional and isokinetic testing at 6 months following primary ACL reconstruction (ACLR) as risk factors for SACL injuries., Methods:  Patients with primary ACLR from 1990 to 2010 were identified. Those with 6-month postoperative functional and isokinetic testing and a minimum of 2-year follow-up were included. Functional testing included vertical jump, single-leg hop, and single-leg triple hop. Isokinetic testing included concentric quadriceps and hamstrings (HSs) strength at 60 and 180 degree/s speeds. Statistical analysis evaluated the significance of the various tests between those with and without a secondary tear., Results:  In total, 344 patients with a mean age of 26.0 ± 9.8 years at an average time of 9.1 ± 3.5 years of follow-up were analyzed. Fifty-nine patients (17%) experienced SACL injuries at an average time of 4.8 years following ACLR with 34 (58%) ipsilateral graft ruptures and 25 (43%) contralateral tears. Several isokinetic measures were significantly different between the NO SACL and the SACL groups: quadriceps 60 degree/s limb symmetry index (LSI) (75 vs. 82% p  = 0.01), HS 60 degree/s LSI (92 vs. 97%, p  = 0.04), quadriceps 180 degree/s involved/body weight (BW) (41 vs. 47%, p  = 0.04), and HS 180 degree/s involved/BW (30 vs. 34%, p  = 0.04). Patients with involved limb peak quadriceps torque value greater than 65 or 50% of BW (60 and 180 degree/s) had a 2.2 and 3.1 times higher risk of an SACL injury., Conclusions:  Patients with certain elevated isokinetic scores in the injured limb at 6 months after ACLR experienced a higher rate of subsequent ACL injuries than those who had lower peak torque. Although a quantitative only analysis may not be sufficient to determine RTS criteria, clinicians should caution high-performing patients about the risk of subsequent ACL injury., Level of Evidence:  Cohort study; 3., Competing Interests: None declared., (Thieme. All rights reserved.)

Considering the frequency of anterior cruciate ligament (ACL) tears, optimal management of these injuries was the subject of a 2022 clinical practice guideline update from The American Academy of Orthopaedic Surgeons (AAOS) with input from representatives from the American Orthopaedic Society for Sports Medicine, the Pediatric Orthopaedic Society of North America, the American Orthopaedic Society for Sports Medicine, the American Medical Society for Sports Medicine, the American Academy of Physical Medicine and Rehabilitation, and the American College of Emergency Physicians. The eight recommendations and seven options to guide orthopaedic surgeons and other physicians managing patients with these anterior cruciate ligament injuries are based on the best current available evidence. The cases presented in this article are examples designed to demonstrate the clinical application of these guidelines., (Copyright © 2023 by the American Academy of Orthopaedic Surgeons.)