Living With Injury: A Phenomenology of Sport Injury Rehabilitation

Is the anterolateral ligament the smoking gun to explain rotational knee laxity or just vaporware?

Techniques in Double-Bundle Anterior Cruciate Ligament Reconstruction: As Simple as ABC, or Putting the Cart Before the Horse?

A Call for More Studies Evaluating Posttraumatic Knee Osteoarthritis in Patients Undergoing Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Stabilization

Osseous Deficits After Anterior Cruciate Ligament Injury and Reconstruction: A Systematic Literature Review With Suggestions to Improve Osseous Homeostasis

Static patellofemoral alignment in anterior cruciate ligament deficient knees; a retrospective analysis with magnetic resonance imaging

Double bundle or double trouble?

Effect of Medial-Lateral Position of the Tibial Anteromedial Bundle Tunnel on Knee Biomechanics

Over 80% of patients anticipate fully returning to sport (RTS) within 1year after anterior cruciate ligament reconstruction (ACLR), but only one quarter of patients succeed. Although several factors influence the RTS process, this study focused on how psychological responses to injury, such as injury-related fear and self-determined motivation, help to explain variation in rehabilitation experiences. There is limited information about how these meaningful psychological responses to injury are connected to responses such as athlete burnout or how patient perceptions of these responses relate to rehabilitation. The purpose of this qualitative study was to explore how patient perceptions of injury-related fear, self-determined motivation, and athlete burnout influence individual psychological and rehabilitation experiences at 4 to 6 months post-ACLR. Qualitative study. Eight patients (female = 4, age = 16.3 ± 1.9) between 4 and 6 months post-ACLR who injured their knee playing or training for sports were included in the study. Patients completed the Sport Motivation Scale-6, Athlete Burnout Questionnaire, Perceived Stress Scale 4, and Tampa Scale of Kinesiophobia-11 to measure self-determined motivation, athlete burnout, stress, and injury fear. These questionnaires collected descriptive data used to guide audio- and video-recorded semistructured interviews. The interviews were transcribed and analyzed in a 6-stage process of thematic analysis. Thematic analysis revealed 3 themes related to how participants perceived their rehabilitation experiences: (1)acknowledging recurring struggles during recovery, (2)finding motivation to RTS and normal life, and (3)successfully navigating the recovery process. In particular, participants described the impact of positive shifts in their psychological perceptions at 4 to 6 months post-ACLR. Patients 4 to 6 months post-ACLR described how struggles during their recovery and rehabilitation experiences were improved by positive shifts in their psychological perceptions. Increasing positive psychological awareness within a supportive rehabilitation environment may improve rehabilitation experiences and RTS rates after ACLR.

The Adverse Effect of Femoral Nerve Blockade on Quadriceps Strength after ACL Reconstruction (SS-13)

Background: With increasing road traffic accidents and athletic participation, traumatic lesions of the ligaments about the knee are becoming increasingly more common. Those injuries can be isolated or combined with other components of the knee. No procedure is ever completely free of risks. However, Anterior Cruciate Ligament (ACL) reconstruction is a safe procedure that is performed thousands of times each year. ACL reconstruction surgery uses a graft to replace the ligament. The most common grafts are autografts using part of body, such as patellar tendon or one of the hamstring tendons. Results of arthroscopic ACL reconstruction have been excellent; the success rate has been reported to be more than 95% in term of patient satisfaction. Aim of the work: was to discuss anatomy and biomechanics of anterior cruciate ligament and the complications of arthroscopic anterior cruciate ligament reconstruction. Conclusion: It could be concluded that the challenge is to perform the reconstructive procedure with high success and minimal complications and morbidity. To accomplish this, it requires a combination of a skilled surgeon, appropriate graft selection and careful attention to the details of rehabilitation.

To investigate the effectiveness of double-bundle anterior cruciate ligament (ACL) reconstruction combined with anterolateral ligament (ALL) reconstruction in the treatment of revision patients with ACL graft failure. Between January 2018 and June 2019, 15 patients underwent ACL revision with double-bundle ACL reconstruction combined with ALL reconstruction. There were 12 males and 3 females with an average age of 30.1 years (range, 17-49 years). The technique of primary ACL reconstruction included single-bundle reconstruction in 13 cases and double-bundle reconstruction in 2 cases. These reconstructions applied autografts in 14 cases and allograft in 1 case. The causes of ACL reconstruction failure were identified as traumatic rupture in 9 cases and non-traumatic failure in 6 cases, including 2 cases of graft absorption and 3 cases of graft laxity. The average time from the primary ACL reconstruction to revision was 28.5 months (range, 8-60 months). The subjective and objective indicators of knee joint function were compared before operation and at last follow-up to evaluate the effectiveness. The subjective indicators included International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score. The objective indicators included anterior tibial translation (dynamic and static) and side-to-side difference (SSD), pivot-shift test, Lachman test, the difference of single-legged hop test, and the loss ratio of extensor muscle strength on the affected side. All incisions healed by first intetion, and no complications such as infection, venous thrombosis of lower extremity, or neurovascular injury occurred. All patients were followed up for an average of 19.1 months (range, 12-30 months). At last follow-up, all patients had returned to pre-injury sports level. The IKDC score, Lysholm score, and Tegner score were significantly improved ( P<0.05); anterior tibial translations (dynamic and static) significantly decreased when compared with preoperative one ( P<0.05) and returned to the physiological range. The SSD, Lachman test, pivot-shift test, the difference of single-legged hop test, and the loss ratio of extensor muscle strength on the affected side were significantly better than those before operation ( P<0.05).During the follow-up, there was no re-rupture of the graft, no stiffness of the knee joint and limitation of mobility; 1 case had a protruding femoral end compression screw, which was removed through the original incision under local anesthesia. Double-bundle ACL reconstruction combined with ALL reconstruction can significantly improve the knee function in revision patients with ACL graft failure. It can reduce the anterior translation of tibia, and effectively prevent postoperative rotational instability of the knee.

Background:The first case series to report on return to play (RTP) in National Football League (NFL) players after primary anterior cruciate ligament (ACL) reconstruction (ACLR) published an RTP rate of 63%. Other studies that have attempted to estimate RTP after ACLR in these elite athletes have been largely based on secondary sources. This study is the second to report the authors’ own results in treating ACL injuries in NFL players spanning a study period of 25+ years.Purpose:To report the senior authors’ experience treating ACL injuries in NFL players as well as revisit the concept of RTP as it is currently used to measure successful surgical outcomes in professional athletes.Study Design:Case series; Level of evidence, 4.Methods:A total of 47 NFL players were treated at our institution for knee injuries that included a complete tear of the ACL; of these, 41 were primary ACLR and 6 were revision ACLR. Of the primary ACLRs, 6 were classified as ACL plus additional ligament and 3 were classified as multiligament. Return to game play (RTGP) was defined as returning to play in a regular-season game. Successful return to previous participation (RTPP) was defined as return to a level of participation equal to the level the player had reached before injury. Multivariate analysis was used to assess predictors of successful RTPP.Results:Using the RTGP criteria proposed by prior authors, the RTGP after primary ACLR was 73%. Using our proposed RTPP criteria, 87.8% of players successfully returned to the same level of participation after primary ACLR. RTGP percentage for all NFL players after ACLR (including multiligament injuries) was 67.6%, and the overall RTPP for those patients was 87.8%. In multivariate analysis, age ≤25 years was predictive of successful RTPP. High draft picks and offensive players played more seasons after primary ACLR. ACL graft rupture occurred in 4.3% of this cohort. Contralateral ACL tear occurred in 8.5%.Conclusion:Regardless of which definition is used to measure a successful outcome after ACLR surgery, the findings of this study suggest that successful return after primary ACLR in NFL athletes is higher than previously reported. While concomitant reconstruction of a single collateral ligament did not affect RTPP, revision ACLR or bicruciate plus collateral ligament reconstruction was associated with a lower RTPP rate. Age ≤25 years predicted successful RTPP. The risk of a future ACL tear of either knee after index reconstruction was approximately 13%.

Objective To explore the operating methods and clinical effects of reconstruction of anterior cruciate ligament with LARS artifical ligament. Methods From October 2012 to June 2015, the clinical data of twenty-four patients with arthroscopic reconstruction of anterior cruciate ligament with LARS artifical ligamennt in Capital Medical University Beijing Friendship Hospital Pinggu Hospital were analyzed retrospectively.All patients underwent anatomical and isometric reconstruction of anterior cruciate ligament to drill femoral and tibial tunnel.The recovery of knee joint function was evaluated by Lysholm scoring system, and the clinical effect was observed. Results All 24 patients were available for follow-up with an average of (22.5±1.5) months.No wound infection occurred during the period.Joint instability and weak leg symptoms and knee pain were obviously improved, the scope of joint activities was increasing.The Lysholm scores improved from a preoperative score of (40.20±1.26) points to postoperative (92.20±2.18)points, and the difference between the two groups was statistically significant (t=2.156, P<0.05). According to the modified Lysholm scoring standard, among 24 cases, 15 cases were excellent, 7 cases were good, 2 cases were fair, and the excellent and good rate was 91.6% (22/24). Conclusion The reconstruction of the anterior cruciate ligament with LARS artificial ligament has the advantages of small trauma, definite curative effect and less complications.It can achieve the purpose of anatomic reconstruction of the anterior cruciate ligament and can effectively restore the stability of the knee joint. Key words: Arthroscopic; LARS; artifical ligament; anterior cruciate ligament(ACL)

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To compare the outcomes of anterior cruciate ligament (ACL) reconstruction with those of combined ACL and anterolateral ligament (ALL) reconstruction in ACL-deficient knees. The objective of this study wasto improve knowledge regarding the treatment of ACL-deficient knees with combined ACL and ALL reconstruction. Combined ACL and ALL reconstruction has been hypothesized to result in better clinical and functional outcomes than isolated ACL reconstruction (ACLR). One-hundred and seven adult male athletes with ACL tears and high-grade pivot shifts were randomized into two groups. Those in group A (n = 54) underwent ACLR, while those in group B (n = 53) underwent combined ACL and ALL reconstruction. The median age was 26 (18-40) and 24 (18-33) years in groups A and B, respectively, and the median follow-up was 60 (55-65) months. Physical examination findings, instrumented knee laxity tested using a KT-1000 arthrometer, and International Knee Documentation Committee Scale (IKDC) scores were used to evaluate the outcomes. One-hundred and two patients were available for follow-up: 52 in group A and 50 in group B. Postoperatively, the pivot shift was normal in 43 (82.7%) and 48 (96%) patients in groups A and B, respectively (p < 0.001). The median instrumented knee laxity was 2.5 ± 0.7 (1.2-6.1) mm in patients in group A and 1.2 ± 0.7 (1.2-3.2) mm in patients in group B (p < 0.001). Additionally, 44 (84.6%) patients in group A had normal IKDC scores and 3 (5.8%) had nearly normal scores, while 48 (96.0%) patients in group B had normal IKDC scores and 2 (4%) had nearly normal scores (p < 0.001). Combined ACL and ALL reconstruction, compared with isolated ACLR resulted in favourable clinical and functional outcomes, as demonstrated by decreased rotational instability and instrumented knee laxity, a lower graft rupture rate and better postoperative IKDC scores. 1.