Anterior Cruciate Ligament Deficiency Research Articles

Plastic deformation of anterior cruciate ligament: listen to the patient, do not just rely on imaging

PurposeDiagnosing plastic deformation of the anterior cruciate ligament (ACL) is challenging: patients may not report knee instability, and MRI may not confirm the lesion, delaying adequate treatment. This study analyzed clinical findings and complaints in patients with a confirmed diagnosis of plastic deformation of the ACL.MethodsData on complaints, physical, imaging and arthroscopic assessment, and subjective evaluation of 15 patients with undiagnosed or delayed ACL insufficiency from plastic deformation of the ACL (Group 1) and 30 patients who underwent an ACL reconstruction following complete tear of the ACL diagnosed clinically and at imaging (Group 2) were compared and analyzed.ResultsA knee effusion was reported in both study groups, occurring within the first 4 h after the index knee injury, and it was statistically more significant in the complete ACL tear group. All patients reported low values (zero, one, and two) on a scale from zero to 10 in their confidence in performing high-intensity pivoting sports and physical activities. All patients reported that they did not feel comfortable in performing changing direction pivoting on their injured knee.ConclusionPlastic deformation of the ACL may not be clearly manifest clinically and on MRI, and physical exam may present subtle findings that do not allow to fully assess the function of the injured ligament. Therefore, surgeons should listen to the patient, not just rely on imaging, taking into account the patient's report of how the knee is working and their complaints as they remain the leading guide for decision-making.Level of Evidence IVDiagnostic studies – Investigating a diagnostic test.

Novel application of an imageless robotic system in simultaneous unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction.

This technical note explores the novel use of an imageless robotic surgical system for simultaneous unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament reconstruction (ACLR). Knee osteoarthritis (OA) and anterior cruciate ligament (ACL) insufficiency are common conditions that traditionally require separate management. The integration of robotic assistance offers enhanced precision in surgical procedures, addressing both medial compartment OA and ACL insufficiency in a single operation. We present a case involving a 47-year-old patient with medial compartment osteoarthritis and complete ACL rupture. The patient underwent a simultaneous robotic-assisted UKA and ACLR using the CORI Surgical System (Smith&Nephew, London, UK). This approach enables accurate tibial tunnel placement and precise soft tissue balancing. The robotic system facilitates real-time gap assessment and balancing, reducing the risk of over- or under-constraint during ACL graft tensioning. The procedure was performed with a standard medial parapatellar approach. Key steps included hamstring autograft harvesting, femoral and tibial tunnel creation, and robotic-assisted implant positioning. Post-operative rehabilitation allowed full weight-bearing by the third week. This case represents the first reported instance of using an imageless robotic system for simultaneous UKA and ACLR, highlighting its potential to standardize and improve results in complex knee surgeries. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Clinical outcomes and long-term efficacy of high tibial osteotomy in treating knee instability: An updated systematic review.

Knee joint stability is influenced by force distribution and ligament structures. High Tibial Osteotomy (HTO) treats knee deformities and redistributes load, reducing further invasive procedures. High Tibial Osteotomy (HTO) is a well-established procedure for addressing knee instability, particularly in cases involving ligament deficiencies such as ACL and PCL insufficiencies. This systematic review aims to evaluate the clinical outcomes and long-term efficacy of HTO in improving knee stability and function. A systematic literature search was conducted using Cochrane Central, PubMed, MEDLINE, and ProQuest databases for studies published between 2000 and June 2024. Eligible studies included human subjects with at least six months of follow-up and focused on HTO for knee instability. Exclusion criteria included animal studies, non-knee joint studies, and reviews. Data on patient demographics, follow-up duration, subjective and objective outcomes, and complications were extracted. Out of 536 studies identified, 11 met the inclusion criteria, encompassing 303 patients. Combining HTO with ACL or PCL reconstruction significantly improved both subjective instability and objective measures, including Lachman and Pivot Shift test grades. Patient satisfaction was high, and functional scores such as Lysholm and Tegner improved markedly. The incidence of complications was low, with minor issues such as infections and delayed union, and no reported graft failures. HTO, particularly when combined with ligament reconstruction, effectively treats knee instability due to ACL or PCL deficiency. The procedure demonstrates strong mid- to long-term outcomes, high patient satisfaction, and a low rate of complications. It remains a viable option for patients with knee instability.

Unicompartmental knee arthroplasty implant survival in patients with borderline indications.

In the literature, 80%-92% of patients are satisfied with their medial femorotibial unicompartmental knee arthroplasties (UKAs). These results are associated with a 10-year implant survival rates ranging from 94% to 98% in various studies. Such outcomes are generally reported after excluding patients with obesity, chronic anterior instability, frontal deformities, or preoperative knee flexion deformities exceeding 10 °. These contraindications remain controversial in the literature. The primary objective of this study was to compare the survival rates of implants used for medial femorotibial UKA performed under borderline indications with those of procedures performed under conventional indications and to identify the prognostic factors for revision surgery. We hypothesized that the survival of medial femorotibial UKAs is not impacted by these contraindications. This was a retrospective, single-center, observational, epidemiological study. All consenting patients who underwent medial femorotibial UKA between 2009 and 2015 were included. Patients who underwent other types of arthroplasties concurrently were excluded. The primary evaluation criterion was implant survival, which was characterized by no need for revision surgery. The borderline indications were defined as follows: obesity (Body Mass index BMI > 30), anterior cruciate ligament (ACL) deficiency, preoperative lower limb frontal deviation ≥10 °, or preoperative flexion deformity ≥10 °. A total of 468 patients were included, and the average follow-up duration was 8.5 years [7.1; 10.3]. Among them, 270 (57.7%) underwent UKA under at least one borderline indication, whereas 198 (42.3%) underwent UKA under conventional indications. Forty revision surgeries were recorded, and the average time to revision surgery was 26 months. No statistically significant difference in survival was observed between patients with borderline indications and those with conventional indications. Multivariate analysis revealed that obesity (HR = 3.0 [1.5-5.7]) and ACL deficiency (HR = 3.5 [1.4-8.8]) significantly increased the risk of revision surgery. This study revealed no significant difference in survival between UKAs performed under borderline versus conventional indications. Larger studies are needed to confirm these findings. IV; retrospective observational study. Mots clés: genou, arthroplastie, obésité, ostéoarthrite, survie.

Changes in the Elongation Pattern of the Medial Collateral Ligament During a Single-Leg Squat After Anterior Cruciate Ligament Reconstruction.

An anterior cruciate ligament (ACL) tear impairs knee biomechanics in daily activities and potentially breaks the synergy among other knee ligaments. Previous studies have demonstrated that the biomechanics of collateral ligaments is influenced by ACL deficiency. To investigate changes in the elongation patterns of the medial collateral ligament (MCL), lateral collateral ligament (LCL), and posterior cruciate ligament (PCL) during the execution of a single-leg squat before and after ACL reconstruction. Descriptive laboratory study. A total of 16 patients (mean age, 24.9 ± 8.5 years) with ACL deficiency were enrolled in the study. Magnetic resonance imaging scans of the affected knees were used to produce 3-dimensional models of the tibia and femur and identify insertion sites of the MCL, LCL, and PCL. Motion capture of a single-leg squat was performed through a biplanar radiographic system. Data were acquired before ACL reconstruction and at a minimum of 18 months (mean, 22.9 ± 4.1 months) postoperatively. The centroids of the ligaments' insertions were used to calculate the length of the investigated structures during the squat task. Absolute length (L), absolute length increase from the orthostatic resting position (ΔL), and relative length increase (ΔL%) were computed for each ligament, and preoperative and postoperative data were compared using the paired Student t test. The intraclass correlation coefficient was used to determine the reliability of the ligament insertion's identification and kinematics between 2 independent observers. Significant differences were found for the MCL in absolute length increase (P = .047; Cohen d = 0.60) and relative length increase (P = .043; Cohen d = 0.61) from rest between preoperatively and postoperatively (ΔL pre = 1.0 mm; ΔL post = -1.1 mm; difference = 2.1 mm) at 0° to 30° of knee flexion during the descending phase of the single-leg squat. No differences were seen in the elongation patterns of the LCL or PCL from before to after ACL reconstruction. The MCL was significantly longer between 0° and 30° in ACL-deficient knees compared with ACL-reconstructed knees during the descending phase of a single-leg squat. No differences were identified for the LCL or PCL. Early ACL reconstruction could have a protective effect on the MCL in combined ACL and MCL lesions.

Functional Outcomes in ACL Reconstruction: A Randomized Controlled Trial Comparing All-Inside and Transportal Techniques.

The two techniques to fix a torn ACL are the Transportal and All-Inside Techniques. However, the argument about which method is better for functional outcomes keeps going on. The aim was to look at how well these two treatments worked and their effects. We hypothesized that All-Inside and Transportal ACL reconstruction procedures would yield similar functional results. The study included 45 patients with ACL insufficiency from AIIMS, Raipur, India. Half of each ACL approach was represented by 22 AI and 23 TP participants, randomly assigned to each group. Preoperative and post-operative VAS, IKDC, and range of motion were determined at 1, 3, and 6 months. The study used IBM SPSS v20 for Data Analysis, comparing two groups using a t-test. P < 0.05 was fixed for Statistical significance. The study was dominated by young males (86.7%, 18-30 years), mainly students (44.4%). Comparable IKDC scores over time (P = 0.628); significant VAS score difference (P = 0.001). A similar movement range (P = 0.153) was observed. AI group had slightly smaller grafts (non-significant, P = 0.235). Similar Lachmann Grade distributions pre- and post-surgery; no significant post-operative complication in either group. When comparing the methods' functionalities, no statistically significant gaps emerged. All-Inside approach preserves bone and gracilis tendon, reduces post-operative pain, and strengthens knee flexors. Although, early rehabilitation favors all inside, both methods are equally effective over time. In comparison to the traditional Transportal Technique, All Inside has a greater learning curve and costs more.

Preoperative knee hyperextension is the most relevant predictor for ACL reconstruction objective failure: a machine learning analysis of 680 patients

Objectives To evaluate the predictive performance of different machine learning algorithms for the occurrence of objective failure in ACL reconstruction and to identify the most relevant predictors associated with this outcome. Methods We evaluated 680 patients submitted submitted to ACL reconstruction between January 2012 and July 2021. The study outcome was ACL objective failure, defined as a complete tear confirmed by MRI or arthroscopy evaluation or clinically ACL insufficiency. Routinely collected imaging, clinical, and demographic data were used to train 9 machine learning algorithms (k-nearest neighbors (KNN) classifier, decision tree classifier, random forest classifier, extra trees classifier, gradient boosting classifier, Light Gradient Boosting Machine (LightGBM), eXtreme Gradient Boosting (XGBoost), CatBoost classifier, and logistic regression). We used a random sample of 70% of patients to train the algorithms, and 30% were left for performance assessment, simulating new data. The performance of the models was evaluated with the area under the receiver operating characteristic curve (AUC). Results The predictive performance of all models was good, with AUC’s ranging from 0.81 to 0.88. The models with the best AUC metric were the Gradient Boosting Classifier (0.88 [95% CI, 0.81 to 0.92]) and Random Forest Classifier (0.88 [ 95% CI, 0.81 to 0.92). Knee hyperextension consistently emerged as the primary predictor across all models subjected to our analysis. Conclusion Machine learning algorithms demonstrated good performance to predict ACL reconstruction objective failure. Additionally, knee hyperextension consistently emerged as the primary predictor across all models subjected to our analysis.

Pediatric Anterior Cruciate Ligament Tears.

Anterior cruciate ligament (ACL) tears have become an increasingly prevalent problem in pediatric patients due to increased youth sports participation and early sports specialization. A high index of suspicion should be utilized for any young patient with an acute knee injury and an associated effusion or difficulty bearing weight. A thorough work-up should be performed that includes a careful assessment of growth remaining and concomitant injuries. While nonoperative management may be a consideration for select cases, most patients will benefit from early surgical management. ACL deficiency or delayed reconstruction can lead to early chondral degeneration and risk for further injury to the cartilage and menisci. The goal of ACL reconstruction is to create a stable knee and prevent secondary chondral or meniscal injury. Physeal-sparing and physeal-respecting transphyseal techniques have been developed that allow for safe and successful ligament reconstruction while minimizing the risk of growth arrest. Younger patients have a higher risk of reinjury and require a longer recovery period for a full return to sports than their older counterparts. Even though there have been advances in the safe and successful treatment of ACL tears in pediatric patients, it remains a devastating physical and psychological injury, and increased efforts should be made at prevention. Injury prevention programs have been shown to reduce the risk of ACL tears, and it is important to increase awareness and utilization of prevention strategies.

ANTERIOR CRUCIATE LIGAMENT RUPTURE DISGUISED AS PATELLAR INSTABILITY: A COMMON MISS

Patellar dislocation is a common presentation with a clear management pathway. Sometimes, however, what a patient experiences as the patella dislocating may, in fact, be ACL insufficiency.We reviewed case notes and imaging of 315 consecutive ACL reconstructions, collecting data on the date and mechanism of injury, time to MRI, and reconstruction. We noted cases initially diagnosed as patellar dislocation.25 of 315 (7.9%) patients were initially diagnosed with a patellar dislocation. Subsequently, however, MRI scans revealed no evidence of patellar dislocation and instead showed ACL rupture with pathognomonic pivot-shift bony oedema. The false patella dislocation group were 32% female and had an average age of 25; the rest of the group average age was 27.1 and there were a lower proportion of females; 21%. The false patella instability patients had a median waiting time of 412 days from injury to operation (range: 70-2445 days), compared to 392 days (range: 9 – 4212 days) for rest of the patients. 5 of the remaining 290 had MRIs showing patella oedema with medial patello-femoral ligament injury in addition to their ACL rupture.From our literature search this is a new finding which shows that ACL rupture can present with symptoms suggestive of patellar dislocation. These findings raise the risk that there are a group of people who have been diagnosed with patellar instability who instead have ACL insufficiency and so are at risk of meniscal and chondral damage. Further research should analyse those diagnosed with patellar instability to quantify missed ACL injuries.

Guided Growth for Correction of Elevated Tibial Posterior Slope in Pediatric ACL Deficiency: A Case Report.

Fourteen-year-old boy, history of autism presented with bilateral knee instability. Imaging revealed bilateral anterior cruciate ligament (ACL) insufficiency, 20° of posterior tibial slope (PTS) on the right and 18° on the left. A guided growth technique using anterior placed tension band plates was used to correct the PTS. At 22 months, the PTS corrected to 5.5° on the right and 6° on the left. The patient's knee stability improved, and he resumed activities at 30 months. Pediatric ACL insufficiency in the setting of elevated PTS can be successfully corrected with a guided growth technique.

Factors Associated With a Successful Return to Performance After Anterior Cruciate Ligament Reconstruction: A Multiparametric Evaluation in Soccer Players.

Anterior cruciate ligament reconstruction (ACLR) is highly recommended in patients with ACL deficiency who must perform at a high physical level. A combination of functional and psychological outcome measures is necessary to provide a comprehensive evaluation of functional status after successful return to sport after ACLR. To identify factors associated with higher functional outcomes among soccer players who had returned to full sports participation after ACLR. Cohort study; Level of evidence, 3. A total of 168 out of 231 patients who underwent primary unilateral arthroscopic anatomic single-bundle ACLR were available at follow-up. Postoperatively, knee function, generic health outcomes, and psychological impact were assessed using the International Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm Knee Scoring Scale, the 12-item Short Form Health Survey (SF-12), and the ACL-Return to Sport after Injury scale. After a mean follow-up of 35.5 ± 22.6 months, 85% of soccer players returned to performance. Midfielder position was associated with a better SF-12 Physical Component Summary (PCS) score (P = .013), IKDC (P = .003), total KOOS (P < .001), KOOS Symptoms (P = .004), KOOS Pain (P = .029), KOOS Activities of Daily Living (ADL) (P = .044), KOOS Sport and Recreation (Sport/Rec) (P = .001), KOOS Quality of Life (QoL) (P < .001), and Lysholm score (P = .008). Playing only on natural grass was associated with lower SF-12 PCS scores (P = .003), total KOOS (P = .001), and KOOS Sport/Rec (P = .011). Playing only on artificial turf was associated with lower Lysholm score (P = .018) and total KOOS (P = .014). The contact mechanism was associated with higher IKDC (P = .044) and KOOS QoL (P = .048), and injury affecting the dominant limb was associated with lower SF-12 Mental Component Summary scores (P = .012). Playing at a nonprofessional level was associated with lower total KOOS (P = .028), KOOS Symptoms (P = .002), KOOS ADL (P = .033), and KOOS Sport/Rec (P = .016). Professional soccer players and the midfielder position are associated with better functional scores upon returning to the sport. A history of noncontact ACL injury and playing on a single type of surface are associated with lower functional outcomes upon returning to the sport. Lower mental health scores can be expected after injury of the dominant limb.

Redistribution Of Inter-joint Sharing Of The Total Support Moment During Uphill Walking In ACL Deficiency

Redistribution Of Inter-joint Sharing Of The Total Support Moment During Uphill Walking In ACL Deficiency

High Tibial Osteotomy in Sport-Related Cases

High Tibial Osteotomy (HTO) is a surgical procedure increasingly employed in sport-related cases with the aim of preserving knee joint function and delaying or altogether avoiding knee compromise. This technique involves the realignment of the tibial plateau through controlled bone cuts, resulting in an optimized distribution of forces on the knee joint. Sport-related activities often lead to unique knee joint stresses, particularly in cases of chronic anterior cruciate ligament (ACL) deficiency, varus malalignment, or early-stage osteoarthritis. HTO offers an alternative treatment option for athletes and active individuals seeking to maintain their performance levels while simultaneously addressing their knee joint issues. This procedure offers an effective approach to alleviate symptoms, correct alignment, improving stability, preserve meniscal tissue and cartilage, The HTO procedure can be a procedure offered along with ligament reconstruction procedures and other soft tissue repairs in the knee in mal-aligned knee conditions. Studies show that there is a relationship between failure of ACL reconstruction and others soft tissue procedurs and mal alignment of the knee Although HTO offers many advantages, careful patient selection and evaluation is essential to maximize the likelihood of a successful outcome. A comprehensive preoperative assessment, including physical examination, radiographic evaluation, and review of detailed medical history, type of exercise, and patient expectations will help identify eligible patients and reduce the potential for complications.

English Translation and Cultural Adaptation of the Knee Numeric-Entity Evaluation Score (KNEES-ACL): A Condition-Specific Patient-Reported Outcome Measure for Anterior Cruciate Ligament Injuries

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.

Younger age, longer delay to surgery and meniscal tears are associated with a smaller ACL remnant: An analysis from the registry of the Francophone Arthroscopic Society

AbstractPurposeThis study aimed to evaluate which preoperative patient, injury or clinical factors were associated with the anterior cruciate ligament (ACL) remnant volume in patients undergoing ACL surgery. It was hypothesized that the main factors determining an insufficient ACL remnant volume at the time of surgery were younger age and longer time to surgery.MethodsA retrospective analysis from the Francophone Arthroscopic Society's registry was conducted, including 1565 patients with an ACL lesion underdoing a primary ACL surgery (reconstruction or repair) between June 2020 and June 2023. Patients were excluded in case of revision surgery and incomplete data. Preoperative factors—including patient demographics, delay to surgery, preoperative laxity and the presence of meniscal tears or cartilage lesions—were analysed to determine their influence on ACL remnant volume (estimated by the surgeon as the percentage of residual volume). Univariate, multivariate and receiver operating characteristic curve analyses were performed to explore these relationships.ResultsMultivariate analyses demonstrated that younger age (&lt;20 years and 20–30 years compared to ≥40, p = 0.02), higher time from injury to surgery (≥12 months compared to &lt;3 months, p = 0.01) and the presence of a medial (p = 0.01) or a lateral meniscal tear (p = 0.02) were significant predictors of an ACL remnant volume ≤ 50%.ConclusionsYounger age (under 30 years of age), a time from injury to surgery above 12 months and the presence of medial and lateral meniscal tears are associated with higher odds of observing a smaller ACL remnant volume at the time of the ACL surgery. These factors should be considered when planning ACL remnant preservation techniques.Level of evidenceLevel III.

Anterior Cruciate Ligament Reconstruction Utilizing Double Adjustable-Loop Suspensory Fixation Devices Provides Good Clinical Outcomes in Patients under the Age of 40 Years at Two-Year Follow-Up.

Background: Anterior cruciate ligament reconstruction (ACLR) using double adjustable fixation gained popularity in the last decade due to its minimally invasive technique. However, suspensory fixation devices could be related to recurrent instability, poor clinical outcomes, and patient dissatisfaction. The present study aims to evaluate the clinical outcomes following ACLR using double adjustable-loop suspensory fixation devices in the demanding population of young patients. Methods: Between 2019 and 2022, 95 patients with knee post-traumatic anterior cruciate ligament insufficiency were treated with primary ACLR using semitendinosus quadrupled graft and double adjustable-loop suspensory fixation devices and followed for at least two years. Concomitant lesions were also treated at the same surgical time. The knee examination form of the International Knee Documentation Committee (IKDC) was used to assess clinical evaluation, and the return to physical activities using the Tegner Activity Scale was recorded. Patient-reported objective measures (PROMs) were also evaluated, including the IKDC subjective and Lysholm scores. Results: Sixty-six males and twenty-nine females with a mean age of 23.8 (range 18-37) and a mean BMI of 24.9 (SD ± 2.42) kg/m2 were included in this study. All patients were evaluated clinically as normal or nearly normal at the final follow-up. PROMs also significantly improved postoperatively (p < 0.05) compared to the preoperative values. The Tegner Activity Scale increased from 2 to 7, the IKDC mean score improved from 43.9 (±8.9) to 93.3 (±12.3), and the modified Lysholm from 47.3 (±11.1) to 92.9 (±16.6). No complications or adverse events were recorded. Conclusions: Anterior cruciate ligament reconstruction utilizing double adjustable-loop suspensory fixation devices provides good clinical and functional outcomes in young patients at a two-year follow-up.

Longitudinal assessment of knee joint proprioception using weight-bearing and non-weight-bearing tests throughout rehabilitation after anterior cruciate ligament reconstruction

ObjectiveEvaluate active knee joint position sense (JPS) throughout rehabilitation after anterior cruciate ligament reconstruction (ACLR). DesignLongitudinal. SettingMotion laboratory. ParticipantsTwenty-two individuals post-ACLR and 22 activity-matched non-injured controls performed weight-bearing and non-weight-bearing knee JPS tests. The ACLR participants performed at three functional timepoints: T1, able to perform single-leg sit-to-stand; T2, able to hop maximally; T3, cleared for return to sports. Controls performed on one occasion. Main outcome measuresConstant, absolute, variable errors (CE, AE, VE) and interlimb symmetry estimates (100% signifying perfect symmetry), for 40° and 65° knee flexion target angles. ResultsFor the weight-bearing 40° condition, CE and AE of the ACLR knee significantly increased from T1 to T2 (P = 0.010) and T1 to T3 (P = 0.002). Consequently, interlimb asymmetry for AE significantly increased from T1 (AEsym% = 101.2% ± 55.4%) to T3 (AEsym% = 139.7% ± 54.8%). Compared to controls, AE for the ACLR knee was significantly smaller at T1 (P = 0.016). No other significant differences were observed. ConclusionsSmaller JPS errors at early rehabilitation while weight-bearing may have been due to heightened quadriceps activation and increased γ motor neuron sensitivity, compensating for deficient ACL mechanoreceptors. In contrast, non-weight-bearing testing did not reveal changes over time. Clinicians are advised to consider these distinctions when assessing proprioception at different rehabilitation stages.

Is Visual Reliance Increased in Athletes After ACL Injury? A Scoping Review.

Individuals with anterior cruciate ligament (ACL) injury often exhibit visual cognitive deficits during tasks that require neuromuscular control. In this paper, we present evidence of increased visual reliance after ACL injury during a range of clinically applicable cognitive-motor tasks. This information is essential to strengthen the scientific rationale for therapeutic interventions that target maladaptive neuroplasticity and may translate to improved return-to-sport (RTS) outcomes following ACL injury. The objectives of this study are (1) to determine if visual reliance is present during common rehabilitation-based assessments after ACL deficiency (ACL-D) or ACL reconstruction (ACL-R), (2) to describe how visual reliance is assessed during such tasks, and (3) to provide information to help clinicians and patients understand the clinical relevance of cognitive load in the assessment and intervention of visual reliance. Scoping review. We searched MEDLINE, EMBASE, CINAHL, SCOPUS, and PEDro databases. Only primary studies published in English were included without time limitations. Qualitative analysis of the included studies was performed. We synthesized the results of 23 studies. A total of 7 studies (31%) included patients with ACL-D, 15 studies (65%) included patients with ACL-R, and 1 study (4%) included patients with ACL-D and ACL-R. Evaluation of tasks, task evaluation setting, visual conditions, outcome measures, and presence of increased visual reliance were identified. Most studies investigating patients with ACL-D, contrary to those with ACL-R, exhibited worse postural stability during eyes-closed conditions than uninjured controls. Complete visual obstruction (i.e., eyes closed or blindfolded) was the most frequently reported method to disrupt vision (52%). The addition of a visual-cognitive challenge resulted in significantly worse postural stability in patients with ACL-R compared with controls. Visual reliance was most commonly assessed during single leg stance with complete visual obstruction. The majority of studies on patients with ACL-D indicate that they exhibit poorer postural stability in eyes-closed conditions when compared with uninjured controls, which suggests increased visual reliance. There is less evidence of visual reliance in patients who have undergone ACL-R compared with those with ACL-D. Adding a visual-cognitive load was found to be more effective in inducing postural stability deficits in individuals who have undergone ACL-R. IV. The protocol was a priori registered on Open Science Framework ( https://osf.io/p4j95/ ).

Health-related quality of life for children with anterior cruciate ligament deficiency: Ensuring content validity of the new KIDS-KNEES-ACL questionnaire.

The existing knee-specific pediatric patient-reported outcome measures (PROMs) lack content and construct validity for children with anterior cruciate ligament (ACL) injury. This impairs their accuracy which can lead to false interpretations of data and inaccurate clinical guidelines. The purpose of this study was to develop a content-valid PROM for children with an ACL injury. The process adhered to the COnsensus-based Standards for the selection of health Measurement INstruments guidelines for PROM development. Informants were children with ACL deficiency and sampled based on age, sex, and treatment. Semistructured interviews were conducted exploring themes within the International Classification of Functioning, Disability and Health model. Interviews continued beyond data saturation. By thematic analysis and by probing items from the adult PROM 'KNEES-ACL', new themes and items emerged. Content coverage, relevance and understandability were continuously evaluated. All interviews were recorded and transcribed verbatim. The NVivo 12 software was used for data analysis and coding of items. A PROM of 60 items across nine subscales was formed. From cognitive interviews, 19 new items emerged. Forty-one of 55 items from KNEES-ACL were endorsed as relevant; however, all required rewording to ensure understandability. Substantial differences in the psychosocial impact between adults and children were observed. The children experienced a more considerable negative psychosocial impact caused by a loss of participation in sports, lower self-confidence and loss of social networks. This resulted in four new domains. The physical issues were similar to adults, with few exceptions. The 'KIDS-KNEES-ACL' 1.0 (qualitative version) was developed. This version will be subjected to psychometric analysis, resulting in adequate measurement properties of the final KIDS-KNEES-ACL 2.0. As the only adequate pediatric ACL-specific PROM, its use in clinical trials and databases will enhance PROM data quality, and strengthen clinical guidelines and thus the treatment of children with ACL injury. Not applicable.

The Stabilized Lachman’s Test: A Highly Sensitive, Specific and Accurate Test to Diagnose Acute ACL Tears

Background The Lachman’s Test (LT) is the one of the most relied tests for the clinical diagnosis of a torn Anterior Cruciate Ligament (ACL). The accuracy of the traditional LT is largely dependent on the skill and experience of the observer as well as the timing of the knee was examined in respect to the injury. Wroble &amp; Linderfeld first described the stabilized Lachman’s Test (SLT) in 1988. The examiner’s thigh is placed underneath and supports the thigh while the examiner’s hand (the opposite one to the extremity being examined) is used to stabilize the thigh. Purpose The purpose of this study was to prospectively analyze the sensitivity, specificity, and accuracy of the SLT to diagnose acute ACL tears. The hypothesis is that the SLT is a very sensitive, specific, and accurate test to diagnose ACL deficiency in acutely injured knees. Methods Two hundred patients with acute knee injuries were prospectively studied. All were examined within 30 days of injury (average – 8.3 days). Any patients with a previous ipsilateral or contralateral ligament knee injury were excluded from this study. All knees were examined prior to examining or interviewing the patient. There were 83 (41.5%) females and 117 (58.5%) males with an average age of 27.3 years. The SLT results were not graded but recorded as a positive or negative result. ACL tears were definitively diagnosed with MRI. Results On the initial examination there were 46 (23%) patients that had SLT that was recorded as positive and 154 (77%) that were considered negative. Forty-eight patients (24%) had a torn ACL and in 152 (76%) knees, the ACL was found to be intact by MRI. The SLT produced 44 (22%) true positives and 150 (75%) true negatives as well as 4 (2%) false negatives and 2 (1%) false positives. The resulting sensitivity was 91.7%, specificity was 98.7% and accuracy was 97%. The positive predictive value was 95.7% with the negative predictive value of 97.0%. The positive likelihood ratio was 69.9 and the negative likelihood ration was 0.085 Discussion The SLT is a highly sensitive, specific and accurate test for diagnosing ACL tears in the knee. The advantage of the SLT is that it allows the patient to relax the leg easily because the thigh is resting on a stable object. The examiner will feel the lower extremity relax by increased pressure on their own thigh and as soon as they feel this the SLT is performed. The examiner’s hand can now easily stabilize the thigh and control the leg’s rotation even in patients with large thighs or with clinicians with smaller hands, thus increasing the reliability and reproducibility of the SLT. Conclusion The SLT is highly sensitive, specific and accurate and has advantages over the standard LT. The SLT is a valuable tool in the armament of the clinician’s physical exam and diagnostic testing. It is beneficial for clinicians to at least try and compare it to the standard LT, especially those with less clinical experience.