Anterior Cruciate Ligament Injury Research Articles

The presence of a Segond fracture in ACL-injured patients is associated with increased internal tibial rotation on preoperative MRIs

BackgroundSegond fracture is considered a component of the anterolateral complex (ALC) injury, yet the underlying cause and clinical outcomes of this bony avulsion remain subjects of debate. Additionally, MRI measurements of altered tibiofemoral position in anterior cruciate ligament (ACL)-injured patients with a Segond fracture have not been reported. The purpose of this study is to measure the rotational tibiofemoral position on MRI in ACL-injured patients with a Segond fracture.MethodsA total of 44 patients with a primary ACL injury and a concomitant Segond fracture were included in the Segond fracture group, with the time from injury to MRI within 3 months. Avulsion was confirmed via preoperative computed tomography (CT) scans. The control group comprised 44 matched patients with primary ACL injury and an MRI-determined ALC injury but without a Segond fracture, also with the time from injury to MRI within 3 months. The MRI-determined ALC injury included injuries to the anterolateral ligament, Kaplan fibers, and anterolateral joint capsule, as identified based on previous studies. Sex, age, and BMI were matched between the two groups using propensity score matching (PSM). Arthroscopic findings, concomitant collateral ligament injuries, and preoperative MRI measurements were compared between the two groups.ResultsThe Segond fracture group demonstrated a higher frequency of concomitant patellar and femoral trochlear injuries (p = 0.0110) and lateral collateral ligament injuries (p = 0.0121) compared to the control group. Additionally, significantly increased internal rotational tibial subluxation (IRTS) (p = 0.0095) and axial internal tibial rotation (ITRa) (p = 0.0306) were observed in the Segond fracture group. A strong positive correlation was found between IRTS and ITRa (rp = 0.8201), indicating that these two tibial rotation measurement methods were correlated. No significant differences were observed in the measurements of anteroposterior tibiofemoral position and posterior tibial slope (PTS) between the two groups.ConclusionThe presence of a Segond fracture was associated with significantly increased internal tibial rotation measured on MRIs, suggesting that this bony avulsion may represent a more severe form of ALC injury in ACL-injured patients and should be managed with caution.

Familial Predisposition to Anterior Cruciate Ligament Injury in Australian Rules Footballers.

A community athlete with an anterior cruciate ligament (ACL) injury is 2.5 times more likely to have a family history of ACL injury than an athlete without an ACL injury. The prevalence of family history and its relationship to ACL injury has not been investigated in elite athletes playing a high-risk sport such as Australian rules football. The purpose of this study was to determine whether there is an association between primary ACL injury and family history in professional male and female Australian Football League (AFL) players. It was hypothesized that players with a history of ACL injury would have greater rates of family history. Case-control study; Level of evidence, 3. All AFL players in the state of Victoria, Australia, were invited to complete a survey querying about their history of ACL injury and whether they had any immediate family members with a history of ACL injury. ACL injury history was compared in those with and without a family history of ACL injury according to sex. Completed surveys were obtained from 615 out of a possible 672 (91.5%) AFL players, of whom 410 were men and 205 were women. Of players with a history of ACL injury, family history was reported in 47% of male players (15 of 32) and 32% of female players (7 of 22). Male players with an ACL injury history were 3.19 times (95% CI, 1.55-6.76; P < .003) more likely to have a positive family history compared with those without ACL injury, and female players with an ACL injury history were 1.7 times (95% CI, 0.66-4.5; P = .2) more likely to report a family history than those without. A strong association was observed between family history and primary ACL injury history in male Australian rules football players. The same association was not statistically significant in female players.

Diagnostic Accuracy of Magnetic Resonance Imaging in the Diagnosis of Anterior Cruciate Ligament Injury taking Arthroscopy as Gold Standard

Objective: To determine the diagnostic accuracy of magnetic resonance imaging (MRI) in the diagnosis of anterior cruciate ligament injury, using arthroscopy as the gold standard. Methodology: It was a descriptive, cross-sectional study that included 154 patients with suspected anterior cruciate ligament injury from the Department of Orthopaedics, Imran Idrees Teaching Hospital, Sialkot. All patients underwent arthroscopy and the presence or absence of ACL (anterior cruciate ligament) injury was noted. MRI findings were compared with arthroscopy findings. Results: Among the 94 MRI-positive patients, 88 (True Positive) had ACL injury while 06 (False Positive) had no ACLinjury on arthroscopy. Out of 60 MRI-negative patients, 08 (False Negative) had ACL injury on arthroscopy while 52 (True Negative) had no ACL injury. Overall sensitivity, specificity, PPV (positive predictive value), NPV (negative predictive value) and DA (diagnostic accuracy) of MRI in the diagnosis of ACLinjury, taking arthroscopy as the gold standard was 91.67%, 89.66%, 83.62%, 86.67% and 90.91% respectively. Conclusion: The study concluded that MRI is a very sensitive and precise diagnostic modality. It has significantly improved the ability to diagnose ACL injuries, allowing for more accurate and reliable assessments. Additionally, the use of MRI has been instrumental in reducing the number of purely diagnostic arthroscopies, thereby minimizing the need for invasive procedures and enhancing patient care. Keywords: Knee injury, Magnetic Resonance Imaging, Arthroscopy, Anterior cruciate ligament.

Establishment of anterior cruciate ligament injury thresholds for injured pediatric population with GNRB®, a prospective study on 141 children

BackgroundTreating an anterior cruciate ligament (ACL) injury in pediatric patients is challenging. The GNRB® is a diagnostic tool for laximetry and can provide valuable information for clinical decision. As few data exist on this subject, the first objective is to provide physiological laxity values of anterior tibial translation in healthy and pathological knees in pediatric population by age and gender groups. A second objective is to establish injury thresholds with the GNRB®. MethodsThis prospective study included 141 pediatric patients with a complete ACL tear. They all underwent GNRB® measurements before the surgery. Age and gender groups were created: child/adolescent girls and child/adolescent boys. Thresholds were established using ROC curves and 2-factors ANOVA tests were used for comparisons. ResultsA significant age effect was found for laxities measured on healthy knees. Significant age and gender effects were found for laxities measured on pathological knees and for side-to-side differences of laxity (SSD) between healthy and pathological knees. The optimal threshold to detect a complete ACL rupture with GNRB® is 1.5 mm at 134N with a sensitivity of 83.7% and a specificity of 92.7%. ConclusionGNRB® brought new information about ACL laxities for healthy and pathological knees in pediatric population. Children have a greater anterior tibial translation which decreases gradually with age, and girls have grater laxities than boys. Thresholds for complete ACL tears, presenting good predictive values, were established and can help surgeons in their decisions to improve clinical practice.Level of evidence: Prospective cohort study, level of evidence III.

Patient-Specific Implant for Anatomic Restoration of Lateral Femoral Condyle Contour After Impaction Fracture Associated With an ACL Tear

Impaction fractures of lateral femoral condyle (LFC-IF) are challenging entities following anterior cruciate ligament tears. Anatomic reduction and restoration of the native LFC curvature is crucial in their treatment, because if they are neglected, it may potentially lead to incongruence in the lateral knee compartment with subsequent cartilage deterioration or damage to other intra-articular structures. Previously established operative techniques seem to achieve these milestones, yet there is still a potential risk of cartilage breakage or nonanatomical reduction. The presented technique addresses those weak points by the use of patient-specific implants, which provides the opportunity to closely restore the anatomical LFC curvature with minimal risk of osteochondral fracture of the LFC-IF site.

High Revision Rate After Transphyseal ACL Reconstruction in Skeletally Immature Patients

Objectives: There remains considerable debate regarding the optimal management of anterior cruciate ligament (ACL) injuries in skeletally immature patients. This study aims to evaluate the clinical outcomes of transphyseal ACL reconstruction in patients with open growth plates. Methods: This retrospective study included skeletally immature patients with full-thickness ACL tears and confirmed open physis. ACL reconstructions were performed using a four-strand semitendinosus autograft, with an additional gracilis tendon graft if needed. The surgical technique emphasized tibial and femoral physeal-sparing tunnel placement to minimize disruption of the growth plates. Clinical assessment included measurements for limb length discrepancy, knee stability, and growth disturbances. Functional outcomes were evaluated using IKDC 2000, Lysholm, and KOOS scores, while ligament stability was assessed with KT-1000 arthrometer measurements at routine follow-up. Results: A total of 31 consecutive patients (15 females, 16 males; mean age 13.6 ± 1.8 years, range 9–16 years) were included. Mean follow-up was 49 ± 26 months (range 18–93 months). The mean time to return to sports was 8.8 ± 4.4 months. Eight patients (26%) experienced ACL graft rupture and underwent revision ACL reconstruction. One additional patient required partial meniscectomy. The overall revision rate was 29%. The mean subjective IKDC score was 91.8 ± 7.2, with Lysholm and KOOS scores of 96.6 ± 7.9 and 94.2 ± 5.3, respectively. No significant growth disturbances were noted. The mean side-to-side difference in KT-1000 testing was 2.2 ± 1.5 mm. Patients who underwent revision ACL reconstruction showed significantly greater length growth compared with those with intact ACL reconstruction (p = 0.02). Spearman correlation revealed a significant association between length growth and anterior tibial translation (p = 0.02, r = 0.46). Conclusions: Transphyseal ACL reconstruction in skeletally immature patients provides favorable clinical and radiological outcomes, with minimal risk of growth disturbance. Most patients returned to pre-injury levels of athletic activity. However, the high revision rate emphasizes the complexity of managing ACL injuries in this population.

Inertial One-Leg Squat Training and Drop Jump Biomechanics in Athletes With Anterior Cruciate Ligament Reconstruction After Return to Sport.

Henderson, FJ and Shimokochi, Y. Inertial one-leg squat training and drop jump biomechanics in athletes with anterior cruciate ligament reconstruction after return to sport. J Strength Cond Res XX(X): 000-000, 2024-Athletes with anterior cruciate ligament reconstruction (ACLR) display altered jumping mechanics persisting long after returning to sport (RTS). We investigated the effects of flywheel rear leg elevated (Bulgarian) split squat (RLESS) training on single-leg drop jump (SLDJ) biomechanics in athletes with ACLR after RTS. Eleven competitive athletes with unilateral ACLR (546 ± 270 days postsurgery) performed 16 sessions of 1 set of deep knee flexion RLESS until failure in the reconstructed leg (REC) using a flywheel. Using motion capture and force plates, jump height and leg joint contribution were calculated during a 30-cm SLDJ, alongside peak vertical ground reaction force (vGRF), lower extremity joint peak angle, displacement, work, peak internal moment, and peak power. After training, the jump height increased in REC (p < 0.05) but not the intact leg (INT), although the jump height in REC remained lower than that in INT. Reconstructed leg knee contribution increased, whereas REC hip contribution decreased, so no bilateral difference remained after training. Although jump height remained unchanged in INT, several kinematic and kinetic variables changed significantly. Vertical ground reaction force showed no significant difference while asymmetry in internal knee varus moment disappeared, suggesting that some risk factors of ACL injury were reduced. Therefore, athletes with ACLR show persistent deficits in jumping performance, but adding 8 weeks of flywheel RLESS in REC can safely improve performance and restore normal joint contribution. Besides, coaches should be aware of possible changes in jumping mechanics in INT despite unchanged jumping performance when monitoring athletes with ACLR.

Comparison of anterior lateral ligament reconstruction and anterior lateral complex repair in the treatment of anterior cruciate ligament combined with anterior lateral ligament injury with high-grade pivot shift

To retrospectively analyze the clinical efficacy of anterior cruciate ligament (ACL) reconstruction combined with anterolateral complex repair and ACL reconstruction combined with ALL reconstruction in the treatment of anterior cruciate ligament injuries with high-grade pivot shift. From January 2018 to June 2022, 49 patients combined ACL and ALL injuries with high-grade pivot shift were retrospectively studied from three hospitals, 29 of them underwent ACL reconstruction with anterolateral complex repair (repair group), including 23 males and 6 females with an average age of (27.5±4.8) years old, ranged from 20 to 37 years old;the injured sides were 13 on the left and 16 on the right, and 11 patients were suffered with meniscus injury. The other 20 patients underwent ACL and ALL reconstruction (reconstruction group) including 17 males and 3 females with the mean age of (27.1±4.5) years old, ranged from 20 to 38 years old;the injured sides were 8 on the left and 12 on the right, and 6 patients were suffered with meniscus injury. Knee stability (pivot shift test, KT-2000), range of motion, knee function (Lysholm scoring scale, Cincinnati sports activity scale (CSAS) scoring scale, and Tegner activity level score between two groups were compared. A total of 49 patients were followed up, the repair group receiving 13 to 20(15.3±1.8) months and the reconstruction group receiving 12 to 21(16.0±2.2) months. There was no statistically significant difference in the preoperative pivot shift test grading distribution between two groups (P>0.05). At the last postoperative follow-up, there were 24 patients with grade 0 and 5 patients with grade 1 in the repair group, and there were 18 patients with grade 0 and 2 patients with grade 1 in the reconstruction group, there is no significant difference in the distribution of axial shift test grading between two groups(P>0.05). The preoperative KT-2000 tibial displacement of two groups were (9.39±0.77) mm (repair group) and (9.14±0.78) mm (reconstruction group) respectively, with no statistically significant difference (P>0.05). At the final postoperative follow-up, there were 24 patients with KT-2000 tibial displacement <3 mm and 5 patients with 3 to 5 mm in the repair group, while 18 patients with <3 mm and 2 patients with 3 to 5 mm in the reconstruction group, KT-2000 tibial displacement distribution of two groups was no significant difference (P>0.05), but the KT-2000 tibial displacement in the reconstruction group (1.30±0.86) mm was significantly smaller than that in the repair group (1.99±1.11) mm (P<0.05). The final postoperative follow-up range of motion of the contralateral side knee between two groups was no significant difference (P>0.05). The range of motion of the suffering knee in the repair group was less than that in the reconstruction group (P<0.05). There was no significant difference in preoperative Lysholm and CSAS scores between two groups (P>0.05). At the final postoperative follow-up, both groups showed significant improvement in Lysholm and CSAS scores, while the Lysholm and CSAS scores of the reconstruction group were better than those of the repair group, and the difference was statistically significant (P<0.05). Significant differences was found in Tegner scores between two groups, which 16 patients in the repair group returned to their pre-injury activity level, and 17 patients in the reconstruction group returned to their pre-injury level (P<0.05). Compared to anterolateral complex repair, combined ACL and ALL reconstruction in the treatment of ACL injuries with high-grade pivot shift results in better knee joint function and stability. This is advantageous in reducing the risk of ACL reconstruction failure.

Association between Overhang of the Posterior Horn of Lateral Meniscus and ACL Injuries

Association between Overhang of the Posterior Horn of Lateral Meniscus and ACL Injuries

Physician-led YouTube videos related to anterior cruciate ligament injuries provide higher quality educational content compared to other sources

IntroductionAnterior cruciate ligament (ACL) injuries and ACL reconstruction (ACLR) surgery are very common. Patients increasingly use social media platforms like YouTube to find healthcare information to help them make medical decisions. The purpose of this study was to evaluate the quality of YouTube videos providing information about ACL injuries and ACL surgery. MethodsThe most-viewed YouTube videos for ACL-associated search terms were reviewed for inclusion and assessed by two authors using four video quality assessment tools: Journal of American Medical Association benchmark (JAMA) (0-4), Global Quality Score (GQS) (1-5), modified DISCERN (mod-DISCERN) (0-5), and YouTube ACL Specific Score (ASS) (0-25). Intraclass Correlation Coefficients (ICCs) were calculated to determine interrater reliability. Unpaired t-tests were used for comparisons between groups and linear regressions to identify associations. ResultsThere were 45 videos that met the inclusion criteria. Overall, 31.1% of videos reported an academic affiliation, and 53.3% listed an MD as the lead author. Mean JAMA score was 2.8, GQS 3.2, mod-DISCERN 2.6, and overall ASS 5.9. There was good interobserver agreement across all quality tools (ICC>0.75). Videos with an MD lead author had significantly higher JAMA (p<0.001) and GQS (p<0.01) scores than non-physicians. Videos with academic affiliations had significantly higher JAMA (p<0.001), GQS (p<0.01), mod-DISCERN (p<0.01), and ASS Management Domain (p=0.04) scores. ConclusionAmong the most-viewed YouTube videos related to ACL injuries and ACL surgery, physician-led and academically affiliated videos provided higher quality educational information compared to other sources, however, the overall quality of content provided is low. Level of EvidenceLevel IV.

Diagnostic performance of dual-energy computed tomography in detecting anterior cruciate ligament injuries: a systematic review and meta-analysis.

Anterior cruciate ligament (ACL) injuries are common and lead to significant physical limitations. While MRI is the diagnostic gold standard, its use is restricted in acute trauma cases due to contraindications and longer imaging times. Dual-energy computed tomography (DECT) has emerged as a potential alternative. This meta-analysis evaluates the diagnostic accuracy of DECT for ACL injuries. Following PRISMA guidelines, a comprehensive literature search was conducted using PubMed, Web of Science, Scopus, and Embase for studies published up to June 2024. Studies that provided diagnostic accuracy data for DECT in ACL ruptures were included. Metrics of diagnostic accuracy were aggregated using a bivariate random effects model. The meta-analysis, which included five studies with a total of 191 patients, found that DECT had a pooled sensitivity of 88.1% (95% CI, 78.0-93.9%) and a specificity of 82.0% (95% CI, 62.0-92.7%) for diagnosing ACL ruptures, with an AUC of 0.92 (95% CI, 0.72-0.96). For complete ruptures, sensitivity was 83.2% (95% CI, 68.2-92.0%), and specificity was 94.9% (95% CI, 92.2-96.7%), with an AUC of 0.96 (95% CI, 0.81-0.98). In acute/subacute settings, sensitivity was 89.4% (95% CI, 76.8-95.6%), and specificity was 82.1% (95% CI, 56.2-94.2%), with an AUC of 0.93 (95% CI, 0.71-0.97). Our findings suggest that DECT is a valuable diagnostic tool for ACL injuries, particularly as an adjunct or alternative when MRI is unavailable or contraindicated, enabling timely and accurate diagnosis.

Investigation research on the mechanism of knee joint injury in table tennis players landing before and after fatigue during stroke play

This study investigated the relationship between lower extremity biomechanics and anterior cruciate ligament (ACL) injury in table tennis players before and after fatigue. We compared the biomechanical changes in the lower limbs of table tennis players during landing after completing a chasse-step while stroking, both before and after fatigue. A further aim was to examine ACL injury and provide a reference for training table tennis players. Ten national Level I table tennis players underwent lower extremity neuromuscular fatigue by running at a constant speed. Biomechanical data of the athletes were collected before and after fatigue. The effects of movement and characteristic time before and after fatigue on biomechanics were determined using a paired sample t-test. After fatigue, the angle of the ankle joint and the range of motion of the knee joint were significantly reduced (p &lt; 0.001), while the angle of motion of the hip joint did not change considerably (p = 0.747). The angular velocity of the ankle and knee joints increased significantly after fatigue (p &lt; 0.001), but the angular velocity of the hip joint decreased significantly (p = 0.013). Additionally, the ankle plantar flexion moment (p = 0.003), knee flexion moment (p &lt; 0.001), and hip flexion moment (p &lt; 0.001) increased significantly after fatigue. The ankle power (p = 0.023), knee power (p = 0.009), and hip power (p &lt; 0.001) were significantly reduced throughout the landing cycle after fatigue. Fatigue in table tennis athletes reduces the sagittal plane buckling angle of the knee and ankle joints during landing. This change increases ground reaction and knee joint forces, significantly elevating the risk of knee injuries, including ACL tears. The reduced flexion angle exposes the knee to greater torque and diminishes its shock absorption capacity, heightening the risk of lower limb injuries. These findings underscore the need to address the impact of fatigue on landing mechanics in sports training and rehabilitation, emphasizing preventive measures.

Risk of contralateral anterior cruciate ligament injury due to kinesiophobia: A narrative review

Background: Fear of movement after a primary anterior cruciate ligament (ACL) rupture has been a risk factor for the emergence of a contralateral anterior cruciate ligament (CACL) injury. Objective: Investigate the relationship between kinesiophobia and CACL. Methods: This is a narrative review that investigated the relationship between kinesiophobia and CACL injury. The search for articles was performed in the digital databases Pubmed, Cochrane, Lilacs, Pedro and Web of Science, published in any language over a ten-year period. Articles that evaluated and followed athletes with kinesiophobia who returned to sport were included. Results: A total of three articles were eligible for analysis, with two showing a relationship between high kinesiophobia in patients who ruptured the ACL, while one study showed no differences between kinesiophobia in patients who ruptured the ACL compared to athletes without injury. Conclusion: This study demonstrated that athletes who have a high level of kinesiophobia during ACL reconstruction surgical recovery have a moderate risk of rupture of the CACL.

Anatomic Risk Factors for Initial and Secondary Noncontact Anterior Cruciate Ligament Injury: A Prospective Cohort Study in 880 Female Elite Handball and Soccer Players.

Anterior cruciate ligament (ACL) injury is one of the most severe injuries for athletes. It is important to identify risk factors because a better understanding of injury causation can help inform athletes about risk and increase their understanding of and motivation for injury prevention. To investigate the relationship between anatomic factors and risk for future noncontact ACL injuries. Cohort study; Level of evidence, 2. A total of 870, excluding 9 players with a new contact ACL injury and a player with a new noncontact ACL injury just before the testing, female elite handball and soccer players-86 of whom had a history of ACL injury-underwent measurements of anthropometrics, alignment, joint laxity, and mobility, including leg length, knee alignment, knee anteroposterior laxity, generalized joint hypermobility, genu recurvatum, and hip anteversion. All ACL injuries among the tested players were recorded prospectively. Welch t tests and chi-square tests were used for comparison between the groups (new injury group, which sustained a new ACL injury in the follow-up period, and no new injury group). An overall 64 new noncontact ACL injuries were registered. No differences were found between athletes with and without a new ACL injury among most of the measured variables. However, static knee valgus was significantly higher in the new injury group than in the no new injury group among all players (mean difference [MD], 0.9°; P = .007), and this tendency was greater in players with a previous ACL injury (MD, 2.1°; P = .002). Players with secondary injury also had a higher degree of knee hyperextension when compared with those previously injured who did not have a secondary injury (MD, 1.6°; P = .007). The anatomic factors that we investigated had a weak or no association with risk for an index noncontact ACL injury. Increased static knee valgus was associated with an increased risk for noncontact ACL injury, in particular for secondary injury. Furthermore, hyperextension of the knee was a risk factor for secondary ACL injury.

Relationships between Patient-Reported Outcomes and Predictors of Second ACL Injuries during Unanticipated Jump Landings

ABSTRACT Background Reactive and external visual-cognitive demands are prevalent in sport and likely contribute to ACL injury scenarios. However, these demands are absent in common return-to-sport assessments. This disconnect leaves a blind spot for determining when an athlete can return to sport with mitigated re-injury risk. Purpose To characterize relationships between patient-reported outcome measures (PROMs) and cognitive-task interference (i.e., cognitive demands exacerbating neuromuscular impairments) for biomechanical predictors of second ACL injuries during jump landings that involved rapid unanticipated decision making. Methods Thirty-six persons following primary ACLR (26F/10M, 19.8±1.8 years; 1.71±0.1 m; 69.6±12.8 kg, 1.5±0.6 years post ACLR; Tegner: 6.8±1.8) participated. PROMs of ACL-RSI, and the Forgotten Joint Score-12 Knee (FJS-12) were selected to assess altered psychological state (e.g., confidence, attention toward knee). Jumping tasks under anticipated and unanticipated secondary jump directions were performed. Biomechanical variables were dual-task changes (unanticipated – anticipated) in 1) uninvolved limb hip rotator impulse (DTC_Uni-HRot_Imp), 2) asymmetry of knee extensor moment at initial contact (DTC_KEM_Asym), and 3) range of involved knee abduction angle (DTC_KAbA_Range). Regression models tested for relationships between PROMs and the dual-task change in biomechanical variables. Results: ACL-RSI (DTC_Uni-HRot_Imp (p &lt; 0.001)) and FJS-12 (DTC_KAbA_Range (p = 0.001)) had significant relationships with dual-task change in the opposite direction as expected (worse PROM ➔ less dual-task change). A follow-up analysis indicated that dual-task change was inversely correlated with the baseline estimates for kinetic biomechanical variables (less risky single-task biomechanics ➔ greater dual-task change for Uni-HRot_Imp and KEM_Asym). Conclusions: The collective results are consistent with higher functioning participants (better PROMs) who also demonstrate desirable biomechanics during single-task conditions being prone to demonstrating the greatest risk-associated DTC in unanticipated scenarios.

Abnormal patella height may be an independent risk factor in meniscal tears: a retrospective study in paediatric patients.

The literature on factors predisposing to meniscal tears in the paediatric population focuses on concomitant injuries such as anterior cruciate ligament rupture (ACL) or abnormal meniscus morphology such as discoid menisci. Patella alta has been associated with ACL ruptures but its association with meniscal tears has not been described. The purpose of our study was to evaluate whether abnormal patella height is associated with isolated meniscus tears in skeletally immature patients METHODS: We retrospectively analysed all patients under 16 years of age who had an isolated meniscal tear diagnosis confirmed on arthroscopic surgery. We examined data on demographics, meniscal morphology and patella height using the Insall-Salvati and Caton-Dechamp ratios. We compared the incidence of meniscal tears to a literature derived sex and age matched asymptomatic control group with normal patella heights. A total of 39 patients with an isolated meniscal tear were identified (mean age 13.2years). Patella alta was present in 16 (41%). 21 had normal meniscus morphology, and 18 had a discoid meniscus. There was a significant association between patella alta and isolated meniscal tears compared to the control group (p = 0.001). Our analysis is the first to demonstrate an association between abnormal patella height and the incidence of isolated meniscal tears in skeletally immature patients. Further research of knee biomechanics is required to elicit the mechanism and quantify the risk which may be used to guide prevention strategies and management of patients who wish to participate in high-risk sporting activities.

Menstrual cycle performance barriers experienced by elite women football players and their management strategies applied: A semi-structured interview-based study

ABSTRACT The objective of this study was to investigate the barriers experienced by elite women football players due to their menstrual cycle, and coping strategies utilised against these barriers. Fifteen elite women footballers from two English Women’s Super League clubs (age: 25.2 years [18–33]) were interviewed using semi-structured interviews, developed using piloting and peer review. Data was audio recorded, transcribed verbatim and analysed thematically using NVivo. Analysis of 27,438 words unveiled key themes: internal barriers, external barriers, coping strategies, and player needs. Fear of leakage, associated with kit colour (n = 15) and lack of effective sanitary products (n = 12), and injury anxiety (n = 7), associated with ACL injury (n = 5), were the most common barriers. To combat these issues, players use internal (feeling fortunate n = 9) and external (support from teammates n = 6; support from club staff n = 4) coping strategies. The findings indicated that menstruation presents significant barriers to players. Increased awareness of menstruation-related barriers to performance and targeted intervention are achievable through staff and player involvement and by minimising concerns of visible leakage by kit interventions.

Evaluating tibial rotation in recurrent patellar dislocation with four-dimensional computed tomography.

This study is to investigate the three-dimensional (3D) kinematic changes in the knee joint in patients with recurrent patellar dislocation using four-dimensional computed tomography (4DCT) imaging and the 3D-3D surface registration technique. Ten knees from nine patients with recurrent patellar dislocation and seven knees from seven controls (unaffected side of patients with unilateral anterior cruciate ligament injury) were analyzed using 4DCT. The patients were asked to extend their knees from 60° of flexion to full extension for 10s in the CT gantry. We used the 3D-3D registration technique, and the 3D angles of the patella and tibia relative to the femur were evaluated. In the dislocation group, the patellar lateral tilt increased as the knee extended. Significant differences were found between the two groups at 0°-20° of knee flexion. The tibia rotated externally as the knee extended in the dislocation group. Significant differences between the two groups were found at 0°-10° of knee flexion. This study demonstrated significant differences in the timing and magnitude of tibial external rotation between patients with recurrent patellar dislocation and controls. Specifically, the tibia began to externally rotate during the early phase of knee extension in the dislocation group. These findings provide new insights into knee kinematics that may inform future treatment strategies for patellar dislocation.

The Importance of Preventing and Managing Anterior Cruciate Ligament Injuries in Female Soccer Players.

The Article Abstract is not available.

Reducing ACL injury risk: A meta-analysis of prevention programme effectiveness.

The aim of this study was to conduct a meta-analysis of the literature regarding anterior cruciate ligament (ACL) injury prevention programmes (IPPs) in order to assess the effectiveness of ACL prevention programmes based on current high-quality studies. The hypothesis was that the implementation of ACL IPPs significantly reduces the incidence of ACL ruptures compared to standard practice. A meta-analysis of the literature was conducted using the databases PubMed, EMBASE, MEDLINE, CINHAL and Cochrane Central Register of Controlled Trials. The search terms utilized were ACL, injury, knee, control and prevention. The collected data and reported clinical outcomes were independently gathered by three different individuals. After evaluating the heterogeneity of the studies, the DerSimonian-Laird random effects models were employed to determine the pooled risk ratios (RRs) and the risk differences (RDs) regarding ACL Injuries. The RD was utilized to ascertain the number needed to treat. The search strategy identified 743 studies, of which 11 met all inclusion and quality criteria for pooled analysis. The total number of study participants was 16,316. The overall RR of sustaining an ACL injury in the intervention group was 0.36 (95% confidence interval [CI]: 0.23 to 0.57) of the control group, showing a significant reduction in the ACL injury risk of the intervention group (p < 0.001). We identified an RD of -1.4% (95% CI: -2.4% to -0.4%) in favour of the intervention group. The number needed to treat in preventing one ACL rupture was 71. In conclusion, the study clearly demonstrates a significant positive preventive effect of training programmes concerning ACL injuries (p < 0.001). The pooled estimates indicate that such programmes result in a significant reduction of ACL injury risks (p < 0.001). Despite the moderate quality of the included literature, the results exhibit robustness. However, based on the literature examined, no definitive superior training programme could be identified. II.