ACL Reconstruction Research Articles

Lateral Meniscal Oblique Radial Tears Were Observed Concomitantly With Anterior Cruciate Ligament Tears in 6% of Pediatric Patients Undergoing Anterior Cruciate Ligament Reconstruction

PurposeThis study aims to identify the incidence of LMORT concomitant with ACL tears in pediatric patients undergoing ACLR. MethodsA single-center retrospective cohort design was used to analyze all patients 18 years and younger undergoing ACL reconstruction between July 2017 and February 2023. Operative notes and intraoperative arthroscopic photos were analyzed to determine the incidence of LMORT. Two independent observers reviewed the images and reached agreement on LMORT incidence and classification of each tear. Demographic, clinical, and outcomes data were collected and analyzed. ResultsLateral meniscus oblique radial tears were identified in 19 of 310 (6.13%) adolescent and pediatric ACL reconstruction cases. Of these patients, 68.4% were male. All but one patient had signs of lateral meniscus injury on preoperative magnetic resonance imaging (MRI). Of the LMORT patients, seven (37%) had a type 1 tear, one (5%) had a type 2 tear, seven (37%) had a type 3 tear, and four (21%) had a type 4 tear. ConclusionsLateral meniscus oblique radial tears were observed concomitantly with ACL tears in 6% of pediatric patients undergoing ACLR. Clinical RelevanceAwareness and recognition of LMORT is important as the treatment paradigm for LMORT injuries continues to evolve.

Overexpression of CGRP receptor attenuates tendon graft degeneration in anterior cruciate ligament reconstruction.

Cell apoptosis or necrosis, extracellular matrix loss, and excessive inflammation may induce tendon graft degeneration. The impairment in the regeneration capability of nerve fibers and blood vessels may be the critical cause. Calcitonin gene-related peptide (CGRP), exhibiting a short half-life, favors cell proliferation, nerve fiber regeneration and angiogenesis. We aimed to investigate the effects of CGRP receptor-mediated signaling on tendon graft integrity and study if the modulation pathways are ascribed to cell proliferation, nerve fiber and blood vessel regeneration. A total of three groups in mice with ACL reconstruction were established: the control group (PBS treatment), the adenovirus vectors expressing CGRP receptor (CALCRL) treated group (Adv-Calcrl treatment), and the adenovirus vectors carrying shRNA targeting Calcrl treated group (Adv-shCalcrl treatment). The histological assessment indicated the Adv-Calcrl treatment was favored while the Adv-shCalcrl significantly impaired tendon graft integrity. TUNEL staining revealed a significant decreased number of apoptotic cells in the Adv-Calcrl group relative to the control group and the adv-shCalcrl group. Compared to the control group and the Adv-shCalcrl group, the Adv-Calcrl group showed significantly enhanced proliferation of nestin positive cells. Of note, the Adv-Calcrl treatment significantly increased EMCN expression at the tendon graft relative to the control and the Adv-shCalcrl groups, which may be ascribed to attenuation of the Hippo signaling pathway. Importantly, the Adv-Calcrl treatment significantly increased sensory nerve fibers and also PIEZO2 levels. Our results demonstrate the activation of CGRP receptor-mediated signaling attenuated tendon graft degeneration, which was ascribed to enhanced proliferation of Nestin positive cells, angiogenesis, and nerve fiber outgrowth.

Medial Meniscal Extrusion After Anterior Cruciate Ligament Reconstruction (ACLR) Associated With Meniscal Repair and Preoperative Extrusion.

The risk of post-traumatic osteoarthritis remains high even after anterior cruciate ligament reconstruction (ACLR). Medial meniscal extrusion (MME) is a valuable clinical sign as an early morphological change. This study aimed to analyze MME before and after ACLR and investigate the factors affecting postoperative MME. This study included patients who underwent anatomical double-bundle ACLR between January 2016 and July 2021. MME was measured using MRI preoperatively and one year postoperatively. The medial meniscus (MM) treatments were categorized into three groups: no MM injury and no repair (no injury/no repair (N/N)), MM injury but no repair (injury/no repair (I/N)), and MM injury and repair (injury/repair (I/R)). We investigated the factors influencing MME after ACLR using multiple linear regression analysis and compared MME before and after ACLR using paired t-tests. This study included 133 patients, of whom 90 (37 males and 53 females) were analyzed. The mean age of the patients at surgery was 27.5 years, and 41, 27, and 22 patients were assigned into N/N, I/N, and I/R groups, respectively. Preoperative MME (p<0.001) and I/R (p<0.001) had significant effects on postoperative MME in a regression analysis. Postoperative MME had greater effects than the preoperative MME in all cases (1.16 and 1.53 mm (p<0.01)) and in every MM treatment group (N/N: 1.02 and 1.32 mm (p<0.01), I/N: 1.16 and 1.44 mm (p<0.01), and I/R: 1.42 and 2.05 mm (p<0.001)). Larger preoperative MME and receiving MM repair were significantly associated with a larger MME after ACLR. Postoperative MME in ACLR patients was significantly greater than preoperative MME.

The Minimum Patient Acceptable Symptom State for the ACL-Return to Sport after Injury Scale Among Patients Treated With Anterior Cruciate Ligament Reconstruction.

Despite most patients reporting optimal knee function after anterior cruciate ligament reconstruction (ACLR), not all return to their pre-injury level of sport, often due to psychological factors. The ACL-Return to Sport after Injury Scale (ACL-RSI) was developed to measure the emotions, confidence in performance, and risk appraisal among athletes returning to sport. The purpose of this study was to determine the Patient Acceptable Symptom State (PASS) threshold for the ACL-RSI in patients undergoing ACLR. Patients with an ACL injury that required surgical reconstruction were included in this prospective study. All patients underwent ACLR with a bone-patellar tendon-bone autograft and completed the ACL-RSI 12 months postoperatively. An anchor-based approach was used to generate a receiver operating characteristic curve and establish the PASS threshold. Multivariable regression analyses were used to evaluate the effect of age, sex, and baseline score on likelihood of achieving PASS. A total of 113 patients (37% female) with a mean age of 28.1±8.2 years and a mean body mass index of 24.7±3.5 kg/m2 were included. At 12 months postoperatively, the threshold value for the PASS of the ACL-RSI was 40 (robust area under the curve: 0.89; sensitivity: 81%; specificity: 85%). Baseline score, sex, and age had no significant influence on achieving PASS at 12 months postoperatively. In a group of patients undergoing ACLR with bone-patellar tendon-bone autograft, the PASS threshold value was 40 for the ACL-RSI at 12 months postoperatively. The PASS value for the ACL-RSI established from this study can be useful for designing future clinical trials. [Orthopedics. 202x;4x(x):xx-xx.].

Similar two‐year improvement in patient‐reported outcomes in patients 40 years and older with outerbridge grade III and IV lesions following ACL reconstruction

AbstractPurposeThis study aims to evaluate clinical and patient‐reported outcome measures (PROMs) of patients 40 years and older that underwent anterior cruciate ligament reconstruction (ACLR) and determine the influence of preexisting arthritis and chondral wear on ACLR outcomes. We hypothesized that patients aged 40+ with ACLR would have excellent clinical outcomes and PROMs regardless of preexisting arthritic changes.MethodsA total of 118 patients were included. Patients aged 40 years and older who underwent ACLR in a single healthcare system between 2009 and 2016 were eligible. Outcomes assessed include Knee Injury and Osteoarthritis Outcome Scores (KOOS), Single Assessment Numeric Evaluation (SANE) scores, intraoperative Outerbridge grading, preoperative Kellgren–Lawrence (KL) grading and postoperative complication rates over a 2‐year period.ResultsAverage increase in KOOS and SANE scores were 21.2 19.9 and 23.5 31.3, respectively. Patients with Outerbridge grade III and IV lesions in weight‐bearing compartments had lower baseline SANE and KOOS scores than those without (47.1 ± 22.0 vs. 64.5 ± 23.6 baseline SANE and 43.1 ± 18.1 vs. 63.5 ± 15.9 baseline KOOS; p = 0.002 and p &lt; 0.001, respectively) with no significant difference in the amount of change in SANE or KOOS scores (p = 0.111 and p = 0.165 respectively). Patients with KL‐grade 2+ osteoarthritis experienced similar changes in KOOS and SANE over the 2‐year period to their counterparts (p = 0.598 and p = 0.643, respectively).ConclusionThere is no correlation between preexisting osteoarthritic changes or chondral defects and PROs. KOOS and SANE scores both increased postoperatively. When treating older patients with an ACL tear, surgeons should consider the activity level and desires of the patient as they determine appropriate treatment. Preexisting osteoarthritis does not correlate with patient‐reported outcomes for ACLR.Level of EvidenceLevel IV

Evaluating Gait with Force Sensing Insoles 6 Months after Anterior Cruciate Ligament Reconstruction: An Autograft Comparison.

Aberrant knee mechanics during gait 6 months after anterior cruciate ligament reconstruction (ACLR) are associated with markers of knee cartilage degeneration. The purpose of this study was to compare loading during walking gait in QT, bone-patellar tendon-bone (BPTB), and hamstring tendon (HT) autograft patients 6 months post-ACLR using loadsol single sensor insoles, and to evaluate associations between loading and patient reported outcomes. 72 patients (13-40 years) who underwent unilateral, primary ACLR with BPTB, QT, or HT autograft completed treadmill gait assessment, the International Knee Documentation Committee (IKDC) survey and the ACL-Return to Sport after Injury (ACL-RSI) survey 6 ± 1 months post-ACLR. Ground reaction forces were collected using loadsols. Limb symmetry indices (LSI) for peak impact force (PIF), loading response instantaneous loading rate (ILR), and loading response average loading rate (ALR) were compared between groups using separate ANCOVAs. Survey scores were compared between groups using one-way ANOVAs. The relationships between IKDC, ACL-RSI, and LSIs were compared using Pearson's product moment correlation coefficients. There were no significant differences between graft sources for LSI in PIF, ILR, ALR, nor impulse. Patient-reported knee function was significantly different between graft source groups with the BPTB group reporting the highest IKDC scores; however, there was no significant difference between groups for ACL-RSI score. There were no significant associations between IKDC score, ACL-RSI score, and biomechanical symmetry among any of the graft source groups. Autograft type does not influence PIF, ILR, ALR, or impulse during walking 6 months post-ACLR. Limb symmetry during gait is not strongly associated with patient reported outcomes regardless of graft source. Loadsols appear to be a suitable tool for use in the clinical rehabilitation setting.

Location of the Anatomic Footprint Centers of the Anterior Cruciate Ligament Determined by Quadrant Method on Three-Dimensional Magnetic Resonance Imaging.

The quadrant method is widely used to determine the femoral footprint center (FFC) on radiographs or computed tomography (CT) and can also describe the tibial footprint center (TFC). However, its application on three-dimensional (3D) magnetic resonance imaging (MRI) has been limited. This study aims to describe the ACL footprint center position on 3D MRI of healthy knees using the quadrant method. Proton density (PD) sequence 3D MRI was conducted on 45 intact knees, aged 18 to 45years. The centers of the ACL footprints were determined, and 2D simulated radiographic images were generated from the 3D MRI data. The quadrant method was then applied to calculate the positions of the footprint centers. The FFC was located at 31.6% in the deep-shallow (DS) direction and 31.3% in the high-low (HL) direction. The TFC was positioned at 45.1% in the mediolateral (ML) direction and 39.9% in the anteroposterior (AP) direction. The ACL footprint centers identified in this study were positioned similarly to previous studies, with the exception of the TFC in the ML direction, which was found to be more medial. This approach has the potential to enhance preoperative planning and intra-operative navigation in ACL reconstruction surgeries.

Combined AMRI and ALRI of the Knee in Elite Kabaddi Players: A Prospective Cohort Study of 26 Players.

ACL tears are the most common injuries in kabaddi, an inherently violent high pivoting and high-velocity direct contact sport. Combined ACL and MCL injuries and combined ACL and ALL injuries have been better understood but there is a lacuna of literature on these combined injuries in kabaddi players and no literature on combined AMRI and ALRI injuries. The present prospective cohort study aims to assess knee outcomes and return to sport for these injuries in elite kabaddi players. A prospective cohort of 26 elite kabaddi players with clinical and MRI findings of ACL and MCL high-grade partial or complete tears were recruited. After ACL reconstruction and MCL repair, the resultant pivot shift was assessed against the now intact medial pillar and those with high-grade or explosive pivot were addressed using a modified deep Lemaire lateral extra-articular tenodesis. Pain scores (VAS) and knee outcomes (IKDC and Lysholm scores) were assessed pre-operatively and at regular intervals until 1-year follow-up. Return to sport and complications were also assessed. There was significant improvement in pain and knee scores throughout the study period, with most patients achieving full scores by six months duration. Return to sport was 96% and return to sport at pre-injury level was 77%. Complication rate of the combined triple procedure was low (< 5%), with most complications being minor. The triple procedure of ACL reconstruction, MCL repair and Lateral extraarticular tenodesis successfully addressed the combined AMRI and ALRI in elite kabaddi players with a high rate of return to sport, excellent knee outcomes and low complication rate. The online version contains supplementary material available at 10.1007/s43465-024-01268-3.

Preoperative Psychological Competitive Ability Is Associated With Emotional States Six Months After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft: A Prospective Study.

Background Psychological state has been reported as one of the factors strongly related to a return to sports after anterior cruciate ligament (ACL) reconstruction. However, its relationship with the emotional state remains unclear. The aim of this study was to investigate whether patients who have undergone ACL reconstruction and have a higher preoperative psychological competitive ability have a better emotional status preoperatively and six months postoperatively. Methods Patients with a Tegner activity score of ≥6 who underwent ACL reconstruction between 2015 and 2020 were divided into two groups according to their grades on the Diagnostic Inventory of Psychological Competitive Ability for Athletes (DIPCA.3). The emotional states preoperatively and at six months postoperatively were assessed using the Profile of Mood States Second Edition (POMS2) and compared between the two groups. Furthermore, the possibility of returning to sports was compared between the groups based on participation in the entire practice at six months postoperatively. Results Eighty-four patients were included and divided into the high (DIPCA.3 grades ≥4, n = 23) and low (DIPCA.3 <4, n = 61) groups. Vigor-activity and friendliness were significantly higher in the high group than in the low group preoperatively. The difference was even greater at six months after ACL reconstruction. In addition, the high group showed significantly better results postoperatively for fatigue-inertia and total mood disturbance. Rates of return to sports did not differ significantly between the high and low groups (56.5% vs. 54.1%). Conclusions Those with a higher preoperative psychological competitive ability were in a positive emotional state preoperatively and six months after ACL reconstruction. However, the psychological competitive ability did not affect the rate of participation in the entire practice at six months postoperatively.

Rehabilitation, Decision-Making, and Return to Pivoting Sports in Athletes 1–3 Years After ACL Reconstruction: A Nationwide Study

OBJECTIVE: To describe rehabilitation and decision-making from ACL reconstruction to return to sport (RTS), characteristics and RTS proportions for pivoting sports athletes undergoing usual care. DESIGN: Cross-sectional study. METHODS: We invited people with ACL reconstruction who were aged 16-40 years, and injured during soccer, handball, or basketball, and registered in the Norwegian Knee Ligament Register, to complete a study-specific questionnaire at 1-3 years post-surgery. We reported descriptive statistics and RTS proportions for return to participation, sport and performance. RESULTS: Of 1,875 individuals, 631 (34%) responded. The physical therapist-led rehabilitation ceased before 9 months in 52% (n=268), and a physical therapist was most frequently involved in RTS decisions (n=462, 77%). Fifty-five percent (n=353) of the participants underwent physical testing prior to RTS. At a mean of 2.3 years (SD=0.8) after ACL reconstruction, 62% (n=391) returned to participation, 50% (n=312) returned to sport, and 17% (n=93) returned to pre-injury performance. The main reasons for non-return were fear of re-injury (35%, n=27) and knee problems (35%, n=27). Median time to RTS was 12 months (interquartile range 10 to 15 months), and 16% (n=102) had sustained a new ACL injury at follow-up. CONCLUSION: This nationwide study found that half of pivoting sport athletes ceased rehabilitation within 9 months, half performed physical testing to inform RTS, with physical therapists most frequently involved in the RTS-decision. Half of the athletes returned to sport, and one in six returned to performance. RTS proportions were highest in athletes younger than 20 years.

Vitamin D Deficiency after Anterior Cruciate Ligament Reconstruction Associates with Knee Osteoarthritis: A Retrospective Study.

The objective of this study was to test the hypothesis that vitamin D deficiency (i.e., serum 25-hydroxyvitamin D (25(OH)D) ≤ 20 ng/mL) associates with the increased occurrence and shortened time to a knee osteoarthritis (OA) diagnosis after anterior cruciate ligament reconstruction (ACLR). This study consisted of a retrospective, case-control design. The inclusion criteria consisted of (1) patients (≥18 y) who underwent arthroscopic ACLR with (cases; n = 28) and without (controls; n = 56) a subsequent knee OA diagnosis (≥90 d from the date of ACLR) and (2) with a documented serum 25(OH)D concentration after ACLR (and before a knee OA diagnosis for the cases). Controls were matched (2:1) to cases based on sex, age at ACLR, date of ACLR, and body mass index. After matching, patients were separated into two groups: (1) vitamin D deficient (serum 25(OH)D ≤ 20 ng/mL) or (2) non-vitamin D deficient (serum 25(OH)D > 20 ng/mL). Data were extracted from the medical records. Thirty-one percent (n = 26) of patients included were vitamin D deficient. Fifty percent (n = 13) of the vitamin D deficient and twenty-six percent (n = 15) of the non-vitamin D deficient patients were subsequently diagnosed with knee OA (p = 0.03). Time from ACLR to a knee OA diagnosis was significantly (p = 0.02) decreased in the vitamin D deficient (OA-free interval, 95% confidence interval [CI] = 7.9 to 10.9 y) compared to the non-vitamin D deficient group (OA-free interval, 95% CI = 10.5 to 12.5 y). Vitamin D deficiency after ACLR may serve as a prognostic biomarker for knee OA following ACLR.

Effects of Single-Joint Type Hybrid Assistive Limb in Knee Rehabilitation on Reduction of Pre-motor Time and Increased Rate of Fast Muscle Activation for Anterior Cruciate Regiment (ACL) Reconstruction.

Changes in muscle characteristics after post-anterior cruciate regiment (ACL) reconstruction are common. Knee robotic-assisted therapy using hybrid assistive limb (HAL) single-joint training for recovery from ACL injury has the potential to optimize muscle activity; however, its neurophysiological effects remain unclear. Thus, this study aimed to explore the electrophysiological parameters. This prospective, nonrandomized, controlled trial was conducted between December 2021 and January 2024. The patients were divided into two groups: the HAL group and the control group, each including five patients who underwent arthroscopic ACL reconstruction. Knee HAL single-joint training was conducted once weekly for three sessions. Three electrophysiological measures were examined related to knee neuromuscular responses pre-motor time, peak amplitude time, and neuromuscular rate of electromyography rise (RER) using surface electromyography (EMG). The pre-motor time and peak amplitude time were assessed in both groups at each session pre- and post-intervention.Bothgroups were evaluated for RERat postoperative weeks 17 and 21. Regarding the interaction of pre-motor time within each group, the interaction of pre-motor time within each group, the effect size of vastus medialis (VM) was larger in the HAL group. The peak amplitude time of EMG, the overall estimated marginal means, and the HAL group exhibited a significant difference in the VM (p=0.019), while vastus lateralis (VL) showed no significant difference but a larger effect size (d=0.61). The RERrevealed a significant difference in semitendinosus-RER30ms in the HAL group (p=0.044). Theknee HAL training for post-ACL reconstruction patients may influence neurophysiological outcomes.

Higher Unilateral Muscle Imbalance at the Contralateral Knee 6 Months after Anterior Cruciate Ligament Reconstruction.

There are a considerable number of patients who, after anterior cruciate ligament reconstruction (ACL), suffer from relapses or reduced performance. Data collected from isokinetic dynamometry can provide useful information on the condition of the knee during rehabilitation. Seventy-one young sports patients with ACL reconstruction performed concentric (CON) isokinetic dynamometry (CON/CON 90°/s and CON/CON 240°/s) to assess the muscle strength of the quadriceps (Q) and hamstrings (H) in both knees at 6 months after ACL reconstruction. Limb symmetry index (LSI) and the H/Q ratio were calculated. Comparative statistical tests and multivariate regression were performed. At 90°/s, 57 patients (80.3%) had an LSI below 90% for quadriceps and 28 (60.6%) for hamstring. The number of imbalanced patients according to H/Q ratio was higher in the non-operated knee (n = 56, 78.9%) (p < 0.001). At 240°/s, 49 cases (69.1%) had LSI values above 90% for quadriceps and 37 (52.1%) for hamstrings. Regarding H/Q, imbalanced cases were higher in the non-operated limb (n = 60, 84.5%) (p < 0.001). Strength data at 6 months after ACL reconstruction and post-operative rehabilitation indicated greater unilateral (H/Q) muscle imbalance in the non-operated knee than in the operated knee. Most patients did not achieve the adequate LSI values.

A Qualitative Study of Factors Perceived to Influence Physical Activity among Young Athletes after ACL Reconstruction.

Despite evidence of alarming declines in physical activity levels after anterior cruciate ligament reconstruction (ACLR), very little is known about how young athletes perceive their experiences with engagement in sports and physical activity in the years following ACLR. The purpose of this study was to answer the research question, "what are the lived experiences and perceptions of factors that facilitate or hinder physical activity among young athletes following ACLR?". Qualitative Study. Ten participants were included in this qualitative study at a median of 5.9 (4.3-10.2) years after adolescent ACLR. Using an interpretive phenomenological methodology, semi-structured interviews were conducted with each participant. Data collection focused on participants' lived experiences related to physical activity participation in the years after ACLR. Iterative coding with two independent coders and a peer debriefing process were used to identify themes from the data. Factors perceived to influence physical activity after ACLR spanned all levels of the socioecological framework. Three overarching themes were generated during thematic analysis: 1) navigation of barriers (common obstacles, injury-related limitations, unique adaptations), 2) movement motives (ingrained desire to move, external motivators, internal motivation), and 3) movement mindset (envisions for future physical activity, perceived impact of injury, belief in the power of sports). The themes identified in this study indicate that the adolescent ACLR experience has the potential to significantly influence one's physical activity into young adulthood, both positively and negatively. These findings serve as an important foundation for future studies to explore the psychological and environmental factors identified as important to one's physical activity participation in the years following adolescent ACLR. Level 3.

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.

Return to Play at Preinjury Level After Anterior Cruciate Ligament Reconstruction in Divisions II and III National Collegiate Athletic Association Student-Athletes.

The rates of return to play (RTP) after anterior cruciate ligament (ACL) reconstruction among professional and National Collegiate Athletic Association (NCAA) Division I athletes are well described in the orthopaedic literature. Less is known about these rates and risk factors for failure to RTP in Division II and III collegiate athletes. To determine the RTP rate after ACL reconstruction among Division II and III collegiate athletes and to explore the factors associated with RTP. Case series; Level of evidence, 4. Demographic and RTP data were retrospectively reviewed for collegiate athletes who underwent ACL reconstructions across high-risk sports over 6 years (2015/16 to 2021/22 seasons) at 5 northeastern NCAA Division II and III institutions. Clinical data collected included Patient Acceptable Symptom State (PASS) on the Knee injury and Osteoarthritis Outcome Score (KOOS) Sport and Recreation questionnaire, graft type, concomitant reparative surgery, reinjury, need for reoperation, and time to RTP and return to preinjury level. Participants completed the survey using a secure web-based questionnaire sent via email or over the telephone at a minimum 6-month follow-up. Descriptive frequencies were calculated for all documented variables, with chi-square and analysis of variance statistics used to assess for associations and significant differences between variables. A total of 61 eligible student-athletes with primary ACL reconstructions were identified in this study period, and 40 knees were enrolled for analysis with a mean time from surgery to survey completion of 45.0 months. The overall RTP rate was 77.5% (31/40) at a mean of 10.1 months. However, only 50.0% (20/40) returned to their preinjury level of competitive play. There was a graft failure rate of 20% (8/40). Of the 32 athletes who did not reinjure their ACL, 81.25% (26/32) demonstrated a PASS on KOOS Sports and Recreation. Graft rerupture (P < .001) and reoperation (P = .007) had significant effects on rates of RTP. Concomitant procedures (P = .010) influenced return to preinjury level of sports. Injury during the active season versus the off-season significantly influenced KOOS PASS status (P = .038). This study demonstrated that the rate of RTP after ACL reconstruction in this patient population of Division II and III collegiate athletes was 77.5%, with only 50% returning to their preinjury level of competitive play. The graft failure rate in this population was 20%. Surgical factors, such as concomitant surgeries and reinjury of ACL graft, as well as athlete-specific data, such as injury in the off-season, were statistically significant negative influences on patient outcomes. Further research is needed to evaluate other potential factors that may play a role in RTP after ACL reconstruction.

Assessing the Impact of Psychological Readiness on Performance and Symmetry in Functional Testing After ACL Reconstruction in Pediatric and Adolescent Patients.

Readiness for return to sports involves both physical and psychological aspects of recovery; however, the relationship between psychological and physical variables after anterior cruciate ligament (ACL) reconstruction (ACLR) is poorly understood. ACLR patients with a higher psychological readiness would demonstrate better functional testing results at 6 months. Cross-sectional study; Level of evidence, 3. Participants were evaluated at 6 months after ACLR with various patient-reported outcome metrics: Hospital for Special Surgery Pediatric Functional Activity Brief Scale, pediatric or adult International Knee Documentation Committee Questionnaire (IKDC), Patient-Reported Outcomes Measurement Information System (PROMIS) - Psychological Stress Experience and ACL - Return to Sport After Injury (ACL-RSI) scale. Functional testing included quadriceps, hamstrings, and gluteal strength testing; Y-balance test; single-leg single hop, crossover hop, and triple hop tests; and timed 6-m hop test. Pearson correlation coefficient and multivariable regression were used to determine associations between the limb symmetry index (LSI) on functional testing and patient-reported outcomes. Those with LSI deficits <20% (better performance) were compared with those with deficits >20% (worse performance). A total of 229 participants (89 male, 140 female) with a median age of 17 years (range, 10.3-30.6 years) were enrolled. IKDC had a moderate negative correlation with PROMIS - Psychological Stress Experience (r = -0.39; 95% CI = -0.49, -0.27; P < .001) and a moderate positive correlation with ACL-RSI (r = 0.55; 95% CI = 0.46, 0.64; P < .001). A total of 151 patients completed functional testing. ACL-RSI demonstrated a positive correlation with single-hop LSI (r = 0.21; 95% CI = 0.05, 0.35; P = .01) and timed 6-m hop (r = 0.28; 95% CI, 0.42; P = .001). When adjusting for sex, age, and graft type, patients who had <20% deficit on the single-hop test scored 16.6 points higher on ACL-RSI (P = .001), and those with <20% deficit on crossover hop testing scored a mean 13.9 points higher on ACL-RSI (P = .04). Higher psychological readiness for return to sport was associated with better performance and greater symmetry on hop testing 6 months after ACLR, suggesting a potential link between physical and psychological recovery.

Personal and Social Correlates of Self-Reported Physical Activity in Individuals With a History of Anterior Cruciate Ligament Reconstruction

Physical activity is negatively impacted after anterior cruciate ligament (ACL) injury and subsequent reconstruction. Previous evidence suggests that individuals with a history of ACL reconstruction (ACLR) may experience additional barriers to sport and physical activity participation. The purpose of this study was to identify personal and social factors (physical literacy, social support, and knee function) that are predictive of self-reported physical activity in individuals with a history of ACLR. Bivariate analyses determined that elements of physical literacy and knee function were positively correlated with self-reported physical activity. The final stepwise linear regression model demonstrated that the PLAYself Physical Literacy Self-description subsection accounted for 12.2% of the variance of self-reported physical activity (p = .003). The significant effect of the PLAYself Physical Literacy Self-description remained (p = .002) even when additional demographic covariates (age, time since ACLR, and sex) were added to the model. Findings suggest that physical literacy may be a salient factor to consider for promoting physical activity after ACLR.

MCL Repair, Isolated Suture-Tape-Bracing and No Repair for Grade III MCL Tears During ACL Reconstruction Have Similar Outcome for Combined ACL With MCL Injury: A 3-Arm Randomized Controlled Trial

Aim of the study was to compare various MCL management strategies(repair vs isolated suture-tape bracing vs no repair) combined with ACL reconstruction and analyse results of MCL sub-types (femoral/mid-substance/tibial-sided tears) occurring at distinct levels. This study is a double blinded prospective randomised controlled trial. 96 consecutive patients with combined ACL and grade III MCL between 2020 and 2023 with minimum follow up of 24 months were included in the study. Chronic MCL and other ligament injuries were excluded, and computer-generated randomisation was done for allotment into three MCL management groups. ACL reconstruction with hamstring autograft was performed and MCL treated by repair in group 1(n=33), isolated suture-tape bracing -group 2(n=32) and no repair-group 3(n=31). At follow-up, stress radiographs were utilized to analyse anterior and medial laxity. IKDC, Lysholm, KOOS scores, duration of surgery and cost of surgery were compared. Also, subgroup analysis was performed to assess outcomes based on location of MCL injury. Demographic data, duration of injury, mode of injury and level of MCL injury is similar across groups. Over all MCL tears-femoral side, mid-substance and tibial side were 58.3%,18.7%and 23.0% respectively. Post-operatively significant improvement in ROM and functional score was observed in all three groups(P=<0.05); however, there was no statistically significant difference between the three groups at final follow-up in anterior tibial translation(P=0.94), medial opening in 0°(P=0.8) & 30°(P=0.64), ROM(P=0.39), IKDC(P=0.17), Lysholm(P=0.14) & KOOS(P=0.68). Three patients in group 2 had stiffness at 3months; two were treated with CPM and physiotherapy and 1 patient needed arthrolysis. Medial opening(00 and 300) was greater in group 3- mid-substance MCL tear patients(P=0.042,0.043). On Minimal clinically important differences (MCID) analysis more than 80% of patients had improvement in range of motion, functional scores and medial opening less than 5mm, suggestive of successful outcome in all the three groups. The duration of surgery was longer in repair group(P=0.001), whereas cost was higher in the suture-tape bracing group(P=0.003). Repair, isolated suture-tape bracing and no repair treatments of MCL result in good radiological (medial stress laxity) and functional outcomes when combined with ACL reconstruction. MCL Repair or isolated suture-tape bracing restore better medial side stability. Mid-substance MCL tears may need additional procedure(repair/bracing) to restore medial stability.

Predicting the Recovery of Isokinetic Knee Strength 6 Months After Anterior Cruciate Ligament Reconstruction.

The limb symmetry index (LSI) is a metric of strength restoration. It is key to successfully return to sports after anterior cruciate ligament (ACL) reconstruction. The threshold for return to sports is generally considered an LSI of ≥85%. To develop a statistical model for predicting the recovery of knee extension and flexion strength (with LSI ≥85%) at 6 months after ACL reconstruction. Case-control study; Level of evidence: 3. Patients who underwent arthroscopic ACL reconstruction between November 2015 and December 2020 were included. The patients were classified into 2 groups: "pass" if the LSI at 6 months postoperatively was ≥85% and "fail" if the LSI was <85%. Factors in 25 categories with 74 levels, including patient characteristics, periarticular procedures, intra-articular lesions and treatment, and perioperative management, were collected. A multivariable logistic regression combined with backward variable elimination was used to determine the predictive parameters for recovery of knee extension and flexion strength. A total of 948 patients were included. Graft site, preoperative isokinetic strength, treatment of meniscal injury, and injured side (left vs right) were identified as general predictors for both knee extension and flexion strength. For knee extension strength, age at injury and partial weightbearing duration were identified as additional predictors. For knee flexion strength, type of meniscal injury, surgeon volume, cartilage procedures, and periarticular procedures were identified as additional predictors. The Nagelkerke R 2 of the final model was 0.178, and the c-statistic was 0.716 (95% CI, 0.676-0.754). The Hosmer-Lemeshow test indicated good calibration (P = .879). Several factors including preoperative isokinetic strength, treatment of meniscal injuries, left vs. right side and graft site were found to predict recovery of ≥85% LSI in knee extension and flexion strength. Despite the numerous factors that were analyzed, the predictive power was moderate (c-statistic = 0.716), indicating there were other nonincluded factors that significantly influence strength performance at 6 months postoperatively.