ACL Reconstruction Research Articles

Effectiveness of In-Home, Augmented Reality-Based Telerehabilitation After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.

New digital technology-based rehabilitation may be a viable option for patients after anterior cruciate ligament reconstruction (ACLR), with advantages such as easy access to treatment and learning as well as cost-effectiveness. To investigate the effects of an augmented reality (AR)-based, telerehabilitation system in patients after ACLR compared with a brochure-based rehabilitation program in terms of patient-reported outcomes and functional performance measures. Randomized controlled trial; Level of evidence, 2. This was a multicenter, assessor-blinded study. Enrolled participants were allocated randomly to either the intervention group, who underwent AR-based telerehabilitation system, or to the control group, who underwent a brochure-based rehabilitation program with a self-log. Both groups performed the same postoperative rehabilitation exercise protocol. Subjective knee function was assessed using the International Knee Documentation Committee (IKDC) as the primary outcome; secondary outcomes were a numeric rating scale for pain, the EuroQol 5-Dimension 5-Level, isometric knee strength, range of motion, and the single-leg hop test. The intervention group also completed a satisfaction survey. Follow-up was conducted at 2, 6, 12, and 24 weeks postoperatively. A total of 28 patients were enrolled in each group; 1 patient in the control group was lost to follow-up. Patients in both groups demonstrated improvement on all outcomes over time. There were no significant between-group differences in the IKDC score from baseline to 12 weeks postoperatively. The intervention group saw a greater increase in the relative isometric strength of the quadriceps on the involved limb at 6, 12, and 24 weeks postoperatively (P < .05 for all). No significant group differences were observed in the remaining secondary outcomes. Study findings indicated that patients who underwent AR-based telerehabilitation in the early rehabilitation phase after ACLR demonstrated similar improvements as those who followed a brochure-based rehabilitation program and had a quicker recovery of knee extensor strength. NCT04513327 (ClinicalTrials.gov identifier).

Y-Balance Test after ACL Reconstruction: The relationship with knee and hip muscle strength, ankle dorsiflexion range of motion and postural stability

BackgroundY-Balance Test (YBT) assesses postural stability. When is applied to patients after anterior cruciate ligament reconstruction (ACLR), it is not clear which variables influence its result. ObjectiveTo connect YBT and postural stability, quadriceps, hamstring, and gluteus complex muscle strength, ankle dorsiflexion range of motion (ADFROM). Study designCross-sectional. MethodsFifty-nine participants (52 males and 7 females) with ACLR ≥6 months were evaluated. YBT anterior, posterolateral, posteromedial, and composite, isokinetic peak torque of the knee, strength of the gluteal complex with Hip Stability Isometric Test, ADFROM with Weight-Bearing Lunge Test, postural stability with Stability Index of Biodex Balance System® were applied. ResultsIn the ACLR limb, the multivariate regression linear models pointed out an association between the quadriceps muscle strength and ADFRM with anterior, posteromedial and composite reaches (R2 = 0.30; 0.23; 0.26). Hamstring muscle strength and ADFRM with posterolateral (R2 = 0.13). In the uninjured limb, overall stability index and ADFRM with anterior reach (R2 = 0.25), strength of gluteal complex with posteromedial (R2 = 0.31), hamstring muscle strength, Overall and lateromedial stability indexes with posterolateral (R2 = 0.20), hamstring muscle strength, Overall stability index, ADFRM and strength of gluteal complex with composite (R2 = 0.32). ConclusionsThe quadriceps muscle strength and ADFRM are important variables for YBT performance in the ACLR limb. In the uninjured limb, ADFROM, the strength of the gluteal complex and hamstring, overall and lateromedial stability indexes are associated with YBT performance. We question the utility of the YBT to measure postural stability given the lack of association with other postural stability measures.

Trends in lateral extra-articular augmentation use and surgical technique with anterior cruciate ligament reconstruction from 2016-2023, an ACL Study Group Survey

PurposeTo survey the ACL study group (ACLSG) members to determine the current practice patterns surrounding the use and methodology of lateral extra-articular procedures (LEAPs), including anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET) during ACL reconstruction (ACLR). MethodsA web-based questionnaire was distributed to members of the ACLSG during the 2016, 2018, 2020, and 2023 biennial meetings. Questions explored the indications and techniques when incorporating LEAPs in ACLR. ResultsAnalysis of survey responses found that the reported use of LEAPs in both primary and revision ACLR significantly increased between 2016 and 2023 and that surgeons were using lateral augmentation more frequently over time. Surgical techniques were stable across survey years, with most surgeons using iliotibial band (ITB) autograft attached at Gerdy's tubercle, passed under the lateral collateral ligament (LCL), and anchored proximal/posterior to the lateral femoral epicondyle. ConclusionSurvey responses demonstrate that LEAPs are becoming more common among ACL surgeons in the ACL SG, with the modified Lemaire LET being the predominant technique. This aligns with recent clinical studies showing improved outcomes and reduced risk of failure in ACLR with lateral augmentation compared to ACLR alone. Level of evidenceLevel V, Expert Opinion

Self-Reported Anxiety Symptoms Are Associated With Knee Pain Severity In Individuals With ACL Reconstruction

Self-Reported Anxiety Symptoms Are Associated With Knee Pain Severity In Individuals With ACL Reconstruction

Hop to it! A systematic review and longitudinal meta-analysis of hop performance after ACL reconstruction

Hop to it! A systematic review and longitudinal meta-analysis of hop performance after ACL reconstruction

Daily Limb Loading During Weightbearing Activities Following ACL Reconstruction Does Not Reflect Laboratory Gait

Daily Limb Loading During Weightbearing Activities Following ACL Reconstruction Does Not Reflect Laboratory Gait

Female Collegiate Soccer Player With Atypical Healing Following ACL Reconstruction: A Level 3 Case Study

Female Collegiate Soccer Player With Atypical Healing Following ACL Reconstruction: A Level 3 Case Study

Resorption characteristics of an open architecture biocomposite interference screw after ACL reconstruction.

Absorbable interference screws for anterior cruciate ligament reconstruction (ACLR) can lead to tunnel widening and cyst formation. The Biosure Regenesorb interference screw (Smith & Nephew). has been developed with an optimised calcium phosphate/polymer composition to promote bone formation during resorption. The present study aims to investigate screw resorption, new bone formation, and tunnel geometry following ACLR with Biosure Regenesorb screw tibial fixation. The study is a prospective single-centre case series of 12 patients with ACL lesions and treated with ACLR using hamstring tendon autograft with Biosure Regenesorb interference screw tibial fixation with a two-year follow-up period. The Biosure Regenesorb consists of 65% polylactide-glycolic acid poly. 20% calcium sulphate and 15% tricalcium phosphate. Primary endpoint: Tunnel volume. implant volume and new bone formation in the tibial tunnel is evaluated by quantitative computed tomography (CT) scanning. Secondary endpoints: Arthrometric knee laxity, International Knee Documentation Committee (IKDC) and Knee Osteoarthritis and Injury Outcome Scores (KOOS) and Tegner activity scale. Screw volume decreased to 44% within the two-year follow-up period while tunnel volume remained unchanged. Only a minor amount (<1% of tunnel volume) of new bone formation in the screw remnants was observed. Sagittal knee laxity at one year was 0.9 mm. The IKDC score increased by 15 points and the KOOS sport and KOOS quality of life scores increased by 25 and 26 points. respectively. ACLR using Biosure Regenesorb interference screw does not result in tunnel widening. showing a screw resorption of 44% after two years and minor new bone formation. Knee stability and subjective outcome improvements are as expected after other ACLR methods. IV.

Inside‐out tibial tunnel drilling technique is a reliable approach for all‐inside ACL reconstruction: A longitudinal MRI assessment

AbstractPurposeTo longitudinally evaluate sockets localization, tunnel morphological changes and graft maturation after the inside‐out tibial tunnel drilling technique for all‐inside Anterior Cruciate Ligament Reconstruction (ACLR). We hypothesized that due the necessary angle for the inside‐out reaming procedure, the described technique could input changes in the tibial socket.MethodsFourteen knees treated with the same all‐inside ACLR technique were randomly assigned for a magnetic resonance evaluation. All patients were operated by the same surgeon and performed the same follow‐up rehabilitation protocol. Socket's localization, shape and widening, as well as graft maturation and integration, were evaluated intraoperatively at 6 months and 4 years after surgery.ResultsBoth femoral and tibial tunnels had an expected increase at 6 months follow‐up. The widening was larger in the tibial tunnel (12.6 ± 10.0% vs. 9.1 ± 8.5%), yet this difference was not statistically different. Tibial tunnel was well centred in the tibial plateau and the integration of the graft was higher in the tibial socket. Four years after surgery, there was a general reduction of diameter in both tunnels. The tunnel occlusion rate was 33.3% for tibia and 16.7% for femur.ConclusionsOverall, our results show that within a 4‐year follow‐up period, the inside‐out tibial tunnel drilling technique for all‐inside ACLR represents a safe technique that did not influence the tibial socket position nor tunnel widening or graft maturation in the long term.Level of EvidenceLevel IV.

Neuroplastic alterations in common synaptic inputs and synergistic motor unit clusters controlling the vastii muscles of individuals with ACL reconstruction.

This cross-sectional study aims to elucidate the neural mechanisms underlying the control of knee extension forces in individuals with anterior cruciate ligament reconstruction (ACLR). Eleven soccer players with ACLR and nine control players performed unilateral isometric knee extensions at 10% and 30% of their maximum voluntary force (MVF). Simultaneous recordings of high-density surface electromyography (HDEMG) and force output were conducted for each lower limb, and HDEMG data from the vastus lateralis (VL) and vastus medialis (VM) muscles were decomposed into individual motor unit spike trains. Force steadiness was estimated using the coefficient of variation of force. An intramuscular coherence analysis was adopted to estimate the common synaptic input (CSI) converging to each muscle. A factor analysis was applied to investigate the neural strategies underlying the control of synergistic motor neuron clusters, referred to as motor unit modes. Force steadiness was similar between lower limbs. However, motor neurons innervating the VL on the reconstructed side received a lower proportion of CSI at low-frequency bandwidths (<5 Hz) compared with the unaffected lower limbs (P < 0.01). Furthermore, the reconstructed side demonstrated a higher proportion of motor units associated with the neural input common to the synergistic muscle, as compared with the unaffected lower limbs (P < 0.01). These findings indicate that the VL muscle of reconstructed lower limbs contribute marginally to force steadiness and that a plastic rearrangement in synergistic clusters of motor units involved in the control of knee extension forces is evident following ACLR.NEW & NOTEWORTHY Chronic quadriceps dysfunction is common after anterior cruciate ligament reconstruction (ACLR). We investigated voluntary force control strategies by estimating common inputs to motor neurons innervating the vastii muscles. Our results showed attenuated common inputs to the vastus lateralis and plastic rearrangements in functional clusters of motor neurons modulating knee extension forces in the reconstructed limb. These findings suggest neuroplastic adjustments following ACLR that may occur to fine-tune the control of quadriceps forces.

Combined Reconstruction of the Anterior Cruciate Ligament and Anterolateral Ligament by Removing the Semitendinosus and Gracilis: A Simple, Reproducible Technique

Persistent rotatory laxity is a factor in failure after anterior cruciate ligament (ACL) reconstruction, and numerous studies have highlighted the benefits of ACL reconstruction combined with anterolateral ligament (ALL) reconstruction, in particular to reduce the risk of iterative rupture and provide additional rotatory stability. Various techniques for combined ACL-ALL reconstruction exist, none of which has been proven to be superior. We propose a surgical technique for combined ACL-ALL reconstruction using the hamstrings, pedicled semitendinosus, and gracilis, with a single femoral tunnel.

Correlation between antropometric status with Hamstring graft Sizes for ACL reconstruction

Correlation between antropometric status with Hamstring graft Sizes for ACL reconstruction

Longevity in Sport 25 years post ACL reconstruction: A prospective study comparing patients with patellar tendon and hamstring grafting to uninjured controls

Longevity in Sport 25 years post ACL reconstruction: A prospective study comparing patients with patellar tendon and hamstring grafting to uninjured controls

Single Bundle vs. Double Bundle ACL Reconstruction: Is there any difference in Joint Stability and Subjectivity?

Single Bundle vs. Double Bundle ACL Reconstruction: Is there any difference in Joint Stability and Subjectivity?

Risk Factors for Graft Rupture following ACL Reconstruction Surgery: A Systematic Review

Risk Factors for Graft Rupture following ACL Reconstruction Surgery: A Systematic Review

The role of anterolateral complex surgery and slope-reducing osteotomies in revision ACL reconstructions: a narrative review.

Anterior cruciate ligament reconstruction (ACLR) failures occur for various reasons including residual laxity, untreated concomitant injuries, poor graft quality, and high tibial slope. Various additional procedures can help to decrease revision ACLR failures including anterolateral complex (ALC) procedures and slope-reducing osteotomies for patients with high tibial slopes. This narrative review aims to review the literature on the roles of ALC augmentation procedures and slope-reducing osteotomies in the setting of patients undergoing revision ACLRs. A narrative review of relevant literature was performed in July 2024. Studies about anterolateral complex reconstructions and slope-reducing osteotomies in revision ACLRs were included. The literature reported that lateral extra-articular tenodesis (LET) and anterolateral ligament reconstructions (ALLR) can be used in revision ACLR cases to significantly reduce clinical knee laxity and the risk of repeated graft failure. There is not currently a strong opinion on which ALC procedure is superior. There are reported slight differences in lateral knee pain and knee stiffness, but both similarly significantly improve clinical and functional outcomes. In revision ACLR cases that also have a high posterior tibial slope (PTS), a slope-reducing tibial osteotomy is warranted. An anterior closing wedge proximal tibial osteotomy (ACW-PTO) significantly reduces anterior tibial translation and graft failure. There is concern about the changes to patellar height, but the literature has found that such changes are either slight or absent by 6 months postoperatively. The risk of ACLR failure is increased by risk factors like high tibial slope, preoperative knee laxity, and prior ACLR rupture. Anterolateral complex procedures and slope-reducing osteotomies may be used to address these specific concerns and reduce the risk of graft rupture. For revision ACLR cases with lower PTS, augmentation with a LET or an ALLR to reduce the risk of graft failure and improve rotational stability may be warranted. In the setting of a revision ACLR in patients with a high PTS of ≥12°, a concomitant ACW-PTO and ALC procedure should be considered to decrease the risk of an ACLR graft failure.

Persons Who Have Undergone ACL Reconstruction Exhibit Altered Patellofemoral Joint Contact Area: Implications For Early Onset Patellofemoral Joint Arthritis

Persons Who Have Undergone ACL Reconstruction Exhibit Altered Patellofemoral Joint Contact Area: Implications For Early Onset Patellofemoral Joint Arthritis

Residual Rotatory Instability after ACL Reconstruction Surgery

Residual Rotatory Instability after ACL Reconstruction Surgery

Practice Patterns and Return-to-Sports Timing of National Football League Head Team Physicians for ACL Reconstruction

Practice Patterns and Return-to-Sports Timing of National Football League Head Team Physicians for ACL Reconstruction

Standardized treatment of infection after anterior cruciate ligament reconstruction

Infection after anterior cruciate ligament reconstruction (ACLR) is a rare and catastrophic postoperative complication. The aims of this study were to investigate the diagnostic, treatment and rehabilitation measures for postoperative infection following after ACLR. A retrospective study was conducted on 1500 patients who underwent ACLR between January 2011 and January 2022. Twenty patients who met the criteria for summarizing the incidence patterns and treatment experiences were selected for a complete investigation of their diagnostic, therapeutic, and rehabilitation processes, as well as outpatient follow-up results. Among the 20 patients who developed postoperative infections, Staphylococcus aureus was the main pathogen (80%). The clinical manifestations mainly included fever (80%) and knee joint pain (100%). Laboratory tests demonstrated that C-reactive protein (CRP) levels were greater than 50 mmol/L in fifteen patients (75%). All of the patients received intravenous antibiotic therapy. Five patients (25%) of tendon socket infection were treated with continuous negative pressure suction irrigation, whereas the other fifteen patients with intra-articular infection were treated with arthroscopic debridement and continuous flushing. The Lysholm score of the affected knee was compared before treatment and 6 months after treatment, and the difference was statistically significant (t = 20.78, P < 0.001). The success rate of treatment was 100%, and there were no significant differences between patients who received secondary treatment and functional exercise and those who underwent ACLR in terms of knee joint function or range of motion during the same time period. Infection was rare after ACLR, however it was fatal, and the main pathogen was Staphylococcus aureus. Early diagnosis and a comprehensive treatment approach are pivotal for the successful management of postoperative infections following ACLR. The results of this study contribute valuable clinical insights for further refining surgical procedures, enhancing infection prevention measures, and optimizing rehabilitation protocols.