Anterior Cruciate Ligament Damage Research Articles

Lever sign test for anterior cruciate ligament injuries: a diagnostic meta-analysis

BackgroundSports-related ACL (anterior cruciate ligament) injuries are frequent. Successful management requires early diagnosis and treatment. One of the clinical tests used to identify ACL damage is the lever sign test. This meta-analysis aimed to assess the lever sign test's diagnostic efficacy for ACL injuries.MethodsAn extensive investigation of the Cochrane Library, Embase, and PubMed databases was conducted until April 2023. Studies assessing the lever sign test's diagnostic efficacy for ACL injuries were also included. A bivariate random-effects model was employed to acquire the pooled estimates of diagnostic odds ratios, specificity, positive and negative likelihood ratios, sensitivity, and curves of the summary receiver operating characteristic (SROC).ResultsThe meta-analysis comprised twelve investigations with a total of 1365 individuals. The lever sign test's combined sensitivity and specificity for the purpose of diagnosing injuries to the ACL were 0.810 (95% confidence interval [CI] 0.686–0.893) and 0.784 (95% CI 0.583–0.904), respectively. The positive and negative likelihood ratios were 3.148 (95% CI 1.784–5.553) and 0.210 (95% CI 0.084–0.528), respectively. The study revealed a diagnostic odds ratio of 17.656, with a 95% CI ranging from 4.800 to 64.951. The SROC curve's area was determined to be 0.912 (95% CI 0.857–0.967).ConclusionWith high specificity and sensitivity, the lever sign test is a reliable diagnostic modality for ACL injuries. However, the test should be used in combination with other diagnostic tests to increase the accuracy of the diagnosis. Further investigations are warranted to assess the clinical practicability of the lever sign test in various populations and settings.

Lever-Test Accuracy in Detecting Anterior Cruciate Ligament (ACL) Tears: A Single Institution Experience.

Background One of the most often damaged ligaments in the knee is the anterior cruciate ligament (ACL). With the increased occurrence of ACL injuries, there is a greater need for clinical diagnostics to rule in or rule out a suspected rupture. The Lever Test, a novel clinical tool for diagnosing ACL rupture, has been presented, with preliminary trials indicating encouraging results. Methods This is a prospective, blinded, diagnostic accuracy study. The aim of this study was to evaluate the accuracy of the Lever Test and other common clinical tests (Anterior Drawer Test, Lachman Test, Pivot Shift Test) for diagnosing ACL injuries. The study enrolled 23 patients who had knee pain, instability, and locking symptoms. The clinical tests were performed on the patients in supine position before, during, and after anesthesia. The results of the clinical tests were compared with MRI findings to determine the sensitivity of each test. Results The patients consisted of 17 men and six women, with a mean age of 30.4±9.95 years. 18 patients had complete tears, four had partial tears, and one had intact ACL damage. 10 (44%) complained in the right knee, 13 (56%) in the left knee, and two (9%) had a generalized ligamentous laxity. 21 (91%) complained of giving away, 22 (96%) complained of knee pain, and 10 (43%) complained of locking of the knee. On the ipsilateral leg examination, pre-operative positivity of Lever Sign was 44%, Lachman 83%, and Anterior Drawer 67%. After being given anesthesia, test positivity rates were 44% for Lever Sign and 56% for Pivot Shift. Post-operative positivity of Lever Sign was 17%, Lachman 39%, and Anterior Drawer 35%. Mcnemar test p values were significant for the difference of positivity anterior drawer test (p=0.002) and were not significant on Lever Sign (p=0.7) and Lachman tests (p=0.13). Correlation analysis showed a weak but not statistically significant interrater reliability between MRI findings and Lever Sign (p=0.846) (Kappa= 0.2). On the contralateral leg examination, the pre-operative positivity of Lever Sign was 9%, Lachman 17%, and Anterior Drawer 22% Conclusion The study suggests that the Lever Test has lower accuracy than other clinical tests when comparing the results of tests with MRI findings. As a result, Lever Test should be used in combination with other clinical tests to accurately rule out suspected ACL injuries.

Substantiation of the application of osteopathic correction in the complex rehabilitation of patients after anterior cruciate ligament reconstruction surgery

Introduction. For a qualitative restoration of the knee joint function after arthroscopic reconstruction of the anterior cruciate ligament, the process of engraftment, restoration of the strength and viability of the graft (new anterior cruciate ligament) is important. The weakening of the inflammatory process after surgery and the return of strength and tone to the muscles that ensure the proper functioning of the injured knee joint are equally important. Restoring the properties of the damaged fascia, providing proprioceptive control of the periarticular muscles for the stability of the knee joint are the priorities of the rehabilitation process. Somatic dysfunctions that have been previously presented, as well as have appeared at the time of injury or during surgery, slow down recovery. Therefore, the inclusion of osteopathic treatment in the rehabilitation process seems to be a logical step. However, the problem of the osteopathic correction role in the rehabilitation process in case of the anterior cruciate ligament damage has been covered very little in the specialized literature.The aim of the study is to substantiate the use of osteopathic correction in the complex rehabilitation of patients after anterior cruciate ligament reconstruction surgery.Materials and methods. The study involved 47 patients who underwent arthroscopic knee surgery for reconstruction of the anterior cruciate ligament. 23 patients who underwent the recommended rehabilitation course were included in the control group, 24 patients who additionally received a course of osteopathic correction were included in the main group. Before and after the treatment, there were assessed osteopathic status of patients, the range of movements in the operated knee joint, the dynamics of the inflammatory process (according to such indicators as changes in the local temperature of the knee joint and the thermal symmetry, as well as the circumference of the knee joint), and the pain intensity.Results. At the beginning of the study, regional somatic dysfunctions of the lower limb region were most often detected in main and control groups (100 and 65,2 %, respectively) and the pelvic region (91,7 and 87 %, respectively). After the treatment, statistically significant (p<0,05) positive dynamics was observed in the main group in terms of such indicators as the detection frequency of regional dysfunctions of the lower extremities, pelvis, neck and thoracic region. There was no significant dynamics in the control group. In both groups, there was a significant (p<0,05) positive dynamics in such indicators as the range of movements in the joint, local temperature and thermal symmetry, joint circumference, pain intensity. A statistically significantly (p<0,05) more pronounced result was observed in the main group than in the control group for all the listed indicators.Conclusion. The study confirms the positive contribution of osteopathic correction to expanding the possibilities of complex rehabilitation of patients after arthroscopic anterior cruciate ligament plasty. However, it is recommended to continue research in this direction on a larger sample size.

Deep learning MRI analysis for automated knee injury diagnosis

Magnetic Resonance Imaging (MRI) plays a pivotal role in non-invasively diagnosing knee injuries. This research focuses on cost-effective, efficient solutions for enhancing automated knee injury detection in MRI scans. The study aims to boost diagnostic accuracy for abnormalities, Anterior Cruciate Ligament (ACL) tears, and meniscal tears using advanced deep learning techniques. Transfer learning is employed, combining pretrained neural networks with transfer models. AlexNet and SqueezeNet are explored as feature extraction architectures, assessing the attention mechanism and maxpooling for sequence reduction. This yields four models, MRNet, MRNet-Squeeze, MRNet-Attend, and MRNet- SqueezeAttend. The primary evaluation metric is the Area Under the ROC Curve (AUC), providing a comprehensive assessment by averaging AUC scores for abnormal, ACL tear, and meniscus tear labels. The initial MRNet achieves the highest AUC (0.940) for anomaly detection, while MRNet-Squeeze excels in diagnosing ACL damage. MRNet- SqueezeAttend achieves the highest AUC (0.885) for meniscus tears. The ensemble of all four models outperforms individual models with an outstanding average AUC of 0.931. Each model exhibits unique strengths. MRNet excels at spotting anomalies, MRNet-Squeeze accurately detects ACL tears, and MRNet-SqueezeAttend excels in identifying meniscal tears. Notably, the ensemble leverages these diverse strengths to deliver cutting-edge results for all injury types. Further investigation reveals varying correlations between model-specific predictions and different diagnosis or sequence combinations. Scrutinizing the MRI sequence frames capturing the models' attention identifies key contributors to the diagnosis.

The Effect of Two Types of Foot Orthoses on the Knee Valgus Angle Within Single-Leg Landing: Implications for ACL Damage Hazard Decrease

Background: Non-contact anterior cruciate ligament (ACL) injuries commonly occur when athletes land in high risk positions such as knee valgus. The impact of foot orthoses during exercises that recreate a non-contact ACL harm system (i.e., landing) in any case will be obscured. Objectives: The purpose of the current study research was to evaluate the effect of two foot orthoses (semi-hard foot orthoses and hard foot orthoses) on knee valgus angle during single-leg drop landing. Methods: Twenty male leisure volleyball gamers performed landing in one-leg step from 30 cm height in 3 conditions (without foot orthoses, mid-hard foot orthoses, and hard foot orthoses). A motion capture system was used to measure lower extremity kinematics. Two risk factors of ACL injury, maximum knee valgus angle (KVA), and maximum knee flexion was measured. ANOVA was used for statistical analysis (P < 0.05). Results: With mid-hard foot, orthoses provide the maximum level of knee flexion and the minimum level of knee valgus during single-leg drop landing. Conclusions: It may be concluded showed that foot orthoses affect knee kinematics. More knee flexion and less knee valgus brought about by mid-hard foot orthoses can reduce injuries of the anterior cruciate ligament (ACL).

Functional outcome of acute tibial eminence fractures treated with arthroscopic assisted pull-through suture technique: A prospective case series

Background and Objective: There is an increased incidence of tibial eminence fractures in skeletally mature adults due to increased road traffic accidents and participation in sports activities (reference). The study has been undertaken to evaluate the functional outcome of acute tibial eminence fractures treated arthroscopically with a pull-through suture technique.Methods: This study included thirty-one patients with acute tibial eminence fractures treated arthroscopically between November 2019 and March 2021. All the fractures were fixed using a pull-through suture technique and tied over the suture disc.Results: Among the thirty-one patients treated, the most common cause of injury was a road traffic accident, followed by sports injuries. Two patients were injured due to a kick by the bull. In sports injuries, Kabaddi was the most prevalent cause of anterior cruciate ligament damage. Males made up 29 (94%) cases, while females made up just 2 (6%). The majority of the patients were between the ages of 40 and 49 (45 per cent). 64.5 per cent of patients (n=20) had surgery within five days of their accident. In our study, the mean preoperative IKDC scores were 50.94, and the mean postoperative IKDC scores were 87.73, indicating a considerable improvement. The mean pre-operative Lysholm score was 60.1, and postoperative Lysholm scores were 91.5. One patient had five degrees of extensor lag, and one patient had a fixed flexion deformity at ten degrees due to poor compliance to rehabilitation. Patients showed significant improvement by the end of 3 months and were allowed to return to daily activities by the end of 3 months and sports by six months. The percentage of patients who ended up having good to excellent outcomes is 83.8 and the percentage of patients returning to pre-injury level is 70.Conclusion: Treating acute tibial eminence fractures with an arthroscopic pull-through suture technique gives good rigid fixation and improves the functional outcome.

Biomechanics of the anterior cruciate ligament under simulated molecular degradation.

Injuries to the knee anterior cruciate ligament (ACL) are common, with a known but poorly understood association with intrinsic and extrinsic risk factors. Some of these factors are enzymatically or mechanically mediated, creating acute focal injuries that may cause significant ligament damage. Understanding the relationship between the basic molecular structure and external loading of the ACL requires a hierarchical connection between the two levels. In the present study, a multi-domain frame was developed connecting the molecular dynamics of the collagen networks to the continuum mechanics of the ACL. The model was used to elucidate the effect of the two possible collagen degradation mechanisms on the aggregate ACL behaviour. Results indicated that collagen content and ACL stiffness were reduced significantly, regardless of the degradation mechanism. Furthermore, the volumetric degradation at the molecular level had a devastating effect on the mechanical behaviour of the ACL when it was compared with the superficial degradation. ACL damage initiation and propagation were clearly influenced by collagen degradation. To summarise, the new insights provided by the predicted results revealed the significance of the collagen network structural integrity to the aggregate mechanical response of the ACL and, hence, underlined the biomechanical factors that may help develop an engineering-based approach towards improving the therapeutic intervention for ACL pathologies.

Predicting the Effect of Localized ACL Damage on Neighbor Ligament Mechanics via Finite Element Modeling.

The anterior cruciate ligament (ACL) plays a pivotal role in support of the knee under loading. When damaged, it is known that substantial changes in the mechanics of the neighboring ligaments can be observed. However, a localized damage approach to investigating how ACL deficiency influences the neighboring ligaments has not been carried out. To do this, a finite element model, incorporating a continuum damage material model of the ACL, was implemented. Localized ACL damage was induced using high quadriceps force loading. Once damaged, anterior shear forces or tibial torque loadings were applied to the knee joint. The relative changes in stress contour and average mid-substance stress were examined for each of the neighboring ligaments following localized ACL damage. It was observed that localized ACL damage could produce notable changes in the mechanics of the neighboring knee ligaments, with non-homogenous stress contour shape changes and average stress magnitude being observed to increase in most cases, with a notable exception occurring in the MCL for both loading modes. In addition, the ligament bearing the most loading also changed with ACL deficiency. These changes carry implications as to morphological effects that may be induced following localized ACL damage, indicating that early diagnosis of ACL injury may be helpful in mitigating other complications post injury.

Correlation of Femoral Trochlear Dysplasia With Anterior Cruciate Ligament Injury in Skeletally Immature Patients

Background:Reports of anterior cruciate ligament (ACL) injury in patients with skeletal immaturity have been increasing. Variations in knee joint anatomy have been linked to ACL injury risk factors.Purpose:To identify associations between ACL injury, patella alta, and femoral trochlear dysplasia in patients with skeletal immaturity by using magnetic resonance imaging (MRI).Study Design:Cross-sectional study; Level of evidence, 3.Methods:This retrospective study included 231 patients with skeletal immaturity—116 with acute complete noncontact ACL injury and 115 without ACL injury (controls)—who underwent knee MRI. Cases of femoral trochlear dysplasia were divided into 4 types according to the Dejour classification scheme. Patellar height and patellar tendon length were measured via sagittal MRI, and the Insall-Salvati ratio (ISR) was calculated.Results:In the ACL injury group, 56 (48.3%) knees exhibited trochlear dysplasia, including 51 (91.1%) that were Dejour type A; and in the control group, 12 (10.4%) knees exhibited trochlear dysplasia, 12 (100%) Dejour type A. The prevalence of femoral trochlear dysplasia was significantly higher in the ACL injury group than in the control group (P < .001). The ISR was not significantly different between the ACL injury and control groups (0.9 ± 0.2 vs 1 ± 0.2 mm; P = .16). The correlation between ISR >1.2 and presence of ACL injury was not significant.Conclusion:Femoral trochlear dysplasia was associated with ACL injury in patients with skeletal immaturity. In particular, Dejour type A femoral trochlear dysplasia was correlated with ACL injury patients with skeletal immaturity. Also, the possibility of ACL damage exists in patients with skeletal immaturity and femoral trochlear dysplasia.

Correlation between knee anatomical angles and anterior cruciate ligament injury in males.

To determine the correlation between anatomical angles of knee joint and anterior cruciate ligament (ACL) injury, and evaluate the effects of these angles on identifying people prone to ACL injury in males. From January 2013 to October 2017, male patients with and without non-contact ACL injury were included in the case and control groups, respectively. Anatomical angles on the sagittal and coronal magnetic resonance (MR) images of these patients were measured by senior radiologist and orthopaedic surgeon. The parameters contained medial tibial slope (MTS), lateral tibial slope (LTS), medial-lateral plateau slope (MLPS), femoral axis-Blumensaat line angle (FABA), anterior tibia slope (ATS), anterior tibial-Blumensaat line angle (ATBA). The Student's-t test or rank sum test was used to compare the independent samples between different groups. Binary logistic regression analysis was used to analyse the effects on identifying people apt to suffer an ACL injury of these angles. A total of 150 male patients were included in the study. There were 72 patients in the case group and 78 patients in the control group. The MTS, LTS and ATBA in the case group were significantly greater than those in the control group (P = 0.021, P < 0.001, P = 0.046). The FABA of the case group was significantly smaller than that of the control group (P = 0.006). There was no significant difference in MLPS and ATS between the two groups. The area under the curve (AUC) of LTS was 0.762, the best anatomical angle for identifying people prone to ACL injury. Combining these anatomical angles can improve the accuracy (AUC = 0.800). The male ACL injury was associated with MTS, LTS, ATBA and FABA of the knee. The LTS might be more suitable for predicting ACL injury. Analysis of these angles alone or in combination could help identify the people apt to suffer ACL damage.

Comparison of Iatrogenic Soft Tissue Trauma in Robotic-Assisted versus Manual Partial Knee Arthroplasty

Partial knee arthroplasty (PKA) is performed to treat end-stage osteoarthritis in a single compartment. There are minimal data characterizing soft-tissue injuries for PKA with robotic and manual techniques. This cadaver study compared the extent of soft-tissue trauma sustained through robotic-arm assisted PKA (RPKA) and manual PKA (MPKA). Five surgeons prepared 24 cadaveric knees for medial PKA, including six MPKA controls and 18 RPKA assigned into three different workflows: RPKA-LB (six knees) – RPKA with legacy burr; RPKA-NB (six knees) – RPKA with new burr design; and RPKA-NBS (six knees) – RPKA with new burr design and oscillating saw. Two surgeons estimated trauma to the patellar tendon, quadriceps tendon, anterior cruciate ligament (ACL), medial collateral ligament (MCL), medial capsule, posterior capsule, and posterior cruciate ligament (PCLs) using a five-grade system: Grade 1 – complete soft tissue preservation; Grade 2 – ≤25%; Grade 3 – 26 to 50%; Grade 4 – 51 to 75%; and Grade 5 – ≥76% trauma. A total trauma grade was assigned by summing the grades. Kruskal-Wallis statistical tests were used to assess outcomes. When compared to the MPKA group, all RPKA subgroups had lower total trauma grading (p&lt;0.01), lower posterior capsular damage (p&lt;0.01), and less severe ACL damage (p&lt;0.01). The analysis demonstrated no significant difference between the three RPKA workflows. As this study was performed using cadaveric specimens, additional investigations are necessary to determine associations between robotic or manual-assisted technique, observed soft tissue damage, and postoperative clinical outcomes following PKA.

Clinical assessment and comparison of ACL reconstruction using synthetic graft (Neoligaments versus FiberTape).

Due to the low potential for primary biological healing of the anterior cruciate ligament (ACL), the most popular approach is currently reconstruction using a graft. Recent research indicates that the technique of strengthening a damaged ligament with synthetic tapes (internal bracing) may be an alternative to reconstructive treatment, especially in cases of partial ACL damage. To compare and evaluate the possibility of using a synthetic graft (Neoligaments or FiberTape) to treat partial lesions of the ACL. This was a retrospective cohort study. Selected from a pool of 128 patients undergoing primary unilateral intra-articular ACL reconstruction due to partial lesion of the ACL, group I (Neoligaments) and group II (FiberTape) each included 30 patients. Range of motion (ROM), the Lachman test, the anterior drawer test and the pivot-shift test, the Lysholm Knee Scoring Scale, and International Knee Documentation Committee (IKDC) 2000 scale were used for assessment. Follow-up was carried out after 2 years. The knee joint regained anterior stability in both the subjective and objective assessments in all patients in both groups. The subjective results were respectively: in group I, 97.2 ±3.2 points on the Lysholm scale and 93.9 ±6.1 points on the IKDC 2000 scale; in group II, 96.1 ±4.9 points on the Lysholm scale and 93.2 ±6.8 points on the IKDC 2000 scale. Group comparison of the results of the IKDC 2000 scale, Lysholm Scale and ROM obtained postoperatively showed no statistically significant differences between groups. Reconstruction of partial ACL lesions using a synthetic graft allows regained stability of the knee joint. The results of subjective assessment are comparable with the functional assessment results. The comparison between Neoligaments and FiberTape shows the same functional and objective results, although FiberTape is preferable from an economical perspective.

The effect of insole on the knee valgus angle and pelvic muscle activity during high-intensity weight-bearing tasks

IntroductionThe purpose was to investigate changes in knee valgus angle, as well as associated pelvic muscles, gluteus medius and tensor fasciae latae, when using an insole in people with leg length mismatch less than 2 cm in high-intensity weight-bearing tasks.MethodsThe knee valgus angle, muscle activity of the gluteus medius, and muscle activity of the tensor fasciae latae were measured with and without an insole during a drop jump task and a step landing task. All measurements were performed 3 times, and the average value was used. The subjects practised 3 times before the measurement and took a sufficient rest between each measurement.ResultsThere was no significant difference between the knee valgus angles with or without an insole during the drop jump task or step landing task. For the drop jump task, a significant difference was observed in the muscle activity of the tensor fasciae latae on the short leg side; for the step landing task, a significant difference was noted in the muscle activity of the gluteus medius on the long leg side (&lt;i&gt;p&lt;/i&gt; &lt; 0.05).ConclusionsThe use of insoles by people with leg length discrepancy during high-intensity landing may prevent non-contact anterior cruciate ligament damage, which is frequently seen in high-intensity landings.

Validation of the Macroscopic Anterior Cruciate Ligament Status Using the Oxford Classification System in Relation to Cartilage Defects on the Medial Tibial Plateau in Osteoarthritic Knees.

This study evaluated the relationships between anterior cruciate ligament (ACL) grading using the Oxford classification system and cartilage defects on the medial tibial plateau to clarify the validity of the system. We studied the location and size of a full-thickness cartilage defect of the medial tibial plateau in 154 knees (97 patients) treated by unicompartmental (113) or total (41) knee arthroplasty between April 2017 and January 2018, and analyzed their relationship to the anterior cruciate ligament (ACL) grade, Grade 1 (normal), Grade 2 (synovial damage), Grade 3 (longitudinal split), Grade 4 (friable and fragmented), and Grade 5 (absent). Significant trends in decreased posterior preserved cartilage, increased defect length, and posteriorized defect center were associated with increasing ACL grade. Multiple comparison analysis revealed that the measurements were significantly different between ACL functional (Grades 1-3) and ACL deficient (Grades 4 and 5). On the other hand, the anterior preserved cartilage was consistent among the Grades. The macroscopic Oxford ACL classification system well described the disease progression where the cartilage defect extends posteriorly with ACL damage. However, 38% of ACL deficient knees had well-preserved posterior cartilage with no evident tibial anterior translation.

ACL Reconstruction: Problems, History and Future. Part 1

Summary. Damage to the anterior cruciate ligament (ACL) of the knee joint is a common injury in sports medicine. Before advances in arthroscopy and surgical techniques, an ACL damage was considered a career ending injury for many athletes. Since the 1990s, there has been a rapid development of arthroscopic surgery for ACL and continuous improvement of these techniques. Today’s athletes can expect a pre-injury level of stability and function after an ACL reconstruction. Modern surgical interventions have come a long way, having studied both the successes and failures of previous surgical techniques. In the United States, an ACL damage is diagnosed annually from 100,000 to 200,000 cases, making this the most common ligament injury [9, 10]. This number continues to increase in both the general population and in individuals who play sports. Football players sustain the greatest number of ACL injuries (53% of the total), with skiers and gymnasts also at high risk. The history of ACL reconstruction can be traced as far back as the Egyptians times. Research and innovation are constantly evolving, and this leads to improved clinical results. The knowledge of the evolution of ACL reconstruction is invaluable to those who continue to try to improve the outcomes of the procedure and reduce the risks of repeating mistakes of the past.

Additional Anterior Cruciate Ligament MRI Examination Protocols: a Standard of Diagnosis or a Whim of Researchers? (Review)

Summary. Standard MRI protocols of the knee joint in case of suspected anterior cruciate ligament (ACL) injury involve tomography in three mutually perpendicular planes – coronal, sagittal, and axial. Modern methods of treatment (especially refixation of the ACL and reconstruction of separate ACL bundles) and rehabilitation require more accurate diagnosis not only of the fact of injury, but also its clear location, degree and term. It is especially difficult to assess the nature and extent of ACL damage in the acute period and in cases of partial injury. Therefore, we propose to introduce into the standard of ACL MRI examination the additional use of oblique sagittal and oblique coronal sequences (images) oriented at an angle of ACL fibers with reduced to 0-2 mm interslice interval to improve the diagnosis of ACL injury. To reduce the duration of the study, it is possible to limit yourself to a small number of slices (images) in additional projections only in the area of the ACL.

COMPARATIVE RESULTS OF ARTHROSCOPIC ANATOMICAL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING PATELLAR TENDON AND HAMSTRINGS AUTOGRAFTS

Complete traumatic injuries of the anterior cruciate ligament (ACL) are the most common knee injury among physically active males and females who are fond of both traditional and extreme sports. Surgical restoration of the anatomical structures of the injured joint, even with isolated ACL damage, remains an urgent problem of modern traumatology and orthopedics. The technology of arthroscopic reconstruction of the ACL is developing along the path of improving the technique of surgery, fixators, plastic materials. The article is devoted to the study of the results of arthroscopic anatomical plastic surgery of the anterior cruciate ligament with autografts from the patellar ligament with two bone blocks and the hamstring flexor tendons. The study included 100 patients of the main group and the comparison group with chronic damage to the anterior cruciate ligament and chronic anterior instability of the knee joint, which were divided into two groups depending on the type of transplant used. Long-standing injuries of the anterior cruciate ligament were diagnosed based on the results of a clinical examination, radiography, magnetic resonance imaging, and hardware arthrometry. Excellent and good results of surgical treatment were obtained in most patients of both groups, however, the highest stabilization indicators of the knee joint were noted in the comparison group.

Evidence-Based Physical Therapy for Anterior Cruciate Ligament Injury: Literature Review

Most athletes with anterior cruciate ligament (ACL) ruptures undergo a surgical ACL reconstruction (ACLR) and rehabilitation. On the other hand, controversy still exists because neither a reconstruction nor rehabilitation have been proven to be superior in the manage ment of ACL injury. This study reviewed the success rates of interventions to provide recommendations for the optimal management af ter an ACL injury. One of the most important considerations after an ACL injury is the timing and type of intervention. At the early stages, which involve the loss of volume and strength of quadriceps femoral muscle, weight bearing (closed kinetic chain) exercises with pain management followed by high velocity resistance exercises in an open kinetic chain environment are recommended to improve the quadriceps function. After that, it is important to apply intensive isokinetic exercise with a lower extension rate. In this case, it is impor tant to apply overload to the muscles and to simultaneously lead the co-contraction of the hamstrings. Standards are essential because the timing and type of interventions are crucial to prevent re-injury and complications, such as osteoarthritis, as well as to confirm the successful outcome of the treatment. Different interventions recommended for ACL damage have yet to reach consensus. Further studies will be needed to observe the effects of the intervention through multidisciplinary approaches.

One-Third of Meniscal Tears Are Repairable: An Epidemiological Study Evaluating Meniscal Tear Patterns in Stable and Unstable Knees

To analyze, in a long series of patients with knee injuries, the meniscal tear patterns in both stable and unstable knees to ascertain the exact proportion of such injuries that could have been repaired. A descriptive cross-sectional study was undertaken by reviewing the clinical reports of arthroscopic knee operations carried out in 1 hospital. A total of 2,066 consecutive patients were included in the study. An analysis of clinical and anatomical data of knee lesions, including the shape of the meniscal tears and the surrounding injuries, was performed. Out of all meniscal tears, 34.9% were found to be repairable, a figure that rose to 55.6% in those tears accompanied by anterior cruciate ligament injuries; 37% of meniscal tears in male patients were repairable, and 28% in their female counterparts; 38.2% of medial meniscal tears were repairable and 30.6% in their lateral counterparts. The most frequently encountered injury was the complex tear (46.9%). Our study concludes that, according to current standard indications, 34.9% of all meniscal injuries offer the potential for repair. Where the injury is also accompanied by anterior cruciate ligament damage, the proportion of repairable tears rises to 55.6%. This information should increase the interest for meniscal preservation in the future. Level IV, case series.

Role of racing in anterior cruciate ligament injury

The use of orthoses and braces in patients with damage to the anterior cruciate ligament and post-arthroscopic re­construction is a fairly widespread phenomenon.Objective: to determine the effectiveness of the application of orthoses of various structures in patients with anterior cruciate liga­ment injury using hardware-software baseometric complex.Methods: 50 patients with anterior cruciate ligament damage and 50 healthy volunteers were screened. Bazometric study with the help of the hardware-software baseometric complex (baseometer) KE 03191680.010-2005 of the UkrNII prosthesis production was carried out without a latch and using 4 types of knee joint fasteners. The parameters of two-stops stand­ing on the base-platform were analyzed: load distribution (%) of the total body mass between the lower extremities, incapacitability, displacement of the general pressure center in the fron­tal and sagittal planes, and the rotation of the general pressure center.Results: in patients with injuries of anterior cruciate ligament, a significant prevalence of body mass distribution for the intact lower limb was found to be significant (73.3 ± 2.8) and (26.7 ± 1.6) %, respectively; the weight bearing factor was 0.36 ± 0.4; displacement of the general CT in the frontal plane — (11.5 ± 1.1) mm; in the sagital — (7.2 ± 1.0) mm; rotating angle of the general pressure center — (7.8 ± 1.2)°. Under the condi­tions of the use of fixators, depending on their type, a tendency to reduce the asymmetry of the body weight distribution between the limbs is determined.Conclusions: as a result of the survey of healthy volunteers, the main indicators of the two-limb stand­ing on the base-platform were obtained. The analysis of base­line rates of patients with anterior cruciate ligament injury showed a significant deviation compared with the group of volunteers. Among the studied designs of knee joint fixation de­vices, the knee joint with a two-axis hinge was most functionally suitable. It allows the maximum correction and improvement of biomechanical indicators of statics and fatigue of the injured limb.