Anterior Cruciate Ligament Injury Research Articles

Statistical Parametric Mapping to detect the effects of the secondary jump direction on landing kinematics.

Anterior cruciate ligament (ACL) injuries in sports often occur with non-contact mechanisms, such as landing and cutting. Previous studies explored the ACL injury biomechanical risk factors through drop-jumps combined with secondary jumps. This study aimed to investigate the effect of the secondary jump direction on first landing kinematic temporal series. Fifty-seven participants (29 males, 28 females) performed three single-leg drop-jumps followed by secondary jumps in vertical (single-planar), 45°-medial and 45°-lateral direction (multi-planar). Lower limb and trunk landing kinematics was recorded using a 9-camera motion capture system and analysed with a One-way ANOVA through Statistical Parametric Mapping (SPM), from initial contact to maximum knee flexion. All variables were affected by the secondary jump direction, except trunk rotation. In sagittal plane, kinematic main differences were found between single- and multi-planar tasks. The latter elicited higher trunk, hip, and knee flexion. Frontal plane kinematics was more influenced by medio-lateral components of secondary jumps. Our results could underline how a single task may be insufficient for ACL injury risk assessment. Single- and multi-planar tasks including a secondary jump should be considered for more comprehensive evaluations in prevention and rehabilitation programs, but caution should be used when comparing results of studies adopting different tasks.

3-Dimensional Biomechanics of Noncontact Anterior Cruciate Ligament Injuries in Male Professional Soccer Players.

The understanding of noncontact anterior cruciate ligament (ACL) injury causation in soccer has improved over the past decades. Bidimensional video analyses have significantly augmented our awareness, representing to date the only practical method to describe injury biomechanics. However, the extent of the problem continues to raise serious concerns. To advance our understanding of the causal pathways leading to ACL injury with a large-scale reconstruction of 3-dimensional (3D) whole-body joint kinematics of injuries that occurred to male elite soccer players, as well as to compare the joint angle time course among situational patterns. Descriptive laboratory study. A total of 33 consecutive noncontact and indirect contact ACL injuries that occurred in 6 national and 2 international professional leagues (seasons 2020-2021 to 2022-2023 until December 2022) were analyzed: (1) multiview noncoaxial television images were inspected; (2) multiple camera views were taken from 400 ms before the initial ground contact to 200 ms after the injury frame; (3) a size-matched pitch was modeled and used to calibrate cameras; (4) a 3D skeletal model was adjusted to fit the player's pose in each frame/view; and (5) poses were interpolated, and Euler joint angles were extracted. The authors reconstructed the 3D lower limb joint kinematic curves preceding and during ACL injuries in 33 cases; notably, a sudden external (up to 5°) and then internal knee rotation was observed after the initial contact and before the injury frame. The overall kinematics at injury were knee moderately flexed (45.9°± 21.7°), abducted (4.3°± 5.1°), and externally rotated (3.0°± 6.4°); trunk shallowly flexed (17.4°± 12.5°) and rotated and tilted toward the injured side; and hip flexed (32.0°± 18.7°), abducted (31.1°± 12.0°), and slightly internally rotated (6.6°± 12.2°). Variable behaviors were observed at the ankle level. Via reconstruction of the sequence of whole-body joint motion leading to injury, we confirmed the accepted gross biomechanics (dynamic valgus trend). This study significantly enriches the current knowledge on multiplanar kinematic features (transverse and coronal plane rotations). Furthermore, it was shown that ACL injuries in male professional soccer players manifest through distinct biomechanical footprints related to the concurrent game situation. Interventions aimed at reducing ACL injuries in soccer should consider that environmental features (ie, situational patterns) affect injury mechanics.

Bone bruise distribution predicts anterior cruciate ligament tear location in non-contact injuries.

It is unclear whether different injury mechanisms lead to divergent anterior cruciate ligament (ACL) tear locations. This study aims to analyse the relationship between bone bruise (BB) distribution or depth and ACL tear location. A retrospective analysis of 446 consecutive patients with acute non-contact ACL injury was performed. Only patients with complete ACL tears verified during subsequent arthroscopy were included. Magnetic resonance imaging (MRI) was used to classify BB location, BB depth, ACL tear location and concomitant injuries (medial/lateral meniscus and medial/lateral collateral ligament). Demographic characteristics included age, gender, body mass index (BMI), type of sport and time between injury and MRI. Multiple linear regression analysis was used to identify independent predictors of ACL tear location. One hundred and fifty-eight skeletally mature patients met the inclusion criteria. The presence of BB in the lateral tibial plateau was associated with a more distal ACL tear location (β = -0.27, p < 0.001). Less BB depth in the lateral femoral condyle showed a tendency towards more proximal ACL tears (β = -0.14; p = 0.054). Older age predicted a more proximal ACL tear location (β = 0.31, p < 0.001). No significant relationship was found between ACL tear location and gender, BMI, type of sport, concomitant injuries and time between injury and MRI. ACL tear location after an acute non-contact injury is associated with distinct patterns of BB distribution, particularly involving the lateral compartment, indicating that different injury mechanisms may lead to different ACL tear locations. Level III.

Externally validated treatment algorithm acceptably predicts nonoperative treatment success in patients with anterior cruciate ligament rupture.

This study aims to develop and externally validate a treatment algorithm to predict nonoperative treatment success or failure in patients with anterior cruciate ligament (ACL) rupture. Data were used from two completed studies of adult patients with ACL ruptures: the Conservative versus Operative Methods for Patients with ACL Rupture Evaluation study (development cohort) and the KNee osteoArthritis anterior cruciate Ligament Lesion study (validation cohort). The primary outcome variable is nonoperative treatment success or failure. Potential predictor variables were collected, entered into the univariable logistic regression modeland then incorporated into the multivariable logistic regression model for constructing the treatment algorithm. Finally, predictive performance and goodness-of-fit were assessed and externally validated by discrimination and calibration measures. In the univariable logistic regression model, a stable knee measured with the pivot shift test and a posttrauma International Knee Documentation Committee (IKDC) score <50 were predictive of needing an ACL reconstruction. Age >30 years and a body mass index > 30 kg/m2 were predictive for not needing an ACL reconstruction. Age, pretrauma Tegner score, the outcome of the pivot shift testand the posttrauma IKDC score are entered into the treatment algorithm. The predictability of needing an ACL reconstruction after nonoperative treatment (discrimination) is acceptable in both the development and the validation cohort: area under the curve = resp. 0.69 (95% confidence interval [CI]: 0.58-0.81) and 0.68 (95% CI: 0.58-0.78). This study shows that the treatment algorithm can acceptably predict whether an ACL injury patient will have a(n) (un)successful nonoperative treatment (discrimination). Calibration of the treatment algorithm suggests a systematical underestimation of the need for ACL reconstruction. Given the limitations regarding the sample size of this study, larger data sets must be constructed to improve the treatment algorithm further. Level II.

Evolution of Core Stability, Athletic Performance, and ACL Injury Risk across a Soccer Season

Evolution of Core Stability, Athletic Performance, and ACL Injury Risk across a Soccer Season

Unanticipated mid-flight external trunk perturbation increased frontal plane ACL loading variables during sidestep cuttings

ABSTRACT Unanticipated trunk perturbation is commonly observed when anterior cruciate ligament (ACL) injuries occur during direction-changing manoeuvres. This study aimed to quantify the effect of mid-flight medial-lateral external trunk perturbation directions/locations on ACL loading variables during sidestep cuttings. Thirty-two recreational athletes performed sidestep cuttings under combinations of three perturbation directions (no-perturbation, ipsilateral-perturbation, and contralateral-perturbation relative to the cutting leg) and two perturbation locations (upper-trunk versus lower-trunk). The pushing perturbation was created by customised devices releasing a slam ball to contact participants near maximum jump height prior to cutting. Perturbation generally resulted in greater peak vertical ground reaction force and slower cutting velocity. Upper-trunk contralateral perturbation showed the greatest lateral trunk bending away from the travel direction, greatest peak knee flexion and abduction angles, and greatest peak internal knee adduction moments compared to other conditions. Such increased ACL loading variables were likely due to the increased lateral trunk bending and whole-body horizontal velocity away from the cutting direction caused by the contralateral perturbation act at the upper trunk. The findings may help understand the mechanisms of indirect contact ACL injuries and develop effective cutting techniques for ACL injury prevention.

Comparison of three techniques for decellularization of porcine bone-tendon-bone grafts

ABSTRACT Anterior cruciate ligament injuries are frequent afflictions related to sports or physical trauma. Autograft reconstruction strategies cause secondary injury to the patient. One alternative, supported by clinical evidence, is porcine xenografts. For clinical use, xenografts must be conditioned to avoid immune rejection. The most widely accepted procedure is tissue decellularization. We analyzed three decellularization strategies: the application of the anionic detergent sodium dodecyl sulfate (SDS), sonication, and freezing and thawing cycles. The treated tissues were evaluated histologically using H&E, Masson’s trichrome, Verhoeff-van Gieson staining, and DAPI for fluorescent staining of nuclei. Finally, collagen fiber preservation was evaluated by quantifying this protein by colorimetry. The most efficient decellularization techniques were sonication and SDS. Collagen fibers were preserved in all experimental conditions.

Evaluation of increased posterior tibial slope as a risk factor for anterior cruciate ligament injury

Individuals who sustain anterior cruciate ligament (ACL) injury have an increased risk of developing early onset post traumatic osteoarthritis of the knee despite treatment received [1]. An increase in the posterior tibial slope is postulated to increase the risk of ACL rupture [2]. Measurement of the posterior tibial slope in individuals would serve as a means of screening and identifying those at increased risk of developing ACL injuries to take measures towards prevention. The aim was to measure and compare the mean value of the posterior tibial slope in adult patients with or without ACL injury. This was a hospital-based case-control study comprising 80 patients divided into two matched groups. Posterior tibial slope was measured on the plain lateral radiograph of the knee using the proximal tibial anatomic axis measurement protocol in all participants. Independent sample t-test was used to compare the means of the measured posterior tibial lope between cases and controls. The difference in the measured mean posterior tibial slope between the ACL injured group and the non-ACL injured group was found to be statistically significant with those in the ACL injured group having higher mean values (12.71 ± 1.2° vs 10.25 ± 1.1°) with a P value of &lt; 0.001. Individuals with ACL injury have a significantly greater posterior tibial slope than those without ACL injury when measured on the lateral plain radiograph of the knee using the proximal tibial anatomic axis measurement protocol.

Comparing novel smartphone pose estimation frameworks with the Kinect V2 for knee tracking during athletic stress tests.

To compare the accuracy of the Microsoft Kinect V2 with novel pose estimation frameworks, in assessing knee kinematics during athletic stress tests, for fast and portable risk assessment of anterior cruciate ligament (ACL) injury. We captured 254 varsity athletes, using the Kinect V2 and a smartphone application utilizing Google's MediaPipe framework. The devices were placed as close as possible and used to capture a person, facing the cameras, performing one of three athletic stress tests at a distance of 2.5ms. Custom software translated the results from both frameworks to the same format. We then extracted relevant knee angles at key moments of the jump and compared them, using the Kinect V2 as the ground truth. The results show relatively small angle differences between the two solutions in the coronal plane and moderate angle differences on the sagittal plane. Overall, the MediaPipe framework results seem to underestimate both knee valgus angles and knee sagittal angles compared to the Kinect V2. This preliminary study demonstrates the potential for Google's MediaPipe framework to be used for calculating lower limb kinematics during athletic stress test motions, which can run on most modern smartphones, as it produces similar results to the Kinect V2. A smartphone application similar to the one developed could potentially be used for low cost and widespread ACL injury prevention.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ РЕЗУЛЬТАТОВ ЛЕЧЕНИЯ ОСТЕОХОНДРАЛЬНЫХ ДЕФЕКТОВ СУСТАВНОЙ ПОВЕРХНОСТИ КОЛЕННОГО СУСТАВА, АССОЦИИРОВАННЫХ С ПОВРЕЖДЕНИЕМ ПЕРЕДНЕЙ КРЕСТООБРАЗНОЙ СВЯЗКИ

Purpose of work: to perform a comparative analysis of the results of treatment of patients with osteochondral defects of the articular surface associated with damage of the anterior cruciate ligament of the knee joint. Materials and Methods. Between 2015 and 2023 inclusive, 72 patients with anterior cruciate ligament injury accompanied by osteochondral defects of femoral condyles were treated. All patients were randomly divided into three groups: the first group - simultaneous ACL reconstruction and abrasive chondroplasty (ACh-ACL group) (n=24); the second group - ACL reconstruction and microfracturing (MF-ACL group) (n=24); the third group - ACL reconstruction and mosaic autochondroplasty (OAT-ACL group) (n=24). For the purpose of independent evaluation, a control group - anterior cruciate ligament reconstruction with intact articular cartilage (IAC-ACL group) (n=24) was introduced for comparison. Results and Discussion. Having analyzed the results of IKDC-2000 and Lysholm + Tegner questionnaires at 3, 6 and 12 months after the operation we noted the greatest positive dynamics in the early postoperative period (3 months) in all groups. From 6 to 12 months the dynamics changed its tendency and more pronouncedly passed into a "plateau" in groups 1 and 2, which was clinically determined by the restoration of passive movements with insufficient volume of active flexion-extension movements in the knee joint, as well as by the persistence of pain syndrome during loading. Conclusions. Simultaneous reconstruction of osteochondral lesions of the articular surface of the knee joint and reconstruction of the anterior cruciate ligament is the basis for full restoration of the function and bearing capacity of the knee joint. In this case, the use of organ-reconstructive methods of surgical intervention (bone-cartilage autochondroplasty and anterior cruciate ligament reconstruction (OAT-ACL)) allows achieving better clinical results compared to "mesenchymal stimulation" of the defect area, showing full functional recovery of the knee joint.

Cost-Outcome Descriptive Study for Mobile App (UPSCALER) in the Rehabilitation of Anterior Cruciate Ligament (ACL) Injuries After Reconstructive Surgery

Cost-Outcome Descriptive Study for Mobile App (UPSCALER) in the Rehabilitation of Anterior Cruciate Ligament (ACL) Injuries After Reconstructive Surgery

A Systematic Review on Deep Learning Model in Computer-aided Diagnosis for Anterior Cruciate Ligament Injury.

In developing Computer-Aided Diagnosis (CAD), a Convolutional Neural Network (CNN) has been commonly used as a Deep Learning (DL) model. Although it is still early, DL has excellent potential in implementing computers in medical diagnosis. This study reviews the use of DL for Anterior Cruciate Ligament (ACL) tear diagnosis. A comprehensive search was performed in PubMed, Embase, and Web of Science databases from 2018 to 2024. The included study criteria used MRI images to evaluate ACL tears, and the diagnosis of ACL tears was performed using the DL model. We summarized the paper by reporting their model accuracy, model comparison with arthroscopy, and explainable. AI implementation in tabular format; we conclude that many medical professionals believe that arthroscopic diagnosis is the most reliable method for diagnosing ACL tears. However, due to its intrusive treatment, CAD is projected to be able to produce similar outcomes from MRI scan results. To gain the trust of physicians and meet the demand for reliable knee injury detection systems, an algorithm for CAD should also meet several criteria, such as being transparent, interpretable, explainable, and easy to use. Therefore, future works should consider creating an Explainable DL model for ACL tear diagnosis. It is also essential to evaluate the performance of this Explainable DL model compared to the gold standard of arthroscopy diagnosis. There are issues regarding the need for Explainable DL in CAD to increase confidence in its result while also highlighting the importance of the involvement of medical practitioners in system design. There is no funding for this work.

[Evaluation of the efficacy of medial open wedge high tibial osteotomy combined with anterior cruciate ligament reconstruction in the treatment of varus knee osteoarthritis with anterior cruciate ligament injury].

Objective: To evaluate the efficacy of medial open wedge high tibial osteotomy (MOWHTO) combined with anterior cruciate ligament (ACL) reconstruction in the treatment of varus knee osteoarthritis (OA) with ACL injury. Methods: A follow-up study. The study retrospectively analyzed the patients underwent MOWHTO combined with ACL reconstruction for treatment of varus knee OA with ACL injury in Tianjin Hospital between April 2018 and September 2022. The preoperative and postoperative posterior slope angle (PSA), hip-knee-ankle angle (HKA), visual analog scale (VAS) pain scores, Lysholm score, International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Tegner score were compared. The follow-up indicators were recorded at 6 weeks, 3 months and 1 year after operation, and the complications were recorded. Results: The study included 32 patients (23 males, 9 females) with a mean age of (50.7±8.4) years. The mean follow-up time was (21.2±4.8) months. PSA increased from 9.2°±1.8° preoperatively to 11.1°±2.4° postoperatively, and HKA increased from 168.7°±2.2° to 181.5°±2.2° (both P<0.01). The indicators such as VAS score (6.8±1.1 vs 1.8±0.4), Lysholm score (52.6±7.1 vs 82.0±6.4), IKDC score (64.7±6.2 vs 80.3±10.0), WOMAC score (51.8±6.3 vs 81.8±6.5), and Tegner score (1.9±0.6 vs 5.0±1.0) were all improved after the operation (all P<0.01). Complications occurred in 5 patients (15.6%), including hematomas, sensory abnormalities, intermuscular vein thrombosis and correction angle loss. Conclusion: MOWHTO combined with ACL reconstruction is a safe and effective approach for the treatment of varus knee OA with ACL injury.

Kinematics of 90° change of direction in young football players: Insights for ACL injury prevention from the CUTtheACLstudy on 6008 trials.

To investigate the 90° change of direction (COD) task in an extensive cohort of competitive healthy football players within the CUTtheACLstudy and to provide normative values and differences between males and females for full-body kinematics based on two-dimensional (2D) video analysis and scoring system. One-thousand-and-two competitive football (soccer) players (age 16.3 ± 2.8 years, 264 females) were prospectively enroled. Each player performed three preplanned 90° COD tasks per limb. The 2D evaluation was performed through objective measures (collected through three high-speed cameras) of frontal and sagittal plane joint kinematics at the cut initial foot contact (IC) and maximum knee flexion angle. A previously published scoring system was adopted to measure the movement quality of the COD task. The scoring system included five criteria (limb stability [LS], pelvis stability [PS], trunk stability [TS], shock absorption [SA], movement strategy [MS]) ranked from 0/2 (nonadequate) to 2/2 (adequate) with a maximum score of 10/10. Normative data were provided for all the variables; statistical differences between male and female players were investigated (p < 0.05). A total of 6008 valid attempts were included. Frontal plane knee projection angle (FPKPA) at initial contact was 24.4 ± 9.8° (95thpercentile: FPKPA > 40°). The total score was ≤4/10 in 71.2% of the trials, the lowest subscores were LS and PS. Female players showed different movement patterns with lower hip and trunk flexion both at IC and maximum knee flexion angle (p < 0.01, ES = 0.41-0.64). Female players also showed worse scores than males in SA, MSand total score (p < 0.01). Female players seem more prone to stiffer lower limb strategy and greater pelvis-trunk frontal plane instability than males. Clinicians could adopt normative data and sex-specific differences in players' movement techniques to improve ACL injury risk mitigation protocols. Level IV.

INCLINOMETERS AND APPS ARE BETTER THAN GONIOMETERS. MEASURING KNEE EXTENSION RANGE OF MOTION IN ANTERIOR CRUCIATE LIGAMENT PATIENTS. RELIABILITY AND MINIMAL DETECTABLE CHANGE FOR THE THREE DEVICES.

Knee extension range of motion (ROM) measurement is important in patients with anterior cruciate ligament (ACL) injury. The main objective is to evaluate the reliability and the minimal detectable change (MDC) of three methods of measuring knee extension ROM in ACL patients. Three common goniometric devices: a universal goniometer, an inclinometer, and a Smartphone app. During a single visit, knee extension ROM was measured in both knees of 92 ACL injured or reconstructed patients by two testers blinded to the other's measures. Intra-rater, inter-rater, and test-retest Intraclass Correlation Coefficients (ICC2,1) were calculated. Intra-rater ICC(2,1) was excellent for the three devices ranging from 0.93-0.96, with the smartphone app yielding the best results (ICC(2,1)=0.96, [95%CI:0.89-0.95]). Inter-rater ICC(2,1), however, varied from 0.36 to 0.80. The inclinometer and the smartphone app yielded similar results 0.80 (95%CI:0.71-0.86) and 0.79 (95%CI:0.70-0.86) respectively, whereas the universal goniometer was 0.36 (95%CI:0.17-0.53). Test-retest ICC(2,1) for the inclinometer was 0.89 (95%CI:0.84-0.93), 0.86 (95%CI:0.79-0.91) for the app, and 0.83 (95%CI:0.74-0.89) for the goniometer. The intra-rater, inter-rater, and test-retest MDC95 values ranged from 1.6° to 3.5°, 3.7° to 10.4 and 2.6° to 5.4° respectively. The goniometer was the least reliable. The inclinometer is the recommended device due to its ease of use compared to the smartphone app.

Effects of various load magnitudes on ACL: an in vitro study using adolescent porcine stifle joints

IntroductionThe escalating incidence of anterior cruciate ligament (ACL) injuries, particularly among adolescents, is a pressing concern. The study of ACL biomechanics in this demographic presents challenges due to the scarcity of cadaveric specimens. This research endeavors to validate the adolescent porcine stifle joint as a fitting model for ACL studies.MethodsWe conducted experiments on 30 fresh porcine stifle knee joints. (Breed: Yorkshire, Weight: avg 90 lbs, Age Range: 2–4 months). They were stored at − 22 °C and a subsequent 24-h thaw at room temperature before being prepared for the experiment. These joints were randomly assigned to three groups. The first group served as a control and underwent only the load-to-failure test. The remaining two groups were subjected to 100 cycles, with forces of 300N and 520N, respectively. The load values of 300N and 520N correspond to three and five times the body weight (BW) of our juvenile porcine, respectively.ResultThe 520N force demonstrated a higher strain than the 300N, indicating a direct correlation between ACL strain and augmented loads. A significant difference in load-to-failure (p = 0.014) was observed between non-cyclically loaded ACLs and those subjected to 100 cycles at 520N. Three of the ten samples in the 520N group failed before completing 100 cycles. The ruptured ACLs from these tests closely resembled adolescent ACL injuries in detachment patterns. ACL stiffness was also measured post-cyclical loading by applying force and pulling the ACL at a rate of 1 mm per sec. Moreover, ACL stiffness measurements decreased from 152.46 N/mm in the control group to 129.42 N/mm after 100 cycles at 300N and a more significant drop to 86.90 N/mm after 100 cycles at 520N. A one-way analysis of variance (ANOVA) and t-test were chosen for statistical analysis.ConclusionsThe porcine stifle joint is an appropriate model for understanding ACL biomechanics in the skeletally immature demographic. The results emphasize the ligament’s susceptibility to injury under high-impact loads pertinent to sports activities. The study advocates for further research into different loading scenarios and the protective role of muscle co-activation in ACL injury prevention.

Two-Year Functional Outcomes of Nonsurgical Treatment in Concomitant Anterior Cruciate Ligament and Medial Collateral Ligament Injuries: A Case-Control Study.

The anterior cruciate ligament (ACL) is a common knee injury in high-intensity sports, which can cause early career loss in young athletes. Concomitant damage to other knee stabilizers may occur, such as the medial collateral ligament (MCL). Recent studies have shown that knee stability can increase without surgical intervention in patients with ACL and MCL injuries. Regarding the importance of functional tests in return to exercise prediction, this study aims to measure nonsurgical approach's long-term outcome for concomitant ACL and MCL injuries with a focus on functional tests. This is a case-control study with a 2-year follow-up. The case group consisted of patients who had provided written consent and completed their 2-year follow-up, and the control group was made up of healthy people who did not have any knee medical conditions and were matched by age, gender, and activity level. Physical examinations, Tegner and International Knee Documentation Committee questionnaires, and knee magnetic resonance imaging were conducted, and functional performance tests were performed after a 10-minute warm-up. Lody's index (the ratio of injured-to-uninjured knee results) was calculated. The data were analyzed using independent t-test, one-way analysis of variance, chi-squared test, and Fisher's exact test. The study involved 11 patients in each concomitant ACL and MCL injury cases and healthy control groups with a mean age of 32.4 and 28 years, respectively. None of the patients reported knee instability symptoms in the 2-year follow-up. More than half of the patients continued their sports field without reinjury, with no significant difference in activity levels between case and control groups. The 6-meter hop test and single-leg hop test showed no significant difference between case and control groups (p-value: 0.326, 0.859), and no significant difference was observed in the three Carioca, cocontraction, and Shuttle tests in the 2-year follow-up. Functional tests in ACL and MCL injuries revealed normal outcomes, implying a nonsurgical approach for patients with proximal ACL tears, better knee stability, and no significant differences between the injured and control groups.

Return to play and Athletic Performance in division I female volleyball players following anterior cruciate ligament injury

ABSTRACT Objectives The purpose of this study is to examine NCAA Division I volleyball players’ return to play rates and performance statistics compared to pre-injury levels following ACL injury. Methods Female volleyball players that sustained ACL injuries from 2008-2020 and competed in one of seven collegiate conferences (n = 99) were identified via an internet search algorithm. Players were categorized by position, academic year, and playing time pre- and post-injury. Post-injury performance statistics were gathered for a subset of outside hitters and middle blockers that played in ≥ 35 sets in a single season for up to 3 years following injury (mean 1.7 seasons). A control group (n = 512) was generated for demographic and statistical comparison. Mean pre-injury and post-injury statistics were compared for players that did not change positions and played ≥ 35 sets before and after injury. Results Volleyball attackers were 54.7% of the control population but sustained 78.8% of identified injuries. Following ACL injury, 6.1% of players registered no in-game statistics, 16.2% played in < 35 sets, 65.7% played in ≥ 35 sets, and 12.1% graduated. Mean performance statistics increased linearly the more years players were from ACL injury. Conclusions Female collegiate volleyball players return to play following ACL injury at high rates (93.1%) and maintain pre-injury performance levels. Volleyball attackers sustain ACL injuries more commonly than setters and libero/defensive specialists.

The effect of bony morphology on anterior cruciate ligament injury and surgery

The effect of bony morphology on anterior cruciate ligament injury and surgery

Factors influencing the posterior cruciate ligament buckling phenomenon—a multiple linear regression analysis of bony and soft tissue structures of the knee joint

PurposeTo determine whether posterior cruciate ligament (PCL) buckling (angular change) is associated with anterior cruciate ligament (ACL) status (intact or ruptured), meniscal bone angle (MBA), anterior tibial translation (ATT), body weight, femoral-tibial rotation (FTR), posterior tibial slope (PTS), PCL length and femoral-tibial distance (FTD) and to identify the factors that have the greatest influence.MethodsAll enrolled participants were scanned with a 3.0 T, 8-channel coil MRI system (Magnetom Verio; Siemens). Bone and soft tissue parameters were measured by MIMICS software for each subject and each measured parameter was correlated with PCL buckling phenomena. The correlated and statistically significant parameters were then analyzed by multiple linear regression to determine the magnitude of the effect of the different parameters on the PCL buckling phenomenon.ResultsA total of 116 subjects (50 ACL ruptured and 66 age, weight and height matched volunteers with uninjured knees) were enrolled. Among all measured parameters, there were 8 parameters that correlated with PCL angle (PCLA), of which ACL status had the strongest correlation with PCLA (r = − 0.67, p =  < 0.001); and 7 parameters that correlated with PCL-posterior femoral cortex angle (PCL-PCA), of which ATT had the strongest correlation with PCL-PCA (r = 0.69, p =  < 0.001). PCLIA was not significantly correlated with any of the measured parameters. Multiple linear regression analyses revealed four parameters can explain PCLA, of which ACL status had the strongest effect on PCLA (absolute value of standardized coefficient Beta was 0.508). Three parameters can explain PCL-PCA, of which ATT had the strongest effect on PCLIA (r = 0.69, p = < 0.001), ATT has the greatest effect on PCL-PCA (absolute value of normalized coefficient Beta is 0.523).ConclusionsPCLA may be a simple and easily reproducible and important supplement for the diagnosis of ACL injury; PCL-PCA is a simple and easily reproducible and important complementary tool for the detection of ATT. The use of PCLA is more recommended to aid in the diagnosis of ACL injury.