Anterior Cruciate Ligament Tears Research Articles

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.

"Molecular mechanisms of mechanosensing and plasticity of tendons and ligaments".

Tendons and ligaments, crucial components of the musculoskeletal system, connect muscles to bones. In the realm of sports, tendons and ligaments are vulnerable tissues with injuries such as Achilles tendon rupture and anterior cruciate ligament tears directly impacting an athlete's career. Furthermore, repetitive trauma and tissue degeneration can lead to conditions like secondary osteoarthritis, ultimately affecting the overall quality of life. Recent research highlights the pivotal role of mechanical stress in maintaining homeostasis within tendons and ligaments. This review delves into the latest insights on the structure of tendons and ligaments and the plasticity of tendon tissue in response to mechanical loads.

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.

Nonsurgical Rehabilitation Perspectives for a Type I Salter-Harris Fracture With Lipohemarthrosis and Concomitant Grade II Anterior Cruciate Ligament (ACL) Tear in a Volleyball Athlete: A Case Report

Nonsurgical Rehabilitation Perspectives for a Type I Salter-Harris Fracture With Lipohemarthrosis and Concomitant Grade II Anterior Cruciate Ligament (ACL) Tear in a Volleyball Athlete: A Case Report

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.

AN INVESTIGATION OF SEX-BASED DIFFERENCES IN PHYSICAL AND PSYCHOLOGICAL RECOVERY, AND RETURN TO SPORT, FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

INTRODUCTION &amp; AIMS Despite the increasing rate of anterior cruciate ligament (ACL) tears and surgical reconstruction (ACLR), little is known about the post-operative recovery in males versus females. Understanding differences in the recovery between sexes will assist in better tailoring rehabilitation, return to sport (RTS) and counselling pathways. This study investigated sex-based differences in the physical and psychological recovery of both females and males after ACLR. METHODS This study recruited 104 patients (49 females, 55 males) undergoing ACLR. Patients were assessed pre-operatively and at 6, 12 and 24 months post-surgery, via patient-reported outcome measures (PROMs) including the International Knee Documentation Committee (IKDC) form, the Tegner Activity Scale (TAS) and the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score. Patients embarked on an assessment of peak isokinetic knee extensor (PKET) and flexor (PKFT) torque and a 4-hop performance battery. Limb Symmetry Indices (LSIs) were calculated. The incidence of RTS was investigated. RESULTS All PROMs significantly improved (p&amp;lt;0.05), though females reported significantly lower ACL-RSI (p=0.002) and IKDC (p=0.007) scores. While no sex-based differences were observed in hop test LSIs, males demonstrated significantly higher mean LSIs for PKET at 6 (p=0.037) and 24 (0.047) months, and PKFT at 6 (p=0.007) and 12 (p=0.002) months. At 24-months post-surgery, a significantly greater (p=0.030) percentage of male patients had returned to pivoting sports. CONCLUSION This study demonstrates the disparity between sexes in physical and psychological recovery, as well as RTS status, in community-level patients undergoing ACLR. The development and implementation of enhanced post-operative patient-centered care may be warranted tailored to sex, encompassing rehabilitation, education, and counseling after ACLR to promote increased engagement in rehabilitation.

High incidence of RAMP lesions and a nonnegligible incidence of anterolateral ligament and posterior oblique ligament rupture in acute ACL injury.

The purpose of this study was to assess the frequency of medial collateral ligament (MCL), posterior oblique ligament (POL) and anterolateral ligament (ALL) tears and different types of RAMP lesions of patients with verified acute anterior cruciate ligament (ACL) tears by magnetic resonance imaging (MRI). MRI was performed on patients with a clinical diagnosis of acute ACL injury. Patients were eligible for inclusion if they had an initially clinically noted ACL tear confirmed on MRI within 30 days of trauma. A total of 146 patients were included in the study, 42 (28.8%) females and 104 (71.2%) males. The mean age at MRI was 27.2 ± 9.4 years, and the mean time from injury to MRI was 15.7 ± 7.8 days. Thirty-four (23.3%) patients had a complete MCL lesion, 32 (21.9%) had a complete POL lesion and 28 (19.2%) had a complete ALL lesion. One hundred and fourteen patients (78.1%) presented with RAMP lesions, while 20 (13.7%) patients reported other meniscal lesions. The mean medial and lateral tibial slopes were 4.0° ± 2.7° and 4.0° ± 3.1°, respectively. Only 10 (6.8%) patients reported no lesions associated with ACL rupture. The most common injuries were isolated RAMP type 3 (18-12.3%) and isolated RAMP type 1 (17-11.6%). Thirteen (8.9%) patients had a combination of MCL, POL and ALL rupture. Isolated lesions of the ACL are extremely rare. In most cases, a single RAMP lesion should be investigated. In the presence of MCL injury, POL injury should always be suspected as well, while nearly 20% of patients present a rupture of the ALL. About one in 10 patients had three lesions (MCL, ALL and POL), and most of them had a combined RAMP lesion. Level IV.

Improving inceptionV4 model based on fractional-order snow leopard optimization algorithm for diagnosing of ACL tears

In the current research study, a new method is presented to diagnose Anterior Cruciate Ligament (ACL) tears by introducing an optimized version of the InceptionV4 model. Our proposed methodology utilizes a custom-made variant of the Snow Leopard Optimization Algorithm, known as the Fractional-order Snow Leopard Optimization Algorithm (FO-LOA), to extract essential features from knee magnetic resonance imaging (MRI) images. This results in a substantial improvement in the accuracy of ACL tear detection. By effectively extracting critical features from knee MRI images, our proposed methodology significantly enhances diagnostic accuracy, potentially reducing false negatives and false positives. The enhanced model based on FO-LOA underwent thorough testing using the MRNet dataset, demonstrating exceptional performance metrics including an accuracy rate of 98.00%, sensitivity of 98.00%, precision of 97.00%, specificity of 98.00%, F1-score of 98.00%, and Matthews Correlation Coefficient (MCC) of 88.00%. These findings surpass current methodologies like Convolutional Neural Network (CNN), Inception-v3, Deep Belief Networks and Improved Honey Badger Algorithm (DBN/IHBA), integration of the CNN with an Amended Cooking Training-based Optimizer version (CNN/ACTO), Self-Supervised Representation Learning (SSRL), signifying a significant breakthrough in ACL injury diagnosis. Using FO-SLO to optimize the InceptionV4 framework shows promise in improving the accuracy of ACL tear identification, enabling prompt and efficient treatment interventions.

Four distinct patterns of anterior cruciate ligament injury in women’s professional football (soccer): a systematic video analysis of 37 match injuries

BackgroundTo identify mechanisms and patterns of anterior cruciate ligament (ACL) injury in adult women’s professional football by means of video match analysis.MethodsACL match injuries sustained in Germany’s first women’s league...

Return to Sports After Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament (ACL) tears are one of the most common orthopedic injuries among athletes. Although a small proportion of patients with isolated tears can return to sports after completing a nonsurgical rehabilitation program, ACL reconstruction is frequently recommended for young athletes, especially those with concomitant knee injuries or symptomatic knee instability. Alongside emerging evidence for the effect of prehabilitation, the current standard of care for postoperative ACL physical therapy includes pain control, range of motion, quadriceps strengthening, weight bearing, postoperative bracing, and dynamic limb stabilization and control. The early rehabilitation period includes non-weight-bearing exercises and passive range of motion, which is followed by a longer period of gradual strengthening focused on regaining preinjury strength, proprioception, and control with progressively more demanding dynamic movements. The total rehabilitation period is expected to take around 9 months, during which the patient should be evaluated at frequent intervals by a licensed physical therapist in addition to a daily home exercise program. Prior to discharge from the rehabilitation program, patients should be evaluated by both the surgeon and physical therapist. Patients are encouraged to return to sports once they meet a set of perceptual, subjective, objective, neuromuscular, functional, sport-specific drills, and load management testing criteria.

Nanosurgical and Bioengineering Treatment of Human Anterior Cruciate Ligament Tears with Ultrasound-Guided Injection of Modified Platelet-Rich Plasma Using Human Cell Memory Based on Clinical, Ultrasound, MRI, and Nanoscope Analyses: A Double-Blind Randomized Trial.

Background: Anterior cruciate ligament (ACL) tears account for 40% to 50% of all ligamentous knee injuries. Most patients with ACL ruptures undergo surgical treatment. There is currently no objective, well-documented, repeatable, and standardized nonsurgical method for ACL tear treatment. This study aimed to investigate ACL outcomes in patients who underwent a novel nanosurgery and bioengineering treatment (NSBT) for an ACL tear. Methods: This was a double-blind randomized trial including 44 patients with a history of traumatic knee injury and a confirmed ACL tear. The final sample comprised 40 patients who met all the eligibility criteria. The patients were divided into two groups: the treatment group (n = 30) and the control group (n = 10). The treatment group underwent nanosurgery with an ultrasound-guided injection of modified platelet-rich plasma (PRP) using human cell memory (RP-hCM). The control group was treated with an ultrasound-guided PRP injection into the joint capsule. At baseline and post-treatment, all patients underwent both ultrasonography and magnetic resonance imaging (MRI), and the following clinical variables were assessed: the WOMAC score, the Lysholm knee score, the visual analog scale score, and knee instability. In most patients, the clinical outcome was verified using nanoscopy. Results: The median WOMAC, VAS, and LKS scores, as well as knee instability, improved significantly 12 weeks after the procedure in the treatment group (p < 0.001). We found a significantly larger improvement in the assessed parameters in the treatment group compared to the control group (p < 0.001). In the treatment group, all the patients had good and very good clinical outcomes, while 90% of the patients had a normal ACL signal in a follow-up MRI scan. In the control group, a physical examination revealed no changes in knee stability after treatment. Conclusions: This study showed that there is a significant difference in patient experience and the duration of recovery for patients with ACL tears treated with NSBT. The novel nonsurgical method was shown to be repeatable, objective, well documented, standardized, and highly effective.

Effects of transcranial direct current stimulation and sensorimotor training in anterior cruciate ligament patients: a sham-controlled pilot study.

Studies showed changes in the central nervous system in patients who sustained an anterior cruciate ligament tear. There is a lack of evidence regarding the effectiveness of transcranial direct-current stimulation in such patients. A sham-controlled randomised study. One group of patients (n = 6) underwent 6 weeks of sensorimotor training after an anterior cruciate ligament tear during transcranial direct-current stimulation. The stimulation consisted of 20 minutes (3 sessions/week; 2 weeks) of 2 mA anodal transcranial direct-current stimulation over the primary motor and premotor cortex. The second group (n = 6) received sham stimulation with 6 weeks of sensorimotor training. Centre of pressure deviations in the medio-lateral and anterior-posterior direction and centre of pressure velocity were measured. The results demonstrated a significant effect of sensorimotor training on the centre of pressure in medio-lateral and anterior-posterior direction (p=0.025) (p=0.03) in the leg in which an anterior cruciate ligament tear occurred. The type of training did not affect the results. Post-hoc tests showed no significant effect of training in the subgroups (p≥0.115). Sensorimotor training led to a decrease in sway of the centre of pressure in patients who sustained an anterior cruciate ligament tear, but the addition of anodal transcranial direct-current stimulation placed over the primary motor cortex did not potentiate the adaptive responses of the sensorimotor training.

Predictive Refined Computational Modeling of ACL Tear Injury Patterns

Anterior cruciate ligament (ACL) ruptures are prevalent knee injuries, with approximately 200,000 ruptures annually, and treatment costs exceed USD two billion in the United States alone. Typically, the initial detection of ACL tears and anterior tibial laxity (ATL) involves manual assessments like the Lachman test, which examines anterior knee laxity. Partial ACL tears can go unnoticed if they minimally affect knee laxity; however, they will progress to a complete ACL tear requiring surgical treatment. In this study, a computational finite element model (FEM) of the knee joint was generated to investigate the effect of partial ACL tears under the Lachman test (GNRB® testing system) boundary conditions. The ACL was modeled as a hyperelastic composite structure with a refined representation of collagen bundles. Five different tear types (I–V), classified by location and size, were modeled to predict the relationship between tear size, location, and anterior tibial translation (ATT). The results demonstrated different levels of ATT that could not be manually detected. Type I tears demonstrated an almost linear increase in ATT, with the growth in tear size ranging from 3.7 mm to 4.2 mm, from 25% to 85%, respectively. Type II partial tears showed a less linear incline in ATT (3.85, 4.1, and 4.75 mm for 25%, 55%, and 85% partial tears, respectively). Types III, IV, and V maintained a nonlinear trend, with ATTs of 3.85 mm, 4.2 mm, and 4.95 mm for Type III, 3.85 mm, 4.25 mm, and 5.1 mm for Type IV, and 3.6 mm, 4.25 mm, and 5.3 mm for Type V, for 25%, 55%, and 85% partial tears, respectively. Therefore, for small tears (25%), knee stability was most affected when the tears were located around the center of the ligament. For moderate tears (55%), the effect on knee stability was the greatest for tears at the proximal half of the ACL. However, severe tears (85%) demonstrated considerable growth in knee instability from the distal to the proximal ends of the tissue, with a substantial increase in knee instability around the insertion sites. The proposed model can enhance the characterization of partial ACL tears, leading to more accurate preliminary diagnoses. It can aid in developing new techniques for repairing partially torn ACLs, potentially preventing more severe injuries.

Intermediate-Term Clinical Outcomes of High-Density Autologous Chondrocyte Implantation in Patients with Concomitant Anterior Cruciate Ligament Reconstruction and Focal Chondral Lesions.

To investigate intermediate-term clinical results in patients with concomitant anterior cruciate ligament (ACL) reconstruction and chondral defect treated with high-density autologous chondrocyte implantation (HD-ACI) compared to patients without ACL tear but with a chondral lesion and HD-ACI treatment. Forty-eight patients with focal chondral lesions underwent HD-ACI (24 with ACL reconstruction after an ACL injury and 24 with an intact ACL). Follow-up assessments occurred at 6, 12, and 24 months. Patient-reported knee function and symptoms were assessed using the International Knee Documentation Committee (IKDC) questionnaire, pain was measured using the Visual Analog Scale (VAS), and adverse events were monitored. Physical activity was assessed using the Tegner Activity Level Scale, and cartilage healing was evaluated with the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. No significant adverse events occurred during follow-up. Both groups showed significant improvements at 2 years compared to baseline (VAS: 8.0 ± 1.3 to 1.4 ± 2.0 [normal ACL]; 7.4 ± 2.3 to 2.1 ± 2.3 [ACL reconstruction]; IKDC: 39.2 ± 10.6 to 76.1 ± 22.0 [intact ACL]; 35.6 ± 12.1 to 74.6 ± 20.9 [ACL reconstruction]). Patients in both groups exceeded the minimal clinically important difference (MCID) for IKDC scores. The Tegner Activity Level Scale decreased immediately after surgery and increased after 2 years, with 70.6% (normal ACL) and 89.5% (ACL reconstruction) returning to their preinjury activity levels. No significant differences in the MOCART score were observed between the groups. ACL reconstruction does not appear to reduce the outcomes (at 2 years) of HD-ACI.

Management of Anterior Cruciate Ligament Tears in Skeletally Immature Patients.

Anterior cruciate ligament (ALC) tears are increasingly common in skeletally immature patients, as more children and adolescents participate in intensive sports training and specialization at increasingly younger ages. These injuries were historically treated nonoperatively, given concerns for physeal damage and subsequent growth disturbances after traditional ACL reconstruction techniques. However, there is now sufficient data to suggest superior outcomes with operative treatment, specifically with physeal-sparing and physeal-respecting techniques. This article reviews considerations of skeletal maturity in patients with ACL tears, then discusses surgical techniques, with a focus on their unique indications and outcomes. Additional surgical adjuncts and components of postoperative rehabilitation, which may reduce retear rates, are also considered. Current research shows favorable patient-reported outcomes and high return-to-sport rates after ACL reconstruction in skeletally immature patients. Graft rupture (ACL retear) rates are low, but notably higher than in most adult populations. Historically, there has been insufficient research to comprehensively compare reconstruction techniques used in this patient population. However, thoughtful systematic reviews and multicenter prospective studies are emerging to address this deficit. Also, more recent data suggests the addition of lateral extra-articular procedures and stringent return-to-sports testing may lower retear rates. Physeal-sparing and physeal-respecting ACL reconstructions result in stabilization of the knee, while respecting the growth remaining in children or skeletally immature adolescents. Future research will be essential to compare these techniques, given that more than one may be appropriate for patients of a specific age and skeletal maturity.

A Systematic Review of Bone Bruise Patterns following Acute Anterior Cruciate Ligament Tears: Insights into the Mechanism of Injury.

(1) Background: The purpose of this systematic review was to determine the prevalence of bone bruises in patients with anterior cruciate ligament (ACL) injuries and the location of the bruises relative to the tibia and femur. Understanding the relative positions of these bone bruises could enhance our comprehension of the knee loading patterns that occur during an ACL injury. (2) Methods: The MEDLINE, EMBASE, and the Cochrane Library databases were searched for studies that evaluated the presence of bone bruises following ACL injuries. Study selection, data extraction, and a systematic review were performed. (3) Results: Bone bruises were observed in 3207 cases (82.8%) at the lateral tibia plateau (LTP), 1608 cases (41.5%) at the medial tibia plateau (MTP), 2765 cases (71.4%) at the lateral femoral condyle (LFC), and 1257 cases (32.4%) at the medial femoral condyle (MFC). Of the 30 studies, 11 were able to assess the anterior to posterior direction. The posterior LTP and center LFC were the most common areas of bone bruises. Among the 30 studies, 14 documented bone bruises across all four sites (LTP, MTP, LFC, and MFC). The most common pattern was bone bruises appearing at the LTP and LFC. (4) Conclusions: The most frequently observed pattern of bone bruises was restricted to the lateral aspects of both the tibia and femur. In cases where bone bruises were present on both the lateral and medial sides, those on the lateral side exhibited greater severity. The positioning of bone bruises along the front-back axis indicated a forward shift of the tibia in relation to the femur during ACL injuries.

Decreased Posterior Tibial Slope and Its Association With Pediatric Posterior Cruciate Ligament Injury

Background: Recent adult studies have demonstrated that decreased posterior tibial slope angle (PTSA) may be a risk factor for posterior cruciate ligament (PCL) injury. However, there is no study investigating this phenomenon in a pediatric population. Understanding risk factors for PCL injuries among a pediatric population is important given the recent rise in athletic competition/specialization and sports-related injuries. Hypothesis/Purpose: The purpose of this study was to compare PTSA between pediatric patients sustaining a primary PCL tear compared with age- and sex-matched controls. It was hypothesized that pediatric patients sustaining a PCL tear would have a decreased PTSA compared with controls, with decreased PTSA being associated with higher odds of PCL injury. Study Design: Cohort study; Level of evidence, 3. Methods: The records of all patients sustaining a PCL injury between 2006 and 2021 at a level 1 pediatric trauma center were reviewed. Patients aged ≤18 years with magnetic resonance imaging–confirmed PCL tear were included. Excluded were patients with concomitant anterior cruciate ligament tears, previous PCL reconstruction, or previous coronal plane realignment. A control cohort, with their ligament shown as intact on magnetic resonance imaging scans, was matched based on age and sex. PTSA was measured on lateral radiographs of the injured knee or tibia. The mean PTSA was compared between cohorts, and odds ratios were calculated based on the normal slope range (7°-10°) described in the literature, an upper range (>10°), and a lower range (<7°). Inter- and intrarater reliability were determined via calculation of an intraclass correlation coefficient. Results: Of the 98 patients who sustained a PCL injury in this study period, 59 (60%) met inclusion criteria, and 59 healthy knee controls were matched. There were no differences between the cohorts for age (P = .90), sex (P > .99), or body mass index (P = .74). The PCL cohort had a lower mean ± SD PTSA compared with the control group (5.9°± 2.7° vs 7.3°± 4.3°; P = .03). PTSA <7° was associated with a 2.8 (95% CI, 1.3-6.0; P = .01) times risk of PCL tear. Conversely, PTSA >10° was associated with a 0.27 (95% CI, 0.09-0.81; P = .02) times risk of PCL tear. These PTSA measurements demonstrated acceptable intrarater and interrater reliability. Conclusion: PTSA <7° was associated with an increased odds of PCL injury, whereas a slope >10° was associated with a decreased odds of PCL injury in a pediatric population. These findings corroborate similar outcomes in adult studies; however, further studies are needed to elucidate PTSA as a risk factor for PCL injury.

Analysis of Gait Pattern Affected by Various Disease : A Review

Gait is pattern of walking of individual, is unique pattern of a person. The gait pattern is affected by various disease, ill condition of a person. In this review article we discuss about various diseases by which gait of an individual gets affected. Some disease are ; Parkinson's disease (PD) is a degenerative brain disorder causing shuffled gait, impaired balance, and freezing of gait. Morquio A syndrome, a group of disorders called mucopolysaccharidosis, can lead to vision, hearing, bone, brain, and heart problems. The anterior cruciate ligament (ACL) is a key stabilizer in the knee, and a torn ACL can cause instability when walking or changing directions. Examination of the gait pattern of a those person who having a disease such as ; Parkinson’s disease, Morquio A syndrome, Anterior Crucial Ligament, etc. In normal human the Gait Cycle has two phases ; Stance and swing phase. The stance phase covers approx 60% gait cycle and swing phase covers remaining 40% of gait cycle. In further studies we can analysis on how this cycle varies in abnormal walking.These review article summarises about gait pattern affected by various diseases. Study of gait pattern used for solving criminal cases as we can recognize various abnormalities a person may have by the analysis of his or her gait pattern. It is used as secondary evidence. By using gait pattern we can find out individuals age, sex, and height.

Anterior Cruciate Ligament Reconstruction in Tibial Eminence Avulsion Fracture: A Case Series

Introduction: Ruptures of the anterior cruciate ligament (ACL) are common orthopedic injuries, especially among patients participating in sports. Anterior cruciate ligament (ACL) avulsion fracture or tibial eminence avulsion fracture is a type of avulsion fracture of the knee. This article describes several cases of ACL rupture management with eminence avulsion. Case report: This case series describes 3 cases of ACL tear with eminence avulsion. The first patient was a 31-year-old female with right knee pain since 6 months ago after a traumatic fall from a motorcycle. The second patient, a 16-year-old girl with a history of bending her legs inward during exercise. The third patient is a 49-year-old female with a history of accidents and complaints of knee pain. All three patients found ACL tear accompanied by an avulsion fracture on the tibial eminence and then undergo ACL reconstruction. Discussion: The most common mechanism of trauma, which leads to a disruption of ACL, is a trauma forcing the knee in hyperextension combined with valgus-external rotation. At times, these lesions can occur in adults; in this instance, the main cause is high-energy trauma, such as road accidents. Based on case reports and previous research, the management approach in this case is still debatable in children and adults and requires a specific approach in each case. Conclusion: The management of ACL reconstruction in patients with tibial eminence avulsion involvement is still a challenge for orthopedic surgeon. Given the rarer cases, a different approach is needed in young and adult cases. Each case requires proper management to improve the patient's functional outcome and their quality of life. Keywords: anterior cruciate ligament reconstruction, avulsion fracture, tibial eminence avulsion

Clinical Outcomes in Patients Undergoing Anterior Cruciate Ligament Reconstruction With Controlled Accelerated Rehabilitation.

Background An anterior cruciate ligament (ACL) tear is one of the most common sports injuries in the knee region. Currently, anatomical ACL reconstruction with quadrupled hamstring tendon autograft and controlled accelerated rehabilitation is a frequently used treatment approach. This study aims to add to the literature the early and mid-term clinical results of the controlled accelerated rehabilitation program we implemented in our clinic to enable patients to return to their daily activities faster after ACL reconstruction. Methodology In this retrospective study, 51 patients (50 males, 1 female) diagnosed with ACL tear and undergoing ACL reconstruction with quadrupled hamstring tendon graft were included in our study.In the femoral fixation of the graft, the transfix method was used in 22 patients and the Endobutton-CL method was used in 29 patients. A controlled accelerated rehabilitation program developed by Shelbourne was employed with some modifications to the patients. Clinical evaluation of patients was performed using Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee (IKDC) scoring systems. Results The mean postoperative follow-up period was 18.7 months (range = 6-36 months). During the physical examination, Lachman, anterior drawer, and pivot shift, 49 (96%) patients achieved excellent or good results, while only two (5%) patients experienced fair clinical outcomes. On clinical assessment using the Lysholm and IKDC scoring systems, 50 (98%) patients demonstrated excellent or good results, whereas only one (2%) patient showed fair results. Excellent and good outcomes were observed in all patients using the Cincinnati scoring system. We found a significant decrease in Tegner activity score pre-surgery, which significantly increased post-surgery. Conclusions The combination of Endobutton and cross-pin for femoral fixation and staples and interference screw for tibial fixation is thought to be safe in patients undergoing controlled accelerated rehabilitation after ACL reconstruction. The implementation of controlled accelerated rehabilitation enables patients to return to their social lives earlier without resulting in clinically poor outcomes in grafts and implants applied in the early and middle stages.