Anterior Cruciate Research Articles

Cranial Tibial Wedge Osteotomy for Treatment of Concomitant Cranial Cruciate Ligament Rupture and Medial Patellar Luxation Using Patient-Specific Surgical Guide in an Immature Cat

Cranial Tibial Wedge Osteotomy for Treatment of Concomitant Cranial Cruciate Ligament Rupture and Medial Patellar Luxation Using Patient-Specific Surgical Guide in an Immature Cat

Anterior cruciate ligament (ACL) injury management: current treatment options and future prospects

The knee provides the body with mobility and stability needed to perform everyday functions. In addition, the knee joint plays a role in our proprioception and muscle coordination through the ligaments. These knee ligaments are involved in stabilizing the joint. The anterior cruciate ligament (ACL) is a ligament that protects the tibia from forward translation. It is one of the most injured ligaments in the knee, with almost 400,000 patients undergoing ACL reconstruction surgery each year in the United States. This review aims to present a concise overview of previous and current management options available to treat ACL injuries.

Anterior Cruciate Ligament Tear Detection Based on T-Distribution Slice Attention Framework with Penalty Weight Loss Optimisation.

Anterior cruciate ligament (ACL) plays an important role in stabilising the knee joint, prevents excessive anterior translation of the tibia, and provides rotational stability. ACL injuries commonly occur as a result of rapid deceleration, sudden change in direction, or direct impact to the knee during sports activities. Although several deep learning techniques have recently been applied in the detection of ACL tears, challenges such as effective slice filtering and the nuanced relationship between varying tear grades still remain underexplored. This study used an advanced deep learning model that integrated a T-distribution-based slice attention filtering mechanism with a penalty weight loss function to improve the performance for detection of ACL tears. A T-distribution slice attention module was effectively utilised to develop a robust slice filtering system of the deep learning model. By incorporating class relationships and substituting the conventional cross-entropy loss with a penalty weight loss function, the classification accuracy of our model is markedly increased. The combination of slice filtering and penalty weight loss shows significant improvements in diagnostic performance across six different backbone networks. In particular, the VGG-Slice-Weight model provided an area score of 0.9590 under the receiver operating characteristic curve (AUC). The deep learning framework used in this study offers an effective diagnostic tool that supports better ACL injury detection in clinical diagnosis practice.

Biomechanical Demand during 90° and 135° Cutting Manoeuvres: Implications for Anterior Cruciate Ligament Injury

Background: Anterior cruciate ligament (ACL) injuries in athletes have financial and health consequences and are considered career-threatening. The current study aimed to shed light on biomechanical differences between various change of direction (COD) manoeuvres. Understanding such differences is important, given their association with the incidence of non-contact ACL injuries. Methods: Thirty-six male recreational soccer players participated and performed 90° and 135° COD manoeuvres. For gait analysis, the Vicon system was used. The speed and shoe-surface interface were standardized in the COD manoeuvres. Paired sample t-tests were used to compare conditions. Results: A Greater peak external knee abduction moment (PEKAM) (p<0.001) and knee abduction angle at initial contact (IC) (p<0.001) in the 135° COD manoeuvre compared to the 90° COD manoeuvre were observed, highlighting the increased injury risk potential at greater COD angles. In addition, the hip sagittal plane range of motion (RoM) from IC to peak knee valgus angle was higher in the 135° COD manoeuvre than 90° COD manoeuvre (p<0.001). Conclusion: The results of the current study support the idea that ACL biomechanical risk factors are angle-dependent. A sharper cutting angle showed a higher risk of ACL injury due to the increase in the PEKAM and the knee abduction angle at initial contact. Therefore, players should be trained to reduce high PEKAM and the knee abduction angle by using different strategies.

Risk-factor analysis of the proximal tibia morphology for secondary ipsilateral injury after anterior cruciate ligament reconstruction: A retrospective cross-sectional study.

Many studies have reported the risk factors associated with primary anterior cruciate ligament (ACL) injury. However, few studies have focused on the bony morphology of secondary ipsilateral injury after ACL reconstruction. This study aimed to investigate the morphological risk factors of the proximal tibia contributing to secondary ipsilateral injury after ACL reconstruction. Twenty patients who were selected from secondary ipsilateral injury after ACL reconstruction between January 2015 and May 2020 were included in the secondary injury group. They were matched in a 1:2 ratio to the control group, which underwent primary ACL reconstruction during the same period and did not experience reinjury at the minimum 2-year follow-up, based on age, gender, and body mass index. All parameters, including medial tibial posterior slope, lateral tibial posterior slope (LTPS), medial tibial plateau depth, and lateral tibial plateau height, were recorded by using magnetic resonance imaging. Binary logistic regression analysis and receiver operator characteristic curves were conducted to explore the risk factors for reinjury and determine the cutoff value for the significant parameter. The LTPS was significantly larger in the secondary injury group than in the control group (9.6 ± 1.5° to 7.0 ± 1.4°, P < .001), and there was no significant difference in the medial tibial posterior slope, medial tibial posterior slope, and lateral tibial plateau height between the 2 groups (P > .05). The LTPS was found to be an independent risk factor for secondary ipsilateral injury after ACL reconstruction (odds ratio = 3.220, 95% confidence interval = 1.904-5.446, P < .001). The cutoff value of the LTPS was 8.8°, with a sensitivity of 91.7% and a specificity of 81.2%. The LTPS could be a unique predictor of secondary ipsilateral injury after ACL reconstruction. Orthopedists should implement effective measurements during primary reconstruction when the LTPS is >8.8°.

Fibrin clot augmentation of high-risk meniscal repairs may result in clinical healing in up to 90% of cases

ObjectiveWhile meniscal repair is preferable to meniscectomy, some cases may be at higher risk of failure if repaired. Incorporating fibrin clot (FC) into the repair has been proposed to improve healing rates. The purpose of this study was to determine the failure rates, patient reported outcome measures (PROMs) and complications of FC augmented meniscal repair for cases considered to be at higher risk of failure. MethodsA retrospective case series of all patients undergoing FC augmented repair of isolated meniscus tears between January 2016 and September 2021 was undertaken. All cases were thought be at higher risk of failure; they included chronic, radial, complex, horizontal cleavage, and tears not in the red–red zone. Patients were excluded if they had a concomitant anterior cruciate ligament (ACL) reconstruction or if the repair was done through an open incision. The primary outcome was clinical failure defined as further repair or debridement. Secondary outcomes were PROMs and surgical complications. PROMs collected were Lysholm score, Knee injury and Osteoarthritis Outcome Score, Oxford Knee Score and the Tegner score. ResultsFifty one inside-out meniscal repairs using FC were performed in 50 patients (62% male). The mean age was 34 years (range 14–70). The median time from injury to repair was 122 days (range 4–1565). The medial meniscus was repaired in 63% of cases. Tear types included radial (31%) and complex (39%) and 71% of cases included repair of the white–white zone. 16% of cases were revision meniscal repairs. FC was used in 43% of isolated meniscal repairs during the study period. All patients were followed up to a median of 46 months (range 22–87 months). PROMs at a median of 30 months post-operatively showed statistically significant improvements. Five patients (10%) underwent further surgery for failure after median 21 months. Two patients (4%) reported sensory disturbance around their skin wounds, no other complications were reported. 13% of medial meniscal repairs failed, whereas only 5% of lateral meniscal repairs failed (p ​= ​0.4). ConclusionsFC augmented meniscal repair performed for tears considered to be at higher risk of failure may result in acceptably low rates of clinical failure. Level of evidenceLevel IV, case series.

Bankart knee. Operative treatment of posterior part of lateral tibial condyle fracture with concomitant avulsion injury of anterior cruciate ligament (ACL). Technique and case report

Fractures of the posterolateral part of the tibial plateau (PLTP) are rare and complex fractures among other orthopedic entities. This case report describes a 54-year-old male who suffered a twisting injury of the left knee in a scooter crash. As a result, impaction fracture and displacement of the posterolateral margin of the tibial plateau were diagnosed with concomitant avulsion of the intercondylar eminence of the tibia and medial tibial condyle cleft fracture. The treatment comprised reduction of the medial tibial condyle (MTC) cleft fracture with one cancellous screw, arthroscopic bone-suture of the intercondylar eminence, and reduction of compressed PLTP with fixation of the displaced fragment on a distal radius T-plate working as a “buttress” rather than firm stabilizer. The operative technique of PLTP impaction fracture reduction is described in an instructional manner.

Effect of Tibial Malrotation on Anterior and Posterior Cruciate Ligaments in Bicruciate-Retaining Total Knee Arthroplasty

Effect of Tibial Malrotation on Anterior and Posterior Cruciate Ligaments in Bicruciate-Retaining Total Knee Arthroplasty

Countermovement jump and vertical hop demonstrate braking/deceleration and performance alterations after ACL reconstruction with BMA, DBM, and suture tape augmentation

ObjectivesThis study evaluated countermovement jump and Single Leg Jump measures to identify landing measures that best distinguish a novel Anterior Cruciate Ligament reconstruction technique using bone marrow aspirate, demineralized bone matrix, and suture tape augmentation patients from controls. The secondary objective assessed performance differences between operated and non-operated limbs post-reconstruction. The hypothesis was that novel Anterior Cruciate Ligament reconstruction patients at return to sport would not differ from controls during landing and that the operated limb's performance would not differ from the unoperated limb. MethodsThe study included 31 patients with the novel reconstruction technique matched with controls in a 1:10 ratio based on age, sex, weight, and height. Both groups underwent screening and were compared during a Countermovement Jump. Using a Sparta Science Force Platform, each patient's unoperated and operated limbs were also compared for Single Leg Jump post-op (6.5 months). ResultsTest patients showed no difference in center of pressure during landing of both jumps compared to controls (P=0.27) and the uninvolved limb (P=0.26). Test patients exhibited increased braking impulse relative to the uninvolved limb during Single Leg Jump (P<0.001). Deceleration upon landing of Countermovement Jump was also increased compared to controls (P<0.001). Test patients demonstrated slower concentric time during a Countermovement Jump compared to controls (P=0.03) and significantly slower compared to the uninjured leg (P<0.001). Countermovement Jump height was decreased compared to controls (P<0.001). Single-leg jump height was decreased in the injured limb compared to the uninjured limb (P<0.001). ConclusionsTest patients did not show significant differences in landing motion compared to controls or the uninvolved leg. However, power and performance alterations were evident at Return to Sport after reconstruction. Although these results are quite promising, they may be too preliminary to draw definitive conclusions. Double and single-legged assessments should be considered in return-to-sport decision-making.

It is challenging to reproduce both anatomical and functional aspects of anterolateral reconstruction: postoperative 3D-CT analysis of the femoral tunnel position

BackgroundThis study aimed to evaluate the femoral tunnel position and fiber length of the anterolateral ligament (ALL) reconstruction compared with the natural anatomy of the ALL. We also evaluated whether the femoral tunnel position would affect residual pivot shift.MethodsThis study was a retrospective review of 55 knees that underwent ALL reconstruction considering the anatomical and functional aspects, during primary anterior cruciate ligament (ACL) reconstruction in the presence of a high-grade pivot shift or revisional ACL reconstruction. We determined the position of the femoral tunnel and the length of graft using a three-dimensional (3D)-computed tomography (CT) model after ALL reconstruction. We also measured graft excursion during surgery and examined pivot shift 2 years after surgery. We conducted a subgroup analysis of femoral tunnel position, fiber length, isometricity, and residual pivot shift depending on whether the tunnel was anterior or posterior to the lateral epicondyle (LE). We also performed a subgroup analysis depending on whether the ACL reconstruction was primary or revisional.ResultsThe mean femoral tunnel position was 2.04 mm posterior and 14.5 mm proximal from the center of the LE. The mean lengths of the anterior and posterior fibers were 66.6 and 63.4 mm, respectively. The femoral tunnel was positioned more proximally than the anatomical position, and both anterior and posterior ALL fibers were longer than the natural anatomy. The anteroposterior femoral tunnel position was significantly correlated with anterior (p = 0.045) and posterior (p = 0.037) fiber excursion. In the subgroup analysis, there was no significant difference in the residual pivot shift between the posterior and anterior tunnel positions. However, there were significant differences for proximal position (p < 0.001) and fiber length (p = 0.006). There was no significant difference between primary and revisional ACL regarding femoral tunnel position and fiber lengths.ConclusionIt is challenging to reproduce both anatomical and functional aspects of ALL reconstruction in both primary and revision ACL reconstruction. Especially for functional reconstruction, the femoral tunnel tended to be positioned more proximally than the anatomical position. However, the femoral tunnel position did not affect functional clinical outcomes at the 2-year follow-up.Level of evidenceLevel IV Case series.

In-vitro study on type I collagen synthesis in low-level laser therapy on the early ligament fibroblasts’ healing process

BackgroundLow-level Laser Therapy (LLLT) has demonstrated its potential in promoting fiber matrix maturation, collagen synthesis, and fibroblast proliferation, contributing to tissue regeneration. Our study aimed to investigate the impact of LLLT on collagen type I synthesis, cell proliferation, and viability in human ligament fibroblasts derived from the Anterior Cruciate Ligament (ACL).MethodsTissue samples were obtained from individuals undergoing arthroscopic ACL reconstruction surgery. Primary human fibroblasts were isolated, and immunohistochemical assays confirmed their characteristics. LLLT at 850 nm was administered in three groups: Low dose (1.0 J/cm²), High dose (5.0 J/cm²), and Control (0.0 J/cm²). Cell viability was calculated using a membrane integrity assay, proliferation was determined by automated counting, and collagen type I concentration in cell culture was measured using an immunoassay.ResultsFibroblasts showed decreased viability after low and high doses of LLLT, increased proliferation at the low dose, and increased collagen synthesis at the high dose on day 10 for both sexes after treatment.ConclusionOur study demonstrated that LLLT may improve the early ligament healing process by increasing cell proliferation at the low dose and enhancing collagen type I synthesis at the high dose in human ligament fibroblasts.

Economical hybrid novelty detection leveraging global aleatoric semantic uncertainty for enhanced MRI-based ACL tear diagnosis

This study presents an innovative hybrid deep learning (DL) framework that reformulates the sagittal MRI-based anterior cruciate ligament (ACL) tear classification task as a novelty detection problem to tackle class imbalance. We introduce a highly discriminative novelty score, which leverages the aleatoric semantic uncertainty as this is modeled in the class scores outputted by the YOLOv5-nano object detection (OD) model. To account for tissue continuity, we propose using the global scores (probability vector) when the model is applied to the entire sagittal sequence. The second module of the proposed pipeline constitutes the MINIROCKET timeseries classification model for determining whether a knee has an ACL tear. To better evaluate the generalization capabilities of our approach, we also carry out cross-database testing involving two public databases (KneeMRI and MRNet) and a validation-only database from University General Hospital of Larissa, Greece. Our method consistently outperformed (p-value<0.05) the state-of-the-art (SOTA) approaches on the KneeMRI dataset and achieved better accuracy and sensitivity on the MRNet dataset. It also generalized remarkably good, especially when the model had been trained on KneeMRI. The presented framework generated at least 2.1 times less carbon emissions and consumed at least 2.6 times less energy, when compared with SOTA. The integration of aleatoric semantic uncertainty-based scores into a novelty detection framework, when combined with the use of lightweight OD and timeseries classification models, have the potential to revolutionize the MRI-based injury detection by setting a new precedent in diagnostic precision, speed and environmental sustainability. Our resource-efficient framework offers potential for widespread application.

The Development and Execution of An Orthopaedic Sports Medicine Fellowship Surgical Skills Assessment

Background: Assessment of orthopaedic surgery trainees is traditionally based on subjective evaluation by faculty. The recent push for value-based health care has placed a premium on improving patient outcomes. As a result, surgical training evaluations for orthopaedic trainees are evolving to include more objective measures to evaluate competency. Purpose: To develop and subsequently demonstrate the efficacy of a novel surgical skills assessment for orthopaedic sports medicine fellows. Study Design: Case series; Level of evidence, 4. Methods: A team of 14 fellowship-trained orthopaedic sports medicine surgeons developed objective scoring rubrics for anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR) using a modified Delphi process. Rubrics were designed based on 10 surgical steps with a grading scale (1-5) based on core competencies with a maximum summative score of 50. Fourteen orthopaedic fellows across a regionally diverse group of sports medicine–accredited fellowship programs were invited to complete both an ACLR and RCR in a surgical skills laboratory at the beginning and end of their fellowship year. Individual surgical steps, overall performance, and total procedure time were evaluated by a single sports medicine surgeon for both sessions. Results: Thirteen of 14 fellows completed both pre- and post-fellowship assessments. For the ACLR procedure, the pre-fellowship mean summative score was 25.4 (SD, 4.4) and the post-fellowship mean summative score was 38.6 (SD, 4.1), which was a statistically significant improvement (P < .001). For the RCR procedure, the pre-fellowship mean summative score was 26.6 (SD, 5.4) and the post-fellowship mean summative score was 38.8 (SD, 4.3), which was also a statistically significant improvement (P < .001). The mean time to completion for the ACLR procedure was 82.3 minutes (SD, 4.3 minutes) pre-fellowship, which improved to 69.7 minutes (SD, 11.6 minutes) post-fellowship (P = .002). The mean time to completion for the RCR procedure was 85.5 minutes (SD, 5.0 minutes) pre-fellowship, which improved to 76.4 minutes (SD, 7.0 minutes) post-fellowship (P < .001). Conclusion: This surgical skills program represents the first standardized and reproducible instrument for the evaluation of 2 arthroscopic sports medicine procedures in the United States. Orthopaedic sports medicine fellows improved significantly in aggregate over their fellowship year with regard to the ACLR and RCR. The described program has the potential to serve as both a training tool and formal orthopaedic sports medicine fellow assessment.

Patellar bone defect grafting does not reduce anterior knee pain after bone-patellar tendon-bone anterior cruciate ligament reconstruction.

Donor site morbidity is the main drawback to using bone-patellar tendon-bone (BPTB) as a graft in anterior cruciate ligament (ACL) reconstruction. The objective of the study was to determine whether refilling the patellar bone defect after BPTB harvesting with autograft bone decreased kneeling pain to a greater degree when compared with a group in which bone defect is left unaddressed. This is a randomised single-blinded controlled study. Forty patients were randomised into two groups; group 1: Patellar bone defect filled with autologous bone; group 2: Bone defect left undressed. Pain was measured by means of pressure algometry (PA). Functional outcomes were measured with the Kujala and Victorian Institute of Sport Assessment-Patella (VISA-P) score. Magnetic resonance imaging (MRI) was done to measure bone buildup between groups at the 1-year follow-up. No differences were observed in the different algometry measurements and the scores were assessed at 3, 6 and 12 months postoperatively. The ratio of void filled remained consistently higher (p = 0.003) in group 1 when compared to group 2. Although refilling the lower pole of the patella with autologous bone from the harvested BPTB autograft loads the bone defect, it does not reduce pain at the donor site 1 year after surgery. Therapeutic study level 1.

Graft choice to decrease the revision rate of anterior cruciate ligament reconstruction: a nationwide retrospective cohort study

There are many graft choices for anterior cruciate ligament (ACL) reconstruction, including autografts and allografts. The choice of graft has been identified as a significant factor affecting the outcome of ACL reconstruction. This study aimed to determine whether allograft or autograft is better for avoiding revisional ACL reconstruction. The National Health Insurance Service-Health screening database analyzed 146,122 patients who underwent ACL reconstruction surgery from Jan. 1, 2002, to Dec. 31, 2021. The study was conducted in two groups, autograft or allograft, and the rates of revision ACL reconstruction between the two groups were compared. Propensity score matching and multivariable Cox Proportional Hazard model analysis were used. The significant predictors for complications (p < 0.05) were as follows. The total of patients with ACL reconstruction was 146,122. Allograft was used in 121,148 patients, and autograft was used in 24,974 patients. 9.2% of the allograft group and 8.7% of the autograft group underwent revision ACL reconstruction. (P < .0001) 70.0% & 63.6% of patients underwent revision surgery within 1 year in the allograft & autograft groups, respectively. In summary, using autograft in primary ACL reconstruction is helpful in lowering the rate of revision surgery.

What's in a Name? Defining 'Failure' in Anterior Cruciate Ligament Reconstruction Randomized Controlled Trials: A Systematic Review.

Graft failure, one of the most common outcomes in anterior cruciate ligament reconstruction randomized controlled trials, lacks a consensus definition. The purpose of this study was to systematically summarize current practice and parameters in defining anterior cruciate ligament reconstruction graft 'failure'. Forty studies (4466 participants) satisfied the inclusion criteria. Of these, 90% either defined failure formally or referenced the etiology of failure, the remaining 10% used the term failure without referencing the anterior cruciate ligament reconstruction graft. Among the included studies, there was a high level of inconsistency between the definitions of graft failure. The extracted data was categorized into broader groups, revealing abnormal knee laxity (80%) and graft re-rupture (37.5%) as the most common parameters incorporated in the definitions of graft failure in high-level randomized controlled trials. This review shows that anterior cruciate ligament reconstruction randomized controlled trials lack a consistent definition for graft failure. A universal definition is vital for clarity in medical practice and research, ideally incorporating both objective (e.g. graft re-rupture) and subjective (e.g. validated questionnaires) parameters. A composite outcome should be established which includes some of the common parameters highlighted in this review. In the future, this review can be used to assist orthopaedic surgeons to establish a formal definition of anterior cruciate ligament reconstruction graft 'failure'.

Comparative analysis of the outcome between aperture and suspensory graft fixation methods in anterior cruciate ligament reconstruction surgeries: a systematic review

Comparative analysis of the outcome between aperture and suspensory graft fixation methods in anterior cruciate ligament reconstruction surgeries: a systematic review

Combining a digital health application with standard care significantly enhances rehabilitation outcomes for ACL surgery patients.

Anterior cruciate ligament (ACL) rupture is one of the most common sports injuries. Regardless of the surgical treatment, patients require intensive education about the pathology, therapeutic optionsand physical therapy. However, it is often not possible for the patient to start physical therapy directly and schedule adequate consultations. Digital health applications are medical devices that can help bridge the gap between physiotherapy sessions and provide qualified, convenientand effective education and treatment. This study is needed to explore alternative methods to ensure continuous and effective rehabilitation for ACL patients who face delays in accessing traditional physiotherapy.The study aimed to compare app-assisted therapy plus standard of care (conventional orthopaedic and physiotherapeutic measures) versus isolated standard of care for patients with planned ACL surgery. A monocentric, two-arm, 1:1 randomized controlled study examined 80 patients after a cruciate ligament rupture with or without meniscal injury. Patients over 18 years with a confirmed diagnosis of ACL rupture and planned surgical reconstruction using autologous grafts were included. The study criteria additionally included willingness to use the Orthopy app and sufficient German language proficiency. The study excluded patients with severe concomitant injuries, prior knee surgeries, chronic pain conditionsand those not compatible with app usage. Patients were randomized and their baseline data (t0) was collected. Subsequently, they received their treatment according to their treatment group. The study included a presurgery period (2-6 weeks) and a postsurgery period (14 weeks). Interim assessments were done via online questionnaires at t1 (if more than 3 weeks before surgery) and t3, t4and t5 (postsurgery). Additional clinical assessments were conducted at t2 (presurgery) and t6 (14 weeks postsurgery). Primary outcome measures included the knee injury and osteoarthritis outcome score (KOOS), with subjective pain and function levels (numeric rating scale [NRS]) as secondary endpoints. The clinical trial was able to show positive outcomes on the KOOS Pain and Symptoms subscale of the primary endpoint KOOS in the interventional group compared to the standard of care group. A statistically significant pain reduction could be seen at t1 (p = 0.0005), t2 (p = 0.0068)and t4 (approximately 6 weeks after surgery; p = 0.01). A significant reduction of symptoms at t1 (p = 0.0001), t2 (p = 0.0036)and t6 (p = 0.0377) were recognized. These findings are further supported by the significant benefit of the pain NRS at t4 and positive tendencies at t3, t5and t6. The KOOS subscales quality of life (p = 0.0066), activities of daily living (p = 0.0009)and Sport (p = 0.0484) showed significant effects before surgery. The Orthopy app is a medical device that is both safe and effective for use. Combining the Orthopy app and standard of care can significantly improve prehabilitation and rehabilitation in surgical treatment with ACL reconstruction compared with the isolated standard of care. Level I.

Demographic and Injury Characteristics as Potential Risk Factors for Anterior Cruciate Ligament Injuries: A Multicentric Cross-Sectional Study.

Background: Anterior cruciate ligament (ACL) injuries are prevalent and can have debilitating consequences, with various factors potentially influencing their occurrence. This multicentric study aimed to comprehensively analyze the epidemiological characteristics of ACL injuries. We hypothesized that specific patient characteristics, such as age, sex, body mass index (BMI), and sports involvement, would be associated with distinct injury patterns and risk profiles. Methods: This cross-sectional study analyzed the medical records of 712 patients aged 15-60 diagnosed with ACL rupture. Data on demographics, injury mechanisms, associated injuries, graft type, and sports involvement were collected. Results: The majority of patients were male (93.1%), aged 15-30 years (80.2%), and overweight (66.7%). Autografts were the predominant graft choice (96.07%). Associated injuries were present in 79.5% of cases, with medial meniscus ruptures being the most common (37.36%). Sports-related (49.3%) and non-sports-related (50.7%) injuries were nearly equal, with non-contact injuries more prevalent (71.1%). In the sports-related subgroup, associated injuries emerged as a significant risk factor for ACL rupture (p = 0.014, OR = 1.596, 95% CI: 1.101-2.314), whereas non-contact mechanisms showed borderline significance (OR = 0.75, p = 0.09). Moreover, younger athletes were more susceptible to sports-related injuries (p = 0.024), with football being the primary sport involved. Conclusions: This study identified a high prevalence of concomitant injuries with ACL injury, which increased the risk of ACL injury, particularly in sports-related cases. Age-related differences in injury patterns highlight the need for age-appropriate preventive measures, especially for younger athletes participating in high-risk sports. This underscores the need for comprehensive injury assessment, targeted prevention strategies, and optimized clinical management approaches tailored to different populations' specific characteristics and risks.

Anterior Cruciate Ligament Rupture: Evidence-Based Concepts on Reconstruction, Repair and Future Developments.

The anterior cruciate ligament (ACL) is a vital but frequently injured structure. An ACL injury can result in dysfunction, meniscal injuries, and the early onset of osteoarthritis. This article aims to discuss favourable reconstruction techniques through a literature review with consideration for novel methods in order to identify superior methods that provide a patient's return to function. Current surgical options include reconstruction using different types of autografts and allografts.