Anterior Cruciate Research Articles

Blood Flow Restriction Training and Its Use in Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

Background/Objectives: Anterior cruciate ligament (ACL) reconstruction (ACLR) is often followed by significant muscle atrophy and subsequent loss of strength. Blood flow restriction training (BFRT) has recently emerged as a potential mode of rehabilitation to mitigate these effects. The goal of this systematic review was to evaluate the efficacy of BFRT in functional recovery when compared to traditional rehabilitation methods. Methods: A literature review was conducted across July and August 2024 using multiple databases that reported randomised controlled trials comparing BFRT to traditional rehabilitation methods. Primary outcomes were changes to thigh muscle mass and knee extensor/flexor strength with secondary outcomes consisting of patient-reported functional measures (IKDC and Lysholm scores). The RoB-2 tool was used to assess the risk of bias. Results: Eight studies met the inclusion criteria; however, substantial heterogeneity prevented a meta-analysis being conducted for the primary outcomes. Three out of the five studies measuring muscle mass reported significant (p < 0.05) findings favouring BFRT. There was variation amongst the strength improvements, but BFRT was generally favoured over the control. Meta analysis of the secondary outcomes showed significant improvements (p < 0.05) favouring BFRT despite moderate heterogeneity. Conclusions: BFRT shows promise for maintaining muscle mass and improving patient reported outcomes following ACL reconstruction. However, the high risk of bias limits the strength of these conclusions. Further high-quality research needs to be conducted to establish optimal BFRT protocols for this cohort and to determine if BFRT has a place in ACL rehabilitation.

First in-vivo magic angle directional imaging using dedicated low-field MRI.

To report the first in-vivo results from exploiting the magic angle effect, using a dedicated low-field MRI scanner that can be rotated about two axes. The magic angle directional imaging (MADI) method is used to depict collagen microstructures with 3D collagen tractography of knee ligaments and the meniscus. A novel low-field MRI system was developed, based on a transverse field open magnet, where the magnet can be rotated about two orthogonal axes. Sets of volume scans at various orientations were obtained in healthy volunteers. The experiments focused on the anterior cruciate ligament (ACL) and the meniscus of the knee. The images were co-registered, anatomical regions of interest (ROIs) were selected and the collagen fiber orientations in each voxel were estimated from the observed image intensity variations. The 3D collagen tractography was superimposed on conventional volume images. The MADI method was successfully employed for the first time producing in-vivo results comparable to those previously reported for excised animal specimens using conventional MRI. Tractography plots were generated for the ACL and the menisci. These results are consistent with the known microstructure of collagen fibers in these tissues. Images obtained using low-field MRI with 1 mm3 resolution were of sufficient quality for the MADI method, which was shown to produce high quality in-vivo information of collagen microstructures. This was achieved using a cost effective and sustainable low-field magnet making the technique potentially accessible and scalable, potentially changing the way we image injuries or disease in joints.

Prevention and Rehabilitation Training Strategies for Knee Injuries in Basketball

Knee injuries in basketball are one of the major issues affecting athletes' performance and long-term health. This paper focuses on knee injuries in basketball, exploring the main types of knee injuries and their causes, including anterior cruciate ligament (ACL) tears, meniscus injuries, patellar tendinopathy, and patellofemoral pain syndrome. The article provides a detailed analysis of the internal and external risk factors for both acute and chronic knee injuries and proposes scientific prevention strategies and rehabilitation training programs. Prevention strategies include proper warm-up, technical optimization, strength and flexibility training, and the use of protective equipment. The rehabilitation training strategies begin with functional protection in the initial phase of injury, progressing to strength and functional training, specialized sport retraining, and finally, establishing a long-term training plan to prevent recurrence. This paper aims to provide comprehensive knee injury prevention and rehabilitation strategies for basketball players, enhancing their athletic performance and joint health.

Clinical characteristics of patients with chronic post-traumatic pain: data from a prospective study

Chronic post-traumatic pain (CPTP) is diagnosed when pain persists for ≥3 months after injury. This is a serious condition that significantly limits patients' quality of life and ability to work and is one of the predictors of the development of post-traumatic osteoarthritis.Objective. To investigate the clinical features of CPTP after knee injury.Material and methods. The study group comprised 103 patients (mean age 39.4±12.5 years, 51.5% women). All patients had a knee injury with diagnosed involvement of the anterior cruciate ligament and/or meniscus and suffered from pain ≥1 month after the injury ≥4 points on the numerical rating scale (NRS, 0–10). Patients were assessed after 3 and 6 months. Pain intensity during movement, at rest and at night and functional impairment were assessed using NRS. KOOS, EQ-5D, PainDETECT, CSI, Pain Catastrophizing, HADS, FIRST and FACIT questionnaires.Results and discussion. After 3 months, the number of patients with CPTP was 33 (32.0%). After 6 months, these patients had significantly more severe symptoms than patients with knee injuries without CPTP (control group, n=70). In the CPTP and control groups, the median pain during movement was 5.0 [4.0; 6.0] and 1.0 [0.0; 1.0] respectively, p12 was found in 24.2 and 2.9% of cases, p <0.001 ; pain at rest – 2.0 [2.0; 3.0] and 0.0 [0.0; 1.0], p <0.001 <0.001;; pain at night – 2.0 [1.0; 3.0] and 0.0 [0.0; 0.0], p <0.001; KOOS score – 4.0 [1.0; 5.5] and 2.0 [1.0; 3.5], p <0.001; quality of life according to EQ-5D – 0.65 [0.52; 0.73] and 0.89 [0.69; 1.0], p <0.001; according to EQ-5D scale – 64.0 [50.0; 70.0] and 80.0 [70.0; 90.0], p <0.001 ; a PainDETECT score of >12 was found in 24.2 and 2.9% of cases, p< 0.0037; according to HADS, depression ≥11 – in 21.2 and 2.9%, p< 0.001, according to HADS, anxiety ≥11 – in 24.2 and 4.3%, p=0.0038; CSI ≥40 – in 9.0 and 0%, p=0.03; pain catastrophizing ≥30 – in 12.1 and 0%, p=0.005; FIRST ≥5 – in 6.1 and 0%, p=0.358; FACIT <30 – in 15.2 and 2.9%, p=0.004. After 6 months, statistically significant differences were found between the CPTP group and the control group in all sections of KOOS questionnaire (p <0.001 for all parameters).Conclusion. Three months after knee injury, 32.0% of patients developed CPTP. All had moderate/severe pain with impaired function and reduced quality of life, one in five patients had symptoms of neuropathic pain, signs of depression and anxiety. Patients with CPTP showed significant changes in all sections of KOOS questionnaire.

Players in the Women's National Basketball Association Are More Likely to Tear Their Anterior Cruciate Ligament if They Are a Guard, Forward, or Driving to the Basket: A Case-Control Study.

The Women's National Basketball Association (WNBA) has grown in popularity since its induction in 1996. Furthermore, it is well known that female athletes are at an increased risk of anterior cruciate ligament (ACL) tears compared with their male counterparts. The purpose was to examine the player positions and player movements during basketball games and practices that contribute to ACL tears in WNBA players. Player position and demographics from WNBA players who suffered an ACL tear from 1996 to 2021 were collected from publicly available sources. Entertainment and Sports Programming Network (ESPN) news reports and video analysis were reviewed to determine what movements each player was performing when the injury occurred. Injured players were matched with two noninjured players by age, position, height, and league experience. Performance statistics were collected one season prior to injury and compared with the matched controls. A total of 62 WNBA players with ACL injuries were identified with an average age of 26.7 (±3.9) years. More guards and forward were seen in the injured cohort and more players were injured while driving to the basket (p < 0.05). ACL injuries occurred more commonly during games than in practice (p < 0.05). Compared with controlled match cohort, the players who suffered ACL tears started more games (p = 0.007), had higher minutes played per game (p = 0.003), more field goals per game (p = 0.04), more field goal attempts per game (p = 0.03), more 3-point attempts per game (p = 0.04), more rebounds per game (p = 0.04), more steals per game (p = 0.02), and more points per game (p = 0.02). WNBA guards and forward were more likely to tear their ACL, especially while driving to the basket during real game play. Additionally, players with higher playing times, rebounds, and steals per game had higher rates of ACL tears. However, there was no impact on their performance on season statistics after returning to sport. LEVEL OF EVIDENCE: III.

Comparison of a full tibial tunnel or an all-inside technique for anterior cruciate ligament reconstruction: An observational study.

This study aims to compare the effectiveness of anterior cruciate ligament (ACL) reconstruction performed with either a full tibial tunnel technique or an all-inside technique. Data from patients with ACL rupture who underwent ACL reconstruction using autogenous hamstring tendon grafts between January 2019 and July 2021 were retrospectively reviewed. Patients were followed up for a minimum of 24 months. Preoperative and postoperative International Knee Documentation Committee scores, Lysholm knee scores, visual analog scale pain scores, Tegner activity scale scores, C-reactive protein levels, erythrocyte sedimentation rate, white blood cell (WBC) count, D-dimer levels, and neutrophils were recorded. At the final follow-up, side-to-side differences were assessed with the pivot shift test, Lachman test, anterior drawer test, and a knee laxity-testing device. This study included 135 patients with ACL rupture, with 62 patients (43 males and 19 females, mean age: 34.42 ± 12.79 years) undergoing the full tibial tunnel technique, and 73 patients (58 males and 15 females, mean age: 32.41 ± 11.01 years) undergoing the all-inside techniques (AITs). There were no significant differences in postoperative International Knee Documentation Committee scores, Lysholm knee scores, or Tegner activity scale scores, except at postoperative 6 months. visual analog scale pain scores showed significant improvement in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 week, 2 weeks, and 1 month; however, there were no significant differences at postoperative 3, 6, 12, 18, and 24 months. C-reactive protein levels, erythrocyte sedimentation rate, WBC count, D-dimer levels, and neutrophils were significantly lower in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 month, but there were no other significant differences in these outcome measures, except for WBC count at postoperative 3 months. There was no significant difference in knee stability at the last follow-up. In ACL reconstruction, functional outcomes following the AIT are satisfactory and similar to the total tibial tunnel technique, but patients experience less pain and a reduced early postoperative inflammatory response. These results highlight the promising potential of AITs in the clinical management of ACL rupture and advocate for their widespread adoption.

Anterior Cruciate Ligament Tear: Individualized Indications for Non-Operative Management.

Anterior cruciate ligament (ACL) rupture represents a common sports injury that is mostly managed operatively. However, non-operative treatment can also play a role, despite the limited high-quality published data on ACL tear management. Both methods have shown favorable outcomes, but clear guidelines based on high-quality research are lacking. Several factors should be considered and discussed with the patient before deciding on the best treatment method. These include patient characteristics and expectations, concomitant injuries, and clinical evaluation, with laxity or/and instability being one of the most essential parameters examined. This should eventually lead to an individualized approach for each patient to ensure the best possible outcome. This review aims to delve into all parameters that are related to ACL rupture and guide physicians in choosing the most appropriate treatment method for each patient.

Impact of anterior cruciate ligament injury on functional capacity and pain: an analysis differentiated by age and gender

Anterior cruciate ligament (ACL) injuries significantly impact knee function, particularly in active populations. This study explores functional capacity and pain post-ACL reconstruction in relation to age, gender, and physical activity. A total of 41 participants who underwent ACL reconstruction were analyzed. Data were collected on age, sex, physical activity level, and pain frequency/intensity. The sample included 56.10% women (n=23) with an average age of 30.27 ± 10.18 years. Among the participants, 19.51% engaged in light activity, 26.83% in moderate, 7.32% in vigorous, 24.39% in very vigorous, and 21.95% were unable to perform any activity. Significant age differences were observed in moderate activity (p = 0.017), with older women more likely to engage in moderate activity. Logistic regression revealed age as a key factor affecting activity level (p &lt; 0.05), and sex had marginal significance (p ≈ 0.054), suggesting men may perform more intense activities. Pain frequency and intensity showed weak correlations with age (p &gt; 0.05), but women reported higher pain levels than men. The average functional ability dropped from 8.73 before the injury to 5.80 post-surgery. Men reported more pain than women, although t-tests showed no statistically significant differences between genders in functional capacity before or after surgery. ACL reconstruction reduces knee function across genders, with men reporting higher pain intensity. Age significantly impacts activity level, emphasizing the need for targeted rehabilitation strategies. Post-surgical recovery programs should consider individual differences in age and sex to optimize outcomes and enhance recovery.

Does cranial cruciate ligament repair by tibial plateau leveling osteotomy surgery restore dog’s natural kinematics? – A case series

Tibial plateau leveling osteotomy (TPLO) serves as an effective method of functional stabilization for treating cranial cruciate ligament (CrCL) deficiency. It is not clear if TPLO could restore the natural kinematics of the stifle, hip, and tarsal joints of the affected limb during walking. The hind limb motion between TPLO cases and control groups in eight adult dogs (4 French Bulldogs and 4 Pit Bull Terrier) was recorded by a motion capture system. Three-dimensional (3D) angular motions of the hip, stifle, and tarsal joints—including flexion-extension, abduction-adduction, and rotations—were computed and compared. Significant differences in joint kinematics were observed between TPLO cases and controls. In Case 1, the TPLO case in the French Bulldog showed differences in hip, stifle, and tarsal flexion-extension, abduction-adduction, and internal-external rotation. Asymmetries between affected and unaffected limbs were also detected in hip and stifle motions (up to 43° in some cases). Similar patterns of differences were found in Pit Bull Terriers Case 2 and Case 3, with significant variations in hip, stifle, and tarsal movements. Case 3 did not show hip asymmetries, but notable stifle and tarsal asymmetries were observed. The general daily activity performance for French Bulldogs and Pit Bull Terriers that underwent TPLO procedures was positive. The general daily restricted activity performance for the French Bulldog and Pit Bull Terriers that underwent TPLO procedures was positive. Our findings suggested that natural hind limb kinematics during gait was not restored in TPLO hind limb cases in both breeds.

MRI deep learning models for assisted diagnosis of knee pathologies: a systematic review.

Despite showing encouraging outcomes, the precision of deep learning (DL) models using different convolutional neural networks (CNNs) for diagnosis remains under investigation. This systematic review aims to summarise the status of DL MRI models developed for assisting the diagnosis of a variety of knee abnormalities. Five databases were systematically searched, employing predefined terms such as 'Knee AND 3D AND MRI AND DL'. Selected inclusion criteria were used to screen publications by title, abstract, and full text. The synthesis of results was performed by two independent reviewers. Fifty-four articles were included. The studies focused on anterior cruciate ligament injuries (n = 19, 36%), osteoarthritis (n = 9, 17%), meniscal injuries (n = 13, 24%), abnormal knee appearance (n = 11, 20%), and other (n = 2, 4%). The DL models in this review primarily used the following CNNs: ResNet (n = 11, 21%), VGG (n = 6, 11%), DenseNet (n = 4, 8%), and DarkNet (n = 3, 6%). DL models showed high-performance metrics compared to ground truth. DL models for the detection of a specific injury outperformed those by up to 4.5% for general abnormality detection. Despite the varied study designs used among the reviewed articles, DL models showed promising outcomes in the assisted detection of selected knee pathologies by MRI. This review underscores the importance of validating these models with larger MRI datasets to close the existing gap between current DL model performance and clinical requirements. Question What is the status of DL model availability for knee pathology detection in MRI and their clinical potential? Findings Pathology-specific DL models reported higher accuracy compared to DL models for the detection of general abnormalities of the knee. DL model performance was mainly influenced by the quantity and diversity of data available for model training. Clinical relevance These findings should encourage future developments to improve patient care, support personalised diagnosis and treatment, optimise costs, and advance artificial intelligence-based medical imaging practices.

The Thai Version of the Injury–Psychological Readiness to Return to Sport Scale (I-PRRS):Translation and Evaluation of Measurement Properties

ObjectivesThis study aimed to translate and culturally adapt the Injury–Psychological Readiness to Return to Sport scale (I-PRRS) into Thai and evaluate the measurement properties of the Thai version (TH-I-PRRS). MethodsThe I-PRRS was translated according to international guidelines. Athletes who had undergone anterior cruciate ligament reconstruction during the previous 6 months to 5 years were recruited to complete two sets of questionnaires. At baseline, participants filled out the TH-I-PRRS questionnaire and other relevant measures. After 2 weeks, they completed the TH-I-PRRS again, along with the Global Rating of Change scale. ResultsThe TH-I-PRRS was successfully translated from English. A total of 142 patients (mean age: 30.7 ± 8.9 years; 83.1% male) participated. Eight of nine predefined hypotheses (88.9%) regarding correlations between the TH-I-PRRS and other measures were confirmed, indicating good construct validity. The TH-I-PRRS exhibited excellent internal consistency (Cronbach’s alpha = 0.92; 95% CI: 0.90–0.94) and high test–retest reliability (intraclass correlation coefficient = 0.83; 95% CI: 0.66–0.90). No floor or ceiling effects were observed. ConclusionThe TH-I-PRRS is a valid and reliable tool for evaluating the psychological readiness of athletes to return to sport after anterior cruciate ligament reconstruction. Level of evidenceII

Changes in Y-Balance Test Scores During Months 4, 5, and 6 of ACL Reconstruction Rehabilitation.

The anterior cruciate ligament (ACL) is well researched since injuries typically result in lengthy recoveries and rehabilitation periods until athletes can return to full activity. Although a large body of literature on the early and late stages of rehabilitation following ACL reconstructive (ACLR) surgery exists, less is known regarding the mid-phase of ACL rehabilitation and healthy versus injured limb differences in functional testing during this stage. The purpose of this study is to determine if Y-Balance Test (YBT) scores obtained during the mid-phase of ACLR rehabilitation change over months 4, 5, and 6. Case Series. Research laboratory. Patients or Other Participants: A total of 27 participants (17 females; 18.96±3.02 years (range 15-24); 173.63±10.29cm; 72.55±17.83kg) who sustained a unilateral ACL injury, experienced no episodes of instability or knee giving away, had not suffered a previous ACL injury, and expressed a desire to return to sport at the end of rehabilitation came in once a month following ACLR to participate in a battery of tests. YBT scores in the anterior, posterolateral (PL), and posteromedial (PM) directions in the healthy and reconstructed limbs. A main effect for limb was observed for the anterior (Healthy: m4: 78.8cm±5.8, m5: 79.5cm±5.2, m6: 79.4±5.8; Reconstructed: m4: 77.2±5.9, m5: 78.5±5.1, m6: 78.1±6.4, p=0.023) and PM (Healthy: m4: 80.0cm±8.7, m5: 81.0cm±9.1, m6: 82.9cm±8.9; Reconstructed: m4: 79.3cm±6.8, m5: 79.4cm±8.2, m6: 81.1cm±8.5, p=0.013). directions indicating that the reconstructed limb performed worse than the healthy limb. A main effect for time was observed for the PL direction (Healthy: m4: 78.8cm±5.8, m5: 79.5cm±5.2, m6: 79.4cm±5.8; Reconstructed: m4: 77.2cm±5.9, m5:78.5cm±5.1, m6: 78.1cm±6.4, p=0.023). The YBT measured improvement in the PL direction across time in the reconstructed limb. In the PM and anterior directions, the YBT did not measure these same improvements across this period.

Preservation of the MMPH and Status of the Notch Configurations Are Important Factors for Successful Revision ACL Reconstruction.

The aim of this study was to identify the differences in anatomical factors between the patients who underwent revision and primary anterior cruciate ligament reconstructions (ACLR) and compare the outcomes between the 2 surgeries. Retrospective cohort study. Single institution tertiary academic center between 2014 and 2020. A total of 84 matched patients who underwent revision (group I) or primary ACLR (group II). Radiological evaluations were performed using side-to-side differences (SS-D), femorotibial angle, and posterior tibial slope. The medial meniscus posterior horn status as width (MMPHW), medial tibial plateau width (MTPW), notch configurations, tunnel positions, and sagittal graft angle were measured using 3D-CT and magnetic resonance imaging (MRI). Graft signals were assessed using MRI. The clinical outcomes were assessed. Group I showed larger SS-D and higher mean Howell grade of anterior cruciate ligament (ACL) graft than group II (P = 0.002 and P = 0.004, respectively). Multivariate regression analyses showed that the decreased MMPHW/MTPW ratio (P = 0.010) and notch width index (P < 0.007) were significantly independent factors associated with the higher Howell grade of ACL grafts. The decreased MMPHW/MTPW ratio (P < 0.001) was a significantly independent factor associated with larger SS-D. In the subgroup analysis, all patients in the notchplasty group showed wider notches postoperatively (P < 0.001). Revision ACLRs resulted in worse ACL signal intensity and stability outcome. The results of this study suggest that it may be important to preserve the MMPHW as much as possible and check notch configurations, especially during a revision ACLR.

The Relationship Between Active Coping Skills and Self-Reported Knee Function in Individuals with Anterior Cruciate Ligament Reconstruction.

Individuals with anterior cruciate ligament (ACL) injury commonly experience injury related stressors which can adversely impact subjective knee function after ACL reconstruction (ACLR). Due to the positive effect of active coping skills on perceived stressors, use of such strategies may influence clinical outcomes in individuals with ACLR, such as self-reported knee function. However, it is unknown whether active coping skills are associated with self-reported knee function in this population. Examine the relationship between active coping skills and self-reported knee function in individuals with ACLR. Cross-Sectional Study. Laboratory. Forty-five participants (34 females; age=20.0[3.3] years) 4-months to 5-years post-unilateral ACLR (time since ACLR=12.0[16.0] months). The Athlete Coping Skills Inventory (ACSI) Confidence and Achievement Motivation (ACSI Confid), Goal Setting/Mental Preparation (ACSI Goal/Prep), and Coping with Adversity (ACSI Coping) subscales were used to measure active coping skill facets. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to measure self reported knee function across 5 subscales: pain (KOOS-Pain), symptoms (KOOS-Symptoms), activities of daily living (KOOS-ADL), quality of life (KOOS-QOL), and sports/recreation (KOOS-Sport). Partial Spearman's correlations were used to examine relationships between active coping skills and self-reported knee function after controlling for time since ACLR and age. Moderate positive correlations were observed between the ACSI Confid and KOOS Pain (r=0.493, P=0.001), ACSI Confid and KOOS-QOL (r=0.505, P<0.001), ACSI Confid and KOOS-Sport (r=0.422, P=0.007), and ACSI Goal/Prep and KOOS-Pain (r=0.441, P=0.004). Weak positive correlations were observed between the ACSI Goal/Prep and KOOS-ADL (r=0.373, P=0.018) and ACSI Goal/Prep and KOOS-QOL (r=0.374, P=0.017). Individuals with ACLR who exhibited greater active coping skill facets reported better knee-related function. Assessing active coping skills among individuals with ACLR and poor self-reported knee function may provide clinicians with insight into the role of coping in perceived function and potential treatment approaches.

Hop to It! A Systematic Review and Longitudinal Meta-analysis of Hop Performance After ACL Reconstruction.

Hop testing is widely used by clinicians to monitor rehabilitation and decide when to return to sport following anterior cruciate ligament reconstruction (ACLR); however, the trajectory of long-term hop performance has not been summarised. To investigate hop performance change over time after ACLR. Systematic review with longitudinal meta-analysis. MEDLINE, EMBASE, CINAHL, Scopus, Cochrane CENTRAL and SPORTDiscus to 28 February 2023. Studies with ≥ 50 participants following primary ACLR, with mean participant age of 18-40years, reporting a quantitative measure of hop performance (e.g. single forward hop distance). Results had to be reported for the ACLR limb and compared with (1) the contralateral limb (within person) and/or (2) an uninjured control limb (between person). We included 136 studies of 23,360 participants. Performance was similar across different hop tests, with steep initial improvements in within-person symmetry, tailing off after 18-24months. ACLR limb hop performance was 5-10% lower compared with the contralateral limb at 1year post-surgery, with largest deficits observed for vertical hop [87.0% contralateral limb (95% CI 85.3-88.8) compared with single forward hop 93.8% (95% CI 92.8-94.9)]. By 3-5years, results were similar between ACLR and contralateral limbs. There were limited data for between-person comparisons (n = 17 studies). Exploratory analyses showed deficits in all forward hopping tests to be very strongly correlated with each other [e.g. single forward and triple hop rho = 0.96 (95% CI 0.90-0.99)], though there was discordance in the relationship between single forward hop and vertical hop performance [rho = 0.27 (95% CI - 0.53 to 0.79)]. Hop performance is comparable to the uninjured limb by 3-5years post-ACLR, with the greatest deficits in within-person symmetry present in vertical and side hop tests. Assessment of hopping in multiple planes and comparison with uninjured controls, may provide the most complete evaluation of functional performance.

A Detailed Anatomical Description of the Gastrocnemius Muscle—Is It Anatomically Positioned to Function as an Antagonist to the Anterior Cruciate Ligament?

A Detailed Anatomical Description of the Gastrocnemius Muscle—Is It Anatomically Positioned to Function as an Antagonist to the Anterior Cruciate Ligament?

Evaluation of the reliability and accuracy of MRI for the diagnosis of meniscal ramp lesions.

Meniscal ramp lesions are a special type of meniscal injury that affects the periphery of the posterior horn of the medial meniscus and/or its meniscocapsular attachments, strongly associated with anterior cruciate ligament (ACL) tears. Due to their location, these lesions can be missed arthroscopically so it is essential to diagnose them on preoperative magnetic resonance imaging (MRI). To evaluate the accuracy of MRI in detecting meniscal ramp lesions in patients with ACL tears using arthroscopy as the reference standard. Two musculoskeletal radiologists, blinded to the surgical findings, retrospectively and independently evaluated 106 knee MRI scans for the presence of meniscal ramp lesions in non-consecutive patients who underwent arthroscopic ACL reconstruction between January 2019 and July 2022 by a single surgeon at one institution. Having arthroscopy as reference, the diagnostic sensitivity and specificity as well as the positive and negative predictive values (PPV/NPV) of the MRI scans were calculated. Cohen's kappa coefficient was used to test inter-observer reliability. A P value <0.05 was considered statistically significant. In the study group of 106 patients (72 men, 34 women; mean age = 33.84 ±13.12 years), 76 had an arthroscopy-confirmed meniscal ramp lesion, while 30 did not. The sensitivity and specificity of MRI for the detection of meniscal ramp lesion were 88% and 87%, respectively. The PPV and NPV were 94% and 74%, respectively. Inter-rater reliability was excellent (k = 0915). This study demonstrates that MRI can accurately detect meniscal ramp lesions.

A Simple Magnetic Resonance Scoring System for Predicting Suitability for Primary Anterior Cruciate Ligament Repair

A Simple Magnetic Resonance Scoring System for Predicting Suitability for Primary Anterior Cruciate Ligament Repair

Comparison between early and late weight bearing after anterior cruciate ligament reconstruction surgery.

The anterior cruciate ligament (ACL) is a strip of dense connective tissue that runs from the femur to the tibia with a relatively poor blood supply. It prevents the femoral condyles from rolling posteriorly. ACL is commonly injured in any knee trauma, ranging from a little sprain to a total rupture. The arthroscope is the gold standard approach for identifying ACL tears, which may be treated conservatively or surgically. To assess the efficiency of immediate and delayed weight bearing after arthroscopic ACL reconstruction. Cohort longitudinal study carried through 6years from 2017 to 2023 et al.-kindy Teaching, Ulamaa, and Almuktar hospitals 186 patients, the patients were divided randomly into 2 groups, group A (n = 93) with immediate (after 10days) weight bearing and group B (n = 93) with delayed (after 1month) weight bearing following ACL reconstruction. any patients with chondral lesions, aged less than 19 or more than 40years, knee osteoarthritis, ligament damage, and deformity in lower extremities were excluded. Patients from both groups A and B had complete ACL tears and underwent arthroscopic ACL reconstruction follow-up for 6months duration regarding stiffness, infection, giving up pain, swelling, and quadriceps muscle atrophy. In group A, there were 93 patients,70 male and 23 female, and meniscal injury was 89 patients. While in group B (93 patients) 57 male and 36 female, meniscal injury in group B was 91. There is a statistically significant difference regarding knee swelling. (80.6% in group A, and 10.8% in group B), and knee pain in which (79.6% in group A patients and only 7.5% in group B). There is no significant value between the two groups about the knee getting given up, infection, stiffness, and quadriceps muscle atrophy. Delay weight bearing after ACL reconstruction makes the patients less prone to knee pain and effusion but more prone to quadriceps muscle atrophy.

Analysis of Limb Loading and Lower Extremity Strength Recovery Across Time After Anterior Cruciate Ligament Reconstruction.

Evidence as to how patient thigh muscle strength and limb loading (LL) during a squatting task recovers throughout rehabilitation after anterior cruciate ligament reconstruction (ACLR) is lacking. Patients will improve LL and strength throughout rehabilitation. Changes in LL and strength over time will be positively correlated. Prospective cohort study. Level 3. A total of 60 participants (28 male/32 female; age, 22.5 ± 9.35 years) participated in 2 visits post-ACLR, assessing LL and strength. Using an instrumented pressure mat, patients completed 3 sets of 3 repetitions of bodyweight squats. Peak force (N), unilateral cumulative load (%), and quadriceps and hamstring isokinetic peak torque (N·m) were calculated and recorded bilaterally. LL and peak torque were compared over time and between limbs. A significant limb-by-time interaction was observed for LL peak force (N), where patients underloaded the ACLR limb at visit 1 compared with the contralateral limb (P < 0.01). Patients increased their ACLR LL across visits (P = 0.04). A limb-by-time interaction for quadriceps peak torque (N·m) was observed where the ACLR limb increased peak torque across visits (P < 0.01); however, strength deficits persisted at visit 2 (P < 0.01) when compared with the nonoperative limb. Weak correlations were observed between all change scores metrics (r, 0.20-0.25). Patients recovering from ACLR exhibited more symmetric loading during a squatting task and improved their lower extremity strength over time. Changes in strength were not related to changes in LL during a squatting task over time. Squatting tasks are safe and easily implemented throughout ACLR recovery. As changes in functional LL and strength recovery are not related, both should be considered in serial postoperative testing for more comprehensive function and strength assessments.