Ligament Tears Research Articles

MRI Enhancement Associated with TFCC and Scapholunate Interosseous Ligament Tears

Abstract Objective This study aimed to evaluate the appearance, timing, and pattern of enhancement on magnetic resonance imaging (MRI) associated with triangular fibrocartilage complex (TFCC) and scapholunate interosseous ligament (SLIL) tears. Materials and Methods A retrospective review of patients with TFCC and SLIL tears identified on MRI was conducted to determine patterns and timelines of enhancement after a gadolinium injection. The appearances were compared with the postcontrast appearances in a group of asymptomatic controls who presented with non-traumatic indications for MRI that required gadolinium contrast. Demographic data, including age, duration of symptoms, and mechanism of injury, was collected. Results Eighty-seven patients with enhancement following gadolinium injection were included in the study. Fifty patients with enhancing peripheral TFCC tears and 54 patients with SLIL tears that showed enhancement were identified from a search of MRI records. In the symptomatic TFCC injuries, all showed contrast enhancement associated with ulna-sided TFCC tears. Forty-four patients showed enhancement extending beyond the confines of the anatomical TFCC into the adjacent fat planes, particularly dorsal to the dorsal radioulnar ligament. For the SLIL, 53 of 54 showed enhancement in or replacing the volar band. In the control patients group, none showed any enhancement related to the TFCC or SLIL. Conclusion Intravenous gadolinium with postcontrast scans may help in diagnosing ulna-sided TFCC tears and SLIL tears. The pattern of enhancement may identify the extent of the tear and, for TFCC injuries possible involvement of the surrounding structures as well as demonstrating adjacent synovitis. These radiographic findings might be used to guide ultrasound-guided therapies and surgical management.

The Docking Technique for Medial Ulnar Collateral Ligament Reconstruction.

The Docking Technique for Medial Ulnar Collateral Ligament Reconstruction.

Gymnastics Medicine: A New Subspecialty in Sports Medicine.

Despite popularity of gymnastics, there is no independent medical organization/subspecialty group to investigate injuries and prevention, and to make the sport safer for all. Thus, a new sports medicine subspecialty is proposed: Gymnastics Medicine. Gymnastics injury rates are higher compared to other sports. Common injuries occurring in gymnastics include gymnast wrist, grip lock, osteochondritis dissecans of the elbow, knee, and ankle, shoulder overuse injuries, mechanical low back pain, spondylolysis, pelvic apophysitis, anterior cruciate ligament tears, ankle instability/ankle sprains, symptomatic accessory navicular, os trigonum/posterior ankle impingement, and calcaneal apophysitis. Gymnastics Medicine will help medical clinicians understand injury patterns, return to play protocols, nutritional needs, and the mental aspects of gymnastics. Gymnastics Medicine is a needed subspecialty. There are many medical subspecialties involved with the care of gymnasts who would benefit from a concentrated field, and this field allows those clinicians to collaborate, enhance research, and most importantly, improve the safety and health of athletes in gymnastics.

Accuracy of Magnetic Resonance Imaging in Diagnosis of Anterior Cruciate Ligament and Meniscus Tear: An Observational Study

Introduction: Magnetic resonance imaging is used for the diagnosis of anterior cruciate ligament and meniscus tears but its value in the diagnosis of these pathologies is limited. This study aims to evaluate the diagnostic value of magnetic resonance imaging in diagnosing anterior cruciate ligament and meniscus tears. Methods: This was an observational cross-section study conducted at a tertiary-level hospital in Nepal. The patients operated on for anterior cruciate ligament and/or meniscus tear were considered for the study. The accuracy of magnetic resonance imaging was calculated by comparing its findings with those in arthroscopy. Results: The total number of cases were 134. The sensitivity and specificity were as follows: medial meniscus 88.81%, 95.10%; lateral meniscus 57.12%, 95.14%; anterior cruciate ligament 96.12%, 75%. The sensitivity and specificity of the injuries for 3 Tesla vs 1.5 Tesla Magnetic Resonance Imaging were as follows: medial meniscus 89.20%, 97.84% vs 87.52%, 87.52%; lateral meniscus 65.25%, 100% vs 30%, 90.91%; anterior cruciate ligament 96.12%, 75% vs 96.12, 75%. Conclusions: The sensitivity of magnetic resonance imaging in diagnosing anterior cruciate ligament injury was higher while specificity was higher for lateral meniscus injury. The study also showed that 3 Tesla was better than 1.5 Tesla magnetic resonance imaging in diagnosing meniscus injury.

Deep learning-assisted detection of meniscus and anterior cruciate ligament combined tears in adult knee magnetic resonance imaging: a crossover study with arthroscopy correlation.

We aimed to compare the diagnostic performance of physicians in the detection of arthroscopically confirmed meniscus and anterior cruciate ligament (ACL) tears on knee magnetic resonance imaging (MRI), with and without assistance from a deep learning (DL) model. We obtained preoperative MR images from 88 knees of patients who underwent arthroscopic meniscal repair, with or without ACL reconstruction. Ninety-eight MR images of knees without signs of meniscus or ACL tears were obtained from a publicly available database after matching on age and ACL status (normal or torn), resulting in a global dataset of 186 MRI examinations. The Keros® (Incepto, Paris) DL algorithm, previously trained for the detection and characterization of meniscus and ACL tears, was used for MRI assessment. Magnetic resonance images were individually, and blindly annotated by three physicians and the DL algorithm. After three weeks, the three human raters repeated image assessment with model assistance, performed in a different order. The Keros® algorithm achieved an area under the curve (AUC) of 0.96 (95% CI 0.93, 0.99), 0.91 (95% CI 0.85, 0.96), and 0.99 (95% CI 0.98, 0.997) in the detection of medial meniscus, lateral meniscus and ACL tears, respectively. With model assistance, physicians achieved higher sensitivity (91% vs. 83%, p = 0.04) and similar specificity (91% vs. 87%, p = 0.09) in the detection of medial meniscus tears. Regarding lateral meniscus tears, sensitivity and specificity were similar with/without model assistance. Regarding ACL tears, physicians achieved higher specificity when assisted by the algorithm (70% vs. 51%, p = 0.01) but similar sensitivity with/without model assistance (93% vs. 96%, p = 0.13). The current model consistently helped physicians in the detection of medial meniscus and ACL tears, notably when they were combined. Diagnostic study, Level III.

Morphological Risk Factors for Pediatric Anterior Cruciate Ligament Tears and Tibial Spine Fractures.

Both tibial spine fractures (TSFs) and anterior cruciate ligament (ACL) tears result in functional loss of knee stability. Nonetheless, it remains unclear why some patients sustain ACL tears, whereas others have TSFs. To identify the common morphological risk factors for pediatric ACL tears and TSFs and to determine the morphological differences between them using multiplanar reconstruction of magnetic resonance imaging (MRI). Cohort study; Level of evidence, 3. Age- and sex-matched participants (159 total [53 ACL tears, 53 TSFs, and 53 controls]) aged <18 years who visited a pediatric tertiary-care center for ACL tears, TSFs, or anterior knee pain from March 2009 to April 2023 were included. Each group comprised 41 male and 12 female participants. Data on demographic characteristics and estimated bone age based on the knee MRI atlas were retrospectively collected, and various knee morphological parameters were evaluated using multiplanar reconstruction of MRI. Parameters showing significant differences among the 3 groups were selected as independent variables for multivariable multinomial logistic regression analysis, with the groups as dependent variables. The mean chronological age at the time of MRI was 13.2 ± 2.3 years. Height, weight, body mass index, bone age, articular medial tibial slope, and bony medial tibial slope did not differ among the groups. Articular lateral tibial slope was independently associated with the occurrence of both ACL tears (relative risk ratio [RRR], 1.42 [95% confidence interval (CI), 1.16-1.74]; P = .001) and TSFs (RRR, 1.33 [95% CI, 1.10-1.62]; P = .004). A high notch width index was a protective factor against ACL tears (RRR, 0.86 [95% CI, 0.77-0.96]; P = .006) but not against TSFs (RRR, 1.01 [95% CI, 0.91-1.12]; P = .848). A high articular lateral tibial slope was a common risk factor for ACL tears and TSFs. Patients with ACL tears had a narrower intercondylar notch than those with TSFs and controls.

Clinical Implementation of Sixfold-Accelerated Deep Learning Super-Resolution Knee MRI in Under 5 Minutes: Arthroscopy-Validated Diagnostic Performance.

Background - Deep learning (DL) super-resolution image reconstruction enables higher acceleration factors for combined parallel imaging-simultaneous multislice-accelerated knee MRI but requires performance validation against external reference standards. Objective - The purpose of this study was to validate the clinical efficacy of sixfold-accelerated sub-5-minute 3-T knee MRI employing combined threefold parallel imaging (PI)-twofold simultaneous multislice (SMS) acceleration and DL super-resolution image reconstruction against arthroscopic surgery. Methods - Consecutive adult patients with painful knee conditions who underwent sixfold PI-SMS-accelerated DL super-resolution 3-T knee MRI and arthroscopic surgery between October 2022 and July 2023 were retrospectively included. Seven fellowship-trained musculoskeletal radiologists independently assessed the MRI studies for image quality parameters, presence of artifacts, structural visibility (Likert scales: 1 [very bad/severe] to 5 [very good/absent]), and the presence of cruciate ligament tears, collateral ligament tears, meniscal tears, cartilage defects, and fractures. Statistical analyses included kappa-based interreader agreements and diagnostic performance testing. Results - The final sample included 124 adult patients (mean age ± SD, 46 ± 17 years; 79 men, 45 women) who underwent knee MRI and arthroscopic surgery within a median of 28 days (range, 4-56 days). Overall image quality was good to very good (median, 4 [IQR, 4-5]) with very good interreader agreement (κ = 0.86). Motion artifacts were absent (median, 5 [IQR, 5-5]), and image noise was minimal (median, 4 [IQR, 4-5]). Visibility of anatomic structures was very good (median, 5 [IQR, 5-5]). Diagnostic performance for diagnosing arthroscopy-validated structural abnormalities was good to excellent (AUC ≥ 0.81) with at least good interreader agreement (κ ≥ 0.72). The sensitivity, specificity, accuracy, and AUC values were 100%, 99%, 99%, and 0.99, for anterior cruciate ligament tears; 100%, 100%, 100%, and 1.00 for posterior cruciate ligament tears; 90%, 95%, 94%, and 0.93 for medial meniscus tears; 76%, 97%, 90%, and 0.86 for lateral meniscus tears; and 85%, 88%, 88%, and 0.81 for articular cartilage defects, respectively. Conclusion - Sixfold PI-SMS-accelerated sub-5-minute DL super-resolution 3-T knee MRI has excellent diagnostic performance for detecting internal derangement. Clinical Impact - Sixfold PI-SMS-accelerated DL super-resolution 3-T knee MRI provides high efficiency through short scan times and high diagnostic performance.

Bicruciate knee ligament deficiency is less harmful to the meniscus and chondral tissue than isolated cruciate injuries.

Bicruciate knee ligament deficiency is less harmful to the meniscus and chondral tissue than isolated cruciate injuries.

Ulnar Extrinsic Ligament Tears: Clinical Presentation, Surgical Management, and Outcomes of Surgical Repair Extending Into Long-term Follow-up.

Injury to the ulnar extrinsic ligaments often causes significant pain without obvious instability. This study aims to further investigate the clinical presentations and outcomes following ulnar extrinsic ligament repair. A retrospective analysis of 113 patients who underwent ulnar extrinsic ligament surgery was conducted. Collected data included demographics, clinical presentation, intraoperative findings, and postoperative outcomes, such as grip strength, Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) scores, complications, and reoperations. Continuous variables were represented by the mean and standard deviation, whereas categorical variables were expressed as counts and percentages. A matched pair T-test was performed for grip strength and Q-DASH changes from pre-op to post-op for patients who had data available at both time points. Preoperative symptoms primarily included wrist pain (100%), difficulties in rotation (16%), and weakness (16%). Intraoperatively, split tears (75%) and avulsions (11%) were common, often accompanied by triangular fibrocartilage complex (TFCC) pathology (83%). Postoperatively, grip strength improved significantly (P < .001), with a mean reduction of 30.3 points in Q-DASH scores (P < .001). Eighty percent of patients returned to work fully, 14% returned in a limited capacity, and 6% were unable to return to work. The overall complication rate was 9%. Reoperation rate was 8.8%. At final follow-up, 83% of patients reported that they would elect to undergo the same surgery again. Ulnar extrinsic ligament injuries frequently present with wrist pain and TFCC pathology. Surgical repair of ulnar extrinsic ligament injuries improves grip strength and functional outcomes with high patient satisfaction.

The Effect of a Rehabilitation Program Using a TENS Device on Thigh Muscle Atrophy in Football Players with Anterior Cruciate Ligament (ACL) Tears After Surgical Intervention

The Effect of a Rehabilitation Program Using a TENS Device on Thigh Muscle Atrophy in Football Players with Anterior Cruciate Ligament (ACL) Tears After Surgical Intervention

Improving tissue contrast visualization in two-point Dixon MRI using dark-fat processing: application in clinical knee imaging.

To improve tissue contrast visualization in water-only images from two-point turbo spin-echo (TSE) Dixon MRI using dark-fat image processing and evaluate in retrospectively acquired clinical knee images. Clinical knee MRI datasets from 36 patients were retrospectively compiled under IRB approval. The dark-fat water-only images were generated and compared with the conventional water-only images from two-point TSE-Dixon MRI. The water-only images from 20 patients were analyzed: (i) qualitatively by two experienced musculoskeletal radiologists, for overall image quality, fat suppression, anatomical visualization, and the absence of artifacts, using Wilcoxon rank tests, and (ii) quantitatively using apparent signal-to-noise ratio (aSNR) and apparent contrast-to-noise ratio (aCNR) from regions of interest (ROIs) with paired t-test. In the remaining 16 patients, the number of cruciate ligament tears identified on MRI was tabulated and compared with arthroscopy results. Compared to conventional water-only images, dark-fat water-only images showed improved fat suppression (reader 1, P < 0.0001; reader 2, P < 0.05), improved overall image quality by reader 1 (P < 0.001), and improved visualization of the sciatic nerve for reader 1 (P < 0.01), while there were no significant differences for the other anatomical structures. aSNR was significantly reduced for bone marrow fat (P < 0.0001), and aCNR between meniscus and articular cartilage was significantly improved (P < 0.0001). There were a higher number of posterior cruciate ligament tears identified in MRI compared to arthroscopy. Dark-fat processed water-only images improved fat suppression and tissue contrast visualization, particularly sciatic nerves, compared to conventional water-only images from two-point TSE-Dixon MR imaging.

Tear Location of Superficial Medial Collateral Ligament Tears: Validation of a Magnetic Resonance Imaging–Based Classification System

Background: The superficial medial collateral ligament (sMCL) is commonly injured, with treatment varying based on associated injuries, tear grade, and location. However, the prevalence of different tear locations and the predictors of tear types have not been studied. Purpose: To evaluate the interrater and intrarater reliability for a magnetic resonance imaging (MRI)–based sMCL classification system and assess the incidence of different tear types with its predictors. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective search in a single institution’s MRI database identified patients with acute, complete sMCL tears (≤30 days between injury and MRI) between January 2018 and December 2022. Exclusion criteria included previous ligamentous knee trauma/surgery, >30 days between injury and MRI, and partial sMCL tears. MRI scans were assessed by 3 independent raters using a predefined sMCL tear location system: type I (proximal 25%), type Ib (proximal femoral bony avulsion), type II (midsubstance, 25%-75%), type III (distal 25%), type IIIb (distal tibial bony avulsion), and type IIIs (Stener-like lesion). The intraclass correlation coefficient (ICC) was used to assess interobserver and intraobserver reliability for continuous data, whereas Fleiss and Cohen kappas were used for categorical data. Univariate and multivariate logistic regression assessed predictors of tear location. Results: The study included 239 patients (49% female; mean age, 38 ± 14 years; range, 13-75 years). The MRI-based sMCL classification system showed excellent interobserver reliability (0.960; 95% CI, 0.951-0.969) and excellent intraobserver reliability (evaluator 1: 0.969 (95% CI, 0.960-0.976); evaluator 2: 0.952 (95% CI, 0.915-0.973)). Type I sMCL tears were most common (65.4%), followed by type III (14.6%), type II (14.5%), type Ib (3.4%), and type IIIs (1.7%). Binary logistic regression identified medial meniscal tears (odds ratio [OR] 7.987; P = .034) and younger age (OR 0.916; P = .0001) as predictors for distal sMCL tears and older age as a predictor for proximal tears (OR 1.048; P = .001). Conclusion: This study validates an MRI-based sMCL classification system for locating high-grade sMCL tears with excellent reliability. Proximal tears were the most common (69%) and were significantly more prevalent with increasing age, whereas distal tears were more commonly seen with younger age and midbody medial meniscal tears. These findings may guide individualized treatment strategies and refine diagnostic protocols for patients with acute sMCL tears.

Temporal Proteome Profiling of Anterior Cruciate Ligament Tear Remnants: Secretory Proteins in the Acute Phase Potentially Promote Tissue Repair.

Previous studies reported that preserving the anterior cruciate ligament (ACL) remnants following ACL rupture during reconstruction surgery could promote graft healing. However, the temporal proteomic expression of ACL remnants remains unclear. Based on previous reports, we have redefined the initial 6 weeks following ACL rupture as the acute phase and the subsequent 6 weeks to 6 months as the subacute phase. High-throughput proteomic sequencing on ACL remnants from the two groups was utilized. Our study unveiled a total of 381 differential expression proteins (DEPs), with 136 upregulated and 245 downregulated proteins in the acute phase. By intersecting these findings with secretory protein databases, we identified 26 upregulated secretory proteins and 19 downregulated in the acute phase. The upregulation of MMP9 and VTN and the downregulation of COL1A1 and POSTN in the acute phase were further confirmed by immunohistochemistry. These findings suggest that the elevated expression of secretory proteins in the acute phase may play crucial roles in promoting cell proliferation, angiogenesis, and tissue repair of the graft. This study not only enhances our understanding of repair mechanisms in ACL remnant preservation but also provides a theoretical foundation for guiding rational clinical surgical timing.

Long-Term Injury Survey in a Japanese University Women’s Soccer Team

BACKGROUND Injuries are common in soccer as it is a contact sport. However, longitudinal studies spanning multiple seasons, focused on injuries in female university soccer players in Japan, are lacking. Additionally, broader comparisons on injury patterns remain unexplored. The purpose of this study was to prospectively investigate injuries among female university soccer players over three seasons. STUDY DESIGN Descriptive epidemiological study METHODS A total of 108 players from a university women’s soccer team were included. A qualified athletic trainer assessed injury type (injury or disability), site and severity according to injury occurrence (game or practice) over three seasons. An orthopedic surgeon confirmed the resulting injury. RESULTS The overall injury rate was 1.62/1000 athlete exposures. The game injury rate (9.86/1000 athlete exposures) was higher than the practice injury rate (1.39/1000 athlete exposures). Sprains were the most common injury in games and practices; concussions and meniscal tears were also common during games. The lower limbs, particularly the ankles and feet, were the most common anatomical injury sites in both games and practices. Severe injuries requiring long-term withdrawal were frequently observed during games and practices. These included anterior cruciate ligament (ACL) tears, meniscal injuries, and severe concussions, all of which necessitated prolonged recovery periods and withdrawal from team activities. CONCLUSION Injury prevention measures should be prioritized for female university soccer players, especially to address the high injury rate during games and the frequent occurrence of severe injuries. LEVEL OF EVIDENCE 3b

Effect of mild aerobic exercise on the rehabilitation of lower limb injuries: A narrative review

Lower limb injuries, including fractures, ligament tears, and stress-related conditions, significantly impact mobility and quality of life. If untreated, they can lead to chronic pain, joint instability, and muscle atrophy. Effective rehabilitation is crucial to restoring function and preventing long-term disability. Mild aerobic exercise, such as walking, cycling, and aquatic activities, has shown the potential to enhance recovery by improving blood circulation, muscle strength, and joint mobility. This review aims to evaluate the role of mild aerobic exercise in rehabilitating lower limb injuries, examining its physiological benefits and optimal implementation strategies. Findings indicate that mild aerobic exercise is crucial in rehabilitating lower limb injury. Aquatic exercises reduce limb swelling and improve muscle function due to hydrostatic pressure and resistance. Blood flow restriction techniques in aerobic training enhance muscle recovery while minimizing excessive strain. However, biomechanical asymmetry post-fatigue and the need for individualized exercise prescriptions remain considerations. Mild aerobic exercise is a safe and effective rehabilitation approach, improving mobility, reducing pain, and enhancing muscle strength. Personalizing exercise intensity and duration under professional supervision optimizes recovery outcomes. Future research should refine aerobic exercise protocols to maximize rehabilitation benefits and minimize risks.

Digital hand-held arthrometry is a reliable and accurate adjunct for diagnosing acute anterior cruciate ligament tears.

To evaluate the intrarater reliability and predictive validity of Lachmeter® measurements for diagnosing acute anterior cruciate ligament (ACL) tears, and to propose diagnostic thresholds. Lachmeter® measurements were recorded during the stabilised Lachman test for consecutive participants presenting to an acute knee injury clinic within 21-days of injury. Intrarater reliability for individual limb and side-to-side (STS) difference (injured limb minus uninjured limb) measurements was investigated using a cross-sectional, repeated-measures design and the intraclass correlation coefficient (ICC). The predictive validity of STS difference and injured limb measurements was investigated using a prospective cohort design; sensitivity, specificity, negative (LR-) and positive likelihood ratios (LR+) were calculated using magnetic resonance imaging as the reference standard. Intrarater reliability was excellent for individual limb and STS difference measurements in 102 participants. Of the 63 participants included in the validity analysis, 31 had a normal ACL and 32 had an ACL tear. LR- point estimates for STS differences <1.4 mm (0.07 [95% confidence interval [CI]: 0.02-0.29]) or injured limb measurements <7.5 mm (0.09 [95% CI: 0.02-0.34] produced 'large' shifts in the probability of ruling out an ACL tear. LR+ point estimates for STS differences ≥3.8 mm (10.67 [95% CI: 2.68-42.51]) or injured limb measurements ≥11.8 mm (10.67 [95% CI: 1.42-80.26]) produced 'large' shifts in the probability of ruling in a full-thickness ACL tear. In participants presenting within 21-days of knee injury, intrarater reliability was excellent for Lachmeter® measurements recorded during the stabilised Lachman test. Based on predictive validity estimates, Lachmeter® measurements can be used to differentiate normal from torn ACLs in acute presentations, but not partial from full-thickness ACL tears. Diagnostic thresholds are proposed based on STS difference and injured limb measurements, and with consideration of the Lachman end point. Level of Evidence: Level I.

The impact of smoking on meniscus surgery: a systematic review.

To provide a comprehensive, systematic review on the relationship and effects of smoking on clinical outcomes after meniscus surgery. The following combination of keywords was entered into the electronic search engines: meniscus, meniscus repairs, meniscectomy, meniscal tear, meniscus excision AND (smoke OR smoking OR nicotine OR tobacco). The year of the study, country, type of study, number of subjects, medial/lateral/both menisci, body mass index, smoking status, mean age, gender, follow-up, type/pattern of injury, surgical implications and clinical outcomes were recorded. A total of 23 studies published in 2013-2024 were included in the analysis. In ten studies, the meniscus injury was associated with an anterior cruciate ligament (ACL) tear. In four studies, the effect of smoking on meniscal allograft transplantation (MAT) was investigated. The neutral effect of smoking on meniscus surgery was revealed in nine studies, and only one of them focused on isolated meniscus pathology and surgery. The negative effect of smoking on meniscus surgery was shown in ten papers, with four papers focused on isolated meniscus tears and six papers presenting data with concurrent ACL reconstructions. This systematic review found that the results regarding the impact of smoking on meniscus repair outcomes were conflicting. Nevertheless, MAT and meniscus repair performed in the presence of concurrent ligamentous injury, both being demanding surgical procedures, require reduction of factors that may contribute to failure. Therefore, cessation of smoking in patients undergoing these procedures is highly advised.

High-grade medial femoral condyle and medial tibial plateau bone bruises predict ramp lesions of the medial meniscus in patients with anterior cruciate ligament tears: A prospective clinical and MRI evaluation.

The purpose of this study was to evaluate potential predictive diagnostic variables on magnetic resonance imaging (MRI) for medial meniscus ramp tears in the presence of an anterior cruciate ligament (ACL) tear. Patients aged ≥16 years undergoing arthroscopic anatomic hamstring single-bundle ACL reconstruction between July 2016 and September 2020 from a single centre were prospectively enroled with a diagnosis based on clinical and MRI evaluations. Demographic data such as age, gender, dominant limb and time from injury to surgery were recorded. Clinical assessments included Lachman and pivot shift tests. Imaging assessments involved grading bone bruises on MRI using the International Cartilage Repair Society (ICRS) scale. Statistical analysis was conducted using parametric tests and regression analysis with a p value of less than 0.05, which is considered significant. The final sample consisted of 108 patients, with a concomitant ACL tear and medial meniscus ramp tear present in 53 (49.1%) patients. In the univariate regression analysis, a higher grade of the medial femoral condyle and medial tibial plateau bone bruises was highly associated with the diagnosis of an ACL tear with a concomitant ramp tear (p = 0.006, β = 0.151 and p < 0.001, β = 0.172, respectively). In the univariate regression analysis, a higher grade of the medial femoral condyle and medial tibial plateau bone bruise was associated with the diagnosis of ACL tear with a concomitant ramp tear (p = 0.006, β = 0.151 and p < 0.001, β = 0.172, respectively). In this prospective series of patients with ACL tears, 49% were found to have concomitant medial meniscal ramp tears. The finding of medial tibial plateau or medial femoral condyle bone bruising was predictive of ramp tear. The presence of this bone bruising pattern along with a high-grade Lachman and/or pivot shift examination, a medial meniscus ramp tear should be suspected. Level II, prospective cohort study.

InternalBrace behavior at different orientation placements during anterior cruciate ligament repair: A computational finite element simulation.

InternalBrace behavior at different orientation placements during anterior cruciate ligament repair: A computational finite element simulation.

Personal and Psychological Perceptions of Return to Activities After Anterior Ligament Reconstruction Among Patients with an Anterior Cruciate Ligament Tear in Jazan Province

Personal and Psychological Perceptions of Return to Activities After Anterior Ligament Reconstruction Among Patients with an Anterior Cruciate Ligament Tear in Jazan Province