Secondary Anterior Cruciate Ligament Injury Research Articles

No Association Between Injury-Related Fear and Isokinetic Quadriceps Strength in Individuals With a History of Anterior Cruciate Ligament Reconstruction.

Injury-related fear and quadriceps strength are independently associated with secondary anterior cruciate ligament (ACL) injury risk. It is not known whether injury-related fear and quadriceps strength are associated, despite their individual predictive capabilities of secondary ACL injury. The purpose of this study was to examine the association between injury-related fear and quadriceps strength in individuals at least 1year after ACL reconstruction (ACLR). Cross-sectional study. Forty participants between the ages of 18 and 35years at least 1year post unilateral primary ACLR. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) and a standard isokinetic quadriceps strength assessment using the Biodex Isokinetic Dynamometer. Pearson Product-Moment correlations were used to examine the linear association between the TSK-11 scores and peak torque (in nanometers per kilogram) for each limb and between the TSK-11 scores and limb symmetry indices for each limb. Pearson Product-Moment correlation coefficients (r) were interpreted as very high (.90-1.00), high (.70-.90), moderate (.50-.70), low (.30-.50), and no correlation (.00-.30). The average TSK-11 score was 18.2 (5.3), average ACLR peak quadriceps torque was 1.9 (0.50)N·m/kg, average contralateral peak quadriceps torque was 2.3 (0.48)N·m/kg, and average limb symmetry index was 85.3% (12.6%). There was no statistically significant correlation between the TSK-11 and peak quadriceps torque on the ACLR limb (r = .12, P = .46), the TSK-11 and contralateral limb (r = .29, P = .07), or the TSK-11 and limb symmetry index (r = -.18, P = .27). There was no association between kinesiophobia and peak isokinetic quadriceps strength in individuals at least 1year post-ACLR. Both factors, independently, have been shown to influence risk of secondary injury in patients after ACLR.

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

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

Knee Biomechanics During Cutting Maneuvers and Secondary ACL Injury Risk: A Prospective Cohort Study of Knee Biomechanics in 756 Female Elite Handball and Soccer Players.

An athlete who returns to sport after an anterior cruciate ligament (ACL) injury has a substantially high risk of sustaining a new secondary ACL injury. Because ACL injuries most frequently occur during cutting maneuvers, such movements should be at the center of research attention. To investigate whether knee biomechanical parameters during side-step cutting maneuvers differ between female elite athletes with and without a history of ACL injury and to evaluate whether such parameters are associated with future secondary ACL injury. Cohort study; Level of evidence, 2. A total of 756 female elite handball and soccer players, of whom 76 had a history of ACL injury, performed a sport-specific cutting task while 3-dimensional kinematics and kinetics were measured. ACL injuries were registered prospectively over an 8-year follow-up period. Seven knee-specific biomechanical variables were the basis for all analyses. Two-way analyses of variance were applied to assess group differences, whereas logistic regression models served to evaluate associations between the knee-specific variables and future secondary ACL injury. When players with a previous ACL injury performed the cutting maneuver with their ipsilateral leg, they exhibited lower knee abduction angles (mean difference [MD], 1.4°-1.5°; 95% CI, 0.2°-2.9°), lower peak knee flexion moments (MD, 0.33 N·m/kg-1; 95% CI, 0.18-0.48 N·m/kg-1), lower peak knee abduction moments (MD, 0.27 N·m/kg-1; 95% CI, 0.12-0.41 N·m/kg-1), and lower peak knee internal rotation moments (MD, 0.06 N·m/kg-1; 95% CI, 0.01-0.12 N·m/kg-1) compared with injury-free players. When players performed the cut with their contralateral leg, no differences were evident (P < .05). None of the 7 knee-specific biomechanical variables was associated with future secondary ACL injury in players with an ACL injury history (P < .05). Approximately 4 years after ACL injury, female elite team-ball athletes still unloaded their ipsilateral knee during cutting maneuvers, yet contralateral knee loading was similar to that of injury-free players. Knee biomechanical characteristics were not associated with future secondary ACL injury.

Effects of Kinesio taping on lower limb biomechanical characteristics during the cutting maneuver in athletes after anterior cruciate ligament reconstruction.

To determine the effects of Kinesio taping (KT) on the biomechanical characteristics of the lower limbs during the 90° cutting maneuver in anterior cruciate ligament (ACL) reconstruction (ACLR) athletes. Eighteen ACLR athletes were recruited and subjected randomly to three taping conditions, KT, placebo taping (PT), and no taping (NT), followed by a 90° cutting test. A nine-camera infrared high-speed motion capture system (Vicon, T40, 200 Hz) was used to record the kinematic parameters of the lower limbs during the cutting maneuver, and a three-dimensional dynamometer (Kistler, 1000 Hz) was used to record the kinetic parameters of the lower limbs. A one-way repeated measures analysis of variance was conducted to compare the differences in the lower limb kinematic and kinetic characteristics of ACLR athletes subjected to these interventions. During the landing phase, the knee valgus angle reduced significantly with KT than with NT (95% confidence interval = -1.399 to -0.154; P = 0.025), whereas no significant difference was observed between PT and NT (95% confidence interval = -1.251 to 0.217; P = 0.236). No significant differences were observed in the other kinematic variables among the three taping conditions (P > 0.05). During the landing phase, no significant differences in the kinetic variables were observed among the three taping conditions (P > 0.05). Although KT does not improve the kinetic variables of athletes after ACLR during the 90° cutting maneuver, it reduces the knee valgus angle, which could reduce the risk of secondary ACL injury.

Abnormal femoral trochlea morphology is a risk factor for secondary injury of anterior cruciate ligament after reconstruction.

Secondary injury of the anterior cruciate ligament (ACL) is a common concern after anterior cruciate ligament (ACL) reconstruction, and identification of morphological risk factors is essential to prevent these injuries. We hypothesized that abnormal femoral trochlea morphology is associated with secondary ACL injuries after reconstruction. This study aimed to investigate the relationship between femoral trochlear morphology and secondary ACL injuries after reconstruction. A retrospective analysis was conducted on 20 patients who experienced secondary ACL injuries after reconstruction in our hospital between 2017 and 2022 (experimental group), and 40 patients were included in the control group. The following femoral trochlear characteristics were compared between the 2 groups: medial condylar height (MCH), trochlear sulcus height (TSH), lateral condylar height (LCH), trochlear sulcus depth (TSD), trochlear sulcus angle (TSA), medial trochlear inclination (MTI), and lateral trochlear inclination (LTI). The study found that patients in the secondary ACL injury after reconstruction group exhibited the following differences when compared to the control group: decreased MCH (56.33 ± 3.52 vs 59.93 ± 3.24, P value = .015), decreased TSD (4.89 ± 1.56 vs 6.98 ± 1.23, P value ˂ .001), decreased MTI (12.54 ± 6.57 vs 19.45 ± 6.35, P value ˂ .001), and increased TSA (145.23 ± 9.76 vs 139.25 ± 8.42, P value ˂ .001). This study demonstrated a significant correlation between abnormal femoral trochlear morphological characteristics and secondary ACL injuries after reconstruction. Decreased MCH, TSD, and MTI along with increased TSA are associated with a higher risk of secondary ACL injury. These data could thus help identify individuals susceptible to secondary ACL injuries after reconstruction.

Lower-Extremity Visuomotor Reaction Time Is Not Different Between Males and Females Following Anterior Cruciate Ligament Reconstruction

Visuomotor reaction time (VMRT) is predictive of lower-extremity musculoskeletal injury and may be a modifiable anterior cruciate ligament (ACL) injury risk factor that affects the incidence of primary and secondary ACL injuries in females. However, it is unknown if females with ACL reconstruction (ACLR) experience diminished VMRT compared with their male counterparts. The purpose of this study was to compare lower-extremity VMRT (LEVMRT) between males and females with ACLR. Female (n = 40) and male (n = 20) participants who were between 4 and 12 months after primary, unilateral ACLR completed a LEVMRT task with each limb using a series of wireless light discs. Mann–Whitney U tests were used to compare between-group differences for LEVMRT (in milliseconds). No statistically significant sex differences were observed for LEVMRT when the ACLR limb deactivated the light discs (females = 509.5 [132.5], males = 507.0 [79.8]; p = .77) or when the ACLR limb was stabilizing while the nonsurgical limb deactivated the light discs (females = 528.5 [105.3], males = 546.0 [92.5]; p = .77). Both males and females may benefit from visual motor training to improve VMRT after ACLR.

Prevalence and Predictors of Concomitant Meniscal and Ligamentous Injuries Associated With ACL Surgery: An Analysis of 20 Years of ACL Reconstruction at a Tertiary Care Children’s Hospital

Background: There is an increasing rate of procedures being performed for concomitant injuries during anterior cruciate ligament (ACL) surgery. Few studies have examined risk factors for these associated injuries in young patients. Hypothesis: There are patient-related factors predictive of concomitant knee pathology that differ between age-based cohorts. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Natural language processing was used to extract clinical variables from available notes of patients undergoing ACL surgery between 2000 and 2020 at a single institution (5174 ACL surgeries; mean age, 17 ± 4 years; 53.1% female; accuracy, >98%). Patients were stratified to pediatric (5-13 years), adolescent (14-19 years), and young adult (20-35 years) cohorts. Logistic regression was used to determine predictors of concomitant injury to the menisci, medial collateral ligament (MCL), posterolateral corner (PLC), and posterior cruciate ligament (PCL). Results: Between 2000 and 2020, 54% of pediatric, 71% of adolescent, and 70% of adult patients had ≥1 concomitant soft tissue injury. In children and adolescents, increased age was consistently predictive of sustaining a concomitant injury (P < .02). Female children had increased odds of concomitant medial meniscal injury, while female adults had decreased odds (P≤ .046). Adolescent and adult female patients had decreased odds of concomitant lateral meniscal injury (P≤ .027). Female children had increased odds of injury to the MCL (P = .015), whereas female children and adolescents had decreased odds of PCL injury (P≤ .044). Adolescents undergoing revision ACL surgery had increased odds of meniscal injury (P≤ .001) and decreased odds of concomitant MCL injury (P = .028). Increased body mass index (BMI) was associated with increased odds of concomitant medial meniscal injury in all cohorts (P≤ .041), lateral meniscal injury in adults (P = .045), and PLC injury in children (P = .016). Contact injuries were associated with increased odds of MCL injury in adolescents (P = .017) and PLC injury in adolescents and adults (P < .014). Conclusion: These findings support the hypothesis, as there were multiple factors that significantly affected the risk of concomitant injuries that differed between cohorts. Increased age, BMI, and contact injury history were generally associated with increased odds of sustaining a concomitant injury, whereas female sex and revision ACL surgery had mixed effects. Further studies are essential to investigate the sex-based differences in risk for concomitant injuries and to develop tailored treatment plans that minimize the risk of secondary ACL injury.

Tibial Spine Fractures in the Child and Adolescent Athlete: A Systematic Review and Meta-analysis.

Tibial spine fractures (TSFs) are uncommon injuries that may result in substantial morbidity in children. A variety of open and arthroscopic techniques are used to treat these fractures, but no single standardized operative method has been identified. To systematically review the literature on pediatric TSFs to determine the current treatment approaches, outcomes, and complications. Meta-analysis; Level of evidence, 4. A systematic review of the literature was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines using PubMed, Embase, and Cochrane databases. Studies evaluating treatment and outcomes of patients <18 years old were included. Patient demographic characteristics, fracture characteristics, treatments, and outcomes were abstracted. Descriptive statistics were used to summarize categorical and quantitative variables, and a meta-analytic technique was used to compare observational studies with sufficient data. A total of 47 studies were included, totaling 1922 TSFs in patients (66.4% male) with a mean age of 12 years (range, 3-18 years). The operative approach was open reduction and internal fixation in 291 cases and arthroscopic reduction and internal fixation in 1236 cases; screw fixation was used in 411 cases and suture fixation, in 586 cases. A total of 13 nonunions were reported, occurring most frequently in Meyers and McKeever type III fractures (n = 6) and in fractures that were treated nonoperatively (n = 10). Arthrofibrosis rates were reported in 33 studies (n = 1700), and arthrofibrosis was present in 190 patients (11.2%). Range of motion loss occurred significantly more frequently in patients with type III and IV fractures (P < .001), and secondary anterior cruciate ligament (ACL) injury occurred most frequently in patients with type I and II fractures (P = .008). No statistically significant differences were found with regard to rates of nonunion, arthrofibrosis, range of motion loss, laxity, or secondary ACL injury between fixation methods (screw vs suture). Despite variation in TSF treatment, good overall outcomes have been reported with low complication rates in both open and arthroscopic treatment and with both screw and suture fixation. Arthrofibrosis remains a concern after surgical treatment for TSF, but no significant difference in incidence was found between the analysis groups. Larger studies are necessary to compare outcomes and form a consensus on how to treat and manage patients with TSFs.

Allograft Anterior Cruciate Ligament Reconstruction Fails at a Greater Rate in Patients Younger Than 34 Years

To characterize the secondary anterior cruciate ligament (ACL) injury rates after primary allograft anterior cruciate ligament reconstruction (ACLR) and to identify the age cut-score at which the risk of allograft failure decreases. All patients who underwent primary ACLR within a single orthopaedic department between January 2005 and April 2020 were contacted at a minimum of 2 years post-ACLR to complete a survey regarding complications experienced post-surgery, activity level, and perceptions of knee health. Patients were excluded for incidence of previous ACLR (ipsilateral or contralateral) and/or age younger than 14 years. Relative proportions were calculated, binary regression analysis was performed, and receiver operating characteristic analysis was used to identify the threshold age for maximal sensitivity and specificity to predict high risk of allograft failure, defined as undergoing revision ACLR. Of the 939 surveys completed, 398 patients underwent primary allograft ACLR (mean age 39.5years; range 16.0-66.1 years; 54.3% female). The secondary ACL injury rate was 11.6% (5.8% ipsilateral revision ACLR, 5.8% contralateral ACL injury). Male and female patients had similar revision (5.5% male, 6.0% female, P= .82) and contralateral ACL injury rates (6.6% male, 5.1% female, P= .52). Receiver operating characteristic analysis indicated that age ≤34 years was threshold for differentiating high risk of allograft failure (area under the curve 0.65, 95% confidence interval 0.55-0.76; P= .014). Patients aged ≤34 years had a greater secondary injury rate than patients >34 years (20.4% (10.2% revision ACLR, 10.2% contralateral ACL injury) versus 6.9% (3.5% revision ACLR, 3.5% contralateral ACL injury; P < .001). Binary regression analysis demonstrated that decreasing age was associated with increased risk of graft failure (χ2= 7.9, P= .02.). Allograft ACLR showed similar failure rates between sexes but displayed suboptimal graft failure outcomes in younger and active patients. By age 34 years, the increased revision risk for younger patients diminished. Level IV, therapeutic case series.

Clinical Outcomes After ACL Reconstruction in Soccer (Football, Futbol) Players: A Systematic Review and Meta-Analysis.

The risk factors for anterior cruciate ligament (ACL) tear for athletes participating in pivoting sports includes young age and female sex. A previous meta-analysis has reported a reinjury rate of 15% after ACL reconstruction (ACLR) for athletes across all sports. To the best of the authors' knowledge, this is the first systematic review and meta-analysis of available literature reporting outcomes after ACLR in soccer players. To review and aggregate soccer-specific outcomes data after ACLR found in current literature to help guide a more tailored discussion regarding expectations and prognosis for soccer players seeking operative management of ACL injuries. A comprehensive search of publications was performed using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and SPORTDiscus databases. Inclusion criteria consisted of original studies, level of evidence 1 to 4, studies reporting clinical and patient-reported outcomes (PROs) after primary ACLR in soccer players at all follow-up length. The primary outcomes of interest were graft failure/reoperation rates, ACL injury in contralateral knee, return to soccer time, and PROs. Level 4. Search of literature yielded 32 studies for inclusion that involved 3112 soccer players after ACLR. The overall graft failure/reoperation rate ranged between 3.0% and 24.8% (mean follow-up range, 2.3-10 years) and the combined ACL graft failure and contralateral ACL injury rate after initial ACLR was 1.0% to 16.7% (mean follow-up range, 3-10 years); a subgroup analysis for female and male players revealed a secondary ACL injury incidence rate of 27%, 95% CI (22%, 32%) and 10%, 95% CI (6%, 15%), respectively. Soccer players were able to return to play between 6.1 and 11.1 months and the majority of PROs showed favorable scores at medium-term follow-up. Soccer players experience high ACL injury rates after primary ACLR and demonstrated similar reinjury rates as found in previous literature of athletes who participate in high-demand pivoting sports.

Secondary Anterior Cruciate Ligament Injury Prevention Training in Athletes: What Is the Missing Link?

After reconstruction, the return to full competition rate of athletes is low, while the re-injury rate remains high despite the completion of a rehabilitation programme. Primary ACL prevention programmes are well developed, yet few research papers focus on secondary ACL injury prevention. The aim of current review is to determine if current ACL secondary prevention training has a positive influence on the re-injury rate, the clinical or functional outcomes, or the risk of re-injury in athletes. Studies investigating secondary prevention of ACL were searched in PubMed and EBSCOhost, followed by a review of the references in the identified articles. The existing evidence suggests that neuromuscular training, eccentric strengthening, and plyometric exercises may have a potential impact on improving biomechanical, functional, and psychological outcomes in athletes; however, the studies on the prevention of second ACL injury in athletes is scarce and inconclusive. Future research is needed to investigate the effectiveness of secondary ACL prevention in reducing the re-injury rates. (PROSPERO Registration number: CRD42021291308).

The effects of core stabilization exercises on the neuromuscular function of athletes with ACL reconstruction

Athletes who have undergone anterior cruciate ligament reconstruction (ACLR) often exhibit persistently impaired kinematics and strength. Core stability training appears to be effective for reducing high-risk landing mechanics and preventing primary anterior cruciate ligament (ACL) injuries; however, there have been few attempts to examine their effects in athletes who have undergone ACLR. This study aimed to investigate the effect of eight weeks of simple core stability training on core endurance, hip strength, and knee kinematics in ACLR athletes. Twenty-six male athletes (20–30 years old) with a history of ACL surgery with hamstring tendon autograft were randomly divided into training (n = 13) and control groups (n = 13). The training group performed core stability exercises for eight weeks before starting their team training; the control group did not receive any intervention. Both groups continued their regular team schedule. The core endurance, hip muscle strength, and knee kinematics were assessed by the McGill test, a hand-held dynamometer, and video-taping, respectively. Analysis of covariance test was used for data analysis. The training group showed a significant increase in core endurance, hip abductor and external rotator strength, knee flexion angle, and a significant decrease in the knee valgus angle during single-leg landing in post-training tests compared to their baseline tests (P < 0.05). Our results demonstrated that core stability exercise alters neuromuscular function to a level that is clinically acceptable and statistically significant. Because of the high incidence rate of secondary ACL injury after ACLR, it is recommended that athletes with a history of ACLR benefit from adding core stability exercises to warm-up routines or tertiary prevention programs even after completing post-operative rehabilitation. It is fast and not time-consuming to perform for athletes to reduce the risk factors of re-injury.Trial registration: This study was registered in the Iranian Registry of Clinical Trials with the number IRCT20190224042827N2, registered on 19 December 2019.

Comprehensive inpatient rehabilitation for elite athletes after anterior cruciate ligament reconstruction.

[Purpose] The authors' institute offers a comprehensive inpatient approach to rehabilitation after anterior cruciate ligament reconstruction surgery, providing nutritional and psychological support in addition to exercise and physical therapy. This study aimed to determine the outcomes of athletes undergoing this comprehensive rehabilitation program and to compare the outcomes of bone-patellar tendon-bone and semitendinosus/gracilis autograft recipients. [Participants and Methods] Elite athletes who underwent comprehensive inpatient rehabilitation at the authors' institute for at least two weeks after anterior cruciate ligament reconstruction were mailed a questionnaire. Their recovery levels, which were measured against preinjury performance, and secondary anterior cruciate ligament injury rates, were evaluated and compared according to graft type. [Results] Valid responses from 45 athletes were analyzed (bone-patellar tendon-bone [n=12]; semitendinosus/gracilis [n=33]). The frequency of return to preinjury activity levels and secondary anterior cruciate ligament injury were comparable between bone-patellar tendon-bone and semitendinosus/gracilis graft recipients. A greater proportion of athletes returned to preinjury activity levels, while a lower percentage experienced re-rupture compared to previous studies. [Conclusion] A comprehensive rehabilitative approach after anterior cruciate ligament reconstruction may contribute to improved postoperative performance irrespective of graft type. Objective evaluations are needed in the future to clarify the benefits of specific rehabilitative approaches.

ACL Research Retreat IX Summary Statement: The Pediatric Athlete, March 17-19, 2022; High Point, North Carolina.

ACL Research Retreat IX Summary Statement: The Pediatric Athlete, March 17-19, 2022; High Point, North Carolina.

ACL Research Retreat IX March 17–19, 2022 High Point, NC

ACL Research Retreat IX March 17–19, 2022 High Point, NC

Epidemiology of recurrent anterior cruciate ligament injuries according to sport type

The anterior cruciate ligament (ACL) is one of the two cruciate ligaments that helps to strengthen the knee joint. It is a common knee injury, which often occurs in sports players. There is no bias against age or gender; however, it has been suggested in literature that women are at increased risk of secondary ACL injury. These injuries can have serious consequences for an injured athlete, including high medical costs, long off playing time, and an elevated chance of developing early osteoarthritis. Recurrent ACL injuries are described as injuries that occur in the same knee which has been previously treated. A recurrent ACL may be the result of a severe injury to the same position, graft failure, or an improper surgical procedure. Studies have reported significant prevalence of recurrent ACL. The purpose of this research is to review the available information about the epidemiology of recurrent ACL injuries. Athletes returning to sports field within two years of injury have higher chance of recurrent ACL injury. Variable prevalence of recurrent ACL injuries is reported in literature and limited studies are available. The young age, high level of exposure to physical activity, and the use of allograft all increase the chances of further ACL injury. Future population-based epidemiological studies can be beneficial and are need of time.

Postoperative complications following ACL reconstruction: Prevention and management

This article aims to conduct a literature analysis on the current care and prevention strategies for postoperative problems following the repair of the anterior cruciate ligament (ACL). A presentation will be given on current trends in rehabilitation procedures, suggestions for interventions, and anticipated milestones in the healing process after ACL surgery. In recent years, protocols for ACL repair have progressed to a criterion-based progression rather than a tissue healing time frame. Because of advancements in ACL surgical reconstruction techniques and rehabilitation protocols, the danger of postoperative complications can manifest itself at any point during the recovery process. This includes both the beginning and the end of the process. In this paper, we will examine the significance of preventative measures for postoperative patient who has undergone ACL repair. Infection and loss of knee motion and strength are short-term complications that can occur after an ACL reconstruction. Long-term complications can include a secondary ACL injury to either the involved knee or the contralateral knee and the inability to return to high-level sports after this procedure. The multifaceted causes of secondary ACL injuries and the limited capacity of patients to return to high-level activities should continue to be the focus of future research.

Paediatric reference anatomy for ACL reconstruction and secondary anterolateral ligament or lateral extra-articular tenodesis procedures

ObjectivesFor iliotibial band (ITB) lateral extra-articular tenodesis or anterolateral ligamentous/capsular reconstruction with anterior cruciate ligament reconstruction, a clear understanding of the referenced anterolateral knee anatomy is critical—especially given the risk of injury to the physis or key anterolateral structures in the paediatric population, which is at high-risk for primary and secondary anterior cruciate ligament injury. The purpose of this study was to quantitatively assess the anatomy of the knee physes, paediatric lateral collateral ligament (LCL) origin, popliteus origin and ITB tibial insertion. MethodsNine paediatric cadaveric knee specimens with average age 4.2 years (range 2 months–10 years) underwent dissection to identify the LCL's and popliteus’ femoral origins and the ITB's tibial insertion. Metallic marking pins demarcated precise anatomic attachment sites, and subsequent computerised tomography scans enabled quantified measurements among them. ResultsLCL & Popliteus: On the femur, the popliteus origin lay consistently deep to the LCL and inserted both distally and anteriorly to the LCL, a mean distance of 4.6 mm (range 1.9–7.6; standard deviation 2.0). From the joint line, the LCL lay a mean distance of 12.5 mm proximally while the popliteus measured a mean of 8.2 mm. Both were consistently distal to the physis. The LCL was a mean distance of 4.4 mm (range 1.0–9.5) and the popliteus was a mean distance of 8.2 (range 1.7–12.5) from the physis. ITB insertion: The ITB insertion at Gerdy's tubercle had an average footprint measuring 28.2 mm2 (range 10.3–58.4) and the ITB centre lay proximal to the physis in 6 specimens (mean age 4.2 years, median 2.5 years) and distal in 3 specimens (mean age 1.5 years, median 4 months). Mean distance from the footprint centre to the physis was 1.6 mm proximal (range 7.1 proximal – 2.2 distal). ConclusionThis study describes relative and quantitative positions of the femoral LCL and popliteus origins and tibial ITB attachment and their respective physeal relationships. Knowledge of paediatric anterolateral knee anatomy will help guide essential future research and procedures providing extra-articular anterolateral rotatory stabilisation and may help reduce iatrogenic physeal injury risk. Level of evidenceN/A (descriptive anatomic study).

Knee Strength Outcomes in Adolescents by Age and Sex During Late-Stage Rehabilitation After Anterior Cruciate Ligament Reconstruction

Background:The incidence of anterior cruciate ligament (ACL) injuries have been consistently increasing in adolescents, with those who return to competitive sport having up to a 32% risk of a secondary ACL injury. There is limited evidence regarding knee strength outcomes in young adolescents following ACL reconstruction during late-stage rehabilitation when compared to older patient groups.Purpose:The purpose of this study was to 1) establish normative knee strength values according to age group in adolescent female and male patients during late-stage rehabilitation following ACLR and 2) determine whether strength differences exist between age groups.Methods:A retrospective review of adolescent patients who underwent primary ACL reconstruction was performed. Patients completed a standardized isokinetic (60°/sec) knee extension and flexion strength assessment during late-stage rehabilitation. Peak torque was normalized to the patient’s body mass (Nm/kg) and used to calculate Limb Symmetry Index (LSI). Analyses were conducted separately for female and male cohorts and grouped by early (11-14 years) and middle (15-17 years) adolescence. An independent samples t-test examined strength differences between age groups.Results:130 females (age=15.4 ± 1.4 years; days since surgery=239.0 ± 84.4) and 112 males (age=15.4 ± 1.5 years; days since surgery= 232.6 ± 91.2) were included. Normalized knee extension peak torque on the involved limb was reported for female (1.5 Nm/kg) and male (1.8 Nm/kg) cohorts. Differences between age groups in knee extension peak torque were found on the surgical and nonsurgical limbs in female (p = 0.02 – 0.05) and male (p<0.001 – 0.002) cohorts. No differences were found between age groups for either cohort when normalized to body mass (p = 0.30 – 0.89). Post hoc power analyses revealed 67% statistical power in the female cohort and 97% in the male cohort with an alpha level set to 0.05 based on the observed effect size for the differences in isokinetic knee extension/flexion peak torque between age groups.Conclusion:Early adolescents produced less knee extension and flexion peak torque compared to middle adolescents after ACLR, but no differences were found between age groups when normalized to body mass for female or male cohorts. Normalized knee extension strength in young adolescents may differ from older patients and should be considered in the rehabilitation process.TABLE 1:Patient Demographics - FemalesTABLE 2:Patient Demographics - MalesTABLE 3:Strength Outcomes by Age Group during Late-Stage Rehabilitation (Females)TABLE 4:Strength Outcomes by Age Group during Late-Stage Rehabilitation (Males)

Risk of Graft Rupture After Adding a Lateral Extra-articular Procedure at the Time of ACL Reconstruction: A Retrospective Comparative Study of Elite Alpine Skiers From the French National Team

Background: Elite alpine skiing is associated with a particularly high risk of anterior cruciate ligament (ACL) injuries, including graft ruptures. Despite a considerable focus on prevention, a reduction in injury rates has not been observed since the 1980s. Purpose: To determine whether elite alpine skiers undergoing ACL reconstruction (ACLR) with a lateral extra–articular procedure (LEAP) had a lower rate of ACL graft rupture when compared with those who underwent isolated ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Elite skiers from the French ski team who had undergone ACLR, with or without a LEAP, and had a minimum follow–up of 2 years were identified from the national ski team database. Rates of secondary ACL injury were determined via interrogation of the database, review of medical notes, and a final telemedicine interview. A multivariable analysis using the penalized Cox model was performed to explore the relationship among graft rupture, surgical procedure type, and any potential explanatory variables. Results: Among 81 ACLR procedures analyzed, 50 were isolated and 31 were combined with a LEAP, which was performed using modified Lemaire or anterolateral ligament reconstruction. Graft rupture rates were 34.0% in the isolated ACLR group and 6.5% in the ACLR + LEAP group. Multivariable analysis demonstrated that adding a LEAP was associated with a significant reduction in risk of ACL graft rupture when compared with isolated ACLR (hazard ratio [HR], 5.286 [95% CI, 1.068-26.149]; P = .0412). Age (HR, 1.114; P = .1157), sex (HR, 1.573; P = .3743), and ACL graft type (HR, 1.417; P = .5394) were not significant risk factors. Conclusion: Combined ACLR and LEAP were associated with a significant reduction in the rate of ACL graft rupture in elite alpine ski athletes. Those treated with isolated ACLR remain at extremely high risk of a second ACL injury.