OBJECTIVE: To compare early graft healing between over-the-top (OTT) and anatomic single-bundle (SB) anterior cruciate ligament (ACL) reconstruction. METHODS: A clinical data of 40 patients underwent ACL reconstruction, who admitted between June 2021 and October 2022 and met the selective criteria, was retrospectively analyzed. Among them, 20 patients were treated with OTT reconstruction (OTT group) and 20 with SB reconstruction (SB group). There was no significant difference between groups ( P>0.05) in the gender, age, affected side, disease duration, degree of meniscus injury, body mass index, and preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, pain visual analogue scale (VAS) score, and KT-2000 measurement. At 3, 6, and 12 months, MRI was performed to measure the signal noise quotient (SNQ) of the proximal end, middle, and distal end of the graft in the two groups, as well as at the corner of the graft with lateral femoral condyle and 1 cm around the femoral fixation point in the OTT group, to observe the degree of graft healing. Before operation and at 3, 6, and 12 months, the knee function and pain were evaluated by IKDC score, Lysholm score, and VAS score. Before operation and at 12 months after operation, the KT-2000 measurement was taken to evaluation the knee joint stability. RESULTS: All operations were successfully completed in both groups and the incisions healed by first intention. All patients were followed up 12-15 months (mean, 12.9 months), with no significant difference in the follow-up time between groups ( P>0.05). After operation, the IKDC score, VAS score, and Lysholm score improved gradually over time in both groups, with significant differences between different time points ( P<0.05). The differences between groups at 3, 6, and 12 months after operation were not significant ( P>0.05). The anterior and posterior stability of the knee joint improved significantly in both groups at 12 months after operation, and the difference in KT-2000 measurements was significant when compared with the preoperative value ( P<0.05), but the difference of pre- and post-operation between groups was not significant ( P>0.05). At 3, 6, and 12 months after operation, MRI showed that the differences in the SNQ of the proximal end and middle of the grafts between the two groups were not significant ( P>0.05), and the SNQ of distal end was significantly higher in the SB group than in the OTT group ( P<0.05). At each time point, grafts in the OTT group had the highest SNQ at the corner and the lowest at the fixation point, and the differences were significant compared to the other sites ( P<0.05). In the two groups, except for the fixation point, the SNQ of the remaining sites were highest at 6 months and lowest at 12 months ( P<0.05). In addition, there were significant differences in SNQ between the different sites of grafts ( P<0.05), and the SNQ was lowest at proximal end and highest at distal end. At last follow-up, the knee grafts in both groups were in good shape and no graft necrosis or loosening of the internal fixation was observed. CONCLUSION The knee joint function and graft healing after OTT reconstruction of ACL are similar to those of SB reconstruction, but it should be noted that the healing at the corner of the graft is slower.
Retrospective Studies ; Treatment Outcome ; Anterior Cruciate Ligament Reconstruction/rehabilitation* ; Follow-Up Studies ; Tibial Meniscus Injuries/surgery* ; Patient Positioning/methods* ; Recovery of Function ; Pain Measurement ; Knee Joint/surgery* ; Humans ; Male ; Female ; Adult ; Wound Healing

This paper explores the impacts of accelerated rehabilitation protocols following anterior cruciate ligament reconstruction(ACLR)on bone tunnel enlargement(BTE).While accelerated rehabilitation can shorten the recovery time and improve the knee function,it may increase the risk of BTE.In the early rehabilitation phase after ACLR,excessive early weight-bearing and rapid progression of knee flexion angles should be avoided,along with the proper use of braces.Continuous passive motion is not recommended in the early phase post-ACLR to prevent potential effects on BTE.Further research is needed to investigate the mechanisms of BTE and develop more effective rehabilitation strategies.This will help to select appropriate rehabilitation protocols for patients and balance functional recovery with the risk of BTE,thereby reducing the revision rate and improving postoperative outcomes.
Humans ; Anterior Cruciate Ligament Reconstruction/rehabilitation*

Objective To investigate the effects of rotation stability after anterior cruciate ligament reconstruction (ACLR) on subjective outcomes,sport performance,psychological readiness,and return to sport. Methods The patients who underwent ACLR in the Sports Hospital,National Institute of Sports Medicine,General Administration of Sport of China from January 2015 to January 2021 were followed up during the period from November 2022 to December 2023.The patients were grouped according to the results of the pivot shift test (PST) of the affected knee at the last follow-up visit.A total of 66 patients who participated in the follow-up and met the inclusion and exclusion criteria were finally enrolled in this study,including 32 patients showing a negative PST result (stable group) and 34 patients showing a positive PST result (unstable group).The basic information,subjective function score,and return-to-sport performance were compared between the two groups. Results In terms of sport performance,the two groups showed differences in the limb symmetry index in single-leg hops,triple hops,and crossover hops (P=0.028,P=0.024,and P=0.044,respectively).The anterior cruciate ligament-return to sport after injury scale score was higher in the stable group than in the unstable group [(70.44±22.82) scores vs. (53.44±21.74) scores,P=0.003].The mean of KT-2000 test results in the stable group was lower than that in the unstable group [(0.53±1.02) mm vs. (2.06±2.31) mm,P=0.001].The Lysholm score,international knee documentation committee score,knee injury and osteoarthritis outcome score,Tegner score,and Marx score did not have significance between the two groups (all P>0.05).The return-to-sport rate was 43.8% (including 14.3% reaching safe return criteria,which accounted for 6.3% in all the patients) in the stable group and 35.3% (including 8.3% reaching safe return criteria,which accounted for 2.9% in all the patients) in the unstable group.There was no difference in the 60°/s isokinetic muscle strength,maximal muscle strength ratio of the affected extensor-flexor muscles,or Y-balance test result between the two groups (all P>0.05). Conclusions Knee joint rotational instability after ACLR results in poor performance in single-leg hops,triple hops,and crossover hops,low psychological readiness,and anterior-posterior knee laxity.In short- to medium-term follow-up for ACLR,the return-to-sport rate remained low regardless of knee joint rotational stability,with the majority of patients failing to meet safe return criteria.
Humans ; Anterior Cruciate Ligament Reconstruction/rehabilitation* ; Male ; Female ; Knee Joint/surgery* ; Athletic Performance/physiology* ; Anterior Cruciate Ligament Injuries/physiopathology* ; Adult ; Joint Instability/physiopathology* ; Return to Sport ; Rotation ; Young Adult

PURPOSE: The purpose of this study was to provide basic data for injury prevention and rehabilitation program development of Taekwondo demonstration team by comparing lower extremity muscles function and proprioceptive senses of Taekwondo demonstration team with or without anterior cruciate ligament (ACL) injury. The subjects were ACL injured Taekwondo demonstration player group (ATD, n=13) who underwent ACL reconstruction and Kukkiwon Taekwondo demonstration player group (KTD, n=13) without injury history.METHODS: To evaluate the lower extremity muscles function, we measured the flexor-extensor muscle strength ratio and isokinetic muscle strength of the knee joint using a isokinetic muscle strength measuring device. In order to investigate the proprioceptive sensory function, position sense, and threshold to detection of passive motion was using a isokinetic muscle strength measuring device. The experiment was conducted on average 26 months after surgery.RESULTS: The results of this study are as follows. There was no significant difference between the two groups in the knee joint flexor-extensor ratio. But there was a significant difference in Knee joint flexion and extension strength between two groups at an angular velocity of 60°/sec, 180°/sec, and 300°/sec. and KTD group was higher than ATD groups (p=0.014, p=0.001, p=0.029, p=0.005, p=0.043, p=0.041, respectively). There was no significant difference between the two groups in the proprioceptive sensory test.CONCLUSION: The results of this study showed that the normal flexor to extensor ratio (50%–70%), But it was close to the injury risk level. Therefore, the training program for the improvement of the muscle strength and the imbalance of the strength of the lower extremity muscle function should be performed in both groups.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Education ; Knee Joint ; Lower Extremity ; Muscle Strength ; Muscles ; Program Development ; Proprioception ; Rehabilitation ; Sensation

BACKGROUND: The present study aimed to evaluate the prevalence of patellofemoral osteoarthritis (PFOA) and identify the factors that affect PFOA development after single-bundle anterior cruciate ligament (ACL) reconstruction with hamstring autograft. We hypothesized that detecting these factors could be helpful in establishment of a rehabilitation strategy to focus on the modifiable factors. METHODS: Of the 324 patients who underwent primary ACL reconstruction between January 2010 and June 2013, 92 patients who were available for follow-up for a minimum of 36 months after the surgery and underwent second-look arthroscopy were enrolled. Subjective assessments and clinical outcome evaluation were conducted. Arthroscopic cartilage evaluation was done using the Outerbridge classification. Univariable and multivariable logistic regression analyses were used. RESULTS: Ninety-two patients were evaluated at an average of 38.9 ± 5.4 months of follow-up. PFOA above grade 2 was observed in 19 patients (20.7%) at the second-look arthroscopy. Of them, three patients with pre-existing PFOA (3.3%) showed progression of the Outerbridge grade, and 16 (17.4%) had newly developed PFOA. According to the multivariable logistic regression analysis, isokinetic extensor deficit at 60°/sec at the last follow-up (odds ratio [OR], 2.193; 95% confidence interval [CI], 1.081 to 12.439; p = 0.031), age at primary surgery (OR, 1.118; 95% CI, 1.019 to 1.227; p = 0.018), and concurrent meniscectomy at primary surgery (OR, 0.091; 95% CI, 1.012 to 1.177; p = 0.023) were the significant predictors of PFOA development. CONCLUSIONS: Significant predictors of PFOA after ACL reconstruction with hamstring autograft were decreased quadriceps strength at last follow-up, increased age, and concurrent meniscectomy at primary surgery. Quadriceps weakness as a modifiable factor should be considered in the establishment of a rehabilitation strategy to prevent PFOA after ACL reconstruction, especially in older age.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Arthroscopy ; Autografts* ; Cartilage ; Classification ; Follow-Up Studies ; Humans ; Logistic Models ; Osteoarthritis* ; Prevalence* ; Rehabilitation ; Risk Factors ; Tendons*

The recovery of quadriceps muscle strength and knee function after knee surgery is important. Recently, neuro-muscular electrical stimulation (NMES), which is a method in which an electrical current is applied to the surrounding targeted muscle, has been incorporated into muscle-strengthening programs. The objective of this review was to evaluate the safety and effectiveness of NMES in patients who have undergone knee surgery. A database search was performed in 8 Korean databases, Medline, Embase, and the Cochrane Library. Article selection and quality assessment were performed by 2 reviewers. Of the 580 articles selected, 14 papers (randomized controlled trials) were included in the final assessment. In the results of the meta-analysis, NMES combined with rehabilitation demonstrated a significant improvement in the enhancement of quadriceps muscle strength after anterior cruciate ligament reconstruction. On the basis of the currently available data, NMES with rehabilitation is associated with favorable outcomes, and should be considered a safe and effective procedure for enhancing quadriceps muscle strength.
Anterior Cruciate Ligament Reconstruction ; Electric Stimulation Therapy* ; Electric Stimulation* ; Humans ; Knee* ; Methods ; Quadriceps Muscle ; Rehabilitation

Reconstruction of a ruptured anterior cruciate ligament (ACL) is a well-established procedure for repair of ACL injury. Despite improvement of surgical and rehabilitation techniques over the past decades, up to 25% of patients still fail to regain satisfactory function after an ACL reconstruction. With development of CT imaging techniques for reducing metal artifacts, multi-planar reconstruction, and three-dimensional reconstruction, early post-operative imaging is increasingly being used to provide immediate feedback to surgeons regarding tunnel positioning, fixation, and device placement. Early post-operative radiography and CT imaging are easy to perform and serve as the baseline examinations for future reference.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Artifacts ; Humans ; Knee ; Radiography ; Rehabilitation ; Surgeons

The aim of this study was to evaluate the postoperative outcomes of anterior cruciate ligament (ACL) reconstructionuction using 2 additional fixation technique on tibial side. Between October 2008 and February 2012, sixty consecutive patients who underwent ACL reconstruction with allograft for ACL injuries were retrospectively enrolled. All patients were reconstructed with fresh frozen achilles tendon or posterior tibialis tendon allograft. Fixation on tibial side with bioabsorbable suture anchor (BSA) was in 30 patients (group A) and metal screw fixation was in 30 patients (group B). The data was collected at preoperatively and at least 1 years postoperatively, which included KT-2000 arthrometer objectively, and Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) scores subjectively. At the final follow up, the KT-2000 arthrometer improved significantly with an average of 3.28 mm anterior translation in the group A, 3.56 mm in group B. The preoperative mean Lysholm, Tegner and IKDC score was 46.14, 4.86, 63.17 in the group A, and 45.30, 4.40, 54.07 in the group B. The postoperative mean Lysholm, Tegner and IKDC score was 83.80, 8.14, 75.57 in the group A, and 88.75, 7.62, 65.10 in the group B. All functional outcomes were improved significantly (p=0.004) in both groups, but no differences were noted between the 2 groups (p>0.05). Both additional fixation techniques using BSA or metal screw fixation on tibial side in ACL reconstruction improved functional outcomes significantly. BSA technique seems to provide adequate strength suitable for early rehabilitation after ACL reconstruction.
Achilles Tendon ; Allografts ; Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction* ; Follow-Up Studies ; Humans ; Knee ; Rehabilitation ; Retrospective Studies ; Suture Anchors* ; Tendons

BACKGROUND: Regarding reconstruction surgery of the anterior cruciate ligament (ACL), there is still a debate whether to perform a single bundle (SB) or double bundle (DB) reconstruction. The purpose of this study was to analyze and compare the volume and surface area of femoral and tibial tunnels during transtibial SB versus transportal DB ACL reconstruction. METHODS: A consecutive series of 26 patients who underwent trantibial SB ACL reconstruction and 27 patients with transportal DB ACL reconstruction using hamstring autograft from January 2010 to October 2010 were included in this study. Three-dimensional computed tomography (3D-CT) was taken within one week after operation. The CT bone images were segmented with use of Mimics software v14.0. The obtained digital images were then imported in the commercial package Geomagic Studio v10.0 and SketchUp Pro v8.0 for processing. The femoral and tibial tunnel lengths, diameters, volumes and surface areas were evaluated. A comparison between the two groups was performed using the independent-samples t-test. A p-value less than the significance value of 5% (p < 0.05) was considered statistically significant. RESULTS: Regarding femur tunnels, a significant difference was not found between the tunnel volume for SB technique (1,496.51 +/- 396.72 mm3) and the total tunnel volume for DB technique (1,593.81 +/- 469.42 mm3; p = 0.366). However, the total surface area for femoral tunnels was larger in DB technique (919.65 +/- 201.79 mm2) compared to SB technique (810.02 +/- 117.98 mm2; p = 0.004). For tibia tunnels, there was a significant difference between tunnel volume for the SB technique (2,070.43 +/- 565.07 mm3) and the total tunnel volume for the DB technique (2,681.93 +/- 668.09 mm3; p < or = 0.001). The tibial tunnel surface area for the SB technique (958.84 +/- 147.50 mm2) was smaller than the total tunnel surface area for the DB technique (1,493.31 +/- 220.79 mm2; p < or = 0.001). CONCLUSIONS: Although the total femoral tunnel volume was similar between two techniques, the total surface area was larger in the DB technique. For the tibia, both total tunnel volume and the surface area were larger in DB technique.
Adult ; Anterior Cruciate Ligament/injuries/surgery ; Anterior Cruciate Ligament Reconstruction/*methods ; Autografts ; Femur/*radiography/surgery ; Humans ; Imaging, Three-Dimensional ; Male ; Tendon Injuries/*radiography/rehabilitation/surgery ; Tendons/transplantation ; Tibia/*radiography/surgery

A 38-year-old man presented with right knee pain and swelling following a football injury. Magnetic resonance (MR) imaging showed a complete anterior cruciate ligament (ACL) tear and lateral meniscal tears. The torn ACL was repaired with a graft obtained from the semitendinosus muscle, and the menisci were debrided. The mechanisms of injury to the ACL are varied and may be due to direct or indirect contact with the knee as well as with twisting injuries. Knowledge of the ACL's normal anatomy, together with MR imaging technique and understanding of the appearance of the lesion on MR examination, is crucial to aid in the identification of an ACL tear. Diagnosis of an ACL tear should be based on direct MR imaging signs, although indirect signs may be helpful, particularly in chronic tears. Other associated injuries to be aware of include meniscal and other ligamentous injuries. Normal ACL graft and post-ACL graft reconstruction complications are also briefly discussed.
Adult ; Anterior Cruciate Ligament ; pathology ; surgery ; Anterior Cruciate Ligament Injuries ; Anterior Cruciate Ligament Reconstruction ; adverse effects ; rehabilitation ; Bone-Patellar Tendon-Bone Grafting ; adverse effects ; rehabilitation ; Football ; injuries ; Humans ; Knee Injuries ; pathology ; rehabilitation ; surgery ; Magnetic Resonance Imaging ; Male ; Postoperative Complications ; diagnosis ; Soccer ; injuries ; Tendons ; transplantation