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Advances in Anterior Cruciate Ligament Injury Treatment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 1 July 2026 | Viewed by 1686

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Special Issue Editor

Prof. Dr. Goran Vrgoč

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Guest Editor

1. Department of Orthopaedic Surgery, Clinical Hospital "Sveti Duh", Zagreb, Croatia
2. Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
Interests: anterior cruciate ligament; meniscus; orthopaedic surgery; knee surgery; sports injuries; rehabilitation

Special Issue Information

Dear Colleagues,

The Special Issue Advances in Anterior Cruciate Ligament Injury Treatment invites high-quality submissions that deepen our understanding of ACL injury mechanisms, assessment strategies, surgical and non-surgical treatments, and evidence-based rehabilitation practices. We aim to highlight innovative research that advances clinical decision-making, enhances patient outcomes, and bridges the gap between laboratory findings and real-world application.

Authors are encouraged to submit original research, reviews, and technological innovations related to biomechanics, neuromuscular control, return-to-sport criteria, prevention strategies, and long-term outcomes following ACL injury. Interdisciplinary work integrating surgical treatment, sports science, physiotherapy, orthopaedics, imaging, and wearable technology is especially welcomed.

This Special Issue seeks to provide clinicians, researchers, and practitioners with cutting-edge insights that help refine ACL surgery and rehabilitation protocols and support individualized patient care. We look forward to your valuable contributions to advancing the field.

Prof. Dr. Goran Vrgoč
Guest Editor

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Keywords

anterior cruciate ligament (ACL) injury
ACL reconstruction techniques
nonoperative ACL treatment
ACL graft
knee biomechanics
return-to-sport assessment
ACL rehabilitation
neuromuscular and proprioceptive training
athletic injuries
performance-enhancing substances
reinjury prevention
psychological readiness
ACL performance testing
osteoarthritis risk

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Published Papers (3 papers)

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16 pages, 1527 KB

Open AccessArticle

Functional Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction Using Retrograde Femoral Socket Drilling via a Far Anteromedial Portal Combined with a Conventional Antegrade Tibial Tunnel: A Retrospective Cohort Study

by Harun Köse, Ekrem Özdemir, Enes Gündüz, Hakan Ertem, Hüseyin Utku Özdeş, Okan Aslantürk and Emre Ergen

J. Clin. Med. 2026, 15(10), 3651; https://doi.org/10.3390/jcm15103651 - 9 May 2026

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Abstract

Background/Objectives: Anterior cruciate ligament (ACL) reconstruction remains the accepted standard of care for ACL ruptures in physically active individuals. Various surgical techniques have been developed to achieve anatomic reconstruction and optimize functional outcomes. The aim of this study was to descriptively report the early functional outcomes of anatomic ACL reconstruction performed using retrograde femoral socket drilling using a FlipCutter through a far anteromedial portal combined with a conventional antegrade tibial tunnel, without claiming superiority over alternative techniques. Methods: This single-center, single-arm retrospective cohort study included 33 consecutive male patients with ACL rupture who underwent arthroscopic ACL reconstruction using hamstring tendon autograft between 2021 and 2022 at a tertiary academic medical center. The surgical technique employed retrograde drilling of the femoral socket using a FlipCutter device introduced through a far anteromedial portal; the tibial tunnel was created with a standard outside-in aiming guide. The pre-specified primary outcome was the change in the Tegner–Lysholm score from baseline to 12 months; secondary outcomes were the Modified Cincinnati and International Knee Documentation Committee (IKDC) subjective scores and clinical stability tests. Functional outcomes were assessed preoperatively and at 6 weeks, 3 months, and 12 months postoperatively using repeated-measures testing with the Friedman test and post hoc Wilcoxon signed-rank tests with Bonferroni correction. Reporting followed the STROBE recommendations for observational studies. Results: All 33 patients (100% male) completed the 12-month follow-up. The mean age was 28 years (range: 18–44), and sports-related injuries accounted for 84.8% of cases. Significant improvements were observed in all functional scores from preoperative to 12-month postoperative assessments (p < 0.001). The mean Tegner-Lysholm score improved from 46.8 ± 17.3 preoperatively to 83.7 ± 10.5 at 12 months (mean change +36.9, 95% CI 30.3 to 43.5; matched-pairs effect size r = 0.87). The mean IKDC score increased from 36.3 ± 14.4 to 68.4 ± 15.1 (mean change +32.1, 95% CI 25.3 to 38.9; r = 0.84), and the Cincinnati score improved from 41.3 ± 15.9 to 80.2 ± 10.9 (mean change +38.9, 95% CI 32.6 to 45.2; r = 0.86). All observed mean changes exceeded the minimal clinically important difference (MCID) reported for these instruments in ACL populations. Postoperative stability assessment demonstrated restoration of knee stability in the majority of patients, with 66.7% showing a negative anterior drawer test at final follow-up. Conclusions: Anatomic ACL reconstruction utilizing retrograde femoral socket drilling using a FlipCutter through a far anteromedial portal combined with a conventional antegrade tibial tunnel was associated with satisfactory early functional outcomes in a small, all-male cohort, comparable to those reported for contemporary anatomic ACL reconstruction techniques. Given the retrospective, single-arm design, modest sample size, homogeneous all-male cohort, absence of instrumented laxity or return-to-sport data, and absence of multivariable adjustment, any suggestion of technique-specific advantages should be regarded as hypothesis-generating. Comparative effectiveness against other anatomic techniques remains to be established in prospective, controlled studies with longer follow-up. Full article

(This article belongs to the Special Issue Advances in Anterior Cruciate Ligament Injury Treatment)

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18 pages, 10911 KB

Open AccessSystematic Review

The Effectiveness of Psychological Interventions for Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Meta-Analysis and Systematic Review

by Manxue Zhang, Bohua Li, Jialiang Tian, Yi Huang and Xiaobing Pu

J. Clin. Med. 2026, 15(10), 3980; https://doi.org/10.3390/jcm15103980 - 21 May 2026

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Abstract

Background: No systematic review has yet been conducted simultaneously on the effectiveness of psychological interventions across multiple outcome measures during rehabilitation following anterior cruciate ligament reconstruction (ACLR). This study aims to assess the effects of such interventions on pain, psychological outcomes, patient-reported knee function, objective knee measures, and quality of life following ACLR. Methods: We searched PubMed, Medline, Embase, PsycINFO, and the Cochrane Library from inception to 20 April 2026 (PROSPERO CRD42023483889). Eligible randomized controlled trials compared psychological interventions with usual care in ACLR patients. Two reviewers assessed eligibility, risk of bias, and extracted data. Random-effects models were used; effect sizes were interpreted using Cohen’s guidelines. Results: Of 401 records screened, 11 RCTs (440 participants) were included. Psychological interventions significantly improved pain (six trials, SMD = −0.96, 95% CI −1.40 to −0.52, p < 0.001, I² = 47%; large effect), kinesiophobia (TSK-11: five trials, SMD = −0.48, −0.74 to −0.22, I² = 0%; small effect), knee self-efficacy (K-SES: three trials, SMD = 0.53, 0.19–0.86, I² = 0%, moderate effect), patient-reported knee function (IKDC: two trials, SMD = 0.58, 0.26–0.90, I² = 0%, moderate effect), and physical role function (SF-36: two trials, SMD = 0.41, 0.04–0.78, I² = 0%, small effect). No significant effects were found for KT1000, knee strength, SF-36 mental well-being, or ACL-RSI (all p > 0.05, with substantial heterogeneity for ACL-RSI). Particularly, imagery therapy reduced pain (three trials, SMD = −1.54, I² = 15%). Conclusions: This meta-analysis provides preliminary evidence that psychological interventions, especially imagery therapy, may improve pain, psychological outcomes, patient-reported knee function, and quality of life after ACLR. Adequately powered trials with standardized protocols are needed to confirm these findings. Full article

(This article belongs to the Special Issue Advances in Anterior Cruciate Ligament Injury Treatment)

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14 pages, 480 KB

Open AccessSystematic Review

Contraindications to Lateral Extra-Articular Tenodesis: A Systematic Review

by Jakub Erdmann, Jan Czerwiński, Adam Kwapisz, Maria Zabrzyńska, Gazi Huri, Piotr Walus and Jan Zabrzyński

J. Clin. Med. 2026, 15(8), 2821; https://doi.org/10.3390/jcm15082821 - 8 Apr 2026

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Abstract

Background: Lateral extra-articular tenodesis (LET) is a surgical procedure that is additionally implemented in concurrent anterior cruciate ligament reconstruction (ACLR). Although numerous articles have addressed the use of LET in conjunction with ACLR, few definitive contraindications were identified. Given the scarcity of literature evaluating contraindications for LET modality, this study aimed to systematically review the reported contraindications of this procedure in the context of concurrent ACLR. Methods: The searched key terms: (extra-articular OR extraarticular) AND (tenodesis OR plasty OR augmentation OR procedure or reconstruction OR reconstructive OR surgical OR surgery OR technique) AND (ACL OR anterior cruciate ligament), with no publication date restrictions in PubMed, ScienceDirect, Cochrane Central, Web of Science, and Embase databases. We included clinical human studies, with levels of evidence I–III and in the English language. Results: The analysis evaluated fourteen articles published between 2012 and 2024. Level III evidence was found in the majority of studies (n = 9) and Level I evidence was found in the rest (n = 5). The majority of the included articles were retrospective (n = 8) and there were also prospective studies (n = 6). The articles reviewed showed that articular cartilage damage and concomitant injuries to other knee ligaments, alongside ACL injury, are the most frequently mentioned. Conclusions: This is the first study that systematized the contraindications for the LET procedure in ACLR. The contraindications remain unclear; however, the following may be highlighted: articular cartilage damage and injury to another ligament in the knee, in addition to ACL injury. Full article

(This article belongs to the Special Issue Advances in Anterior Cruciate Ligament Injury Treatment)

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