Medicina

Research

13 pages, 787 KB

Open AccessArticle

Lateral Extra-Articular Tenodesis Does Not Impact Postural Stability After Pediatric Anterior Cruciate Ligament Reconstruction with Hamstrings Tendons

by Alex Delisle, David Mazy, Siyu Wang, Zoé David, Mélanie Sarda, Guy Grimard and Marie-Lyne Nault

Medicina 2026, 62(5), 857; https://doi.org/10.3390/medicina62050857 - 30 Apr 2026

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Abstract

Background and Objectives: Given the high rates of anterior cruciate ligament graft rupture in the pediatric population, lateral extra-articular tenodesis (LET) is increasingly used in combination with anterior cruciate ligament reconstruction (ACLR) to mitigate the risk of re-injury. This study aimed [...] Read more.

Background and Objectives: Given the high rates of anterior cruciate ligament graft rupture in the pediatric population, lateral extra-articular tenodesis (LET) is increasingly used in combination with anterior cruciate ligament reconstruction (ACLR) to mitigate the risk of re-injury. This study aimed to compare postoperative postural stability between patients undergoing ACLR with and without LET. It was hypothesized that postural stability would be comparable between patients with and without LET. Materials and Methods: This retrospective, single-center, double-surgeon case–control study included patients who underwent primary ACLR using hamstring tendon autografts between January 2022 and May 2025. Postoperative postural stability was assessed using the Biodex Stability System (BSS) global stability index (GSI), which was the primary outcome of interest. Demographic and surgical data were collected as well as all postoperative GSIs. GSI comparisons between the LET and no-LET groups were made at ≤6 months and >6 months postoperatively. Secondary analysis compared GSI differences between the healthy and operated legs. Results: Among 229 patients screened, 100 met the inclusion criteria (median age, 16 years [IQR, 15–17]); 65 underwent LET and 35 did not, and 54 were female (54%). The groups were comparable on demographic and surgical data (p-value: n.s.). No operated leg GSI difference was observed between the LET and no-LET groups at ≤6 months (p = 0.372) and >6 months postoperatively (p = 0.424). Patients with LET had significantly better (lower) healthy leg GSIs (Mean ± SD; 2.7 ± 0.9) than no-LET patients (3.9 ± 1.8) at >6 months postoperatively (p = 0.004). At ≤6 months, patients showed better GSIs on their operated limb (Median [IQR]; 2.6 [2.1–3.9]) compared to the healthy limb (3.5 [2.3–4.6]) (p = 0.003). This difference disappeared at the latest follow-up. Conclusions: The addition of LET concomitant with ACLR was not associated with a significant difference in postural stability, as assessed by the GSI from the BSS. However, given the sample size and study limitations, these findings should be interpreted with caution. Increased attention to the healthy limb during ACLR rehabilitation may be warranted, particularly in the early postoperative period (<6 months). Further studies with larger cohorts are needed to confirm these observations. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL) Injury)

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20 pages, 2140 KB

Open AccessArticle

Serial Changes in Knee Muscle Strength and Functional Performance After Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study of 107 Patients

by Seung Ik Cho, Ju Won Bae, Youngwook Sim, Dhong Won Lee, Byung Sun Park, Yu Bin Lee, Hun-Young Park, Eunjoo Lee, Sang Jin Yang and Joon Kyu Lee

Medicina 2026, 62(3), 489; https://doi.org/10.3390/medicina62030489 - 5 Mar 2026

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Abstract

Background and Objectives: Anterior cruciate ligament (ACL) reconstruction (ACLR) is widely performed to restore knee stability and facilitate return to activity. However, recovery of muscle strength, balance, functional performance, and patient-reported outcomes does not occur uniformly over time. The longitudinal recovery trajectory [...] Read more.

Background and Objectives: Anterior cruciate ligament (ACL) reconstruction (ACLR) is widely performed to restore knee stability and facilitate return to activity. However, recovery of muscle strength, balance, functional performance, and patient-reported outcomes does not occur uniformly over time. The longitudinal recovery trajectory across various functional areas during the first year after ACLR remains insufficiently characterized. Materials and Methods: We included 107 patients who underwent isolated unilateral ACLR using a hamstring autograft. Isokinetic knee extensor and flexor strength, postural stability, Y-Balance Test (YBT) performance, and subjective knee function scores were assessed post-injury (approximately six weeks after ACL injury and prior to ACLR) and at 3, 6, and 12 months postoperatively. All patients followed a standardized postoperative rehabilitation protocol. Results: Knee extensor strength deficit worsened at 3 months and remained present at 12 months. In contrast, knee flexor strength deficit decreased progressively and reached near-symmetrical values by 12 months. Sway path length decreased significantly over time in both limbs. In the operated limb, improvements plateaued after 6 months, and limb symmetry indices approached symmetry by 12 months. YBT limb symmetry indices demonstrated a non-linear recovery pattern. Anterior, posterolateral, and composite scores decreased at 3 months, recovered to post-injury levels by 6 months, and showed significant improvement at 12 months. Posteromedial reach did not decline at 3 months and improved significantly only at 12 months. Subjective knee function scores (Lysholm and IKDC) did not differ significantly between post-injury and 3-month assessments, but improved significantly from 6 months onward. Tegner activity scores gradually increased and returned to pre-injury levels by 12 months. Conclusions: Recovery after ACLR is prolonged and non-synchronous. Quadricep strength remains incompletely restored at 12 months, whereas hamstring strength recovers more favorably. Balance, functional performance, and subjective outcomes improve mainly after 6 months. These findings support the need for prolonged rehabilitation and serial, multidimensional functional assessments beyond time-based criteria. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL) Injury)

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14 pages, 1608 KB

Open AccessArticle

Chronic ACL Injury Drives a Fibrotic and Matrix-Degradative Shift: A Multi-Level Analysis of MMP-13 and TGF-β1

by Yılmaz Mertsoy, Mustafa Altıntaş, Sözdar Güzel and Alpay Çetin

Medicina 2026, 62(3), 457; https://doi.org/10.3390/medicina62030457 - 27 Feb 2026

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Abstract

Background and Objectives: The biological state of anterior cruciate ligament (ACL) remnant tissue may influence postoperative healing, yet the molecular changes associated with injury chronicity remain poorly defined. This study evaluated MMP-13 and TGF-β1 expression in human ACL remnants to characterize their [...] Read more.

Background and Objectives: The biological state of anterior cruciate ligament (ACL) remnant tissue may influence postoperative healing, yet the molecular changes associated with injury chronicity remain poorly defined. This study evaluated MMP-13 and TGF-β1 expression in human ACL remnants to characterize their regenerative or fibrotic potential. Materials and Methods: ACL remnants from acute (<3 months) and chronic (>6 months) injuries were analyzed using histology, immunohistochemistry, and QuPath-based digital quantification. Clinical outcomes were correlated with marker expression. Protein–protein interaction and KEGG enrichment analyses were performed to identify extracellular matrix (ECM)-related pathways associated with MMP-13 and TGF-β1. Results: Chronic ACL remnants exhibited disorganized ECM structure with significantly higher MMP-13 and TGF-β1 expression across all digital metrics, including DAB-positive area, cell density, optical density, and H-score (p < 0.01). Higher expression of both markers correlated with lower IKDC and Lysholm scores and greater residual pivot-shift positivity. Bioinformatic analysis identified 39 shared proteins enriched in ECM-receptor interaction, TGF-β signaling, and fibrosis-related pathways, aligning with the degenerative phenotype observed in chronic tissue. Conclusions: ACL remnant biology evolves from a reparative profile in acute injuries to a fibrotic, matrix-degradative state in chronic injuries. MMP-13 and TGF-β1 serve as indicators of remnant quality and may help guide timing of surgery and future biologic strategies aimed at improving ACL reconstruction outcomes. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL) Injury)

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13 pages, 1020 KB

Open AccessArticle

Modified Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction in 291 High-Level Athletes: Clinical Outcomes at Minimum 2.5-Year Follow-Up

by Tomislav Kottek, Stjepan Bulat, Goran Vrgoč, Alan Ivković, Frane Bukvić, Joško Jeličić and Saša Janković

Medicina 2025, 61(10), 1762; https://doi.org/10.3390/medicina61101762 - 29 Sep 2025

Cited by 1 | Viewed by 1617

Abstract

Background and Objectives: Combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction has been advocated to improve rotational stability and reduce graft failure in high-risk athletes. We aimed to evaluate the mid-term functional outcomes of a modified combined ACL and ALL [...] Read more.

Background and Objectives: Combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction has been advocated to improve rotational stability and reduce graft failure in high-risk athletes. We aimed to evaluate the mid-term functional outcomes of a modified combined ACL and ALL reconstruction technique using hamstring tendon autografts developed at our institution. Materials and Methods: We retrospectively reviewed 395 patients who underwent combined ACL and ALL reconstruction between 2018 and 2022. Of these, 291 patients (73.6%) completed the minimum follow-up of 2.5 years and were included in the analysis. Primary outcomes were graft rerupture and return to sport (RTS) at the pre-injury level. Secondary outcomes included graft survival, a change in Tegner score from pre-injury to follow-up and complications. Results: The cohort consisted of 219 males (75.3%) and 72 females (24.7%), with a mean age of 20.6 ± 4.0 years (range 14–35). Eleven patients experienced graft rerupture, yielding a rate of 3.78% (95% CI, 2.1–6.6). At final follow-up, 220 patients (75.6%; 95% CI, 70.4–80.2) returned to their pre-injury level of sport performance. The mean Tegner activity score decreased from 7.9 ± 1.4 preoperatively to 7.2 ± 1.8 postoperatively (paired t-test, p < 0.0001; Wilcoxon signed-rank test, p < 0.0001). Postoperative complications occurred in 18 patients (6.2%), the majority of which related to meniscal re-ruptures. Conclusions: Our modified combined ACL and ALL reconstruction technique demonstrated excellent mid-term results in a high-risk athletic population, with low rerupture rates and high RTS rates, while also being a safe procedure without significant complications. These findings support the use of this technique in young and professional athletes where rotational stability is necessary. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL) Injury)

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16 pages, 5095 KB

Open AccessEditor’s ChoiceArticle

Nationwide Epidemiology of Hospitalized Acute ACL Ruptures in Romania: A 7-Year Analysis (2017–2023)

by Gloria Alexandra Tolan, Ionut Daniel Raducan, Bogdan Uivaraseanu, Delia Mirela Tit, Gabriela S. Bungau, Andrei-Flavius Radu and Cristian George Furau

Medicina 2025, 61(9), 1672; https://doi.org/10.3390/medicina61091672 - 15 Sep 2025

Cited by 5 | Viewed by 1625

Abstract

Background and Objectives: Anterior cruciate ligament (ACL) rupture is one of the most frequent and debilitating knee injuries, especially among young, physically active individuals. While extensively studied in Western countries, large-scale epidemiological data from Eastern Europe remain scarce. This study offers the first [...] Read more.

Background and Objectives: Anterior cruciate ligament (ACL) rupture is one of the most frequent and debilitating knee injuries, especially among young, physically active individuals. While extensively studied in Western countries, large-scale epidemiological data from Eastern Europe remain scarce. This study offers the first nationwide assessment of hospitalization-based incidence of acute ACL rupture in Romania. Materials and Methods: We conducted a retrospective analysis of all hospital discharges coded as S83.53 (ACL rupture) between 2017 and 2023, using national public health datasets. Incidence rates were calculated per 100,000 inhabitants based on the 2021 national census. Data were analyzed by sex, age, year, and region. Results: A total of 4332 ACL-related discharges were recorded (3130 males and 1202 females), yielding an average incidence of 3.23 per 100,000 per year. Incidence in males was consistently higher (up to 5.63) than in females (up to 2.10). The peak incidence occurred in 2023, while the lowest was observed in 2020, likely due to COVID-19-related restrictions. Linear regression showed a significant upward trend over time (R² = 0.966, p < 0.001). The highest age-specific incidence was found in males aged 25–29 years (116.3/100,000) and in females aged 15–19 years (35.4/100,000). Cases were rare above the age of 50. Geographically, incidence varied widely, with Bucharest, Timiș, and Bihor recorded the highest rates, while several other counties reported near-zero values. Conclusions: This study provides the first nationwide analysis of hospitalization-based ACL rupture incidence in Romania, revealing marked differences by age, sex, and region. While the findings reflect only acute cases requiring inpatient care, they underscore the need for more comprehensive injury surveillance, improved access to orthopedic services, and targeted prevention strategies tailored to high-risk populations. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL) Injury)

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Graphical abstract

12 pages, 4469 KB

Open AccessFeature PaperArticle

Clinical and Radiological Outcomes of Revision Anterior Cruciate Ligament Reconstruction Using a Quadriceps Tendon Autograft with a Bone Block: A Single-Center Case Series

by Dhong Won Lee, Sung Gyu Moon, Ji Hee Kang, Seung Ik Cho and Woo Jong Kim

Medicina 2025, 61(9), 1634; https://doi.org/10.3390/medicina61091634 - 10 Sep 2025

Cited by 1 | Viewed by 2178

Abstract

Background and Objectives: Revision anterior cruciate ligament reconstruction (ACLR) is demanding and yields inferior outcomes compared with primary procedures. The quadriceps tendon (QT) autograft with bone block has biomechanical and biological advantages though clinical evidence in revision remains limited. This study evaluated the [...] Read more.

Background and Objectives: Revision anterior cruciate ligament reconstruction (ACLR) is demanding and yields inferior outcomes compared with primary procedures. The quadriceps tendon (QT) autograft with bone block has biomechanical and biological advantages though clinical evidence in revision remains limited. This study evaluated the clinical and radiological outcomes of revision ACLR using bone-block QT autograft in young, active patients. Materials and Methods: A case series with a level of evidence of 4. Thirty-four patients (28 men, 6 women; mean age, 27.2 ± 5.8 years) who underwent revision ACLR with a bone-block QT autograft between 2021 and 2023 were retrospectively reviewed. The mean follow-up was 37.4 ± 3.2 months. Clinical assessments included the Lysholm, International Knee Documentation Committee (IKDC) subjective, and Tegner activity scores, along with isokinetic strength testing. Objective stability was evaluated using pivot shift grading and Telos stress radiography. Radiological analyses included 3D computed tomography for tunnel positioning and magnetic resonance imaging for tunnel widening. Perioperative and postoperative complications were recorded. Results: All clinical outcomes improved significantly from baseline to 2-year follow-up: Lysholm (62.7 ± 9.6 to 87.1 ± 10.3), IKDC (59.0 ± 10.8 to 79.5 ± 11.1), and Tegner (3.5 ± 1.2 to 5.6 ± 1.3; all p < 0.001). However, the Tegner score remained lower than the pre-injury level (6.1 ± 1.4; p = 0.035). At the final follow-up, 91.2% of the patients had returned to sports, with 59% resuming sports at their pre-injury level or higher. Side-to-side anterior laxity decreased from 8.5 ± 1.7 mm to 1.4 ± 1.1 mm on Telos stress radiography (p < 0.001). Preoperatively, 82% of patients demonstrated high grade pivot shift (≥grade 2), which improved to 91% graded as negative or grade 1 at final follow-up (p < 0.001). Isokinetic evaluation showed improvements in quadriceps (28.7% ± 12.5% to 12.4% ± 8.1%) and hamstring (18.3% ± 9.7% to 8.9% ± 6.5%) deficit (both p < 0.001). MRI demonstrated minimal tunnel widening (tibia, +1.3 ± 0.9 mm, p = 0.012; femur, +0.3 ± 0.6 mm, p = 0.148). Three complications (8.8%) were observed: one cyclops lesion, one transient extension deficit, and one graft rupture. No patellar fractures, septic arthritis, or revision procedures occurred during the follow-up period. Conclusions: Bone-block QT autografts provide a reliable option for revision ACLR, yielding functional improvement, restored stability, and minimal donor-site morbidity, with low complications. These findings support their consideration as the preferred graft choice for young active patients needing revision reconstruction. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL) Injury)

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12 pages, 578 KB

Open AccessArticle

The Role of Allografts in Revision ACL Reconstruction

by Antonio Maestro, Carmen Toyos, Nicolás Rodríguez, Iván Pipa, Lucía Lanuza, Filipe Machado, César Castaño and Santiago Maestro

Medicina 2025, 61(8), 1350; https://doi.org/10.3390/medicina61081350 - 25 Jul 2025

Cited by 2 | Viewed by 1592

Abstract

Background and Objectives: Although the use of allografts in revision anterior cruciate ligament reconstruction is associated with theoretical advantages, it has historically led to poorer clinical results and lower survival rates. However, the heterogeneity of the available literature makes it difficult to [...] Read more.

Background and Objectives: Although the use of allografts in revision anterior cruciate ligament reconstruction is associated with theoretical advantages, it has historically led to poorer clinical results and lower survival rates. However, the heterogeneity of the available literature makes it difficult to elucidate the effectiveness of allographs, as most of the studies published do not make any reference to some of the key aspects related to the processing of the allograft employed. The present study analyzed the clinical results and the survival of allografts in patients undergoing revision anterior cruciate ligament reconstruction with a well-characterized, single type of allograft. Materials and Methods: This was a retrospective observational study analyzing a series of patients undergoing revision anterior cruciate ligament reconstruction with an Achilles tendon allograft with a bone block (FlexiGraft, LifeNet Health), subjected to low-dose irradiation at dry ice temperatures. Preoperative and follow-up clinical variables (IKDC, pain, hop test, and YBT scores) were recorded. Survival was analyzed using the Kaplan–Meier methodology. Results: A total of 39 patients (34 male, 5 female) were included in the study. The mean patient age was 37.3 years and mean postoperative follow-up was 78.7 months. Forty-one percent of patients were competitive athletes, and all of the patients in the sample exhibited preoperative instability. The mean allograft thickness was 9.2 mm. During surgery, 51.3% of patients required meniscus repair and 20.5% had to be treated for chondral defects. At the last follow-up visit, 92.3% of the subjects presented with IKDC grade A and 7.7% with IKDC grade B. The mean subjective IKDC score was 0.79 and mean pain intensity was 1.15 according to the VAS scale. Limb symmetry, as measured by the various hop tests and the Y balance test, were within the safety range, with 74.4% of patients succeeding in returning to their previous level of sport. Ten-year survival was estimated at 97.4%. Conclusions: Allografts obtained and processed following the current regulations governing patient selection and graft harvesting, which are additionally processed without recourse to chemical procedures and sterilized at less than 2 MRad in dry ice conditions, represent an effective and safe alternative in revision anterior cruciate ligament reconstruction. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL) Injury)

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10 pages, 1268 KB

Open AccessArticle

Optimal Tunnel Positioning and Graft Diameter to Minimize Impingement in Single-Bundle ACL Reconstruction: A 3D CT Simulation Analysis

by Sang-Woo Jeon, Sung-Hwan Kim and Kang-Il Kim

Medicina 2025, 61(6), 946; https://doi.org/10.3390/medicina61060946 - 22 May 2025

Cited by 2 | Viewed by 1944

Abstract

Background and Objectives: Graft impingement against the intercondylar notch has been identified as a significant contributor to graft deterioration and suboptimal outcomes following anterior cruciate ligament (ACL) reconstruction. This study aimed to (1) identify the optimal combination of tunnel positions that minimizes impingement [...] Read more.

Background and Objectives: Graft impingement against the intercondylar notch has been identified as a significant contributor to graft deterioration and suboptimal outcomes following anterior cruciate ligament (ACL) reconstruction. This study aimed to (1) identify the optimal combination of tunnel positions that minimizes impingement between the ACL graft and femoral intercondylar notch. Materials and Methods: Three-dimensional models of nine normal knees were reconstructed using computed tomography scans obtained at four knee flexion angles (0°, 45°, 90°, and 120°). Virtual ACL grafts with diameters of 7 mm and 9 mm were modeled as cylinders. Nine graft configurations were investigated by varying femoral and tibial footprint locations (anteromedial, central, and posterolateral) in all possible combinations. For each configuration, impingement volume was quantified by measuring the overlap between the intercondylar notch and the virtual graft using Boolean operators in 3D simulation software. The effects of graft diameter, footprint location, and knee flexion angle on impingement volume were analyzed. Results: Maximum impingement volumes were observed at 0° knee extension, with significant reductions at 45° flexion (p < 0.01) and negligible impingement at 90° and 120° flexion. The 9 mm diameter grafts demonstrated significantly greater impingement volumes than 7 mm grafts (p < 0.01). Impingement volumes increased progressively as footprint locations shifted from posterolateral to anteromedial positions in both femoral and tibial components. However, statistically significant differences in impingement volume across footprint locations were observed only for tibial positioning (p < 0.001), not for femoral positioning (p > 0.05). The femoral anteromedial-tibial anteromedial configuration exhibited the highest impingement volume (577.8 ± 171.3 mm³ for 9 mm grafts), while the femoral posterolateral-tibial posterolateral configuration showed the lowest (73.5 ± 85.6 mm³). Conclusions: Tunnel position, graft diameter, and knee flexion angle significantly influence impingement risk in ACL reconstruction. Tibial tunnel position appears more critical than femoral position in minimizing graft impingement. Posterolateral positioning of tunnels, particularly on the tibial side, may reduce impingement volume. Clinical Relevance: This study provides quantitative evidence to guide surgeons in optimizing tunnel placement and graft selection for anatomical single-bundle ACL reconstruction, potentially reducing the risk of graft deterioration and failure due to mechanical impingement. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL) Injury)

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Review

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19 pages, 1022 KB

Open AccessReview

Clearance Criteria for Determining Eligibility for Force Plate Testing After Anterior Cruciate Ligament Reconstruction: A Scoping Review

by Landon Christoffel, Lauren Beaupre, Stephanie Nathanail, Wasim Labban, Mark Sommerfeldt, Lindsey Westover and Gail M. Thornton

Medicina 2026, 62(3), 503; https://doi.org/10.3390/medicina62030503 - 9 Mar 2026

Cited by 1 | Viewed by 969

Abstract

Background and Objectives: Throughout the return-to-play process after anterior cruciate ligament reconstruction (ACLR), clearance criteria and limb symmetry indices (LSI) play an important role in clinical decision-making by helping evaluate patient readiness and informing safe activity progressions, with the goal of reducing [...] Read more.

Background and Objectives: Throughout the return-to-play process after anterior cruciate ligament reconstruction (ACLR), clearance criteria and limb symmetry indices (LSI) play an important role in clinical decision-making by helping evaluate patient readiness and informing safe activity progressions, with the goal of reducing re-injury risk. How clearance criteria are implemented in research studies to evaluate patient readiness, specifically in force plate jumping studies, is currently unknown. This scoping review was a focused examination of clearance criteria and limb symmetry indices in studies performing force plate-based jumping assessments with ACLR patients. The research questions guiding this scoping review were as follows: (1) What clearance criteria are reported in studies involving primary ACLR patients who participate in jumping assessments on force plates? (2) What LSI are reported in force plate studies, and what level of symmetry is deemed acceptable to allow for safe participation of ACLR patients who participate in jumping assessments of force plates? Materials and Methods: Nine databases were searched on 7 or 8 September 2024 for three concepts: ACLR, force plates, and movement properties. Inclusion criteria were as follows: (a) primary ACLR patients at least 6 months post-surgery; (b) performing a countermovement or drop jump; (c) collecting at least one kinetic parameter using a force plate. Clearance criteria was operationally defined as a time from surgery boundary, functional or performance-based testing criteria, medical evaluation, or completion/participation in a rehabilitation program. Results: Thirty-five studies were included. Time from surgery was the most frequently reported clearance criteria (26/35; 74.3%), followed by medical evaluation (18/35; 51.4%), and completion of rehabilitation (10/35; 28.6%). Use of LSI as clearance criteria was limited (5/35; 14.3%). Minimum required LSI ranged from 85 to 90% in quadriceps strength and hop testing. Conclusions: Clearance criteria varied by jump type and post-surgical time frame when the participant was tested. Standardized rehabilitation was common prior to 2 years post-surgery, whereas medical clearance was common after 2 years post-surgery. Single leg jumps typically required 2–3 clearance criteria, whereas double leg jumps required 1–2 clearance criteria. Limb symmetry indices were used in combination with two other clearance criteria in studies with single-leg countermovement or drop jumps. Improvements in clearance criteria and adverse event reporting may help improve patient safety and interpretation of findings across studies. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL) Injury)

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Other

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18 pages, 1575 KB

Open AccessEditor’s ChoiceSystematic Review

Anterior Cruciate Ligament Reconstruction Using Lateral Extra-Articular Procedures: A Systematic Review

by Filippo Migliorini, Ludovico Lucenti, Ying Ren Mok, Tommaso Bardazzi, Riccardo D’Ambrosi, Angelo De Carli, Domenico Paolicelli and Nicola Maffulli

Medicina 2025, 61(2), 294; https://doi.org/10.3390/medicina61020294 - 8 Feb 2025

Cited by 30 | Viewed by 5504

Abstract

Background and Objectives: The present systematic review investigated the efficacy of lateral extra-articular tenodesis (LET) and anterolateral ligament (ALL) as lateral extra-articular procedures (LEAPs) for anterior cruciate ligament (ACL) reconstruction. ACL reconstruction using LEAP may reduce graft rupture and rotatory laxity and [...] Read more.

Background and Objectives: The present systematic review investigated the efficacy of lateral extra-articular tenodesis (LET) and anterolateral ligament (ALL) as lateral extra-articular procedures (LEAPs) for anterior cruciate ligament (ACL) reconstruction. ACL reconstruction using LEAP may reduce graft rupture and rotatory laxity and allow a quicker return to sports. The outcomes of interest were patient-reported outcome measures (PROMs), return to sport, laxity, failure rate, and safety profile. Materials and Methods: The present systematic review followed the 2020 PRISMA guidelines. In December 2024, PubMed, EMBASE, and Web of Science were accessed without constraints. All clinical investigations evaluating LEAP for ACL reconstruction were considered. Only studies that considered LET and ALL as LEAP were considered. Only studies using a hamstring tendon autograft associated with LET or ALL were considered. Results: Data from 27 clinical studies (3423 patients) were retrieved. The mean length of follow-up was 61.8 ± 39.5 months. ACL reconstruction using LEAP led to a statistically significant improvement in the Lysholm score (p < 0.01) and IKDC (p < 0.01). The mean joint laxity, as measured by the arthrometer, was 1.5 ± 1.8 mm. Finally, 72.3% (623 of 668) of patients returned to their pre-injury level of sport at a mean of 6.3 ± 4.4 months. At the last follow-up, the LET group showed greater IKDC (p = 0.04). On the other hand, there was a statistically significant greater rate of patients positive to the Lachman test (p < 0.01), return to sport (p < 0.01), and reoperation (p = 0.01). No significant differences were found in Lysholm scores (p = 0.6), Tegner scores (p = 0.2), arthrometer measurements (p = 0.2), Pivot shift test results (p = 0.1), time to return to sport (p = 0.3), and failure rates (p = 0.7). Conclusions: LEAP for ACL reconstructions seems to be effective and safe. Most patients returned to their pre-injury level of sport after a mean of 6 months. LET-based ACL reconstruction may be associated with greater clinical outcomes and a higher reoperation rate compared to ALL-based reconstruction. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL) Injury)

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