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Medicina
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Anterior Cruciate Ligament (ACL) Injury
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Anterior Cruciate Ligament (ACL) Injury

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 31 January 2026 | Viewed by 1917

Special Issue Editors

Dr. Riccardo D'Ambrosi

E-Mail Website
Guest Editor
IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161 Milan, Italy
Interests: anterior cruciate ligament; arthroscopy; sports medicine; meniscus; posterior cruciate ligament; multi-ligament knee injuries
Special Issues, Collections and Topics in MDPI journals
Dr. Alessandro Carrozzo

E-Mail Website
Guest Editor
Department of Life Sciences, Health, and Health Professions, Link Campus University, Via del Casale di San Pio V, 00165 Rome, Italy
Interests: anterolateral ligament; knee; arthroscopy; ACL; sports medicine; knee arthroplasty
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Anterior cruciate ligament (ACL) injury is one of the most commonly treated injuries in sports medicine surgery. Currently, many kinds of surgical treatment options are being developed for ACL injuries and disorders. There have been many developments in ACL surgery; surgeons are focusing on methods to make the procedure less invasive, more precise, and last longer, helping to lessen the likelihood of revision, secondary surgeries or persistent instability. In this Special Issue of Medicina, we aim to provide an overview of the recent advances in the field of ACL surgery, outcomes and rehabilitation. Therefore, researchers in the field of ACL surgery are encouraged to submit original articles or reviews to this Special Issue.

Dr. Riccardo D'Ambrosi
Dr. Alessandro Carrozzo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • anterior cruciate ligament
  • anterolateral ligament
  • arthroscopy
  • knee
  • sports medicine

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Published Papers (2 papers)

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10 pages, 1268 KiB  
Article
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
Viewed by 187
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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18 pages, 1575 KiB  
Systematic 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 2 | Viewed by 1380
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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