Search Results (359)

Background/Objectives: To analyse postoperative pain trajectories after anterior cruciate ligament (ACL) reconstruction using data from a digital rehabilitation system, and to determine (i) whether combined ligament injuries are perceived as more painful than isolated ACL tears, (ii) which patient characteristics are associated with clinically relevant pain (visual analogue scale [VAS] > 5), and (iii) whether higher early pain is associated with later discontinuation of digital monitoring. Methods: This retrospective cohort study used routine data recorded by a validated sensor-based home rehabilitation system in patients after ACL reconstruction. This approach has previously been used to analyse functional recovery trajectories. All patients with ACL-related indications who performed at least one postoperative test were included and classified into four groups: isolated ACL rupture, ACL + meniscus, ACL + collateral ligament, and ACL + collateral ligament + meniscus. Pain during exercises and tests was recorded on a 0–10 VAS. High pain was defined as VAS > 5. Group comparison between indication types, anthropometric and activity-related variables and the proportion of high-pain events were performed using chi-square tests. Early pain (first postoperative month) was analysed in relation to the presence of later tests (≥3 months) to explore associations with discontinuation of digital monitoring. Results: Combined ligament injuries showed a significantly higher proportion of high-pain events during rehabilitation compared with isolated ACL ruptures (5.8% vs. 2.4%, overall p < 0.001). In particular, combined ligament injuries with ACL + collateral ligament rupture were associated with a greater share of VAS > 5 ratings in the early rehabilitation phases. No relevant association was observed between sex or BMI category and the occurrence of high pain, while age group showed an overall association without a consistent directional pattern. Sport activity level showed a strong relationship with high pain (p < 0.001). Early pain demonstrated a small but statistically significant negative correlation with later test participation (r = −0.15, approximately 2% of variance, p = 0.0076); however, this association was attenuated and no longer statistically significant when analysed using mixed-effects models accounting for within-patient clustering, indicating that patients with higher early pain tended to discontinue digital monitoring. Conclusions: Digital routine data after ACL reconstruction suggest that (i) combined ACL–collateral ligament injuries are perceived as more painful than isolated ACL tears, (ii) high postoperative pain is more closely related to activity level and injury pattern than to sex or BMI, while age group shows an overall but non-directional association, and (iii) higher early pain shows a weak bivariate correlation with digital disengagement that was not confirmed in mixed-effects models. Pain is therefore an exploratory marker warranting further investigation, rather than a confirmed independent predictor of adherence in app-based rehabilitation. Full article

Background and Objectives: Atelocollagen, a purified collagen derivative, has demonstrated potential benefits in various orthopedic applications; however, its role in anterior cruciate ligament (ACL) reconstruction remains unclear. This study aimed to compare magnetic resonance imaging (MRI) graft signal following ACL reconstruction with and without atelocollagen interposition and to evaluate its effects on knee joint laxity and clinical outcomes. Materials and Methods: A retrospective review was conducted on patients who underwent primary ACL reconstruction using hamstring autografts between March 2015 and July 2023. Patients were divided into two groups: without atelocollagen (Group N) and with atelocollagen interposition (Group C). The primary outcome was ACL graft signal intensity (intra-articular and intra-tunnel) on 1-year postoperative MRI. Secondary outcomes included tunnel widening, knee joint laxity, and patient-reported outcome measures (PROMs). Results: A total of 57 patients (Group N: 34; Group C: 23) were analyzed. Baseline characteristics were comparable between groups. Group C had a higher proportion of thicker graft constructs (quintuple/sextuple: 73% vs. 17.6%, p < 0.001) and more frequent concomitant anterolateral ligament reconstruction (78.3% vs. 8.8%, p < 0.001). No significant difference in intra-articular graft signal was observed. However, femoral intra-tunnel graft signal was significantly lower in Group C (p = 0.018), accompanied by reduced femoral tunnel widening (p < 0.001). Tibial tunnel widening, knee joint laxity, and PROMs did not differ significantly at 1 and 2 years. In multivariable analysis, atelocollagen interposition was associated with reduced femoral tunnel widening (B = −1.1, p = 0.025). Conclusions: Atelocollagen interposition during ACL reconstruction was associated with more favorable intra-tunnel graft healing signals and reduced femoral tunnel widening, although it did not appear to influence short-term clinical outcomes. Full article

Anterior cruciate ligament (ACL) injuries remain a leading cause of morbidity in athletic populations, with 70–80% occurring through non-contact mechanisms driven by biomechanical risk factors including knee valgus (>10°), low knee flexion (<30°), tibial internal rotation (>20°), and loading asymmetry (>15°), yet implementation of evidence-based neuromuscular training (which reduces injury risk by 50–70%) remains limited due to barriers in identifying at-risk individuals through accessible field-based screening. This narrative review synthesizes motion analysis technologies spanning laboratory-based optical systems (marker-based), wearable inertial measurement units (IMUs), computer vision and marker-less pose estimation, force plate and pressure-sensitive insole systems, and integrated drone-based field assessment platforms to address this critical gap. We present a three-tier clinical screening framework that progresses from basic anthropometric and single-plane video analysis to multi-modal biomechanical assessment using real-time kinematic feedback. As an illustrative example of emerging field-deployable technology, an integrated drone-based motion capture and smart insole system combining 4K video capture, AI-driven 3D motion reconstruction, and plantar pressure mapping is described to demonstrate how laboratory-quality biomechanical assessment can be achieved in ecologically valid field settings. This evidence-based review addresses current gaps between laboratory research and practical field deployment, with emphasis on cost-effectiveness, accessibility, and clinical utility for ACL injury prevention in diverse sporting environments. Full article

Background/Objectives: The peroneus longus tendon has gained attention as an alternative autograft source for anterior cruciate ligament reconstruction; however, donor-site morbidity remains a concern because of its role in ankle eversion and lateral ankle function. Methods: This cross-sectional observational study evaluated whether peroneus longus tendon harvest causes measurable donor-site changes using shear wave elastography. Forty patients who underwent anterior cruciate ligament reconstruction with a peroneus longus tendon autograft and who completed at least 12 months of follow-up were included. The graft-harvested side was compared with the contralateral side in terms of ankle plantar flexion, eversion range of motion, and shear wave elastography-derived tendon stiffness. Results: Pain was assessed using the visual analog scale. Postoperative VAS scores were significantly lower than preoperative scores [8 (5–9) vs. 2 (1–4); p < 0.001]. No significant differences were found between the graft-harvested and contralateral sides in plantar flexion, eversion, or tendon stiffness. A strong positive correlation was observed between operated-side and contralateral-side shear wave elastography values (r = 0.950; p < 0.001). Conclusions: Peroneus longus tendon harvest was not associated with measurable residual tendon stiffness or ankle range-of-motion changes at 12 months. Full article

Background: Anterior cruciate ligament reconstruction (ACLR) is a common orthopedic procedure with generally favorable outcomes, yet graft failure remains a significant challenge, particularly in young and active patients. While various anatomical and biomechanical risk factors for graft failure have been proposed, the influence of the sagittal tibial tubercle–trochlear groove (sTTTG) distance, representing anterior–posterior alignment of the tibial tubercle, has not been sufficiently explored. This study aimed to evaluate the association between sTTTG and ACL graft failure and assess contributing biomechanical variables, including tibiofemoral rotation (TFR), posterior tibial slope (PTS), and knee flexion angle. Methods: For this secondary analysis, a retrospective matched case–control study was conducted, involving 151 patients with ACL graft failure who underwent revision ACLR and 151 controls with intact grafts after a minimum 2-year follow-up period. sTTTG was measured on axial MRI as the anteroposterior distance from the trochlear groove to the tibial tubercle, perpendicular to the posterior femoral condylar axis. Secondary measurements included TT-TG, TFR, medial and lateral PTS, and knee flexion angle. Group differences as well as factors predictive of sTTTG were analyzed. Results: The ACLR failure group demonstrated a significantly lower sTTTG distance compared to controls (0.5 ± 4.6 mm vs. 2.4 ± 4.8 mm, p = 0.001). Logistic regression analysis revealed that a 1 mm increase in sTTTG was associated with an 8% reduction in revision risk (OR = 0.93 per 1 mm increase; 95% CI, 0.88–0.97; p = 0.003), although the predictive accuracy was low (AUC = 0.6). Multivariable analysis identified lateral PTS and knee flexion as significant independent predictors of sTTTG. Conclusions: A decreased sTTTG distance was significantly associated with ACL graft failure, underscoring the relevance of sagittal tibial tubercle positioning in ACL biomechanics. While not an independent clinical decision-making tool, sTTTG appears relevant to graft failure and may be considered in future risk assessment strategies. Full article

Background and Objectives: Persistent quadriceps weakness, muscle atrophy, and functional deficits are common following anterior cruciate ligament (ACL) reconstruction and may compromise return to sport and increase the risk of reinjury. Eccentric-oriented strength training has been widely used to enhance muscle strength and hypertrophy in various musculoskeletal conditions; however, its specific application within ACL rehabilitation remains insufficiently explored. The aim of this scoping review was to map the existing evidence on the use of eccentric-oriented strength training in ACL rehabilitation, identify gaps in the current literature, and provide suggestions for future research. Materials and Methods: A scoping review search was conducted in PubMed, Scopus, Web of Science, and PEDro from inception to February 2026 using the following keywords and Boolean operators: (“anterior cruciate ligament”, “ACL”, “anterior cruciate ligament reconstruction”, “ACLR”) AND (“eccentric training”, “eccentric exercise”, “eccentric loading”, “flywheel training”, “isoinertial training”). Eligible studies included studies that investigated eccentric exercises as part of ACL rehabilitation and reported outcomes related to muscle strength, muscle morphology, functional performance, or return to sport. Data were extracted and synthesized descriptively in accordance with the PRISMA-ScR extension for Scoping Reviews guidelines. Methodological quality and risk of bias were evaluated using the PEDro scale (RCTs) and the ROBINS-I tool (non-randomized studies). Results: Fifteen studies met the inclusion criteria. The included literature primarily examined isokinetic eccentric exercise, eccentric cycling, early progressive eccentric resistance training, Nordic hamstring exercise, eccentric ergometry, and flywheel strength training. Most studies reported improvements in quadriceps strength and muscle morphology, with additional benefits observed in functional performance measures (i.e., hop tests), gait mechanics, and limb symmetry. Evidence was unevenly distributed across rehabilitation phases, with relatively few studies focusing on the mid-phase of ACL rehabilitation. Conclusions: Eccentric-oriented strength training represents a promising but underexplored component of ACL rehabilitation. However, the existing literature lacks standardized protocols, comprehensive outcome measures, and phase-specific guidance, particularly during the mid and late stages of rehabilitation. Further high-quality studies are needed to clarify the optimal timing, dosage, and integration of eccentric training across rehabilitation phases. Full article

Background/Objectives: Anterior cruciate ligament (ACL) tears in children and adolescents are occurring at the intersection of skeletal growth and often early sports specialization, requiring a specialized approach, as pediatric ACL injury is not merely a scaled-down version of adult injury. Methods: This review synthesizes the current understanding of diagnostic protocols, evolution of knee morphology and neuromechanical risk factors characteristic of the pediatric population. It further examines the spectrum of specific management strategies including conservative approaches, primary repair and various reconstruction techniques, alongside rehabilitation, prevention and follow-up procedures. Results: In the diagnostic phase, pediatric-specific clinical and imaging findings must be carefully interpreted. Certain anatomical and neuromuscular characteristics seem to be linked to injury. Management remains complex, requiring a delicate balance between restoring stability and sparing bone growth. While conservative treatment may be attempted in specific cases, it must be promptly redirected toward surgical intervention if persistent instability occurs. Consensus on optimal surgical strategies remain impeded by the lack of robust evidence. Anterior cruciate ligament reconstruction (ACLR) still faces challenges such as growth disturbances, high graft failure, contralateral rupture rates and the biological process of graft remodeling. However, ACLR currently remains the gold standard compared to ACL repair. Tailored rehabilitation and robust prevention programs are needed. Conclusions: The management of ACL rupture in the pediatric population remains complex and constrained by important evidence gaps. Continued refinement of management strategies and future prospective, multicenter pediatric studies are needed. Full article

Background/Objectives: Anterior cruciate ligament (ACL) injuries are common in sports; they can be seen with an arthroscope in more than half of instances of acute traumatic hemarthrosis and are frequently associated with meniscal tears. By reducing soft tissue injury and enabling faster recovery while attaining comparable long-term outcomes, the switch from open surgery to arthroscopic ACL repair (ACLR) has transformed treatment. However, maintaining efficient intra-articular visualization is essential for both patient safety and surgical precision. Methods: Using the PRISMA guidelines, a comprehensive systematic search was conducted across major medical databases, including PubMed, Web of Science, and ScienceDirect. The search strategy incorporated key terms such as epinephrine, irrigation fluid, and ACL reconstruction to identify relevant studies. The study focused on English-language clinical studies within the last 10 years that clearly assessed the safety and efficacy of epinephrine-added irrigation in ACL repair. The study design, patient demographics, specific outcomes (visualization, operation time, hemodynamics), and statistical findings were all carefully retrieved. The results were combined to determine the intervention’s safety profile and clinical value. Results: The pooled analysis demonstrated that the intervention group significantly decreased operating time (SMD = −0.51, 95% CI: −0.90 to −0.12, p = 0.01; I² = 24%). However, postoperative knee function showed no statistically significant difference between groups (OR = 1.80, 95% CI: 0.61 to 5.30, p = 0.29; I² = 0%). Postoperative pain levels also did not differ significantly between groups (SMD = −0.27, 95% CI: −0.63 to 0.09, p = 0.14; I² = 0%). Heterogeneity was low across all analyses (I² = 0–24%). Conclusions: Low-dose epinephrine in irrigation fluid significantly reduces operative time during arthroscopic ACL reconstruction, suggesting improved surgical efficiency. However, it does not significantly improve postoperative knee function or reduce pain compared to control irrigation. The intervention appears to be a reasonable alternative to tourniquets without major systemic cardiovascular effects. Nevertheless, preclinical data indicate potential chondrotoxicity. Therefore, while epinephrine can be considered to improve operating efficiency and reduce tourniquet-related problems, surgeons should weigh its use cautiously, especially in younger patients or those with susceptible cartilage. Full article

Background/Objectives: Anterior cruciate ligament reconstruction, often combined with anterolateral ligament reconstruction, requires accurate anatomical positioning of bone tunnels, which is a key determinant of surgical success. In current clinical practice, postoperative radiographs are routinely performed for both medico-legal and clinical purposes. The objective of this study is to analyze the content of early postoperative radiology reports following ACL ± ALL reconstruction and assess their clinical relevance regarding tunnel positioning, as well as the terminology used to describe surgical findings. Methods: A retrospective bicentric descriptive study was conducted, including 100 consecutive postoperative radiographic reports performed within two weeks after ACL ± ALL reconstruction. The primary outcome was the mention of bone tunnel positioning. Secondary outcomes included the reporting of joint effusion, surgical complications, fixation devices, and terminology used. All radiographs were independently reviewed by two experienced orthopedic surgeons. Results: Among the 100 reports analyzed, interpretations were performed by 60 different radiologists. None of the reports included an assessment of bone tunnel positioning based on validated anatomical criteria. Joint effusion was reported in 83% of cases, without specification of its physiological nature. In 22% of reports, bone tunnels were not mentioned. Terms such as “sequelae” or “stigmata” of ligament reconstruction were used in 50% of reports. No complications or surgical errors were identified upon independent radiographic review. Conclusions: Early postoperative radiology reports after ACL reconstruction appear standardized but often lack clinically relevant contextualization regarding tunnel-related technical aspects. Rather than advocating replacement of surgeon-led image review, our findings support clearer postoperative terminology and better contextualized reporting, including explicit acknowledgment when detailed tunnel assessment is not feasible on routine radiographs. Full article

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

Lane detection is a crucial perception task for autonomous driving, but existing methods often struggle with spatial information loss, feature upsampling artifacts, and prediction discontinuities under complex scenarios such as occlusions or poor lighting. To address these limitations, this paper proposes ACL-Net, an end-to-end lane detection network integrating attention mechanisms and context enhancement based on the Cross Layer Refinement Network framework. First, a coordinate attention module is embedded at the output of the backbone network to recalibrate spatial position information and mitigate depth-induced detail loss. Second, the feature pyramid network is reconstructed utilizing a dynamic upsampling operator and an additional bottom-up pathway to prevent edge distortion and preserve fine-grained geometric features. Finally, a lane-aware atrous spatial pyramid pooling module with asymmetric convolutions is designed to aggregate multi-scale global context, effectively reconnecting fragmented lane lines caused by visual occlusions. Extensive experiments on the TuSimple and CULane datasets demonstrate the superiority of the proposed approach. ACL-Net achieves an accuracy of 96.98% on TuSimple and a total F1-measure of 80.34% on CULane, outperforming the baseline Cross Layer Refinement Network while maintaining a real-time inference speed of 61.90 FPS. The results indicate that ACL-Net significantly improves the utilization of geometric features and exhibits enhanced robustness in challenging road conditions, including severe occlusions, nighttime, and large-curvature curves. Full article

Background/Objectives: An accurate understanding of anterior cruciate ligament (ACL) morphology is essential for individualized surgical planning in ACL reconstruction. Morphometric parameters of the knee, including the femoral notch width and surrounding soft tissue characteristics, may influence native ACL dimensions and potentially assist in preoperative graft sizing. Methods: This retrospective case–control study analyzed medical records, radiographs, and knee magnetic resonance imaging (MRI) performed at a tertiary academic medical center. Variables collected included femoral notch width, thigh thickness, and ACL attachment dimensions at the femoral and tibial insertions. Comparisons between patients with ACL tears and those with intact ACLs were also performed. Correlation analyses were performed to evaluate associations between morphometric parameters and ACL attachment size. Multivariable linear regression models were constructed to identify independent predictors after adjusting for age, sex, body mass index (BMI), limb side (left or right leg), and ACL status. Results: A total of 600 participants were included. The mean femoral notch width was 21.55 ± 6.15 mm, and the mean thigh thickness was 53.05 ± 11.66 mm. The mean ACL femoral and tibial attachment sizes were 8.12 ± 2.57 mm and 11.79 ± 3.89 mm, respectively. Thigh thickness demonstrated weak but significant positive correlations with both ACL femoral (r = 0.168, p = 0.001) and tibial attachment sizes (r = 0.236, p < 0.001). Femoral notch width showed a borderline association with ACL femoral attachment size (r = 0.092, p = 0.068) and a weak but significant correlation with ACL tibial attachment size (r = 0.095, p = 0.039). ACL tear group exhibited smaller thigh thickness measurements compared with controls (49.80 ± 12.00 mm vs. 55.65 ± 14.80 mm, p < 0.001) and smaller femoral notch width measurements compared with controls (21.20 ± 3.40 mm vs. 22.50 ± 3.18 mm, p = 0.001). Moreover, further analysis demonstrated that ACL tear status was associated with smaller measured ACL attachment sizes (p < 0.001). Conclusions: Thigh thickness and femoral notch width demonstrate measurable association with ACL attachment dimensions and differ between patients with ACL tears and those with intact ligaments. These findings indicate that both osseous and soft-tissue morphometric characteristics may influence ACL morphology and susceptibility to injury. Comprehensive preoperative imaging assessment of these anatomical parameters may help to optimize individualized surgical planning in ACL reconstruction. Full article

(1) Background: Asymmetry in strength, movement, and neuromuscular control is common in youth sports, yet its role in anterior cruciate ligament (ACL) injury risk in pediatric athletes remains underexamined. (2) Methods: This narrative review synthesized studies that examined lower-limb asymmetry, biomechanics, ACL injury or reconstruction (ACLR), and rehabilitation in participants younger than 18 years, supplemented by key mechanistic and methodological work. (3) Results: Evidence indicates that asymmetry is multifactorial and sometimes functional, arising from limb dominance, sport-specific loading, growth-related morphological change, and neuromuscular variability. However, asymmetry becomes concerning when it coincides with high-risk landing or cutting mechanics, growth-related coordination deficits, or incomplete recovery after ACL reconstruction. Persistent strength and loading asymmetries are linked to secondary ACL injury and early structural joint changes, whereas neuromuscular training and technique-modification programs can improve symmetry and reduce high-risk mechanics. Major gaps include the absence of pediatric-specific asymmetry norms, limited longitudinal and sex-specific data, and heterogeneous measurement approaches. (4) Conclusions: Clarifying when asymmetry is adaptive versus maladaptive, and integrating this knowledge into screening, rehabilitation, and return-to-sport decision-making, will be essential for optimizing performance and promoting lifelong knee health in pediatric athletes. Full article

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

Background/Objectives: Psychological barriers, particularly kinesiophobia and diminished psychological readiness, represent critical yet undertreated obstacles to a successful return to sport following anterior cruciate ligament reconstruction (ACLR). Scalable, preference-aligned educational interventions capable of addressing these barriers during early rehabilitation are lacking. We aimed to evaluate the effectiveness of structured educational content delivered via Snapchat, as an adjunct to standard ACLR rehabilitation, in reducing kinesiophobia (primary outcome) and improving psychological readiness and perceived knee function (secondary outcomes). Methods: A total of 120 adults with clinically elevated kinesiophobia (TSK-17 > 37) undergoing post-operative ACLR rehabilitation were enrolled in a quasi-experimental, two-arm study with non-randomized allocation at the clinic-branch level at two branches of the same sports rehabilitation clinic (Joint Clinics, Riyadh, Saudi Arabia). Branch allocation assigned 60 participants to each group (intervention and control). The intervention group received 12 weekly structured educational videos via Snapchat alongside standard rehabilitation; the control group received standard rehabilitation alongside general ACLR information videos via Snapchat. TSK-17, ACL-RSI, and IKDC were assessed at baseline and at 12 weeks. Primary analysis used ANCOVA covarying baseline scores, complemented by mixed repeated measures ANOVA and intent-to-treat analysis. Results: Both groups improved across all outcomes; the intervention group demonstrated significantly greater gains. ANCOVA revealed significant between-group differences favoring the intervention for TSK-17 (adjusted mean difference = −2.82; d = 0.54; p < 0.001; d represents Cohen’s d calculated from adjusted mean differences and pooled SD), ACL-RSI (+8.06; d = 0.77; p < 0.001), and IKDC (+8.90; d = 0.54; p = 0.002). Mean video completion was 82.8% among intervention participants. Intent-to-treat analyses using Multiple Imputation confirmed all findings. Conclusions: Snapchat-based structured education was associated with improvements in kinesiophobia, psychological readiness, and perceived knee function among the 102 analyzed participants (control n = 52; intervention n = 50) of the 120 enrolled. High engagement supports preference-based digital delivery as a scalable adjunct to standard rehabilitation. Full article