Search Results (130)

Background/Objectives: Preoperative patient education (PPE) has been increasingly recognized as an important component of perioperative care in patients undergoing total knee arthroplasty (TKA). This study aimed to evaluate the association between preoperative education and knowledge acquisition, functional outcomes, health-related quality of life, and anxiety levels following TKA. Methods: A prospective controlled longitudinal study included 120 patients undergoing primary TKA. Participants were allocated to an intervention group receiving structured preoperative education (n = 80) and a control group receiving standard perioperative care (n = 40). Outcomes were assessed preoperatively and at one and six months postoperatively using validated instruments, including WOMAC, KOOS, Lysholm score, RAND SF-36, and the Beck Anxiety Inventory. Knowledge levels were evaluated using a structured knowledge test. Between-group comparisons and correlation analyses were performed. Results: Patients in the intervention group demonstrated significantly higher knowledge scores following education. The intervention group demonstrated more favorable postoperative functional outcomes across follow-up assessments, reflected by lower WOMAC scores and higher KOOS and Lysholm scores. Significant improvements in health-related quality of life were observed across most RAND SF-36 domains. Anxiety levels decreased over time in both groups, with consistently lower scores observed in the intervention group. Significant correlations were identified between baseline knowledge levels and selected functional and quality-of-life outcomes. Conclusions: Structured preoperative patient education was associated with improved knowledge acquisition and more favorable postoperative functional and health-related quality-of-life outcomes following TKA. Anxiety scores decreased over time in both groups; however, anxiety-related findings should be interpreted with caution because baseline BAI scores differed between groups. These findings support the integration of structured patient education into routine perioperative care pathways for individuals undergoing total knee arthroplasty. 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 and Objectives: Autologous matrix-induced chondrogenesis (AMIC) is an established technique for the treatment of focal cartilage defects of the knee, with well-documented clinical outcomes. However, the biological processes underlying early postoperative cartilage remodeling remain poorly characterized, and the role of synovial fluid biomarkers in this setting is not well defined. This study aimed to assess short-term changes in selected synovial fluid and serum biomarkers of cartilage turnover after AMIC and to examine their associations with clinical outcomes. Materials and Methods: Fifteen patients undergoing AMIC for focal knee chondral or osteochondral defects were prospectively enrolled. Synovial fluid and serum samples were collected intraoperatively and at 6 and 12 weeks postoperatively. Concentrations of matrix metalloproteinase-3 (MMP-3), tissue inhibitor of metalloproteinases-2 (TIMP-2), cartilage oligomeric matrix protein (COMP), and procollagen type II C-terminal propeptide (PIICP) were measured using multiplex flow luminescence immunoassay. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) and Lysholm scores preoperatively and at 6 and 12 months. Results: Both IKDC and Lysholm scores improved significantly during follow-up. Absolute biomarker concentrations in synovial fluid were low and did not change significantly over time. Nevertheless, higher MMP-3 levels, higher COMP concentrations, and a higher MMP-3/TIMP-2 ratio were associated with poorer clinical improvement. Correlations between synovial fluid and serum biomarker levels were generally weak. Total synovial fluid protein increased postoperatively but did not account for the low biomarker concentrations. Conclusions: Early biomarker profiles after AMIC were characterized by low absolute concentrations without significant temporal changes. However, associations of COMP, MMP-3, and the MMP-3/TIMP-2 ratio with clinical outcomes suggest that relative biomarker patterns may reflect early intra-articular remodeling. Synovial fluid analysis may provide more informative insight into local joint biology than serum measurements in this setting. These findings should be interpreted cautiously and require confirmation in larger cohorts. Full article

Objectives: To evaluate the effectiveness and durability of matrix-associated autologous chondrocyte implantation with periosteal flap (pMACI) in treating knee cartilage defects using clinical scores and MRI evaluations. Methods: Data were collected from 37 knees of 17 patients, with a mean follow-up of 5 years (range: 0.1–20 years). Clinical outcomes were assessed using the Lysholm Knee Scoring Scale (LKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Tissue quality was quantitatively evaluated using MRI T1ρ and T2 mapping (biochemical) and MR observation of cartilage repair tissue: MOCART 2.0 (morphological). A linear mixed model was used to identify factors affecting outcomes, including etiology (trauma, OCD, OA), graft site, and defect size. Results: At the 20-year follow-up, clinical scores remained significantly improved from baseline (mean LKS: 55.6 to 86.5; KOOS: 37.8 to 70.8). The biochemical MRI parameters (T1ρ and T2 values) stabilized at levels comparable to native cartilage across all etiologies and sites (p = 0.326 and 0.412, respectively), indicating stable long-term tissue quality. In contrast, the MOCART 2.0 scores significantly declined over time (annual rate: −1.14 points; p < 0.001). Etiology was a significant factor; the OA group showed significantly lower clinical and MOCART scores compared to the trauma/OCD groups (p < 0.05). However, no significant differences were found in LKS and KOOS based on graft site (p = 0.489) or defect size (p > 0.05). Conclusions: pMACI may be a highly durable treatment capable of maintaining biological tissue quality and providing clinical benefits for two decades. The observed morphological deterioration after 20 years likely reflects joint-wide aging—especially in OA cases—rather than graft failure, highlighting the importance of long-term MRI monitoring. Full article

Background: The necessity of cyclic graft loading during anterior cruciate ligament (ACL) reconstruction remains debated. This study aimed to compare clinical outcomes between patients undergoing ACL reconstruction with and without cyclic graft loading. Methods: A retrospective comparative study was conducted involving 216 patients who underwent ACL reconstruction between 2021 and 2022. Patients were divided into two groups: those whose grafts were cyclically loaded intraoperatively (n = 104) and those who did not undergo cyclic loading (n = 112). All surgeries used hamstring autografts and similar fixation techniques. Outcomes, including graft re-rupture rates, knee laxity (measured by arthrometer, Rolimeter^®), and patient-reported outcomes, were evaluated at a minimum follow-up of two years. Results: The demographics of both groups were comparable. Re-rupture rates were 2.5% in the cyclic loading group and 2.9% in the non-cyclic loading group (p = 0.78). Mean side-to-side laxity difference in anterior tibial translation measured by Rolimeter^® was 1.1 mm ± 0.6 in the cyclic loading group and 1.2 mm ± 0.7 in the non-cyclic loading group (p = 0.39). No significant differences in Lysholm or IKDC scores were observed between groups. Conclusion: In this retrospective, non-randomized cohort, no statistically significant differences were detected between ACL reconstruction performed with or without cyclic graft loading. These findings should be interpreted with caution, given the potential for temporal confounding. Further prospective, randomized studies are required to confirm these results. Full article

Purpose: To critically evaluate the role or effect of platelet-rich plasma (PRP) in anterior cruciate ligament (ACL) reconstruction in terms of clinical and radiological outcomes. Method: We conducted a systematic search of PubMed, Embase, the Cochrane Library, and Web of Science to identify relevant studies. Clinical outcomes included the Visual Analogue Scale (VAS), International Knee Documentation Committee (IKDC) subjective and objective evaluations, Lysholm score, Tegner score, anterior knee laxity, Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala score, Victorian Institute of Sport Assessment (VISA) scale, proprioception, isokinetic strength, and physical examination tests (anterior drawer, Lachman, and pivot-shift tests). Radiological outcomes encompassed measures obtained via magnetic resonance imaging (MRI), computed tomography (CT), X-ray, and ultrasound. Statistical significance was defined as a p value < 0.05, and all analyses were performed using R software (version 4.1.3). Results: A total of 23 studies, including 19 randomized controlled trials, met the inclusion criteria, encompassing 1072 patients overall. The meta-analysis showed significant differences between PRP group and non-PRP group with regard to VAS score at 6- and 12-month follow-up, Lysholm score at 6-month follow-up, and Tegner score at 6-month follow-up. Meta-regression showed that the two group differences in VAS score changed significantly with follow-up time (p < 0.01). In terms of radiological findings, about half of the assessments favored PRP to facilitate the graft maturation and integration at 6-month follow-up. Conclusions: PRP application in ACL reconstruction compared with non-PRP, may produce short-term but not long-term clinical outcomes such as VAS score, Lysholm score and Tegner score. While some short-term statistical differences exist, their magnitude and durability do not yet justify routine clinical adoption of PRP in ACL reconstruction. Larger samples and higher-quality studies are needed to support our results and further explore the advantages of PRP in other aspects. Level of evidence: Level II. Full article

Background/Objectives: To evaluate the efficacy of platelet-rich plasma (PRP) as an adjunctive treatment in anterior cruciate ligament reconstruction (ACLR) and its impact on key clinical outcomes. Methods: A systematic search was conducted across five databases until 11 November 2024, including 33 randomized controlled trials (RCTs) that investigated PRP in ACLR. Outcomes analyzed included ligamentization (MRI hypointensity grades), pain VAS scores, functional scores (IKDC, Lysholm, Tegner), knee stability (KT-1000 arthrometer), and tunnel characteristics. Subgroup analyses were performed based on PRP application site, graft type, risk of bias, and follow-up duration. Results: PRP significantly enhanced ligamentization, particularly at 12 months, with marked reductions in MRI hypointensity grades. Patellar tendon grafts demonstrated the most substantial benefits. PRP also significantly reduced postoperative pain, with effects most pronounced in the early recovery period (1–9 months). However, the analgesic benefits diminished over time. Improvements in IKDC scores were observed only in studies with a high risk of bias, while Lysholm and Tegner scores showed no consistent differences between PRP and controls. Knee stability improved significantly with PRP, but this effect was limited to early follow-up periods (3 months). The heterogeneity in PRP preparation methods, application protocols, and patient populations limited the generalizability of the findings. Conclusions: PRP enhances ligamentization and provides short-term pain relief and stability benefits in ACLR. However, its impact on long-term functional recovery and other clinical outcomes remains limited and inconsistent. Standardization of PRP protocols and further high-quality research are necessary to refine its application and therapeutic potential. Full article

Background/Objectives: The aim of this study was to report first experiences with dynamic intraligamentary stabilization (DIS) technique for anterior cruciate ligament (ACL) rupture in children and adolescents. Methods: A case series of 22 children and adolescents with a mean age of 13.3 years underwent primary repair of an ACL rupture using the DIS technique as an off-label use in skeletally immature patients. Patients were evaluated for laxity, strength, range of motion (ROM), and functional tests, as well as Tegner, Lysholm, International Knee Documentation Committee (IKDC), and PedsQL scores after 3 years. A follow up after 11 years was conducted to analyze long-term results, rerupture rates and reinterventions. Results: Three years after surgery, there was no significant difference in laxity, strength, ROM, and in the functional tests comparing the injured to the contralateral knee. The Tegner Index after surgery showed a slight drop of 0.8 points, from 7.1 preoperatively to 6.3. Mean IKDC, Lysholm, and peds-QL scores were 91.17 (range 62.64–98.85, median 94.25), 88.27 (range 58–100, median 93), and 88.78 (range 58.15–100, median 91.30). Overall failure rate of the DIS-repaired knees was 55% (12 of 22 patients). In ten patients, reruptures happened at an average time of 3.2 years after initial surgery; additionally, two patients with chronic instability had to undergo revision ACL reconstruction. Conclusions: DIS repair might help ACL healing with satisfactory functional outcomes. However, given the high failure and reintervention rates, further studies need to show non-inferiority of the DIS technique in children and adolescents before being considered a valid treatment option. Full article

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

Background: Focal chondral and osteochondral knee defects have limited intrinsic healing capacity and may progress toward post-traumatic osteoarthritis. Early post-operative inflammatory signaling may influence clinical recovery after cartilage repair. This prospective, single-center observational cohort study aimed to characterize short-term post-operative inflammatory biomarker profiles in synovial fluid and serum after AMIC and to assess associations with patient-reported outcomes over 12 months. Methods: Fifteen patients undergoing autologous matrix-induced chondrogenesis (AMIC) for focal knee chondral/osteochondral defects were prospectively enrolled. International Knee Documentation Committee (IKDC) and Lysholm scores were recorded pre-operatively and at 6 and 12 months. Synovial fluid and serum were collected intraoperatively, at 6 and 12 weeks post-operatively. Interleukin (IL)-1β, IL-1 receptor antagonist (IL-1RA), and IL-6 were quantified using multiplex flow luminescence immunoassay, and the total synovial fluid protein level was measured. Non-parametric repeated-measures testing and Spearman’s rank correlation were applied (p < 0.05). Results: IKDC and Lysholm scores improved from (30.6 ± 9.4) to (58.8 ± 15.0) and from (57.5 ± 18.6) to (78.2 ± 14.7), respectively, exceeding established minimal clinically important difference (MCID) thresholds. Synovial fluid IL-1β and IL-1RA increased significantly over time ((p = 0.01357) and (p = 0.03953), respectively); IL-1β remained elevated, whereas IL-1RA tended to decline after 6 weeks. IL-6 levels remained low throughout. Total synovial fluid protein increased significantly (p = 0.00043). No significant correlations were observed between corresponding biomarker levels in synovial fluid and serum. Higher IL-6 and a higher IL-1β/IL-1RA ratio were associated with poorer clinical improvement (ρ = −0.80, p < 0.05 and ρ = −0.580, p < 0.05, respectively). Conclusions: AMIC was associated with a sustained intra-articular inflammatory response despite favorable 12-month outcomes. Exploratory analyses suggest that inflammatory dysregulation—particularly involving IL-6 and IL-1β/IL-1RA balance—may be linked to less favourable clinical recovery. Synovial fluid measurements provided more relevant information on local joint biology than serum sampling. Full article

Objective: The aim of the study was to compare postoperative pain, functional recovery, knee stability and complication profiles between the all-inside technique and the conventional full tibial tunnel technique for anterior cruciate ligament (ACL) reconstruction. Methods: This retrospective comparative cohort study included 104 patients who underwent primary ACL reconstruction between 2018 and 2020. Surgical technique allocation was non-randomized. Patients were divided into two groups based on the surgical technique employed; the conventional full tibial tunnel group (n = 58) and all-inside group (n = 46). Hamstring tendon autografts were used in all cases, and the procedures were performed by the same surgical team to ensure consistency. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) for pain, Lysholm knee score and International Knee Documentation Committee (IKDC) score. Knee stability was assessed with the Lachman and pivot-shift test. Additionally, postoperative complications and revision rates were recorded. Results: The study included 104 patients, with 58 treated using the conventional technique and 46 using the all-inside technique. Baseline characteristics, trauma mechanisms, and follow-up duration were comparable between groups (p > 0.05). Four patients in each group underwent revision surgery and excluded from the final analysis. Revision rates were comparable between groups (6.9% vs. 8.6%) and were considered descriptively when interpreting outcomes. The preoperative VAS, Lysholm and IKDC scores were comparable between groups. At 3 months, the all-inside group demonstrated significantly lower VAS pain scores and higher Lysholm and IKDC scores (with moderate-to-large effect sizes) (all p < 0.01). No significant differences were observed at the 12-month or final follow-up. Postoperative knee stability was comparable between groups, whereas anterior knee pain was significantly less frequent in the all-inside group (p < 0.001). Moreover, patients treated with the all-inside technique returned to sports significantly earlier than those treated with the conventional technique (13.25 ± 2.70 vs. 16.40 ± 5.85 months, p < 0.001; Cohen’s d = 0.66). However, the proportion of patients who returned to their preinjury sports level was comparable between the two groups (81.0% vs. 83.3%, p = 0.78). Conclusions: The all-inside ACL reconstruction technique was associated with superior early pain relief and short-term functional outcomes compared with the conventional technique, while achieving comparable knee stability and mid-term clinical results. These advantages occur without increasing complications or revision rates. These findings support the all-inside technique as patient-centered, optimizing early recovery without sacrificing mid-term clinical durability. These findings should be interpreted in the context of the non-randomized retrospective study design. Full article

Background/Objectives: Juvenile osteochondritis dissecans (JOCD) of the knee is commonly treated using conservative or joint-preserving surgical techniques. While clinical outcomes are generally favorable, the risk of early cartilage degeneration remains unclear. Joint space width (JSW) on weight-bearing radiographs serves as an indirect marker of cartilage health. Artificial intelligence (AI)-based JSW assessment may enable sensitive and reproducible detection of early degenerative changes. Methods: This cross-sectional feasibility study included 21 skeletally immature patients treated for JOCD of the distal femur between 2002 and 2017. Treatment modalities comprised conservative management, retrograde drilling, and fragment refixation. Fully automated JSW measurements were performed on standardized anteroposterior knee radiographs using a validated AI-based software IB Lab KOALA™, Version 2.4. JSW of the affected compartment was compared with the contralateral knee and between treatment groups. Clinical outcomes were assessed using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score. Additionally, a systematic review of the literature on post-treatment degenerative changes following OCD therapy was conducted according to PRISMA guidelines. Results: Compared with manually reviewing images, the software IB Lab KOALA™, Version 2.4 as easy to implement. AI-based analysis revealed no significant differences in JSW between the affected and contralateral knees, nor between treatment modalities. Average JSW exceeded 6 mm in all groups after a median follow-up of 64 (min. 27, max. 177) months. Clinical scores were high and comparable across treatments. A moderate positive correlation was observed between the JSW and Lysholm score, while increasing age and longer follow-up were associated with a reduced JSW. The systematic review identified ten relevant studies, reporting generally favorable long-term clinical outcomes with a low but present risk of osteoarthritis progression. Conclusions: Our AI-based analysis showed no differences in JSW between conservative and joint-preserving surgical treatments of JOCD in the follow-up. This technology can provide a valuable tool for standardized and sensitive radiographic monitoring in young patients. Full article

Background/Objectives: The aim of our study was to evaluate the transverse stiffness of selected soft tissues in the knee joint region on the previously injured and uninjured sides of female handball players and non-athlete women, in the lying and standing positions, and to investigate the relationship between stiffness, age, sporting practice, and clinical assessments of the knees. Methods: A total of 25 young female handball players (the SPORT group) and 27 healthy non-athletic individuals (the CONTROL group) were examined. The MyotonPRO device was used to measure the stiffness of the patellar tendon (PT), rectus femoris (RF), and biceps femoris (BF) muscles on both sides and in both positions. The function of the knee joints was clinically assessed using the Knee Outcome Survey—Sports Activities Scale and the Lysholm Knee Scoring Scale. Results: ANOVA indicated a significant effect of group (p < 0.003) on the PT’s stiffness, and a significant effect of position (p < 0.0001) on the PT, RF, and BF muscle stiffness. The SPORT group demonstrated significantly higher PT transverse stiffness when lying down (p < 0.01), but not when sitting up (p > 0.05), compared to the CONTROL group. Significant negative correlations were found between PT stiffness and both clinical scales in the SPORT group (rho from −0.39 to −0.71, p < 0.05). Conclusions: In female handball players, only the patellar tendon transverse stiffness was higher than in the control group. While this higher stiffness could indicate an adaptive rebuilding process, it was negatively correlated with the clinical assessment of joint function, meaning poorer knee joint function. Full article

Background: The optimal timing and staging of anterior cruciate ligament reconstruction (ACLR) in patients with concomitant medial collateral ligament (MCL) injury remain controversial. This study aimed to compare clinical outcomes between a one-stage ACLR group and a two-stage ACLR group in patients with combined ACL and MCL injuries in which the MCL was surgically managed. Methods: This retrospective study included 68 patients with combined ACL and grade III MCL injuries treated with ACLR and MCL surgery. Patients were divided into the one-stage ACLR group (n = 42) and the two-stage ACLR group (n = 26) according to the timing and staging of ACLR relative to MCL surgery. Clinical outcomes, including knee stability, patient-reported outcomes, and range of motion (ROM), were compared between groups. Results: After a minimum 2-year follow-up, both groups demonstrated significant improvements in clinical and stability outcomes, with enhanced anterior knee stability, improved patient-reported outcomes, and better objectively assessed knee function. No significant differences were found between groups in anterior, valgus (one-stage: 1.8 ± 1.1 mm, two-stage: 2.3 ± 1.3 mm; p = 0.160), or rotational stability. Likewise, there were no significant differences in mean flexion deficits (one-stage: 2.6 ± 4.1°, two-stage: 1.0 ± 2.0°; p = 0.137), mean extension deficits (one-stage: 1.5 ± 2.5°, two-stage: 1.3 ± 2.0°; p = 0.137), flexion deficits ≥10° (one-stage: 9.5% [4/42], two-stage: 0%; p = 0.290), extension deficits ≥ 5° (one-stage: 9.5% [4/42], two-stage: 3.8% [1/26]; p = 0.642), or additional procedures for postoperative stiffness (one-stage: 16.7% [7/42], two-stage: 11.5% [3/26]; p = 0.730). Patient-reported outcomes, including the Lysholm and IKDC subjective scores, were also comparable between groups. Conclusions: Both the one-stage ACLR group and the two-stage ACLR group for surgically managed combined ACL and MCL injuries yielded comparable clinical and stability outcomes, suggesting that one-stage ACLR can be performed without an apparent increase in the risk of postoperative stiffness or ROM limitations. However, given the limited sample size, these results should be interpreted cautiously because the study may have been insufficiently powered to detect small clinically meaningful differences. Full article

Background: Arthroscopic anterior cruciate ligament (ACL) reconstruction is widely recognised as the primary treatment for ACL injuries. However, with the increasing incidence of sports-related injuries and growing demand for rehabilitation services, conventional rehabilitation models—largely reliant on therapists’ experience and subjective assessment—are increasingly insufficient to meet the clinical need for precise and individualised rehabilitation programmes. This study aimed to evaluate the effectiveness of a rehabilitation protocol incorporating an artificial intelligence (AI)-based assessment and correction system on functional recovery following ACL reconstruction. Methods: Using convenience sampling, 80 patients undergoing ACL reconstruction between June to December 2024 were recruited for this randomised controlled trial. Participants were randomly assigned to either a control group (n = 40), which received conventional functional exercise training, or a trial group (n = 40), which received rehabilitation intervention guided by an AI-based assessment and correction system. Knee function scores (Lysholm score, IKDC score), Berg Balance Scale (BBS) scores, joint range of motion (ROM), and rehabilitation exercise compliance scores were collected and analysed 1, 2, 3, and 4 months postoperatively. Results: Compared with the control group, the trial group demonstrated significantly greater improvements in Lysholm score, IKDC score, BBS score, and active knee joint ROM (p < 0.05) at postoperative assessment points. Additionally, rehabilitation exercise adherence was significantly higher in the trial group compared to the control group (p < 0.05). Conclusions: Rehabilitation protocols integrating AI-based assessment and correction systems effectively enhance knee function recovery, joint mobility and balance ability following ACL reconstruction. Moreover, these protocols significantly improve rehabilitation exercise adherence, demonstrating superior efficacy compared to conventional rehabilitation approaches. This digital rehabilitation model represents an efficient and promising intervention for postoperative ACL rehabilitation. Full article