Search Results (475)

Objectives: This study aimed to perform matched comparisons of the surgical outcomes of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction with those of isolated ACL reconstruction, in which allografts were used for the ACL. Methods: Patients who underwent anatomical ACL reconstruction with or without additional ALL reconstruction between 2017 and 2023 and had a minimum follow-up of 2 years were included and grouped according to whether an additional ALL reconstruction was performed. The cohorts were statistically adjusted using an inverse probability of treatment weighting (IPTW) to control for potential confounders related to surgical indication, including age, activity level, sex, rotational knee laxity, and preoperative osteoarthritic grade. Between-group comparisons were conducted for baseline characteristics, clinical outcomes, knee laxity, and radiologic parameters. Results: Fifty-nine patients were included (Group 1: 39 isolated ACL reconstructions; Group 2: 20 combined ACL and ALL reconstructions). Before IPTW adjustment, a significant difference was observed in the preoperative pivot-shift test (p = 0.008), which was no longer significant after weighting. Postoperative functional outcomes and knee stability were comparable between groups; however, the incidence of surgical failure was significantly lower in Group 2 both before and after IPTW adjustment (p = 0.044 and p = 0.049, respectively). Regarding radiologic parameters, the signal-to-noise quotient of the ACL graft was also significantly lower in Group 2, both before and after IPTW adjustment (p = 0.046 and p = 0.038, respectively). Conclusions: In ACL reconstruction using allografts, the addition of ALL reconstruction resulted in more favorable clinical and radiologic outcomes—particularly a lower incidence of surgical failure and greater postoperative graft maturity—compared with isolated ACL reconstruction. Full article

Background/Objectives: Lower extremity injuries represent a major health concern in elite snowsport disciplines, where high mechanical loads, complex movement patterns, and demanding environmental conditions substantially increase injury risk. Understanding injury incidence and burden in this population is essential for developing sport- and sex-specific prevention strategies. This retrospective study determined lower extremity injury incidence and burden among elite snowsport athletes. Methods: Ninety-nine Turkish National Snowsport Teams Training Camp athletes (34 females; 65 males) consented to a review of their medical records for injury incidence. Overall, sex- and sport-specific injury incidence (number/10,000 h) and burden (weeks missing/10,000 h) were calculated. Results: Overall, medial tibial stress syndrome (MTSS) was the highest burden (9.5 ± 38.7), and ankle sprain (1.7 ± 0.4) was the highest-incident injury. However, injury incidence and burden patterns differed by sex and sport. Notably, medial tibial stress syndrome (MTSS) showed comparable incidence in female and male athletes but resulted in a substantial injury burden in both sexes, reflecting prolonged time-loss from training and competition and indicating a meaningful negative impact on athletic performance. Specifically, the highest-burden injury for women was anterior cruciate ligament (ACL) rupture (16.2 ± 64.5), and for men the most common injury was MTSS (9.7 ± 40.7). For cross-country skiers, MTSS had the highest burden and incidence. For all other sports, and across sexes, ankle sprain was the highest incidence injury—women (1.3 ± 3.0), men (2.0 ± 4.5), biathletes (2.3 ± 5.7), Alpine skiers (2.8 ± 4.5), ski jumpers (1.6 ± 3.1), and snowboarders (3.2 ± 4.7)—plus the highest-burden injury for biathletes (6.9 ± 14.3) and ski jumpers (6.0 ± 14.0). The highest burden injury for Alpine skiers was ACL damage (34.3 ± 87.2), and for snowboarders it was knee collateral ligament injury (27.8 ± 78.6). Moreover, patellar tendinitis, hamstring strains, calf strains, Achilles ruptures, anterior tibial pain, meniscus tears, and hip injuries were frequently observed in injury patterns. Conclusions: Ankle sprains were the most frequent lower extremity injury in elite snowsport athletes, whereas medial tibial stress syndrome (MTSS) and anterior cruciate ligament (ACL) injuries accounted for the greatest injury burden. Injury incidence and burden differed by sex and snowsport discipline. Full article

Background: Patient-reported outcome measures (PROMs) provide important insights into recovery after anterior cruciate ligament reconstruction (ACLR). Previous research suggests that males and females recover differently after ACLR, with females reporting greater pain, slower functional gains, and lower psychological readiness at later stages of rehabilitation. However, it is unknown if patient-reported outcomes differ by sex early after ACLR. To address this gap, we conducted a cross-sectional analysis comparing patient-reported outcome measures between sexes three months after ACLR. We hypothesized that females would report worse PROMs compared to males. Methods: This cross-sectional analysis used data from a prospectively maintained ACL reconstruction cohort. Fifty-six individuals (female: 23 and male: 33) with primary, unilateral ACLR completed PROMs three months after surgery. These PROMs included the Knee Injury and Osteoarthritis Outcome Score (KOOS; Symptoms, Pain, Activities of Daily Living, Sport and Recreation, Quality of Life), International Knee Documentation Committee (IKDC) subjective score, Knee Outcome Survey–Activities of Daily Living Scale (KOS-ADLS), Anterior Cruciate Ligament–Return to Sport After Injury (ACL-RSI), and the Tampa Scale of Kinesiophobia (TSK). All outcomes were expressed on a 0 to 100 percent scale, with higher scores indicating better outcomes, except for TSK, where lower scores indicated better outcomes. Normality was assessed within sex, using the Shapiro–Wilk test. Two-tailed independent-samples t-tests with Welch correction were used for approximately normal variables; otherwise, Mann–Whitney U tests were utilized (α = 0.05). Several outcomes had limited statistical power to detect MCID-sized differences, and findings for these measures should be interpreted cautiously. Results: No significant differences between sexes were found for any of the PROMs. Males trended towards having better KOOS Sport and Recreation and IKDC, but these were not statistically significant, and the effect sizes were small-to-moderate. Conclusions: No statistically significant sex-based differences were detected in PROMs at approximately 3 months after ACLR, indicating that any sex-related divergences between these measures may not occur until later in recovery. 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

Background/Objectives: Meniscal root tears, particularly those of the posterolateral root, are frequently associated with anterior cruciate ligament (ACL) injuries and significantly alter load distribution and knee stability. Surgical repair of the posterolateral meniscal root (PLMR) aims to restore normal biomechanics; however, postoperative rehabilitation strategies remain heterogeneous. The objective of this systematic review was to describe and analyze postoperative weight-bearing (WB) and range-of-motion (ROM) protocols following concomitant PLMR repair and anterior cruciate ligament reconstruction (ACLR), integrating both clinical and biomechanical perspectives. Methods: This systematic review followed PRISMA guidelines and analyzed biomechanical and clinical studies assessing postoperative WB and ROM management following PLMR repair combined with ACLR. Results: Eleven studies were included, describing heterogeneous postoperative rehabilitation protocols for WB and ROM following posterolateral meniscal root repair with ACLR. Biomechanical data consistently showed that root section increased tibial internal rotation and contact pressure on the lateral tibial plateau, whereas repair restored near-native load sharing. Clinically, most authors recommended non-weight-bearing or toe-touch loading for 4–6 weeks and flexion limited to 0–90° during early rehabilitation. Gradual progression to full loading and motion between 8 and 12 weeks was the most consistent strategy. Conclusions: Although the current evidence is limited and mainly based on low-level studies, available data suggest that a cautious and progressive rehabilitation protocol after PLMR repair with ACLR early controlled motion and delayed full loading may optimize repair healing while protecting graft integrity. Full article

Background, Clinical Significance: Anterior cruciate ligament (ACL) injuries are common, however the occurrence of concurrent gastrocnemius muscle tears is exceptionally rare. Given this, the diagnosis and management of this pattern of injury is poorly characterised, with lack of current clinically relevant classification systems and evidence-based guidelines to guide treatment. Early recognition is essential. with advanced imaging critical to guiding the diagnosis and management of patients with this pattern of injury. Case presentation: A 39 year old man presented with acute right knee swelling, pain and difficulty weightbearing following a sports-related fall. Clinical examination was suspicious for an ACL injury. Magnetic Resonance Imaging (MRI) of the knee demonstrated the disrupted and displaced ACL fibres, with extensive peri-cruciate oedema around the expected position of the ACL. It was associated with partial avulsion of the medial gastrocnemius origin and incomplete avulsion of the lateral gastrocnemius origin. The patient was referred for an urgent orthopaedics review and is currently on trial of conservative management. Conclusions: In this case report and review of the literature, we evaluate the current understanding of the complexities of combined musculoskeletal injuries and limitations of existing classifications in providing accurate diagnosis and management strategies. Given the rarity of this presentation, the case underscores the lack of evidence-based recommendations for early management, particularly in young, active individuals who are at risk of significant long-term functional impact. Full article

Background: The anterior cruciate ligament (ACL) and medial collateral ligament (MCL) display strikingly different healing behaviors, despite their similar structural roles within the knee. The epiligament (EL)—a vascular and cellular envelope surrounding each ligament—has emerged as a critical determinant of repair capacity. The aim of this study was to perform a region-specific, comparative analysis of EL molecular profiles in the ACL and MCL to elucidate the mechanisms underlying their contrasting reparative outcomes. Methods: Human ACL and MCL specimens were obtained from 12 fresh knee joints. Immunohistochemical labeling for CD34, α-smooth muscle actin (α-SMA), and vascular endothelial growth factor (VEGF) was performed across proximal, mid-substance, and distal EL regions. Quantitative image analysis using IHC Profiler for ImageJ generated semiquantitative (negative, low-positive, positive) distributions, and inter-ligament comparisons were quantified using t-tests (p  <  0.05). Results: Distinct, region-specific EL signatures were identified. The ACL EL exhibited strong proximal α-SMA expression (0% neg/66.8% low+/33.2%+) and notable distal CD34 positivity (0% neg/83.3% low+/16.7%+), while VEGF expression was confined to the mid-substance (≈55% low+/26%+). In contrast, the MCL EL was largely negative for CD34 and VEGF across all regions, showing a homogeneous but functionally oriented α-SMA profile: proximally negative, sparse mid positivity, and high distal low-positive staining (93.4% low+). Differences in proximal and distal CD34 and α-SMA expression between the ACL and MCL were highly significant (p  <  0.0001–0.001), confirming a mechanistic divergence in EL organization. Conclusions: The ACL EL is regionally heterogeneous, vascularly biased, and enriched in contractile α-SMA+ cells, suggesting localized but poorly coordinated reparative potential. In contrast, the MCL EL is structurally uniform, with distributed α-SMA activity supporting stable wound contraction and tissue continuity, despite limited angiogenic signaling. These findings indicate that the ACL’s failure to heal is not attributable to the absence of progenitor or angiogenic factors, but rather to its fragmented spatial organization and dominant contractile phenotype. Therapeutically, preserving and modulating the EL, particularly its CD34+ and α-SMA+ compartments, could be key to enhancing intrinsic ACL repair and improving outcomes in ligament reconstruction and regeneration. Full article

Background/Objectives: Changes in the physiological activity of transforming growth factor-beta (TGF-β) family caused by genetic variability may significantly affect the phenotype of the musculoskeletal system and, consequently, the risk of sports injuries. This study aimed to investigate whether the TGFBI (rs1442), TGFBR3 (rs1805113 and rs1805117), and MSTN (rs11333758) polymorphisms, either individually or in combination, were associated with susceptibility to muscle injury, anterior cruciate ligament (ACL) rupture, and other injuries. Methods: The study group included 202 physically active Caucasians with reported sport injuries and 133 healthy controls. All the samples were genotyped using real-time polymerase chain reaction (real-time PCR). Results: The results revealed that (1) the TGFBR3 rs1805117 TC genotype was nominally associated with increased ACL injury risk; (2) the MSTN rs11333758 heterozygotes was more frequent in the one injury group (vs controls) and in the ACL group, whereas in the multiple vs. one comparison the over-dominant model suggested lower odds for heterozygotes; and (3) the TGFBI rs1442 CG genotype was nominally associated with lower odds of fractures, dislocations or sprains. In addition, simultaneous analysis of chosen SNPs revealed interactions between TGFBR3 rs1805117 and rs1805113, with a nominal association of the rs1805113 G allele with increased injury risk, as did rs11333758 and rs1805113, with a potential effect of rs11333758 on injury status. However, haplotype analysis of the TGFBR3 SNPs revealed no significant associations. After Bonferroni correction, none of the associations remained statistically significant. Conclusions: The results suggested that carrying specific TGFBI, TGFBR3, and MSTN genotypes may be potentially associated with susceptibility to musculoskeletal injuries in a physically active Caucasians. Full article

Background: Anterior cruciate ligament reconstruction (ACLR), one of the most frequently performed orthopedic procedures, has experienced rising demand and escalating costs, driving efforts to reduce expenses through shorter hospital stays and an increased shift toward outpatient settings. This study aims to evaluate how differing definitions of “outpatient” surgery influence the interpretation of outcomes following ACLR. Methods: ACS-NSQIP was queried for patients undergoing primary ACL reconstruction between 2014 and 2023. Patients ≥ 18 years with CPT code 29888 were included. Patients with missing hospital length of stay (LOS) data or a LOS > 2 days (≥99th percentile) were excluded. Two definitions of “outpatient” surgery were evaluated: hospital-defined outpatient (HDO) and same-day discharge (SDD, LOS = 0). Propensity score matching of baseline demographics and comorbidities was used to compare HDO and SDD cohorts to their respective inpatient counterparts. Primary outcomes analyzed included 30-day readmission, reoperation, and postoperative complications. Univariate and multivariate analyses were performed to compare risks of complications for HDO and SDD cohorts compared to their inpatient counterparts. Results: A total of 37,546 patients were included in this study, with 35,334 HDO (94.1%) and 34,801 (92.7%) SDD cases. 1021 (2.9%) of the 35,334 HDO patients had an inpatient hospital stay of at least 1 night. In propensity-matched cohorts, hospital-defined inpatient ACLR was associated with significantly greater risk of 30-day reoperation (odds ratio [OR] 3.167, 95% CI 1.267–7.915, p = 0.009) and superficial surgical site infection (SSI) (OR 5.0, 95% CI 1.712–14.604 p = 0.001), while HDO ACLR was associated with increased risk of deep vein thrombosis (DVT) (OR 0.333, 95% CI 0.121–0.916, p = 0.025). Compared to the propensity-matched SDD cohort, inpatient ACLR was significantly associated with greater rates of 30-day readmission (OR 1.988, 95% CI 1.088–3.630, p < 0.001), reoperation (OR 3.222, 95% CI 1.528–6.794, p = 0.001), and superficial SSI (OR 3.286, 95% CI 1.412–7.644, p = 0.003). Conclusions: This study found differences in readmission and deep vein thrombosis between HDO and SDD cohorts when compared to inpatient ACLR. A standardized definition of outpatient surgery should be created to clearly distinguish same-day discharge from other outpatient categories, considering discharge timing and patient monitoring practices. Full article

Background/Objectives: Variations in drill orientation during femoral and tibial tunnel creation can alter intra-articular tunnel aperture morphology in anterior cruciate ligament (ACL) reconstruction. Enlarged or irregular apertures may affect graft–tunnel conformity and graft mechanics. This study aimed to assess the relationship between intra-articular femoral and tibial tunnel aperture areas, postoperative clinical outcomes, and graft rerupture. This study specifically focuses on MRI-based measurement of intra-articular tunnel aperture area, a morphological parameter that has not been routinely evaluated in previous ACL reconstruction studies and differs conceptually from tunnel diameter or drilling angles. Methods: This retrospective case–control study included patients who underwent primary ACL reconstruction with an 8 mm hamstring autograft using the anteromedial portal technique. All patients completed a minimum 2-year follow-up and postoperative MRI. Femoral and tibial intra-articular aperture areas were measured on MRI Clinical outcomes (Lysholm scores and KOOSs) in patients with intact grafts. Patients were categorized into intact-graft and rerupture groups. Correlation analyses were used to evaluate associations between aperture areas and clinical outcomes. Logistic regression identified predictors of rerupture. Results: A total of 152 patients met the inclusion criteria, including 13 with graft rerupture. In the intact-graft group, mean femoral and tibial aperture areas were 127.34 ± 8.92 mm² and 138.33 ± 7.08 mm², respectively. Both aperture areas demonstrated significant negative correlations with Lysholm scores and KOOSs. Patients with rerupture had significantly larger femoral (145.26 ± 4.22 mm²) and tibial (158.02 ± 2.88 mm²) aperture areas (p < 0.001 for both). Logistic regression identified tibial aperture area as a significant predictor of rerupture. Conclusions: Larger intra-articular tunnel aperture areas were associated with inferior functional outcomes, and increased tibial aperture area correlated significantly with graft rerupture. Aperture morphology may represent an important factor influencing graft integrity and postoperative recovery after ACL reconstruction. Full article

Background: An anterior cruciate ligament (ACL) rupture is one of the most psychologically demanding injuries in professional sport. This study aimed to describe a structured psychological intervention conducted during the rehabilitation process following an ACL rupture in a professional female futsal player. Methods: A single-case longitudinal design was implemented with three phases (pre-test, intervention, post-test) across a 12-month rehabilitation period. Psychological assessment was conducted at four key points: initial evaluation, rehabilitation follow-up, medical discharge, and three- and six-month follow-ups. The battery included perfectionism (FMPS), anxiety (STAI), depression (BDI-II), mental health indicators (DASS-21, GHQ-12), sleep quality (PSQI), pain perception and catastrophizing (VAS, PCS), mood states (POMS), psychological readiness for return to play (PRIA-RS), and perceived intervention effectiveness. The program consisted of 15 individual sessions plus a follow-up, combining cognitive–behavioral therapy principles, mindfulness-based techniques (relaxation, body scan, visualization), cognitive restructuring, sleep hygiene, goal setting, problem-solving, and emotional expression strategies. Results: Progressive and sustained improvements were observed in mood states and pain catastrophizing, along with enhanced sleep quality, psychological readiness, and reintegration into competition. Improved overall mental health indicators were also observed, supporting adherence to rehabilitation and return-to-play confidence. Conclusions: This case highlights the relevance of structured psychological intervention as an integral component of injury rehabilitation in professional athletes with ACL rupture, supporting its inclusion in multidisciplinary care and future research to optimize recovery and prevent maladaptive outcomes. Full article

Anterior cruciate ligament (ACL) rupture causes joint instability and increases the risk of osteoarthritis due to the ligament’s limited healing capacity. Silk, particularly from Bombyx mori, combines high cytocompatibility with robust biomechanical properties. Its main components are fibroin and sericin, with the latter usually being removed to reduce immunogenicity and improve biocompatibility. Silk threads were processed either as raw silk (designated as “untreated”) or subjected to a patented degumming procedure (DE102021118652A1) to obtain purified silk. Both variants were used alone or in combination with poly(L-lactic acid-co-caprolactone) (P(LA-CL)) fibers, yielding four scaffold groups: untreated silk, purified silk, untreated silk/P(LA-CL), and purified silk/P(LA-CL). Three-layer scaffolds were fabricated using a zigzag embroidery pattern. Structural analysis revealed scaffold porosity of ≈38% for silk, ≈46% for purified silk, and up to ≈70% for scaffolds containing P(LA-CL). Uniaxial tensile testing showed that purified silk scaffolds achieved the highest maximum force at break (≈684 N), whereas elongation at maximum force was limited in the hybrid scaffolds—silk/P(LA-CL) ≈ 28% and p-silk/P(LA-CL) ≈ 32%—despite the high intrinsic extensibility of P(LA-CL). All scaffolds supported cell adhesion and showed no cytotoxicity. P-silk and p-silk/P(LA-CL) scaffolds exhibited the highest fibroblast adherence and pronounced paxillin expression, indicating strong cell–material interactions. Gene expression of ligament-related ECM components and connexin 43 was maintained across all groups. These results demonstrate that embroidered silk fibroin scaffolds provide a reproducible architecture with tunable porosity and mechanical properties, supporting fibroblast colonization and ligament-specific ECM expression. Such scaffolds represent promising candidates for ACL tissue engineering and future graft development. Full article

Background/Objectives: Posterior tibial slope (PTS) is an established risk factor for anterior cruciate ligament (ACL) injury in adults. In pediatric population, this relation is less established, and the PTS measurement is not clearly defined. To determine the agreement between X-ray (XR) and magnetic resonance imaging (MRI) PTS measurements and to establish an MRI cutoff corresponding to the standard radiographic ≥12° definition of “high slope”. Methods: In this retrospective study, 108 adolescent knees with ACL rupture underwent paired XR and MRI evaluation by two reviewers. Agreement was assessed with Pearson and Spearman correlation, intraclass correlation coefficient (ICC), Bland–Altman analysis, and Deming regression. Diagnostic performance of MRI thresholds was compared with XR ≥ 12° as reference. Results: Mean PTS was higher on XR (10.2 ± 3.1°) than on MRI (8.4 ± 2.8°), with a systematic bias of +1.8° revealed by Bland–Altman analysis. These two measurements showed strong positive correlation (r = 0.602, p < 0.001) and moderate concordance (ICC = 0.506, 95% CI, 0.186–0.696, p = 0.0015). Individual differences ranged up to ±5° between modalities. Using XR ≥ 12° as reference for “high slope,” ROC analysis identified an optimal MRI cutoff of 8.8° with excellent diagnostic accuracy (AUC = 0.841, 95% CI, 0.760–0.922). Conclusions: Radiographic measurements systematically overestimate PTS relative to MRI. Numeric thresholds are not interchangeable between modalities. An MRI cutoff of approximately 9° corresponds to the radiographic ≥12° definition of high slope and may serve as a pragmatic reference for interpreting MRI-based measurements in pediatric patients, requiring further validation. Full article

Background/Objectives: Injuries to the anterior cruciate ligament (ACL) frequently occur in physically active populations and often lead to long-term complications, such as osteoarthritis and recurrent injury. The ACL’s structural integrity depends on extracellular matrix (ECM) remodeling, regulated by matrix metalloproteinases (MMPs). This study examined the association between three polymorphisms—MMP1 rs1799750, MMP10 rs486055, and MMP12 rs2276109—and ACL injury outcomes, including injury frequency, strain, partial rupture, and complete rupture. Methods: A total of 296 physically active, unrelated Caucasian males participated in this case–control study, including 160 with ACL injuries (classified as ACLF—ACL injury frequency, ACLS—strain, ACLRP—partial rupture, ACLRC—complete rupture, and ACL—general ACL injury) and 136 healthy controls (CON) with no previous ACL injuries. All injuries resulted from non-contact mechanisms. Results: The MMP1 rs1799750 polymorphism showed a protective effect against ACL injury compared to controls (OR = 0.42, 95% CI: 0.21–0.85, Padj = 0.014). Within the injury group, MMP10 rs486055 was significantly associated with partial ruptures, especially in heterozygous carriers (OR = 3.47, 95% CI: 1.64–7.33, p = 0.001). The MMP12 rs2276109 variant, under a dominant model, was linked to higher injury frequency (OR = 3.80, 95% CI: 1.69–8.54, p = 0.0009) but showed no association with injury severity. Conclusions: The MMP1 rs1799750 polymorphism showed a protective effect against ACL injury, MMP10 rs486055 was associated with an increased risk of partial rupture, and MMP12 rs2276109 was linked to higher injury frequency. These findings highlight the complex genetic and biomechanical interactions underlying ACL injuries. The MMP1 rs1799750 polymorphism showed a protective effect (58% reduction in the odds compared to controls) against ACL injury, MMP10 rs486055 was associated with an increased risk (3.47 times higher odds) of partial rupture, and MMP12 rs2276109 was linked to 3.8 times higher odds of an injury. Identifying genetic risk factors may support personalized injury prevention and rehabilitation strategies, offering new opportunities to reduce long-term complications in athletes and active individuals. Full article