Search Results (41)

Background: Persistent neuromuscular deficits following anterior cruciate ligament reconstruction (ACLR) are frequently attributed to arthrogenic muscle inhibition (AMI). The type of autologous graft used may influence the trajectory of neuromuscular recovery. Objective: To investigate the influence of graft type—bone–patellar tendon–bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT)—on the contractile properties of periarticular knee muscles over a 9-month post-operative period. Hypothesis: Each graft type would result in distinct recovery patterns of muscle contractility, as measured by tensiomyography (TMG). Methods: Thirty-one patients undergoing ACLR with BPTB (n = 8), HT (n = 12), or QT (n = 11) autografts were evaluated at 3, 6, and 9 months post-operatively. TMG was used to measure contraction time (Tc) and maximal displacement (Dm) in the rectus femoris, vastus medialis, vastus lateralis, and biceps femoris. Results: Significant within-group improvements in Tc and Dm were observed across all graft types from 3 to 9 months (Tc: p < 0.001 to p = 0.02; Dm: p < 0.001 to p = 0.01). The QT group showed the most pronounced Tc reduction in RF (from 30.16 ± 2.4 ms to 15.44 ± 1.6 ms, p < 0.001) and VM (from 31.05 ± 2.6 ms to 18.65 ± 1.8 ms, p = 0.004). In contrast, HT grafts demonstrated limited Tc recovery in BF between 6 and 9 months compared to BPTB and QT (p < 0.001), indicating a stagnation phase. BPTB exhibited persistent bilateral deficits in both quadriceps and BF at 9 months. Conclusions: Autograft type significantly influences neuromuscular recovery patterns after ACLR. TMG enables objective, muscle-specific monitoring of contractile dynamics and may support future individualized rehabilitation strategies. Full article

Background: The incidence of anterior cruciate ligament ruptures in football has experienced a marked increase in recent years, affecting both professional and amateur players. This injury is characterised by being highly disabling, causing the player to withdraw from the field of play for prolonged periods and there is no clear consensus on how to carry out the different phases of rehabilitation, which poses a major challenge for health professionals. Case presentation: This study followed a semi-professional player who suffered an anterior cruciate ligament tear following two forced valgus actions without direct contact in the same match. Outcome and follow-up: The patient underwent surgery using an autologous hamstring graft. He followed a progressive rehabilitation programme consisting of one preoperative phase and six phases after the operation. After a 12-month follow-up, with exercises aimed at perfecting step-by-step basic and specific physical skills, the player showed a complete functional recovery, achieving the desired parameters. Conclusions: This case highlights the importance of structured rehabilitation adapted to the specific needs of the football player through an approach with coherent progressions, which considers the muscle chains that determine the movements performed on the football pitch. Full article

Background and Objectives: A prominent area of research in adolescent ACL reconstruction (ACLR) involves graft selection, with particular interest in the quadriceps tendon (QT) as an alternative to hamstring tendon (HT) autografts, although comparative studies on muscle strength outcomes and patient satisfaction in adolescents remain limited. This study aims to evaluate the influence of QT and HT autografts on muscle strength and satisfaction outcomes post-ACLR in adolescents. Methods: This prospective study was conducted at the Lithuanian University of Health Sciences, enrolling 68 patients aged 12–17. ACLRs were performed using QT or HT autografts. Muscle strength was assessed using an isokinetic dynamometer (Biodex), while patient satisfaction was evaluated through IKDC, Lysholm, and ACL-RSI surveys preoperatively and 12 months postoperatively. Results: 54 patients (24 QT and 30 HT) completed the study. The data are non-parametric and are presented as median (IQR). Isokinetic measurements indicated that QT harvesting led to significantly lower extension strength compared to HT 6 months (p = 0.019) and 12 months post-op (p < 0.001) but showed better H/Q ratios 6 months (p = 0.019) and 12 months post-op (p < 0.001). There was no significant difference between the QT and HT groups in ACL-RSI and Lysholm scores. IKDC scores were significantly higher in the HT group (p = 0.009). Conclusions: QT autografts provide favorable H/Q ratios, yet they exhibit weaker extension strength and lower satisfaction outcomes compared to HT. These results suggest a need for individualized rehabilitation protocols and further research to optimize ACLR graft selection for adolescents. Full article

Background: The isolated rectus femoris tendon (RT) is a less commonly used autograft for anterior cruciate ligament (ACL) reconstruction. Graft selection is a critical part of ACL reconstruction, especially in revision surgery. Hypothesis: This study compares patient-reported outcome measurements (PROMs) between revision ACL reconstruction with an RT autograft and a hamstring tendon (HT) autograft. We hypothesized that the RT autograft will yield comparable functional results and high patient satisfaction. Study Design: This was a cohort study; the level of evidence is III. Methods: Fifty-five patients (RT n = 28; HT n = 27) who underwent revision ACL reconstruction were included in this study, with a mean follow-up time of 40.3 months (range, 16.4–64.8) for RT and 61.2 months (range, 34.6–86.3) for HT. Apart from the harvesting technique, the surgical technique was the same for both groups. Clinical and intraoperative data were collected for our postoperative registry. In addition, funcinal outcome was measured using the International Knee Documentation Committee score (IKDC), the Lysholm score, Tegner activity scale, and numeric rating scale (NRS). The type and frequency of postoperative complications were documented. Results: At the final follow-up, no significant differences were observed between the RT and HT groups in the IKDC (mean ± SD: 74.7 ± 10.9 vs. 74.9 ± 12.9), Lysholm score (90.9 ± 15.0 vs. 89.0 ± 14.6), or Tegner activity scale (median [IQR]: 5 [4–6] vs. 5 [4–6]). The mean femoral tunnel diameter was 9.0 mm (range, 7.5–10 mm) for the RT and 8.2 mm (range 7.0–9.5 mm) for the HT. The use of the RT reduced the need for a two-stage procedure by 50% compared to HT (n = 5 vs. n = 10), although this difference was not statistically significant (p = 0.11). Stability measured by the Lachman test improved significantly in both groups from the pre- to postoperative period. Retear of the ACL graft was observed in two patients in both groups (7.1% RT and 7.4% HT). Conclusions: The RT and HT autografts achieved similar outcomes in PROMs for revision ACL reconstruction. Good tendon quality with parallel fibers and adjustable thickness characterize the RT. A tendency for a reduced rate of two-stage surgery with RT was noticed. Clinical Relevance: The incidence of revision ACL reconstruction is rising. Surgeons should be aware of all the available graft options. The isolated RT expands the range of autografts available for ACL reconstruction. Full article

This study aimed to analyze the biomechanical differences in knees that underwent reconstruction using four-strand hamstring or bone–patellar tendon–bone autografts during the side-hop test. This case–control study included 46 participants: 18 controls, and 28 individuals who underwent reconstruction with hamstring (n = 15) or patellar (n = 13) tendons. The Theia Markerless system and Visual3D provided information on knee kinematics, namely time of contact with the ground, maximum varus and valgus angles, and flexion during maximum valgus and varus. Additionally, we assessed the activity levels of the participants pre- and post-surgery using the Tegner Activity Scale. Data analysis was conducted using ANOVA and Tukey’s post hoc test. Significant differences were observed in terms of contact time with the ground between the control and autograft groups (p = 0.025, g = −1.13; p = 0.014, g = −1.09), but not between the autograft groups. Other variables did not demonstrate statistically significant differences; however, there was a slight tendency to greater valgus in patellar autografts and greater varus with hamstring tendons. The absence of significant differences between the groups may indicate that both autografts allow knee kinematics restoration by engaging neuromuscular and proprioceptive mechanisms that compensate for anatomical alterations. Full article

Purpose: Anterior cruciate ligament reconstruction (ACLR) using the hamstring graft is commonly performed to restore knee stability; however, it induces significant neuromuscular and biomechanical changes, particularly in the hamstring. This study aimed to evaluate the changes in maximum effective angle, hamstring strength, and hamstring-to-quadriceps (H/Q) strength ratio at 3 and 6 months post-ACLR and compare these outcomes to a control group. Methods: This prospective controlled study included 20 ACLR patients and 20 age- and gender-matched controls. Hamstring peak torque, maximum effective angle (MEA), and the H/Q ratio were assessed using isokinetic dynamometry at 60°/s. The ACLR group was evaluated postoperatively at 3 and 6 months, while the control group underwent a single evaluation. Results: At 3 and 6 months, the ACLR group exhibited significantly lower MEA (26.3° ± 8.2 and 28.2° ± 9.4) compared to the control group (36.4° ± 12.0; p < 0.01). Hamstring peak torque and H/Q ratios were also lower in the ACLR group but showed slight improvements over time. The H/Q ratio increased significantly between 3 and 6 months (51% to 56%; p = 0.041). Conclusion: The use of hamstring graft in ACLR leads to persistent MEA and strength deficits despite rehabilitation. Advanced, targeted rehabilitation protocols are essential to address these deficits, optimize recovery, and reduce the risk of reinjury. Full article

Introduction: Many orthopedic surgeons recommend ischemic tourniquets during arthroscopic anterior cruciate ligament (ACL) repair to reduce blood loss and improve visibility. However, their use remains controversial due to potential complications. Similarly, the practice of postoperative drainage is debated. While its proponents argue it reduces limb swelling, DVT, adhesions, and stiffness, others contend that it may increase infection risk or harm the ACL graft and joint surfaces. Materials and Methods: A total of 456 patients underwent anterior cruciate ligament reconstruction between September 2015 and December 2024, without the use of a tourniquet or drainage. The patients were 334 men with a mean age of 34.7 years and 122 women with a mean age of 32.3 years. In 389 cases the graft type was a hamstring autograft, in 55 cases a patellar tendon autograft (BPTB) was used, and in 12 cases a quadriceps tendon autograft was used. Results: The mean operative time was 61 min (range 52–79). No cases experienced visual impairment or required ischemia to enhance visibility. Bleeding sites were successfully cauterized during arthroscopy. Postoperative complications included knee hematoma in three patients (0.7%), resolved after drainage on day one, and two infections (0.4%), treated successfully with arthroscopic drainage and implant removal. No further complications were reported. Conclusion: Although many orthopedic surgeons prefer arthroscopic ACL repair with a tourniquet for better visibility and reduced intraoperative blood loss, this approach carries risks such as nerve palsy, joint swelling, stiffness, muscle weakness, and vascular changes. Not using a tourniquet can help to identify bleeding sites and allows for a more thorough procedure. The literature suggests that avoiding a tourniquet also reduces postoperative pain and accelerates recovery. The mean operative time for ACL reconstruction was consistent with the literature, indicating that avoiding a tourniquet did not cause delays. Additionally, the absence of postoperative drainage did not lead to complications, with most patients showing no issues like bleeding, hematoma, ischemia, or poor wound healing. Full article

Objectives: The aim of this study is to evaluate the literature for comparing clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with concomitant anterolateral ligament reconstruction (ALLR) versus isolated ACLR, with a primary focus on analyzing differences in outcomes based on the type of graft used for ALLR. Methods: We identified comparative studies involving primary ACLR performed in conjunction with ALLR. Graft failure rates, residual pivot shift, residual anterior–posterior (AP) laxity at follow-up, and patient-reported outcome measures were determined. Variables associated with isolated ACLR and ACLR combined with ALLR were compared based on the type of graft used for ALLR. Results: This systematic review included nine studies involving 2740 patients. Combined ACLR with ALLR using hamstring tendon (HT) autografts or tibialis allografts showed lower graft failure rates than isolated ACLR (HT autograft: rate, 0–5.9%, odds ratio [OR], 2.16–12.91; tibialis allograft: rate, 0%, OR, 2.00–5.27). Similarly, the combined procedure showed reduced residual pivot shift rates (HT autograft: rate, 0–9.1%, OR, 2.00–12.16; tibialis allograft: rate, 0%, OR, 7.65–15.33) compared to isolated ACLR. Residual AP laxity and patient-reported outcomes were similar or more favorable for the combined procedure; however, the results were heterogeneous. Complications related to the type of graft used for ALLR or the presence of ALLR itself were not reported. Conclusions: Regardless of the graft type used for ALLR, the combination of ACLR with ALLR showed better clinical outcomes, including reduced graft failure rates and superior residual rotational stability compared to isolated ACLR. However, the high heterogeneity observed across studies suggests that these findings should be interpreted with caution, and further research is needed to draw more definitive conclusions. Full article

Background: Rupture of the ACL is a common injury among men and women athletes. While planning the surgical ACL reconstruction procedure, the eventual graft’s diameter is extremely important. Many parameters are therefore evaluated pre-surgery to ensure access to reliable data for estimating the graft diameter. Considering this, magnetic resonance imaging (MRI), particularly qualitative analyses of the hamstring tendons, offers a promising approach. Methods: In a retrospective analysis, we carried out 3D segmentation of the gracilis (GT) and semitendinosus tendon (ST) utilizing MRI with varying slice thicknesses and field strengths. The cross-sectional area (CSA) was calculated on different levels (by relying on the models we had thus created) to generate a mean of CSA with six specific segments. We then correlated the mean CSA with the diameter of the graft measured during surgery. Results: A total of 32 patients were included (12 female, 20 male) in this retrospective analysis. We observed the largest CSA in segment 10 mm–0 (16.8 ± 6.1) with differences between men and women. The graft size and tendon diameter correlated significantly in all segments throughout our study cohort. The strongest correlation was apparent in the segment 10 mm–0 (r = 0.552). Conclusions: MRI-based 3D segmentation and the STGT CSA represent a reliable method for estimating preoperatively a quadrupled hamstring graft diameter. The 10 mm–0 mm segment above the joint line showed a strong correlation, making it an ideal reference for graft planning. Full article

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

Background: Injury to the anterior cruciate ligament is one of the most common knee injuries. Following anterior cruciate ligament reconstruction, strength deficits and reduced quadriceps and hamstring muscle mass are common. Traditional strengthening protocols recommend the use of heavy loads. However, following surgery, heavy-load exercises are contraindicated to protect the joint and graft. Blood flow restriction resistance training is an alternative that optimizes muscle recovery. The aim of this study was to evaluate the effects of blood flow restriction resistance training on muscle mass and strength after ACLR. Methods: The Pubmed, Cochrane Library, and PEDro databases were used to constitute the corpus of this systematic review. The methodological quality of the studies was assessed with the Cochrane Collaboration’s analysis grid. Results: Thirty-four articles were identified in the initial search, and five randomized controlled trials were included in this review. Not all studies reported significant results regarding strength and muscle mass. Two of these studies observed a significant improvement in strength associated with blood flow restriction resistance training compared with the control group. A significant increase in muscle mass was observed in one study. Conclusions: The blood flow restriction resistance training method shows superior efficacy to training without occlusion, yet this device has not been shown to be more effective than heavy-load resistance training in terms of muscular strength and muscle mass. Blood flow restriction resistance training shows superior efficacy in both these variables when used with low loads. However, there are still few random controlled trials on this subject, and this review presents their limitations and biases. Future research is needed on guidelines for the application of blood flow restriction resistance training in clinical populations. Full article

Background/Objectives: The purpose of this study was to preoperatively estimate the four-strand hamstring graft size in a White Caucasian population, using anthropometric data. Methods: This was a prospective study of a consecutive series of fifty patients with anterior cruciate ligament (ACL) rupture, who were scheduled for reconstruction using hamstring autografts; however, one of them was ultimately not enrolled according to the exclusion criteria (49 patients in total). Preoperatively, age, sex, weight, body mass index (BMI), length, and diameter of the contralateral thigh, length of the harvested gracilis/semitendinosus tendons, and length and thickness of the four-stranded graft were recorded. Graft diameter and length were dependent variables, measured via a graft sizer and a ruler, respectively. Quantitative variables were described with mean ± SD (correlated in a pairwise manner with Pearson’s r correlation). Qualitative variables were described with an absolute count (relative % percent) per categorical level, and their dependency on any quantitative (dependent) variable was assessed via Student’s t-test. Results: The mean lengths of the gracilis and semitendinosus were 25.6 ± 3.2 cm and 28.4 ± 3.3 cm, respectively, and they were positively correlated with the length of the four-strand hamstring graft along with the patients’ height and thigh length. Conclusions: The use of anthropometric data can assist in the prediction of the hamstring autograft size, aiding the selection of an appropriate graft type. The four-strand hamstring graft length was related to the gracilis, semitendinosus, and thigh length. The patients’ height was related to the graft length and diameter. Full article

Anterior cruciate ligament (ACL) injuries are common in sports and often require surgical intervention, e.g., ACL reconstruction (ACLR), aimed at restoring knee stability and enabling a return to pre-injury activity levels. The choice of graft is crucial, impacting biomechanical properties, clinical outcomes, and complication rates, and is especially important in revision surgeries after graft failure. Over the past 30 years, trends in graft selection have evolved towards more individualized approaches, considering factors such as patient activity level, prior injuries, and tissue availability. In Europe, autografts like hamstring tendon (HT), bone-patellar tendon-bone (BTB), and quadriceps tendon (QT) are preferred, with the increasing use of QT grafts. This review synthesizes the current literature on graft selection and its influence on ACLR outcomes. Full article

Objectives: Rupture of the anterior cruciate ligament (ACL) is a severe injury common in sports. It also has a high rate of re-injury. The aim of this work was to assess hamstring muscle fatigue in active football players after ACL reconstruction who were cleared to play and to determine symmetry between the lateral and medial hamstring muscles. Methods: In professional football players post ACL reconstruction (n = 25) and non-injured players (n = 26), the bioelectrical activity of the medial (biceps femoris—BF) and lateral (semimembranosus and semitendinosus—SEM) hamstring muscles was measured during 60 s of isometric contraction. The fatigue variables were calculated using the Continuous Wavelet Transform (CWT) tool. Results: The football players following ACL reconstruction demonstrated significant asymmetry in fatigue of the lateral and medial hamstring muscles, with greater fatigue in the SEM compared to the BF muscle. Moreover, in those after reconstruction, the changes are more pronounced, with higher muscle fatigue in both limbs (they have lower MDF than non-injured players) and more severe SEM muscle insufficiency (noted in both limbs but with greater intensity in the non-operated one). Conclusions: The higher SEM muscle fatigue observed in this study influenced the lateral-to-medial activation ratio within the hamstring muscle, which may be a probable cause of this muscle’s insufficiency in laterally stabilizing the knee in the frontal and transverse plane. Furthermore, the hamstring muscles after reconstruction were more fatigued in both limbs, which may be another risk factor for ACL graft rupture. Therefore, increased fatigue in specific hamstring muscles may indicate the direction in which knee stabilization is compromised due to ACL overload. A muscle that becomes fatigued and inefficient more quickly also becomes ineffective in performing its function sooner, which can lead to increased overloading forces acting on the ACL graft. Full article

Background/Objectives: The optimal graft, particularly in combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries, remains controversial. We evaluated the influence of graft choice between bone-patellar tendon-bone (BPTB) and hamstring autografts on clinical outcomes in combined ACL and MCL injuries. Methods: This retrospective analysis included patients with concurrent ACL and MCL injuries who underwent single-bundle ACL reconstruction with BPTB (group B) or hamstring (group H) grafts, between 2010 and 2019, with a ≥2-year follow-up. Patients were classified based on the MCL injury grade (I, II, or III). Clinical outcomes were assessed through knee stability evaluations using valgus stress radiographs and the KT-2000 arthrometer, patient-reported outcomes using the International Knee Documentation Committee (IKDC) subjective score and Lysholm score, and radiologic outcomes using the IKDC radiographic grade. Results: The study included 169 patients (group B, 92; group H, 77). No significant between-group differences in knee stability or functional outcomes were found after follow-up. Within the same MCL injury grade, particularly in high-grade MCL injuries, BPTB grafts resulted in significantly better medial stability (side-to-side difference in medial joint opening on valgus stress radiographs: grade II, p = 0.006; grade III, p = 0.039) and functional outcomes (IKDC subjective score: grade II, p = 0.045; grade III, p = 0.038) than hamstring grafts. In the hamstring group, higher-grade MCL injuries were associated with worse outcomes (Lysholm knee score, p = 0.009; IKDC subjective score, p = 0.015). Conclusions: Graft choice in ACL reconstruction with concomitant MCL injuries may affect clinical outcomes, particularly in high-grade MCL injuries. Although both graft types performed similarly overall, BPTB grafts provided superior medial stability and functional results in higher-grade MCL injuries. However, caution is needed when interpreting these results due to limitations such as the small sample size and the lack of randomization in graft selection. Full article