Anterior cruciate ligament (ACL) injuries are among the most common and debilitating knee injuries in professional athletes with an incidence in females up to eight-times higher than their male counterparts.
Introduction. Anterior Cruciate Ligament (ACL) injury prevention programs can reduce injury risk in various sports. The perception of
Introduction. Perception of
Abstract. Introduction. Perception of
Background: Anterior cruciate ligament (ACL) injury and re-injury rates are high and continue to rise in adolescents. After surgical reconstruction, less than 50% of patients return to their pre-injury level of physical activity. Clearance for return-to-play and rehabilitation progression typically requires assessment of performance during functional tests. Pain may impact this performance. However, the patient's level of pain is often overlooked during these assessments. Purpose: To investigate the level of pain during functional tests in adolescents with
Limb symmetry on a battery of functional tests is becoming more common as a clinical rehabilitation tool serving as a proxy assessment for readiness to return to sport following anterior cruciate ligament reconstruction (ACLR). The predictive capability of each included test for determining the likelihood of a second
Anterior cruciate ligament (ACL) ruptures are debilitating injuries, often managed via ACL reconstruction (ACLR). Reduced range of motion (ROM), particularly loss of extension (LOE), is the most significant contributor to post-operative patient dissatisfaction. LOE may preclude return to sport, increase re-rupture rates and precipitate osteoarthritis. Passive LOE rates following ACLR have been reported at 15%. However, LOE incidence during active tasks are poorly characterised. Our review sought to determine knee extension angles for active tasks following an
A quick, portable and reliable tool for predicting
Aims. The aim of this study was to estimate the incremental use of resources, costs, and quality of life outcomes associated with surgical reconstruction compared to rehabilitation for long-standing anterior cruciate ligament (ACL) injury in the NHS, and to estimate its cost-effectiveness. Methods. A total of 316 patients were recruited and randomly assigned to either surgical reconstruction or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment). Healthcare resource use and health-related quality of life data (EuroQol five-dimension five-level health questionnaire) were collected in the trial at six, 12, and 18 months using self-reported questionnaires and medical records. Using intention-to-treat analysis, differences in costs, and quality-adjusted life years (QALYs) between treatment arms were estimated adjusting for baseline differences and following multiple imputation of missing data. The incremental cost-effectiveness ratio (ICER) was estimated as the difference in costs divided by the difference in QALYs between reconstruction and rehabilitation. Results. At 18 months, patients in the surgical reconstruction arm reported higher QALYs (0.052 (95% confidence interval (CI) -0.012 to 0.117); p = 0.177) and higher NHS costs (£1,017 (95% CI 557 to 1,476); p < 0.001) compared to rehabilitation. This resulted in an ICER of £19,346 per QALY with the probability of surgical reconstruction being cost-effective of 51% and 72% at a willingness-to-pay threshold of £20,000 and £30,000 per QALY, respectively. Conclusion. Surgical reconstruction as a management strategy for patients with long-standing
Background. Non-contact anterior cruciate ligament (ACL) injuries occurs with a higher incidence in female athletes compared with males after the onset of puberty. One anatomical factor with clinically observable differences between males and females is lower extremity alignment. The knee joint valgus in the coronal plane, which is associated with
Anterior cruciate ligament (ACL) injuries are frequent among athletes and a leading cause of time away from competition. Stability of the knee involves the ACL for limiting anterior tibial translation and the ALL (anterolateral ligament) to restrain internal rotation of the tibia. Present indications for treatment with a combined ACL-ALL reconstruction remain unclear and mostly subjective. We mathematically modeled the tibial plateau geometry to try and identify patients at risk of
Purpose: The aim of the study was to evaluate whether the recognition rates of
This study set out to determine the incidence of avulsion of the posterior horn of the lateral meniscus in isolated
Background. Return to sports after anterior cruciate ligament reconstruction (ACLR) is multifactorial and rotational stability is one of the main concerns. Anterolateral ligament reconstruction (ALLR) has been recommended to enhance rotational stability. Purpose. To assess the effect of ALLR on return to sports. Study Design. Retrospective comparative cohort study;. Level of evidence: III. Methods. A total of 68 patients who underwent ACLR after acute
We aim to identify any changes in the demographics of ACL injured patients over the last decade. Over a twelve month period, the demographic data from 117 consecutive new patients with
Aims: To identify any changes in the demographics of ACL injured patients over the last decade. Methods: Over a twelve month period, the demographic data from 117 consecutive new patients with
The purpose of the present study is to determine a correlation between articular cartilage changes and underlying bone contusions in ACL-deficient knees. Analysis of surgical and MRI findings in thirty-seven knees shows that medial femoral condyle and medial tibial plateau bone contusions, present in 30% of
Introduction Late degeneration of the ACL injured knee may be in part due to repeat injury, but also due to aberrant kinematics altering the wear pattern at the chondral surface. The aim of this study was to use tibio-femoral contact mapping by MRI to examine kinematic changes due to chronic ACL deficiency. Methods Twenty-three subjects with a history of chronic ACL deficiency (mean 18 years since injury) performed a closed chain leg press, relaxed and against a 15 kilogram weight. MRI recorded the tibio-femoral contact position at 15° intervals from 0° to 90° of knee flexion. Intra-articular pathology was assessed for all subjects by MRI, and at arthroscopy for 10 subjects. Results The tibio-femoral contact pattern of the ACL injured knee differed from the healthy contralateral knee (p=0.003). This difference was greatest in the medial compartment, particularly at 0° and 15° of knee flexion (p<
0.01), with the femur two millimetres (mean, SD 3.2 mm) posterior on the tibial plateau. Damage to the chondral surface was seen in the medial compartment in 16 subjects and lateral compartment in 12; medial meniscus damage was present in 16 subjects and lateral meniscus in 15. Chondral surface damage correlated with the difference in the tibio-femoral contact pattern between the healthy and injured knee in the medial compartment of the knee. Joint damage was not related significantly to time since injury, or Cincinnati knee score. Joint damage was related to level of sports participation, but probably indicates that as the joint failed, subjects curtailed their activity. Conclusions The kinematic consequences of chronic
Introduction and Aims: Late degeneration of the ACL injured knee may be in part due to repeat injury, but also due to aberrant kinematics altering the wear pattern at the chondral surface. The aim of this study was to use tibio-femoral contact mapping by MRI to examine kinematic changes due to chronic ACL deficiency. Method: Twenty subjects with a recent unilateral ACL deficiency (mean 13 months since injury) and 23 subjects with a chronic ACL deficiency (mean 18 years since injury) were recruited. Passive ligament laxity was quantified using a KT1000® device. Subjects performed a closed-chain leg press, relaxed and against a 15 kg weight. MRI recorded the tibio-femoral contact position at 15-degree intervals from zero to 90 degrees of knee flexion. Tibio-femoral contact points were measured at each position. Damage to the knee was recorded for all subjects by MRI, and at arthroscopy. Results: The tibio-femoral contact pattern of the ACL injured knee was different from the healthy contralateral knee (p = 0.001). The contact pattern of the recently injured knees was different to the chronic ACL deficient knees (p = 0.034). In the recently injured knees the lateral compartment of the knee showed a posterior pattern of femoral contact, and in the chronic ACL deficient knees the medial compartment showed a posterior femoral contact pattern, particularly at zero and 15 degrees of knee flexion (p <
0.01), with the femur two millimetres (mean, SD 3.2mm) posterior on the tibial plateau. There was no difference in passive laxity between the recent and chronic injured knees (side-to-side difference: 5.8mm±2.4 for the recently injured knees, and 4.6±2.8mm for the chronic ACL-deficient knees). Nine of 20 recently injured knees had associated joint damage: three medial and three lateral meniscal tears, two with medial femoral condyle and two with patello-femoral damage. Eleven of 23 chronic ACL deficient subjects had associated joint damage: 15 medial and 16 lateral meniscus tears, 16 with medial and 12 with lateral compartment chondral damage. Greater kinematic changes in the chronic ACL deficient knees were associated with more severe chondral damage in the medial compartment. Conclusion: