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Advancements in Anterior Cruciate Ligament Injury: From Diagnosis to the Return-to-Sports

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Sports Medicine".

Deadline for manuscript submissions: closed (15 December 2024) | Viewed by 6770

Special Issue Editors

Dr. Alexandre Hardy

E-Mail Website
Guest Editor
Clinique du Sport, Universidad de París V Descartes, 75005 Paris, France
Interests: sports medicine; anterior cruciate ligament reconstruction (ACLR); timing of ACLR; ramp lesion; meniscal lesion; lateral extraarticular procedure; hamstring surgery; ankle reconstruction
Dr. Nicolas Bouguennec

E-Mail Website
Guest Editor
Clinique du Sport de Bordeaux-Merignac, 33700 Merignac, France
Interests: sports medicine; anterior cruciate ligament reconstruction (ACLR); timing of ACLR; ramp lesion; meniscal lesion; lateral extraarticular procedure; hamstring surgery; ankle reconstruction

Special Issue Information

Dear Colleagues,

Anterior cruciate ligament (ACL) reconstruction remains a critical aspect of orthopedic sports medicine, as the ACL is the most reconstructed ligament in the body. The evolution of ACL reconstruction has seen remarkable advancements from traditional techniques to more anatomically aligned and biomechanically sound procedures, enhancing patient outcomes and reducing recovery times.

Furthermore, the integration of techniques such as the lateral extra-articular procedure (LEAP) has further tailored the approach to patients with high rotational instability and shows promising results in reducing re-rupture rates. Despite these advancements, challenges remain, such as the ideal indications for LEAPs; the long-term impact of these procedures, such as osteoarthritis and stiffness; the effective management of complex multiligament injuries; and optimizing the timing and techniques of ACL reconstruction. New techniques and materials in ACL reconstruction are continually evolving, from biologic augmentations to novel imaging and post-operative protocols. The aim is to ensure the highest return-to-sports rate, at the same pre-injury level, with the least risk of re-rupture.

To enable this, we are soliciting original research articles, reviews, cohort studies, and meta-analyses that contribute to understanding ACL injuries from diagnosis to the return to sports.

Dr. Alexandre Hardy
Dr. Nicolas Bouguennec
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • anterior cruciate ligament reconstruction (ACLR)
  • timing of ACLR
  • ramp lesion
  • meniscal lesion
  • lateral extra-articular procedure

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Published Papers (5 papers)

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9 pages, 964 KiB  
Article
Tensile Strength of the Achilles Tendon Allograft: A Comparative Study of Graft Preparation Technique
by Grace E. Thiel, Tyler D. Perleberg, Troy B. Puga, Benedict F. Figuerres, Ganesh Thiagarajan and Jennifer F. Dennis
J. Clin. Med. 2024, 13(21), 6488; https://doi.org/10.3390/jcm13216488 - 29 Oct 2024
Viewed by 699
Abstract
Background/Objectives: The Achilles tendon is a popular allograft option for anterior cruciate ligament (ACL) reconstruction. Structurally, the tendon is known to have a 90-degree rotational fiber track. Preparation techniques, with this consideration, may influence the strength of the graft. This study aims [...] Read more.
Background/Objectives: The Achilles tendon is a popular allograft option for anterior cruciate ligament (ACL) reconstruction. Structurally, the tendon is known to have a 90-degree rotational fiber track. Preparation techniques, with this consideration, may influence the strength of the graft. This study aims to assess the tensile strength of a novel Achilles tendon allograft harvest procedure following the rotational fiber track. Methods: Both Achilles tendons were harvested from formalin-embalmed cadavers [(n = 20), male n = 13, female n = 7, average age = 70]. Ten cadavers had the right Achilles as the control and the left Achilles as the fiber track sample; 10 cadavers had the opposing designation. Tensile strength was tested utilizing a Bose machine. An unpaired t-test was used to compare data across groups. Results: The average ultimate load for the control group was 874.17 N, with an average elastic stiffness of 76.01 N/mm. The ultimate load for the fiber track group was 807.84 N, with an average elastic stiffness of 64.75 N/mm. No statistically significant difference (p = 0.21) was determined between the average ultimate loads or elastic loads (p = 0.18) across groups. Conclusions: These data suggest that the rotational fiber track method of Achilles allograft has consistent tensile strength and elastic stiffness as compared to the common harvest procedure. The rotational fiber track method for ACL harvesting is a viable alternative option to the common harvest procedure for usage in an ACL reconstruction. Full article
(This article belongs to the Special Issue Advancements in Anterior Cruciate Ligament Injury: From Diagnosis to the Return-to-Sports)
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11 pages, 1806 KiB  
Article
Infratubercle Anterior Closing Wedge Osteotomy Corrects Sagittal Alignment without Affecting Coronal Alignment or Patellar Height
by Shintaro Onishi, Youngji Kim, Hiroshi Nakayama, Alfred A. Mansour III, Walter R. Lowe and Matthieu Ollivier
J. Clin. Med. 2024, 13(16), 4715; https://doi.org/10.3390/jcm13164715 - 11 Aug 2024
Cited by 1 | Viewed by 1043
Abstract
Background: Excessive posterior tibial slope (PTS) has been associated with a higher risk of graft failure after anterior cruciate ligament reconstruction (ACLR). Although anterior closing wedge osteotomy (ACWO) can reduce the PTS, it may also change the coronal alignment and patellar height. Purpose: [...] Read more.
Background: Excessive posterior tibial slope (PTS) has been associated with a higher risk of graft failure after anterior cruciate ligament reconstruction (ACLR). Although anterior closing wedge osteotomy (ACWO) can reduce the PTS, it may also change the coronal alignment and patellar height. Purpose: To elucidate the radiological outcomes after infratubercle ACWO, specifically to evaluate its influence on perioperative changes in patellar height. Methods: Patients who underwent infratubercle ACWO with combined ACLR with a minimum follow-up of 3 months were included. Surgery was indicated when the PTS was greater than 12°. Radiological evaluation included measurements of the hip–knee–ankle angle (HKA), PTS, femoral patellar height index (FPHI), and Caton–Deschamps index (CDI) preoperatively and 3 months postoperatively. Patellar height was classified as patella baja, normal, or alta based on CDI values. Knee recurvatum was measured preoperatively and at final follow-up. Results: A total of 21 patients with a mean age of 21.6 ± 3.0 years were included. Although HKA did not significantly change, significant corrections were achieved in the PTS from 14.5° ± 1.6° to 5.7° ± 1.0° (p < 0.001). No significant change in FPHI was found (preoperative: 1.33 ± 0.11 vs postoperative: 1.30 ± 0.09). Patellar height categories showed no significant differences pre- and postoperatively, while three patients (14.3%) changed their patellar height category (all moved up one category). Knee recurvatum increased significantly from 4.9° ± 2.9° preoperatively to 7.8° ± 3.1° at the final follow-up (p < 0.001). Conclusions: Precise sagittal correction was achieved after infratubercle ACWO without altering the coronal alignment and patella height. Level of Evidence: IV, Case series. Full article
(This article belongs to the Special Issue Advancements in Anterior Cruciate Ligament Injury: From Diagnosis to the Return-to-Sports)
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13 pages, 538 KiB  
Article
Correlation between Anterior Cruciate Ligament–Return to Sport after Injury Score at 6 Months after Anterior Cruciate Ligament Reconstruction and Mid-Term Functional Test Results: An Observational Study at 5-Year Follow-Up
by Alexis Gerfroit, Thibault Marty-Diloy, Pierre Laboudie, Nicolas Graveleau and Nicolas Bouguennec
J. Clin. Med. 2024, 13(15), 4498; https://doi.org/10.3390/jcm13154498 - 1 Aug 2024
Cited by 1 | Viewed by 1329
Abstract
Background/Objectives: Evaluations allowing patients to return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) should be multimodal, including a psychological evaluation. The goal of this study was to determine if there is a correlation between the ACL–return to sport after injury [...] Read more.
Background/Objectives: Evaluations allowing patients to return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) should be multimodal, including a psychological evaluation. The goal of this study was to determine if there is a correlation between the ACL–return to sport after injury (ACL-RSI) score at 6 months post-ACLR and mid-term functional results. Methods: A total of 498 patients were assessed 6 months after primary ACLR using a composite test including isokinetics, hops, and ACL-RSI. A minimum of 3 years of follow-up was necessary. At the last follow-up, each patient completed clinical and functional evaluations, including the subjective International Knee Documentation Committee (IKDC) score, Tegner Activity Scale, Self Knee Value (SKV), and ACL-RSI score. The results were compared overall and item by item. Results: At the last follow-up, the mean SKV, Tegner, IKDC, and ACL-RSI scores were 86.8 ± 14.3%, 6 ± 2.1, 77 ± 11.9%, and 68.8 ± 25.7%, respectively. A significant correlation existed between the 6-month ACL-RSI score and each functional test (respectively, ρ = 0.189 p < 0.001; ρ = 0.174 p < 0.001; ρ = 0.237 p < 0.001). The ACL-RSI score was significantly higher than at 6 months after surgery (p < 0.001). Over half (59.2%) of the cohort returned to an equal or greater level of activity, and there was a significant correlation between the 6-month ACL-RSI score and post-surgery level of activity. Conclusions: Patients with better ACL-RSI scores at 6 months post-ACLR have better functional results in the medium term and are more likely to RTS. Our results show a correlation between psychological factors at 6 months, measured through the ACL-RSI score, and activity level at mid-term follow-up. This study underlines the relationship between RTS and psychological effects, and the importance of ACLR rehabilitation to focus on decreasing apprehension and fear. Full article
(This article belongs to the Special Issue Advancements in Anterior Cruciate Ligament Injury: From Diagnosis to the Return-to-Sports)
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16 pages, 2268 KiB  
Article
Combined Anterolateral Ligament Reconstruction Results in Better Knee Stability and More Satisfactory Subjective Outcomes in Non-Athlete Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction
by Se-Han Jung, Ji-Soo Park, Min Jung, Kwangho Chung, Tae-Ho Ha, Chong Hyuk Choi and Sung-Hwan Kim
J. Clin. Med. 2024, 13(14), 4087; https://doi.org/10.3390/jcm13144087 - 12 Jul 2024
Viewed by 1049
Abstract
Background: Consensus has not yet been reached regarding combined anterior cruciate ligament reconstruction (ALLR) with revisional anterior cruciate ligament reconstruction (RACLR). We aimed to compare the clinical outcomes between patients who underwent isolated RACLR and those who underwent RACLR combined with ALLR. [...] Read more.
Background: Consensus has not yet been reached regarding combined anterior cruciate ligament reconstruction (ALLR) with revisional anterior cruciate ligament reconstruction (RACLR). We aimed to compare the clinical outcomes between patients who underwent isolated RACLR and those who underwent RACLR combined with ALLR. Methods: Between June 2010 and June 2021, 49 patients who underwent RACLR were retrospectively reviewed over a 24-month follow-up. Patients were categorized into the isolated RACLR (n = 37, group 1) or combined ALLR group (n = 12, group 2). Clinical outcomes were evaluated with several patient-reported outcome measures (PROMs) and minimal clinically important differences (MCIDs) for each PROM. The side-to-side difference (SSD) of the anterior instability was measured. The pivot-shift test was performed. Results: Baseline characteristics showed no differences between the groups. PROMs showed no significant differences between the groups at the 2-year follow-up. Group 2 was superior to group 1 in the MCID achievement rate for Lysholm knee and International Knee Documentation Committee (IKDC) subjective scores at 24 months postoperatively. At the final follow-up, the proportion of IKDC grade A in SSD for anterior laxity was higher in group 2 than in group 1 (58.3% versus [vs.] 18.3%, p = 0.009), and the proportion of pivot-shift grade 0 was also higher in group 2 (66.7% vs. 27.0%, p = 0.013). The “near return to activity” rate was also higher in group 2 than in group 1 (83.3% vs. 45.9%, p = 0.043). Conclusions: Combining ALLR with RACLR in non-athletes results in a higher proportion of patients with less mechanical graft failure and satisfactory clinical outcomes. Full article
(This article belongs to the Special Issue Advancements in Anterior Cruciate Ligament Injury: From Diagnosis to the Return-to-Sports)
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20 pages, 715 KiB  
Systematic Review
Sure Steps: Key Strategies for Protecting Basketball Players from Injuries—A Systematic Review
by Yoel Antoranz, Eduardo Sáez de Villarreal, Juan del Campo Vecino and Sergio L. Jiménez-Saiz
J. Clin. Med. 2024, 13(16), 4912; https://doi.org/10.3390/jcm13164912 - 20 Aug 2024
Viewed by 2139
Abstract
Background: Basketball is a high-intensity sport, which includes actions such as jumping, changes of direction, accelerations, and decelerations, which generates fatigue situations that may increase the risk of injury. Specifically, the joints at greatest risk are the ankle and knee, with ankle sprains [...] Read more.
Background: Basketball is a high-intensity sport, which includes actions such as jumping, changes of direction, accelerations, and decelerations, which generates fatigue situations that may increase the risk of injury. Specifically, the joints at greatest risk are the ankle and knee, with ankle sprains and anterior cruciate ligament (ACL) tears being the most prevalent injuries. There are several strategies aimed at reducing the incidence, based on training methods or other prophylactic measures. Therefore, the purpose of the study is to perform a systematic review of the different injury prevention strategies in competitive-level basketball players with respect to general injuries, ankle sprains, and ACL injuries. Methods: For this purpose, the PRISMA methodology was applied, performing a search in three databases (PubMed, SPORTDiscus, and Cochrane) between 25 September 2023 and 8 October 2023. Results: A total of 964 articles were identified, out of which 283 were duplicates and 644 were discarded. Out of the remaining 37, 23 were excluded because they did not meet the inclusion criteria; therefore, 14 articles were finally included. With respect to general injuries, 8 out of 14 studies reviewed them. Concerning ankle sprains, 7 studies specifically analyzed them. Finally, 3 studies focused on ACL injuries. Conclusions: Training programs that combine different contents, known as neuromuscular training, including strength work, stabilization or core, mobility, and agility are the most effective for both general injuries and ACL injuries. For ankle sprains, the most effective measures are training programs based on analytical ankle stability exercises and the use of ankle braces. Adherence to prevention programs is essential, so they can be included as part of the warm-up. Other strategies such as training load control, functional assessment, or rule modification are not used in the included articles, so their effectiveness as prophylactic methods could not be justified. Full article
(This article belongs to the Special Issue Advancements in Anterior Cruciate Ligament Injury: From Diagnosis to the Return-to-Sports)
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