Editorial Commentary: Proper Anterior Cruciate Ligament Graft Choice Mitigates Against the Need for Anterolateral Ligament Reconstruction.

It is not coincidence that fervor surrounding anterolateral ligament (ALL) reconstruction increased as double-bundle anterior cruciate ligament reconstruction (ACLR) enthusiasm cooled. But perhaps we shifted our focus too soon, or perhaps we shifted our focus too much. But we must remember that the ACL is primary.

Trunk and lower extremity long-axis rotation exercise improves forward single leg jump landing neuromuscular control.

Background: Anterior cruciate ligament (ACL) injuries often involve sudden single leg loading with directional changes. Trunk and lower extremity (LE) load transfer and muscle power are directly coupled during these movements. The effect of trunk and LE long-axis rotation training on forward single leg drop jump landing and stabilization (FSLDJLS) was studied.

Return to sports bridge program improves outcomes, decreases ipsilateral knee re-injury and contralateral knee injury rates post-ACL reconstruction.

Purpose: To present the results of a return to sports bridge program designed to reduce knee injuries following ACL reconstruction and physical therapy.

Methods: One hundred and fifty (male = 83, female = 67) patients participated in a whole body neuromuscular control, progressive resistance strength and agility training program. Post-program testing included functional movement form, dynamic knee stability, lower extremity power, agility, and sports skill assessments.

Quadriceps tendon autograft ACL reconstruction has less pivot shift laxity and lower failure rates than hamstring tendon autografts.

Purpose: Quadriceps tendon (QT) autograft ACL reconstruction was hypothesized to possess less anterior knee laxity, pivot shift laxity, and lower failure rates than hamstring tendon (HT) autografts.

Methods: Terms "hamstring tendon autograft" and "ACL reconstruction" or "quadriceps tendon autograft" and "ACL reconstruction" were searched in Embase and PubMed. Inclusion criteria required that studies included patients treated for primary ACL injury with reconstruction using either a QT autograft (Group 1) or a HT autograft (Group 2) and instrumented anterior knee laxity assessment.

Isolated Patellofemoral Joint Arthroplasty: Can Preoperative Bone Scans Predict Survivorship?

Background: Isolated patellofemoral joint arthritis has been identified in 10% of the population presenting with symptomatic knee osteoarthritis. Patient selection is important in order to improve survivorship following PF arthroplasty. The purpose of this study is to compare the use of a preoperative bone scan vs a magnetic resonance imaging (MRI) to identify the patient with isolated PF arthritis.

Cruciate ligament healing and injury prevention in the age of regenerative medicine and technostress: homeostasis revisited.

Purpose: This clinical concepts paper discusses the essential elements of cruciate ligament recuperation, micro-trauma repair, and remodeling.

Methods: Cruciate ligament mechanobiology and tissue heterogeneity, anatomy and vascularity, and synovial membrane and fluid functions are discussed in relationship to deficiency-induced inflammatory responses, nervous and immune system function, recuperation, repair and remodeling, and modern threats to homeostasis.

Results: Cruciate ligament surgical procedures do not appreciate the vital linked functions of the central, peripheral, and autonomic nervous systems and immune system function on knee ligament injury recuperation, micro-trauma repair, and remodeling.

Tissue healing following segmental meniscal allograft transplantation: a pilot study.

Purpose: This in vivo histological study using an ovine model evaluated the 90-day healing of unilateral segmental meniscal allograft transplantation.

Methods: Fresh-frozen medial menisci were transplanted to replace the right medial meniscus of six female sheep. Tissue healing was evaluated using semi-quantitative, descriptive methods.

Medial meniscus grafting restores normal tibiofemoral contact pressures.

Background: Tissue excision in the setting of a meniscal tear has been shown to dramatically increase peak contact stresses in the affected tibiofemoral joint compartment, leading to the development of degenerative changes and osteoarthritis.

Purpose/hypothesis: The current in vitro study utilized a porcine model to evaluate the effectiveness of segmental medial meniscal grafting following partial meniscectomy. The study hypothesis was that the procedure would normalize medial tibofemoral joint compartment pressure magnitudes, areas, and locations relative to an intact meniscus.

Permanent knee sensorimotor system changes following ACL injury and surgery.

The cruciate ligaments are components of the knee capsuloligamentous system providing vital neurosensory and biomechanical function. Since most historical primary ACL repair attempts were unsuccessful, reconstruction has become the preferred surgery. However, an increased understanding of the efficacy of lesion-site scaffolding, innovative suturing methods and materials, and evolving use of biological healing mediators such as platelet-rich plasma and stem cells has prompted reconsideration of what was once believed to be impossible.

Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update.

Anatomical discoveries and a growing appreciation of the knee as a complex organ are driving innovations in patient care decision-making following anterior cruciate ligament (ACL) injury. Surgeons are increasing their efforts to restore combined mechanical-neurosensory ACL function and placing more consideration on when to reconstruct versus repair native anatomical structures. Surgical options now include primary repair with or without reinforcing the injured ACL with suture-based internal bracing, and growing evidence supports biological augmentation using platelet-rich plasma and mesenchymal stem cells to enhance tissue healing.

In situ comparison of varying composite tibial tunnel interference screws used for ACL soft tissue graft fixation.

Purpose: This mechanical study using an in vitro porcine model compared composite interference screw fixation of soft tissue ACL grafts in tibial tunnels.

Methods: Forty-eight porcine profundus tendons and tibiae were divided into four groups of 12 closely matched specimens. Equivalent diameter grafts were assigned to each group.

Lower extremity neuromuscular compensations during instrumented single leg hop testing 2-10 years following ACL reconstruction.

Background: This study compared lower extremity EMG activation and sagittal plane kinematics of subjects at a minimum of 2 years post-successful ACL reconstruction and rehabilitation during instrumented single leg hop testing.

Methods: Comparisons were made based on subject responses to the following question, "compared to prior to your knee injury how capable are you now in performing sports activities"? Group 1=very capable, Group 2=capable, and Group 3=not capable. In addition to EMG (1000 Hz) and kinematic (60 Hz) data, subjective knee function, internal health locus of control, sports activity characteristics (intensity, frequency) pre-knee injury, and at follow-up were also compared.

Preserving knee function following osteoarthritis diagnosis: a sustainability theory and social ecology clinical commentary.

To sustain natural systems, there must be an ongoing balance between environmental, social, and economic considerations. A key element of sustainability theory is to identify the most vulnerable surroundings. The most vulnerable knee tissue is the articular cartilage as it is the last line of osteoarthritis (OA) defense.

ACL double bundle linked cortical-aperture tibial fixation: a technical note.

Introduction: The purpose of this technical note is to describe the tibial fixation characteristics for an all-inside anatomic anterior cruciate ligament (ACL) reconstruction method that links extra-cortical button suspensory and aperture fixation replicating double bundle soft tissue graft function in single femoral and tibial sockets.

Materials And Methods: A 55° drill guide aligned guidewires in the ACL footprint center of 8 porcine tibiae (mean apparent bone mineral density = 1.15 g/cm(2)).

Outside-in continuous suturing is superior to interrupted suturing for repairing peripheral meniscus lesions: an in vitro biomechanical study using a porcine model.

Purpose: This in vitro biomechanical study using a porcine model compared peripheral longitudinal vertical meniscus lesion (PLVML) outside-in suture repair fixation strength using either interrupted or continuous "N" configuration No. 2-0 braided polyester sutures.

Methods: Porcine lateral menisci were randomly assigned to group 1 (continuous) or group 2 (interrupted).

Progressive resistance, whole body long-axis rotational training improves kicking motion motor performance.

Objectives: To evaluate lower extremity muscle activation, peak resultant ground reaction force (GRF) production and quickness during performance of a kicking motion following progressive resistance, whole body long-axis rotational training.

Design: Randomized, controlled study.

Setting: Kinesiological research laboratory.

Repair of peripheral vertical meniscus lesions in porcine menisci: in vitro biomechanical testing of 3 different meniscus repair devices.

Background: All-inside meniscus repair eliminates the need for an extra incision and decreases neurovascular injury risk. Biomechanical testing can help delineate the efficacy of all-inside device use.

Hypothesis: There would be no group differences between 4 peripheral meniscus repair techniques and 3 different devices tested.

Viscosupplementation with hyaluronic acid in the treatment for cartilage lesions: a review of current evidence and future directions.

Diseases involving the articular cartilage are one of the leading causes of physical impairment among the adult population. While surgical technique and advancement have allowed us effective means at treating these diseases, this is not without significant risk and morbidity. With a very solid safety profile, viscosupplementation with hyaluronic acid (HA) derivatives has become an excellent modality for treating diseased articular cartilage.

Sports involvement following ACL reconstruction is related to lower extremity neuromuscular adaptations, subjective knee function and health locus of control.

Purpose: This retrospective study compared the influence of perceived sports involvement on lower extremity neuromuscular adaptations during single-leg countermovement jumping (CMJ), perceived knee function and internal health locus of control (HLOC) scores at a minimum 2-year post-anterior cruciate ligament reconstruction. The hypothesis was that subjects with higher-level sports involvement would display significant differences compared to subjects with lower-level sports involvement.

Methods: Uninvolved and involved lower extremity EMG amplitude (1,000 Hz), vertical ground reaction force (VGRF) (500 Hz) and kinematic (60 Hz) displacement differences were determined during single-leg CMJ.

"Figure 8" single socket double bundle ACL technique.

Using single femoral and tibial tunnels, we describe a technique of anatomically recreating the anteromedial and posterolateral anterior cruciate ligament (ACL) bundles. Transtibial, flexible reamers are utilized to create a "Figure 8" notched tunnel thereby recreating the anatomic footprint of the femoral insertion of the ACL. Rotational control of the individual bundles is created via the notched tunnel and each bundle is tensioned to 80 N individually.

Cyclic test comparison of all-inside device and inside-out sutures for radial meniscus lesion repair: an in vitro porcine model study.

Purpose: To compare biomechanical fixation and gapping characteristics of a new all-inside meniscus repair method for radial meniscus lesion repair versus conventional inside-out suture repair under submaximal cyclic loading and load-to-failure test conditions.

Methods: Fresh-frozen porcine tibiae with attached lateral menisci and joint capsules were harvested and stored for 48 hours at -20°C. After thawing for 12 hours, equivalent-size healthy specimens were randomly assigned to 2 groups of 8 specimens each.