Multiligament knee injury (MLKI): an expert consensus statement on nomenclature, diagnosis, treatment and rehabilitation.

Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study.

Implementing Velocity-Based Training to Optimize Return to Sprint After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Clinical Commentary.

After anterior cruciate ligament reconstruction (ACLR), return to sprint is poorly documented in the literature. In soccer, return to sprint is an essential component of return to play and performance after ACLR. The characteristics of running in soccer are specific (velocity differences, nonlinear, intensity).

Sensorimotor Dysfunction Following Anterior Cruciate Ligament Reconstruction- an Afferent Perspective: A Scoping Review.

Background: Sensorimotor dysfunction is thought to occur following anterior cruciate ligament (ACL) injury which may have implications on future reinjury risk. Dysfunction has been demonstrated within the efferent component of the sensorimotor system. However, no reviews have examined the two main components of the afferent system: the visual and somatosensory systems.

Beware of the "Moving Target" - Uninvolved Limb Strength Increases to Exceed Preoperative Values During Rehabilitation After ACL Reconstruction in Male Professional and Recreational Athletes.

To describe the changes in quadriceps and hamstrings muscle strength in the uninvolved limb of male professional and recreational athletes during rehabilitation after anterior cruciate ligament reconstruction (ACLR) and compare to preoperative strength values. Prospective longitudinal study. During rehabilitation, 665 participants who underwent unilateral ACLR performed a strength test preoperatively and every 6 weeks after surgery for up to 9 months.

The MyJump App is a Valid Method of Assessing and Classifying Limb Symmetry During Recovery from Anterior Cruciate Ligament Reconstruction.

Background: Jump testing performance and limb symmetry measures are important metrics for clinicians to monitor during rehabilitation after Anterior Cruciate Ligament (ACL) reconstruction, however they require hardware and software which is not commonly available in clinical practice. Video-based solutions may present a feasible alternative, but their veracity in classifying patients using limb-symmetry of 90% has not been established, nor have the clinimetric values for the performance measures been reported in this population.

Purpose: To describe the diagnostic accuracy (pass/fail using 90% LSI) and clinimetrics of an iPad-based app ("MyJump") compared to reference force plate analyses for limb symmetry, jump/hop height, contact time, flight time, and reactive strength index.

Performance and symmetry measures during vertical jump testing at return to sport after ACL reconstruction.

Objective: Vertical jump tests are more sensitive in revealing asymmetries in performance metrics at the time of return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR) than horizontal hop tests. However, it remains unclear which vertical tests (bilateral or unilateral) and which metrics (kinetics or performance) are most effective in informing the rehabilitation status and readiness for return to sport. We aimed to investigate the status of athletes during vertical jump testing at return to sport after ACLR.

Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction.

This guideline was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR) and was performed in accordance with the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A Guideline Development Group systematically searched and reviewed evidence using randomised clinical trials and systematic reviews to evaluate the effectiveness of rehabilitation interventions and guide clinicians and patients on the content of the optimal rehabilitation protocol after ACLR.The guideline targets patients during rehabilitation after ACLR and investigates the effectiveness of the available interventions to the physiotherapist, alone or in combination (eg, exercise, modalities, objective progression criteria).

Movement Variability and Loading Characteristics in Athletes With Athletic Groin Pain: Changes After Successful Return to Play and Compared With Uninjured Athletes.

Background: Athletic groin pain (AGP) can lead to altered movement patterns during rapid deceleration and acceleration. However, the effect of AGP on movement variability and loading patterns during such actions remains less clear.

Purpose: To investigate, using a continuous lateral hurdle hop task, how movement variability and magnitude measures of 3-dimensional (3D) kinematic, kinetic, and vertical ground-reaction force (vGRF) variables are (1) affected by AGP (AGP vs uninjured controls [CON]) and (2) changed after successful rehabilitation (AGP prerehabilitation vs AGP postrehabilitation vs CON).

Angle-specific analysis of knee strength deficits after ACL reconstruction with patellar and hamstring tendon autografts.

After anterior cruciate ligament reconstruction (ACLR), there are differences in the neuromuscular deficits observed in patients with bone-patellar tendon-bone (BPTB) and with hamstring tendon (HT) autografts. The differences in knee extensor and flexor strength are commonly reported, but analyses have largely focused on peak torque metrics despite the requirement to generate torque through range when returning to sport. The aim of this study was to investigate the angle-specific strength and strength asymmetry differences between BPTB and HT around the time of return to play after ACLR.

Return to play in paediatric & adolescent patients following anterior cruciate ligament reconstruction.

Background: There is an increased risk of anterior cruciate ligament (ACL) rupture and subsequent ACL reconstruction in patients <18 years old due to their high levels of sporting participation.

Purpose: The purpose of this study was to assess the rate and timing of return to play (RTP) in paediatric and adolescent patients following ACL reconstruction, and to compare the outcomes between those undergoing ACL reconstruction with bone patella tendon bone autograft (BTB) and hamstring tendon (HT) autograft.

Study Design: Level of Evidence: Level III; Retrospective Comparative Cohort Study.

Biomechanical asymmetries differ between autograft types during unplanned change of direction after ACL reconstruction.

Nine months after anterior cruciate ligament (ACL) reconstruction, athletes who undergo surgery using a bone-patellar-tendon-bone (BPTB) autograft demonstrate higher loading asymmetries during vertical jumping than those with a hamstring tendon (HT) autograft. These asymmetries may transfer into sporting movements with a greater ACL injury risk. The aim of this study was to compare between-limb asymmetries in knee mechanics and task performance during an unplanned 90° change-of-direction (CoD) task in male field sport athletes reconstructed with BPTB or HT autografts.

Hip and groin pain prevalence and prediction in Elite Gaelic Games: 2703 male athletes across two seasons.

Objective: Hip and groin pain is highly prevalent in sub-elite Gaelic Athletic Association (GAA) athletes, but its prevalence at the elite level is unknown. The aims of this study were to report hip and groin pain prevalence in elite male athletes, to report changes in Copenhagen Hip and Groin Outcome Score (HAGOS) across two seasons and to assess if previous hip and groin pain or pre-season HAGOS could predict future hip and groin pain.

Methods: During the 2017 and 2018 pre-season male Gaelic Players Association (GPA) playing members were invited to complete two questionnaires.

Relationship Between Isokinetic Knee Strength and Single-Leg Drop Jump Performance 9 Months After ACL Reconstruction.

Background: Deficits in knee strength after anterior cruciate ligament reconstruction (ACLR) surgery are common. Deficits in the single-leg drop jump (SLDJ), a test of plyometric ability, are also found.

Purpose: To examine the relationship between isokinetic knee strength, SLDJ performance, and self-reported knee function 9 months after ACLR.

Validation of the Copenhagen Hip and Groin Outcome Score (HAGOS) using modern test theory across different cultures and languages: a cross-sectional study of 452 male athletes with groin pain.

Bkground: No studies have tested the validity of the Copenhagen Hip and Groin Outcome Score (HAGOS) using modern test theory, across different cultures and languages.

Objective: To validate the Danish, English and Norwegian versions of HAGOS and its six subscales (Symptoms (S, Item 1-7), Pain (P, Item 1-10), activities of daily living (Item 1-5), Sport and recreation (Sport/rec, Item 1-8), Participation in physical activity (item 1-2) and quality of life (item 1-5)) by evaluating differential item functioning (DIF) and measurement invariance across the three language versions in male multidirectional team athletes with groin pain. Second, to modify subscales depending on goodness-of-fit to the item response theory models and calculate conversion tables if language DIF was observed.

Movement strategy correspondence across jumping and cutting tasks after anterior cruciate ligament reconstruction.

There are currently a multitude of tests used to assess readiness to return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to establish the extent to which movement strategies transfer between three common assessment tasks to help improve design of athlete testing batteries following ACLR. A cohort of 127 male patients 8-10 months post-ACLR and 45 non-injured controls took part in the study.

Vertical jump impulse deficits persist from six to nine months after ACL reconstruction.

Later-stage rehabilitation following anterior cruciate ligament (ACL) reconstruction (ACLR) provides a valuable opportunity to target performance deficits before return to sport. This study aimed to: (1) evaluate bilateral counter-movement jump (CMJ) phase-specific impulse and isokinetic strength inter-limb asymmetry progression from 6 to 9 months post-ACLR; and (2) examine the extent to which individual changes in strength asymmetry could explain changes in impulse asymmetry. Male athletes ( = 44) with a hamstring tendon or bone-patellar tendon-bone autograft were tested 6 and 9 months post-ACLR.

The effect of meniscal pathology and management with ACL reconstruction on patient-reported outcomes, strength, and jump performance ten months post-surgery.

Background: The purpose of this study was to examine the differences in patient-reported outcome measures, isokinetic strength, plyometric ability and ability to meet return to play criteria ten months after anterior cruciate ligament (ACL) reconstruction surgery between those who underwent meniscectomy, those who underwent meniscal repair and those with no meniscal intervention alongside ACL reconstruction surgery.

Methods: Three hundred and thirteen athletes with clinically and radiologically confirmed ACL ruptures were included in this study. Participants were grouped according to their intra-operative procedures (isolated ACL reconstruction surgery n = 155, ACL reconstruction surgery with meniscectomy n = 128, ACL reconstruction surgery with meniscal repair n = 30).

Hip Muscle Strength Explains Only 11% of the Improvement in HAGOS With an Intersegmental Approach to Successful Rehabilitation of Athletic Groin Pain.

Background: Exercise-based rehabilitation targeting intersegmental control has high success rates and fast recovery times in the management of athletic groin pain (AGP). The influence of this approach on hip strength and lower limb reactive strength and how these measures compare with uninjured athletes (CON) remain unknown. Additionally, the efficacy of this program after return to play (RTP) has not been examined.

Return to Play After Patellar Tendon Autograft for Primary Anterior Cruciate Ligament Reconstruction in Rugby Players.

Background: There is scant literature on outcomes after anterior cruciate ligament (ACL) reconstruction in rugby players, and no prior study has evaluated the outcomes of bone-patellar tendon-bone (BTB) autograft ACL reconstruction.

Purpose: To assess the rate of return to play, the timing of that return, and the subsequent graft reinjury rate among rugby players after ACL reconstruction with BTB autograft.

Methods: The ACL registry at a single hospital was screened for professional and amateur rugby players who had undergone a primary ACL reconstruction with BTB autograft.

Biomechanical but Not Strength or Performance Measures Differentiate Male Athletes Who Experience ACL Reinjury on Return to Level 1 Sports.

Background: Performance measures such as strength, jump height/length, and change of direction (CoD) time during anterior cruciate ligament (ACL) rehabilitation have been used to determine readiness to return to play and identify those who may be at risk of rerupture. However, athletes may reach these criteria despite ongoing biomechanical deficits when performing these tests. Combining return-to-play criteria with an assessment of movement through 3-dimensional (3D) biomechanics in male field sports athletes to identify risk factors for ACL rerupture has not been explored previously.

Can Biomechanical Testing After Anterior Cruciate Ligament Reconstruction Identify Athletes at Risk for Subsequent ACL Injury to the Contralateral Uninjured Limb?

Background: Athletes are twice as likely to rupture the anterior cruciate ligament (ACL) on their healthy contralateral knee than the reconstructed graft after ACL reconstruction (ACLR). Although physical testing is commonly used after ACLR to assess injury risk to the operated knee, strength, jump, and change-of-direction performance and biomechanical measures have not been examined in those who go on to experience a contralateral ACL injury, to identify factors that may be associated with injury risk.

Purpose: To prospectively examine differences in biomechanical and clinical performance measures in male athletes 9 months after ACLR between those who ruptured their previously uninjured contralateral ACL and those who did not at 2-year follow-up and to examine the ability of these differences to predict contralateral ACL injury.