To assess the level of agreement among experts on the heel raise exercise parameters that influence midportion and insertional Achilles tendinopathy (AT) rehabilitation outcomes. An international expert panel in AT rehabilitation was invited to complete a three-round Delphi survey. In the first two rounds, experts were asked to review a pregenerated list of exercise parameters (based on the heel raise exercise) and rate their perceived influence on rehabilitation outcome, using a 5-point Likert scale. For each parameter, consensus criteria for major influence on rehabilitation were (a) median≥4, (b) ≥75% of scoring 4 or 5 and (c) IQR≤1. The third round aimed to rank the exercise parameters according to importance (from most to least important) during rehabilitation. 17 experts participated in the entire Delphi process. A total of 16 exercise parameters were assessed, of which 4 (intensity of contraction, total time under tension, number of repetitions and sets, type of contraction) reached consensus as having a major influence on rehabilitation for midportion AT and 3 reached consensus for insertional AT (range of ankle dorsiflexion during the exercise, intensity of contraction, number of repetitions and sets). The rankings of parameters that reached consensus showed that contraction intensity was perceived as the most important variable for midportion AT rehabilitation, while range of ankle dorsiflexion was deemed the most important variable for insertional AT rehabilitation. This study identified key exercise parameters for mid-portion and insertional AT rehabilitation based on expert opinion. This information should assist practitioners in optimising their approach to deliver more effective, patient-specific exercises for AT rehabilitation.

Background: Arthrogenic muscle inhibition (AMI), anterior knee laxity, and kinesiophobia are key barriers to recovery after anterior cruciate ligament reconstruction (ACLR). While each has been independently studied, their interrelationships during the early postoperative phase remain unclear. Methods: This cross-sectional study included 56 patients (mean age: 26.5 ± 5.7 years) who underwent ACLR using hamstring autografts. Clinical AMI grading, GNRB^® arthrometer measurements of anterior tibial translation, and the Tampa Scale for Kinesiophobia-11 (TSK-11) were used to assess neuromuscular inhibition, mechanical laxity, and psychological fear, respectively. All evaluations were performed at 34.9 ± 4.2 postoperative days. Statistical analyses included one-way ANOVA, Kruskal–Wallis, and Spearman correlation. Results: No significant differences in TSK-11 scores were observed across AMI grades (p = 0.327). Similarly, anterior laxity did not differ significantly between AMI groups (p = 0.182). Correlation between GNRB measurements and TSK-11 scores was non-significant (rho = −0.220, p = 0.103). Conclusions: In the early phase following ACLR, AMI, anterior laxity, and kinesiophobia appear to be independent domains. These findings suggest that early postoperative rehabilitation should address each dimension individually. Further longitudinal studies are needed to explore their potential interactions over time.

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.

Background: Modifiable risk factors for anterior cruciate ligament (ACL) injury and re-injury have been widely investigated to inform rehabilitation strategies and return-to-sport decision-making. However, less attention has been given to the electromyographic (EMG) activity of the triceps surae after ACL injury and reconstruction. Hypothesis/Purpose: The primary objective of this study was to compare triceps surae EMG activity during single-leg jumping tasks between individuals who had undergone ACLR and healthy controls. The secondary objective was to examine whether any observed neuromuscular differences were present bilaterally within the ACLR group. It was hypothesized that individuals after ACLR would demonstrate lower triceps surae EMG activity compared with healthy controls and that any observed differences would also be present in the non-operated limb. Study Design: Cross-sectional case–control study. Methods: Twelve individuals with ACLR (mean 5.6 ± 0.7 months postoperatively) and nine healthy controls performed four trials of single-leg countermovement jump (SLCMJ) and single-leg drop jump (SLDJ) tasks. Bilateral surface EMG activity of the triceps surae muscles (gastrocnemius medialis, gastrocnemius lateralis, and soleus) was recorded and normalized to maximal voluntary isometric contraction (% MVIC). For the SLCMJ, peak EMG activity during the propulsion phase was analyzed, whereas for the SLDJ, mean EMG activity was computed over a 0.5-second window preceding peak EMG following ground contact. Between-group and between-limb comparisons were performed using independent and paired t-tests (α = 0.05). Results: Compared with controls, individuals after ACLR demonstrated significantly lower soleus EMG activity during both SLCMJ (p < 0.01) and SLDJ (p = 0.02). Gastrocnemius medialis activity was also significantly lower in the ACLR group during the SLDJ (p < 0.01), whereas no significant differences were observed for gastrocnemius lateralis. No statistically significant differences were found between the operated and non-operated limbs within the ACLR group (all p > 0.05). Conclusion: Individuals with ACLR demonstrate lower triceps surae EMG activity during single-leg jumping tasks, particularly for the soleus. These findings suggest the presence of altered neuromuscular patterns that may be bilateral and muscle specific. Level of Evidence: Level 3, cross-sectional case–control study.