Background: Despite the high prevalence of anterior cruciate ligament (ACL) surgeries, standardized, evidence-based rehabilitation protocols remain lacking. Digital medical devices (DMDs) like the “Orthelligent” system have gained relevance as adjuncts to traditional physiotherapy, offering continuous, objective monitoring of functional recovery. Methods: A retrospective cohort analysis included 335 patients who underwent ACL reconstruction and used the “Orthelligent home” system between August 2022 and December 2024. In total, 5675 recorded test and exercise events were analyzed. Functional recovery was assessed using the Limb Symmetry Index (LSI) across five defined rehabilitation phases (0–4). All patients followed a structured rehabilitation program aligned with current clinical practice guidelines, supplemented by Orthelligent as a home-based digital tool for daily monitoring. Results: Significant functional improvement was observed during early rehabilitation phases, with the LSI increasing from 0.64 ± 0.02 in phase 0 to 0.81 ± 0.01 in phase 2 (p < 0.001). Time since surgery was a significant positive predictor (p = 0.034), while pain showed a strong negative impact on performance (p < 0.001). Anthropometric factors had no significant effect. Exercises associated with high rates of drop-out, pain, or difficulty were identified and linked to specific rehab phases. Conclusions: This study demonstrates that digital rehabilitation monitoring can reliably reflect patient progress after ACL reconstruction. The early postoperative period (first 3 months) is critical for functional gains, highlighting the need for individualized, pain-sensitive rehabilitation strategies.

Background: Osteochondral fractures (OCFs) following acute patellar dislocation significantly influence treatment decisions and long-term prognosis, yet reliable risk stratification remains elusive. This study aimed to identify demographic and trochlear morphology predictors of fracture occurrence in a large patient cohort. Methods: This retrospective analysis included 261 skeletally mature patients with acute patellar dislocation from 2000 to 2024 (mean age 24 ± 10 years, 59% male), excluding those with previous knee surgery, additional injuries, or skeletal immaturity. A comprehensive MRI assessment evaluated trochlear morphology (Dejour classification, sulcus angle, trochlear groove depth, and facet measurements) and patellofemoral alignment parameters (TT-TG distance, Q-angle, and congruence angle). Multivariate logistic regression identified independent risk factors for the development of osteochondral fractures. Results: Osteochondral fractures occurred in 133 patients (51% [of those undergoing MRI evaluation]). Male gender emerged as the strongest predictor (OR 2.38, 95% CI: 1.30–4.42, p = 0.005), followed by right-sided dislocation (OR 2.33, 95% CI: 1.21–4.58, p = 0.013). Notably, higher-grade trochlear dysplasia (Dejour Grades 3–4) was associated with lower fracture rates, being more common in non-fracture patients (27% vs. 10%, p = 0.003). Trochlear condyle asymmetry was also significant (OR 1.14, p = 0.004). Most patellofemoral alignment parameters, including TT-TG distance and Q-angle, showed no significant predictive value. Conclusions: Male gender and right-sided dislocation are associated with higher rates of osteochondral fracture after patellar dislocation. Patients with normal trochlear anatomy have higher fracture rates than those with severe dysplasia. These findings suggest that demographic factors and trochlear morphology should be considered in the diagnostic workup of acute patellar dislocations, though prospective validation is needed before implementing screening protocols.

Background/Objectives: To analyse postoperative pain trajectories after anterior cruciate ligament (ACL) reconstruction using data from a digital rehabilitation system, and to determine (i) whether combined ligament injuries are perceived as more painful than isolated ACL tears, (ii) which patient characteristics are associated with clinically relevant pain (visual analogue scale [VAS] > 5), and (iii) whether higher early pain is associated with later discontinuation of digital monitoring. Methods: This retrospective cohort study used routine data recorded by a validated sensor-based home rehabilitation system in patients after ACL reconstruction. This approach has previously been used to analyse functional recovery trajectories. All patients with ACL-related indications who performed at least one postoperative test were included and classified into four groups: isolated ACL rupture, ACL + meniscus, ACL + collateral ligament, and ACL + collateral ligament + meniscus. Pain during exercises and tests was recorded on a 0–10 VAS. High pain was defined as VAS > 5. Group comparison between indication types, anthropometric and activity-related variables and the proportion of high-pain events were performed using chi-square tests. Early pain (first postoperative month) was analysed in relation to the presence of later tests (≥3 months) to explore associations with discontinuation of digital monitoring. Results: Combined ligament injuries showed a significantly higher proportion of high-pain events during rehabilitation compared with isolated ACL ruptures (5.8% vs. 2.4%, overall p < 0.001). In particular, combined ligament injuries with ACL + collateral ligament rupture were associated with a greater share of VAS > 5 ratings in the early rehabilitation phases. No relevant association was observed between sex or BMI category and the occurrence of high pain, while age group showed an overall association without a consistent directional pattern. Sport activity level showed a strong relationship with high pain (p < 0.001). Early pain demonstrated a small but statistically significant negative correlation with later test participation (r = −0.15, approximately 2% of variance, p = 0.0076); however, this association was attenuated and no longer statistically significant when analysed using mixed-effects models accounting for within-patient clustering, indicating that patients with higher early pain tended to discontinue digital monitoring. Conclusions: Digital routine data after ACL reconstruction suggest that (i) combined ACL–collateral ligament injuries are perceived as more painful than isolated ACL tears, (ii) high postoperative pain is more closely related to activity level and injury pattern than to sex or BMI, while age group shows an overall but non-directional association, and (iii) higher early pain shows a weak bivariate correlation with digital disengagement that was not confirmed in mixed-effects models. Pain is therefore an exploratory marker warranting further investigation, rather than a confirmed independent predictor of adherence in app-based rehabilitation.

Background: Injury epidemiology in women’s football has primarily focused on elite athletes, whereas the amateur level, representing the vast majority of female players worldwide, remains largely under-explored. We aimed to provide a first prospective one-season characterisation of injuries in German amateur women’s football. Methods: In this prospective observational cohort study, 26 clubs comprising 450 female amateur players in Bavaria were monitored over the 2023/24 season using standardised time-loss injury questionnaires as used in current professional registry studies. Injuries were characterised by anatomical location, type, mechanism, and activity context (match vs. training); proportions are reported with 95% binomial exact confidence intervals (CI). Results: A total of 68 injuries were recorded. Regarding injuries with documented information, 66.7% (95% CI 54.0–77.8) were acute traumatic and 78.2% (95% CI 65.0–88.2) occurred during matches. Lower-extremity injuries dominated (80.3%; 95% CI 71.2–90.5), led by the knee as the single most frequent region (28.2%; 95% CI 18.1–40.1). Ligament injuries were the most common injury type (27.9%). Seven ACL ruptures were documented (10.3%; 95% CI 4.2–20.1), all of which occurred during match play. Indirect-contact mechanisms were significantly over-represented among all knee injuries (OR 6.92, 95% CI 1.52–31.6; p = 0.012). Conclusions: Amateur injury profile in this study reproduced the knee-centred, match-dominated pattern of elite female football while carrying a relative ACL burden at the upper end of professional reference data; given the small number of ACL events (n = 7), this signal is hypothesis-generating. These findings support the extension of structured neuromuscular prevention programmes into German amateur women’s football.