To determine the functional recovery, active reincorporation, and anteroposterior and rotational stability of patients undergoing anterior cruciate ligament (ACL) reconstruction using arthroscopy techniques with simple-bundle (SB) or double-bundle (DB). The following databases were searched: PubMed, Embase (Elsevier platform), the Cochrane Central Register of Controlled Trials (Wiley platform), Web of Science, and CINAHL. Level I and II studies involving anterior cruciate ligament arthroscopy were included in the search. Records were screened by title and abstract and assessed the risk of bias of selected studies. Meta-analyses using RevMan 5.3 software were conducted on the following outcomes: knee functionality, objective measurements of knee stability, rotational knee stability and knee anterior stability, sports reincorporation, and subjective assessments. Twenty-four studies of patients undergoing ACL reconstruction were included in the qualitative and quantitative synthesis (1707 patients) for Lysholm score, Subjective International Knee Documentation Committee (IKDC) score, Tegner score, KT-1000/2000, Lachman test, Objective IKDC score, and Pivot-Shift test. A return to pre-injury level showed a significant decrease in the Lysholm score (mean difference, − 0.99; 95% CI − 1.71 to − 0.40; P = 0.007) and Tegner score (mean difference, − 0.07; 95% CI, − 0.13 to − 0.01; P = 0.02) at DB reconstruction, similar to the knee functionality outcome of the subjective IKDC score (mean difference − 1.42; 95% CI − 2.46 to − 0.38; P = 0.007). There is no clear or significant difference in clinical stability and knee function or in sports incorporation with the true difference occurring in the subjective assessment.

To measure the impact of training models on injury incidence, data of health and performance were integrated to study fiber adaptation during a competitive season. We studied football players over a season, analyzing hours of exposure to sport by serum changes in fast and slow myosin, creatine kinase and lactate dehydrogenase. A new assay was developed to measure the myosin isoforms in 49 non-sporting volunteers and in 27 professional football players. Myosin isoforms in volunteers with mean ages of 30±8 were 1553 µg/L fast and 1284 µg/L slow; in the group with of 56±7 were 1426 µg/L fast and 1046 µg/L slow. Slow myosin was significantly lower in older subjects (-18%). Samples from the players in preseason had lower mean scores for fast myosin (1123 µg/L) and higher for slow myosin (2072 µg/L) than reference volunteers. During the season, myosins reached the maximum with the maximum load (1537 µg/L fast, 2195 µg/L slow but decreased and adapted to the high level of demand (425 µg/L fast, 1342 µg/L slow). CK and LDH were maximal at the pre-season (227 U/L, 333 U/L) while myosin levels were maximal at the beginning of season (1537 µg/L, 2195 µg/L). Measuring serum myosin isoforms we identify the type and amount of damage caused by training and matches, making it a new control tool capable of advising training towards a minimum of blood slow myosin but controlling the fast fiber participating and be able to improve the performance of the players.

Background: Posterolateral corner (PLC) lesions and knee dislocations (KDs) have been recognized as risk factors for vascular and neurological injuries in patients with multiligament knee injury (MLKI), but an association between Schenck KD grade and neurovascular lesions has yet to be established. Hypothesis: The ligamentous injury pattern in MLKIs with high KD grades will be associated with a higher likelihood of vascular and neurological injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 144 patients from a multicenter database with surgically treated MLKI. All patients were skeletally mature, had MLKI lesion identified on magnetic resonance imaging and confirmed intraoperatively, and did not have any previous knee surgery or previous vascular or neurological lesions. Demographic data (sex, age), injury mechanism (high energy, sports injury, low energy), ligaments injured, and neurological and vascular lesions were recorded. A new classification for MLKI based on ligamentous injury pattern, and intended for all MLKIs (with and without KD) was developed, and all patients were categorized according to this classification. Associations were evaluated between the risk of vascular and neurological lesion and demographic data, injury mechanism, and new classification grade. Results: The mean patient age was 33.9 years (range, 15-64 years), and 72% were male. High-energy trauma was the most common injury mechanism (55.6%). Vascular injury was present in 5 patients (3.5%) and nerve injury in 17 (11.8%), with 1 patient (0.7%) having both. None of the analyzed variables were associated with the presence of vascular lesion. Univariate logistic regression showed that medial collateral ligament (MCL) lesion decreased the probability of neurological injury (odds ratio [OR], 0.29; 95% CI, 0.1-0.87; P = .03) while PLC injury increased that probability (OR, 12.66; 95% CI, 1.63-100; P = .02). Multivariate logistic regression showed that the proposed MLKI grade was significantly associated with the presence of neurological lesions, with a 2.5-fold increase in the odds of having a neurological injury for each increase in grade (OR, 2.47; 95% CI, 1.36-4.50; P = .003). Conclusion: PLC injuries increased the odds of neurological injury in MLKI, while MCL injuries decreased these odds. MLKI grade and presence of PLC injury was associated with the presence of neurological injury. MLKI grade was not associated with the presence of a vascular lesion.

Injuries to the knee ligaments can be particularly disabling in young patients, given the risk of long-term disability if adequate fixation is not achieved during initial repair. The TWINFIX™ titanium (Ti) suture anchor with ULTRABRAID™ Suture (Smith and Nephew, London, UK) was designed to secure tendon and ligament reconstructions with increased boney ingrowth at the anchor site with minimal invasive technique. This retrospective analysis looked at 33 patients (41 implants) operated with this device between 2015 and 2019 at a single institution. The average age of patients was 33.18 years (standard deviation [SD], 15.26), with an average body mass index of 24.88 (SD, 3.49). The indications were lateral extra-articular tenodesis during anterior cruciate ligament reconstruction, medial patellofemoral ligament reconstruction, quadriceps or patellar tendon repair and medial collateral ligament repair. After an average follow up of 24.3 + 6.53 months, there was no reports of clinical failure or radiographic evidence of implant failure or loosening. One patient experienced a complication unrelated to the study device, requiring manipulation under anesthesia with resolution of symptoms. This case series supports the safety and performance of this implants for the knee procedures in which its use is indicated. Additional follow-up will be required to determine whether these effects are sustained at medium- and long-term durations.

Background and Objectives: Although the use of allografts in revision anterior cruciate ligament reconstruction is associated with theoretical advantages, it has historically led to poorer clinical results and lower survival rates. However, the heterogeneity of the available literature makes it difficult to elucidate the effectiveness of allographs, as most of the studies published do not make any reference to some of the key aspects related to the processing of the allograft employed. The present study analyzed the clinical results and the survival of allografts in patients undergoing revision anterior cruciate ligament reconstruction with a well-characterized, single type of allograft. Materials and Methods: This was a retrospective observational study analyzing a series of patients undergoing revision anterior cruciate ligament reconstruction with an Achilles tendon allograft with a bone block (FlexiGraft, LifeNet Health), subjected to low-dose irradiation at dry ice temperatures. Preoperative and follow-up clinical variables (IKDC, pain, hop test, and YBT scores) were recorded. Survival was analyzed using the Kaplan–Meier methodology. Results: A total of 39 patients (34 male, 5 female) were included in the study. The mean patient age was 37.3 years and mean postoperative follow-up was 78.7 months. Forty-one percent of patients were competitive athletes, and all of the patients in the sample exhibited preoperative instability. The mean allograft thickness was 9.2 mm. During surgery, 51.3% of patients required meniscus repair and 20.5% had to be treated for chondral defects. At the last follow-up visit, 92.3% of the subjects presented with IKDC grade A and 7.7% with IKDC grade B. The mean subjective IKDC score was 0.79 and mean pain intensity was 1.15 according to the VAS scale. Limb symmetry, as measured by the various hop tests and the Y balance test, were within the safety range, with 74.4% of patients succeeding in returning to their previous level of sport. Ten-year survival was estimated at 97.4%. Conclusions: Allografts obtained and processed following the current regulations governing patient selection and graft harvesting, which are additionally processed without recourse to chemical procedures and sterilized at less than 2 MRad in dry ice conditions, represent an effective and safe alternative in revision anterior cruciate ligament reconstruction.