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Hurley ET, Withers D, King E, Franklyn-Miller A, Jackson M, Moran R. Return to Play After Patellar Tendon Autograft for Primary Anterior Cruciate Ligament Reconstruction in Rugby Players. Orthop J Sports Med 2021; 9:23259671211000460. [PMID: 34017876 PMCID: PMC8114267 DOI: 10.1177/23259671211000460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/02/2020] [Indexed: 12/01/2022] Open
Abstract
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. Professional rugby players were those playing for one of the professional provincial teams in Ireland. Outcomes were analyzed for the rate and timing of return to play, functional outcomes, and subsequent graft ruptures. Additionally, outcomes were compared between professional and amateur athletes. Study Design: Case series; Level of evidence, 4. Results: A total of 126 patients with 24 months of follow-up were enrolled. The overall rate of return to play was 84.9%, with 75.4% returning to the same level of play; 8.7% of patients did not return to play secondary to non–knee-related issues. The mean time to return was 10.9 ± 4.9 months. Among professional rugby players, 93.3% were able to return at a mean time of 9.7 ± 4.4 months; 80% returned to the same level. The mean Anterior Cruciate Ligament–Return to Sport after Injury score was 78.4 ± 20.2, the Cincinnati knee score was 92.5 ± 8.0, the International Knee Documentation Committee score was 88.2 ± 8.1, and the Marx score was 9.7 ± 5.3. Two patients sustained a subsequent rerupture of the reconstructed ACL, and 4 players sustained a contralateral ACL injury within the follow-up interval of 2 years. Conclusion: Rugby players receiving BTB ACL reconstruction demonstrated good clinical outcomes with a high rate of return to sport, with the majority returning before 12 months. The rate of a subsequent ACL injury was low among the authors’ cohort at short-term follow-up.
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Affiliation(s)
- Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Enda King
- Sports Surgery Clinic, Dublin, Ireland
| | | | | | - Ray Moran
- Sports Surgery Clinic, Dublin, Ireland
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Kuršumović K, Charalambous CP. Relationship of Graft Type and Vancomycin Presoaking to Rate of Infection in Anterior Cruciate Ligament Reconstruction. JBJS Rev 2020; 8:e1900156. [DOI: 10.2106/jbjs.rvw.19.00156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Featherall J, Oak SR, Strnad GJ, Farrow LD, Jones MH, Miniaci AA, Parker RD, Rosneck JT, Saluan PM, Spindler KP. Smartphone Data Capture Efficiently Augments Dictation for Knee Arthroscopic Surgery. J Am Acad Orthop Surg 2020; 28:e115-e124. [PMID: 31977610 PMCID: PMC6964865 DOI: 10.5435/jaaos-d-19-00074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The objectives of this study are (1) to develop a provider-friendly, evidence-based data capture system for lower-limb orthopaedic surgeries and (2) to assess the performance of the data capture system on the dimensions of agreement with operative note and implant log, consistency of data, and speed of provider input. METHODS A multidisciplinary team developed a database and user interfaces for Android and iOS operating systems. Branching logic and discrete fields were created to streamline provider data input. One hundred patients were randomly selected from the first four months of data collection (February to June 2015). Patients were limited to those undergoing anterior cruciate ligament reconstruction, meniscal repair, partial meniscectomy, or a combination of these procedures. Duplicate data on these 100 patients were collected through chart review. These two data sets were compared. Cohen's kappa statistic was used to assess agreement. RESULTS The database and smartphone data capture tool show almost perfect agreement (kappa > 0.81) for all data tested. In addition, data are more comprehensive with near-perfect provider completion (100% for all data tested). Furthermore, provider data entry is extremely efficient (median 151-second completion time). CONCLUSION A well-designed database and user-friendly interface have greater potential for research utility, clinical efficiency, and, thus, cost-effectiveness when compared with standard voice-dictated operative notes. Widespread utilization of such tools can accelerate the pace and improve the quality of orthopaedic clinical research. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Joseph Featherall
- From the Cleveland Clinic Lerner College of Medicine (Mr. Featherall), the Department of Orthopaedic Surgery, Cleveland Clinic (Dr. Oak, Mr. Strnad, Dr. Farrow, Dr. Jones, Dr. Miniaci, Dr. Parker, Dr. Rosneck, Dr. Saluan, and Dr. Spindler), and the Cleveland Clinic Sports Health Center, Cleveland Clinic (Dr. Farrow, Dr. Jones, Dr. Miniaci, Dr. Parker, Dr. Rosneck, Dr. Saluan, and Dr. Spindler), Cleveland, OH
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Graft Choice for Anterior Cruciate Ligament Reconstruction With a Concomitant Non-surgically Treated Medial Collateral Ligament Injury Does Not Influence the Risk of Revision. Arthroscopy 2020; 36:199-211. [PMID: 31526609 DOI: 10.1016/j.arthro.2019.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/04/2019] [Accepted: 07/10/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the risk of anterior cruciate ligament (ACL) revision and the patient-reported outcome after ACL reconstruction with a concomitant non-surgically treated medial collateral ligament (MCL) injury with regard to 3 ACL graft choices; the use of semitendinosus (ST), the use of semitendinosus-gracilis (ST-G), and the use of patellar tendon (PT) autograft. It was hypothesized that the use of ST-G would be associated with a greater risk of ACL revision and poorer patient-reported knee function. METHODS Patients older than 15 years of age registered for a primary ACL reconstruction with a concomitant non-surgically treated MCL injury in the Swedish National Knee Ligament Registry were assessed for eligibility. Three groups were created according to ACL autograft choice; the ST, the ST-G, and the PT group. The primary outcomes were ACL revision and the 1- and 2-year Knee injury and Osteoarthritis Outcome Score (KOOS), including the KOOS patient acceptable symptom state (PASS). Cox regression analysis was applied to determine the proportional hazard ratio (HR) of primary ACL reconstruction survival. The KOOS was compared using the Mann-Whitney U test and Fisher exact test. RESULTS A total of 622 patients (mean age 29.7 years, 42.4% women) were included. There was no difference in the risk of ACL revision for either the ST group (HR 1.354; 95% confidence interval [CI] 0.678-2.702 or the PT group (HR 0.837; 95% CI 0.334-2.100), compared with the ST-G group. The ST group reported a greater mean 2-year KOOS sports and recreation (68.5, standard deviation [SD] 28.5) than the ST-G group (57.4 [SD 27.6], P = .010) and the PT group (54.1 [SD 30.3], P = .006). The ST group was superior in terms of achieving PASS in sports and recreation (55.3%; 95% CI 44.1-66.1%) compared with both the ST-G (37.4%; 95% CI 29.8-45.5%; P = .014) and the PT group (33.9%; 95% CI 22.1-47.4%; P = .009). CONCLUSIONS The risk of ACL revision did not differ between HT and PT autografts in patients undergoing ACL reconstruction with a non-surgically treated MCL injury. However, the use of ST-G was associated with poorer 2-year patient-reported knee function compared with the ST. LEVEL OF EVIDENCE Retrospective comparative trial, Level III.
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Prentice HA, Lind M, Mouton C, Persson A, Magnusson H, Gabr A, Seil R, Engebretsen L, Samuelsson K, Karlsson J, Forssblad M, Haddad FS, Spalding T, Funahashi TT, Paxton LW, Maletis GB. Patient demographic and surgical characteristics in anterior cruciate ligament reconstruction: a description of registries from six countries. Br J Sports Med 2018; 52:716-722. [PMID: 29574451 DOI: 10.1136/bjsports-2017-098674] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Findings from individual anterior cruciate ligament reconstruction (ACLR) registry studies are impactful, but how various registries from different countries compare with different patient populations and surgical techniques has not been described. We sought to describe six ACLR registry cohorts to understand variation across countries. METHODS Five European registries and one US registry participated. For each registry, all primary ACLR registered between registry establishment through 31December 2014 were identified. Descriptive statistics included frequencies, proportions, medians and IQRs. Revision incidence rates following primary ACLR were computed. RESULTS 101 125 ACLR were included: 21 820 in Denmark, 300 in Luxembourg, 17 556 in Norway, 30 422 in Sweden, 2972 in the UK and 28 055 in the US. In all six cohorts, males (range: 56.8%-72.4%) and soccer injuries (range: 14.1%-42.3%) were most common. European countries mostly used autografts (range: 93.7%-99.7%); allograft was most common in the US (39.9%). Interference screw was the most frequent femoral fixation in Luxembourg and the US (84.8% and 42.9%), and suspensory fixation was more frequent in the other countries (range: 43.9%-75.5%). Interference was the most frequent tibial fixation type in all six cohorts (range: 64.8%-98.2%). Three-year cumulative revision probabilities ranged from 2.8% to 3.7%. CONCLUSIONS Similarities in patient demographics and injury activity were observed between all cohorts of ACLR. However, graft and fixation choices differed. Revision rates were low. This work, including >100 000 ACLR, is the most comprehensive international description of contemporary practice to date.
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Affiliation(s)
- Heather A Prentice
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
| | - Martin Lind
- Division of Sports Surgery, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Clinique d'Eich-Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Andreas Persson
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Norwegian Knee Ligament Registry, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
| | - Henrik Magnusson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ayman Gabr
- Trauma and Orthopaedic Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Romain Seil
- Department of Orthopaedic Surgery, Clinique d'Eich-Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Norwegian Knee Ligament Registry, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
| | - Kristian Samuelsson
- Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jon Karlsson
- Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Magnus Forssblad
- Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Fares S Haddad
- Department of Trauma and Orthopaedics, University College London Hospitals, London, UK
| | - Tim Spalding
- University Hospitals Coventry and Warwickshire (UHCW), Coventry, UK
| | - Tadashi T Funahashi
- Department of Orthopaedics, Southern California Permanente Medical Group, Irvine, California, USA
| | - Liz W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
| | - Gregory B Maletis
- Department of Orthopaedics, Southern California Permanente Medical Group, Baldwin Park, California, USA
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Herbort M, Michel P, Raschke MJ, Vogel N, Schulze M, Zoll A, Fink C, Petersen W, Domnick C. Should the Ipsilateral Hamstrings Be Used for Anterior Cruciate Ligament Reconstruction in the Case of Medial Collateral Ligament Insufficiency? Biomechanical Investigation Regarding Dynamic Stabilization of the Medial Compartment by the Hamstring Muscles. Am J Sports Med 2017; 45:819-825. [PMID: 28029798 DOI: 10.1177/0363546516677728] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Semitendinosus and gracilis muscles are frequently harvested for autologous tendon grafts for cruciate ligament reconstruction. This study investigated the joint-stabilizing effects of these hamstring muscles in cases of insufficiency of the medial collateral ligament (MCL). HYPOTHESES First, both the semitendinosus and gracilis muscles can actively stabilize the joint against valgus moments in the MCL-deficient knee. Second, the stabilizing influence of these muscles decreases with an increasing knee flexion angle. STUDY DESIGN Controlled laboratory study. METHODS The kinematics was examined in 10 fresh-frozen human cadaveric knees using a robotic/universal force moment sensor system and an optical tracking system. The knee kinematics under 5- and 10-N·m valgus moments were determined in the different flexion angles of the (1) MCL-intact and (2) MCL-deficient knee using the following simulated muscle loads: (1) 0-N (idle) load, (2) 200-N semitendinosus (ST) load, and (3) 280-N (200/80-N) combined semitendinosus/gracilis (STGT) load. RESULTS Cutting the MCL increased the valgus angle under all tested conditions and angles compared with the MCL-intact knee by 4.3° to 8.1° for the 5-N·m valgus moment and 6.5° to 11.9° for the 10-N·m valgus moment ( P < .01). The applied 200-N simulated ST load reduced the valgus angle significantly at 0°, 10°, 20°, and 30° of flexion under 5- and 10-N·m valgus moments ( P < .05). At 0°, 10°, and 20° of flexion, these values were close to those for the MCL-intact joint under the respective moments (both P > .05). The combined 280-N simulated STGT load significantly reduced the valgus angle in 0°, 10°, and 20° of flexion under 5- and 10-N·m valgus moments ( P < .05) to values near those for the intact joint (5 N·m: 0°, 10°; 10 N·m: 0°, 10°, 20°; P > .05). In 60° and 90° of flexion, ST and STGT loads did not decrease the resulting valgus angle of the MCL-deficient knee without hamstring loads ( P > .05 vs deficient; P = .0001 vs intact). CONCLUSION In this human cadaveric study, semitendinosus and gracilis muscles successfully stabilize valgus moments applied to the MCL-insufficient knee when the knee is near extension. CLINICAL RELEVANCE In the valgus-unstable knee, these data suggest that the hamstring muscles should be preserved in (multi-) ligament surgery when possible.
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Affiliation(s)
- Mirco Herbort
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Philipp Michel
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Nils Vogel
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Martin Schulze
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Alexander Zoll
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Christian Fink
- Research Unit for Orthopedic Sports Medicine and Injury Prevention, Institute of Sports and Alpine Medicine, University of Hall in Tirol, Tirol, Austria
| | - Wolf Petersen
- Department of Orthopedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
| | - Christoph Domnick
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
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Häner M, Bierke S, Petersen W. Anterior Cruciate Ligament Revision Surgery: Ipsilateral Quadriceps Versus Contralateral Semitendinosus-Gracilis Autografts. Arthroscopy 2016; 32:2308-2317. [PMID: 27209621 DOI: 10.1016/j.arthro.2016.03.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/20/2016] [Accepted: 03/11/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the subjective outcomes, knee stability, and donor-site morbidity after revision ACL reconstruction using either autologous ipsilateral quadriceps tendon or contralateral semitendinosus-gracilis tendon. METHODS A sample size calculation suggested that we needed 25 patients in each group to detect equality between both groups. Therefore, we evaluated 30 consecutive patients who underwent an ACL revision surgery with ipsilateral bone-quadriceps tendon grafts and 30 consecutive patients with the contralateral semitendinosus-gracilis grafts between January 2010 and December 2012. Because of follow-up and exclusion criteria, finally 51 patients were evaluated. All patients were followed prospectively for at least 2 years with KT1000 arthrometer testing and the International Knee Documentation Committee (IKDC) objective grading. At the 24-month follow-up, additional clinical scores were evaluated: the Knee Injury Osteoarthritis Outcome Score (KOOS), the Lysholm score, assessing pain during kneeling, and anterior knee pain. RESULTS The KT1000 postoperative arthrometer side-to-side difference was 2.0 ± 1.2 mm for the quadriceps group and 3.0 ± 2.9 mm for the semitendinosus-gracilis group. The difference was not statistically significant (P = .461). There was also no difference in the rate of positive pivot-shift tests between groups (P = .661). The Lysholm score was 82.5 ± 18 in the quadriceps group and 73.8 ± 19 in the semitendinosus-gracilis group. The difference was not statistically significant (P = .060). There was also no significant difference in the single KOOS subscores, assessing pain while kneeling and anterior knee pain (included in the KOOS score). No rerupture occurred during follow-up. CONCLUSIONS Revision ACL reconstruction using the quadriceps tendon graft showed clinical outcomes similar to those of the contralateral semitendinosus-gracilis graft in terms of knee stability and function. Thus, the bone-quadriceps tendon graft may be a good alternative to the contralateral semitendinosus-gracilis tendon graft for revision ACL reconstruction. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Martin Häner
- Charité-University Medicine Berlin, Berlin, Germany.
| | - Sebastian Bierke
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany; Academic Teaching Hospital of the Charité-University Medicine Berlin, Berlin, Germany
| | - Wolf Petersen
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany; Academic Teaching Hospital of the Charité-University Medicine Berlin, Berlin, Germany
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Type and frequency of healthcare encounters can predict poor surgical outcomes in anterior cruciate ligament reconstruction patients. Int J Med Inform 2016; 90:32-9. [DOI: 10.1016/j.ijmedinf.2016.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/20/2015] [Accepted: 03/15/2016] [Indexed: 11/23/2022]
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Seil R, Mouton C, Lion A, Nührenbörger C, Pape D, Theisen D. There is no such thing like a single ACL injury: Profiles of ACL-injured patients. Orthop Traumatol Surg Res 2016; 102:105-10. [PMID: 26776099 DOI: 10.1016/j.otsr.2015.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/05/2015] [Accepted: 11/16/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Current ACL registries rarely include non-operatively treated patients thus delivering an incomplete picture of the ACL-injured population. The aim of this study was to get an image of the population and treatment decision of an intrahospital registry. Our hypotheses were that patient-specific subtypes can be identified and that the percentage of operated patients differs between them. MATERIAL AND METHODS Three hundred and forty-six operated and non-operated patients were included from March 2011 to December 2013. Standardized questionnaires allowed for data collection on gender, age, sports practice and previous ACL injuries. Chi-square tests allowed to compare these parameters between genders and age groups. A cluster analysis was computed to determine profiles of patients with similar characteristics. RESULTS Three age groups were considered (I: ≤20; II: 21-35; III: ≥36 years). For males, the highest frequency of injuries was noted in group II with a greater proportion of injuries compared to females. In group III, more females were injured than males. Before injury, 54% patients were involved in competitive sports. Males were more likely to be injured in pivoting/contact sports before 35 and females during recreational skiing after 35. Twenty-one percent of the patients had had a previous ACL injury. The percentage of surgical treatment was superior to 80% in patients under 35 years involved in competitive sports, of 60-80% for those not involved in competitive sports and inferior to 60% for patients above 35 years. DISCUSSION Systematic data collection allowed to identify specific subtypes of ACL-injured patient according to gender, age, previous ACL injury and preinjury level of practice. The decision-making process for or against ACL reconstructions at time of presentation depended on these characteristics. Consideration of these parameters will serve as a basis for an individualized treatment approach and a better understanding of patients at risk for ACL injuries. LEVEL OF EVIDENCE III.
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Affiliation(s)
- R Seil
- Sports Clinic, clinique d'Eich, Academic Teaching Hospital of the Saarland University Medical Centre, centre hospitalier de Luxembourg, 76, rue d'Eich, 1460 Luxembourg, Luxembourg; Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76, rue d'Eich, 1460 Luxembourg, Luxembourg; Cartilage Net of the Greater Region Saar-Lor-Lux, Luxembourg, Luxembourg.
| | - C Mouton
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76, rue d'Eich, 1460 Luxembourg, Luxembourg; Cartilage Net of the Greater Region Saar-Lor-Lux, Luxembourg, Luxembourg
| | - A Lion
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76, rue d'Eich, 1460 Luxembourg, Luxembourg; Cartilage Net of the Greater Region Saar-Lor-Lux, Luxembourg, Luxembourg
| | - C Nührenbörger
- Sports Clinic, clinique d'Eich, Academic Teaching Hospital of the Saarland University Medical Centre, centre hospitalier de Luxembourg, 76, rue d'Eich, 1460 Luxembourg, Luxembourg
| | - D Pape
- Sports Clinic, clinique d'Eich, Academic Teaching Hospital of the Saarland University Medical Centre, centre hospitalier de Luxembourg, 76, rue d'Eich, 1460 Luxembourg, Luxembourg; Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76, rue d'Eich, 1460 Luxembourg, Luxembourg; Cartilage Net of the Greater Region Saar-Lor-Lux, Luxembourg, Luxembourg
| | - D Theisen
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76, rue d'Eich, 1460 Luxembourg, Luxembourg; Cartilage Net of the Greater Region Saar-Lor-Lux, Luxembourg, Luxembourg
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