Los Músculos Isquiosurales y su Capacidad Profiláctica sobre la Translación Tibial Anterior en Lesión de Ligamento Cruzado Anterior: Una Revisión Sistemática / The Hamstrings Muscles and their Prophylactic Capacity on Anterior Tibial Translation in Anterior Cruciate Ligament Injury: A Systematic Review

La ruptura de ligamento cruzado anterior (LCA) es la lesión de rodilla más común que se trata de una reconstruc- ción quirúrgica. El objetivo principal de esta revisión fue analizar la importancia de la función de los músculos isquiosurales como factor de riesgo de posibles lesiones de LCA. Se llevó a cabo siguiendo las normas Preferred Reported Item for Systematic Reviews and Meta- analyses (PRISMA). La fuente de la recopilación de datos fue la consulta directa de las bases de datos Pubmed, Sportdiscus, Web of Science y Scopus. Para la recuperación documental, se utilizaron varias palabras clave y se evaluó la calidad de los estudios que fueron seleccionados mediante la escala PEDro. Los déficits de la función muscular en los músculos isquiosurales se han relacionado con una mayor translación tibial anterior y, como consecuencia, un incremento del estrés tensional sobre el LCA entre los 10° y 45° de flexión de rodilla. Una co-activación de los músculos isquiosurales con el músculo cuádriceps femoral puede ser de gran ayuda para reducir los factores de riesgo de la lesión LCA.

SUMMARY: Anterior cruciate ligament (ACL) rupture is the most common knee injury to undergo surgery in the sports setting. The main objective of this review was to analyze the importance of hamstring function as a risk factor for potential ACL injury. It was conducted following the Preferred Reported Item for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The source of data collection was direct consultation of the Pubmed, Sportdiscus, Web of Science and Scopus databases. For documentary retrieval, several key words were used and the quality of the studies that were selected was assessed using the PEDro scale. Muscle function deficits in the hamstrings have been related to increased anterior tibial translation and, as a consequence, increased tensional stress on the ACL between 10° and 45° of knee flexion. A co-activation of the hamstrings with the quadriceps may be helpful in reducing the risk factors for ACL injury.

Peroneus Longus Tendon Graft to Reconstruct the Posterolateral Corner of the Knee / Enxerto do tendão fibular longo na reconstrução do canto posterolateral do joelho

Abstract The posterolateral corner is critical to knee stability. Neglected injuries have a direct impact on the prognosis due to residual instability, chronic pain, deformities, and failure to repair other structures. Several techniques are used to reconstruct the posterolateral corner, often with autologous ischiotibial grafts or homologous grafts. An option little used for knee ligament reconstructions is the peroneus longus tendon graft. Although reported as a good alternative for anterior cruciate ligament reconstruction, we found no case using a peroneus longus tendon graft for posterolateral corner reconstruction. Here, we describe the case of a patient who underwent a non-anatomical reconstruction of the posterolateral corner using a peroneus longus tendon graft. The patient underwent surgical procedures for ligament reconstruction and correction of the deformity caused by a failed graft, but his knee remained unstable. During the preoperative planning, it was decided to reconstruct the posterolateral corner with an ipsilateral peroneus longus tendon graft. Studies have shown that the peroneus longus tendon graft does not increase ankle morbidity, and that its length and diameter favor ligament reconstruction. Thus, the present article highlights the importance of the proper diagnosis of ligament injuries in the acute phase, and describes a new technique for posterolateral corner reconstruction that must be included in the surgeon's body of knowledge, increasing the amount of technical options.

Resumo O canto posterolateral tem grande importância na estabilidade do joelho. Sua lesão pode ser negligenciada, o que tem um impacto direto no prognóstico e resulta em instabilidade residual, dor crônica, deformidades e falha do reparo de outras estruturas. Existem diversas técnicas de reconstrução do canto posterolateral e o uso de enxertos autólogos dos isquiotibiais ou homólogos são as mais comuns. Uma opção pouco utilizada para reconstruções ligamentares no joelho é o enxerto do tendão fibular longo. Apesar de descrito como boa opção na reconstrução do ligamento cruzado anterior, não foi encontrado nenhum caso de uso do enxerto do tendão fibular longo na reconstrução do canto posterolateral. Neste artigo, descrevemos o caso de um paciente submetido a reconstrução não anatômica do canto posterolateral com uso do enxerto do tendão fibular longo. O paciente foi submetido a procedimentos cirúrgicos para reconstrução ligamentar e correção de deformidade ocasionada pela falha do enxerto, mas manteve instabilidade ligamentar. No planejamento pré-operatório, optou-se pela reconstrução do canto posterolateral com enxerto do tendão fibular longo ipsilateral. Estudos evidenciaram que o enxerto do tendão fibular longo não provoca aumento de morbidadeem relação aotornozelo abordado, bem comoseapresenta com comprimento e diâmetro favoráveis à reconstrução ligamentar. Dessa forma, este artigo aponta para a importânciadodiagnóstico correto das lesões ligamentaresnafase aguda,e para uma nova técnica na reconstrução do canto posterolateral, que deve fazer parte do arsenal de conhecimentos do cirurgião, pois aumenta as opções de técnicas.

Long-term outcomes of lateral femoral notch after early anterior cruciate ligament reconstruction / 中国骨伤

OBJECTIVE@#To investigate the outcome of lateral femoral notch (LFN) after early anterior cruciate ligament (ACL) reconstruction and evaluate the recovery of knee joint function after the operation.@*METHODS@#The clinical data of 32 patients who underwent early ACL reconstruction from December 2015 to December 2019 were retrospectively analyzed. The study included 18 males and 14 females, aged 16 to 54 years old, with an average age of (25.39±2.82) years. The body mass index (BMI) of the patients ranged from 20 to 30 kg/cm2, with an average of (26.15±3.09) kg/cm2. Among them, 6 cases were caused by traffic accidents, 19 by exercise, and 7 by the crush of heavy objects. MRI of all patients showed LFN depth was more than 1.5 mm after injury, and no intervention for LFN was performed during surgery. Preoperative and postoperative depth, area, and volume of LFN defects were observed by MRI data. International Cartilage Repair Society (ICRS) score, Lysholm score, Tegner activity levels, and knee injury and osteoarthritis outcome score (KOOS) were analyzed before and after the operation.@*RESULTS@#All patients were followed up from 2 to 6 years with an average of (3.28±1.12) years. There was no significant difference in the defect depth of LFN from (2.31±0.67) mm before the operation to (2.53±0.50) mm at follow-up (P=0.136). The defect area of LFN was decreased from (207.55±81.01)mm2 to (171.36±52.69)mm2 (P=0.038), and the defect volume of LFN was decreased from (426.32±176.54) mm3 to (340.86±151.54)mm3 (P=0.042). The ICRS score increased from (1.51±0.34) to (2.92±0.33) (P<0.001), the Lysholm score increased from (35.37±10.54) to (94.46±8.45) (P<0.001), and the Tegner motor score increased from (3.45±0.94) to (7.56±1.28), which was significantly higher than that of the preoperative data (P<0.001). The KOOS score of the final follow-up was 90.42±16.35.@*CONCLUSION@#With the increase of recovery time after anterior cruciate ligament reconstruction, the defect area and volume of LFN decreased gradually, but the defect depth remained unchanged. The knee joint function of the patients significantly improved. The cartilage of the LFN defect improved, but the repair effect was not good.

Correlation between spatial inclination of Blumensaat line and anterior cruciate ligament injury based on EOS biplanar 3D imaging system / 中国骨伤

OBJECTIVE@#To explore correlation between femoral mechanical axis and Blumensaat line (FMBL) angle of knee joint (angle between Blumensaat line and femoral mechanical axis), α angle (angle between Blumensaat line and axis of distal femur in sagittal plane) on EOS biplane imaging and non-contact anterior cruciate ligament(ACL) injury, and evaluate angle for its accuracy in predicting the populations prone to non-contact ACL injury.@*METHODS@#From February 2018 to October 2020, EOS imaging and clinical data from 88 patients (176 knees) with unilateral non-contact ACL injury were retrospectively analyzed, including 53 males and 35 females, aged from 18 to 45 years old with an average of (30.3±6.2) years old, 48 patients on the left side and 40 patients on the right side. The patients were divided into ACL-affected group and ACL-health group according to side of ACL injuries, and 51 patients (51 knees) with non-ACL identified from EOS database were included in normal control group, including 28 males and 23 females, aged from 20 to 44 years old with an average of (31.6±5.5) years old, 26 patients on the left side and 25 patients on the right side. Full-length EOS imaging of skeleton extremitatis inferioris among three groups were reconstructed to 3D images of skeletal system with EOS software, and then FMBL angle and α angle were measured on the images. Univariate binary Logistic regression analysis was performed to determine the influence of the univariate(FMBL angle or α angle) on ACL status(normal or torn). And the angle cutoff value for univariate was selected based on receiver operating characteristics curve (ROC) to got the best accuracy.@*RESULTS@#There was no statistically significant difference in age, gender and side distribution between ACL-injured group and normal control group(P>0.05). Statistical analyses (one-way ANOVA) indicated no significant difference in FMBL angle between ACL-injured knee group (32.8±2.3)° and ACL-injured contralateral knee group(32.5±2.3)°(P>0.05), but the values between two groups were significantly lower than that in normal control group (37.0±2.0)°(P<0.001). There was no statistically significant difference in α angle among three groups (P>0.05). Univariate binary Logistic regression analysis demonstrated that FMBL angle was risk factor for non-contact ACL injury[OR=0.433, 95%CI(0.330, 0.569), P<0.001]. The area under ROC curve for FMBL angle was 0.909[95%CI(0.861, 0.958), P<0.001], and the sensitivity and specificity were 70.5% and 98.0% respectively, cut-off value was 33.7°.@*CONCLUSION@#FMBL angle formed by Blumensaat line and femoral mechanical axis is one of the risk factors for non-contact ACL injury and has good predictive accuracy. The general population with FMBL angle below 33.7° may be increased risk for ACL injury.

Establishment of anterior cruciate ligament reconstruction model in cynomolgus monkey with autogenous hamstring tendon transplantation / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility of establishing an anterior cruciate ligament (ACL) reconstruction model using hamstring tendon autograft in cynomolgus monkeys.@*METHODS@#Twelve healthy adult male cynomolgus monkeys, weighing 8-13 kg, were randomly divided into two groups ( n=6). In the experimental group, the ACL reconstruction model of the right lower limb was prepared by using a single bundle of hamstring tendon, and the ACL of the right lower limb was only cut off in the control group. The survival of animals in the two groups was observed after operation. Before operation and at 3, 6, and 12 months after operation, the knee range of motion, thigh circumference, and calf circumference of the two groups were measured; the anterior tibial translation D-value (ATTD) was measured by Ligs joint ligament digital body examination instrument under the loads of 13-20 N, respectively. At the same time, the experimental group underwent MRI examination to observe the graft morphology and the signal/ noise quotient (SNQ) was caculated.@*RESULTS@#All animals survived to the end of the experiment. In the experimental group, the knee range of motion, thigh circumference, and calf circumference decreased first and then gradually increased after operation; the above indexes were significantly lower at 3 and 6 months after operation than before operation ( P<0.05), and no significant difference was found between pre-operation and 12 months after operation ( P>0.05). In the control group, there was no significant change in knee range of motion after operation, showing no significant difference between pre- and post-operation ( P>0.05), but the thigh circumference and calf circumference gradually significantly decreased with time ( P<0.05), and the difference was significant when compared with those before operation ( P<0.05). At 6 and 12 months after operation, the thigh circumference and calf circumference were significantly larger in the experimental group than in the control group ( P<0.05). At 3 and 6 months after operation, the knee range of motion was significantly smaller in the experimental group than in the control group ( P<0.05). Under the loading condition of 13-20 N, the ATTD in the experimental group increased first and then decreased after operation; and the ATTD significantly increased at 3, 6 months after operation when compared with the value before operation ( P<0.05). But there was no significant difference between the pre-operation and 12 months after operation ( P>0.05). There was no significant change in ATTD in the control group at 3, 6, and 12 months after operation ( P>0.05), and which were significantly higher than those before operation ( P<0.05). At each time point after operation, the ATTD was significantly smaller in the experimental group than in the control group under the same load ( P<0.05). The MRI examination of the experimental group showed that the ACL boundary gradually became clear after reconstruction and was covered by the synovial membrane. The SNQ at each time point after operation was significantly higher than that before operation, but gradually decreased with time, and the differences between time points were significant ( P<0.05).@*CONCLUSION@#The ACL reconstruction model in cynomolgus monkey with autogenous hamstring tendon transplantation was successfully established.

Effectiveness of anterior cruciate ligament reconstruction with personalized femoral locator based on apex of deep cartilage / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of anterior cruciate ligament (ACL) reconstruction assisted by personalized femoral locator based on the apex of deep cartilage (ADC) combined with patient imaging data.@*METHODS@#Between January 2021 and January 2022, a total of 40 patients with primary ACL rupture were selected and randomly divided into study group (ACL reconstruction assisted by personalized femoral locator based on ADC) and control group (ACL reconstruction assisted by intraoperative fluoroscopy and traditional femoral locator), with 20 cases in each group. There was no significant difference in gender, age, body mass index, affected side, cause of injury, and preoperative International Knee Documentation Committee (IKDC) score, Lyshlom score, and Tegner score between the two groups ( P>0.05). IKDC score, Lyshlom score, and Tegner score were used to evaluate the functional recovery of the affected knee before operation and at 3, 6, and 12 months after operation. CT scan and three-dimensional reconstruction were performed before and after operation to measure the horizontal distance from ADC to the anterior cartilage margin (L) and the horizontal distance from ADC to the center of the femoral canal (I), and the anteroposterior position of the bone canal (R) was calculated by I/L; the distance from the center to the distal cartilage margin (D) was measured on the two-dimensional cross section; the R value and D value were compared between the two groups.@*RESULTS@#The operation time of the study group was significantly less than that of the control group [ MD=-6.90 (-8.78, -5.03), P<0.001]. The incisions of the two groups healed by first intention, and no complication such as intra-articular infection, nerve injury, and deep vein thrombosis of lower limbs occurred. There was no significant difference in the R value and D value between the preoperative simulated positioning and the actual intraoperative positioning in the study group [ MD=0.52 (-2.85, 3.88), P=0.758; MD=0.36 (-0.39, 1.11), P=0.351]. There was no significant difference in the actual intraoperative positioning R value and D value between the study group and the control group [ MD=1.01 (-2.57, 4.58), P=0.573; MD=0.24 (-0.34, 0.82), P=0.411]. The patients in both groups were followed up 12-13 months (mean, 12.4 months). The IKDC score, Lysholm score, and Tegner score of the two groups increased gradually with time, and there were significant differences between pre- and post-operation ( P<0.05). There was no significant difference in the scores between the two groups at each time point after operation ( P>0.05).@*CONCLUSION@#The personalized femoral locator based on ADC can accurately assist the femoral tunnel positioning in ACL reconstruction, which can shorten the operation time when compared with traditional surgical methods, and achieve satisfactory early effectiveness.

Three-dimensional kinematic analysis of knee joint after anterior cruciate ligament reconstruction with personalized femoral positioner based on apex of deep cartilage / 中国修复重建外科杂志

OBJECTIVE@#To investigate the changes of knee joint kinematics after anterior cruciate ligament (ACL) reconstruction assisted by personalized femoral positioner based on the apex of deep cartilage (ADC).@*METHODS@#Between January 2021 and January 2022, a total of 40 patients with initial ACL rupture who met the selection criteria were randomly divided into the study group (using the personalized femoral positioner based on ADC design to assist ACL reconstruction) and the control group (not using the personalized femoral positioner to assist ACL reconstruction), with 20 patients in each group. Another 20 volunteers with normal knee were collected as a healthy group. There was no significant difference in gender, age, body mass index, and affected side between groups ( P>0.05). Gait analysis was performed at 3, 6, and 12 months after operation using Opti _ Knee three-dimensional knee joint motion measurement and analysis system, and the 6 degrees of freedom (flexion and extension angle, varus and valgus angle, internal and external rotation angle, anteroposterior displacement, superior and inferior displacement, internal and external displacement) and motion cycle (maximum step length, minimum step length, and step frequency) of the knee joint were recorded. The patients' data was compared to the data of healthy group.@*RESULTS@#In the healthy group, the flexion and extension angle was (57.80±3.45)°, the varus and valgus angle was (10.54±1.05)°, the internal and external rotation angle was (13.02±1.66)°, and the anteroposterior displacement was (1.44±0.39) cm, the superior and inferior displacement was (0.86±0.20) cm, and the internal and external displacement was (1.38±0.39) cm. The maximum step length was (51.24±1.29) cm, the minimum step length was (45.69±2.28) cm, and the step frequency was (12.45±0.47) step/minute. Compared with the healthy group, the flexion and extension angles and internal and external rotation angles of the patients in the study group and the control group decreased at 3 months after operation, and the flexion and extension angles of the patients in the control group decreased at 6 months after operation, and the differences were significant ( P<0.05); there was no significant difference in the other time points and other indicators when compared with healthy group ( P>0.05). In the study group, the flexion and extension angles and internal and external rotation angles at 6 and 12 months after operation were significantly greater than those at 3 months after operation ( P<0.05), while there was no significant difference in the other indicators at other time points ( P>0.05). There was a significant difference in flexion and extension angle between the study group and the control group at 6 months after operation ( P<0.05), but there was no significant difference of the indicators between the two groups at other time points ( P>0.05).@*CONCLUSION@#Compared with conventional surgery, ACL reconstruction assisted by personalized femoral positioner based on ADC design can help patients achieve more satisfactory early postoperative kinematic results, and three-dimensional kinematic analysis can more objectively and dynamically evaluate the postoperative recovery of knee joint.

Effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament tibial insertion fracture in adults / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament (PCL) tibial insertion fractures in adults.@*METHODS@#Between October 2019 and October 2021, 16 patients with PCL tibial insertion fractures were treated with arthroscopic binding fixation using suture through single bone tunnel. There were 11 males and 5 females with an average age of 41.1 years (range, 26-58 years). The fractures were caused by traffic accident in 12 cases and sports in 4 cases. The time from injury to operation ranged from 2 to 10 days with an average of 6.0 days. The fractures were classified as Meyers-McKeever type Ⅱ in 4 cases and type Ⅲ in 9 cases, and Zaricznyi type Ⅳ in 3 cases. There were 2 cases of grade Ⅰ, 7 cases of grade Ⅱ, and 7 cases of grade Ⅲ in the posterior drawer test. There were 3 cases combined with lateral collateral ligament injury and 2 cases with meniscus injury. The visual analogue scale (VAS) score, Lysholm score, International Knee Documentation Committee (IKDC) score, and knee range of motion were used to evaluate knee joint function. The posterior drawer test and knee stability tester (Kneelax 3) were used to evaluate knee joint stability. The X-ray films were used to evaluate fracture reduction and healing.@*RESULTS@#All incisions healed by first intention after operation. There was no incision infection, popliteal neurovascular injury, or deep venous thrombosis of lower limbs. All patients were followed up 6-12 months, with an average of 10 months. X-ray films at 6 months after operation showed the fractures obtained bone union. There were 11 cases of grade 0, 4 cases of gradeⅠ, and 1 case of grade Ⅱin posterior drawer test, showing significant difference when compared with preoperative results ( Z=23.167, P<0.001). The VAS score, Lysholm score, IKDC score, knee range of motion, and the results of Kneelax3 examination all significantly improved when compared with preoperative results ( P<0.05).@*CONCLUSION@#For adult patients with PCL tibial insertion fractures, the arthroscopic binding fixation using suture through single bone tunnel has the advantages of minimal trauma, good fracture reduction, reliable fixation, and fewer complications. The patient's knee joint function recovers well.

Risk factors for contralateral anterior cruciate ligament injury after primary anterior cruciate ligament reconstruction / 中国修复重建外科杂志

OBJECTIVE@#To investigate the risk factors of contralateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction.@*METHODS@#A retrospective review was conducted on the 716 patients with ACL injury who received primary ACL reconstruction surgery and met the selection criteria between January 2012 and September 2018. After a mean follow-up period of 7.6 years (range, 4-10 years), 65 patients (9.1%) experienced contralateral ACL injury (injured group) and 651 patients (90.9%) did not (uninjured group). There was no significant difference in age, body mass index, and preoperative Lachman test degree between groups ( P>0.05). However, the proportion of female in the injured group was significantly higher than that of male ( P<0.05), and the preoperative posterior tibial slope (PTS) was significantly higher than that of the uninjured group ( P<0.05). Using the outcome of contralateral ACL injury as the dependent variable, the clinical data of the patient was first used as the independent variable, and univariate COX regression was used to analyze the prognostic influencing factors. Then, the indicators with differences in univariate COX regression were used as the independent variable, and multivariate COX regression was used to analyze the independent risk factors affecting prognosis. Log-Rank (Mantel-Cox) test was used to test and analyze the occurrence time of contralateral ACL injury in patients of different genders; X-tile software was used to analyze the occurrence time of contralateral ACL injury in patients with different PTS using Log-Rank (Mantel-Cox) test and PTS cut-off values.@*RESULTS@#Univariate COX regression analysis showed that gender and PTS were influence factors for contralateral ACL injury ( P<0.05); further multivariate COX regression analysis showed that female and increased PTS were independent risk factors for contralateral ACL injury ( P<0.05). The Log-Rank (Mantel-Cox) test results showed that the contralateral ACL injury occurred in female at 8.853 (8.600, 9.106) years, which was significantly shorter than that in male [9.661 (9.503, 9.819) years] ( χ 2=20.323, P<0.001). Using X-tile software to analyze the cut-off value of PTS, it was found that the cut-off value of PTS for contralateral ACL injury was 10.92°. According to the Log-Rank (Mantel-Cox) test, it was found that the contralateral ACL injury occurred in 5.762 (4.981, 6.543) years in patients with PTS≥10.92°, which was significantly shorter than patients with PTS<10.92° [9.751 (9.650, 9.853) years]( χ 2 =302.479, P<0.001).@*CONCLUSION@#Female and PTS≥10.92° after primary ACL reconstruction are independent risk factors for contralateral ACL injury.

Progress in evaluation of return to sports after anterior cruciate ligament reconstruction / 中国修复重建外科杂志

OBJECTIVE@#To summarize the evaluation methods of return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR) in recent years, in order to provide reference for clinical practice.@*METHODS@#The literature related to the RTS after ACLR was searched from CNKI, Wanfang, PubMed, and Foreign Medical Information Resources Retrieval Platform (FMRS) databases. The retrieval range was from 2010 to 2023, and 66 papers were finally included for review. The relevant literature was summarized and analyzed from the aspects of RTS time, objective evaluation indicators, and psychological evaluation.@*RESULTS@#RTS is the common desire of patients with ACL injury and doctors, as well as the initial intention of selecting surgery. A reasonable and perfect evaluation method of RTS can not only help patients recover to preoperative exercise level, but also protect patients from re-injury. At present, the main criterion for clinical judgement of RTS is time. It is basically agreed that RTS after 9 months can reduce the re-injury. In addition to time, it is also necessary to test the lower limb muscle strength, jumping, balance, and other aspects of the patient, comprehensively assess the degree of functional recovery and determine the different time of RTS according to the type of exercise. Psychological assessment plays an important role in RTS and has a good clinical predictive effect.@*CONCLUSION@#RTS is one of the research hotspots after ACLR. At present, there are many related evaluation methods, which need to be further optimized by more research to build a comprehensive and standardized evaluation system.

Reparación primaria versus reparación y aumentación con cinta de polietileno de alto peso molecular en lesiones del ligamento cruzado anterior: resultados funcionales / Primary repair versus repair and augmentation with high molecular weight polyethylene tape in ACL injuries. Functional results

Introducción: el objetivo del trabajo es evaluar y comparar resultados funcionales en pacientes que fueron sometidos a una reparación primaria del LCA y aquellos en quienes se efectuó reparación asociada con aumentación con cinta de polietileno. Materiales y métodos: se realizó un estudio comparativo en el que se analizaron ochenta y siete pacientes intervenidos quirúrgicamente por lesión proximal del LCA entre 2017 y 2019. El grupo 1, con lesión Sherman I, fue tratado con reparación primaria (cincuenta y seis pacientes). En el grupo 2, con lesiones Sherman II, se efectuó reparación más aumentación (treinta y un pacientes). Se evaluaron el IKDC (Lysholm, Tegner, International Knee Documentation Committee), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), y KOOS (Knee Injury and Osteoarthritis Score), preoperatorio y a los seis, doce y veinticuatro meses postoperatorios. Se consideraron significativas aquellas pruebas con p <0.001 (IC 95%). Los análisis estadísticos fueron llevados a cabo en el software estadístico R (R Core Team, 2022).Resultados: el índice de falla fue de 10.4% y 7.6% para los grupos 1 y 2, respectivamente, a los dos años del postoperatorio. Todos los scores mejoraron en el postoperatorio y fue estadísticamente significativa la diferencia con el preoperatorio a los seis y a los veinticuatro meses (p <0.001). El tipo de cirugía no tiene un efecto estadísticamente significativo en los scores clínicos. Conclusión: la reparación en una lesión proximal de LCA (Sherman I o II) es una buena alternativa quirúrgica que permite una mejoría rápida de los scores clínicos, buenos resultados y con bajo índice de complicaciones. Nivel de Evidencia: IV

Introduction: the objective of this study is to compare clinical and functional results in patients who underwent primary ACL repair and primary repair associated with augmentation with polyethylene tape. Materials and methods: eighty-seven patients who underwent surgery for proximal ACL injury between 2017 and 2019 were analyzed. The group 1, with Sherman I injury was treated with primary repair (fifty-six patients). In the group 2, with Sherman II lesions, repair plus augmentation was performed (thirty-one patients). IKDC (Lysholm, Tegner, International Knee Documentation Committee), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and KOOS (Knee Injury and Osteoarthritis Score) were evaluated preoperatively and at six, twelve, and twenty-four months postoperatively. Those tests with p <0.001 (95% CI) were considered significant. Statistical analyzes were carried out in the statistical software R (R Core Team, 2022). Results: the failure rate was 10.4% and 7.6% for groups 1 and 2, respectively, at two years after surgery. All the scores improved in the postoperative period, with significant difference respect to the preoperative period at six and at twenty-four months (p <0.001). Type of surgery does not have a significant effect on clinical scores.Conclusion: repairing a proximal ACL injury (Sherman I or II) is a good surgical alternative, which allows fast improvement of clinical scores, good results and a low rate of complications. Level of Evidence: IV

ACL reconstruction associated with lateral extra-articular tenodesis with shared femoral tunnel

Recently, the anterolateral ligament has gained attention in knee surgery for its ability to improve rotational stability in ACL reconstructions. However, the lateral extra-articular tenodesis (LET) procedure, which involves creating a femoral tunnel using the modified Lemaire technique, presents a risk of overlapping with the femoral tunnel used in the ACL reconstruction. This can lead to complications and limit the success of the surgery. To avoid these issues without needing additional fixation, we describe an easily reproducible surgical technique in which a single femoral tunnel is shared for both ACL reconstruction and LET using the iliotibial tract

Recientemente, el ligamento anterolateral ha ganado atención en la cirugía de rodilla por su capacidad para mejorar la estabilidad rotacional en las reconstrucciones del LCA. Sin embargo, el procedimiento de tenodesis lateral extraarticular (TLE), que implica la creación de un túnel femoral utilizando la técnica modificada de Lemaire, presenta un riesgo de solapamiento con el túnel femoral utilizado en la reconstrucción del LCA. Esto puede provocar complicaciones y limitar el éxito de la cirugía. Para evitar estos problemas, sin necesidad de una fijación adicional, describimos una técnica quirúrgica fácilmente reproducible en la que se comparte un solo túnel femoral tanto para la reconstrucción del LCA como para LET utilizando el tracto iliotibial

Programa preventivo de lesión de ligamento cruzado anterior en fútbol femenino durante períodos de confinamiento / Anterior Cruciate Ligament Injury Preventive Program for Soccer Female Players During Confinement Periods

Resumen La pandemia por COVID-19 obligó a paralizar el deporte en todo el mundo; por lo tanto, se redujo la carga de trabajo de los deportistas, lo cual, sumado al probable aumento de la densidad competitiva tras el período de confinamiento, resultará en un incremento del riesgo de lesión después del retorno a la competición. A este respecto, la rodilla es una de las zonas con mayor prevalencia de lesión en el fútbol femenino y la lesión del ligamento cruzado anterior (LCA) es de las más frecuentes y graves. En consecuencia, el objetivo del presente trabajo fue desarrollar un plan de prevención de lesión de LCA que pudiera ser llevado a cabo por mujeres futbolistas, durante períodos de confinamiento. Luego de una revisión de la literatura, se ha encontrado que el entrenamiento de fuerza (especialmente de la cadena posterior), el trabajo de la técnica de aterrizajes, así como el de estabilidad lumbopélvica y flexibilidad se asocian con un menor riesgo de lesión de LCA en mujeres. El programa se centra en factores de riesgo modificables, por lo que debe servir como una guía susceptible de adaptaciones, en función de cada contexto: las características individuales, el estado inicial y la evolución del sujeto durante su desarrollo. Por ende, en este estudio se plantea una intervención que pretende disminuir la probabilidad de lesión de LCA en mujeres futbolistas, tras el confinamiento, incidiendo, para ello, de forma directa sobre los mecanismos de lesión de LCA reportados en esta población.

Abstract The COVID-19 pandemic resulted in a worldwide sports shutdown, leading to a reduced athletes' workload, which is likely to increase the risk of injury after return to play when coupled with the expected increase in competitive density after the confinement period. In this regard, the knee is one of the joints with the highest injury prevalence among female soccer players, being the injury of the anterior cruciate ligament (ACL) one of the most frequent and severe. Thus, the present study aimed to develop an ACL injury prevention program that female soccer players could carry out during confinement periods. After reviewing the scientific literature, it was observed that strength training (with a main focus on the posterior chain), improved landing technique, lumbopelvic stability, and flexibility are associated with a lower risk of ACL injury in women. The program focuses on modifiable risk factors, so it should serve as a guide that can be adapted according to each context: individual characteristics, initial conditions, and evolution of the subject during development. Therefore, this study presents an intervention aiming at reducing the probability of ACL injury in female soccer players, after confinement periods, by directly influencing mechanisms of ACL injury previously reported for female soccer players.

Resumo A pandemia da COVID-19 forçou uma paralização mundial do esporte; portanto, a carga de trabalho dos atletas foi reduzida, o que, juntamente com o provável aumento da densidade competitiva após o período de confinamento, resultará em um risco maior de lesões após o retorno à competição. A esse respeito, o joelho é uma das áreas de lesão mais prevalecentes no futebol feminino e a lesão do ligamento cruzado anterior (LCA) é uma das mais frequentes e graves. Consequentemente, o objetivo do presente estudo é desenvolver um plano de prevenção de lesões do ACL que pode ser implementado por jogadoras de futebol feminino durante os períodos de internação. Após uma revisão da literatura, descobriu-se que o treinamento de força (especialmente da cadeia posterior), a técnica de aterrissagem, assim como o treinamento de estabilidade e flexibilidade lombo pélvica estão associados a um menor risco de lesão do LCA nas mulheres. O programa se concentra em fatores de risco modificáveis, portanto deve servir como um guia que possa ser adaptado de acordo com cada contexto: as características individuais, o estado inicial e a evolução da pessoa durante seu desenvolvimento. Portanto, este estudo propõe uma intervenção que visa reduzir a probabilidade de lesão do ACL em jogadoras de futebol feminino após o confinamento, afetando diretamente os mecanismos de lesão do ACL nelas relatados.

Anatomical Study of the Medial Region of the Knee: Qualitative, Quantitative Analysis and Description of the Anterior Oblique Ligament / Estudo anatômico da região medial do joelho: Análise qualitativa, quantitativa e descrição do ligamento oblíquo anterior

Abstract Objective To describe all ligamentous, capsular, tendinous and bone landmarks structures of the medial region of the knee, as well as a new ligamentous structure identified in a series of anatomical dissections of cadaveric specimens. Methods Twenty cadaver knees were dissected to study the medial compartment. The main structures of this region were identified during dissection. The morphology of the structures and their relationship with known anatomical parameters were determined both qualitatively and quantitatively. The collected data were analyzed and interpreted using descriptive statistics. Results In the dissection of all specimens, all ligamentous structures previously described in the anatomical study of the medial part of the knee were identified, and objective measures that can help as parameters for surgical ligament reconstruction were identified. When dissecting the medial collateral ligament, a bony prominence immediately distal to its proximal tibial insertion was observed and described, as well as a bursa below the ligament, in which it was not inserted. We also described a ligamentous structure with extracapsular location, originated anteriorly to the medial epicondyle and following obliquely towards the tibia. These structures were named, respectively, interinsertional tubercle, interinsertional bursa and anterior oblique ligament. Conclusion In addition to the description and measurement of the structures and parameters already existing in the anatomical study of the medial part of the knee, it was possible to describe three new structures not yet described in the literature: the interinsertional tubercle, the interinsertional bursa, and the anterior oblique ligament. These structures were found in all dissections performed.

Resumo Objetivo Descrever todas as estruturas ligamentares, capsulares, tendinosas e marcos ósseos da região medial do joelho, assim como uma nova estrutura ligamentar identificada em uma série de dissecções anatômicas de espécimes cadavéricos. Métodos Vinte joelhos de cadáveres foram dissecados para estudar o compartimento medial. As principais estruturas dessa região foram identificadas durante a dissecção. A morfologia das estruturas e sua relação com parâmetros anatômicos conhecidos foram determinados tanto de forma qualitativa quanto de forma quantitativa. Os dados coletados foram analisados e interpretados por meio de estatística descritiva. Resultados Na dissecção de todos os espécimes, foram identificadas todas as estruturas ligamentares já descritas anteriormente no estudo anatômico da porção medial do joelho, e foram realizadas medidas objetivas que podem auxiliar como parâmetros para a reconstrução ligamentar cirúrgica. Foram observados e descritos, ainda, ao se desprender o ligamento colateral medial superficial, uma proeminência óssea imediatamente distal à sua inserção tibial proximal, uma bursa abaixo do ligamento, na qual o mesmo não se mostrava inserido, assim como uma estrutura ligamentar localizada extracapsularmente e com origem na face anterior do epicôndilo medial, seguindo obliquamente em direção à tíbia, aos quais foram dados os nomes, respectivamente, de tubérculo interinsercional, bursa interinsercional e ligamento oblíquo anterior. Conclusão Além da descrição e medida das estruturas e parâmetros já existentes no estudo anatômico da porção medial do joelho, foi possível a descrição de três novas estruturas: o tubérculo interinsercional a bursa interinsercional e o ligamento oblíquo anterior, ainda não descritos na literatura. Essas estruturas foram encontradas em todas as dissecções realizadas.

Early Accelerated versus Delayed Conservative Rehabilitation Protocol after Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial / Protocolo de reabilitação acelerada precoce versus conservadora retardada após reconstrução do ligamento cruzado anterior: Um ensaio prospectivo randomizado

Abstract Objective To compare the effectiveness of the early accelerated rehabilitation and delayed conservative rehabilitation protocols after arthroscopic anterior cruciate ligament reconstruction, in terms of the International Knee Documentation Committee (IKDC) score, pain (according to the Visual Analog Scale), laxity, and stiffness one year postoperatively to determine the best outcome. Materials and Methods A total of 80 subjects were divided into 2e groups (early accelerated group and delayed conservative group), which were analyzed by the Pearson Chi-squared and Wilcoxon rank-sum tests. Results One year postoperatively, knee laxity was significantly higher (p = 0.039) in the early accelerated group compared with the delayed conservative group. Regarding postoperative pain (according to the Visual Analogue Scale) and IKDC scores, both groups presented similar results. The postoperative range of motion was better in the early accelerated group, but this was not statistically significant (p = 0.36). Conclusion One year postoperatively, the early accelerated rehabilitation protocol was associated with significant knee laxity compared to the delayed conservative rehabilitation protocol.

Resumo Objetivo Comparar a eficácia dos protocolos de reabilitação acelerada precoce e de reabilitação conservadora retardada após reconstrução artroscópica do ligamento cruzado anterior, em termos da escala do International Knee Documentation Committee (IKDC), da dor (segundo a Escala Visual Analógica), da frouxidão e da rigidez no pós-operatório de um ano para determinar o melhor desfecho. Materiais e Métodos Um total de 80 participantes foram divididos em dois grupos (grupo da acelerada precoce e grupo da conservadora retardada), que foram analisados pelos testes do Qui-quadrado de Pearson e da soma dos postos de Wilcoxon. Resultados A frouxidão do joelho no pós-operatório de 1 ano foi significativamente mais alta (p = 0,039) no grupo da acelerada precoce do que no grupo da conservadora retardada. Em termos de dor pós-operatória (pela Escala Visual Analógica) e pontuações no IKDC, ambos os grupos apresentaram resultados similares. A amplitude de movimento pós-operatória foi melhor no grupo da acelerada precoce, mas isso não foi estatisticamente significativo (p = 0,36). Conclusão O protocolo de reabilitação acelerada precoce foi associado com uma frouxidão significativa do joelho em um ano de pós-operatório em comparação com o protocolo de reabilitação conservadora retardada.

High frequency transcutaneous electrical stimulation in the immediate postoperative period of anterior cruciate ligament reconstruction: a randomized clinical trial / Estimulação elétrica transcutânea de alta frequência no pós operatório imediato de reconstrução do ligamento cruzado anterior: um ensaio clínico randomizado

INTRODUCTION: The anterior cruciate ligament (ACL) is an important structure for knee stability. Transcutaneous electrical nerve stimulation (TENS) is an electrical current applied for significant pain relief. OBJECTIVE: To evaluate the effects of high-frequency TENS on the immediate postoperative period of ACL reconstruction. METHODS: 46 patients in the postoperative period of ACL reconstruction were randomly assigned to a control group (CG=23) and a TENS group (TG=23). Knee range of motion (ROM), pain, muscle strength, and drug intake were assessed before surgery and 24 and 48 hours after surgery. The TENS intervention protocol started in the recovery room, shortly after surgery, and was maintained continuously for the first 48 hours after surgery. RESULTS: The TENS group (TG) significantly controlled the increased level of postoperative pain (p<0.05) and significantly increased flexion ROM (p<0.05). When compared to the Control group (CG), the TENS group had a lower intake of ketoprofen (48.27%), diazepam (256.98%), and dipyrone (121.21%), morphine (320.77%), and tramadol (437.46%). CONCLUSION: Continuous high-frequency TENS significantly reduced pain intensity and significantly improved ROM, muscle strength, and drug intake in the postoperative period of ACL reconstruction.

Functional Outcome of Lateral Extraarticular Tenodesis (LET) Procedure in Addition to Anterior Cruciate Ligament Reconstruction: A Metaanalysis / Resultado funcional do procedimento de tenodese extra-articular lateral (TEL) como complemento à reconstrução do ligamento cruzado anterior: Uma metanálise

Abstract Objectives The aim of the present study is to systematically review and analyze the functional outcome of lateral extraarticular tenodesis (LET) procedure in addition to anterior cruciate ligament reconstruction (ACLR) in studies with a high level of evidence. Methods We performed a literature search for clinical studies comparing the LET method as an augmentation to ACL reconstruction with ACL reconstruction alone. The primary outcomes were the International Knee Documentation Committee (IKDC) score, the Lysholm score, and graft failures. Continuous variables were reported as means and 95% confidence intervals (CIs). Results Six clinical studies with 1,049 patients were included in the metaanalysis. The follow-up period was, in average, 24 months (range, 6-63 months). The addition of the LET procedure to ACLR results in better functional outcome based on the IKDC score (p< 0.05). Graft failure was found to be lower in the ACLR plus LET group (16 of 342 patients) compared with the ACLR-only group (46 of 341 patients) (p< 0.05). Conclusion There is high-level evidence that LET procedure in addition to ACLR is preferable in terms of functional outcome and graft failure.

Resumo Objetivos O objetivo deste estudo é revisar e analisar sistematicamente o desfecho funcional do procedimento de tenodese extra-articular lateral (TEL) em complemento à reconstrução do ligamento cruzado anterior (RLCA) em de estudos com alto nível de evidências. Métodos Realizamos a pesquisa bibliográfica para estudos clínicos comparando o método TEL como complemento à RCLA com a RLCA isolada. Os resultados principais foram a pontuação no Comitê Internacional de Documentação de Joelho (IKDC, na sigla em inglês), pontuação de Lysholm, e falhas no enxerto. Variáveis contínuas foram relatadas, como médias e intervalos de confiança (ICs) de 95%. Resultados Seis estudos clínicos com 1,049 pacientes foram incluídos na metanálise. O período de seguimento foi de, em média, 24 meses (intervalo de 6-63 meses). A adição do procedimento TEL à reconstrução do LCA resultou em melhor resultado funcional com base no escore IKDC (p< 0,05). A falha do enxerto foi menor no grupo RLCA mais TEL (16 dos 342 pacientes) em comparação com o grupo apenas RLCA (46 dos 341 pacientes) (p< 0,05). Conclusão Há evidências de alto nível de que o procedimento TEL como complemento à RLCA é preferível em termos de resultado funcional e falha do enxerto.

Meniscus repair with simultaneous anterior cruciate ligament reconstruction: Clinical outcomes, failure rates and subsequent processing / 中华创伤杂志(英文版)

PURPOSE@#To retrospectively analyze the clinical outcomes of meniscus repair with simultaneous anterior cruciate ligament (ACL) reconstruction and explore the causes of failure of meniscus repair.@*METHODS@#From May 2013 to July 2018, the clinical data of 165 patients who were treated with meniscus surgery and simultaneous ACL reconstruction, including 69 cases of meniscus repair (repair group) and 96 cases of partial meniscectomy (partial meniscectomy group) were retrospectively analyzed. The exclusion criteria were as follows: (1) ACL rupture associated with fracture, collateral ligament injury, or complex ligament injury; (2) a history of knee surgery; or (3) a significant degree of osteoarthritis. The 69 patients in the repair group were divided into the non-failure group (62 cases) and the failure group (7 cases) depending on the repair effect. Postoperative outcomes of the repair group and the partial meniscectomy group were compared. General conditions and postoperative outcomes of the failure group and the non-failure group were compared. During the median follow-up period of 28 months (range, 4 - 65 months) after the second arthroscopy, postoperative outcomes of seven patients in the failure group were summarized. SPSS 25.0 statistical software was used for statistical analysis. A p value less than 0.05 was considered statistically significant.@*RESULTS@#Seven patients in the failure group who underwent the second arthroscopy were followed up for (30 ± 17.4) months and their postoperative outcomes were summarized. Compared with the partial meniscectomy group, the International Knee Documentation Committee scores of patients in the repair group improved significantly (p = 0.031). Compared with the non-failure group, more patients in the failure group were younger than 24 years (p = 0.030). The median follow-up period was 39.5 months. All patients recovered well after subsequent partial meniscectomy and relieved clinical symptoms. Visual analog scale scores decreased significantly (p = 0.026), and the International Knee Documentation Committee and Lysholm scores improved significantly (p = 0.046 for both).@*CONCLUSION@#The failure rate of meniscus repair in this study was 10.1% (7/69), all of which were medial meniscus tears. However, the surgical outcomes of ACL reconstruction were not affected, and there might be a role for graft protection. Therefore, meniscus retears can be successful treated by performing subsequent partial meniscectomy in patients with repair failure.

Clinical effects of arthroscopy-assisted anterior cruciate ligament tibial eminence avulsion fracture compared with traditional open surgery:a Meta-analysis / 中国骨伤

OBJECTIVE@#To systematically evaluate the clinical efficacy of arthroscopy and traditional incision in the treatment of tibial avulsion fracture of anterior cruciate ligament (ACL).@*METHODS@#From July 2010 to July 2020, clinical comparative trial about arthroscopy and traditional incision in the treatment of ACL tibial avulsion fracture was conducted by using computer-based databases, including Embase, Pubmed, Central, Cinahl, PQDT, CNKI, Weipu, Wanfang, Cochrane Library, CBM. Literature screening and data extraction were carried out according to the inclusion and exclusion criteria, and the quality of the included literature was evaluated by improved Jadad score and Ottawa Newcastle scale (NOS). The operation time, hospital stay, fracture healing time, knee range of motion, postoperative excellent and good rate, complication rate, Lysholm score, International Knee Documentation Committee (IKDC) score and Tegner score were statistically analyzed by Review Manager 5.3 software.@*RESULTS@#Finally, 16 literatures were included, including 1 randomized controlled trial and 15 non randomized controlled trials, with a total of 822 patients (405 in arthroscopy group and 417 in traditional incision group). Meta analysis showed that the operation time [MD=-9.03, 95% CI(-14.36, -3.70), P<0.001], hospital stay [MD=-5.81, 95%CI(-9.32, -2.31), P=0.001] and fracture healing time [MD=-14.61, 95% CI(-17.93, -11.28), P<0.001] in the arthroscopy group were better than those in the traditional incision group. The incidence of complications in arthroscopy group was lower than that in traditional incision group[OR=0.15, 95%CI(0.07, 0.33), P<0.001]. The postoperative excellent and good rate[OR=4.39, 95%CI (1.96, 9.82), P<0.001], knee mobility[MD=6.78, 95%CI(2.79, 10.77), P<0.001], Lysholm score[MD=11.63, 95%CI(4.91, 18.36), P<0.001], IKDC score[MD=7.83, 95%CI(6.09, 9.57), P<0.001] and Tegner score[MD=0.60, 95%CI(0.31, 0.89), P<0.001] in the arthroscopic group were higher than those in the traditional incision group.@*CONCLUSION@#Compared with the traditional open reduction and internal fixation, arthroscopic surgery in patients with ACL tibial avulsion fracture can shorten the operation time, hospital stay and fracture healing time, reduce the incidence of postoperative complications, and obtain good postoperative knee function. It can be recommended as one of the first choice for patients with ACL tibial avulsion fracture.

Rehabilitation of neuromuscular function by physical exercise / Reabilitação da função neuromuscular por meio de exercícios físicos / Rehabilitación de la función neuromuscular mediante ejercicio físico

ABSTRACT Introduction In long-term sports, especially in explosive sports such as accelerated starting, athletes are prone to rupture the anterior cruciate ligament (ACL). It is the ultimate goal of ACL reconstruction for athletes to restore the stability (static and dynamic) and mechanical structure of the knee joint through reconstruction surgery. Object This article uses ACL reconstruction to repair patients' ACL and explores the effect of athletes' nerve recovery after sports. Methods We collected 35 ACL reconstruction athletes and randomly divided them into two groups (experimental group, 18; control group, 17). After reconstruction, the athletes in the experimental group were treated with sports rehabilitation. Results The experimental and control groups had great differences in knee joint exercise indexes and nerve function recovery. Conclusion Sports rehabilitation training can effectively improve the nerve function of the knee joint after ACL reconstruction. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução Em esportes de longa duração, especialmente em esportes explosivos, como partidas aceleradas, os atletas têm tendência a romper o ligamento cruzado anterior (LCA). O objetivo final da reconstrução do LCA para atletas é restaurar a estabilidade (estática e dinâmica) e a estrutura mecânica da articulação do joelho por meio da cirurgia de reconstrução. Objetivo Este artigo considera a reconstrução do reparo do LCA em pacientes e explora o efeito da recuperação nervosa em atletas após a prática de esportes. Métodos Foram coletados 35 atletas de reconstrução do LCA e os dividimos aleatoriamente em dois grupos (grupo experimental, 18; grupo controle, 17). Após a reconstrução, os atletas do grupo experimental foram tratados com reabilitação esportiva. Resultados Os grupos experimental e controle tiveram grandes diferenças nos índices de exercício da articulação do joelho e recuperação da função nervosa. Conclusão O treinamento de reabilitação esportiva pode efetivamente melhorar a função nervosa da articulação do joelho após a reconstrução do LCA. Nível de evidência II; Estudos terapêuticos: investigação dos resultados do tratamento.

RESUMEN Introducción En deportes de larga duración, especialmente en deportes explosivos como la partida acelerada, los deportistas son propensos a romperse el ligamento cruzado anterior (LCA). El objetivo final de la reconstrucción del LCA para los atletas es restaurar la estabilidad (estática y dinámica) y la estructura mecánica de la articulación de la rodilla mediante la cirugía de reconstrucción. Objeto Este artículo considera la reconstrucción para reparar el LCA de los pacientes y explora el efecto de la recuperación nerviosa de los atletas después de los deportes. Métodos Recogimos 35 deportistas de reconstrucción del LCA y los dividimos aleatoriamente en dos grupos (grupo experimental, 18; grupo de control, 17). Después de la reconstrucción, los atletas del grupo experimental fueron tratados con rehabilitación deportiva. Resultados Los grupos experimental y de control tuvieron grandes diferencias en los índices de ejercicio de la articulación de la rodilla y la recuperación de la función nerviosa. Conclusión el entrenamiento de rehabilitación deportiva puede mejorar eficazmente la función nerviosa de la articulación de la rodilla después de la reconstrucción del LCA. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.