Prevalence of hip femoroacetabular impingement deformities in high-level (La Liga) male professional football players.

BACKGROUND: Femoroacetabular impingement (FAI) is considered one of the main causes of hip osteoarthritis in young adults, especially in athletes. In recent years, morphological changes in FAI in the hip have been linked to early and intense sports participation, but studying top-level athlete samples is not easy. This paper presents the prevalence of FAI radiological markers in 120 active white male professional football players in the Spanish First Division League (La Liga) and compares the morphological changes with those of a control group of healthy individuals without significant sport activity. METHODS: The precontract medical evaluation hip X-rays of 120 white male professional football players from four different First Division Spanish football teams were prospectively filed and retrospectively reviewed by a dedicated skeletal radiologist. The footballers' hip X-rays were compared with those of a control group of 80 healthy individuals (age-sex matched) without significant sport activity (obtained from routine work medical checks). RESULTS: The femoral head-neck deformity associated with the Cam type of femoroacetabular impingement was observed in 61.6% of professional football players and only in 11.6% of the control group (p <0.01). The presence of "herniation pit" (11.6%) and os acetabuli (13.3%) also reached statistical significance in the professional football players group. In the other analyzed parameters, no statistically significant differences between the groups were observed. CONCLUSIONS: White professional top-level football players have an increased incidence of abnormal lateral epiphyseal extension ("pistol grip deformity"), os acetabuli and herniation pits.

Genetic Profile in Genes Associated with Sports Injuries in Elite Endurance Athletes.

Injuries are a complex trait that can stem from the interaction of several genes. The aim of this research was to examine the relationship between muscle performance-related genes and overuse injury risk in elite endurance athletes, and to examine the feasibility of determining a total genotype score that significantly correlates with injury. A cohort of 100 elite endurance athletes (50 male and 50 female) was selected. AMPD1 (rs17602729), ACE (rs4646994), ACTN3 (rs1815739), CKM (rs8111989) and MLCK ([rs2849757] and [rs2700352]) polymorphisms were genotyped by using real-time polymerase chain reaction (real time-PCR). Injury characteristics during the athletic season were classified following the Consensus Statement for injuries evaluation. The mean total genotype score (TGS) in non-injured athletes (68.263±13.197 arbitrary units [a.u.]) was different from that of injured athletes (50.037±17.293 a.u., p<0.001). The distribution of allelic frequencies in the AMPD1 polymorphism was also different between non-injured and injured athletes (p<0.001). There was a TGS cut-off point (59.085 a.u.) to discriminate non-injured from injured athletes with an odds ratio of 7.400 (95% CI 2.548-21.495, p<0.001). TGS analysis appears to correlate with elite endurance athletes at higher risk for injury. Further study may help to develop this as one potential tool to help predict injury risk in this population.

Association of the CKM rs8111989 Polymorphism with Injury Epidemiology in Football Players.

The influence of the rs8111989 polymorphism in the muscle-specific creatine kinase gene (CKM) on injury incidence is unknown. The aim was to investigate CKM polymorphism on injury incidence in high-performance football players. A cohort of 109 high-performance players was genotyped by using saliva samples. Injury incidence was similar in players with the GG, GA, and AA genotypes and did not modify incidence during training or match exposure (p=0.583 and p=0.737 respectively). GG players had a higher frequency of slight-severity injuries (60.0 vs. 10.2 vs. 24.2%, p<0.001), while GA players had a higher frequency of severe injuries (16.7 vs. 30.8 vs. 10.0%, p=0.021). GA players also had a higher frequency of muscle tears (34.8 vs. 59.0 vs. 20.0%, p<0.001). Muscle contracture was a more frequent injury in players with the GG genotype (40.0%, p<0.001). G allele carriers had lower frequencies of gradual-onset injuries (4.1 vs. 16.7%, p=0.035) and recurrent injuries (6.1 vs. 16.7%, p=0.003) than AA players. A allele carriers had higher frequency of severe injuries (10.0 vs. 21.9%, p=0.044) than GG players. Genotypes in the CKM rs8111989 polymorphism did not affect injury incidence in high-performance football players. Players with the GA genotype were more prone to severe injuries and muscle tears when compared to GG and AA players.

Genetic profile in genes associated with muscle injuries and injury etiology in professional soccer players.

Many causes define injuries in professional soccer players. In recent years, the study of genetics in association with injuries has been of great interest. The purpose of this study was to examine the relationship between muscle injury-related genes, injury risk and injury etiology in professional soccer players. In a cross-sectional cohort study, one hundred and twenty-two male professional football players were recruited. AMPD1 (rs17602729), ACE (rs4646994), ACTN3 (rs1815739), CKM (rs8111989) and MLCK (rs2849757 and rs2700352) polymorphisms were genotyped by using Single Nucleotide Primer Extension (SNPE). The combined influence of the six polymorphisms studied was calculated using a total genotype score (TGS). A genotype score (GS) of 2 was assigned to the "protective" genotype for injuries, a GS of 1 was assigned to the heterozygous genotype while a GS of 0 was assigned to the "worst" genotype. Injury characteristics and etiology during the 2021/2022 season were classified following a Consensus Statement for injuries recording. The distribution of allelic frequencies in the AMPD1 and MLCK c.37885C>A polymorphisms were different between non-injured and injured soccer players (p < 0.001 and p = 0.003, respectively). The mean total genotype score (TGS) in non-injured soccer players (57.18 ± 14.43 arbitrary units [a.u.]) was different from that of injured soccer players (51.71 ± 12.82 a.u., p = 0.034). There was a TGS cut-off point (45.83 a.u.) to discriminate non-injured from injured soccer players. Players with a TGS beyond this cut-off had an odds ratio of 1.91 (95%CI: 1.14-2.91; p = 0.022) to suffer an injury when compared with players with lower TGS. In conclusion, TGS analysis in muscle injury-related genes presented a relationship with professional soccer players at increased risk of injury. Future studies will help to develop this TGS as a potential tool to predict injury risk and perform prevention methodology in this cohort of football players.

Genetic profiles to identify talents in elite endurance athletes and professional football players.

The genetic profile that is needed to identify talents has been studied extensively in recent years. The main objective of this investigation was to approach, for the first time, the study of genetic variants in several polygenic profiles and their role in elite endurance and professional football performance by comparing the allelic and genotypic frequencies to the non-athlete population. In this study, genotypic and allelic frequencies were determined in 452 subjects: 292 professional athletes (160 elite endurance athletes and 132 professional football players) and 160 non-athlete subjects. Genotyping of polymorphisms in liver metabolisers (CYP2D6, GSTM1, GSTP and GSTT), iron metabolism and energy efficiency (HFE, AMPD1 and PGC1a), cardiorespiratory fitness (ACE, NOS3, ADRA2A, ADRB2 and BDKRB2) and muscle injuries (ACE, ACTN3, AMPD1, CKM and MLCK) was performed by Polymerase Chain Reaction-Single Nucleotide Primer Extension (PCR-SNPE). The combination of the polymorphisms for the "optimal" polygenic profile was quantified using the genotype score (GS) and total genotype score (TGS). Statistical differences were found in the genetic distributions between professional athletes and the non-athlete population in liver metabolism, iron metabolism and energy efficiency, and muscle injuries (p<0.001). The binary logistic regression model showed a favourable OR (odds ratio) of being a professional athlete against a non-athlete in liver metabolism (OR: 1.96; 95% CI: 1.28-3.01; p = 0.002), iron metabolism and energy efficiency (OR: 2.21; 95% CI: 1.42-3.43; p < 0.001), and muscle injuries (OR: 2.70; 95% CI: 1.75-4.16; p < 0.001) in the polymorphisms studied. Genetic distribution in professional athletes as regards endurance (professional cyclists and elite runners) and professional football players shows genetic selection in these sports disciplines.

Injury Incidence Increases after COVID-19 Infection: A Case Study with a Male Professional Football Team.

Background: The SARS-CoV-2 virus disease has caused numerous changes in sports routines in the last two years, showing the influence on an increase in sports injuries. The aim of this study was to prospectively analyze the incidence and characteristics of injuries in male professional football players diagnosed with COVID-19 when they return to play after recovering from this illness. Methods: Injury characteristics of professional male football players were recorded for the 2020−2021 season following the international consensus statement from the International Olympic Committee (IOC). SARS-CoV-2 infection in the football players was certified by PCR analysis. Injury epidemiology was compared in players infected by the SARS-CoV-2 virus before and after being diagnosed with COVID-19. Results: 14 players (53.8%) were diagnosed with COVID-19 during 2020−2021 season and 12 (46.2%) were not infected (controls). Only three (21.4%) had suffered an injury before being diagnosed with COVID-19. Eleven players (78.6%) had injuries after being diagnosed with COVID-19 (p < 0.001). Among the players diagnosed with COVID-19, injury incidence increased on their return to play after the infection (3.8 to 12.4 injuries/1000 h of exposure, p < 0.001). Additionally, injury incidence during training (10.6 vs. 5.1 injuries/1000 h of exposure, p < 0.001) and matches (56.3 vs. 17.6 injuries/1000 h of exposure, p < 0.001) was ~two-fold higher on return to play after COVID-19 compared to controls (33.4 vs. 17.6 injuries/1000 h of exposure, respectively, p < 0.001). Conclusions: Injury incidence in professional football players who had been infected by the SARS-CoV-2 virus significantly increased compared to the injury rates that these same players had prior to the illness. Additionally, the injury incidence was higher when compared to players who were not infected by the SARS-CoV-2 virus during the season, especially during matches.

Genetics and sports performance: the present and future in the identification of talent for sports based on DNA testing.

The impact of genetics on physiology and sports performance is one of the most debated research aspects in sports sciences. Nearly 200 genetic polymorphisms have been found to influence sports performance traits, and over 20 polymorphisms may condition the status of the elite athlete. However, with the current evidence, it is certainly too early a stage to determine how to use genotyping as a tool for predicting exercise/sports performance or improving current methods of training. Research on this topic presents methodological limitations such as the lack of measurement of valid exercise performance phenotypes that make the study results difficult to interpret. Additionally, many studies present an insufficient cohort of athletes, or their classification as elite is dubious, which may introduce expectancy effects. Finally, the assessment of a progressively higher number of polymorphisms in the studies and the introduction of new analysis tools, such as the total genotype score (TGS) and genome-wide association studies (GWAS), have produced a considerable advance in the power of the analyses and a change from the study of single variants to determine pathways and systems associated with performance. The purpose of the present study was to comprehensively review evidence on the impact of genetics on endurance- and power-based exercise performance to clearly determine the potential utility of genotyping for detecting sports talent, enhancing training, or preventing exercise-related injuries, and to present an overview of recent research that has attempted to correct the methodological issues found in previous investigations.

Hamstrings injuries in football.

Background: Hamstrings injuries are a major concern in football (soccer), affecting both recreational players and professional athletes. Although being a recognized issue within the football community, its incidence has been increasing over the last years and still poses a challenge to all practitioners involved. Study objectives and rationale: The goal of this narrative review is to outline hamstrings injuries epidemiology and mechanisms of injury, identify and discuss its risk factors, provide an approach to a proper early diagnosis, evaluate the efficacy of current treatment options and return to sports, and present the best strategies for hamstrings injury prevention. These guidelines will help the sports medicine staff team on how to better manage their players with or at risk of hamstrings injuries. Conclusion: Despite several breakthroughs in research of hamstrings injuries, there is still heterogeneity across studies and lack of consensus in regards to classification, diagnosis, treatment and prevention. Hamstrings injuries compromise the athlete's performance with time loss due to injury, shortens their highest-level career longevity with higher risk of reinjury rates, and is a defying problem for clubs to balance financial losses due to having their players off the pitch. Further research is warranted to keep moving forward with evidence on treating and preventing hamstrings injuries to mitigate its high incidence and keep the players safe.

Biomechanical Behavior Characterization and Constitutive Models of Porcine Trabecular Tibiae.

Customizing any trauma surgery requires prior planning by surgeons. Nowadays, the use of numerical tools is increasingly needed to facilitate this planning. The success of this analysis begins with the definition of all the mechanical constitutive models of the materials implied. Our target is the trabecular bone because almost all trauma surgeries are closely related to it. This work focuses on the experimental characterization of porcine trabecular tibiae and defining its best constitutive model. Therefore, different types of compression tests were performed with tibia samples. Once the potential constitutive models were defined, stress-strain state from numerical approaches were compared with the corresponding experimental results. Experimental results from uniaxial compression tests showed than trabecular bone exhibits clear anisotropy with more stiffness and strength when it is loaded in the tibia longitudinal direction. Results from confined compression tests confirmed that the plastic behavior of trabecular bone depends on the hydrostatic and deviatoric invariants, so an alternative formulation (crushable foam volumetric (CFV)) has been proposed to describe its behavior. A new method to obtain CFV characteristic parameters has been developed and validated. Predictions of the CFV model better describe trabecular bone mechanical behavior under confined conditions. In other cases, classical plasticity formulations work better.

Subjective assessment reported by patients shows differences between single-bundle and double-bundle anterior cruciate ligament reconstruction, systematic review and meta-analysis.

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.

Safety and Performance of Titanium Suture Anchors Used in Knee Ligament Repair Procedures.

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.

Assessment of muscle fiber adaptation in footballers using a new ELISA assay of myosin isoforms.

BACKGROUND: 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. METHODS: A new assay was developed to measure the myosin isoforms in 49 non-sporting volunteers and in 27 professional football players. RESULTS: 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). CONCLUSIONS: 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.

Clinical Management in Early OA.

Knee osteoarthritis affects an important percentage of the population throughout their life. Several factors seem to be related to the development of knee osteoarthritis including genetic predisposition, gender, age, meniscal deficiency, lower limb malalignments, joint instability, cartilage defects, and increasing sports participation. The latter has contributed to a higher prevalence of early onset of knee osteoarthritis at younger ages with this active population demanding more consistent and durable outcomes. The diagnosis is complex and the common signs and symptoms are often cloaked at these early stages. Classification systems have been developed and are based on the presence of knee pain and radiographic findings coupled with magnetic resonance or arthroscopic evidence of early joint degeneration. Nonsurgical treatment is often the first-line option and is mainly based on daily life adaptations, weight loss, and exercise, with pharmacological agents having only a symptomatic role. Surgical treatment shows positive results in relieving the joint symptomatology, increasing the knee function and delaying the development to further degenerative stages. Biologic therapies are an emerging field showing early promising results; however, further high-level research is required.

Análisis de la fuerza y movilidad de la cadera como factores de riesgo de lesión en fútbol femenino amateur: un estudio piloto / Analysis of hip strength and mobility as injury risk factors in amateur women’s soccer: a pilot study

Objetivos: Los objetivos del presente estudio consisten en aalizar la incidencia de lesiones no traumáticas de las extremidades inferiores en un equipo amateur femenino de fútbol y valorar su relación con la fuerza de la musculatura abductora y la movilidad en rotación externa de la cadera. Material y método: La presente investigación consiste en un estudio epidemiológico, observacional, analítico, longitudinal prospectivo. La muestra se seleccionó mediante un muestreo por conveniencia quedando compuesta por las 23 jugadoras que compusieron la plantilla del E.F. Mareo en la temporada 2013-2014, equipo ubicado en la Segunda División Nacional Española. El rango de edad de las participantes fue de los 14 a los 33 años (x=22,5; s=5,7). Las jugadoras fueron evaluadas en pretemporada y posteriormente se las siguió hasta el final del período competitivo para registrar las lesiones aparecidas. Resultados: Se apreciaron diferencias estadísticamente significativas entre la extremidad inferior dominante y la no dominante tanto en la fuerza de la musculatura abductora como en los rangos de movilidad en rotación externa de la cadera (p < 0,01). A lo largo de la temporada, el 52,2% de las participantes se vio afectado por alguna lesión no traumática en las extremidades inferiores. En cuanto a la tipología, el 53,8% fueron ligamentosas y afectaron principalmente al tobillo, con sólo una de ellas afectando a la rodilla (rotura de LCA), mientras que el 15,4% fueron lesiones tendinosas que afectaron a la rodilla y el 30,8% restante fueron lesiones tendinosas en la cadera. No se apreció relación de la fuerza de la musculatura abductora o de la movilidad en rotación externa de la cadera con la producción de lesiones. Conclusiones: Resultan necesarias más investigaciones para alcanzar resultados concluyentes

Objectives: The aims of the present study were to analize the incidence of overuse injuries of the lower limbs in an amateur women ́s soccer club throughout a competitive season and to assess its relationship with hip abductors strength and hip external rotation mobility. Material and methods: This research is an epidemiological, observational, analytical, prospective longitudinal study. The sample was selected by a non-random convenience sampling and it was composed of the 23 football players who made up the team of the E. F. Mareo in 2013-2014 season. Participant ages ranged between 14 and 33 years (x=22.5; s=5.7). The players were subjected to an evaluation of their hip abductors strength and hip external rotation mobility in preseason and, then, they were followed until the end of the competitive period recording the injuries that were appearing. Results: Statistically significant differences were observed between the dominant and non dominant limbs in hip abductors strength and hip external rotation mobility (p< 0.01). Along the season, 52.2% of the participants experienced some kind of overuse injury affecting the lower extremities. Regarding the type of injury, 53.8% were ligamentous injuries mainly affecting the ankle, only one of them involved the knee (ACL tear), 15.4% were tendinous injuries affecting the knee and the remaining 30.8% were tendinous injuries affecting the hip. No significant relationship was observed between overuse injury incidence and player’s hip abductors strength or hip external rotation mobility. Conclusions: More research is needed to achieve concluding evidence about the influence of hip abductor strength and hip external rotation mobility on overuse injuries of the lower extremities in women's soccer

Whole-exome sequencing analysis in twin sibling males with an anterior cruciate ligament rupture.

Familial predisposition is among the major genetic risk factors for non-contact musculoskeletal tissue injuries. Personal genome sequence shows that different polymorphism profiles may account for the number and the degree of injuries and the recovery time. Genotyping studies allow investigation into genome factors with potential impact on pathogenesis of non-contact ligament injuries. We have studied a family with twin sibling males surgically diagnosed of an anterior cruciate ligament non-contact rupture and non-affected progenitors (father and mother) were subjected to whole exome sequencing (WES) analysis. WES analysis previously carried out on 16 individuals, without ACL injury medical records, were also included in this study for single nucleotide variants (SNVs) and small insertions and deletions detection (indels), variant filtering and to prioritize variants relative to the disease. WES analysis to identify SNVs and indels was performed using open web-based bioinformatics tools. A set of 11 new variants shared by family members can be associated to ACL non-contact injury, including SerpinA11, ARSI, NOCHT4, EPB41, FDFT1, POMC, KIF26A, OLFML2B, ATG7, FAH and WDR6. All of them, except ATG7 and WDR6, have shown a damaging predictive pattern by combinatorial standard predictive scores. In combination to the identified SNVs of EPB41 and SerpinA11 genes, ACTL7A gene showed a predicted deleterious variant reinforcing the idea these variants impact on of fibroblast-like cells deformability and ECM misbalance, Differential gene expression and RNA sequencing analysis will help to understand the combined participation of these protein coding genes in ACL non-contact injuries.

Viability of Pathologic Cartilage Fragments as a Source for Autologous Chondrocyte Cultures.

OBJECTIVE: To study if a culture of chondrocytes can be obtained from pathologic hyaline cartilage (PHC) fragments. DESIGN: Twenty-five men and 9 women with osteochondritis dissecans (OCD) in 11 cases, arthrosis in 13 patients, and trauma in the remaining 10 cases were included. The PHC fragments and a small sample of the next healthy cartilage were extracted by arthroscopy. According to the appearance, the PHC samples were divided into fixed (3 cases), flapped (6 patients), or loose bodies (25 cases), depending on the attachment degree of the cartilage to the subchondral bone. Approximately half of each pathologic sample and the whole healthy one were digested to isolate the cells trying to establish the cell culture. RESULTS: We were able to establish a cell culture in 7 out of 34 (20.6%) PHC samples (positive samples), whereas in the remaining 27 (79.4%) no cell growth was observed (negative samples). Most of the negative samples were loose bodies (P = 0.005) taken from patients with OCD or arthrosis (P = 0.001) with an evolution time of more than 1 year (P < 0.001). The best binary logistic regression model (P < 0.001) showed that the only factor affecting the establishment of cell culture was the evolution time (P = 0.044). CONCLUSION: It is possible to culture chondrocytes from osteochondral fragments if they are traumatic, within a year of injury and not from fragments due to arthrosis or OCD.

In vitro comparison between cortical and cortico-cancellous femoral suspension devices for anterior cruciate ligament reconstruction: implications for mobilization.

PURPOSE: To analyse the capability of cortical and cortical-cancellous suspension devices to provide a strong fixation in order to follow an aggressive early mobilization protocol. METHODS: Anterior cruciate ligament (ACL) reconstruction was performed in vitro on 40 porcine femurs employing a high-strength braided cord as a graft. Four femoral suspension devices were analysed: the cortical suspension devices Endobutton and XO Button and the cortical-cancellous suspension devices Biosteon Cross-pin and Cross-pin ACL. Two kinds of biomechanical testing were carried out: static and post-fatigue failure strength tests. Stiffness, failure load, elongation at failure load, elongation after 20 cycles and elongation after 1,000 cycles were assessed. The bones were cut after testing to analyse the failure pattern. RESULTS: All of the devices exceed 50 % of total elongation in the first 20 cycles of fatigue. In the static failure tests, there were significant differences (p < 0.05) in elongation to failure between the cortical-cancellous suspension devices Biosteon Cross-pin and Cross-pin ACL and the cortical suspension device Endobutton. No significant differences were found in the failure tests after 1,000 cycles of loading. The failure mode of the cortical devices comprised breakage of the cortical bone, accompanied by introduction of the device into the tunnel. The failure mode of the cortical-cancellous devices was pin breakage accompanied by tunnel enlargement. CONCLUSION: The first cycles of mobilization are critical for elongation. This mobilization process does not significantly diminish the mechanical characteristics of the reconstructions. All the fixations support an intensive early mobilization protocol, with loads of over 500 N.

Stability evaluation after isolated reconstruction of anteromedial or posterolateral bundle in symptomatic partial tears of anterior cruciate ligament.

OBJECTIVE: To evaluate the stability achieved in isolated reconstruction of each ACL bundles (minimum 2-year follow-up). STUDY GROUP: 39 consecutive patients (28.1 years of mean age) underwent anteromedial (AM) and posterolateral (PL) bundle reconstruction surgery (31.71 months of mean follow-up). CONTROL GROUP: 36 non-concurrent patients using single-bundle (SB) technique (more than 2-year follow-up). Evaluation based on IKDC scores, taking anterior-posterior translation and rotational stability as primary endpoints, and epidemiological data, ischaemia time, waiting time for surgery and complications as secondary endpoints. RESULTS: SB, AM and PL groups showed an anteroposterior translation (APT) at 2 years of 2.3, 1.8 and 1.8 mm, respectively, with an APT reduction of 5.4, 2.9 and 2.3 mm, respectively, but with no difference between both types of partial reconstruction (p = 0.552). IKDC scores in the AM group were as follows: preoperative (11 cases in group A, 12 B, 3 C), postoperative (24 A, 2 B); IKDC in the PL group: preoperative (7 B, 6 C), postoperative (10 A, 3 B). Mobility restored in all cases, while in group B, 2 AM patients and 3 PL had a slight Pivot Shift. There were no differences in complications as compared to conventional techniques. DISCUSSION: All techniques showed global significant enhancement in rotational stability (p < 0.0005). Improvement in anterior-posterior translation in AM group and in rotational stability in PL group was achieved; both showed no relevant statistical significance. Residual translation shows directly proportional relationship with preoperative status, surgical ischaemia time and patient weight. CONCLUSION: Reconstruction of one ACL bundle or the other can restore knee stability and function. Care should be taken to detect where the PL bundle reaches maximum tension and in improving patient preoperative status and ischaemia time.

ACL reconstruction with single tibial tunnel: single versus double bundle.

Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction is designed with the aim of reproducing the anatomy and the function of a healthy knee. This can be done by creating two femoral tunnels and one tibial tunnel (DB-3T), or two femoral and two tibial tunnels (DB-4T), There is very little comparative information regarding DB-3T, which is supposed to be more anatomical than DB-4T, and single bundle (SB). DB-3T reconstruction produces greater joint stability and clinical behavior than SB. Consecutive patients with a unilateral rupture of the ACL treated with the DB-3T technique, and a control group of 36 nonconcurrent patients, with similar conditions, treated with the SB technique were followed during 2 years. Anterior/posterior translation (APT), pivot-shift test, one-leg hop, and IKDC (International Knee Documentation Committee) subjective evaluations were performed. There were no significant differences in the reduction of APT. However, there was a significant improvement in the remaining parameters in the DB-3T group: greater reduction in rotational instability, greater one-leg hop capacity, and greater subjective evaluation. At the 2-year follow-up, patients having undergone ACL reconstruction using hamstring tendons by means of a DB technique with a single tibial tunnel showed greater rotational stability, greater one-legged hop capacity, and a greater subjective evaluation than those having undergone SB reconstruction.

Anterior cruciate ligament reconstruction: a multicenter prospective cohort study evaluating 3 different grafts using same bone drilling method.

OBJECTIVE: To compare the clinical outcomes after anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone autograft (BPTBAu), BPTB allograft (BPTBAll), or hamstring (semitendinosus-gracilis) tendon autograft (HTAu), performing bone drilling with same methods in terms of transtibial drilling, orientation, positioning, and width of femoral and tibial tunnels. DESIGN: Multicenter prospective cohort study (level of evidence II). SETTING: Departments of Orthopedic Surgery of Centro Médico Teknon (Barcelona, Spain) Clínica Universitaria de Navarra (Navarra, Spain), and Clínica FREMAP (Gijón, Spain). PATIENTS: All patients with ACL tears attending 3 different institutions between January 2004 and June 2006 were approached for eligibility and those meeting inclusion criteria finally participated in this study. INTERVENTION: Each institution was assigned to perform a specific surgical technique. Patients were prospectively followed after undergoing ACL reconstruction with BPTBAu, BPTBAll, or HTAu, with a minimum follow-up of 24 months. MAIN OUTCOME MEASURES: Included knee laxity and International Knee Documentation Committee (IKDC) score. Knee laxity was assessed with the KT-1000 arthrometer (evaluated with neutral and external rotation positions) and both Lachman and pivot shift tests. Additional outcomes included main symptoms (anterior knee pain, swelling, crepitation, and instability), disturbance in knee sensation, visual analogue scale (VAS) for satisfaction with surgery, range of motion (ROM), and isokinetic knee strength. RESULTS: There were no significant differences among the 3 groups for any of the clinical outcomes, except for a slightly greater KT-1000-measured knee laxity in external rotation in the BPTBAu compared with the other groups. All patients demonstrated grade A or B of the IKDC. The mean VAS for satisfaction with surgery in all patients was 8.5. CONCLUSIONS: The selection of the surgical technique for ACL reconstruction may be based on the surgeon's preferences.