The application of primary repair for anterior cruciate ligament (ACL) injuries remains controversial, and evidence-based guidelines have not yet been established. Remarkable advancements in arthroscopic techniques and biological stimuli have been achieved in the past decades, which may change expectations regarding the potential of ACL healing and clinical outcomes for patients. In this study, a global expert consensus on the primary repair of proximal ACL injuries was established. A panel of 16 experts from the fields of sports medicine and arthroscopic surgery was invited to participate in the compilation of this consensus statement. This project followed the Delphi approach to the consensus process involving steering, rating, and peer review groups. Ultimately, 14 statements were retained: four achieved unanimous support, six achieved strong consensus, and four did not achieve consensus. The expert consensus statement established in this study focused on surgical indications, decision-making, surgical techniques, adjunctive methods, prognostic factors, and rehabilitation following ACL repair. The accepted recommendations in these areas will assist doctors and therapists in standardizing the management of related pathologies. The consensus statement clearly states that the tear site and tissue quality are important for ensuring successful ACL repair, while other factors should also be considered. ACL reconstruction remains the gold standard for ACL repair until long-term follow-up data demonstrates otherwise.
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Open Access
Guideline
Issue
Open Access
Original Article
Issue
Although previous research has suggested that a greater body mass index (BMI) may be linked to a higher incidence of ankle–foot sprains, the causal relationship between BMI and these injuries has not been established. This study aims to determine the causal effect of BMI-related features on ankle–foot sprains using a two-sample Mendelian randomization (MR) analysis.
Exposure single-nucleotide polymorphisms were collected from Genetic Investigation of Anthropometric Traits (GIANT Consortium) for BMI, hip circumference (HIP), hip circumference adjusted for BMI (HIPadjBMI), waist circumference (WC), waist circumference adjusted for BMI (WCadjBMI), waist-to-hip ratio (WHR), and waist-to-hip ratio adjusted for BMI (WHRadjBMI), encompassing a study population of more than 200000 individuals. Furthermore, exposure statistics were gathered from MEC-IEU for body fat percentage (BFP), involving a study population of 454633 individuals. Additionally, outcome statistics for ankle sprains were identified from FinnGen based on hospital discharge records (9141 cases and 290508 healthy controls). Random-effect, inverse-variance weighted MR was used as the primary method.
BMI (β = 0.173, p = 0.035), BFP (β = 0.341, p = 9.08 × 10−6), hip circumference (β = 0.265, p = 0.001), and WC (β = 0.193, p = 0.045) were found to have positive causal relationships with higher risk of ankle–foot sprains, whereas HIPadjBMI, WCadjBMI, WHR, and WHRadjBMI were found to have no such effect. Additionally, no reverse causal effect was found between ankle–foot sprains and BMI or BFP.
A genetic predisposition to higher BMI-related features can lead to a higher risk of ankle–foot sprains, providing new insight into how to prevent ankle–foot sprains in middle-aged and elderly people.
Open Access
Original Article
Issue
Ankle proprioception deficits have been widely reported in patients with chronic ankle instability (CAI), but their central neuropathological mechanisms have not been fully discussed. So, we aimed to figure out whether the structural and functional features of the cerebellar vermis differed between patients with CAI and healthy controls, and are associated with proprioception deficits in patients.
Twenty-two patients and 25 control individuals were enrolled in a cross-sectional investigation. All participants underwent structural and resting-state functional magnetic resonance imaging scanning to calculate voxel-based morphometry (VBM) and fractional amplitude of low-frequency fluctuation (fALFF) of the vermis. Between-group comparisons of the ankle instability-related subregions of the vermis were performed. Correlation analyses were performed between the outcomes of the surviving subregions and the proprioceptive scores of the ankle inversion discrimination apparatus for landing test.
The subregion of vermis Ⅳ/Ⅴ survived the multiple comparison correction to reveal a lower VBM value in patients than in healthy controls (Cohen's d = −0.968). The patients also showed significantly higher fALFF (Cohen's d = 0.666) in this subregion. After controlling the demographic features, the proprioceptive scores were significantly correlated with VBM (r = 0.622) and fALFF values (r = −0.512) in the group of patients.
Patients with CAI have lower gray matter volume and higher activity intensity in the cerebellar vermis than healthy control. The more severe proprioception deficits were significantly associated with the vermal volume and activity, which might be able to facilitate future diagnoses and treatments for CAI.
Open Access
Original Article
Issue
Lateral ankle sprains (LAS) are associated with corticospinal pathway deficits. Existing evidence is primarily based on cross-sectional investigations and noncausal speculations. This study aims to determine whether maladaptive corticospinal pathway alterations occur pre- and postligament transection in LAS mouse models. Additionally, this study explores whether the alterations are more pronounced in adolescent mice than adults.
Twenty-four 8-week-old adolescent and twenty-four 24-week-old adult mice were randomly assigned to lateral ankle ligament transection or sham surgery. Diffusion-weighted imaging of the corticospinal pathway was performed presurgery and 8 weeks postsurgery. Fractional anisotropy (FA) values, reflecting fiber integrity within the corticospinal subregions of the medulla, pons, midbrain, and cerebrum, were extracted.
Overall, 41 mice completed repeated image acquisition. Before surgery, no significant group effects on FA within the four corticospinal subregions were detected in either adolescent or adult mice. Two months after surgery, the adolescent cohort displayed a significant reduction in FA in the medulla subregion following ankle ligament transection (β-baseline-adjusted = −0.083, 95% CI, −0.145 to −0.021, p-corrected = 0.048). Conversely, no significant effects of ankle ligament transection on corticospinal FA were observed in the adult cohort.
The maladaptive alterations in the corticospinal tract could be observed in the adolescent LAS mouse model, characterized by reduced fiber integrity in the medulla subregion. While these results are derived from an animal model, they provide a foundation for future investigations into the mechanisms underlying neurological deficits following musculoskeletal injuries.
Open Access
Review
Issue
Postural control deficits and persistent joint stability issues are prevalent in population with anterior cruciate ligament (ACL) injuries or reconstructions. Postural control is typically assessed using the center of pressure (CoP) parameters during the static single-leg stance with a force plate. However, previous studies have reported unclear definitions and descriptions of the CoP parameters, causing inconsistent results of postural control deficits in a specific population.
To 1) summarize CoP parameters commonly used to evaluate postural control deficits in ACL injured or reconstructed population, and 2) identify the differences in CoP parameters with opened and closed eyes during the single-leg stance between ACL injured or reconstructed and control groups.
PubMed, Embase, Cochrane Library, CINAHL, Scopus, Web of Science, and SPORTDiscus databases were searched up to July 2023. Data were obtained from the selected articles and underwent quality and risk of bias assessment and meta-analysis using random-effect models. Subgroup analysis within ACL injured or reconstructed group were also performed.
A total of 14 articles were included in the analysis after screening. The injured knee of the ACL injured or reconstructed group differed insignificantly in sway amplitude, sway area, and sway velocity during static single-leg stance under opened and closed eyes when compared with the control group. In the subgroup analysis, we found that there was only significant difference in sway velocity with open eyes (SMD = 0.47, p = 0.001) between ACL reconstructed group and control group.
This study summarized the common CoP parameters used to evaluate postural control in ACL injured or reconstructed population. The results only showed weak difference in sway velocity between ACL reconstructed population and healthy individuals with opened eyes during the static single-leg stance.
Open Access
Original Article
Issue
Ankle-foot sprains are the most common musculoskeletal injuries, which can impair balance and theoretically increase the risk of falls, but still, there is a lack of evidence supporting the direct association between ankle-foot sprains and the future risk of falls.
UK Biobank cohort was utilized to measure the association between ankle-foot sprains and fall risk with covariates adjusted. Then, the two-sample Mendelian randomization (MR) analysis was applied based on the genetically predicated ankle-foot sprains from FinnGen to validate causal relationship. Finally, genetically predicated cerebellar neuroimaging features were used to explore the mediating role of maladaptive neuroplasticity between ankle-foot sprains and falls by two-step MR analyses.
Patients with ankle-foot sprains history exhibited a slightly increased risk of falls than the matched controls before and after adjustment for covariates (odd ratio [OR] ranged from 1.632 to 1.658). Two-sample MR analysis showed that ankle-foot sprains led to a higher risk of falls (OR = 1.036) and a lower fractional anisotropy of superior cerebellar peduncle (SCP) (left, β = −0.052; right, β = −0.053). A trend of mediating effect was observed for the fractional anisotropy of right SCP in the causal effects of ankle-foot sprains on falls (β = 0.003).
The history of ankle-foot sprains is associated with a slightly increased risk of falls. These findings improve our understanding of the clinical consequences of ankle-foot sprains in terms of fall risk and suggest the importance of adopting more efficient strategies for managing residual functional deficits after the injuries.
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