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Grant E. Norte, Katherine R. Knaus, Chris Kuenze, Geoffrey G. Handsfield, Craig H. Meyer, Silvia S. Blemker and Joseph M. Hart

Anterior cruciate ligament (ACL) injuries continue to constitute a common major joint injury among active individuals, often resulting in high economic costs, 1 reduced physical activity, 2 and decreased quality of life. 2 An estimated range of 80,000 to more than 250,000 ACL injuries are

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Mina Samukawa, David Magee and Masaki Katayose


The effects of tibial rotation after ACL injury have not yet been well determined.


To show whether clinical outcomes such as the amount of tibial rotation can affect functional outcomes in normal and ACL deficient knees.


Case control study.


Research laboratory.


Twenty normal subjects (Control) and 20 subjects with ACL deficient knees (ACL).

Main Outcome Measures:

Tibial rotation at 30 and 90 degrees of knee flexion was measured using an inclinometer. One-legged hop, crossover hop, figure-of-eight running and 10-m running tests were used and determined the effect(s) of tibial rotation on the outcome of the functional tests.


There were significant between-group differences in internal and external rotation. The relationship between external tibial rotation and the figure-of-eight index was significantly negatively correlated.


The amount of tibial rotation is greater in ACL ruptured knees than in uninjured knees, and these greater amounts of tibial rotation affected the figure-of-eight running index.

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Yukio Urabe, Mitsuo Ochi and Kiyoshi Onari


To investigate changes in muscle strength in the lower extremity after ACL reconstruction.


Prospective case series.

Dependent Variables:

Isokinetic muscle strength measured in 6 movements (hip extension/flexion, hip adduction/abduction, knee extension/flexion) and circumference of the thigh/calf.


Clinic and home.


44 (24 men, 20 women) between the ages of 16 and 47 years with an ACL rupture. All underwent reconstruction via a semitendinosus autograft.

Main Outcome Measures:

The peak torque for each joint movement was recorded. Repeated-measures ANOVA and power analysis were conducted to detect significant interaction effects.


The decline of muscle strength after ACL reconstruction remained not only in the knee extensors and flexors but also in the hip adductors.


Rehabilitation programs that address the behavioral patterns and physiological characteristics of an ACL injury will benefit the athlete’s whole body and lead to a full recovery.

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Travis Anderson, Sandra J. Shultz, Nancy I. Williams, Ellen Casey, Zachary Kincaid, Jay L. Lieberman and Laurie Wideman

Epidemiological research has shown female athletes are up to three times more likely to suffer a non-contact anterior cruciate ligament (ACL) injury than male athletes in similar sports ( Prodromos, Han, Rogowski, Joyce, & Shi, 2007 ). These ACL injuries and associated surgeries result in

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Akihiro Tamura, Kiyokazu Akasaka and Takahiro Otsudo

Injury of the anterior cruciate ligament (ACL) is common in high-impact sports. 1 However, approximately 70% of all ACL injuries reportedly occur in noncontact situations and only 30% occur in contact situations. 2 Moreover, females are more likely than males to have noncontact ACL injuries and

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Jessica E. Digiacomo, Riann M. Palmieri-Smith, John A. Redman III and Lindsey K. Lepley

Anterior cruciate ligament (ACL) injuries are among the most functionally disabling conditions in orthopedics, most commonly occurring in young athletes between the ages of 15 and 25. 1 , 2 The rate of injury is estimated at more than 200,000 times per year, with about 75% of individuals electing

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David M. Werner and Joaquin A. Barrios

injury 4 MCL∶2 PCL Meniscus tear 19 Graft type (HS∶PT∶Allo) 9∶12∶4 Abbreviations: ACLR, Anterior Cruciate Ligament Reconstruction; Allo, allograft; BMI, body mass index; HS, hamstrings; MCL, medial collateral ligament; NCAA, National Collegiate Athletic Association; PCL, posterior cruciate ligament; PT

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Takayuki Hasegawa, Toshiro Otani, Kentaro Takeda, Hideo Matsumoto, Kengo Harato, Yoshiaki Toyama and Takeo Nagura

The purpose of the current study was to longitudinally evaluate how preoperative knee kinematics change after ACL reconstruction. Three-dimensional gait analysis using the point cluster method was undertaken on the same subjects preoperatively and at 3, 6, and 12 months after ACL reconstructive surgery. Thirteen subjects (7 males, 6 females) were examined while performing 2 different activities at self-selected speeds: walking and walk-pivoting (walking, pivoting toward the landed limb side and walking away). The contralateral knees of subjects at 12 months postoperatively were selected as control knees. Flexion range in the stance phase increased with time after surgery, but remained lower than in the contralateral knee, even at 12 months postoperatively (P < .05) during walking and walk-pivoting. The rotation pattern during walking and walk-pivoting showed an offset toward external rotation by 6 months postoperatively compared with control knees, while at 12 months postoperatively the offset had nearly disappeared and the movement pattern resembled that in control knees. These findings suggest that a return to sport participation by 6 months after ACL reconstruction requires careful consideration. Depending on the type of sport, activity restriction even after 12 months may need to be considered to allow complete kinematic restoration.

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Erica M. Willadsen, Andrea B. Zahn and Chris J. Durall

Clinical Scenario The high prevalence of noncontact anterior cruciate ligament (ACL) injuries in adolescent female athletes is thought to originate from hormonal, neuromuscular, and structural differences between sexes. 1 Although hormonal and structural factors are nonmodifiable, neuromuscular

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Luke M. Mueller, Ben A. Bloomer and Chris J. Durall

Clinical Scenario:

Anterior cruciate ligament (ACL) injuries are associated with a lengthy recovery time, decreased performance, and an increased rate of reinjury. To improve performance of the injured knee, affected athletes often undergo surgical reconstruction and rehabilitation. Determining when an athlete is ready to safely return to play (RTP), however, can be challenging for clinicians. Although various outcome measures have been recommended, their ability to predict a safe RTP is questionable.

Focused Clinical Question:

Which outcome measures should be used to determine readiness to return to play after ACL reconstruction?