UNASSIGNED: Chronic lateral ankle instability is a relatively frequent consequence after acute ankle sprain. In case of unsuccessful conservative treatment, surgical therapy is recommended to prevent osteoarthritis of the ankle joint. To date, different surgical methods have evolved. Yet, it remains unclear which approach reveals the best results. We hypothesized that the modified Broström-Gould procedure with suture anchor ligament fixation leads to superior postoperative results compared to the Broström-Gould procedure or the periosteal flap technique.
UNASSIGNED: In a prospective study, we examined the three surgical techniques. For this purpose, we performed a matched-pair analysis with four groups according to age, sex, and body mass index: periosteal flap technique (G1), Broström-Gould procedure (G2), modified Broström-Gould procedure with suture anchor ligament fixation (G3), and a control group (G4). Results were compared with the American Orthopaedic Foot & Ankle Society (AOFAS) score, a functional analysis as well as measuring postural stability with the Biodex balance system.
UNASSIGNED: No significant differences were found between all four groups concerning AOFAS score, functional results, as well as postural stability.
UNASSIGNED: All three surgical methods revealed satisfactory results. No significant differences could be detected in clinical and functional categories. The Broström-Gould method as well as the modified procedure with anchor can be recommended as surgical therapy for chronic lateral ankle instability. Additional anchors do not seem to have a significant positive impact on the results.

High-resolution ultrasound (US) can be used to assess soft tissue abnormalities in the foot and ankle. Compared to MRI, it has lower cost, is widely available, allows portability and dynamic assessment. US is an excellent method to evaluate foot and ankle tendon injuries, ligament tears, plantar fascia, peripheral nerves, and the different causes of metatarsalgia.

BACKGROUND: In vivo measurement of limb stiffness and conformation provides a non-invasive proxy assessment of superficial digital flexor tendon (SDFT) and suspensory ligament (SL) function. Here, we compared it in fore and hindlimbs and after injury.
OBJECTIVE: To compare the limb stiffness and conformation in forelimbs and hindlimbs, changes with age, and following injury to the SDFT and SL.
METHODS: Retrospective cohort study.
METHODS: Limb stiffness was calculated using floor scales and an electrogoniometer taped to the dorsal fetlock. The fetlock angle and weight were simultaneously recorded five times with the limb weight-bearing and when the opposite limb was picked up (increased load). Limb stiffness of both limbs was calculated from the gradient of the regression line of angle versus load. Fetlock angle when the weight was zero was extrapolated from the graph and used as a measure of conformation. Limb stiffness was measured in uninjured forelimbs (n = 42 limbs), hindlimbs (n = 19 limbs), forelimbs with SDFT injury (n = 18) and hindlimbs with SL injury (n = 5).
RESULTS: Limb stiffness correlated with weight in forelimbs as shown previously (p < 0.001) but also in hindlimbs (p = 0.006). When normalised to the horse\'s weight (503 kg, IQR 471.5-560), forelimb stiffness was significantly higher (22.3 [±4.5] × 10-3 degree-1) than for the hindlimb (16.4 [±4.0] × 10-3 degree-1; p < 0.001). While there were no significant differences between forelimb and hindlimb conformation in unaffected or SDFT injury, both limb stiffness and conformation was significantly greater in limbs with SL injury (p = 0.009 and p = 0.002, respectively).
CONCLUSIONS: Small sample size, lack of clinical data including lameness and quantification of injuries.
CONCLUSIONS: Injury to the forelimb SDFT does not alter limb stiffness or conformation in the long-term, while hindlimb SL injury simultaneously increases limb stiffness and fetlock angle, suggesting an increase in SL length following injury.
UNASSIGNED: Die in vivo Messung der Steifigkeit und Konformation der Gliedmaßen bietet eine nicht‐invasive Möglichkeit zur Beurteilung der Funktion der oberflächlichen Beugesehne (SDFT) und des Fesselträgers (SL). Diese wurde bei Vorder‐ und Hintergliedmaßen sowie nach einer Verletzung verglichen.
UNASSIGNED: Der Vergleich der Steifigkeit und Konformation der Gliedmaßen bei Vorder‐ und Hintergliedmaßen, Veränderungen im Alter und nach Verletzungen der SDFT und SL.
METHODS: Retrospektive Kohortenstudie.
METHODS: Die Steifigkeit der Gliedmaßen wurde mithilfe von Bodenwaagen und einem an das dorsale Fesselgelenk geklebten Elektrogoniometer berechnet. Der Fesselwinkel und das Gewicht wurden gleichzeitig fünfmal erfasst, sowohl mit tragender Gliedmaße als auch bei Anheben der gegenüberliegenden Gliedmaße (erhöhte Belastung). Die Steifigkeit der Gliedmaßen beider Beine wurde aus der Steigung der Regressionslinie von Winkel zu Last berechnet. Der Fesselwinkel bei einem Gewicht von null wurde aus dem Diagramm extrapoliert und als Maß für die Konformation verwendet. Die Steifigkeit der Gliedmaßen wurde bei unverletzten Vordergliedmaßen (n = 42 Gliedmaßen), Hintergliedmaßen (n = 19 Gliedmaßen), Vordergliedmaßen mit SDFT‐Verletzung (n = 18) und Hintergliedmaßen mit SL‐Verletzung (n = 5) gemessen.
RESULTS: Die Steifigkeit der Gliedmaßen korrelierte mit dem Gewicht bei den Vordergliedmaßen, wie zuvor gezeigt (p < 0,001), aber auch bei den Hintergliedmaßen (p = 0,006). Nach Normierung auf das Gewicht des Pferdes (503 kg, IQR 471,5–560) war die Steifigkeit der Vordergliedmaßen signifikant höher (22,3 [±4,5] × 10−3 Grad‐1) als die der Hintergliedmaßen (16,4 [±4,0] × 10−3 Grad‐1; p < 0,001). Während es keine signifikanten Unterschiede zwischen der Konformation von Vorder‐ und Hintergliedmaßen bei unbeeinträchtigten oder SDFT‐verletzten Tieren gab, waren sowohl die Steifigkeit als auch die Konformation bei Gliedmaßen mit SL‐Verletzung signifikant größer (p = 0,009 bzw. p = 0,002). WICHTIGSTE EINSCHRÄNKUNGEN: Kleine Stichprobengröße, Mangel an klinischen Daten, einschließlich Lahmheit und Quantifizierung der Verletzungen.
UNASSIGNED: Eine Verletzung der oberflächlichen Beugesehne (SDFT) der Vordergliedmaße verändert die Steifigkeit oder Konformation der Gliedmaße langfristig nicht, während eine Verletzung des Fesselträgers (SL) der Hintergliedmaße gleichzeitig die Steifigkeit der Gliedmaße und den Fesselwinkel erhöht, was auf eine Verlängerung des Fesselträgers nach der Verletzung hindeutet.

Injuries to tendons and ligaments are highly prevalent in the musculoskeletal system. Current treatments involve autologous transplants with limited availability and donor site morbidity. Tissue engineering offers a new approach through temporary load-bearing scaffolds. These scaffolds have to fulfill numerous requirements, the majority of which can be met using braiding combined with high-strength polycaprolactone (PCL) fibers. Considering regulatory requirements, several medical-grade PCL materials were assessed regarding their mechanical, degradational and cell biological properties. In the course of the investigation, an excellent fiber tensile strength of up to 850 MPa was achieved. The fibers were braided into multilayer scaffolds and scaled to match the human ACL. These were characterized regarding their morphology and their mechanical and degradational properties. Two strategies were followed to provide biological cues: (a) applying a chitosan-graft-PCL surface modification and (b) using non-circular fiber morphologies as topographical stimuli. Cell vitality assays showed generally positive cytocompatibility and no impairments due to the surface modification or material grade. The best cell vitality was achieved with a scaffold consisting of snowflake-shaped monofilaments combined with a 25° braiding angle. The surface modification equips the scaffold with a release platform for function molecules (as recently demonstrated) so that a holistic approach to addressing the numerous requirements is provided.

UNASSIGNED: Research and clinical studies on multiligamentous knee injuries (MLKI) have recently gained interest with several clinical studies reported recently. This study aims to identify, visualize, and characterize the MLKI research, to analyze the knowledge structure of MLKI during 2008-2023 and to identify the emerging research trends from a bibliometric perspective.
UNASSIGNED: All articles reporting MLKI from 2008 to 2023 were curated from the Scopus database, on 1st January 2024. VOS viewer and Microsoft Excel were used to analyze the publications including the participating countries, authors, organizations, journals and research focus. These data were used to generate visual knowledge maps of the outputs.
UNASSIGNED: 406 papers on MLKI were published in 115 journals by 483 authors. There has been a slow publication growth in the past 16 years. The United States had more than 50% share in global publications. Knee Surgery Sports Traumatology Arthroscopy, Orthopaedic Journal of Sports Medicine and American Journal of Sports Medicine published the most papers. The three USA institutions, namely Mayo Clinic, Hospital for Special Surgery-New York and Twin Cities Orthopedics contributed the largest number of publications. B.A. Levy (Mayo Clinic, USA) (n = 66) and M.J. Stuart (Mayo Clinic, USA) (n = 63) have registered the highest collaborative links with other authors.
UNASSIGNED: This study is the first comprehensive bibliometric study to analyze MLKI. The findings shed light on the growth trajectory of publications, the extent of international collaborations, the influence of highly cited articles, and the key countries, institutions, journals, and authors contributing to the field.
UNASSIGNED:
UNASSIGNED: The online version contains supplementary material available at 10.1007/s43465-024-01149-9.

The purpose of this study was (1) to determine the utility of shear wave elastography as a predictor for the mechanical failure of superficial knee ligaments and (2) to determine the viability of shear wave elastography to assess injury risk potential. Our hypothesis was that shear wave elastography measurements of the anterolateral ligament and medial collateral ligament would directly correlate with the material properties and the mechanical failure of the ligament, serving as a prognostic measurement for injury risk. 8 cadaveric specimens were acquired, and tissue stiffness for the anterolateral ligament and medial collateral ligament were evaluated with shear wave elastography. The anterolateral ligament and medial collateral ligament were dissected and isolated for unilateral mechanical failure testing. Ultimate failure testing was performed at 100 % strain per second after 50 cycles of 3 % strain viscoelastic conditioning. Each specimen was assessed for load, displacement, and surface strain throughout failure testing. Rate of force, rate of strain development, and Young\'s modulus were calculated from these variables. Shear wave elastography stiffness for the anterolateral ligament correlated with mean longitudinal anterolateral ligament strain at failure (R2 = 0.853; P<0.05). Medial collateral ligament shear wave elastography calculated modulus was significantly greater than the anterolateral ligament shear wave elastography calculated modulus. Shear wave elastography currently offers limited reliability in the prediction of mechanical performance of superficial knee ligaments. The utility of shear wave elastography assessment for injury risk potential remains undetermined.

UNASSIGNED: While initial reports of surgical repair of ulnar collateral ligament tears are promising, studies detailing post-repair outcomes are lacking. This study explores the effectiveness of ulnar collateral ligament (UCL) repair in returning professional baseball players to their pre-injury level of play. Our hypothesis is that professional baseball players undergoing UCL repair will have successful outcomes and high return to sport rates after surgery.
UNASSIGNED: Publicly available databases were utilized to search for data on professional baseball players who underwent UCL repair from 2016 to 2021. Players undergoing primary UCL repair with an internal brace were included. Amateur players were excluded as were those undergoing revision UCL repair or UCL reconstruction.
UNASSIGNED: Of the 11 pitchers who underwent UCL repair, minor league baseball (MiLB) pitchers returned to the sport at an average of 17.5 months. MiLB pitchers had similar earned run averages (ERAs), games played, innings pitched, and walks plus hits per inning pitched ratios (WHIPs) before and after surgery. Four major league baseball (MLB) pitchers (80%) returned to the sport at 9.55 months. MLB pitchers played fewer games and pitched fewer innings than before the surgery, but their ERAs and WHIPs were similar before and after surgery. Pitch velocity and spin rates after surgery varied based on pitch type. The seven positional players who underwent UCL repair showed no differences in batting or fielding performance before and after surgery.
UNASSIGNED: UCL repair can successfully return both pitchers and positional players at both the MiLB and MLB levels to play at pre-injury performance levels. Repair can be considered as an option for qualifying injuries in players hoping to maximize performance after surgery with minimal recovery time. Level of Evidence: IV.

UNASSIGNED: Allograft tendons are perceived to have a high ACL graft failure rate in primary anterior cruciate ligament (ACL) reconstruction (ACLR). Historical series may be biased by graft processing methods that degrade the biomechanical properties of donor tendons such as irradiation. Supercritical carbon dioxide (SCCO2) is a validated method of terminally sterilizing biomaterials at physiological temperatures without irradiation, but in vivo use of SCCO2-processed tendon allografts for primary ACLR has not been reported to date.
UNASSIGNED: ACLR with SCCO2 allografts would result in acceptable failure rates, subjective knee scores, and clinical evaluation at 2 years postoperatively.
UNASSIGNED: Case series; Level of evidence, 4.
UNASSIGNED: Patients underwent primary ACLR with terminally sterilized SCCO2-processed human gracilis, peroneus longus, semitendinosus, tibialis anterior, and tibialis posterior tendon allografts. Patient demographics were collected, along with tendon donor age and sex. At 1 year postoperatively, subjective International Knee Documentation Committee (IKDC) and ACL-Return to Sport After Injury (ACL-RSI) scores were collected, as well as clinical evaluation. At 2 years postoperatively, the IKDC and ACL-RSI scores were repeated, and return to sports and further knee injuries were recorded.
UNASSIGNED: A total of 144 patients with a medianage of 26 (IQR 14) years formed the study group. Patients were predominately male (58%). The loss to follow-up rate was 8% (n = 12). The mean age of allograft tendon donors was 37 (range 17-58) years, and the majority were male (83%). The mean allograft diameter was 8.9 ± 1.0 mm. At 2 years, ACL graft failureoccurred in 5% (n = 7). All graft failureswere in patients aged ≤25 years (P = .007). Neither donor age (≤40 or >40 years) nor donor sex was associated with graft failure (P > .05). The median IKDC subjective score was 95 and ACL-RSI score was 75. There were no revisions for sepsis within the first 2 years postoperatively.
UNASSIGNED: SCCO2 processing of allograft tendons demonstrated satisfactory clinical and patient-reported outcomes at 24 months postoperatively in a consecutive series of patients with primary ACLR, with similar ACL graft failure rates and subjective knee scores compared with those reported in published series of hamstring tendon autograft and fresh frozen nonirradiated allograft.

Scapholunate ligament lesion is the most common ligament lesion in the wrist. We assessed the reliability of sonography in detecting it during Watson test. Twenty patients with scapholunate ligament lesion confirmed on MRI and intraoperatively were assessed preoperatively between July 2020 and April 2023. Sonography was performed on the scaphoid dorsal subluxation in wrist neutral and during Watson test and compared with the healthy contralateral side. Dorsal subluxation was measured by two independent investigators and intra- and inter-observer reliability were assessed. We found a significant difference between dorsal subluxation of the scaphoid in the healthy (0.89 mm, SD 0.67 mm) compared to the pathological side (1.67 mm, SD 0.95 mm). Reliability was very good and the standard error of measurement was less than 0.4 mm for all measurements. Sonography during Watson test demonstrated high reliability in diagnosing scapholunate lesions. LEVEL OF EVIDENCE: III.

Hierarchical collagen fibers are the primary source of strength in tendons and ligaments; however, these fibers largely do not regenerate after injury or with repair, resulting in limited treatment options. We previously developed a static culture system that guides ACL fibroblasts to produce native-sized fibers and early fascicles by 6 weeks. These constructs are promising ligament replacements, but further maturation is needed. Mechanical cues are critical for development in vivo and in engineered tissues; however, the effect on larger fiber and fascicle formation is largely unknown. Our objective was to investigate whether intermittent cyclic stretch, mimicking rapid muscle activity, drives further maturation in our system to create stronger engineered replacements and to explore whether cyclic loading has differential effects on cells at different degrees of collagen organization to better inform engineered tissue maturation protocols. Constructs were loaded with an established intermittent cyclic loading regime at 5 or 10 % strain for up to 6 weeks and compared to static controls. Cyclic loading drove cells to increase hierarchical collagen organization, collagen crimp, and tissue tensile properties, ultimately producing constructs that matched or exceeded immature ACL properties. Further, the effect of loading on cells varied depending on degree of organization. Specifically, 10 % load drove early improvements in tensile properties and composition, while 5 % load was more beneficial later in culture, suggesting a shift in mechanotransduction. This study provides new insight into how cyclic loading affects cell-driven hierarchical fiber formation and maturation, which will help to develop better rehabilitation protocols and engineer stronger replacements. STATEMENT OF SIGNIFICANCE: Collagen fibers are the primary source of strength and function in tendons and ligaments throughout the body. These fibers have limited regenerate after injury, with repair, and in engineered replacements, reducing treatment options. Cyclic load has been shown to improve fibril level alignment, but its effect at the larger fiber and fascicle length-scale is largely unknown. Here, we demonstrate intermittent cyclic loading increases cell-driven hierarchical fiber formation and tissue mechanics, producing engineered replacements with similar organization and mechanics as immature ACLs. This study provides new insight into how cyclic loading affects cell-driven fiber maturation. A better understanding of how mechanical cues regulate fiber formation will help to develop better engineered replacements and rehabilitation protocols to drive repair after injury.