Anterior Cruciate Ligament Reconstruction: Clinical Advances and Prognosis

Dear Colleagues,

Anterior Cruciate Ligament Reconstruction (ACLR) remains one of the most common surgical interventions in orthopaedics and sports medicine. Although more patients return to full activity without significant complications, there is still a continuous need for the evolution and improvement of existing techniques. Furthermore, there is still a lot of controversy regarding the ideal graft, while novel techniques have emerged, such as the all-inside repair technique or the utilization of scaffolds to enhance local biology, in an attempt to achieve better outcomes. The possibility of functional instead of surgical repair, graft choice, fixation of the graft, concomitant injuries and their management, and complications following reconstruction are some of the issues that orthopaedic surgeons have to face in everyday clinical practice when addressing ACL tears. Lastly, a relatively early but mainly safe return to sports, along with a high rate of patient satisfaction, constitutes a primary objective of ACL reconstruction.

The goal of this Special Issue is to provide a comprehensive review of these challenges by collecting papers from an expert panel of authors, with a particular focus on clinical advances and prognosis after ACL reconstruction.

Dr. Georgios Komnos
Prof. Dr. Michael Hantes
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• anterior cruciate ligament
• ACL reconstruction
• ACL grafts
• ACL biology
• challenges

Title: Effects of single-joint type hybrid assistive limb in knee rehabilitation on reduction of pre-motor time and increased rate of rapid muscle activation for ACL reconstruction: a pilot study
Authors: Yuichiro Soma; Hirotaka Mutsuzaki; Tomokazu Yoshioka; Shigeki Kubota; Koichi Iwai; Yukiyo Shimizu; Akihiro Kanamori; Masashi Yamazaki
Affiliation: Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital
Abstract: Background/Objectives: After undergoing anterior cruciate regiment (ACL) reconstruction, physiological changes in muscle characteristics are common. Our previous research on knee hybrid assistive limb (HAL) single-joint training in post-ACL reconstruction patients revealed its potential for optimizing muscle activity. Although existing evidence supports the positive impact of this training on muscle strength recovery and efficiency, its neurophysiological effects remain unclear. This study aimed to explore electrophysiological parameters, including pre-motor time, peak amplitude time, and neuromuscular activation rate, using electromyography (EMG). Methods: This study examined three electrophysiological measures related to knee neuromuscular responses: pre-motor time, peak amplitude time, and neuromuscular activation rate, using EMG rise. Both the HAL and control groups were evaluated for EMG rise rate (RER) at postoperative weeks 17 and 21. The pre-motor time and peak amplitude time were assessed in both groups at each session pre- and post-intervention. Results: Regarding the interaction of pre-motor time within each group using the estimated mean, significant differences were observed in semitendinosus (ST) and biceps femoris (BF) in both groups, with no significant differences in the vastus medialis (VM). Notably, the effect size of VM was larger in the HAL group. For the peak amplitude time of EMG, although no group differences were observed, the p-value for the VM approached a significance level. The analysis confirmed the contrast between the pre- and post-intervention for each group based on the estimated mean. The HAL group exhibited a significant difference in the VM, while the vastus lateralis (VL) showed no significant difference but had a larger effect size. In terms of RER, regardinggroup, the interaction between Group and Pre-Post was significant in the VM and VL. Conclusions: It indicates that knee HAL training for post-ACL reconstruction patients may influence neurophysiological mechanisms.