scholarly journals Effect of Workload After ACL Reconstruction on Rerupture Rates in NBA Players

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096446
Author(s):  
Lafi S. Khalil ◽  
Robert N. Matar ◽  
Tahsin Rahman ◽  
Sreten Franovic ◽  
Muhammad J. Abbas ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Return To Play ◽  
Control Group ◽  
Primary Group ◽  
Level Of Evidence ◽  
Performance Statistics ◽  
Anterior Cruciate ◽  
And Performance ◽  
Game Performance

Background: Rupture of the anterior cruciate ligament (ACL) is a common and potentially career-altering injury sustained by players in the National Basketball Association (NBA). Strategies have been employed by the league to prevent reinjury of players after ACL reconstruction (ACLR), including minute restrictions and rest games; however, it remains unknown whether workload metrics after ACLR influence the risk for reinjury and revision surgery. Purpose: To evaluate whether workload changes after return to play (RTP) from primary ACLR influences the risk of rerupture in NBA players. Study Design: Case-control study; Level of evidence, 3. Methods: We identified NBA players from 1975 to 2018 who underwent primary ACLR as well as those who required revision ACLR. Primary outcomes included workload measures such as games played, games started, and minutes per game. Secondary outcomes included in-game performance statistics. Statistical analysis was used to compare relative workload and performance 3 years before and 3 years after undergoing primary ACLR. Workload was also compared between the control group of NBA players who underwent primary ACLR and those who required revision ACLR. Results: A total of 68 players who underwent primary ACLR were included, 8 of whom subsequently required revision ACLR. In their first season upon RTP, control players (primary ACLR) demonstrated a significant reduction in all workload metrics relative to the season before injury ( P < .001), while the revision group demonstrated an unchanged to increased workload. In a comparison between the primary and revision groups during the first season after RTP, the primary group demonstrated significantly fewer games started (mean ± SD, 22.2 ± 3.0 vs 35.8 ± 8.3; P = .039) and minutes per game (20.5 ± 1.1 vs 27.0 ± 3.1; P = .048) than revision players. The primary ACLR group demonstrated reduced cumulative workload trends for the first 3 years after RTP relative to 3 years before injury, which was not demonstrated in the revision ACLR group, albeit statistically insignificant. Conclusion: Our study found that after ACLR, a reduction in workload parameters relative to preinjury baseline was associated with players who did not sustain rerupture. Further study is required to determine if workload measures following RTP from primary ACLR should be individualized relative to preinjury baseline.

scholarly journals Return to Play and Performance in the Women’s National Basketball Association After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712094707 ◽  
Author(s):  
Joseph S. Tramer ◽  
Lafi S. Khalil ◽  
Alexander Ziedas ◽  
Nima Mehran ◽  
Kelechi R. Okoroha
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
National Basketball Association ◽  
Return To Play ◽  
Level Of Evidence ◽  
Women's National Basketball Association ◽  
Playing Time ◽  
Anterior Cruciate ◽  
And Performance

Background: The incidence of anterior cruciate ligament (ACL) injuries in Women’s National Basketball Association (WNBA) athletes continues to increase. There is a paucity of data regarding return-to-play (RTP) rates and performance after ACL reconstruction in these athletes. Purpose: To quantify RTP rates and performance after ACL reconstruction in WNBA athletes. Study Design: Cohort study; Level of evidence, 3. Methods: All ACL tears sustained in the WNBA from 1997 through 2018 were identified. Body mass index (BMI), age, and position at the time of injury were collected for each player. RTP rates were calculated, and performance data were collected for each player before and after injury to determine changes in playing time and statistical performance. Players who successfully returned to play after ACL reconstruction were compared with a group of healthy controls who were matched by age, years of experience, position, height, and BMI. Statistics at 1 and 3 years after injury were compared to assess acute and longitudinal changes in performance relative to preinjury baseline. Results: A total of 59 WNBA players sustained ACL tears during the study period, and 41 (69.5%) were able to successfully RTP. Players played a mean of 7.5 ± 12.8 fewer games, played 5.0 ± 9.2 fewer minutes per game, and scored 3.7 ± 5.0 fewer points per game in their first year after RTP compared with the year before injury. Athletes with ACL reconstruction demonstrated significantly decreased performance measures regarding games played, games started, minutes, rebounds, assists, and blocks per game in their first season after RTP compared with control athletes in the same indexed year; however, these differences resolved by year 3 after surgery. Conclusion: WNBA athletes have a high RTP rate after ACL reconstruction. Players may experience an initial decrease in playing time and performance when returning to play; however, these variables were found to return to baseline over time.

scholarly journals Return to Play Rates in NFL Wide Receivers and Running Backs After ACL Reconstruction: An Updated Analysis

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097474
Author(s):  
Aditya Manoharan ◽  
Dane Barton ◽  
Ansab Khwaja ◽  
L. Daniel Latt
Keyword(s):  
Acl Reconstruction ◽  
National Football League ◽  
Cruciate Ligament ◽  
Return To Play ◽  
Control Group ◽  
Factors Affecting ◽  
Significant Difference ◽  
Before And After ◽  
Performance Statistics ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) ruptures are potentially career-threatening injuries to National Football League (NFL) skill position players. A 2006 study showed a return-to-play (RTP) rate of 79% for NFL running backs (RBs) and wide receivers (WRs). Since then, a number of factors affecting RTP, including style of play as well as rules regarding hits to the head, have changed how defensive players tackle offensive ball carriers. Purpose/Hypothesis: To determine whether the RTP rate for RBs and WRs in the NFL has changed since data were collected in the 2000s. Additionally, we evaluated player performance before and after ACL reconstruction (ACLR). We hypothesized that there will be a lower RTP rate than previously reported as well as a decrease in performance statistics after ACLR. Study Design: Descriptive epidemiology study. Methods: Publicly available NFL injury reports between the 2009-2010 and 2015-2016 seasons were utilized for RBs and WRs who underwent ACLR. Successful RTP was indicated by playing in at least 1 NFL game after reconstruction. Position-specific performance statistics from before and after reconstruction were gathered for these players, and the RTP players were compared against the players who did not RTP (dnRTP group). Pre- and postinjury performance measures were also compared against a matched control group of NFL RBs and WRs who had not sustained an ACL injury. Results: Overall, 61.8% of players (64.5% of RBs, 60% of WRs) returned to play at a mean of 13.6 months. Prior to injury, the RTP group had played in significantly more career games and had significantly more rushes and receptions per game than the dnRTP group; however, there was no significant difference in performance after ACLR. The WR RTP group had significantly decreased performance in all measured categories when compared with the control group. Conclusion: Our study found a lower RTP rate in RBs and WRs than previous studies conducted in the early 2000s. WRs who achieved RTP had decreased performance when compared with noninjured controls.

Performance-Based Outcomes After Anterior Cruciate Ligament Reconstruction in Professional Athletes Differ Between Sports

2017 ◽  
Vol 45 (10) ◽  
pp. 2226-2232 ◽  
Author(s):  
Harry T. Mai ◽  
Danielle S. Chun ◽  
Andrew D. Schneider ◽  
Brandon J. Erickson ◽  
Ryan D. Freshman ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
National Football League ◽  
Cruciate Ligament ◽  
Survival Rates ◽  
The Other ◽  
Return To Play ◽  
Professional Athletes ◽  
Level Of Evidence ◽  
Performance Statistics ◽  
Anterior Cruciate

Background: Excellent outcomes have been reported for anterior cruciate ligament (ACL) reconstruction (ACLR) in professional athletes in a number of different sports. However, no study has directly compared these outcomes between sports. Purpose: To determine if differences in performance-based outcomes exist after ACLR between professional athletes of each sport. Study Design: Cohort study; Level of evidence, 3. Methods: National Football League (NFL), National Basketball Association (NBA), National Hockey League (NHL), and Major League Baseball (MLB) athletes undergoing primary ACLR for an acute rupture were identified through an established protocol of injury reports and public archives. Sport-specific performance statistics were collected before and after surgery for each athlete. Return to play (RTP) was defined as a successful return to the active roster for at least 1 regular-season game after ACLR. Results: Of 344 professional athletes who met the inclusion criteria, a total of 298 (86.6%) returned to play. NHL players had a significantly higher rate of RTP (95.8% vs 83.4%, respectively; P = .04) and a shorter recovery time (258 ± 110 days vs 367 ± 268 days, respectively; P < .001) than athletes in all the other sports. NFL athletes experienced significantly shorter careers postoperatively than players in all the other sports (2.1 vs 3.2 years, respectively; P < .001). All athletes played fewer games ( P ≤ .02) 1 season postoperatively, while those in the NFL had the lowest rate of active players 2 and 3 seasons postoperatively (60%; P = .002). NBA and NFL players showed decreased performance at season 1 after ACLR ( P ≤ .001). NFL players continued to have lower performance at seasons 2 and 3 ( P = .002), while NBA players recovered to baseline performance. Conclusion: The data indicate that NFL athletes fare the worst after ACLR with the lowest survival rate, shortest postoperative career length, and sustained decreases in performance. NHL athletes fare the best with the highest rates of RTP, highest survival rates, longest postoperative career lengths, and no significant changes in performance. The unique physical demand that each sport requires is likely one of the explanations for these differences in outcomes.

scholarly journals Return to Play (RTP) and Performance in the Women’s National Basketball Association (WNBA) Following Anterior Cruciate Ligament (ACL) Reconstruction (194)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0030
Author(s):  
Joseph Tramer ◽  
Lafi Khalil ◽  
Alexander Ziedas ◽  
Muhammad Abbas ◽  
Nima Mehran ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Return To Play ◽  
Post Injury ◽  
Acl Injuries ◽  
Post Surgery ◽  
Before And After ◽  
Playing Time ◽  
Anterior Cruciate ◽  
And Performance

Objectives: The incidence of ACL injuries in WNBA athletes has been on the rise, despite the high rates of ACL injury there is a paucity of recent research examining the effect of ACL reconstruction on RTP and performance in these athletes. This cohort study seeks to quantify the effect of ACL reconstruction on RTP and performance on WNBA athletes. Methods: All ACL tears sustained in the WNBA from 1997-2018 were identified. BMI, age and position at the time of injury were collected for each player. RTP rates were calculated and performance data was collected for each player before and after injury to determine changes in playing time and statistical performance. Players who successfully RTP after ACL reconstruction were compared to a group of healthy controls who were matched by age, years of experience, position, height, and BMI. Statistics at one year and three years’ post-injury were compared to assess acute and longitudinal changes in performance relative to pre-injury baseline. Results: A total of fifty-nine WNBA players sustained an isolated ACL tear during the study period. Forty-one (69.5%) were able to RTP. There was no difference in demographic characteristics between forty-one players and matched controls. Following RTP athletes played an average of 7.5±12.8 fewer games, 5.1±9.2 fewer minutes per game, and scored 3.7±5.0 less points per game in their first year compared to the year prior to injury. (Table1) When compared to matched controls, WNBA players returning from ACL reconstruction demonstrated a significant decline in games played, games started, minutes per game, rebounds, assists, and blocks per game in their first season after RTP. These differences resolved by year three post-surgery (Table 2). Conclusions: There is a high RTP rate following ACL reconstruction in WNBA athletes. Players may experience a decrease in playing time and performance initially when returning to play, however these variables were found to return to baseline over time.

scholarly journals REHABILITATION OF NEUROMUSCULAR FUNCTION BY PHYSICAL EXERCISE

2021 ◽  
Vol 27 (3) ◽  
pp. 291-294
Author(s):  
Qiang Li
Keyword(s):  
Knee Joint ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Control Group ◽  
Nerve Function ◽  
Level Of Evidence ◽  
Nerve Recovery ◽  
Anterior Cruciate ◽  
The Stability ◽  
Experimental Group

ABSTRACT Introduction In long-term sports, especially in explosive sports such as accelerated starting, athletes are prone to rupture the anterior cruciate ligament (ACL). It is the ultimate goal of ACL reconstruction for athletes to restore the stability (static and dynamic) and mechanical structure of the knee joint through reconstruction surgery. Object This article uses ACL reconstruction to repair patients’ ACL and explores the effect of athletes’ nerve recovery after sports. Methods We collected 35 ACL reconstruction athletes and randomly divided them into two groups (experimental group, 18; control group, 17). After reconstruction, the athletes in the experimental group were treated with sports rehabilitation. Results The experimental and control groups had great differences in knee joint exercise indexes and nerve function recovery. Conclusion Sports rehabilitation training can effectively improve the nerve function of the knee joint after ACL reconstruction. Level of evidence II; Therapeutic studies - investigation of treatment results.

Factors That Predict Sagittal Plane Knee Biomechanical Symmetry After Anterior Cruciate Ligament Reconstruction: A Decision Tree Analysis

2021 ◽  
pp. 194173812110049
Author(s):  
Riann M. Palmieri-Smith ◽  
Michael T. Curran ◽  
Steven A. Garcia ◽  
Chandramouli Krishnan
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Return To Play ◽  
Knee Biomechanics ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Anterior Cruciate

Background: Biomechanical knee asymmetry is commonly present after anterior cruciate ligament (ACL) reconstruction. Factors that could assist in identification of asymmetrical biomechanics after ACL reconstruction could help clinicians in making return-to-play decisions. The purpose of this study is to determine factors that may contribute to knee biomechanical asymmetry present after ACL reconstruction. Hypothesis: We hypothesized that quadriceps strength and activation and patient-reported function would allow for identification of patients with symmetrical knee biomechanics. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Thirty-one subjects (18 women; time since ACL reconstruction = 284.4 ± 53.6 days) who underwent ACL reconstruction and were to return to activity were recruited. Participants completed bilateral assessments of isokinetic quadriceps strength, quadriceps activation using the superimposed burst technique, and biomechanical function testing during a single-leg forward hop. The International Knee Documentation Committee (IKDC) subjective knee form was also completed. Symmetry values were calculated for each variable. Decision trees were utilized to determine which input factors (quadriceps strength symmetry, quadriceps activation symmetry, IKDC score, age, sex, height, mass, graft type) were able to identify participants who had symmetrical knee flexion angles (KFAs) and extension moments. Angles and moments were considered symmetrical if symmetry values were ≥90%. Results: Quadriceps strength and activation symmetry were able to predict whether a patient landed with symmetrical or asymmetrical KFAs, with thresholds of 77.2% strength symmetry and 91.3% activation symmetry being established. Patient-reported function and quadriceps strength were factors that allowed for classification of participants with symmetrical/asymmetrical knee extension moments, with thresholds of 89.1 for the IKDC and 80.0% for quadriceps strength symmetry. Conclusions: Quadriceps strength contributed to both models and appears to be a critical factor for achieving symmetrical knee biomechanics. High patient-reported function and quadriceps activation are also important for restoring knee biomechanical symmetry after ACL reconstruction. Clinical Relevance: Quadriceps strength and activation and patient-reported function may be able to assist clinicians in identifying ACL patients with symmetrical/asymmetrical knee biomechanics.

Return to sport following anterior cruciate ligament reconstruction: the argument for a multimodal approach to optimise decision-making: current concepts

2021 ◽  
pp. jisakos-2020-000597
Author(s):  
Deepak Chona ◽  
Karl Eriksson ◽  
Simon W Young ◽  
Matteo Denti ◽  
Parag K Sancheti ◽  
...  
Keyword(s):  
Decision Making ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Return To Sport ◽  
Cognitive Testing ◽  
Return To Play ◽  
Level Of Evidence ◽  
Anterior Cruciate

Existing literature is varied in the methods used to make this determination in the treatment of athletes who have undergone recent anterior cruciate ligament (ACL) reconstruction. Some authors report using primarily time-based criteria, while others advocate for physical measures and kinematic testing to inform decision-making. The goal of this paper is to elucidate the most current medical evidence regarding identification of the earliest point at which a patient may safely return to sport. The present review therefore seeks to examine the evidence from a critical perspective—breaking down the biology of graft maturation, effect of graft choice, potential for image-guided monitoring of progression and results associated with time-based versus functional criteria-based return to play—to justify a multifactorial approach to effectively advance athletes to return to sport. The findings of the present study reaffirm that time is a prerequisite for the biological progression that must occur for a reconstructed ligament to withstand loads demanded by athletes during sport. Modifications of surgical techniques and graft selection may positively impact the rate of graft maturation, and evidence suggests that imaging studies may offer informative data to enhance monitoring of this process. Aspects of both functional and cognitive testing have also demonstrated utility in prior studies and consequently have been factored into modern proposed methods of determining the athlete’s readiness for sport. Further work is needed to definitively determine the optimal method of clearing an athlete to return to sport after ACL reconstruction. Evidence to date strongly suggests a role of a multimodal algorithmic approach that factors in time, graft biology and functional testing in return-to-play decision-making after ACL reconstruction.Level of evidence: level V.

scholarly journals Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098164
Author(s):  
Steven F. DeFroda ◽  
Devan D. Patel ◽  
John Milner ◽  
Daniel S. Yang ◽  
Brett D. Owens
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Odds Ratio ◽  
Cruciate Ligament ◽  
Case Series ◽  
National Basketball Association ◽  
High Rate ◽  
Return To Play ◽  
Lower Percentage ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injury in National Basketball Association (NBA) players can have a significant impact on player longevity and performance. Current literature reports a high rate of return to play, but there are limited data on performance after ACL reconstruction (ACLR). Purpose/Hypothesis: To determine return to play and player performance in the first and second seasons after ACLR in NBA players. We hypothesized that players would return at a high rate. However, we also hypothesized that performance in the first season after ACLR would be worse as compared with the preinjury performance, with a return to baseline by postoperative year 2. Study Design: Case series; Level of evidence, 4. Methods: An online database of NBA athlete injuries between 2010 and 2019 was queried using the term ACL reconstruction. For the included players, the following data were recorded: name; age at injury; position; height, weight, and body mass index; handedness; NBA experience; dates of injury, surgery, and return; knee affected; and postoperative seasons played. Regular season statistics for 1 preinjury season and 2 postoperative seasons were compiled and included games started and played, minutes played, and player efficiency rating. Kaplan-Meier survivorship plots were computed for athlete return-to-play and retirement endpoints. Results: A total of 26 athletes underwent ACLR; of these, 84% (95% CI, 63.9%-95.5%) returned to play at a mean 372.5 days (95% CI, 323.5-421.5 days) after surgery. Career length after injury was a mean of 3.36 seasons (95% CI, 2.27-4.45 seasons). Factors that contributed to an increased probability of return to play included younger age at injury (odds ratio, 0.71 [95% CI, 0.47-0.92]; P = .0337) and fewer years of experience in the NBA before injury (odds ratio, 0.70 [95% CI, 0.45-0.93]; P = .0335). Postoperatively, athletes played a significantly lower percentage of total games in the first season (48.4%; P = .0004) and second season (62.1%; P = .0067) as compared with the preinjury season (78.5%). Player efficiency rating in the first season was 19.3% less than that in the preinjury season ( P = .0056). Performance in the second postoperative season was not significantly different versus preinjury. Conclusion: NBA players have a high rate of RTP after ACLR. However, it may take longer than a single season for elite NBA athletes to return to their full preinjury performance. Younger players and those with less NBA experience returned at higher rates.

Comparison of the Position-Matching and Position-Reproducing Tasks to Detect Deficits in Knee Position Sense After Reconstruction of the Anterior Cruciate Ligament

2020 ◽  
Vol 29 (1) ◽  
pp. 87-92
Author(s):  
Takuma Hoshiba ◽  
Hiroki Nakata ◽  
Yasuaki Saho ◽  
Kazuyuki Kanosue ◽  
Toru Fukubayashi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Sport Participation ◽  
Cruciate Ligament ◽  
Knee Extension ◽  
Position Sense ◽  
Matching Task ◽  
Control Group ◽  
Knee Position ◽  
Anterior Cruciate

Context: Deficits in knee position sense following reconstruction of the anterior cruciate ligament (ACL) can delay an athlete’s return to sport participation and increase the risk of reinjury. Deficits in position sense postreconstruction have been evaluated using either a position-reproducing or position-matching task. Objective: The aim of our study was to combine both to determine which assessment would be more effective to identify deficits in knee position sense. Design: Longitudinal laboratory-based study. Participants: Eleven athletes (6 men and 5 women; mean age, 20.5 [1.2] y), who had undergone ACL reconstruction with an ipsilateral hamstring autograft, and 12 age-matched controls. Interventions: Position sense was evaluated at 6 and 12 months postreconstruction and once for the control group. In addition, peak isokinetic knee extension and flexion strength, at 60°/s and 180°/s, was assessed for the ACL reconstruction group to evaluate possible influences of muscle strength on knee joint position sense. Main Outcome Measures: The variables include the angular differences between the reference limb and indicator limb, and peak torque values of isokinetic knee extension and flexion. Results: Significant matching differences were identified at 6 months postsurgery on the position-matching task, but not at 12 months postsurgery. No significant between-group and within-subject differences were identified on the position-reproducing task. No significant matching errors were identified for the control group. There was no correlation between errors in position sense and maximum isokinetic strength. Conclusion: The position-matching task is more sensitive than the position-reproducing task to identify deficits in knee position sense over the first year following ACL reconstruction surgery.

The Effect of Remnant Preservation on Tibial Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction with Polyethylene Terephthalate Artificial Ligament in a Large Animal Model

2018 ◽  
Vol 32 (11) ◽  
pp. 1094-1101
Author(s):  
Jiangyu Cai ◽  
Fang Wan ◽  
Chengchong Ai ◽  
Wenhe Jin ◽  
Dandan Sheng ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Bone Tunnel ◽  
Control Group ◽  
Micro Ct ◽  
Tunnel Enlargement ◽  
Artificial Ligament ◽  
Remnant Preservation ◽  
Anterior Cruciate

AbstractAn enlarged bone tunnel may affect the graft–bone integration and pose a problem for revision anterior cruciate ligament (ACL) surgery. The purpose of this study was to evaluate the effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with polyethylene terephthalate (PET) artificial ligament. Twenty-four skeletally mature male beagles underwent ACL reconstruction with PET artificial ligament for both knees. One knee was reconstructed with remnant preservation using sleeve technique (remnant group), while the contralateral was reconstructed without remnant preservation (control group). The animals were sacrificed at 1 day, 6 weeks, and 12 weeks after surgery for further evaluation including macroscopic observation, microcomputed tomography (micro-CT), histological assessment, and biomechanical testing. The remnant group had better synovial coverage than the control group at 6 and 12 weeks after surgery. The micro-CT analysis showed the tibial tunnel area (TTA) of the remnant group was significantly smaller and the bone volume/total volume fraction (BV/TV) value was higher than those of the control group at 6 and 12 weeks. Moreover, TTA and BV/TV at each time point were divided into three groups according to the different grade of synovial coverage. Significant association was observed between the synovial coverage degree and the TTA and BV/TV values. The histological assessment revealed that the interface width between the graft and host bone in the remnant group was smaller than that in the control group in the tibial tunnels at 6 and 12 weeks. Moreover, the remnant group had better failure load and stiffness than the control group at 12 weeks. The remnant preservation using sleeve technique could effectively promote the synovial coverage of the graft, decrease the risk of tibial tunnel enlargement by sealing the bone tunnel entrance, and enhance the biological environment for graft–bone healing after ACL reconstruction using PET artificial ligament. This technique provides a potential solution for bone tunnel enlargement following artificial ligament surgery for the acute ACL rupture in the clinical practice.

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