Leaf spring exercise: A safe quadriceps strengthening exercise after anterior cruciate ligament reconstruction

Objective: To investigate the application value of the weight-bearing magnetic resonance imaging (MRI) in evaluating the stability of knee joint after anterior cruciate ligament reconstruction. Methods: From July 2011 to August 2013, a total of 25 patients with anterior cruciate ligament rupture and reconstruction surgery in the Second Affiliated Hospital of Soochow University were enrolled in this study, including 18 males and 7 females, with an average age of (32±5) years. All the patients underwent the weight-bearing MRI, knee joint passive relaxation test (Kneelax 3), and Lysholm score before the surgery and 3 and 6 months after the surgery. The three examinations before and after the operation were analyzed by repeated measures of general linear model, and paired t test was used to compare the results before and after the operation. The correlation between the three preoperative examinations was statistically analyzed. Results: The relaxation data measured by Kneelax 3 after the surgery was significantly lower than that before the operation [(1.1±0.9) mm vs (6.1±1.3) mm, t=16.9, P<0.01]. The post-operative lateral tibial plateau anterior shift score was less than the pre-operative score [(3.0±0.7) mm vs (4.8±1.2) mm, t=6.2, P<0.01]. The post-operative Lysholm score was significantly higher than that before the operation (89±6 vs 64±14, t=-8.3, P<0.05). There was a negative correlation between the anterior displacement of the lateral platform and Lysholm score (r=-0.902, P<0.01). There was no correlation between anterior displacement and passive relaxation of the lateral platform in preoperative weight-bearing MRI. Conclusions: Anterior cruciate ligament reconstruction can improve the knee stability. The stability of knee joint can be evaluated by weight-bearing MRI. The anterior tibial displacement measured by the weight-bearing MRI is correlated with the clinical score.

Objectives:Anterior cruciate ligament (ACL) tears are one of the most common ligamentous injuries of the knee. While many advances have been made in both surgical technique and rehabilitation protocols, it still remains a very serious athletic injury. In recent years, a few high-profile athletes have returned to an elite sport performance level relatively quickly after ACL reconstruction, but previously published literature suggests otherwise. The purpose of this study is to evaluate a college athlete's perception and understanding of ACL injury and subsequent reconstruction.Methods:During pre-participation physicals, a total of 157 surveys were prospectively administered to athletes at a single NCAA Division II university, all of which were returned. Consent was obtained prior to survey administration. The surveys, consisting of sixteen questions, were designed to evaluate the athletes’ knowledge of ACL injury, anatomy, and recovery from surgery. In addition, basic demographic information was obtained including the participants’ source of ACL knowledge. Statistical analysis is pending.Results:The average age of participants was 20.1 years (Range: 18-23). Football, soccer and baseball were the most represented sports among participants, but a wide variety were present. Of the 157 surveys administered, 106 of participants (68%) knew that the ACL was a ligament. The majority of participants (63%) thought it would take 8-12 months to return to sport after an injury, but 31% said an athlete could return in less than 6 months (Range: 2 to 15 months). On average, the participants thought 64% of athletes could return to play in their sport after an ACL injury and reconstruction, but only 45% could return to their previous level of play. However, several participants (8%) believed greater than 80% of athletes could return to their previous level of play after an ACL reconstruction. Only 11% of respondents knew that a knee brace cannot prevent ACL injury. Most participants (82%) said that if they had an ACL injury they would undergo reconstructive surgery. Only 26% of participants knew that an athlete with an ACL injury was at an increased risk for an injury to their contralateral ACL. Furthermore, about half of the participants (54%) thought that on-field performance would not improve following an ACL injury and reconstruction. The most common source of participants’ knowledge of ACL injury was from a friend or family member (71%). Far fewer participants gained at least some of their knowledge from the internet (32%), television (27%) or their physician/surgeon (29%).Conclusion:This is the first study, to our knowledge, to assess the perceptions of high-level athletes with regards to ACL injury, reconstruction and return to play. This study demonstrates that there is a large amount of variability in college athletes’ perception of ACL injuries. The range of recovery time from surgery was quite large, signifying a knowledge gap among high-level athletes with regard to this very common injury. Orthopaedic surgeons may want to assess and tailor their pre-surgical discussions with a college athlete to the individual's knowledge of ACL injury and reconstructions, so that realistic pre-surgical expectations are set. However, the benefits of this approach warrant further investigation.

Following anterior cruciate ligament (ACL) injury, quadriceps muscle atrophy persists despite rehabilitation, leading to loss of lower limb strength, osteoarthritis, poor knee joint health and reduced quality of life. However, the molecular mechanisms responsible for these deficits in hypertrophic adaptations within the quadriceps muscle following ACL injury and reconstruction are poorly understood. While resistance exercise training stimulates skeletal muscle hypertrophy, attenuation of these hypertrophic pathways can hinder rehabilitation following ACL injury and reconstruction, and ultimately lead to skeletal muscle atrophy that persists beyond ACL reconstruction, similar to disuse atrophy. Numerous studies have documented beneficial roles of nutritional support, including nutritional supplementation, in maintaining and/or increasing muscle mass. There are three main mechanisms by which nutritional supplementation may attenuate muscle atrophy and promote hypertrophy: (1) by directly affecting muscle protein synthetic machinery; (2) indirectly increasing an individual’s ability to work harder; and/or (3) directly affecting satellite cell proliferation and differentiation. We propose that nutritional support may enhance rehabilitative responses to exercise training and positively impact molecular machinery underlying muscle hypertrophy. As one of the fastest growing knee injuries worldwide, a better understanding of the potential mechanisms involved in quadriceps muscle deficits following ACL injury and reconstruction, and potential benefits of nutritional support, are required to help restore quadriceps muscle mass and/or strength. This review discusses our current understanding of the molecular mechanisms involved in muscle hypertrophy and disuse atrophy, and how nutritional supplements may leverage these pathways to maximise recovery from ACL injury and reconstruction.

Quadriceps Tendon: The Forgotten Graft

In recent years, many studies on the safe return to sport (RTS) have been published, but there are still no clear and validated guidelines. After ACL reconstruction between limbs, asymmetry of muscle strength affects knee mechanics during walking and running, and asymmetrical joint kinematics and kinetics are considered as a strong risk factor of musculoskeletal injury. Therefore, proper diagnosis of any motor deficits remaining after ACL reconstruction seems particularly important. The aim of this study was to analyze how many tests should be included in the RTS test battery and which of them are most indicative for functional deficits related to anterior cruciate ligament (ACL) reconstruction. Sixty-five male football players (age 18–25 years) were divided into three groups: ACL group—after ACL rupture and reconstruction, mild injury group—post mild lower limb injuries, and the control group—without injuries. They performed five tests: Functional Movement Screen, Tuck Jump Assessment, Y-balance Test, Hop Test for Distance, and Isokinetic Test. The Composite Score of Readiness (CSR) index was calculated and expressed as the sum of z-scores. The multiple regression model for all tests was calculated, and then redundant variables were excluded. We observed that all tests significantly influenced the final CSR index. The Y-balance Test, Tuck Jump Assessment, and Isokinetic Test for knee flexion influenced the final CSR index the most, which means that these tests are greatly indicative of functional deficits related to ACL reconstruction. The strength of the extensor (quadriceps) muscle and the quadriceps/hamstring ratio appeared to be non-sensitive for testing functional deficits related to ACL reconstruction. If the test battery includes 4–5 tests, it better differentiates the athletes following ACL reconstruction from those after mild injuries, even if they all were cleared to play.

Osseous Deficits After Anterior Cruciate Ligament Injury and Reconstruction: A Systematic Literature Review With Suggestions to Improve Osseous Homeostasis

BackgroundCombined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injury is the most common combination of ligamentous knee injury. Many authors support the conservative treatment of MCL tears. This study aimed to compare the outcomes of simultaneous ACL reconstruction (ACL-R) and MCL reconstruction with ACL-R and conservative MCL treatment in cases of combined ACL and grade III MCL injuries.MethodsIn this retrospective cohort study, we evaluated consecutive patients with combined ACL and MCL injuries who underwent surgical treatment over five years in two private hospitals in Tehran, Iran. We compared postoperative knee range of motion (ROM), pain intensity (visual analog scale [VAS]), functional outcomes (Tegner-Lysholm and International Knee Documentation Committee Subjective Knee Form [IKDC] scores), time to and proportion of return to sports, time to return to work, activity level (Marx activity rating scale), and graft failure rate between ACL-R and conservative MCL treatment (ACL-R + conservative MCL group) and ACL-R and MCL reconstruction (ACL-R + MCL-R group). All patients were followed for at least twelve months.ResultsOverall, 110 patients, comprising 92 men (83.6%) and 18 women (16.4%), were included, consisting of 67 (60.9%) in the ACL-R + conservative MCL group and 43 (39.1%) in the ACL-R + MCL-R group. The mean age of the patients was 27.5 ± 9.0 years. Age, sex, side, and follow-up period were comparable between the groups (P > 0.05 for all). Graft failure occurred in 6 patients (9.0%) in the ACL-R + conservative MCL group, but in none of the patients in the ACL-R + MCL-R group (P = 0.046). Range of extension and flexion of the knee, VAS, Tegner-Lysholm score, IKDC score, time to return to sports, time to return to work, proportion of return to sports, and activity level did not differ significantly between the groups (P > 0.05 for all).ConclusionACL-R and MCL reconstruction resulted in similar knee ROM, pain intensity, functional outcomes, time to return to work and sports, and activity level to ACL-R and conservative MCL treatment in patients with combined ACL and MCL injury. However, ACL-R and MCL reconstruction significantly reduced graft failure rates, suggesting the potential benefit of surgical MCL management in conjunction with ACL reconstruction.

Background:The first case series to report on return to play (RTP) in National Football League (NFL) players after primary anterior cruciate ligament (ACL) reconstruction (ACLR) published an RTP rate of 63%. Other studies that have attempted to estimate RTP after ACLR in these elite athletes have been largely based on secondary sources. This study is the second to report the authors’ own results in treating ACL injuries in NFL players spanning a study period of 25+ years.Purpose:To report the senior authors’ experience treating ACL injuries in NFL players as well as revisit the concept of RTP as it is currently used to measure successful surgical outcomes in professional athletes.Study Design:Case series; Level of evidence, 4.Methods:A total of 47 NFL players were treated at our institution for knee injuries that included a complete tear of the ACL; of these, 41 were primary ACLR and 6 were revision ACLR. Of the primary ACLRs, 6 were classified as ACL plus additional ligament and 3 were classified as multiligament. Return to game play (RTGP) was defined as returning to play in a regular-season game. Successful return to previous participation (RTPP) was defined as return to a level of participation equal to the level the player had reached before injury. Multivariate analysis was used to assess predictors of successful RTPP.Results:Using the RTGP criteria proposed by prior authors, the RTGP after primary ACLR was 73%. Using our proposed RTPP criteria, 87.8% of players successfully returned to the same level of participation after primary ACLR. RTGP percentage for all NFL players after ACLR (including multiligament injuries) was 67.6%, and the overall RTPP for those patients was 87.8%. In multivariate analysis, age ≤25 years was predictive of successful RTPP. High draft picks and offensive players played more seasons after primary ACLR. ACL graft rupture occurred in 4.3% of this cohort. Contralateral ACL tear occurred in 8.5%.Conclusion:Regardless of which definition is used to measure a successful outcome after ACLR surgery, the findings of this study suggest that successful return after primary ACLR in NFL athletes is higher than previously reported. While concomitant reconstruction of a single collateral ligament did not affect RTPP, revision ACLR or bicruciate plus collateral ligament reconstruction was associated with a lower RTPP rate. Age ≤25 years predicted successful RTPP. The risk of a future ACL tear of either knee after index reconstruction was approximately 13%.

Additional anterolateral ligament (ALL) reconstruction has been associated with improved clinical outcomes and reduced failure rates in anterior cruciate ligament (ACL) reconstruction. Despite the excellent clinical results reported, there is still a heated debate about its indications. Currently, the indications are mainly based on the patient's clinical criteria and not the imaging diagnosis of the injury of this ligament. To compare the clinical outcomes of patients undergoing isolated ACL reconstruction and combined ACL and ALL reconstruction conditioned to intraoperative ultrasound-guided diagnosis of the ALL lesion. Cohort study; Level of evidence, 3. A retrospective analysis of prospectively collected data was performed. Patients undergoing primary ACL reconstruction between January 2017 and January 2022 were included. Patients were excluded if they had a previous history of ipsilateral knee surgery or if they underwent other concomitant procedures, including multiligament reconstruction surgery or osteotomy. The decision to perform an ALL reconstruction in addition to isolated ACL reconstruction was based on ultrasound diagnosis of this lesion. At the end of the study period, further knee injury and any other reoperations or complications were recorded and compared between patients who had isolated ACL reconstruction (no-ALLR group) and combined ACL and ALL. Propensity score matching was performed between groups. A multivariable analysis using the penalized Cox model was performed to explore the relationship between the graft rupture, surgical procedure type, and potential explanatory variables. A total of 339 patients met the predefined eligibility criteria; 146 ACL reconstructions were performed in an isolated manner (no-ALLR group) and 193 were combined with ALL (ALLR group). After matching, 130 patients were allocated to each group. The mean follow-up was 36.7 months. The overall graft failure rate was 4.6% (6.9% in the no-ALLR group and 2.3% in the ALLR group; P = .076). The adjusted Cox regression showed that graft failure rate was nonsignificantly different between the groups (adjusted hazard ratio [HR], 0.36 [95% CI, 0.096-1.364]; P = .133). Younger age (≤20 years) was associated with graft failure (adjusted HR, 0.29 [95% CI, 0.121-0.719]; P = .007). Combined ACL and ALL reconstruction conditioned to intraoperative ultrasound-guided diagnosis of the ALL lesion has an equivalent ACL graft failure rate to isolated ACL. Intraoperative ultrasound diagnosis of an ALL injury may be an indication for the addition of an ALL reconstruction.

Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Shows Superior Graft Remodeling, Maturation, and Stability Compared With Isolated Anterior Cruciate Ligament Reconstruction.

Background: Meniscal allograft transplantation (MAT) is indicated in the setting of anterior cruciate ligament (ACL) reconstruction to restore proper arthrokinematics and load distribution for the meniscus-deficient knee. Objective outcomes after ACL reconstruction with concomitant MAT in athletic populations are scarcely reported and highly variable. Purpose: To compare patient outcomes using an objective functional performance battery, self-reported outcome measures, and return-to-sport rates between individuals undergoing ACL reconstruction with concomitant MAT and a matched group undergoing isolated ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A single-surgeon ACL reconstruction database (N = 1431) was used to identify patients undergoing ACL reconstruction with concomitant MAT between 2014 and 2019. Patients were age-, sex-, and revision-matched to a group undergoing isolated ACL reconstruction. Baseline patient and surgical data were obtained. Patients completed an objective functional performance battery at the time of return to sport that included range of motion, single-leg squat performance, single-leg hop test performance, self-reported function (International Knee Documentation Committee [IKDC] score), and psychological readiness (ACL Return to Sports After Injury scale). Between-limb comparisons were assessed using limb symmetry indices. Injury surveillance was conducted for 2 years and included the Single Assessment Numeric Evaluation (SANE), reinjury rates, complications, and current level of sports participation. Between-group comparisons at the time of return to sport and 2 years later were analyzed using generalized linear models for parametric and nonparametric equivalents with an a priori alpha level of .05. Results: A total of 46 patients were included in the ACL reconstruction with concomitant MAT group (38 medial MAT, 8 lateral MAT), and 46 patients were included in the isolated ACL reconstruction group. Baseline differences existed between groups, with the MAT group exhibiting lower body weight (84.0 ± 14.1 vs 93.2 ± 191.8 kg; P = .036) and Marx scores (4.8 ± 4.5 vs 9.3 ± 4.1; P = .024) than the isolated ACL reconstruction group, respectively. At the time of return to sport, the MAT group reported lower IKDC scores (83.2 ± 12.6 vs 91.1 ± 11.3; P = .037); however, no other functional performance or self-reported differences were observed. At 2 years, no significant differences existed between groups for SANE score (87.8 ± 12.3 vs 89.3 ± 11.4; P = .793), ACL graft reinjury rates (6.5% vs 2.2%; P = .688), or level of return to sport (P > .05). The MAT group demonstrated a significantly lower rate of return to previous level of sport (69.5% vs 78.3%; P = .026). Conclusion: The majority of patients (87%) undergoing ACL reconstruction with concomitant MAT were able to return to some level of sports participation at 2 years with a low risk of revision ACL reconstruction or meniscal transplant failure. Patients receiving a concomitant MAT exhibited lower self-reported function at return to sport compared with matched controls undergoing isolated ACL reconstruction; however, these differences were not present at 2 years. Clinicians should consider patient characteristics, self-reported function, and return-to-sport rates when counseling patients regarding ACL reconstruction with MAT.

Background: Because of the multitude of variables that affect the retirement decisions of professional soccer players, it has proven difficult to isolate the effect of undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) on career longevity. Purpose: To compare the career longevity of professional soccer players after a primary ACLR with that of an uninjured matched control cohort. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of a consecutive series of primary ACLR was performed between 2008 and 2018 in professional male soccer players from the senior author's practice. Each athlete with ACLR was matched to 3 control athletes who had not undergone ACLR according to age, league, playing position, and preinjury game appearances/minutes played. Player career statistics—including league, game appearances, and game minutes—were compiled for each year until retirement or July 1, 2022. Results: A total of 82 soccer players in the English Premier League or Championship at the time of their primary ACLR were matched to 246 control athletes. The mean career length after ACLR was 6 ± 2.6 years, while that of the matched control athletes was 7.6 ± 2.8 years (P < .001). After primary ACLR, an athlete had a 2 times greater chance of retirement compared with the matched control athlete (hazard ratio, 2.19; P < .001). At 5 years after ACLR, 16% of athletes had retired from professional soccer, while 8.5% of the matched cohort were retired (P = .060). By 10 years, 72% of the ACLR cohort had retired compared with 43% of the matched cohort (P < .001). Forwards were more likely to have shortened careers compared with goalkeepers (P = .021); however, no significant differences were observed between midfielders, defenders, and forwards. Within the ACLR cohort, a contralateral ACL tear during the athlete's career caused a 2.30 times (P = .022) increased chance of retirement compared with athletes with only 1 ACL tear during their career. Mechanism of injury, meniscal pathology, graft rerupture, and chondral lesions did not affect career length. Conclusion: Professional male soccer players who underwent ACLR had decreased career length by approximately 1.6 years compared with a matched player cohort.

Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013;346:F232. Does early anterior cruciate ligament (ACL) reconstruction with rehabilitation lead to better patient-reported outcomes and a lower incidence of osteoarthritis at 5 years postinjury compared with delayed ACL reconstruction with rehabilitation? This randomized controlled trial with extended follow-up at 5 years postrandomization was conducted in 2 Swedish orthopaedic departments. The authors studied a total of 121 moderately active adults (age = 18-35 years) with an acute ACL rupture in a knee with no other history of trauma. Excluded were patients with a collateral ligament rupture, full-thickness cartilage defect, or extensive meniscal fixation. One patient assigned to the early ACL-reconstruction group did not attend the 5-year follow-up visit. Patients were randomly assigned to (1) an early ACL reconstruction plus structured rehabilitation group (n = 62, surgery within 10 weeks of injury) or (2) optional-delayed ACL reconstruction plus structured rehabilitation group (n = 59). The primary outcome measure was change in the average of 4 out of 5 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS). The authors also assessed crude KOOS (combined 4 subscales), KOOS subscale scores, general physical and mental health (Short-Form 36), activity level (Tegner Activity Scale), mechanical knee stability (Lachman and pivot shift tests), meniscal surgery status, and presence of knee osteoarthritis on radiographs. Among patients randomized to the optional-delayed ACL-reconstruction group, 30 (51%) opted for an ACL reconstruction. The treatment groups had comparable 5-year patient-reported outcomes and changes in patient-reported outcomes (eg, knee pain, knee symptoms, activities of daily living, sport and recreational levels, knee-related quality of life, general physical health, and general mental health). Patients in the optional-delayed ACL-reconstruction group had greater mechanical knee instability than patients who received early ACL reconstruction; however, this was primarily among the patients opting for conservative management alone. In the overall sample, 61 knees (51%) required meniscal surgery over 5 years, regardless of treatment group. At 5 years, radiographs were available for 113 patients (93%). Overall, 29 patients (26%) had knee osteoarthritis at 5 years. Specifically, 13 patients (12%) developed tibiofemoral radiographic osteoarthritis (9 patients [16%] in the early ACL-reconstruction group, 4 [7%] in the optional-delayed ACL-reconstruction group) and 22 (19%) developed patellofemoral osteoarthritis (14 patients [24%] in the early ACL-reconstruction group, 8 [15%] in the optional-delayed ACL-reconstruction group). Patients with patellar tendon grafts (n = 40) had a greater incidence of ipsilateral patellofemoral osteoarthritis than patients with hamstrings tendon grafts (n = 51), but the 2 groups had similar incidences of ipsilateral tibiofemoral osteoarthritis. Six knees (5%) had both tibiofemoral and patellofemoral osteoarthritis. Early ACL reconstruction plus rehabilitation did not provide better results at 5 years compared with optional-delayed ACL reconstruction plus rehabilitation. Furthermore, the authors found no radiographic differences among patients with early ACL reconstruction, delayed ACL reconstruction, or no ACL reconstruction (rehabilitation alone).

ABSTRACTObjectiveThe incidence of anterior cruciate ligament (ACL) ruptures has been increasing annually. However, clinical surgeons have overlooked the impaction fractures of the posterolateral tibial plateau and lateral femoral condyle in patients with ACL ruptures. The purpose of the present study was to report the detection rate of the posterolateral tibial plateau impaction fractures in patients with ACL ruptures, and to evaluate the functional outcomes of patients following ACL reconstruction (ACLR) without treatment of the tibial fractures at a 2‐year postoperative follow‐up.MethodsFour hundred eighty‐eight patients treated for ACL ruptures between January 2016 and June 2020 were retrospectively reviewed, and the posterolateral tibial plateau impaction fractures were classified based on MRI assessment. The detection rate of the posterolateral tibial plateau impaction fractures was calculated, and the functional outcomes (SF‐12 Mental Component Summaries, SF‐12 Physical Component Summaries, Tegner, Lysholm, IKDC, and KOOS) were evaluated at a 2‐year postoperative follow‐up.ResultsThe detection rate of posterolateral tibial plateau impaction fractures was 41.6% among ACL ruptures. Of these, 285 cases (58.4%) had no fractures, 98 cases (20.1%) had type I impaction fractures, 41 cases (8.4%) had type IIA impaction fractures, 15 cases (3.1%) had type IIB impaction fractures, 22 cases (4.5%) had type IIIA impaction fractures, and 27 cases (5.5%) had type IIIB impaction fractures. Patients with type IIIA or IIIB impaction fractures showed an increased detection rate of contact mechanism compared to the other subgroups. Significant differences in Tegner (postoperation) and KOOS (QOL) were found between no fracture and type IIIB impaction fractures in patients following ACLR.ConclusionsThe detection rate of posterolateral tibial plateau impaction fractures in patients with ACL ruptures was high. Patients with type IIIB impaction fractures following ACLR had poor functional outcomes.

BackgroundNonanatomical anterior cruciate ligament (ACL) reconstruction occasionally induces ACL failure without an evident injury episode, necessitating revision surgery. Although the in vivo kinematics of ACL deficiency before primary ACL reconstruction are well documented, the kinematics of ACL failure after nonanatomical reconstruction remain unexplored. The aim of this study is to investigate ACL failure kinematics following nonanatomical reconstruction.Patients and methodsThis study enrolled three patients with ACL failure after nonanatomical reconstruction, 20 normal and 16 ACL-deficient knees. The anteroposterior (AP) translation of the medial and lateral femoral condyles and center of the femur and femoral rotation relative to the tibia during squatting were evaluated using a two- to three-dimensional registration technique under fluoroscopy.ResultsMedial AP translation of the nonanatomically reconstructed knee in one patient showed posterior location and abnormal kinematics compared with the ACL-deficient knees. In contrast, the lateral AP position of the nonanatomically reconstructed knees in two patients were more posteriorly located and showed more abnormal kinematics than the ACL-deficient knees. Central AP translation of the nonanatomically reconstructed knees in two patients was located more posteriorly throughout the range of midflexion. Femoral rotation of the nonanatomically reconstructed knees showed abnormal kinematics compared with that of the normal and ACL-deficient knees.ConclusionsBy independently assessing the medial and lateral aspects of the femur, the medial or lateral condyle of the femur of nonanatomically reconstructed knees exhibited a more pronounced abnormality compared with ACL-deficient knees. The femur of the nonanatomically reconstructed knees showed abnormal rotational kinematics. Considering the kinematic aspect, nonanatomical ACL reconstruction should be avoided.