Anterior cruciate ligament (ACL) injuries continue to be a major focus in sports medicine research. With so many changes to our understanding of ACL anatomy and with rapid advances in reconstruction techniques and rehabilitation protocols within the past 20 years, it is important to identify the landmark research that has laid the foundation for current ACL treatments. Using the Web of Science citation index, a search was carried out for the 30 most cited articles on ACL injury published in the last 20 years. The generated list was sorted from highest to lowest citation number. Clinical studies were subcategorized as therapeutic, prognostic, diagnostic, or economic/decision analysis and assigned a level of evidence. Basic science articles were designated anatomic, animal, biomechanical, or clinical. The number of citations per year (citation density) was calculated. The search yielded 6,345 articles. The total number of citations among the top 30 ranged from 188 to 611. Citation density ranged from 10.1 to 66.2. Nineteen articles were clinical, 8 were basic science, and 3 were video analyses. Clinical articles were most commonly therapeutic (18 of 19; 95%). Basic science articles were most commonly biomechanical (7 of 8; 88%). The most common level of evidence was Level II (10 of 19; 53%). More than half of the articles in the top 30 (16 of 30; 53%) were published in The American Journal of Sports Medicine. Many of these articles have played a large role in shaping current clinical practice regarding ACL injuries. We hope that by compiling this list we can draw attention to the continued need for studies of the highest level of evidence.
Older adults are at increased risk of injury when initiating exercise due to inactivity, functional limitation, illness, or fall risk. We studied a novel non-impact cardio unit in an effort to determine whether there were differences in physiologic, functional, and strength benefits compared to a treadmill (TM), while producing less stress on the knee and lessening the risk of fall and injury. Utilizing a prospective, randomized, nonblinded, cohort design, individuals aged 50-80 years were recruited and enrolled in a 16-week exercise program. Subjects were randomly allocated to either exercise on the Cybex arc trainer or on a TM. Participants exercised for 120 min per week. Resistance was adjusted to achieve a target RPE in each group. Functional, strength, and physiologic markers were analyzed through balance testing, tenrepetition max leg press, body composition analysis, and lipid panel results. Overall health-related quality of life was also measured. There was a significant improvement in triglyceride and very low density lipoprotein levels from baseline to exit within the arc trainer group. An equal and significant increase in strength capacity was observed in both the arc trainer and TM groups, as were feelings of increased energy, improved emotional well-being, and decreased fatigue. Leg strength increased, percentage of body fat decreased, and balance improved following use of either an arc trainer or a TM in a study population of 58 participants over a 16-week period. This study demonstrated that positive change occurs, physiologically and psychologically when an arc trainer or TM is utilized. Given the similar benefits seen in this study, use of a non-impact modality such as the arc trainer may be a better alternative in the older population.
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