Native ACLs have a smaller cross-sectional area, are "flatter," and experience less incidence of impingement compared with anatomically placed BPTB ACL grafts.

Weight-bearing ankle DF ROM should not be assumed to be bilaterally symmetrical. These findings suggest that side-to-side differences in WB DF may need to be interpreted while considering which side is dominant. The difference in bilateral symmetry between the WB and NWB measurements, as well as the only moderate level of correlation between them, suggests that both measurements should be performed routinely.

Background Anterior cruciate ligament (ACL) tears are being seen and treated with increasing frequency in youth athletes, with the goal of returning patients to sports activity. This is particularly important for youth athletes, for whom sports provide physical, social and psychological development. Objectives To perform a systematic review of the orthopaedic surgery literature to investigate for any associations between treatment strategy and return to athletic activity after ACL tear in youth athletes under age 18 years. Data sources PubMed, EMBASE and Cochrane computerised databases. Study eligibility criteria Inclusion criteria: (1) <18 years of age, (2) investigation of a relationship between time to treatment and consequent rates of returning to preinjury levels of athletic activity, (3) original research article (eg, not a review, case report or meta-analysis). Exclusion criteria: (1) revision ACL surgery, (2) language other than English, and (3) not a clinically based study. Participants Youth <18 years old with ACL tears. Interventions Acute ACL reconstruction, delayed ACL reconstruction, non-operative management. Synthesis methods Qualitative synthesis. Results Twenty studies met inclusion and exclusion criteria, of which four evaluated return to play after acute ACL reconstruction (ACLR), five studies evaluated return to play after delayed ACLR, and nine evaluated return to play after ACLR with an unspecified injury-tosurgery time interval. Two studies investigated return to play in a non-operative cohort. Of the 18 surgical studies, 14 employed a soft tissue transphyseal reconstruction. Rates of return to play were 78-100% after acute ACLR, 84-100% after delayed ACLR, 41-100% after ACLR with an indeterminate injury-tosurgery time interval and 6-52% after non-operative treatment of ACL tear. Limitations Several studies did not provide details about the timing of injury-to-surgery, and study heterogeneity precluded combining results in quantitative meta-analysis. Furthermore, the amount of time to full postinjury recovery remains largely unstudied. Conclusions and implications of key findingsBased on available literature, there appears to be an improved rate of return to athletic activity after ACLR when compared with non-operative treatment. Future research should directly focus on time to return to sports activity, while taking into account the unique aspects of ACL reconstruction and non-operative management in youth athletes. This is of particular importance in children and adolescents given the physical, social and psychological development that occurs with sports participation. Trial registration number CRD42015027536.

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Injuries to ligaments are common, painful and debilitating, causing joint instability and impaired protective proprioception sensation around the joint. Healing of torn ligaments usually fails to take place, and surgical replacement or reconstruction is required. Previously, we showed that in vivo application of the recombinant human amelogenin protein (rHAM +) resulted in enhanced healing of the tooth‐supporting tissues. The aim of this study was to evaluate whether amelogenin might also enhance repair of skeletal ligaments. The rat knee medial collateral ligament (MCL) was chosen to prove the concept. Full thickness tear was created and various concentrations of rHAM +, dissolved in propylene glycol alginate (PGA) carrier, were applied to the transected MCL. 12 weeks after transection, the mechanical properties, structure and composition of transected ligaments treated with 0.5 μg/μl rHAM + were similar to the normal un‐transected ligaments, and were much stronger, stiffer and organized than control ligaments, treated with PGA only. Furthermore, the proprioceptive free nerve endings, in the 0.5 μg/μl rHAM + treated group, were parallel to the collagen fibres similar to their arrangement in normal ligament, while in the control ligaments the free nerve endings were entrapped in the scar tissue at different directions, not parallel to the axis of the force. Four days after transection, treatment with 0.5 μg/μl rHAM + increased the amount of cells expressing mesenchymal stem cell markers at the injured site. In conclusion application of rHAM + dose dependently induced mechanical, structural and sensory healing of torn skeletal ligament. Initially the process involved recruitment and proliferation of cells expressing mesenchymal stem cell markers.