Background There is limited information on outcomes and return to play (RTP) after ACL reconstruction (ACLR) in soccer athletes. Hypothesis The purpose of this study was to (i) test the hypotheses that player sex, side of injury and graft choice do not influence RTP, and (ii) define the risk for future ACL injury in soccer players after ACLR. Study design Retrospective cohort study, Level II. Methods Soccer players in a prospective cohort were contacted to determine RTP following ACLR. Information regarding if and when they returned to play, their current playing status, the primary reason they stopped playing soccer (if relevant) and incidence of subsequent ACL surgery was recorded. Results Initially, 72% of 100 soccer athletes (55 male, 45 female) with a mean age of 24.2 years at the time of ACL reconstruction returned to soccer. At average follow up of 7.0 years, 36% were still playing, a significant decrease compared to initial RTP (p<0.0001). Based on multivariate analysis, older athletes (p=0.006) and females (p=0.037) were less likely to return to play. Twelve soccer athletes had undergone further ACL surgery, including 9 on the contralateral knee and 3 on the ipsilateral knee. In a univariate analysis, females were more likely to have future ACL surgery (20% v. 5.5%, p=0.03). Soccer athletes who underwent ACLR on their non-dominant limb had a higher future rate of contra-lateral ACLR (16%) than soccer athletes who underwent ACLR on their dominant limb (3.5%) (p=0.03). Conclusion Younger and male soccer players are more likely to return to play after ACL reconstruction. Return to soccer following ACLR declines over time.

Background The predictors of ACL reconstruction outcome at six years as measured by validated patient based outcomes instruments are unknown. Hypothesis We hypothesize that certain variables evaluated at the time of ACL reconstruction will predict return to sports function (as measured by the IKDC and KOOS Sports and Recreation subscale), knee-related quality of life (as measured by the KOOS Knee Related Quality of Life subscale), and activity level (as measured by the Marx scale). Potential predictor variables include demographics, surgical technique and graft choice for ACL reconstruction, and intra-articular injuries and treatment. Study Design Prospective cohort, Level 1 Methods All unilateral ACL reconstructions from 2002 currently enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) cohort were evaluated. Patients preoperatively completed a series of validated outcome instruments, including the IKDC, KOOS, and Marx activity level. Physicians documented intra-articular pathology, treatment, and surgical techniques utilized at the time of surgery. At 2 and 6 years postoperatively, patients completed the same validated outcome instruments. Results Follow-up was obtained on 395/448 (88%) at 2 years and 378/448 (84%) at 6 years. The cohort was 57% male with median age of 23 at the time of enrollment. The ability to perform sports function was maintained at six years (IKDC T2 = 75, T6 = 77; KOOSsports/rec T2 = 85, T6 = 90). The Marx activity level continued to decline from baseline (T0 = 12, T2 = 9, T6 = 7). Revision ACL reconstruction and use of allograft predicted worse outcomes on the IKDC and both KOOS subscales. Lateral meniscus treatment, smoking status, and BMI at T0 were each predictors on two of three scales. The predictors of lower activity level were revision ACL reconstruction and female sex. Conclusions Six years after ACL reconstruction, patients are able to perform sports-related functions and maintain a high knee-related quality of life similar to their two year level, although their physical activity level (Marx) drops over time. Choosing autograft rather than allograft, not smoking, and having normal BMI are advised to improve long-term outcomes.

Purpose The hypothesis of this study was that single-legged horizontal hop test ratios would correlate with IKDC, KOOS, and Marx activity level scores in patients 2 years after primary ACL reconstruction. Methods Individual patient-reported outcome tools and hop test ratios on 69 ACL reconstructed patients were compared using correlations and multivariable modeling. Correlations between specific questions on the IKDC and KOOS concerning the ability to jump and hop ratios were also performed. Results The triple-hop ratio was moderately but significantly correlated with the IKDC, KOOS Sports and Recreation subscale, and the KOOS Knee Related Quality of Life subscale, as well as with the specific questions related to jumping. Similar but weaker relationship patterns were found for the single-hop ratio and timed hop. No significant correlations were found for the Marx activity level or crossover-hop ratio. Multivariable modeling showed almost no significant additional contribution to predictability of the IKDC or KOOS subscores by gender, BMI, or the number of faults on either leg. Conclusions The triple-hop test is most significantly correlated with patient-reported outcome scores. Multivariable modeling indicates that less than a quarter of the variability in outcome scores can be explained by hop test results. This indicates that neither test can serve as a direct proxy for the other; however, assessment of patient physical function by either direct report using validated outcome tools or by the hop test will provide relatively comparable data. Level of evidence II.

The continuous infusion of intra-articular bupivacaine via pain control infusion pumps after anterior cruciate ligament reconstruction using ipsilateral autograft quadrupled semitendinosus cannot be supported when postoperative visual analog scale pain scores and analgesic use are the rationale for justification.

Nanoemulsions containing hydrophobic drugs have a great potential in the pharmaceutical industries to improve the bioavailability of the drug. However, currently there is no cost-effective way of producing nanoemulsions in large scale. The need of subjecting emulsions to an extreme pressure of 50 MPa demands a large excess of energy for the manufacturing process, while low-energy method requires large amount of solvents. Here, nanoemulsions containing a well-characterized hydrophobic drug, carboxyamidotriazole (CAI), are produced in both batch and continuous modes to demonstrate the scalability of nanoemulsion production using Covaris' Adaptive Focused Acoustics™ (AFA) technology. To move from batch scale to continuous flow, the acoustic and thermal energy inputs can be manipulated to adjust particle size, while the composition and temperature of starting materials can be altered to achieve complete dissolution of hydrophobic drugs, thus providing 100% encapsulation efficiency. Furthermore, using two AFA systems in series can drastically enhance the production flow rates, making AFA a competitive means for producing nanoemulsions in the pharmaceutical industry.