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Open research questions in Knee injuries and reconstruction techniques

129 unresolved questions extracted from the limitations and future-work sections of 841 Knee injuries and reconstruction techniques papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Although limited by its retrospective design and small sample size, this study contributes valuable clinicoradiological and outcome data from a region where published experience remains scarce. Prospective multicenter studies incorporating standardized symptom assessment, quality-of-life measures, and long-term follow-up are warranted to refine patient selection and establish evidence-based management strategies.

    Median Arcuate Ligament Syndrome: Diagnostic Challenges and Outcomes Following Laparoscopic Decompression · 2026 · DOI

  • Purpose The posterior cruciate ligament (PCL) is a major stabilizing structure of the flexion space, yet current evidence is inconclusive regarding change in gap laxity associated with its resection.

    Association Between Posterior Cruciate Ligament Resection and Medial Gap Laxity in Robotic-Assisted Total Knee Arthroplasty · 2026 · DOI

  • 654 Future qualitative and mixed-methods studies using larger, multi-centre samples across public 655 and private care settings are needed to better understand variation in diagnostic experiences. 656 Comparing patients who receive early versus delayed diagnosis may also help identify 657 indicators of best practice. In addition, incorporating clinician perspectives could elucidate 658 challenges to acute assessment and identify alternative approaches to early knee injury 659 evaluation.

    Patient Perspectives on the Contributors to and Impact of Delayed ACL Injury Diagnosis: A Qualitative Study · 2026 · DOI

  • Open growth plates are precautions for modalities such as ultrasound and electri- cal stimulation, but at this time there is no consensus as to whether open growth plates should serve as a precau- tion or contraindication to BFRT.

    Factors Affecting Clinical Decision Making for Blood Flow Restriction Training in Pediatric and Adolescent Patients Following Anterior Cruciate Ligament Injury · 2026 · DOI

  • Because the purpose of this study was to describe the influence of patient clinical presentation on BFRT use, the authors did not account for the type of BFRT system, cuff style, width or length.

    Factors Affecting Clinical Decision Making for Blood Flow Restriction Training in Pediatric and Adolescent Patients Following Anterior Cruciate Ligament Injury · 2026 · DOI

  • Although structural healing could not be confirmed in the absence of postoperative MRI or second-look arthroscopy, the excellent clinical outcome observed supports further investigation of this biological augmentation strategy in selected revision cases.

    Revision Repair of a Failed Bucket-Handle Medial Meniscal Tear Using Autologous Fibrin Clot Augmentation: A Case Report With One-Year Follow-Up · 2026 · DOI

  • Management of failed meniscal repair remains controversial, with some surgeons favoring partial meniscectomy, whereas others advocate revision repair in an attempt to preserve meniscal 2026 Lamzira et al.

    Revision Repair of a Failed Bucket-Handle Medial Meniscal Tear Using Autologous Fibrin Clot Augmentation: A Case Report With One-Year Follow-Up · 2026 · DOI

  • The present study provides innovative and positive find- ings on the comparison between video-supported tel- erehabilitation and traditional exercise programs in the early postoperative period following ACL surgery -an area with limited research in the literature.

    Comparison of Early Outcomes of Video-Assisted Telerehabilitation and Traditional Exercise Program after Anterior Cruciate Ligament Surgery · 2026 · DOI

  • The study's limitations include the fact that the surg- eries were performed by different surgeons at the same clinic, and that exercise compliance charts were com- pleted based on patients' self-reports. In revenge, the use of camera recordings for observational gait assess- ments, and the evaluation of strength and propriocep- tion using an isokinetic dynamometer are notable strengths of the study. CONCLUSION The present study provides innovative and positive find- ings on the comparison between video-supported tel- erehabilitation and traditional exercise programs in the early postoperative period following ACL surgery -an area with limited research in the literature. In this study, video-supported telerehabilitation was compared with traditional rehabilitation programs delivered to patients in written and verbal form, and it was shown that telere- habilitation yielded more favorable outcomes in the ear- ly postoperative phase. Data obtained suggest that tel- erehabilitation may serve as a valuable tool for early re- habilitation, especially in extraordinary situations such as a pandemic, where clinical rehabilitation is not very feasible or access to hospitals is restricted. In this con- text, telerehabilitation can be considered a viable method for patients who have undergone or are sched- When comparing exercise compliance results between uled to undergo ACL surgery, particularly in settings the two groups, we found that the telerehabilitation where access to healthcare facilities is limited. However, group had significantly better compliance. In a study whether telerehabilitation can fully replace face-to-face conducted by Campbell et al. [39], it was stated that in clinical rehabilitation remains an area that requires fur- patients who underwent total knee arthroplasty ther scientific investigation and expert consensus. surgery, the duration of participation in home-based ex- Therefore, we believe that the telerehabilitation ap- ercises in the telerehabilitation group was significantly proach used in our study should be considered a promising option for appropriate patients in the future.

    Comparison of Early Outcomes of Video-Assisted Telerehabilitation and Traditional Exercise Program after Anterior Cruciate Ligament Surgery · 2026 · DOI

  • Background Change-of-direction maneuvers can be executed with deceptive intent (‘fake-cuts’), yet the biomechanical determinants of fake-cut performance and their trade-offs with anterior cruciate ligament (ACL) injury risk remain poorly understood.

    Fake-cut maneuvers: biomechanical determinants of performance and ACL injury risk · 2026 · DOI

  • ContextAlthough knee extensor and flexor strength deficits are well-documented after anterior cruciate ligament reconstruction, limited data exist characterizing how strength recovery evolves over time.

    Recovery Trends Show Greater Quadriceps Weakness After Patellar Tendon Versus Hamstring Autografts in ACL Reconstruction · 2026 · DOI

  • Background: Previous studies have demonstrated that as posterior tibial slope (PTS) increases, increased force is transmitted through anterior cruciate ligament (ACL) grafts, but limited literature assesses PTS effects on anterior tibial translation (ATT) with concomitant medial meniscus (MM) pathology.

    Restoration of Anterior Tibial Translation Is Achievable With an Anterior Cruciate Ligament Reconstruction and Ramp Repair With Increasing Posterior Tibial Slope While Medial Meniscus Deficiency Requires Concomitant Slope-Correcting Osteotomy · 2026 · DOI

  • This work provides foundational evidence for age-dependent hormonal responsiveness in the ACL and motivates further investigation into how sex hormones influence ACL injury risk in adolescent females.

    Estrogen Receptor Expression Changes After Puberty in the Porcine Anterior Cruciate Ligament · 2026 · DOI

  • 1 Directions for Future Research To advance the understanding of degenerative meniscus injury management, future research should address several methodological challenges present in the current literature: Handling Crossover Rates: The considerable crossover rate from non-surgical to surgical groups can lead to an underestimation of the potential structural harm of APM when analyzed using the intention-to-treat principle.

    Management of Degenerative Meniscus Injury: Surgical vs Conservative approach · 2026 · DOI

  • This systematic review and meta-analysis has several strengths, in PROSPERO and adherence to the PRISMA checklist. However, some limitations should be acknowledged. The exclusion of grey literature may have introduced publi- cation bias. Moreover, a limited number of high-quality studies available for analysis may reduce the robustness of the findings. Additionally, inherent limitations of the included observational studies, such as heterogeneity in participants’ characteristics (time since injury/sur- gery, surgical technique), prevent causal inferences and may introduce confounding. Therefore, these limitations should be considered when interpreting and applying the findings of this review.

    Changes in Quadriceps Force Control and Torque Quality Following Anterior Cruciate Ligament Injury and Reconstruction: Associations with Functional Performance—A Systematic Review and Meta-Analysis · 2026 · DOI

  • To further enhance our understanding in this field, high- quality longitudinal studies are needed to examine the quality of force control following ACL injury and recon- struction surgeries. Further research should also inves- tigate the relationship between quadriceps force control and functional outcomes to provide a more comprehen- sive assessment of ACL recovery progression. Potential contributing factors, particularly time since injury or sur- gery, should also be explored for their impact on quadri- ceps force control adaptations. Also, applying non-linear analysis of force signals may provide deeper insights into following ACL neuromuscular control mechanisms injury, offering a promising direction for future research.

    Changes in Quadriceps Force Control and Torque Quality Following Anterior Cruciate Ligament Injury and Reconstruction: Associations with Functional Performance—A Systematic Review and Meta-Analysis · 2026 · DOI

  • Rugby and codified football (COF) tackle-law rule changes show conceptual precedent for modifying contact-injury risk, but actual prevention effects and unintended consequences remain unmonitored. Future research should prospectively evaluate whether enhanced tackle-technique coaching, strengthened officiating for knee contact, and equipment interventions (e.g., task-adaptive knee bracing) reduce ACL injury incidence while tracking secondary outcomes and behavioral adaptation in these contact-dominant sports.

    Situations Leading to Anterior Cruciate Ligament Injury in Sports: A Systematic Review with Meta-analysis · 2026 · DOI

  • Video source and quality, rater background characteristics, and sample representativeness were substantially under-reported across included studies (identified in QA-SIVAS assessment). Future video-analysis studies of ACL injury situations must explicitly document: video resolution/frame rate, number and expertise level of raters, inter-rater reliability statistics, sampling bias (e.g., elite vs. recreational athletes), and representativeness of the injury sample to the source population.

    Situations Leading to Anterior Cruciate Ligament Injury in Sports: A Systematic Review with Meta-analysis · 2026 · DOI

  • Netball's early match clustering (37.8% in first quarter) shows a temporal pattern, but causal drivers are unexplained. Future prospective studies should examine whether early-match clustering in netball relates to inadequate field activation, insufficient game-speed landing/deceleration exposure in warm-up, or physiological readiness factors, with analysis of warm-up timing alignment to match start and landing technique quality metrics.

    Situations Leading to Anterior Cruciate Ligament Injury in Sports: A Systematic Review with Meta-analysis · 2026 · DOI

  • Contact-injury classification currently lacks standardized criteria distinguishing minor postural perturbations from contact events that significantly alter knee-joint loading and stability. Future research should establish operationalized definitions differentiating contact based on force magnitude, direction, timing relative to foot contact, and biomechanical consequence (postural destabilization vs. maintained alignment) to improve cross-sport comparability of contact vs. noncontact injury categorization.

    Situations Leading to Anterior Cruciate Ligament Injury in Sports: A Systematic Review with Meta-analysis · 2026 · DOI

  • Defensive action classification in team sports currently lacks injury-level granularity across code-specific contexts. Future video-analysis studies must use consensus-driven reporting that explicitly documents, per injury: player role (tackler vs. ball carrier), tackle type (pressing vs. contact tackling), contact location (lower limb, torso, knee), timing relative to injury event, and force characteristics to enable valid cross-sport synthesis of tackle-related ACL injury mechanisms.

    Situations Leading to Anterior Cruciate Ligament Injury in Sports: A Systematic Review with Meta-analysis · 2026 · DOI

  • Netball-specific ACL injury prevention evidence is limited to two studies with substantial uncertainty in estimates. Future video-analysis research in netball should prospectively examine the relationship between high horizontal velocity approach phases, deceleration biomechanics, and landing technique (single vs. double leg) across noncontact and indirect-contact injury mechanisms to validate the hypothesized efficacy of rapid approach-deceleration drills.

    Situations Leading to Anterior Cruciate Ligament Injury in Sports: A Systematic Review with Meta-analysis · 2026 · DOI

  • Time-stamped exposure data relating warm-up strategy timing to ACL injury situations needs confirmation through prospective video analysis. Specifically, studies should document warm-up duration, intensity progression, and movement patterns (landing sequences, cutting drills) in relation to injury mechanism classification (contact, indirect-contact, noncontact) across the match timeline.

    Situations Leading to Anterior Cruciate Ligament Injury in Sports: A Systematic Review with Meta-analysis · 2026 · DOI

  • This study also identifies important opportunities for future research. There is a clear need for high-quality, prospective trials directly comparing femoral fixation methods for LET, with standardized surgical techniques and clearly defined patient risk profiles. In addition, future investigations integrating LET fixation strategies into personalized ACLR treatment algorithms, based on patient age, activity level, graft type, and laxity patterns, may help optimize outcomes while minimizing complications. This systematic review was conducted in accordance with the PRISMA 2020 guidelines. The PRISMA 2020 checklist was followed to ensure transparent and comprehensive reporting of the study. CONCLUSION Our systematic review and meta-analysis demonstrate that augmentation of ACLR with a modified Lemaire LET is associated with a significant reduction in graft failure isolated ACLR. Among the evaluated compared with femoral fixation techniques, suture anchor and staple fixation were associated with the greatest reduction in graft rupture rates, while other fixation methods showed a trend toward improved graft survivorship without reaching statistical significance. The protective effect of LET was most pronounced in primary ACLR, supporting its role in enhancing rotational stability and reducing graft strain in high-risk patients. Overall, these findings support the selective use of modified Lemaire LET as an effective adjunct to ACLR, particularly in primary procedures at increased risk of failure. Further high-quality, prospective studies directly comparing femoral fixation techniques are warranted to better define the optimal fixation strategy and to clarify long- term clinical and radiographic outcomes. Author contributions : CD: Conceptualized and designed the study, conducted the literature search, performed data extraction and statistical analysis, and drafted the manuscript. VS: Contributed to study design, supervised the methodology, resolved disagreements during study selection and data synthesis, and critically revised the manuscript for important intellectual content; JD: Assisted with data extraction, quality assessment, and interpretation of results, and contributed to manuscript editing. All authors reviewed, and approved the final manuscript.

    Lateral extra-articular tenodesis by femoral fixation is beneficial to anterior cruciate ligament graft survival: A systematic review and meta-analysis · 2026 · DOI

  • Long-term complication surveillance data beyond short-term outcomes are limited for lateral extra-articular tenodesis procedures. Systematic tracking of delayed complications (persistent peroneal nerve symptoms, chronic lateral knee pain, graft incorporation failure, hardware-related issues) across ≥5-year follow-up periods with standardized assessment scales is absent.

    Extra-articular Tenodesis for ACL Reconstruction: Who Needs it and is there a Superior Technique? · 2026 · DOI

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129 open questions have been extracted from the limitations and future-work passages of 841 Knee injuries and reconstruction techniques papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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