Skip to content

Related Anatomy

Foot & ankle anatomical variations—coalitions, accessory bones, and congenital anomalies—impact diagnosis & surgical planning.

Overview

Emerging anatomic reconstructions of the anterolateral ligament (ALL) have been proposed, though data on their effectiveness remain limited [4]. Current evidence indicates that anatomic ALL reconstruction leads to overconstraint at any fixation angle [20]. Consequently, the surgical technique and indications for this procedure require further investigation, and its use is recommended with caution [20]. Understanding the current evidence and appropriate indications for such emerging technologies is critical for their clinical utilization [21].

For anterior cruciate ligament reconstruction (ACLR), graft selection is influenced by patient preference and surgeon recommendation [53]. In pediatric patients, larger graft diameters are associated with a reduced likelihood of long-term complications [23]. While high tibial osteotomy can extend indications for ligament reconstruction to potentially halt arthritis evolution and preserve the natural joint [24], revision ACLR practices vary widely with no uniform consensus on graft choice or indications for ALL augmentation [58].

Anatomic tibial insertion sites of the anteromedial and posterolateral bundles can be described using basic fluoroscopic data, yet significant anatomic variation exists, necessitating individualized tunnel placement decisions [56]. A minimally invasive technique for reconstructing the medial posterolateral corner associated with ACLR is less invasive, practical, and reproducible compared to traditional anatomical techniques [28]. Furthermore, thorough knowledge of anatomy and alternative fixation techniques is imperative to ensure optimal outcomes if cortical blowout occurs during ACLR [49]. Finally, a consensus paper provides practical guidelines for reporting outcome entities and suggests preferred tools for reliable assessment following ACL treatment [63].

Anatomy & Pathophysiology

Osseous and Joint Morphology

The proposed Rotterdam Foot Classification system categorizes foot anatomic features into four distinct groups [1]. Quantifiable parameters for first metatarsophalangeal joint motion delineate patterns in normal feet as well as those with hallux valgus or hallux rigidus [50]. Hallux valgus deformity severity correlates positively with the magnitude of anteroposterior postural sway [103]. A cadaveric study directly measured transverse forces between the first and second metatarsals using a suture button device [65]. From a mechanical perspective, the metacarpophalangeal joint represents a joint with five kinematic degrees of freedom [67].

Ligamentous and Soft Tissue Structures

Comprehensive overviews detail ligamentous structures, muscle compartments, joint kinematics, and gait mechanics of the foot and ankle [32]. Recent advances highlight the importance of anatomic syndesmotic reduction, the utility of gait analysis, and the evolving landscape of ankle reconstruction and total ankle arthroplasty [81]. A proof-of-concept study demonstrates a feasible method of quantifying muscle morphology and composition for individual intrinsic foot muscles using advanced high-field MRI techniques [96]. Gracilis tendon harvest in healthy knees does not lead to altered knee kinematics [101].

Kinematics and Biomechanics

Hallux valgus is a dynamic condition where the deformity may correlate more with motions during weightbearing than with plain static measurements [82]. Three-dimensional kinematics under static full weightbearing were opposite between the ankle and subtalar joints on their respective axes [87]. Sport-related movements load the plantar surface of the foot more than running straight [73]. Dual task conditions during single-leg drop landing increased maximum internal tibial rotation angle and anterior tibial translation compared to single task conditions [93]. Asymmetrical movement patterns potentially put the non-operative limbs at an increased risk for injury [98]. Dynamic limb valgus scores were similar across all groups [100].

Assessment and Classification

Methods for analysis of the kinematics of the first metatarsophalangeal joint delineate quantifiable parameters to define patterns of motion for this articulation in normal feet as well as those afflicted with hallux valgus or hallux rigidus [50]. The single-leg cross drop task has moderate to good reliability of kinematic and kinetic measures across institutions after implementation of a standardized testing protocol [83]. The NNHt and FPI-6 consensus is highlighted for foot posture classification in asymptomatic adults [99]. Future research should focus on biomechanics and clinical outcomes, including the potential progression to osteoarthritis [102].

Classification

Rotterdam Foot Classification: This system categorizes anatomic features of the foot into four distinct categories [1].

Medial Knee Ligament Nomenclature: The medial side of the knee demonstrates a consistent three-layered anatomical pattern [2]. Based on this layered architecture, specific nomenclature for the superficial medial ligament and posteromedial capsule is suggested over the term 'posterior oblique ligament' [2].

Anterolateral Ligament (ALL) Reconstruction: Newer 'anatomic' reconstructions of the ALL have been proposed but currently possess limited data regarding their effectiveness [4].

Lisfranc Joint Complex: The manuscript provides a comprehensive anatomical review of the Lisfranc joint complex to enhance understanding of injury patterns [8].

Extensor Hallucis Longus Insertion: Knowledge of particular types of extensor hallucis longus insertion is essential for clinicians and anatomists [12].

Proximal Femur Shape and FAI: Results regarding proximal femur shape variations may help physicians better classify cam-type femoroacetabular impingement (FAI) [18]. These findings may also provide guidelines for patient-specific care based on hip anatomy [18].

First Metatarsophalangeal Joint (MTPJ): Histological analysis provides further understanding of the structures of the capsuloligamentous complex of the first MTPJ [22].

Medial Posterolateral Corner (MPLC) Reconstruction: The construct for minimally invasive reconstruction of the medial posterolateral corner of the knee is less invasive, practical, and reproducible compared to traditional anatomical techniques [28].

Medial Meniscus Ramp Tears: A classification system for medial meniscus ramp tears allows for the evaluation of differing repair patterns and their effects on postoperative clinical outcomes [33].

Tarsal Coalitions: Associated tarsal coalitions are classified into dual, threefold, massive, and total types based on the number and sites of involved joints [51]. Dual coalitions represent the most common configuration of associated tarsal coalitions [51].

Foot Type Classification in Down Syndrome: There is a need to determine the reliability and validity of footprint measurement methods used for clinical classification of foot types in subjects with Down syndrome [55].

Lateral Meniscal Oblique Radial Tears (LMORTs): A classification scheme was developed for posterior horn lateral meniscal oblique radial tears (LMORTs) to aid reporting and clinical decision making [70].

Clinical Presentation

The proposed Rotterdam Foot Classification system categorizes foot anatomic features into four distinct groups [1]. In the medial knee, a consistent three-layered anatomical pattern is observed, supporting the use of specific nomenclature for the superficial medial ligament and posteromedial capsule rather than the term 'posterior oblique ligament' [2]. Knowledge of particular types of extensor hallucis longus insertion remains essential for clinicians and anatomists [12].

Imaging Modalities: MRI is utilized to establish proper diagnoses for knee injuries in rock climbing and bouldering [3]. The accessory soleus muscle presents a typical appearance on plain radiographs and a diagnostic appearance on computed tomography [9]. A 'normal' MRI report should not preclude consideration of injury to the anterolateral structures in an ACL-deficient knee [14]. The presence of either the gap or footprint signs on coronal MRI is suggestive of an isolated tear of the posterolateral bundle of the ACL, with both signs together being particularly suggestive [16]. Secondary arthrosis signs are detected sporadically on MRI following long-term ACL reconstruction in childhood and adolescence [13].

Stability and Special Tests: The anterolateral ligament is a consistent finding from week 13 of embryonic to fetal development onward [15]. Concomitant intraarticular pathology is seen in both tibial spine fracture and ACL-injured patients, necessitating careful evaluation for additional pathology when treating these injuries [42]. Results regarding proximal femur shape variations may assist in classifying cam-type FAI and providing guidelines for patient-specific care based on hip anatomy [18]. Osseous morphology may contribute to the development of a radiographic DISI deformity in scapholunate dissociation cases [19].

Red-Flag Patterns: Early diagnosis is vital for mucormicosis following ACL reconstruction due to its fulminant nature, requiring a high rate of clinical suspicion [34]. Early diagnosis and proper treatment are critical for synovial chondromatosis of the hip [36]. A specific clinical sign may alert the orthopaedist to consider the greater trochanteric area as the source of a lesion in children with osteomyelitis, though it is not diagnostic [40]. The heterogeneity of pathology treated, follow-up time, and outcome measures limits comparison between studies regarding clinical outcomes of high tibial osteotomy for knee instability [6]. Conservative treatment is the proper therapeutic approach for knee injuries in rock climbing and bouldering [3].

Investigations

Plain radiography: Full-length lateral radiographs demonstrate less variability than standard short knee radiographs when evaluating posterior tibial slope in revision ACL patients [59]. Osseous morphology may play a role in the development of a radiographic DISI deformity in cases of scapholunate dissociation [19]. The incidence of Segond lesions found with Ultrasound Imaging (29%) is much higher than previously recorded with MRI (3-6%) or X-ray (9%) [71].

MRI: MRI demonstrates proper diagnosis and guides conservative treatment for knee injuries in rock climbing and bouldering [3]. There is no convincing evidence that a bone bruise alone identified on index MRI adversely affects the outcome of surgically reconstructed anterior cruciate ligaments [7]. A 'normal' MRI report should not preclude consideration of injury to the anterolateral structures [14]. The presence of either the gap or footprint signs on coronal MRI, and particularly the presence of both signs together, are suggestive of an isolated tear of the posterolateral bundle [16]. Over 65% of ACL partial tears are misdiagnosed by MRI only [27]. Digital MRI allows for a high degree of accuracy in tunnel positioning of AM and PL bundles in anatomic ACL reconstruction [43]. Preoperative MRI reliably identified the tear location, with a good strength of agreement between preoperative MRI and diagnostic arthroscopy [61]. Physeal-specific MRI reveals minimal growth plate disturbance following all-inside ACL reconstruction relative to a PTP technique in skeletally immature athletes, though both techniques reveal no evidence of significant complications [62]. MRI overestimates how distal a tear is compared to arthroscopic findings, which may influence surgical decision-making [69]. MRI may not be completely reliable in assessing the degree and location of an ACL tear, and surgeons should not solely rely on MRI imaging for ruling out possible ACL repair [74]. The anterolateral ligament of the knee is readily identifiable on MRI and its structural integrity was maintained in the overwhelming majority of knees with a complete tear of the ACL [75]. While MRI-based systems may suffer from motion artifacts, they offer the advantage of detecting articular cartilage surfaces for a snug fit in patients with extreme deformities [76]. MRI is an effective method of preoperative assessment, and the presence of type 3 changes should be used as criteria for radiologically definitive ramp lesion diagnosis [77]. MRI follow-up confirms the success of patellar tendon reconstruction using semitendinosus autograft with preserved distal insertion [79]. Secondary arthrosis signs can only be detected sporadically in MRI following ACL reconstruction in childhood and adolescence [13].

CT: The accessory soleus muscle has a typical appearance on plain radiographs and a diagnostic appearance on computed tomography [9].

Other Considerations: Histological analysis provides further understanding of the structures of the capsuloligamentous complex of the first metatarsophalangeal joint [22].

Treatment

Non-Operative

Conservative management is the primary therapeutic approach for knee injuries in rock climbing and bouldering, with MRI confirming the diagnosis to guide this strategy [3]. For pediatric patients awaiting operative reconstruction, adherence to conservative modalities such as crutches and bracing is strongly encouraged to reduce the risk of secondary meniscal pathology [91]. Non-operative management of proximal rectus femoris avulsion injuries is associated with highly variable convalescence periods, poor return to preinjury function, and a high risk of recurrence [68]. In cases of coxa vara in childhood, moderate nonprogressive deformity often does not require surgery, whereas intervention is indicated for progressive, painful, unilateral deformity or leg-length discrepancy [30]. Patients with an osteochondritis dissecans lesion of the trochlear groove can be successfully managed nonoperatively with a locked knee brace, returning to full activity without complication [86]. Both operative and nonoperative management of MCL tears demonstrate clinical improvements between study enrollment and 2-year follow-up in patients with ACL and Grade III MCL injuries [60], with outcomes showing no difference between the two treatments in patients with combined ACL and MCL injuries [92].

Operative

Indications: Surgical intervention is indicated for ACL reconstruction in youth athletes to improve the rate of return to athletic activity compared with non-operative treatment [94]. In non-elite patients, persistent Grade 2 or 3 MCL laxity beyond 12 weeks should prompt combined ACL reconstruction with MCL repair and reconstruction [85]. Surgical management for coxa vara is indicated specifically for progressive, painful, unilateral deformity or leg-length discrepancy [30]. Pre-existing chondromalacia or osteo-arthritic changes constitute an absolute contraindication to the Jones procedure and its Guy's Hospital modification for ACL reconstruction [64]. The bone-block iliotibial-band transfer procedure is contraindicated when there is posterior or single-plane lateral laxity [57].

Surgical Approach / Technique: Anatomical anterior cruciate ligament reconstruction (ACLR) results in fewer rates of atraumatic graft rupture and higher rates of rotatory knee stability compared to non-anatomical approaches, although the overall failure rate remains similar between the two methods [37]. Anatomic anterolateral ligament reconstruction of the knee leads to overconstraint at any fixation angle, necessitating further investigation into surgical technique and indications with caution [20]. Newer 'anatomic' reconstructions of the anterolateral ligament (ALL) have been proposed, but data on their effectiveness remain limited [4]. Intraoperative ultrasound diagnosis of an ALL injury may indicate the addition of an ALL reconstruction [88]. Non-anatomical ACL remnants do not contribute dynamic knee stability or anterior-posterior stability in ACL-injured patients [89]. Success in ACL reconstruction failure and revision surgery depends on determining and addressing the cause of failure of the index surgery to restore knee function and improve patient-reported outcomes [17]. Both single-stage revision ACL reconstruction and two-stage revision with tunnel bone grafting resulted in significantly improved outcomes and patient subjective outcomes without notable differences in failure rates [46].

Implant Selection: ACLR with tibialis anterior allograft is an effective treatment for correcting loss of function and increasing quality of life [39]. Clinical outcomes using quadriceps tendon graft for ACL reconstruction are excellent, with a 4.2% failure rate in nearly 1,000 grafts [47]. Regardless of the type of previous cartilage repair, additional bone grafting in secondary M-ACI improves clinical outcome, response rate, and survival at 36 months compared with M-ACI alone [38].

Other Considerations: Repair of horizontal cleavage meniscus tears results in substantial improvements in patient-reported outcomes, acceptable midterm clinical healing rates, and low reoperation/failure rates [10]. Surgical treatment of concomitant double radial tears of the lateral meniscus and ACL reconstruction has a low failure rate at short-term follow-up, with patients tending to have good clinical outcomes with improvement in pain and overall function [41]. Equivalent clinical outcomes were seen between age groups over 40 years and other age groups after double-bundle ACL reconstruction [45]. Satisfactory clinical outcomes after ACL reconstruction at long-term follow-up could be achieved with different modern surgical techniques [44]. A comprehensive assessment after ACL treatment should aim to provide a complete overview of the treatment result, optimally including early adverse events, patient-reported outcomes, ACL graft failure, and clinical measures of knee function and structure, with a minimum follow-up of 2 years and an optimal follow-up rate of 80% [35]. Understanding the current evidence and appropriate indications of emerging technologies in orthopaedic trauma is of critical importance for their utilization [21]. Over 65% of ACL partial tears are misdiagnosed by MRI only [27]. Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors [97].

Complications

Instability: Heterogeneity in pathology, follow-up duration, and outcome measures limits comparative analysis of clinical outcomes for high tibial osteotomy regarding knee instability [6]. In revision anterior cruciate ligament reconstruction (ACLR), a remaining postoperative side-to-side difference (SSD) of ≥6 mm is associated with inferior patient outcomes compared with an SSD <6 mm [80]. Success in ACLR revision surgery depends on determining and addressing the cause of failure of the index surgery to restore knee function and improve patient-reported outcomes [17]. The most frequently reported cause of revision after primary anterior cruciate ligament reconstruction is new trauma [107]. Women and patients with a 3- to 10-year history of ACLR demonstrated vertical drop jump biomechanics that may be associated with knee motion control challenges [109].

Implant and Graft Failure: The LARS artificial ligament provided significantly better survivorship compared with the ABC purely polyester ligament at short- to midterm follow-up for ACL reconstruction [29]. Pediatric ACLR patients with larger graft diameters are less likely to suffer long-term complications [23]. Sustained clinical and functional outcomes for primary anterior cruciate ligament repair (ACLPR) were observed between short-term and midterm follow-up, with failure rates of 11.5% and 15.9%, respectively [25]. There were no observed differences in patient-reported outcome scores, reoperations, or knee-related complications between primary repair and reconstruction of the anterior cruciate ligament [84]. Early suture of recent anterior cruciate ligament tears gives excellent results, but the technique has its greatest application to old injuries or cases where primary repair is not feasible [31].

Cartilage and Meniscal Pathology: Substantial improvements in patient-reported outcomes were observed with acceptable midterm clinical healing rates and low reoperation/failure rates for repair of horizontal cleavage meniscus tears [10]. There is no convincing evidence that a bone bruise alone identified on index MRI adversely affects the outcome of anterior cruciate ligament reconstruction (ACLR) [7]. Further studies with long-term follow-up are needed to determine if the grafted area maintains structural and functional integrity over time following autologous matrix-induced chondrogenesis for focal cartilage defects [11].

Arthritis and Degeneration: Arthritis is a poor prognostic indicator of long-term results following hip arthroscopy for labral pathology [26]. Despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis for radial head arthroplasty [106]. High tibial osteotomy may extend the indication for ligament reconstruction to ultimately halt the evolution of arthritis and preserve the natural knee joint for a longer period [24].

Other Considerations: The prevalence of a ramp lesion in adolescent patients undergoing primary ACL reconstruction was 12% [108]. Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in childhood coxa vara, while moderate nonprogressive deformity often does not require surgery [30].

Recovery

Light activity (weeks): Evidence does not specify a discrete week range for light activity or driving; however, early suture of recent ACL tears is noted to yield excellent results, while the technique is primarily indicated for old injuries or cases where primary repair is not feasible [31].

Full activity (months): Simultaneous reconstruction of acute anterior cruciate ligament injury and grade III medial collateral ligament injury resulted in excellent functional outcomes with return to the same level of sports in the majority of patients at short-term follow-up [66]. At mid-term follow-up, the bone-patella tendon-bone (BTB) cohort demonstrated higher activity scores compared to the quadriceps autograft cohort [72].

Complete recovery / outcome plateau (months): Sustained clinical and functional outcomes for primary anterior cruciate ligament repair (ACLPR) were observed between short-term and midterm follow-up, with failure rates of 11.5% and 15.9%, respectively [25]. Although favorable initial evolution occurs at 30 months after a complete ACL lesion, the re-rupture rate or 'scar tissue' rupture is 40% at a mean follow-up of 8 years [110]. The study reports the first long-term results of combined ACL and anterolateral ligament reconstruction [78]. Outcomes in the first report of a revision ACL cohort at minimum 10-year follow-up demonstrate worrisome outcomes at a still young age [113]. Long-term data for primary ACL repair is pending, though basic science and early clinical studies are promising [112].

Rehabilitation protocol: A structured preoperative exercise program resulted in better postoperative functional outcomes at the long term [48]. Further studies are required to understand if two-incision femoral tunnel placement in ACL reconstruction can ameliorate proprioception and clinical outcome at long-term follow-up [52]. Further studies with long-term follow-up are needed to determine whether the grafted area in autologous matrix-induced chondrogenesis will maintain structural and functional integrity over time [11].

Functional milestones: Arthritis is a poor prognostic indicator of long-term results after hip arthroscopy for labral pathology [26]. The LARS artificial ligament provided significantly better survivorship compared with the ABC purely polyester ligament at short- to midterm follow-up [29]. There is no convincing evidence that a bone bruise alone identified on index MRI adversely affects the outcome of surgically reconstructed anterior cruciate ligaments [7].

Other Considerations: Heterogeneity of pathology, follow-up time, and outcome measures limits comparison between studies on high tibial osteotomy for knee instability [6]. The study aimed to determine the long-term objective and subjective outcome of untreated articular cartilage defects observed at the time of ACL reconstruction [114]. Surgeons should anticipate increased operative time in patients with a history of anterior cruciate ligament reconstruction undergoing subsequent total knee arthroplasty [115]. Analysis of risk factors in the 2002-2003 cohort led to a shift in clinical practice that improved the risk profile for ACL graft tear in the 2007-2008 cohort [116].

Key Evidence

  • [L4] The proposed classification system contains 4 categories of anatomic features of the foot. (10.2106/jbjs.15.01416)
  • [L5] The study delineated a consistent three-layered anatomical pattern of the medial knee, suggesting the use of specific nomenclature for the superficial medial ligament and posteromedial capsule rather than the term 'posterior oblique ligament'. (10.2106/00004623-197961010-00011)
  • [L4] MRI shows the proper diagnosis and the proper therapeutic approach is conservative treatment. (10.1177/2325967118s00019)
  • [L3] Newer 'anatomic' reconstructions of the ALL have recently been proposed but there are limited data on their effectiveness. (10.1136/jisakos-2015-000043)
  • [L4] The heterogeneity of the pathology treated, follow-up time, and outcome measures limit comparison between studies. (10.1177/2325967116633419)
  • [L4] Based on the studies included in this systematic review, there is no convincing evidence that bone bruise alone identified on index MRI adversely affects outcome of ACLR. (10.1136/jisakos-2016-000117)
  • [L5] The manuscript provides a comprehensive anatomical review of the Lisfranc joint complex to enhance understanding of injury patterns and support clinicians in accurate diagnosis and effective management to achieve optimal clinical outcomes. (10.1002/ksa.70260)
  • [L4] The accessory soleus muscle has a typical appearance on plain radiographs and a diagnostic appearance on computed tomography. (10.2106/00004623-198668050-00014)
  • [L3] There were substantial improvements in patient-reported outcomes, showing acceptable midterm clinical healing rates and low reoperation/failure rates. (10.1016/j.arthro.2020.12.150)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L5] Knowledge of particular types of insertion is essential for both clinicians and anatomists. (10.1186/s12891-019-2688-8)
  • [L4] Secondary arthrosis signs can only be detected sporadically in MRI (10.1177/2325967120s00296)
  • [L4] The case also highlights that a 'normal' MRI report should not preclude consideration of injury to the anterolateral structures. (10.1177/2325967117728877)
  • [L5] The anterolateral ligament was a consistent finding from week 13 of development onward. (10.1177/23259671241302770)
  • [L3] The presence of either the gap or footprint signs on coronal MRI, and particularly the presence of both signs together, are suggestive of the presence of an isolated tear of the posterolateral bundle. (10.1177/2325967115597641)
  • [L5] Success depends on determining and addressing the cause of failure of the index surgery to restore knee function and improve patient-reported outcomes. (10.1136/jisakos-2020-000457)
  • [L4] The results may help physicians better classify cam-type FAI and provide clinicians with guidelines for patient-specific care based on hip anatomy. (10.1177/2325967125s00191)
  • [L2] Osseous morphology may play a role in the development of a radiographic DISI deformity. (10.1016/j.jhsa.2009.06.017)
  • [L5] The surgical technique and indications for this procedure should be investigated further and it is recommended that ALLR be used with caution. (10.1177/2325967116s00166)
  • [L4] The histological analysis provides further understanding of the structures of the capsuloligamentous complex of the first MTPJ from previous studies. (10.1186/s13018-021-02795-7)
  • [L3] This data supports the existing literature that pediatric ACLR patients with larger graft diameters are less likely to suffer long-term complications. (10.1177/2325967120s00174)
  • [L4] The use of high tibial osteotomy has been able to extend the indication for ligament reconstruction which, when combined, may ultimately halt the evolution of arthritis and preserve their natural knee joint for a longer period of time. (10.1302/2058-5241.1.000001)
  • [L4] Sustained clinical and functional outcomes for ACLPR were observed between short-term and midterm follow-up, with failure rates of 11.5% and 15.9%, respectively. (10.1177/03635465251340087)
  • [L3] Arthritis is a poor prognostic indicator of long term results. (10.1016/j.arthro.2008.04.057)
  • [L4] Over 65% of partial tears are misdiagnosed by MRI only. (10.1177/2325967118s00201)
  • [L4] The construct is less invasive, practical, and reproducible compared to traditional anatomical techniques. (10.1177/2325967118s00181)
  • [L4] However, the LARS ligament provided significantly better survivorship compared with the ABC ligament at short- to midterm follow-up. (10.1177/2325967116653359)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L4] The author notes that while early suture of recent tears gives excellent results, this technique has its greatest application to old injuries or cases where primary repair is not feasible. (10.2106/00004623-197052070-00002)
  • [L4] This classification system allows for the ability to evaluate differing repair patterns and their effects on postoperative clinical outcomes. (10.1177/2325967125s00101)
  • [L5] Early diagnosis is vital, requiring a high rate of clinical suspicion due to its fulminant nature. (10.1177/2325967118s00202)
  • [L5] A comprehensive assessment after ACL treatment should aim to provide a complete overview of the treatment result, optimally including early adverse events, patient-reported outcomes, ACL graft failure, and clinical measures of knee function and structure, with a minimum follow-up of 2 years and an optimal follow-up rate of 80%. (10.1177/2325967120934751)
  • [Case_report] The findings stress the importance of early diagnosis and proper treatment of synovial chondromatosis of the hip. (10.2106/00004623-199173090-00019)
  • [L1] The overall failure rate was similar between the anatomical and non-anatomical approaches. (10.1136/jisakos-2020-000476)
  • [L3] Regardless of the type of previous cartilage repair, additional bone grafting in secondary M-ACI improves clinical outcome, response rate and survival at 36 months compared with M-ACI alone. (10.1016/j.jisako.2025.100634)
  • [L4] ACLR with tibialis anterior allograft is an effective treatment for correcting loss of function and increasing quality of life. (10.1177/2325967114s00154)
  • [L4] This clinical sign may alert the orthopaedist to consider the greater trochanteric area as the source of the lesion, although it is not diagnostic. (10.2106/00004623-198163050-00024)
  • [L4] The variety of surgical treatment techniques have a low failure rate at short-term follow-up, and patients tend to have good clinical outcomes with improvement in pain and overall function after surgically treating these injuries with simultaneous ACL reconstruction. (10.1016/j.asmr.2021.02.005)
  • [L3] Concomitant intraarticular pathology can be seen in both tibial spine fracture and ACL injured patients, care must be taken to evaluate for additional pathology when treating these injuries. (10.1016/j.jisako.2023.03.115)
  • [L4] Digital MRI allows for a high degree of accuracy. (10.1016/j.arthro.2007.03.023)
  • [L1] Satisfactory clinical outcomes after ACL reconstruction at long-term follow-up could be achieved with different modern surgical techniques. (10.1177/2325967124s00279)
  • [L3] Equivalent clinical outcomes were seen between the 2 age groups after double-bundle ACL reconstruction. (10.1177/2325967118773685)
  • [L3] Both procedures resulted in significantly improved outcomes and patient subjective outcomes without notable differences in failure rates. (10.1177/2325967117s00299)
  • [L4] Clinical outcomes using this graft are excellent with a 4.2% failure rate in nearly 1,000 grafts. (10.1016/j.arthro.2019.01.011)
  • [L2] A structured preoperative exercise program resulted in better post operative functional outcomes at the long term. (10.1016/j.arthro.2013.07.252)
  • [L5] A thorough knowledge of the anatomy and alternative fixation techniques is imperative to ensure optimal patient outcomes if cortical blowout occurs despite careful planning and adherence to proper surgical technique. (10.1177/2325967116652122)
  • [L5] This study describes methods for analysis of the kinematics of the first metatarsophalangeal joint and delineates quantifiable parameters that can be used to define patterns of motion for this articulation in normal feet as well as for those afflicted with hallux valgus or hallux rigidus. (10.2106/00004623-198668030-00012)
  • [L4] Associated tarsal coalitions are classified into dual, threefold, massive, and total types based on the number and sites of involved joints, with dual coalitions being the most common configuration. (10.5435/jaaos-d-24-01191)
  • [L5] Further studies are required to understand if this kind of reconstruction can ameliorate proprioception as well as clinical outcome at a long-term follow-up. (10.1186/1749-799x-2-10)
  • [L3] The study findings underscore the importance of patient preference and surgeon recommendation in a patient's graft selection and highlight the need to be cognizant of the information sources available to patients when researching their graft options. (10.1177/23259671241258429)
  • [L4] There is a need to determine the reliability and validity of the footprint measurement methods used for clinical classification of the foot types in subjects with DS. (10.1186/s13018-021-02667-0)
  • [L4] The study utilized basic fluoroscopic data to describe anatomic tibial insertion sites of the AM and PL bundles, noting that while measurements can serve as a useful guideline, significant anatomic variation exists and tunnel placement decisions should be individualized. (10.1016/j.arthro.2009.04.043)
  • [L4] The procedure is contraindicated when there is posterior or single-plane lateral laxity. (10.2106/00004623-198163040-00006)
  • [L3] Revision ACLR practices vary widely, with no uniform consensus on graft choice and indications for ALC augmentation. (10.1177/23259671251386878)
  • [L2] Because full-length lateral radiographs demonstrate less variability, the authors recommend obtaining them to evaluate these complex patients. (10.1177/23259671241241346)
  • [L3] Both operative and nonoperative management of MCL tears demonstrated clinical improvements between study enrollment and 2-year follow-up. (10.1177/2325967117s00126)
  • [L2] Preoperative MRI reliably identified the tear location, with a good strength of agreement between preoperative MRI and diagnostic arthroscopy. (10.1177/23259671251383081)
  • [L4] Physeal-specific MRI reveals minimal growth plate disturbance following AE reconstruction relative to a PTP technique; however, both techniques reveal no evidence of significant complications. (10.1016/j.arthro.2014.04.010)
  • [L5] This consensus paper provides practical guidelines for how the aforementioned entities of outcomes should be reported and suggests the preferred tools for a reliable and valid assessment of outcome after ACL treatment. (10.1136/jisakos-2020-000494)
  • [L4] Pre-existing chondromalacia or osteo-arthritic changes constitute an absolute contraindication to this surgery. (10.2106/00004623-196850060-00012)
  • [L5] The study directly measured transverse forces between the 1st and 2nd metatarsals using a suture button device, providing data to better understand foot biomechanics and facilitate the development of new devices for hallux valgus surgery. (10.1186/s13018-016-0459-x)
  • [L4] This procedure resulted in excellent functional outcomes, with return to the same level of sports in the majority of patients at short-term follow-up. (10.1177/2325967117s00031)
  • [L5] From a mechanical perspective, the metacarpophalangeal joint represents a joint with 5 kinematic degrees of freedom. (10.1016/j.jhsa.2008.10.004)
  • [L4] Non-operative management is associated with highly variable periods of convalescence, poor return to preinjury level of function and high risk of injury recurrence. (10.1302/2058-5241.5.200055)
  • [L3] MRI overestimates how distal a tear is compared to arthroscopic findings, which may influence surgical decision-making. (10.1177/2325967125s00286)
  • [L3] A classification scheme was developed for posterior horn LMORTs to aid reporting and clinical decision making for these common tears. (10.1177/2325967120921737)
  • [L4] The incidence of Segond lesions found with Ultrasound Imaging (29%) is much higher than previously recorded with MRI (3-6%) or X-ray (9%). (10.1177/2325967125s00335)
  • [L3] At mid-term follow-up, the BTB cohort had higher activity and mental health scores. (10.1177/2325967120s00492)
  • [L4] Sport-related movements load the plantar surface of the foot more than running straight. (10.1177/0363546507309315)
  • [L4] MRI may not be completely reliable in assessing the degree and location of an ACL tear, and surgeons should not solely rely on MRI imaging for ruling out possible ACL repair. (10.1177/2325967119s00398)
  • [L4] The anterolateral ligament of the knee is readily identifiable on MRI and its structural integrity was maintained in the overwhelming majority of knees with a complete tear of the ACL. (10.1177/2325967114s00042)
  • [L5] The authors clarify that patients with extreme deformities were not excluded but had mild to moderate deformities, acknowledge the potential for CT-based technology in patients with metallic implants, and note that while MRI-based systems may suffer from motion artifacts, they offer the advantage of detecting articular cartilage surfaces for a snug fit. (10.1016/j.arth.2018.05.038)
  • [L4] MRI is an effective method of preoperative assessment, and the presence of type 3 changes should be used as criteria for radiologically definitive ramp lesion diagnosis. (10.1016/j.asmr.2020.03.003)
  • [L4] This study reports the first long-term results of combined ACL and ALL reconstruction. (10.1177/2325967121s00237)
  • [Case_report] MRI follow-up confirms the success of this repair technique. (10.1177/2325967119877802)
  • [L3] A remaining postoperative side-to-side difference (SSD) of ≥6 mm was associated with inferior patient outcomes compared with an SSD <6 mm. (10.1177/23259671231219695)
  • [L5] Hallux valgus is a dynamic condition, and the deformity could be more correlated with motions during weightbearing than with plain static measurements. (10.1097/corr.0000000000002265)
  • [L4] The single-leg cross drop task has moderate to good reliability of kinematic and kinetic measures across institutions after implementation of a standardized testing protocol. (10.1177/2325967115617905)
  • [L1] There were no observed differences in patient-reported outcome scores, reoperations, or knee-related complications between approaches. (10.1177/23259671241253591)
  • [L5] In non-elite patients, persistent grade 2 or 3 laxity beyond 12 weeks should prompt combined anterior cruciate ligament reconstruction with MCL repair and reconstruction. (10.1002/arj.70105)
  • [Case_report] The patient was successfully managed nonoperatively with a locked knee brace and returned to full activity in 5 months without complication. (10.1155/2021/9776362)
  • [L4] Three-dimensional kinematics under static full weightbearing were opposite between the ankle and subtalar joints on their respective axes. (10.1186/s13018-019-1443-z)
  • [L3] Intraoperative ultrasound diagnosis of an ALL injury may be an indication for the addition of an ALL reconstruction. (10.1177/23259671241298924)
  • [L3] Non-anatomical ACL remnants do not contribute to dynamic knee stability or anterior-posterior stability in ACL-injured patients. (10.1177/2325967114s00107)
  • [L5] Ramp lesions did not significantly affect knee biomechanics. (10.1177/2325967119s00237)
  • [L3] Surgeons should strongly encourage adherence to these conservative modalities in patients awaiting operative reconstruction to reduce the risk of secondary meniscal pathology. (10.1177/23259671241309862)
  • [L1] Outcomes were not different between operative and nonoperative treatments of MCL rupture in patients with combined ACL and MCL injuries. (10.2106/jbjs.8902.ebo1)
  • [L4] Dual task conditions during single-leg drop landing increased maximum internal tibial rotation angle and anterior tibial translation compared to single task conditions, suggesting that neurocognitive load disturbs balance and alters knee biomechanics. (10.1186/s40634-019-0170-z)
  • [L1] 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. (10.1136/jisakos-2015-000013)
  • [L5] This proof-of-concept study demonstrates a feasible method of quantifying muscle morphology and composition for individual intrinsic foot muscles using advanced high-field MRI techniques. (10.1186/s12891-020-03926-7)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L3] These asymmetrical movement patterns potentially put the non-operative limbs at an increased risk for injury. (10.1177/2325967115s00116)
  • [L4] This finding highlights the NNHt and FPI-6 consensus for foot posture classification in asymptomatic adults. (10.1186/s12891-022-06023-z)
  • [L3] Dynamic limb valgus scores were similar across all groups. (10.1177/2325967121s00472)
  • [L3] Gracilis tendon harvest in healthy knees does not lead to altered knee kinematics. (10.1177/2325967118s00021)
  • [L4] Future research should focus on biomechanics and clinical outcomes, including the potential progression to osteoarthritis. (10.1136/jisakos-2015-000001)
  • [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. (10.1186/s12891-021-04385-4)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L3] The most frequently reported cause of revision was a new trauma. (10.1016/j.arthro.2017.08.170)
  • [L3] The prevalence of a ramp lesion in our cohort was 12%, mirroring historical reports in adult patients. (10.1177/2325967123s00289)
  • [L3] Women and patients with a 3- to 10-year history of ACLR demonstrated VDJ biomechanics that may be associated with knee motion control challenges. (10.1177/23259671211058105)
  • [L4] Although favorable initial evolution at 30 months after a complete ACL lesion, our series show a re-rupture rate or 'scar tissue' rupture of 40% at a mean follow-up of 8 years. (10.1177/2325967118s00188)
  • [L3] The calcaneal apophysis ossifies in a consistent fashion characterized by six different stages. (10.2106/jbjs.n.00671)
  • [L4] Long-term data is pending, but basic science and early clinical studies are promising. (10.1177/2325967118s00049)
  • [L3] Outcomes in this first ever report of a revision ACL cohort at minimum 10 years follow-up demonstrates worrisome outcomes at a still young age. (10.1177/2325967124s00017)
  • [L3] The study aimed to determine the long-term objective and subjective outcome of untreated articular cartilage defects observed at the time of ACL reconstruction. (10.1016/j.arthro.2014.04.071)
  • [L3] Surgeons should anticipate increased operative time in patients with a history of ACLR. (10.1177/2325967119857551)
  • [L3] Analysis of risk factors in the 2002-2003 cohort led to a shift in clinical practice that improved the risk profile for ACL graft tear in the 2007-2008 cohort. (10.1177/2325967115s00028)

See Also

References

[1] The Rotterdam Foot Classification. Journal of Bone and Joint Surgery. 2016. DOI: 10.2106/jbjs.15.01416

[2] The supporting structures and layers on the medial side of the knee. The Journal of Bone & Joint Surgery. 1979. DOI: 10.2106/00004623-197961010-00011

[3] Knee injuries in Rock climbing and Bouldering - An Update. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118s00019

[4] The Classic from John Feagin and Walton Curl (1976) on the 5-year follow-up of the repair of the isolated tear of the anterior cruciate ligament. Is there a role for ACL repair in 2016?. Journal of ISAKOS. 2016. DOI: 10.1136/jisakos-2015-000043

[6] Clinical Outcomes of High Tibial Osteotomy for Knee Instability. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116633419

[7] Limited evidence that the presence of a bone bruise alone affects the clinical outcome of surgically reconstructed anterior cruciate ligaments: a systematic review. Journal of ISAKOS. 2017. DOI: 10.1136/jisakos-2016-000117

[8] Anatomy of the Lisfranc joint complex: An illustrated review with surgical approach. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70260

[9] Accessory soleus muscle. A clinical and radiographic presentation of eleven cases.. The Journal of Bone & Joint Surgery. 1986. DOI: 10.2106/00004623-198668050-00014

[10] Repair of Horizontal Cleavage Meniscus Tears. Results from a Prospective Multi-Center STITCH Trial. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2020.12.150

[11] Mid‐term results of Autologous Matrix‐Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1042-3

[12] A cadaveric study of the morphology of the extensor hallucis longus - a proposal for a new classification. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2688-8

[13] Long term results after ACL-reconstruction in childhood and adolescence. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00296

[14] Elimination of the Pivot-Shift Sign After Repair of an Occult Anterolateral Ligament Injury in an ACL-Deficient Knee. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117728877

[15] Morphological Description of the Embryonic to Fetal Development of the Menisco- Tibio-Popliteus-Fibular Complex and the Anterolateral Ligament. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671241302770

[16] Two Helpful MRI Signs for Evaluation of Posterolateral Bundle Tears of the Anterior Cruciate Ligament. Orthopaedic Journal of Sports Medicine. 2015. DOI: 10.1177/2325967115597641

[17] Anterior cruciate ligament reconstruction failure and revision surgery: current concepts. Journal of ISAKOS. 2020. DOI: 10.1136/jisakos-2020-000457

[18] Poster 85: Proximal Femur Shape Variations within a Patient Cohort with Cam Femoroacetabular Impingement. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00191

[19] Association Between Lunate Morphology and Carpal Collapse in Cases of Scapholunate Dissociation. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.06.017

[20] Anatomic Anterolateral Ligament Reconstruction of the Knee Leads to Overconstraint at any Fixation Angle. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116s00166

[21] Chapter 3 Emerging Technologies in Orthopaedic Trauma. 2021.

[22] High-resolution 3T magnetic resonance imaging and histological analysis of capsuloligamentous complex of the first metatarsophalangeal joint. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02795-7

[23] ACLR GRAFT STRAND NUMBER: LONG-TERM FOLLOW-UP ON 400 PATIENTS. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00174

[24] High tibial osteotomy in knee laxities: Concepts review and results. EFORT Open Reviews. 2016. DOI: 10.1302/2058-5241.1.000001

[25] Sustained Clinical and Functional Outcomes After Primary Anterior Cruciate Ligament Repair: A Minimum 5-Year Follow-up Study. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251340087

[26] Hip Arthroscopy for Labral Pathology: Prospective Analysis With 10‐year Follow‐up (SS‐57). Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.04.057

[27] ACL partial tears: Is it possible to define which bundle is compromised using magnetic resonance?. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118s00201

[28] Minimally Invasive Technique for the Reconstruction of the Medial Posteral Corner of the Knee associated to Anterior Cruciate Ligament. Functional Outcomes. Case Series. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118s00181

[29] LARS Artificial Ligament Versus ABC Purely Polyester Ligament for Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116653359

[30] Coxa Vara in Childhood: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199803000-00003

[31] Reconstruction of the Anterior Cruciate Ligament Using the Central One-Third of the Patellar Ligament. The Journal of Bone & Joint Surgery. 1970. DOI: 10.2106/00004623-197052070-00002

[32] Chapter 108 Anatomy and Biomechanics of the Foot and Ankle. 2019.

[33] Paper 44: Medial Meniscus Ramp Tears: An Internationally Developed Surgically Relevant Classification System Based on Tear Morphology. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00101

[34] Mucormicosis after Anterior Cruciate Ligament (ACL) Reconstruction. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118s00202

[35] Clinical Outcomes After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120934751

[36] Synovial chondromatosis with secondary subluxation of the hip. A case report.. The Journal of Bone & Joint Surgery. 1991. DOI: 10.2106/00004623-199173090-00019

[37] Anatomical anterior cruciate ligament reconstruction (ACLR) results in fewer rates of atraumatic graft rupture, and higher rates of rotatory knee stability: a meta-analysis. Journal of ISAKOS. 2020. DOI: 10.1136/jisakos-2020-000476

[38] Two Year Outcomes of Anterior Cruciate Ligament Reconstruction with Osteochondral Transplant Versus Isolated ACL Reconstruction: A Matched Case Control Study. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100634

[39] Functional Outcomes of Primary Anterior Cruciate Ligament Reconstruction with Tibialis Anterior Allograft. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114s00154

[40] Osteomyelitis of the greater trochanter in children. Report of three cases.. The Journal of Bone & Joint Surgery. 1981. DOI: 10.2106/00004623-198163050-00024

[41] Good Surgical Outcomes After Concomitant Repair of Double Radial Tears of the Lateral Meniscus and Anterior Cruciate Ligament Reconstruction. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2021.02.005

[42] The Significance of Posterior Tibial Slope and Rate of Concomitant Pathology in Pediatric Tibia Spine Avulsion and Anterior Cruciate Ligament Injuries. Journal of ISAKOS. 2023. DOI: 10.1016/j.jisako.2023.03.115

[43] Tunnel Positioning of AM and PL Bundle in Anatomic ACL Reconstruction (SS‐10). Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.03.023

[44] Poster 312: Prospective and Randomized Evaluation of Three Different Anterior Cruciate Ligament (ACL) Reconstruction Techniques Including a Lateral Extra-Articular Tenodesis (LET): A Clinical and Radiographic Evaluation at Minimum 20 Years Follow-Up. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00279

[45] Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Hybrid Grafts in Patients Over 40 Years of Age: Comparisons Between Different Age Groups. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118773685

[46] Outcomes Following Single-Stage Revision Anterior Cruciate Ligament Reconstruction versus Two-Stage Revision with Tunnel Bone Grafting. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00299

[47] Quadriceps Tendon Graft for Anterior Cruciate Ligament Reconstruction: THE GRAFT OF THE FUTURE!. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.01.011

[48] Paper #248: Does Preoperative Exercise Influence the Outcome of ACL Reconstruction?. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.07.252

[49] Posterior Wall Blowout in Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116652122

[50] Kinematics of the first metatarsophalangeal joint.. The Journal of Bone & Joint Surgery. 1986. DOI: 10.2106/00004623-198668030-00012

[51] Associated Coalitions of Tarsal Bones: Review of the Literature and Presentation of a Classification. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01191

[52] Femoral tunnel placement in anterior cruciate ligament reconstruction: rationale of the two incision technique. Journal of Orthopaedic Surgery and Research. 2007. DOI: 10.1186/1749-799x-2-10

[53] Patient Preferences for Graft Selection in Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671241258429

[54] 8. Foot and Ankle Surgery. 2013.

[55] Footprint measurement methods for the assessment and classification of foot types in subjects with Down syndrome: a systematic review. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02667-0

[56] Intra‐operative Fluoroscopic Measurements to Determine Tibial Tunnel Placement in Anatomical Double Bundle ACL Reconstruction (SS‐44). Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.04.043

[57] Bone-block iliotibial-band transfer for anterior cruciate insufficiency.. The Journal of Bone & Joint Surgery. 1981. DOI: 10.2106/00004623-198163040-00006

[58] Current Trends and Indications for Extra-Articular Reconstruction in Revision ACL Reconstruction: A Cross-Sectional Study. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251386878

[59] Variability Between Full-Length Lateral Radiographs and Standard Short Knee Radiographs When Evaluating Posterior Tibial Slope in Revision ACL Patients. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671241241346

[60] Outcomes Following ACL and Grade III MCL Injuries. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00126

[61] Reliability of Preoperative Magnetic Resonance Imaging in Determining the Anterior Cruciate Ligament Tear Location. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251383081

[62] Physeal‐Sensitive MRI Analysis Shows that an All‐Inside, Anterior Cruciate Ligament Reconstruction in Skeletally Immature Athletes is Safe to the Physis. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.04.010

[63] Clinical outcomes after anterior cruciate ligament injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group. Journal of ISAKOS. 2020. DOI: 10.1136/jisakos-2020-000494

[64] Reconstruction of the Anterior Cruciate Ligament Using the Jones Procedure and Its Guyʼs Hospital Modification. The Journal of Bone & Joint Surgery. 1968. DOI: 10.2106/00004623-196850060-00012

[65] Measurement of transverse forces between the first and second metatarsals: a cadaveric study. Journal of Orthopaedic Surgery and Research. 2016. DOI: 10.1186/s13018-016-0459-x

[66] Return to Sports after Acute Simultaneous Reconstruction of Anterior Cruciate Ligament Injury and Grade III Medial Collateral Ligament Injury. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00031

[67] Quantified Contours of Curvature in Female Index, Middle, Ring, and Small Metacarpophalangeal Joints. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.10.004

[68] The management of proximal rectus femoris avulsion injuries. EFORT Open Reviews. 2020. DOI: 10.1302/2058-5241.5.200055

[69] Poster 196: Reliability of Preoperative MRI in the Prediction of ACL Tear Type. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00286

[70] Lateral Meniscal Oblique Radial Tears Are Common With ACL Injury: A Classification System Based on Arthroscopic Tear Patterns in 600 Consecutive Patients. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120921737

[71] Validation of refixation of ALL /Segond complex avulsion diagnosed with dynamic Ultrasound Imaging. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967125s00335

[72] Comparison of Bone-Patella Tendon-Bone (BTB) and Quadriceps Autograft for ACL Reconstruction. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00492

[73] Regional Foot Pressure during Running, Cutting, Jumping, and Landing. The American Journal of Sports Medicine. 2007. DOI: 10.1177/0363546507309315

[74] Evaluating the Reliability Of MRI In Predicting The Degree Of ACL Tears In Pre-operative Planning For The Surgical Treatment Of ACL Tears: A Retrospective Study. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00398

[75] MRI Evaluation of the Anterolateral Ligament of the Knee In The Setting of ACL Rupture. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114s00042

[76] Response to Letter to the Editor on “Comparison of Customized Cutting Block and Conventional Cutting Instrument in Total Knee Arthroplasty: A Randomized Controlled Trial”. The Journal of Arthroplasty. 2018. DOI: 10.1016/j.arth.2018.05.038

[77] Meniscal “Ramp” Lesions: Surgical Incidence and the Development of Magnetic Resonance Imaging Diagnostic Criteria. Arthroscopy, Sports Medicine, and Rehabilitation. 2020. DOI: 10.1016/j.asmr.2020.03.003

[78] Isolated ACL Reconstruction Versus Combined ACL and Anterolateral Ligament Reconstruction: A Matched Case Series with Mean Follow Up of 9 Years. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967121s00237

[79] Patellar Tendon Reconstruction Using Semitendinosus Autograft With Preserved Distal Insertion for Treatment of Patellar Tendon Rupture After Bone–Patellar Tendon–Bone ACL Reconstruction: A Case Report. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119877802

[80] Association of Remaining Anterior Knee Laxity With Inferior Outcomes After Revision ACL Reconstruction. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671231219695

[81] Chapter 42 Foot and Ankle Anatomy and Biomechanics. 2020.

[82] Impact of First Metatarsal Hyperpronation on First Ray Alignment: A Study in Cadavers. Clinical Orthopaedics & Related Research. 2022. DOI: 10.1097/corr.0000000000002265

[83] Reliability of 3-Dimensional Measures of Single-Leg Cross Drop Landing Across 3 Different Institutions. Orthopaedic Journal of Sports Medicine. 2015. DOI: 10.1177/2325967115617905

[84] Clinical Results of Primary Repair Versus Reconstruction of the Anterior Cruciate Ligament: A Systematic Review and Meta-analysis of Contemporary Trials. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671241253591

[85] Treatment of Medial Collateral Ligament Injuries in the Setting of Anterior Cruciate Ligament Rupture. Arthroscopy. 2026. DOI: 10.1002/arj.70105

[86] Osteochondritis Dissecans Lesion of the Trochlear Groove: A Case of Nonsurgical Management for a Rare Lesion. Case Reports in Orthopedics. 2021. DOI: 10.1155/2021/9776362

[87] Three-dimensional kinematic change of hindfoot during full weightbearing in standing: an analysis using upright computed tomography and 3D-3D surface registration. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1443-z

[88] Clinical Outcomes of Isolated ACL Reconstruction Versus Combined ACL and ALL Reconstruction With Indication Guided by Intraoperative Ultrasound: A Propensity Score–Matched Study of 260 Patients With a Minimum 2-Year Follow-up. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671241298924

[89] Non-anatomical Anterior Cruciate Ligament Remnants Do Not Contribute Dynamic Knee Stability ˜Quantitative Measurement Of The Pivot Shift Test˜. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114s00107

[90] Effect of Meniscal Ramp Lesion Repair on Knee Kinematics, ACL In-Situ Forces and Bony Contact Forces – A Biomechanical Study. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00237

[91] The Role of Crutches and Bracing in Preventing Secondary Meniscal Tears After Anterior Cruciate Ligament Injury in Pediatric Patients. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671241309862

[92] Operative and Nonoperative Treatments of Medial Collateral Ligament Rupture Were Not Different in Combined Medial Collateral and Anterior Cruciate Ligament Rupture. The Journal of Bone & Joint Surgery. 2007. DOI: 10.2106/jbjs.8902.ebo1

[93] Knee biomechanics changes under dual task during single‐leg drop landing. Journal of Experimental Orthopaedics. 2019. DOI: 10.1186/s40634-019-0170-z

[94] ACL reconstruction in youth athletes results in an improved rate of return to athletic activity when compared with non-operative treatment: a systematic review of the literature. Journal of ISAKOS. 2016. DOI: 10.1136/jisakos-2015-000013

[96] New insights into intrinsic foot muscle morphology and composition using ultra‐high‐field (7-Tesla) magnetic resonance imaging. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-020-03926-7

[97] Current Concepts Review - Hallux Rigidus and Osteoarthrosis of the First Metatarsophalangeal Joint. The Journal of Bone & Joint Surgery*. 1998. DOI: 10.2106/00004623-199806000-00015

[98] Evaluation Of Three-Dimensional Motion During Side-step Cutting After Anterior Cruciate Ligament Reconstruction in Pediatric Athletes. Orthopaedic Journal of Sports Medicine. 2015. DOI: 10.1177/2325967115s00116

[99] Agreement between clinical measures to classify foot posture in asymptomatic adults. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-06023-z

[100] Comparison of Dynamic Limb Valgus and Stiff Landing Between Limbs with and Without Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/2325967121s00472

[101] Effects of gracilis tendon harvest on in vivo knee joint kinematics. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118s00021

[102] Anterior cruciate ligament reconstruction. Journal of ISAKOS. 2016. DOI: 10.1136/jisakos-2015-000001

[103] Hallux valgus deformity and postural sway: a cross-sectional study. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04385-4

[106] Mid- to long-term results after bipolar radial head arthroplasty. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.05.022

[107] Paper #207: New Trauma is the Most Common Cause of Revision After Primary Anterior Cruciate Ligament Reconstruction – A Study from the Norwegian Knee Ligament Registry 2004‐2015. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.170

[108] Poster 321: MENISCAL RAMP LESIONS IN ADOLESCENT PATIENTS UNDERGOING PRIMARY ACL RECONSTRUCTION. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00289

[109] Vertical Drop Jump Biomechanics of Patients With a 3- to 10-Year History of Youth Sport–Related Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/23259671211058105

[110] Spontaneous Healing in complete ACL ruptures: results at eight-year mean follow-up. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118s00188

[111] Relationship of Calcaneal and Iliac Apophyseal Ossification to Peak Height Velocity Timing in Children. Journal of Bone and Joint Surgery. 2015. DOI: 10.2106/jbjs.n.00671

[112] Primary ACL Repair vs Reconstruction: Investigating the Current Conventional Wisdom. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118s00049

[113] Paper 04: Clinical Outcomes, Graft Failure Rate, and Incidence of Structural and Symptomatic Osteoarthritis in an ACL Revision Cohort: Minimum 10-Year Onsite Follow-up in the MARS Cohort. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00017

[114] Distal Femoral Condyle Osteochondral Allograft Topography: Medial Versus Lateral Condyle. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.04.071

[115] Does Prior Anterior Cruciate Ligament Reconstruction Affect Outcomes of Subsequent Total Knee Arthroplasty? A Systematic Review. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119857551

[116] Modification of Practice Patterns after Analysis of Risk Factors Improved ACLR Outcomes. Orthopaedic Journal of Sports Medicine. 2015. DOI: 10.1177/2325967115s00028

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.