Increased Hazard Ratio of a Second ACL Injury After Return to Sport for Each Positive Hypermobility Test on the Beighton Score: A Registry Study.

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Abstract

Conflict of interest statement: Declarations. Ethics Approval: The principles of the Helsinki declaration have been used as guidance in this study. Ethical approval has been obtained from the Swedish Ethical Review Authority (registration number: 2020-02501, 2024-08724-01), and the Regional Ethical Review Board in Gothenburg, Sweden (registration numbers: 265-13, T023-17). Consent to Participate: Data for this study are based on a rehabilitation registry project (Project ACL), where all patients have received written information and have given their informed consent in the research project. Consent for Publication: Informed consent for the publication of anonymized patient data and registry details was obtained from all participants prior to enrollment in the registry. Competing Interests: Jakob Lindskog reports financial support was provided by Research and development primary health care Gothenburg and Södra Bohuslän. Kristian Samuelsson reports a relationship with Getinge AB that includes: board membership. Authors Bálint Zsidai, Axel Sundberg, Johan Högberg, Rebecca Hamrin Senorski, Behnam Liaghat, Roland Thomeé, Ramana Piussi, and Eric Hamrin Senorski declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. 14. Skeletal Radiol. 2026 Aug;55(8):2017-2032. doi: 10.1007/s00256-026-05126-1. Epub 2026 Jan 24. Sports injury: biomechanical approach to interpretation of knee MRI. Mercer RW(1), Stewart ZE(2), Simeone FJ(2), Vicentini JRT(2), Balza R(2), Palmer WE(2). Author information: (1)Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. rmercer@mgh.harvard.edu. (2)Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. Sports-related knee injuries are common and clinically consequential. Interpreting MR imaging through a biomechanical lens links injury patterns to the forces that produced them, improving the detection of subtle but prognostically important lesions. Characteristic osseous findings-contusions, subchondral/osteochondral fractures, and avulsions-act as "maps" of force vectors that distinguish compression from distraction mechanisms. In anterior cruciate ligament (ACL) trauma, bone bruise locations have kinematic associations (i.e., valgus-flexion-external rotation vs varus-flexion-internal rotation) and enable a targeted search for injuries involving functionally related structures, such as the menisci. The medial meniscus functions as a secondary stabilizer to anterior tibial translation. Therefore, peripheral vertical longitudinal tears and meniscocapsular ramp lesions are frequent companions of ACL rupture and may be overlooked without a mechanism-based approach. The lateral meniscus is vulnerable to radial/posterior root and peripheral capsular injuries during translational and compressive loading of the lateral compartment. Posterolateral corner structures resist varus and external rotation forces; unrecognized PLC injury compromises cruciate reconstruction and perpetuates rotatory instability. This review synthesizes biomechanical principles to provide a practical, pathophysiological framework for MRI interpretation and reporting. Applying this approach enhances diagnostic accuracy, guides surgical decision-making, and supports better outcomes for athletes with acute knee trauma. KEY POINTS: • Biomechanical principles provide a systematic framework for interpreting knee MRI after sports trauma, improving diagnostic accuracy and detection of subtle lesions. • Characteristic injury patterns on MRI often reveal the underlying traumatic mechanism, directing targeted evaluation of osseous structures, ligaments, tendons, and menisci. • Subtle injuries such as Segond fracture, ramp lesion, or posterolateral corner disruption may be overlooked without a mechanism-based interpretive approach. © 2026. The Author(s), under exclusive licence to International Skeletal Society (ISS). DOI: 10.1007/s00256-026-05126-1