{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:50:28Z","timestamp":1792083028315,"version":"4.4.0"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":80,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Clinical reasoning after anterior cruciate ligament (ACL) injury is still often built on isolated proxies such as imaging, instrumented laxity, functional testing or patient\u2010reported instability. These variables are clinically useful, but they are not interchangeable and do not answer the same question. The purpose of this work is to propose FIRM\u2010P (Functional, Individual, Radiological and Mechanical instability plus patient context) as a practical conceptual framework that separates the ACL\u2010related knee phenotype from patient\u2010context indication, while integrating arthrogenic muscle inhibition (AMI) as a cross\u2010domain modifier rather than as a separate instability pillar.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>FIRM\u2010P has two layers. FIRM describes the knee through Functional, Individual, Radiological and Mechanical instability. P describes the patient context through performance demands, priorities and expectations, rehabilitation potential and personal modifiers. Each domain is interpreted as favourable, borderline or unfavourable. Discordant patterns do not directly produce treatment decisions; they trigger a verification loop. AMI is integrated as a mechanism that may alter the expression of Functional and Individual instability, may coexist with true ACL insufficiency and may influence the timing of elective surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After verification, an explicit classification rule assigns the knee to one of four mutually exclusive phenotypes: low\u2010instability\/non\u2010ACL, occult or associated\u2010instability, compensated ACL\u2010deficient or overt ACL\u2010instability. Patient context is applied only after the knee has been phenotyped. A simplified decision pathway is provided in the main manuscript; the full operational 32\u2010scenario matrix and an interactive HTML prototype that allows readers to simulate the algorithm across the 32 operational scenarios are provided as Supporting Information.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>FIRM\u2010P is proposed as a conceptual framework, not a validated score. Its immediate value is to organize ACL\u2010related instability reasoning into a transparent sequence: phenotype the knee, verify discordance and then apply patient context. Its future value will depend on content validation, reliability testing and prospective derivation work.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level V.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70914","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T16:45:22Z","timestamp":1789836322000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["FIRM\u2010P separates knee phenotype from patient context in anterior cruciate ligament\u2010related instability: A conceptual framework integrating arthrogenic muscle inhibition as a cross\u2010domain modifier"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1794-2988","authenticated-orcid":false,"given":"Dario","family":"Giunchi","sequence":"first","affiliation":[{"name":"Ars Medica Clinic Gravesano Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Denti","sequence":"additional","affiliation":[{"name":"Ars Medica Clinic Gravesano Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Barrera Uso","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology HFR Fribourg \u2013 Cantonal Hospital Fribourg Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"e_1_2_24_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07648-w"},{"key":"e_1_2_24_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physio.2023.12.005"},{"key":"e_1_2_24_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/jisakos-2015-000030"},{"key":"e_1_2_24_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43019-023-00197-z"},{"key":"e_1_2_24_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2018.02.006"},{"key":"e_1_2_24_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06012-6"},{"key":"e_1_2_24_8_1","unstructured":"Emovi. X\u2010rays MRI and knee kinesiography.https:\/\/kneekinesiography.com\/why-choose-kneekg\/difference-xray-mri\/(2026). Accessed 11 May 2026."},{"key":"e_1_2_24_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jeo2.70674"},{"key":"e_1_2_24_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14082633"},{"key":"e_1_2_24_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2023.12.032"},{"key":"e_1_2_24_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4246-3"},{"key":"e_1_2_24_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/23259671211005090"},{"key":"e_1_2_24_14_1","unstructured":"Isokinetic Medical Group. Movement Analysis Test (M.A.T.).https:\/\/isokinetic.com\/en\/movement-analysis-test\/. 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