{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T02:09:56Z","timestamp":1790215796612,"version":"4.1.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2018,7,1]],"date-time":"2018-07-01T00:00:00Z","timestamp":1530403200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The Arthritis Society of Canada"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Proc Inst Mech Eng H"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:p>The consequences of ligament re-injury have received limited attention. Although the mechanical properties of injured ligaments improve over time, these properties are never fully recaptured, rendering these injured ligaments susceptible to re-injury. Previous injury is a significant risk factor for recurrent injury, and this re-injury can result in longer absence from activity than the initial injury. A rabbit medial collateral ligament model was used to compare mechanically re-injured right medial collateral ligaments to injured left medial collateral ligaments. Two groups of different re-injury severity were investigated: \u2018minor\u2019 re-injury comparing transection re-injured right medial collateral ligaments to transection injured left medial collateral ligaments; \u2018major\u2019 re-injury comparing gap re-injured right medial collateral ligaments to transection injured left medial collateral ligaments. Initial injuries for both groups were right medial collateral ligament transections 1 week before re-injury. After 5\u20136 weeks of healing, mechanical testing was performed to determine (dimensionally) cross-sectional area; (structurally) medial collateral ligament laxity, failure load, and stiffness; and (materially) cyclic creep strain and failure stress. Because we wanted to evaluate whether the mechanical properties of re-injured ligaments were equivalent or, at least, no worse than injured ligaments, we used equivalence\/noninferiority testing. This approach evaluates a research hypothesis of equivalence, rather than difference, and determines whether comparisons are \u2018statistically equivalent\u2019, \u2018noninferior\u2019, or \u2018potentially inferior\u2019. Transection re-injured and gap re-injured ligaments were \u2018statistically equivalent\u2019 structurally to transection injured ligaments. Transection re-injured ligaments were \u2018noninferior\u2019 both materially and dimensionally to transection injured ligaments. Gap re-injured ligaments were \u2018potentially inferior\u2019 both materially and dimensionally to transection injured ligaments. Two differences between the re-injuries, which affect healing, may explain the mechanical outcomes: the presence or lack of healing products and the proximity of ligament ends at the time of re-injury. Our findings suggest that (in the short term) there is a severity of re-injury below which there is no additional disadvantage to the healing process, mechanical behaviour, and resulting potential for re-injury.<\/jats:p>","DOI":"10.1177\/0954411918784088","type":"journal-article","created":{"date-parts":[[2018,7,2]],"date-time":"2018-07-02T01:17:26Z","timestamp":1530494246000},"page":"665-672","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Are re-injured ligaments equivalent mechanically to injured ligaments: The role of re-injury severity?"],"prefix":"10.1177","volume":"232","author":[{"given":"Johnathan L","family":"Sevick","sequence":"first","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan J","family":"Heard","sequence":"additional","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian KY","family":"Lo","sequence":"additional","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A","family":"Randle","sequence":"additional","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyril B","family":"Frank","sequence":"additional","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel G","family":"Shrive","sequence":"additional","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail M","family":"Thornton","sequence":"additional","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada"},{"name":"Department of Orthopaedics, The University of British Columbia, Vancouver, BC, 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