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Xu D, Cen X, Wang M, Rong M, István B, Baker JS, Gu Y. Temporal Kinematic Differences between Forward and Backward Jump-Landing. Int J Environ Res Public Health 2020; 17:ijerph17186669. [PMID: 32933208 PMCID: PMC7559031 DOI: 10.3390/ijerph17186669] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/04/2020] [Accepted: 09/11/2020] [Indexed: 12/14/2022]
Abstract
Backward jump-landing during sports performance will result in dynamic postural instability with a greater risk of injury, and most research studies have focused on forward landing. Differences in kinematic temporal characteristics between single-leg and double-leg backward jump-landing are seldom researched and understood. The purpose of this study was to compare and analyze lower extremity kinematic differences throughout the landing phases of forward and backward jumping using single-leg and double-leg landings (FS and BS, FD and BD). Kinematic data were collected during the landing phases of FS and BS, FD and BD in 45 participants. Through statistical parametric mapping (SPM) analysis, we found that the BS showed smaller hip and knee flexion and greater vertical ground reactive force (VGRF) than the FS during 0–37.42% (p = 0.031), 16.07–32.11% (p = 0.045), and 23.03–17.32% (p = 0.041) landing phases. The BD showed smaller hip and knee flexion than the FD during 0–20.66% (p = 0.047) and 0–100% (p < 0.001) landing phases. Most differences appeared within a time frame during the landing phase at 30–50 ms in which non-contact anterior cruciate ligament (ACL) injuries are thought to occur and are consistent with the identification of risk in biomechanical analysis. A landing strategy that consciously increases the knee and hip flexion angles during backward landing should be considered for people as a measure to avoid injury during the performance of this type of physical activity.
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Affiliation(s)
- Datao Xu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (D.X.); (X.C.)
| | - Xuanzhen Cen
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (D.X.); (X.C.)
| | - Meizi Wang
- Savaria Institute of Technology, Eötvös Loránd University, 9700 Szombathely, Hungary;
| | - Ming Rong
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (D.X.); (X.C.)
- Correspondence: (M.R.); (Y.G.); Tel.: +86-574-87600456 (M.R.); +86-574-87600208 (Y.G.)
| | - Bíró István
- Faculty of Engineering, University of Szeged, 6724 Szeged, Hungary;
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Hong Kong Baptist University, Hong Kong 999077, China;
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (D.X.); (X.C.)
- Correspondence: (M.R.); (Y.G.); Tel.: +86-574-87600456 (M.R.); +86-574-87600208 (Y.G.)
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152
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李 宇, 张 豪, 肖 世, 郑 秋, 曾 亚, 杨 洪. [Effectiveness comparison of LARS artificial ligament and autogenous hamstring tendon in one-stage reconstruction of anterior and posterior cruciate ligaments]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020; 34:1018-1024. [PMID: 32794672 PMCID: PMC8171912 DOI: 10.7507/1002-1892.201908051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 03/03/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the effectiveness of arthroscopic one-stage reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) with LARS artificial ligament and autogenous hamstring tendon, respectively. METHODS A retrospective study was performed on 23 patients with ACL and PCL injuries, who were treated with one-stage reconstruction, between June 2013 and June 2017. The ACL and PCL were reconstructed with LARS artificial ligament in 11 patients (artificial ligament group) and autogenous hamstring tendon in 12 patients (autogenous tendon group). There was no significant difference in gender, age, side of injury, cause of injury, time from injury to operation, and preoperative Lysholm score and International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). The operation time, the time of recovery of daily activities and preoperative exercise level, the occurrence of surgical-related complications, Lysholm score, IKDC score, and the results of knee stability assessment were recorded and compared between the two groups. RESULTS The operation time and the time of recovery of daily activities and preoperative exercise level were significantly shorter in artificial ligament group than in autogenous tendon group ( P<0.05). All incisions healed primarily. In autogenous tendon group, the common fibular nerve injury occurred in 1 case and intermuscular vein thrombosis occurred in 1 case. No complication occurred in the remaining patients of the two groups. All the patients were followed up 24-54 months (mean, 36.4 months). At last follow-up, the Lysholm score and IKDC score of the two groups were significantly higher than preoperative scores ( P<0.05). There was no significant difference between the two groups ( P>0.05). The varus and valgus stress tests of the two groups were negative. There was no significant difference in anterior drawer test, posterior drawer test, and Lachman test between the two groups ( P>0.05). CONCLUSION The effectiveness of arthroscopic one-stage reconstruction of ACL and PCL with LARS artificial ligament or autogenous hamstring tendon was similar. The knee function and stability recover well. But the patients with LARS artificial ligament reconstruction can resume daily activities and return to exercise earlier.
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Affiliation(s)
- 宇 李
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
- 宜宾市第一人民医院骨科(四川宜宾 644000)Department of Orthopedics, the First People’s Hospital of Yibin, Yibin Sichuan, 644000, P.R.China
| | - 豪 张
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - 世卓 肖
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - 秋 郑
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - 亚兰 曾
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - 洪彬 杨
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
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Cheng X, Liu F, Zhou D, Paulus AC. Surgical intra- and extra-articular anterior cruciate ligament reconstruction: a meta-analysis. BMC Musculoskelet Disord 2020; 21:414. [PMID: 32605641 PMCID: PMC7325370 DOI: 10.1186/s12891-020-03438-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/18/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is still controversial whether the combination of anterior cruciate ligament (ACL) reconstruction and extra-articular reconstruction (EAR) have good clinical efficacy. This meta-analysis aims systematically to compare the clinical effectiveness of ACL reconstruction and combined reconstruction. METHODS Electronic databases, including Medline/PubMed, Embase and the Cochrane Library, were systematically searched to identify targeted studies. A meta-analysis were performed to pool the outcome estimates of interest, such as the Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores and the results from the KT-1000/2000 arthrometer test, the Lachman test and the pivot shift test. RESULTS Twelve studies involving 1146 knees were identified. Compared with single ACL reconstruction, combined reconstruction had better results for a pivot shift of grade 1 (relative ratio [RR] = 0.88, 95% CI: 0.83-0.94) and grade 2 (RR = 0.95, 95% CI: 0.91-0.99) rather than grade 3 (RR = 0.98, 95% CI: 0.90-1.06) and no statistically significant difference for both Lachman grade 1 (RR = 0.96, 95% CI: 0.89-1.05) and grade 2 (RR = 0.96, 95% CI: 0.90-1.03). Combined reconstruction resulted in significant improvements on the instrumented joint laxity test when considering a failure standard of more than 5 mm (a side-to-side arthrometric difference) (RR = 0.94, 95% CI: 0.89-0.98) rather than 3 mm (RR = 0.94, 95% CI: 0.86-1.03). Moreover, combined reconstruction increased the IKDC score at the 12-month (weighted mean difference [WMD] = - 6.38, 95% CI: - 9.66 to - 3.10), 24-month (WMD = - 5.60, 95% CI: - 8.54 to - 2.66) and 36-month follow-ups (WMD = - 4.71, 95% CI: - 7.59 to - 1.83) and the Tegner score at the 36-month follow-up (WMD = - 0.53, 95% CI: - 0.97 to - 0.09), but it did not increase the Lysholm score at the 36-month follow-up (WMD = - 0.84, 95% CI: - 2.02 to 0.34). CONCLUSION With the advances in reconstruction techniques, combined reconstructions were found to be effective in improving rotational stability and to lead to good functional scores. However, obviously, the combined reconstruction technique is more time-consuming and requires an additional incision, which is not suitable for all ACL-deficient patients. Therefore, programs should be personalized and customized for the specific situation of each patient.
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Affiliation(s)
- Xiangyun Cheng
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Ludwig-Maximilians-University, Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany
| | - Fanxiao Liu
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Ludwig-Maximilians-University, Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany.
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Alexander C Paulus
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Ludwig-Maximilians-University, Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany
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Ahmadian N, Nazarahari M, Whittaker JL, Rouhani H. Quantification of Triple Single-Leg Hop Test Temporospatial Parameters: A Validated Method using Body-Worn Sensors for Functional Evaluation after Knee Injury. Sensors (Basel) 2020; 20:s20123464. [PMID: 32575452 PMCID: PMC7349604 DOI: 10.3390/s20123464] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/15/2023]
Abstract
Lower extremity kinematic alterations associated with sport-related knee injuries may contribute to an unsuccessful return to sport or early-onset post-traumatic osteoarthritis. Also, without access to sophisticated motion-capture systems, temporospatial monitoring of horizontal hop tests during clinical assessments is limited. By applying an alternative measurement system of two inertial measurement units (IMUs) per limb, we obtained and validated flying/landing times and hop distances of triple single-leg hop (TSLH) test against motion-capture cameras, assessed these temporospatial parameters amongst injured and uninjured groups, and investigated their association with the Knee Injury and Osteoarthritis Outcome Score (KOOS). Using kinematic features of IMU recordings, strap-down integration, and velocity correction techniques, temporospatial parameters were validated for 10 able-bodied participants and compared between 22 youth with sport-related knee injuries and 10 uninjured youth. With median (interquartile range) errors less than 10(16) ms for flying/landing times, and less than 4.4(5.6)% and 2.4(3.0)% of reference values for individual hops and total TSLH progression, differences between hopping biomechanics of study groups were highlighted. For injured participants, second flying time and all hop distances demonstrated moderate to strong correlations with KOOS Symptom and Function in Daily Living scores. Detailed temporospatial monitoring of hop tests is feasible using the proposed IMUs system.
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Affiliation(s)
- Niloufar Ahmadian
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada; (N.A.); (M.N.)
| | - Milad Nazarahari
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada; (N.A.); (M.N.)
| | - Jackie L. Whittaker
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
- Arthritis Research Canada, Richmond, BC V6X 2C7, Canada
| | - Hossein Rouhani
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada; (N.A.); (M.N.)
- Correspondence: ; Tel.: +1-780-492-8344
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156
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Li R, Liu Y, Fang Z, Zhang J. Introducing the Lateral Femoral Condyle Index as a Risk Factor for Anterior Cruciate Ligament Injury: Letter to the Editor. Am J Sports Med 2020; 48:NP42. [PMID: 32501159 DOI: 10.1177/0363546520920546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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157
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Al'khafaji I, Devitt BM. Editorial Commentary: Magnetic Resonance Imaging Evaluation of the Anterolateral Complex-Is Seeing Really Believing? Arthroscopy 2020; 36:1092-1094. [PMID: 32247406 DOI: 10.1016/j.arthro.2020.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 02/02/2023]
Abstract
The anatomic and biomechanical role of the anterolateral complex (ALC) of the knee has gained increased interest in recent years. Specifically, a keen focus has been on magnetic resonance imaging (MRI) evaluation of the ALC in the setting of anterior cruciate ligament injury. Although many of these studies are well designed and conducted, they are based on a foundation of controversial gross anatomy and MRI protocols and scanners not typically used in standard practice. Ultimately, there is a lack of correlation between MRI evidence of injury to the ALC and clinical evaluation of anterolateral rotatory laxity. So, do we believe in what we see or believe in what we feel?
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158
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Parroquín-Maldonado JA, Mas-Celis F, Cruz-Miranda A. [Reconstruction of medial collateral ligament: Description of a new augmentation technique with allograft and interference biocomposite screws]. Acta Ortop Mex 2020; 34:129-133. [PMID: 33244915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Medial Collateral Ligament (LCM) instability is associated with multi-ligamentary lesions. There are several procedures for the reconstruction of MCL, we present a percutaneous technique of augmentation. Our goal is to describe a new technique of reconstruction of the LCM by grafting and fixing with biocomposite screws. MATERIAL AND METHODS We present the technique in a total of 21 consecutive patients with MCL injury operated in the period of December 2011 to October 2014. Reconstruction of MCL was performed with long, tibial or long hallux tendon allografts in 18 patients and only one patient was used autograft. Eighteen of the 20 patients had associated lesions: 5 with medial meniscus injury, 8 with anterior cruciate ligament injury, (ACL), 8 with condral injury and 1 with lateral meniscus injury. CONCLUSION The surgical technique presented is simple to perform, without damage to other structures and with a strong fixation.
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Affiliation(s)
| | - F Mas-Celis
- Hospital Ángeles Pedregal. Ciudad de México. México
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159
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Russell F, Kormushev P, Vaidyanathan R, Ellison P. The Impact of ACL Laxity on a Bicondylar Robotic Knee and Implications in Human Joint Biomechanics. IEEE Trans Biomed Eng 2020; 67:2817-2827. [PMID: 32031928 DOI: 10.1109/tbme.2020.2971855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Elucidating the role of structural mechanisms in the knee can improve joint surgeries, rehabilitation, and understanding of biped locomotion. Identification of key features, however, is challenging due to limitations in simulation and in-vivo studies. In particular the coupling of the patello-femoral and tibio-femoral joints with ligaments and its impact on joint mechanics and movement is not understood. We investigate this coupling experimentally through the design and testing of a robotic sagittal plane model. METHODS We constructed a sagittal plane robot comprised of: 1) elastic links representing cruciate ligaments; 2) a bi-condylar joint; 3) a patella; and 4) actuator hamstrings and quadriceps. Stiffness and geometry were derived from anthropometric data. [Formula: see text] squatting tests were executed at speeds of [Formula: see text] over a range of anterior cruciate ligament (ACL) slack lengths. RESULTS Increasing ACL length compromised joint stability, yet did not impact quadriceps mechanical advantage and force required for squat. The trend was consistent through varying condyle contact point and ligament force changes. CONCLUSION The geometry of the condyles allows the ratio of quadriceps to patella tendon force to compensate for contact point changes imparted by the removal of the ACL. Thus the system maintains a constant mechanical advantage. SIGNIFICANCE The investigation uncovers critical features of human knee biomechanics. Findings contribute to understanding of knee ligament damage, inform procedures for knee surgery and orthopaedic implant design, and support design of trans-femoral prosthetics and walking robots. Results further demonstrate the utility of robotics as a powerful means of studying human joint biomechanics.
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Hohmann E. Editorial Commentary: Fifty Is the New 30? Do Patients in Their 50s Deserve an Anterior Cruciate Ligament Reconstruction? Arthroscopy 2020; 36:563-565. [PMID: 32014185 DOI: 10.1016/j.arthro.2019.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 02/02/2023]
Abstract
Evidence suggests that anterior cruciate ligament reconstruction in patients older than 50 years of age has similar outcomes when compared with younger patients. However, poorer results are associated with advanced degenerative intra-articular chondral changes. The caveat here is that these conclusions are mainly based on retrospective level IV case series. The question is whether functionally unstable patients 50 years and older, whether active or not, benefit from surgical reconstruction and the answer is clearly yes. It provides restoration of function and should be considered in active older patients with subjective instability who have not responded to nonoperative treatment.
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Vieira TD, Blakeney WG, Canuto S, Cavaignac E, Claes S, Daggett M, Helito CP, Muramatsu K, de Padua VBC, Ouanezar H, Saithna A, Sonnery-Cottet B. Effect of Meniscal Ramp Lesion Repair on Knee Kinematics, Bony Contact Forces, and In Situ Forces in the Anterior Cruciate Ligament: Letter to Editor. Am J Sports Med 2020; 48:NP23-NP25. [PMID: 32003637 DOI: 10.1177/0363546519897010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Chen T, Chen S. [Artificial ligaments applied in anterior cruciate ligament repair and reconstruction: Current products and experience]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020; 34:1-9. [PMID: 31939226 PMCID: PMC8171823 DOI: 10.7507/1002-1892.201908084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/15/2019] [Indexed: 01/12/2023]
Abstract
The application of artificial ligament products in anterior cruciate ligament (ACL) surgeries has gone through a long twisty way. In the 1970s, early artificial ligament products were initially used for ACL surgeries, which showed poor clinical efficacy and eventually ended up in failure. Over the last 20 years, there has been a growing number of ACL reconstruction with new artificial ligament products, including the Leeds-Keio TM, the LARS TM (Ligament Advanced Reinfocement System), and the Trevira Hochfest TM. Among these new products, the LARS TM has been more commonly applied for ACL surgeries. Although these new artificial ligament products have good mechanical properties and show significant improvement of cumulative failure and complication rate, they still have limitations.
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Affiliation(s)
- Tianwu Chen
- Sports Medicine Institute, Fudan University, Shanghai, 200040, P.R.China;Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, P.R.China
| | - Shiyi Chen
- Sports Medicine Institute, Fudan University, Shanghai, 200040, P.R.China;Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040,
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Santos ADA, Carneiro-Filho M, e Albuquerque RFDM, de Moura JPFM, Franciozi CE, Luzo MVM. Mechanical evaluation of tibial fixation of the hamstring tendon in anterior cruciate ligament double-bundle reconstruction with and without interference screws. Clinics (Sao Paulo) 2020; 75:e1123. [PMID: 32556055 PMCID: PMC7196727 DOI: 10.6061/clinics/2020/e1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/29/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare two postero-lateral bundle (PLB) tibial fixation techniques for the reconstruction of the anterior cruciate ligament with double bundle: a technique without the use of an interference screw, preserving the native tibial insertion of the tendons of the gracilis and semitendineous muscles, and a technique with the use of an interference screw and without preserving the insertion of the tendons. METHODS A comparative study was conducted in cadavers with a universal mechanical test machine. In total, 23 cadaver knees were randomized for tibial fixation of the PLB using the two techniques: Maintaining the tibial insertion of the tendons during reconstruction, without the use of an interference screw (group A, 11 cases); and fixating the graft with an interference screw, without maintaining the insertion of the tendons (group B, 12 cases). A continuous traction was performed (20 mm/min) in the same direction as the produced tunnel, and force (N), elongation (mm), rigidity (N/mm), and tension (N/mm2) were objectively determined in each group. RESULTS Group A exhibited a maximum force (MF) of 315.4±124.7 N; maximum tension of 13.57±3.65 N/mm2; maximum elongation of 19.73±4.76 mm; force at the limit of proportionality (FLP) of 240.6±144.0 N; and an elongation at the limit of proportionality of 14.37±6.58 mm. Group B exhibited a MF of 195.7±71.8 N; maximum tension of 8.8±3.81 N/mm2; maximum elongation of 15.3±10.73 mm; FLP of 150.1±68.7 N; and an elongation at the limit of proportionality of 6.86±2.42 mm. When comparing the two groups, significant differences were observed in the variables of maximum force (p=0.016), maximum tension (p=0.019), maximum elongation (p=0.007), and elongation at the limit of proportionality (p=0.003). CONCLUSION The use of the native insertion of the semitendineous and gracilis tendons, without an additional fixation device, presented mechanical superiority over their fixation with interference screws.
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Affiliation(s)
- Anderson de Aquino Santos
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Mario Carneiro-Filho
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Roberto Freire da Mota e Albuquerque
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Carlos Eduardo Franciozi
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Marcus Vinícius Malheiros Luzo
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
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Béreš M, Svoboda Z, Gallo J, Kalina R, Zahutová E, Zapletalová J. [Influence of Anterior Cruciate Ligament Reconstruction on Gait Kinematics]. Acta Chir Orthop Traumatol Cech 2020; 87:17-23. [PMID: 32131966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The anterior cruciate ligament (ACL) reconstruction is a tried and tested method in treating knee joint instability which brings valuable results in an acceptable time frame. In the long-term follow-up, however, a higher risk of knee osteoarthritis development is described. One of the possible reasons is considered to be the abnormal kinematics of the operated knee. The purpose of our study was to determine the degree to which the ACL reconstruction helps restore the correct gait cycle compared to the healthy limb. MATERIAL AND METHODS The study included patients after the ACL reconstruction performed in the period from 1 January 2016 to 31 March 2018. With the use of strict criteria, 11 patients were selected for kinematic analysis, who underwent examinations in a gait laboratory and were also evaluated using the Tegner and Lysholm rating systems and the IKDC (International Knee Documentation Committee) knee score, namely preoperatively and at 6 and 12 months postoperatively. The kinematic assessment of gait was carried out using the Vicon MX system with the placement of reflexive markers in line with the Plug-In Gait model. RESULTS The clinical outcomes (namely the score according to Tegner, Lysholm as well as the IKDC) during the first year postoperatively showed a major improvement in knee function and the achievement of the pre-injury activity level. The kinematic analysis revealed lower knee extension at the stance phase and lower overall range of motion of the limb with the injured ACL compared to the healthy limb. The follow-up evaluation at 6 and 12 months postoperatively showed a persisting between-limbs difference in knee extension, whereas the range of motion gradually improved during the year. CONCLUSIONS Although our study confirmed that the ACL reconstruction is an efficient method to treat knee joint instability, it also indicated that even at one year after the ACL reconstruction, the kinematics of the operated knee was not fully restored to the level of the heathy knee. The persisting limb-difference in gait kinematics could contribute to the gradual development of degenerative changes in the operated knee joint. Key words: anterior cruciate ligament deficiency, anterior cruciate ligament reconstruction, knee kinematics during gait, knee osteoarthritis.
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Affiliation(s)
- M Béreš
- Ortopedická klinika Fakultní nemocnice Olomouc a Lékařské fakulty Univerzity Palackého v Olomouci
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Spang RC, Getgood A, Strickland SM, Amendola AN, Gomoll AH. Optimizing Anterior Cruciate Ligament (ACL) Outcomes: What Else Needs Fixing Besides the ACL? Instr Course Lect 2020; 69:653-660. [PMID: 32017758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This review focuses on the management of anterior cruciate ligament (ACL) reconstruction patients when other concomitant pathology may need to be addressed at the time of surgery. Given the role of the posterior horn of the medial meniscus in preventing osteoarthritis progression and contributing to knee stability, medial meniscus repair should always be considered when performing ACL reconstruction. Meniscal transplant may also be appropriate in select patients with normal knee alignment and absent of cartilage abnormalities in the compartment. Varus alignment with a varus thrust or increased posterior tibial slope will increase stress on the ACL graft and may predispose to early failure. Alignment should be assessed with appropriate radiographs and corrective osteotomy in isolation or in conjunction with ACL reconstruction should be considered for certain patients. Low-grade medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries can be treated nonsurgically prior to ACL reconstruction. These are frequently missed with either physical examination or radiographic imaging. High-grade LCL injuries are often treated with repair versus reconstruction in conjunction with ACL reconstruction depending on the timing of the injury. When chronic MCL injuries show opening in extension, MCL reconstruction may be needed in addition to the ACL reconstruction to improve outcome. The role of extra-articular reconstruction or anterolateral ligament (ALL) reconstruction remains controversial but may have a role in protecting rotatory stability in primary ACL reconstruction for high-risk patients, and in the revision setting. Cartilage lesions noted in the setting of ACL injury should be considered. Small, asymptomatic lesions in locations unrelated to the ACL injury may not necessitate additional intervention. Large symptomatic lesions may require additional cartilage restoration procedures at the time of ACL reconstruction or in a staged fashion. In this ICL, we will address the diagnosis, management, and surgical indications of other concomitant pathology associated with ACL ruptures.
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166
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Hunnicutt JL, Jayanthi NA, Labib SA. Editorial Commentary: Considering Fatigue When Assessing Athletes for Dynamic Knee Valgus: Is This the Next Big Step in Identifying Anterior Cruciate Ligament Injury Risk? Arthroscopy 2020; 36:223-224. [PMID: 31864580 DOI: 10.1016/j.arthro.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
Excessive dynamic knee valgus during jumping is a poor movement strategy that has been well-documented as a risk factor for anterior cruciate ligament injury. Yet, there has been little progress in the translation of findings from high-tech motion capture laboratories to clinically applicable settings. One barrier to widespread use is expensive technology that requires time; therefore, field-based efficient assessment tools that can be used by several types of clinicians are desperately needed. Further, fatigue can influence dynamic knee valgus and should be considered when assessing or conditioning athletes.
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Thoma L, Grindem H, Logerstedt D, Axe M, Engebretsen L, Risberg MA, Snyder-Mackler L. Coper Classification Early After ACL Rupture Changes With Progressive Neuromuscular and Strength Training and Is Associated With 2-Year Success: Response. Am J Sports Med 2019; 47:NP65-NP66. [PMID: 31479325 DOI: 10.1177/0363546519863309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Maffulli N, Oliva F. Coper Classification Early After ACL Rupture Changes With Progressive Neuromuscular and Strength Training and Is Associated With 2-Year Success: Letter to the Editor. Am J Sports Med 2019; 47:NP64-NP65. [PMID: 31479329 DOI: 10.1177/0363546519863310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Leggit JC. Sports Medicine: Fractures, Sprains, and Other Musculoskeletal Injuries. FP Essent 2019; 482:23-26. [PMID: 31259509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Family physicians commonly treat athletes with simple fractures and other musculoskeletal injuries that require temporary immobilization. Certain fractures (eg, intraarticular, multiple, open, associated with dislocations or tendon injury) typically are managed by orthopedic subspecialists. During the healing process, a custom-molded or prefabricated orthopedic support, known as an orthosis, may be used to support the injured area and prevent reinjury. To reduce the risk of complications that may develop from orthosis use, timely follow-up is required. Proficiency in specific orthotic applications, such as splint application and cast making, requires continued skill maintenance. Patients with suspected scaphoid bone fractures should initially undergo splinting or bracing in a thumb spica device until fracture is definitively diagnosed or ruled out. Injuries to the extensor tendons of the finger are managed with continuous extension splinting for 4 to 6 weeks. Patients with grade I and II medial collateral ligament injuries heal well with use of a hinged knee brace for 4 to 6 weeks. There is no good evidence for use of a brace after anterior cruciate ligament repair. Lateral ankle sprains are common, and bracing is an integral component of functional rehabilitation and injury prevention. There are specific requirements related to reimbursement for orthoses prescriptions.
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Affiliation(s)
- Jeffrey C Leggit
- Uniformed Services University Department of Family Medicine, 4301 Jones Bridge Road A1038, Bethesda, MD 20814-4799
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Hernández-Téllez IE, Godínez-Victoria MC, Floriano-Sánchez E, Sáenz-Guerra J. [IGF-1 levels in anterior cruciate ligament reconstruction using allograft vs autograft in patients at Central Military Hospital]. Acta Ortop Mex 2019; 33:225-231. [PMID: 32246592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Treatment of ACL injury is surgical reconstruction. It is not known whether the result is better depending on the type of graft used. Insulin-like growth factor type 1(IGF-1) is a powerful stimulant of extracellular matrix and chondrocyte growth. MATERIAL AND METHODS Experimental, analytical, prospective, longitudinal study in patients with ACL reconstruction in a period from 2016 to 2017. The concentration of IGF-1 in synovial fluid of these patients operated with allograft and autograft was determined, its association with postoperative evolution was determined. For statistical analysis, two-way ANOVA with Mann-Whitney post-hoc U was used. RESULTS A significant increase in IGF-1 was identified in the allograft group at 90 days of postopertory. In the autograft group, a significant increase in IGF-1 was observed from 30 days of postoperative. The autograft group was found to have significantly higher levels of IGF-1 (3.27 ± 0.09 ng/ml) compared to the allograft group (2.80 ± 0.11 ng/ml; p 0.001) at 90 days after graft placement. DISCUSSION IGF-1 levels were higher in patients with autologous graft, knee functionality was clinically similar in both groups at 30 and 90 days.
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Kircher J. Editorial Commentary: The Measurement of Knee Laxity: Instrumented Measurement and Stress Radiography for Anterior Cruciate Ligament Injuries. Arthroscopy 2019; 35:1733-1735. [PMID: 31159960 DOI: 10.1016/j.arthro.2019.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 02/02/2023]
Abstract
The measurement of anterior knee laxity in anterior cruciate ligament injuries is an established method for both clinical practice and clinical studies in regard to anterior cruciate ligament surgery. Stress radiography was succeeded or paralleled by instrumented testing with the development of standardized devices starting in the 1980s. Because knee stability depends on the flexion angle test, conditions need to be comparable for both instrumented testing and stress radiography. The lack of a general consensus becomes even more evident for testing and measuring rotational instability. Knee laxity measurement in all dimensions, such as with robots in cadaver studies, has not found its general application in the clinical setting yet, but will be expected in the near future.
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Steiger CN, Ceroni D. Mechanism and predisposing factors for proximal tibial epiphysiolysis in adolescents during sports activities. Int Orthop 2019; 43:1395-1403. [PMID: 30267244 DOI: 10.1007/s00264-018-4168-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Proximal tibial epiphysiolysis (PTE) can have debilitating consequences for young athletes. The mechanism and predisposing factors for this lesion have yet to be determined. To find a common denominator and a biomechanical explanation for PTE, we were using a retrospective analysis of 15 cases in combination with a systematic review of literature. METHODS A retrospective review of medical charts was performed to identify all PTE between 2003 and 2012. Records were screened for patient age and gender, sports activity, mechanism of injury, and treatment protocols. Additionally, a literature review (MEDLINE/PubMed database, the Cochrane Library, online search engines) was conducted. RESULTS Medical charts of 14 adolescents (15 Salter-Harris I and II fractures) were analyzed. The literature review revealed additional 75 fractures. The predominant mechanisms were landing from a jump, takeoff for a jump, stop and go movements, and eccentric muscle contraction with the knee in flexion. The main sports-activities implicated in these injuries were basketball. CONCLUSIONS Landing from a jump with a decreased knee and hip flexion movement increases tensile forces on the proximal tibia epiphysis. During physiological epiphysiodesis, the growth plate displays an increased vulnerability and such increased tensile forces can lead to a growth plate failure. Neuromuscular fatigue can alter coordination and proprioceptive accuracy during landing from a vertical jump and thus perturbs sagittal shock absorption. In our opinion, trainers should instruct young athletes in techniques that help avoiding uncontrolled high impact landings. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Christina N Steiger
- Département de l'enfant et de l'adolescent, Service d'orthopédie pédiatrique, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, 1205, Genève, Switzerland.
| | - Dimitri Ceroni
- Département de l'enfant et de l'adolescent, Service d'orthopédie pédiatrique, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, 1205, Genève, Switzerland
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Abstract
Given increasing health care costs and clinical equipoise on numerous topics, value calculations are critical. Cost-minimization analysis evaluates throughout a single episode of care. For anterior cruciate ligament reconstruction, this is a reasonable approach given that cost-effectiveness data have been published. Using Healthcare Cost and Utilization Project data, general anesthesia, anesthesia time, greater age, and medical comorbidities were correlated with higher costs. Among the surprising results were increased costs with male gender and Hispanic race. Interestingly, the location of the surgery, surgery center versus hospital, or meniscal repair did not significantly impact costs. This information can be used by physicians for cost comparison and factors that determine costs.
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Sanders TL, Pareek A, Desai VS, Hewett TE, Levy BA, Stuart MJ, Dahm DL, Krych AJ. Low Accuracy of Diagnostic Codes to Identify Anterior Cruciate Ligament Tear in Orthopaedic Database Research: Response. Am J Sports Med 2019; 47:NP21-NP22. [PMID: 30822129 DOI: 10.1177/0363546519825631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Alenazi AM, Alshehri YS. Low Accuracy of Diagnostic Codes to Identify Anterior Cruciate Ligament Tear in Orthopaedic Database Research: Letter to the Editor. Am J Sports Med 2019; 47:NP21. [PMID: 30822122 DOI: 10.1177/0363546519825633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Fabricant PD. Editorial Commentary: Mild Limb Asymmetry and Pediatric Anterior Cruciate Ligament Reconstruction-A Classic "Chicken and Egg" Scenario? Arthroscopy 2019; 35:950-952. [PMID: 30827445 DOI: 10.1016/j.arthro.2018.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 02/02/2023]
Abstract
Growth disturbance from a physeal injury is considered by many surgeons to be the most feared iatrogenic surgical complication after anterior cruciate ligament (ACL) reconstruction in skeletally immature patients, typically resulting in valgus, recurvatum, and/or a short limb. These deformities also predispose children to an ACL injury in the first instance, and therefore, a firm understanding of the contributions of both preoperative deformity and iatrogenic injury to postoperative limb asymmetry is critical. Preoperative and postoperative imaging (until 2 years postoperatively or skeletal maturity) should include standing hip-to-ankle alignment radiographs when the patient is able to straighten the knee and fully bear weight, as well as a lateral projection of the knee to quantify tibial slope. This should be the standard of care for children with open physes undergoing ACL reconstruction.
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Harner CD, Warth RJ, Poehling GG. Editorial Commentary: Déjà Vu: Double-Bundle Anterior Cruciate Ligament Reconstruction Revisited. Arthroscopy 2019; 35:552-553. [PMID: 30712630 DOI: 10.1016/j.arthro.2018.10.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 02/02/2023]
Abstract
Regardless of the technique utilized, tunnel expansion following anterior cruciate ligament reconstruction remains a mystery and a clinical challenge. No procedure seems to be immune to this, even anatomic double-bundle reconstruction. This technique was introduced more than 20 years ago and showed great promise while also contributing significantly to our current knowledge of anterior cruciate ligament anatomy and biomechanics. However, we must remember that new techniques do carry with them new side effects that we must document and acknowledge if we hope to improve our surgical outcomes.
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Okoroha KR, Patel RB, Kadri O, Jildeh TR, Krause A, Gulledge C, Makhni EC, Moutzouros V. Abnormal tibial alignment is a risk factor for lateral meniscus posterior root tears in patients with anterior cruciate ligament ruptures. Knee Surg Sports Traumatol Arthrosc 2019; 27:590-595. [PMID: 30288568 DOI: 10.1007/s00167-018-5171-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/21/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of this study was to identify if abnormal tibial alignment was a risk factor for lateral meniscus posterior root tears (LMPRT) in patients with acute anterior cruciate ligament (ACL) ruptures. METHODS The medical charts of 200 patients treated for ACL ruptures between 2013 and 2016 were retrospectively reviewed and evaluated. MRI images and reports were assessed for concurrent meniscal tears. Radiographs were reviewed for tibia vara and tibial slope angles and MRI reports identifying lateral root tears were compared to intraoperative reports to determine accuracy. Multiple logistic regression models were constructed to identify potential risk factors for LMPRTs. RESULTS Of the 200 patients reviewed, a total of 97 individuals with concurrent meniscal injuries were identified. In patients sustaining a concurrent meniscal injury, there was a 4% incidence of medial meniscus posterior root tears and a 10.3% incidence of LMPRTs. Patients sustaining an ACL injury with an LMPRT were found to have greater tibia vara angles (4.2 ± 1.0 vs. 2.9 ± 1.7; p = 0.024), increased tibial slopes (12.6 ± 1.5 vs. 10.7 ± 2.9; p = 0.034), and higher BMIs (27.3 ± 2.9 vs. 25.3 ± 5.9; p = 0.034) when compared to patients without meniscus tears. There was low agreement between MRI and arthroscopic findings (kappa rate = 0.54). Multiple logistic regression analysis demonstrated that a tibia vara angle > 3 was associated with a 5.2-fold increase (95% CI 0.99-27.01; p = 0.050), and a tibial slope > 12 with a 5.4-fold increase (95% CI 1.03-28.19; p = 0.046) in LMPRTs. CONCLUSIONS Patients with greater tibia varus angles, increased tibial slopes, and higher BMIs were found to have an increased risk of LMPRTs when sustaining an ACL rupture. There was a low rate of agreement between MRI and arthroscopy in identifying LMPRTs. In patients with ACL ruptures who have abnormal tibial alignment or increased BMI, physicians should be watchful for lateral meniscus posterior root tears. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Health System, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
| | - Ravi B Patel
- Department of Orthopaedic Surgery, Henry Ford Health System, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Omar Kadri
- Department of Orthopaedic Surgery, Henry Ford Health System, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Health System, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Andrew Krause
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Caleb Gulledge
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health System, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Health System, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
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Levy BA, Stuart MJ, MacDonald PB, Marx RG, Stannard JP, LaPrade RF, Engebretsen L, Miller MD, Whelan D, Boyd JL, Fanelli GC. Comprehensive Case-Based Review of Knee Ligament Injuries. Instr Course Lect 2019; 68:513-544. [PMID: 32032066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The management of knee ligament injuries continues to evolve, and much debate persists over the timing of surgery, repair versus reconstruction, surgical technique, postoperative rehabilitation, graft selection, and fixation. Surgeons should be aware of updates on the best management strategies of knee ligament injuries in 2018 and understand the important history and physical examination findings of the knee with ligamentous injury; the anterior cruciate ligament; the role of the anterolateral ligament and lateral extra-articular tenodesis; combined anterior cruciate ligament and medial collateral ligament injuries; the posterior cruciate ligament; medial collateral ligament repair versus reconstruction; posterolateral corner repair versus reconstruction; the role of coronal plane osteotomies, including high tibial osteotomy and distal femoral osteotomy; the role of sagittal plane osteotomies, including anterior closing wedge osteotomy and anterior opening wedge osteotomy; the initial management of the multiligament-injured knee; and five keys to avoiding complications in the multiligament-injured knee. The best available evidence and sample case presentations help guide surgical decision making and improve patient outcomes.
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Chowdhury AZ, Ali MH, Faisal MA, Kundu IK, Arifeen KN, Mahmood CI, Rana MM, Buyan JH. Anterior Cruciate Ligament Reconstruction Using Autologous Hamstring Double Bundle Graft Compared With Single Bundle Graft Procedures. Mymensingh Med J 2019; 28:126-136. [PMID: 30755561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Anterior cruciate ligament injury is one of the commonest sports injuries, which often markedly reduces activity and the quality of life. The autologous hamstring double bundle graft and single bundle graft are commonly used for anterior cruciate ligament reconstruction. The choice of graft material for ACL reconstruction is believed to play a major role in the outcome but still there are controversies about the graft selection for primary ACL reconstruction. The aim of this study was to compare the clinical and functional outcome of autologous double bundle (DB) hamstring graft and single bundle (SB) hamstring graft reconstruction for the ACL injury. This prospective observational study was conducted in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2015 to September 2017. Total 42 cases of ACL injury that required reconstruction surgery was selected as per inclusion criteria. Total patients were allocated into two groups. One group was treated by single bundle graft and other group was treated by double bundle graft for the ACL reconstruction. In this study, the mean age of double bundle and single bundle groups were 28±6.63 and 30.14±7.55 years respectively and majority of the subjects were male. The post-operative symptoms and signs were more improved in double bundle group than single bundle group during last follow-up period of 6th months. The Lachman test, Anterior drawer test and pivot sift test were more negative in double bundle group than that of single bundle groups. The Lysholm and Tegner activity were better in double bundle group than single bundle group. Again rotational and anterior stability of the knee was better in the double bundle group. However, the differences were not statistically significant and all patients in our study were able to return their activity. Double bundle group showed better rotational stability than the single bundle groups and all knees were improved by anterior cruciate ligament reconstruction compared with their pre-operative status.
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Affiliation(s)
- A Z Chowdhury
- Professor Dr Abu Zaffar Chowdhury, Chairman Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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Hanus M, Handl M, Stančák A, Trč T. [New Anterior Cruciate Ligament Reconstrucion Using Harmstring Tendon Grafts - Clinical Part]. Acta Chir Orthop Traumatol Cech 2019; 86:46-50. [PMID: 30843513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE OF THE STUDY The authors present the clinical use of the new instrumentation set for the anterior cruciate ligament (ACL) reconstruction using the hamstring tendons (HS). The positionning of the femoral tunnel and the fixation of the graft play an important role for the results of the surgery. The aim of the study was to confirm the proposed surgical technique and the methods of the graft fixation, especially from the point of view of the clinical midterm results at the evaluation up to eight years after the surgery. MATERIAL AND METHODS The clinical evaluation comprises 58 patients operated from 2007 to 2014 using the new instrumentation set. There were 9 men and 49 women included in the sample. The mean age was 34.6 years (range 18 - 58 yrs), namely 36.7 in women and 32.4 years in men. The evaluation was performed pre-opeatively and at 3 and 6 months, 1, 3, 5 and 8 years post-operatively. All the patients were followed based on the same criteria - clinical range of motion (ROM), stability of the knee - instrumentation Lachman test utilizing Rolimeter, subjective IKDC score and pain VAS scale for the harvesting site. The ocurrence and the rate of post-operative complications were monitored. RESULTS The integration and the ingrowth of the graft were achieved in all cases, the full ROM was gained as well, no pathological instability was observed. The fixation of the HS graft in the bone was confirmed by post-op X ray at 3 months after the surgery. The clinical evaluation showed the following mean differences in the pre-op and final post-op findings. The average preoperative laxity using the Lachmann test was 9.7 mm (range 6-12 mm), at 3 months 1.8 mm (1.4-2.1 mm), at 6 months 1.6 mm (1.2 - 2.2 mm), at 1 year 1.6 mm (1.1-2.3 mm), at 3 years the stability was 1.7 mm (1.2 mm-2.4 mm), at 5 years 2.3 mm (1.2-3.6 mm) and at 8 years after surgery it was 2.5 mm (1.2-3.9 mm). None of the patitents included in the study showed pathological instability that would be considered an indication for revision. In the evaluation of the subjective IKDC score, the pre-operative average was 56, with the range of 42-66, at 3 months post-operatively 79 (69-85), at 6 months 88 (74-92), at 1 year 95 (88-100), at 3 years 96 (89-100), at 5 years 94 (87-100), and at 8 years 92 (84-98). No severe complications were observed. CONCLUSIONS The method provided sufficient post-operative stability of the knee joint. Fixation of the femoral screw satisfied the demands laid on it. Regarding the pain perception, the method was considered positive, the level of pain involved in the procedure was low. No severe complications or technical mistakes occurred during the surgical procedures. The new instrumentation set developed for the ACL reconstruction offers an easy technique and comfortof use. Key words:anterior cruciate ligament, reconstruction, hamstrings, knee arthroscopy, instrumentation set.
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Affiliation(s)
- M Hanus
- Klinika dětské a dospělé ortopedie a traumatologie 2. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha, ČR
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Hewett TE, Schilaty ND. Determination of the Position of the Knee at the Time of an Anterior Cruciate Ligament Rupture for Male Versus Female Patients by an Analysis of Bone Bruises: Letter to the Editor. Am J Sports Med 2018; 46:NP47-NP48. [PMID: 30169142 DOI: 10.1177/0363546518788319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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de Araujo FX, de Castro MP, Schell MS, Vidmar MF, Marques FO, Pierri CAA, Silva MF. Twenty-Year Follow-up Study Comparing Operative Versus Nonoperative Treatment of Anterior Cruciate Ligament Ruptures in High-Level Athletes: Letter to the Editor. Am J Sports Med 2018; 46:NP55-NP57. [PMID: 30169143 DOI: 10.1177/0363546518788318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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184
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Owusu-Akyaw KA, Kim SY, Spritzer CE, Collins AT, Englander ZA, Utturkar GM, Garrett WE, DeFrate LE. Determination of the Position of the Knee at the Time of an Anterior Cruciate Ligament Rupture for Male Versus Female Patients by an Analysis of Bone Bruises: Response. Am J Sports Med 2018; 46:NP48-NP51. [PMID: 30169145 DOI: 10.1177/0363546518788316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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185
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Matava MJ. Editorial Commentary: National Football League Hopefuls Beware: Your Stock May Be Falling After Anterior Cruciate Ligament Reconstruction. Arthroscopy 2018; 34:2454-2456. [PMID: 30077268 DOI: 10.1016/j.arthro.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 02/02/2023]
Abstract
Making a National Football League (NFL) team is tough; making one after undergoing an anterior cruciate ligament (ACL) reconstruction is tougher. NFL Combine participants who are post-ACL reconstruction, particularly with certain graft types such as allografts and to a lesser extent hamstring grafts, are frequently 'down-graded' despite the presence of a stable, well-placed graft without any associated meniscal or chondral damage. Whether NFL general managers are truly prescient in accurately predicting decreased performance by choosing a player later in the draft, or whether NFL coaching staffs knowingly or unknowingly restrict an athlete's playing time based on draft position or surgical history is unknown. Yet, any collegiate football player who is good enough to make it to the Combine possesses a rare combination of athleticism, strength, determination, and toughness. An ACL tear used to mark the beginning of the end of an athlete's playing career, but today's athletes are able to return at an elite level following ACL injury and surgery. Unfortunately, despite a successful surgery, prospective NFL players who undergo ACL reconstruction may still be at a disadvantage compared to their uninjured counterparts in terms of their ability to be drafted and play in the first two years of their careers.
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186
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Roy A, Subair M. Letter to Editor regarding the article by wang et al "Open reduction and internal fixation in a one-stage anterior cruciate ligament reconstruction surgery for the treatment of tibial plateau fractures: A case report and literature review". Injury 2018; 49:1635. [PMID: 29958687 DOI: 10.1016/j.injury.2018.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/21/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Antony Roy
- Deptt Of Orthopaedic Surgery, Government Medical College, Kozhikkode, India.
| | - Mohsina Subair
- Deptt Of Plastic Surgery and Burns, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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187
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Hewett TE, Myer GD. Mapping current research trends on anterior cruciate ligament injury risk against the existing evidence: In vivo biomechanical risk factors - A Letter to the Editor. Clin Biomech (Bristol, Avon) 2018; 56:92-93. [PMID: 27717510 PMCID: PMC6590683 DOI: 10.1016/j.clinbiomech.2016.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/21/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Timothy E Hewett
- Mayo Clinic, 200 First Street SW; RO_Gu_01_28BIOM; Rochester, MN 55905 United States.
| | - Gregory D Myer
- Cincinnati Children's Hospital, 3333 Burnet Avenue MLC 10001 Cincinnati, OH 45229-3039, United States
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188
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Voleti PB. A Novel Anatomic Risk Factor for Anterior Cruciate Ligament Injury?: Commentary on an article by Thomas R. Pfeiffer, MD, et al.: "An Increased Lateral Femoral Condyle Ratio Is a Risk Factor for Anterior Cruciate Ligament Injury". J Bone Joint Surg Am 2018; 100:e74. [PMID: 29762296 DOI: 10.2106/jbjs.17.01615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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189
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Abstract
Musculoskeletal injuries account for more than 70% of time away from sports. One of the reasons for the high number of injuries and long return to play is that we have only a very basic understanding of how our training alters tendon and ligament (sinew) structure and function. Sinews are highly dense tissues that are difficult to characterize both in vivo and in vitro. Recently, engineered ligaments have been developed in vitro using cells from human anterior cruciate ligaments or hamstring tendons. These three-dimensional tissues can be grown in a laboratory, treated with agents thought to affect sinew physiology, and then mechanically tested to determine their function. Using these tissues, we have learned that sinews, like bone, quickly become refractory to an exercise stimulus, suggesting that short (<10 min) periods of activity with relatively long (6 h) periods of rest are best to train these tissues. The engineered sinews have also shown how estrogen decreases sinew function and that a factor released following intense exercise increases sinew collagen synthesis and function. Last, engineered sinews are being used to screen possible nutritional interventions that may benefit tendon or ligament function. Using the data derived from these tissue-engineered sinews, new nutritional and training regimes are being designed and tested with the goal of minimizing injury and accelerating return to play.
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Affiliation(s)
- Keith Baar
- Department of Neurobiology, Physiology and Behavior, University of California Davis, One Shields Ave, Davis, CA, 95616, USA.
- Department of Physiology and Membrane Biology, University of California Davis, One Shields Ave, Davis, CA, 95616, USA.
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190
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Estrada-Cruz K, Pérez-Meave JA. [Postoperative functional angular anatomy in patients with anterior cruciate ligament with autologous graft]. Acta Ortop Mex 2018; 32:157-162. [PMID: 30521707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Reconstruction of the anterior cruciate ligament (ACL) aims to restore the original anatomy. The clinical outcome could be imperfect when graft placement is not in an anatomical position; moreover, the conventional transtibial reconstruction of the ACL often locates the graft away from the anatomical site, leading to abnormal biomechanical behavior and kinematics of the knee. The objective of this work was to assess the importance of the angular reconstruction of the anterior cruciate ligament during arthroscopic replacement and to compare the postoperative functional results. MATERIAL AND METHODS We studied 21 patients to whom the IKDC 2000 form of objective and subjective evaluation was applied; radiographic evaluation in anteroposterior and lateral bending at 30o. We made an statistical analysis with Pearson P, correlating the anteroposterior and lateral angulation of the graft direction and the subjective projection of the operated knee function, as well as age and time of evolution with the operated knee. RESULTS We included 21 patients of 18 to 56 years of age; follow-up: one to three years. Objective evaluation: 95.24% normal and 4.76% almost normal. Subjective assessment: average 84.31% (range 70.93 to 97.99%), CI 95%. AP angle: 68.8o, range: 62o to 77o. Average sagittal angle: 64.9o, range: 58o to 75o. Correlations: AP angle and subjective function -0.19, angle in sagittal and subjective function -0.54, age and subjective function -0.77, duration and subjective function -0.74. Function average: 84.31%. DISCUSSION The anatomical angular reconstruction of the ACL graft is key to the stability of the knee; the evaluated patients got a more similar direction to that of the native ACL, better stability and knee function.
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Affiliation(s)
| | - J A Pérez-Meave
- Servicio de Cirugía Articular, Hospital Juárez de México, Ciudad de México
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191
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Saithna A, Cavaignac E, Monaco E, Helito CP, Ouanezar H, Daggett M, Sonnery-Cottet B. Segond Fractures Are Not a Risk Factor for Anterior Cruciate Ligament Reconstruction Failure: Letter to the Editor. Am J Sports Med 2018; 46:NP23-NP24. [PMID: 29601244 DOI: 10.1177/0363546518765991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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192
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Krych AJ, Melugin HP, Johnson NR, Wu IT, Levy BA, Stuart MJ. Is Treatment of Segond Fracture Necessary With Combined Anterior Cruciate Ligament Reconstruction? Response. Am J Sports Med 2018; 46:NP15-NP16. [PMID: 29601235 DOI: 10.1177/0363546518764417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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193
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Pennock AT, Gaunder C, Bastrom T. Segond Fractures Are Not a Risk Factor for Anterior Cruciate Ligament Reconstruction Failure: Response. Am J Sports Med 2018; 46:NP24-NP25. [PMID: 29601237 DOI: 10.1177/0363546518765984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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194
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Cavaignac E, Saithna A, Monaco E, Helito CP, Daggett M, Reina N, Sonnery-Cottet B. Is Treatment of Segond Fracture Necessary With Combined Anterior Cruciate Ligament Reconstruction? Letter to the Editor. Am J Sports Med 2018; 46:NP13-NP14. [PMID: 29601246 DOI: 10.1177/0363546518764420] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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195
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Pan Z, Dong Q, Xu Y, Zhou H, Xu W, Mao Y. Is Treatment of Segond Fracture Necessary With Combined Anterior Cruciate Ligament Reconstruction? Letter to the Editor. Am J Sports Med 2018; 46:NP17. [PMID: 29601245 DOI: 10.1177/0363546518764421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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196
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Krych AJ, Melugin HP, Johnson NR, Wu IT, Levy BA, Stuart MJ. Is Treatment of Segond Fracture Necessary With Combined Anterior Cruciate Ligament Reconstruction? Response. Am J Sports Med 2018; 46:NP18-NP19. [PMID: 29601234 DOI: 10.1177/0363546518764419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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197
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Hickner J. Reduce unnecessary imaging by refining clinical exam skills. J Fam Pract 2018; 67:128. [PMID: 29509815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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198
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Johnson DH. Editorial Commentary: A Revisit of an Old Clinical Dilemma-To Operate or Not to Operate on Acute Knee Anterior Cruciate Ligament Injuries. Arthroscopy 2018; 34:603-604. [PMID: 29413196 DOI: 10.1016/j.arthro.2017.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/13/2017] [Indexed: 02/02/2023]
Abstract
There is a feeling among knee surgeons that operating on an acute anterior cruciate ligament injury will increase the incidence of arthrofibrosis. A recent systematic review and meta-analysis of 7 recent articles compared early versus delayed anterior cruciate ligament reconstruction. The conclusions were that the clinical and stability results were comparable in both groups.
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199
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Hunt TJ. Editorial Commentary: Animal Trials Using Stem Cells to Enhance Anterior Cruciate Ligament Treatment Are Interesting. But, Why Not More About Us Humans? Arthroscopy 2018; 34:343-344. [PMID: 29304973 DOI: 10.1016/j.arthro.2017.08.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 02/02/2023]
Abstract
Although hampered by heterogeneous studies with low methodologic quality and high risk for bias, the current literature demonstrates the potential for enhanced healing of anterior cruciate ligament injuries during the early phase using adult stem cells in animal trials. There are only 2 published controlled clinical trials on the subject matter, and they have small sample sizes, undefined cell numbers, and unstandardized selection criteria and surgical techniques. There is a clear need for studies with higher levels of evidence that would include long-term, larger animal studies ultimately leading to improved clinical trials.
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200
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Faisal MA, Chowdhury AZ, Kundu IK, Arifeen KN, Ullah AS, Mahmud CI, Dastagir OM, Islam MA, Paul MS. Comparative Study of Patellar Tendon Graft versus Hamstrings Graft for Anterior Cruciate Ligament Reconstruction. Mymensingh Med J 2018; 27:108-115. [PMID: 29459600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Graft selection for primary anterior cruciate ligament reconstruction is very important part of knee stability. The purpose of this Qasi experimental study was to compare the clinical outcomes after ACL reconstruction using either a BPTB graft or a four-strand hamstrings graft and conducted from January 2012 to December 2013. Patients presented with a symptomatic unilateral ACL rupture who were underwent ACL reconstruction by using either BPTB or Hamstrings graft, IPD of Department of Orthopedics at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka as well as in a private hospital in Dhaka, Bangladesh were selected as study population. Patients were divided into Group A who were treated with the patellar tendon bone graft and Group B patients who were received hamstrings tendon graft. All surgery was performed by the same surgeon and the both procedures were arthroscopically assisted. Operation was performed at least three (03) weeks after initial trauma. All patients were assessed by independent examiner before surgery, at 6 months, 12 months and then annually by clinically. A total number of 70 patients were recruited for this study. The mean age with SD of Group A and Group B were 27.31±10.91 and 26.97±10.10 years respectively (p=0.892). Tegner scores were measured preoperatively and post-operatively. The score were 2.2±1.1 and 2.1±1.0 in preoperatively (p=0.817). In post-operatively the mean score were 6.0±1.7 and 5.8±1.5 in Group A and Group B respectively (p=0.508). Regarding outcome of the operation excellent was 18(51%) cases in both Group A and Group B, good was 15 (43%) and 16(46%) cases in Group A and Group B respectively (p=0.793). In conclusion there was no significant difference between the two groups of the ACL reconstructions cases.
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Affiliation(s)
- M A Faisal
- Dr Md Ali Faisal, Assistant Professor, Department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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