1
|
Davidson EJ, Figgie C, Nguyen J, Pedoia V, Majumdar S, Potter HG, Koff MF. Chondral Injury Associated With ACL Injury: Assessing Progressive Chondral Degeneration With Morphologic and Quantitative MRI Techniques. Sports Health 2024; 16:722-734. [PMID: 37876228 PMCID: PMC11346233 DOI: 10.1177/19417381231205276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are associated with a risk of post-traumatic osteoarthritis due to chondral damage. Magnetic resonance imaging (MRI) techniques provide excellent visualization and assessment of cartilage and can detect subtle and early chondral damage. This is often preceding clinical and radiographic post-traumatic osteoarthritis. HYPOTHESIS Morphologic and quantitative MRI techniques can assess early and progressive degenerative chondral changes after acute ACL injury. STUDY DESIGN Prospective longitudinal cohort. LEVEL OF EVIDENCE Level 3. METHODS Sixty-five participants with acute unilateral ACL injuries underwent bilateral knee MRI scans within 1 month of injury. Fifty-seven participants presented at 6 months, while 54 were evaluated at 12 months. MRI morphologic evaluation using a modified Noyes score assessed cartilage signal alteration, chondral damage, and subchondral bone status. Quantitative T1ρ and T2 mapping at standardized anatomic locations in both knees was assessed. Participant-reported outcomes at follow-up time points were recorded. RESULTS Baseline Noyes scores of MRI detectable cartilage damage were highest in the injured knee lateral tibial plateau (mean 2.5, standard error (SE) 0.20, P < 0.01), followed by lateral femoral condyle (mean 2.1, SE 0.18, P < 0.01), which progressed after 1 year. Longitudinal prolongation at 12 months in the injured knees was significant for T1ρ affecting the medial and lateral femoral condyles (P < 0.01) and trochlea (P < 0.01), whereas T2 values were prolonged for medial and lateral femoral condyles (P < 0.01) and trochlea (P < 0.01). The contralateral noninjured knees also demonstrated T1ρ and T2 prolongation in the medial and lateral compartment chondral subdivisions. Progressive chondral damage occurred despite improved patient-reported outcomes. CONCLUSION After ACL injury, initial and sustained chondral damage predominantly affects the lateral tibiofemoral compartment, but longitudinal chondral degeneration also occurred in other compartments of the injured and contralateral knee. CLINICAL RELEVANCE Early identification of chondral degeneration post-ACL injury using morphological and quantitative MRI techniques could enable interventions to be implemented early to prevent or delay PTOA.
Collapse
Affiliation(s)
| | | | - Joseph Nguyen
- HSS MRI Laboratory, Hospital for Special Surgery, New York
| | - Valentina Pedoia
- University of California San Francisco, San Francisco, California
| | | | | | | |
Collapse
|
2
|
Toguchi K, Watanabe A, Horii M, Watanabe S, Itoh R, Sakamoto T, Murata Y, Ohtori S, Sasho T. Longitudinal Analysis of Knee Articular Cartilage Degeneration After Anterior Cruciate Ligament Reconstruction: Comparison of T1rho and T2 Mapping. Cartilage 2024:19476035241264013. [PMID: 39058092 DOI: 10.1177/19476035241264013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE To assess articular cartilage degeneration in anterior cruciate ligament (ACL) reconstructed knees as detected by MR T1rho and T2 mapping relative to controls and longitudinally at 3 months and 1 year after ACL reconstruction (ACLR). DESIGN Twenty-five patients with acute ACL injury were enrolled (13 women and 12 men; mean age 30.8), and 14 healthy controls were selected by sex and age matching. The affected knees of the ACLR participants were imaged using a 3.0T magnetic resonance (MR) scanner 3 months and 1 year after ACLR. Cartilage T1rho and T2 values were quantified for subcompartments in the full-thickness, superficial, and deep layers and were compared with the matched subcompartments of control knees. The influence of concomitant meniscal tears identified using proton density-weighted imaging (PDWI) was also investigated. RESULTS In the posterior lateral tibia, T1rho and T2 values were significantly higher in ACLR participants at 3 months and slightly decreased at 1-year compared to the control group. T1rho values in the medial compartment exhibited a significant increase at 1-year compared with those of control knees, while T2 showed no significance. In cartilage with medial meniscal tears, the T1rho values in multiple medial subcompartments were significantly higher than those in cartilage without medial meniscal tears, and this alteration was relatively detectable by T1rho. CONCLUSIONS T1rho and T2 mapping is effective in evaluating cartilage degeneration following ACLR. T1rho may exhibit greater sensitivity for assessing the progression of early degeneration in the medial compartment after ACLR.
Collapse
Affiliation(s)
- Kaoru Toguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsuya Watanabe
- Osteoarthritis Center, Medical Corporation Jyunhokai, Chiba, Japan
| | - Manato Horii
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shotaro Watanabe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryu Itoh
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuya Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuaki Murata
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| |
Collapse
|
3
|
Bank NC, Sanghvi P, Hecht CJ, Mistovich RJ. The Epidemiology of Posttraumatic Osteoarthritis of the Knee in the United States: An Analysis of 948,853 Patients From 2000 to 2022. J Am Acad Orthop Surg 2024; 32:e313-e320. [PMID: 38236910 DOI: 10.5435/jaaos-d-23-00662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/27/2023] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Posttraumatic osteoarthritis of the knee (PTOAK) is a known sequela of bony and soft-tissue articular knee injuries, although its historically reported prevalence is highly variable with no recent population-based studies. METHODS The TriNetX/US Collaborative Network database was queried to identify adult patients diagnosed with a history of knee trauma using ICD-10-CM coding. Primary outcomes measured were yearly incidence proportion (IP), incidence rate (IR), and prevalence of knee osteoarthritis in the United States from 2000 to 2022. Chi square analyses were conducted to compare outcomes across categorical data. Regression modeling was performed to project PTOAK epidemiology to 2030. Statistical significance was held at P < 0.05 for all analyses. RESULTS Nine hundred forty-eight thousand eight hundred fifty-three patients meeting criteria were identified. As of 2022, the IP of PTOAK was 5.93%, IR was 2.26 × 10 -4 cases/person-day, and prevalence was 21.1%. By strata in 2022, posttraumatic knee OA is most prevalent among the 54 to 59-year-old age group (50.9%), 60 to 64-year-old age group (50.3%), 50 to 54-year-old age group (49.7%), female patients (24.2%), and White patients (23.1%). Regression analyses revealed that the IP, IR, and prevalence of PTOAK have increased exponentially from 2000 to 2022. By 2030, the model predicts that the IP will further increase to 10.7% (95% PI = 9.79% to 11.7%), IR will be 3.79 × 10 -4 cases/person-day (95% PI = 3.28 × 10 -4 to 4.29 × 10 -4 ), and prevalence of PTOAK in the United States will be 40.6% (95% PI = 39.1% to 42.0%). DISCUSSION These findings echo earlier, smaller scale studies but reveal an alarming rise in PTOAK prevalence, potentially doubling by 2030. The financial burden of knee OA treatment in the United States is already substantial, costing between $5.7 and $15 billion USD annually. This projected increase in prevalence could further increase healthcare expenditures by $1 to 3 billion by 2030. These results emphasize the need for additional research into factors contributing to PTOAK, evidence-based preventive public health interventions, and the development of multidisciplinary system-based care delivery optimization pathways.
Collapse
Affiliation(s)
- Nicholas C Bank
- From the Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH (Bank, Sanghvi, Hecht II, and Mistovich), the Department of Orthopaedics, University of North Carolina, Chapel Hill, NC (Bank), and the MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (Mistovich)
| | | | | | | |
Collapse
|
4
|
Itoh M, Itou J, Okazaki K, Iwasaki K. Estimation Failure Risk by 0.5-mm Differences in Autologous Hamstring Graft Diameter in Anterior Cruciate Ligament Reconstruction: A Meta-analysis. Am J Sports Med 2024; 52:535-543. [PMID: 36876736 DOI: 10.1177/03635465221150654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Because grafts are made in 0.5-mm increments clinically for anterior cruciate ligament (ACL) reconstruction, it is important to clarify how the failure rate decreases as the diameter increases. Moreover, it is important to know whether even a slight increase in the graft diameter decreases the risk of failure. HYPOTHESIS The risk of failure decreases significantly with each 0.5-mm increase in hamstring graft diameter. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS The systematic review and meta-analysis have estimated the diameter-specific failure risk for each 0.5-mm increase in ACL reconstruction using autologous hamstring grafts. We searched for studies describing the relationship between graft diameter and failure rate published before December 1, 2021, in leading databases, such as PubMed, EMBASE, Cochrane Library, and Web of Science, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies using single-bundle autologous hamstring grafts to investigate the relationship between failure rate and graft diameter of 0.5-mm intervals with >1-year follow-up. Then, we calculated the failure risk caused by 0.5-mm differences in autologous hamstring graft diameter. Assuming Poisson distribution for the statistical model, we employed an extended linear mixed-effects model in the meta-analyses. RESULTS Five studies containing 19,333 cases were eligible. The meta-analysis revealed that the estimated value of the coefficient of diameter in the Poisson model was -0.2357 with a 95% CI of -0.2743 to -0.1971 (P < .0001). With every 1.0-mm increase in diameter, the failure rate decreased by 0.79 (0.76-0.82) times. In contrast, the failure rate increased by 1.27 (1.22-1.32) times for each 1.0-mm decrease in diameter. The failure rate significantly decreased with each 0.5-mm increase in graft diameter in the range of <7.0 to >9.0 mm from 3.63% to 1.79%. CONCLUSION The risk of failure decreased correspondingly with each 0.5-mm increase in graft diameter in the range of <7.0 to >9.0 mm. Failure is multifactorial; however, increasing the graft diameter as much as possible to match each patient's anatomic space without overstuffing is an effective precaution that surgeons can take to reduce failures.
Collapse
Affiliation(s)
- Masafumi Itoh
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
- Institute for Medical Regulatory Science, Comprehensive Research Organization, Waseda University, Shinjuku, Tokyo, Japan
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Shinjuku, Tokyo, Japan
| | - Junya Itou
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Shinjuku, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - Kiyotaka Iwasaki
- Institute for Medical Regulatory Science, Comprehensive Research Organization, Waseda University, Shinjuku, Tokyo, Japan
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Shinjuku, Tokyo, Japan
- Department of Modern Mechanical Engineering, Waseda University, Shinjuku, Tokyo, Japan
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Shinjuku, Tokyo, Japan
| |
Collapse
|
5
|
Di Paolo S, Nijmeijer EM, Bragonzoni L, Gokeler A, Benjaminse A. Definition of High-Risk Motion Patterns for Female ACL Injury Based on Football-Specific Field Data: A Wearable Sensors Plus Data Mining Approach. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23042176. [PMID: 36850776 PMCID: PMC9961558 DOI: 10.3390/s23042176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 05/30/2023]
Abstract
The aim of the present study was to investigate if the presence of anterior cruciate ligament (ACL) injury risk factors depicted in the laboratory would reflect at-risk patterns in football-specific field data. Twenty-four female footballers (14.9 ± 0.9 year) performed unanticipated cutting maneuvers in a laboratory setting and on the football pitch during football-specific exercises (F-EX) and games (F-GAME). Knee joint moments were collected in the laboratory and grouped using hierarchical agglomerative clustering. The clusters were used to investigate the kinematics collected on field through wearable sensors. Three clusters emerged: Cluster 1 presented the lowest knee moments; Cluster 2 presented high knee extension but low knee abduction and rotation moments; Cluster 3 presented the highest knee abduction, extension, and external rotation moments. In F-EX, greater knee abduction angles were found in Cluster 2 and 3 compared to Cluster 1 (p = 0.007). Cluster 2 showed the lowest knee and hip flexion angles (p < 0.013). Cluster 3 showed the greatest hip external rotation angles (p = 0.006). In F-GAME, Cluster 3 presented the greatest knee external rotation and lowest knee flexion angles (p = 0.003). Clinically relevant differences towards ACL injury identified in the laboratory reflected at-risk patterns only in part when cutting on the field: in the field, low-risk players exhibited similar kinematic patterns as the high-risk players. Therefore, in-lab injury risk screening may lack ecological validity.
Collapse
Affiliation(s)
- Stefano Di Paolo
- Department for Life Quality Studies, University of Bologna, 40136 Bologna, Italy
| | - Eline M. Nijmeijer
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, 40136 Bologna, Italy
| | - Alli Gokeler
- Exercise and Neuroscience Unit, Department Exercise & Health, Faculty of Science, University of Paderborn, 33098 Paderborn, Germany
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Center, 1081 HZ Amsterdam, The Netherlands
- Faculty of Health, Amsterdam University of Applied Sciences, 1091 GC Amsterdam, The Netherlands
| | - Anne Benjaminse
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
- School of Sport Studies, Hanze University Groningen, 9747 AS Groningen, The Netherlands
| |
Collapse
|
6
|
Welhaven HD, Welfley AH, Pershad P, Satalich J, O’Connell R, Bothner B, Vap AR, June RK. Metabolomic Phenotypes Reflect Patient Sex and Injury Status: A Cross-Sectional Analysis of Human Synovial Fluid. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.03.527040. [PMID: 36846378 PMCID: PMC9959930 DOI: 10.1101/2023.02.03.527040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Post-traumatic osteoarthritis (PTOA) is caused by knee injuries like anterior cruciate ligament (ACL) injuries. Often, ACL injuries are accompanied by damage to other tissues and structures within the knee including the meniscus. Both are known to cause PTOA but underlying cellular mechanisms driving disease remain unknown. Aside from injury, patient sex is a prevalent risk factor associated with PTOA. Hypothesis Metabolic phenotypes of synovial fluid that differ by knee injury pathology and participant sex will be distinct from each other. Study Design A cross-sectional study. Methods Synovial fluid from n=33 knee arthroscopy patients between 18 and 70 years with no prior knee injuries was obtained pre-procedure and injury pathology assigned post-procedure. Synovial fluid was extracted and analyzed via liquid chromatography mass spectrometry metabolomic profiling to examine differences in metabolism between injury pathologies and participant sex. Additionally, samples were pooled and underwent fragmentation to identify metabolites. Results Metabolite profiles revealed that injury pathology phenotypes were distinct from each other where differences in endogenous repair pathways that are triggered post-injury were detected. Specifically, acute differences in metabolism mapped to amino acid metabolism, lipid-related oxidative metabolism, and inflammatory-associated pathways. Lastly, sexual dimorphic metabolic phenotypes were examined between male and female participants, and within injury pathology. Specifically, Cervonyl Carnitine and other identified metabolites differed in concentration between sexes. Conclusions The results of this study suggest that different injuries (e.g., ligament vs. meniscus), as well as sex are associated with distinct metabolic phenotypes. Considering these phenotypic associations, a greater understanding of metabolic mechanisms associated with specific injuries and PTOA development may yield data regarding how endogenous repair pathways differ between injury types. Furthermore, ongoing metabolomic analysis of synovial fluid in injured male and female patients can be performed to monitor PTOA development and progression. Clinical Relevance Extension of this work may potentially lead to the identification of biomarkers as well as drug targets that slow, stop, or reverse PTOA progression based on injury type and patient sex.
Collapse
Affiliation(s)
- Hope D. Welhaven
- Department of Chemistry & Biochemistry, Montana State University, Bozeman MT
| | - Avery H. Welfley
- Department of Microbiology & Cell Biology, Montana State University, Bozeman MT
| | - Prayag Pershad
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond VA
| | - James Satalich
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond VA
| | - Robert O’Connell
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond VA
| | - Brian Bothner
- Department of Chemistry & Biochemistry, Montana State University, Bozeman MT
| | - Alexander R. Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond VA
| | - Ronald K. June
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman MT
| |
Collapse
|
7
|
Xu L, Hu YJ, Peng Y, Wang Z, Wang J, Lu WW, Tang B, Guo XE. Early zoledronate treatment inhibits subchondral bone microstructural changes in skeletally-mature, ACL-transected canine knees. Bone 2023; 167:116638. [PMID: 36464243 DOI: 10.1016/j.bone.2022.116638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
Anterior cruciate ligament (ACL) tear leads to post-traumatic osteoarthritis (PTOA), a significant clinical burden worldwide that currently has no cure. Recent studies suggest a role of subchondral bone adaptations in the development of PTOA. Particularly, microstructural changes in the rod-and-plate microstructure of subchondral bone may precede and contribute to OA progression. In this study, we quantified microstructural changes in subchondral trabecular rods and plates after ACL-transection for the first time in the well-established preclinical canine model of PTOA and investigated the therapeutic potentials of a bisphosphonate (zoledronate) and NSAID treatment (meloxicam). Unilateral hindlimb ACL transection was performed on skeletally-mature (2-year-old, N = 20) and juvenile (10-month-old, N = 20) male beagles. Animals were assigned to 4 groups (N = 5): ACLT, un-operated control, ACLT with zoledronate, and ACLT with meloxicam treatment. Subchondral bone microstructure was evaluated by micro-computed tomography and cartilage integrity was evaluated histologically. We found that ACL-induced subchondral bone changes depended on skeletal maturity of animals. In mature animals, significant loss of trabecular plates that resulted in reduced PR ratio occurred at Month 1 and persisted until Month 8. Zoledronate treatment prevented trabecular plate loss while meloxicam treatment did not. Whether cartilage degeneration is also attenuated warrants further investigation. In juvenile animals that have not reached skeletal maturity, transient changes in trabecular plate and rod microstructure occurred at Month 3 but not Month 9. Neither zoledronate nor meloxicam treatment attenuated bone microstructural changes or cartilage damages. Findings from this study suggest that early inhibition of bone resorption by bisphosphonate after injury may be a promising therapeutic approach to prevent alterations in subchondral bone microstructure associated with PTOA. Our results further demonstrate that pathogenesis of PTOA may differ between adolescent and adult patients and therefore require distinct management strategies.
Collapse
Affiliation(s)
- Lei Xu
- Department of Biomedical Engineering, the Southern University of Science and Technology, Shenzhen, PR China; Department of Orthopeadics and Traumatology, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong; Department of Orthopeadics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, PR China
| | - Yizhong Jenny Hu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Ying Peng
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Zexi Wang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Jingyi Wang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - W William Lu
- Department of Orthopeadics and Traumatology, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Bin Tang
- Department of Biomedical Engineering, the Southern University of Science and Technology, Shenzhen, PR China
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA.
| |
Collapse
|
8
|
Narez GE, Brown G, Herrick A, Ek RJ, Dejardin L, Wei F, Haut RC, Haut Donahue TL. Evaluating the Efficacy of Combined P188 Treatment and Surgical Intervention in Preventing Post-Traumatic Osteoarthritis Following a Traumatic Knee Injury. J Biomech Eng 2022; 144:1120716. [PMID: 34751734 DOI: 10.1115/1.4052564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 11/08/2022]
Abstract
Previous studies have shown that reconstructive surgery alone following injury to the anterior cruciate ligament (ACL) does not prevent the development of post-traumatic osteoarthritis (PTOA). Poloxamer 188 (P188) has been shown to prevent cell death following trauma in both articular cartilage and meniscal tissue. This study aims to test the efficacy of single or multiple administrations of P188 in conjunction with reconstructive surgery to help prevent or delay the onset of the disease. Thirty skeletally mature rabbits underwent closed-joint trauma that resulted in ACL rupture and meniscal damage and were randomly assigned to one of four treatment groups with varying doses of P188. ACL reconstruction was then performed using an autograft from the semitendinosus tendon. Animals were euthanized 1-month following trauma, meniscal tissue was assessed for changes in morphology, mechanical properties, and proteoglycan content. Femurs and tibias were scanned using microcomputed tomography to determine changes in bone quality, architecture, and osteophyte formation. The medial meniscus experienced more damage and a decrease in the instantaneous modulus regardless of treatment group, while P188 treatment tended to limit degenerative changes in the lateral meniscus. Both lateral and medial menisci had documented decreases in the equilibrium modulus and inconsistent changes in proteoglycan content. Minimal changes were documented in the tibias and femurs, with the only significant change being the formation of osteophytes in both bones regardless of treatment group. The data suggest that P188 was able to limit some degenerative changes in the meniscus associated with PTOA and may warrant future studies.
Collapse
Affiliation(s)
- Gerardo E Narez
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA 01003
| | - Gabriel Brown
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA 01003
| | - Ashley Herrick
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA 01003
| | - Ryan J Ek
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA 01003
| | - Loic Dejardin
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI 48824
| | - Feng Wei
- Orthopaedic Biomechanics Laboratories, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824
| | - Roger C Haut
- Orthopaedic Biomechanics Laboratories, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824; Department of Mechanical Engineering, Michigan State University, East Lansing, MI 48824
| | - Tammy L Haut Donahue
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA 01003; S631 Life Sciences Laboratory, University of Massachusetts, 240 Thatcher Road, Amherst, MA 01003
| |
Collapse
|
9
|
Grassi A, Pizza N, Al-Zu'bi BBH, Fabbro GD, Lucidi GA, Zaffagnini S. Clinical Outcomes and Osteoarthritis at Very Long-term Follow-up After ACL Reconstruction: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671211062238. [PMID: 35024368 PMCID: PMC8743946 DOI: 10.1177/23259671211062238] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/16/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Few studies on outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) have provided insight into the very long-term effects of this procedure. Purpose: To systematically review the outcomes, failure rate, incidence, and predictors of osteoarthritis (OA) for different ACLR techniques at a minimum 20-year follow-up. Study Design: Systematic review; Level of evidence, 4. Methods: A search of the PubMed, SCOPUS, and Cochrane databases was performed on June 2020 for studies of patients who underwent ACLR and had a minimum follow-up of 20 years. We extracted data on patient and surgical characteristics, patient-reported outcomes (Lysholm score, subjective International Knee Documentation Committee [IKDC] score, Knee injury and Osteoarthritis Outcome Score [KOOS], and Tegner score), clinical outcomes (IKDC grade, pivot shift, Lachman, and KT-1000 laxity), degree of OA (Kellgren-Lawrence, Ahlbäck, and IKDC OA grading), revisions, and failures. Relative risk (RR) of OA between the operated and contralateral knees was calculated as well as the pooled rate of revisions, failures, and conversion to total knee arthroplasty (TKA). Results: Included were 16 studies (N = 1771 patients; mean age, 24.8 years; mean follow-up, 22.7 years); 80% of the patients underwent single-bundle bone–patellar tendon–bone (BPTB) reconstruction. The average Lysholm (89.3), IKDC (78.6), and KOOS subscale scores were considered satisfactory. Overall, 33% of patients had “abnormal” or “severely abnormal” objective IKDC grade, 6.7% had KT-1000 laxity difference of ≥5 mm, 9.4% had Lachman ≥2+, and 6.4% had pivot shift ≥2+. Signs of OA were reported in 73.3% of patients, whereas severe OA was reported in 12.8%. The operated knee had a relative OA risk of 2.8 (P < .001) versus the contralateral knee. Identified risk factors for long-term OA were male sex, older age at surgery, delayed ACLR, meniscal or cartilage injuries, BPTB autograft, lateral plasty, nonideal tunnel placement, residual laxity, higher postoperative activity, and postoperative range of motion deficits. Overall, 7.9% of patients underwent revision, and 13.4% of ACLRs were considered failures. TKA was performed in 1.1% of patients. Conclusion: Most patients had satisfactory subjective outcomes 20 years after ACLR; however, abnormal anteroposterior or rotatory laxity was found in nearly 10% of cases. The presence of radiographic OA was high (RR 2.8 vs uninjured knee), especially in patients with concomitant meniscal or cartilage injuries, older age, and delayed surgery; however, severe OA was present in only 12.8% of cases, and TKA was required in only 1.1%.
Collapse
Affiliation(s)
- Alberto Grassi
- 2nd Orthopaedic and Trauma Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Nicola Pizza
- 2nd Orthopaedic and Trauma Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | | | - Giacomo Dal Fabbro
- Investigation Performed at Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Gian Andrea Lucidi
- 2nd Orthopaedic and Trauma Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Trauma Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| |
Collapse
|
10
|
Kawakami Y, Nonaka K, Fukase N, Amore AD, Murata Y, Quinn P, Luketich S, Takayama K, Patel KG, Matsumoto T, Cummins JH, Kurosaka M, Kuroda R, Wagner WR, Fu FH, Huard J. A Cell-free Biodegradable Synthetic Artificial Ligament for the Reconstruction of Anterior Cruciate Ligament in a Rat Model. Acta Biomater 2021; 121:275-287. [PMID: 33129986 DOI: 10.1016/j.actbio.2020.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
Traditional Anterior Cruciate Ligament (ACL) reconstruction is commonly performed using an allograft or autograft and possesses limitations such as donor site morbidity, decreased range of motion, and potential infection. However, a biodegradable synthetic graft could greatly assist in the prevention of such restrictions after ACL reconstruction. In this study, artificial grafts were generated using "wet" and "dry" electrospinning processes with a biodegradable elastomer, poly (ester urethane) urea (PEUU), and were evaluated in vitro and in vivo in a rat model. Four groups were established: (1) Wet PEUU artificial ligament, (2) Dry PEUU artificial ligament, (3) Dry polycaprolactone artificial ligament (PCL), and (4) autologous flexor digitorum longus tendon graft. Eight weeks after surgery, the in vivo tensile strength of wet PEUU ligaments had significantly increased compared to the other synthetic ligaments. These results aligned with increased infiltration of host cells and decreased inflammation within the wet PEUU grafts. In contrast, very little cellular infiltration was observed in PCL and dry PEUU grafts. Micro-computed tomography analysis performed at 4 and 8 weeks postoperatively revealed significantly smaller bone tunnels in the tendon autograft and wet PEUU groups. The Wet PEUU grafts served as an adequate functioning material and allowed for the creation of tissues that closely resembled the ACL.
Collapse
Affiliation(s)
- Yohei Kawakami
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213; Stem Cell Research Center, University of Pittsburgh, Pittsburgh, PA 15219; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Kazuhiro Nonaka
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Naomasa Fukase
- Steadman Philippon Research Institute, Vail CO 81657; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Antonio D' Amore
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Yoichi Murata
- Steadman Philippon Research Institute, Vail CO 81657
| | - Patrick Quinn
- Steadman Philippon Research Institute, Vail CO 81657
| | - Samuel Luketich
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Koji Takayama
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213; Stem Cell Research Center, University of Pittsburgh, Pittsburgh, PA 15219; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Kunj G Patel
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213; Stem Cell Research Center, University of Pittsburgh, Pittsburgh, PA 15219
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | | | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - William R Wagner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213
| | - Johnny Huard
- Steadman Philippon Research Institute, Vail CO 81657.
| |
Collapse
|
11
|
Li AK, Ochoa JK, Pedoia V, Amano K, Souza RB, Li X, Ma CB. Altered tibiofemoral position following ACL reconstruction is associated with cartilage matrix changes: A voxel-based relaxometry analysis. J Orthop Res 2020; 38:2454-2463. [PMID: 32369216 DOI: 10.1002/jor.24708] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 12/18/2019] [Accepted: 04/23/2020] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to analyze the relationship between postsurgical tibial translation (TT) and tibial rotation (TR) with cartilage matrix changes using quantitative magnetic resonance imaging, specifically voxel-based relaxometry with T1ρ and T2 mapping sequences. Knee magnetic resonance imaging's (MRI's) of 51 patients with unilateral anterior cruciate ligament injury, no concomitant ligamentous injury, history of osteoarthritis (OA), and previous knee surgery were scanned prior to surgery. Thirty-four patients completed follow-up MRI scans at 6-month, 1- and 2-year post-reconstruction and were included in this study. Knee biomechanics, T1ρ, and T2 were calculated using an in-house Matlab program. Compared to the contralateral knee, the injured knee demonstrated significantly increased anterior TT at baseline (P < .001), 6-month (P < .001), 1- (P = .001), and 2-year (P < .001). Furthermore, patients were divided into groups based on TT at 6-month. When compared to patients with normal TT, those with increased anterior TT at 6-month displayed significantly longer T1ρ and T2 relaxation times in 10.4% and 7.4% of the voxels in the injured medial tibia at 1-year, respectively, as well as 12.4% and 9.8% of the voxels in the injured medial tibia at 2-year, respectively. Our results demonstrate an association between abnormal tibiofemoral position and early degradative changes to the articular cartilage matrix of the injured knee. Clinical significance: These findings suggest that altered tibiofemoral position following ACL reconstruction is associated with early degeneration of knee cartilage. Future prospective studies employing longer follow-up times are warranted to evaluate the relationship between abnormal tibiofemoral position and the early onset of posttraumatic OA.
Collapse
Affiliation(s)
- Alan K Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California
| | - Jonathan K Ochoa
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California.,School of Medicine, University of California, San Francisco (UCSF), San Francisco, California
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California
| | - Keiko Amano
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California.,Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), San Francisco, California
| | - Richard B Souza
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California.,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco (UCSF), San Francisco, California
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California.,Department of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, Ohio
| | - Chunbong B Ma
- Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), San Francisco, California
| |
Collapse
|
12
|
Meynard P, Pelet H, Angelliaume A, Legallois Y, Lavignac P, De Bartolo R, Fabre T, Costes S. ACL reconstruction with lateral extra-articular tenodesis using a continuous graft: 10-year outcomes of 50 cases. Orthop Traumatol Surg Res 2020; 106:929-935. [PMID: 32534897 DOI: 10.1016/j.otsr.2020.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Persistence of pivot shift is the main problem after isolated intra-articular anterior cruciate ligament (ACL) reconstruction. Adding lateral extra-articular tenodesis (LET) to the ACL procedure increases the knee's stability by controlling rotational laxity. The aim of this study was to evaluate the long-term clinical and radiological outcomes of combined ACL reconstruction with LET using a continuous hamstring graft as a first-line procedure. MATERIAL AND METHODS Fifty patients were reviewed at 10 years postoperative. Subjective outcome scores -IKDC, Lysholm, KOOS and Tegner- were collected. A clinical and radiological assessment was done. The knees' anteroposterior laxity was measured with a rollimeter. RESULTS The mean IKDC subjective score was 85.5, the mean Lysholm score was 90.2 and 80% of patients had a score graded as good or very good. No pivot shift was present in 94% of patients and there was a firm endpoint in the Lachman test in 86% of patients. There was a flexion deficit>5° in 5 patients and an extension deficit of 10° in one patient. Most patients (56%) had resumed their physical activities at the same level as before the surgery. Signs of osteoarthritis were found in 26% of patients (16% were Ahlback stage 1 and 10% were stage 2). There was only one graft failure. These good outcomes are consistent with other published studies on combined ACL-LET. There was neither significant stiffness, nor a higher rate of secondary osteoarthritis relative to ACL reconstruction only, particularly in the lateral tibiofemoral compartment. CONCLUSION Adding primary LET to ACL reconstruction improves control of rotational laxity over time without increasing the complication rate. LEVEL OF EVIDENCE IV, retrospective study without control group.
Collapse
Affiliation(s)
- Pierre Meynard
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Hugo Pelet
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Audrey Angelliaume
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Yohan Legallois
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Pierre Lavignac
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Rafael De Bartolo
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Thierry Fabre
- Département d'orthopédie-traumatologie, hôpital universitaire de Bordeaux, site Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Stéphane Costes
- Département d'orthopédie-traumatologie, hôpital Robert-Boulin, 112, rue de la Marne, 33500 Libourne, France
| |
Collapse
|
13
|
Liu S, Liu J, Chen W, Zhang L, Wu S, Wang F, Pan J, Luo M, Liu X, Zhang S. Diffusion Tensor Imaging for Quantitative Assessment of Anterior Cruciate Ligament Injury Grades and Graft. J Magn Reson Imaging 2020; 52:1475-1484. [PMID: 32820561 DOI: 10.1002/jmri.27322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND As the need for quantitative assessment of anterior cruciate ligament (ACL) injuries and ACL graft increases, diffusion tensor imaging (DTI) becomes a more valuable measuring tool. However, DTI changes in differing injury grades of ACL and longitudinal graft remain unclear. PURPOSE To investigate the diagnostic performance of DTI in quantitatively assessing ACL injury severity and the development of ACL grafts within 6 months of surgery. STUDY TYPE A cohort study. SUBJECTS Thirty-five patients diagnosed with grades I-IV ACL injuries and 20 volunteers as controls were recruited. FIELD STRENGTH/SEQUENCE T1 -weighted, T2 -weighted, proton density (PD)-weighted, and DTI at 3.0T MRI. ASSESSMENT ACL injury grades in arthroscopic images and DTI quantitative data were evaluated from July 2016 to July 2018. STATISTICAL TESTS Chi-square test, analysis of variance, Spearman correlation analysis, and receiver operator characteristic (ROC) curves. RESULTS Both fractional anisotropy (FA) (r = -0.898, P < 0.05) and apparent diffusion coefficient (ADC) (r = 0.851, P < 0.05) were significantly correlated with the severity of ACL injuries. The area under the curve (AUC) values for differentiation between low- and high-grade ACL injuries with FA and ADC were 0.973 and 0.963, respectively. Although there were no significant differences in FA (P > 0.05) and ADC (P > 0.05) between grades I and II ACL injuries or in ADC (P > 0.05) between grades III and IV, there were significant differences in FA and ADC between two grades (P < 0.05). There were significant differences in FA (P < 0.05) and ADC (P < 0.05) between normal ACL and 3-month graft postoperation, as well as in ADC values between 3-month and 6-month graft postoperation (P < 0.05). DATA CONCLUSION DTI could be used to quantitatively evaluate the ACL injury grades and the development of ACL grafts. The diagnostic efficiency of FA values was higher than that of ADC values. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 3.
Collapse
Affiliation(s)
- Shuyi Liu
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jing Liu
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Weicui Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Lu Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shanshan Wu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Fei Wang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jianke Pan
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Minghui Luo
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Xian Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Shuixing Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| |
Collapse
|
14
|
Yan X, Yang XG, Feng JT, Liu B, Hu YC. Does Revision Anterior Cruciate Ligament (ACL) Reconstruction Provide Similar Clinical Outcomes to Primary ACL Reconstruction? A Systematic Review and Meta-Analysis. Orthop Surg 2020; 12:1534-1546. [PMID: 32790162 PMCID: PMC7767695 DOI: 10.1111/os.12638] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 01/14/2023] Open
Abstract
More revisionary reconstruction procedures are required following failing anterior cruciate ligament (ACL) reconstructions, which are often regarded as a technique challenge with very limited goals. This study will be performed to compare the outcomes between groups of primary and revision knee reconstruction. Two observers conducted the literature retrieval from the platforms of PubMed, Embase, and CENTRAL. Studies which compared knee function and stability between primary and revisionary reconstructions were included. The data was synthesized by meta‐analysis with fixed‐ or random‐effects models as appropriate. A total of 10 eligible studies were included with 954 subjects in the primary group and 378 in the revision group. The International Knee Documentation Committee International Knee Documentation Committee (IKDC) subscores, side‐to‐side difference, and Lysholm score were demonstrated to be significantly improved at final follow‐up in both groups, while Tegner score was not. The overall IKDC, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm scores were significantly inferior in the revision group compared to the primary group. However, knee laxity according to side‐to‐side difference was demonstrated to be similar between the two groups. Revision ACL reconstruction (RACLR) could provide patients with excellent restoration of knee outcomes compared to the status before revision. Also, while knee function in the revision group was inferior to the primary group, knee stability was equivalent between the two groups at the final follow‐up.
Collapse
Affiliation(s)
- Xu Yan
- Department of Orthopedics Emergency, Tianjin Hospital, Tianjin, China
| | - Xiong-Gang Yang
- Department of Orthopedic Oncology, Tianjin Hospital, Tianjin, China
| | - Jiang-Tao Feng
- Department of Orthopedic Oncology, Tianjin Hospital, Tianjin, China
| | - Bin Liu
- Center for Medical Device Evaluation NMPA, Beijing, China
| | - Yong-Cheng Hu
- Department of Orthopedic Oncology, Tianjin Hospital, Tianjin, China
| |
Collapse
|
15
|
Freiberger C, Kiapour AM, Liu S, Henderson RN, Barnett S, Sant NJ, Proffen BL, Fleming BC, Ecklund K, Kramer DE, Micheli LJ, Murray MM, Yen YM. Higher Physiologic Platelet Counts in Whole Blood Are Not Associated With Improved ACL Cross-sectional Area or Signal Intensity 6 Months After Bridge-Enhanced ACL Repair. Orthop J Sports Med 2020; 8:2325967120927655. [PMID: 32656289 PMCID: PMC7331772 DOI: 10.1177/2325967120927655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/21/2020] [Indexed: 01/08/2023] Open
Abstract
Background: A bridge-enhanced anterior cruciate ligament (ACL) repair (BEAR) procedure places an extracellular matrix implant, combined with autologous whole blood, in the gap between the torn ends of the ligament at the time of suture repair to stimulate healing. Prior studies have suggested that white blood cell (WBC) and platelet concentrations significantly affect the healing of other musculoskeletal tissues. Purpose/Hypothesis: The purpose of this study was to determine whether concentrations of various blood cell types placed into a bridging extracellular matrix implant at the time of ACL repair would have a significant effect on the healing ligament cross-sectional area or tissue organization (as measured by signal intensity). We hypothesized that patients with higher physiologic platelet and lower WBC counts would have improved healing of the ACL on magnetic resonance imaging (MRI) (higher cross-sectional area and/or lower signal intensity) 6 months after surgery. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 61 patients underwent MRI at 6 months after bridge-enhanced ACL repair as part of the BEAR II trial. The normalized signal intensity and average cross-sectional area of the healing ligament were measured from a magnetic resonance stack obtained using a gradient echo sequence. The results were stratified by sex, and univariate and multivariate regression analyses determined significant correlations between blood cell concentrations on these 2 magnetic resonance parameters. Results: In unadjusted analyses, older age and male sex were associated with greater healing ligament cross-sectional area (P < .04) but not signal intensity (P > .15). Adjusted multivariable analyses indicated that in female patients, a higher monocyte concentration correlated with a higher ACL cross-sectional area (β = 1.01; P = .049). All other factors measured, including the physiologic concentration of platelets, neutrophils, lymphocytes, basophils, and immunoglobulin against bovine gelatin, were not significantly associated with either magnetic resonance parameter in either sex (P > .05 for all). Conclusion: Although older age, male sex, and monocyte concentration in female patients were associated with greater healing ligament cross-sectional area, signal intensity of the healing ligament was independent of these factors. Physiologic platelet concentration did not have any significant effect on cross-sectional area or signal intensity of the healing ACL at 6 months after bridge-enhanced ACL repair in this cohort. Given these findings, factors other than the physiologic platelet concentration and total WBC concentration may be more important in the rate and amount of ACL healing after bridge-enhanced ACL repair.
Collapse
Affiliation(s)
- Christina Freiberger
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ata M Kiapour
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Shanshan Liu
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Rachael N Henderson
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Samuel Barnett
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Nicholas J Sant
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Benedikt L Proffen
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Braden C Fleming
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kirsten Ecklund
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dennis E Kramer
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lyle J Micheli
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Martha M Murray
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Costa GG, Grassi A, Perelli S, Agrò G, Bozzi F, Lo Presti M, Zaffagnini S. Age over 50 years is not a contraindication for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:3679-3691. [PMID: 30944945 DOI: 10.1007/s00167-019-05450-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/25/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE To report clinical and functional results of ACL reconstruction in patients over 50 years old and investigate the influence of surgery on osteoarthritis progression in this cohort of patients. METHODS A systematic review was performed on PubMed, Scopus, Google scholar, Cochrane library and EMBASE, using a strategy search design to collect clinical studies reporting outcomes of ACL reconstruction in patients aged 50 years or older. The primary outcome measure was clinical and functional results, including failure rate defined as reoperation for revision ACL surgery or conversion to total knee arthroplasty; secondary outcomes included radiological findings, expressed according to the validated grading score. RESULTS A total of 16 studies were found suitable and included. Overall, 470 arthroscopic ACL reconstructions were performed in 468 patients (278 males, 190 females), with a mean age of 53.6 years (50-75 years). The total failure rate, described as reoperation for revision ACL surgery was 2.7% (10 knees), ranging from 0 to 14.3% in the selected studies. All papers reviewed showed a statistically significant improvement of clinical and functional scores at final follow-up, comparable to younger control group, when reported. Post-operative objective stability testing with KT-1000 arthrometer device or equivalent was performed in seven studies, with a mean side-to-side difference of 2.2 mm (0.2-2.7 mm). Radiographic signs of progression of osteoarthritis were reported in six studies, where severe signs of degeneration (grade 3 or 4 according Kellgren-Lawrence or Ahlbäck classification) shifted from 4 out of 216 knees (1.9%) before surgery to 28 out of 187 knees (15%) following ACL reconstruction, after a mean period of follow-up ranging from 32 to 64 months. CONCLUSION ACL reconstruction in patients older than 50 years is a safe procedure with good results that are comparable to those of younger patients previously reported. Age itself is not a contraindication to ACL surgery because physiological age, clinical symptoms and functional requests are more important than chronological age in decision process. Since cohort size in the present study is not large enough, and taking into account the high occurrence of concomitant meniscal and chondral lesions, more high-quality studies are necessary to draw definitive conclusions about development of osteoarthritis of the knee after ACL surgery in these patients. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Giuseppe Gianluca Costa
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy.
| | - Alberto Grassi
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Simone Perelli
- Università Cattolica del Sacro Cuore-Fondazione Poliambulanza, Via Bissolati n. 57, 25124, Brescia, Italy
| | - Giuseppe Agrò
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Federico Bozzi
- Università Cattolica del Sacro Cuore-Fondazione Poliambulanza, Via Bissolati n. 57, 25124, Brescia, Italy
| | - Mirco Lo Presti
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| |
Collapse
|
17
|
Knee Surgery Is Associated With Greater Odds of Knee Osteoarthritis Diagnosis. J Sport Rehabil 2019; 28:716-723. [PMID: 30040014 DOI: 10.1123/jsr.2018-0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/14/2018] [Accepted: 07/05/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Knee osteoarthritis (OA) frequently develops following knee injury/surgery. It is accepted that knee injury/surgery precipitates OA with previous studies examining this link in terms of years after injury/surgery. However, postinjury OA prevalence has not been examined by decade of life; thereby, limiting our understanding of the age at which patients are diagnosed with posttraumatic knee OA. OBJECTIVE Evaluate the association between the knee injury and/or surgical history, present age, and history of receiving a diagnosis of knee OA. DESIGN Cross-sectional survey. SETTING Online survey. PARTICIPANTS A total of 3660 adults were recruited through ResearchMatch©. Of these, 1723 (47.1%) were included for analysis due to history of (1) knee surgery (SURG: n = 276; age = 53.8 [15.3] y; and body mass index [BMI] = 29.9 [8.0] kg/m2), (2) nonsurgical knee injury (INJ: n = 449; age = 46.0 [15.6] y; and BMI = 27.5 [6.9] kg/m2), or (3) no knee injury (CTRL: n = 998; age = 44.0 [25.2] y; and BMI = 26.9 [6.6] kg/m2). Respondents were subdivided by decade of life (20-29 through 70+). INTERVENTION An electronic survey regarding knee injury history, treatment, and diagnosis of knee OA. MAIN OUTCOME MEASURES Binary logistic regression determined the association between knee surgical status and OA by decade of life. Participants with no histories of OA or lower-extremity injury were the referent categories. BMI was a covariate in all analyses. RESULTS SURG respondents were more likely to report having knee OA than CTRL for all age groups (odds ratios: 11.43-53.03; P < .001). INJ respondents aged 30 years and older were more likely to have OA than CTRL (odds ratios: 2.99-14.22; P < .04). BMI influenced associations for respondents in their 50s (P = .001) and 60s (P < .001) only. CONCLUSIONS INJ increased the odds of reporting a physician diagnosis of knee OA in adults as young as 30 to 39 years. Importantly, SURG yielded 3 to 4 times greater odds of being diagnosed with knee OA compared with INJ in adults as young as 20 to 29 years. Delaying disease onset in these young adults is imperative to optimize the quality of life long term after surgery.
Collapse
|
18
|
Poulsen E, Goncalves GH, Bricca A, Roos EM, Thorlund JB, Juhl CB. Knee osteoarthritis risk is increased 4-6 fold after knee injury - a systematic review and meta-analysis. Br J Sports Med 2019; 53:1454-1463. [PMID: 31072840 DOI: 10.1136/bjsports-2018-100022] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To estimate knee osteoarthritis (OA) risk following anterior cruciate ligament (ACL), meniscus or combined ACL and meniscus injury. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, SPORTDiscus, CINAHL and Web of Science until November 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Prospective or retrospective studies with at least 2-year follow-up including adults with ACL injury, meniscal injury or combined injuries. Knee OA was defined by radiographs or clinical diagnosis and compared with the contralateral knee or non-injured controls. STUDY APPRAISAL AND SYNTHESIS Risk of bias was assessed using the SIGN50 checklist. ORs for developing knee OA were estimated using random effects meta-analysis. RESULTS 53 studies totalling ∼1 million participants were included: 185 219 participants with ACL injury, mean age 28 years, 35% females, 98% surgically reconstructed; 83 267 participants with meniscal injury, mean age 38 years, 36% females, 22% confirmed meniscectomy and 73% unknown; 725 362 participants with combined injury, mean age 31 years, 26% females, 80% treated surgically. The OR of developing knee OA were 4.2 (95% CI 2.2 to 8.0; I2=92%), 6.3 (95% CI 3.8 to 10.5; I2=95%) and 6.4 (95% CI 4.9 to 8.3; I2=62%) for patients with ACL injury, meniscal injury and combined injuries, respectively. CONCLUSION The odds of developing knee OA following ACL injury are approximately four times higher compared with a non-injured knee. A meniscal injury and a combined injury affecting both the ACL and meniscus are associated with six times higher odds compared with a non-injured knee. Large inconsistency (eg, study design, follow-up period and comparator) and few high-quality studies suggest that future studies may change these estimates. CLINICAL RELEVANCE Patients sustaining a major knee injury have a substantially increased risk of developing knee OA, highlighting the importance of knee injury prevention programmes and secondary prevention strategies to prevent or delay knee OA development.PROSPERO registration number CRD42015016900.
Collapse
Affiliation(s)
- Erik Poulsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Glaucia H Goncalves
- Department of Physical Therapy, Universidade Federal de Sao Carlos, Sao Carlos, Brazil
| | - Alessio Bricca
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jonas B Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Carsten B Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Occupational and Physical Therapy, Gentofte and Herlev Hospitals, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
19
|
Weber AE, Zuke W, Mayer EN, Forsythe B, Getgood A, Verma NN, Bach BR, Bedi A, Cole BJ. Lateral Augmentation Procedures in Anterior Cruciate Ligament Reconstruction: Anatomic, Biomechanical, Imaging, and Clinical Evidence. Am J Sports Med 2019; 47:740-752. [PMID: 29401410 DOI: 10.1177/0363546517751140] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There has been an increasing interest in lateral-based soft tissue reconstructive techniques as augments to anterior cruciate ligament reconstruction (ACLR). The objective of these procedures is to minimize anterolateral rotational instability of the knee after surgery. Despite the relatively rapid increase in surgical application of these techniques, many clinical questions remain. PURPOSE To provide a comprehensive update on the current state of these lateral-based augmentation procedures by reviewing the origins of the surgical techniques, the biomechanical data to support their use, and the clinical results to date. STUDY DESIGN Systematic review. METHODS A systematic search of the literature was conducted via the Medline, EMBASE, Scopus, SportDiscus, and CINAHL databases. The search was designed to encompass the literature on lateral extra-articular tenodesis (LET) procedures and the anterolateral ligament (ALL) reconstruction. Titles and abstracts were reviewed for relevance and sorted into the following categories: anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes. RESULTS The search identified 4016 articles. After review for relevance, 31, 53, 27, 35, 45, and 78 articles described the anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes of either LET procedures or the ALL reconstruction, respectively. A multitude of investigations were available, revealing controversy in addition to consensus in several categories. The level of evidence obtained from this search was not adequate for systematic review or meta-analysis; thus, a current concepts review of the anatomy, biomechanics, imaging, surgical techniques, and clinical outcomes was performed. CONCLUSION Histologically, the ALL appears to be a distinct structure that can be identified with advanced imaging techniques. Biomechanical evidence suggests that the anterolateral structures of the knee, including the ALL, contribute to minimizing anterolateral rotational instability. Cadaveric studies of combined ACLR-LET procedures demonstrated overconstraint of the knee; however, these findings have yet to be reproduced in the clinical literature. The current indications for LET augmentation in the setting of ACLR and the effect on knee kinematic and joint preservation should be the subject of future research.
Collapse
Affiliation(s)
- Alexander E Weber
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
| | - William Zuke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Erik N Mayer
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Alan Getgood
- Fowler Kennedy Sports Clinic, Western University, London, Ontario, Canada
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Bernard R Bach
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
20
|
Shekarforoush M, Barton KI, Beveridge JE, Scott M, Martin CR, Muench G, Heard BJ, Sevick JL, Hart DA, Frank CB, Shrive NG. Alterations in Joint Angular Velocity Following Traumatic Knee Injury in Ovine Models. Ann Biomed Eng 2019; 47:790-801. [DOI: 10.1007/s10439-019-02203-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/09/2019] [Indexed: 01/13/2023]
|
21
|
Lecoq FA, Parienti JJ, Murison J, Ruiz N, Bouacida K, Besse J, Morin V, Padiolleau G, Cucurulo T, Graveleau N, Hulet C. Graft Choice and the Incidence of Osteoarthritis After Anterior Cruciate Ligament Reconstruction: A Causal Analysis From a Cohort of 541 Patients. Am J Sports Med 2018; 46:2842-2850. [PMID: 30199646 DOI: 10.1177/0363546518795137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction is important to prevent knee osteoarthritis. Neither of the 2 most common graft techniques-the patellar tendon (PT) or hamstring tendon (HS) graft-has demonstrated superiority in terms of the long-term osteoarthritis rate. HYPOTHESIS Based on the International Knee Documentation Committee (IKDC) radiographic grading system, PT grafts decrease the incidence of osteoarthritis by providing better knee stability as compared with HS grafts over 12 years of follow-up. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All adults with a first ACL rupture who underwent surgery with a PT or HS graft technique between January 2002 and December 2003 were included in the 2014 French Society of Orthopedic Surgery and Traumatology Symposium database. Baseline characteristics were collected. The primary endpoint was the occurrence of moderate to severe osteoarthritis in each group. The secondary endpoints included clinical subjective evaluations by the IKDC score and Knee injury and Osteoarthritis Outcome Score. To control the differences in baseline characteristics, the data were analyzed with propensity score matching. RESULTS In the cohort, 541 patients from 18 centers were included: 311 PT and 230 HS ACL reconstructions. The baseline characteristics were similar after inverse probability weighting treatment (IPWT). The occurrence of osteoarthritis was similar after IPWT (19.3% for PT and 19.6% for HS, P = .94). Age at surgery >29 years and IKDC osteoarthritis stage B at the index surgery were identified as risk factors for moderate to severe osteoarthritis. Most functional outcomes were significantly higher in the HS group; however, the difference between groups remained <10 points. Of the 106 patients who needed a medial meniscectomy, the proportion of patients with moderate to severe osteoarthritis was much higher in the HS group (43.5% vs 18.3%, P = .006). However, after IPWT, the difference was not statistically significant. CONCLUSION At 12 years of follow-up, neither graft technique was superior to the other in terms of the rate of osteoarthritis.
Collapse
Affiliation(s)
- Flore-Anne Lecoq
- Department of Orthopaedic Surgery and Traumatology, Unit INSERM COMETE, UMR U1075, Caen University Hospital, Caen, France
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France
| | - James Murison
- Clinic of Traumatology and Orthopaedics, Percy Military Hospital, Clamart, France
| | - Nicolas Ruiz
- Orthopaedic Department, North Mayenne Hospital, Mayenne, France
| | - Khaled Bouacida
- Department of Orthopaedic Surgery, Antibes Hospital, Antibes, France
| | - Jérémy Besse
- Department of Orthopedic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Vincent Morin
- Department of Orthopedic Surgery, Grenoble University Hospital, Grenoble, France
| | - Giovany Padiolleau
- Department of Orthopedic Surgery, Nantes University Hospital, Nantes, France
| | | | - Nicolas Graveleau
- Orthopaedic Surgeon and Sport Medicine Consultation, Sports Clinic of Bordeaux-Mérignac, Mérignac, France
| | - Christophe Hulet
- Department of Orthopaedic Surgery and Traumatology, Unit INSERM COMETE, UMR U1075, Caen University Hospital, Caen, France
| | -
- Société Française de Chirurgie Orthopédique et de Traumatologie, Paris, France
| |
Collapse
|
22
|
Sonnery-Cottet B, Saithna A, Blakeney WG, Ouanezar H, Borade A, Daggett M, Thaunat M, Fayard JM, Delaloye JR. Anterolateral Ligament Reconstruction Protects the Repaired Medial Meniscus: A Comparative Study of 383 Anterior Cruciate Ligament Reconstructions From the SANTI Study Group With a Minimum Follow-up of 2 Years. Am J Sports Med 2018; 46:1819-1826. [PMID: 29741400 DOI: 10.1177/0363546518767659] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prevalence of osteoarthritis after successful meniscal repair is significantly less than that after failed meniscal repair. PURPOSE To determine whether the addition of anterolateral ligament reconstruction (ALLR) confers a protective effect on medial meniscal repair performed at the time of anterior cruciate ligament reconstruction (ACLR). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Retrospective analysis of prospectively collected data was performed to include all patients who had undergone primary ACLR with concomitant posterior horn medial meniscal repair through a posteromedial portal between January 2013 and August 2015. ACLR autograft choice was bone-patellar tendon-bone, hamstring tendons (or quadrupled hamstring tendons), or quadrupled semitendinosus tendon graft with or without ALLR. At the end of the study period, all patients were contacted to determine if they had undergone reoperation. A Kaplan-Meier survival curve was plotted, and a Cox proportional hazards regression model was used to perform multivariate analysis. RESULTS A total of 383 patients (mean ± SD age, 27.4 ± 9.2 years) were included with a mean follow-up of 37.4 months (range, 24-54.9 months): 194 patients underwent an isolated ACLR, and 189 underwent a combined ACLR + ALLR. At final follow-up, there was no significant difference between groups in postoperative side-to-side laxity (isolated ACLR group, 0.9 ± 0.9 mm [min to max, -1 to 3]; ACLR + ALLR group, 0.8 ± 1.0 mm [min to max, -2 to 3]; P = .2120) or Lysholm score (isolated ACLR group, 93.0 [95% CI, 91.3-94.7]; ACLR + ALLR group, 93.7 [95% CI, 92.3-95.1]; P = .556). Forty-three patients (11.2%) underwent reoperation for failure of the medial meniscal repair or a new tear. The survival rates of meniscal repair at 36 months were 91.2% (95% CI, 85.4%-94.8) in the ACLR + ALLR group and 83.8% (95% CI, 77.1%-88.7%; P = .033) in the ACLR group. The probability of failure of medial meniscal repair was >2 times lower in patients with ACLR + ALLR as compared with patients with isolated ACLR (hazard ratio, 0.443; 95% CI, 0.218-0.866). No other prognosticators of meniscal repair failure were identified. CONCLUSION Combined ACLR and ALLR is associated with a significantly lower rate of failure of medial meniscal repairs when compared with those performed at the time of isolated ACLR.
Collapse
Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Adnan Saithna
- Southport and Ormskirk Hospital, Southport, UK.,School of Science and Technology, Nottingham Trent University, Clifton Campus, Nottingham, UK
| | - William G Blakeney
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Herve Ouanezar
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Amrut Borade
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Matt Daggett
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Jean-Romain Delaloye
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| |
Collapse
|
23
|
Quantitative T2-Mapping and T2 ⁎-Mapping Evaluation of Changes in Cartilage Matrix after Acute Anterior Cruciate Ligament Rupture and the Correlation between the Results of Both Methods. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7985672. [PMID: 29888279 PMCID: PMC5985074 DOI: 10.1155/2018/7985672] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/11/2018] [Indexed: 12/19/2022]
Abstract
Objectives To quantitatively assess changes in cartilage matrix after acute anterior cruciate ligament (ACL) rupture using T2- and T2⁎-mapping and analyze the correlation between the results of both methods. Methods Twenty-three patients and 23 healthy controls were enrolled and underwent quantitative MRI examination. The knee cartilage was segmented into six compartments, including lateral femur (LF), lateral tibia (LT), medial femur (MF), medial tibia (MT), trochlea (Tr), and patella (Pa). T2 and T2⁎ values were measured in full-thickness as well as superficial and deep layers of each cartilage compartment. Differences of T2 and T2⁎ values between patients and controls were compared using unpaired Student's t-test, and the correlation between their reciprocals was analyzed using Pearson's correlation coefficient. Results ACL-ruptured patients showed higher T2 and T2⁎ values in full-thickness and superficial layers of medial and lateral tibiofemoral joint. Meanwhile, patients exhibited higher T2⁎ values in deep layers of lateral tibiofemoral joint. The elevated percentages of T2 and T2⁎ value in superficial LT were most significant (20.738%, 17.525%). The reciprocal of T2⁎ value was correlated with that of T2 value (r = 0.886, P < 0.001). Conclusion The early degeneration could occur in various knee cartilage compartments after acute ACL rupture, especially in the superficial layer of LT. T2⁎-mapping might be more sensitive in detecting deep layer of cartilage than T2-mapping.
Collapse
|
24
|
Spindler KP, Huston LJ, Chagin KM, Kattan MW, Reinke EK, Amendola A, Andrish JT, Brophy RH, Cox CL, Dunn WR, Flanigan DC, Jones MH, Kaeding CC, Magnussen RA, Marx RG, Matava MJ, McCarty EC, Parker RD, Pedroza AD, Vidal AF, Wolcott ML, Wolf BR, Wright RW. Ten-Year Outcomes and Risk Factors After Anterior Cruciate Ligament Reconstruction: A MOON Longitudinal Prospective Cohort Study. Am J Sports Med 2018; 46. [PMID: 29543512 PMCID: PMC6036619 DOI: 10.1177/0363546517749850] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The long-term prognosis and risk factors for quality of life and disability after anterior cruciate ligament (ACL) reconstruction remain unknown. Hypothesis/Purpose: Our objective was to identify patient-reported outcomes and patient-specific risk factors from a large prospective cohort at a minimum 10-year follow-up after ACL reconstruction. We hypothesized that meniscus and articular cartilage injuries, revision ACL reconstruction, subsequent knee surgery, and certain demographic characteristics would be significant risk factors for inferior outcomes at 10 years. STUDY DESIGN Therapeutic study; Level of evidence, 2. METHODS Unilateral ACL reconstruction procedures were identified and prospectively enrolled between 2002 and 2004 from 7 sites in the Multicenter Orthopaedic Outcomes Network (MOON). Patients preoperatively completed a series of validated outcome instruments, including the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity rating scale. At the time of surgery, physicians documented all intra-articular abnormalities, treatment, and surgical techniques utilized. Patients were followed at 2, 6, and 10 years postoperatively and asked to complete the same outcome instruments that they completed at baseline. The incidence and details of any subsequent knee surgeries were also obtained. Multivariable regression analysis was used to identify significant predictors of the outcome. RESULTS A total of 1592 patients were enrolled (57% male; median age, 24 years). Ten-year follow-up was obtained on 83% (n = 1320) of the cohort. Both IKDC and KOOS scores significantly improved at 2 years and were maintained at 6 and 10 years. Conversely, Marx scores dropped markedly over time, from a median score of 12 points at baseline to 9 points at 2 years, 7 points at 6 years, and 6 points at 10 years. The patient-specific risk factors for inferior 10-year outcomes were lower baseline scores; higher body mass index; being a smoker at baseline; having a medial or lateral meniscus procedure performed before index ACL reconstruction; undergoing revision ACL reconstruction; undergoing lateral meniscectomy; grade 3 to 4 articular cartilage lesions in the medial, lateral, or patellofemoral compartments; and undergoing any subsequent ipsilateral knee surgery after index ACL reconstruction. CONCLUSION Patients were able to perform sports-related functions and maintain a relatively high knee-related quality of life 10 years after ACL reconstruction, although activity levels significantly declined over time. Multivariable analysis identified several key modifiable risk factors that significantly influence the outcome.
Collapse
Affiliation(s)
| | - Kurt P. Spindler
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura J. Huston
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin M. Chagin
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael W. Kattan
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emily K. Reinke
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annunziato Amendola
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jack T. Andrish
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert H. Brophy
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles L. Cox
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Warren R. Dunn
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David C. Flanigan
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Morgan H. Jones
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher C. Kaeding
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert A. Magnussen
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert G. Marx
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew J. Matava
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric C. McCarty
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard D. Parker
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Angela D. Pedroza
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Armando F. Vidal
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michelle L. Wolcott
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian R. Wolf
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rick W. Wright
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
25
|
Inoue H, Furumatsu T, Miyazawa S, Fujii M, Kodama Y, Ozaki T. Improvement in the medial meniscus posterior shift following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:434-441. [PMID: 28965142 DOI: 10.1007/s00167-017-4729-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/20/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) reconstruction can reduce the risk of developing osteoarthritic knees. The goals of ACL reconstruction are to restore knee stability and reduce post-traumatic meniscal tears and cartilage degradation. A chronic ACL insufficiency frequently results in medial meniscus (MM) injury at the posterior segment. How ACL reconstruction can reduce the deformation of the MM posterior segment remains unclear. In this study, we evaluated the form of the MM posterior segment and anterior tibial translation before and after ACL reconstruction using open magnetic resonance imaging (MRI). METHODS Seventeen patients who underwent ACL reconstructions without MM injuries were included in this study. MM deformation was evaluated using open MRI before surgery and 3 months after surgery. We measured medial meniscal length (MML), medial meniscal height (MMH), medial meniscal posterior body width (MPBW), MM-femoral condyle contact width (M-FCW) and posterior tibiofemoral distance (PTFD) at knee flexion angles of 10° and 90°. RESULTS There were no significant pre- and postoperative differences during a flexion angle of 10°. At a flexion angle of 90°, MML decreased from 43.7 ± 4.5 to 41.4 ± 4.5 mm (P < 0.001), MMH from 7.5 ± 1.4 to 6.9 ± 1.4 mm (P = 0.006), MPBW from 13.1 ± 2.0 to 12.2 ± 1.9 mm (P < 0.001) and M-FCW from 10.0 ± 1.5 to 8.5 ± 1.5 mm (P < 0.001) after ACL reconstruction. The PTFD increased from 2.1 ± 2.8 to 2.7 ± 2.4 mm after ACL reconstruction (P = 0.015). CONCLUSIONS ACL reconstruction affects the contact pattern between the MM posterior segment and medial femoral condyle and can reduce the deformation of the MM posterior segment in the knee-flexed position by reducing abnormal anterior tibial translation. It possibly prevents secondary injury to the MM posterior segment and cartilage that progresses to knee osteoarthritis. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Hiroto Inoue
- Department of Orthopedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Shinichi Miyazawa
- Department of Orthopedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Masataka Fujii
- Department of Orthopedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yuya Kodama
- Department of Orthopedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| |
Collapse
|
26
|
Maerz T, Fleischer M, Newton MD, Davidson A, Salisbury M, Altman P, Kurdziel MD, Anderson K, Bedi A, Baker KC. Acute mobilization and migration of bone marrow-derived stem cells following anterior cruciate ligament rupture. Osteoarthritis Cartilage 2017; 25:1335-1344. [PMID: 28284998 DOI: 10.1016/j.joca.2017.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/21/2017] [Accepted: 03/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Little is known regarding acute local and systemic processes following anterior cruciate ligament (ACL) rupture. No study has elucidated whether bone marrow-derived mesenchymal stem cells (MSCs) are mobilized into circulation and recruited to the injured joint. METHODS In Part 1, Lewis rats were randomized to noninvasive ACL rupture (Rupture) or non-injured (Control) (n = 6/group). After 72 h, whole blood MSC concentration was assessed using flow cytometry. Synovial fluid and serum were assayed for stromal cell-derived factor (SDF)-1α and cartilage degeneration biomarkers, respectively. In Part 2, 12 additional rats were randomized and intravenously-injected with fluorescently-labeled allogenic MSCs. Cell tracking was performed using longitudinal, in vivo and ex vivo near-infrared (NIR) imaging and histology. Synovium SDF-1α and interleukin (IL)-17A immunostaining was performed. Serum was assayed for SDF-1α and 29 other cytokines. RESULTS In Part 1, there was a significant increase in MSC concentration and synovial fluid SDF-1α in Rupture. No differences in cartilage biomarkers were observed. In Part 2, Rupture had significantly higher NIR signal at 24, 48, and 72 h, indicating active recruitment of MSCs to the injured joint. Ex vivo cell tracking demonstrated MSC localization in the synovium and myotendinous junction (MTJ) of the quadriceps. Injured synovia exhibited increased synovitis grade and higher degree of IL-17A and SDF-1α immunostaining. CONCLUSION ACL rupture induced peripheral blood mobilization of MSCs and migration of intravenously-injected allogenic MSCs to the injured joint, where they localized in the synovium and quadriceps MTJ.
Collapse
Affiliation(s)
- T Maerz
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA; Department of Orthopaedic Surgery, Oakland University - William Beaumont School of Medicine, Rochester, MI, USA
| | - M Fleischer
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA
| | - M D Newton
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA
| | - A Davidson
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA
| | - M Salisbury
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA
| | - P Altman
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | - M D Kurdziel
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA; Department of Orthopaedic Surgery, Oakland University - William Beaumont School of Medicine, Rochester, MI, USA
| | - K Anderson
- Department of Orthopaedic Surgery, Oakland University - William Beaumont School of Medicine, Rochester, MI, USA; Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | - A Bedi
- MedSport and Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - K C Baker
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, MI, USA; Department of Orthopaedic Surgery, Oakland University - William Beaumont School of Medicine, Rochester, MI, USA.
| |
Collapse
|
27
|
Riccardo C, Fabio C, Pietro R. Knee Osteoarthritis after Reconstruction of Isolated Anterior Cruciate Ligament Injuries: A Systematic Literature Review. JOINTS 2017; 5:39-43. [PMID: 29114629 PMCID: PMC5672858 DOI: 10.1055/s-0037-1601409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Purpose
The aim of this review was to analyze the current literature on osteoarthritic evolution of knees without any combined meniscal or ligament lesions undergoing anterior cruciate ligament (ACL) reconstruction.
Methods
A PubMed/MEDLINE research was performed using the following keywords: “Anterior Cruciate Ligament Reconstruction” [Mesh] AND “Osteoarthritis, Knee” [Mesh]. Only English language literature and articles published after 2005 were included. Studies including concomitant meniscal tears, posterior cruciate or collateral ligament injuries, previous surgery in the affected knees, infections, osteochondral defects, loose bodies, synovial plica syndrome, and posteromedial or posterolateral corner injuries were not considered in this review.
Results
Twelve studies were selected. These papers included 892 patients (mean age at the time of surgery was 22.3 years), with an average follow-up of 11 years. Imaging at follow-up was obtained with standard radiographs in nine studies, magnetic resonance imaging (MRI) in one study, and both X-rays and MRI in two studies. Eight studies reported osteoarthritic evolution, with different prevalence.
Conclusion
Only few high-quality studies focused on these specific patients have been published. When reconstructed, isolated ACL-deficient knees have a low risk of osteoarthritic evolution, but mild signs of joint degeneration are reported by the current literature.
Level of Evidence
Level IV, systematic review of level I to level IV studies.
Collapse
Affiliation(s)
- Compagnoni Riccardo
- ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini - CTO, Milan, Italy
| | - Catani Fabio
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Randelli Pietro
- ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini - CTO, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, University of Milan, Milan, Italy
| |
Collapse
|
28
|
Combined anterior cruciate ligament reconstruction and lateral extra-articular tenodesis does not result in an increased rate of osteoarthritis: a systematic review and best evidence synthesis. Knee Surg Sports Traumatol Arthrosc 2017; 25:1149-1160. [PMID: 28289822 DOI: 10.1007/s00167-017-4510-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 03/06/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE The role of lateral extra-articular tenodesis (LEAT) as an augment to primary anterior cruciate ligament reconstruction (ACLR) remains controversial. However, concerns exist regarding the risk of development of osteoarthritis due to over constraint of the knee. To systematically review the literature to analyse the long-term incidence of osteoarthritis in patients who had an LEAT performed in isolation or in combination with intra-articular ACLR for the treatment of ACL deficiency. METHODS Two reviewers independently searched five databases for randomized controlled trials (RCTs), non-randomized comparative, and retrospective cohort studies (CS) with long-term radiological follow-up of patients with ACL deficiency treated with ACLR combined with LEAT or LEAT in isolation. Risk of bias was performed using a modified Downs & Black's checklist. The primary outcome was the development of osteoarthritis. The studies were divided into those with moderate/severe osteoarthritis at between 5 to 10 years and >10-year follow-up. The rate of meniscal pathology at the time of the index surgery was recorded. A best evidence synthesis was performed. RESULTS Eight studies reported on 421 patients in which an LEAT procedure was carried out. There were two high-quality RCTs and six low-quality CS. The follow-up was between 5- and 10-years in 5 studies and >10-years in 3. The presence of moderate/severe osteoarthritis was not detected in three studies and was found in 4/44 (9%) and 13/70 (18.6%) patients in the other two. At 11 year follow-up, one study demonstrated no osteoarthritis, while the other two studies reported rates of 54/100 (54%) and 17/24 (71%) respectively at >24 years. In the latter two cases, the rate of meniscal pathology was >50%. A best evidence synthesis revealed that there was insufficient evidence that the addition of a LEAT to an ACLR resulted in an increased rate of osteoarthritis. CONCLUSION The best available evidence would suggest that the addition of a LEAT to ACLR does not result in an increase rate of osteoarthritis of the knee. In knees that have undergone a combined ACLR and LEAT, the incidence of osteoarthritis was low up to 11 years but increased thereafter. The presence of meniscal injury at the index surgery was reported to be greater predictor of the development of osteoarthritis. LEVEL OF EVIDENCE IV.
Collapse
|
29
|
Murtha AS, Johnson AE, Buckwalter JA, Rivera JC. Total knee arthroplasty for posttraumatic osteoarthritis in military personnel under age 50. J Orthop Res 2017; 35:677-681. [PMID: 27177309 DOI: 10.1002/jor.23290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/10/2016] [Indexed: 02/04/2023]
Abstract
United States military personnel frequently suffer knee injuries. The resulting progressive posttraumatic osteoarthritis (PTOA) causes significant disability in these young high-demand patients for which total knee arthroplasty (TKA) is the only effective treatment of their pain and impairment. Yet the use of this option for treatment of PTOA has not been studied. This retrospective review identified 74 knees in 64 U.S. military personnel who underwent TKA at ≤50 years of age during an 8-year period at a tertiary-care, academic, military medical center. Fifty-five knees (74.3%) experienced one or more prior ligamentous, meniscal, or chondral injuries prior to arthroplasty. Only one subject had a history of osteochondral intra-articular fracture. The average at injury was 29.2 years (95%CI of ±2.50) with an average age at arthroplasty of 44.3 years (±1.11). The most common injury was anterior cruciate ligament rupture (n = 19) with a mean time to TKA of 23.1 (±10.54) and 18.8 years (±7.01) when concomitant meniscal pathology was noted. Nineteen patients were noted to have radiographic and symptomatic end-stage osteoarthritis without a specified etiology at 41.4 years (±1.47) and underwent subsequent TKA. This is the first study to evaluate treatment of end-stage PT OA in young people treated with TKA, finding that the incidence of PTOA as an indication for arthroplasty is significantly higher than among civilians. In this otherwise healthy, high-demand patient population, the rate of OA progression following knee injury is accelerated and the long term implications can be career and life altering. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:677-681, 2017.
Collapse
Affiliation(s)
- Andrew S Murtha
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas
| | - Anthony E Johnson
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas
| | - Joseph A Buckwalter
- Department of Orthopaedic Surgery, University of Iowa Hospitals, Iowa City, Iowa
| | - Jessica C Rivera
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas.,US Army Institute of Surgical Research and San Antonio Military Medical Center, 3698 Chambers Pass, JBSA Fort Sam Houston 78234, Texas
| |
Collapse
|
30
|
Pike AN, Bryant T, Ogura T, Minas T. Intermediate- to Long-Term Results of Combined Anterior Cruciate Ligament Reconstruction and Autologous Chondrocyte Implantation. Orthop J Sports Med 2017; 5:2325967117693591. [PMID: 28321429 PMCID: PMC5347433 DOI: 10.1177/2325967117693591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cartilage injury associated with anterior cruciate ligament (ACL) ruptures is common; however, relatively few reports exist on concurrent cartilage repair with ACL reconstruction. Autologous chondrocyte implantation (ACI) has been utilized successfully for treatment of moderate to large chondral defects. HYPOTHESIS ACL insufficiency with relatively large chondral defects may be effectively managed with concurrent ACL reconstruction and ACI. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients undergoing concurrent ACL primary or revision reconstruction with ACI of single or multiple cartilage defects were prospectively evaluated for a minimum 2 years. Pre- and postoperative outcome measures included the modified Cincinnati Rating Scale (MCRS), Western Ontario and McMaster Universities Osteoarthritis Index, visual analog pain scales, and postsurgery satisfaction surveys. ACI graft failure or persistent pain without functional improvement were considered treatment failures. RESULTS Twenty-six patients were included, with 13 primary and 13 revision ACL reconstructions performed. Mean defect total surface area was 8.4 cm2, with a mean follow-up of 95 months (range, 24-240 months). MCRS improved from 3.62 ± 1.42 to 5.54 ± 2.32, Western Ontario and McMaster Universities Osteoarthritis Index from 45.31 ± 17.27 to 26.54 ± 17.71, and visual analog pain scale from 6.19 ± 1.27 to 3.65 ± 1.77 (all Ps <.001). Eight patients were clinical failures, 69% of patients were improved at final follow-up, and 92% stated they would likely undergo the procedure again. No outcome correlation was found with regard to age, body mass index, sex, defect size/number, follow-up time, or primary versus revision ACL reconstruction. In subanalysis, revision ACL reconstructions had worse preoperative MCRS scores and greater defect surface areas. However, revision MCRS score improvements were greater, resulting in similar final functional scores when compared with primary reconstructions. CONCLUSION Challenging cases of ACL tears with large chondral defects treated with concurrent ACL reconstruction and ACI can lead to moderately improved pain and function at long-term follow-up. Factors associated with clinical failure are not clear. When combined with ACI, patients undergoing revision ACL reconstructions have worse function preoperatively compared with those undergoing primary reconstructions but have similar final outcomes.
Collapse
Affiliation(s)
- Andrew N Pike
- Department of Orthopaedic Surgery, Division of Sports Medicine, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Tim Bryant
- Department of Orthopaedic Surgery, Cartilage Repair Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts, USA
| | - Takahiro Ogura
- Department of Orthopaedic Surgery, Cartilage Repair Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts, USA
| | - Tom Minas
- Department of Orthopaedic Surgery, Cartilage Repair Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts, USA
| |
Collapse
|
31
|
Michalitsis S, Hantes M, Thriskos P, Tsezou A, Malizos KN, Fezoulidis I, Vlychou M. Articular cartilage status 2 years after arthroscopic ACL reconstruction in patients with or without concomitant meniscal surgery: evaluation with 3.0T MR imaging. Knee Surg Sports Traumatol Arthrosc 2017; 25:437-444. [PMID: 27141867 DOI: 10.1007/s00167-016-4153-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess articular cartilage changes in the knee joint as detected on 3.0T MR imaging after 2-year follow-up in patients who underwent arthroscopic anterior cruciate ligament reconstruction (ACLR) with or without concomitant meniscal surgery. METHODS A total of twenty-nine patients (mean age 30.3 ± 10 years), who underwent arthroscopic ACLR, received clinical and imaging follow-up at an average of 27.8 ± 4.8 months after surgery. Our patients were divided into two subgroups: eighteen patients with additional meniscal injuries at the time of arthroscopic ACLR who underwent meniscal surgery and eleven patients with intact menisci. The cartilage status of all knees at the time of arthroscopic ACLR was recorded. All patients underwent an MRI scan preoperatively and at follow-up with the same imaging protocol. Cartilage status of all knee compartments was evaluated at the time of follow-up by MR imaging and the ICRS classification. RESULTS Deterioration of the cartilage status was found at all knee compartments of our study group, with respect to the number of cartilage defects. The cartilage of the lateral femoral condyle (LFC) was most severely affected, followed by patellar and medial femoral condyle (MFC) cartilage. A statistically significant relation was found between surgery of the medial meniscus and the development of new cartilage defects in LFC (p = 0.01) and MFC (p = 0.03) after adjusting for the site of meniscal surgery. The cartilage of LFC and the status of the medial meniscus were also found to be significantly related (p = 0.04). Partial meniscectomy was found to be associated with an increased incidence of new cartilage defects when compared to either meniscal repair or absence of meniscal surgery, although it was not statistically significant. CONCLUSION Development of new cartilage lesions was evident after 2-year follow-up in patients with arthroscopic ACLR as detected by MR imaging. There was a multicompartmental pattern of cartilage involvement, and the lateral compartment was most severely affected. Partial meniscectomy at the time of arthroscopic ACLR could be suggested as an additional risk factor for the progression of chondral lesions. LEVEL OF EVIDENCE Prospective comparative study, Level II.
Collapse
Affiliation(s)
- S Michalitsis
- Department of Orthopedics, University Hospital of Larissa, Larissa, Greece
| | - M Hantes
- Department of Orthopedics, University Hospital of Larissa, Larissa, Greece
| | - P Thriskos
- Department of Radiology, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece
| | - A Tsezou
- Laboratory of Molecular Genetics, University Hospital of Larissa, Larissa, Greece
| | - K N Malizos
- Department of Orthopedics, University Hospital of Larissa, Larissa, Greece
| | - I Fezoulidis
- Department of Radiology, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece
| | - M Vlychou
- Department of Radiology, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece.
| |
Collapse
|
32
|
Jungmann PM, Baum T, Nevitt MC, Nardo L, Gersing AS, Lane NE, McCulloch CE, Rummeny EJ, Link TM. Degeneration in ACL Injured Knees with and without Reconstruction in Relation to Muscle Size and Fat Content-Data from the Osteoarthritis Initiative. PLoS One 2016; 11:e0166865. [PMID: 27918596 PMCID: PMC5137877 DOI: 10.1371/journal.pone.0166865] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 11/04/2016] [Indexed: 12/19/2022] Open
Abstract
Background Anterior cruciate ligaments (ACL) injuries represent a major risk factor for early osteoarthritis (OA). Purpose To evaluate the prevalence and 4-year progression of knee OA measured with 3T MR-imaging in individuals with ruptured, reconstructed or normal ACL and to assess the impact of thigh muscle characteristics. Methods A total of 54 knees (23/54 male, 31/54 female) were recruited from the Osteoarthritis Initiative (OAI). At baseline, 15/54 subjects had prevalent ACL ruptures and 15/54 subjects had prevalent ACL reconstruction (24/54 normal ACL). Western Ontario and McMasters Universities Arthritis Index (WOMAC) scores, Physical Activity Scores of the Elderly (PASE) and thigh muscle characteristics including strength, fat infiltration (Goutallier score) and thigh muscle cross-sectional area (CSA) MR measurements were obtained at baseline. Whole-organ MR-imaging Scores (WORMS) were obtained at baseline and at a 4-year follow-up time-point. Multivariate regression models, adjusting for covariates (age, gender, body mass index), were used for statistical analysis. Results At baseline, subjects with prevalent ACL ruptures had worse WORMS total scores (mean±SEM, 44.1±3.5) than subjects with ACL reconstruction (30.8±4.0; P = 0.015) and worse than subjects with normal ACL (21.3±3.0; P<0.001). Cartilage scores were worse in both femorotibial compartments in ACL injured knees than in knees with normal ACL (P<0.05). Knees with ACL reconstruction showed an increased degeneration of the medial meniscus (P = 0.036), cartilage degeneration at the medial femoral condyle (P = 0.011). In a multivariate regression model, including both ACL groups and total muscle characteristics as influence parameters, high thigh muscle CSA, high muscle/ fat ratio and low Goutallier scores were associated with less degenerative changes at the knee, independent of ACL status. Knees with ACL reconstruction showed an increased progression of cartilage degeneration at the medial tibia compared to the normal ACL group (P = 0.027). Conclusions High thigh muscle CSA is associated with less degenerative changes at the knee, independent of the ACL status and may potentially be advantageous in the prevention of early OA.
Collapse
Affiliation(s)
- Pia M. Jungmann
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
- * E-mail:
| | - Thomas Baum
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Lorenzo Nardo
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | | | - Nancy E. Lane
- Department of Internal Medicine, UC Davis Medical Center, Sacramento, California, United States of America
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Ernst J. Rummeny
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
| | - Thomas M. Link
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| |
Collapse
|
33
|
Cantin O, Lustig S, Rongieras F, Saragaglia D, Lefèvre N, Graveleau N, Hulet C. Outcome of cartilage at 12years of follow-up after anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 2016; 102:857-861. [PMID: 27544885 DOI: 10.1016/j.otsr.2016.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/05/2016] [Accepted: 06/09/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In cases of chronic anterior laxity, reconstruction of the anterior cruciate ligament (ACL) can slow the development of osteoarthritis. This study was conducted to determine the overall prevalence of osteoarthritis and to identify the risk factors after ACL reconstruction. HYPOTHESIS Meniscus tears, time from injury to surgery, body mass index (BMI), residual laxity, and cartilage lesions influence the progression towards osteoarthritis. MATERIALS AND METHODS This multicenter, retrospective study on the outcome of cruciate ligaments at 12 years of follow-up was conducted within the 2014 SOFCOT Symposium. The cohort included 675 arthroscopic reconstructions of the ACL from January 2002 to December 2003. The clinical evaluation included the objective and subjective IKDC score. Osteoarthritis was analyzed on 589 knee X-rays according to the IKDC classification. The predictive factors of osteoarthritis development studied were age, gender, BMI, time from injury to surgery, activity level, medial or lateral meniscectomy, type of graft, medial or lateral chondropathy, tunnel positioning, and residual laxity. Univariate and multivariate analyses with logistic regression were performed. RESULTS The mean follow-up was 11.9±0.8 years. The subjective IKDC score was 83.7±13. At 12 years, the rate of moderate to severe osteoarthritis l (IKDCC or D) was 19% (16% medial tibiofemoral osteoarthritis, 4% lateral tibiofemoral osteoarthritis, and 2% patellofemoral osteoarthritis). The prognostic factors were age at surgery greater than 34 years (P<0.05), cartilage lesions at surgery (P<0.05), medial or lateral meniscectomy (P<0.05), and residual laxity (P<0.05). CONCLUSIONS This large-scale study identified risk factors for osteoarthritis that should improve the information provided to patients on long-term progression after ACL reconstruction. LEVEL OF EVIDENCE Retrospective cohort study, level IV.
Collapse
Affiliation(s)
- O Cantin
- Service de chirurgie orthopédique, centre Albert-Trillat, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - S Lustig
- Service de chirurgie orthopédique, centre Albert-Trillat, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - F Rongieras
- Service de chirurgie orthopédique, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - D Saragaglia
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
| | - N Lefèvre
- Institut de l'appareil locomoteur Nollet, 75017 Paris, France; Clinique du sport Paris V, 75005 Paris, France
| | - N Graveleau
- Centre de consultation orthopédique et sportive, clinique du sport de Bordeaux-Mérignac, 2, rue Negrevergne, 33700 Mérignac, France
| | - C Hulet
- Département d'orthopédie-traumatologie, Unité Inserm COMETE, UMR U1075, CHU de Caen, avenue Côte-de-Nacre, 14000 Caen, France
| | -
- SoFCOT, 56, rue Boissonade, 75014 Paris, France
| |
Collapse
|
34
|
Articular cartilage degeneration following anterior cruciate ligament injury: a comparison of surgical transection and noninvasive rupture as preclinical models of post-traumatic osteoarthritis. Osteoarthritis Cartilage 2016; 24:1918-1927. [PMID: 27349462 DOI: 10.1016/j.joca.2016.06.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Post-traumatic osteoarthritis (PTOA) is commonly studied using animal models. Surgical ACL transection is an established model, but noninvasive models may mimic human injury more closely. The purpose of this study was to quantify and compare changes in 3D articular cartilage (AC) morphology following noninvasive ACL rupture and surgical ACL transection. METHODS Thirty-six rats were randomized to uninjured control, noninvasive ACL rupture (Rupture), and surgical ACL transection (Transection), and 4 and 10 week time points (n = 6 per group). Contrast-enhanced micro-computed tomography (CE-μCT) was employed for AC imaging. Femoral and tibial AC were segmented and converted into thickness maps. Compartmental and sub-compartmental AC thickness and surface roughness (Sa) were computed. OARSI histologic scoring was performed. RESULTS In both injury groups, zones of adjacent thickening and thinning were evident on the medial femoral condyle, along with general thickening and roughening of femoral and tibial AC. The posterior tibia exhibited drastic thickening and surface degeneration, and this was worse in Transection. Both injury groups had increased AC thickness and Sa compared to Control at both time points, and Transection exhibited significantly higher Sa in every tibial compartment compared to Rupture. Histologic score was elevated in both groups, and the medial femur exhibited the most severe histologic degeneration. CONCLUSIONS This is the first 3D quantification of preclinical AC remodeling after ACL injury. Both injury models induced similar changes in AC morphology, but Transection exhibited higher tibial Sa and a greater degree of posterior tibial degeneration. We conclude that AC degeneration is a time-, compartment-, and injury-dependent cascade.
Collapse
|
35
|
Ferretti A, Monaco E, Ponzo A, Basiglini L, Iorio R, Caperna L, Conteduca F. Combined Intra-articular and Extra-articular Reconstruction in Anterior Cruciate Ligament-Deficient Knee: 25 Years Later. Arthroscopy 2016; 32:2039-2047. [PMID: 27157658 DOI: 10.1016/j.arthro.2016.02.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 01/29/2016] [Accepted: 02/02/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether an anterior cruciate ligament (ACL)-reconstructed knee with hamstring autograft has a greater incidence of degenerative changes when an extra-articular reconstruction is added and to determine the effect of the combined reconstruction on knee stability and function at long-term follow-up. METHODS For this retrospective study, patients who underwent ACL reconstruction between January 2002 and December 2003 were selected and classified into 2 groups, I and II. Group I consisted of patients operated by a standard ACL reconstruction, and group II consisted of patients in whom, owing to the presence of risk factors (severe pivot shift graded +++ or high-risk sports), an extra-articular reconstruction performed with ileo-tibial tract according to McIntosh as modified by Cocker Arnold technique, was used in conjunction with intra-articular ACL reconstruction. At final follow-up, Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores were used. An arthrometric KT-1000 evaluation was done. Comparative weight-bearing radiographs were taken, including a skyline view for the patellofemoral joint and analyzed according to Fairbank, Kellgren, and IKDC classification. RESULTS Seventy-two of the 75 (96%) patients in group I and 68 of the 75 patients in group II were available at the final follow-up (minimum 10 years). Subjective scores improved significantly in both groups, with no significant difference. Objectively, the number of patients receiving C and D IKDC objective activity scores in group I (7/56; 12.5%) was significantly higher than in group II (0/60) (P = .01). Considering as a failure a side-to-side arthrometric difference more than 5 mm or a pivot shift test graded as ++ or +++, or any giving way episode occurring postoperatively, we found 8 cases in group I and no cases in group II (P = .01) despite the presence of risk factors that group I did not include. Radiologic evaluation showed less arthritic changes in group II in both tibiofemoral and patellofemoral joints. CONCLUSIONS On the basis of the results of this study, adding an extra-articular reconstruction to an anatomically placed intra-articular ACL reconstruction, followed by a modern rehabilitation protocol, does not increase the risk of osteoarthritis and may be able to reduce the rate of failure. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Andrea Ferretti
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy.
| | - Edoardo Monaco
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy
| | - Antonio Ponzo
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy
| | - Luca Basiglini
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy
| | - Raffaele Iorio
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy
| | - Ludovico Caperna
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy
| | - Fabio Conteduca
- "La Sapienza" University, Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", Rome, Italy
| |
Collapse
|
36
|
Chou YC, Yeh WL, Chao CL, Hsu YH, Yu YH, Chen JK, Liu SJ. Enhancement of tendon-bone healing via the combination of biodegradable collagen-loaded nanofibrous membranes and a three-dimensional printed bone-anchoring bolt. Int J Nanomedicine 2016; 11:4173-86. [PMID: 27601901 PMCID: PMC5003596 DOI: 10.2147/ijn.s108939] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A composite biodegradable polymeric model was developed to enhance tendon graft healing. This model included a biodegradable polylactide (PLA) bolt as the bone anchor and a poly(D,L-lactide-co-glycolide) (PLGA) nanofibrous membrane embedded with collagen as a biomimic patch to promote tendon–bone interface integration. Degradation rate and compressive strength of the PLA bolt were measured after immersion in a buffer solution for 3 months. In vitro biochemical characteristics and the nanofibrous matrix were assessed using a water contact angle analyzer, pH meter, and tetrazolium reduction assay. In vivo efficacies of PLGA/collagen nanofibers and PLA bolts for tendon–bone healing were investigated on a rabbit bone tunnel model with histological and tendon pullout tests. The PLGA/collagen-blended nanofibrous membrane was a hydrophilic, stable, and biocompatible scaffold. The PLA bolt was durable for tendon–bone anchoring. Histology showed adequate biocompatibility of the PLA bolt on a medial cortex with progressive bone ingrowth and without tissue overreaction. PLGA nanofibers within the bone tunnel also decreased the tunnel enlargement phenomenon and enhanced tendon–bone integration. Composite polymers of the PLA bolt and PLGA/collagen nanofibrous membrane can effectively promote outcomes of tendon reconstruction in a rabbit model. The composite biodegradable polymeric system may be useful in humans for tendon reconstruction.
Collapse
Affiliation(s)
- Ying-Chao Chou
- Department of Mechanical Engineering, Chang Gung University; Department of Orthopedic Surgery, Chang Gung Memorial Hospital
| | - Wen-Lin Yeh
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital
| | - Chien-Lin Chao
- Department of Mechanical Engineering, Chang Gung University
| | - Yung-Heng Hsu
- Department of Mechanical Engineering, Chang Gung University; Department of Orthopedic Surgery, Chang Gung Memorial Hospital
| | - Yi-Hsun Yu
- Department of Mechanical Engineering, Chang Gung University; Department of Orthopedic Surgery, Chang Gung Memorial Hospital
| | - Jan-Kan Chen
- Department of Physiology and Pharmacology, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University; Department of Orthopedic Surgery, Chang Gung Memorial Hospital
| |
Collapse
|
37
|
Thomas AC, Hubbard-Turner T, Wikstrom EA, Palmieri-Smith RM. Epidemiology of Posttraumatic Osteoarthritis. J Athl Train 2016; 52:491-496. [PMID: 27145096 DOI: 10.4085/1062-6050-51.5.08] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Osteoarthritis is a leading cause of disability whose prevalence and incidence continue to increase. History of joint injury represents an important risk factor for posttraumatic osteoarthritis and is a significant contributor to the rapidly growing percentage of the population with osteoarthritis. This review will present the epidemiology associated with posttraumatic osteoarthritis, with particular emphasis on the knee and ankle joints. It is important to understand the effect of posttraumatic osteoarthritis on the population so that sufficient resources can be devoted to countering the disease and promoting optimal long-term health for patients after joint injury.
Collapse
Affiliation(s)
- Abbey C Thomas
- Biodynamics Research Laboratory, University of North Carolina at Charlotte
| | | | - Erik A Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | |
Collapse
|
38
|
Subchondral and epiphyseal bone remodeling following surgical transection and noninvasive rupture of the anterior cruciate ligament as models of post-traumatic osteoarthritis. Osteoarthritis Cartilage 2016; 24:698-708. [PMID: 26620090 DOI: 10.1016/j.joca.2015.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Animal models are frequently used to study post-traumatic osteoarthritis (PTOA). A common anterior cruciate ligament (ACL) injury model is surgical transection, which may introduce confounding factors from surgery. Noninvasive models could model human injury more closely. The purpose of this study was to compare subchondral and epiphyseal trabecular bone remodeling after surgical transection and noninvasive rupture of the ACL. METHODS Thirty-six rats were randomized to an uninjured control, surgical transection (Transection), or noninvasive rupture (Rupture). Animals were randomized to 4 or 10 week time points (n = 6 per group). Micro computed tomography (μCT) imaging was performed with an isotropic voxel size of 12 μm. Subchondral and epiphyseal bone was segmented semi-automatically, and morphometric analysis was performed. RESULTS Transection caused a greater decrease in subchondral bone volume fraction (BV/TV) than Rupture in the femur and tibia. Rupture had greater subchondral bone tissue mineral density (TMD) at 4 and 10 weeks in the femur and tibia. Subchondral bone thickness (SCB.Th) was decreased in the femur in Transection only. Epiphyseal BV/TV was decreased in Transection only, and Rupture exhibited increased femoral epiphyseal TMD compared to both Control and Transection. Rupture exhibited greater femoral epiphyseal trabecular thickness (Tb.Th.) compared to Control and Transection at 4 weeks, and both Rupture and Transection had increased femoral epiphyseal Tb.Th. at 10 weeks. Epiphyseal trabecular number (Tb.N) was decreased in both injury groups at both time points. Femoral and tibial epiphyseal structure model index (SMI) increased in both groups. CONCLUSIONS The two injury models cause differences in post-injury bone morphometry, and surgical transection may be introducing confounding factors that affect downstream bony remodeling.
Collapse
|
39
|
One-leg hop kinematics 20 years following anterior cruciate ligament rupture: Data revisited using functional data analysis. Clin Biomech (Bristol, Avon) 2015; 30:1153-61. [PMID: 26365484 DOI: 10.1016/j.clinbiomech.2015.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite interventions, anterior cruciate ligament ruptures can cause long-term deficits. To assist in identifying and treating deficiencies, 3D-motion analysis is used for objectivizing data. Conventional statistics are commonly employed to analyze kinematics, reducing continuous data series to discrete variables. Conversely, functional data analysis considers the entire data series. METHODS Here, we employ functional data analysis to examine and compare the entire time-domain of knee-kinematic curves from one-leg hops between and within three groups. All subjects (n=95) were part of a long-term follow-up study involving anterior cruciate ligament ruptures treated ~20 years ago conservatively with physiotherapy only or with reconstructive surgery and physiotherapy, and matched knee-healthy controls. FINDINGS Between-group differences (injured leg, treated groups; non-dominant leg, controls) were identified during the take-off and landing phases, and in the sagittal (flexion/extension) rather than coronal (abduction/adduction) and transverse (internal/external) planes. Overall, surgical and control groups demonstrated comparable knee-kinematic curves. However, compared to controls, the physiotherapy-only group exhibited less flexion during the take-off (0-55% of the normalized phase) and landing (44-73%) phase. Between-leg differences were absent in controls and the surgically treated group, but observed during the flight (4-22%, injured leg>flexion) and the landing (57-85%, injured leg<internal rotation) phases in the physiotherapy-only group. INTERPRETATION Functional data analysis identified specific functional knee-joint deviations from controls persisting 20 years post anterior cruciate ligament rupture, especially when treated conservatively. This approach is suggested as a means for comprehensively analyzing complex movements, adding to previous analyses.
Collapse
|
40
|
Ruffilli A, Buda R, Pagliazzi G, Baldassarri M, Cavallo M, Luciani D, Ferranti E, Giannini S. Over-the-Top Anterior Cruciate Ligament Reconstruction Using Single- or Double-Strand Hamstrings Autograft. Orthopedics 2015; 38:e635-43. [PMID: 26186328 DOI: 10.3928/01477447-20150701-64] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 08/27/2014] [Indexed: 02/03/2023]
Abstract
The purpose of this study is to (1) report the long-term clinical and radiographic outcomes of a nonanatomical anterior cruciate ligament (ACL) reconstruction using an over-the-top (OTT) femoral route and (2) compare single-strand (1SHG) and double-strand (2SHG) hamstrings graft reconstruction. Fifty-one consecutive patients (mean age, 29.2±3.8 years) underwent nonanatomical ACL reconstruction using OTT femoral passage. Twenty patients underwent 1SHG reconstruction and 31 underwent 2SHG reconstruction. International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner score, and KT-1000 (Medmetric Corporation, San Diego, California) evaluation were recorded at a mean follow-up of 12.1±1.6 years. At final follow-up, radiographic evaluation was performed according to the IKDC grading system. Mean IKDC subjective score at follow-up was 76.6±21.9 in the 1SHG group and 88.9±10.0 in the 2SHG (P=.009). Average KOOS was 82.6±18.7 in the 1SHG group and 92.4±9.2 in the 2SHG group (P=.016). Objective IKDC evaluation showed a higher percentage of normal knees in the 2SHG group (P=.018). Pivot shift testing revealed a significantly higher number of normal knees in the 2SHG group (P=.001). Radiographs showed fewer degenerative changes in the 2SHG group at final follow-up in the medial (P=.01) and lateral (P=.037) compartments. Nonanatomical ACL reconstruction using the OTT technique provided satisfactory results in terms of control of both static and dynamic instability at long-term follow-up, thus preventing degenerative joint disease. The 2SHG group showed better subjective and functional outcomes with fewer degenerative changes compared with the 1SHG group at long-term follow-up.
Collapse
|
41
|
Harris KP, Driban JB, Sitler MR, Cattano NM, Balasubramanian E, Hootman JM. Tibiofemoral Osteoarthritis After Surgical or Nonsurgical Treatment of Anterior Cruciate Ligament Rupture: A Systematic Review. J Athl Train 2015; 52:507-517. [PMID: 25562459 DOI: 10.4085/1062-6050-49.3.89] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine if surgical or nonsurgical treatment of anterior cruciate ligament rupture affects the prevalence of posttraumatic tibiofemoral osteoarthritis (OA). DATA SOURCES Studies published between 1983 and April 2012 were identified via EBSCOhost and OVID. Reference lists were then screened in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. STUDY SELECTION Studies were included if (a) treatment outcomes focused on a direct comparison of surgical versus nonsurgical treatment of anterior cruciate ligament rupture, (b) the prevalence of tibiofemoral OA was reported, and (c) they were written in English. Studies were excluded if (a) the included patients were treated with cast immobilization after surgery, (b) the mean follow-up was less than 10 years, or (c) the patients underwent anterior cruciate ligament revision surgery. DATA EXTRACTION Two independent investigators reviewed the included articles using the Newcastle-Ottawa Scale. Frequency of OA, surgical procedure, nonsurgical treatments, and participant characteristics were extracted and summarized. We calculated prevalence (%) and 95% confidence intervals for treatment groups for each individual study and overall. We developed 2 × 2 contingency tables to assess the association between treatment groups (exposed had surgery, referent was nonsurgical treatment) and the prevalence of OA. DATA SYNTHESIS Four retrospective studies were identified (140 surgical patients, 240 nonsurgical patients). The mean Newcastle-Ottawa Scale score was 5 (range = 4-6 [of 10] points). Average length of follow-up was 11.8 years (range = 10-14 years). The prevalence of OA for surgically treated patients ranged from 32.6% to 51.2% (overall = 41.4%, 95% confidence interval = 35.0%, 48.1%) and for nonsurgical patients ranged from 24.5% to 42.3% (overall = 30.9%, 95% confidence interval = 24.4%, 38.3%). CONCLUSIONS Although OA prevalence was higher in the surgical treatment group at a mean follow-up of 11.8 years, no definitive evidence supports surgical or nonsurgical treatment after anterior cruciate ligament injury to prevent posttraumatic OA. Current studies have been limited by small sample sizes, low methodologic quality, and a lack of data regarding confounding factors.
Collapse
Affiliation(s)
- Kyle P Harris
- Department of Health, Physical Education and Nursing, Bucks County Community College, Newtown, PA
| | | | - Michael R Sitler
- Department of Health, Physical Education and Nursing, Bucks County Community College, Newtown, PA
| | - Nicole M Cattano
- Department of Sports Medicine, West Chester University of Pennsylvania
| | | | - Jennifer M Hootman
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
42
|
Abstract
Anterior cruciate ligament (ACL) rupture is a common and devastating injury with long-term sequelae that include meniscal tears, chondral injury, and an increased risk of knee osteoarthritis (OA). ACL reconstruction is recommended to protect against knee instability, reduce the likelihood of meniscal tears and further surgery, and enable earlier return to sporting activities. ACL reconstruction, however, does not reduce the incidence of early-onset OA. In this review, we discuss the factors before and after surgery that are believed to contribute to the premature development of degenerative joint disease.
Collapse
Affiliation(s)
- David Dare
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA,
| | | |
Collapse
|
43
|
Neuromuscular Retraining in Female Adolescent Athletes: Effect on Athletic Performance Indices and Noncontact Anterior Cruciate Ligament Injury Rates. Sports (Basel) 2015. [DOI: 10.3390/sports3020056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
44
|
McLean SG, Mallett KF, Arruda EM. Deconstructing the Anterior Cruciate Ligament: What We Know and Do Not Know About Function, Material Properties, and Injury Mechanics. J Biomech Eng 2015; 137:020906. [DOI: 10.1115/1.4029278] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Indexed: 12/20/2022]
Abstract
Anterior cruciate ligament (ACL) injury is a common and potentially catastrophic knee joint injury, afflicting a large number of males and particularly females annually. Apart from the obvious acute injury events, it also presents with significant long-term morbidities, in which osteoarthritis (OA) is a frequent and debilitative outcome. With these facts in mind, a vast amount of research has been undertaken over the past five decades geared toward characterizing the structural and mechanical behaviors of the native ACL tissue under various external load applications. While these efforts have afforded important insights, both in terms of understanding treating and rehabilitating ACL injuries; injury rates, their well-established sex-based disparity, and long-term sequelae have endured. In reviewing the expanse of literature conducted to date in this area, this paper identifies important knowledge gaps that contribute directly to this long-standing clinical dilemma. In particular, the following limitations remain. First, minimal data exist that accurately describe native ACL mechanics under the extreme loading rates synonymous with actual injury. Second, current ACL mechanical data are typically derived from isolated and oversimplified strain estimates that fail to adequately capture the true 3D mechanical response of this anatomically complex structure. Third, graft tissues commonly chosen to reconstruct the ruptured ACL are mechanically suboptimal, being overdesigned for stiffness compared to the native tissue. The net result is an increased risk of rerupture and a modified and potentially hazardous habitual joint contact profile. These major limitations appear to warrant explicit research attention moving forward in order to successfully maintain/restore optimal knee joint function and long-term life quality in a large number of otherwise healthy individuals.
Collapse
Affiliation(s)
- Scott G. McLean
- Human Performance Innovation Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, MI 48109 e-mail:
| | - Kaitlyn F. Mallett
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109 e-mail:
| | - Ellen M. Arruda
- Department of Mechanical Engineering, Department of Biomedical Engineering, Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109 e-mail:
| |
Collapse
|
45
|
Christensen JC, Goldfine LR, Barker T, Collingridge DS. What can the first 2 months tell us about outcomes after anterior cruciate ligament reconstruction? J Athl Train 2015; 50:508-15. [PMID: 25594914 DOI: 10.4085/1062-6050-49.3.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
CONTEXT Substantial research has been conducted on anterior cruciate ligament reconstruction (ACLR) to evaluate patient outcomes. However, little attention has been given to outcomes during the early phase of recovery and how early deficits affect both short- and long-term outcomes. OBJECTIVE To identify relationships between demographic (age, sex, and body mass index [BMI]) and intraoperative (isolated ACLR versus primary ACLR + secondary procedures), and postoperative (range-of-motion [ROM] and peak isometric knee-extension force [PIF]) variables during the first 2 months after ACLR using self-reported outcomes. DESIGN Cohort study. SETTING Outpatient orthopaedic hospital. PATIENTS OR OTHER PARTICIPANTS A total of 63 patients (38 men, 25 women; age = 33.0 ± 12.1 years; BMI = 26.3 ± 6.5 kg/m(2)) who underwent ACLR. MAIN OUTCOME MEASURE(S) Demographic, intraoperative, and postoperative variables were collected at 1 and 2 months after ACLR and were compared with International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form scores at 1, 2, and ≥12 months. RESULTS Significant relationships were identified between ≥12-month IKDC scores and the 1-month (Pearson correlation, r = 0.283, r(2) = 0.08; P = .025) and 2-month (r = 0.301, r(2) = 0.09; P = .017) IKDC scores. After controlling for other variables, we found that the PIF ratio measures at 1 and 2 months were positively associated with 1- and 2-month IKDC scores (P < .001) and BMI was negatively associated with both 1- and 2-month IKDC scores (P < .05). One-month IKDC scores were related to the 1-month difference in knee-flexion ROM (P = .04). CONCLUSIONS The IKDC scores during the first 2 months were positively correlated with patients' perceptions of function on long-term IKDC scores. It also appears that improvements in lower extremity strength and flexion ROM deficits were positively associated with short-term IKDC scores. Higher BMI was negatively associated with patients' perceptions of function on short-term IKDC scores.
Collapse
|
46
|
Norbakhsh ST, Zafarani Z, Najafi A, Aslani H. Arthroscopic posterior cruciate ligament reconstruction by using hamstring tendon autograft and transosseous screw fixation: minimal 3 years follow-up. Arch Orthop Trauma Surg 2014; 134:1723-30. [PMID: 25186074 DOI: 10.1007/s00402-014-2082-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND The aim of this trial is to prospectively evaluate the outcomes of PCL reconstruction by means of quadruple hamstring tendon autograft with a double-fixation method at minimal 3-year follow-up. MATERIALS AND METHODS Only patients who underwent PCL reconstruction without any other concomitant injury were included in this study. A hamstring tendon graft is composed of a quadruple-stranded gracilis tendon and semitendinosus tendon about 10 cm in length. An arthroscopic technique via a two incision and a double-fixation method was applied. Clinical evaluations were performed for 52 patients. Clinical assessment of patients included the Lysholm knee scores, International Knee Documentation Committee (IKDC) scores, thigh muscle evaluation, and radiographic investigation. RESULTS On the Lysholm knee score, 90 % of the patients displayed good or excellent rating in the final assessment. In the IKDC rating analyses, 60 % of the patients demonstrated 3-5-mm ligament laxity. For the IKDC final rating, 81 % were normal or nearly normal. Seventy-nine percent of the cases revealed less than a 10-mm difference in thigh girth between their reconstructed and contra lateral limbs. CONCLUSION Arthroscopic PCL reconstruction using quadruple hamstring tendon autograft provides acceptable outcomes at a minimum 3-year follow-up. The four-stranded hamstring tendon graft is suitable in graft size and results in minimal harvesting morbidity. We recommend that quadruple hamstring tendon graft be chosen for PCL reconstruction to achieve good ligament reconstruction. A double-fixation method which has been applied in this trial can be used to provide rigid fixation.
Collapse
|
47
|
Luc B, Gribble PA, Pietrosimone BG. Osteoarthritis prevalence following anterior cruciate ligament reconstruction: a systematic review and numbers-needed-to-treat analysis. J Athl Train 2014; 49:806-19. [PMID: 25232663 PMCID: PMC4264654 DOI: 10.4085/1062-6050-49.3.35] [Citation(s) in RCA: 255] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the prophylactic capability of anterior cruciate ligament (ACL) reconstruction in decreasing the risk of knee osteoarthritis (OA) when compared with ACL-deficient patients, as well as the effect of a concomitant meniscectomy. We also sought to examine the influence of study design, publication date, and graft type as well as the magnitude of change in physical activity from preinjury Tegner scores in both cohorts. DATA SOURCES We searched Web of Science and PubMed databases from 1960 through 2012 with the search terms osteoarthritis, meniscectomy, anterior cruciate ligament, anterior cruciate ligament reconstruction, and anterior cruciate ligament deficient. STUDY SELECTION Articles that reported the prevalence of tibiofemoral or patellofemoral OA based on radiographic assessment were included. We calculated numbers needed to treat and relative risk reduction with associated 95% confidence intervals for 3 groups (1) patients with meniscal and ACL injury, (2) patients with isolated ACL injury, and (3) total patients (groups 1 and 2). DATA EXTRACTION A total of 38 studies met the criteria. Of these, 27 assessed the presence of tibiofemoral osteoarthritis in patients treated with anterior cruciate ligament reconstruction. DATA SYNTHESIS Overall, ACL reconstruction (ACL-R) yielded a numbers needed to treat to harm of 16 with a relative risk increase of 16%. Anterior cruciate ligament reconstruction along with meniscectomy yielded a numbers needed to treat to benefit of 15 and relative risk reduction of 11%. Isolated ACL-R showed a numbers needed to treat to harm of 8 and relative risk increase of 43%. Activity levels were decreased in both ACL-R (d = -0.90; 95% confidence interval = 0.77, 1.13) and ACL-deficient (d = -1.13; 95% confidence interval = 0.96, 1.29) patients after injury. CONCLUSIONS The current literature does not provide substantial evidence to suggest that ACL-R is an adequate intervention to prevent knee osteoarthritis. With regard to osteoarthritis prevalence, the only patients benefiting from ACL-R were those undergoing concomitant meniscectomy with reconstruction.
Collapse
Affiliation(s)
- Brittney Luc
- Neuromuscular Research Laboratory, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | - Phillip A. Gribble
- Musculoskeletal Research Laboratory, Department of Rehabilitation Sciences, Division of Athletic Training, University of Kentucky, Lexington
| | - Brian G. Pietrosimone
- Neuromuscular Research Laboratory, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| |
Collapse
|
48
|
Kijowski R, Roemer F, Englund M, Tiderius CJ, Swärd P, Frobell RB. Imaging following acute knee trauma. Osteoarthritis Cartilage 2014; 22:1429-43. [PMID: 25278054 DOI: 10.1016/j.joca.2014.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/21/2014] [Accepted: 06/03/2014] [Indexed: 02/02/2023]
Abstract
Joint injury has been recognized as a potent risk factor for the onset of osteoarthritis. The vast majority of studies using imaging technology for longitudinal assessment of patients following joint injury have focused on the injured knee joint, specifically in patients with anterior cruciate ligament injury and meniscus tears where a high risk for rapid onset of post-traumatic osteoarthritis is well known. Although there are many imaging modalities under constant development, magnetic resonance (MR) imaging is the most important instrument for longitudinal monitoring after joint injury. MR imaging is sensitive for detecting early cartilage degeneration and can evaluate other joint structures including the menisci, bone marrow, tendons, and ligaments which can be sources of pain following acute injury. In this review, focusing on imaging following acute knee trauma, several studies were identified with promising short-term results of osseous and soft tissue changes after joint injury. However, studies connecting these promising short-term results to the development of osteoarthritis were limited which is likely due to the long follow-up periods needed to document the radiographic and clinical onset of the disease. Thus, it is recommended that additional high quality longitudinal studies with extended follow-up periods be performed to further investigate the long-term consequences of the early osseous and soft tissue changes identified on MR imaging after acute knee trauma.
Collapse
Affiliation(s)
- R Kijowski
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
| | - F Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany; Department of Radiology, Boston University, Boston, MA, USA
| | - M Englund
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University, Boston, MA, USA
| | - C J Tiderius
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
| | - P Swärd
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
| | - R B Frobell
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
| |
Collapse
|
49
|
Ajuied A, Wong F, Smith C, Norris M, Earnshaw P, Back D, Davies A. Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med 2014; 42:2242-52. [PMID: 24214929 DOI: 10.1177/0363546513508376] [Citation(s) in RCA: 293] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Knee osteoarthritis after anterior cruciate ligament (ACL) injury has previously been reported. However, there has been no meta-analysis reporting the development and progression of osteoarthritis. PURPOSE We present the first meta-analysis reporting on the development and progression of osteoarthritis after ACL injury at a minimum mean follow-up of 10 years, using a single and widely accepted radiologic classification, the Kellgren & Lawrence classification. STUDY DESIGN Meta-analysis. METHOD Articles were included for systematic review if they reported radiologic findings of ACL-injured knees and controls using the Kellgren & Lawrence classification at a minimum mean follow-up period of 10 years. Appropriate studies were then included for meta-analysis. RESULTS Nine studies were included for systematic review, of which 6 studies were further included for meta-analysis. One hundred twenty-one of 596 (20.3%) ACL-injured knees had moderate or severe radiologic changes (Kellgren & Lawrence grade III or IV) compared with 23 of 465 (4.9%) uninjured ACL-intact contralateral knees. After ACL injury, irrespective of whether the patients were treated operatively or nonoperatively, the relative risk (RR) of developing even minimal osteoarthritis was 3.89 (P < .00001), while the RR of developing moderate to severe osteoarthritis (grade III and IV) was 3.84 (P < .0004). Nonoperatively treated ACL-injured knees had significantly higher RR (RR, 4.98; P < .00001) of developing any grade of osteoarthritis compared with those treated with reconstructive surgery (RR, 3.62; P < .00001). Investigation of progression to moderate or severe osteoarthritis (grade III or IV only) after 10 years showed that ACL-reconstructed knees had a significantly higher RR (RR, 4.71; P < .00001) compared with nonoperative management (RR, 2.41; P = .54). It was not possible to stratify for return to sports among the patients undergoing ACL reconstruction. CONCLUSION Results support the proposition that ACL injury predisposes knees to osteoarthritis, while ACL reconstruction surgery has a role in reducing the risk of developing degenerative changes at 10 years. However, returning to sports activities after ligament reconstruction may exacerbate the development of arthritis.
Collapse
Affiliation(s)
- Adil Ajuied
- Department of Trauma & Orthopaedic, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Fabian Wong
- Department of Trauma & Orthopaedic, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christian Smith
- Department of Trauma & Orthopaedic, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mark Norris
- Department of Trauma & Orthopaedic, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Peter Earnshaw
- Department of Trauma & Orthopaedic, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Diane Back
- Department of Trauma & Orthopaedic, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | | |
Collapse
|
50
|
Barenius B, Ponzer S, Shalabi A, Bujak R, Norlén L, Eriksson K. Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial. Am J Sports Med 2014; 42:1049-57. [PMID: 24644301 DOI: 10.1177/0363546514526139] [Citation(s) in RCA: 287] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The reported prevalence of radiological osteoarthritis (OA) after anterior cruciate ligament (ACL) reconstruction varies from 10% to 90%. Purpose/ HYPOTHESIS To report the prevalence of OA after ACL reconstruction and to compare the OA prevalence between quadrupled semitendinosus tendon (ST) and bone-patellar tendon-bone (BPTB) grafts. The hypothesis was that there would be no difference in OA prevalence between the graft types. The secondary aim was to study whether patient characteristics and additional injuries were associated with long-term outcomes. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Radiological examination results, Tegner activity levels, and Knee injury and Osteoarthritis Outcome Score (KOOS) values were determined in 135 (82%) of 164 patients at a mean of 14 years after ACL reconstruction randomized to an ST or a BPTB graft. Osteoarthritis was defined according to a consensus by at least 2 of 3 radiologists of Kellgren-Lawrence grade ≥2. Using regression analysis, graft type, sex, age, overweight, time between injury and reconstruction, additional meniscus injury, and a number of other variables were assessed as risk factors for OA 14 years after ACL reconstruction. RESULTS Osteoarthritis of the medial compartment was most frequent, with 57% of OA cases in the ACL-reconstructed knee and 18% of OA cases in the contralateral knee (P < .001). There was no difference between the graft types: 49% of OA of the medial compartment for BPTB grafts and 65% for ST grafts (P = .073). The KOOS results were lower for patients with OA in all subscales, indicating that OA was symptomatic. No difference in the KOOS between the graft types was found. Meniscus resection was a strong risk factor for OA of the medial compartment (odds ratio, 3.6; 95% CI, 1.4-9.3) in the multivariable logistic regression analysis. CONCLUSION A 3-fold increased prevalence of OA was found after an ACL injury treated with reconstruction compared with the contralateral healthy knee. No differences in the prevalence of OA between the BPTB and quadrupled ST reconstructions were found. An initial meniscus resection was a strong risk factor for OA; the time between injury and reconstruction was not.
Collapse
Affiliation(s)
- Björn Barenius
- Björn Barenius, Orthopaedics Section, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden.
| | | | | | | | | | | |
Collapse
|