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Abstract
Knee and leg injuries are extremely common presentations to the emergency department. Understanding the anatomy of the knee, particularly the vasculature and ligamentous structures, can help emergency physicians (EPs) diagnose and manage these injuries. Use of musculoskeletal ultrasonography can further aid EPs through the diagnostic process. Proper use of knee immobilizers can also improve long-term patient outcomes.
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Affiliation(s)
- Moira Davenport
- Department of Emergency Medicine, Allegheny General Hospital, Temple University School of Medicine, 320 East North Avenue, Pittsburgh, PA 15212, USA.
| | - Matthew P Oczypok
- Department of Emergency Medicine, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
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52
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Abstract
Sex differences in biomechanics may provide one explanation for the greater incidence of knee injuries in women, but few studies have compared internal forces. In this study, a musculoskeletal model was used to compare male and female, bilateral and unilateral landings based on motion capture and force plate data. Participants were classified as landing medially or laterally loaded based upon the mediolateral load share at the knee (bilateral: p < 0.001, η2=0.452; unilateral: p < 0.001, η2 = 0.444). Knee kinematics and ground reaction forces were not different between the two groups (p > 0.05, η2 = 0.001 - 0.059), but there were differences in muscular recruitment. Landing strategy did not appear to be dependent on sex. However, for both medially and laterally loaded bilateral landings men had greater gluteal (p = 0.017, η2 = 0.085) and hamstrings forces (p < 0.001, η2 = 0.183), whereas women had greater quadriceps forces (p = 0.004, η2 = 0.116). This study demonstrates an association between muscular recruitment and medially loaded landings. Landing strategy seems to be a function of skill not sex; however, within a particular landing strategy there may be sex differences in muscular activation that contribute to the difference in injury rates.
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53
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Gföller P, Abermann E, Runer A, Hoser C, Pflüglmayer M, Wierer G, Fink C. Non-operative treatment of ACL injury is associated with opposing subjective and objective outcomes over 20 years of follow-up. Knee Surg Sports Traumatol Arthrosc 2019; 27:2665-2671. [PMID: 30467579 DOI: 10.1007/s00167-018-5296-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/13/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study was the evaluation of long-term clinical and radiological outcomes of non-operative treatment of anterior cruciate ligament (ACL) deficiency. The hypothesis was that conservative treatment would be associated with a deterioration of subjective and objective measures of joint health and disability over time. METHODS From an initial sample of 41 patients conservatively treated for ACL rupture, 10 received secondary ACL reconstruction, 1 was excluded due to contralateral ACL injury, and 1 patient required total knee replacement and a high tibial osteotomy. Seven further patients were lost to follow-up. The remaining 21 patients (15 male, 6 female, mean age 53.1 ± 9.2 years at the last follow-up) were evaluated by the same two examiners 5-7, 10-13 and 20-22 years after the injury. The evaluation was based on objective and subjective scores, instrumented testing, radiographic examination and assessment of sports activity. RESULTS While subjective patient satisfaction improved over time, objective scores stayed constant or deteriorated (radiologic evaluation). Instrumented knee laxity testing showed an initial tendency to increasing instability, followed by a decrease in anterior tibial translation in the second half of the observation period. Physical activity levels, particularly in high-risk sports, decreased significantly (p < 0.05) compared to preinjury levels. All patients developed significant arthritic degenerative changes over time compared to the uninjured contralateral knee. No correlation to activities in high- or low-risk pivoting sports was found. CONCLUSIONS Patient satisfaction with conservative treatment of ACL injuries is good in spite of objective measures indicating increasing degenerative changes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Peter Gföller
- Gelenkpunkt-Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria
| | - Elisabeth Abermann
- Gelenkpunkt-Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria
| | - Armin Runer
- Gelenkpunkt-Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria. .,Department for Trauma Surgery and Sports Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Christian Hoser
- Gelenkpunkt-Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria.,Research Unit of Orthopaedic Sports Medicine and Injury Prevention, ISAG/UMIT, Eduard Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - Mario Pflüglmayer
- Klinikum Schallerbacherhof, Schallerbacherhofstraße 1, 4701, Bad Schallerbach, Austria
| | - Guido Wierer
- Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria.,Research Unit of Orthopaedic Sports Medicine and Injury Prevention, ISAG/UMIT, Eduard Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria
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54
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Kaku N, Shimada T, Tanaka A, Ando T, Tabata T, Tagomori H, Tsumura H. Ultrastructure and three-dimensional architecture of the anterior cruciate ligament in the knee joints of young and old monkeys. Med Mol Morphol 2019; 53:7-14. [PMID: 31104131 DOI: 10.1007/s00795-019-00224-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/11/2019] [Indexed: 12/20/2022]
Abstract
We examined the ultrastructure of the anterior cruciate ligament and assessed age-related changes by comparing the ligaments of young and old monkeys. Ultrathin sections of the anterior cruciate ligament were observed by transmission electron microscopy. The three-dimensional architecture of collagen fibers in the ligament was examined by scanning electron microscopy after tissue specimens were treated with 2 N NaOH to digest the extracellular matrix. At the surface layer of the cruciate ligament in young monkeys, fusiform-shaped fibroblasts actively produced collagen fibrils. The ligament consisted of parallel bundles of dense collagen fibrils of approximately 200 nm in diameter. Collagen fibrils appeared to run linearly. Ligament fibrocytes in the deep layer had a stellate form. Ligament fibrocytes decreased in number and showed marked atrophy in old age. Collagen fibrils had a looser configuration in older monkeys. Despite atrophy of fibroblasts in the deep layer of the anterior cruciate ligament, the area with atrophic fibroblasts in the ligament expands with age, which can likely cause deterioration of and a reduction in collagen fibers. This information can be applied in studies on the cause of the low repair ability of and aging-related changes in the anterior cruciate ligament in humans.
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Affiliation(s)
- Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Tatsuo Shimada
- Oita College of Judo Therapy and Acupuncture-Moxibustion, 1-1 Chiyo machi, Oita, Oita, Japan
| | - Ai Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Tetsuo Ando
- Oita College of Judo Therapy and Acupuncture-Moxibustion, 1-1 Chiyo machi, Oita, Oita, Japan
| | - Tomonori Tabata
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan
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Inhibition of early response genes prevents changes in global joint metabolomic profiles in mouse post-traumatic osteoarthritis. Osteoarthritis Cartilage 2019; 27:504-512. [PMID: 30572121 PMCID: PMC6391201 DOI: 10.1016/j.joca.2018.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/09/2018] [Accepted: 11/21/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Although joint injury itself damages joint tissues, a substantial amount of secondary damage is mediated by the cellular responses to the injury. Cellular responses include the production and activation of proteases (MMPs, ADAMTSs, Cathepsins), and the production of inflammatory cytokines. The trajectory of cellular responses is driven by the transcriptional activation of early response genes, which requires Cdk9-dependent RNA Polymerase II phosphorylation. Our objective was to determine whether inhibition of cdk9-dependent early response gene activation affects changes in the joint metabolome. DESIGN To model post-traumatic osteoarthritis, we subjected mice to non-invasive Anterior Cruciate Ligament (ACL)-rupture joint injury. Following injury, mice were treated with flavopiridol - a potent and selective inhibitor of Cdk9 kinase activity - to inhibit Cdk9-dependent transcriptional activation, or vehicle control. Global joint metabolomics were analyzed 1 h after injury. RESULTS We found that injury induced metabolomic changes, including increases in Vitamin D3 metabolism, anandamide, and others. Inhibition of primary response gene activation immediately after injury largely prevented the global changes in the metabolomics profiles. Cluster analysis of joint metabolomes identified groups of injury-induced and drug-responsive metabolites. CONCLUSIONS Metabolomic profiling provides an instantaneous snapshot of biochemical activity representing cellular responses. We identified two sets of metabolites that change acutely after joint injury: those that require transcription of primary response genes, and those that do not. These data demonstrate the potential for inhibition of early response genes to alter the trajectory of cell-mediated degenerative changes following joint injury, which may offer novel targets for cell-mediated secondary joint damage.
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56
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Dong Z, Niu Y, Qi J, Song Y, Wang F. Long term results after double and single bundle ACL reconstruction: Is there any difference? A meta - analysis of randomized controlled trials. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:92-99. [PMID: 30686570 PMCID: PMC6506993 DOI: 10.1016/j.aott.2018.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/20/2018] [Accepted: 12/19/2018] [Indexed: 12/23/2022]
Abstract
Objective The double-bundle (DB) techniques are considered to yield better stability of the knee compared with single-bundle (SB) for anterior cruciate ligament (ACL) reconstruction. However, most studies followed up patients in short to middle-term within 5 years, and the longer-term efficacy of SB and DB ACL reconstruction is still beyond consensus. The purpose of this meta-analysis is to compare the longer-term efficacy between double-bundle (DB) and single-bundle (SB) techniques. Methods PubMed, EMBASE, and Cochrane Library databases were searched for relevant articles published up to November, 2017 with an English language restriction. The searches were limited to human subjects and randomized controlled trials (RCTs). In addition, the reference lists of identified articles were checked manually to avoid missing other potentially eligible studies. This process was performed iteratively until no additional articles could be included. The quality of the included studies was assessed using The Cochrane Collaboration's risk of bias tool. All statistical analyses were performed with Review Manager soft-ware. Results A total of five RCTs involving 294 patients were included finally. No studies were excluded due to insufficient data or low quality. The pooled results showed no statistically significant difference between SB and double bundle DB reconstructions for Lysholm, IKDC, pivot shift, KT scores, and the development of osteoarthritis at a minimum of 5 years. No significant heterogeneity was found across all outcomes. Conclusion The best available evidence demonstrated that SB and DB techniques could yield similar efficacy for ACL reconstruction. And no superiority was founded in DB ACL reconstruction with a minimal 5-year follow-up. Given that, the relatively simple and proven techniques of SB ACL reconstruction may be preferable for orthopedic surgeons. Level of evidence: Level I, Therapeutic Study.
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Affiliation(s)
- Zhenyue Dong
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
| | - Yingzhen Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
| | - Jianchao Qi
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
| | - Yifan Song
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
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Ismail SA, Simic M, Salmon LJ, Roe JP, Pinczewski LA, Smith R, Pappas E. Side-to-Side Differences in Varus Thrust and Knee Abduction Moment in High-Functioning Individuals With Chronic Anterior Cruciate Ligament Deficiency. Am J Sports Med 2019; 47:590-597. [PMID: 30525874 DOI: 10.1177/0363546518812883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is evidence that frontal plane knee joint motion plays a crucial role in the pathogenesis of knee osteoarthritis, yet investigation of individuals with chronic anterior cruciate ligament-deficient (ACLD) knees remains sparse. PURPOSE To investigate (1) if individuals with chronic ACLD knees demonstrate higher biomechanical measures of medial knee load as compared with their anterior cruciate ligament-intact (ACLI) knees, (2) if differences in static knee alignment of the ACLD knee will demonstrate a difference in the magnitude of biomechanical measures of medial knee load when compared with the ACLI knee, and (3) the side-to-side concordance of varus thrust among individuals with chronic ACLD knees. STUDY DESIGN Descriptive laboratory study. METHODS Participants were sourced from a metropolitan orthopaedic surgeon group. Those who met the inclusion criteria and agreed to participate underwent a 3-dimensional gait analysis assessment to measure knee adduction moment (KAM), knee flexion moment (KFM), KAM peaks, KAM impulse, and varus thrust. Frontal plane knee static alignment was measured with a digital inclinometer fixed to medical calipers. The participants were divided according to their static knee alignment (neutral, varus, and valgus) for subgroup analysis. Peak knee angular velocity and frontal plane knee angle were used to establish if a participant was walking with a knee thrust. An individual was deemed to have knee thrust during gait if the largest frontal plane knee movement coincided with the peak knee angular velocity that occurred within the first 30% of stance phase. RESULTS Forty-five participants were recruited. The mean (SD) time from injury was 34.5 (55.6) months. ACLD knees did not demonstrate higher mean KAM and KFM ( P > .5) or early-stance peak KAM ( P = .3-.8) and KAM impulse ( P = .3-.9) as compared with ACLI knees as a whole group or when the varus, neutral, and valgus alignment subgroups were investigated separately. Twenty-three percent (n = 9) of the participants had a varus thrust at the ACLD or ACLI knee, 44% (n = 4) had a varus thrust at the ACLD knee, and 22% (n = 2) had varus thrust at both knees. CONCLUSION There were no side-to-side differences in mean KAM and KFM and early-stance peak KAM and KAM impulse among high-functioning individuals with chronic unilateral ACLD knees. There was a low prevalence of varus thrust among high-functioning individuals with chronic unilateral ACLD knees.
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Affiliation(s)
| | - Milena Simic
- The University of Sydney, Faculty of Health Sciences, Lidcombe, Australia
| | - Lucy J Salmon
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Justin P Roe
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Leo A Pinczewski
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
- University of Notre Dame, Medical School, Sydney, Australia
| | - Richard Smith
- The University of Sydney, Faculty of Health Sciences, Lidcombe, Australia
| | - Evangelos Pappas
- The University of Sydney, Faculty of Health Sciences, Lidcombe, Australia
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58
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Raad M, Thevenin Lemoine C, Bérard E, Laumonerie P, Sales de Gauzy J, Accadbled F. Delayed reconstruction and high BMI z score increase the risk of meniscal tear in paediatric and adolescent anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2019; 27:905-911. [PMID: 30353211 DOI: 10.1007/s00167-018-5201-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to identify epidemiologic risk factors for secondary meniscal tears in paediatric and adolescent patients who sustain an anterior cruciate ligament (ACL) tear. The hypothesis was that delayed reconstruction and elevated BMI z score, increase the risk for secondary meniscal tears. METHODS A prospective, descriptive and analytical study of consecutively accrued children and adolescents with an ACL tear was performed. One hundred and sixty subjects (114 males and 46 females) were identified between 2006 and 2015 at one institution. The age range was between 7 and 19 years. Fifteen parameters were recorded and analysed: age at initial trauma, initial trauma circumstance, sex, BMI z score, affected side, type of sport, Tegner score, athletic level, time to MRI, time to first referral, time to surgery, age at surgery, attempted non-operative treatment, operative report and associated meniscal tear. These meniscal lesions could be diagnosed by an MRI and / or during surgery. RESULTS Out of the 160 cases, 143 were treated surgically and 17 cases non-operatively. Median corrected BMI z score was 0.5 (range - 1.8 to 4.7). 41.9% had one or more meniscal lesions. 55 patients were initially treated non-operatively, of which 39 patients were secondarily operated. There was a positive relationship between meniscal lesion and: BMI z score (p = 0.0364), attempted non-operative treatment (p = 0.001) and time to surgery (p = 0.002). The median time to ACL reconstruction was 229 days for patients with secondary meniscal lesions. CONCLUSIONS Patients with ACL tears treated non-operatively developed secondary meniscal lesions requiring delayed surgical management. There was a positive correlation between BMI z score and secondary meniscal lesions. Thus, early ACL reconstruction is advocated in young athletes. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Maroun Raad
- CHU Toulouse, Hôpital des enfants, 330 Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse cedex 9, France.
| | - Camille Thevenin Lemoine
- CHU Toulouse, Hôpital des enfants, 330 Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse cedex 9, France
| | - Emilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM-University of Toulouse III, Toulouse University Hospital (CHU), Toulouse, France
| | - Pierre Laumonerie
- CHU Toulouse, Hôpital des enfants, 330 Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse cedex 9, France
| | - Jerome Sales de Gauzy
- CHU Toulouse, Hôpital des enfants, 330 Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse cedex 9, France
| | - Franck Accadbled
- CHU Toulouse, Hôpital des enfants, 330 Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse cedex 9, France
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Aalirezaie A, Arumugam SS, Austin M, Bozinovski Z, Cichos KH, Fillingham Y, Ghanem E, Greenky M, Huang W, Jenny JY, Lazarovski P, Lee GC, Manrique J, Manzary M, Oshkukov S, Patel NK, Reyes F, Spangehl M, Vahedi H, Voloshin V. Hip and Knee Section, Prevention, Risk Mitigation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S271-S278. [PMID: 30348568 DOI: 10.1016/j.arth.2018.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Heusdens CHW, Hopper GP, Dossche L, Roelant E, Mackay GM. Anterior cruciate ligament repair with Independent Suture Tape Reinforcement: a case series with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 2019; 27:60-67. [PMID: 30382289 DOI: 10.1007/s00167-018-5239-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 10/17/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE The treatment of acute anterior cruciate ligament (ACL) ruptures with a repair technique has recently regained interest. A novel ACL repair technique was described using Independent Suture Tape Reinforcement with 2-year follow-up results. METHODS Forty-two consecutive patients with an acute ACL rupture undergoing repair using this technique were followed up for a minimum of 2 years. Patients with mid-substance, distal ACL ruptures, poor ACL tissue quality or retracted ACL remnants as well as patients with multi-ligament injuries were excluded. Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analogue Pain Scale (VAS-pain), Veterans RAND 12 Item Health Survey (VR-12) and the Marx Activity scale were collected by online questionnaires. Two-year postoperative patients were asked by telephone if they had experienced a rerupture. RESULTS All the KOOS subscales improved significantly in comparison to the preoperative score. The largest improvement of all scores was seen at 3 months postoperatively which is significant in all cases. The KOOS sport and recreation showed a meaningful change and the largest improvement of the KOOS subscales at 3 months postoperatively, as well as the highest total improvement at 1 year postoperatively compared to preoperatively. The VAS-pain and VR-12 physical score improved significantly, however the Marx activity scale decreased significantly in comparison to preoperative scores. Two patients reported a rerupture (4.8%, CI 1.7-11.2%). CONCLUSIONS This is the first case series that described the 2-year follow-up results of patients with an acute, proximal ACL rupture, treated with the Independent Suture Tape Reinforcement repair technique. A meaningful KOOS sport and recreation change and significant improvements in the KOOS, VAS-pain and VR-12 physical scores as well as a significant decrease of the Marx activity scale in comparison to preoperative scores are demonstrated. Two of the 42 patients (4.8%) reported an ACL rerupture. Repair with this technique could be clinically relevant as a treatment option for patients with an acute, proximal ACL rupture which is not retracted and of good tissue quality. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Graeme P Hopper
- Speciality Registrar (T&O), Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, Scotland
| | - Lieven Dossche
- Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
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Ristolainen L, Kettunen JA, Montin L, Harilainen A, Sandelin J, Kujala UM. Knee arthroplasty until age 60: role of sports and other injuries. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.17.03703-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Du PZ, Markolf KL, Boguszewski DV, McAllister DR. Femoral Contact Forces in the Anterior Cruciate Ligament Deficient Knee: A Robotic Study. Arthroscopy 2018; 34:3226-3233. [PMID: 30396801 DOI: 10.1016/j.arthro.2018.06.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To measure contact forces (CFs) at standardized locations representative of clinical articular cartilage defects on the medial and lateral femoral condyles during robotic tests with simulated weightbearing knee flexion. METHODS Eleven human knees had 20-mm-diameter cylinders of native bone/cartilage cored from both femoral condyles at standardized locations, with each cylinder attached to a custom-built load cell that maintained the plug in its precise anatomic position. A robotic test system was used to flex the knee from 0° to 50° under 200-N tibiofemoral compression without and with a 2 Nm internal tibial torque, 5 Nm external tibial torque, and 45 N anterior tibial force (AF). CFs and knee kinematics were recorded before and after cutting the anterior cruciate ligament (ACL). RESULTS ACL sectioning did not significantly increase medial or lateral CFs for any loading condition, with the exception of AF, in which increases in medial CF ranged from 38 N (at 15° flexion, P < .01) to 77 N (at 50° flexion, P < .002). Compared with the intact condition, ACL sectioning significantly increased anterior tibial translation by 12.33 mm (at 15° flexion, P < .001) and 17.4 mm (at 50° flexion, P < .001), and increased valgus rotation by 2.4° (at 15° flexion, P < .001) and 3.8° (at 50° flexion, P < .001). CONCLUSIONS Our hypothesis that CF would increase after ACL section was confirmed for the AF test condition only, and only for the medial condyle beyond 10° flexion. With the ACL sectioned, it appeared that the increased CF was owing to the medial condyle riding up over the posterior tibial plateau resulting from the large anterior tibial displacements. CLINICAL RELEVANCE Aside from our limited finding with AF, we concluded that CFs were generally unaffected by ACL section.
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Affiliation(s)
- Peter Z Du
- Department of Orthopaedic Surgery, University of Arizona - Tucson (P.Z.D.), Tucson, Arizona; Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A..
| | - Keith L Markolf
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Daniel V Boguszewski
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - David R McAllister
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
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Somthavil S. Altered kinematics after anterior cruciate ligament reconstruction, and their role in the prevention of osteoarthritis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.10.529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Anterior cruciate ligament injury is common, and anterior cruciate ligament reconstruction has become the standard of care that aims to restore knee stability, return to activity, and prevent secondary injury. Methods: A literature review was carried out using PubMed and Science Direct databases from 1998 through 2017. Search terms included: anterior cruciate ligament reconstruction and knee osteoarthritis; kinematics after anterior cruciate ligament reconstruction; and prevention of knee osteoarthritis. A total of 356 studies matched the search terms. After removing duplicates and any studies that were not relevant, 73 studies remained. Findings: Individuals usually have impaired neuromuscular control after reconstruction, and abnormal biomechanical patterns may lead to loading of cartilage areas that are not commonly loaded and that, longitudinally, can lead to osteoarthritis. The knee adduction moment indicates loading of the knee joint and has been associated with the development of osteoarthritis and altered gait mechanics have also been implicated in the increased rate of osteoarthritis after anterior cruciate ligament reconstruction, including differences in tibial rotation during walking. Furthermore, altered ankle joint mechanics may be the result of deviations in ankle joint alignment secondary to the structural changes at the knee. It is clear that abnormal mechanical stimulation may cause dysfunction of articular chondrocytes and breakdown of cartilage extracellular matrix, leading to articular cartilage degradation and chondrocyte death. The affected joint will progress to post-traumatic osteoarthritis. Conclusions: The restoration of normal knee anatomy and mechanics, such as returning the joint to normal function, improving muscle strength, functional movement prevention programmes, restoring gait symmetry and weight management are recommended.
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Affiliation(s)
- Sompiya Somthavil
- Lecturer Faculty of Sports Science, Kasetsart University, Nakhon Pathom, Thailand
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Ren S, Yu Y, Shi H, Miao X, Jiang Y, Liang Z, Hu X, Huang H, Ao Y. Three dimensional knee kinematics and kinetics in ACL-deficient patients with and without medial meniscus posterior horn tear during level walking. Gait Posture 2018; 66:26-31. [PMID: 30142451 DOI: 10.1016/j.gaitpost.2018.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/18/2018] [Accepted: 08/09/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The location of the meniscus tear has been reported to influence kinematics in anterior cruciate ligament deficient (ACLD) knees. Medial meniscus posterior horn tear (MMPHT) often occurred after ACL rupture. Whether MMPHT influences the kinematics and kinetics in ACLD knees has not been reported yet. RESEARCH QUESTION The purpose of this study was to investigate three-dimensional (3D) kinematics and kinetics in ACLD knees with and without MMPHT (ACLD + MMPHT, ACLDs) during level walking. METHODS Fifteen patients with isolated unilateral ACLD, ten with unilateral ACLD + MMPHT, and twenty-two healthy controls underwent gait testing between January 2014 and December 2016. Participant characteristics, as well as gait parameters, were compared among control, ACLDs and ACLD + MMPHT knees. RESULTS Compared to the healthy controls, the ACLD knees with and without MMPHT showed significant extension deficiency at maximum extension (flexion: ACLDs: 7.83 ± 4.3°, ACLD + MMPHT: 11.09 ± 7.8°, control: 3.12 ± 4.6°, p = 0.005) and lower extension moments during terminal stance phase of gait. Compared with the healthy controls, significantly increased external tibial rotation during pre-swing phase and lower rotation moments at terminal stance phase were observed in the ACLD + MMPHT knees, but not in the ACLDs knees. No significant differences in gait parameters were observed between ACLDs and ACLD + MMPHT knees during stance phase of walking. SIGNIFICANCE The ACLD knees with medial meniscus posterior horn tear exhibited extension deficiency, increased external tibial rotation, lower extension and internal rotation moments during the terminal stance phase compared to healthy control knees, presenting a combination of "stiffening gait" and "pivot shift gait" pattern. The ACLDs knees only presented extension deficiency and lower extension moments compared with healthy control knees, presenting a "stiffening gait". Medial meniscus posterior horn tear did not significantly affect gait patterns during stance of walking in ACLD knees.
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Affiliation(s)
- Shuang Ren
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Yuanyuan Yu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Huijuan Shi
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Xin Miao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Yanfang Jiang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Zixuan Liang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Hongshi Huang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China
| | - Yingfang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100871, PR China.
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65
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Capin JJ, Khandha A, Zarzycki R, Manal K, Buchanan TS, Snyder-Mackler L. Gait Mechanics After ACL Reconstruction Differ According to Medial Meniscal Treatment. J Bone Joint Surg Am 2018; 100:1209-1216. [PMID: 30020126 PMCID: PMC6636792 DOI: 10.2106/jbjs.17.01014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Knee osteoarthritis risk is high after anterior cruciate ligament reconstruction (ACLR) and arthroscopic meniscal surgery, and higher among individuals who undergo both. Although osteoarthritis development is multifactorial, altered walking mechanics may influence osteoarthritis progression. The purpose of this study was to compare gait mechanics after ACLR among participants who had undergone no medial meniscal surgery, partial medial meniscectomy, or medial meniscal repair. METHODS This was a secondary analysis of data collected prospectively as part of a clinical trial. Sixty-one athletes (mean age of 21.4 ± 8.2 years) who had undergone primary ACLR participated in the study when they achieved impairment resolution (5.3 ± 1.7 months postoperatively), including minimal to no effusion, full knee range of motion, and ≥80% quadriceps-strength symmetry. Participants were classified by concomitant medial meniscal treatment: no involvement or nonsurgical management of a small, stable tear; partial meniscectomy; or meniscal repair. Participants underwent comprehensive walking analyses. Joint contact forces were estimated using a previously validated, electromyography-driven musculoskeletal model. Variables were analyzed using a mixed-model analysis of variance with group and limb comparisons (α = 0.05); group comparisons of interlimb differences in measurements (surgical minus contralateral limb) were performed to determine significant interactions. RESULTS The participants in the partial meniscectomy group walked with a higher peak knee adduction moment (pKAM) in the surgical versus the contralateral limb as compared with those in the meniscal repair group and those with no medial meniscal surgery (group difference for partial versus repair: 0.10 N-m/kg-m, p = 0.020; and for partial versus none: 0.06 N-m/kg-m, p = 0.037). Participants in the repair group walked with a smaller percentage of medial to total tibiofemoral loading in the surgical limb compared with both of the other groups (group difference for repair versus partial: -12%, p = 0.001; and for repair versus none: -7%, p = 0.011). The participants in the repair group loaded the medial compartment of the surgical versus the contralateral limb 0.5 times body weight less than did the participants in the partial meniscectomy group. CONCLUSIONS Participants in the partial meniscectomy group walked with higher pKAM and shifted loading toward the medial compartment of the surgical limb, while participants in the repair group did the opposite, walking with lower pKAM and unloading the surgical limb relative to the contralateral limb. These findings may partially explain the conflicting evidence regarding pKAM after ACLR and the elevated risk for osteoarthritis (whether from overloading or underloading) after ACLR with concomitant medial meniscectomy or repair. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jacob J. Capin
- University of Delaware, Newark, Delaware,E-mail address for J.J. Capin:
| | | | | | - Kurt Manal
- University of Delaware, Newark, Delaware
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66
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Mechanical alterations of the bone-cartilage unit in a rabbit model of early osteoarthrosis. J Mech Behav Biomed Mater 2018; 83:1-8. [DOI: 10.1016/j.jmbbm.2018.03.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 12/20/2022]
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Nawasreh Z, Failla M, Marmon A, Logerstedt D, Snyder-Mackler L. Comparing the effects of mechanical perturbation training with a compliant surface and manual perturbation training on joints kinematics after ACL-rupture. Gait Posture 2018; 64:43-49. [PMID: 29852358 PMCID: PMC6062476 DOI: 10.1016/j.gaitpost.2018.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/15/2018] [Accepted: 05/22/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Performing physical activities on a compliant surface alters joint kinematics and increases joints stiffness. However, the effect of compliant surface on joint kinematics after ACL-rupture is yet unknown. AIM To compare the effects of mechanical perturbation training with a compliant surface to manual perturbation training on joint kinematics after ACL-rupture. METHODS Sixteen level I/II athletes with ACL-rupture participated in this preliminary study. Eight patients received mechanical perturbation with compliant surface (Mechanical) and 8 patients received manual perturbation training (Manual). Patients completed standard gait analysis before (Pre) and after (Post) training. RESULTS Significant group-by-time interactions were found for knee flexion angle at initial contact (IC) and peak knee flexion (PKF) (p<0.004), with manual group significantly increased knee flexion angle at IC and PKF (p<0.03). Main effects of group were found for hip flexion angle at IC (Manual:34.34+3.51°, Mechanical:27.68+4.08°, p = 0.011), hip rotation angle at PKE (Manual:-3.40+4.78°, Mechanical:5.43+4.78°, p < 0.0001), and knee adduction angle at PKE (Manual:-2.00+2.23°, Mechanical:0.55+2.23°, p = 0.039). Main effects of time were found for hip adduction angle at PKE (Pre:6.98+4.48°, Post:8.41+4.91°, p = 0.04), knee adduction angle at IC (Pre:-2.90+3.50°, Post:-0.62+2.58°, p = 0.03), ankle adduction angle at IC (Pre:2.16+3.54, Post:3.8+3.68, p = 0.008), and ankle flexion angle at PKF (Pre:-4.55+2.77°, Post:-2.39+3.48°, p = 0.01). DISCUSSION Training on a compliant surface induces different effects on joint kinematics compared to manual perturbation training after ACL-rupture. Manual perturbation improved hip alignment and increased knee flexion angles, while mechanical training decreased knee flexion angles throughout the stance phase. Administering training on a compliant surface after ACL-rupture may help improving dynamic knee stability, however, long-term effects on knee health needs to be determined.
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Affiliation(s)
- Zakariya Nawasreh
- Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, DE, USA,Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan
University of Science and Technology, Irbid, Jordan,Corresponding author at: P.O. Box 3030, Irbid, 22110, Jordan., (Z.
Nawasreh)
| | - Mathew Failla
- Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Adam Marmon
- Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - David Logerstedt
- University of the Sciences, Department of Physical Therapy, Philadelphia, PA, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA,Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
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Cinque ME, Dornan GJ, Chahla J, Moatshe G, LaPrade RF. High Rates of Osteoarthritis Develop After Anterior Cruciate Ligament Surgery: An Analysis of 4108 Patients. Am J Sports Med 2018; 46:2011-2019. [PMID: 28982255 DOI: 10.1177/0363546517730072] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Posttraumatic osteoarthritis (PTOA) after anterior cruciate ligament (ACL) reconstruction ultimately translates into a large economic effect on the health care system owing to the young ages of this population. Purpose/Hypothesis: The purposes were to perform a meta-analysis to determine the prevalence of osteoarthritis after an ACL reconstruction, examining the effects of length of time after surgery, preoperative time interval from injury to surgery, and patient age at the time of surgery. It was hypothesized that the prevalence of PTOA increased with time from surgery and that increased time from injury to surgery and age were also risk factors for the development of PTOA. STUDY DESIGN Meta-analysis. METHODS A meta-analysis of the prevalence of radiographic PTOA after ACL reconstruction was performed of studies with a minimum of 5 years' follow-up, with a level of evidence of 1, 2, or 3. The presence of osteoarthritis was defined according to knee radiographs evaluated with classification based on Kellgren and Lawrence, Ahlbäck, International Knee Documentation Committee, or the Osteoarthritis Research Society International. Metaregression models quantified the relationship between radiographic PTOA prevalence and the mean time from injury to surgery, mean patient age at time of surgery, and mean postoperative follow-up time. RESULTS Thirty-eight studies (4108 patients) were included. Longer postsurgical follow-up time was significantly positively associated with a higher proportion of PTOA development. The model-estimated proportion of PTOA (95% CI) at 5, 10, and 20 years after surgery was 11.3% (6.4%-19.1%), 20.6% (14.9%-27.7%), and 51.6% (29.1%-73.5%), respectively. Increased chronicity of the ACL tear before surgery and increased patient age were also associated with a higher likelihood of PTOA development. CONCLUSION The prevalence of osteoarthritis after an ACL reconstruction significantly increased with time. Longer chronicity of ACL tear and older age at the time of surgery were significantly positively correlated with the development of osteoarthritis. A timely referral and treatment of symptomatic patients are vital to diminish the occurrence of PTOA.
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Affiliation(s)
- Mark E Cinque
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Oslo University Hospital, Oslo, Norway
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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Li G, Li JS, Torriani M, Hosseini A. Short-Term Contact Kinematic Changes and Longer-Term Biochemical Changes in the Cartilage After ACL Reconstruction: A Pilot Study. Ann Biomed Eng 2018; 46:1797-1805. [PMID: 29946971 DOI: 10.1007/s10439-018-2079-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 06/20/2018] [Indexed: 12/22/2022]
Abstract
Investigation of the development of cartilage degeneration after ACL reconstruction is important for improving current surgical treatment of ACL injuries to prevent long-term knee joint degeneration. This pilot study examined the relationship between the changes in weight-bearing knee contact kinematics 6 months after ACL reconstruction and the biochemical composition changes in the knee cartilage measured using T2 relaxation values 3 years after the surgery in seven patients. The analysis indicated that the change of the knee contact kinematics in short-term after ACL reconstruction is associated with an increase of T2 values of the cartilage in longer follow up times. The data of this study could provide preliminary data to power future studies that use prospective, longitudinal research and large patient populations to establish prognostic biomechanical markers for determination of long-term cartilage degeneration after ACL reconstruction.
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Affiliation(s)
- Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital and Harvard Medical School, Newton, MA, 02462, USA.
| | - Jing-Sheng Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital and Harvard Medical School, Newton, MA, 02462, USA.,College of Health and Rehabilitation Sciences, Boston University, Boston, MA, 02215, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02215, USA
| | - Ali Hosseini
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital and Harvard Medical School, Newton, MA, 02462, USA
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70
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Effect of Fucoidan on Anterior Cruciate Ligament Transection and Medial Meniscectomy Induced Osteoarthritis in High-Fat Diet-Induced Obese Rats. Nutrients 2018; 10:nu10060686. [PMID: 29843440 PMCID: PMC6024650 DOI: 10.3390/nu10060686] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 01/05/2023] Open
Abstract
Osteoarthritis (OA) has become one of the most common disabilities among elders, especially in females. Obesity and mechanical injuries caused by OA are attributed to joint loading, cartilage disintegration, and bone loss, as well as inflammation. Pharmacological and non-pharmacological treatments can be used for OA. Fucoidan possesses several bioactivities such as antitumor, antiviral, anticoagulation, anti-obesity, and immunomodulation. This study aims to investigate the effect of fucoidan in surgery-induced OA on rats with diet-induced obesity. OA was induced by an anterior cruciate ligament transection and a partial medial meniscectomy (ACLT + MMx). The male SD rats were fed with a high-fat diet (HFD) for 4 weeks to induce obesity before causing ACLT + MMx to induce OA. The OA rats were administered with intragastric water or fucoidan in three different concentrations (32 mg/kg, 64 mg/kg, and 320 mg/kg) after the surgeries for 40 days with an HFD. We observed that the swelling in the knee joint was alleviated and the hind paw weight distribution was rectified after feeding them with fucoidan and that there was no significant effect on the weight gain and feed intake. Fucoidan administration indicated no significant variation on the high-density lipoprotein (HDL)-Cholesterol level, but it did indicate reduced plasma triglycerides and low-density lipoprotein (LDL)-Cholesterol levels. In addition, the weight-bearing tests showed an improvement in the fucoidan-treated group. Our results suggested that fucoidan may improve meniscal/ligamentous injury and obesity-induced OA.
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71
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Wang XM, Ji G, Wang XM, Kang HJ, Wang F. Biological and Biomechanical Evaluation of Autologous Tendon Combined with Ligament Advanced Reinforcement System Artificial Ligament in a Rabbit Model of Anterior Cruciate Ligament Reconstruction. Orthop Surg 2018; 10:144-151. [PMID: 29624874 DOI: 10.1111/os.12370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/14/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To compare the biomechanical and histological changes in a rabbit model after reconstructing the anterior cruciate ligament (ACL) with solely autologous tendon and with autologous tendon combined with the ligament advanced reinforcement system (LARS) artificial ligament. METHODS Anterior cruciate ligament reconstruction was performed in 72 knees from 36 healthy New Zealand white rabbits (bodyweight, 2500-3000 g). The Achilles tendons were harvested bilaterally. The left ACL were reconstructed solely with autografts (autologous tendon group), while the right ACL were reconstructed with autografts combined with LARS ligaments (combined ligaments group). The gross observation, histological determination, and the tension failure loads in both groups were evaluated at 12 weeks (n = 18) and 24 weeks (n = 18) postoperatively. RESULTS Gross examination of the knee joints showed that all combined ligaments were obviously covered by a connective tissue layer at 12 weeks, and were completely covered at 24 weeks. Fibrous tissue ingrowth was observed between fascicles and individual fibers in the bone-artificial ligament interface at both time points; this fibrovascular tissue layer localized at the bone-artificial ligament interface tended to be denser in specimens obtained at 24 weeks compared with those obtained at 12 weeks. The tension failure loads of the knees were similar in the autologous tendon group and the combined ligaments group at 12 weeks (144.15 ± 3.92 N vs. 140.88 ± 2.75 N; P > 0.05), and at 24 weeks (184.15 ± 1.96 N vs. 180.88 ± 3.21 N; P > 0.05). CONCLUSION Reconstructing the ACL in rabbits using autologous tendon combined with the LARS artificial ligament results in satisfactory biointegration, with no obvious immunological rejection between the autologous tendon and the artificial ligament, and is, therefore, a promising ACL reconstruction method.
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Affiliation(s)
- Xin-Min Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Gang Ji
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiao-Meng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hui-Jun Kang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Ushio T, Okazaki K, Mizu-Uchi H, Hamai S, Akasaki Y, Nakashima Y. Anterior cruciate ligament reconstruction in a patient who has received systemic steroids for autoimmune disease. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2018; 11:12-14. [PMID: 29552504 PMCID: PMC5850882 DOI: 10.1016/j.asmart.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/09/2017] [Accepted: 11/19/2017] [Indexed: 11/22/2022]
Abstract
Background An anterior cruciate ligament (ACL) reconstruction has become more common and the surgical morbidity has decreased, it has been performed not only in younger people to play sports but also middle-aged people, with satisfactory results. Therefore, some patients might have comorbidities for which they take medicines. Especially the medicines, such as systemic steroids, might influence the reconstructed ligament strength and durability. Case report A 49-year-old woman who was taking oral steroids for autoimmune hepatitis suffered a spontaneous ACL injury. She complained of unstable symptoms in the knee despite initial conservative treatment. Then, she was treated operatively with autologous hamstring tendon grafts. Three years postoperatively, her knee remained stable with 1.8 mm side-to-side difference on a Kneelax arthrometer and with 1.6 mm on anterior stress radiographs. There was no rerupture or instability. Conclusion The patient who had received systemic steroids for a long time recovered satisfactorily after the operation, with achievement of knee stability and possibility to prevent degenerative change in the knee joint. ACL reconstruction should be considered even in patients with such medication.
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Affiliation(s)
- Tetsuro Ushio
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-0054, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Lichtenberg MC, Koster CH, Teunissen LPJ, Oosterveld FGJ, Harmsen AMK, Haverkamp D, Hoornenborg D, Berg RP, Bloemers FW, Faber IR. Does the Lever Sign Test Have Added Value for Diagnosing Anterior Cruciate Ligament Ruptures? Orthop J Sports Med 2018; 6:2325967118759631. [PMID: 29568784 PMCID: PMC5858649 DOI: 10.1177/2325967118759631] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Diagnosing an anterior cruciate ligament (ACL) rupture based on a physical examination remains a challenge for both surgeons and physical therapists. The lever sign test was developed to overcome the practical limitations of other tests and to optimize diagnosis. An evaluation of the measurement properties of the lever sign test is needed to make adequate interpretations in practice. Purpose: To evaluate the reliability and diagnostic value of the lever sign test. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 94 patients were recruited between November 2014 and July 2016. Patients were included if they were at least 16 years old, suffered from knee trauma, and had indications for knee arthroscopic surgery. Lever sign, anterior drawer, Lachman, and pivot-shift test outcomes were examined by an orthopaedic/trauma surgeon and a physical therapist. A test-retest design was used to investigate interrater reliability. Moreover, the lever sign test outcomes, alone and in combination with the other diagnostic tests, were compared with arthroscopic results, which served as the gold standard for the test’s diagnostic value. Results: The lever sign test and pivot-shift test had kappa values exceeding 0.80 for interrater reliability. The kappa values for the anterior drawer test and Lachman test were 0.80 and 0.77, respectively. The lever sign test showed the highest specificity (100%) and the lowest sensitivity (39%) when compared with the other 3 tests. Moreover, its positive and negative predictive values were 100% and 65%, respectively, while an accuracy of 71% was calculated. Clustering the lever sign test parallel with the other 3 tests resulted in the highest accuracy of 91%. Conclusion: The lever sign test appears to have high interrater reliability and is the most specific test, showing a maximal positive predictive value. A positive lever sign test result indicates an ACL rupture. These results support the added value of the lever sign test for diagnosing ACL ruptures.
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Affiliation(s)
| | - Christiaan H Koster
- Department of Trauma Surgery, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Lennart P J Teunissen
- Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Frits G J Oosterveld
- Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Annelieke M K Harmsen
- Department of Trauma Surgery, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Daniel Haverkamp
- Department of Orthopaedic Surgery, Medical Centre Slotervaart, Amsterdam, the Netherlands
| | - Daniel Hoornenborg
- Department of Orthopaedic Surgery, Medical Centre Slotervaart, Amsterdam, the Netherlands
| | - Robert P Berg
- Department of Orthopaedic and Trauma Surgery, Regional Hospital Koningin Beatrix, Winterswijk, the Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Irene R Faber
- Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
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Iorio R, Iannotti F, Ponzo A, Proietti L, Redler A, Conteduca F, Ferretti A. Anterior cruciate ligament reconstruction in patients older than fifty years: a comparison with a younger age group. INTERNATIONAL ORTHOPAEDICS 2018. [PMID: 29532113 DOI: 10.1007/s00264-018-3860-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate functional and radiological results in patients older than 50 years who underwent an anatomic anterior cruciate ligament (ACL) reconstruction with semitendinosus and gracilis tendons and to compare these results with those of patients younger than 40 years. METHODS Thirty-six patients over the age of 50 years with a diagnosis of ACL complete lesion and 36 consecutive patients under 40 years were included in this prospective study. Follow-up included clinical evaluation using Lysholm, IKDC, and Tegner scores and a KT-1000 arthrometric evaluation. Bilateral weight-bearing radiographs were obtained before surgery and at final follow-up of five years to evaluate the degree of osteoarthritis. All patients were evaluated at a one year follow-up (T1) (range 13-17 months) and at final follow-up (T2) (range 60-72 months). RESULTS No statistically significant difference was found between the two groups at the subjective and objective evaluations. At a KT-1000 arthrometric evaluation, the mean side to side maximum manual difference was 1.6 mm in the over 50 (group I) and 2.7 mm in the under 40 (group II) (p = 0.009). At 30 lb, the mean side to side difference was 1.7 mm in the over 50 group and 2.6 mm in the under 40 group (p = 0.040). No statistically significant increase in the degree of osteoarthritis was found at follow-up in the over 50 group. CONCLUSIONS The results of this study seems to confirm that ACL reconstruction in patients older than 50 years is a safe procedure with good to excellent subjective, objective, and radiological outcomes that are comparable to those for younger patients.
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Affiliation(s)
- Raffaele Iorio
- Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", "La Sapienza" University, Via di Grottarossa, 1035-1039, Rome, Italy
| | - Ferdinando Iannotti
- Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", "La Sapienza" University, Via di Grottarossa, 1035-1039, Rome, Italy
| | - Antonio Ponzo
- Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", "La Sapienza" University, Via di Grottarossa, 1035-1039, Rome, Italy
| | - Lorenzo Proietti
- Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", "La Sapienza" University, Via di Grottarossa, 1035-1039, Rome, Italy.
| | - Andrea Redler
- Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", "La Sapienza" University, Via di Grottarossa, 1035-1039, Rome, Italy
| | - Fabio Conteduca
- Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", "La Sapienza" University, Via di Grottarossa, 1035-1039, Rome, Italy
| | - Andrea Ferretti
- Sant'Andrea Hospital, Traumatology Sports Center "Kilk Kilgour", "La Sapienza" University, Via di Grottarossa, 1035-1039, Rome, Italy
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Davis HC, Spang JT, Loeser RF, Larsson S, Ulici V, Blackburn JT, Creighton RA, Kamath GM, Jordan JM, Marshall SW, Pietrosimone B. Time between anterior cruciate ligament injury and reconstruction and cartilage metabolism six-months following reconstruction. Knee 2018; 25. [PMID: 29525545 PMCID: PMC5886724 DOI: 10.1016/j.knee.2018.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND To determine the association between time from injury to ACL reconstruction (TimeInjury-ACLR) and biochemical markers of cartilage metabolism and inflammation six months following ACL reconstruction (ACLR). METHODS Individuals with a unilateral ACL injury were enrolled at initial presentation in the orthopedic clinic; blood was collected six months following ACLR. Enzyme-linked immunosorbent assays were used to analyze the ratio of serum concentrations of type-II collagen breakdown (C2C) to synthesis (CPII), plasma matrix metalloproteinase-3 (MMP-3), interleukin-6 (IL-6), and serum aggrecan neoepitope (ARGS). We used separate linear regressions to assess associations between biochemical markers and TimeInjury-ACLR. RESULTS Twenty-two participants (50% females, mean [SD], age 21.9 [4.5] years old; BMI 23.8 [2.6] kg/m2) completed the study. TimeInjury-ACLR ranged from nine to 67days (31.0 [14.4days]). Greater TimeInjury-ACLR predicted greater serum C2C:CPII ratios six months following ACLR (C2C:CPII=0.15 [0.02], R2=0.213, P=0.030). Males (R2=0.733, P=0.001) but not females (R2=0.030, P=0.609) demonstrated a significant association between greater C2C:CPII and TimeInjury-ACLR at the six-month follow-up exam. TimeInjury-ACLR did not associate with IL-6, MMP-3, or ARGS at six months. CONCLUSIONS Greater time between injury and ACL reconstruction was associated with greater serum C2C:CPII six months following ACLR in males but not females, and IL-6, MMP-3, and ARGS levels were not associated with TimeInjury-ACLR in males or females. The time between ACL injury and ACLR may affect collagen metabolism in males and should be further investigated in a larger study along with other patient-relevant outcomes.
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Affiliation(s)
- Hope C. Davis
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Jeffery T. Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Richard F. Loeser
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Staffan Larsson
- Lund University, Department of Clinical Sciences, Orthopaedics, Lund, Sweden
| | - Veronica Ulici
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, United States
| | - J. Troy Blackburn
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, United States
| | - R. Alexander Creighton
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Ganesh M Kamath
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Stephen W. Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Brian Pietrosimone
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, United States
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76
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Nakamae A, Adachi N, Deie M, Ishikawa M, Nakasa T, Ikuta Y, Ochi M. Risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament reconstruction. Bone Joint J 2018; 100-B:285-293. [DOI: 10.1302/0301-620x.100b3.bjj-2017-0837.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims To investigate the risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament (ACL) reconstruction. Patients and Methods A total of 174 patients who underwent second-look arthroscopic evaluation after anatomical ACL reconstruction were enrolled in this study. The graded condition of the articular cartilage at the time of ACL reconstruction was compared with that at second-look arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction technique, meniscal conditions, and other variables were assessed by regression analysis as risk factors for progression of damage to the articular cartilage. Results In the medial compartment, multivariable logistic regression analysis indicated that partial medial meniscectomy (odds ratio (OR) 6.82, 95% confidence interval (CI) 2.11 to 22.04, p = 0.001), pivot-shift test grade at the final follow-up (OR 3.53, CI 1.39 to 8.96, p = 0.008), BMI (OR 1.15, CI 1.03 to 1.28, p = 0.015) and medial meniscal repair (OR 3.19, CI 1.24 to 8.21, p = 0.016) were significant risk factors for progression of cartilage damage. In the lateral compartment, partial lateral meniscectomy (OR 10.94, CI 4.14 to 28.92, p < 0.001) and side-to-side differences in anterior knee laxity at follow-up (OR 0.63, p = 0.001) were significant risk factors. Conclusion Partial meniscectomy was found to be strongly associated with the progression of articular cartilage damage despite r anatomical ACL reconstruction. Cite this article: Bone Joint J 2018;100-B:285–93.
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Affiliation(s)
- A. Nakamae
- Department of Orthopaedic Surgery, Division
of Medicine, Biomedical Sciences Major, Graduate School of Biomedical
Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - N. Adachi
- Department of Orthopaedic Surgery, Division
of Medicine, Biomedical Sciences Major, Graduate School of Biomedical
Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - M. Deie
- Department of Orthopaedic Surgery, Aichi
Medical University, 21 Karimata, Yazako, Nagakute
City, Aichi 480-1195, Japan
| | - M. Ishikawa
- Department of Orthopaedic Surgery, Division
of Medicine, Biomedical Sciences Major, Graduate School of Biomedical
Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - T. Nakasa
- Department of Orthopaedic Surgery, Division
of Medicine, Biomedical Sciences Major, Graduate School of Biomedical
Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - Y. Ikuta
- Department of Orthopaedic Surgery, Division
of Medicine, Biomedical Sciences Major, Graduate School of Biomedical
Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - M. Ochi
- Hiroshima University, 1-3-2
Kagamiyama Higashi-Hiroshima 739-8511, Japan
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Kwee RM, Hafezi-Nejad N, Roemer FW, Zikria BA, Hunter DJ, Guermazi A, Demehri S. Association of Mucoid Degeneration of the Anterior Cruciate Ligament at MR Imaging with Medial Tibiofemoral Osteoarthritis Progression at Radiography: Data from the Osteoarthritis Initiative. Radiology 2018; 287:912-921. [PMID: 29465334 DOI: 10.1148/radiol.2018171565] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose To determine whether anterior cruciate ligament (ACL) mucoid degeneration in participants with or at risk for osteoarthritis is associated with longitudinal risk of radiographic progression of medial tibiofemoral compartment joint space loss (JSL). Materials and Methods Baseline demographic, clinical, radiographic, and Magnetic Resonance (MR) Imaging Osteoarthritis Knee Score (MOAKS) data were evaluated in 600 participants from the Osteoarthritis Initiative database. Two blinded musculoskeletal radiologists independently evaluated baseline MR images for ACL mucoid degeneration. Multiple logistic regression was used to investigate the association between ACL mucoid degeneration at MR imaging and JSL progression at radiography, defined as a minimum joint space width decrease greater than 0.7 mm (48 months; cutoff according to mean and standard deviation of 1-year minimum joint space width changes in 90 knees of reference group). Stratified analysis was performed based on baseline cartilage surface damage. Results Knees with ACL mucoid degeneration showed a greater proportion of JSL progression compared with knees with a normal ACL (64% vs 47%; P = .004). After adjustment for all demographic, clinical, radiographic, and MOAKS variables, ACL mucoid degeneration was not statistically significantly associated with JSL progression in the entire cohort (adjusted odds ratio, 1.66; 95% confidence interval: 1.00, 2.77; P = .051). In subgroup analysis, ACL mucoid degeneration was statistically significantly associated with JSL progression in participants with less baseline cartilage surface damage (maximum cartilage surface loss of ≤75% in all subregions [P = .015] and ≤4 of involved subregions with cartilage surface loss [P = .028]). Conclusion ACL mucoid degeneration in participants with or at risk for osteoarthritis is associated with progression of medial tibiofemoral compartment JSL in knees with less baseline cartilage surface area damage. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Robert M Kwee
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Nima Hafezi-Nejad
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Frank W Roemer
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Bashir A Zikria
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - David J Hunter
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Ali Guermazi
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Shadpour Demehri
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
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Kaku N, Shimada T, Tabata T, Tagomori H, Abe T, Zhang JJ, Tsumura H. Three-dimensional architecture of the ligamentum teres in the human hip joint. Muscles Ligaments Tendons J 2018; 7:442-448. [PMID: 29387637 DOI: 10.11138/mltj/2017.7.3.442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background We aimed to investigate the three-dimensional structure of the collagenous fibers of the ligamentum teres (LT) of the human hip and clarify the LT micro-anatomy at the attachment of the femoral head. Methods Femoral heads and LT were collected during hip arthroplasty. Specimens were cut into 5-10-mm squares, prepared, developed, and observed under a light microscope. Next, specimens were prepared and examined under a scanning electron microscope (SEM). Results Under optical microscope, LT adhered to the artificial cartilage at the attachment of the femoral head. Under SEM, LT comprised parallelly arranged collagenous fibers and the fine collagenous fibrils were twisted. While the central collagenous fibers of the LT at the attachment of the femoral head penetrated the articular cartilage tissue and reached the ring-shaped bone, fibers at the margin traversed and adhered to the cartilage surface. Conclusion Articular cartilage and subchondral bone are present at the LT attachment to the femoral head. Although collagenous fibers of the LT show parallel arrangement at the main trunk, they are dispersed at the cartilage surface and not all reach the thin subchondral bone of the femoral head. This could possibly weaken ligament strength at the attachment of the femoral head. Level of evidence IV.
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Affiliation(s)
- Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Oita, Japan
| | - Tatsuo Shimada
- Oita College of Judo Therapy and Acupuncture-Moxibustion, Yufu City, Oita, Japan
| | - Tomonori Tabata
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Oita, Japan
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Oita, Japan
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Oita, Japan
| | - Juan Juan Zhang
- Department of Matrix Medicine, Faculty of Medicine, Oita University, Yufu City, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Oita, Japan
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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.
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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
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80
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Recovery of ACL function after dynamic intraligamentary stabilization is resultant to restoration of ACL integrity and scar tissue formation. Knee Surg Sports Traumatol Arthrosc 2018; 26:589-595. [PMID: 28741153 DOI: 10.1007/s00167-017-4656-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Dynamic intraligamentary stabilization (DIS) is recognized as a ligament preserving technique for the treatment of acute anterior cruciate ligament (ACL) injuries. The aim of this study was to assess the integrity and morphology of the recovered ACL after DIS repair. METHODS The cohort comprised 47 patients with an acute proximal ACL rupture undergoing DIS repair. All patients underwent diagnostic arthroscopy after a minimum postoperative interval of 6 months for semi-quantitative evaluation of ACL integrity, function and scar tissue formation. Tegner, Lysholm and International Knee Documentation Committee (IKDC) scores as well as objective anteroposterior (ap) translation were assessed at 6 weeks, 3-, 6- and 12 months postoperatively. RESULTS Full restoration of the ACL volume was affirmed in 30 (63.8%) patients and two-third restoration in 13 (27.7%). Hypertrophic scar formation was observed in 23 (48.9%) patients. Forty-four patients (93.6%) demonstrated sufficient ACL tensioning intraoperatively upon anterior stress. At final follow-up, the median Tegner activity level was 5.5 (3-10), Lysholm and IKDC scores were 100 (64-100) and 94 (55-100) points, respectively. The mean ap-translation differed from the normal knee by 2.1 ± 2.2 mm. Deficient ACL recovery was noted in four patients (8.5%), none of which required secondary reconstructive surgery. CONCLUSION The results demonstrate that clinical recovery of ACL function after DIS repair is resultant to both restoration of ACL volume and scar tissue formation. Factors influencing the degree of scar tissue formation need further investigation to enable future attempts of guiding a balanced biological healing response. LEVEL OF EVIDENCE IV.
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Abstract
The management of complex cartilage and meniscal pathology in young, athletic patients is extremely challenging. Joint preservation surgery is most difficult in patients with concomitant knee pathologies, including cartilage defects, meniscal deficiency, malalignment, and/or ligamentous insufficiency. Clinical decision making for these patients is further complicated by articular cartilage lesions, which often are incidental findings; therefore, treatment decisions must be based on the confirmed contribution of articular cartilage lesions to symptomatology. Surgical management of any of the aforementioned knee pathologies that is performed in isolation typically results in acceptable patient outcomes; however, concomitant procedures for the management of concomitant knee pathologies often are essential to the success of any single procedure. The use of biologic therapy as an alternative to or to augment more conventional surgical management has increased in popularity in the past decade, and indications for biologic therapy continue to evolve. Orthopaedic surgeons should understand knee joint preservation techniques, including biologic and reconstructive approaches in young, high-demand patients.
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82
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Järvelä S, Kiekara T, Suomalainen P, Järvelä T. Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study With 10-Year Results. Am J Sports Med 2017; 45:2578-2585. [PMID: 28661696 DOI: 10.1177/0363546517712231] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A long-term follow-up comparing double-bundle and single-bundle techniques for anterior cruciate ligament (ACL) reconstruction has not been reported before. HYPOTHESIS Double-bundle ACL reconstruction may have fewer graft ruptures, lower rates of osteoarthritis (OA), and better stability than single-bundle reconstruction. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Ninety patients were randomized for double-bundle ACL reconstruction with bioabsorbable screw fixation (DB group; n = 30), single-bundle ACL reconstruction with bioabsorbable screw fixation (SBB group; n = 30), and single-bundle ACL reconstruction with metallic screw fixation (SBM group; n = 30). Evaluation methods consisted of a clinical examination, KT-1000 arthrometer measurements, International Knee Documentation Committee (IKDC) and Lysholm knee scores, and a radiographic examination of both the operated and contralateral knees. RESULTS Eighty-one patients (90%) were available at the 10-year follow-up. Eleven patients (1 in the DB group, 7 in the SBB group, and 3 in the SBM group) had a graft failure during the follow-up and went on to undergo revision ACL surgery ( P = .043). In the remaining 70 patients at 10 years, no significant group differences were found in the pivot-shift test findings, KT-1000 arthrometer measurements, or knee scores. The most OA findings were found in the medial compartment of the knee, with 38% of the patients in the operated knee and 28% of the patients in the contralateral nonoperated knee. However, no significant group difference was found. The most severe OA changes were in the patients who had the longest delay from the primary injury to ACL reconstruction ( P = .047) and in the patients who underwent partial meniscal resection at the time of ACL reconstruction ( P = .024). CONCLUSION Double-bundle ACL reconstruction resulted in significantly fewer graft failures than single-bundle ACL reconstruction during the follow-up. Knee stability and OA rates were similar at 10 years. The most severe OA changes were found in the patients who had the longest delay from the primary injury to ACL reconstruction and in the patients who underwent partial meniscal resection at the time of ACL reconstruction.
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Affiliation(s)
- Sally Järvelä
- Department of Accidents and Emergencies, Tampere University Hospital, Tampere, Finland.,Arthroscopic and Sports Medicine Center, Pohjola Hospital, Tampere, Finland
| | - Tommi Kiekara
- Medical Imaging Centre, Tampere University Hospital, Tampere, Finland
| | - Piia Suomalainen
- Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Timo Järvelä
- Arthroscopic and Sports Medicine Center, Pohjola Hospital, Helsinki, Finland
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Larson KM, Zhang L, Badger GJ, Jay GD. Early genetic restoration of lubricin expression in transgenic mice mitigates chondrocyte peroxynitrite release and caspase-3 activation. Osteoarthritis Cartilage 2017; 25:1488-1495. [PMID: 28579418 PMCID: PMC5565702 DOI: 10.1016/j.joca.2017.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 05/10/2017] [Accepted: 05/25/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study investigated the ability of endogenous lubricin secretion to restore joint health following a brief <21 day, postnatal lubricin-null state, in a C57BL/6J Prg4 gene trap (GT) mouse under the control of cre-recombinase. Previously we showed that re-expression of lubricin at 21 days was partly restorative of joint lubrication. DESIGN The tibio-femoral joints of adult C57BL/6J mice containing lubricin, lacking lubricin, and postnatally lacking lubricin until restoration of lubricin expression at 7 days or 14 days of age were evaluated ex vivo. At 8-weeks of age, whole joint coefficient of friction (COF), and caspase-3 activation were measured and the tibial-femoral joints histologically analyzed for degenerative changes, following progressive cyclic loading. The peroxynitrite content of femoral head cartilage from these mice prior to cyclic loading was measured. RESULTS Mice that underwent gene recombination at 7 and 14 days of age did not reestablish low COF as joint cycling time increased and were histopathologically indistinguishable from the joints of lubricin-null littermates. However, cartilage from tibio-femoral joints that underwent recombination at 7 and 14 days of age had significantly fewer caspase-3 positive cells and significantly reduced peroxynitrite content compared to lubricin-null littermates. CONCLUSIONS The biological effects of lubricin, which include limiting inflammation via peroxynitrite production and caspase-3 activation, may be achieved without completely restituting low COF. However, fully recapitulating low COF may require undamaged cartilage surfaces or absence of biofouling, which may interfere with the activity of lubricin.
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Affiliation(s)
- Katherine M. Larson
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI, USA
| | - Ling Zhang
- Emergency Medicine Research Laboratory, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Gregory D. Jay
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI, USA,Emergency Medicine Research Laboratory, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA,Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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84
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Wang Y, Dang Z, Cui W, Yang L. Mechanical stretch and hypoxia inducible factor-1 alpha affect the vascular endothelial growth factor and the connective tissue growth factor in cultured ACL fibroblasts. Connect Tissue Res 2017; 58:407-413. [PMID: 27600173 DOI: 10.1080/03008207.2016.1231179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSES The adult human anterior cruciate ligament (ACL) has poor functional healing response. Hypoxia plays an important role in regulating the microenvironment of the joint cavity after ACL injury, however, its role in mechanical injury is yet to be examined fully in ACL fibroblasts. In this study, we used CoCl2 to induce Hypoxia-inducible factor-1α (HIF-1α) in our experimental model to study its affect on matrix metalloproteinase-2 (MMP-2), vascular endothelial growth factor (VEGF), and connective tissue growth factor (CTGF) expression in ACL fibroblasts after mechanical stretch. MATERIALS AND METHODS Cell treatments were performed in the stretch chamber in all experimental groups. Quantitative real-time PCR was used to check mRNA expression levels of MMP-2, CTGF, VEGF, and HIF-1α. Western blot was used to detect the HIF-1α production. Enzyme-Linked immunosorbent assay was performed to check the VEGF and CTGF protein contents in supernatant. MMP-2 activity was assayed by gelatin zymography. RESULTS The real-time PCR results show that mechanical stretch or CoCl2 treatment increases the expression of MMP-2, VEGF, CTGF, and HIF-1α; however, the combined effects of mechanical stretch and CoCl2-induced HIF-1α increased MMP-2 production but decreased the VEGF and CTGF expression, compared to the CoCl2 treatment group alone. Western blot analysis and ELISA also confirmed these results. CONCLUSIONS Our results demonstrated that mechanical stretch and CoCl2-induced HIF-1α together increased the level of MMP-2 and decreased the levels of VEGF and CTGF in cultured ACL fibroblasts. The differential expression and production of HIF-1α, VEGF, MMP-2, and CTGF might help to explain the poor healing ability of ACL.
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Affiliation(s)
- Yequan Wang
- a Institute of Forensic Medicine and Laboratory Medicine , Jining Medical University , Jining , China.,b Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College , Chongqing University , Chongqing , China.,c "111" Biomechanics and Tissue Repair Laboratory, Bioengineering College , Chongqing University , Chongqing , China
| | - Zhen Dang
- a Institute of Forensic Medicine and Laboratory Medicine , Jining Medical University , Jining , China
| | - Wen Cui
- a Institute of Forensic Medicine and Laboratory Medicine , Jining Medical University , Jining , China
| | - Li Yang
- b Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College , Chongqing University , Chongqing , China.,c "111" Biomechanics and Tissue Repair Laboratory, Bioengineering College , Chongqing University , Chongqing , China
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85
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Sonesson S, Kvist J. Dynamic and static tibial translation in patients with anterior cruciate ligament deficiency initially treated with a structured rehabilitation protocol. Knee Surg Sports Traumatol Arthrosc 2017. [PMID: 26210960 DOI: 10.1007/s00167-015-3714-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To compare dynamic and static tibial translation, in patients with anterior cruciate ligament deficiency, at 2- to 5-year follow-up, with the tibial translation after 4 months of rehabilitation initiated early after the injury. Secondarily, to compare tibial translation in the injured knee and non-injured knee and explore correlations between dynamic and static tibial translation. METHODS Twelve patients with ACL rupture were assessed at 3-8 weeks after ACL injury, after 4 months of structured rehabilitation, and 2-5 years after ACL injury. Sagittal tibial translation was measured during the Lachman test (static translation) and during gait (dynamic translation) using a CA-4000 electrogoniometer. RESULTS Static tibial translation was increased bilateral 2-5 years after ACL injury, whereas the dynamic tibial translation was unchanged. Tibial translation was greater in the injured knee compared with the non-injured knee (Lachman test 134 N 9.1 ± 1.0 vs. 7.0 ± 1.7 mm, P = 0.001, gait 5.6 ± 2.1 vs. 4.7 ± 1.8 mm, P = 0.011). There were no correlations between dynamic and static tibial translation. CONCLUSION Dynamic tibial translation was unchanged in spite of increased static tibial translation in the ACL-deficient knee at 2- to 5-year follow-up compared to directly after rehabilitation. Dynamic tibial translation did not correlate with the static tibial translation. A more normal gait kinematics may be maintained from completion of a rehabilitation programme to mid-term follow-up in patients with ACL deficiency treated with rehabilitation only. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sofi Sonesson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.
| | - Joanna Kvist
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
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86
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Priano F. Early Efficacy of Intra-Articular HYADD® 4 (Hymovis®) Injections for Symptomatic Knee Osteoarthritis. JOINTS 2017; 5:79-84. [PMID: 29114635 PMCID: PMC5672870 DOI: 10.1055/s-0037-1603677] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose The aim of the study was to evaluate the clinical effects of HYADD® 4, an hydrogel based on a hyaluronic acid derivative, in patients with symptomatic knee osteoarthritis, on symptoms, and joint function. Methods This retrospective study of patients with Kellgren-Lawrence grade II to IV knee osteoarthritis (American College of Rheumatology criteria) enrolled patients who had received two infiltrations of HYADD® 4, (24 mg/3 mL) 1 week apart, and evaluated: pain at rest, pain with movement, change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score; change in nonsteroidal anti-inflammatory drugs (NSAIDs)/acetaminophen use; satisfaction with therapy; tolerability. Study duration was 6 months for all predefined endpoints, with a 6-month extension for pain symptoms only. Results After 6 months, all predefined endpoints were evaluable in 698 of 937 enrolled patients (74.5%). Mean WOMAC scores were reduced by 56.3% from baseline ( p < 0.05). NSAIDs/acetaminophen use ≥2 times/week (48.8% of patients at baseline) was substantially reduced after 1 month and was 19.6% after 6 months. After 6 months, 85.6% of patients were satisfied about efficacy. There were no significant adverse effects. The effect on resting pain was rapid, strong, and lasting: reduction from baseline was 45.1% at 1 month ( p < 0.05), 56.8% at 6 months ( p < 0.05), and 53.6% at 12 months ( p < 0.05). Pain on moving was reduced by 47.4% after 6 months ( p < 0.05) and 46.0% after 12 months ( p < 0.05), results at 6 and 12 months were similar. Conclusion HYADD® 4 is a new-generation hyaluronic acid with distinctive viscoelastic and rheological properties. In patients with mild-to-severe knee OA (Kellgren-Lawrence grades II-IV), two consecutive infiltrations 1 week apart reduced WOMAC scores and NSAIDs/acetaminophen consumption for at least 6 months. In a subpopulation ( n = 106), efficacy on pain lasted approximately 12 months. Adverse events were reported in 11.2% of patients; the most frequent were arthralgias. No cases of allergic reactions or systemic effects were recorded. Level of Evidence Level IV, retrospective case series.
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Affiliation(s)
- Ferdinando Priano
- Centro Ortopedico "Policlinico di Monza," Ospedale S.M. Misericordia, Albenga, Italy
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87
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Biomechanical Factors Associated With Pain and Symptoms Following Anterior Cruciate Ligament Injury and Reconstruction. PM R 2017; 10:56-63. [PMID: 28602934 DOI: 10.1016/j.pmrj.2017.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/08/2017] [Accepted: 05/20/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Few studies have investigated the associations between patient-reported outcome and gait in patients with anterior cruciate ligament (ACL) injury and reconstruction over time. Because there is an association between ACL rupture and the presence of osteoarthritis later in life, a better understanding of these relationships will help to elucidate how patients' gait pattern may affect pain and symptoms, potentially leading to better treatment for or preventing the development of knee OA. OBJECTIVE To evaluate the associations between gait characteristics and self-reported pain and symptoms before, 6 months after, and 1 year after anterior cruciate ligament reconstruction. DESIGN Prospective cohort study. SETTING The Human Performance Center at the Orthopedic Institute at the University of California, San Francisco. PATIENTS Patients with full unilateral ACL tears were enrolled. A total of 43 patients were included at 12 months postsurgery. METHODS The independent variable in this study comprised specific gait variables in patients who had undergone ACL reconstruction. At each time point, 3-dimensional motion analysis was performed. Participants also completed the Knee Osteoarthritis Outcome Score (KOOS) questionnaire. MAIN OUTCOMES MEASUREMENTS The primary study outcome measurement was the KOOS and was planned before data collection began. Partial correlations were used to examine cross-sectional associations between gait characteristics and KOOS pain and symptom scores at all time points. In addition, partial correlations were performed to examine the associations between change in postoperative KOOS from 6 months to 1 year and gait characteristics at baseline and 6 months. RESULTS Significant associations between KOOS and gait characteristics were found at all time points, including an association between peak medial ground reaction force and pain (r = -0.344, P = .02) and symptoms (r = -0.407, P = .007) at baseline. CONCLUSIONS Specific gait variables may be predictive of greater pain and symptoms and less improvement over time postreconstruction. This could help to inform rehabilitation exercises post injury and pre reconstruction. LEVEL OF EVIDENCE IV.
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Increased Risk of Revision, Reoperation, and Implant Constraint in TKA After Multiligament Knee Surgery. Clin Orthop Relat Res 2017; 475:1618-1626. [PMID: 28091802 PMCID: PMC5406333 DOI: 10.1007/s11999-017-5230-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/04/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The risk of major complications and revision arthroplasty after TKA in patients who previously underwent multiligament knee surgery have been poorly characterized. QUESTIONS/PURPOSES Is multiligament knee surgery before TKA associated with (1) worse implant survival, (2) increased use of TKA design constraint, (3) a greater risk for major complications, and (4) poorer scores for pain and function compared with similar patients receiving TKA for primary osteoarthritis? METHODS Fifty-nine TKAs were performed at our institution between 1985 and 2014 in 59 patients (36 men, 23 women; mean age, 53 years) with a history of previous multiligament knee surgery (≥ two ligaments). Of those, we had followup for 39 (66%), 18 (31%), and six (10%) patients at 5, 10, and 15 years, respectively; mean followup was 5.4 years (range, 1-25 years). A two-to-one matched control group consisting of patients undergoing primary TKA for the diagnosis of osteoarthritis was selected for comparison. Patients were matched based on gender, age at primary TKA (within 5 years), and date of the TKA (within 5 years). Medical records were reviewed for survivorship, TKA design, complications (reoperation, revision, infection, manipulation under anesthesia, and periprosthetic joint infection), TKA design, and clinical outcomes (Knee Society Scores [KSS], Knee Society Function Score [KSS-F]). RESULTS The overall 15-year revision-free survival in patients with prior multiligament knee surgery was decreased in comparison to the matched controls (42% [95% CI, 16%-73%] vs 94% [95% CI, 81%-99%]; p < 0.001). Varus-valgus constraint implant design was used for more patients in the multiligament cohort at index TKA than in the matched control group (9/59 [15%] vs 0/110 [0%], respectively; odds ratio [OR], 45; 95% CI, 3-781; p = 0.009). Patients with a history of multiligament knee surgery also were at increased risk of reoperation for any cause (14/59 [24%] vs 7/118 [6%]; OR, 5; 95% CI, 2-14; p = 0.001). With the numbers available, there was no difference in the frequency of manipulation under anesthesia after TKA (10% [6/59] versus 3% [4/118]; p = 0.08) A higher proportion of patients in the multiligament cohort had infections develop compared with the matched controls (4/59 [7%] vs 1/118 [< 1%)], respectively; p = 0.04). There was no difference in the KSS improvement after TKA between the multiligament group and the control group (34 ± 18 vs 28 ± 15; p = 0.088). The final KSS and KSS-F scores likewise showed no difference between those groups (88 ± 13 vs 85 ± 10; p = 0.232) (85 ± 17 vs 84 ± 14; p = 0.75). CONCLUSIONS A history of multiligament surgery is associated with lower long-term survivorship, higher use of constrained TKA designs, and higher risk of major complications, including reoperation and infection. Further research is necessary to determine if a particular multiligamentous surgical technique can prevent posttraumatic arthritis and TKA complications. LEVEL OF EVIDENCE Level III, therapeutic study.
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89
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Peeler J, Anderson J, Piotrowski S, Stranges G. Motion of the anterior cruciate ligament during internal and external rotation at the knee: A cadaveric study. Clin Anat 2017; 30:861-867. [DOI: 10.1002/ca.22896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 04/20/2017] [Accepted: 04/24/2017] [Indexed: 01/13/2023]
Affiliation(s)
- J. Peeler
- Department of Human Anatomy & Cell Science; University of Manitoba; Winnipeg Manitoba Canada
- Pan Am Clinic, Winnipeg, Manitoba, Canada Pan Am Clinic; Winnipeg Manitoba Canada
| | - J. Anderson
- Department of Biological Sciences; University of Manitoba; Winnipeg Manitoba Canada
| | - S. Piotrowski
- Department of Human Anatomy & Cell Science; University of Manitoba; Winnipeg Manitoba Canada
| | - G. Stranges
- Pan Am Clinic, Winnipeg, Manitoba, Canada Pan Am Clinic; Winnipeg Manitoba Canada
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Lohkamp M, Kromer TO, Schmitt H. Osteoarthritis and joint replacements of the lower limb and spine in ex-professional soccer players: A systematic review. Scand J Med Sci Sports 2017; 27:1038-1049. [PMID: 28150871 DOI: 10.1111/sms.12846] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 12/14/2022]
Abstract
After a professional career as a soccer player, the risk of developing osteoarthritis (OA) in different joints of the spine and lower limb might be increased. The extent of this problem to date is not clear. Therefore, the aim of this systematic review is to summarize the prevalence of OA and joint replacement of the lower limb and spine in former professional soccer players. Relevant databases were searched with different combinations of key words: for example, OA, hip, knee, ankle, foot, joint replacement, soccer. Studies were included if they were original research, included a sample of former professional male soccer players, and had OA in the lower limb and/or spine; OA was diagnosed either through questionnaires or X-rays; and the article is in English, Dutch, or German. Sixteen studies with 1576 former players and 2153 control subjects were included in the review. Studies agreed that the prevalence of hip OA and hip replacements is significantly higher in former players compared to the control group. For the ankle and spine, there is only limited information, and for the prevalence of knee OA and knee replacement, the results are contradictory. The quality of the included studies was moderate. Future studies should have a prospective design to control for confounding factors, to identify possible risk factors and consequences for the individuals, and to be able to develop a prevention program.
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Affiliation(s)
- M Lohkamp
- SRH Hochschule Heidelberg, Heidelberg, Germany
| | - T O Kromer
- SRH Hochschule Heidelberg, Heidelberg, Germany
| | - H Schmitt
- ATOS Klinik Heidelberg GmbH & Co. KG, Heidelberg, Germany
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91
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Paschos NK. Anterior cruciate ligament reconstruction and knee osteoarthritis. World J Orthop 2017; 8:212-217. [PMID: 28361013 PMCID: PMC5359756 DOI: 10.5312/wjo.v8.i3.212] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/12/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
Anterior cruciate ligament (ACL) injury is a traumatic event that can lead to significant functional impairment and inability to participate in high-level sports-related activities. ACL reconstruction is considered the treatment of choice for symptomatic ACL-deficient patients and can assist in full functional recovery. Furthermore, ACL reconstruction restores ligamentous stability to normal, and, therefore, can potentially fully reinstate kinematics of the knee joint. As a consequence, the natural history of ACL injury could be potentially reversed via ACL reconstruction. Evidence from the literature is controversial regarding the effectiveness of ACL reconstruction in preventing the development of knee cartilage degeneration. This editorial aims to present recent high-level evidence in an attempt to answer whether ACL injury inevitably leads to osteoarthritis and whether ACL reconstruction can prevent this development or not.
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92
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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.
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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
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93
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Syam K, Chouhan DK, Dhillon MS. Outcome of ACL Reconstruction for Chronic ACL Injury in Knees without the Posterior Horn of the Medial Meniscus: Comparison with ACL Reconstructed Knees with An Intact Medial Meniscus. Knee Surg Relat Res 2017; 29:39-44. [PMID: 28231647 PMCID: PMC5336373 DOI: 10.5792/ksrr.16.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 01/14/2023] Open
Abstract
Purpose Cadaveric studies have shown that deficiency of the posterior horn of the medial meniscus (PHMM) increases strain on the anterior cruciate ligament (ACL) graft. However, its influence on the clinical and radiological outcome after ACL reconstruction is less discussed and hence evaluated in this study. Materials and Methods This study included 77 cases of ACL reconstruction with a minimum 18-month follow-up. Of the 77 cases, 41 patients with intact menisci were compared clinically and radiologically with 36 patients with an injury to the PHMM that required various grades of meniscectomy. The knees were evaluated using subjective International Knee Documentation Committee (IKDC) score and Orthopadische Arbeitsgruppe Knie (OAK) score. Results Cases with intact menisci showed better stability (p=0.004) at an average of 44.51 months after surgery. No significant differences were noted in the overall OAK score, subjective IKDC score, and functional OAK score (p=0.082, p=0.526, and p=0.363, respectively). The incidence of radiological osteoarthrosis was significantly higher in the posterior horn deficient knees (p=0.022). Conclusions The tendency toward relatively higher objective instability and increased incidence of osteoarthrosis in the group with absent posterior horn reinforces its importance as a secondary stabiliser of the knee.
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Affiliation(s)
- Kevin Syam
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devendra K Chouhan
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Bojicic KM, Beaulieu ML, Imaizumi Krieger DY, Ashton-Miller JA, Wojtys EM. Association Between Lateral Posterior Tibial Slope, Body Mass Index, and ACL Injury Risk. Orthop J Sports Med 2017; 5:2325967116688664. [PMID: 28255568 PMCID: PMC5315236 DOI: 10.1177/2325967116688664] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: While body mass index (BMI), a modifiable parameter, and knee morphology, a nonmodifiable parameter, have been identified as risk factors for anterior cruciate ligament (ACL) rupture, the interaction between them remains unknown. An understanding of this interaction is important because greater compressive axial force (perhaps due to greater BMI) applied to a knee that is already at an increased risk because of its geometry, such as a steep lateral posterior tibial slope, could further increase the probability of ACL injury. Purpose: To quantify the relationship between BMI and select knee morphological parameters as potential risk factors for ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: Sagittal knee magnetic resonance imaging (MRI) files from 76 ACL-injured and 42 uninjured subjects were gathered from the University of Michigan Health System’s archive. The posterior tibial slope (PTS), middle cartilage slope (MCS), posterior meniscus height (PMH), and posterior meniscus bone angle (MBA) in the lateral compartment were measured using MRI. BMI was calculated from demographic data. The association between the knee structural factors, BMI, and ACL injury risk was explored using univariate and multivariate logistic regression. Results: PTS (P = .043) and MCS (P = .037) significantly predicted ACL injury risk. As PTS and MCS increased by 1°, odds of sustaining an ACL injury increased by 12% and 13%, respectively. The multivariate logistic regression analysis, which included PTS, BMI centered around the mean (cBMI), and their interaction, showed that this interaction predicted the odds of ACL rupture (P = .050; odds ratio, 1.03). For every 1-unit increase in BMI from the average that is combined with a 1° increase in PTS, the odds of an ACL tear increased by 15%. Conclusion: An increase in BMI was associated with increased risk of ACL tear in the presence of increased lateral posterior tibial slope. Larger values of PTS or MCS were associated with an increased risk of ACL tear.
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Affiliation(s)
| | - Mélanie L Beaulieu
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - James A Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA.; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Edward M Wojtys
- MedSport, Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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95
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Watters TS, Zhen Y, Martin JR, Levy DL, Jennings JM, Dennis DA. Total Knee Arthroplasty After Anterior Cruciate Ligament Reconstruction: Not Just a Routine Primary Arthroplasty. J Bone Joint Surg Am 2017; 99:185-189. [PMID: 28145948 DOI: 10.2106/jbjs.16.00524] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the success of restoring joint stability and improving early functional outcomes after anterior cruciate ligament (ACL) reconstruction, the long-term risk of developing symptomatic osteoarthritis requiring total knee arthroplasty is higher than that in the uninjured population. The purpose of this study was to compare operative characteristics and early outcomes of patients undergoing total knee arthroplasty after ACL reconstruction with those of a matched cohort of control subjects with primary osteoarthritis and no history of ligament reconstruction. METHODS All patients who had undergone total knee arthroplasty from 2005 to 2013 at our institution with a history of ACL reconstruction and a minimum 2-year follow-up were identified from a prospective research database. These patients were matched by demographic and surgeon variables to patients who had not undergone prior ACL reconstruction. Outcomes included Knee Society Scores (KSS), range of motion, operative variables, complications, and reoperations. RESULTS A cohort of 122 patients was identified as the ACL study group and was compared with the matched control cohort. The mean age at the time of the surgical procedure was 58 years, and 55% of the patients were male. The mean follow-up was 3.3 years in the ACL group and 3.0 years in the control group. There was no significant difference in the latest KSS outcomes between groups postoperatively (p > 0.05). Although preoperative flexion was significantly lower (p = 0.01) in the ACL group (119°) than in the control group (123°), there was no difference between groups postoperatively. Fifty percent (61 of 122) of patients in the ACL group required implant removal at the time of total knee arthroplasty. The operative time was significantly longer (p < 0.001) in the ACL group (88 minutes) compared with the control group (73 minutes). There were a total of 11 reoperations in the ACL group, including 4 for periprosthetic infection, whereas there were only 2 reoperations in the control group. The risk of reoperation in the ACL group was more than 5 times higher than in the control group (relative risk, 5.5 [95% confidence interval, 1.2 to 24.3]; p = 0.01). CONCLUSIONS The results of this retrospective matched cohort study suggest that prior ACL reconstruction results in longer operative time and increased risk of early reoperation after total knee arthroplasty. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tyler Steven Watters
- 1Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado 2Bone and Joint Department, Qianfoshan Hospital, Shandong University, Jinan, China
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Verniba D, Vescovi JD, Hood DA, Gage WH. The analysis of knee joint loading during drop landing from different heights and under different instruction sets in healthy males. SPORTS MEDICINE-OPEN 2017; 3:6. [PMID: 28101732 PMCID: PMC5243232 DOI: 10.1186/s40798-016-0072-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/20/2016] [Indexed: 11/29/2022]
Abstract
Background Mechanical loading during exercise has been shown to promote tissue remodeling. Safe and accessible exercise may be beneficial to populations at risk of diminished bone and joint health. We examined the effect of drop height and instruction on knee loading during a drop-landing task and proposed a task that makes use of drop heights that may be appropriate for rehabilitation purposes and functional in daily life to examine transient knee joint loads. Methods Twenty males (22.0 ± 2.8 years) performed drop landings from 22 cm (low) and 44 cm (high) heights, each under three instructions: “land naturally” (natural), “softly” (soft), and “stiffly” (stiff). Knee compression force and external flexion moment were estimated using three-dimensional inverse dynamics and normalized to body mass. Results Peak knee compression force was larger (p < 0.001) for high (17.8 ± 0.63 N/kg) than low (14.8 ± 0.61 N/kg) heights. There was an increase (p < 0.001) in the knee compression force across soft (11.8 ± 0.40 N/kg), natural (17.0 ± 0.62 N/kg), and stiff (20.2 ± 0.67 N/kg) instructions. Peak knee flexion moment in high-natural (2.12 ± 0.08 Nm/kg) was larger (p < 0.001) than in high-soft (1.88 ± 0.08 Nm/kg), but lower than in high-stiff (2.23 ± 0.08 Nm/kg). No differences in peak knee flexion moment were observed across instructions for the low height. Conclusions We propose a drop-landing task that creates a scalable increase in knee compression loading. The absence of increased knee flexion moment with drop from the low height, compared to high, suggests that individuals could perform the task without incremental risk of knee injury. This task could be used in future studies to examine the effect of acute bouts of mechanical loading on bone and cartilage metabolism.
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Affiliation(s)
- Dmitry Verniba
- Orthopaedic Neuromechanics Laboratory, Sherman Health Science Research Centre, York University, Toronto, Ontario, Canada. .,Muscle Health Research Centre, York University, Toronto, Ontario, Canada. .,School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
| | - Jason D Vescovi
- Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - David A Hood
- Muscle Health Research Centre, York University, Toronto, Ontario, Canada.,School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - William H Gage
- Orthopaedic Neuromechanics Laboratory, Sherman Health Science Research Centre, York University, Toronto, Ontario, Canada.,Muscle Health Research Centre, York University, Toronto, Ontario, Canada.,School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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Takata Y, Nakase J, Toratani T, Numata H, Oshima T, Kitaoka K, Tsuchiya H. Conscious performance and arthroscopic findings in athletes with anterior cruciate ligament injuries treated via conservative therapy during the competitive season. J Orthop Surg (Hong Kong) 2017; 25:2309499016684751. [PMID: 28193143 DOI: 10.1177/2309499016684751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Athletes often receive conservative treatment for injured anterior cruciate ligaments (ACLs) so that they can continue to play to the end of their season. The purpose of this study was to examine the conscious performance and arthroscopic findings of athletes who received conservative therapy for ACL injuries. METHODS Forty-two patients with ACL injuries underwent conservative treatment. After the season ended, ACL reconstruction was performed. We examined the following parameters: (1) time required for return to competition after injury, (2) conscious performance after return to competition, (3) whether the injured knee gave way during conservative therapy or after return to competition, and (4) cause of performance deterioration if applicable. To determine conscious performance, patients were asked to rate their performance after therapy relative to their performance before injury. RESULTS Thirty-eight of the 42 patients (90.5%) returned to competition after conservative treatment. The mean time to return was 13.8 ± 7.6 weeks, and the mean conscious performance score was 58.4 ± 16.5%. Thirty-eight patients (90.5%) experienced their knee giving way, of whom 36 (94.9%) stated that fear of their knee giving way hampered their performance. At the time of ACL reconstruction, 9 patients had chondral injuries and 22 patients had meniscus injuries. CONCLUSION Most athletes with damaged ACLs returned to the field within the same season after conservative treatment. However, conscious performance was only about 60%. It is possible that knees giving way caused secondary meniscus and joint cartilage damage. Therefore, conservative treatment of individuals with ACL injuries should be considered carefully.
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Affiliation(s)
- Yasushi Takata
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Tatsuhiro Toratani
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Hitoaki Numata
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Takeshi Oshima
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | | | - Hiroyuki Tsuchiya
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
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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.
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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
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Ranawat AS, Nwachukwu BU, Pearle AD, Zuiderbaan HA, Weeks KD, Khamaisy S. Comparison of Lateral Closing-Wedge Versus Medial Opening-Wedge High Tibial Osteotomy on Knee Joint Alignment and Kinematics in the ACL-Deficient Knee. Am J Sports Med 2016; 44:3103-3110. [PMID: 27496910 DOI: 10.1177/0363546516657824] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lateral closing-wedge (LCW) and medial opening-wedge (MOW) high tibial osteotomies (HTOs) correct varus knee alignment and stabilize the anterior cruciate ligament (ACL)-deficient knee. Tibiofemoral and patellofemoral alignment and kinematics after HTO are not well quantified. PURPOSE To compare the effect of LCW and MOW HTO on tibiofemoral and patellofemoral alignment in the ACL-deficient knee. STUDY DESIGN Controlled laboratory study. METHODS Anterior drawer, Lachman, and pivot-shift tests were performed on cadaveric specimens (N = 16), and anterior tibial translation and tibial rotation were measured for the native and ACL-sectioned knee. The right and left knee of each cadaveric specimen underwent an LCW and MOW HTO, respectively, and stability testing was repeated. All cadavers underwent pre- and postosteotomy computerized tomography with 3-dimensional computer modeling to determine the effect of HTO on posterior tibial slope, as well as tibial and patellofemoral axial plane alignment (tibial axial rotation and patellar axial tilt). RESULTS Correction to neutral coronal alignment was obtained with both osteotomy techniques; however, larger posterior tibial slope neutralization was achieved with LCW compared with MOW (mean ± SD, 11° ± 3.8° vs 5° ± 5°). LCW demonstrated a greater decrease in anterior tibial translation (P < .05) during Lachman testing, with translation values approximating those of the native knee, especially for the lateral compartment. A similar decrease in anterior tibial translation with LCW was not found during anterior drawer testing. Anterior tibial translation did not improve for either the Lachman or the anterior drawer test after MOW. Osteotomy type did not affect tibial rotation with pivot shift. Relative to MOW, LCW resulted in greater tibial axial rotation and patellar axial tilt (7.7° ± 4° and 5.6° ± 3.9° [LCW], 2.8° ± 2.3° and 2.4° ± 0.9° [MOW], respectively; P < .05). CONCLUSION/CLINICAL RELEVANCE LCW shows more reproducible posterior tibial slope neutralization and decreased anterior tibial translation in ACL deficiency compared with MOW; however, LCW is associated with increased external tibial axial rotation and lateral patellar tilt, which may adversely affect the patellofemoral joint. More work is needed to understand the clinical and functional outcome of these biomechanical findings in the ACL-deficient knee.
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Affiliation(s)
- Anil S Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D Pearle
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Kenneth D Weeks
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Saker Khamaisy
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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