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Slovák L, Zahradník D, Land WM, Sarvestan J, Hamill J, Abdollahipour R. Response of Knee Joint Biomechanics to Landing Under Internal and External Focus of Attention in Female Volleyball Players. Motor Control 2024; 28:341-361. [PMID: 38702047 DOI: 10.1123/mc.2023-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 05/06/2024]
Abstract
The aim of this study was to examine the effect of attentional focus instructions on the biomechanical variables associated with the risk of anterior cruciate ligament injury of the knee joint during a drop landing task using a time series analysis. Ten female volleyball players (age: 20.4 ± 0.8 years, height: 169.7 ± 7.1 cm, mass: 57.6 ± 3.1 kg, experience: 6.3 ± 0.8 years) performed landings from a 50 cm height under three different attentional focus conditions: (1) external focus (focus on landing as soft as possible), (2) internal focus (focus on bending your knees when you land), and (3) control (no-focus instruction). Statistical parameter mapping in the sagittal plane during the crucial first 30% of landing time showed a significant effect of attentional focus instructions. Despite the similarity in landing performance across foci instructions, adopting an external focus instruction promoted reduced vertical ground reaction force and lower sagittal flexion moment during the first 30% of execution time compared to internal focus, suggesting reduced knee loading. Therefore, adopting an external focus of attention was suggested to reduce most biomechanical risk variables in the sagittal plane associated with anterior cruciate ligament injuries, compared to internal focus and control condition. No significant differences were found in the frontal and horizontal planes between the conditions during this crucial interval.
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Affiliation(s)
- Lukáš Slovák
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
| | - David Zahradník
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
| | - William M Land
- Department of Kinesiology, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Javad Sarvestan
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Biomechanics and Functional Morphology Laboratory, CIPER, Faculdade de Motricidade Humana, University of Lisbon, Lisboa, Portugal
| | - Joseph Hamill
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
- Biomechanics Laboratory, University of Massachusetts, Amherst, MA, USA
| | - Reza Abdollahipour
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
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Mulcahey MK. Editorial Commentary: Early Anterior Cruciate Ligament Reconstruction Decreases the Risk of Developing Irreparable Meniscus Tears in Female Athletes. Arthroscopy 2023; 39:623-625. [PMID: 36740286 DOI: 10.1016/j.arthro.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 02/07/2023]
Abstract
There has been a substantial increase in the participation of women in sports since the passage of Title IX in 1972. With increased participation has come a rise in athletic injuries, including anterior cruciate ligament (ACL) tears. Numerous factors (modifiable and nonmodifiable) contribute to the 2 to 8 times increased risk of ACL tears in female compared with male athletes. The sports with the greatest risk of ACL injury include cutting sports such as soccer (1.1% per season), basketball (0.9% per season), volleyball, and lacrosse. In addition, female patients have a 33.7% greater risk of a subsequent contralateral ACL tear. Approximately 70% of ACL tears are the result of noncontact injuries. Numerous factors contribute to the increased risk of ACL tears in female athletes, including nonmodifiable (hormonal fluctuations, sex differences in knee geometry) and modifiable risk factors (neuromuscular control). Injury-prevention programs focus on modifiable risk factors and have been shown to be incredibly effective, decreasing the risk of ACL tears up to 50%. ACL tears commonly are associated with meniscus tears, including medial meniscus ramp and lateral posterior root lesions; therefore, thorough assessment is critical to identify this pathology. Early ACL reconstruction (i.e., <12 months following injury) increases the likelihood of being able to repair meniscus tears. Given the much greater risk of ACL tears and lower rate of return to sport in female athletes, this group warrants special attention to identify and treat these injuries earlier and subsequently improve overall outcomes.
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Costa MQ, Badger GJ, Chrostek CA, Carvalho OD, Faiola SL, Fadale PD, Hulstyn MJ, Gil HC, Shalvoy RM, Fleming BC. Effects of Initial Graft Tension and Patient Sex on Knee Osteoarthritis Outcomes After ACL Reconstruction: A Randomized Controlled Clinical Trial With 10- to 12-Year Follow-up. Am J Sports Med 2022; 50:3510-3521. [PMID: 36259724 PMCID: PMC9633422 DOI: 10.1177/03635465221124917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The initial graft tension applied during anterior cruciate ligament (ACL) graft fixation may promote posttraumatic osteoarthritis (PTOA). PURPOSE/HYPOTHESIS This study sought to assess the effect of initial graft tension and patient sex on PTOA outcomes at 10 to 12 years after ACL reconstruction (ACLR). The hypothesis was that there would be no group- or sex-based differences in outcomes. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients were randomized to receive ACLR with a low or high initial graft tension. Outcomes were evaluated at 10 to 12 years postoperatively and compared with a matched, uninjured control group. Outcomes included clinical assessments (anteroposterior [AP] knee laxity measurement, International Knee Documentation Committee [IKDC] examination score), a functional assessment (single-leg hop for distance), patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS], 36-Item Short Form Health Survey, Tegner activity level, patient satisfaction), and PTOA imaging (Osteoarthritis Research Society International [OARSI] radiographic score and Whole-Organ Magnetic Resonance Imaging Score [WORMS]). Two-way mixed-model analyses of variance were used to evaluate differences in outcomes between tension groups and the control group and between female and male patients. RESULTS Both tension groups scored worse than the control group for the IKDC examination (P≤ .021), KOOS (Pain, Activities of Daily Living, Sport/Recreation, and Quality of Life subscales) (P≤ .049), and WORMS difference score (P≤ .042). The low-tension group scored worse than the control group for KOOS Symptoms (P = .016) and the OARSI difference score (P = .015). The index limb had worse scores than the contralateral limb within the high-tension group for AP laxity (P = .030) and hop deficit (P = .011). This result was also observed within both tension groups for the WORMS (P≤ .050) and within the low-tension group for the OARSI score (P = .001). Male patients had higher Tegner scores (mean ± SE) relative to female patients (male, 5.49 ± 1.88; female, 4.45 ± 1.65) and worse OARSI difference scores (male, 1.89 ± 5.38; female, 0.244 ± 0.668) (P = .007 and .034, respectively). However, no significant differences were detected between tension groups for any of the outcomes measured. CONCLUSION Overall, ACLR failed to prevent PTOA regardless of initial graft tension. However, male patients treated with a low initial graft tension may be at greater risk for PTOA. These results do not support the hypothesis of no sex differences in outcomes at 10 to 12 years after ACLR.
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Affiliation(s)
- Meggin Q. Costa
- Dept of Orthopaedics, Brown University/Rhode Island Hospital, Providence, RI
| | - Gary J. Badger
- Dept of Medical Biostatistics, University of Vermont, Burlington, VT
| | - Cynthia A. Chrostek
- Dept of Orthopaedics, Brown University/Rhode Island Hospital, Providence, RI
| | - Orianna D. Carvalho
- Dept of Orthopaedics, Brown University/Rhode Island Hospital, Providence, RI
| | - Stacy L. Faiola
- Dept of Orthopaedics, Brown University/Rhode Island Hospital, Providence, RI
| | - Paul D. Fadale
- Dept of Orthopaedics, Brown University/Rhode Island Hospital, Providence, RI
| | - Michael J. Hulstyn
- Dept of Orthopaedics, Brown University/Rhode Island Hospital, Providence, RI
| | - Holly C. Gil
- Dept of Diagnostic Imaging, Brown University/Rhode Island Hospital, Providence, RI
| | - Robert M. Shalvoy
- Dept of Orthopaedics, Brown University/Rhode Island Hospital, Providence, RI
| | - Braden C. Fleming
- Dept of Orthopaedics, Brown University/Rhode Island Hospital, Providence, RI
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Time, graft, sex, geographic location, and isokinetic speed influence the degree of quadriceps weakness after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3367-3376. [PMID: 35224649 DOI: 10.1007/s00167-022-06906-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Although quadriceps weakness after ACL reconstruction (ACLR) is well documented, the magnitude of reported weakness varies considerably. Such variation raises the possibility that certain patients may be more susceptible to quadriceps weakness after ACLR. This meta-analysis identified factors explaining between-study variability in quadriceps weakness post-ACLR. METHODS Studies between 2010 and 2020 were screened for the following criteria: human subjects, unilateral ACLR, and strength reported both for the ACLR leg and the uninjured or healthy-control leg. 122 studies met the criteria, resulting in 303 and 152 Cohen's d effect sizes (ESs) comparing ACLR legs to uninjured legs (a total of 4135 ACLR subjects) and to healthy controls (a total of 1,507 ACLR subjects vs. 1-193 healthy controls), respectively. Factors (time, graft, sex, activity, mass/height, geographic area, concomitant injury, and type of strength testing) that may affect study ES were examined. RESULTS Meta-regressions indicated an association between time post-ACLR and study ESs (P < 0.001) and predicted full recovery (ES = 0) to occur at 54-59 months post-ACLR. When compared to uninjured legs, patients with patellar tendon autografts had greater deficits than studies using hamstring tendon autografts (P = 0.023). When compared to uninjured legs, studies including only males reported greater deficits than studies combining males and females (P = 0.045); whereas when compared to healthy controls, studies combining males and females reported greater deficits than studies with males (P = 0.013). When compared to controls, studies from USA reported greater deficits than studies from Europe (P = 0.003). Increased isokinetic-testing speed was associated with smaller deficits (P ≤ 0.025). Less than 25% of patients achieved a between-limb symmetry in quadriceps strength > 90% between 6 and 12 months post-ACLR. CONCLUSION Time post-surgery, graft, sex, geographic location, and isokinetic speed influenced the magnitude of post-ACLR quadriceps weakness. Patients with patellar tendon autografts demonstrated greater between-limb asymmetry in quadriceps strength, while female strength deficits were underestimated to a greater extent. A slower isokinetic speed provided a more sensitive assessment of quadriceps strength post-ACLR. The overwhelming majority of patients were returning to sport with significantly impaired quadriceps strength. LEVEL OF EVIDENCE III.
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Shultz SJ, Cruz MR, Casey E, Dompier TP, Ford KR, Pietrosimone B, Schmitz RJ, Taylor JB. Sex-Specific Changes in Physical Risk Factors for Anterior Cruciate Ligament Injury by Chronological Age and Stages of Growth and Maturation From 8 to 18 Years of Age. J Athl Train 2022; 57:830-876. [PMID: 36638346 PMCID: PMC9842121 DOI: 10.4085/1062-6050-0038.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To critically assess the literature focused on sex-specific trajectories in physical characteristics associated with anterior cruciate ligament (ACL) injury risk by age and maturational stage. DATA SOURCES PubMed, CINAHL, Scopus, and SPORTDiscus databases were searched through December 2021. STUDY SELECTION Longitudinal and cross-sectional studies of healthy 8- to 18-year-olds, stratified by sex and age or maturation on ≥1 measure of body composition, lower extremity strength, ACL size, joint laxity, knee-joint geometry, lower extremity alignment, balance, or lower extremity biomechanics were included. DATA EXTRACTION Extracted data included study design, participant characteristics, maturational metrics, and outcome measures. We used random-effects meta-analyses to examine sex differences in trajectory over time. For each variable, standardized differences in means between sexes were calculated. DATA SYNTHESIS The search yielded 216 primary and 22 secondary articles. Less fat-free mass, leg strength, and power and greater general joint laxity were evident in girls by 8 to 10 years of age and Tanner stage I. Sex differences in body composition, strength, power, general joint laxity, and balance were more evident by 11 to 13 years of age and when transitioning from the prepubertal to pubertal stages. Sex differences in ACL size (smaller in girls), anterior knee laxity and tibiofemoral angle (greater in girls), and higher-risk biomechanics (in girls) were observed at later ages and when transitioning from the pubertal to postpubertal stages. Inconsistent study designs and data reporting limited the number of included studies. CONCLUSIONS Critical gaps remain in our knowledge and highlight the need to improve our understanding of the relative timing and tempo of ACL risk factor development.
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Affiliation(s)
- Sandra J. Shultz
- Department of Kinesiology, University of North Carolina, Greensboro
| | | | | | | | | | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Randy J. Schmitz
- Department of Kinesiology, University of North Carolina, Greensboro
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Schmitz RJ, Ford KR, Pietrosimone B, Shultz SJ, Taylor JB. ACL Research Retreat IX Summary Statement: The Pediatric Athlete, March 17-19, 2022; High Point, North Carolina. J Athl Train 2022; 57:990-995. [PMID: 36638340 PMCID: PMC9842120 DOI: 10.4085/1062-6050-0219.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Randy J. Schmitz
- Applied Neuromechanics Research Laboratory, Department of Kinesiology, School of Health and Human Sciences, University of North Carolina, Greensboro
| | - Kevin R. Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Sandra J. Shultz
- Applied Neuromechanics Research Laboratory, Department of Kinesiology, School of Health and Human Sciences, University of North Carolina, Greensboro
| | - Jeffrey B. Taylor
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
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Sim K, Rahardja R, Zhu M, Young SW. Optimal Graft Choice in Athletic Patients with Anterior Cruciate Ligament Injuries: Review and Clinical Insights. Open Access J Sports Med 2022; 13:55-67. [PMID: 35800660 PMCID: PMC9255990 DOI: 10.2147/oajsm.s340702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/23/2022] [Indexed: 12/03/2022] Open
Abstract
Anterior cruciate ligament (ACL) rupture is a common sporting-related knee injury with a potentially detrimental impact on the athlete’s career, yet there is no formal consensus on the optimal graft choice for reconstructing the ruptured ACL in this specific population. Options for reconstruction include autograft, allograft, and artificial grafts. However, each has associated failure risk and donor site morbidity. Our operational definition of the athlete is a skeletally mature individual participating in high level activity with the expectation to return to pre-injury level of activity. The athlete has unique injury characteristics, post-operative expectations, and graft demands that differ to the general population. Long-term outcomes are of particular importance given on-going mechanical demands on the reconstructed knee. Therefore, the purpose of this review is to consolidate current literature on the various ACL reconstruction graft options, with a focus on the optimal graft for returning the athlete to activity with the lowest rate of re-injury.
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Affiliation(s)
- Katarina Sim
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
- Correspondence: Katarina Sim, Department of Orthopaedics, North Shore Hospital, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand, Email
| | - Richard Rahardja
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Mark Zhu
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | - Simon W Young
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Devana SK, Solorzano C, Nwachukwu B, Jones KJ. Disparities in ACL Reconstruction: the Influence of Gender and Race on Incidence, Treatment, and Outcomes. Curr Rev Musculoskelet Med 2022; 15:1-9. [PMID: 34970713 PMCID: PMC8804118 DOI: 10.1007/s12178-021-09736-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament (ACL) rupture is a common injury that has important clinical and economic implications. We aimed to review the literature to identify gender, racial and ethnic disparities in incidence, treatment, and outcomes of ACL injury. RECENT FINDINGS Females are at increased risk for ACL injury compared to males. Intrinsic differences such as increased quadriceps angle and increased posterior tibial slope may be contributing factors. Despite lower rates of injury, males undergo ACL reconstruction (ACLR) more frequently. There is conflicting evidence regarding gender differences in graft failure and ACL revision rates, but males demonstrate higher return to sport (RTS) rates. Females report worse functional outcome scores and have worse biomechanical metrics following ACLR. Direct evidence of racial and ethnic disparities is limited, but present. White athletes have greater risk of ACL injury compared to Black athletes. Non-White and Spanish-speaking patients are less likely to undergo ACLR after ACL tear. Black and Hispanic youth have greater surgical delay to ACLR, increased risk for loss to clinical follow-up, and less physical therapy sessions, thereby leading to greater deficits in knee extensor strength during rehabilitation. Hispanic and Black patients also have greater risk for hospital admission after ACLR, though this disparity is improving. Females have higher rates of ACL injury with inconclusive evidence on anatomic predisposition and ACL failure rate differences between genders. Recent literature has suggested inferior RTS and functional outcomes following ACLR in females. Though there is limited and mixed data on incidence and outcome differences between races and ethnic groups, recent studies suggest there may be disparities in those who undergo ACLR and time to treatment.
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Affiliation(s)
- Sai K. Devana
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
| | - Carlos Solorzano
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
| | - Benedict Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
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Cristiani R, Forssblad M, Edman G, Eriksson K, Stålman A. Age, time from injury to surgery and hop performance after primary ACLR affect the risk of contralateral ACLR. Knee Surg Sports Traumatol Arthrosc 2022; 30:1828-1835. [PMID: 34617125 PMCID: PMC9033698 DOI: 10.1007/s00167-021-06759-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate factors affecting the risk of contralateral anterior cruciate ligament reconstruction (ACLR) within 5 years of primary ACLR. METHODS Primary ACLRs performed at Capio Artro Clinic, Stockholm, Sweden, during the period 2005-2014, were reviewed. The outcome of the study was the occurrence of contralateral ACLR within 5 years of primary ACLR. Univariable and multivariable logistic regression analyses were employed to identify preoperative [age, gender, body mass index (BMI), time from injury to surgery, pre-injury Tegner activity level], intraoperative [graft type, medial meniscus (MM) and lateral meniscus (LM) resection or repair, cartilage injury] and postoperative [limb symmetry index (LSI) for quadriceps and hamstring strength and single-leg-hop test performance at 6 months] risk factors for contralateral ACLR. RESULTS A total of 5393 patients who underwent primary ACLR were included. The incidence of contralateral ACLR within 5 years was 4.7%. Univariable analysis revealed that age ≥ 25 years, BMI ≥ 25 kg/m2, time from injury to surgery ≥ 12 months and the presence of a cartilage injury reduced the odds, whereas female gender, pre-injury Tegner activity level ≥ 6, quadriceps and hamstring strength and a single-leg-hop test LSI of ≥ 90% increased the odds of contralateral ACLR. Multivariable analysis showed that the risk of contralateral ACLR was significantly affected only from age ≥ 25 years (OR 0.40; 95% CI 0.28-0.58; P < 0.001), time from injury to surgery ≥ 12 months (OR 0.48; 95% CI 0.30-0.75; P = 0.001) and a single-leg-hop test LSI of ≥ 90% (OR 1.56; 95% CI 1.04-2.34; P = 0.03). CONCLUSION Older age (≥ 25 years) and delayed primary ACLR (≥ 12 months) reduced the odds, whereas a symmetrical (LSI ≥ 90%) 6-month single-leg-hop test increased the odds of contralateral ACLR within 5 years of primary ACLR. Knowledge of the factors affecting the risk of contralateral ACLR is important when it comes to the appropriate counselling for primary ACLR. Patients should be advised regarding factors affecting the risk of contralateral ACLR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Riccardo Cristiani
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden.
- Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486, Stockholm, Sweden.
| | - Magnus Forssblad
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Edman
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Karl Eriksson
- Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anders Stålman
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
- Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486, Stockholm, Sweden
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Shultz SJ, Schmitz RJ, Kulas AS, Labban JD, Wang HM. Quadriceps muscle volume positively contributes to ACL volume. J Orthop Res 2022; 40:268-276. [PMID: 33506964 DOI: 10.1002/jor.24989] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/12/2020] [Accepted: 01/11/2021] [Indexed: 02/04/2023]
Abstract
Females have smaller anterior cruciate ligaments (ACLs) than males and smaller ACLs have been associated with a greater risk of ACL injury. Overall body dimensions do not adequately explain these sex differences. This study examined the extent to which quadriceps muscle volume (VOLQUAD ) positively predicts ACL volume (VOLACL ) once sex and other body dimensions were accounted for. Physically active males (N = 10) and females (N = 10) were measured for height, weight, and body mass index (BMI). Three-Tesla magnetic resonance images of their dominant and nondominant thigh and knee were then obtained to measure VOLACL , quadriceps, and hamstring muscle volumes, femoral notch width, and femoral notch width index. Separate three-step regressions estimated associations between VOLQUAD and VOLACL (third step), after controlling for sex (first step) and one body dimension (second step). When controlling for sex and sex plus BMI, VOLHAM , notch width, or notch width index, VOLQUAD consistently exhibited a positive association with VOLACL in the dominant leg, nondominant leg, and leg-averaged models (p < 0.05). Findings were inconsistent when controlling for sex and height (p = 0.038-0.102). Once VOLQUAD was included, only notch width and notch width index retained a statistically significant individual association with VOLACL (p < 0.01). Statement of Clinical Significance: The positive association between VOLQUAD and VOLACL suggests ACL size may in part be modifiable. Future studies are needed to determine the extent to which an appropriate training stimulus (focused on optimizing overall lower extremity muscle mass development) can positively impact ACL size and structure in young females.
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Affiliation(s)
- Sandra J Shultz
- Department of Kinesiology, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Randy J Schmitz
- Department of Kinesiology, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Anthony S Kulas
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
| | - Jeffrey D Labban
- HHS Office of Research, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Hsin-Min Wang
- Department of Sports, National Changhua University of Education, Changhua, Taiwan
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Thorolfsson B, Svantesson E, Snaebjornsson T, Sansone M, Karlsson J, Samuelsson K, Senorski EH. Adolescents Have Twice the Revision Rate of Young Adults After ACL Reconstruction With Hamstring Tendon Autograft: A Study From the Swedish National Knee Ligament Registry. Orthop J Sports Med 2021; 9:23259671211038893. [PMID: 34660824 PMCID: PMC8516395 DOI: 10.1177/23259671211038893] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/25/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Previous studies have identified young age as a risk factor for anterior cruciate ligament (ACL) revision. However, few studies have looked separately at pediatric patients and adolescents with regard to outcomes after ACL reconstruction. Purpose: To determine whether patient age at ACL reconstruction affects the risk of undergoing revision surgery in young patients. Study Design: Cohort study; Level of evidence, 3. Methods: This study was based on data from the Swedish National Knee Ligament Registry. Patients aged 5 to 35 years who underwent a primary ACL reconstruction with a hamstring tendon autograft between January 1, 2005, and December 31, 2015, were included. The cohort was stratified into different age groups of pediatric patients, adolescents, and young adults to estimate patients with open, recently closed, and closed epiphyses, respectively. The primary endpoint was ACL revision. A multivariable Cox regression model was used to assess the ACL revision rate. The results were expressed as hazard ratios (HRs) and 95% CIs. Results: A total of 36,274 ACL reconstructions were registered during the study period. Of these, 2848 patients were included in the study: 47 pediatric patients (mean age, 13.6 years; range, 9-15 years), 522 adolescents (mean age, 17.4; range, 14-19 years), and 2279 young adults (mean age, 27.0; range, 20-35 years). A total of 31 patients (1.1%) underwent ACL revision within 2 years (0 pediatric patients, 9 adolescents [1.7%], and 22 young adults [1.0%]) and a total of 53 patients (2.6%) underwent ACL revision within 5 years (2 pediatric patients [6.9%], 15 adolescents [3.9%], and 36 young adults [2.2%]). The adolescent age group had a 1.91 times higher rate of ACL revision compared with the young adults (HR = 1.91 [95% CI, 1.13-3.21]; P = .015). There were no differences in revision rates between the pediatric age group and the young adults (HR = 2.93 [95% CI, 0.88-9.79]; P = .081). Conclusion: Adolescents had almost twice the rate of revision ACL reconstruction compared with young adults.
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Affiliation(s)
- Baldur Thorolfsson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sports Trauma Research Center, Gothenburg, Sweden
| | - Eleonor Svantesson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sports Trauma Research Center, Gothenburg, Sweden
| | - Thorkell Snaebjornsson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sports Trauma Research Center, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sports Trauma Research Center, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sports Trauma Research Center, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sports Trauma Research Center, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Gothenburg Sports Trauma Research Center, Gothenburg, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sportrehab Sports Medicine Clinic, Gothenburg, Sweden
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12
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McMurray NS, Bates NA, Fischer S, Schilaty ND, Hewett TE. INVESTIGATION OF PRIMARY AND SECOND ANTERIOR CRUCIATE LIGAMENT TEARS USING A GEOGRAPHIC DATABASE. Int J Sports Phys Ther 2020; 15:593-602. [PMID: 33354392 PMCID: PMC7735687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) injuries has been estimated at 1 in 3500 individuals in the literature. Second ACL tears represent 7-14% of all ACL tears. The location of ACL tears has been noted to be primarily proximal. PURPOSE The purpose of this study was to corroborate previous data as well as to add novel data to the literature regarding the location of ACL tears, risk factors associated with second ACL tears, and correlation between hearing a "pop" at the time of injury and concomitant injuries. STUDY DESIGN Epidemiologic Review. METHODS A geographic database containing the medical records of individuals in a rural county in Midwest, USA was utilized to identify ACL injuries that occurred in the county from 2011 to 2016. A total of 743 ACL injuries were identified, which were reviewed and stratified by primary and second tears, sex, race, age, activity level, number of "pops" heard at time of injury, side of injury, location of tear, graft type used in reconstruction, location of fixation, and concomitant injuries. FINDINGS ACL tear location was noted to be primarily midsubstance (44.1%) or proximal (34.1%). The majority of individuals (56.3%) who reported hearing "multiple pops" at the time of injury sustained multiple types of concomitant injuries. The incidence of second ACL tears was 16.8% of total ACL injuries. Second ACL tears were associated with multiple factors, including tear type (p < 0.015) and tear location (p < 0.022). When comparing primary versus second ACL tears, no significant difference in concomitant injuries was noted. CONCLUSIONS The majority of ACL tears (78.2%) occur in the midsubstance or proximal fibers. Hearing multiple "pops" at the time of injury may be associated with more concomitant injuries. The incidence of second ACL tears in this population was comparable to previous studies. Second ACL injuries differed statistically from primary injuries in association with tear type and location. LEVEL OF EVIDENCE 2C.
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Affiliation(s)
| | | | - Samuel Fischer
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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13
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Zhou P, Liu JC, Deng XT, Li Z. Hamstring autograft versus patellar tendon autograft for anterior cruciate ligament reconstruction, which graft has a higher contralateral anterior cruciate ligament injury rate?: A meta-analysis of 5561 patients following the PRISMA guidelines. Medicine (Baltimore) 2020; 99:e21540. [PMID: 32756207 PMCID: PMC7402893 DOI: 10.1097/md.0000000000021540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Contralateral anterior cruciate ligament (CACL) injury is one of the devastating complications after anterior cruciate ligament (ACL) reconstruction. Whether the risk of CACL tear is related to graft selection remains controversial due to contradictory results in studies. There are no meta-analyses to compare which graft has a higher CACL injury rate. Hence, this meta-analysis was conducted to compare the incidence of the CACL injury after ACL reconstruction with bone-patellar tendon-bone (BPTB) autografts compared with hamstring (HT) autografts. METHODS A comprehensive search of literature published between 1980 and January 2020 was performed using MEDLINE, EMBASE, Web of Science, and the Cochrane Library databases. RevMan 5.3 software was used for meta-analysis. The overall risk ratio (RR) was calculated using a fixed- or random-effects. The heterogeneity among the included results was analyzed by chi-square test with significance set at P < .10, and the heterogeneity was quantitatively detected by I-square tests. RESULTS Fifteen prospective comparative studies met inclusion criteria. In the BPTB group, the CACL rupture rate ranged from 1.8% to 30%, with a pooled percentage of 8.5%. In the HT group, the CACL rupture rate ranged from 0% to 14.4%, with a pooled percentage of 3.3%. The overall CACL rupture rate was 3.1% and ranged from 1.1% to 27.1%, with a pooled percentage of 4.9%. The pooled results indicate that there was a statistical significant difference in CACL rupture risk rate between BPTB and HT autograft. (RR, 1.53; 95% CL, 1.21-1.91; P = .0004). CONCLUSION This review showed that patients undergoing primary ACL reconstruction with BPTB autograft were more likely to have CACL rupture than patients treated with HT autograft.
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Affiliation(s)
- Peng Zhou
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province
| | - Jun-Cai Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province
| | - Xiang-Tian Deng
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province
- School of Medicine, Nankai University, Tianjin, P.R. China
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province
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14
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Schneider A, Arias C, Bankhead C, Gaillard R, Lustig S, Servien E. Greater medial tibial slope is associated with increased anterior tibial translation in females with an ACL-deficient knee. Knee Surg Sports Traumatol Arthrosc 2020; 28:1901-1908. [PMID: 31375877 DOI: 10.1007/s00167-019-05643-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 07/19/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of the study was to determine the correlation between medial tibial slope (MTS) and anterior tibial translation (ATT) in female patients with an ACL-deficient knee. It was hypothesized that female patients with a greater medial tibial slope had an increased anterior tibial translation compared to males. METHODS MTS and ATT were analysed in 276 patients (138 females and 138 males) with a complete ACL rupture from 2012 to 2016. The mean age was 32 ± 12 years. Previous surgery or additional ligament injury was excluded. CT scan was used for measuring MTS. Meniscal findings were reported. Anterior tibial translation and side to side difference (SSD) were measured by bilateral Telos™ stress radiography with knee flexion of 20°. RESULTS There was no significant difference in ATT between females (5.4 ± 3.9) and males (5.8 ± 4.2), nor was there a difference in MTS between females (9.8 ± 2.8) and males (9.8 ± 2.7). A positive correlation was found between MTS and ATT absolute (r = 0.35, p < 0.001) and side to side difference (r = 0.12, p = 0.03). MTS greater or equal to 11° significantly increased the ATT (p < 0.05). For each degree of increase of the MTS, increases in ATT absolute of 0.6 mm and SSD of 0.18 mm were observed. Greater MTS was identified as a risk factor for an increase of ATT in females (r = 0.37, p < 0.001) but not in males (r = - 0.1, n.s). Increases of 1° of MTS increased ATT 0.57 mm in female patients (p < 0.001). MTS was influential in ATT despite the presence (r = 0.28 [0.11, 0.44], p = 0.001) or absence (r = 0.48 [0.35, 0.6], p < 0.001) of meniscal lesions. CONCLUSIONS Greater medial tibial slope is associated with increased anterior tibial translation in females with ACL-deficient knees compared to males, despite the presence or absence of meniscal lesions. This could be due to a quadriceps/hamstring imbalance in females and the ability of the hamstring muscles to moderate ATT. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Antoine Schneider
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Hospices civils de Lyon, Université Claude-Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Claudia Arias
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Hospices civils de Lyon, Université Claude-Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France. .,Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.
| | - Chris Bankhead
- Department of Orthopaedics, University of New Mexico, Albuquerque, NM, USA
| | - Romain Gaillard
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Hospices civils de Lyon, Université Claude-Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Sebastien Lustig
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Hospices civils de Lyon, Université Claude-Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.,Laboratoire de Biomécanique Et Mécanique Des Chocs (Université Lyon 1/IFSTTAR) LBMC, UMR_T9406, Lyon, France
| | - Elvire Servien
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Hospices civils de Lyon, Université Claude-Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.,EA 7424, Inter-University Laboratory of Human Movement Science, Lyon, France
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15
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Piussi R, Beischer S, Thomeé R, Hamrin Senorski E. Hop tests and psychological PROs provide a demanding and clinician-friendly RTS assessment of patients after ACL reconstruction, a registry study. BMC Sports Sci Med Rehabil 2020; 12:32. [PMID: 32426142 PMCID: PMC7218571 DOI: 10.1186/s13102-020-00182-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/06/2020] [Indexed: 02/08/2023]
Abstract
Background There is growing interest in assessing psychological well-being in patients after anterior cruciate ligament (ACL) reconstruction. It is unknown whether an assessment of psychological outcome in addition to tests of muscle function can facilitate decisions on return to sport (RTS). Therefore, the aim of this study was to evaluate passing rates in different physical RTS test batteries, with and without the inclusion of psychological outcome measures 1 year after ACL reconstruction. Method In this cross-sectional cohort study a total of 320 patients (51% men) aged 18–65 years were included 1 year after ACL reconstruction. Passing rates on different muscle function (MF) test batteries (with results presented as Limb Symmetry Index (LSI)), consisting of knee extension and flexion strength tests, 3 hop tests, and 2 psychological patient-reported outcomes (PROs); Quality of Life subscale from the Knee injury and Osteoarthritis Outcome Score (KOOS QoL) and ACL Return to Sport after Injury (ACL-RSI), were evaluated 1 year after ACL reconstruction. Muscle function test batteries comprised: 2 MF tests (vertical hop and hop for distance; pass = 90% LSI); 2 MF tests and 2 PRO (pass = 90% LSI, 62.5 points on KOOS QoL and 76.6 points on ACL-RSI), 5 MF tests (2 strength and 3 hop tests, pass = 90% LSI), and 5 MF tests and 2 PRO (pass = 90% LSI, 62.5 points on KOOS QoL and 76.6 points on ACL-RSI). Results Passing rates in the different test batteries were 47% for 2 MF tests, 19% for 2 MF tests and 2 PROs, 29% for 5 MF tests and 13% for 5 MF tests and 2 PROs. The use of psychological PROs together with tests of muscle function gave the lowest passing rate (13%). There was a very strong correlation between passing 2 hop tests and 2 PROs and passing 5 MF tests (rφ = 0.41) as well as passing 5 MF tests and 2 PROs (rφ = 0.79). Conclusion The use of hop tests together with psychological PROs provides a clinician-friendly RTS test battery for assessment 1 year after ACL reconstruction as the passing rate was 19% when using 2 hop-tests combined with 2 PROs, compared with 29% when using 5 tests of MF requiring advanced testing equipment.
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Affiliation(s)
- Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
| | - Susanne Beischer
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden.,2Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden.,2Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden.,2Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
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16
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Barber-Westin S, Noyes FR. One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years. Sports Health 2020; 12:587-597. [PMID: 32374646 DOI: 10.1177/1941738120912846] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Anterior cruciate ligament (ACL) reconstruction (ACLR) is frequently performed in patients younger than 20 years whose goal is to return to sport (RTS). Varying reinjury rates have been reported, and the factors responsible are unclear. Studies differ with regard to age, graft type, surgical techniques, postoperative rehabilitation, RTS guidelines, and methods used to determine ACL failures. OBJECTIVE To determine RTS rates; the effect of participation in high-risk sports, sex, and graft type on ACL reinjury rates; and whether objective test criteria before RTS correlate with lower reinjury rates. DATA SOURCES A systematic review of the literature from inception to May 31, 2019, was conducted using the PubMed and Cochrane databases. STUDY SELECTION Studies on transphyseal ACLR in athletes <20 years old with a minimum mean follow-up of 2 years that reported reinjury rates, the number that RTS, and detailed the type of sport were included. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. RESULTS A total of 1239 patients in 8 studies were included; 87% returned to sport and 80% resumed high-risk activities. Of the patients, 18% reinjured the ACL graft and/or the contralateral ACL. Nine percent of patellar tendon autografts and 15% of hamstring autografts failed (odds ratio [OR], 0.52; P = 0.002). Of reinjuries, 90% occurred during high-risk sports. Male patients had a significantly higher rate of ACL graft failure than female patients (OR, 1.64; P = 0.01). There was no sex-based effect on contralateral ACL injuries. Only 1 study cited objective criteria for RTS. CONCLUSION A high percentage of athletes returned to sport, but 1 in 5 suffered reinjuries to either knee. Male patients were more likely to reinjure the ACL graft. Objective criteria for RTS were rarely mentioned or not detailed. The need for testing of knee stability, strength, neuromuscular control, agility, and psychological measures before RTS remains paramount in young athletes.
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Affiliation(s)
- Sue Barber-Westin
- Cincinnati Sportsmedicine and Orthopaedic Center-Mercy Health, and the Noyes Knee Institute, Cincinnati, Ohio
| | - Frank R Noyes
- Cincinnati Sportsmedicine and Orthopaedic Center-Mercy Health, and the Noyes Knee Institute, Cincinnati, Ohio
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17
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Cartilage damage at the time of anterior cruciate ligament reconstruction is associated with weaker quadriceps function and lower risk of future ACL injury. Knee Surg Sports Traumatol Arthrosc 2020; 28:576-583. [PMID: 31598765 DOI: 10.1007/s00167-019-05739-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine whether articular cartilage damage noted at the time of primary anterior cruciate ligament reconstruction (ACLR) affects the likelihood of achieving ≥ 90% symmetry for isokinetic extension strength at 6 months after surgery or risk of recurrent ACL injury. METHODS Five hundred and eight patients underwent primary ACLR and diagnostic arthroscopy. All identified cartilage lesions were graded using the Outerbridge system. All patients underwent isokinetic strength testing. The association between cartilage Outerbridge grade and a ≥ 90% Limb Symmetry Index (LSI) and recurrent ACL injury risk at mean 38.7 month follow-up (SD 31.8) was evaluated via multivariate regression analysis. RESULTS Grade 2 or higher damage was present in 394 (77.5%) of patients, grade 3 or higher in 143 (28.1%) and grade 4 in 83 (16.4%) at time of ACLR. Ipsilateral ACLR graft rupture occurred in 31 (6.1%) of patients. Contralateral ACL injury occurred in 19 (3.7%). Patients with grade 2 or higher damage were significantly less likely to meet an LSI goal of ≥ 90% for fast (300°/s) isokinetic extension. There was no association with slow isokinetic extension. Cartilage lesion severity at or beyond grade 2 had a similar effect on isokinetic testing results regardless of compartment involvement or performance of microfracture. Patients with grade 2-4 cartilage damage were less likely to sustain a second ipsilateral ACL injury or a contralateral native ACL injury. CONCLUSIONS Cartilage damage seen at time of ACL reconstruction is common and associated with lower likelihood of achieving ≥ 90% symmetry for isokinetic extension strength at 6 months after surgery. However, lower recurrent ACL injury rates are seen in patients with concurrent cartilage damage. These data may inform future clinical decisions regarding operative managment of recurrent ACL injuries. LEVEL OF EVIDENCE III.
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18
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Svantesson E, Hamrin Senorski E, Danielsson A, Sundemo D, Westin O, Ayeni OR, Samuelsson K. Strength in numbers? The fragility index of studies from the Scandinavian knee ligament registries. Knee Surg Sports Traumatol Arthrosc 2020; 28:339-352. [PMID: 31190245 PMCID: PMC6995986 DOI: 10.1007/s00167-019-05551-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/31/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE The fragility index (FI) is a metric to evaluate the robustness of statistically significant results. It describes the number of patients who would need to change from a non-event to an event to change a result from significant to non-significant. This systematic survey aimed to evaluate the feasibility of applying the FI to findings related to anterior cruciate ligament (ACL) reconstruction in the Scandinavian knee ligament registries. METHODS The PubMed, EMBASE, Cochrane Library and AMED databases were searched. Studies from the Scandinavian knee ligament registers were eligible if they reported a statistically significant result (p < 0.05) for any of the following dichotomous outcomes; ACL revision, contralateral ACL reconstruction or the presence of postoperative knee laxity. Only studies with a two-arm comparative analysis were included. Eligibility assessment, data extraction and quality assessment were performed by two independent reviewers. The dichotomous analyses were stratified according to the grouping variable for the two comparative arms as follows; age, patient sex, activity at injury, graft choice, drilling technique, graft fixation, single- versus double-bundle, concomitant cartilage injury and country. The two-sided Fisher's exact test was used to calculate the FI of all statistically significant analyses. RESULTS From 158 identified studies, 13 studies were included. They reported statistical significance for a total of 56 dichotomous analyses, of which all but two had been determined by a time-to-event analysis. The median sample size for the arms was 5540 (range 92-38,666). The mean FI for all 56 dichotomous analyses was 80.6 (median 34.5), which means that a mean of 80.6 patients were needed to change outcome status to generate a non-significant result instead of a significant one. Seventeen analyses (30.4%) immediately became non-significant when performing the two-sided Fisher's exact test and, therefore, had an FI of 0. The analyses related to age were the most robust, with a mean FI of 178.5 (median 116, range 1-1089). The mean FI of the other grouping variables ranged from 0.5 to 48.0. CONCLUSION There was large variability in the FI in analyses from the Scandinavian knee ligament registries and almost one third of the analyses had an FI of zero. The FI is a rough measurement of robustness when applied to registry studies, however, future studies are needed to determine the most appropriate metric for robustness in registry studies. The use of the FI can provide clinicians with a deeper understanding of significant study results and promotes an evidence-based approach in the clinical care of patients. LEVEL OF EVIDENCE Systematic review of prospective cohort studies, Level II.
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Affiliation(s)
- Eleonor Svantesson
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Adam Danielsson
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Sundemo
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olof Westin
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Olufemi R. Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON Canada
| | - Kristian Samuelsson
- Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
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Shultz SJ, Schmitz RJ, Cameron KL, Ford KR, Grooms DR, Lepley LK, Myer GD, Pietrosimone B. Anterior Cruciate Ligament Research Retreat VIII Summary Statement: An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14-16, 2019, Greensboro, NC. J Athl Train 2019; 54:970-984. [PMID: 31461312 PMCID: PMC6795093 DOI: 10.4085/1062-6050-54.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sandra J. Shultz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Randy J. Schmitz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Kenneth L. Cameron
- John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY
| | - Kevin R. Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute and Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens
| | | | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, and Departments of Pediatrics and Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, OH
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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20
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Houck DA, Kraeutler MJ, McCarty EC, Frank RM, Bravman JT. "Doctor, What Happens After My Anterior Cruciate Ligament Reconstruction?". J Bone Joint Surg Am 2019; 101:372-379. [PMID: 30801380 DOI: 10.2106/jbjs.18.00426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Darby A Houck
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
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21
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Webster KE, Feller JA, Kimp AJ, Whitehead TS. Low Rates of Return to Preinjury Sport After Bilateral Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:334-338. [PMID: 30525891 DOI: 10.1177/0363546518813901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with bilateral anterior cruciate ligament (ACL) injuries tend to report worse results in terms of knee function and quality of life as compared with those with unilateral injury. There are limited data regarding return to preinjury sport in this group. PURPOSE To report return-to-sport rates for patients who had bilateral ACL reconstruction and to compare outcomes according to age and sex. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 107 patients (62 male, 45 female) who underwent primary ACL reconstruction surgery to both knees completed a detailed sports activity survey at a mean 5-year follow-up (range, 2.5-10 years). Follow-up also included the International Knee Documentation Committee subjective form, Marx Activity Scale, and Knee injury and Osteoarthritis Outcome Score-Quality of Life subscale. Rates of return to preinjury levels of sport were calculated for the whole cohort, and for further analysis, the group was divided according to age (<25 vs ≥25 years), sex, and time between the reconstruction procedures (<3 vs ≥3 years). RESULTS The rate of return to preinjury sport after bilateral ACL reconstruction was 40% (95% CI, 31%-50%), as compared with an 83% (95% CI, 74%-88%) return rate after the first reconstruction procedure. Although not statistically significant, return rates were higher for male versus female patients (47% vs 31%) and older versus younger patients (45% vs 31%). Of those who returned to their preinjury levels of sport after the second reconstruction, 72% thought that they could perform as well as before their ACL injuries. In contrast, only 20% thought that they could perform as well if they returned to a lower level. Fear of reinjury was the most common reason cited for failure to return to sport after the second reconstruction. Patient-reported outcome scores were higher for those who returned to their preinjury levels of sport but did not differ for sex and age. CONCLUSION Return-to-sport rates drop markedly after a second (contralateral) ACL reconstruction, with less than half of the investigated cohort returning to its preinjury level of sport. Return-to-sport outcomes are less than ideal for patients who have ACL reconstruction surgery to both knees.
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Affiliation(s)
- Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Julian A Feller
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Australia
| | - Alexander J Kimp
- School of Allied Health, La Trobe University, Melbourne, Australia
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Svantesson E, Hamrin Senorski E, Baldari A, Ayeni OR, Engebretsen L, Franceschi F, Karlsson J, Samuelsson K. Factors associated with additional anterior cruciate ligament reconstruction and register comparison: a systematic review on the Scandinavian knee ligament registers. Br J Sports Med 2018; 53:418-425. [DOI: 10.1136/bjsports-2017-098192] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 01/14/2023]
Abstract
ObjectiveTo present an overview of the Scandinavian knee ligament registers with regard to factors associated with additional ACL reconstruction, and studies comparing the Scandinavian registers with other knee ligament registers.DesignSystematic review.Data sourcesFour electronic databases: PubMed, EMBASE, the Cochrane Library and AMED were searched, and 157 studies were identified. Two reviewers independently screened titles, abstracts and full-text studies for eligibility. A modified version of the Downs and Black checklist was applied for quality appraisal.Eligibility criteria for selecting studiesEligible studies were those published since the establishment of the Scandinavian registers in 2004, which reported factors associated with additional ACL reconstruction and compared data from other registers.ResultsThirty-one studies met the inclusion criteria and generally displayed good reporting quality. Adolescent age (<20 years) was the most common factor associated with additional ACL reconstruction. The choice of hamstring tendon graft compared with patella tendon, transportal femoral tunnel drilling, smaller graft diameter and utilisation of suspensory fixation devices were associated with additional ACL reconstruction. Concomitant cartilage injury decreased the likelihood of additional ACL reconstruction. Patient sex alone did not influence the likelihood. The demographics of patients undergoing ACL reconstruction in the Scandinavian registers are comparable to registers in other geographical settings. However, there are differences in surgical factors including the presence of intra-articular pathology and graft choice.SummaryThe studies published from the Scandinavian registers in general have a high reporting quality when regarded as cohort studies. Several factors are associated with undergoing additional ACL reconstruction. The results from the registers may help facilitate treatment decisions.
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Wu B, Qiu Z, Li S, Liang D, Xu J, Zhong M, Lu W, Wang D, Liu H, Zhu W, Ouyang K, Li H. [Histological properties of autogenous hamstring grafts after anterior cruciate ligament reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:873-879. [PMID: 30129311 DOI: 10.7507/1002-1892.201802001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the histological characteristics of autogenous hamstring grafts after anterior cruciate ligament (ACL) reconstruction. Methods The patients who underwent arthroscopic single-bundle ACL reconstruction with autogenous hamstring tendons and were followed up at least 4 years and also underwent second-look arthroscopy between March 2017 and December 2017 and met the selection criteria were considered for enrollment. Graft quality under arthroscopy was evaluated as good remodeling group (GRG, the total scores were 4-6) and poor remodeling group (PRG, the total scores were 1-3) according to synovial and vascular coverage, the apparent tension of the grafts, the thickness and retear of the grafts. During the second-look arthroscopic procedures, ACL graft biopsies were performed. Normal ACL tissues harvested from the patients under 60 years old who underwent total knee arthroplasty were designated as normal controls. Graft vascularity, cellular morphology, cellular metabolism, and collagen fibril distribution were analyzed. Results The 18 specimens (11 cases of GRG group and 7 cases of PRG group) and 9 native ACL biopsied tissue sample were enrolled into the study. Arthroscopy scores were 2-6 (mean, 4.7). The biology under light microscopy of GRG group was similar to that of native ACL in control group. There was no significant difference in the scores of graft vascularity and cellular morphology between GRG group and control group ( P>0.05), while PRG group was significantly lower than the other two groups ( P<0.05). Transmission electron microscope evaluation showed that GRG group and control group had better collagen fibril distribution and lower levels of cellular metabolism than PRG group ( P<0.05). There was no significant difference in cellular metabolism between GRG and control groups ( P>0.05), while collagen fibril distribution score of GRG group was significantly lower than that of control group ( P<0.05). Conclusion While good remodeling grafts under arthroscopy in histological maturation period was proved to be more similar to normal ACL on ultrastructure properties under light and electron microscope, ultra structural differences regarding collagen fibril distribution still persist.
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Affiliation(s)
- Bing Wu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China;Department of Medicine, Shenzhen University, Shenzhen Guangdong, 518061, P.R.China
| | - Zhihe Qiu
- Department of Medicine, Shenzhen University, Shenzhen Guangdong, 518061,
| | - Sheng Li
- Department of Medicine, Shenzhen University, Shenzhen Guangdong, 518061, P.R.China
| | - Daqiang Liang
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - Jian Xu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China;Department of Medicine, Shenzhen University, Shenzhen Guangdong, 518061, P.R.China
| | - Mingjin Zhong
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China;Department of Medicine, Shenzhen University, Shenzhen Guangdong, 518061, P.R.China
| | - Wei Lu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China;Department of Medicine, Shenzhen University, Shenzhen Guangdong, 518061,
| | - Daping Wang
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China;Department of Medicine, Shenzhen University, Shenzhen Guangdong, 518061, P.R.China
| | - Haifeng Liu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China;Department of Medicine, Shenzhen University, Shenzhen Guangdong, 518061, P.R.China
| | - Weimin Zhu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China;Department of Medicine, Shenzhen University, Shenzhen Guangdong, 518061, P.R.China
| | - Kan Ouyang
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China;Department of Medicine, Shenzhen University, Shenzhen Guangdong, 518061, P.R.China
| | - Hao Li
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China;Department of Medicine, Shenzhen University, Shenzhen Guangdong, 518061, P.R.China
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Schneider A, Si-Mohamed S, Magnussen RA, Lustig S, Neyret P, Servien E. Tibiofemoral joint congruence is lower in females with ACL injuries than males with ACL injuries. Knee Surg Sports Traumatol Arthrosc 2018; 26:1375-1383. [PMID: 29052744 DOI: 10.1007/s00167-017-4756-7] [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: 05/27/2017] [Accepted: 10/06/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE Previous research has demonstrated that women have a higher risk of anterior cruciate ligament (ACL) injury than men. Tibiofemoral articular geometry may play a role in the occurrence of ACL tears. The purpose of this study was to analyze the gender-specific geometric characteristics differences in tibiofemoral morphology in ACL-deficient patients. METHODS Medial tibial slope (MTS), lateral tibial slope (LTS), medial tibial plateau concavity, medial and lateral femoral condyle convexity, and lateral plateau convexity were analyzed in 276 patients with complete ACL injuries (138 females and 138 males). Two blinded observers measured the anatomical parameters of tibiofemoral geometry with use of multiplanar CT scans. Intra- and inter-rater reliabilities were assessed and comparisons between anatomic measures were made between male and female patients. RESULTS The average ICC for all measurements was 0.90 (range 0.83-0.97) indicating good reliability. Male ACL injured patients demonstrated significantly greater LTS (10.5° ± 2.8) than female patients (9.6° ± 3.5°; p < 0.05). No gender difference in MTS was found (n.s.). Medial and lateral femoral condyle convexity and medial tibial plateau concavity were greater in males than females (all p < 0.05). Lateral tibial plateau convexity in females was higher than in males (p < 0.001). The medial and lateral compartments were found to be more incongruent in females than males (p < 0.01 and p < 0.001, respectively). CONCLUSIONS Female patients were noted to have more incongruent medial and lateral compartments than male patients. These gender-specific differences in joint morphology may contribute to graft tear risk and outcomes of ACL reconstruction; however, comparative clinical studies are needed to confirm this possibility. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Antoine Schneider
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Univ Lyon-University Claude Bernard Lyon 1, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Salim Si-Mohamed
- Radiology Department, Creatis Laboratory, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | | | - Sebastien Lustig
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Univ Lyon-University Claude Bernard Lyon 1, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Laboratoire de Biomécanique et Mécanique des Chocs (Université Lyon 1/IFSTTAR) LBMC, UMR_T9406, Lyon, France
| | - Philippe Neyret
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Univ Lyon-University Claude Bernard Lyon 1, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Elvire Servien
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Univ Lyon-University Claude Bernard Lyon 1, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,EA 7424-Inter-University Laboratory of Human Movement Science, Lyon, France
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Timing, not magnitude, of force may explain sex-dependent risk of ACL injury. Knee Surg Sports Traumatol Arthrosc 2018; 26:2424-2429. [PMID: 29429044 PMCID: PMC6061759 DOI: 10.1007/s00167-018-4859-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/02/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE The anterior cruciate ligament is loaded through valgus moment, vertical ground reaction force, and internal rotation moment. The aim of this study was to compare the timing of force peaks during early stance between youth girls and boys. METHODS One-hundred and twenty-nine team sport athletes aged 9-12 completed a total of 2540 cutting maneuvers captured with an 8-camera motion capture system. Timing of early force peaks was analyzed within 100 ms after ground contact. RESULTS Genders showed different mean (95% CI) time to peak valgus-(32 ms (30-33 ms) vs 37 ms (36-38 ms), P < 0.001) and time to peak internal rotation moments (36 ms (35-37 ms) vs 38 ms (37-39 ms), P = 0.029) but not time to peak vertical ground reaction force [38 ms (37-40 ms) vs 37 ms (36-38 ms, n.s.)]. Girls showed a smaller time between vertical ground reaction force and valgus moment peaks (mean (95% CI) of 1 ms (1-2 ms) vs 7 ms (5-9 ms), P < 0.001), and valgus- and internal rotation moment peaks (0 ms (- 2 to 1.0 ms) vs - 5 ms (- 6 to - 3 ms), P = 0.0003) but not between internal rotation moment and vertical ground reaction force. CONCLUSIONS Concurrent force peaks are more common for girls compared with boys, leading to more frequent multi-planar loading of the knee. Timing may explain sex-dependent risk of ACL injuries. Exposure to repeated cutting movements may result in greater ACL injury risk due to timing of knee forces as well as magnitude. Such exposure should be minimized for at-risk athletes. LEVEL OF EVIDENCE III.
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Abstract
As female athlete sports participation has continued to increase, the rate of anterior cruciate ligament (ACL) rupture in female athletes has also increased. Individualized, patient-specific treatment is crucial to achieving optimal outcomes; ACL reconstruction must accurately restore native ACL anatomy and address any concomitant injury to secondary stabilizers. Rehabilitation programs should target hip, core, and trunk neuromuscular control; allow adequate time for graft ligamentization; and address the psychosocial needs of the athlete.
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Schilaty ND, Nagelli C, Bates NA, Sanders TL, Krych AJ, Stuart MJ, Hewett TE. Incidence of Second Anterior Cruciate Ligament Tears and Identification of Associated Risk Factors From 2001 to 2010 Using a Geographic Database. Orthop J Sports Med 2017; 5:2325967117724196. [PMID: 28840155 PMCID: PMC5564962 DOI: 10.1177/2325967117724196] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The reported rate of second anterior cruciate ligament (ACL) injuries (20%-30%), including graft failure and contralateral ACL tears, after ACL reconstruction (ACLR) or nonoperative therapy indicates that multiple factors may predispose patients to subsequent ACL injuries. PURPOSE To determine the incidence of second ACL injuries in a population-based cohort over a 10-year observation period (2001-2010) and to identify factors that contribute to the risk of second injuries. STUDY DESIGN Descriptive epidemiological study. METHODS International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACLR were utilized to search the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 2001 and 2010. The complete medical records for all cases were reviewed to confirm diagnosis and treatment details. A total of 914 unique patients with 1019 acute, isolated ACL tears were identified. These patients were stratified by primary and secondary tears, sex, age, activity level, side of injury, sex × side of injury, and graft type of reconstruction. RESULTS Second ACL tears were recorded in 141 (13.8%) of the 914 patients diagnosed with an ACL tear in Olmsted County, Minnesota, USA, from 2001 to 2010; 50.4% of these occurred in the contralateral knee. A noncontact mechanism was responsible for 76.4% of all ACL injuries. A second ACL injury was influenced by factors of sex × age group, treatment type × age group, and treatment type × activity level. Nonparametric analysis of graft disruption × graft type demonstrated that a higher prevalence of second ACL tears occurred with allografts compared with hamstring autografts (P = .0054) and patellar tendon autografts (P = .0001). CONCLUSION The incidence of second ACL tears in this population-based cohort was 13.8%, and half occurred to the ACL of the contralateral knee. Statistically, second ACL injuries differed by sex, occurring in female patients younger than 25 years and male patients aged 26 to 45 years. Allografts continued to be associated with a greater risk of second ACL injuries compared with hamstring and patellar tendon autografts. Nonoperative treatment carried more risk of contralateral tears than ACLR.
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Affiliation(s)
- Nathan D Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Biomechanics Laboratory and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher Nagelli
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Biomechanics Laboratory and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Biomechanics Laboratory and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas L Sanders
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Biomechanics Laboratory and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Biomechanics Laboratory and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Biomechanics Laboratory and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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Eckenrode BJ, Carey JL, Sennett BJ, Zgonis MH. Prevention and Management of Post-operative Complications Following ACL Reconstruction. Curr Rev Musculoskelet Med 2017; 10:315-321. [PMID: 28710739 DOI: 10.1007/s12178-017-9427-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper is to review the current management and prevention of post-operative complications after anterior cruciate ligament (ACL) reconstruction. Trends in rehabilitation techniques will be presented, in addition to suggestions for interventions and expected milestones in ACL reconstruction recovery. RECENT FINDINGS ACL reconstruction protocols have evolved to more of a criterion-based progression rather than a tissue-healing time frame. Given the evolution of ACL surgical reconstruction techniques and rehabilitation protocols, the risk of post-operative complications can arise both early and late in the recovery process. This paper will discuss the role of preventative measures as it applies to the post-operative patient with ACL reconstruction. Short-term complications following ACL reconstruction include infection and deficits to knee motion and strength, whereas long-term complications include secondary ACL injury to either the involved or contralateral knee and lack of ability to return to high-level sports following this procedure. Future research should continue to address the multifactorial causes of secondary ACL injury and limited ability of patients to return to high level activities.
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Affiliation(s)
- Brian J Eckenrode
- Arcadia University, 450 S. Easton Road, Glenside, PA, 19038, USA. .,Good Shepherd Penn Partners at Penn Sports Medicine Center, Philadelphia, PA, USA.
| | - James L Carey
- Penn Sports Medicine Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Brian J Sennett
- Penn Sports Medicine Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Miltiadis H Zgonis
- Penn Sports Medicine Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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