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Johnson CC, Dzewaltowski AC, Dever DE, Krajewski KT, Rai A, Ahamed NU, Allison KF, Flanagan SD, Graham SM, Lovalekar M, Anderst WJ, Connaboy C. Load carriage changes tibiofemoral arthrokinematics during ambulatory tasks in recruit-aged women. Sci Rep 2024; 14:9542. [PMID: 38664550 PMCID: PMC11045865 DOI: 10.1038/s41598-024-60187-3] [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: 01/31/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
The introduction of women into U.S. military ground close combat roles requires research into sex-specific effects of military training and operational activities. Knee osteoarthritis is prevalent among military service members; its progression has been linked to occupational tasks such as load carriage. Analyzing tibiofemoral arthrokinematics during load carriage is important to understand potentially injurious motion and osteoarthritis progression. The study purpose was to identify effects of load carriage on knee arthrokinematics during walking and running in recruit-aged women. Twelve healthy recruit-aged women walked and ran while unloaded (bodyweight [BW]) and carrying additional + 25%BW and + 45%BW. Using dynamic biplane radiography and subject-specific bone models, tibiofemoral arthrokinematics, subchondral joint space and center of closest contact location between subchondral bone surfaces were analyzed over 0-30% stance (separate one-way repeated measures analysis of variance, load by locomotion). While walking, medial compartment contact location was 5% (~ 1.6 mm) more medial for BW than + 45%BW at foot strike (p = 0.03). While running, medial compartment contact location was 4% (~ 1.3 mm) more lateral during BW than + 25%BW at 30% stance (p = 0.04). Internal rotation was greater at + 45%BW compared to + 25%BW (p < 0.01) at 30% stance. Carried load affects tibiofemoral arthrokinematics in recruit-aged women. Prolonged load carriage could increase the risk of degenerative joint injury in physically active women.
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Affiliation(s)
- Camille C Johnson
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
- Orthopaedic Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alex C Dzewaltowski
- Center of Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine & Science, Chicago, IL, USA
| | - Dennis E Dever
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kellen T Krajewski
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ajinkya Rai
- Orthopaedic Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nizam U Ahamed
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katelyn F Allison
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn D Flanagan
- Center of Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine & Science, Chicago, IL, USA
| | - Scott M Graham
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK
| | - Mita Lovalekar
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J Anderst
- Orthopaedic Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chris Connaboy
- Center of Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine & Science, Chicago, IL, USA.
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Kolin DA, Apostolakos J, Fabricant PD, Jivanelli B, Yen YM, Kramer DE, Kocher MS, Pennock AT, Nepple JJ, Willimon SC, Perkins CA, Ellis HB, Wilson PL, McClincy M, Everett Voos J, Spence DD, Heyworth BE. Knee Flexion Angle of Fixation During Anterolateral Ligament Reconstruction or Lateral Extra-articular Tenodesis: A Systematic Review and Meta-analysis of Lateral Extra-articular Reinforcement Techniques Performed in Conjunction With ACL Reconstruction. Orthop J Sports Med 2024; 12:23259671241231254. [PMID: 38425364 PMCID: PMC10903213 DOI: 10.1177/23259671241231254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 03/02/2024] Open
Abstract
Background Anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET) is being used more frequently in conjunction with anterior cruciate ligament reconstruction (ACLR). However, the knee flexion angle at which fixation of ALLR or LET is performed during the procedure is quite variable based on existing technique descriptions. Purpose/Hypothesis The purpose of this study was to identify whether flexion angle at the time of ALLR/LET fixation affected postoperative outcomes in a clinical population. It was hypothesized that ALLR/LET fixation at low versus high flexion angles would lead to no statistically significant differences in patient-reported outcome measures and graft failure rates. Study Design Systematic review; Level of evidence, 4. Methods The PubMed, Embase, and Cochrane Library databases were searched according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify published clinical studies of ACLR with ALLR/LET in which the knee flexion angle at the time of ALLR/LET was reported. A priori, low flexion was defined as 0° to 30°, and high flexion was defined as 60° to 90°. Studies were excluded if the flexion angle was between 31° and 59° because these angles constituted neither low nor high flexion angles and including them in an analysis of high versus low flexion angle at fixation would have biased the study results toward the null. The overall risk of bias was assessed using the Newcastle-Ottawa Scale. The pooled results of the studies were analyzed using the International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores, along with reported graft failure rates. Results A total of 32 clinical studies (5230 patients) met inclusion criteria: 22 studies (1999 patients) in the low-flexion group and 10 studies (3231 patients) in the high-flexion group. The median Newcastle-Ottawa Scale score was 6. Comparisons of patients with a low flexion angle versus a high flexion angle demonstrated no differences in the IKDC (P = .84), Lysholm (P = .67), or Tegner (P = .44) scores or in graft failure (3.4% vs 4.1%, respectively; P = .69). Conclusion The results of this review indicated that ACLR performed in conjunction with ALLR/LET provides good to excellent patient-reported outcomes and low graft failure rates when ALLR/LET fixation is performed in either low or high knee flexion.
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Affiliation(s)
| | | | - Peter D. Fabricant
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | | | | | - Yi-Meng Yen
- Boston Children’s Hospital, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | - Michael McClincy
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Ahsan ZS, Berube EE, Frondorf BJ, Bin Kim H, Marom N, Zayyad ZA, Fraychineaud TJ, Patel RM, Wickiewicz TL, Imhauser CW, Pearle AD, Nawabi DH. Role of Lateral Extra-articular Tenodesis in Restraining Internal Tibial Rotation: In Vitro Biomechanical Assessment of Lateral Tissue Engagement. Am J Sports Med 2024; 52:87-95. [PMID: 38164684 DOI: 10.1177/03635465231211534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND The way in which force increases in the anterolateral tissues and the lateral extra-articular tenodesis (LET) tissue to resist internal rotation (IR) of the tibia after anterior cruciate ligament (ACL) reconstruction in isolation and after LET augmentation, respectively, is not well understood. PURPOSE (1) To compare in a cadaveric model how force increases (ie, engages) in the anterolateral tissues with IR of the tibia after isolated ACL reconstruction and in the LET tissue after augmentation of the ACL reconstruction with LET and (2) to determine whether IR of the tibia is related to engagement of the LET tissue. STUDY DESIGN Controlled laboratory study. METHODS IR moments were applied to 9 human cadaveric knees at 0°, 30°, 60°, and 90° of flexion using a robotic manipulator. Each knee was tested in 2 states: (1) after isolated ACL reconstruction with intact anterolateral tissues and (2) after LET was performed using a modified Lemaire technique with the LET tissue fixed at 60° of flexion under 44 N of tension. Resultant forces carried by the anterolateral tissues and the LET tissue were determined via superposition. The way force increased in these tissues was characterized via parameters of tissue engagement, namely in situ slack, in situ stiffness, and tissue force at peak applied IR moment, and then compared (α < .05). IR was related to parameters of engagement of the LET tissue via simple linear regression (α < .05). RESULTS The LET tissue exhibited less in situ slack than the anterolateral tissues at 30°, 60°, and 90° of flexion (P≤ .04) and greater in situ stiffness at 30° and 90° of flexion (P≤ .043). The LET tissue carried greater force at the peak applied IR moment at 0° and 30° of flexion (P≤ .01). IR was related to the in situ slack of the LET tissue (R2≥ 0.88; P≤ .0003). CONCLUSION LET increased restraint to IR of the tibia compared with the anterolateral tissue, particularly at 30°, 60°, and 90° of flexion. IR of the tibia was positively associated with in situ slack of the LET tissue. CLINICAL RELEVANCE Fixing the LET at 60° of flexion still provided IR restraint in the more functionally relevant flexion angle of 30°. Surgeons should pay close attention to the angle of internal and/or external tibial rotation when fixing the LET tissue intraoperatively because this surgical parameter is related to in situ slack of the LET tissue and, therefore, the amount of IR of the tibia.
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Affiliation(s)
- Zahab S Ahsan
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Erin E Berube
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Brian J Frondorf
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Ho Bin Kim
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Niv Marom
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Zaid A Zayyad
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | | | - Ronak M Patel
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Thomas L Wickiewicz
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Danyal H Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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Xu C, Aloi N, Gale T, Nishida K, Fu F, Anderst W. Symmetry in knee arthrokinematics in healthy collegiate athletes during fast running and drop jump revealed through dynamic biplane radiography. Osteoarthritis Cartilage 2023; 31:1501-1514. [PMID: 37394227 DOI: 10.1016/j.joca.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/17/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Changes in cartilage contact area and/or contact location after knee injury can initiate and exacerbate cartilage degeneration. Typically, the contralateral knee is used as a surrogate for native cartilage contact patterns on the injured knee. However, symmetry in cartilage contact patterns between healthy knees during high-impact activities is unknown. METHOD Tibiofemoral kinematics were measured on 19 collegiate athletes during fast running and drop jump using dynamic biplane radiography and a validated registration process that matched computed tomography (CT)-based bone models to the biplane radiographs. Cartilage contact area and location were measured with participant-specific magnetic resonance imaging (MRI)-based cartilage models superimposed on the CT-based bone models. Symmetry in cartilage contact area and location was assessed by the absolute side-to-side differences (SSD) within participants. RESULTS The SSD in contact area during running (7.7 ± 6.1% and 8.0 ± 4.6% in the medial and lateral compartments, respectively) was greater than during drop jump (4.2 ± 3.7% and 5.7 ± 2.6%, respectively) (95% CI of the difference: medial [2.4%, 6.6%], lateral [1.5%, 4.9%]). The average SSD in contact location was 3.5 mm or less in the anterior-posterior (AP) direction and 2.1 mm or less in the medial-lateral (ML) direction on the femur and tibia for both activities. The SSD in AP contact location on the femur was greater during running than during drop jump (95% CI of the difference: medial [1.6 mm, 3.6 mm], lateral [0.6 mm, 1.9 mm]). CONCLUSION This study provides context for interpreting results from previous studies on tibiofemoral arthrokinematics. Previously reported differences between ligament-repaired and contralateral knee arthrokinematics fall within the range of typical SSDs observed in healthy athletes. Previously reported arthrokinematics differences that exceed SSDs found in these healthy athletes occur only in the presence of anterior cruciate ligament (ACL) deficiency or meniscectomy.
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Affiliation(s)
- Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicholas Aloi
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA; Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tom Gale
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Kyohei Nishida
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Freddie Fu
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - William Anderst
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA.
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Gibbs CM, Hughes JD, Popchak AJ, Chiba D, Winkler PW, Lesniak BP, Anderst WJ, Musahl V. Preoperative quantitative pivot shift does not correlate with in vivo kinematics following ACL reconstruction with or without lateral extraarticular tenodesis. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07232-8. [PMID: 36394585 DOI: 10.1007/s00167-022-07232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Quantitative pivot shift (QPS) testing using PIVOT technology can detect high- and low-grade rotatory knee instability following anterior cruciate ligament injury or reconstruction (ACLR). The aim of this project was to determine if preoperative QPS correlates with postoperative knee kinematics in the operative and contralateral, healthy extremity following ACLR with or without lateral extraarticular tenodesis (LET) using a highly precise in vivo analysis system. A positive correlation between preoperative QPS and postoperative tibial translation and rotation following ACLR with or without LET in the operative and healthy, contralateral extremity was hypothesized. METHODS Twenty patients with ACL injury and high-grade rotatory knee instability were randomized to undergo anatomic ACLR with or without LET as part of a prospective randomized trial. At 6 and 12 months postoperatively, in vivo kinematic data were collected using dynamic biplanar radiography superimposed with high-resolution computed tomography scans of patients' knees during downhill running. Total anterior-posterior (AP) tibial translation and internal-external tibial rotation were measured during the gait cycle. Spearman's rho was calculated for preoperative QPS and postoperative kinematics. RESULTS In the contralateral, healthy extremity, a significant positive correlation was seen between preoperative QPS and total AP tibial translation at 12 months postoperatively (rs = 0.6, p < 0.05). There were no additional significant correlations observed between preoperative QPS and postoperative knee kinematics at 6 and 12 months postoperatively in the operative and contralateral, healthy extremity for combined isolated ACLR and ACLR with LET patients as well as isolated ACLR patients or ACLR with LET patients analyzed separately. DISCUSSION The main finding of this study was that there was a significant positive correlation between preoperative QPS and total AP tibial translation at 12 months postoperatively in the contralateral, healthy extremity. There were no significant correlations between preoperative QPS and postoperative in vivo kinematics at 6 and 12 months following ACLR with or without LET. This suggests that QPS as measured with PIVOT technology does correlate with healthy in vivo knee kinematics, but QPS does not correlate with in vivo kinematics following ACLR with or without LET.
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Affiliation(s)
- Christopher M Gibbs
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA.
| | - Jonathan D Hughes
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA
| | - Adam J Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daisuke Chiba
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA.,Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Philipp W Winkler
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA.,Department for Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Bryson P Lesniak
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA
| | - William J Anderst
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA
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Perelli S, Morales-Avalos R, Formagnana M, Rojas-Castillo G, Serrancolí G, Monllau JC. Lateral extraarticular tenodesis improves stability in non-anatomic ACL reconstructed knees: in vivo kinematic analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:1958-1966. [PMID: 35091787 DOI: 10.1007/s00167-021-06854-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To carry out an in vivo kinematic analysis to determine whether adding a lateral extraarticular tenodesis (LET) for those patients with subjective instability and objective residual laxity after a transtibial (TT) anterior cruciate ligament reconstruction (ACLR) reduces anteroposterior and rotational laxity and to evaluate the 2-year follow-up clinical outcomes to analyze whether biomechanical changes determine clinical improvement or not. METHODS A total of 19 patients with residual knee instability after TT ACLR who underwent a modified Lemaire LET were prospectively evaluated for at least 2-year follow-up. Preoperative, intraoperative, and 6 and 24-month postoperative kinematic analyses were carried out using the KiRA accelerometer and KT1000 arthrometer to look for residual anterolateral rotational instability and residual anteroposterior instability. Functional outcomes were measured with the single-leg vertical jump test and the single-leg hop test. Clinical outcomes were evaluated using the IKDC 2000, Lysholm, and Tegner scores. RESULTS A significant reduction in anterolateral rotational instability was detected with the patient under anesthesia (from 3 ± 1.2 to 1.1 ± 1.1 m/s2; p < 0.05) as well as with the patient awake (from 2.1 ± 0.8 to 0.7 ± 1.4 m/s2; p < 0.05). A significant reduction in anteroposterior instability was only present under anesthesia (from 3.4 ± 1.9 to 2.1 ± 1.1 mm; p < 0.05), while no difference was present without anesthesia (from 2.3 ± 1.1 to 1.6 ± 1 mm; n.s.). Postoperative analysis of knee laxity did not show any significant variation from the first to the last follow-up. Both the single-leg vertical jump test and single-leg hop test improved significantly at the last follow-up (both p < 0.05). The mean values of both the IKDC and Tegner scores showed an improvement (p < 0.05 and p < 0.05, respectively), whereas that was not the case with the Lysholm score (n.s.). CONCLUSIONS The modified Lemaire LET can improve the kinematics of a non-anatomic ACL reconstructed knee with residual subjective and objective instability. These kinematic changes were able to lead to an improvement in subjective stability as well as the function of the knee in a small cohort of recreationally active patients. At 2-year follow-up, the kinematic changes as well as the level of activity of the patients and the IKDC score show their improvement sustained. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Simone Perelli
- Institut Català de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - Rodolfo Morales-Avalos
- Institut Català de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr, José Eleuterio González", Universidad Autonoma de Nuevo León, Monterrey, Mexico. .,Knee Unit, Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr, José Eleuterio González", Universidad Autonoma de Nuevo León (U.A.N.L.), 4th Floor, Central Building of the University Hospital, Av. Francisco I. Madero and Av. Dr. Eduardo Aguirre Pequeño, s/n, Col. Mitras Centro, C.P. 64460, Monterrey, Nuevo León, Mexico.
| | - Mario Formagnana
- Department of Orthopaedic Surgery and Traumatology, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - Gonzalo Rojas-Castillo
- Department of Orthopaedic Surgery and Traumatology, Talca Regional Hospital, Universidad Catolica del Maule, Talca, Chile
| | - Gil Serrancolí
- Department of Mechanical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Juan Carlos Monllau
- Institut Català de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
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In search of a gold standard for objective clinical outcome: using dynamic biplane radiography to measure knee kinematics. Knee Surg Sports Traumatol Arthrosc 2022; 30:1499-1501. [PMID: 34853896 DOI: 10.1007/s00167-021-06781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
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Augmentation of Anterolateral Structures of the Knee Causes Undesirable Tibiofemoral Cartilage Contact in Double-Bundle Anterior Cruciate Ligament Reconstruction-A Randomized In-Vivo Biomechanics Study. Arthroscopy 2022; 38:1224-1236. [PMID: 34509591 DOI: 10.1016/j.arthro.2021.08.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the in vivo tibiofemoral cartilage contact patterns in knees undergoing double-bundle anterior cruciate ligament reconstruction(DB-ACLR) with or without anterolateral structure augmentation (ALSA). METHODS Twenty patients with an ACL-ruptured knee and a healthy contralateral side were included. Nine patients received an isolated DB-ACLR (DB-ACLR group), and 11 patients had a DB-ACLR with ALSA (DB+ALSA group). At 1-year follow-up, a combined computed tomography, magnetic resonance imaging, and dual fluoroscopy imaging system analysis was used to capture a single-legged lunge of both the operated and healthy contralateral side. Tibiofemoral contact points (CPs) of the medial and lateral compartments were compared. CP locations were expressed as anteroposterior (AP, +/-) and medial-lateral (ML, -/+) values according to the tibia. RESULTS In the DB-ACLR knees, no significant differences were found in CPs when compared with the healthy contralateral knees (P ≥ .31). However, in the DB+ALSA knees, the CPs in the lateral compartment had a significantly more anterior (mean AP: operative, -2.8 mm, 95% confidence interval [CI] -5.0 to-0.7 vs healthy, -5.0 mm, 95% CI -6.7 to -3.2; P = .006) and lateral (mean ML: operative, 23.2 mm, 95% CI 21.9-24.5 vs healthy, 21.8 mm, 95% CI 20.2-23.3; P = .013) location. The CPs in the medial compartment were located significantly more posterior (mean AP: operative, -3.4, 95% CI -5.0 to -1.9 vs healthy, -1.3, 95% CI -2.6 to -0.1; P = .006) and lateral (mean ML: operative, -21.3, 95% CI -22.6 to -20.0 vs healthy, -22.6, 95% CI -24.2 to -21.0; P = .021). CONCLUSIONS DB-ACLR restored the tibiofemoral cartilage contact mechanics to near-normal values at 1-year follow-up. Adding the ALSA to the DB-ACLR resulted in significantly altered tibiofemoral cartilage contact locations in both the medial and lateral compartments. CLINICAL RELEVANCE In DB-ACLR knees, the addition of an ALSA may be unfavorable as it caused significantly changed arthrokinematics.
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Musahl V, Nazzal EM, Lucidi GA, Serrano R, Hughes JD, Margheritini F, Zaffagnini S, Fu FH, Karlsson J. Current trends in the anterior cruciate ligament part 1: biology and biomechanics. Knee Surg Sports Traumatol Arthrosc 2022; 30:20-33. [PMID: 34927221 DOI: 10.1007/s00167-021-06826-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022]
Abstract
A trend within the orthopedic community is rejection of the belief that "one size fits all." Freddie Fu, among others, strived to individualize the treatment of anterior cruciate ligament (ACL) injuries based on the patient's anatomy. Further, during the last two decades, greater emphasis has been placed on improving the outcomes of ACL reconstruction (ACL-R). Accordingly, anatomic tunnel placement is paramount in preventing graft impingement and restoring knee kinematics. Additionally, identification and management of concomitant knee injuries help to re-establish knee kinematics and prevent lower outcomes and registry studies continue to determine which graft yields the best outcomes. The utilization of registry studies has provided several large-scale epidemiologic studies that have bolstered outcomes data, such as avoiding allografts in pediatric populations and incorporating extra-articular stabilizing procedures in younger athletes to prevent re-rupture. In describing the anatomic and biomechanical understanding of the ACL and the resulting improvements in terms of surgical reconstruction, the purpose of this article is to illustrate how basic science advancements have directly led to improvements in clinical outcomes for ACL-injured patients.Level of evidenceV.
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Affiliation(s)
- Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | - Ehab M Nazzal
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA.
| | - Gian Andrea Lucidi
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA.,IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rafael Serrano
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | | | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Freddie H Fu
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | - Jon Karlsson
- The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Chen J, Wang C, Xu C, Qiu J, Xu J, Tsai TY, Zhao J. Effects of Anterolateral Structure Augmentation on the In Vivo Kinematics of ACL-Reconstructed Knees: Response. Am J Sports Med 2021; 49:NP43-NP44. [PMID: 34259605 DOI: 10.1177/03635465211023749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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