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Kantrowitz DE, Colvin A. Comprehensive Clinical Examination of ACL Injuries. Clin Sports Med 2024; 43:311-330. [PMID: 38811112 DOI: 10.1016/j.csm.2023.08.001] [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] [Indexed: 05/31/2024]
Abstract
A comprehensive clinical examination of the potentially anterior cruciate ligament (ACL)-deficient knee should proceed as follows: inspection; palpation; range of motion; varus and valgus stress; neurovascular status; and finally provocative maneuvers. The Lachman, anterior drawer, Lever, and pivot shift tests are all greater than 90% specific for ACL pathology. Due to the relatively high coincidence of ACL injuries and those to the posterior cruciate ligament, posterolateral corner , posteromedial corner , and menisci, it is critical that the examiner perform provocative maneuvers to evaluate the integrity of these structures as well.
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Affiliation(s)
- David E Kantrowitz
- Department of Orthopedics, The Mount Sinai Hospital, 5 E 98th Street, 9th floor, New York, NY 10029, USA.
| | - Alexis Colvin
- Department of Orthopedics, The Mount Sinai Hospital, 5 E 98th Street, 9th floor, New York, NY 10029, USA
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Si Heng Sharon T, Fadzil K, Andrew Kean Seng L, James Hoipo H. Surgical management of tibial eminence avulsion fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05318-1. [PMID: 38896276 DOI: 10.1007/s00402-024-05318-1] [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: 07/22/2023] [Accepted: 04/04/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE The ideal surgical management for tibial eminence avulsion fractures remains controversial with varying approach, methods of fixation and post-operative regimes reported throughout literature. The current systematic review and meta-analysis aims to compare between the different approaches, methods of fixation and post-operative regimes for tibial eminence fractures. METHODS The systematic review was conducted according to PRISMA guidelines. A search was conducted using PubMed, MEDLINE and CINAHL databases. The keywords used were "anterior cruciate ligament", "tibial spine" or "tibial eminence" and "fracture" or "avulsion". All original human studies that reported the surgical outcomes of tibial eminence fractures were included. Individual patient data meta-analysis was performed. RESULTS 48 studies with 1367 patients were included. Arthroscopic fixation resulted in significantly greater stability in terms of anterior drawer test (p = 0.018) and Lachman's test (p = 0.042), as compared to open fixation, though there was no significant difference for pivot shift test. There was no significant difference identified in functional scores and activity, including Lysholm score, IKDC subjective score, Tegner score and return to sports. Suture fixation had significantly increased stability compared to screw fixation, in terms of anterior drawer test (p = 0.001) and Lachman's test (p = 0.001), though no significant difference was identified for pivot shift test. Significantly better subjective scores and return to activity were also noted for suture fixation, in terms of Lysholm score (p = 0.008), IKDC subjective score (p = 0.001) and Tegner score (p = 0.001), though no significant difference was identified for return to sports. CONCLUSION Arthroscopic and suture fixation had significantly superior outcomes when compared to open and screw fixation. Arthroscopic fixation resulted in significantly improved stability of the knee as compared to open fixation, though no significant difference was identified in terms of functional knee scores and return to activity. Suture fixation resulted in significantly improved stability of the knee and functional knee screws as compared to screw fixation.
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Affiliation(s)
- Tan Si Heng Sharon
- Department of Orthopaedic Surgery, National University Health System (NUHS), 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
| | - Kamarudin Fadzil
- Department of Orthopaedic Surgery, National University Health System (NUHS), 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Lim Andrew Kean Seng
- Department of Orthopaedic Surgery, National University Health System (NUHS), 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Hui James Hoipo
- Department of Orthopaedic Surgery, National University Health System (NUHS), 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
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Kaizik MA, Hancock MJ, Herbert RD. DiTA: helping you search for evidence of diagnostic test accuracy in physical therapy. Braz J Phys Ther 2024; 28:101082. [PMID: 38848626 DOI: 10.1016/j.bjpt.2024.101082] [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: 03/19/2024] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Physical therapists use diagnostic tests in a variety of settings. Choosing the best diagnostic test to apply in a particular situation can be difficult. The choice of diagnostic test should be informed, at least in part, by evidence of test accuracy. Finding evidence of diagnostic test accuracy has, until recently, been challenging. Ideally, there would exist a database that comprehensively indexes evidence on diagnostic tests relevant to physical therapy practice, is free to access, and is easy to use. OBJECTIVE This Masterclass will describe the DiTA (Diagnostic Test Accuracy) database (dita.org.au) including its development and search interface, and provide advice on how to search and retrieve records. DISCUSSION DiTA indexes more than 2400 primary studies and systematic reviews of diagnostic test accuracy relevant to physical therapy practice. Users can search DiTA using text fields and dropdown lists to find evidence of diagnostic test accuracy. The database is freely accessible on the internet. Since its launch, DiTA has been accessed from almost every country in the world, the largest number of searches having been conducted from Brazil.
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Affiliation(s)
- Mark A Kaizik
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Robert D Herbert
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Neuroscience Research Australia (NeuRA), Sydney, Australia
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Pineda T, Cance N, Dan MJ, Demey G, Dejour DH. Evaluation of Anterior Tibial Translation Under Physiological Axial Load After ACL Reconstruction With Lateral Extra-articular Tenodesis. Orthop J Sports Med 2024; 12:23259671241246111. [PMID: 38774385 PMCID: PMC11107324 DOI: 10.1177/23259671241246111] [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: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 05/24/2024] Open
Abstract
Background Postoperative laxity correlates with negative clinical outcomes after anterior cruciate ligament reconstruction (ACLR). The influence of lateral extra-articular tenodesis (LET) on anteroposterior translation is unclear. Purpose/Hypothesis This study aimed to evaluate the reduction in radiographic static anterior tibial translation (SATT) and dynamic anterior tibial translation (DATT) after LET as an adjunctive procedure to ACLR. It was hypothesized that adding a LET procedure would have no effect on postoperative SATT and DATT. Study Design Cohort study; Level of evidence, 3. Methods Patients who underwent primary ACLR with hamstring tendon autografts between 2020 and 2022 were reviewed, and those who underwent ACLR and LET as an anterolateral associate procedure were paired 1 to 1 with those who underwent isolated ACLR (control) based on age, sex, preoperative SATT, and posterior tibial slope (PTS). The indications for LET were age <18 years and anterolateral rotary instability (grade ≥2 pivot shift). A previously validated technique was used to measure SATT, DATT, and PTS on lateral weightbearing and lateral stress knee radiographs. Preoperative and 9-month postoperative radiographs were compared between the 2 groups. Results A total of 72 patients were included in the analysis (n = 36 patients in each group). The inter- and intraobserver reliability of the SATT, DATT, and PTS measurements was excellent (intraclass correlation coefficients, 0.88-0.99). The mean pre- and postoperative SATT in the ACLR+LET group was 2.44 ± 2.90 mm and 2.44 ± 2.38 mm, respectively, compared with 2.60 ± 2.99 mm and 2.12 ± 2.74 mm, respectively, in the control group. The mean pre- and postoperative reduction in side-to-side DATT in the ACLR+LET group was 5.44 ± 4.65 mm and 1.13 ± 2.95 mm, respectively, compared with 5.03 ± 3.66 mm and 2 ± 3.12 mm, respectively, in the control group. There was no pre- to postoperative difference in SATT (P = .51). However, the side-to-side DATT was reduced by 3.66 ± 3.37 mm postoperatively (P < .001), without significant differences between groups (P = .24). Conclusion Including a LET procedure for patients undergoing ACLR did not reduce SATT; that is, it did not decrease the amount of tibial translation due to physiological axial load.
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Affiliation(s)
- Tomas Pineda
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
- Hospital el Carmen, Santiago, Chile
| | - Nicolas Cance
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
| | - Michael J. Dan
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
- Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School University of New South Wales, Sydney, Australia
| | - Guillaume Demey
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
| | - David H. Dejour
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
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Hesmerg MK, Oostenbroek MHW, van der List JP. Lever sign test shows high diagnostic accuracy for anterior cruciate ligament injuries: A systematic review and meta-analysis of 3299 observations. Knee 2024; 47:81-91. [PMID: 38310817 DOI: 10.1016/j.knee.2024.01.003] [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: 10/31/2023] [Revised: 12/05/2023] [Accepted: 01/18/2024] [Indexed: 02/06/2024]
Abstract
PURPOSE Injuries of the anterior cruciate ligament (ACL) are common knee injuries among active and younger patients. The Lever Sign Test (LST) is a relatively newer test, of which the accuracy is disputed in the existing literature. The aim of this study was to assess the accuracy with and without anesthesia of the Lever Sign test in the literature. METHODS PRISMA guidelines were followed, studies were identified using PubMed, EMBASE and Google Scholar. All studies that reported accuracy of LST performed by a clinical professional were included. Integrity of ACL was confirmed using magnetic resonance imaging or arthroscopy. Sensitivity and specificity were calculated using uni- and bivariate methods. RESULTS After inclusion, 3299 observations in 2516 patients were included from 23 studies. Mean age was 31.8 years and 64.2% were male. Without anesthesia, sensitivity was 79.2% (95% CI 68.7-86.9) and specificity was 92.0% (95% CI 82.2-96.6). An area under the curve (AUC) of 86.1% was found. With anesthesia, sensitivity was 86.6% (95% CI 68.0-95.2), specificity was 93.4% (95% CI 84.5-97.3) and the AUC was 91.6%. CONCLUSION The Lever Sign test shows very good to excellent accuracy for ACL injury, and is a useful tool for clinical practice.
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Affiliation(s)
- Mees K Hesmerg
- Centre for Orthopaedic Research Alkmaar (CORAL), Alkmaar, The Netherlands; Amsterdam UMC, Location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
| | - Maurits H W Oostenbroek
- Centre for Orthopaedic Research Alkmaar (CORAL), Alkmaar, The Netherlands; Northwest Clinics, Department of Orthopaedic Surgery, Alkmaar, The Netherlands
| | - Jelle P van der List
- Centre for Orthopaedic Research Alkmaar (CORAL), Alkmaar, The Netherlands; Northwest Clinics, Department of Orthopaedic Surgery, Alkmaar, The Netherlands; Atrium Health Wake Forest Baptist, Department of Orthopaedic Surgery and Rehabilitation, Winston Salem, NC, United States
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Hu S, Wang X, Wang Q, Feng W. Lever sign test for anterior cruciate ligament injuries: a diagnostic meta-analysis. J Orthop Surg Res 2024; 19:155. [PMID: 38429720 PMCID: PMC10905791 DOI: 10.1186/s13018-024-04635-w] [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: 12/03/2023] [Accepted: 02/21/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Sports-related ACL (anterior cruciate ligament) injuries are frequent. Successful management requires early diagnosis and treatment. One of the clinical tests used to identify ACL damage is the lever sign test. This meta-analysis aimed to assess the lever sign test's diagnostic efficacy for ACL injuries. METHODS An extensive investigation of the Cochrane Library, Embase, and PubMed databases was conducted until April 2023. Studies assessing the lever sign test's diagnostic efficacy for ACL injuries were also included. A bivariate random-effects model was employed to acquire the pooled estimates of diagnostic odds ratios, specificity, positive and negative likelihood ratios, sensitivity, and curves of the summary receiver operating characteristic (SROC). RESULTS The meta-analysis comprised twelve investigations with a total of 1365 individuals. The lever sign test's combined sensitivity and specificity for the purpose of diagnosing injuries to the ACL were 0.810 (95% confidence interval [CI] 0.686-0.893) and 0.784 (95% CI 0.583-0.904), respectively. The positive and negative likelihood ratios were 3.148 (95% CI 1.784-5.553) and 0.210 (95% CI 0.084-0.528), respectively. The study revealed a diagnostic odds ratio of 17.656, with a 95% CI ranging from 4.800 to 64.951. The SROC curve's area was determined to be 0.912 (95% CI 0.857-0.967). CONCLUSION With high specificity and sensitivity, the lever sign test is a reliable diagnostic modality for ACL injuries. However, the test should be used in combination with other diagnostic tests to increase the accuracy of the diagnosis. Further investigations are warranted to assess the clinical practicability of the lever sign test in various populations and settings.
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Affiliation(s)
- Shiqiang Hu
- Orthopaedics Department, Xiaolan People's Hospital of Zhongshan, Zhongshan, People's Republic of China
| | - Xiaoping Wang
- Orthopaedics Department, Xiaolan People's Hospital of Zhongshan, Zhongshan, People's Republic of China
| | - Qiyue Wang
- Sports Medicine Center, Department of Orthopaedics Surgery, First Affiliated Hospital of Shantou University Medical College, Shantou, People's Republic of China
| | - Weili Feng
- Orthopaedics Department, Xiaolan People's Hospital of Zhongshan, Zhongshan, People's Republic of China.
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Shankar DS, Milton HA, Mojica ES, Buzin S, Strauss EJ, Campbell KA, Alaia MJ, Gonzalez-Lomas G, Jazrawi LM. Force plate jump testing metrics are predictive of performance on a multimodal return to sport testing protocol among anterior cruciate ligament reconstruction patients at minimum six-month follow-up. J Sports Med Phys Fitness 2023; 63:1208-1217. [PMID: 37526491 DOI: 10.23736/s0022-4707.23.14850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Force plate-based jump testing may serve as a potential alternative to traditional return to sport (RTS) testing batteries. The purpose of our study was to identify force plate jump metrics that were predictive of RTS test findings in patients who were at least six months postoperative following anterior cruciate ligament reconstruction (ACLR). METHODS We conducted a cross-sectional study of patients who underwent ACLR at our center and were at least six months postoperative. Subjects completed a multimodal Institutional RTS (IRTS) testing battery which included range of motion (ROM) testing and isokinetic quadriceps strength testing. Subjects also completed a countermovement jump testing protocol on a commercially-available force plate. Jump metrics predictive of IRTS test findings were identified using multivariable linear and logistic regression with stepwise selection. Model significance was assessed at α=0.002. RESULTS Sixteen patients (7M, 9F) were enrolled in our study with median age of 29 years (range 20-47). Relative concentric impulse was positively predictive of knee flexion active ROM (β=7.07, P=0.01) and passive ROM (β=9.79, P=0.003). Maximum power was positively predictive of quadriceps strength at 60 deg/s (β=3.27, P<0.001) and 180 deg/s (β=2.46, P<0.001). Center-of-pressure (COP) shift acceleration along the force plate X-axis was negatively predictive of Bunkie lateral test score (β=-945, P<0.001) and medial test score (β=-839, P=0.03). CONCLUSIONS Force plate-derived vertical jump testing metrics are predictive of certain components of a multimodal RTS physical assessment for ACLR patients, including knee flexion ROM, quadriceps strength on isokinetic testing, and Bunkie Test performance.
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Affiliation(s)
- Dhruv S Shankar
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA -
| | - Heather A Milton
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Edward S Mojica
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Scott Buzin
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Eric J Strauss
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Michael J Alaia
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Guillem Gonzalez-Lomas
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Laith M Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
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Chen H, Liu L, Zhang Y. Finite element analysis of the knee joint stress after partial meniscectomy for meniscus horizontal cleavage tears. BMC Musculoskelet Disord 2023; 24:744. [PMID: 37726679 PMCID: PMC10508030 DOI: 10.1186/s12891-023-06868-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 09/10/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE To establish a finite element model of meniscus horizontal cleavage and partial resection, to simulate the mechanical changes of knee joint under 4 flexion angles, and to explore what is the optimal surgical plan. METHODS We used Mimics Research, Geomagic Wrap, and SolidWorks computer software to reconstruct the 3D model of the knee joint, and then produced the horizontal cleavage tears model of the internal and lateral meniscus, the suture model, and the partial meniscectomy model. These models were assembled into a complete knee joint in SolidWorks software, and corresponding loads and boundary constraints were added to these models in ANSYS software to simulate the changing trend of pressure and shear force on femoral condylar cartilage, meniscus, and tibial cartilage under the flexion angles of 0°, 10°, 20°, 30° and 40° of the knee joint. At the same time, the difference of force area between medial interventricular and lateral interventricular of knee joint under four states of bending the knee was compared, to explore the different effects of different surgical methods on knee joint after horizontal meniscus tear. RESULTS Within the four medial meniscus injury models, the lowest peak internal pressure and shear force of the knee joint was observed in the meniscal suture model; the highest values were found in the bilateral leaflet resection model and the inferior leaflet resection model; the changes of pressure, shear force and stress area in the superior leaflet resection model were the most similar to the changes of the knee model with the meniscal suture model. CONCLUSION Suture repair is the best way to maintain the force relationship in the knee joint. However, resection of the superior leaflet of the meniscus is also a reliable choice when suture repair is difficult.
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Affiliation(s)
- Hao Chen
- Department of Sport Medicine, Beijing DCN Orthopedic Hospital, No.19 Fushi Road, Beijing, 100143 China
| | - Lantao Liu
- Department of Spinal Medicine, Qingdao Hospital, University of Health and Rehabilitation Sciences, Qingdao Municipal Hospital, No.5 Donghai Zhong Road, Qingdao, 266000 China
| | - Youlei Zhang
- Department of Sport Medicine, Beijing DCN Orthopedic Hospital, No.19 Fushi Road, Beijing, 100143 China
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Bosco F, Giustra F, Ghirri A, Cacciola G, Massè A, Capella M. All-Inside Anterior Cruciate Ligament Reconstruction Technique: Tips and Tricks. J Clin Med 2023; 12:5793. [PMID: 37762734 PMCID: PMC10532376 DOI: 10.3390/jcm12185793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The all-inside anterior cruciate ligament reconstruction (ACLR) technique was developed to improve patient outcomes by reducing the procedure's invasiveness, minimizing complications and pain, and enabling faster postoperative recovery. This study presents a detailed description of the all-inside ACLR technique, which involves the use of quadrupled semitendinosus (ST) graft and suspension devices at both tibial and femoral sites, as well as valuable tips for avoiding complications that may arise during the procedure. The surgical procedure employs retrograde drills to create bony sockets for graft passage, which are then fixed with suspension devices at both the tibial and femoral sites. This technique has no specific restrictions and may be applied to all patients with anterior cruciate ligament (ACL) injuries. The literature reports the advantages, good clinical outcomes, and medium- to long-term graft survival achieved with the all-inside ACLR technique. However, the complications and disadvantages associated with the technique must be considered.
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Affiliation(s)
- Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, Centro Traumatologico Ortopedico (CTO), 10124 Turin, Italy; (F.G.); (G.C.); (A.M.); (M.C.)
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino—ASL Città di Torino, 10154 Turin, Italy;
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, Centro Traumatologico Ortopedico (CTO), 10124 Turin, Italy; (F.G.); (G.C.); (A.M.); (M.C.)
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino—ASL Città di Torino, 10154 Turin, Italy;
| | - Alessandro Ghirri
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino—ASL Città di Torino, 10154 Turin, Italy;
| | - Giorgio Cacciola
- Department of Orthopaedics and Traumatology, University of Turin, Centro Traumatologico Ortopedico (CTO), 10124 Turin, Italy; (F.G.); (G.C.); (A.M.); (M.C.)
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, Centro Traumatologico Ortopedico (CTO), 10124 Turin, Italy; (F.G.); (G.C.); (A.M.); (M.C.)
| | - Marcello Capella
- Department of Orthopaedics and Traumatology, University of Turin, Centro Traumatologico Ortopedico (CTO), 10124 Turin, Italy; (F.G.); (G.C.); (A.M.); (M.C.)
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Gong H, Li Q, Len Y, He K, Zhao W, Li Y, Sun G, Peng X, Yin Y. The posterior cruciate ligament index as a reliable indirect sign of anterior cruciate ligament rupture is associated with the course of knee joint injury. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07357-4. [PMID: 36899193 DOI: 10.1007/s00167-023-07357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE The objective of this study was to clarify the clinical value of the posterior cruciate ligament index (PCLI) in anterior cruciate ligament (ACL) rupture, to explore the relationship between the PCLI and course of disease, and to identify the influencing factors of the PCLI. METHODS The PCLI was defined a quotient of the X (the tibial and femoral PCL attachments) and the Y (the maximum perpendicular distance from X to the PCL). A total of 858 patients were enrolled in this case-control study, including 433 patients with ACL ruptures who were assigned to the experimental group and 425 patients with meniscal tears (MTs) who were allocated to the control group. Some patients in the experimental group have collateral ligament rupture (CLR). Information, such as the patient's age, sex, and course of disease, was recorded. All patients underwent magnetic resonance imaging (MRI) preoperatively, and the diagnosis was confirmed with the aid of arthroscopy. The PCLI and the depth of the lateral femoral notch sign (LFNS) were calculated based on the MRI findings, and the characteristics of the PCLI were explored. RESULTS The PCLI in the experimental group (5.1 ± 1.6) was significantly smaller than that in the control group (5.8 ± 1.6) (P < 0.05). The PCLI gradually decreased with time and was only 4.8 ± 1.4 in patients in the chronic phase (P < 0.05). This change was not due to the decrease in X but rather the increase in Y. The results also showed that the PCLI was not related to the depth of the LFNS or injuries of other structures in the knee joint. Furthermore, when the optimal cut-off point of the PCLI was 5.2 (area under the curve = 71%), the specificity and the sensitivity were 84% and 67%, respectively, but the Youden index was just 0.3 (P < 0.05). CONCLUSION The PCLI decreases due to the increase in Y instead of the decrease in X with time, especially in the chronic phase. The change in X in this process may be offset during imaging. In addition, there are fewer influencing factors that lead to changes in the PCLI. Therefore, it can be used as a reliable indirect sign of ACL rupture. However, it is difficult to quantify the diagnostic criteria of the PCLI in clinical practice. Thus, the PCLI as a reliable indirect sign of ACL rupture is associated with the course of knee joint injury, and it can be used to describe the instability of the knee joint. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Heng Gong
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Qingshan Li
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Yu Len
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Ke He
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Wenbo Zhao
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Yu Li
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Guanjun Sun
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Xu Peng
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China
| | - Yi Yin
- Orthopaedics, Suining Central Hospital, Suining, Sichuan, China.
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Courage O, van Rooij F, Saffarini M. Ultrasound is more reliable than clinical tests to both confirm and rule out pathologies of the long head of the biceps: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:662-671. [PMID: 36114842 DOI: 10.1007/s00167-022-07154-5] [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: 07/18/2022] [Accepted: 08/31/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To synthesize the literature and critically appraise current evidence to determine the most accurate physical examination (clinical test or ultrasound) to detect pathologies of the long head of the biceps tendon (LHBT). METHODS A search was performed on PubMed, Embase®, and Cochrane. Studies that compared the diagnostic accuracy of clinical tests or ultrasound versus arthroscopy for the assessment of LHBT pathologies were included. RESULTS Seven studies were included reporting on a total of 448 patients. One study on instability using ultrasound reported sensitivity and specificity of 1.00 and 0.96, respectively. Two studies on full-thickness tears using ultrasound reported sensitivity and specificity of 0.88-0.95 and 0.71-0.98, respectively. Four studies on partial-thickness LHBT tears reported sensitivity and specificity of 0.17-0.68 and 0.38-0.92, respectively, for clinical tests, versus 0.27-0.71 and 0.71-1.00, respectively, for ultrasound. Three studies on other LHBT pathologies reported sensitivity and specificity of 0.18-0.79 and 0.53-0.85, respectively, for clinical tests, versus 0.50 and 1.00, respectively, for ultrasound. CONCLUSION To detect LHBT pathologies, sensitivity is high-to-excellent using ultrasound, and moderate using Neer's sign and Speed's test, while specificity is high-to-excellent also using ultrasound, as well as the belly press, lift-off and Kibler's tests. The clinical relevance of these findings is that clinical tests are only reliable either to confirm or rule out LHBT pathologies, whereas ultrasound is reliable both to confirm and rule out LHBT pathologies. While diagnostic imaging cannot substitute for patient history and physical examination, the reliability and accessibility of ultrasound render it practical for routine use, particularly if clinical tests render unclear or contradictory findings. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Mo Saffarini
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland
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Piussi R, Magnusson C, Andersson S, Mannerkorpi K, Thomeé R, Samuelsson K, Hamrin Senorski E. Some, but not all, patients experience full symptom resolution and a positive rehabilitation process after ACL reconstruction: an interview study. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07271-1. [PMID: 36484809 DOI: 10.1007/s00167-022-07271-1] [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: 09/22/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To gain a deeper understanding of patients' experiences over 5 years after anterior cruciate ligament (ACL) reconstruction. METHODS Seventeen semi-structured interviews were performed with patients treated with ACL reconstruction at least 5 years earlier without a second knee injury. Interviews were transcribed and analyzed using qualitative content analysis according to methods described by Graneheim and Lundman. RESULTS Patients' long-term experiences after an ACL reconstruction were summarized as: "to cope or not to cope, that is the question", and five main categories: (1) Adapting life after knee symptom: the past will not come back; (2) An arduous and demanding rehabilitation: sailing against the wind; (3) Accepting what cannot be changed: biting the bullet; (4) Being satisfied with results: end of a chapter; (5) Apprehensively peregrinating on an unknown road. CONCLUSIONS More than 5 years after ACL reconstruction, patients can experience full symptom resolution and the ACL injury process as positive, or experience persistent symptoms and are forced to accept negative life-changing choices due to the injury. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ramana Piussi
- Sportrehab, Sport Medicine Clinic, Gothenburg, Sweden. .,Sahlgrenska Sports Medicine Center, Gothenburg, Sweden. .,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | | | - Sara Andersson
- Sportrehab, Sport Medicine Clinic, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kaisa Mannerkorpi
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roland Thomeé
- Sportrehab, Sport Medicine Clinic, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab, Sport Medicine Clinic, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Zhou T, Xu Y, Zhou L, Wang S, Wang S, Xu W. Multi-planar instability, laxity and reduced knee flexion during the support phase of walking are determinants of return to sports. Front Bioeng Biotechnol 2022; 10:1047135. [PMID: 36406209 PMCID: PMC9669481 DOI: 10.3389/fbioe.2022.1047135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background: After anterior cruciate ligament reconstruction, some patients are not recommended to return to high-level physical activity because they fail to pass return-to-sports tests. The kinematic difference between these patients and those who pass the return-to-sports tests is unclear. Methods: Eighty-two patients who received anatomic single-bundle anterior cruciate ligament (ACL) reconstruction for unilateral ACL injury underwent return-to-sport tests during a hospital visit at a minimum of 9 months (9–11 months) of follow-up. Fifteen patients who passed the return-to-sports tests (RTS group) and fifteen patients who did not (NRTS group) were randomly selected to perform a treadmill walk under dual-fluoroscopic imaging system surveillance for a 6 degrees of freedom kinematic evaluation. Results: Of the 82 patients, 53 passed the return-to-sports tests 9 months after surgery, with a return-to-sports rate of 64.6%. In the stance phase, the NRTS group had a larger anterior tibial translation (1.00 ± 0.03 mm vs. 0.76 ± 0.03 mm, p = 0.001), a larger lateral tibial movement (1.61 ± 0.05 mm vs. 0.77 ± 0.05 mm, p < 0.001), a larger distal tibial displacement (−3.09 ± 0.05 mm vs. −2.69 ± 0.05 mm, p < 0.001), a smaller knee flexion angle (6.72 ± 0.07° vs. 8.34 ± 0.07°, p < 0.001), a larger varus angle (−0.40 ± 0.03°VS. -0.01 ± 0.03°, p < 0.001) and a larger external rotation angle (1.80 ± 0.05° vs. 1.77 ± 0.05°, p < 0.001) than the RTS group. The maximum anterior tibial translation of the NRTS group is also larger than that of the RTS group (3.64 ± 0.42 mm vs. 3.03 ± 0.59 mm, p = 0.003). Conclusion: Compared with patients passing RTS tests, those who fail to pass show significant anterior, lateral, and rotational instability; knee laxity; and reduced flexion angle of the knee in the support phase during walking, which may be the possible factors hindering a return to sports.
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Affiliation(s)
- Tianping Zhou
- Department of Joint Surgery and Sports Medicine, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
| | | | - Lan Zhou
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Siya Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
- *Correspondence: Shaobai Wang, ; Weidong Xu,
| | - Weidong Xu
- Department of Joint Surgery and Sports Medicine, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
- *Correspondence: Shaobai Wang, ; Weidong Xu,
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Evers BJ, Van Den Bosch MHJ, Blom AB, van der Kraan PM, Koëter S, Thurlings RM. Post-traumatic knee osteoarthritis; the role of inflammation and hemarthrosis on disease progression. Front Med (Lausanne) 2022; 9:973870. [PMID: 36072956 PMCID: PMC9441748 DOI: 10.3389/fmed.2022.973870] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Knee injuries such as anterior cruciate ligament ruptures and meniscal injury are common and are most frequently sustained by young and active individuals. Knee injuries will lead to post-traumatic osteoarthritis (PTOA) in 25–50% of patients. Mechanical processes where historically believed to cause cartilage breakdown in PTOA patients. But there is increasing evidence suggesting a key role for inflammation in PTOA development. Inflammation in PTOA might be aggravated by hemarthrosis which frequently occurs in injured knees. Whereas mechanical symptoms (joint instability and locking of the knee) can be successfully treated by surgery, there still is an unmet need for anti-inflammatory therapies that prevent PTOA progression. In order to develop anti-inflammatory therapies for PTOA, more knowledge about the exact pathophysiological mechanisms and exact course of post-traumatic inflammation is needed to determine possible targets and timing of future therapies.
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Affiliation(s)
- Bob J. Evers
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
- Canisius Wilhelmina Hospital, Nijmegen, Netherlands
- *Correspondence: Bob J. Evers
| | - Martijn H. J. Van Den Bosch
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Arjen B. Blom
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Peter M. van der Kraan
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | | | - Rogier M. Thurlings
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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