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Mussell EA, Crawford AE, Ithurburn MP, Layton BO, Fleisig GS, Rothermich MA, Emblom BA, Ryan MK, Dugas JR, Andrews JR, Cain EL. Outcomes of Surgical Treatment for Multiligament Knee Injuries in a Cohort Including Competitive Athletes With Long-Term Follow-Up. Orthop J Sports Med 2024; 12:23259671241266619. [PMID: 39247533 PMCID: PMC11375643 DOI: 10.1177/23259671241266619] [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: 01/26/2024] [Accepted: 02/13/2024] [Indexed: 09/10/2024] Open
Abstract
Background There is a paucity of outcomes data on surgical reconstruction for multiligament knee injury (MLKI) in the orthopaedic literature. Purpose To examine functional and return-to-sports (RTS) outcomes and revision rates after single-stage reconstruction for MLKIs in a cohort containing a large proportion of competitive athletes over a 20-year period. Study Design Case series; Level of evidence, 4. Methods We identified all patients at our institution who underwent surgical reconstruction for an anterior cruciate ligament (ACL) or bicruciate (ACL-posterior cruciate ligament) MLKI between 2001 and 2020 and had ≥2 years of postoperative outcome data. Patient-reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) form, a surgical satisfaction survey, and questions about subsequent knee surgery and RTS administered via telephone. Summary statistics for all outcomes data were calculated, and predictors of IKDC scores at follow-up were examined using univariable linear regression. Results Out of 151 patients eligible for this study, outcomes data were collected in 119 patients (79%). The mean follow-up time was 8.3 ± 4.4 years, and the mean IKDC score at follow-up was 79 ± 17. A total of 83 competitive athletes were included; 62 of these athletes attempted to return to preinjury sport. Among the 62 who attempted RTS, 50 (81%) were successful, and 12 were unable to return due to limitations from their surgery. At follow-up, 112 of the overall cohort of 119 patients (94%) were either satisfied or very satisfied with their surgical outcome, and 91% stated the surgery met or exceeded their expectations. In addition, 24% had subsequent ipsilateral knee operations after their index multiligament knee reconstruction. Older age at surgery and female sex were associated with worse IKDC scores at follow-up. Conclusion Despite the severity of the injuries in our cohort, we found high levels of patient-reported function and a high rate of successful RTS in the competitive athletes. Older age and female sex were associated with worse patient-reported knee function at follow-up.
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Affiliation(s)
- Eric A Mussell
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Anna E Crawford
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Matthew P Ithurburn
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Branum O Layton
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Glenn S Fleisig
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Marcus A Rothermich
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Benton A Emblom
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Michael K Ryan
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- Prevea Health Orthopaedics and Sports Medicine, Green Bay, Wisconsin, USA
| | - Jeffrey R Dugas
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - James R Andrews
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - E Lyle Cain
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
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Herman ZJ, Kaarre J, Wackerle AM, Lott A, Apseloff NA, Lesniak BP, Irrgang JJ, Musahl V. Timing of Surgery & Rehabilitation After Multiligamentous Knee Reconstruction. Curr Rev Musculoskelet Med 2024:10.1007/s12178-024-09923-w. [PMID: 39174807 DOI: 10.1007/s12178-024-09923-w] [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] [Accepted: 08/07/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE OF REVIEW To provide an overview of the current evidence of the timing of surgery and rehabilitation after multiligamentous knee injuries (MLKIs) and offer insights into the ongoing multi-center randomized controlled study, the 'STaR trial'. RECENT FINDINGS Due to the complexity of the MKLIs, they are usually treated surgically with the goal of either repairing or reconstructing the injured ligaments. Although the current literature on MLKIs is relatively extensive, the consensus on the timing of surgery or rehabilitation following surgery for MLKIs is still lacking. While current literature mostly suggests early treatment, there is also evidence preferring delayed treatment. Furthermore, evidence on the timing of postoperative rehabilitation is limited. Thus, the current multi-center randomized controlled study, the 'STaR trial', is expected to respond to these questions by adding new high-level evidence. The MLKIs are often associated with knee dislocation and constitute a highly complex entity, including concomitant injuries, such as neurovascular, meniscal, and cartilaginous injuries. The treatment of MLKIs usually aims to either repair or reconstruct the injured ligaments, however, there is no general consensus on the timing of surgery or rehabilitation following an MLKI surgery. This current review stresses the need for more high-level research to address the paucity of evidence-based treatment guidelines for the treatment of complex MLKIs.
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Affiliation(s)
- Zachary J Herman
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, Pittsburgh, USA.
| | - Janina Kaarre
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, Pittsburgh, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anja M Wackerle
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, Pittsburgh, USA
- Department of Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ariana Lott
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, Pittsburgh, USA
| | - Nicholas A Apseloff
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, Pittsburgh, USA
| | - Bryson P Lesniak
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, Pittsburgh, USA
| | - James J Irrgang
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, PA, Pittsburgh, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, Pittsburgh, USA
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Ibañez M, Valcarenghi J, Hoffmann F, Mouton C, Pioger C, Siboni R, Monllau JC, Seil R. Nonanatomic Posteromedial Bundle Augmentation of the Posterior Cruciate Ligament after Hyperextension Trauma. Arthrosc Tech 2024; 13:103013. [PMID: 39233795 PMCID: PMC11369956 DOI: 10.1016/j.eats.2024.103013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/01/2024] [Indexed: 09/06/2024] Open
Abstract
The surgical management of posterior cruciate ligament (PCL) injuries can be challenging. As most PCL injuries occur in a flexed knee position, the anterolateral bundle is thought to be more commonly injured than the posteromedial bundle (PMB); however, in hyperextension, the PMB plays a more significant role. The smaller size of the PMB compared with the anterolateral bundle and its lower strength may explain why isolated hyperextension PMB injuries can be easily overlooked. In this Technical Note, a surgical technique to perform a nonanatomic PMB augmentation of the PCL using a gracilis tendon autograft or allograft is reported. These technical features aim to overcome current limitations in existing techniques to address the symptoms after partial PCL hyperextension injuries.
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Affiliation(s)
- Maximiliano Ibañez
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg - Clinique d’Eich, Luxembourg, Luxembourg
- ICATME, Hospital Universitari Dexeus, UAB, Barcelona, Spain
| | - Jérôme Valcarenghi
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg - Clinique d’Eich, Luxembourg, Luxembourg
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire d’Ambroise, Paré, Mons, Belgium
| | - Felix Hoffmann
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg - Clinique d’Eich, Luxembourg, Luxembourg
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg - Clinique d’Eich, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg
| | - Charles Pioger
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg - Clinique d’Eich, Luxembourg, Luxembourg
- Department of Orthopaedic Surgery, Ambroise Paré Hospital, Paris Saclay University, Boulogne-Billancourt, France
| | - Renaud Siboni
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg - Clinique d’Eich, Luxembourg, Luxembourg
- Department of Orthopaedic Surgery, Reims Teaching Hospital, Hôpital Maison Blanche, Reims, France
| | - Joan Carles Monllau
- ICATME, Hospital Universitari Dexeus, UAB, Barcelona, Spain
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg - Clinique d’Eich, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods (HOSD), Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg
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4
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Mouton C, Ibañez M, Hoffmann F, Monllau JC, Seil R. Injuries of the posteromedial bundle of the posterior cruciate ligament after knee hyperextension trauma: A new clinical entity based on an original case series. J Exp Orthop 2024; 11:e12052. [PMID: 38974050 PMCID: PMC11224766 DOI: 10.1002/jeo2.12052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose This original case series aims to describe an uncommon triad of clinical signs in patients presenting with persistent pain and inability to resume physical activities after knee hyperextension trauma. Methods Patient history, clinical examination, arthroscopic findings and investigations of 12 patients who consulted with the senior author are presented. Results Twelve patients (seven males/five females) presented with persistent pain after knee hyperextension trauma either in sport or a traffic accident. They had a median age of 18.5 and a median body mass index of 23 kg/m2. All had medical visits and at least one magnetic resonance imaging (MRI) before visiting the senior author's institution but the cause of their problems could not be explained. The clinical examination of the injured knee appeared normal except for an uncommon triad of clinical signs with the knee close to extension: (1) a grade 1+ anterior-posterior laxity around 10-20° of knee flexion with a firm end-point (pseudo-Lachman sign), (2) a grade 1+ tibiofemoral step-off sign with a posterior drawer at 10-20° of knee flexion and (3) an increased knee hyperextension compared to the contralateral side. Arthroscopy of eight patients confirmed the pseudo-Lachman sign with a grade I posterior drawer close to knee extension, normal posterior laxity at 90° of knee flexion and an intact anterior cruciate ligament. Conclusion Patients displayed an increased hyperextension and posterior laxity close to knee extension which normalised at 90° of knee flexion. In patients with a history of knee hyperextension trauma associated with persistent pain, inability to resume physical activities, inconclusive MRIs and a standard clinical examination, clinicians should consider extending their investigations with the knee close to extension to identify this clinical triad consistent with a lesion to the posteromedial bundle of the posterior cruciate ligament. Level of evidence Level IV.
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Affiliation(s)
- Caroline Mouton
- Department of Orthopaedic SurgeryCentre Hospitalier Luxembourg—Clinique d'EichLuxembourgLuxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS)LuxembourgLuxembourg
| | - Maximiliano Ibañez
- Department of Orthopaedic SurgeryCentre Hospitalier Luxembourg—Clinique d'EichLuxembourgLuxembourg
- ICATME, Hospital Universitari Dexeus, UABBarcelonaSpain
| | - Felix Hoffmann
- Department of Orthopaedic SurgeryCentre Hospitalier Luxembourg—Clinique d'EichLuxembourgLuxembourg
| | - Joan Carles Monllau
- ICATME, Hospital Universitari Dexeus, UABBarcelonaSpain
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la EsperanzaUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Romain Seil
- Department of Orthopaedic SurgeryCentre Hospitalier Luxembourg—Clinique d'EichLuxembourgLuxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS)LuxembourgLuxembourg
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods (HOSD), Luxembourg Institute of Health (LIH)LuxembourgLuxembourg
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Zhi X, Wen Z, Zhang J, Lai D, Ye H, Wu J, Li J, Shao Y, Canavese F, Zeng C, Xu H. Epidemiology and distribution of cruciate ligament injuries in children and adolescents, with an analysis of risk factors for concomitant meniscal tear. Front Pediatr 2024; 12:1332989. [PMID: 38523842 PMCID: PMC10957772 DOI: 10.3389/fped.2024.1332989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction To investigate the epidemiological features and prevalence of cruciate ligament injuries (CLI) in children and adolescents, and to examine the potential risk factors associated with concomitant meniscal tear (MT) among this population. Methods The demographic data and injury details of children and adolescents with CLI from Southeast China were analyzed to describe their distribution characteristics, alongside an analysis of the prevalence of MTs, the most frequent complication. In addition, binary logistic analysis was employed to ascertain the risk factors linked to MT in individuals suffering from CLI. Results A total of 203 patients with CLI (n = 206) met the inclusion criteria, with a male-to-female ratio of 2.3:1. Notably, a higher proportion of females were aged ≤16 years old compared to males, who predominated in patients aged >16 years (P = 0.001). Among children and adolescents, anterior cruciate ligament (ACL) injuries were the primary type of CLI, accounting for 88.18% (179/203) of all cases. The majority of cases (132/203, 65.02%) were sustained during sports activities, and sprains were the predominant mechanism of injury (176/203, 86.7%). Additionally, the most common associated injury was an MT (157/203, 77.34%). The posterior horn is the most frequently affected site for both medial MT (62.93% out of 73 cases) and lateral MT (70.19% out of 73 cases). Moreover, vertical tears constituted the majority of medial MTs (59.48% out of 116 cases). Furthermore, patients with a higher BMI faced an increased risk of associated MT in comparison to non-overweight patients (88% vs. 73.86%; P = 0.038). Each increase in BMI unit was linked with a 14% higher probability of associated MT occurrence in children and adolescents with CLI (OR = 1.140; P = 0.036). Discussion ACL injuries are a common form of knee ligament injury among children and adolescents, especially those over the age of 16, and are often the result of a sprain. Meniscal posterior horn injury is the most commonly associated injury of youth with CLI. Additionally, overweight or obese people with CLI are at a greater risk of developing MT.
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Affiliation(s)
- Xinwang Zhi
- Department of Pediatric Orthopedics, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Orthopedic Hospital of Guangdong Province, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- Translational Research Centre of Regenerative Medicine and 3D Printing of Guangzhou Medical University, Guangdong Province Engineering Research Center for Biomedical Engineering, State Key Laboratory of Respiratory Disease, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhicheng Wen
- Orthopedic Hospital of Guangdong Province, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Jiexin Zhang
- Orthopedic Hospital of Guangdong Province, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Dongbo Lai
- Department of Pediatric Neurosurgery, Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Huilan Ye
- School of Pediatrics, Guangzhou Medical University, Guangzhou, China
| | - Jianping Wu
- Department of Pediatric Orthopedics, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jintao Li
- Orthopedic Hospital of Guangdong Province, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yan Shao
- Orthopedic Hospital of Guangdong Province, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Federico Canavese
- Department of Pediatric Orthopedics, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Pediatric Orthopedic Surgery, Lille University Center and Faculty of Medicine, Jeanne de Flandre Hospital, Lille, France
| | - Chun Zeng
- Orthopedic Hospital of Guangdong Province, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hongwen Xu
- Department of Pediatric Orthopedics, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Zsidai B, Engler ID, Narup E, Lin RT, Nazzal EM, Winkler PW, Samuelsson K, Irrgang JJ, Musahl V. Delayed multiligament PCL reconstruction is associated with a higher prevalence of intraarticular injury and may influence treatment. BMC Musculoskelet Disord 2023; 24:502. [PMID: 37337235 DOI: 10.1186/s12891-023-06638-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/15/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate differences in concomitant injury patterns and their treatment in patients undergoing early (≤ 12 weeks) and delayed (> 12 weeks) primary multiligament posterior cruciate ligament (PCL) reconstruction (PCL-R). METHODS This study was a retrospective chart review of patients undergoing primary multiligament PCL-R at a single institution between 2008 and 2020. Multiligament PCL-R was defined as PCL-R and concurrent surgical treatment of one or more additional knee ligament(s). Exclusion criteria included isolated PCL-R, PCL repair, and missing data for any variable. Patients were dichotomized into early (≤ 12 weeks) and delayed (> 12 weeks) PCL-R groups based on the time elapsed between injury and surgery. Between-group comparison of variables were conducted with the Chi-square, Fisher's exact, and independent samples t-tests. RESULTS A total of 148 patients were eligible for analysis, with 57 (38.5%) patients in the early and 91 (61.1%) patients in the delayed multiligament PCL-R groups. Concomitant LCL/PLC reconstruction (LCL-R/PLC-R) was performed in 55 (60%) of delayed multiligament PCL-Rs and 23 (40%) of early PCL-Rs (p = 0.02). Despite similar rates of meniscus injury, concomitant meniscus surgery was significantly more prevalent in the early (n = 25, 44%) versus delayed (n = 19, 21%) multiligament PCL-R group (p = 0.003), with a significantly greater proportion of medial meniscus surgeries performed in the early (n = 16, 28%) compared to delayed (n = 13, 14%) PCL-R group (p = 0.04). The prevalence of knee cartilage injury was significantly different between the early (n = 12, 24%) and delayed (n = 41, 46%) multiligament PCL-R groups (p = 0.01), with more frequent involvement of the lateral (n = 17, 19% vs. n = 3, 5%, respectively; p = 0.04) and medial (n = 31, 34% vs. n = 6, 11%, respectively; p = 0.005) femoral condyles in the delayed compared to the early PCL-R group. CONCLUSIONS Given higher rates of chondral pathology and medial meniscus surgery seen in delayed multiligament PCL-R, early management of PCL-based multiligament knee injury is recommended to restore knee stability and potentially prevent the development of further intraarticular injury. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Bálint Zsidai
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA.
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ian D Engler
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA
- Central Maine Healthcare Orthopedics, Central Maine Medical Center, Auburn, USA
| | - Eric Narup
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ryan T Lin
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA
| | - Ehab M Nazzal
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA
| | - Philipp W Winkler
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Linz, Austria
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - James J Irrgang
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Different patient and activity-related characteristics result in different injury profiles for patients with anterior cruciate ligament and posterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 2023; 31:308-315. [PMID: 36029316 PMCID: PMC9859844 DOI: 10.1007/s00167-022-07131-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/17/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To compare patient characteristics including patient sex, age, body mass index (BMI), activities at the time of injury and injury profiles in patients with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries. METHODS Data were obtained from the Swedish National Knee Ligament Registry. Two study groups were created: (1) index ACL reconstruction (ACL group) and (2) index PCL reconstruction (PCL group). Between-group differences were investigated using Fisher's exact test and Fisher's non-parametric permutation test for dichotomous variables and continuous variables, respectively. RESULTS Of 39,010 patients, 38,904 were ACL injuries. A larger proportion of patients with combined injuries to the PCL, meniscus and cartilage were female, aged > 25 years and with a BMI of > 35 kg/m2 compared with patients with combined injuries to the ACL, meniscus and cartilage. An isolated ACL injury was more commonly found in males, while all other injury profiles of ACL, including combined injuries with meniscus, cartilage and collateral ligament injuries, were more frequently observed in females. The PCL injuries were sustained either during pivoting sports, non-pivoting sports or were traffic-related. CONCLUSION Different patient characteristics (BMI, age and sex), and activities at the time of injury (sport- versus traffic-related activities), resulted in distinct injury profiles for the ACL and PCL groups. These findings provide valuable information of the way specific injury patterns of cruciate ligament injuries occur, and subsequently may help clinicians with the diagnostic process of ACL and PCL injuries. LEVEL OF EVIDENCE III.
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8
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D'Ambrosi R, Hallé A, Hardy A. Good clinical and radiological results following remnant-preserving posterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 31:2418-2432. [PMID: 36208342 PMCID: PMC10183434 DOI: 10.1007/s00167-022-07192-z] [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: 06/25/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The objective of this systematic literature review was to report the results and complications of recent remnant preservation techniques in posterior cruciate ligament (PCL) reconstruction. METHODS A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers searched the PubMed, Scopus, Embase, and Cochrane Library databases using the terms "posterior cruciate ligament" or "PCL" and "remnant preserving." The outcome measures extracted from the studies were the Lysholm score, the International Knee Documentation Committee's (IKDC) subjective and objective scores, Tegner scores, Orthopädische Arbeitsgruppe Knie (OAK) rate of return to sports, and rate of complications. Data were also extracted from studies that used stress radiographs to perform a quantitative assessment of the preoperative and postoperative anteroposterior stability. RESULTS The systematic review included 13 studies. The patient cohort of consisted of 643 participants (544 [84.6%] men and 99 [15.4%] women) with a mean age of 32.9 ± 4.0 years. The mean postoperative follow-up was 34.5 ± 10.9 months (range: 24-96 months), while the mean time from injury to surgery was 14.4 ± 9.9 months (range: 0-240 months). All studies reported clinically significant improvement at final follow-up, as evident from the measured subjective and objective IKDC scores, Lysholm score, Tegner score, and OAK rate. Only three studies reported return to sports activity, with a mean percentage of 90.8% (99/109). All studies showed a significant improvement in posterior translation, from 11.5 ± 1.2 mm to 3.3 ± 1.1 mm, using radiography (side-to-side difference). This systematic review revealed 13 (2.0%) failures and 33 (5.1%) minor complications: 10 (1.6%) cases of stiffness, 21 (4.9%) screws removal, 1 (0.2%) injury of the peroneal nerve, and 1 (0.2%) fibular fracture. CONCLUSIONS With the currently available data, all studies included in the review on posterior cruciate ligament reconstruction with remnant preservation demonstrated satisfactory outcomes at mid-term follow-up (> 24 months), despite varying surgical techniques and graft types, and intervals from injury to surgery. For clinical relevance, standard PCL reconstruction is a highly effective operation in terms of improvement in functional status, knee stability, quality of life, and cost effectiveness. The remnant preservation technique requires more comprehensive diagnostic assessments of the PCL remnant patterns and more complicated surgical procedures. Given the absence so far of high quality studies with long-term follow-up, the remnant-preserving techniques should be recommended only by experienced knee arthroscopic surgeons. LEVEL OF EVIDENCE Level IV. STUDY REGISTRATION reviewregistry1376- www.researchregistry.com .
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
| | - Aurélien Hallé
- Service de Chirurgie Orthopedique et Traumatologique, CHU de Cochin, Paris, France
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9
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Standardized Rehabilitation or Individual Approach?—A Retrospective Analysis of Early Rehabilitation Protocols after Isolated Posterior Cruciate Ligament Reconstruction. J Pers Med 2022; 12:jpm12081299. [PMID: 36013248 PMCID: PMC9409670 DOI: 10.3390/jpm12081299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/31/2022] [Accepted: 08/05/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: Isolated posterior cruciate ligament (PCL) tears represent a severe type of injury. In hospitals, PCL reconstruction (PCL-R) is less frequently performed than other types of knee surgery. It is unclear whether there is consensus among surgeons on how to perform rehabilitation after PCL-R or if there are different, more individual approaches in daily routines. (2) Methods: Rehabilitation protocols and their main criteria (the progression of weight bearing and range of motion, the use of knee braces, rehabilitation training, and sports-specific training) were retrospectively analyzed after PCL-R. (3) Results: Only 33 of 120 (27.5%) analyzed institutes use rehabilitation protocols after PCL-R. The applied protocols showed vast differences between the individual rehabilitation criteria, especially with regard to the progression of weight bearing and the range of motion. The only standardized recommendations were the obligatory use of knee braces and the general restriction of weight bearing and range of motion immediately post-surgery. Therefore, because of the lack of a consensus about a standardized rehabilitation protocol after PCL-R, no recommendation can be made on one particular protocol. (4) Conclusion: There is no acknowledged standardized rehabilitation protocol after PCL-R. In clinical practice, recommendations are influenced by, i.a., surgeons’ opinions and experience. The lack of scientific evidence on a particular standardized rehabilitation protocol after PCL-R suggests that rehabilitation protocols need to be tailored to the individual patient.
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Sports activity and quality of life improve after isolated ACL, isolated PCL, and combined ACL/PCL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 31:1781-1789. [PMID: 35809104 PMCID: PMC10090003 DOI: 10.1007/s00167-022-07060-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare patient-reported outcomes following isolated anterior cruciate ligament reconstruction (ACL-R), isolated posterior cruciate ligament reconstruction (PCL-R), and combined ACL-R and PCL-R (ACL/PCL-R), at a minimum follow-up of 2 years. METHODS This was a prospective observational registry cohort study based on the Swedish National Knee Ligament Registry. Patients undergoing isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R between 2005 and 2019 were eligible for inclusion. Demographic characteristics as well as injury- and surgery-related data were queried from the SNKLR. To evaluate functional outcomes, the Knee Injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1- and 2-year follow-ups and compared between the treatment groups. RESULTS In total, 45,169 patients underwent isolated ACL-R, 192 patients isolated PCL-R, and 203 patients combined ACL/PCL-R. Preoperatively, and at the 1- and 2-year follow-ups, KOOS subscales were highest for the isolated ACL-R group, followed by the isolated PCL-R, and lowest for the combined ACL/PCL-R groups. Significant improvements were observed across all treatment groups in the majority of KOOS subscales between the preoperative, and 1- and 2-year follow-ups. All treatment groups showed the greatest improvements between the preoperative and 2-year follow-ups in the knee-related quality of life (mean improvement: isolated ACL-R, + 28 points; isolated PCL-R, + 23 points; combined ACL/PCL-R, + 21 points) and the function in sport and recreation (mean improvement: isolated ACL-R, + 26 points; isolated PCL-R, + 20 points; combined ACL/PCL-R, + 19 points) subscales. CONCLUSION Clinically relevant improvements in knee function can be expected after isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R. Functional improvements were particularly pronounced in the KOOS function in sport and recreation subscale, indicating the importance of knee stability for sports activity. This study facilitates more comprehensive patient education about functional expectations after surgical treatment of isolated and combined ACL and PCL injuries. LEVEL OF EVIDENCE Level 2.
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