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Tischer T, Karlsson J, Seil R. Sport-specific differences in ACL injury, treatment and return to sports. Knee Surg Sports Traumatol Arthrosc 2024; 32:1359-1362. [PMID: 38586977 DOI: 10.1002/ksa.12174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Thomas Tischer
- Department of Orthopaedic and Trauma Surgery, Waldkrankenhaus Erlangen, Erlangen, Germany
- Department of Orthopaedic Surgery, University Medicine Rostock, Rostock, Germany
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier-Clinique d'Eich and Luxembourg Institute of Health, Luxembourg
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Murgier J, Duthon V, Deygas A, Ehkirch FP. Does an early post traumatic knee brace reduce the incidence of knee rotational instability? Arch Orthop Trauma Surg 2024; 144:1161-1169. [PMID: 38253710 DOI: 10.1007/s00402-024-05206-8] [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: 07/22/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE Several anterolateral stabilization procedures have been developed recently to address rotational instability of the knee. Currently, these procedures tend to be systematically used by some practitioners. However, antero-lateral structures of the knee (including the anterolateral ligament, ALL) have a self-healing potential which can reduce the need to perform an antero-lateral procedure. In this study, it was hypothesized that early post-traumatic immobilization of the knee with a knee brace would allow partial healing of antero-lateral structures and also allow control of the pivot shift, thus avoiding antero-lateral extra-articular stabilization. The objective of this study was to compare the severity of pivot shift between two groups of patients who all experienced anterior cruciate ligament (ACL) tear and respectively underwent post-traumatic immobilization of the knee versus no immobilization. METHODS This was a comparative, multicentric (three centers' study) retrospective, consecutive study including 168 patients who underwent ACL reconstruction between May and September 2022. The application or not of post-traumatic immobilization and its duration, the severity of pivot shift observed in the operating room under general anesthesia, the presence of anterolateral lesions as revealed by MRI and the patients' pre-injury sport activity were recorded. RESULTS A grade 3 pivot shift was found in 44 patients (27%). It was more frequently observed in the group without a brace compared to the group with a knee brace (18 patients out of 36: 50% versus 26 patients out of 132: 19.7%; p = 0.0012). Wearing a brace, whether hinged (OR = 0.221, [0.070-0.652]; p = 0.006) or not (OR = 0.232, [0.076-0.667]; p = 0.0064), was protective from the risk of developing a significant pivot shift. CONCLUSION This study demonstrated that the presence of pivot-shift was lower in the patients that had an early post-injury knee brace before their ACL reconstruction. Based on this result, systematic brace placement could be advocated for in patients after knee trauma. LEVEL OF EVIDENCE III, prognostic retrospective case-control study.
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Affiliation(s)
- Jérôme Murgier
- Orthopedics Department, Aguiléra Clinic, 21 Rue de L'Estagnas, 64200, Biarritz, France.
| | - Victoria Duthon
- Centre de Médecine du Sport et de L'Exercice, Swiss Olympic Medical Center, Hirslanden Clinique La Colline, Geneva, Switzerland
| | - Aymeric Deygas
- Orthopaedic Department, Clinique Maussins-Nollet, Paris, France
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Chen H, Li J, Li S, Wang X, Xu G, Li M, Li G. Research progress of procyanidins in repairing cartilage injury after anterior cruciate ligament tear. Heliyon 2024; 10:e26070. [PMID: 38420419 PMCID: PMC10900419 DOI: 10.1016/j.heliyon.2024.e26070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
Anterior cruciate ligament (ACL) tear is a common sports-related injury, and cartilage injury always emerges as a serious complication following ACL tear, significantly impacting the physical and psychological well-being of affected individuals. Over the years, efforts have been directed toward finding strategies to repair cartilage injury after ACL tear. In recent times, procyanidins, known for their anti-inflammatory and antioxidant properties, have emerged as potential key players in addressing this concern. This article focuses on summarizing the research progress of procyanidins in repairing cartilage injury after ACL tear. It covers the roles, mechanisms, and clinical significance of procyanidins in repairing cartilage injury following ACL tear and explores the future prospects of procyanidins in this domain. This review provides novel insights and hope for the repair of cartilage injury following ACL tear.
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Affiliation(s)
- Hanlin Chen
- The First Hospital of Lanzhou University, Lanzhou, China
- Major in Clinical Medicine, First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Jingrui Li
- The First Hospital of Lanzhou University, Lanzhou, China
- Major in Clinical Medicine, First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Shaofei Li
- The First Hospital of Lanzhou University, Lanzhou, China
- Major in Clinical Medicine, First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xiaoqi Wang
- Major in Clinical Medicine, Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Ge Xu
- The First Hospital of Lanzhou University, Lanzhou, China
- Major in Clinical Medicine, First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Molan Li
- The First Hospital of Lanzhou University, Lanzhou, China
- Major in Clinical Medicine, First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Guangjie Li
- The First Hospital of Lanzhou University, Lanzhou, China
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Häner M, Petersen W. [Treatment of acute injury of the anterior cruciate ligament : Always only reconstruction?]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:8-17. [PMID: 37597054 DOI: 10.1007/s00113-023-01357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/21/2023]
Abstract
The aim of treatment of a ruptured anterior cruciate ligament (ACL) is the return of the patient to an acceptable level of activity without giving way phenomena as well as adequate treatment of prognostically relevant concomitant lesions. The treatment of acute ACL ruptures can be either early reconstruction or a primary physiotherapy with optional later reconstruction. Which path is taken depends on possible concomitant injuries that require early surgical intervention (e.g., repairable meniscal injury or distal rupture of the medial collateral ligament) and on patient-specific factors (age, level of activity). Isolated ruptures of the ACL can also be primarily treated without surgery. Then the injured knee joint should first be so far conditioned by rehabilitative measures that pain, swelling and posttraumatic restriction of movement are improved and neuromuscular training can be started. A screening test consisting of jumping tests, patient-reported outcome measures and the testing for giving way phenomena can be suitable to differentiate compensators (copers) from noncompensators (non-copers). Surgical reconstruction of the ACL should be recommended to non-compensators in the sense of participatory decision-making. Activity modification (adapter) can also be considered as a treatment strategy. If instability events (giving way) or secondary meniscal lesions occur during nonsurgical therapy, cruciate ligament reconstruction should be considered.
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Affiliation(s)
- Martin Häner
- Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyß-Str. 27-31, 14193, Berlin, Deutschland
| | - Wolf Petersen
- Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyß-Str. 27-31, 14193, Berlin, Deutschland.
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Vittone G, Mouton C, Valcarenghi J, Dor J, Seil R. Case report: unusual posteromedial capsular lesion with posterior lateral meniscus root tear in two patients with constitutional genu recurvatum presenting after an acute ACL injury. J Exp Orthop 2023; 10:136. [PMID: 38091161 PMCID: PMC10719229 DOI: 10.1186/s40634-023-00684-y] [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: 08/16/2023] [Accepted: 10/21/2023] [Indexed: 12/17/2023] Open
Abstract
Ramp lesions of the medial meniscus and posterior lateral meniscus root tears (LMPRT) can be present simultaneously in up to 8% of patients undergoing anterior cruciate ligament (ACL) reconstruction. The prevalence of these complex and highly unstable meniscal tears increases exponentially with the severity of the injury. The posteromedial capsule (PMC) has often been disregarded in the past when discussing ligamentous and meniscal injuries, but the recent interest in ramp lesions has drawn surgeons' attention to the posteromedial structures of the ACL injured knee. While the meniscocapsular junction is commonly repaired in unstable ramp lesions, in the current literature there is no report regarding proximal PMC lesions, be they in isolation or associated with complex meniscal injuries.We report here two cases of proximal posteromedial capsular lesions associated with medial meniscus instability and posterior lateral root tears after ACL injury. The first case involves a meniscus ramp lesion associated with a proximal PMC tear and a posteromedial fluid collection in the muscle plane on magnetic resonance in a 22-year-old male soccer player. The second case involves a 21-year-old female soccer player who presented with a PMC lesion after hyperextension/valgus knee injury. The capsular lesions were repaired to restore capsular tension and improve medial meniscus posterior horn stability.
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Affiliation(s)
- Giulio Vittone
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg - Clinique d'Eich, Clinique d'Eich 78 Rue d'Eich, L-1460, Luxembourg, Luxembourg
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg - Clinique d'Eich, Clinique d'Eich 78 Rue d'Eich, L-1460, Luxembourg, Luxembourg
- Sports Medicine and Science (LIROMS), Luxembourg Institute of Research in Orthopaedics, Luxembourg, Luxembourg
| | - Jérôme Valcarenghi
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg - Clinique d'Eich, Clinique d'Eich 78 Rue d'Eich, L-1460, Luxembourg, Luxembourg
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire d'ambroise Paré, Mons, Belgium
| | - Jérémie Dor
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg - Clinique d'Eich, Clinique d'Eich 78 Rue d'Eich, L-1460, Luxembourg, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg - Clinique d'Eich, Clinique d'Eich 78 Rue d'Eich, L-1460, Luxembourg, Luxembourg.
- Sports Medicine and Science (LIROMS), Luxembourg Institute of Research in Orthopaedics, Luxembourg, Luxembourg.
- Orthopaedics, Sports Medicine and Digital Methods (HOSD), Human Motion, Luxembourg Institute of Health, Luxembourg, Luxembourg.
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Oronowicz J, Mouton C, Pioger C, Valcarenghi J, Tischer T, Seil R. The posterior cruciate ligament-posterior femoral cortex angle (PCL-PCA) and the lateral collateral ligament (LCL) sign are useful parameters to indicate the progression of knee decompensation over time after an ACL injury. Knee Surg Sports Traumatol Arthrosc 2023; 31:5128-5136. [PMID: 37805550 DOI: 10.1007/s00167-023-07583-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: 06/21/2023] [Accepted: 09/06/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE The posterior cruciate ligament-posterior cortex angle (angle between the most vertical part of the anterolateral PCL bundle and the posterior diaphyseal cortex of the femur; PCL-PCA) is the most accurate approach to describe the PCL buckling phenomenon observed in anterior cruciate ligament (ACL)-deficient knees. The aim of this study was to determine whether the PCL-PCA is associated with chronicity of the ACL rupture, the meniscal status, preoperative knee laxity or imaging signs such as the lateral collateral ligament (LCL) sign or the posterior tibial slope (PTS) in ACL-injured knees. METHODS Patients with a primary ACL reconstruction (ACLR) after physeal closure were selected retrospectively from a hospital-based ACL registry from 2015 to 2021. Exclusion criteria were: previous ipsilateral/contralateral knee surgery, previous ipsilateral ACL or meniscal tear, ipsilateral PCL and/or collateral ligament injuries or tibial plateau fracture. The ACL deficiency was defined as chronic if time from injury to MRI was > 6 months. The meniscal status was assessed during ACLR, separately for the medial and lateral meniscus, and classified into no tear, minor or major unstable tear. The MRI analyses included the assessment of the PCL-PCA and the LCL sign. PTS was assessed from the lateral plain radiographs of the injured knee. The side-to-side difference in anterior tibial translation (ATT) at 200N was obtained with the GNRB. RESULTS Eighty-two patients (forty-eight males/thirty-four females) were included in this study. The median PCL-PCA was 16.2° (Q1-Q3: 10.6-24.7) and differed between acute (18.4°) and chronic (10.7°) injuries (p < 0.01). The median PCL-PCA was significantly lower (- 4.6°) in patients with a positive LCL sign (p = 0.03) No significant association could be found between PCL-PCA and meniscal status, PTS or preoperative anterior knee laxity (Lachman, pivot shift and ATT in millimetres). CONCLUSION The PCL-PCA was significantly lower in chronic ACL injuries and in patients with a positive LCL sign, indicating a higher buckling phenomenon of the PCL in these patients. These results support the fact that PCL-PCA and the LCL sign may be useful parameters to indicate the progression of knee decompensation over time after an ACL injury, and therefore may constitute a helpful tool to optimise treatment choice and timing of ACL reconstruction if necessary. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jakub Oronowicz
- Clinic for Orthopaedics and Trauma Surgery, Malteser St. Mary's Hospital, Erlangen, Germany
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
- Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg, Luxembourg
| | - Charles Pioger
- Department of Orthopaedic Surgery, Ambroise Paré Hospital, Paris Saclay University, Paris, France
| | - Jérôme Valcarenghi
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Ambroise Paré, Mons, Belgium
| | - Thomas Tischer
- Clinic for Orthopaedics and Trauma Surgery, Malteser St. Mary's Hospital, Erlangen, Germany
- Department of Orthopaedics, University of Rostock, Rostock, Germany
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg.
- Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg, Luxembourg.
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxemburg Institute of Health, Luxembourg, Luxembourg.
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Nasir AZ, Henne T, Khan N. Mucoid degeneration of the anterior cruciate ligament corrected with autograft reconstruction. BMJ Case Rep 2023; 16:e253307. [PMID: 37580096 PMCID: PMC10432630 DOI: 10.1136/bcr-2022-253307] [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: 08/16/2023] Open
Abstract
The anterior cruciate ligament (ACL) is the most frequently injured knee ligament, typically in non-contact athletic injuries in young adults. Mucoid degeneration of the ACL (ACL-MD) is an uncommon ACL pathology in which glycosaminoglycans deposition within the collagenous bundles leads to hypertrophy, loss of full knee flexion and knee pain without instability. ACL-MD usually presents in individuals over 40 years with sudden-onset knee pain after minimal trauma or as an incidental MRI finding. ACL-MD is rarely described in young adults. We present a case of ACL-MD in a previously healthy adult in his early 20s who presented with 3-month recalcitrant dull left knee pain and limited range of motion after 'stepping funny' with slight twisting. This case highlights the need to critically reflect on the anatomical structures when presented with musculoskeletal pathologies and to consider the unique presentation of musculoskeletal disease in atypical age groups.
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Affiliation(s)
- Ali Zagham Nasir
- Internal Medicine Residency, Trinity Health Grand Rapids Hospital, Grand Rapids, Michigan, USA
| | - Timothy Henne
- Orthopaedics, Trinity Health Grand Rapids Hospital, Grand Rapids, Michigan, USA
| | - Nasir Khan
- Internal Medicine, Trinity Health Grand Rapids Hospital, Grand Rapids, Michigan, USA
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