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Labban W, Manaseer T, Golberg E, Sommerfeldt M, Nathanail S, Dennett L, Westover L, Beaupre L. Jumping into recovery: A systematic review and meta-analysis of discriminatory and responsive force plate parameters in individuals following anterior cruciate ligament reconstruction during countermovement and drop jumps. J Exp Orthop 2024; 11:e12018. [PMID: 38572392 PMCID: PMC10986632 DOI: 10.1002/jeo2.12018] [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: 10/18/2023] [Revised: 02/12/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
Purpose Comprehensive understanding of force plate parameters distinguishing individuals postprimary anterior cruciate ligament reconstruction (ACLR) from healthy controls during countermovement jumps (CMJ) and/or drop jumps (DJ) is lacking. This review addresses this gap by identifying discriminative force plate parameters and examining changes over time in individuals post-ACLR during CMJ and/or DJ. Methods We conducted a systematic review and meta analyses following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Nine databases were searched from inception to March 2022. We included cross-sectional papers comparing post-ACLR with healthy controls or longitudinal studies of individuals at least 6 months postprimary ACLR while performing CMJ and/or DJ on force plates. The methodological quality was appraised using the Modified Downs and Black Checklist. Results Thirty-three studies including 1185 (50.38%) participants post-ACLR, and 1167 (49.62%) healthy controls, were included. Data were categorised into single-leg CMJ, double-leg CMJ, single-leg DJ, and double-leg DJ. Jump height was reduced in both single (mean difference [MD] = -3.13; p < 0.01; 95% confidence interval [CI]: [-4.12, -2.15]) and double-leg (MD = -4.24; p < 0.01; 95% CI: [-5.14, -3.34]) CMJs amongst individuals with ACLR. Similarly, concentric impulse and eccentric/concentric impulse asymmetry could distinguish between ACLR (MD = 3.42; p < 0.01; 95% CI: [2.19, 4.64]) and non-ACLR (MD = 5.82; p < 0.01; 95% CI: [4.80, 6.80]) individuals. In double-leg DJs, peak vertical ground reaction forces were lower in the involved side (MD = -0.10; p = 0.03; 95% CI: [-0.18, -0.01]) but higher in the uninvolved side (MD = 0.15; p < 0.01; 95% CI: [0.10, 0.20]) when compared to controls and demonstrated significant changes between 6 months and 3 years post-ACLR. Conclusion This study identified discriminative kinetic parameters when comparing individuals with and without ACLR and also monitored neuromuscular function post-ACLR. Due to heterogeneity, a combination of parameters may be required to better identify functional deficits post-ACLR. Level of Evidence Level III.
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Affiliation(s)
- Wasim Labban
- Department of Physiotherapy, Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
- Mirdif Center for Physiotherapy and RehabilitationDubaiUnited Arab Emirate
| | - Thaer Manaseer
- Department of Sport Rehabilitation, Faculty of Physical Education & Sports SciencesThe Hashemite UniversityZarqaJordan
| | - Eric Golberg
- Department of Physiotherapy, Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
| | - Mark Sommerfeldt
- Department of Surgery, Division of Orthopedic Surgery, Faculty of Medicine & DentistryUniversity of AlbertaEdmontonCanada
- Glen Sather Sports Medicine ClinicUniversity of AlbertaEdmontonCanada
| | | | - Liz Dennett
- Geoffrey and Robyn Sperber Health Sciences LibraryUniversity of AlbertaEdmontonCanada
| | | | - Lauren Beaupre
- Department of Physiotherapy, Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
- Department of Surgery, Division of Orthopedic Surgery, Faculty of Medicine & DentistryUniversity of AlbertaEdmontonCanada
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Liu Y, Havasy J, Green S, Deng XH, Chen D, Piacentini A, Rodeo SA. Short-Term Evaluation of Bone-ACL-Bone Complex Allograft in ACL Reconstruction in a Rabbit Model. J Clin Med 2023; 12:7057. [PMID: 38002670 PMCID: PMC10671951 DOI: 10.3390/jcm12227057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/26/2023] [Accepted: 08/25/2023] [Indexed: 11/26/2023] Open
Abstract
The study is to evaluate incorporation of a bone-anterior cruciate ligament-bone (B-ACL-B) allograft in anterior cruciate ligament (ACL) reconstruction in a rabbit model. A total of 61 New Zealand white rabbits were used, with 23 donor rabbits for harvesting B-ACL-B allografts and 38 recipient rabbits undergoing unilateral ACL reconstruction with B-ACL-B allograft. Animals were euthanized for biomechanical testing, micro-computed tomography examination, histological analysis, multi-photon microscopy and transmission electron microscopy testing at 2, 4 and 8 weeks after surgery. Gross inspection and radiographs confirmed the intact ACL allograft in the proper anatomic position. Progressive healing occurred between the bone block and the bone tunnel as demonstrated by a gradual increase in average bone volume fraction and total mineral density at 4 and 8 weeks. Histological analysis showed new bone formation at the bone block-tunnel interface, with maintenance of the native ACL enthesis. Ultrastructural analysis demonstrated the maintenance of overall collagen matrix alignment, while there was repopulation with smaller diameter collagen fibrils. There was no significant difference between 4 and 8 weeks in mean failure force (p = 0.39) or stiffness (p = 0.15) for the B-ACL-B allografts. This study demonstrates the restoration of the normal anatomy of the ACL and progressive graft incorporation and remodeling using a B-ACL-B allograft for ACL reconstruction in the rabbit knee.
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Affiliation(s)
- Yulei Liu
- Department of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY 10021, USA
| | - Janice Havasy
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY 10021, USA
| | - Samuel Green
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY 10021, USA
| | - Xiang-Hua Deng
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY 10021, USA
| | - Daoyun Chen
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY 10021, USA
| | - Alexander Piacentini
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY 10021, USA
| | - Scott A. Rodeo
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY 10021, USA
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Liu Y, Deng XH, Havasy J, Green S, Piacentini A, Chen D, Rodeo SA. Bone-ACL-bone allograft for anterior cruciate ligament reconstruction: Short-term evaluation in a rabbit model with microcomputed tomography. J Orthop Res 2023; 41:1697-1708. [PMID: 36691866 DOI: 10.1002/jor.25520] [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: 06/17/2022] [Revised: 12/06/2022] [Accepted: 01/19/2023] [Indexed: 01/25/2023]
Abstract
The standard grafts used for anterior cruciate ligament (ACL) reconstruction are tendon, either patellar tendon, hamstring, or quadriceps. However, the microstructure and composition of tendon differs from ligament. Ideally, the ACL would be replaced with the same tissue. To evaluate the incorporation of a bone-ACL-bone (B-ACL-B) graft for ACL reconstruction, we performed a controlled laboratory study in a rabbit model with microcomputed tomography (μCT). Forty-six New Zealand white rabbits were used, with 17 donor rabbits to harvest bilateral B-ACL-B allografts and 29 rabbits undergoing unilateral ACL reconstruction with B-ACL-B allograft. Knee specimens were collected for biomechanical testing (n = 14) at 4 and 8 weeks and for μCT analysis (n = 15) at 2, 4, and 8 weeks after surgery. Gross inspection and μCT examination confirmed bone blocks in the appropriate anatomic position. Biomechanical tests revealed no difference in mean load-to-failure force for B-ACL-B allografts between 4 and 8 weeks. Progressive healing occurred between the bone block and the tunnel as demonstrated by a gradual increase on average bone-volume fraction and total mineral density (TMD) in both femoral and tibial tunnels. Remodeling of the bone block was evidenced by a significant decrease in TMD of both tibial and femoral bone blocks. This is a report of a novel rabbit B-ACL-B allograft reconstruction model demonstrating early signs of graft remodeling and incorporation. Clinical Relevance: This study demonstrates ACL reconstruction using an anatomically matched ACL allograft, rather than a tendon graft, may be possible based on early findings in this lapine model.
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Affiliation(s)
- Yulei Liu
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York City, New York, USA
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Xiang-Hua Deng
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York City, New York, USA
| | - Janice Havasy
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York City, New York, USA
| | - Samuel Green
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York City, New York, USA
| | - Alexander Piacentini
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York City, New York, USA
| | - Daoyun Chen
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York City, New York, USA
| | - Scott A Rodeo
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York City, New York, USA
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Romanchuk NJ, Livock H, Lukas KJ, Del Bel MJ, Benoit DL, Carsen S. Criteria Used to Determine Unrestricted Return to Activity After ACL Reconstruction in Pediatric and Adolescent Patients: A Systematic Review. Orthop J Sports Med 2023; 11:23259671231154540. [PMID: 36909673 PMCID: PMC9996745 DOI: 10.1177/23259671231154540] [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: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 03/14/2023] Open
Abstract
Background The rates of anterior cruciate ligament (ACL) graft failure or contralateral ACL rupture range from 17% to 30% in pediatric patients after ACL reconstruction (ACLR). A contributing factor to the high reinjury rate in this population may be the limited evidence regarding appropriate criteria for allowing unrestricted return to activity (RTA) postoperatively. Purpose To review the literature and identify the most commonly used criteria when determining unrestricted RTA after ACLR in pediatric patients. Study Design Systematic review; Level of evidence, 4. Methods A search was performed of the Medline/PubMed, Cochrane Central Register of Controlled Trials, Embase, CINAHL, and SPORTDiscus databases using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The authors identified studies that included pediatric patients (<19 years of age) and specified the criteria used to determine RTA after ACLR. Results A total of 27 articles met all criteria for review, of which 13 studies only used 1 criterion when determining RTA. Objective criteria were the most common type of criteria for RTA (17 studies). Strength tests (15 studies) and hop tests (10 studies) were the most commonly used tasks when deriving RTA criteria. Only 2 studies used validated questionnaires to assess the patient's physiological readiness for RTA, and only 2 studies used an objective assessment of movement quality before RTA. Conclusion Only 14 of the 27 reviewed studies reported using >1 criterion when determining RTA. Furthermore, few studies used patient-reported outcome measures or lower limb kinematics as RTA criteria, indicating that more research is needed to validate these metrics in the pediatric population.
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Affiliation(s)
- Nicholas J Romanchuk
- Biomedical Engineering Program, Faculty of Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Holly Livock
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kenneth J Lukas
- Division of Orthopaedic Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael J Del Bel
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel L Benoit
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sasha Carsen
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Division of Orthopaedic Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Romanchuk NJ, Livock H, Lukas KJ, Del Bel MJ, Benoit DL, Carsen S. Protocol for the systematic review of return-to-activity criteria in adolescent patients following an anterior cruciate ligament reconstruction. Syst Rev 2022; 11:93. [PMID: 35568927 PMCID: PMC9107732 DOI: 10.1186/s13643-022-01965-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a debilitating knee injury associated with sequela such as joint instability and progressive degeneration. Unfortunately, following surgical ACL reconstruction in adolescents, the rates of ACL graft failure range from 17 to 19%. A contributing factor to the high reinjury rate in this population may be the limited evidence regarding appropriate criteria for allowing unrestricted return-to-activities (RTA) postoperatively. Several systematic reviews have already sought to develop a consensus on what criteria should be utilized for releasing patients to unrestricted sports activities; however, these reviews have focused on adult populations, a group at much lower risk for reinjury. Our objective is to systematically examine the literature and identify the criteria used when determining unrestricted RTA following an ACL reconstruction in an adolescent population. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search will be performed of the MEDLINE/PubMed, Cochrane, Embase, CINAHL, and SPORTDiscus electronic databases. Searches will be conducted from January 1, 2000, until submission of the final review. Studies will be identified that include adolescent patients (10-18 years old) undergoing a primary ACL reconstruction and which have specified the criteria used to determine RTA. Each article will be independently screened by two reviewers. To supplement the electronic database search, citations within all included studies will be manually reviewed. Reviewers will record the RTA assessment utilized and the rates of ACL reinjury through a standardized data extraction sheet. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the most commonly used types of RTA criteria. DISCUSSION This systematic review will determine the most commonly used RTA criteria in adolescent patients post-ACL reconstruction. This will help future interventions build more effective adolescent-specific RTA assessments through the validation of current RTA criteria as well as the implementation of new criteria according to the identified literature gaps.
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Affiliation(s)
- Nicholas J Romanchuk
- Ottawa Carleton Institute for Biomedical Engineering, University of Ottawa, 800 King Edward Ave., Ottawa, ON, K1N 6N5, Canada
| | - Holly Livock
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, K1H 8L1, Canada
| | - Kenneth J Lukas
- Trinity College, University of Dublin, College Green, Dublin 2, Dublin, Ireland
| | - Michael J Del Bel
- School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Daniel L Benoit
- Ottawa Carleton Institute for Biomedical Engineering, University of Ottawa, 800 King Edward Ave., Ottawa, ON, K1N 6N5, Canada.,School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.,School of Human Kinetics, University of Ottawa, 125 University, Ottawa, ON, K1N 6N5, Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, K1H 8L1, Canada.
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Kinetic measurement system use in individuals following anterior cruciate ligament reconstruction: a scoping review of methodological approaches. J Exp Orthop 2021; 8:81. [PMID: 34568996 PMCID: PMC8473525 DOI: 10.1186/s40634-021-00397-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/27/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose Our primary objectives were to (1) describe current approaches for kinetic measurements in individuals following anterior cruciate ligament reconstruction (ACLR) and (2) suggest considerations for methodological reporting. Secondarily, we explored the relationship between kinetic measurement system findings and patient-reported outcome measures (PROMs). Methods We followed the PRISMA extension for scoping reviews and Arksey and O’Malley’s 6-stage framework. Seven electronic databases were systematically searched from inception to June 2020. Original research papers reporting parameters measured by kinetic measurement systems in individuals at least 6-months post primary ACLR were included. Results In 158 included studies, 7 kinetic measurement systems (force plates, balance platforms, pressure mats, force-measuring treadmills, Wii balance boards, contact mats connected to jump systems, and single-sensor insoles) were identified 4 main movement categories (landing/jumping, standing balance, gait, and other functional tasks). Substantial heterogeneity was noted in the methods used and outcomes assessed; this review highlighted common methodological reporting gaps for essential items related to movement tasks, kinetic system features, justification and operationalization of selected outcome parameters, participant preparation, and testing protocol details. Accordingly, we suggest considerations for methodological reporting in future research. Only 6 studies included PROMs with inconsistency in the reported parameters and/or PROMs. Conclusion Clear and accurate reporting is vital to facilitate cross-study comparisons and improve the clinical application of kinetic measurement systems after ACLR. Based on the current evidence, we suggest methodological considerations to guide reporting in future research. Future studies are needed to examine potential correlations between kinetic parameters and PROMs. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-021-00397-0.
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Marchiori G, Berni M, Cassiolas G, Vivarelli L, Lopomo NF, Fini M, Dallari D, Govoni M. Extra-Corporeal Membrane Oxygenation Cadaver Donors: What about Tissues Used as Allografts? MEMBRANES 2021; 11:membranes11070545. [PMID: 34357195 PMCID: PMC8307999 DOI: 10.3390/membranes11070545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/16/2023]
Abstract
Several studies demonstrated the efficacy of post-mortem extracorporeal membrane oxygenation (ECMO) on donors in preserving organ function addressing organ transplantation. Nevertheless, no common and shared evidence was reached about the possibility of using ECMO donors in tissue harvesting. Therefore, this work aimed first to review the current scientific literature about ECMO donors, and then to focus on the use of ECMO tissues as allografts, mainly addressing musculoskeletal tissues, which are of the most interest for reconstruction. A search was conducted on the current scientific literature, focusing on the keywords "ECMO" and "Donor". Several online databases were used, including PubMed, Scopus, and Web of Science. From the preliminary search, 478 articles were obtained, out of which 173 specifically reported the use of ECMO for donation and transplantation purposes. Literature reported extensive analyses of ECMO organs-overall from the abdomen-both in pre- and post-transplantation studies. On the other hand, ECMO tissues were explanted only in a very limited number of cases; moreover, no information was referred about their status and use. A revision of the current scientific literature highlighted the lack of information concerning ECMO tissues and the necessity to perform preclinical, ex vivo studies to compare allografts from ECMO donors, with respect to standard donors, and, thus, to verify whether they can be harvested and implanted safely and with efficacy.
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Affiliation(s)
- Gregorio Marchiori
- Surgical Sciences and Technologies Complex Structure, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (G.M.); (M.F.)
| | - Matteo Berni
- Medical Technology Laboratory Complex Structure, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Giorgio Cassiolas
- Department of Information Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (G.C.); (N.F.L.)
| | - Leonardo Vivarelli
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136 Bologna, Italy; (D.D.); (M.G.)
- Correspondence:
| | - Nicola Francesco Lopomo
- Department of Information Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy; (G.C.); (N.F.L.)
| | - Milena Fini
- Surgical Sciences and Technologies Complex Structure, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (G.M.); (M.F.)
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136 Bologna, Italy; (D.D.); (M.G.)
| | - Marco Govoni
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136 Bologna, Italy; (D.D.); (M.G.)
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Jiang H, Zhang L, Zhang RY, Zheng QJ, Li MY. Comparison of hamstring and quadriceps strength after anatomical versus non-anatomical anterior cruciate ligament reconstruction: a retrospective cohort study. BMC Musculoskelet Disord 2021; 22:452. [PMID: 34006272 PMCID: PMC8132361 DOI: 10.1186/s12891-021-04350-1] [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: 11/01/2020] [Accepted: 05/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background Strength recovery of injured knee is an important parameter for patients who want to return to sport after anterior cruciate ligament reconstruction (ACLR). Comparison of muscle strength between anatomical and non-anatomical ACLR has not been reported. Purpose To evaluate the difference between anatomical and non-anatomical single-bundle ACLR in hamstring and quadriceps strength and clinical outcomes. Methods Patients received unilateral primary single-bundle hamstring ACLR between January 2017 to January 2018 were recruited in this study. Patients were divided into anatomical reconstruction group (AR group) and non-anatomical reconstruction group (NAR group) according to femoral tunnel aperture position. The hamstring and quadriceps isokinetic strength including peak extension torque, peak flexion torque and H/Q ratio were measured at an angular velocity of 180°/s and 60°/s using an isokinetic dynamometer. The isometric extension and flexion torques were also measured. Hamstring and quadriceps strength were measured preoperatively and at 3, 6, and 12 months after surgery. Knee stability including Lachman test, pivot-shift test, and KT-1000 measurement and subjective knee function including International Knee Documentation Committee (IKDC) and Lysholm scores were evaluated during the follow-up. Results Seventy-two patients with an average follow-up of 30.4 months (range, 24–35 months) were included in this study. Thirty-three were in AR group and 39 in NAR group. The peak knee flexion torque was significant higher in AR group at 180°/s and 60°/s (P < 0.05 for both velocity) at 6 months postoperatively and showed no difference between the two groups at 12 months postoperatively. The isometric knee extension torque was significant higher in AR group at 6 months postoperatively (P < 0.05) and showed no difference between the two groups at 12 months postoperatively. No significant differences between AR group and NAR group were found regarding knee stability and subjective knee function evaluations at follow-up. Conclusions Compared with non-anatomical ACLR, anatomical ACLR showed a better recovery of hamstring and quadriceps strength at 6 months postoperatively. However, the discrepancy on hamstring and quadriceps strength between the two groups vanished at 1 year postoperatively.
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Affiliation(s)
- Hai Jiang
- Department of Orthopedic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, NO. 106, Zhongshan 2nd Road, 510000, Guangzhou, China
| | - Lei Zhang
- Department of Rehabilitation, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, NO. 106, Zhongshan 2nd Road, 510000, Guangzhou, China
| | - Rui-Ying Zhang
- Department of Orthopedic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, NO. 106, Zhongshan 2nd Road, 510000, Guangzhou, China
| | - Qiu-Jian Zheng
- Department of Orthopedic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, NO. 106, Zhongshan 2nd Road, 510000, Guangzhou, China.
| | - Meng-Yuan Li
- Department of Orthopedic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, NO. 106, Zhongshan 2nd Road, 510000, Guangzhou, China.
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Tedesco S, Crowe C, Ryan A, Sica M, Scheurer S, Clifford AM, Brown KN, O’Flynn B. Motion Sensors-Based Machine Learning Approach for the Identification of Anterior Cruciate Ligament Gait Patterns in On-the-Field Activities in Rugby Players. SENSORS 2020; 20:s20113029. [PMID: 32471051 PMCID: PMC7309071 DOI: 10.3390/s20113029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/10/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022]
Abstract
Anterior cruciate ligament (ACL) injuries are common among athletes. Despite a successful return to sport (RTS) for most of the injured athletes, a significant proportion do not return to competitive levels, and thus RTS post ACL reconstruction still represents a challenge for clinicians. Wearable sensors, owing to their small size and low cost, can represent an opportunity for the management of athletes on-the-field after RTS by providing guidance to associated clinicians. In particular, this study aims to investigate the ability of a set of inertial sensors worn on the lower-limbs by rugby players involved in a change-of-direction (COD) activity to differentiate between healthy and post-ACL groups via the use of machine learning. Twelve male participants (six healthy and six post-ACL athletes who were deemed to have successfully returned to competitive rugby and tested in the 5–10 year period following the injury) were recruited for the study. Time- and frequency-domain features were extracted from the raw inertial data collected. Several machine learning models were tested, such as k-nearest neighbors, naïve Bayes, support vector machine, gradient boosting tree, multi-layer perceptron, and stacking. Feature selection was implemented in the learning model, and leave-one-subject-out cross-validation (LOSO-CV) was adopted to estimate training and test errors. Results obtained show that it is possible to correctly discriminate between healthy and post-ACL injury subjects with an accuracy of 73.07% (multi-layer perceptron) and sensitivity of 81.8% (gradient boosting). The results of this study demonstrate the feasibility of using body-worn motion sensors and machine learning approaches for the identification of post-ACL gait patterns in athletes performing sport tasks on-the-field even a number of years after the injury occurred.
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Affiliation(s)
- Salvatore Tedesco
- Tyndall National Institute, University College Cork, Lee Maltings Complex, Dyke Parade, T12R5CP Cork, Ireland; (C.C.); (M.S.); (B.O.)
- Correspondence: ; Tel.: +353-21-234-6286
| | - Colum Crowe
- Tyndall National Institute, University College Cork, Lee Maltings Complex, Dyke Parade, T12R5CP Cork, Ireland; (C.C.); (M.S.); (B.O.)
| | - Andrew Ryan
- School of Allied Health, Health Research Institute, University of Limerick, V94T9PX Limerick, Ireland; (A.R.); (A.M.C.)
| | - Marco Sica
- Tyndall National Institute, University College Cork, Lee Maltings Complex, Dyke Parade, T12R5CP Cork, Ireland; (C.C.); (M.S.); (B.O.)
| | - Sebastian Scheurer
- Insight Centre for Data Analytics, School of Computer Science and Information Technology, University College Cork, T12XF62 Cork, Ireland; (S.S.); (K.N.B.)
| | - Amanda M. Clifford
- School of Allied Health, Health Research Institute, University of Limerick, V94T9PX Limerick, Ireland; (A.R.); (A.M.C.)
| | - Kenneth N. Brown
- Insight Centre for Data Analytics, School of Computer Science and Information Technology, University College Cork, T12XF62 Cork, Ireland; (S.S.); (K.N.B.)
| | - Brendan O’Flynn
- Tyndall National Institute, University College Cork, Lee Maltings Complex, Dyke Parade, T12R5CP Cork, Ireland; (C.C.); (M.S.); (B.O.)
- Insight Centre for Data Analytics, School of Computer Science and Information Technology, University College Cork, T12XF62 Cork, Ireland; (S.S.); (K.N.B.)
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Shimizu T, Markes AR, Samaan MA, Tanaka MS, Souza RB, Li X, Ma CB. Patients With Abnormal Limb Kinetics at 6 Months After Anterior Cruciate Ligament Reconstruction Have an Increased Risk of Persistent Medial Meniscal Abnormality at 3 Years. Orthop J Sports Med 2020; 8:2325967119895248. [PMID: 32030346 PMCID: PMC6978828 DOI: 10.1177/2325967119895248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/28/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Several reports have shown that altered biomechanics after anterior cruciate
ligament reconstruction (ACLR) are associated with the development of
posttraumatic osteoarthritis. However, it is not fully understood whether
altered biomechanics are associated with meniscal changes after ACLR. Purpose: To investigate changes in gait and landing biomechanics over a 3-year period
and their correlation with meniscal matrix alterations present before and
after ACLR through use of magnetic resonance T1ρ/T2 mapping, which can allow
detection of early meniscal degeneration. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 36 patients with ACLR and 14 healthy controls were included in
this study. All patients underwent magnetic resonance imaging and
biomechanical analysis during gait of the injured knee and contralateral
knee preoperatively and at 6 months, 1 year, 2 years, and 3 years after
ACLR, as well as biomechanical analysis during drop-landing from 6 months to
3 years postoperatively. To evaluate biochemical changes of the mensical
matrix, T1ρ/T2 relaxation times of the meniscus were calculated. Results: Mean T1ρ/T2 values of ACLR knees were significantly higher than values in the
contralateral and control knees in the posterior lateral and medial horns up
to 1 year after surgery; however, the differences were not seen at 3 years
after surgery. The ACLR knee exhibited significantly lower peak knee flexion
moment and angle during gait at 6 months compared with baseline and
continued to decrease until 3 years. The ACLR knee exhibited significantly
lower peak vertical ground-reaction force and peak knee flexion moment and
angle during landing at 6 months. However, the differences were no longer
present at 3 years. Biomechanics at 6 months had significant correlations
with changes of mean T1ρ/T2 values in the medial posterior horn from 6
months to 3 years after ACLR. Conclusion: Although mean T1ρ/T2 values of meniscus seen before ACLR improved after 3
years, approximately 30% of patients with ACLR did not show decreases from 6
months to 3 years. Patients with abnormal lower limb kinetics of the ACLR
knee at 6 months showed less recovery in the medial posterior horn from 6
months to 3 years, suggesting that biomechanical parameters during the early
stage of recovery might be potential biomarkers for predicting persistent
medial meniscal abnormality after ACLR.
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Affiliation(s)
- Tomohiro Shimizu
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA.,Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Alexander R Markes
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA
| | - Michael A Samaan
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Matthew S Tanaka
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Richard B Souza
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA
| | - Xiaojuan Li
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, Ohio, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA
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11
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Nyland J, Taniyama D. Editorial Commentary: Rehabilitation and Return-to-Sports Readiness, the "Black Box" of Anterior Cruciate Ligament Reconstruction Patient Recovery. Arthroscopy 2019; 35:2080-2082. [PMID: 31272627 DOI: 10.1016/j.arthro.2019.03.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 02/02/2023]
Abstract
When progressing patients who have undergone anterior cruciate ligament reconstruction through rehabilitation and deciding whether they are ready to safely return to sports, the health care team needs to consider what they know and what they do not know about each patient. Although increased postsurgical time without related functional improvement is of limited value, greater time postsurgery that leads to enhanced neuromuscular control and dynamic knee stability restoration may be of considerable value, particularly when soft tissue grafts are combined with extracortical suspensory devices or other forms of indirect fixation.
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Affiliation(s)
- John Nyland
- Kosair Charities College of Health and Natural Sciences, Spalding University (D.T.), and the College of Sport and Health Sciences, Ritsumeikan University (D.T.)
| | - Daiki Taniyama
- Kosair Charities College of Health and Natural Sciences, Spalding University (D.T.), and the College of Sport and Health Sciences, Ritsumeikan University (D.T.)
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