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Jia Z, Greven J, Hildebrand F, Kobbe P, Eschweiler J. Conservative treatment versus surgical reconstruction for ACL rupture: A systemic review. J Orthop 2024; 57:8-16. [PMID: 38948499 PMCID: PMC11208802 DOI: 10.1016/j.jor.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Background Anterior cruciate ligament (ACL) rupture is a prevalent sports injury with rising rates attributed to increased population participation in sports activities. ACL rupture can lead to severe knee complications including cartilage damage, torn meniscus, and osteoarthritis. Current treatment options include conservative measures and surgical interventions. However, debates persist regarding the optimal approach. Purpose This analysis intended to compare the function, knee stability, and incidence rate of secondary surgery between conservative and surgical treatments in ACL rupture patients. Methods A systematic search was performed via Embase, Ovid Medline, PubMed, Cochrane Library, Web of Science, and Google Scholar for reporting outcomes of conservative and surgical treatments after ACL rupture. The outcomes included patient-reported outcome measures (PROMs), knee stability, the need for secondary meniscal surgery, delayed ACL reconstruction surgery, and revision ACL reconstruction surgery. Outcomes were analyzed using mean differences or odd ratios (OR) with 95 % CIs. Results 11 studies were included with 1516 patients. For PROMs, our evidence indicated no differences in KOOS Pain, KOOS Symptoms, KOOS Sport/Rec, KOOS ADL, and KOOS QOL. (all p > 0.05). for knee stability, pivot shift (OR, 0.14; p < 0.001), Lachman test (OR, 0.06; p < 0.001), and tibia translation (p < 0.001) were evaluated, and the available evidence favored surgical treatment over conservative treatment. For the incidence rate of any secondary surgery after the first diagnosis, the surgical group showed a lower rate of meniscal surgery with statistical significance (OR, 0.37; p < 0.001). The average rate of revision ACL reconstruction is 5.80 %, while the rate of delayed ACL reconstruction after conservative treatment is 18.51 %. Conclusion Currently, there is insufficient empirical evidence to advocate a systematic surgical reconstruction for any patient who tore his ACL. This review found no differences in function outcomes between conservative and surgical treatments. Regarding knee stability and secondary meniscal surgery, the results prefer the surgical treatments. The occurrence rate of revision and delayed ACL reconstruction are non-negligible factors that must be fully understood by both surgeons and patients before choosing a suitable treatment.
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Affiliation(s)
- Zhongyu Jia
- Department for Orthopaedic, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Germany
| | - Johannes Greven
- Department for Thoracic Surgery, RWTH Aachen University Hospital, Germany
| | - Frank Hildebrand
- Department for Orthopaedic, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Germany
| | - Philipp Kobbe
- Department for Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost Halle, Halle (Saale), Germany
- Department for Trauma and Reconstructive Surgery, University Hospital of the Martin Luther University Halle, Halle (Saale), Germany
| | - Jörg Eschweiler
- Department for Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost Halle, Halle (Saale), Germany
- Department for Trauma and Reconstructive Surgery, University Hospital of the Martin Luther University Halle, Halle (Saale), Germany
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Zhu X, Sun S, Yao Y, Jiang F, Yang F, Zhao H, Xue Z, Dai S, Yu T, Xiao X. Preliminary identification of somatic mutations profile in ACL injury. Sci Rep 2024; 14:22847. [PMID: 39354002 PMCID: PMC11445548 DOI: 10.1038/s41598-024-73718-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 09/20/2024] [Indexed: 10/03/2024] Open
Abstract
Anterior cruciate ligament (ACL) injury is a common orthopedic disease with a high incidence, long recovery time, and often requiring surgical treatment. However, the susceptibility factors for ACL injury are currently unclear, and there is a lack of analysis on the differences in the ligament itself. Previous studies have focused on germline mutations, with less research on somatic mutations. To determine the role of somatic mutations in ACL injuries, we recruited seven patients between the ages of 20 and 39 years diagnosed with ACL injuries, collected their peripheral blood, injured ligament ends, and healthy ligament ends tissues, and performed exome sequencing with gene function enrichment analysis. We detected multiple gene mutations and gene deletions, which were only present in some of the samples. Unfortunately, it was not possible to determine whether these somatic mutations are related to ligament structure or function, or are involved in ACL injury. However, this study provides valuable clues for future in-depth research.
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Affiliation(s)
- Xuesai Zhu
- The Second School of Clinical Medical College of Binzhou Medical College, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, 264100, Shandong Province, China
- Department of Orthopedic Surgery, Key Laboratory of Orthopedics, Sports Medicine & Rehabilitation, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, 266071, Shandong Province, China
| | - Shenjie Sun
- Department of Emergency, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, 266071, Shandong Province, China
| | - Yizhi Yao
- Department of Orthopedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, Shandong Province, China
| | - Fan Jiang
- Department of Orthopedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, Shandong Province, China
| | - Fenghua Yang
- Department of Orthopedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, Shandong Province, China
| | - Haibo Zhao
- Department of Orthopedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, Shandong Province, China
| | - Zichao Xue
- Department of Sports Medicine, Qingdao Municipal Hospital, Qingdao, 266071, Shandong Province, China
| | - Shiyou Dai
- Department of Orthopedic Surgery, Key Laboratory of Orthopedics, Sports Medicine & Rehabilitation, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, 266071, Shandong Province, China
| | - Tengbo Yu
- Department of Orthopedic Surgery, Key Laboratory of Orthopedics, Sports Medicine & Rehabilitation, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, 266071, Shandong Province, China.
| | - Xiao Xiao
- Central Laboratories, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, 266071, Shandong Province, China.
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Geeslin AG, Tollefson LV, Slette EL, Shoemaker EP, Carlson M, LaPrade RF, Engebretsen L, Moatshe G. The Fibular Collateral Ligament is a More Important Restraint to Varus Laxity Compared to the Anterolateral Complex in the Anterior Cruciate Ligament Deficient Knee in a Cadaveric Biomechanical Study. Arthroscopy 2024:S0749-8063(24)00741-2. [PMID: 39326574 DOI: 10.1016/j.arthro.2024.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 09/07/2024] [Accepted: 09/09/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE The purpose of this study was to compare the influence of the fibular collateral ligament (FCL) and the anterolateral complex (ALC) on varus knee laxity in paired anterior cruciate ligament (ACL)-deficient cadaveric knees using varus stress radiographs. METHODS Varus laxity in nine paired (N=18, mean age 73.8 years) human cadaveric knees was assessed using varus stress radiographs with a 12 Nm varus stress applied at 20° of knee flexion. All knees underwent testing in the intact state and following ACL sectioning. One knee of each pair was randomly assigned to undergo FCL sectioning and the contralateral knee was assigned to undergo ALC sectioning (anterolateral ligament [ALL] followed by the Kaplan fibers). RESULTS Both FCL sectioning and ALC (ALL and the Kaplan fibers) sectioning resulted in increased lateral compartment gapping compared to the intact state, 2.44 mm and 1.13 mm, respectively. ALL sectioning with intact Kaplan fibers did not result in increased lateral compartment gapping. Paired knee comparison revealed a significantly greater influence of the FCL than the ALC in restraining lateral compartment gapping under an applied varus stress (p=0.0003). CONCLUSIONS Sectioning the FCL resulted in significantly greater lateral compartment gapping under a varus stress than combined sectioning of the ALL and Kaplan fibers in an ACL deficient knee, although both scenarios resulted in significantly increased gapping compared to the intact state. Sectioning of the ALL with intact Kaplan fibers did not result in increased lateral compartment gapping. CLINICAL RELEVANCE The FCL is the most important structure in restraining varus laxity in the ACL deficient knee and the ALC is of secondary importance in restraining varus laxity. In ACL deficient patients with a high-grade pivot shift, mild varus laxity on clinical examination, and an intact FCL on MRI, injury to the anterolateral complex should be considered and may be evaluated with varus stress radiographs. This study validates prior biomechanical studies of FCL deficiency and demonstrates that approximately 1 mm increase in lateral compartment gapping on varus stress radiographs may occur secondary to ALC injury and clinicians should be aware of this when considering treatment for ACL deficient patients with high-grade anterolateral laxity.
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Skvortsov D, Altukhova A, Kaurkin S, Akhpashev A. Long-Term Outcomes of Anterior Cruciate Ligament Reconstruction Based on Gait Analysis. Diagnostics (Basel) 2024; 14:1977. [PMID: 39272761 PMCID: PMC11394042 DOI: 10.3390/diagnostics14171977] [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: 07/30/2024] [Revised: 08/30/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Currently available studies on the long-term functional outcomes of anterior cruciate ligament (ACL) reconstruction have yielded conflicting results. The purpose of this study was to evaluate the biomechanical characteristics of walking in the long term after ACL reconstruction. METHODS The study included a test group of 18 patients (3.4 years from the date of ACL reconstruction on average) and a control group of 20 healthy subjects. Their gaits were assessed using functional tests at voluntary walking and fast-walking speeds. The biomechanical assessments utilized included spatiotemporal and kinematic parameters of walking, as well as surface electromyography (EMG) amplitudes of the main flexor-extensor muscles of the lower extremities. RESULTS Fast-walking speeds and the clearances of the operated-upon limbs in the patient group exceeded those in the control group. The gait cycle in the patient group was significantly longer when walking at a voluntary speed compared to the control group. In the patient group, most of the movements were symmetrical at both speeds, and the parameters did not differ from the control group. The only exception was the hip joint amplitude and the main amplitude of the knee joint flexion, which significantly and simultaneously increased when walking at a fast speed. CONCLUSIONS In the postoperative period, at voluntary speeds, the patient group was characterized by increased amplitudes in the hip and knee joints and higher EMG amplitudes, which almost disappeared at higher speeds.
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Affiliation(s)
- Dmitry Skvortsov
- Research and Clinical Centre, 107031 Moscow, Russia
- Center for Brain and Neurotechnology, 117513 Moscow, Russia
| | | | - Sergey Kaurkin
- Research and Clinical Centre, 107031 Moscow, Russia
- Center for Brain and Neurotechnology, 117513 Moscow, Russia
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Song Y, Salsgiver L, Van Valkenburg K, Christofferson N, Lo Y, Feng Z, McGuinness B, Dai B. Hopping backward to move forward: Single-leg backward hopping can better detect decreased quadriceps strength induced by a fatigue protocol compared to forward and vertical hopping. JOURNAL OF SPORT AND HEALTH SCIENCE 2024:100976. [PMID: 39237062 DOI: 10.1016/j.jshs.2024.100976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/05/2024] [Accepted: 04/18/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Deficits in quadriceps strength of the injured leg have been observed in patients following anterior cruciate ligament (ACL) reconstructions and may contribute to ACL re-injury risk. Single-leg forward hopping is a widely used task for assessing knee function in patients following ACL reconstructions as it has been shown not to be particularly challenging to the knee. This study aimed to quantify the effect of decreased quadriceps strength induced by a fatigue protocol on hopping performance and lower limb mechanics in single-leg forward, vertical, and backward hopping. METHODS Thirty-four injury-free participants performed single-leg forward, vertical, and backward hopping on both legs pre- and post-fatigue, with 1 leg experiencing a fatigue protocol. Peak moments, power, and work of hip, knee, and ankle joints were quantified during the jumping phase. Hopping performance and bilateral asymmetries in performance were assessed. RESULTS Single-leg backward hopping demonstrated the greatest knee moments, power, and work compared to forward and vertical hopping, regardless of leg and fatigue. Fatigue protocol resulted in significantly less knee moments, power, and work, and decreased performance of the fatigued leg among all tasks. Bilateral symmetries in hopping performance decreased in post-fatigue, with the greatest decrease in backward hopping. CONCLUSION The greater sensitivity of the backward hopping to detect quadriceps fatigue suggests it may act as a better or at least an additional metric to evaluate quadriceps strength deficits. The findings may contribute to the development of a clinically applicable and valid strength assessment to monitor the rehabilitation progress in patients following ACL reconstructions.
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Affiliation(s)
- Yu Song
- Department of Health, Sport & Exercise Sciences, University of Kansas, Lawrence, KS 66045, USA
| | - Lauren Salsgiver
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82071, USA
| | - Kaden Van Valkenburg
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82071, USA
| | | | - Yessica Lo
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82071, USA
| | - Zhichen Feng
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82071, USA
| | - Brenna McGuinness
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT 59812, USA
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82071, USA.
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Wu J, Wu J, Liu Z, Gong Y, Feng D, Xiang W, Fang S, Chen R, Wu Y, Huang S, Zhou Y, Liu N, Xu H, Zhou S, Liu B, Ni Z. Mesenchymal stem cell-derived extracellular vesicles in joint diseases: Therapeutic effects and underlying mechanisms. J Orthop Translat 2024; 48:53-69. [PMID: 39170747 PMCID: PMC11338158 DOI: 10.1016/j.jot.2024.07.005] [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: 03/05/2024] [Revised: 06/09/2024] [Accepted: 07/08/2024] [Indexed: 08/23/2024] Open
Abstract
Joint diseases greatly impact the daily lives and occupational functioning of patients globally. However, conventional treatments for joint diseases have several limitations, such as unsatisfatory efficacy and side effects, necessitating the exploration of more efficacious therapeutic strategies. Mesenchymal stem cell (MSC)-derived EVs (MSC-EVs) have demonstrated high therapeutic efficacyin tissue repair and regeneration, with low immunogenicity and tumorigenicity. Recent studies have reported that EVs-based therapy has considerable therapeutic effects against joint diseases, including osteoarthritis, tendon and ligament injuries, femoral head osteonecrosis, and rheumatoid arthritis. Herein, we review the therapeutic potential of various types of MSC-EVs in the aforementioned joint diseases, summarise the mechanisms underlying specific biological effects of MSC-EVs, and discuss future prospects for basic research on MSC-EV-based therapeutic modalities and their clinical translation. In general, this review provides an in-depth understanding of the therapeutic effects of MSC-EVs in joint diseases, as well as the underlying mechanisms, which may be beneficial to the clinical translation of MSC-EV-based treatment. The translational potential of this article: MSC-EV-based cell-free therapy can effectively promote regeneration and tissue repair. When used to treat joint diseases, MSC-EVs have demonstrated desirable therapeutic effects in preclinical research. This review may supplement further research on MSC-EV-based treatment of joint diseases and its clinical translation.
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Affiliation(s)
- Jinhui Wu
- Department of Joint Surgery and Sport Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410000, China
| | - Jiangyi Wu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Zheng Liu
- Department of Joint Surgery and Sport Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410000, China
| | - Yunquan Gong
- Department of Rehabilitation Medicine, Daping Hospital, Army Medical University, Chongqing, 400022, China
| | - Daibo Feng
- Department of Rehabilitation Medicine, Daping Hospital, Army Medical University, Chongqing, 400022, China
| | - Wei Xiang
- Department of Rehabilitation Medicine, Daping Hospital, Army Medical University, Chongqing, 400022, China
| | - Shunzheng Fang
- Department of Rehabilitation Medicine, Daping Hospital, Army Medical University, Chongqing, 400022, China
| | - Ran Chen
- War Trauma Medical Center, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical Center, Daping Hospital, Army Medical University, Chongqing, 40038, China
| | - Yaran Wu
- Department of Clinical Biochemistry, Faculty of Pharmacy and Laboratory Medicine, Army Medical University, Gantaoyan Street, Shapinba District, Chongqing, 400038, China
| | - Shu Huang
- Department of Joint Surgery and Sport Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410000, China
| | - Yizhao Zhou
- Department of Joint Surgery and Sport Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410000, China
| | - Ningning Liu
- Department of Laboratory Medicine, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450003, China
| | - Hao Xu
- Department of Laboratory Medicine, the Third Affiliated Hospital of Zhengzhou University Zhengzhou, 450003, China
| | - Siru Zhou
- War Trauma Medical Center, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical Center, Daping Hospital, Army Medical University, Chongqing, 40038, China
| | - Baorong Liu
- Department of Joint Surgery and Sport Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410000, China
| | - Zhenhong Ni
- Department of Rehabilitation Medicine, Daping Hospital, Army Medical University, Chongqing, 400022, China
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7
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Morrow DL, Hughes AG, Murray RD, Bruce JR. Arthroscopic Primary Repair of Proximally Based Anterior Cruciate Ligament Tear With Augmentation and All-Epiphyseal Fixation. Arthrosc Tech 2024; 13:103040. [PMID: 39308583 PMCID: PMC11411292 DOI: 10.1016/j.eats.2024.103040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/02/2024] [Indexed: 09/25/2024] Open
Abstract
Arthroscopic anterior cruciate ligament (ACL) reconstruction has been the gold standard of care for ACL injuries for many years. Recently, there has been growing literature and interest in arthroscopic primary ACL repair in select patients with predominantly proximally based ACL tears. This Technical Note demonstrates a surgical technique that offers an efficient minimally invasive and physeal-sparing anatomic ACL repair with all-inside internal brace augmentation that in the short term has offered good results for our patients.
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Affiliation(s)
- Dillon L. Morrow
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Tennessee, U.S.A
| | - Austin G. Hughes
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Tennessee, U.S.A
| | - Richard D. Murray
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Tennessee, U.S.A
| | - Jeremy R. Bruce
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Tennessee, U.S.A
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Knapik DM, Kamitani A, Smith MV, Motley J, Haas AK, Matava MJ, Wright RW, Brophy RH. Relationship between Kinesiophobia and Dynamic Postural Stability after Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study. J Knee Surg 2024; 37:796-803. [PMID: 38677296 DOI: 10.1055/a-2315-8034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Anterior cruciate ligament (ACL) injuries in young, active patients generally require ACL reconstruction (ACLR) to restore mechanical and postural stability. The fear of movement or reinjury (kinesiophobia) has become increasingly recognized in the post-ACLR population; however, the association between restoration of postural stability and kinesiophobia remains largely unknown. The purpose of this study was to investigate changes in mean Tampa Scale of Kinesiophobia-11 (TSK-11), dynamic motion analysis (DMA) scores, and time on the testing platform, as well as any correlation between TSK-11 and mean overall and individual translational and rotational DMA scores during the first 12 months following ACLR. Cohort study. Patients undergoing ACLR were prospectively enrolled and dynamic postural stability and kinesiophobia based on the TSK-11 were collected within 2 days prior to surgery and at 6 and 12 months following ACLR. Dynamic postural stability was quantified by calculating a DMA score, with score calculated in three translational (anterior/posterior [AP], up/down [UD], medial/lateral [ML]) and three rotational (left/right [LR], flexion/extension, and internal/external rotation) independent planes of motions. Correlations between DMA and TSK-11 scores at each time point were analyzed. A total of 25 patients meeting inclusion criteria were analyzed. Mean overall DMA and TSK-11 scores increased with each successive testing interval. At 6-month follow-up, a weakly positive association between TSK-11 and DMA scores was appreciated based on overall DMA, AP, UD, ML, and LR. At 12 months, a moderately positive correlation was appreciated between TSK-11 and the translational, but not rotational, planes of motion. Following ACLR, lower level of kinesiophobia were found to be moderately associated with improved dynamic stability, especially in the translation planes of motion.
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Affiliation(s)
- Derrick M Knapik
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Aguri Kamitani
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Matthew V Smith
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - John Motley
- STAR Sports Therapy and Rehabilitation, Chesterfield, Missouri
| | - Amanda K Haas
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Matthew J Matava
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Robert H Brophy
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
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Liu W, Wang B, Feng Z, Zhang H, Zhao Z, Han S. Risk-factor analysis of the proximal tibia morphology for secondary ipsilateral injury after anterior cruciate ligament reconstruction: A retrospective cross-sectional study. Medicine (Baltimore) 2024; 103:e39395. [PMID: 39213253 PMCID: PMC11365653 DOI: 10.1097/md.0000000000039395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/15/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
Many studies have reported the risk factors associated with primary anterior cruciate ligament (ACL) injury. However, few studies have focused on the bony morphology of secondary ipsilateral injury after ACL reconstruction. This study aimed to investigate the morphological risk factors of the proximal tibia contributing to secondary ipsilateral injury after ACL reconstruction. Twenty patients who were selected from secondary ipsilateral injury after ACL reconstruction between January 2015 and May 2020 were included in the secondary injury group. They were matched in a 1:2 ratio to the control group, which underwent primary ACL reconstruction during the same period and did not experience reinjury at the minimum 2-year follow-up, based on age, gender, and body mass index. All parameters, including medial tibial posterior slope, lateral tibial posterior slope (LTPS), medial tibial plateau depth, and lateral tibial plateau height, were recorded by using magnetic resonance imaging. Binary logistic regression analysis and receiver operator characteristic curves were conducted to explore the risk factors for reinjury and determine the cutoff value for the significant parameter. The LTPS was significantly larger in the secondary injury group than in the control group (9.6 ± 1.5° to 7.0 ± 1.4°, P < .001), and there was no significant difference in the medial tibial posterior slope, medial tibial posterior slope, and lateral tibial plateau height between the 2 groups (P > .05). The LTPS was found to be an independent risk factor for secondary ipsilateral injury after ACL reconstruction (odds ratio = 3.220, 95% confidence interval = 1.904-5.446, P < .001). The cutoff value of the LTPS was 8.8°, with a sensitivity of 91.7% and a specificity of 81.2%. The LTPS could be a unique predictor of secondary ipsilateral injury after ACL reconstruction. Orthopedists should implement effective measurements during primary reconstruction when the LTPS is >8.8°.
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Affiliation(s)
- Wei Liu
- Department of Orthopaedic Surgery, Fengfeng General Hospital of North China Medical & Health Group, Handan, Hebei, PR China
| | - Bin Wang
- Department of Orthopaedic Surgery, Fengfeng General Hospital of North China Medical & Health Group, Handan, Hebei, PR China
| | - Zhiwei Feng
- Department of Orthopaedic Surgery, Fengfeng General Hospital of North China Medical & Health Group, Handan, Hebei, PR China
| | - He Zhang
- Department of Orthopaedic Surgery, Fengfeng General Hospital of North China Medical & Health Group, Handan, Hebei, PR China
| | - Zhiguang Zhao
- Department of Orthopaedic Surgery, Fengfeng General Hospital of North China Medical & Health Group, Handan, Hebei, PR China
| | - Shoujiang Han
- Department of Orthopaedic Surgery, Fengfeng General Hospital of North China Medical & Health Group, Handan, Hebei, PR China
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Motififard M, Akbari Aghdam H, Ravanbod H, Jafarpishe MS, Shahsavan M, Daemi A, Mehrvar A, Rezvani A, Jamalirad H, Jajroudi M, Shahsavan M. Demographic and Injury Characteristics as Potential Risk Factors for Anterior Cruciate Ligament Injuries: A Multicentric Cross-Sectional Study. J Clin Med 2024; 13:5063. [PMID: 39274276 PMCID: PMC11396503 DOI: 10.3390/jcm13175063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/09/2024] [Accepted: 05/17/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Anterior cruciate ligament (ACL) injuries are prevalent and can have debilitating consequences, with various factors potentially influencing their occurrence. This multicentric study aimed to comprehensively analyze the epidemiological characteristics of ACL injuries. We hypothesized that specific patient characteristics, such as age, sex, body mass index (BMI), and sports involvement, would be associated with distinct injury patterns and risk profiles. Methods: This cross-sectional study analyzed the medical records of 712 patients aged 15-60 diagnosed with ACL rupture. Data on demographics, injury mechanisms, associated injuries, graft type, and sports involvement were collected. Results: The majority of patients were male (93.1%), aged 15-30 years (80.2%), and overweight (66.7%). Autografts were the predominant graft choice (96.07%). Associated injuries were present in 79.5% of cases, with medial meniscus ruptures being the most common (37.36%). Sports-related (49.3%) and non-sports-related (50.7%) injuries were nearly equal, with non-contact injuries more prevalent (71.1%). In the sports-related subgroup, associated injuries emerged as a significant risk factor for ACL rupture (p = 0.014, OR = 1.596, 95% CI: 1.101-2.314), whereas non-contact mechanisms showed borderline significance (OR = 0.75, p = 0.09). Moreover, younger athletes were more susceptible to sports-related injuries (p = 0.024), with football being the primary sport involved. Conclusions: This study identified a high prevalence of concomitant injuries with ACL injury, which increased the risk of ACL injury, particularly in sports-related cases. Age-related differences in injury patterns highlight the need for age-appropriate preventive measures, especially for younger athletes participating in high-risk sports. This underscores the need for comprehensive injury assessment, targeted prevention strategies, and optimized clinical management approaches tailored to different populations' specific characteristics and risks.
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Affiliation(s)
- Mehdi Motififard
- Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Hossein Akbari Aghdam
- Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Hadi Ravanbod
- Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | | | - Mahdi Shahsavan
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Amin Daemi
- Department of Medical Biochemistry, Faculty of Medicine, Cukurova University, Adana 01330, Turkey
| | - Amir Mehrvar
- Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran 19839-69411, Iran
| | - Arghavan Rezvani
- Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Hossein Jamalirad
- Department of Medical Informatics, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Mahdie Jajroudi
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Mohammad Shahsavan
- Department of Orthopedic Surgery, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
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11
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Curi GOBDC, Costa FDD, Medeiros VDS, Barbosa VD, Santos TRT, Dionisio VC. The effects of core muscle fatigue on lower limbs and trunk during single-leg drop landing: A comparison between recreational runners with and without dynamic knee valgus. Knee 2024; 50:96-106. [PMID: 39128175 DOI: 10.1016/j.knee.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/03/2024] [Accepted: 07/18/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND A deficit in neuromuscular trunk control can impact the lower limb motion, predisposing runners to injuries. This deficit may show a greater impact on runners with dynamic knee valgus. This study aimed to compare the effect of core fatigue on kinetic, kinematic, and electromyographic parameters of the trunk and lower limbs during single-leg drop landing between runners with and without dynamic knee valgus. METHODS Twenty-seven recreational runners were allocated to the valgus (n = 14) and non-valgus groups (n = 13). They performed the test before and after a fatigue protocol, taking a step forward and landing on the force platform while maintaining balance. The fatigue protocol included isometric and dynamic exercises performed consecutively until voluntary exhaustion. The vertical ground reaction force, the sagittal and frontal plane angles, and the electromyographic activity were evaluated. The integral of electromyographic activity was calculated into three movement phases. ANOVA with repeated measures was used to verify the group, time, and interaction effects. RESULTS After fatigue, both groups showed a significant reduction in the minimum (p = 0.01) and maximum (p = 0.02) knee angles in the frontal plane (more dynamic knee valgus) and greater gluteus medius activity (p = 0.05) from the peak of knee flexion to the end of the movement. The valgus group had a greater hip excursion (p = 0.01) and vertical linear shoulder displacement (p = 0.02) than the non-valgus. CONCLUSION Our results suggest that core fatigue can impact the local muscle and the distal joint and that the groups presented different strategies to deal with the demand during landing.
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Affiliation(s)
| | - Franciele Dias da Costa
- Faculty of Physical Education and Physiotherapy, Federal University of Uberlandia, Uberlandia MG, Brazil
| | - Victor de Souza Medeiros
- Faculty of Physical Education and Physiotherapy, Federal University of Uberlandia, Uberlandia MG, Brazil
| | - Vinícius Dias Barbosa
- Faculty of Physical Education and Physiotherapy, Federal University of Uberlandia, Uberlandia MG, Brazil
| | | | - Valdeci Carlos Dionisio
- Faculty of Physical Education and Physiotherapy, Federal University of Uberlandia, Uberlandia MG, Brazil
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12
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Cote MP, Kearney GJ, McKay MJ, Tanaka MJ. Location and Progression of Chondral Injuries at the Time of Revision Anterior Cruciate Ligament Surgery Varies by Sex. Arthroscopy 2024; 40:2229-2235.e1. [PMID: 38161048 DOI: 10.1016/j.arthro.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/29/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To quantify progression of chondral and meniscal injuries between primary and revision anterior cruciate ligament (ACL) surgery. METHODS Patients who underwent both index and revision ACL reconstruction between 2000 and 2020 at our institution were identified, and dates of injury and surgery, demographics, and clinical data were obtained from operative reports. Outerbridge grade was recorded in each compartment, along with presence and location of meniscal injury. The frequency of each injury between first and second cases was calculated. Differences in injury and progression were compared over time as well as between patient sex and age. RESULTS The study included 189 patients (96 female, 93 male). Age at first surgery was 31.7 ± 13.2 years. Mean time to second injury was 3.3 ± 3.0 years. In total, 116 patients had a new or previous chondral injury (odds ratio, 1.6; 95% CI, 1.2-2.1). The medial femoral condyle (31%) and the patella (21%) accounted for the highest proportion of new injury to articular surfaces, whereas new injury to menisci was comparable between the medial (25%) and lateral (23%) meniscus. At the time of revision ACL reconstruction, females had a high prevalence of chondral injuries to the lateral compartment, whereas males had a high prevalence of chondral injury to the medial femoral condyle. The prevalence of new chondral injuries was comparable between sexes, with males having a slightly higher proportion. While time between surgeries, sex, and age had graphical evidence of moderating risk, the effects were small and imprecise. CONCLUSIONS Revision ACL reconstruction carried a 1.6 increase in the odds for new or progressive chondral lesions in our cohort. At the time of revision, females had a relatively higher proportion of lateral-sided chondral injuries, whereas males had a relatively higher proportion of medial femoral condyle injuries. The greatest increase in the prevalence of new and progressive lesions was observed in the medial femoral condyle and trochlea. This progression appeared to be moderated by time between surgeries, patient sex, and age; however, the differences were small and imprecise. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Mark P Cote
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Garrett J Kearney
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Maxwell J McKay
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A..
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13
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Blumenschein LA, Kolin DA, Fabricant PD, Park J, Gilmore A, Seeley M, Mistovich RJ. Prevalence of Concomitant Injuries by Sport in Pediatric Patients With ACL Rupture. Orthop J Sports Med 2024; 12:23259671241260051. [PMID: 39157019 PMCID: PMC11328314 DOI: 10.1177/23259671241260051] [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: 11/21/2023] [Accepted: 01/01/2024] [Indexed: 08/20/2024] Open
Abstract
Background Although the risk of concomitant injury with anterior cruciate ligament (ACL) tears as a function of specific sports participation has been studied in adults, the topic has not been examined in pediatric and adolescent patients. Purpose/Hypothesis The purpose of the study was to determine if certain sports were associated with a higher risk of concomitant injuries in the setting of an ACL tear. It was hypothesized that the risk of concomitant injuries with ACL tears will differ by type of sport participation in the pediatric population. Study Design Cross-sectional study; Level of evidence, 3. Methods Patients ≤18 years old from 2 tertiary children's hospitals who had undergone primary ACL reconstruction between 2006 and 2018 were included. Sport at the time of injury, demographic factors, and injury pattern (medial meniscal [MM] tears, lateral meniscal [LM] tears, posterior cruciate ligament [PCL] tears, medial collateral ligament [MCL] tears, lateral collateral ligament [LCL] tears, and any concomitant injury) were identified. Results A total of 855 patients with a mean age of 15.5 ± 1.7 years (range, 7-22 years) met the inclusion criteria. Of the included patients, 353 (41.3%) had an isolated ACL tear. A concomitant MM tear was identified in 27.6% of patients, LM tear in 42.9%, PCL injury in 0.4%, MCL injury in 3.0%, and LCL injury in 0.5%. There was no difference in the likelihood of concomitant MM injuries by sex (29.3% for male patients vs 26% for female patients; P = .31) or by sex within basketball (29.3% for male patients vs 25.6% for female patients; P = .96) or soccer (32.3% vs 26.3%; P = .06). Boys had higher proportions of LM injuries overall (51.7% for male patients vs 34.6% for female patients; P < .001) but not within the basketball subgroup (50.5% vs 40.0%; P = .86) or the soccer subgroup (59.7% vs 40.0%; P = .19). No statistically significant associations were found between patient age and specific ACL concomitant injury patterns. When stratifying by body mass index, it was found overweight and obese individuals constituted a greater proportion of LM (49.6% vs 39.1%; P = .01) but not MM (29.4% vs 25.5%; P = .28) injuries when compared to normal-weight patients. Using basketball as the comparison group, soccer and football injuries were 18% more likely to result in any concomitant injury, including concomitant MM, LM, PCL, MCL, and LCL injuries. Conclusion In the pediatric population, soccer and football players were more likely to present with a concomitant injury in addition to ACL injury relative to basketball players. This study aids in understanding sport-associated ACL injury patterns and can help physicians with patient counseling and injury prevention.
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Affiliation(s)
- Lucas A. Blumenschein
- Case Western Reserve, University Hospitals, Cleveland Medical Center, Cleveland, Ohio, USA
| | | | | | - Joshua Park
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Allison Gilmore
- Case Western Reserve, University Hospitals, Cleveland Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mark Seeley
- Geisinger Medical Center, Danville, Pennsylvania, USA
| | - R. Justin Mistovich
- Case Western Reserve, University Hospitals, Cleveland Medical Center, Cleveland, Ohio, USA
- MetroHealth System, Cleveland, Ohio, USA
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14
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Braz JNPDSV, Alves LFTG, Ferreira FAL, Barros AS, de Sousa AMSN, Gutierres MAP. The presence of a deep lateral femoral notch sign in ACL-injured patients is associated with a 2.7° steeper posterior tibial slope and a 19% higher frequency of lateral meniscal injuries. Knee Surg Sports Traumatol Arthrosc 2024; 32:2003-2012. [PMID: 38751091 DOI: 10.1002/ksa.12262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE The purpose of this study was to study the relationship between the presence of a deep lateral femoral notch sign (DLFNS) in anterior cruciate ligament (ACL)-injured patients and a higher posterior lateral tibial slope (LPTS), a reduced meniscal bone angle (MBA), a higher LPTS/MBA ratio and a higher incidence of concomitant injuries in primary ACL tears. METHODS A retrospective case-control study was performed in patients submitted to primary ACL reconstruction with an available preoperative magnetic resonance imaging (MRI) scan. Patients with ACL tears and a femoral impactation with a depth ≥2 mm were assorted to the DLFNS group and patients with ACL tear and without a DLFNS to the control group. LPTS and MBA were measured in MRI. The presence of concomitant injuries (meniscal, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament and bone injuries) was assessed in MRI. Quantitative data are presented in the median ± interquartile range (IQR). RESULTS There were 206 patients included in the study, with 46 patients assorted to the DLFNS group and 160 patients to the control group. In the DLFNS group, the median LPTS was 6.7° (IQR: 4.0-8.2) versus 4.0° in the control group (IQR: 2.2-6.5) (p = 0.003). The LPTS/MBA ratio was significantly higher in the DLFNS group, with a median of 0.32 (IQR: 0.19-0.44), in comparison to the control group, with a median of 0.19 (IQR: 0.11-0.31) (p < 0.001). The multivariable logistic regression analysis showed that the LPTS is an independent risk factor to having a DLFNS (odds ratio [OR] = 1.161; 95% confidence interval [CI]: 1.042-1.293, p = 0.007). There was a higher incidence of concomitant lateral meniscal injuries in the DLFNS group (67% vs. 48%, p = 0.017). CONCLUSIONS In patients with ACL tears, the presence of a DLFNS is associated with a steeper lateral posterior tibial slope, as well as a higher incidence of concomitant lateral meniscal injuries. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Luís F T G Alves
- Department of Orthopaedics and Traumatology, São João University Hospital, Porto, Portugal
| | | | - António S Barros
- RISE - Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - António M S N de Sousa
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Orthopaedics and Traumatology, São João University Hospital, Porto, Portugal
| | - Manuel A P Gutierres
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Orthopaedics and Traumatology, São João University Hospital, Porto, Portugal
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15
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Chen C, Liu X, Wu P, Liang Q, Peng S, Hu P, Liao Y. High-resolution oblique coronal MRI at optimal flexed-knee angle: a novel imaging method for enhanced anterior cruciate ligament tear diagnosis. J Orthop Surg Res 2024; 19:456. [PMID: 39090629 PMCID: PMC11293168 DOI: 10.1186/s13018-024-04956-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/28/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The accuracy of traditional knee MR imaging in diagnosing anterior cruciate ligament tears, especially partial tears, is relatively low, which may lead to misdiagnosis and missed diagnosis. This study aimed to assess the diagnostic performance of a novel imaging method, high-resolution oblique coronal MRI at an optimal flexed-knee Angle, for ACL tears. METHODS 50 healthy volunteers were scanned with a scan-assisted device for the optimal flexion angle of ACL. For 92 knee trauma patients selected strictly according to inclusion and exclusion criteria, conventional extended-knee scans (control group) and high-resolution oblique coronal scans based on the optimal flexed-knee angle (experimental group) were conducted. Two observers rated ACL visibility blindly on a 5-point scale. Arthroscopy-defined outcomes determined diagnostic metrics for each method and sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. RESULTS The average optimal flexion angle for healthy volunteers was approximately 30° (30.3° ± 5.0°). Imaging demonstrated complete visualization of the ACL in 96.7% of images in the experimental group versus 12.0% in the control group. The diagnostic indicators of the experimental group surpassed those of the control group: sensitivity (94.9% vs. 76.3%), specificity (97.0% vs. 81.8%), positive predictive value (98.2% vs. 88.2%), negative predictive value(91.4% vs. 65.9%), and accuracy (95.7% vs. 78.3%). ROC analysis indicated superior diagnostic performance in the experimental group, with an AUC of 0.945 compared with 0.776 for the control group (p < 0.0001). CONCLUSIONS High-resolution oblique coronal imaging at the optimal 30° flexed-knee angle improved ACL visualization and diagnostic performance compared with conventional techniques.
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Affiliation(s)
- Can Chen
- Department of Radiology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Xiao Liu
- Department of Radiology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Peng Wu
- Clinical and Technical Support, Philips Healthcare, Shanghai, China
| | - Qi Liang
- Department of Radiology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Song Peng
- Department of Radiology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Pengzhi Hu
- Department of Radiology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Yunjie Liao
- Department of Radiology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China.
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16
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Zhu S, Li R. All-Inside Anterior Cruciate Ligament Reconstruction Had Clinical Outcome Similar to the Transtibial Technique Except for Improved Side-to-Side Difference and Tegner Activity Scale: A Systematic Review and Meta-analysis. Arthroscopy 2024; 40:2276-2288. [PMID: 38354760 DOI: 10.1016/j.arthro.2024.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE To compare clinical outcomes of the all-inside technique with the transtibial technique in anterior cruciate ligament reconstruction based on available literature on this topic. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist, we conducted a systematic search for randomized controlled trials and cohort studies. Our comprehensive search encompassed PubMed, Embase, Cochrane Library, and Web of Science. We included randomized controlled trials (RCTs) and cohort studies that compared the 2 techniques with a minimal 1-year follow-up. Two independent authors assessed RCTs using the risk of bias tool developed by the Cochrane Collaboration and evaluated the quality of cohort studies using the Newcastle-Ottawa Scale for Assessing the Quality of Nonrandomized Comparative Trials. The subjective and objective outcomes, complications, and graft failure were obtained. R software was used to perform the analysis. RESULTS The present analysis enrolled 9 RCTs (n = 687) and 11 cohort studies (n = 910). After a minimal 1-year follow-up in RCTs, functional outcomes such as International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner activity scale, Knee Society Score, and hop test were found to be similar between 2 techniques. The laxity outcomes, including the IKDC objective grade and pivot-shift test, were suggested to be comparable. There was a significant difference favoring the transtibial technique in terms of side-to-side difference (P = .04; 95% confidence interval [CI], 0.08-0.90). The pooled data from cohort studies indicated equivalent results in terms of IKDC subjective score, Lysholm score, side-to-side difference, IKDC objective grade, complications, and graft failure, with the exception of statistical difference in the Tegner activity scale (P = .03; 95% CI, -0.50 to -0.04). CONCLUSIONS Our findings suggest that there is no difference in most outcome scores between the all-inside and transtibial techniques for anterior cruciate ligament reconstruction. There are statistically significant differences in side-to-side difference and Tegner activity scale favoring the all-inside technique. LEVEL OF EVIDENCE Level IV, meta-analysis of Level I to IV studies.
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Affiliation(s)
- Shuang Zhu
- Department of Orthopaedics, Southern Medical University Zhujiang University, Guangzhou, China
| | - Renbin Li
- Department of Orthopaedics, Southern Medical University Zhujiang University, Guangzhou, China.
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17
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Farey JE, Salmon LJ, Roe JP, Russell V, Sundaraj K, Pinczewski LA. Outcomes of ACL Reconstruction Utilizing Supercritical CO 2-Sterilized Allografts. Orthop J Sports Med 2024; 12:23259671241254115. [PMID: 39135859 PMCID: PMC11318055 DOI: 10.1177/23259671241254115] [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: 11/19/2023] [Accepted: 12/06/2023] [Indexed: 08/15/2024] Open
Abstract
Background Allograft tendons are perceived to have a high ACL graft failure rate in primary anterior cruciate ligament (ACL) reconstruction (ACLR). Historical series may be biased by graft processing methods that degrade the biomechanical properties of donor tendons such as irradiation. Supercritical carbon dioxide (SCCO2) is a validated method of terminally sterilizing biomaterials at physiological temperatures without irradiation, but in vivo use of SCCO2-processed tendon allografts for primary ACLR has not been reported to date. Hypothesis ACLR with SCCO2 allografts would result in acceptable failure rates, subjective knee scores, and clinical evaluation at 2 years postoperatively. Study Design Case series; Level of evidence, 4. Methods Patients underwent primary ACLR with terminally sterilized SCCO2-processed human gracilis, peroneus longus, semitendinosus, tibialis anterior, and tibialis posterior tendon allografts. Patient demographics were collected, along with tendon donor age and sex. At 1 year postoperatively, subjective International Knee Documentation Committee (IKDC) and ACL-Return to Sport After Injury (ACL-RSI) scores were collected, as well as clinical evaluation. At 2 years postoperatively, the IKDC and ACL-RSI scores were repeated, and return to sports and further knee injuries were recorded. Results A total of 144 patients with a medianage of 26 (IQR 14) years formed the study group. Patients were predominately male (58%). The loss to follow-up rate was 8% (n = 12). The mean age of allograft tendon donors was 37 (range 17-58) years, and the majority were male (83%). The mean allograft diameter was 8.9 ± 1.0 mm. At 2 years, ACL graft failureoccurred in 5% (n = 7). All graft failureswere in patients aged ≤25 years (P = .007). Neither donor age (≤40 or >40 years) nor donor sex was associated with graft failure (P > .05). The median IKDC subjective score was 95 and ACL-RSI score was 75. There were no revisions for sepsis within the first 2 years postoperatively. Conclusion SCCO2 processing of allograft tendons demonstrated satisfactory clinical and patient-reported outcomes at 24 months postoperatively in a consecutive series of patients with primary ACLR, with similar ACL graft failure rates and subjective knee scores compared with those reported in published series of hamstring tendon autograft and fresh frozen nonirradiated allograft.
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Affiliation(s)
- John E. Farey
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Wollstonecraft, New South Wales, Australia
| | - Lucy J. Salmon
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Wollstonecraft, New South Wales, Australia
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Justin P. Roe
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Wollstonecraft, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Vivianne Russell
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Wollstonecraft, New South Wales, Australia
| | - Keran Sundaraj
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Wollstonecraft, New South Wales, Australia
| | - Leo A. Pinczewski
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Wollstonecraft, New South Wales, Australia
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
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18
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Perry NM, Kelly JJ, Levy BA. Editorial Commentary: Surgical Videos on YouTube Are Not Peer Reviewed and Have Low Educational Value. Arthroscopy 2024; 40:2244-2245. [PMID: 38467169 DOI: 10.1016/j.arthro.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024]
Abstract
The rise of online platforms like YouTube for health information has prompted scrutiny over the quality of medical/surgical-related video content. Recent research on YouTube videos regarding anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon autograft shows low educational quality and reliability using established assessment tools. Physicians primarily published content, with longer videos, and physician-generated videos, generally correlating with higher quality. However, YouTube's inadequacy as a reliable source for ACLR information underscores the need for alternative educational resources. Orthopaedic health care professionals must play a pivotal role in guiding patients toward credible sources and take aim at improving online content quality. Understanding patient preferences for online resources is essential for enhancing patient education, the patient-provider relationship, and decision-making in orthopaedic care.
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19
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Vendrig T, Keizer MN, Brouwer RW, Hoogeslag RA. Incidence of Osteoarthritis Between ACL Reconstruction With Different Graft Types and Between ACL Reconstruction and Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Orthop J Sports Med 2024; 12:23259671241258775. [PMID: 39157020 PMCID: PMC11328256 DOI: 10.1177/23259671241258775] [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: 12/17/2023] [Accepted: 01/01/2024] [Indexed: 08/20/2024] Open
Abstract
Background Variation in stiffness, fixation methods, and donor-site morbidity after anterior cruciate ligament reconstruction (ACLR) with different graft types and with anterior cruciate ligament suture repair (ACLSR) can lead to differences in dynamic knee laxity and consequent differences in posttraumatic osteoarthritis (PTOA) development. Purpose To compare the incidence of PTOA between different graft types used for primary ACLR and between primary ACLR and ACLSR. It was hypothesized that the incidence of PTOA would vary between ACLR with different autografts and allografts and between ACLR and ACLSR. Study Design Systematic review; Level of evidence, 1. Methods A search of the literature was performed to identify all randomized controlled trials (RCTs) comparing radiographic evidence of PTOA after ACLR between different graft types-hamstring tendon (HT) autograft, bone-patellar tendon-bone (BPTB) autograft, quadriceps tendon autograft, and allograft-and between ACLR and ACLSR. The minimum follow-up was 2 years. Study quality was assessed using the modified Coleman Methodology Score. A meta-analysis was performed to determine whether there was a difference in the incidence of PTOA between the different graft types and between ACLR and ACLSR. Results Eleven randomized controlled trials were included in the meta-analysis-HT: 440 patients (mean follow-up, 9.7 years); BPTB: 307 patients (mean follow-up, 11.8 years); allograft: 246 patients (mean follow-up, 5 years); ACLSR, 22 patients (5 years). No study reporting the incidence after ACLR with quadriceps tendon was included. The study quality ranged from 70 to 88. The meta-analysis indicated no significant difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR (risk ratios: HT vs BPTB, 1.05; HT vs allograft, 0.81; BPTB vs allograft, 0.82; HT vs ACLSR, not estimable [P > .05 for all]). The combined number of patients with PTOA in all studies per graft type showed that patients who underwent ACLR with a BPTB autograft had the highest percentage of PTOA (HT, 23.4%; BPTB, 29.6%; allograft, 8.1%; ACLSR, 0%). However, excluding studies with a follow-up <5 years resulted in similar outcomes for patients with an HT autograft and a BPTB autograft. Conclusion This meta-analysis reported no difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR. More research is necessary to make a reliable conclusion about which technique is associated with the lowest incidence of PTOA after ACL surgery.
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Affiliation(s)
- Tom Vendrig
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michèle N.J. Keizer
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Reinoud W. Brouwer
- Department of Orthopedic Surgery, Martini Hospital, Groningen, Groningen, the Netherlands
| | - Roy A.G. Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, the Netherlands
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20
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Guan Y, Li J, Wei Y, Shi PT, Yang C, Yun X, Quan Q, Wang WJ, Yu XG, Wei M. Brain functional connectivity alterations in patients with anterior cruciate ligament injury. Brain Res 2024; 1836:148956. [PMID: 38657888 DOI: 10.1016/j.brainres.2024.148956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Abstract
Recent advancements in neuroimaging have illustrated that anterior cruciate ligament (ACL) injuries could impact the central nervous system (CNS), causing neuroplastic changes in the brain beyond the traditionally understood biomechanical consequences. While most of previous functional magnetic resonance imaging (fMRI) studies have focused on localized cortical activity changes post-injury, emerging research has suggested disruptions in functional connectivity across the brain. However, these prior investigations, albeit pioneering, have been constrained by two limitations: a reliance on small-sample participant cohorts, often limited to two to three patients, potentially limiting the generalizability of findings, and an adherence to region of interest based analysis, which may overlook broader network interactions. To address these limitations, our study employed resting-state fMRI to assess whole-brain functional connectivity in 15 ACL-injured patients, comparing them to matched controls using two distinct network analysis methods. Using Network-Based Statistics, we identified widespread reductions in connectivity that spanned across multiple brain regions. Further modular connectivity analysis showed significant decreases in inter-modular connectivity between the sensorimotor and cerebellar modules, and intra-modular connectivity within the default-mode network in ACL-injured patients. Our results thus highlight a shift from localized disruptions to network-wide dysfunctions, suggesting that ACL injuries induce widespread CNS changes. This enhanced understanding has the potential to stimulate the development of strategies aiming to restore functional connectivity and improve recovery outcomes.
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Affiliation(s)
- Yu Guan
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China; Medical School of Chinese PLA, Beijing 100853, China
| | - Ji Li
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China
| | - Yu Wei
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China
| | - Peng-Tao Shi
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China; Medical School of Chinese PLA, Beijing 100853, China
| | - Chen Yang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China; Medical School of Chinese PLA, Beijing 100853, China
| | - Xing Yun
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China; Medical School of Chinese PLA, Beijing 100853, China
| | - Qi Quan
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China; Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma &War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
| | - Wen-Juan Wang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China
| | - Xin-Guang Yu
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Min Wei
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100142, China; Medical School of Chinese PLA, Beijing 100853, China.
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Fang Z, Liu W. Obesity-associated outcomes after ACL reconstruction: a propensity-score-matched analysis of the US Nationwide Inpatient Sample 2005-2018. J Orthop Traumatol 2024; 25:36. [PMID: 39048813 PMCID: PMC11269535 DOI: 10.1186/s10195-024-00779-x] [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: 01/28/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are common among physically active individuals, and obesity may increase the risk of such injuries due to factors like biomechanical stress on the knee. We aimed to determine if obesity affects postoperative outcomes after ACL reconstruction. METHODS Data from adults aged 20 years and older with ACL injuries who underwent inpatient reconstruction from 2005 to 2018 were extracted from the United States (US) Nationwide Inpatient Sample (NIS) database. Patients were divided into two groups based on the presence of co-existing obesity, defined as a body mass index (BMI) ≥ 30 kg/m2. Propensity-score matching (PSM) was employed to balance between-group differences. Associations between obesity and concomitant meniscus injury, length of stay (LOS), post-procedural complications, and non-routine discharge were examined using univariate and multivariable logistic and linear regressions. RESULTS After PSM, data from 1323 patients (representing 6396 individuals in the US) were analyzed. Of these, 441 (33%) were classified as obese, while 882 (67%) were not obese. After adjustment, obesity was significantly associated with a longer LOS (adjusted beta (aBeta) = 0.32, 95% confidence interval (CI) 0.31-0.321) and an increased likelihood of non-routine discharge (adjusted OR (aOR) = 2.18, 95% CI 1.47-3.22). There were no significant associations between obesity and concomitant meniscus injury (aOR = 1.04, 95% CI 0.81-1.32) or post-procedural complications (aOR = 0.97, 95% CI 0.74-1.27). CONCLUSIONS In patients undergoing ACL reconstruction in the US, obesity is independently associated with a longer LOS and a higher risk of non-routine discharge. Nevertheless, obesity does not appear to be associated with concomitant meniscus injury or post-procedural complications.
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Affiliation(s)
- Zhaoyi Fang
- Biodynamics Laboratory, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wenxin Liu
- Department of Sports Medicine, National Center for Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China.
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22
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Lin Q, Wu J, Qiu S. Meta-analysis of the value of dual-energy computed tomography in the diagnosis of anterior cruciate ligament injuries of the knee. BMC Musculoskelet Disord 2024; 25:557. [PMID: 39020351 PMCID: PMC11256425 DOI: 10.1186/s12891-024-07632-6] [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: 04/22/2024] [Accepted: 06/26/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND This meta-analysis assessed the efficacy of dual-energy computed tomography (DECT) in the diagnosis of anterior cruciate ligament (ACL) injuries. METHODS The literature search was performed up to December 8, 2023, and included a comprehensive examination of several databases: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP. Diagnostic metrics sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and a summary receiver operating characteristic (SROC) were determined using a bivariate model analysis. Heterogeneity within the data was explored through subgroup analyses, which considered variables including geographical region, use of magnetic resonance imaging (MRI), arthroscopy, and study design. RESULTS The analysis included ten studies encompassing 544 patients. DECT demonstrated substantial diagnostic utility for ACL injuries of the knee, with a sensitivity of 0.91 (95% confidence interval [CI]: 0.88-0.94), a specificity of 0.90 (95% CI: 0.81-0.95), a PLR of 9.20 (95% CI: 4.50-19.00), a NLR of 0.10 (95% CI: 0.06-0.14), a DOR of 97.00 (95% CI: 35.00-268.00), and an area under the curve (AUC) of 0.95 (95% CI: 0.93-0.97). The subgroup analyses consistently showed high diagnostic precision for ACL injuries across Asian population (sensitivity: 0.91, specificity: 0.91, PLR: 9.90, NLR: 0.09, DOR: 105.00, AUC: 0.96), in MRI subgroup (sensitivity: 0.85, specificity: 0.94, PLR: 9.57, NLR: 0.18, DOR: 56.00, AUC: 0.93), in arthroscopy subgroup (sensitivity: 0.92, specificity: 0.89, PLR: 8.40, NLR: 0.09, DOR: 94.00, AUC: 0.95), for prospective studies (sensitivity: 0.92, specificity: 0.88, PLR: 7.40, NLR: 0.09, DOR: 78.00, AUC: 0.95), and for retrospective studies (sensitivity: 0.91, specificity: 0.93, AUC: 0.93). CONCLUSION DECT exhibits a high value in diagnosing ACL injuries. The significant diagnostic value of DECT provides clinicians with a powerful tool that enhances the accuracy and efficiency of diagnosis and optimizes patient management and treatment outcomes.
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Affiliation(s)
- Qiao Lin
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, People's Republic of China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No.16, Airport Road, Baiyun District, Guangzhou, 510405, People's Republic of China
| | - Jiwen Wu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, People's Republic of China
| | - Shijun Qiu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, People's Republic of China.
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No.16, Airport Road, Baiyun District, Guangzhou, 510405, People's Republic of China.
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Murphy J, LaVigne C, Rush A, Pendleton A. Risk Factors for the Development of Arthrofibrosis After Anterior Cruciate Ligament Reconstruction in Children and Adolescents. Orthopedics 2024; 47:e161-e166. [PMID: 38810127 DOI: 10.3928/01477447-20240520-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Arthrofibrosis is a fibrotic joint disorder resulting in restricted joint motion and pain. Risk factors associated with the development of postoperative arthrofibrosis include female sex, type of graft, and quicker time to reconstruction. These patients have typically benefitted from manipulation under anesthesia or arthroscopic lysis of adhesions. The purpose of this study was to retrospectively review the rate of arthrofibrosis in children and adolescents who previously underwent anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS This was a retrospective chart review examining patients 18 years or younger who underwent ACL reconstruction between 2013 and 2023. Data collected included age, body mass index, reconstruction technique, concomitant meniscal or ligamentous pathology, and need for revision surgery for arthroscopic lysis of adhesions vs manipulation under anesthesia. RESULTS A total of 461 patients 18 years or younger who underwent ACL reconstruction were included in this study. Eighteen (3.90%) patients required reoperation for the development of arthrofibrosis. Skeletally immature patients were found to have a statistically significant lower rate of arthrofibrosis compared with skeletally mature patients (0% vs 4.80%; P=.0184). Patients with a higher weight and body mass index had an increased rate of arthrofibrosis (P=.0485 and P=.0410, respectively). Graft type did not have a significant impact on arthrofibrosis rates. There were no significant findings in terms of concomitant injuries and rate of arthrofibrosis. CONCLUSION Arthrofibrosis developed in 3.90% of patients after ACL reconstruction. Skeletal immaturity may be protective against the development of arthrofibrosis. No association was found between graft type or concomitant knee pathology and arthrofibrosis. [Orthopedics. 2024;47(4):e161-e166.].
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24
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Dadoo S, Herman ZJ, Nazzal EM, Drain NP, Finger L, Reddy RP, Miller L, Lesniak BP, Musahl V, Hughes JD. Outcomes After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon in Adolescent Athletes at Mean Follow-up of 4 Years. Orthop J Sports Med 2024; 12:23259671241254795. [PMID: 39100218 PMCID: PMC11295237 DOI: 10.1177/23259671241254795] [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: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 08/06/2024] Open
Abstract
Background Despite increasing use of quadriceps tendon (QT) autograft in anterior cruciate ligament (ACL) reconstruction (ACLR), limited data exist regarding its outcomes in high-risk adolescent athletes. Purpose To (1) report the outcomes after QT ACLR in adolescent athletes and (2) identify patient-related and surgery-related factors that may influence failure rates after QT ACLR. Study Design Case series; Level of evidence, 4. Methods All patients aged 14 to 17 years who underwent primary anatomic, transphyseal, single-bundle QT ACLR between 2010 and 2021 with a minimum 2-year follow-up were included for analysis. Demographic and surgical data as well as preoperative International Knee Documentation Committee (IKDC) and Marx activity scores were collected retrospectively. All patients were also contacted to assess postoperative patient-reported outcomes (PROs), including IKDC and Marx activity scores, and return-to-sports (RTS) data. Outcomes of interest included rates of revision ACLR and ipsilateral complications, contralateral ACL tears, difference in pre- and postoperative PROs, and rates of RTS. Patient and surgical characteristics were compared between groups who required revision ACLR versus those who did not. Results A total of 162 patients met inclusion criteria, of which 89 adolescent athletes (mean age 16.2 ± 1.1 years, 64% female) were included for analysis at mean follow-up of 4.0 years. Postoperative IKDC scores were significantly higher than preoperative scores (88.5 vs 37.5; P < .001), whereas Marx activity scores decreased postoperatively (14.3 vs 12.2; P = .011). Successful RTS occurred in 80% of patients at a mean time of 9.7 ± 6.9 months, and 85% of these patients returned to the same or higher level of sports. The most common reasons for failure to RTS included lack of time (n = 7, 70%) and fearing reinjury in the operative knee (n = 5, 50%). The overall revision ACLR rate was 10% (n = 9), and contralateral ACL tears occurred in 14% (n = 12) of patients. The overall ipsilateral knee reoperation rate was 22.5% (n = 20). No statistically significant differences in patient or surgical characteristics were observed between patients who underwent revision ACLR and those who did not. Conclusion At a minimum 2-year follow-up after QT ACLR, adolescent athletes experienced significantly improved postoperative IKDC scores, high rates of RTS, and low rates of graft failure, despite a relatively high ipsilateral reoperation rate. Surgeons may utilize this information when identifying the optimal graft choice for adolescent athletes who have sustained an ACL injury and wish to return to high level of sporting activities.
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Affiliation(s)
- Sahil Dadoo
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zachary J. Herman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ehab M. Nazzal
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nicholas P. Drain
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Logan Finger
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rajiv P. Reddy
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Liane Miller
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bryson P. Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jonathan D. Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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25
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Eshraghi N, Mirghaderi P, Omid R, Sajadi M, Pashapour‐Yeganeh A, Mortazavi SMJ. Cross-cultural adaptation and measurement properties of the Persian version of the modified Cincinnati knee rating system. J Exp Orthop 2024; 11:e70003. [PMID: 39193486 PMCID: PMC11347933 DOI: 10.1002/jeo2.70003] [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: 02/21/2024] [Revised: 05/31/2024] [Accepted: 06/11/2024] [Indexed: 08/29/2024] Open
Abstract
Purpose To validate and assess the cross-sectional adaptation of the modified Cincinnati knee rating system (MCRKS) Persian translation. Methods To assess test-pretest reliability, 102 participants were asked to fill out the MCRKS (Per) scale after anterior cruciate ligament (ACL) reconstruction surgery. Internal consistency (Cronbach's α), reliability (intraclass correlation coefficients), construct validity (Pearson's r) and sensitivity (floor/ceiling effect) were determined. In addition, patients completed other relevant measures as the ACL return to sports after injury (ACL-RSI) survey, hospital for special surgery ACL satisfaction survey (HSS ACL-SS), visual analogue scale (VAS) of pain and patient's satisfaction, Tegner activity score (TAS), single assessment numeric evaluation, and Lysholm score. Results Using MCRKS (Per), the internal consistency (Cronbach's α) was 0.9 (if item deleted: 0.81-0.86); the construct validity (Pearson's r) varied between -0.50 (for VAS pain scale) and 0.79 (for Lysholm score); the reliability (ICC value) varied between 0.82 and 0.97; furthermore, no ceiling or floor effect was present. Conclusion The MCRKS (Per) has adequate measurement properties and is considered a valid, reliable and sensitive instrument which can identify clinical outcomes after ACLR surgery. Level of Evidence Level IV.
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Affiliation(s)
- Nasim Eshraghi
- Surgical Research Society (SRS), Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Peyman Mirghaderi
- Surgical Research Society (SRS), Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Reza Omid
- Surgical Research Society (SRS), Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Mohamad Sajadi
- Surgical Research Society (SRS), Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Amirreza Pashapour‐Yeganeh
- Surgical Research Society (SRS), Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
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26
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Solie BS, Tollefson LV, Doney CP, O'Keefe JMJ, Thompson WC, LaPrade RF. Return to the Pre-Injury Level of Sport after Anterior Cruciate Ligament Reconstruction: A Practical Review with Medical Recommendations. Int J Sports Med 2024; 45:572-588. [PMID: 38527465 DOI: 10.1055/a-2270-3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Returning to sport after anterior cruciate ligament reconstruction (ACLR) can be a challenging and complex process for the athlete, with the rate of return to the pre-injury level of sport observed to be less than athlete expectations. Of the athletes that do return to sport (RTS), knee re-injury rates remain high, and multiple studies have observed impaired athletic performance upon RTS after ACLR as well as reduced playing time, productivity, and career lengths. To mitigate re-injury and improve RTS outcomes, multiple RTS after ACLR consensus statements/clinical practice guidelines have recommended objective RTS testing criteria to be met prior to medical clearance for unrestricted sports participation. While the achievement of RTS testing criteria can improve RTS rates after ACLR, current criteria do not appear valid for predicting safe RTS. Therefore, there is a need to review the various factors related to the successful return to the pre-injury level of sport after ACLR, clarify the utility of objective performance testing and RTS criteria, further discuss safe RTS decision-making as well as present strategies to reduce the risk of ACL injury/re-injury upon RTS. This article provides a practical review of the current RTS after ACLR literature, as well as makes medical recommendations for rehabilitation and RTS decision-making after ACLR.
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Affiliation(s)
- Braidy S Solie
- Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
- Research, Twin Cities Orthopedics, Edina, MN, United States
| | | | - Christopher P Doney
- Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
| | - Jeremy M J O'Keefe
- Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
| | - Will C Thompson
- Sports Science, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
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Brown J, DiCicco L, Shepard S, Hughes G, Bennett S, Anderson JM, Hanson C, Heckler M. Transparency Matters: Assessing Harms Reporting Compliance in Randomized Controlled Trials Underpinning the AAOS Clinical Practice Guideline for Anterior Cruciate Ligament Injuries. Am J Sports Med 2024; 52:2244-2249. [PMID: 39101735 DOI: 10.1177/03635465241259738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
BACKGROUND The American Academy of Orthopaedic Surgeons (AAOS) has developed a clinical practice guideline (CPG) for management of anterior cruciate ligament (ACL) injuries. Primary studies such as randomized controlled trials (RCTs) are cited as evidence for the guidelines. Given the influence that these trials have on patient care, adherence to standardized protocols for conducting and reporting RCTs is essential. PURPOSE To evaluate the CONSORT (Consolidated Standards of Reporting Trials) Extension for Harms-related reporting of RCTs cited as supporting evidence for the AAOS CPG on the management of ACL tears. STUDY DESIGN Cross-sectional study. METHODS The reference section of the AAOS guideline for ACL tears was first screened for RCTs cited in the CPG. Next, each RCT was evaluated for adherence to the CONSORT Extension for Harms checklist. Both identification of RCTs and assessment of adherence were performed in a masked and duplicate process. Descriptive statistics were used to summarize adherence to CONSORT Extension for Harms items. A Pearson correlation test was conducted to assess the relationship between the year of publication and adherence to CONSORT harms reporting. RESULTS The sample included 113 RCTs, of which 16 (14.2%) were published before the CONSORT Extension for Harms was implemented in 2004. Sample sizes ranged from 24 to 4564 participants, with a mean of 228. None of the included RCTs included all 18 items in the CONSORT Extension for Harms checklist. The mean number of checklist items reported was 4 (of 18; 22.2%). A moderate, positive, and statistically significant correlation was found between the RCT publication year and the adherence with reporting of the CONSORT Extension for Harms (t111 = 3.54; P < .001) (r = 0.32; 95% CI, 0.14-0.47). CONCLUSION Harms were infrequently reported in RCTs cited as supporting evidence in the AAOS CPG for the management of ACL tears. One encouraging finding was the positive correlation between the year when RCTs were published and how well they adhered to reporting harms. Efforts to improve adverse event reporting are warranted, as RCTs are commonly used to make clinical decisions in orthopaedic surgery.
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Affiliation(s)
- Jim Brown
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
| | - Luke DiCicco
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
| | - Samuel Shepard
- Kettering Health Dayton, Department of Orthopedic Surgery, Dayton, Ohio, USA
| | - Griffin Hughes
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Steven Bennett
- Kettering Health Dayton, Department of Orthopedic Surgery, Dayton, Ohio, USA
| | - J Michael Anderson
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Chad Hanson
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Matt Heckler
- Kettering Health Dayton, Department of Orthopedic Surgery, Dayton, Ohio, USA
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28
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Xing Y, He A, Kang Y, Yang Z, Meng F, Wu P. Loop technique for anterior cruciate ligament reconstruction combined with anterolateral structure reinforcement: technical description and clinical results. BMC Surg 2024; 24:182. [PMID: 38877438 PMCID: PMC11177408 DOI: 10.1186/s12893-024-02439-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/06/2024] [Indexed: 06/16/2024] Open
Abstract
PURPOSE We describe a surgical technique for ACL reconstruction combined with anterolateral structure reinforcement and report early clinical follow-up results. METHODS The semitendinosus and gracilis tendons are braided into 5 strands and the ACL femoral tunnel and tibial tunnel are created. The graft is passed through the tunnel with the use of a traction suture and the tibial end is fixed with absorbable interference screws at 30° of knee flexion. The ACL graft traction suture is used as an anterolateral reconstruction structure to pass through the proximal exit of the ACL femoral tunnel and then through the depth of the iliotibial bundle to the anterior to Gerdy's tubercle, a bony tunnel is created from the anterior to Gerdy's tubercle to the goose foot, and the traction suture is passed through this bony tunnel to form a Loop structure at 20° of knee flexion. Between March 2021 and May 2022 IKDC score, Lysholm score, and Tegner score were performed preoperatively and 6-12 months postoperatively in 24 consecutive patients who met the indications for this procedure and underwent surgery. The patient's maximum flexion angle, the circumference of the thigh, and the stress X-ray between the operated and healthy knee were measured. RESULTS Patients showed significant improvement in IKDC score, Lysholm score and Tegner score at a mean follow-up of 7 months postoperatively compared to preoperatively. No significant increase in anterior tibial displacement was found between the patient's operated side and the healthy side. CONCLUSION The Loop technique ACLR combined with ALSA can be used in patients with an ACL tear combined with a high degree of positive pivot shift. The patient's subjective perception was significantly improved from the preoperative period and knee stability was restored. LEVEL OF EVIDENCE IV, therapeutic study.
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Affiliation(s)
- Yang Xing
- Department of Sports Medicine, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Aishan He
- Department of Sports Medicine, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Yan Kang
- Department of Sports Medicine, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Zibo Yang
- Department of Sports Medicine, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Fangang Meng
- Department of Sports Medicine, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Peihui Wu
- Department of Sports Medicine, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Second Road, Guangzhou, 510080, China.
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29
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Stitelmann A, Allet L, Armand S, Tscholl P. Reliability and Validity of Temporal Parameters during the Side Hop Test in Patients after Anterior Cruciate Ligament Reconstruction. J Clin Med 2024; 13:3407. [PMID: 38929938 PMCID: PMC11204192 DOI: 10.3390/jcm13123407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/26/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The side hop test (SHT) measures the number of jumps performed over 30 s. Although this measure has demonstrated its value in clinical practice, the temporal parameters of the SHT allow for a deeper analysis of the execution strategy. The aim of this study is to assess the reliability and construct validity of contact time parameters during the SHT recorded by a video analysis system in anterior cruciate ligament reconstructed (ACLR) patients. Methods: We investigated the reliability (intra-rater, standard error of measurement (SEM), and minimum detectable change (MDC)), discriminant validity (operated (OP) versus non-operated (NOP) side), and convergent validity (relationship with strength and psychological readiness) of SHT contact time parameters, number of valid hops and limb symmetry index (LSI) in 38 ACLR patients. Contact time parameters are presented as mean, standard deviation (SD), and coefficient of variation (CV) of contact time. Results: Intra-tester reliability was good to excellent for all contact time parameters. For discriminant validity, the mean and SD contact times of the OP leg were significantly longer than those of the NOP leg, although the difference was smaller than the SEM and MDC values. The number of valid jumps and CV contact time parameters were not significantly different. Isokinetic quadriceps strength (60°/s) was strongly correlated with mean contact time for both legs. However, psychological readiness was not correlated with any of the contact time parameters. Conclusions: Temporal parameters of the SHT measured on video analysis are valid and reliable parameters to assess the performance strategy of the SHT. The results should be interpreted with caution regarding the SEM and MDC values. Further studies are needed to measure criterion validity, inter-rater reliability, and responsiveness.
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Affiliation(s)
- Anna Stitelmann
- Department of Orthopedic Surgery and Traumatology of the Musculoskeletal System, Geneva University Hospitals, 1205 Geneva, Switzerland
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1202 Geneva, Switzerland
| | - Lara Allet
- Wallis School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1950 Sion, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Philippe Tscholl
- Department of Orthopedic Surgery and Traumatology of the Musculoskeletal System, Geneva University Hospitals, 1205 Geneva, Switzerland
- ReFORM IOC Research Centre for Prevention of Injury and Protection of Athlete Health, 4000 Liège, Belgium
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Yahagi Y, Gale T, Nukuto K, Irrgang J, Musahl V, Anderst W. Tibial spine volume is smaller in ACL-injured athletes compared to healthy athletes. Knee Surg Sports Traumatol Arthrosc 2024; 32:1370-1375. [PMID: 38529659 DOI: 10.1002/ksa.12161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE The aim of this study was to investigate whether the whole tibial spine volume and femoral intercondylar notch volume are risk factors for anterior cruciate ligament (ACL) injury. The hypothesis was that the whole tibial spine volume and femoral notch volume would be smaller in athletes who sustained ACL injury than in athletes with no history of ACL injury. METHODS Computed tomography scans of both knees were acquired and three-dimensional bone models were created using Mimics to measure whole tibial spine volume and femoral notch volume. Tibial spine volume, femoral notch volume and each of these volumes normalised by tibial plateau area were compared between the ACL-injured and the ACL-intact group. RESULTS Fifty-one athletes undergoing unilateral anatomical ACL reconstruction (17 female, 34 male: average age 22.0 ± 7.5) and 19 healthy collegiate athletes with no previous knee injury (eight female, 11 male: average age 20.1 ± 1.3) were included in this study. The whole tibial spine volume in the ACL-injured group (2.1 ± 0.5 cm3) was 20.7% smaller than in the ACL-intact group (2.7 ± 0.7 cm3) (p = 0.005). No differences were observed between the femoral notch volume in the ACL-injured group (9.5 ± 2.1 cm3) and the ACL-intact group (8.7 ± 2.7 cm3) (n.s.). CONCLUSIONS The main finding of this study was that the whole tibial spine volume of the ACL-injured group was smaller than the ACL-intact group. A small tibial spine volume can be added to the list of anatomical risk factors that may predispose athletes to ACL injury. LEVEL OF EVIDENCE Level Ⅲ.
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Affiliation(s)
- Yoshiyuki Yahagi
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tom Gale
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Koji Nukuto
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - James Irrgang
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William Anderst
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Entezari B, Lex JR, Peck J, Igbokwe EN, Kubik JF, Backstein DJ, Wolfstadt JI. Intraoperative and Postoperative Outcomes of Patients Undergoing Total Knee Arthroplasty With Prior Anterior Cruciate Ligament Reconstruction: A Matched Cohort Analysis. Arthroplast Today 2024; 27:101330. [PMID: 39071823 PMCID: PMC11282402 DOI: 10.1016/j.artd.2024.101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/11/2023] [Accepted: 01/27/2024] [Indexed: 07/30/2024] Open
Abstract
Background Previous anterior cruciate ligament (ACL) injury is a risk factor for the development of knee osteoarthritis. Despite advances in ACL reconstruction (ACLR) techniques, many patients with history of ACLR develop end-stage osteoarthritis necessitating total knee arthroplasty (TKA). The purpose of this study was to investigate the impact of prior ACLR on intraoperative and postoperative outcomes of TKA. Methods This was a single-centre matched cohort study of all patients with prior ACLR undergoing primary TKA from January 2000 to May 2022. Patients were matched 1:1 to patients undergoing TKA with no prior ACL injury based on age, sex, and body mass index. Outcomes investigated included TKA procedure duration, soft-tissue releases, implant design, and complications requiring reoperation. Results Forty-two ACLR patients were identified and matched to controls. Mean follow-up was 6.8 years and 5.0 years in the ACLR and control cohorts, respectively (P = .115). ACLR patients demonstrated longer procedure durations (122.8 minutes vs 87.0 minutes, P < .001) and more frequently required soft-tissue releases (40.5% vs 14.3%, P = .007), stemmed implants (23.8% vs 4.8%, P = .013), and patellar resurfacing (59.5% vs 26.2%, P = .002). There were no significant differences in postoperative clinical or surgical outcomes between groups. Ten-year implant survivorship was 92% and 95% in the ACLR and control cohorts, respectively (P = .777). Conclusions TKA is an effective procedure for the management of end-stage osteoarthritis with prior ACLR. The care team should be prepared for longer operative times and the utilization of advanced techniques to achieve satisfactory soft-tissue balance and implant stability.
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Affiliation(s)
- Bahar Entezari
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada
- Queen’s University School of Medicine, Kingston, ON, Canada
| | - Johnathan R. Lex
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jonathan Peck
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Emmanuel N. Igbokwe
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jeremy F. Kubik
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - David J. Backstein
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jesse I. Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Russell HC, Arendt EA, Wiese-Bjornstal DM. Psychological Responses During Latter Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction Surgery. J Athl Train 2024; 59:627-632. [PMID: 38446462 PMCID: PMC11220769 DOI: 10.4085/1062-6050-0058.23] [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: 03/07/2024]
Abstract
CONTEXT Despite positive physical outcomes of anterior cruciate ligament reconstruction (ACLR), many athletes do not return to sport afterward. OBJECTIVE To determine if there were differences between athletes who returned to play and those who did not return to sport after ACLR in patterns of psychological responses to injury over the latter course of rehabilitation and return to sport. DESIGN Case-control study. SETTING Comprehensive orthopedic medical center referrals. PATIENTS OR OTHER PARTICIPANTS Thirty-nine recreational and competitive athletes (13 to 58 years, 21 males) with a first ACL tear were observed over the course of the study. MAIN OUTCOME MEASURE(S) Return to sport. RESULTS Fifty-two percent of participants returned to play by 9 months post-ACLR. Those who returned showed a linear decrease in reinjury anxiety from 4 to 9 months post-ACLR, whereas those who did not return showed a linear decrease from 4 to 6 months post-ACLR and then a leveling off from 6 to 9 months. Those who returned showed linear and quadratic effects on perceived limitations of ability with a decrease from 4 to 9 months post-ACLR that accelerated over time, whereas nonreturners showed a linear decrease over time. No significant differences were found between returners and nonreturners in knee self-efficacy, perceived percent recovery, and psychological distress. CONCLUSIONS Our results suggest that reinjury anxiety and perceived limitations of ability are psychological constructs on which returners and nonreturners differ and therefore may be points of intervention to increase the likelihood of return to sport.
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Affiliation(s)
- Hayley C. Russell
- Department of Health and Exercise Science, Gustavus Adolphus College, Saint Peter, MN
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Brinkman JC, Moore ML, Lai C, Tummala SV, Pollock JR, McQuivey KS, Hassebrock JD, Thompson AB, Chhabra A. Patient Interest in Quadriceps Autograft Anterior Cruciate Ligament Reconstruction Is Increasing Over Other Autograft Options: A 12-Year Google Trends Analysis. Arthrosc Sports Med Rehabil 2024; 6:100942. [PMID: 39006776 PMCID: PMC11240022 DOI: 10.1016/j.asmr.2024.100942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 04/02/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To use Google trends to explore differences in public interest among types of anterior cruciate ligament (ACL) autografts, specifically quadriceps tendon, patellar tendon, and hamstring tendon autografts, between 2008 and 2019. Methods Data were obtained by querying Google Trends for key terms and phrases for online search data ranging from January 2008 to December 2019. Relative search volumes were created based on searches related to ACL reconstruction with comparative analysis generated for search terms related to quadriceps ACL, patellar tendon ACL, and hamstring ACL autografts. Statistical analysis included linear regression analysis, comparison of quarterly search volume trends over time, and comparison of cumulative annual search volumes for 2008 versus 2019. Results Linear models for respective search terms were statistically significant for the quadriceps (P < .001) and patellar (P = .007) tendon autograft groups but not the hamstring group (P = .129). The quadriceps autograft group demonstrated a 12-year search volume trend change of 0.56, which was significantly greater than the hamstring (0.07; P < .001) and patellar tendon (0.168; P < .001) groups. There was no significant difference in the trend change between hamstring and patellar tendon groups (P = .20). Percent change in cumulative relative annual search volumes between 2008 and 2019 was 112% for the quadriceps tendon group, 12.9% for the hamstring group, and 18.6% for the patellar tendon group. Conclusions This study indicates a consistently increasing public interest in quadriceps tendon autograft for ACL reconstruction. The quadriceps autograft group demonstrated a significantly greater 12-year online search volume, greater linear correlation, and larger percent change between 2008 and 2019 compared with patellar tendon or hamstring autograft groups. Clinical Relevance Awareness of patient perceptions has value in informing shared decision-making, aligning patient expectations, and guiding areas of future research. Each of these has an impact on patient care. Being aware of patient interest and expectations is particularly important in areas with controversial or emerging research.
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Affiliation(s)
- Joseph C. Brinkman
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - M. Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A
| | - Cara Lai
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Sailesh V. Tummala
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | | | - Kade S. McQuivey
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | | | - Adam B. Thompson
- The Robert Larner M.D. College of Medicine at The University of Vermont, Burlington, Vermont, U.S.A
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
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Ananías J, Vidal C, Ortiz-Muñoz L, Irarrázaval S, Besa P. Use of electromyographic biofeedback in rehabilitation following anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Physiotherapy 2024; 123:19-29. [PMID: 38244487 DOI: 10.1016/j.physio.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/30/2023] [Accepted: 12/14/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Rehabilitation following anterior cruciate ligament (ACL) reconstruction surgery is essential to regain functionality and return to previous activity level. Electromyographic biofeedback may be an effective intervention for rehabilitation of patients following ACL surgery. OBJECTIVE To synthesize the available evidence on the effect of electromyographic biofeedback in the treatment of quadriceps strength following ACL surgery. DESIGN Systematic review with meta-analysis. DATA SOURCES PubMed, EMBASE, CENTRAL and Epistemonikos were searched. ELIGIBILITY CRITERIA Randomized clinical trials with patients undergoing ACL reconstruction surgery comparing biofeedback with a standard rehabilitation control group. DATA EXTRACTION AND DATA SYNTHESIS Two authors selected articles and performed data extraction. The analysed outcomes were strength, function, pain, knee extension and balance. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool. Results were combined through random-effects meta-analysis, reporting mean differences. RESULTS Eight articles were included in the qualitative analysis, and four articles were included in the quantitative analysis. The interventions lasted between 4 and 12 weeks. Three studies evaluated the effect of biofeedback on quadriceps strength; of these, two studies showed a significant difference in favour of the biofeedback group. In addition, biofeedback was found to improve knee extension [standardized mean difference - 1.3, 95% confidence interval (CI) - 1.74 to -0.86] and balance (one study). There was no significant difference in Lysholm score (mean difference -6.21, 95% CI -17.51 to 5.08; I2 =59%) or pain between the biofeedback group and the control group. CONCLUSION Electromyographic biofeedback in knee rehabilitation could be useful following ACL reconstruction surgery. KEY MESSAGES SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42020193768).
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Affiliation(s)
- Joaquín Ananías
- Orthopaedics Department, Pontifical Catholic University of Chile, Santiago, Chile
| | - Catalina Vidal
- Orthopaedics Department, Pontifical Catholic University of Chile, Santiago, Chile.
| | - Luis Ortiz-Muñoz
- Centro Evidencia UC, Pontifical Catholic University of Chile, Santiago, Chile
| | | | - Pablo Besa
- Orthopaedics Department, Pontifical Catholic University of Chile, Santiago, Chile
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Beard DJ, Davies L, Cook JA, Stokes J, Leal J, Fletcher H, Abram S, Chegwin K, Greshon A, Jackson W, Bottomley N, Dodd M, Bourke H, Shirkey BA, Paez A, Lamb SE, Barker KL, Phillips M, Brown M, Lythe V, Mirza B, Carr A, Monk P, Areia CM, O'Leary S, Haddad F, Wilson C, Price A. Comparison of surgical or non-surgical management for non-acute anterior cruciate ligament injury: the ACL SNNAP RCT. Health Technol Assess 2024; 28:1-97. [PMID: 38940695 PMCID: PMC11228690 DOI: 10.3310/vdkb6009] [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: 06/29/2024] Open
Abstract
Background Anterior cruciate ligament injury of the knee is common and leads to decreased activity and risk of secondary osteoarthritis of the knee. Management of patients with a non-acute anterior cruciate ligament injury can be non-surgical (rehabilitation) or surgical (reconstruction). However, insufficient evidence exists to guide treatment. Objective(s) To determine in patients with non-acute anterior cruciate ligament injury and symptoms of instability whether a strategy of surgical management (reconstruction) without prior rehabilitation was more clinically and cost-effective than non-surgical management (rehabilitation). Design A pragmatic, multicentre, superiority, randomised controlled trial with two-arm parallel groups and 1:1 allocation. Due to the nature of the interventions, no blinding could be carried out. Setting Twenty-nine NHS orthopaedic units in the United Kingdom. Participants Participants with a symptomatic (instability) non-acute anterior cruciate ligament-injured knee. Interventions Patients in the surgical management arm underwent surgical anterior cruciate ligament reconstruction as soon as possible and without any further rehabilitation. Patients in the rehabilitation arm attended physiotherapy sessions and only were listed for reconstructive surgery on continued instability following rehabilitation. Surgery following initial rehabilitation was an expected outcome for many patients and within protocol. Main outcome measures The primary outcome was the Knee Injury and Osteoarthritis Outcome Score 4 at 18 months post randomisation. Secondary outcomes included return to sport/activity, intervention-related complications, patient satisfaction, expectations of activity, generic health quality of life, knee-specific quality of life and resource usage. Results Three hundred and sixteen participants were recruited between February 2017 and April 2020 with 156 randomised to surgical management and 160 to rehabilitation. Forty-one per cent (n = 65) of those allocated to rehabilitation underwent subsequent reconstruction within 18 months with 38% (n = 61) completing rehabilitation and not undergoing surgery. Seventy-two per cent (n = 113) of those allocated to surgery underwent reconstruction within 18 months. Follow-up at the primary outcome time point was 78% (n = 248; surgical, n = 128; rehabilitation, n = 120). Both groups improved over time. Adjusted mean Knee Injury and Osteoarthritis Outcome Score 4 scores at 18 months had increased to 73.0 in the surgical arm and to 64.6 in the rehabilitation arm. The adjusted mean difference was 7.9 (95% confidence interval 2.5 to 13.2; p = 0.005) in favour of surgical management. The per-protocol analyses supported the intention-to-treat results, with all treatment effects favouring surgical management at a level reaching statistical significance. There was a significant difference in Tegner Activity Score at 18 months. Sixty-eight per cent (n = 65) of surgery patients did not reach their expected activity level compared to 73% (n = 63) in the rehabilitation arm. There were no differences between groups in surgical complications (n = 1 surgery, n = 2 rehab) or clinical events (n = 11 surgery, n = 12 rehab). Of surgery patients, 82.9% were satisfied compared to 68.1% of rehabilitation patients. Health economic analysis found that surgical management led to improved health-related quality of life compared to non-surgical management (0.052 quality-adjusted life-years, p = 0.177), but with higher NHS healthcare costs (£1107, p < 0.001). The incremental cost-effectiveness ratio for the surgical management programme versus rehabilitation was £19,346 per quality-adjusted life-year gained. Using £20,000-30,000 per quality-adjusted life-year thresholds, surgical management is cost-effective in the UK setting with a probability of being the most cost-effective option at 51% and 72%, respectively. Limitations Not all surgical patients underwent reconstruction, but this did not affect trial interpretation. The adherence to physiotherapy was patchy, but the trial was designed as pragmatic. Conclusions Surgical management (reconstruction) for non-acute anterior cruciate ligament-injured patients was superior to non-surgical management (rehabilitation). Although physiotherapy can still provide benefit, later-presenting non-acute anterior cruciate ligament-injured patients benefit more from surgical reconstruction without delaying for a prior period of rehabilitation. Future work Confirmatory studies and those to explore the influence of fidelity and compliance will be useful. Trial registration This trial is registered as Current Controlled Trials ISRCTN10110685; ClinicalTrials.gov Identifier: NCT02980367. Funding This award was funded by the National Institute of Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/140/63) and is published in full in Health Technology Assessment; Vol. 28, No. 27. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Loretta Davies
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Jamie Stokes
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Jose Leal
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Heidi Fletcher
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Simon Abram
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Katie Chegwin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Akiko Greshon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - William Jackson
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nicholas Bottomley
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matthew Dodd
- Swansea Bay University Health Board, Swansea, UK
| | - Henry Bourke
- Heatherwood and Wexham Park Hospitals, Frimley Health NHS Foundation Trust, Slough, UK
| | - Beverly A Shirkey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Arsenio Paez
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Karen L Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Vanessa Lythe
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Burhan Mirza
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Paul Monk
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Carlos Morgado Areia
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
| | - Sean O'Leary
- Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Fares Haddad
- University College Hospitals, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chris Wilson
- University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, UK
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Figueroa D, Figueroa ML, Figueroa F. Return to sports in female athletes after anterior cruciate ligament reconstruction: A systematic review and metanalysis. J ISAKOS 2024; 9:378-385. [PMID: 38242500 DOI: 10.1016/j.jisako.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/26/2023] [Accepted: 01/14/2024] [Indexed: 01/21/2024]
Abstract
IMPORTANCE Return to sport (RTS) is considered an indicator of successful recovery after anterior cruciate ligament reconstruction (ACLR). In recent years, there has been major interest in documenting RTS following anterior cruciate ligament (ACL) injury. Despite women being at increased risk for ACL injuries and a global increase in women's participation in sports, research has not adequately focused on female athletes. OBJECTIVE The purpose of this study is to conduct a systematic review and meta-analysis evaluating the RTS rate in female athletes after ACLR. We hypothesize that most of the female athletes can RTS. EVIDENCE REVIEW A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic databases (PubMed, Embase, and Epistemonikos) were searched for articles reporting RTS rates and contextual data in female athletes. The following search terms were used: "anterior cruciate ligament reconstruction" OR "ACL reconstruction" AND "female" OR "women" AND "return to sports" OR "return to play" to retrieve all relevant articles published between 2003 and 2023. A quality assessment of the included studies was conducted. FINDINGS Fifteen articles were included, reporting on 1456 female athletes participating in pivoting sports. The included studies comprised 9 cohorts, 1 case-control study, 2 case series, 2 descriptive epidemiology studies, and 1 observational study. Eight out of fifteen studies focused solely on elite-level athletes. The participants had a mean age of 23.13 years. Soccer was the most prevalent sport among the participants, accounting for 49.7% of all athletes included. All 15 studies reported an RTS rate, yielding a meta-proportion of 69% [95% CI, 58-80%] for RTS. Nine articles reported the average time to RTS, which was 10.8 months [95% CI, 8.7-12.8 months]. CONCLUSIONS This systematic review demonstrates that a majority of female athletes (69 %) can RTS participation at an average of 10.8 months, however, the available information is insufficient, and quantitative data and reasons for not returning to play are lacking. Future studies should establish return-to-play criteria in this population and determine reasons for not returning to play. LEVEL OF EVIDENCE III.
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Affiliation(s)
- David Figueroa
- Departamento de Traumatologia, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, 7650568, Chile
| | - María Loreto Figueroa
- Departamento de Traumatologia, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, 7650568, Chile.
| | - Francisco Figueroa
- Departamento de Traumatologia, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, 7650568, Chile; Departamento de Traumatología, Hospital Dr. Sótero del Río, Santiago, 8207257, Chile
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Elrosasy A, Abo Zeid M, Abbas AW, Eldeeb H, Eljadid GY, Hamid AK, Al Azzawi MAD. What is the impact of Kinesio taping on anterior cruciate ligament reconstruction: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2213-2222. [PMID: 38502344 DOI: 10.1007/s00590-024-03878-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE As a therapeutic intervention for several musculoskeletal illnesses, the benefits and effectiveness of Kinesio taping (KT) are currently unclear. This systematic review and meta-analysis's (MA) goal is to evaluate the effectiveness of KT for anterior cruciate ligament (ACL) reconstruction and its impact on clinical outcomes. METHODS A comprehensive search of online databases was done to discover relevant studies. Inclusion criteria included controlled or randomized clinical trials that were published in English. Changes in pain, flexion strength, and extension strength were among the outcomes of interest. RevMan 5.4 was used to extract and analyze data. RESULTS After satisfying the inclusion requirements, five studies were included in the MA. Pooled analysis showed that, in comparison with the intervention group, the control group had a statistically significant improvement in flexion strength (Standardized mean difference (SMD) = 0.44, 95% Confidence interval (CI) [0.01, 0.87], p = 0.04). Extension strength and pain, however, did not significantly differ between the intervention and control groups (SMD = 30, 95% CI [- 0.12, 0.72], p = 0.16), (SMD = 0.26, 95% CI [- 0.14, 0.66], p = 0.20), respectively. CONCLUSIONS This analysis suggests limited to no benefits of KA post-ACL reconstruction. While the control group surprisingly showed better improvement in flexion strength, no significant differences were found in extension strength and pain. Further rigorous trials are needed to confirm its utility in rehabilitation.
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Affiliation(s)
- Amr Elrosasy
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Ahmed W Abbas
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hatem Eldeeb
- Faculty of Medicine, Alazhar University, Cairo, Egypt
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Brinkman C, Reiche E, Genoese F, Hoch J, Baez S. No Association Between Injury-Related Fear and Isokinetic Quadriceps Strength in Individuals With a History of Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2024; 33:275-281. [PMID: 38604600 DOI: 10.1123/jsr.2023-0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 04/13/2024]
Abstract
CONTEXT Injury-related fear and quadriceps strength are independently associated with secondary anterior cruciate ligament (ACL) injury risk. It is not known whether injury-related fear and quadriceps strength are associated, despite their individual predictive capabilities of secondary ACL injury. The purpose of this study was to examine the association between injury-related fear and quadriceps strength in individuals at least 1 year after ACL reconstruction (ACLR). DESIGN Cross-sectional study. METHODS Forty participants between the ages of 18 and 35 years at least 1 year post unilateral primary ACLR. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) and a standard isokinetic quadriceps strength assessment using the Biodex Isokinetic Dynamometer. Pearson Product-Moment correlations were used to examine the linear association between the TSK-11 scores and peak torque (in nanometers per kilogram) for each limb and between the TSK-11 scores and limb symmetry indices for each limb. Pearson Product-Moment correlation coefficients (r) were interpreted as very high (.90-1.00), high (.70-.90), moderate (.50-.70), low (.30-.50), and no correlation (.00-.30). RESULTS The average TSK-11 score was 18.2 (5.3), average ACLR peak quadriceps torque was 1.9 (0.50) N·m/kg, average contralateral peak quadriceps torque was 2.3 (0.48) N·m/kg, and average limb symmetry index was 85.3% (12.6%). There was no statistically significant correlation between the TSK-11 and peak quadriceps torque on the ACLR limb (r = .12, P = .46), the TSK-11 and contralateral limb (r = .29, P = .07), or the TSK-11 and limb symmetry index (r = -.18, P = .27). CONCLUSIONS There was no association between kinesiophobia and peak isokinetic quadriceps strength in individuals at least 1 year post-ACLR. Both factors, independently, have been shown to influence risk of secondary injury in patients after ACLR.
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Affiliation(s)
- Caitlin Brinkman
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elaine Reiche
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Francesca Genoese
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Johanna Hoch
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY, USA
| | - Shelby Baez
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Tedesco A, Sharma AK, Acharya N, Rublev G, Hashmi S, Wu HH, Lee YP, Scolaro J, Bhatia N. The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery: A Review of Postoperative Outcomes. JBJS Rev 2024; 12:01874474-202404000-00004. [PMID: 38619394 DOI: 10.2106/jbjs.rvw.23.00242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
» Identification of malnourished and at-risk patients should be a standardized part of the preoperative evaluation process for every patient.» Malnourishment is defined as a disorder of energy, protein, and nutrients based on the presence of insufficient energy intake, weight loss, muscle atrophy, loss of subcutaneous fat, localized or generalized fluid accumulation, or diminished functional status.» Malnutrition has been associated with worse outcomes postoperatively across a variety of orthopaedic procedures because malnourished patients do not have a robust metabolic reserve available for recovery after surgery.» Screening assessment and basic laboratory studies may indicate patients' nutritional risk; however, laboratory values are often not specific for malnutrition, necessitating the use of prognostic screening tools.» Nutrition consultation and perioperative supplementation with amino acids and micronutrients are 2 readily available interventions that orthopaedic surgeons can select for malnourished patients.
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Affiliation(s)
- Amanda Tedesco
- School of Medicine, University of California, Irvine, Irvine, California
| | - Abhinav K Sharma
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Nischal Acharya
- School of Medicine, University of California, Irvine, Irvine, California
| | - George Rublev
- David Tvildiani Medical University, Tbilisi, Georgia
| | - Sohaib Hashmi
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Hao-Hua Wu
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - John Scolaro
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Nitin Bhatia
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
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Queiroz NCA, Hamu TCDDS, Barboza SD, Oliveira-Junior SAD, Luiz Carregaro R. Are lower limb symmetry and self-reported symptoms associated with functional and neuromuscular outcomes in Brazilian adults with anterior cruciate ligament reconstruction? A cross-sectional study. J Bodyw Mov Ther 2024; 38:168-174. [PMID: 38763558 DOI: 10.1016/j.jbmt.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 09/19/2023] [Accepted: 12/12/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION After anterior cruciate ligament (ACL) reconstruction, determining readiness to return to participation is challenging. The understanding of which neuromuscular performance parameters are associated with limb symmetry and self-reported symptoms may be useful to improve monitoring the rehabilitation towards adequate decision-making to return. OBJECTIVES To compare the ACL-operated and injury-free lower limbs regarding functional performance; and to investigate whether lower limb strength and functional performance are associated with self-reported symptoms and functional lower limb symmetry. METHOD Thirty-four participants were included. Functional performance was assessed by using the Y-Balance test, Single-leg Hop, and Functional Movement Screen. An isokinetic dynamometer was used to evaluate the strength levels in open and closed kinetic chains. The functional lower limb symmetry was calculated considering the single-leg hop test results for each lower limb. RESULTS There were no differences in dynamic balance (Y-Balance) between the operated and injury-free limbs. The operated limb presented a worst performance in the single-leg hop. Self-reported symptoms prevalence and lower limb symmetry were associated with knee extension strength and functional performance (Y-Balance). CONCLUSION Individuals submitted to ACL-reconstruction presented worse functional performance in the operated limb compared to the injury-free limb. Both knee strength and dynamic balance were associated with limb symmetry and self-reported symptoms.
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Affiliation(s)
| | - Tânia Cristina Dias da Silva Hamu
- Physiotherapy Department, Musculoskeletal Research Laboratory (LAPEME), State Universidade Estadual de Goiás (UEG), Goiânia Campus, Brazil
| | - Saulo Delfino Barboza
- Master Program on Health & Education, University of Ribeirao Preto, Sao Paulo, Brazil; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Universities Medical Centers, VU University Medical Center Amsterdam, Amsterdam, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports, Amsterdam Movement Sciences, Amsterdam Universities Medical Centers, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | | | - Rodrigo Luiz Carregaro
- Master in Rehabilitation Sciences, Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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Inclan PM, Hicks JJ, Retzky JS, Janosky JJ, Pearle AD. Team Approach: Neuromuscular Training for Primary and Secondary Prevention of Anterior Cruciate Ligament Injury. JBJS Rev 2024; 12:e23.00207. [PMID: 38994007 PMCID: PMC11236273 DOI: 10.2106/jbjs.rvw.23.00207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Neuromuscular training is a method of performance optimization-typically combining plyometrics, balancing training, agility, and dynamic stabilization-predicated on improving the efficiency of fundamental movement patterns. Neuromuscular training has consistently been shown to reduce the risk of anterior cruciate ligament injury, particularly for athletes engaged in activities associated with noncontact knee injuries (i.e., women's soccer). Successful implementation of neuromuscular training programs requires input from coaches, physical therapists, athletic trainers, and physicians to generate efficacious programs with high rates of adherence.
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Affiliation(s)
- Paul M Inclan
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
| | - Justin J Hicks
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
| | - Julia S Retzky
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
| | - Joseph J Janosky
- Department of Athlete Health, Hospital for Special Surgery, New York, New York
| | - Andrew D Pearle
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
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He Y, Fan Y, Zhai L, Zhu W. Comparative efficacy and safety of different surgical approaches for the treatment of anterior cruciate ligament injury: a Bayesian network meta-analysis protocol. BMJ Open 2024; 14:e077242. [PMID: 38553073 PMCID: PMC10982744 DOI: 10.1136/bmjopen-2023-077242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) rupture can be treated surgically or non-surgically, with several surgical interventions available at present. However, the comparatively effective surgical intervention with relatively fewer side effects remains unknown. This study aims to fill in this gap by conducting a Bayesian network meta-analysis (NMA) and provide a theoretical basis for the clinical application. METHOD AND ANALYSIS We will perform a Bayesian NMA and will include randomised controlled trials (RCTs) published in English or Chinese that compare surgical intervention (ie, standard ACL reconstruction, ACL remnant-preserving reconstruction and ACL repair with suture augmentation to conservative therapy or studies that compare one surgical intervention to another for the symptom relief and function recovery of patients with ACL rupture. Primary outcome will be the proportion of patients with symptomatic and functional improvement measured by the Knee Injury and Osteoarthritis Outcome Score before and 6 months after treatment, with scores ranging from 0 (worst) to 100 (best). Secondary outcomes will be knee-specific quality of life (ACL QoL), return to activity and level of sport participation (Tegner or modified Tegner score), health-related QoL (EuroQol Group 5-Dimension 5-Level, EQ-5D-5L), resource use, intervention-related complications and patient satisfaction. We have developed search strategies for PubMed, Embase, the Cochrane Library and Web of Science, retrieving RCTs that meet the inclusion criteria from database inception to 1 December 2023. The methodological quality of the included RCTs will be assessed based on the Cochrane risk of bias table. The relative ranking probability of the best intervention will be estimated using the surface under the cumulative ranking curve. The Bayesian NMA will be conducted by using WinBUGS V.1.4.3. The Grading of Recommendations Assessment, Development and Evaluation approach will be applied to determine our confidence in an overall treatment ranking from the NMA. ETHICS AND DISSEMINATION Ethical approval for this study is not required because no private or confidential patient data will be used in this study. Findings of this study would be disseminated through the publication in a peer-reviewed medical journal. PROSPERO REGISTRATION NUMBER CRD42023437115.
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Affiliation(s)
- Yuchen He
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yishu Fan
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Central South University, Changsha, Hunan, China
| | - Longxiang Zhai
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Weihong Zhu
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Li X, Lu J, Su JI, Li H, Liu X, Ding R. High flexion femoral side remnant preservation positioning technique: a new method for positioning the femoral tunnel in anterior cruciate ligament reconstruction. J Orthop Surg Res 2024; 19:189. [PMID: 38500214 PMCID: PMC10949667 DOI: 10.1186/s13018-024-04670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE The aim of this study is to find a new method for femoral side preservation positioning in anterior cruciate ligament (ACL) reconstruction and test the accuracy and precision of this method. METHOD Fifty patients with isolated ACL rupture (42 males and 8 females) who underwent single-bundle ACL reconstruction in our hospital between July 2022 and July 2023 were included. The lowest point of the cartilage margin of the lateral wall of the intercontinental fossa and the tibial plateau plumb line at 120° of knee flexion were used as the anatomical landmarks for positioning of the femoral tunnel for ACL reconstruction surgery. Femoral side remnant preservation was performed in all cases. Three-dimensional CT was performed 3 days postoperatively to collect the data, which were analyzed using Mimics 21.0 software. We measured the posterior cortical distance of the femoral condyle at 90° of knee flexion and the vertical distance from the center of the bone tunnel to the cortical extension line behind the femur. All femoral tunnel positions were marked on a 4 × 4 grid and visualized using the quadrant method. RESULTS Using the new positioning method in 50 knees, the average distance of x was 25.26 ± 2.76% of t and the average distance of y was 23.69 ± 6.19% of h. This is close to the results of previous studies, where x was 24.2 ± 4.0% of t and the average distance of y was 21.6 ± 5.2% of h. Most femoral tunnel positions were located in the same area. The D values were distributed as follows: 60% in the range of 0 to 2 mm, 24% in the range of 2 to 4 mm, and 16% more than 4 mm. The E values were distributed as follows: 80% in the range of 0 to 4 mm and 20% more than 4 mm. CONCLUSION In arthroscopic ACL reconstruction, the knee was flexed at 120° and the lowest point of the cartilage edge of the lateral wall of the intercondylar fossa and the tibial plateau plumb line were used as anatomical landmarks for the positioning of the femoral bone tunnel, which resulted in more accurate femoral bone tunnel positioning, better reproducibility, and better preservation of the femoral stump compared to traditional positioning methods.
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Affiliation(s)
- Xiaobo Li
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
- Department of Spine, Trauma Surgery, The First People's Hospital of Guangyuan, Guangyuan, Sichuan Province, China
| | - Jiajun Lu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - JIxian Su
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Hanlin Li
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Xiaoying Liu
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Guangyuan, Guangyuan, Sichuan Province, China
| | - Ran Ding
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China.
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China.
- School of Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China.
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Momaya A, Harris C, Hargreaves M. Why Your Patient May Need an ACL Reconstruction Plus Lateral Extra-Articular Tenodesis Procedure. Int J Sports Phys Ther 2024; 19:251-257. [PMID: 38439781 PMCID: PMC10909304 DOI: 10.26603/001c.94015] [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] [Indexed: 03/06/2024] Open
Abstract
Anterior cruciate ligament (ACL) tears are one of the most common knee injuries experienced by active individuals engaging in cutting sports. Despite improved surgical techniques and rehabilitation, the return to sport rate and re-tear rates remain unsatisfactory. Lateral extra-articular tenodesis (LET) is a procedure that has been growing in interest when performed in conjunction with ACL reconstruction. The benefits of adding an LET procedure to an ACL surgery may include greater rotational stability, decreased re-tear rates, and improved return to play. Level of evidence: V.
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Rangasamy K, Baburaj V, Gopinathan NR, Dhillon MS, Parikh SN. Quadriceps tendon autograft is promising with lower graft rupture rates and better functional Lysholm scores than hamstring tendon autograft in pediatric ACL reconstruction. A systematic review and meta-analysis. J Orthop 2024; 49:156-166. [PMID: 38223427 PMCID: PMC10787221 DOI: 10.1016/j.jor.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose Graft rupture is the most prevalent complication following pediatric anterior cruciate ligament reconstruction (ACLR). The hamstring tendon (HT) autograft is frequently employed, while the quadriceps tendon (QT) autograft has garnered increased attention recently. This study aims to perform a systematic review to assess the complication rates and functional outcomes associated with these two widely used autografts in skeletally immature patients - comparing HT versus QT autografts. Research question Is QT autograft better than HT autograft for ACLR in skeletally immature cohorts? Methodology Three electronic databases (PubMed/Medline, Scopus, and Ovid) were comprehensively searched to identify pertinent articles reporting the outcomes of HT and QT autografts in pediatric ACLR with a minimum 2-year follow-up. Data on the outcome parameters, such as graft rupture rates, contralateral ACL injury rates, functional outcomes, and growth disturbances rates, were extracted. Meta-analysis was performed using OpenMeta Analyst software. Results Twelve studies were included for meta-analysis (pooled analysis) with 659 patients (QT: 205; HT: 454). The analysis showed that QT autografts had a significantly lesser graft rupture rate than HT autografts (3.5 % [95 % CI 0.2, 6.8] and 12.4 % [95 % CI 6.1, 18.7] respectively, p < 0.001). The graft rupture rates between QT with bone and without bone block showed no statistically significant difference (4.6 % [95 % CI 0.8, 1.0] and 3.5 % [95 % CI 2.0, 8.9] respectively, p = 0.181). The overall contralateral ACL injury rate was 10.2 %, and the subgroup analysis revealed no statistically significant difference between the QT and HT groups (p = 0.7). Regarding functional outcome scores at the final follow-up, the mean Lysholm score demonstrated a significant increase in the QT group compared to the HT group (p < 0.001). There were no significant differences between the two groups concerning growth disturbances at the final follow-up. Return to sports (RTS) varied between 6 and 13.5 months after surgery. Conclusion QT autografts demonstrate encouraging outcomes, showcasing lower graft rupture rates, better functional outcomes, and comparable contralateral ACL injury rates and growth disturbances relative to the commonly used HT autograft in skeletally immature patients undergoing ACLR.
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Affiliation(s)
- Karthick Rangasamy
- Clinical Fellow, Paediatric Orthopaedic Division, Children's Hospital, London Health Science Centre, London, Ontario, Canada
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishnu Baburaj
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nirmal Raj Gopinathan
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shital N. Parikh
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, USA
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Wu X, Chen J, Ye Z, Dong S, Xie G, Zhao S, Xu C, Li Z, Xu J, Zhao J. Clinical and Radiological Outcomes After Combined ACL and MPFL Reconstruction Versus Isolated ACL Reconstruction for ACL Injury With Patellar Instability. Am J Sports Med 2024; 52:936-947. [PMID: 38349070 DOI: 10.1177/03635465241226976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND An anterior cruciate ligament (ACL) injury accompanied by patellar instability (PI) is a topic that has gained orthopaedic surgeons' attention recently. Untreated PI is reportedly associated with worse clinical outcomes after isolated ACL reconstruction (ACLR) in patients after an ACL injury with PI. Nevertheless, the appropriate surgical approach and its long-term therapeutic effects in these patients remain unclear. PURPOSE (1) To compare the clinical and radiological outcomes between isolated ACLR (iACLR) and combined ACLR and medial patellofemoral ligament reconstruction (cAMR) in patients after an ACL injury with PI and (2) to explore the correlations between these 2 procedures and clinical and radiological outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 106 patients diagnosed with an ACL injury accompanied by PI between January 2016 and April 2021 were analyzed in this study. There were 34 patients excluded because of missing postoperative radiological data. Among the remaining 72 patients, 34 patients underwent iACLR, while 38 patients underwent cAMR. Demographic characteristics, intraoperative findings, and patient-reported outcomes (Lysholm score, subjective International Knee Documentation Committee score, and Tegner activity score) were prospectively collected. Patellar alignment parameters and worsening patellofemoral osteoarthritis (PFOA) features (evaluated with the modified Whole-Organ Magnetic Resonance Imaging Score) were analyzed longitudinally on magnetic resonance imaging. The Kujala score was used to evaluate the functional recovery of the patellofemoral joint, and redislocations of the patella were prospectively recorded. Finally, multivariate logistic regression analysis was used to explore the correlations between these 2 procedures and clinical (not achieving the minimal detectable change [MDC] for the Lysholm score) and radiological (worsening PFOA features) outcomes. RESULTS The mean follow-up duration was 28.9 ± 6.2 and 27.1 ± 6.8 months for the iACLR and cAMR groups, respectively (P = .231). Significantly higher Lysholm scores (88.3 ± 9.9 vs 82.1 ± 11.1, respectively; P = .016) and subjective International Knee Documentation Committee scores (83.6 ± 11.9 vs 78.3 ± 10.2, respectively; P = .046) were detected in the cAMR group compared with the iACLR group postoperatively. The rates of return to preinjury sports were 20.6% and 44.7% in the iACLR and cAMR groups, respectively (difference, 24.1% [95% CI, 3.3%-45.0%]; P = .030). Moreover, the rates of worsening PFOA features were 44.1% and 18.4% in the iACLR and cAMR groups, respectively (difference, 25.7% [95% CI, 4.9%-46.4%]; P = .018). In addition, significantly higher Kujala scores (87.9 ± 11.3 vs 80.1 ± 12.0, respectively; P = .006), lower redislocation rates (0.0% vs 11.8%, respectively; difference, 11.8% [95% CI, 0.9%-22.6%]; P = .045), and significantly better patellar alignment were detected in the cAMR group compared with the iACLR group postoperatively. Furthermore, multivariate logistic regression analysis determined that iACLR and partial lateral meniscectomy were significantly correlated with not achieving the MDC for the Lysholm score and worsening PFOA features in our study population. CONCLUSION In patients after an ACL injury with PI, cAMR yielded better clinical and radiological outcomes compared with iACLR, with better patellar stability and a lower proportion of worsening PFOA features. Furthermore, not achieving the MDC for the Lysholm score and worsening PFOA features were significantly correlated with iACLR and partial lateral meniscectomy. Our study suggests that cAMR may be a more appropriate procedure for patients after an ACL injury with PI, which warrants further high-level clinical evidence.
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Affiliation(s)
- Xiulin Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyun Li
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Mortimer JW, Rust PA, Paxton JZ. Anatomical design and production of a novel three-dimensional co-culture system replicating the human flexor digitorum profundus enthesis. J Anat 2024. [PMID: 38400563 DOI: 10.1111/joa.14027] [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: 11/29/2023] [Revised: 01/27/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
The enthesis, the specialized junction between tendon and bone, is a common site of injury. Although notoriously difficult to repair, advances in interfacial tissue engineering techniques are being developed for restorative function. Most notably are 3D in vitro co-culture models, built to recreate the complex heterogeneity of the native enthesis. While cell and matrix properties are often considered, there has been little attention given to native enthesis anatomical morphometrics and replicating these to enhance clinical relevance. This study focuses on the flexor digitorum profundus (FDP) tendon enthesis and, by combining anatomical morphometrics with computer-aided design, demonstrates the design and construction of an accurate and scalable model of the FDP enthesis. Bespoke 3D-printed mould inserts were fabricated based on the size, shape and insertion angle of the FDP enthesis. Then, silicone culture moulds were created, enabling the production of bespoke anatomical culture zones for an in vitro FDP enthesis model. The validity of the model has been confirmed using brushite cement scaffolds seeded with osteoblasts (bone) and fibrin hydrogel scaffolds seeded with fibroblasts (tendon) in individual studies with cells from either human or rat origin. This novel approach allows a bespoke anatomical design for enthesis repair and should be applied to future studies in this area.
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Affiliation(s)
- Jeremy W Mortimer
- Anatomy@Edinburgh, Deanery of Biomedical Sciences, Old Medical School, University of Edinburgh, Edinburgh, UK
- School of Anatomy, University of Bristol, Bristol, UK
| | - Philippa A Rust
- Anatomy@Edinburgh, Deanery of Biomedical Sciences, Old Medical School, University of Edinburgh, Edinburgh, UK
- Hooper Hand Unit, St. John's Hospital, Livingston, Edinburgh, UK
| | - Jennifer Z Paxton
- Anatomy@Edinburgh, Deanery of Biomedical Sciences, Old Medical School, University of Edinburgh, Edinburgh, UK
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Tang H, Xiao YF, Liu WJ, Meng JH, Wu YM, Xiong YL, Gao SG. Preferences in anterior cruciate ligament reconstruction: A survey among orthopedic surgeons in China. Medicine (Baltimore) 2024; 103:e36482. [PMID: 38363894 PMCID: PMC10869037 DOI: 10.1097/md.0000000000036482] [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: 09/17/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024] Open
Abstract
The purpose of this study was to reveal the current trends and preferences of Chinese orthopedic surgeons regarding anterior cruciate ligament (ACL) reconstruction through a nationwide web-based survey conducted in China. The survey questionnaire was distributed via WeChat to the chairmen of provincial orthopedic and sports medicine organizing committees in China, who then shared it in their respective WeChat workgroups. The questionnaire consisted of 52 multiple-choice questions covering 8 sections. Data collection was implemented by Questionnaire Star. A total of 812 valid questionnaires were returned: 94.21% of the respondents preferred single-bundle reconstruction of ACL, while 61.70% preferred autogenous semitendinosus plus gracilis reconstruction; 76.35% of the respondents preferred establishing the femoral tunnel first, while 47.29% preferred establishing the femoral tunnel through a medial auxiliary approach; and 85.10% of the respondents recommended patients to undergo surgery within 3 months after ligament injury. Besides, the vast majority of respondents chose to retain the ligamentous remnant bundle (92.98%) and recommended routine use of knee braces postoperatively (94.09%). It is recommended to perform arthroscopic single-bundle ACL reconstruction with the remnant preserving technique using a hamstring autograft within 3 months of ACL rupture, with support of postoperative functional braces.
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Affiliation(s)
- Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yi-fan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Wei-jie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Jia-hao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yu-mei Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yi-lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shu-guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Mert A, Çınaroğlu S, Aydın M, Çiçek F, Ceranoğlu FG. Comparison of stiffness, elasticity and resilience values of ACL with autografts used instead of ACL in terms of texture analysis. Heliyon 2024; 10:e25588. [PMID: 38356561 PMCID: PMC10864985 DOI: 10.1016/j.heliyon.2024.e25588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
Background Anterior cruciate ligament (ACL) ruptures are one of the most extensively studied injuries in the field of orthopedics, but despite the extensive research, graft selection for ACL reconstruction remains a matter of debate. The present study aims to evaluate the stiffness and elasticity of native ACLs using texture profile analysis and compare results with those of autografts used in ACL reconstruction. Methods Included in the study were dissected 12 cadavers from which grafts were recovered. The graft characteristics, such as stiffness, elasticity and resilience, were measured using a TA.XT Plus Texture Analyzer. Findings Among the grafts studied, Achilles' tendon graft (0.70; 0.64) had the highest resilience in both males and females, while the greatest elasticity was identified in the patellar tendon graft (Male: 93 %; Female: 94 %) in all subjects. The highest stiffness value in males was recorded for the quadriceps tendon graft (2928.76 N), while the highest stiffness value in females was recorded for Achilles' tendon graft (2204.61 N). Interpretation According to the study data, the autografts that may be considered as an alternative to ACL were, listed in order of strength from high to low, the quadriceps, Achilles', patella and hamstring tendons in men, and the Achilles', quadriceps, patellar and hamstring tendons in women. It is worthy of note that the hamstring tendon graft, which is the most frequently preferred autograft in ACL reconstruction, was found to be the lowest in all parameters in both groups.
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Affiliation(s)
- Ahmet Mert
- Department of Orthopedics and Traumatology, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240, Niğde, Turkey
| | - Selim Çınaroğlu
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240, Niğde, Turkey
| | - Murat Aydın
- Department of Orthopedics and Traumatology, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240, Niğde, Turkey
| | - Fatih Çiçek
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240, Niğde, Turkey
| | - Faruk Gazi Ceranoğlu
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240, Niğde, Turkey
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Li XY, Wang YL, Yang S, Liao CS, Li SF, Han PF. Correlation between vascular endothelial growth factor A gene polymorphisms and tendon and ligament injury risk: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:122. [PMID: 38317252 PMCID: PMC10845593 DOI: 10.1186/s13018-024-04589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/28/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Relevant evidence suggests that angiogenic factors contribute significantly to fibril matrix reconstruction following physical injuries to tendon ligaments. Vascular endothelial growth factor A (VEGFA), with its potent angiogenic effect, has been studied extensively, and its functional polymorphisms, including rs699947, rs1570360, and rs2010963, have been the focus of numerous investigations. Some scholars have explored the association between gene polymorphisms in the VEGFA and the risk of tendon ligament injury, but the findings are not entirely consistent. OBJECTIVES The purpose of this study was to investigate the association between rs699947, rs1570360, and rs2010963 gene polymorphisms in VEGFA and the risk of tendon and ligament injuries. METHODS After including articles about the association of VEGFA rs699947, rs1570360, and rs2010963 polymorphisms with tendon and ligament injuries according to the search strategy, we assessed their quality and conducted meta-analyses to examine the link between these polymorphisms and the risk of tendon and ligament injuries using odds ratios and 95% confidence intervals. RESULTS Of 86 related articles, six were included in the meta-analysis. Some of these suggest an association between VEGFA rs2010963 and the risk of tendon and ligament injury in the population, with the specific C allele being one of the adverse factors for knee injury. Some studies suggest that VEGFA rs699947 and VEGFA rs1570360 single-nucleotide polymorphisms are associated with anterior cruciate ligament rupture. The risk of non-contact anterior cruciate ligament rupture is nearly doubled in individuals with the rs699947 CC genotype compared to the control group. Our analysis did not find any significant relationship between VEGFA gene polymorphisms (rs699947, rs1570360, and rs2010963) and the chance of tendon and ligament injury without consideration of race. However, the European population reveals that the CC genotype of VEGFA rs699947 can result in a greater risk of tendon and ligament injury, whereas the AG genotype for rs1570360 provides some protection. Additionally, rs2010963 was significantly associated with tendon and ligament injury; individuals with the C allele and the CC genotype had higher risk. False-positive report probability confirmed the high credibility of our results. CONCLUSION Overall, this study found no significant association between VEGFA rs699947, rs1570360, and rs2010963 polymorphisms and the risk of tendon ligament injury. However, in subgroup analysis, some genotypes of VEGFA rs699947, rs1570360, and rs2010963 were found to increase the risk of tendon ligament injury in European populations.
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Affiliation(s)
- Xi-Yong Li
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
- Graduate School, Changzhi Medical College, Changzhi, People's Republic of China
| | - Yun-Lu Wang
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China
- Graduate School, Changzhi Medical College, Changzhi, People's Republic of China
| | - Su Yang
- Graduate School, Changzhi Medical College, Changzhi, People's Republic of China
| | - Chang-Sheng Liao
- Graduate School, Changzhi Medical College, Changzhi, People's Republic of China
| | - Song-Feng Li
- Graduate School, Changzhi Medical College, Changzhi, People's Republic of China
| | - Peng-Fei Han
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, 110 South Yan'an Road, Changzhi, 046000, People's Republic of China.
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