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Luo P, Wang Q, Cao P, Chen T, Li S, Wang X, Li Y, Gong Z, Zhang Y, Ruan G, Zhou Z, Wang Y, Han W, Zhu Z, Hunter DJ, Li J, Ding C. The association between anterior cruciate ligament degeneration and incident knee osteoarthritis: Data from the osteoarthritis initiative. J Orthop Translat 2024; 44:1-8. [PMID: 38174315 PMCID: PMC10762318 DOI: 10.1016/j.jot.2023.09.005] [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: 01/07/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 01/05/2024] Open
Abstract
Background Though anterior cruciate ligament (ACL) tear has been widely accepted as an important accelerator for knee osteoarthritis (KOA), the role of intrinsic ACL degeneration in developing KOA has not been fully investigated. Purpose To determine whether ACL degeneration, in the absence of ACL tear, is associated with incident KOA over 4 years. Study design Cohort study; Level of evidence, 2. Methods Participants' knees in this nested case-control study were selected from the Osteoarthritis Initiative (OAI) study, with Kellgren-Lawrence grading (Kellgren-Lawrence grading) of 0 or 1 at baseline (BL). Case knees which had incident KOA (KLG ≥2) over 4 years, were matched 1:1 with control knees by gender, age and radiographic status. ACL signal intensity alteration (0-3 scale) and volume were assessed as compositional feature and morphology of ACL degeneration, using knee MRI at P0 (time of onset of incident KOA), P-1 (1 year prior to P0) and baseline. Conditional logistic regression was applied to analyze the association between measures of ACL degeneration and incident KOA. Results 337 case knees with incident KOA were matched to 337 control knees. Participants were mostly female (68.5%), with an average age of 59.9 years old. ACL signal intensity alterations at BL, P-1 and P0 were significantly associated with an increased odds of incident KOA respectively (all P for trend ≤0.001). In contrast, ACL volumes were not significantly associated with incident KOA at any time points. Conclusions ACL signal intensity alteration is associated with increased incident KOA over 4 years, whereas ACL volume is not.The translational potential of this article: This paper focused on ACL signal intensity alteration which could better reflect ACL degeneration rather than ACL tear during the progression of KOA and explored this topic in a nested case-control study. Utilizing MR images from KOA participants, we extracted the imaging features of ACL. In addition, we established a semi-quantitative score for ACL signal intensity alteration and found a significant correlation between it and KOA incidence. Our findings confirmed that the more severe the ACL signal intensity alteration, the stronger relationship with the occurrence of KOA. This suggests that more emphasis should be placed on ACL degeneration rather than ACL integrity in the future.
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Affiliation(s)
- Ping Luo
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Department of Spinal Surgery, The Fourth Hospital of Changsha, Changsha Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Qianyi Wang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Peihua Cao
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Tianyu Chen
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Shengfa Li
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoshuai Wang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yamin Li
- Department of Nephrology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ze Gong
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Zhang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Guangfeng Ruan
- Clinical Research Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Zuoqing Zhou
- Department of Orthopedics, The First Affiliated Hospital, Shaoyang University, Shaoyang, Hunan, China
| | - Yuanyuan Wang
- Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Weiyu Han
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhaohua Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - David J. Hunter
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Department of Rheumatology, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Australia
| | - Jia Li
- Division of Orthopaedic Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Changhai Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Li Z, Zhang S, Mao G, Xu Y, Kang Y, Zheng L, Long D, Chen W, Gu M, Zhang Z, Kang Y, Sheng P, Zhang Z. Identification of anterior cruciate ligament fibroblasts and their contribution to knee osteoarthritis progression using single-cell analyses. Int Immunopharmacol 2023; 125:111109. [PMID: 37883816 DOI: 10.1016/j.intimp.2023.111109] [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: 08/06/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Abstract
The mechanical properties of the anterior cruciate ligament (ACL) in the knee have been highlighted, but its role in the regulation of the joint microenvironment remains unclear, especially in the progression of Knee Osteoarthritis (KOA). Here, single-cell RNA sequencing (scRNA-seq) and single-cell assay for transposase-accessible chromatin sequencing (scATAC-seq) data were integrated to reveal the transcriptional and epigenomic landscape of ACL in normal and OA states. We identified a novel subpopulation of fibroblasts in ACL, which provides new insights into the role of the ACL in knee homeostasis and disease. Degeneration of the ACL during OA mechanically alters the knee joint homeostasis and influences the microenvironment by regulating inflammatory- and osteogenic-related factors, thereby contributing to the progression of KOA. Additionally, the specific mechanism by which these Inflammation-associated Fibroblasts (IAFs) regulate KOA progression was uncovered, providing new foundation for the development of targeted treatments for KOA.
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Affiliation(s)
- Zhiwen Li
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Shiyong Zhang
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Guping Mao
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Yiyang Xu
- Department of Orthopaedics, Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, China
| | - Yunze Kang
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Linli Zheng
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Dianbo Long
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Weishen Chen
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Minghui Gu
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Zhiqi Zhang
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
| | - Yan Kang
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
| | - Puyi Sheng
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
| | - Ziji Zhang
- Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
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Liu D, Hu P, Cai ZJ, Lu WH, Pan LY, Liu X, Peng XJ, Li YS, Xiao WF. Valid and reliable diagnostic performance of dual-energy CT in anterior cruciate ligament rupture. Eur Radiol 2023; 33:7769-7778. [PMID: 37171489 PMCID: PMC10598075 DOI: 10.1007/s00330-023-09720-y] [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: 12/19/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To determine whether dual-energy CT (DECT) can be used to accurately and reliably detect anterior cruciate ligament (ACL) rupture. MATERIALS AND METHODS Participants with unilateral ACL rupture were prospectively enrolled, and the bilateral knees were scanned by DECT. A tissue-specific mapping algorithm was applied to improve the visualization of the ACLs. The 80-keV CT value, mixed-keV CT value, electron density (Rho), and effective atomic number (Zeff) were measured to quantitatively differentiate torn ACLs from normal ACLs. MRI and arthroscopy served as the reference standards. RESULTS Fifty-one participants (mean age, 27.0 ± 8.7 years; 31 men) were enrolled. Intact and torn ACLs were explicitly differentiated on color-coded DECT images. The 80-keV CT value, mixed-keV CT value, and Rho were significantly lower for the torn ACLs than for the intact ACLs (p < 0.001). The optimal cutoff values were an 80-keV CT value of 61.8 HU, a mixed-keV CT value of 60.9 HU, and a Rho of 51.8 HU, with AUCs of 98.0% (95% CI: 97.0-98.9%), 99.2% (95% CI: 98.6-99.7%), and 99.8% (95% CI: 99.6-100.0%), respectively. Overall, DECT had almost perfect reliability and validity in detecting ACL integrity (sensitivity = 97.1% [95% CI: 88.1-99.8%]; specificity = 98.0% [95% CI: 89.5-99.9%]; PPV = 98.0% [95% CI: 93.0-99.8%]; NPV = 97.1% [95% CI: 91.7-99.4%]; accuracy = 97.5% [95% CI: 94.3-99.2%]). There was no evidence of a difference between MRI and DECT in the diagnostic performance (p > 0.99). CONCLUSION DECT has excellent diagnostic accuracy and reliability in qualitatively and quantitatively diagnosing ACL rupture. CLINICAL RELEVANCE STATEMENT DECT could validly and reliably diagnose ACL rupture using both qualitative and quantitative methods, which may become a promising substitute for MRI to evaluate the integrity of injured ACLs and the maturity of postoperative ACL autografts. KEY POINTS • On color-coded DECT images, an uncolored ACL was a reliable sign for qualitatively diagnosing ACL rupture. • The 80-keV CT value, mixed-keV CT value, and Rho were significantly lower for the torn ACLs than for the intact ACLs, which contributed to the quantitative diagnosis of ACL rupture. • DECT had an almost perfect diagnostic performance for ACL rupture, and diagnostic capability was comparable between MRI and DECT.
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Affiliation(s)
- Di Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Ping Hu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Zi-Jun Cai
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Wen-Hao Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Lin-Yuan Pan
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Xu Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Xian-Jing Peng
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| | - Yu-Sheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| | - Wen-Feng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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Demehri S, Kasaeian A, Roemer FW, Guermazi A. Osteoarthritis year in review 2022: imaging. Osteoarthritis Cartilage 2023; 31:1003-1011. [PMID: 36924919 DOI: 10.1016/j.joca.2023.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/17/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE This narrative review summarizes original research focusing on imaging in osteoarthritis (OA) published between April 1st 2021 and March 31st 2022. We only considered English publications that were in vivo human studies. METHODS The PubMed, Medline, Embase, Scopus, and ISI Web of Science databases were searched for "Osteoarthritis/OA" studies based on the search terms: "Radiography", "Ultrasound/US", "Computed Tomography/CT", "DXA", "Magnetic Resonance Imaging/MRI", "Artificial Intelligence/AI", and "Deep Learning". This review highlights the anatomical focus of research on the structures within the tibiofemoral, patellofemoral, hip, and hand joints. There is also a noted focus on artificial intelligence applications in OA imaging. RESULTS Over the last decade, the increasing trend of using open-access large databases has reached a plateau (from 17 to 37). Compositional MRI has had the most prominent use in OA imaging and its biomarkers have been used in the detection of preclinical OA and prediction of OA outcomes. Most noteworthy, there has been an accelerated rate of publications on the implications of artificial intelligence, used in developing prediction models and performing trabecular texture analysis, in OA imaging (from 17 to 154). CONCLUSIONS While imaging has maintained its key role in OA research, publication trends have shown an emphasis on the integration of AI. During the past year, MRI has maintained the highest prevalence in usage while US and CT remain as readily available modalities. Finally, there has been a notable uptake in the development and validation of AI techniques used to perform texture analysis and predict OA progression.
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Affiliation(s)
- S Demehri
- Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - A Kasaeian
- Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - F W Roemer
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - A Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
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5
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Bosco F, Giustra F, Giai Via R, Lavia AD, Capella M, Sabatini L, Risitano S, Cacciola G, Vezza D, Massè A. Could anterior closed-wedge high tibial osteotomy be a viable option in patients with high posterior tibial slope who undergo anterior cruciate ligament reconstruction? A systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03419-4. [PMID: 36308547 PMCID: PMC10368555 DOI: 10.1007/s00590-022-03419-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/18/2022] [Indexed: 05/16/2023]
Abstract
PURPOSE This study aims to examine the clinical and radiological outcomes of patients who underwent ACL reconstruction (ACLR) combined with anterior closed-wedge high tibial osteotomy (ACW-HTO) for posterior tibial slope (PTS) reduction to investigate the efficacy of this procedure in improving anterior knee stability and preventing graft failure in primary and revision ACLR. METHODS A literature search was conducted in six databases (PubMed, Embase, Medline, Web of Science, Cochrane, and Scopus). The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The initial screening identified 1246 studies. Each eligible clinical article was screened according to the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence (LoE), excluding clinical studies of LoE V. Quality assessment of the articles was performed using the ROBINS-I methodological evaluation. This systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that were possible to perform a meta-analysis, a p < 0.05 was considered statistically significant. RESULTS Five clinical studies were included in the final analysis. A total of 110 patients were examined. Pre- and post-operative clinical and objective tests that assess anteroposterior knee stability, PTS, clinical scores, and data on surgical characteristics, complications, return to sports activity, and graft failure after ACLR were investigated. A meta-analysis was conducted using R software, version 4.1.3 (2022, R Core Team), for Lysholm score and PTS outcomes. A statistically significant improvement for both these clinical and radiological outcomes (p < 0.05) after the ACW-HTO surgical procedure was found. CONCLUSION ACLR combined with ACW-HTO restores knee stability and function with satisfactory clinical and radiological outcomes in patients with an anterior cruciate ligament injury associated with a high PTS and seems to have a protective effect from further ruptures on the reconstructed ACL. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Riccardo Giai Via
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | | | - Marcello Capella
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Salvatore Risitano
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Giorgio Cacciola
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Daniele Vezza
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
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Solís GS, Waghchoure C, Vinagre G. Symptomatic ACL mucoid degeneration in middle-age athletes. J Orthop 2022; 31:67-71. [PMID: 35496356 PMCID: PMC9038521 DOI: 10.1016/j.jor.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/03/2022] [Accepted: 04/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background Mucoid degeneration of the anterior cruciate ligament (ACL) is an uncommon non-traumatic cause of knee pain and motion restriction, typically seen in a middle-aged population. Primarily, the management consists of partial arthroscopic debridement and notchplasty, which has proven satisfactory clinical and functional outcomes. Study objectives This review aims to highlight key clinical, radiological and arthroscopic findings of mucoid ACL degeneration, and also to provide an approach to manage a symptomatic middle-aged athlete. Rationale Due to the paucity of literature on ACL mucoid degeneration, symptomatic presentation in a middle-aged athlete can be challenging to manage. Diffuse central pain, motion restriction in extension or flexion, absence of trauma, and an intact enlarged ACL on Magnetic resonance imaging (MRI) should raise suspicion for mucoid degeneration in middle-aged athletes. Specific radiological and arthroscopic findings can help to confirm the diagnosis. In this review article, we have also described a new clinical test to mimic the pain due to anterior impingement in the presence of an enlarged ACL. Conclusion In symptomatic middle-aged athletes, knowledge of characteristic findings can help in the timely diagnosis of mucoid degeneration of ACL. Treatment options include arthroscopic debridement, notchplasty, ACL augmentation, and ACL reconstruction. The presence of associated injuries can influence return-to-sports prognosis.
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7
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Kreuzbandanomalien mit
höherer Kniegelenksdegeneration
assoziiert. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1550-8811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Frühere Studien berichten über ausgeprägtere
Knorpeldegenerationen im Kniegelenk bei Patient*innen mit
verschiedenen Arten von nicht-traumatischen Verletzungen des vorderen
Kreuzbandes (VKB) im Vergleich zu Patient*innen mit gesundem VKB.
Dennoch sind bislang weder die Ätiologie noch die Bedeutung von
zufälligen, nicht-traumatischen Kreuzbandrissen vollständig
geklärt.
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8
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Ricciardi BF. CORR Insights®: Is Cam Morphology Found in Ancient and Medieval Populations in Addition to Modern Populations? Clin Orthop Relat Res 2021; 479:1839-1841. [PMID: 33950878 PMCID: PMC8277271 DOI: 10.1097/corr.0000000000001801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/13/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Benjamin F Ricciardi
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, University of Rochester School of Medicine, Rochester, NY, USA
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