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Wen ZH, Tang CC, Lin YY, Yao ZK, Hsieh SP, Gar-Hwa-Lai, Chen WF, Jean YH. Effects of Etanercept on Experimental Osteoarthritis in Rats: Role of Histone Deacetylases. Cartilage 2024:19476035241264012. [PMID: 39057748 DOI: 10.1177/19476035241264012] [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] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE Mounting evidence suggests that histone deacetylases (HDAC) inhibitors reduce cartilage destruction in animal models of osteoarthritis (OA). Tumor necrosis factor (TNF)-α-blocking treatment for OA may provide effective joint protection by slowing joint damage. To investigate the effects of intraperitoneal administration of etanercept (a TNF-α inhibitor) on OA development in rats and changes in the nociceptive behavior of rats and expression of HDACs, RUNX2, and MMP13 in cartilage. METHODS Induction of OA in Wistar rats was accomplished through anterior cruciate ligament transection (ACLT). One or five milligrams (mg) of etanercept was administered intraperitoneally for 5 consecutive weeks after ACLT to the ACLT + etanercept (1 and 5 mg/kg) groups. Nociceptive behavior and changes in knee joint width were analyzed. Cartilage was evaluated histologically and immunohistochemically. RESULTS ACLT + etanercept significantly improved mechanical allodynia and weight-bearing distribution compared to ACLT alone. In OA rats treated with etanercept, cartilage degeneration and synovitis were significantly less pronounced than those in ACLT rats. OA-affected cartilage also showed reduced expression of HDAC 6, 7, RUNX-2, and MMP-13 in response to etanercept but increased expression of HDAC4. CONCLUSION Our study demonstrated that etanercept therapy (1) attenuated the development of OA and synovitis in rats, (2) reduced nociception, and (3) regulated chondrocyte metabolism, possibly by inhibiting cell HDAC6 and HDAC7, RUNX2, and MMP13 and increasing HDAC4 expression. Based on new evidence, etanercept may have therapeutic potential in OA.
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Affiliation(s)
- Zhi-Hong Wen
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chi-Chieh Tang
- Department of Early Childhood Education, National Pintung University, Pingtung, Taiwan
| | - Yen-You Lin
- Department of Sports Medicine, China Medical University, Taichung, Taiwan
| | - Zhi-Kang Yao
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shih-Peng Hsieh
- Section of Pathology, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Gar-Hwa-Lai
- Section of Orthopedic Surgery, Pingtung Veterans General Hospital, Pingtung, Taiwan
| | - Wu-Fu Chen
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Neurosurgery, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, Taiwan
| | - Yen-Hsuan Jean
- Section of Orthopedic Surgery, Pingtung Christian Hospital, Pingtung, Taiwan
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Battersby HS, Holmes SC, Shumski EJ, Heredia CE, Garcia SA, Pamukoff DN. The Influence of Knee Position on Ultrasound Imaging of Femoral Cartilage in Individuals with Anterior Cruciate Ligament Reconstruction. Cartilage 2024; 15:84-93. [PMID: 37846037 DOI: 10.1177/19476035231205682] [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: 10/18/2023] Open
Abstract
BACKGROUND Articular cartilage is important for knee function and can be imaged using ultrasound. The purpose was to compare femoral cartilage thickness and echo intensity (EI) measured at 90° and 140° of knee flexion and between limbs in a cohort with unilateral anterior cruciate ligament reconstruction (ACLR). We also examined associations between gait biomechanics and cartilage outcomes. METHODS Twenty-seven individuals with primary unilateral ACLR participated (12 men, 15 women; age = 22.3 ± 3.8 years; time since ACLR = 71.2 ± 47.2 months). Ultrasound was used to obtain femoral cartilage measurements. Gait outcomes included peak KFA (knee flexion angle) and peak external knee flexion moment (KFM). Cartilage outcomes were compared using a 2 (position) × 2 (limb) repeated measures ANOVA (analysis of variance). Gait and cartilage associations were assessed using linear regression. FINDINGS There were no position × limb interactions for any cartilage outcome (all P > 0.05). Medial (P = 0.038) and central cartilage (P < 0.001) were thicker, whereas central (P = 0.029) and lateral cartilage EI (P = 0.003) were lower when measured at 90° than those at 140° of knee flexion. Medial cartilage was thicker in the ACLR than that in the contralateral limb (P = 0.016). A larger KFM was associated with thicker medial cartilage (ΔR2 = 0.146, P = 0.021) and central cartilage (ΔR2 = 0.159, P = 0.039) measured at 140° of knee flexion in the ACLR limb but not at 90°. INTERPRETATION Findings suggest that imaging position influences cartilage thickness and EI measurements in individuals with ACLR and should be considered in study designs and clinical evaluation. A greater KFM was associated with thicker cartilage within specific portions of the distal femur.
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Affiliation(s)
| | - Skylar C Holmes
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Eric J Shumski
- Department of Kinesiology, University of Georgia, Athens, GA, USA
| | | | - Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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Zong L, Wang Q, Sun H, Wu Q, Xu Y, Yang H, Lv S, Zhang L, Geng D. Intra-Articular Injection of PLGA/Polydopamine Core-Shell Nanoparticle Attenuates Osteoarthritis Progression. ACS APPLIED MATERIALS & INTERFACES 2024; 16:21450-21462. [PMID: 38649157 DOI: 10.1021/acsami.3c18464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Osteoarthritis (OA) is a common joint disease characterized by progressive cartilage degeneration. Unfortunately, currently available clinical drugs are mainly analgesics and cannot alleviate the development of OA. Kartogenin (KGN) has been found to promote the differentiation of bone marrow mesenchymal stem cells (BMSCs) into chondrocytes for the treatment of cartilage damage in early OA. However, KGN, as a small hydrophobic molecule, is rapidly cleared from the synovial fluid after intra-articular injection. This study synthesized a KGN-loaded nanocarrier based on PLGA/polydopamine core/shell structure to treat OA. The fluorescence signal of KGN@PLGA/PDA-PEG-E7 nanoparticles lasted for 4 weeks, ensuring long-term sustained release of KGN from a single intra-articular injection. In addition, the polyphenolic structure of PDA enables it to effectively scavenge reactive oxygen species, and the BMSC-targeting peptide E7 (EPLQLKM) endows KGN@PLGA/PDA-PEG-E7 NPs with an effective affinity for BMSCs. As a result, the KGN@PLGA/PDA-PEG-E7 nanoparticles could effectively induce cartilage in vitro and protect the cartilage and subchondral bone in a rat ACLT model. This therapeutic strategy could also be extended to the delivery of other drugs, targeting other tissues to treat joint diseases.
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Affiliation(s)
- Lujie Zong
- Department of Orthopaedics, The First People's Hospital of Changzhou, Soochow University, Changzhou, Jiangsu 213000, China
| | - Qing Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu 215000, China
| | - Houyi Sun
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China
| | - Qian Wu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu 215000, China
| | - Yaozeng Xu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu 215000, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu 215000, China
| | - Shujun Lv
- Department of Orthopedics, Hai'an People's Hospital, Hai'an, Jiangsu 226000, China
| | - Liang Zhang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100000, China
| | - Dechun Geng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu 215000, China
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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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Hellberg C, Kostogiannis I, Stylianides A, Neuman P. Outcomes >30 Years After Initial Nonoperative Treatment of Anterior Cruciate Ligament Injuries. Am J Sports Med 2024; 52:320-329. [PMID: 38193189 PMCID: PMC10838478 DOI: 10.1177/03635465231214423] [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: 01/12/2023] [Accepted: 09/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND It is unclear how anterior cruciate ligament (ACL) reconstruction (ACLR) affects the development of osteoarthritis (OA). This uncertainty is partly caused by the lack of long-term studies on ACL injuries treated primarily without reconstruction and the underreporting of symptomatic OA. PURPOSE To determine (1) the knee function, symptoms, and activity level, as well as the presence of radiographic and symptomatic OA; (2) how these clinical outcomes have changed over time; and (3) the frequency of subsequent knee surgeries after the index ACL injury in a cohort of patients with ACL injuries treated primarily without reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 100 patients underwent initial nonoperative treatment >30 years ago (mean, 33.2 ± 1.4 years). Of these, 81 patients (mean age, 59 ± 8 years) completed the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Scoring Scale, and Tegner Activity Scale. Seventy-three patients underwent radiography to evaluate tibiofemoral and patellofemoral OA in the ACL-injured knee. Patients only underwent late ACLR if they experienced insufficient knee stability. RESULTS At 33 years after the ACL injury, the KOOS Activities of Daily Living subscore was better than population-based reference values, but scores were similar for the remaining KOOS subscales. Furthermore, 65% of patients had a good or excellent Lysholm score (≥84 points). The Tegner score decreased 4 points from before the injury to 33-year follow-up (P < .001). Most patients (75%) had evidence of radiographic tibiofemoral and/or patellofemoral OA, but only 38% were classified as having symptomatic OA (defined as radiographic OA in combination with a symptomatic knee according to cutoffs on the KOOS). Approximately 50% underwent meniscal surgery, and 29% subsequently underwent ACLR for recurrent instability. There were 2 patients who underwent total knee replacement. CONCLUSION Despite a high prevalence of radiographic OA, patients achieved acceptable subjective knee function and had a relatively low prevalence of symptomatic OA at >30 years after an ACL injury when an initial nonoperative treatment strategy was employed.
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Affiliation(s)
- Clara Hellberg
- Clinical Epidemiology Unit, Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ioannis Kostogiannis
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alexandros Stylianides
- Musculoskeletal Radiology Section, Skåne University Hospital, Lund University, Lund, Sweden
| | - Paul Neuman
- Department of Orthopaedics, Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Itthipanichpong T, Kulrat P, Limskul D, Tanpowpong T, Virulsri C, Tangpornprasert P, Kuptniratsaikul S, Thamrongskulsiri N. Traditional suture tape versus multiple high-strength sutures for augmentation of anterior cruciate ligament primary repair: A time-zero biomechanical study. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 35:39-42. [PMID: 38162803 PMCID: PMC10755459 DOI: 10.1016/j.asmart.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/20/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Background/objective During the initial stages of rehabilitation after anterior cruciate ligament (ACL) surgery, a pivotal role is played in ensuring effective recuperation and averting complications. An often-employed strategy to tackle ACL laxity during this period involves the incorporation of synthetic materials for reinforcement. The objective of this study is to compare the effectiveness of conventional suture tape and multiple high-strength sutures as augmentation techniques for ACL repair. Methods Ten preserved cadaveric knees embalmed using the Thiel method were segregated into two groups, each containing five knees. In one group, traditional suture tape was employed for augmentation, while the other group utilized multiple high-strength sutures. Each knee underwent a cyclic load of 1000 sine wave cycles, succeeded by an axial distraction load until failure ensued. The resultant displacement and ultimate load at failure were assessed to contrast the efficacy of the two augmentation techniques. Results The group utilizing multiple high-strength sutures exhibited a significantly higher load to failure at time-zero (1690.7 N) compared to the suture tape group (987.6 N) (P = .003). Furthermore, the multiple high-strength sutures group demonstrated significantly reduced displacement after 1000 cyclic loads (6.6 mm) in comparison to the suture tape group (16.3 mm) (P < .001). Conclusions Multiple high-strength sutures show better biomechanical properties for the augmentation of ACL repair at time-zero. Both suture tape and multiple high-strength sutures had ultimate load-to-failure values higher than the natural ACL loads. Therefore, these substances might serve as augmentation options to prevent the ACL's gradual elongation, a critical concern particularly in the initial stages of rehabilitation.
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Affiliation(s)
- Thun Itthipanichpong
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Puchong Kulrat
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Danaithep Limskul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Thanathep Tanpowpong
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Chanyaphan Virulsri
- Center of Excellence for Prosthetic and Orthopedic Implant, Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Pairat Tangpornprasert
- Center of Excellence for Prosthetic and Orthopedic Implant, Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Somsak Kuptniratsaikul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
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Ross AG, Agresta B, McKay M, Pappas E, Cheng T, Peek K. Financial burden of anterior cruciate ligament reconstructions in football (soccer) players: an Australian cost of injury study. Inj Prev 2023; 29:474-481. [PMID: 37666517 DOI: 10.1136/ip-2023-044885] [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: 02/24/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To estimate the financial burden of anterior cruciate ligament (ACL) reconstructions in amateur football (soccer) players in Australia over a single year, including both direct and indirect cost. METHODS Available national direct and indirect cost data were applied to the annual incidence of ACL reconstructions in Australia. Age-adjusted and sex-adjusted total and mean costs (ACL and osteoarthritis (OA)) were calculated for amateur football (soccer) players in Australia using an incidence-based approach. RESULTS The estimated cost of ACL reconstructions for amateur football players is $A69 623 211 with a mean total cost of $A34 079. The mean indirect costs are 19.8% higher than the mean direct costs. The mean indirect costs are lower in female (11.5%, $A28 628) and junior (15.3%, $A29 077) football players. The mean ACL costs are 3-4-fold greater than the mean OA costs ($A27 099 vs $A6450, respectively), remaining consistent when stratified by sex and age group. Our model suggests that for every 10% increase in adherence to injury prevention programmes, which equates to approximately 102 less ACL injuries per year, $A9 460 224 in ACL costs could be saved. CONCLUSION While the number of ACL reconstructions per year among football players in Australia is relatively small, the annual financial burden is high. Our study suggests that if injury prevention exercises programmes are prioritised by stakeholders in football, significant cost-savings are possible.
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Affiliation(s)
- Andrew George Ross
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Blaise Agresta
- Health Economics and Health Technology Assessment, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marnee McKay
- Discipline of Physiotherapy, The University of Sydney, Sydney, New South Wales, Australia
| | - Evangelos Pappas
- School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Tegan Cheng
- Faculty of Medicine and Health & Children's Hospital at Westmead, University of Sydney School of Health Sciences, Sydney, New South Wales, Australia
| | - Kerry Peek
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Kim MJ, Moon SG, Kang JH, Lee DW. Usefulness of 3-Dimensional Computed Tomography Assessment of Femoral Tunnel after Anterior Cruciate Ligament Reconstruction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1716. [PMID: 37893436 PMCID: PMC10608529 DOI: 10.3390/medicina59101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Positioning of the femoral tunnel during anterior cruciate ligament (ACL) reconstruction is the most crucial factor for successful procedure. Owing to the inter-individual variability in the intra-articular anatomy, it can be challenging to obtain precise tunnel placement and ensure consistent results. Currently, the three-dimensional (3D) reconstruction of computed tomography (CT) scans is considered the best method for determining whether femoral tunnels are positioned correctly. Postoperative 3D-CT feedback can improve the accuracy of femoral tunnel placement. Precise tunnel formation obtained through feedback has a positive effect on graft maturation, graft failure, and clinical outcomes after surgery. However, even if femoral tunnel placement on 3D CT is appropriate, we should recognize that acute graft bending negatively affects surgical results. This review aimed to discuss the implementation of 3D-CT evaluation for predicting postoperative outcomes following ACL re-construction. Reviewing research that has performed 3D CT evaluations after ACL reconstruction can provide clinically significant evidence of the formation of ideal tunnels following anatomic ACL reconstruction.
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Affiliation(s)
- Min-Jeong Kim
- Department of Radiology, Incheon Sarang Hospital, Incheon 22135, Republic of Korea;
| | - Sung-Gyu Moon
- Department of Radiology, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (S.-G.M.); (J.-H.K.)
| | - Ji-Hee Kang
- Department of Radiology, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (S.-G.M.); (J.-H.K.)
| | - Dhong-Won Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
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Ferrero S, Louvois M, Barnetche T, Breuil V, Roux C. Impact of anterior cruciate ligament surgery on the development of knee osteoarthritis: A systematic literature review and meta-analysis comparing non-surgical and surgical treatments. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100366. [PMID: 37252633 PMCID: PMC10209532 DOI: 10.1016/j.ocarto.2023.100366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Context: The development of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is now widely recognized. The impact of surgical or non-surgical management on the development of post-traumatic osteoarthritis is still debated in the medical community.Here, we present a meta-analysis comparing the impact of surgical or non-surgical management of ACL injuries on the development of knee OA. Method A systematic literature review was conducted using data from the PubMed, EMBASE, Medline, and Cochrane libraries from February to May 2019. Only randomized clinical trials published between 2005 and 2019 with a non-surgical group and a surgical group were included to explore the onset or progression of knee OA after ACL injury. Trials had to have at least one radiographic endpoint (Kellgren-Lawrence scoring system). Heterogeneity was assessed using the Cochrane's Q and I2 statistical methods. Results Only three randomized controlled trials met the inclusion criteria and were selected for meta-analysis. Of the 343 injured knees included in the studies, 180 underwent ACL reconstruction and 163 underwent non-surgical treatment. The relative risk of knee osteoarthritis was higher after surgery than after non-surgical treatment (RR 1.72, CI 95% [1.18-2.53], I2 = 0%). Conclusion The results of this meta-analysis suggest a predisposition to knee osteoarthritis after ACL reconstruction surgery compared with non-surgical management. Due to the small number of good quality studies available, further well-conducted randomised studies are needed to confirm these findings.
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Affiliation(s)
- Stephanie Ferrero
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Nice Sophia Antipolis University, F-06000, Nice, France
| | - Marion Louvois
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Nice Sophia Antipolis University, F-06000, Nice, France
| | - Thomas Barnetche
- Department of Rheumatology, University Hospital of Bordeaux Pellegrin, France
| | - Veronique Breuil
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Nice Sophia Antipolis University, F-06000, Nice, France
| | - Christian Roux
- Department Rheumatology, University of Cote D'Azur, Nice Hospital, Laboratory LAMHESS, EA6312, IBV CNRS IMR 7277 INSERM U1091 UNS, France
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Chen NF, Lin YY, Yao ZK, Tseng CC, Liu YW, Hung YP, Jean YH, Wen ZH. Oral Administration of Protease-Soluble Chicken Type II Collagen Ameliorates Anterior Cruciate Ligament Transection-Induced Osteoarthritis in Rats. Nutrients 2023; 15:3589. [PMID: 37630779 PMCID: PMC10459594 DOI: 10.3390/nu15163589] [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: 07/27/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
This study investigated whether oral supplementation with protease-soluble chicken type II collagen (PSCC-II) mitigates the progression of anterior cruciate ligament transection (ACLT)-induced osteoarthritis (OA) in rats. Eight-week-old male Wistar rats were randomly assigned to the following groups: control, sham, ACLT, group A (ACLT + pepsin-soluble collagen type II collagen (C-II) with type I collagen), group B (ACLT + Amano M-soluble C-II with type I collagen), group C (ACLT + high-dose Amano M-soluble C-II with type I collagen), and group D (ACLT + unproteolyzed C-II). Various methods were employed to analyze the knee joint: nociceptive tests, microcomputed tomography, histopathology, and immunohistochemistry. Rats treated with any form of C-II had significant reductions in pain sensitivity and cartilage degradation. Groups that received PSCC-II treatment effectively mitigated the ACLT-induced effects of OA concerning cancellous bone volume, trabecular number, and trabecular separation compared with the ACLT alone group. Furthermore, PSCC-II and unproteolyzed C-II suppressed ACLT-induced effects, such as the downregulation of C-II and upregulation of matrix metalloproteinase-13, tumor necrosis factor-α, and interleukin-1β. These results indicate that PSCC-II treatment retains the protective effects of traditional undenatured C-II and provide superior benefits for OA management. These benefits encompass pain relief, anti-inflammatory effects, and the protection of cartilage and cancellous bone.
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Affiliation(s)
- Nan-Fu Chen
- Division of Neurosurgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan;
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung 80424, Taiwan;
| | - Yen-You Lin
- Department of Sports Medicine, China Medical University, Taichung 40402, Taiwan;
| | - Zhi-Kang Yao
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung 80424, Taiwan;
| | - Chung-Chih Tseng
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung 80424, Taiwan;
| | - Yu-Wei Liu
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung 80424, Taiwan;
| | - Ya-Ping Hung
- R&D Department, Taiyen Biotech Co., Ltd., Tainan 70263, Taiwan;
| | - Yen-Hsuan Jean
- Department of Orthopedic Surgery, Pingtung Christian Hospital, Pingtung 90059, Taiwan
| | - Zhi-Hong Wen
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung 80424, Taiwan;
- Institute of BioPharmaceutical Sciences, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
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Wen ZH, Sung CS, Lin SC, Yao ZK, Lai YC, Liu YW, Wu YY, Sun HW, Liu HT, Chen WF, Jean YH. Intra-Articular Lactate Dehydrogenase A Inhibitor Oxamate Reduces Experimental Osteoarthritis and Nociception in Rats via Possible Alteration of Glycolysis-Related Protein Expression in Cartilage Tissue. Int J Mol Sci 2023; 24:10770. [PMID: 37445948 DOI: 10.3390/ijms241310770] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/11/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Osteoarthritis (OA) is the most common form of arthritis and joint disorder worldwide. Metabolic reprogramming of osteoarthritic chondrocytes from oxidative phosphorylation to glycolysis results in the accumulation of lactate from glycolytic metabolite pyruvate by lactate dehydrogenase A (LDHA), leading to cartilage degeneration. In the present study, we investigated the protective effects of the intra-articular administration of oxamate (LDHA inhibitor) against OA development and glycolysis-related protein expression in experimental OA rats. The animals were randomly allocated into four groups: Sham, anterior cruciate ligament transection (ACLT), ACLT + oxamate (0.25 and 2.5 mg/kg). Oxamate-treated groups received an intra-articular injection of oxamate once a week for 5 weeks. Intra-articular oxamate significantly reduced the weight-bearing defects and knee width in ACLT rats. Histopathological analyses showed that oxamate caused significantly less cartilage degeneration in the ACLT rats. Oxamate exerts hypertrophic effects in articular cartilage chondrocytes by inhibiting glucose transporter 1, glucose transporter 3, hexokinase II, pyruvate kinase M2, pyruvate dehydrogenase kinases 1 and 2, pyruvate dehydrogenase kinase 2, and LHDA. Further analysis revealed that oxamate significantly reduced chondrocyte apoptosis in articular cartilage. Oxamate attenuates nociception, inflammation, cartilage degradation, and chondrocyte apoptosis and possibly attenuates glycolysis-related protein expression in ACLT-induced OA rats. The present findings will facilitate future research on LDHA inhibitors in prevention strategies for OA progression.
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Affiliation(s)
- Zhi-Hong Wen
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
- Institute of BioPharmaceutical Sciences, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Chun-Sung Sung
- Division of Pain Management, Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Sung-Chun Lin
- Department of Orthopedic Surgery, Pingtung Christian Hospital, No. 60 Dalian Road, Pingtung 90059, Taiwan
| | - Zhi-Kang Yao
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
- Department of Orthopedic Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan
| | - Yu-Cheng Lai
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
- Department of Orthopedics, Asia University Hospital, Taichung 41354, Taiwan
| | - Yu-Wei Liu
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Yu-Yan Wu
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Hsi-Wen Sun
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Hsin-Tzu Liu
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
| | - Wu-Fu Chen
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833301, Taiwan
| | - Yen-Hsuan Jean
- Department of Orthopedic Surgery, Pingtung Christian Hospital, No. 60 Dalian Road, Pingtung 90059, Taiwan
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12
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Ross AG, McKay MJ, Pappas E, Peek K. Insurance cost and injury characteristics of anterior cruciate ligament injuries in sub-elite football: A population analysis involving 3 years of Australian insurance data. J Sci Med Sport 2023:S1440-2440(23)00129-9. [PMID: 37349252 DOI: 10.1016/j.jsams.2023.06.003] [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: 01/03/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To investigate the injury characteristics and insurance cost of anterior cruciate ligament injuries in sub-elite football players in New South Wales, Australia. DESIGN Descriptive epidemiological study. METHODS Three years of insurance records (2018-2020) was used to describe anterior cruciate ligament injury costs and characteristics. Concomitant injuries and the mechanism of injury were determined by analysing the injury descriptions. Claim characteristics and costs are presented by age group (junior = 7-17 years, senior = 18-34 years, and veteran = 35 + years) and sex. Categorical data (including age-groups and sex) are presented as counts and percentages and analysed using a Chi squared or Fisher's exact test. Cost data are reported as means ± standard deviation with 95 % confidence intervals. RESULTS Over the course of three football seasons (2018-2020), 786 anterior cruciate ligament injuries were reported to the injury insurance company. The total insurance cost was AU$3,614,742 with direct injury insurance costs accounting for 36.3 % of the total costs. The mean indirect insurance costs were six-fold higher than direct insurance costs (AU$11,458 vs AU$1914). Isolated injuries had an average cost of $4466 whilst concomitant injuries had an average cost of $4951. Surgical costs are excluded from direct cost calculations. The peak injury count occurred in the first month of all three football seasons, immediately after the pre-season. CONCLUSIONS Anterior cruciate ligament injuries represent a substantial economic burden to the insurer and individual. The cost data provided can be used for future economic and modelling studies.
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Affiliation(s)
- Andrew G Ross
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Marnee J McKay
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Evangelos Pappas
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Faculty of Science, Medicine and Health, Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Kerry Peek
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
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Yang T, Jiang C, Ma Y. CLINICAL DIAGNOSIS AND TRAINING OPTIMIZATION ON KNEE SPORTS INJURIES. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329012022_0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Introduction: The knee joint is one of the sites of greatest mechanical stress in the lower limbs. The overload generated by impacts, blows from falls, and torsions in collisions can generate disabling tissue damage that is difficult to recover from. Although lacking clinical diagnosis, some studies have pointed out that implementing functional training in rehabilitation can reduce the period of disability and the harmful effects of immobilization. Objective: Study the clinical diagnosis and the optimization of training for knee sports injuries. Methods: This experiment uses the intra-group comparison method. The method used in the experiment is a rehabilitation training protocol for the knee joint, focusing on quadriceps muscle strength and balance. The training cycle is six times per week for one month. Results: The optimization in exercise training evidenced a good improvement in functional ability and pain condition, reflected in the athletes’ balance ability. After training optimization, 9 out of 12 athletes recovered completely, and three improved significantly. Conclusion: Trainers should follow the physical rehabilitation orders and match them with the athletes’ actual situation, sport types, etc., designing the appropriate sports mode for the athletes to promote training optimization and reduce sports joint injuries. Level of Evidence II; Therapeutic Studies - Outcome Investigation.
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Affiliation(s)
- Tianyu Yang
- Northeastern University at Qinhuangdao, China
| | | | - Yunfei Ma
- Yanshan University, China; Yanshan University, China
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14
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Chokhandre S, Schwartz A, Klonowski E, Landis B, Erdemir A. Open Knee(s): A Free and Open Source Library of Specimen-Specific Models and Related Digital Assets for Finite Element Analysis of the Knee Joint. Ann Biomed Eng 2023; 51:10-23. [PMID: 36104640 PMCID: PMC9832097 DOI: 10.1007/s10439-022-03074-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/04/2022] [Indexed: 01/28/2023]
Abstract
There is a growing interest in the use of virtual representations of the knee for musculoskeletal research and clinical decision making, and to generate digital evidence for design and regulation of implants. Accessibility to previously developed models and related digital assets can dramatically reduce barriers to entry to conduct simulation-based studies of the knee joint and therefore help accelerate scientific discovery and clinical innovations. Development of models for finite element analysis is a demanding process that is both time consuming and resource intensive. It necessitates expertise to transform raw data to reliable virtual representations. Modeling and simulation workflow has many processes such as image segmentation, surface geometry generation, mesh generation and finally, creation of a finite element representation with relevant loading and boundary conditions. The outcome of the workflow is not only the end-point knee model but also many other digital by-products. When all of these data, derivate assets, and tools are freely and openly accessible, researchers can bypass some or all the steps required to build models and focus on using them to address their research goals. With provenance to specimen-specific anatomical and mechanical data and traceability of digital assets throughout the whole lifecycle of the model, reproducibility and credibility of the modeling practice can be established. The objective of this study is to disseminate Open Knee(s), a cohort of eight knee models (and relevant digital assets) for finite element analysis, that are based on comprehensive specimen-specific imaging data. In addition, the models and by-products of modeling workflows are described along with model development strategies and tools. Passive flexion served as a test simulation case, demonstrating an end-user application. Potential roadmaps for reuse of Open Knee(s) are also discussed.
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Affiliation(s)
- Snehal Chokhandre
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ariel Schwartz
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ellen Klonowski
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin Landis
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmet Erdemir
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
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Zhou Y, Li L, Chen R, Gong M. Double-bundle versus single-bundle anterior cruciate ligament reconstruction in preventing the progression of osteoarthritis: A protocol for systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e31101. [PMID: 36626441 PMCID: PMC9750529 DOI: 10.1097/md.0000000000031101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The knee has a high incidence of osteoarthritis (OA) following the anterior cruciate ligament (ACL) injury, which was reduced by ACL reconstruction including double-bundle (DB) techniques and single-bundle (SB) techniques. However, the effectiveness of preventing the progression of OA after the ACL reconstruction using DB and SB techniques is controversial. METHODS This meta-analysis was performed following the preferred reporting items for systematic reviews and meta-analyses guidelines. The databases, including PubMed, Embase, and Cochrane Library, were searched. Randomized controlled trials comparing DB with SB ACL reconstruction and reporting clinical outcomes of radiological OA were included. Quality of the included studies was assessed using the Cochrane Collaboration's risk of bias tool. The outcome was analyzed using the risk ratio (RR) and its corresponding 95% confidence interval (CI). RESULTS Ten Randomized controlled trials studies were included in this meta-analysis (accounting 1062 knees: 475 SB and 587 DB). The rate of radiological OA after the ACL reconstruction was 39% in SB group and 34% in DB group. The results of meta-analysis showed no difference in the occurrence of radiological OA between DB group and in SB group (RR, 1.05; 95% CI, 0.85-1.30, P = .63), including subgroup of radiological scores of OA (subgroup of Minimal OA: RR, 0.95; 95% CI, 0.61-1.48; P = .82; subgroup of Notable OA: RR, 1.16; 95% CI, 0.75-1.78; P = .51), subgroup of follow-up time in 5 years and more than 5 years (RR, 0.98; 95% CI, 0.80-1.20; P = .85), and subgroup of autograft graft for ACL (RR, 0.97; 95% CI, 0.79-1.19; P = .77). However, the DB group had less incidences of knee OA than the SB group in subgroup of less than 5 years (RR, 1.48; 95% CI, 1.13-1.92; P = .004) and subgroup of allograft type (RR, 1.42; 95% CI, 1.06-1.91; P = .02). CONCLUSION Overall, this meta-analysis showed that the DB technique was no more effective in preventing the progression of OA than the SB technique in ACL reconstruction at midterm follow-up.
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Affiliation(s)
- Yun Zhou
- People’s Hospital of Leshan, Leshan, Sichuan, China
| | - Linji Li
- Department of Anesthesiology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Ran Chen
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Min Gong
- Department of Orthopaedic Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- * Correspondence: Min Gong, Department of Orthopaedics, the Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi’er Qiao Rd, Chengdu, Sichuan 610075, China (e-mail: )
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The development of long-term osteoarthritis following anterior cruciate ligament injury: reconstruction vs no reconstruction. Arch Orthop Trauma Surg 2022; 143:3201-3211. [PMID: 36305965 DOI: 10.1007/s00402-022-04662-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/10/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE The high incidence of osteoarthritis (OA) in relatively young sportspeople following anterior cruciate ligament (ACL) reconstruction is concerning. Surgery is considered to reduce the development of OA compared to conservative management. This long-term study aimed to compare the incidence and severity of tibiofemoral OA (TFOA) and patellofemoral OA (PFOA) between reconstructed and non-reconstructed treatment groups and to determine which factors influence the development of OA. MATERIALS AND METHODS Fifty-six ACL-reconstructed and 45 conservatively treated patients from a cohort of 330 were followed for 11 years (mean) post-injury. Twenty-nine patients had received a bone-patellar tendon-bone (B-PT-B) graft, and 27 had received a hamstring (semitendinosus/gracilis) tendon (HT) graft. Assessment included objective and subjective stability, quadriceps and hamstring strength and radiology. Chi-square analyses compared OA between reconstructed and non-reconstructed groups and between B-PT-B, HT and non-surgical groups. Further analysis assessed the relationship between OA and age, time post-injury, meniscal injury/meniscectomy, quadriceps strength, hamstring strength, objective and subjective stability and sporting activity. RESULTS Forty-eight per cent reconstructed and 53% non-reconstructed patients developed TFOA (p = 0.690). Thirty-six per cent reconstructed and 38% non-reconstructed patients developed PFOA (p = 0.831) with moderate PFOA occurring only in the non-reconstructed group. Close to significant differences (p = 0.075) were found comparing the severity of TFOA between groups with a higher incidence of moderate/severe OA in the non-reconstructed and B-PT-B groups. TFOA differed significantly between the B-PT-B and HT groups. The development of OA was related to age, time post-injury, meniscal injury/meniscectomy, quadriceps strength and subjective stability. CONCLUSIONS There were no significant differences in OA incidence between reconstructed and non-reconstructed groups but fewer patients developed TFOA following HT grafting compared to B-PT-B grafting and to non-surgical treatment. Quadriceps weakness and meniscal injuries/meniscectomy, both potentially modifiable, were strongly associated with the development of TF and PFOA.
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17
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Mao Z, Wang Z, Xu C, Liu C, Zhang Z, Ren X, Xue A, Li Z, Zhao F, Yao Q, Yu J. Intra-Articular Biomechanical Changes of the Meniscus and Ligaments During Stance Phase of Gait Circle after Different Anterior Cruciate Ligament Reconstruction Surgical Procedures: A Finite Element Analysis. Orthop Surg 2022; 14:3367-3377. [PMID: 36222205 PMCID: PMC9732611 DOI: 10.1111/os.13516] [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: 06/26/2021] [Revised: 08/15/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The debate on the superiority of single- or double-bundle for anterior cruciate ligament reconstruction has not ceased. The comparative studies on intra-articular biomechanics after different surgical reconstructions are rare. This study is to evaluate the biomechanical stress distribution intra-knee after single- and double-bundle anterior cruciate ligament reconstruction by three-dimensional finite element analysis, and to observe the change of stress concentration under the condition of vertical gradient loads. METHODS In this study, magnetic resonance imaging data were extracted from patients and healthy controls for biomechanical analysis. Patients included in the three models were matched in age and sex. The strength and distribution of induced stresses were analyzed in two frequently used procedures, anatomical single-bundle anterior cruciate ligament reconstruction and anatomical double-bundle anterior cruciate ligament reconstruction, using femoral-graft-tibial system under different loads, to mimic a post-operation mechanical motion. The three-dimensional finite-element models for normal ligament and two surgical methods were applied. A vertical force simulating daily walking was performed on the models to assess the interfacial stresses and displacements of intra-articular tissues and ligaments. The evaluation results mainly included the stress of each part of ligament and meniscus. The stress values of different parts of three models were extracted and compared. RESULTS The stress of ligament/graft at femoral side of three finite-element models was significantly higher than at tibial side, while the highest level was observed in single-bundle reconstruction finite-element model. With the increase of force, the maximum stress in the medial (7.1-7.1 MPa) and lateral (4.9-7.4 MPa) meniscus of single-bundle reconstruction finite-element model shifted from the anterior horn to the central area (p = 0.0161, 0.0479, respectively). The stress was shown to be at a lower level at femoral side and posterior cruciate ligament of intra-knee in two reconstruction finite-element models than that in normal finite-element models, while presented higher level at the tibial side than normal knee (p = 0.3528). The displacement of the femoral side and intra-knee areas in reconstruction finite-element models was greater than that in normal finite-element model (p = 0.0855). CONCLUSION Compared with the single-bundle technique, the graft of double-bundle anterior cruciate ligament reconstruction has better stress dissipation effect and can prevent postoperative meniscus tear more effectively.
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Affiliation(s)
- Zi‐mu Mao
- Department of Joint SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina,Institute of Sports MedicinePeking UniversityBeijingChina
| | - Zhen‐wei Wang
- Department of Joint SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
| | - Chao Xu
- Xinjiang Key Laboratory Neurological Disorder ResearchKey Laboratory of Autonomous RegionUrumchiChina,The Department of OrthopaedicsThe Second Affiliated Hospital of Xinjiang Medical UniversityUrumchiChina
| | - Chen‐he Liu
- Department of OrthopaedicsFirst Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Zhi‐yu Zhang
- Department of Sports MedicineYan'an Traditional Chinese Medicine HospitalYan'anChina
| | - Xiao‐li Ren
- Shanxi Institute of Sports ScienceTaiyuanTaiyuanChina
| | - An‐qi Xue
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical EngineeringSchool of Biological Science and Medical Engineering, Beihang UniversityBeijingChina,Beijing Institute of Medical Device TestingBeijingChina
| | - Ze‐nan Li
- Fengtai Fourth Outpatient DepartmentBeijing GarrisonBeijingChina
| | - Feng Zhao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical EngineeringSchool of Biological Science and Medical Engineering, Beihang UniversityBeijingChina
| | - Qi Yao
- Department of Joint SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
| | - Jia‐kuo Yu
- Institute of Sports MedicinePeking UniversityBeijingChina
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18
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Shu L, Abe N, Li S, Sugita N. Importance of posterior tibial slope in joint kinematics with an anterior cruciate ligament-deficient knee. Bone Joint Res 2022; 11:739-750. [PMID: 36226477 PMCID: PMC9582864 DOI: 10.1302/2046-3758.1110.bjr-2022-0039.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aims To fully quantify the effect of posterior tibial slope (PTS) angles on joint kinematics and contact mechanics of intact and anterior cruciate ligament-deficient (ACLD) knees during the gait cycle. Methods In this controlled laboratory study, we developed an original multiscale subject-specific finite element musculoskeletal framework model and integrated it with the tibiofemoral and patellofemoral joints with high-fidelity joint motion representations, to investigate the effects of 2.5° increases in PTS angles on joint dynamics and contact mechanics during the gait cycle. Results The ACL tensile force in the intact knee was significantly affected with increasing PTS angle. Considerable differences were observed in kinematics and initial posterior femoral translation between the intact and ACLD joints as the PTS angles increased by more than 2.5° (beyond 11.4°). Additionally, a higher contact stress was detected in the peripheral posterior horn areas of the menisci with increasing PTS angle during the gait cycle. The maximum tensile force on the horn of the medial meniscus increased from 73.9 N to 172.4 N in the ACLD joint with increasing PTS angles. Conclusion Knee joint instability and larger loading on the medial meniscus were found on the ACLD knee even at a 2.5° increase in PTS angle (larger than 11.4°). Our biomechanical findings support recent clinical evidence of a high risk of failure of ACL reconstruction with steeper PTS and the necessity of ACL reconstruction, which would prevent meniscus tear and thus the development or progression of osteoarthritis. Cite this article: Bone Joint Res 2022;11(10):739–750.
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Affiliation(s)
- Liming Shu
- Research into Artifacts, Center for Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan,Department of Mechanical Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan,Department of Mechanical Engineering, Dalian University of Technology, Dalian, China
| | - Nobuhiro Abe
- Department of Orthopaedic Surgery and Sport Medicine, General Medical Center, Kawasaki Medical School, Okayama, Japan, Nobuhiro Abe. E-mail:
| | - Shihao Li
- Research into Artifacts, Center for Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan,Department of Mechanical Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Naohiko Sugita
- Research into Artifacts, Center for Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan,Department of Mechanical Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
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Guo W, Wan T, Tan H, Fan G, Gao X, Liu P, Jiang C. Anterior cruciate ligament deficiency versus intactness for outcomes in patients after unicompartmental knee arthroplasty: a systematic review and meta-analysis. Front Bioeng Biotechnol 2022; 10:890118. [PMID: 36082162 PMCID: PMC9445614 DOI: 10.3389/fbioe.2022.890118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: The unicondylar knee arthroplasty (UKA) procedure is primarily indicated for osteoarthritis of the knee. Anterior cruciate ligament (ACL) defects have long been considered a contraindication to UKA. However, recent clinical studies have found that ACL defects do not affect postoperative outcomes in UKA. To elucidate whether ACL defects affect postoperative outcomes in UKA, we performed a systematic review and Meta-analysis of observational cohort studies comparing the effects of ACL defects and intactness on surgical outcomes in UKA. Methods: In this study, we used “Anterior Cruciate Ligament”, “Anterior Cruciate Ligament Injuries” and “Arthroplasty, Replacement, Knee” as the subject terms according to PICOS principles. These subject terms and the corresponding free texts were used to conduct a systematic search in the three major databases PubMed, Embase and Cochrane on December 9, 2021. The main study variables included age, gender, region, definition of ACL defect and diagnosed diseases. The study used a random effect model to pool the effect of 95% CIs. To explore the sources of heterogeneity and to test the stability of the results, a sensitivity analysis was performed. Results: The systematic review found no significant differences in postoperative clinical outcomes in the elderly population when unicondylar replacement was performed in the setting of multiple factors such as injury, defects, longitudinal tear, and synovial bursa injury defined as ACL deficiency. The primary clinical outcomes included postoperative revision, Tegner activity score, and Oxford Knee Score (OKS). After statistical meta-analysis, postoperative outcomes such as postoperative revision (OR, 1.174; 95% CIs, 0.758–1.817) and Tegner activity score (OR, -0.084; 95% CIs, -0.320–0.151) were not statistically different. Conclusion: There was no difference in postoperative revision rates and functional outcomes such as Tegner activity score between the ACL-deficient group compared with the ACL-intact group. For the present results, it is not advisable to consider ACL deficiency as a contraindication of UKA.
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Affiliation(s)
- Weiming Guo
- Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Teng Wan
- Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Haifeng Tan
- Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Gang Fan
- Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Xiaoyu Gao
- Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Pan Liu
- Hengyang Medical College, University of South China, Hengyang, Hunan, China
- *Correspondence: Pan Liu, ; Changqing Jiang,
| | - Changqing Jiang
- Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- *Correspondence: Pan Liu, ; Changqing Jiang,
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Sun TY, Hsu CL, Tseng WC, Yeh TT, Huang GS, Shen PH. Risk Factors Associated with Cartilage Defects after Anterior Cruciate Ligament Rupture in Military Draftees. J Pers Med 2022; 12:jpm12071076. [PMID: 35887573 PMCID: PMC9317476 DOI: 10.3390/jpm12071076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 01/21/2023] Open
Abstract
This study aimed to evaluate the different clinical results and factors associated with cartilage defects in military draftees who underwent different treatments after anterior cruciate ligament (ACL) rupture. Overall, 105 patients who had sustained ACL rupture were military draftees who underwent a conscription examination for physical status assessment from January 2012 to December 2020. Patients were divided into three groups: conservative treatment after ACL rupture, status post-anterior cruciate ligament reconstruction (ACLR), but graft rupture, and status post-ACLR with graft intact. Inter-group comparisons and statistical analyses were performed for age, body mass index (BMI), thigh circumference difference, side-to-side difference in anterior knee translation by KT-2000, meniscus tear, and cartilage defect. Multivariate logistic regression analysis was used to determine the factors associated with cartilage defects. The multivariable regression model showed that BMI (odds ratio OR: 1.303; 95% CI: 1.016–1.672; p = 0.037), thigh circumference difference (OR: 1.403; 95% CI: 1.003–1.084; p = 0.034), tear of lateral meniscus (LM) and medial meniscus (MM) (OR: 13.773; 95% CI: 1.354–140.09; p = 0.027), and graft rupture group (OR: 5.191; 95% CI: 1.388–19.419; p = 0.014) increased the risk of cartilage defects. There was no correlation between cartilage defects and age, KT-2000 difference, tear of LM or MM, or graft intact group. Progression of osteoarthritis was concerned after ACL rupture, and this study identified several factors of post-ACLR graft rupture, greater thigh circumference difference, BMI, and meniscus tear of both LM and MM affecting cartilage defects, which represent early degenerative osteoarthritis changes of the knee. The results of this study should be customized for rehabilitation and military training, especially in military draftees with ACL injuries.
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Affiliation(s)
- Ting-Yi Sun
- Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-Y.S.); (C.-L.H.); (T.-T.Y.)
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chun-Liang Hsu
- Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-Y.S.); (C.-L.H.); (T.-T.Y.)
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Wei-Cheng Tseng
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Tsu-Te Yeh
- Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-Y.S.); (C.-L.H.); (T.-T.Y.)
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Pei-Hung Shen
- Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-Y.S.); (C.-L.H.); (T.-T.Y.)
- Correspondence: ; Tel.: +886-2-87923311; Fax: +886-2-87927186
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21
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Jagadeesh N, Paidipati R, Parameshwar A, Shivalingappa VM. Correlation of tibial parameters like medial, lateral posterior tibial slope and medial plateau depth with ACL injuries: randomized control study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1267-1274. [PMID: 35608693 DOI: 10.1007/s00590-022-03288-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aims to compare variables such as medial posterior tibial slope, lateral posterior tibial slope, medial tibial plateau depth calculated by preoperative MRI, and posterior tibial slope calculated by lateral knee X-ray on randomly selected patients with ACL injuries to a control group of patients without the injury. The secondary aim is to determine the critical value of these parameters and ascertain whether they can be used as a screening tool to identify at-risk individuals. METHODS Study participants included 426 subjects with noncontact knee injuries. Using stratified systematic random sampling, they were randomly divided into two equal groups of sixty, one for patients with ACL tears, and the other for those with ACL that was intact based on clinical and MRI findings. Based on the blinded assessment, MPTS, LPTS, MTPD, and PTS were assessed in MRI and lateral knee X-ray (PTS only), and the results were compared between groups using appropriate statistical models. RESULTS There were higher MPTS, LPTS, and PTS scores in the ACL tear group when compared to the control group (p < 0.01), while MTPD was lower when compared to the control group (p > 0.05). ROC analysis for predicting ACL tear revealed an area under the curve for MPTS, LPTS, PTS, and MTPD as 0.942, 0.907, 0.967, and 0.878, respectively. The critical angle for MPTS, LTPS, PTS and MTPD was 8.25°,6.75°,8.5° and 2.25 mm, respectively, which has sensitivity of 91.0%, 86.7%, 93.3% and 80%; specificity of 86.7%, 78.3%, 90.0% and 71.7%, respectively. CONCLUSIONS Medial posterior tibial slope, lateral posterior tibial slope, and posterior tibial slope were significantly higher in individuals in the ACL tear group but there was no significant difference in medial tibial plateau depth. MPTS, LPTS, and PTS are better predictors of identifying at-risk individuals predisposed to ACL injury than MTPD.
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Affiliation(s)
- Nuthan Jagadeesh
- Department of Orthopedics, Vydehi Institute of Medical Sciences, Whitefield, Bangalore, Karnataka, India.
| | - Rajashree Paidipati
- Department of Orthopedics, Vydehi Institute of Medical Sciences, Whitefield, Bangalore, Karnataka, India
| | - Ambareesh Parameshwar
- Department of Orthopedics, Vydehi Institute of Medical Sciences, Whitefield, Bangalore, Karnataka, India
| | - Vishwanath M Shivalingappa
- Department of Orthopedics, Vydehi Institute of Medical Sciences, Whitefield, Bangalore, Karnataka, India
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Affiliation(s)
- Vishal Rajput
- University College London Hospitals, London, UK.,The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- University College London Hospitals, London, UK.,The Princess Grace Hospital, London, UK.,The NIHR Biomedical Research Centre at UCLH, London, UK.,The Bone & Joint Journal , London, UK
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23
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Lindanger L, Strand T, Mølster AO, Solheim E, Fischer-Bredenbeck C, Ousdal OT, Inderhaug E. Predictors of Osteoarthritis Development at a Median 25 Years After Anterior Cruciate Ligament Reconstruction Using a Patellar Tendon Autograft. Am J Sports Med 2022; 50:1195-1204. [PMID: 35234531 DOI: 10.1177/03635465221079327] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have investigated the outcome ≥20 years after an anterior cruciate ligament reconstruction (ACLR) with a bone-patellar tendon-bone autograft, and there is a wide range in the reported rates of radiographic osteoarthritis (OA). PURPOSE To report on radiographic OA development and to assess risk factors of knee OA at a median 25 years after ACLR with a bone-patellar tendon-bone autograft. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Unilateral ACLRs performed at a single center from 1987 to 1994 were included (N = 235). The study population was followed prospectively with clinical testing and questionnaires. Results from the 3-month, 12-month, and median 25-year follow-up are presented. In addition, a radiographic evaluation was performed at the final follow-up. Radiographic OA was defined as Kellgren-Lawrence grade ≥2 or having undergone ipsilateral knee replacement surgery. Possible predictors of OA development included patient age, sex, time from injury to surgery, use of a Kennedy ligament augmentation device, any concomitant meniscal surgery, and return to preinjury sports after surgery. RESULTS At long-term follow-up, 60% (141/235) of patients had radiographic OA in the involved knee and 18% (40/227) in the contralateral knee (P < .001). Increased age at surgery, male sex, increased time between injury and surgery, a Kennedy ligament augmentation device, and medial and lateral meniscal surgery were significant predictors of OA development in univariate analyses. Return to preinjury level of sports after surgery was associated with less development of OA. In the multivariate model, medial meniscal surgery and lateral meniscal surgery were independently associated with OA development. The adjusted odds ratio was 1.88 (95% CI, 1.03-3.43; P = .041) for medial meniscal surgery and 1.96 (95% CI, 1.05-3.67; P = .035) for lateral meniscal surgery. Patients who had developed radiographic signs of OA had significantly lower Knee injury and Osteoarthritis Outcome Score and Lysholm scores at long-term follow-up. CONCLUSION At 25 years after ACLR, 60% of patients had developed OA in the involved knee, and these patients reported significantly lower subjective outcomes. Medial meniscal surgery and lateral meniscal surgery were independent predictors of OA development at long-term follow-up.
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Affiliation(s)
- Line Lindanger
- Department of Orthopedics, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Torbjørn Strand
- Department of Orthopedics, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Orthopedics, Haukeland University Hospital, The Coastal Hospital at Hagevik, Bergen, Norway
| | - Anders Odd Mølster
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eirik Solheim
- Department of Orthopedics, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | | | - Eivind Inderhaug
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Orthopedics, Haukeland University Hospital, Bergen, Norway
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Riepen D, Kanski G, Chavez AA, Tavakolian P, Gronbeck C, Khazzam M, Coyner KJ. Demographic Factors Associated With an Increased Incidence of Intra-articular Injuries After Delayed Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671211073905. [PMID: 35387362 PMCID: PMC8977713 DOI: 10.1177/23259671211073905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Delays from the time of an anterior cruciate ligament (ACL) tear to surgical
reconstruction are associated with an increased incidence of meniscal and
chondral injuries. Purpose: To evaluate the association between delays in ACL reconstruction (ACLR) and
risk factors for intra-articular injuries across 8 patient demographic
subsets. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We performed a retrospective chart review of all patients who underwent ACLR
from January 2009 to May 2015 at a single institution. Variables collected
were age, sex, body mass index, time from injury to surgery, and presence of
meniscal tears and chondral injuries. Demographic subsets were created
according to sex, age (<27 vs ≥27 years), body mass index (<25 vs ≥25
kg/m2), and injury setting (sports vs non–sports related).
Subsets were divided by time from injury to ACLR: 0 to <6 months (control
group), 6 to <12 months, and ≥12 months. Multivariate logistic
regression–generated odds ratios (ORs) were calculated. Results: Overall, 410 patients were included. ORs were significant for an increased
incidence of medial meniscal tears (MMTs) (OR, 1.12-3.72; P
= .02), medial femoral condyle (MFC) injuries (OR, 1.18-4.81;
P = .02), and medial tibial plateau (MTP) injuries (OR,
1.33-31.07; P = .02) with surgical delays of 6 to <12
months. With ≥12-month delays, significance was found for MMTs (OR,
2.92-8.64; P < .001), MFC injuries (OR, 1.86-5.88;
P < .001), MTP injuries (OR, 1.37-21.22;
P = .02), lateral femoral condyle injuries (OR,
2.41-14.94; P < .001), and lateral tibial plateau
injuries (OR, 1.15-5.27; P = .02). In the subset analysis,
differences in the timing, location, rate, and pattern of chondral and
meniscal injuries became evident. Female patients and patients with
non–sports-related ACL tears had less risk of associated injuries with
delayed surgery, while other demographic groups showed an increased injury
risk. Conclusion: When analyzing patients who were symptomatic enough to eventually require
surgery, an increased incidence of MMTs and medial chondral injuries was
associated with ≥6-month delays in ACLR, and an increased incidence of
lateral chondral injuries was associated with ≥12-month delays. Female
patients and patients with non–sports-related ACL tears had less risk of
injuries with delayed ACLR.
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Affiliation(s)
- Dietrich Riepen
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Paul Tavakolian
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Michael Khazzam
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Haffar A, Ali R, Mehta N, Patel A, Fricka KB, Della Valle CJ, Gerlinger TL, Krueger CA, Lonner JH. Prior Anterior Cruciate Ligament Reconstruction Does Not Compromise the Functional Outcomes of Medial Unicompartmental Knee Arthroplasty Although Revision for Progressive Arthritis May Occur Earlier. J Arthroplasty 2022; 37:238-242. [PMID: 34699914 DOI: 10.1016/j.arth.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/07/2021] [Accepted: 10/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) deficiency is commonly considered a contraindication for unicompartmental knee arthroplasty (UKA). The purpose of this study is to compare the outcomes of UKA after prior ACL reconstruction (rACL cohort) to UKA with an intact native ACL (nACL cohort). METHODS Forty-five patients from 3 institutions who underwent medial UKA after prior rACL were matched by age, gender, preoperative function scores, and body mass index to 90 patients who underwent UKA with an intact nACL. Primary outcomes were Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Oxford Knee Scores, Knee Society Functional Scores, and Kellgren-Lawrence scores in the unresurfaced, lateral tibiofemoral compartment. Secondary outcomes were postoperative complications and the need for revision to TKA. RESULTS At a mean of 3.6 years, all PROMs improved significantly with no differences identified between groups. The incidence of revision TKA was similar between cohorts (P = 1.00); however, the mean time to revision for progressive osteoarthritis was 4.0 years in the nACL group and 2.2 years in the rACL group. Twenty percent of rACL patients had a postoperative complication compared to 8% in the nACL group. Despite presenting with a similar degree of lateral arthritis, a greater percentage of patients developed Kellgren-Lawrence scores of ≥3 in the rACL cohort (9%) than in the nACL cohort (0%). CONCLUSION A previously reconstructed ACL does not appear to compromise the short-term functional outcomes of UKA; however, there is a higher rate of minor complications and progression of lateral compartment arthritis, which should be considered with patients in the shared decision process.
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Affiliation(s)
- Amer Haffar
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Raheel Ali
- Anderson Orthopaedic Research Institute, Alexandria, VA; Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA
| | - Nabil Mehta
- Midwest Orthopaedics at Rush, Rush Univesity Medical Center, Chicago, IL
| | - Arpan Patel
- Midwest Orthopaedics at Rush, Rush Univesity Medical Center, Chicago, IL
| | - Kevin B Fricka
- Anderson Orthopaedic Research Institute, Alexandria, VA; Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA
| | | | - Tad L Gerlinger
- Midwest Orthopaedics at Rush, Rush Univesity Medical Center, Chicago, IL
| | - Chad A Krueger
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Osteoarthritis Progression after ACL Reconstruction Was Significantly Higher Than That of the Healthy Contralateral Knees: Long-Term Follow Up Study of Mean 16.4 Years. J Clin Med 2022; 11:jcm11030775. [PMID: 35160227 PMCID: PMC8836687 DOI: 10.3390/jcm11030775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023] Open
Abstract
Background: This study aimed to assess long-term progression of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction in athletes compared to the healthy contralateral side. Methods: The study included 15 patients and 30 knees with a mean age of 40 years (range, 35–46) years, none of whom had had revision surgery or an injury to the contralateral side. The mean follow-up period was 16.4 years (range, 13–22). Clinical and radiographic assessment included the Tegner activity scale (TAS), International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Kellgren and Lawrence (KL) grade. The long-term results of the injured knees were compared with the status of the healthy contralateral side and compared with previously published mid-term results of the same cohort of patients. Results: Patients generally remained clinically asymptomatic or mildly symptomatic at final follow-up, which is reflected by a KOOS pain score of 33 points (maximum 36 points) and an IKDC total subjective score of 87% (maximum 100%). There was a significant difference between mid-term and final follow-up in terms of the function score of the IKDC subjective questionnaire (p = 0.031), compartment findings and donor site morbidity of the IKDC functional examination (both p = 0.034), and the total KOOS score (p = 0.047). The KL score indicated significant progression of OA from mid-term to final follow-up in the injured knees (p = 0.004) and healthy contralateral knees (p = 0.014). Mean OA grades of the injured knees were significantly higher compared with the healthy contralateral side (p = 0.006) at final follow-up, and two patients showed moderate to severe signs of OA in the injured knee. Conclusions: Although most patients remained clinically asymptomatic or mildly symptomatic, long-term progression of OA after isolated ACL reconstruction in athletes was significantly higher compared with the healthy contralateral knee.
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Kim SH, Seo JH, Kim DA, Lee JW, Kim KI, Lee SH. Steep posterior lateral tibial slope, bone contusion on lateral compartments and combined medial collateral ligament injury are associated with the increased risk of lateral meniscal tear. Knee Surg Sports Traumatol Arthrosc 2022; 30:298-308. [PMID: 33687540 DOI: 10.1007/s00167-021-06504-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/10/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine the risk factors for lateral meniscus and root tears in patients with acute anterior cruciate ligament (ACL) injuries. METHODS A total of 226 patients undergoing acute ACL reconstruction were included in the study sample. Exclusion criteria were revisions, fractures, chronic cases, and multiple ligament injuries, with the exception of medial collateral ligament (MCL) injuries. The patients were divided into groups based on the presence of lateral meniscus and root tears by arthroscopy. Binary logistic regression was used to analyze risk factors including age, sex, body mass index (BMI), injury mechanism (contact/non-contact), Segond fracture, side-to-side laxity, location of bone contusion, medial and lateral tibial and meniscal slope, mechanical axis angle, and grade of pivot shift. RESULTS Overall lateral meniscus (LM) tears were identified in 97 patients (42.9%), and LM root tears were found in 22 patients (9.7%). The risk of an LM tear in ACL-injured knees increased with bone contusion on LTP (odds ratio [OR], 3.5; 95% confidence interval [CI] 1.419-8.634; P = 0.007), steeper lateral tibial slope (OR, 1.133; 95% CI 1.003-1.28; P = 0.045), MCL injury (OR, 2.618; 95% CI 1.444-4.746; P = 0.002), and non-contact injury mechanism (OR, 3.132; 95% CI 1.446-6.785; P = 0.004) in logistic regression analysis. The risk of LM root tear in ACL-injured knees increased with high-grade pivot shift (OR, 9.127; 95% CI 2.821-29.525; P = 0.000) and steeper lateral tibial slope (OR, 1.293; 95% CI 1.061-1.576; P = 0.011). CONCLUSION The increased risk of LM lesions in acute ACL-injured knees should be considered if significant risk factors including bone contusion on lateral compartments, MCL injury, and a steeper lateral tibial slope are present. Moreover, high-grade rotational injury with steeper lateral tibial slope are also significant risk factors for LM root tears, and therefore care should be taken by clinicians not to miss such lesions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang Univ., Namyangju-Si, Kyunggi-Do, Korea
- Department of Orthopedic Surgery, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, Korea
| | - Jeung-Hwan Seo
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul, 134-727, Korea
| | - Dae-An Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul, 134-727, Korea
| | - Joong-Won Lee
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul, 134-727, Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul, 134-727, Korea
| | - Sang Hak Lee
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul, 134-727, Korea.
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An older age, a longer duration between injury and surgery, and positive pivot shift test results increase the prevalence of articular cartilage injury during ACL reconstruction in all three compartments of the knee in patients with ACL injuries. Knee Surg Sports Traumatol Arthrosc 2022; 30:219-230. [PMID: 33543356 DOI: 10.1007/s00167-021-06461-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate factors that influence the prevalence of articular cartilage injury in patients with anterior cruciate ligament (ACL) injury. METHODS This multicentre study included patients with ACL injury. Logistic regression analysis was conducted to identify factors that influence the prevalence of cartilage injury during ACL reconstruction. RESULTS A total of 811 patients were enrolled. The factors that significantly influenced the prevalence of cartilage injury were age (odds ratio [OR], 1.04; P = 0.000), a positive pivot shift test result (OR, 1.43; P = 0.021), medial meniscal injury (OR, 2.55; P = 0.000), and delayed surgery (≥ 12 months) (OR, 2.52; P = 0.028) in the medial compartment of the knee; age (OR, 1.05; P = 0.000), subjective grades of apprehension during the pivot shift test (OR, 1.46; P = 0.010), lateral meniscal injury (OR, 1.98; P = 0.003), femoro-tibial angle (FTA) (OR, 0.92; P = 0.006), and delayed surgery (≥ 12 months) (OR, 2.63; P = 0.001) in the lateral compartment; and age (OR, 1.06; P = 0.000), body mass index (OR, 1.07; P = 0.028), a positive pivot shift test result (OR, 1.60; P = 0.018), FTA (OR, 0.90; P = 0.006), and delayed surgery (≥ 12 months) (OR, 3.17; P = 0.008) in the patellofemoral compartment. CONCLUSION An older age, a longer duration between injury and surgery, and a positive pivot shift test result were positively associated with the prevalence of cartilage injury in three compartments in patients with ACL injuries. Early ACL reconstruction is recommended to prevent cartilage injury. LEVEL OF EVIDENCE Level III.
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Good functional outcomes in patient’s age > 40 years after anterior cruciate ligament reconstruction with hamstring tendon graft: a retrospective study. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00754-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Meglic U, Salapura V, Zupanc O. MRI Findings of Early Osteoarthritis in Patients Who Sustained Septic Arthritis of the Knee After ACL Reconstruction. Orthop J Sports Med 2021; 9:23259671211052519. [PMID: 34778482 PMCID: PMC8573493 DOI: 10.1177/23259671211052519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Although a rare complication, septic arthritis (SA) after anterior cruciate ligament (ACL) reconstruction has potentially devastating consequences for the knee joint. Purpose: To prospectively analyze, at a mean 4-year follow-up, subjective, clinical, radiographic, and magnetic resonance imaging (MRI) findings between patients with SA and those with no septic complication after ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Of 2006 ACL reconstructions performed between 2004 and 2014, a total of 20 patients experienced SA. All patients were treated with arthroscopic irrigation and graft-retaining debridement immediately after diagnosis and at least 6 weeks of antibiotic treatment. After the exclusion process, 18 patients were included in the SA group and 20 in the control group. At final follow-up at a mean 48 months, a physical examination, KT-1000 arthrometer laxity test, Lysholm knee score, Tegner activity score, and International Knee Documentation Committee radiographic score were completed and then compared with preoperative data. The Boston-Leeds Osteoarthritis Knee Score was used for MRI evaluation at final follow-up to note chondral changes. Results: No significant differences between the SA and control groups were observed in pre- and perioperative variables that could indicate a higher incidence of early osteoarthritis (OA). Although range of motion and knee stability were not significantly different between the groups at final follow-up, the Lysholm score (mean ± SD, 79.8 ± 13.1 vs 90.9 ± 8.6; P < .01) and Tegner score (6.0 ± 1.1 vs 7.0 ± 1.4; P = .03) were significantly lower in the SA group as compared with the control group. MRI evaluation at final follow-up demonstrated a significantly higher degree of early knee OA in the SA group versus the control group. However, no differences in the degree of OA were seen on plain radiographs at final follow-up between the groups. Conclusion: MRI evaluation provided signs of worsened chondral state in the SA group, which could be associated with reduced functional outcome and return to sports. In contrast to radiograph analyses, MRI was excellent at distinguishing damage to the cartilage and can be useful in early follow-up evaluation of patients with SA after ACL reconstruction.
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Affiliation(s)
- Uros Meglic
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vladka Salapura
- Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Oskar Zupanc
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
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BORGES JOSEHUMBERTODESOUZA, CAMPOS BRUNOSANTOSLEAL, ANDRADE RENANANTÔNIOQUINTINODE, FREITAS ANDERSON, RIBEIRO MATHEUSDASILVA, LOBO JUNIOR PAULO. DOES PARTIAL MENISCECTOMY AFFECT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION RESULTS? ACTA ORTOPEDICA BRASILEIRA 2021; 29:308-311. [PMID: 34849095 PMCID: PMC8601378 DOI: 10.1590/1413-785220212906244475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/14/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the application of partial meniscectomy concomitant with primary ACL reconstruction, using the graft from the patellar tendon with individuals who underwent only ACL reconstruction, in clinical functional criteria and degree of osteoarthritis (OA), after 10 years of the surgical process. METHODS This is a retrospective cross-sectional study with 37 patients who underwent ACL reconstruction with a graft from the patellar tendon, associated or not with partial meniscectomy, divided into 2 groups: with meniscal injury (n = 22) and without meniscal injury (n = 15). Anthropometric data and four outcome measures were used to analyze the results: SF-36 questionnaire, arc of motion assessment, Knee injury and Osteoarthritis Outcome Score (KOOS), and Ahlbäck Radiographic Classification. RESULTS No differences were found for health-related quality of life, arc of motion, functional condition and knee OA severity/grade in patients who underwent partial or no meniscectomy in conjunction with ACL reconstruction (p > 0.05). CONCLUSION Participants who underwent partial meniscectomy in conjunction with primary ACL reconstruction with a graft from the patellar tendon, after 10 years of the surgical process, showed no significant differences in the clinical functional criteria and severity of knee OA, compared to individuals who underwent only ACL reconstruction. Level of Evidence II, Prognostic study.
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Incidence of Total Knee Replacement in Patients With Previous Anterior Cruciate Ligament Reconstruction. Clin J Sport Med 2021; 31:e442-e446. [PMID: 33914491 DOI: 10.1097/jsm.0000000000000852] [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: 07/15/2019] [Accepted: 02/29/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the rate of total knee replacement (TKR) after anterior cruciate ligament reconstruction (ACL-R) compared to the general population. DESIGN Retrospective review. SETTING All hospitals that performed TKR and ACL-R in Manitoba between 1980 and 2015. PARTICIPANT All patients that underwent TKR and ACL-R in Manitoba between 1980 and 2015. INTERVENTION Patient factors gathered at time of surgery included: age, sex, urban or rural residence, neighborhood income quintile, and resource utilization band (RUB). Each person was matched with up to 5 people from the general population who had never had ACL-R and had not had a TKR at the time of the case ACL-R. MAIN OUTCOME MEASURES The rate of TKR after ACL-R. RESULTS Overall from 1980 to 2015, 8500 ACL-R were identified within the 16 to 60 years age group with a resultant 42 497 population matches. Sex was predominantly male. The mean age of the ACL-R group at the time of TKR was 53.7 years, whereas the mean age for the matched cohort was 58.2 years, P < 0.001. Those with ACL-R were 4.85 times more likely to go on to have TKR. Apart from age, no other risk factors examined (location, year of surgery, place of residence, income quintile, and RUB) seemed to increase risk of TKR after ACL-R. CONCLUSION Patients who underwent ACL-R were 5 times more likely to undergo TKR.
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Irfan A, Kerr S, Hopper G, Wilson W, Wilson L, Mackay G. A Criterion Based Rehabilitation Protocol for ACL Repair with Internal Brace Augmentation. Int J Sports Phys Ther 2021; 16:870-878. [PMID: 34123539 PMCID: PMC8169034 DOI: 10.26603/001c.22217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022] Open
Abstract
The anterior cruciate ligament (ACL) is one of the main stabilizing structures of the knee and its rupture is a common injury in young active adults. ACL reconstruction has been the preferred operative management of an ACL rupture for several decades; however, success rates are variable. Recently, interest in arthroscopic primary repair of the ligament has increased. The repair is augmented with an Internal Brace (IB), which is an ultra-high strength suture tape that bridges the ligament. This technique protects the ligament during the healing and the ligament is encouraged to heal naturally, whilst not requiring any external braces. It acts as a stabiliser to permit early mobilization and optimise rehabilitation. As understanding of rehabilitation has progressed, there has been an increased focus on early weight-bearing and achieving full range of movement. While detailed criterion-based rehabilitation protocols exist for ACL reconstruction, this is not the case for ACL repair. The purpose of this commentary is to present a novel criterion-based rehabilitation protocol following ACL repair surgery augmented with an IB. LEVEL OF EVIDENCE V.
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Kawashima I, Tsukahara T, Sakai T, Kawai R, Ishizuka S, Hiraiwa H, Imagama S. Delayed anterior cruciate ligament reconstruction increases the incidence of medial meniscal bucket handle tears and medial compartment chondral injuries in patients aged 40 years and older. Arch Orthop Trauma Surg 2021; 141:971-975. [PMID: 33426607 DOI: 10.1007/s00402-020-03745-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION No widely accepted evidence-based indications exist for the initial surgical management of patients with anterior cruciate ligament (ACL) injuries ≥ 40 years old, and treatment for these patients remains controversial. This study aimed to evaluate the association between elapsed time from ACL injury to surgery and the incidence of meniscal tears and chondral injury in patients aged ≥ 40 years. MATERIALS AND METHODS The patients who underwent primary ACL reconstruction were divided into two groups based on elapsed time from injury to surgery: early group, < 12 months; and delayed group, ≥ 12 months. Patient records were reviewed for incidence and types of meniscal tears and chondral injuries in each group. Chondral injury grades were evaluated with International Cartilage Regeneration and Joint Preservation Society (ICRS) Criteria. RESULTS This study evaluated 67 knees in the early group and 33 knees in the delayed group. Mean ages in each group were 46.9 ± 6.5 and 46.9 ± 6.0. The delayed group showed significantly higher rates of medial meniscal tear [31 of 33, 93.9% vs 29 of 67, 43.3%; P < 0.0001; odds ratio (OR), 20.31; 95% confidence interval (CI), 4.49-91.9], medial femoral condyle chondral injuries ≥ ICRS grade II (15 of 33, 45.5% vs 8 of 67, 11.9%; P < 0.001; OR, 6.15; 95% CI 2.24-16.83), and medial tibial chondral injuries ≥ ICRS grade II (7 of 33, 21.2% vs 3 of 67, 4.5%; P < 0.05; OR, 5.74; 95% CI 1.38-23.9) compared with the early group. With respect to types of medial meniscal tear, the delayed group showed a significantly higher frequency of bucket handle tears (11 of 33, 33.3%) compared with the early group (2 of 67, 3.0%; P < 0.0001; OR, 16.25; 95% CI 3.34-79.1). CONCLUSIONS Delayed ACL reconstruction was associated with increased incidence of chondral injuries and medial meniscal tears, particularly bucket handle tears in this cohort. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Itaru Kawashima
- Asahi University Hospital, Gifu, Japan. .,Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan. .,Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Takashi Tsukahara
- Asahi University Hospital, Gifu, Japan.,Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan
| | - Tadahiro Sakai
- Department of Orthopaedic Surgery, Toyota Memorial Hospital, 1-1 Heiwa-cho, Toyota, Aichi, 471-8513, Japan
| | - Ryosuke Kawai
- Asahi University Hospital, Gifu, Japan.,Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hideki Hiraiwa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Abstract
Deep learning for MRI detection of sports injuries poses unique challenges. To address these difficulties, this study examines the feasibility and incremental benefit of several customized network architectures in evaluation of complete anterior cruciate ligament (ACL) tears. Two hundred sixty patients, ages 18-40, were identified in a retrospective review of knee MRIs obtained from September 2013 to March 2016. Half of the cases demonstrated a complete ACL tear (624 slices), the other half a normal ACL (3520 slices). Two hundred cases were used for training and validation, and the remaining 60 cases as an independent test set. For each exam with an ACL tear, coronal proton density non-fat suppressed sequence was manually annotated to delineate: (1) a bounding-box around the cruciate ligaments; (2) slices containing the tear. Multiple convolutional neural network (CNN) architectures were implemented including variations in input field-of-view and dimensionality. For single-slice CNN architectures, validation accuracy of a dynamic patch-based sampling algorithm (0.765) outperformed both cropped slice (0.720) and full slice (0.680) strategies. Using the dynamic patch-based sampling algorithm as a baseline, a five-slice CNN input (0.915) outperformed both three-slice (0.865) and single-slice (0.765) inputs. The final highest performing five-slice dynamic patch-based sampling algorithm resulted in independent test set AUC, sensitivity, specificity, PPV, and NPV of 0.971, 0.967, 1.00, 0.938, and 1.00. A customized 3D deep learning architecture based on dynamic patch-based sampling demonstrates high performance in detection of complete ACL tears with over 96% test set accuracy. A cropped field-of-view and 3D inputs are critical for high algorithm performance.
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36
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Vajapey SP, Alvarez PM, Greco NJ, Chonko DJ. Medial Osteoarthritis in an ACL-Deficient Knee: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202103000-00005. [PMID: 33735156 DOI: 10.2106/jbjs.rvw.20.00132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» In anterior cruciate ligament (ACL)-deficient knees, treatment of medial compartment osteoarthritis (OA) that is refractory to nonoperative modalities is a controversial subject. » Currently available treatment options include unicompartmental knee arthroplasty (UKA) with or without ACL reconstruction (ACLR), high tibial osteotomy (HTO) with or without ACLR, and total knee arthroplasty (TKA). » Each treatment option has its own risks and benefits, and the evidence that is reviewed in this article suggests that patient characteristics guide treatment selection. » Future high-quality prospective studies that directly compare all 3 of the modalities are necessary to determine the best treatment option for different patient populations.
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Affiliation(s)
- Sravya P Vajapey
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Flanagan SD, Proessl F, Dunn-Lewis C, Sterczala AJ, Connaboy C, Canino MC, Beethe AZ, Eagle SR, Szivak TK, Onate JA, Volek JS, Maresh CM, Kaeding CC, Kraemer WJ. Differences in brain structure and theta burst stimulation-induced plasticity implicate the corticomotor system in loss of function after musculoskeletal injury. J Neurophysiol 2021; 125:1006-1021. [PMID: 33596734 DOI: 10.1152/jn.00689.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Traumatic musculoskeletal injury (MSI) may involve changes in corticomotor structure and function, but direct evidence is needed. To determine the corticomotor basis of MSI, we examined interactions among skeletomotor function, corticospinal excitability, corticomotor structure (cortical thickness and white matter microstructure), and intermittent theta burst stimulation (iTBS)-induced plasticity. Nine women with unilateral anterior cruciate ligament rupture (ACL) 3.2 ± 1.1 yr prior to the study and 11 matched controls (CON) completed an MRI session followed by an offline plasticity-probing protocol using a randomized, sham-controlled, double-blind, cross-over study design. iTBS was applied to the injured (ACL) or nondominant (CON) motor cortex leg representation (M1LEG) with plasticity assessed based on changes in skeletomotor function and corticospinal excitability compared with sham iTBS. The results showed persistent loss of function in the injured quadriceps, compensatory adaptations in the uninjured quadriceps and both hamstrings, and injury-specific increases in corticospinal excitability. Injury was associated with lateralized reductions in paracentral lobule thickness, greater centrality of nonleg corticomotor regions, and increased primary somatosensory cortex leg area inefficiency and eccentricity. Individual responses to iTBS were consistent with the principles of homeostatic metaplasticity; corresponded to injury-related differences in skeletomotor function, corticospinal excitability, and corticomotor structure; and suggested that corticomotor adaptations involve both hemispheres. Moreover, iTBS normalized skeletomotor function and corticospinal excitability in ACL. The results of this investigation directly confirm corticomotor involvement in chronic loss of function after traumatic MSI, emphasize the sensitivity of the corticomotor system to skeletomotor events and behaviors, and raise the possibility that brain-targeted therapies could improve recovery.NEW & NOTEWORTHY Traumatic musculoskeletal injuries may involve adaptive changes in the brain that contribute to loss of function. Our combination of neuroimaging and theta burst transcranial magnetic stimulation (iTBS) revealed distinct patterns of iTBS-induced plasticity that normalized differences in muscle and brain function evident years after unilateral knee ligament rupture. Individual responses to iTBS corresponded to injury-specific differences in brain structure and physiological activity, depended on skeletomotor deficit severity, and suggested that corticomotor adaptations involve both hemispheres.
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Affiliation(s)
- Shawn D Flanagan
- Department of Human Sciences, The Ohio State University, Columbus, Ohio.,Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Felix Proessl
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Courtenay Dunn-Lewis
- Department of Cardiothoracic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adam J Sterczala
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chris Connaboy
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maria C Canino
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anne Z Beethe
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shawn R Eagle
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tunde K Szivak
- Department of Health Sciences, Merrimack College, North Andover, Massachusetts
| | - James A Onate
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Jeff S Volek
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - Carl M Maresh
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - Christopher C Kaeding
- Sports Health and Performance Institute, Department of Orthopaedics, The Ohio State University, Columbus, Ohio
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
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Conley CEW, Mattacola CG, Jochimsen KN, Dressler EV, Lattermann C, Howard JS. A Comparison of Neuromuscular Electrical Stimulation Parameters for Postoperative Quadriceps Strength in Patients After Knee Surgery: A Systematic Review. Sports Health 2021; 13:116-127. [PMID: 33428557 DOI: 10.1177/1941738120964817] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Postoperative quadriceps strength weakness after knee surgery is a persistent issue patients and health care providers encounter. OBJECTIVE To investigate the effect of neuromuscular electrical stimulation (NMES) parameters on quadriceps strength after knee surgery. DATA SOURCES CINAHL, MEDLINE, SPORTDiscus, and PubMed were systematically searched in December 2018. STUDY SELECTION Studies were excluded if they did not assess quadriceps strength or if they failed to report the NMES parameters or quadriceps strength values. Additionally, studies that applied NMES to numerous muscle groups or simultaneously with other modalities/treatments were excluded. Study quality was assessed with the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 1. DATA EXTRACTION Treatment parameters for each NMES treatment was extracted for comparison. Quadriceps strength means and standard deviations were extracted and utilized to calculate Hedge g effect sizes with 95% CIs. RESULTS Eight RCTs were included with an average Physiotherapy Evidence Database scale score of 5 ± 2. Hedge g effect sizes ranged from small (-0.37; 95% CI, -1.00 to 0.25) to large (1.13; 95% CI, 0.49 to 1.77). Based on the Strength of Recommendation Taxonomy Quality of Evidence table, the majority of the studies included were low quality RCTs categorized as level 2: limited quality patient-oriented evidence. CONCLUSION Because of inconsistent evidence among studies, grade B evidence exists to support the use of NMES to aid in the recovery of quadriceps strength after knee surgery. Based on the parameters utilized by studies demonstrating optimal treatment effects, it is recommended to implement NMES treatment during the first 2 postoperative weeks at a frequency of ≥50 Hz, at maximum tolerable intensity, with a biphasic current, with large electrodes and a duty cycle ratio of 1:2 to 1:3 (2- to 3-second ramp).
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Affiliation(s)
- Caitlin E W Conley
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Carl G Mattacola
- College of Health and Human Sciences, The University of North Carolina Greensboro, Greensboro, North Carolina
| | - Kate N Jochimsen
- Division of Athletic Training, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Emily V Dressler
- Department of Biostatistics and Data Science, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Christian Lattermann
- Department of Orthopedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer S Howard
- Department of Health and Exercise Science, Beaver College of Health Sciences, Appalachian State University, Boone, North Carolina
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Kawashima I, Hiraiwa H, Ishizuka S, Kawai R, Kusaka Y, Ohtomo K, Tsukahara T. Incidence of Medial and Lateral Meniscal Tears After Delayed Anterior Cruciate Ligament Reconstruction in Pediatric Patients. Orthop J Sports Med 2020; 8:2325967120964603. [PMID: 33283009 PMCID: PMC7686615 DOI: 10.1177/2325967120964603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The treatment of pediatric anterior cruciate ligament (ACL) injuries is
controversial, and no clear management guidelines have been established. Purpose: To evaluate the association between elapsed time from ACL injury to surgery
and the incidence of meniscal tears and chondral injuries in patients aged
≤16 years. Study Design: Cohort study; Level of evidence, 3. Methods: Between December 2012 and April 2019, a total of 207 consecutive knees in 207
patients aged ≤16 years underwent primary ACL reconstruction and were
included in this study. Patients were divided into 1 of 2 groups (early
group [≤150 days] and delayed group [>150 days]) based on the time
between injury and surgery. Patient records, including arthroscopic findings
identified by 2 experienced knee surgeons at the time of surgery, were
reviewed for demographic information, incidence and types of medial and
lateral meniscal tears, and chondral injuries and their locations in each
group. Results: There were 180 knees in the early group and 27 knees in the delayed group.
The delayed group showed a significantly higher rate of medial meniscal
tears than the early group: 16 of 27 (59.2%) and 46 of 180 (25.6%),
respectively (odds ratio [OR], 4.24 [95% CI, 1.83-9.33]; P
= .0011). The delayed group had a significantly lower rate of lateral
meniscal tears than the early group: 6 of 27 (22.2%) and 90 of 180 (50.0%),
respectively (OR, 0.29 [95% CI, 0.11-0.70]; P = .007). The
delayed group had significantly higher rates of chondral injuries in the
medial femoral condyle and the medial tibial plateau than the early group: 8
of 27 (29.6%) and 25 of 180 (13.9%), respectively (OR, 2.61 [95% CI,
1.03-6.62]; P = .049), and 2 of 27 (7.4%) and 1 of 180
(0.6%), respectively (OR, 14.32 [95% CI, 1.58-208.10]; P =
.045). Conclusion: Delayed ACL reconstruction was associated with an increased incidence of
medial chondral injuries and medial meniscal tears but with a decreased
incidence of lateral meniscal tears.
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Affiliation(s)
- Itaru Kawashima
- Department of Orthopaedic Surgery, Asahi University Hospital, Gifu, Japan.,Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Hiraiwa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryosuke Kawai
- Department of Orthopaedic Surgery, Asahi University Hospital, Gifu, Japan
| | - Yoshiaki Kusaka
- Department of Orthopaedic Surgery, Asahi University Hospital, Gifu, Japan
| | - Katsuyuki Ohtomo
- Department of Orthopaedic Surgery, Asahi University Hospital, Gifu, Japan
| | - Takashi Tsukahara
- Department of Orthopaedic Surgery, Asahi University Hospital, Gifu, Japan
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Reconstruction of the anterior cruciate- and anterolateral ligament deficient knee with a modified iliotibial graft reduces instability more than with an intra-articular hamstring graft. Knee Surg Sports Traumatol Arthrosc 2020; 28:2526-2534. [PMID: 32040678 DOI: 10.1007/s00167-020-05850-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/10/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare knee kinematics before and after anterior cruciate ligament ACL reconstruction (ACL-R) using hamstring graft (HG) and a double-stranded iliotibial tract graft attached to Gerdy's tubercle (providing an extra-articular anterolateral tenodesis) (named the modified iliotibial tract graft = MIT). METHOD Eighteen cadaveric knees were tested in a 6 degree of freedom kinematics rig. An optical tracking system recorded kinematics of the knee from 0 to 80 degrees of flexion applying no load, internal/external rotation (IR/ER), valgus/varus rotation (VGR/VRR), simulated pivot shift (SPS), anterior translation (AT) and posterior translation loads. The knee was tested before and after resection of the ACL and the anterolateral ligament (ALL), respectively; then after HG-ACL-R and MIT-ACL-R. Grafts were fixed at 20° of flexion. Results were compared to the intact knee. RESULTS ACL resection resulted in a significant increase in AT (p < 0.05) over the entire range of motion, peaking at 20° of flexion, mean difference 6.6 ± 2.25 mm (p = 0.0007). ACL-R with HG-ACL and MIT-ACL restored AT. Resection of the ALL increased IR in the fully extended knee, mean difference 2.4 ± 2.1° (p = 0.024). When compared to the intact knee and the knee after HG-ACL-R, MIT-ACL-R knee reduced IR/SPS significantly (p < 0.05) in deep flexion angles (60°-80°), peaking at 80° of flexion. The MIT-ACL-R caused significantly less VRR at 80° flexion (p = 0.02). CONCLUSION MIT-ACL-R restored AT equally to the HG-ACL-R. The MIT-ACL-R reduced IR and SPS in deep flexion, resulting in overconstraint. MIT-ACL-R can be used as an alternative to standard reconstruction methods.
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Ren S, Shi H, Yu Y, Liang Z, Jiang Y, Wang Q, Miao X, Li D, Zhang S, Hu X, Huang H, Ao Y. Dynamic Between-Leg Differences While Walking in Anterior Cruciate Ligament-Deficient Patients With and Without Medial Meniscal Posterior Horn Tears. Orthop J Sports Med 2020; 8:2325967120919058. [PMID: 32548180 PMCID: PMC7249581 DOI: 10.1177/2325967120919058] [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] [Indexed: 11/24/2022] Open
Abstract
Background: Patients with anterior cruciate ligament–deficient (ACLD) knees with medial
meniscal posterior horn tears (MMPHTs) have been reported to demonstrate a
combined stiffening and pivot-shift gait pattern compared with healthy
controls. Movement asymmetries are implicated in the development and
progression of osteoarthritis. Purpose: To investigate the knee kinematics and kinetic asymmetries in ACLD patients
with (ACLD + MMPHT group) and without (ACLD group) MMPHTs while walking on
level ground. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 15 patients with isolated unilateral ACL ruptures, 10 with
unilateral ACL ruptures and MMPHTs, and 22 healthy controls underwent gait
testing between January 2014 and December 2016. Between-leg differences
(BLDs) in knee kinematics and kinetics were compared among participants in
all groups. Results: The ACLD + MMPHT group demonstrated significantly greater BLDs in knee
moments in the sagittal plane during the loading response phase than the
ACLD and control groups. Compared with the control group, the ACLD and ACLD
+ MMPHT groups demonstrated significantly greater BLDs in knee angles in the
sagittal plane during the midstance and terminal stance phases. Compared
with the control group, significantly greater BLDs in knee rotation moments
were found throughout the stance phase in both the ACLD and the ACLD + MMPHT
groups. BLDs in lateral ground-reaction forces (GRFs) in the ACLD + MMPHT
and ACLD groups were both significantly greater than the control group
during the loading response phase. BLDs in anterior GRFs in the ACLD + MMPHT
and ACLD groups were both significantly greater than the control group
during the loading response phase. Only the ACLD + MMPHT group demonstrated
greater BLDs in vertical GRFs than the control group during the loading
response phase, while no significant differences were observed between the
ACLD and control groups. Conclusion: The ACLD + MMPHT group demonstrated significantly more knee flexion moment
asymmetries than the ACLD and control groups during the loading response
phase. Both the ACLD + MMPHT and the ACLD groups demonstrated significant
knee angle and moment asymmetries in the sagittal plane during the terminal
stance phase than the control group. Both the ACLD + MMPHT and the ACLD
groups demonstrated knee rotation moment asymmetries during the midstance
and terminal stance phases compared with the control group. A rehabilitation
program for ACLD patients both with and without MMPHTs should take into
consideration these asymmetric gait patterns.
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Affiliation(s)
- Shuang Ren
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Huijuan Shi
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yuanyuan Yu
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Zixuan Liang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yanfang Jiang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Qi Wang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Xin Miao
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Dai Li
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Si Zhang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Xiaoqing Hu
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Hongshi Huang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yingfang Ao
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
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Li AK, Pedoia V, Tanaka M, Souza RB, Ma CB, Li X. Six-month post-surgical elevations in cartilage T1rho relaxation times are associated with functional performance 2 years after ACL reconstruction. J Orthop Res 2020; 38:1132-1140. [PMID: 31788845 DOI: 10.1002/jor.24544] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/26/2019] [Indexed: 02/04/2023]
Abstract
The current study looks to: (i) investigate postural stability following anterior cruciate ligament (ACL) reconstruction, as assessed by Y-Balance Test, by comparing single-leg balance of the injured limb against those of controls and the uninjured limb; (ii) analyze the relationship between postural stability symmetry with localized cartilage matrix changes and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Bilateral knee MRI of 36 patients who underwent ACL reconstruction were performed before surgery, 6 months, 1 year, and 2 years, postoperatively. Postural stability was evaluated based on Y-Balance Test at 1 and 2 years. ACL patients were also split into three groups based on postural stability symmetry at 2 years and symmetry thresholds associated with elevated risks of lower extremity injury. Voxel-based relaxometry employing analysis of covariance was used to analyze localized differences in cartilage composition at all time-points (using quantitative magnetic resonance [MR] T1ρ and T2 mapping) between the three groups. The ACL patients displayed no significant deficits in postural stability. Compared with symmetric patients, those with asymmetric postural stability at 2 years had significantly prolonged cartilage T1ρ-indicating deterioration of the cartilage matrix-specifically in the injured knee's medial tibia as early as 6-month post-reconstruction. Prolonged T1ρ in asymmetric patients persisted up to 2 years, where the group also reported worse KOOS. Our results demonstrate an association between early stages of cartilage matrix deterioration and postural stability symmetry that may manifest in elevated lower extremity injury risk and worse patient-reported outcomes. Quantitative MR, in combination with local analysis performed with voxel-based relaxometry, is a tool to further study this relationship. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1132-1140, 2020.
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Affiliation(s)
- Alan K Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California
| | - Matthew Tanaka
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California
| | - Richard B Souza
- Department of Physical Therapy and Rehabilitation Science, UCSF, San Francisco, California
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, UCSF, San Francisco, California
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California
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Flies A, Denecke T, Kraus N, Kruppa P, Provencher MT, Becker R, Kopf S. Tendon regeneration and muscle hypotrophy after isolated Gracilis tendon harvesting - a pilot study. J Exp Orthop 2020; 7:19. [PMID: 32266508 PMCID: PMC7138873 DOI: 10.1186/s40634-020-00236-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/30/2020] [Indexed: 01/12/2023] Open
Abstract
Purpose The gracilis tendon (GT) is a commonly used autologous graft in Orthopaedic surgery. The majority of information on knee function and outcomes after hamstring harvest is related to both semitendinosus and GT harvest. Little is known regarding isolated harvest of a GT. It was hypothesized that isolated GT harvest would lead to altered gait patterns (e.g. augmented anterior-posterior translation or rotation in the tibiofemoral joint) and consequently a higher prevalence of cartilage lesions and meniscal tears in knees. Methods GT harvesting was performed on patients with chronic acromioclavicular joint instability without previous knee injuries or surgeries. MRI of both knees and thighs were performed. Knee MRI were evaluated using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Inter- and intraobserver reliabilities, cross-sectional areas of different muscles, fatty infiltration of the gracilis muscle (GM) and GT regeneration were evaluated. The contralateral limb served as reference. The observers were blinded towards the identity of the patients and the operatively treated side. Results After a mean time of 44 months after surgery testing was performed on 12 patients. No significant side-to-side differences were found using WORMS, although there was a trend towards increased cartilage lesions after GT harvest (median healthy knee 4.8 and GT harvested knee 7.8 p = 0.086). Inter- and intraobserver repeatability was high with 0.899 (95% confidence interval (CI) 0.708–0.960) and 0.988 (95% CI 0.973–0.995), respectively. A significant hypotrophy of the GM with a mean decrease of 25.3%, 18.4% and 16.9% occurred at 25% (p = 0.016), 50% (p = 0.007) and 75% (p = 0.002) of the length of the femur from distal. No compensatory hypertrophy of other thigh muscles or increased fatty infiltration of the GM was found. Tendon regeneration took place in eight out of 12 patients. In case of regeneration, the regenerated tendon inserted in a more proximal place. Conclusion Isolated harvest of the GT for shoulder procedures did not affect knee MRI significantly indicating therefore in general suitable graft utilization for surgeries outside of the knee. GT regenerated in most patients with just a more proximal insertion and a hypotrophy of the muscle belly.
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Affiliation(s)
- Anne Flies
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Timm Denecke
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Natascha Kraus
- Clinic and Outpatient Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine, Greifswald, Germany
| | - Philipp Kruppa
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/Hand surgery, Hospital Ernst von Bergmann, Potsdam, Germany
| | | | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Hospital Brandenburg an der Havel, 14770, Brandenburg an der Havel, Germany
| | - Sebastian Kopf
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Hospital Brandenburg an der Havel, 14770, Brandenburg an der Havel, Germany.
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Patel NM, Bram JT, Talathi NS, DeFrancesco CJ, Lawrence JTR, Ganley TJ. Which Children Are at Risk for Contralateral Anterior Cruciate Ligament Injury After Ipsilateral Reconstruction? J Pediatr Orthop 2020; 40:162-167. [PMID: 30882565 DOI: 10.1097/bpo.0000000000001364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Following anterior cruciate ligament (ACL) reconstruction, children are at significant risk for complications, including contralateral ACL rupture. The purpose of this study is to determine which children are at risk for a contralateral ACL tear after ipsilateral reconstruction. METHODS After review of medical records, we contacted patients who underwent primary ACL reconstruction between 2009 and 2016. Patients were included in the study if they were able to provide follow-up data either in person or remotely at least 2 years after surgery. Demographic data, sports participation, and intraoperative findings and techniques were recorded. All patients were also asked to confirm returning to sport information and postoperative complications (including contralateral ACL tear). Univariate analysis consisted of χ and independent samples t tests. Purposeful entry logistic regression was then conducted to control for confounding factors. Kaplan-Meier analysis was performed to assess contralateral ACL survival. RESULTS A total of 498 children with average follow-up of 4.3±2.1 years were included in the analysis. The mean age was 15.0±2.3 years and 262 patients (52.6%) were female. Thirty-five subjects (7.0%) sustained a contralateral ACL tear at a mean of 2.7±1.7 years following index reconstruction. Kaplan-Meier analysis revealed the median contralateral ACL survival time to be 8.9 years [95% confidence interval (CI): 8.3, 9.5 y]. In univariate analysis, 11.5% of female patients had a contralateral rupture compared with 2.1% of male patient (P<0.001). Patients with a contralateral tear had a mean age of 14.4±2.0 years compared with 15.1±2.3 years for those without an ACL injury in the opposite knee (P=0.04). After controlling for numerous factors in a multivariate model, female patients had 3.5 times higher odds of sustaining a contralateral ACL tear than male patients (95% CI: 1.1, 10.6; P=0.03). Each year of decreasing age raised the odds of contralateral injury by a factor of 1.3 (95% CI: 1.1, 1.6; P=0.02). Furthermore, children younger than 15 years had 3.1 times higher odds of contralateral rupture than those aged 15 and older (95% CI: 1.3, 7.2; P=0.01). CONCLUSIONS After adjusting for confounding factors in a multivariate model, female patients were at increased risk of contralateral ACL tear following ipsilateral reconstruction, as were younger children. Specifically, ACL rupture in the opposite knee was more likely in patients below the age of 15 years. LEVEL OF EVIDENCE Level III-prognostic study.
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Affiliation(s)
- Neeraj M Patel
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Joshua T Bram
- The Children's Hospital of Philadelphia, Philadelphia, PA
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Naghibi H, Janssen D, Van Tienen T, Van de Groes S, Van de Boogaard T, Verdonschot N. A novel approach for optimal graft positioning and tensioning in anterior cruciate ligament reconstructive surgery based on the finite element modeling technique. Knee 2020; 27:384-396. [PMID: 32024608 DOI: 10.1016/j.knee.2020.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/26/2019] [Accepted: 01/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND In ACL-reconstructed patients the postoperative knee biomechanics may differ from the intact knee biomechanical behavior which can alter knee kinematics and kinetics, and as a result lead to the progression of knee osteoarthritis. The aim of this study was to demonstrate the potential of finite element models to define the optimal choices in surgical parameters in terms of optimal graft positioning in combination with graft type in order to restore the kinematic and kinetic behavior of the knee as best as possible. METHODS A workflow was proposed based on cadaveric experiments in order to restore the injured knee to a near normal physiological condition. Femoral and tibial graft insertion sites and graft fixation tension were optimized to obtain similar intact knee laxity, for three common single-bundle and one double-bundle reconstructions. To verify the success of the surgery with the variables calculated using the proposed workflow, a full walking cycle was simulated with the intact, ACL-ruptured, optimal ACL-reconstructed and non-optimal reconstructed knees. RESULTS Our results suggested that for patellar tendon and hamstring tendon grafts, anatomical positioning (fixation force: 40 N), and for quadriceps tendon graft, isometric positioning (fixation tension: 85 N) could recover the intact joint kinematics and kinetics. Also for double-bundle reconstruction, with the numerically calculated optimal insertion sites, both bundles needed 50-N fixation force. CONCLUSIONS With optimal graft positioning parameters, following the proposed workflow in this study, any of the single-bundle graft types and surgical techniques (single vs. double-bundle) may be used to acceptably recover the intact knee joint biomechanical behavior.
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Affiliation(s)
- Hamid Naghibi
- Robotics and Mechatronics Lab, University of Twente, Enschede, the Netherlands.
| | - Dennis Janssen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Lab, 6525, GA, Nijmegen, the Netherlands
| | - Tony Van Tienen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Lab, 6525, GA, Nijmegen, the Netherlands
| | - Sebastiaan Van de Groes
- Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Lab, 6525, GA, Nijmegen, the Netherlands
| | - Ton Van de Boogaard
- Nonlinear Solid Mechanics, Faculty of Engineering Technology, University of Twente, Enschede, the Netherlands
| | - Nico Verdonschot
- Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Lab, 6525, GA, Nijmegen, the Netherlands; Laboratory of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
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Cheung EC, DiLallo M, Feeley BT, Lansdown DA. Osteoarthritis and ACL Reconstruction-Myths and Risks. Curr Rev Musculoskelet Med 2020; 13:115-122. [PMID: 31894466 DOI: 10.1007/s12178-019-09596-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament (ACL) injury is one of the most common ligamentous injuries suffered by athletes participating in cutting sports. A common misperception is that ACL reconstruction can prevent osteoarthritis (OA). The goal of this paper is to review and discuss the contributing factors for the development of OA following ACL injury. RECENT FINDINGS There has been interesting new research related to ACL reconstruction. As understanding of knee biomechanics following ACL injury and reconstruction has changed over time, many surgeons have changed their surgical techniques to low anterior drilling to position their femoral tunnel in an attempt to place the ACL in a more anatomic position. Even with this change in the femoral tunnel position, 85% of knees following ACL reconstruction have abnormal tibial motion compared to contralateral non-injured knees. Studies have shown increases in inflammatory cytokines in the knee following ACL injury, and newer MRI sequences have allowed for earlier objective detection of degenerative changes to cartilage following injury. Recent studies have shown that injecting IL-1 receptor antagonist and corticosteroids can modulate the post-injury inflammatory cascade. ACL reconstruction does not prevent the development of OA but can improve knee kinematics and reduce secondary injury to the cartilage and meniscus. Advancements in imaging studies has allowed for earlier detection of degenerative changes in the knee, which has allowed researchers to study how new interventions can alter the course of degenerative change in the knee following ACL injury.
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Affiliation(s)
- Edward C Cheung
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU-320W, San Francisco, CA, 94143, USA.
| | - Marcus DiLallo
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU-320W, San Francisco, CA, 94143, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU-320W, San Francisco, CA, 94143, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU-320W, San Francisco, CA, 94143, USA
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Hatamzadeh M, Hassannejad R, Sharifnezhad A. A new method of diagnosing athlete's anterior cruciate ligament health status using surface electromyography and deep convolutional neural network. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2019.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Ishibashi Y, Adachi N, Koga H, Kondo E, Kuroda R, Mae T, Uchio Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury - Secondary publication. J Orthop Sci 2020; 25:6-45. [PMID: 31843222 DOI: 10.1016/j.jos.2019.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND This clinical guideline presents recommendations for the management of patients with anterior cruciate ligament (ACL) injury, endorsed by the Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). METHODS The JOA ACL guideline committee revised the previous guideline based on "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which proposed a desirable method for preparing clinical guidelines in Japan. Furthermore, the importance of "the balance of benefit and harm" was also emphasized. This guideline consists of 21 clinical questions (CQ) and 23 background questions (BQ). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS We evaluated the objectives and results of each study in order to make a decision on the level of evidence so as to integrate the results with our recommendations for each CQ. For BQ, the guideline committee proposed recommendations based on the literature. CONCLUSIONS This guideline is intended to be used by physicians, orthopedic surgeons, physical therapists, and athletic trainers managing ACL injuries. We hope that this guideline is useful for appropriate decision-making and improved management of ACL injuries.
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Affiliation(s)
- Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Japan.
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Japan
| | - Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University School of Medicine, Japan
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Whitaker S, Edwards JH, Guy S, Ingham E, Herbert A. Stratifying the mechanical performance of a decellularized xenogeneic tendon graft for anterior cruciate ligament reconstruction as a function of graft diameter: An animal study. Bone Joint Res 2019; 8:518-525. [PMID: 31832171 PMCID: PMC6888738 DOI: 10.1302/2046-3758.811.bjr-2019-0065.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objectives This study investigated the biomechanical performance of decellularized porcine superflexor tendon (pSFT) grafts of varying diameters when utilized in conjunction with contemporary ACL graft fixation systems. This aimed to produce a range of ‘off-the-shelf’ products with predictable mechanical performance, depending on the individual requirements of the patient. Methods Decellularized pSFTs were prepared to create double-bundle grafts of 7 mm, 8 mm, and 9 mm diameter. Femoral and tibial fixation systems were simulated utilizing Arthrex suspension devices and interference screws in bovine bone, respectively. Dynamic stiffness and creep were measured, followed by ramp to failure from which linear stiffness and load at failure were measured. The mechanisms of failure were also recorded. Results Dynamic stiffness was found to increase with greater graft diameter, with significant differences between all groups. Conversely, dynamic creep reduced with increasing graft diameter with significant differences between the 7 mm and 9 mm groups and the 8 mm and 9 mm groups. Significant differences were also found between the 7 mm, 8 mm, and 9 mm groups for linear stiffness, but no significant differences were found between groups for load at failure. The distribution of failure mechanisms was found to change with graft diameter. Conclusion This study showed that decellularized pSFTs demonstrate comparable biomechanical properties to other ACL graft options and are a potentially viable option for ACL reconstruction. Although grafts can be stratified by their diameter to provide varying biomechanical properties, it may be more appropriate to alter the fixation technique to stratify for a greater diversity of biomechanical requirements. Cite this article: Bone Joint Res 2019;8:518–525.
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Affiliation(s)
| | - Jennifer H Edwards
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Stephen Guy
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Eileen Ingham
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Anthony Herbert
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
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Lindanger L, Strand T, Mølster AO, Solheim E, Inderhaug E. Return to Play and Long-term Participation in Pivoting Sports After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:3339-3346. [PMID: 31633994 DOI: 10.1177/0363546519878159] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rupture of the anterior cruciate ligament (ACL) is a common and feared injury among athletes because of its potential effect on further sports participation. Reported rates of return to pivoting sports after ACL reconstruction (ACLR) vary in the literature, and the long-term consequences of returning have rarely been studied. PURPOSE To examine the rate and level of return to pivoting sports after ACLR, the duration of sports participation, and long-term consequences of returning to pivoting sports. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS All primary ACLRs with a bone-patellar tendon-bone autograft between 1987 and 1994 (N = 234) in athletes participating in team handball, basketball, or soccer before injury were selected from a single-center quality database. A long-term evaluation (median, 25 years; range, 22-30 years) was performed using a questionnaire focusing on return to pivoting sports, the duration of sports activity after surgery, later contralateral ACL injuries, revision surgery, and knee replacement surgery. Participants were stratified into 2 groups depending on the time between injury and surgery (early, <24 months; late, ≥24 months). RESULTS A total of 93% of patients (n = 217) responded to the questionnaire. Although 83% of patients returned to pivoting sports after early ACLR, only 53% returned to preinjury level. Similar return-to-sport rates were observed in males and females (P > .05), but males had longer sports careers (median, 10 years; range, 1-23 years) than females (median, 4 years; range, 1-25 years; P < .001). The incidence of contralateral ACL injuries was 28% among athletes who returned to sports versus 4% among athletes who did not return (P = .017) after early ACLR. The pooled reinjury rate after return to preinjury level of sports was 41% (30%, contralateral injuries; 11%, revision surgery). The incidence of contralateral ACL injuries was 32% among females versus 23% among males (P > .05) and, for revision surgery, was 12% among females versus 7% among males (P > .05) after returning to sports. Having a late ACLR was associated with an increased risk of knee replacement surgery (9% vs 3%; P = .049) when compared with having an early ACLR. CONCLUSION ACLR does not necessarily enable a return to preinjury sports participation. By returning to pivoting sports after ACLR, athletes are also facing a high risk of contralateral ACL injuries. Long-term evaluations in risk assessments after ACLR are important, as a significant number of subsequent ACL injuries occur later than the routine follow-up.
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Affiliation(s)
- Line Lindanger
- Department of Orthopedics, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Torbjørn Strand
- Department of Orthopedics, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Orthopedics, Haukeland University Hospital, The Coastal Hospital at Hagevik, Bergen, Norway
| | - Anders Odd Mølster
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eirik Solheim
- Department of Orthopedics, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eivind Inderhaug
- Department of Orthopedics, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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