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Mizuno Y, Takata Y, Yoshioka K, Demura S, Nakase J. Collagen-Type Composition in the Semitendinosus, Quadriceps, and Patellar Tendons of a 22-Year-Old Patient: A Case Report. Cureus 2024; 16:e61324. [PMID: 38947600 PMCID: PMC11213621 DOI: 10.7759/cureus.61324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
Graft failure is a common postoperative complication after anterior cruciate ligament (ACL) reconstruction. Recently, a theory has emerged that histological and microstructural factors of autografts may be related to graft failure. We simultaneously collected the semitendinosus tendon (ST), quadriceps tendon (QT), and patellar tendon (PT) from a 22-year-old patient to provide insights into the differences in the collagen-type composition of the three tendons in skeletally mature patients. These findings may serve as a basis for selecting autografts for ACL to reduce graft failure rates. The patient was a 22-year-old female who required the removal of artificial ligament, screws, and washers and medial patellofemoral ligament (MPFL) reconstruction with an ST autograft after two surgeries for recurrent dislocation of the left patella. The ST, QT, and PT obtained during necessary intraoperative procedures were used as samples. The tissues were processed and immunostained; this was followed by confocal microscopy. Evaluation was performed by calculating the percentage of areas positive for collagen types I and III.The percentage of type I collagen in the ST, QT, and PT groups was 88%, 85%, and 88%, respectively.The collagen-type composition was examined following simultaneous collection of the ST, QT, and PT. The results revealed no significant differences in the content of physically strong type I collagen, which supports previous findings showing that the clinical outcomes after ACL reconstruction do not vary with the autograft used.
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Affiliation(s)
- Yushin Mizuno
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, JPN
- Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, JPN
| | - Yasushi Takata
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, JPN
| | - Kazuaki Yoshioka
- Department of Physiology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, JPN
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, JPN
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, JPN
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Migliorini F, Pilone M, Memminger MK, Eschweiler J, Giorgino R, Maffulli N. All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review. J Orthop Traumatol 2024; 25:7. [PMID: 38376718 PMCID: PMC10879072 DOI: 10.1186/s10195-024-00751-9] [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: 07/24/2023] [Accepted: 01/13/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears in skeletally immature patients are increasingly common. Evidence comparing the outcomes of all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients is limited, and the current literature could benefit from a comprehensive systematic review. The present study compared all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients. The outcomes of interest were to compare joint laxity, patient-reported outcome measures (PROMs), return to sport, and complications. METHODS This study was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In November 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. No additional filters were used in the database search. All the clinical studies investigating ACL reconstruction in skeletally immature patients were accessed. Only articles that clearly stated the surgical technique (all- or trans-epiphyseal) were eligible. Only articles with a minimum of 6 months of follow-up were included. Only articles that clearly stated that surgeries were conducted in children with open physis were eligible. RESULTS Data from 1489 patients (1493 procedures) were collected, of which 32% (490 of 1489 patients) were female. The mean length of follow-up was 46.6 months. The mean age of the patients was 12.7 years. No difference was found in joint laxity (Table 3): positive pivot shift (P = 0.4), positive Lachman test (P = 0.3), and mean arthrometer laxity (P = 0.1). No difference was found in PROMs (Table 4): International Knee Documentation Committee (IKDC) (P = 0.3), Lysholm (P = 0.4), and Tegner (P = 0.7). The trans-epiphyseal technique was associated with a greater rate of patients unable to return to sports (1% versus 7%, P = 0.0001) and with a longer time to return to sports (7.7 versus 8.6 months, P = 0.01). Though the trans-epiphyseal technique was associated with a lower rate of return to sport, this difference was not statistically significant (P = 0.8). No difference was evidenced in the rate of patients who had reduced their league or level of sports activity (P = 0.6) or in the rate of patients who had returned to their previous league or level of sports activity (P = 0.7). No difference was found in the rate of complication: re-tear (P = 0.8), reoperation (P = 0.7), increased laxity (P = 0.9), and persistent instability sensation (P = 0.3). CONCLUSION Trans-epiphyseal ACL reconstruction was associated with a greater rate of patients unable to return to sport and with a longer time to return to sport compared with the all-epiphyseal technique in skeletally immature patients. Level of evidence Level III, systematic review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
| | - Marco Pilone
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Michael Kurt Memminger
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
- Department of Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost, Halle, Germany
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Nicola Maffulli
- Department of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, ST4 7QB, Stoke on Trent, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, E1 4DG, London, England
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Migliorini F, Cocconi F, Schäfer L, Memminger MK, Giorgino R, Maffulli N. Anterior cruciate ligament reconstruction in skeletally immature patients is effective: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024; 32:418-431. [PMID: 38258963 DOI: 10.1002/ksa.12048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE The present study evaluated the outcomes of anterior cruciate ligament (ACL) reconstruction in children with open physes. The outcomes of interest were to compare the increase in joint laxity and PROMs from baseline to the last follow-up, the rate and features of the return to sport and the rate of complications. METHODS This study was conducted according to the 2020 PRISMA guidelines. In October 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase. All the clinical studies investigating ACL reconstruction in skeletally immature patients were accessed. Only articles which clearly stated that surgeries were conducted in children with open physis were eligible. RESULTS Data from 53 studies (1691 procedures) were collected. 35% (597 out of 1691 patients) were women. The mean length of the follow-up was 44.7 ± 31.3 months. The mean age of the patients was 12.7 ± 1.1 years old. All PROMs significantly improved from the baseline values to those at the last follow-up. The mean time to return to sport was 8.3 ± 1.9 months. 89% (690 out of 771 patients) returned to sports, 15% (109 out of 721 patients) reduced their level of sports activity or league, and 84% (651 out of 771 patients) returned to their previous level of sport. 9% (112 out of 1213) of patients experienced re-tear of the reconstructed ACL, and 11% (75 out of 660) of patients underwent a further ACL reoperation. No patients (0 out of 83) demonstrated increased laxity at the last follow-up, and persistent sensation of instability was reported by 5% (11 out of 235) of patients. CONCLUSION ACL reconstruction in skeletally immature patients is effective and safe, and is associated with fast recovery and a high rate of return to sport. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
| | - Federico Cocconi
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
| | - Luise Schäfer
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, Germany
| | - Michael Kurt Memminger
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
| | - Riccardo Giorgino
- Residency Program in Orthopaedic and Traumatology, University of Milan, Milan, Italy
| | - Nicola Maffulli
- Department of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke-on-Trent, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, UK
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Asai K, Nakase J, Kuzumaki T, Ishikawa T, Ozaki N, Tsuchiya H. Differences in the microstructural and mechanical qualities of semitendinosus tendon grafts between skeletally immature and mature patients in anterior cruciate ligament reconstruction. J Orthop Sci 2023:S0949-2658(23)00318-4. [PMID: 37985294 DOI: 10.1016/j.jos.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/03/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND This study aimed to investigate the microstructural and mechanical properties of semitendinosus tendon graft tissues during anterior cruciate ligament reconstruction and the clinical outcomes in skeletally immature and mature patients. METHODS Twenty-two patients who underwent primary anterior cruciate ligament reconstruction using a hamstring tendon graft were analyzed and divided into skeletally immature (n = 7) and mature groups (n = 15) based on magnetic resonance imaging findings of the epiphyseal plate of the distal femur. Tissue samples were collected from the mid-portion of the semitendinosus tendon. The collagen fibril diameter, maximum stress, and strain at maximum stress point in the semitendinosus tendon tissues were calculated for comparison of the microstructural and mechanical properties between the two groups. Postoperative outcomes were also assessed between the two groups. RESULTS The mean and 60th and 80th percentiles of fibril diameters in the skeletally immature group were significantly smaller than those in the mature group (65.9 ± 13.0, 73.5 ± 19.3, and 91.3 ± 27.4 nm in the skeletally immature group; and 90.3 ± 14.7, 94.0 ± 18.4, and 125.3 ± 19.9 nm in the skeletally immature group; p = 0.001, 0.024, and 0.004, respectively). Additionally, the strain at maximum stress was higher in the skeletally immature group (237.2 ± 102.4% vs. 121.5 ± 51.9%, p = 0.024). However, there was no difference in maximum stress between the skeletally immature and mature groups (19.9 ± 14.3 MPa vs. 24.5 ± 23.4 MPa, p = 0.578). Strain was negatively correlated with the mean fibril diameter and the 60th and 80th percentiles of fibril diameters, whereas stress was positively correlated with the mean fibril diameter. The skeletally immature group had a higher pivot shift test-positive rate than the mature group at the last follow-up (p = 0.023). CONCLUSION Semitendinosus tendon graft tissues differed microstructurally and mechanically between skeletally immature and mature patients. LEVEL OF EVIDENCE Level Ⅳ.
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Affiliation(s)
- Kazuki Asai
- Department of Orthopaedic Surgery, School of Medical Science, Kanazawa University, 13-1 Takara-machi, 920-8641, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, School of Medical Science, Kanazawa University, 13-1 Takara-machi, 920-8641, Kanazawa, Japan.
| | - Toru Kuzumaki
- Department of Mechanical Engineering & Department of Materials Science, School of Engineering, Tokai University, 4-1-1 Kitakaname, 259-1292, Hiratsuka, Japan
| | - Tatsuya Ishikawa
- Department of Functional Anatomy, School of Medical Science, Kanazawa University, 13-1 Takara-machi, 920-8640 Kanazawa, Japan
| | - Noriyuki Ozaki
- Department of Functional Anatomy, School of Medical Science, Kanazawa University, 13-1 Takara-machi, 920-8640 Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, School of Medical Science, Kanazawa University, 13-1 Takara-machi, 920-8641, Kanazawa, Japan
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Mizuno Y, Nakase J, Yoshioka K, Sengoku T, Yoshimizu R, Kanayama T, Yanatori Y, Tsuchiya H. Differences in collagen types in the semitendinosus, quadriceps, and patellar tendons: A report using samples from an 11-year-old patient. Knee 2023; 42:339-346. [PMID: 37148616 DOI: 10.1016/j.knee.2023.04.007] [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: 11/03/2022] [Revised: 03/18/2023] [Accepted: 04/07/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND This study aimed to determine the differences in the proportions of types I and type III collagen in the semitendinosus tendon (ST), quadriceps tendon (QT), and patellar tendon (PT), which are frequently used as autografts for anterior cruciate ligament (ACL) reconstruction. METHODS Orthopedic surgeons diagnosed habitual dislocation of the left patella and surgically treated an 11-year-old boy. Medial patellofemoral ligament reconstruction, medial patellar tibial ligament reconstruction, and arthroscopic lateral release were performed simultaneously. Tissue samples obtained during treatment that were no longer necessary were used as samples for this study. The samples were fixed, paraffin-embedded, and immunostained for type I and type III collagen. Stained samples were observed under a confocal microscope and evaluated visually and quantitatively to determine the percentages of type I and type III collagen. RESULTS Visually, the ST had a higher percentage of type III collagen than the PT and QT. The QT and PT were similar in appearance; both consisted mostly of collagen type I. Quantitative evaluation using images showed that the PT comprised 100% type I collagen. The QT comprised 1% type III collagen. The ST comprised 34% type III collagen. CONCLUSION In this patient, the QT and PT had higher percentages of type I collagen, which is considered physically strong. Type III collagen, which is considered physically weak, was most common in the ST. These factors may be associated with the high re-injury rates after ACL reconstruction using the ST for physically immature patients.
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Affiliation(s)
- Yushin Mizuno
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan.
| | - Kazuaki Yoshioka
- Department of Physiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Takuya Sengoku
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Rikuto Yoshimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tomoyuki Kanayama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yusuke Yanatori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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Asai K, Nakase J, Yoshimizu R, Kimura M, Kanayama T, Yanatori Y, Tsuchiya H. High initial graft tension is a post-operative risk factor for high UTE T2* value of the graft 6 months after anterior cruciate ligament reconstruction. Knee 2023; 40:143-151. [PMID: 36434971 DOI: 10.1016/j.knee.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/09/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND To evaluate the risk factor of "ligamentization" using the ultrashort echo time (UTE)-T2* imaging. METHODS Fifty-nine patients (23 males and 36 females, age of 21.9 ± 10.6 years old) who underwent anterior cruciate ligament (ACL) reconstruction with hamstring tendon were evaluated. The UTE T2* values of the reconstructed ACL at 6 months postoperatively were calculated. Circular regions of interest (5-10 mm2) were set at the proximal, mid-substance, and distal regions of the reconstructed ACL. The UTE T2* values of the entire reconstructed ACL were calculated as the average of these three points. Patients were divided into high (27 knees) and low (32 knees) UTE T2* groups by calculating whether their UTE T2* values were greater than the median of the UTE T2* values of all patients. Risk factors for high UTE T2* values were evaluated. Clinical outcomes were compared between the two groups. RESULTS There were no significant differences in any measured parameters and clinical outcomes between the two UTE T2* groups. Logistic regression analysis revealed that graft tension was a significant risk factor for patients with high UTE-T2* values (P = 0.047, odds ratio [OR] = 2.285). The UTE-T2* values of the 20 N graft tension using the Tension loc system were significantly lower than those of the 40 N using double-spike plate (DSP) with screws at each site and the 30 N using the Tension loc system at the distal site. CONCLUSIONS Higher graft tension was an independent risk factor for high UTE T2* values of the reconstructed ACL.
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Affiliation(s)
- Kazuki Asai
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan; Department of Orthopedic Surgery, KKR Hokuriku Hospital, 13-43 izumigaoka nicyoume, Kanazawa-city 921-8035, Japan
| | - Junsuke Nakase
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan.
| | - Rikuto Yoshimizu
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
| | - Mitsuhiro Kimura
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
| | - Tomoyuki Kanayama
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
| | - Yusuke Yanatori
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa-city 920-8641, Japan
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Ang ACH, Wong D, Lui PPY. Increased Risk of Concomitant Meniscal Injuries in Adolescents With Elevated Body Mass Index After Anterior Cruciate Ligament Tear: A Systematic Review. Arthroscopy 2022; 38:3209-3221. [PMID: 35660518 DOI: 10.1016/j.arthro.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate existing studies examining the association between body mass index (BMI) and outcomes of anterior cruciate ligament reconstruction (ACLR) in adolescent patients. METHODS A literature search was conducted on PubMed and Embase. Studies examining associations between BMI and outcomes after ACLR in adolescents were included. Quality assessment was performed. Data on patient age, sex, study design, time of follow-up, sample size, graft type, concomitant injuries (meniscal injury, surgical procedures), clinical outcomes (revision ACLR, postoperative weight gain, post-traumatic osteoarthritis [PTOA], range of motion [ROM]), and functional outcome (muscle strength) were extracted. RESULTS Eleven papers of Levels II-IV evidence were included. Five studies found positive correlations between BMI and risk of concomitant meniscal injuries. Two of them reported young patients with elevated BMI having 1.6 times greater odds of requiring meniscectomy (P < .01) and 1.031 times greater odds of requiring concomitant surgeries (P = .011). One study showed significant positive association of postoperative weight gain by time (r = 0.28, P < .01), with smaller increase in the overweight and obese groups compared with the normal-weight group. One study demonstrated greater cartilage breakdown in young patients with overweight and obesity postsurgery, contributing to PTOA (r = 0.42, P = .009). There was no clinically important difference in postoperative ROM and muscle strength. Four studies reviewed the association between BMI and revision ACLR risk, but results were heterogeneous and a firm conclusion cannot be drawn. CONCLUSIONS Adolescents with elevated BMI are more likely to have concomitant meniscal injuries and surgical procedures after ACL tear. There is some weak evidence of the association of elevated BMI with PTOA and slight postoperative weight gain post-ACLR. There may not be any clinically significant association of obesity with post-operative muscle strength and ROM, and current studies are inconclusive regarding the impact of BMI on revision ACLR risk. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Ashley Cheuk Hei Ang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Doris Wong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Pauline Po Yee Lui
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Neuromusculoskeletal Restorative Medicine, Hong Kong SAR, China.
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Characterization of microRNA Levels in Synovial Fluid from Knee Osteoarthritis and Anterior Cruciate Ligament Tears. Biomedicines 2022; 10:biomedicines10112909. [PMID: 36428476 PMCID: PMC9687202 DOI: 10.3390/biomedicines10112909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/07/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
This study investigated modifications of microRNA expression profiles in knee synovial fluid of patients with osteoarthritis (OA) and rupture of the anterior cruciate ligament (ACL). Twelve microRNAs (26a-5p, 27a-3p, let7a-5p, 140-5p, 146-5p, 155-5p, 16-5p,186-5p, 199a-3p, 210-3p, 205-5p, and 30b-5p) were measured by real-time quantitative polymerase chain reaction (RT-qPCR) in synovial fluids obtained from 30 patients with ACL tear and 18 patients with knee OA. These 12 miRNAs were chosen on the basis of their involvement in pathological processes of bone and cartilage. Our results show that miR-26a-5p, miR-186-5p, and miR-30b-5p were expressed in the majority of OA and ACL tear samples, whereas miR-199a-3p, miR-210-3p, and miR-205-5p were detectable only in a few samples. Interestingly, miR-140-5p was expressed in only one sample of thirty in the ACL tear group. miR-140-5p has been proposed to modulate two genes (BGN and COL5A1100) that are involved in ligamentous homeostasis; their altered expression could be linked with ACL rupture susceptibility. The expression of miR-30b-5p was higher in OA and chronic ACL groups compared to acute ACL samples. We provide evidence that specific miRNAs could be detected not only in synovial fluid of patients with OA, but also in post-traumatic ACL tears.
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Shi BY, Levine B, Ghazikhanian V, Bugarin A, Schroeder G, Wu S, Kremen T, Jones K. Reliability of MRI Detection of Kaplan Fiber Injury in Pediatric and Adolescent Patients with ACL Tears. Orthop J Sports Med 2022; 10:23259671221128601. [PMID: 36324697 PMCID: PMC9618750 DOI: 10.1177/23259671221128601] [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: 06/20/2022] [Accepted: 08/02/2022] [Indexed: 11/07/2022] Open
Abstract
Background: While studies have described Kaplan fiber (KF) injury in up to 60% of adults with anterior cruciate ligament (ACL) tears, the incidence of KF injury in the pediatric and adolescent population remains unknown. Purpose: To (1) determine the reliability of using magnetic resonance imaging (MRI) to identify KF injury in the pediatric and adolescent population and (2) define the incidence of KF injury in these patients with acute ACL injuries. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The authors retrospectively identified patients ≤18 years of age who underwent ACL reconstruction for acute tears between 2013 and 2020. All preoperative MRI scans were reviewed independently and in a blinded fashion by 2 musculoskeletal radiologists, who noted the presence of the KF complex and any evidence of injury; interrater reliability was assessed. Patient characteristics, time from injury to MRI, laterality, and concomitant ligamentous or meniscal injuries were recorded, and associations between patient or injury characteristics and KF integrity on MRI were assessed. Results: In total, 51 patients (mean age, 14.9 years) met the inclusion criteria. Of these, 27 patients were female and 31 sustained an injury to the right knee. With respect to KF integrity, radiologist 1 visualized KF injury in 29% of patients, while radiologist 2 visualized KF injury in 35% of patients. In 12% of cases for radiologist 1 and 6% of cases for radiologist 2, KFs were unable to be visualized at all. The overall percentage agreement between the 2 radiologists was 76.5% with a kappa statistic of 0.57 (moderate agreement). There were no significant associations found between the presence of KF injury and patient age, sex, laterality, body mass index, concomitant ligamentous injury, or meniscal injury. However, visualization of KF injury on MRI was associated with a shorter time from index injury to MRI (15 days vs 23 days; P = .044). Conclusion: Approximately one-third of pediatric and adolescent patients who underwent ACL reconstruction were found to have KF injuries. Standard preoperative MRI scans can reliably be used to visualize KF injury in the majority of pediatric and adolescent patients with ACL tears, especially when the MRI is performed in the acute setting.
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Affiliation(s)
- Brendan Y. Shi
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA.,Brendan Y. Shi, MD, UCLA Health Orthopaedic Surgery Center, 1225 15th Street, Suite 2100, Santa Monica, CA 90404, USA ()
| | - Benjamin Levine
- Department of Diagnostic Radiology, University of California, Los Angeles, Los Angeles, California, USA
| | - Varand Ghazikhanian
- Department of Diagnostic Radiology, University of California, Los Angeles, Los Angeles, California, USA
| | - Amador Bugarin
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Grant Schroeder
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Shannon Wu
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Thomas Kremen
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Kristofer Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
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