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Knapik DM, Kamitani A, Smith MV, Motley J, Haas AK, Matava MJ, Wright RW, Brophy RH. Relationship between Kinesiophobia and Dynamic Postural Stability after Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study. J Knee Surg 2024; 37:796-803. [PMID: 38677296 DOI: 10.1055/a-2315-8034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Anterior cruciate ligament (ACL) injuries in young, active patients generally require ACL reconstruction (ACLR) to restore mechanical and postural stability. The fear of movement or reinjury (kinesiophobia) has become increasingly recognized in the post-ACLR population; however, the association between restoration of postural stability and kinesiophobia remains largely unknown. The purpose of this study was to investigate changes in mean Tampa Scale of Kinesiophobia-11 (TSK-11), dynamic motion analysis (DMA) scores, and time on the testing platform, as well as any correlation between TSK-11 and mean overall and individual translational and rotational DMA scores during the first 12 months following ACLR. Cohort study. Patients undergoing ACLR were prospectively enrolled and dynamic postural stability and kinesiophobia based on the TSK-11 were collected within 2 days prior to surgery and at 6 and 12 months following ACLR. Dynamic postural stability was quantified by calculating a DMA score, with score calculated in three translational (anterior/posterior [AP], up/down [UD], medial/lateral [ML]) and three rotational (left/right [LR], flexion/extension, and internal/external rotation) independent planes of motions. Correlations between DMA and TSK-11 scores at each time point were analyzed. A total of 25 patients meeting inclusion criteria were analyzed. Mean overall DMA and TSK-11 scores increased with each successive testing interval. At 6-month follow-up, a weakly positive association between TSK-11 and DMA scores was appreciated based on overall DMA, AP, UD, ML, and LR. At 12 months, a moderately positive correlation was appreciated between TSK-11 and the translational, but not rotational, planes of motion. Following ACLR, lower level of kinesiophobia were found to be moderately associated with improved dynamic stability, especially in the translation planes of motion.
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Affiliation(s)
- Derrick M Knapik
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Aguri Kamitani
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Matthew V Smith
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - John Motley
- STAR Sports Therapy and Rehabilitation, Chesterfield, Missouri
| | - Amanda K Haas
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Matthew J Matava
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Robert H Brophy
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
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Zhang J, Jia Z, Yang Y, Zhang L, Huang T, Tsai TY, Li P. In the Acute Phase of Anterior Cruciate Ligament Rupture: Quantitative Assessment of Matrix Changes and Correlation between Different States of Meniscus and Adjacent Cartilage. Orthop Surg 2024. [PMID: 39093708 DOI: 10.1111/os.14176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE Cartilage and meniscus are important structures that maintain the health of the knee joint. Early detection of changes in the internal components of cartilage and meniscus before morphological changes occur is essential to prevent and delay the development of osteoarthritis (OA). This study was designed to determine the changes in the matrix composition of morphologically intact cartilage and meniscus during the acute phase of an anterior cruciate ligament (ACL) rupture, as well as the effect of different states of meniscus (intact or tear) on adjacent cartilage during the acute phase. METHODS This cross-sectional study compared and analyzed 50 patients in the acute phase of ACL rupture who underwent surgical treatment and 66 age-, weight- and height-matched healthy volunteers from May 2022 to May 2023 at our institution. Mean T2 relaxation times and effect sizes in different regions of tibiofemoral articular cartilage and meniscus were compared between the two groups using the Mann-Whitney nonparametric t-test, and correlations between different meniscal states and adjacent cartilage were analyzed. RESULTS Both in the lateral and medial compartments of the knee, T2 relaxation times were significantly higher in all subregions of cartilage and meniscus in the ACL rupture group (p < 0.05), and the site of injury was predominantly centered in the medial compartment (femur, p = 0.000; tibia, p = 0.000; anterior horn, p = 0.000). In the respective compartments, the posterior horn of the lateral meniscus showed a significant positive correlation with the mid-cartilage of the femoral and tibial (r = 0.566, p = 0.035; r = 0.611, p = 0.02); and the posterior horn of the medial meniscus showed a significant positive correlation with the posterior tibial cartilage (r = 0.668, p = 0.018). CONCLUSION During the acute phase of ACL rupture, the internal composition of the cartilage and meniscus undergoes significant changes, even if the morphology is intact. More importantly, the state of the meniscus significantly affects the internal composition of the adjacent cartilage. This is an early warning sign of OA, which should be closely monitored and carefully managed in clinical practice.
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Affiliation(s)
- Jiaying Zhang
- Department of Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhenyu Jia
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yangyang Yang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Lihang Zhang
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Tianwen Huang
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Tsung-Yuan Tsai
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
| | - Pingyue Li
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Farey JE, Salmon LJ, Roe JP, Russell V, Sundaraj K, Pinczewski LA. Outcomes of ACL Reconstruction Utilizing Supercritical CO 2-Sterilized Allografts. Orthop J Sports Med 2024; 12:23259671241254115. [PMID: 39135859 PMCID: PMC11318055 DOI: 10.1177/23259671241254115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/06/2023] [Indexed: 08/15/2024] Open
Abstract
Background Allograft tendons are perceived to have a high ACL graft failure rate in primary anterior cruciate ligament (ACL) reconstruction (ACLR). Historical series may be biased by graft processing methods that degrade the biomechanical properties of donor tendons such as irradiation. Supercritical carbon dioxide (SCCO2) is a validated method of terminally sterilizing biomaterials at physiological temperatures without irradiation, but in vivo use of SCCO2-processed tendon allografts for primary ACLR has not been reported to date. Hypothesis ACLR with SCCO2 allografts would result in acceptable failure rates, subjective knee scores, and clinical evaluation at 2 years postoperatively. Study Design Case series; Level of evidence, 4. Methods Patients underwent primary ACLR with terminally sterilized SCCO2-processed human gracilis, peroneus longus, semitendinosus, tibialis anterior, and tibialis posterior tendon allografts. Patient demographics were collected, along with tendon donor age and sex. At 1 year postoperatively, subjective International Knee Documentation Committee (IKDC) and ACL-Return to Sport After Injury (ACL-RSI) scores were collected, as well as clinical evaluation. At 2 years postoperatively, the IKDC and ACL-RSI scores were repeated, and return to sports and further knee injuries were recorded. Results A total of 144 patients with a medianage of 26 (IQR 14) years formed the study group. Patients were predominately male (58%). The loss to follow-up rate was 8% (n = 12). The mean age of allograft tendon donors was 37 (range 17-58) years, and the majority were male (83%). The mean allograft diameter was 8.9 ± 1.0 mm. At 2 years, ACL graft failureoccurred in 5% (n = 7). All graft failureswere in patients aged ≤25 years (P = .007). Neither donor age (≤40 or >40 years) nor donor sex was associated with graft failure (P > .05). The median IKDC subjective score was 95 and ACL-RSI score was 75. There were no revisions for sepsis within the first 2 years postoperatively. Conclusion SCCO2 processing of allograft tendons demonstrated satisfactory clinical and patient-reported outcomes at 24 months postoperatively in a consecutive series of patients with primary ACLR, with similar ACL graft failure rates and subjective knee scores compared with those reported in published series of hamstring tendon autograft and fresh frozen nonirradiated allograft.
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Affiliation(s)
- John E. Farey
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Wollstonecraft, New South Wales, Australia
| | - Lucy J. Salmon
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Wollstonecraft, New South Wales, Australia
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Justin P. Roe
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Wollstonecraft, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Vivianne Russell
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Wollstonecraft, New South Wales, Australia
| | - Keran Sundaraj
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Wollstonecraft, New South Wales, Australia
| | - Leo A. Pinczewski
- North Sydney Orthopaedic and Sports Medicine Centre, Mater Clinic, Wollstonecraft, New South Wales, Australia
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
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Fithian A, Manoharan A, Chapek M, Xie V, Ghahremani J, Culler M, Watarastaporn T, Khan N. Medial Meniscectomy at the Time of ACL Reconstruction Is Associated With Postoperative Anterior Tibial Translation: A Retrospective Analysis. Orthop J Sports Med 2024; 12:23259671241263096. [PMID: 39157026 PMCID: PMC11328289 DOI: 10.1177/23259671241263096] [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: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 08/20/2024] Open
Abstract
Background Medial meniscal pathology and management have not been associated with postoperative anterior tibial translation (ATT) after anterior cruciate ligament reconstruction (ACLR). Purpose The purpose of this study was to evaluate the role of medial meniscal injury and treatment on pre- and postoperative ATT in the setting of primary ACLR. More specifically, the association between repairable medial meniscal tears, medial meniscectomy, and postoperative ATT, along with rates of revision surgery, was examined. Study Design Cohort study; Level of evidence, 3. Methods A retrospective review was performed for patients who underwent ACLR between January 1, 2010 and December 31, 2015 at a single center. Descriptive data were obtained from an institutional database for a total of 396 patients included in this study and followed for 1 year postoperatively. Statistical analysis was performed to examine associations of meniscal treatment with postoperative ATT measurements made by KT-1000 arthrometer. Results A total of 243 patients underwent isolated ACLR with autograft, 72 patients underwent autograft ACLR and partial medial meniscectomy (MMx) (ACLR + MMx), and 81 patients underwent autograft ACLR and medial meniscal repair (MMR) (ACLR + MMR). Patients with ACLR + MMx had higher mean age and body mass index compared with patients in the other groups. Patients who underwent ACLR + MMx had greater postoperative side-to-side ATT compared with patients undergoing ACLR (1.55 mm vs 1.07 mm; P = .04) or patients undergoing ACLR + MMR (1.55 mm vs 1.01 mm; P = .03). The ACLR + MMx group was less likely to have symmetric (<3-mm side-to-side difference) postoperative ATT compared with the ACLR group (85% vs 93%; P = .03). There was no difference in postoperative ATT between ACLR and ACLR + MMR. Postoperative return to the operating room was greater in the ACLR + MRR group compared with the ACLR + MMx group (21.9% vs 8.2%; P = .05). Conclusion MMx at the time of ACLR led to higher postoperative ATT compared with isolated ACLR or ACLR + MMR.
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Affiliation(s)
- Andrew Fithian
- Southern California Permanente Medical Group, San Diego, California, USA
| | - Aditya Manoharan
- Southern California Permanente Medical Group, San Diego, California, USA
| | - Michael Chapek
- Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Virginia Xie
- Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | | | - Mckenzie Culler
- Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | | | - Najeeb Khan
- Southern California Permanente Medical Group, San Diego, California, USA
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Nakamae A, Tsukisaka K, Deie M, Miyamoto A, Eguchi A, Kato T, Nekomoto A, Adachi N. Subjective grade of apprehension during the pivot-shift test reflects patient-reported outcomes more than conventional pivot-shift test grade after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39049502 DOI: 10.1002/ksa.12383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE To investigate whether the pivot-shift test reflects patient-reported outcomes 1 year after anterior cruciate ligament (ACL) reconstruction based on a multicentre prospective cohort study. METHODS This study included patients who underwent primary ACL reconstruction using the hamstring tendons. The pivot-shift test grades were determined according to the International Knee Documentation Committee (IKDC) form as 0, 1+, 2+ or 3+. In addition, patients' subjective apprehension during the pivot-shift test were classified as 0 (no-apprehension), 1+ (mild-apprehension), 2+ (moderate-apprehension) or 3+ (severe-apprehension). In this study, a positive pivot-shift test was defined as grade 1+ or higher. RESULTS A total of 837 patients were enroled in this study. One year postoperatively, there was no significant difference in the Knee injury and Osteoarthritis Outcome Score (KOOS), IKDC score, Lysholm knee scale and Tegner activity scale between the positive (118 patients) and negative (719 patients) groups of the conventional IKDC grading of the pivot-shift test. However, when divided into two groups based on the apprehension grading of the pivot-shift test after surgery, the postoperative scores were significantly lower in the apprehension-positive group (114 patients) than those in the apprehension-negative group (723 patients) on the Tegner activity scale and KOOS Symptom, Sports/Rec and Quality of Life subscales. CONCLUSIONS Patients' subjective apprehension during the pivot-shift test after ACL reconstruction was significantly associated with the postoperative Tegner activity scale and three subscales of the KOOS. However, there was no association between the conventional IKDC grading of the pivot-shift test and any patient-reported outcomes postoperatively. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Atsuo Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Masataka Deie
- Department of Orhopaedic Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Ayato Miyamoto
- Department of Orthopaedic Surgery, Matsuyama Shimin Hospital, Matsuyama, Japan
| | - Akio Eguchi
- Department of Orthopaedic Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Tomohiro Kato
- Department of Orthopedic Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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6
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Ravi V, Rehman M, Xia S, Chhabra A, Silva FD. Association of tibial slope alterations with anterior cruciate ligament (ACL) injury and mucoid degeneration. Skeletal Radiol 2024:10.1007/s00256-024-04744-x. [PMID: 39017944 DOI: 10.1007/s00256-024-04744-x] [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: 04/19/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE To compare radiographic measurements of lateral tibial slope (LTS), medial TS (MTS), and coronal TS (CTS) in MRI-defined intact, injured, and mucoid-degenerated native ACL knees and determine inter-reader reliability. MATERIALS AND METHODS Patient records from 2 years at tertiary care hospitals were reviewed for individuals aged 18-100 undergoing 3-Tesla knee MRI and radiographs. Two randomly selected cohorts, control, and pathologic ACLs on MRI with 86 patients each, were age, gender, and BMI-matched. A fellowship-trained musculoskeletal radiologist reevaluated curated images, characterizing ACL status. Two trained medical students independently collected clinical data and measured slopes on blinded radiographs. ICC, Cohen's kappa, and case-control matching were performed using SPSS statistical package, with ICC and ANOVA used for comparisons. RESULTS Among 172 patients with 172 MRIs and radiographs, there were 86 controls and 86 ACL lesions. There were 108/172 (62.79%) males and 64/172 (37.21%) females. ICCs were 0.966 for MTS, 0.975 for LTS, and 0.978 for CTS. Mucoid degeneration patients had a higher BMI and were older than control (p < .05) or completely torn (p < .001) ACL patients. There was no difference in TS between normal and pathologic ACLs; however, LTS-MTS differences were larger with partial tears (2.5 ± 4.9) than normal ACLs by 4.5° (± 1.2, p < .001), complete tears by 4.5° (± 1.3, p < .001), and mucoid degeneration by 4.9° (± 1.5, p = .001). CONCLUSION Various TS measurements are reliable. LTS-MTS differences are associated with different ACL lesions compared to normal ACLs.
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Affiliation(s)
- Varun Ravi
- UT Southwestern Medical School, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mahad Rehman
- UT Southwestern Medical School, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shuda Xia
- UT Southwestern Medical School, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA.
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Flavio Duarte Silva
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA
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Amer A. Rehabilitation from the perspective of a hijabi: a tale of finding myself while navigating unchartered territory-Dr Aminah Amer. Br J Sports Med 2024:bjsports-2024-108731. [PMID: 38964768 DOI: 10.1136/bjsports-2024-108731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 07/06/2024]
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Wagala NN, Fatora G, Brown C, Lesniak BP. Complications in Anterior Cruciate Ligament Surgery and How to Avoid Them. Clin Sports Med 2024; 43:465-477. [PMID: 38811122 DOI: 10.1016/j.csm.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Complications following anterior cruciate ligament (ACL) reconstruction can be detrimental to a patient's recovery and limit their ability to successfully return to sport. Arthrofibrosis, graft failure, and infection are a few examples of complications that can arise. Therefore, it is important for surgeons to recognize that each step during perioperative surgical decision making can impact patients' risk for such complications. The purpose of this paper is to discuss common complications following ACL reconstruction and how surgeons can avoid or reduce the risk of complications.
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Affiliation(s)
- Nyaluma N Wagala
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gabrielle Fatora
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cortez Brown
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Fraca-Fernández E, Ceballos-Laita L, Hernández-Lázaro H, Jiménez-del-Barrio S, Mingo-Gómez MT, Medrano-de-la-Fuente R, Hernando-Garijo I. Effects of Blood Flow Restriction Training in Patients before and after Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:1231. [PMID: 38921345 PMCID: PMC11203215 DOI: 10.3390/healthcare12121231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/04/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
(1) Objective: To examine the effects of blood flow restriction (BFR) training on muscle strength, cross-sectional area and knee-related function in patients selected for anterior cruciate ligament reconstruction (ACLR). (2) Methods: A literature search was conducted in PubMed, PEDro, Cochrane Library, Web of Science, SCOPUS, and ProQuest databases until 20 May 2024. Controlled clinical trials comparing the effects of BFR training with unrestricted training in patients before or after ACLR were selected. The GRADE approach was used to assess the degree of certainty for each meta-analysis. (3) Results: Ten studies were included (n = 287 participants). Standardized mean differences in favor of BFR training applied postoperatively were observed in knee extensor (SMD = 0.79; 95% CI = 0.06 to 1.52; I2: 68%) and flexor isokinetic strength (SMD = 0.53; 95% CI = 0.04 to 1.01; I2: 0%), and quadriceps cross-sectional area (SMD = 0.76; 95% CI = 0.27 to 1.26; I2: 0%). No changes were found in knee extensor isometric strength and knee-related function. The degree of certainty according to the GRADE was very low. (4) Conclusions: Very low degree of certainty suggests that BFR training provides additional benefits to unrestricted training on isokinetic strength and quadriceps cross-sectional area in patients undergoing ACLR.
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Affiliation(s)
- Eduardo Fraca-Fernández
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (E.F.-F.); (L.C.-L.); (H.H.-L.); (S.J.-d.-B.); (M.T.M.-G.); (I.H.-G.)
| | - Luis Ceballos-Laita
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (E.F.-F.); (L.C.-L.); (H.H.-L.); (S.J.-d.-B.); (M.T.M.-G.); (I.H.-G.)
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
| | - Héctor Hernández-Lázaro
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (E.F.-F.); (L.C.-L.); (H.H.-L.); (S.J.-d.-B.); (M.T.M.-G.); (I.H.-G.)
| | - Sandra Jiménez-del-Barrio
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (E.F.-F.); (L.C.-L.); (H.H.-L.); (S.J.-d.-B.); (M.T.M.-G.); (I.H.-G.)
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
| | - María Teresa Mingo-Gómez
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (E.F.-F.); (L.C.-L.); (H.H.-L.); (S.J.-d.-B.); (M.T.M.-G.); (I.H.-G.)
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
| | - Ricardo Medrano-de-la-Fuente
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (E.F.-F.); (L.C.-L.); (H.H.-L.); (S.J.-d.-B.); (M.T.M.-G.); (I.H.-G.)
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
| | - Ignacio Hernando-Garijo
- Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain; (E.F.-F.); (L.C.-L.); (H.H.-L.); (S.J.-d.-B.); (M.T.M.-G.); (I.H.-G.)
- Clinical Research in Health Sciences Group, University of Valladolid, 42004 Soria, Spain
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Stehle M, Amini M, Venkatesan JK, Liu W, Wang D, Nguyen TN, Leroux A, Madry H, Migonney V, Cucchiarini M. Commitment of human mesenchymal stromal cells towards ACL fibroblast differentiation upon rAAV-mediated FGF-2 and TGF-β overexpression using pNaSS-grafted PCL films. Biotechnol Bioeng 2024. [PMID: 38877726 DOI: 10.1002/bit.28773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/29/2024] [Accepted: 05/28/2024] [Indexed: 06/16/2024]
Abstract
Despite various clinical options, human anterior cruciate ligament (ACL) lesions do not fully heal. Biomaterial-guided gene therapy using recombinant adeno-associated virus (rAAV) vectors may improve the intrinsic mechanisms of ACL repair. Here, we examined whether poly(sodium styrene sulfonate)-grafted poly(ε-caprolactone) (pNaSS-grafted PCL) films can deliver rAAV vectors coding for the reparative basic fibroblast growth factor (FGF-2) and transforming growth factor beta (TGF-β) in human mesenchymal stromal cells (hMSCs) as a source of implantable cells in ACL lesions. Efficient and sustained rAAV-mediated reporter (red fluorescent protein) and therapeutic (FGF-2 and TGF-β) gene overexpression was achieved in the cells for at least 21 days in particular with pNaSS-grafted PCL films relative to all other conditions (up to 5.2-fold difference). Expression of FGF-2 and TGF-β mediated by rAAV using PCL films increased the levels of cell proliferation, the DNA contents, and the deposition of proteoglycans and of type-I and -III collagen (up to 2.9-fold difference) over time in the cells with higher levels of transcription factor expression (Mohawk, Scleraxis) (up to 1.9-fold difference), without activation of inflammatory tumor necrosis alpha especially when using pNaSS-grafted PCL films compared with the controls. Overall, the effects mediated by TGF-β were higher than those promoted by FGF-2, possibly due to higher levels of gene expression achieved upon rAAV gene transfer. This study shows the potential of using functionalized PCL films to apply rAAV vectors for ACL repair.
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Affiliation(s)
- Meret Stehle
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Mahnaz Amini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Jagadeesh K Venkatesan
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Wei Liu
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Dan Wang
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Tuan N Nguyen
- LBPS/CSPBAT UMR CNRS 7244, Université Sorbonne Paris Nord, Villetaneuse, France
| | - Amélie Leroux
- LBPS/CSPBAT UMR CNRS 7244, Université Sorbonne Paris Nord, Villetaneuse, France
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Véronique Migonney
- LBPS/CSPBAT UMR CNRS 7244, Université Sorbonne Paris Nord, Villetaneuse, France
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg, Saarland, Germany
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Cao Z, Wang C, Ma Y, Wang J, Wang H, Liu P, Yang Y, Gong X, Wang J, Shi W. Good clinical outcomes of anterior cruciate ligament reconstruction in patients over 60 years of age. Knee Surg Sports Traumatol Arthrosc 2024; 32:1396-1404. [PMID: 38558103 DOI: 10.1002/ksa.12148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To evaluate the clinical outcomes following arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) in patients over 60 years and to investigate the potential impact of preoperative osteoarthritis (OA) on these outcomes. METHODS A retrospective study included ACL-injured patients over 60 years who underwent primary arthroscopic ACLR between 2010 and 2020. The Lysholm score and the International Knee Documentation Committee (IKDC) score were assessed preoperatively and at the final follow-up. The Tegner activity scale was performed to evaluate patients' activity levels. Data on return to sports, patient satisfaction, subsequent injuries and complications were collected. Preoperative radiographs were used to grade OA according to the Kellgrene-Lawrence classification. Correlation analysis between OA and clinical outcomes was performed. The rates of achieving the minimal clinically significant difference and patient-acceptable symptoms state were documented. RESULTS A total of 37 patients were included in this study. The mean age at surgery was 62.3 ± 2.3 years, with a mean follow-up of 6.3 ± 3.2 years (range: 2.1-12.4). Patients showed statistically significant (all p < 0.001) improvements in the mean IKDC (38.9 ± 9.4-66.8 ± 12.5), Lysholm (48.8 ± 15.4-83.0 ± 12.8) and Tegner (1-3) scores. Fourteen patients (37.8%) returned to sports. No correlation was observed between the degree of preoperative OA and clinical outcomes (n.s.). CONCLUSION Patients over 60 years with symptomatic ACL-deficient knees could benefit from ACLR, even when mild to moderate OA is present preoperatively. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Zhuohan Cao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yong Ma
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jian Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Haijun Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Ping Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yuping Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Xi Gong
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jianquan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Weili Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
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12
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Butler L, Greenberg E, Giampetruzzi N, Link M, Prati V, Weaver A, Saper M. Comparison of physical therapy utilization, timing of return-to-sport test completion, and hop test performance by age and between sexes in youth athletes after anterior cruciate ligament reconstruction. Phys Ther Sport 2024; 67:1-6. [PMID: 38387378 DOI: 10.1016/j.ptsp.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To compare physical therapy (PT) utilization, timing of return-to-sport (RTS) test and hop test performance by age and between sexes in youth after anterior cruciate ligament reconstruction (ACLR). DESIGN Multicenter retrospective cohort. METHODS A retrospective review of adolescents after primary ACLR was conducted. Participants completed return-to-sport (RTS) tests including single-legged hop testing. PT frequency, average weekly visits, and timing of RTS test were calculated. T-tests assessed the effect of age and sex on average weekly PT visits and multivariable logistic regressions assessed odds of passing hop tests. RESULTS 289 participants were included (15.7 ± 1.9 years). There was no difference in average weekly PT visits (p = 0.321) or time to RTS test (p = 0.162) by age. There were significant differences in average weekly PT visits (p = 0.047) and mean time from surgery to RTS test (p = 0.048) between sexes with small effect sizes (d = 0.24 and d = 0.21, respectively). Age and sex had no effect on odds of passing hop tests (OR, 1.29; 95% CI, 0.71-2.35 and OR, 0.79; 95%CI, 0.43-1.45, respectively). CONCLUSION In a youth cohort, age and sex may have no clinically important effect on PT visit utilization, timing of RTS test or hop test performance.
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Affiliation(s)
- Lauren Butler
- Florida International University, Miami, FL, USA; Nicklaus Children's Hospital, Miami, FL, USA.
| | | | | | - Meredith Link
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Victor Prati
- Arkansas Children's Hospital, Little Rock, AR, USA
| | - Adam Weaver
- Connecticut Children's Medical Center, Hartford, CT, USA
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13
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Elrosasy A, Abo Zeid M, Abbas AW, Eldeeb H, Eljadid GY, Hamid AK, Al Azzawi MAD. What is the impact of Kinesio taping on anterior cruciate ligament reconstruction: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2213-2222. [PMID: 38502344 DOI: 10.1007/s00590-024-03878-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE As a therapeutic intervention for several musculoskeletal illnesses, the benefits and effectiveness of Kinesio taping (KT) are currently unclear. This systematic review and meta-analysis's (MA) goal is to evaluate the effectiveness of KT for anterior cruciate ligament (ACL) reconstruction and its impact on clinical outcomes. METHODS A comprehensive search of online databases was done to discover relevant studies. Inclusion criteria included controlled or randomized clinical trials that were published in English. Changes in pain, flexion strength, and extension strength were among the outcomes of interest. RevMan 5.4 was used to extract and analyze data. RESULTS After satisfying the inclusion requirements, five studies were included in the MA. Pooled analysis showed that, in comparison with the intervention group, the control group had a statistically significant improvement in flexion strength (Standardized mean difference (SMD) = 0.44, 95% Confidence interval (CI) [0.01, 0.87], p = 0.04). Extension strength and pain, however, did not significantly differ between the intervention and control groups (SMD = 30, 95% CI [- 0.12, 0.72], p = 0.16), (SMD = 0.26, 95% CI [- 0.14, 0.66], p = 0.20), respectively. CONCLUSIONS This analysis suggests limited to no benefits of KA post-ACL reconstruction. While the control group surprisingly showed better improvement in flexion strength, no significant differences were found in extension strength and pain. Further rigorous trials are needed to confirm its utility in rehabilitation.
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Affiliation(s)
- Amr Elrosasy
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Ahmed W Abbas
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hatem Eldeeb
- Faculty of Medicine, Alazhar University, Cairo, Egypt
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14
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Colbrunn RW, Loss JG, Gillespie CM, Pace EB, Nagle TF. Methodology for Robotic In Vitro Testing of the Knee. J Knee Surg 2024. [PMID: 38513696 DOI: 10.1055/a-2292-1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
The knee joint plays a pivotal role in mobility and stability during ambulatory and standing activities of daily living (ADL). Increased incidence of knee joint pathologies and resulting surgeries has led to a growing need to understand the kinematics and kinetics of the knee. In vivo, in silico, and in vitro testing domains provide researchers different avenues to explore the effects of surgical interactions on the knee. Recent hardware and software advancements have increased the flexibility of in vitro testing, opening further opportunities to answer clinical questions. This paper describes best practices for conducting in vitro knee biomechanical testing by providing guidelines for future research. Prior to beginning an in vitro knee study, the clinical question must be identified by the research and clinical teams to determine if in vitro testing is necessary to answer the question and serve as the gold standard for problem resolution. After determining the clinical question, a series of questions (What surgical or experimental conditions should be varied to answer the clinical question, what measurements are needed for each surgical or experimental condition, what loading conditions will generate the desired measurements, and do the loading conditions require muscle actuation?) must be discussed to help dictate the type of hardware and software necessary to adequately answer the clinical question. Hardware (type of robot, load cell, actuators, fixtures, motion capture, ancillary sensors) and software (type of coordinate systems used for kinematics and kinetics, type of control) can then be acquired to create a testing system tailored to the desired testing conditions. Study design and verification steps should be decided upon prior to testing to maintain the accuracy of the collected data. Collected data should be reported with any supplementary metrics (RMS error, dynamic statistics) that help illuminate the reported results. An example study comparing two different anterior cruciate ligament reconstruction techniques is provided to demonstrate the application of these guidelines. Adoption of these guidelines may allow for better interlaboratory result comparison to improve clinical outcomes.
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15
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Sharabi M, Agron R, Dolev A, Haj-Ali R, Yassin M. Predictive Refined Computational Modeling of ACL Tear Injury Patterns. Bioengineering (Basel) 2024; 11:413. [PMID: 38790281 PMCID: PMC11118060 DOI: 10.3390/bioengineering11050413] [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: 03/23/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Anterior cruciate ligament (ACL) ruptures are prevalent knee injuries, with approximately 200,000 ruptures annually, and treatment costs exceed USD two billion in the United States alone. Typically, the initial detection of ACL tears and anterior tibial laxity (ATL) involves manual assessments like the Lachman test, which examines anterior knee laxity. Partial ACL tears can go unnoticed if they minimally affect knee laxity; however, they will progress to a complete ACL tear requiring surgical treatment. In this study, a computational finite element model (FEM) of the knee joint was generated to investigate the effect of partial ACL tears under the Lachman test (GNRB® testing system) boundary conditions. The ACL was modeled as a hyperelastic composite structure with a refined representation of collagen bundles. Five different tear types (I-V), classified by location and size, were modeled to predict the relationship between tear size, location, and anterior tibial translation (ATT). The results demonstrated different levels of ATT that could not be manually detected. Type I tears demonstrated an almost linear increase in ATT, with the growth in tear size ranging from 3.7 mm to 4.2 mm, from 25% to 85%, respectively. Type II partial tears showed a less linear incline in ATT (3.85, 4.1, and 4.75 mm for 25%, 55%, and 85% partial tears, respectively). Types III, IV, and V maintained a nonlinear trend, with ATTs of 3.85 mm, 4.2 mm, and 4.95 mm for Type III, 3.85 mm, 4.25 mm, and 5.1 mm for Type IV, and 3.6 mm, 4.25 mm, and 5.3 mm for Type V, for 25%, 55%, and 85% partial tears, respectively. Therefore, for small tears (25%), knee stability was most affected when the tears were located around the center of the ligament. For moderate tears (55%), the effect on knee stability was the greatest for tears at the proximal half of the ACL. However, severe tears (85%) demonstrated considerable growth in knee instability from the distal to the proximal ends of the tissue, with a substantial increase in knee instability around the insertion sites. The proposed model can enhance the characterization of partial ACL tears, leading to more accurate preliminary diagnoses. It can aid in developing new techniques for repairing partially torn ACLs, potentially preventing more severe injuries.
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Affiliation(s)
- Mirit Sharabi
- Department of Mechanical Engineering and Mechatronics, Ariel University, Ariel 407000, Israel;
| | - Raz Agron
- Department of Mechanical Engineering and Mechatronics, Ariel University, Ariel 407000, Israel;
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Amir Dolev
- Department of Orthopedics, HaSharon Hospital, Rabin Medical Center, Petach Tikva 49372, Israel; (A.D.); (M.Y.)
| | - Rami Haj-Ali
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Mustafa Yassin
- Department of Orthopedics, HaSharon Hospital, Rabin Medical Center, Petach Tikva 49372, Israel; (A.D.); (M.Y.)
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16
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Meng Q, Dai R, Wang C, Shi W, Jiang Y, Liu N, Li R, Ao Y, Gong X, Ma Y. Additional suture augmentation to anterior cruciate ligament reconstruction with hamstring autografts bring no benefits to clinical results, graft maturation and graft-bone interface healing. BMC Musculoskelet Disord 2024; 25:301. [PMID: 38632590 PMCID: PMC11022449 DOI: 10.1186/s12891-024-07426-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND From the perspective of graft protection and early rehabilitation during the maturation and remodeling phases of graft healing, suture augmentation (SA) for anterior cruciate ligament reconstruction (ACLR) has attracted more and more attention. STUDY DESIGN Retrospective study. PURPOSE To determine whether the additional SA affects clinical results, graft maturation and graft-bone interface healing during two years follow-up after ACLR. METHODS 20 ACLRs with additional SA (ACLR-SA group) and 20 ACLRs without additional SA (ACLR group) were performed between January 2020 and December 2021 by the same surgeon and were retrospectively analyzed. Pre- and postoperative International Knee Documentation Committee (IKDC) scores, Lysholm scores, graft failure and reoperation were evaluated. The signal/noise quotient (SNQ) of autografts and the signal intensity of graft-bone interface were analyzed. All 40 patients in ACLR-SA group and ACLR group completed 2-years follow-up. RESULTS There was no patient in the two cohorts experienced graft failure and reoperation. The postoperative IKDC and Lysholm scores have been significantly improved compared with preoperative scored in both ACLR-SA group and ACLR group, however, there was no significant difference between two groups. The SNQ of proximal graft of ACLR-SA group (14.78 ± 8.62 vs. 8.1 ± 5.5, p = 0.041) was significantly greater while the grades of graft-bone interface healing of posterior tibial was significantly lower than that of ACLR group at 1-year postoperatively (p = 0.03), respectively. There were no significant differences between the two groups of the SNQ of proximal, distal medial graft segments, and the graft-bone interface healing grades of anterior femoral, posterior femoral, anterior tibial and posterior tibial at other time points (p>0.05). CONCLUSIONS The additional SA in ACLR had no effect on IKDC scores, Lysholm scores, graft maturation and graft-bone interface healing at 2-year postoperatively. Our research does not support the routine use of SA in ACLR.
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Affiliation(s)
- Qingyang Meng
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Ruilan Dai
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- College of Exercise and health Sciences, Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China
| | - Cheng Wang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Weili Shi
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yanfang Jiang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Ningjing Liu
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Rui Li
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yingfang Ao
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Xi Gong
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Yong Ma
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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Fan Y, Yuh J, Lekkala S, Asik MD, Thomson A, McCanne M, Randolph MA, Chen AF, Oral E. The efficacy of vitamin E in preventing arthrofibrosis after joint replacement. Animal Model Exp Med 2024; 7:145-155. [PMID: 38525803 PMCID: PMC11079150 DOI: 10.1002/ame2.12388] [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: 08/16/2023] [Accepted: 01/10/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Arthrofibrosis is a joint disorder characterized by excessive scar formation in the joint tissues. Vitamin E is an antioxidant with potential anti-fibroblastic effect. The aim of this study was to establish an arthrofibrosis rat model after joint replacement and assess the effects of vitamin E supplementation on joint fibrosis. METHODS We simulated knee replacement in 16 male Sprague-Dawley rats. We immobilized the surgical leg with a suture in full flexion. The control groups were killed at 2 and 12 weeks (n = 5 per group), and the test group was supplemented daily with vitamin E (0.2 mg/mL) in their drinking water for 12 weeks (n = 6). We performed histological staining to investigate the presence and severity of arthrofibrosis. Immunofluorescent staining and α2-macroglobulin (α2M) enzyme-linked immunosorbent assay (ELISA) were used to assess local and systemic inflammation. Static weight bearing (total internal reflection) and range of motion (ROM) were collected for functional assessment. RESULTS The ROM and weight-bearing symmetry decreased after the procedure and recovered slowly with still significant deficit at the end of the study for both groups. Histological analysis confirmed fibrosis in both lateral and posterior periarticular tissue. Vitamin E supplementation showed a moderate anti-inflammatory effect on the local and systemic levels. The vitamin E group exhibited significant improvement in ROM and weight-bearing symmetry at day 84 compared to the control group. CONCLUSIONS This model is viable for simulating arthrofibrosis after joint replacement. Vitamin E may benefit postsurgical arthrofibrosis, and further studies are needed for dosing requirements.
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Affiliation(s)
- Yingfang Fan
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
- Department of Orthopaedic SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Jean Yuh
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
| | - Sashank Lekkala
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
| | - Mehmet D. Asik
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
- Department of Orthopaedic SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Andrew Thomson
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
| | - Madeline McCanne
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
| | - Mark A. Randolph
- Department of Orthopaedic SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Department of SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Antonia F. Chen
- Department of Orthopaedic SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
- Department of Orthopaedic SurgeryHarvard Medical SchoolBostonMassachusettsUSA
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18
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Beyer J, Jones R, Igo I, Furyes AR, Liu J, Sohn DH. Comparison of Graft Type and Fixation Method in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis Based on Randomized Control Studies. JBJS Rev 2024; 12:01874474-202404000-00001. [PMID: 38574182 DOI: 10.2106/jbjs.rvw.23.00222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND The anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee. ACL reconstruction (ACLR) proves the standard for treating this injury. However, graft choice and method of fixation remain a heavily debated topic. This study investigates the following: bone-patellar tendon-bone (BPTB) vs. hamstring tendon (HT) autograft, single-bundle vs. double-bundle hamstring graft, and metal vs. bioabsorbable screws in ACLR. METHODS A systematic review was performed on PubMed and Google Scholar according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were collected on patient demographics, complications, and functionality scores including International Knee Documentation Committee (IKDC) and Lysholm scores. A systematic review and meta-analysis were conducted with Review Manager. Outcome measurements were determined using forest plots with significant differences considered p < 0.05. RESULTS Twenty-five studies were included, accounting for 2,170 patients. No statistically significant difference was appreciated when comparing BPTB to hamstring autografts. Patients who received a double bundle HT autograft exhibited significantly superior outcomes in terms of revision (p = 0.05), failure (p = 0.002), normal pivot shift tests (p = 0.04), and normal IKDC (p = 0.008). When comparing screw types, bioabsorbable screws had a greater Lysholm score (p = 0.01) and lower failure rates for copolymer screws (p = 0.03). CONCLUSION Overall, the data collected suggested that BPTB and HT autografts display similar postoperative results. However, if an HT autograft is used, the data suggest a double-bundle graft improves both functionality and decreases the possible complications. Finally, bioabsorbable screws prove superior to metal screws when looking at both functionality and failure rates. Further research into the superior graft type is still needed. LEVEL OF EVIDENCE Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Julia Beyer
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
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19
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He Y, Fan Y, Zhai L, Zhu W. Comparative efficacy and safety of different surgical approaches for the treatment of anterior cruciate ligament injury: a Bayesian network meta-analysis protocol. BMJ Open 2024; 14:e077242. [PMID: 38553073 PMCID: PMC10982744 DOI: 10.1136/bmjopen-2023-077242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) rupture can be treated surgically or non-surgically, with several surgical interventions available at present. However, the comparatively effective surgical intervention with relatively fewer side effects remains unknown. This study aims to fill in this gap by conducting a Bayesian network meta-analysis (NMA) and provide a theoretical basis for the clinical application. METHOD AND ANALYSIS We will perform a Bayesian NMA and will include randomised controlled trials (RCTs) published in English or Chinese that compare surgical intervention (ie, standard ACL reconstruction, ACL remnant-preserving reconstruction and ACL repair with suture augmentation to conservative therapy or studies that compare one surgical intervention to another for the symptom relief and function recovery of patients with ACL rupture. Primary outcome will be the proportion of patients with symptomatic and functional improvement measured by the Knee Injury and Osteoarthritis Outcome Score before and 6 months after treatment, with scores ranging from 0 (worst) to 100 (best). Secondary outcomes will be knee-specific quality of life (ACL QoL), return to activity and level of sport participation (Tegner or modified Tegner score), health-related QoL (EuroQol Group 5-Dimension 5-Level, EQ-5D-5L), resource use, intervention-related complications and patient satisfaction. We have developed search strategies for PubMed, Embase, the Cochrane Library and Web of Science, retrieving RCTs that meet the inclusion criteria from database inception to 1 December 2023. The methodological quality of the included RCTs will be assessed based on the Cochrane risk of bias table. The relative ranking probability of the best intervention will be estimated using the surface under the cumulative ranking curve. The Bayesian NMA will be conducted by using WinBUGS V.1.4.3. The Grading of Recommendations Assessment, Development and Evaluation approach will be applied to determine our confidence in an overall treatment ranking from the NMA. ETHICS AND DISSEMINATION Ethical approval for this study is not required because no private or confidential patient data will be used in this study. Findings of this study would be disseminated through the publication in a peer-reviewed medical journal. PROSPERO REGISTRATION NUMBER CRD42023437115.
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Affiliation(s)
- Yuchen He
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yishu Fan
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Central South University, Changsha, Hunan, China
| | - Longxiang Zhai
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Weihong Zhu
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Megafu M, Megafu E, Mian H, Singhal S, Lee A, Gladstone JN, Parisien RL. Fragile Statistical Findings in Randomized Controlled Trials Evaluating Autograft Versus Allograft Use in Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2024; 40:1009-1018. [PMID: 37579956 DOI: 10.1016/j.arthro.2023.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE To analyze the statistical stability of randomized controlled trials (RCTs) evaluating the surgical management of autografts versus allografts in the anterior cruciate ligament reconstruction (ACLR) literature and calculate the fragility index (FI) and fragility quotient and explore a subgroup analysis by calculating the proportion of outcome events where the FI was less than the number of patients lost to follow-up. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic search in the PubMed and Cochrane databases to identify RCTs published between 2000 and 2022 that investigated the use of autografts versus allografts in ACLR literature and reported dichotomous data. The fragility index of each dichotomous variable was calculated through the reversal of a single outcome event until significance was reversed. The fragility quotient was calculated by dividing each fragility index by the study sample size. The interquartile range also was calculated. RESULTS Of the 4407 articles screened, 23 met the search criteria, with 11 RCTs evaluating ALCR using autografts and allografts included for analysis. Two hundred and 18 outcome events with 32 significant (P < .05) outcomes and 186 nonsignificant (P ≥ .05) outcomes were identified. The overall fragility index and fragility quotient for all 218 outcomes were 6 subjects (interquartile range 5-8) and 0.058 (interquartile range 0.039-0.077). Fragility analysis of statistically significant outcomes and nonsignificant outcomes had a fragility index of 3.5 (interquartile range 1-5.5) and 6 (interquartile range 5-8), respectively. All of the studies reported a loss to follow-up where 45.5% (5) reported a loss to follow-up greater or equal to 6. CONCLUSIONS The RCTs in the ACLR peer-reviewed literature evaluating autograft versus allograft use are vulnerable to a small number of outcome event reversals and exemplify significant statistical fragility in statistically significant findings. LEVEL OF EVIDENCE Level I, systematic review of Level I studies.
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Affiliation(s)
- Michael Megafu
- A.T. Still University, Kirksville College of Osteopathic Medicine, Kirksville, Missouri, U.S.A..
| | - Emmanuel Megafu
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, U.S.A
| | - Hassan Mian
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, Minnesota, U.S.A
| | - Sulabh Singhal
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Alexander Lee
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - James N Gladstone
- Mount Sinai Hospital, Department of Orthopedic Surgery and Sports Medicine, New York, New York, U.S.A
| | - Robert L Parisien
- Mount Sinai Hospital, Department of Orthopedic Surgery and Sports Medicine, New York, New York, U.S.A
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Strassman AK, Stokes DJ, Sanchez RA, Shinsako KK, Smith PA, DiFelice GS, Frank RM. Anterior Cruciate Ligament Repair Using a Re-tensionable All-Suture Construct. Arthrosc Tech 2024; 13:102890. [PMID: 38584624 PMCID: PMC10995730 DOI: 10.1016/j.eats.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/02/2023] [Indexed: 04/09/2024] Open
Abstract
Anterior cruciate ligament (ACL) tears are among the most common injuries to the knee. With recent improvements in imaging that allow for more precise identification of ACL tear patterns, improved techniques for repair, and advancements in biological augmentation, there has been a re-emerging interest in primary ACL repair, especially for acute proximal ACL tears. This article aims to describe a surgical technique for primary ACL repair using a re-tensionable all-suture-based construct.
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Affiliation(s)
| | - Daniel J Stokes
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado, U.S.A
| | | | - Kevin K Shinsako
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado, U.S.A
| | | | | | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado, U.S.A
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22
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Firth AD, Pritchett SL, Milner JS, Atkinson HF, Bryant DM, Holdsworth DW, Getgood AMJ. Quantitative Magnetic Resonance Imaging of Lateral Compartment Articular Cartilage After Lateral Extra-articular Tenodesis. Am J Sports Med 2024; 52:909-918. [PMID: 38385189 DOI: 10.1177/03635465241228193] [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: 02/23/2024]
Abstract
BACKGROUND Concerns have arisen that anterior cruciate ligament reconstruction (ACLR) with lateral extra-articular tenodesis (LET) may accelerate the development of posttraumatic osteoarthritis in the lateral compartment of the knee. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate whether the augmentation of ACLR with LET affects the quality of lateral compartment articular cartilage on magnetic resonance imaging (MRI) at 2 years postoperatively. We hypothesized that there would be no difference in T1rho and T2 relaxation times when comparing ACLR alone with ACLR + LET. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A consecutive subgroup of patients at the Fowler Kennedy Sport Medicine Clinic participating in the STABILITY 1 Study underwent bilateral 3-T MRI at 2 years after surgery. The primary outcome was T1rho and T2 relaxation times. Articular cartilage in the lateral compartment was manually segmented into 3 regions of the tibia (lateral tibia [LT]-1 to LT-3) and 5 regions of the femur (lateral femoral condyle [LFC]-1 to LFC-5). Analysis of covariance was used to compare relaxation times between groups, adjusted for lateral meniscal tears and treatment, cartilage and bone marrow lesions, contralateral relaxation times, and time since surgery. Semiquantitative MRI scores according to the Anterior Cruciate Ligament OsteoArthritis Score were compared between groups. Correlations were used to determine the association between secondary outcomes (including results of the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, Lower Extremity Functional Scale, 4-Item Pain Intensity Measure, hop tests, and isokinetic quadriceps and hamstring strength tests) and cartilage relaxation. RESULTS A total of 95 participants (44 ACLR alone, 51 ACLR + LET) with a mean age of 18.8 years (61.1% female [58/95]) underwent 2-year MRI (range, 20-36 months). T1rho relaxation times were significantly elevated for the ACLR + LET group in LT-1 (37.3 ± 0.7 ms vs 34.1 ± 0.8 ms, respectively; P = .005) and LFC-2 (43.9 ± 0.9 ms vs 40.2 ± 1.0 ms, respectively; P = .008) compared with the ACLR alone group. T2 relaxation times were significantly elevated for the ACLR + LET group in LFC-1 (51.2 ± 0.7 ms vs 49.1 ± 0.7 ms, respectively; P = .03) and LFC-4 (45.9 ± 0.5 ms vs 44.2 ± 0.6 ms, respectively; P = .04) compared with the ACLR alone group. All effect sizes were small to medium. There was no difference in Anterior Cruciate Ligament OsteoArthritis Scores between groups (P = .99). Weak negative associations (rs = -0.27 to -0.22; P < .05) were found between relaxation times and quadriceps and hamstring strength in the anterolateral knee, while all other correlations were nonsignificant (P > .05). CONCLUSION Increased relaxation times demonstrating small to medium effect sizes suggested early biochemical changes in articular cartilage of the anterolateral compartment in the ACLR + LET group compared with the ACLR alone group. Further evidence and long-term follow-up are needed to better understand the association between these results and the potential risk of the development of osteoarthritis in our patient cohort.
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Affiliation(s)
- Andrew D Firth
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stephany L Pritchett
- Division of Musculoskeletal Imaging, Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jaques S Milner
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Hayden F Atkinson
- School of Physical Therapy, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Dianne M Bryant
- School of Physical Therapy, Western University, London, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David W Holdsworth
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alan M J Getgood
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Department of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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23
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Momaya A, Harris C, Hargreaves M. Why Your Patient May Need an ACL Reconstruction Plus Lateral Extra-Articular Tenodesis Procedure. Int J Sports Phys Ther 2024; 19:251-257. [PMID: 38439781 PMCID: PMC10909304 DOI: 10.26603/001c.94015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Anterior cruciate ligament (ACL) tears are one of the most common knee injuries experienced by active individuals engaging in cutting sports. Despite improved surgical techniques and rehabilitation, the return to sport rate and re-tear rates remain unsatisfactory. Lateral extra-articular tenodesis (LET) is a procedure that has been growing in interest when performed in conjunction with ACL reconstruction. The benefits of adding an LET procedure to an ACL surgery may include greater rotational stability, decreased re-tear rates, and improved return to play. Level of evidence: V.
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24
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Tang H, Xiao YF, Wu YM, Xiong YL, Gao SG. Physeal-Sparing, All-Inside Anterior Cruciate Ligament Reconstruction Using Quadrupled Semitendinosus Autograft and Suture Tape Augmentation for Skeletally Immature Patients. Arthrosc Tech 2024; 13:102889. [PMID: 38584626 PMCID: PMC10995729 DOI: 10.1016/j.eats.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/04/2023] [Indexed: 04/09/2024] Open
Abstract
The anterior cruciate ligament (ACL) is the primary soft-tissue structure for anterior stabilization of the knee and is one of the most frequently injured structures. The incidence of ACL injuries in children and adolescents ranges from 92 to 151 per 100,000 person-years. The choice of surgical treatment for this population group is controversial, with a widespread concern that adult reconstruction techniques may damage the epiphyseal plate, compromise growth, or cause deformity. In this article, we describe a physeal-sparing, all-inside ACL reconstruction technique for skeletally immature patients. This technique is supported by retrograde drilling of the femoral tunnel and retrograde drilling of the tibial tunnel, both of which are able to avoid the epiphyseal growth line. Fixation of the quadrupled semitendinosus autograft and suture tape augmentation are achieved by soft-tissue buttons on the femur and tibia. The surgical details of this reproducible reconstruction technique are elaborated.
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Affiliation(s)
- Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi-Fan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yu-Mei Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi-Lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shu-Guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Wu X, Chen J, Ye Z, Dong S, Xie G, Zhao S, Xu C, Li Z, Xu J, Zhao J. Clinical and Radiological Outcomes After Combined ACL and MPFL Reconstruction Versus Isolated ACL Reconstruction for ACL Injury With Patellar Instability. Am J Sports Med 2024; 52:936-947. [PMID: 38349070 DOI: 10.1177/03635465241226976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND An anterior cruciate ligament (ACL) injury accompanied by patellar instability (PI) is a topic that has gained orthopaedic surgeons' attention recently. Untreated PI is reportedly associated with worse clinical outcomes after isolated ACL reconstruction (ACLR) in patients after an ACL injury with PI. Nevertheless, the appropriate surgical approach and its long-term therapeutic effects in these patients remain unclear. PURPOSE (1) To compare the clinical and radiological outcomes between isolated ACLR (iACLR) and combined ACLR and medial patellofemoral ligament reconstruction (cAMR) in patients after an ACL injury with PI and (2) to explore the correlations between these 2 procedures and clinical and radiological outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 106 patients diagnosed with an ACL injury accompanied by PI between January 2016 and April 2021 were analyzed in this study. There were 34 patients excluded because of missing postoperative radiological data. Among the remaining 72 patients, 34 patients underwent iACLR, while 38 patients underwent cAMR. Demographic characteristics, intraoperative findings, and patient-reported outcomes (Lysholm score, subjective International Knee Documentation Committee score, and Tegner activity score) were prospectively collected. Patellar alignment parameters and worsening patellofemoral osteoarthritis (PFOA) features (evaluated with the modified Whole-Organ Magnetic Resonance Imaging Score) were analyzed longitudinally on magnetic resonance imaging. The Kujala score was used to evaluate the functional recovery of the patellofemoral joint, and redislocations of the patella were prospectively recorded. Finally, multivariate logistic regression analysis was used to explore the correlations between these 2 procedures and clinical (not achieving the minimal detectable change [MDC] for the Lysholm score) and radiological (worsening PFOA features) outcomes. RESULTS The mean follow-up duration was 28.9 ± 6.2 and 27.1 ± 6.8 months for the iACLR and cAMR groups, respectively (P = .231). Significantly higher Lysholm scores (88.3 ± 9.9 vs 82.1 ± 11.1, respectively; P = .016) and subjective International Knee Documentation Committee scores (83.6 ± 11.9 vs 78.3 ± 10.2, respectively; P = .046) were detected in the cAMR group compared with the iACLR group postoperatively. The rates of return to preinjury sports were 20.6% and 44.7% in the iACLR and cAMR groups, respectively (difference, 24.1% [95% CI, 3.3%-45.0%]; P = .030). Moreover, the rates of worsening PFOA features were 44.1% and 18.4% in the iACLR and cAMR groups, respectively (difference, 25.7% [95% CI, 4.9%-46.4%]; P = .018). In addition, significantly higher Kujala scores (87.9 ± 11.3 vs 80.1 ± 12.0, respectively; P = .006), lower redislocation rates (0.0% vs 11.8%, respectively; difference, 11.8% [95% CI, 0.9%-22.6%]; P = .045), and significantly better patellar alignment were detected in the cAMR group compared with the iACLR group postoperatively. Furthermore, multivariate logistic regression analysis determined that iACLR and partial lateral meniscectomy were significantly correlated with not achieving the MDC for the Lysholm score and worsening PFOA features in our study population. CONCLUSION In patients after an ACL injury with PI, cAMR yielded better clinical and radiological outcomes compared with iACLR, with better patellar stability and a lower proportion of worsening PFOA features. Furthermore, not achieving the MDC for the Lysholm score and worsening PFOA features were significantly correlated with iACLR and partial lateral meniscectomy. Our study suggests that cAMR may be a more appropriate procedure for patients after an ACL injury with PI, which warrants further high-level clinical evidence.
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Affiliation(s)
- Xiulin Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyun Li
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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du Moulin W, Bourne M, Diamond LE, Konrath J, Vertullo C, Saxby DJ. Moment arm and torque generating capacity of semitendinosus following tendon harvesting for anterior cruciate ligament reconstruction: A simulation study. J Orthop Res 2024. [PMID: 38400545 DOI: 10.1002/jor.25814] [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: 09/27/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Altered semitendinosus (ST) morphology and distal tendon insertion following anterior cruciate ligament reconstruction (ACLR) may reduce knee flexion torque generating capacity of the hamstrings via impaired ST force generation and/or moment arm. This study used a computational musculoskeletal model to simulate mechanical consequences of tendon harvest for ACLR on ST function by modeling changes in ST muscle tendon insertion point, moment arm, and torque generating capacity across a physiological range of motion. Simulated ST function was then compared between ACLR and uninjured contralateral limbs. Magnetic resonance imaging from 18 individuals with unilateral history of ACLR involving a hamstring autograft was used to analyse bilateral hamstring muscle (ST, semimembranosus, bicep femoris long head and short head) morphology and distal ST tendon insertion. The ACLR cohort was sub-grouped into those with and without ST regeneration. For each participant with ST regeneration (n = 7), a personalized musculoskeletal model was created including postoperative remodeling of ST using OpenSim 4.1. Knee flexion and internal rotation moment arms and torque generating capacities of hamstrings were evaluated. Bilateral differences were calculated with an asymmetry index (%) ([unaffected limb-affected limb]/[unaffected limb + affected limb]*100%). Smaller moment arms or knee torques within injured compared to uninjured contralateral limbs were considered a deficit. Compared to uninjured contralateral limbs, ACLR limbs with tendon regeneration (n = 7) had minor reductions in knee flexion (5.80% [95% confidence interval (CI) = 3.97-7.62]) and internal rotation (4.92% [95% CI = 2.77-7.07]) moment arms. Decoupled from muscle morphology, altered ST moment arms in ACLR limbs with tendon regeneration resulted in negligible deficits in knee flexion (1.20% [95% CI = 0.34-2.06]) and internal rotation (0.24% [95% CI = 0.22-0.26]) torque generating capacity compared to uninjured contralateral limbs. Coupled with muscle morphology, ACLR limbs with tendon regeneration had substantial deficits in knee flexion (19.32% [95% CI = 18.35-20.28]) and internal rotation (15.49% [95% CI = 14.56-16.41]) torques compared to uninjured contralateral limbs. Personalized musculoskeletal models with measures of ST distal insertion and muscle morphology provided unique insights into post-ACLR ST and hamstring function. Deficits in knee flexor and internal rotation moment arms and torque generating capacities were evident in those with ACLR even when tendon regeneration occurred. Future studies may wish to implement this framework in personalized musculoskeletal models following ACLR to better understand individual muscle function for injury prevention and treatment evaluation.
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Affiliation(s)
- William du Moulin
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Australia
| | - Matthew Bourne
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Australia
| | - Jason Konrath
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- Principia Technology, Crawley, Australia
| | - Christopher Vertullo
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- Knee Research Australia, Gold Coast, Australia
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Australia
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Tang H, Xiao YF, Liu WJ, Meng JH, Wu YM, Xiong YL, Gao SG. Preferences in anterior cruciate ligament reconstruction: A survey among orthopedic surgeons in China. Medicine (Baltimore) 2024; 103:e36482. [PMID: 38363894 PMCID: PMC10869037 DOI: 10.1097/md.0000000000036482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024] Open
Abstract
The purpose of this study was to reveal the current trends and preferences of Chinese orthopedic surgeons regarding anterior cruciate ligament (ACL) reconstruction through a nationwide web-based survey conducted in China. The survey questionnaire was distributed via WeChat to the chairmen of provincial orthopedic and sports medicine organizing committees in China, who then shared it in their respective WeChat workgroups. The questionnaire consisted of 52 multiple-choice questions covering 8 sections. Data collection was implemented by Questionnaire Star. A total of 812 valid questionnaires were returned: 94.21% of the respondents preferred single-bundle reconstruction of ACL, while 61.70% preferred autogenous semitendinosus plus gracilis reconstruction; 76.35% of the respondents preferred establishing the femoral tunnel first, while 47.29% preferred establishing the femoral tunnel through a medial auxiliary approach; and 85.10% of the respondents recommended patients to undergo surgery within 3 months after ligament injury. Besides, the vast majority of respondents chose to retain the ligamentous remnant bundle (92.98%) and recommended routine use of knee braces postoperatively (94.09%). It is recommended to perform arthroscopic single-bundle ACL reconstruction with the remnant preserving technique using a hamstring autograft within 3 months of ACL rupture, with support of postoperative functional braces.
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Affiliation(s)
- Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yi-fan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Wei-jie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Jia-hao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yu-mei Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yi-lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shu-guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Abid H, Rougereau G, Bohu Y, Meyer A, Gerometta A, Grimaud O, Lefevre N, Hardy A. French Version of the Short Anterior Cruciate Ligament-Return to Sport After Injury Scale: Development and Validation. Orthop J Sports Med 2024; 12:23259671231220959. [PMID: 38322979 PMCID: PMC10846212 DOI: 10.1177/23259671231220959] [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: 07/11/2023] [Accepted: 07/31/2023] [Indexed: 02/08/2024] Open
Abstract
Background The 12-item Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale was developed to assess the psychological readiness of patients to return to sports after ACL reconstruction (ACLR). A short (6-item) English version was also developed, which has shown to have good reliability and validity. Purpose/Hypothesis We aimed to develop and validate a French version of the short ACL-RSI scale. We hypothesized that the same questions would remain in the selection as the English version and that the French version of the scale would have the same psychometric properties. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods The full 12-item French ACL-RSI scale was administered to 1000 patients who had undergone ACLR surgery. Reliability (Cronbach alpha) and factor analysis of the full scale were determined. Item selection and elimination process was conducted to develop a short (6-item) version. The same methodology was used to develop the English short ACL-RSI scale. A minimal (3-item) version was also developed and assessed. Results Internal consistency of the full version of the French ACL-RSI was found to be high (Cronbach alpha = .95), suggesting item redundancy. The short (6-item) version was also found to have high internal consistency (Cronbach alpha = .92) and was strongly correlated with the full version (r = 0.98). The minimal (3-item) version was also found to have high internal consistency, as well as a strong correlation with the full version (r = 0.94). Conclusion The French version of the short (6-item) ACL-RSI scale was valid, discriminant, consistent, and reproducible. The minimal (3-item) version was also found to be useful and more efficient to collect the information provided by the full ACL-RSI in a French-speaking population.
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Affiliation(s)
- Hichem Abid
- Clinique du Sport, Paris, France
- Faculté de Medecine de Tunis, Tunis, Tunisia
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Kawanishi Y, Kobayashi M, Yasuma S, Fukushima H, Kato J, Murase A, Takenaga T, Yoshida M, Kuroyanagi G, Kawaguchi Y, Murakami H, Nozaki M. Factors Associated With Residual Pivot Shift After ACL Reconstruction: A Quantitative Evaluation of the Pivot-Shift Test Preoperatively and at Minimum 12-Month Follow-up. Orthop J Sports Med 2024; 12:23259671241230967. [PMID: 38414663 PMCID: PMC10898316 DOI: 10.1177/23259671241230967] [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: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 02/29/2024] Open
Abstract
Background Postoperative residual rotatory laxity remains despite improvement in surgical techniques for anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose To evaluate factors associated with residual pivot shift after ACLR by quantitative measurement of the pivot shift before and after surgery. Study Design Case-control study; Level of evidence, 3. Methods A total of 97 patients who underwent primary double-bundle ACLR between June 2016 and March 2021 and underwent surgery to remove staples, with at least 12 months of follow-up evaluation, were enrolled. Quantitative measurements were performed under general anesthesia immediately before ACLR (preoperatively), after temporary fixation of the ACL graft (intraoperatively), and immediately before staple removal (postoperatively). The laxity of pivot shift was assessed using inertial sensors to measure acceleration and external rotational angular velocity (ERAV). Descriptive data were assessed for associations with postoperative acceleration and ERAV in a univariate analysis. A multiple linear regression analysis was performed to identify factors associated with postoperative acceleration and ERAV. Results Anterior tibial translation, acceleration, and ERAV increased from intra- to postoperatively (P < .05). Factors significantly associated with postoperative acceleration were age (β = -0.238; P = .021), lateral posterior tibial slope (PTS) (β = 0.194; P = .048), and preoperative acceleration (β = 0.261; P = .008). Factors significantly affecting postoperative ERAV were age (β = -0.222; P = .029), ramp lesions (β = 0.212; P = .027), and preoperative ERAV (β = 0.323; P = .001). Conclusion Greater preoperative laxity in the pivot shift was the factor having the most significant association with residual pivot shift after ACLR using quantitative measurements under general anesthesia. Younger age, higher lateral PTS, and concomitant ramp lesions were significant predictors of residual pivot shift. These findings can help pre- and intraoperative decision-making regarding whether an anterolateral structure augmentation should be added.
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Affiliation(s)
- Yusuke Kawanishi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Makoto Kobayashi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Sanshiro Yasuma
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Hiroaki Fukushima
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Jiro Kato
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Atsunori Murase
- Kasugai Joint & Sports Orthopedic, Pain Clinic, Kasugai, Japan
| | - Tetsuya Takenaga
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Masahito Yoshida
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Gen Kuroyanagi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Yohei Kawaguchi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Masahiro Nozaki
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
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Itoh M, Itou J, Okazaki K, Iwasaki K. Estimation Failure Risk by 0.5-mm Differences in Autologous Hamstring Graft Diameter in Anterior Cruciate Ligament Reconstruction: A Meta-analysis. Am J Sports Med 2024; 52:535-543. [PMID: 36876736 DOI: 10.1177/03635465221150654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Because grafts are made in 0.5-mm increments clinically for anterior cruciate ligament (ACL) reconstruction, it is important to clarify how the failure rate decreases as the diameter increases. Moreover, it is important to know whether even a slight increase in the graft diameter decreases the risk of failure. HYPOTHESIS The risk of failure decreases significantly with each 0.5-mm increase in hamstring graft diameter. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS The systematic review and meta-analysis have estimated the diameter-specific failure risk for each 0.5-mm increase in ACL reconstruction using autologous hamstring grafts. We searched for studies describing the relationship between graft diameter and failure rate published before December 1, 2021, in leading databases, such as PubMed, EMBASE, Cochrane Library, and Web of Science, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies using single-bundle autologous hamstring grafts to investigate the relationship between failure rate and graft diameter of 0.5-mm intervals with >1-year follow-up. Then, we calculated the failure risk caused by 0.5-mm differences in autologous hamstring graft diameter. Assuming Poisson distribution for the statistical model, we employed an extended linear mixed-effects model in the meta-analyses. RESULTS Five studies containing 19,333 cases were eligible. The meta-analysis revealed that the estimated value of the coefficient of diameter in the Poisson model was -0.2357 with a 95% CI of -0.2743 to -0.1971 (P < .0001). With every 1.0-mm increase in diameter, the failure rate decreased by 0.79 (0.76-0.82) times. In contrast, the failure rate increased by 1.27 (1.22-1.32) times for each 1.0-mm decrease in diameter. The failure rate significantly decreased with each 0.5-mm increase in graft diameter in the range of <7.0 to >9.0 mm from 3.63% to 1.79%. CONCLUSION The risk of failure decreased correspondingly with each 0.5-mm increase in graft diameter in the range of <7.0 to >9.0 mm. Failure is multifactorial; however, increasing the graft diameter as much as possible to match each patient's anatomic space without overstuffing is an effective precaution that surgeons can take to reduce failures.
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Affiliation(s)
- Masafumi Itoh
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
- Institute for Medical Regulatory Science, Comprehensive Research Organization, Waseda University, Shinjuku, Tokyo, Japan
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Shinjuku, Tokyo, Japan
| | - Junya Itou
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Shinjuku, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - Kiyotaka Iwasaki
- Institute for Medical Regulatory Science, Comprehensive Research Organization, Waseda University, Shinjuku, Tokyo, Japan
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Shinjuku, Tokyo, Japan
- Department of Modern Mechanical Engineering, Waseda University, Shinjuku, Tokyo, Japan
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Shinjuku, Tokyo, Japan
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Yang Q, Lu W, Luo Y, Li J, Huang X, You T. A Novel Predictor of the Length and Size of ACL Grafts in Chinese Han Adults for ACL Reconstruction: An MRI Study. Orthop Surg 2024; 16:481-489. [PMID: 38174408 PMCID: PMC10834193 DOI: 10.1111/os.13976] [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: 07/05/2023] [Revised: 11/25/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Currently, there is no simple and valid method to predict the length and size of the native anterior cruciate ligament (ACL) in each adult patient who will undergo ACL reconstruction. This study aimed to develop an imaging prediction method that can predict the length and size of ACL grafts using the intact posterior cruciate ligament (PCL), in order to enhance the graft preparation individualized sizing. METHODS Three hundred and nineteen patients aged 18 years or older who underwent magnetic resonance imaging (MRI) of the knee at an orthopaedic clinic between September 9, 2021, and February 5, 2023, were included. The length, sagittal diameter, and coronal diameter of the ACL and PCL were measured in all patients, and F-test were performed to explore linear relationship between ligament measurements. RESULTS Equations were established to predict a variable of the native ACL for the corresponding variable of the intact PCL (i.e., sagittal diameter of the ACL = 4.32 + 1.08 × sagittal diameter of the PCL, and coronal diameter of the ACL = 2.45 + 0.59 × coronal diameter of the PCL, length of the male ACL = 10.92 + 0.64 × length of the male PCL, length of the female ACL = 11.76 + 0.58 × length of the female PCL) (R2 = 0.532; R2 = 0.417; R2 = 0.488; R2 = 0.509; respectively). CONCLUSIONS The length and size of the intact PCL in cases without PCL buckling are predictors of the length and size of the native ACL in adults, respectively. The use of this information to optimize graft diameter may lower the rates of ACL graft failure in the future.
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Affiliation(s)
- Qingjun Yang
- Peking University Shenzhen HospitalShenzhenChina
| | - Wenqian Lu
- Clinical Medical CollegeShenzhen UniversityShenzhenChina
| | - Yong Luo
- Clinical Medical CollegeShantou UniversityShantouChina
| | - Jiatong Li
- Clinical Medical CollegeShenzhen UniversityShenzhenChina
| | - Xiancheng Huang
- Clinical Medical College, Weifang Medical UniversityWeifangChina
| | - Tian You
- Peking University Shenzhen HospitalShenzhenChina
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Chen J, Wu X, Guo J, Zhang X, Zhao J, Xie G. Characterization of the CT-based risk factors for concomitant patellofemoral instability in patients with anterior cruciate ligament injury. Eur Radiol 2024; 34:250-259. [PMID: 37532901 DOI: 10.1007/s00330-023-10028-0] [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: 01/05/2023] [Revised: 05/22/2023] [Accepted: 06/14/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES Underestimation of concomitant patellofemoral instability in patients with anterior cruciate ligament (ACL) injury has aroused extensive attention. However, the characteristics of the combined injury is not well recognized. Hence, we aimed to characterize the features of the combined injury, and determine the radiographic risk factors. METHODS Fifteen radiological parameters were identified after discussion and pilot-tested. Radiographic measurements were compared using the analysis of variance model with Tukey post hoc analysis. A stepwise binomial logistic regression was performed and a nomogram model combining the significant risk factors was created. The model performance was validated by C-index, calibration plot, and decision curve. RESULTS A total of 204 patients (mean [SD] age, 25.1 [6.7] years; 108 [52.9%] male) were included. The final model was updated through regression analysis using 4 parameters as significant risk factors: lateral femoral condyle ratio (OR (95% CI), 1.194 (1.023 to 1.409)), medial anterior tibial subluxation (mATS) (OR (95% CI), 1.234 (1.065 to 1.446)), medial posterior plateau tibial angle (mPPTA) (OR (95% CI), 1.266 (1.088 to 1.500)), and trochlear depth (OR (95% CI), 0.569 (0.397 to 0.784)). C-index for the nomogram was 0.802 (95% CI, 0.731 to 0.873) and was confirmed to be 0.784 through bootstrapping validation. Calibration plot established a good agreement between prediction and observation. Decision curve analysis showed that if threshold probability was over 10%, using the nomogram adds more benefit than either all or none scheme. CONCLUSIONS Lateral femoral condyle ratio, mATS, mPPTA, and trochlear depth are strong adverse predictors of patellofemoral instability in patients with ACL injury. CLINICAL RELEVANCE This study characterizes the radiological features of the combined injury. Patellofemoral instability should be noted when treating ACL injuries. KEY POINTS • The radiological characteristics of the combined ACL injury and patellofemoral instability is not well recognized. • Lateral femoral condyle ratio, mATS, mPPTA, and trochlear depth are predominant risk factors for patellofemoral instability in patients with ACL injury. • Patellofemoral instability should be noted when treating ACL injuries.
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Affiliation(s)
- Jiebo Chen
- Department of Sports Medicine, National Clinical Medical Centre of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Xiulin Wu
- Department of Sports Medicine, National Clinical Medical Centre of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Jingyi Guo
- Clinical Research Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Xueying Zhang
- Department of Sports Medicine, National Clinical Medical Centre of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Jinzhong Zhao
- Department of Sports Medicine, National Clinical Medical Centre of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
| | - Guoming Xie
- Department of Sports Medicine, National Clinical Medical Centre of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
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Ma W, Yang Y, Ha X. Two-stage ligament reconstruction with remnant preservation as treatment of knee dislocation. BMC Surg 2023; 23:371. [PMID: 38066516 PMCID: PMC10704695 DOI: 10.1186/s12893-023-02271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the clinical outcomes of two-stage reconstruction (peripheral reconstruction in phase I and central anterior cruciate ligament (ACL) / posterior cruciate ligament (PCL) reconstruction in phase II) with remnant preservation for patients with knee dislocation. METHODS A total of 70 patients (10 IIIM, 17 IIIL, and 43 IV) with knee dislocation were randomly divided into the remnant-preserved group and the simple reconstruction group. Patients underwent two-stage reconstruction, including the reconstruction of collateral ligament in phase I and the reconstruction of ACL/PCL in phase II (12 weeks after phase I). Grafts were harvested from the semitendinosus and gracilis tendons from both lower limbs. After the surgery, the joint flexion and extension, bone tunnel and ligament healing, and joint stability were evaluated. RESULTS After the surgery, the lateral stability recovered in all patients, and X-ray revealed a good position of bone tunnel. Follow-up was performed at 12 months postoperatively and ranged from 24 to 91 months. At the final follow-up, knee flexion angle, IKDC, Lysholm, and Tegner scores were all higher in both groups compared to the preoperative period. Notably, the remnant-preserved group showed superior results in these parameters compared to the simple reconstruction group. There was statistical significance between the two groups in terms of the Lachman test. CONCLUSION The knee function was well recovered after two-stage ligament reconstruction with remnant preservation.
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Affiliation(s)
- Wenpu Ma
- Department of Orthopaedics, Liaocheng People's Hospital, No. 67, Dongchang west Road, Liaocheng City, 252000, Shandong Province, China
| | - Yiqun Yang
- Department of Orthopaedics, Liaocheng People's Hospital, No. 67, Dongchang west Road, Liaocheng City, 252000, Shandong Province, China
| | - Xin Ha
- Department of Electromyogram, Liaocheng People's Hospital, No. 67, Dongchang west Road, Liaocheng City, 252000, Shandong Province, China.
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Wen Y, Latham CM, Moore AN, Thomas NT, Lancaster BD, Reeves KA, Keeble AR, Fry CS, Johnson DL, Thompson KL, Noehren B, Fry JL. Vitamin D status associates with skeletal muscle loss after anterior cruciate ligament reconstruction. JCI Insight 2023; 8:e170518. [PMID: 37856482 PMCID: PMC10795826 DOI: 10.1172/jci.insight.170518] [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: 03/21/2023] [Accepted: 10/17/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUNDAlthough 25-hydroxyvitamin D [25(OH)D] concentrations of 30 ng/mL or higher are known to reduce injury risk and boost strength, the influence on anterior cruciate ligament reconstruction (ACLR) outcomes remains unexamined. This study aimed to define the vitamin D signaling response to ACLR, assess the relationship between vitamin D status and muscle fiber cross-sectional area (CSA) and bone density outcomes, and discover vitamin D receptor (VDR) targets after ACLR.METHODSTwenty-one young, healthy, physically active participants with recent ACL tears were enrolled (17.8 ± 3.2 years, BMI 26.0 ± 3.5 kg/m2). Data were collected through blood samples, vastus lateralis biopsies, dual energy x-ray bone density measurements, and isokinetic dynamometer measures at baseline, 1 week, 4 months, and 6 months after ACLR. The biopsies facilitated CSA, Western blotting, RNA-seq, and VDR ChIP-seq analyses.RESULTSACLR surgery led to decreased circulating bioactive vitamin D and increased VDR and activating enzyme expression in skeletal muscle 1 week after ACLR. Participants with less than 30 ng/mL 25(OH)D levels (n = 13) displayed more significant quadriceps fiber CSA loss 1 week and 4 months after ACLR than those with 30 ng/mL or higher (n = 8; P < 0.01 for post hoc comparisons; P = 0.041 for time × vitamin D status interaction). RNA-seq and ChIP-seq data integration revealed genes associated with energy metabolism and skeletal muscle recovery, potentially mediating the impact of vitamin D status on ACLR recovery. No difference in bone mineral density losses between groups was observed.CONCLUSIONCorrecting vitamin D status prior to ACLR may aid in preserving skeletal muscle during recovery.FUNDINGNIH grants R01AR072061, R01AR071398-04S1, and K99AR081367.
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Affiliation(s)
- Yuan Wen
- Center for Muscle Biology, College of Health Sciences
- Department of Physiology, College of Medicine
- Division of Biomedical Informatics, Department of Internal Medicine, College of Medicine
| | | | | | | | | | | | - Alexander R. Keeble
- Center for Muscle Biology, College of Health Sciences
- Department of Physiology, College of Medicine
| | | | | | - Katherine L. Thompson
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, Kentucky, USA
| | - Brian Noehren
- Center for Muscle Biology, College of Health Sciences
- Department of Orthopaedic Surgery & Sports Medicine, and
| | - Jean L. Fry
- Center for Muscle Biology, College of Health Sciences
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Gao H, Hu H, Sheng D, Sun L, Chen J, Chen T, Chen S. Risk Factors for Ipsilateral Versus Contralateral Reinjury After ACL Reconstruction in Athletes: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231214298. [PMID: 38145217 PMCID: PMC10748928 DOI: 10.1177/23259671231214298] [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: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 12/26/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) reinjury after ACL reconstruction (ACLR) can occur on the ipsilateral or contralateral side. Limited evidence exists regarding the difference between the incidence of reinjury to either knee, which is important in developing interventions to prevent ACL reinjury. Purpose To compare the reinjury rate of the ACL on the ipsilateral side versus the contralateral side in athletes after ACLR and investigate the risk factors that may cause different reinjury rates between the sides. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies that involved ACL reinjury in athletes after ACLR were reviewed. Considering several risk factors, including age and sex, a comparison of ACL reinjury incidence on the ipsilateral and contralateral sides was performed using a meta-analysis. Results Of the 17 selected studies, 3 were found to be at high risk of bias, and thus, 14 (n = 3424 participants) studies were included in the meta-analysis. In this athletic population, the contralateral ACL had a significantly higher rupture rate than the ipsilateral graft (risk ratio [RR], 1.41; P < .0001). Female athletes were found to have a greater risk of ACL reinjury on the contralateral versus the ipsilateral side (RR, 1.65; P = .0005), but different results were found in male athletes. (RR, 0.81; P = .21). There was no statistical difference in the incidence rate of ACL reinjury to either side in adolescent athletes (RR, 1.15; P = .28). Conclusion The contralateral ACL was more vulnerable to reinjury than the ipsilateral side in athletes after ACLR. Female athletes were more likely to reinjure their contralateral native ACL, while the same trend was not found in their male counterparts. The reinjury rate was comparable in both knees in adolescent athletes.
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Affiliation(s)
- Han Gao
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Haichen Hu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Dandan Sheng
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Luyi Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Tianwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Iriuchishima T, Goto B. ACL Volume Measurement Using a Multi-truncated Pyramid Shape Simulation. Indian J Orthop 2023; 57:2082-2087. [PMID: 38009176 PMCID: PMC10673783 DOI: 10.1007/s43465-023-01025-y] [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: 04/09/2023] [Accepted: 10/12/2023] [Indexed: 11/28/2023]
Abstract
Purpose The purpose of this study was to measure anterior cruciate ligament (ACL) volume in a newly reported multi-truncated pyramid shape simulation using axial magnetic resonance imaging (MRI) for the detailed knowledge of the ACL anatomy. Methods Fifty subjects (27 female and 23 male, average age: 23 ± 7.8) visiting our clinic with knee pain and in whom MRI showed no structural injury were included in this study. Using the axial image of the MRI, four deferent levels of the cross-sectional area of the ACL were measured. ACL height was measured as the distance between the most proximal and distal slices of the MRI. ACL volume was calculated using a multi-truncated pyramid shape simulation. Femoral intercondylar notch height, area, and trans-epicondylar length (TEL) were also measured using MRI. Results The measured top, proximal 1/3, distal 1/3, and bottom of the ACL cross-sectional area were, 36.8 ± 10.7, 59.9 ± 15.4, 66.4 ± 20.8, and 107.3 ± 21.1mm2, respectively. ACL height was 26.3 ± 3.9 mm. Using these data, the calculated ACL volume was 1755 ± 874mm3. Significant correlations were observed between ACL volume and notch height, area, and TEL. Conclusion Similar ACL volume with previous reports was obtained in this simple and easy multi-truncated pyramid shape simulation from axial MRI evaluation. Significant correlation was observed between ACL volume and knee bony morphology. The ability of surgeons to measure ACL volume simply and effectively can be useful for the detailed ACL anatomical knowledge, and also for prediction and prevention of ACL injury.Level of evidence: IV, Case series.
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Affiliation(s)
| | - Bunsei Goto
- Department of Orthopedic Surgery, Kamimoku Spa Hospital, Minakami, Japan
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Xiao Y, Tang H, Wu Y, Meng J, Liu W, Gao S. How to predict the dimensions of anterior cruciate ligament in children based on MRI? Medicine (Baltimore) 2023; 102:e35028. [PMID: 37960762 PMCID: PMC10637532 DOI: 10.1097/md.0000000000035028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/09/2023] [Indexed: 11/15/2023] Open
Abstract
There are many studies examining the dimensions of the anterior cruciate ligament (ACL) in children. The correlations between the ACL size in children and other parameters are not well understood. To detect the correlations between the ACL size in children and other parameters including age, gender, bone and soft tissue parameters through measurements on MRI images, and to establish prediction models for the ACL size. A total of 99 patients who underwent MRI scan were included (39 girls, 60 boys; mean age, 13.01 ± 3.94; range of age, 4 to 18). The following measurements were taken on MRI images by 2 observers: ACL length, ACL width, posterior cruciate ligament (PCL) length, the distance from the most anterior aspect of the tibial epiphysis to the anterior aspect of the ACL tibial insertion (AATI), the distance from the most anterior aspect of the tibial epiphysis to the posterior aspect of the ACL tibial insertion (APTI), and the tibial anteroposterior diameter (AP). Correlations between these measurements and the patients' gender and age were investigated, and univariate and multiple linear regression models were established accordingly. Before 13 years old, the ACL length was significantly correlated with the tibial anteroposterior diameter and age (R2 = 0.872, P < .001), and there were no statistically significant gender differences. After 13 years old, the ACL length was significantly correlated with the PCL length and APTI in males (R2 = 0.443, P < .001), and with the PCL length in females (R2 = 0.443, P < .001). In children under 13 years old, there was no significant gender difference in ACL length, and the tibial anteroposterior diameter and age were found to be important indicators in assessing the ACL size. After 13 years old, a significant gender difference in ACL length was observed, and the ACL length was found to be weakly correlated with age and bone parameters. In order to accurately evaluate the ACL size in children aged 13 years and above, it is necessary to refer to the dimensions of the ACL on the collateral side.
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Affiliation(s)
- Yifan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yumei Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiahao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weijie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuguang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Oğuzdoğan GY, Arslan FZ. Evaluation of Anatomical Variations with Morphological Measurements and Their Relationship to Meniscal Injury and Ligament Damage. J Knee Surg 2023; 36:1357-1364. [PMID: 36041483 DOI: 10.1055/a-1933-3592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to reveal the anatomical risk factors for anterior and posterior cruciate ligament (ACL and PCL) injuries and menisci injury. We aim to investigate whether there are significant relationships between tibial tubercle-trochlear groove (TT-TG) distance, patella angle, trochlear sulcus angle (TSA), trochlear groove depth (TGD), medial and lateral trochlea length (MT and LT), MT/LT ratio, lateral patellar tilt angle (LPTA), patella-patellar tendon angle (P-PTA), quadriceps-patellar tendon angle (QPA), Insall-Salvati index (ISI), medial and lateral trochlear inclination (MTI and LTI) measurements and important common pathologies such as ACL, PCL, medial and lateral meniscal injuries (MM and LM), peripatellar fat pad edema, chondromalacia, and effusion. Thus, the mechanisms of injury will be better understood by revealing important anatomical variations for meniscus and ligament damage. Three hundred eighty patients with knee magnetic resonance imaging examination were included in this study. Our patients who underwent knee magnetic resonance imaging were divided into groups according to the presence of MM tear, LM tear, ACL tear, PCL tear, peripatellar fat pad edema, chondromalacia and effusion. TT-TG distance, patella angle, TSA, TGD, MT, LT, MT/LT ratio, LPTA, P-PTA, QPA, ISI, MTI, and LTI were measured. In patients with ACL tear, age, LT, ML/LT ratio, and QPA measurements were found to be significantly higher. There was no significant difference between the participants' LPTA value and the presence of ACL tear, MM and LM injury. MT and ML/LT ratio were found to be significantly lower in the group with MM tear (p <0.001). The TT-TG distance was found to be significantly lower in the group with LM tear. Increased age, LT, ML/LT ratio, and QPA are predisposed risk for ACL tear. Decreased MT and ML/LT ratio are among the risk factors for MM tear. The anatomical variations are associated with ligament and meniscal injury.
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Affiliation(s)
| | - Fatma Zeynep Arslan
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
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Hasegawa ME, Delos Reyes CD, Rimm JB, Radi JK, Singh DS, Obana KK, Weldon EJ, Thorne TJ, Tamate TM, Alferos SR, Min KS. Update on Current Concepts of Blood Flow Restriction in the Perioperative Period of Anterior Cruciate Ligament Reconstruction. Orthopedics 2023; 46:e333-e340. [PMID: 37561100 DOI: 10.3928/01477447-20230804-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Anterior cruciate ligament tears or ruptures are common orthopedic injuries. Anterior cruciate ligament reconstruction (ACLR) is an orthopedic procedure allowing for earlier return to sports, improved maintenance of lifestyle demands, and restored knee stability and kinematics. A perioperative rehabilitative adjunct recently gaining interest is blood flow restriction (BFR), a method in which temporary restriction of blood flow to a chosen extremity is introduced and can be used as early as a few days postoperative. There has been increasing investigation and recent literature regarding BFR. This review synthesizes current concepts of BFR use in the ACLR perioperative period. [Orthopedics. 2023;46(6):e333-e340.].
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Xiao Y, Liang Z, Shen S, Liu F, Hu H, Chen B. Increased ACL direct insertion coverage provided more positive biomechanical effects on graft and bone tunnel during knee flexion: a simulation study. J Exp Orthop 2023; 10:108. [PMID: 37897510 PMCID: PMC10613193 DOI: 10.1186/s40634-023-00677-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023] Open
Abstract
PURPOSE Flattened femoral tunnels were recently applied in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction. Little is known about the biomechanical effect of such changes during knee flexion. The aim of the present simulation study was to assess the effect of altered ACL direct insertion coverage on the biomechanics of the graft and bone tunnel. METHODS Five finite element (FE) models, including a round femoral tunnel and four progressively flattened rounded rectangular femoral tunnels, were established to represent the ACL reconstructions. In vivo knee kinematics data obtained from the validated dual fluoroscopic imaging techniques controlled the FE models to simulate lunge motions. The maximal principal stress of the graft and the volume of equivalent strain within 1000-3000 microstrain (V1000-3000) of the cancellous bone were subsequently calculated at 0°, 30°, 60° and 90° of knee flexion. RESULTS A lower stress state on the graft and a more beneficial strain state on the cancellous bone were observed when the femoral tunnel better covered the ACL direct insertion. The average maximal principal stress of each model were 3.93 ± 0.60 MPa, 3.82 ± 0.54 MPa, 3.43 ± 0.44 MPa, 3.45 ± 0.44 MPa and 3.05 ± 0.43 MPa, respectively. The average V1000-3000 of the cancellous bone of each model were 179.06 ± 89.62 mm3, 221.40 ± 129.83 mm3, 247.57 ± 157.78 mm3, 282.74 ± 178.51 mm3 and 295.71 ± 162.59 mm3, respectively. Both the stress and strain values exhibited two peaks during the flexion simulation. The highest value occurred at 30° of flexion, and the second highest value occurred at 90° of flexion. CONCLUSIONS Increased ACL direct insertion coverage provided more positive biomechanical effects after anatomical single-bundle ACL reconstruction during knee flexion.
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Affiliation(s)
- Yang Xiao
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhaoxin Liang
- The First Clinical College of Southern Medical University, Guangzhou, China
| | - Shiwen Shen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fei Liu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hai Hu
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Bin Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Pereira CS, Klauznicer J, Maree D, McAuliffe S, Farooq A, Whiteley R, Finni T. Quadriceps strength, patellar tendon quality, relative load exposure, and knee symptoms in male athletes before the anterior cruciate ligament reconstruction. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1283635. [PMID: 37928751 PMCID: PMC10624220 DOI: 10.3389/fresc.2023.1283635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
Introduction Anterior cruciate ligament (ACL) injuries cause knee instability, knee pain, weight-bearing adjustments, and functional deficits but their association to patellar tendon quality is unknown. Our purpose was to investigate quadriceps strength, patellar tendon quality, relative load exposure, perceived knee stability, knee pain, extension angle, and time from ACL injury; in addition to examining their relative associations. Methods Injured and uninjured legs of 81 male athletes of different sports with a unilateral ACL injury (18-45 years) were examined. Participants reported location and intensity of knee pain and their perceived stability using a numerical rating scale (NRS 0-10). Strength was tested with an isokinetic device. Tendon quality was measured using ultrasound tissue characterization. Means ± standard deviation (SD) of perceived knee stability, knee extension angle, knee pain, isokinetic quadriceps strength in relation to body mass, proportion of echo-types (I-IV), tendon volume, and number of days from ACL injury to assessment are reported. Values of effect sizes (ES) and correlations (rs) were calculated. Results ACL injured leg demonstrated reduced reported knee stability (6.3 ± 2.5), decreased knee extension angle (-0.7 ± 3.1° vs. -2.7 ± 2.2°; ES = 0.7; P < 0.001), greater knee pain (NRS 3.1 ± 2.2 vs. 0.0 ± 0.1; ES = 2.0; P < 0.001), and 22% lower quadriceps strength (228.0 ± 65.0 vs. 291.2 ± 52.9 Nm/kg: ES = 1.2; P < 0.001) as compared to the uninjured leg. However, patellar tendons in both legs displayed similar quality. Quadriceps strength was associated with stability (rs = -0.54; P < 0.001), pain (rs = -0.47; P < 0.001), extension angle (rs = -0.39; P < 0.001), and relative load exposure (rs = -0.34; P < 0.004). Echo-types distribution was beneficially associated with time from ACL injury (rs range: -0.20/ -0.32; P < 0.05). Discussion ACL injured athletes displayed knee pain, extension deficit, and weaker quadriceps in the injured leg. While there were no differences in patellar tendon quality between legs, longer time from ACL injury showed better tendon quality.
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Affiliation(s)
- Carla S. Pereira
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
- Neuromuscular Research Center, Biology of PhysicalActivity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jasenko Klauznicer
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Dustin Maree
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Sean McAuliffe
- Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Abdulaziz Farooq
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Rod Whiteley
- Rehabilitation Department, ASPETAR, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Taija Finni
- Neuromuscular Research Center, Biology of PhysicalActivity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Li F, Zhai P, Yang C, Feng G, Yang J, Yuan Y. Automated diagnosis of anterior cruciate ligament via a weighted multi-view network. Front Bioeng Biotechnol 2023; 11:1268543. [PMID: 37885456 PMCID: PMC10598377 DOI: 10.3389/fbioe.2023.1268543] [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: 07/28/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Objective: To build a three-dimensional (3D) deep learning-based computer-aided diagnosis (CAD) system and investigate its applicability for automatic detection of anterior cruciate ligament (ACL) of the knee joint in magnetic resonance imaging (MRI). Methods: In this study, we develop a 3D weighted multi-view convolutional neural network by fusing different views of MRI to detect ACL. The network is evaluated on two MRI datasets, the in-house MRI-ACL dataset and the publicly available MRNet-v1.0 dataset. In the MRI-ACL dataset, the retrospective study collects 100 cases, and four views per patient are included. There are 50 ACL patients and 50 normal patients, respectively. The MRNet-v1.0 dataset contains 1,250 cases with three views, of which 208 are ACL patients, and the rest are normal or other abnormal patients. Results: The area under the receiver operating characteristic curve (AUC) of the ACL diagnosis system is 97.00% and 92.86% at the optimal threshold for the MRI-ACL dataset and the MRNet-v1.0 dataset, respectively, indicating a high overall diagnostic accuracy. In comparison, the best AUC of the single-view diagnosis methods are 96.00% (MRI-ACL dataset) and 91.78% (MRNet-v1.0 dataset), and our method improves by about 1.00% and 1.08%. Furthermore, our method also improves by about 1.00% (MRI-ACL dataset) and 0.28% (MRNet-v1.0 dataset) compared with the multi-view network (i.e., MRNet). Conclusion: The presented 3D weighted multi-view network achieves superior AUC in diagnosing ACL, not only in the in-house MRI-ACL dataset but also in the publicly available MRNet-v1.0 dataset, which demonstrates its clinical applicability for the automatic detection of ACL.
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Affiliation(s)
- Feng Li
- Orthopedic Department, Ningbo No. 2 Hospital, Ningbo, China
| | - Penghua Zhai
- Center for Pattern Recognition and Intelligent Medicine, Guoke Ningbo Life science and Health industry Research Institute, Ningbo, China
| | - Chao Yang
- Orthopedic Department, Ningbo No. 2 Hospital, Ningbo, China
| | - Gong Feng
- Orthopedic Department, Ningbo No. 2 Hospital, Ningbo, China
| | - Ji Yang
- Orthopedic Department, Ningbo No. 2 Hospital, Ningbo, China
| | - Yi Yuan
- Orthopedic Department, Ningbo No. 2 Hospital, Ningbo, China
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Liang C, Li X, Qin Y, Li M, Ma Y, Wang R, Xu X, Yu J, Lv S, Luo H. Effective automatic detection of anterior cruciate ligament injury using convolutional neural network with two attention mechanism modules. BMC Med Imaging 2023; 23:120. [PMID: 37697236 PMCID: PMC10494428 DOI: 10.1186/s12880-023-01091-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND To develop a fully automated CNN detection system based on magnetic resonance imaging (MRI) for ACL injury, and to explore the feasibility of CNN for ACL injury detection on MRI images. METHODS Including 313 patients aged 16 - 65 years old, the raw data are 368 pieces with injured ACL and 100 pieces with intact ACL. By adding flipping, rotation, scaling and other methods to expand the data, the final data set is 630 pieces including 355 pieces of injured ACL and 275 pieces of intact ACL. Using the proposed CNN model with two attention mechanism modules, data sets are trained and tested with fivefold cross-validation. RESULTS The performance is evaluated using accuracy, precision, sensitivity, specificity and F1 score of our proposed CNN model, with results of 0.8063, 0.7741, 0.9268, 0.6509 and 0.8436. The average accuracy in the fivefold cross-validation is 0.8064. For our model, the average area under curves (AUC) for detecting injured ACL has results of 0.8886. CONCLUSION We propose an effective and automatic CNN model to detect ACL injury from MRI of human knees. This model can effectively help clinicians diagnose ACL injury, improving diagnostic efficiency and reducing misdiagnosis and missed diagnosis.
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Affiliation(s)
- Chen Liang
- Department of Minimally Invasive Surgery and Sports Medicine, The 2Nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xiang Li
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, 150001, China
| | - Yong Qin
- Department of Minimally Invasive Surgery and Sports Medicine, The 2Nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Minglei Li
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, 150001, China
| | - Yingkai Ma
- Department of Minimally Invasive Surgery and Sports Medicine, The 2Nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Ren Wang
- Department of Minimally Invasive Surgery and Sports Medicine, The 2Nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xiangning Xu
- Department of Minimally Invasive Surgery and Sports Medicine, The 2Nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Jinping Yu
- Department of Minimally Invasive Surgery and Sports Medicine, The 2Nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Songcen Lv
- Department of Minimally Invasive Surgery and Sports Medicine, The 2Nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
| | - Hao Luo
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, 150001, China.
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Wang L, Wan F, Xu Y, Xie S, Zhao T, Zhang F, Yang H, Zhu J, Gao J, Shi X, Wang C, Lu L, Yang Y, Yu X, Chen S, Sun X, Ding J, Chen P, Ding C, Xu F, Yu H, Peng H. Hierarchical helical carbon nanotube fibre as a bone-integrating anterior cruciate ligament replacement. NATURE NANOTECHNOLOGY 2023; 18:1085-1093. [PMID: 37142709 DOI: 10.1038/s41565-023-01394-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/31/2023] [Indexed: 05/06/2023]
Abstract
High rates of ligament damage require replacements; however, current synthetic materials have issues with bone integration leading to implant failure. Here we introduce an artificial ligament that has the required mechanical properties and can integrate with the host bone and restore movement in animals. The ligament is assembled from aligned carbon nanotubes formed into hierarchical helical fibres bearing nanometre and micrometre channels. Osseointegration of the artificial ligament is observed in an anterior cruciate ligament replacement model where clinical polymer controls showed bone resorption. A higher pull-out force is found after a 13-week implantation in rabbit and ovine models, and animals can run and jump normally. The long-term safety of the artificial ligament is demonstrated, and the pathways involved in integration are studied.
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Affiliation(s)
- Liyuan Wang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Fang Wan
- Department of Orthopedic Sports Medicine, Huashan Hospital, The Sports Medicine Institute, Fudan University, Shanghai, China
| | - Yifan Xu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Songlin Xie
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Tiancheng Zhao
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Fan Zhang
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Han Yang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Jiajun Zhu
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingming Gao
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Xiang Shi
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Chuang Wang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Linwei Lu
- Department of Integrative Medicine, Huashan Hospital, The Academy of Integrative Medicine, Fudan University, Shanghai, China
| | - Yifan Yang
- Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Xiaoye Yu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Orthopedic Sports Medicine, Huashan Hospital, The Sports Medicine Institute, Fudan University, Shanghai, China.
| | - Xuemei Sun
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China.
| | - Jiandong Ding
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China
| | - Peining Chen
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China.
| | - Chen Ding
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Fan Xu
- Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Hongbo Yu
- Vision Research Laboratory, School of Life Sciences, State Key Laboratory of Medical Neurobiology, Collaborative Innovation Centre for Brain Science, Fudan University, Shanghai, China
| | - Huisheng Peng
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science and Laboratory of Advanced Materials, Fudan University, Shanghai, China.
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Shetty ND, Dhande R, Unadkat BS, Parihar P. A Comprehensive Review on the Diagnosis of Knee Injury by Deep Learning-Based Magnetic Resonance Imaging. Cureus 2023; 15:e45730. [PMID: 37868582 PMCID: PMC10590246 DOI: 10.7759/cureus.45730] [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: 04/14/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
The continual improvement in the field of medical diagnosis has led to the monopoly of using deep learning (DL)-based magnetic resonance imaging (MRI) for the diagnosis of knee injury related to meniscal injury, ligament injury including the cruciate ligaments, collateral ligaments and medial patella-femoral ligament, and cartilage injury. The present systematic review was done by PubMed and Directory of Open Access Journals (DOAJ), wherein we finalised 24 studies conducted on the accuracy of DL MRI studies for knee injury identification. The studies showed an accuracy of 72.5% to 100% indicating that DL MRI holds an equivalent performance as humans in decision-making and management of knee injuries. This further opens up future exploration for improving MRI-based diagnosis keeping in mind the limitations of verification bias and data imbalance in ground truth subjectivity.
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Affiliation(s)
- Neha D Shetty
- Department of Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajasbala Dhande
- Department of Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhavik S Unadkat
- Department of Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Department of Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Mainz H, Frandsen L, Fauno P, Lomborg K, Lind M. The impact of a patient decision aid on treatment choices after anterior cruciate ligament injuries. J Exp Orthop 2023; 10:82. [PMID: 37584784 PMCID: PMC10429475 DOI: 10.1186/s40634-023-00633-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/05/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE The present study aimed to investigate whether exposure to a patient decision aid (PDA) had an impact on the proportion of patients selecting non-surgical or surgical treatments after anterior cruciate ligament (ACL) injuries and whether exposure to a PDA affected the proportion of patients switching from non-surgical to surgical treatment within the first year. METHODS In a consecutive case series, proportions of surgery and non-surgery were compared before and after patients' exposure to a PDA. Data were collected from the health records of patients with ACL injuries who presented to the Clinic of Sports Traumatology. To identify proportional differences between the two groups, t-tests and proportion tests were used. RESULTS In total, 1,053 patients with ACL injuries were included: 563 patients with no exposure to the PDA (January 2015 to January 2017) and 490 patients with exposure to the PDA (January 2017 to January 2019). Before implementing the PDA, 27% of the patients selected non-surgical treatment. After implementing the PDA, 30% choose non-surgical treatment (p > 0.05). Before implementing the PDA, 21% of patients who initially chose non-surgical treatment had surgery within the first year. After implementation of the PDA, this number fell to 16%, but the difference was not statistically significant (p > 0,05). CONCLUSION Exposure to the PDA did not significantly alter the proportion of ACL injury patients selecting non-surgical or surgical treatments or the proportion of patients switching to surgery within the first year.
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Affiliation(s)
- Hanne Mainz
- Clinic of Sports Traumatology, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark.
- Research Centre of Patient Involvement, Aarhus University Hospital, Aarhus, Denmark.
| | - Lone Frandsen
- Clinic of Sports Traumatology, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Fauno
- Clinic of Sports Traumatology, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Lomborg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Martin Lind
- Clinic of Sports Traumatology, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Xiao M, van Niekerk M, Trivedi NN, Hwang CE, Sherman SL, Safran MR, Abrams GD. Patients Who Return to Sport After Primary Anterior Cruciate Ligament Reconstruction Have Significantly Higher Psychological Readiness: A Systematic Review and Meta-analysis of 3744 Patients. Am J Sports Med 2023; 51:2774-2783. [PMID: 35722814 DOI: 10.1177/03635465221102420] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although objective outcomes assessing knee function are essential measurements for return to sport, psychological factors have become increasingly recognized as equally important parameters for determining an athlete's ability to return to sport after surgery. PURPOSE To systematically review the literature to determine whether patients who returned to sport after anterior cruciate ligament (ACL) reconstruction had improved psychological scores (as measured with validated questionnaires) compared with patients who did not return to sport. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 3. METHODS A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was preregistered on PROSPERO. Four databases were searched for level 1 to 3 studies that compared at least 1 psychological outcome measured by a validated questionnaire for patients who did and did not return to sport after primary ACL reconstruction. The following data were recorded: study and patient characteristics; psychological metrics (ACL-Return to Sport Injury [ACL-RSI] scale, Knee Self-Efficacy Scale [K-SES], and Tampa Scale of Kinesiophobia [TSK/TSK-11]); International Knee Documentation Committee (IKDC) score; and clinical metrics. Study methodological quality was analyzed using the methodological index for non-randomized studies (MINORS), and the mean difference (MD) and 95% CI were calculated for each psychological outcome score using the inverse variance method. RESULTS We included and analyzed 16 articles (3744 patients; 38.9% female; mean age range, 17-28.7 years; mean MINORS score, 19.9 ± 1.4). Overall, 61.8% of athletes returned to sport (66.8% of male patients; 55.4% of female patients). Patients who returned scored significantly higher on the ACL-RSI scale (MD, 20.8; 95% CI, 15.9 to 25.7; P < .001), significantly higher on the K-SES (MD, 1.3; 95% CI, 0.2 to 2.3; P = .036), and significantly lower on the TSK/TSK-11 (MD, 10.1%; 95% CI, -12.1% to -8.2%; P = .004). Those returning to sport did not exceed the minimal clinically important difference for IKDC score versus those not returning to sport. CONCLUSION Patients who returned to sport after primary ACL reconstruction had significantly higher psychological readiness, higher self-efficacy, and lower kinesiophobia compared with those who did not return to sport, despite having clinically similar knee function scores. Evaluation of psychological readiness, in combination with other objective measurements, is a critical component of return-to-sport evaluation in athletes after primary ACL reconstruction. REGISTRATION CRD42021284735 (PROSPERO).
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Affiliation(s)
- Michelle Xiao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Maike van Niekerk
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Nikunj N Trivedi
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Calvin E Hwang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
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Amini M, Venkatesan JK, Nguyen TN, Liu W, Leroux A, Madry H, Migonney V, Cucchiarini M. rAAV TGF-β and FGF-2 Overexpression via pNaSS-Grafted PCL Films Stimulates the Reparative Activities of Human ACL Fibroblasts. Int J Mol Sci 2023; 24:11140. [PMID: 37446318 DOI: 10.3390/ijms241311140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Lesions in the human anterior cruciate ligament (ACL) are frequent, unsolved clinical issues due to the limited self-healing ability of the ACL and lack of treatments supporting full, durable ACL repair. Gene therapy guided through the use of biomaterials may steadily activate the processes of repair in sites of ACL injury. The goal of the present study was to test the hypothesis that functionalized poly(sodium styrene sulfonate)-grafted poly(ε-caprolactone) (pNaSS-grafted PCL) films can effectively deliver recombinant adeno-associated virus (rAAV) vectors as a means of overexpressing two reparative factors (transforming growth factor beta-TGF-β and basic fibroblast growth factor-FGF-2) in primary human ACL fibroblasts. Effective, durable rAAV reporter red fluorescent protein and candidate TGF-β and FGF-2 gene overexpression was achieved in the cells for at least 21 days, especially when pNaSS-grafted PCL films were used versus control conditions, such as ungrafted films and systems lacking vectors or films (between 1.8- and 5.2-fold differences), showing interactive regulation of growth factor production. The expression of TGF-β and FGF-2 from rAAV via PCL films safely enhanced extracellular matrix depositions of type-I/-III collagen, proteoglycans/decorin, and tenascin-C (between 1.4- and 4.5-fold differences) in the cells over time with increased levels of expression of the specific transcription factors Mohawk and scleraxis (between 1.7- and 3.7-fold differences) and without the activation of the inflammatory mediators IL-1β and TNF-α, most particularly with pNaSS-grafted PCL films relative to the controls. This work shows the value of combining rAAV gene therapy with functionalized PCL films to enhance ACL repair.
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Affiliation(s)
- Mahnaz Amini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, 66421 Homburg, Germany
| | - Jagadeesh K Venkatesan
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, 66421 Homburg, Germany
| | - Tuan N Nguyen
- LBPS/CSPBAT UMR CNRS 7244, Université Sorbonne Paris Nord, 93430 Villetaneuse, France
| | - Wei Liu
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, 66421 Homburg, Germany
| | - Amélie Leroux
- LBPS/CSPBAT UMR CNRS 7244, Université Sorbonne Paris Nord, 93430 Villetaneuse, France
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, 66421 Homburg, Germany
| | - Véronique Migonney
- LBPS/CSPBAT UMR CNRS 7244, Université Sorbonne Paris Nord, 93430 Villetaneuse, France
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, 66421 Homburg, Germany
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49
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Baek SY, Beaulieu ML, Wojtys EM, Ashton-Miller JA. Relationship Between Lateral Tibial Posterior Slope and Tibiofemoral Kinematics During Simulated Jump Landings in Male Cadaveric Knees. Orthop J Sports Med 2023; 11:23259671231160213. [PMID: 37347020 PMCID: PMC10280540 DOI: 10.1177/23259671231160213] [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: 10/21/2022] [Accepted: 01/01/2023] [Indexed: 06/23/2023] Open
Abstract
Background It is not known mechanistically whether a steeper lateral posterior tibial slope (LTS) leads to an increase in anterior tibial translation (ATT) as well as internal tibial rotation (ITR) during a given jump landing. Hypothesis A steeper LTS will result in increased ATT and ITR during simulated jump landings when applying knee compression, flexion, and internal tibial torque of increasing severity. Study Design Descriptive laboratory study. Methods Seven pairs of cadaveric knees were harvested from young male adult donors (mean ± SD; age, 25.71 ± 5.53 years; weight, 71.51 ± 4.81 kg). The LTS of each knee was measured by a blinded observer from 3-T magnetic resonance images. Two sets of 25 impact trials of ∼700 N (1× body weight [BW] ±10%) followed by 2 sets of 25 trials of 1400 N (2× BW ±10%) were applied to a randomly selected knee of each pair. Similarly, on the contralateral knee, 2 sets of 25 impact trials of ∼1800 N (2.5× BW ±10%) followed by 2 sets of 25 trials of ∼2100 N (3× BW ±10%) were applied. Three-dimensional knee kinematics, including ATT and ITR, were measured at 400 Hz using optoelectronic motion capture. Two-factor linear mixed effect models were used to determine the relationship of LTS to ATT and ITR as impact loading increased. Results As LTS increased, so did ATT and ITR during increasingly severe landings. LTS had an increasing effect on ATT (coefficient, 0.50; 95% CI, 0.29-0.71) relative to impact force (coefficient, 0.52; 95% CI, 0.50-0.53). ITR was proportional to LTS (coefficient, 1.36; 95% CI, 0.80-1.93) under increasing impact force (coefficient, 0.49; 95% CI, 0.47-0.52). For steeper LTS, the increase in ITR was proportionally greater than the increase in ATT. Conclusion In male knee specimens, a steeper LTS significantly increased ATT and ITR during jump landings. Clinical Relevance Increases in ITR and ATT during jump landings lead to increased strain on the anterior cruciate ligament and are therefore associated with greater risk of ligament failure.
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Affiliation(s)
- So Young Baek
- Department of Mechanical Engineering,
University of Michigan, Ann Arbor, Michigan, USA
| | - Mélanie L. Beaulieu
- Department of Orthopedic Surgery,
University of Michigan, Ann Arbor, Michigan, USA
| | - Edward M. Wojtys
- Department of Orthopedic Surgery,
University of Michigan, Ann Arbor, Michigan, USA
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50
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Meena A, Farinelli L, Hoser C, Abermann E, Raj A, Hepperger C, Herbort M, Fink C. Revision ACL reconstruction using quadriceps, hamstring and patellar tendon autografts leads to similar functional outcomes but hamstring graft has a higher tendency of graft failure. Knee Surg Sports Traumatol Arthrosc 2023; 31:2461-2468. [PMID: 36266369 PMCID: PMC10183416 DOI: 10.1007/s00167-022-07200-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the differences in the patient-reported functional outcomes, and graft failure in revision ACL reconstruction using quadriceps tendon (QT), Hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts. METHODS Between 2010 and 2020, 97 patients who underwent revision ACL reconstruction (40 patients received a QT, 26 an HT and 31 a BPTB graft) met the inclusion criteria. Pre-injury and at 2-year postoperatively patients were evaluated for patient-reported functional outcomes; Lysholm knee score, Tegner activity level and VAS (visual analogue scale) for pain; and graft failure. Patient-reported outcomes and graft failure were compared between the QT, HT and BPTB groups. The patients with graft failure were not included for outcome analysis at 2-years of follow-up. RESULTS All three revision groups with QT, HT and BPTB autograft did not differ significantly in terms of age, sex, time from injury to surgery, concomitant injuries and single-stage or double-stage procedures (n.s.). No significant difference was found in the pre-injury patient-reported outcome; Lysholm knee score, Tegner activity and VAS for pain (n.s.) between the three groups. At the 2-year follow-up functional outcomes improved in all three groups and all the patients returned to pre-injury activity level; however, no significant difference was found in functional outcomes at the 2-year follow-up between the three groups (n.s.). Graft failure occurred in 4 (10%), 5 (19%) and 3 (10%) patients of QT, HT and BPTB groups, respectively. However, the rate of failure did not differ significantly between groups. CONCLUSION All three autografts (QT, HT and BPTB) demonstrated satisfactory patient-reported outcomes in revision ACL reconstruction. Compared with QT and BPTB grafts, HT graft showed a higher tendency for failure rates. With the increasing incidence of revision ACL reconstruction, surgeons should be aware of all the available graft options. The findings of this study will assist the surgeons in the graft selection for revision ACL reconstruction. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Amit Meena
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Christian Hoser
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
| | - Elisabeth Abermann
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
| | - Akshya Raj
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029 India
| | - Caroline Hepperger
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
| | - Mirco Herbort
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
- OCM Clinic, Munich, Germany
| | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria
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