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Todor A. Advances in Anterior Cruciate Ligament Injury, Reconstruction and Rehabilitation. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:136. [PMID: 38256396 PMCID: PMC10821448 DOI: 10.3390/medicina60010136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
Another Special Issue dedicated to the anterior cruciate ligament (ACL) of the knee joint [...].
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Affiliation(s)
- Adrian Todor
- Department of Orthopaedics and Traumatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400000 Cluj-Napoca, Romania
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Marquina V, Sánchez C, Mariscal G, Espí F, Crespo D, Hernández L. Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:64-72. [PMID: 37406733 DOI: 10.1016/j.recot.2023.06.017] [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: 02/11/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analyzed using Review Manager 5.4 software. RESULTS A total of 7 retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group vs. 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.
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Affiliation(s)
- V Marquina
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - C Sánchez
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - G Mariscal
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - F Espí
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - D Crespo
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Hernández
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Marquina V, Sánchez C, Mariscal G, Espí F, Crespo D, Hernández L. [Translated article] Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T64-T72. [PMID: 37995820 DOI: 10.1016/j.recot.2023.11.014] [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: 02/11/2023] [Accepted: 06/29/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analysed using Review Manager 5.4 software. RESULTS A total of seven retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group versus 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.
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Affiliation(s)
- V Marquina
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - C Sánchez
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - G Mariscal
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - F Espí
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - D Crespo
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - L Hernández
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Nuelle CW, Shubert D, Leary E, Pringle LC. Two-Dimensional Magnetic Resonance Imaging in Preparation for Autograft Anterior Cruciate Ligament Reconstruction Demonstrates Quadriceps Tendon Is Thicker Than Patellar Tendon. Arthrosc Sports Med Rehabil 2023; 5:e783-e791. [PMID: 37388871 PMCID: PMC10300585 DOI: 10.1016/j.asmr.2023.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/13/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose The purpose of this study was to assess patellar tendon (PT) and quadriceps tendon (QT) thickness on preoperative magnetic resonance imaging (MRI), in both the sagittal and axial planes, at multiple points along each tendon, and to correlate these findings to anthropometric patient data before anterior cruciate ligament (ACL) surgery. Methods Patients who underwent PT or QT autograft ACL reconstruction between 2020 and 2022 and who had preoperative MRIs with adequate visualization of the proximal QT and distal PT were retrospectively identified. Patient demographics were recorded (age, height, weight, sex, injury side). Preoperative MRI measurements were performed by 3 independent examiners using standardized protocol. Preoperative MRI measurements were the QT anterior-posterior (AP) thickness at 1, 2, and 4 cm from the proximal patella on axial and sagittal MRI images at the central aspect of the tendon, as well as PT AP thickness at 1, 2, and 4 cm from the distal patella on axial and sagittal MRI images at the central aspect of the tendon. Results Forty-one patients (21 females, 20 males) were evaluated, with a mean age of 33.4 years. The quadriceps tendon was significantly thicker than the patellar tendon at all measured locations (P < .0001) with average QT versus PT thickness (in mm) at each level sagittal 1 cm (7.13 vs 4.35), sagittal 2 cm (7.41 vs 4.44), sagittal 4 cm (7.26 vs 4.81), axial 1 cm (7.35 vs 4.50), axial 2 cm (7.63 vs 4.47), axial 4 cm (7.46 vs 4.62), respectively. There were no significant correlations between tendon size and patient body mass index. Conclusions The quadriceps tendon is significantly thicker than the patellar tendon at 1, 2, and 4 cm from the patella in both males and females based on preoperative MRI before ACL surgery. Clinical relevance Investigating the thickness of the tendons available for autograft harvest before surgery will give us a better understanding of tendon anatomy in the setting of ACL reconstruction.
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Affiliation(s)
- Clayton W. Nuelle
- University of Missouri Hospitals, Columbia, Missouri
- Mizzou Joint Preservation Center, Missouri Orthopaedic Institute, Columbia, Missouri
| | | | - Emily Leary
- University of Missouri Hospitals, Columbia, Missouri
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Sood M, Kulshrestha V, Kumar S, Kumar P, Amaravati RS, Singh S. "Trends and beliefs in ACL reconstruction surgery: Indian perspectives". J Clin Orthop Trauma 2023; 39:102148. [PMID: 36974199 PMCID: PMC10039028 DOI: 10.1016/j.jcot.2023.102148] [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: 03/23/2022] [Revised: 01/19/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
Objectives The survey aimed to assess trends and beliefs in the management of anterior cruciate ligament reconstruction (ACLR) amongst orthopaedic surgeons in India. Methods A survey was created and distributed among the various orthopaedic surgeons from India. The questionnaire included brief details of surgeons and their experience, clinical assessment, management strategies and the rehabilitation protocol. Results 135 surgeons completed the survey. 35% of them were having experience of more than 12 years. A large number of surgeons were from government academic institutes (35.5%). The most common criteria for deciding about surgery was Clinical evaluation (94.8%). The most common graft choice was hamstring tendon (94%), and suspensory fixation on the femur side and interference screw on the tibial side (80%) is the most common fixation method. Almost two-thirds of surgeons in this survey use bracing to protect ACL graft in the initial phase. Conclusion We presented the preferences amongst the group of surgeons on the management of ACL injuries. Hamstring tendon graft remains the most preferred graft for ACL reconstruction. Further, the suspensory loop on the femoral side and interference screw on the tibial side are the preferred fixation method. This group of surgeons is conservative in terms of the timing of surgeries and post-operative bracing. Level of evidence Level V, Expert Opinion.
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Affiliation(s)
| | | | | | | | | | - Shalendra Singh
- Department of Anesthesia, Armed Forces Medical College, Pune, 411040, India
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Morris JL, McEwen P, Letson HL, Dobson GP. Anterior Cruciate Ligament Reconstruction Surgery: Creating a Permissive Healing Phenotype in Military Personnel and Civilians for Faster Recovery. Mil Med 2022; 187:1310-1317. [PMID: 35389483 PMCID: PMC9617292 DOI: 10.1093/milmed/usac093] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Anterior cruciate ligament (ACL) rupture in military personnel and civilians can be a devastating injury. A service member is 10 times more likely to suffer an ACL injury than their civilian counterparts, and despite successful surgical stabilization, 4%-35% will develop arthrofibrosis, over 50% will not return to full active duty, and up to 50% will develop post-traumatic osteoarthritis (PTOA) within 15 years. Equally concerning, woman are 2 to 8 times more likely to experience ACL injuries than men, which represents a major knowledge gap. Materials and Methods A comprehensive literature search was performed in December 2021 using structured search terms related to prevalence, risk factors, disease progression, and treatment of ACL injury and reconstruction. The literature search was conducted independently by two researchers using PubMed, Cochrane, and Embase databases, with inclusion of articles with military, civilian, and sex relevance, and exclusion of most papers with a publication date greater than 10 years. The resources used for the review reflect the most current data, knowledge, and recommendations associated with research and clinical findings from reliable international sources. Results Currently, there is no effective system-based drug therapy that creates a “permissive environment” to reduce synovial and cartilage stress after ACL injury and reconstruction and prevent secondary complications. We argue that progress in this area has been hampered by researchers and clinicians failing to recognize that (1) an ACL injury is a system’s failure that affects the whole joint, (2) the early molecular events define and perpetuate different injury phenotypes, (3) male and female responses may be different and have a molecular basis, (4) the female phenotype continues to be under-represented in basic and clinical research, and (5) the variable outcomes may be perpetuated by the trauma of surgery itself. The early molecular events after ACL injury are characterized by an overexpression of joint inflammation, immune dysfunction, and trauma-induced synovial stress. We are developing an upstream adenosine, lidocaine, and magnesium therapy to blunt these early molecular events and expedite healing with less arthrofibrosis and early PTOA complications. Conclusions ACL injuries continue to be a major concern among military personnel and civilians and represent a significant loss in command readiness and quality of life. The lack of predictability in outcomes after ACL repair or reconstruction underscores the need for new joint protection therapies. The male–female disparity requires urgent investigation.
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Affiliation(s)
- Jodie L Morris
- Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
| | - Peter McEwen
- The Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, QLD 4812, Australia
| | - Hayley L Letson
- Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
| | - Geoffrey P Dobson
- Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
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Lynch TB, Patzkowski JC, Swan ER, Roach CJ, Schmitz MR, Dickens JF, Sheean AJ. Current Practice Patterns in Anterior Cruciate Ligament Reconstruction Among Fellowship-Trained Military Orthopaedic Surgeons. Arthrosc Sports Med Rehabil 2020; 2:e523-e529. [PMID: 33134990 PMCID: PMC7588646 DOI: 10.1016/j.asmr.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate current practice patterns in anterior cruciate ligament reconstruction (ACLR) surgery among fellowship-trained military surgeons. Methods The MOTION database is a prospectively collected dataset of intraoperative variables across the Military Health System. This database was queried using Current Procedural Terminology code 29888 for ACLR among active-duty service members between October 2016 and December 2019. The intraoperative data pertaining to ACLR involving both isolated primary ACLRs and primary ACLRs combined with meniscal or chondral injuries were extracted with patient age, sex, and rank. Results Two hundred sixty-six primary ACLRs performed by 21 fellowship-trained orthopaedic surgeons at 9 MTFs were identified. The mean age of patients undergoing ACLR was 27.2 ± 7.7 years. Bone–patellar tendon–bone autograft was the most commonly used graft source (137 of 266 [51.5%] cases.) Meniscal injuries were treated with an isolated debridement in 53 of 156 (34.0%) tears, whereas meniscal repair was performed in 86 of 156 (55.1%) tears. Concomitant chondral pathology was noted in 43 of 266 cases (16.2%) and most commonly addressed with chondroplasty (25 of 49 [51.0%] chondral lesions). Conclusions Bone–patellar tendon–bone autograft was the most commonly used graft type in ACLR among fellowship-trained surgeons treating active-duty service members. Concomitant meniscal pathology was encountered at rates comparable with what has been previously reported, and meniscal repair was favored over meniscal debridement in more than 50% cases. Level of Evidence Level IV: Therapeutic case series.
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Affiliation(s)
- Thomas B Lynch
- San Antonio Military Medical Center, Fort Sam Houston, Texas, U.S.A
| | | | - Erin R Swan
- San Antonio Military Medical Center, Fort Sam Houston, Texas, U.S.A
| | | | | | | | - Andrew J Sheean
- San Antonio Military Medical Center, Fort Sam Houston, Texas, U.S.A
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Anterior knee pain in ACL reconstruction with BPTB graft - Is it a myth? Comparative outcome analysis with hamstring graft in 1,250 patients. J Orthop 2020; 22:408-413. [PMID: 33029045 DOI: 10.1016/j.jor.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/03/2020] [Accepted: 09/21/2020] [Indexed: 12/11/2022] Open
Abstract
Anterior Knee Pain(AKP) has been quoted as the main disadvantage of Bone Patellar Tendon Bone (BPTB)graft in Anterior Cruciate Ligament Reconstruction (ACLR). We overcome the problem by harvesting BPTB graft by mini-open mobile window technique. Objectives To investigate postoperative incidence of AKP with BPTB graft in comparison with hamstring graft during primary ACLR. Methods Total of 1737 patients underwent ACLR in the study period of which 1250 met eligibility criteria (622-BPTB graft, , 628-Hamstring graft). Results Incidence of AKP, Lysholm score and IKDC score were analysed and found no statistically significant difference at 18-month followup. Conclusion BPTB graft harvested by mini-open mobile window technique has a low incidence of AKP as of hamstring graft.
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