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Vakili S, Vivacqua T, Getgood A, Willing R. In Vitro Assessment of Knee Joint Biomechanics Using a Virtual Anterior Cruciate Ligament Reconstruction. J Biomech Eng 2024; 146:101006. [PMID: 38683101 DOI: 10.1115/1.4065417] [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: 12/07/2023] [Accepted: 04/24/2024] [Indexed: 05/01/2024]
Abstract
Understanding the biomechanical impact of injuries and reconstruction of the anterior cruciate ligament (ACL) is vital for improving surgical treatments that restore normal knee function. The purpose of this study was to develop a technique that enables parametric analysis of the effect of the ACL reconstruction (ACLR) in cadaver knees, by replacing its contributions with that of a specimen-specific virtual ACLR that can be enabled, disabled, or modified. Twelve ACLR reconstructed knees were mounted onto a motion simulator. In situ ACLR graft forces were measured using superposition, and these data were used to design specimen-specific virtual ACLRs that would yield the same ligament force-elongation behaviors. Tests were then repeated using the virtual ACLR in place of the real ACLR and following that in ACL deficient knee by disabling the virtual ACLR. In comparison to the ACL deficient state, the virtual ACLRs were able to restore knee stability to the same extent as real ACLRs. The average differences between the anterior tibial translation (ATT) of the virtual ACLR versus the real ACLR were +1.6 ± 0.9 mm (p = 0.4), +2.1 ± 0.4 mm (p = 0.4), and +1.0 ± 0.9 mm (p = 0.4) during Anterior drawer, Lachman and Pivot-shift tests, respectively, which is small in comparison to the full ATT range of motion (ROM) of these knees. Therefore, we conclude that a virtual ACLR can be used in place of real ACLR during biomechanical testing of cadaveric knees. This capability opens the door for future studies that can leverage parameterization of the ACLR for surgical design optimization.
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Affiliation(s)
- Samira Vakili
- School of Biomedical Engineering, Western University, 1151 Richmond Street N, London, ON N6A 5B9, Canada;Western's Bone and Joint Institute, Western University, London, ON N6A 5B9, Canada
| | - Thiago Vivacqua
- Fowler Kennedy Sport Medicine Clinic, Department of Surgery, Western University, 3M Centre, London, ON N5A 3K7, Canada
- Western University
| | - Alan Getgood
- Department of Orthopaedic Surgery, London Health Sciences Centre University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada;Fowler Kennedy Sport Medicine Clinic, Department of Surgery, Western University, 3M Centre, London, ON N5A 3K7, Canada;Western's Bone and Joint Institute, Western University, London, ON N6A 5A5, Canada
| | - Ryan Willing
- School of Biomedical Engineering, Western University, 1151 Richmond Street N, London, ON N6A 5B9, Canada;Department of Mechanical & Materials Engineering, Western University, 1151 Richmond Street N, London, ON N6A 5B9, Canada;Western's Bone and Joint Institute, Western University, London, ON N6A 5A5, Canada
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Agres AN, Brisson NM, Duda GN, Jung TM. Activity-Dependent Compensation at the Hip and Ankle at 8 Years After the Reconstruction of Isolated and Combined Posterior Cruciate Ligament Injuries. Am J Sports Med 2024; 52:1804-1812. [PMID: 38761007 PMCID: PMC11143757 DOI: 10.1177/03635465241248819] [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: 04/26/2023] [Accepted: 02/29/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND After posterior cruciate ligament reconstruction (PCLR), functional deficits at the knee can persist. It remains unclear if neighboring joints compensate for the knee during demanding activities of daily living. PURPOSE To assess long-term alterations in lower limb mechanics in patients after PCLR. STUDY DESIGN Descriptive laboratory study. METHODS A total of 28 patients who had undergone single-bundle unilateral isolated or combined PCLR performed stair navigation, squat, sit-to-stand, and stand-to-sit tasks at 8.2 ± 2.2 years after surgery. Motion capture and force plates were used to collect kinematic and kinetic data. Then, 3-dimensional hip, knee, and ankle kinematic data of the reconstructed limb were compared with those of the contralateral limb using statistical parametric mapping. RESULTS Side-to-side differences at the knee were primarily found during upward-driven movements at 8 years after surgery. The reconstructed knee exhibited lower internal rotation during the initial loading phase of stair ascent versus the contralateral knee (P = .005). During the sit-to-stand task, higher flexion angles during the midcycle (P = .017) and lower external rotation angles (P = .049) were found in the reconstructed knee; sagittal knee (P = .001) and hip (P = .016) moments were lower in the reconstructed limb than the contralateral limb. In downward-driven movements, side-to-side differences were minimal at the knee but prominent at the ankle and hip: during stair descent, the reconstructed ankle exhibited lower dorsiflexion and lower external rotation during the midcycle versus the contralateral ankle (P = .006 and P = .040, respectively). Frontal hip moments in the reconstructed limb were higher than those in the contralateral limb during the stand-to-sit task (P = .010); during squats, sagittal hip angles in the reconstructed limb were higher than those in the contralateral limb (P < .001). CONCLUSION Patients after PCLR exhibited compensations at the hip and ankle during downward-driven movements, such as stair descent, squats, and stand-to-sit. Conversely, residual long-term side-to-side differences at the knee were detected during upward-driven movements such as stair ascent and sit-to-stand. CLINICAL RELEVANCE After PCLR, side-to-side differences in biomechanical function were activity-dependent and occurred either at the knee or neighboring joints. When referring to the contralateral limb to assess knee function in the reconstructed limb, concentric, upward-driven movements should be prioritized. Compensations at the hip and ankle during downward-driven movements lead to biases in long-term functional assessments.
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Affiliation(s)
- Alison N. Agres
- Julius Wolff Institute, Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Nicholas M. Brisson
- Julius Wolff Institute, Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Georg N. Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias M. Jung
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Harrison K, Holmes HH, Finley EB, Guzman KS, Kimbrough KC, Roper JA. Incline and decline running alters joint moment contributions but not peak support moments in individuals with an anterior cruciate ligament reconstruction and controls. Front Sports Act Living 2023; 5:1217783. [PMID: 38046933 PMCID: PMC10691489 DOI: 10.3389/fspor.2023.1217783] [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: 05/05/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Individuals with an anterior cruciate ligament reconstruction (ACLR) commonly exhibit altered gait patterns, potentially contributing to an increased risk of osteoarthritis (OA). Joint moment contributions (JMCs) and support moments during incline and decline running are unknown in healthy young adults and individuals with an ACLR. Understanding these conditional joint-level changes could explain the increased incidence of OA that develops in the long term. Therefore, this knowledge may provide insight into the rehabilitation and prevention of OA development. We aimed to identify the interlimb and between-group differences in peak support moments and subsequent peak ankle, knee, and hip JMCs between individuals with an ACLR and matched controls during different sloped running conditions. A total of 17 individuals with unilateral ACLR and 17 healthy individuals who were matched based on sex, height, and mass participated in this study. The participants ran on an instrumented treadmill at an incline of 4°, decline of 4°, incline of 10°, and decline of 10°. The last 10 strides of each condition were used to compare the whole-stance phase support moments and JMCs between limbs, ACLR, and control groups and across conditions. No differences in JMCs were identified between limbs or between the ACLR and healthy control groups across all conditions. Support moments did not change among the different sloped conditions, but JMCs significantly changed. Specifically, ankle and knee JMCs decreased and increased by 30% and 33% from an incline of 10° to a decline of 10° running. Here, the lower extremities can redistribute mechanics across the ankle, knee, and hip while maintaining consistent support moments during incline and decline running. Our data provide evidence that those with an ACLR do not exhibit significant alterations in joint contributions while running on sloped conditions compared to the matched controls. Our findings inform future research interested in understanding the relationship between sloped running mechanics and the incidence of deleterious acute or chronic problems in people with an ACLR.
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Affiliation(s)
| | | | | | | | | | - Jaimie A. Roper
- School of Kinesiology, Auburn University, Auburn, AL, United States
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Brown MJ, Klemm HJ, Webster KE, Feller JA. Effect of Age and Femoral Tunnel Drilling Technique on the Prevalence of Intra-articular Pathology at Both Primary and Revision ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231209074. [PMID: 37954862 PMCID: PMC10637178 DOI: 10.1177/23259671231209074] [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: 06/27/2023] [Accepted: 07/31/2023] [Indexed: 11/14/2023] Open
Abstract
Background Studies have shown that meniscal and chondral lesions are more common at the time of revision anterior cruciate ligament reconstruction (ACLR) compared with primary surgery; however, few have evaluated the same patients through both primary and revision surgery. Purpose To describe the prevalence of meniscal and chondral lesions at the time of primary and subsequent revision ACLR and to determine the effect of age and femoral tunnel drilling technique on the development of intra-articular pathology over time. Study Design Case series; Level of evidence, 4. Methods All patients who had primary and subsequent revision ACLR in the same knee between 1997 and 2022 were identified from a prospectively collated database. The grading of chondral surfaces in each compartment, the presence of any meniscal tears, and treatment performed were recorded. Patients were grouped according to age and femoral tunnel drilling technique to allow subgroup analysis. Results Overall, 262 patients were included. Median age at primary surgery was 20.2 years. Lateral meniscal tears were more prevalent than medial tears at both primary (34.7% vs 28.2%; P = .11) and revision surgery (44.3% vs 40.8%; P = .43). Chondral lesions were most frequently found on the patella (8.8%) and the medial femoral condyle (MFC; 8.0%) at primary surgery. Between surgeries, new lesions developed most commonly on the MFC (13.0%) and the lateral femoral condyle (LFC; 11.1%). It was significantly more common for lateral meniscal tears treated with repair or left in situ at primary surgery to be healed at the time of revision surgery than medial tears (P = .01). Significantly more patients who had transtibial drilling of the femoral tunnel had a new meniscal tear at revision surgery (P = .001). Age did not have a significant influence on the prevalence of meniscal pathology. Conclusion The prevalence of intra-articular pathology increased between primary and revision ACLR. Lateral meniscal tears were more prevalent than medial tears at both surgeries. At revision surgery, new chondral lesions were more commonly found on the MFC than the LFC. The higher incidence of new meniscal tears observed in the transtibial group may reflect the more vertical graft orientation with this technique and its inferior ability to control rotation.
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Affiliation(s)
- Michael J.C. Brown
- OrthoSport Victoria Research Unit, Epworth Richmond, Richmond, Victoria, Australia
| | - Haydn J. Klemm
- OrthoSport Victoria Research Unit, Epworth Richmond, Richmond, Victoria, Australia
| | - Kate E. Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Julian A. Feller
- OrthoSport Victoria Research Unit, Epworth Richmond, Richmond, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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Karatekin YS, Altınayak H, Kehribar L, Yılmaz AK, Korkmaz E, Anıl B. Does Rotation and Anterior Translation Persist as Residual Instability in the Knee after Anterior Cruciate Ligament Reconstruction? (Evaluation of Coronal Lateral Collateral Ligament Sign, Tibial Rotation, and Translation Measurements in Postoperative MRI). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1930. [PMID: 38003979 PMCID: PMC10672908 DOI: 10.3390/medicina59111930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023]
Abstract
Purpose: The aim of this study was to evaluate the presence of residual instability in the knee after ACL reconstruction through the analysis of MRI findings. Methods: This study included patients who underwent isolated ACL reconstruction between December 2019 and December 2021, and had preoperative and postoperative MRI, clinical scores, and postoperative isokinetic measurements. The anterior tibial translation (ATT) distance, coronal lateral collateral ligament (LCL) sign, and femorotibial rotation (FTR) angle were compared preoperatively and postoperatively. The correlation between the changes in preoperative-postoperative measurements and postoperative measurements with clinical scores and isokinetic measurements was examined. The clinical outcomes were compared based on the presence of a postoperative coronal LCL sign. Inclusion criteria were set as follows: the time between the ACL rupture and surgery being 6 months, availability of preoperative and postoperative clinical scores, and objective determination of muscle strength using isokinetic dynamometer device measurements. Patients with a history of previous knee surgery, additional ligament injuries other than the ACL, evidence of osteoarthritis on direct radiographs, cartilage injuries lower limb deformities, and contralateral knee injuries were excluded from this study. Results: This study included 32 patients. After ACL reconstruction, there were no significant changes in the ATT distance (preoperatively: 6.5 ± 3.9 mm, postoperatively: 5.7 ± 3.2 mm) and FTR angle (preoperatively: 5.4° ± 2.9, postoperatively: 5.2° ± 3.5) compared to the preoperative measurements (p > 0.05). The clinical measurements were compared based on the presence of a postoperative coronal LCL sign (observed in 17 patients, not observed in 15 patients), and no significant differences were found for all parameters (p > 0.05). There were no observed correlations between postoperative FTR angle, postoperative ATT distance, FTR angle change, and ATT distance change values with postoperative clinical scores (p > 0.05). Significant correlations were observed between the high strength ratios generated at an angular velocity of 60° and a parameters FTR angle and ATT distance (p-values: 0.028, 0.019, and r-values: -0.389, -0.413, respectively). Conclusions: Despite undergoing ACL reconstruction, no significant changes were observed in the indirect MRI findings (ATT distance, coronal LCL sign, and FTR angle). These results suggest that postoperative residual tibiofemoral rotation and tibial anterior translation may persist; however, they do not seem to have a direct impact on clinical scores. Furthermore, the increase in tibial translation and rotation could potentially negatively affect the flexion torque compared to the extension torque in movements requiring high torque at low angular velocities.
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Affiliation(s)
- Yavuz Selim Karatekin
- Department of Orthopaedics and Traumatology, Samsun Education and Research Hospital, 55090 Samsun, Turkey;
| | - Harun Altınayak
- Department of Orthopaedics and Traumatology, Samsun Education and Research Hospital, 55090 Samsun, Turkey;
| | - Lokman Kehribar
- Medical Faculty, Department of Orthopaedics and Traumatology, Samsun University, 55090 Samsun, Turkey;
| | - Ali Kerim Yılmaz
- Faculty of Yasar Doğu Sport Sciences, Ondokuz Mayıs University, 55090 Samsun, Turkey; (A.K.Y.); (E.K.); (B.A.)
| | - Esra Korkmaz
- Faculty of Yasar Doğu Sport Sciences, Ondokuz Mayıs University, 55090 Samsun, Turkey; (A.K.Y.); (E.K.); (B.A.)
| | - Berna Anıl
- Faculty of Yasar Doğu Sport Sciences, Ondokuz Mayıs University, 55090 Samsun, Turkey; (A.K.Y.); (E.K.); (B.A.)
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Garcia SA, Kahan S, Gallegos J, Balza I, Krishnan C, Palmieri-Smith RM. Walking speed differentially affects lower extremity biomechanics in individuals with anterior cruciate ligament reconstruction compared to uninjured controls. Clin Biomech (Bristol, Avon) 2023; 108:106059. [PMID: 37562332 DOI: 10.1016/j.clinbiomech.2023.106059] [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: 05/10/2023] [Revised: 06/30/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Walking biomechanics are commonly affected after anterior cruciate ligament reconstruction and differ compared to uninjured controls. Manipulating task difficulty has been shown to affect the magnitude of walking impairments in those early after knee surgery but it is unclear if patients in later phases post-op are similarly affected by differing task demands. Here, we evaluated the effects of manipulating walking speed on between-limb differences in ground reaction force and knee biomechanics in those with and without anterior cruciate ligament reconstruction. METHODS We recruited 28 individuals with anterior cruciate ligament reconstruction and 20 uninjured control participants to undergo walking assessments at three speeds (self-selected, 120%, and 80% self-selected speed). Main outcomes included sagittal plane knee moments, angles, excursions, and ground reaction forces (vertical and anterior-posterior). FINDINGS We observed walking speed differentially impacted force and knee-outcomes in those with anterior cruciate ligament reconstruction. Between-limb differences increased at fast and decreased at slow speeds in those with anterior cruciate ligament reconstruction while uninjured participants maintained between-limb differences regardless of speed (partial η2 = 0.13-0.33, p < 0.05). Anterior cruciate ligament reconstruction patients underloaded the surgical limb relative to both the contralateral, and uninjured controls in GRFs and sagittal plane knee moments (partial η2 range = 0.13-0.25, p < 0.05). INTERPRETATION Overall, our findings highlight the persistence of walking impairments in those with anterior cruciate ligament reconstruction despite completing formal rehabilitation. Further research should consider determining if those displaying larger changes in gait asymmetries in response to fast walking also exhibit poorer strength and/or joint health outcomes.
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Affiliation(s)
- Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Seth Kahan
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Jovanna Gallegos
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Isabella Balza
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Neuromuscular and Rehabilitation Robotics Laboratory, University of Michigan, Ann Arbor, MI, USA; Robotics Institute, University of Michigan, Ann Arbor, MI, USA
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA; Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI, USA.
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Herbst E, Costello J, Popchak AJ, Tashman S, Irrgang JJ, Fu FH, Musahl V. Untreated Injuries to the Anterolateral Capsular Structures Do Not Affect Outcomes and Kinematics after Anatomic Anterior Cruciate Ligament Reconstruction. J Clin Med 2023; 12:4408. [PMID: 37445441 DOI: 10.3390/jcm12134408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/11/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Injuries to the anterolateral complex (ALC) may contribute to increased rotatory knee laxity. However, it has not been evaluated whether such injuries affect in vivo kinematics when treated in situ. The purpose of this study was to determine the grade of ALC injury and its effect on kinematic and clinical outcomes of ACL-injured patients 24 months after anatomic ACL reconstruction. It was hypothesized that injury to the ALC would be significantly related to patient-reported outcomes (PROs) and in vivo knee kinematics during downhill running. METHODS Thirty-five subjects (mean age: 22.8 ± 8.5 years) participating in a randomized clinical trial to compare single- and double-bundle ACL reconstruction were included in the study. Subjects were divided into two groups based on the presence or absence of injury to the ALC, as determined on MRI scans performed within 6 weeks of injury. None of the patients underwent treatment for these ALC injuries. At 24 months, PROs, including the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS) and in vivo knee kinematics during downhill running, were obtained. Pivot-shift test results, PROs and in vivo knee kinematics were compared between groups with and without ALC injury using the Pearson's Chi Squared test and Mann-Whitney U test with significance set at p < 0.05. RESULTS The average interval between injury and performing the MRI scans was 9.5 ± 10 days. ALC injury was observed in 17 (49%) study participants. No significant differences were detected in PROs and in vivo kinematics between subjects with and without ALC injury (n.s.). CONCLUSION The findings of this study demonstrate that MRI evidence of an ALC injury does not significantly affect in vivo knee kinematics and PROs even in individuals with a high-grade ALC injury. Injuries to the ALC as observed on MRI might not be a useful indication for an anterolateral procedure.
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Affiliation(s)
- Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, 48149 Münster, Germany
| | - Joanna Costello
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Adam J Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Scott Tashman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
- Steadman Philippon Research Institute, Vail, CO 81657, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
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8
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McLeod KC, Barber FA. Pivot Shift Syndrome of the Knee. Sports Med Arthrosc Rev 2023; 31:34-40. [PMID: 37418172 DOI: 10.1097/jsa.0000000000000365] [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: 07/08/2023]
Abstract
The pivot shift test, in contrast to the Lachman or anterior drawer, is a manually subjective clinical test that simulates the injury mechanism. It is the most sensitive test to determine ACL insufficiency. This paper reviews the history, development, research, and treatment associated with the pivot shift phenomenon which is associated with tearing and loss of function of the knee anterior cruciate ligament. The pivot shift test most closely recapitulates what the symptomatic anterior cruciate ligament deficient patient feels is happening which is an abnormal translation and rotation of the injured joint during flexion or extension. The test is best conducted in the relaxed patient by applying knee flexion, tibial external rotation, and valgus stress. The pivot shift biomechanics and treatment measures are reviewed.
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Affiliation(s)
- Kevin C McLeod
- Baptist Health Specialty - Arkadelphia, Orthopedic Surgeon, 2915 Cypress Rd, Suite D, Arkadelphia, AR
| | - F Alan Barber
- Plano Orthopedic and Sports Medicine Center, Fellowship Director Emeritus, Plano, TX
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9
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Spatholt RJ, Minoughan CE, Gooch C, Harms SP, Taylor ML, Galloway MT, Shearn JT. Determine the vertical ground reaction forces and knee mechanics with different gait inclinations in the sheep model. J Orthop Res 2023; 41:779-786. [PMID: 35822352 DOI: 10.1002/jor.25416] [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: 12/03/2021] [Revised: 04/20/2022] [Accepted: 07/07/2022] [Indexed: 02/04/2023]
Abstract
Our current understanding of knee mechanics and anterior cruciate ligament (ACL) function is predominately based on data recorded during simulations of clinical examinations or the application of nonphysiologic loads and motions. These methodologies provide little information on knee and ACL mechanics during activities of daily living (ADLs). Additionally, researchers have not directly measured knee kinetics, knee contact pressures, and ACL forces, and it is unknown how these parameters change with different activities. This study quantified the effects of activity level on vertical ground reaction forces, knee kinematics, and joint and ligament forces during in vivo motions. Five female Suffolk sheep were walked twice weekly on a treadmill during level (0°), inclined (+6°), and declined (-6°) gait for 12 weeks. Electromagnetic (EM) trackers were surgically implanted onto the left distal femur and the left proximal tibia, and in vivo motions were recorded for all activities. Following sacrifice, the in vivo motions were applied to their respective knees using a serial robot with a multi-axis load cell. In vitro simulations were repeated to measure (a) total knee forces, (b) contact pressure maps, and (c) ACL-only forces. Declining the gait surface led to increased posterior translation during the swing phase and decreased flexion at hoof-strike, decreased medial contact pressure at push-off, decreased ACL force at hoof-strike and increased ACL force at push-off. This study established a system that can be used to examine knee mechanics and ACL forces during ADLs for different knee states to define design requirements for ACL reconstruction techniques.
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Affiliation(s)
- Rebecca J Spatholt
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| | - Chelsea E Minoughan
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| | - Cynthia Gooch
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samuel P Harms
- Orthopaedic Associates of Duluth, Duluth, Minnesota, USA
| | - Michal L Taylor
- Rocky Mountain Associates in Orthopaedic Medicine, Denver, Colorado, USA
| | | | - Jason T Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
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10
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Küpper JC, Zandiyeh P, Ronsky JL. Empirical joint contact mechanics: A comprehensive review. Proc Inst Mech Eng H 2023; 237:147-162. [PMID: 36468563 DOI: 10.1177/09544119221137397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Empirical joint contact mechanics measurement (EJCM; e.g. contact area or force, surface velocities) enables critical investigations of the relationship between changing joint mechanics and the impact on surface-to-surface interactions. In orthopedic biomechanics, understanding the changes to cartilage contact mechanics following joint pathology or aging is critical due to its suggested role in the increased risk of osteoarthritis (OA), which might be due to changed kinematics and kinetics that alter the contact patterns within a joint. This article reviews and discusses EJCM approaches that have been applied to articulating joints such that readers across different disciplines will be informed of the various measurement and analysis techniques used in this field. The approaches reviewed include classical measurement approaches (radiographic and sectioning, dye staining, casting, surface proximity, and pressure measurement), stereophotogrammetry/motion analysis, computed tomography (CT), magnetic resonance imaging (MRI), and high-speed videoradiography. Perspectives on approaches to advance this field of EJCM are provided, including the value of considering relative velocity in joints, tractional stress, quantification of joint contact area shape, consideration of normalization techniques, net response (superposition) of multiple input variables, and establishing linkages to regional cartilage health status. EJCM measures continue to provide insights to advance our understanding of cartilage health and degeneration and provide avenues to assess the efficacy and guide future directions of developing interventions (e.g. surgical, biological, rehabilitative) to optimize joint's health and function long term.
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Affiliation(s)
- Jessica C Küpper
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, AB, Canada.,McCaig Institute for Bone and Joint Health, Calgary, AB, Canada
| | - Payam Zandiyeh
- Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX, USA
| | - Janet L Ronsky
- McCaig Institute for Bone and Joint Health, Calgary, AB, Canada.,Departments of Mechanical and Manufacturing Engineering and Biomedical Engineering, University of Calgary, Calgary, AB, Canada
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11
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Adouni M, Faisal T, Dhaher Y. Effect of Surgical Design Variations on the Knee Contact Behavior during Anterior Cruciate Ligament Reconstruction. J Knee Surg 2023; 36:310-321. [PMID: 34375997 DOI: 10.1055/s-0041-1733879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this study, we aimed to develop an in-silico synthesis of the effect of critical surgical design parameters on articular contact behavior for a bone-patellar-tendon-bone anterior cruciate ligament reconstruction (ACL-R) surgery. A previously developed finite element model of the knee joint consisting of all relevant soft tissues was employed. The knee model was further updated with additional features to develop the parametric FE model of the biomechanical experiments that depicted the ACL-R surgery. The parametricity was created involving femoral tunnel architecture (orientations and locations) and graft fixation characteristics (pretension and angle of fixation). A global sensitivity analysis based on variance decomposition was used to investigate the contribution of the surgical parameters to the uncertainty in response to the ACL-R joint. Our examinations indicated that the total contact force was primarily influenced by either combined or individual action of the graft pretension and fixation angle, with a modest contribution of the graft insertion sites. The joint contact center and area were affected mainly by the angle of fixation and the tunnel placements. Graft pretension played the dominant role in the maximum contact pressure variability, an observation that has been well-documented in the literature. Interestingly, the joint contact behavior was almost insensitive to the tunnel's coronal and sagittal orientations. Our data provide an evaluation of how the surgical parameters affect the knee joint's contact behavior after ACL-R and may provide additional information to better explain the occurrence of osteoarthritis as an aftermath of such surgery.
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Affiliation(s)
- Malek Adouni
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois.,Department of Mechanical Engineering, Australian College of Kuwait, Kuwait City, Kuwait
| | - Tanvir Faisal
- Department of Bioengineering, University of Texas Southwest, Dallas, Texas
| | - Yasin Dhaher
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois.,Department of Mechanical Engineering, University of Louisiana at Lafayette, Louisiana.,Department of Physical Medicine and Rehabilitation, University of Texas Southwest, Dallas, Texas.,Department of Orthopedic Surgery, University of Texas Southwest, Dallas, Texas
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12
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Gibbs CM, Hughes JD, Popchak AJ, Chiba D, Winkler PW, Lesniak BP, Anderst WJ, Musahl V. Preoperative quantitative pivot shift does not correlate with in vivo kinematics following ACL reconstruction with or without lateral extraarticular tenodesis. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07232-8. [PMID: 36394585 DOI: 10.1007/s00167-022-07232-8] [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: 06/28/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Quantitative pivot shift (QPS) testing using PIVOT technology can detect high- and low-grade rotatory knee instability following anterior cruciate ligament injury or reconstruction (ACLR). The aim of this project was to determine if preoperative QPS correlates with postoperative knee kinematics in the operative and contralateral, healthy extremity following ACLR with or without lateral extraarticular tenodesis (LET) using a highly precise in vivo analysis system. A positive correlation between preoperative QPS and postoperative tibial translation and rotation following ACLR with or without LET in the operative and healthy, contralateral extremity was hypothesized. METHODS Twenty patients with ACL injury and high-grade rotatory knee instability were randomized to undergo anatomic ACLR with or without LET as part of a prospective randomized trial. At 6 and 12 months postoperatively, in vivo kinematic data were collected using dynamic biplanar radiography superimposed with high-resolution computed tomography scans of patients' knees during downhill running. Total anterior-posterior (AP) tibial translation and internal-external tibial rotation were measured during the gait cycle. Spearman's rho was calculated for preoperative QPS and postoperative kinematics. RESULTS In the contralateral, healthy extremity, a significant positive correlation was seen between preoperative QPS and total AP tibial translation at 12 months postoperatively (rs = 0.6, p < 0.05). There were no additional significant correlations observed between preoperative QPS and postoperative knee kinematics at 6 and 12 months postoperatively in the operative and contralateral, healthy extremity for combined isolated ACLR and ACLR with LET patients as well as isolated ACLR patients or ACLR with LET patients analyzed separately. DISCUSSION The main finding of this study was that there was a significant positive correlation between preoperative QPS and total AP tibial translation at 12 months postoperatively in the contralateral, healthy extremity. There were no significant correlations between preoperative QPS and postoperative in vivo kinematics at 6 and 12 months following ACLR with or without LET. This suggests that QPS as measured with PIVOT technology does correlate with healthy in vivo knee kinematics, but QPS does not correlate with in vivo kinematics following ACLR with or without LET.
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Affiliation(s)
- Christopher M Gibbs
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA.
| | - Jonathan D Hughes
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA
| | - Adam J Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daisuke Chiba
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA.,Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Philipp W Winkler
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA.,Department for Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Bryson P Lesniak
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA
| | - William J Anderst
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA
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Can Increased Locomotor Task Difficulty Differentiate Knee Muscle Forces After Anterior Cruciate Ligament Reconstruction? J Appl Biomech 2022; 38:84-94. [PMID: 35287111 DOI: 10.1123/jab.2021-0215] [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: 07/04/2021] [Revised: 12/10/2021] [Accepted: 01/21/2022] [Indexed: 11/18/2022]
Abstract
Changes in knee mechanics following anterior cruciate ligament (ACL) reconstruction are known to be magnified during more difficult locomotor tasks, such as when descending stairs. However, it is unclear if increased task difficulty could distinguish differences in forces generated by the muscles surrounding the knee. This study examined how knee muscle forces differ between individuals with ACL reconstruction with different graft types (hamstring tendon and patellar tendon autograft) and "healthy" controls when performing tasks with increasing difficulty. Dynamic simulations were used to identify knee muscle forces in 15 participants when walking overground and descending stairs. The analysis was restricted to the stance phase (foot contact through toe-off), yielding 162 separate simulations of locomotion in increasing difficulty: overground walking, step-to-floor stair descent, and step-to-step stair descent. Results indicated that knee muscle forces were significantly reduced after ACL reconstruction, and stair descent tasks better discriminated changes in the quadriceps and gastrocnemii muscle forces in the reconstructed knees. Changes in quadriceps forces after a patellar tendon graft and changes in gastrocnemii forces after a hamstring tendon graft were only revealed during stair descent. These results emphasize the importance of incorporating sufficiently difficult tasks to detect residual deficits in muscle forces after ACL reconstruction.
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14
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Single-Tunnel Double-Bundle-Like Effect With Footprint Enhancing Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2022; 11:e307-e314. [PMID: 35256968 PMCID: PMC8897561 DOI: 10.1016/j.eats.2021.10.023] [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: 09/27/2021] [Accepted: 10/28/2021] [Indexed: 02/03/2023] Open
Abstract
The anterior cruciate ligament (ACL) consists of an anteromedial bundle and a posterolateral bundle giving anteroposterior and rotational stability. It's one of the most commonly injured ligaments and also one of the most commonly performed arthroscopic procedures. Management of ACL injuries is one of the most frequently studied subjects in the literature. Surgical management of ACL injuries varies from extraarticular tenodesis to arthroscopic transtibial reconstruction to double-bundle reconstruction to anatomic single-bundle reconstruction. Although double-bundle ACL reconstruction gives more rotational stability than anatomic single-bundle, functional outcome of both are the same, but the complication rates are much higher for double-bundle reconstruction. Hence, anatomic single-bundle ACL reconstruction has gained popularity. The femoral and tibial footprint of the ACL varies in shape and size; it can be oval, elliptical, rectangular, C-shape, and more. But all available ACL reconstruction techniques prepare a circular tunnel; hence, the footprint coverage of the native ACL is maximum after double-bundle reconstruction and less after anatomic single-bundle reconstruction. So, to have the benefit of double-bundle reconstruction with a single tunnel, we propose our technique of a single-tunnel double-bundle-like effect, with the footprint enhancing ACL reconstruction using our newly designed tunnel dilators.
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15
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Gibbs CM, Hughes JD, Popchak AJ, Chiba D, Lesniak BP, Anderst WJ, Musahl V. Anterior cruciate ligament reconstruction with lateral extraarticular tenodesis better restores native knee kinematics in combined ACL and meniscal injury. Knee Surg Sports Traumatol Arthrosc 2022; 30:131-138. [PMID: 33566146 DOI: 10.1007/s00167-021-06476-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/25/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE To determine if anterior cruciate ligament (ACL) reconstruction (ACLR) with lateral extraarticular tenodesis (LET) is beneficial for restoring knee kinematics with concomitant meniscal pathology causing rotatory knee instability. METHODS Twenty patients with an ACL tear were randomized to either isolated ACLR or ACLR with LET. Patients were divided into four groups based on the surgery performed and the presence of meniscal tear (MT): ACLR without MT, ACLR with MT, ACLR with LET without MT, and ACLR with LET with MT. Kinematic data normalized to the contralateral, healthy knee were collected using dynamic biplanar radiography superimposed with high-resolution computed tomography scans of patients' knees during downhill running. Anterior tibial translation (ATT) and tibial rotation (TR) as well as patient-reported outcome measures (PROMs) were analyzed at 6- and 12-months postoperatively. RESULTS At 6 months, ACLR with LET resulted in significantly decreased ATT at heel strike compared to ACLR (ACLR without MT: 0.3 ± 0.8 mm and ACLR with MT: 1.4 ± 3.1 mm vs. ACLR with LET without MT: - 2.5 ± 3.4 mm and ACLR with LET with MT: - 1.5 ± 1.2 mm ATT, p = 0.02). At 6 months, at toe off ACLR with LET better restored ATT to that of the contralateral, healthy knee in patients with meniscal pathology, while in patients without meniscal pathology, ACLR with LET resulted in significantly decreased ATT (1.0 ± 2.6 mm ATT vs. - 2.6 ± 1.7 mm ATT, p = 0.04). There were no significant differences in kinematics or PROMs between groups at 12 months. CONCLUSION For combined ACL and meniscus injury, ACLR with LET restores native knee kinematics at toe off but excessively decreases ATT at heel strike in the early post-operative period (6 months) without altering knee kinematics in the long term. Future large-scale clinical studies are needed to better understand the function of LET and ultimately improve patient outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Christopher M Gibbs
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water St, Pittsburgh, PA, 15203, USA.
| | - Jonathan D Hughes
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water St, Pittsburgh, PA, 15203, USA
| | - Adam J Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daisuke Chiba
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water St, Pittsburgh, PA, 15203, USA
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Bryson P Lesniak
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water St, Pittsburgh, PA, 15203, USA
| | - William J Anderst
- Biodynamics Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water St, Pittsburgh, PA, 15203, USA
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16
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Nishida K, Gale T, Chiba D, Suntaxi F, Lesniak B, Fu F, Anderst W, Musahl V. The effect of lateral extra-articular tenodesis on in vivo cartilage contact in combined anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:61-70. [PMID: 33580345 DOI: 10.1007/s00167-021-06480-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/25/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Lateral extra-articular tenodesis (LET) may confer improved rotational stability after anterior cruciate ligament reconstruction (ACLR). Little is known about how LET affects in vivo cartilage contact after ACLR. The aim of this study was to investigate the effect of LET in combination with ACLR (ACLR + LET) on in vivo cartilage contact kinematics compared to isolated ACLR (ACLR) during downhill running. It was hypothesised that cartilage contact area in the lateral compartment would be larger in ACLR + LET compared with ACLR, and that the anterior-posterior (A-P) position of the contact center on the lateral tibia would be more anterior after ACLR + LET than after ACLR. METHODS Twenty patients were randomly assigned into ACLR + LET or ACLR during surgery (ClinicalTrials.gov:NCT02913404). At 6 months and 12 months after surgery, participants were imaged during downhill running using biplane radiography. Tibiofemoral motion was tracked using a validated registration process. Patient-specific cartilage models, obtained from 3 T MRI, were registered to track bone models and used to calculate the dynamic cartilage contact area and center of cartilage contact in both the medial and lateral tibiofemoral compartments, respectively. The side-to-side differences (SSD) were compared between groups using a Mann-Whitney U test. RESULTS At 6 months after surgery, the SSD in A-P cartilage contact center in ACLR + LET (3.9 ± 2.6 mm, 4.4 ± 3.1 mm) was larger than in ACLR (1.2 ± 1.6 mm, 1.5 ± 2.0 mm) at 10% and 20% of the gait cycle, respectively (p < 0.01, p < 0.05). There was no difference in the SSD in cartilage contact center at 12 months after surgery. There was no difference in SSD of cartilage contact area in the medial and lateral compartments at both 6 and 12 months after surgery. There were no adverse events during the trial. CONCLUSION LET in combination with ACLR may affect the cartilage contact center during downhill running in the early post-operation phase, but this effect is lost in the longer term. This suggests that healing and neuromuscular adaptation occur over time and may also indicate a dampening of the effect of LET over time. (337 /350 words) LEVEL OF EVIDENCE: Level II.
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Affiliation(s)
- Kyohei Nishida
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA
| | - Tom Gale
- Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA.,Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA.,Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Felipe Suntaxi
- Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA
| | - Bryson Lesniak
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie Fu
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - William Anderst
- Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex, 3820 South Water Street, Pittsburgh, PA, 15203, USA.
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
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Garcia SA, Brown SR, Koje M, Krishnan C, Palmieri-Smith RM. Gait asymmetries are exacerbated at faster walking speeds in individuals with acute anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:219-230. [PMID: 34101887 PMCID: PMC8651805 DOI: 10.1002/jor.25117] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/10/2021] [Accepted: 05/10/2021] [Indexed: 02/04/2023]
Abstract
Previous research suggests more biomechanically demanding tasks (e.g., stair descent, hopping) magnify biomechanical asymmetries compared with walking after anterior cruciate ligament (ACL) reconstruction. However, it is unclear if modifying task-specific constraints, like walking speed also elicits greater biomechanical asymmetries in this population. We examined the effects of manipulating walking speed on ground reaction force (GRF) asymmetries in individuals with ACL reconstruction and uninjured controls. Thirty individuals with ACL reconstruction (age = 20.6 ± 5.4 years, body mass index [BMI] = 23.9 ± 3.3 kg/m2 ) and 15 controls (age = 23.1 ± 4.5 years, BMI = 23.6 ± 2.7 kg/m2 ) were tested on an instrumented treadmill at three speeds (100%, 120%, and 80% self-selected speed). Bilateral vertical and posterior-anterior GRFs were recorded at each speed. GRF asymmetries were calculated by subtracting the uninjured from the injured limb at each percent of stance. Statistical parametric mapping was used to evaluate the effects of speed on GRF asymmetries across stance. We found vertical and posterior GRF asymmetries were exacerbated at faster speeds and reduced at slower speeds in ACL individuals but not controls (p < .05). No differences in anterior GRF asymmetries were observed between speeds in either group (p > .05). Our results suggest increasing walking speed magnifies GRF asymmetries in individuals with ACL reconstruction. Statement of Clinical Significance: Evaluating both preferred and fast walking speeds may aid in characterizing biomechanical asymmetries in individuals with ACL reconstruction which may be valuable in earlier rehabilitative time points when more difficult tasks like hopping and running are not feasible.
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Affiliation(s)
- Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott R Brown
- Department of Kinesiology, Aquinas College, Grand Rapids, Michigan, USA
| | - Mary Koje
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Neuromuscular & Rehabilitation Robotics (NeuRRo) Laboratory, Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Neuromuscular & Rehabilitation Robotics (NeuRRo) Laboratory, Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
- Robotics Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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18
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Nishida K, Xu C, Gale T, Anderst W, Fu F. Symmetry and sex differences in knee kinematics and ACL elongation in healthy collegiate athletes during high-impact activities revealed through dynamic biplane radiography. J Orthop Res 2022; 40:239-251. [PMID: 34387908 DOI: 10.1002/jor.25162] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/26/2021] [Accepted: 07/13/2021] [Indexed: 02/04/2023]
Abstract
The objectives of this study were to determine symmetry and sex differences in knee kinematics and anterior cruciate ligament (ACL) elongation waveforms in healthy athletes without a history of a knee injury during fast running, drop jump, and 180° internal/external rotation hops. It was hypothesized that knee abduction angle and ACL relative elongation would be greater in women than in men during all activities. Bilateral knee kinematics and ACL relative elongation were determined in 19 collegiate athletes using dynamic biplane radiography. Sex differences in kinematics and ACL relative elongation waveforms were identified using statistical parametric mapping. Average absolute side-to-side differences (SSDA ) in kinematics and ACL relative elongation waveforms were determined for each activity. Women had up to 2.3° (all p < 0.05) less knee adduction angle and had greater ACL relative elongation (max. 4.8%-9.2%; all p < 0.01) than men during all activities, in support of the hypotheses. SSDA in kinematics were 1.4 mm and 5.5° or less in all components of translation and rotation, respectively, while SSDA in ACL relative elongation was 3.6% or less across all activities. Greater ACL relative elongation across a variety of activities may make women more susceptible to ACL injury than men. This study provides valuable reference data for identifying abnormal asymmetry in knee kinematics and ACL elongation in athletes after the ACL injury. These novel results improve our understanding of ACL elongation during demanding athletic activities and may help guide the development of sex-specific risk screening metrics, return to play assessments, and rehabilitation protocols after the ACL injury.
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Affiliation(s)
- Kyohei Nishida
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caiqi Xu
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Tom Gale
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William Anderst
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie Fu
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Truong CD, Kha TD, Vuong TH, Zakzouk A, Dung NM, Tran TDX, Makram AM, Huy NT. A Simplified Double-Bundle Anterior Cruciate Ligament Reconstruction by the Three-Inside Technique With Two Suspension Buttons and One Interference Screw. Arthrosc Tech 2021; 11:e43-e52. [PMID: 35127428 PMCID: PMC8807718 DOI: 10.1016/j.eats.2021.08.037] [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: 06/22/2021] [Accepted: 08/30/2021] [Indexed: 02/03/2023] Open
Abstract
In comparison with the single-bundle technique, double-bundle anterior cruciate ligament (ACL) reconstruction has proven its superiority regarding biomechanical studies and clinical outcomes in both rotational knee stability and anterior translation function. However, the complexity and risk of complications remain a great concern for the orthopaedic surgeon performing double-bundle ACL reconstruction. We present a simplified double-bundle ACL reconstruction by the 3-inside technique with 2 suspension buttons and 1 interference screw. The semitendinosus tendon is tripled to be the anteromedial (AM) bundle, whereas the gracilis is doubled for the posterolateral (PL) bundle. We perform a 3-socket approach with an inside-out femoral tunnel for the AM bundle, an outside-in femoral tunnel for the PL bundle, and a retrograde tibial socket for the tibial bundle. Thus, this technique is, simply, a combination of 2 procedures: one single all-inside method (for the AM bundle) and one outside-in method (for the PL bundle), with which most arthroscopic surgeons are familiar. The AM and PL bundles are fixed at 30° and 45°, respectively, using 2 suspension buttons and 1 interference screw. Our simplified technique could reduce surgical costs and minimize complications while maintaining isometric position and appropriate graft size for each patient.
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Affiliation(s)
| | - To Dong Kha
- School of Medicine, Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam,Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thanh Huan Vuong
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh city, Vietnam
| | | | | | - Tung Dang Xuan Tran
- Van Hanh Private Hospital, Ho Chi Minh City, Vietnam,School of Dentistry, Taipei Medical University, Taipei City, Taiwan
| | | | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan,Address correspondence to Cong Dung Truong, M.D., Van Hanh Private Hospital, Ho Chi Minh City, Vietnam. E-mail: ; or Nguyen Tien Huy, M.D., Ph.D., School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki 852-8523, Japan.
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20
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Adouni M, Faisal TR, Dhaher YY. Sensitivity analysis of the knee ligament forces to the surgical design variation during anterior cruciate ligament reconstruction: a finite element analysis. Comput Methods Biomech Biomed Engin 2021; 25:1063-1071. [PMID: 34821520 DOI: 10.1080/10255842.2021.2006647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to understand the effect of essential surgical design parameters on collateral and cruciate ligaments behavior for a Bone-Patellar-Tendon-Bone (BPTB) anterior cruciate ligament reconstruction (ACL-R) surgery. A parametric finite element model of biomechanical experiments depicting the ACL-R surgery associated with a global sensitivity analysis was adopted in this work. The model parameters were six intraoperative variables, two-quadrant coordinates of femoral tunnel placement, femoral tunnel sagittal and coronal angles, graft pretension, and the joint angle at which the BPTB graft is tensioned (fixation angle). Our results indicated that cruciate ligaments (posterior cruciate ligament (PCL) and graft) were mainly sensitive to graft pretension (23%), femoral tunnel sites (56%), and the angle at which the surgeon decided to fix the graft (14%). The collateral ligaments (medial and lateral) were also affected by the same set of surgical parameters as the cruciate ligaments except for graft pretension. The output data of this study may help to identify a better role for the ACL-R intraoperative variables in optimizing the knee joint ligaments' postsurgical functionality.
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Affiliation(s)
- Malek Adouni
- Physical Medicine and Rehabilitation Department, Northwestern University, Chicago, IL, USA.,Mechanical Engineering department, Australian College of Kuwait, Kuwait City, Kuwait
| | - Tanvir R Faisal
- Department of Mechanical Engineering, University of Louisiana at Lafayette, Lafayette, LA, USA
| | - Yasin Y Dhaher
- Physical Medicine and Rehabilitation Department, Northwestern University, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, University of Texas Southwest, Dallas, TX, USA.,Department of Orthopedic Surgery, University of Texas Southwest, Dallas, TX, USA.,Bioengineering, University of Texas Southwest, Dallas, TX, USA
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21
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Kim-Wang SY, Holt AG, McGowan AM, Danyluk ST, Goode AP, Lau BC, Toth AP, Wittstein JR, DeFrate LE, Yi JS, McNulty AL. Immune cell profiles in synovial fluid after anterior cruciate ligament and meniscus injuries. Arthritis Res Ther 2021; 23:280. [PMID: 34736523 PMCID: PMC8567695 DOI: 10.1186/s13075-021-02661-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/17/2021] [Indexed: 01/18/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) and meniscus tears are common knee injuries. Despite the high rate of post-traumatic osteoarthritis (PTOA) following these injuries, the contributing factors remain unclear. In this study, we characterized the immune cell profiles of normal and injured joints at the time of ACL and meniscal surgeries. Methods Twenty-nine patients (14 meniscus-injured and 15 ACL-injured) undergoing ACL and/or meniscus surgery but with a normal contralateral knee were recruited. During surgery, synovial fluid was aspirated from both normal and injured knees. Synovial fluid cells were pelleted, washed, and stained with an antibody cocktail consisting of fluorescent antibodies for cell surface proteins. Analysis of immune cells in the synovial fluid was performed by polychromatic flow cytometry. A broad spectrum immune cell panel was used in the first 10 subjects. Based on these results, a T cell-specific panel was used in the subsequent 19 subjects. Results Using the broad spectrum immune cell panel, we detected significantly more total viable cells and CD3 T cells in the injured compared to the paired normal knees. In addition, there were significantly more injured knees with T cells above a 500-cell threshold. Within the injured knees, CD4 and CD8 T cells were able to be differentiated into subsets. The frequency of total CD4 T cells was significantly different among injury types, but no statistical differences were detected among CD4 and CD8 T cell subsets by injury type. Conclusions Our findings provide foundational data showing that ACL and meniscus injuries induce an immune cell-rich microenvironment that consists primarily of T cells with multiple T helper phenotypes. Future studies investigating the relationship between immune cells and joint degeneration may provide an enhanced understanding of the pathophysiology of PTOA following joint injury.
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Affiliation(s)
- Sophia Y Kim-Wang
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.,Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Abigail G Holt
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Alyssa M McGowan
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Stephanie T Danyluk
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Adam P Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Alison P Toth
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Louis E DeFrate
- Department of Biomedical Engineering, Duke University, Durham, NC, USA. .,Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA. .,Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
| | - John S Yi
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Amy L McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.,Department of Pathology, Duke University School of Medicine, Durham, NC, USA
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22
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Murray MM. Optimizing outcomes of ACL surgery-Is autograft reconstruction the only reasonable option? J Orthop Res 2021; 39:1843-1850. [PMID: 34191344 PMCID: PMC8387392 DOI: 10.1002/jor.25128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) injuries occur at a high frequency in the United States with approximately 400,000 ACL reconstructions being performed each year. While ACL reconstruction is our current gold standard of treatment, it does not restore joint motion, or prevent the premature development of posttraumatic osteoarthritis (PTOA) in many patients. Thus, new treatments for an ACL injury, which are less invasive and minimize patient morbidity, including cartilage damage, are highly desirable. We have used a tissue-engineered approach to stimulate ligament healing, to improve upon current treatment options. In this review, we describe and discuss our work moving a tissue engineering strategy from the concept to bench, preclinical, clinical trials and ultimately FDA 510(k) de Novo approval, providing clinicians and patients with a viable alternative to ACL reconstruction.
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Affiliation(s)
- Martha M. Murray
- Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital Harvard Medical School Boston Massachusetts USA
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23
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Di Paolo S, Agostinone P, Grassi A, Lucidi GA, Pinelli E, Bontempi M, Marchiori G, Bragonzoni L, Zaffagnini S. Dynamic Radiostereometry Evaluation of 2 Different Anterior Cruciate Ligament Reconstruction Techniques During a Single-Leg Squat. Orthop J Sports Med 2021; 9:23259671211011940. [PMID: 34350300 PMCID: PMC8287361 DOI: 10.1177/23259671211011940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Lateral extra-articular tenodesis in the context of anterior cruciate
ligament (ACL) reconstruction (ACLR) is performed to better control
anterolateral knee instability in patients with high-grade preoperative
pivot shift. However, some authors believe these procedures may cause
lateral compartment overconstraint, affecting knee motion in daily life. Purpose/Hypothesis: The primary aim of the present study was to identify kinematic differences
during the execution of an activity under weightbearing conditions between
knees having undergone ACLR using anatomic single-bundle (SB) versus
single-bundle plus lateral plasty (SBLP) techniques. The secondary aim was
to compare the postoperative kinematic data with those from the same knees
before ACLR and from the healthy contralateral knees in order to investigate
if ACLR was able to restore physiologic knee biomechanics during squat
execution. The hypotheses were that (1) the SBLP technique would allow a
better restoration of internal-external (IE) knee rotation than would SB and
(2) regardless of the technique, ACLR would not fully restore physiologic
knee biomechanics. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: In total, 32 patients (42 knees) were included in the study. Patients were
asked to perform a single-leg squat before surgery (ACL-injured group, n =
32; healthy contralateral group, n = 10) and at minimum 18-month follow-up
after ACLR (SB group, n = 9; SBLP group, n = 18). Knee motion was determined
using a validated model-based tracking process that matched patient-specific
magnetic resonance imaging bone models to dynamic biplane radiographic
images under the principles of roentgen stereophotogrammetric analysis. Data
processing was performed using specific software. The authors compared IE
and varus-valgus rotations and anterior-posterior and medial-lateral
translations among the groups. Results: The mean follow-up period was 21.7 ± 4.5 months. No kinematic differences
were found between the SB and SBLP groups (P > .05). A
more medial tibial position (P < .05) of the ACL-injured
group was reported during the entire motor task and persisted after ACLR in
both the SB and the SBLP groups. Differences in IE and varus-valgus
rotations were found between the ACL-injured and healthy groups. Conclusion: There were no relevant kinematic differences between SBLP and anatomic SB
ACLR during the execution of a single-leg squat. Regardless of the surgical
technique, ACLR failed in restoring knee biomechanics. Registration: NCT02323386 (ClinicalTrials.gov
identifier).
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Affiliation(s)
- Stefano Di Paolo
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Piero Agostinone
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Alberto Grassi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Andrea Lucidi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erika Pinelli
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Marco Bontempi
- Scienze e Tecnologie chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gregorio Marchiori
- Scienze e Tecnologie chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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24
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Wang W, Tsai T, Tian F, Li J, Zhao Y, Zhu R, Li J, Liu Y, Wang S. High-speed fluoroscopic imaging for investigation of three-dimensional knee kinematics before and after marathon running. Gait Posture 2021; 88:231-237. [PMID: 34119778 DOI: 10.1016/j.gaitpost.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/11/2021] [Accepted: 06/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee injuries often occur during or shortly after marathon running, and are linked to altered knee kinematics. RESEARCH QUESTION The kinematics of healthy knees during pre- and post-marathon running have not been examined with high-speed fluoroscopy. This study aimed to evaluate the effects of marathon running on knee kinematics during walking and running by using a combined high-speed fluoroscopy and MRI technique. METHODS Ten healthy runners underwent knee MRI within 24 h before marathon running to construct three-dimensional (3D) knee models. Knee kinematics during treadmill walking and running were evaluated using high-speed fluoroscopy (200hz) within 24 h before and as soon as possible (within 5 h) after marathon running. All pre- and post-marathon measurements were compared. RESULTS (1) For post-marathon walking, posterior femoral translation increased 1.4 mm at initial contact (p = 0.015); proximal-distal distance of tibia and femur decreased 0.7 mm and 0.8 mm at initial contact and after contact, respectively (p = 0.039, p = 0.046); and valgus femur rotation increased 1.2° after contact (p = 0.027). (2) For post-marathon running, proximal-distal distance decreased 0.7 mm and 1.0 mm at initial contact and after contact (p = 0.011, p = 0.003) respectively; knee flexion decreased 4.3° before contact (p = 0.007); knee flexion increased 1.8° and 2.6° at initial contact and after contact, respectively (p = 0.038, p = 0.011); external femoral rotation increased 1.2° and 1.8° at initial contact and after contact, respectively (p = 0.012, p = 0.037). Valgus femoral rotation after contact increased 2.3° (p = 0.001). SIGNIFICANCE Post-marathon changes in valgus and external femoral rotation, knee flexion, posterior femoral translation, and proximal-distal distance may increase the risk of knee injury. This study provides information to better understand the response of the knee to marathon running.
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Affiliation(s)
- Wenjin Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - TsungYuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Fei Tian
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China; Department of Rehabilitation Medicine, Heping Hospital Affiliated to Changzhi Medical College, Shanxi, 046000, China
| | - Jixin Li
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yaqi Zhao
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Renkun Zhu
- China Basketball College, Beijing Sport University, Beijing, 100048, China
| | - Junjie Li
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yu Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, China.
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25
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Chiba D, Gale T, Nishida K, Suntaxi F, Lesniak BP, Fu FH, Anderst W, Musahl V. Lateral Extra-articular Tenodesis Contributes Little to Change In Vivo Kinematics After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial. Am J Sports Med 2021; 49:1803-1812. [PMID: 33872056 DOI: 10.1177/03635465211003298] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lateral extra-articular tenodesis (LET) in combination with anterior cruciate ligament (ACL) reconstruction (ACLR) has been proposed to improve residual rotatory knee instability in patients having ACL deficiency. PURPOSE/HYPOTHESIS The purpose was to compare the effects of isolated ACLR (iACLR) versus LET in combination with ACLR (ACLR+LET) on in vivo kinematics during downhill running. It was hypothesized that ACLR+LET would reduce the internal rotation of the reconstructed knee in comparison with iACLR. STUDY DESIGN Controlled laboratory study. METHODS A total of 18 patients with ACL deficiency were included. All participants were randomly assigned to receive ACLR+ LET or iACLR during surgery. Six months and 12 months after surgery, knee joint motion during downhill running was measured using dynamic biplane radiography and a validated registration process that matched patient-specific 3-dimensional bone models to synchronized biplane radiographs. Anterior tibial translation (ATT; positive value means "anterior translation") and tibial rotation (TR) relative to the femur were calculated for both knees. The side-to-side differences (SSDs) in kinematics were also calculated (operated knee-contralateral healthy knee). The SSD value was compared between ACLR+LET and iACLR groups using a Mann-Whitney U test. RESULTS At 6 months after surgery, the SSD of ATT in patients who had undergone ACLR+LET (-1.9 ± 2.0 mm) was significantly greater than that in patients who had undergone iACLR (0.9 ± 2.3 mm) at 0% of the gait cycle (foot strike) (P = .031). There was no difference in ATT 12 months after surgery. Regarding TR, there were no differences between ACLR+LET and iACLR at either 6 months (P value range, .161-.605) or 12 months (P value range, .083-.279) after surgery. CONCLUSION LET in combination with ACLR significantly reduced ATT at the instant of foot strike during downhill running at 6 months after surgery. However, this effect was not significant at 12 months after surgery. The addition of LET to ACLR had no effect on TR at both 6 and 12 months after surgery. CLINICAL RELEVANCE LET in combination with ACLR may stabilize sagittal knee motion during downhill running in the early postoperation phase, but according to this study, it has no effect on 12-month in vivo kinematics. REGISTRATION NCT02913404 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Daisuke Chiba
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.,Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tom Gale
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kyohei Nishida
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Felipe Suntaxi
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bryson P Lesniak
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William Anderst
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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26
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Chen J, Wang C, Xu C, Qiu J, Xu J, Tsai TY, Zhao J. Effects of Anterolateral Structure Augmentation on the In Vivo Kinematics of Anterior Cruciate Ligament-Reconstructed Knees. Am J Sports Med 2021; 49:656-666. [PMID: 33464924 DOI: 10.1177/0363546520981743] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Double-bundle anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-known treatment that restores the stability of ACL-deficient knees. However, some isolated ACL-reconstructed knees ultimately show rotatory laxity and develop osteoarthritis. Whether combined ACLR with anterolateral structure (ALS) augmentation (ALSA) can provide better improvement in the in vivo knee rotational kinematics remains unknown. HYPOTHESIS When compared with isolated double-bundle ACLR, combined double-bundle ACLR with ALSA can improve knee in vivo rotational kinematics and provide better restoration of knee kinematics. STUDY DESIGN Controlled laboratory study. METHODS Sixteen patients with unilateral ACL injury were randomly divided into 2 groups to receive either combined double-bundle ACLR and ALSA (ALSA group) or isolated double-bundle ACLR (ACLR group). All patients performed a single-leg lunge using the operative and nonoperative/contralateral legs under dual-fluoroscopic imaging system surveillance during a hospital visit at a minimum 1 year (12-13 months) of follow-up to assess the 6 degrees of freedom knee kinematics. Functional evaluation using the Lysholm and Marx rating scales and clinical examinations were also performed. RESULTS From full extension to approximately 90° of knee flexion at 5° intervals, the mean ± SD internal rotation of the reconstructed knees in the ALSA group (1.5°± 0.9°) was significantly smaller than that of the contralateral knees (8.2°± 1.9°; P = .008). The ALSA group knees also showed significantly (P = .045) more medial translation than the contralateral knees. In the ACLR group, the mean internal rotation of the reconstructed knee (6.0°± 2.1°) was significantly smaller than that of the contralateral knees (8.9°± 0.6°; P < .001). At full extension, the tibia was significantly more externally rotated than that of the contralateral legs (0.5°± 7.4° vs 7.6°± 3.4°, P = .049). CONCLUSION When compared with isolated double-bundle ACLR, double-bundle ACLR augmented with ALS reconstruction resulted in anterolateral rotatory overconstraint during the lunge motion. CLINICAL RELEVANCE Additional ALSA of double-bundle ACL-reconstructed knees overconstrained rotatory stability. Therefore, the use of ALSA for ACL-reconstructed knees should be considered with caution for patients with ACL deficiency and anterolateral rotatory instability. Longer-term follow-up to evaluate long-term outcomes and altered kinematics over time is recommended.
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Affiliation(s)
- Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Cong Wang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiayu Qiu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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27
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Agostinone P, Di Paolo S, Grassi A, Pinelli E, Bontempi M, Bragonzoni L, Zaffagnini S. ACL deficiency influences medio-lateral tibial alignment and knee varus-valgus during in vivo activities. Knee Surg Sports Traumatol Arthrosc 2021; 29:389-397. [PMID: 32253481 DOI: 10.1007/s00167-020-05979-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The role of the anterior cruciate ligament (ACL) in knee biomechanics in vivo and under weight-bearing is still unclear. The purpose of this study was to compare the tibiofemoral kinematics of ACL-deficient knees to healthy contralateral ones during the execution of weight-bearing activities. METHODS Eight patients with isolated ACL injury and healthy contralateral knees were included in the study. Patients were asked to perform a single step forward and a single leg squat first with the injured knee and then with the contralateral one. Knee motion was determined using a validated model-based tracking process that matched subject-specific MRI bone models to dynamic biplane radiographic images, under the principles of Roentgen stereophotogrammetric analysis (RSA). Data processing was performed in a specific software developed in Matlab. RESULTS Statistically significant differences (p < 0.05) were found for single leg squat along the frontal plane: ACL-deficient knees showed a more varus angle, especially at the highest knee flexion angles (40°-50° on average), compared to the contralateral knees. Furthermore, ACL-deficient knees showed tibial medialization along the entire task, while contralateral knees were always laterally aligned. This difference became statistically relevant (p < 0.05) for knee flexion angles included between 0° and about 30°. CONCLUSION ACL-deficient knees showed an abnormal tibial medialization and increased varus angle during single leg squat when compared to the contralateral knees. These biomechanical anomalies could cause a different force distribution on tibial plateau, explaining the higher risk of early osteoarthritis in ACL deficiency. The clinical relevance of this study is that also safe activities used in ACL rehabilitation protocols are significantly altered in ACL deficiency. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Piero Agostinone
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Via Giulio Cesare Pupilli, 1, 40136, Bologna, BO, Italy.
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erika Pinelli
- Dipartimento di Scienze per la Qualità della Vita QuVi, Università di Bologna, Bologna, Italy
| | - Marco Bontempi
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Laura Bragonzoni
- Dipartimento di Scienze per la Qualità della Vita QuVi, Università di Bologna, Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Via Giulio Cesare Pupilli, 1, 40136, Bologna, BO, Italy
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28
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Park S, Yoon S. Quantifying Coordination and Variability in the Lower Extremities after Anterior Cruciate Ligament Reconstruction. SENSORS 2021; 21:s21020652. [PMID: 33477847 PMCID: PMC7832890 DOI: 10.3390/s21020652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 01/13/2023]
Abstract
Patients experience various biomechanical changes following reconstruction for anterior cruciate ligament (ACL) injury. However, previous studies have focused on lower extremity joints as a single joint rather than simultaneous lower extremity movements. Therefore, this study aimed to determine the movement changes in the lower limb coordination patterns according to movement type following ACL reconstruction. Twenty-one post ACL reconstruction patients (AG) and an equal number of healthy adults (CG) participated in this study. They were asked to perform walking, running, and cutting maneuvers. The continuous relative phase and variability were calculated to examine the coordination pattern. During running and cutting at 30 and 60°, the AG demonstrated a lower in-phase hip–knee coordination pattern in the sagittal plane. The AG demonstrated low hip–knee variability in the sagittal plane during cutting at 60°. The low in-phase coordination pattern can burden the knee by generating unnatural movements following muscle contraction in the opposite direction. Based on the results, it would be useful to identify the problem and provide the fundamental evidence for the optimal timing of return-to-sport after ACL reconstruction (ACLR) rehabilitation, if the coordination variable is measured with various sensors promptly in the sports field to evaluate the coordination of human movement.
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29
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Tashman S, Zandiyeh P, Irrgang JJ, Musahl V, West RV, Shah N, Fu FH. Anatomic single- and double-bundle ACL reconstruction both restore dynamic knee function: a randomized clinical trial-part II: knee kinematics. Knee Surg Sports Traumatol Arthrosc 2021; 29:2676-2683. [PMID: 33615404 PMCID: PMC8298343 DOI: 10.1007/s00167-021-06479-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/25/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Compare side-to-side differences for knee kinematics between anatomic single-bundle (SB) and anatomic double-bundle (DB) ACLR during downhill running at 6 and 24 months post ACLR using high-accuracy dynamic stereo X-ray imaging. It was hypothesized that anatomic DB ACLR would better restore tibio-femoral kinematics compared to SB ACLR, based on comparison to the contralateral, uninjured knee. METHODS Active individuals between 14 and 50 years of age that presented within 12 months of injury were eligible to participate. Individuals with prior injury or surgery of either knee, greater than a grade 1 concomitant knee ligament injury, or ACL insertion sites less than 14 mm or greater than 18 mm were excluded. Subjects were randomized to undergo SB or DB ACLR with a 10 mm-wide quadriceps tendon autograft harvested with a patellar bone block and were followed for 24 months. Dynamic knee function was assessed during treadmill downhill running using a dynamic stereo X-ray tracking system at 6 and 24 months after surgery. Three-dimensional tibio-femoral kinematics were calculated and compared between limbs (ACLR and uninjured contralateral) at each time point. RESULTS Fifty-seven subjects were randomized (29 DB) and 2-year follow-up was attained from 51 (89.5%). No significant differences were found between SB and DB anatomic ACLR for any of the primary kinematic variables. CONCLUSIONS Contrary to the study hypothesis, double-bundle reconstruction did not show superior kinematic outcomes compared to the single-bundle ACLR. While neither procedure fully restored normal knee kinematics, both anatomic reconstructions were similarly effective for restoring near-normal dynamic knee function. The findings of this study indicate both SB and DB techniques can be used for patients with average size ACL insertion sites. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
| | | | - James J. Irrgang
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA USA ,Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213 USA
| | | | | | - Neha Shah
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213 USA
| | - Freddie H. Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213 USA
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30
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Anandan V, Goh TC, Zamri KS. Single-Bundle Versus Double-Bundle Arthroscopic Anterior Cruciate Ligament Reconstruction: Comparison of Long-Term Functional Outcomes. Cureus 2020; 12:e12243. [PMID: 33500862 PMCID: PMC7819458 DOI: 10.7759/cureus.12243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To compare long-term functional results of ACL reconstruction with a single bundle (SB) and double bundle (DB). Methods Sixty patients who underwent ACL reconstructions from January 2007 to December 2008 were retrospectively evaluated (30 SB and 30 DB ACL reconstructions). Clinical and functional outcomes were measured pre- and postoperatively in terms of anterior drawer test, Lachman’s test, pivot shift test, KT1000 side-to-side difference, range of motion, International Knee Documentation Committee Scoring, Lysholm knee scoring scale (LKS), and Tegner activity level scale. The period of follow-up was 10 years. Results Clinical outcome measured showed that anterior drawer test result were equally normal for both groups (93.3%; p > 0.995); however, the Lachman test was 76.7% in the DB group and 56.7% in the SB group (p > 0.100), the pivot shift was 83% in the DB group and 50% in the SB group (p < 0.001), and KT1000 was 76.7% in the DB group and 56.7% in the SB group (p > 0.100). Regarding the functional outcome, it favored the DB group of patients, with the LKS being statistically significant (p < 0.007) and the Tegner activity level scale p-value being <0.001 Conclusions DB ACL reconstruction produces better rotational stability and gives superior functional outcome in terms of return to pre-injury activity level in comparison to SB reconstruction. DB ACL reconstruction using hamstring tendon autograft produces better functional results at 10 years follow-up.
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Affiliation(s)
- Vicknesh Anandan
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Teik Chiang Goh
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Kamarul Syariza Zamri
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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Lee J, Pathak P, Panday SB, Moon J. Effect of Foot-Planting Strategy on Anterior Cruciate Ligament Loading in Women During a Direction Diversion Maneuver: A Musculoskeletal Modeling Approach. Orthop J Sports Med 2020; 8:2325967120963180. [PMID: 33283003 PMCID: PMC7686614 DOI: 10.1177/2325967120963180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/03/2020] [Indexed: 11/15/2022] Open
Abstract
Background Although there is a higher prevalence of noncontact anterior cruciate ligament (ACL) injuries during a direction diversion maneuver (DDM), no previous studies have reported how foot-planting strategies affect ACL loading. Purpose To investigate the effect of foot-planting strategies on ACL loading in women during a DDM task using a musculoskeletal modeling approach. Study Design Descriptive laboratory study. Methods A total of 13 female participants performed a DDM task, which involved running at 4.5 ± 0.2 m/s and turning left at 35° to 55° under a foot-planting strategy in 3 directions: neutral, toe-in, and toe-out. Kinematic and kinetic data were measured with the use of a 3-dimensional motion capture system and force platform to calculate variables such as joint angle, shear force, and moment. Anterior ACL and posterior ACL forces were extracted using musculoskeletal modeling. Results The peak anterior ACL force was significantly larger for the toe-out condition (31.29 ± 4.02 N/body weight [BW]) compared with the toe-in condition (25.43 ± 5.68 N/BW) (P = .047), with no significant difference in the neutral condition. The toe-out condition had a higher knee valgus angle (2.98° ± 4.20°; P = .041), knee shear force (10.20 ± 1.69 N/BW; P = .009), and knee internal rotation moment (-0.18 ± 0.16 N·m/BW×height; P = .012) than the toe-in and neutral conditions. Conclusion Through musculoskeletal modeling, we were able to conclude that the toe-out condition during the DDM might result in a higher risk of ACL injuries. Athletes and sports practitioners should avoid the toe-out foot-planting strategy when participating in a sporting activity. Clinical Relevance Based on these findings, medical professionals and athletic coaches can gain knowledge on how foot-planting strategy affects ACL loading. Understanding the actual cause of an ACL injury can be useful for designing preventive training programs or strategies to decrease the risk of such injuries.
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Affiliation(s)
- Jusung Lee
- Department of Sport Science, Kangwon National University, Chuncheon, Republic of Korea
| | - Prabhat Pathak
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
| | - Siddhartha Bikram Panday
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea.,Department of Sport and Leisure Studies, Keimyung University, Daegu, Republic of Korea
| | - Jeheon Moon
- Department of Physical Education, Korea National University of Education, Cheongju, Republic of Korea.,Department of Sport Science, Korea Institute of Sport Science, Seoul, Republic of Korea
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Gale T, Anderst W. Tibiofemoral helical axis of motion during the full gait cycle measured using biplane radiography. Med Eng Phys 2020; 86:65-70. [PMID: 33261735 DOI: 10.1016/j.medengphy.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/03/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
The helical axis of motion (HAM), which describes the simultaneous multiplanar translations and rotations that occur within a joint, has been proposed as a single measure to characterize dynamic joint function. The objective of this study was to determine the tibiofemoral HAM during 5 discrete phases of gait. Thirty-nine knees from 20 healthy adults were imaged using high-speed biplane radiography during treadmill walking. The primary outcome measures were the intersection of the HAM with the sagittal plane of the femur, and the direction of the HAM. The intersection point translated an average of 12.7 ± 5.5% of femur condyle depth in the anterior-posterior direction and 28.6 ± 13.3% of femur condyle height in the proximal-distal direction during gait. The anterior/posterior and proximal/distal components of the HAM vector were greater during stance (5.6°±3.8° and 11.1°±5.0°, respectively) than during swing (2.0°±1.1° and 6.4°±3.8°, respectively) (p<0.001) reflecting greater coupled rotations during stance. No significant side-to-side differences in intersection point location or HAM orientation were found during any of the 5 phases of gait (max difference 4.1 ± 3.4% of femur condyle depth and 13.1 ± 16.7% of femur condyle height; 12.7°±12.3° proximal/distal and 4.2°±4.5° anterior/posterior direction). Loading significantly affected HAM location and orientation (p<0.001). Knowledge of healthy knee HAM and typical side-to-side differences during gait can serve as a baseline for evaluating knee motion after clinical interventions.
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Affiliation(s)
- Tom Gale
- Biodynamics Lab, Department of Orthopaedic Surgery, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203, USA.
| | - William Anderst
- Biodynamics Lab, Department of Orthopaedic Surgery, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203, USA
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Techniques for In Vivo Measurement of Ligament and Tendon Strain: A Review. Ann Biomed Eng 2020; 49:7-28. [PMID: 33025317 PMCID: PMC7773624 DOI: 10.1007/s10439-020-02635-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022]
Abstract
The critical clinical and scientific insights achieved through knowledge of in vivo musculoskeletal soft tissue strains has motivated the development of relevant measurement techniques. This review provides a comprehensive summary of the key findings, limitations, and clinical impacts of these techniques to quantify musculoskeletal soft tissue strains during dynamic movements. Current technologies generally leverage three techniques to quantify in vivo strain patterns, including implantable strain sensors, virtual fibre elongation, and ultrasound. (1) Implantable strain sensors enable direct measurements of tissue strains with high accuracy and minimal artefact, but are highly invasive and current designs are not clinically viable. (2) The virtual fibre elongation method tracks the relative displacement of tissue attachments to measure strains in both deep and superficial tissues. However, the associated imaging techniques often require exposure to radiation, limit the activities that can be performed, and only quantify bone-to-bone tissue strains. (3) Ultrasound methods enable safe and non-invasive imaging of soft tissue deformation. However, ultrasound can only image superficial tissues, and measurements are confounded by out-of-plane tissue motion. Finally, all in vivo strain measurement methods are limited in their ability to establish the slack length of musculoskeletal soft tissue structures. Despite the many challenges and limitations of these measurement techniques, knowledge of in vivo soft tissue strain has led to improved clinical treatments for many musculoskeletal pathologies including anterior cruciate ligament reconstruction, Achilles tendon repair, and total knee replacement. This review provides a comprehensive understanding of these measurement techniques and identifies the key features of in vivo strain measurement that can facilitate innovative personalized sports medicine treatment.
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Fazlali H, Sadeghi H, Sadeghi S, Ojaghi M, Allard P. Comparison of four methods for determining the cut-off frequency of accelerometer signals in able-bodied individuals and ACL ruptured subjects. Gait Posture 2020; 80:217-222. [PMID: 32540777 DOI: 10.1016/j.gaitpost.2020.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Selecting the appropriate cut-off frequency to filter triaxial accelerometric data is a challenging issue in gait analyses. It reduces soft tissues artifacts and the variability in the kinematic data waveform from able-bodied and physically impaired gaits. RESEARCH QUESTION Are cut-off frequencies estimated by four filtering methods similar along each axis of a triaxial accelerometer and for able-bodied subjects and those with an anterior cruciate ligament rupture (ACLR)? METHODS After walking on a treadmill, the cut-off frequency for the tibial accelerations was calculated using 95 and 99 per cent of the energy spectrum (E), residual analysis (RA) and, the method (Yu) proposed by Yu et al. [1]. The coefficient of variation was used to express the variability of the cut-off frequencies estimated by the four methods. t-Test and repeated measure ANOVA were applied to examine the effects of healthiness and acceleration axis on cut-off frequencies. RESULTS On average, E95 and E99 gave the lowest and the highest cut-off frequencies respectively. The results demonstrated the effect of ACL injury and axes on the cut-off frequencies, especially on the RA method. There was a significant difference in the cut-off frequencies between healthy and ACLR subjects for the vertical axis with the RA method and for the anterior-posterior (AP) axis with the Yu method. Similar cut-off frequencies were obtained for all axes with the E99 method for within groups' comparison. The E95 and E99 methods gave the least and most variable outputs respectively. Significant within group differences between cut off frequencies calculated by four methods, led to disappearing peaks in the more fluctuating portion of the acceleration data. SIGNIFICANCE A single cut-off frequency is not recommended for all individuals and axes. In cases where a single cut-off frequency is necessary for all individuals or axes, RA or E99 methods are suggested respectively.
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Affiliation(s)
- Hesam Fazlali
- Kinesiology Research Center, Kharazmi University, Tehran, Iran.
| | - Heydar Sadeghi
- Kinesiology Research Center, Kharazmi University, Tehran, Iran; Department of Physical Education and Sport Science, Kharazmi University, Tehran, Iran.
| | - Saba Sadeghi
- Faculty of Arts & Science, University of Toronto, Toronto, Canada.
| | - Mojtaba Ojaghi
- Member of Rehabilitation Center of Sports Medicine Federation of Iran, Tehran, Iran.
| | - Paul Allard
- School of Kinesiology, Faculty of Medicine, Univesity of Montreal, Montreal, Canada.
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Sritharan P, Schache AG, Culvenor AG, Perraton LG, Bryant AL, Crossley KM. Between-Limb Differences in Patellofemoral Joint Forces During Running at 12 to 24 Months After Unilateral Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2020; 48:1711-1719. [PMID: 32374673 DOI: 10.1177/0363546520914628] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral joint (PFJ) osteoarthritis may occur after anterior cruciate ligament reconstruction (ACLR). The mechanisms underpinning the development of PFJ osteoarthritis are not known but may relate to altered PFJ loading. Few studies have assessed PFJ loads during high-impact tasks, such as running, beyond the acute rehabilitation phase (ie, >12 months) after ACLR. PURPOSE/HYPOTHESIS The purpose was to compare between-limb joint angles, joint moments, and PFJ contact force during running in individuals at 12 to 24 months after unilateral ACLR. We hypothesized that peak knee flexion angle, knee extension moment, and PFJ contact force during stance would be lower in the ACLR limb compared with the uninjured limb. STUDY DESIGN Controlled laboratory study. METHODS A total of 55 participants (mean ± SD age, 28 ± 7 years), 12 to 24 months after ACLR, ran at a self-selected speed (2.9 ± 0.3 m/s). Measured kinematics and ground-reaction forces were input into musculoskeletal models to calculate joint moments and muscle forces. These values were subsequently input into a PFJ model to calculate contact force peak and impulse. Outcome measures were compared between the ACLR and uninjured limbs. RESULTS In the ACLR limb, compared with the uninjured limb, the PFJ contact force displayed a lower peak (ACLR, 6.1 ± 1.3 body weight [BW]; uninjured, 6.7 ± 1.4 BW; P < .001) and impulse (ACLR, 0.72 ± 0.17 BW*seconds [BWs]; uninjured, 0.81 ± 0.17 BWs; P < .001). At the time of the peak PFJ contact force, the knee extension moment was lower in the ACLR limb (ACLR, 14.0 ± 2.4 %BW*height [%BW*HT]; uninjured, 15.5 ± 2.5 %BW*HT; P < .001). The opposite was true for the ankle plantarflexion moment (ACLR, 12.1 ± 2.6 %BW*HT; uninjured, 11.5 ± 2.7 %BW*HT; P = .019) and the hip extension moment (ACLR, 2.3 ± 2.5 %BW*HT; uninjured, 1.6 ± 2.3 %BW*HT; P = .013). The foot-ground center of pressure was located more anteriorly with respect to the ankle joint center (ACLR, 5.8 ± 0.9 %height [%HT]; uninjured, 5.4 ± 1.0 %HT; P = .001). No differences were found for the sagittal plane hip, knee, and ankle angles. CONCLUSION The ACLR limb experienced lower peak PFJ loads during running, explained by a small anterior shift in the foot-ground center of pressure during stance that offloaded the torque demand away from the ACLR knee. CLINICAL RELEVANCE Lower net PFJ loading during running in the ACLR limb more than 12 months after ACLR suggests that underloading might play a role in the onset of PFJ osteoarthritis after ACLR.
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Affiliation(s)
| | | | - Adam G Culvenor
- School of Allied Health, La Trobe University, Victoria, Australia
| | - Luke G Perraton
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Adam L Bryant
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Victoria, Australia
| | - Kay M Crossley
- School of Allied Health, La Trobe University, Victoria, Australia
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Effect of rocker-sole footwear on knee joint biomechanics while walking in people with ACL-reconstructed knees: a cross-sectional biomechanical study. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dutt S, Kumar V. A comparative study of anatomical single-bundle anterior cruciate ligament reconstruction using femoral offset aimer versus freehand technique for femoral tunnel preparation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:493-499. [PMID: 31734760 DOI: 10.1007/s00590-019-02595-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND ACL reconstruction is one of the commonest orthopaedic procedures performed. There has been a shift in techniques from single bundle to double bundle to anatomic single-bundle reconstruction and also from transtibial to anteromedial method. Anteromedial technique results in more anatomic femoral tunnel with graft positioned at the native insertion site. The tunnel position is crucial for better outcome after ACL reconstruction. PURPOSE To compare the femoral tunnel position made by anatomic single-bundle ACL reconstruction using femoral offset aimer device versus freehand drilling with 3D computed tomography. STUDY DESIGN A prospective case series involving 60 patients with ACL tear who underwent anteromedial single-bundle ACL reconstruction. METHODS Computed tomography scans were performed on 60 knees that underwent single-bundle anteromedial ACL reconstruction with 30 cases involving femoral drilling through aimer device and another 30 cases involving freehand drilling of the tunnel. Three-dimensional models were created, and the data were analysed according to the co-ordinate axes method. Femoral tunnel position was measured in proximal-to-distal and posterior-to-anterior directions. Data from both the groups were compared with each other and already published reference data on anatomical tunnel position. RESULTS In the aimer group, the femoral tunnel centre on the medial wall of lateral femoral condyle was located at 35 ± 9% in the posterior-to-anterior direction and at 30 ± 12% in the proximal-to-distal direction. In the freehand group, tunnel was placed at 37 ± 10% in posterior-to-anterior and 28 ± 7% in proximal-to-distal directions. There was no significant difference in tunnel position in both the groups. CONCLUSION This study shows there is no significant difference between both the drilling techniques of femoral tunnel, i.e. freehand drilling and drilling with aimer device. Also, it reiterates the efficacy and utility of computed tomography and three-dimensional reconstruction in the analysis of femoral tunnel in ACL reconstruction.
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Affiliation(s)
- Saurabh Dutt
- Sports Injury Centre, Vardhman Mahaveer Medical College and Safdarjung Hospital, Delhi, New Delhi, India.
| | - Vinod Kumar
- Maulana Azad Medical College, Delhi, New Delhi, India
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Hosseini Nasab SH, Smith CR, Schütz P, Postolka B, List R, Taylor WR. Elongation Patterns of the Collateral Ligaments After Total Knee Arthroplasty Are Dominated by the Knee Flexion Angle. Front Bioeng Biotechnol 2019; 7:323. [PMID: 31799245 PMCID: PMC6861521 DOI: 10.3389/fbioe.2019.00323] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/28/2019] [Indexed: 11/13/2022] Open
Abstract
The primary aim of this study was to assess the effects of total knee arthroplasty (TKA) implant design on collateral ligament elongation patterns that occur during level walking, downhill walking, and stair descent. Using a moving fluoroscope, tibiofemoral kinematics were captured in three groups of patients with different TKA implant designs, including posterior stabilized, medial stabilized, and ultra-congruent. The 3D in vivo joint kinematics were then fed into multibody models of the replaced knees and elongation patterns of virtual bundles connecting origin and insertion points of the medial and lateral collateral ligaments (MCL and LCL) were determined throughout complete cycles of all activities. Regardless of the implant design and activity type, non-isometric behavior of the collateral ligaments was observed. The LCL shortened with increasing knee flexion, while the MCL elongation demonstrated regional variability, ranging from lengthening of the anterior bundle to slackening of the posterior bundle. The implant component design did not demonstrate statistically significant effects on the collateral elongation patterns and this was consistent between the studied activities. This study revealed that post-TKA collateral ligament elongation is primarily determined by the knee flexion angle. The different anterior translation and internal rotation that were induced by three distinctive implant designs had minimal impact on the length change patterns of the collateral ligaments.
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Affiliation(s)
| | - Colin R Smith
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Pascal Schütz
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Barbara Postolka
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Renate List
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - William R Taylor
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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Zhang Q, Yang Y, Li J, Zhang H, Fu Y, Wang Y. Functional double-bundle anterior cruciate ligament reconstruction using hamstring tendon autografts with preserved insertions is an effective treatment for tibiofemoral instability. Knee Surg Sports Traumatol Arthrosc 2019; 27:3471-3480. [PMID: 30796489 DOI: 10.1007/s00167-019-05401-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 02/06/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to introduce a modified anatomical anterior cruciate ligament reconstruction using functional double bundles (F-DBACLR), which achieved sequential tensioning at all flexion angles postoperatively, and compare its clinical outcomes with the anatomical single-bundle technique (A-SBACLR). METHODS A total of 156 patients with an ACL injury underwent ACLR (A-SB group, n = 78; F-DB group, n = 78). All operations were performed by anatomically identifying the ACL footprints and fixing the graft at a pre-determined degree of knee flexion. Two observers blinded to the patient identities examined the patients preoperatively and during follow-up (median 28.2 months; range 26-31 months). Multiple subjective and objective clinical evaluation tests and assessment of clinical outcomes concerning the translational and rotational stability of the knee including the International Knee Documentation Committee (IKDC) questionnaire, Lysholm Knee Scoring Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale, KT-1000 laxity measurements, Lachman test and pivot-shift test were performed preoperatively and postoperatively. RESULTS Preoperatively, no differences were found between the two groups. During the 2-year observation period, patients in the F-DB group revealed better clinical outcomes in terms of the Tegner Activity Scale Score, IKDC, KOOS and Lysholm Knee Scoring Scale. Similar results were shown in regard to the translational stability in both groups, while the F-DB group had more rotational stability at 2 years of follow-up. CONCLUSIONS The clinical outcomes indicated that F-DBACLR is clinically practicable and advantageous in the treatment of the ACL-deficient knee. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Qiang Zhang
- Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
- Department of Orthopaedic Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, UK.
| | - Yimeng Yang
- Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, 28 Fuxing Road, Haidian District, Beijing, 100853, China
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Ji Li
- Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hao Zhang
- Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yangmu Fu
- Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yan Wang
- Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Englander ZA, Garrett WE, Spritzer CE, DeFrate LE. In vivo attachment site to attachment site length and strain of the ACL and its bundles during the full gait cycle measured by MRI and high-speed biplanar radiography. J Biomech 2019; 98:109443. [PMID: 31679755 DOI: 10.1016/j.jbiomech.2019.109443] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to measure in vivo attachment site to attachment site lengths and strains of the anterior cruciate ligament (ACL) and its bundles throughout a full cycle of treadmill gait. To obtain these measurements, models of the femur, tibia, and associated ACL attachment sites were created from magnetic resonance (MR) images in 10 healthy subjects. ACL attachment sites were subdivided into anteromedial (AM) and posterolateral (PL) bundles. High-speed biplanar radiographs were obtained as subjects ambulated at 1 m/s. The bone models were registered to the radiographs, thereby reproducing the in vivo positions of the bones and ACL attachment sites throughout gait. The lengths of the ACL and both bundles were estimated as straight line distances between attachment sites for each knee position. Increased attachment to attachment ACL length and strain were observed during midstance (length = 28.5 ± 2.6 mm, strain = 5 ± 4%, mean ± standard deviation), and heel strike (length = 30.5 ± 3.0 mm, strain = 12 ± 5%) when the knee was positioned at low flexion angles. Significant inverse correlations were observed between mean attachment to attachment ACL lengths and flexion (rho = -0.87, p < 0.001), as well as both bundle lengths and flexion (rho = -0.86, p < 0.001 and rho = -0.82, p < 0.001, respectively). AM and PL bundle attachment to attachment lengths were highly correlated throughout treadmill gait (rho = 0.90, p < 0.001). These data can provide valuable information to inform design criteria for ACL grafts used in reconstructive surgery, and may be useful in the design of rehabilitation and injury prevention protocols.
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Affiliation(s)
- Zoë A Englander
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | | | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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Grassi A, Signorelli C, Lucidi GA, Raggi F, Macchiarola L, Roberti Di Sarsina T, Marcheggiani Muccioli GM, Filardo G, Zaffagnini S. ACL reconstruction with lateral plasty reduces translational and rotatory laxity compared to anatomical single bundle and non-anatomical double bundle surgery: An in vivo kinematic evaluation with navigation system. Clin Biomech (Bristol, Avon) 2019; 69:1-8. [PMID: 31260843 DOI: 10.1016/j.clinbiomech.2019.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/24/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Significantly better stability may be achieved with a Single Bundle Lateral Plasty (SBLP) reconstruction compared with the Single Bundle (SB) and Double Bundle (DB) procedures. METHODS The study included 42 patients who underwent ACL reconstruction. Patients were randomly selected for one of the following surgical procedure defining three study groups: Single-Bundle-Lateral-Plasty, Single-Bundle and Double-Bundle procedures. Laxity evaluation was performed with an intraoperative navigation system. Lachman test (AP30), Drawer test (AP90), Varus-Valgus stress test at 0° and 30° knee flexion (VV0, VV30), Internal-External rotation (IE30, IE90), and pivot shift (PS) test are the clinical test executed for the laxity evaluation. Laxity reduction was defined as the difference between laxity before the fixation of the graft used for the reconstruction and the laxity just after its fixation. FINDINGS For all the analyzed surgical techniques, the pre-reconstruction laxity values were statistically higher (P < 0.05) than the post-reconstruction values for all the analyzed tests. The analysis of the Drawer test and Internal-External rotation at 30° and 90° of knee flexion, highlighted a significant difference at time zero after surgery among the three study groups. The results showed that the SBLP technique had the highest reduction values compared to SB (PIE90 = 0.001) and DB (PAP90 = 0.012; PIE30 = 0.021; PIE90 = 0.003) techniques. INTERPRETATION SBLP technique showed significantly superior results in terms of antero-posterior and internal-external laxity reduction at time-zero after ACL reconstruction.
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Affiliation(s)
- Alberto Grassi
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy; IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Via Foscolo 7, 40123 Bologna, BO, Italy.
| | - Cecilia Signorelli
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy.
| | - Gian Andrea Lucidi
- IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy.
| | - Federico Raggi
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy; IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Via Foscolo 7, 40123 Bologna, BO, Italy
| | - Luca Macchiarola
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy; IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Via Foscolo 7, 40123 Bologna, BO, Italy
| | - Tommaso Roberti Di Sarsina
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy; IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Via Foscolo 7, 40123 Bologna, BO, Italy
| | - Giulio Maria Marcheggiani Muccioli
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy; IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Via Foscolo 7, 40123 Bologna, BO, Italy
| | - Giuseppe Filardo
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di NanoBiotecnologie (NaBi), Via Di Barbiano 1/10, 40136 Bologna, BO, Italy.
| | - Stefano Zaffagnini
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Via Di Barbiano 1/10, 40136 Bologna, BO, Italy; IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Via Pupilli 1, 40136 Bologna, BO, Italy; Università di Bologna, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Via Foscolo 7, 40123 Bologna, BO, Italy.
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Nagai K, Gale T, Chiba D, Su F, Fu FH, Anderst W. The Complex Relationship Between In Vivo ACL Elongation and Knee Kinematics During Walking and Running. J Orthop Res 2019; 37:1920-1928. [PMID: 31042309 PMCID: PMC6719793 DOI: 10.1002/jor.24330] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/23/2019] [Indexed: 02/04/2023]
Abstract
In vivo anterior cruciate ligament (ACL) bundle (anteromedial bundle [AMB] and posterolateral bundle [PLB]) relative elongation during walking and running remain unknown. In this study, we aimed to investigate in vivo ACL relative elongation over the full gait cycle during walking and running. Ten healthy volunteers walked and ran at a self-selected pace on an instrumented treadmill while biplane radiographs of the knee were acquired at 100 Hz (walking) and 150 Hz (running). Tibiofemoral kinematics were determined using a validated model-based tracking process. The boundaries of ACL insertions were identified using high-resolution magnetic resonance imaging (MRI). The AMB and PLB centroid-to-centroid distances were calculated from the tracked bone motions, and these bundle lengths were normalized to their respective lengths on MRI to calculate relative elongation. Maximum AMB relative elongation during running (6.7 ± 2.1%) was significantly greater than walking (5.0 ± 1.7%, p = 0.043), whereas the maximum PLB relative elongation during running (1.1 ± 2.1%) was significantly smaller than walking (3.4 ± 2.3%, p = 0.014). During running, the maximum AMB relative elongation was significantly greater than the maximum PLB relative elongation (p < 0.001). ACL relative elongations were correlated with tibiofemoral six degree-of-freedom kinematics. The AMB and PLB demonstrate similar elongation patterns but different amounts of relative elongation during walking and running. The complex relationship observed between ACL relative elongation and knee kinematics indicates that ACL relative elongation is impacted by tibiofemoral kinematic parameters in addition to flexion/extension. These findings suggest that ACL strain is region-specific during walking and running. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1920-1928, 2019.
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Affiliation(s)
- Kanto Nagai
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tom Gale
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Favian Su
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie H. Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William Anderst
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ithurburn MP, Paterno MV, Thomas S, Pennell ML, Evans KD, Magnussen RA, Schmitt LC. Change in Drop-Landing Mechanics Over 2 Years in Young Athletes After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:2608-2616. [PMID: 31373856 DOI: 10.1177/0363546519864688] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While between-limb landing asymmetries after anterior cruciate ligament reconstruction (ACLR) are linked with poor function and risk of additional injury, it is not currently understood how landing symmetry changes over time after ACLR. PURPOSE/HYPOTHESIS The purpose was to investigate how double-legged drop vertical jump (DVJ) landing and single-legged drop-landing symmetry changed from the time of return-to-sport (RTS) clearance to 2 years later in a prospective cohort of young athletes after ACLR. It was hypothesized that double-legged DVJ landing and single-legged drop-landing symmetry would improve from the time of RTS to 2 years later. STUDY DESIGN Descriptive laboratory study. METHODS The authors followed 64 young athletes with primary, unilateral ACLR for 2 years after RTS clearance. At the time of RTS and 2 years later, between-limb symmetry values for biomechanical variables of interest (VOIs) were calculated with 3-dimensional motion analysis during double-legged DVJ and single-legged drop-landing tasks. VOIs included knee flexion excursion, peak internal knee extension moment, peak vertical ground-reaction force, and peak trunk flexion (for single-legged task only). Symmetry values and proportions of participants meeting 90% symmetry cutoffs were compared between time points. RESULTS For double-legged DVJ landing, symmetry values for all VOIs and the proportions meeting 90% cutoffs for peak internal knee extension moment and peak vertical ground-reaction force were higher at 2 years after RTS as compared with RTS. For single-legged drop-landing, symmetry values were higher for knee flexion excursion and lower for peak trunk flexion at 2 years after RTS as compared with RTS, but the proportions meeting 90% cutoffs for all VOIs did not differ between time points. CONCLUSION Double-legged DVJ landing symmetry improved across VOIs over the 2 years after RTS following ACLR, while single-legged drop-landing did not improve as consistently. The implications of longitudinal landing asymmetry after ACLR should be further studied.
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Affiliation(s)
- Matthew P Ithurburn
- Department of Physical Therapy and Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mark V Paterno
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Staci Thomas
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michael L Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Kevin D Evans
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Robert A Magnussen
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Laura C Schmitt
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Division of Physical Therapy, The Ohio State University, Columbus, Ohio, USA
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44
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Pairot-de-Fontenay B, Willy RW, Elias ARC, Mizner RL, Dubé MO, Roy JS. Running Biomechanics in Individuals with Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Med 2019; 49:1411-1424. [DOI: 10.1007/s40279-019-01120-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Tanabe Y, Yasuda K, Kondo E, Kawaguchi Y, Akita K, Yagi T. Comparison of Graft Length Changes During Knee Motion Among 5 Different Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction Approaches: A Biomechanical Study. Orthop J Sports Med 2019; 7:2325967119834933. [PMID: 30937322 PMCID: PMC6435881 DOI: 10.1177/2325967119834933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: In several anatomic single-bundle anterior cruciate ligament (ACL) reconstruction (ASB-ACLR) procedures, the femoral and tibial tunnel apertures are created at different locations within the native ACL attachment area. Hypothesis: Graft length changes during knee motion will be different among ASB-ACLR procedures with different femoral and tibial tunnel aperture locations. Study Design: Controlled laboratory study. Methods: A total of 12 cadaveric knees were used in this study. In each knee, 4 and 3 thin tunnels were created within the ACL attachment area on the femur and the tibia, respectively. Using 1 of 5 different combinations of femoral and tibial tunnel aperture location, 5 ASB-ACLRs were performed on each knee. In each reconstruction approach, a strong thread was used in place of the tendon graft, and the tibial graft end was tethered to a custom-made isometric positioner at 0° of knee flexion, with an approximately 12-N load applied to the thread. Then, each specimen underwent 5 cycles of knee flexion-extension motion in a range between 0° and 120°, and graft length changes were determined for each SB-ACLR approach. Results: The length changes of the graft were significantly different among the 5 ASB-ACLRs. The maximum length change values of the 3 grafts that were implanted between the femoral and tibial centers of the posterolateral bundle attachments or implanted into the femoral tunnel created at the center of the fanlike extension fiber attachment were significantly greater than those of the graft implanted between the centers of the anteromedial bundle attachments (P < .0001) and of the graft implanted between the centers of the whole ACL attachments (P < .0001). Conclusion: The length changes of the graft during knee motion were significantly different among the 5 ASB-ACLR approaches, even though all of the tunnel apertures were created within the femoral and tibial attachments of the native ACL. Clinical Relevance: The grafts in the first 3 graft locations may be so relaxed during knee flexion that they cannot resist anterior drawer loads exerted on the tibia.
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Affiliation(s)
- Yoshie Tanabe
- Department of Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of Physical Therapy, Hokkaido Bunkyo University Graduate School of Rehabilitation Science, Eniwa, Japan
| | - Kazunori Yasuda
- Department of Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Knee Research Center, Yagi Orthopaedic Hospital, Sapporo, Japan
| | - Eiji Kondo
- Department of Advanced Therapeutic Research for Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yasuyuki Kawaguchi
- Department of Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomonori Yagi
- Knee Research Center, Yagi Orthopaedic Hospital, Sapporo, Japan
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46
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Gagliardi AG, Carry PM, Parikh HB, Traver JL, Howell DR, Albright JC. ACL Repair With Suture Ligament Augmentation Is Associated With a High Failure Rate Among Adolescent Patients. Am J Sports Med 2019; 47:560-566. [PMID: 30730755 DOI: 10.1177/0363546518825255] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The anterior cruciate ligament (ACL) repair technique avoids graft harvest and therefore the risk of donor site morbidity. However, early failure rates after ACL repair with suture ligament augmentation (SLA) remain high. PURPOSE To compare surgical failure, functional outcomes, return to sport, and joint laxity between adolescents who underwent ACL repair with SLA and those who underwent ACL reconstruction with quadriceps tendon-patellar bone autograft (QPA). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Adolescent patients (7-18 years old) underwent ACL repair with SLA or ACL reconstruction with QPA. The authors collected data from those who had postoperative information pertaining to repaired ligament or graft failure, range of motion, complications, and return to sport at a minimum of 6 months after surgery. Participants were contacted after surgery to complete study questionnaires. RESULTS The cohort included 22 consecutive patients in the SLA group and 157 in the QPA group. The median duration of follow-up was 2.7 years (interquartile range, 2.0-3.6 years) in the QPA group and 3.2 years (2.2-3.4 years) in the SLA group. After adjustment for sex, age, body mass index, and time from injury to surgery, the hazard of graft failure in the SLA group was 10.66 times (95% CI, 3.41-32.92; P < .0001) that of the QPA group. The cumulative incidence of graft failure in the first 3 years after surgery was 48.8% (95% CI, 28.9%-73.1%) in the SLA group, as opposed to 4.7% (2.1%-10.3%) in the QPA group. There was no difference in return to sport between the groups. Among individuals who did not rerupture their ACL, International Knee Documentation Committee and Lysholm scores were comparable between the groups, as well as range of motion. CONCLUSION The risk of failure was significantly increased in the SLA group relative to the QPA group. The high risk of failure for the SLA group in this short-term follow-up should be considered when selecting the treatment for adolescent patients with an ACL injury.
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Affiliation(s)
| | | | - Harin B Parikh
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - David R Howell
- Children's Hospital Colorado, Aurora, Colorado, USA.,School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jay C Albright
- Children's Hospital Colorado, Aurora, Colorado, USA.,School of Medicine, University of Colorado, Aurora, Colorado, USA
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47
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Gale T, Anderst W. Asymmetry in healthy adult knee kinematics revealed through biplane radiography of the full gait cycle. J Orthop Res 2019; 37:609-614. [PMID: 30644134 DOI: 10.1002/jor.24222] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/08/2019] [Indexed: 02/04/2023]
Abstract
One commonly used criterion in evaluating a patients' response to knee surgery or rehabilitation is bilateral symmetry. However, the natural symmetry in uninjured healthy adult knee kinematics remains relatively unknown, making it challenging to determine if clinical treatment has adequately restored bilateral symmetry. The primary purpose of this study was to determine the typical side-to-side differences in 6 degree of freedom (DOF) knee kinematics over the entire gait cycle in healthy adults using biplane radiography. Six DOF tibiofemoral kinematics were measured during treadmill walking in 19 participants using a validated volumetric model-based tracking process that matched subject-specific bone models to biplane radiographs collected at 100 images/s. Average absolute side-to-side differences in knee kinematics at foot strike were 1.3 mm or less in translation and 3.8° or less in rotation. Peak side-to-side differences in knee kinematics occurred during the swing phase and were up to 2.2 mm in translation and 7.1° in rotation. Dominant versus non-dominant leg differences were 0.8 mm and 2.8° or less at foot strike and reached maximum values of 0.8 mm and 7.2° over the full gait cycle. Statement of Clinical Significance: This study quantifies the inherent asymmetry of knee kinematics in healthy individuals over the entire gait cycle. The values of asymmetry presented here may serve as a guide for evaluating functional outcomes and restoration of so-called "normal" kinematics after injury and clinical intervention. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Tom Gale
- Biodynamics Lab, Department of Orthopaedic Surgery, University of Pittsburgh, 3820 South Water Street, Pittsburgh, Pennsylvania, 15203
| | - William Anderst
- Biodynamics Lab, Department of Orthopaedic Surgery, University of Pittsburgh, 3820 South Water Street, Pittsburgh, Pennsylvania, 15203
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48
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Hanzlíková I, Richards J, Hébert-Losier K, Smékal D. The effect of proprioceptive knee bracing on knee stability after anterior cruciate ligament reconstruction. Gait Posture 2019; 67:242-247. [PMID: 30380509 DOI: 10.1016/j.gaitpost.2018.10.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/24/2018] [Accepted: 10/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Injury to the anterior cruciate ligament (ACL) is common among young athletes and can impact knee stability and control. Wearing proprioceptive knee braces can improve knee control and may reduce the risk factors associated with injury and re-injury, although the effect of such braces after ACL reconstruction (ACLR) is unclear. RESEARCH QUESTION This study aimed to determine the effect of proprioceptive knee bracing on knee control and subjective rating of participants post ACLR during three dynamic tasks. METHODS Fifteen participants 2-10 years post ACLR performed a slow step down, single leg drop jump, and pivot turn jump with and without a proprioceptive knee brace. Knee kinematics in the sagittal (flexion - extension), coronal (abduction - adduction), and transverse (internal - external rotation) planes were collected using a 3D infrared system. Paired t-tests were performed to explore differences in knee angles and angular velocities between the no brace and brace conditions during the three tasks. After each task, subjective ratings regarding ease of the task were recorded. RESULTS The brace reduced the peak knee external rotation angle and range of motion in the transverse plane during the pivot turn jump task, and significantly increased the maximum knee flexion angular velocity during the single leg drop jump task. The majority of participants reported that tasks were easier to perform with the proprioceptive brace than without. SIGNIFICANCE This study confirms that proprioceptive knee braces can significantly influence knee kinematics during dynamic tasks post ACLR. The observed effects were clinically relevant.
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Affiliation(s)
- I Hanzlíková
- Faculty of Physical Culture, Palacký University, Olomouc, Czech Republic; Faculty of Health, Sport and Human Performance, Adams Centre for High Performance, The University of Waikato, New Zealand.
| | - J Richards
- Allied Health Research Unit, University of Central Lancashire, United Kingdom
| | - K Hébert-Losier
- Faculty of Health, Sport and Human Performance, Adams Centre for High Performance, The University of Waikato, New Zealand
| | - D Smékal
- Faculty of Physical Culture, Palacký University, Olomouc, Czech Republic
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49
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Somthavil S. Altered kinematics after anterior cruciate ligament reconstruction, and their role in the prevention of osteoarthritis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.10.529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Anterior cruciate ligament injury is common, and anterior cruciate ligament reconstruction has become the standard of care that aims to restore knee stability, return to activity, and prevent secondary injury. Methods: A literature review was carried out using PubMed and Science Direct databases from 1998 through 2017. Search terms included: anterior cruciate ligament reconstruction and knee osteoarthritis; kinematics after anterior cruciate ligament reconstruction; and prevention of knee osteoarthritis. A total of 356 studies matched the search terms. After removing duplicates and any studies that were not relevant, 73 studies remained. Findings: Individuals usually have impaired neuromuscular control after reconstruction, and abnormal biomechanical patterns may lead to loading of cartilage areas that are not commonly loaded and that, longitudinally, can lead to osteoarthritis. The knee adduction moment indicates loading of the knee joint and has been associated with the development of osteoarthritis and altered gait mechanics have also been implicated in the increased rate of osteoarthritis after anterior cruciate ligament reconstruction, including differences in tibial rotation during walking. Furthermore, altered ankle joint mechanics may be the result of deviations in ankle joint alignment secondary to the structural changes at the knee. It is clear that abnormal mechanical stimulation may cause dysfunction of articular chondrocytes and breakdown of cartilage extracellular matrix, leading to articular cartilage degradation and chondrocyte death. The affected joint will progress to post-traumatic osteoarthritis. Conclusions: The restoration of normal knee anatomy and mechanics, such as returning the joint to normal function, improving muscle strength, functional movement prevention programmes, restoring gait symmetry and weight management are recommended.
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Affiliation(s)
- Sompiya Somthavil
- Lecturer Faculty of Sports Science, Kasetsart University, Nakhon Pathom, Thailand
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50
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An interpolation technique to enable accurate three-dimensional joint kinematic analyses using asynchronous biplane fluoroscopy. Med Eng Phys 2018; 60:109-116. [PMID: 30098937 DOI: 10.1016/j.medengphy.2018.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/25/2018] [Accepted: 07/22/2018] [Indexed: 11/22/2022]
Abstract
Biplane 2D-3D model-based registration and radiostereometric analysis (RSA) approaches have been commonly used for measuring three-dimensional, in vivo joint kinematics. However, in clinical biplane systems, the x-ray images are acquired asynchronously, which introduces registration errors. The present study introduces an interpolation technique to reduce image registration error by generating synchronous fluoroscopy image estimates. A phantom study and cadaveric shoulder study were used to evaluate the level of improvement in image registration that could be obtained as a result of using our interpolation technique. Our phantom study results show that the interpolated bead tracking technique was in better agreement with the true bead positions than when asynchronous images were used alone. The overall RMS error of glenohumeral kinematics for interpolated biplane registration was reduced by 1.27 mm, 0.40 mm, and 0.47 mm in anterior-posterior, superior-inferior, and medial-lateral translation, respectively; and 0.47°, 0.67°, and 0.19° in ab-adduction, internal-external rotation and flexion-extension, respectively, compared to asynchronous registration. The interpolated biplane registration results were consistent with previously reported studies using custom synchronous biplane fluoroscopy technology. This approach will be particularly useful for improving the kinematic accuracy of high velocity activities when using clinical biplane fluoroscopes or two independent c-arms, which are available at a number of institutions.
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