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Aoki A, Tamura T, Hoshi K, Gamada K. Effect of unpredictable timing on the hip, knee, and ankle kinematics and center of mass during deceleration tasks. J Sports Med Phys Fitness 2024; 64:425-431. [PMID: 38445844 DOI: 10.23736/s0022-4707.23.15344-8] [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: 03/07/2024]
Abstract
BACKGROUND Unpredictable stopping or deceleration tasks are crucial to prevent ACL injury. The purpose of this study was to reveal differences and relationships in kinematics during different deceleration tasks with and without anticipation. METHODS Twenty-four collegiate athletes were recruited. Three commercial video cameras were used to capture frontal and sagittal lower-extremity kinematics. Participants were instructed to perform three deceleration tasks: 1) anticipated stopping and running backward at a point indicated previously (SRB-P); 2) anticipated stopping and running backward in front of a badminton net (SRB-N); and 3) unanticipated stopping and running backward upon random flashing of a light (SRB-U). Differences and relationships between hip, knee, and ankle kinematics at stopping (SS) and deceleration steps (DS) and the height of the great trochanter (HGT) at SS were analyzed. RESULTS For all tasks, the knee flexion angle was less than 25° at SS. There were no significant differences in hip, knee, and ankle kinematics between tasks. HGT during SRB-U was higher than that in the other tasks at DS. Hip flexion angle at SS and DS was significantly correlated with HGT at SS. During SRB_P and SRB_N, only knee flexion angle at DS was significantly correlated with HGT at SS. CONCLUSIONS The deceleration task in this study, SRB, causes a low knee-flexion angle at SS. The COM remained higher during unanticipated stopping, which is related only to hip flexion angle during the task. Knee flexion movement does not contribute to lowering COM during an unpredictable deceleration task.
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Affiliation(s)
- Akino Aoki
- Department of Physical Therapy, International University of Health and Welfare, Narita, Japan -
| | - Tomoyo Tamura
- Graduate School of Medical Technology and Health Welfare Science, Hiroshima International University, Higashihiroshima, Japan
| | - Kenji Hoshi
- Department of Rehabilitation, Kato Orthopedic Sports Clinic, Hiroshima, Japan
| | - Kazuyoshi Gamada
- Faculty of Rehabilitation, Hiroshima International University, Higashihiroshima, Japan
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Sohn S, AlShammari SM, Hwang BJ, Kim MS. A Systematic Review of Bone Bruise Patterns following Acute Anterior Cruciate Ligament Tears: Insights into the Mechanism of Injury. Bioengineering (Basel) 2024; 11:396. [PMID: 38671817 PMCID: PMC11048204 DOI: 10.3390/bioengineering11040396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: The purpose of this systematic review was to determine the prevalence of bone bruises in patients with anterior cruciate ligament (ACL) injuries and the location of the bruises relative to the tibia and femur. Understanding the relative positions of these bone bruises could enhance our comprehension of the knee loading patterns that occur during an ACL injury. (2) Methods: The MEDLINE, EMBASE, and the Cochrane Library databases were searched for studies that evaluated the presence of bone bruises following ACL injuries. Study selection, data extraction, and a systematic review were performed. (3) Results: Bone bruises were observed in 3207 cases (82.8%) at the lateral tibia plateau (LTP), 1608 cases (41.5%) at the medial tibia plateau (MTP), 2765 cases (71.4%) at the lateral femoral condyle (LFC), and 1257 cases (32.4%) at the medial femoral condyle (MFC). Of the 30 studies, 11 were able to assess the anterior to posterior direction. The posterior LTP and center LFC were the most common areas of bone bruises. Among the 30 studies, 14 documented bone bruises across all four sites (LTP, MTP, LFC, and MFC). The most common pattern was bone bruises appearing at the LTP and LFC. (4) Conclusions: The most frequently observed pattern of bone bruises was restricted to the lateral aspects of both the tibia and femur. In cases where bone bruises were present on both the lateral and medial sides, those on the lateral side exhibited greater severity. The positioning of bone bruises along the front-back axis indicated a forward shift of the tibia in relation to the femur during ACL injuries.
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Affiliation(s)
- Sueen Sohn
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Republic of Korea;
| | | | - Byung Jun Hwang
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
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Tang H, Xiao YF, Liu WJ, Meng JH, Wu YM, Xiong YL, Gao SG. Preferences in anterior cruciate ligament reconstruction: A survey among orthopedic surgeons in China. Medicine (Baltimore) 2024; 103:e36482. [PMID: 38363894 PMCID: PMC10869037 DOI: 10.1097/md.0000000000036482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024] Open
Abstract
The purpose of this study was to reveal the current trends and preferences of Chinese orthopedic surgeons regarding anterior cruciate ligament (ACL) reconstruction through a nationwide web-based survey conducted in China. The survey questionnaire was distributed via WeChat to the chairmen of provincial orthopedic and sports medicine organizing committees in China, who then shared it in their respective WeChat workgroups. The questionnaire consisted of 52 multiple-choice questions covering 8 sections. Data collection was implemented by Questionnaire Star. A total of 812 valid questionnaires were returned: 94.21% of the respondents preferred single-bundle reconstruction of ACL, while 61.70% preferred autogenous semitendinosus plus gracilis reconstruction; 76.35% of the respondents preferred establishing the femoral tunnel first, while 47.29% preferred establishing the femoral tunnel through a medial auxiliary approach; and 85.10% of the respondents recommended patients to undergo surgery within 3 months after ligament injury. Besides, the vast majority of respondents chose to retain the ligamentous remnant bundle (92.98%) and recommended routine use of knee braces postoperatively (94.09%). It is recommended to perform arthroscopic single-bundle ACL reconstruction with the remnant preserving technique using a hamstring autograft within 3 months of ACL rupture, with support of postoperative functional braces.
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Affiliation(s)
- Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yi-fan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Wei-jie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Jia-hao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yu-mei Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Yi-lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shu-guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Zhang L, Huang T, Li C, Xing X, Zou D, Dimitriou D, Tsai T, Li P. Race and Gender Differences in Anterior Cruciate Ligament Femoral Footprint Location and Orientation: A 3D-MRI Study. Orthop Surg 2024; 16:216-226. [PMID: 37953405 PMCID: PMC10782238 DOI: 10.1111/os.13918] [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: 03/16/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE The femoral tunnel position is crucial to anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, but the ideal femoral footprint position are mostly based on small-sized cadaveric studies and elderly patients with a single ethnic background. This study aimed to identify potential race- or gender-specific differences in the ACL femoral footprint location and ACL orientation, determine the correlation between the ACL orientation and the femoral footprint location. METHODS Magnetic resonance images (MRIs) of 90 Caucasian participants and 90 matched Chinese subjects were used for reconstruction of three-dimensional (3D) femur and tibial models. ACL footprints were sketched by several experienced orthopedic surgeons on the MRI photographs. The anatomical coordinate system was applied to reflect the ACL footprint location and orientation of scanned samples. The femoral ACL footprint locations were represented by their distance from the origin in the anteroposterior (A/P) and distal-proximal (D/P) directions. The orientation of the ACL was described with the sagittal, coronal and transverse deviation angles. The ACL orientation and femoral footprint position were compared by the two-sided t-test. Multiple regression analysis was used to study the correlation between the orientation and femoral footprint position. RESULTS The average femur footprint A/P position was -6.6 ± 1.6 mm in the Chinese group and -5.1 ± 2.3 mm in the Caucasian group, (p < 0.001). The average femur footprint D/P position was -2.8 ± 2.4 mm in Chinese and - 3.9 ± 2.0 mm in Caucasians, (p = 0.001). The Chinese group had a mean difference of a 1.5 mm (6.1%) more posterior and 1.1 mm (5.3%) more proximal in the position from the flexion-extension axis (FEA). And the males have a sagittal plane elevation about 4-5° higher than females in both racial groups. Furthermore, for every 1% (0.40 mm) increase in A/P and D/P values, the sagittal angle decreased by about 0.12° and 0.24°, respectively; the coronal angle decreased by about 0.10° and 0.30°, respectively. For every 1% (0.40 mm) increase in D/P value, the transverse angle increased by about 0.14°. CONCLUSION The significant race- and gender-specific differences in the femoral footprint and orientation of the ACL should be taken in consideration during anatomic single-bundle ACL reconstruction. Furthermore, the quantitative relationship between the ACL orientation and the footprint location might provide some reference for surgeons to develop a surgical strategy in ACL single-bundle reconstruction and revision.
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Affiliation(s)
- Lihang Zhang
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Tianwen Huang
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Changzhao Li
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- Department of BiostatisticsBioinformatics & Biomathematics Georgetown UniversityWashington, DCUSA
| | - Xing Xing
- School of Biomedical Engineering & Med‐X Research InstituteShanghai Jiao Tong UniversityShanghaiChina
| | - Diyang Zou
- Engineering Research Center of Digital Medicine and Clinical TranslationMinistry of EducationShanghaiChina
- Department of Orthopedic Surgery, Shanghai Key Laboratory of Orthopedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of OrthopedicsUniversity Hospital BalgristZurichSwitzerland
| | | | - Tsung‐Yuan Tsai
- Engineering Research Center of Digital Medicine and Clinical TranslationMinistry of EducationShanghaiChina
- Department of Orthopedic Surgery, Shanghai Key Laboratory of Orthopedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of OrthopedicsUniversity Hospital BalgristZurichSwitzerland
| | - Pingyue Li
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
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Ferrero S, Louvois M, Barnetche T, Breuil V, Roux C. Impact of anterior cruciate ligament surgery on the development of knee osteoarthritis: A systematic literature review and meta-analysis comparing non-surgical and surgical treatments. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100366. [PMID: 37252633 PMCID: PMC10209532 DOI: 10.1016/j.ocarto.2023.100366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Context: The development of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is now widely recognized. The impact of surgical or non-surgical management on the development of post-traumatic osteoarthritis is still debated in the medical community.Here, we present a meta-analysis comparing the impact of surgical or non-surgical management of ACL injuries on the development of knee OA. Method A systematic literature review was conducted using data from the PubMed, EMBASE, Medline, and Cochrane libraries from February to May 2019. Only randomized clinical trials published between 2005 and 2019 with a non-surgical group and a surgical group were included to explore the onset or progression of knee OA after ACL injury. Trials had to have at least one radiographic endpoint (Kellgren-Lawrence scoring system). Heterogeneity was assessed using the Cochrane's Q and I2 statistical methods. Results Only three randomized controlled trials met the inclusion criteria and were selected for meta-analysis. Of the 343 injured knees included in the studies, 180 underwent ACL reconstruction and 163 underwent non-surgical treatment. The relative risk of knee osteoarthritis was higher after surgery than after non-surgical treatment (RR 1.72, CI 95% [1.18-2.53], I2 = 0%). Conclusion The results of this meta-analysis suggest a predisposition to knee osteoarthritis after ACL reconstruction surgery compared with non-surgical management. Due to the small number of good quality studies available, further well-conducted randomised studies are needed to confirm these findings.
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Affiliation(s)
- Stephanie Ferrero
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Nice Sophia Antipolis University, F-06000, Nice, France
| | - Marion Louvois
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Nice Sophia Antipolis University, F-06000, Nice, France
| | - Thomas Barnetche
- Department of Rheumatology, University Hospital of Bordeaux Pellegrin, France
| | - Veronique Breuil
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Nice Sophia Antipolis University, F-06000, Nice, France
| | - Christian Roux
- Department Rheumatology, University of Cote D'Azur, Nice Hospital, Laboratory LAMHESS, EA6312, IBV CNRS IMR 7277 INSERM U1091 UNS, France
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Taghizadeh Kerman M, Brunetti C, Yalfani A, Atri AE, Sforza C. The Effects of FIFA 11+ Kids Prevention Program on Kinematic Risk Factors for ACL Injury in Preadolescent Female Soccer Players: A Randomized Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1206. [PMID: 37508703 PMCID: PMC10377808 DOI: 10.3390/children10071206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
This study aimed to investigate the effects of the 8-week FIFA 11+ Kids program on kinematic risk factors for ACL injury in preadolescent female soccer players during single-leg drop landing. For this, 36 preadolescent female soccer players (10-12 years old) were randomly allocated to the FIFA 11+ Kids program and control groups (18 players per group). The intervention group performed the FIFA 11+ Kids warm-up program twice per week for 8 weeks, while the control group continued with regular warm-up. Trunk, hip, and knee peak angles (from initial ground contact to peak knee flexion) were collected during the single-leg drop landing using a 3D motion capture system. A repeated measure ANOVA was used to analyze groups over time. Significant group × time interactions were found for the peak knee flexion, with a medium effect size (p = 0.05; effect size = 0.11), and peak hip internal rotation angles, with a large effect size (p < 0.01; effect size = 0.28). We found that the FIFA 11+ Kids program was effective in improving knee flexion and hip internal rotation, likely resulting in reducing ACL stress during single-leg drop landing in young soccer players.
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Affiliation(s)
- Maedeh Taghizadeh Kerman
- Department of Sports Injury and Corrective Exercises, Faculty of Physical Education and Sport Sciences, Bu-Ali Sina University, Hamadan 65167-38695, Iran
| | - Claudia Brunetti
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, 20133 Milan, Italy
| | - Ali Yalfani
- Department of Sports Injury and Corrective Exercises, Faculty of Physical Education and Sport Sciences, Bu-Ali Sina University, Hamadan 65167-38695, Iran
| | - Ahmad Ebrahimi Atri
- Department of Sports Physiology, Faculty of Sports Sciences, Ferdowsi University of Mashhad, Mashhad 91779-48974, Iran
| | - Chiarella Sforza
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, 20133 Milan, Italy
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Primary Proximal ACL Repair: A Biomechanical Evaluation of Different Arthroscopic Suture Configurations. J Clin Med 2023; 12:jcm12062340. [PMID: 36983341 PMCID: PMC10059937 DOI: 10.3390/jcm12062340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/22/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023] Open
Abstract
Purpose: Several suture techniques have been described in the past for direct ACL repair with poor healing capacity and a high re-rupture rate. Therefore, we investigated a refixation technique for acute primary proximal ACL repair. The purpose of this study is to compare the biomechanical properties of different suture configurations using a knotless anchor. Methods: In this study, 35 fresh-frozen porcine knees underwent proximal ACL refixation. First, in 10 porcine femora, the biomechanical properties of the knotless anchor, without the ligament attached, were tested. Then, three different suture configurations were evaluated to reattach the remaining ACL. Using a material testing machine, the structural properties were evaluated for cyclic loading followed by loading to failure. Results: The ultimate failure load of the knotless anchor was 198, 76 N ± 23, 4 N significantly higher than all of the tested ACL suture configurations. Comparing the different configurations, the modified Kessler–Bunnell suture showed significant superior ultimate failure load, with 81, 2 N ± 15, 6 N compared to the twofold and single sutures (50, 5 N ± 14 N and 37, 5 ± 3, 8 N). In cyclic loading, there was no significant difference noted for the different configurations in terms of stiffness and elongation. Conclusions: The results of this in vitro study show that when performing ACL suture using a knotless anchor, a modified Kessler–Bunnell suture provides superior biomechanical properties than a single and a twofold suture. Within this construct, no failure at the bone–anchor interface was seen. Clinical relevance: Since primary suture repair techniques of ACL tears have been abandoned because of inconsistent results, ACL reconstruction remains the gold standard of treating ACL tears. However, with the latest improvements in surgical techniques, instrumentation, hardware and imaging, primary ACL suture repair might be a treatment option for a select group of patients. By establishing an arthroscopic technique in which proximal ACL avulsion can be reattached, the original ACL can be preserved by using a knotless anchor and a threefold suture configuration. Nevertheless, this technique provides an inferior ultimate failure load compared to graft techniques, so a careful rehabilitation program must be followed if using this technique in vivo.
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Markus DH, Hurley ET, Mojica ES, Anil U, Kanakamedala A, Avila A, Gyftopoulos S, Strauss EJ. Concentration of synovial fluid biomarkers on the day of anterior cruciate ligament (ACL)-reconstruction predict size and depth of cartilage lesions on 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 2022; 31:1753-1760. [PMID: 35904566 DOI: 10.1007/s00167-022-07045-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/04/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The current investigation evaluated the relationship between the synovial fluid cytokine microenvironment at the time of isolated anterior cruciate ligament (ACL) reconstruction and the presence of subsequent chondral wear and radiologic evidence of osteoarthritis (OA) on cartilage-specific MRI sequences at a minimum of 5-year follow-up. METHODS Patients who underwent primary ACL reconstruction with no baseline concomitant cartilage or meniscal defects and had synovial fluid samples obtained at the time of surgery were retrospectively identified. Patients with a minimum of 5 years of postoperative follow-up were contacted and asked to complete patient-reported outcome (PRO) measures including Visual Analog Scale (VAS) for pain, Lysholm Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner Activity Scale, along with postoperative magnetic resonance imaging (MRI). The concentration of ten biomarkers that have previously been suggested to play a role in cartilage degradation and inflammation in the joint space was measured. Linear regression controlling for age, sex, and body mass index (BMI) was performed to create a model using the synovial fluid concentrations at the time of surgery to predict postoperative semiquantitative cartilage lesion size and depth on MRI at a minimum of 5 years follow up. RESULTS The patients were comprised of eight males (44.4%) and ten females (55.6%) with a mean age at the time of surgery of 30.8 ± 8.7 years (range 18.2-44.5 years). The mean follow-up time was 7.8 ± 1.5 years post-operatively (range 5.7-9.7 years). MCP-1, VEGF, and IL-1Ra were found to have significant associations with the presence of postoperative cartilage wear (p < 0.05). No correlations were demonstrated among the biomarker concentrations at the time of injury with PRO scores at final follow-up (NS). CONCLUSION Synovial fluid inflammatory biomarker concentrations at the time of injury can predict progression of early-stage post-traumatic osteoarthritis at a mean of almost 8 years post-operatively. Findings from this study may help identify treatment targets to alter the natural history of cartilage loss following anterior cruciate ligament injury. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Danielle H Markus
- Division of Sports Medicine, Orthopaedic Surgery Department, NYU Langone Medical Center, New York Langone Health, 333 E 38th Street, New York, NY, 10016, USA.
| | - Eoghan T Hurley
- Division of Sports Medicine, Orthopaedic Surgery Department, NYU Langone Medical Center, New York Langone Health, 333 E 38th Street, New York, NY, 10016, USA
| | - Edward S Mojica
- Division of Sports Medicine, Orthopaedic Surgery Department, NYU Langone Medical Center, New York Langone Health, 333 E 38th Street, New York, NY, 10016, USA
| | - Utkarsh Anil
- Division of Sports Medicine, Orthopaedic Surgery Department, NYU Langone Medical Center, New York Langone Health, 333 E 38th Street, New York, NY, 10016, USA
| | - Ajay Kanakamedala
- Division of Sports Medicine, Orthopaedic Surgery Department, NYU Langone Medical Center, New York Langone Health, 333 E 38th Street, New York, NY, 10016, USA
| | - Amanda Avila
- Division of Sports Medicine, Orthopaedic Surgery Department, NYU Langone Medical Center, New York Langone Health, 333 E 38th Street, New York, NY, 10016, USA
| | - Soterios Gyftopoulos
- Department of Radiology, NYU Langone Medical Center, 660 First Ave, New York, NY, 10016, USA
| | - Eric J Strauss
- Division of Sports Medicine, Orthopaedic Surgery Department, NYU Langone Medical Center, New York Langone Health, 333 E 38th Street, New York, NY, 10016, USA
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Itoh M, Imasu H, Takano K, Umezu M, Okazaki K, Iwasaki K. Time-series biological responses toward decellularized bovine tendon graft and autograft for 52 consecutive weeks after rat anterior cruciate ligament reconstruction. Sci Rep 2022; 12:6751. [PMID: 35468916 PMCID: PMC9038763 DOI: 10.1038/s41598-022-10713-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
There is an essential demand for developing biocompatible grafts for knee anterior cruciate ligament reconstruction (ACLR). This study investigated cell infiltration into decellularized bovine tendon xenografts using a rat knee ACLR model. Twelve-week-old Sprague–Dawley rats were used. At weeks 1, 2, 4, 8, 16, 26, and 52 (each period, n = 6) after ACLR, rats receiving decellularized bovine tendon (group D, n = 42) or autologous tendon (group A, n = 42) as grafts underwent peritibial bone tunnel bone mineral density (BMD), histological, and immunohistological assessments. BMD increased over time in both the groups until week 16 and then remained unchanged without exhibiting significant differences between the groups. Initially, cellularity in group D was lower than that in group A; however, by weeks 4–8, both the groups were comparable to the native anterior cruciate ligament group and cellularity remained unchanged until week 52. Initially, group A had more M1 macrophages, indicating inflammation, whereas group D had more M2 macrophages, indicating tissue regeneration. Nonetheless, the M1 and M2 macrophage counts of both the groups were comparable at most times. This study revealed the excellent recellularization and tendon–bone integration abilities of decellularized tendons using a cross-species model.
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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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11
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Borjali A, Nourani A, Moeinnia H, Mohseni M, Korani H, Ghias N, Chizari M. Comparison of mechanical properties in interference screw fixation technique and organic anterior cruciate ligament reconstruction method: a biomechanical study. BMC Musculoskelet Disord 2021; 22:1047. [PMID: 34930185 PMCID: PMC8691038 DOI: 10.1186/s12891-021-04788-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/13/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Bone and Site Hold Tendon Inside (BASHTI) technique is an organic implant-less technique for anterior cruciate ligament (ACL) reconstruction with some clinical advantages, such as speeding up the healing process, over implantable techniques. The study aims to compare the mechanical properties of BASHTI technique with the conventional interference screw technique. METHODS To investigate the mechanical properties, 20 in-vitro experimental tests were conducted. Synthetic dummy bone, along with fresh digital bovine tendons, as a graft, were used for experiments. Three loading steps were applied to all specimens, including a preconditioning, a main cyclic, and a pull-out loading. RESULTS The mechanical characters of an interference screw technique using an 8 mm tendon diameter, including fixation strength, average cyclic stiffness (ACS), and average pull-out stiffness (APS) were found to be 439 ± 132 N, 10.3 ± 5.3 kN/mm, and 109 ± 40 N/mm, respectively. In the case of an interference screw using a 9 mm tendon, the fixation strength, ACS, and APS were obtained 549 ± 87 N, 10.3 ± 4.7 kN/mm, and 91 ± 13 N/mm, respectively. In parallel, the fixation strength, APS, and ACS of BASHTI technique using an 8 mm tendon were 360 ± 123 N, 3.3 ± 0.6 kN/mm, and 79 ± 27 N/mm, respectively, while, for 9 mm tendon 278 ± 103 N, 2.4 ± 1.2 kN/mm, and 111 ± 40 N/mm, were reported for fixation strength, APS, and ACS respectively when BASHTI technique was used. CONCLUSION About 50% of interference screw samples showed superior mechanical properties compared to BASHTI technique, but in another half of the samples, the differences were not significant (N.S.). However, due to organic advantages of BASHTI technique and lower cost, it could be used as a substitute for interference screw technique, especially where fast recovery is expected.
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Affiliation(s)
- Amirhossein Borjali
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Amir Nourani
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - Hadi Moeinnia
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Mahdi Mohseni
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Hossein Korani
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Narges Ghias
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Mahmoud Chizari
- Department of Engineering and Technology, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
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Cevallos N, Soriano KKJ, Lansdown DA, Ma CB, Feeley BT, Zhang AL. Contemporary Practice Patterns for the Treatment of Anterior Cruciate Ligament Tears in the United States. Orthop J Sports Med 2021; 9:23259671211040891. [PMID: 34604433 PMCID: PMC8485167 DOI: 10.1177/23259671211040891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background: There is a lack of research investigating current practice trends in the
treatment of anterior cruciate ligament (ACL) tears as well as common
concomitant procedures and reoperations associated with ACL reconstruction
(ACLR). Purpose: To analyze current practice patterns for ACLR as well as the frequency of
concomitant and revision procedures with respect to patient characteristics
in a cross-sectional population of the United States. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patient data between 2010 and 2017 were queried using the Mariner PearlDiver
database. International Classification of Diseases, Ninth Revision (in
2010-2014) and Tenth Revision (ICD-10; in 2015-2017), diagnosis codes were
used to identify ACL tears, and Current Procedural Terminology codes were
used to identify ACLR and concomitant surgical procedures. Patient
characteristics were stratified by sex and age. Cases of subsequent knee
surgery and conversion to total knee arthroplasty (TKA) within 2 years after
ACLR were tracked using ICD-10 codes between 2015 and 2017 to ensure
ipsilateral laterality. Results: Of 229,295 patients identified with an ACL tear diagnosis during the study
period, 75% underwent ACLR. In patients aged 10 to 39 years, 84% to 92%
underwent ACLR, while patients aged 50 to 59 (50%) and 60 to 69 (28%) years
were less likely to have surgery after an ACL tear. Female and male patients
underwent ACLR at a similar rate (75%). Within the patients who underwent
ACLR, 44% underwent concomitant meniscal debridement as compared with 11%
with concomitant meniscal repair. Male patients were more likely to undergo
meniscal debridement (48% vs 40%; P < .0001). The
frequency of meniscal repair increased from 9% in 2010 to 14% in 2017, while
the frequency of meniscal debridement decreased from 47% to 41%
(P < .0001). Within 2 years of ACLR, 6% of patients
underwent revision ACLR; 4%, subsequent meniscal debridement; 1%, meniscal
repair; and 1%, conversion to TKA. Conclusion: The frequency of ACLR for ACL tears has remained relatively stable in recent
years and was similar between female and male patients in this
cross-sectional population. The majority of patients aged 10 to 39 years
underwent ACLR, while less than half of patients >50 years underwent
surgery.
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Affiliation(s)
- Nicolas Cevallos
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Kylen K J Soriano
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
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Ruelos VCB, Puzzitiello RN, Menendez ME, Pagani NR, Moverman MA, Forsythe B, Salzler MJ. Vancomycin Presoaking of Anterior Cruciate Ligament Tendon Grafts Is Highly Cost-Effective for Preventing Infection. Arthroscopy 2021; 37:3152-3156. [PMID: 33887413 DOI: 10.1016/j.arthro.2021.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/18/2021] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to (1) determine whether intraoperative graft soaking with vancomycin is a cost-effective measure for preventing infection after arthroscopic anterior cruciate ligament (ACL) reconstruction and (2) provide an adaptable model for providers and institutions to determine the cost effectiveness of this strategy over a range of initial infection rates, infection-related care costs, and vancomycin costs. METHODS Baseline postoperative infection rates and the costs of antibiotics and infection-related care were gathered from the literature. The cost of treating infection was determined for 2 alternative protocols-irrigation and debridement with revision ACL reconstruction or ACL graft retention. Using a break-even economic analysis, we developed an equation to determine the absolute risk reduction (ARR) in infection rate required for the use of vancomycin graft soaking to be deemed cost-effective. To provide a widely applicable robust model, multiple simulations were performed at varying unit costs, infection rates, and ACL reconstruction postoperative infection related care costs. The number needed to treat was calculated from the ARR. RESULTS Intraoperative vancomycin was determined to be cost-effective if it prevents 1 infection in 550 cases (ARR = 0.182%), given costs of $24,178 and $44/1,000 mg for revision ACL reconstruction and vancomycin, respectively. If the ACL graft is retained following infection, intraoperative vancomycin was considered cost-effective if it prevents 1 infection in 146 cases (ARR = 0.685%), given costs of $6,424 and $44/1,000 mg for arthroscopic debridement and vancomycin prophylaxis, respectively. For any specific cost of treating infection and cost of vancomycin, variation in baseline infection rates did not influence the economic viability of vancomycin graft soaking. This intervention remained economically viable over a wide range of unit costs of vancomycin. CONCLUSIONS Through break-even economic analysis, this study demonstrates that the use of intraoperative graft preparation with vancomycin is a highly cost-effective prophylactic measure for infection prevention in arthroscopic ACL reconstruction. LEVEL OF EVIDENCE IV, economic analysis.
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Affiliation(s)
- Verdinand C B Ruelos
- Department of Orthopaedic Surgery, Tufts University Medical Center, Boston, Massachusetts, U.S.A
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts University Medical Center, Boston, Massachusetts, U.S.A
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, Tufts University Medical Center, Boston, Massachusetts, U.S.A
| | - Nicholas R Pagani
- Department of Orthopaedic Surgery, Tufts University Medical Center, Boston, Massachusetts, U.S.A
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts University Medical Center, Boston, Massachusetts, U.S.A
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts University Medical Center, Boston, Massachusetts, U.S.A..
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Optimizing Whole-Body Kinematics During Single-Leg Jump Landing to Reduce Peak Abduction/Adduction and Internal Rotation Knee Moments: Implications for Anterior Cruciate Ligament Injury Risk. J Appl Biomech 2021; 37:432-439. [PMID: 34504045 DOI: 10.1123/jab.2020-0407] [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: 12/29/2020] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022]
Abstract
Knee abduction/adduction moment and knee internal rotation moment are known surrogate measures of anterior cruciate ligament (ACL) load during tasks like sidestepping and single-leg landing. Previous experimental literature has shown that a variety of kinematic strategies are associated or correlated with ACL injury risk; however, the optimal kinematic strategies needed to reduce peak knee moments and ACL injury are not well understood. To understand the complex, multifaceted kinematic factors underpinning ACL injury risk and to optimize kinematics to prevent the ACL injury, a musculoskeletal modeling and simulation experimental design was used. A 14-segment, 37-degree-of-freedom, dynamically consistent skeletal model driven by force/torque actuators was used to simulate whole-body single-leg jump landing kinematics. Using the residual reduction algorithm in OpenSim, whole-body kinematics were optimized to reduce the peak knee abduction/adduction and internal/external rotation moments simultaneously. This optimization was repeated across 30 single-leg jump landing trials from 10 participants. The general optimal kinematic strategy was to bring the knee to a more neutral alignment in the transverse plane and frontal plane (featured by reduced hip adduction angle and increased knee adduction angle). This optimized whole-body kinematic strategy significantly reduced the peak knee abduction/adduction and internal rotation moments, transferring most of the knee load to the hip.
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15
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Shi H, Ding L, Jiang Y, Zhang H, Ren S, Hu X, Liu Z, Huang H, Ao Y. Comparison Between Soccer and Basketball of Bone Bruise and Meniscal Injury Patterns in Anterior Cruciate Ligament Injuries. Orthop J Sports Med 2021; 9:2325967121995844. [PMID: 33912617 PMCID: PMC8050764 DOI: 10.1177/2325967121995844] [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: 09/28/2020] [Accepted: 11/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The varying effectiveness of anterior cruciate ligament (ACL) injury
prevention programs between soccer and basketball may be due to differences
in sport-specific injury mechanisms. Bone bruise patterns may provide
information regarding injury mechanisms. Purpose: To compare bone bruise and meniscal injury patterns for ACL injuries
sustained in soccer versus basketball. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Clinical notes, operative reports, and magnetic resonance imaging scans were
reviewed for patients who sustained a noncontact ACL rupture while playing
soccer or basketball between August 2016 and August 2018. The presence,
location, and signal intensity of bone bruises on the tibia and femur were
documented, and patterns were classified according to the location of the
bone bruise in the lateral-medial direction. The meniscal and bone bruise
injury patterns and the specific bone bruise locations were compared between
the soccer and basketball groups. Results: Overall, 138 patients were included (56 with soccer-related and 82 with
basketball-related ACL injury). No significant difference between the groups
was observed in bone bruise patterns (P = .743) or meniscal
injury patterns (P = .952). Bone bruise on the lateral side
only of both the femur and the tibia was the most common pattern in both
soccer (41.9%) and basketball (47.0%) groups; the most common meniscal
injury type was an isolated lateral meniscal injury in both soccer (50.0%)
and basketball (45.0%) groups. For patients with bone bruises on both the
lateral and the medial sides of both the femur and the tibia (BF+BT), the
bone bruise signal intensity on the lateral side of the femur
(P < .001) and tibia (P = .009) was
significantly higher than that on the medial side for both groups. The bone
bruises on the lateral side of the femur (P < .001) and
tibia (P = .002) were significantly more anterior than
those on the medial side for patients with the BF+BT pattern. Conclusion: No significant differences in bone bruise location or meniscal injury type
were detected when comparing ACL injuries sustained during soccer versus
basketball. The study results suggest a similar biomechanical loading
pattern for ACL injuries in these sports.
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Affiliation(s)
- Huijuan Shi
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Li Ding
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Yanfang Jiang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Haocheng Zhang
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Shuang Ren
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Zhenlong Liu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Hongshi Huang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yingfang Ao
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
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16
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Scull G, Fisher MB, Brown AC. Fibrin-Based Biomaterial Systems to Enhance Anterior Cruciate Ligament Healing. MEDICAL DEVICES & SENSORS 2021; 4:e10147. [PMID: 34458685 PMCID: PMC8386506 DOI: 10.1002/mds3.10147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Anterior cruciate ligament (ACL) tears are a common and potentially career-ending injury, particularly for athletes and soldiers. Partial and complete ruptures of this ligament cause instability in the knee, and the ACL does not have the capacity for healing due, in part, to its position within the highly thrombolytic synovial fluid environment of the knee joint. Traditional methods of ACL reconstruction, such as graft replacement with attached bone anchors for bone integration, restore stability, but do not prevent the development of post-traumatic osteoarthritis. To enhance therapeutic treatment options, novel fibrin-based technologies and repair techniques have been recently explored and show promise for improved patient outcomes. Through modification of existing surgical methods, such as the use of fibrin glues incorporating growth factors and cells and the implementation of scaffolds containing platelet-rich plasma, platelet-rich fibrin, and other blood derivatives, surgeons are attempting to overcome the shortcomings of traditional treatments. This mini-review will detail current efforts using fibrin-based treatments and discuss opportunities to further enhance ACL healing.
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Affiliation(s)
- Grant Scull
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Raleigh, NC 27695
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Raleigh, NC 27695
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695
| | - Ashley C. Brown
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Raleigh, NC 27695
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695
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17
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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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18
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Returning a Division I Hurdler to Sport After Multiple Knee Ligament Injuries. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY AND TRAINING 2021. [DOI: 10.1123/ijatt.2019-0121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An 18-year-old male hurdler reported to preparticipation physicals, with a history of anterior cruciate ligament, lateral collateral ligament, and posterior cruciate ligament sprain; medial meniscocapsular sprain; and biceps femoris tendon avulsion. The patient received full clearance from his surgeon, despite functional deficits. Rehabilitation and return-to-play decision making included analysis of patient-reported outcome scores and tests of symmetry and neuromuscular control. After graduated intervention and multiple batteries of assessments, the patient was allowed to return to full participation. The nature of this sport and the time between surgery and the intervention made thorough evaluation of function and graduated progression a necessity.
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Li LT, Bokshan SL, McGlone PJ, Owens BD. Decline in Racial Disparities for United States Hospital Admissions After Anterior Cruciate Ligament Reconstruction From 2007 to 2015. Orthop J Sports Med 2020; 8:2325967120964473. [PMID: 33283006 PMCID: PMC7682220 DOI: 10.1177/2325967120964473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background Racial disparities in perioperative complications have been shown to exist for many procedures in orthopaedic surgery. Although anterior cruciate ligament reconstruction (ACLR) is commonly performed as an outpatient procedure, the rate of admission to the hospital postoperatively is not insignificant. Hispanic patients have been shown to have higher odds of admission compared with non-Hispanic patients. Hypothesis We hypothesized that racial disparities would decrease from 2007 to 2015, resulting in lower rates of hospital admission for Black and Hispanic patients. Study Design Descriptive epidemiology study. Methods This study represents a retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database for patients undergoing ACLR between 2007 and 2015. We performed bivariate analysis as well as binary logistic regression, with postoperative admission as the primary outcome. Previously identified risk factors for admission were used as predictors in addition to a term for the statistical interaction between year of surgery and ethnicity. Results A total of 7542 patients undergoing ACLR were assessed. The logistic regression model showed that Hispanic patients had higher overall odds of admission (odds ratio [OR], 3.320; P < .001) than White patients; Black patients also had higher odds compared with White patients (OR, 1.929; P = .009). However, there was a significant interaction between year of surgery and both Black ethnicity (OR, 0.907; P = .026) and Hispanic ethnicity (OR, 0.835; P = .002), indicating a significant decrease in the admission rates for these minority patients compared with White patients over time. Other risk factors for admission were the use of regional anesthesia (OR, 3.482; P < .001), bleeding disorders (OR, 5.064; P = .002), a higher body mass index (OR, 1.029; P < .001), and longer operative times (OR, 1.012; P < .001). More recent surgery was associated with lower odds of admission (OR, 0.826; P < .001). Conclusion Admission rates after ACLR declined from 2007 to 2015. Black and Hispanic patients were more likely to be admitted overall, but they also saw a greater decrease in the odds of admission than White patients. This represents a reduction in disparity between the 2 groups and is a reassuring improvement in racial disparity trends after a common sports procedure.
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Affiliation(s)
- Lambert T Li
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Steven L Bokshan
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Patrick J McGlone
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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García-Luna MA, Cortell-Tormo JM, García-Jaén M, Ortega-Navarro M, Tortosa-Martínez J. Acute Effects of ACL Injury-Prevention Warm-Up and Soccer-Specific Fatigue Protocol on Dynamic Knee Valgus in Youth Male Soccer Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155608. [PMID: 32759692 PMCID: PMC7432391 DOI: 10.3390/ijerph17155608] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/19/2022]
Abstract
Childhood anterior cruciate ligament (ACL) injuries—which can pose a major risk to a child’s sporting career—have been on the rise in the last few decades. Dynamic knee valgus (DKV) has been linked to an increased risk of ACL injury. Therefore, the aim of this study was to analyze the acute effects of an ACL injury prevention protocol (ACL-IPP) and a soccer-specific fatigue protocol (SSFP) on DKV in youth male soccer players. The research hypothesis was that DKV would be reduced by the ACL-IPP and increased by the SSFP. Eighteen youth male soccer players were divided according to baseline DKV. Those with moderate or large DKV performed a neuromuscular training protocol based on activation of the abductor and external rotator hip muscles. Those with little or no DKV performed a soccer-specific fatigue protocol. DKV was assessed using the single-leg squat pre- and post-protocols in both legs. The ACL-IPP significantly decreased DKV during single-leg squat (p < 0.01, effect size = 1.39), while the SSFP significantly increased baseline DKV in the dominant leg during single-leg squat (p = 0.012; effect size = 1.74). In conclusion, the ACL-IPP appears to acutely reduce the DKV in youth male soccer players, and the SSFP seems to acutely increase the DKV in those players who showed a light or no DKV in a non-fatigue situation. By using the SSFP, it may be possible to determine which players would benefit from injury prevention programs due to increased DKV during game scenarios, while hip abductor and external rotator neuromuscular training may be beneficial for players who have moderate and severe DKV during single-leg squat under non-fatigued scenarios.
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21
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Shi H, Ding L, Ren S, Jiang Y, Zhang H, Hu X, Huang H, Ao Y. Prediction of Knee Kinematics at the Time of Noncontact Anterior Cruciate Ligament Injuries Based on the Bone Bruises. Ann Biomed Eng 2020; 49:162-170. [PMID: 32383042 DOI: 10.1007/s10439-020-02523-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/25/2020] [Indexed: 01/13/2023]
Abstract
Biomechanical risk factors associated with the alignment and position of the knee for anterior cruciate ligament (ACL) injury are still not conclusive. As bone bruises identified on magnetic resonance imaging (MRI) following acute ACL injury could represent the impact footprint at the time of injury. To improve understanding of the ACL injury mechanism, we aimed to determine the knee kinematics during ACL injury based on the bone bruises. Knee MRI scans of patients who underwent acute noncontact ACL injuries were acquired. Numerical optimization was used to match the bone bruises of the femur and tibia and predict the knee positions during injury. Knee angles were compared between MRI measured position and predicted position. The knee flexion, abduction, and external tibial rotation angles were significantly greater in the predicted position than that in MRI measured position. Relative to MRI measured position, patients had a mean of 34.3 mm of anterior tibial translation, 4.0 mm of lateral tibial translation, and 16.0 mm superior tibial translation in the predicted position. The results suggest that knee valgus and external tibial rotation accompanied by knee flexion are high-risk movement pattern for ACL injury in patients with lateral compartment bone bruising in conjunction with ACL injury.
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Affiliation(s)
- Huijuan Shi
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China.,Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Li Ding
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Shuang Ren
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Yanfang Jiang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Haocheng Zhang
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Hongshi Huang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China.
| | - Yingfang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China.
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22
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Shi H, Ding L, Jiang Y, Zhang H, Ren S, Hu X, Liu Z, Huang H, Ao Y. Bone Bruise Distribution Patterns After Acute Anterior Cruciate Ligament Ruptures: Implications for the Injury Mechanism. Orthop J Sports Med 2020; 8:2325967120911162. [PMID: 32313810 PMCID: PMC7160777 DOI: 10.1177/2325967120911162] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Bone bruises observed on magnetic resonance imaging (MRI) after an anterior cruciate ligament (ACL) injury could provide significant information about ACL injury mechanisms. Purpose/Hypothesis The purpose of this study was to investigate common bone bruise patterns after an ACL injury. It was hypothesized that the most common bone bruise distribution pattern would be only the lateral side of both the femur and tibia. Study Design Cross-sectional study; Level of evidence, 3. Methods Knee MRI scans of patients who underwent acute ACL reconstruction from August 2016 to August 2018 at our institution were selected. Imaging sequences in the sagittal and coronal planes were used for determining the bone bruise location in the lateral-medial and anterior-posterior directions, respectively. The presence, location, and intensity of bone bruises within specific compartments of the tibia and femur were documented. The relative bone bruise patterns of the tibia and femur were classified and analyzed. Results A total of 207 patients (165 men, 42 women) met the inclusion criteria from a total of 4209 ACL reconstruction cases. The most common relative bone bruise pattern was located on only the lateral side of both the femur and the tibia (44.4%), followed by the lateral and medial sides of both the femur and tibia (29.0%). For the pattern found on the lateral and medial sides of both the femur and tibia, the bone bruises on only the lateral side of both the tibia and femur were more severe (P < .001 and P < .001, respectively) and more anterior (P < .001 and P < .001, respectively) than those on only the medial side. Conclusion The most common relative bone bruise pattern observed was on only the lateral side of both the tibia and femur. Bone bruises on the lateral side were more severe than those on the medial side in patients with bone bruises on the lateral and medial sides of both the femur and tibia. Anterior translation of the tibia relative to the femur occurred during an ACL injury based on the location of bone bruises in the anterior-posterior direction.
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Affiliation(s)
- Huijuan Shi
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Li Ding
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yanfang Jiang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Haocheng Zhang
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Shuang Ren
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Xiaoqing Hu
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Zhenlong Liu
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Hongshi Huang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yingfang Ao
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
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23
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Validated Pediatric Functional Outcomes of All-epiphyseal ACL Reconstructions: Does Reinjury Affect Outcomes? J Pediatr Orthop 2020; 40:157-161. [PMID: 32132445 DOI: 10.1097/bpo.0000000000001217] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Greater frequency and intensity level of sports participation may be contributing to an increasing incidence of anterior cruciate ligament (ACL) tears in skeletally immature athletes. Prior studies have assessed the functional outcomes of physeal-respecting ACL reconstruction in this patient population based on adult functional outcomes scoring systems; however, there is only sparse literature evaluating functional outcomes of this specific patient population. This study aimed to retrospectively evaluate a cohort of pediatric patients who had undergone all-epiphyseal ACL reconstruction (AEACLR) with a set of clinically validated, pediatric-specific patient-reported functional outcomes scores (PRFOS). We hypothesized that patients who had rerupture would have significantly lower outcomes scores compared with those who did not rerupture. METHODS This was a retrospective evaluation of AEACLR patients at a single, tertiary care, children's hospital within a period of 2 years and had >6 months of initial clinical postoperative follow-up. Those who consented to participation were provided an online combined survey including questions relating to demographics and rerupture as well as 3 validated pediatric PRFOS. Statistical analysis of the cohort demographics, PRFOS, and subgroup analysis of the rerupture group compared with the ACL intact patients was performed. RESULTS The mean functional outcome scores at a mean of 48.6 months from surgery demonstrated excellent return to functional activity (Mean International Knee Documentation Committee, 93.8; Pedi-Patient-Reported Outcomes Measurement Information System, 98.8; Pedi- Functional Activity Brief Score, 21.6). There was a 13% rerupture rate and rerupture patients had a significantly decreased Pedi-International Knee Documentation Committee (94.9 intact vs. 86.0 rerupture; P=0.001) and Pedi-Patient-Reported Outcomes Measurement Information System (99.4 intact vs. 95.4 rupture; P=0.001) scores. CONCLUSIONS AEACLR patients have excellent outcomes based on pediatric-specific PRFOS. Rerupture patients demonstrated a decrease in functional outcomes scores compared with intact ACL patients. The results demonstrate the efficacy of AEACLR as measured by pediatric-specific functional outcome scores for the treatment of ACL rupture in skeletally immature athletes. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Dimitriou D, Wang Z, Zou D, Tsai TY, Helmy N. The Femoral Footprint Position of the Anterior Cruciate Ligament Might Be a Predisposing Factor to a Noncontact Anterior Cruciate Ligament Rupture. Am J Sports Med 2019; 47:3365-3372. [PMID: 31647682 DOI: 10.1177/0363546519878706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although the femoral tunnel position is crucial to anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, the recommendations for the ideal femoral footprint position are mostly based on cadaveric studies with small sample sizes, elderly patients with unknown ACL status, and 2-dimensional techniques. Furthermore, a potential difference in the femoral ACL footprint position and ACL orientation between ACL-ruptured and ACL-intact knees has not been reported in the literature. HYPOTHESIS The femoral ACL footprint position and ACL orientation vary significantly between ACL-ruptured and matched control ACL-intact knees. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Magnetic resonance images of the knees of 90 patients with an ACL rupture and 90 matched control participants who had a noncontact knee injury without an ACL rupture were used to create 3-dimensional models of the femur and tibia. The ACL footprints were outlined on each model, and their positions (normalized to the lateral condyle width) as well as ACL orientations were measured with an anatomic coordinate system. RESULTS The femoral ACL footprint in patients with an ACL rupture was located at 36.6% posterior and 11.2% distal to the flexion-extension axis (FEA). The ACL orientation was 46.9° in the sagittal plane, 70.3° in the coronal plane, and 20.8° in the transverse plane. The ACL-ruptured group demonstrated a femoral ACL footprint position that was 11.0% more posterior and 7.7% more proximal than that of the control group (all P < .01). The same patients also exhibited 5.7° lower sagittal elevation, 3.1° higher coronal plane elevation, and 7.9° lower transverse plane deviation (all P < .01). The optimal cutoff value of the femoral ACL footprint position to prevent an ACL rupture was at 30% posterior and 12% distal to the FEA. CONCLUSION The ACL femoral footprint position might be a predisposing factor to an ACL rupture. Patients with a >30% posterior and <12% distal position of the femoral ACL footprint from the FEA might have a 51.2-times increased risk of an ACL rupture.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopaedics, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Zhongzheng Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education of the People's Republic of China, Beijing, China
| | - Diyang Zou
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education of the People's Republic of China, Beijing, China
| | - Tsung-Yuan Tsai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education of the People's Republic of China, Beijing, China
| | - Naeder Helmy
- Department of Orthopaedics, Bürgerspital Solothurn, Solothurn, Switzerland
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Janko M, Verboket RD, Plawetzki E, Geiger EV, Lustenberger T, Marzi I, Nau C. Vergleichbare Ergebnisse nach arthroskopischem Ersatz des vorderen Kreuzbandes. Chirurg 2019; 91:67-75. [DOI: 10.1007/s00104-019-01050-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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26
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Nakano N, Bartlett J, Khanduja V. Is restricted hip movement a risk factor for anterior cruciate ligament injury? J Orthop Surg (Hong Kong) 2019; 26:2309499018799520. [PMID: 30253690 DOI: 10.1177/2309499018799520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Restricted hip movement along with femoroacetabular impingement (FAI) has been reported to be an important risk factor in anterior cruciate ligament (ACL) injury. We performed a literature review assessing the evidence that FAI, or restricted hip movement, contributes to the likelihood of sustaining an ACL injury to provide an evidence-based and comprehensive update on the relationship between these pathologies. Studies were divided into three categories: clinical studies, radiological studies and cadaveric studies. Clinical studies primarily assessed the limitations to hip movement in patients with ACL injury, and numerous studies of this kind have demonstrated a relationship between restricted movement and ACL injury. Radiological studies have been able to demonstrate a higher number of bony hip abnormalities in patients with ACL injury. However, due to variable results within these studies, it is unclear which kinds of bony abnormality are specifically associated with an increased risk of ACL injury. Cadaveric studies have demonstrated that peak ACL relative strain was inversely related to the range of internal rotation of the femur, thus providing a potential mechanism for this relationship. In conclusion, clinical and radiological studies have established a correlation between restricted hip and ACL injury, but have been unable to demonstrate an increased risk of future ACL injury in individuals with restricted hip movement. Future prospective cohort studies are necessary to confirm this. Additionally, these findings highlight the need for a thorough clinical assessment of the hip when assessing patients with an ACL injury.
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Affiliation(s)
| | | | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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27
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Abstract
Anterolateral rotational laxity of the knee is a persistent problem following anterior cruciate ligament reconstruction (ACLR) that can lead to increased rates of graft failure. Renewed interest in the anterolateral complex of the knee has led to a resurgence in the use of adjunctive techniques such as lateral extra-articular tenodesis and anterolateral ligament reconstruction. Use of these techniques can restore normal knee kinematics and potentially thereby reduce the rate of graft failure. Historically, experience with modified ACLR techniques such as the double-bundle ACLR have shown that improved biomechanics is not always reflected in clinical outcome trials. Additional procedures also come with additional costs and further economic analysis needs to be performed to clarify whether these additional costs are offset by improved clinical and societal outcomes in the longer-term.
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Affiliation(s)
- Ryan Wood
- The Fowler Kennedy Sport Medicine Clinic
| | - Jacquelyn Marsh
- Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
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Kuenze C, Lisee C, Pfeiffer KA, Cadmus-Bertram L, Post EG, Biese K, Bell DR. Sex differences in physical activity engagement after ACL reconstruction. Phys Ther Sport 2018; 35:12-17. [PMID: 30396146 DOI: 10.1016/j.ptsp.2018.10.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To investigate the effects of sex as an effect modifier of objectively measured moderate-to-vigorous physical activity (MVPA) in individuals following ACLR and healthy controls. DESIGN Cross-sectional research study. SETTING University community. PARTICIPANTS 59 participants (42.4% male) with a history of ACLR and 55 healthy control participants (40.0% male). MAIN OUTCOME MEASURES Participants were outfitted with an ActiGraph wGT3X-BT accelerometer for a period of 7 days to assess MVPA. Weekly time engaged in MVPA (in bouts≥ 10 min), % of total time engaged in MVPA, and odds of meeting national physical activity guidelines (MVPA≥ 150 min/wk) were compared between males and females with a history of ACLR and healthy controls. RESULTS There were significant sex X group interactions for weekly MVPA (p = 0.02) and % total time in MVPA (p = 0.01). The odds of a female ACLR participant meeting national physical activity guidelines were significantly worse (X2 = 4.18, OR = 2.54, CI95 = 1.03-6.27) when compared to participants without ACLR. CONCLUSIONS Female participants with ACLR were found to be less active than healthy control participants and their odds of meeting national MVPA guidelines were also 2.54 times worse than healthy participants.
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Affiliation(s)
- Christopher Kuenze
- Michigan State University, Department of Kinesiology, 308 W. Circle Drive #105c, East Lansing, MI, 48824, USA; Michigan State University, Division of Sports Medicine, College of Osteopathic Medicine, 4660 Hagadorn Rd #420, East Lansing, MI, 48823, USA.
| | - Caroline Lisee
- Michigan State University, Department of Kinesiology, 308 W. Circle Drive #105c, East Lansing, MI, 48824, USA
| | - Karin A Pfeiffer
- Michigan State University, Department of Kinesiology, 308 W. Circle Drive #105c, East Lansing, MI, 48824, USA
| | - Lisa Cadmus-Bertram
- The University of Wisconsin at Madison, Department of Kinesiology, 2000 Observatory Drive, Madison, WI, 53706-1121, USA
| | - Eric G Post
- The University of Wisconsin at Madison, Department of Kinesiology, 2000 Observatory Drive, Madison, WI, 53706-1121, USA
| | - Kevin Biese
- The University of Wisconsin at Madison, Department of Kinesiology, 2000 Observatory Drive, Madison, WI, 53706-1121, USA
| | - David R Bell
- The University of Wisconsin at Madison, Department of Kinesiology, 2000 Observatory Drive, Madison, WI, 53706-1121, USA; The University of Wisconsin at Madison, Department of Orthopedics and Rehabilitation, 1685 Highland Avenue, Madison, School of Medicine and Public Health, WI, 53705-2281, USA
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29
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Yang C, Yao W, Garrett WE, Givens DL, Hacke J, Liu H, Yu B. Effects of an Intervention Program on Lower Extremity Biomechanics in Stop-Jump and Side-Cutting Tasks. Am J Sports Med 2018; 46:3014-3022. [PMID: 30148646 DOI: 10.1177/0363546518793393] [Citation(s) in RCA: 18] [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 Anterior cruciate ligament (ACL) injury is one of the most common injuries in sport. To reduce the risk of noncontact ACL injury, it is critical to understand the effects of an intervention program on neuromuscular control-related biomechanical risk factors. HYPOTHESIS A newly developed 4-week intervention program would significantly increase the knee flexion angle at peak impact posterior ground-reaction force and would significantly decrease the peak impact posterior and vertical ground-reaction forces in the stop-jump and side-cutting tasks, while the intervention effects would be retained after the training was completed. STUDY DESIGN Controlled laboratory study. METHODS A total of 22 male and 18 female collegiate basketball and volleyball players with biomechanical characteristics associated with increased risk of ACL injury were recruited and randomly assigned to either the intervention group or the control group. The intervention group executed a program to improve landing techniques through strength and plyometric training 3 times a week for 4 weeks while participating in their regular training. The control group participated in only their regular training for 4 weeks. Three-dimensional kinematic and kinetic data in the stop-jump and side-cutting tasks were collected at week 0 (the beginning of the study) and at the ends of weeks 4, 8, 16, and 20. Knee flexion angle and ground-reaction forces were calculated. Analyses of variance with a mixed design were performed to determine the intervention effects and the retention of intervention effects for each sex. RESULTS Male participants in the intervention group significantly increased the knee flexion angle at peak impact posterior ground-reaction force in the stop-jump task at weeks 8, 12, and 20 when compared with that at week 0 and with the male control group ( P ≤ .002). No significant intervention effects on knee flexion angle and ground-reaction force were found in the side-cutting task for male participants. No significant interaction effects on takeoff velocities were detected in any task for male participants. No significant intervention effects on knee flexion angle and ground-reaction force were found in any task for female participants. Vertical takeoff velocity in the stop-jump task was significantly lower in the intervention group at week 20 compared with the control group ( P = .011). CONCLUSION A 4-week intervention program significantly increased the knee flexion angle at peak impact posterior ground-reaction force of male collegiate athletes in the stop-jump task without significant effect on the performance of the task. This intervention effect was retained for at least 16 weeks after the training was completed. The intervention program, however, did not affect knee flexion angle and ground-reaction force in any task for female collegiate athletes. A reduction in vertical takeoff velocity of the stop-jump task was observed for female collegiate athletes 16 weeks after the intervention. CLINICAL RELEVANCE The intervention program with strength conditioning and plyometric exercises could modify landing biomechanics of male collegiate athletes in a stop-jump task. The intervention program may be a useful tool for preventing noncontact ACL injury for male collegiate athletes.
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Affiliation(s)
- Chen Yang
- Biomechanics Laboratory, College of Human Movement Science, Beijing Sport University, Beijing, China
| | - Wanxiang Yao
- Department of Kinesiology, Health, and Nutrition, University of Texas at San Antonio, San Antonio, Texas, USA
| | - William E Garrett
- Duke Sports Medicine Center, Duke University, Durham, North Carolina, USA
| | - Deborah L Givens
- Center for Human Movement Science, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathon Hacke
- Center for Human Movement Science, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hui Liu
- Biomechanics Laboratory, College of Human Movement Science, Beijing Sport University, Beijing, China
| | - Bing Yu
- Center for Human Movement Science, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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30
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Grassi A, Carulli C, Innocenti M, Mosca M, Zaffagnini S, Bait C. New Trends in Anterior Cruciate Ligament Reconstruction: A Systematic Review of National Surveys of the Last 5 Years. JOINTS 2018; 6:177-187. [PMID: 30582107 PMCID: PMC6301855 DOI: 10.1055/s-0038-1672157] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 08/10/2018] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to analyze national surveys of orthopaedic surgeons on anterior cruciate ligament (ACL) reconstruction to determine their preferences related to the preferred graft, femoral tunnel positioning, fixation and tensioning methods, antibiotic and anti-thromboembolic prophylaxis, and use of tourniquet and drains. A systematic search of PubMed, Web of Science, and Cochrane Library was performed. Inclusion criteria were surveys of ACL reconstruction trends and preferences published in the past 5 years (2011–2016), involving members of national societies of orthopaedics. Information regarding survey modalities, population surveyed, graft choice both in the general or in the athletic population, surgical technique, fixation, use of antibiotic, tourniquet, drains, and anti-thromboembolic prophylaxis was extracted. Eight national surveys were included from Europe (three), North or Latin America (three), and Asia (two). Overall, 7,420 questionnaires were sent, and 1,495 participants completed the survey (response rate ranging from 16 to 76.6%). All surveys reported the hamstring tendon (HT) autograft as the preferred graft, ranging from 45 to 89% of the surveyed population, followed by bone-patellar tendon-bone (BPTB) graft (2–41%) and allograft (2–17%). Only two surveys focusing on graft choice in athletic population underlined how in high-demand sportive population the graft choices changes in favor of BPTB. Single-bundle reconstruction was the preferred surgical technique in the four surveys that investigated this issue. Five surveys were in favor of anteromedial (AM) portal and two in favor of trans-tibial technique. Suspension devices for femoral fixation were the preferred choice in all but one survey, while interference screws were the preferred method for tibial fixation. The two surveys that investigated graft tensioning were in favor of manual tensioning. The use of tourniquet, antibiotics, drains, and anti-thromboembolic prophylaxis were vaguely reported. A trend toward the preference of HT autograft was registered in all the surveys; however, sport participation has been highlighted as an important variable for increased use of BPTB. Single-bundle reconstruction with AM portal technique and suspension femoral fixation and screws fixation for the tibia seem the preferred solution. Other variables such as tensioning, antibiotic, anti-thromboembolic prophylaxis, tourniquet use, and drains were investigated scarcely among the surveys; therefore, no clear trends could be delineated. This is a Level V, systematic review of expert opinion study.
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Affiliation(s)
- Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Christian Carulli
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Matteo Innocenti
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Massimiliano Mosca
- II Clinica Ortopedica e Traumatologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Corrado Bait
- Joint Surgery and Sport Medicine Unit, Istituto Clinico Villa Aprica, Como, Italy
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31
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Centeno C, Markle J, Dodson E, Stemper I, Williams C, Hyzy M, Ichim T, Freeman M. Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non-controlled registry study. J Transl Med 2018; 16:246. [PMID: 30176875 PMCID: PMC6122476 DOI: 10.1186/s12967-018-1623-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/29/2018] [Indexed: 12/13/2022] Open
Abstract
Background Bone marrow concentrate (BMC) has shown promise in the treatment of several orthopedic conditions. This registry study investigated the use of autologous BMC and platelet products for percutaneous anterior cruciate ligament (ACL) treatment. Methods Twenty-nine patients presenting to a single outpatient interventional musculoskeletal and pain practice with symptomatic grade 1, 2, or 3 ACL tears with less than 1 cm retraction were enrolled. Patients were treated with a percutaneous ACL injection of autologous BMC and platelet products using fluoroscopic guidance. Pre- and post-treatment magnetic resonance imaging analysis was completed for 23 patients using ImageJ software for an objective quantitative analysis of pixel density as a proxy for ACL integrity. Subjective clinical outcome measures collected pre-treatment and at 1, 3, 6, 12, 18, 24, and 36 months post-treatment include the Numerical Pain Scale (NPS), the Lower Extremity Functional Scale (LEFS), the International Knee Documentation Committee (IKDC) form, and a modified version of the Single Assessment Numeric Evaluation. Results Seventy-seven percent of patients treated with BMC injections into the ACL showed significant improvement (p < 0.01) in objective measures of ACL integrity at an average of 8.8 months (median 4.7 months). The mean of last patient-reported improvement was 72% (SD = 35) at an average of 23 (SD = 10) months post-treatment. Mean scores were found to be significantly different (p < 0.05) for the NPS at 6, 18, and 24 months, and LEFS and IKDC at all time points (i.e. 1, 3, 6, 12, 18, 24, and 36 months) relative to baseline. Conclusion In symptomatic patients with grade 1, 2, or even grade 3 tears with minimal retraction, ACL treatment with percutaneous injection of BMC and platelet products shows promise as a non-surgical alternative. However, a larger randomized controlled trial is warranted to confirm these findings. Trial registration NCT03011398. A Clinical Registry of Orthobiologics Procedures. https://clinicaltrials.gov/ct2/show/NCT03011398?term=orthobiologics&rank=1. Registered 29 December 2016. Enrollment 1 December 2011-retrospectively registered
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Affiliation(s)
- Christopher Centeno
- Centeno-Schultz Clinic, 403 Summit Blvd Suite 201, Broomfield, CO, 80021, USA.,Regenexx, LLC, Des Moines, IA, 50321, USA
| | - Jason Markle
- Centeno-Schultz Clinic, 403 Summit Blvd Suite 201, Broomfield, CO, 80021, USA
| | | | | | | | - Matthew Hyzy
- Centeno-Schultz Clinic, 403 Summit Blvd Suite 201, Broomfield, CO, 80021, USA
| | | | - Michael Freeman
- CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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32
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Amirtharaj MJ, Hardy BM, Kent RN, Nawabi DH, Wickiewicz TL, Pearle AD, Imhauser CW. Automated, accurate, and three-dimensional method for calculating sagittal slope of the tibial plateau. J Biomech 2018; 79:212-217. [PMID: 30217556 DOI: 10.1016/j.jbiomech.2018.07.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 01/13/2023]
Abstract
Increased posterior-inferior directed slope of the subchondral bone of the lateral tibial plateau is a risk factor for noncontact rupture of the anterior cruciate ligament (ACL). Previous measures of lateral tibial slope, however, vary from study to study and often lack documentation of their accuracy. These factors impede identifying the magnitude of lateral tibial slope that increases risk of noncontact ACL rupture. Therefore, we developed and evaluated a new method that (1) requires minimal user input; (2) employs 3D renderings of the tibia that are referenced to a 3D anatomic coordinate system; and (3) is precise, reliable, and accurate. The user first isolated the proximal tibia from computed tomography (CT) scans. Then, the algorithm placed the proximal tibia in an automatically generated tibial coordinate system. Next, it identified points along the rim of subchondral bone around the lateral tibial plateau, iteratively fit a plane to this rim of points, and, finally, referenced the plane to the tibial coordinate system. Precision and reliability of the lateral slope measurements were respectively assessed via standard deviation and intra- and inter-class correlation coefficients using CT scans of three cadaveric tibia. Accuracy was quantified by comparing changes in lateral tibial slope calculated by our algorithm to predefined in silico changes in slope. Precision, reliability, and accuracy were ≤0.18°, ≥0.998, and ≤0.13°, respectively. We will use our novel method to better understand the relationship between lateral tibial slope and knee biomechanics towards preventing ACL rupture and improving its treatment.
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Affiliation(s)
- Mark J Amirtharaj
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, 535 E 70(th) St, New York, NY 10021, USA
| | - Brendan M Hardy
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, 535 E 70(th) St, New York, NY 10021, USA
| | - Robert N Kent
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, 535 E 70(th) St, New York, NY 10021, USA
| | - Danyal H Nawabi
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, 535 E 70(th) St, New York, NY 10021, USA
| | - Thomas L Wickiewicz
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, 535 E 70(th) St, New York, NY 10021, USA
| | - Andrew D Pearle
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, 535 E 70(th) St, New York, NY 10021, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, 535 E 70(th) St, New York, NY 10021, USA.
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Aga C, Risberg MA, Fagerland MW, Johansen S, Trøan I, Heir S, Engebretsen L. No Difference in the KOOS Quality of Life Subscore Between Anatomic Double-Bundle and Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction of the Knee: A Prospective Randomized Controlled Trial With 2 Years' Follow-up. Am J Sports Med 2018; 46:2341-2354. [PMID: 30021073 DOI: 10.1177/0363546518782454] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The double-bundle reconstruction technique was developed to resemble the properties of the native anterior cruciate ligament (ACL) more closely than the conventional single-bundle technique. The clinical benefit of the operative procedure is controversial, and there is a need for studies with a focus on patient-reported outcomes (PROs). STUDY DESIGN Randomized controlled trial; Level of evidence, 1. HYPOTHESIS Anatomic double-bundle ACL reconstruction would be superior to anatomic single-bundle reconstruction regarding the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscore from baseline to 2-year follow-up. METHODS According to sample size calculations, 120 patients aged 18 to 40 years with a primary ACL injury of their knee were randomized to the anatomic double-bundle or anatomic single-bundle reconstruction groups. Patients with posterior cruciate ligament, posterolateral corner, or lateral collateral ligament injuries or with established osteoarthritis were excluded. Patients with residual laxity from a coexistent medial collateral ligament injury were excluded. Data were registered at baseline, 1 year, and 2 years. In 24 patients, postoperative 3-dimensional computed tomography was performed to verify the positioning of the bundles. The outcome measures were the change in KOOS subscores and the International Knee Documentation Committee 2000 subjective score, pivot-shift test result, Lachman test finding, KT-1000 arthrometer measurement, activity level, return-to-sports rate, and osteoarthritic changes on radiographs. A linear mixed model was used for the analysis of all the PROs, including the primary outcome. RESULTS The change in the KOOS QoL subscore from baseline to 2-year follow-up was not different between the double- and single-bundle groups (mean change, 29.2 points vs 28.7 points, respectively; -0.5-point difference; 95% CI, -8.4 to 7.4 points; P = .91). Neither were there any differences between the 2 groups in the remaining PROs, knee laxity measurements, or activity levels of the patients. Radiological signs of osteoarthritis were found in 2 patients. Eleven patients had a graft rupture: 8 in the single-bundle group and 3 in the double-bundle group ( P = .16). Three-dimensional computed tomography of the knees verified the positioning of the anteromedial bundle, posterolateral bundle, and single-bundle grafts to be within acceptable limits. CONCLUSION There was no difference in the KOOS QoL subscore, the remaining PROs, knee laxity measurements, or activity levels comparing the double- and single-bundle ACL reconstruction techniques. The number of bundles does not seem to influence clinical and subjective outcomes, as long as the tunnels are adequately positioned. Registration: NCT01033188 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Cathrine Aga
- Department of Orthopedic Surgery, Martina Hansens Hospital, Bærum, Norway.,Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - May Arna Risberg
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Sports Trauma Research Center, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Steinar Johansen
- Department of Orthopedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Ingrid Trøan
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Stig Heir
- Department of Orthopedic Surgery, Martina Hansens Hospital, Bærum, Norway.,Oslo Sports Trauma Research Center, Oslo, Norway
| | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Similar cost-utility for double- and single-bundle techniques in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:634-647. [PMID: 28939947 PMCID: PMC5794842 DOI: 10.1007/s00167-017-4725-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/15/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim was to estimate the cost-utility of the DB technique (n = 53) compared with the SB (n = 50) technique 2 years after ACL reconstruction. METHODS One hundred and five patients with an ACL injury were randomised to either the Double-bundle (DB) or the Single-bundle (SB) technique. One hundred and three patients (SBG n = 50, DBG n = 53) attended the 2-year follow-up examination. The mean age was 27.5 (8.4) years in the SBG and 30.1 (9.1) years in the DBG. The cost per quality-adjusted life years (QALYs) was used as the primary outcome. Direct costs were the cost of health care, in this case outpatient procedures. Indirect costs are costs related to reduce work ability for health reasons. The cost-utility analysis was measured in terms of QALY gained. RESULTS The groups were comparable in terms of clinical outcome. Operating room time was statistically significantly longer in the DBG (p = 0.001), making the direct costs statistically significantly higher in the DBG (p = 0.005). There was no significant difference in QALYs between groups. In the cost-effectiveness plane, the mean difference in costs and QALYs from the trial data using 1000 bootstrap replicates in order to visualise the uncertainty associated with the mean incremental cost-effectiveness ratio (ICER) estimate showed that the ICERs were spread out over all quadrants. The cost-effectiveness acceptability curve showed that there was a 50% probability of the DB being cost-effective at a threshold of Euro 50,000. CONCLUSION The principal findings are that the DB is more expensive from a health-care perspective. This suggests that the physician may choose individualised treatment to match the patients' expectations and requirements.
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Variations in Knee Kinematics After ACL Injury and After Reconstruction Are Correlated With Bone Shape Differences. Clin Orthop Relat Res 2017; 475:2427-2435. [PMID: 28451863 PMCID: PMC5599391 DOI: 10.1007/s11999-017-5368-8] [Citation(s) in RCA: 30] [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 The factors that contribute to the abnormal knee kinematics after anterior cruciate ligament (ACL) injury and ACL reconstruction remain unclear. Bone shape has been implicated in the development of hip and knee osteoarthritis, although there is little knowledge about the effects of bone shape on knee kinematics after ACL injury and after ACL reconstruction. QUESTIONS/QUESTIONS: (1) What is the relationship between bony morphology with alterations in knee kinematics after ACL injury? (2) Are baseline bone shape features related to abnormal knee kinematics at 12 months after ACL reconstruction? METHODS Thirty-eight patients (29 ± 8 years, 21 men) were prospectively followed after acute ACL injury and before ligamentous reconstruction. Patients were excluded if there was a history of prior knee ligamentous injury, a history of inflammatory arthritis, associated meniscal tears that would require repair, or any prior knee surgery on either the injured or contralateral side. In total, 54 patients were recruited with 42 (78%) patients completing 1-year followup and four patients excluded as a result of incomplete or unusable imaging data. MR images were obtained for the bilateral knees at two time points 1 year apart for both the injured (after injury but before reconstruction and 1 year after reconstruction) and contralateral uninjured knees. Kinematic MRI was performed with the knee loaded with 25% of total body weight, and static images were obtained in full extension and in 30° of flexion. The side-to-side difference (SSD) between tibial position in the extended and flexed positions was determined for each patient. Twenty shape features, referred to as modes, for the tibia and femur each were extracted independently from presurgery scans with the principal component analysis-based statistical shape modeling algorithm. Spearman rank correlations were used to evaluate the relationship between the SSD in tibial position and bone shape features with significance defined as p < 0.05. Each of the shape features (referred to as the bone and mode number such as Femur 18 for the 18th unique femoral bone shape) associated with differences in tibial position was then investigated by modeling the mean shape ± 3 SDs. RESULTS Two of the 20 specific femur bone shape features (Femur 10, Femur 18) and two of the 20 specific tibial bone shape features (Tibia 19, Tibia 20) were associated with an increasingly anterior SSD in the tibial position for the patients with ACL injury before surgical treatment. The shape features described by these modes include the superoinferior height of the medial femoral condyle (Femur 18; ρ = 0.33, p = 0.040); the length of the anterior aspect of the lateral tibial plateau (Tibia 20; ρ = -0.35, p = 0.034); the sphericity of the medial femoral condyle (Femur 10; ρ = -0.52, p < 0.001); and tibial slope (Tibia 19; ρ = 0.34; p = 0.036). One year after surgical treatment, there were two of 20 femoral shape features that were associated with SSD in the tibial position in extension (Femur 10, Femur 18), one of 20 femoral shape features associated with SSD in the tibial position in flexion (Femur 10), and three of 20 tibial shape features associated with SSD in the tibial position in flexion (Tibia 2, Tibia 4, Tibia 19). The shape features described by these modes include the sphericity of the medial femoral condyle (Femur 10; ρ = -0.38, p = 0.020); the superoinferior height of the medial femoral condyle (Femur 18; ρ = 0.34, p = 0.035); the height of the medial tibial plateau (Tibia 2; ρ = -0.32, p = 0.048); the AP length of the lateral tibial plateau (Tibia 4; ρ = -0.37, p = 0.021); and tibial slope (Tibia 19; ρ = 0.34, p = 0.038). CONCLUSIONS We have observed multiple bone shape features in the tibia and the femur that may be associated with abnormal knee kinematics after ACL injury and ACL reconstruction. Future directions of research will include the influence of bony morphology on clinical symptoms of instability in patients with and without ACL reconstruction and the long-term evaluation of these shape factors to better determine specific contributions to posttraumatic arthritis and graft failure. LEVEL OF EVIDENCE Level II, therapeutic study.
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Silva LO, Mendes LMR, Lima PODP, Almeida GPL. Translation, cross-adaptation and measurement properties of the Brazilian version of the ACL-RSI Scale and ACL-QoL Questionnaire in patients with anterior cruciate ligament reconstruction. Braz J Phys Ther 2017; 22:127-134. [PMID: 28941959 PMCID: PMC5883994 DOI: 10.1016/j.bjpt.2017.09.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 01/13/2023] Open
Abstract
The Brazilian versions of ACL-RSI and ACL-QoL were translated and culturally adapted. The Brazilian ACL-RSI and ACL-QoL demonstrated adequate measurement properties. The Brazilian ACL-RSI and ACLQoL are useful outcomes for clinical and research.
Background Scales to assess the quality of life and return-to-sport after reconstruction of the anterior cruciate ligament (ACL) may help the clinical decision-making process. Objective To cross-culturally adapt and determine the validity of the Brazilian versions of the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) and the Quality of Life Questionnaire (ACL-QoL). Methods The process of translation and cross-cultural adaptation followed the recommendations of international guidelines. One hundred participants filled out the Brazilian versions of these instruments, the Tampa Scale for Kinesiophobia (TSK), the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and the 36-Item Short Form Health Survey (SF-36). The measurement properties of reliability, internal consistency and construct validity were measured. Results The ACL-RSI and the ACL-QoL were successfully translated and cross-culturally adapted. Both questionnaires showed good test–retest reliability (ICC2,1 = 0.78, 95% CI = 0.67–0.85 for the ACL-RSI; and ICC2,1 = 0.84, 95% CI = 0.76–0.90 for the ACL-QoL) and good internal consistency (Cronbach's alpha = 0.87 for the ACL-RSI; and Cronbach's alpha = 0.96 for the ACL-QoL). A reasonable correlation was found between both questionnaires and the TSK, and a low to reasonable correlation was found between the questionnaires and the SF-36 in terms of validity. Compared to the IKDC Subjective Knee Evaluation Form, the ACL-RSI had a reasonable correlation and the ACL-QoL had a good correlation. Conclusion The Brazilian versions of the ACL-RSI and the ACL-QoL have adequate measurement properties and may be used in assessing Brazilians after ACL reconstruction.
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Affiliation(s)
- Laryssa Oliveira Silva
- Department of Physical Therapy, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil; Knee Research Group, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil
| | - Luana Maria Ramos Mendes
- Department of Physical Therapy, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil; Knee Research Group, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil
| | - Pedro Olavo de Paula Lima
- Department of Physical Therapy, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil; Knee Research Group, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil
| | - Gabriel Peixoto Leão Almeida
- Department of Physical Therapy, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil; Knee Research Group, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil.
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Buyukdogan K, Laidlaw MS, Miller MD. Two-Stage Revision Anterior Cruciate Ligament Reconstruction Using Allograft Bone Dowels. Arthrosc Tech 2017; 6:e1297-e1302. [PMID: 29354432 PMCID: PMC5622280 DOI: 10.1016/j.eats.2017.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/11/2017] [Indexed: 02/03/2023] Open
Abstract
Revision anterior cruciate ligament (ACL) reconstruction is substantially more challenging than primary reconstruction. Management of previously malpositioned or widened tunnels often requires innovative approaches for managing bony defects. Massive osteolysis with poor bone stock and convergence or overlapping of revision tunnels into the previously placed tunnels may necessitate a staged revision procedure. In this surgical technique description, we describe a method for the management of bony deficiencies using allograft bone dowels in staged revision ACL reconstruction.
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Affiliation(s)
| | | | - Mark D. Miller
- Address correspondence to Mark D. Miller, M.D., Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Suite 300, Charlottesville, VA 22903, U.S.A.Department of Orthopaedic SurgeryUniversity of Virginia400 Ray C. Hunt Drive, Suite 300CharlottesvilleVA22903U.S.A.
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Biomechanical Factors Associated With Pain and Symptoms Following Anterior Cruciate Ligament Injury and Reconstruction. PM R 2017; 10:56-63. [PMID: 28602934 DOI: 10.1016/j.pmrj.2017.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/08/2017] [Accepted: 05/20/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Few studies have investigated the associations between patient-reported outcome and gait in patients with anterior cruciate ligament (ACL) injury and reconstruction over time. Because there is an association between ACL rupture and the presence of osteoarthritis later in life, a better understanding of these relationships will help to elucidate how patients' gait pattern may affect pain and symptoms, potentially leading to better treatment for or preventing the development of knee OA. OBJECTIVE To evaluate the associations between gait characteristics and self-reported pain and symptoms before, 6 months after, and 1 year after anterior cruciate ligament reconstruction. DESIGN Prospective cohort study. SETTING The Human Performance Center at the Orthopedic Institute at the University of California, San Francisco. PATIENTS Patients with full unilateral ACL tears were enrolled. A total of 43 patients were included at 12 months postsurgery. METHODS The independent variable in this study comprised specific gait variables in patients who had undergone ACL reconstruction. At each time point, 3-dimensional motion analysis was performed. Participants also completed the Knee Osteoarthritis Outcome Score (KOOS) questionnaire. MAIN OUTCOMES MEASUREMENTS The primary study outcome measurement was the KOOS and was planned before data collection began. Partial correlations were used to examine cross-sectional associations between gait characteristics and KOOS pain and symptom scores at all time points. In addition, partial correlations were performed to examine the associations between change in postoperative KOOS from 6 months to 1 year and gait characteristics at baseline and 6 months. RESULTS Significant associations between KOOS and gait characteristics were found at all time points, including an association between peak medial ground reaction force and pain (r = -0.344, P = .02) and symptoms (r = -0.407, P = .007) at baseline. CONCLUSIONS Specific gait variables may be predictive of greater pain and symptoms and less improvement over time postreconstruction. This could help to inform rehabilitation exercises post injury and pre reconstruction. LEVEL OF EVIDENCE IV.
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Lanzetti RM, Lupariello D, De Carli A, Monaco E, Guzzini M, Fabbri M, Vadalà A, Ferretti A. Can the outside-in half-tunnel technique reduce femoral tunnel widening in anterior cruciate ligament reconstruction? A CT study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:659-664. [PMID: 28389757 DOI: 10.1007/s00590-017-1950-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are different techniques for drilling the femoral tunnel in the anterior cruciate ligament reconstruction (ACLR), but their influence in the bone tunnel enlargement in unknown. The purpose of this study was to compare two different surgical techniques for evaluating femoral tunnel enlargement in ACLR. The hypothesis was that tunnel placement using the outside-in technique leads to less tunnel enlargement compared to the transtibial technique. METHODS Forty-four patients treated for ACLR between March 2013 and March 2014 were prospectively enrolled in this study. According to the surgical technique, subjects were assigned to Group A (Out-in) or Group B (Transtibial). All patients underwent CT examination in order to evaluate the femoral tunnel enlargement at four different levels. Moreover, all patients were evaluated with the Lachman test and pivot shift test, and the KT1000 arthrometer was used to measure the anterior laxity of the knee. A subjective evaluation was performed using the 2000 International Knee Documentation Committee Subjective Knee score, Lysholm knee score and Tegner activity scale. All patients were assessed after 24 months of follow-up. RESULTS At the final follow-up, there were statistically significant differences (p < 0.05) in femoral tunnel enlargement between the two groups at all four femoral levels in favor of the out-in group. No statistical significant differences were found in the objective and subjective clinical outcomes between the two groups (p > 0.05). CONCLUSIONS In ACLR with a suspension system, the outside-in technique leads to less enlargement of the femoral tunnel lower than the transtibial technique.
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Affiliation(s)
- Riccardo Maria Lanzetti
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, RM, Italy
| | - Domenico Lupariello
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, RM, Italy.
| | - Angelo De Carli
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, RM, Italy
| | - Edoardo Monaco
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, RM, Italy
| | - Matteo Guzzini
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, RM, Italy
| | - Mattia Fabbri
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, RM, Italy
| | - Antonio Vadalà
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, RM, Italy
| | - Andrea Ferretti
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, RM, Italy
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Jacobs CA, Burnham JM, Makhni E, Malempati CS, Swart E, Johnson DL. Allograft Augmentation of Hamstring Autograft for Younger Patients Undergoing Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2017; 45:892-899. [PMID: 28298052 DOI: 10.1177/0363546516676079] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Younger patients and those with smaller hamstring autograft diameters have been shown to be at significantly greater risk of graft failure after anterior cruciate ligament (ACL) reconstruction. To date, there is no information in the literature about the clinical success and/or cost-effectiveness of increasing graft diameter by augmenting with semitendinosus allograft tissue for younger patients. HYPOTHESIS Hybrid hamstring grafts are a cost-effective treatment option because of a reduced rate of graft failure. STUDY DESIGN Cohort study (economic and decision analysis); Level of evidence, 3. METHODS We retrospectively identified patients younger than 18 years who had undergone ACL reconstruction by a single surgeon between 2010 and 2015. During this period, the operating surgeon's graft selection algorithm included the use of bone-patellar tendon-bone (BTB) autografts for the majority of patients younger than 18 years. However, hamstring autografts (hamstring) or hybrid hamstring autografts with allograft augment (hybrid) were used in skeletally immature patients and in those whom the surgeon felt might have greater difficulty with postoperative rehabilitation after BTB graft harvest. Patient demographics, graft type, graft diameter, the time the patient was cleared to return to activity, and the need for secondary surgical procedures were compared between the hamstring and hybrid groups. The clinical results were then used to assess the potential cost-effectiveness of hybrid grafts in this select group of young patients with an ACL injury or reconstruction. RESULTS This study comprised 88 patients (hamstring group, n = 46; hybrid group, n = 42). The 2 groups did not differ in terms of age, sex, timing of return to activity, or prevalence of skeletally immature patients. Graft diameters were significantly smaller in the hamstring group (7.8 vs 9.9 mm; P < .001), which corresponded with a significantly greater rate of graft failure (13 of 46 [28.3%] vs 5 of 42 [11.9%]; P = .049). As a result of the reduced revision rate, the hybrid graft demonstrated incremental cost savings of US$2765 compared with the hamstring graft, and the hybrid graft was the preferred strategy in 89% of cases. CONCLUSION Driven by increased graft diameters and the reduced risk of revision, hybrid grafts appear to be a more cost-effective treatment option in a subset of younger patients with an ACL injury.
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Affiliation(s)
- Cale A Jacobs
- Department of Orthopedics and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Jeremy M Burnham
- Department of Orthopedics and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eric Makhni
- Department of Orthopedic Surgery, Rush University, Chicago, Illinois, USA
| | - Chaitu S Malempati
- Department of Orthopedics and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Eric Swart
- Columbia University Medical Center, New York, New York, USA
| | - Darren L Johnson
- Department of Orthopedics and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
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Bojicic KM, Beaulieu ML, Imaizumi Krieger DY, Ashton-Miller JA, Wojtys EM. Association Between Lateral Posterior Tibial Slope, Body Mass Index, and ACL Injury Risk. Orthop J Sports Med 2017; 5:2325967116688664. [PMID: 28255568 PMCID: PMC5315236 DOI: 10.1177/2325967116688664] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: While body mass index (BMI), a modifiable parameter, and knee morphology, a nonmodifiable parameter, have been identified as risk factors for anterior cruciate ligament (ACL) rupture, the interaction between them remains unknown. An understanding of this interaction is important because greater compressive axial force (perhaps due to greater BMI) applied to a knee that is already at an increased risk because of its geometry, such as a steep lateral posterior tibial slope, could further increase the probability of ACL injury. Purpose: To quantify the relationship between BMI and select knee morphological parameters as potential risk factors for ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: Sagittal knee magnetic resonance imaging (MRI) files from 76 ACL-injured and 42 uninjured subjects were gathered from the University of Michigan Health System’s archive. The posterior tibial slope (PTS), middle cartilage slope (MCS), posterior meniscus height (PMH), and posterior meniscus bone angle (MBA) in the lateral compartment were measured using MRI. BMI was calculated from demographic data. The association between the knee structural factors, BMI, and ACL injury risk was explored using univariate and multivariate logistic regression. Results: PTS (P = .043) and MCS (P = .037) significantly predicted ACL injury risk. As PTS and MCS increased by 1°, odds of sustaining an ACL injury increased by 12% and 13%, respectively. The multivariate logistic regression analysis, which included PTS, BMI centered around the mean (cBMI), and their interaction, showed that this interaction predicted the odds of ACL rupture (P = .050; odds ratio, 1.03). For every 1-unit increase in BMI from the average that is combined with a 1° increase in PTS, the odds of an ACL tear increased by 15%. Conclusion: An increase in BMI was associated with increased risk of ACL tear in the presence of increased lateral posterior tibial slope. Larger values of PTS or MCS were associated with an increased risk of ACL tear.
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Affiliation(s)
| | - Mélanie L Beaulieu
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - James A Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA.; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Edward M Wojtys
- MedSport, Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Lord BR, El-Daou H, Sabnis BM, Gupte CM, Wilson AM, Amis AA. Biomechanical comparison of graft structures in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:559-568. [PMID: 27637854 PMCID: PMC5331106 DOI: 10.1007/s00167-016-4316-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/01/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction may offer kinematic restoration superior to anatomic single bundle (SB), but it remains technically challenging. The femoral attachment site has the most effect on ACL graft isometry, so a simplified three-socket (3S) construct which still uses two sockets to cover the femoral ACL attachment is attractive. It was hypothesised that ACL reconstruction using three- and four-socket techniques would more closely restore native knee kinematics compared to anatomic two-socket (SB) surgery. METHODS Nine cadaveric knees were used to evaluate the kinematics of ACL-intact, ACL-deficient, anatomic SB, three-socket, and DB arthroscopic ACL reconstructions. Suspensory fixation was used, and grafts were tensioned to match the anterior draw of the intact knee at 20°. A six-degree-of-freedom robotic system measured knee laxity under 90 N anterior tibial force and rotational laxity under 5 N-m torque. Combined moments were applied to simulate the pivot-shift subluxation: 4 N-m internal rotation and 8 N-m valgus. RESULTS Significant differences between reconstructions were not found during anterior tibial loading, apart from SB being more lax than DB at 60° flexion. All reconstructions produced comparable laxity to the intact state, apart from SB at 60°. Significant differences between reconstructions were not found at any flexion angle during tibial internal/external applied torques. Under combined loading, DB produced significantly less laxity than SB constructs apart from anterior tibial translation at 0° and internal rotation at 45°. 3S and DB were comparable to the native knee throughout. CONCLUSION Although 3S restored laxities to a similar extent to DB, significant superiority over SB surgery was not observed. Although statistically significant differences were found between SB and DB surgery during anterior tibial and simulated pivot-shift loading, both remained similar to the native knee. The clinical relevance is that this study did not support an ACL graft construct more complex than an anatomic single bundle.
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Affiliation(s)
- Breck R. Lord
- 0000 0001 2113 8111grid.7445.2The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ UK ,0000 0004 0400 7883grid.414262.7Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Hadi El-Daou
- 0000 0001 2113 8111grid.7445.2The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ UK
| | - Bhushan M. Sabnis
- 0000 0004 0400 7883grid.414262.7Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Chinmay M. Gupte
- 0000 0001 2113 8111grid.7445.2Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine, Charing Cross Hospital, London, UK
| | - Adrian M. Wilson
- 0000 0004 0400 7883grid.414262.7Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Andrew A. Amis
- 0000 0001 2113 8111grid.7445.2The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ UK ,0000 0001 2113 8111grid.7445.2Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine, Charing Cross Hospital, London, UK
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Suter LG, Smith SR, Katz JN, Englund M, Hunter DJ, Frobell R, Losina E. Projecting Lifetime Risk of Symptomatic Knee Osteoarthritis and Total Knee Replacement in Individuals Sustaining a Complete Anterior Cruciate Ligament Tear in Early Adulthood. Arthritis Care Res (Hoboken) 2016; 69:201-208. [PMID: 27214559 DOI: 10.1002/acr.22940] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/19/2016] [Accepted: 05/17/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To estimate the lifetime risk of knee osteoarthritis (OA) and total knee replacement (TKR) in persons sustaining anterior cruciate ligament (ACL) tear by age 25 years. METHODS We used the Osteoarthritis Policy Model to project the cumulative incidence of symptomatic knee OA requiring TKR in varying situations: no prevalent or incident injury; isolated ACL tear, surgically treated; isolated ACL tear, nonoperatively treated; or a prevalent history or surgically treated ACL and meniscal tear (MT). We estimated MT prevalence and incidence and increased risk of knee OA associated with ACL injury and MT from published literature. We conducted a range of sensitivity analyses to examine the impact of uncertainty in input parameters. RESULTS Estimated lifetime risk of symptomatic knee OA was 34% for the cohort with ACL injury and MT, compared to 14% for the no-injury cohort. ACL injury without MT was associated with a lifetime risk of knee OA between 16% and 17%, depending on ACL treatment modality. Estimated lifetime risk of TKR ranged from 6% in the no-injury cohort to 22% for the ACL injury and MT cohort. Subjects in the ACL injury and MT cohort developed OA approximately 1.5 years earlier (55.7 versus 57.1) and underwent TKR approximately 2 years earlier (66 versus 68) than the cohort without knee injuries. CONCLUSION Sustaining ACL injury early in adulthood leads to greater lifetime risk and earlier onset of knee OA and TKR; concomitant MTs compound this risk. These data provide insight into the impact of sustainable injury prevention interventions in young adults.
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Affiliation(s)
- Lisa G Suter
- Yale School of Medicine, Yale New Haven Health Services Corporation Center for Outcome Research and Evaluation, and VA Connecticut Healthcare System, West Haven
| | | | - Jeffrey N Katz
- Brigham and Women's Hospital, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts
| | - Martin Englund
- Lund University, Lund, Sweden, and Boston University School of Medicine, Boston, Massachusetts
| | - David J Hunter
- University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Elena Losina
- Brigham and Women's Hospital, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts
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Koga H, Engebretsen L, Fu FH, Muneta T. Revision anterior cruciate ligament surgery: state of the art. J ISAKOS 2016. [DOI: 10.1136/jisakos-2016-000071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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45
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Gong J, Pedoia V, Facchetti L, Link TM, Ma CB, Li X. Bone marrow edema-like lesions (BMELs) are associated with higher T 1ρ and T 2 values of cartilage in anterior cruciate ligament (ACL)-reconstructed knees: a longitudinal study. Quant Imaging Med Surg 2016; 6:661-670. [PMID: 28090444 DOI: 10.21037/qims.2016.12.11] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND To evaluate the longitudinal changes of bone marrow edema-like lesions (BMELs) in patients after anterior cruciate ligament (ACL) reconstruction and to investigate the effect of BMELs on cartilage matrix composition changes measured using MR T1ρ and T2 mapping. METHODS Patients with acute ACL tear were enrolled in a prospective study. MR imaging was performed at baseline (before surgeries) and at 6-month, 1-year and 2-year after ACL reconstruction. MR imaging included sagittal high-resolution, 3D fast spin-echo (CUBE) sequences for BMEL evaluation, and 3D T1ρ mapping and T2 mapping for cartilage assessment. BMELs were assessed using whole-organ magnetic resonance imaging score (WORMS), and the volume of BMELs was measured by a semi-automatic method. Generalized estimating equation (GEE) was used to explore association between BMELs at baseline and cartilage changes during follow-up. RESULTS Fifty four patients were included in the present study and 39 patients had completed 2-year follow-up. BMELs were noted in 42 injured knees (77.8%) with 105 lesions and in 7 contralateral knees (13.0%) with 9 lesions (χ2=45.763, P<0.001) at the baseline. The WORMS and volume of BMELs of the injured knees were 2.36±0.65 and 386.98±382.54 mm3 (r=0.681, P<0.001), respectively. 87 BMELs were found at baseline in 34 patients (87.2%) of the 39 patients who had completed 2 years follow-up. During the follow-up, 18 (20.7%), 12 (13.8%), and 5 (5.7%) baseline lesions were still seen at 6-month, 1-year and 2-year, respectively. The changes of BMELs prevalence regarding bone compartments over time points were statistically significant (χ2=163.660, P<0.001). Except T2 value at 6 months, T1ρ and T2 values of cartilage overlying baseline BMELs in the injured knees were higher than that of anatomically matched cartilage in the contralateral knees at baseline and each follow-up time-point. In the injured knees, GEE analysis showed that baseline BMELs were significantly associated with higher T1ρ and T2 values of cartilage after adjustment of age, gender, body mass index (BMI), effusion and meniscus tear. The association between BMELs and Knee Injury and Osteoarthritis Outcome Scores (KOOS) scores was not statistically significant. CONCLUSIONS BMEL is a common finding in patients with acute ACL injury and resolves rapidly over time after ACL reconstruction. It is often associated with increased T1ρ and T2 values of cartilage. BMEL at baseline is an independent predictor for faster cartilage degeneration during follow-up.
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Affiliation(s)
- Jingshan Gong
- Department of Radiology, Shenzhen People's Hospital, the Second Clinical Medical College, Jinan University, Shenzhen 518020, China;; Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94107, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94107, USA
| | - Luca Facchetti
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94107, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94107, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94107, USA
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94107, USA
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Fleaca R, Prejbeanu R, Feier AM, Russu O, Todor A, Predescu V, Codorean B, Bățagă T, Roman M. Single- or Double-Bundle Technique in the Anterior Cruciate Ligament Reconstruction — Current Concepts and Review of the Literature. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The treatment for anterior cruciate ligament (ACL) deficient knee consists in its surgical reconstruction. There are several available and validated techniques, but there are still numerous questions to be answered concerning the best approach in terms of stability, functional outcome, and avoiding further damage in the knee. This paper sought to analyze the studies published in the literature comparing the outcomes of ACL restoration with single-bundle versus double-bundle techniques. The results demonstrate that even if biomechanical studies find an increased steadiness with double-bundle ACL reconstruction, there seems to be no clinical or functional benefit compared with single-bundle reconstruction.
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Affiliation(s)
- Radu Fleaca
- “Victor Papillan” Faculty of Medicine, “Lucian Blaga” University, Sibiu, Romania
| | - Radu Prejbeanu
- “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
| | - Andrei-Marian Feier
- University of Medicine and Pharmacy, Tîrgu Mureș, Str. Gheorghe Marinescu nr. 38 540139, Romania
| | - Octav Russu
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Adrian Todor
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vlad Predescu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Bogdan Codorean
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Tiberiu Bățagă
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Mihai Roman
- “Victor Papillan” Faculty of Medicine, “Lucian Blaga” University, Sibiu, Romania
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Sacramento SN, Magalhães E, Christel P, Ingham S, Fukuda TY. A new technique in double-bundle anterior cruciate ligament reconstruction with implant-free tibial fixation. Knee Surg Sports Traumatol Arthrosc 2016; 24:2831-2837. [PMID: 25630275 DOI: 10.1007/s00167-014-3430-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This case-series outcome study presents a surgical technique for anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with 4-tunnel using two interference screws. There was a 2-year minimum follow-up. METHODS From January to December 2009, an ACL 4-tunnel, anatomic, double-bundle reconstruction was performed on 27 patients. Double-strand hamstring tendon grafts were used in each femoral tunnel as well as two interference screws. Tibial fixation was insured through manual tension, by tying non-absorbable sutures on the bone bridge between the two tunnels at 20° of knee flexion. Clinical assessments included the International Knee Documentation Committee (IKDC) and Lysholm knee scores, range of motion (ROM), pivot-shift test, single-leg hop, and quadriceps-hamstrings strength tests using a hand-held dynamometer. Anterior knee laxity was also assessed using a rolimeter. A single examiner performed all testing pre-operatively at 6 months and during the 2-year follow-up. RESULTS All patients were assessed during the 2-year follow-up. At that time, 92 % of the patients presented normal anterior laxity (average, 1.3 ± 0.5 mm) and rotational knee stability. No statistical side-to-side difference was found for ROM, muscle strength, single-leg hop, and function (n.s.). All patients presented a normal knee function according to the IKDC and the Lysholm score. In addition, no infection, graft failure, or pain were observed at the harvesting site. CONCLUSION The study shows that satisfactory results in relation to knee laxity, function, and strength can be achieved with the implant-free tibial fixation in the ACL double-bundle reconstruction with two interference screws. LEVEL OF EVIDENCE Therapeutic case series, Level IV.
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Affiliation(s)
| | | | | | - Sheila Ingham
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thiago Yukio Fukuda
- Santa Casa de São Paulo School of Medical Sciences (ISCMSP), Centro Universitário São Camilo (CUSC), São Paulo, SP, Brazil
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Saltzman BM, Cvetanovich GL, Nwachukwu BU, Mall NA, Bush-Joseph CA, Bach BR. Economic Analyses in Anterior Cruciate Ligament Reconstruction: A Qualitative and Systematic Review. Am J Sports Med 2016; 44:1329-35. [PMID: 25930672 DOI: 10.1177/0363546515581470] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND As the health care system in the United States (US) transitions toward value-based care, there is an increased emphasis on understanding the cost drivers and high-value procedures within orthopaedics. To date, there has been no systematic review of the economic literature on anterior cruciate ligament reconstruction (ACLR). PURPOSE To evaluate the overall evidence base for economic studies published on ACLR in the orthopaedic literature. Data available on the economics of ACLR are summarized and cost drivers associated with the procedure are identified. STUDY DESIGN Systematic review. METHODS All economic studies (including US-based and non-US-based) published between inception of the MEDLINE database and October 3, 2014, were identified. Given the heterogeneity of the existing evidence base, a qualitative, descriptive approach was used to assess the collective results from the economic studies on ACLR. When applicable, comparisons were made for the following cost-related variables associated with the procedure for economic implications: outpatient versus inpatient surgery (or outpatient vs overnight hospital stay vs >1-night stay); bone-patellar tendon-bone (BPTB) graft versus hamstring (HS) graft source; autograft versus allograft source; staged unilateral ACLR versus bilateral ACLR in a single setting; single- versus double-bundle technique; ACLR versus nonoperative treatment; and other unique comparisons reported in single studies, including computer-assisted navigation surgery (CANS) versus traditional surgery, early versus delayed ACLR, single- versus double-incision technique, and finally the costs of ACLR without comparison of variables. RESULTS A total of 24 studies were identified and included; of these, 17 included studies were cost identification studies. The remaining 7 studies were cost utility analyses that used economic models to investigate the effect of variables such as the cost of allograft tissue, fixation devices, and physical therapy, the percentage and timing of revision surgery, and the cost of revision surgery. Of the 24 studies, there were 3 studies with level 1 evidence, 8 with level 2 evidence, 6 with level 3 evidence, and 7 with level 4 evidence. The following economic comparisons were demonstrated: (1) ACLR is more cost-effective than nonoperative treatment with rehabilitation only (per 3 cost utility analyses); (2) autograft use had lower total costs than allograft use, with operating room supply costs and allograft costs most significant (per 5 cost identification studies and 1 cost utility analysis); (3) results on hamstring versus BPTB graft source are conflicting (per 2 cost identification studies); (4) there is significant cost reduction with an outpatient versus inpatient setting (per 5 studies using cost identification analyses); (5) bilateral ACLR is more cost efficient than 2 unilateral ACLRs in separate settings (per 2 cost identification studies); (6) there are lower costs with similarly successful outcomes between single- and double-bundle technique (per 3 cost identification studies and 2 cost utility analyses). CONCLUSION Results from this review suggest that early single-bundle, single (endoscopic)-incision outpatient ACLR using either BPTB or HS autograft provides the most value. In the setting of bilateral ACL rupture, single-setting bilateral ACLR is more cost-effective than staged unilateral ACLR. Procedures using CANS technology do not yet yield results that are superior to the results of a standard surgical procedure, and CANS has substantially greater costs.
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Affiliation(s)
- Bryan M Saltzman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory L Cvetanovich
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nathan A Mall
- St Louis Center for Cartilage Restoration and Repair Sports Medicine, St Louis, Missouri, USA
| | - Charles A Bush-Joseph
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bernard R Bach
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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49
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Panos JA, Hoffman JT, Wordeman SC, Hewett TE. Medio-lateral knee fluency in anterior cruciate ligament-injured athletes during dynamic movement trials. Clin Biomech (Bristol, Avon) 2016; 33:7-12. [PMID: 26895446 PMCID: PMC4821715 DOI: 10.1016/j.clinbiomech.2016.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 01/25/2016] [Accepted: 01/28/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Correction of neuromuscular impairments after anterior cruciate ligament injury is vital to successful return to sport. Frontal plane knee control during landing is a common measure of lower-extremity neuromuscular control and asymmetries in neuromuscular control of the knee can predispose injured athletes to additional injury and associated morbidities. Therefore, this study investigated the effects of anterior cruciate ligament injury on knee biomechanics during landing. METHODS Two-dimensional frontal plane video of single leg drop, cross over drop, and drop vertical jump dynamic movement trials was analyzed for twenty injured and reconstructed athletes. The position of the knee joint center was tracked in ImageJ software for 500 milliseconds after landing to calculate medio-lateral knee motion velocities and determine normal fluency, the number of times per second knee velocity changed direction. The inverse of this calculation, analytical fluency, was used to associate larger numerical values with fluent movement. FINDINGS Analytical fluency was decreased in involved limbs for single leg drop trials (P=0.0018). Importantly, analytical fluency for single leg drop differed compared to cross over drop trials for involved (P<0.001), but not uninvolved limbs (P=0.5029). For involved limbs, analytical fluency values exhibited a stepwise trend in relative magnitudes. INTERPRETATION Decreased analytical fluency in involved limbs is consistent with previous studies. Fluency asymmetries observed during single leg drop tasks may be indicative of abhorrent landing strategies in the involved limb. Analytical fluency differences in unilateral tasks for injured limbs may represent neuromuscular impairment as a result of injury.
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Affiliation(s)
- Joseph A. Panos
- Department of Biomedical Engineering, Columbus, OH, USA, 43210
| | - Joshua T. Hoffman
- Sports Health and Performance Institute (SHPI) OSU Sports Medicine, Columbus, OH, USA, 43210
| | - Samuel C. Wordeman
- Sports Health and Performance Institute (SHPI) OSU Sports Medicine, Columbus, OH, USA, 43210
| | - Timothy E. Hewett
- Department of Biomedical Engineering, Columbus, OH, USA, 43210,Sports Health and Performance Institute (SHPI) OSU Sports Medicine, Columbus, OH, USA, 43210,The Ohio State University, Columbus, OH, USA, 43210,Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA, 44905,Departments of Physiology and Biomedical Engineering, and Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA, 44905
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50
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Gribbin TC, Slater LV, Herb CC, Hart JM, Chapman RM, Hertel J, Kuenze CM. Differences in hip-knee joint coupling during gait after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2016; 32:64-71. [PMID: 26851564 DOI: 10.1016/j.clinbiomech.2016.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/25/2015] [Accepted: 01/19/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND After anterior cruciate ligament injury, patients have increased risk for developing degenerative osteoarthritis, potentially due to the kinematic changes that persist after surgical reconstruction. Current research only describes single joint kinematic differences rather than the way in which two joints behave concurrently, termed joint coupling. The purpose of this study was to compare knee motion relative to hip motion in anterior cruciate ligament reconstructed and healthy limbs during walking and jogging. METHODS Thirty-seven recreationally active volunteers (22 reconstructed, 15 healthy) walked and jogged at 4.83 km/h and 9.66 km/h respectively. Vector coding methods were used to calculate stride-to-stride variability, magnitude, and vector angle of 6 joint couples during walking and jogging: hip frontal-knee frontal planes, hip frontal-knee sagittal, hip frontal-knee transverse, hip sagittal-knee frontal, hip sagittal-knee transverse, and hip transverse-knee frontal planes. FINDINGS The hip sagittal-knee frontal and hip sagittal-knee transverse joint couples had decreased variability during mid-stance, and all other couples had increased variability during the stance phase in the reconstructed group. The reconstructed group had decreased magnitude of joint excursion in the hip frontal-knee sagittal couple during all phases of gait during walking. Vector angles of the hip frontal-knee transverse couple increased in the reconstructed group during the loading, middle, and terminal stance phases, and swing phase of gait during walking. INTERPRETATION The increased variability and decreased magnitude of joint excursion indicate that movement patterns were less consistent during walking gait despite employing a more constrained system during movement in the reconstructed limb compared to healthy controls.
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Affiliation(s)
- Timothy C Gribbin
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22904, USA
| | - Lindsay V Slater
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22904, USA.
| | - C Collin Herb
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22904, USA
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22904, USA
| | - Ryan M Chapman
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22904, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22904, USA
| | - Christopher M Kuenze
- Department of Kinesiology, Michigan State University, East Lansing, MI 48824, USA
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