1
|
Seppänen A, Kiekara T, Suomalainen P, Mäenpää H, Huhtala H, Järvelä T. No difference was found between double-bundle and single-bundle anterior cruciate ligament reconstructions in terms of osteoarthritis at 15-year follow-up. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38819943 DOI: 10.1002/ksa.12304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE The purpose of the study was to determine whether the grade of osteoarthritis (OA) is higher with single-bundle (SB) or double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. The hypothesis was that there will be no difference in the grade of OA between the techniques. METHODS This study was a randomised controlled trial (RCT) with a follow-up period of 15 years. Patients were randomly assigned to either the SB group (n = 78) or the DB group (n = 75). Surgical techniques were anatomic, and the rehabilitation protocol was standardised. Evaluation included Kellgren-Lawrence (KL) difference and absolute OA results. OA was defined as a KL grade of at least 2. RESULTS At 15-year follow-up, information was available on 101 patients (66%), of whom 56 (37%) were accepted in the final statistical analysis. No difference was found between the SB and DB techniques in terms of KL difference or absolute OA results. Significantly less OA was found in the contralateral knee (21%) than in the reconstructed knee (59%) (p < 0.001). Patients with meniscal tears who underwent partial meniscal resection during ACL reconstruction had a significantly higher rate of OA changes (82%) compared with patients with isolated ACL tears (33%) (p < 0.001). A longer delay between initial injury and surgery did not appear to affect the severity of the KL classification. CONCLUSION At 15-year follow-up, no difference was found between the DB and SB techniques in terms of OA. LEVEL OF EVIDENCE Level I.
Collapse
Affiliation(s)
- Arttu Seppänen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tommi Kiekara
- Medical Imaging Center, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Piia Suomalainen
- Head of Tampere University Hospital Orthopaedics Trauma Unit, Tampere, Finland
| | - Heikki Mäenpää
- Department of Orthopaedics, Tampere University Hospital, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Timo Järvelä
- Sports Medicine and Arthroscopic Center, Hospital Mehiläinen, Tampere, Finland
| |
Collapse
|
2
|
Roberts J, Puzzitiello R, Salzler M. Anterior Cruciate Ligament Reconstruction in Patients Over 40 Years Old Shows Low Failure Rates: A Systematic Review. Arthrosc Sports Med Rehabil 2024; 6:100899. [PMID: 38706974 PMCID: PMC11065657 DOI: 10.1016/j.asmr.2024.100899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/12/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose To review the literature reporting on complications and failure rates after primary anterior cruciate ligament reconstruction (ACLR) in patients ≥40 years. Methods This was a secondary analysis from a prior systematic review of the MEDLINE, CINAHL, SportDiscus, Embase, Web of Science, and Cochrane databases on studies evaluating clinical outcomes in ACLR patients ≥40 years. Studies were included based on the following criteria: English-language studies reporting on postoperative complications and/or ACLR failure rates in patients ≥40 years. Case reports, technical notes, studies with duplicate reporting of patient cohorts, or studies using publicly available registry data were excluded. ACLR failure definitions, failure rates, graft rupture rates, revision ACLR and non-ACLR revision rates, and complication rates were recorded. Results Twenty-one studies were included following full-text review. Autografts were used in 89.0% of cases. Definitions for ACLR failure varied, ranging from (1) revision ACLR, (2) graft rupture, (3) clinical examination of increased knee laxity, and (4) postoperative arthrofibrosis requiring an additional surgery. The median ACLR failure rate was 5.0% (range, 0%-12.1%) among the 9 studies reporting this outcome, with only 4 of the studies providing explicit definitions of failure. The median ACLR revision surgery, graft rupture, and non-ACLR revision surgery rates were 0% (range, 0%-7.7%), 2.7% (range, 0%-9.1%), and 7.2% (range 0%-34.4%), respectively. Commonly reported complications included pain (range, 0%-14.0%), stiffness (range, 0%-12.7%), hematoma (range, 2.5%-8.8%), neurovascular (range, 0%-41.7%), and undefined (range, 0%-13.8%). Conclusions ACLR in patients over 40 years old shows low failure rates. Level of Evidence Level IV, systematic review of Level II-IV studies.
Collapse
Affiliation(s)
- John Roberts
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Richard Puzzitiello
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Matthew Salzler
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| |
Collapse
|
3
|
Yang JS, Prentice HA, Reyes CE, Lehman CR, Maletis GB. Risk of Revision and Reoperation After Quadriceps Tendon Autograft ACL Reconstruction Compared With Patellar Tendon and Hamstring Autografts in a US Cohort of 21,973 Patients. Am J Sports Med 2024; 52:670-681. [PMID: 38284229 DOI: 10.1177/03635465231222267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND The use of quadriceps tendon (QT) autografts has increased in the past 10 years. However, there remains a dearth of large studies examining the effects of graft selection on anterior cruciate ligament reconstruction (ACLR) that includes QT grafts. PURPOSE To evaluate the risk of subsequent surgical outcomes, including revision and reoperation, for a large cohort of patients with primary ACLR according to autograft selection. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Data from a US health care system ACLR registry were used to conduct a cohort study. Primary isolated autograft ACLRs were identified (2012-2021). The exposure of interest was autograft type: QT, bone-patellar tendon-bone (BPTB), and hamstring tendon (HT). Multivariable Cox regression models were used to evaluate the risk of aseptic revision (defined as a subsequent surgery where removal and replacement of the original graft for noninfectious reasons was required) and risk of aseptic reoperation (defined as any subsequent surgery for noninfectious reasons where the graft was left intact) according to autograft selection. RESULTS The study sample comprised 21,973 ACLRs performed by 290 surgeons at 53 hospitals. QT, BPTB, and HT autografts were used in 1103 (5.0%), 9519 (43.3%), and 11,351 (51.7%) ACLRs, respectively. In adjusted models, no significant differences were observed in revision risk (hazard ratio [HR], 1.06; 95% CI, 0.60-1.89; P = .837) or reoperation risk (HR, 1.00; 95% CI, 0.70-1.43; P = .993) within 4 years of follow-up when comparing QT ACLR with BPTB ACLR. Additionally, no differences in 4-year revision (HR, 0.62; 95% CI, 0.34-1.12; P = .111) or reoperation (HR, 1.24; 95% CI, 0.85-1.80; P = .262) risks were observed when comparing QT ACLR with HT ACLR. HT ACLRs were noted to have a higher risk of revision (HR, 1.52; 95% CI, 1.25-1.84; P < .001) compared with BPTB ACLRs but a lower risk of reoperation (HR, 0.86; 95% CI, 0.75-0.98; P = .024). CONCLUSION In this large multicenter study using data from an ACLR registry, the authors found no difference in the risk of revision or reoperation when QT was compared with BPTB or HT autograft with the numbers available, but they did find a 1.5 times higher risk of revision when HT autograft was compared with BPTB autograft. Surgeons may use this information when choosing the appropriate graft for ACLR in their patients.
Collapse
Affiliation(s)
- Justin S Yang
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Los Angeles, California, USA
| | - Heather A Prentice
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California, USA
| | - Chelsea E Reyes
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California, USA
| | - Christopher R Lehman
- Department of Orthopedic Surgery, Permanente Medical Group, South San Francisco, California, USA
| | - Gregory B Maletis
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Baldwin Park, California, USA
| |
Collapse
|
4
|
Pulver M, Hilfiker R, Bizzini M, Mathieu N, Meyer S, Allet L. Clinical practice and barriers among Swiss physiotherapists treating patients with anterior cruciate ligament reconstruction: A survey of pre-operative rehabilitation to return to sport. Phys Ther Sport 2024; 65:38-48. [PMID: 38006798 DOI: 10.1016/j.ptsp.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVES To investigate current clinical practice of Swiss physiotherapists treating patients with anterior cruciate ligament reconstruction (ACLR) from pre-operative rehabilitation until return to sport (RTS). We assessed optimisation strategies in daily practice and the perceived barriers to these optimisations, and evaluated whether there was a relevant difference in clinical practice for physiotherapists with post-graduate certification in sports physiotherapy or deep clinical experience and those without such experience. DESIGN Cross-sectional survey. SETTING Online survey platform. PARTICIPANTS Swiss physiotherapists. MAIN OUTCOME MEASURES The survey comprised six sections: participant information, pre-operative rehabilitation, post-operative rehabilitation, RTS, re-injury prevention, and optimisation strategies and barriers. RESULTS A minority of physiotherapists treated ACLR patients pre-operatively. Overall, 91% included quadriceps open kinetic chain exercise in their treatment, 37% used patient-reported outcomes measures (PROMs) and 39% considered psychological criteria when making decisions about RTS. Most physiotherapists (67%) felt limited due to the time available, the number of prescriptions and the tariffication system. CONCLUSION This study highlights areas within ACLR rehabilitation practice in Switzerland that could be improve. Improvements in understanding of the barriers to implementation of best evidence in practice and a redefinition of the clinical process around ACLR rehabilitation in Switzerland are necessary.
Collapse
Affiliation(s)
- Mathieu Pulver
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Sion, Switzerland.
| | | | - Mario Bizzini
- Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Nicolas Mathieu
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Switzerland
| | - Stephan Meyer
- Sport Physiotherapy, Swiss Federal Institute of Sport Magglingen SFISM, Magglingen, Switzerland
| | - Lara Allet
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Sion, Switzerland; The Sense, Innovation & Research Center, Sion, Switzerland; Department of Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| |
Collapse
|
5
|
Sengoku T, Nakase J, Mizuno Y, Kanayama T, Ishida Y, Yanatori Y, Arima Y. Limited preoperative knee extension in anterior cruciate ligament reconstruction using a hamstring tendon affects improvement of postoperative knee extensor strength. Knee Surg Sports Traumatol Arthrosc 2023; 31:5621-5628. [PMID: 37857706 DOI: 10.1007/s00167-023-07620-8] [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: 06/23/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE This study aimed to determine the factors affecting knee extensor strength 6 months after anterior cruciate ligament (ACL) reconstruction using autograft hamstring tendon. METHODS 144 patients who could undergo regular follow-up after ACL reconstruction were divided into 2 groups: those with greater than 90% (Group A: n = 95) and less than 85% (Group B: n = 49) isokinetic knee contraction at 60°/s 6 months post-ACL reconstruction. Basic information, injury status, limited preoperative knee extension, and knee extensor strength at 3 and 6 months postoperatively were compared between the groups. Multivariate logistic analysis was performed and included variables that showed statistically significant differences between the groups in the univariate analysis. In addition, the cut-off value for the limb symmetry index (LSI) at 3 months postoperatively needed to exceed an LSI of 90% at 6 months postoperatively was calculated using the receiver operating characteristics curve. RESULTS Age, preoperative waiting period, limited preoperative knee extension, and knee extensor strength at 3 months postoperatively were significantly different between the two groups. The multivariate logistic analysis showed that all the variables affected the improvement in knee extensor strength at 6 months postoperatively. Limited preoperative knee extension was the most significant factor (odds ratio: 15.1, 95% confidence interval: 2.57-118.56, p < 0.01). The LSI cut-off value at 3 months postoperatively was 72.0%. CONCLUSION Key factors in achieving the necessary knee extensor strength criteria for return to sports at 6 months post-ACL reconstruction include addressing limited preoperative knee extension and achieving an LSI ≥ 72% in knee extensor strength at 3 months postoperatively. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Takuya Sengoku
- Section of Rehabilitation, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
| | - Yushin Mizuno
- Section of Rehabilitation, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Tomoyuki Kanayama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Yoshihiro Ishida
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Yusuke Yanatori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Yu Arima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| |
Collapse
|
6
|
Li J, Mao Y, Wang D, Fu W, Li Q, Tang X, Chen G, Chen X, Yao L, You M, Xiong Y, Li J. Correlation Between the Location and Distance of Kissing Contusions and Knee Laxity in Acute Noncontact ACL Injury. Am J Sports Med 2023; 51:3179-3189. [PMID: 37715506 DOI: 10.1177/03635465231196865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
BACKGROUND Bone bruise (BB) and kissing contusion are common features of acute anterior cruciate ligament (ACL) injury on magnetic resonance imaging (MRI). The correlation between the location and distance of kissing contusions and knee laxity remains unclear. PURPOSE To determine the significance of different patterns of BB in acute noncontact ACL injury and assess the correlation between the location and distance of kissing contusions and the severity of knee laxity. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 205 patients with acute noncontact ACL injury undergoing arthroscopic treatment between January 2021 and May 2022 were included in this retrospective analysis. Patients were grouped according to the different patterns of BB. The type of ACL injury and concomitant injuries were analyzed on MRI and confirmed by arthroscopy. Anterior knee laxity was assessed by the Ligs digital arthrometer and stress radiography, and rotational knee laxity was assessed by the intraoperative pivot-shift test. The MRI parameters of the location and distance of kissing contusions were measured to assess their correlations with the severity of knee laxity. RESULTS Of the 205 patients with acute noncontact ACL injury, 38 were in the non-BB group and 167 were in the BB group, the latter including 32 with the isolated BB on the lateral tibial plateau and 135 with kissing contusions. There was no significant difference in the mean time from initial injury to MRI scan between the non-BB group and the BB group (14.34 ± 2.92 vs 15.17 ± 2.86 days; P = .109) or between the isolated BB subgroup and the kissing contusion subgroup (14.94 ± 2.92 vs 15.23 ± 2.85 days; P = .605). The side-to-side difference (SSD) in anterior knee laxity and the incidences of complete ACL injury, concomitant injuries, and high-grade pivot-shift test were significantly higher in the BB group than in the non-BB group, and in the kissing contusion subgroup compared with the isolated BB subgroup. The kissing contusion index of the lateral femoral condyle (LFC) and the sagittal distance of kissing contusions were significantly correlated with the SSD in anterior knee laxity and the grade of pivot-shift test (P < .001). CONCLUSION The presence of BB, in particular the appearance of kissing contusions, was related to greater knee laxity and higher incidences of complete ACL injury and concomitant injuries in acute noncontact ACL injury. For patients with kissing contusions, as the location of BB on the LFC moved forward and the distance between kissing contusions increased, anterior and rotational knee laxity became more serious.
Collapse
Affiliation(s)
- Junqiao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yunhe Mao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Duan Wang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Chen
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Chen
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Yao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Mingke You
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Xiong
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
7
|
Fayard JM, Foissey C, Pacoret V, Abid H, Vieira TD, Gabr A, Thaunat M. Return to Sports After ACL Augmentation With Anterolateral Reconstruction (ALR) Harvesting Gracilis Only Compared With ACL Reconstruction With ALR Harvesting Both Hamstring Tendons. Am J Sports Med 2023; 51:2918-2927. [PMID: 37548031 DOI: 10.1177/03635465231187038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) repair (ACL-Rp) is known to be a valuable alternative to ACL reconstruction (ACL-Rc) in selected indications. The majority of the ACL-Rp techniques recommend the use of a synthetic brace. The use of the gracilis allows both a biological internal brace and anterolateral ligament reconstruction (ALR). PURPOSE The primary objective was to compare the early ability to return to sports between patients who underwent ACL-Rp using a gracilis autograft as an internal brace augmentation with ALR and patients who underwent the conventional ACL-Rc with ALR technique sacrificing both the gracilis and the semitendinosus. The secondary objective was to compare the failure rate, clinical scores, and return to sports at a minimum follow-up of 2 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis was undertaken. A total of 49 patients who underwent ACL-Rp with ALR between December 2018 and May 2019 were propensity matched at a 1:1 ratio to those who underwent ACL-Rc with ALR during the same period. The decision to perform ACL-Rp with ALR was based on preoperative selection and intraoperative arthroscopic findings: proximal avulsion tear, partial ACL tear, low- to midlevel sports participation, and good tissue quality. The ability to return to sports was assessed using isokinetic tests and the Knee Santy Athletic Return to Sport test functional test at 6 months postoperatively. At the final follow-up, knee laxity parameters, return to sports, and clinical outcome (Lysholm score, Tegner Activity Scale score, International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and Anterior Cruciate Ligament-Return to Sport after Injury score) were recorded. RESULTS The ACL-Rp group had significantly less hamstring strength deficit when compared with their counterparts who underwent ACL-Rc (0.2% vs 10.2% in concentric, P < .001; 2.5% vs 14% in eccentric, P < .001). The mean Knee Santy Athletic Return to Sport test score was significantly higher in the ACL-Rc group (69.7% ± 16.6% [range, 19%-100%] vs 61% ± 16.8% [range, 19%-100%]; P = .001). In the ACL-Rp group, 61% (30/49) of the patients were authorized to return to pivot sports versus 41% (20/49) in the ACL-Rc group (P = .04). At a mean final follow-up of 31.4 ± 3.5 months, no significant differences were demonstrated between groups with respect to clinical scores and knee laxity parameters. There was a trend for a higher failure rate in the ACL-Rp group without any significance (ACL-Rp: 6.1% [3/49] vs ACL-Rc: 0%; P = .08). CONCLUSION At 6 months after operation, harvesting only the gracilis with this ACL-Rp and augmentation with ALR technique was linked to a better early ability to return to sports compared with the ACL-Rc with ALR technique harvesting both the gracilis and semitendinosus. This technique had a limited effect on early flexion strength and provided a satisfactory rerupture rate.
Collapse
Affiliation(s)
- Jean-Marie Fayard
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Constant Foissey
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Victor Pacoret
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Hichem Abid
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Ayman Gabr
- University College London Hospital, London, United Kingdom
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Lyon, France
- Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| |
Collapse
|
8
|
Lemme NJ, Yang DS, Talley-Bruns R, Alsoof D, Daniels AH, Petit L, Fadale PD. Risk Factors and Outcomes for Preoperative Stiffness Requiring Intervention Before Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2023; 11:23259671231181371. [PMID: 37457045 PMCID: PMC10345918 DOI: 10.1177/23259671231181371] [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: 02/07/2023] [Accepted: 03/09/2023] [Indexed: 07/18/2023] Open
Abstract
Background To date, there is a scarcity of literature related to the incidence of prolonged stiffness after an anterior cruciate ligament (ACL) tear that requires manipulation under anesthesia/lysis of adhesions (MUA/LOA) in the preoperative period before ACL reconstruction (ACLR) and how preoperative stiffness influences outcomes after ACLR. Hypothesis Preoperative stiffness requiring MUA/LOA would increase the risk for postoperative stiffness, postoperative complications, and the need for subsequent procedures after ACLR. Study Design Cohort study; Level of evidence, 3. Methods The PearlDiver Research Program was used to identify patients who sustained an ACL tear and underwent ACLR using their respective International Classification of Diseases, 9th or 10th Revision, and Current Procedure Terminology (CPT) codes. Within this group, patients with preoperative stiffness were identified using the CPT codes for MUA or LOA. Significant risk factors for preoperative stiffness were identified through univariate and multivariate logistic regression analyses. Outcomes after ACLR were analyzed between patients with and without preoperative stiffness using multivariate logistic regression, controlling for age, sex, and Elixhauser Comorbidity Index. Results Between 2008 and 2018, 187,071 patients who underwent ACLR were identified. Of these patients, 241 (0.13%) underwent MUA/LOA before ACLR. Patients with preoperative stiffness began preoperative physical therapy significantly later than patients without stiffness (P = .0478) and had a delay in time to ACLR (P = .0003). Univariate logistic regression demonstrated that female sex, older age, anxiety/depression, obesity, and anticoagulation use were significant risk factors for preoperative stiffness (P < .05 for all). After multivariate regression, anticoagulation use was the only independent risk factor deemed significant (odds ratio, 6.69 [95% CI, 4.01-10.51]; P < .001). Patients with preoperative stiffness were at an increased risk of experiencing postoperative stiffness, deep vein thrombosis, pulmonary embolism, surgical-site infection, and septic knee arthritis after ACLR (P < .05 for all). Conclusion Although the risk of preoperative stiffness requiring an MUA/LOA before ACLR is low, the study findings indicated that patients with preoperative stiffness were at increased risk for postoperative complications compared with patients with no stiffness before ACLR.
Collapse
Affiliation(s)
- Nicholas J. Lemme
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel S. Yang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rachel Talley-Bruns
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel Alsoof
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alan H. Daniels
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Logan Petit
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Paul D. Fadale
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
9
|
Young BL, Hammond KE. Editorial Commentary: Limited Preoperative Range of Motion Is Associated With Range of Motion Deficits After Anterior Cruciate Ligament Reconstruction: "If the Knee Is Not Straight, Wait". Arthroscopy 2023; 39:1690-1691. [PMID: 37286287 DOI: 10.1016/j.arthro.2023.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 06/09/2023]
Abstract
Optimal timing of anterior cruciate ligament reconstruction (ACLR) remains under debate. Prolonging time between injury and ACLR risks damaging the meniscus and chondral surface, as well as delays return to play. Early ACLR may be associated with postoperative stiffness or arthrofibrosis. We emphasize that optimal timing for ACLR depends on criterion-based return of knee range of motion and quadriceps strength, not a quantitative temporal period. The length of time is far less important that the quality of prereconstruction care provided. Prereconstruction care includes "prehabilitation," including prone hangs focusing on optimizing knee range of motion, postinjury effusion resolution, and mentally preparing the patient for postoperative expectations. Defining preoperative criteria for proceeding with surgery is crucial to decrease the risk of arthrofibrosis. Some patients meet these criteria within 2 weeks, whereas others linger to 10 weeks. Reduction in arthrofibrosis requiring surgical intervention is multifactorial and not solely dependent on the length of time between injury and intervention.
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss treatment options, rehabilitation protocols, return-to-play criteria, and expected outcomes after non-operative and operative treatment of anterior cruciate ligament (ACL) tears among an athletic population. RECENT FINDINGS Non-operative treatment may be a viable option for some athletes with an ACL tears but can be difficult to predict "copers," and those that resume to sports return at lower performance level and/or less intense activities. Most studies assessing function after ACL reconstruction demonstrate favorable outcomes using patient-reported outcome studies. However, return-to-play and graft re-rupture rates vary substantially based on patient characteristics and level and type of athletic activity. Grafts used to reconstruct ACL produce similar objective outcomes and favorable patient-reported outcomes but have variable re-rupture rates depending on study and differ largely on morbidity associated with graft harvest. Various treatment methods including non-operative and operative techniques have been demonstrated to be efficacious in returning athletes to athletic activity depending on patient age and level of activity. Adherence to fundamental rehabilitation principles and accepted return-to-play guidelines can optimize outcomes and limit re-injury to the injured or contralateral limb.
Collapse
|
11
|
Zhang L, Fan S, Ye J, Jiang X, Cai B. Gender differences in knee kinematics during weight-bearing knee flexion for patients with arthrofibrosis after anterior cruciate ligament reconstruction. J Orthop Surg Res 2021; 16:573. [PMID: 34565414 PMCID: PMC8474925 DOI: 10.1186/s13018-021-02729-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Knowledge of tibiofemoral and patellofemoral joint kinematics is important for understanding gender-related dimorphism in developing knee arthrofibrosis and advancement of related treatments. The objective of our study was to investigate gender differences existing in tibiofemoral kinematics and patellar tracking in patients with arthrofibrosis after anterior cruciate ligament (ACL) reconstruction during weight-bearing knee flexion. Methods The tibiofemoral and patellofemoral joint kinematics were measured in 30 patients (15 male and 15 female) with arthrofibrosis after ACL reconstruction during a lunge task, using computed tomography and dual fluoroscopic imaging system. These data were analyzed for gender differences. Results The range of tibial rotation, patellar inferior shift, tilt, and flexion were significantly decreased in the affected knee compared to the contralateral knee from 15° to 75° of knee flexion (P ≤ 0.04). Statistically significant difference was detected for medial tibial translation between male and female patients at 60° (P = 0.04) and 75° of knee flexion (P = 0.02). The tibial rotation was significantly decreased at 60° (P = 0.03) and 75° of knee flexion (P < 0.01) in females. The inferior patellar shift in females was significantly lower than that in males at 15° (P = 0.04) and 30° of knee flexion (P = 0.01). The patellar tilt was significantly lower at 60° (P = 0.02) and 75° of knee flexion (P < 0.01) in females compared to males. Conclusions The results indicated a significant effect of gender on knee kinematics in patients with arthrofibrosis after ACL reconstruction during weight-bearing knee flexion. These gender differences in tibiofemoral kinematics and patellar tracking may warrant further investigations to determine implications for making gender-specific surgical treatments and rehabilitation programs.
Collapse
Affiliation(s)
- Ling Zhang
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Shuai Fan
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Jiling Ye
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Xin Jiang
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Bin Cai
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China.
| |
Collapse
|
12
|
Gillet B, Blache Y, Rogowski I, Vigne G, Capel O, Sonnery-Cottet B, Fayard JM, Thaunat M. Isokinetic Strength After ACL Reconstruction: Influence of Concomitant Anterolateral Ligament Reconstruction. Sports Health 2021; 14:176-182. [PMID: 33794712 DOI: 10.1177/19417381211005405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To reduce the rate of anterior cruciate ligament (ACL) graft rupture, recent surgeries have involved anterolateral ligament reconstruction (ALLR). This reconstruction procedure harvests more knee flexor muscle tendons than isolated ACL reconstruction (ACLR), but its influence on knee muscle strength recovery remains unknown. This study aimed to assess the influence of ALLR with a gracilis graft on the strength of the knee extensor and flexor muscles at 6 months postoperatively. HYPOTHESIS The additional amount of knee flexor harvest for ALLR would result in impairment in knee flexor muscle strength at 6 months postoperatively. STUDY DESIGN Retrospective cohort study. LEVEL OF EVIDENCE Level 2. METHODS A total of 186 patients were assigned to 2 groups according to the type of surgery: ACL + ALLR (graft: semitendinosus + gracilis, n = 119) or isolated ACLR (graft: semitendinosus, n = 67). The strength of the knee extensor and flexor muscles was assessed using an isokinetic dynamometer at 90, 180, and 240 deg/s for concentric and 30 deg/s for eccentric contractions and compared between groups using analysis of variance statistical parametric mapping. RESULTS Regardless of the surgery and the muscle, the injured leg produced significantly less strength than the uninjured leg throughout knee flexion and extension from 30° to 90° for each angular velocity (30, 90, 180, and 240 deg/s). However, the knee muscle strength was similar between the ACL + ALLR and ACLR groups. CONCLUSION The addition of ALLR using the gracilis tendon during ACLR does not alter the muscle recovery observed at 6 months postoperatively. CLINICAL RELEVANCE Although more knee flexor muscle tendons were harvested in ACL + ALLR, the postoperative strength recovery was similar to that of isolated ACLR.
Collapse
|
13
|
Dingenen B, Billiet B, De Baets L, Bellemans J, Truijen J, Gokeler A. Rehabilitation strategies of Flemish physical therapists before and after anterior cruciate ligament reconstruction: An online survey. Phys Ther Sport 2021; 49:68-76. [PMID: 33621760 DOI: 10.1016/j.ptsp.2021.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The primary objective of the study was to investigate rehabilitation strategies of Flemish physical therapists before and after anterior cruciate ligament (ACL) reconstruction. Secondly, we aimed to investigate physical therapists' preferences on continuing education and evaluate their self-rated confidence and competence when treating patients before and after ACL reconstruction. DESIGN Survey-based study. SETTING Online survey platform. PARTICIPANTS Flemish physical therapists (n = 283). MAIN OUTCOME MEASURES The online survey consisted of a combination of 40 open- and closed-ended questions, divided across 5 sections: (1) participant demographics and clinical practice information, (2) patient population information, (3) continued education practices, (4) rehabilitation strategies, and (5) physical therapist self-rated confidence and competence to treat patients with ACL reconstruction. RESULTS A wide variability in rehabilitation strategies were found across the whole ACL rehabilitation continuum, which were in general not in line with best available evidence. Nevertheless, the overall self-rated confidence and competence of physical therapists treating patients before and after ACL reconstruction were high. CONCLUSION Our findings indicate a need to improve rehabilitation practices before and after ACL reconstruction. Advanced research dissemination and implementation are required to achieve better rehabilitation outcomes.
Collapse
Affiliation(s)
- Bart Dingenen
- Reval Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.
| | - Bart Billiet
- Reval Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Liesbet De Baets
- Reval Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Johan Bellemans
- Department of Orthopedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jan Truijen
- Department of Orthopedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Alli Gokeler
- Exercise Science & Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany; Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, VU Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
14
|
Franck F, Saithna A, Vieira TD, Pioger C, Vigne G, Le Guen M, Rogowski I, Fayard JM, Thaunat M, Sonnery-Cottet B. Return to Sport Composite Test After Anterior Cruciate Ligament Reconstruction (K-STARTS): Factors Affecting Return to Sport Test Score in a Retrospective Analysis of 676 Patients. Sports Health 2021; 13:364-372. [PMID: 33550916 DOI: 10.1177/1941738120978240] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Return to sport (RTS) to the preinjury level is the main purpose after anterior cruciate ligament (ACL) reconstruction but the factors affecting the RTS are not completely known. Knee Santy Athletic Return to Sport (K-STARTS) is a composite test designed to assess readiness for RTS after ACL reconstruction. PURPOSE To determine the key factors that influence K-STARTS scores in a large cohort of patients after ACL reconstruction. STUDY DESIGN Case-control study. LEVEL OF EVIDENCE Level 3. METHODS A retrospective analysis of prospectively collected data was undertaken. All patients who underwent ACL reconstruction surgery between March 2016 and May 2017 and also had a K-STARTS assessment at 6 months postoperatively were included. To identify factors influencing the K-STARTS score, an analysis of variance was performed. Age, sex, sports level, delay between injury and surgery, concomitant lesions, graft type, additional lateral tenodesis procedure, and participation in the RTS program were analyzed to identify factors influencing the K-STARTS score. RESULTS A total of 676 patients were included in the study. The K-STARTS score was significantly higher in male patients than in female patients (13.9 vs 12.4; P < 0.001), in younger patients (those aged <30 years vs older patients; 14.2 vs 12; P < 0.001), ACL reconstructions performed with hamstring tendon autografts compared with bone-patellar tendon-bone (13.5 vs 13.1; P = 0.03) and in those who completed a specific RTS program in addition to standard rehabilitation, compared with those who did not participate (17.1 vs 13.1; P < 0.001). However, the only factor that significantly influenced the K-STARTS score beyond the minimal detectable change threshold was the completion of the additional RTS program. The preinjury frequency of sports participation, whether the dominant limb was injured, time from injury to surgery, the presence of associated meniscal injuries, and whether a lateral tenodesis was performed did not significantly influence the K-STARTS score. CONCLUSION Completion of a specific RTS program, in addition to standard rehabilitation, was the most important factor influencing the K-STARTS composite functional and psychological RTS test score at 6 months after ACL reconstruction. CLINICAL RELEVANCE This study shows that the completion of a specific RTS program affects positively the RTS test score at 6 months after ACL reconstruction.
Collapse
Affiliation(s)
- Florent Franck
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Adnan Saithna
- Arizona Brain, Spine & Sports Injuries Center, Scottsdale, Arizona
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Charles Pioger
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | | | | | - Isabelle Rogowski
- Laboratoire Interuniversitaire de Biologie de la Motricité, Université de Lyon, Villeurbanne Cedex, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| |
Collapse
|
15
|
Rushdi I, Sharifudin S, Shukur A. Arthrofibrosis Following Anterior Cruciate Ligament Reconstruction. Malays Orthop J 2019; 13:34-38. [PMID: 31890108 PMCID: PMC6915315 DOI: 10.5704/moj.1911.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Anterior cruciate ligament (ACL) tear is a frequent injury and its reconstruction is among the most commonly performed orthopaedic surgical procedures. ACL reconstruction generally yields good results. However, its recovery can be hampered by the development of postoperative complications. The aim of this study was to review complications following arthroscopic ACL reconstruction done in Hospital Raja Permaisuri Bainun, Ipoh and Hospital Teluk Intan, Perak with the emphasis on arthrofibrosis. Arthrofibrosis is defined as a loss of 15 degrees extension or more, with or without flexion loss compared to the contralateral knee. Materials and Methods: The study is based on a series of retrospective cases, on which medical records of 200 patients who underwent ACL reconstruction surgeries between March 2007 and December 2014 were reviewed. Follow-up treatment records were available for 166 patients (83%). The data was analysed to identify the risk factors for developing complications with an emphasis on arthrofibrosis. Results: Eight patients (5%) developed arthrofibrosis in the post-operative period. Early surgical intervention, preoperative limited range of motion and female gender are the risk factors correlate with arthrofibrosis. However, the type of graft used and meniscal procedure do not have a significant correlation with the development of arthrofibrosis. Other complications encountered are local infections, hypertrophic scar and chronic regional pain syndromes. Conclusion: The 5% incidence of arthrofibrosis following an ACL reconstruction in our centres can be reduced with proper preventive measures which include thorough preoperative evaluation, proper patient selection, restoration of ROM prior to surgery and proper timing of surgery.
Collapse
Affiliation(s)
- I Rushdi
- Department of Orthopaedics, Hospital Teluk Intan, Teluk Intan, Malaysia
| | - S Sharifudin
- Department of Orthopaedics, Hospital Teluk Intan, Teluk Intan, Malaysia
| | - A Shukur
- Department of Orthopaedics, Hospital Teluk Intan, Teluk Intan, Malaysia
| |
Collapse
|
16
|
Gage A, Kluczynski MA, Bisson LJ, Marzo JM. Factors Associated With a Delay in Achieving Full Knee Extension Before Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2019; 7:2325967119829547. [PMID: 30886874 PMCID: PMC6410389 DOI: 10.1177/2325967119829547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Arthrofibrosis commonly occurs after an acute anterior cruciate ligament (ACL) injury and following ACL reconstruction and can lead to poor outcomes. Preoperative stiffness has been shown to be associated with postoperative stiffness; however, few studies have examined predictors of preoperative delay in obtaining full knee extension. Purpose: To examine demographic and injury factors as predictors of time required to achieve full knee extension preoperatively in patients with an acute ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 172 patients with an acute ACL tear at presentation (defined as ≤3 weeks from injury) who underwent magnetic resonance imaging (MRI) within 6 weeks of the injury were included in this analysis. Preoperative data included date of injury, age at injury, sex, body mass index, mechanism of injury (noncontact/contact), time from injury to surgery (days), time to achieve full extension prior to surgery (weeks), and bone bruising on MRI. Time to achieve full extension was categorized as <3 or ≥3 weeks. Unadjusted and adjusted logistic regression was used to examine predictors of delayed time to achieve full extension (≥3 vs <3 weeks). Odds ratios and 95% CIs were reported. Results: Time to achieve full extension was early (<3 weeks) in 98 patients and delayed (≥3 weeks) in 74 patients. The average time to achieve full extension was 7 days in the early group and 32.5 days in the delayed group. Delayed time to achieve full extension was associated with increased lateral femoral condyle (LFC) bruising compared with early time to achieve extension (82.8% vs 66.7%, respectively; P = .03). No other statistically significant predictors were found after adjustment for age, sex, body mass index, and mechanism of injury. Conclusion: Acute ACL injuries associated with LFC bone bruising seen on MRI are more likely to result in reduced extension prior to ACL reconstruction. These injuries should be identified and addressed by an appropriate preoperative rehabilitation program, and surgery should be delayed to avoid risking arthrofibrosis postoperatively by reconstructing a knee with less than full extension.
Collapse
Affiliation(s)
- Andrew Gage
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, SUNY University at Buffalo, Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, SUNY University at Buffalo, Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, SUNY University at Buffalo, Buffalo, New York, USA
| | - John M Marzo
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, SUNY University at Buffalo, Buffalo, New York, USA
| |
Collapse
|
17
|
Bone bruise in anterior cruciate ligament rupture entails a more severe joint damage affecting joint degenerative progression. Knee Surg Sports Traumatol Arthrosc 2019; 27:44-59. [PMID: 29869683 PMCID: PMC6510815 DOI: 10.1007/s00167-018-4993-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/30/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE During anterior cruciate ligament (ACL) injury, the large external forces responsible for ligament rupture cause a violent impact between tibial and femoral articular cartilage, which is transferred to bone resulting in bone bruise detectable at MRI. Several aspects remain controversial and await evidence on how this MRI finding should be managed while addressing the ligament lesion. Thus, the aim of the present review was to document the evidence of all available literature on the role of bone bruise associated with ACL lesions. METHODS A systematic review of the literature was performed on bone bruise associated with ACL injury. The search was conducted in September 2017 on three medical electronic databases: PubMed, Web of Science, and the Cochrane Collaboration. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used. Relevant articles were studied to investigate three main aspects: prevalence and progression of bone bruise associated with ACL lesions, its impact on the knee in terms of lesion severity and joint degeneration progression over time and, finally, the influence of bone bruise on patient prognosis in terms of clinical outcome. RESULTS The search identified 415 records and, after an initial screening according to the inclusion/exclusion criteria, 83 papers were used for analysis, involving a total of 10,047 patients. Bone bruise has a high prevalence (78% in the most recent papers), with distinct patterns related to the mechanism of injury. This MRI finding is detectable only in a minority of cases the first few months after trauma, but its presence and persistence have been correlated to a more severe joint damage that may affect the degenerative progression of the entire joint, with recent evidence suggesting possible effects on long-term clinical outcome. CONCLUSION This systematic review of the literature documented a growing interest on bone bruise associated with ACL injury, highlighting aspects which could provide to orthopaedic surgeons evidence-based suggestions in terms of clinical relevance when dealing with patients affected by bone bruise following ACL injury. However, prospective long-term studies are needed to better understand the natural history of bone bruise, identifying prognostic factors and targets of specific treatments that should be developed in light of the overall joint derangements accompanying ACL lesions. LEVELS OF EVIDENCE IV, Systematic review of level I-IV studies.
Collapse
|
18
|
Mustamsir E, Hidayat R. Anterior cruciate ligament reconstruction in patient with lateral femoral condyle bone loss: Case report. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
19
|
Association of the Graft Size and Arthrofibrosis in Young Patients After Primary Anterior Cruciate Ligament Reconstruction. J Am Acad Orthop Surg 2018; 26:e483-e489. [PMID: 30148751 DOI: 10.5435/jaaos-d-17-00177] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This study investigated the association of graft-related surgical factors and patient characteristics with the odds of arthrofibrosis after primary anterior cruciate ligament reconstruction (ACL-R). METHODS A retrospective case-control study assessed consecutive patients who underwent primary ACL-R in one tertiary pediatric hospital. Each arthrofibrosis case was matched to three controls for sex, calendar year, and age at the time of ACL-R, as well as the primary surgeon. Conditional multivariable logistic regression assessed the independent association of graft diameter, time from injury to ACL-R, concomitant knee pathologies, and body mass index. RESULTS Twenty arthrofibrosis cases of 1,121 ACL-R patients (incidence 1.8%) were matched to 60 controls resulting in the mean age of 14.5 years. An increase of 1 mm graft diameter was associated with 3.2-times increased odds of arthrofibrosis. Other variables were not independently associated with arthrofibrosis. CONCLUSION For young patients, the decision on the graft size must consider the possibility of arthrofibrosis with a larger graft versus reinjury with a smaller graft.
Collapse
|
20
|
Gómez JE, Molina DD, Rettig SD, Kan JH. Bone Bruises in Children and Adolescents Not Associated With Ligament Ruptures. Orthop J Sports Med 2018; 6:2325967118786960. [PMID: 30109238 PMCID: PMC6083756 DOI: 10.1177/2325967118786960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Clinical characteristics of uncomplicated bone bruises (ie, not associated with a ligament rupture, meniscal tear, or fracture of the knee) in young athletes have scarcely been reported. Purpose: To identify mechanisms of injury, characterize bone bruise patterns, and identify clinical factors relating to recovery in young patients suffering uncomplicated bone bruises about the knee. Study Design: Case series; Level of evidence, 4. Methods: A review of clinical records and magnetic resonance imaging (MRI) findings of patients seen at a single institution was completed. Results: We identified 62 children and teenagers (mean age, 13.9 years; range, 8-18 years) who had a total of 101 bone bruises on MRI. The injuries occurred during a variety of organized and recreational sporting activities, the most common being football, basketball, and soccer. The majority (61.4%) of bone bruises occurred as a result of noncontact mechanisms. Patients reported a mean pain scale score of 6.3 of 10 (range, 2-10) on presentation. Frequent clinical findings included non–joint-line tenderness (64.5%), limited range of motion (58.1%), joint-line tenderness (54.8%), and positive meniscal signs (50.0%). The majority of bone bruises (61.4%) were located medially, and the most common bone bruise type was subcortical (58.4%), followed by medullary/reticular (35.6%) and articular impaction (5.9%). The only factor related to time to recovery was mechanism of injury; patients reporting a noncontact mechanism required significantly more time to recover than those reporting a contact mechanism (mean, 99.7 ± 74.8 vs 65.7 ± 38.8 days, respectively; F = 3.753, P = .049). Conclusion: In this case series of 62 pediatric patients with non–anterior cruciate ligament (ACL) bone bruises, the majority occurred in the medial compartment, suggesting that these bone bruises result from a mechanism distinct from the pivot-shift mechanism, classically thought to cause ACL injuries.
Collapse
Affiliation(s)
- Jorge E. Gómez
- Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Daren D. Molina
- Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Shaylon D. Rettig
- Children’s Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas, USA
| | - J. Herman Kan
- Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
21
|
Batailler C, Lustig S, Reynaud O, Neyret P, Servien E. Complications and revision surgeries in two extra-articular tenodesis techniques associated to anterior cruciate ligament reconstruction. A case-control study. Orthop Traumatol Surg Res 2018; 104:197-201. [PMID: 29292120 DOI: 10.1016/j.otsr.2017.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/23/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Numerous techniques of anterior cruciate ligament (ACL) reconstruction associated to extra-articular tenodesis (EAT) have been described, but there have been few comparative studies, especially in terms of complications and revision procedures. The present study sought to compare two ACL reconstruction techniques using the patellar tendon (KJ): associating EAT by fascia lata (KJL2) or by gracilis (KJG). The study hypothesis was that the KJL2 technique incurs no extra risk of complications or surgical revision compared to the KJG technique. METHOD A prospective case-control study compared 41 patients undergoing KJL2 and 41 controls undergoing KJG. Complications, reconstruction failure and revision procedures were assessed at a mean 13 months follow-up (range, 6-20 months). RESULTS The KJL2 group showed no extra risk of postoperative complications or reconstruction failure compared to the KJG group: 1 versus 2 re-tears, respectively, not requiring revision. Revision surgery was significantly more frequent in the KJG group (31.7% vs. 7.3%), notably for arthrolysis and meniscectomy. DISCUSSION The KJL2 technique is reliable, without greater risk of complications or early revision surgery than the KJG technique. LEVEL OF EVIDENCE III - Case-control study.
Collapse
Affiliation(s)
- C Batailler
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de La-Croix-Rousse, 69004 Lyon, France.
| | - S Lustig
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de La-Croix-Rousse, 69004 Lyon, France
| | - O Reynaud
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de La-Croix-Rousse, 69004 Lyon, France
| | - P Neyret
- Centre Albert-Trillat, 69004 Lyon, France
| | - E Servien
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de La-Croix-Rousse, 69004 Lyon, France
| |
Collapse
|
22
|
Thomas AC, Palmieri-Smith RM. Knee Frontal-Plane Biomechanics in Adults With or Without Bone Marrow Edema-Like Lesions After Anterior Cruciate Ligament Injury. J Athl Train 2018; 52:581-586. [PMID: 28653868 DOI: 10.4085/1062-6050-51.12.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Lateral subchondral bone bruises (BBs) occur frequently with anterior cruciate ligament (ACL) injuries. These BBs are associated with pain during weight bearing, leading individuals to increase medial tibiofemoral loading to alleviate pain laterally. Increased medial tibiofemoral loading may precipitate the development or progression of posttraumatic osteoarthritis; however, no in vivo biomechanical data exist to confirm that lateral BBs increase medial tibiofemoral loading as measured by the external knee-adduction moment (KAM). OBJECTIVE To determine whether lateral BBs after ACL injury increase the external KAM during walking. DESIGN Descriptive laboratory study. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS Eleven volunteers with an ACL injury (age = 20.36 ± 4.03 years, height = 177.60 ± 8.59 cm, mass = 79.70 ± 16.33 kg), 12 with an ACL injury and a lateral BB (ACL + BB; age = 19.25 ± 5.58 years, height = 170.71 ± 9.40 cm, mass = 66.79 ± 11.91 kg), and 12 healthy controls (age = 19.67 ± 5.19 years, height = 173.29 ± 11.58 cm, mass = 67.07 ± 11.25 kg) participated. INTERVENTION(S) We recorded peak KAM during 3 walking trials (1.1 ± 0.6 m/s) in which participants walked over a force platform located in the field of view of a motion-capture system. MAIN OUTCOME MEASURE(S) Peak KAM was calculated during the first half of stance using standard inverse-dynamics analysis, averaged across trials, and examined via 1-way analysis of variance. Knee pain and function were determined from the International Knee Documentation Committee Subjective Knee Evaluation Form and compared among groups via the Kruskal-Wallis test. RESULTS Peak KAM did not differ among groups (ACL injury = 0.14 ± 0.07 Nm·kg-1·m-1, ACL + BB = 0.21 ± 0.08 Nm·kg-1·m-1, control = 0.20 ± 0.08 Nm·kg-1·m-1; F2,35 = 3.243, P = .052). Knee-pain frequency and severity were greater in the ACL-injury (frequency = 2.55 ± 1.81, severity = 3.36 ± 1.75; both P < .001) and ACL + BB (frequency = 3.58 ± 2.81, severity = 4.08 ± 3.20; both P < .001) groups than in the control group (frequency = 0.00 ± 0.00, severity = 0.00 ± 0.00). Knee function was greater in the control group (100.00 ± 0.00) than in the ACL-injury (59.35 ± 17.31; P < .001) and ACL + BB (46.46 ± 25.85; P < .001) groups. CONCLUSIONS The ACL + BB groups did not walk with a greater external KAM than the ACL-injury or control groups. Thus, lateral tibiofemoral BB did not influence knee frontal-plane loading after ACL injury.
Collapse
Affiliation(s)
- Abbey C Thomas
- Department of Kinesiology, University of North Carolina at Charlotte
| | | |
Collapse
|
23
|
Ithurburn MP, Altenburger AR, Thomas S, Hewett TE, Paterno MV, Schmitt LC. Young athletes after ACL reconstruction with quadriceps strength asymmetry at the time of return-to-sport demonstrate decreased knee function 1 year later. Knee Surg Sports Traumatol Arthrosc 2018; 26:426-433. [PMID: 28918506 DOI: 10.1007/s00167-017-4678-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/14/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Quadriceps femoris (QF) strength deficits at return-to-sport (RTS) after ACL reconstruction (ACLR) contribute to decreased knee function at the same time point. However, the impact of QF strength at RTS on longitudinal function has not been examined. The purpose of this study was to test the hypothesis that young athletes after ACLR with QF strength asymmetry at RTS would demonstrate decreased knee-related function and lower proportions of functional recovery at 1 year post-RTS compared to young athletes following ACLR with nearly symmetric QF strength at RTS. METHODS Participants included 76 young athletes (74% female; mean age at RTS = 17.3 years) after primary, unilateral ACLR, cleared to RTS, and followed for 1 year after RTS. At the time of RTS, QF strength was quantified on an isokinetic dynamometer and a Limb Symmetry Index (LSI) was calculated [(involved/uninvolved) × 100%]. The cohort was subdivided into two groups based on RTS QF LSI: high quadriceps (HQ; LSI ≥ 90%; n = 36) and low quadriceps (LQ; LSI < 85%; n = 36). The cohort was followed for 1 year post-RTS, and knee-related function was assessed using the International Knee Documentation Committee subjective form (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and LSI of single-leg hop tests. Functional recovery at 1 year post-RTS was defined as KOOS scores above literature-reported cut-offs. RESULTS While the HQ group demonstrated higher symmetry on all 1 year post-RTS hop tests, only the triple-hop test (p = 0.020) was found to be statistically different. Similarly, while the HQ group scored higher on all 1 year post-RTS self-reported knee function measures, only differences on the KOOS-Sport/Rec score (p = 0.039) and IKDC score (p = 0.011) were statistically different. Additionally, the HQ group demonstrated higher proportions of functional recovery at 1 year post-RTS than the LQ group on the KOOS-Symptoms (HQ: 88.9%, LQ: 69.4%; p = 0.040) and KOOS-Sport/Rec (HQ: 91.7%, LQ: 69.4%; p = 0.017). CONCLUSIONS Young athletes after ACLR with QF strength asymmetry at RTS demonstrated decreased knee-related function and lower proportions of functional recovery at 1 year post-RTS. However, group differences did not exceed reported minimal clinically important difference values. Further study is warranted to understand factors that contribute to longitudinal knee function after ACLR. Clinicians should focus on restoring symmetric QF strength at RTS after ACLR, which may promote higher longitudinal knee function. LEVEL OF EVIDENCE Level II, Prospective cohort study.
Collapse
Affiliation(s)
- Matthew P Ithurburn
- Movement Analysis and Performance Laboratory, School of Health and Rehabilitation Sciences, The Ohio State University, 2050 Kenny Road, Columbus, OH, USA
- OSU Sports Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alex R Altenburger
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Atwell Hall, Columbus, OH, USA
| | - Staci Thomas
- Divisions of Occupational and Physical Therapy and Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 10001, Cincinnati, OH, USA
| | - Timothy E Hewett
- Biomechanics Laboratories and Sports Medicine, Departments of Orthopaedic Surgery, Physical Medicine and Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, RO_GU_01_22, Rochester, MN, USA
| | - Mark V Paterno
- Divisions of Occupational and Physical Therapy and Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 10001, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Laura C Schmitt
- Movement Analysis and Performance Laboratory, School of Health and Rehabilitation Sciences, The Ohio State University, 2050 Kenny Road, Columbus, OH, USA.
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Atwell Hall, Columbus, OH, USA.
| |
Collapse
|
24
|
Pinto FG, Thaunat M, Daggett M, Kajetanek C, Marques T, Guimares T, Quelard B, Sonnery-Cottet B. Hamstring Contracture After ACL Reconstruction Is Associated With an Increased Risk of Cyclops Syndrome. Orthop J Sports Med 2017; 5:2325967116684121. [PMID: 28203602 PMCID: PMC5298440 DOI: 10.1177/2325967116684121] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Cyclops syndrome is characterized by loss of terminal knee extension due to proliferative fibrous nodule formation in the intercondylar notch. This complication occurs in the early postoperative period after anterior cruciate ligament reconstruction (ACLR). The pathogenesis of Cyclops syndrome is not well understood. Hypothesis: Persistent hamstring contracture after ACLR is associated with an increased risk of subsequent Cyclops syndrome. Study Design: Case-control study; Level of evidence, 3. Methods: The files of 45 patients who underwent arthroscopic debridement of a Cyclops lesion after ACLR were analyzed. Recorded data included demographic information and technical details of surgery. Preoperative magnetic resonance images were also analyzed, and patients with femoral bone bruising were identified. Passive and active range of motion were recorded in all patients preoperatively and at 3 and 6 weeks after surgery to address the Cyclops lesion. Passive extension deficit was evaluated in comparison with the contralateral limb and classified as secondary to hamstring contracture when contracture was observed and palpated in the prone position and when the extension deficit was reversed after exercises performed to fatigue the hamstrings. A control group was selected using a random numbers table among our entire ACLR cohort. Statistical analysis was performed to analyze differences between the 2 groups. Results: There was no significant difference between the groups with regard to age at ACLR, sex distribution, time from injury to surgery (P > .05), proportion of professional athletes, presence of femoral bone bruise, or technical aspects of surgery. The overall extension deficit incidence was significantly higher in the Cyclops group at 3 weeks (Cyclops, 71%; control, 22%) (P < .001) and at 6 weeks (Cyclops, 60%; control, 7%) (P < .001). The extension deficit related to hamstring contracture was significantly higher in the Cyclops group at 3 weeks (Cyclops, 58%; control, 22%) (P < .001) and at 6 weeks (Cyclops, 29%; control, 2%) (P < .001). Conclusion: The Cyclops lesion is associated with a persistent hamstring contracture at 3 and 6 weeks after ACLR.
Collapse
Affiliation(s)
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Matt Daggett
- Kansas City University, Kansas City, Missouri, USA
| | - Charles Kajetanek
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Tiago Marques
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Tales Guimares
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Bénédicte Quelard
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| |
Collapse
|
25
|
Clinical outcomes of anatomic, all-inside, anterior cruciate ligament (ACL) reconstruction. Knee 2017; 24:55-62. [PMID: 27692693 DOI: 10.1016/j.knee.2016.09.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 09/02/2016] [Accepted: 09/05/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND This paper reports the outcomes of patients undergoing ACL reconstruction using a TransLateral single bundle, all-inside hamstring technique at a minimum of two year follow-up. METHODS The semitendinosus alone is harvested, quadrupled and attached in series to two adjustable suspensory fixation devices. Femoral and tibial sockets are produced using a retrograde drill. The graft is deployed, fixed and tensioned on both tibia and femur. Patients were evaluated preoperatively using the KOOS, Lysholm and Tegner scores and at six, 12 and 24months postoperatively. Objective assessment of knee laxity was performed using the KT-1000 along with goniometric measurement of range or motion. RESULTS One hundred and eight patients, mean age 30.9years (range 15 to 61) were included. Mean follow-up 49.8months (range 30-66). The mean increase in KOOS at two years was 30.3 points; Lysholm, 33.1 points; Tegner Activity scale, 2.0 levels. These were all statistically significant (p<0.001). Range of motion in the reconstructed knee approximated the uninjured knee by 12months and was restored by two years. KT-1000 showed significant reduction in side-side difference to no more than 2.4mm at all postoperative time points (p<0.001). Re-rupture rate in this series was 6.5%, all following episodes of significant additional postoperative trauma to the knee. CONCLUSIONS TransLateral all-inside ACL reconstruction demonstrates good medium term subjective and objective outcomes with a low complication and failure rate.
Collapse
|
26
|
Prevalence of knee stiffness after arthroscopic bone suture fixation of tibial spine avulsion fractures in adults. Orthop Traumatol Surg Res 2016; 102:625-9. [PMID: 27426237 DOI: 10.1016/j.otsr.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/11/2016] [Accepted: 05/13/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibial spine avulsion fractures (TSAFs) occur chiefly in adolescents. Few published data are available on outcomes after arthroscopic surgical treatment of TSAFs in adults. OBJECTIVES To evaluate outcomes of consecutive patients with TSAFs managed by arthroscopic bone suture followed by a standardised non-aggressive rehabilitation programme. HYPOTHESIS Arthroscopic bone suture followed by non-aggressive rehabilitation therapy reliably produces satisfactory outcomes in adults with TSAF. METHODS Thirteen adults were included. Outcomes were evaluated based on the Tegner score, International Knee Documentation Committee (IKDC) score, anterior-posterior knee laxity, passive and active motion ranges, and radiological appearance. RESULTS After a mean follow-up of 41±27months (12-94months), all 13 patients had healed fractures without secondary displacement. No patient had knee instability. Post-operative stiffness was noted in 5 patients (2 with complex regional pain syndrome and 3 with extension lag), 1 of whom required surgical release. The mean IKDC score was 91.3±11.7. The mean Tegner score was 5.46±1.37 compared to 6.38±0.70 before surgery. Mean tibial translation (measured using the Rolimeter) was 1.09±1.22mm, compared to 5.9±1.85mm before surgery. CONCLUSION The outcomes reported here support the reliability of arthroscopic bone suture for TSAF fixation. Nevertheless, a substantial proportion of patients experienced post-operative stiffness, whose contributory factors may include stunning of the quadriceps due to the short time from injury to surgery and the use of a gentle rehabilitation programme. LEVEL OF EVIDENCE IV, retrospective study of treatment outcomes.
Collapse
|
27
|
Kluczynski MA, Marzo JM, Rauh MA, Bernas GA, Bisson LJ. A Case-Control Study Comparing Bone Bruising and Intra-articular Injuries in Patients Undergoing Anterior Cruciate Ligament Reconstruction With and Without Medial Collateral Ligament Tears. Orthop J Sports Med 2016; 4:2325967116660053. [PMID: 27540558 PMCID: PMC4973400 DOI: 10.1177/2325967116660053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Concomitant injuries can occur in patients with combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears; however, no studies have compared these injuries in patients undergoing ACL reconstruction with an MCL tear to those with an intact MCL. Purpose: To compare bone bruising, meniscus tears, and chondral lesions in patients undergoing ACL reconstruction with an MCL tear (cases) to those with an intact MCL (controls). Study Design: Case-control study; Level of evidence, 3. Methods: Thirty-two cases and 352 controls were identified from a prospective registry. Bone bruising was confirmed on magnetic resonance imaging, and meniscus tears and chondral lesions were confirmed arthroscopically. Demographics and concomitant injuries were compared between cases and controls using exact chi-square tests. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% CIs adjusted for age, sex, body mass index, and mechanism and type of injury. Results: Cases had significantly more contact injuries than controls (58.1% vs 21.3%, P < .0001). The prevalence and odds of bone bruising of the lateral tibial plateau (89.7% vs 84.6%; P = .59; OR, 3.53; 95% CI, 0.45-27.71), lateral femoral condyle (82.8% vs 72.8%; P = .28; OR, 1.94; 95% CI, 0.64-5.88), medial tibial plateau (20.7% vs 31.7%; P = 0.29; OR, 0.53; 95% CI, 0.19-1.53), and medial femoral condyle (6.9% vs 8.3%; P ≥ .999; OR, 1.07; 95% CI, 0.21-5.40) did not differ significantly between cases and controls. The prevalence and odds of lateral meniscus tears (53.3% vs 43%; P = .34; OR, 1.85; 95% CI, 0.76-4.52), medial meniscus tears (31.3% vs 33.5%; P = .85; OR, 0.90; 95% CI, 0.37-2.21), and chondral lesions (16% vs 10.8%; P = .50; OR, 0.70; 95% CI, 0.15-3.21) also did not significantly differ between cases and controls. Conclusion: ACL-MCL injuries were most often due to a contact mechanism, whereas ACL tears without associated MCL injury were more frequently due to a noncontact mechanism. However, there were no significant differences in concomitant injuries in ACL-MCL knees versus ACL knees.
Collapse
Affiliation(s)
- Melissa A Kluczynski
- University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - John M Marzo
- University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Michael A Rauh
- University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Geoffrey A Bernas
- University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Leslie J Bisson
- University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| |
Collapse
|
28
|
van Melick N, van Cingel REH, Brooijmans F, Neeter C, van Tienen T, Hullegie W, Nijhuis-van der Sanden MWG. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med 2016; 50:1506-1515. [PMID: 27539507 DOI: 10.1136/bjsports-2015-095898] [Citation(s) in RCA: 438] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2016] [Indexed: 12/26/2022]
Abstract
AIM The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction. DESIGN Clinical practice guideline underpinned by systematic review and expert consensus. DATA SOURCES A multidisciplinary working group and steering group systematically reviewed the literature and wrote the guideline. MEDLINE and the Cochrane Library were searched for meta-analyses, systematic reviews, randomised controlled trials and prospective cohort studies published between January 1990 and June 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Included literature must have addressed 1 of 9 predetermined clinical topics: (1) preoperative predictors for postoperative outcome, (2) effectiveness of physical therapy, (3) open and closed kinetic chain quadriceps exercises, (4) strength and neuromuscular training, (5) electrostimulation and electromyographic feedback, (6) cryotherapy, (7) measurements of functional performance, (8) return to play and (9) risk for reinjury. SUMMARY Ninety studies were included as the basis for the evidence statement. Rehabilitation after ACL injury should include a prehabilitation phase and 3 criterion-based postoperative phases: (1) impairment-based, (2) sport-specific training and (3) return to play. A battery of strength and hop tests, quality of movement and psychological tests should be used to guide progression from one rehabilitation stage to the next. Postoperative rehabilitation should continue for 9-12 months. To assess readiness to return to play and the risk for reinjury, a test battery, including strength tests, hop tests and measurement of movement quality, should be used.
Collapse
Affiliation(s)
- Nicky van Melick
- Funqtio, Steyl, The Netherlands.,Radboud University Medical Center, Research Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Robert E H van Cingel
- Sport Medisch Centrum Papendal, Arnhem, The Netherlands.,Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | | | | | | | | | |
Collapse
|
29
|
Tardy N, Thaunat M, Sonnery-Cottet B, Murphy C, Chambat P, Fayard JM. Extension deficit after ACL reconstruction: Is open posterior release a safe and efficient procedure? Knee 2016; 23:465-71. [PMID: 26875053 DOI: 10.1016/j.knee.2016.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 12/24/2015] [Accepted: 01/02/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Extension loss is a potentially devastating consequence of anterior cruciate ligament reconstruction (ACLR). It can often be treated by anterior arthroscopic release. In rare cases, a chronic flexion contracture requires an additional posterior open release. To our knowledge, no study analysing the results of both posteromedial and posterolateral approaches has been performed so far. The purposes of this study were (1) to analyse the midterm outcome and complications of a combined procedure, anterior arthroscopic debridement and posterior open capsulotomy - for the treatment of chronic extension deficits after ACLR and (2) to describe the surgical technique of posterior open release with both posteromedial and posterolateral approaches. MATERIAL AND METHODS This is a retrospective clinical cohort study. Twelve patients presenting a chronic flexion contracture of 10° or more after ACLR treated by open posterior arthrolysis with an average follow-up time of 38months (range six to 90) were included. At last follow-up, they underwent both a clinical examination with range of motion analysis, International Knee Documentation Committee (IKDC) and KOOS scores. RESULTS At follow-up, all patients except one (93%) achieved complete extension. Only one patient (7%) had a residual post-operative flexion deformity of five degrees. The range of motion (ROM) improved significantly after arthrolysis from 96°±14.3° (SD) to 14.3°±7°(SD)(p<0.001). No post-operative complications were recorded. No patients required further open debridement. The post-operative objective IKDC score was grade A for five patients, B for seven versus C for five patients and D for seven preoperatively. The mean post-operative subjective IKDC score was 86.4±9.7. The post-operative Knee injury and Osteoarthritis Outcome Score (KOOS) distribution was as follows: pain 93.8±5 (SD); symptoms 88±8.6 (SD); ADL 96.8±3.7 (SD); sports activities 83.6±12.3 (SD); and quality of life 82.9±8.8 (SD). Mean patients' satisfaction was 9.25±0.6 (SD) out of 10 after arthrolysis. CONCLUSIONS Open posterior release with both posteromedial and posterolateral approaches is a safe and efficient additional procedure in case of persistent flexion contracture after ACLR with good ROM gain, functional scores and patients' satisfaction. LEVEL OF EVIDENCE Therapeutic study - Level IV.
Collapse
Affiliation(s)
- Nicolas Tardy
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008 Lyon, France.
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008 Lyon, France.
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008 Lyon, France.
| | - Colin Murphy
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008 Lyon, France.
| | - Pierre Chambat
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008 Lyon, France.
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008 Lyon, France.
| |
Collapse
|
30
|
Kluczynski MA, Kang JV, Marzo JM, Bisson LJ. Magnetic Resonance Imaging and Intra-articular Findings After Anterior Cruciate Ligament Injuries in Ice Hockey Versus Other Sports. Orthop J Sports Med 2016; 4:2325967116646534. [PMID: 27294167 PMCID: PMC4887880 DOI: 10.1177/2325967116646534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prevalence of comorbid knee pathology has been examined for sports-related anterior cruciate ligament (ACL) injuries, but it has not been examined in ice hockey players. PURPOSE To compare concomitant bone bruising, collateral ligament injuries, and intra-articular injuries in ACL injuries suffered during ice hockey versus other sports. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 20 patients with ACL injuries sustained during ice hockey were identified from a prospective registry, of which 95% were male and 90% had a contact mechanism of injury (MOI). Thirteen cases and 46 controls who sustained ACL injuries from ice hockey and other sports, respectively, were included. Inclusion criteria for cases and controls were male sex, contact MOI, no prior knee surgery, magnetic resonance imaging (MRI) within 6 weeks of injury, and surgery within 3 months of injury. Age, body mass index (BMI), MRI findings (bone bruising, medial and lateral collateral ligament [MCL, LCL] injuries), and arthroscopic findings (meniscus tears, chondral injuries) were compared for cases versus controls using t tests or exact chi-square tests. RESULTS Age (22.9 ± 8.8 vs 23.4 ± 10.4 years, P = .88) and BMI ≥25 kg/m(2) (50% vs 65.9%, P = .66) did not differ between cases and controls. Cases had less lateral bone bruising (lateral femoral condyle: 54.6% vs 93%, P = .01; lateral tibial plateau: 72.7% vs 93%, P = .09) and no medial bone bruising (medial femoral condyle: 0% vs 7%, P = .06; medial tibial plateau: 0% vs 32.6%, P = .05) compared with controls. Cases had less frequent lateral meniscus tears than controls (23.1% vs 58.5%, P = .05). There were no significant differences in MCL (40% vs 31.2%, P = .77), LCL (0% vs 3.9%, P > .999), medial meniscus tears (7.7% vs 37%, P = .08), and chondral injuries (10% vs 9.4%, P > .999) for cases versus controls. CONCLUSION Male ice hockey players with ACL injuries had less lateral femoral condyle and medial tibial plateau bone bruising compared with other sports injuries. They also had fewer lateral meniscus tears, and there was a trend toward fewer medial meniscus tears. These differences may reflect different MOIs, or the ability to dissipate energy, for contact ACL injuries that occur during ice hockey versus other sports.
Collapse
Affiliation(s)
- Melissa A. Kluczynski
- University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Jeansol V. Kang
- University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - John M. Marzo
- University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Leslie J. Bisson
- University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| |
Collapse
|
31
|
Papalia R, Torre G, Vasta S, Zampogna B, Pedersen DR, Denaro V, Amendola A. Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence. Open Access J Sports Med 2015; 6:37-48. [PMID: 25733936 PMCID: PMC4340462 DOI: 10.2147/oajsm.s75345] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Bone bruises are frequently associated with anterior cruciate ligament (ACL) tears as a result of trauma or direct shear stress of the bone. Purpose To review the evidence regarding the characteristics of the bone bruise associated with ACL tears, its relevance on clinical outcomes, and its progression over time. In particular, the long-term effects of the bone bruise on the knee osteochondral architecture and joint function were evaluated. Study design Review; level of evidence: 4. Methods An electronic search was performed on PubMed. Combinations of keywords included: “bone bruise AND knee”; “bone bruise AND anterior cruciate ligament”; “bone bruise AND osteo-chondral defects”. Any level of evidence studies concerning bone bruises in patients with partial or complete ACL tears were retrieved. Results A total of 25 studies were included; three of them investigated biomechanical parameters, seven were concerned with clinical outcomes, and 15 were radiological studies. Evaluation of the bone bruise is best performed using a fat-saturated T2-weighted fast spin echo exam or a short tau inversion recovery sequence where fat saturation is challenging. The location of the injury has been demonstrated to be more frequent in the lateral compartment of the joint (lateral femoral condyle and lateral tibial plateau). It is associated with ACL tears in approximately 70% of cases, often with collateral ligament or meniscal tears. Mid- and long-term outcomes demonstrated a complete healing of the marrow lesions at magnetic resonance imaging, but chondral defects detected with T1ρ sequences are still present 1 year after the ACL injury. Functional examination of the knee, through clinical International Knee Documentation Committee scores, did not show any correlation with the bone bruise. Conclusion Although bone bruise presence yields to higher pain levels, no correlation with functional outcomes was reported. Most studies have a short-term follow-up (<2 years) compared to the length of time it takes to develop post-traumatic osteoarthritis, so it still remains unclear whether the initial joint injury and bone bruise have a direct relationship to long-term function.
Collapse
Affiliation(s)
- Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Guglielmo Torre
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sebastiano Vasta
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Douglas R Pedersen
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA ; Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Annunziato Amendola
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
32
|
Patel SA, Hageman J, Quatman CE, Wordeman SC, Hewett TE. Prevalence and location of bone bruises associated with anterior cruciate ligament injury and implications for mechanism of injury: a systematic review. Sports Med 2014; 44:281-93. [PMID: 24158783 DOI: 10.1007/s40279-013-0116-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bone bruising is commonly observed on magnetic resonance imaging (MRI) after non-contact anterior cruciate ligament (ACL) injury. OBJECTIVES The primary objective of this study was to determine if the location and prevalence of tibial and femoral bone bruises after ACL injury can be explained by specific injury mechanism(s). The secondary objective was to determine whether the bone-bruise literature supports sex-specific injury mechanism(s). We hypothesized that most studies would report bone bruising in the lateral femoral condyle (LFC) and on the posterior lateral tibial plateau (LTP). METHODS MEDLINE, PubMed, and SCOPUS were searched for studies that reported bone bruise prevalence and location in ACL-injured subjects. Sex differences in bone-bruise patterns were assessed. Time from injury to imaging was assessed to account for confounding effects on bone-bruise size and location. RESULTS Thirty-eight studies met the inclusion/exclusion criteria. Anterior-posterior location of bone bruises within the tibiofemoral compartment was assessed in 11 studies. Only five of these studies reported bone-bruise locations on both the tibia and the femur. The most common bone-bruise combination in all five studies was on the LFC and the posterior LTP. Sex differences were only assessed in three studies, and only one reported significantly greater prevalence of LTP bruising in females. CONCLUSION Bone-bruise patterns in the current literature support a valgus-driven ACL injury mechanism; however, more studies should report the specific locations of tibial and femoral bone bruises. There is insufficient evidence in the literature to determine whether there are sex-specific bone-bruise patterns in ACL-injured subjects.
Collapse
Affiliation(s)
- Sonika A Patel
- Sports Medicine and Sports Health and Performance Institute, The Ohio State University, Columbus, 2050 Kenny Road, Suite 3100, Columbus, OH, 43221, USA
| | | | | | | | | |
Collapse
|