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Martorell-de Fortuny L, Torres-Claramunt R, Sánchez-Soler JF, Perelli S, Hinarejos P, Monllau JC. Patellar bone defect grafting does not reduce anterior knee pain after bone-patellar tendon-bone anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39194385 DOI: 10.1002/ksa.12449] [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: 05/15/2024] [Revised: 08/04/2024] [Accepted: 08/04/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE Donor site morbidity is the main drawback to using bone-patellar tendon-bone (BPTB) as a graft in anterior cruciate ligament (ACL) reconstruction. The objective of the study was to determine whether refilling the patellar bone defect after BPTB harvesting with autograft bone decreased kneeling pain to a greater degree when compared with a group in which bone defect is left unaddressed. METHODS This is a randomised single-blinded controlled study. Forty patients were randomised into two groups; group 1: Patellar bone defect filled with autologous bone; group 2: Bone defect left undressed. Pain was measured by means of pressure algometry (PA). Functional outcomes were measured with the Kujala and Victorian Institute of Sport Assessment-Patella (VISA-P) score. Magnetic resonance imaging (MRI) was done to measure bone buildup between groups at the 1-year follow-up. RESULTS No differences were observed in the different algometry measurements and the scores were assessed at 3, 6 and 12 months postoperatively. The ratio of void filled remained consistently higher (p = 0.003) in group 1 when compared to group 2. CONCLUSIONS Although refilling the lower pole of the patella with autologous bone from the harvested BPTB autograft loads the bone defect, it does not reduce pain at the donor site 1 year after surgery. LEVEL OF EVIDENCE Therapeutic study level 1.
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Affiliation(s)
| | - Raul Torres-Claramunt
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
- ICATKnee, Institut Català de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus, UAB, Barcelona, Spain
| | - Juan Francisco Sánchez-Soler
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
- Knee Surgery Department, Barcelona Trauma Institute, Centro Médico Teknon, Barcelona, Spain
| | - Simone Perelli
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
- ICATKnee, Institut Català de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus, UAB, Barcelona, Spain
| | - P Hinarejos
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Joan Carles Monllau
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
- ICATKnee, Institut Català de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus, UAB, Barcelona, Spain
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Dastgerdi AK, Esrafilian A, Carty CP, Nasseri A, Barzan M, Korhonen RK, Astori I, Hall W, Saxby DJ. Surgical parameters influence paediatric knee kinematics and cartilage stresses in anterior cruciate ligament reconstruction: Navigating subject-specific variability using neuromusculoskeletal-finite element modelling analysis. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39105430 DOI: 10.1002/ksa.12413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/13/2024] [Accepted: 07/17/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE Anterior cruciate ligament (ACL) rupture is increasingly common in paediatric and adolescent populations, typically requiring surgical ACL reconstruction (ACLR) to restore knee stability. However, ACLR substantially alters knee biomechanics (e.g., motion and tissue mechanics) placing the patient at elevated risk of early-onset knee osteoarthritis. METHODS This study employed a linked neuromusculoskeletal (NMSK)-finite element (FE) model to determine effects of four critical ACLR surgical parameters (graft type, size, location and pre-tension) on tibial articular cartilage stresses in three paediatric knees of different sizes during walking. Optimal surgical combinations were defined by minimal kinematic and tibial cartilage stress deviations in comparison to a corresponding intact healthy knee, with substantial deviations defined by normalized root mean square error (nRMSE) > 10%. RESULTS Results showed unique trends of principal stress deviations across knee sizes with small knee showing least deviation from intact knee, followed by large- and medium-sized knees. The nRMSE values for cartilage stresses displayed notable variability across different knees. Surgical combination yielding the highest nRMSE in comparison to the one with lowest nRMSE resulted in an increase of maximum principal stress on the medial tibial cartilage by 18.0%, 6.0% and 1.2% for small, medium and large knees, respectively. Similarly, there was an increase of maximum principal stress on lateral tibial cartilage by 11.2%, 4.1% and 12.7% for small, medium and large knees, respectively. Knee phenotype and NMSK factors contributed to deviations in knee kinematics and tibial cartilage stresses. Although optimal surgical configurations were found for each knee size, no generalizable trends emerged emphasizing the subject-specific nature of the knee and neuromuscular system. CONCLUSION Study findings underscore subject-specific complexities in ACLR biomechanics, necessitating personalized surgical planning for effective restoration of native motion and tissue mechanics. Future research should expand investigations to include a broader spectrum of subject-specific factors to advance personalized surgical planning. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ayda Karimi Dastgerdi
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia
| | - Amir Esrafilian
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Christopher P Carty
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia
- Department of Orthopedics, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Azadeh Nasseri
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia
| | - Martina Barzan
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Ivan Astori
- Department of Orthopedics, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Wayne Hall
- School of Engineering and Built Environment, Mechanical Engineering and Industrial Design, Griffith University, Gold Coast, Queensland, Australia
| | - David John Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia
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Wang H, Yao G, He K, Wang Z, Cheng CK. ACL reconstruction combined with anterolateral structures reconstruction for treating ACL rupture and knee injuries: a finite element analysis. Front Bioeng Biotechnol 2024; 12:1437684. [PMID: 39170062 PMCID: PMC11337200 DOI: 10.3389/fbioe.2024.1437684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/12/2024] [Indexed: 08/23/2024] Open
Abstract
Introduction: The biomechanical indication for combining anterolateral structures reconstruction (ASLR) with ACL reconstruction (ACLR) to reduce pivot shift in the knee remains unclear. This study aims to investigate knee functionality after ACL rupture with different combinations of injuries, and to compare the effectiveness of ALSR with ACLR for treating these injuries. Methods: A validated finite element model of a human cadaveric knee was used to simulate pivot shift tests on the joint in different states, including 1) an intact knee; 2) after isolated ACL rupture; 3) after ACL rupture combined with different knee injuries or defect, including a posterior tibial slope (PTS) of 20°, an injury to the anterolateral structures (ALS) and an injury to the posterior meniscotibial ligament of the lateral meniscus (LP); 4) after treating the different injuries using isolated ACLR; v. after treating the different injuries using ACLR with ALSR. The knee kinematics, maximum von Mises stress (Max.S) on the tibial articular cartilage (TC) and force in the ACL graft were compared among the different simulation groups. Results and discussion: Comparing with isolated ACL rupture, combined injury to the ALS caused the largest knee laxity, when a combined PTS of 20° induced the largest Max.S on the TC. The joint stability and Max.S on the TC in the knee with an isolated ACL rupture or a combined rupture of ACL and LP were restored to the intact level after being treated with isolated ACLR. The knee biomechanics after a combined rupture of ACL and ALS were restored to the intact level only when being treated with a combination of ACLR and ALSR using a large graft diameter (6 mm) for ALSR. However, for the knee after ACL rupture combined with a PTS of 20°, the ATT and Max.S on the TC were still greater than the intact knee even after being treated with a combination of ACLR and ALSR. The finite element analysis showed that ACLR should include ALSR when treating ACL ruptures accompanied by ALS rupture. However, pivot shift in knees with a PTS of 20° was not eliminated even after a combined ACLR and ALSR.
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Affiliation(s)
- Huizhi Wang
- School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Center for Intelligent Medical Equipment and Devices (iMED), University of Science and Technology of China, Suzhou, Jiangsu, China
| | - Gai Yao
- The Fifth Medial Center of Chinese PLA General Hospital, Beijing, China
| | - Kaixin He
- School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Zimin Wang
- Department of Orthopedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
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Vendrig T, Keizer MN, Brouwer RW, Hoogeslag RA. Incidence of Osteoarthritis Between ACL Reconstruction With Different Graft Types and Between ACL Reconstruction and Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Orthop J Sports Med 2024; 12:23259671241258775. [PMID: 39157020 PMCID: PMC11328256 DOI: 10.1177/23259671241258775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/01/2024] [Indexed: 08/20/2024] Open
Abstract
Background Variation in stiffness, fixation methods, and donor-site morbidity after anterior cruciate ligament reconstruction (ACLR) with different graft types and with anterior cruciate ligament suture repair (ACLSR) can lead to differences in dynamic knee laxity and consequent differences in posttraumatic osteoarthritis (PTOA) development. Purpose To compare the incidence of PTOA between different graft types used for primary ACLR and between primary ACLR and ACLSR. It was hypothesized that the incidence of PTOA would vary between ACLR with different autografts and allografts and between ACLR and ACLSR. Study Design Systematic review; Level of evidence, 1. Methods A search of the literature was performed to identify all randomized controlled trials (RCTs) comparing radiographic evidence of PTOA after ACLR between different graft types-hamstring tendon (HT) autograft, bone-patellar tendon-bone (BPTB) autograft, quadriceps tendon autograft, and allograft-and between ACLR and ACLSR. The minimum follow-up was 2 years. Study quality was assessed using the modified Coleman Methodology Score. A meta-analysis was performed to determine whether there was a difference in the incidence of PTOA between the different graft types and between ACLR and ACLSR. Results Eleven randomized controlled trials were included in the meta-analysis-HT: 440 patients (mean follow-up, 9.7 years); BPTB: 307 patients (mean follow-up, 11.8 years); allograft: 246 patients (mean follow-up, 5 years); ACLSR, 22 patients (5 years). No study reporting the incidence after ACLR with quadriceps tendon was included. The study quality ranged from 70 to 88. The meta-analysis indicated no significant difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR (risk ratios: HT vs BPTB, 1.05; HT vs allograft, 0.81; BPTB vs allograft, 0.82; HT vs ACLSR, not estimable [P > .05 for all]). The combined number of patients with PTOA in all studies per graft type showed that patients who underwent ACLR with a BPTB autograft had the highest percentage of PTOA (HT, 23.4%; BPTB, 29.6%; allograft, 8.1%; ACLSR, 0%). However, excluding studies with a follow-up <5 years resulted in similar outcomes for patients with an HT autograft and a BPTB autograft. Conclusion This meta-analysis reported no difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR. More research is necessary to make a reliable conclusion about which technique is associated with the lowest incidence of PTOA after ACL surgery.
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Affiliation(s)
- Tom Vendrig
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michèle N.J. Keizer
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Reinoud W. Brouwer
- Department of Orthopedic Surgery, Martini Hospital, Groningen, Groningen, the Netherlands
| | - Roy A.G. Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, the Netherlands
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Liu Y, Chen P, Hu B, Xiao Y, Su T, Luo X, Tu M, Cai G. Excessive mechanical loading promotes osteoarthritis development by upregulating Rcn2. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167251. [PMID: 38795835 DOI: 10.1016/j.bbadis.2024.167251] [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: 01/15/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/28/2024]
Abstract
Exposure of articular cartilage to excessive mechanical loading is closely related to the pathogenesis of osteoarthritis (OA). However, the exact molecular mechanism by which excessive mechanical loading drives OA remains unclear. In vitro, primary chondrocytes were exposed to cyclic tensile strain at 0.5 Hz and 10 % elongation for 30 min to simulate excessive mechanical loading in OA. In vivo experiments involved mice undergoing anterior cruciate ligament transection (ACLT) to model OA, followed by interventions on Rcn2 expression through adeno-associated virus (AAV) injection and tamoxifen-induced gene deletion. 10 μL AAV2/5 containing AAV-Rcn2 or AAV-shRcn2 was administered to the mice by articular injection at 1 week post ACLT surgery, and Col2a1-creERT: Rcn2flox/flox mice were injected with tamoxifen intraperitoneally to obtain Rcn2-conditional knockout mice. Finally, we explored the mechanism of Rcn2 affecting OA. Here, we identified reticulocalbin-2 (Rcn2) as a mechanosensitive factor in chondrocytes, which was significantly elevated in chondrocytes under mechanical overloading. PIEZO type mechanosensitive ion channel component 1 (Piezo1) is a critical mechanosensitive ion channel, which mediates the effect of mechanical loading on chondrocytes, and we found that increased Rcn2 could be suppressed through knocking down Piezo1 under excessive mechanical loading. Furthermore, chondrocyte-specific deletion of Rcn2 in adult mice alleviated OA progression in the mice receiving the surgery of ACLT. On the contrary, articular injection of Rcn2-expressing adeno-associated virus (AAV) accelerated the progression of ACLT-induced OA in mice. Mechanistically, Rcn2 accelerated the progression of OA through promoting the phosphorylation and nuclear translocation of signal transducer and activator of transcription 3 (Stat3).
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Affiliation(s)
- Yalin Liu
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China
| | - Peng Chen
- Department of Orthopedic, Xiangya Hospital of Central South University, Changsha, China
| | - Biao Hu
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China
| | - Ye Xiao
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China
| | - Tian Su
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China
| | - Xianghang Luo
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Manli Tu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China; Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, China; Jiangxi Branch of National Clinical Research Center for metabolic Disease, China.
| | - Guangping Cai
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.
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6
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Bingol I, Kamaci S, Kaya I, Fidanci AA, Ayvali MO, Ata N, Ulgu MM, Birinci S, Atay OA, Kaya A. Low meniscus reoperation rates following meniscus repair during anterior cruciate ligament reconstruction in Turkey: an in-depth national analysis of 8-years. BMC Musculoskelet Disord 2024; 25:554. [PMID: 39020339 PMCID: PMC11253353 DOI: 10.1186/s12891-024-07662-0] [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: 01/27/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Concomitant knee injuries, such as meniscal tears, are observed in up to 80% of cases and can have a detrimental impact on outcomes following anterior cruciate ligament reconstruction (ACLR). Over recent decades, there has been a growing recognition of the importance of preserving meniscal tissue. Consequently, the prevalence of meniscal-preserving procedures has been on the rise. PURPOSE The objective of this study was to examine the prevalence of concurrent meniscal procedures, assess the success rate, and identify factors associated with the failure of meniscal repair in patients undergoing ACLR. METHODS All patients who underwent ACLR due to anterior cruciate ligament (ACL) injury between January 2015 and December 2022 were extracted from the Republic of Türkiye National health system using operation-specific procedure codes. Patients with multiple ligament injuries, revision ACL patients, and patients with missing data were excluded from the study. The treatment methods were grouped into the subsets of meniscectomy, meniscal repair, transplantation, and meniscectomy + repair. The distribution of ACLR and meniscus treatment methods according to years, age and sex groups, hospital characteristics, and geographical regions was examined. A secondary analysis was performed to assess the effect of patient demographics and hospital healthcare level on revision meniscal procedures in the ACLR + concomitant meniscal repair group. RESULTS A total of 91,700 patients who underwent ACLR between 2015 and 2022 were included in the study. A concomitant meniscal procedure was noted in 19,951(21.8%) patients (16,130 repair,3543 meniscectomy). In the 8 years studied, meniscus repair rates increased from 76.3%to87.9%, while meniscectomy rates decreased from 23.7%to12.1% (p < 0.001). The revision meniscus surgery rate following ACLR + meniscal repair was 3.7%at a mean follow-up of 50 ± 26 months. The interval between primary and revision surgery was 20.5 ± 21.2 months. The meniscectomy rates were higher in community hospitals, while private hospitals showed the lowest revision meniscus surgery rates. Younger age was associated with increased meniscus repair failure rates. CONCLUSION The propensity towards using repair techniques to treat meniscal tears during concurrent ACLR has significantly increased in Turkey. Age and the healthcare level of the treating hospital affect the success of meniscal repair.
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Affiliation(s)
- Izzet Bingol
- Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, Ankara, Türkiye.
| | - Saygin Kamaci
- Department of Orthopaedic Surgery, Hacettepe University, Ankara, Türkiye
| | - Ibrahim Kaya
- Department of Orthopaedics and Traumatology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Türkiye
| | | | - Mustafa Okan Ayvali
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | - Naim Ata
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | - M Mahir Ulgu
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | | | - Ozgur Ahmet Atay
- Department of Orthopaedic Surgery, Hacettepe University, Ankara, Türkiye
| | - Alper Kaya
- Department of Orthopaedic Surgery, Acibadem University, Istanbul, Türkiye
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Wagala NN, Fatora G, Brown C, Lesniak BP. Complications in Anterior Cruciate Ligament Surgery and How to Avoid Them. Clin Sports Med 2024; 43:465-477. [PMID: 38811122 DOI: 10.1016/j.csm.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Complications following anterior cruciate ligament (ACL) reconstruction can be detrimental to a patient's recovery and limit their ability to successfully return to sport. Arthrofibrosis, graft failure, and infection are a few examples of complications that can arise. Therefore, it is important for surgeons to recognize that each step during perioperative surgical decision making can impact patients' risk for such complications. The purpose of this paper is to discuss common complications following ACL reconstruction and how surgeons can avoid or reduce the risk of complications.
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Affiliation(s)
- Nyaluma N Wagala
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gabrielle Fatora
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cortez Brown
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Muench LN. Editorial Commentary: Noninferiority of Anterior Cruciate Ligament Repair With Dynamic Intraligamentary Stabilization at Short- to Mid-Term Follow-Up Does Not Justify Superseding Anterior Cruciate Ligament Reconstruction as the "Gold Standard" for Anterior Cruciate Ligament Surgery. Arthroscopy 2024; 40:2132-2134. [PMID: 38458549 DOI: 10.1016/j.arthro.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
With advances in surgical technology, including the introduction of some kind of mechanical augmentation, there has been a resurgence of interest in primary repair of the anterior cruciate ligament (ACL). If successful, ACL repairs may provide several advantages over reconstruction resulting from the preservation of the native anatomy and proprioception. Recently, augmentation of ACL repair using dynamic intraligamentary stabilization (DIS) has been proposed, to create an optimal biomechanical environment for healing. In the DIS technique, an additional nonresorbable cord is placed along the ACL and attached to a dynamic spring fixed in the proximal tibia, keeping the tibia in a posterior drawer position at every degree of flexion. The analyzed randomized controlled trials comparing ACL repair with DIS to ACL reconstruction found overall similar failure and revision rates, whereas the few observed statistically significant differences in functional scores or knee stability favoring either of the techniques were clearly not clinically relevant. Of course, repair of a torn ACL should be limited to a specific subset of patients presenting with an acute femoral avulsion tear with minimal retraction and good tissue quality. However, the present short- to mid-term results do not justify ACL reconstruction to be superseded by ACL repair with DIS as the "gold standard" for surgical treatment of ACL tears in the future, even in this subset of patients.
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Kantrowitz DE, Colvin A. Comprehensive Clinical Examination of ACL Injuries. Clin Sports Med 2024; 43:311-330. [PMID: 38811112 DOI: 10.1016/j.csm.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
A comprehensive clinical examination of the potentially anterior cruciate ligament (ACL)-deficient knee should proceed as follows: inspection; palpation; range of motion; varus and valgus stress; neurovascular status; and finally provocative maneuvers. The Lachman, anterior drawer, Lever, and pivot shift tests are all greater than 90% specific for ACL pathology. Due to the relatively high coincidence of ACL injuries and those to the posterior cruciate ligament, posterolateral corner , posteromedial corner , and menisci, it is critical that the examiner perform provocative maneuvers to evaluate the integrity of these structures as well.
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Affiliation(s)
- David E Kantrowitz
- Department of Orthopedics, The Mount Sinai Hospital, 5 E 98th Street, 9th floor, New York, NY 10029, USA.
| | - Alexis Colvin
- Department of Orthopedics, The Mount Sinai Hospital, 5 E 98th Street, 9th floor, New York, NY 10029, USA
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10
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Sherman SL, Raji Y, Calcei JG, Sherman MF. Anterior Cruciate Ligament Repair-Here to Stay or History Repeating Itself? Clin Sports Med 2024; 43:433-448. [PMID: 38811120 DOI: 10.1016/j.csm.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Anterior cruciate ligament (ACL) injuries continue to be a prevalent concern among athletes and individuals with an active lifestyle. Traditionally, the standard of care for ACL tears has involved surgical reconstruction using autograft or allograft. This article aims to provide an overview of the evolving landscape of primary ACL repair, examining the current evidence, surgical techniques, patient selection criteria, outcomes, and potential future directions in this field.
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Affiliation(s)
- Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway, MC 6342, Pavilion C, Redwood City, CA 94063, USA.
| | - Yazdan Raji
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway, MC 6342, Pavilion C, Redwood City, CA 94063, USA
| | - Jacob G Calcei
- University Hospitals Drusinsky Sports Medicine Institute, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Hanna House 6th Floor, Cleveland, OH 44106, USA
| | - Mark F Sherman
- Richmond University Medical Center, 2052 Richmond Road, Staten Island, NY 10306, USA
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11
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Biały M, Kublin K, Wilczyński B, Forelli F, Gnat R. Does Concomitant Meniscectomy or Meniscus Repair Affect Muscle Strength, Lower Extremity Balance, and Functional Tests after Anterior Cruciate Ligament Reconstruction? J Clin Med 2024; 13:3310. [PMID: 38893022 PMCID: PMC11172927 DOI: 10.3390/jcm13113310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objective: The effects of concomitant meniscal tears and their associated treatment on strength, lower extremity balance, and functional status after anterior cruciate ligament reconstruction (ACLR) have not been widely investigated. This study aimed to compare the functional outcomes in patients who underwent ACLR with concomitant treatment of the medial meniscus repair versus meniscectomy when returning to unrestricted physical activity. Methods: A total of 85 patients who underwent primary ACLR with combined meniscal repair (MREP; n = 39) or meniscectomy (MRES; n = 46) were assessed. The dataset included the Functional Movement ScreenTM (FMS) outcomes and single-leg balance test (SLBT) with anterior-posterior, medial-lateral, and overall stability indexes. Isokinetic knee extension and flexion strengths were tested at velocities of 60 deg·s-1 and 180 deg·s-1. The peak torque-to-body weight ratio (PT/BW) and limb symmetry index (LSI) were calculated. Results: In the functional assessment, there was no significant inter-group difference in the composite score of the FMS (MREP: 15.08 pts vs. MRES: 15.13 pts; p > 0.05). The SLBT outcomes in inter-group and inter-extremity comparisons were irrelevant (p > 0.05), too. Significant differences emerged in the inter-group comparison of the knee extension strength in the non-operated extremity at both 60 deg·s-1 and 180 deg·s-1 (p = 0.02). Inter-extremity differences were significant in both the MREP and MRES groups for knee extension and flexion at both angular velocities (all p values < 0.05). For knee extension, the LSI values ranged from 82% to 87%, and for flexion, from 77% to 84%, with no significant inter-group differences. Conclusions: Patients undergoing ACLR with concomitant meniscal repair or resection did not exhibit differences in isokinetic muscle strength, lower extremity balance, and functional tests upon returning to activity. However, participants in both groups demonstrated significant differences between the operated and non-operated extremities as far as the knee joint extensor and flexor strengths are concerned. Therefore, rehabilitation protocols should prioritize equalizing inter-extremity strength differences after the ACLR with additional treatment procedures addressing the menisci.
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Affiliation(s)
- Maciej Biały
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
- Functional Diagnostics Laboratory, Sport-Klinika, Scanmed Sport, 44-240 Żory, Poland
| | - Kamil Kublin
- Motion Analysis Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (K.K.); (R.G.)
| | - Bartosz Wilczyński
- Department of Immunobiology and Environment Microbiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Florian Forelli
- Orthosport Rehab Center, Sport Rehabilitation Department, 95330 Domont, France;
- Clinic of Domont, Education, Rehabilitation and Research Department, Orthopedic Surgery Department, Ramsay Healthcare, 95330 Domont, France
- SFMKS-Lab, Société Française des Masseurs-Kinésithérapeutes du Sport, 93380 Pierrefitte-sur-Seine, France
| | - Rafał Gnat
- Motion Analysis Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (K.K.); (R.G.)
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12
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Battersby HS, Holmes SC, Shumski EJ, Heredia CE, Garcia SA, Pamukoff DN. The Influence of Knee Position on Ultrasound Imaging of Femoral Cartilage in Individuals with Anterior Cruciate Ligament Reconstruction. Cartilage 2024; 15:84-93. [PMID: 37846037 DOI: 10.1177/19476035231205682] [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: 10/18/2023] Open
Abstract
BACKGROUND Articular cartilage is important for knee function and can be imaged using ultrasound. The purpose was to compare femoral cartilage thickness and echo intensity (EI) measured at 90° and 140° of knee flexion and between limbs in a cohort with unilateral anterior cruciate ligament reconstruction (ACLR). We also examined associations between gait biomechanics and cartilage outcomes. METHODS Twenty-seven individuals with primary unilateral ACLR participated (12 men, 15 women; age = 22.3 ± 3.8 years; time since ACLR = 71.2 ± 47.2 months). Ultrasound was used to obtain femoral cartilage measurements. Gait outcomes included peak KFA (knee flexion angle) and peak external knee flexion moment (KFM). Cartilage outcomes were compared using a 2 (position) × 2 (limb) repeated measures ANOVA (analysis of variance). Gait and cartilage associations were assessed using linear regression. FINDINGS There were no position × limb interactions for any cartilage outcome (all P > 0.05). Medial (P = 0.038) and central cartilage (P < 0.001) were thicker, whereas central (P = 0.029) and lateral cartilage EI (P = 0.003) were lower when measured at 90° than those at 140° of knee flexion. Medial cartilage was thicker in the ACLR than that in the contralateral limb (P = 0.016). A larger KFM was associated with thicker medial cartilage (ΔR2 = 0.146, P = 0.021) and central cartilage (ΔR2 = 0.159, P = 0.039) measured at 140° of knee flexion in the ACLR limb but not at 90°. INTERPRETATION Findings suggest that imaging position influences cartilage thickness and EI measurements in individuals with ACLR and should be considered in study designs and clinical evaluation. A greater KFM was associated with thicker cartilage within specific portions of the distal femur.
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Affiliation(s)
| | - Skylar C Holmes
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Eric J Shumski
- Department of Kinesiology, University of Georgia, Athens, GA, USA
| | | | - Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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13
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Entezari B, Lex JR, Peck J, Igbokwe EN, Kubik JF, Backstein DJ, Wolfstadt JI. Intraoperative and Postoperative Outcomes of Patients Undergoing Total Knee Arthroplasty With Prior Anterior Cruciate Ligament Reconstruction: A Matched Cohort Analysis. Arthroplast Today 2024; 27:101330. [PMID: 39071823 PMCID: PMC11282402 DOI: 10.1016/j.artd.2024.101330] [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: 08/23/2023] [Revised: 12/11/2023] [Accepted: 01/27/2024] [Indexed: 07/30/2024] Open
Abstract
Background Previous anterior cruciate ligament (ACL) injury is a risk factor for the development of knee osteoarthritis. Despite advances in ACL reconstruction (ACLR) techniques, many patients with history of ACLR develop end-stage osteoarthritis necessitating total knee arthroplasty (TKA). The purpose of this study was to investigate the impact of prior ACLR on intraoperative and postoperative outcomes of TKA. Methods This was a single-centre matched cohort study of all patients with prior ACLR undergoing primary TKA from January 2000 to May 2022. Patients were matched 1:1 to patients undergoing TKA with no prior ACL injury based on age, sex, and body mass index. Outcomes investigated included TKA procedure duration, soft-tissue releases, implant design, and complications requiring reoperation. Results Forty-two ACLR patients were identified and matched to controls. Mean follow-up was 6.8 years and 5.0 years in the ACLR and control cohorts, respectively (P = .115). ACLR patients demonstrated longer procedure durations (122.8 minutes vs 87.0 minutes, P < .001) and more frequently required soft-tissue releases (40.5% vs 14.3%, P = .007), stemmed implants (23.8% vs 4.8%, P = .013), and patellar resurfacing (59.5% vs 26.2%, P = .002). There were no significant differences in postoperative clinical or surgical outcomes between groups. Ten-year implant survivorship was 92% and 95% in the ACLR and control cohorts, respectively (P = .777). Conclusions TKA is an effective procedure for the management of end-stage osteoarthritis with prior ACLR. The care team should be prepared for longer operative times and the utilization of advanced techniques to achieve satisfactory soft-tissue balance and implant stability.
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Affiliation(s)
- Bahar Entezari
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada
- Queen’s University School of Medicine, Kingston, ON, Canada
| | - Johnathan R. Lex
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jonathan Peck
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Emmanuel N. Igbokwe
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jeremy F. Kubik
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - David J. Backstein
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jesse I. Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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14
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Rechter GR, Mason E, Levy BA. Editorial Commentary: Gracilis-Sparing Anterior Cruciate Ligament Hamstring Graft Reconstruction Is Less Invasive Than Semitendinosus-Gracilis Graft Harvest, and Shows No Clinical Difference in Outcomes With Grafts Greater Than 8 mm in Diameter. Arthroscopy 2024; 40:1833-1836. [PMID: 38219098 DOI: 10.1016/j.arthro.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 01/15/2024]
Abstract
Although patellar tendon grafts are most commonly used for anterior cruciate ligament reconstruction in the United States, hamstring autograft is most commonly used worldwide. Hamstring advantages include easy, quick harvest; low morbidity; ease of rehabilitation (compared with patellar tendon grafts); and relatively less pain. Historically, both the semitendinosus (ST) and gracilis are harvested, but by doubling, tripling, or quadrupling the ST to achieve an 8-mm graft, the gracilis can be spared, resulting in less knee flexion weakness. However, recent research has shown no clinically important difference between ST and ST-gracilis patient outcomes.
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Affiliation(s)
| | - Eric Mason
- Orlando Health Jewett Orthopedic Institute
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15
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Lustig MA, Hazzard S, Fitzgerald B, Stovall N, Asnis P. Body Mass Index Between 15 and 30 Does Not Influence Patient-Reported Outcomes After Anterior Cruciate Ligament Surgery Using a 10-mm-Diameter Bone-Tendon-Bone Graft. Arthrosc Sports Med Rehabil 2024; 6:100925. [PMID: 39006775 PMCID: PMC11240024 DOI: 10.1016/j.asmr.2024.100925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/09/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To investigate the relation between body mass index (BMI) and outcomes after anterior cruciate ligament reconstruction (ACLR) using 10-mm-diameter bone-patellar tendon-bone grafts. Methods In this retrospective study, the Surgical Outcome System was used to measure patient-reported outcomes before and after ACLR between 2015 and 2019. The inclusion criteria consisted on patients undergoing primary ACLR performed by the senior surgeon, with recorded age of 15 years or older and BMI of 15.0 to 30. The exclusion criteria included revisions, concomitant procedures, age younger than 15 years, and unknown BMI. Patients were divided into cohorts to evaluate the Marx Activity Rating Scale (MARS), Tegner, International Knee Documentation Committee (IKDC), and Lysholm scores at various time points from injury to 2 years postoperatively. Results A total of 137 patients (100 male and 37 female patients) with an average age of 33 years (95% confidence interval, 30.6-35.4 years) and average BMI of 23.58 (95% confidence interval, 23.1-24.0) were divided into those with a BMI of 15 to 23.4 (group A, n = 69) and those with a BMI of 23.5 to 30 (group B, n = 68). A significant difference in MARS scores was found between the BMI groups before treatment, with mean scores of 11.55 (group A) and 9.41 (group B) (P = .011), and Tegner scores showed significance at 2 years, with scores of 6.45 and 5.41 for groups A and B, respectively (P = .009). Daily function scores were all insignificant. Female patients exhibited no significant differences across any patient-reported outcome measures or time points. Contrarily, male patients showed a significant difference in pretreatment MARS scores (14.30 in group A vs 9.96 in group B, P = .011). Additionally, scores at 2 years depicted Tegner values of 7.40 in group A versus 5.30 in group B (P = .012) and IKDC values of 96.92 in group A versus 90.47 in group B (P = .048). All results for female and male patients aged 30 years or younger indicated no significance. Conclusions Regardless of patient age or sex, BMI is not significantly associated with patient-reported outcomes after ACLR using 10-mm-diameter bone-patellar tendon-bone grafts. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Mia Adler Lustig
- Department of Orthopaedic Surgery/Sports Medicine, Massachusetts General Hospital, Waltham, Massachusetts, U.S.A
| | - Sean Hazzard
- Department of Orthopaedic Surgery/Sports Medicine, Massachusetts General Hospital, Waltham, Massachusetts, U.S.A
| | - Brendan Fitzgerald
- Department of Orthopaedic Surgery/Sports Medicine, Massachusetts General Hospital, Waltham, Massachusetts, U.S.A
| | - Nasir Stovall
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Peter Asnis
- Department of Orthopaedic Surgery/Sports Medicine, Massachusetts General Hospital, Waltham, Massachusetts, U.S.A
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16
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Michaud A, Koskoletos C, Patterson BE, Crossley KM, Birmingham TB, Culvenor AG, Hart HF. Longitudinal changes in adiposity following anterior cruciate ligament reconstruction and associations with knee symptoms and function. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100473. [PMID: 38737984 PMCID: PMC11088183 DOI: 10.1016/j.ocarto.2024.100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024] Open
Abstract
Objective To evaluate adiposity after anterior cruciate ligament reconstruction (ACLR): i) cross-sectionally (1-year post-ACLR) compared to uninjured controls; ii) longitudinally up to 5 years post-ACLR; and iii) associations with patient-reported symptoms and physical performance. Methods In 107 individuals post-ACLR and 19 controls, we assessed global (BMI), peripheral (subcutaneous adipose tissue thickness on the posteromedial side of knee MRI), and central (waist circumference in ACLR group) adiposity. Patient-reported symptoms (Knee injury and Osteoarthritis Outcome Score) and physical performance (hop for distance) were evaluated at 1 and 5 years post-ACLR. Linear regression models evaluated adiposity between groups. Paired t-tests evaluated changes in adiposity from 1- to 5 years post-ACLR. Linear regression models analyzed adiposity's associations with patient-reported symptoms and physical performance at 1-year post-ACLR, changes in symptoms and performance over 4 years post-ACLR, and longitudinal changes in adiposity and symptoms and performance, controlling for age, sex, and activity level. Results Individuals 1-year post-ACLR were associated with higher average global (3 kg/m2) and peripheral adiposity (2.3 mm). From 1- to 5 years post-ACLR, higher average global (0.58 kg/m2) and central (5 cm) adiposity, and lower average peripheral adiposity (1.3 mm) were observed. In general, adiposity at one-year post-ACLR was negatively associated with patient-reported symptoms and physical performance, and changes from 1 to 5 years post-ACLR. Increases in adiposity were negatively associated with changes in patient-reported symptoms and physical performance over four years post-ACLR. Conclusion Greater global and central adiposity is a feature of young adults following ACLR and influences current and future patient-reported symptoms and physical performance.
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Affiliation(s)
- Amélie Michaud
- Action Sport Physio, Sherbrooke, Canada
- School of Physical Therapy, Western University, London, Canada
| | - Chris Koskoletos
- Rewind Physio, Embrun, Ontario, Canada
- School of Physical Therapy, Western University, London, Canada
| | - Brooke E. Patterson
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Kay M. Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | | | - Adam G. Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Harvi F. Hart
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- School of Physical Therapy, Western University, London, Canada
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17
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Abdul W, Moore I, Robertson A. Anterior Cruciate Ligament Injury Prevention Programs in Welsh Netball: A Survey of Knowledge, Implementation and Barriers Amongst Players and Coaches. Cureus 2024; 16:e60405. [PMID: 38882996 PMCID: PMC11179151 DOI: 10.7759/cureus.60405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Background Anterior cruciate ligament (ACL) injury prevention programs can reduce injury risk in various sports. The perception of ACL injury prevention programs amongst professional netball players and coaches has not been studied. Purpose The aim of this study was to determine (1) the level of awareness and experience of ACL injury prevention programs, (2) the use of ACL injury prevention programs, and (3) barriers and potential facilitators to implementing a sustainable ACL injury prevention program in netball. Materials and methods Female netball players representing Welsh senior and under-21 teams and elite and amateur coaches were invited electronically to participate in this web-based cross-sectional observational study between 1st May and 31st July 2021. Information on ACL injury susceptibility and seriousness, knowledge, experience, and implementation of ACL injury prevention programs were ascertained. Results Twenty-eight players (78%) and 29 coaches (13%) completed the questionnaire. Seventeen (61%) players and 15 (52%) coaches reported that female athletes were at greater risk of sustaining ACL injuries. Over 90% of respondents identified netball as high-risk, whilst 89% (n=25) of players and 76% (n=22) of coaches reported these injuries to be preventable. Only two (7%) players and six (21%) coaches utilised an ACL injury prevention program with a lack of time and engagement from coaches and players identified. The majority of respondents indicated that their club has neither promoted, advocated the use nor demonstrated exercises for ACL injury prevention. Over 90% of respondents would utilise an ACL injury prevention program if it minimised players' risk with appropriate information and demonstration of exercises. Conclusion This study highlights limited knowledge of female athletes' increased susceptibility to ACL injuries amongst players and coaches with a lack of communication and education on ACL injury prevention programs between sporting associations, coaches, and players. However, the results demonstrate willingness amongst both players and coaches to implement an ACL injury prevention program in netball.
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Affiliation(s)
- Wahid Abdul
- Trauma and Orthopaedics, University Hospital of Wales, Cardiff, GBR
| | - Isabel Moore
- Sports and Exercise Medicine, Cardiff Metropolitan University, Cardiff, GBR
| | - Angus Robertson
- Orthopaedic Surgery, University Hospital of Wales, Cardiff, GBR
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18
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Johnston CD, Dewig DR, Pietrosimone B, Padua D, Ryan ED, Hart J, Spang J, Blackburn T. Longitudinal Changes in Quadriceps Morphology over the First 3 Months after Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2024; 56:933-941. [PMID: 38109204 DOI: 10.1249/mss.0000000000003359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
PURPOSE Neuromuscular deficits and atrophy after anterior cruciate ligament reconstruction (ACLR) may be accompanied by changes in muscle composition and poor quadriceps muscle quality (QMQ). Quadriceps atrophy occurs after ACLR but improves within the first three postoperative months, yet this hypertrophy could be attributable to increases in noncontractile tissue (i.e., poor QMQ). The purposes of this study were to evaluate changes in QMQ after ACLR and to determine if changes in QMQ and cross-sectional area (CSA) occur in parallel or independently. METHODS A longitudinal prospective cohort design was implemented to evaluate QMQ and CSA in 20 individuals with ACLR and 12 healthy controls. Participants completed three testing sessions (baseline/presurgery, 1 month, and 3 months) during which ultrasound images were obtained from the vastus lateralis (VL) and rectus femoris (RF). QMQ was calculated as the echo intensity (EI) of each image, with high EI representing poorer QMQ. Anatomical CSA was also obtained from each image. RESULTS RF and VL EI were greater at 1 and 3 months in the ACLR limb compared with baseline and the contralateral limb and did not change between 1 and 3 months. VL and RF CSA in the ACLR limb were smaller at 1 and 3 months compared with the contralateral limb and controls (VL only) but increased from 1 to 3 months. Changes in QMQ and CSA were not correlated. CONCLUSIONS QMQ declines within the first month after ACLR and does not improve by 3 months although hypertrophy occurs, suggesting that these morphological characteristics change independently after ACLR. Poorer QMQ represents greater concentration of noncontractile tissues within the muscle and potentially contributes to chronic quadriceps dysfunction observed after ACLR.
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Affiliation(s)
| | - Derek R Dewig
- Department of Health and Human Performance, Fairmont State University, Fairmont, WV
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Darin Padua
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Eric D Ryan
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joe Hart
- Department of Orthopaedics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffrey Spang
- Department of Orthopaedics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Troy Blackburn
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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19
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Yu F, Xiao LE, Wang T, Hu Y, Xiao J. Nurse-Assisted Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction. Orthop Nurs 2024; 43:163-178. [PMID: 38861747 DOI: 10.1097/nor.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Despite significant advancements in surgical instruments and operation skills, short- and long-term outcomes following anterior cruciate ligament reconstruction (ACLR) remain unsatisfactory, as many patients fail to return to their pre-injury level of sports. Inadequate ACL rehabilitation is the primary cause of poor outcomes. Nurses have become a crucial element in the rehabilitation process. Although there is no consensus regarding the optimal post-operative rehabilitation protocols, restoring muscle strength and neuromuscular control are consistently the primary goals. This literature review presents nurse-assisted rehabilitation protocols aiming at improving muscle strength and neuromuscular control. The review discusses postoperative rehabilitation, including home-based and supervised rehabilitation, open and closed kinetic chain exercises, eccentric and concentric training, blood flow restriction training, and plyometric training. Each training protocol has its benefits and drawbacks, and should be used cautiously in specific stages of rehabilitation. Neuromuscular training, such as neuromuscular electrical stimulation, neuromuscular control exercises, and vibration therapy, is considered crucial in rehabilitation.
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Affiliation(s)
- Fang Yu
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Li-En Xiao
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Tao Wang
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Yong Hu
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Jun Xiao
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
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20
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D'Ambrosi R, Carrozzo A, Meena A, Corona K, Yadav AK, Annibaldi A, Kambhampati SBS, Abermann E, Fink C. A slight degree of osteoarthritis appears to be present after anterior cruciate ligament reconstruction compared with contralateral healthy knees at a minimum of 20 years: A systematic review of the literature. J Exp Orthop 2024; 11:e12017. [PMID: 38577065 PMCID: PMC10993150 DOI: 10.1002/jeo2.12017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/03/2024] [Accepted: 03/14/2024] [Indexed: 04/06/2024] Open
Abstract
Purpose The aim of the present systematic review was to quantitatively synthesize the best literature evidence regarding osteoarthritis developing after anterior cruciate ligament reconstruction (ACLR), including only studies with a follow-up duration of at least 20 years. Material and Methods A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on four electronic databases (PubMed, Scopus, EMBASE and Cochrane Library). The outcome measures extracted from the studies were failure rate, subsequent knee surgery on the same knee, radiographic development of osteoarthritis measured with Kellgren-Lawrence, International Knee Documentation Committee (IKDC) radiographic score and Ahlbäck classification. The health of both the ACLR knee and the contralateral knee was compared. Results A total of 1552 patients were included in the study, of which 1290 (83.11%) were operated on using a patellar tendon graft, 190 (12.24%) with hamstrings, 27 (1.73%) with an iliotibial band and 45 (2.89%) with patellar tendon plus a ligament augmentation device (LAD). The mean age at the time of surgery was 25.18 ± 1.91 years, and the mean follow-up time was 23.34 ± 2.56 years. Analysing IDKC Score at final follow-up, ACLR Group showed a higher degree of OA compared with contralateral healthy knee (p < 0.01), but only 33.2% (324/976) of the patients showed a moderate to severe degree (Grade C or D) of osteoarthritis, while for Kellgren-Lawrence, ACLR Group showed a higher degree of OA compared with contralateral healthy knee (p < 0.01), but only 28.9% (196/678) of the patients showed a moderate to severe degree (Grade III or IV) of osteoarthritis. In total, 1552 patients were registered, 155 reruptures (9.98%) and a total of 300 (19.3%) new surgeries, of which 228 meniscectomy (14.69%), 21 (1.35%) knee arthroplasty and 17 (1.09%) hardware removal were recorded. Conclusions ACL reconstruction appears to result in mild osteoarthritis in the long term in most of the patients and only less than 33.2% develop a moderate to severe degree of knee OA according to IKDC radiographic score. A slight degree of osteoarthritis appears to be present in ACLR knees compared with contralateral healthy knees. Level of Evidence Level IV.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi—Sant'AmbrogioMilanItaly
- Dipartimento di Scienze Biomediche per la SaluteUniversità degli Studi di MilanoMilanItaly
| | - Alessandro Carrozzo
- Orthopaedic Unit, Sant'Andrea HospitalUniversity of Rome La SapienzaRomeItaly
| | - Amit Meena
- Division of OrthopedicsShalby Multi‐Specialty HospitalJaipurIndia
- Gelenkpunkt—Sports and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
| | - Katia Corona
- Department of Medicine and Health Sciences “Vincenzo Tiberio”University of MoliseCampobassoItaly
| | | | | | | | - Elisabeth Abermann
- Gelenkpunkt—Sports and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
| | - Christian Fink
- Gelenkpunkt—Sports and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health SciencesMedical Informatics and TechnologyInnsbruckAustria
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21
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Nilius A, Dewig DR, Johnston CD, Pietrosimone BG, Blackburn JT. Quadriceps composition and function influence downhill gait biomechanics >1 year following anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2024; 114:106229. [PMID: 38490072 DOI: 10.1016/j.clinbiomech.2024.106229] [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: 11/01/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Quadriceps dysfunction is common following anterior cruciate ligament reconstruction and contributes to aberrant gait biomechanics. Changes in quadriceps composition also occur in these patients including greater concentrations of non-contractile tissue. The purpose of this study was to evaluate associations between quadriceps composition, function, and gait biomechanics in individuals with anterior cruciate ligament reconstruction. METHODS Forty-eight volunteers with anterior cruciate ligament reconstruction completed gait biomechanics and quadriceps function and composition assessments. Gait biomechanics were sampled during downhill walking (-10° slope) on an instrumented treadmill. Quadriceps function (peak torque and rate of torque development) was assessed via maximal isometric contractions, while composition was evaluated via ultrasound echo intensity. FINDINGS Greater quadriceps peak torque was associated with a greater peak knee extension moment (r = 0.365, p = 0.015). Greater vastus lateralis echo intensity (i.e. poorer muscle quality) was associated with less knee flexion displacement (r = -0.316, p = 0.032). Greater echo intensity of the vastus lateralis (r = -0.298, p = 0.044) and rectus femoris (r = -0.322, p = 0.029) was associated with a more abducted knee angle at heel strike. Quadriceps peak torque explained 11-16% of the variance in echo intensity. INTERPRETATION Both quadriceps function and composition influence aberrant gait biomechanics following anterior cruciate ligament reconstruction. Quadriceps composition appears to provide insight into quadriceps dysfunction independent of muscle strength, as they associated with different gait biomechanics outcomes and shared minimal variance. Future research is necessary to determine the influence of changes in quadriceps composition on joint health outcomes.
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Affiliation(s)
- Alex Nilius
- Program in Human Movement Science, University of North Carolina at Chapel Hill, USA; MOTION Science Institute, University of North Carolina at Chapel Hill, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA
| | - Derek R Dewig
- College of Education, Health & Human Performance, Fairmont State University, USA
| | | | - Brian G Pietrosimone
- Program in Human Movement Science, University of North Carolina at Chapel Hill, USA; MOTION Science Institute, University of North Carolina at Chapel Hill, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA
| | - J Troy Blackburn
- Program in Human Movement Science, University of North Carolina at Chapel Hill, USA; MOTION Science Institute, University of North Carolina at Chapel Hill, USA; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA.
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22
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Lawrence KW, Okewunmi JO, Chakrani Z, Cordero JK, Li X, Parisien RL. Randomized Controlled Trials Comparing Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autografts in Anterior Cruciate Ligament Reconstruction Surgery Are Statistically Fragile: A Systematic Review. Arthroscopy 2024; 40:998-1005. [PMID: 37543146 DOI: 10.1016/j.arthro.2023.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/07/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To assess the statistical fragility of recently published randomized controlled trials (RCTs) comparing the use of hamstring tendon autograft with bone-patellar tendon-bone autograft for anterior cruciate ligament (ACL) reconstruction. METHODS The PubMed, Embase, and MEDLINE databases were queried for RCTs published since 2010 comparing autograft type (bone-patellar tendon-bone vs hamstring tendon) in ACL reconstruction surgery. The fragility index (FI) and reverse FI (rFI) were determined for significant and nonsignificant outcomes, respectively, as the number of outcome reversals required to change statistical significance. The fragility quotient (FQ) and reverse FQ, representing fragility as a proportion of the study population, were calculated by dividing the FI and rFI, respectively, by the sample size. RESULTS We identified 19 RCTs reporting 55 total dichotomous outcomes. The median FI of the 55 total outcomes was 5 (interquartile range [IQR], 4-7), meaning a median of 5 outcome event reversals would alter the outcomes' significance. Five outcomes were reported as statistically significant with a median FI of 4 (IQR, 2-6), meaning a median of 4 outcome event reversals would change outcomes to be nonsignificant. Fifty outcomes were reported as nonsignificant with a median rFI of 5 (IQR, 4-7), meaning a median of 5 outcome event reversals would change outcomes to be significant. The FQ and reverse FQ for significant and nonsignificant outcomes were 0.025 (IQR, 0.018-0.045) and 0.082 (IQR, 0.041-0.106), respectively. For 61.8% of outcomes, patients lost to follow-up exceeded the corresponding FI or rFI. CONCLUSIONS There is substantial statistical fragility in recent RCTs on autograft choice in ACL reconstruction surgery given that altering a few outcome events is sufficient to reverse study findings. For over half of outcomes, maintaining patients lost to follow-up may have been sufficient to reverse study conclusions. CLINICAL RELEVANCE We recommend co-reporting FIs and P values to provide a more comprehensive representation of a study's conclusions when conducting an RCT.
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Affiliation(s)
- Kyle W Lawrence
- Boston University School of Medicine, Boston, Massachusetts, U.S.A..
| | | | - Zakaria Chakrani
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - John K Cordero
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Xinning Li
- Boston University School of Medicine, Boston, Massachusetts, U.S.A
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23
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Nawasreh ZH, Yabroudi MA, Daradkeh SM, Abujaber SB, Alyamani A, Bashaireh KM. Joint contributions to sagittal plane total support moment in patients with knee osteoarthritis after anterior cruciate ligament reconstruction. Gait Posture 2024; 108:347-353. [PMID: 38219330 DOI: 10.1016/j.gaitpost.2024.01.002] [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: 08/29/2023] [Revised: 12/05/2023] [Accepted: 01/02/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Patients with anterior cruciate ligament reconstruction (ACLR) demonstrate lower knee loading. This study aimed to determine whether sagittal plane TSM and joint contributions to total support moment (TSM) in the surgical limb are different between athletes who did and did not show radiological features of knee OA at 2 years after ACLR during triple hops (TH), single hop (TH), single-legged vertical jump (VJ), and walking. METHODS Forty-one athletes with 2 years of unilateral ACLR surgery participated in this cross-sectional study. Athletes completed motion analysis testing of single-legged TH, SH, VJ, and walking tasks. Sagittal plane TSM and individual joint (ankle, knee, and hip) contributions to TSM were computed at peak knee flexion angle (TSM-PKF). Posterior-anterior radiographs were completed in standing and 30° knee flexion. Kellgren-Lawrence (KL) system was used to identify radiological features of knee OA in the medial compartment of the reconstructed knee (OA-group: KL ≥2; Non-OA group: KL<2). RESULTS There was a significant group-by-joint-by-task interaction for joint contributions to TSM-PKF (p = 0.012), with the OA-group (n = 13) had lower knee and higher hip contributions compared to the non-OA group during TH, SH, and VJ (p ≤ 0.049). There was a significant joint-by-group interaction for the joint contributions to TSM-PKF (p = 0.004), with the OA-group having lower knee (p = 0.003) and higher hip (p = 0.001) contributions compared to the Non-OA group. SIGNIFICANCE The OA-group exhibited lower knee and higher hip contributions to the sagittal plane TSM compared to the Non-OA group during the landing phase of single-limb high-demand activities. The OA-group exhibited decreased knee loading and compensated by shifting the mechanical load to the hip joint within the reconstructed knee. Decreased knee loading in the OA-group may have affected the required mechanical loading to maintain knee metabolism and integrity.
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Affiliation(s)
- Zakariya H Nawasreh
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid 22110, Jordan.
| | - Mohammad A Yabroudi
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid 22110, Jordan
| | - Sharf M Daradkeh
- Department of Rehabilitation Sciences, Jordan University of Science and Technology (JUST), Irbid 22110, Jordan
| | - Sumayeh B Abujaber
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman 11942, Jordan
| | - Almuthanna Alyamani
- Orthopaedic and Sports Surgery, Queen Alia Military Hospital, Jordanian Royal Medical Services, Amman, Jordan
| | - Khaldoon M Bashaireh
- Jordan University of Science and Technology (JUST), Department of Special Surgery, College of Medicine, Irbid 22110, Jordan
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24
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Alfayyadh A, Williams JR, Neal K, Khandha A, Manal K, Snyder-Mackler L, S Buchanan T. Unbalanced Medial-to-Lateral Knee Muscle Co-Contractions are Associated with Medial Tibiofemoral Underloading during Gait Three Months after Anterior Cruciate Ligament Reconstruction. J Biomech 2024; 163:111925. [PMID: 38184905 PMCID: PMC10922905 DOI: 10.1016/j.jbiomech.2024.111925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
Altered medial/lateral knee muscle co-contraction (measure by co-contraction indices, CCI) occurs during gait early after anterior cruciate ligament reconstruction (ACLR). Changes in peak medial compartment forces (pMCF) are also observed early after ACLR and are linked to the development of knee osteoarthritis. We do not know if imbalanced co-contraction is associated with these alterations in knee load. The purpose of this study was to evaluate the association between pMCF and the CCIs of medial/lateral knee muscle pairs during walking three months after ACLR. Bilateral knee gait mechanics and electromyography (EMG) data were collected from 44 participants 3 months following surgery. CCIs of six muscle pairs and medial-to-lateral (M:L) CCIs ratios were calculated during the weight acceptance interval. Bilateral pMCFs were calculated using a subject-based neuromusculoskeletal model. Based on interlimb pMCF symmetry, participants were divided into three groups: symmetric loaders, underloaders, and overloaders. A 2 × 3 (limb × group) ANOVA was used to compare CCIs between limbs in all groups. A partial Spearman's test was performed to examine the association between CCIs ratios and pMCF. The CCIs of the vastus lateralis-lateral gastrocnemius muscle pair was higher in the involved limb of underloaders (vs. the uninvolved limb and vs. the involved limb of symmetric loaders). The ratio of M:L CCIs was significantly lower (more lateral CCIs) in the involved limb, which was associated with lower pMCF. These results suggest that individuals early after ACLR who walk with higher CCIs of lateral knee musculature (vs. medial), have medial tibiofemoral underloading.
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Affiliation(s)
- Abdulmajeed Alfayyadh
- Physical Therapy and Rehabilitation Department, Jouf University, Jouf, Saudi Arabia; Biomechanics and Movement Science, University of Delaware, Newark, DE, USA.
| | - Jack R Williams
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, USA; Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Kelsey Neal
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Ashutosh Khandha
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Kurt Manal
- Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA; Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Thomas S Buchanan
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Mechanical Engineering, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
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25
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Kharaz YA, Zamboulis DE, Fang Y, Welting TJM, Peffers MJ, Comerford EJ. Small RNA signatures of the anterior cruciate ligament from patients with knee joint osteoarthritis. Front Mol Biosci 2023; 10:1266088. [PMID: 38187089 PMCID: PMC10768046 DOI: 10.3389/fmolb.2023.1266088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction: The anterior cruciate ligament (ACL) is susceptible to degeneration, resulting in joint pain, reduced mobility, and osteoarthritis development. There is currently a paucity of knowledge on how anterior cruciate ligament degeneration and disease leads to osteoarthritis. Small non-coding RNAs (sncRNAs), such as microRNAs and small nucleolar RNA (snoRNA), have diverse roles, including regulation of gene expression. Methods: We profiled the sncRNAs of diseased osteoarthritic ACLs to provide novel insights into osteoarthritis development. Small RNA sequencing from the ACLs of non- or end-stage human osteoarthritic knee joints was performed. Significantly differentially expressed sncRNAs were defined, and bioinformatics analysis was undertaken. Results and Discussion: A total of 184 sncRNAs were differentially expressed: 68 small nucleolar RNAs, 26 small nuclear RNAs (snRNAs), and 90 microRNAs. We identified both novel and recognized (miR-206, -365, and -29b and -29c) osteoarthritis-related microRNAs and other sncRNAs (including SNORD72, SNORD113, and SNORD114). Significant pathway enrichment of differentially expressed miRNAs includes differentiation of the muscle, inflammation, proliferation of chondrocytes, and fibrosis. Putative mRNAs of the microRNA target genes were associated with the canonical pathways "hepatic fibrosis signaling" and "osteoarthritis." The establishing sncRNA signatures of ACL disease during osteoarthritis could serve as novel biomarkers and potential therapeutic targets in ACL degeneration and osteoarthritis development.
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Affiliation(s)
- Yalda A. Kharaz
- Department of Musculoskeletal Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Danae E. Zamboulis
- Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
| | - Yongxiang Fang
- Centre for Genomic Research, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Tim J. M. Welting
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mandy J. Peffers
- Department of Musculoskeletal Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Eithne J. Comerford
- Department of Musculoskeletal Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Institute of Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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26
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Murakami R, Taketomi S, Yamagami R, Kono K, Kawaguchi K, Kage T, Arakawa T, Inui H, Tanaka S. Postoperative quadriceps weakness and male sex are risk factors for patellofemoral articular cartilage lesions after anatomical anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:5681-5689. [PMID: 37884728 PMCID: PMC10719126 DOI: 10.1007/s00167-023-07633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Patellofemoral (PF) compartment cartilage lesions are a frequent problem after anterior cruciate ligament (ACL) reconstruction. This study aimed to determine the factors that influence PF cartilage lesions after anatomical ACL reconstruction. METHODS This study enrolled a total of 114 patients who did not manifest PF compartment cartilage lesions during anatomical ACL reconstruction and underwent second-look arthroscopy 18 months postoperatively. Arthroscopy using the International Cartilage Repair Society (ICRS) classification was used to assess cartilage lesions. The correlation between surgical findings, radiographic factors, and clinical factors and change of ICRS grade was analysed. Multivariate regression analysis was conducted to reveal the independent risk factors for PF cartilage lesions among patients' demographic data and parameters that correlated with the change of ICRS grade in the correlation analyses. RESULTS ICRS grade changes in PF cartilage were significantly correlated with age, sex, quadriceps strength at 1 year postoperatively, hamstrings strength at pre- and 1 year postoperatively, and single leg hop test at 1 year postoperatively. However, no significant correlation was found between the time between injury and surgery, posterior tibial slope angle, pre- and postoperative Tegner activity scale, graft type, initial graft tension, meniscus injury, meniscus injury treatment, pre- and postoperative range of motion, anteroposterior laxity and preoperative quadriceps strength, and the change in ICRS grade. Multivariate regression analysis revealed male (P = 0.019) and quadriceps strength weakness at 1 year postoperatively (P = 0.009) as independent risk factors for PF cartilage lesions. CONCLUSIONS Quadriceps strength weakness 1 year after ACL reconstruction and males were correlated with a new PF cartilage lesion after anatomical ACL reconstruction, with no significant correlation between bone-patellar tendon-bone autograft, initial graft tension, or extension deficit and new PF cartilage lesion. Rehabilitation that focuses on quadriceps strength after ACL reconstruction is recommended to prevent new PF cartilage lesions. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ryo Murakami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takahiro Arakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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27
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Li H, Huang H, Zhang S, Ren S, Rong Q. Muscle dynamics analysis by clustered categories during jogging in patients with anterior cruciate ligament deficiency. BMC Musculoskelet Disord 2023; 24:919. [PMID: 38017430 PMCID: PMC10683279 DOI: 10.1186/s12891-023-07000-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/29/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Patients with anterior cruciate ligament (ACL) deficiency (ACLD) tend to have altered lower extremity dynamics. Little is known about the changes in dynamic function and activation during jogging in patients with ACLD. METHODS Twenty patients with an injured ACL before ACL reconstruction (ACLD group) and nine healthy male volunteers (control group) were recruited. Each volunteer repeated the jogging experiment five times. Based on the experimental data measured, a musculoskeletal multibody dynamics model was employed to simulate the tibiofemoral joint dynamics during jogging. Eighteen muscles were used for analysis. The obtained dynamics data were used for clustering and curve difference analysis. RESULTS The 18 muscles studied were divided into 3 categories. All the quadriceps, the soleus, the gastrocnemius, and the popliteus were classified as label 1. All the hamstrings were classified as label 2, and the sartorius muscles were classified as label 3. Among them, the classification of the short head of the biceps femoris was significantly different between the two groups (P < 0.001). The force curves of all 18 muscles and the between-group differences were studied according to clustered categories. Most muscle force in label 1 was approaching zero in the terminal stance phase, which was significantly lower than that in the control group (P < 0.05). The muscle force in label 2 had areas with significant differences in the stance phase. Muscle force in label 3 was significantly lower than that in the control group in the pre-swing phase. CONCLUSIONS This study showed that there are various changes of muscle function and activation in patients with ACLD. Through clustering and curve analysis, the joint reactions and changes of different muscle forces in the gait cycle between the ACLD and control groups could be further clarified.
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Affiliation(s)
- Haoran Li
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, 100871, China
| | - Hongshi Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, 100871, China
| | - Si Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, 100871, China
| | - Shuang Ren
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, 100871, China.
| | - Qiguo Rong
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, 100871, China.
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28
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Harrison K, Holmes HH, Finley EB, Guzman KS, Kimbrough KC, Roper JA. Incline and decline running alters joint moment contributions but not peak support moments in individuals with an anterior cruciate ligament reconstruction and controls. Front Sports Act Living 2023; 5:1217783. [PMID: 38046933 PMCID: PMC10691489 DOI: 10.3389/fspor.2023.1217783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Individuals with an anterior cruciate ligament reconstruction (ACLR) commonly exhibit altered gait patterns, potentially contributing to an increased risk of osteoarthritis (OA). Joint moment contributions (JMCs) and support moments during incline and decline running are unknown in healthy young adults and individuals with an ACLR. Understanding these conditional joint-level changes could explain the increased incidence of OA that develops in the long term. Therefore, this knowledge may provide insight into the rehabilitation and prevention of OA development. We aimed to identify the interlimb and between-group differences in peak support moments and subsequent peak ankle, knee, and hip JMCs between individuals with an ACLR and matched controls during different sloped running conditions. A total of 17 individuals with unilateral ACLR and 17 healthy individuals who were matched based on sex, height, and mass participated in this study. The participants ran on an instrumented treadmill at an incline of 4°, decline of 4°, incline of 10°, and decline of 10°. The last 10 strides of each condition were used to compare the whole-stance phase support moments and JMCs between limbs, ACLR, and control groups and across conditions. No differences in JMCs were identified between limbs or between the ACLR and healthy control groups across all conditions. Support moments did not change among the different sloped conditions, but JMCs significantly changed. Specifically, ankle and knee JMCs decreased and increased by 30% and 33% from an incline of 10° to a decline of 10° running. Here, the lower extremities can redistribute mechanics across the ankle, knee, and hip while maintaining consistent support moments during incline and decline running. Our data provide evidence that those with an ACLR do not exhibit significant alterations in joint contributions while running on sloped conditions compared to the matched controls. Our findings inform future research interested in understanding the relationship between sloped running mechanics and the incidence of deleterious acute or chronic problems in people with an ACLR.
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Affiliation(s)
| | | | | | | | | | - Jaimie A. Roper
- School of Kinesiology, Auburn University, Auburn, AL, United States
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29
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Tseng TH, Chen CL, Chang CH, Wang JH, Young TH. IL-6 induces periostin production in human ACL remnants: a possible mechanism causing post-traumatic osteoarthritis. J Orthop Surg Res 2023; 18:824. [PMID: 37919719 PMCID: PMC10621128 DOI: 10.1186/s13018-023-04308-0] [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: 07/28/2023] [Accepted: 10/22/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE Perostin (POSTN) and IL-6 consistently elevated after ACL injury, and ACL has been proposed as the major source of POSTN. However, there is a lack of evidence whether IL-6 induces ACL remnants to produce POSTN. This study aimed to investigate the effect of IL-6 on POSTN production in ACL fibroblasts, which may help us understand more about the mechanism of PTOA after ACL injury and ACL reconstruction. METHODS ACL remnants were harvested from 27 patients undergoing ACL reconstruction. Quantitative real-time polymerase chain reaction (PCR) was performed to examine the POSTN gene expression of ACL fibroblasts after treatment of different concentrations of IL-6. The POSTN protein production of ACL fibroblasts was determined using western blot analysis. The blockers of possible signaling pathways, including PI3K/Akt, Ras/MAPK, and JAK/STAT pathways, were added to test whether the effect of IL-6 on ACL fibroblast could be attenuated. ACL fibroblast and chondrocyte co-culture was carried out to determine the influence of ACL and IL-6 on chondrocytes. RESULTS Quantitative real-time PCR showed that IL-6 time-dependently and dose-dependently increased POSTN gene expression of ACL fibroblast. Western blot analysis also revealed that IL-6 dose-dependently induced POSTN protein production. Regarding the chronicity of ACL injury, the POSTN protein production was comparable between ACL remnants which were derived within 3 months of injury and at least 6 months after injury. PI3K/Akt blockers could attenuate the effect of IL-6 on ACL remnants, whereas Ras/MAPK and JAK/STAT did not decrease POSTN production. The coexistence of ACL and IL-6 induced more MMP-13 and ADAMTS-4 by chondrocytes. CONCLUSIONS IL-6 induced ACL remnants to produce POSTN. This effect could be attenuated by the PI3K/Akt blocker. Coexistence of IL-6 and ACL remnants may accelerate post-traumatic arthritis.
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Affiliation(s)
- Tzu-Hao Tseng
- Department of Biomedical Engineering, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei City, 10002, Taiwan
- Department of Orthopaedic Surgery, National Taiwan University Hospital, 7 Chungsan South Road, Taipei City, 10002, Taiwan
| | - Chien-Lin Chen
- Department of Biomedical Engineering, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei City, 10002, Taiwan
| | - Chung-Hsun Chang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, 7 Chungsan South Road, Taipei City, 10002, Taiwan
| | - Jyh-Horng Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, 7 Chungsan South Road, Taipei City, 10002, Taiwan.
| | - Tai-Horng Young
- Department of Biomedical Engineering, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei City, 10002, Taiwan.
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30
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Kempfert DJ, Chaconas EJ, Daugherty ML, Clark NC. Test-retest reliability of quantitative sensory testing, active joint position sense, and functional hop testing in amateur adult athletes with unilateral anterior cruciate ligament reconstruction. Phys Ther Sport 2023; 64:63-73. [PMID: 37778110 DOI: 10.1016/j.ptsp.2023.09.007] [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: 06/20/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES The somatosensory system fulfils a critical role in functional knee joint stability (FKJS) by providing afferent feedback necessary for neuromuscular control. Individuals with anterior cruciate ligament reconstruction (ACLr) have altered somatosensory function. Somatosensory characteristics are assessed by proprioception and quantitative sensory testing. The purpose of the study was to examine intra-rater and inter-rater reliability of methods used to assess somatosensory characteristics and FKJS in amateur adult athletes with unilateral ACLr. DESIGN Repeated measures. SETTING University. PARTICIPANTS 8 female, 4 male with unilateral autogenous ACLr. MAIN OUTCOME MEASURES Bilateral measurements at 5 lower extremity locations and the anterior forearm: light touch (LT), vibration sense (VS), pressure pain threshold (PPT); knee active joint position sense (AJPS); adapted crossover hop for distance (ACHD). Intraclass correlation coefficients (ICC) determined reliability, defined as: poor (<0.50), moderate (0.50-0.75), good (0.75-0.90). RESULTS ACLr-side intra-rater/inter-rater ICCs ranged: LT, -0.27-0.80/-0.01-0.84; VS, 0.12-0.90/0.25-0.90; PPT, 0.49-0.98/0.86-0.99; AJPS, 0.15-0.79/0.55-0.87; ACHD, 0.98/0.99. Uninjured-side intra-rater/inter-rater ICCs ranged: LT, 0.12-0.66/-0.09-0.64; VS, 0.35-0.89/0.05-0.81; PPT, 0.65-0.99/0.45-0.95; AJPS, 0.07-0.81/0.37-0.99; ACHD, 0.99/0.98. CONCLUSIONS Intra-rater and inter-rater reliability was poor to good for both limbs. Overall, PPT and the ACHD demonstrated the highest ICCs. Some somatosensory assessments can be employed with confidence, while others should be used with caution.
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Affiliation(s)
- David J Kempfert
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, St. Augustine, FL, 32086, United States.
| | - Eric J Chaconas
- Doctor of Science Physical Therapy Program, Bellin College, 3201 Eaton Rd, Green Bay, WI, 54311, United States.
| | - Matthew L Daugherty
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, St. Augustine, FL, 32086, United States.
| | - Nicholas C Clark
- School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, C04 3SQ, United Kingdom.
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Liukkonen R, Vaajala M, Mattila VM, Reito A. Prevalence of post-traumatic osteoarthritis after anterior cruciate ligament injury remains high despite advances in surgical techniques. Bone Joint J 2023; 105-B:1140-1148. [PMID: 37907079 DOI: 10.1302/0301-620x.105b11.bjj-2023-0058.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims The aim of this study was to report the pooled prevalence of post-traumatic osteoarthritis (PTOA) and examine whether the risk of developing PTOA after anterior cruciate ligament (ACL) injury has decreased in recent decades. Methods The PubMed and Web of Science databases were searched from 1 January 1980 to 11 May 2022. Patient series, observational studies, and clinical trials having reported the prevalence of radiologically confirmed PTOA after ACL injury, with at least a ten-year follow-up, were included. All studies were analyzed simultaneously, and separate analyses of the operative and nonoperative knees were performed. The prevalence of PTOA was calculated separately for each study, and pooled prevalence was reported with 95% confidence intervals (CIs) using either a fixed or random effects model. To examine the effect of the year of injury on the prevalence, a logit transformed meta-regression analysis was used with a maximum-likelihood estimator. Results from meta-regression analyses were reported with the unstandardized coefficient (β). Results The pooled prevalence of PTOA was 37.9% (95% CI 32.1 to 44) for operatively treated ACL injuries with a median follow-up of 14.6 years (interquartile range (IQR) 10.6 to 16.7). For nonoperatively treated ACL injuries, the prevalence was 40.5% (95% CI 28.9 to 53.3), with a median of follow-up of 15 years (IQR 11.7 to 20.0). The association between the year of operation and the prevalence of PTOA was weak and imprecise and not related to the choice of treatment (operative β -0.038 (95% CI -0.076 to 0.000) and nonoperative β -0.011 (95% CI -0.101 to 0.079)). Conclusion The initial injury, irrespective of management, has, by the balance of probability, resulted in PTOA within 20 years. In addition, the prevalence of PTOA has only slightly decreased during past decades. Therefore, further research is warranted to develop strategies to prevent the development of PTOA after ACL injuries.
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Affiliation(s)
- Rasmus Liukkonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Matias Vaajala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Aleksi Reito
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Arhos EK, Pohlig RT, Di Stasi S, Risberg MA, Snyder-Mackler L, Silbernagel KG. Clinically Relevant Subgroups Among Athletes Who Have Ruptured Their Anterior Cruciate Ligaments: A Delaware-Oslo Cohort Study. Arthritis Care Res (Hoboken) 2023; 75:1914-1924. [PMID: 36645015 PMCID: PMC10349896 DOI: 10.1002/acr.25089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/12/2022] [Accepted: 01/12/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To identify subgroups of individuals with anterior cruciate ligament (ACL) injuries based on patient characteristics, self-reported outcomes, and functional performance at baseline, and to associate subgroups with long-term outcomes after ACL rupture. METHODS A total of 293 participants (45.7% male, mean ± SD age 26.2 ± 9.4 years, days from injury 58 ± 35) were enrolled after effusion, pain, and range of motion impairments were resolved and quadriceps strength was at least 70% of the uninvolved limb. Mixture modeling was used to uncover latent subgroups without a prior group classification using probabilistic assignment. Variables include demographics, functional testing, and self-reported outcome measures. Radiographic evidence of osteoarthritis (OA; i.e., Kellgren/Lawrence grade of ≥1) in the involved knee at 5 years after injury was the primary outcome of interest. Chi-square tests assessed differences in the presence of radiographic OA in the involved knee between subgroups at 5 years after ACL rupture. Secondary outcomes of interest included radiographic OA in the uninvolved knee, return to preinjury sport by 2 years, operative status, and clinical OA (classified using Luyten et al criteria) at 5 years. RESULTS Four distinct subgroups exist after ACL rupture (younger good self-report, younger poor self-report, older poor self-report, older good self-report) with 30%, 31%, 47%, and 53%, respectively, having involved knee OA. The percentage of radiographic OA was not significantly different between the groups (P = 0.059). CONCLUSION The prevalence of OA in all subgroups is highly concerning. These results suggest there are unique subgroupings of individuals that may guide treatment after ACL rupture and reconstruction by providing support for developing a patient-centered approach.
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Affiliation(s)
| | | | | | - May Arna Risberg
- Oslo University Hospital and Norwegian School of Sport Sciences, Oslo, Norway
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Cance N, Erard J, Shatrov J, Fournier G, Gunst S, Martin GL, Lustig S, Servien E. Delaying anterior cruciate ligament reconstruction increases the rate and severity of medial chondral injuries. Bone Joint J 2023; 105-B:953-960. [PMID: 37652445 DOI: 10.1302/0301-620x.105b9.bjj-2022-1437.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Aims The aim of this study was to evaluate the association between chondral injury and interval from anterior cruciate ligament (ACL) tear to surgical reconstruction (ACLr). Methods Between January 2012 and January 2022, 1,840 consecutive ACLrs were performed and included in a single-centre retrospective cohort. Exclusion criteria were partial tears, multiligament knee injuries, prior ipsilateral knee surgery, concomitant unicompartmental knee arthroplasty or high tibial osteotomy, ACL agenesis, and unknown date of tear. A total of 1,317 patients were included in the final analysis, with a median age of 29 years (interquartile range (IQR) 23 to 38). The median preoperative Tegner Activity Score (TAS) was 6 (IQR 6 to 7). Patients were categorized into four groups according to the delay to ACLr: < three months (427; 32%), three to six months (388; 29%), > six to 12 months (248; 19%), and > 12 months (254; 19%). Chondral injury was assessed during arthroscopy using the International Cartilage Regeneration and Joint Preservation Society classification, and its association with delay to ACLr was analyzed using multivariable analysis. Results In the medial compartment, delaying ACLr for more than 12 months was associated with an increased rate (odds ratio (OR) 1.93 (95% confidence interval (CI) 1.27 to 2.95); p = 0.002) and severity (OR 1.23 (95% CI 1.08 to 1.40); p = 0.002) of chondral injuries, compared with < three months, with no association in patients aged > 50 years old. No association was found for shorter delays, but the overall dose-effect analysis was significant for the rate (p = 0.015) and severity (p = 0.026) of medial chondral injuries. Increased TAS was associated with a significantly reduced rate (OR 0.88 (95% CI 0.78 to 0.99); p = 0.036) and severity (OR 0.96 (95% CI 0.92 to 0.99); p = 0.017) of medial chondral injuries. In the lateral compartment, no association was found between delay and chondral injuries. Conclusion Delay was associated with an increased rate and severity of medial chondral injuries in a dose-effect fashion, in particular for delays > 12 months. Younger patients seem to be at higher risk of chondral injury when delaying surgery. The timing of ACLr should be optimally reduced in this population.
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Affiliation(s)
- Nicolas Cance
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Julien Erard
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Jobe Shatrov
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Sydney Orthopaedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - Gaspard Fournier
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Stanislas Gunst
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Guillaume L Martin
- Département de Santé Publique, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Sébastien Lustig
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- IFSTTAR, LBMC, Université Claude Bernard Lyon 1, Lyon, France
| | - Elvire Servien
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Interuniversity Laboratory of Human Movement Science, Université Claude Bernard Lyon 1, Lyon, France
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Garcia SA, Kahan S, Gallegos J, Balza I, Krishnan C, Palmieri-Smith RM. Walking speed differentially affects lower extremity biomechanics in individuals with anterior cruciate ligament reconstruction compared to uninjured controls. Clin Biomech (Bristol, Avon) 2023; 108:106059. [PMID: 37562332 DOI: 10.1016/j.clinbiomech.2023.106059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/30/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Walking biomechanics are commonly affected after anterior cruciate ligament reconstruction and differ compared to uninjured controls. Manipulating task difficulty has been shown to affect the magnitude of walking impairments in those early after knee surgery but it is unclear if patients in later phases post-op are similarly affected by differing task demands. Here, we evaluated the effects of manipulating walking speed on between-limb differences in ground reaction force and knee biomechanics in those with and without anterior cruciate ligament reconstruction. METHODS We recruited 28 individuals with anterior cruciate ligament reconstruction and 20 uninjured control participants to undergo walking assessments at three speeds (self-selected, 120%, and 80% self-selected speed). Main outcomes included sagittal plane knee moments, angles, excursions, and ground reaction forces (vertical and anterior-posterior). FINDINGS We observed walking speed differentially impacted force and knee-outcomes in those with anterior cruciate ligament reconstruction. Between-limb differences increased at fast and decreased at slow speeds in those with anterior cruciate ligament reconstruction while uninjured participants maintained between-limb differences regardless of speed (partial η2 = 0.13-0.33, p < 0.05). Anterior cruciate ligament reconstruction patients underloaded the surgical limb relative to both the contralateral, and uninjured controls in GRFs and sagittal plane knee moments (partial η2 range = 0.13-0.25, p < 0.05). INTERPRETATION Overall, our findings highlight the persistence of walking impairments in those with anterior cruciate ligament reconstruction despite completing formal rehabilitation. Further research should consider determining if those displaying larger changes in gait asymmetries in response to fast walking also exhibit poorer strength and/or joint health outcomes.
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Affiliation(s)
- Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Seth Kahan
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Jovanna Gallegos
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Isabella Balza
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Neuromuscular and Rehabilitation Robotics Laboratory, University of Michigan, Ann Arbor, MI, USA; Robotics Institute, University of Michigan, Ann Arbor, MI, USA
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA; Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI, USA.
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Wang YJ, Zhang JC, Zhang YZ, Liu YH. Assessment of functional prognosis of anterior cruciate ligament reconstruction in athletes based on a body shape index. World J Clin Cases 2023; 11:4567-4578. [PMID: 37469737 PMCID: PMC10353512 DOI: 10.12998/wjcc.v11.i19.4567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND A healthy body shape is essential to maintain athletes’ sports level. At present, little is known about the effect of athletes’ body shape on anterior cruciate ligament reconstruction (ACLR). Moreover, the relationship between body shape and variables such as knee joint function after operation and return to the field has not been well studied.
AIM To verify the relationship between a body shape index (ABSI) and the functional prognosis of the knee after ACLR in athletes with ACL injuries.
METHODS We reviewed 76 athletes with unilateral ACL ruptures who underwent ACLR surgery in the First Hospital of Shanxi Medical University between 2017 and 2020, with a follow-up period of more than 24 mo. First, all populations were divided into a High-ABSI group (ABSI > 0.835, n = 38) and a Low-ABSI group (ABSI < 0.835, n = 38) based on the arithmetic median (0.835) of ABSI values. The primary exposure factor was ABSI, and the outcome indicators were knee function scores as well as postoperative complications. The correlation between ABSI and postoperative knee function scores and postoperative complications after ACLR were analyzed using multifactorial logistic regression.
RESULTS The preoperative knee function scores of the two groups were similar. The surgery and postoperative rehabilitation exercises, range of motion (ROM) compliance rate, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score of the two groups gradually increased, whereas the quadriceps atrophy index gradually decreased. The knee function scores were higher in the Low-ABSI group than in the High-ABSI group at the 24-mo postoperative follow-up (P < 0.05). In multifactorial logistic regression, ABSI was a risk factor of low knee joint function score after surgery, specifically low ROM scores (odds ratio [OR] = 1.31, 95% confidence interval [CI] [1.10-1.44]; P < 0.001), low quadriceps atrophy index (OR = 1.11, 95%CI [0.97-1.29]; P < 0.05), low Lysholm scores (OR = 2.34, 95%CI [1.78-2.94]; P < 0.001), low symptoms (OR = 1.14, 95%CI [1.02-1.34]; P < 0.05), low activity of daily living (OR = 1.34, 95%CI [1.18-1.65]; P < 0.05), low sports (OR = 2.47, 95%CI [1.78-2.84]; P < 0.001), and low quality of life (OR = 3.34, 95%CI [2.88-3.94]; P < 0.001). ABSI was also a risk factor for deep vein thrombosis of the lower limb (OR = 2.14, 95%CI [1.88-2.36], P < 0.05] and ACL recurrent rupture (OR = 1.24, 95%CI [0.98-1.44], P < 0.05) after ACLR.
CONCLUSION ABSI is a risk factor for the poor prognosis of knee function in ACL athletes after ACLR, and the risk of poor knee function after ACLR, deep vein thrombosis of lower limb, and ACL recurrent rupture gradually increases with the rise of ABSI.
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Affiliation(s)
- Yun-Jun Wang
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan 030006, Shanxi Province, China
| | - Jun-Chang Zhang
- Department of Orthopedics, First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Yu-Ze Zhang
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan 030006, Shanxi Province, China
| | - Ying-Hai Liu
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan 030006, Shanxi Province, China
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Zhang M, Liu C, Lin H, Wang H, Qin L, Zhang Z, Liu C, Lu Y, Yan F, Zhang Y, Wei H. Age-Related Changes in the Spatial Variation of Magnetic Susceptibility of Human Articular Cartilage. J Magn Reson Imaging 2023; 58:198-207. [PMID: 36322382 DOI: 10.1002/jmri.28513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Quantitative susceptibility mapping (QSM) has shown great potential for revealing the layer structure of articular cartilage based on the laminar susceptibility difference at different depths. However, more information is needed on the effects of age on the spatial distribution of magnetic susceptibility in human cartilage. PURPOSE To assess the ability of QSM to quantify the age-related differences in depth-wise cartilage susceptibility values in healthy populations. STUDY TYPE Prospective. POPULATION A total of 94 healthy asymptomatic subjects in three age cohorts: 19-30 (n = 36, 20 males), 31-50 (n = 45, 27 males), and 51-66 years (n = 13, 7 males). FIELD STRENGTH/SEQUENCE 3D gradient echo sequences at 3.0 T. ASSESSMENT Four cartilage compartments were analyzed, including the central lateral/medial femur (cLF/cMF) and the lateral/medial tibia (LT/MT). The spatial susceptibility profile and the corresponding 95% confidence interval (CI) of each age cohort were obtained as functions of the normalized distance from the bone-cartilage interface to the cartilage surface (cartilage depth from 0.0 to 1.0). STATISTICAL TESTS The relationship between age and cartilage thickness of each cartilage subregion was tested by Pearson correlation with P < 0.05 considered significant. Cartilage depths with separations of 95% CIs were considered to have significant susceptibility differences between two age cohorts with a Bonferroni-corrected P < 0.05. RESULTS The cartilage thickness did not change significantly with age (P value range: 0.06-0.85). Susceptibilities were significantly higher in the 51-66-year-olds compared with the 31-50-year-olds in the deep layer of cMF (cartilage depth: 0.0-0.22) and LT (0.05-0.28). Susceptibilities were significantly higher in the 51-66-year-olds compared with the 19-30-year-olds near the cartilage-bone interface of cMF (0.0-0.34), cLF (0.0-0.28), and LT (0.0-0.58). There were also significantly higher susceptibilities in the 31-50-year-olds compared with the 19-30-year-olds in the deeper regions of cMF (0.26-0.57), cLF (0.0-0.40), and LT (0.07-0.80). DATA CONCLUSION Age-related susceptibility changes in the deeper regions of knee cartilage were observed using QSM. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ming Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chenglei Liu
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huimin Lin
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanqi Wang
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Le Qin
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyong Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chunlei Liu
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California, USA
| | - Yong Lu
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyao Zhang
- School of Information and Science and Technology, ShanghaiTech University, Shanghai, China
| | - Hongjiang Wei
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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Sollberger VD, Korthaus A, Barg A, Pagenstert G. Long-term results after anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon autograft with a minimum follow-up of 10 years-a systematic review. Arch Orthop Trauma Surg 2023; 143:4277-4289. [PMID: 36441213 PMCID: PMC10293370 DOI: 10.1007/s00402-022-04687-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/28/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A lot of research addresses superiority of the two commonly used autografts bone-patellar tendon-bone (BPTB) and hamstring tendon for anterior cruciate ligament (ACL) reconstruction, without getting to consensus. While there are numerous studies and reviews on short- to mid-term follow-up, not much literature is available on long-term follow-up. As patients suffering ACL injuries are often of young age and high athletic activity, it is crucial to have the best evidence possible for graft choice to minimize consequences, like osteoarthritis later on. MATERIALS AND METHODS A search of the online databases, PubMed and Embase, was carried out last on 31st March 2022 for studies comparing BPTB and hamstring tendon (HT) autografts for ACL reconstruction in human patients with a minimum follow-up of 10 years. The methodological quality of each study has been evaluated using the modified Coleman Methodology Score. Results on the three variables patient-oriented outcomes, clinical testing and measurements and radiographic outcomes were gathered and are presented in this review. RESULTS Of 1299 records found, nine studies with a total of 1833 patients were identified and included in this systematic review. The methodological quality of the studies ranged from a Coleman Score of 63-88. Many studies reported no or only few statistically significant differences. Significant results in favour of BPTB were found for activity levels and for instrumented laxity testing with the KT-1000 arthrometer. Better outcomes for HT were found in IKDC-SKF, the KOOS, donor site morbidity, pivot shift test, radiographic osteoarthritis (IKDC C or D) and contralateral ACL rupture. No studies presented significant differences in terms of Lysholm Score or Tegner Activity Score, Lachman test, single-legged hop test, deficits in range of motion, osteoarthritis using the Kellgren and Lawrence classification or graft rupture. CONCLUSION We cannot recommend one graft to be superior, since both grafts show disadvantages in the long-term follow-up. Considering the limitation of our systematic review of no quantitative analysis, we cannot draw further conclusions from the many insignificant results presented by individual studies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- V. D. Sollberger
- CLARAHOF Clinic of Orthopaedic Surgery, University of Basel, Clarahofweg 19a, 4058 Basel, Switzerland
| | - A. Korthaus
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Germany, Martinistr. 52, 20251 Hamburg, Germany
| | - A. Barg
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Germany, Martinistr. 52, 20251 Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - G. Pagenstert
- CLARAHOF Clinic of Orthopaedic Surgery, University of Basel, Clarahofweg 19a, 4058 Basel, Switzerland
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Evans-Pickett A, Davis-Wilson HC, Johnston CD, Blackburn JT, Hackney AC, Pietrosimone B. Immediate Effects of Walking With a Knee Brace After Anterior Cruciate Ligament Reconstruction: A Biomechanical, Biochemical, and Structural Approach. J Athl Train 2023; 58:542-553. [PMID: 35119477 PMCID: PMC10496450 DOI: 10.4085/1062-6050-0700.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Individuals who undergo anterior cruciate ligament reconstruction (ACLR) are at higher risk of posttraumatic osteoarthritis. Altered joint tissue loading caused by aberrant gait biomechanics leads to deleterious changes in joint health linked to the onset of posttraumatic osteoarthritis. Knee braces have been used to modify joint tissue loading in individuals with joint injury, yet the effects of walking with a brace after ACLR on biomechanical, biochemical, and structural cartilage outcomes are unknown. OBJECTIVE To compare biomechanical, biochemical, and structural outcomes between braced and nonbraced walking in individuals with ACLR. DESIGN Crossover study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 34 individuals with unilateral ACLR (18 females, 16 males; time since ACLR = 50.1 ± 36.8 months). INTERVENTION(S) Gait biomechanics were assessed during braced and unbraced conditions on separate days. MAIN OUTCOME MEASURE(S) Vertical ground reaction force, knee-flexion angle, and internal knee-extension moment waveforms were evaluated throughout the stance phase and compared between conditions. Percentage changes in serum cartilage oligomeric matrix protein (%ΔCOMP) and femoral cartilage cross-sectional area (%ΔCSA) measured via ultrasound were calculated after a 3000-step walking protocol. RESULTS Braced walking increased the knee-flexion angle (largest difference = 3.56°; Cohen d effect size = 1.72) and knee-extension moment (largest difference = -0.48% body weight × height; Cohen d effect size = -1.14) compared with nonbraced walking but did not influence vertical ground reaction force. Whereas no difference (P = .20) in %ΔCOMP existed between the braced and nonbraced conditions in the entire cohort (n = 30 with complete blood data), a larger increase (P = .04) in %ΔCOMP was seen during nonbraced than braced walking in individuals who demonstrated increased COMP during nonbraced walking. No difference (P = .86) in %ΔCSA was present between the braced and nonbraced conditions. CONCLUSIONS Braced walking may improve sagittal-plane gait biomechanics and %ΔCOMP in a subset of individuals who demonstrate a typical increased COMP response to load (ie, increase in COMP) after nonbraced walking.
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Affiliation(s)
- Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Hope C. Davis-Wilson
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Physical Therapy Department, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Christopher D. Johnston
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Athletic Training, High Point University, NC
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
| | - Anthony C. Hackney
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
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Singleton S, Scofield H, Davis B, Waller A, Garrison C, Goto S, Hannon J. Altered Knee Loading Following Primary ACL Repair versus ACL Reconstruction. Int J Sports Phys Ther 2023; V18:596-605. [PMID: 37415672 PMCID: PMC10321778 DOI: 10.26603/001c.77362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/11/2023] [Indexed: 07/08/2023] Open
Abstract
Background ACL repair (ACL-r) has recently gained renewed clinical interest for treatment of ACL tears. ACL-r has several potential benefits over ACL reconstruction (ACL-R) including maintaining the native ACL innervation and blood supply, no graft site morbidity, and possible improved knee biomechanics and decrease in osteoarthritis. The purpose of this study was to assess for differences in metrics of knee joint loading during a single limb squat task between individuals following a primary ACL-r versus those who underwent a standard ACL-R with a patella bone-tendon-bone autograft. Study type Case Control Study. Methods The ACL-r group [n: 15, age(yrs): 38.8±13.9] sustained a proximal ACL disruption that was amenable to repair, while the ACL-R group [n: 15, age(yrs): 25.60±1.7] underwent primary reconstruction with patella bone-tendon-bone autograft. At 12-weeks post-operation, both groups completed the IKDC questionnaire and biomechanical testing during performance of the single limb squat. Bilateral peak knee extension moment and total knee joint power as a measure of eccentric loading (contraction) during the descent phase of the squat were calculated on the surgical and non-surgical limb and averaged across the middle three of five trials. Participants also completed quadriceps strength testing on both limbs three months after surgery on an isokinetic dynamometer at 60°/sec. LSI (Limb Strength Index) was calculated for all variables. Separate ANCOVAs were performed on each biomechanical variable to examine differences between groups. Results The ACL-r had a significantly greater peak knee extension moment LSI (ACL-r: 78.46±5.79%; ACL-R: 56.86±5.79%; p=0.019, ηp2=.186) and total knee joint power LSI (ACL-r: 72.47±7.39%; ACL-R: 39.70±7.39%, p=0.006, ηp2=.245) than the ACL-R group. The ACL-r also had a significantly greater quadriceps LSI than the ACL-R group (ACL-r: 66.318±4.61%, ACL-R: 48.03±4.61%, p=0.013, ηp2=.206). Conclusions Individuals following ACL-r demonstrate increased knee joint loading symmetry during a single leg squat task and greater quadriceps strength symmetry at 12 weeks post-surgery compared to those who underwent ACL-R. Level of Evidence 3.
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Chalatsis G, Mitrousias V, Siouras A, Panteliadou F, Tziolas I, Solomou C, Hantes M. Long-term Quality of Life in Patients After ACL Reconstruction With Concomitant Meniscal Injury Treatment: Patient-Reported Outcomes at Minimum 10-Year Follow-up. Orthop J Sports Med 2023; 11:23259671231177279. [PMID: 37347018 PMCID: PMC10280537 DOI: 10.1177/23259671231177279] [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: 06/23/2023] Open
Abstract
Background Long-term studies of patients after anterior cruciate ligament (ACL) reconstruction with or without concomitant meniscal tear treatment are limited. Purposes To (1) report postoperative outcomes after anatomic ACL reconstruction with a hamstring autograft, (2) investigate how concomitant treatment of meniscal injury could affect these outcomes, and (3) evaluate the association between quality of life and activity levels at a minimum 10-year follow-up. Study Design Cohort study; Level of evidence, 3. Methods Patients treated with a unilateral, anatomic ACL reconstruction between 2005 and 2011 were investigated. The following patient-reported outcome measures (PROMs) were reported for the overall sample as well as a subsample of patients with meniscal injury: International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee score, Tegner activity scale, 5-level EQ-5D (EQ-5D-5L), and patient satisfaction. Sex, age, body mass index (BMI), and meniscal injury treatment (meniscectomy vs meniscal repair) were examined as patient-specific risk factors regarding long-term activity and quality of life. Results Overall, 106 patients, 90 men (85%) and 16 women (15%), were enrolled in the study, with a mean follow-up of 13.2 years. The ACL retear rate was 2.8%. The mean scores were 80.6 ± 16.7 (IKDC-SKF), 87.4 ± 15.0 (KOOS), 90.5 ± 11.5 (Lysholm), 5.6 ± 1.9 (Tegner), and 91.8 ± 14.5 (EQ-5D-5L). The majority (90.6%) of patients considered their knee state satisfactory during follow-up. When compared with patients who underwent meniscal repair, patients who underwent meniscectomy had statistically significantly lower scores on all PROMs except for the Tegner and EQ-5D-5L (P < .05 for all). The mean difference between the 2 groups was ≥7 points on all PROM scores. Patient sex, age, and BMI did not affect PROM scores. There was a statistically significant, strong positive correlation between quality of life and activity. Conclusion Patients had few or no symptoms and considered their knee state satisfactory 13.2 years after anatomic ACL reconstruction. Patients with concomitant meniscal tears having undergone meniscal repair had improved PROMs compared with those treated with meniscectomy. Finally, participation in activities of daily living and sports was interrelated with quality of life and was not affected by patient age, sex, or BMI.
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Affiliation(s)
- Georgios Chalatsis
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Vasileios Mitrousias
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Athanasios Siouras
- Department of Computer Science and
Biomedical Informatics, School of Science, University of Thessaly, Lamia,
Greece
- AIDEAS OÜ, Tallinn, Estonia
| | - Freideriki Panteliadou
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Ioannis Tziolas
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Chrysovalantis Solomou
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
| | - Michael Hantes
- Department of Orthopaedic Surgery &
Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences,
University of Thessaly, Larissa, Greece
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Wong CY(T, Mok KM, Yung SH(P. Secondary Anterior Cruciate Ligament Injury Prevention Training in Athletes: What Is the Missing Link? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4821. [PMID: 36981735 PMCID: PMC10049415 DOI: 10.3390/ijerph20064821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
After reconstruction, the return to full competition rate of athletes is low, while the re-injury rate remains high despite the completion of a rehabilitation programme. Primary ACL prevention programmes are well developed, yet few research papers focus on secondary ACL injury prevention. The aim of current review is to determine if current ACL secondary prevention training has a positive influence on the re-injury rate, the clinical or functional outcomes, or the risk of re-injury in athletes. Studies investigating secondary prevention of ACL were searched in PubMed and EBSCOhost, followed by a review of the references in the identified articles. The existing evidence suggests that neuromuscular training, eccentric strengthening, and plyometric exercises may have a potential impact on improving biomechanical, functional, and psychological outcomes in athletes; however, the studies on the prevention of second ACL injury in athletes is scarce and inconclusive. Future research is needed to investigate the effectiveness of secondary ACL prevention in reducing the re-injury rates. (PROSPERO Registration number: CRD42021291308).
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Affiliation(s)
- Choi-Yan (Tiffany) Wong
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (C.-Y.W.); (K.-M.M.)
| | - Kam-Ming Mok
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (C.-Y.W.); (K.-M.M.)
- Office of Student Affairs, Lingnan University, Hong Kong, China
- School of Interdisciplinary Studies, Lingnan University, Hong Kong, China
| | - Shu-Hang (Patrick) Yung
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (C.-Y.W.); (K.-M.M.)
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Klausner F, Csapo R, Gonaus C, Gföller P, Hoser C, Braun S, Abermann E, Fink C. [Importance and application of injury prevention in Austrian football - a survey among 687 coaches]. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2023; 37:37-44. [PMID: 36878219 DOI: 10.1055/a-1920-5133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND Soccer is one of the most popular sports in the world but associated with a high risk of injury. For this reason, the study of the etiology of injuries is of great interest and numerous prevention programs have been developed in recent years. Since these prevention programs must be embedded into training routine, trainers are primarily responsible for their implementation. The present study aimed to survey Austrian soccer coaches engaged in professional, amateur or youth teams with respect to their opinions on injuries as well as the application of respective prevention programs. METHODS An online questionnaire was developed and sent to all coaches registered in the Austrian Football Association.In addition to personal data, the trainers' attitudes to the subject of injury prevention were also asked. It was also asked which preventive measures the trainers consider important and which they also use in their training and to what extent. RESULTS A total of 687 trainers took part in the survey. 2,3%, 37,5% and 43,6% of trainers were engaged in professional, amateur and youth clubs, respectively. The rest gave no information. The majority of respondents (56%) considered injuries a major concern in soccer. Inadequate fitness (75,7%) as well as insufficient preparation (60,7%) and poor regeneration (59,2%) were seen as the greatest risk factors for injuries. Appropriate warm-up (66,8%), regeneration (59,4%) and core stabilization training (58,2%) were considered the most effective preventative measures. More than 50% of the participants were not familiar with any of the most widely applied injury prevention programs, and only 15.4% actually implemented those programs in their training.The substantial interest in injury prevention notwithstanding, the respective standard of knowledge amongst Austrian coaches is poor. In light of the high prevalence of injuries, it is most important to inform trainers about injury prevention programs and possibilities to implement them in training practice.
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Affiliation(s)
- Florian Klausner
- Sportwissenschaften, FIFA Medical Center of Excellence Innsbruck/Austria, Innsbruck, AUSTRIA
| | - Robert Csapo
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private Iniversity for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria, Hall in Tirol, AUSTRIA
| | - Christoph Gonaus
- Sport and Exercise Science, University of Salzburg: Universitat Salzburg, Hallein/Rif, AUSTRIA
| | - Peter Gföller
- Gelenkpunkt - Sports and Joint Surgery, Innsbruck, Austria, Innsbruck, AUSTRIA
| | - Christian Hoser
- Gelenkpunkt - Sports and Joint Surgery, Innsbruck/Asutria, Innsbruck, AUSTRIA
| | - Sepp Braun
- Gelenkpunkt - Sports and Joint Surgery, Innsbruck/Austria, Innsbruck, AUSTRIA
| | - Elisabeth Abermann
- Gelenkpunkt - Sports and Joint Surgery, Innsbruck/Asutria, Innsbruck, AUSTRIA
| | - Christian Fink
- Gelenkpunkt - Sports and Joint Surgery, Innsbruck/Asutria, Innsbruck, AUSTRIA
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Giordano L, Maffulli N, Carimati G, Morenghi E, Volpi P. Increased Time to Surgery After Anterior Cruciate Ligament Tear in Female Patients Results in Greater Risk of Medial Meniscus Tear: A Study of 489 Female Patients. Arthroscopy 2023; 39:613-622. [PMID: 36309227 DOI: 10.1016/j.arthro.2022.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/25/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE This study assessed the incidence of meniscal tears in anterior cruciate ligament (ACL)-deficient knees, considering the time between injury and reconstruction in a large sample of female patients. Furthermore, we evaluated whether the rate of meniscal repair or meniscectomy was affected by age and body mass index (BMI). METHODS The medical records of 489 patients who underwent ACL-reconstructive surgery between January 2011 and April 2021 were analyzed to collect data on the prevalence of meniscal tears, surgical timing, patient age, and BMI. Logistic regression was performed to estimate the association between the prevalence of meniscal tears and the independent variables of surgical timing, age, and BMI. RESULTS Between 24 and 60 months after their injury, female patients showed a statistically significant increase in the presence of associated meniscal lesions when compared with ACL reconstruction performed earlier (odds ratio [OR] of 3.11; 95% 1.06-9.10 confidence interval [CI]), especially for medial meniscal tears, with an OR of 1.94 (95% CI 1.23-3.05, P = .004) between 12 and 24 months. There is a statistically significant difference after 12 months in the rate of meniscal suturing for medial meniscus tears (OR 3.30; CI 1.37-7.91 P = .007). Increasing age was associated with a greater prevalence of meniscal tears up to 30-50 years, but there was no clear association between BMI and associated lesions other than a greater rate of meniscectomies. CONCLUSIONS In female patients who experienced an ACL injury, a delay in surgery greater than 12 months is associated with a gradual increase in the risk of nonrepairable medial meniscal tear; this risk becomes statistically significant after 24 months. A high BMI does not seem to have relevance in the onset of associated lesions in women but results in a greater rate of meniscectomies compared with meniscal sutures, whereas age between 30 and 50 years is associated with a greater risk of associated injuries. LEVEL OF EVIDENCE III, retrospective comparative prognostic trial.
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Affiliation(s)
- Lorenzo Giordano
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Centre for Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom; School of Pharmacy and Bioengineering, Keele University School of Medicine, Staffordshire, United Kingdom.
| | - Giulia Carimati
- Knee Surgery and Sport Traumatology Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Piero Volpi
- Knee Surgery and Sport Traumatology Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
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Li H, Huang H, Ren S, Rong Q. Leveraging Multivariable Linear Regression Analysis to Identify Patients with Anterior Cruciate Ligament Deficiency Using a Composite Index of the Knee Flexion and Muscle Force. Bioengineering (Basel) 2023; 10:bioengineering10030284. [PMID: 36978675 PMCID: PMC10045096 DOI: 10.3390/bioengineering10030284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Patients with anterior cruciate ligament (ACL) deficiency (ACLD) tend to have altered lower extremity kinematics and dynamics. Clinical diagnosis of ACLD requires more objective and convenient evaluation criteria. Twenty-five patients with ACLD before ACL reconstruction and nine healthy volunteers were recruited. Five experimental jogging data sets of each participant were collected and calculated using a musculoskeletal model. The resulting knee flexion and muscle force data were analyzed using a t-test for characteristic points, which were the time points in the gait cycle when the most significant difference between the two groups was observed. The data of the characteristic points were processed with principal component analysis to generate a composite index for multivariable linear regression. The accuracy rate of the regression model in diagnosing patients with ACLD was 81.4%. This study demonstrates that the multivariable linear regression model and composite index can be used to diagnose patients with ACLD. The composite index and characteristic points can be clinically objective and can be used to extract effective information quickly and conveniently.
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Affiliation(s)
- Haoran Li
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing 100871, China
| | - Hongshi Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100871, China
| | - Shuang Ren
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100871, China
- Correspondence: (S.R.); (Q.R.)
| | - Qiguo Rong
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing 100871, China
- Correspondence: (S.R.); (Q.R.)
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Xu L, Hu YJ, Peng Y, Wang Z, Wang J, Lu WW, Tang B, Guo XE. Early zoledronate treatment inhibits subchondral bone microstructural changes in skeletally-mature, ACL-transected canine knees. Bone 2023; 167:116638. [PMID: 36464243 DOI: 10.1016/j.bone.2022.116638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
Anterior cruciate ligament (ACL) tear leads to post-traumatic osteoarthritis (PTOA), a significant clinical burden worldwide that currently has no cure. Recent studies suggest a role of subchondral bone adaptations in the development of PTOA. Particularly, microstructural changes in the rod-and-plate microstructure of subchondral bone may precede and contribute to OA progression. In this study, we quantified microstructural changes in subchondral trabecular rods and plates after ACL-transection for the first time in the well-established preclinical canine model of PTOA and investigated the therapeutic potentials of a bisphosphonate (zoledronate) and NSAID treatment (meloxicam). Unilateral hindlimb ACL transection was performed on skeletally-mature (2-year-old, N = 20) and juvenile (10-month-old, N = 20) male beagles. Animals were assigned to 4 groups (N = 5): ACLT, un-operated control, ACLT with zoledronate, and ACLT with meloxicam treatment. Subchondral bone microstructure was evaluated by micro-computed tomography and cartilage integrity was evaluated histologically. We found that ACL-induced subchondral bone changes depended on skeletal maturity of animals. In mature animals, significant loss of trabecular plates that resulted in reduced PR ratio occurred at Month 1 and persisted until Month 8. Zoledronate treatment prevented trabecular plate loss while meloxicam treatment did not. Whether cartilage degeneration is also attenuated warrants further investigation. In juvenile animals that have not reached skeletal maturity, transient changes in trabecular plate and rod microstructure occurred at Month 3 but not Month 9. Neither zoledronate nor meloxicam treatment attenuated bone microstructural changes or cartilage damages. Findings from this study suggest that early inhibition of bone resorption by bisphosphonate after injury may be a promising therapeutic approach to prevent alterations in subchondral bone microstructure associated with PTOA. Our results further demonstrate that pathogenesis of PTOA may differ between adolescent and adult patients and therefore require distinct management strategies.
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Affiliation(s)
- Lei Xu
- Department of Biomedical Engineering, the Southern University of Science and Technology, Shenzhen, PR China; Department of Orthopeadics and Traumatology, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong; Department of Orthopeadics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, PR China
| | - Yizhong Jenny Hu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Ying Peng
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Zexi Wang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Jingyi Wang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - W William Lu
- Department of Orthopeadics and Traumatology, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Bin Tang
- Department of Biomedical Engineering, the Southern University of Science and Technology, Shenzhen, PR China
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA.
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Zuk EF, Kim S, Burland JP, Glaviano NR. The Comparison of Psychological Barriers Between Individuals with a History of Anterior Knee Pain, Anterior Cruciate Ligament Reconstruction, and Healthy Individuals. Int J Sports Phys Ther 2023; 18:92-101. [PMID: 36793558 PMCID: PMC9897036 DOI: 10.26603/001c.68045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 11/03/2022] [Indexed: 02/05/2023] Open
Abstract
Background Psychological barriers due to anterior knee pain (AKP) and anterior cruciate ligament reconstruction (ACLR) may have a direct impact on an individual's return to physical activity. A comprehensive understanding of these psychological barriers in individuals with AKP and ACLR may help clinicians to develop and implement better treatment strategies to address deficits that may exist in these individuals. Hypothesis/Purpose The primary purpose of this study was to evaluate fear-avoidance, kinesiophobia, and pain catastrophizing in individuals with AKP and ACLR compared with healthy individuals. The secondary purpose was to directly compare psychological characteristics between the AKP and ACLR groups. It was hypothesized that 1) individuals with AKP and ACLR would self-report worse psychosocial function than healthy individuals and 2) the extent of the psychosocial impairments between the two knee pathologies would be similar. Study Design Cross-sectional study. Methods Eighty-three participants (28 AKP, 26 ACLR, and 29 healthy individuals) were analyzed in this study. Fear avoidance belief questionnaire (FABQ) with the physical activity (FABQ-PA) and sport (FABQ-S) subscales, Tampa scale of Kinesiophobia (TSK-11) and pain catastrophizing scale (PCS) assessed psychological characteristics. Kruskal-Wallis tests were used to compare the FABQ-PA, FABQ-S, TSK-11, and PCS scores across the three groups. Mann-Whitney U tests were performed to determine where group differences occurred. Effect sizes (ES) were calculated with the Mann-Whitney U z-score divided by the square root of the sample size. Results Individuals with AKP or ACLR had significantly worse psychological barriers compared to the healthy individuals for all questionnaires (FABQ-PA, FABQ-S, TSK-11, and PCS) (p<0.001, ES>0.86). There were no differences between the AKP and ACLR groups (p≥0.67), with a medium ES (-0.33) in the FABQ-S between AKP and ACLR groups. Conclusion Greater psychological scores indicate impaired psychological readiness to perform physical activity. Clinicians should be aware of fear-related beliefs following knee-related injuries and are encouraged to measure psychological factors during the rehabilitation process. Level of Evidence 2.
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Affiliation(s)
- Emma F Zuk
- Department of Kinesiology University of Connecticut
- Institute for Sports Medicine University of Connecticut
| | - Sungwan Kim
- Department of Kinesiology University of Connecticut
- Institute for Sports Medicine University of Connecticut
| | - Julie P Burland
- Department of Kinesiology University of Connecticut
- Institute for Sports Medicine University of Connecticut
| | - Neal R Glaviano
- Department of Kinesiology University of Connecticut
- Institute for Sports Medicine University of Connecticut
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Comparison of survival rates between total knee arthroplasty after a previous anterior cruciate ligament reconstruction and primary total knee arthroplasty via propensity score matching. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04773-6. [PMID: 36656350 DOI: 10.1007/s00402-023-04773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/07/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Although the survival rate of total knee arthroplasty (TKA) in patients treated with anterior cruciate ligament reconstruction (ACLR) is not as favorable as that in patients treated with primary TKA without ligament reconstruction, the exact survival rates and complications associated with these procedures are still controversial. Therefore, the purpose of the current study was to compare the revision rates of TKA in patients with knee osteoarthritis (OA) with a previous ACLR and those of patients with primary TKA with no history of knee surgery by using propensity score matching analysis. MATERIALS AND METHODS A list of patients who underwent TKA from January 1, 2008 to May 31, 2019 was obtained from the Korean National Health Insurance database. Among these, 460 patients underwent TKA in a knee with a previous ACLR and 569,766 patients who underwent primary TKA due to degenerative OA. We performed propensity scoring matching to compare the revision rates including septic revision due to prosthetic joint infection after TKA and perioperative complication rates within 90 days after revision TKA between the two groups. RESULTS Matched patients were assigned to one of the two groups (group A: 2,201 patients who underwent TKA due to primary OA, group B: 448 patients who underwent TKA in a knee with a previous ACLR) based on the propensity score. The total number of revisions per 1000 person-years was significantly higher in group B than in group A (10.16 vs 4.66, respectively). Group B showed a higher risk of revision than group A at 10 years post-TKA (hazard ratio: 2.49, 95% confidence interval: 1.30-4.77). However, group B showed a similar risk of septic revision as group A (p = 0.44). Perioperative complications within 90 days after TKA showed no significant differences between the groups. CONCLUSIONS Surgeons should be aware of the relatively higher revision rate of TKA in patients who had previously undergone an ACLR compared to that in patients who underwent primary TKA.
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Long T, Fernandez J, Liu H, Li H. Evaluating the risk of knee osteoarthritis following unilateral ACL reconstruction based on an EMG-assisted method. Front Physiol 2023; 14:1160261. [PMID: 37153223 PMCID: PMC10160379 DOI: 10.3389/fphys.2023.1160261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Objective: Anterior cruciate ligament reconstruction (ACLR) cannot decrease the risk of knee osteoarthritis after anterior cruciate ligament rupture, and tibial contact force is associated with the development of knee osteoarthritis. The purpose of this study was to compare the difference in bilateral tibial contact force for patients with unilateral ACLR during walking and jogging based on an EMG-assisted method in order to evaluate the risk of knee osteoarthritis following unilateral ACLR. Methods: Seven unilateral ACLR patients participated in experiments. The 14-camera motion capture system, 3-Dimension force plate, and wireless EMG test system were used to collect the participants' kinematics, kinetics, and EMG data during walking and jogging. A personalized neuromusculoskeletal model was established by combining scaling and calibration optimization. The inverse kinematics and inverse dynamics algorithms were used to calculate the joint angle and joint net moment. The EMG-assisted model was used to calculate the muscle force. On this basis, the contact force of the knee joint was analyzed, and the tibial contact force was obtained. The paired sample t-test was used to analyze the difference between the participants' healthy and surgical sides of the participants. Results: During jogging, the peak tibial compression force on the healthy side was higher than on the surgical side (p = 0.039). At the peak moment of tibial compression force, the muscle force of the rectus femoris (p = 0.035) and vastus medialis (p = 0.036) on the healthy side was significantly higher than that on the surgical side; the knee flexion (p = 0.042) and ankle dorsiflexion (p = 0.046) angle on the healthy side was higher than that on the surgical side. There was no significant difference in the first (p = 0.122) and second (p = 0.445) peak tibial compression forces during walking between the healthy and surgical sides. Conclusion: Patients with unilateral ACLR showed smaller tibial compression force on the surgical side than on the healthy side during jogging. The main reason for this may be the insufficient exertion of the rectus femoris and vastus medialis.
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Affiliation(s)
- Ting Long
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Biomechanics Laboratory, Beijing Sport University, Beijing, China
- *Correspondence: Ting Long, ; Hanjun Li,
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Hui Liu
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Hanjun Li
- Biomechanics Laboratory, Beijing Sport University, Beijing, China
- *Correspondence: Ting Long, ; Hanjun Li,
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Williams JR, Neal K, Alfayyadh A, Capin JJ, Khandha A, Manal K, Snyder-Mackler L, Buchanan TS. Patellofemoral contact forces and knee gait mechanics 3 months after ACL reconstruction are associated with cartilage degradation 24 months after surgery. Osteoarthritis Cartilage 2023; 31:96-105. [PMID: 36252943 PMCID: PMC9771964 DOI: 10.1016/j.joca.2022.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Evaluate patellofemoral cartilage health, as assessed by quantitative magnetic resonance imaging (qMRI) T2 relaxation times, 24-months after ACL reconstruction (ACLR) and determine if they were associated with patellofemoral contact forces and knee mechanics during gait 3 months after surgery. DESIGN Thirty individuals completed motion analysis during overground walking at a self-selected speed 3 months after ACLR. An EMG-driven neuromusculoskeletal model was used to determine muscle forces, which were then used in a previously described model to estimate patellofemoral contact forces. Biomechanical variables of interest included peak patellofemoral contact force, peak knee flexion angle and moment, and walking speed. These same participants underwent a sagittal bilateral T2 mapping qMRI scan 24-months after surgery. T2 relaxation times were estimated for both patellar and trochlear cartilage. Paired t-tests were used to compare T2 relaxation times between limbs while Pearson correlations and linear regressions were utilized to assess the association between the biomechanical variables of interest and T2 relaxation times. RESULTS Prolonged involved limb trochlear T2 relaxation times (vs uninvolved) were present 24-months after surgery, indicating worse cartilage health. No differences were detected in patellar cartilage. Significant negative associations were present within the involved limb for all the biomechanical variables of interest 3 months after ACLR and trochlear T2 relaxation times at 24-months. No associations were found in patellar cartilage or within the uninvolved limb. CONCLUSIONS Altered involved limb trochlear cartilage health is present 24-months after ACLR and may be related to patellofemoral loading and other walking gait mechanics 3 months after surgery.
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Affiliation(s)
- J R Williams
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
| | - K Neal
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
| | - A Alfayyadh
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Physical Therapy and Rehabilitation Department, Jouf University, Jouf, Saudi Arabia.
| | - J J Capin
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA.
| | - A Khandha
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA.
| | - K Manal
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
| | - L Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA; Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - T S Buchanan
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA; Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Biomedical Engineering, University of Delaware, Newark, DE, USA.
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Wang H, Fang C, Tao M, Shi Q, He K, Cheng CK. Hourglass-shaped grafts are superior to conventional grafts for restoring knee stability and graft force at knee flexion angle of 30° following anterior cruciate ligament reconstruction: A finite element analysis. Front Bioeng Biotechnol 2022; 10:967411. [PMID: 36601393 PMCID: PMC9807226 DOI: 10.3389/fbioe.2022.967411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Anterior cruciate ligament reconstruction (ACLR) using a generally columnar graft is considered the gold standard for treating anterior cruciate ligament ruptures, but such grafts cannot replicate the geometry and mechanical properties of the native anterior cruciate ligament. Purpose: To evaluate the effectiveness of an innovative hourglass-shaped graft versus a traditional columnar graft for restoring joint stability and graft force, while avoiding notch impingement following anterior cruciate ligament reconstruction. Methods: Finite element models of a human knee were developed to simulate ① An intact state, ② anterior cruciate ligament reconstruction using columnar grafts with different diameters (7.5-12 mm in 0.5 mm increments), ③ anterior cruciate ligament reconstruction using columnar grafts with different Young's moduli (129.4, 168.0 and 362.2 MPa) and ④ anterior cruciate ligament reconstruction using hourglass-shaped grafts with different Young's moduli. The knee model was flexed to 30° and loaded with an anterior tibial load of 103 N, internal tibial moment of 7.5 Nm, and valgus tibial moment of 6.9 Nm. The risk of notch impingement, knee stability and graft forces were compared among the different groups. Results: This study found that columnar grafts could not simultaneously restore knee stability in different degree of freedoms (DOFs) and graft force to a level similar to that of the intact knee. The anterior tibial translation and graft force were restored to a near-normal condition when the internal tibial rotation was over-restrained and valgus tibial rotation was lax. A graft diameter of at least 10 mm was needed to restore knee stability and graft force to physiological levels, but such large grafts were found to be at high risk of notch impingement. In contrast, the hourglass-shaped graft was able to simultaneously restore both knee stability and graft force at knee flexion of 30° while also having a much lower risk of impingement. Conclusion: Under knee flexion angle of 30°, an hourglass-shaped graft was better able to restore joint stability and graft force to a near-physiological level than columnar grafts, while also reducing the risk of notch impingement.
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Affiliation(s)
- Huizhi Wang
- Engineering Research Center for Digital Medicine of the Ministry of Education, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chaohua Fang
- Engineering Research Center for Digital Medicine of the Ministry of Education, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Department of Joint Surgery, The 6th Hospital of Ningbo, Ningbo, Zhejiang, China
| | - Mingzhu Tao
- Engineering Research Center for Digital Medicine of the Ministry of Education, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qinyi Shi
- Engineering Research Center for Digital Medicine of the Ministry of Education, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Kaixin He
- Engineering Research Center for Digital Medicine of the Ministry of Education, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng-Kung Cheng
- Engineering Research Center for Digital Medicine of the Ministry of Education, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,*Correspondence: Cheng-Kung Cheng,
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