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Ubl ST, Vieider RP, Seilern und Aspang J, Gaebler C, Platzgummer H. Bone bruise distribution predicts anterior cruciate ligament tear location in non-contact injuries. J Exp Orthop 2024; 11:e12034. [PMID: 38741902 PMCID: PMC11089843 DOI: 10.1002/jeo2.12034] [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: 01/15/2024] [Revised: 04/12/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose It is unclear whether different injury mechanisms lead to divergent anterior cruciate ligament (ACL) tear locations. This study aims to analyse the relationship between bone bruise (BB) distribution or depth and ACL tear location. Methods A retrospective analysis of 446 consecutive patients with acute non-contact ACL injury was performed. Only patients with complete ACL tears verified during subsequent arthroscopy were included. Magnetic resonance imaging (MRI) was used to classify BB location, BB depth, ACL tear location and concomitant injuries (medial/lateral meniscus and medial/lateral collateral ligament). Demographic characteristics included age, gender, body mass index (BMI), type of sport and time between injury and MRI. Multiple linear regression analysis was used to identify independent predictors of ACL tear location. Results One hundred and fifty-eight skeletally mature patients met the inclusion criteria. The presence of BB in the lateral tibial plateau was associated with a more distal ACL tear location (β = -0.27, p < 0.001). Less BB depth in the lateral femoral condyle showed a tendency towards more proximal ACL tears (β = -0.14; p = 0.054). Older age predicted a more proximal ACL tear location (β = 0.31, p < 0.001). No significant relationship was found between ACL tear location and gender, BMI, type of sport, concomitant injuries and time between injury and MRI. Conclusion ACL tear location after an acute non-contact injury is associated with distinct patterns of BB distribution, particularly involving the lateral compartment, indicating that different injury mechanisms may lead to different ACL tear locations. Level of Evidence Level III.
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Affiliation(s)
- Steffen T. Ubl
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical CenterWitten/Herdecke UniversityCologneGermany
| | - Romed P. Vieider
- Department of Sports Orthopaedics, Klinikum Rechts der IsarTechnical University of MunichMunichGermany
| | - Jesse Seilern und Aspang
- Department of Orthopaedic Surgery, Grady Memorial HospitalEmory University School of MedicineAtlantaGeorgiaUSA
| | - Christian Gaebler
- Sportambulatorium Wien – Zentrum für Orthopaedie und Sportchirurgie (ZOS)ViennaAustria
| | - Hannes Platzgummer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
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Champagne AA, Zuleger TM, Warren SM, Smith DR, Lamplot JD, Xerogeanes JW, Slutsky-Ganesh AB, Jayaram P, Patel JM, Myer GD, Diekfuss JA. Automated quantitative assessment of bone contusions and overlying articular cartilage following anterior cruciate ligament injury. J Orthop Res 2024. [PMID: 38885494 DOI: 10.1002/jor.25920] [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: 03/29/2024] [Revised: 05/15/2024] [Accepted: 06/01/2024] [Indexed: 06/20/2024]
Abstract
Quantitative methods to characterize bone contusions and associated cartilage injury remain limited. We combined standardized voxelwise normalization and 3D mapping to automate bone contusion segmentation post-anterior cruciate ligament (ACL) injury and evaluate anomalies in articular cartilage overlying bone contusions. Forty-five patients (54% female, 26.4 ± 11.8 days post-injury) with an ACL tear underwent 3T magnetic resonance imaging of their involved and uninvolved knees. A novel method for voxelwise normalization and 3D anatomical mapping was used to automate segmentation, labeling, and localization of bone contusions in the involved knee. The same mapping system was used to identify the associated articular cartilage overlying bone lesions. Mean regional T1ρ was extracted from articular cartilage regions in both the involved and uninvolved knees for quantitative paired analysis against ipsilateral cartilage within the same compartment outside of the localized bone contusion. At least one bone contusion lesion was detected in the involved knee within the femur and/or tibia following ACL injury in 42 participants. Elevated T1ρ (p = 0.033) signal were documented within the articular cartilage overlying the bone contusions resulting from ACL injury. In contrast, the same cartilaginous regions deprojected onto the uninvolved knees showed no ipsilateral differences (p = 0.795). Automated bone contusion segmentation using standardized voxelwise normalization and 3D mapping deprojection identified altered cartilage overlying bone contusions in the setting of knee ACL injury.
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Affiliation(s)
- Allen A Champagne
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Taylor M Zuleger
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Neuroscience Graduate Program, University of Cincinnati, Cincinnati, Ohio, USA
| | - Shayla M Warren
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel R Smith
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - John W Xerogeanes
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alexis B Slutsky-Ganesh
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Prathap Jayaram
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jay M Patel
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Youth Physical Development Center, Cardiff Metropolitan University, Wales, UK
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, United States
| | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
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3
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Sohn S, AlShammari SM, Hwang BJ, Kim MS. A Systematic Review of Bone Bruise Patterns following Acute Anterior Cruciate Ligament Tears: Insights into the Mechanism of Injury. Bioengineering (Basel) 2024; 11:396. [PMID: 38671817 PMCID: PMC11048204 DOI: 10.3390/bioengineering11040396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: The purpose of this systematic review was to determine the prevalence of bone bruises in patients with anterior cruciate ligament (ACL) injuries and the location of the bruises relative to the tibia and femur. Understanding the relative positions of these bone bruises could enhance our comprehension of the knee loading patterns that occur during an ACL injury. (2) Methods: The MEDLINE, EMBASE, and the Cochrane Library databases were searched for studies that evaluated the presence of bone bruises following ACL injuries. Study selection, data extraction, and a systematic review were performed. (3) Results: Bone bruises were observed in 3207 cases (82.8%) at the lateral tibia plateau (LTP), 1608 cases (41.5%) at the medial tibia plateau (MTP), 2765 cases (71.4%) at the lateral femoral condyle (LFC), and 1257 cases (32.4%) at the medial femoral condyle (MFC). Of the 30 studies, 11 were able to assess the anterior to posterior direction. The posterior LTP and center LFC were the most common areas of bone bruises. Among the 30 studies, 14 documented bone bruises across all four sites (LTP, MTP, LFC, and MFC). The most common pattern was bone bruises appearing at the LTP and LFC. (4) Conclusions: The most frequently observed pattern of bone bruises was restricted to the lateral aspects of both the tibia and femur. In cases where bone bruises were present on both the lateral and medial sides, those on the lateral side exhibited greater severity. The positioning of bone bruises along the front-back axis indicated a forward shift of the tibia in relation to the femur during ACL injuries.
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Affiliation(s)
- Sueen Sohn
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Republic of Korea;
| | | | - Byung Jun Hwang
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
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Wheatley MGA, Pearle AD, Shamritsky DZ, Hirth JM, Nawabi DH, Wickiewicz TL, Beynnon BD, Imhauser CW. Statistical shape analysis and computational modeling reveal novel relationships between tibiofemoral bony geometry and knee mechanics in young, female athletes. J Biomech 2024; 167:112030. [PMID: 38583375 DOI: 10.1016/j.jbiomech.2024.112030] [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: 01/23/2023] [Revised: 12/30/2023] [Accepted: 02/29/2024] [Indexed: 04/09/2024]
Abstract
Young female athletes participating in sports requiring rapid changes of direction are at heightened risk of suffering traumatic knee injury, especially noncontact rupture of the anterior cruciate ligament (ACL). Clinical studies have revealed that geometric features of the tibiofemoral joint are associated with increased risk of suffering noncontact ACL injury. However, the relationship between three-dimensional (3D) tibiofemoral geometry and knee mechanics in young female athletes is not well understood. We developed a statistically augmented computational modeling workflow to determine relationships between 3D geometry of the knee and tibiofemoral kinematics and ACL force in response to an applied loading sequence of compression, valgus, and anterior force, which is known to load the ACL. This workflow included 3D characterization of tibiofemoral bony geometry via principal component analysis and multibody dynamics models incorporating subject-specific knee geometries. A combination of geometric features of both the tibia and the femur that spanned all three anatomical planes was related to increased ACL force and to increased kinematic coupling (i.e., anterior, medial, and distal tibial translations and internal tibial rotation) in response to the applied loads. In contrast, a uniplanar measure of tibiofemoral geometry that is associated with ACL injury risk, sagittal plane slope of the lateral tibial plateau subchondral bone, was not related to ACL force. Thus, our workflow may aid in developing mechanics-based ACL injury screening tools for young, active females based on a unique combination of bony geometric features that are related to increased ACL loading.
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Affiliation(s)
| | - Andrew D Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - David Z Shamritsky
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Jacob M Hirth
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Danyal H Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | | | - Bruce D Beynnon
- Department of Orthopaedics and Rehabilitation, McClure Musculoskeletal Research Center, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA.
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5
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Dai R, Wu Y, Jiang Y, Huang H, Yan W, Shi H, Meng Q, Ren S, Ao Y. Comparison of Bone Bruise Pattern Epidemiology between Anterior Cruciate Ligament Rupture and Patellar Dislocation Patients-Implications of Injury Mechanism. Bioengineering (Basel) 2023; 10:1366. [PMID: 38135957 PMCID: PMC10740614 DOI: 10.3390/bioengineering10121366] [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: 09/18/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Different bone bruise patterns observed using magnetic resonance imaging (MRI) after non-contact anterior cruciate ligament (ACL) rupture and lateral patellar dislocation may indicate different knee injury mechanisms. In this study, 77 ACL ruptures and 77 patellar dislocations in knee MR images taken from patients with bone bruises at our institution between August 2020 and March 2022 were selected and analyzed. In order to determine typical bone bruising patterns following by ACL rupture and patellar dislocation, sagittal- and transverse-plane images were used to determine bone bruise locations in the directions of medial-lateral and superior-inferior with MR images. The presence, intensity, and location of the bone bruises in specific areas of the femur and tibial after ACL rupture and patellar dislocation were recorded. Relative bone bruise patterns after ACL rupture and patellar dislocation were classified. The results showed that there were four kinds of bone bruise patterns (1-, 2-, 3-, and 4- bone bruises) after ACL rupture. The most common two patterns after ACL rupture were 3- bone bruises (including the lateral femoral condyle and both the lateral-medial tibial plateau, LF + BT; both the lateral-medial femoral condyle and the lateral tibial plateau, BF + LT; and the medial femoral condyle and both the medial and lateral tibial plateau, MF + BT) followed by 4- bone bruises (both the lateral-medial femoral condyle and the tibial plateau, BF + BT), 2- bone bruises (the lateral femoral condyle and tibial plateau, LF + LT; the medial femoral condyle and the lateral tibial plateau, MF + LT; the lateral femoral condyle and the medial tibial plateau, LF + MT; the medial femoral condyle and the tibial plateau, MF + MT; both the lateral-medial tibial plateau, 0 + BT), and 1- bone bruise (only the lateral tibial plateau, 0 + LT). There was only a 1- bone bruise (the latera femoral condyle and medial patella bone bruise) for patellar dislocation, and the most common pattern of patellar dislocation was in the inferior medial patella and the lateral anterior inferior femur. The results suggested that bone bruise patterns after ACL rupture and patellar dislocation are completely different. There were four kinds of bone bruise patterns after non-contact ACL rupture, while there was only one kind of bone bruise pattern after patellar dislocation in patients, which was in the inferior medial patella and lateral anterior inferior femur.
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Affiliation(s)
- Ruilan Dai
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin 300170, China
| | - Yue Wu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin 300170, China
| | - Yanfang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
| | - Hongshi Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
| | - Wenqiang Yan
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
| | - Huijuan Shi
- Biomechanics Laboratory, College of Human Movement Science, Beijing Sport University, Beijing 100080, China;
| | - Qingyang Meng
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
| | - Shuang Ren
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
| | - Yingfang Ao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin 300170, China
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6
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Li J, Mao Y, Wang D, Fu W, Li Q, Tang X, Chen G, Chen X, Yao L, You M, Xiong Y, Li J. Correlation Between the Location and Distance of Kissing Contusions and Knee Laxity in Acute Noncontact ACL Injury. Am J Sports Med 2023; 51:3179-3189. [PMID: 37715506 DOI: 10.1177/03635465231196865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
BACKGROUND Bone bruise (BB) and kissing contusion are common features of acute anterior cruciate ligament (ACL) injury on magnetic resonance imaging (MRI). The correlation between the location and distance of kissing contusions and knee laxity remains unclear. PURPOSE To determine the significance of different patterns of BB in acute noncontact ACL injury and assess the correlation between the location and distance of kissing contusions and the severity of knee laxity. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 205 patients with acute noncontact ACL injury undergoing arthroscopic treatment between January 2021 and May 2022 were included in this retrospective analysis. Patients were grouped according to the different patterns of BB. The type of ACL injury and concomitant injuries were analyzed on MRI and confirmed by arthroscopy. Anterior knee laxity was assessed by the Ligs digital arthrometer and stress radiography, and rotational knee laxity was assessed by the intraoperative pivot-shift test. The MRI parameters of the location and distance of kissing contusions were measured to assess their correlations with the severity of knee laxity. RESULTS Of the 205 patients with acute noncontact ACL injury, 38 were in the non-BB group and 167 were in the BB group, the latter including 32 with the isolated BB on the lateral tibial plateau and 135 with kissing contusions. There was no significant difference in the mean time from initial injury to MRI scan between the non-BB group and the BB group (14.34 ± 2.92 vs 15.17 ± 2.86 days; P = .109) or between the isolated BB subgroup and the kissing contusion subgroup (14.94 ± 2.92 vs 15.23 ± 2.85 days; P = .605). The side-to-side difference (SSD) in anterior knee laxity and the incidences of complete ACL injury, concomitant injuries, and high-grade pivot-shift test were significantly higher in the BB group than in the non-BB group, and in the kissing contusion subgroup compared with the isolated BB subgroup. The kissing contusion index of the lateral femoral condyle (LFC) and the sagittal distance of kissing contusions were significantly correlated with the SSD in anterior knee laxity and the grade of pivot-shift test (P < .001). CONCLUSION The presence of BB, in particular the appearance of kissing contusions, was related to greater knee laxity and higher incidences of complete ACL injury and concomitant injuries in acute noncontact ACL injury. For patients with kissing contusions, as the location of BB on the LFC moved forward and the distance between kissing contusions increased, anterior and rotational knee laxity became more serious.
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Affiliation(s)
- Junqiao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yunhe Mao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Duan Wang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Chen
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Chen
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Yao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Mingke You
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Xiong
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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7
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Kim-Wang SY, Spritzer CE, Owusu-Akyaw K, Coppock JA, Goode AP, Englander ZA, Wittstein JR, DeFrate LE. The Predicted Position of the Knee Near the Time of ACL Rupture Is Similar Between 2 Commonly Observed Patterns of Bone Bruising on MRI: Response. Am J Sports Med 2023; 51:NP22-NP24. [PMID: 37392078 DOI: 10.1177/03635465231172184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
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8
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Moran J, Lee MS, Kunze KN, Green JS, Katz LD, Wang A, McLaughlin WM, Gillinov SM, Jimenez AE, Hewett TE, LaPrade RF, Medvecky MJ. Examining the Distribution of Bone Bruise Patterns in Contact and Noncontact Acute Anterior Cruciate Ligament Injuries. Am J Sports Med 2023; 51:1155-1161. [PMID: 36867053 DOI: 10.1177/03635465231159899] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Bone bruises are commonly seen on magnetic resonance imaging (MRI) in acute anterior cruciate ligament (ACL) injuries and can provide insight into the underlying mechanism of injury. There are limited reports that have compared the bone bruise patterns between contact and noncontact mechanisms of ACL injury. PURPOSE To examine and compare the number and location of bone bruises in contact and noncontact ACL injuries. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Three hundred twenty patients who underwent ACL reconstruction surgery between 2015 and 2021 were identified. Inclusion criteria were clear documentation of the mechanism of injury and MRI within 30 days of the injury on a 3-T scanner. Patients with concomitant fractures, injuries to the posterolateral corner or posterior cruciate ligament, and/or previous ipsilateral knee injury were excluded. Patients were stratified into 2 cohorts based on a contact or noncontact mechanism. Preoperative MRI scans were retrospectively reviewed by 2 musculoskeletal radiologists for bone bruises. The number and location of the bone bruises were recorded in the coronal and sagittal planes using fat-suppressed T2-weighted images and a standardized mapping technique. Lateral and medial meniscal tears were recorded from the operative notes, while medial collateral ligament (MCL) injuries were graded on MRI. RESULTS A total of 220 patients were included, with 142 (64.5%) noncontact injuries and 78 (35.5%) contact injuries. There was a significantly higher frequency of men in the contact cohort compared with the noncontact cohort (69.2% vs 54.2%, P = .030), while age and body mass index were comparable between the 2 cohorts. The bivariate analysis demonstrated a significantly higher rate of combined lateral tibiofemoral (lateral femoral condyle [LFC] + lateral tibial plateau [LTP]) bone bruises (82.1% vs 48.6%, P < .001) and a lower rate of combined medial tibiofemoral (medial femoral condyle [MFC] + medial tibial plateau [MTP]) bone bruises (39.7% vs 66.2%, P < .001) in knees with contact injuries. Similarly, noncontact injuries had a significantly higher rate of centrally located MFC bone bruises (80.3% vs 61.5%, P = .003) and posteriorly located MTP bruises (66.2% vs 52.6%, P = .047). When controlling for age and sex, the multivariate logistical regression model demonstrated that knees with contact injuries were more likely to have LTP bone bruises (OR, 4.721 [95% CI, 1.147-19.433], P = .032) and less likely to have combined medial tibiofemoral (MFC + MTP) bone bruises (OR, 0.331 [95% CI, 0.144-0.762], P = .009) compared with those with noncontact injuries. CONCLUSION Significantly different bone bruise patterns were observed on MRI based on ACL injury mechanism, with contact and noncontact injuries demonstrating characteristic findings in the lateral tibiofemoral and medial tibiofemoral compartments, respectively.
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Affiliation(s)
- Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael S Lee
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kyle N Kunze
- The Hospital for Special Surgery, New York, New York, USA
| | - Joshua S Green
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lee D Katz
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Musculoskeletal Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Annie Wang
- Department of Musculoskeletal Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - William M McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Timothy E Hewett
- Department of Orthopaedics, Marshall University School of Medicine, Huntington, West Virginia, USA
| | | | - Michael J Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
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Kim-Wang SY, Bradley PX, Cutcliffe HC, Collins AT, Crook BS, Paranjape CS, Spritzer CE, DeFrate LE. Auto-segmentation of the tibia and femur from knee MR images via deep learning and its application to cartilage strain and recovery. J Biomech 2023; 149:111473. [PMID: 36791514 PMCID: PMC10281551 DOI: 10.1016/j.jbiomech.2023.111473] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/21/2022] [Accepted: 01/24/2023] [Indexed: 01/27/2023]
Abstract
The ability to efficiently and reproducibly generate subject-specific 3D models of bone and soft tissue is important to many areas of musculoskeletal research. However, methodologies requiring such models have largely been limited by lengthy manual segmentation times. Recently, machine learning, and more specifically, convolutional neural networks, have shown potential to alleviate this bottleneck in research throughput. Thus, the purpose of this work was to develop a modified version of the convolutional neural network architecture U-Net to automate segmentation of the tibia and femur from double echo steady state knee magnetic resonance (MR) images. Our model was trained on a dataset of over 4,000 MR images from 34 subjects, segmented by three experienced researchers, and reviewed by a musculoskeletal radiologist. For our validation and testing sets, we achieved dice coefficients of 0.985 and 0.984, respectively. As further testing, we applied our trained model to a prior study of tibial cartilage strain and recovery. In this analysis, across all subjects, there were no statistically significant differences in cartilage strain between the machine learning and ground truth bone models, with a mean difference of 0.2 ± 0.7 % (mean ± 95 % confidence interval). This difference is within the measurement resolution of previous cartilage strain studies from our lab using manual segmentation. In summary, we successfully trained, validated, and tested a machine learning model capable of segmenting MR images of the knee, achieving results that are comparable to trained human segmenters.
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Affiliation(s)
- Sophia Y Kim-Wang
- Duke University School of Medicine, United States; Department of Biomedical Engineering, Duke University, United States
| | - Patrick X Bradley
- Department of Mechanical Engineering and Materials Science, Duke University, United States
| | | | - Amber T Collins
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
| | - Bryan S Crook
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
| | - Chinmay S Paranjape
- Department of Orthopaedic Surgery, Duke University School of Medicine, United States
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, United States
| | - Louis E DeFrate
- Department of Biomedical Engineering, Duke University, United States; Department of Mechanical Engineering and Materials Science, Duke University, United States; Department of Orthopaedic Surgery, Duke University School of Medicine, United States.
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10
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Wang HD, Zhang J, Li Y, Li Z, Yan W, Ao Y. Classification of Bone Bruises in Pediatric Patients With Anterior Cruciate Ligament Injuries. Orthop J Sports Med 2023; 11:23259671221144780. [PMID: 36814766 PMCID: PMC9940179 DOI: 10.1177/23259671221144780] [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] [Indexed: 02/24/2023] Open
Abstract
Background Bone bruises are frequently found on magnetic resonance imaging (MRI) after an anterior cruciate ligament (ACL) tear in pediatric patients. Purpose To establish a classification system for different bone bruise patterns to estimate the severity of a knee injury in pediatric patients with ACL tears. Study Design Cross-sectional study; Level of evidence, 3. Methods A medical database was retrospectively reviewed to identify all cases of primary ACL tears in patients who were aged ≤17 years at the time of the injury and underwent MRI at our institution within 4 weeks of the injury between January 2011 and December 2020. A total of 188 patients were identified (67 male, 121 female; mean age, 15.1 ± 1.4 years). Bone bruises were classified according to their depth and location on MRI in the sagittal and coronal planes. Results The new classification system identified 3 grades of depth: grade I, the bone bruise was located within the epiphysis but did not reach the epiphyseal plate (n = 54 [35.3%]); grade II, the bone bruise was within the epiphysis that reached the epiphyseal plate (n = 55 [35.9%]); and grade III, the bone bruise was in both the epiphysis and metaphysis (n = 44 [28.8%]). The bone bruise location was classified into 4 types: type a, the deepest bone bruise area was in the lateral tibial plateau (n = 66 [43.1%]); type b, the deepest bone bruise area was in the lateral femoral condyle, commonly occurring in the lateral one-third to two-thirds of the lateral femoral condyle (n = 22 [14.4%]); type c, the bone bruise area had a similar depth in both the lateral femoral condyle and lateral tibial plateau (n = 54 [35.3%]); and type d, the bone bruise area was in the lateral tibial plateau and lateral femoral condyle and extended to the fibular head (n = 11 [7.2%]). The prevalence of collateral ligament injuries increased from grade I to III. All patients with grade III type c bone bruises had meniscal lesions. Conclusion This new classification system provides a basis for estimating associated lesions of the knee before surgery.
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Affiliation(s)
- Hong-De Wang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China
| | - Jiahao Zhang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China
| | - Yuwan Li
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China
| | - Zong Li
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China
| | - Wenqiang Yan
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China
| | - Yingfang Ao
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China.,Yingfang Ao, MD, Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, China ()
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Foody JN, Bradley PX, Spritzer CE, Wittstein JR, DeFrate LE, Englander ZA. Elevated In Vivo ACL Strain Is Associated With a Straight Knee in Both the Sagittal and the Coronal Planes. Am J Sports Med 2023; 51:422-428. [PMID: 36625427 DOI: 10.1177/03635465221141876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Noncontact anterior cruciate ligament (ACL) injuries typically occur during deceleration movements such as landing or cutting. However, conflicting data have left the kinematic mechanisms leading to these injuries unclear. Quantifying the influence of sagittal and coronal plane knee kinematics on in vivo ACL strain may help to elucidate noncontact ACL injury mechanisms. PURPOSE/HYPOTHESIS The purpose of this study was to measure in vivo sagittal and coronal plane knee kinematics and ACL strain during a single-leg jump. We hypothesized that ACL strain would be modulated primarily by motion in the sagittal plane and that limited coronal plane motion would be measured during this activity. STUDY DESIGN Descriptive laboratory study. METHODS Seventeen healthy participants (8 male/9 female) underwent magnetic resonance imaging (MRI) followed by high-speed biplanar radiography, obtained as participants performed a single-leg jump. Three-dimensional models of the femur, tibia, and associated ACL attachment site footprints were created from the MRIs and registered to the radiographs to reproduce the position of the knee during the jump. ACL strain, knee flexion/extension angles, and varus/valgus angles were measured throughout the jump. Spearman rank correlations were used to assess relationships between mean ACL strain and kinematic variables. RESULTS Mean ACL strain increased with decreasing knee flexion angle (ρ = -0.3; P = .002), and local maxima in ACL strain occurred with the knee in a straight position in both the sagittal and the coronal planes. In addition, limited coronal plane motion (varus/valgus angle) was measured during this activity (mean ± SD, -0.5°± 0.3°). Furthermore, we did not detect a statistically significant relationship between ACL strain and varus/valgus angle (ρ = -0.01; P = .9). CONCLUSION ACL strain was maximized when the knee was in a straight position in both the sagittal and coronal planes. Participants remained in <1° of varus/valgus position on average throughout the jump. As a ligament under elevated strain is more vulnerable to injury, landing on a straight knee may be an important risk factor for ACL rupture. CLINICAL RELEVANCE These data may improve understanding of risk factors for noncontact ACL injury, which may be useful in designing ACL injury prevention programs.
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Affiliation(s)
- Jacqueline N Foody
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Patrick X Bradley
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | | | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Louis E DeFrate
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Zoë A Englander
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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12
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The injury mechanism correlation between MRI and video-analysis in professional football players with an acute ACL knee injury reveals consistent bone bruise patterns. Knee Surg Sports Traumatol Arthrosc 2023; 31:121-132. [PMID: 35691962 PMCID: PMC9859865 DOI: 10.1007/s00167-022-07002-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/04/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To analyze the MRI features, in particular bone bruises pattern, of Anterior Cruciate Ligament (ACL) injured footballers, and to correlate them with the characteristics of injury mechanism and situation obtained from direct video footage. METHODS Nineteen professional football (soccer) players that sustained ACL injury while playing during an official match of First League Championship were included in the study. The video of injury was obtained from the Television broadcast. Knee Magnetic Resonance (MRI) was obtained within 7 days from the injury. BB and meniscal lesions were analyzed on MRI, while a video-analysis of mechanisms of ACL injury and injury dynamic were assessed from the videos. RESULTS The most commonly involved Bone Bruise areas in the knee were the Posterior Lateral Tibial Plateau (LTp) in 16 cases (84%) and the Central Lateral Femoral Condyle (LFc) in 11 cases (58%). Three patients (16%) had bone bruise in the Posterior Medial Tibial Plateau (MTp) while none (0%) had bone bruise in the Medial Femoral Condyle. Based on the bone bruise pattern, 11 (58%) had simultaneous LFc and LTp and were defined "Typical" while 8 (42%) had other locations or no bone bruise and were defined "Atypical". 9 out of 11 injuries (82%) of athletes with "Typical" pattern occurred with a "Pivoting" action", in contrast to only 1 case (12%) in those with "Atypical" bone bruise pattern (p = 0.0055). The most common situational mechanism pattern on video analysis was "pressing" (n = 7) accounting for the 47% of the "indirect" ACL injuries. In terms of movement pattern, ten injuries (52%) occurred during a "Pivoting" movement (7 pressing, 1 dribbling, 1 tackled, 1 goalkeeping), whereas the remaining were classified as "Planting" in four cases, "Direct Blow" in four cases and "Landing". CONCLUSION A well-defined and consistent bone bruise pattern involving the posterior tibial plateau and central femoral condyle of lateral compartment is present in footballers that sustained non-contact and indirect ACL injuries during pivoting with sudden change of direction/deceleration, while heterogeneous patterns were present in those with direct contact or injury mechanisms involving high horizontal velocity. LEVEL OF EVIDENCE Level IV.
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13
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Kim-Wang SY, Spritzer CE, Owusu-Akyaw K, Coppock JA, Goode AP, Englander ZA, Wittstein JR, DeFrate LE. The Predicted Position of the Knee Near the Time of ACL Rupture Is Similar Between 2 Commonly Observed Patterns of Bone Bruising on MRI. Am J Sports Med 2023; 51:58-65. [PMID: 36440714 DOI: 10.1177/03635465221131551] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bone bruises observed on magnetic resonance imaging (MRI) can provide insight into the mechanisms of noncontact anterior cruciate ligament (ACL) injury. However, it remains unclear whether the position of the knee near the time of injury differs between patients evaluated with different patterns of bone bruising, particularly with regard to valgus angles. HYPOTHESIS The position of the knee near the time of injury is similar between patients evaluated with 2 commonly occurring patterns of bone bruising. STUDY DESIGN Descriptive laboratory study. METHODS Clinical T2- and T1-weighted MRI scans obtained within 6 weeks of noncontact ACL rupture were reviewed. Patients had either 3 (n = 20) or 4 (n = 30) bone bruises. Patients in the 4-bone bruise group had bruising of the medial and lateral compartments of the femur and tibia, whereas patients in the 3-bone bruise group did not have a bruise on the medial femoral condyle. The outer contours of the bones and associated bruises were segmented from the MRI scans and used to create 3-dimensional surface models. For each patient, the position of the knee near the time of injury was predicted by moving the tibial model relative to the femoral model to maximize the overlap of the tibiofemoral bone bruises. Logistic regressions (adjusted for sex, age, and presence of medial collateral ligament injury) were used to assess relationships between predicted injury position (quantified in terms of knee flexion angle, valgus angle, internal rotation angle, and anterior tibial translation) and bone bruise group. RESULTS The predicted injury position for patients in both groups involved a flexion angle <20°, anterior translation >20 mm, valgus angle <10°, and internal rotation angle <10°. The injury position for the 3-bone bruise group involved less flexion (odds ratio [OR], 0.914; 95% CI, 0.846-0.987; P = .02) and internal rotation (OR, 0.832; 95% CI, 0.739-0.937; P = .002) as compared with patients with 4 bone bruises. CONCLUSION The predicted position of injury for patients displaying both 3 and 4 bone bruises involved substantial anterior tibial translation (>20 mm), with the knee in a straight position in both the sagittal (<20°) and the coronal (<10°) planes. CLINICAL RELEVANCE Landing on a straight knee with subsequent anterior tibial translation is a potential mechanism of noncontact ACL injury.
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Affiliation(s)
- Sophia Y Kim-Wang
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kwadwo Owusu-Akyaw
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - James A Coppock
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Adam P Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zoë A Englander
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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14
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Korthaus A, Krause M, Pagenstert G, Warncke M, Brembach F, Frosch KH, Kolb JP. Tibial slope in the posterolateral quadrant with and without ACL injury. Arch Orthop Trauma Surg 2022; 142:3917-3925. [PMID: 34964068 PMCID: PMC9596559 DOI: 10.1007/s00402-021-04298-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/30/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION An increased tibial slope is a risk factor for rupture of the anterior cruciate ligament. In addition, a tibial bone bruise or posterior lateral impression associated with slope changes also poses chronic ligamentous instability of the knee joint associated with an anterior cruciate ligament (ACL) injury. In the majority of cases, the slope is measured in one plane X-ray in the lateral view. However, this does not sufficient represent the complex anatomy of the tibial plateau and especially for the posterolateral quadrant. Normal values from a "healthy" population are necessary to understand if stability of the knee joint is negatively affected by an increasing slope in the posterolateral area. Until now there are no data about the physiological slope in the posterolateral quadrant of the tibial plateau. MATERIALS AND METHODS In 116 MRI scans of patients without ligamentous lesions and 116 MRI scans with an ACL rupture, tibial slope was retrospectively determined using the method described by Hudek et al. Measurements were made in the postero-latero-lateral (PLL) and postero-latero-central (PLC) segments using the 10-segment classification. In both segments, the osseous as well as the cartilaginous slope was measured. Measurements were performed by two independent surgeons. RESULTS In the group without ligamentous injury the mean bony PLL slope was 5.8° ± 4.8° and the cartilaginous PLL slope was 6.7° ± 4.8°. In the PLC segment the mean bony slope was 6.6° ± 5.0° and the cartilaginous slope was 9.4° ± 5.7°. In the cohort with ACL rupture, the bony and cartilaginous slope in both PLL and PCL were significantly higher (P < 0.001) than in the group without ACL injury (bony PLL 9.8° ± 4.8°, cartilage PLL 10.4° ± 4.7°, bony PLC 10.3° ± 4.8°, cartilage PLL 12.8° ± 4.3°). Measurements were performed independently by two experienced surgeons. There were good inter- (CI 87-98.7%) and good intraobserver (CI 85.8-99.6%) reliability. CONCLUSION The bony and the cartilaginous slope in the posterolateral quadrant of the tibial plateau are different but not independent. Patients with an anterior cruciate ligament injury have a significantly steeper slope in the posterolateral quadrant compared to a healthy group. Our data indicate that this anatomic feature might be a risk factor for a primary ACL injury which has not been described yet. LEVEL OF EVIDENCE III.
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Affiliation(s)
- A Korthaus
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - M Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - G Pagenstert
- CLARAHOF Clinic of Orthopaedic Surgery, University of Basel, Basel, Switzerland
| | - M Warncke
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Brembach
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany.
| | - J P Kolb
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Design and validation of a semi-automatic bone segmentation algorithm from MRI to improve research efficiency. Sci Rep 2022; 12:7825. [PMID: 35551485 PMCID: PMC9098419 DOI: 10.1038/s41598-022-11785-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/22/2022] [Indexed: 11/24/2022] Open
Abstract
Segmentation of medical images into different tissue types is essential for many advancements in orthopaedic research; however, manual segmentation techniques can be time- and cost-prohibitive. The purpose of this work was to develop a semi-automatic segmentation algorithm that leverages gradients in spatial intensity to isolate the patella bone from magnetic resonance (MR) images of the knee that does not require a training set. The developed algorithm was validated in a sample of four human participants (in vivo) and three porcine stifle joints (ex vivo) using both magnetic resonance imaging (MRI) and computed tomography (CT). We assessed the repeatability (expressed as mean ± standard deviation) of the semi-automatic segmentation technique on: (1) the same MRI scan twice (Dice similarity coefficient = 0.988 ± 0.002; surface distance = − 0.01 ± 0.001 mm), (2) the scan/re-scan repeatability of the segmentation technique (surface distance = − 0.02 ± 0.03 mm), (3) how the semi-automatic segmentation technique compared to manual MRI segmentation (surface distance = − 0.02 ± 0.08 mm), and (4) how the semi-automatic segmentation technique compared when applied to both MRI and CT images of the same specimens (surface distance = − 0.02 ± 0.06 mm). Mean surface distances perpendicular to the cartilage surface were computed between pairs of patellar bone models. Critically, the semi-automatic segmentation algorithm developed in this work reduced segmentation time by approximately 75%. This method is promising for improving research throughput and potentially for use in generating training data for deep learning algorithms.
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Moran J, Katz LD, Schneble CA, Li DT, Kahan JB, Wang A, Porrino J, Fosam A, Cheng R, Jokl P, Hewett TE, Medvecky MJ. A Novel MRI Mapping Technique for Evaluating Bone Bruising Patterns Associated With Noncontact ACL Ruptures. Orthop J Sports Med 2022; 10:23259671221088936. [PMID: 35480066 PMCID: PMC9036340 DOI: 10.1177/23259671221088936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Bone bruise patterns in the knee can aid in understanding the mechanism of injury in anterior cruciate ligament (ACL) ruptures. There is no universally accepted magnetic resonance imaging (MRI) mapping technique to describe the specific locations of bone bruises. Hypothesis: The authors hypothesized that (1) our novel mapping technique would show high interrater and intrarater reliability for the location of bone bruises in noncontact ACL-injured knees and (2) the bone bruise patterns reported from this technique would support the most common mechanisms of noncontact ACL injury, including valgus stress, anterior tibial translation, and internal tibial rotation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 43 patients who underwent ACL reconstruction between 2018 and 2020, with MRI within 30 days of the injury on a 3.0-T scanner, documentation of a noncontact mechanism of injury, and no concomitant or previous knee injuries. Images were retrospectively reviewed by 2 radiologists blinded to all clinical data. The locations of bone bruises were mapped on fat-suppressed T2-weighted coronal and sagittal images using a novel technique that combined the International Cartilage Repair Society (ICRS) tibiofemoral articular cartilage surgical lesions diagram and the Whole-Organ Magnetic Resonance Imaging Scoring (WORMS) mapping system. Reliability between the reviewers was assessed using the intraclass correlation coefficient (ICC), where ICC >0.90 indicated excellent agreement. Results: The interrater and intrarater ICCs were 0.918 and 0.974, respectively, for femoral edema mapping and 0.979 and 0.978, respectively, for tibial edema mapping. Significantly more bone bruises were seen within the lateral femoral condyle compared with the medial femoral condyle (67% vs 33%; P < .0001), and more bruises were seen within the lateral tibial plateau compared with the medial tibial plateau (65% vs 35%; P < .0001). Femoral bruises were almost exclusively located in the anterior/central regions (98%) of the condyles as opposed to the posterior region (2%; P < .0001). Tibial bruises were localized to the posterior region (78%) of both plateaus as opposed to the anterior/central regions (22%; P < .0001). Conclusion: The combined mapping technique offered a standardized and reliable method for reporting bone bruises in noncontact ACL injuries. The contusion patterns identified using this technique were indicative of the most commonly reported mechanisms for noncontact ACL injuries.
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Affiliation(s)
- Jay Moran
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Lee D. Katz
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher A. Schneble
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Don T. Li
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Joseph B. Kahan
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Annie Wang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jack Porrino
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andin Fosam
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Ryan Cheng
- Yale University, New Haven, Connecticut, USA
| | - Peter Jokl
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Michael J. Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
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Boden BP, Sheehan FT. Mechanism of non-contact ACL injury: OREF Clinical Research Award 2021. J Orthop Res 2022; 40:531-540. [PMID: 34951064 PMCID: PMC8858885 DOI: 10.1002/jor.25257] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) ruptures significantly impact athletes in terms of return to play and loss of long-term quality of life. Before the onset of this study, understanding the mechanism of ACL injury was limited. Thus, the primary focus of this manuscript is to describe our multi-faceted approach to uncovering the mechanism of noncontact ACL injury (NC-ACLI) with the goal of developing preventive strategies. The initial qualitative analysis of ACL injury events revealed most (70%) injuries involve minimal to no contact and occurr during landing or deceleration maneuvers in team sports with a minor perturbation before the injury that may disrupt the neuromuscular system leading to poor body dynamics. A series of quantitative videotape studies demonstrated differences in leg and trunk positions at the time of NC-ACLI in comparison to control subjects. Analysis of the faulty dynamics provoking NC-ACLI, especially the flat-footed landing component, supports the theory that an axial compressive force is the critical factor responsible for NC-ACLI. Our magnetic resonance imaging study demonstrated the NC-ACLI position was associated with a higher tibial slope, and joint contact occurring on the flat, anterior portion of the lateral femoral condyle versus the round, posterior aspect. Both anatomic conditions favor sliding (pivot shift) over rolling in the presence of an axial compressive force. Subsequent cadaveric studies supported axial compressive forces as the primary component of NC-ACLI. Both a strong eccentric quadriceps contraction and knee abduction moments may increase the compressive force at the joint thereby lowering the axial threshold to injury. This manuscript summarizes the NC-ACLI mechanism portion of the 2021 OREF Clinical Research Award.
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Affiliation(s)
- Barry P. Boden
- The Orthopaedic Center, a Division of Centers for Advanced Orthopaedics, 14995 Shady Grove Road, Suite 350, Rockville, MD 20815
| | - Frances T. Sheehan
- National Institutes of Health, Department of Rehabilitation Medicine, 6707 Democracy Blvd., Suite 856, Bethesda, Maryland 20817
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Binversie EE, Walczak BE, Cone SG, Baker LA, Scerpella TA, Muir P. Canine ACL rupture: a spontaneous large animal model of human ACL rupture. BMC Musculoskelet Disord 2022; 23:116. [PMID: 35123473 PMCID: PMC8818196 DOI: 10.1186/s12891-021-04986-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) rupture in humans is a common condition associated with knee pain, joint instability, and secondary osteoarthritis (OA). Surgical treatment with an intraarticular graft provides reasonable outcomes at mid and long-term follow-up. Non-modifiable and modifiable factors influence risk of ACL rupture. The etiology, mechanobiology, causal biomechanics, and causal molecular pathways are not fully understood. The dog model has shared features of ACL rupture that make it a valuable spontaneous preclinical animal model. In this article, we review shared and contrasting features of ACL rupture in the two species and present information supporting spontaneous canine ACL rupture as a potentially useful preclinical model of human ACL rupture with a very large subject population. Results ACL rupture is more common in dogs than in humans and is diagnosed and treated using similar approaches to that of human patients. Development of OA occurs in both species, but progression is more rapid in the dog, and is often present at diagnosis. Use of client-owned dogs for ACL research could reveal impactful molecular pathways, underlying causal genetic variants, biomechanical effects of specific treatments, and opportunities to discover new treatment and prevention targets. Knowledge of the genetic contribution to ACL rupture is more advanced in dogs than in humans. In dogs, ACL rupture has a polygenetic architecture with moderate heritability. Heritability of human ACL rupture has not been estimated. Conclusion This article highlights areas of One Health research that are particularly relevant to future studies using the spontaneous canine ACL rupture model that could fill gaps in current knowledge.
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Agostinone P, Di Paolo S, Lucidi GA, Dal Fabbro G, Grassi A, Zaffagnini S. Severe bicompartmental bone bruise is associated with rotatory instability in anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2022; 30:1725-1732. [PMID: 34491380 PMCID: PMC9033705 DOI: 10.1007/s00167-021-06735-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/30/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The presence and severity of bone bruise is more and more investigated in the non-contact anterior cruciate ligament (ACL) injury context. Recent studies have advocated a correlation between bone bruise and preoperative knee laxity. The aim of the present study was to investigate the correlation between bone bruise and preoperative rotatory knee laxity. METHODS Twenty-nine patients (29.1 ± 9.8 years) with MRI images at a maximum of 3 months after ACL injury (1.6 ± 0.8 months) were included. The bone bruise severity was evaluated according to the International Cartilage Repair Society (ICRS) scale for lateral femoral condyle, lateral tibial plateau, medial femoral condyle, and medial tibial plateau. The intraoperative rotational knee laxity was evaluated through a surgical navigation system in terms of internal-external rotation at 30° and 90° of knee flexion (IE30, IE90) and internal-external rotation and acceleration during pivot-shift test (PS IE, PS ACC). The KOOS score was also collected. The association between ICRS grade of bone bruise and rotational laxity or KOOS was investigated. RESULTS Significant correlation (p < 0.05) was found between the bone bruise severity on the medial tibial plateau and rotational laxity (IE90, PS IE, and PS ACC) and between the severity of bone bruise on femoral lateral condyle and KOOS-Symptoms sub-score. The presence of bone bruise on the medial tibial plateau was significantly associated with a lateral femoral notch sign > 2 mm (very strong odds ratio). No kinematical differences were found between none-to-deep and extensive-generalized lateral bone bruise, while higher IE30 and IE90 were found in extensive-generalized bicompartmental bone bruise than isolated extensive-generalized lateral bone bruise. CONCLUSION A severe bicompartmental bone bruise was related to higher rotatory instability in the intraoperative evaluation of ACL deficient knees. The severity of edema on the medial tibial plateau was directly correlated with higher intraoperative pivot shift, and the size of edema on the lateral femoral condyle was associated with lower preoperative clinical scores. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Piero Agostinone
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, BO Italy
| | - Stefano Di Paolo
- Dipartimento di Scienze per la Qualità della Vita QUVI, Università Di Bologna, Corso D'Augusto 237, 47921, Rimini, RN, Italy.
| | - Gian Andrea Lucidi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, BO Italy
| | - Giacomo Dal Fabbro
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, BO Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, BO Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, BO Italy
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20
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Beel W, Mouton C, Tradati D, Nührenbörger C, Seil R. Ramp lesions are six times more likely to be observed in the presence of a posterior medial tibial bone bruise in ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:184-191. [PMID: 33661324 DOI: 10.1007/s00167-021-06520-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to determine whether posterior tibial slope (PTS), meniscal slope (MS), and bone bruise pattern (BBP), as observed on magnetic resonance imaging (MRI), differed between patients with or without medial meniscus ramp lesions at the time of anterior cruciate ligament reconstruction (ACLR). The hypothesis was that patients with a ramp lesion had a higher PTS and MS, with a different BBP than patients without a ramp lesion. METHODS Fifty-six patients undergoing ACLR were selected from an in-house registry and separated into 2 groups: (1) the RAMP group included patients with a primary ACLR and a medial meniscus ramp lesion diagnosed intraoperatively; (2) the CONTROL group included patients with a primary ACLR without ramp lesion after arthroscopic exploration of the posteromedial knee area. The two groups were matched for age, sex and type of concomitant meniscal lesions. The medial/lateral-PTS/MS and BBP were subjected to blinded evaluation on the preoperative MRI of the reconstructed knee. RESULTS Twenty eight patients (21 males; 7 females) were included in each group. No significant difference could be observed between groups in terms of demographical characteristics, PTS, and MS. A posteromedial tibial plateau (PMTP) bone bruise was more often observed in the RAMP group (n = 23/28) compared to the CONTROL group (n = 12/28) (p < 0.01). The RAMP group was 6.1 (95%CI [1.8; 20.8]) times more likely to present a PMTP bone bruise. The likelihood of having a bone bruise in both the medial and lateral compartments was 4.5 (95%CI [1.2; 16.5]) times higher in the RAMP group. However, a BBP only involving the lateral tibiofemoral compartment was more likely to be observed in the CONTROL group (n = 10/28) compared to the RAMP group (n = 3/28, p < 0.05 - odds ratio 4.6 (95%CI [1.1; 19.2]). CONCLUSION Ramp lesions were 6.1 and 4.5 times more likely to be observed in the presence of a posteromedial tibia plateau bone bruise or a combined bone bruise respectively in both the medial and lateral tibiofemoral compartment in patients undergoing ACLR. The tibial and meniscal slopes did not differ between patients with or without ramp lesions undergoing ACLR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Wouter Beel
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg City, Luxembourg
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg City, Luxembourg.,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg City, Luxembourg
| | - Daniele Tradati
- Department of Orthopaedic Surgery, Hospital San Raffaele, Milan, Italy
| | - Christian Nührenbörger
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg City, Luxembourg.,Department of Sports Medicine, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg City, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg City, Luxembourg. .,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg City, Luxembourg. .,Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg City, Luxembourg.
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21
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Adouni M, Faisal TR, Dhaher YY. Sensitivity analysis of the knee ligament forces to the surgical design variation during anterior cruciate ligament reconstruction: a finite element analysis. Comput Methods Biomech Biomed Engin 2021; 25:1063-1071. [PMID: 34821520 DOI: 10.1080/10255842.2021.2006647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to understand the effect of essential surgical design parameters on collateral and cruciate ligaments behavior for a Bone-Patellar-Tendon-Bone (BPTB) anterior cruciate ligament reconstruction (ACL-R) surgery. A parametric finite element model of biomechanical experiments depicting the ACL-R surgery associated with a global sensitivity analysis was adopted in this work. The model parameters were six intraoperative variables, two-quadrant coordinates of femoral tunnel placement, femoral tunnel sagittal and coronal angles, graft pretension, and the joint angle at which the BPTB graft is tensioned (fixation angle). Our results indicated that cruciate ligaments (posterior cruciate ligament (PCL) and graft) were mainly sensitive to graft pretension (23%), femoral tunnel sites (56%), and the angle at which the surgeon decided to fix the graft (14%). The collateral ligaments (medial and lateral) were also affected by the same set of surgical parameters as the cruciate ligaments except for graft pretension. The output data of this study may help to identify a better role for the ACL-R intraoperative variables in optimizing the knee joint ligaments' postsurgical functionality.
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Affiliation(s)
- Malek Adouni
- Physical Medicine and Rehabilitation Department, Northwestern University, Chicago, IL, USA.,Mechanical Engineering department, Australian College of Kuwait, Kuwait City, Kuwait
| | - Tanvir R Faisal
- Department of Mechanical Engineering, University of Louisiana at Lafayette, Lafayette, LA, USA
| | - Yasin Y Dhaher
- Physical Medicine and Rehabilitation Department, Northwestern University, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, University of Texas Southwest, Dallas, TX, USA.,Department of Orthopedic Surgery, University of Texas Southwest, Dallas, TX, USA.,Bioengineering, University of Texas Southwest, Dallas, TX, USA
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22
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Li K, Zheng X, Li J, Seeley RA, Marot V, Murgier J, Liang X, Huang W, Cavaignac E. Increased lateral femoral condyle ratio is associated with greater risk of ALC injury in non-contact anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2021; 29:3077-3084. [PMID: 33170316 DOI: 10.1007/s00167-020-06347-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine whether increased lateral femoral condyle ratio (LFCR) correlates with increased risk of Anterior cruciate ligament (ACL) injury (1) and to evaluate the relationship between the LFCR and anterolateral complex (ALC) injury in non-contact ACL torn knees (2). METHODS Six hundred and seventy-two patients who underwent ACL reconstruction surgery between 2013 and 2019 were retrospectively reviewed, and 120 patients were finally included in the study. Forty patients (ACL + ALC injury) were included in the study group, while forty patients with isolated ACL injury (isolated ACL injury group) and 40 patients who suffered from meniscal tear without ACL or ALC injury were matched in a 1:1 fashion by age, sex, and BMI to the study group (ACL + ALC injury). The LFCR was measured on standard lateral radiographs in a blinded fashion. The differences between the three groups were analyzed by ANOVA. A ROC (Receiver Operating Characteristic) curve was produced to determine risk of ACL injury and risk of concomitant ALC injury in non-contact ACL injury. RESULTS The mean LFCR was 71.9% ± 3.1% in the ACL + ALC injury group, 68.4% ± 3.2% in the isolated ACL injury group, and 66.8% ± 2.6% in the control group (patients who suffered from meniscal tear without ACL or ALC injury). Significantly greater LFCR was found in the ACL + ALC injury group than that in the isolated ACL injury group (p < 0.017). Greater LFCR was additionally confirmed in the ACL injury group as compared to the control group (p < 0.05). ROC curve analysis demonstrated that LFCR > 68.3% was predictive for an increased risk of ACL injury in the entire cohort. LFCR > 69.4% was predictive for an increased risk of ALC injury in non-contact ACL ruptured patients. CONCLUSION Increased LFCR was found to be associated with greater risk of ALC injury in non-contact ACL ruptured patients. Additionally, increased LFCR was further confirmed to be correlated with increased risk of ACL injury in an Asian population. The data from this study may help recognize patients undergoing ACL reconstruction that could benefit from additional extra-articular tenodesis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ke Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Xiaoqing Zheng
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rebecca A Seeley
- Department of Orthopaedic Surgery, Translational Research Program in Pediatric Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Vincent Marot
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Jérôme Murgier
- Aguilera Private Clinic, Ramsey Santé, 64200, Biarritz, France
| | - Xi Liang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Toulouse, France
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23
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Younger age increases the risk of sustaining multiple concomitant injuries with an ACL rupture. Knee Surg Sports Traumatol Arthrosc 2021; 29:2701-2708. [PMID: 33772603 DOI: 10.1007/s00167-021-06538-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/16/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) tears have a major impact on the individual and society. Long term effects may be mediated by injuries that occur concurrently to the ACL tear. The purpose of this study was to describe in a nationwide cohort the traumatic meniscal injuries and bone marrow lesions concomitant to ACL tears, their age and sex distribution and the rate any association with ACL reconstruction. METHODS All ACL tears in Iceland from 2006 to 2011 and their concomitant bone marrow lesions and meniscal injuries were identified from MRI reports. These injuries were further classified by location, sex and age. The cohort was divided into under 17, 17-29, 30-49 and above 50 to reflect likely differences in the mechanisms of injury and risk factors that may vary with age. Data from the Icelandic Social Insurance Administration were used identify all those who were operated. Descriptive analysis was performed to show the proportion of ACL injured knees sustaining concomitant injuries and how these injuries varied with age, sex, and subsequent treatment RESULTS: 1365 knees with ACL ruptures were included. Only 13% of knees had no concomitant injury identified. Overall, 57% of knees had a bone marrow lesion in at least one location and 70% of knees had at least one traumatic meniscal injury. A greater number of combined lateral tibial and femoral bone marrow lesion was seen in younger age groups (χ2 (3) = 113.32, p < 0.0001). Bruises in the medial compartment were the least common concomitant injuries. More injuries were related to higher chances of ACL reconstruction (OR 1.6, 95% CI 1.4-1.7). Age was associated with risk of all injury types and locations with older age generally being associated with fewer injuries. CONCLUSION In an ACL ruptured cohort, the overall incidence of BMLs may be lower and meniscus injuries higher than previously reported. However, these injuries are more prevalent in the younger cohort potentially resulting in a poorer long-term prognosis. Knowledge of the association between age and concomitant injuries will help guide rehabilitation. LEVEL OF EVIDENCE II.
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24
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Willinger L, Athwal KK, Williams A, Amis AA. An Anterior Cruciate Ligament In Vitro Rupture Model Based on Clinical Imaging. Am J Sports Med 2021; 49:2387-2395. [PMID: 34115540 PMCID: PMC8283191 DOI: 10.1177/03635465211017145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biomechanical studies on anterior cruciate ligament (ACL) injuries and reconstructions are based on ACL transection instead of realistic injury trauma. PURPOSE To replicate an ACL injury in vitro and compare the laxity that occurs with that after an isolated ACL transection injury before and after ACL reconstruction. STUDY DESIGN Controlled laboratory study. METHODS Nine paired knees were ACL injured or ACL transected. For ACL injury, knees were mounted in a rig that imposed tibial anterior translation at 1000 mm/min to rupture the ACL at 22.5° of flexion, 5° of internal rotation, and 710 N of joint compressive force, replicating data published on clinical bone bruise locations. In contralateral knees, the ACL was transected arthroscopically at midsubstance. Both groups had ACL reconstruction with bone-patellar tendon-bone graft. Native, ACL-deficient, and reconstructed knee laxities were measured in a kinematics rig from 0° to 100° of flexion with optical tracking: anterior tibial translation (ATT), internal rotation (IR), anterolateral (ATT + IR), and pivot shift (IR + valgus). RESULTS The ACL ruptured at 26 ± 5 mm of ATT and 1550 ± 620 N of force (mean ± SD) with an audible spring-back tibiofemoral impact with 5o of valgus. ACL injury and transection increased ATT (P < .001). ACL injury caused greater ATT than ACL transection by 1.4 mm (range, 0.4-2.2 mm; P = .033). IR increased significantly in ACL-injured knees between 0° and 30° of flexion and in ACL transection knees from 0° to 20° of flexion. ATT during the ATT + IR maneuver was increased by ACL injury between 0° and 80° and after ACL transection between 0° and 60°. Residual laxity persisted after ACL reconstruction from 0° to 40° after ACL injury and from 0° to 20° in the ACL transection knees. ACL deficiency increased ATT and IR in the pivot-shift test (P < .001). The ATT in the pivot-shift increased significantly at 0° to 20° after ACL transection and 0° to 50° after ACL injury, and this persisted across 0° to 20° and 0° to 40° after ACL reconstruction. CONCLUSION This study developed an ACL injury model in vitro that replicated clinical ACL injury as evidenced by bone bruise patterns. ACL injury caused larger increases of laxity than ACL transection, likely because of damage to adjacent tissues; these differences often persisted after ACL reconstruction. CLINICAL RELEVANCE This in vitro model created more realistic ACL injuries than surgical transection, facilitating future evaluation of ACL reconstruction techniques.
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Affiliation(s)
- Lukas Willinger
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK,Orthopaedic Surgery Department, Technical University of Munich, Munich, Germany
| | - Kiron K. Athwal
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK
| | - Andy Williams
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK,Fortius Clinic, London, UK
| | - Andrew A. Amis
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK,Andrew A. Amis, FREng, DSc(Eng), Mechanical Engineering Department, Imperial College London, London, SW7 2AZ, UK ()
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25
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Otsuki R, Benoit D, Hirose N, Fukubayashi T. Effects of an Injury Prevention Program on Anterior Cruciate Ligament Injury Risk Factors in Adolescent Females at Different Stages of Maturation. JOURNAL OF SPORTS SCIENCE AND MEDICINE 2021; 20:365-372. [PMID: 34211330 DOI: 10.52082/jssm.2021.365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 03/29/2021] [Indexed: 12/23/2022]
Abstract
The ideal timing to implement anterior cruciate ligament injury prevention programs with respect to maturation is unclear. The purpose of this study was to investigate the effects of an injury prevention program on knee mechanics in early-, late-, and post-pubertal females. In the study, 178 adolescent female basketball players were assigned to six groups: early-pubertal training, early-pubertal control, late-pubertal training, and late-pubertal control, post-pubertal training, and post-pubertal control. The training groups performed an injury prevention program for six months. Medial knee displacement, knee flexion range of motion, and the probability of high knee abduction moment were assessed before and after the training period. After the six-month training period, medial knee displacement was significantly increased in the early-pubertal control group whereas it was unchanged in the early-pubertal training group. Knee flexion range of motion was significantly decreased in the early-pubertal control group whereas it did not change in the early-pubertal training group. The probability of high knee abduction moment was increased in the early-pubertal control group whereas it was unchanged in the earl-pubertal training group. The probability of high knee abduction moment was also decreased in the post-pubertal training group whereas it did not change in the post-pubertal control group. The program limited the development of high-risk movement patterns associated with maturation in early puberty while improving the knee mechanics in post-pubertal adolescents. Therefore, an injury prevention program should be initiated in early puberty and continue through the post-puberty years.
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Affiliation(s)
- Reiko Otsuki
- Faculty of Sport Sciences, Waseda University, Saitama, Japan.,Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Benoit
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Englander ZA, Lau BC, Wittstein JR, Goode AP, DeFrate LE. Patellar Tendon Orientation and Strain Are Predictors of ACL Strain In Vivo During a Single-Leg Jump. Orthop J Sports Med 2021; 9:2325967121991054. [PMID: 33796591 PMCID: PMC7983247 DOI: 10.1177/2325967121991054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background: There is little in vivo data that describe the relationships between patellar
tendon orientation, patellar tendon strain, and anterior cruciate ligament
(ACL) strain during dynamic activities. Quantifying how the quadriceps load
the ACL via the patellar tendon is important for understanding ACL injury
mechanisms. Hypothesis: We hypothesized that flexion angle, patellar tendon orientation, and patellar
tendon strain influence ACL strain during a single-leg jump. Specifically,
we hypothesized that patellar tendon and ACL strains would increase
concurrently when the knee is positioned near extension during the jump. Study Design: Descriptive laboratory study. Methods: Models of the femur, tibia, ACL, patellar tendon, and quadriceps tendon
attachment sites of 8 male participants were generated from magnetic
resonance imaging (MRI). High-speed biplanar radiographs during a single-leg
jump were obtained. The bone models were registered to the radiographs,
thereby reproducing the in vivo positions of the bones, ligament, and tendon
attachment sites. Flexion angle, patellar tendon orientation, patellar
tendon strain, and ACL strain were measured from the registered models. ACL
and patellar tendon strains were approximated by normalizing their length at
each knee position to their length at the time of MRI. Two separate
bivariate linear regression models were used to assess relationships between
flexion angle and patellar tendon orientation and between ACL strain and
patellar tendon strain. A multivariate linear regression model was used to
assess whether flexion angle and patellar tendon strain were significant
predictors of ACL strain during the inflight and landing portions of the
jump. Results: Both flexion angle and patellar tendon strain were significant predictors
(P < .05) of ACL strain. These results indicate that
elevated ACL and patellar tendon strains were observed concurrently when the
knee was positioned near extension. Conclusion: Concurrent increases in patellar tendon and ACL strains indicate that the
quadriceps load the ACL via the patellar tendon when the knee is positioned
near extension. Clinical Relevance: Increased ACL strain when the knee is positioned near extension before
landing may be due to quadriceps contraction. Thus, landing with
unanticipated timing on an extended knee may increase vulnerability to ACL
injury as a taut ligament is more likely to fail.
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Affiliation(s)
- Zoë A Englander
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Duke Sport Science Institute, Department of Orthopaedics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Duke Sport Science Institute, Department of Orthopaedics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Duke Sport Science Institute, Department of Orthopaedics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Adam P Goode
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Duke Sport Science Institute, Department of Orthopaedics, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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27
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Kolb JP, Frosch KH. Bedeutung der posterolateralen Impressionsfraktur bei Versorgung der vorderen Kreuzbandruptur. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-020-00403-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Kim-Wang SY, Scribani MB, Whiteside MB, DeFrate LE, Lassiter TE, Wittstein JR. Distribution of Bone Contusion Patterns in Acute Noncontact Anterior Cruciate Ligament-Torn Knees. Am J Sports Med 2021; 49:404-409. [PMID: 33411563 PMCID: PMC8214466 DOI: 10.1177/0363546520981569] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone contusions are commonly observed on magnetic resonance imaging (MRI) in individuals who have sustained a noncontact anterior cruciate ligament (ACL) injury. Time from injury to image acquisition affects the ability to visualize these bone contusions, as contusions resolve with time. PURPOSE To quantify the number of bone contusions and their locations (lateral tibial plateau [LTP], lateral femoral condyle [LFC], medial tibial plateau [MTP], and medial femoral condyle [MFC]) observed on MRI scans of noncontact ACL-injured knees acquired within 6 weeks of injury. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS We retrospectively reviewed clinic notes, operative notes, and imaging of 136 patients undergoing ACL reconstruction. The following exclusion criteria were applied: MRI scans acquired beyond 6 weeks after injury, contact ACL injury, and previous knee trauma. Fat-suppressed fast spin-echo T2-weighted MRI scans were reviewed by a blinded musculoskeletal radiologist. The number of contusions and their locations (LTP, LFC, MTP, and MFC) were recorded. RESULTS Contusions were observed in 135 of 136 patients. Eight patients (6%) had 1 contusion, 39 (29%) had 2, 41 (30%) had 3, and 47 (35%) had 4. The most common contusion patterns within each of these groups were 6 (75%) with LTP for 1 contusion, 29 (74%) with LTP/LFC for 2 contusions, 33 (80%) with LTP/LFC/MTP for 3 contusions, and 47 (100%) with LTP/LFC/MTP/MFC for 4 contusions. No sex differences were detected in contusion frequency in the 4 locations (P > .05). Among the participants, 50 (37%) had medial meniscal tears and 52 (38%) had lateral meniscal tears. CONCLUSION The most common contusion patterns observed were 4 locations (LTP/LFC/MTP/MFC) and 3 locations (LTP/LFC/MTP).
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Affiliation(s)
- Sophia Y Kim-Wang
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | | | | | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Tally E Lassiter
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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Grassi A, Agostinone P, Di Paolo S, Lucidi GA, Macchiarola L, Bontempi M, Marchiori G, Bragonzoni L, Zaffagnini S. Knee position at the moment of bone bruise could reflect the late phase of non-contact anterior cruciate ligament injury rather than the mechanisms leading to ligament failure. Knee Surg Sports Traumatol Arthrosc 2021; 29:4138-4145. [PMID: 33656566 PMCID: PMC8595158 DOI: 10.1007/s00167-021-06470-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/20/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of the present study was to trace knee position at the time of bone bruise (BB) and investigate how much this position departed from the knee biomechanics of an in vivo flexion-extension. METHODS From an original cohort of 62 patients, seven (11%) presented bicompartmental edemas and were included in the study. 3D models of bones and BB were obtained from MRI. Matching bone edemas, a reconstruction of the knee at the moment of BB was obtained. For the same patients, knee kinematics of a squat was calculated using dynamic Roentgen sterephotogrammetric analysis (RSA). Data describing knee position at the moment of BB were compared to kinematics of the same knee extrapolated from RSA system. RESULTS Knee positions at the moment of BB was significantly different from the kinematics of the squat. In particular, all the patients' positions were out of squat range for both anterior and proximal tibial translation, varus-valgus rotation (five in valgus and two in varus), tibial internal-external rotation (all but one, five externally and one internally). A direct comparison at same flexion angle between knee at the moment of BB (average 46.1° ± 3.8°) and knee during squat confirmed that tibia in the former was significantly more anterior (p < 0.0001), more externally rotated (6.1 ± 3.7°, p = 0.04), and valgus (4.1 ± 2.4°, p = 0.03). CONCLUSION Knee position at the moment of Bone bruise position was out of physiological in-vivo knee range of motion and could reflect a locked anterior subluxation occurring in the late phase of ACL injury rather than the mechanism leading to ligament failure. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Alberto Grassi
- grid.419038.70000 0001 2154 6641Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Agostinone
- grid.419038.70000 0001 2154 6641Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- Dipartimento di Scienze per la Qualità Della Vita QUVI, Università di Bologna, Bologna, Italy.
| | - Gian Andrea Lucidi
- grid.419038.70000 0001 2154 6641Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Macchiarola
- grid.419038.70000 0001 2154 6641Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Bontempi
- grid.419038.70000 0001 2154 6641Laboratorio di Scienze e Tecniche Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gregorio Marchiori
- grid.419038.70000 0001 2154 6641Laboratorio di Scienze e Tecniche Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Laura Bragonzoni
- grid.6292.f0000 0004 1757 1758Dipartimento di Scienze per la Qualità Della Vita QUVI, Università di Bologna, Bologna, Italy
| | - Stefano Zaffagnini
- grid.419038.70000 0001 2154 6641Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy ,grid.6292.f0000 0004 1757 1758Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
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30
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Menzdorf L, Drenck T, Akoto R, Hartel M, Krause M, Guttowski D, Barg A, Frosch KH, Kolb JP. Clinical results after surgical treatment of posterolateral tibial plateau fractures ("apple bite fracture") in combination with ACL injuries. Eur J Trauma Emerg Surg 2020; 46:1239-1248. [PMID: 32980883 DOI: 10.1007/s00068-020-01509-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/19/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The anterior cruciate ligament (ACL)-tear is a common injury in orthopaedic trauma. Depending on the energy of impact fractures of the posterolateral tibial plateau are often associated. Different morphologic variants of posterolateral tibial plateau impaction fractures have been described in the setting of an ACL-tear. Up to now an algorithm of treatment for a combined injury of a posterolateral tibial head fracture and an injury to the anterior cruciate ligament is missing. METHODS We present a retrospective study with clinical and radiological analysis of posterolateral fractures in combination with ACL-tear. Impressions with a depth of more than 2 mm and/or a width that outreaches more than half of the posterior horn of the lateral meniscus with additional 3. degree positive pivot-shift-test indicated surgical treatment of the fracture with additional ACL repair or reconstruction. Clinical evaluation included follow-up examination, Visual Analog Scale (VAS), International Knee Documentation Committee Score (IKDC), functional and radiological Rasmussen score. RESULTS 20 patients were included with a mean age of 43.6 ± 12.4 years. Mean follow-up was 18,2 ± 13,5 months. The fracture was arthroscopically reduced and percutaneously fixed with a screw osteosynthesis (Group 1), reduced via a dorsal approach without (Group 2) or with an autologous bone graft (Group 3). Subjective IKDC score was 79,15 ± 6,07. Functional Rasmussen scores ranged from 27 to 30 (mean 28 ± 2.71). Radiological Rasmussen scores ranged from 16 to 18 points (mean 16.75 ± 1.33). According to IKDC score (p = 0.60), functional Rasmussen score (p = 0.829) and radiological Rasmussen score (p = 0.679) no significant discrepancy between the groups were seen. There was no failure of the ACL graft recorded. CONCLUSIONS Posterolateral tibial plateau fractures in combination with an ACL-tear, can cause persistent instability and increase rotational instability. Indication for treatment of these fractures is still under debate. From the biomechanical aspect the lack of more than 50% of the posterior horn of the lateral meniscus and dislocation/depression of more than 2 mm results in an increased rotational instability of the ACL deficient knee. Combined surgical treatment with ACL repair or reconstruction is a safe procedure that results in good, short-term clinical outcome, if our algorithm is followed. In addition this study shows, that majority of posterolateral tibial plateau fractures can be treated arthroscopically.
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Affiliation(s)
- Leif Menzdorf
- Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Tobias Drenck
- Department of Trauma and Orthopaedic Surgery Sportstraumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany
| | - Ralf Akoto
- Department of Trauma and Orthopaedic Surgery Sportstraumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany
| | - Maximilian Hartel
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Department of Trauma and Orthopaedic Surgery Sportstraumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dario Guttowski
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Alexej Barg
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Department of Trauma and Orthopaedic Surgery Sportstraumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany
| | - Jan Philipp Kolb
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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31
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Schilaty ND, Bates NA, Kruisselbrink S, Krych AJ, Hewett TE. Linear Discriminant Analysis Successfully Predicts Knee Injury Outcome From Biomechanical Variables. Am J Sports Med 2020; 48:2447-2455. [PMID: 32693617 PMCID: PMC7566284 DOI: 10.1177/0363546520939946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The most commonly damaged structures of the knee are the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and menisci. Given that these injuries present as either isolated or concomitant, it follows that these events are driven by specific mechanics versus coincidence. This study was designed to investigate the multiplanar mechanisms and determine the important biomechanical and demographic factors that contribute to classification of the injury outcome. HYPOTHESIS Linear discriminant analysis (LDA) would accurately classify each injury type generated by the mechanical impact simulator based on biomechanical input variables (ie, ligament strain and knee kinetics). STUDY DESIGN Controlled laboratory study. METHODS In vivo kinetics and kinematics of 42 healthy, athletic participants were measured to determine stratification of injury risk (ie, low, medium, and high) in 3 degrees of knee forces/moments (knee abduction moment, anterior tibial shear, and internal tibial rotation). These stratified kinetic values were input into a cadaveric impact simulator to assess ligamentous strain and knee kinetics during a simulated landing task. Uniaxial and multiaxial load cells and implanted strain sensors were used to collect mechanical data for analysis. LDA was used to determine the ability to classify injury outcome by demographic and biomechanical input variables. RESULTS From LDA, a 5-factor model (Entropy R2 = 0.26) demonstrated an area under the receiver operating characteristic curve (AUC) for all 5 injury outcomes (ACL, MCL, ACL+MCL, ACL+MCL+meniscus, ACL+meniscus) of 0.74 or higher, with "good" prediction for 4 of 5 injury classifications. A 10-factor model (Entropy R2 = 0.66) improved the AUC to 0.86 or higher, with "excellent" prediction for 5 injury classifications. The 15-factor model (Entropy R2 = 0.85), produced 94.1% accuracy with the AUC 0.98 or higher for all 5 injury classifications. CONCLUSION Use of LDA accurately predicted the outcome of knee injury from kinetic data from cadaveric simulations with the use of a mechanical impact simulator at 25° of knee flexion. Thus, with clinically relevant kinetics, it is possible to determine clinical risk of injury and also the likely presentation of singular or concomitant knee injury. CLINICAL RELEVANCE LDA demonstrates that injury outcomes are largely characterized by specific mechanics that can distinguish ACL, MCL, and medial meniscal injury. Furthermore, as the mechanics of injury are better understood, improved interventional prehabilitation can be designed to reduce these injuries.
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Affiliation(s)
- Nathan D. Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Nathaniel A. Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | | | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
| | - Timothy E. Hewett
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
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32
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Response to the Letter to the Editor on "Prediction of Knee Kinematics at Time of Noncontact Anterior Cruciate Ligament Injuries Based on Bone Bruises". Ann Biomed Eng 2020; 49:4-6. [PMID: 32705426 DOI: 10.1007/s10439-020-02576-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
The present Letter responded to the Letter to the Editor on "Prediction of Knee Kinematics at Time of Noncontact Anterior Cruciate Ligament Injuries Based on Bone Bruises" from Grassi et al.
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33
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Grassi A, Agostinone P, Di Paolo S, Zaffagnini S. Letter to the Editor on "Prediction of Knee Kinematics at Time of Noncontact Anterior Cruciate Ligament Injuries Based on Bone Bruises". Ann Biomed Eng 2020; 49:1-3. [PMID: 32691263 PMCID: PMC7370628 DOI: 10.1007/s10439-020-02574-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/15/2020] [Indexed: 01/13/2023]
Abstract
The aim of the present Letter was to comment on the paper “Prediction of Knee Kinematics at Time of Noncontact Anterior Cruciate Ligament Injuries Based on Bone Bruises” from Shi et al. (Ann Biomed Eng, 2020, 10.1007/s10439-020-02523-y). Though the authors provided an extremely interesting paper on a debated topic in Sport Medicine, with a strong methodology and consistent results, caution should be used when drawing conclusions on Anterior Cruciate Ligament injury mechanism through the interpretation of such data.
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Affiliation(s)
- Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Agostinone
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Via Giulio Cesare Pupilli, 1, 40136, Bologna, BO, Italy.
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Via Giulio Cesare Pupilli, 1, 40136, Bologna, BO, Italy
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34
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Henderson ZJ, Sanzo P, Zerpa C, Kivi D. Ankle bracing's effects during a modified agility task: analysis of sEMG, impulse, and time to complete using a crossover, repeated measures design. Sports Biomech 2020:1-15. [PMID: 32643530 DOI: 10.1080/14763141.2020.1778777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study explored the effects of no braces, softshell (AE), and semi-rigid (T1) ankle braces on time to complete a modified agility task, as well as lower extremity muscle activity and impulse during the change of direction component of the task. Thirty-nine healthy, active individuals completed a modified agility task under the three brace conditions. Time to complete the modified agility task, along with mean surface electromyographic activity (sEMG) and impulse during the deceleration and propulsive phases of the task were measured. There were no significant differences across conditions with respect to sEMG or impulse measures during the deceleration or propulsive phases. There was a significant change in time to complete the modified agility task, F(2,76) = 17.242, p< 0.001, ηp2 = 0.312. Post-hoc analysis revealed a significant increase in time to complete the modified agility task when wearing the AE (0.16 (95% CI, 0.062 to 0.265) seconds, p< 0.001) and T1 (0.20 (95% CI, 0.113 to 0.286) seconds, p< 0.001) ankle braces compared to no braces. It appears that performance on a modified agility task may be diminished when wearing ankle braces, although sEMG activity and impulse are unaffected.
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Affiliation(s)
- Zachariah J Henderson
- School of Kinesiology, Lakehead University, Thunder Bay, Canada.,Applied Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Paolo Sanzo
- School of Kinesiology, Lakehead University, Thunder Bay, Canada.,Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Carlos Zerpa
- School of Kinesiology, Lakehead University, Thunder Bay, Canada
| | - Derek Kivi
- School of Kinesiology, Lakehead University, Thunder Bay, Canada
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35
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Englander ZA, Spritzer CE, DeFrate LE. In vivo attachment site to attachment site length and strain of the ACL and its bundles during the full gait cycle measured by MRI and high-speed biplanar radiography: Response. J Biomech 2020; 109:109918. [PMID: 32660758 DOI: 10.1016/j.jbiomech.2020.109918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Zoë A Englander
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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36
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Li K, Li J, Zheng X, Marot V, Murgier J, Cavaignac E, Huang W. Increased lateral meniscal slope is associated with greater incidence of lateral bone contusions in noncontact ACL injury. Knee Surg Sports Traumatol Arthrosc 2020; 28:2000-2008. [PMID: 31595339 DOI: 10.1007/s00167-019-05724-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 09/16/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE (1) To investigate whether an increased lateral meniscal slope measured on magnetic resonance image (MRI) would be associated with greater risk of bone contusions in noncontact anterior cruciate ligament injury, and (2) to measure the relationship between the occurrence of bone contusions and associated findings observed in ACL deficient knees such as cartilage damage, anterolateral complex injury and concomitant meniscal tears. METHOD Patients who underwent ACL reconstruction surgery between 2013 and 2018 were retrospectively reviewed. Sixty-three patients were included in the study group (ACL + bone contusions group), 56 participants were in the control group (isolated ACL group). The presence and severity of bone contusions were determined from preoperative MRIs. The lateral meniscal slope and lateral posterior tibial slope were measured on the MRIs in a blinded fashion. The predictors of lateral bone contusions including age, sex, body mass index, lateral meniscal slope and lateral posterior tibial slope were examined by multivariable logistic regression. Associated findings including concomitant meniscal lesions, intra-articular cartilage damage and anterolateral complex injury, which were also calculated by multivariable logistic regression. RESULTS The mean lateral meniscal slope in the study group was 6.5° ± 3.5°, which was significantly larger than that in the control group (3.8° ± 2.7°; P < 0.01). In addition, increased lateral meniscal slope was significantly associated with lateral bone contusions in noncontact ACL injury (Lateral femoral condyle (LFC): AOR 16.5; 95% CI 5.40-50.20; P < 0.01; Lateral tibial plateau (LTP): AOR 31.8; 95% CI 8.68-116.7; P < 0.01). However, lateral posterior tibial slope was not significantly associated with bone contusions. Moreover, the presence of lateral bone contusions was associated with concomitant lateral meniscal tears (OR 12.4; 95% CI 3.30-46.30) and cartilage damage (OR 2.9; 95% CI 1.04-8.18). CONCLUSION An increased lateral meniscal slope was associated with increased risk of lateral bone contusions in noncontact ACL injury. In addition, the presence of lateral bone contusions was associated with intra-articular cartilage damage, anterolateral complex injury and concomitant meniscal tears. Hence, additional information was provided for counseling patients who have increased LMS on the greater risk of knee rotational instability and identify patients undergoing ACL reconstruction who may benefit from extra-articular tenodesis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ke Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoqing Zheng
- Department of Pathology, University of Michigan, 1150 West Medical Center Dr MSRB I, Ann Arbor, MI, 48108, USA
| | - Vincent Marot
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Jérôme Murgier
- OrthoSport Victoria Research Unit, Epworth Healthcare, Melbourne, Australia
| | - Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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37
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Keizer MNJ, Hijmans JM, Gokeler A, Benjaminse A, Otten E. Healthy subjects with lax knees use less knee flexion rather than muscle control to limit anterior tibia translation during landing. J Exp Orthop 2020; 7:32. [PMID: 32415565 PMCID: PMC7229106 DOI: 10.1186/s40634-020-00246-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/28/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose It has been reported that there is no correlation between anterior tibia translation (ATT) in passive and dynamic situations. Passive ATT (ATTp) may be different to dynamic ATT (ATTd) due to muscle activation patterns. This study aimed to investigate whether muscle activation during jumping can control ATT in healthy participants. Methods ATTp of twenty-one healthy participants was measured using a KT-1000 arthrometer. All participants performed single leg hops for distance during which ATTd, knee flexion angles and knee flexion moments were measured using a 3D motion capture system. During both tests, sEMG signals were recorded. Results A negative correlation was found between ATTp and the maximal ATTd (r = − 0.47, p = 0.028). An N-Way ANOVA showed that larger semitendinosus activity was seen when ATTd was larger, while less biceps femoris activity and rectus femoris activity were seen. Moreover, larger knee extension moment, knee flexion angle and ground reaction force in the anterior-posterior direction were seen when ATTd was larger. Conclusion Participants with more ATTp showed smaller ATTd during jump landing. Muscle activation did not contribute to reduce ATTd during impact of a jump-landing at the observed knee angles. However, subjects with large ATTp landed with less knee flexion and consequently showed less ATTd. The results of this study give information on how healthy people control knee laxity during jump-landing. Level of evidence III
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Affiliation(s)
- Michèle N J Keizer
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 219, Groningen, 9713AV, The Netherlands.
| | - Juha M Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alli Gokeler
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 219, Groningen, 9713AV, The Netherlands.,Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg.,Department Exercise & Health, Exercise Science and Neuroscience, University of Paderborn, Paderborn, Germany
| | - Anne Benjaminse
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 219, Groningen, 9713AV, The Netherlands.,School of Sport Studies, Hanze University Groningen, Groningen, The Netherlands
| | - Egbert Otten
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 219, Groningen, 9713AV, The Netherlands
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38
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Shi H, Ding L, Ren S, Jiang Y, Zhang H, Hu X, Huang H, Ao Y. Prediction of Knee Kinematics at the Time of Noncontact Anterior Cruciate Ligament Injuries Based on the Bone Bruises. Ann Biomed Eng 2020; 49:162-170. [PMID: 32383042 DOI: 10.1007/s10439-020-02523-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/25/2020] [Indexed: 01/13/2023]
Abstract
Biomechanical risk factors associated with the alignment and position of the knee for anterior cruciate ligament (ACL) injury are still not conclusive. As bone bruises identified on magnetic resonance imaging (MRI) following acute ACL injury could represent the impact footprint at the time of injury. To improve understanding of the ACL injury mechanism, we aimed to determine the knee kinematics during ACL injury based on the bone bruises. Knee MRI scans of patients who underwent acute noncontact ACL injuries were acquired. Numerical optimization was used to match the bone bruises of the femur and tibia and predict the knee positions during injury. Knee angles were compared between MRI measured position and predicted position. The knee flexion, abduction, and external tibial rotation angles were significantly greater in the predicted position than that in MRI measured position. Relative to MRI measured position, patients had a mean of 34.3 mm of anterior tibial translation, 4.0 mm of lateral tibial translation, and 16.0 mm superior tibial translation in the predicted position. The results suggest that knee valgus and external tibial rotation accompanied by knee flexion are high-risk movement pattern for ACL injury in patients with lateral compartment bone bruising in conjunction with ACL injury.
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Affiliation(s)
- Huijuan Shi
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China.,Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Li Ding
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Shuang Ren
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Yanfang Jiang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Haocheng Zhang
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Hongshi Huang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China.
| | - Yingfang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China.
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Shi H, Ding L, Jiang Y, Zhang H, Ren S, Hu X, Liu Z, Huang H, Ao Y. Bone Bruise Distribution Patterns After Acute Anterior Cruciate Ligament Ruptures: Implications for the Injury Mechanism. Orthop J Sports Med 2020; 8:2325967120911162. [PMID: 32313810 PMCID: PMC7160777 DOI: 10.1177/2325967120911162] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Bone bruises observed on magnetic resonance imaging (MRI) after an anterior cruciate ligament (ACL) injury could provide significant information about ACL injury mechanisms. Purpose/Hypothesis The purpose of this study was to investigate common bone bruise patterns after an ACL injury. It was hypothesized that the most common bone bruise distribution pattern would be only the lateral side of both the femur and tibia. Study Design Cross-sectional study; Level of evidence, 3. Methods Knee MRI scans of patients who underwent acute ACL reconstruction from August 2016 to August 2018 at our institution were selected. Imaging sequences in the sagittal and coronal planes were used for determining the bone bruise location in the lateral-medial and anterior-posterior directions, respectively. The presence, location, and intensity of bone bruises within specific compartments of the tibia and femur were documented. The relative bone bruise patterns of the tibia and femur were classified and analyzed. Results A total of 207 patients (165 men, 42 women) met the inclusion criteria from a total of 4209 ACL reconstruction cases. The most common relative bone bruise pattern was located on only the lateral side of both the femur and the tibia (44.4%), followed by the lateral and medial sides of both the femur and tibia (29.0%). For the pattern found on the lateral and medial sides of both the femur and tibia, the bone bruises on only the lateral side of both the tibia and femur were more severe (P < .001 and P < .001, respectively) and more anterior (P < .001 and P < .001, respectively) than those on only the medial side. Conclusion The most common relative bone bruise pattern observed was on only the lateral side of both the tibia and femur. Bone bruises on the lateral side were more severe than those on the medial side in patients with bone bruises on the lateral and medial sides of both the femur and tibia. Anterior translation of the tibia relative to the femur occurred during an ACL injury based on the location of bone bruises in the anterior-posterior direction.
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Affiliation(s)
- Huijuan Shi
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Li Ding
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yanfang Jiang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Haocheng Zhang
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Shuang Ren
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Xiaoqing Hu
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Zhenlong Liu
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Hongshi Huang
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yingfang Ao
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
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Ahn J, Choi B, Lee YS, Lee KW, Lee JW, Lee BK. The mechanism and cause of anterior cruciate ligament tear in the Korean military environment. Knee Surg Relat Res 2019; 31:13. [PMID: 32660592 PMCID: PMC7219609 DOI: 10.1186/s43019-019-0015-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 11/04/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose Anterior cruciate ligament (ACL) injury is very common but few studies have analyzed the injury mechanism and cause of ACL tear in a specific environment such as a military institution. The purpose of this study was to analyze the injury mechanism and cause of ACL injury in the military environment. Additionally, this study could provide outcomes that may aid future studies on prevention of ACL injury in military personnel. Materials and methods This study retrospectively analyzed 168 patients who sustained ACL tear while in military service and underwent ACL reconstruction surgery in a military hospital. Analysis of the injury mechanism and the cause was evaluated by analyzing the medical records. Knee magnetic resonance imaging analysis was also conducted for further evaluation of associated injury. Results The majority of ACL injuries in the military environment occurred through non-contact injury. Changing direction (46.4%) was the most common lower-leg position, followed by landing with the knee in a valgus position (26.8%). The activity undertaken at the time of injury was exercise in 76.2% of cases and military training/daily activities in 23.8% of cases. The incidence of ACL injury was higher in the soldier compared to the officer group during exercise (P = 0.017). Soccer was the most common activity at the time of injury (54.1%), followed by military training/daily activities, futsal, and basketball. The most common injury time was between 30 and 60 min after the start of exercise. Commonly associated injury sites were the medial meniscus and the medial collateral ligament. Conclusions The main mechanism of ACL injury occurring in the military environment was non-contact injury, especially on changing the direction of the lower leg. Soccer was the most frequent activity at the time of the injury. These findings suggested that preventive strategies against ACL injury in the military environment could effectively reduce the incidence of ACL injury.
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Affiliation(s)
- Joosuk Ahn
- Department of Orthopaedic surgery, Armed Forces Capital Hospital, 81, Saemaeul-ro 177beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Byungseop Choi
- Department of Orthopaedic surgery, Armed Forces Capital Hospital, 81, Saemaeul-ro 177beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Ki Woung Lee
- Department of Orthopaedic surgery, Armed Forces Capital Hospital, 81, Saemaeul-ro 177beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jung Woo Lee
- Department of Orthopaedic Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Beom Koo Lee
- Department of Orthopaedic Surgery, Gil Hospital, Gachon University of Medicine and Science, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea.
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Englander ZA, Baldwin EL, Smith WA, Garrett WE, Spritzer CE, DeFrate LE. In Vivo Anterior Cruciate Ligament Deformation During a Single-Legged Jump Measured by Magnetic Resonance Imaging and High-Speed Biplanar Radiography. Am J Sports Med 2019; 47:3166-3172. [PMID: 31593498 PMCID: PMC7042957 DOI: 10.1177/0363546519876074] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The in vivo mechanics of the anterior cruciate ligament (ACL) and its bundles during dynamic activities are not completely understood. An improved understanding of how the ACL stabilizes the knee is likely to aid in the identification and prevention of injurious maneuvers. PURPOSE/HYPOTHESIS The purpose was to measure in vivo ACL strain during a single-legged jump through use of magnetic resonance imaging (MRI) and high-speed biplanar radiography. We hypothesized that ACL strain would increase with the knee near extension, and a peak in ACL strain would occur just before landing from the jump, potentially due to quadriceps contraction in anticipation of landing. STUDY DESIGN Descriptive laboratory study. METHODS Models of the femur, tibia, and ACL attachment sites of 8 male participants were generated from MRI scans through use of solid modeling. High-speed biplanar radiographs were obtained from these participants as they performed a single-legged jump. The bone models were registered to the biplanar radiographs, thereby reproducing the in vivo positions of the joint throughout the jump. ACL and bundle elongations were defined as the centroid to centroid distances between attachment sites for each knee position. ACL strain was defined as ACL length normalized to its length measured in the position of the knee at the time of MRI. RESULTS Peaks in ACL strain were observed before toe-off and 55 ± 35 milliseconds before initial ground contact. These peaks were associated with the knee positioned at low flexion angles. Mean ACL strain was inversely related to mean flexion angle (rho = -0.73, P < .001), such that ACL strain generally increased with knee extension throughout the jumping motion. ACL bundle lengths were significantly (rho > 0.85, P < .001) correlated with overall ACL length. CONCLUSION These findings provide insight into how landing in extension can increase the risk of ACL injury. Specifically, this study shows that peak ACL strain can occur just before landing from a single-legged jump. Thus, when an individual lands on an extended knee, the ACL is relatively taut, which may make it particularly vulnerable to injury, especially in the presence of a movement perturbation or unanticipated change in landing strategy. CLINICAL RELEVANCE This study provides a novel measurement of dynamic ACL strain during an athletic maneuver and lends insight into how landing in extension can increase the likelihood of ACL failure.
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Affiliation(s)
- Zoë A. Englander
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Edward L. Baldwin
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Wyatt A.R. Smith
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - William E. Garrett
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | | | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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Englander ZA, Garrett WE, Spritzer CE, DeFrate LE. In vivo attachment site to attachment site length and strain of the ACL and its bundles during the full gait cycle measured by MRI and high-speed biplanar radiography. J Biomech 2019; 98:109443. [PMID: 31679755 DOI: 10.1016/j.jbiomech.2019.109443] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to measure in vivo attachment site to attachment site lengths and strains of the anterior cruciate ligament (ACL) and its bundles throughout a full cycle of treadmill gait. To obtain these measurements, models of the femur, tibia, and associated ACL attachment sites were created from magnetic resonance (MR) images in 10 healthy subjects. ACL attachment sites were subdivided into anteromedial (AM) and posterolateral (PL) bundles. High-speed biplanar radiographs were obtained as subjects ambulated at 1 m/s. The bone models were registered to the radiographs, thereby reproducing the in vivo positions of the bones and ACL attachment sites throughout gait. The lengths of the ACL and both bundles were estimated as straight line distances between attachment sites for each knee position. Increased attachment to attachment ACL length and strain were observed during midstance (length = 28.5 ± 2.6 mm, strain = 5 ± 4%, mean ± standard deviation), and heel strike (length = 30.5 ± 3.0 mm, strain = 12 ± 5%) when the knee was positioned at low flexion angles. Significant inverse correlations were observed between mean attachment to attachment ACL lengths and flexion (rho = -0.87, p < 0.001), as well as both bundle lengths and flexion (rho = -0.86, p < 0.001 and rho = -0.82, p < 0.001, respectively). AM and PL bundle attachment to attachment lengths were highly correlated throughout treadmill gait (rho = 0.90, p < 0.001). These data can provide valuable information to inform design criteria for ACL grafts used in reconstructive surgery, and may be useful in the design of rehabilitation and injury prevention protocols.
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Affiliation(s)
- Zoë A Englander
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | | | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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Shultz SJ, Schmitz RJ, Cameron KL, Ford KR, Grooms DR, Lepley LK, Myer GD, Pietrosimone B. Anterior Cruciate Ligament Research Retreat VIII Summary Statement: An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14-16, 2019, Greensboro, NC. J Athl Train 2019; 54:970-984. [PMID: 31461312 PMCID: PMC6795093 DOI: 10.4085/1062-6050-54.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sandra J. Shultz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Randy J. Schmitz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Kenneth L. Cameron
- John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY
| | - Kevin R. Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute and Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens
| | | | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, and Departments of Pediatrics and Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, OH
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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Choi WR, Yang JH, Jeong SY, Lee JK. MRI comparison of injury mechanism and anatomical factors between sexes in non-contact anterior cruciate ligament injuries. PLoS One 2019; 14:e0219586. [PMID: 31369583 PMCID: PMC6675514 DOI: 10.1371/journal.pone.0219586] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/27/2019] [Indexed: 01/13/2023] Open
Abstract
Non-contact anterior cruciate ligament (ACL) rupture is mostly caused by a pivot shift mechanism including valgus collapse and internal tibial rotation. In female athletes, the incidence of ACL rupture has been reported to be significantly higher than in their male counterparts. However, to date, there have been limited reports and controversy regarding sex differences underlying injury mechanisms of ACL and severity of injury. In this study, we hypothesized that 1) in patients with non-contact ACL rupture, the incidence and severity of pivot shift injury, which are determined by injury pattern on MRI, would be significantly higher in females, and 2) anatomical factors associated with pivot shift injury would be significantly associated with female sex. A total of 148 primary ACL ruptures (145 patients) caused by non-contact injury mechanisms were included in this study. Among them, 41 knees (41 patients) were female and 107 knees (104 patients) were male. The status of the osseous lesions, lateral and medial tibial slope, depth of the medial tibial plateau, collateral ligaments, and menisci were assessed by MRI and compared between sexes. The severity of osseous lesions at the lateral tibial plateau, lateral femoral condyle, medial tibial plateau, and medial femoral condyle were comparable between sexes. There were no significant differences between sexes in the location of tibial contusions (p = 0.21), femoral contusions (p = 0.23), or meniscus tears (p = 0.189). Lateral tibial slope was found to be significantly larger in females (8.95° vs. 6.82°; p<0.0001; odds ratio = 1.464), and medial tibial depth was significantly shallower in females (1.80mm vs. 2.41mm; p<0.0001; odds ratio = 0.145). In conclusion, females showed greater lateral tibial slope and shallower medial tibial depth compared to males, however it did not affect the sex differences in injury pattern.
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Affiliation(s)
- Won Rak Choi
- Department of Orthopaedic Surgery, Hanyang University Seoul Hospital, Seongdong-gu, Seoul, Korea
| | - Jae-Hyuk Yang
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Gyeonggi-do, Korea
| | - Soo-Young Jeong
- Department of Orthopaedic Surgery, Hanyang University Seoul Hospital, Seongdong-gu, Seoul, Korea
| | - Jin Kyu Lee
- Department of Orthopaedic Surgery, Hanyang University Seoul Hospital, Seongdong-gu, Seoul, Korea
- * E-mail:
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Schilaty ND, Bates NA, Krych AJ, Hewett TE. Frontal Plane Loading Characteristics of Medial Collateral Ligament Strain Concurrent With Anterior Cruciate Ligament Failure. Am J Sports Med 2019; 47:2143-2150. [PMID: 31219708 PMCID: PMC7304256 DOI: 10.1177/0363546519854286] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Both the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) bear load during athletic tasks of landing, cutting, pivoting, and twisting. As dynamic knee valgus is a purported mechanism for ACL injury, the MCL should bear significant strain load with valgus force. HYPOTHESIS The intact MCL will demonstrate a significant increase in strain upon failure of the ACL at 25° of knee flexion. STUDY DESIGN Controlled laboratory study. METHODS In vivo kinetics/kinematics of 44 healthy athletic participants were measured to determine stratification of injury risk (ie, low, medium, and high) in 3 degrees of knee forces/moments (knee abduction moment, anterior tibial shear, and internal tibial rotation). These stratified kinetic values were input into a cadaveric impact simulator to assess ligamentous strain during a simulated landing task. Uniaxial and multiaxial load cells and differential variable reluctance transducer strain sensors were utilized to collect mechanical data for analysis. Conditions of external loads applied to the cadaveric limbs were varied and randomized. RESULTS ACL strain increased with increased dynamic knee abduction moment (χ2[5] = 14.123, P = .0148). The most extreme dynamic knee abduction moment condition demonstrated significantly higher ACL strain compared with lower loaded trials (P≤ .0203). Similarly, MCL strain increased with dynamic knee abduction moment (χ2[5] = 36.578, P < .0001). Matched-pairs analysis compared ACL strain with MCL strain (maximum ACL strain - maximum MCL strain) and demonstrated high strain for the ACL versus the MCL (S177 = 6223.5, P < .0001). CONCLUSION Although significant, MCL strain had minimal increase with increased dynamic knee abduction moment, and the event of ACL failure did not significantly increase MCL strain when compared with high dynamic knee abduction moment conditions in the cadaveric model. The ACL bears more strain than the MCL at increasing amounts of dynamic knee abduction moment at 25° of knee flexion, which may explain the limited concomitant MCL injury rate that can occur during a dynamic valgus collapse of the knee. CLINICAL RELEVANCE These characteristics of ACL and MCL strain are important to understand the mechanisms that drive these injuries at the knee and will improve rehabilitation and injury prevention techniques.
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Affiliation(s)
- Nathan D. Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota,Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota,CORRESPONDING AUTHOR: Name: Nathan Schilaty, DC, PhD, Address: Biomechanics Laboratories – 200 First Street SW, Rochester, MN 55905, Telephone: 507-538-7047, Fax: 507-284-5392,
| | - Nathaniel A. Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota,Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
| | - Timothy E. Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota,Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota,Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
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Dai B, Garrett WE, Gross MT, Padua DA, Queen RM, Yu B. The effect of performance demands on lower extremity biomechanics during landing and cutting tasks. JOURNAL OF SPORT AND HEALTH SCIENCE 2019; 8:228-234. [PMID: 31193278 PMCID: PMC6523039 DOI: 10.1016/j.jshs.2016.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/29/2016] [Accepted: 08/01/2016] [Indexed: 06/09/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries commonly occur during the early phase of landing and cutting tasks that involve sudden decelerations. The purpose of this study was to investigate the effects of jump height and jump speed on lower extremity biomechanics during a stop-jump task and the effect of cutting speed on lower extremity biomechanics during a side-cutting task. METHODS Thirty-six recreational athletes performed a stop-jump task under 3 conditions: jumping fast, jumping for maximum height, and jumping for 60% of maximum height. Participants also performed a side-cutting task under 2 conditions: cutting at maximum speed and cutting at 60% of maximum speed. Three-dimensional kinematic and kinetic data were collected. RESULTS The jumping fast condition resulted in increased peak posterior ground reaction force (PPGRF), knee extension moment at PPGRF, and knee joint stiffness and decreased knee flexion angle compared with the jumping for maximum height condition. The jumping for 60% of maximum height condition resulted in decreased knee flexion angle compared with the jumping for maximum height condition. Participants demonstrated greater PPGRF, knee extension moment at PPGRF, knee valgus angle and varus moment at PPGRF, knee joint stiffness, and knee flexion angle during the cutting at maximum speed condition compared with the cutting at 60% maximum speed condition. CONCLUSION Performing jump landing at an increased jump speed resulted in lower extremity movement patterns that have been previously associated with an increase in ACL loading. Cutting speed also affected lower extremity biomechanics. Jump speed and cutting speed need to be considered when designing ACL injury risk screening and injury prevention programs.
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Affiliation(s)
- Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82070, USA
| | - William E. Garrett
- Department of Orthopaedic Surgery, Duke University, Durham, NC 27710, USA
| | - Michael T. Gross
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Robin M. Queen
- Kevin Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA
| | - Bing Yu
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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In vivo assessment of the interaction of patellar tendon tibial shaft angle and anterior cruciate ligament elongation during flexion. J Biomech 2019; 90:123-127. [PMID: 31072596 DOI: 10.1016/j.jbiomech.2019.04.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/05/2019] [Accepted: 04/21/2019] [Indexed: 12/19/2022]
Abstract
A potential cause of non-contact anterior cruciate ligament (ACL) injury is landing on an extended knee. In line with this hypothesis, studies have shown that the ACL is elongated with decreasing knee flexion angle. Furthermore, at low flexion angles the patellar tendon is oriented to increase the anterior shear component of force acting on the tibia. This indicates that knee extension represents a position in which the ACL is taut, and thus may have an increased propensity for injury, particularly in the presence of excessive force acting via the patellar tendon. However, there is very little in vivo data to describe how patellar tendon orientation and ACL elongation interact during flexion. Therefore, this study measured the patellar tendon tibial shaft angle (indicative of the relative magnitude of the shear component of force acting via the patellar tendon) and ACL length in vivo as subjects performed a quasi-static lunge at varying knee flexion angles. Spearman rho rank correlations within each individual revealed that flexion angles were inversely correlated to both ACL length (rho = -0.94 ± 0.07, mean ± standard deviation, p < 0.05) and patellar tendon tibial shaft angle (rho = -0.99 ± 0.01, p < 0.05). These findings indicate that when the knee is extended, the ACL is both elongated and the patellar tendon tibial shaft angle is increased, resulting in a relative increase in anterior shear force on the tibia acting via the patellar tendon. Therefore, these data support the hypothesis that landing with the knee in extension is a high risk scenario for ACL injury.
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Critchley ML, Davis DJ, Keener MM, Layer JS, Wilson MA, Zhu Q, Dai B. The effects of mid-flight whole-body and trunk rotation on landing mechanics: implications for anterior cruciate ligament injuries. Sports Biomech 2019; 19:421-437. [PMID: 30945626 DOI: 10.1080/14763141.2019.1595704] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The purpose was to quantify the effects of mid-flight whole-body and trunk rotation on knee mechanics in a double-leg landing. Eighteen male and 20 female participants completed a jump-landing-jump task in five conditions: no rotation, testing leg ipsilateral or contralateral (WBRC) to the whole-body rotation direction, and testing leg ipsilateral (TRI) or contralateral to the trunk rotation direction. The WBRC and TRI conditions demonstrated decreased knee flexion and increased knee abduction angles at initial contact (2.6 > Cohen's dz > 0.3) and increased peak vertical ground reaction forces and knee adduction moments during the 100 ms after landing (1.7 > Cohen's dz > 0.3). The TRI condition also showed the greatest knee internal rotation angles at initial contact and peak knee abduction and internal rotation angles and peak knee extension moments during the 100 ms after landing (2.0 > Cohen's dz > 0.5). Whole-body rotation increased contralateral knee loading because of its primary role in decelerating medial-lateral velocities. Trunk rotation resulted in the greatest knee loading for the ipsilateral knee due to weight shifting and mechanical coupling between the trunk and lower extremities. These findings may help understand altered trunk motion in anterior cruciate ligament injuries.
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Affiliation(s)
- Meghan L Critchley
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Daniel J Davis
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Michaela M Keener
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Jacob S Layer
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Margaret A Wilson
- Department of Theatre and Dance, University of Wyoming , Laramie, WY, USA
| | - Qin Zhu
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming , Laramie, WY, USA
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49
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Bone Bruises Associated with Anterior Cruciate Ligament Injury as Indicators of Injury Mechanism: A Systematic Review. Sports Med 2019; 49:453-462. [DOI: 10.1007/s40279-019-01060-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Englander ZA, Cutcliffe HC, Utturkar GM, Garrett WE, Spritzer CE, DeFrate LE. A Comparison of Knee Abduction Angles Measured by a 3D Anatomic Coordinate System Versus Videographic Analysis: Implications for Anterior Cruciate Ligament Injury. Orthop J Sports Med 2019; 7:2325967118819831. [PMID: 30729143 PMCID: PMC6350144 DOI: 10.1177/2325967118819831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Knee positions involved in noncontact anterior cruciate ligament (ACL) injury have been studied via analysis of injury videos. Positions of high ACL strain have been identified in vivo. These methods have supported different hypotheses regarding the role of knee abduction in ACL injury. Purpose/Hypothesis The purpose of this study was to compare knee abduction angles measured by 2 methods: using a 3-dimensional (3D) coordinate system based on anatomic features of the bones versus simulated 2-dimensional (2D) videographic analysis. We hypothesized that knee abduction angles measured in a 2D videographic analysis would differ from those measured from 3D bone anatomic features and that videographic knee abduction angles would depend on flexion angle and on the position of the camera relative to the patient. Study Design Descriptive laboratory study. Methods Models of the femur and tibia were created from magnetic resonance images of 8 healthy male participants. The models were positioned to match biplanar fluoroscopic images obtained as participants posed in lunges of varying flexion angles (FLAs). Knee abduction angle was calculated from the positioned models in 2 ways: (1) varus-valgus angle (VVA), defined as the angle between the long axis of the tibia and the femoral transepicondylar axis by use of a 3D anatomic coordinate system; and (2) coronal plane angle (CPA), defined as the angle between the long axis of the tibia and the long axis of the femur projected onto the tibial coronal plane to simulate a 2D videographic analysis. We then simulated how changing the position of the camera relative to the participant would affect knee abduction angles. Results During flexion, when CPA was calculated from a purely anterior or posterior view of the joint-an ideal scenario for measuring knee abduction from 2D videographic analysis-CPA was significantly different from VVA (P < .0001). CPA also varied substantially with the position of the camera relative to the participant. Conclusion How closely CPA (derived from 2D videographic analysis) relates to VVA (derived from a 3D anatomic coordinate system) depends on FLA and camera orientation. Clinical Relevance This study provides a novel comparison of knee abduction angles measured from 2D videographic analysis and those measured within a 3D anatomic coordinate system. Consideration of these findings is important when interpreting 2D videographic data regarding knee abduction angle in ACL injury.
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Affiliation(s)
- Zoë A Englander
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Hattie C Cutcliffe
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | | | - William E Garrett
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA
| | | | - Louis E DeFrate
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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