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Napolitano J, Duerson D, MacDonald J. Anterior Cruciate Ligament Injuries in Female Athletes. JAMA 2024:2821550. [PMID: 39052277 DOI: 10.1001/jama.2024.13405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
This JAMA Insights discusses anterior cruciate ligament (ACL) injuries in female athletes, including modifiable and nonmodifiable sex-based risk factors and the implementation of ACL injury prevention programs.
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Affiliation(s)
- Jonathan Napolitano
- Department of Pediatrics, Division of Sports Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Physical Medicine and Rehabilitation, Ohio State University College of Medicine, Columbus
| | - Drew Duerson
- Department of Pediatrics, Division of Sports Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, Ohio State University College of Medicine, Columbus
| | - James MacDonald
- Department of Pediatrics, Division of Sports Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, Ohio State University College of Medicine, Columbus
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Nedder VJ, Raju AG, Moyal AJ, Calcei JG, Voos JE. Impact of Psychological Factors on Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health 2024:19417381241256930. [PMID: 39041333 DOI: 10.1177/19417381241256930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
CONTEXT Anterior cruciate ligament (ACL) tears are a common orthopaedic injury, and the incidence of ACL reconstruction (ACLR) continues to increase. Current clinical practice guidelines (CPGs) recognize the role of psychological factors in rehabilitation, but patient-reported outcome measures (PROs) and psychological readiness are rarely incorporated into rehabilitation. OBJECTIVE The purpose of this review was to highlight the importance of psychological health after ACL injury, understand the current metrics used to monitor psychological recovery, and outline how psychological recovery can be better incorporated in current CPGs. DATA SOURCES A systematic review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA); 63 studies were identified with a PubMed search using the term "ACL Injuries/psychology". STUDY SELECTION Exclusion criteria included lack of consideration of psychological effects or studies validating PROs after ACLR. Studies were reviewed by multiple reviewers, and a total of 38 studies were included after applying exclusion criteria. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3b. DATA EXTRACTION Two independent reviewers analyzed the included articles to extract sample size, psychological readiness scale or other measures used, and key results. RESULTS Psychological outcomes, especially kinesiophobia and fear of reinjury, are seen commonly after ACLR. Psychological factors were shown to impede return to sport (RTS), alter measurable knee biomechanics, and potentially increase the risk for re-rupture. Targeted interventions such as kinesiotaping, knee bracing, and imagery training can help improve psychological and functional testing after ACLR. CONCLUSION ACLR is often complicated by psychological factors. Psychological readiness is a crucial yet often unincorporated part of rehabilitation. Patients with higher levels of kinesiophobia and lower psychological readiness to RTS specifically should be identified to allow for administration of interventions, such as imagery training, knee bracing, or kinesiotaping, that can mitigate the negative effects of psychological outcomes and improve recovery.
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Affiliation(s)
| | - Akash G Raju
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Andrew J Moyal
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jacob G Calcei
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - James E Voos
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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Slovák L, Zahradník D, Land WM, Sarvestan J, Hamill J, Abdollahipour R. Response of Knee Joint Biomechanics to Landing Under Internal and External Focus of Attention in Female Volleyball Players. Motor Control 2024; 28:341-361. [PMID: 38702047 DOI: 10.1123/mc.2023-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 05/06/2024]
Abstract
The aim of this study was to examine the effect of attentional focus instructions on the biomechanical variables associated with the risk of anterior cruciate ligament injury of the knee joint during a drop landing task using a time series analysis. Ten female volleyball players (age: 20.4 ± 0.8 years, height: 169.7 ± 7.1 cm, mass: 57.6 ± 3.1 kg, experience: 6.3 ± 0.8 years) performed landings from a 50 cm height under three different attentional focus conditions: (1) external focus (focus on landing as soft as possible), (2) internal focus (focus on bending your knees when you land), and (3) control (no-focus instruction). Statistical parameter mapping in the sagittal plane during the crucial first 30% of landing time showed a significant effect of attentional focus instructions. Despite the similarity in landing performance across foci instructions, adopting an external focus instruction promoted reduced vertical ground reaction force and lower sagittal flexion moment during the first 30% of execution time compared to internal focus, suggesting reduced knee loading. Therefore, adopting an external focus of attention was suggested to reduce most biomechanical risk variables in the sagittal plane associated with anterior cruciate ligament injuries, compared to internal focus and control condition. No significant differences were found in the frontal and horizontal planes between the conditions during this crucial interval.
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Affiliation(s)
- Lukáš Slovák
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
| | - David Zahradník
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
| | - William M Land
- Department of Kinesiology, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Javad Sarvestan
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Biomechanics and Functional Morphology Laboratory, CIPER, Faculdade de Motricidade Humana, University of Lisbon, Lisboa, Portugal
| | - Joseph Hamill
- Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
- Biomechanics Laboratory, University of Massachusetts, Amherst, MA, USA
| | - Reza Abdollahipour
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
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Gaudiani MA, Castle JP, Abbas MJ, Pratt BA, Myles MD, Moutzouros V, Lynch TS. ChatGPT-4 Generates More Accurate and Complete Responses to Common Patient Questions About Anterior Cruciate Ligament Reconstruction Than Google's Search Engine. Arthrosc Sports Med Rehabil 2024; 6:100939. [PMID: 39006779 PMCID: PMC11240040 DOI: 10.1016/j.asmr.2024.100939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/27/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To replicate a patient's internet search to evaluate ChatGPT's appropriateness in answering common patient questions about anterior cruciate ligament reconstruction compared with a Google web search. Methods A Google web search was performed by searching the term "anterior cruciate ligament reconstruction." The top 20 frequently asked questions and responses were recorded. The prompt "What are the 20 most popular patient questions related to 'anterior cruciate ligament reconstruction?'" was input into ChatGPT and questions and responses were recorded. Questions were classified based on the Rothwell system and responses assessed via Flesch-Kincaid Grade Level, correctness, and completeness were for both Google web search and ChatGPT. Results Three of 20 (15%) questions were similar between Google web search and ChatGPT. The most common question types among the Google web search were value (8/20, 40%), fact (7/20, 35%), and policy (5/20, 25%). The most common question types amongst the ChatGPT search were fact (12/20, 60%), policy (6/20, 30%), and value (2/20, 10%). Mean Flesch-Kincaid Grade Level for Google web search responses was significantly lower (11.8 ± 3.8 vs 14.3 ± 2.2; P = .003) than for ChatGPT responses. The mean correctness for Google web search question answers was 1.47 ± 0.5, and mean completeness was 1.36 ± 0.5. Mean correctness for ChatGPT answers was 1.8 ± 0.4 and mean completeness was 1.9 ± 0.3, which were both significantly greater than Google web search answers (P = .03 and P = .0003). Conclusions ChatGPT-4 generated more accurate and complete responses to common patient questions about anterior cruciate ligament reconstruction than Google's search engine. Clinical Relevance The use of artificial intelligence such as ChatGPT is expanding. It is important to understand the quality of information as well as how the results of ChatGPT queries compare with those from Google web searches.
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Affiliation(s)
- Michael A. Gaudiani
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Joshua P. Castle
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Muhammad J. Abbas
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Brittaney A. Pratt
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Marquisha D. Myles
- Michigan State University College of Human Medicine, Detroit, Michigan, U.S.A
| | - Vasilios Moutzouros
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - T. Sean Lynch
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
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Turati M, Anghilieri FM, Gatti SD, Courvoisier A, Rigamonti L, Zatti G, Nicolaou N, Bigoni M. Arthroscopic repair of proximal anterior cruciate ligament tears in children and adolescents: A systematic review. J Child Orthop 2024; 18:249-257. [PMID: 38831852 PMCID: PMC11144375 DOI: 10.1177/18632521241244626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/17/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Anterior cruciate ligament repair techniques are of growing interest because they allow for minimally invasive surgery that avoids harvesting of the transplant, without risking growth deficiencies in young patients. The aim of this study is to summarize the published evidence about arthroscopic repair of anterior cruciate ligament proximal tears in skeletally immature patients. Methods In total, four studies were included and processed for data extraction after screening for eligibility for this systematic review: one retrospective cohort study and three retrospective case series. Altogether, the four studies included in this review included 61 skeletally immature patients with a mean age of 12.1 years diagnosed with proximal anterior cruciate ligament tear who underwent arthroscopic repair with preservation of the native ligament. The mean follow-up period was 2.8 years. Results The most relevant and objective outcome that we considered was re-rupture rate. One study reports a cumulative incidence of graft failure in the first 3 years after surgery of 48.8% while the others report a 0%, 0% and 21.5% re-rupture rate. No growth disturbances were reported in the included studies. Conclusion Despite growing interest surrounding anterior cruciate ligament repair techniques, the presence of limited quality studies in the literature means repair cannot be strongly supported at present. Some encouraging data regarding the absence of growth disturbance and functional outcomes does exist, but studies with larger samples are required. Level of evidence level IV.
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Affiliation(s)
- Marco Turati
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfants, Grenoble Alpes University, Grenoble, France
| | | | - Simone Daniel Gatti
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Aurelien Courvoisier
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfants, Grenoble Alpes University, Grenoble, France
| | - Luca Rigamonti
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Giovanni Zatti
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nicolas Nicolaou
- Sheffield Children’s Hospital and Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
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Nadeau N, Richards S. The potential for hyperbaric oxygen therapy in ACL reconstruction. J Orthop Res 2024. [PMID: 38814158 DOI: 10.1002/jor.25911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Affiliation(s)
- Nicolas Nadeau
- Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Sean Richards
- Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
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Lou J, Ma Q, Zhao X, Wu S, Gao H, Zhang W, Zhao B, Cai X. Comparison of the biomechanical properties of grafts in three anterior cruciate ligament reconstruction techniques based on three-dimensional finite element analysis. J Orthop Surg Res 2024; 19:322. [PMID: 38812053 PMCID: PMC11137914 DOI: 10.1186/s13018-024-04777-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE To evaluate the biomechanical characteristics of grafts from three different anterior cruciate ligament (ACL) reconstructive surgeries and to determine which method is better at restoring knee joint stability. METHODS A 31-year-old female volunteer was enrolled in the study. According to the magnetic resonance imaging of her left knee, a three-dimensional model consisting of the distal femur, proximal tibia and fibula, ACL, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament was established. Then, the ACL was removed from the original model to simulate the knee joint after ACL rupture. Based on the knee joint model without the ACL, single-bundle ACL reconstruction, double-bundle ACL reconstruction, and flat-tunnel ACL reconstruction were performed. The cross-sectional diameters of the grafts were equally set as 6 mm in the three groups. The bone tissues had a Young's modulus of 17 GPa and a Poisson's ratio of 0.36. The ligaments and grafts had a Young's modulus of 390 MPa and a Poisson's ratio of 0.4. Six probes were placed in an ACL or a graft to obtain the values of the equivalent stress, maximum principal stress, and maximum shear stress. After pulling the proximal tibia with a forward force of 134 N, the distance that the tibia moved and the stress distribution in the ACL or the graft, reflected by 30 mechanical values, were measured. RESULTS The anterior tibial translation values were similar among the three groups, with the double-bundle ACL reconstruction group performing the best, followed closely by the patellar tendon ACL reconstruction group. In terms of stress distribution, 13 out of 30 mechanical values indicated that the grafts reconstructed by flat bone tunnels had better performance than the grafts in the other groups, while 12 out of 30 showed comparable outcomes, and 5 out of 30 had worse outcomes. CONCLUSION Compared with traditional single-bundle and double-bundle ACL reconstructions, flat-tunnel ACL reconstruction has advantages in terms of stress dispersion. Additionally, flat-tunnel ACL reconstruction falls between traditional double-bundle and single-bundle ACL reconstructions in terms of restoring knee joint stability and is superior to single-bundle ACL reconstruction.
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Affiliation(s)
- Jiawnag Lou
- Hebei North University, 11-South Diamond Road, Gaoxin District, Zhangjiakou City, 075000, China.
- Joint Diseases Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
- Beijing MEDERA Medical Group, Beijing, 102200, China.
| | - Qi Ma
- Joint Diseases Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
- Beijing MEDERA Medical Group, Beijing, 102200, China
| | - Xijiu Zhao
- Joint Diseases Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Sha Wu
- Joint Diseases Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
- Beijing MEDERA Medical Group, Beijing, 102200, China
| | - Hong Gao
- Beijing MEDERA Medical Group, Beijing, 102200, China
| | - Wei Zhang
- Joint Diseases Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
- Beijing MEDERA Medical Group, Beijing, 102200, China
| | - Baojing Zhao
- Joint Diseases Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Xu Cai
- Joint Diseases Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
- Beijing MEDERA Medical Group, Beijing, 102200, China
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Dauty M, Combes P, Gernigon M, Menu P, Crenn V, Daley P, Fouasson-Chailloux A. Difference of Knee Strength Recovery Between Revision and Primary ACL Reconstruction. Int J Sports Med 2024; 45:390-398. [PMID: 38267006 DOI: 10.1055/a-2253-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Different grafting procedures are available to restore knee stability after revision anterior cruciate ligament (ACL) reconstruction. We compared knee strength recovery between ACL revision surgery and primary reconstruction. One hundred and ten patients with ACL revision surgery were matched with 110 patients with primary reconstruction based on the graft procedure. The isokinetic knee strength had been assessed for the first 9 months post-surgery. Knee laxity, function, and activity score were also evaluated. Limb symmetry index for knee extensor and flexor strength was not different at 4-, 6- and 9-months post-surgery between revision surgery and primary reconstruction. These results depended on ipsilateral or contralateral graft choice. Ipsilateral hamstring tendon (HT) and contralateral bone-patellar-tendon-bone (BPTB) graft procedures were similar for a revision of a BPTB graft failure. Contralateral HT procedure was better than ipsilateral BPTB procedure for a revision of a HT graft failure. The early recovery of isokinetic knee strength after ACL revision surgery regardless of the HT or BPTB procedures, was similar to the recovery after primary ACL reconstruction with the same graft technique. These results apparently depended on a temporary quadriceps arthrogenic muscle inhibition and on a persistent donor site morbidity, concerning the new and the previous grafts, respectively.
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Affiliation(s)
- Marc Dauty
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes, France
- Institut Régional de Médecine du Sport, CHU Nantes, Nantes, France
| | - Philippe Combes
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes, France
| | - Marie Gernigon
- CIAMS, Université Paris-Saclay, Gif-sur-Yvette, France
- CIAMS, Université d'Orléans, Orleans, France
| | - Pierre Menu
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes, France
| | - Vincent Crenn
- Clinique Chirurgicale Orthopédique et Traumatologique, CHU Nantes, Nantes, France
| | - Pauline Daley
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes, France
- Institut Régional de Médecine du Sport, CHU Nantes, Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, Nantes, France
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Knapic H, Shanley E, Thigpen CA, Prats-Uribe A, Fair CD, Bullock GS. Impact of Prolonged Sport Stoppage on Knee Injuries in High School Athletes: An Ecological Study. J Sport Rehabil 2024; 33:225-230. [PMID: 38412853 DOI: 10.1123/jsr.2023-0018] [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: 01/17/2023] [Revised: 01/03/2024] [Accepted: 01/16/2024] [Indexed: 02/29/2024]
Abstract
CONTEXT In March 2020, public health concerns resulted in school closure throughout the United States. The prolonged sport cessation may affect knee injury risk in high school athletes. The purpose of this study was to describe and compare risk of knee injuries in high school athletes during 2019-2020 and 2020-2021 academic years, and stratify by gender, severity, mechanism of injury, injury type, and knee anatomic region. DESIGN Historical-prospective cohort study. METHODS This historical-prospective cohort study included 176 schools in 6 states matched by sport participation in control and COVID years from July 1, 2019 to June 30, 2021. Injury rates per 1000 athletes per year were calculated with 95% confidence intervals. A negative binomial regression was performed to assess potential differences in knee injuries between academic years. RESULTS 94,847 and 72,521 high school athletes participated in the 2019-2020 (19-20) and 2020-2021 (20-21) seasons. Knee injury risk was higher in the 20-21 season (19-20: 28.89% [27.82-29.96]; 20-21: 33.82% [32.50-35.14]). Risk increased for male athletes from 2019-2020 to 2020-2021 (19-20: 29.42% [28.01-30.83]; 20-21: 40.32% [38.89-41.75]). Female knee injury risk was similar between years (19-20: 25.78% [24.29-27.27]; 20-21: 26.03% [24.31-27.75]). Knee injuries increased by a ratio of 1.2 ([95% CI, 1.1-1.3], P < .001) during 2020-2021. CONCLUSIONS Knee injury risk and relative risk increased among males in 2020-2021. Results indicate changes in knee injury risk following return from COVID shelter in place among high school athletes and implicate potential negative downstream effects of interrupted sports training and participation on high school injury risk.
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Affiliation(s)
- Hannah Knapic
- Department of Public Health Studies, Elon University, Elon, NC, USA
| | - Ellen Shanley
- ATI Physical Therapy, Greenville, SC, USA
- Center for Rehabilitation and Reconstruction Sciences, University of South Carolina, Columbia, SC, USA
| | - Charles A Thigpen
- ATI Physical Therapy, Greenville, SC, USA
- Center for Rehabilitation and Reconstruction Sciences, University of South Carolina, Columbia, SC, USA
| | - Albert Prats-Uribe
- Pharmaco- and Device Epidemiology, Center for Statistics in Medicine, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Cynthia D Fair
- Department of Public Health Studies, Elon University, Elon, NC, USA
| | - Garrett S Bullock
- Department of Orthopedic Surgery and Rehabilitation, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, United Kingdom
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Gamble AR, McKay MJ, Anderson DB, Pappas E, Alvarez Cooper I, Macpherson S, Harris IA, Filbay SR, McCaffery K, Thompson R, Hoffmann TC, Maher CG, Zadro JR. Development of a patient decision aid for children and adolescents following anterior cruciate ligament rupture: an international mixed-methods study. BMJ Open 2024; 14:e081421. [PMID: 38684251 PMCID: PMC11086191 DOI: 10.1136/bmjopen-2023-081421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
AIM To develop and user test an evidence-based patient decision aid for children and adolescents who are considering anterior cruciate ligament (ACL) reconstruction. DESIGN Mixed-methods study describing the development of a patient decision aid. SETTING A draft decision aid was developed by a multidisciplinary steering group (including various types of health professionals and researchers, and consumers) informed by the best available evidence and existing patient decision aids. PARTICIPANTS People who ruptured their ACL when they were under 18 years old (ie, adolescents), their parents, and health professionals who manage these patients. Participants were recruited through social media and the network outreach of the steering group. PRIMARY AND SECONDARY OUTCOMES Semistructured interviews and questionnaires were used to gather feedback on the decision aid. The feedback was used to refine the decision aid and assess acceptability. An iterative cycle of interviews, refining the aid according to feedback and further interviews, was used. Interviews were analysed using reflexive thematic analysis. RESULTS We conducted 32 interviews; 16 health professionals (12 physiotherapists, 4 orthopaedic surgeons) and 16 people who ruptured their ACL when they were under 18 years old (7 were adolescents and 9 were adults at the time of the interview). Parents participated in 8 interviews. Most health professionals, patients and parents rated the aid's acceptability as good-to-excellent. Health professionals and patients agreed on most aspects of the decision aid, but some health professionals had differing views on non-surgical management, risk of harms, treatment protocols and evidence on benefits and harms. CONCLUSION Our patient decision aid is an acceptable tool to help children and adolescents choose an appropriate management option following ACL rupture with their parents and health professionals. A clinical trial evaluating the potential benefit of this tool for children and adolescents considering ACL reconstruction is warranted.
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Affiliation(s)
- Andrew R Gamble
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marnee J McKay
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David B Anderson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Evangelos Pappas
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | | | - Sophie Macpherson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian A Harris
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Stephanie R Filbay
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Thompson
- Discipline of Behavioural and Social Sciences in Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Christopher G Maher
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joshua R Zadro
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
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Childers J, Eng E, Lack B, Lin S, Knapik DM, Kaplan DJ, Jackson GR, Chahla J. Reported Anterior Cruciate Ligament Injury Incidence in Adolescent Athletes Is Greatest in Female Soccer Players and Athletes Participating in Club Sports: A Systematic Review and Meta-analysis. Arthroscopy 2024:S0749-8063(24)00298-6. [PMID: 38692337 DOI: 10.1016/j.arthro.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE To identify the risk of anterior cruciate ligament (ACL) injury in adolescent athletes based on sex, sport, and sport affiliation. METHODS A literature search was performed using 3 online databases (PubMed, Cochrane Library, and EMBASE) from database inception to November 2023 per the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies consisted of Level I or II studies reporting on ACL injury exposures in time (hours) or injuries per 1,000 athlete-exposures (AEs) (1 game or practice) in adolescent athletes. Exclusion criteria consisted of non-English studies, case reports, animal/cadaveric studies, and review articles. Methodological quality and bias assessment of the included studies was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. ACL injuries were analyzed and pooled to calculate incidence rates (IRs), per-season risk, and relative risk (RR) based on sex, sport, and sport affiliation (club sport participation vs school sport participation). RESULTS A total of 1,389 ACL injuries over 19,134,167 AEs were identified (IR, 0.075; 95% confidence interval [CI], 0.071-0.079). Of these, 670 ACL injuries were reported in female athletes over 7,549,892 AEs (IR, 0.089; 95% CI, 0.087-0.091) with 719 in males over 11,584,275 AEs (IR, 0.062; 95% CI, 0.058-0.067). The greatest RR for ACL injury in females was in soccer (RR, 3.12; 95% CI, 2.58-3.77) for AEs. The greatest per-season risk of ACL injuries reported in female athletes occurred in soccer (1.08%), basketball (1.03%), and gymnastics (1.01%). The greatest per-season risk of ACL injuries reported in male athletes occurred in football (0.82%), lacrosse (0.64%), and soccer (0.35%). Club sport participation, in both AEs (RR, 3.94; 95% CI, 3.19-4.87) and hours of exposure (RR, 1.57; 95% CI, 1.07-2.28), demonstrated an increased risk of ACL injury. CONCLUSIONS The risk of ACL injuries was 1.56-fold greater in adolescent female athletes compared with male athletes. The highest-risk sport for females was soccer. Participation in club sports possessed higher rates of injury compared with school sports. LEVEL OF EVIDENCE Level II; meta-analysis of Level I and II studies.
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Affiliation(s)
- Justin Childers
- Charles E. Schmidt School of Medicine, Florida Atlantic University, Boca Raton, Florida, U.S.A
| | - Emma Eng
- Charles E. Schmidt School of Medicine, Florida Atlantic University, Boca Raton, Florida, U.S.A
| | - Benjamin Lack
- Charles E. Schmidt School of Medicine, Florida Atlantic University, Boca Raton, Florida, U.S.A
| | - Shu Lin
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, Florida, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, Missouri, U.S.A
| | - Daniel J Kaplan
- NYU Langone Health, New York University Langone Medical Center, New York, New York, U.S.A
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
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12
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Colombo V, Valenčič T, Steiner K, Škarabot J, Folland J, O'Sullivan O, Kluzek S. Comparison of Blood Flow Restriction Interventions to Standard Rehabilitation After an Anterior Cruciate Ligament Injury: A Systematic Review. Am J Sports Med 2024:3635465241232002. [PMID: 38591459 DOI: 10.1177/03635465241232002] [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: 04/10/2024]
Abstract
BACKGROUND Blood flow restriction training (BFR-t) data are heterogeneous. It is unclear whether rehabilitation with BFR-t after an anterior cruciate ligament (ACL) injury is more effective in improving muscle strength and muscle size than standard rehabilitation. PURPOSE To review outcomes after an ACL injury and subsequent reconstruction in studies comparing rehabilitation with and without BFR-t. STUDY DESIGN Systematic review. Level of evidence, 3. METHODS A search of English-language human clinical studies published in the past 20 years (2002-2022) was carried out in 5 health sciences databases, involving participants aged 18-65 undergoing rehabilitation for an ACL injury. Outcomes associated with muscle strength, muscle size, and knee-specific patient-reported outcome measures (PROMs) were extracted from studies meeting inclusion criteria and compared. RESULTS The literature search identified 279 studies, of which 5 met the selection criteria. Two studies suggested that BFR-t rehabilitation after an ACL injury improved knee or thigh muscle strength and muscle size compared with rehabilitation consisting of comparable and higher load resistance training, with two studies suggesting the opposite. The single study measuring PROMs showed improvement compared to traditional rehabilitation, with no difference in muscle strength or size. CONCLUSION BFR-t after an ACL injury seems to benefit muscle strength, muscle size, and PROM scores compared with standard rehabilitation alone. However, only 1 large study included all these outcomes, which has yet to be replicated in other settings. Further studies utilizing similar methods with a common set of outcome measures are required to confirm the effects of BFR-t on ACL rehabilitation.
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Affiliation(s)
- Valentina Colombo
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tamara Valenčič
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Kat Steiner
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Jakob Škarabot
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Jonathan Folland
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Oliver O'Sullivan
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - Stefan Kluzek
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
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13
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Jin X, Wu X, Xu W, She C, Li L, Mao Y. Gender differences in the impact of anatomical factors on non-contact anterior cruciate ligament injuries: a magnetic resonance study. BMC Musculoskelet Disord 2024; 25:264. [PMID: 38575985 PMCID: PMC10996128 DOI: 10.1186/s12891-024-07390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE To identify MRI-detected anatomical risk factors for non-contact anterior cruciate ligament (ACL) injuries across genders. METHODS A retrospective analysis was performed on 141 ACL-reconstructed patients (35 females, 106 males) and 142 controls (37 females, 105 males) from January 2020 to April 2022. Inclusion criteria were primary non-contact ACL injuries. The tibial plateau slope, lateral femoral condyle index, Insall-Salvati index, and patellar tendon angle were measured, using binary logistic regression for gender-specific risk evaluation. RESULTS Increased lateral tibial plateau slope, reduced intercondylar notch width index, lateral femoral condyle index, and patellar tendon angle correlated with ACL injuries in both genders. The Insall-Salvati index was a significant risk factor in females but not in males. CONCLUSION This study identifies the lateral tibial plateau slope, notch width index, lateral femoral condyle index, and patellar tendon angle at near-extension as risk factors for ACL injuries in both genders, with the Insall-Salvati index also implicated in females.
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Affiliation(s)
- Xixin Jin
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Xujin Wu
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Wei Xu
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Chang She
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Liubing Li
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Yongtao Mao
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China.
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14
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Donelon TA, Edwards J, Brown M, Jones PA, O'Driscoll J, Dos'Santos T. Differences in Biomechanical Determinants of ACL Injury Risk in Change of Direction Tasks Between Males and Females: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2024; 10:29. [PMID: 38561438 PMCID: PMC10984914 DOI: 10.1186/s40798-024-00701-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Change of direction (COD) movements are associated with non-contact anterior cruciate ligament (ACL) injuries in multidirectional sports. Females appear at increased risk compared to males, which could be attributable to whole body kinematic strategies and greater multiplanar knee joint loads (KJLs) during COD which can increase ACL loading. OBJECTIVE The aim of this systematic review and meta-analysis was to examine and quantitatively synthesise the evidence for differences between males and females regarding KJLs and their biomechanical determinants (whole body kinematic strategies determining KJLs) during COD tasks. METHODS Databases including SPORTDiscus, Web of Science, and PubMed were systematically searched (July 2021-June 2023) for studies that compared differences in knee joint loads and biomechanical determinants of KJLs during COD between males and females. Inclusion criteria were: (1) females and males with no prior history of ACL injury (18-40 years); (2) examined biomechanical determinants of KJLs and/ or KJLs during COD tasks > 20°; (3) compared ≥ 1 outcome measure between males and females. Studies published between 2000 and 2023 examining a cutting task > 20° with a preceding approach run that compared KJLs or the whole body multiplanar kinematics associated with them, between sexes, using three-dimensional motion analysis. RESULTS This meta-analysis included 17 studies with a pooled sample size of 451 participants (227 males, 224 females). Meta-analysis revealed females displayed significantly less peak knee flexion during stance (SMD: 0.374, 95% CI 0.098-0.649, p = 0.008, I2: 0%); greater knee abduction at initial contact (IC) (SMD: 0.687, 95% CI 0.299-1.076, p = 0.001, I2: 55%); less hip internal rotation (SMD: 0.437, 95% CI 0.134-0.741, p = 0.005, I2: 34%) and hip abduction at IC (SMD: -0.454, 95% CI 0.151-0.758, p = 0.003, I2: 33%). No significant differences were observed between males and females for any internal or externally applied KJLs. All retrieved studies failed to control for strength, resistance training or skill history status. CONCLUSION No differences were observed in KJLs between males and females despite females displaying greater knee abduction at IC and less peak knee flexion during the stance phase of CODs, which are visual characteristics of non-contact ACL injury. Further research is required to examine if this translates to a similar injury risk, considering morphological differences in strain characteristics of the ACL between males and females. This observation may in part explain the disproportionate ACL injury incidence in female multidirectional athletes. Further higher quality controlled research is required whereby participants are matched by skill training history, resistance training history and strength status to ensure an appropriate comparison between males and females.
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Affiliation(s)
- Thomas A Donelon
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK.
| | - Jamie Edwards
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK
| | - Mathew Brown
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK
| | - Paul A Jones
- School of Health Sciences, C702 Allerton Building, University of Salford, Salford, M6 6PU, UK
| | - Jamie O'Driscoll
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK
| | - Thomas Dos'Santos
- Department of Sport and Exercise Sciences | Manchester Metropolitan University, 2.01 Institute of Sport, 99 Oxford Road, Manchester, M1 7EL, UK
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15
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Smith PA, Daniel AV, Stensby JD, Cook CS, Wijdicks CA. Quadriceps Tendon Autograft ACL Reconstruction With Suture Tape Augmentation: Safe Results Based on Minimum 2-Year Follow-up MRI. Orthop J Sports Med 2024; 12:23259671241239275. [PMID: 38617885 PMCID: PMC11010759 DOI: 10.1177/23259671241239275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/18/2023] [Indexed: 04/16/2024] Open
Abstract
Background The potential intra-articular effects of ≥1 year after anterior cruciate ligament reconstruction (ACLR) with independent suture tape augmentation (STA) are not fully understood. Purpose To investigate whether incorporating suture tape in an all-soft tissue quadriceps tendon autograft (QTA) ACLR leads to satisfactory patient outcomes while having no intra-articular side effects as determined by magnetic resonance imaging (MRI). Study Design Case series; Level of evidence, 4. Methods Included were 25 patients with a mean age of 19.9 years (95% CI, 17.3-22.5 years) who underwent QTA ACLR with STA between 2016 and 2019. All patients underwent MRI at ≥1 year postoperatively and had at least a 2-year follow-up (mean, 28 months [95% CI, 26.5-29.5 months]) that included physical examination with anterior laxity testing with KT-1000 arthrometer, radiographs, and patient-reported outcome measures (PROMs). At the final follow-up, the minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) for applicable PROMs were applied to each patient. Postoperative graft and joint integrity were assessed using the Howell classification and the MRI Osteoarthritis Knee Score (MOAKS) joint effusion/synovitis grade. The Mann-Whitney U test for continuous variables and the chi-square or the Fisher exact test for categorical variables were used for statistical analyses. Results The MRI assessment of the grafts demonstrated intact grafts in all patients. Overall, 96% of patients demonstrated grades 0 or 1 MOAKS for joint effusion/synovitis. All patient outcomes significantly improved from preoperatively to the final follow-up (P < .001), except for the Marx score, which decreased significantly (14.2 [95% CI, 12.7-15.8] vs 9.72 [95% CI, 7.3-12.2]; P = .0014). At least 68% of the patients achieved the MCID threshold, and 92% achieved the PASS threshold for all applicable PROMs. Conclusion QTA ACLR with STA did not demonstrate adverse intra-articular changes on MRI at ≥1 year postoperatively. In addition, STA did not appear to negatively affect PROMs.
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Affiliation(s)
| | | | - James D. Stensby
- Diagnostic Radiology, University of Missouri, Columbia, Missouri, USA
| | - Corey S. Cook
- The Columbia Orthopaedic Group, Columbia, Missouri, USA
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16
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Inclan PM, Hicks JJ, Retzky JS, Janosky JJ, Pearle AD. Team Approach: Neuromuscular Training for Primary and Secondary Prevention of Anterior Cruciate Ligament Injury. JBJS Rev 2024; 12:e23.00207. [PMID: 38994007 PMCID: PMC11236273 DOI: 10.2106/jbjs.rvw.23.00207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Neuromuscular training is a method of performance optimization-typically combining plyometrics, balancing training, agility, and dynamic stabilization-predicated on improving the efficiency of fundamental movement patterns. Neuromuscular training has consistently been shown to reduce the risk of anterior cruciate ligament injury, particularly for athletes engaged in activities associated with noncontact knee injuries (i.e., women's soccer). Successful implementation of neuromuscular training programs requires input from coaches, physical therapists, athletic trainers, and physicians to generate efficacious programs with high rates of adherence.
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Affiliation(s)
- Paul M Inclan
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
| | - Justin J Hicks
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
| | - Julia S Retzky
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
| | - Joseph J Janosky
- Department of Athlete Health, Hospital for Special Surgery, New York, New York
| | - Andrew D Pearle
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
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17
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Daniel AV, Sheth CD, Shubert DJ, Smith PA. Primary Anterior Cruciate Ligament Reconstruction with Suture Tape Augmentation: A Case Series of 252 Patients. J Knee Surg 2024; 37:381-390. [PMID: 37451280 DOI: 10.1055/a-2129-8893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) using suture tape augmentation to internally brace is a relatively new technique. The primary goal of this study was to prospectively collect patient-reported outcomes (PROs) and surgical history from patients who underwent primary ACLR with internal bracing to determine if internal bracing resulted in a low graft failure rate while maintaining acceptable PROs. A total of 252 patients with a mean age of 23.6 years (95% confidence interval [CI]: 22.1-25.1) and a mean follow-up of 37.9 months (95% CI: 35.8-40.0) were included in this study. Patients who underwent primary ACLR with internal brace augmentation between July 12, 2016 and July 31, 2021 were eligible. A total of 222 patients were contacted via telephone and administered the visual analog scale (VAS), the single assessment numeric evaluation (SANE), the Lysholm knee score scale, and, if applicable, the short version ACL return to sport after injury (SV-ACL-RSI) survey. Additionally, patients were asked to give an updated orthopaedic history. Thirty additional patients were included from either our institution's registry or by completing their surveys in-office or by e-mail. The minimal clinically important difference (MCID) and patient-acceptable symptom states (PASS) were calculated based on our patient population and applied to each individual patient. The patients' electronic health record (EHR) was searched for pre- and postoperative clinical data including KT-1000 arthrometer measurements. Two patients (0.8%) had subsequent graft failures and one patient (0.4%) required a revision surgery. MCID was achieved in 242 patients (96.0%) for the Lysholm, 227 patients (90.1%) for the SANE, and 146 patients (57.9%) for the VAS. PASS was achieved in 214 patients (84.9%) for the Lysholm, 198 patients (78.6%) for the SANE, and 199 (80.0%) patients for the VAS, postoperatively. Of note, 65 patients (25.8%) exceeded the PASS threshold for the VAS preoperatively. A total of 127 patients (84.4%) met the cutoff of ≥60/100 for the SV-ACL-RSI survey postoperatively. Postoperative KT-1000 measurements showed near-identical side-to-side differences at both the 13.6-kg pull and manual maximum pull. When stratifying patients based on age at the time of surgery, it was noted that patients younger than 25 years had significantly higher SANE scores (91.6 [95% CI: 90.2-92.9] vs. 82.6 [95% CI: 79.0-86.2]; p < 0.0001) and lower VAS pain scores (0.7 [95% CI: 0.5-0.8] vs. 1.2 [95% CI: 0.8-1.5]; p = 0.004). Primary ACLR with internal bracing led to acceptable patient outcomes and a graft failure rate of less than 1%. LEVEL OF EVIDENCE:: case series, IV.
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Affiliation(s)
- Adam V Daniel
- Department of Orthopaedic Surgery, Columbia Orthopaedic Group, Columbia, Missouri
| | - Chirag D Sheth
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, Missouri
| | - Daniel J Shubert
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, Missouri
| | - Patrick A Smith
- Department of Orthopaedic Surgery, Columbia Orthopaedic Group, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, Missouri
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18
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Daniel AV, Smith PA. Primary All-Soft Tissue Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction With Suture Tape Augmentation Resulted in Satisfactory Patient Outcomes and a Low Graft Failure Rate in High School and Collegiate Athletes. Arthroscopy 2024:S0749-8063(24)00234-2. [PMID: 38518869 DOI: 10.1016/j.arthro.2024.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE To evaluate ≥2-year patient outcomes after primary all-soft tissue quadriceps tendon autograft (ASTQ) anterior cruciate ligament reconstruction (ACLR) with suture tape augmentation (STA) in skeletally mature high school and collegiate athletes. METHODS All high school and collegiate athletes who underwent primary ASTQ ACLR with STA with a minimum of 2-year follow-up were analyzed retrospectively. Patients were administered validated patient-reported outcome measures (PROMs) pre- and postoperatively. The minimal clinically important difference was calculated for each PROM based on this study population and applied to the individual patient. Return to sport, subsequent surgical intervention including contralateral ACLR, and KT-1000 arthrometer measurements for knee laxity were collected. Complications were assessed by physical examination, radiologic studies, or obtained via telephone. RESULTS In total, 60 patients were included in the final data analysis, with a mean age of 16.8 years (95% confidence interval 13-23) and mean final follow-up of 37.1 months (95% confidence interval 33.1-41.1). Twelve patients (20%) required subsequent surgery on the ipsilateral knee, which included 7 patients having a subsequent meniscal procedure and 3 patients who underwent arthrolysis. None sustained a graft failure, and 6 patients sustained a contralateral ACL injury necessitating surgery. All PROMs improved at the final follow-up (P < .001). In addition, KT-1000 arthrometer measurements significantly improved postoperatively at 1-year clinical follow-up (P < .001). Most patients obtained the minimal clinically important difference thresholds for each PROM at the final follow-up. There were 48 patients (80%) who participated in pivoting sports. The return-to-sport rate at same level was 54 patients (90%), with 6 patients (10%) not returning to the same level because of graduation. CONCLUSIONS ASTQ ACLR with STA in a young athletic patient population may result in a low graft failure rate while maintaining satisfactory patient outcomes at short-term follow-up, including a return to sport at the same level of 90%. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Adam V Daniel
- Columbia Orthopaedic Group, Columbia, Missouri, U.S.A..
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19
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Mouhli D, Cojean T, Lustig S, Servien E. Influence of hamstring stiffness on anterior tibial translation after anterior cruciate ligament rupture. Knee 2024; 47:121-128. [PMID: 38394991 DOI: 10.1016/j.knee.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/09/2023] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND There is a correlation between the hamstring stiffness and the decrease of anterior tibial translation in athletic patients with healthy knees. This observation could question the clinical reliability of the Lachman-Trillat test to detect complete ACL ruptures in patients with an important hamstring stiffness. This study aims to determine if anterior tibial translation is correlated with hamstring stiffness in patients with complete ACL rupture. METHODS This is a prospective study including patients with unilateral complete ACL rupture confirmed by MRI. The arthrometer GNRB® was used to measure anterior tibial translation on both knees at 134 N and compute the side-to-side difference. The hamstring stiffness was assessed with the eccentric peak torque using the isokinetic dynamometer CON-TREX. Linear regressions were done between these two parameters on two study groups: one included all patients (GR1), and the other included only isolated ACL injuries without associated lesions (GR2). RESULTS Fifty-two patients were included (29 men, 23 women) with an average of 34.9 years old. The mean eccentric peak torque of the hamstrings for pathological knees was 94.9Nm for GR1 and 91.7Nm for GR2. The mean side-to-side difference was 2.42 mm for GR1 and 1.99 mm for GR2. No significant correlations were identified for GR1 (p = 0.66) and GR2 (p = 0.105). CONCLUSION No significant linear correlation was found between side-to-side difference measured by GNRB® and hamstring stiffness for pathological knees with complete ACL rupture. These results lead to believe that the Lachman-Trillat clinical test is not influenced by hamstring stiffness. LEVEL OF EVIDENCE Prospective study, level of evidence IV.
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Affiliation(s)
- Djaffar Mouhli
- Département de Chirurgie Orthopédique et de Médecine du Sport, FIFA Medical Center of Excellence, Hôpital de la Croix Rousse, Centre Hospitalo-Universitaire de Lyon, France
| | - Théo Cojean
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR_T 9406, F-69622 Lyon, France.
| | - Sébastien Lustig
- Département de Chirurgie Orthopédique et de Médecine du Sport, FIFA Medical Center of Excellence, Hôpital de la Croix Rousse, Centre Hospitalo-Universitaire de Lyon, France; Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR_T 9406, F-69622 Lyon, France
| | - Elvire Servien
- Département de Chirurgie Orthopédique et de Médecine du Sport, FIFA Medical Center of Excellence, Hôpital de la Croix Rousse, Centre Hospitalo-Universitaire de Lyon, France; LIBM - EA 7424, Laboratoire interuniversitaire de la Biologie du Mouvement, Université Claude Bernard Lyon 1, Lyon, France
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20
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Douoguih WA, Apseloff NA, Murray JC, Kelly RL, Svoboda SJ. Suture-Augmented Anterior Cruciate Ligament Repair for Proximal Avulsion or High-Grade Partial Tears Shows Similar Side-to-Side Difference and No Clinical Differences at Two Years Versus Conventional Anterior Cruciate Ligament Reconstruction for Mid-Substance Tears or Poor Anterior Cruciate Ligament Tissue Quality. Arthroscopy 2024; 40:857-867. [PMID: 37479153 DOI: 10.1016/j.arthro.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To compare objective and subjective clinical outcomes between suture-augmented anterior cruciate ligament (ACL) repair (SAACLR) and conventional ACL reconstruction (CACLR) with minimum 2-year follow-up. METHODS In this nonrandomized, prospective study, 30 patients underwent SAACLR for proximal ACL avulsion or high-grade partial ACL tear (Sherman grade 1 or 2) and 30 patients underwent CACLR for proximal one-third/distal two-thirds junction tears and mid-substance tears (Sherman grade 3 or 4) tear types by 1 surgeon between 2018 and 2020. Failure was defined as ACL reinjury. Outcome measures were KT-1000 for side-to-side knee laxity evaluation, Visual Analog Scale for pain, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Severity Score (KOOS), Tegner Activity Scale, Western Ontario and McMaster Universities Osteoarthritis Index, Lysholm Knee Scoring Scale, and Single Assessment Numeric Evaluation. Minimal clinically important difference (MCID) was calculated for IKDC and KOOS subscores. RESULTS Three failures (10%) occurred in the SAACLR group, with no failures in the CACLR group (P = .24). A total of 23 (85%) SAACLR patients and 27 (90%) CACLR patients had patient-reported outcomes and physical examination at minimum 2 years. Two-year KT-1000 testing with 20 lbs showed less than 1 mm side-to-side difference between the groups. No significant differences in the percentage of patients meeting the MCID were found between the SAACLR and CACLR groups at 2 years: IKDC, 10.81 (82%) versus 10.54 (93%) (P = .48); KOOS Pain, 11.55 (73%) versus 10.58 (78%) (P = .94); KOOS Symptoms, 8.15 (77%) versus 10.32 (74%) (P = 1.0); KOOS Activities of Daily Living, 12.19 (59%) versus 12.28 (70%) (P = .60); 18.99 (71%) versus 16.77 (86%) (P = .42). Significantly higher IKDC scores were observed with SAACLR versus CACLR at 3 months (P = .01) and 6 months (P = .02), and significantly higher Lysholm scale, Tegner Activity Scale, and all KOOS subscale scores were observed at 6 months. CONCLUSIONS At 2 years after surgery, KT-1000 testing showed less than 1 mm side-to-side difference and no differences were observed between the groups in the percentage of patients who met or exceeded the MCID. Significantly higher early patient-reported outcome scores were found with SAACLR versus CACLR. The rerupture rate between the groups was not significantly different. LEVEL OF EVIDENCE Level II, Prospective cohort study.
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Affiliation(s)
- Wiemi A Douoguih
- MedStar Lafayette Orthopaedic and Sports Medicine Center, MedStar Washington Hospital Center, Washington, District of Columbia, U.S.A.; Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A.; Georgetown University School of Medicine, Washington, District of Columbia, U.S.A..
| | - Nicholas A Apseloff
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A
| | - Jerome C Murray
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Richard Lance Kelly
- MedStar National Rehabilitation Network, Washington, District of Columbia, U.S.A
| | - Steven J Svoboda
- MedStar Lafayette Orthopaedic and Sports Medicine Center, MedStar Washington Hospital Center, Washington, District of Columbia, U.S.A.; Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A
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Wu X, Chen J, Ye Z, Dong S, Xie G, Zhao S, Xu C, Li Z, Xu J, Zhao J. Clinical and Radiological Outcomes After Combined ACL and MPFL Reconstruction Versus Isolated ACL Reconstruction for ACL Injury With Patellar Instability. Am J Sports Med 2024; 52:936-947. [PMID: 38349070 DOI: 10.1177/03635465241226976] [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: 03/17/2024]
Abstract
BACKGROUND An anterior cruciate ligament (ACL) injury accompanied by patellar instability (PI) is a topic that has gained orthopaedic surgeons' attention recently. Untreated PI is reportedly associated with worse clinical outcomes after isolated ACL reconstruction (ACLR) in patients after an ACL injury with PI. Nevertheless, the appropriate surgical approach and its long-term therapeutic effects in these patients remain unclear. PURPOSE (1) To compare the clinical and radiological outcomes between isolated ACLR (iACLR) and combined ACLR and medial patellofemoral ligament reconstruction (cAMR) in patients after an ACL injury with PI and (2) to explore the correlations between these 2 procedures and clinical and radiological outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 106 patients diagnosed with an ACL injury accompanied by PI between January 2016 and April 2021 were analyzed in this study. There were 34 patients excluded because of missing postoperative radiological data. Among the remaining 72 patients, 34 patients underwent iACLR, while 38 patients underwent cAMR. Demographic characteristics, intraoperative findings, and patient-reported outcomes (Lysholm score, subjective International Knee Documentation Committee score, and Tegner activity score) were prospectively collected. Patellar alignment parameters and worsening patellofemoral osteoarthritis (PFOA) features (evaluated with the modified Whole-Organ Magnetic Resonance Imaging Score) were analyzed longitudinally on magnetic resonance imaging. The Kujala score was used to evaluate the functional recovery of the patellofemoral joint, and redislocations of the patella were prospectively recorded. Finally, multivariate logistic regression analysis was used to explore the correlations between these 2 procedures and clinical (not achieving the minimal detectable change [MDC] for the Lysholm score) and radiological (worsening PFOA features) outcomes. RESULTS The mean follow-up duration was 28.9 ± 6.2 and 27.1 ± 6.8 months for the iACLR and cAMR groups, respectively (P = .231). Significantly higher Lysholm scores (88.3 ± 9.9 vs 82.1 ± 11.1, respectively; P = .016) and subjective International Knee Documentation Committee scores (83.6 ± 11.9 vs 78.3 ± 10.2, respectively; P = .046) were detected in the cAMR group compared with the iACLR group postoperatively. The rates of return to preinjury sports were 20.6% and 44.7% in the iACLR and cAMR groups, respectively (difference, 24.1% [95% CI, 3.3%-45.0%]; P = .030). Moreover, the rates of worsening PFOA features were 44.1% and 18.4% in the iACLR and cAMR groups, respectively (difference, 25.7% [95% CI, 4.9%-46.4%]; P = .018). In addition, significantly higher Kujala scores (87.9 ± 11.3 vs 80.1 ± 12.0, respectively; P = .006), lower redislocation rates (0.0% vs 11.8%, respectively; difference, 11.8% [95% CI, 0.9%-22.6%]; P = .045), and significantly better patellar alignment were detected in the cAMR group compared with the iACLR group postoperatively. Furthermore, multivariate logistic regression analysis determined that iACLR and partial lateral meniscectomy were significantly correlated with not achieving the MDC for the Lysholm score and worsening PFOA features in our study population. CONCLUSION In patients after an ACL injury with PI, cAMR yielded better clinical and radiological outcomes compared with iACLR, with better patellar stability and a lower proportion of worsening PFOA features. Furthermore, not achieving the MDC for the Lysholm score and worsening PFOA features were significantly correlated with iACLR and partial lateral meniscectomy. Our study suggests that cAMR may be a more appropriate procedure for patients after an ACL injury with PI, which warrants further high-level clinical evidence.
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Affiliation(s)
- Xiulin Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyun Li
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Phillips T, Ronna B, Sullivan B, Terner Z, Goldenberg N, Kushare I, Shybut T. Skeletal Maturity Is Associated With Increased Meniscal and Chondral Pathology in Patients Under 21 Years of Age Undergoing Primary Anterior Cruciate Ligament Reconstruction Within 6 Months of Injury. Arthroscopy 2024:S0749-8063(24)00066-5. [PMID: 38311268 DOI: 10.1016/j.arthro.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To compare injury profiles of meniscal and/or chondral injury in skeletally mature (SM) with immature (SI) patients undergoing primary anterior cruciate ligament reconstruction (ACLR). METHODS Current Procedural Terminology code 29888 was queried from January 2012 to April 2020. Patients younger than 22 years who underwent primary ACLR within 6 months of injury were included. Exclusion criteria included age older than 22 years, treatment after 6 months, revision ACLR, concurrent osteotomy, or multiligamentous injury. All patients required a minimum 1-year follow-up. Demographics and intraoperative pathology were recorded. Data were analyzed for factors affecting intra-articular injury and stratified by sport. RESULTS Of 927 patients (739 SM, 188 SI), the mean age was 16.63 and 14.00 years for the SM and SI cohorts, respectively (P < .001). There were more SM males (51.4%) compared to SI males (81.9%) (P < .001); however, in univariate analysis, sex did not significantly affect the rates of meniscal (P = .519) or chondral injury (P = .961). In total, 887 meniscal injuries were recorded (344 medial, 543 lateral) in 659 patients. SM sustained greater rates of medial meniscal tear (MMT) (P < .001) and underwent higher rates of partial meniscectomy (P = .022). Male sex conferred meniscal injury (95% confidence interval [CI], 0.43-0.81; P = .001). Body mass index prognosticated medial meniscal (95% CI, 1.01-1.06; P = .002) and medial chondral injuries (95% CI, 1.02-1.09; P < .001). Skeletal maturity was a superior predictor of intra-articular pathology than age for all outcomes: MMT (95% CI, 0.00-0.06; P = .002), lateral meniscal tear (95% CI, 0.00-0.75; P = .034), and chondral injury (95% CI, 0.00-0.49; P = .049). In sport subanalysis, soccer anterior cruciate ligament (ACL) injuries were most common (32.6%). Soccer and basketball athletes were more likely SM (P = .016, P = .003 respectively) with increased medial compartment pathology. Football ACL injuries occurred significantly in SI athletes (P = .001) via contact mechanisms (P = .025). CONCLUSIONS Skeletal maturity affects the meniscal and chondral injury profile in ACL-injured patients. SM patients have greater risk of sustaining concomitant meniscal injury, while chondral injury profile depends more on the mechanism of injury. Mechanism of injury and skeletal maturity status affect risk of sports-related ACL rupture and ACL-concurrent pathology in young patients. Patient-specific variables influence injury profiles within each sport. Skeletal maturity rather than age predicts concomitant intra-articular injury risk. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Todd Phillips
- Department of Orthopeadic Surgery, Baylor College of Medicine, Houston, Texas, U.S.A..
| | - Brenden Ronna
- Department of Orthopeadic Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Brian Sullivan
- Piedmont Healthcare, OrthoAtlanta, Atlanta, Georgia, U.S.A
| | | | - Neal Goldenberg
- Dartmouth Health, Cheshire Medical Center, Keene, New Hampshire, U.S.A
| | - Indranil Kushare
- Division of Orthopaedic Surgery, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Theodore Shybut
- Southern California Orthopedic Institute, Van Nuys, California, U.S.A
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Xiao H, Wen B, Yan D, Li Q, Yang Y, Yin X, Chen D, Liu J. Hot spots and frontiers in bone-tendon interface research: a bibliometric analysis and visualization from 2000 to 2023. Front Surg 2024; 10:1326564. [PMID: 38327873 PMCID: PMC10847327 DOI: 10.3389/fsurg.2023.1326564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/19/2023] [Indexed: 02/09/2024] Open
Abstract
Objective In this research, we investigated the current status, hotspots, frontiers, and trends of research in the field of bone-tendon interface (BTI) from 2000 to 2023, based on bibliometrics and visualization and analysis in CiteSpace, VOSviewer, and a bibliometric package in R software. Methods We collected and organized the papers in the Web of Science core collection (WoSCC) for the past 23 years (2000-2023), and extracted and analyzed the papers related to BTI. The extracted papers were bibliometrically analyzed using CiteSpace for overall publication trends, authors, countries/regions, journals, keywords, research hotspots, and frontiers. Results A total of 1,995 papers met the inclusion criteria. The number of papers published and the number of citations in the field of BTI have continued to grow steadily over the past 23 years. In terms of research contribution, the United States leads in terms of the number and quality of publications, number of citations, and collaborations with other countries, while the United Kingdom and the Netherlands lead in terms of the average number of citations. The University of Leeds publishes the largest number of papers, and among the institutions hosting the 100 most cited papers Hospital for Special Surgery takes the top spot. MCGONAGLE D has published the highest number of papers (73) in the last 10 years. The top three clusters include #0 "psoriatic arthritis", #1 "rotator cuff repair", and #2 "tissue engineering". The structure and function of the BTI and its key mechanisms in the healing process are the key to research, while new therapies such as mechanical stimulation, platelet-rich plasma, mesenchymal stem cells, and biological scaffolds are hot topics and trends in research. Conclusion Over the past 23 years, global research on the BTI has expanded in both breadth and depth. The focus of research has shifted from studies concentrating on the structure of the BTI and the disease itself to new therapies such as biomaterial-based alternative treatments, mechanical stimulation, platelet-rich plasma, etc.
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Affiliation(s)
- Hao Xiao
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Boyuan Wen
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Dong Yan
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Quansi Li
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Yujie Yang
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Xianye Yin
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Deyu Chen
- School of Journalism and Communication, Hunan University, Changsha, China
| | - Jiachen Liu
- XiangYa School of Medicine, Central South University, Changsha, China
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Center of System Biology and Data Information, School of Basic Medical Science, Central South University, Changsha, Hunan, China
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24
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Cernat EM, Dima A, Popescu C, Neagu A, Betianu C, Moga M, Manolescu LSC, Barbilian A. Anterior Intercondylar Notch Geometry in Relation to the Native Anterior Cruciate Ligament Size. J Clin Med 2024; 13:309. [PMID: 38256446 PMCID: PMC10816285 DOI: 10.3390/jcm13020309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The intercondylar notch (ICN) and the anterior cruciate ligament (ACL) are important structures in knee morphometry, with key roles in stabilizing the knee. AIM To determine the associations between the specific shape of the ICN (A-, W-, or U-shape) and the ACL size in patients with intact ACLs. METHODS Magnetic resonance imaging (MRI) scans were independently analyzed by two experts: one orthopedic surgeon and one imaging physician. In all cases, the following measurements were taken based on the existing definitions: ACL area, anterior ICN (aICN) area, ICN width, lateral trochlear inclination (LTI), and Insall-Salvati index. RESULTS A total of 65 cases (50.8% male; 33.8 ± 10.2 years mean age at inclusion) were included in the study. The ACL and aICN areas were significantly larger in patients with U-shaped compared with A-shaped and W-shaped ICNs: 0.50 (0.20-0.80) vs. 0.40 (0.20-0.80) vs. 0.40 (0.30-0.80), p = 0.011 and 1.16 (0.57-3.60) vs. 0.47 (0.15-0.95) vs. 0.37 (0.15-0.81), p < 0.001, respectively. Internal meniscal lesions were more common in cases with U-shaped ICNs (64.0%), while external ones were more common in W-shaped ICN cases (35.3%). None of the A-shaped cases had external chondral or meniscal lesions. The ACL area was significantly larger in males and internal meniscal injuries, with no differences between chondral lesions, external meniscal injuries, patellar chondral lesions, patella alta, or trochlear dysplasia. CONCLUSION The specific shape of the intercondylar notch was associated with the anterior cruciate ligament-anterior intercondylar notch (ACL-aICN) area size correlation, with a strong correlation between ACL and aICN area when the intercondylar notch was A-shaped or W-shaped, and a low correlation when the notch was U- shaped. The specific shape of the intercondylar notch (A-, W-, or U-shape) was associated with the occurrence of both internal and external meniscal injuries, with the U-shaped intercondylar notch morphometry being more frequent in cases with internal meniscal injuries and the W-shape being more common in cases with external meniscal injuries.
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Affiliation(s)
- Eduard M. Cernat
- Department of Clinical Education, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.M.C.); (M.M.); (A.B.)
- Department of Orthopedics, Dr. Carol Davila Central Military University Emergency Hospital, 010242 Bucharest, Romania
| | - Alina Dima
- Department of Reumatology, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Claudiu Popescu
- Department of Clinical Education, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.M.C.); (M.M.); (A.B.)
- Department of Reumatology, Dr. Ion Stoia Rheumatic Disease Center, 030167 Bucharest, Romania
| | - Andrei Neagu
- Department of Radiology, Dr. Carol Davila Central Military University Emergency Hospital, 010242 Bucharest, Romania; (A.N.); (C.B.)
| | - Cezar Betianu
- Department of Radiology, Dr. Carol Davila Central Military University Emergency Hospital, 010242 Bucharest, Romania; (A.N.); (C.B.)
| | - Marius Moga
- Department of Clinical Education, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.M.C.); (M.M.); (A.B.)
- Department of Orthopedics, Dr. Carol Davila Central Military University Emergency Hospital, 010242 Bucharest, Romania
| | | | - Adrian Barbilian
- Department of Clinical Education, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.M.C.); (M.M.); (A.B.)
- Department of Orthopedics, Dr. Carol Davila Central Military University Emergency Hospital, 010242 Bucharest, Romania
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Gross BD, Yendluri A, Iyer AI, Patel AV, Cagle PJ. Most cited articles involving lacrosse since 1990 primarily focus on concussion and traumatic brain injury. PHYSICIAN SPORTSMED 2024:1-10. [PMID: 38174552 DOI: 10.1080/00913847.2024.2301919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024]
Abstract
OBJECTIVES The purpose of this study was to identify the 50 most-cited publications relating to lacrosse since 1990 and conduct a bibliometric analysis of the identified studies. METHODS Clarivate Analytics Web of Science database was queried to identify all publication titles, abstracts, and keywords for the term 'lacrosse' on 9 June 2023. The resulting articles were sorted by total number of citations. Titles and abstracts were included based on their relevance to lacrosse. Once the 50 most cited articles were identified, each article was further analyzed to obtain author name, publication year, country of origin, journal name, article type, research topic, competition level, total number of citations, and the level of evidence. Citation density (total number of citations/years since publication) was calculated and recorded for each of the most-cited studies. RESULTS The 50 most-cited articles were cited 4237 of times with an average of 84 citations per article. The most cited article was cited 637 (15.0%) times. The articles came from 2 different countries, with the United States and Australia comprising 49 and 1 articles, respectively. All articles were published in English. The American Journal of Sports Medicine published the most articles (n = 21, 42.0%). The most studied topic was concussion/traumatic brain injury (n = 18) followed by studies assessing all injuries (n = 7). Collegiate-level lacrosse was the most studied level of competition (n = 22), while high school-level followed (n = 12). CONCLUSIONS The majority of the 50 most-cited articles related to lacrosse since 1990 focus on the prevalence, diagnosis and identification of concussion/traumatic brain injury in high school and collegiate-level athletes. These articles are predominantly epidemiological or cohort studies with Level III or IV evidence that almost unanimously originate from the United States.
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Affiliation(s)
- Benjamin D Gross
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Avanish Yendluri
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amogh I Iyer
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Akshar V Patel
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Paul J Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Pruneski JA, Heyworth BE, Kocher MS, Tavabi N, Milewski MD, Kramer DE, Christino MA, Yen YM, Micheli LJ, Murray MM, Gilreath L, Kim A, Murray J, Kiapour AM. Prevalence and Predictors of Concomitant Meniscal and Ligamentous Injuries Associated With ACL Surgery: An Analysis of 20 Years of ACL Reconstruction at a Tertiary Care Children's Hospital. Am J Sports Med 2024; 52:77-86. [PMID: 38164668 DOI: 10.1177/03635465231205556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND There is an increasing rate of procedures being performed for concomitant injuries during anterior cruciate ligament (ACL) surgery. Few studies have examined risk factors for these associated injuries in young patients. HYPOTHESIS There are patient-related factors predictive of concomitant knee pathology that differ between age-based cohorts. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Natural language processing was used to extract clinical variables from available notes of patients undergoing ACL surgery between 2000 and 2020 at a single institution (5174 ACL surgeries; mean age, 17 ± 4 years; 53.1% female; accuracy, >98%). Patients were stratified to pediatric (5-13 years), adolescent (14-19 years), and young adult (20-35 years) cohorts. Logistic regression was used to determine predictors of concomitant injury to the menisci, medial collateral ligament (MCL), posterolateral corner (PLC), and posterior cruciate ligament (PCL). RESULTS Between 2000 and 2020, 54% of pediatric, 71% of adolescent, and 70% of adult patients had ≥1 concomitant soft tissue injury. In children and adolescents, increased age was consistently predictive of sustaining a concomitant injury (P < .02). Female children had increased odds of concomitant medial meniscal injury, while female adults had decreased odds (P≤ .046). Adolescent and adult female patients had decreased odds of concomitant lateral meniscal injury (P≤ .027). Female children had increased odds of injury to the MCL (P = .015), whereas female children and adolescents had decreased odds of PCL injury (P≤ .044). Adolescents undergoing revision ACL surgery had increased odds of meniscal injury (P≤ .001) and decreased odds of concomitant MCL injury (P = .028). Increased body mass index (BMI) was associated with increased odds of concomitant medial meniscal injury in all cohorts (P≤ .041), lateral meniscal injury in adults (P = .045), and PLC injury in children (P = .016). Contact injuries were associated with increased odds of MCL injury in adolescents (P = .017) and PLC injury in adolescents and adults (P < .014). CONCLUSION These findings support the hypothesis, as there were multiple factors that significantly affected the risk of concomitant injuries that differed between cohorts. Increased age, BMI, and contact injury history were generally associated with increased odds of sustaining a concomitant injury, whereas female sex and revision ACL surgery had mixed effects. Further studies are essential to investigate the sex-based differences in risk for concomitant injuries and to develop tailored treatment plans that minimize the risk of secondary ACL injury.
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Affiliation(s)
- James A Pruneski
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton E Heyworth
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mininder S Kocher
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nazgol Tavabi
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew D Milewski
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis E Kramer
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa A Christino
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lyle J Micheli
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Martha M Murray
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leah Gilreath
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Kim
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph Murray
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ata M Kiapour
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Chen J, Wu X, Guo J, Zhang X, Zhao J, Xie G. Characterization of the CT-based risk factors for concomitant patellofemoral instability in patients with anterior cruciate ligament injury. Eur Radiol 2024; 34:250-259. [PMID: 37532901 DOI: 10.1007/s00330-023-10028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/22/2023] [Accepted: 06/14/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES Underestimation of concomitant patellofemoral instability in patients with anterior cruciate ligament (ACL) injury has aroused extensive attention. However, the characteristics of the combined injury is not well recognized. Hence, we aimed to characterize the features of the combined injury, and determine the radiographic risk factors. METHODS Fifteen radiological parameters were identified after discussion and pilot-tested. Radiographic measurements were compared using the analysis of variance model with Tukey post hoc analysis. A stepwise binomial logistic regression was performed and a nomogram model combining the significant risk factors was created. The model performance was validated by C-index, calibration plot, and decision curve. RESULTS A total of 204 patients (mean [SD] age, 25.1 [6.7] years; 108 [52.9%] male) were included. The final model was updated through regression analysis using 4 parameters as significant risk factors: lateral femoral condyle ratio (OR (95% CI), 1.194 (1.023 to 1.409)), medial anterior tibial subluxation (mATS) (OR (95% CI), 1.234 (1.065 to 1.446)), medial posterior plateau tibial angle (mPPTA) (OR (95% CI), 1.266 (1.088 to 1.500)), and trochlear depth (OR (95% CI), 0.569 (0.397 to 0.784)). C-index for the nomogram was 0.802 (95% CI, 0.731 to 0.873) and was confirmed to be 0.784 through bootstrapping validation. Calibration plot established a good agreement between prediction and observation. Decision curve analysis showed that if threshold probability was over 10%, using the nomogram adds more benefit than either all or none scheme. CONCLUSIONS Lateral femoral condyle ratio, mATS, mPPTA, and trochlear depth are strong adverse predictors of patellofemoral instability in patients with ACL injury. CLINICAL RELEVANCE This study characterizes the radiological features of the combined injury. Patellofemoral instability should be noted when treating ACL injuries. KEY POINTS • The radiological characteristics of the combined ACL injury and patellofemoral instability is not well recognized. • Lateral femoral condyle ratio, mATS, mPPTA, and trochlear depth are predominant risk factors for patellofemoral instability in patients with ACL injury. • Patellofemoral instability should be noted when treating ACL injuries.
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Affiliation(s)
- Jiebo Chen
- Department of Sports Medicine, National Clinical Medical Centre of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Xiulin Wu
- Department of Sports Medicine, National Clinical Medical Centre of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Jingyi Guo
- Clinical Research Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Xueying Zhang
- Department of Sports Medicine, National Clinical Medical Centre of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Jinzhong Zhao
- Department of Sports Medicine, National Clinical Medical Centre of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
| | - Guoming Xie
- Department of Sports Medicine, National Clinical Medical Centre of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
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Fridén C, Ekenros L, Hirschberg AL, von Rosen P. Body Weight Satisfaction, Comments, Nutrition and Injury Risk in 489 Adolescent Elite Athletes. Int J Sports Med 2023; 44:1086-1092. [PMID: 37848049 DOI: 10.1055/a-2160-1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Exposure to critical body weight comments in youth athletes could lead to decreased self-esteem, affect body image, and increase the risk of eating disorders and cause depressive symptoms. The aim was to explore differences between sex, body mass index, sports type, with regards to body weight satisfaction, exposure to critical body weight comments from their coach and nutrition status in adolescent elite athletes. A questionnaire about body weight, critical body weight comments and nutrition was distributed to 489 adolescent elite athletes and injury prevalence was monitored across 20 weeks. The results showed that almost one in four athletes (n=116, 24%) was not satisfied with their weight and 12% (n=59) had received critical body weight comments from their coach. Of the athletes who were unsatisfied with their body weight (n=116), 47% wanted to lose weight (n=55). A significant (p<0.05) higher proportion of ice hockey players and swimmers used nutritional supplements, were unsatisfied with their body weight, and were more exposed to critical body weight comments compared to athletes from other sports. Adolescent elite athletes as young as 15-16 years old are exposed to critical body weight comments from their coach and experience challenges with body weight satisfaction that is partly dependent on the sport-specific context.
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Affiliation(s)
- Cecilia Fridén
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Linda Ekenros
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Philip von Rosen
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
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Turner TW, Kaar SG. Time to return to school following ACL reconstruction: influence of the COVID-19 pandemic. PHYSICIAN SPORTSMED 2023; 51:558-563. [PMID: 36243035 DOI: 10.1080/00913847.2022.2136983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/12/2022] [Indexed: 10/24/2022]
Abstract
INTRODUCTION ACL reconstruction is commonly performed in school-aged patients for whom missed time from school can have an impact on their education. Additionally, the COVID-19 pandemic has led to different ways of accessing school content. We sought to determine how many days of school school-aged patients should expect to miss following ACL reconstruction and how the availability of remote learning during the COVID-19 pandemic affected this. METHODS We evaluated 53 ACL reconstruction patients in grades 7-12 undergoing surgery during the school year. Demographic, medical, and educational information were collected. Patients were placed into 1 of 2 cohorts: Group A (surgery before the COVID-19 pandemic) or Group B (surgery during the COVID-19 pandemic). We calculated days missed from school after surgery until return to either virtual or in-person school. RESULTS Overall, patients returned to school after missing an average of 4.4 (SD, 3.0) days of school after ACL reconstruction surgery. Patients in Group A missed an average of 5.5 (SD, 2.9) school days, while patients in Group B missed an average of 2.3 (SD, 1.4) school days (p <.001). Eighty-nine percent of Group B patients first returned to school utilizing a virtual option. Among those returning virtually, these patients missed an average of 1.9 (SD, 0.9) school days. CONCLUSIONS A virtual distance learning option results in fewer missed days of school post ACL reconstruction. When given this option, school-aged patients can expect to return to school within two days post-op. Otherwise, patients should expect to miss about one week of in-person schooling. In this regard, the COVID-19 pandemic has positively impacted educational opportunities for students post-surgery, and physicians should advocate for continuing virtual options for students receiving medical treatment.
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Affiliation(s)
- Travis W Turner
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Scott G Kaar
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri, USA
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30
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Hong IS, Pierpoint LA, Hellwinkel JE, Berk AN, Salandra JM, Meade JD, Piasecki DP, Fleischli JE, Ahmad CS, Trofa DP, Saltzman BM. Clinical Outcomes After ACL Reconstruction in Soccer (Football, Futbol) Players: A Systematic Review and Meta-Analysis. Sports Health 2023; 15:788-804. [PMID: 36988238 PMCID: PMC10606974 DOI: 10.1177/19417381231160167] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
CONTEXT The risk factors for anterior cruciate ligament (ACL) tear for athletes participating in pivoting sports includes young age and female sex. A previous meta-analysis has reported a reinjury rate of 15% after ACL reconstruction (ACLR) for athletes across all sports. To the best of the authors' knowledge, this is the first systematic review and meta-analysis of available literature reporting outcomes after ACLR in soccer players. OBJECTIVE To review and aggregate soccer-specific outcomes data after ACLR found in current literature to help guide a more tailored discussion regarding expectations and prognosis for soccer players seeking operative management of ACL injuries. DATA SOURCES A comprehensive search of publications was performed using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and SPORTDiscus databases. STUDY SELECTION Inclusion criteria consisted of original studies, level of evidence 1 to 4, studies reporting clinical and patient-reported outcomes (PROs) after primary ACLR in soccer players at all follow-up length. STUDY DESIGN The primary outcomes of interest were graft failure/reoperation rates, ACL injury in contralateral knee, return to soccer time, and PROs. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Search of literature yielded 32 studies for inclusion that involved 3112 soccer players after ACLR. RESULTS The overall graft failure/reoperation rate ranged between 3.0% and 24.8% (mean follow-up range, 2.3-10 years) and the combined ACL graft failure and contralateral ACL injury rate after initial ACLR was 1.0% to 16.7% (mean follow-up range, 3-10 years); a subgroup analysis for female and male players revealed a secondary ACL injury incidence rate of 27%, 95% CI (22%, 32%) and 10%, 95% CI (6%, 15%), respectively. Soccer players were able to return to play between 6.1 and 11.1 months and the majority of PROs showed favorable scores at medium-term follow-up. CONCLUSION Soccer players experience high ACL injury rates after primary ACLR and demonstrated similar reinjury rates as found in previous literature of athletes who participate in high-demand pivoting sports.
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Affiliation(s)
- Ian S. Hong
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | | | - Justin E. Hellwinkel
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Alexander N. Berk
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - Jonathan M. Salandra
- Department of Orthopaedic Surgery, Jersey City Medical Center, RWJBarnabas Health, Jersey City, New Jersey
| | - Joshua D. Meade
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - Dana P. Piasecki
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - James E. Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - Christopher S. Ahmad
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - David P. Trofa
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Bryan M. Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
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Nakamura Y, Shah N, Stirpe A, Gupta P, Liolios N. The Lived Experience of Rehabilitation Following Anterior Cruciate Ligament Reconstructive Surgery: A Social Ecological Analysis. Physiother Can 2023; 75:359-365. [PMID: 38037578 PMCID: PMC10686301 DOI: 10.3138/ptc-2021-0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 12/02/2023]
Abstract
Purpose To identify, using a social ecological model, the multi-level facilitators and barriers that shape the lived experience of rehabilitation following anterior cruciate ligament reconstructive (ACLR) surgery. Method Semi-structured interviews with 12 adults who experienced rehabilitation following ACLR surgery. Thematic analysis of qualitative data was completed following Braun and Clarke's framework. Results The experience of rehabilitation was influenced by intrapersonal, interpersonal, physical, institutional, community, and policy level factors. Conclusions A patient's ability to successfully complete a rehabilitation program, particularly home exercises, can be situated within a social and ecological context in ways that could improve patient adherence and compliance.
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Affiliation(s)
- Yuka Nakamura
- From the:
From the: Faculty of Health, York University, Toronto, Ontario, Canada
| | - Nirtal Shah
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Alenna Stirpe
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Prateek Gupta
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Liolios
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
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32
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Hasegawa ME, Delos Reyes CD, Rimm JB, Radi JK, Singh DS, Obana KK, Weldon EJ, Thorne TJ, Tamate TM, Alferos SR, Min KS. Update on Current Concepts of Blood Flow Restriction in the Perioperative Period of Anterior Cruciate Ligament Reconstruction. Orthopedics 2023; 46:e333-e340. [PMID: 37561100 DOI: 10.3928/01477447-20230804-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Anterior cruciate ligament tears or ruptures are common orthopedic injuries. Anterior cruciate ligament reconstruction (ACLR) is an orthopedic procedure allowing for earlier return to sports, improved maintenance of lifestyle demands, and restored knee stability and kinematics. A perioperative rehabilitative adjunct recently gaining interest is blood flow restriction (BFR), a method in which temporary restriction of blood flow to a chosen extremity is introduced and can be used as early as a few days postoperative. There has been increasing investigation and recent literature regarding BFR. This review synthesizes current concepts of BFR use in the ACLR perioperative period. [Orthopedics. 2023;46(6):e333-e340.].
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Maheshwer B, Paliobeis A, Halkiadakis P, Konda S, Calcei JG, Voos JE. Anterior Cruciate Ligament Tears in the Adolescent Population: Injury Demographics and Risk of Reinjury Among High School Athletes. J Pediatr Orthop 2023; 43:591-597. [PMID: 37728131 DOI: 10.1097/bpo.0000000000002505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) injuries is increasing among the adolescent population with a peak occurring in the high school age range. PURPOSE To characterize recent epidemiologic trends of ACL injuries, ACL reconstruction (ACLR), and retear rates in high school adolescents based on age, participating sport, and mechanism of injury. STUDY DESIGN Retrospective case series. METHODS A prospectively maintained institutional database was retrospectively reviewed for all patients 18 or younger who underwent primary ACLR between 2015 and 2020. Odds ratios were calculated for baseline patient characteristics and their association with risk of retear. Multivariate regression analysis was also performed to identify the relationship between retear and specific categorical variables. RESULTS A total of 482 patients were included, with a mean follow-up time of 13.0 ± 11.8 months. Patients were an average age of 16.1 ± 1.3 years old (range: 13 to 18 y). Initial presentation of ACL injuries in high school athletes often occurred at 16 years old regardless of the sport played. Based on age, high school freshmen and seniors are found to have an increased risk of ACL retear. One hundred three patients (21.6%) completed at least 2 or more years of follow-up after ACLR. Of these patients, 38.8% received a bone-tendon-bone (BTB) autograft, 36.9% hamstring autograft, 14.6% quadriceps tendon autograft, and 3.9% received hamstring allograft or other graft (eg, tibialis anterior and BTB allograft), respectively. There were 25 ipsilateral ACL retears that occurred in the patient cohort (5.2%). Thirteen (52%) of retears were females. Football and soccer were the most common sports played by patients with a retear of the ipsilateral knee (31.8% and 27.3%, respectively). Patients who were 13 to 14 or 18 years old ( P = 0.009 and 0.035, respectively) or who received a tibialis anterior/BTB allograft ( P = 0.002) were found to have increased risk of ACL retear compared with other age groups. When evaluating by sex, female soccer players had a greater risk of retear compared with male soccer players ( P = 0.007). When adjusting for multiple variables, (including age, sex, body mass index, primary reconstruction graft choice, sport, and length of follow-up), the odds of ipsilateral retear in patients who received hamstring autograft ( P = 0.02), sustained a contralateral ACL tear ( P = 0 .04), or a contact injury ( P = 0.01) were increased. CONCLUSION Initial presentation of ACL injuries in high school athletes often occurs at 16 years old regardless of the sport played. Based on age, high school freshmen and seniors are found to have an increased risk of ACL retear. However, the overall rate of ACL retear in high school athletes of all ages is low. Patients who underwent ACLR with hamstring tendon autograft had a greater risk of retear compared with other graft types. Female soccer players also had a greater risk of ACL retear. High school athletes must take caution when in the early high school years (underclassman) and more senior years (upperclassman), as susceptibility for ACL retears is elevated. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Bhargavi Maheshwer
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; and
| | - Andrew Paliobeis
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; and
| | - Penelope Halkiadakis
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; and
| | - Sreenivas Konda
- Department of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL
| | - Jacob G Calcei
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; and
| | - James E Voos
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; and
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Ekenros L, Fridén C, von Rosen P. Previous Injury and Lower Well-being Increase Injury Risk in Female Adolescent Athletes. Int J Sports Med 2023; 44:919-924. [PMID: 37490928 DOI: 10.1055/a-2108-6463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Several risk factors for injury have been suggested in female elite athletes. However, there is a lack of prospective studies in young female athletes where multiple risk factors have been studied. The aim of this study was to identify risk factors for injury in female adolescent elite athletes. Substantial injuries were monitored in 222 athletes using the validated Oslo Sports Trauma Research Centre Questionnaire over 20 weeks. Over 20 potential risk factors were explored. Based on a binomial generalized linear mixed model, two significant (p<0.05) risk factors for injury were identified; previous injury within the last 12 months (OR 2.55) and well-being (OR 0.97). An athlete with a previous injury had twice as high a risk of injury (13% vs. 6%) compared to an athlete with no previous injury. Higher perceived well-being was associated with a decreased risk of injury. Based on a prospective design with a large sample of female adolescent elite athletes, investigating over 20 potential risk factors for injury, our results suggest that a previous injury and well-being are risk factors for injury.
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Affiliation(s)
- Linda Ekenros
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Cecilia Fridén
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Philip von Rosen
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
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Zarro M, Dickman M, Hulett T, Rowland R, Larkins D, Taylor J, Nelson C. Hop to It! The Relationship Between Hop Tests and The Anterior Cruciate Ligament - Return to Sport Index After Anterior Cruciate Ligament Reconstruction in NCAA Division 1 Collegiate Athletes. Int J Sports Phys Ther 2023; 18:1076-1084. [PMID: 37795334 PMCID: PMC10547069 DOI: 10.26603/001c.86130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/05/2023] [Indexed: 10/06/2023] Open
Abstract
Background Outcomes after anterior cruciate ligament reconstruction (ACLR) may not be optimal, with poor physical and psychological function potentially affecting return to sport (RTS) ability. Understanding the relationship between commonly used hop tests and the Anterior Cruciate Ligament - Return to Sport Index (ACL-RSI) may improve rehabilitation strategies and optimize patient outcomes. Hypothesis/Purpose The purpose of this study was to examine the relationship between ACL-RSI scores and limb symmetry index (LSI) for the single hop for distance (SHD), triple hop for distance (THD), crossover hop for distance (CHD), timed 6-meter hop (T6H), and single leg vertical hop (SLVH) in a cohort of National Collegiate Athletic Association (NCAA) Division 1 collegiate athletes after ACLR. The hypothesis was that SLVH LSI would be more highly correlated with ACL-RSI score than all horizontal hop tests. Study design Cross-Sectional Study. Methods Twenty-one National Collegiate Athletic Association (NCAA) Division 1 collegiate athletes (7 males, 14 females) at 6.62 ± 1.69 months after ACLR were included in this retrospective study. Primary outcomes were ACL-RSI score and LSI for SHD, THD, CHD, T6H, and SLVH. The relationship between ACL-RSI scores and performance on hop tests (LSIs) was evaluated using correlation analysis and step-wise linear regression (p ≤ 0.05). Results There were significant correlations found when comparing ACL-RSI and the LSI for SHD (rs = 0.704, p < 0.001), THD (rs = 0.617, p = 0.003), CHD (rs = 0.580, p = 0.006), and SLVH (rs = 0.582, p = 0.006). The CHD explained 66% (R2 value of 0.660) of the variance in the ACL-RSI, while the other hop tests did not add to the predictive model. Conclusions Physical function has the capacity to influence psychological status after ACLR. Clinicians should recognize that SLVH, SHD, THD, and CHD are correlated with ACL-RSI and improvements in physical function during rehabilitation may improve psychological status and optimize RTS after ACLR. Level of evidence Level 3.
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Affiliation(s)
- Michael Zarro
- Physical Therapy and Rehabilitation Science University of Maryland, Baltimore
- Orthopaedics University of Maryland, Baltimore
| | - Madelyn Dickman
- Physical Therapy and Rehabilitation Science University of Maryland, Baltimore
| | - Timothy Hulett
- Physical Therapy and Rehabilitation Science University of Maryland, Baltimore
| | - Robert Rowland
- Physical Therapy and Rehabilitation Science University of Maryland, Baltimore
- Orthopaedics University of Maryland, Baltimore
| | - Derrick Larkins
- Physical Therapy and Rehabilitation Science University of Maryland, Baltimore
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36
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Kano T, Minegish Y, Terada H, Takasu C, Kojima T, Oka Y, Kawabata S, Shimada N, Morishita Y, Murata K, Kanemura N. The infrapatellar fat pad contributes to spontaneous healing after complete anterior cruciate ligament injury. Exp Biol Med (Maywood) 2023; 248:1895-1904. [PMID: 38149772 PMCID: PMC10792419 DOI: 10.1177/15353702231215921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/12/2023] [Indexed: 12/28/2023] Open
Abstract
Anterior cruciate ligament (ACL) injuries have a very low healing capacity but have recently been shown to heal spontaneously with conservative treatment. This study examined the mechanism of spontaneous ACL healing by focusing on the intra-articular tissues of the knee joint. Skeletally mature Wistar rats (n = 70) were randomly assigned to two groups: the controlled abnormal movement (CAM) and anterior cruciate ligament transection (ACLT) groups. The ACL was completely transected at the mid-portion in both groups. Only the CAM group underwent extra-articular braking to control for abnormal tibial translation. The animals were allowed full cage activity until sacrifice for histological, and molecular biology analyses. The results showed that the behavior of the stump after ACL injury differed between models 12 h after injury. The femoral stump in the ACLT group retreated posteriorly and upwardly. Macrophage polarity analysis revealed that the stump immune response in the CAM group was more activated than that in the ACLT group 6 h after injury. Microarray analysis of the ACL parenchyma and infrapatellar fat pads suggested the involvement of nuclear factor kappa B (NF-κB) signaling. Real-time polymerase chain reaction (PCR) analysis showed that NF-κB gene expression in the infrapatellar fat pad was significantly increased in the CAM group than in the ACLT group. However, there was no difference in the gene expression levels in the ACL parenchyma between models. In conclusion, the healing response of the ACL was activated within 12 h of injury, resulting in differences in the healing response between the models. It has been suggested that infrapatellar fat pads are involved in the healing process and that angiogenesis and antiapoptotic effects through NF-κB signaling may contribute to this mechanism.
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Affiliation(s)
- Takuma Kano
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama 343-8540, Japan
- Soka Orthopedic Internal Medicine, Saitama 340-0016, Japan
- Yatsuka Orthopedic Internal Medicine, Saitama 340-0028, Japan
| | - Yuki Minegish
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama 343-8540, Japan
- Department of Rehabilitation, Faculty of Health Sciences, Nihon Institute of Medical Science, Saitama 350-0435, Japan
| | - Hidenobu Terada
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama 343-8540, Japan
- Yatsuka Orthopedic Internal Medicine, Saitama 340-0028, Japan
| | - Chiharu Takasu
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama 343-8540, Japan
- Yatsuka Orthopedic Internal Medicine, Saitama 340-0028, Japan
| | - Takuma Kojima
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama 343-8540, Japan
- Soka Orthopedic Internal Medicine, Saitama 340-0016, Japan
| | - Yuichiro Oka
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
| | - Sora Kawabata
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama 343-8540, Japan
| | - Naoki Shimada
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama 343-8540, Japan
| | | | - Kenji Murata
- Saitama Prefectural University, Saitama 343-8540, Japan
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Jackson GR, Lee J, Tuthill T, Chan J, Sugrañes J, Mowers CC, Batra A, Khan ZA, Mameri ES, Brusalis CM, Chahla J, Verma NN. Higher Rates of Residual Postoperative Instability after Anterior Cruciate Ligament Reconstruction in Female Patients: A Systematic Review of Level II Studies. Arthrosc Sports Med Rehabil 2023; 5:100772. [PMID: 37560145 PMCID: PMC10407150 DOI: 10.1016/j.asmr.2023.100772] [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: 12/31/2022] [Accepted: 06/03/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE To compare revision rates and residual postoperative instability after anterior cruciate ligament (ACL) reconstruction based on biological sex. METHODS A systematic review was conducted according to the 2020 PRISMA guidelines. PubMed, Embase, MEDLINE, and Cochrane library databases were queried from database inception through October 2022. Level I and II prospectively-enrolling human clinical studies that compared revision rates and physical examination of postoperative stability after ACL reconstruction between male and female patients were included. Outcomes were stratified by patient sex and quantitatively compared using a χ2 test. Study quality was assessed using the MINORS criteria. RESULTS Four studies consisting of 406 patients (50% males) with a mean age of 25 years (range, 13.9-62 years) were identified. Mean follow-up time was 34.4 months (range, 22-60 months). Hamstring tendon autografts were used in 62% of ACL reconstructions in males and in 65% of ACL reconstructions in females, whereas bone-patellar tendon-bone autografts were used in 38% and 35% of procedures in males and females, respectively. A residual positive Lachman test result was more frequently reported among females compared to males (5.8% vs 0.6%; P = 0.03). No significant difference in revision rates or residual pivot-shift on examination was observed between males and females (P = 0.38 and P = 0.08, respectively). CONCLUSION Female patients undergoing ACL reconstruction have higher reported rates of residual anterior instability with Lachman than male patients. However, no sex-based differences were identified with residual pivot-shift on examination or rate of revision ACL surgery. LEVEL OF EVIDENCE II; Systematic Review of level II studies.
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Affiliation(s)
- Garrett R. Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jonathan Lee
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Trevor Tuthill
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jimmy Chan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Joan Sugrañes
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- Department of Orthopaedic Surgery, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Colton C. Mowers
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Anjay Batra
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Zeeshan A. Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Enzo S. Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- Instituto Brasil de Tecnologia da Saúde, Rio de Janeiro
- Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | | | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Nikhil N. Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Liao TC, Bird A, Samaan MA, Pedoia V, Majumdar S, Souza RB. Persistent underloading of patellofemoral joint following hamstring autograft ACL reconstruction is associated with cartilage health. Osteoarthritis Cartilage 2023; 31:1265-1273. [PMID: 37116856 PMCID: PMC11167283 DOI: 10.1016/j.joca.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/31/2023] [Accepted: 04/14/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To determine the longitudinal changes of patellofemoral joint (PFJ) contact pressure following anterior cruciate ligament reconstruction (ACLR). To identify the associations between PFJ contact pressure and cartilage health. DESIGN Forty-nine subjects with hamstring autograft ACLR (27 males; age 28.8 [standard deviation, 8.3] years) and 19 controls (12 males; 30.7 [4.6] years) participated. A sagittal plane musculoskeletal model was used to estimate PFJ contact pressure. A combined T1ρ/T2 magnetic resonance sequence was obtained. Assessments were performed preoperatively, at 6 months, 1, 2, and 3 years postoperatively in ACLR subjects and once for controls. Repeated Analysis of Variance (ANOVA) was used to compare peak PFJ contact pressure between ACLR and contralateral knees, and t-tests to compare with control knees. Statistical parametric mapping was used to evaluate the associations between PFJ contact pressure and cartilage relaxation concurrently and longitudinally. RESULTS No changes in peak PFJ contact pressure were found within ACLR knees over 3 years (preoperative to 3 years, 0.36 [CI, -0.08, 0.81] MPa), but decreased over time in the contralateral knees (0.75 [0.32, 1.18] MPa). When compared to the controls, ACLR knees exhibited lower PFJ contact pressure at all time points (at baseline, -0.64 [-1.25, -0.03] MPa). Within ACLR knees, lower PFJ contact pressure at 6 months was associated with elevated T2 times (r = -0.47 to -0.49, p = 0.021-0.025). CONCLUSIONS Underloading of the PFJ following ACLR persists for up to 3 years and has concurrent and future consequences in cartilage health. The non-surgical knees exhibited normal contact pressure initially but decreased over time achieving limb symmetry.
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Affiliation(s)
- Tzu-Chieh Liao
- Department of Physical Therapy, University of Michigan-Flint, Flint, MI, USA; Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
| | - Alyssa Bird
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, USA
| | - Michael A Samaan
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Richard B Souza
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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Zaid HHG, Yang G, Xu Hua. Anterior Cruciate Ligament Reconstruction Using Autologous Hamstrings Augmented with Ligament Augmentation and Reconstruction Systems (LARS) or Synthetic Meshwork of LARS Compared with Four-Strand Hamstring Tendon Grafts Alone, a Prospective, Randomized Clinical Study with 2- to 8-Year Follow-Up. Indian J Orthop 2023; 57:1497-1509. [PMID: 37609011 PMCID: PMC10441880 DOI: 10.1007/s43465-023-00956-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/13/2023] [Indexed: 08/24/2023]
Abstract
Purpose To compare the long-term outcomes of anterior cruciate ligament (ACL) reconstruction using a four-strand hamstring tendon graft alone (hamstring group) or with synthetics (Ligament Augmentation and Reconstruction System, LARS group) or synthetic meshwork of LARS (meshwork group). Methods Patients who underwent ACL reconstruction using four-strand hamstring tendon grafts (hamstring group), autologous hamstrings augmented with the LARS (LARS group), or synthetic meshwork of LARS (meshwork group) were selected in this prospective randomized clinical study. Patient-reported outcome measures (PROMs) were obtained preoperatively; at 6, 12, and 18 months postoperatively; and at final follow-up between 3 and 8 years. Second-look arthroscopic findings were used to evaluate graft morphology based on graft tension, graft tear, and synovial coverage. Results A total of 141 consecutive patients underwent ACL reconstruction, 47 patients in each group, and 21 patients were lost to follow-up during the study period. At the 6-month follow-up, the IKDC scores and Lysholm scores were significantly better in the LARS group (P < 0.05). At the 6- and 12-month follow-ups, the KOS-ADLS, KOOS-activities of daily living and quality of life, NSARS scores, GRC scores, Tegner scores, and ACL-RSI scores were significantly better in the LARS group (P < 0.05). For the LARS group, hamstring group, and meshwork group, the cumulative failure rates were 8.5%, 12.8%, and 4.3%, respectively. Malposition of the femoral tunnel was significantly associated with cumulative failure (P < 0.05). There was no difference between the groups in other outcomes at any other time, including radiographic and arthroscopic outcomes. Conclusions ACL reconstruction using autologous hamstring augmented with LARS resulted in significantly better clinical scores with a faster return to sports and comparative side-to-side differences in graft laxity by 6 and 12 months follow-up. Despite these findings, no statistically significant differences were seen among the three patient groups in terms of objective outcomes and clinical scores at the 18-month, 3-year and 8-year follow-ups. Additionally, a malpositioned femoral tunnel was associated with graft failure.
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Affiliation(s)
- Hamood H. G. Zaid
- Department of Sports Medicine, The First Affiliated Hospital of Xiamen University, No. 55 Zhenhai Street, Siming District, Xiamen, 361026 Fujian China
- College of Integrative Medicine, Fujian University of Traditional Chinese Medicine, No. 282, Wusi Road, Gulou District, Fuzhou, 350122 Fujian China
| | - Guo Yang
- Department of Sports Medicine, The First Affiliated Hospital of Xiamen University, No. 55 Zhenhai Street, Siming District, Xiamen, 361026 Fujian China
| | - Xu Hua
- Department of Orthopedics, Xinglin Branch of the First Affiliated Hospital of Xiamen University, No. 11 Xinglin Hongdai Road, Jimei District, Xiamen, 361026 Fujian China
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40
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Zhang ZY, Huang HJ, Maimaitijiang P, Pan XY, Fu XY, Wang C, Wang JQ. Comparisons of diagnostic performance and the reliability in identifying ACL injury between two measuring protocols of anterior tibial subluxation on MR images. Skeletal Radiol 2023; 52:1713-1720. [PMID: 37036469 DOI: 10.1007/s00256-023-04336-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/01/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance in identifying an anterior cruciate ligament (ACL) injury and the reliability between two measuring protocols of anterior tibial subluxation (ATS). MATERIALS AND METHODS A total of 165 patients with ACL injury and 157 ACL-intact patients were included in this study. Two different measuring protocols of ATS were performed on sagittal MR images, including the modified protocol using the longitudinal tibial axis (axis protocol) and the established protocol using a line perpendicular to the tibial plateau (plateau protocol). Receiver-operating characteristic (ROC) curves were calculated to evaluate the diagnostic performance in identifying an ACL injury, and areas under the curves (AUCs) were compared between the two protocols. Intra- and interobserver reliability tests were performed to evaluate the reliability of the measurements. RESULTS Lateral ATS (P < 0.001) and medial ATS (P < 0.001) were increased in patients with ACL injury under both protocols. To identify an ACL injury, ATS measured under the axis protocol showed higher AUC values than the plateau protocol, including lateral ATS (AUC 0.828 vs. 0.688, P < 0.001), medial ATS (AUC 0.829 vs. 0.789, P = 0.013), and the combined indicator of lateral and medial ATS (AUC 0.885 vs. 0.810, P < 0.001). Reliability tests showed that both protocols were reliable. CONCLUSIONS ATS measured under the modified protocol using the longitudinal tibial axis showed superior diagnostic performance in identifying an ACL injury compared to the established protocol, indicating that the modified protocol may better reflect the characteristics of an ACL-deficient knee.
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Affiliation(s)
- Zhi-Yu Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Hong-Jie Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | | | - Xiao-Yu Pan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xiao-Yue Fu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
| | - Jian-Quan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
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41
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Heering T, Rolley TL, Lander N, Fox A, Barnett LM, Duncan MJ. Identifying modifiable risk factors and screening strategies associated with anterior cruciate ligament injury risk in children aged 6 to 13 years: A systematic review. J Sports Sci 2023; 41:1337-1362. [PMID: 37930935 DOI: 10.1080/02640414.2023.2268900] [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: 03/17/2023] [Accepted: 10/03/2023] [Indexed: 11/08/2023]
Abstract
Growing anterior cruciate ligament (ACL) injury incidence is reported in countries across Europe, North America and in Australia for 5-14-year-olds, yet research on injury risk reduction predominantly focuses on populations aged > 13 years. For injury risk reduction, it is crucial to understand (i) which modifiable risk factors are associated with ACL injury in children (6-13 years) and (ii) how these risk factors are assessed. Articles were grouped according to sex/gender and/or maturational/age differences and examined modifiable risk factors during different physical screening tasks. The included articles (n = 40) predominantly examined intrinsic risk factors in girls aged 10-13 years. Factors mechanically linked to increased ACL loading at this age included increased peak knee adductor moments, knee valgus angles, hip and knee extension, and ground reaction forces. Assessment focused on laboratory-based assessments (e.g., motion capture, force plates). This review concluded that modifiable risk factors are present in children aged 6-13 years and that injury risk reduction strategies should be implemented as early as possible regardless of sex/gender. Further, screening strategies need updating to be childhood specific and feasible for the wide community. Additional research on extrinsic risk factors, norm values and children aged 6-9 years could allow for more targeted risk reduction strategies.
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Affiliation(s)
- Theresa Heering
- Centre of Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK
- School of Health and Social Development, Deakin University, Victoria, Australia
| | - Tess L Rolley
- School of Exercise and Nutrition Science, Deakin University, Victoria, Australia
| | - Natalie Lander
- Institute for Physical Activity and Nutrition, Deakin University, Victoria, Australia
| | - Aaron Fox
- School of Exercise and Nutrition Science, Deakin University, Victoria, Australia
| | - Lisa M Barnett
- School of Health and Social Development, Deakin University, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Victoria, Australia
| | - Michael J Duncan
- Centre of Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK
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42
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Jeffs AD, Boyd M, Larabee L, Shelton M, Bassil A, Taylor R, Berkoff D. The role of leukotriene inhibition using a 5-lipoxygenase (5-LO) inhibitor in a joint contracture model. J Exp Orthop 2023; 10:64. [PMID: 37341811 DOI: 10.1186/s40634-023-00616-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/05/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Arthrofibrosis is a common inflammatory complication of joint trauma and surgery. 5lipoxygenase (5-LO) is a key enzyme involved in inflammation. Inhibition of 5-LO has been shown to reduce inflammation in heart and lung models but has not been examined in a joint contracture model. METHODS Twenty-six rats underwent joint contracture. Six rats served as non-surgical controls. A 5-LO inhibitor, caffeic acid (CA), suspended in 10% ethanol was orally administered to 14 rats and ethanol without CA to the remaining 12 rats daily for 21 days. Leukotriene B4 (LTB4) levels were measured, both systemically and locally. 5-LO levels in the posterior capsule were quantified by measuring the ratio of the length of the posterior capsule demonstrating 5-LO immunostaining to the total length of the capsule. RESULTS Joint contracture was successfully achieved in all rats who underwent manipulation. Levels of 5- LO measured in the posterior capsule were significantly increased in the animals who underwent surgery (56%/44-64) compared to the non-surgical control animals (7%/4-9). LTB4 levels were found to be significantly lower in the non-surgical control animals (107.79 ± 34.08 pg/ml) compared to all surgical animals (157.6 ± 55.3 pg/ml). CONCLUSION Surgical intervention resulted in increased 5-LO activity of the synovial surface of the posterior capsule and increased LTB4 levels in the patellar tendon-fat pad. Oral administration of the 5LO inhibitor, CA, was ineffective at reducing systemic and local LTB4 levels and preventing knee joint contracture. Inhibiting 5-LO activity may still be effective in preventing arthrofibrosis and warrants further investigation.
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Affiliation(s)
- Alexander D Jeffs
- Department of Orthopaedics, The University of North Carolina, Chapel Hill, NC, USA.
| | - Michael Boyd
- Department of Orthopaedics, The University of North Carolina, Chapel Hill, NC, USA
- Department of Family Medicine, The University of North Carolina, Chapel Hill, NC, USA
| | - Landon Larabee
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Matthew Shelton
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Ross Taylor
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - David Berkoff
- Department of Orthopaedics, The University of North Carolina, Chapel Hill, NC, USA
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Stojanović MDM, Andrić N, Mikić M, Vukosav N, Vukosav B, Zolog-Șchiopea DN, Tăbăcar M, Melinte RM. Effects of Eccentric-Oriented Strength Training on Return to Sport Criteria in Late-Stage Anterior Cruciate Ligament (ACL)-Reconstructed Professional Team Sport Players. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1111. [PMID: 37374316 DOI: 10.3390/medicina59061111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: An effective post-injury training program is essential to regain performance and fulfill criteria for return to sport for team sport athletes following anterior cruciate ligament (ACL) reconstruction. The aim of this study was to compare the effects of 6 weeks of eccentric-oriented strength training vs. traditional strength training during the late-stage ACL-rehab phase on leg strength and vertical and horizontal jumping performance in professional team sport athletes. Materials and Methods: Twenty-two subjects (14 males, 8 females, age 19.9 ± 4.4 years, mass 77.4 ± 15.6 kg, height 182.4 ± 11.7 cm) (mean ± SD) with a unilateral reconstructed ACL (BTB graft) were included in the study. All participants enrolled in the same rehabilitation protocol prior to the training study. Players were randomly assigned to an experimental (ECC: n = 11, age 21.8 ± 4.6 years, mass 82.7 ± 16.6 kg, height 185.4 ± 12.2 cm), and a control group (CON: n = 11, age 19.1 ± 2.1 years, mass 76.6 ± 16.5 kg, height 182.5 ± 10.2 cm). Both groups underwent an equivolumed rehabilitation program, with the only difference being in strength training, which consisted of flywheel training vs. traditional strength training for the experimental and control groups, respectively. Testing was organized before and after the 6-week training programs and included isometric semi-squat tests (ISOSI-injured and ISOSU-uninjured legs), vertical jump tests (CMJ), single-leg vertical jump tests (SLJI-injured and SLJU-uninjured legs), single-leg hop tests (SLHI-injured and SLHU-uninjured legs), and triple hop tests (TLHI-injured and TLHU-uninjured legs). In addition, limb symmetry indexes were calculated for the isometric semi-squat (ISOSLSI) test, the single-leg vertical jump (SLJLSI), and the hop (SLHLSI) tests, as well as the triple-leg hop (THLLSI) test. Results: Main effects of time across training were observed for all dependent variables (posttest > pretest, p < 0.05). Significant group-by-time interactions were found for ISOSU (p < 0.05, ES = 2.51, very large), ISOSI (p < 0.05, ES = 1.78, large), CMJ (p < 0.05, ES = 2.23, very large), SLJI (p < 0.05, ES = 1.48, large), SLHI (p < 0.05, ES = 1.83, large), and TLHI (p < 0.05, ES = 1.83, large). Conclusions: This study suggests that eccentric-oriented strength training in late-stage ACL recovery, undertaken twice or three times weekly for 6 weeks, results in better outcomes than traditional strength training in leg strength, vertical jump ability, and single and triple hop tests with injured legs in professional team sport athletes. It seems that flywheel strength training can be recommended in late-stage ACL recovery for professional team sport athletes in order to regain recommended performance outcome levels faster.
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Affiliation(s)
- Marko D M Stojanović
- Training Expertise Lab, Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Nikola Andrić
- Training Expertise Lab, Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Mladen Mikić
- Training Expertise Lab, Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Nikola Vukosav
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Borko Vukosav
- Sports Medicine Department, Medical Clinic "ST Medicina", 21000 Novi Sad, Serbia
| | - Dan-Nicolae Zolog-Șchiopea
- Orthopedic Department, Puls Hospital of Regina Maria Hospital, 540136 Targu Mures, Romania
- Orthopedic Surgery and Traumatology Department, Humanitas Hospital, 400001 Cluj Napoca, Romania
| | - Mircea Tăbăcar
- Orthopedic Department, Puls Hospital of Regina Maria Hospital, 540136 Targu Mures, Romania
| | - Răzvan Marian Melinte
- Orthopedic Department, Puls Hospital of Regina Maria Hospital, 540136 Targu Mures, Romania
- Orthopedic Surgery and Traumatology Department, Humanitas Hospital, 400001 Cluj Napoca, Romania
- Fizionova Reahabilitation, 540136 Targu Mures, Romania
- Orthopedic Surgery and Traumatology Department, Dimitrie Cantemir University, 540136 Targu Mures, Romania
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Jorge PB, Horita MM, de Oliveira e Silva M, Marinho de Gusmão Canuto S, Helito CP, Escudeiro de Oliveira D. Anterior Cruciate and Anterior Oblique Ligament Reconstruction Using Hamstrings and Peroneus Longus' Anterior Half Grafts. Arthrosc Tech 2023; 12:e861-e866. [PMID: 37424635 PMCID: PMC10323729 DOI: 10.1016/j.eats.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/12/2023] [Accepted: 02/11/2023] [Indexed: 07/11/2023] Open
Abstract
Anterior cruciate ligament injuries are common in high school and college with an estimated 120,000 cases per year in the United States. Most sports injuries occur without direct contact, and knee valgus with external rotation of the foot is the most common movement. This movement may be related to the injury of the anterior oblique ligament located in the anteromedial quadrant of the knee. This technical note presents anterior cruciate ligament reconstruction with extraarticular anteromedial reinforcement using hamstring and the anterior half of the peroneus longus grafts.
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Affiliation(s)
- Pedro Baches Jorge
- Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Melanie Mayumi Horita
- Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Marconde de Oliveira e Silva
- Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Camilo Partezani Helito
- Department of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Diego Escudeiro de Oliveira
- Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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Zhang L, Xia Q, Yang R, Fan L, Hu Y, Fu W. Anatomical factors associated with the development of anterior tibial spine fractures based on MRI measurements. J Orthop Surg Res 2023; 18:357. [PMID: 37173712 PMCID: PMC10182680 DOI: 10.1186/s13018-023-03836-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Numerous studies have investigated anatomic factors for anterior cruciate ligament (ACL) injuries, such as posterior tibial slope (PTS) and notch width index (NWI). However, anterior tibial spine fracture (ATSF) as a specific pattern of ACL injury, a bony avulsion of the ACL from its insertion on the intercondylar spine of the tibia, has rarely been explored for its anatomical risk factors. Identifying anatomic parameters of the knee associated with ATSF is important for understanding injury mechanisms and prevention. METHODS Patients who underwent surgery for ATSF between January 2010 and December 2021 were retrospectively reviewed, and 38 patients were included in the study group. Thirty-eight patients who suffered from isolated meniscal tear without other pathologic findings were matched in a 1:1 fashion by age, sex and BMI to the study group. The lateral posterior tibial slope (LPTS), medial posterior tibial slope (MPTS), medial tibial depth, lateral tibial height, lateral femoral condyle ratio (LFCR) and NWI were measured and compared between the ATSF and control groups. Binary logistic regressions identified independent predictors of ATSF. Receiver operator characteristic (ROC) curves were performed to compare the diagnostic performance and determine the cutoff values of associated parameters. RESULTS The LPTS, LFCR and MPTS were significantly larger in the knees in the ATSF group than in the control group (P = 0.001, P = 0.012 and P = 0.005, respectively). The NWI was significantly smaller in the knees in the ATSF group than in the control group (P = 0.005). According to the results of logistic regression analysis, the LPTS, LFCR and NWI were independently associated with ATSF. The LPTS was the strongest predictor variable, and the ROC analysis revealed 63.2% sensitivity and 76.3% specificity (area under the curve, 0.731; 95% CI 0.619-0.844) for values above 6.9. CONCLUSION The LPTS, LFCR and NWI were found to be associated with the ATSF; in particular, LPTS could provide the most accurate predictive performance. The findings of this study may aid clinicians in identifying people at risk for ATSF and taking individualized preventive measures. However, further investigation regarding the pattern and biomechanical mechanisms of this injury is required.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Qinghong Xia
- Operating Room of Anesthesia Surgery Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Runze Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Fan
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yunan Hu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
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Bano JM, McAdams RJ, Roberts KJ, Yang J, McKenzie LB. Lacrosse-related injuries in boys and girls treated in U.S. emergency departments, 2000-2016. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:414-422. [PMID: 32810607 DOI: 10.1016/j.jshs.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/07/2020] [Accepted: 06/29/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND Lacrosse is one of the fastest-growing sports in the United States. Its rules regarding permitted contact differ by sex and age. There are no known studies using a nationally representative data set to analyze lacrosse injury patterns over several years by sex and age in the youth population. METHODS A retrospective analysis was performed using data from the National Electronic Injury Surveillance System for youth aged 11-18 years who were treated for lacrosse-related injuries in U.S. emergency departments from 2000 to 2016. Based on our review of the case narratives, we created and coded a new injury-mechanism variable. We generated national estimates from 6406 cases. RESULTS An estimated 206,274 lacrosse-related injuries to youths aged 11-18 years were treated in U.S. emergency departments from 2000 to 2016. The rate of injuries per 10,000 significantly increased from 1.9 in 2000 to a peak of 5.3 in 2012 (p < 0.0001), followed by a significant decrease to 3.4 in 2016 (p = 0.020). Injury mechanism, body part injured, and diagnosis differed by sex. Boys were 1.62 times (95% confidence interval (95%CI): 1.25-2.09) more likely than girls to be injured by player-to-player contact. Girls were 2.21 times (95%CI: 1.96-2.49) more likely than boys to have non-contact injuries. Overall, as age increased, the percentage of injuries from lacrosse sticks decreased and player-to-player contact increased. CONCLUSION Despite additional protective regulations in the sport, lacrosse is an important source of injury where we continue to see differences by sex and age. This study supports the continuation, modification, and addition of rules aimed at reducing lacrosse injury risk.
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Affiliation(s)
- Joseph M Bano
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Rebecca J McAdams
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Kristin J Roberts
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Jingzhen Yang
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, OH 43205, USA; Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, OH 43210, USA
| | - Lara B McKenzie
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, OH 43205, USA; Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, OH 43210, USA.
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Kremen TJ, Wu SY, Upfill-Brown A, Bugarin A, Huang J, Jones KJ, Shi BY. Impact of the COVID-19 Pandemic Hiatus From Sports Activities on Injuries Observed Among Division I NCAA Athletes. Orthop J Sports Med 2023; 11:23259671231169188. [PMID: 37250744 PMCID: PMC10209719 DOI: 10.1177/23259671231169188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/24/2023] [Indexed: 05/31/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted athletic activities, including those in the Pacific 12 (Pac-12) Conference of the National Collegiate Athletic Association. It is currently unknown how the disruption in training and competition impacted athletes' risk of injury upon resumption of activities. Purpose To describe and compare the rate, timing, mechanism, and severity of injuries among collegiate athletes across multiple sports in the Pac-12 Conference before and after the COVID-19 pandemic-associated hiatus of intercollegiate athletic activities. Study Design Descriptive epidemiology study. Methods Descriptive and injury data among intercollegiate athletes from both the season before the hiatus and the season after the hiatus were acquired from the Pac-12 Health Analytics Program database. Injury elements (timing of injury onset, injury severity, mechanism, recurrence, outcome, need for procedural intervention, and event segment during which the injury took place) were compared by time using the chi-square test and a multivariate logistic regression model. Subgroup analyses were performed on knee and shoulder injuries among athletes participating in sports with traditionally high rates of knee and shoulder injuries. Results A total of 12,319 sports-related injuries across 23 sports were identified, with 7869 pre-hiatus injuries and 4450 post-hiatus injuries. There was no difference in the overall incidence of injury between the pre-hiatus and post-hiatus seasons. However, the proportion of noncontact injuries was higher in the post-hiatus season for football, baseball, and softball players, and the proportion of nonacute injuries in the post-hiatus season was higher among football, basketball, and rowing athletes. Finally, the overall proportion of injuries sustained by football players in the final 25% of competition or practice was higher in the post-hiatus season. Conclusion Athletes competing in the post-hiatus season were observed to have higher rates of noncontact injuries and injuries sustained in the final 25% of competition. This study demonstrates that the COVID-19 pandemic has had varied effects on athletes from different sports, suggesting that many factors must be considered when designing return-to-sports programs for athletes after an extended absence from organized training.
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Affiliation(s)
- Thomas J. Kremen
- Department of Orthopaedic Surgery,
David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shannon Y. Wu
- David Geffen School of Medicine at
UCLA, Los Angeles, California, USA
| | - Alexander Upfill-Brown
- Department of Orthopaedic Surgery,
David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Amador Bugarin
- David Geffen School of Medicine at
UCLA, Los Angeles, California, USA
| | - Julian Huang
- University of California at Los
Angeles, Los Angeles, California, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery,
David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Brendan Y. Shi
- Department of Orthopaedic Surgery,
David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Jonasson G, Ghasemi MH, Jonsdottir US, Briem K, Sveinsson P. Effects of gender and fatigue on strength and activity of gluteus medius muscle during a controlled cutting maneuver in preadolescent athletes. J Electromyogr Kinesiol 2023; 70:102779. [PMID: 37141731 DOI: 10.1016/j.jelekin.2023.102779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/06/2023] Open
Abstract
The present study aimed to investigate the effects of gender on hip muscle strength and activity during a controlled cutting maneuver in preadolescent athletes. Fifty-six football and handball preadolescent players participated (35 females and 21 males). Normalized mean activity of the gluteus medius (GM) muscle was measured using surface electromyography during cutting maneuvers in pre-activation and eccentric phases. The stance duration and the strength of hip abductors and external rotators were recorded with a force plate and a handheld dynamometer, respectively. Descriptive statistics and mixed model analysis were used to assess statistical difference (α = 0.05). The results showed that boys activate the GM muscle significantly more than girls during the pre-activation phase (P = 0.022). Boys also demonstrated greater normalized strength of hip external rotation than girls (P = 0.038), but not for hip abduction or duration of stance (P > 0.05). When adjusted for abduction strength, however, boys had significantly shorter stance duration than girls (P = 0.006). It seems that sex-dependent differences are present in preadolescent athletes as observed in the strength of hip external rotator muscles and neuromuscular activity of the GM muscle during a cutting maneuver. Future studies are needed to investigate whether these changes influence risk of lower limb/ACL injury during sport activities.
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Affiliation(s)
- G Jonasson
- Department of Physical Therapy, University of Iceland, Reykjavik, Iceland; Sjukrapjalfun Reykjavikur Physical Therapy Clinic, Reykjavik, Iceland
| | - M H Ghasemi
- Department of Physical Therapy, University of Iceland, Reykjavik, Iceland.
| | - U S Jonsdottir
- Department of Physical Therapy, University of Iceland, Reykjavik, Iceland; Gaski Physical Therapy Clinic, Reykjavik, Iceland; Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Briem
- Department of Physical Therapy, University of Iceland, Reykjavik, Iceland; Research Centre of Movement Science, University of Iceland, Reykjavik, Iceland
| | - P Sveinsson
- Department of Physical Therapy, University of Iceland, Reykjavik, Iceland; Research Centre of Movement Science, University of Iceland, Reykjavik, Iceland
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Milutinović A, Jakovljević V, Dabović M, Faude O, Radovanović D, Stojanović E. Isokinetic Muscle Strength in Elite Soccer Players 3 and 6 months After Anterior Cruciate Ligament Reconstruction. J Strength Cond Res 2023; 37:e297-e304. [PMID: 35836308 DOI: 10.1519/jsc.0000000000004331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Milutinović, A, Jakovljević, V, Dabović, M, Faude, O, Radovanović, D, and Stojanović, E. Isokinetic muscle strength in elite soccer players 3 months and 6 months after anterior cruciate ligament reconstruction. J Strength Cond Res 37(4): e297-e304, 2023-The aim of this study was to evaluate interlimb symmetry in quadriceps and hamstring peak torque of elite soccer players at 3 months (stage 1) and 6 months (stage 2) after anterior cruciate ligament (ACL) reconstruction. Eight male professional soccer players competing at the highest level across different European countries, who had undergone ACL reconstruction, participated in this study. All patients underwent a supervised physiotherapy program after surgery. Data analyses included the use of separate two-way repeated-measures analyses of variance and effect sizes. Although knee extensor and flexor strength of the non-injured limb was found to be relatively unaltered ( g = -0.10 to 0.00) between stage 1 and stage 2, comparisons across time points revealed moderate improvements in quadriceps peak torque ( p = 0.01, g = 0.52), hamstring peak torque ( p = 0.07, g = 0.51), and hamstring:quadriceps (H/Q) ratio ( p = 0.03, g = -0.68) of the injured leg, as well as small-large improvements in the quadriceps ( p = 0.004, g = 1.24) and hamstring limb symmetry index (LSI) ( p = 0.056, g = 0.41). A time-dependent moderate-large asymmetry observed at stage 1 between the injured and noninjured leg in quadriceps peak torque ( p < 0.001, g = -1.83), hamstring peak torque ( p = 0.157, g = -0.67), and the H:Q ratio ( p = 0.06, g = 1.01), as well as between the hamstring and quadriceps LSI ( p = 0.03, g = -0.74) was eliminated at stage 2 ( g = -0.31 to 0.42). Our findings indicate the importance of supervised and comprehensive therapy, as well as strength screening to assist in recovery aimed at optimizing identified strength deficits following ACL reconstruction.
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Affiliation(s)
- Andreja Milutinović
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Vladimir Jakovljević
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Human Pathology, I.M. Sechenov First State Medical University, Moscow, Russia
| | - Milinko Dabović
- Faculty of Sport and Physical Education, University of Belgrade, Belgrade, Serbia
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland ; and
| | | | - Emilija Stojanović
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland ; and
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Age and Sex Comparisons in Pediatric Track and Field Hurdle Injuries Seen in Emergency Departments of the US. Sports (Basel) 2023; 11:sports11030065. [PMID: 36976951 PMCID: PMC10052995 DOI: 10.3390/sports11030065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
There is limited literature analyzing pediatric hurdle injuries based on sex and age. This study compares hurdle-related injury types, injured body parts, and injury mechanisms by age and sex in pediatrics. Hurdle-related injury data from the National Electronic Injury Surveillance System were used to retrospectively review the injuries of hurdlers 18 years and under. Differences in injured body parts, injury types, and mechanisms were analyzed by age (pre-high school vs. high school) and sex (male vs. female). A total of 749 cases were extracted. Fractures were more common in pre-high schoolers (34.1% vs. 21.5%, p = 0.001), while more sprains were identified in high schoolers (29.6%) than pre-high schoolers (22.8%, p = 0.036). Males suffered more fractures than females (35.1% vs. 24.3%, p = 0.001). Females sustained more joint sprains (29.1% vs. 21.0%, p = 0.012) and contusions/hematomas (12.7% vs. 7.5%, p = 0.020). Ankle injuries were more common in females (24.0%) than males (12.0%, p = 0.001), while wrist injuries were more prevalent in males (11.7% vs. 7.2%, p = 0.034). The most common injury mechanism was apparatus-related, with no differences based on age or sex. Injury types and injured body parts differed depending on age and sex in pediatric hurdle injuries seen in emergency departments. These findings may be helpful for injury prevention and medical care for pediatric hurdlers.
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