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Imhauser C. CORR Insights®: Differences in Cortical Activation During Dorsiflexion and Plantarflexion in Chronic Ankle Instability: A Task-fMRI Study. Clin Orthop Relat Res 2024; 482:827-830. [PMID: 38289693 PMCID: PMC11008632 DOI: 10.1097/corr.0000000000002991] [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: 11/23/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Carl Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
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Crotti M, Heering T, Lander N, Fox A, Barnett LM, Duncan MJ. Extrinsic Risk Factors for Primary Noncontact Anterior Cruciate Ligament Injury in Adolescents Aged between 14 and 18 years: A Systematic Review. Sports Med 2024; 54:875-894. [PMID: 38236505 DOI: 10.1007/s40279-023-01975-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Adolescents present a high incidence of ACL injury compared with other age groups. Examining the risk factors that predispose adolescents to primary noncontact ACL injury is a key strategy to decrease the number of injuries in this population. OBJECTIVE The aim of this systematic review was to summarise the existing literature investigating extrinsic risk factors that have been linked with primary noncontact ACL injury risk (identified either using ACL injury occurrence or using screening tests measuring biomechanical mechanisms for noncontact ACL injury) in adolescents including research investigating: (1) the association between extrinsic risk factors and primary noncontact ACL injury risk; and (2) whether primary noncontact ACL injury risk was different in populations or groups exposed to different extrinsic risk factors in adolescents. METHODS The same search strategy was used in MEDLINE, SPORTDiscus, CINAHL, PubMed and Embase. Articles were included if: written in English; published in peer-reviewed journals; investigating and discussing primary noncontact ACL injury risk associated with extrinsic risk factors; they were original research articles with an observational design; and participants presented a mean age ranging between 14 and 18 years. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (QATOCCS) was used to assess the quality and risk of bias of the articles included in this systematic review. RESULTS The systematic review included 16 eligible articles published up to August 2022 about extrinsic risk factors for primary noncontact ACL injury including: sport (8 studies); sport exposure amount (5); sport level (3); sport season (1); environment (2); equipment (1). Differences in biomechanical risk factors predisposing to ACL injury were reported by sport in female adolescents playing basketball and soccer; however, no good evidence of differences in primary noncontact ACL injury rate by sport was reported in both male and female adolescents. There was contrasting evidence about associations between sport exposure and biomechanical and neuromuscular risk factors predisposing to ACL injury or primary noncontact ACL injury rate in both male and female adolescent players from different sports. There was weak evidence of differences in biomechanical risk factors predisposing to ACL injury by environmental condition in both male and female adolescents playing soccer and season phase in male adolescents playing basketball. Lastly, few good-quality articles suggested that higher sport level might be associated with increased primary noncontact ACL injury rate in female adolescents playing basketball and floorball and that bracing might not prevent primary noncontact ACL injuries in both male and female adolescent players from different sports. DISCUSSION The findings emphasise the need for further research to clarify the evidence about extrinsic risk factors and primary noncontact ACL injury in adolescents to develop ACL injury prevention guidelines that would help practitioners and researchers identify adolescents at risk and design future interventions. Future epidemiological studies should collect data about extrinsic factors as well as data about primary noncontact injury separately from secondary injuries or contact injuries to better inform primary noncontact ACL injury prevention in adolescents. REGISTRATION https://doi.org/10.17605/OSF.IO/VM82F (11/08/2021).
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Affiliation(s)
- Matteo Crotti
- Centre for Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK.
| | - Theresa Heering
- Centre for Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Natalie Lander
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia
| | - Aaron Fox
- School of Exercise and Nutrition Science, Deakin University, Melbourne, VIC, Australia
| | - Lisa M Barnett
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia
| | - Michael J Duncan
- Centre for Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK
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Shultz SJ, Morrissey MC, Vauhnik R. Anterior knee laxity is greater in athletic females who attain menarche at a younger age. Knee Surg Sports Traumatol Arthrosc 2024; 32:889-895. [PMID: 38454787 DOI: 10.1002/ksa.12138] [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: 01/16/2024] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Females with above-average anterior knee laxity values are at increased risk of anterior cruciate ligament (ACL) injury. The purpose of this study was to examine the effects of menarche age (MA) and menarche offset on anterior knee laxity in young, physically active women. METHODS Anterior knee laxity (KT-2000) and menstrual characteristics (per self-report) were recorded in 686 Slovenian sportswomen from team handball, volleyball and basketball club sports (average years sport participation: 7.3 ± 3.6 years). Females were stratified into four groups based on their self-reported age at menarche: 9-11, 12, 13 and 14+ years. Anterior knee laxity was compared across MA groups using a univariate analysis of variance (ANOVA) with Bonferroni correction, with and without controlling for factors that could potentially differ between groups and influence anterior knee laxity. Females were then stratified into four groups based on the number of years they were away from their age at onset of menarche. Groups were compared using a univariate ANOVA with Bonferroni correction, with and without controlling for factors that differed between groups and could influence anterior knee laxity. RESULTS Anterior knee laxity was greater in females who attained menarche at 12 years of age (6.4 ± 1.5 mm) or younger (6.6 ± 1.6 mm) compared to 14 years of age or older (5.8 ± 1.2 mm) (p < 0.001; partial η2 = 0.032). Anterior knee laxity was 0.7-1.4 mm greater in females who were 5 or more years away from menarche compared to those who were within 2 years of menarche (5.8 ± 1.3 mm; p < 0.001). CONCLUSION Anterior knee laxity is greater in females who attained menarche at a younger age and in females who are 5 or more years postmenarche. Age of menarche represents a critical pubertal event that is easy for women to recall and may provide important insights into factors that moderate anterior knee laxity, a risk factor for ACL injury in women. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sandra J Shultz
- Department of Kinesiology, University of North Carolina, Greensboro, Greensboro, North Carolina, USA
| | - Matthew C Morrissey
- Biomechanical Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Renata Vauhnik
- Biomechanical Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
- Arthron, Institute for Joint and Sports Injuries, Ljubljana, Slovenia
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Tagawa N, Okamura K, Araki D, Sugahara A, Kanai S. Influence of the menstrual cycle on static and dynamic kinematics of the foot medial longitudinal arch. J Orthop Sci 2024; 29:609-614. [PMID: 36759230 DOI: 10.1016/j.jos.2023.01.009] [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: 09/30/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND In women, the laxity of the plantar fascia increases during the ovulation phase of the menstrual cycle. Although it is possible that this increased laxity results in a decreased height of the foot in the medial longitudinal arch and exacerbates symptoms of several overuse injuries of the lower extremity, the influence of the menstrual cycle on static and dynamic kinematics of the medial longitudinal arch is unclear. The purpose of this study was to confirm that the medial longitudinal arch height during static standing, gait, and landing decrease during the menstrual cycle ovulation phase. METHODS Participants in this study were 16 female college students with normal menstrual cycles and 16 male college students. Navicular height in the static standing position was measured using a three-dimensional foot scanner. Kinematics of the medial longitudinal arch during gait and landing were measured using a three-dimensional motion capture system to determine the navicular height at initial contact, minimal navicular height, and dynamic navicular drop. In all measurements, female participants were tested twice during the course of one complete menstrual cycle: once during the follicular phase and once during the ovulation phase. Male participants were tested twice with an interval of ≥1 week and <2 weeks. RESULTS In women, navicular height in the static standing position significantly decreased during the ovulation phase compared with follicular phase (mean difference [95% confidence interval] = 2.1 [0.9-3.4] mm; p = 0.002), whereas men showed no statistical difference between the first and second measurements. In both men and women, no statistical differences were identified for the dynamic medial longitudinal arch kinematics measured during gait and landing. CONCLUSIONS Navicular height in the static standing position slightly decreased during the ovulation phase.
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Affiliation(s)
- Nanoha Tagawa
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1 Gakuen-cho, Mihara-shi, Hiroshima, 723-0053, Japan; Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| | - Kazunori Okamura
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1 Gakuen-cho, Mihara-shi, Hiroshima, 723-0053, Japan.
| | - Daisuke Araki
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1 Gakuen-cho, Mihara-shi, Hiroshima, 723-0053, Japan
| | - Ayaka Sugahara
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1 Gakuen-cho, Mihara-shi, Hiroshima, 723-0053, Japan; Department of Rehabilitation Technology, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kita-ku, Osaka-shi, Osaka, 530-0012, Japan
| | - Shusaku Kanai
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1 Gakuen-cho, Mihara-shi, Hiroshima, 723-0053, Japan
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Reist H, Vacek PM, Endres N, Tourville TW, Failla M, Geeslin A, Geeslin M, Borah A, Krug M, Choquette R, Toth M, Beynnon BD. Risk Factors for Concomitant Meniscal Injury With Sport-Related Anterior Cruciate Ligament Injury. Orthop J Sports Med 2023; 11:23259671231196492. [PMID: 37693810 PMCID: PMC10492489 DOI: 10.1177/23259671231196492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background Previous studies of concomitant meniscal injury in athletes with anterior cruciate ligament (ACL) injury have examined age, sex, body mass index (BMI), injury mechanism, and time from injury to surgery as potential risk factors. Purpose To identify additional risk factors for concomitant meniscal injury, including preinjury joint laxity and lower extremity alignment, in athletes with sport-related ACL injury. Study Design Cross-sectional study; Level of evidence, 3. Methods This study included 180 participants aged 13 to 26 years who underwent ACL reconstruction (ACLR) after a first-time ACL injury sustained during participation in sport. Contralateral lower extremity alignment and joint laxity were used as surrogate measures for the injured knee before trauma. Concomitant meniscal tear patterns were identified at the time of ACLR. Sex-specific analyses were conducted. Results Concomitant meniscal injury was observed in 60.6% of the subjects. The prevalence of concomitant injury was higher in male than female participants (69.9% vs 54.2%; P = .035) due to a higher prevalence of lateral meniscal injuries (56.2% vs 38.3%; P = .018). Among male patients, there was a significant difference in the prevalence of concomitant lateral meniscal tear according to sport participation (≥9 vs <9 h/week: 67.4% vs 35.7%; P = .032). Among male patients, the likelihood of concomitant injury to both the lateral and medial menisci increased by 28.8% for each 1-mm decrease in navicular drop. Among female patients, the likelihood of concomitant injury to the lateral meniscus increased by 15% per degree increase in genu recurvatum and 14% per degree decrease in standing quadriceps angle, with similar effects on the likelihood of concurrent injury to both the lateral and medial menisci. Conclusion Measures of lower extremity alignment and genu recurvatum previously identified as risk factors for ACL injury were also associated with concomitant meniscal injury in female patients while other risk factors, including BMI and joint laxity, were not. Increased time spent participating in sport and navicular drop were associated with concomitant meniscal injury in male patients.
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Affiliation(s)
- Hailee Reist
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Pamela M. Vacek
- Department of Medical Biostatistics, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Nathan Endres
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Timothy W. Tourville
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Mathew Failla
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Andrew Geeslin
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Matthew Geeslin
- Department of Radiology, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Andy Borah
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mickey Krug
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Rebecca Choquette
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mike Toth
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Medicine, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Bruce D. Beynnon
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
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Park-Braswell K, Shultz SJ, Ross SE, Sunnassee D, Grooms DR, Schmitz RJ. The Impact of Differential Knee Laxity on Brain Activation During Passive Knee Joint Loading. J Orthop Res 2023; 42:10.1002/jor.25664. [PMID: 37442639 PMCID: PMC10851619 DOI: 10.1002/jor.25664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 07/11/2023] [Indexed: 07/15/2023]
Abstract
Although higher anterior knee laxity is an established risk factor of ACL injury, underlying mechanisms are uncertain. While decreased proprioception and altered movement patterns in individuals with anterior knee laxity have been identified, the potential impact of higher laxity on brain activity is not well understood. Thus, the purpose of this study is to identify the impact of different magnitudes of knee laxity on brain function during anterior knee joint loading. Twenty-seven healthy and active female college students without any previous severe lower leg injuries volunteered for this study. Anterior knee laxity was measured using a knee arthrometer KT-2000 to assign participants to a higher laxity (N=15) or relatively lower laxity group (N=12). Functional magnetic resonance images were obtained during passive anterior knee joint loading in a task-based design using a 3T MRI scanner. Higher knee laxity individuals demonstrated diminished cortical activation in the left superior parietal lobe during passive anterior knee joint loading. Less brain activation in the regions associated with awareness of bodily movements in females with higher knee laxity may indicate a possible connection between brain activity and knee laxity. The results of this study may help researchers and clinicians develop effective rehabilitation programs for individuals with increased knee laxity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Sandra J. Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Scott E. Ross
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Devdass Sunnassee
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA
- Division of Physical Therapy & Division of Athletic Training, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
| | - Randy J. Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
- Gateway MRI Center University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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Razu SS, Jahandar H, Zhu A, Berube EE, Manzi JE, Pearle AD, Nawabi DH, Wickiewicz TL, Santner TJ, Imhauser CW. Bayesian Calibration of Computational Knee Models to Estimate Subject-Specific Ligament Properties, Tibiofemoral Kinematics, and Anterior Cruciate Ligament Force With Uncertainty Quantification. J Biomech Eng 2023; 145:071003. [PMID: 36826392 PMCID: PMC10782874 DOI: 10.1115/1.4056968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/26/2023] [Accepted: 02/05/2023] [Indexed: 02/25/2023]
Abstract
High-grade knee laxity is associated with early anterior cruciate ligament (ACL) graft failure, poor function, and compromised clinical outcome. Yet, the specific ligaments and ligament properties driving knee laxity remain poorly understood. We described a Bayesian calibration methodology for predicting unknown ligament properties in a computational knee model. Then, we applied the method to estimate unknown ligament properties with uncertainty bounds using tibiofemoral kinematics and ACL force measurements from two cadaver knees that spanned a range of laxities; these knees were tested using a robotic manipulator. The unknown ligament properties were from the Bayesian set of plausible ligament properties, as specified by their posterior distribution. Finally, we developed a calibrated predictor of tibiofemoral kinematics and ACL force with their own uncertainty bounds. The calibrated predictor was developed by first collecting the posterior draws of the kinematics and ACL force that are induced by the posterior draws of the ligament properties and model parameters. Bayesian calibration identified unique ligament slack lengths for the two knee models and produced ACL force and kinematic predictions that were closer to the corresponding in vitro measurement than those from a standard optimization technique. This Bayesian framework quantifies uncertainty in both ligament properties and model outputs; an important step towards developing subject-specific computational models to improve treatment for ACL injury.
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Affiliation(s)
- Swithin S. Razu
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Hamidreza Jahandar
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Andrew Zhu
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Erin E. Berube
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Joseph E. Manzi
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Andrew D. Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021
| | - Danyal H. Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021
| | | | - Thomas J. Santner
- Department of Statistics, The Ohio State University, Columbus, OH 43210-1247
| | - Carl W. Imhauser
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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Zeitlin J, Fontana MA, Parides MK, Nawabi DH, Wickiewicz TL, Pearle AD, Beynnon BD, Imhauser CW. Key Thresholds and Relative Contributions of Knee Geometry, Anteroposterior Laxity, and Body Weight as Risk Factors for Noncontact ACL Injury. Orthop J Sports Med 2023; 11:23259671231163627. [PMID: 37197036 PMCID: PMC10184233 DOI: 10.1177/23259671231163627] [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: 01/09/2023] [Accepted: 01/27/2023] [Indexed: 05/19/2023] Open
Abstract
Background Limited data exist regarding the association of tibiofemoral bony and soft tissue geometry and knee laxity with risk of first-time noncontact anterior cruciate ligament (ACL) rupture. Purpose To determine associations of tibiofemoral geometry and anteroposterior (AP) knee laxity with risk of first-time noncontact ACL injury in high school and collegiate athletes. Study Design Cohort study; Level of evidence, 2. Methods Over a 4-year period, noncontact ACL injury events were identified as they occurred in 86 high school and collegiate athletes (59 female, 27 male). Sex- and age-matched control participants were selected from the same team. AP laxity of the uninjured knee was measured using a KT-2000 arthrometer. Magnetic resonance imaging was taken on ipsilateral and contralateral knees, and articular geometries were measured. Sex-specific general additive models were implemented to investigate associations between injury risk and 6 features: ACL volume, meniscus-bone wedge angle in the lateral compartment of the tibia, articular cartilage slope at the middle region of the lateral compartment of the tibia, femoral notch width at the anterior outlet, body weight, and AP displacement of the tibia relative to the femur. Importance scores (in percentages) were calculated to rank the relative contribution of each variable. Results In the female cohort, the 2 features with the highest importance scores were tibial cartilage slope (8.6%) and notch width (8.1%). In the male cohort, the 2 top-ranked features were AP laxity (5.6%) and tibial cartilage slope (4.8%). In female patients, injury risk increased by 25.5% with lateral middle cartilage slope becoming more posteroinferior from -6.2° to -2.0° and by 17.5% with lateral meniscus-bone wedge angle increasing from 27.3° to 28.2°. In males, an increase in AP displacement from 12.5 to 14.4 mm in response to a 133-N anterior-directed load was associated with a 16.7% increase in risk. Conclusion Of the 6 variables studied, there was no single dominant geometric or laxity risk factor for ACL injury in either the female or male cohort. In males, AP laxity >13 to 14 mm was associated with sharply increased risk of noncontact ACL injury. In females, lateral meniscus-bone wedge angle >28° was associated with a sharply decreased risk of noncontact ACL injury.
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Affiliation(s)
- Jacob Zeitlin
- Weill Cornell Medical College, New York, New York, USA
- Department of Biomechanics Research, Hospital for Special Surgery, New York, New York, USA
- Jacob Zeitlin, BA, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA ()
| | - Mark A. Fontana
- Weill Cornell Medical College, New York, New York, USA
- Center for Analytics, Modeling, and Performance, Hospital for Special Surgery, New York, New York, USA
| | - Michael K. Parides
- Biostatistics and Bioinformatics Program, Hospital for Special Surgery, New York, New York, USA
| | - Danyal H. Nawabi
- Department of Biomechanics Research, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Thomas L. Wickiewicz
- Department of Biomechanics Research, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D. Pearle
- Department of Biomechanics Research, Hospital for Special Surgery, New York, New York, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Bruce D. Beynnon
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Carl W. Imhauser
- Department of Biomechanics Research, Hospital for Special Surgery, New York, New York, USA
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Kelley EA, Hogg JA, Gao L, Waxman JP, Shultz SJ. Demographic Factors and Instantaneous Lower Extremity Injury Occurrence in a National Collegiate Athletic Association Division I Population. J Athl Train 2023; 58:393-400. [PMID: 35789230 PMCID: PMC11220903 DOI: 10.4085/1062-6050-0673.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Temporal prediction of the lower extremity (LE) injury risk will benefit clinicians by allowing them to better leverage limited resources and target those athletes most at risk. OBJECTIVE To characterize the instantaneous risk of LE injury by demographic factors of sex, sport, body mass index (BMI), and injury history. DESIGN Descriptive epidemiologic study. SETTING National Collegiate Athletic Association Division I athletic program. PATIENTS OR OTHER PARTICIPANTS A total of 278 National Collegiate Athletic Association Division I varsity student-athletes (119 males, 159 females; age = 19.07 ± 1.21 years, height = 175.48 ± 11.06 cm, mass = 72.24 ± 12.87 kg). MAIN OUTCOME MEASURE(S) Injuries to the LE were tracked for 237 ± 235 consecutive days. Sex-stratified univariate Cox regression models were used to investigate the association between time to first LE injury and sport, BMI, and LE injury history. The instantaneous LE injury risk was defined as the injury risk at any given point in time after the baseline measurement. Relative risk ratios and Kaplan-Meier curves were generated. Variables identified in the univariate analysis were included in a multivariate Cox regression model. RESULTS Female athletes displayed similar instantaneous LE injury risk to male athletes (hazard ratio [HR] = 1.29; 95% CI= 0.91, 1.83; P = .16). Overweight athletes (BMI >25 kg/m2) had similar instantaneous LE injury risk compared with athletes with a BMI of <25 kg/m2 (HR = 1.23; 95% CI = 0.84, 1.82; P = .29). Athletes with previous LE injuries were not more likely to sustain subsequent LE injury than athletes with no previous injury (HR = 1.09; 95% CI = 0.76, 1.54; P = .64). Basketball (HR = 3.12; 95% CI = 1.51, 6.44; P = .002) and soccer (HR = 2.78; 95% CI = 1.46, 5.31; P = .002) athletes had a higher risk of LE injury than cross-country athletes. In the multivariate model, instantaneous LE injury risk was greater in female than in male athletes (HR = 1.55; 95% CI = 1.00, 2.39; P = .05), and it was greater in male athletes with a BMI of >25 kg/m2 than that in all other athletes (HR = 0.44; 95% CI = 0.19, 1.00; P = .05), but these findings were not significantly different. CONCLUSIONS In a collegiate athlete population, previous LE injury was not a contributor to the risk of future LE injury, whereas being female or being male with a BMI of >25 kg/m2 resulted in an increased risk of LE injury. Clinicians can use these data to extrapolate the LE injury risk occurrence to specific populations.
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Affiliation(s)
| | - Jennifer A. Hogg
- Department of Health and Human Performance, University of Tennessee at Chattanooga
| | - Lani Gao
- Department of Mathematics, University of Tennessee at Chattanooga
| | | | - Sandra J. Shultz
- Department of Kinesiology, University of North Carolina at Greensboro
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Beynnon BD, Tourville TW, Hollenbach HC, Shultz S, Vacek P. Intrinsic Risk Factors for First-Time Noncontact ACL Injury: A Prospective Study of College and High School Athletes. Sports Health 2023; 15:433-442. [PMID: 36154754 PMCID: PMC10170220 DOI: 10.1177/19417381221121136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A comprehensive understanding of the intrinsic risk factors for anterior cruciate ligament (ACL) disruption is important for identifying individuals at increased risk for suffering this trauma and developing interventions to mitigate risk. HYPOTHESIS A variety of risk factors predispose athletes to first-time, noncontact ACL injury and some of these differ between male and female athletes. STUDY DESIGN Prospective cohort study with nested case-control sampling. LEVEL OF EVIDENCE Level 2. METHODS Sport teams at 28 high schools and 8 colleges were monitored prospectively over 4 years, and 109 of 130 athletes who suffered their first noncontact ACL injury participated in the study. At the time of injury, matched control subjects were randomly selected from among the case's teammates and a total of 227 athletes participated. Demographic characteristics, joint laxity, lower extremity alignment, strength, and personality characteristics were measured. The association of each risk factor with injury risk was assessed by conditional logistic regression. RESULTS The risk factors that were associated with ACL injury in both male and female athletes included having a parent with prior ACL injury and increases of the following variables: body weight, anterior displacement of the tibia relative to the femur, genu recurvatum, and generalized joint laxity. Risk factors that are unique to female athletes included increased body mass index, increased trunk flexion strength, and prior non-ACL knee injury. The risk factors specific to male athletes were decreased standing quadriceps angle, decreased hip adduction strength, and chronic disease. CONCLUSION A diverse set of risk factors predispose both male and female athletes to ACL injury, whereas others appear to be sex-specific. CLINICAL RELEVANCE Different approaches for assessing risk and preventing ACL injury are needed for male and female athletes. In addition, personalized prevention strategies may be needed to target the specific characteristics that place an individual at increased risk of suffering this trauma.
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Affiliation(s)
- Bruce D. Beynnon
- Department of Orthopedics and
Rehabilitation, Robert Larner College of Medicine, University of Vermont,
Burlington, Vermont
- Department of Electrical and Biomedical
Engineering, University of Vermont, Burlington, Vermont
| | - Timothy W. Tourville
- Department of Orthopedics and
Rehabilitation, Robert Larner College of Medicine, University of Vermont,
Burlington, Vermont
- Department of Rehabilitation and
Movement Science, College of Nursing and Health Sciences, University of Vermont,
Burlington, Vermont
| | - Helen C. Hollenbach
- Department of Orthopedics and
Rehabilitation, Robert Larner College of Medicine, University of Vermont,
Burlington, Vermont
| | - Sandy Shultz
- Department of Kinesiology, School of
Health and Human Sciences, University of North Carolina at Greensboro, Greensboro,
North Carolina
| | - Pamela Vacek
- Department of Medical Biostatistics,
Robert Larner College of Medicine, University of Vermont, Burlington, Vermont
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11
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Straub RK, Powers CM. Is muscular strength a predictor for primary or secondary ACL injury? A scoping review of prospective studies. Phys Ther Sport 2023; 61:91-101. [PMID: 36965459 DOI: 10.1016/j.ptsp.2023.03.004] [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: 02/06/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To identify strength-related risk factors of ACL injury by conducting a scoping review of the peer-reviewed literature. METHODS PubMed and EBSCO host (CINAHL Complete, MEDLINE Complete, SPORTDiscus) were searched from inception to August 2022. Prospective studies that examined strength strength-related risk factors for ACL injury (primary and secondary) were included. PRISMA Extension for Scoping Reviews guided data charting/extraction. RESULTS 17 studies were included (eight primary ACL injury, nine secondary ACL injury). Knee flexor strength was the most studied predictor (10 studies), followed by hip abductor strength (9 studies). Across studies, measures of muscle performance were inconsistent. Significant strength-related risk factors were reported in seven of 17 studies. Potential strength-related risk factors of primary ACL injury included measures of hip strength (abductor or external rotator) and knee strength (knee flexor/extensor ratio and knee extensor strength symmetry) for secondary ACL injury. Limited/conflicting evidence was found for all strength-related risk factors. CONCLUSION Measures of muscle strength appear to be predictive of primary and secondary ACL injury in a subset of identified studies. The heterogeneity of study designs and lack of standardization related to strength testing make it difficult to determine the overall impact of strength in predicting ACL injury.
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Affiliation(s)
- Rachel K Straub
- University of Southern California, Division of Biokinesiology & Physical Therapy, Los Angeles, CA, USA
| | - Christopher M Powers
- University of Southern California, Division of Biokinesiology & Physical Therapy, Los Angeles, CA, USA.
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12
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Liu Y, Rodeo SA, Deng XH, Song Z, Chen D, Casey E. Evaluation of sex differences in rodent anterior cruciate ligament injury. J Orthop Res 2023; 41:32-43. [PMID: 35451139 DOI: 10.1002/jor.25346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/31/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
The relative contributions of sex differences in anatomy, biomechanics, and hormones to the increased risk of anterior cruciate ligament (ACL) injury in female athletes remains unknown. The purpose of this study is to investigate sex differences in anatomy and biomechanics of the native and reconstructed ACL using our established murine model. A total of 140 12-week-old wild-type C57Bl/6 (70 male vs. 70 female) mice were used for this study. ACL reconstruction was performed on 120 mice who were split into four groups: Group 1 (30 males sacrificed at 14 days), Group 2 (30 females sacrificed at 14 days), Group 3 (30 males sacrificed at 28 days), and Group 4 (30 females sacrificed at 28 days). Tendon graft-to-bone healing was assessed by biomechanical, histological, and micro-CT analysis. Twenty mice were used for baseline testing. Females showed significantly higher anterior (p < 0.05) and total displacement (p < 0.05). Males demonstrated a significantly higher load-to-failure force of native ACLs compared to females (p < 0.05). There was no significant difference in load-to-failure force in the ACL autograft. There were no significant sex differences in histological analysis of graft integration or tibial slope. The increased knee laxity and reduced load-to-failure of the native ACL observed in the female mice are consistent with some of the proposed risk factors driving the increased risk of ACL injury in females. Understanding the relative contributions of factors driving sex differences in material properties of the ACL will provide insight into the sex differences in ACL injury and future prevention strategies.
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Affiliation(s)
- Yake Liu
- Hospital for Special Surgery, New York, New York, USA.,The Affiliate Hospital to Nantong University, Nantong, Jiangsu, China
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
| | | | - Zhe Song
- Hospital for Special Surgery, New York, New York, USA
| | - Daoyun Chen
- Hospital for Special Surgery, New York, New York, USA
| | - Ellen Casey
- Hospital for Special Surgery, New York, New York, USA
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13
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Morphometric characteristics of the knee are associated with the injury of the meniscus. J Orthop Surg Res 2022; 17:498. [PMCID: PMC9675146 DOI: 10.1186/s13018-022-03380-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background To assess the geometrical risk factors for meniscal injuries. We hypothesized that the narrowness of the intercondylar notch and the smaller tibial spine could increase the risk of meniscal injuries. Methods We retrospectively studied two hundred and seven patients examined for knee magnetic resonance images. Two experienced orthopedists evaluated the severity of meniscal injuries. The notch width, bicondylar notch width, notch width index, condyle width of the femur, tibial spine height, and intercondylar angle were measured in magnetic resonance image slides by two blinded orthopedists.
Results A total of 112 patients with a meniscus injury and 95 patients were as healthy control in all two hundred and seven patients. The NWI (P = 0.027) in patients with meniscus injuries was significantly different from the control group. A 1 SD (0.04 mm) increase in NWI was associated with a 0.4-fold increase in the risk of meniscal injury. A 1 SD (0.04 mm) increase in NWI was associated with a 0.64-fold increase in the risk of grade 3 meniscal injury. Furthermore, NWI and medial spine height are decreased significantly in grade 2 (P < 0.05) meniscal injury than in other grades. The medial spine height was significantly decreased in the meniscal injury group (P = 0.025), and the decrease in medial spine height would increase the risk of meniscal injury (OR = 0.77) and grade 3 meniscal injury (OR = 0.8). Conclusions The stenosis of the femoral intercondylar notch and small medial tibial spine is risk factors of meniscal injury. The decreased NWI and the medial tibial spine height were also associated with the severity of the meniscal injury. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03380-2.
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14
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Shultz SJ, Cruz MR, Casey E, Dompier TP, Ford KR, Pietrosimone B, Schmitz RJ, Taylor JB. Sex-Specific Changes in Physical Risk Factors for Anterior Cruciate Ligament Injury by Chronological Age and Stages of Growth and Maturation From 8 to 18 Years of Age. J Athl Train 2022; 57:830-876. [PMID: 36638346 PMCID: PMC9842121 DOI: 10.4085/1062-6050-0038.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To critically assess the literature focused on sex-specific trajectories in physical characteristics associated with anterior cruciate ligament (ACL) injury risk by age and maturational stage. DATA SOURCES PubMed, CINAHL, Scopus, and SPORTDiscus databases were searched through December 2021. STUDY SELECTION Longitudinal and cross-sectional studies of healthy 8- to 18-year-olds, stratified by sex and age or maturation on ≥1 measure of body composition, lower extremity strength, ACL size, joint laxity, knee-joint geometry, lower extremity alignment, balance, or lower extremity biomechanics were included. DATA EXTRACTION Extracted data included study design, participant characteristics, maturational metrics, and outcome measures. We used random-effects meta-analyses to examine sex differences in trajectory over time. For each variable, standardized differences in means between sexes were calculated. DATA SYNTHESIS The search yielded 216 primary and 22 secondary articles. Less fat-free mass, leg strength, and power and greater general joint laxity were evident in girls by 8 to 10 years of age and Tanner stage I. Sex differences in body composition, strength, power, general joint laxity, and balance were more evident by 11 to 13 years of age and when transitioning from the prepubertal to pubertal stages. Sex differences in ACL size (smaller in girls), anterior knee laxity and tibiofemoral angle (greater in girls), and higher-risk biomechanics (in girls) were observed at later ages and when transitioning from the pubertal to postpubertal stages. Inconsistent study designs and data reporting limited the number of included studies. CONCLUSIONS Critical gaps remain in our knowledge and highlight the need to improve our understanding of the relative timing and tempo of ACL risk factor development.
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Affiliation(s)
- Sandra J. Shultz
- Department of Kinesiology, University of North Carolina, Greensboro
| | | | | | | | | | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Randy J. Schmitz
- Department of Kinesiology, University of North Carolina, Greensboro
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15
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Schmitz RJ, Ford KR, Pietrosimone B, Shultz SJ, Taylor JB. ACL Research Retreat IX Summary Statement: The Pediatric Athlete, March 17-19, 2022; High Point, North Carolina. J Athl Train 2022; 57:990-995. [PMID: 36638340 PMCID: PMC9842120 DOI: 10.4085/1062-6050-0219.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Randy J. Schmitz
- Applied Neuromechanics Research Laboratory, Department of Kinesiology, School of Health and Human Sciences, University of North Carolina, Greensboro
| | - Kevin R. Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Sandra J. Shultz
- Applied Neuromechanics Research Laboratory, Department of Kinesiology, School of Health and Human Sciences, University of North Carolina, Greensboro
| | - Jeffrey B. Taylor
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
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16
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Zimmerer A, Schneider MM, Semann C, Schopf W, Sobau C, Ellermann A. 17-Year Results following Transepiphyseal Anterior Cruciate Ligament Reconstruction in Children and Adolescents. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:393-399. [PMID: 33601463 DOI: 10.1055/a-1352-5541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Rupture of the anterior cruciate ligament (ACL) in childhood and adolescence is a serious injury. It is now known that conservative therapy of an unstable knee joint in childhood or adolescence under can lead to poor subjective and objective results. The aim of this study is to record long-term results after transepiphyseal ACL reconstruction using autologous hamstring tendons and extracortical fixation in childhood and adolescence with open physes - at least 15 years after surgery. METHODS Our internal registry was used to identify all patients who received surgical treatment of an acl tear during childhood and adolescence by transepiphyseal acl reconstruction more than 15 years previously. In these patients, the International Knee Documentation Committee for Subjective Knee Form (IKDCsubj.), Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Score (TAS) and Lysholm Score were collected, and clinical and magnetic resonance imaging (MRI) examinations were performed. RESULTS A total of 22 patients were identified, 5 of whom could not be contacted. The mean age at the time of surgery was 13.1 years, and the mean follow-up time was 17.4 years. In 3 patients, a traumatic tear was observed with subsequent reconstruction of the ACL. None of the included patients showed a growth disorder during the course of the study. The IKDCsubj. was 92.4 ± 14.7 (48 - 100), the Lysholm score was 87.9 ± 16.9 (34 - 100), the TAS was 5.7 ± 2.3 (3 - 9) and the pain level based on VAS was 3.5 ± 2.6 (1 - 8) points. The values showed subjective and objective deterioration compared to the 10-year results, with no statistical significance. The following subscores were reported for the KOOS: KOOSpain 90.9 ± 17.6 (28 - 100); KOOSsymptom 82.9 ± 22.6 (11 - 100); KOOOSADL 94.3 ± 13.7 (44 - 100); KOOSSport 80.3 ± 26.4 (15 - 100); KOOSQOL 80.9 ± 25.8 (0 - 100). 13 of the 17 patients could also be clinically and radiologically examined. In 92% of patients, an intact acl reconstruction was found without evidence of cartilage or meniscus damage. The mean lateral difference in the KT-1000 measurement was 1.5 mm. CONCLUSION ACL reconstruction in childhood and adolescence provides good functionality and stability of the knee joint over the long term. Secondary signs of osteoarthritis can only be detected in isolated cases by MRI. ACL reconstruction using the transepiphyseal technique can be considered the method of choice for open growth plate knee joints.
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Affiliation(s)
- Alexander Zimmerer
- Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany.,Orthopaedic and Orthopaedic Surgery Clinic, University Medical Clinics Greifswald, Germany
| | - Marco M Schneider
- Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
| | - Carina Semann
- Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
| | - Wolfgang Schopf
- Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
| | - Christian Sobau
- Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
| | - Andree Ellermann
- Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
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17
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Adiposity as a Risk Factor for Sport Injury in Youth: A Systematic Review. Clin J Sport Med 2022; 32:418-426. [PMID: 33797475 DOI: 10.1097/jsm.0000000000000927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether high or low adiposity is associated with youth sport-related injury. DATA SOURCES Ten electronic databases were searched to identify prospective studies examining the association between adiposity [body mass index (BMI) or body fat] and a future time-loss or medical attention sport-related musculoskeletal injury or concussion in youth aged 20 years and younger. Two independent raters assessed the quality (Downs and Black criteria) and risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Random-effects meta-analyses were used to calculate pooled odds ratio [95% confidence interval (CI)] of injury. MAIN RESULTS Of 11 424 potentially relevant records, 38 articles were included with 17 eligible for meta-analyses. In qualitative synthesis, no clear association was identified between adiposity and any sport injury; however, 16/22 studies identified high adiposity as a significant risk factor for lower-extremity injury. Meta-analyses revealed higher BMI in youth with any sport-related injury and lower BMI in youth who developed a bone stress injury (BSI) compared with noninjured controls. The pooled OR (95% CI) examining the association of BMI and injury risk (excluding bone injury) was 1.18 (95% CI: 1.03-1.34). A major source of bias in included articles was inconsistent adjustment for age, sex, and physical activity participation. CONCLUSIONS Level 2b evidence suggests that high BMI is associated with greater risk of youth sport injury, particularly lower-extremity injury and excluding BSI or fracture. Although pooled mean differences were low, anthropometric risk of injury seems to be dependent on type and site of injury in youth sport.
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18
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Maruyama S, Sekine C, Shagawa M, Yokota H, Hirabayashi R, Togashi R, Yamada Y, Hamano R, Ito A, Sato D, Edama M. Menstrual Cycle Changes Joint Laxity in Females—Differences between Eumenorrhea and Oligomenorrhea. J Clin Med 2022; 11:jcm11113222. [PMID: 35683609 PMCID: PMC9181714 DOI: 10.3390/jcm11113222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/29/2022] [Accepted: 06/03/2022] [Indexed: 01/27/2023] Open
Abstract
The purpose of this study was to investigate the changes in anterior knee laxity (AKL), stiffness, general joint laxity (GJL), and genu recurvatum (GR) during the menstrual cycle in female non-athletes and female athletes with normal and irregular menstrual cycles. Participants were 19 female non-athletes (eumenorrhea, n = 11; oligomenorrhea, n = 8) and 15 female athletes (eumenorrhea, n = 8; oligomenorrhea, n = 7). AKL was measured as the amount of anterior tibial displacement at 67 N–133 N. Stiffness was calculated as change in (Δ)force/Δ anterior displacement. The Beighton method was used to evaluate the GJL. The GR was measured as the maximum angle of passive knee joint extension. AKL, stiffness, GJL, and GR were measured twice in four phases during the menstrual cycle. Stiffness was significantly higher in oligomenorrhea groups than in eumenorrhea groups, although no significant differences between menstrual cycle phases were evident in female non-athletes. GR was significantly higher in the late follicular, ovulation, and luteal phases than in the early follicular phase, although no significant differences between groups were seen in female athletes. Estradiol may affect the stiffness of the periarticular muscles in the knee, suggesting that GR in female athletes may change during the menstrual cycle.
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Affiliation(s)
- Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Mayuu Shagawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Ryoya Togashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Yuki Yamada
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Rena Hamano
- Department of Health and Sports, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City 950-3198, Japan; (R.H.); (A.I.)
| | - Atsushi Ito
- Department of Health and Sports, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City 950-3198, Japan; (R.H.); (A.I.)
| | - Daisuke Sato
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
- Correspondence: ; Tel./Fax: +81-25-257-4723
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19
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Familial Predisposition to Anterior Cruciate Ligament Injury: A Systematic Review with Meta-analysis. Sports Med 2022; 52:2657-2668. [PMID: 35829993 PMCID: PMC9585006 DOI: 10.1007/s40279-022-01711-1] [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] [Accepted: 05/22/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Having a family history of anterior cruciate ligament (ACL) injury has been investigated in the literature but few studies have focused on this factor specifically or reported their outcomes by sex. OBJECTIVE We aimed to systematically review family history as a risk factor for sustaining a primary ACL injury and the impact it has on ACL graft rupture or contralateral ACL injury in male and female individuals. METHODS A literature search was completed in seven databases from inception until March 2021 to investigate primary and subsequent ACL injuries in those with a family history of ACL injury. Articles were screened by prespecified inclusion criteria, and the methodological quality of each study was determined. Study results were combined using an odds ratio (OR) meta-analysis. Subgroup analysis was also completed by sex for primary ACL injury, as well as by graft rupture and contralateral ACL injury for subsequent ACL injuries. RESULTS Twelve studies were acquired for systematic review and meta-analysis. Four studies that investigated primary ACL injury, seven that investigated ACL graft and/or contralateral ACL ruptures and one study that investigated both primary and subsequent ACL injury. Having a family history of ACL injury increased the odds of injury across all outcomes. Those with a family history had a 2.5 times greater odds for sustaining a primary ACL injury (OR 2.53 [95% confidence interval [CI] 1.96-3.28, p < 0.001)]. There was no significant difference of injury odds for primary ACL injury when analysed by sex. Family history of ACL injury was found to increase the odds of subsequent ACL injury by 2.38 (95% CI 1.64-3.46, p < 0.001) and was significant for both graft ruptures (OR 1.80 [95% CI 1.20-2.71, p = 0.005]) and contralateral ACL injuries (OR 2.28 [95% CI 1.28-4.04, p = 0.005]). When compared directly, the odds of sustaining a graft rupture versus a contralateral ACL injury were similar for those with a family history. Outcomes were not frequently reported by sex for subsequent ACL injuries. CONCLUSIONS Having a family history of ACL injury more than doubles the odds of sustaining a primary or subsequent ACL injury. However, if a family history of ACL injury is present, the sex of the athlete does not increase the risk for primary injury nor is there a difference in the risk for a subsequent graft rupture compared to a contralateral ACL injury. CLINICAL TRIAL REGISTRATION PROSPERO: CRD42020186472.
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20
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Shultz SJ, Schmitz RJ, Kulas AS, Labban JD, Wang HM. Quadriceps muscle volume positively contributes to ACL volume. J Orthop Res 2022; 40:268-276. [PMID: 33506964 DOI: 10.1002/jor.24989] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/12/2020] [Accepted: 01/11/2021] [Indexed: 02/04/2023]
Abstract
Females have smaller anterior cruciate ligaments (ACLs) than males and smaller ACLs have been associated with a greater risk of ACL injury. Overall body dimensions do not adequately explain these sex differences. This study examined the extent to which quadriceps muscle volume (VOLQUAD ) positively predicts ACL volume (VOLACL ) once sex and other body dimensions were accounted for. Physically active males (N = 10) and females (N = 10) were measured for height, weight, and body mass index (BMI). Three-Tesla magnetic resonance images of their dominant and nondominant thigh and knee were then obtained to measure VOLACL , quadriceps, and hamstring muscle volumes, femoral notch width, and femoral notch width index. Separate three-step regressions estimated associations between VOLQUAD and VOLACL (third step), after controlling for sex (first step) and one body dimension (second step). When controlling for sex and sex plus BMI, VOLHAM , notch width, or notch width index, VOLQUAD consistently exhibited a positive association with VOLACL in the dominant leg, nondominant leg, and leg-averaged models (p < 0.05). Findings were inconsistent when controlling for sex and height (p = 0.038-0.102). Once VOLQUAD was included, only notch width and notch width index retained a statistically significant individual association with VOLACL (p < 0.01). Statement of Clinical Significance: The positive association between VOLQUAD and VOLACL suggests ACL size may in part be modifiable. Future studies are needed to determine the extent to which an appropriate training stimulus (focused on optimizing overall lower extremity muscle mass development) can positively impact ACL size and structure in young females.
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Affiliation(s)
- Sandra J Shultz
- Department of Kinesiology, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Randy J Schmitz
- Department of Kinesiology, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Anthony S Kulas
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
| | - Jeffrey D Labban
- HHS Office of Research, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Hsin-Min Wang
- Department of Sports, National Changhua University of Education, Changhua, Taiwan
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21
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Validation of a magnetic resonance imaging based method to study passive knee laxity: An in-situ study. Med Eng Phys 2022; 99:103733. [DOI: 10.1016/j.medengphy.2021.103733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 11/18/2022]
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Mahmoud A, Torbey S, Honeywill C, Myers P. Lateral Extra-Articular Tenodesis Combined With Anterior Cruciate Ligament Reconstruction Is Effective in Knees With Additional Features of Lateral, Hyperextension, or Increased Rotational Laxity: A Matched Cohort Study. Arthroscopy 2022; 38:119-124. [PMID: 34090996 DOI: 10.1016/j.arthro.2021.04.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/25/2021] [Accepted: 04/14/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the patient-reported outcome measures (PROMs) and graft survival of combined anterior cruciate ligament reconstruction (ACLR) and lateral extra-articular tenodesis (ACLR-LET) compared with a matched cohort having ACLR alone. METHODS Patients were retrospectively recruited from a consecutive series of primary ACLR-LET, between 1996 and 2015, with a minimum postsurgical time of 4 years. ACLR-LET were matched with isolated ACLR for age, gender, and operation year. The indications for adding lateral extra-articular tenodesis were lateral laxity of grade 1 or 2, hyperextension laxity, and/or increased rotational laxity of 5° to 10°. The technique used involved detaching a strip of iliotibial band proximally, before being passed deep to the lateral collateral ligament, looped through Kaplan's fibers, and sutured back onto itself at physiological tension. The PROMs used were the Lysholm Knee Scoring Scale, Tegner Activity Scale, Oxford Knee Score, and International Knee Documentation Committee subjective knee form. Failure was defined as graft rupture. Student's t-test was used to compare the matched groups and Kaplan-Meier analysis for survivorship. RESULTS Eighty-three patients had ACLR-LET between 1996 and 2015. Nine revision cases and 2 with less than 4 years follow-up were excluded. The remaining 72 ACLR-LET patients were matched and included in the survival analysis. Seventy percent of patients completed the PROMs. In both groups, 76% were males, and the mean age was 25 years (standard deviation ± 8.5). The median follow-up was 10 years (interquartile range, 6.7 years). There was no significant change of PROMs (Lysholm Knee Scoring Scale: P = .82, 95% confidence interval (CI) -13 to 11; International Knee Documentation Committee: P = .07, CI -1 to 24; Oxford Knee Score: P = .5, CI -8 to 4; Tegner Activity Scale: P = .5, CI -1 to 3) between the groups. The pre- to postoperative PROMs, except the Tegner Activity Scale, improved significantly, clinically and statistically. There was no statistically significant difference in graft failure between the ACLR-LET group (n = 4, 5%) and the ACLR group (n = 9, 11%) (log-rank P = .099). CONCLUSION ACLR-LET shows good graft survival and PROMs in a high-risk population. This suggests that lateral extra-articular tenodesis is an effective technique to restore joint stability to a knee with additional features of laxity. LEVEL OF EVIDENCE III, matched cohort study.
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Affiliation(s)
- Ahmed Mahmoud
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia; Brisbane Orthopaedic & Sports Medicine Centre, Brisbane Private Hospital, Brisbane, Queensland, Australia.
| | - Stephen Torbey
- Brisbane Orthopaedic & Sports Medicine Centre, Brisbane Private Hospital, Brisbane, Queensland, Australia
| | - Conor Honeywill
- Brisbane Orthopaedic & Sports Medicine Centre, Brisbane Private Hospital, Brisbane, Queensland, Australia
| | - Peter Myers
- Brisbane Orthopaedic & Sports Medicine Centre, Brisbane Private Hospital, Brisbane, Queensland, Australia
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Relationships between Risk Events, Personality Traits, and Risk Perception of Adolescent Athletes in Sports Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010445. [PMID: 35010699 PMCID: PMC8744543 DOI: 10.3390/ijerph19010445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022]
Abstract
Personality traits have close relationships with risky behaviors in various domains, including physical education, competition, and athletic training. It is yet little known about how trait personality dimensions associate with risk events and how vital factors, such as risk perception, could affect the happening of risk events in adolescent athletes. The primary purpose of this study is to investigate the prediction of risk events by regression analysis with dimensions of personality, risk perception and sports, relations between risk events, risk perception, and the facets of the personality dimensions via data collecting from 664 adolescent athletes aged 13–18 years (male 364, female 300). Secondary intent is to assess school-specific levels of training risks among sports schools, regular schools, and sports and education integrated schools. The results show that psychology events are the strongest predicted by personality traits, risk perception, and sports, followed by injury and nutrition. Emotionality has the most significant positive correlation with risk events, while other traits have a significant negative correlation with risk events, except agreeableness. The integration schools are more conducive to the healthy development of adolescent athletes’ personalities. Moreover, the research indicates that sports training can strengthen the development directions of different personality characteristics.
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Shagawa M, Maruyama S, Sekine C, Yokota H, Hirabayashi R, Hirata A, Yokoyama M, Edama M. Comparison of anterior knee laxity, stiffness, genu recurvatum, and general joint laxity in the late follicular phase and the ovulatory phase of the menstrual cycle. BMC Musculoskelet Disord 2021; 22:886. [PMID: 34663291 PMCID: PMC8524894 DOI: 10.1186/s12891-021-04767-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One risk factor for anterior cruciate ligament (ACL) injury may be fluctuations in female hormones. This study examined variability in joint laxity, as a risk factor for ACL injury, during the menstrual cycle. METHODS Subjects were 15 female university students with regular menstrual cycles. We measured estradiol (E2) concentration, anterior knee laxity (AKL), stiffness, genu recurvatum (GR), and general joint laxity (GJL) during the late follicular and ovulatory phases. AKL was measured as anterior tibial displacement of the femur after application of 44-, 89-, and 133-N loads on the tibia. Stiffness was calculated as Δforce/Δdisplacement at loads of 44-89 N and between 89 and 133 N. GR was measured prone, with the base of the patella distal to the edge of the bed. The University of Tokyo joint laxity test was used to evaluate GJL. RESULTS E2 concentration was significantly higher in the ovulatory phase than in the late follicular phase (p = 0.018), AKL and stiffness did not differ significantly between phases, and GR and GJL were significantly higher in the ovulatory phase than in the late follicular phase (p = 0.011, 0.031). CONCLUSION These findings suggest that E2 concentrations may affect GR and GJL during the menstrual cycle.
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Affiliation(s)
- Mayuu Shagawa
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Chie Sekine
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Hirotake Yokota
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Ryo Hirabayashi
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Arisa Hirata
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan
| | - Mizuki Yokoyama
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan
| | - Mutsuaki Edama
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan.
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan.
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Barnum MS, Boyd ED, Vacek P, Slauterbeck JR, Beynnon BD. Association of Geometric Characteristics of Knee Anatomy (Alpha Angle and Intercondylar Notch Type) With Noncontact ACL Injury. Am J Sports Med 2021; 49:2624-2630. [PMID: 34236929 PMCID: PMC9310444 DOI: 10.1177/03635465211023750] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The femoral intercondylar notch type and the alpha angle (the angle between the femoral notch roof and the long axis of the femur) are easily measured in clinical settings; however, their associations with anterior cruciate ligament (ACL) injury remain unclear. HYPOTHESIS/PURPOSE The purpose was to determine if the alpha angle and the femoral notch type are associated with noncontact ACL injury univariately and in combination with previously identified knee geometric risk factors. We hypothesized that the alpha angle and the femoral notch type are associated with noncontact ACL injury and that the association differs between men and women. STUDY DESIGN Case control study; Level of evidence, 3. METHODS The alpha angle and the femoral notch type were measured via 3T magnetic resonance imaging (MRI) acquired from 61 women and 25 men with a first-time noncontact ACL injury. Each injured patient was matched with a control participant based on age, sex, and participation on the same sports team. A conditional logistic regression was used to assess univariate associations with ACL injury as well as multivariate associations using MRI-based risk factors of knee geometry identified in previous analyses: femoral intercondylar notch width at the anterior outlet, femoral intercondylar notch anteromedial ridge thickness, volume of the ACL, tibial plateau lateral compartment subchondral bone slope, lateral compartment middle articular cartilage slope, lateral compartment meniscus-cartilage height, lateral compartment meniscus-bone angle, and medial tibial spine volume. RESULTS For female athletes, the alpha angle (odds ratio, [OR], 1.82 per 1-degree increase; P = .001), the tibial lateral compartment articular cartilage slope (OR, 1.25 per 1-degree increase in the posterior-inferior directed slope; P = .022), and the femoral notch anteromedial ridge thickness (OR, 3.36 per 1-mm increase; P = .027) were independently associated with ACL disruption. For men, no other variables entered the models after the alpha angle was inputted as the first step (OR, 2.19 per 1-degree increase; P = .010). CONCLUSION For women, ACL injury was most strongly associated with increased alpha angle, increased tibial plateau slope, and increased femoral notch ridge thickness. For men, increased alpha angle was the most significant factor associated with ACL injury. The mechanism of injury might be associated with a combination of impingement of the ACL against the bone and increased ligament loading.
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Affiliation(s)
- Michael S. Barnum
- Department of Orthopedics and Rehabilitation, McClure Musculoskeletal Research Center, Robert Larner MD, College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Evan D. Boyd
- Department of Orthopedics and Rehabilitation, McClure Musculoskeletal Research Center, Robert Larner MD, College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Pamela Vacek
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - James R. Slauterbeck
- Department of Orthopedics and Rehabilitation, McClure Musculoskeletal Research Center, Robert Larner MD, College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Bruce D. Beynnon
- Department of Orthopedics and Rehabilitation, McClure Musculoskeletal Research Center, Robert Larner MD, College of Medicine, University of Vermont, Burlington, Vermont, USA.,Address correspondence to Bruce D. Beynnon, MS, PhD, Department of Orthopedics and Rehabilitation, McClure Musculoskeletal Research Center, 95 Carrigan Drive, 438A Stafford Hall, Burlington, VT 05405-0084, USA ()
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Marchiori G, Lopomo NF, Bologna E, Spadaro D, Camarda L, Berni M, Visani A, Zito M, Zaffagnini S, Zingales M. How preconditioning and pretensioning of grafts used in ACLigaments surgical reconstruction are influenced by their mechanical time-dependent characteristics: Can we optimize their initial loading state? Clin Biomech (Bristol, Avon) 2021; 83:105294. [PMID: 33667940 DOI: 10.1016/j.clinbiomech.2021.105294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Consensus about a pre-implant preparation protocol adaptable to any graft used in Anterior Cruciate Ligament reconstruction is still lacking. In fact, there is not agreement on reliable metrics that consider both specific graft dimensional characteristics, such as its diameter, and the inherent properties of its constitutive material, i.e. ligaments or tendons. Aim of the present study was to investigate and propose the applied engineering stress as a possible metrics. METHODS Preconditioning and pretensioning protocol involved groups of grafts with different section (10 or 32 mm2) and materials (i.e. human patellar and hamstring tendons, and synthetic grafts). A 140 N load was applied to the grafts and maintained for 100 s. Initial stress and following stress-relaxation (a mechanical characteristic that can be related to knee laxity) were specifically analysed. FINDINGS Initial stress, ranging between 4 and 12 MPa, was affected primarily by the graft cross-section area and secondarily by the choice of the graft material. In terms of loss of the initial stress, stress-relaxation behaviour varied instead on a narrower range, namely 13-17%. INTERPRETATION Engineering stress can be identified as the correct metrics to optimize the initial state of each graft to avoid excessive stiffness, laxity or fatigue rupture phenomena.
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Affiliation(s)
- Gregorio Marchiori
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Scienze e Tecnologie Chirurgiche, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Nicola Francesco Lopomo
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Scienze e Tecnologie Chirurgiche, Via di Barbiano 1/10, 40136 Bologna, Italy; Department of Information Engineering, University of Brescia, Via Branze 38, 25123, Brescia, Italy
| | - Emanuela Bologna
- Engineering Department, University of Palermo, Viale delle Scienze ed.8, 90100 Palermo, Italy; Bio/NanoMechanics for Medical Sciences Laboratory, ATeN-Center, University of Palermo, Viale delle Scienze ed.8, 90100 Palermo, Italy
| | - Doriana Spadaro
- Fallprotec SA, 43-45 ZA Op Zaemer, 4959 Bascharage, Luxembourg
| | - Lawrence Camarda
- Department of Discipline Surgical, Oncology and Dentistry, University of Palermo, Via Liborio Giuffrè, 5, 90127, Palermo, Italy
| | - Matteo Berni
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Tecnologia Medica, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Andrea Visani
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Scienze e Tecnologie Chirurgiche, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Marianna Zito
- Engineering Department, University of Palermo, Viale delle Scienze ed.8, 90100 Palermo, Italy
| | - Stefano Zaffagnini
- IRCCS Istituto Ortopedico Rizzoli, IIa Clinica Ortopedica e Traumatologica, Via Pupilli 1/10, 40136 Bologna, Italy
| | - Massimiliano Zingales
- Engineering Department, University of Palermo, Viale delle Scienze ed.8, 90100 Palermo, Italy; Bio/NanoMechanics for Medical Sciences Laboratory, ATeN-Center, University of Palermo, Viale delle Scienze ed.8, 90100 Palermo, Italy.
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A Magnetic Resonance Imaging-Compatible Device to Perform In Vivo Anterior Knee Joint Loading. J Sport Rehabil 2021; 30:1102-1105. [PMID: 33596546 DOI: 10.1123/jsr.2020-0367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/09/2020] [Accepted: 11/27/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT Greater anterior knee laxity (AKL) is associated with impaired sensory input and decreased functional knee stability. As functional magnetic resonance imaging (MRI) is the gold standard for understanding brain function, methods to load the anterior cruciate ligament in the MRI environment could further our understanding of the ligament's sensory role in knee joint stability. OBJECTIVE To design and validate an MRI-compatible anterior knee joint loading device. DESIGN Descriptive laboratory study. SETTING University laboratory study. PARTICIPANTS Sixteen healthy and physically active females participated (age = 23.4 [3.7] y; mass = 64.4 [8.4] kg). INTERVENTIONS The AKL was assessed by a commercially available arthrometer. The AKL was also assessed with a custom-made, MRI-compatible device that produced anterior knee joint loading in a manner similar to the commercial arthrometer while obtaining dynamic structural MRI data. MAIN OUTCOME MEASUREMENTS The AKL (in millimeters) at 133 N of loading was assessed with the commercial knee arthrometer. Anterior displacement of the tibia relative to the femur obtained at 133 N of loading was measured from dynamic MRI data obtained during usage of the custom device. Pearson correlations were used to examine relationships between the 2 measures. The 95% limits of agreement compared the absolute differences between the 2 devices. RESULTS There was a 3.2-mm systematic difference between AKL (6.3 [1.6] mm) and anterior tibial translation (3.2 [1.0] mm) measures. There was a significant positive correlation between values obtained from the commercial arthrometer and the MRI-compatible device values (r = .553, P = .026). CONCLUSIONS While systematic differences were observed, the MRI-compatible anterior knee joint loading device anteriorly translated the tibia relative to the femur in a similar manner to a commercial arthrometer design to stress the anterior cruciate ligament. Such a device may be beneficial in future functional magnetic resonance imaging study of anterior cruciate ligament mechanoreception.
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Magnusson K, Turkiewicz A, Hughes V, Frobell R, Englund M. High genetic contribution to anterior cruciate ligament rupture: Heritability ~69. Br J Sports Med 2020; 55:bjsports-2020-102392. [PMID: 33288618 DOI: 10.1136/bjsports-2020-102392] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We aimed to determine the lifetime genetic risk for anterior cruciate ligament (ACL) rupture. METHODS We used a twin study approach, linking the Swedish Twin Register with national healthcare data to form a 30 year, population wide, longitudinal twin cohort. We studied ACL rupture in this cohort of 88 414 identical and fraternal twins, aged ≥17 years, to determine the familial risk and heritability of ACL rupture. RESULTS The incidence rate of ACL rupture was 70 (95% CI 66 to 74) per 100 000 person years. The familial risk, which is the excess risk ratio (RR) of the second twin having ACL rupture given that the first twin has had such a rupture, was higher in identical twin pairs (RR=8.6, 95% CI 6.2 to 11.0) than in fraternal twin pairs (RR=1.9, 95% CI 0.9 to 3.0). The overall heritability of ACL rupture was high, 69% (95% CI 47 to 91), increasing from 60% at age 17 years to 80% at age 60 years. Women and men had similar familial risk and heritability of ACL rupture. CONCLUSION The genetic contribution to ACL rupture of ~69% is high and suggests strong familial clustering. If clinicians recognise the high genetic risk of such injury, they may be better able to counsel athletes whose near relatives have had ACL rupture.
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Affiliation(s)
- Karin Magnusson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
- Diakonhjemmet Hospital, Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway
| | - Aleksandra Turkiewicz
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Velocity Hughes
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Richard Frobell
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, Sweden
| | - Martin Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
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Fiber splay precludes the direct identification of ligament material properties: Implications for ACL graft selection. J Biomech 2020; 113:110104. [PMID: 33161304 DOI: 10.1016/j.jbiomech.2020.110104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/08/2020] [Accepted: 10/17/2020] [Indexed: 11/20/2022]
Abstract
Anterior cruciate ligament (ACL) injuries typically require surgical reconstruction to restore adequate knee stability. The middle third of an injured patient's patellar tendon (PT) is a commonly used graft for ACL reconstruction. However, many clinicians and researchers question whether it is the best option, as several studies have suggested that it is a stiffer material than the ACL. Still, there is little to no consensus on even the most basic material property of ligaments/tendons: the tangent modulus in the fiber direction, or slope of the linear portion of the uniaxial stress-strain curve. In this study, we investigate the effect of fiber splay (the tendency of collagen fibers to spread out near the enthesis) on the apparent tangent modulus. Using a simplified theoretical model, we establish a quantity we call the splay ratio, which describes the relationship between splay geometry and the apparent tangent modulus. We then more rigorously investigate the effect of the splay ratio on the apparent tangent modulus of the ovine PT and anteromedial and posterolateral regions of the ACL using experimental and computational methods. Both approaches confirmed that splay geometry significantly affects the apparent material behavior. Because true material properties are independent of geometry, we conclude that the macroscopic response of ligaments and tendons is not sufficient for the characterization of their material properties, but rather is reflective of both material and structural properties. We further conclude that the PT is probably not a stiffer material than ACL, but that the PT graft is likely a stiffer structure than either ACL region.
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Stumpff K, Hadley M, Corn K, Templeton K. Sex-Based Reporting of Common Musculoskeletal Conditions. J Womens Health (Larchmt) 2020; 30:689-693. [PMID: 33090896 DOI: 10.1089/jwh.2020.8628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction: Sex- and gender-based differences affect all aspects of health and disease, including musculoskeletal conditions. However, it is unknown how often authors publish outcomes of common conditions based on sex. We reviewed the frequency with which articles in orthopedic journals published sex-specific outcomes with regard to a condition with known sex-based differences and one in which differences are less known. Materials and Methods: Articles that reported original clinical studies from four high-impact orthopedic journals were reviewed: Journal of Bone and Joint Surgery (JBJS), Clinical Orthopedics and Related Research (CORR), American Journal of Sports Medicine (AJSM), and Journal of Arthroplasty (JOA). JBJS and CORR were reviewed as journals intended for a general audience, while AJSM and JOA were included as subspecialty journals. Analysis of data based on sex beyond the statement of how many men and women were included was designated as successfully reporting sex-specific outcomes. The gender of authors was assessed for impact on reporting. Results: Sex-specific outcomes were reported in 24%-29% of articles regarding rotator cuff pathology and in 32%-40% of publications concerning knee osteoarthritis. There was a trend toward more publications with sex-specific outcomes in knee osteoarthritis (p = 0.0562). No significant changes in rates of reporting were noted over time. Articles listing a woman as the first or last author were significantly more likely to report results based on sex. Conclusions: While there was a trend for sex-specific outcomes to be reported more often in knee osteoarthritis, the level of reporting was still low. Reporting based on sex was higher if a woman was the first or last author. To improve care for all patients, sex-specific outcomes should be reported across all orthopedic conditions by all researchers.
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Affiliation(s)
- Kelly Stumpff
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Morgan Hadley
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Karsen Corn
- Department of Orthopaedic Surgery, St. Louis University, St. Louis, Missouri, USA
| | - Kim Templeton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Haselhorst A, Rho M. Musculoskeletal Issues and Care Specific to the Female Athlete. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Risk factors for noncontact anterior cruciate ligament injury in female high school basketball and handball players: A prospective 3-year cohort study. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2020; 22:34-38. [PMID: 32821647 PMCID: PMC7417616 DOI: 10.1016/j.asmart.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/23/2020] [Accepted: 06/19/2020] [Indexed: 11/24/2022]
Abstract
Introduction The risk factors of noncontact anterior cruciate ligament (ACL) injury remain an enigma. The purpose of this study was to prospectively evaluate the risk factors for noncontact ACL injury in female high school basketball and handball players. Materials and Methods We conducted a 3-year prospective cohort study between 2009 and 2014, and it included 317 female high school athletes aged 15 years. At baseline, they underwent detailed examinations for various parameters that were documented during their first year of high school. The parameters assessed were height (cm), weight (kg), general joint laxity (points), navicular drop (mm), anterior laxity of the knee using the KT-1000 Knee Ligament Arthrometer (mm), angle of femoral anteversion (º), knee extensor/flexor muscle strength (Nm/kg), and hip abductor strength (Nm/kg). All ACL injuries that occurred during these 3 years were recorded. Results Of 317 players, 27 were excluded because they either had a history of ACL injury or could not complete the study. Thirty ACL tears occurred. Three of the ACL injuries were contact injuries, whereas the remaining 27 were noncontact injuries. Greater body weight (95% confidence interval [CI], 1.030–1.174; P = 0.004), a high hip abductor strength (95% CI, 1.462–4.827; P = 0.001), and small femoral anteversion (95% CI, 0.746–0.982; P = 0.027) were found to be risk factors in logistic regression analysis. Conclusion Greater body weight, a high hip abductor strength, and small femoral anteversion were risk factors for noncontact ACL injury in female high school basketball and handball players.
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Cronström A, Creaby MW, Ageberg E. Do knee abduction kinematics and kinetics predict future anterior cruciate ligament injury risk? A systematic review and meta-analysis of prospective studies. BMC Musculoskelet Disord 2020; 21:563. [PMID: 32819327 PMCID: PMC7441716 DOI: 10.1186/s12891-020-03552-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 07/31/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND To systematically review the association between knee abduction kinematics and kinetics during weight-bearing activities at baseline and the risk of future anterior cruciate ligament (ACL) injury. METHODS Systematic review and meta-analysis according to PRISMA guidelines. A search in the databases MEDLINE (PubMed), CINAHL, EMBASE and Scopus was performed. Inclusion criteria were prospective studies including people of any age, assessing baseline knee abduction kinematics and/or kinetics during any weight-bearing activity for the lower extremity in individuals sustaining a future ACL injury and in those who did not. RESULTS Nine articles were included in this review. Neither 3D knee abduction angle at initial contact (Mean diff: -1.68, 95%CI: - 4.49 to 1.14, ACL injury n = 66, controls n = 1369), peak 3D knee abduction angle (Mean diff: -2.17, 95%CI: - 7.22 to 2.89, ACL injury n = 25, controls n = 563), 2D peak knee abduction angle (Mean diff: -3.25, 95%CI: - 9.86 to 3.36, ACL injury n = 8, controls n = 302), 2D medial knee displacement (cm; Mean diff:: -0.19, 95%CI: - 0,96 to 0.38, ACL injury n = 72, controls n = 967) or peak knee abduction moment (Mean diff:-10.61, 95%CI: - 26.73 to 5.50, ACL injury n = 54, controls n = 1330) predicted future ACL injury. CONCLUSION Contrary to clinical opinion, our findings indicate that knee abduction kinematics and kinetics during weight-bearing activities may not be risk factors for future ACL injury. Knee abduction of greater magnitude than that observed in the included studies as well as factors other than knee abduction angle or moment, as possible screening measures for knee injury risk should be evaluated in future studies.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden. .,Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Australia
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
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Reliability of a Robotic Knee Testing Tool to Assess Rotational Stability of the Knee Joint in Healthy Female and Male Volunteers. SPORTS MEDICINE-OPEN 2020; 6:33. [PMID: 32748169 PMCID: PMC7399727 DOI: 10.1186/s40798-020-00266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 07/24/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Several clinical tests exist to assess knee laxity. Although these assessments are the predominant tools of diagnosis, they are subjective and rely on the experience of the clinician. The robotic knee testing (RKT) device has been developed to quantitatively and objectively measure rotational knee laxity. The purpose of this study was primarily to determine the intra-tester reliability of rotational knee laxity and slack, the amount of rotation occurring between the two turning points of the load deformation curve, measured by the RKT device and investigate the differences between female and male measurements. METHODS Ninety-one healthy and moderately active volunteers took part in the study, of which twenty-five participated in the reliability study. Tibial rotation was performed using a servomotor to a torque of 6 N m, while measurements of motion in all 6° of freedom were collected. Reliability measurements were collected over 5 days at similar times of the day. Intra-class correlation coefficient (ICC) values and standard error of measurement (SEM) were determined across the load deformation curves. Linear mixed effects modelling was used to further assess the reliability of the measurement of external and internal tibial rotation using features of the curve (internal/external rotational laxity and slack). Measurements of internal/external rotational laxity and slack were compared between the sexes using the Student t test. RESULTS Pointwise axial rotation measurements of the tibia had good reliability [ICC (2,1) 0.83-0.89], while reliability of the secondary motions ranged between poor and good [ICC (2,1) 0.31-0.89]. All SEMs were less than 0.3°. Most of the variation of the curve features were accounted for by inter-subject differences (56.2-77.8%) and showed moderate to good reliability. Comparison of the right legs of the sexes revealed that females had significantly larger amounts of internal rotation laxity (females 6.1 ± 1.3° vs males 5.6 ± 0.9°, p = 0.037), external rotation laxity (females 6.0 ± 1.6° vs males 5.0 ± 1.2°, p = 0.002) and slack (females 19.2 ± 4.2° vs males 16.6 ± 2.9°, p = 0.003). Similar results were seen within the left legs. CONCLUSIONS Overall, the RKT is a reliable and precise tool to assess the rotational laxity of the knee joint in healthy individuals. Finally, greater amounts of laxity and slack were also reported for females.
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Abstract
BACKGROUND Orthopaedic studies have reported the prevalence of injuries and outcomes after treatment in men and women patients, and although these differences have been recognized, few studies have evaluated for gender-specific injury patterns, disease progression, and treatment outcomes. A thorough understanding of gender-related differences is important to better individualize treatment and improve outcomes. QUESTIONS/PURPOSES In this study, we sought (1) to determine the proportion of studies published in six orthopaedic journals that provided sex- or gender-specific analyses in 2016 and whether a difference was found in outcomes between men and women and (2) to evaluate whether this proportion varied across several orthopaedic subspecialty journals or between general orthopaedic journals and subspecialty journals. METHODS Six leading orthopaedic surgery journals were selected for review, including two general orthopaedic journals (Journal of Bone and Joint Surgery and Clinical Orthopaedics and Related Research®) and four subspecialty journals (American Journal of Sports Medicine, Journal of Arthroplasty, Journal of Shoulder and Elbow Surgery, and Spine). Journal issues published in the even-numbered months of 2016 were reviewed for clinical randomized controlled, cohort, and case-control studies in which women were a part of the study population. A total of 712 studies evaluating 24,607,597 patients met the criteria and were included in our review of publications from 2016. The selected studies were stratified based on whether gender was a variable in a multifactorial statistical model. Outcomes of interest included the proportion of patients who were women and the presence or absence of a gender-specific analysis. These endpoints were compared between journals. RESULTS Overall, 55% (13,565,773 of 24,607,597) of patients analyzed in these studies were women. Only 34% (241 of 712) of the studies published in 2016 included gender as variable in a multifactorial statistical model. Of these, 39% (93 of 241) demonstrated a difference in the outcomes between patients who were men and women. The Journal of Arthroplasty had the greatest percentage of patients who were women (60%, 9,251,068 of 15,557,187) and the American Journal of Sports Medicine had the lowest (44%, 1,027,857 of 2,357,139; p < 0.001). Orthopaedic subspecialty journals tended to include a greater percentage of women (54%) than did general orthopaedic journals (50%; p = 0.04). CONCLUSION Currently, it is unclear what percentage of published orthopaedic studies should include a gender-specific analysis. In the current study, more than one-third of publications that performed a gender-specific analysis demonstrated a difference in outcomes between men and women, thereby emphasizing the need to determine when such an analysis is warranted. CLINICAL RELEVANCE Future studies should aim to determine when a gender-specific analysis is necessary to improve the management of orthopaedic injuries in men and women. It is important for investigators at the individual-study level to look for every opportunity to ensure that both men's and women's health needs are met by performing appropriate by-sex and by-gender analyses, but not to perform them when they are unnecessary or inappropriate.
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Schneider A, Arias C, Bankhead C, Gaillard R, Lustig S, Servien E. Greater medial tibial slope is associated with increased anterior tibial translation in females with an ACL-deficient knee. Knee Surg Sports Traumatol Arthrosc 2020; 28:1901-1908. [PMID: 31375877 DOI: 10.1007/s00167-019-05643-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 07/19/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of the study was to determine the correlation between medial tibial slope (MTS) and anterior tibial translation (ATT) in female patients with an ACL-deficient knee. It was hypothesized that female patients with a greater medial tibial slope had an increased anterior tibial translation compared to males. METHODS MTS and ATT were analysed in 276 patients (138 females and 138 males) with a complete ACL rupture from 2012 to 2016. The mean age was 32 ± 12 years. Previous surgery or additional ligament injury was excluded. CT scan was used for measuring MTS. Meniscal findings were reported. Anterior tibial translation and side to side difference (SSD) were measured by bilateral Telos™ stress radiography with knee flexion of 20°. RESULTS There was no significant difference in ATT between females (5.4 ± 3.9) and males (5.8 ± 4.2), nor was there a difference in MTS between females (9.8 ± 2.8) and males (9.8 ± 2.7). A positive correlation was found between MTS and ATT absolute (r = 0.35, p < 0.001) and side to side difference (r = 0.12, p = 0.03). MTS greater or equal to 11° significantly increased the ATT (p < 0.05). For each degree of increase of the MTS, increases in ATT absolute of 0.6 mm and SSD of 0.18 mm were observed. Greater MTS was identified as a risk factor for an increase of ATT in females (r = 0.37, p < 0.001) but not in males (r = - 0.1, n.s). Increases of 1° of MTS increased ATT 0.57 mm in female patients (p < 0.001). MTS was influential in ATT despite the presence (r = 0.28 [0.11, 0.44], p = 0.001) or absence (r = 0.48 [0.35, 0.6], p < 0.001) of meniscal lesions. CONCLUSIONS Greater medial tibial slope is associated with increased anterior tibial translation in females with ACL-deficient knees compared to males, despite the presence or absence of meniscal lesions. This could be due to a quadriceps/hamstring imbalance in females and the ability of the hamstring muscles to moderate ATT. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Antoine Schneider
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Hospices civils de Lyon, Université Claude-Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Claudia Arias
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Hospices civils de Lyon, Université Claude-Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France. .,Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.
| | - Chris Bankhead
- Department of Orthopaedics, University of New Mexico, Albuquerque, NM, USA
| | - Romain Gaillard
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Hospices civils de Lyon, Université Claude-Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Sebastien Lustig
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Hospices civils de Lyon, Université Claude-Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.,Laboratoire de Biomécanique Et Mécanique Des Chocs (Université Lyon 1/IFSTTAR) LBMC, UMR_T9406, Lyon, France
| | - Elvire Servien
- Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Hospices civils de Lyon, Université Claude-Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.,EA 7424, Inter-University Laboratory of Human Movement Science, Lyon, France
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Hietamo J, Parkkari J, Leppänen M, Steffen K, Kannus P, Vasankari T, Heinonen A, Mattila VM, Pasanen K. Association between lower extremity muscular strength and acute knee injuries in young team‐sport athletes. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.172] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jussi Hietamo
- Tampere Research Center of Sport Medicine UKK Institute for Health Promotion Research Tampere Finland
- KHKS Hämeenlinna Finland
| | - Jari Parkkari
- Tampere Research Center of Sport Medicine UKK Institute for Health Promotion Research Tampere Finland
- Department of Orthopedics and Traumatology Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology University of Tampere Tampere Finland
| | - Mari Leppänen
- Tampere Research Center of Sport Medicine UKK Institute for Health Promotion Research Tampere Finland
| | - Kathrin Steffen
- Oslo Sports Trauma Research Center Department of Sports Medicine Norwegian School of Sport Sciences Oslo Norway
| | - Pekka Kannus
- UKK Institute for Health Promotion Research Tampere Finland
| | | | | | - Ville M. Mattila
- Department of Orthopedics and Traumatology Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology University of Tampere Tampere Finland
| | - Kati Pasanen
- Tampere Research Center of Sport Medicine UKK Institute for Health Promotion Research Tampere Finland
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
- McCaig Institute for Bone and Joint Health Cumming School of Medicine University of Calgary Calgary AB Canada
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Taylor JB, Nguyen AD, Shultz SJ, Ford KR. Hip biomechanics differ in responders and non-responders to an ACL injury prevention program. Knee Surg Sports Traumatol Arthrosc 2020; 28:1236-1245. [PMID: 30259145 DOI: 10.1007/s00167-018-5158-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 09/17/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate the differences in demographic, anthropometric, biomechanical, and/or performance variables between those that do (responders) and do not (non-responders) exhibit reductions in knee abduction moments after an anterior cruciate ligament injury prevention program (ACL-IPP). METHODS Forty-three adolescent female athletes completed biomechanical (3D motion analysis of a drop vertical jump) and performance testing before and after randomization into a 6-week ACL-IPP. Participants were classified into responders and non-responders based on their level of reduction of knee abduction moment from pre- to post-test. RESULTS Compared to non-responders, responders exhibited increased hip adduction excursion at baseline (p = 0.02) and trended towards attending more training sessions (p = 0.07) and participating in soccer and not basketball (p = 0.07). Responders also showed greater improvements in hip flexion angles (p = 0.02) and moments (p < 0.001), and knee abduction angles (p < 0.001) and excursions (p = 0.001). There were no significant differences in age or experience with prior injury prevention programs (n.s.). CONCLUSIONS After an ACL-IPP, athletes that exhibit the greatest reduction in knee abduction moments exhibit greater hip adduction excursion at baseline and show corresponding improvements in hip flexion and knee abduction kinematics and hip flexion moments. These results can help clinicians prospectively identify individuals that may not respond to an ACL-IPP and target individualized training for those at risk of injury. LEVEL OF EVIDENCE I. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT02530333.
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Affiliation(s)
- Jeffrey B Taylor
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, One University Parkway, High Point, NC, 27268, USA. .,Department of Kinesiology, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA.
| | - Anh-Dung Nguyen
- Department of Athletic Training, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Sandra J Shultz
- Department of Kinesiology, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Kevin R Ford
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, One University Parkway, High Point, NC, 27268, USA
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Beynnon BD, Fiorentino N, Gardner-Morse M, Tourville TW, Slauterbeck JR, Sturnick DR, Argentieri EC, Imhauser CW. Combined Injury to the ACL and Lateral Meniscus Alters the Geometry of Articular Cartilage and Meniscus Soon After Initial Trauma. J Orthop Res 2020; 38:759-767. [PMID: 31705680 PMCID: PMC7071961 DOI: 10.1002/jor.24519] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/23/2019] [Indexed: 02/04/2023]
Abstract
Combined injury to the anterior cruciate ligament (ACL) and meniscus is associated with earlier onset and increased rates of post-traumatic osteoarthritis compared with isolated ACL injury. However, little is known about the initial changes in joint structure associated with these different types of trauma. We hypothesized that trauma to the ACL and lateral meniscus has an immediate effect on morphometry of the articular cartilage and meniscus about the entire tibial plateau that is more pronounced than an ACL tear without meniscus injury. Subjects underwent magnetic resonance imaging scanning soon after injury and prior to surgery. Those that suffered injury to the ACL and lateral meniscus underwent changes in the lateral compartment (increases in the posterior-inferior directed slopes of the articular cartilage surface, and the wedge angle of the posterior horn of the meniscus) and medial compartment (the cartilage-to-bone height decreased in the region located under the posterior horn of the meniscus, and the thickness of cartilage increased and decreased in the mid and posterior regions of the plateau, respectively). Subjects that suffered an isolated ACL tear did not undergo the same magnitude of change to these articular structures. A majority of the changes in morphometry occurred in the lateral compartment of the knee; however, change in the medial compartment of the knee with a normal appearing meniscus also occurred. Statement of clinical significance: Knee injuries that involve combined trauma to the ACL and meniscus directly affect both compartments of the knee, even if the meniscus and articular cartilage appears normal upon arthroscopic examination. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:759-767, 2020.
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Affiliation(s)
- Bruce D Beynnon
- Department Orthopaedics and Rehabilitation, University of Vermont,Department of Mechanical Engineering, University of Vermont,Department of Electrical and Biomedical Engineering, University of Vermont
| | - Niccolo Fiorentino
- Department Orthopaedics and Rehabilitation, University of Vermont,Department of Mechanical Engineering, University of Vermont,Department of Electrical and Biomedical Engineering, University of Vermont
| | | | | | | | | | - Erin C Argentieri
- Department of Radiology and Imaging, Hospital for Special Surgery, New York
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York
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Denızoglu Kulli H, Yeldan I, Yildirim NU. Influence of quadriceps angle on static and dynamic balance in young adults. J Back Musculoskelet Rehabil 2020; 32:857-862. [PMID: 30932878 DOI: 10.3233/bmr-181332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Changes in postural stability may be a reason for injuries in individuals who have altered musculoskeletal alignment. Q angle (QA) has shown to be a predictor for lower extremity injuries. However, the relationship between balance and QA has not been investigated in young adults. OBJECTIVE The aim of the study was to investigate the relationship between QA and balance in young adults. METHODS Ninety participants performed the single leg stance test (SLST) and Star Excursion Balance Test (SEBT) to assess static and dynamic balance, respectively. QA was measured using a manual goniometer. Participants were divided into low, normal and high QA groups. RESULTS The relationship between SLST and QA was not statistically significant in both eyes opened and closed condition (r=-0.030, p= 0.782; r= 0.031, p= 0.774; respectively). SLST scores did not differ among the three groups in both eyes opened and closed condition (p= 0.781, p= 0.790; respectively). QA significantly correlated with lateral, posterolateral directions and sum score of SEBT (r= 0.240, p= 0.023; r= 0.269, p= 0.010; r= 0.210, p= 0.047). The comparisons among the low, normal and high Q angle groups' SEBT scores showed that balance performance in lateral direction was poorer in low QA group (p= 0.027). CONCLUSIONS The results of the study showed that QA and dynamic balance have a significant relationship. To reduce musculoskeletal injury risk, the dynamic balance should be assessed in young adults who have lower QA.
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Affiliation(s)
- Hilal Denızoglu Kulli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
| | - Ipek Yeldan
- Department of Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Necmiye Un Yildirim
- Department of Physiotherapy and Rehabilitation, Gulhane Faculty of Health Sciences, Health Science University, Ankara, Turkey
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Slater LV, Blemker SS, Hertel J, Saliba SA, Weltman AL, Hart JM. Sex affects gait adaptations after exercise in individuals with anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2020; 71:189-195. [PMID: 31770661 DOI: 10.1016/j.clinbiomech.2019.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/30/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteoarthritis after anterior cruciate ligament reconstruction has been linked with changes in gait. Individuals with reconstruction demonstrate gait changes after exercise, however there is no information on altered gait after exercise based on sex. The purpose of this study was to examine the association of sex on changes in running gait after exercise in individuals with reconstruction compared to healthy. METHODS Forty females (22 reconstructed) and 22 men (11 reconstructed) ran before and after exercise. Triplanar lower extremity kinematics and kinetics were measured on the involved limb. Data were reduced to 0-100% of gait. Change scores were calculated for each 1% with 90% confidence intervals. Mean differences were calculated for all significant differences. FINDINGS After exercise, females with reconstruction increased knee valgus (1.81°), knee external rotation (2.02°), lateral trunk flexion (1.24°) and trunk rotation (2.15°) compared to healthy females. Females with reconstruction increased knee extension moment (0.07 Nm/kg), knee abduction moment (0.08 Nm/kg), hip extension moment (0.14 Nm/kg) and hip internal rotation moment (0.04 Nm/kg) compared to healthy females. After exercise, males with reconstruction decreased knee varus (-4.83°), hip adduction (-1.99°), and hip internal rotation (-4.44°), however increased lateral trunk flexion (1.94°) compared to healthy males. Males with reconstruction increased knee extension moment (0.07 Nm/kg), knee adduction moment (0.31 Nm/kg), knee internal rotation moment (0.13 Nm/kg), hip flexion moment (0.17 Nm/kg), and hip external rotation moment (0.05 Nm/kg) compared to healthy males. INTERPRETATION Males with reconstruction increased hip loading while women with reconstruction increased trunk motion post-exercise. Sex should be considered when evaluating response to exercise after reconstruction.
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Affiliation(s)
- Lindsay V Slater
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA.
| | - Silvia S Blemker
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Susan A Saliba
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Arthur L Weltman
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
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Kent RN, Imhauser CW, Thein R, Marom N, Wickiewicz TL, Nawabi DH, Pearle AD. Engagement of the Secondary Ligamentous and Meniscal Restraints Relative to the Anterior Cruciate Ligament Predicts Anterior Knee Laxity. Am J Sports Med 2020; 48:109-116. [PMID: 31765242 DOI: 10.1177/0363546519888488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with high-grade preoperative side-to-side differences in anterior laxity as assessed via the Lachman test after unilateral anterior cruciate ligament (ACL) rupture are at heightened risk of early ACL graft failure. Biomechanical factors that predict preoperative side-to-side differences in anterior laxity are poorly understood. PURPOSE To assess, in a cadaveric model, whether the increase in anterior laxity caused by sectioning the ACL (a surrogate for preoperative side-to-side differences in anterior laxity) during a simulated Lachman test is associated with two biomechanical factors: (1) the tibial translation at which the secondary anterior stabilizers, including the remaining ligaments and the menisci, begin to carry force, or engage, relative to that of the ACL or (2) the forces carried by the ACL and secondary stabilizers at the peak applied anterior load. STUDY DESIGN Controlled laboratory study. METHODS Seventeen fresh-frozen human cadaveric knees underwent Lachman tests simulated through a robotic manipulator with the ACL intact and sectioned. The net forces carried by the ACL and secondary soft tissue stabilizers (the medial meniscus and all remaining ligaments, measured as a whole) were characterized as a function of anterior tibial translation. The engagement points of the ACL (with the ACL intact) and each secondary stabilizer (with the ACL sectioned) were defined as the anterior translation at which they began to carry force, or engaged, during a simulated Lachman test. Then, the relative engagement point of each secondary stabilizer was defined as the difference between the engagement point of each secondary stabilizer and that of the ACL. Linear regressions were performed to test each association (P < .05). RESULTS The increase in anterior laxity caused by ACL sectioning was associated with increased relative engagement points of both the secondary ligaments (β = 0.87; P < .001; R2 = 0.75) and the medial meniscus (β = 0.66; P < .001; R2 = 0.58). Smaller changes in anterior laxity were also associated with increased in situ medial meniscal force at the peak applied load when the ACL was intact (β = -0.06; P < .001; R2 = 0.53). CONCLUSION The secondary ligaments and the medial meniscus require greater anterior tibial translation to engage (ie, begin to carry force) relative to the ACL in knees with greater changes in anterior laxity after ACL sectioning. Moreover, with the ACL intact, the medial meniscus carries more force in knees with smaller changes in anterior laxity after ACL sectioning. CLINICAL RELEVANCE Relative tissue engagement is a new biomechanical measure to characterize in situ function of the ligaments and menisci. This measure may aid in developing more personalized surgical approaches to reduce high rates of ACL graft revision in patients with high-grade laxity.
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Affiliation(s)
- Robert N Kent
- Hospital for Special Surgery, New York, New York, USA
| | | | - Ran Thein
- Chaim Sheba Medical Center, Kadima, Israel
| | - Niv Marom
- Hospital for Special Surgery, New York, New York, USA
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Davey AP, Vacek PM, Caldwell RA, Slauterbeck JR, Gardner-Morse MG, Tourville TW, Beynnon BD. Risk Factors Associated With a Noncontact Anterior Cruciate Ligament Injury to the Contralateral Knee After Unilateral Anterior Cruciate Ligament Injury in High School and College Female Athletes: A Prospective Study. Am J Sports Med 2019; 47:3347-3355. [PMID: 31689130 PMCID: PMC9295727 DOI: 10.1177/0363546519886260] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence of contralateral anterior cruciate ligament (CACL) injuries after recovery from a first-time anterior cruciate ligament (ACL) disruption is high in women; however, little is known about the risk factors associated with this trauma. HYPOTHESIS Patient characteristics, strength, anatomic alignment, and neuromuscular characteristics of the contralateral uninjured leg at the time of the first ACL trauma are associated with risk of subsequent CACL injury, and these risk factors are distinct from those for a first-time ACL injury. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Sixty-one women who suffered a first-time noncontact ACL injury while participating in high school or college sports and underwent measurement of potential risk factors on their contralateral limb soon after the initial ACL injury and before reconstruction were followed until either a CACL injury or an ACL graft injury occurred, or until the last date of contact. RESULTS Follow-up information was available for 55 (90.0%) of the 61 athletes and 11 (20.0%) suffered a CACL injury. Younger age, decreased participation in sport before the first ACL disruption, decreased anterior stiffness of the contralateral knee, and increased hip anteversion were associated with increases in the risk of suffering a CACL injury. CONCLUSION A portion of CACL injury risk factors were modifiable (time spent participating in sport and increasing anterior knee stiffness with bracing), while others were nonmodifiable (younger age and increased hip anteversion). The relationship between younger age at the time of an initial ACL injury and increased risk of subsequent CACL trauma may be explained by younger athletes having more years available to be exposed to at-risk activities compared with older athletes. A decrease of anterior stiffness of the knee is linked to decreased material properties and width of the ACL, and this may explain why some women are predisposed to bilateral ACL trauma while others only suffer the index injury. The risk factors for CACL injury are unique to women who suffer bilateral ACL trauma compared with those who suffer unilateral ACL trauma. This information is important for the identification of athletes who may benefit from risk reduction interventions.
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Affiliation(s)
- Annabelle P. Davey
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Pamela M. Vacek
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Ryan A. Caldwell
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - James R. Slauterbeck
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mack G. Gardner-Morse
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Timothy W. Tourville
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Bruce D. Beynnon
- McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA.,Address correspondence to Bruce D. Beynnon, MS, PhD, McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont, Burlington, VT 05405-0084, USA ()
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44
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Slater LV, Wasserman EB, Hart JM. Trends in Recurrent Anterior Cruciate Ligament Injuries Differ From New Anterior Cruciate Ligament Injuries in College and High School Sports: 2009-2010 Through 2016-2017. Orthop J Sports Med 2019; 7:2325967119883867. [PMID: 31799331 PMCID: PMC6873278 DOI: 10.1177/2325967119883867] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Knee injuries are common and result in extended time missed from sports participation. Little is known regarding the comparative characteristics of recurrent versus first-time anterior cruciate ligament (ACL) injuries sustained during athletic events and how they are influenced by sex, sports participation level, and game-time features. Purpose: To evaluate the characteristics (sex, sports level, and game timing [ie, early vs late in the game]) of recurrent ACL injury in National Collegiate Athletic Association (NCAA) and high school athletes compared with first-time ACL injury. Study Design: Descriptive epidemiology study. Methods: Athletic trainers reported ACL injury occurrences and characteristics for collegiate athletes during the 2009-2010 through 2016-2017 academic years and for high school athletes during the 2011-2012 through 2013-2014 academic years. Logistic regression was used to estimate odds ratios (ORs) and 95% CIs for recurrent versus first-time ACL injury. The number of ACL injuries, proportions, and ORs were calculated by sex, competition level, and time in game played. Results were also classified according to injury mechanism: noncontact, overuse, or surface contact. Results: A total of 705 ACL injuries were reported, including 644 first-time injures and 61 recurrent injuries. When restricting to noncontact ACL injuries, 416 were reported (373 first-time injuries and 43 recurrent injuries). The odds of a recurrent versus new ACL injury in NCAA student-athletes were 4.6 times that of high school student-athletes (95% CI, 1.41-15.24; P = .01). When restricting to noncontact ACL injuries, the odds of a recurrent versus new ACL injury during postseason and preseason were 4.5 and 2.8 times that during the regular season, respectively. Athletes in limited-contact and noncontact sports had greater odds of a recurrent versus new ACL injury compared with athletes playing football and other contact and collision sports. There was no significant difference in the odds of a recurrent ACL injury by sex or time in game. Conclusion: Based on the current study, the odds of recurrent ACL injuries are associated with the level of competition but not associated with sex or timing of game play. Determinants of reinjury after primary ACL reconstruction will help advance care for young injured athletes who continue to participate in competitive sports.
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Affiliation(s)
- Lindsay V Slater
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Erin B Wasserman
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, Indiana, USA
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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45
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Sundemo D, Hamrin Senorski E, Karlsson L, Horvath A, Juul-Kristensen B, Karlsson J, Ayeni OR, Samuelsson K. Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: a systematic review. BMJ Open Sport Exerc Med 2019; 5:e000620. [PMID: 31798951 PMCID: PMC6863654 DOI: 10.1136/bmjsem-2019-000620] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2019] [Indexed: 01/02/2023] Open
Abstract
Objectives To investigate the association between generalised joint hypermobility (GJH) and ACL injury risk. Secondary aims involved evaluating associations between GJH and postoperative outcome (including graft-failure risk, knee laxity and patient-reported outcome). Furthermore, we aimed to compare the performance of different grafts in patients with GJH. Methods Databases MEDLINE/PubMed, EMBASE and the Cochrane Library were searched, including 2760 studies. Two reviewers independently screened studies for eligibility. A modified version of the MINORS score was applied for quality appraisal. Studies assessing GJH while reporting the risk of ACL injury and/or postoperative outcome were included. Results Twenty studies were included, using several different methods to determine GJH. There was consistent evidence showing that GJH is a risk factor for unilateral ACL injury in males, while in females, the results were conflicting. There was limited evidence associating GJH with increased knee laxity 5 years postoperatively. There was consistent evidence of inferior postoperative patient-reported outcome in patients with GJH. Moreover, there was limited yet consistent evidence indicating that patellar-tendon autografts are superior to hamstring-tendon autografts in patients with GJH in terms of knee laxity and patient-reported outcome. There was insufficient evidence to draw conclusions regarding the outcomes of bilateral ACL injury and graft failure. Conclusions In men, GJH was associated with an increased risk of unilateral ACL injury. Moreover, GJH was associated with greater postoperative knee laxity and inferior patient-reported outcome. Based on the available evidence, a patellar-tendon autograft appears to be superior to a hamstring-tendon autograft in patients with GJH. However, the included studies were heterogeneous and there is a need for consensus in the assessment of GJH within sports medicine.
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Affiliation(s)
- David Sundemo
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabiltation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Karlsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alexandra Horvath
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, Syddansk Universitet Det Sundhedsvidenskabelige Fakultet, Odense, Denmark
| | - Jon Karlsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olufemi R Ayeni
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kristian Samuelsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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46
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Shultz SJ, Schmitz RJ, Cameron KL, Ford KR, Grooms DR, Lepley LK, Myer GD, Pietrosimone B. Anterior Cruciate Ligament Research Retreat VIII Summary Statement: An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14-16, 2019, Greensboro, NC. J Athl Train 2019; 54:970-984. [PMID: 31461312 PMCID: PMC6795093 DOI: 10.4085/1062-6050-54.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sandra J. Shultz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Randy J. Schmitz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Kenneth L. Cameron
- John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY
| | - Kevin R. Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute and Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens
| | | | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, and Departments of Pediatrics and Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, OH
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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47
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Anderson T, Wasserman EB, Shultz SJ. Anterior Cruciate Ligament Injury Risk by Season Period and Competition Segment: An Analysis of National Collegiate Athletic Association Injury Surveillance Data. J Athl Train 2019; 54:787-795. [PMID: 31322904 DOI: 10.4085/1062-6050-501-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Although fatigue has been implicated in anterior cruciate ligament (ACL) injury, few researchers have examined the timing of injury across a competitive sport season or within a competitive session to gain insight into the potential effects of fatigue on the incidence of ACL injury. OBJECTIVE To identify the time segments across a competitive season or within an individual competition associated with the greatest ACL injury incidence. DESIGN Descriptive epidemiology study. METHODS Data from the National Collegiate Athletic Association Injury Surveillance Program for 2004-2005 through 2015-2016 for basketball, lacrosse, and soccer were analyzed. Incidence rate ratios (IRRs) compared ACL injury rates by sport, sex, season segment, and competition period. Poisson regression was used to examine the associations between each of these categories and the incidence of ACL injury as well as interaction effects. RESULTS During the early regular season, the incidence rate was elevated relative to the preseason (IRR = 1.86; 95% confidence interval [CI] = 1.27, 2.74), middle regular season (IRR = 1.48; 95% CI = 1.01, 2.15), late regular season (IRR = 1.56; 95% CI = 1.08, 2.27), and postseason (IRR = 2.20; 95% CI = 1.06, 4.56). A sport-by-season interaction indicated this effect was largely attributable to a higher incidence in the early season among lacrosse athletes. An interaction between season segment and competition period (P = .02) revealed a greater injury incidence before halftime in the early regular season (IRR = 0.38, 95% CI = 0.19, 0.76), but a greater incidence after halftime in the late regular season (IRR = 2.40, 95% CI = 1.15, 5.02). Fewer noncontact injuries occurred in soccer than in basketball or lacrosse. CONCLUSIONS The ACL injury incidence was higher in the early part of the regular season, particularly among lacrosse athletes. Although the injury incidences before and after halftime were similar, further analyses of player time and time of injury within each half are necessary. Coaches and practitioners should be cognizant of the elevated injury incidence during the early season among lacrosse athletes. Future authors should consider more specific analyses to further elucidate the potential role of fatigue development in exacerbating the incidence of ACL injury in collegiate athletes both within games and across the season.
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Affiliation(s)
- Travis Anderson
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Erin B Wasserman
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
| | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro
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48
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Wojtys EM. Making Progress. Sports Health 2019; 11:299-300. [PMID: 31253068 DOI: 10.1177/1941738119854691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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49
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Marchiori G, Parrilli A, Sancisi N, Berni M, Conconi M, Luzi L, Cassiolas G, Zaffagnini S, Lopomo N. Integration of micro-CT and uniaxial loading to analyse the evolution of 3D microstructure under increasing strain: application to the Anterior Cruciate Ligament. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.matpr.2018.11.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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50
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Lin CY, Casey E, Herman DC, Katz N, Tenforde AS. Sex Differences in Common Sports Injuries. PM R 2018; 10:1073-1082. [PMID: 29550413 PMCID: PMC6138566 DOI: 10.1016/j.pmrj.2018.03.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/25/2018] [Accepted: 03/12/2018] [Indexed: 12/27/2022]
Abstract
Common sports injuries include bone stress injuries (BSIs), anterior cruciate ligament (ACL) injuries, and concussions. Less commonly recognized are the specific sex differences in epidemiology, risk factors, and outcomes of these conditions by sex. An understanding of these factors can improve their clinical management, from prescribing appropriate prehabilitation to guiding postinjury rehabilitation and return to play. This narrative review summarizes the sex differences in the diagnosis and management of BSIs, ACL injuries, and concussions. Although BSIs are more common in female athletes, risk factors for both sexes include prior injury and relative energy deficiency in sport (RED-S). Risk factors in female athletes include smaller calf girth, femoral adduction, and higher rates of loading. Female athletes are also at greater risk for developing ACL injuries in high school and college, but their injury rate is similar in professional sports. Increased lateral tibial slope, smaller ACL size, and suboptimal landing mechanics are additional risk factors more often present in female athletes. Male athletes are more likely to have ACL surgery and have a higher rate of return to sport. Concussions occur more commonly in female athletes; however, female athletes are also more likely to report concussions. Male athletes more commonly sustain concussion through contact with another player. Female athletes more commonly sustain injury from contact with playing equipment. Managing post-concussion symptoms is important, and female athletes may have prolonged symptoms. An understanding of the sex-specific differences in these common sports injuries can help optimize their prehabilitation and rehabilitation. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Cindy Y Lin
- Husky Stadium Sports Medicine Center, University of Washington Medical Center, 3800 Montlake Blvd NE, Seattle, WA 98195
| | | | | | - Nicole Katz
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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