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Ubl ST, Vieider RP, Seilern und Aspang J, Gaebler C, Platzgummer H. Bone bruise distribution predicts anterior cruciate ligament tear location in non-contact injuries. J Exp Orthop 2024; 11:e12034. [PMID: 38741902 PMCID: PMC11089843 DOI: 10.1002/jeo2.12034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/12/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose It is unclear whether different injury mechanisms lead to divergent anterior cruciate ligament (ACL) tear locations. This study aims to analyse the relationship between bone bruise (BB) distribution or depth and ACL tear location. Methods A retrospective analysis of 446 consecutive patients with acute non-contact ACL injury was performed. Only patients with complete ACL tears verified during subsequent arthroscopy were included. Magnetic resonance imaging (MRI) was used to classify BB location, BB depth, ACL tear location and concomitant injuries (medial/lateral meniscus and medial/lateral collateral ligament). Demographic characteristics included age, gender, body mass index (BMI), type of sport and time between injury and MRI. Multiple linear regression analysis was used to identify independent predictors of ACL tear location. Results One hundred and fifty-eight skeletally mature patients met the inclusion criteria. The presence of BB in the lateral tibial plateau was associated with a more distal ACL tear location (β = -0.27, p < 0.001). Less BB depth in the lateral femoral condyle showed a tendency towards more proximal ACL tears (β = -0.14; p = 0.054). Older age predicted a more proximal ACL tear location (β = 0.31, p < 0.001). No significant relationship was found between ACL tear location and gender, BMI, type of sport, concomitant injuries and time between injury and MRI. Conclusion ACL tear location after an acute non-contact injury is associated with distinct patterns of BB distribution, particularly involving the lateral compartment, indicating that different injury mechanisms may lead to different ACL tear locations. Level of Evidence Level III.
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Affiliation(s)
- Steffen T. Ubl
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical CenterWitten/Herdecke UniversityCologneGermany
| | - Romed P. Vieider
- Department of Sports Orthopaedics, Klinikum Rechts der IsarTechnical University of MunichMunichGermany
| | - Jesse Seilern und Aspang
- Department of Orthopaedic Surgery, Grady Memorial HospitalEmory University School of MedicineAtlantaGeorgiaUSA
| | - Christian Gaebler
- Sportambulatorium Wien – Zentrum für Orthopaedie und Sportchirurgie (ZOS)ViennaAustria
| | - Hannes Platzgummer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
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Haack C, Zeppieri G, Moser MW. Rehabilitation Following ACL Repair with Internal Brace Ligament Augmentation in Female Gymnast: A Resident's Case Report. Int J Sports Phys Ther 2024; 19:745-757. [PMID: 38835983 PMCID: PMC11144659 DOI: 10.26603/001c.117773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/09/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction Anterior Cruciate Ligament (ACL) injuries continue to be a major source of morbidity in gymnastics. The gold standard is to perform an ACL Reconstruction (ACLR). However, injuries to the proximal femoral attachment of the ACL have demonstrated an ability to regenerate. An alternative surgical intervention to the ACLR in this ACL tear subgroup is an ACL repair. The purpose of this case report is to provide a rehabilitation progression for a female gymnast after an ACL repair with Internal Brace Ligament Augmentation (IBLA). Case Description The subject was a 16-year-old female who presented with a Sherman Type 1 proximal avulsion of her ACL. She underwent an ACL repair with IBLA. Physical therapy interventions followed a sequential and multi-phased approach based on time for tissue physiologic healing and individual progression. Patient reported outcomes including the International Knee Documentation Committee (IKDC), the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) and the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) were assessed in conjunction with isokinetic strength and hop performance testing to determine return to sport readiness. Outcomes The subject completed 42 sessions over the course of 26 weeks in addition to a home exercise program. At return to sport, clinically meaningful improvement was observed in patient reported outcomes including the IKDC, ACL-RSI, and OSPRO-YF. Additionally, strength and hop performance surpassed established thresholds of clinical significance. The subject returned to sport at six months post-operatively. Conclusion The subject in this case report returned to full participation in gymnastics six months after an ACL repair with internal bracing following a sequential and multi-phased rehabilitation. The primary ACL repair with IBLA appeared beneficial to this patient and could benefit from additional study in other athletes and athletic populations. Level of Evidence Level 5.
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Affiliation(s)
- Colten Haack
- Department of Sports MedicineUniversity of Wisconsin Health
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3
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Schneider KN, Theil C, Gosheger G, Weller JF, Goth A, Ahlbaeumer G. Rate of Revision Surgery and Associated Risk Factors After Primary Arthroscopic ACL Repair With Additional Suture Augmentation. Orthop J Sports Med 2024; 12:23259671241244734. [PMID: 38827140 PMCID: PMC11143819 DOI: 10.1177/23259671241244734] [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: 12/14/2023] [Accepted: 02/02/2024] [Indexed: 06/04/2024] Open
Abstract
Background Recent studies have suggested promising patient-reported outcomes after primary anterior cruciate ligament (ACL) repair with additional suture augmentation (SA). Purpose To evaluate the risk for revision surgery and identify patient- and injury-related risk factors after ACL repair with SA in a large patient cohort subject to strict patient selection. Study Design Case-control study; Level of evidence, 3. Methods Included were 86 patients (61 female; 93% follow-up rate) who underwent arthroscopic ACL repair with SA between January 2017 and March 2019 by a single surgeon and had a minimum follow-up of 24 months. Patients were selected for surgery with regard to time to surgery (preferably on the day of injury), tear pattern (limited to Sherman types 1 and 2), and tissue quality (intact synovial coverage). Postoperatively, the patients who needed revision surgery were identified and compared with patients who did not undergo revision surgery, using the Mann-Whitney U test for nonparametric analysis and the Student t test for parametric analysis. A Kaplan-Meier analysis was performed to investigate the survival rate of the ACL repair. Results A total of 9 patients (10%; median age, 48 years; interquartile range [IQR], 27-50 years) underwent revision surgery at 12 months postoperatively (IQR, 8-25 months). The median follow-up of patients without revision surgery was 35 months (IQR, 33-44 months). The revision-free survival rate was 97% (95% CI, 93%-100%) after 1 year, 93% (95% CI, 88%-98%) after 2 years, and 90% (95% CI, 83%-97%) after 4 years. Patient-related factors-such as sex (P = .98), age at surgery (P = .459), body mass index (P = .352), and preinjury level of sports (P = .53)-had no significant impact on the survival rate of the ACL repair. Injury-related factors-such as concomitant injuries of the medial (P = .860) and lateral menisci (P = .414) and the medial (P = .801) and lateral collateral ligaments (P = .534) or same-day surgery compared with a delay of surgery of up to 18 days (P = .277)-had no significant impact on the survival rate of the ACL repair. Conclusion The revision rate of primary ACL repair with SA at a 2-year follow-up was 10%. Patient- and injury-related factors were not associated with the survival rate of the ACL repair.
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Affiliation(s)
- Kristian Nikolaus Schneider
- Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Christoph Theil
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Jan Frederic Weller
- Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
| | - Anna Goth
- Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
- Department of Trauma Surgery, BG Trauma Clinic Frankfurt, Frankfurt, Germany
| | - Georg Ahlbaeumer
- Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
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4
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Fritz B. [Imaging of the anterior cruciate ligament and anterolateral rotational instability of the knee joint]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:261-270. [PMID: 38441595 DOI: 10.1007/s00117-024-01278-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/28/2024]
Abstract
The anterior cruciate ligament (ACL) is essential for the stability of the knee joint and ACL tears are one of the most common sports injuries with a high incidence, especially in sports that require rotational movements and abrupt changes in direction. Injuries of the ACL are rarely isolated and are often accompanied by meniscal and other internal knee injuries, which increase the risk of osteoarthritis. The spectrum of ACL injuries includes strains, partial tears and complete tears. Magnetic resonance imaging (MRI) plays a pivotal role in the diagnostics as it can accurately depict not only the ACL but also accompanying injuries. Proton density and T2-weighted sequences are particularly suitable for evaluating the ACL, which is usually well visible and assessable in all planes. In addition to depicting fiber disruption as a direct sign and central diagnostic indicator of an ACL tear, there are numerous other direct and indirect signs of an ACL injury in MRI. These include abnormal fiber orientations, signal increases and an anterior subluxation of the tibia relative to the femur. The bone marrow edema patterns often associated with ACL tears are indicative of the underlying injury mechanism. The treatment of ACL tears can be conservative or surgical depending on various factors, such as the patient's activity level and the presence of accompanying injuries. The precise and comprehensive description of ACL injuries by radiology is crucial for optimal treatment planning. Anterolateral rotational instability (ALRI) of the knee joint characterizes a condition of excessive lateral and rotational mobility of the tibia in relation to the femur in the anterolateral knee region. This instability is primarily caused by a rupture of the ACL, with the anterolateral ligament (ALL) that was rediscovered about 10 years ago, also being attributed a role in stabilizing the knee. Although ALRI is primarily diagnosed through clinical examinations, MRI is indispensable for detecting injuries to the ACL, ALL, and other internal knee structures, which is essential for developing an optimal treatment strategy.
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Affiliation(s)
- Benjamin Fritz
- Abteilung für Radiologie, Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz.
- Medizinische Fakultät, Universität Zürich, Zürich, Schweiz.
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5
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Wang J, Luo J, Liang J, Cao Y, Feng J, Tan L, Wang Z, Li J, Hounye AH, Hou M, He J. Lightweight Attentive Graph Neural Network with Conditional Random Field for Diagnosis of Anterior Cruciate Ligament Tear. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:688-705. [PMID: 38343260 PMCID: PMC11031558 DOI: 10.1007/s10278-023-00944-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/23/2023] [Accepted: 10/16/2023] [Indexed: 04/20/2024]
Abstract
Anterior cruciate ligament (ACL) tears are prevalent orthopedic sports injuries and are difficult to precisely classify. Previous works have demonstrated the ability of deep learning (DL) to provide support for clinicians in ACL tear classification scenarios, but it requires a large quantity of labeled samples and incurs a high computational expense. This study aims to overcome the challenges brought by small and imbalanced data and achieve fast and accurate ACL tear classification based on magnetic resonance imaging (MRI) of the knee. We propose a lightweight attentive graph neural network (GNN) with a conditional random field (CRF), named the ACGNN, to classify ACL ruptures in knee MR images. A metric-based meta-learning strategy is introduced to conduct independent testing through multiple node classification tasks. We design a lightweight feature embedding network using a feature-based knowledge distillation method to extract features from the given images. Then, GNN layers are used to find the dependencies between samples and complete the classification process. The CRF is incorporated into each GNN layer to refine the affinities. To mitigate oversmoothing and overfitting issues, we apply self-boosting attention, node attention, and memory attention for graph initialization, node updating, and correlation across graph layers, respectively. Experiments demonstrated that our model provided excellent performance on both oblique coronal data and sagittal data with accuracies of 92.94% and 91.92%, respectively. Notably, our proposed method exhibited comparable performance to that of orthopedic surgeons during an internal clinical validation. This work shows the potential of our method to advance ACL diagnosis and facilitates the development of computer-aided diagnosis methods for use in clinical practice.
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Affiliation(s)
- Jiaoju Wang
- School of Mathematics and Statistics, Central South University, Changsha, 410083, Hunan, China
| | - Jiewen Luo
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jiehui Liang
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Yangbo Cao
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jing Feng
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Lingjie Tan
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Zhengcheng Wang
- Department of Orthopaedic Surgery, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750021, Ningxia Hui Autonomous Region, China
| | - Jingming Li
- School of Civil Engineeringand Architecture, Nanyang Normal University, Nanyang, 473061, Henan, China
| | - Alphonse Houssou Hounye
- School of Mathematics and Statistics, Central South University, Changsha, 410083, Hunan, China
| | - Muzhou Hou
- School of Mathematics and Statistics, Central South University, Changsha, 410083, Hunan, China.
| | - Jinshen He
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China.
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6
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Strassman AK, Stokes DJ, Sanchez RA, Shinsako KK, Smith PA, DiFelice GS, Frank RM. Anterior Cruciate Ligament Repair Using a Re-tensionable All-Suture Construct. Arthrosc Tech 2024; 13:102890. [PMID: 38584624 PMCID: PMC10995730 DOI: 10.1016/j.eats.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/02/2023] [Indexed: 04/09/2024] Open
Abstract
Anterior cruciate ligament (ACL) tears are among the most common injuries to the knee. With recent improvements in imaging that allow for more precise identification of ACL tear patterns, improved techniques for repair, and advancements in biological augmentation, there has been a re-emerging interest in primary ACL repair, especially for acute proximal ACL tears. This article aims to describe a surgical technique for primary ACL repair using a re-tensionable all-suture-based construct.
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Affiliation(s)
| | - Daniel J Stokes
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado, U.S.A
| | | | - Kevin K Shinsako
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado, U.S.A
| | | | | | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado, U.S.A
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7
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Gao S, Wang T. Suture Anchor Technique for Bridge Enhanced Anterior Cruciate Ligament Restoration. Arthrosc Tech 2024; 13:102880. [PMID: 38584620 PMCID: PMC10995693 DOI: 10.1016/j.eats.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/02/2023] [Indexed: 04/09/2024] Open
Abstract
Anterior cruciate ligament (ACL) injuries are common in the athletic population. ACL repair with bridge enhancement is an emerging technology with promising clinical outcomes in patients with a proximal to midsubstance ACL tears. Currently, there are a variety of fixation methods described for isolated ACL repair, including suspensory and anchor techniques. This Technical Note describes a bridge enhanced ACL restoration procedure technique, using suture anchors for the femoral fixation. Advantages of this technique include more rigid fixation and avoiding need for accessory over-the-top incision. Additionally, the surgical workflow is more similar to an ACL reconstruction with intra-articular screw fixation, which may be more readily adopted by some surgeons.
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Affiliation(s)
- Sean Gao
- Department of Orthopaedic Surgery, Sports Medicine, Scripps Clinic Medical Group, La Jolla, California, U.S.A
| | - Tim Wang
- Department of Orthopaedic Surgery, Sports Medicine, Scripps Clinic Medical Group, La Jolla, California, U.S.A
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8
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Bamania P, Osmani HT, Robinson P, McDonnell S, Ahmed N. The patient with a painful knee. Br J Hosp Med (Lond) 2024; 85:1-10. [PMID: 38416527 DOI: 10.12968/hmed.2023.0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Knee pain encompasses a wide array of differential diagnoses and can often pose a diagnostic challenge, as it can have traumatic or non-traumatic causes. A good clinical history, assessment and anatomical knowledge gives a strong foundation to narrow down the diagnosis, and understanding the correct imaging modality and findings further informs correct and timely management. This article reviews various disease processes including fractures, inflammatory, infective and neoplastic causes, and discusses the assessment and various imaging modalities to aid diagnosis in both primary and secondary care.
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Affiliation(s)
- Prashant Bamania
- Department of Radiology, Chelsea and Westminster Hospital, London, UK
| | - Humza T Osmani
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | - Philip Robinson
- University of Leeds and Biochemical Research Centre, Musculoskeletal Centre, Department of Radiology, Chapel Allerton Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - Stephen McDonnell
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | - Naeem Ahmed
- Department of Radiology, Chelsea and Westminster Hospital, London, UK
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9
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Jaramillo Quiceno GA, Sarmiento Riveros PA, Arias Pérez RD, Tabares NG. Novel surgical technique for soft tissue distal avulsion of the anterior cruciate ligament: Technical note. J ISAKOS 2024; 9:59-61. [PMID: 37689246 DOI: 10.1016/j.jisako.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/05/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
The most popular surgical treatment for anterior cruciate ligament (ACL) injuries is reconstruction. However, different native tissue preservation and repair techniques have recently become popular. Among the different types of ACL injuries, the least frequent is the tibial-sided soft-tissue avulsion type. Which can be managed with primary repair as an alternative to reconstruction. However, there aren't many procedures reported for treating these rare injuries. As a result, a repair technique is presented using a suture anchor in the tibial footprint with a double-row construct. We present a prospective intervention cohort of two cases where this procedure was used with adequate clinical evolution and stable fixation at 24 months of follow-up. Likewise, there were no complications or reinterventions performed during follow-up. To our knowledge, this technique had not been reported before in the literature for these lesions and combines the benefits of using a suture anchor with a double-row construct and preserves the native tissue and ACL insertion site. Therefore, in these uncommon lesions, a double-row suture anchor technique can be useful to repair acute distal soft tissue avulsion-type ACL injuries.
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Affiliation(s)
| | | | - Rubén Darío Arias Pérez
- Orthopedic and Traumatology Resident of Pontifical Bolivarian University, St 78B # 72 A 109, Medellín-Antioquia, 050034, Colombia.
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10
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Avey AM, Valdez O, Baar K. Characterization of an in vitro engineered ligament model. Matrix Biol Plus 2024; 21:100140. [PMID: 38235356 PMCID: PMC10792631 DOI: 10.1016/j.mbplus.2023.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024] Open
Abstract
In vivo tendon and ligament research can be limited by the difficultly of obtaining tissue samples that can be biochemically analyzed. In this study, we characterize the most widely used in vitro engineered ligament model. Despite previous works suggesting multiple passages change gene expression in 2D primary tenocytes, we found no relationship between passage number and expression of classical tendon fibroblast markers across different biological donors. When engineered into 3D ligaments, there was an increase in maximal tensile load between 7 and 14 days in culture, that corresponded with an increase in collagen content. By contrast, percent collagen increased logarithmically from Day 7 to Day 14, and this was similar to the increase in the modulus of the tissue. Importantly, there was no relationship between passage number and mechanical function or collagen content in the two independent donors tested. These results suggest that the model develops quickly and is reliable across differing passage numbers. This provides the field with the ability to 1) consistently determine functional changes of interventions out to passage number 10; and 2) to time interventions to the appropriate developmental stage: developing/regenerating (Day 7) or mature (Day 14) tissue.
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Affiliation(s)
- Alec M. Avey
- Department of Neurobiology, Physiology and Behavior, University of California Davis, Davis, CA 95616, United States
| | - Omar Valdez
- Department of Neurobiology, Physiology and Behavior, University of California Davis, Davis, CA 95616, United States
| | - Keith Baar
- Department of Neurobiology, Physiology and Behavior, University of California Davis, Davis, CA 95616, United States
- Department of Physiology and Membrane Biology, University of California Davis, Davis, CA 95616, United States
- VA Northern California Health Care System, Mather, CA 95655, USA
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11
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Noh S, Lee SJ, Yoo JJ, Jin YJ, Yun HW, Min BH, Park JY, Park DY. Synovium-Derived Mesenchymal Stem Cell-Based Scaffold-Free Fibrocartilage Engineering for Bone-Tendon Interface Healing in an Anterior Cruciate Ligament Reconstruction Model. Tissue Eng Regen Med 2024; 21:341-351. [PMID: 37856071 PMCID: PMC10825091 DOI: 10.1007/s13770-023-00593-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Current tendon and ligament reconstruction surgeries rely on scar tissue healing which differs from native bone-to-tendon interface (BTI) tissue. We aimed to engineer Synovium-derived mesenchymal stem cells (Sy-MSCs) based scaffold-free fibrocartilage constructs and investigate in vivo bone-tendon interface (BTI) healing efficacy in a rat anterior cruciate ligament (ACL) reconstruction model. METHODS Sy-MSCs were isolated from knee joint of rats. Scaffold-free sy-MSC constructs were fabricated and cultured in differentiation media including TGF-β-only, CTGF-only, and TGF-β + CTGF. Collagenase treatment on tendon grafts was optimized to improve cell-to-graft integration. The effects of fibrocartilage differentiation and collagenase treatment on BTI integration was assessed by conducting histological staining, cell adhesion assay, and tensile testing. Finally, histological and biomechanical analyses were used to evaluate in vivo efficacy of fibrocartilage construct in a rat ACL reconstruction model. RESULTS Fibrocartilage-like features were observed with in the scaffold-free sy-MSC constructs when applying TGF-β and CTGF concurrently. Fifteen minutes collagenase treatment increased cellular attachment 1.9-fold compared to the Control group without affecting tensile strength. The failure stress was highest in the Col + D + group (22.494 ± 13.74 Kpa) compared to other groups at integration analysis in vitro. The ACL Recon + FC group exhibited a significant 88% increase in estimated stiffness (p = 0.0102) compared to the ACL Recon group at the 4-week postoperative period. CONCLUSION Scaffold-free, fibrocartilage engineering together with tendon collagenase treatment enhanced fibrocartilaginous BTI healing in ACL reconstruction.
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Affiliation(s)
- Sujin Noh
- Department of Biomedical Sciences, Graduate School of Ajou University, 206 World Cup-Ro, Yeongtong-Gu, Suwon, Republic of Korea
| | - Sang Jin Lee
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - James J Yoo
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Yong Jun Jin
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Hee-Woong Yun
- Cell Therapy Center, Ajou Medical Center, Suwon, Republic of Korea
| | - Byoung-Hyun Min
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Jae-Young Park
- Department of Orthopedics Surgery, CHA University Bundang Medical Center, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Do Young Park
- Department of Biomedical Sciences, Graduate School of Ajou University, 206 World Cup-Ro, Yeongtong-Gu, Suwon, Republic of Korea.
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea.
- Cell Therapy Center, Ajou Medical Center, Suwon, Republic of Korea.
- Leading Convergence of Healthcare and Medicine, Institute of Science & Technology (ALCHeMIST), Ajou University, Suwon, Republic of Korea.
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12
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Rilk S, Goodhart GC, O'Brien R, DiFelice GS. Arthroscopic Anatomic Anterior Cruciate Ligament Primary Repair Restores Anterior Tibial Translation Intraoperatively at Time Zero With No Additional Effect of Suture Augmentation. Arthroscopy 2024:S0749-8063(23)00982-9. [PMID: 38266743 DOI: 10.1016/j.arthro.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE To intraoperatively evaluate the ability of anterior cruciate ligament (ACL) primary repair (ACLPR) to restore anterior tibial translation (ATT) at time zero and to assess the influence of additional suture augmentation (SA) on ATT. METHODS Patients with proximal ACL tears undergoing arthroscopic ACLPR with dual-suture anchor fixation were included in this time-zero clinical study. Laxity measurements were taken with a digital arthrometer to evaluate ATT stability preoperatively in the office (T0) as a standardized diagnostic tool, preoperatively under anesthesia (T1), at time zero intraoperatively after ACLPR but prior to SA fixation (T2), and after SA fixation (T3). RESULTS A total of 27 patients (mean age ± standard deviation [SD], 35.1 ± 12.0 years) with proximal ACL tears and significant preoperative (T0) ATT side-to-side differences (SSDs) (mean ± SD, 4.1 ± 1.5 mm) were evaluated. ACLPR was shown to restore ATT SSD at time zero (mean ± SD, 0.2 ± 1.1 mm) given that a significant reduction in ATT SSD (mean difference ± standard error, -4.7 ± 0.21 mm; P < .001) was achieved when comparing preoperative and intraoperative measurements after separate refixation of both ACL bundles with suture anchors. Additional SA fixation did not further decrease ATT when comparing measurements of the ipsilateral leg after ACL refixation and after SA fixation (mean difference ± SD, 0.03 ± 0.22 mm; P = .496). CONCLUSIONS ACLPR with dual-suture anchor fixation restores time-zero ATT laxity in adults with proximal ACL tears. Additional SA fixation in full knee extension does not further decrease ATT. CLINICAL RELEVANCE This study provides important information about the effectiveness of ACLPR in restoring ATT. SA with the knee fixed in full knee extension does not further decrease ATT; therefore, augmentation may not lead to overconstraint of the knee or stress shielding of the repaired ACL.
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Affiliation(s)
- Sebastian Rilk
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A.; Medical University of Vienna, Vienna, Austria
| | - Gabriel C Goodhart
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A
| | - Robert O'Brien
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A.; Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - Gregory S DiFelice
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A..
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13
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Xue Y, Yang S, Sun W, Tan H, Lin K, Peng L, Wang Z, Zhang J. Approaching expert-level accuracy for differentiating ACL tear types on MRI with deep learning. Sci Rep 2024; 14:938. [PMID: 38195977 PMCID: PMC10776725 DOI: 10.1038/s41598-024-51666-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/08/2024] [Indexed: 01/11/2024] Open
Abstract
Treatment for anterior cruciate ligament (ACL) tears depends on the condition of the ligament. We aimed to identify different tear statuses from preoperative MRI using deep learning-based radiomics with sex and age. We reviewed 862 patients with preoperative MRI scans reflecting ACL status from Hunan Provincial People's Hospital. Based on sagittal proton density-weighted images, a fully automated approach was developed that consisted of a deep learning model for segmenting ACL tissue (ACL-DNet) and a deep learning-based recognizer for ligament status classification (ACL-SNet). The efficacy of the proposed approach was evaluated by using the sensitivity, specificity and area under the receiver operating characteristic curve (AUC) and compared with that of a group of three orthopedists in the holdout test set. The ACL-DNet model yielded a Dice coefficient of 98% ± 6% on the MRI datasets. Our proposed classification model yielded a sensitivity of 97% and a specificity of 97%. In comparison, the sensitivity of alternative models ranged from 84 to 90%, while the specificity was between 86 and 92%. The AUC of the ACL-SNet model was 99%, demonstrating high overall diagnostic accuracy. The diagnostic performance of the clinical experts as reflected in the AUC was 96%, 92% and 88%, respectively. The fully automated model shows potential as a highly reliable and reproducible tool that allows orthopedists to noninvasively identify the ACL status and may aid in optimizing different techniques, such as ACL remnant preservation, for ACL reconstruction.
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Affiliation(s)
- Yang Xue
- School of Computer Science, Hunan First Normal University, Changsha, 410205, China
- Hunan Provincial Key Laboratory of Information Technology for Basic Education, Changsha, 410205, China
| | - Shu Yang
- Department of Orthopaedic, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410002, China
| | - Wenjie Sun
- Department of Radiology, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410002, China
| | - Hui Tan
- Department of Radiology, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410002, China
| | - Kaibin Lin
- School of Computer Science, Hunan First Normal University, Changsha, 410205, China
- Hunan Provincial Key Laboratory of Information Technology for Basic Education, Changsha, 410205, China
| | - Li Peng
- School of Computer Science, Hunan First Normal University, Changsha, 410205, China
- Hunan Provincial Key Laboratory of Information Technology for Basic Education, Changsha, 410205, China
| | - Zheng Wang
- School of Computer Science, Hunan First Normal University, Changsha, 410205, China.
- Hunan Provincial Key Laboratory of Information Technology for Basic Education, Changsha, 410205, China.
| | - Jianglin Zhang
- Department of Dermatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
- Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen, 518020, Guangdong, China.
- Department of Geriatrics, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
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14
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Wilson WT, Banger MS, Hopper GP, Blyth MJG, MacKay GM, Riches PE. Deficits in muscle strength are not seen following recovery from augmented primary repair of anterior cruciate ligament tears. J ISAKOS 2023; 8:436-441. [PMID: 37775044 DOI: 10.1016/j.jisako.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES Anterior cruciate ligament (ACL) repair for proximal tears, where the ligament is re-attached and augmented with suture tape, can negate the need for graft harvest, thereby maintaining native anatomy. Autograft harvest has been associated with persistent deficits in lower limb muscle strength after recovery from ACL reconstruction. The aim of this study is to compare lower limb muscle strength following ACL repair and reconstruction. METHODS Nineteen ACL repair patients augmented with suture tape and nineteen ipsilateral semitendinosus-gracilis autograft ACL reconstruction patients (both mean 4 years postoperatively) were recruited, along with twenty healthy volunteers. Patient-reported outcome measures (PROMs) were obtained using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and Tegner scores. Maximal isometric quadriceps and hamstring strength at 90° knee flexion were measured using a fixed Myometer after a warm-up and three maximal-effort contractions. RESULTS Mean hamstring strength of the reconstructed legs was lower than that of healthy volunteers by 0.29 Nm/kg. The hamstring strength ratio of the operated side to the uninjured side was greater in the repair (95% ± 13) than in the reconstruction (81% ± 18) group. There were no statistically significant differences between sides for quadriceps peak torque or for hamstrings in the volunteer or repair group. PROMs scores for the reconstruction group were significantly lower than volunteers across all domains and lower than repair for KOOS activities of daily living and Lysholm scores. CONCLUSION Hamstring weakness seen following ACL reconstruction is not evident following ACL repair with suture tape augmentation. Strength asymmetry could contribute to re-injury risk and influence functional performance, while altered loads affect knee biomechanics and may lead to osteoarthritis progression. The absence of these deficits in the repair group demonstrates a potential benefit of this technique when used in appropriate patients. LEVEL OF EVIDENCE II.
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Affiliation(s)
- W T Wilson
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, G4 0NW, UK; Department of Orthopaedics, Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, G4 0SF, UK.
| | - M S Banger
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, G4 0NW, UK
| | - G P Hopper
- Department of Trauma & Orthopaedics, NHS Lanarkshire University Hospitals, Wishaw, ML2 0DP, UK
| | - M J G Blyth
- Department of Orthopaedics, Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, G4 0SF, UK
| | | | - P E Riches
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, G4 0NW, UK
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15
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Zhang K, Meng Q, Zhang J, Gao Y, Yang Y, Liu P, Wang C, Ma Y, Shi W. The apex of the deep cartilage is a stable landmark to position the femoral tunnel during remnant-preserving anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:5932-5939. [PMID: 37955676 DOI: 10.1007/s00167-023-07656-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE The aim of this retrospective cohort study was to investigate whether the apex of the deep cartilage (ADC) could help surgeons position the femoral tunnel accurately in remnant-preserving anterior cruciate ligament (ACL) reconstruction (ACLR). METHODS In the current retrospective cohort study, a total of 134 patients who underwent ACLR between 2016 and 2020 were included. The femoral tunnel position was located using ADC as the landmark. The patients were divided into two groups: the remnant-preserving group (RP group, n = 68) underwent remnant-preserving ACLR, and the nonremnant group (NRP group, n = 66) underwent traditional ACLR with remnant removal. Postoperatively, the femoral tunnel position was evaluated on 3D-CT. The length from the ADC to the shallow cartilage margin (L) and to the centre of the femoral tunnel (l) and the length from the centre of the femoral tunnel to a low cartilage ratio in the direction from high to low (H) were measured. RESULTS The l/L values of the RP and NRP groups were both 0.4 ± 0.1 after rounding (n.s.), and the H values were 9.3 ± 1.6 mm and 9.3 ± 1.7 mm, respectively (n.s.). There was no significant difference in l/L or H between the two groups. The estimation plot also showed high consistency of H and l/L of the two groups. The inter- and intraobserver reliability of I, L, l/L, and H were almost perfect. CONCLUSIONS The apex of the deep cartilage is a good landmark for positioning the femoral tunnel in remnant-preserving ACL reconstruction. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Keying Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Qingyang Meng
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jingwei Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yitian Gao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yuping Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Ping Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yong Ma
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
| | - Weili Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
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16
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Müller S, Bühl L, Nüesch C, Pagenstert G, Mündermann A, Egloff C. Favorable Patient-Reported, Clinical, and Functional Outcomes 2 Years After ACL Repair and InternalBrace Augmentation Compared With ACL Reconstruction and Healthy Controls. Am J Sports Med 2023; 51:3131-3141. [PMID: 37675973 PMCID: PMC10543955 DOI: 10.1177/03635465231194784] [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: 02/06/2023] [Accepted: 07/11/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Recently, interest in anterior cruciate ligament (ACL) preservation and repair after proximal ACL tears has been resurrected. Although good clinical outcomes have been reported in the literature with adequate patient selection, to date detailed scientific evidence for the functional benefit of primary ACL repair with ligament augmentation is scarce. PURPOSE To compare patient-reported, clinical, and functional outcomes in patients 2 years after ACL repair and InternalBrace augmentation (ACL-IB) with age- and sex-matched patients 2 years after ACL reconstruction (ACL-R) and with matched healthy controls. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS In total, 29 patients 2 years after ACL-IB, 27 sex- and age- matched patients 2 years after ACL-R (hamstring autografts), and 29 matched healthy controls were included. Patient-reported outcomes were assessed using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, EQ-5D-5L, Tegner Activity Scale, and Anterior Cruciate Ligament Return to Sports after Injury scale. Surgery time was recorded. For clinical outcomes, range of motion and thigh and shank circumference were measured, and passive anterior translation was determined using the Rolimeter. Isokinetic muscle strength was measured using a Biodex dynamometer. The limb symmetry index (operated/contralateral or nondominant/dominant × 100), side-to-side differences (operated - contralateral, nondominant - dominant), and hamstring-quadriceps ratios were calculated for functional parameters. Failure and reoperation rates were not compared. RESULTS Two years after surgery, patients treated with ACL-IB showed good to excellent patient-reported outcomes comparable with those of patients after ACL-R. Surgery time, including concomitant surgeries, was significantly shorter in the ACL-IB group (mean, 81 minutes) compared with the ACL-R group (mean, 97 minutes) (P = .024). Isokinetic muscle strength was comparable between patient groups without significant differences in extensor and flexor strength or in hamstring-quadriceps ratios. CONCLUSION These results suggest that ACL-IB achieves comparable patient-reported, clinical, and functional outcomes with ACL-R at 2 years postoperatively and, after careful patient selection, should be considered as a valuable early treatment alternative for proximal ACL tears. REGISTRATION NCT04429165 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Sebastian Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Linda Bühl
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Clarahof Clinic of Orthopaedic Surgery, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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17
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Nukuto K, Hoshino Y, Kataoka K, Kuroda R. Current development in surgical techniques, graft selection and additional procedures for anterior cruciate ligament injury: a path towards anatomic restoration and improved clinical outcomes-a narrative review. ANNALS OF JOINT 2023; 8:39. [PMID: 38529242 PMCID: PMC10929350 DOI: 10.21037/aoj-23-39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/30/2023] [Indexed: 03/27/2024]
Abstract
Background and Objective Anterior cruciate ligament (ACL) reconstruction has been widely used for ACL injury for a long time. However, residual rotational instability and osteoarthritic changes after ACL reconstruction have been identified as problems. Thus, anatomic reconstruction techniques, various types of grafts and additional procedures have been desired to improve the clinical outcomes and knee instability. Although clinical outcomes and knee stability are better than in the past, ipsilateral graft failures still occur in 4-17% and osteoarthritic changes are seen in about 20% of patients after ACL reconstruction. To remedy these problems, it is necessary to improve the understanding of various surgical techniques and grafts and to pursue further improvement of surgical techniques. Therefore, the objective of this review is to summarize the advantages and disadvantages of various surgical techniques and graft selection, and additional procedures for ACL injury. Methods A literature review was conducted on the surgical procedures for ACL injury. Recent trends in surgical techniques, graft selection, and additional procedures for ACL injury were described. We performed a literature search in PubMed for studies published from origin to May 8, 2023. Studies were required to be English-language articles. Key Content and Findings Although many reports indicate that double-bundle ACL reconstruction is comparable to anatomic single-bundle (SB) reconstruction, intraoperative complications such as tunnel coalition exist in double-bundle reconstruction, and the technique needs to be improved. ACL repair has shown good short-term results, but long-term results need to be examined in the future. Quadriceps tendon autograft is being used more frequently, but hamstrings tendon autograft and bone-patellar tendon-bone autograft also have good results. In addition, in higher-risk cases, lateral extra-articular tenodesis (LET) and anterolateral ligament (ALL) reconstruction can be performed with good results. Conclusions To further improve clinical outcomes, more anatomical reconstructions should be pursued. Autografts are better than allografts and synthetic grafts, but further study is needed to determine which graft is better. Additional procedures should be performed in highly unstable cases and in revision cases.
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Affiliation(s)
- Koji Nukuto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kiminari Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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18
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Menghini D, Kaushal SG, Flannery SW, Ecklund K, Murray MM, Fleming BC, Kiapour AM. Three-dimensional magnetic resonance imaging analysis shows sex-specific patterns in changes in anterior cruciate ligament cross-sectional area along its length. J Orthop Res 2023; 41:771-778. [PMID: 35803594 PMCID: PMC9825677 DOI: 10.1002/jor.25413] [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: 12/01/2021] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 02/04/2023]
Abstract
Smaller anterior cruciate ligament (ACL) size in females has been hypothesized to be a key contributor to a higher incidence of ACL tears in that population, as a lower cross-sectional area (CSA) directly corresponds to a larger stress on the ligament for a given load. Prior studies have used a mid-length CSA measurement to quantify ACL size. In this study, we used magnetic resonance imaging to quantify the CSA along the entire length of the intact ACL. We hypothesized that changes in the ACL CSA along its length would have different patterns in males and females. We also hypothesized that changes in ACL CSA along its length would be associated with body size or knee size with different associations in females and males. MR images of contralateral ACL-intact knees of 108 patients (62 females, 13-35 years) undergoing ACL surgery were used to measure the CSA along the ACL length, using a custom program. For both females and males, the largest CSA was located at 37%-39% of ACL length from the tibial insertion. Compared to females, males had a significantly larger CSA only within the distal 41% of the ACL (p < 0.001). ACL CSA was associated with patient height and weight in males (r > 0.3; p < 0.05), whereas it was associated with intercondylar notch width in females (r > 0.3; p < 0.05). These findings highlight the importance of standardizing the location of measurement of ACL CSA.
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Affiliation(s)
- Danilo Menghini
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115
- Department of Health Sciences and Technology, ETH Zurich, CH-8092 Zurich, Switzerland
| | - Shankar G. Kaushal
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115
| | - Sean W. Flannery
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence RI 02818
| | - Kirsten Ecklund
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115
| | - Martha M. Murray
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence RI 02818
| | - Ata M. Kiapour
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115
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19
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Batista JP, Maestu R, Barbier J, Chahla J, Kunze KN. Propensity for Clinically Meaningful Improvement and Surgical Failure After Anterior Cruciate Ligament Repair. Orthop J Sports Med 2023; 11:23259671221146815. [PMID: 37065184 PMCID: PMC10102942 DOI: 10.1177/23259671221146815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/11/2022] [Indexed: 04/18/2023] Open
Abstract
Background Primary repair of the anterior cruciate ligament (ACL) confers an alternative to ACL reconstruction in appropriately selected patients. Purpose To prospectively assess survivorship and to define the clinically meaningful outcomes after ACL repair. Study Design Case series; Level of evidence, 4. Methods Included were consecutive patients with Sherman grade 1-2 tears who underwent primary ACL repair with or without suture augmentation between 2017 and 2019. Patient-reported outcomes (Lysholm, Tegner, International Knee Documentation Committee, Western Ontario and McMaster Universities Osteoarthritis Index, and Knee injury and Osteoarthritis Outcome Score [KOOS] subscales) were collected preoperatively and at 6 months, 1 year, and 2 years postoperatively. The minimal clinically important difference (MCID) was calculated using a distribution-based method, whereas the Patient Acceptable Symptom State (PASS) and substantial clinical benefit (SCB) were calculated using an anchor-based method. Plain radiographs and magnetic resonance imaging (MRI) were obtained at 6 months, 1 year, and 2 years postoperatively. Results A total of 120 patients were included. The overall failure rate was 11.3% at 2 years postoperatively. Changes in outcome scores required to achieve the MCID ranged between 5.1 and 14.3 at 6 months, 4.6 and 8.4 at 1 year, and 4.7 and 11.9 at 2 years postoperatively. Thresholds for PASS achievement ranged between 62.5 and 89 at 6 months, 75 and 89 at 1 year, and 78.6 and 93.2 at 2 years postoperatively. Threshold scores (absolute/change based) for achieving the SCB ranged between 82.8 and 96.4/17.7 and 40.1 at 6 months, between 94.7 and 100/23 and 45 at 1 year, and between 95.3 and 100/29.4 and 45 at 2 years. More patients achieved the MCID and PASS at 1 year compared with 6 months and 2 years. For SCB, this trend was also observed for non-KOOS outcomes, while for KOOS subdomains, more patients achieved the SCB at 2 years. High-intensity signal of the ACL repair (odds ratio [OR], 31.7 [95% CI, 1.5-73.4]; P = .030) and bone contusions on MRI (OR, 4.2 [95% CI, 1.7-25.2]; P = .041) at 1 year postoperatively were independently associated with increased risk of ACL repair failure. Conclusion The rate of clinically meaningful outcome improvement was high early after ACL repair, with the greatest proportion of patients achieving the MCID, PASS, and SCB at 1 year postoperatively. Bone contusions involving the posterolateral tibia and lateral femoral condyle as well as high repair signal intensity at 1 year postoperatively were independent predictors of failure at 2 years postoperatively.
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Affiliation(s)
| | - Rodrigo Maestu
- Centro de Tratamiento de Enfermedades
Articulares, Buenoa Aires, Argentina
| | - Jose Barbier
- Centro Artroscópico Jorge Batista SA,
Buenos Aires, Argentina
| | - Jorge Chahla
- Division of Sports Medicine, Department
of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois,
USA
| | - Kyle N. Kunze
- Department of Orthopedic Surgery,
Hospital for Special Surgery, New York, New York, USA
- Kyle N. Kunze, M.D,
Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th
Street, New York, NY 10021, USA ()
(Twitter: @kylekunzemd)
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20
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Weng PW, Chen CH, Lin YC, Chen KH, Yeh YY, Lai JM, Chiang CJ, Wong CC. Platelet-Rich Fibrin-Augmented Gap-Bridging Strategy in Rabbit Anterior Cruciate Ligament Repair. Am J Sports Med 2023; 51:642-655. [PMID: 36752674 DOI: 10.1177/03635465221149993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND We assessed the efficacy of a novel platelet-rich fibrin (PRF)-augmented repair strategy for promoting biological healing of an anterior cruciate ligament (ACL) midsubstance tear in a rabbit model. The biological gap-bridging effect of a PRF scaffold alone or in combination with rabbit ligamentocytes on primary ACL healing was evaluated both in vitro and in vivo. HYPOTHESIS A PRF matrix can be implanted as a provisional fibrin-platelet bridging scaffold at an ACL defect to facilitate functional healing. STUDY DESIGN Controlled laboratory study. METHODS The biological effects of PRF on primary rabbit ligamentocyte proliferation, tenogenic differentiation, migration, and tendon-specific matrix production were investigated for treatment of cells with PRF-conditioned medium (PRFM). Three-dimensional (3D) lyophilized PRF (LPRF)-cell composite was fabricated by culturing ligamentocytes on an LPRF patch for 14 days. Cell-scaffold interactions were investigated under a scanning electron microscope and through histological analysis. An ACL midsubstance tear model was established in 3 rabbit groups: a ruptured ACL was treated with isolated suture repair in group A, whereas the primary repair was augmented with LPRF and LPRF-cell composite to bridge the gap between ruptured ends of ligaments in groups B and C, respectively. Outcomes-gross appearance, magnetic resonance imaging, and histological analysis-were evaluated in postoperative weeks 8 and 12. RESULTS PRFM promoted cultured ligamentocyte proliferation, migration, and expression of tenogenic genes (type I and III collagen and tenascin). PRF was noted to upregulate cell tenogenic differentiation in terms of matrix production. In the 3D culture, viable cells formed layers at high density on the LPRF scaffold surface, with notable cell ingrowth and abundant collagenous matrix depositions. Moreover, ACL repair tissue and less articular cartilage damage were observed in knee joints in groups B and C, implying the existence of a chondroprotective phenomenon associated with PRF-augmented treatment. CONCLUSION Our PRF-augmented strategy can facilitate the formation of stable repair tissue and thus provide gap-bridging in ACL repair. CLINICAL RELEVANCE From the translational viewpoint, effective primary repair of the ACL may enable considerable advancement in therapeutic strategy for ACL injuries, particularly allowing for proprioception retention and thus improved physiological joint kinematics.
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Affiliation(s)
- Pei-Wei Weng
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- Research Center of Biomedical Devices, Taipei Medical University, Taipei, Taiwan
| | - Chih-Hwa Chen
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
- Research Center of Biomedical Devices, Taipei Medical University, Taipei, Taiwan
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Cheng Lin
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Hao Chen
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Biomedical Materials and Engineering, Taipei Medical University, Taipei, Taiwan
| | - Yi-Yen Yeh
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jen-Ming Lai
- Department of Orthopaedic Surgery, Woodlands Health, Singapore
| | - Chang-Jung Chiang
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chin-Chean Wong
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Biomedical Devices, Taipei Medical University, Taipei, Taiwan
- International PhD Program for Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Abstract
Acute knee injury ranges among the most common joint injuries in professional and recreational athletes. Radiographs can detect joint effusion, fractures, deformities, and malalignment; however, MR imaging is most accurate for radiographically occult fractures, chondral injury, and soft tissue injuries. Using a structured checklist approach for systematic MR imaging evaluation and reporting, this article reviews the MR imaging appearances of the spectrum of traumatic knee injuries, including osteochondral injuries, cruciate ligament tears, meniscus tears and ramp lesions, anterolateral complex and collateral ligament injuries, patellofemoral translation, extensor mechanism tears, and nerve and vascular injuries.
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Jurgensmeier K, Till SE, Lu Y, Arguello AM, Stuart MJ, Saris DBF, Camp CL, Krych AJ. Risk factors for secondary meniscus tears can be accurately predicted through machine learning, creating a resource for patient education and intervention. Knee Surg Sports Traumatol Arthrosc 2023; 31:518-529. [PMID: 35974194 PMCID: PMC10138786 DOI: 10.1007/s00167-022-07117-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/05/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE This study sought to develop and internally validate a machine learning model to identify risk factors and quantify overall risk of secondary meniscus injury in a longitudinal cohort after primary ACL reconstruction (ACLR). METHODS Patients with new ACL injury between 1990 and 2016 with minimum 2-year follow-up were identified. Records were extensively reviewed to extract demographic, treatment, and diagnosis of new meniscus injury following ACLR. Four candidate machine learning algorithms were evaluated to predict secondary meniscus tears. Performance was assessed through discrimination using area under the receiver operating characteristics curve (AUROC), calibration, and decision curve analysis; interpretability was enhanced utilizing global variable importance plots and partial dependence curves. RESULTS A total of 1187 patients underwent ACLR; 139 (11.7%) experienced a secondary meniscus tear at a mean time of 65 months post-op. The best performing model for predicting secondary meniscus tear was the random forest (AUROC = 0.790, 95% CI: 0.785-0.795; calibration intercept = 0.006, 95% CI: 0.005-0.007, calibration slope = 0.961 95% CI: 0.956-0.965, Brier's score = 0.10 95% CI: 0.09-0.12), and all four machine learning algorithms outperformed traditional logistic regression. The following risk factors were identified: shorter time to return to sport (RTS), lower VAS at injury, increased time from injury to surgery, older age at injury, and proximal ACL tear. CONCLUSION Machine learning models outperformed traditional prediction models and identified multiple risk factors for secondary meniscus tears after ACLR. Following careful external validation, these models can be deployed to provide real-time quantifiable risk for counseling and timely intervention to help guide patient expectations and possibly improve clinical outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kevin Jurgensmeier
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Sara E Till
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Alexandra M Arguello
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Age and Bone Bruise Patterns Predict Tear Location in the Anterior Cruciate Ligament. Arthrosc Sports Med Rehabil 2022; 5:e41-e50. [PMID: 36866318 PMCID: PMC9971897 DOI: 10.1016/j.asmr.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/03/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose To assess the influence of demographic risk factors, anatomic risk factors, and injury mechanisms on anterior cruciate ligament (ACL) tear patterns. Methods All patients undergoing knee magnetic resonance imaging at our institution for acute ACL tears (within 1 month of injury) in 2019 were retrospectively analyzed. Patients with partial ACL tears and full-thickness posterior cruciate ligament injuries were excluded. On sagittal magnetic resonance images, the proximal and distal remnant lengths were measured, and the tear location was calculated as the distal remnant length divided by the total remnant length. Previously reported demographic and anatomic risk factors associated with ACL injury were then reviewed, including the notch width index, notch angle, intercondylar notch stenosis, alpha angle, posterior tibial slope, meniscal slope, and lateral femoral condyle index. In addition, the presence and severity of bone bruises were recorded. Finally, risk factors associated with ACL tear location were further analyzed using multivariate logistic regression. Results A total of 254 patients (44% male patients; mean age, 34 years; age range, 9-74 years) were included, of whom 60 (24%) had a proximal ACL tear (tear at the proximal quarter). Multivariate enter logistic regression analysis showed that older age (P = .008) was predictive of a more proximal tear location whereas open physes (P = .025), bone bruises in both compartments (P = .005), and posterolateral corner injury (P = .017) decreased the likelihood of a proximal tear (R 2 = 0.121, P < .001). Conclusions No anatomic risk factors were identified to play a role in tear location. Although most patients have midsubstance tears, proximal ACL tears were more commonly found in older patients. Bone contusions involving the medial compartment are associated with midsubstance tears; these findings may indicate that different injury mechanisms play a role in the location at which the ACL tears. Level of Evidence Level III, prognostic, retrospective cohort study.
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Ferreira A, Saithna A, Carrozzo A, Guy S, Vieira TD, Barth J, Sonnery-Cottet B. The Minimal Clinically Important Difference, Patient Acceptable Symptom State, and Clinical Outcomes of Anterior Cruciate Ligament Repair Versus Reconstruction: A Matched-Pair Analysis From the SANTI Study Group. Am J Sports Med 2022; 50:3522-3532. [PMID: 36259683 DOI: 10.1177/03635465221126171] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There has been increasing interest in anterior cruciate ligament (ACL) repair because of theoretical advantages over ACL reconstruction; however, the contemporary literature has failed to provide high-quality evidence to demonstrate these advantages. PURPOSE To compare the clinical and functional outcomes of ACL repair versus ACL reconstruction at a minimum follow-up of 2 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent ACL repair were propensity matched (based on demographics, time between injury and surgery, knee laxity parameters, presence of meniscal lesions, preoperative activity level, and sport participation), in a 1:1 ratio, to those who underwent ACL reconstruction during the same period. Isokinetic testing was used to evaluate strength deficits at 6 months postoperatively. Knee laxity parameters were evaluated at 12 months. Complications, return to sport, and patient-reported outcome scores were recorded at final follow-up. RESULTS In total, 75 matched pairs (150 patients) were evaluated. The repair group had significantly better mean hamstring muscle strength at 6 months compared with the reconstruction group (1.7% ± 12.2% vs -10.0% ± 12.8%, respectively; P < .0001). At a mean final follow-up of 30.0 ± 4.8 months, the repair group had a significantly better mean Forgotten Joint Score-12 (FJS-12) score compared with the reconstruction group (82.0 ± 15.1 vs 74.2 ± 21.7, respectively; P = .017). Noninferiority criteria were met for ACL repair, compared with ACL reconstruction, with respect to the subjective International Knee Documentation Committee score (86.8 ± 9.0 vs 86.7 ± 10.1, respectively; P < .0001) and side-to-side anteroposterior laxity difference (1.1 ± 1.4 vs 0.6 ± 1.0 mm, respectively; P < .0001). No significant differences were found for other functional outcomes or the pivot-shift grade. There were no significant differences in the rate of return to the preinjury level of sport (repair group: 74.7%; reconstruction group: 60.0%; P = .078). A significant difference was observed regarding the occurrence of ACL reruptures (repair group: 5.3%; reconstruction group: 0.0%; P = .045). Patients who experienced a failure of ACL repair were significantly younger than those who did not (26.8 vs 40.7 years, respectively; P = .013). There was no significant difference in rupture rates between the repair and reconstruction groups when only patients aged >21 years were considered (2.9% vs 0.0%, respectively; P = .157). The minimal clinically important difference and Patient Acceptable Symptom State (PASS) thresholds were defined for the ACL repair group. A significantly greater proportion of patients in the repair group achieved the PASS for the FJS-12 compared with their counterparts in the reconstruction group (77.3% vs 60.0%, respectively; P = .034). CONCLUSION ACL repair was associated with some advantages over ACL reconstruction including superior hamstring muscle strength at 6 months and significantly better FJS-12 scores. However, the failure rate was significantly higher after ACL repair, and younger patients were particularly at risk.
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Affiliation(s)
- Alexandre Ferreira
- Centre Orthopedique Santy, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Adnan Saithna
- Arizona Brain and Spine Center, Scottsdale, Arizona, USA
| | - Alessandro Carrozzo
- Centre Orthopedique Santy, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France.,Department of Orthopaedics and Traumatology, Sapienza University of Rome, Rome, Italy
| | - Sylvain Guy
- Centre Orthopedique Santy, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
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Yang XA, Vermeijden HD, O'Brien R, van der List JP, DiFelice GS. Bilateral simultaneous anterior cruciate ligament tears treated with single staged simultaneous primary repair: A case report. Int J Surg Case Rep 2022; 99:107670. [PMID: 36152371 PMCID: PMC9568759 DOI: 10.1016/j.ijscr.2022.107670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction and importance Simultaneous bilateral anterior cruciate ligament (ACL) injuries are a rare injury pattern within the literature. There is not a consensus optimal management of this injury. Bilateral primary ACL repair in a single stage surgery provides knee stability with a minimally morbid surgery in a single rehabilitation period. This case report offers another option for surgeons to consider in the treatment of this rare injury. Case presentation A 45-year-old female skier presented with simultaneous bilateral isolated proximal anterior cruciate ligament injuries. MRI demonstrated bilateral proximal ACL tear patterns which were amenable to primary ACL repair. The patient subsequently underwent acute single-staged arthroscopic primary ACL repair with suture augmentation of both knees. She attained rehabilitation milestones and was fully cleared to return to sporting activities one year post-operatively. Two years post-operatively the patient continues to do well with excellent clinical outcomes. Clinical discussion The other treatment modalities reported in the literature were single staged and two staged ACL reconstruction with either autograft or allograft. While single staged procedures are more time and cost efficient, the primary concern is that simultaneous rehabilitation of bilateral ACL reconstructions may lead to severe quadriceps deconditioning. Primary ACL repair poses a potential solution as a minimally morbid surgery with faster rehabilitation from surgery. Conclusion Due to the limited invasiveness and morbidity of ACL primary repair with suture augmentation, simultaneous primary repair surgery could be an excellent treatment option for this rare patient population, saving time and cost while providing appropriate knee stability. Level of evidence Level IV, Case Report. Single-stage bilateral ACL repair is a viable treatment option in a patient with simultaneous bilateral ACL injuries ACL repair might be an excellent treatment option for this population due to its minimally morbid nature. Simultaneous bilateral ACL repair allows for early return to ambulation and range of motion
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Borque KA, Jones M, Balendra G, Willinger L, Pinheiro VH, Anand BS, Williams A. High return to play rate following treatment of multiple-ligament knee injuries in 136 elite athletes. Knee Surg Sports Traumatol Arthrosc 2022; 30:3393-3401. [PMID: 35279739 DOI: 10.1007/s00167-022-06926-3] [Citation(s) in RCA: 2] [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: 12/24/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the study is to assess return to play rate and timing of elite athletes treated for multi-ligament knee injuries with modern surgical techniques. METHODS A retrospective review was performed of all professional or national/international level athletes treated for a multi-ligament knee injury by the senior author in the period from February 2001 to October 2019, with a minimum of 2-year follow-up. The study cohort consisted of 136 elite athletes who underwent surgery of two or more knee ligaments. Outcomes measures were return to play (RTP), defined as return to elite level sport, return to play time, and further surgical procedures. RESULTS One hundred and twenty (88.2%) athletes returned to elite level sport at an average of 12.8 months from operation. In unicruciate injuries, ACL and PCL-based injuries had similar return to play rates (89.1% vs. 87.5% respectfully, n.s.) although mean RTP time was longer in those with PCL-based injuries (15.2 vs. 11.9 months, p < 0.01). Bicruciate injuries had longer RTP times compared to unicruciate injuries (mean RTP 16.0vs. 12.4 months, p < 0.05) but were able to return at a similar rate (83.3% vs. 88.9%, n.s.). Medial and lateral sided injuries had similar RTP rates (89.3% vs. 87.9%, n.s.) though lateral sided injuries took longer before returning to play (13.4 vs. 11.6 months, p < 0.05). Further surgery was required in 54 (39.9%) patients including 25 (18.4%) manipulations under anaesthesia. Four (2.9%) of the athletes underwent revision ligament surgery. CONCLUSION Modern surgical techniques used in the treatment of multi-ligament knee injuries can lead to high return to play rates in elite athletes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kyle A Borque
- Houston Methodist Orthopedics and Sports Medicine, Houston, USA
| | - Mary Jones
- Fortius Clinic, 17 Fitzhardinge Street, London, W1H 6EQ, UK
- FIFA Medical Centre of Excellence, London, UK
| | - Ganesh Balendra
- Fortius Clinic, 17 Fitzhardinge Street, London, W1H 6EQ, UK
- FIFA Medical Centre of Excellence, London, UK
| | - Lukas Willinger
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Vitor Hugo Pinheiro
- Fortius Clinic, 17 Fitzhardinge Street, London, W1H 6EQ, UK
- FIFA Medical Centre of Excellence, London, UK
| | - Bobby Singh Anand
- Fortius Clinic, 17 Fitzhardinge Street, London, W1H 6EQ, UK
- FIFA Medical Centre of Excellence, London, UK
| | - Andy Williams
- Fortius Clinic, 17 Fitzhardinge Street, London, W1H 6EQ, UK.
- FIFA Medical Centre of Excellence, London, UK.
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Qu C, Yang H, Wang C, Wang C, Ying M, Chen Z, Yang K, Zhang J, Li K, Dimitriou D, Tsai TY, Liu X. A deep learning approach for anterior cruciate ligament rupture localization on knee MR images. Front Bioeng Biotechnol 2022; 10:1024527. [PMID: 36246358 PMCID: PMC9561886 DOI: 10.3389/fbioe.2022.1024527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: To develop and evaluate a deep learning-based method to localize and classify anterior cruciate ligament (ACL) ruptures on knee MR images by using arthroscopy as the reference standard. Methods: We proposed a fully automated ACL rupture localization system to localize and classify ACL ruptures. The classification of ACL ruptures was based on the projection coordinates of the ACL rupture point on the line connecting the center coordinates of the femoral and tibial footprints. The line was divided into three equal parts and the position of the projection coordinates indicated the classification of the ACL ruptures (femoral side, middle and tibial side). In total, 85 patients (mean age: 27; male: 56) who underwent ACL reconstruction surgery under arthroscopy were included. Three clinical readers evaluated the datasets separately and their diagnostic performances were compared with those of the model. The performance metrics included the accuracy, error rate, sensitivity, specificity, precision, and F1-score. A one-way ANOVA was used to evaluate the performance of the convolutional neural networks (CNNs) and clinical readers. Intraclass correlation coefficients (ICC) were used to assess interobserver agreement between the clinical readers. Results: The accuracy of ACL localization was 3.77 ± 2.74 and 4.68 ± 3.92 (mm) for three-dimensional (3D) and two-dimensional (2D) CNNs, respectively. There was no significant difference in the ACL rupture location performance between the 3D and 2D CNNs or among the clinical readers (Accuracy, p < 0.01). The 3D CNNs performed best among the five evaluators in classifying the femoral side (sensitivity of 0.86 and specificity of 0.79), middle side (sensitivity of 0.71 and specificity of 0.84) and tibial side ACL rupture (sensitivity of 0.71 and specificity of 0.99), and the overall accuracy for sides classifying of ACL rupture achieved 0.79. Conclusion: The proposed deep learning-based model achieved high diagnostic performances in locating and classifying ACL fractures on knee MR images.
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Affiliation(s)
- Cheng Qu
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Heng Yang
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Cong Wang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Chongyang Wang
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengjie Ying
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheyi Chen
- Department of Radiology, Shanghai Municipal Eighth People’s Hospital, Shanghai, China
| | - Kai Yang
- Department of Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhang
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Kang Li
- West China Hospital, Sichuan University, Chengdu, China
| | - Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zurich, Switzerland
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Tsung-Yuan Tsai, ; Xudong Liu,
| | - Xudong Liu
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Tsung-Yuan Tsai, ; Xudong Liu,
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Annibaldi A, Monaco E, Daggett M, Carrozzo A, Mazza D, Previ L, Rossi G, Orlandi P, Ferretti A. In-office needle arthroscopic assessment after primary ACL repair: short-term results in 15 patients. J Exp Orthop 2022; 9:89. [PMID: 36070161 PMCID: PMC9452609 DOI: 10.1186/s40634-022-00528-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose In-office needle arthroscopy has been reported as a diagnostic tool for different knee pathologies. In addition, ACL repair has seen a resurgence with the advent of innovative orthopedic devices. The aim of this study was to assess clinical, radiological, and in-office needle arthroscopic findings in 15 adult patients who underwent acute (within 14 days from injury) anterior cruciate ligament (ACL) repair. Methods Fifteen patients voluntarily participated in the study. A second-look arthroscopy was performed with an in-office needle arthroscopy at an average of 7.2 months after the primary repair. The parameters included in the investigation were the continuity of the anatomical footprint of the repaired ACL, subjective assessment of the ACL tension with the probe, and synovial coverage of the ACL. All patients had a Magnetic Resonance Imaging (MRI) at 6 months after repair and an arthrometric evaluation with the KT-1000. Clinical evaluation with the scores, Tegner Lysholm Knee Scoring Scale (TLKSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) was performed at the final follow-up of 2 years. Moreover, a correlation between the characteristics of ACL appearance at the time of the second look in-office needle arthroscopy, MRI and KT-1000 was performed. Results The mean TLKSS was 97.86, the mean KOOS was 98.08 and the mean subjective IKDC was 96.71. The objective IKDC was A in 10 patients and B in 5 patients. ACL healing was graded as A in 11 patients and B in 4 patients. Synovial coverage was graded as good in 10 patients and fair in 5 while MRI assessment showed a type I ACL in 10 patients, type II in 4 patients and type III in 1 patient. Conclusion In-office needle arthroscopy is a reliable tool to assess the condition of a repaired ACL. In addition, ACL repair performed in acute proximal tears demonstrated excellent clinical results.
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Affiliation(s)
| | - Edoardo Monaco
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy.
| | | | | | - Daniele Mazza
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Leonardo Previ
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Giorgio Rossi
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | | | - Andrea Ferretti
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
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Chen KH, Yang CY, Wang HY, Ma HL, Lee OKS. Artificial Intelligence-Assisted Diagnosis of Anterior Cruciate Ligament Tears From Magnetic Resonance Images: Algorithm Development and Validation Study. JMIR AI 2022; 1:e37508. [PMID: 38875555 PMCID: PMC11135221 DOI: 10.2196/37508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/15/2022] [Accepted: 07/05/2022] [Indexed: 06/16/2024]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are common in sports and are critical knee injuries that require prompt diagnosis. Magnetic resonance imaging (MRI) is a strong, noninvasive tool for detecting ACL tears, which requires training to read accurately. Clinicians with different experiences in reading MR images require different information for the diagnosis of ACL tears. Artificial intelligence (AI) image processing could be a promising approach in the diagnosis of ACL tears. OBJECTIVE This study sought to use AI to (1) diagnose ACL tears from complete MR images, (2) identify torn-ACL images from complete MR images with a diagnosis of ACL tears, and (3) differentiate intact-ACL and torn-ACL MR images from the selected MR images. METHODS The sagittal MR images of torn ACL (n=1205) and intact ACL (n=1018) from 800 cases and the complete knee MR images of 200 cases (100 torn ACL and 100 intact ACL) from patients aged 20-40 years were retrospectively collected. An AI approach using a convolutional neural network was applied to build models for the objective. The MR images of 200 independent cases (100 torn ACL and 100 intact ACL) were used as the test set for the models. The MR images of 40 randomly selected cases from the test set were used to compare the reading accuracy of ACL tears between the trained model and clinicians with different levels of experience. RESULTS The first model differentiated between torn-ACL, intact-ACL, and other images from complete MR images with an accuracy of 0.9946, and the sensitivity, specificity, precision, and F1-score were 0.9344, 0.9743, 0.8659, and 0.8980, respectively. The final accuracy for ACL-tear diagnosis was 0.96. The model showed a significantly higher reading accuracy than less experienced clinicians. The second model identified torn-ACL images from complete MR images with a diagnosis of ACL tear with an accuracy of 0.9943, and the sensitivity, specificity, precision, and F1-score were 0.9154, 0.9660, 0.8167, and 0.8632, respectively. The third model differentiated torn- and intact-ACL images with an accuracy of 0.9691, and the sensitivity, specificity, precision, and F1-score were 0.9827, 0.9519, 0.9632, and 0.9728, respectively. CONCLUSIONS This study demonstrates the feasibility of using an AI approach to provide information to clinicians who need different information from MRI to diagnose ACL tears.
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Affiliation(s)
- Kun-Hui Chen
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Yu Yang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Yi Wang
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anaesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiao-Li Ma
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Oscar Kuang-Sheng Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- China Medical University Hospital, Taichung, Taiwan
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Tan L, Liang J, Feng J, Cao Y, Luo J, Liao Y, Cao X, Wang Z, He J, Wu S. Medial meniscus tears are most prevalent in type I ACL tears, while type I ACL tears only account for 8% of all ACL tears. Knee Surg Sports Traumatol Arthrosc 2022; 31:2349-2357. [PMID: 35842857 DOI: 10.1007/s00167-022-07068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/01/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to assess the distribution of different anterior cruciate ligament (ACL) tear locations in different magnetic resonance imaging (MRI) planes, and to explore the relationships of ACL tear types with both meniscus injuries and bone bruising. METHODS A retrospective study was performed in patients under 60 years old who underwent MRI scans in the sagittal and coronal oblique planes of the knee for ACL tears between 2014 and 2020. Patients with reports of chronic tears, partial tears, or prior surgeries were excluded. Tear locations were classified into five types, and the meniscus tear measurement variables included the presence of ramp, root, bucket-handle, and other types of tears. All injuries were confirmed by arthroscopy. Meanwhile, the presence and location of bone bruising were analysed and scored with the Whole-Organ Magnetic Resonance Imaging Score (WORMS) bone bruising subscale. RESULTS A total of 291 patients were included. The prevalence rates of type I and type III injuries were 23/291 (7.9%) and 145/291 (49.8%) in the sagittal plane and 22/291 (7.6%) and 179/291 (61.5%) in the oblique coronal plane, respectively. The prevalence of medial meniscus tears with ACL tears was 126/291 (43.3%), while that of lateral meniscus tears with ACL tears was 77/291 (26.5%). The highest prevalence of medial meniscus injury with ACL tears was 15/22 (68.2%) for type I injuries. Bone bruises were located on the lateral femoral center in 125 patients (46%) and on the lateral tibia posterior in 132 patients (48%); the common areas of bone bruising were slightly correlated with type III ACL tears but not correlated with type I ACL tears. CONCLUSION The plane in which an MRI scan is performed affects the classification of ACL tears. The tear type is associated with the prevalence of medial meniscus injuries, and medial meniscus tears are most prevalent in type I ACL tears. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lingjie Tan
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jiehui Liang
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jing Feng
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Yangbo Cao
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jiewen Luo
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Yunjie Liao
- Department of Radiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Xu Cao
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Zili Wang
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jinshen He
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China.
| | - Song Wu
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
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31
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Ramos-Mucci L, Elsheikh A, Keenan C, Eliasy A, D'Aout K, Bou-Gharios G, Comerford E, Poulet B. The anterior cruciate ligament in murine post-traumatic osteoarthritis: markers and mechanics. Arthritis Res Ther 2022; 24:128. [PMID: 35637500 PMCID: PMC9150328 DOI: 10.1186/s13075-022-02798-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Knee joint injuries, common in athletes, have a high risk of developing post-traumatic osteoarthritis (PTOA). Ligaments, matrix-rich connective tissues, play important mechanical functions stabilising the knee joint, and yet their role post-trauma is not understood. Recent studies have shown that ligament extracellular matrix structure is compromised in the early stages of spontaneous osteoarthritis (OA) and PTOA, but it remains unclear how ligament matrix pathology affects ligament mechanical function. In this study, we aim to investigate both structural and mechanical changes in the anterior cruciate ligament (ACL) in a mouse model of knee trauma. Methods Knee joints were analysed following non-invasive mechanical loading in male C57BL/6 J mice (10-week-old). Knee joints were analysed for joint space mineralisation to evaluate OA progression, and the ACLs were assessed with histology and mechanical testing. Results Joints with PTOA had a 33–46% increase in joint space mineralisation, indicating OA progression. Post-trauma ACLs exhibited extracellular matrix modifications, including COL2 and proteoglycan deposition. Additional changes included cells expressing chondrogenic markers (SOX9 and RUNX2) expanding from the ACL tibial enthesis to the mid-substance. Viscoelastic and mechanical changes in the ACLs from post-trauma knee joints included a 20–21% decrease in tangent modulus at 2 MPa of stress, a decrease in strain rate sensitivity at higher strain rates and an increase in relaxation during stress-relaxation, but no changes to hysteresis and ultimate load to failure were observed. Conclusions These results demonstrate that ACL pathology and viscoelastic function are compromised in the post-trauma knee joint and reveal an important role of viscoelastic mechanical properties for ligament and potentially knee joint health. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02798-7.
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Affiliation(s)
- Lorenzo Ramos-Mucci
- Institute of Life Course and Medical Sciences, University of Liverpool, Apex building, West Derby street, Liverpool, L7 8TX, UK
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Brownlow Hill, Liverpool, L69 3GH, UK.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100083, China.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Craig Keenan
- Institute of Life Course and Medical Sciences, University of Liverpool, Apex building, West Derby street, Liverpool, L7 8TX, UK.,Faculty of Health, Social Care and Medicine, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK
| | - Ashkan Eliasy
- School of Engineering, University of Liverpool, Brownlow Hill, Liverpool, L69 3GH, UK
| | - Kristiaan D'Aout
- Institute of Life Course and Medical Sciences, University of Liverpool, Apex building, West Derby street, Liverpool, L7 8TX, UK
| | - George Bou-Gharios
- Institute of Life Course and Medical Sciences, University of Liverpool, Apex building, West Derby street, Liverpool, L7 8TX, UK
| | - Eithne Comerford
- Institute of Life Course and Medical Sciences, University of Liverpool, Apex building, West Derby street, Liverpool, L7 8TX, UK.,School of Veterinary Science, Institute of Infection, Veterinary and Ecological Sciences, Leahurst Campus, University of Liverpool, Chester High Rd, Neston, CH64 7TE, UK
| | - Blandine Poulet
- Institute of Life Course and Medical Sciences, University of Liverpool, Apex building, West Derby street, Liverpool, L7 8TX, UK.
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32
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Kano T, Kokubun T, Murata K, Oka Y, Ozone K, Arakawa K, Morishita Y, Takayanagi K, Kanemura N. Influence of the site of injury on the spontaneous healing response in a rat model of total rupture of the anterior cruciate ligament. Connect Tissue Res 2022; 63:138-150. [PMID: 33588658 DOI: 10.1080/03008207.2021.1889529] [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] [Indexed: 02/03/2023]
Abstract
AIM The healing ability of the anterior cruciate ligament (ACL) injury is very poor; however, it has recently been shown to undergo self-healing with conservative treatments. In this study, we evaluated the influence of the site of injury on the healing process after complete transverse tear of ACL using a rat model. MATERIALS AND METHODS A total of 58 skeletally mature Wistar rats were randomly assigned to various ACL injury groups: controlled abnormal movement-mid-portion (CAM-MP), controlled abnormal movement-femoral side (CAM-FS), ACL transection-mid-portion (ACLT-MP), or ACL transection-femoral side (ACLT-FS) injury groups. The ACL was completely transected in the mid-portion in the ACLT-MP and CAM-MP groups, and on the femoral side in the ACLT-FS and CAM-FS groups. Both CAM groups underwent extra-articular braking to control for abnormal tibial translation. The animals were allowed full cage activity until sacrifice postoperatively for histological and biomechanical assessment. RESULTS Significant differences were found in the ratios of residual ligament lengths between the CAM-MP and CAM-FS groups, demonstrating the validity of each model. Spontaneous healing of the injured ACL was observed in the CAM-MP and CAM-FS groups but not in the ACLT-MP and ACLT-FS groups. The mechanical strength of the healing ACL did not differ between the CAM-MP and CAM-FS groups 8 weeks after injury; however, the former had better mechanical strength than the latter 12 weeks after the injury. CONCLUSION ACL injuries in the mid-portion and on the femoral side may be treated with conservative therapy for spontaneous healing.
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Affiliation(s)
- Takuma Kano
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Japan.,Department of Rehabilitation, Soka Orthopedics Internal Medicine, Soka, Japan.,Department of Rehabilitation, Yatsuka Orthopedics Internal Medicine, Soka, Japan
| | - Takanori Kokubun
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan
| | - Kenji Murata
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan
| | - Yuichiro Oka
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Japan
| | - Kaichi Ozone
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Japan
| | - Kohei Arakawa
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Japan
| | - Yuri Morishita
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Japan
| | - Kiyomi Takayanagi
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan
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33
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Wilson WT, Hopper GP, Banger MS, Blyth MJG, Riches PE, MacKay GM. Anterior cruciate ligament repair with internal brace augmentation: A systematic review. Knee 2022; 35:192-200. [PMID: 35366618 DOI: 10.1016/j.knee.2022.03.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/11/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Primary repair of anterior cruciate ligament (ACL) ruptures has re-emerged as a treatment option for proximal tears, with internal brace augmentation often utilised. The aim of this study is to provide an overview of the current evidence presenting outcomes of ACL repair with internal bracing to assess the safety and efficacy of this technique. METHODS All studies reporting outcomes of arthroscopic primary repair of proximal ACL tears, augmented with internal bracing from 2014-2021 were included. Primary outcome was failure rate and secondary outcomes were subjective patient reported outcome measures (PROMs) and objective assessment of anteroposterior knee laxity. RESULTS Nine studies were included, consisting of 347 patients, mean age 32.5 years, mean minimum follow up 2 years. There were 36 failures (10.4%, CI 7.4% - 14.1%). PROMs reporting was variable across studies. KOOS, Lysholm and IKDC scores were most frequently used with mean scores > 87%. The mean Tegner and Marx scores at follow-up were 6.1 and 7.8 respectively. The mean side to side difference measured for anteroposterior knee laxity was 1.2mm. CONCLUSIONS This systematic review with meta-analysis shows that ACL repair with internal bracing is a safe technique for treatment of proximal ruptures, with a failure rate of 10.4%. Subjective scores and clinical laxity testing also revealed satisfactory results. This suggests that ACL repair with internal bracing should be considered as an alternative to ACL reconstruction for acute proximal tears, with the potential benefits of retained native tissue and proprioception, as well as negating the need for graft harvest.
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Affiliation(s)
- W T Wilson
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK; NHS Greater Glasgow & Clyde, Glasgow, UK.
| | - G P Hopper
- NHS Greater Glasgow & Clyde, Glasgow, UK.
| | - M S Banger
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.
| | | | - P E Riches
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.
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34
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A Torn ACL Mapping in Knee MRI Images Using Deep Convolution Neural Network with Inception-v3. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7872500. [PMID: 35178233 PMCID: PMC8846973 DOI: 10.1155/2022/7872500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/07/2022] [Accepted: 01/17/2022] [Indexed: 11/17/2022]
Abstract
The anterior cruciate ligaments (ACL) are the fundamental structures in preserving the common biomechanics of the knees and most frequently damaged knee ligaments. An ACL injury is a tear or sprain of the ACL, one of the fundamental ligaments in the knee. ACL damage most generally happens during sports, for example, soccer, ball, football, and downhill skiing, which include sudden stops or changes in direction, jumping, and landings. Magnetic resonance imaging (MRI) has a major role in the field of diagnosis these days. Specifically, it is effective for diagnosing the cruciate ligaments and any related meniscal tears. The primary objective of this research is to detect the ACL tear from MRI knee images, which can be useful to determine the knee abnormality. In this research, a Deep Convolution Neural Network (DCNN) based Inception-v3 deep transfer learning (DTL) model was proposed for classifying the ACL tear MRI images. Preprocessing, feature extraction, and classification are the main processes performed in this research. The dataset utilized in this work was collected from the MRNet database. A total of 1,370 knee MRI images are used for evaluation. 70% of data (959 images) are used for training and testing, and 30% of data (411 images) are used in this model for performance analysis. The proposed DCNN with the Inception-v3 DTL model is evaluated and compared with existing deep learning models like VGG16, VGG19, Xception, and Inception ResNet-v28. The performance metrics like accuracy, precision, recall, specificity, and F-measure are evaluated to estimate the performance analysis of the model. The model has obtained 99.04% training accuracy and 95.42% testing accuracy in performance analysis.
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35
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van der List JP. Arthroscopic primary repair of the anterior cruciate ligament: rationale, patient selection and early outcomes (PhD Academy Award). Br J Sports Med 2022; 56:bjsports-2021-105295. [PMID: 35045970 DOI: 10.1136/bjsports-2021-105295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/03/2022]
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36
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Takeuchi S, Rothrauff BB, Kanto R, Onishi K, Fu FH. Superb microvascular imaging (SMI) detects increased vascularity of the torn anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2022; 30:93-101. [PMID: 34121144 DOI: 10.1007/s00167-021-06640-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Ultrasound with superb microvascular imaging (SMI) is a novel microvascular imaging technology which may be useful to assess the vascularity of the torn anterior cruciate ligament (ACL) as a potential measure of healing potential following surgery. This study aimed to quantify the vascularity of the torn and intact ACL using ultrasound with SMI. METHODS 23 patients (mean age ± standard deviation, 27.1 ± 12.8 years), who were diagnosed with an ACL tear with an intact contralateral ACL were enrolled (ACL injury group). Ten healthy volunteers (36.1 ± 4.9 years) who had intact ACLs in both knees were also recruited (ACL healthy controls). The vascularity of the ACL was assessed using SMI within 15 mm from the tibial insertion in both knees. The amount of the vascular signal was assessed using a semi-quantitative grading scale (vascularity grade: grade 0-3) and a quantified ratio of vascularized area with respect to total area of the region of interest (vascularity ratio). RESULTS In the ACL injury group, a significantly higher vascularity grade and ratio were observed in the torn ACL (vascularity grade 0-3: 1, 8, 7, and 7 patients, respectively; vascularity ratio: 1.3 ± 1.4%) than the contralateral intact ACL (vascularity grade 0-3: 21, 1, 1, and 0 patients, respectively; vascularity ratio: 0.1 ± 0.5%) (P < 0.001), whereas no significant difference was observed between both ACLs in the ACL healthy control group. CONCLUSIONS SMI was useful to assess the increased vascularity in torn ACL, which may reflect the potential for, or state of, ACL maturation following reconstruction or repair. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Satoshi Takeuchi
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Orthopaedic Surgery, Toyohashi Medical Center, Toyohashi, Aichi, Japan
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ryo Kanto
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kentaro Onishi
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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37
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Vermeijden HD, Cerniglia B, Mintz DN, Rademakers MV, Kerkhoffs GMMJ, van der List JP, DiFelice GS. Distal remnant length can be measured reliably and predicts primary repair of proximal anterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc 2021; 29:2967-2975. [PMID: 33057796 DOI: 10.1007/s00167-020-06312-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the reliability and predictive value of quantifying anterior cruciate ligament (ACL) tear location on magnetic resonance imaging (MRI) and assess the predictive value of tear location on the eligibility for arthroscopic primary repair of proximal ACL tears. METHODS In this case-control study, all adult patients undergoing acute ACL surgery between 2008 and 2020 were retrospectively reviewed. All patients were treated with the treatment algorithm of undergoing primary repair when proximal tears with sufficient tissue quality were present intraoperatively, and otherwise underwent single-bundle ACL reconstruction. Sagittal MRI images were reviewed to measure proximal and distal remnant lengths along the anterior aspect of the torn ligament, and tear location was calculated as distal remnant divided by total remnant length. Interobserver and intraobserver reliability for remnant measurements were calculated. Then, receiver operating curve analysis (ROC) was performed to calculate the optimal cut-off for the possibility of primary repair with the different measurements. RESULTS Two hundred and forty-eight patients were included, of which 151 underwent repair (61%). Inter- and intraobserver reliability ranged between 0.92 and 0.96 [95% confidence interval (CI) 0.55-0.98] and 0.91-0.97 (95% CI 0.78-0.98, respectively). All patients with a tear location of ≥ 80% on MRI could undergo repair, whereas all patients with tear location of < 60% required reconstruction. The positive predictive value of a proximal quarter tear (≥ 75%) on primary repair was 94%. Older age was correlated with more proximal tear location (p < 0.001), but there was no correlation between tear location and gender, BMI, or timing of surgery (all n.s). CONCLUSION This study showed that tear location could reliably be quantified on MRI by assessing distal and proximal remnant lengths. Tear location in the proximal quarter of the ACL was found to have a positive predictive value for repairability of 94%. These findings may assist orthopaedic surgeons in evaluating which patients are eligible for primary ACL repair preoperatively. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Harmen D Vermeijden
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands
| | - Brett Cerniglia
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Douglas N Mintz
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Maarten V Rademakers
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Amsterdam Collaboration On Health and Safety in Sports (ACHSS), University of Amsterdam and Vrije Universiteit Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands
| | - Gregory S DiFelice
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
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38
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Mazza D, Monaco E, Daggett M, Annibaldi A, Pagnotta SM, Carrozzo A, Ferretti A. Combined ACL and Segond Repair in Combined Acute Proximal ACL Tears and Segond Fracture. Arthrosc Tech 2021; 10:e2151-e2156. [PMID: 34504755 PMCID: PMC8417392 DOI: 10.1016/j.eats.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/18/2021] [Indexed: 02/03/2023] Open
Abstract
A renewed interest in anterior cruciate ligament preservation has been noted using arthroscopic primary repair in patients with proximal tears, but the main concern remained the control of the rotational instability. Segond fracture occurs in less than 10% of cases of acute anterolateral instability, but it can result in continued rotation instability. The aim of this study is to describe the surgical technique to acutely repair both the anterior cruciate ligament and Segond fracture in the acute setting.
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Affiliation(s)
- Daniele Mazza
- University of Rome “Sapienza”, Sant’Andrea Hospital, Rome, Italy
| | - Edoardo Monaco
- University of Rome “Sapienza”, Sant’Andrea Hospital, Rome, Italy,Address correspondence to Edoardo Monaco, M.D., University of Rome La Sapienza, Sant’Andrea Hospital, Rome (Italy), Via di Grottarossa 1039 – Rome, Italy.
| | | | | | | | | | - Andrea Ferretti
- University of Rome “Sapienza”, Sant’Andrea Hospital, Rome, Italy
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39
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Mehier C, Ract I, Metten MA, Najihi N, Guillin R. Primary anterior cruciate ligament repair: magnetic resonance imaging characterisation of reparable lesions and correlation with arthroscopy. Eur Radiol 2021; 32:582-592. [PMID: 34255158 DOI: 10.1007/s00330-021-08155-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/05/2021] [Accepted: 06/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES A recent treatment algorithm suggests that proximal anterior cruciate ligament (ACL) tears with good-to-excellent tissue quality are amenable to primary repair. Our primary objective was to assess the ability of MRI to determine the exact tear location and tissue quality, using arthroscopy as a reference standard. METHODS In an initial sample of 71 patients with prior ACL surgery (repair or reconstruction), the diagnostic accuracy of MRI was assessed using arthroscopy as a reference standard. Each native ACL tear was graded according to Sherman's arthroscopic classifications during the surgical procedure. MRI scans were retrospectively reviewed for grading, blinded to arthroscopic findings and in consensus by two musculoskeletal radiologists. Tear location and tissue quality were graded using the MRI Sherman tear location (MSTL), MRI Sherman tissue quality (MSTQ) and simplified MRI Sherman tissue quality (S-MSTQ) classifications. Intra- and inter-observer agreement was assessed on a second sample of 77 patients. MRI classification accuracy was compared by McNemar's tests. Intra- and inter-observer agreement was assessed using Cohen's kappa coefficient. RESULTS Regarding tear location, diagnostic accuracy was 70% (50/71) based on the MSTL classification. Diagnostic accuracy for tissue quality was 52% (15/29) based on the MSTQ classification and 90% (26/29) for the S-MSTQ classification (p = 0.003). Inter-observer agreement was good for MSTL (κ = 0.78) and moderate-to-good for the MSTQ and S-MSTQ classifications (κ = 0.44 and 0.63 respectively). CONCLUSIONS MRI seems to be accurate in assessing tear location and tissue quality and may help clinicians to predict the reparability of ACL tears. KEY POINTS • MRI seems to be accurate in assessing tear location and tissue quality and may help clinicians to predict the reparability of ACL tears. • High intra-observer agreement was demonstrated when grading the tear location into one of five types. • The diagnostic accuracy of the simplified MRI tissue quality classification, involving deletion of the ligament stump signal criterion, was better than that observed with the MRI Sherman tissue quality classification, but was moderate to good in terms of inter- and intra-observer agreement.
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Affiliation(s)
- Clement Mehier
- Department of Radiology, Rennes University Hospital, 2 Rue Henri le Guilloux, 35000, Rennes, France.
| | - Isabelle Ract
- Department of Radiology, Rennes University Hospital, 2 Rue Henri le Guilloux, 35000, Rennes, France
| | - Marie-Astrid Metten
- University of Rennes, Rennes University Hospital, Inserm, EHESP, Irset (Research Institute for Environmental and Occupational Health) - UMR_S 1085, F-35000, Rennes, France
| | - Nabil Najihi
- Department of Orthopaedic Surgery, St Laurent Hospital, 320 Av. Général George S. Patton, 35700, Rennes, France
| | - Raphael Guillin
- Department of Radiology, Rennes University Hospital, 2 Rue Henri le Guilloux, 35000, Rennes, France
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40
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Acute Primary Repair of the Anterior Cruciate Ligament With Anterolateral Ligament Augmentation. Arthrosc Tech 2021; 10:e1633-e1639. [PMID: 34258215 PMCID: PMC8252825 DOI: 10.1016/j.eats.2021.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/02/2021] [Indexed: 02/03/2023] Open
Abstract
Acute injuries of the anterior cruciate ligament are often associated with concurrent injuries to the structures of the anterolateral complex, specifically the anterolateral ligament. Some injury patterns of the anterior cruciate ligament involve tearing of the majority of the ligament from the femoral origin, leaving a large, viable ligament remnant. In these patients, a repair of the anterior cruciate ligament back to the femoral origin can be undertaken. Subsequently, percutaneous repair of the anterolateral ligament can be performed through anatomical, percutaneous suture tape augmentation. The combined technique of anterior cruciate ligament repair with anterolateral ligament reinforcement is presented.
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41
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Shu HT, Wegener NR, Connors KM, Yang DS, Lockey SD, Thomas JM, Argintar EH. Accuracy of magnetic resonance imaging in predicting anterior cruciate ligament tear location and tear degree. J Orthop 2021; 25:129-133. [PMID: 34025056 DOI: 10.1016/j.jor.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/02/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose The purpose of this study is to evaluate the reliability of magnetic resonance imaging (MRI) in predicting the location of ACL tears in preoperative planning for anterior cruciate ligament (ACL) repair. Methods Thirty-four patients who underwent ACL repair were retrospectively analyzed to compare intraoperative arthroscopic findings with preoperative MRIs. Results For identifying type I tears, the sensitivity of MRI was 9.0% and the accuracy of MRI was 8.8%. There was moderate interrater agreement between MRI findings for tear location and tear degree. Conclusion MRI alone may not necessarily be accurate in identifying which ACL tears are amenable to repair. Study design Retrospective case series; Level of Evidence: IV.
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Affiliation(s)
- Henry T Shu
- Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC, 20007, USA.,School of Medicine, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | | | - Katherine M Connors
- Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, N.Y., 11203, USA
| | - Daniel S Yang
- Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
| | - Stephen D Lockey
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Ground Floor Pasquerilla Healthcare Center, Washington, DC, 20007, USA
| | - Jennifer M Thomas
- Department of Radiology, MedStar Washington Hospital Center, Washington, D., 20007, USA
| | - Evan H Argintar
- Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC, 20007, USA
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42
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Vermeijden HD, van der List JP, O'Brien RJ, DiFelice GS. Primary Repair of Anterior Cruciate Ligament Injuries: Current Level of Evidence of Available Techniques. JBJS Rev 2021; 9:01874474-202105000-00001. [PMID: 33956672 DOI: 10.2106/jbjs.rvw.20.00174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Recently, there has been a resurgence of interest in primary anterior cruciate ligament (ACL) repair that has the potential to preserve native tissue using a more minimally invasive approach. Multiple repair techniques for different tear types have been reported over the last decade. » From a healing perspective, proximal tears can be reapproximated directly to the femoral wall because they have better intrinsic healing capacity than midsubstance tears. These procedures can be classified further as direct suture repair with or without static or dynamic augmentation. Current evidence does not support direct repair of midsubstance tears because of their limited healing capacity. In many instances, biological augmentation is needed to enhance the healing potential of the ACL. » While ACL repair is certainly not an effective surgical approach for all tears or in all patients, this procedure can be an effective and less morbid alternative to ACL reconstruction in carefully selected patients. » The overall current reported level of evidence of published studies has ranged from low to moderate, and thus there is a need for higher-quality, comparative studies in which outcomes of larger patient groups are compared with the current gold standard of ACL reconstruction.
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Affiliation(s)
- Harmen D Vermeijden
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York-Presbyterian, Weill Medical College of Cornell University, New York, NY
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Robert J O'Brien
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York-Presbyterian, Weill Medical College of Cornell University, New York, NY
| | - Gregory S DiFelice
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York-Presbyterian, Weill Medical College of Cornell University, New York, NY
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Anterior Cruciate Ligament Reconstruction Graft Preference Most Dependent on Patient Age: A Survey of United States Surgeons. Arthroscopy 2021; 37:1559-1566. [PMID: 33539983 DOI: 10.1016/j.arthro.2021.01.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to define the anterior cruciate ligament (ACL) reconstruction (ACLR) graft preference of surgeons and to explore factors associated with their predilection. METHODS A 15-question survey regarding ACLR graft preference in various situations was completed by 514 American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America surgeons. Surgeon and practice demographics, along with various patient factors, were evaluated with bivariate and multivariable models for association with surgeon preference. Surgeons were also queried about their preference for their own ACLR. For surgeons who personally sustained an ACL, an additional 6 questions inquired about their experience. RESULTS Surgeons reported the 5 most important factors in patient graft choice, in order: patient age, graft failure in literature and practice, pivot sport, and patient preference. Autograft patellar and quadriceps tendon were strongly preferred for younger, pivoting athletes (P < .001), among those with fellowship training (47% vs 33%, P = .006), in academic practices (52% vs 44%, P = .003), and in more sports medicine-specific practices, with a higher number of ACLRs performed per year (P < .001). Northeast, Southeast, Midwest, and Southwest surgeons had lower hamstring autograft preference (P < .001). Non-fellowship-trained surgeons preferred hamstring autograft (P = .010). Allograft was preferred for older patients (P < .001). Nonsignificant predictors included highest level of athlete for whom an ACLR had been performed, level of athlete serving as team physician, and years in practice. No factors were associated with surgeon preference for their own ACLR despite deeming these factors important for patients. ACL tears were reported by 13% of respondents, with 86% stating it influenced their decision to enter orthopaedics. CONCLUSIONS Patient age was the most important factor in graft choice, with patellar and quadriceps tendon autograft the preferred graft for ACLR for younger, pivoting athletes. Fellowship training and practice demographics were also correlated with graft choice for patients. CLINICAL RELEVANCE Graft preference for ACLR varies among surgeons and is associated with surgeon experience and patient characteristics, including patient age, type of sport, and patient preference.
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van der List JP, Vermeijden HD, Sierevelt IN, Rademakers MV, Falke MLM, Helmerhorst GTT, Hoogeslag RAG, van der Wal WA, van Noort A, Kerkhoffs GMMJ. Repair versus reconstruction for proximal anterior cruciate ligament tears: a study protocol for a prospective multicenter randomized controlled trial. BMC Musculoskelet Disord 2021; 22:399. [PMID: 33931067 PMCID: PMC8088019 DOI: 10.1186/s12891-021-04280-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/20/2021] [Indexed: 01/11/2023] Open
Abstract
Background For active patients with a tear of the anterior cruciate ligament (ACL) who would like to return to active level of sports, the current surgical gold standard is reconstruction of the ACL. Recently, there has been renewed interest in repairing the ACL in selected patients with a proximally torn ligament. Repair of the ligament has (potential) advantages over reconstruction of the ligament such as decreased surgical morbidity, faster return of range of motion, and potentially decreased awareness of the knee. Studies comparing both treatments in a prospective randomized method are currently lacking. Methods This study is a multicenter prospective block randomized controlled trial. A total of 74 patients with acute proximal isolated ACL tears will be assigned in a 1:1 allocation ratio to either (I) ACL repair using cortical button fixation and additional suture augmentation or (II) ACL reconstruction using an all-inside autologous hamstring graft technique. The primary objective is to assess if ACL repair is non-inferior to ACL reconstruction regarding the subjective International Knee Documentation Committee (IKDC) score at two-years postoperatively. The secondary objectives are to assess if ACL repair is non-inferior with regards to (I) other patient-reported outcomes measures (i.e. Knee Injury and Osteoarthritis Outcome Score, Lysholm score, Forgotten Joint Score, patient satisfaction and pain), (II) objective outcome measures (i.e. failure of repair or graft defined as rerupture or symptomatic instability, reoperation, contralateral injury, and stability using the objective IKDC score and Rollimeter/KT-2000), (III) return to sports assessed by Tegner activity score and the ACL-Return to Sports Index at two-year follow-up, and (IV) long-term osteoarthritis at 10-year follow-up. Discussion Over the last decade there has been a resurgence of interest in repair of proximally torn ACLs. Several cohort studies have shown encouraging short-term and mid-term results using these techniques, but prospective randomized studies are lacking. Therefore, this randomized controlled trial has been designed to assess whether ACL repair is at least equivalent to the current gold standard of ACL reconstruction in both subjective and objective outcome scores. Trial registration Registered at Netherlands Trial Register (NL9072) on 25th of November 2020.
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Affiliation(s)
- Jelle P van der List
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands.
| | - Harmen D Vermeijden
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands.,Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Mark L M Falke
- Department of Orthopaedic Surgery, Flevoziekenhuis, Almere, The Netherlands
| | | | - Roy A G Hoogeslag
- Department of Orthopaedic Surgery, Centre for Orthopaedic Surgery OCON, Hengelo, The Netherlands
| | - Wybren A van der Wal
- Department of Orthopaedic Surgery, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
| | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam UMC, Amsterdam Collaboration on Health & Safety in Sports (ACHSS), University of Amsterdam and Vrije Universiteit Amsterdam IOC Research Center, Amsterdam, The Netherlands
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Vermeijden HD, Yang XA, van der List JP, DiFelice GS. Role of Age on Success of Arthroscopic Primary Repair of Proximal Anterior Cruciate Ligament Tears. Arthroscopy 2021; 37:1194-1201. [PMID: 33220465 DOI: 10.1016/j.arthro.2020.11.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/11/2020] [Accepted: 11/11/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess failure rates and patient-reported outcomes measures following arthroscopic primary anterior cruciate ligament (ACL) repair of proximal tears in different age groups. METHODS Between 2008 and 2017, the first 113 consecutive patients treated with repair were retrospectively reviewed at minimum of 2 years. Patients were stratified into 3 age groups: ≤21, 22-35, and >35 years. Primary outcomes were ipsilateral reinjury or reoperation, and contralateral injury rates, and secondary outcomes consisted of Lysholm, modified Cincinnati, Single Assessment Numeric Evaluation, International Knee Documentation Committee subjective, pain, and satisfaction scores. Group differences were compared using χ2 tests and Mann-Whitney U tests. RESULTS Follow-up was obtained in 113 patients (100%). Median age was 35 years (interquartile range [IQR] 23-43) and median follow-up was 2.2 years (IQR 2.0-2.8). Overall, ACL reinjury occurred in 13 patients (11.5%), reoperation in 7 patients (6.2%), complications in 2 patients (1.8%) and contralateral ACL injury in 4 patients (3.5%). Overall, median Lysholm was 95 (IQR 89-100) and International Knee Documentation Committee subjective 92 (IQR 84-99). Treatment failure was significantly greater in the youngest age group (37.0%) as compared with the middle and older groups (4.2% and 3.2%, both P < .005). No significant differences were seen in reoperation, complication, or contralateral injury rates between groups (all P > .2), nor in patient-reported outcomes measures between the groups (all P > .1). CONCLUSIONS The failure rate of primary repair of proximal ACL tears is high in patients aged 21 or younger (37.0%), and this should be taken into account when discussing repair in this patient group. In patients older than 21, repair may be an excellent treatment with low failure (3.5%) and complication rates (1.2%) and good subjective scores. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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Affiliation(s)
- Harmen D Vermeijden
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A
| | - Xiuyi A Yang
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A
| | - Jelle P van der List
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A.; Amsterdam UMC, University of Amsterdam Department of Orthopaedic Surgery, Amsterdam, The Netherlands
| | - Gregory S DiFelice
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A..
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Hoogeslag RAG, Buitenhuis MB, Brouwer RW, Derks RPH, van Raak SM, Veld RHI'. Standard MRI May Not Predict Specific Acute Anterior Cruciate Ligament Rupture Characteristics. Orthop J Sports Med 2021; 9:2325967121992472. [PMID: 33855093 PMCID: PMC8010830 DOI: 10.1177/2325967121992472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background There has been renewed interest in the concept of anterior cruciate ligament (ACL) suture repair (ACLSR). Morphologic characteristics of the ruptured ACL remnant play a role in deciding whether a patient is eligible for ACLSR. However, no classification of these characteristics of ACL rupture on magnetic resonance imaging (MRI) scans has yet been compared with intraoperative findings in the context of ACLSR. Purpose To investigate the value of using preoperative MRI to predict specific characteristics of acute complete ACL rupture. Study Design Cohort study (diagnostic); Level of evidence, 2. Methods A total of 25 patients were included. Two radiologists classified ACL rupture location and pattern on preoperative 1.5-T MRI scans with a standard sequence; the results were compared with the corresponding findings at arthroscopy conducted by a single surgeon. The agreement between the MRI and surgical findings was calculated using Cohen κ values. Furthermore, the reliability coefficients of the MRI classifications within and between radiologists were calculated. Results The agreement between MRI classification and arthroscopic findings for ACL rupture location was slight (Cohen κ, 0.016 [radiologist 1] and 0.087 [radiologist 2]), and for ACL rupture pattern, this was poor to slight (Cohen κ, <0 and 0.074). The intraobserver reliability of MRI classification for ACL rupture location was moderate for radiologist 1 and slight for radiologist 2 (Cohen κ, 0.526 and 0.061, respectively), and for ACL rupture pattern, this was slight for radiologist 1 and 2 (Cohen κ, 0.051 and 0.093, respectively). The interobserver reliability of MRI classification for ACL rupture location and pattern was slight between radiologists (Cohen κ, 0.172 and 0.040, respectively). Conclusion In the current study, we found poor to slight agreement between MRI classification and arthroscopic findings of specific ACL rupture characteristics. In addition, the intra- and interobserver reliability for MRI classification of the ACL rupture characteristics was slight to moderate.
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Affiliation(s)
| | | | - Reinoud W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Rosalie P H Derks
- Department of Musculoskeletal Radiology ZGT, Hengelo, the Netherlands
| | - Sjoerd M van Raak
- Department of Musculoskeletal Radiology ZGT, Hengelo, the Netherlands
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Wei Y, Yun X, Liu Y, Wei M. [Effectiveness of partial anterior cruciate ligament suture repair with wide awake local anesthesia no tourniquet technique]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:337-342. [PMID: 33719243 DOI: 10.7507/1002-1892.202008127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of partial anterior cruciate ligament (ACL) suture repair with wide awake local anesthesia no tourniquet (WALANT) technique. Methods Between July 2017 and July 2019, 18 patients with partial ACL injury were admitted. There were 10 males and 8 females, with an average age of 40.5 years (range, 22-57 years). There were 5 cases on the left knee and 13 cases on the right knee. Forteen cases had a clear history of trauma or sports injury, and 4 cases had no obvious cause. The time from injury to operation was 1-6 months (median, 3 months). Partial ligament was sutured using WALANT technique under arthroscopy. The operation time, total hospital stay, and postoperative hospital stay were recorded. Lachman test and anterior drawer test were performed to evaluate the knee joint stability after treatment, and Lysholm and International Knee Documentation Committee (IKDC) scores were used to evaluate the knee function. Five-point Likert scaling were used to evaluate postoperative patient satisfaction. Results The operation time was 30-100 minutes (mean, 64.2 minutes). The total hospital stay was 2-12 days (mean, 4.5 days). Postoperative hospital stay was 1-4 days (mean, 1.8 days). All incisions healed by first intention after operation, and no surgery-related complications occurred. All patients were followed up 12-36 months (mean, 19.1 months). Lachman test and anterior drawer test were negative after operation. Lysholm score and IKDC score at 6 and 12 months after operation were significantly higher than those before operation, and at 12 months after operation were higher than those at 6 months after operation, the differences were significant ( P<0.05). At last follow-up, according to five-point Likert scaling of patient satisfaction, 7 cases were very satisfied, 10 cases were relatively satisfied, and 1 case was general. The total patient satisfaction rate was 94.4% (17/18). MRI scan showed the good ligament tension. Conclusion Using WALANT technique to repair partial ACL injuries under arthroscopy can retain the patient's own ligament tissue to the maximum extent and achieve satisfactory short-term effectiveness.
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Affiliation(s)
- Yu Wei
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | | | - Yang Liu
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Min Wei
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
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Zanna L, Del Prete A, Benelli G, Turelli L. Knee central pivot bicruciate avulsion and proximal anterior cruciate ligament tear primary repair: A rare case report. Trauma Case Rep 2021; 32:100406. [PMID: 33665303 PMCID: PMC7905071 DOI: 10.1016/j.tcr.2021.100406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 11/23/2022] Open
Abstract
The knee is susceptible to complex injuries after trauma including fractures, multiple ligamentous lesions and avulsions due to its numerous tendinous, ligamentous and meniscal attachments. The authors describe a rare case of a 33-year-old male patient with a trauma of the right knee following a motorcycle accident, who sustained avulsion of both femoral and tibial insertion sites of anterior cruciate ligament and avulsion of tibial insertion of posterior cruciate ligament without other associated ligament lesions. The patient underwent a clinical-anamnestic and imaging evaluation to identify the lesions. Knee X-rays showed a tibial avulsion of anterior and posterior cruciate ligaments confirmed by CT scan, classified as type 3b according to Meyers and Mckeever. The authors decided for a surgical management: reduction and internal fixation of anterior and posterior cruciate ligament tibial bone fragments and repair of anterior cruciate ligament femoral avulsion using suture pull-out technique. The patient has been followed, with accurate clinical and radiological follow up controls, for 12 months and showed excellent clinical outcomes using Tegner-Lysholm Knee Score (95/100 points) and good range of motion and knee stability.
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Affiliation(s)
- Luigi Zanna
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1, 50139 Florence, Italy
| | - Armando Del Prete
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1, 50139 Florence, Italy
| | - Giovanni Benelli
- Orthopaedic and Traumatology, Ospedale di Prato, Asl Toscana Centro, Via Suor Niccolina Infermiera, 20/22, 59100 Prato, PO, Italy
| | - Luca Turelli
- Orthopaedic and Traumatology, Ospedale di Pescia, Asl Toscana Centro, Via Cesare Battisti, 2, 51017 Pescia, Italy
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Baker LA, Momen M, McNally R, Berres ME, Binversie EE, Sample SJ, Muir P. Biologically Enhanced Genome-Wide Association Study Provides Further Evidence for Candidate Loci and Discovers Novel Loci That Influence Risk of Anterior Cruciate Ligament Rupture in a Dog Model. Front Genet 2021; 12:593515. [PMID: 33763109 PMCID: PMC7982834 DOI: 10.3389/fgene.2021.593515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
Anterior cruciate ligament (ACL) rupture is a common condition that disproportionately affects young people, 50% of whom will develop knee osteoarthritis (OA) within 10 years of rupture. ACL rupture exhibits both hereditary and environmental risk factors, but the genetic basis of the disease remains unexplained. Spontaneous ACL rupture in the dog has a similar disease presentation and progression, making it a valuable genomic model for ACL rupture. We leveraged the dog model with Bayesian mixture model (BMM) analysis (BayesRC) to identify novel and relevant genetic variants associated with ACL rupture. We performed RNA sequencing of ACL and synovial tissue and assigned single nucleotide polymorphisms (SNPs) within differentially expressed genes to biological prior classes. SNPs with the largest effects were on chromosomes 3, 5, 7, 9, and 24. Selection signature analysis identified several regions under selection in ACL rupture cases compared to controls. These selection signatures overlapped with genome-wide associations with ACL rupture as well as morphological traits. Notable findings include differentially expressed ACSF3 with MC1R (coat color) and an association on chromosome 7 that overlaps the boundaries of SMAD2 (weight and body size). Smaller effect associations were within or near genes associated with regulation of the actin cytoskeleton and the extracellular matrix, including several collagen genes. The results of the current analysis are consistent with previous work published by our laboratory and others, and also highlight new genes in biological pathways that have not previously been associated with ACL rupture. The genetic associations identified in this study mirror those found in human beings, which lays the groundwork for development of disease-modifying therapies for both species.
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Affiliation(s)
- Lauren A Baker
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Mehdi Momen
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Rachel McNally
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Mark E Berres
- Bioinformatics Resource Center, Biotechnology Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Emily E Binversie
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Susannah J Sample
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Peter Muir
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
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van der List JP, Hagemans FJA, Zuiderbaan HA, van Dijke CF, Rademakers MV, van Noort A, Kerkhoffs GMMJ. Age, activity level and meniscus injury, but not tear location, tibial slope or anterolateral ligament injury predict coping with anterior cruciate ligament injury. Knee 2021; 29:222-232. [PMID: 33640621 DOI: 10.1016/j.knee.2021.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/04/2021] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Early recognition of potential predictors on the success of conservative treatment of anterior cruciate ligament (ACL) is important, as appropriate treatment can be applied to each individual patient. The goal of this study is to assess the patient demographic and radiological parameters that predict coping with ACL injuries. METHODS All patients presenting with a complete ACL injury between 2014 and 2018 at our clinic were included. The role of patient demographics (age, gender, activity level, meniscus injury and time from injury to clinic), and ACL tear location, bone bruises, tibial slope, and anterolateral ligament (ALL) injury were assessed on the success of conservative treatment using univariate and multivariate analyses. RESULTS Sixty-five patients (32%) were copers and 141 (68%) were non-copers. Univariate analysis showed that copers were significantly older (40 vs. 27 years, P < 0.001), had lower preinjury activity level (Tegner 5.7 vs. 6.5, P < 0.001) and less often lateral meniscus tears (16% vs. 5%, P = 0.019) but not medial meniscus tears (17% vs. 14%, P = 0.609) than non-copers. Multivariate analysis revealed that increasing age (P < 0.001), Tegner level ≤ 6 (P = 0.003) and no meniscus injury (P = 0.045) were independent predictors of coping with ACL deficiency. CONCLUSIONS Older age, participation in lower activity sports levels and absence of meniscus injury were predictive of coping with ACL deficiency, whereas there was no such role for tear location, tibial slope, lateral bone bruise presence, ALL injury or gender. These findings might help to identify potential copers and guide surgeons early in the optimal treatment for patients with ACL injury.
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Affiliation(s)
- Jelle P van der List
- NorthWest Clinics, Department of Orthopaedic Surgery, Alkmaar, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands; Spaarne Gasthuis, Department of Orthopaedic Surgery, Hoofddorp, the Netherlands.
| | - Frans J A Hagemans
- NorthWest Clinics, Department of Orthopaedic Surgery, Alkmaar, the Netherlands
| | - Hendrik A Zuiderbaan
- NorthWest Clinics, Department of Orthopaedic Surgery, Alkmaar, the Netherlands; Medical Clinics Velsen, Department of Orthopaedic Surgery, Velsen, the Netherlands
| | | | | | - Arthur van Noort
- Spaarne Gasthuis, Department of Orthopaedic Surgery, Hoofddorp, the Netherlands
| | - Gino M M J Kerkhoffs
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, the Netherlands; Amsterdam UMC, Amsterdam Collaboration on Health & Safety in Sports (ACHSS), University of Amsterdam and Vrije Universiteit Amsterdam IOC Research Center, Amsterdam, the Netherlands
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