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Albright JA, Chang K, Byrne RA, Quinn MS, Meghani O, Daniels AH, Owens BD. A Diagnosis of Vitamin D Deficiency Is Associated With Increased Rates of Anterior Cruciate Ligament Tears and Reconstruction Failure. Arthroscopy 2023; 39:2477-2486. [PMID: 37127241 DOI: 10.1016/j.arthro.2023.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE To characterize the association between a diagnosis of hypovitaminosis D and primary anterior cruciate ligament (ACL) tear, primary anterior cruciate ligament reconstruction (ACLR), and revision ACLR in different sex and age cohorts. METHODS In this retrospective cohort study of the PearlDiver claims database, records were queried between January 1, 2011, and October 31, 2018 for all patients aged 10 to 59 years who received a diagnosis of hypovitaminosis D. Rates of primary ACL tears, primary reconstruction, and revision reconstruction were calculated for sex- and age-specific cohorts and compared with a control of patients without a diagnosis of hypovitaminosis D. Incidence rates for primary ACL injuries were calculated, and multivariable logistic regression was used to compare rates of ACL injury, primary reconstruction, and revision reconstruction while controlling for age, sex, Charlson Comorbidity Index, and several other comorbidities. RESULTS Among the 328,011 patients (mean age 41.9 ± 12.6 years, 65.8% female) included in both the hypovitaminosis D and control cohorts, the incidence of ACL tears was 115.2 per 100,000 person-years (95% confidence interval [CI] 107.2-123.7) compared with 61.0 (95% CI 55.2-67.2) in the demographic- and comorbidity-matched control cohort. The study cohort was significantly more likely to suffer an ACL tear over a 1- (aOR 1.67, 95% CI 1.41-1.99, P < .001) and 2-year (aOR 1.81, 95% CI 1.59-2.06, P < .001) period. This trend remained for both male patients at the 1- (aOR 1.66, 95% CI 1.29-2.14, P < .001) and 2-year (aOR 1.68, 95% CI 1.37-2.06, P < .001) mark and female patients at the 1- (aOR 1.69, 95% CI 1.33-2.14, P < .001) and 2-year (aOR 1.80, 95% CI 1.51-2.14, P < .001) mark. Finally, patients with vitamin D deficiency had a significantly increased likelihood of undergoing a revision ACLR within 2 years of a primary reconstruction (aOR 1.28, 95% CI 1.05-1.55, P = .012). CONCLUSIONS This study reports an association between patients previously diagnosed with hypovitaminosis D and significantly increased rates of both index ACL tears (81% increase within 2 years of diagnosis) and revision ACLR (28% within 2 years). These results identify a population with increased odds of injury and provide valuable knowledge as we expand our understanding of the relationship between vitamin D and musculoskeletal health. LEVEL OF EVIDENCE Level III, retrospective database study.
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Affiliation(s)
- J Alex Albright
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A.
| | - Kenny Chang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Rory A Byrne
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, U.S.A
| | - Matthew S Quinn
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, U.S.A
| | - Ozair Meghani
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, U.S.A
| | - Alan H Daniels
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, U.S.A
| | - Brett D Owens
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, U.S.A
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Ashy C, Bailey E, Hutchinson J, Brennan E, Bailey R, Michael Pullen W, Xerogeanes JW, Slone HS. Quadriceps tendon autograft has similar clinical outcomes when compared to hamstring tendon and bone-patellar tendon-bone autografts for revision ACL reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5463-5476. [PMID: 37804345 DOI: 10.1007/s00167-023-07592-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/11/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Research regarding revision anterior cruciate ligament reconstruction (RACLR) with quadriceps tendon (QT) autografts is lacking. The purpose of this study was to perform a systematic review and meta-analysis of RACLR with QT and compare its patient outcomes to RACLR with hamstring tendon (HT) and bone-patellar tendon-bone (BTB) autografts. METHODS Adhering to PRISMA guidelines, a search for studies using QT in RACLR was performed within PubMed, Scopus, and CINAHL from database date of inception through December 26, 2022. Primary outcomes sought included: failure rate, Lysholm scores, International Knee Documentation Committee (IKDC) scores, IKDC grades, arthrometric knee side-to-side differences (STSD), pivot shift grade, donor site morbidity, return to sport, visual analog scale (VAS) pain scores. RESULTS Nine studies were included consisting of 606 RACLR: 349 QT, 169 HT, and 88 BTB. Overall failure rates were 7.6% QT, 13.3% HT, and 8.7% BTB. Mean weighted Lysholm scores were 85.8 ± 3.8 QT, 82.5 ± 3.8 HT and 86.6 ± 4.5 BTB. IKDC average scores were 82.3 ± 1.6 QT, 80.1 ± 1.7 HT, and 81.7 ± 5.5BTB. Combined rates of IKDC A/B grades were 88.4% and 80.0% for QT and HT, respectively. VAS average scores were 0.9 ± 1.1 QT, 1.4 ± 0.2 HT, and 0.7 ± 0.8 for BTB. Side-to-side difference was reported for QT and HT with average values of 1.7 ± 0.6 mm and 2.1 ± 0.5 mm, respectively. Grade 0 or 1 pivot shifts were reported in 96.2% of QT patients and 91.3% of HT. Donor site morbidity, only reported for QT and HT, was 14.6 ± 9.7% and 23.6 ± 14.1%, respectively. QT resulted in a mean Tegner score of 5.9 ± 1.5 versus HT 5.7 ± 1.5. Rate of return to pivoting sports was 38.0% QT, 48.6% HT, and 76.9% BTB. Across all outcomes, there was no significant difference when comparing QT to HT, QT to BTB, and QT compared to HT and BTB combined. CONCLUSIONS RACLR with QT yields satisfactory patient reported outcomes, satisfactory improvement in knee laxity, expected return to sport rates, and has an overall 7.6% failure rate. Outcomes are comparative to those of HT and BTB making it an acceptable graft choice for RACLR. Surgeons should consider using QT autograft for RACLR, especially when other autografts are unavailable. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Cody Ashy
- Department of Orthopaedics and Physical Medicine, Clinical Sciences Building, CSB, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC Code: 708, Charleston, SC, 29425, USA.
| | - Evan Bailey
- College of Medicine, Medical University of South Carolina, Charleston, USA
| | - Joshua Hutchinson
- College of Medicine, Medical University of South Carolina, Charleston, USA
| | - Emily Brennan
- MUSC Libraries, Medical University of South Carolina, Charleston, USA
| | | | - William Michael Pullen
- Department of Orthopaedics and Physical Medicine, Clinical Sciences Building, CSB, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC Code: 708, Charleston, SC, 29425, USA
| | | | - Harris S Slone
- Department of Orthopaedics and Physical Medicine, Clinical Sciences Building, CSB, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC Code: 708, Charleston, SC, 29425, USA
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Weaver AP, Walaszek MC, Roman DP, Harkey MS, Kuenze C. The Impact of Meniscal Tear Type and Surgical Treatment on Quadriceps Strength: A Study of Adolescent Patients Post Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2023; 51:2357-2365. [PMID: 37272684 PMCID: PMC10865339 DOI: 10.1177/03635465231177626] [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] [Indexed: 06/06/2023]
Abstract
BACKGROUND Treatment of meniscal injuries at the time of anterior cruciate ligament reconstruction (ACLR) can result in restrictions on weightbearing and range of motion in the early rehabilitative phases. What is unknown is the effect of (1) meniscal tear type and location at the time of anterior cruciate ligament injury and (2) meniscal treatment at the time of ACLR on quadriceps strength in adolescents during the late rehabilitative phase. HYPOTHESIS Meniscal tears involving the root and requiring repair would adversely affect quadriceps strength at 6 to 9 months postoperatively. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent ACLR at 1 of 2 research sites between 2013 and 2021 were identified. Adolescent participants were included if they were between the ages of 12 and 20 years at the time of assessment and had undergone primary unilateral ACLR in the previous 6 to 9 months. Participants were subgrouped by meniscal tear type (no tear, nonroot tear, root tear) and meniscal treatment at the time of ACLR (no treatment, meniscectomy, meniscal repair), which were confirmed via chart review. Isokinetic strength testing occurred at 60 deg/s, and quadriceps strength and quadriceps strength limb symmetry index were compared between the meniscal tear type and meniscal procedure subgroups using analysis of covariance while controlling for the effects of age, sex, and ACLR graft source. RESULTS An overall 236 patients were included in this analysis (109 male, 127 female; mean ± SD age, 16.0 ± 1.9 years). There were no significant differences in ACLR limb quadriceps strength based on meniscal tear type (P = .61) or meniscal procedure at the time of ACLR (P = .61), after controlling for age, biological sex, and ACLR graft source. Similarly, quadriceps strength limb symmetry index did not differ by meniscal tear type (P = .38) or meniscal procedure at the time of ACLR (P = .40). CONCLUSION Meniscal tear type and treatment at the time of ACLR did not affect quadriceps strength or quadriceps strength symmetry in adolescents 6 to 9 months after ACLR.
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Affiliation(s)
- Adam P. Weaver
- Address correspondence to Adam P. Weaver, PT, DPT, Sports Physical Therapy, Connecticut Children’s, 399 Farmington Ave, Farmington, CT 06032, USA () (Twitter: @adampweaver)
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Cleary CJ, Weir JP, Vopat BG, Herda AA. Evaluation of raw segmental bioelectrical impedance variables throughout anterior cruciate ligament reconstruction rehabilitation. Physiol Meas 2022; 43. [PMID: 36575155 DOI: 10.1088/1361-6579/acaa87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Background.Raw bioelectrical impedance analysis (BIA) variables are related to physical function in healthy and diseased populations. Therefore, BIA may be an insightful, noninvasive method of assessment to track following anterior cruciate ligament reconstruction (ACLR).Objectives.Evaluate phase angle, reactance and impedance at 50 kHz (PhA50, Xc50, andZ50, respectively) in the operative (OP) and non-operative (NOP) limbs during ACLR rehabilitation.Approach.Seventeen patient (12 M, 5 F; 18.8 ± 4.8 years) clinic reports were evaluated prior to ACLR (PRE), two- (2 W), six- (6 W), and twelve-weeks (12 W) post-ACLR and at return to sport testing (RTS).Setting.All observations occurred during the participant's physical therapy visits.Measurements.A multi-frequency BIA device measured segmental PhA, Xc, andZ. Linear mixed effects models were used to assess any leg and time interaction and changes over leg and time, independently. Any interactions or main effects were considered significant atp< 0.05.Main results.Significant legxtime interactions were observed for each variable. PhA50and Xc50of NOP were higher (p< 0.001) than OP at each time point by an average of by 0.9° and 4.9 Ω, respectively. In OP, PhA50and Xc50decreased from PRE to 2 W and increased from 6 to 12 W and 12 W to RTS (p< 0.01, for all). At RTS, PhA50and Xc50were similar to PRE in OP (p> 0.05). ForZ50, the OP leg did not change over time (p> 0.05).Z50was greater in NOP at 2 and 6 W (p< 0.01, for both). There were differences in PhA50in NOP between PRE and 6 W and from 6 W to RTS (p< 0.05 for both). Xc50did not change (p> 0.05), andZ50PRE was lower than at 2 W (p< 0.05).Significance.A multi-frequency BIA device can detect changes in segmental BIA variables following ACLR.
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Affiliation(s)
- Christopher J Cleary
- Department of Health, Sport, and Exercise Sciences, University of Kansas Edwards Campus, Overland Park, Kansas, United States of America
| | - Joseph P Weir
- Department of Health, Sport, and Exercise Sciences, University of Kansas Lawrence Campus, Lawrence, Kansas, United States of America
| | - Bryan G Vopat
- University of Kansas Medical Center, Department of Orthopedic Surgery and Sports Medicine, Kansas City, Kansas, United States of America
| | - Ashley A Herda
- Department of Health, Sport, and Exercise Sciences, University of Kansas Edwards Campus, Overland Park, Kansas, United States of America
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Freshman RD, Truong NM, Cevallos N, Lansdown DA, Feeley BT, Ma CB, Zhang AL. Delayed ACL reconstruction increases rates of concomitant procedures and risk of subsequent surgery. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07249-z. [PMID: 36459171 DOI: 10.1007/s00167-022-07249-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE To utilise a large cross-sectional database to analyse the effects of time duration between diagnosis of anterior cruciate ligament (ACL) tear and ACL reconstruction (ACLR) on concomitant procedures performed and subsequent surgery within 2 years. METHODS An analysis from 2015 to 2018 was performed using the Mariner PearlDiver Patient Records Database. Current Procedural Terminology (CPT), and International Classification of Diseases (ICD-10) codes identified patients with a diagnosis of ACL tear who underwent subsequent ACLR. Patients were stratified in biweekly and bimonthly increments based on the time duration between initial diagnosis of ACL tear and surgical treatment. Chi-squared analysis was used to compare categorical variables, and trend analysis was performed with Cochran-Armitage independence testing. RESULTS Of 11,867 patients who underwent ACLR, 76.1% underwent surgery within 2 months of injury diagnosis. Patients aged 10-19 were most likely to undergo surgery within 2 months of injury diagnosis (83.5%, P < 0.0001). As duration from injury diagnosis to ACLR increased from < 2 months to > 6 months, rates of concomitant meniscectomy increased from 9.1% to 20.5% (P < 0.0001). The overall 2-year subsequent surgery rate was 5.3%. The incidence of revision ACLR was highest for patients who underwent surgery > 6 months after diagnosis (P < 0.0001), whilst the incidence of ipsilateral lysis of adhesions and manipulation under anaesthesia (MUA) was highest for patients who underwent surgery < 2 months after diagnosis (P < 0.0001). ACLR at 6-8 weeks after diagnosis demonstrated the lowest risk for concomitant procedures as well as 2-year subsequent surgery. CONCLUSION The majority of patients undergo ACL reconstruction within 2 months of initial ACL tear diagnosis. Delayed surgery greater than 6 months after the diagnosis of an ACL rupture leads to increased need for concomitant meniscectomy as well as higher risk for revision ACLR within 2 years, but immediate surgery may increase risk for knee arthrofibrosis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ryan D Freshman
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA.
| | - Nicole M Truong
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - Nicolas Cevallos
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
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Arthroscopic Treatment Yields Lower Reoperation Rates than Open Treatment for Native Knee but Not Native Shoulder Septic Arthritis. Arthrosc Sports Med Rehabil 2022; 4:e1167-e1178. [PMID: 35747656 PMCID: PMC9210470 DOI: 10.1016/j.asmr.2022.04.014] [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: 02/04/2022] [Accepted: 04/16/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To compare the incidence, patient demographics, complication rates, readmission rates, and reoperation rates of open and arthroscopic surgery performed for septic arthritis in native knee and shoulder joints. Methods Records of patients who were diagnosed with native knee or shoulder septic arthritis and underwent open or arthroscopic irrigation and debridement (I&D) between 2015 and 2018 were queried from the PearlDiver Mariner Database. International Classification of Diseases 10th (ICD-10) diagnosis and procedure codes were used to identify patients and track reoperations. Reoperation procedures, including revision open and arthroscopic I&D, were analyzed at 1 month, 1 year, and 2 years. Complications, emergency department (ED) admissions, and hospital readmissions within 30 days were analyzed and compared between the open and arthroscopic cohorts. Results The query resulted with 1,993 patients who underwent knee I&D (75.3% arthroscopic, 24.7% open, P < .001) and 476 patients who underwent shoulder I&D (64.8% arthroscopic, 35.2% open, P < .001). One-month complication rates (11.6-22.7%) and hospital readmission rates (15.8-19.6%) were similar for arthroscopic and open treatment for knee and shoulder septic arthritis. Reoperation rates for revision I&D of the knee were higher after open compared to arthroscopic treatment at 1 month, 1 and 2 years (20.9% vs. 16.7%, 32.5% vs 27.6% and 34.1% vs. 29.4%, P < .05, respectively). For shoulder septic arthritis 1-month, 1-year, and 2-year reoperation rates were similar for open and arthroscopic treatment (16.0% vs 11.7%, 22.0% vs 19.3%, and 22.7% vs 20.0%, P = .57, respectively). Lastly, 6.7% of patients with native septic knee arthritis underwent subsequent arthroplasty by 2 years. Conclusion Arthroscopic treatment carries a lower reoperation rate than open surgery for knee septic arthritis, but in the shoulder, the risk for revision I&D is similar after arthroscopic or open surgery.
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Age-related differences in hamstring tendon used as autograft in reconstructive anterior cruciate ligament surgery. INTERNATIONAL ORTHOPAEDICS 2022; 46:845-853. [DOI: 10.1007/s00264-021-05285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
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