Bone Morphological Characteristics as Risk Factors for Anterior Cruciate Ligament Injury: Comparison Between Contact and Noncontact Injury

Editorial Commentary: Increased Lateral Femoral Condyle Ratio, Increased Posterior Tibial Slope, and Narrow Notch Width Are all Risk Factors for Anterior Cruciate Ligament Tear, and Anterior Cruciate Ligament Graft Tear

Bony risk factors for anterior cruciate ligament (ACL) injuries have been investigated during past 2 decades. Deep posterior femoral condylar depth, measured by the lateral femoral condyle ratio, influences anterolateral instability and the graft survival following ACL reconstructions. Before planning of revision ACL reconstruction, other bony risk factors, including the posterior tibial slope and intercondylar notch width, should be carefully evaluated to protect the ACL graft.

Effects of Kinesio taping on lower limb biomechanical characteristics during the cutting maneuver in athletes after anterior cruciate ligament reconstruction

PURPOSE

To determine the effects of Kinesio taping (KT) on the biomechanical characteristics of the lower limbs during the 90° cutting maneuver in anterior cruciate ligament (ACL) reconstruction (ACLR) athletes.

METHOD

Eighteen ACLR athletes were recruited and subjected randomly to three taping conditions, KT, placebo taping (PT), and no taping (NT), followed by a 90° cutting test. A nine-camera infrared high-speed motion capture system (Vicon, T40, 200 Hz) was used to record the kinematic parameters of the lower limbs during the cutting maneuver, and a three-dimensional dynamometer (Kistler, 1000 Hz) was used to record the kinetic parameters of the lower limbs. A one-way repeated measures analysis of variance was conducted to compare the differences in the lower limb kinematic and kinetic characteristics of ACLR athletes subjected to these interventions.

RESULTS

During the landing phase, the knee valgus angle reduced significantly with KT than with NT (95% confidence interval = -1.399 to -0.154; P = 0.025), whereas no significant difference was observed between PT and NT (95% confidence interval = -1.251 to 0.217; P = 0.236). No significant differences were observed in the other kinematic variables among the three taping conditions (P > 0.05). During the landing phase, no significant differences in the kinetic variables were observed among the three taping conditions (P > 0.05).

CONCLUSIONS

Although KT does not improve the kinetic variables of athletes after ACLR during the 90° cutting maneuver, it reduces the knee valgus angle, which could reduce the risk of secondary ACL injury.

Risk factors for the development of stifle injuries in canine agility athletes

Objectives

Our aim was to determine risk factors for developing stifle injuries in canine agility athletes. We hypothesized that increased weight, increased frequency of competing, and greater number of runs/day would increase risk.

Study design

Internet based survey, n = 4,197.

Methods

Individuals with at least one dog who had competed in agility in the past 3 years were eligible. Injury history was defined as an injury to the stifle that kept the dog from participating in agility for >1 week. Logistic regression models were used to estimate associations between variables of interest and injury history.

Results

Handlers of 216 dogs reported a history of injury. The majority were cranial cruciate ligament (CCL) injury (101/216), and patella luxation (40/216). In the final model, five variables were independently associated with odds of stifle injury (in addition to age). Heavier dogs (adjusted for height), Border Collies, male dogs neutered <10 months, female dogs spayed before their first heat cycle, handlers aged 18-24, and teeter contact behavior were associated with increased risk.

Conclusion

Heavier dogs were more likely to report injury, but there was no association with injury and increased number of competition days, or runs/day. The Border Collie breed was at the highest risk of injury. There was substantial risk for stifle injury with early spay/neuter. Additionally, a significant increase in risk of injury was reported for younger (18-24) vs. older handlers (65+). Athlete fitness level, conformation, and genetic predisposition to injury may play the most significant role in the development of injury.

Editorial Commentary: The Number One Cause of Anterior Cruciate Ligament Reconstruction Graft Failure Is a Misplaced Femoral Tunnel: Over-the-Top Technique Plus Lateral Extra-Articular Tenodesis Is Recommended

Patient factors (notably high tibial slope and narrow femoral intercondylar notch width) and surgical factors (including meniscus treatment and anterior cruciate ligament [ACL] tunnel position) contribute to ACL reconstruction failure. The number one cause of failure is a misplaced ACL femoral tunnel. Tunnel malposition leads to a higher incidence of postoperative meniscal lesions, inferior clinical outcomes, and higher revision rates.

Decreased posterior tibial slope is a risk factor for primary posterior cruciate ligament rupture and posterior cruciate ligament reconstruction failure: A systematic review

PURPOSE

To determine bony knee morphological factors associated with primary posterior cruciate ligament (PCL) rupture or PCL graft failure after PCL reconstruction.

METHODS

Three databases, namely MEDLINE, PubMed and EMBASE, were searched on 30th May 2023. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data such as receiver operating characteristic curve parameters, as well as p-values for comparisons of values between patients with PCL pathology and control patients, were recorded.

RESULTS

Nine studies comprising 1054 patients were included. Four studies reported that patients with PCL injury had flatter medial posterior tibial slopes (MTS) than controls, with mean values of 4.3 (range: 3.0-7.0) and 6.5 (range: 5.0-9.2) degrees, respectively. Two studies reported an MTS cutoff value ranging below 3.90-3.93° being a significant risk factor for primary PCL rupture or PCL graft failure. Two studies reported that shallow medial tibial depths were associated with primary PCL rupture, with mean values of 2.1 (range: 2.0-2.2) and 2.6 (range: 2.4-2.7) mm in PCL injury and control groups, respectively. Stenotic intercondylar notches and femoral condylar width were not consistently associated with PCL injuries.

CONCLUSION

Decreased MTS is associated with primary PCL rupture and graft failure after PCL reconstruction with values below 3.93° being considered as a significant risk factor. Less common risk factors include shallow medial tibial depth, while femoral condylar width and parameters with regards to the intercondylar notch, such as notch width, notch width index and intercondylar notch volume, demonstrated conflicting associations with primary or secondary PCL injuries.

LEVEL OF EVIDENCE

Level III.

Though five-strand hamstring autografts demonstrate greater graft diameter, postoperative outcomes are equivocal to four-strand hamstring autograft preparations: a systematic review and meta-analysis of level I and II studies

PURPOSE

To compare graft dimensions, functional outcomes, and failure rates following anterior cruciate ligament reconstruction (ACLR) with either five-strand or four-strand hamstring autograft options.

METHODS

Three databases (MEDLINE, PubMed, and EMBASE) were searched from inception to 22 April 2023 for level I and II studies comparing five- and four-strand hamstring autografts in ACLR. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, surgical details and rehabilitation, graft diameter, patient-reported outcome measures (PROMs), and rates of positive Lachman test, positive pivot shift test, and graft rupture were extracted. PROMs included Knee Osteoarthritis and Outcome Score (KOOS) subscales, Lysholm, and International Knee Documentation Committee (IKDC).

RESULTS

One randomized controlled trial (RCT) and four prospective cohort studies with 572 patients were included. Graft diameters were larger in the five-strand group with a mean difference of 0.93 mm (95% CI 0.61 to 1.25, p < 0.001, I2 = 66%). The five-strand group reported statistically higher KOOS ADL subscale and Lysholm scores with a mean difference of 4.85 (95% CI 0.14 to 9.56, p = 0.04, I2 = 19%) and 3.01 (95% CI 0.48 to 5.53, p = 0.02, I2 = 0%), respectively. There were no differences in KOOS symptoms, pain, quality of life, or sports subscales, or IKDC scores. There were no differences in rates of positive Lachman test, positive pivot shift test, or graft rupture with pooled odds ratios of 0.62 (95% CI 0.13 to 2.91, n.s., I2 = 80%), 0.94 (95% CI 0.51 to 1.75, n.s., I2 = 31%), and 2.13 (95% CI 0.38 to 12.06, n.s., I2 = 0%), respectively.

CONCLUSIONS

Although five-stranded hamstring autografts had significantly larger graft diameters compared to four-stranded grafts with a mean difference of 0.93 mm, similar graft rupture rates and clinical laxity assessments were identified following ACLR. While some PROMs were statistically superior in the five-stranded hamstring groups, the threshold for the minimal clinical important difference was not reached indicating similar clinical outcomes overall.

LEVEL OF EVIDENCE

Level II.