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Ferrero S, Louvois M, Barnetche T, Breuil V, Roux C. Impact of anterior cruciate ligament surgery on the development of knee osteoarthritis: A systematic literature review and meta-analysis comparing non-surgical and surgical treatments. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100366. [PMID: 37252633 PMCID: PMC10209532 DOI: 10.1016/j.ocarto.2023.100366] [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: 11/18/2022] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Context: The development of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is now widely recognized. The impact of surgical or non-surgical management on the development of post-traumatic osteoarthritis is still debated in the medical community.Here, we present a meta-analysis comparing the impact of surgical or non-surgical management of ACL injuries on the development of knee OA. Method A systematic literature review was conducted using data from the PubMed, EMBASE, Medline, and Cochrane libraries from February to May 2019. Only randomized clinical trials published between 2005 and 2019 with a non-surgical group and a surgical group were included to explore the onset or progression of knee OA after ACL injury. Trials had to have at least one radiographic endpoint (Kellgren-Lawrence scoring system). Heterogeneity was assessed using the Cochrane's Q and I2 statistical methods. Results Only three randomized controlled trials met the inclusion criteria and were selected for meta-analysis. Of the 343 injured knees included in the studies, 180 underwent ACL reconstruction and 163 underwent non-surgical treatment. The relative risk of knee osteoarthritis was higher after surgery than after non-surgical treatment (RR 1.72, CI 95% [1.18-2.53], I2 = 0%). Conclusion The results of this meta-analysis suggest a predisposition to knee osteoarthritis after ACL reconstruction surgery compared with non-surgical management. Due to the small number of good quality studies available, further well-conducted randomised studies are needed to confirm these findings.
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Affiliation(s)
- Stephanie Ferrero
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Nice Sophia Antipolis University, F-06000, Nice, France
| | - Marion Louvois
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Nice Sophia Antipolis University, F-06000, Nice, France
| | - Thomas Barnetche
- Department of Rheumatology, University Hospital of Bordeaux Pellegrin, France
| | - Veronique Breuil
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Nice Sophia Antipolis University, F-06000, Nice, France
| | - Christian Roux
- Department Rheumatology, University of Cote D'Azur, Nice Hospital, Laboratory LAMHESS, EA6312, IBV CNRS IMR 7277 INSERM U1091 UNS, France
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Moustridi E, Risvas K, Moustakas K. Predictive simulation of single-leg landing scenarios for ACL injury risk factors evaluation. PLoS One 2023; 18:e0282186. [PMID: 36893124 PMCID: PMC9997920 DOI: 10.1371/journal.pone.0282186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/08/2023] [Indexed: 03/10/2023] Open
Abstract
The Anterior Cruciate Ligament (ACL) rupture is a very common knee injury during sport activities. Landing after jump is one of the most prominent human body movements that can lead to such an injury. The landing-related ACL injury risk factors have been in the spotlight of research interest. Over the years, researchers and clinicians acquire knowledge about human movement during daily-life activities by organizing complex in vivo studies that feature high complexity, costs and technical and most importantly physical challenges. In an attempt to overcome these limitations, this paper introduces a computational modeling and simulation pipeline that aims to predict and identify key parameters of interest that are related to ACL injury during single-leg landings. We examined the following conditions: a) landing height, b) hip internal and external rotation, c) lumbar forward and backward leaning, d) lumbar medial and lateral bending, e) muscle forces permutations and f) effort goal weight. Identified on related research studies, we evaluated the following risk factors: vertical Ground Reaction Force (vGRF), knee joint Anterior force (AF), Medial force (MF), Compressive force (CF), Abduction moment (AbdM), Internal rotation moment (IRM), quadricep and hamstring muscle forces and Quadriceps/Hamstrings force ratio (Q/H force ratio). Our study clearly demonstrated that ACL injury is a rather complicated mechanism with many associated risk factors which are evidently correlated. Nevertheless, the results were mostly in agreement with other research studies regarding the ACL risk factors. The presented pipeline showcased promising potential of predictive simulations to evaluate different aspects of complicated phenomena, such as the ACL injury.
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Affiliation(s)
- Evgenia Moustridi
- Department of Electrical and Computer Engineering, University of Patras, Patras, Achaia, Greece
| | - Konstantinos Risvas
- Department of Electrical and Computer Engineering, University of Patras, Patras, Achaia, Greece
| | - Konstantinos Moustakas
- Department of Electrical and Computer Engineering, University of Patras, Patras, Achaia, Greece
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Cuzzolin M, Previtali D, Zaffagnini S, Deabate L, Candrian C, Filardo G. Anterior Cruciate Ligament Reconstruction versus Nonoperative Treatment: Better Function and Less Secondary Meniscectomies But No Difference in Knee Osteoarthritis-A Meta-Analysis. Cartilage 2021; 13:1658S-1670S. [PMID: 34929763 PMCID: PMC8808919 DOI: 10.1177/19476035211046041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The impact of anterior cruciate ligament (ACL) reconstruction on knee osteoarthritis (OA) is still unclear. The aim of the current meta-analysis was to compare surgical treatment versus nonoperative management of ACL tears to assess the impact of these approaches on knee OA development at a 5 and 10 years of follow-up. DESIGN A meta-analysis was performed after a systematic literature search (May 2021) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Both randomized and nonrandomized comparative studies with more than 5 years of follow-up were selected. Influence of the treatment was assessed in terms of knee OA development, subjective and objective clinical results, activity level, and risk of further surgeries. Risk of bias and quality of evidence were assessed following the Cochrane guidelines. RESULTS Twelve studies matched the inclusion criteria, for a total of 1,004 patients. Level of evidence was rated low to very low. No difference was documented in terms of knee OA development, Tegner score, subjective International Knee Documentation Committee (IKDC), and Lysholm scores. A significant difference favoring the surgical treatment in comparison with a nonsurgical approach was observed in terms of objective IKDC score (P = 0.03) and risk of secondary meniscectomy (P < 0.0001). The level of evidence was considered very low for subjective IKDC, low for knee OA development, objective IKDC, number of secondary meniscectomies, and Lysholm score, and moderate for post-op Tegner score. CONCLUSIONS The meta-analysis did not support an advantage of ACL reconstruction in terms of OA prevention in comparison with a nonoperative treatment. Moreover, no differences were reported for subjective results and activity level at 5 and 10 years of follow-up. On the contrary, patients who underwent surgical treatment of their ACL tear presented important clinical findings in terms of better objective knee function and a lower rate of secondary meniscectomies when compared with conservatively managed patents.Protocol Registration: CRD420191156483 (PROSPERO).
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Affiliation(s)
- Marco Cuzzolin
- Orthopaedic and Traumatology Unit,
Ospedale Regionale di Lugano Service of Orthopedics and Traumatology, Department of
Surgery, EOC, Lugano, Switzerland
| | - Davide Previtali
- Orthopaedic and Traumatology Unit,
Ospedale Regionale di Lugano Service of Orthopedics and Traumatology, Department of
Surgery, EOC, Lugano, Switzerland,Davide Previtali, Orthopaedic and
Traumatology Unit, Ospedale Regionale di Lugano, EOC, Via Tesserete 46, 6900
Lugano, Switzerland.
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Deabate
- Orthopaedic and Traumatology Unit,
Ospedale Regionale di Lugano Service of Orthopedics and Traumatology, Department of
Surgery, EOC, Lugano, Switzerland
| | - Christian Candrian
- Orthopaedic and Traumatology Unit,
Ospedale Regionale di Lugano Service of Orthopedics and Traumatology, Department of
Surgery, EOC, Lugano, Switzerland,Facoltà di Scienze Biomediche,
Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Giuseppe Filardo
- Orthopaedic and Traumatology Unit,
Ospedale Regionale di Lugano Service of Orthopedics and Traumatology, Department of
Surgery, EOC, Lugano, Switzerland,Facoltà di Scienze Biomediche,
Università della Svizzera Italiana (USI), Lugano, Switzerland,Applied and Translational Research
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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4
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Clifford C, Ayre C, Edwards L, Guy S, Jones A. Acute knee clinics are effective in reducing delay to diagnosis following anterior cruciate ligament injury. Knee 2021; 30:267-274. [PMID: 33979729 DOI: 10.1016/j.knee.2021.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/10/2021] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Delays to diagnosis of anterior cruciate ligament (ACL) injury and specialist consultation continue to place patients at risk of early onset osteoarthritis. Incorporating acute knee clinics within a streamlined accident and emergency (A&E) pathway have shown potential in reducing delay but specific evaluative research is lacking. The aim of this service evaluation was to investigate the effectiveness of an acute knee clinic at one NHS Trust in the United Kingdom (UK), on reducing the delay to diagnosis of ACL injury and specialist consultation compared to a standard A&E pathway. METHODS An uncontrolled before and after design was utilised for this service evaluation. Data were collected from historical electronic patient records over a 1-year period with analysed results compared against previously collected data from the same NHS Trust. RESULTS 81 records met the criteria for the streamlined A&E pathway and were compared against 50 from the standard A&E pathway. For the streamlined A&E pathway median delay to diagnosis reduced from 97 to 14 days and delay to specialist consultation reduced from 158.5 to 45 days and were of statistical significance. The incorporation of an acute knee clinic was identified as the most influential factor on delay in addition to the location of presentation and mechanism of injury. CONCLUSIONS Introducing an acute knee clinic within a streamlined A&E pathway has a clinically relevant effect on reducing delay to diagnosis and specialist consultation and allows findings to be extrapolated and implemented to all UK based NHS Trust A&E departments.
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Affiliation(s)
- Carl Clifford
- Bradford Teaching Hospitals NHS Foundation Trust, Physiotherapy Department, Bradford Royal Infirmary, Bradford BD9 6DA, UK.
| | - Colin Ayre
- Bradford Teaching Hospitals NHS Foundation Trust, Department of Trauma and Orthopaedics, Bradford Royal Infirmary, Bradford BD9 6DA, UK; University of Bradford, Faculty of Health Studies, Bradford BD7 1DP, UK
| | - Lisa Edwards
- University of Bradford, Faculty of Health Studies, Bradford BD7 1DP, UK
| | - Stephen Guy
- Bradford Teaching Hospitals NHS Foundation Trust, Department of Trauma and Orthopaedics, Bradford Royal Infirmary, Bradford BD9 6DA, UK
| | - Alistair Jones
- Bradford Teaching Hospitals NHS Foundation Trust, Accident and Emergency Department MSK Service, Bradford Royal Infirmary, Bradford BD9 6DA, UK
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5
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Bobman J, Mayfield CK, Bolia IK, Kang HP, Hinckel BB, Gipsman A, Hatch GFR, Heckmann N, Weber AE. Conversion rates and timing to total knee arthroplasty following anterior cruciate ligament reconstruction: a US population-based study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:353-362. [PMID: 33893545 DOI: 10.1007/s00590-021-02966-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/29/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE To define the rate of subsequent TKA following ACLR in a large US cohort and to identify factors that influence the risk of later undergoing TKA after ACLR. METHODS The California's Office of Statewide Health Planning and Development (OSHPD) database was queried from 2000 to 2014 to identify patients who underwent primary ACLR (ACL group). An age-and gender-matched cohort that underwent appendectomy was selected as the control group. The cumulative incidence of TKA was calculated and ten-year survival was investigated using Kaplan-Meier analysis with failure defined as conversion to arthroplasty. Univariate and multivariate analyses were performed to explore the risk factors for conversion to TKA following ACLR. RESULTS A total of 100,580 ACLR patients (mean age 34.48 years, 66.1%male) were matched to 100,545 patients from the general population. The ACL cohort had 1374 knee arthroplasty events; conversion rate was 0.71% at 2-year follow-up, 2.04% at 5-year follow-up, and 4.86% at 10-year follow-up. This conversion rate was higher than that of the control group at all time points, with an odds ratio of 3.44 (p<0.001) at 10-year follow-up. Decreasing survivorship following ACLR was observed with increasing age, female gender, and worker's compensation insurance, while increased survivorship was found in patients of Hispanic and Asian Pacific Islander racial heritage and those who underwent concomitant meniscal repair. CONCLUSIONS In this US statewide study, the rate of TKA after ACLR is higher than reported elsewhere, with significantly increased odds when compared to a control group. Age, gender, concomitant knee procedures and other socioeconomic factors influence the rate of conversion to TKA following ACLR.
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Affiliation(s)
- Jacob Bobman
- Family Center for Sports Medicine at Keck Medicine of USA, USC Epstein, Los Angeles, CA, USA
| | - Cory K Mayfield
- Family Center for Sports Medicine at Keck Medicine of USA, USC Epstein, Los Angeles, CA, USA
| | - Ioanna K Bolia
- Family Center for Sports Medicine at Keck Medicine of USA, USC Epstein, Los Angeles, CA, USA
| | - Hyunwoo P Kang
- Family Center for Sports Medicine at Keck Medicine of USA, USC Epstein, Los Angeles, CA, USA
| | | | - Aaron Gipsman
- Family Center for Sports Medicine at Keck Medicine of USA, USC Epstein, Los Angeles, CA, USA
| | - George F Rick Hatch
- Family Center for Sports Medicine at Keck Medicine of USA, USC Epstein, Los Angeles, CA, USA
| | - Nathanael Heckmann
- Family Center for Sports Medicine at Keck Medicine of USA, USC Epstein, Los Angeles, CA, USA
| | - Alexander E Weber
- Family Center for Sports Medicine at Keck Medicine of USA, USC Epstein, Los Angeles, CA, USA.
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6
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Hsieh CY, Huang HY, Liu KC, Chen KH, Hsu SJP, Chan CT. Subtask Segmentation of Timed Up and Go Test for Mobility Assessment of Perioperative Total Knee Arthroplasty. SENSORS 2020; 20:s20216302. [PMID: 33167444 PMCID: PMC7663910 DOI: 10.3390/s20216302] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 01/20/2023]
Abstract
Total knee arthroplasty (TKA) is one of the most common treatments for people with severe knee osteoarthritis (OA). The accuracy of outcome measurements and quantitative assessments for perioperative TKA is an important issue in clinical practice. Timed up and go (TUG) tests have been validated to measure basic mobility and balance capabilities. A TUG test contains a series of subtasks, including sit-to-stand, walking-out, turning, walking-in, turning around, and stand-to-sit tasks. Detailed information about subtasks is essential to aid clinical professionals and physiotherapists in making assessment decisions. The main objective of this study is to design and develop a subtask segmentation approach using machine-learning models and knowledge-based postprocessing during the TUG test for perioperative TKA. The experiment recruited 26 patients with severe knee OA (11 patients with bilateral TKA planned and 15 patients with unilateral TKA planned). A series of signal-processing mechanisms and pattern recognition approaches involving machine learning-based multi-classifiers, fragmentation modification and subtask inference are designed and developed to tackle technical challenges in typical classification algorithms, including motion variability, fragmentation and ambiguity. The experimental results reveal that the accuracy of the proposed subtask segmentation approach using the AdaBoost technique with a window size of 128 samples is 92%, which is an improvement of at least 15% compared to that of the typical subtask segmentation approach using machine-learning models only.
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Affiliation(s)
- Chia-Yeh Hsieh
- Department of Biomedical Engineering, National Yang-Ming University, Taipei 11221, Taiwan; (C.-Y.H.); (H.-Y.H.)
| | - Hsiang-Yun Huang
- Department of Biomedical Engineering, National Yang-Ming University, Taipei 11221, Taiwan; (C.-Y.H.); (H.-Y.H.)
| | - Kai-Chun Liu
- Research Center for Information Technology Innovation, Academia Sinica, Taipei 11529, Taiwan;
| | - Kun-Hui Chen
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- Department of Biomedical Engineering, Hungkuang University, Taichung 43302, Taiwan
| | - Steen Jun-Ping Hsu
- Department of Information Management, Minghsin University of Science and Technology, Hsinchu 30401, Taiwan;
| | - Chia-Tai Chan
- Department of Biomedical Engineering, National Yang-Ming University, Taipei 11221, Taiwan; (C.-Y.H.); (H.-Y.H.)
- Correspondence: ; Tel.: +886-2-2826-7371
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7
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Chang CW, Lee JH, Chao PHG. Chemical Optimization for Functional Ligament Tissue Engineering. Tissue Eng Part A 2020; 26:102-110. [DOI: 10.1089/ten.tea.2019.0142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Chun-Wei Chang
- Department of Biomedical Engineering, School of Engineering and School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jian-Hong Lee
- Department of Biomedical Engineering, School of Engineering and School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pen-hsiu Grace Chao
- Department of Biomedical Engineering, School of Engineering and School of Medicine, National Taiwan University, Taipei, Taiwan
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8
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Chen IJ, Lin SH, Wong CS. Oral shea nut oil triterpene concentrate supplement ameliorates pain and histological assessment of articular cartilage deterioration in an ACLT injured rat knee osteoarthritis model. PLoS One 2019; 14:e0215812. [PMID: 31002699 PMCID: PMC6474620 DOI: 10.1371/journal.pone.0215812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 04/09/2019] [Indexed: 01/25/2023] Open
Abstract
Osteoarthritis (OA) is a multifactorial joint disease and a common disabling condition in the elderly population. The associated pain and pathohistological changes in cartilage are common features of OA in both humans and animal models. Shea nut oil extract (SheaFlex75) contains a high triterpenoid concentration and has demonstrated anti-inflammatory and antiarthritic effects in both human and animal studies. In this study, we aim to investigate the potential of SheaFlex75 to prevent articular cartilage deterioration in a rat model of chronic OA progression. By employing anterior cruciate ligament transection (ACLT) with medial meniscectomy (MMx)-induced OA, we found attenuation of both early and chronic onset OA pain and cartilage degeneration in ACLT+MMx rats receiving SheaFlex75 dietary supplementation. Under long-term oral administration, the rats with induced OA presented sustained protection of both pain and OA cartilage integrity compared to the OA-control rats. Moreover, rats subjected to long-term SheaFlex75 ingestion showed normal biochemical profiles (AST, BUN and total cholesterol) and presented relatively lower triglycerides (TGs) and body weights than the OA-control rats, which suggested the safety of prolonged use of this oil extract. Based on the present evidence, preventive management is advised to delay/prevent onset and progression in OA patients. Therefore, we suggest that SheaFlex75 may be an effective management strategy for symptom relief and cartilage protection in patients with both acute and chronic OA.
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Affiliation(s)
- Ing-Jung Chen
- Department of Medical Research, Cathay General Hospital, Taipei, Taiwan
- Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan
| | - Sheng-Hsiung Lin
- Planing and Management Office, Tri-Service General Hospital, Taipei, Taiwan
| | - Chih-Shung Wong
- Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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9
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Deckers C, Stephan P, Wever KE, Hooijmans CR, Hannink G. The protective effect of anterior cruciate ligament reconstruction on articular cartilage: a systematic review of animal studies. Osteoarthritis Cartilage 2019; 27:219-229. [PMID: 30317001 DOI: 10.1016/j.joca.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE It is unclear if anterior cruciate ligament (ACL) reconstruction can prevent the onset of degenerative changes in the knee. Previous studies were inconclusive on this subject. The aim of this study was to systematically review all studies on the effect of ACL reconstruction on articular cartilage in animals. DESIGN Pubmed and Embase were searched to identify all original articles concerning the effect of ACL reconstruction on articular cartilage compared with both its positive (ACL transection) and negative (sham and/or non-operated) control in animals. Subsequently a Risk of bias and meta analysis was conducted based on five outcomes (gross macroscopic assessment, medical imaging, histological histochemical grading, histomophometrics and biomechanical characterization) related to articular cartilage. RESULTS From the 19 included studies, 29 independent comparisons could be identified which underwent ACL reconstruction with an average timing of data collection of 23 weeks (range 1-104 weeks). Due to limited data availability meta-analysis could only be conducted for gross macroscopic damage. ACL reconstruction caused significant gross macroscopic damage compared with intact controls (SMD 2.0 [0.88; 3.13]). These findings were supported by individual studies reporting on histomorphometrics, histology and imaging. No significant gross macroscopic damage was found when ACL reconstruction was compared with ACL transection (SMD -0.64 [-1.85; 0.57]). CONCLUSION This systematic review with an average follow up of included studies of 23 weeks (range 1-104 weeks) demonstrates that, in animals, ACL reconstruction does not protect articular cartilage from degenerative changes. The consistency of the direction of effect, provides some reassurance that the direction of effect in humans might be the same.
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Affiliation(s)
- C Deckers
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - P Stephan
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - K E Wever
- Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE), Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - C R Hooijmans
- Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE), Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - G Hannink
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands.
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Ge H, Liu C, Shrestha A, Wu P, Cheng B. Do Nonsteroidal Anti-Inflammatory Drugs Affect Tissue Healing After Arthroscopic Anterior Cruciate Ligament Reconstruction? Med Sci Monit 2018; 24:6038-6043. [PMID: 30160247 PMCID: PMC6128182 DOI: 10.12659/msm.910942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Experimental studies have reported nonsteroidal anti-inflammatory drugs (NSAIDs) could impair tendon healing. The purpose of this study was to investigate whether NSAIDs could affect recovery of knee joint function in patients after anterior cruciate ligament (ACL) reconstruction. Material/Methods We enrolled 40 patients treated with celecoxib and 40 patients treated with tramadol, who underwent ACL reconstruction from January 2011 to December 2017. Visual analogue scale (VAS) and functional outcomes were collected and evaluated. The follow-up period was 12 months. Results In both groups, all patients obtained pain release after surgery, compared with that before surgery. But no significant differences were observed between the 2 groups in VAS scores. We also did not find any differences between the 2 groups at 1 year of follow-up, in terms of anterior drawer test, Lachman test, side-to-side laxity assessed by KT-2000, IKDC score, Lysholm score, and Tegner scale. However, the celecoxib group showed a reduced incidence of nausea compared to the tramadol group (P=0.048). Conclusions The use of NSAIDs after ACL reconstruction is relatively safe and could decrease adverse side effects which were caused by opioid drugs.
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Affiliation(s)
- Heng'an Ge
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Tongji University School of Medicine, Shanghai, China (mainland)
| | - Centao Liu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Suzhou University School of Medicine, Suzhou, Jiangsu, China (mainland)
| | - Amrit Shrestha
- Shiva Jyoti Hospital and Research Center PVT. Ltd., Kathmandu, Nepal
| | - Peng Wu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Biao Cheng
- Department of Orthopeadics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
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Evidence-Based Cutoff Threshold Values from Receiver Operating Characteristic Curve Analysis for Knee Osteoarthritis in the 50-Year-Old Korean Population: Analysis of Big Data from the National Health Insurance Sharing Service. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2013671. [PMID: 30140691 PMCID: PMC6081598 DOI: 10.1155/2018/2013671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 12/14/2017] [Indexed: 12/23/2022]
Abstract
We aimed to investigate the characteristics of patients with osteoarthritis (OA), using the data of all Koreans registered in the National Health Insurance Sharing Service Database (NHISS DB), and to provide ideal alternative cutoff thresholds for alleviating OA symptoms. Patients with OA (codes M17 and M17.1–M17.9 in the Korean Standard Classification of Disease and Causes of Death) were analyzed using SAS software. Optimal cutoff thresholds were determined using receiver operating characteristic curve analysis. The 50-year age group was the most OA pathogenic group (among 40~70 years, n = 2088). All exercise types affected the change of body mass index (p < 0.05) and the sex difference in blood pressure (BP) (p < 0.01). All types of exercise positively affected the loss of waist circumference and the balance test (standing time on one leg in seconds) (p < 0.01). The cutoff threshold for the time in seconds from standing up from a chair to walking 3 m and returning to the same chair was 8.25 (80% sensitivity and 100% specificity). By using the exercise modalities, categorized multiple variables, and the cutoff threshold, an optimal alternative exercise program can be designed for alleviating OA symptoms in the 50-year age group.
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12
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Sauerschnig M, Stolberg-Stolberg J, Schmidt C, Wienerroither V, Plecko M, Schlichting K, Perka C, Dynybil C. Effect of COX-2 inhibition on tendon-to-bone healing and PGE2 concentration after anterior cruciate ligament reconstruction. Eur J Med Res 2018; 23:1. [PMID: 29304843 PMCID: PMC5756348 DOI: 10.1186/s40001-017-0297-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/12/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs are commonly used to reduce pain and inflammation in orthopaedic patients. Selective cyclooxygenase-2 (COX-2) inhibitors have been developed to minimize drug-specific side effects. However, they are suspected to impair both bone and tendon healing. The objective of this study is to evaluate the effect of COX-2 inhibitor administration on tendon-to-bone healing and prostaglandin E (PGE2) concentration. METHODS Thirty-two New Zealand white rabbits underwent reconstructions of the anterior cruciate ligaments and were randomized into four groups: Two groups postoperatively received a selective COX-2 inhibitor (Celecoxib) on a daily basis for 3 weeks, the two other groups received no postoperative COX-2 inhibitors at all and were examined after three or 6 weeks. The PGE2 concentration of the synovial fluid, the osseous integration of the tendon graft at tunnel aperture and midtunnel section, as well as the stability of the tendon graft were examined via biomechanic testing. RESULTS After 3 weeks, the PGE2 content of the synovial fluid in the COX-2 inhibitor recipients was significantly lower than that of the control group (p = 0.018). At the same time, the COX-2 inhibitor recipients had a significantly lower bone density and lower amount of new bone formation than the control group (p = 0.020; p = 0.028) in the tunnel aperture. At the 6-week examination, there was a significant increase in the PGE2 content within synovial fluid of the COX-2 inhibitor recipients (p = 0.022), whose treatment with COX-2 inhibitors had ended 3 weeks earlier; in contrast, the transplant stability decreased and was reduced by 37% compared to the controls. CONCLUSIONS Selective COX-2 inhibitors cause impaired tendon-to-bone healing, weaken mechanical stability and decrease PGE2 content of the synovial fluid. The present study suggests a reluctant use of COX-2 inhibitors when tendon-to-bone healing is intended.
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Affiliation(s)
- Martin Sauerschnig
- Center for Musculoskeletal Surgery, University Hospital Charité, Charitéplatz 1, 10117, Berlin, Germany. .,Department of Experimental Trauma Surgery, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany. .,Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany. .,Trauma Hospital Graz, Unfallkrankenhaus der Allgemeinen Unfallversicherungsanstalt (AUVA), Göstinger Straße 24, 8020, Graz, Austria.
| | - Josef Stolberg-Stolberg
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Carmen Schmidt
- Center for Musculoskeletal Surgery, University Hospital Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Valerie Wienerroither
- Department of Experimental Trauma Surgery, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Michael Plecko
- Trauma Hospital Graz, Unfallkrankenhaus der Allgemeinen Unfallversicherungsanstalt (AUVA), Göstinger Straße 24, 8020, Graz, Austria
| | - Karin Schlichting
- Center for Musculoskeletal Surgery, University Hospital Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, University Hospital Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Christian Dynybil
- Center for Musculoskeletal Surgery, University Hospital Charité, Charitéplatz 1, 10117, Berlin, Germany
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