1
|
Donelon TA, Edwards J, Brown M, Jones PA, O'Driscoll J, Dos'Santos T. Differences in Biomechanical Determinants of ACL Injury Risk in Change of Direction Tasks Between Males and Females: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2024; 10:29. [PMID: 38561438 PMCID: PMC10984914 DOI: 10.1186/s40798-024-00701-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Change of direction (COD) movements are associated with non-contact anterior cruciate ligament (ACL) injuries in multidirectional sports. Females appear at increased risk compared to males, which could be attributable to whole body kinematic strategies and greater multiplanar knee joint loads (KJLs) during COD which can increase ACL loading. OBJECTIVE The aim of this systematic review and meta-analysis was to examine and quantitatively synthesise the evidence for differences between males and females regarding KJLs and their biomechanical determinants (whole body kinematic strategies determining KJLs) during COD tasks. METHODS Databases including SPORTDiscus, Web of Science, and PubMed were systematically searched (July 2021-June 2023) for studies that compared differences in knee joint loads and biomechanical determinants of KJLs during COD between males and females. Inclusion criteria were: (1) females and males with no prior history of ACL injury (18-40 years); (2) examined biomechanical determinants of KJLs and/ or KJLs during COD tasks > 20°; (3) compared ≥ 1 outcome measure between males and females. Studies published between 2000 and 2023 examining a cutting task > 20° with a preceding approach run that compared KJLs or the whole body multiplanar kinematics associated with them, between sexes, using three-dimensional motion analysis. RESULTS This meta-analysis included 17 studies with a pooled sample size of 451 participants (227 males, 224 females). Meta-analysis revealed females displayed significantly less peak knee flexion during stance (SMD: 0.374, 95% CI 0.098-0.649, p = 0.008, I2: 0%); greater knee abduction at initial contact (IC) (SMD: 0.687, 95% CI 0.299-1.076, p = 0.001, I2: 55%); less hip internal rotation (SMD: 0.437, 95% CI 0.134-0.741, p = 0.005, I2: 34%) and hip abduction at IC (SMD: -0.454, 95% CI 0.151-0.758, p = 0.003, I2: 33%). No significant differences were observed between males and females for any internal or externally applied KJLs. All retrieved studies failed to control for strength, resistance training or skill history status. CONCLUSION No differences were observed in KJLs between males and females despite females displaying greater knee abduction at IC and less peak knee flexion during the stance phase of CODs, which are visual characteristics of non-contact ACL injury. Further research is required to examine if this translates to a similar injury risk, considering morphological differences in strain characteristics of the ACL between males and females. This observation may in part explain the disproportionate ACL injury incidence in female multidirectional athletes. Further higher quality controlled research is required whereby participants are matched by skill training history, resistance training history and strength status to ensure an appropriate comparison between males and females.
Collapse
Affiliation(s)
- Thomas A Donelon
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK.
| | - Jamie Edwards
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK
| | - Mathew Brown
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK
| | - Paul A Jones
- School of Health Sciences, C702 Allerton Building, University of Salford, Salford, M6 6PU, UK
| | - Jamie O'Driscoll
- Section of Sport Section of Sport, Exercise and Rehabilitation Sciences, School of Human and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1Q, UK
| | - Thomas Dos'Santos
- Department of Sport and Exercise Sciences | Manchester Metropolitan University, 2.01 Institute of Sport, 99 Oxford Road, Manchester, M1 7EL, UK
| |
Collapse
|
2
|
Queiroz NCA, Hamu TCDDS, Barboza SD, Oliveira-Junior SAD, Luiz Carregaro R. Are lower limb symmetry and self-reported symptoms associated with functional and neuromuscular outcomes in Brazilian adults with anterior cruciate ligament reconstruction? A cross-sectional study. J Bodyw Mov Ther 2024; 38:168-174. [PMID: 38763558 DOI: 10.1016/j.jbmt.2023.12.002] [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: 12/28/2021] [Revised: 09/19/2023] [Accepted: 12/12/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION After anterior cruciate ligament (ACL) reconstruction, determining readiness to return to participation is challenging. The understanding of which neuromuscular performance parameters are associated with limb symmetry and self-reported symptoms may be useful to improve monitoring the rehabilitation towards adequate decision-making to return. OBJECTIVES To compare the ACL-operated and injury-free lower limbs regarding functional performance; and to investigate whether lower limb strength and functional performance are associated with self-reported symptoms and functional lower limb symmetry. METHOD Thirty-four participants were included. Functional performance was assessed by using the Y-Balance test, Single-leg Hop, and Functional Movement Screen. An isokinetic dynamometer was used to evaluate the strength levels in open and closed kinetic chains. The functional lower limb symmetry was calculated considering the single-leg hop test results for each lower limb. RESULTS There were no differences in dynamic balance (Y-Balance) between the operated and injury-free limbs. The operated limb presented a worst performance in the single-leg hop. Self-reported symptoms prevalence and lower limb symmetry were associated with knee extension strength and functional performance (Y-Balance). CONCLUSION Individuals submitted to ACL-reconstruction presented worse functional performance in the operated limb compared to the injury-free limb. Both knee strength and dynamic balance were associated with limb symmetry and self-reported symptoms.
Collapse
Affiliation(s)
| | - Tânia Cristina Dias da Silva Hamu
- Physiotherapy Department, Musculoskeletal Research Laboratory (LAPEME), State Universidade Estadual de Goiás (UEG), Goiânia Campus, Brazil
| | - Saulo Delfino Barboza
- Master Program on Health & Education, University of Ribeirao Preto, Sao Paulo, Brazil; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Universities Medical Centers, VU University Medical Center Amsterdam, Amsterdam, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports, Amsterdam Movement Sciences, Amsterdam Universities Medical Centers, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | | | - Rodrigo Luiz Carregaro
- Master in Rehabilitation Sciences, Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| |
Collapse
|
3
|
Posterior hamstring harvest improves aesthetic satisfaction and decreases sensory complications as compared to the classic anterior approach in anterior cruciate ligament reconstruction surgery. J Exp Orthop 2022; 9:109. [PMID: 36326935 PMCID: PMC9633883 DOI: 10.1186/s40634-022-00547-y] [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: 08/31/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose The use of the posterior approach for harvesting hamstring grafts has recently become popular thanks to new all-inside techniques and retrograde drills. This study aims to compare the classic anterior approach with the posterior approach in the popliteal fossa. Methods Retrospective comparative study of 100 consecutive cases of primary ligamentoplasty performed using ipsilateral semitendinosus autograft with at least one year of follow-up. 50 patients with anterior approach (group A) and 50 patients with posterior approach (P). Ratio men/women: 9/1. Mean age: 32 ± 13 years. Mean operative time: 64.88 ± 12.28 min. Study variables Graft harvest time; intraoperative complications (semitendinous [ST] tendon cut); postoperative neurological complications (allodynia, paresthesia, pain) or hematoma in the donor area; atrophy of the operated thigh compared to the contralateral thigh, postoperative VAS score, aesthetic satisfaction and overall satisfaction. Results Graft harvest time of 9.5 min in group A versus 5.25 min in group P (p < 0.05). Sensory complications: 16% in group A versus 2% in group P (p < 0.05). Regarding the patient’s evaluation of the aesthetic result of the surgery, 80% in group A and 92% in group P were very satisfied, 16% in group A and 8% in group P were satisfied and 4% in group A and no patients in group P not very satisfied (p < 0.05). No significant differences were found in terms of total operative time, postoperative joint movement, atrophy of the operated thigh, postoperative VAS, or overall patient satisfaction. Conclusions The posterior approach to harvesting the ipsilateral hamstring graft obtained better results than the anterior approach in terms of aesthetic satisfaction of the patient, lower rate of neurological complications (allodynia, paresthesias and hypoesthesia in the anterior region of the knee and leg) and shorter hamstring harvest time. Level of evidence IV.
Collapse
|
4
|
de Souza Borges JH, Oliveira M, Junior PL, de Souza Machado R, Lima R, Ramos LA, Cohen M. Is contralateral autogenous patellar tendon graft a better choice than ipsilateral for anterior cruciate ligament reconstruction in young sportsmen? A randomized controlled trial. Knee 2022; 36:33-43. [PMID: 35468330 DOI: 10.1016/j.knee.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/09/2022] [Accepted: 03/29/2022] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study was to compare the peak extensor torque (primary outcome), sensory-motor capacity and Lysholm questionnaire score up to the fourth postoperative month post-primary anterior cruciate ligament reconstruction (ACLR) with bone-patellar-tendon-bone (BPTB) graft using either ipsilateral or contralateral technique in young sportsmen. METHODS We performed a randomized controlled trial from 2018 to 2019. The same preoperative protocol, surgical technique and postoperative protocol were used in both groups. Eighty-eight young adult male patients were randomized, and 44 of each group completed the trial. RESULTS After the follow up analysis, the contralateral receptor and donor limb demonstrated a statistically significant increase in peak extension torque compared with the ipsilateral operated limb (effect size (ES) = 0.99, power = 0.99, P < 0.0001; ES = 0.46, power = 0.56, P < 0.04). The symmetry between limbs was compared between groups. In the contralateral group, there was a significant decrease in the recipient limb (after surgery), compared with the donor limb (before surgery) (ES = 0.87, power = 0.99, P < 0.0001). In the ipsilateral group, the operated limb demonstrated a significant decrease in peak extension torque compared with the non-operated limb after surgery (ES = 1.88, power = 0.99, P < 0.0001). The comparison between groups in sensory-motor capacity and Lysholm score demonstrated a non-significant group effect postoperatively. CONCLUSION The use of contralateral BPTB is more effective in increasing peak extension torque when compared with ipsilateral technique in young sportsmen. Furthermore, patients achieved greater symmetry (side to side) in quadriceps muscle performance after the 4-month follow up with a contralateral graft.
Collapse
Affiliation(s)
- Jose Humberto de Souza Borges
- Institute of Research and Teaching, Orthopedic Hospital and Specialized Medicine (IPE - H O M E), Brasília, Distrito Federal, Brazil; Department of Orthopedics, Traumatology and Sports Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
| | - Marcio Oliveira
- Institute of Research and Teaching, Orthopedic Hospital and Specialized Medicine (IPE - H O M E), Brasília, Distrito Federal, Brazil; University Center of Brasília (UniCEUB), Brasília, Distrito Federal, Brazil
| | - Paulo Lobo Junior
- Institute of Research and Teaching, Orthopedic Hospital and Specialized Medicine (IPE - H O M E), Brasília, Distrito Federal, Brazil
| | - Ronny de Souza Machado
- Institute of Research and Teaching, Orthopedic Hospital and Specialized Medicine (IPE - H O M E), Brasília, Distrito Federal, Brazil
| | - Révia Lima
- Institute of Research and Teaching, Orthopedic Hospital and Specialized Medicine (IPE - H O M E), Brasília, Distrito Federal, Brazil
| | - Leonardo Addêo Ramos
- Department of Orthopedics, Traumatology and Sports Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Moises Cohen
- Department of Orthopedics, Traumatology and Sports Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
5
|
Oliveira M, Júnior PL, Imoto AM, Santos T, Borges JHS, Nunes P, Barin FR, Damando M, Peccin MS. Unilateral Versus Bilateral Resistance Exercise in Postoperative Rehabilitation After ACL Reconstruction With Bone-Patellar Tendon-Bone Graft: A Randomized Controlled Trial. Orthop J Sports Med 2022; 10:23259671221088830. [PMID: 35464901 PMCID: PMC9019374 DOI: 10.1177/23259671221088830] [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: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022] Open
Abstract
Background Lower limb muscle strength symmetry has been suggested as an essential criterion for the safe return to sports after anterior cruciate ligament (ACL) reconstruction. Limited evidence is available regarding the most effective intervention to achieve symmetry after reconstruction with contralateral bone-patellar tendon-bone (BPTB) graft. Purpose To verify whether unilateral isotonic resistance exercise is more effective than bilateral exercise for obtaining postoperative functional and muscular strength symmetry between the donor limb and reconstructed limb for patients who received BPTB graft. Study Design Randomized controlled trial; Level of evidence, 1. Methods A total of 88 patients were randomly divided into a control group (n = 44) and an intervention group (n = 44). All participants performed an 8-week exercise program starting at the beginning of the fourth postoperative month and were evaluated before and after the program. The control group performed bilateral exercises, and the intervention group performed unilateral exercises for the donor limb only (the limb with the greatest disability). The primary outcome was muscle strength (peak torque and hamstrings to quadriceps [H:Q] ratio), and the secondary outcomes were range of motion (ROM; goniometry), KT-1000 arthrometer side-to-side difference in anteroposterior knee laxity, and objective (single-leg hop test) and subjective (Lysholm score) functionality. Results Both groups improved significantly from before to after the exercise program. The improvements were significantly greater in the intervention group regarding peak torque, H:Q ratio, flexion ROM, single-leg hop test, and Lysholm score in the donor limb (P < .001 for all), and the improvements were significantly greater in the control group regarding peak torque and single-leg hop test in the reconstructed limb (P < .001 for both). Comparison between the groups showed significantly increased symmetry regarding peak torque, H:Q ratio, and single-leg hop test in the intervention group compared with the control group (P < .001), with large effect sizes (>0.80) except for the H:Q ratio. Conclusion Although postoperative, bilateral, isotonic resistance exercise provided better strength gains to the reconstructed limb, unilateral exercise was more effective in obtaining functional and muscle strength between-limb symmetry in patients who underwent ACL reconstruction with contralateral BPTB graft. Registration Brazilian Registry of Clinical Trials (number RBR-22rnjh).
Collapse
Affiliation(s)
- Marcio Oliveira
- Institute of Research and Teaching, Orthopedic Hospital and
Specialized Medicine/FIFA Medical Centre of Excellence (IPE/HOME), Brasília,
Brazil
- Health Evidence-Based Graduate Program, Universidade Federal de São
Paulo (UNIFESP), São Paulo, Brazil
| | - Paulo Lobo Júnior
- Institute of Research and Teaching, Orthopedic Hospital and
Specialized Medicine/FIFA Medical Centre of Excellence (IPE/HOME), Brasília,
Brazil
| | | | - Tácio Santos
- Institute of Research and Teaching, Orthopedic Hospital and
Specialized Medicine/FIFA Medical Centre of Excellence (IPE/HOME), Brasília,
Brazil
| | - José Humberto Souza Borges
- Institute of Research and Teaching, Orthopedic Hospital and
Specialized Medicine/FIFA Medical Centre of Excellence (IPE/HOME), Brasília,
Brazil
| | - Pedro Nunes
- Institute of Research and Teaching, Orthopedic Hospital and
Specialized Medicine/FIFA Medical Centre of Excellence (IPE/HOME), Brasília,
Brazil
| | - Fabrício Reichert Barin
- Institute of Research and Teaching, Orthopedic Hospital and
Specialized Medicine/FIFA Medical Centre of Excellence (IPE/HOME), Brasília,
Brazil
| | - Meire Damando
- Institute of Research and Teaching, Orthopedic Hospital and
Specialized Medicine/FIFA Medical Centre of Excellence (IPE/HOME), Brasília,
Brazil
| | - Maria Stella Peccin
- Health Evidence-Based Graduate Program, Universidade Federal de São
Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
6
|
Arnold MP, Calcei JG, Vogel N, Magnussen RA, Clatworthy M, Spalding T, Campbell JD, Bergfeld JA, Sherman SL. ACL Study Group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades. Knee Surg Sports Traumatol Arthrosc 2021; 29:3871-3876. [PMID: 33486558 DOI: 10.1007/s00167-021-06443-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/11/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Anterior cruciate ligament reconstruction (ACLR) aims to restore knee function and stability, allowing patients to return to the activities they enjoy and minimize further injury to the meniscus and cartilage and their ultimate progression to osteoarthritis. This study aims to present the evolution of graft choice over the last three decades according to members of the ACL Study Group (SG). METHODS Prior to the January 2020 ACL SG biannual meeting, a survey was administered consisting of 87 questions and 16 categories, including ACLR graft choice. A similar questionnaire has been administered prior to each meeting and survey results from the past 14 meetings (1992 through 2020, excluding 1994) are included in this work. Survey responses are reported as frequencies in percentages to quantify changes in practice over the surgery period. RESULTS In 1992, the most frequent graft choice for primary ACLR was bone-patellar tendon-bone (BTB) autograft, at nearly 90%. Hamstring tendon (HT) autografts have increased in popularity, currently over 50%, followed by just under 40% BTB autograft. Recently, quadriceps tendon (QT) autograft has increased in popularity since 2014. CONCLUSION Autograft (HT, BTB, QT) is an overwhelming favorite for primary ACLR over allograft. The preference for HT autograft increased over the study period relative to BTB autograft, with QT autograft gaining in popularity in recent years. Graft selection should be individualized for each patient and understanding the global trends in graft choice can help orthopaedic surgeons discuss graft options with their patients and determine the appropriate graft for each case. LEVEL OF EVIDENCE Level V, Expert Opinion.
Collapse
Affiliation(s)
- Markus P Arnold
- Practice LEONARDO, Hirslanden Clinic Birshof, Münchenstein, Switzerland
| | - Jacob G Calcei
- Department of Orthopaedic Surgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Nicole Vogel
- Practice LEONARDO, Hirslanden Clinic Birshof, Münchenstein, Switzerland
| | - Robert A Magnussen
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA
| | - Mark Clatworthy
- Department of Orthopaedics, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | - Tim Spalding
- Department of Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - John D Campbell
- Bridger Orthopedics and Sports Medicine, PC, Montana State University, Bozeman, MT, USA
| | - John A Bergfeld
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
| | | |
Collapse
|
7
|
Sherman SL, Calcei J, Ray T, Magnussen RA, Musahl V, Kaeding CC, Clatworthy M, Bergfeld JA, Arnold MP. ACL Study Group presents the global trends in ACL reconstruction: biennial survey of the ACL Study Group. J ISAKOS 2021; 6:322-328. [PMID: 34272329 DOI: 10.1136/jisakos-2020-000567] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The primary objective of this survey was to gauge the current global trends in anterior cruciate ligament reconstruction (ACLR) as reported by the members of the Anterior Cruciate Ligament (ACL) Study Group (SG). METHODS A survey was created and distributed among the members of the ACL SG consisting of 87 questions and 16 categories related to ACLR, including member demographics, preoperative management, primary ACLR techniques and graft choice, use of concomitant procedures and biological augmentation, postoperative rehabilitation, and more. RESULTS The survey was completed by the 140 members of the ACL SG. Fifty per cent of members are from Europe, 29% from the USA, 15% from the Asia-Pacific and the remaining 6% are from Latin America, the Middle East, New Zealand and Africa. Most (92%) do not believe there is a role for non-operative management of ACL tears in higher level athletes; conversely, most agree there is a role for non-operative management in lower impact athletes (92%). A single-bundle (90%) technique with hamstring autograft (53%) were most common for primary ACLR. Tunnel position varied among respondents. Sixty-one per cent do not use allograft for primary ACLR. Fifty per cent of respondents use cortical suspensory fixation on the femur, with variable responses on the tibia. Most (79%) do not use biologics in primary ACLR, while 83% think there is a selective role for extra-articular augmentation in primary ACLR. Fifty per cent prefer bone-tendon-bone autograft for revision ACLR and extra-articular augmentation is more commonly used (13% always, 26% often) than in primary ACLR (0% always, 15% often). A majority (53%) use a brace after primary ACLR. The most common responses for minimal time to return to play after primary ACLR were 6-8 months (44%) and 8-12 months (41%). CONCLUSION We presented the thoughts and preferences of the ACL SG on the management of ACL injuries. This survey will help to facilitate an ongoing discussion with regard to ACLR by providing global insights into the current surgical trends in ACLR. LEVEL OF EVIDENCE Level V, Expert Opinion.
Collapse
Affiliation(s)
- Seth L Sherman
- Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Jacob Calcei
- Orthopaedic Surgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
| | - Taylor Ray
- Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | | | - Volker Musahl
- Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - John A Bergfeld
- Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Marcus P Arnold
- Orthopaedics, Practice LEONARDO, Hirslanden Clinic Birshot, Münchenstein, Switzerland
| |
Collapse
|
8
|
Stoelben KJV, Pappas E, Mota CB. Lower extremity joint moments throughout gait at two speeds more than 4 years after ACL reconstruction. Gait Posture 2019; 70:347-354. [PMID: 30952108 DOI: 10.1016/j.gaitpost.2019.02.025] [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: 10/24/2018] [Revised: 01/06/2019] [Accepted: 02/25/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Long-term gait adaptations after anterior cruciate ligament reconstruction (ACLR) have been reported. However, it is still unclear if they persist more than 4 years after surgery and if they are affected by gait speed. RESEARCH QUESTION To investigate differences between groups, legs and walking speeds for ankle, knee and hip joint moments in three planes throughout the stance phase of gait. METHODS Reconstructed participants (n = 20 males, 32.5 years, 5.5 years post-ACLR) and healthy controls (n = 20 males, 30.6 years) took part in the study. Gait analysis was performed in two different speeds (self-selected and 30% faster). Sagittal, frontal and transverse plane external moments were measured for ankle, knee and hip and compared throughout the stance phase using 95% confidence intervals. Significant differences were established as a consecutive 5% of gait cycle in which 95% confidence interval did not overlap. RESULTS The reconstructed leg did not demonstrate higher joint moments; there were largely no differences while there was lower knee external rotation moment compared to the non-preferred leg of the control group. Higher joint moments were observed during fast speed walking on sagittal plane for knee and hip moments in both groups, and in the frontal and transverse plane for ankle moments. SIGNIFICANCE Gait kinetics appear to be largely normalized at a minimum of 4 years after ACLR. Faster walking speed increase lower extremity joint moments.
Collapse
Affiliation(s)
- Karine Josibel Velasques Stoelben
- Federal University of Pampa - Laboratory of Applied Neuromechanics, BR 472 km 592 - Po box 118 - ZIP 97500-970, Uruguaiana, RS, Brazil.
| | - Evangelos Pappas
- The University of Sydney, Faculty of Health Sciences, 75 East str, Lidcombe, NSW 2141, Australia.
| | - Carlos Bolli Mota
- Federal University of Santa Maria, Laboratory of Biomechanics, 1000 Roraima Avenue, building 51, room 1007, ZIP: 97105-900, Santa Maria, RS, Brazil.
| |
Collapse
|
9
|
Costa LA, Foni NO, Antonioli E, Teixeira de Carvalho R, Paião ID, Lenza M, Ferretti M. Analysis of 500 anterior cruciate ligament reconstructions from a private institutional register. PLoS One 2018; 13:e0191414. [PMID: 29351558 PMCID: PMC5774771 DOI: 10.1371/journal.pone.0191414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/04/2018] [Indexed: 01/13/2023] Open
Abstract
Purpose The aims of this study are to describe the epidemiological characteristics of anterior cruciate ligament reconstructions in a private hospital in Brazil and to determine trends in medical practice for comparison with previous studies. Methods We retrospectively reviewed the anterior cruciate ligament institutional register to obtain data from all patients who underwent primary anterior cruciate ligament reconstruction from July 2014 to June 2016. Descriptive statistics were used to summarize the sample. Specific statistical tests were used to assess associations between the meniscal lesion and other variables. Results During the study period, 72.6% out of 500 patients were male. The mean age at surgery was 35.1 years. The mean age was higher among females than among males (37.3 ± 12.1 vs 34.3 ± 10.8 years). The median time from injury to surgery was 44 days. The most common femoral and tibial fixations used were suspensory fixation (60.8%) and interference screw (96%), respectively. The most commonly used graft was hamstring tendon (70.2%), followed by bone-patellar tendon-bone (28.8%). A meniscal lesion was noted in 44.8% of cases. Partial meniscectomy was performed in 69.5% of meniscal lesions, and meniscal repair was performed in 14.1% of lesions. The mean length of hospital stay was 1.4 days. The proportion of men in the group of patients with an associated meniscal lesion was higher than that in the group of patients without a meniscal lesion (p = 0.007). Conclusions In this study, we identified that the vast majority of surgeries were performed in male patients in all age groups, and patients older than 30 years and with a short time from injury to surgery predominated. Concerning surgical technique, we noted a low rate of meniscal repair and a higher preference for the use of hamstring graft and suspensory fixation on the femoral side.
Collapse
Affiliation(s)
| | | | - Eliane Antonioli
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | | | - Mário Lenza
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Mário Ferretti
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- * E-mail:
| |
Collapse
|
10
|
Ferrari D, Lopes TJA, França PFA, Azevedo FM, Pappas E. Outpatient versus inpatient anterior cruciate ligament reconstruction: A systematic review with meta-analysis. Knee 2017; 24:197-206. [PMID: 28117216 DOI: 10.1016/j.knee.2017.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/27/2016] [Accepted: 01/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Efforts to reduce the financial costs related to anterior cruciate ligament reconstruction (ACLR) include reducing the length of hospitalization of the patient undergoing ACLR. However, it is unclear if inpatient and outpatient ACLR differ in terms of safety, satisfaction, costs and clinical outcomes. AIM To systematically review and synthesize the literature that directly compared costs and outcomes after outpatient and inpatient ACLR. METHODS Studies that directly compared outcomes of inpatient and outpatient ACLR were retrieved via searches in MEDLINE, EMBASE, CINAHL, AMED, Cochrane, SPORTDiscus, Web of Science and SCOPUS databases. Random effects meta-analysis and descriptive analysis were performed for relevant outcomes. RESULTS Costs analysis suggests that outpatient ACLR may be a cost effective procedure with savings ranging from $1371 to $7390. There were no differences for systemic and local complications p=0.64 (odds ratio 1.65, 95% confidence interval 0.20 to 13.49) and p=0.72 (0.81, 0.26 to 2.56) respectively, or pain in the second and seventh days after surgery, p=0.78 (mean difference -0.16; 95% confidence interval -1.28 to 0.96) and p=0.44 (0.48, -0.75 to 1.71), respectively. However, the outpatient group had less pain than the inpatient group in the first and third days after surgery, p=0.0001 (-0.39, -0.57 to -0.21) and p=0.0001(-0.39, -0.39 to -0.20), respectively. Descriptive analysis revealed that the outpatient group experienced similar or better satisfaction, strength and knee function compared to the inpatient group. CONCLUSION AND KEY FINDINGS Complications, pain, satisfaction, knee function and strength are similar or better after outpatient compared to inpatient ACLR. Furthermore, cost savings may be achieved with outpatient ACLR. However, included studies presented low methodological quality and the quality of evidence was very low, so these results need to be confirmed by future studies. REGISTRATION NUMBER PROSPERO (CRD42015024990).
Collapse
Affiliation(s)
- Deisi Ferrari
- University of São Paulo, Post-Graduation Program Interunits Bioengineering EESC/FMRP/IQSC-USP, São Carlos, Brazil; CAPES Foundation, Ministry of Education of Brazil, Brasília, DF 70.040-020, Brazil.
| | - Thiago J A Lopes
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia; Research Laboratory of Exercise Science, The Brazilian Navy, Rio de Janeiro, Brazil.
| | - Paulo F A França
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Fábio M Azevedo
- University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil.
| | - Evangelos Pappas
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| |
Collapse
|