1
|
Girard CI, Romanchuk NJ, Del Bel MJ, Carsen S, Chan ADC, Benoit DL. Classifiers of anterior cruciate ligament status in female and male adolescents using return-to-activity criteria. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39344772 DOI: 10.1002/ksa.12462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 08/21/2024] [Accepted: 08/28/2024] [Indexed: 10/01/2024]
Abstract
PURPOSE A lack of standardization exists for functional tasks in return-to-activity (RTA) guidelines for adolescents with anterior cruciate ligament injury (ACLi). Identifying the variables that discern ACLi status among adolescents is a first step in the creation of such guidelines following surgical reconstruction. This study investigated the use of classification models to discern ACLi status of adolescents with and without injury using spatiotemporal variables from functional tasks typically used in RTA guidelines for adults. METHODS Sixty-four adolescents with ACLi and 70 uninjured adolescents completed single-limb hops, lunges, squats, countermovement jumps and drop-vertical jumps. Jumping distances, heights, and depths were collected. Decision trees (DTs) were used to classify ACLi status and were evaluated using the F-measure (F1), kappa statistic (ĸ) and area under the precision-recall curve (PRC). Independent t tests and effect sizes were calculated for each important classifier of the DT models. RESULTS A five-variable model classified ACLi status with an accuracy of 67.5% (F1 = 0.6842; ĸ = 0.350; PRC = 0.491) with sex as a classifier. Significant differences were found in three of the four spatiotemporal variables (p ≤ 0.002). Separate models then classified ACLi status in males and females with an accuracy of 53.3% (F1 = 0.5882; ĸ = 0.0541; PRC = 0.476) and 76.9% (F1 = 0.7692; ĸ = 0.541; PRC = 0.528), respectively, with significant differences for all variables (p ≤ 0.013). CONCLUSIONS Among the DT models, females were better able to classify ACLi status compared to males, highlighting the importance of sex-specific rehabilitation guidelines for adolescents. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Céline I Girard
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa-Carleton Institute of Biomedical Engineering, Ottawa, Ontario, Canada
| | - Nicholas J Romanchuk
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa-Carleton Institute of Biomedical Engineering, Ottawa, Ontario, Canada
| | - Michael J Del Bel
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, CHEO, Ottawa, Ontario, Canada
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Adrian D C Chan
- Ottawa-Carleton Institute of Biomedical Engineering, Ottawa, Ontario, Canada
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel L Benoit
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
2
|
Paschos NK, Reikersdorfer K, Jayne C, McGauley C, Brodeur J, Medina G, Cote M. Revision Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Patients Yields Low Rates of Graft Failure and Good Functional Scores, but Low Rates of Return to Sport: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00612-1. [PMID: 39209072 DOI: 10.1016/j.arthro.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE To evaluate outcomes after revision anterior cruciate ligament reconstruction (ACLR) in pediatric and adolescent patients in terms of graft failure rate and functional patient outcomes. METHODS A systematic review of Cochrane, Embase, Scopus, Ovid, and PubMed databases was performed for all original clinical studies that reported outcomes of pediatric and adolescent patients undergoing revision ACLR. Non-English studies and studies not reporting both graft failure rates and an additional outcome measure were excluded. We evaluated patient demographics, injury mechanisms, surgical technique characteristics, concomitant injuries, failure rates, patient-reported outcome measures (PROMs), complications, and return to sports rates. Risk of bias (ROB) was assessed with the methodological index for nonrandomized studies (MINORS). RESULTS Five studies with a total of 239 knees in 234 patients were included. Failure of the revision ACLR ranged from 9% to 21%. Return to previous level of activity ranged between 27% and 68%. PROMs were variable, with good Lysholm Knee Scoring Scale score (range 84.5-93.7), moderate Tegner Activity Score (range 5.5-9.0), and good International Knee Documentation Committee knee scores (range 79.9-80.0). Allograft was used in 48% of revisions, followed by bone patellar tendon bone autograft in 34%, and hamstrings (HS) autograft in 14%. Meniscus injury and cartilage injury was present in 53.1% to 92.5% and 5.5% to 59.4% of knees, respectively. Gwet's AC1 coefficient was 0.89, indicating a high degree of interrater reliability. The average MINORS score was 6, and heterogeneity was low (I2 = 9%). The included studies did not present with sufficient detail to disaggregate clinical outcomes by patient sex. CONCLUSIONS Revision ACLR yields a graft failure ranging from 9 to 20%. Revision patients experience good PROMs but low rates of return to preinjury level of sport. Further, revision ACLR was associated with high rates of intra-articular damage and relatively low rates of meniscal repair at the time of second surgery. LEVEL OF EVIDENCE Level IV, systematic review of level IV evidence.
Collapse
Affiliation(s)
- Nikolaos K Paschos
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, U.S.A..
| | - Kristen Reikersdorfer
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Christopher Jayne
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, St. Joseph's/Alpine Orthopaedics, Stockton, California, U.S.A
| | - Colleen McGauley
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Jon Brodeur
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Giovanna Medina
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Mark Cote
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| |
Collapse
|
3
|
Alonso-Hernández J, Galán-Olleros M, Miranda-Gorozarri C, Cabello Blanco J, Garlito-Díaz H, Manzarbeitia-Arroba P, Araúz De Robles S. Transphyseal arthroscopic anterior cruciate ligament reconstruction in children under 12 years. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05497-x. [PMID: 39174765 DOI: 10.1007/s00402-024-05497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 08/14/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) injuries in children is on the rise. Despite this trend, the optimal management of these injuries remains a matter of ongoing debate. In this light, our study seeks to assess the clinical, radiological, and functional outcomes of transphyseal ACL reconstruction in preadolescent patients in the medium-term. METHODS This prospective study included preadolescent patients aged up to 12 years who underwent ACL transphyseal reconstruction between 2010 and 2020 and had a minimum follow-up of 2 years. Clinical assessments encompassed joint stability and range of motion. Furthermore, leg length discrepancy (LLD) and femorotibial alignment were evaluated both clinically and radiologically using full-length lower limb standing radiographs. Pre- and postoperative functional outcomes were assessed using the International Knee Documentation Committee (IKDC) and Lysholm scales, and the return to normal sports activity was evaluated using the ACL-Return to Sport after Injury (ACL-RSI) scale. Complications and relevant follow-up data were also recorded. Statistical analyses were conducted to evaluate these outcomes. RESULTS A total of 35 preadolescent patients, consisting of 24 males and 11 females, with a mean age at surgery of 11.2 ± 0.7 years (8.7-12), were included in the study. The mean follow-up was 52.3 ± 20.7 months (24.1-95.9). No significant growth disturbances or clinically relevant LLD were evidenced. All patients demonstrated clinically stable knees with full range of motion at the 2-year follow-up. There were statistically significant improvements in pre- and postoperative IKDC (39.3 ± 13.5 vs. 99.7 ± 0.8, p < 0.005) and Lysholm scores (48.2 ± 15.1 vs. 99.6 ± 1.4, p < 0.005). All but two patients were able to return to their pre-injury level of sports activity, with a mean ACL-RSI score of 93.5 ± 1.3. The analysis revealed an 8.6% rerupture rate and an 11.4% rate of contralateral ACL injuries, with 5-year survival rates of 92.3% and 88.8%, respectively. Subgroup analyses based on age, gender, surgical delay, or associated meniscal lesions did not reveal any significant differences in functional outcomes. Additionally, there was no discernible relationship between age or timing of ACL reconstruction and the risk of meniscal injuries. CONCLUSIONS Our study reinforces the value of ACL reconstruction in skeletally immature preadolescent patients, with transphyseal technique proven to be a safe, effective, and technically simpler option, even for children under the age of 12. The findings indicate excellent functional outcomes, a high rate of successful return to sporting activities, and minimal to no incidence of growth-related complications in the medium-term. LEVEL OF EVIDENCE Level II, prospective comparative cohort study, before and after intervention.
Collapse
Affiliation(s)
- Javier Alonso-Hernández
- Pediatric Orthopaedic Unit, Clínica CEMTRO, Av. Ventisquero de la Condesa 42, Madrid, 28035, Spain
- Pediatric Orthopaedic, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - María Galán-Olleros
- Pediatric Orthopaedic Unit, Clínica CEMTRO, Av. Ventisquero de la Condesa 42, Madrid, 28035, Spain.
- Pediatric Orthopaedic, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - Carlos Miranda-Gorozarri
- Pediatric Orthopaedic Unit, Clínica CEMTRO, Av. Ventisquero de la Condesa 42, Madrid, 28035, Spain
- Pediatric Orthopaedic, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Juan Cabello Blanco
- Pediatric Orthopaedic Unit, Clínica CEMTRO, Av. Ventisquero de la Condesa 42, Madrid, 28035, Spain
- Pediatric Orthopaedic, Orthopaedic Surgery and Traumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Hugo Garlito-Díaz
- Pediatric Orthopaedic Unit, Clínica CEMTRO, Av. Ventisquero de la Condesa 42, Madrid, 28035, Spain
- Pediatric Orthopaedic, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Paloma Manzarbeitia-Arroba
- Pediatric Orthopaedic Unit, Clínica CEMTRO, Av. Ventisquero de la Condesa 42, Madrid, 28035, Spain
- Pediatric Orthopaedic, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | |
Collapse
|
4
|
Hays TR, Barnum MS, Levy BA. Editorial Commentary: Combined Anterior Cruciate Ligament/Medial Collateral Ligament Injuries: Surgeons Should Have a Low Threshold to Operate on the Medial Collateral Ligament. Arthroscopy 2024:S0749-8063(24)00500-0. [PMID: 39033983 DOI: 10.1016/j.arthro.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/23/2024]
Abstract
Combined anterior cruciate ligament/medial collateral ligament (ACL/MCL) injuries are relatively common, and multiple factors are involved in surgical decision-making, particularly when it comes to the MCL. Historically, most surgeons treated the MCL conservatively and performed staged MCL reconstruction after MCL reconstruction only if there was persistent medial instability. This was followed by a nonoperative approach for the MCL (when reconstructing the ACL) unless there was evidence of extreme (grade III or >1 cm) valgus instability, valgus malalignment, or mid-substance or tibial-sided injury, avulsion, or Stener lesion. However, the most recent research demonstrates that combined ACL/MCL injuries present a higher risk of ACL reconstruction failure and subsequent revision compared to ACL injuries alone. With growing biomechanical and clinical evidence, more surgeons are repairing or reconstructing the MCL in these combined injuries. Although there is no clear consensus, we recommend surgeons consider surgically treating the MCL to avoid not only excessive force on the ACL graft but also persistent valgus laxity, which can lead to ACL failure. For distal MCL avulsions, repairs have shown excellent midterm outcomes, especially if the tissue quality is pristine. If the tissue quality is not repairable, then we would advocate for repairing whatever tissue is repairable and augmenting with an MCL reconstruction. For mid-substance MCL injuries, if surgical intervention is required, we advocate for MCL reconstruction. For proximal tears, the same criteria used for distal tears apply with management based on tissue quality and joint stability after repair. The ACL is a secondary stabilizer to valgus loads, and MCL deficiency results in tremendous strain on ACL graft reconstructions. If the MCL is even mildly incompetent, we strongly advocate for treating the MCL surgically in this setting.
Collapse
|
5
|
Quinn M, Lemme N, Morrissey P, Fadale P, Owens BD. An Update on Emerging Techniques and Considerations in Revision Anterior Cruciate Ligament Reconstruction. JBJS Rev 2024; 12:01874474-202407000-00007. [PMID: 39018384 DOI: 10.2106/jbjs.rvw.24.00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
» The rate of primary anterior cruciate ligament reconstruction (ACLR) failure in at-risk populations remains unacceptably high and necessitates thorough evaluation of native alignment and concomitant injuries.» Posterior tibial slope of >12° is a substantial risk factor of ACLR failure and should be corrected through anterior closing wedge osteotomy.» Varus malalignment of >5° exacerbates stress on the ACL graft, increases ACLR failure risks, and should be considered for correction through high tibial osteotomy at the time of revision ACLR.» Injuries to the anterolateral ligamentous complex are prevalent in ACL ruptures, and high-risk patients have shown benefit from anterolateral ligament reconstruction or lateral extra-articular tenodesis in the revision setting.» Addressing posterolateral corner, collateral ligament, and meniscal injuries, during revision ACLR, is vital to mitigate increased graft forces and optimize knee stability and functional outcomes.
Collapse
Affiliation(s)
- Matthew Quinn
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | | | | | | |
Collapse
|
6
|
Bixby EC, Heyworth BE. Management of Anterior Cruciate Ligament Tears in Skeletally Immature Patients. Curr Rev Musculoskelet Med 2024; 17:258-272. [PMID: 38639870 PMCID: PMC11156825 DOI: 10.1007/s12178-024-09897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament (ALC) tears are increasingly common in skeletally immature patients, as more children and adolescents participate in intensive sports training and specialization at increasingly younger ages. These injuries were historically treated nonoperatively, given concerns for physeal damage and subsequent growth disturbances after traditional ACL reconstruction techniques. However, there is now sufficient data to suggest superior outcomes with operative treatment, specifically with physeal-sparing and physeal-respecting techniques. This article reviews considerations of skeletal maturity in patients with ACL tears, then discusses surgical techniques, with a focus on their unique indications and outcomes. Additional surgical adjuncts and components of postoperative rehabilitation, which may reduce retear rates, are also considered. RECENT FINDINGS Current research shows favorable patient-reported outcomes and high return-to-sport rates after ACL reconstruction in skeletally immature patients. Graft rupture (ACL retear) rates are low, but notably higher than in most adult populations. Historically, there has been insufficient research to comprehensively compare reconstruction techniques used in this patient population. However, thoughtful systematic reviews and multicenter prospective studies are emerging to address this deficit. Also, more recent data suggests the addition of lateral extra-articular procedures and stringent return-to-sports testing may lower retear rates. Physeal-sparing and physeal-respecting ACL reconstructions result in stabilization of the knee, while respecting the growth remaining in children or skeletally immature adolescents. Future research will be essential to compare these techniques, given that more than one may be appropriate for patients of a specific age and skeletal maturity.
Collapse
Affiliation(s)
- Elise C Bixby
- Department of Sports Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Benton E Heyworth
- Department of Sports Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| |
Collapse
|
7
|
Dadoo S, Herman ZJ, Nazzal EM, Drain NP, Finger L, Reddy RP, Miller L, Lesniak BP, Musahl V, Hughes JD. Outcomes After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon in Adolescent Athletes at Mean Follow-up of 4 Years. Orthop J Sports Med 2024; 12:23259671241254795. [PMID: 39100218 PMCID: PMC11295237 DOI: 10.1177/23259671241254795] [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: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 08/06/2024] Open
Abstract
Background Despite increasing use of quadriceps tendon (QT) autograft in anterior cruciate ligament (ACL) reconstruction (ACLR), limited data exist regarding its outcomes in high-risk adolescent athletes. Purpose To (1) report the outcomes after QT ACLR in adolescent athletes and (2) identify patient-related and surgery-related factors that may influence failure rates after QT ACLR. Study Design Case series; Level of evidence, 4. Methods All patients aged 14 to 17 years who underwent primary anatomic, transphyseal, single-bundle QT ACLR between 2010 and 2021 with a minimum 2-year follow-up were included for analysis. Demographic and surgical data as well as preoperative International Knee Documentation Committee (IKDC) and Marx activity scores were collected retrospectively. All patients were also contacted to assess postoperative patient-reported outcomes (PROs), including IKDC and Marx activity scores, and return-to-sports (RTS) data. Outcomes of interest included rates of revision ACLR and ipsilateral complications, contralateral ACL tears, difference in pre- and postoperative PROs, and rates of RTS. Patient and surgical characteristics were compared between groups who required revision ACLR versus those who did not. Results A total of 162 patients met inclusion criteria, of which 89 adolescent athletes (mean age 16.2 ± 1.1 years, 64% female) were included for analysis at mean follow-up of 4.0 years. Postoperative IKDC scores were significantly higher than preoperative scores (88.5 vs 37.5; P < .001), whereas Marx activity scores decreased postoperatively (14.3 vs 12.2; P = .011). Successful RTS occurred in 80% of patients at a mean time of 9.7 ± 6.9 months, and 85% of these patients returned to the same or higher level of sports. The most common reasons for failure to RTS included lack of time (n = 7, 70%) and fearing reinjury in the operative knee (n = 5, 50%). The overall revision ACLR rate was 10% (n = 9), and contralateral ACL tears occurred in 14% (n = 12) of patients. The overall ipsilateral knee reoperation rate was 22.5% (n = 20). No statistically significant differences in patient or surgical characteristics were observed between patients who underwent revision ACLR and those who did not. Conclusion At a minimum 2-year follow-up after QT ACLR, adolescent athletes experienced significantly improved postoperative IKDC scores, high rates of RTS, and low rates of graft failure, despite a relatively high ipsilateral reoperation rate. Surgeons may utilize this information when identifying the optimal graft choice for adolescent athletes who have sustained an ACL injury and wish to return to high level of sporting activities.
Collapse
Affiliation(s)
- Sahil Dadoo
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zachary J. Herman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ehab M. Nazzal
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nicholas P. Drain
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Logan Finger
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rajiv P. Reddy
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Liane Miller
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bryson P. Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jonathan D. Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
8
|
Lundgaard-Nielsen M, Herzog RB, Warming S, Rathcke MW, Magnusson SP, Krogsgaard MR. Good physical function but reduced quality of life in children 3 years after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2024; 32:1725-1733. [PMID: 38666741 DOI: 10.1002/ksa.12211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/30/2024] [Accepted: 04/09/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE To assess children's physical function and subjective knee status 1 and 3 years after anterior cruciate ligament (ACL) reconstruction. It was hypothesised that there was no difference between the operated and normal legs in relation to physical strength and function, that there was <-2 mm side-to-side difference in knee laxity, and that the subjective knee function was better 3 years after ACL reconstruction compared to 1 year after. METHODS Children (<16 years of age) who had an ACL reconstruction had follow-up with physical function tests (four hop tests and strength measurement in a power rig [PR]), anterior knee laxity (measured using a Rolimeter) and patient-reported outcome measures (Pedi-International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]-Child) 1 and 3 years postoperatively. Changes from 1- to 3-year follow-up were evaluated with a paired t test. RESULTS Out of 148 ACL reconstructed children, 60 had all measures. The four hop tests and the PR all yielded a Limb Symmetry Index >90% at both follow-ups. There was a significant improvement from 1- to 3-year follow-up in two-hop tests (6 m on time and crossover hop). Side-to-side knee laxity was >2 mm in four children at 1- and 3-year tests. Pedi-IKDC scores increased, and KOOS-Child improved significantly from 1 to 3 years in two of the five domains: 'Sport' and 'Quality of life', but scores were lower than in a cohort of normal children. CONCLUSION The children had good objective physical function 1 and 3 years after ACL reconstruction. However, scores from the KOOS-Child sport-specific function and quality of life domains were lower than in normal children. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Mathilde Lundgaard-Nielsen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Robert Bennike Herzog
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Susan Warming
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Martin Wyman Rathcke
- Section for Sports Traumatology M51, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Stig Peter Magnusson
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Rindom Krogsgaard
- Section for Sports Traumatology M51, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
9
|
Ramachandran AK, Pedley JS, Moeskops S, Oliver JL, Myer GD, Lloyd RS. Changes in Lower Limb Biomechanics Across Various Stages of Maturation and Implications for ACL Injury Risk in Female Athletes: a Systematic Review. Sports Med 2024; 54:1851-1876. [PMID: 38671176 PMCID: PMC11257789 DOI: 10.1007/s40279-024-02022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Female athletes are four to six times more likely to sustain an anterior cruciate ligament (ACL) injury than male athletes. Jump-landing biomechanics are influenced by maturation, with post-pubertal female athletes at a heightened risk of ACL injuries. OBJECTIVE The aim of our systematic review was to identify and summarise the current evidence regarding the changes in kinematic and kinetic risk factors associated with ACL injuries during jump-landing tasks in female athletes at various stages of maturity. METHODS A systematic search was conducted in PubMed, CINAHL, Web of Science, SPORTDiscus, EMBASE and Scopus. Articles were included if they: (1) conducted the research on uninjured female athletes with no restriction on playing level/experience; (2) provided information regarding the stage of the maturity and the scale used for estimating the maturity status of the participants; and (3) reported a biomechanical risk factor associated with ACL injuries during jump-landing tasks across at least two different maturity groups (e.g. pre-pubertal vs post-pubertal). RESULTS Sixteen articles involving 2323 female athletes were included in our review. A total of 12 kinematic and 8 kinetic variables were identified across these studies. Of the 12 kinematic variables reported in our review, we found strong evidence for higher peak knee abduction angle in post-pubertal female individuals compared with pre-pubertal girls (p < 0.05). With regard to the 8 kinetic variables, we found strong evidence for lower relative peak vertical ground reaction force, higher external knee abduction moment and internal rotation moment in post-pubertal compared with pre-pubertal athletes. The strength of evidence for the remaining kinematic and kinetic variables ranged from conflicting to moderate and, in some instances, could not be determined. CONCLUSIONS Our study provides an overview of the changes in biomechanical risk factors in female athletes during jump-landing tasks at various stages of maturity. We found moderate-to-limited evidence for most kinematic and kinetic variables, highlighting the need for further research.
Collapse
Affiliation(s)
- Akhilesh Kumar Ramachandran
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK.
| | - Jason S Pedley
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
| | - Sylvia Moeskops
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
| | - Jon L Oliver
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
- Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
| | - Gregory D Myer
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Rhodri S Lloyd
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
- Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
- Centre for Sport Science and Human Performance, Waikato Institute of Technology, Hamilton, New Zealand
| |
Collapse
|
10
|
Dastgerdi AK, Esrafilian A, Carty CP, Nasseri A, Barzan M, Korhonen RK, Astori I, Hall W, Saxby DJ. Sensitivity analysis of paediatric knee kinematics to the graft surgical parameters during anterior cruciate ligament reconstruction: A sequentially linked neuromusculoskeletal-finite element analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 248:108132. [PMID: 38503071 DOI: 10.1016/j.cmpb.2024.108132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/26/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND AND OBJECTIVE Incidence of paediatric anterior cruciate ligament (ACL) rupture has increased substantially over recent decades. Following ACL rupture, ACL reconstruction (ACLR) surgery is typically performed to restore passive knee stability. This surgery involves replacing the failed ACL with a graft, however, surgeons must select from range of surgical parameters (e.g., type, size, insertion, and pre-tension) with no robust evidence guiding these decisions. This study presents a systemmatic computational approach to study effects of surgical parameter variation on kinematics of paediatric knees. METHODS This study used sequentially-linked neuromusculoskeletal (NMSK) finite element (FE) models of three paediatric knees to estimate the: (i) sensitivity of post-operative knee kinematics to four surgical parameters (type, size, insertion, and pre-tension) through multi-input multi-output sensitivity analysis; (ii) influence of motion and loading conditions throughout stance phase of walking gait on sensitivity indices; and (iii) influence of subject-specific anatomy (i.e., knee size) on sensitivivty indices. A previously validated FE model of the intact knee for each subject served as a reference against which ACLR knee kinematics were compared. RESULTS Sensitivity analyses revealed significant influences of surgical parameters on ACLR knee kinematics, albeit without discernible trend favouring any one parameter. Graft size and pre-tension were primary drivers of variation in knee translations and rotations, however, their effects fluctuated across stance indicating motion and loading conditions affect system sensitivity to surgical parameters. Importantly, the sensitivity of knee kinematics to surgical parameter varied across subjects, indicating geometry (i.e., knee size) influenced system sensitivity. Notably, alterations in graft parameters yielded substantial effects on kinematics (normalized root-mean-square-error > 10 %) compared to intact knee models, indicating surgical parameters vary post-operative knee kinematics. CONCLUSIONS Overall, this initial study highlights the importance of surgical parameter selection on post-operative kinematics in the paediatric ACLR knee, and provides evidence of the need for personalized surgical planning to ultimately enhance patient outcomes.
Collapse
Affiliation(s)
- Ayda Karimi Dastgerdi
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia.
| | - Amir Esrafilian
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Christopher P Carty
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia; Department of Orthopedics, Children's Health Queensland Hospital and Health Service, QLD, Australia
| | - Azadeh Nasseri
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia
| | - Martina Barzan
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Ivan Astori
- Department of Orthopedics, Children's Health Queensland Hospital and Health Service, QLD, Australia
| | - Wayne Hall
- School of Engineering and Built Environment, Mechanical Engineering and Industrial Design, Griffith University, Gold Coast, QLD, Australia
| | - David John Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia
| |
Collapse
|
11
|
Butler L, Greenberg E, Giampetruzzi N, Link M, Prati V, Weaver A, Saper M. Comparison of physical therapy utilization, timing of return-to-sport test completion, and hop test performance by age and between sexes in youth athletes after anterior cruciate ligament reconstruction. Phys Ther Sport 2024; 67:1-6. [PMID: 38387378 DOI: 10.1016/j.ptsp.2024.02.004] [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: 10/24/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To compare physical therapy (PT) utilization, timing of return-to-sport (RTS) test and hop test performance by age and between sexes in youth after anterior cruciate ligament reconstruction (ACLR). DESIGN Multicenter retrospective cohort. METHODS A retrospective review of adolescents after primary ACLR was conducted. Participants completed return-to-sport (RTS) tests including single-legged hop testing. PT frequency, average weekly visits, and timing of RTS test were calculated. T-tests assessed the effect of age and sex on average weekly PT visits and multivariable logistic regressions assessed odds of passing hop tests. RESULTS 289 participants were included (15.7 ± 1.9 years). There was no difference in average weekly PT visits (p = 0.321) or time to RTS test (p = 0.162) by age. There were significant differences in average weekly PT visits (p = 0.047) and mean time from surgery to RTS test (p = 0.048) between sexes with small effect sizes (d = 0.24 and d = 0.21, respectively). Age and sex had no effect on odds of passing hop tests (OR, 1.29; 95% CI, 0.71-2.35 and OR, 0.79; 95%CI, 0.43-1.45, respectively). CONCLUSION In a youth cohort, age and sex may have no clinically important effect on PT visit utilization, timing of RTS test or hop test performance.
Collapse
Affiliation(s)
- Lauren Butler
- Florida International University, Miami, FL, USA; Nicklaus Children's Hospital, Miami, FL, USA.
| | | | | | - Meredith Link
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Victor Prati
- Arkansas Children's Hospital, Little Rock, AR, USA
| | - Adam Weaver
- Connecticut Children's Medical Center, Hartford, CT, USA
| | | |
Collapse
|
12
|
Lorange JP, Senécal L, Moisan P, Nault ML. Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review of the Criteria. Am J Sports Med 2024; 52:1641-1651. [PMID: 38299217 DOI: 10.1177/03635465231187039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Postoperative rehabilitation is an important component of recovery after anterior cruciate ligament (ACL) reconstruction (ACLR), facilitating successful return to sport (RTS) by reducing risk factors for repeat injury. PURPOSE This systematic review aimed to determine the best protocol for RTS after ACLR in children. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS PubMed, Embase, PEDro, SPORTDiscus, and Web of Science databases were searched from October 3, 2014, to November 3, 2022. The inclusion criteria were the pediatric population (<18 years old) after ACLR with clear RTS criteria and/or mean/median time to RTS. Multiligament knee injuries were excluded from this study. The methodologic quality of the included articles was assessed using the methodological index for non-randomized studies (MINORS). The highest possible score was 24 points for comparative studies (ie, a study comparing 2 protocols or more). Noncomparative studies or studies with a single protocol could score a maximum of 16 points as assessed by the MINORS score. RESULTS The search yielded 1816 titles, and 24 were retained based on the inclusion and exclusion criteria. Every study was published between 2015 and 2022. Among the 24 studies included, 13 were retrospective and 11 were prospective. The mean MINORS score for the noncomparative studies was 13 of 16 (n = 23) and 23 of 24 for the comparative study (n = 1). The studies were categorized into unspecified clearance (n = 10), milestone based (n = 13), and combined time and milestone (n = 1). A total of 1978 patients (57% female) were included in the review. The mean age at ACLR was 14.7 years. The most common endpoint used was graft rupture (0% to 35%). In the unspecified group, the quickest RTS was 5.8 months and the longest was 9.6 months. Statistically significant risk factors for ACL reinjury included younger age and earlier RTS. The latter was a significant contributor to graft failure for combined time-based and milestone-based RTS. In the milestone-based group, the most common criteria were ≥90% limb symmetry measured using hamstring strength, quadriceps strength, and/or hop tests. The mean RTS time was 6.8 to 13.5 months. CONCLUSION RTS should be delayed, when possible, especially in the younger population. A combination of quantitative tests and qualitative tests is also recommended. However, optimal RTS criteria have yet to be determined. Future prospective studies should focus on comparing the different times and milestones currently available.
Collapse
Affiliation(s)
| | | | - Philippe Moisan
- Faculty of Medicine, University of Montréal, Montréal, QC, Canada
| | - Marie-Lyne Nault
- McGill University Health Center, Montréal, QC, Canada
- Faculty of Medicine, University of Montréal, Montréal, QC, Canada
- CHU Sainte-Justine, Montréal, QC, Canada
- Department of Orthopedic Surgery, CIUSSS Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| |
Collapse
|
13
|
Usami S, Kimura Y, Matsuzaka M, Sasaki Y, Sasaki S, Sasaki E, Tsuda E, Ishibashi Y. A new neural network model that detects graft ruptures and contralateral anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 2024; 32:872-880. [PMID: 38461400 DOI: 10.1002/ksa.12123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE The purpose of this study was to develop a neural network model for predicting second anterior cruciate ligament (ACL) injury risk following ACL reconstruction using patient features from medical records. METHODS Of 486 consecutive patients who underwent primary unilateral ACL reconstruction, 386 patients (198 women, 188 men) with a mean age of 25.1 ± 11.6 years were included in this study. Fifty-eight features, including demographic data, surgical, preoperative and postoperative data, were retrospectively collected from medical records, and features with an incidence of less than 5% were excluded. Finally, 14 features were used for the analysis. The multilayer perceptron was composed of four hidden layers with a rectified linear unit as activation and was trained to maximise the area under the receiver-operating characteristic curve (auROC). Subsequently, validation was carried out through a rigorous threefold cross-validation process. To ascertain the most efficacious combination of features with the highest auROC, a single feature with the least impact on auROC maximisation was systematically eliminated from the comprehensive variable set, ultimately resulting in the retention of a mere two variables. RESULTS The median follow-up period was 50.5 (24-142) months. Fifty-seven knees had a second ACL injury, with a graft rupture rate of 7.7% and a contralateral injury rate of 6.9%. The maximum auROC for predicting graft rupture was 0.81 with two features: young age and hamstring graft. Meanwhile, the maximum auROC for predicting contralateral ACL injury was 0.74 with seven features, including young age, presence of medial meniscus tear, small body mass index, hamstring graft, female sex and medial meniscus repair or treatment. CONCLUSION A neural network model with patient features from medical records detected graft ruptures and contralateral ACL injuries with acceptable accuracy. This model can serve as a new, useful tool in clinical practice to inform decisions about ACL reconstruction and retuning to sports postoperatively. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Shintaro Usami
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masashi Matsuzaka
- Department of Medical Informatics, Hirosaki University Hospital, Hirosaki, Japan
| | - Yoshihiro Sasaki
- Department of Medical Informatics, Hirosaki University Hospital, Hirosaki, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
14
|
Yensen K, Mayfield CK, Bolia IK, Palmer RA, Brown M, Kim DR, Abu-Zahra MS, Kotlier JL, Webb T, Cleary E, Saboori N, Petrigliano FA, Weber AE. Subjective Causes for Failure to Return to Sport After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Sports Health 2024:19417381241231631. [PMID: 38532528 DOI: 10.1177/19417381241231631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
CONTEXT While current literature has explored the outcomes of athletes who return to sport (RTS) after anterior cruciate ligament (ACL) injuries, less is known about the outcomes of those who are unsuccessful in returning to sport. OBJECTIVE To determine the rate of athletes who did not RTS after primary ACL reconstruction (ACLR) and to identify the specific subjective reasons for failure to RTS. DATA SOURCES A comprehensive search of the PubMed/MEDLINE, Scopus, and Web of Science databases was conducted through April 2021. STUDY SELECTION Eligible studies included those explicitly reporting the rate of failure for RTS after ACLR as well as providing details on reasons for athletes' inability to return; 31 studies met the inclusion criteria. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 2 to 4. DATA EXTRACTION The reasons for failure to RTS referred to in our study are derived from those established previously in the studies included. Data were collected on the number of athletes, mean age, mean follow-up time, type of sport played, failure to RTS rate, and specific reasons for failure to return. RESULTS The weighted rate of failure to RTS after ACLR was 25.5% (95% CI, 19.88-31.66). The estimated proportion of psychosocial-related reasons cited for failure to RTS was significantly greater than knee-related reasons for failure RTS (55.4% vs 44.6%, P < 0.01). The most cited reason for failure to RTS was fear of reinjury (33.0%). CONCLUSION This study estimates the rate of failure to RTS after ACLR to be 25.5%, with the majority of athletes citing fear of reinjury as the major deterrent for returning to sports. We highlight how factors independent of surgical outcomes may impact an athlete's ability to return to play given that the predominant reason for no RTS after ACLR was unrelated to the knee.
Collapse
Affiliation(s)
- Katie Yensen
- Keck School of Medicine of USC, Los Angeles, California
| | | | | | - Ryan A Palmer
- Keck School of Medicine of USC, Los Angeles, California
| | - Michael Brown
- Keck School of Medicine of USC, Los Angeles, California
| | - Daniel R Kim
- Keck School of Medicine of USC, Los Angeles, California
| | | | | | - Thomas Webb
- Keck School of Medicine of USC, Los Angeles, California
| | - Emmett Cleary
- Keck School of Medicine of USC, Los Angeles, California
| | - Nima Saboori
- Keck School of Medicine of USC, Los Angeles, California
| | | | | |
Collapse
|
15
|
Piussi R, Simonson R, Zsidai B, Grassi A, Karlsson J, Della Villa F, Samuelsson K, Senorski EH. Better Safe Than Sorry? A Systematic Review with Meta-analysis on Time to Return to Sport After ACL Reconstruction as a Risk Factor for Second ACL Injury. J Orthop Sports Phys Ther 2024; 54:161-175. [PMID: 38032099 DOI: 10.2519/jospt.2023.11977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVE: To compare the time to return to sport (RTS) between patients who did and did not suffer a second anterior cruciate ligament (ACL) injury after ACL reconstruction. DESIGN: Etiology systematic review with meta-analysis. LITERATURE SEARCH: Cochrane Library, Embase, Medline, AMED, and PEDro databases were searched in August 2021 and again in November 2022. STUDY SELECTION CRITERIA: Clinical studies reporting time to RTS after ACL reconstruction and second ACL injury were eligible. DATA SYNTHESIS: We pooled continuous data (time [months] and proportions [%]), with random-effects meta-analyses. Pooled estimates were summarized in forest plots. A qualitative data synthesis was also performed. RESULTS: Twenty-one studies were included in the meta-analysis and 33 in the qualitative synthesis. Pooled incidence of second ACL injury was 16.9% (95% confidence interval [CI]: 12.8, 21.6). Patients who suffered a second ACL injury returned to sport significantly earlier (25 days; 95% CI: 9.5, 40.4) than those who did not suffer another injury. There was no difference in time to RTS for professional athletes who suffered a second ACL injury and those who did not. The certainty of evidence was very low. CONCLUSION: There was very low-certainty evidence that patients who suffered a second ACL injury had returned to sport 25 days earlier than patients who did not have another injury. For professional athletes, there was no difference in time to RTS between athletes who suffered a second ACL injury and athletes who did not. J Orthop Sports Phys Ther 2024;54(3):1-15. Epub 30 November 2023. doi:10.2519/jospt.2023.11977.
Collapse
|
16
|
Rangasamy K, Baburaj V, Gopinathan NR, Dhillon MS, Parikh SN. Quadriceps tendon autograft is promising with lower graft rupture rates and better functional Lysholm scores than hamstring tendon autograft in pediatric ACL reconstruction. A systematic review and meta-analysis. J Orthop 2024; 49:156-166. [PMID: 38223427 PMCID: PMC10787221 DOI: 10.1016/j.jor.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose Graft rupture is the most prevalent complication following pediatric anterior cruciate ligament reconstruction (ACLR). The hamstring tendon (HT) autograft is frequently employed, while the quadriceps tendon (QT) autograft has garnered increased attention recently. This study aims to perform a systematic review to assess the complication rates and functional outcomes associated with these two widely used autografts in skeletally immature patients - comparing HT versus QT autografts. Research question Is QT autograft better than HT autograft for ACLR in skeletally immature cohorts? Methodology Three electronic databases (PubMed/Medline, Scopus, and Ovid) were comprehensively searched to identify pertinent articles reporting the outcomes of HT and QT autografts in pediatric ACLR with a minimum 2-year follow-up. Data on the outcome parameters, such as graft rupture rates, contralateral ACL injury rates, functional outcomes, and growth disturbances rates, were extracted. Meta-analysis was performed using OpenMeta Analyst software. Results Twelve studies were included for meta-analysis (pooled analysis) with 659 patients (QT: 205; HT: 454). The analysis showed that QT autografts had a significantly lesser graft rupture rate than HT autografts (3.5 % [95 % CI 0.2, 6.8] and 12.4 % [95 % CI 6.1, 18.7] respectively, p < 0.001). The graft rupture rates between QT with bone and without bone block showed no statistically significant difference (4.6 % [95 % CI 0.8, 1.0] and 3.5 % [95 % CI 2.0, 8.9] respectively, p = 0.181). The overall contralateral ACL injury rate was 10.2 %, and the subgroup analysis revealed no statistically significant difference between the QT and HT groups (p = 0.7). Regarding functional outcome scores at the final follow-up, the mean Lysholm score demonstrated a significant increase in the QT group compared to the HT group (p < 0.001). There were no significant differences between the two groups concerning growth disturbances at the final follow-up. Return to sports (RTS) varied between 6 and 13.5 months after surgery. Conclusion QT autografts demonstrate encouraging outcomes, showcasing lower graft rupture rates, better functional outcomes, and comparable contralateral ACL injury rates and growth disturbances relative to the commonly used HT autograft in skeletally immature patients undergoing ACLR.
Collapse
Affiliation(s)
- Karthick Rangasamy
- Clinical Fellow, Paediatric Orthopaedic Division, Children's Hospital, London Health Science Centre, London, Ontario, Canada
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishnu Baburaj
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nirmal Raj Gopinathan
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shital N. Parikh
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, USA
| |
Collapse
|
17
|
Ishida T, Ino T, Yamakawa Y, Wada N, Koshino Y, Samukawa M, Kasahara S, Tohyama H. Estimation of Vertical Ground Reaction Force during Single-leg Landing Using Two-dimensional Video Images and Pose Estimation Artificial Intelligence. Phys Ther Res 2024; 27:35-41. [PMID: 38690532 PMCID: PMC11057390 DOI: 10.1298/ptr.e10276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/09/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Assessment of the vertical ground reaction force (VGRF) during landing tasks is crucial for physical therapy in sports. The purpose of this study was to determine whether the VGRF during a single-leg landing can be estimated from a two-dimensional (2D) video image and pose estimation artificial intelligence (AI). METHODS Eighteen healthy male participants (age: 23.0 ± 1.6 years) performed a single-leg landing task from a 30-cm height. The VGRF was measured using a force plate and estimated using center of mass (COM) position data from a 2D video image with pose estimation AI (2D-AI) and three-dimensional optical motion capture (3D-Mocap). The measured and estimated peak VGRFs were compared using a paired t-test and Pearson's correlation coefficient. The absolute errors of the peak VGRF were also compared between the two estimations. RESULTS No significant difference in the peak VGRF was found between the force plate measured VGRF and the 2D-AI or 3D-Mocap estimated VGRF (force plate: 3.37 ± 0.42 body weight [BW], 2D-AI: 3.32 ± 0.42 BW, 3D-Mocap: 3.50 ± 0.42 BW). There was no significant difference in the absolute error of the peak VGRF between the 2D-AI and 3D-Mocap estimations (2D-AI: 0.20 ± 0.16 BW, 3D-Mocap: 0.13 ± 0.09 BW, P = 0.163). The measured peak VGRF was significantly correlated with the estimated peak by 2D-AI (R = 0.835, P <0.001). CONCLUSION The results of this study indicate that peak VGRF estimation using 2D video images and pose estimation AI is useful for the clinical assessment of single-leg landing.
Collapse
Affiliation(s)
- Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Japan
| | - Takumi Ino
- Faculty of Health Sciences, Hokkaido University of Science, Japan
| | | | - Naofumi Wada
- Faculty of Engineering, Hokkaido University of Science, Japan
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Japan
| | | | | |
Collapse
|
18
|
Migliorini F, Pilone M, Memminger MK, Eschweiler J, Giorgino R, Maffulli N. All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review. J Orthop Traumatol 2024; 25:7. [PMID: 38376718 PMCID: PMC10879072 DOI: 10.1186/s10195-024-00751-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/13/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears in skeletally immature patients are increasingly common. Evidence comparing the outcomes of all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients is limited, and the current literature could benefit from a comprehensive systematic review. The present study compared all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients. The outcomes of interest were to compare joint laxity, patient-reported outcome measures (PROMs), return to sport, and complications. METHODS This study was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In November 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. No additional filters were used in the database search. All the clinical studies investigating ACL reconstruction in skeletally immature patients were accessed. Only articles that clearly stated the surgical technique (all- or trans-epiphyseal) were eligible. Only articles with a minimum of 6 months of follow-up were included. Only articles that clearly stated that surgeries were conducted in children with open physis were eligible. RESULTS Data from 1489 patients (1493 procedures) were collected, of which 32% (490 of 1489 patients) were female. The mean length of follow-up was 46.6 months. The mean age of the patients was 12.7 years. No difference was found in joint laxity (Table 3): positive pivot shift (P = 0.4), positive Lachman test (P = 0.3), and mean arthrometer laxity (P = 0.1). No difference was found in PROMs (Table 4): International Knee Documentation Committee (IKDC) (P = 0.3), Lysholm (P = 0.4), and Tegner (P = 0.7). The trans-epiphyseal technique was associated with a greater rate of patients unable to return to sports (1% versus 7%, P = 0.0001) and with a longer time to return to sports (7.7 versus 8.6 months, P = 0.01). Though the trans-epiphyseal technique was associated with a lower rate of return to sport, this difference was not statistically significant (P = 0.8). No difference was evidenced in the rate of patients who had reduced their league or level of sports activity (P = 0.6) or in the rate of patients who had returned to their previous league or level of sports activity (P = 0.7). No difference was found in the rate of complication: re-tear (P = 0.8), reoperation (P = 0.7), increased laxity (P = 0.9), and persistent instability sensation (P = 0.3). CONCLUSION Trans-epiphyseal ACL reconstruction was associated with a greater rate of patients unable to return to sport and with a longer time to return to sport compared with the all-epiphyseal technique in skeletally immature patients. Level of evidence Level III, systematic review.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
| | - Marco Pilone
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Michael Kurt Memminger
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
- Department of Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost, Halle, Germany
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Nicola Maffulli
- Department of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, ST4 7QB, Stoke on Trent, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, E1 4DG, London, England
| |
Collapse
|
19
|
Li Y, Deng T, Aili D, Chen Y, Zhu W, Liu Q. Cell Sheet Technology: An Emerging Approach for Tendon and Ligament Tissue Engineering. Ann Biomed Eng 2024; 52:141-152. [PMID: 37731091 DOI: 10.1007/s10439-023-03370-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/09/2023] [Indexed: 09/22/2023]
Abstract
Tendon and ligament injuries account for a substantial proportion of disorders in the musculoskeletal system. While non-operative and operative treatment strategies have advanced, the restoration of native tendon and ligament structures after injury is still challenging due to its innate limited regenerative ability. Cell sheet technology is an innovative tool for tissue fabrication and cell transplantation in regenerative medicine. In this review, we first summarize different harvesting procedures and advantages of cell sheet technology, which preserves intact cell-to-cell connections and extracellular matrix. We then describe the recent progress of cell sheet technology from preclinical studies, focusing on the application of stem cell-derived sheets in treating tendon and ligament injuries, as well as highlighting its effects on mitigating inflammation and promoting tendon/graft-bone interface healing. Finally, we discuss several prerequisites for future clinical translation including the selection of appropriate cell source, optimization of preparation process, establishment of suitable animal model, and the fabrication of vascularized complex tissue. We believe this review could potentially provoke new ideas and drive the development of more functional biomimetic tissues using cell sheet technology to meet the needs of clinical patients.
Collapse
Affiliation(s)
- Yexin Li
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Ting Deng
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Dilihumaer Aili
- Department of Orthopedic Surgery, Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University, Ürümqi, People's Republic of China
| | - Yang Chen
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Weihong Zhu
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Qian Liu
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.
| |
Collapse
|
20
|
Doxey SA, Kleinsmith RM, Huyke-Hernández FA, Schweitzer A, Only AJ, Tompkins M, Kweon CY, Cunningham BP. Improved Patient-reported Outcomes in Patients Aged 16 and Younger at Two Years After Anterior Cruciate Ligament Reconstruction Despite Relatively High Rates of Reinjury and Repeat Surgery. J Pediatr Orthop 2024; 44:106-111. [PMID: 38031490 DOI: 10.1097/bpo.0000000000002567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) in adolescent patients, particularly those aged 16 and under, are increasingly common procedure that lacks robust clinical and patient-reported outcome (PRO) data. The purpose of this study was to report 2-year PROs of patients receiving ACLR aged 16 or younger using the single assessment numerical evaluation (SANE) and knee injury and osteoarthritis outcome score (KOOS). Secondary aims included characterizing treatment characteristics, return to sport (RTS), and clinical outcomes. METHODS The institutional PRO database was queried for patients receiving ACLR from 2009 to 2020. Patients aged older than 16, revision procedures, concomitant ligament repairs/reconstructions, and patients without full outcome data at 2 years were excluded. Outcomes over 2 years after ACLR included SANE, KOOS, reinjuries, reoperations, and time to RTS. RESULTS A total of 98 patients were included with an average age of 15.0 years. Most patients were females (77.6%). Bone-tendon-bone autograft (69.4%) was the most used. Average RTS was 8.7 months (range: 4.8 to 24.0 mo), with 90% of patients eventually returning to sport. A total of 23 patients (23.5%) experienced a reinjury and 24.5% (n = 24) underwent reoperation. Timing to RTS was not associated with reinjury, but patients who returned between 9.5 and 13.7 months did not sustain reinjuries. Mean KOOS and SANE scores at 2 years were 87.1 and 89.1, respectively, with an average improvement of +18.4 and +22.9, respectively. Change in KOOS was negatively impacted by reinjury to the anterior cruciate ligament graft and reoperation (anterior cruciate ligament failure: +10.0 vs 19.3, P = 0.081, respectively; reoperation: +13.2 vs +20.1, P = 0.051, respectively), though these did not reach statistical significance. CONCLUSION Patients experienced improved SANE and KOOS scores after ACLR. Rates of reinjury and reoperation were relatively high and negatively impacted PRO scores but were not associated with the timing of RTS. Adolescent patients should be counseled regarding the risk of subsequent ipsilateral and contralateral knee injury after ACLR. LEVEL OF EVIDENCE Level IV-case series.
Collapse
Affiliation(s)
- Stephen A Doxey
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington
| | - Rebekah M Kleinsmith
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington
| | - Fernando A Huyke-Hernández
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington
| | - Adam Schweitzer
- Department of Orthopaedic Surgery, Des Moines University College of Osteopathic Medicine, Des Moines, IA
| | - Arthur J Only
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Marc Tompkins
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington
| | | | - Brian P Cunningham
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park
- Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington
| |
Collapse
|
21
|
Kemper WC, Carpenter CM, Wagner KJ, Chen CC, Saleem L, Wilson PL, Ellis HB. Differences in Short-Term Sport-Specific Functional Recovery After Primary ACL Reconstruction in the Adolescent Athlete. Sports Health 2024; 16:139-148. [PMID: 36872596 PMCID: PMC10732105 DOI: 10.1177/19417381231156395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Although anterior cruciate ligament (ACL) injury rates have been studied extensively, it is unclear whether levels of functional and psychological readiness for return-to-sport after primary ACL reconstruction (ACLR) differ based on an athlete's primary sport. HYPOTHESIS Youth athletes in different primary sports will demonstrate differences in short-term functional recovery, as well as patient-reported psychological and functional recovery after primary ACLR. STUDY DESIGN Retrospective cohort study of consecutive patients treated for ACL injury in pediatric sports medicine clinics. LEVEL OF EVIDENCE Level 3. METHODS Patients included underwent primary ACLR between December 1, 2015 and December 31, 2019 and reported sports participation at the time of injury. Demographic data, sports participation, surgical data, functional testing scores (Y-Balance Test [YBT]), functional and psychological patient-reported outcome measures (PROMs), and timing of return-to-play clearance were reviewed. YBT scores were the primary metric for clearance. Four groups were studied: soccer, football, basketball, and other. RESULTS A total of 220 male and 223 female athletes were included; 65.28% of soccer players were female and 100% of football players were male (P < 0.01). At initial postoperative YBT testing (6-9 months), soccer players had higher operative (P < 0.01) and nonoperative (P < 0.01) leg composite scores when compared with basketball players. No significant differences were found between sports in functional or psychological PROMs at presurgical baseline or 6 months postoperatively. When compared with football, soccer players completed functional clearance in a shorter time from surgery (P = 0.02). Multivariate analysis showed level of competition as a significant independent variable for clearance in female athletes. CONCLUSION After primary ACLR, athletes, especially female athletes, demonstrated short-term sport-specific differences in YBT scores. Soccer players attained clearance sooner than football players. Level of competition influenced YBT composite scores in all athletes and time to clearance in female athletes. CLINICAL RELEVANCE Sport-specific differences in reinjury should be investigated to determine whether changes in return-to-play evaluation should be implemented.
Collapse
Affiliation(s)
| | | | - K. John Wagner
- Texas Scottish Rite Hospital for Children, Frisco, Texas
| | | | - Laura Saleem
- Texas Scottish Rite Hospital for Children, Frisco, Texas
| | - Philip L. Wilson
- Texas Scottish Rite Hospital for Children, Frisco, Texas
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Henry B. Ellis
- Texas Scottish Rite Hospital for Children, Frisco, Texas
- University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
22
|
Dewig DR, Boltz AJ, Moffit RE, Rao N, Collins CL, Chandran A. Epidemiology of Anterior Cruciate Ligament Tears in National Collegiate Athletic Association Athletes: 2014/2015-2018/2019. Med Sci Sports Exerc 2024; 56:29-36. [PMID: 37616175 DOI: 10.1249/mss.0000000000003281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE This study aimed to describe the epidemiology of ACL tears in NCAA men's and women's sports. METHODS Injury and exposure data collected within the NCAA Injury Surveillance Program from 2014/2015 to 2018/2019 were analyzed. ACL tear frequencies, injury rates (IR), and injury proportions were used to describe injury incidence by sport, event type, injury mechanism, and injury history. Injury rate ratios (IRR) were used to examine differential injury rates, and injury proportion ratios (IPR) were used to examine differential distributions. RESULTS A total of 729 ACL tears were reported from 8,474,401 recorded athlete exposures (AE) during the study period (IR = 0.86 per 10,000 AE), and the competition-related ACL tear rate was higher than the practice-related rate (IRR = 5.52, 95% confidence interval [CI] = 4.75-6.39). Among men's sports, the highest overall ACL tear rate was observed in men's football (IR = 1.44 per 10,000 AE), whereas among women's sports, the highest overall rate was observed in women's soccer (IR = 2.60 per 10,000 AE). Among sex-comparable sports, ACL tear rates were higher in women's basketball, softball, and soccer, as compared with their men's counterparts. ACL tears were more prevalently attributed to player contact mechanisms in men's sports than women's sports (IPR = 1.73, 95% CI = 1.37-2.19), but more prevalently attributed to noncontact mechanisms in women's sports than men's sports (IPR = 1.17, 95% CI = 1.01-1.35). CONCLUSIONS ACL tear risk in women's sports continues to warrant attention and prevention efforts. Given the differential rates by event type, future research efforts may also evaluate initiatives to reduce competition-related injury burden in NCAA sports.
Collapse
Affiliation(s)
- Derek R Dewig
- College of Education, Health and Human Performance, Fairmont State University, Fairmont WV
| | | | - Reagan E Moffit
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Neel Rao
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| |
Collapse
|
23
|
Gao H, Hu H, Sheng D, Sun L, Chen J, Chen T, Chen S. Risk Factors for Ipsilateral Versus Contralateral Reinjury After ACL Reconstruction in Athletes: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231214298. [PMID: 38145217 PMCID: PMC10748928 DOI: 10.1177/23259671231214298] [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: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 12/26/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) reinjury after ACL reconstruction (ACLR) can occur on the ipsilateral or contralateral side. Limited evidence exists regarding the difference between the incidence of reinjury to either knee, which is important in developing interventions to prevent ACL reinjury. Purpose To compare the reinjury rate of the ACL on the ipsilateral side versus the contralateral side in athletes after ACLR and investigate the risk factors that may cause different reinjury rates between the sides. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies that involved ACL reinjury in athletes after ACLR were reviewed. Considering several risk factors, including age and sex, a comparison of ACL reinjury incidence on the ipsilateral and contralateral sides was performed using a meta-analysis. Results Of the 17 selected studies, 3 were found to be at high risk of bias, and thus, 14 (n = 3424 participants) studies were included in the meta-analysis. In this athletic population, the contralateral ACL had a significantly higher rupture rate than the ipsilateral graft (risk ratio [RR], 1.41; P < .0001). Female athletes were found to have a greater risk of ACL reinjury on the contralateral versus the ipsilateral side (RR, 1.65; P = .0005), but different results were found in male athletes. (RR, 0.81; P = .21). There was no statistical difference in the incidence rate of ACL reinjury to either side in adolescent athletes (RR, 1.15; P = .28). Conclusion The contralateral ACL was more vulnerable to reinjury than the ipsilateral side in athletes after ACLR. Female athletes were more likely to reinjure their contralateral native ACL, while the same trend was not found in their male counterparts. The reinjury rate was comparable in both knees in adolescent athletes.
Collapse
Affiliation(s)
- Han Gao
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Haichen Hu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Dandan Sheng
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Luyi Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Tianwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
24
|
Aldag L, Dallman J, Henkelman E, Herda A, Randall J, Tarakemeh A, Morey T, Vopat BG. Various Definitions of Failure Are Used in Studies of Patients Who Underwent Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2023; 5:100801. [PMID: 37766857 PMCID: PMC10520319 DOI: 10.1016/j.asmr.2023.100801] [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: 03/04/2023] [Accepted: 08/10/2023] [Indexed: 09/29/2023] Open
Abstract
Purpose To conduct a literature review to assess the definitions of anterior cruciate ligament reconstruction (ACLR) failure used throughout the orthopaedic literature. Methods A systematic search of Embase, Ovid Medline, SPORTDiscus, and Web of Science was conducted by a university librarian to identity level I-IV clinical studies on ACLR failure. Inclusion criteria consisted of patients who underwent ACLR and included a definition of failure of ACLR. Patients who underwent anterior cruciate ligament (ACL) repairs, animal/cadaver studies, review studies, non-English language articles, and non-full text articles were excluded. Failure data were extracted from each study and categorized. Other data that were extracted included follow-up time after ACLR, failure reoperation rate, and failure reoperation procedure. Descriptive statistics was used to analyze the data. Results Out of 2,775 studies, 104 (3.75%) met inclusion criteria and were analyzed in this review. The most common definition of ACLR failure included the use of a physical examination, specifically Lachman's test (21/104 [20.2%]), anterior laxity assessment, or a Pivot-Shift test (24/104 [35.2%]) or undergoing or requiring revision ACLR (39/104 [37.5%]). Although some studies used quantitative tests or imaging to help define "failure," others simply defined it as graft rerupture that was otherwise not defined (22/104 [22.5%]). Other common definitions included: the use of imaging (magnetic resonance imaging/radiographs) to confirm graft re-rupture (37/104 [35.6%]), patient-reported outcomes (recurrent instability)/patient reported outcomes measures (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner) (18/104 [17.3%]), and the use of an arthrometer (KT-1000/2000, Rollimeter, or Kneelax) (17/104 [16.3%]). The least common definitions included graft failure or rerupture confirmed by arthroscopy (13/104 [12.5%]) and nonrevision surgery (2/104 [1.0%]). The failure rate of this procedure ranged from 0% to 100% depending on the definition of "failure." Conclusion In this study, we found that a variety of definitions of failure are used among studies published in the orthopaedic literature. The most common criteria for failure of ACLR were the results of physical examination tests (35%), the need for undergoing a revision ACLR (36%), and the use of imaging to diagnose the failure (34%). About 17% of studies included in this review used patient-reported outcomes, specifically recurrent instability, or PROMs (IKDC, KOOS, Tegner) in their assessment of failure of ACLR. The least used definitions of "failure" of ACLR included nonrevision ACLR surgery (2%). Although some studies used similar tests or categories in their definition of failure, there were a variety of score and grade cutoff points between them. Level of Evidence Level IV, systematic review of Level II-IV studies.
Collapse
Affiliation(s)
- Levi Aldag
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Johnathan Dallman
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Erik Henkelman
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Ashley Herda
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas, U.S.A
| | - Jeffrey Randall
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Armin Tarakemeh
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Tucker Morey
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| | - Bryan G. Vopat
- Department of Orthopaedic Surgery and Sports Medicine, the University of Kansas Health System, Kansas City, Kansas, U.S.A
| |
Collapse
|
25
|
Roman DP, Burland JP, Fredericks A, Giampetruzzi N, Prue J, Lolic A, Pace JL, Crepeau AE, Weaver AP. Early- and Late-Stage Benefits of Blood Flow Restriction Training on Knee Strength in Adolescents After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2023; 11:23259671231213034. [PMID: 38035209 PMCID: PMC10683400 DOI: 10.1177/23259671231213034] [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: 06/06/2023] [Accepted: 06/20/2023] [Indexed: 12/02/2023] Open
Abstract
Background Blood flow restriction training (BFRT) after anterior cruciate ligament reconstruction (ACLR) is rising in popularity because of its benefits in reducing muscle atrophy and mitigating knee strength deficits. Purpose To investigate the impact BFRT has on adolescent knee strength after ACLR at 2 postoperative time points: at 3 months and the time of return to sport (RTS). Study Design Cohort study; Level of evidence, 3. Methods A prospective intervention (BFRT) group was compared to an age-, sex-, and body mass index-matched retrospective control group. Patients aged 12 to 18 years who underwent primary ACLR with a quadriceps tendon autograft were included. Along with a traditional rehabilitation protocol, the BFRT group completed a standardized BFRT protocol (3 BFRT exercises performed twice weekly for the initial 12 weeks postoperatively). Peak torque values for isometric knee extension and flexion strength (at 3 months and RTS) and isokinetic strength at 180 deg/s (at RTS) as well as Pediatric International Knee Documentation Committee (Pedi-IKDC) scores were collected. Differences between the BFRT and control groups were compared with 2-way mixed analysis of variance and 1-way analysis of variance. Results The BFRT group consisted of 16 patients (10 female; mean age, 14.84 ± 1.6 years) who were matched to 16 patients in the control group (10 female; mean age, 15.35 ± 1.3 years). Regardless of the time point, the BFRT group demonstrated significantly higher isometric knee extension torque compared to the control group (2.15 ± 0.12 N·m/kg [95% CI, 1.90-2.39] vs 1.74 ± 0.12 N·m/kg [95% CI, 1.49-1.98], respectively; mean difference, 0.403 N·m/kg; P = .024). The BFRT group also reported significantly better Pedi-IKDC scores compared to the control group at both 3 months (68.91 ± 9.68 vs 66.39 ± 12.18, respectively) and RTS (89.42 ± 7.94 vs 72.79 ± 22.81, respectively) (P = .047). Conclusion In adolescents, the addition of a standardized BFRT protocol to a traditional rehabilitation protocol after ACLR significantly improved knee strength and patient-reported function compared to a traditional rehabilitation program alone.
Collapse
Affiliation(s)
- Dylan P. Roman
- Sports Physical Therapy, Connecticut Children's, Farmington, Connecticut, USA
| | - Julie P. Burland
- Institute for Sports Medicine, University of Connecticut, Storrs, Connecticut, USA
| | - Arthur Fredericks
- Sports Physical Therapy, Connecticut Children's, Farmington, Connecticut, USA
| | | | - Jennifer Prue
- Sports Physical Therapy, Connecticut Children's, Farmington, Connecticut, USA
| | - Adel Lolic
- Sports Physical Therapy, Connecticut Children's, Farmington, Connecticut, USA
| | - J. Lee Pace
- Children’s Health Andrews Institute for Orthopaedics & Sports Medicine, Plano, Texas, USA
| | | | - Adam P. Weaver
- Sports Physical Therapy, Connecticut Children's, Farmington, Connecticut, USA
| |
Collapse
|
26
|
Kay J, Liotta ES, Sugimoto D, Heyworth BE. Assessment of Return to Sport After ACL Reconstruction With Soft Tissue Autograft in Adolescent Athletes: Quadriceps Versus Hamstring Tendon. Orthop J Sports Med 2023; 11:23259671231207113. [PMID: 38021299 PMCID: PMC10676070 DOI: 10.1177/23259671231207113] [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: 04/18/2023] [Accepted: 05/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Quadriceps tendon soft tissue autograft represents an increasingly popular graft option for anterior cruciate ligament reconstruction (ACLR), particularly for adolescents, some of whom have an open physis, precluding use of graft options with bone plugs. Purpose/Hypothesis The purpose of this study was to quantify return-to-sport performance assessments in adolescents at 6 months after ACLR with all-soft tissue quadriceps tendon autograft (ACLR-Q) versus hamstring tendon autograft (ACLR-HS). It was hypothesized that ACLR-Q would be associated with improved hamstring strength and hamstring-to-quadriceps (HS:Q) ratios compared with ACLR-HS, albeit with decreased quadriceps strength. Study Design Cross-sectional study; Level of evidence, 3. Methods Included were patients aged 12 to 19 years who underwent primary ACLR by a single surgeon and who completed a return-to-sport performance assessment between 5 and 9 months postoperatively. The performance assessment included manual muscle strength tests (hamstring, quadriceps, hip abductor and adductor), dynamic balance test (Y-balance), and functional hop tests (single hop, triple hop, crossover hop, 6-m timed hop). Data were converted to limb symmetry indices, and limb symmetry index deficits were compared between the ACLR-Q and ACLR-HS cohorts using the Student t test or Wilcoxon-Mann-Whitney test. Results An initial cohort of 90 ACLR-Q patients was compared with 54 ACLR-HS patients, with no significant differences in patient characteristics. Differences in meniscal repair rates, however, prompted use of propensity score matching on age, sex, body mass index, meniscectomy, and meniscal repair to produce comparable subcohorts. The matching resulted in 67 ACLR-Q and 52 ACLR-HS patients. Hamstring strength deficits were significantly greater in ACLR-HS versus ACLR-Q patients (-40.5% vs -5.7%; P < .001). Quadriceps strength deficits were significantly greater in ACLR-Q versus ACLR-HS patients (-12.8% vs -0.4%; P < .001). ACLR-Q patients had a significantly greater HS:Q ratio on the operative knee (P < .001) and significantly higher Y-balance composite score deficits (-2.9% vs -0.4%; P = .01) than ACLR-HS patients. There were no significant differences in hop test performance between groups. Conclusion Adolescent athletes who underwent ACLR-Q showed significantly greater quadriceps strength deficits but significantly smaller hamstring strength deficits than those who underwent ACLR-HS, leading to more favorable HS:Q ratios in ACLR-Q patients at 6 months postoperatively.
Collapse
Affiliation(s)
- Jeffrey Kay
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
- Division of Sports Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Elizabeth S. Liotta
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
| | - Benton E. Heyworth
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
- Division of Sports Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
27
|
Pauw AHJ, Buck TMF, Gokeler A, Tak IJR. Reconsideration of Return-to-Sport Decision-Making After Pediatric ACL Injury: A Scoping Review. Sports Health 2023; 15:898-907. [PMID: 36715226 PMCID: PMC10606966 DOI: 10.1177/19417381221146538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
CONTEXT Up to 90% of pediatric athletes return to sport (RTS) after anterior cruciate ligament reconstruction (ACL-R); however, <50% RTS at the same level and second ACL injury rates are up to 32%. OBJECTIVES (1) Determine which physical and patient-reported outcome measures guide clinical decision-making on RTS in pediatric athletes after ACL-R and (2) present a framework with insights from cognitive and neurophysiological domains to enhance rehabilitation outcomes. DATA SOURCES PubMed, CINAHL, Embrase, and Cochrane library databases and gray literature. STUDY SELECTION Data on pediatric (<18 years) ACL-R patients, RTS, tests, and decision-making were reported in 1214 studies. Two authors independently reviewed titles and abstract, excluding 962 studies. Gray literature and cross-reference checking resulted in 7 extra studies for full-text screening of 259 studies. Final data extraction was from 63 eligible studies. STUDY DESIGN Scoping review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Details on study population, aims, methodology, intervention, outcome measures, and important results were collected in a data chart. RESULTS Studies included 4456 patients (mean age, 14 years). Quadriceps and hamstring strength (n = 25), knee ligament arthrometer (n = 24), and hop tests (n = 22) were the most-reported physical outcome measures guiding RTS in <30% of studies with cutoff scores of limb symmetry index (LSI) ≥85% or arthrometer difference <3 mm. There were 19 different patient-reported outcome measures, most often reporting the International Knee Documentation Committee (IKDC) (n = 24), Lysholm (n = 23), and Tegner (n = 15) scales. Only for the IKDC was a cutoff value of 85% reported. CONCLUSION RTS clearance in pediatric ACL-R patients is not based on clear criteria. If RTS tests were performed, outcomes did not influence time of RTS. Postoperative LSI thresholds likely overestimate knee function since biomechanics are impaired despite achieving RTS criteria. RTS should be considered a continuum, and biomechanical parameters and contextual rehab should be pursued with attention to the individual, task, and environment. There is a need for psychological monitoring of the ACL-R pediatric population.
Collapse
Affiliation(s)
| | - Tristan Marcel Frank Buck
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, the Netherlands
| | - Alli Gokeler
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, the Netherlands
- Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, the Netherlands
| | - Igor Joeri Ramon Tak
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, the Netherlands
- Fysiotherapie Utrecht Oost, Utrecht, the Netherlands
| |
Collapse
|
28
|
Jildeh TR, Bowen E, Bedi A. Revision Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients. J Am Acad Orthop Surg 2023; 31:e920-e929. [PMID: 37364250 DOI: 10.5435/jaaos-d-23-00288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/27/2023] [Indexed: 06/28/2023] Open
Abstract
Revision anterior cruciate ligament (ACL) reconstruction in the skeletally immature patient is a challenging procedure for pediatric patients with recurrent instability after primary ACL reconstruction. The pediatric population presents unique technical challenges and complications secondary to open physes compared with the adult population. Complications can include growth disturbances, recurrent graft failure, instability, and secondary chondral and/or meniscal injury. Moreover, identifying the etiology of graft failure is critical for a successful revision. Patients should undergo a complete history and physical examination with a focus on patient physiologic age, physeal status, mechanical axis, tibial slope, collagen status, injury mechanism, concomitant injuries, and previous surgical procedures. The surgeon must be adept at reconstruction with various grafts as well as socket or tunnel preparation and fixation, including over-the-top, all-epiphyseal, transphyseal, extra-articular augmentation, and staging approaches. Reported rates of return to sport are lower than those of primary reconstruction, with higher rates of cartilage and meniscal degeneration. Future research should focus on optimizing surgical outcomes and graft survivorship after primary ACL reconstruction with minimized trauma to the physis.
Collapse
Affiliation(s)
- Toufic R Jildeh
- From the Department of Orthopaedics, Michigan State University, East Lansing, MI (Jildeh), the Weill Cornell Medical College, New York, NY (Bowen), and the NorthShore Medical Group, Skokie, IL (Bedi)
| | | | | |
Collapse
|
29
|
Kooy CEVW, Jakobsen RB, Fenstad AM, Persson A, Visnes H, Engebretsen L, Ekås GR. Major Increase in Incidence of Pediatric ACL Reconstructions From 2005 to 2021: A Study From the Norwegian Knee Ligament Register. Am J Sports Med 2023; 51:2891-2899. [PMID: 37497771 PMCID: PMC10478322 DOI: 10.1177/03635465231185742] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/15/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND The incidence of pediatric and adolescent anterior cruciate ligament reconstruction (ACLR) is increasing in several countries. It is uncertain whether this trend applies to countries that traditionally prefer an initial nonoperative treatment approach whenever possible, like Norway. Nationwide, long-term patient-reported outcomes and revision rates after ACLR in the pediatric population are also lacking. PURPOSE To determine the incidence of pediatric ACLR in Norway since 2005, as well as to detect trends in surgical details and describe patient-reported outcomes up to 10 years after ACLR. STUDY DESIGN Descriptive cohort study. METHODS This study is based on prospectively collected data on girls ≤14 years and boys ≤16 years, registered in the Norwegian Knee Ligament Register at the time of their primary ACLR, between 2005 and 2021. The main outcome was the incidence of ACLR, adjusted to the corresponding population numbers for each year. The time trend was analyzed by comparing the mean of the first and last 3-year period (2005-2007 and 2019-2021). Patient-reported outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score preoperatively and at 2, 5, and 10 years postoperatively. RESULTS A total of 1476 patients (1484 cases) were included, with a mean follow-up of 8.1 years (range, 1-17). The incidence of pediatric ACLRs per 100,000 population increased from 18 to 26, which corresponds to an increase of 40% for boys and 55% for girls. Concurrent meniscal procedures increased significantly from 45% to 62%, and the proportion of meniscal repairs increased from 19% to 43% when comparing the first and last time period. The mean Knee injury and Osteoarthritis Outcome Score values for the Sport and Recreation and Quality of Life subscales were between 72 and 75 at the 2-, 5- and 10-year follow-up. The 5-year revision rate was 9.9%. CONCLUSION There was a major increase in incidence of pediatric ACLR in Norway during the study period. There was a shift in the approach to concomitant meniscal procedures from resection to repair, with more than a doubling of the proportion of meniscal repairs. Patient-reported outcomes revealed long-lasting reduced knee function.
Collapse
Affiliation(s)
- Caroline E. v. W. Kooy
- Oslo Sports Trauma Research, Norwegian School of Sports Science, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopedic Surgery, Akershus University Hospital, Oslo, Norway
| | - Rune B. Jakobsen
- Oslo Sports Trauma Research, Norwegian School of Sports Science, Oslo, Norway
- Department of Orthopedic Surgery, Akershus University Hospital, Oslo, Norway
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne M. Fenstad
- The Norwegian Knee Ligament Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Andreas Persson
- Oslo Sports Trauma Research, Norwegian School of Sports Science, Oslo, Norway
- The Norwegian Knee Ligament Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Håvard Visnes
- Oslo Sports Trauma Research, Norwegian School of Sports Science, Oslo, Norway
- The Norwegian Knee Ligament Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Orthopedic Surgery, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Lars Engebretsen
- Oslo Sports Trauma Research, Norwegian School of Sports Science, Oslo, Norway
- Department of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Guri R. Ekås
- Oslo Sports Trauma Research, Norwegian School of Sports Science, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopedic Surgery, Akershus University Hospital, Oslo, Norway
| |
Collapse
|
30
|
Mohan R, Kwaees TA, Thomas T, Pydisetty R. Cohort study of short-term outcomes after ACL-reconstruction using autograft with internal brace reinforcement versus isolated autograft demonstrating no significant difference. J Orthop 2023; 43:115-120. [PMID: 37593689 PMCID: PMC10429725 DOI: 10.1016/j.jor.2023.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/23/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023] Open
Abstract
Background The gold standard treatment for Anterior Cruciate Ligament injury is reconstruction (ACL-R). Graft failure is the concern and ensuring a durable initial graft with rapid integration is crucial. Graft augmentation with implantable devices (internal brace reinforcement) is a technique purported to reduce the risk of rupture and hasten recovery. Few studies have examined these techniques, in particular when compared to non-augmented grafts. This study assesses the short-term outcome of ACL-R using augmented and non-augmented hamstring tendon autografts. Methods This was a retrospective cohort study comparing augmented and non-augmented ACL-R. All procedures were performed in a single centre using the same technique. The Knee injury and Osteoarthritis Outcome Score [KOOS] was used to assess patient-reported outcomes. Results There were 70 patients in the augmented and 111 patients in the control group. Mean graft diameter in the augmented group was 8.82 mm versus 8.44 mm in the non-augmented. Six strand graft was achievable in 73.5% of the augmented group compared to 33% in the non-augmented group. Two graft failures were reported in the non-augmented group and none in the augmented group. Patient satisfaction rates were higher in the augmented group. There was a statistically insignificant improvement in the postoperative KOOS in the augmented group compared to the non-augmented group (p 0.6). Irrespective of augmentation status, no correlation was found between the functional score and age, or femoral tunnel width. Conclusion No statistically significant difference was demonstrated in the short-term functional outcome of ACL reconstruction using an augmented or non-augmented hamstring graft. Augmented ACL-R may achieve superior graft diameters, failure rates and patient reported outcomes when compared to nonaugmented ACL-R. Prospective trials are needed to examine this further.
Collapse
Affiliation(s)
- Rahul Mohan
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, L35 5DR, United Kingdom
| | - Tariq Adam Kwaees
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, L35 5DR, United Kingdom
| | - Terin Thomas
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, L35 5DR, United Kingdom
| | - Ravi Pydisetty
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, L35 5DR, United Kingdom
| |
Collapse
|
31
|
Verhagen S, Dietvorst M, Delvaux E, van der Steen MC, Janssen R. Clinical outcomes of different autografts used for all-epiphyseal, partial epiphyseal or transphyseal anterior cruciate ligament reconstruction in skeletally immature patients - a systematic review. BMC Musculoskelet Disord 2023; 24:630. [PMID: 37537529 PMCID: PMC10401849 DOI: 10.1186/s12891-023-06749-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Different types of grafts can be used for anterior cruciate ligament reconstruction (ACLR). There is little published data regarding skeletally immature patients. The purpose of this systematic review was to assess the clinical outcomes and complications for different autograft types used in all-epiphyseal, transphyseal and partial epiphyseal/hybrid ACLR in skeletally immature children and adolescents. METHODS PubMed, Embase and Cochrane databases were systematically searched for literature regarding ACLR using hamstrings, quadriceps or bone-patellar-tendon-bone (BPTB) autografts in skeletally immature patients. Studies were included if they examined at least one of the following outcomes: graft failure, return to sport(s), growth disturbance, arthrofibrosis or patient reported outcomes and had a minimum follow-up of 1 year. Case reports, conference abstracts and studies examining allografts and extra-articular or over-the-top ACL reconstruction techniques were excluded. Graft failure rates were pooled for each graft type using the quality effects model of MetaXL. A qualitative synthesis of secondary outcomes was performed. RESULTS The database search identified 242 studies. In total 31 studies were included in this review, comprising of 1358 patients. Most patients (81%) were treated using hamstring autograft. The most common used surgical technique was transphyseal. The weighted, pooled failure rate for each graft type was 12% for hamstring tendon autografts, 8% for quadriceps tendon autografts and 6% for BPTB autografts. Confidence intervals were overlapping. The variability in time to graft failure was high. The qualitative analysis of the secondary outcomes showed similar results with good clinical outcomes and low complication rates across all graft types. CONCLUSIONS Based on this review it is not possible to determine a superior graft type for ACLR in skeletally immature. Of the included studies, the most common graft type used was the hamstring tendon. Overall, graft failure rates are low, and most studies show good clinical outcomes with high return to sports rates.
Collapse
Affiliation(s)
- S Verhagen
- Department of Orthopaedic Surgery & Trauma, PO box, Máxima, Eindhoven, 5600 PD, MC, The Netherlands.
| | - M Dietvorst
- Department of Orthopaedic Surgery & Trauma, PO box, Máxima, Eindhoven, 5600 PD, MC, The Netherlands
| | - Ejlg Delvaux
- MMC Academy, Máxima, Veldhoven, MC, The Netherlands
| | - M C van der Steen
- Department of Orthopaedic Surgery & Trauma, PO box, Máxima, Eindhoven, 5600 PD, MC, The Netherlands
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, PO box 1350, Eindhoven, 5602 ZA, The Netherlands
| | - Rpa Janssen
- Department of Orthopaedic Surgery & Trauma, PO box, Máxima, Eindhoven, 5600 PD, MC, The Netherlands
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Chair Value‑Based Health Care, Department of Paramedical Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| |
Collapse
|
32
|
Ellis HB, Zak TK, Jamnik A, Lind DRG, Dabis J, Losito M, Wilson P, Moatshe G. Management of Pediatric Anterior Cruciate Ligament Injuries: A Critical Analysis. JBJS Rev 2023; 11:01874474-202308000-00001. [PMID: 37535763 DOI: 10.2106/jbjs.rvw.22.00223] [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] [Indexed: 08/05/2023]
Abstract
» Overall evidence for the treatment of an anterior cruciate ligament (ACL) injury in a pediatric or skeletally immature patient remains lows.» An ACL reconstruction is recommended with concomitant repairable chondral and meniscus injury or with symptoms of persistent instability despite high-quality rehabilitation.» Treatment decision for pediatric ACL reconstruction should use a shared decision-making model weighing the risks and benefits of both a nonoperative vs. surgical treatment.
Collapse
Affiliation(s)
- Henry B Ellis
- Scottish Rite for Children, Dallas, Texas
- University of Texas Southwestern, Dallas, Texas
| | | | | | - Dane R G Lind
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Philip Wilson
- Scottish Rite for Children, Dallas, Texas
- University of Texas Southwestern, Dallas, Texas
| | - Gilbert Moatshe
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Orthopedics, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
33
|
An BJ, Wang YT, Zhao Z, Wang MX, Xing GY. Comparative study of the clinical efficacy of all-inside and traditional techniques in anterior cruciate ligament reconstruction. World J Clin Cases 2023; 11:3195-3203. [PMID: 37274047 PMCID: PMC10237140 DOI: 10.12998/wjcc.v11.i14.3195] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/05/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Many studies have focused on the femoral tunnel technique and fixation method, but few studies have involved the tibial tunnel technique and fixation method. The all-inside technique is one of the new techniques that has been described in recent years. All-inside anterior cruciate ligament (ACL) reconstruction is based on a tibial socket instead of a full tunnel. This method has many potential advantages.
AIM To compare clinical outcomes of knee ACL autograft reconstruction using all-inside quadrupled semitendinosus (AIST) and traditional hamstring tendon (TBT) techniques.
METHODS From January 2017 to October 2019, the clinical data of 80 patients with ACL reconstruction were retrospectively analyzed, including 67 males and 13 females. The patients had an average age of 24.3 ± 3.1 years (age range: 18-33 years). The AIST technique was used in 42 patients and the TBT technique was used in 38 patients. The time between operation and injury, operative duration, postoperative visual analogue scale (VAS) score and knee functional recovery were recorded and compared between the two groups. The International Knee Documentation Committee (IKDC) and Lysholm scoring system were used to comprehensively evaluate clinical efficacy.
RESULTS Eighty patients were followed for 24-36 mo, with an average follow-up duration of 27.5 ± 1.8 mo. There were no significant differences in the time between surgery and injury, operative duration, IKDC and Lysholm scores of the affected knee at the last follow-up evaluation between the two groups. There were significant differences in VAS scores 1 d, 3 d, 7 d, 2 wk and 1 mo after surgery (P < 0.05). There was no significant difference in VAS score at 3 mo, 6 mo and 1 year after operation.
CONCLUSION The efficacy of the AIST ACL reconstruction technique was comparable to the TBT technique, but the postoperative pain was less with the AIST technique. Thus, the AIST technique is an ideal treatment choice for ACL reconstruction.
Collapse
Affiliation(s)
- Bai-Jing An
- Department of Sports Medicine, The Fourth Medical Center of PLA General Hospital, Beijing 100000, China
| | - Yao-Ting Wang
- Department of Sports Medicine, The Fourth Medical Center of PLA General Hospital, Beijing 100000, China
| | - Zhe Zhao
- Department of Sports Medicine, The Fourth Medical Center of PLA General Hospital, Beijing 100000, China
| | - Ming-Xin Wang
- Department of Sports Medicine, The Fourth Medical Center of PLA General Hospital, Beijing 100000, China
| | - Geng-Yan Xing
- Department of Sports Medicine, The Fourth Medical Center of PLA General Hospital, Beijing 100000, China
| |
Collapse
|
34
|
Adhitya IPGS, Wibawa A, Aryana IGNW, Tegner Y. Reliability, validity, and responsiveness of the Indonesian version of the Lysholm knee score and Tegner activity scale in patients with anterior cruciate ligament reconstruction. J Bodyw Mov Ther 2023; 34:53-59. [PMID: 37301557 DOI: 10.1016/j.jbmt.2023.04.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/08/2023] [Accepted: 04/12/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aims to examine the reliability, validity, and responsiveness of the Lysholm knee score (LKS) and Tegner activity scale (TAS) in Indonesian patients with anterior cruciate ligament reconstruction (ACLR). DESIGN Cross-sectional study. SETTING The LKS and TAS were translated into Indonesian through standardized procedures with the owners' permission, and the test-retest reliabilities, validities, and responsiveness were performed. PARTICIPANTS Data of LS, TAS, Short Form (SF)-36, as well as MRI results were collected from 206 patients with unilateral ACLR. MAIN OUTCOME MEASURES LKS and TAS. RESULTS The questionnaires showed an adequate interclass correlation coefficient of 0.81-0.84 for the test-retest reliabilities, while an appropriate Cronbach's alpha value of 0.83 was obtained for internal consistency using LKS. They also had moderate-high correlations with the selected measures, which have similar constructs (r values, 0.44-0.68) except for the TAS with SF-36 physical function (PF; r value, 0.32). Meanwhile, low associations were observed with other measures with different constructs (r, 0.21-0.31). The results showed that Guyatt's responsiveness index for LKS and TAS changed in the SF-36's PF from 0.50 to 1.60 after one year. CONCLUSIONS The Indonesian version of LKS and TAS have acceptable reliabilities, validities, and responsiveness in ACLR patients.
Collapse
Affiliation(s)
- I Putu Gde Surya Adhitya
- Department of Physical Therapy, College of Medicine, Universitas Udayana, P.B Sudirman Street, Denpasar, 80232, Bali, Indonesia.
| | - Ari Wibawa
- Department of Physical Therapy, College of Medicine, Universitas Udayana, P.B Sudirman Street, Denpasar, 80232, Bali, Indonesia
| | - I Gusti Ngurah Wien Aryana
- Department of Orthopaedic and Traumatology, College of Medicine and Sanglah General Hospital, Universitas Udayana, Pulau Nias Street, Denpasar, 80113, Bali, Indonesia
| | - Yelverton Tegner
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| |
Collapse
|
35
|
Romanchuk NJ, Livock H, Lukas KJ, Del Bel MJ, Benoit DL, Carsen S. Criteria Used to Determine Unrestricted Return to Activity After ACL Reconstruction in Pediatric and Adolescent Patients: A Systematic Review. Orthop J Sports Med 2023; 11:23259671231154540. [PMID: 36909673 PMCID: PMC9996745 DOI: 10.1177/23259671231154540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 03/14/2023] Open
Abstract
Background The rates of anterior cruciate ligament (ACL) graft failure or contralateral ACL rupture range from 17% to 30% in pediatric patients after ACL reconstruction (ACLR). A contributing factor to the high reinjury rate in this population may be the limited evidence regarding appropriate criteria for allowing unrestricted return to activity (RTA) postoperatively. Purpose To review the literature and identify the most commonly used criteria when determining unrestricted RTA after ACLR in pediatric patients. Study Design Systematic review; Level of evidence, 4. Methods A search was performed of the Medline/PubMed, Cochrane Central Register of Controlled Trials, Embase, CINAHL, and SPORTDiscus databases using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The authors identified studies that included pediatric patients (<19 years of age) and specified the criteria used to determine RTA after ACLR. Results A total of 27 articles met all criteria for review, of which 13 studies only used 1 criterion when determining RTA. Objective criteria were the most common type of criteria for RTA (17 studies). Strength tests (15 studies) and hop tests (10 studies) were the most commonly used tasks when deriving RTA criteria. Only 2 studies used validated questionnaires to assess the patient's physiological readiness for RTA, and only 2 studies used an objective assessment of movement quality before RTA. Conclusion Only 14 of the 27 reviewed studies reported using >1 criterion when determining RTA. Furthermore, few studies used patient-reported outcome measures or lower limb kinematics as RTA criteria, indicating that more research is needed to validate these metrics in the pediatric population.
Collapse
Affiliation(s)
- Nicholas J. Romanchuk
- Biomedical Engineering Program, Faculty of Engineering, University
of Ottawa, Ottawa, Ontario, Canada
| | - Holly Livock
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa,
Ontario, Canada
| | - Kenneth J. Lukas
- Division of Orthopaedic Surgery, Faculty of Medicine, University of
Ottawa, Ottawa, Ontario, Canada
| | - Michael J. Del Bel
- School of Rehabilitation Sciences, Faculty of Health Sciences,
University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel L. Benoit
- School of Rehabilitation Sciences, Faculty of Health Sciences,
University of Ottawa, Ottawa, Ontario, Canada
| | - Sasha Carsen
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa,
Ontario, Canada
- Division of Orthopaedic Surgery, Faculty of Medicine, University of
Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
36
|
Anderson AB, Dekker TJ, Pav V, Mauntel TC, Provencher MT, Tokish JM, Volker M, Sansone M, Karlsson J, Dickens JF. Survival of anterior cruciate ligament reconstructions in active-duty military populations. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07335-w. [PMID: 36809509 DOI: 10.1007/s00167-023-07335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Anterior cruciate ligament tears and anterior cruciate ligament reconstruction (ACLR) are common in young athletes. The modifiable and non-modifiable factors contributing to ACLR failure and reoperation are incompletely understood. The purpose of this study was to determine ACLR failure rates in a physically high-demand population and identify the patient-specific risk factors, including prolonged time between diagnosis and surgical correction, that portend failure. METHODS A consecutive series of military service members with ACLR with and without concomitant procedures (meniscus [M] and/or cartilage [C]) done at military facilities between 2008 and 2011 was completed via the Military Health System Data Repository. This was a consecutive series of patients without a history of knee surgery for two years prior to the primary ACLR. Kaplan-Meier survival curves were estimated and evaluated with Wilcoxon test. Cox proportional hazard models calculated hazard ratios (HR) with 95% confidence intervals (95% CI) to identify demographic and surgical factors that influenced ACLR failure. RESULTS Of the 2735 primary ACLRs included in the study, 484/2,735 (18%) experienced ACLR failure within four years, including (261/2,735) (10%) undergoing revision ACLR and (224/2,735) (8%) due to medical separation. The factors that increased failure include Army Service (HR 2.19, 95% CI 1.67, 2.87), > 180 days from injury to ACLR (HR 1.550, 95% CI 1.157, 2.076), tobacco use (HR 1.429 95% CI 1.174, 1.738), and younger patient age (HR 1.024, 95% CI 1.004, 1.044). CONCLUSION The overall clinical failure rate of service members with ACLR is 17.7% with minimum four-year follow-up, where more patients are likely to fail due to revision surgery than medical separation. The cumulative probability of survival at 4 years was 78.5%. Smoking cessation and treating ACLR patients promptly are modifiable risk factors impacting either graft failure or medical separation. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Ashley B Anderson
- Uniformed Services University-Walter Reed National Military Medical Center Department of Surgery Division of Orthopaedics, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA.
| | - Travis J Dekker
- Department of Orthopaedics, Eglin Air Force Base, Eglin, FL, USA
| | - Veronika Pav
- Kennell & Associates, Inc., Falls Church, VA, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy C Mauntel
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Fort Bragg, NC, USA
| | | | | | - Musahl Volker
- Medical Center Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Sansone
- Department of Orthopaedics Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.,Gothenburg University, Göteborg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.,Gothenburg University, Göteborg, Sweden
| | - Jonathan F Dickens
- Uniformed Services University-Walter Reed National Military Medical Center Department of Surgery Division of Orthopaedics, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA.,Department of Orthopaedics Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.,Gothenburg University, Göteborg, Sweden.,Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.,John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, United States Military Academy, West Point, NY, USA.,Duke University Hospital Department of Orthopaedics, Durham, NC, USA
| |
Collapse
|
37
|
The effects of core stabilization exercises on the neuromuscular function of athletes with ACL reconstruction. Sci Rep 2023; 13:2202. [PMID: 36750662 PMCID: PMC9905573 DOI: 10.1038/s41598-023-29126-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Athletes who have undergone anterior cruciate ligament reconstruction (ACLR) often exhibit persistently impaired kinematics and strength. Core stability training appears to be effective for reducing high-risk landing mechanics and preventing primary anterior cruciate ligament (ACL) injuries; however, there have been few attempts to examine their effects in athletes who have undergone ACLR. This study aimed to investigate the effect of eight weeks of simple core stability training on core endurance, hip strength, and knee kinematics in ACLR athletes. Twenty-six male athletes (20-30 years old) with a history of ACL surgery with hamstring tendon autograft were randomly divided into training (n = 13) and control groups (n = 13). The training group performed core stability exercises for eight weeks before starting their team training; the control group did not receive any intervention. Both groups continued their regular team schedule. The core endurance, hip muscle strength, and knee kinematics were assessed by the McGill test, a hand-held dynamometer, and video-taping, respectively. Analysis of covariance test was used for data analysis. The training group showed a significant increase in core endurance, hip abductor and external rotator strength, knee flexion angle, and a significant decrease in the knee valgus angle during single-leg landing in post-training tests compared to their baseline tests (P < 0.05). Our results demonstrated that core stability exercise alters neuromuscular function to a level that is clinically acceptable and statistically significant. Because of the high incidence rate of secondary ACL injury after ACLR, it is recommended that athletes with a history of ACLR benefit from adding core stability exercises to warm-up routines or tertiary prevention programs even after completing post-operative rehabilitation. It is fast and not time-consuming to perform for athletes to reduce the risk factors of re-injury. Trial registration: This study was registered in the Iranian Registry of Clinical Trials with the number IRCT20190224042827N2, registered on 19 December 2019.
Collapse
|
38
|
Tang C, Kwaees TA, Accadbled F, Turati M, Green DW, Nicolaou N. Surgical techniques in the management of pediatric anterior cruciate ligament tears: Current concepts. J Child Orthop 2023; 17:12-21. [PMID: 36755552 PMCID: PMC9900020 DOI: 10.1177/18632521221149059] [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: 10/19/2022] [Accepted: 12/14/2022] [Indexed: 01/16/2023] Open
Abstract
Background Anterior cruciate ligament injury in the child and adolescent patient remains a controversial topic when considering management, especially regarding surgical choices. Treatment variations are seen not just when comparing different countries but also within nations. This arises partly as contemporary treatment is mostly inferred from the adult population who physiologically and in terms of outcomes differ significantly from children. There is an increasing body of evidence for this cohort of patients who have specific challenges and difficulties when determining the optimum treatment. Methods Within this article, we will summarize the current evidence for surgical management of anterior cruciate ligament injury for the pediatric patient. Results and Conclusions There remain many controversies and gaps inthe treatment of Paediatric Anterior cruciate ligament reconstruction and this high risk cohort continues to cause difficulty in identifying the best mode of surgical management. Level of evidence level IV.
Collapse
Affiliation(s)
- Chun Tang
- Department of Paediatric Orthopaedics and Spinal Surgery, Sheffield Children’s Hospital, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Tariq Adam Kwaees
- Department of Paediatric Orthopaedics and Spinal Surgery, Sheffield Children’s Hospital, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Franck Accadbled
- Department of Orthopaedics, Children’s Hospital, CHU de Toulouse, Toulouse, France
| | - Marco Turati
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France
| | - Daniel W Green
- Department of Pediatric Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Nicolas Nicolaou
- Department of Paediatric Orthopaedics and Spinal Surgery, Sheffield Children’s Hospital, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
39
|
Clinical Outcomes of Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-articular Tenodesis Procedures in Skeletally Immature Patients: A Systematic Review From the SANTI Study Group. J Pediatr Orthop 2023; 43:24-30. [PMID: 35980761 DOI: 10.1097/bpo.0000000000002236] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The treatment of anterior cruciate ligament (ACL) tears in the pediatric population has changed significantly in the past few decades. Pediatric patients who underwent ACL reconstruction (ACLR) have a high risk of rerupture of up to 32%. The addition of lateral extra-articular procedures [lateral extra-articular tenodesis (LET)], already shown to be effective in reducing the risk of rerupture in adults, may also be effective in pediatric patients. The purpose of this study was to systematically review the clinical outcomes of ACLR+LET tenodesis in pediatric patients. METHODS Data were collected from Pubmed, MEDLINE, Cochrane, and Scopus Databases according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Studies reporting the clinical outcomes of ACLR+LET in the pediatric population using autograft, return to play, growth disturbances, failure rate, and surgical complications were included. RESULTS A total of 5 studies comprising 381 pediatric patients were included. Three main surgical techniques with common features were used. The mean age of all pediatric patients in the included studies was 11.73 years (range, 5.6 to 16) with a mean follow-up of 50.1 months. The overall graft failure rate of the included studies was 4.65%. The return to play was 95.11%. The mean Lysholm score was 94.51 and the mean Pediatric International Knee Documentation Committee (Pedi-IKDC) was 93.39. In all, 1.9% of the patients had a coronal plane deformity and 0.8% had a limb length discrepancy. 4.6% of the patients had a contralateral ACL tear. CONCLUSIONS A combined ACLR+LET in pediatric patients showed a graft failure ranging from 0% to 13.6% at a mean follow-up of 50.1 months. This low graft failure rate is consistent with ACLR+LET in adults. Further investigations are needed to validate these findings and the potential role of LET in reducing graft rupture rates in this population. LEVEL OF EVIDENCE Level IV-systematic review of level IV studies.
Collapse
|
40
|
Pagliazzi G, Cuzzolin M, Pacchiarini L, Delcogliano M, Filardo G, Candrian C. Physeal-sparing ACL reconstruction provides better knee laxity restoration but similar clinical outcomes to partial transphyseal and complete transphyseal approaches in the pediatric population: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:206-218. [PMID: 35838794 DOI: 10.1007/s00167-022-07032-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/30/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this meta-analysis was to evaluate complete transphyseal (CTP), partial transphyseal (PTP), and physeal-sparing (PS) techniques for anterior cruciate ligament (ACL) reconstruction. METHODS A systematic literature search of the PubMed, Web of Science, Cochrane Library, and Scopus literature databases was performed on 10.05.2021. All human studies evaluating the outcomes of CTP, PTP, and PS techniques were included. The influence of the selected approach was evaluated in terms of rates of retears, return to previous level of sport competition, IKDC subjective and objective scores, Lysholm score, rate of normal Lachman and pivot-shift tests, limb length discrepancy, and hip-knee angle (HKA) deviation. Risk of bias and quality of evidence were assessed following the Downs and Black checklist. RESULTS Forty-nine out of 425 retrieved studies (3260 patients) met the inclusion criteria. The results of the meta-analysis comparing CTP, PTP, and PS approaches for ACL reconstruction in the under 20-year-old population showed a significant difference in terms of differential laxity (CTP 1.98 mm, PTP 1.69 mm, PS 0.22 mm, p < 0.001). No significant differences were seen in terms of growth malalignment, rate of normal Lachman and pivot-shift tests, and rate of normal/quasi-normal IKDC objective score. CONCLUSIONS The present meta-analysis found overall similar results with the three ACL reconstruction approaches. The PS technique showed better results in terms of knee laxity than the PTP and CTP approaches, but this did not lead to a significant difference in terms of subjective and objective scores. No clear superiority of one technique over the others was found with respect to re-ruptures, growth disturbances, and axial deviations. While the argument for avoiding growth malalignment does not seem to be a crucial point, the PS technique should be the preferred approach in a young population to ensure knee laxity restoration. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Gherardo Pagliazzi
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Department of Paediatric Orthopaedics, University of Basel Children's Hospital, Basel, Switzerland
| | - Marco Cuzzolin
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Luca Pacchiarini
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland.
| | - Marco Delcogliano
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| |
Collapse
|
41
|
Cronström A, Tengman E, Häger CK. Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction. Sports Med 2023; 53:91-110. [PMID: 36001289 PMCID: PMC9807539 DOI: 10.1007/s40279-022-01747-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified. OBJECTIVE The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR. METHODS A systematic review with meta-analysis (PROSPERO CRD42020140129) based on PRISMA guidelines was performed. MEDLINE, CINAHL and EMBASE were searched from inception to September 2021. Prospective and retrospective studies addressing risk factors for graft rupture after ACLR in males/females of all ages were considered. Meta-analyses using a random effect model (effect measure: odds ratio [OR] with 95% confidence interval [CI]) were performed. The GRADE tool was used to assess evidence quality. RESULTS Following full-text screening of 310 relevant papers, 117 were eventually included, incorporating up to 133,000 individuals in each meta-analysis. Higher Tegner activity level (≥ 7 vs < 7) at primary injury (OR 3.91, 95% CI 1.69-9.04), increased tibial slope (degrees) (OR 2.21, 95% CI 1.26-3.86), lower psychological readiness to return to sport (RTS) (OR 2.18, 95% CI 1.32-3.61), early surgery (< 12 vs ≥ 12 months) (OR 1.87, 95% CI 1.58-2.22), RTS (pre-injury level) (OR 1.87, 95% CI 1.21-2.91) and family history of ACL injury (OR 1.76, 95% CI 1.34-2.31) were all associated with increased odds of graft rupture. Higher age (OR 0.47, 95% CI 0.39-0.59), female sex (OR 0.88, 95% CI 0.79-0.98), fewer self-reported knee symptoms pre-reconstruction (OR 0.81, 95% CI 0.69-0.95) and concomitant cartilage injuries (OR 0.70, 95% CI 0.62-0.79) instead decreased the odds. Meta-analysis revealed no association between body mass index, smoking, joint laxity, RTS time, knee kinematics, muscle strength or hop performance and graft rupture. CONCLUSION Conspicuous risk factors for graft rupture were mainly sports and hereditary related. Few studies investigated function-related modifiable factors or included sports exposure data.
Collapse
Affiliation(s)
- Anna Cronström
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Eva Tengman
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| |
Collapse
|
42
|
Perelli S, Costa GG, Terron VM, Formagnana M, Bait C, Espregueira-Mendes J, Monllau JC. Combined Anterior Cruciate Ligament Reconstruction and Modified Lemaire Lateral Extra-articular Tenodesis Better Restores Knee Stability and Reduces Failure Rates Than Isolated Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients. Am J Sports Med 2022; 50:3778-3785. [PMID: 36345894 DOI: 10.1177/03635465221128926] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The increase in anterior cruciate ligament (ACL) injuries in pediatric patients and the high failure rate reported in the literature in this population are driving surgeons to search for specific techniques to better restore knee stability. Recent literature has reported that the combination of lateral extra-articular tenodesis (LET) and ACL reconstruction improves outcomes in high-risk patients. However, such advantages in pediatric patients have been infrequently evaluated. PURPOSE To assess whether adding LET to ACL reconstruction can significantly improve knee stability, clinical outcomes, and failure rates in pediatric patients. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A multicentric study involving 3 orthopaedic teaching centers was conducted to evaluate pediatric patients aged between 12 and 16 years who had undergone primary ACL reconstruction using a physeal-sparing femoral tunnel drilling technique. A minimum 2-year follow-up evaluation was required. Based on the surgical technique performed, the patients were divided into 2 group. The patients in group 1 underwent an isolated arthroscopic ACL reconstruction, while the patients in group 2 had an arthroscopic ACL reconstruction in combination with a modified Lemaire LET procedure. Group 1 was a historical control cohort of patients, whereas group 2 was prospectively enrolled. All the patients included in the present study were clinically evaluated using the Pediatric International Knee Documentation Committee (Pedi-IKDC) subjective score and the Pediatric Functional Activity Brief Scale (Pedi-FABS) score. Anteroposterior knee stability was measured using the KT-1000 knee ligament arthrometer, and the objective pivot-shift evaluation was documented using a triaxial accelerometer (Kinematic Rapid Assessment [KiRA]). The included patients also underwent a standardized radiological protocol to evaluate leg-length discrepancies, axial deviation, and degenerative signs preoperatively and at last follow-up. RESULTS This study included 66 pediatric patients with an anatomic hybrid ACL reconstruction using an autologous 4-strand hamstring graft. In group 1, there were 34 patients (mean age, 13.5 ± 1.2 years), while 32 patients (mean age, 13.8 ± 1.4 years) were included in group 2. The clinical outcome scores showed no difference between the 2 groups (Pedi-IKDC, P = .072; Pedi-FABS, P = .180). Nevertheless, the patients in group 2 had better anteroposterior stability measured using a KT-1000 arthrometer (1.9 ± 1.1 mm in group 1 vs 0.8 ± 0.8 mm in group 2; P = .031), as well as better rotational stability measured using the KiRA (-0.59 ± 1.05 m/s2 in group 2 vs 0.98 ± 1.12 m/s2 in group 1; P = .012). The patients in group 1 returned to sports at the same competitive level at a rate of 82.4%, while patients included in group 2 returned at the same competitive level in 90.6% of the cases without a significant difference between the 2 groups (P = .059). No leg-length discrepancies were found between the 2 groups at last follow-up (P = .881). Two patients displayed an increased valgus deformity of 3° on the operated limb at last follow-up (1 patient in group 1 and 1 patient in group 2). Group 1 had a significatively higher cumulative failure rate (14.7% vs 6.3%; P = .021). No intra- or postoperative complications was observed between the 2 groups. CONCLUSION Performing a modified Lemaire LET along with an ACL reconstruction with hamstring graft in pediatric patients reduced the cumulative failure rate and improved objective stability with no increase in intra- or postoperative complications. No significant difference was found between the 2 groups in terms of patient-reported outcomes or in the return-to-sports activity.
Collapse
Affiliation(s)
- Simone Perelli
- Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain.,Knee and Arthroscopy Unit, Department of Orthopedic Surgery, Institut Catalá de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Mario Formagnana
- Orthopaedic Surgery Department, E. Agnelli Hospital, Pinerolo (Torino), Italy
| | - Corrado Bait
- Orthopaedic Surgery Department, Istituto Clinico Villa Aprica, Como, Italy
| | - João Espregueira-Mendes
- Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal.,School of Medicine, University of Minho, Braga, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
| | - Juan Carlos Monllau
- Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain.,Knee and Arthroscopy Unit, Department of Orthopedic Surgery, Institut Catalá de Traumatologia i Medicina de l'Esport (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
43
|
Sugarman BS, Sullivan ZB, Le D, Killelea C, Faherty MS, Diehl LH, Wittstein JR, Riboh JC, Toth AP, Amendola A, Taylor DC, Sell TC. Isometric Knee Strength is Greater in Individuals Who Score Higher on Psychological Readiness to Return to Sport After Primary Anterior Cruciate Ligament Reconstruction. Int J Sports Phys Ther 2022; 17:1330-1339. [PMID: 36518832 PMCID: PMC9718725 DOI: 10.26603/001c.39737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/16/2022] [Indexed: 10/08/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) injury is extremely common among athletes. Rate of second ACL injury due to surgical graft rupture or contralateral limb ACL injury is approximately 15-32%. Psychological readiness to return to sport (RTS) may be an important predictor of successful RTS outcomes. Psychological readiness can be quantified using the ACL Return to Sport after Injury (ACL-RSI) questionnaire, with higher scores demonstrating greater psychological readiness. Purpose The purpose of this study was to investigate differences in functional performance and psychological readiness to return to sport among athletes who have undergone primary ACL reconstruction (ACLR). Study Design Descriptive cohort study. Methods Eighteen athletes who had undergone primary ACLR were tested at time of RTS clearance. The cohort was divided into two groups, high score (HS) and low score (LS), based on median ACL-RSI score, and performance on static and dynamic postural stability testing, lower extremity isokinetic and isometric strength testing, and single leg hop testing was compared between the groups using an independent samples t-test. Results The median ACL-RSI score was 74.17. The average ACL-RSI score was 83.1±6.2 for the HS group and 61.8±8.0 for the LS group. High scorers on the ACL-RSI performed significantly better on isometric knee flexion as measured via handheld dynamometry (22.61% ±6.01 vs. 12.12% ±4.88, p=0.001) than the low score group. Conclusion The findings suggest that increased knee flexion strength may be important for psychological readiness to RTS after primary ACLR. Further research is indicated to explore this relationship, however, a continued emphasis on improving hamstring strength may be appropriate during rehabilitation following ACLR to positively impact psychological readiness for RTS. Level of Evidence III.
Collapse
Affiliation(s)
| | | | - Daniel Le
- School of Medicine University of North Carolina
| | | | | | - Lee H Diehl
- Orthopaedic Surgery Duke University Medical Center
| | | | | | | | | | | | | |
Collapse
|
44
|
Rosso F, Rossi R, Faletti R, Cantivalli A, Blonna D, Bonasia DE. Transepicondylar distance measured on MRI can predict the length of the graft required for different anterior cruciate ligament reconstruction (ACLR) techniques useful for revision surgery. J Orthop Traumatol 2022; 23:50. [PMID: 36242704 PMCID: PMC9569264 DOI: 10.1186/s10195-022-00670-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/24/2022] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study is to find a correlation between linear measurements and the graft length required for different anterior cruciate ligament (ACL) revision techniques, to extract formulas to predict required graft length during the preoperative planning. Methods At time 0 and 30 days later, two observers measured eight linear distances on standard 2D knee magnetic resonance imaging (MRI), and nine curved distances on 3D MRI sequences, corresponding to different techniques for ACL revision, anatomic anterolateral ligament (ALL) reconstruction, and lateral extrarticular tenodesis (LET). Intra- and interobserver reliability was tested for 2D and 3D measurements. The correlation between 2D and 3D measurements was tested. The 2D measurements with highest repeatability and reproducibility, and with strongest correlation with 3D measurements were used to extract formulas to calculate the graft length from 2D values. Results Fifty MRIs acquired with both 2D and 3D sequences were used. The intra- and interobserver reliability of linear 2D measurement was high, with the transepicondylar distance (TD) showing the highest reproducibility and repeatability. The intra- and interobserver reliability of 3D measurements was lower than 2D, but acceptable for all measurements except for ALL reconstruction. The TD showed the strongest correlation with 3D measurements. The formulas extracted to calculate the graft length from the TD proved to be accurate. Conclusion Accurate formulas were created to calculate the graft length needed for different ACL revision techniques and ALL reconstruction/LET techniques from TD. These formulas can be used during preoperative planning of ACL revision cases.
Collapse
Affiliation(s)
- Federica Rosso
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy. .,Università Degli Studi Di Torino, Via Po 8, 10100, Turin, Italy.
| | - Riccardo Faletti
- Department of Radiology, AOU "Città Della Salute e Della Scienza" Hospital, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Antonino Cantivalli
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy
| | - Davide Blonna
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy
| | - Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy
| |
Collapse
|
45
|
Foissey C, Thaunat M, Caron E, Haidar I, Vieira TD, Gomes L, Freychet B, Sonnery-Cottet B, Fayard JM. Combining Anterior Cruciate Ligament Reconstruction With Lateral Extra-Articular Procedures in Skeletally Immature Patients Is Safe and Associated With a Low Failure Rate. Arthrosc Sports Med Rehabil 2022; 4:e1941-e1951. [PMID: 36579042 PMCID: PMC9791843 DOI: 10.1016/j.asmr.2022.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 08/01/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose To analyze the rates of graft ruptures and growth disorders, the level of return to sport, and the clinical results of 2 lateral extra-articular procedures in growing children. Methods This study was a retrospective, single-center study of patients undergoing anterior cruciate ligament (ACL) surgery combined with 2 different lateral extra-articular procedures (anatomic reconstruction with a gracilis graft or modified Lemaire technique with a strip of fascia lata). The measurements of side-to-side anterior laxity and pivot shift were performed preoperatively and at the last follow-up. The sports level and the complications rate were assessed. The minimal clinically important differences (MCID) and patient acceptable symptoms state threshold scores were calculated. Results Thirty-nine patients (40 ACLs) were included (20 anatomic and 20 modified Lemaire) at an average follow-up of 57 months ± 10 [42-74]. One patient (2.5%) was lost to follow-up. The mean age at surgery was 13.8 ± 1.4 years old [9.8; 16.5]. One graft failure was reported (2.6% [0.06-13.5]) at 35.6 months after surgery. Two cases (5.4%) of femoral overgrowth were observed, and one of them required distal femoral epiphysiodesis. Ninety-two percent of the patients returned to sports. At the final follow-up, side-to-side anterior laxity was significantly improved, and no residual pivot shift was recorded in 95% of patients. Eighty-nine percent of the patients presented a Pedi-International Knee Documentation Committee score greater than the MCID postoperatively, and 77% presented a Lysholm score greater than the MCID. Conclusions This series of ACL reconstructions combined with 2 different lateral extra-articular procedures in skeletally immature patients demonstrated promising findings. The low rate of observed complications, including graft rupture and growth disturbance, is encouraging, but the small study population and lack of comparative group precludes reliable conclusions. Level of Evidence IV, therapeutic case series.
Collapse
Affiliation(s)
| | | | | | | | - Thais Dutra Vieira
- Address correspondence to Thais Dutra Vieira, M.D., Centre Orthopédique Santy, 24 avenue Paul Santy, 69008 Lyon, France.
| | | | | | | | | |
Collapse
|
46
|
Butler LS, Janosky JJ, Sugimoto D. Pediatric and Adolescent Knee Injuries. Clin Sports Med 2022; 41:799-820. [DOI: 10.1016/j.csm.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
47
|
Patankar AG, Christino MA, Milewski MD. Psychological Aspects of Adolescent Knee Injuries. Clin Sports Med 2022; 41:595-609. [DOI: 10.1016/j.csm.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
48
|
Feroe AG, Hassan MM, Kocher MS. Physeal-Sparing Anterior Cruciate Ligament Reconstruction with Iliotibial Band Autograft in the Skeletally Immature Knee. Arthrosc Tech 2022; 11:e1597-e1603. [PMID: 36185112 PMCID: PMC9520009 DOI: 10.1016/j.eats.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/14/2022] [Indexed: 02/03/2023] Open
Abstract
Conventional adult anterior cruciate ligament reconstruction techniques are controversial in skeletally immature patients due to the risk of iatrogenic physeal damage and potential growth disturbance. The physeal-sparing, combined intra- and extra-articular anterior cruciate ligament reconstruction using an autogenous iliotibial band was developed to mitigate this risk in prepubescent, skeletally immature patients, with excellent functional outcomes and a low revision rate. This article describes the surgical details of this reproducible reconstruction technique.
Collapse
Affiliation(s)
- Aliya G. Feroe
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children’s Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mahad M. Hassan
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
- TRIA Orthopaedic Center, Bloomington, Minnesota, U.S.A
| | - Mininder S. Kocher
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children’s Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Address correspondence to Mininder S. Kocher, M.D., M.P.H., Boston Children’s Hospital, Orthopaedic Surgery & Sports Medicine, 300 Longwood Ave., Boston, MA 02115, U.S.A.
| |
Collapse
|
49
|
Rohde MS, Cinque ME, LaPrade CM, Ganley TJ, Shea KG. The Spectrum of Anterior Cruciate Ligament Reconstruction Options for the Pediatric and Adolescent Patient: A Narrative Review. J Athl Train 2022; 57:961-971. [PMID: 35380680 PMCID: PMC9842125 DOI: 10.4085/1062-6050-0542.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
As youth sports participation has increased in recent years, injuries to the anterior cruciate ligament (ACL) have become increasingly common in pediatric patients. Historically, ACL reconstruction was delayed in pediatric patients to avoid physeal damage with the potential for leg-length discrepancy or angular deformity. Current research shows that delaying reconstruction or choosing nonoperative management is associated with increased rates of meniscal and chondral injuries, persistent knee instability, and low rates of return to previous activity. Early ACL reconstruction using techniques to avoid physeal growth disturbance is now widely accepted among physicians. The purpose of this review was to describe the pediatric ACL in terms of the relevant anatomy and biomechanics, physical examination, and diagnostic imaging. In addition, the importance of skeletal age and possible physeal injury is discussed in the context of ACL reconstruction options by skeletal age and remaining growth potential.
Collapse
Affiliation(s)
- Matthew S. Rohde
- Department of Orthopaedics, Stanford University School of Medicine, CA
| | - Mark E. Cinque
- Department of Orthopaedics, Stanford University School of Medicine, CA
| | | | | | - Kevin G. Shea
- Department of Orthopaedics, Stanford University School of Medicine, CA
| |
Collapse
|
50
|
Monfort SM, Simon JE, Miko SC, Grooms DR. Effects of cognitive- and motor-dual tasks on postural control regularity following anterior cruciate ligament reconstruction. Gait Posture 2022; 97:109-114. [PMID: 35917701 PMCID: PMC10871862 DOI: 10.1016/j.gaitpost.2022.07.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/28/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND High injury rates following anterior cruciate ligament reconstruction (ACLR) motivate the need to better understand lingering movement deficiencies following return to sport. Athletic competition involves various types of sensory, motor, and cognitive challenges; however, postural control deficiencies during this spectrum of conditions are not well understood following ACLR. RESEARCH QUESTION To what extent is postural control altered following ACLR in the presence of sensory, motor, and cognitive challenges, and does postural control correlate with patient-reported symptoms? METHODS Fourteen individuals following ACLR (4 m/10 f, 21.2 ± 2.4 yr, 76.9 ± 19.1 kg, 1.70 ± 0.14 m) and fourteen matched healthy controls (4 m/10 f, 21.2 ± 1.4 yr, 75.4 ± 15.3 kg, 1.70 ± 0.15 m) participated in the study. Participants completed single-leg balance, ACLR limb or matched side for controls, under four conditions: 1) eyes open, 2) eyes closed, 3) visual-cognitive dual task (i.e., reverse digit span), and 4) motor dual task (i.e., catching a ball). Sample entropy (SEn) was calculated for each balance condition to characterize regularity of center of pressure control. Participants also completed patient-reported outcomes to characterize self-reported knee function, symptoms, and fear. A mixed effects model tested for differences in SEn between balance conditions, and Spearman correlations tested for relationships between SEn and patient-reported outcomes. RESULTS A significant Group-by-Condition interaction was detected (P = 0.043). While the motor dual task and eyes closed balance conditions were associated with the lowest SEn for both groups, only the visual-cognitive dual task condition demonstrated a significant difference between groups, with the ACLR group having lower SEn [95% confidence interval for ΔSEn: (0.03, 0.35)]. Lower KOOS-Sport scores were associated with decreased SEn for the ACLR group (ρ = 0.81, P < 0.001). SIGNIFICANCE These findings are consistent with ACLR individuals using a less automatic approach to postural control compared to controls, particularly when presented with a visual-cognitive challenge. Altered neuromuscular control persists well after ACLR surgery and can be related to patient-reported outcomes.
Collapse
Affiliation(s)
- Scott M Monfort
- Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, MT, USA.
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, USA; School of Applied Health Sciences and Wellness, College of Health Sciences & Professions, Ohio University, Athens, OH, USA
| | - Sarah C Miko
- School of Applied Health Sciences and Wellness, College of Health Sciences & Professions, Ohio University, Athens, OH, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, USA; School of Applied Health Sciences and Wellness, College of Health Sciences & Professions, Ohio University, Athens, OH, USA; School of Rehabilitation and Communication Sciences, College of Health Sciences & Professions, Ohio University, Athens, OH, USA
| |
Collapse
|