Identifying Clinical and MRI Characteristics Associated with Quality of Life in Patients with Anterior Cruciate Ligament Injury: Prognostic Factors for Long-Term

A cross-sectional study on the assessment of COLL11A1, VEGF, and GDF5 gene polymorphisms in Turkish patients with primary knee osteoarthritis

BACKGROUND

This study aimed to assess the relationships between knee OA (KOA) and the genes encoding collagen type XI-alpha1 (COL11A1), vascular endothelial growth factor (VEGF), and growth differentiation factor-5 (GDF-5), which have recently been investigated for their role in the pathophysiology of KOA in a Turkish Population.

METHODS

This study included 100 patients who underwent surgery for KOA at Pamukkale University Medical Faculty's Orthopedics and Traumatology clinics and 100 volunteers with knee pain but without radiological evidence of KOA as a control group. Knee radiographs were assessed, and blood samples were collected from both groups for gene polymorphism analysis, with a focus on COL11A1 rs4907986, COL11A1 rs1241164, VEGF rs833058, and GDF5 rs143383.

RESULTS

Our findings revealed no statistically significant difference between the KOA and control groups for COL11A1 rs4907986 and rs1241164. However, COL11A1 rs4907986 was found to be more common in women. The VEGF rs833058 polymorphism did not significantly differ between the KOA and control groups, although the equal distribution of homozygous polymorphisms in both groups suggests its potential utility in diagnostic considerations. Similarly, no significant difference was observed for the GDF-5 rs143383 polymorphism. However, this polymorphism was more frequent than the wild type in both groups, suggesting its potential association with KOA and its possible utility as an early diagnostic marker.

CONCLUSION

While no significant associations were found between COLL11A1, VEGF, or GDF-5 polymorphisms and KOA, the findings highlight the prevalence of GDF5 rs143383 in both groups, suggesting its potential role in the pathogenesis of KOA and its utility as a diagnostic marker. Further research is needed to better understand the genetic factors involved in KOA.

CLINICAL TRIAL NUMBER

Not applicable.

Prevalence and factor associated with depressive symptoms in patients with osteoarthritis: A cross-sectional study

OBJECTIVE

Osteoarthritis (OA) is a prevalent degenerative joint condition. Among OA patients, depressive symptoms are the most frequent psychiatric disorder, negatively impacting both prognosis and quality of life. This study analyzed the independent factors associated with the development of depressive symptoms in patients with OA and constructed a nomogram to assess the risk of developing depressive symptoms.

METHODS

An analysis was conducted on data from 2093 OA patients in the NHANES database, covering 2007 to 2014. A training set and a validation set were randomly assigned to participants in a 7:3 ratio. Variables significantly associated with depressive symptoms in OA patients were identified using the least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression analyses and nomograms were constructed. Its performance and clinical relevance were assessed using receiver operating characteristic (ROC) curves, C indices, calibration curves, and decision curves.

RESULTS

Among the 2093 OA patients, 357 were assessed as having depressive symptoms. There are eight independent relevant factors, which are gender, age, poverty-to-income ratio (PIR), race, educational attainment, smoking status, diabetes, and sleep disorder. The AUC values of the training and validation sets were 0.718 (95 %CI: 0.683-0.752) and 0.733 (95 %CI: 0.678-0.788). Calibration and decision curve analyses showed that this nomogram exhibits high accuracy, good discrimination, and potential clinical benefits on both training and validation sets.

CONCLUSIONS

We screened to obtain factors associated with depressive symptoms in patients with OA. Dynamic nomograms enable the combination of individual relevant factors for better assessing and managing high-risk OA groups.

Association of Scoliosis and Severe Knee Osteoarthritis: A Case-Control Study

Background/Objectives: Scoliosis has been linked to pelvic position and tilt angle, but few studies have explored its relationship with knee pathology, which can be a significant burden for the elderly. Our aim is to investigate the relationship between scoliosis and knee osteoarthritis (OA). Methods: This population-based case-control study using data from the National Health Insurance Database of Taiwan included patients diagnosed with OA who underwent total knee replacement (TKR) for the first time between 2014 and 2019. Propensity score matching was employed to select controls who did not undergo TKR. Scoliotic cases were identified if they had been diagnosed before knee OA and TKR. The study samples included 10,021 patients with OA/TKR and 30,063 patients without OA/TKR. We then utilized logistic regression analysis to calculate the odds ratio (OR) and 95% confidence interval (CI) for the diagnosis of scoliosis prior to the index date. Results: The findings indicate that patients with pre-existing scoliosis have a 1.627 times greater likelihood of undergoing TKR, with significantly higher odds ratios observed across both female (OR = 1.583) and male (OR = 1.909) and younger (OR = 2.102) and older (OR = 1.575) patients. However, a notable limitation of this study is the absence of data on scoliosis curve side, which prevented us from analyzing the relationship between curve direction and knee arthritis laterality. Furthermore, while we included diagnostic codes indicating left or right TKR, the lack of precise measurements for variables such as lower limb length discrepancies may introduce residual confounding. Conclusions: Our research suggests a significant association between scoliosis and the development of knee OA.

Higher Unilateral Muscle Imbalance at the Contralateral Knee 6 Months after Anterior Cruciate Ligament Reconstruction

There are a considerable number of patients who, after anterior cruciate ligament reconstruction (ACL), suffer from relapses or reduced performance. Data collected from isokinetic dynamometry can provide useful information on the condition of the knee during rehabilitation. Seventy-one young sports patients with ACL reconstruction performed concentric (CON) isokinetic dynamometry (CON/CON 90°/s and CON/CON 240°/s) to assess the muscle strength of the quadriceps (Q) and hamstrings (H) in both knees at 6 months after ACL reconstruction. Limb symmetry index (LSI) and the H/Q ratio were calculated. Comparative statistical tests and multivariate regression were performed. At 90°/s, 57 patients (80.3%) had an LSI below 90% for quadriceps and 28 (60.6%) for hamstring. The number of imbalanced patients according to H/Q ratio was higher in the non-operated knee (n = 56, 78.9%) (p < 0.001). At 240°/s, 49 cases (69.1%) had LSI values above 90% for quadriceps and 37 (52.1%) for hamstrings. Regarding H/Q, imbalanced cases were higher in the non-operated limb (n = 60, 84.5%) (p < 0.001). Strength data at 6 months after ACL reconstruction and post-operative rehabilitation indicated greater unilateral (H/Q) muscle imbalance in the non-operated knee than in the operated knee. Most patients did not achieve the adequate LSI values.

Spanish Version of the Anterior Cruciate Ligament-Quality of Life Questionnaire: Translation, Cross-cultural Adaptation, and Validation

Background

The Anterior Cruciate Ligament-Quality of Life (ACL-QOL) questionnaire is a patient-reported outcome measure used to assess the effect of an anterior cruciate ligament (ACL) injury on the lives of patients. It was originally written in English, which may affect its use when completed by nonnative English speakers.

Purpose

To translate and adapt the ACL-QOL to Spanish and provide evidence of its psychometric properties.

Study Design

Cohort study (diagnosis); Level of evidence, 2.

Methods

A total of 183 patients with an ACL injury from 4 Catalan hospitals were included: 99 patients who had undergone ACL reconstruction (ACLR) completed the Spanish version of the ACL-QOL (ACL-QOL-Sp) twice (mean interval, 15.2 days) in 2 weeks for test-retest reliability, and 84 patients completed the ACL-QOL-Sp, the Lysholm knee scoring scale, the Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale, and the 12-item Short Form Health Survey (SF-12) before and at 4 and 9 months after ACLR to assess responsiveness. The association between the ACL-QOL-Sp and the other outcome measures was evaluated with the Spearman correlation coefficient.

Results

The ACL-QOL-Sp showed good internal consistency (Cronbach alpha = 0.96) and test-retest reliability (intraclass correlation coefficient = 0.97). The standard error of measurement was 3.6, also suggesting the precision of measurements. The smallest detectable change was 9.98 in 94% of patients. No association was found between the ACL-QOL-Sp score and the Tegner score or SF-12 mental component summary score; however, a moderate correlation was found with the overall KOOS score (r = -0.545), Lysholm score (r = 0.509), and SF-12 physical component summary score (r = 0.607). The correlation ranged from weak for the KOOS-Symptoms subscore (r = -0.290) to moderate for the KOOS-Quality of Life subscore (r = -0.698). No ceiling or floor effects were observed. The ACL-QOL-Sp showed a moderate effect size (0.73) at 4 months but a large effect size (1.70) at 9 months.

Conclusion

The ACL-QOL-Sp showed adequate internal consistency, test-retest reliability, and responsiveness in evaluating quality of life after ACLR in Spanish-speaking patients.

Assessments of early patellofemoral joint osteoarthritis features after anterior cruciate ligament reconstruction: a cross-sectional study

BACKGROUND

Persistent anterior knee pain and subsequent patellofemoral joint (PFJ) osteoarthritis (OA) are common symptoms after anterior cruciate ligament reconstruction (ACLR). Quadriceps weakness and atrophy is also common after ACLR. This can be contributed by arthrogenic muscle inhibition and disuse, caused by joint swelling, pain, and inflammation after surgery. With quadriceps atrophy and weakness are associated with PFJ pain, this can cause further disuse exacerbating muscle atrophy. Herein, this study aims to identify early changes in musculoskeletal, functional and quality of health parameters for knee OA after 5 years of ACLR.

METHODS

Patients treated with arthroscopically assisted single-bundle ACLR using hamstrings graft for more than 5 years were identified and recruited from our clinic registry. Those with persistent anterior knee pain were invited back for our follow-up study. For all participants, basic clinical demography and standard knee X-ray were taken. Likewise, clinical history, symptomatology, and physical examination were performed to confirm isolated PFJ pain. Outcome measures including leg quadriceps quality using ultrasound, functional performance using pressure mat and pain using self-reported questionnaires (KOOS, Kujala and IKDC) were assessed. Interobserver reproducibility was assessed by two reviewers.

RESULTS

A total of 19 patients with unilateral injury who had undergone ACLR 5-years ago with persistent anterior knee pain participated in this present study. Toward the muscle quality, thinner vastus medialis and more stiffness in vastus lateralis were found in post-ACLR knees (p < 0.05). Functionally, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb with increasing knee flexion. In accordance, rectus femoris muscle stiffness in the ACLR knee was significantly correlated with pain (p < 0.05).

CONCLUSION

In this study, it was found that patients having higher degree of anterior knee pain were associated with higher vastus medialis muscle stiffness and thinner vastus lateralis muscle thickness. Similarly, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb leading to an abnormal PFJ loading. Taken together, this current study helped to indicate that persistent quadriceps muscle weakness is potential contributing factor to the early development of PFJ pain.

The Relationship of Knee-related Quality of Life With Function, Psychological Factors, Strength, Performance, and Postural Stability After ACL Reconstruction: A Cross-Sectional Study

BACKGROUND

Patients after anterior cruciate ligament reconstruction (ACLR) have decreased health-related quality of life (QoL) compared with healthy control participants. Few studies have verified the predictors of QoL using Quality of Life Outcome Measure Questionnaire for Chronic Anterior Cruciate Ligament Deficiency (ACL-QoL), and no study has verified the relationship of psychological factors and knee function with ACL-QoL in patients after ACLR.

HYPOTHESIS

Knee functional status, muscle strength, performance in hop tests, postural stability, and psychological factors would be the predictors of QoL after ACLR.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 4.

METHODS

A total of 131 participants who had undergone ACLR at least 6 months previously were evaluated. QoL was assessed using ACL-QoL; knee functional status, using International Knee Documentation Committee Subjective Knee (IKDC) and global rating scale (GRS); psychological readiness, using Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI); kinesiophobia, using Tampa Scale for Kinesiophobia (TSK-17); knee strength, using isokinetic dynamometer; performance, using single-leg hop tests; and postural stability, using Biodex Balance System. Pearson's linear correlation and stepwise hierarchical multiple linear regression analyses were performed to verify the predictors of QoL.

RESULTS

ACL-QoL showed a moderate correlation with IKDC (r = 0.69), GRS (r = 0.55), ACL-RSI (r = 0.50), and TSK-17 (r = -0.49). ACL-QoL presented none to low correlations with the variables of muscle strength, postural stability, and performance in hop tests. The variables related to the knee functional status and psychological factors (IKDC, GRS, ACL-RSI, and TSK-17) were found to be the predictors of QoL (R2 = 0.56; P = 0.01).

CONCLUSION

Knee functional status, psychological readiness, and kinesiophobia were the predictors of knee-related QoL in patients after ACLR.

CLINICAL RELEVANCE

These results can assist clinicians in the therapeutic monitoring of the factors that may interfere with QoL in patients after ACLR.

The relationship between drop vertical jump action-observation brain activity and kinesiophobia after anterior cruciate ligament reconstruction: A cross-sectional fMRI study

BACKGROUND

Injury and reconstruction of anterior cruciate ligament (ACL) result in central nervous system alteration to control the muscles around the knee joint. Most individuals with ACL reconstruction (ACLR) experience kinesiophobia which can prevent them from returning to activity and is associated with negative outcomes after ACLR. However, it is unknown if kinesiophobia alters brain activity after ACL injury.

OBJECTIVES

To compare brain activity between an ACLR group and matched uninjured controls during an action-observation drop vertical jump (AO-DVJ) paradigm and to explore the association between kinesiophobia and brain activity in the ACLR group.

METHODS

This cross-sectional study enrolled 26 individuals, 13 with ACLR (5 males and 8 females, 20.62 ± 1.93 years, 1.71 ± 0.1 m, 68.42 ± 14.75 kg) and 13 matched uninjured controls (5 males and 8 females, 22.92 ± 3.17 years, 1.74 ± 0.10 m, 70.48 ± 15.38 kg). Individuals were matched on sex and activity level. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) to evaluate the level of movement-related fear. To assay the brain activity associated with a functional movement, the current study employed an action-observation/motor imagery paradigm during functional magnetic resonance imaging (fMRI).

RESULTS

The ACLR group had lower brain activity in the right ventrolateral prefrontal cortex relative to the uninjured control group. Brain activity of the left cerebellum Crus I and Crus II, the right cerebellum lobule IX, amygdala, middle temporal gyrus, and temporal pole were positively correlated with TSK-11 scores in the ACLR group.

CONCLUSION

Brain activity for the AO-DVJ paradigm was different between the ACLR group and uninjured controls. Secondly, in participants with ACLR, there was a positive relationship between TSK-11 scores and activity in brain areas engaged in fear and cognitive processes during the AO-DVJ paradigm.

Relationships between Jumping Performance and Psychological Readiness to Return to Sport 6 Months Following Anterior Cruciate Ligament Reconstruction: A Cross-Sectional Study

Background: Investigating the relationship between functional capacity and psychological readiness is of paramount importance when planning sport resumption following knee surgery. The aim of this study was to prospectively assess clinical and functional outcomes in athletes 6 months after primary anterior cruciate ligament (ACL) reconstruction and to evaluate whether jumping ability is related to psychological readiness to return to sport following ACL surgery. Methods: Patients who underwent ACL reconstruction were prospectively enrolled and evaluated pre-operatively and 6 months after surgery. Assessment included Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level, and the ACL−Return to Sport after Injury (ACL-RSI) scale. Jumping ability was instrumentally assessed by an infrared optical acquisition system using a test battery including mono- and bipodalic vertical jump and a side hop test. Patients were dichotomized by ACL-RSI into two groups: group A (ACL-RSI > 60), and group B (ACL-RSI < 60). Results: Overall, 29 males and two females from the original study group of 37 patients (84%) were available for clinical evaluation. Mean age at surgery was 34.2 years (SD 11.3). Mean body mass index (BMI) was 25.4 (SD 3.7). Mean overall Lysholm, IKDC, and ACL-RSI scores increased from pre-operatively (p < 0.001). No differences in Tegner score were reported (p = 0.161). Similarly, improvement in most variables regarding jumping ability were observed at follow-up (p < 0.05). According to ACL-RSI, 20 subjects were allocated in group A (ACL-RSI > 60), while 11 were allocated in group B (ACL-RSI < 60). A statistically significant difference in favor of patients in group A was recorded for the post-operative Lysholm and Tegner score, as well as Side Hop test LSI level (p < 0.05), while a trend for IKDC was observed without statistical significance (p = 0.065). Conclusions: Patients with higher values of ACL-RSI scores showed better functional and clinical outcomes as well as improved performance 6 months after ACL reconstruction

Comparison among U-17, U-20, and Professional Female Soccer in the GPS Profiles during Brazilian Championships

The purpose of this study was to compare and characterize the physical demand of official matches among under-17 (U-17), under-20 (U-20), and professional (Pro) female soccer players. All matches were from the U-17, U-20, and Pro National Brazilian Championships. Fourteen Pro matches, nine U-20 matches, and four U-17 matches were analyzed. The external load was measured by the global positioning system (GPS) and the internal workload was assessed by the ratings of perceived exertion (RPE) multiplied by the duration of the match. The activity profiles measured were total distance covered (km), total sprint distance (m) (speed > 18 km·h^-1), number of accelerations and decelerations (between 1 and 2 m·s^-2 and >3 m·s^-2), and top speed (km·h^-1). For the analysis, we standardized all the metrics (except the top speed) by the time (in minutes) played. The Pro group presented higher sprint distances, number of accelerations and decelerations, and top speeds, compared to U-20 and U-17. There was no difference in the total distance among groups, and there was no difference in any GPS metrics between U-20 and U-17. The RPE was higher in Pro and U-17, compared to U-20; however, the workload-RPE was higher in Pro, compared to both U-17 and U-20 groups. These findings provide important information for the evolution of physical performance according to age categories in elite female soccer players.

Assessment of Pain and External Load in Amputee Football Using Digital Pain Drawing and GNSS Tracking—A Pilot Study

Amputee Football (AF) players move using lofstrand crutches (LC) and a single leg during training and matches, which may expose them to excessive loads. Due to a lack of scientific articles describing these issues, this pilot study aims to gain insight into the assessment of pain experiences, as well as external loads during training and matches in AF. An observational study design was followed. Twelve male AF players (2 goalkeepers—GK and 10 field players—FP), 29.9 ± 8.7 years, stature 178.3 ± 6.5 cm, body mass 77.2 ± 8.9 kg were involved in the study. After stature and body mass measures, participants filled out the questionnaire for pain. The players were familiarized with digital pain drawing (DPD). Afterwards, they reported pain typically felt in relation to regular AF training and playing matches—recall pain (RP). During a two-day training camp (TC) with two training sessions each day and during a two-day international tournament (IT) with two matches each day, the players were monitored using DPD, rate of perceived exertion (RPE) and overall pain level (OPL) scales. In addition, during an international tournament (IT), match players were monitored using a GNSS tracking system for external load assessment. All of the participants reported multiple locations of pain after AF training or a match. The area of recall pain (RP) was the highest: +0.5% when compared to the end of TC and +43% when compared to end of IT. The pain area registered at the end of IT was significantly lower (p = 0.028) compared to RP and lower without statistical significance when compared to the end of TC. Average RPE was 3.31 ± 1.38 and average OPL was 2.86 ± 1.81 in 0–10 scale. Typical RPE was higher than that registered at the end of IT. Also typical OPL was higher compared to that registered after the end of TC, which was higher than after the end of IT. The average distance covered by a FP during a match ranged from 2483.14 ± 583.64 m to 2911.08 ± 828.90 m. AF field players suffered pain as a consequence of training and matches. The loads coming from playing and training, combined with pain, may lead to injuries. Further research directions should include assessments of the relationship of pain characteristics, injuries and GNSS tracking parameters.