201
|
Roos PE, Button K, van Deursen RWM. Motor control strategies during double leg squat following anterior cruciate ligament rupture and reconstruction: an observational study. J Neuroeng Rehabil 2014; 11:19. [PMID: 24581172 PMCID: PMC3941570 DOI: 10.1186/1743-0003-11-19] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 02/20/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injured individuals often show asymmetries between the injured and non-injured leg. A better understanding of the underlying motor control could help to improve rehabilitation. Double leg squat exercises allow for compensation strategies. This study therefore investigated motor control strategies during a double leg squat with the aim to investigate if individuals with ACL rupture (ACLD), ACL reconstruction (ACLR) and healthy control subjects (CONT) used different strategies. METHODS 20 ACLD and 21 ACLR were compared to 21 CONT subjects. Participants performed eight continuous double leg squats to their maximum depth, while kinematic and kinetic data were collected. Outcome measures were calculated to quantify the behavior of the injured and non-injured legs and the asymmetry between these legs. RESULTS Squat depth was significantly reduced in ACLR and ACLD compared to CONT (p < 0.05; 106 ± 17°; 105 ± 21°; 113 ± 21°). Peak knee extensor moments (Mkn(mx)) were significantly reduced in ACLR and ACLD compared to CONT in the injured leg only (p < 0.05; 0.045 ± 0.015; 0.046 ± 0.016; 0.059 ± 0.022 body weight.height respectively). There was no significant correlation between symmetry of the support moment (SYM(Msup)) and of the % support moment by the knee (SYM%supkn) in CONT (R(2) = -0.07). Data distribution average indicated good symmetry. ACLR showed a significant correlation between SYM(Msup) and SYM%sup(kn) (R(2) = 0.561) when two participants who did not recover as well were excluded. ACLR controlled knee moment magnitude using two strategies; 1) transfer of support moment to non-injured leg; 2) transfer of support moment from knee to ankle and/or hip of injured leg. These were combined in different proportions, but with the same effect on the knee moment. ACLD showed no significant correlation between SYM(Msup) and SYM%sup(kn) (R(2) = 0.015). Data distribution average indicated reduced symmetry. ACLD therefore used an avoidance strategy: reducing squat depth and subsequently the support moment in the injured leg and the knee contribution. CONCLUSIONS ACLD and ACLR individuals used different squatting strategies compared to controls, with ACLR using controlled and ACLD using avoidance behavior regarding knee loading. This has major implications for rehabilitation as these kinetic strategies cannot be observed, but result in the injured leg not being exercised as intended.
Collapse
Affiliation(s)
- Paulien E Roos
- School of Healthcare Sciences, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
| | | | | |
Collapse
|
202
|
Szivek JA, Heden GJ, Geffre CP, Wenger KH, Ruth JT. In vivotelemetric determination of shear and axial loads on a regenerative cartilage scaffold following ligament disruption. J Biomed Mater Res B Appl Biomater 2014; 102:1415-25. [DOI: 10.1002/jbm.b.33120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 12/03/2013] [Accepted: 01/30/2014] [Indexed: 01/01/2023]
Affiliation(s)
- John A. Szivek
- Orthopaedic Research Lab; Orthopaedic Surgery, University of Arizona; Tucson Arizona
| | - Gregory J. Heden
- Orthopaedic Research Lab; Orthopaedic Surgery, University of Arizona; Tucson Arizona
| | - Christopher P. Geffre
- Orthopaedic Research Lab; Orthopaedic Surgery, University of Arizona; Tucson Arizona
| | | | - John T. Ruth
- Orthopaedic Research Lab; Orthopaedic Surgery, University of Arizona; Tucson Arizona
| |
Collapse
|
203
|
Onur TS, Wu R, Chu S, Chang W, Kim HT, Dang ABC. Joint instability and cartilage compression in a mouse model of posttraumatic osteoarthritis. J Orthop Res 2014; 32:318-23. [PMID: 24167068 PMCID: PMC4462343 DOI: 10.1002/jor.22509] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/03/2013] [Indexed: 02/04/2023]
Abstract
Joint instability and cartilage trauma have been previously studied and identified as key mediators in the development of posttraumatic osteoarthritis (PTOA). The purpose of this study was to use an in vivo model to compare the effect of joint instability, caused by the rupture of the anterior cruciate ligament (ACL), versus cartilage compression. In this study, mice were subjected to cyclical axial loads of twelve Newtons (N) for 240 cycles or until the ACL ruptured. One and eight weeks after this procedure, knees were sectioned coronally and evaluated for osteoarthritis by histology. Using a scoring scale established by [Pritzker K, Gay S, Jimenez S, et al. (2006): Osteoarthritis Cartilage 14:13-29], the articular cartilage across each surface was scored and combined to produce a total degeneration score. The ACL-ruptured group had a significantly greater total degeneration score than either control or compression treated joints at 1 and 8 weeks. Additionally, only sections from ACL-ruptured knees consistently showed synovitis after 1 week and osteophyte formation after 8 weeks. Thus, it appears using that ACL rupture consistently creates a severe osteoarthritis phenotype, while axial cartilage compression alone does not appear to be an appropriate method of inducing PTOA in vivo.
Collapse
Affiliation(s)
- Tarik S. Onur
- San Francisco Veterans Affairs Medical Center; Department of Orthopaedic Surgery
| | - Ruobin Wu
- San Francisco Veterans Affairs Medical Center; Department of Orthopaedic Surgery
| | - Stacey Chu
- San Francisco Veterans Affairs Medical Center; Department of Orthopaedic Surgery
| | - Wenhan Chang
- San Francisco Veterans Affairs Medical Center; Department of Endocrinology,University of California, San Francisco; Department of Endocrinology
| | - Hubert T. Kim
- San Francisco Veterans Affairs Medical Center; Department of Orthopaedic Surgery,University of California, San Francisco; Department of Orthopaedic Surgery
| | - Alexis BC Dang
- San Francisco Veterans Affairs Medical Center; Department of Orthopaedic Surgery,University of California, San Francisco; Department of Orthopaedic Surgery
| |
Collapse
|
204
|
Kluger D, Major MJ, Fatone S, Gard SA. The effect of trunk flexion on lower-limb kinetics of able-bodied gait. Hum Mov Sci 2014; 33:395-403. [DOI: 10.1016/j.humov.2013.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 12/17/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
|
205
|
Theologis AA, Haughom B, Liang F, Zhang Y, Majumdar S, Link TM, Ma CB, Li X. Comparison of T1rho relaxation times between ACL-reconstructed knees and contralateral uninjured knees. Knee Surg Sports Traumatol Arthrosc 2014; 22:298-307. [PMID: 23370983 PMCID: PMC3692610 DOI: 10.1007/s00167-013-2397-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 01/14/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The goal of this study is to compare the cartilage of anterior cruciate ligament (ACL)-reconstructed and uninjured contralateral knees using T 1ρ MRI 12-16 months after ACL reconstructions. METHODS Eighteen patients with ACL-reconstructed knees (10 women, 8 men, mean age = 38.3 ± 7.8 years) were studied using 3T MRI. Injured and contralateral knee MR studies were acquired 12-16 months post-operatively. Cartilage sub-compartment T 1ρ values of each injured knee were compared with the contralateral knee's values. Subgroup analysis of sub-compartment T 1ρ values in both knees was performed between patients with and without meniscal tears at the time of ACL reconstruction using a paired Student's t test. RESULTS In ACL-injured knees, the T 1ρ values of the medial tibia (MT) and medial femoral condyle (MFC) were significantly elevated at 12-16 months follow-up compared to contralateral knees. Patients with a medial meniscal tear had higher MFC and MT T 1ρ values compared to respective regions in contralateral knees. Patients with lateral meniscal tears had higher lateral femoral condyle and LT T 1ρ values compared to respective regions in contralateral knees. There were no differences between the injured and contralateral knees of patients without meniscal tears. CONCLUSIONS T 1ρ MRI can detect significant changes in the medial compartments' cartilage matrix of ACL-reconstructed knees at 1 year post-operatively compared to contralateral knees. The presence of a meniscal tear at the time of ACL reconstruction is a risk factor for cartilage matrix degeneration in the femorotibial compartments on the same side as the meniscal tear.
Collapse
Affiliation(s)
- Alexander A. Theologis
- University of California, San Francisco School of Medicine, Department of Orthopaedic Surgery, 500 Parnassus Ave, MU320W, San Francisco, CA 94143
| | - Bryan Haughom
- University of California, San Francisco School of Medicine, Department of Radiology, China Basin Landing, 185 Berry Street, Suite 350, San Francisco, CA 94107
| | - Fei Liang
- University of California, San Francisco School of Medicine, Department of Radiology, China Basin Landing, 185 Berry Street, Suite 350, San Francisco, CA 94107
| | - Yu Zhang
- University of California, San Francisco School of Medicine, Department of Radiology, China Basin Landing, 185 Berry Street, Suite 350, San Francisco, CA 94107
| | - Sharmila Majumdar
- University of California, San Francisco School of Medicine, Radiology and Biomedical Imaging, 1700 4th Street, Suite 203, San Francisco, CA, 94143
| | - Thomas M. Link
- University of California, San Francisco School of Medicine, Radiology and Biomedical Imaging, 400 Parnassus Avenue, San Francisco, CA, 94122
| | - C. Benjamin Ma
- University of California, San Francisco School of Medicine, Department of Orthopaedic Surgery, 500 Parnassus Ave, MU320W, San Francisco, CA 94143
| | - Xiaojuan Li
- University of California, San Francisco School of Medicine, Department of Radiology, China Basin Landing, 185 Berry Street, Suite 350, San Francisco, CA 94107
| |
Collapse
|
206
|
Tourville TW, Jarrell KM, Naud S, Slauterbeck JR, Johnson RJ, Beynnon BD. Relationship between isokinetic strength and tibiofemoral joint space width changes after anterior cruciate ligament reconstruction. Am J Sports Med 2014; 42:302-11. [PMID: 24275860 PMCID: PMC6604053 DOI: 10.1177/0363546513510672] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been hypothesized that quadriceps muscle weakness is directly associated with the onset and progression of posttraumatic osteoarthritis after anterior cruciate ligament (ACL) injury and reconstruction (ACLR). This relationship, however, has not been studied with a prospective approach that includes the use of tibiofemoral joint space width difference (JSW-D) measurements to characterize the onset of posttraumatic osteoarthritis before the clinical manifestation of the disease. PURPOSE To assess the relationship between thigh muscle strength and JSW-D at presurgery baseline and at 1- and 4-year follow-up after ACLR compared with healthy, noninjured participants of similar sex, age, body mass index, and activity level. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 39 unilateral ACL-injured patients and 32 healthy controls were followed prospectively. During each follow-up, JSW, isokinetic knee strength, single-legged hop, and clinical- and patient-oriented outcomes were assessed. At final follow-up, ACL-injured participants who had JSW-D values (considered as the injured minus normal knee) that were less than the 95% confidence interval of controls were considered to be in the ACLR-narrow group, while those with JSW-D values that fell within the confidence intervals were in the ACLR-normal group. Relationships were evaluated between ACLR groups and controls via multilevel regression, as well as Kruskal-Wallis tests for between-group comparisons at 4-year follow-up. RESULTS At 4-year follow-up, 30 participants (79%) were in the ACLR-normal group and 8 (21%) were in the ACLR-narrow group. At baseline, the extension, flexion, and extension/flexion ratio strength values for both ACLR groups were significantly lower than those of controls (P ≤ .05), while the ACLR-narrow group had significantly lower extension strength at 60 and 180 deg/s (P = .04 and .03, respectively), as well as extension/flexion ratio at 60 deg/s (P = .04) in comparison with the ACL-normal group. At 4-year follow-up, 60 deg/s extension strength deficits persisted in the ACLR-narrow group compared with controls and ACLR-normal participants (P = .01 and .04, respectively). Flexion strength at 180 and 300 deg/s was also significantly lower in the ACLR-narrow group compared with ACLR-normal (P = .02 and .04, respectively), as was single-legged hop distance (P = .04). CONCLUSION Strength deficits present within months after ACL injury and persist through 4 years after ACLR in participants with significantly narrowed JSW-D, compared with ACLR participants with normal JSW-D and controls. This study revealed a significant relationship between quadriceps strength loss that occurred soon after injury and JSW narrowing.
Collapse
Affiliation(s)
- Timothy W. Tourville
- Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont
| | - Kathleen M. Jarrell
- Department of Rehabilitation and Movement Sciences, University of Vermont, Burlington, Vermont
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - James R. Slauterbeck
- Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont
| | - Robert J. Johnson
- Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont
| | - Bruce D. Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont.,Address correspondence to Bruce D. Beynnon, PhD, Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, 95 Carrigan Drive, Stafford Hall 438A, Burlington, VT 05405 ()
| |
Collapse
|
207
|
Scanlan SF, Donahue JP, Andriacchi TP. The in vivo relationship between anterior neutral tibial position and loss of knee extension after transtibial ACL reconstruction. Knee 2014; 21:74-9. [PMID: 23830645 DOI: 10.1016/j.knee.2013.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 04/24/2013] [Accepted: 06/11/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Restoration of anterior tibial stability while avoiding knee extension deficit are a common goal of anterior cruciate ligament (ACL) reconstruction. However, achieving this goal can be challenging. The purpose of this study was to determine whether side-to-side differences in anterior tibial neutral position and laxity are correlated with knee extension deficit in subjects 2 years after ACL reconstruction. METHODS In the reconstructed and contralateral knees of 29 subjects with transtibial reconstruction, anterior tibiofemoral neutral position was measured with MRI and three-dimensional modeling techniques; terminal knee extension at heel strike of walking and during a seated knee extension were measured via gait analysis; and anterior laxity was measured using the KT-1000. RESULTS Knees that approached normal anterior stability and anterior tibial position had increased extension deficit relative to the contralateral knee. On average the reconstructed knee had significantly less (2.1±4.4°) extension during active extension and during heel strike of walking (3.0±4.3º), with increased anterior neutral tibial position (2.5±1.7 mm) and anterior laxity (1.8±1.0 mm). There was a significant correlation between side-to-side difference in anterior neutral tibial position with both measures of knee extension (walking, r=-0.711, p<0.001); active knee extension, r=-0.544, p=0.002). CONCLUSION The results indicate a relationship between the loss of active knee extension and a change in anterior neutral tibial position following non-anatomic transtibial ACL reconstruction. Given the increasing evidence of a link between altered kinematics and premature osteoarthritis, these findings provide important information to improve our understanding of in vivo knee function after ACL reconstruction.
Collapse
Affiliation(s)
- Sean F Scanlan
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA.
| | - Joseph P Donahue
- Sports Orthopedic and Rehabilitation Medicine Associates (SOAR), Redwood City, CA, USA
| | - Thomas P Andriacchi
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA; Palo Alto VA, Bone and Joint Center, Palo Alto, CA, USA; Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| |
Collapse
|
208
|
Comparison of kinematics of ACL-deficient and healthy knees during passive flexion and isometric leg press. Knee 2013; 20:505-10. [PMID: 23044469 DOI: 10.1016/j.knee.2012.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 08/26/2012] [Accepted: 09/06/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studying the kinematics of the ACL deficient (ACLD) knees, during different physiological activities and muscle contraction patterns, can improve our understanding of the joint's altered biomechanics due to ACL deficiency as well as the efficacy and safety of the rehabilitations exercises. METHODS Twenty-five male volunteers, including 11 normal and 14 unilateral ACLD subjects, participated in this study. The kinematics of the injured knees of the ACLD subjects was compared with their intact knees and the healthy group during passive flexion and isometric leg press with the knees flexed from full extension to 45° flexion, with 15° intervals. An accurate registration algorithm was used to obtain the three dimensional kinematical parameters, from magnetic resonance images. RESULTS The ACL deficiency mainly altered the tibial anterior translation, and to some extent its internal rotation, with the change in other parameters not significant. During leg press, the anterior translation of the ACLD knees was significantly larger than that of the normal knees at 30° flexion, but not at 45°. Comparison of the anterior translations of the ACLD knees during leg press with that of the passive flexion revealed improved consistency (CVs changed from 1.2 and 4.0 to 0.6 and 0.6, at 30° and 45° flexion, respectively), but considerable larger translations (means increased by 6.2 and 4.9mm, at 30° and 45° flexion, respectively). CONCLUSION The simultaneous contraction of the quadriceps and hamstrings during leg press, although reduces the knee laxity, cannot compensate for the loss of the ACL to restore the normal kinematics of the joint, at least during early flexion.
Collapse
|
209
|
Sayre EC, Singer J, Thorne A, Wong H, Kopec JA, Esdaile JM, Guermazi A, Nicolaou S, Cibere J. Does moderate or severe nonspecific knee injury affect radiographic osteoarthritis incidence and progression? BMC Musculoskelet Disord 2013; 14:309. [PMID: 24164716 PMCID: PMC4231427 DOI: 10.1186/1471-2474-14-309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 10/22/2013] [Indexed: 11/16/2022] Open
Abstract
Background Knee injuries can lead to radiographic osteoarthritis (ROA). Injuries may be “specific” (SI) including ligament or meniscal tears or patellar trauma, or “nonspecific” (NSI). Our objective is to understand the effect of knee NSI on ROA incidence and progression. Methods 163 people (sample-weighted for population representativeness) aged 40+ with history of knee pain had radiographs assessed on Kellgren Lawrence (KL) grade (0/1 collapsed) at baseline and follow-up (median 3.2 years apart). Progression was an increase in KL score. SIs and NSIs were labeled “severe” (walking aid for ≥1 week) or “moderate”. One model treated SI and NSI as dichotomous (yes/no), and another as trichotomous (none/moderate/severe). Models were adjusted for age, sex, BMI, KL grade and follow-up time. Results SI/NSI history was none, moderate (7.8/24.4%) or severe (11.0/10.8%). Duration at baseline since SI/NSI ranged from <1 year to several decades (SI/NSI mean 4.6/6.5 years). SI was significantly associated with ROA incidence and progression (odds ratio (OR) = 2.90; 95% CI = 1.04, 8.09), but NSI showed no significant effect (OR = 1.36; 95% CI = 0.61, 3.02). In the trichotomous model, severe SI was significant (OR = 4.35, 95% CI = 1.26, 15.02), while moderate SI was not (OR = 1.51, 95% CI = 0.33, 6.84). NSI showed no effect: moderate OR = 1.51, 95% CI = 0.61, 3.74; severe OR = 0.90, 95% CI = 0.24, 3.40. This study had 80% power to detect an NSI OR of 2.9. Conclusion We find no evidence that history of NSI affects knee ROA incidence and progression in a population with knee pain, adjusting for SI, age, sex, BMI, KL grade and follow-up time.
Collapse
Affiliation(s)
- Eric C Sayre
- Arthritis Research Centre of Canada, 5591 No, 3 Rd, Richmond, BC, V6X 2C7, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
210
|
Hoshino Y, Fu FH, Irrgang JJ, Tashman S. Can joint contact dynamics be restored by anterior cruciate ligament reconstruction? Clin Orthop Relat Res 2013; 471:2924-31. [PMID: 23283673 PMCID: PMC3734431 DOI: 10.1007/s11999-012-2761-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotational kinematics has become an important consideration after ACL reconstruction because of its possible influence on knee degeneration. However, it remains unknown whether ACL reconstruction can restore both rotational kinematics and normal joint contact patterns, especially during functional activities. QUESTIONS/PURPOSES We asked whether knee kinematics (tibial anterior translation and axial rotation) and joint contact mechanics (tibiofemoral sliding distance) would be restored by double-bundle (DB) or single-bundle (SB) reconstruction. METHODS We retrospectively studied 17 patients who underwent ACL reconstruction by the SB (n = 7) or DB (n = 10) procedure. We used dynamic stereo x-ray to capture biplane radiographic images of the knee during downhill treadmill running. Tibial anterior translation, axial rotation, and joint sliding distance in the medial and lateral compartments were compared between reconstructed and contralateral knees in both SB and DB groups. RESULTS We observed reduced anterior tibial translation and increased knee rotation in the reconstructed knees compared to the contralateral knees in both SB and DB groups. The mean joint sliding distance on the medial compartment was larger in the reconstructed knees than in the contralateral knees for both the SB group (9.5 ± 3.9 mm versus 7.5 ± 4.3 mm) and the DB group (11.1 ± 1.3 mm versus 7.9 ± 3.8 mm). CONCLUSIONS Neither ACL reconstruction procedure restored normal knee kinematics or medial joint sliding. CLINICAL RELEVANCE Further study is necessary to understand the clinical significance of abnormal joint contact, identify the responsible mechanisms, and optimize reconstruction procedures for restoring normal joint mechanics after ACL injury.
Collapse
Affiliation(s)
- Yuichi Hoshino
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213 USA ,Department of Orthopaedic Surgery, Kobe University, Kobe, Hyogo Japan
| | - Freddie H. Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213 USA
| | - James J. Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213 USA
| | - Scott Tashman
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213 USA
| |
Collapse
|
211
|
Adrian CP, Haussler KK, Kawcak C, Reiser RF, Riegger-Krugh C, Palmer RH, McIlwraith CW, Taylor RA. The role of muscle activation in cruciate disease. Vet Surg 2013; 42:765-73. [PMID: 23980704 DOI: 10.1111/j.1532-950x.2013.12045.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 04/11/2013] [Indexed: 12/01/2022]
Abstract
Traditional investigations into the etiopathogenesis of canine cranial cruciate ligament (CCL) disease have focused primarily on the biological and mechanical insults to the CCL as a passive stabilizing structure of the stifle. However, with recent collaboration between veterinarians and physical therapists, an increased focus on the role of muscle activity and aberrant motor control mechanisms associated with anterior cruciate ligament (ACL) injuries and rehabilitation in people has been transferred and applied to dogs with CCL disease. Motor control mechanisms in both intact and cruciate-deficient human knees may have direct translation to canine patients, because the sensory and motor components are similar, despite moderate anatomic and biomechanical differences. Components of motor control, such as muscle recruitment and the coordination and amplitudes of activation are strongly influenced by afferent proprioceptive signaling from peri- and intra-articular structures, including the cruciate ligaments. In people, alterations in the timing or amplitude of muscle contractions contribute to uncoordinated movement, which can play a critical role in ACL injury, joint instability and the progression of osteoarthritis (OA). A better understanding of motor control mechanisms as they relate to canine CCL disease is vitally important in identifying modifiable risk factors and applying preventative measures, for development of improved surgical and rehabilitative treatment strategies. The purpose of this review article is to analyze the influence of altered motor control, specifically pelvic limb muscle activation, in dogs with CCL disease as evidenced by mechanisms of ACL injury and rehabilitation in people.
Collapse
Affiliation(s)
- Caroline P Adrian
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | | | | | | | | | | | | | | |
Collapse
|
212
|
Fu RZ, Lin DD. Surgical and Biomechanical Perspectives on Osteoarthritis and the ACL Deficient Knee: A Critical Review of the Literature. Open Orthop J 2013; 7:292-300. [PMID: 24015160 PMCID: PMC3763676 DOI: 10.2174/1874325001307010292] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 03/21/2013] [Accepted: 03/28/2013] [Indexed: 11/22/2022] Open
Abstract
This review was undertaken to better understand the debate regarding the issue of osteoarthritis associated with anterior cruciate ligament (ACL) injuries, from a surgical and biomechanical standpoint. Much of the current debate focuses on contributory surgical factors and their relative roles in increasing or decreasing the risk of future osteoarthritis development, primarily highlighting the controversy over whether reconstructive surgery itself is necessarily protective. This review addresses the evolution of ACL reconstruction techniques over time, and with a view to thoroughly examine the role of surgery, outcome differences in procedural technique are reviewed, with a focus on open versus arthroscopic methods, graft choice and the use of a double versus single bundle reconstruction technique. Moreover, other potentially important contributory factors are identified and discussed, such as intrinsic biomechanical alterations sustained at the time of initial injury, and how these may have a more significant role with regard to future osteoarthritic changes in the knee than previously attributed.
Collapse
Affiliation(s)
- Richard Z Fu
- Department of Medicine, Imperial College London, UK
| | - David D Lin
- Department of Surgery, West Middlesex University Hospital, Imperial College Academic Health Sciences Partner, London, UK
| |
Collapse
|
213
|
Su F, Hilton JF, Nardo L, Wu S, Liang F, Link TM, Ma CB, Li X. Cartilage morphology and T1ρ and T2 quantification in ACL-reconstructed knees: a 2-year follow-up. Osteoarthritis Cartilage 2013; 21:1058-67. [PMID: 23707754 PMCID: PMC3752987 DOI: 10.1016/j.joca.2013.05.010] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 04/13/2013] [Accepted: 05/13/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe cartilage matrix and morphology changes, assessed using quantitative magnetic resonance imaging (MRI), after acute anterior cruciate ligament (ACL) injury relative to controls and longitudinally during 2 years following reconstruction. METHOD Fifteen patients with acute ACL injuries and 16 healthy volunteers with a similar demographic profile but no history of osteoarthritis or knee injury were studied. The injured knee of each participant was imaged with a 3.0 T MR scanner at baseline (prior to ACL reconstruction); patients' knees were re-imaged 1 and 2 years after ACL reconstruction. Cartilage T1ρ and T2 values in full thickness, superficial layers, and deep layers, and cartilage thickness of the full layer were quantified within subcompartments of the knee joint. RESULTS In the posterolateral tibial cartilage, T1ρ values were significantly higher in ACL-injured knees than control knees at baseline and were not fully recovered 2 after ACL reconstruction. T1ρ values of medial tibiofemoral cartilage in ACL-injured knees increased over the 2-year study and were significantly elevated compared to that of the control knees. T2 values in cartilage of the central aspect of the medial femoral condyle at the 2-year follow-up were significantly elevated compared with control knees. Cartilage in the posterior regions of the lateral tibia was significantly thinner, while cartilage in the central aspect of the medial femur was significantly thicker than that of controls. Patients with lesions in the posterior horn of the medial meniscus exhibited significantly higher T1ρ values in weight-bearing regions of the tibiofemoral cartilage than that of control subjects over the 2-year period, whereas patients without medial meniscal tears did not. CONCLUSION Quantitative MRI provides powerful in vivo tools to quantitatively evaluate early changes of cartilage matrix and morphology after acute ACL injury and reconstruction, which may possibly relate to the development of post-traumatic osteoarthritis in such joints.
Collapse
Affiliation(s)
- Favian Su
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Joan F. Hilton
- Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Lorenzo Nardo
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Samuel Wu
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Fei Liang
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Thomas M. Link
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Xiaojuan Li
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, CA, USA,Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), San Francisco, CA, USA,Address correspondence and reprint requests to: Dr Xiaojuan Li, Ph.D., Department of Radiology, University of California at San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA. Tel: 1-415-353-4909; Fax: 1-415-353-3438;
| |
Collapse
|
214
|
Van Ginckel A, Verdonk P, Witvrouw E. Cartilage adaptation after anterior cruciate ligament injury and reconstruction: implications for clinical management and research? A systematic review of longitudinal MRI studies. Osteoarthritis Cartilage 2013; 21:1009-24. [PMID: 23685095 DOI: 10.1016/j.joca.2013.04.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 03/12/2013] [Accepted: 04/24/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize the current evidence of magnetic resonance imaging (MRI)-measured cartilage adaptations following anterior cruciate ligament (ACL) reconstruction and of the potential factors that might influence these changes, including the effect of treatment on the course of cartilage change (i.e., surgical vs non-surgical treatment). METHODS A literature search was conducted in seven electronic databases extracting 12 full-text articles. These articles reported on in vivo MRI-related cartilage longitudinal follow-up after ACL injury and reconstruction in "young" adults. Eligibility and methodological quality was rated by two independent reviewers. A best-evidence synthesis was performed for reported factors influencing cartilage changes. RESULTS Methodological quality was heterogenous amongst articles (i.e., score range: 31.6-78.9%). Macroscopic changes were detectable as from 2 years follow-up next to or preceded by ultra-structural and functional (i.e., contact-deformation) changes, both in the lateral and medial compartment. Moderate-to-strong evidence was presented for meniscal lesion or meniscectomy, presence of bone marrow lesions (BMLs), time from injury, and persisting altered biomechanics, possibly affecting cartilage change after ACL reconstruction. First-year morphological change was more aggravated in ACL reconstruction compared to non-surgical treatment. CONCLUSION In view of osteoarthritis (OA) prevention after ACL reconstruction, careful attention should be paid to the rehabilitation process and to the decision on when to allow return to sports. These decisions should also consider cartilage fragility and functional adaptations after surgery. In this respect, the first years following surgery are of paramount importance for prevention or treatment strategies that aim at impediment of further matrix deterioration. Considering the low number of studies and the methodological caveats, more research is needed.
Collapse
Affiliation(s)
- A Van Ginckel
- Fellowship Research Foundation, FWO Aspirant, Flanders, Brussels, Belgium.
| | | | | |
Collapse
|
215
|
Westphal CJ, Schmitz A, Reeder SB, Thelen DG. Load-dependent variations in knee kinematics measured with dynamic MRI. J Biomech 2013; 46:2045-52. [PMID: 23806309 DOI: 10.1016/j.jbiomech.2013.05.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 04/04/2013] [Accepted: 05/25/2013] [Indexed: 10/26/2022]
Abstract
Subtle changes in knee kinematics may substantially alter cartilage contact patterns and moment generating capacities of soft tissues. The objective of this study was to use dynamic magnetic resonance imaging (MRI) to measure the influence of the timing of quadriceps loading on in vivo tibiofemoral and patellofemoral kinematics. We tested the hypothesis that load-dependent changes in knee kinematics would alter both the finite helical axis of the tibiofemoral joint and the moment arm of the patellar tendon. Eight healthy young adults were positioned supine in a MRI-compatible device that could impose either elastic or inertial loads on the lower leg in response to cyclic knee flexion-extension. The elastic loading condition induced concentric quadriceps contractions with knee extension, while an inertial loading condition induced eccentric quadriceps contractions with knee flexion. Peak internal knee extension moments ranged from 23 to 33 N m, which is comparable to loadings seen in normal walking. We found that anterior tibia translation, superior patella glide, and anterior patella translation were reduced by an average of 5.1, 5.7 and 2.9 mm when quadriceps loading coincided with knee flexion rather than knee extension. These kinematic variations induced a distal shift in the finite helical axis of the tibiofemoral joint and a reduction in the patellar tendon moment arm. We conclude that it may be important to consider such load-dependent changes in knee kinematics when using models to ascertain soft tissue and cartilage loading during functional tasks such as gait.
Collapse
Affiliation(s)
- Christopher J Westphal
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI 53706-1572, United States
| | | | | | | |
Collapse
|
216
|
Wilson DR, McWalter EJ, Johnston JD. The measurement of joint mechanics and their role in osteoarthritis genesis and progression. Rheum Dis Clin North Am 2013; 39:21-44. [PMID: 23312409 DOI: 10.1016/j.rdc.2012.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mechanics play a role in the initiation and progression of osteoarthritis. However, our understanding of which mechanical parameters are most important, and what their impact is on the disease, is limited by the challenge of measuring the most important mechanical quantities in living subjects. Consequently, comprehensive statements cannot be made about how mechanics should be modified to prevent, slow or arrest osteoarthritis. Our current understanding is based largely on studies of deviations from normal mechanics caused by malalignment, injury, and deformity. Some treatments for osteoarthritis focus on correcting mechanics, but there appears to be scope for more mechanically based interventions.
Collapse
Affiliation(s)
- David R Wilson
- Department of Orthopaedics, Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | | |
Collapse
|
217
|
Beveridge JE, Shrive NG, Frank CB. Repeatability and precision of a weighted centroid method for estimating dynamicin vivotibiofemoral surface interactions in sheep. Comput Methods Biomech Biomed Engin 2013; 17:1853-63. [DOI: 10.1080/10255842.2013.772592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
218
|
Di Stasi SL, Logerstedt D, Gardinier ES, Snyder-Mackler L. Gait patterns differ between ACL-reconstructed athletes who pass return-to-sport criteria and those who fail. Am J Sports Med 2013; 41:1310-8. [PMID: 23562809 PMCID: PMC3732407 DOI: 10.1177/0363546513482718] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The current standard of practice for an athlete to return to sport after anterior cruciate ligament (ACL) reconstruction is varied. Attempt to return to activity is typically advised 6 months after surgery, but functional performance deficits and gait abnormalities are often still evident and may have important implications on future function. HYPOTHESIS When comparing the involved and uninvolved limbs, patients who failed return-to-sport (RTS) criteria would demonstrate (1) smaller peak knee angles, extensor moments, and peak power absorption at the knee of the involved limb and (2) larger peak hip angles, extensor moments, and peak power generation of the involved limb. STUDY DESIGN Controlled laboratory study. METHODS A total of 42 patients completed functional and biomechanical gait assessment 6 months after ACL reconstruction. Functional testing involved an isometric quadriceps strength test, 4 single-legged hop tests, and 2 self-report questionnaires. Three-dimensional motion analysis was used to measure sagittal plane kinematics and kinetics of the hip and knee. A mixed-model analysis of variance and post hoc t tests were used to compare the limb symmetry of those who passed and those who did not pass RTS criteria. Minimal clinically important differences were calculated from healthy gait data and used to further define meaningful limb asymmetries. RESULTS Twenty of the 42 (48%) patients passed RTS criteria 6 months after ACL reconstruction. Patients who did not pass the criteria demonstrated statistically significant differences between limbs on all kinematic and kinetic variables at the knee (P ≤ .027). Clinically meaningful asymmetries at the hip were also identified in this group. Only kinetic asymmetries at the knee were identified in the patients who passed RTS criteria. CONCLUSION Athletes who demonstrate superior functional performance 6 months after ACL reconstruction may have fewer abnormal and asymmetrical gait behaviors than their poorer performing counterparts. Patients who did not pass RTS criteria not only demonstrated larger kinematic and kinetic asymmetries between limbs but also appeared to use a gait strategy more closely aligned with athletes early after ACL rupture. CLINICAL RELEVANCE Poor performance on a battery of functional performance measures may be related to the presence of movement asymmetries in athletes after ACL reconstruction. Objective RTS criteria have the potential to provide information to clinicians who determine when these athletes return to activity, and may aid in the prescription of targeted rehabilitation to address underlying movement asymmetry.
Collapse
Affiliation(s)
- Stephanie L. Di Stasi
- Sports Health & Performance Institute, The Ohio State University Sports Medicine, Columbus, Ohio.,Address correspondence to Stephanie L. Di Stasi, PT, PhD, OCS, The Ohio State University Sports Medicine, Sports Health & Performance Institute, 2050 Kenny Road, Suite 3100, Columbus, OH 43221 ()
| | - David Logerstedt
- Department of Physical Therapy, College of Health Sciences, Newark, Delaware.,Delaware Rehabilitation Institute, Newark, Delaware
| | - Emily S. Gardinier
- Delaware Rehabilitation Institute, Newark, Delaware.,Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
| | - Lynn Snyder-Mackler
- Department of Physical Therapy, College of Health Sciences, Newark, Delaware.,Delaware Rehabilitation Institute, Newark, Delaware.,Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
| |
Collapse
|
219
|
Herfat ST, Boguszewski DV, Nesbitt RJ, Shearn JT. Effect of perturbing a simulated motion on knee and anterior cruciate ligament kinetics. J Biomech Eng 2013; 134:104504. [PMID: 23083204 DOI: 10.1115/1.4007626] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Current surgical treatments for common knee injuries do not restore the normal biomechanics. Among other factors, the abnormal biomechanics increases the susceptibility to the early onset of osteoarthritis. In pursuit of improving long term outcome, investigators must understand normal knee kinematics and corresponding joint and anterior cruciate ligament (ACL) kinetics during the activities of daily living. Our long term research goal is to measure in vivo joint motions for the ovine stifle model and later simulate these motions with a 6 degree of freedom (DOF) robot to measure the corresponding 3D kinetics of the knee and ACL-only joint. Unfortunately, the motion measurement and motion simulation technologies used for our project have associated errors. The objective of this study was to determine how motion measurement and motion recreation error affect knee and ACL-only joint kinetics by perturbing a simulated in vivo motion in each DOF and measuring the corresponding intact knee and ACL-only joint forces and moments. The normal starting position for the motion was perturbed in each degree of freedom by four levels (-0.50, -0.25, 0.25, and 0.50 mm or degrees). Only translational perturbations significantly affected the intact knee and ACL-only joint kinetics. The compression-distraction perturbation had the largest effect on intact knee forces and the anterior-posterior perturbation had the largest effect on the ACL forces. Small translational perturbations can significantly alter intact knee and ACL-only joint forces. Thus, translational motion measurement errors must be reduced to provide a more accurate representation of the intact knee and ACL kinetics. To account for the remaining motion measurement and recreation errors, an envelope of forces and moments should be reported. These force and moment ranges will provide valuable functional tissue engineering parameters (FTEPs) that can be used to design more effective ACL treatments.
Collapse
Affiliation(s)
- Safa T Herfat
- Department of Biomedical Engineering, Tissue Engineering and Biomechanics Laboratories, University of Cincinnati, Cincinnati, OH 45221, USA.
| | | | | | | |
Collapse
|
220
|
Imhauser C, Mauro C, Choi D, Rosenberg E, Mathew S, Nguyen J, Ma Y, Wickiewicz T. Abnormal tibiofemoral contact stress and its association with altered kinematics after center-center anterior cruciate ligament reconstruction: an in vitro study. Am J Sports Med 2013; 41:815-25. [PMID: 23470858 PMCID: PMC4086881 DOI: 10.1177/0363546512475205] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Abnormal tibiofemoral contact stress and aberrant kinematics may influence the progression of osteoarthritis in the anterior cruciate ligament (ACL)-deficient and the ACL-reconstructed knee. However, relationships between contact stress and kinematics after ACL reconstruction are poorly understood. Therefore, we posed the following research questions: (1) How do ACL deficiency and reconstruction affect the kinematics of and contact stress in the tibiofemoral joint? (2) What kinematic differences are associated with abnormal contact stress after ACL reconstruction? HYPOTHESIS Center-center ACL reconstruction will not restore knee kinematics and contact stress. Correlations will exist between abnormal contact stress and aberrant kinematics after ACL reconstruction. STUDY DESIGN Controlled laboratory study. METHODS Clinical tests of anterior and rotational stability were simulated on 11 cadaveric knees using an industrial robot. Tests were conducted with the ACL intact, sectioned, and after single-bundle ACL reconstruction using a quadrupled hamstring autograft with tunnels drilled through the center of the native footprints. Kinematics were recorded during the tests. Contact stress was continuously recorded from a stress transducer fixed to the tibial plateau, and mean contact stress was calculated regionally. RESULTS ACL deficiency resulted in increased mean contact stress in the posterior sectors of the medial and lateral compartments under anterior and rotational loads, respectively. Reconstruction reduced stress in these locations; however, contact stress abnormalities remained. On average, kinematics were overconstrained after ACL reconstruction (≤1.8 mm and ≤2.6° in all directions). However, combinations of overconstrained and underconstrained motions in abduction/adduction and medial-lateral translation in response to combined moments, and anterior-posterior translation, medial-lateral translation, and axial rotation in response to an anterior load were associated with abnormal mean contact stress. CONCLUSION ACL reconstruction reduces high stresses generated in the posterior compartment of the ACL-deficient knee. Abnormal contact stress after ACL reconstruction is related to multiplanar variations in knee kinematics. CLINICAL RELEVANCE Clinical measures of multiplanar kinematics may help to better characterize the quality of ACL reconstruction. Such measures may help identify patients at increased risk of long-term joint degeneration following this surgery.
Collapse
Affiliation(s)
- Carl Imhauser
- Biomechanics Department, Hospital for Special Surgery, New York, New York
| | - Craig Mauro
- Burke and Bradley Orthopedics, St Margaret, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Daniel Choi
- Biomechanics Department, Hospital for Special Surgery, New York, New York
| | - Eric Rosenberg
- Biomechanics Department, Hospital for Special Surgery, New York, New York
| | - Stephen Mathew
- Biomechanics Department, Hospital for Special Surgery, New York, New York
| | - Joseph Nguyen
- Epidemiology and Biostatistics, Hospital for Special Surgery, New York, New York
| | - Yan Ma
- Epidemiology and Biostatistics, Hospital for Special Surgery, New York, New York
| | - Thomas Wickiewicz
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York Investigation performed at the Biomechanics Department, Hospital for Special Surgery, New York, New York
| |
Collapse
|
221
|
Deneweth JM, Newman KE, Sylvia SM, McLean SG, Arruda EM. Heterogeneity of tibial plateau cartilage in response to a physiological compressive strain rate. J Orthop Res 2013; 31:370-5. [PMID: 22952052 DOI: 10.1002/jor.22226] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 08/16/2012] [Indexed: 02/04/2023]
Abstract
Knowledge of the extent to which tibial plateau cartilage displays non-uniform mechanical topography under physiologically relevant loading conditions is critical to evaluating the role of biomechanics in knee osteoarthritis. Cartilage explants from 21 tibial plateau sites of eight non-osteoarthritic female cadaveric knees (age: 41-54; BMI: 14-20) were tested in unconfined compression at 100% strain/s. The elastic tangent modulus at 10% strain (E(10%) ) was calculated for each site and averaged over four geographic regions: not covered by meniscus (I); covered by meniscus-anterior (II); covered by meniscus-exterior (III); and covered by meniscus-posterior (IV). A repeated-measures mixed model analysis of variance was used to test for effects of plateau, region, and their interaction on E(10%) . Effect sizes were calculated for each region pair. E(10%) was significantly different (p<0.05) for all regional comparisons, except I-II and III-IV. The regional pattern of variation was consistent across individuals. Moderate to strong effect sizes were evident for regional comparisons other than I-II on the lateral side and III-IV on both sides. Healthy tibial cartilage exhibits significant mechanical heterogeneity that manifests in a common regional pattern across individuals. These findings provide a foundation for evaluating the biomechanical mechanisms of knee osteoarthritis.
Collapse
Affiliation(s)
- Jessica M Deneweth
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan 48109, USA.
| | | | | | | | | |
Collapse
|
222
|
Struewer J, Ziring E, Oberkircher L, Schüttler KF, Efe T. Isolated anterior cruciate ligament reconstruction in patients aged fifty years: comparison of hamstring graft versus bone-patellar tendon-bone graft. INTERNATIONAL ORTHOPAEDICS 2013; 37:809-17. [PMID: 23377111 DOI: 10.1007/s00264-013-1807-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/19/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Anterior cruciate ligament (ACL) deficiency contributes to symptomatic functional instability of the knee, regardless of age. We evaluated patient-reported clinical outcome, instrumental stability and prevalence of radiological osteoarthritis based on two homogenous patient samples aged 50 years, an average of three years after isolated ACL reconstruction. METHODS ACL reconstruction using a bone-patellar tendon-bone (BPTB) autograft was done in 19 patients and a four-stranded semitendinosus tendon (ST) autograft in 22 patients. Clinical and functional follow-up assessment was performed an average of 32 months after surgical treatment. Clinical and functional follow-up assessment included the International Knee Documentation Committee (IKDC) score, Tegner score and Lysholm score. Instrumental stability testing was carried out using the KT-1000™ arthrometer. The degree of degenerative changes and prevalence of osteoarthritis was based on the Kellgren-Lawrence classification. RESULTS Mean follow-up was 32 months (range, 28-36). Mean age was 49.4 years in both groups. The median pre-injury Tegner score was 5.5 (range, 2-8) and the median preoperative Lysholm score was 35 (range, 15-69). At two years, all variables improved significantly for both groups compared to the preoperative values (P < 0.05), with no significant intergroup differences. Approximately 76 % of patients were graded A or B according to the IKDC score in both groups. Activity level according to the scores of Tegner and Lysholm was 4.9/5.3 and 83.4/82.5 on two-year-follow up in both groups. Radiological assessment reported degenerative changes of grade I Osteoarthritis (OA) in 36 % of patients. Grade-II OA was found in 31 % of patients. Grade-III OA and grade-IV OA were found in about 24 % and 7 % of all patients, respectively. Correlation analyses showed significant relationships between conservation of knee-joint stability and clinical outcome according to the IKDC score, and activity level according to the Lysholm score (p < 0.05). CONCLUSION Arthroscopic ACL reconstruction using either BPTB graft or hamstring graft in appropriately selected middle-aged patients results in patient satisfaction and good clinical results, with return to a reasonable level of activity regardless of surgical method and graft choice.
Collapse
Affiliation(s)
- Johannes Struewer
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Baldingerstraße, 35043, Marburg, Germany.
| | | | | | | | | |
Collapse
|
223
|
The Health and Structural Consequences of Acute Knee Injuries Involving Rupture of the Anterior Cruciate Ligament. Rheum Dis Clin North Am 2013; 39:107-22. [DOI: 10.1016/j.rdc.2012.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
224
|
Levine JW, Kiapour AM, Quatman CE, Wordeman SC, Goel VK, Hewett TE, Demetropoulos CK. Clinically relevant injury patterns after an anterior cruciate ligament injury provide insight into injury mechanisms. Am J Sports Med 2013; 41:385-95. [PMID: 23144366 PMCID: PMC3935824 DOI: 10.1177/0363546512465167] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The functional disability and high costs of treating anterior cruciate ligament (ACL) injuries have generated a great deal of interest in understanding the mechanism of noncontact ACL injuries. Secondary bone bruises have been reported in over 80% of partial and complete ACL ruptures. PURPOSE The objectives of this study were (1) to quantify ACL strain under a range of physiologically relevant loading conditions and (2) to evaluate soft tissue and bony injury patterns associated with applied loading conditions thought to be responsible for many noncontact ACL injuries. STUDY DESIGN Controlled laboratory study. METHODS Seventeen cadaveric legs (age, 45 ± 7 years; 9 female and 8 male) were tested utilizing a custom-designed drop stand to simulate landing. Specimens were randomly assigned between 2 loading groups that evaluated ACL strain under either knee abduction or internal tibial rotation moments. In each group, combinations of anterior tibial shear force, and knee abduction and internal tibial rotation moments under axial impact loading were applied sequentially until failure. Specimens were tested at 25° of flexion under simulated 1200-N quadriceps and 800-N hamstring loads. A differential variable reluctance transducer was used to calculate ACL strain across the anteromedial bundle. A general linear model was used to compare peak ACL strain at failure. Correlations between simulated knee injury patterns and loading conditions were evaluated by the χ2 test for independence. RESULTS Anterior cruciate ligament failure was generated in 15 of 17 specimens (88%). A clinically relevant distribution of failure patterns was observed including medial collateral ligament tears and damage to the menisci, cartilage, and subchondral bone. Only abduction significantly contributed to calculated peak ACL strain at failure (P = .002). While ACL disruption patterns were independent of the loading mechanism, tibial plateau injury patterns (locations) were significantly (P = .002) dependent on the applied loading conditions. Damage to the articular cartilage along with depression of the midlateral tibial plateau was primarily associated with knee abduction moments, while cartilage damage with depression of the posterolateral tibial plateau was primarily associated with internal tibial rotation moments. CONCLUSION The current findings demonstrate the relationship between the location of the tibial plateau injury and ACL injury mechanisms. The resultant injury locations were similar to the clinically observed bone bruises across the tibial plateau during a noncontact ACL injury. These findings indicate that abduction combined with other modes of loading (multiplanar loading) may act to produce ACL injuries. CLINICAL RELEVANCE A better understanding of ACL injury mechanisms and associated risk factors may improve current preventive, surgical, and rehabilitation strategies and limit the risk of ACL and secondary injuries, which may in turn minimize the future development of posttraumatic osteoarthritis of the knee.
Collapse
Affiliation(s)
- Jason W. Levine
- Engineering Center for Orthopaedic Research Excellence (ECORE), The University of Toledo, Toledo, Ohio.,Departments of Orthopaedics and Bioengineering, The University of Toledo, Toledo, Ohio
| | - Ata M. Kiapour
- Engineering Center for Orthopaedic Research Excellence (ECORE), The University of Toledo, Toledo, Ohio.,Departments of Orthopaedics and Bioengineering, The University of Toledo, Toledo, Ohio
| | - Carmen E. Quatman
- Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio.,Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio
| | - Samuel C. Wordeman
- Departments of Orthopaedics and Bioengineering, The University of Toledo, Toledo, Ohio.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Vijay K. Goel
- Engineering Center for Orthopaedic Research Excellence (ECORE), The University of Toledo, Toledo, Ohio.,Departments of Orthopaedics and Bioengineering, The University of Toledo, Toledo, Ohio
| | - Timothy E. Hewett
- Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio.,Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio.,Departments of Physiology and Cell Biology and Family Medicine and the School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio.,Sports Medicine Biodynamics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Constantine K. Demetropoulos
- Engineering Center for Orthopaedic Research Excellence (ECORE), The University of Toledo, Toledo, Ohio.,Departments of Orthopaedics and Bioengineering, The University of Toledo, Toledo, Ohio.,Address correspondence to Constantine K. Demetropoulos, PhD, Engineering Center for Orthopaedic Research Excellence (ECORE), The University of Toledo, 2801 West Bancroft Street, 5035 Nitschke Hall, MS 303, Toledo, OH 43606 ()
| |
Collapse
|
225
|
Scanlan SF, Favre J, Andriacchi TP. The relationship between peak knee extension at heel-strike of walking and the location of thickest femoral cartilage in ACL reconstructed and healthy contralateral knees. J Biomech 2013; 46:849-54. [PMID: 23375789 DOI: 10.1016/j.jbiomech.2012.12.026] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 12/09/2012] [Accepted: 12/28/2012] [Indexed: 10/27/2022]
Abstract
Reports that knee cartilage health is sensitive to kinematic changes, combined with reports of extension loss following ACL reconstruction, underscores the importance of restoring ambulatory knee extension in the context of preventing premature osteoarthritis. The purpose of this study was to test the relationship between individual variations in peak knee extension at heel-strike of walking and the anterior-posterior location of thickest cartilage in the medial and lateral femoral condyles of healthy contralateral and ACL reconstructed knees. In vivo gait analysis and knee MR images were collected from 29 subjects approximately 2 years after unilateral ACL reconstruction. Knee extension was measured at heel-strike of walking and 3-D femoral cartilage thickness models were reconstructed from MR images. The ACL reconstructed knees had significantly reduced knee extension (-1.5±4.2°) relative to the contralateral knees (-4.6±3.4°) at heel-strike of walking but did not have side-to-side differences in the anterior-posterior location or magnitude of thickest medial and lateral femoral cartilage. The anterior-posterior location of the thickest medial femoral cartilage was correlated with knee extension at heel-strike in both the healthy contralateral (R(2)=0.356, p<0.001) and reconstructed (R(2)=0.234, p=0.008) knees. These results suggest that ACL reconstruction can impair terminal extension at periods of ambulatory loading known to be related to cartilage morphology in healthy joints. The fact that the femoral cartilage thickness distribution had not changed at 2 years post-op, even in the subset of subjects with extension loss, suggests that loads may be shifted to thinner cartilage regions, which could have important implications on long-term joint health.
Collapse
Affiliation(s)
- Sean F Scanlan
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA.
| | | | | |
Collapse
|
226
|
Osteoarthritis as a disease of mechanics. Osteoarthritis Cartilage 2013; 21:10-5. [PMID: 23041436 PMCID: PMC3538894 DOI: 10.1016/j.joca.2012.09.012] [Citation(s) in RCA: 434] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 08/24/2012] [Accepted: 09/19/2012] [Indexed: 02/02/2023]
Abstract
Mechanics means relating to or caused by movement or physical forces. In this paper, I shall contend that osteoarthritis (OA) is almost always caused by increased physical forces causing damage to a joint. While examples of joint injury causing OA are numerous, I shall contend that most or almost all OA is caused in part by mechanically induced injury to joint tissues. Further, once joint pathology has developed, as is the case for almost all clinical OA, pathomechanics overwhelms all other factors in causing disease progression. Treatments which correct the pathomechanics have long lasting favorable effects on pain and joint function compared with treatments that suppress inflammation which have only temporary effects. I shall lastly contend that the mechanically induced joint injury leads to variable inflammatory responses but that the role of this inflammation in worsening structural damage in an already osteoarthritic joint has not yet been proven.
Collapse
|
227
|
Anterior Cruciate Ligament Tear: Surgical Reconstruction Versus Nonsurgical Management. PM R 2012; 4:1006-14. [DOI: 10.1016/j.pmrj.2012.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 11/09/2012] [Indexed: 11/22/2022]
|
228
|
Peng J, Zheng NN, Fan J. Leveraging social supports for improving personal expertise on ACL reconstruction and rehabilitation. IEEE J Biomed Health Inform 2012. [PMID: 23193248 DOI: 10.1109/titb.2012.2226737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this paper, a social health support system is developed to assist both ACL (anterior cruciate ligament) patients and clinicians on making better decisions and choices for ACL reconstruction and rehabilitation. By providing a good platform to enable more effective sharing of personal expertise and ACL treatments, our social health support system can allow: (1) ACL patients to identify the best-matching social groups and locate the most suitable expertise for personal health management; and (2) clinicians to easily locate the best-matching ACL patients and learn from well-done treatments, so that they can make better decisions for new ACL patients (who have similar ACL injuries and close social principles with those best-matching ACL patients) and prescribe safer and more effective knee rehabilitation treatments.
Collapse
|
229
|
The pathophysiology of osteoarthritis: a mechanical perspective on the knee joint. PM R 2012; 4:S3-9. [PMID: 22632700 DOI: 10.1016/j.pmrj.2012.01.020] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 11/21/2022]
Abstract
Osteoarthritis (OA) is the most frequent cause of disability in the United States, with the medial compartment of the knee being most commonly affected. The initiation and progression of knee OA is influenced by many factors, including kinematics. In response to loading during weight-bearing activity, cartilage in healthy knees demonstrates spatial adaptations in morphology and mechanical properties. These adaptations allow certain regions of the cartilage to respond to loading; other regions are less well suited to accommodate loading. Alterations in normal knee kinematics shift loading from cartilage regions adapted for loading to regions less well suited for loading, which leads to the initiation and progression of degenerative processes consistent with knee OA. Kinematic variables that are associated with the development, progression, and severity of knee OA are the adduction moment and tibiofemoral rotation. Because of its strong correlation with disease progression and pain, the peak adduction moment during gait has been identified as a target for treatment design. Gait modification offers a noninvasive option for seeking significant reductions. Gait modification has the potential to reduce pain and slow the progression of medial compartment knee OA.
Collapse
|
230
|
Delahunt E, Prendiville A, Sweeney L, Chawke M, Kelleher J, Patterson M, Murphy K. Hip and knee joint kinematics during a diagonal jump landing in anterior cruciate ligament reconstructed females. J Electromyogr Kinesiol 2012; 22:598-606. [DOI: 10.1016/j.jelekin.2012.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 02/16/2012] [Accepted: 02/16/2012] [Indexed: 01/14/2023] Open
|
231
|
Proffen BL, McElfresh M, Fleming BC, Murray MM. A comparative anatomical study of the human knee and six animal species. Knee 2012; 19:493-9. [PMID: 21852139 PMCID: PMC3236814 DOI: 10.1016/j.knee.2011.07.005] [Citation(s) in RCA: 259] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 06/03/2011] [Accepted: 07/17/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Animal models are an indispensable tool for developing and testing new clinical applications regarding the treatment of acute injuries and chronic diseases of the knee joint. Therefore, the purpose of this study was to compare the anatomy of the intra-articular structures of the human knee to species commonly used in large animal research studies. METHODS Fresh frozen cow (n=4), sheep (n=3), goat (n=4), dog (n=4), pig (n=5), rabbit (n=5), and human (n=4) cadaveric knees were used. Passive range of motion and intra-articular structure sizes of the knees were measured, the structure sizes normalized to the tibial plateau, and compared among the species. RESULTS Statistically significant differences in the range of motion and intra-articular structure sizes were found among all the species. Only the human knee was able to attain full extension. After normalization, only the pig ACL was significantly longer than the human counterpart. The tibial insertion site of the ACL was split by the anterior lateral meniscus attachment in the cow, sheep, and pig knees. The sheep PCL had two distinct tibial insertion sites, while all the other knees had only one. Furthermore, only in human knees, both lateral meniscal attachments were located more centrally than the medial meniscal attachments. CONCLUSIONS/CLINICAL RELEVANCE Despite the relatively preserved dimensions of the cruciate ligaments, menisci, and intercondylar notch amongst human and animals, structural differences in the cruciate ligament attachment sites and morphology of the menisci between humans and animals are important to consider when selecting an animal model.
Collapse
Affiliation(s)
- Benedikt L Proffen
- Department of Orthopaedic Surgery, Children's Hospital of Boston, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
| | | | | | | |
Collapse
|
232
|
Haughom B, Schairer W, Souza RB, Carpenter D, Ma CB, Li X. Abnormal tibiofemoral kinematics following ACL reconstruction are associated with early cartilage matrix degeneration measured by MRI T1rho. Knee 2012; 19:482-7. [PMID: 21807522 PMCID: PMC3274608 DOI: 10.1016/j.knee.2011.06.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 06/03/2011] [Accepted: 06/22/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Altered kinematics following ACL-reconstruction may be a cause of post-traumatic osteoarthritis. T(1ρ) MRI is a technique that detects early cartilage matrix degeneration. Our study aimed to evaluate kinematics following ACL-reconstruction, cartilage health (using T(1ρ) MRI), and assess whether altered kinematics following ACL-reconstruction are associated with early cartilage degeneration. METHODS Eleven patients (average age: 33 ± 9 years) underwent 3T MRI 18 ± 5 months following ACL-reconstruction. Images were obtained at extension and 30° flexion under simulated loading (125 N). Tibial rotation (TR) and anterior tibial translation (ATT) between flexion and extension, and T(1ρ) relaxation times of the knee cartilage were analyzed. Cartilage was divided into five compartments: medial and lateral femoral condyles (MFC/LFC), medial and lateral tibias (MT/LT), and patella. A sub-analysis of the femoral weight-bearing (wb) regions was also performed. Patients were categorized as having "abnormal" or "restored" ATT and TR, and T(1ρ) percentage increase was compared between these two groups of patients. RESULTS As a group, there were no significant differences between ACL-reconstructed and contralateral knee kinematics, however, there were individual variations. T(1ρ) relaxation times of the MFC and MFC-wb region were elevated (p ≤ 0.05) in the ACL-reconstructed knees compared to the uninjured contralateral knees. There were increases (p ≤ 0.05) in the MFC-wb, MT, patella and overall average cartilage T(1ρ) values of the "abnormal" ATT group compared to "restored" ATT group. The percentage increase in the T(1ρ) relaxation time in the MFC-wb cartilage approached significance (p=0.08) in the "abnormal" versus "restored" TR patients. CONCLUSIONS Abnormal kinematics following ACL-reconstruction appear to lead to cartilage degeneration, particularly in the medial compartment.
Collapse
Affiliation(s)
- Bryan Haughom
- University of California San Francisco School of Medicine,University of California San Francisco, Department of Radiology and Biomedical Imaging
| | - William Schairer
- University of California San Francisco School of Medicine,University of California San Francisco, Department of Radiology and Biomedical Imaging
| | - Richard B. Souza
- University of California San Francisco, Department of Radiology and Biomedical Imaging
| | - Dana Carpenter
- University of California San Francisco, Department of Radiology and Biomedical Imaging
| | - C Benjamin Ma
- University of California San Francisco, Department of Orthopaedic Surgery
| | - Xiaojuan Li
- University of California San Francisco, Department of Radiology and Biomedical Imaging
| |
Collapse
|
233
|
Hemmerich A, van der Merwe W, Batterham M, Vaughan CL. Knee rotational laxity: an investigation of bilateral asymmetry for comparison with the contralateral uninjured knee. Clin Biomech (Bristol, Avon) 2012; 27:607-12. [PMID: 22342266 DOI: 10.1016/j.clinbiomech.2012.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 01/15/2012] [Accepted: 01/17/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Instability associated with anterior cruciate ligament injury is commonly evaluated against the patient's contralateral knee. The objectives of this study were, therefore, to assess symmetry of rotational knee laxity in vivo under passive torsional loading in uninjured subjects, and to compare mean rotation of this control group with the contralateral, intact knees of anterior cruciate ligament deficient patients. METHODS Axial knee rotation was measured in 29 patients with unilateral anterior cruciate ligament injury and 15 uninjured age and gender-matched control subjects using an imaging-compatible torsional loading device. Side-to-side differences in internal, external, and range of knee rotation were assessed in the control group and mean bilateral knee rotation was compared to the patients' contralateral knee data at both full extension and 30° of flexion. FINDINGS Statistically significant differences in symmetry were found in three of the six measures of transverse plane rotation in the uninjured knees; a mean side-to-side difference of 2.2° in range of rotation was detected in the flexed position. No significant differences were observed between the mean values of the healthy control group and the contralateral knees of the anterior cruciate ligament deficient patients. INTERPRETATION Bilateral asymmetry of rotational laxity occurs in healthy individuals. Nevertheless, comparability of rotational knee laxity between the contralateral limbs of patients and the uninjured population was evidence that rotational laxity was not inherent or developed in the contralateral knees of the anterior cruciate ligament deficient participants.
Collapse
Affiliation(s)
- A Hemmerich
- Department of Human Biology, University of Cape Town, South Africa.
| | | | | | | |
Collapse
|
234
|
Tibial rotation during pivoting in anterior cruciate ligament reconstructed knees using a single bundle technique. Clin Biomech (Bristol, Avon) 2012; 27:480-4. [PMID: 22154277 DOI: 10.1016/j.clinbiomech.2011.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 11/14/2011] [Accepted: 11/15/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction does not necessarily restore normal knee movement. Increased tibial rotation has previously been noted during pivoting activities and may be due to the orientation of the anterior cruciate ligament graft associated with traditional single bundle reconstruction techniques. Recent research has shown that it is possible to limit rotation during level walking using a single bundle anterior cruciate ligament reconstruction. This study evaluated rotational knee kinematics during a pivot task in a group of patients who had undergone anterior cruciate ligament reconstruction using a single bundle technique and compared the findings to a normal control group. METHODS In 27 anterior cruciate ligament reconstruction and 25 control participants, internal-external rotation was measured during a descend stairs and pivot task in a gait laboratory. FINDINGS Results showed that the anterior cruciate ligament reconstruction patients had less internal tibial rotation (for both range of rotation and maximum rotation) than the control participants (effect size=0.7). INTERPRETATION These results suggest that it is possible to limit rotation after anterior cruciate ligament reconstruction using a single bundle technique, even during a pivoting movement that places a high rotational load at the knee joint. The positioning of the femoral tunnel in a more anatomical position may be responsible for the reduced tibial rotation.
Collapse
|
235
|
Abstract
For decades, implantable sensors have been used in research to provide comprehensive understanding of the biomechanics of the human musculoskeletal system. These complex sensor systems have improved our understanding of the in vivo environment by yielding in vivo measurements of force, torque, pressure, and temperature. Historically, implants have been modified to be used as vehicles for sensors and telemetry systems. Recently, microfabrication and nanofabrication technology have sufficiently evolved that wireless, passive sensor systems can be incorporated into implants or tissue with minimal or no modification to the host implant. At the same time, sensor technology costs per unit have become less expensive, providing opportunities for use in daily clinical practice. Although diagnostic implantable sensors can be used clinically without significant increases in expense or surgical time, to date, orthopaedic smart implants have been used exclusively as research tools. These implantable sensors can facilitate personalized medicine by providing exquisitely accurate in vivo data unique to each patient.
Collapse
|
236
|
Scanlan SF, Lai J, Donahue JP, Andriacchi TP. Variations in the three-dimensional location and orientation of the ACL in healthy subjects relative to patients after transtibial ACL reconstruction. J Orthop Res 2012; 30:910-8. [PMID: 22105556 DOI: 10.1002/jor.22011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 10/20/2011] [Indexed: 02/04/2023]
Abstract
Recent reports have indicated that anatomical placement of the anterior cruciate ligament (ACL) graft is an important factor for restoration of joint function following ACL reconstruction. The objective of this study was to address a need for a better understanding of anatomical variations in ACL position and orientation within the joint. Specifically, variations in the ACL anatomy were assessed by testing for side-to-side ACL footprint location symmetry in a healthy population relative to the operative and contralateral knee in a patient population after traditional transtibial single-bundle ACL reconstruction. MRI and three-dimensional modeling techniques were used to determine the in vivo tibiofemoral ACL footprint centers and the resulting ACL orientations in both knees of 30 healthy subjects and 30 subjects after transtibial ACL reconstruction. While there were substantial inter-subject variations in ACL anatomy, the side-to-side RMS differences in the ACL footprint center were 1.20 and 1.34 mm for the femur and tibia, respectively, for the healthy subjects and no clinically meaningful intra-subject differences were measured. However, there were large intra-subject side-to-side differences after transtibial ACL reconstruction, with ACL grafts placed 5.63 and 7.64 mm from the center of the contralateral femoral and tibial ACL footprint centers, respectively. Grafts were placed more medial, anterior, and superior on the femur and more posterior on the tibia; producing grafts that were more vertical in the sagittal and coronal planes. Given the large variation among subjects, these findings advocate the use of the contralateral ACL morphology for retrospectively evaluating patient-specific anatomic graft placement.
Collapse
Affiliation(s)
- Sean F Scanlan
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA.
| | | | | | | |
Collapse
|
237
|
Webster KE, Feller JA. Tibial rotation in anterior cruciate ligament reconstructed knees during single limb hop and drop landings. Clin Biomech (Bristol, Avon) 2012; 27:475-9. [PMID: 22244510 DOI: 10.1016/j.clinbiomech.2011.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 11/02/2011] [Accepted: 12/08/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alterations in knee joint kinematics have been suggested as a potential mechanism that influences the development of osteoarthritis of the knee after anterior cruciate ligament reconstruction. Whilst previous work has shown changes in internal-external tibial rotation during level walking, many patients aim to return to high impact activities following surgery. This study examined tibial rotation during single limb hop and drop landings in anterior cruciate ligament reconstructed knees compared to a control group, and also evaluated the influence of graft type (hamstring or patellar tendon). METHODS In 48 participants (17 patellar tendon graft, 18 hamstring graft and 13 controls) internal-external rotation was measured during single limb hop and drop landings in a gait laboratory at mean of 10 months after surgery. FINDINGS There was no difference between the two graft types and both patient groups had less internal rotation when compared to the control group. For 60% of patients, internal rotation values were at least 5° less than the control group mean. INTERPRETATION Anterior cruciate ligament reconstructed knees with both hamstring tendon and patellar tendon grafts show altered rotational kinematic patterns during high impact dynamic load activities.
Collapse
Affiliation(s)
- Kate E Webster
- Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Australia.
| | | |
Collapse
|
238
|
Paxton JZ, Wudebwe UNG, Wang A, Woods D, Grover LM. Monitoring sinew contraction during formation of tissue-engineered fibrin-based ligament constructs. Tissue Eng Part A 2012; 18:1596-607. [PMID: 22439983 DOI: 10.1089/ten.tea.2011.0535] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The ability to study the gross morphological changes occurring during tissue formation is vital to producing tissue-engineered structures of clinically relevant dimensions in vitro. Here, we have used nondestructive methods of digital imaging and optical coherence tomography to monitor the early-stage formation and subsequent maturation of fibrin-based tissue-engineered ligament constructs. In addition, the effect of supplementation with essential promoters of collagen synthesis, ascorbic acid (AA) and proline (P), has been assessed. Contraction of the cell-seeded fibrin gel occurs unevenly within the first 5 days of culture around two fixed anchor points before forming a longitudinal ligament-like construct. AA+P supplementation accelerates gel contraction in the maturation phase of development, producing ligament-like constructs with a higher collagen content and distinct morphology to that of unsupplemented constructs. These studies highlight the importance of being able to control the methods of tissue formation and maturation in vitro to enable the production of tissue-engineered constructs with suitable replacement tissue characteristics for repair of clinical soft-tissue injuries.
Collapse
Affiliation(s)
- Jennifer Z Paxton
- School of Chemical Engineering, College of Physical Sciences and Engineering, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | | | | | | | | |
Collapse
|
239
|
Effects of intraarticular IL1-Ra for acute anterior cruciate ligament knee injury: a randomized controlled pilot trial (NCT00332254). Osteoarthritis Cartilage 2012; 20:271-8. [PMID: 22273632 DOI: 10.1016/j.joca.2011.12.009] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 11/25/2011] [Accepted: 12/21/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the clinical effectiveness of intraarticular IL-1 receptor antagonist (IL-1Ra) for anterior cruciate ligament (ACL) tear. METHODS Eleven patients with acute ACL tear confirmed by magnetic resonance imaging (MRI) were randomized to receive a single intraarticular injection of IL-1Ra (anakinra 150 mg, n = 6) or equal volume of saline placebo (1 ml, n = 5). The double-blinded treatment was administered a mean 2 weeks after injury. Synovial fluid (SF) (n = 9 patients) and sera (all patients) were available at baseline (prior to injection) and immediately prior to surgery (mean 35 days later) and analyzed for SF IL-1α, IL-1β, IL-1Ra and serum hyaluronan (HA), an indicator of synovial inflammation. The primary outcome, standardized Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, was obtained at 0 (baseline), 4, and 14 days after injection. RESULTS Compared with placebo, the IL-1Ra group had substantially greater improvement in key outcomes over 14 days (KOOS pain P = 0.001; activities of daily living P = 0.0015; KOOS sports function P = 0.0026; KOOS quality of life (QOL) P = 0.0048; and total KOOS P < 0.0001). There were no adverse reactions in either group. SF IL-1α (P = 0.05) and serum HA (P = 0.03), but not IL-1β, or IL-1Ra, decreased significantly in the IL-1Ra but not the placebo treated patients. Compared with placebo, IL-1α was borderline significantly different in the IL-1Ra treated group (P = 0.06). CONCLUSIONS Administered within the first month following severe knee injury, IL-1Ra reduced knee pain and improved function over a 2-week interval. This promising proof of concept study provides a new paradigm for studies of acute joint injury and suggests that a larger follow-up study is warranted.
Collapse
|
240
|
Kumar D, Rudolph KS, Manal KT. EMG-driven modeling approach to muscle force and joint load estimations: case study in knee osteoarthritis. J Orthop Res 2012; 30:377-83. [PMID: 21901754 PMCID: PMC3250571 DOI: 10.1002/jor.21544] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 08/11/2011] [Indexed: 02/04/2023]
Abstract
It is important to know the magnitude and patterns of joint loading in people with knee osteoarthritis (OA), since altered loads are implicated in onset and progression of the disease. We used an EMG-driven forward dynamics model to estimate joint loads during walking in a subject with knee OA and a healthy control subject. Kinematic, kinetic, and surface EMG data were used to predict muscle forces using a Hill-type muscle model. The muscle forces were used to balance the frontal plane moment to obtain medial and lateral condylar loads. Loads were normalized to body weight (BWs) and the mean of three trials taken. The OA subject had greater medial and lower lateral loads compared to the control subject. Seventy-five to 80% of the total load was borne on the medial compartment in the control subject, compared to 90-95% in the OA subject. In fact, complete lateral unloading occurred during midstance for the OA subject. Loading for the healthy subject was consistent with the data from instrumented knee studies. In the future, the model can be used to analyze the impact of various interventions to reduce the loads on the medial compartment in people with knee OA.
Collapse
Affiliation(s)
- Deepak Kumar
- Research Assistant, Interdisciplinary Program in Biomechanics and Movement Sciences, Dept of Physical Therapy, University of Delaware, Newark, DE
| | - Katherine S. Rudolph
- Associate Professor, Dept of Physical Therapy, University of Delaware, Newark, DE
| | - Kurt T. Manal
- Research Assistant Professor, Center for Biomedical Engineering Research, Dept of Mechanical Engineering, University of Delaware, Newark, DE
| |
Collapse
|
241
|
Tashman S, Kopf S, Fu FH. The Kinematic Basis of Anterior Cruciate Ligament Reconstruction. OPER TECHN SPORT MED 2012. [DOI: 10.1053/j.otsm.2012.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
242
|
Wang H, Fleischli JE, Nigel Zheng N. Effect of lower limb dominance on knee joint kinematics after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2012; 27:170-5. [PMID: 21899934 DOI: 10.1016/j.clinbiomech.2011.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 08/10/2011] [Accepted: 08/11/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Normal ambulatory kinematics of the knee joint is often not fully restored after anterior cruciate ligament reconstruction, which may increase the risk for cartilage degeneration and premature osteoarthritis in the involved knees. Lower limb dominance may have impacts on knee joint kinematics after anterior cruciate ligament reconstruction, which may lead to a different prevalence of cartilage degeneration. This study aimed to evaluate the knee joint kinematics among patients with reconstruction on the dominant and non-dominant side. METHODS Forty-one subjects with unilateral anterior cruciate ligament reconstruction (19 dominant, 22 non-dominant) were recruited after being discharged from rehabilitation programs. Twenty healthy subjects were recruited as the control group. Six degrees-of-freedom tibiofemoral motion during level walking was determined using a redundant point cluster-based marker set. Tibiofemoral joint motion and its bilateral differences were compared within each group and between groups. FINDINGS The non-dominant reconstructed knees had less extension compared to their contralateral knees at heel strike and during middle stance phase (P=0.02); whereas, the dominant reconstructed knees exhibited significantly reduced varus rotation (-2.1° on mean, P=0.027) and internal tibial rotation (P=0.034) compared to their contralateral knees during both stance and swing phases. INTERPRETATION The results show that different kinematics has been developed between the involved dominant and non-dominant knees after anterior cruciate ligament reconstruction, especially the secondary rotations. The differences are consistent with the unequal prevalence of cartilage degeneration in the knee joint. The findings demonstrated that the lower limb dominance had a significant effect on post-surgery knee kinematics.
Collapse
Affiliation(s)
- Hongsheng Wang
- Center for Biomedical Engineering Systems, Department of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, NC 28233, USA
| | | | | |
Collapse
|
243
|
Delahunt E, Sweeney L, Chawke M, Kelleher J, Murphy K, Patterson M, Prendiville A. Lower limb kinematic alterations during drop vertical jumps in female athletes who have undergone anterior cruciate ligament reconstruction. J Orthop Res 2012; 30:72-8. [PMID: 21809380 DOI: 10.1002/jor.21504] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 06/24/2011] [Indexed: 02/04/2023]
Abstract
The aim of this study was to determine if anterior cruciate ligament reconstructed (ACL-R) female athletes exhibit altered lower limb kinematic profiles during jump landing when compared to a non-injured age, sex, and activity matched control group. Fourteen ACL-R and 14 non-injured control subjects performed 3 vertical drop jump (DVJ) trials. Lower limb kinematics were recorded at 200 Hz. Peak and time-averaged angular displacements were quantified and utilized for between-group analysis. The ACL-R group displayed altered hip joint frontal and transverse plane kinematic alterations, and knee joint frontal and sagittal plane kinematic alterations. Specifically the ACL-R group displayed an increased adducted (p < 0.05) and internally rotated (p < 0.05) hip joint position, both peak and time-averaged, following landing. The ACL-R group also displayed a decreased adducted (p < 0.05) and flexed (p < 0.05) position of the knee joint following landing. The observed aberrant lower limb kinematics could pre-dispose ACL-R athletes to potential future knee joint injuries. Further studies are required to determine in a prospective manner whether such deficits increase the incidence of recurrent ACL injury, and whether specific sensorimotor protocols following ACL reconstruction can minimize these kinematic deficits.
Collapse
|
244
|
Huebner KD, O'Brien EJO, Heard BJ, Chung M, Achari Y, Shrive NG, Frank CB. Post-natal molecular adaptations in anteromedial and posterolateral bundles of the ovine anterior cruciate ligament: one structure with two parts or two distinct ligaments? Connect Tissue Res 2011; 53:277-84. [PMID: 22148917 DOI: 10.3109/03008207.2011.637652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The human anterior cruciate ligament (ACL) is a composite structure of two anatomically distinct bundles: an anteromedial (AM) and posterolateral (PL) bundles. Tendons are often used as autografts for surgical reconstruction of ACL following severe injury. However, despite successful surgical reconstruction, some people experience re-rupture and later development of osteoarthritis. Understanding the structure and molecular makeup of normal ACL is essential for its optimal replacement. Reportedly the two bundles display different tensions throughout joint motion and may be fundamentally different. This study assessed the similarities and differences in ultrastructure and molecular composition of the AM and PL bundles to test the hypothesis that the two bundles of the ACL develop unique characteristics with maturation. ACLs from nine mature and six immature sheep were compared. The bundles were examined for mRNA and protein levels of collagen types I, III, V, and VI, and two proteoglycans. The fibril diameter composition of the two bundles was examined with transmission electron microscopy. Maturation does alter the molecular and structural composition of the two bundles of ACL. Although the PL band appears to mature slower than the AM band, no significant differences were detected between the bundles in the mature animals. We thus reject our hypothesis that the two ACL bundles are distinct. The two anatomically distinct bundles of the sheep ACL can be considered as two parts of one structure at maturity and material that would result in a structure of similar functionality can be used to replace each ACL bundle in the sheep.
Collapse
Affiliation(s)
- Kyla D Huebner
- McCaig Institute for Bone & Joint Health, Faculty of Medicine, University of Calgary, Calgary, AL, Canada
| | | | | | | | | | | | | |
Collapse
|
245
|
Hemmerich A, van der Merwe W, Batterham M, Vaughan CL. Double-bundle ACL surgery demonstrates superior rotational kinematics to single-bundle technique during dynamic task. Clin Biomech (Bristol, Avon) 2011; 26:998-1004. [PMID: 21798637 DOI: 10.1016/j.clinbiomech.2011.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 05/09/2011] [Accepted: 06/13/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND While traditional surgical repair of the anterior cruciate ligament is able to restore anterior-posterior knee stability, laxity in the transverse plane remains. Double-bundle reconstruction has demonstrated greater rotational restraint than the single-bundle technique under passive loading conditions; however, no comparison has been made under physiological weight-bearing conditions. The purpose of this study was to determine differences in rotational knee kinematics during a dynamic task in patients who had received either a single- or double-bundle reconstruction. METHODS Twenty-two patients exhibiting isolated anterior cruciate ligament rupture were randomly allocated either a single or double-bundle reconstruction. Three-dimensional knee kinematics were measured during a dynamic cutting activity prior to and following surgery. Functional range of rotation was compared between groups pre- and post-operatively and kinematics were assessed against uninjured control subjects. FINDINGS No difference in overall range of rotation was found under physiological loading conditions. However, a significant interaction of the midpoint of the range of movement was observed; a greater external rotational shift in the single-bundle group followed reconstruction, while the kinematics of the double-bundle patient group shifted closer to those of the control group. INTERPRETATION The double-bundle reconstruction demonstrated superior outcome in rotational kinematics to the single-bundle technique.
Collapse
Affiliation(s)
- A Hemmerich
- Department of Human Biology, University of Cape Town, South Africa.
| | | | | | | |
Collapse
|
246
|
Farshad M, Gerber C, Meyer DC, Schwab A, Blank PR, Szucs T. Reconstruction versus conservative treatment after rupture of the anterior cruciate ligament: cost effectiveness analysis. BMC Health Serv Res 2011; 11:317. [PMID: 22098703 PMCID: PMC3236993 DOI: 10.1186/1472-6963-11-317] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 11/19/2011] [Indexed: 01/12/2023] Open
Abstract
Background The decision whether to treat conservatively or reconstruct surgically a torn anterior cruciate ligament (ACL) is an ongoing subject of debate. The high prevalence and associated public health burden of torn ACL has led to continuous efforts to determine the best therapeutic approach. A critical evaluation of benefits and expenditures of both treatment options as in a cost effectiveness analysis seems well-suited to provide valuable information for treating physicians and healthcare policymakers. Methods A literature review identified four of 7410 searched articles providing sufficient outcome probabilities for the two treatment options for modeling. A transformation key based on the expert opinions of 25 orthopedic surgeons was used to derive utilities from available evidence. The cost data for both treatment strategies were based on average figures compiled by Orthopaedic University Hospital Balgrist and reinforced by Swiss national statistics. A decision tree was constructed to derive the cost-effectiveness of each strategy, which was then tested for robustness using Monte Carlo simulation. Results Decision tree analysis revealed a cost effectiveness of 16,038 USD/0.78 QALY for ACL reconstruction and 15,466 USD/0.66 QALY for conservative treatment, implying an incremental cost effectiveness of 4,890 USD/QALY for ACL reconstruction. Sensitivity analysis of utilities did not change the trend. Conclusion ACL reconstruction for reestablishment of knee stability seems cost effective in the Swiss setting based on currently available evidence. This, however, should be reinforced with randomized controlled trials comparing the two treatment strategies.
Collapse
Affiliation(s)
- Mazda Farshad
- Department of Orthopedic Surgery, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
| | | | | | | | | | | |
Collapse
|
247
|
Pinney JR, Taylor C, Doan R, Burghardt AJ, Li X, Kim HT, Benjamin Ma C, Majumdar S. Imaging longitudinal changes in articular cartilage and bone following doxycycline treatment in a rabbit anterior cruciate ligament transection model of osteoarthritis. Magn Reson Imaging 2011; 30:271-82. [PMID: 22071411 DOI: 10.1016/j.mri.2011.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 09/28/2011] [Accepted: 09/30/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The development of osteoarthritis following traumatic anterior cruciate ligament (ACL) injury is well established. However, few reliable indicators of early osteoarthritic changes have been established, which has limited the development of effective therapies. T(1ρ) and T(2) mapping techniques have the ability to provide highly accurate and quantitative measurements of articular cartilage degeneration in vivo. Relating these cartilaginous changes to high-resolution bone-densitometric evaluations of the late-stage osteoarthritic bone is crucial in elucidating the mechanisms of development of traumatic osteoarthritis (OA) and potential therapies for early- or late-stage intervention. METHODS Twelve rabbits were monitored with in vivo magnetic resonance imaging (MRI) scans following ACL transection surgery with a contralateral leg sham operation. Six of the rabbits were treated with oral doxycycline for the duration of the experiment. At 12 weeks, the excised knees from three animals from each group (n=6 overall) were subjected to micro-computed tomography (CT) analysis. RESULTS Consistent with previous studies, initial elevations in T(1ρ) and T(2) values in ACL-transected animals were observed with relative normalization towards values see in sham-operated legs over the 12-week study. This biphasic pattern could hold diagnostic potential to differentiate osteoarthritic cartilage by tracking the relative proportions of T(1ρ) and T(2) values as they rise with inflammation then fall as collagen and proteoglycan loss leads to further dehydration. The addition of doxycycline resulted in inconclusive, yet potentially interesting, cartilaginous changes in several compartments of the rabbit legs. Micro-CT studies demonstrated decreased bone densitometrics in ACL-transected knees. Correlation studies suggest that the cartilaginous changes may be associated with some aspects of bony change and the development of OA. CONCLUSION We conclude that there are definite relationships between cartilaginous changes as seen on MRI and late-stage microstructural bony changes after traumatic ACL injury in rabbits. In addition, doxycycline may show promise in mitigating early-stage cartilage damage that may serve to lessen late-stage osteoarthritic changes. This study demonstrates the ability to track OA progression and therapeutic efficacy with imaging modalities in vivo.
Collapse
Affiliation(s)
- James R Pinney
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA 94158-2330, USA.
| | | | | | | | | | | | | | | |
Collapse
|
248
|
Rishiraj N, Taunton JE, Niven B, Lloyd-Smith R, Regan W, Woollard R. Performance of healthy braced participants during aerobic and anaerobic capacity tasks. J Athl Train 2011; 46:395-402. [PMID: 21944071 DOI: 10.4085/1062-6050-46.4.395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Knee braces were introduced in sports approximately 30 years ago. However, the effects of a functional knee brace (FKB) on aerobic and anaerobic performance after fatigue are unknown. OBJECTIVE To investigate whether FKB use in noninjured participants hindered performance during aerobic (Léger beep test) and anaerobic (repeated high-intensity shuttle test [RHIST]) tasks. DESIGN Crossover study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-seven healthy male provincial and national basketball and field hockey athletes (age = 19.4±3.0 years, range, 17-26 years; height = 182.6±6.8 cm, range, 168-196 cm; mass = 80.0±9.1 kg, range, 66-108 kg). INTERVENTION(S) Each participant was provided a custom-fitted FKB and performed 5 nonbraced (NBR) testing sessions over 3 days, followed by 5 braced (BR) testing sessions over 3 days, for a total of 17.5 hours of testing per condition. During each testing session, participants performed 1 trial of the Léger beep test and 1 trial of the RHIST in each condition. MAIN OUTCOME MEASURE(S) Predicted maximal oxygen consumption (Vo(2) max) and time performance measures were recorded for each NBR and BR trial. RESULTS Initial performance levels were lower for BR than NBR for both the Léger beep test (BR = 44.3 mL/kg/min, NBR = 47.3 mL/kg/min; F(1,26) = 8.726; P = .007) and the RHIST (BR = 16.5 seconds, NBR = 16.2 seconds; F(1,26) = 13.98, P = .001). However, with continued FKB use, the aerobic performance measure remained higher for only the first 2 BR testing sessions (NBR = 46.9 mL/kg/min, BR = 42.4 mL/kg/min; F(3.0,79.8) = 4.95, P = .003). For the anaerobic test, no performance difference was noted between the testing conditions (NBR = 16.2 seconds, BR = 16.4 seconds; P = .7), whereas fatigue levels were lower during BR testing sessions (NBR = 33%, BR = 31%). After 14.0 hours of FKB use, performance levels were almost equal between the testing conditions (NBR = 47.6 mL/kg/min, BR = 46.1 mL/kg/min). CONCLUSIONS We found an initial decrement in performance when the FKB was used during an aerobic or anaerobic task. However, after 14.0 hours of FKB use, accommodation to the FKB was possible.
Collapse
Affiliation(s)
- Neetu Rishiraj
- ACTIN Health & Rehabilitation, Inc, Vancouver, BC, Canada.
| | | | | | | | | | | |
Collapse
|
249
|
Fernandez JW, Akbarshahi M, Crossley KM, Shelburne KB, Pandy MG. Model predictions of increased knee joint loading in regions of thinner articular cartilage after patellar tendon adhesion. J Orthop Res 2011; 29:1168-77. [PMID: 21384421 DOI: 10.1002/jor.21345] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 12/06/2010] [Indexed: 02/04/2023]
Abstract
Patellar tendon adhesion is a complication from anterior cruciate ligament (ACL) reconstruction that may affect patellofemoral and tibiofemoral biomechanics. A computational model was used to investigate the changes in knee joint mechanics due to patellar tendon adhesion under normal physiological loading during gait. The calculations showed that patellar tendon adhesion up to the level of the anterior tibial plateau led to patellar infera, increased patellar flexion, and increased anterior tibial translation. These kinematic changes were associated with increased patellar contact force, a distal shift in peak patellar contact pressure, a posterior shift in peak tibial contact pressure, and increased peak tangential contact sliding distance over one gait cycle (i.e., contact slip). Postadhesion, patellar and tibial contact locations corresponded to regions of thinner cartilage. The predicted distal shift in patellar contact was in contrast to other patellar infera studies. Average patellar and tibial cartilage pressure did not change significantly following patellar tendon adhesion; however, peak medial tibial pressure increased. These results suggest that changes in peak tibial cartilage pressure, contact slip, and the migration of contact to regions of thinner cartilage are associated with patellar tendon adhesion and may be responsible for initiating patellofemoral pain and knee joint structural damage observed following ACL reconstruction.
Collapse
Affiliation(s)
- Justin W Fernandez
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | | | | | | | | |
Collapse
|
250
|
Gao B, Cordova ML, Zheng NN. Three-dimensional joint kinematics of ACL-deficient and ACL-reconstructed knees during stair ascent and descent. Hum Mov Sci 2011; 31:222-35. [PMID: 21798608 DOI: 10.1016/j.humov.2011.04.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 04/25/2011] [Accepted: 04/28/2011] [Indexed: 01/13/2023]
Abstract
Mechanical environmental changes in the knee are induced by altered joint kinematics under cyclic loading during activities of daily living after anterior cruciate ligament (ACL) injury. This is considered a risk factor in progressive cartilage degeneration and the early onset of osteoarthritis following ACL injury and even after reconstructive surgery. The purpose of this study was to examine 3D joint kinematics of ACL-deficient and ACL-reconstructed knees to health controls during stair ascent and descent. A 3D optical video motion capture system was used to record coordinate data from reflective markers positioned on subjects as they ascended and descended a custom-built staircase. Spatiotemporal gait and knee joint kinematic variables were calculated and further analyzed. The ACL-deficient knees exhibited a significant extension deficit compared to the ACL-intact controls. A more varus and internally rotated tibial position was also identified in the ACL-deficient knees during both stair ascent and descent. The ACL-reconstructed knees exhibited less abnormality in both spatiotemporal gait parameters and joint kinematics, but these variables were not fully restored to a normal level. The kinematic profiles of the ACL-reconstructed knees were more similar to those of the ACL-deficient knees when compared to the ACL-intact knees. This suggests that the ACL-reconstructed knees had been "under-corrected" rather than "over-corrected" by the reconstructive surgery procedure. Findings from this study may provide more insight with respect to improving ACL reconstruction surgical techniques, which may aid the early progression of cartilage degeneration in ACL-reconstructed knees.
Collapse
Affiliation(s)
- Bo Gao
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | | | | |
Collapse
|