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Chen N, Wang C, Li D, Jiang Y, Ao Y. Effect of Joint Infection After Arthroscopic Single-Bundle ACL Reconstruction With Autologous Hamstring Tendon: A Retrospective Matched MRI Study. Orthop J Sports Med 2022; 10:23259671221125493. [PMID: 36263310 PMCID: PMC9575462 DOI: 10.1177/23259671221125493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Joint infection after anterior cruciate ligament (ACL) reconstruction is a
rare but serious complication. Purpose: To assess the effect of joint infection on the graft, cartilage, and bone
tunnel using magnetic resonance imaging (MRI) after arthroscopic
single-bundle ACL reconstruction with autologous hamstring tendons. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective matched cohort study included 26 patients who underwent
arthroscopic single-bundle ACL reconstruction with hamstring tendon graft at
the authors’ institute between January 2002 and December 2017 and developed
postoperative joint infection. These patients were matched 1:3 to patients
who did not sustain joint infection after ACL reconstruction (control
group). MRI scans were collected at the time of follow-up. The following
parameters were evaluated: graft signal-to-noise quotient (SNQ); graft
signal intensity at the bone-graft interface and within the knee joint; bone
tunnel enlargement at the tunnel aperture, midsection, and exit of the
tibial and femoral tunnels; and cartilage integrity. Results: The average follow-up time was 47.8 months in the infection group and 48.5
months in the control group. Compared with the control group, the infection
group had a significantly higher SNQ (20.01 ± 12.08 vs 7.61 ± 6.70;
P = .014) as well as a higher signal intensity at the
bone-graft interface (P = .037) and higher Howell grade
(P = .031). The mean enlargement at the femoral tunnel
aperture was 31.20% ± 26.76% in the infection group and 19.22% ± 20.10% in
the control group (P = .037). The articular cartilage of
the patellofemoral and lateral femorotibial joints showed more degenerative
change in the infection group. Conclusion: Study findings indicated that graft ligamentization and incorporation graft
maturity were inferior in patients who experienced a joint infection after
ACL reconstruction compared with patients who did not.
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Affiliation(s)
- Nayun Chen
- Department of Sports Medicine, Peking University Third Hospital,
Beijing, China.,Institute of Sports Medicine of Peking University, Beijing,
China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital,
Beijing, China.,Institute of Sports Medicine of Peking University, Beijing,
China
| | - Dai Li
- Department of Sports Medicine, Peking University Third Hospital,
Beijing, China.,Institute of Sports Medicine of Peking University, Beijing,
China
| | - Yanfang Jiang
- Department of Sports Medicine, Peking University Third Hospital,
Beijing, China.,Institute of Sports Medicine of Peking University, Beijing,
China
| | - Yingfang Ao
- Department of Sports Medicine, Peking University Third Hospital,
Beijing, China.,Institute of Sports Medicine of Peking University, Beijing,
China.,Yingfang Ao, MD, Institute of Sports Medicine of Peking
University, 49 North Garden Road, Haidian District, Beijing 100191, China
()
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Huang Z, Cui J, Zhong M, Deng Z, Chen K, Zhu W. Risk factors of cartilage lesion after anterior cruciate ligament reconstruction. Front Cell Dev Biol 2022; 10:935795. [PMID: 36158222 PMCID: PMC9498578 DOI: 10.3389/fcell.2022.935795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Anterior cruciate ligament injury is the most common sports injury in orthopaedics, which can adversely affect knee joint function and exercise of patients. Using arthroscopy to reconstruct the anterior cruciate ligament has become the first choice for treating anterior cruciate ligament rupture. However, different degrees of articular cartilage injury of the knee can be observed in patients after anterior cruciate ligament reconstruction. More importantly, the articular cartilage injury after anterior cruciate ligament reconstruction indicates that it will develop into osteoarthritis in the long term. It is of great significance to fully understand the factors that lead to the occurrence and development of cartilage injury. This article reviews the effects of surgical methods, meniscus status, different grafts, time from injury to surgical intervention, postoperative knee joint stability, postoperative rehabilitation, knee joint anatomical factors, and demographic characteristics of patients on articular cartilage degeneration after anterior cruciate ligament reconstruction. The present review provides insights into the anterior cruciate ligament reconstruction, which can be used to investigate new treatment strategies to delay and prevent the progress of osteoarthritis. At the same time, it provides a holistic understanding of the influence of multiple factors on cartilage lesions after anterior cruciate ligament reconstruction.
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Affiliation(s)
- Zirong Huang
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Jiaming Cui
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Jiaming Cui, ; Weimin Zhu,
| | - Mingjin Zhong
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Zhenhan Deng
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Kang Chen
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Weimin Zhu
- Department of Sports Medicine, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, China
- Guangdong Key Laboratory of Tissue Engineering, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Jiaming Cui, ; Weimin Zhu,
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Zampeli F, Pappas E, Velonakis G, Roumpelakis IM, Poulou LS, Papagiannis GI, Kelekis AD, Mastrokalos DS. Development of new cartilage lesions after ACL reconstruction is associated with abnormal knee rotation. Knee Surg Sports Traumatol Arthrosc 2022; 30:842-851. [PMID: 33528592 DOI: 10.1007/s00167-020-06387-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to examine the association between the development of articular cartilage pathology and knee rotation after single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS Seventeen patients that underwent single-bundle ACL reconstruction and did not have any cartilage lesions at the time of surgery based on the Outerbridge classification or meniscal injury that required meniscectomy > 20% were examined by MRI and in the biomechanics laboratory at a 6-year minimum follow-up. Cartilage lesions that occurred after reconstruction were graded on MRI according to a modified Noyes scale. For cartilage evaluation, the lateral and medial femoral condyles were divided into 9 segments each (lateral, central, and medial third and each third was divided into anterior, central, and posterior segment). Tibial rotation during a pivoting task was measured with optoelectronic motion analysis system and side-to-side differences of tibial rotation between the reconstructed and contralateral intact knees were calculated. The association between the total modified Noyes scale score (outcome variable) and side-to-side differences of tibial rotation after controlling for meniscectomy and meniscal repair was investigated with hierarchical regression models. RESULTS Side-to-side difference of tibial rotation was associated with total modified Noyes scale score (p = 0.015, β = 0.667, adjusted R2 = 42.1%). All patients developed new cartilage lesions in MRI located mainly at the central region of the lateral femoral condyle and less frequently in the central and anterior regions of the medial femoral condyle. CONCLUSION Abnormally increased tibial rotation that persists after ACL-R is significantly associated with the development of new articular cartilage lesions at mean 8.4 years after reconstruction which were located mainly at the central region of the LFC and secondarily in the central and anterior regions of the MFC (more superficial lesions). These findings suggest that there is emerging evidence that abnormal rotational kinematics is a potential risk factor for the pathogenesis and onset of posttraumatic articular cartilage degeneration after ACLR. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- F Zampeli
- 1st Department of Orthopaedics, ATTIKO University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece.
- Orthopaedic Research and Education Center P.N.Soukakos, Biomechanics and Gait Analysis Laboratory, 1st Department of Orthopaedics, Medical School, ATTIKO University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - E Pappas
- Discipline of Physiotherapy - Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - G Velonakis
- 2nd Dept of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - I M Roumpelakis
- Orthopaedic Research and Education Center P.N.Soukakos, Biomechanics and Gait Analysis Laboratory, 1st Department of Orthopaedics, Medical School, ATTIKO University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - L S Poulou
- 2nd Dept of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - G I Papagiannis
- Orthopaedic Research and Education Center P.N.Soukakos, Biomechanics and Gait Analysis Laboratory, 1st Department of Orthopaedics, Medical School, ATTIKO University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A D Kelekis
- 2nd Dept of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - D S Mastrokalos
- 1st Department of Orthopaedics, ATTIKO University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece
- Orthopaedic Research and Education Center P.N.Soukakos, Biomechanics and Gait Analysis Laboratory, 1st Department of Orthopaedics, Medical School, ATTIKO University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Altahawi F, Reinke EK, Briskin I, Cantrell WA, Flanigan DC, Fleming BC, Huston LJ, Li X, Oak S, Obuchowski NA, Scaramuzza EA, Winalski CS, Zajichek A, Spindler KP, Jones MH, Jones MH. Meniscal Treatment as a Predictor of Worse Articular Cartilage Damage on MRI at 2 Years After ACL Reconstruction: The MOON Nested Cohort. Am J Sports Med 2022; 50:951-961. [PMID: 35373606 PMCID: PMC9176689 DOI: 10.1177/03635465221074662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients undergoing anterior cruciate ligament reconstruction (ACLR) are at an increased risk for posttraumatic osteoarthritis (PTOA). While we have previously shown that meniscal treatment with ACLR predicts more radiographic PTOA at 2 to 3 years postoperatively, there are a limited number of similar studies that have assessed cartilage directly with magnetic resonance imaging (MRI). HYPOTHESIS Meniscal repair or partial meniscectomy at the time of ACLR independently predicts more articular cartilage damage on 2- to 3-year postoperative MRI compared with a healthy meniscus or a stable untreated tear. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A consecutive series of patients undergoing ACLR from 1 site within the prospective, nested Multicenter Orthopaedic Outcomes Network (MOON) cohort underwent bilateral knee MRI at 2 to 3 years postoperatively. Patients were aged <36 years without previous knee injuries, were injured while playing sports, and had no history of concomitant ligament surgery or contralateral knee surgery. MRI scans were graded by a board-certified musculoskeletal radiologist using the modified MRI Osteoarthritis Knee Score (MOAKS). A proportional odds logistic regression model was built to predict a MOAKS-based cartilage damage score (CDS) relative to the contralateral control knee for each compartment as well as for the whole knee, pooled by meniscal treatment, while controlling for sex, age, body mass index, baseline Marx activity score, and baseline operative cartilage grade. For analysis, meniscal injuries surgically treated with partial meniscectomy or meniscal repair were grouped together. RESULTS The cohort included 60 patients (32 female; median age, 18.7 years). Concomitant meniscal treatment at the time of index ACLR was performed in 17 medial menisci (13 meniscal repair and 4 partial meniscectomy) and 27 lateral menisci (3 meniscal repair and 24 partial meniscectomy). Articular cartilage damage was worse in the ipsilateral reconstructed knee (P < .001). A meniscal injury requiring surgical treatment with ACLR predicted a worse CDS for medial meniscal treatment (medial compartment CDS: P = .005; whole joint CDS: P < .001) and lateral meniscal treatment (lateral compartment CDS: P = .038; whole joint CDS: P = .863). Other predictors of a worse relative CDS included age for the medial compartment (P < .001), surgically observed articular cartilage damage for the patellofemoral compartment (P = .048), and body mass index (P = .007) and age (P = .020) for the whole joint. CONCLUSION A meniscal injury requiring surgical treatment with partial meniscectomy or meniscal repair at the time of ACLR predicted worse articular cartilage damage on MRI at 2 to 3 years after surgery. Further research is required to differentiate between the effects of partial meniscectomy and meniscal repair.
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Affiliation(s)
- Faysal Altahawi
- Department of Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Ave., A-21, Cleveland, OH
| | - Emily K Reinke
- Department of Orthopaedic Surgery, Duke University, 3475 Erwin Rd., Durham, NC 27705
| | - Isaac Briskin
- Department of Quantitative Health Services, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - William A Cantrell
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr., Suite 2212, Columbus, OH 43202
| | - Braden C Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Coro West, Suite 404, 1 Hoppin Street, Providence RI 02903
| | - Laura J Huston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, MCE, South Tower, Suite 4200, Nashville, TN 37232
| | - Xiaojuan Li
- Imaging Institute, Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine (CCLCM), 9500 Euclid Avenue, ND20, Cleveland, OH 44195
| | - Sameer Oak
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Nancy A Obuchowski
- Department of Quantitative Health Services, Cleveland Clinic, JJN3-296, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Erica A Scaramuzza
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, MCE, South Tower, Suite 4200, Nashville, TN 37232
| | - Carl S Winalski
- Department of Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Ave., A-21, Cleveland, OH
| | - Alex Zajichek
- Department of Quantitative Health Services, Cleveland Clinic, Cleveland, OH
| | - Kurt P Spindler
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 5555 Transportation Blvd., Garfield Heights, OH 44125
| | - Morgan H Jones
- Brigham and Women’s Hospital, Department of Orthopaedic Surgery, 75 Francis Street, Boston, MA 02115
| | - Morgan H Jones
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA and Venderbilt Medical Center, Nashville, Tennessee
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5
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Andrä K, Prill R, Kayaalp E, Irlenbusch L, Liesaus E, Trommer T, Ullmann P, Becker R. Increase in cartilage degeneration in all knee compartments after failed ACL reconstruction at 4 years of follow-up. J Orthop Traumatol 2021; 22:54. [PMID: 34914026 PMCID: PMC8677851 DOI: 10.1186/s10195-021-00618-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/08/2021] [Indexed: 01/20/2023] Open
Abstract
Purpose Degeneration of the cartilage after anterior cruciate ligament reconstruction (ACL-R) is known, and further deterioration can be expected in patients with tunnel malplacement or partial meniscal resection. It was hypothesized that there is a significant increase in cartilage degeneration after failed ACL-R. Material and methods Isolated ACL revision surgery was performed in 154 patients at an interval of 46 ± 33 months (5–175 months) between primary and revision surgery. Cartilage status at the medial, lateral femorotibial, and patellofemoral compartments were assessed arthroscopically during primary and revision ACL-R in accordance with the Outerbridge classification. Tunnel placement, roof angle, and tibial slope was measured using anteroposterior and lateral radiographic views. Results Cartilage degeneration increased significantly in the medial femorotibial compartment, followed by the lateral and patellofemoral compartments. There was a correlation between both cartilage degeneration in the patellofemoral compartment (PFC) (rs = 0.28, p = 0.0012) and medial tibial plateau (Rs = 0.24, p = 0.003) in relation to the position of tibial tunnel in the frontal plane. Worsening of the cartilage status in the medial femorotibial compartment, either femoral or tibial, was correlated with the tibial aperture site in the lateral view (Rs = 0.28, p < 0.001). Cartilage degeneration in the lateral compartment of the knee, on both femoral or tibial side, was inversely correlated with the femoral roof angle (Rs = −0.1985, p = 0.02). Meniscal tears, either at the medial or lateral site or at both, were found in 93 patients (60%) during primary ACL-R and increased to 132 patients (86%) during revision ACL-R. Discussion Accelerated cartilage degeneration and high prevalence of meniscal lesions are seen in failed ACL-R. Tunnel placement showed significant impact on cartilage degeneration and may partially explain the increased risk of an inferior outcome when revision surgery is required after failed primary ACL-R. Level of evidence: Level IV—retrospective cohort study.
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Affiliation(s)
- Kathleen Andrä
- Center of Orthopaedics and Traumatology, University of Brandenburg, Medical School "Theodor Fontane", Hochstrasse 29, 14770, Brandenburg an der Havel, Germany.,SportsClinic Erfurt, Erfurt, Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University of Brandenburg, Medical School "Theodor Fontane", Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
| | - Enes Kayaalp
- Department of Orthopedics and Traumatology, Istanbul Taksim Training and Research Hospital, Siraselviler Cad, Beyoglu, Istanbul, 34433, Turkey
| | | | | | | | | | - Roland Becker
- Center of Orthopaedics and Traumatology, University of Brandenburg, Medical School "Theodor Fontane", Hochstrasse 29, 14770, Brandenburg an der Havel, Germany.
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Kim MS, Park HJ, Kim JN, Jeon MR, Kim E, Park JH, Lee YT. Postsurgical status of articular cartilage after arthroscopic posterior cruciate ligament reconstruction in patients with or without concomitant meniscal pathology. Clin Imaging 2021; 80:406-412. [PMID: 34536910 DOI: 10.1016/j.clinimag.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/18/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Several factors present at the time of posterior cruciate ligament reconstruction (PCLR) may cause the subsequent progression of articular cartilage lesions. This study aimed to evaluate postsurgical articular cartilage lesions which can be seen on MRI in patients who underwent arthroscopic PCLR with or without concomitant meniscal pathology. MATERIAL AND METHODS A total of sixty-five patients (mean age 35.8 ± 12.3 years) who underwent arthroscopic PCLR were included in this retrospective study. Patients were divided into two groups: ten patients with concomitant meniscal injuries at the time of PCLR who underwent meniscal surgery and fifty-five patients with intact menisci. The cartilage status of all knees was evaluated by MRI and modified Noyes classification. RESULTS Cartilage lesions were observed in 18 patients (27.7%) on the last follow-up MRI. The cartilage lesions were more common in the medial (15.4%) and patellofemoral (12.3%) compartments than in the lateral compartment (7.7%). Progression of cartilage lesions was present in 11 patients (16.9%) during follow-up MRI. The majority of cartilage lesions with progression were located in the medial compartment. The meniscal pathology group showed a higher prevalence of articular cartilage lesions on the last follow-up MRI (21.8% versus 60%, p = 0.022). In multivariate Cox regression, concomitant meniscal pathology was significantly associated with progression of articular cartilage lesions (p = 0.044). CONCLUSION PCLR patients with associated meniscal pathology showed worse cartilage condition and more progression of cartilage lesions than isolated PCLR patients. Attention to this risk factor might provide more applicable treatment options for potential osteoarthritis prevention strategies.
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Affiliation(s)
- Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Ji Na Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Mi Ran Jeon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eugene Kim
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jai Hyung Park
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Taek Lee
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Female gender and medial meniscal lesions are associated with increased pain and symptoms following anterior cruciate ligament reconstruction in patients aged over 50 years. Knee Surg Sports Traumatol Arthrosc 2021; 29:2987-3000. [PMID: 33108528 DOI: 10.1007/s00167-020-06318-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Several studies report satisfactory clinical outcomes following ACLR in older patients, but none evaluated the effects of meniscal and cartilage lesions. The aim was to evaluate the influence of meniscal and cartilage lesions on outcomes of ACLR in patients aged over 50 years. METHODS The authors prospectively collected records of 228 patients that underwent primary ACLR, including demographics, time from injury to surgery, whether injuries were work related, and sports level (competitive, recreational, or none). At a minimum follow-up of 6 months, knee injury and osteoarthritis outcome scores (KOOS), International Knee Documentation Committee (IKDC) score and Tegner activity level were recorded, and differential laxity was measured as the side-to-side difference in anterior tibial translation (ATT) using instrumented laximetry devices. Regression analyses were performed to determine associations between outcomes and meniscal and cartilage lesions as well as nine independent variables. RESULTS A total of 228 patients aged 54.8 ± 4.3 years at index ACLR were assessed at a follow-up of 14.3 ± 3.8 months. KOOS subcomponents were 85 ± 13 for symptoms, 91 ± 10 for pain, 75 ± 18 for daily activities, 76 ± 18 for sport, and 88 ± 12 for quality of life (QoL). The IKDC score was A for 84 (37%) knees, B for 96 (42%) knees, C for 29 (13%) knees, and D for 8 (4%) knees. Tegner scores showed a decrease (median 0, range -4 to 4) and differential laxity also decreased (median - 4, range - 23.5 to 6.0). KOOS symptoms worsened with higher BMI (p = 0.038), for women (p = 0.007) and for knees that had medial meniscectomy (p = 0.029). KOOS pain worsened with higher BMI (p ≤ 0.001), for women (p = 0.002) and for knees with untreated (p = 0.047) or sutured (p = 0.041) medial meniscal lesions. Differential laxity increased with follow-up (p = 0.024) and in knees with lateral cartilage lesions (p = 0.031). CONCLUSION In primary ACLR for patients aged over 50 years, female gender and medial meniscal lesions significantly compromised KOOS symptoms and pain, while lateral cartilage lesions significantly increased differential laxity. Compared to knees with an intact medial meniscus, those with sutured or untreated medial meniscal lesions had worse pain, while those in which the medial meniscus was resected had worse symptoms. These findings are clinically relevant as they could help surgeons with patient selection and adjusting expectations according to their functional demands. LEVEL OF EVIDENCE III.
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8
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Üşen A, Tolu S. Factors Affecting the Femoral Cartilage Thickness After Anterior Cruciate Ligament Reconstruction. Indian J Orthop 2020; 55:352-359. [PMID: 33927813 PMCID: PMC8046890 DOI: 10.1007/s43465-020-00262-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the changes in the distal femoral cartilage thickness in patients that underwent anterior cruciate ligament reconstruction (ACLR) and to analyze their association with concomitant meniscal surgery, knee muscle strength, kinesophobia, and physical activity level. METHODS The demographic characteristics and surgical data of 47 male patients that underwent unilateral ACLR (mean, 27.55 ± 5.63; range, 18-40 years) were evaluated. The patients were assessed in three groups depending on surgery: isolated ACLR (n = 15), ACLR + partial medial meniscus resection (ACLR&M) (n = 16), and ACLR + medial meniscus repair (ACLR&MR) (n = 16). The medial (MCCT), intercondylar (ICCT), and lateral (LCCT) femoral cartilage thicknesses on both limbs were measured using ultrasonography. The extensor and flexor muscles strength of the knees was assessed using an isokinetic dynamometer at 60°/s. The physical activity level was evaluated by the International Physical Activity Questionnaire (IPAQ) short form and Tegner Activity Scale (TAS). The fear of movement was assessed by the Tampa Scale for Kinesiophobia Questionnaire (TSKQ). RESULTS The postoperative mean follow-up duration was 32.24 ± 9.17 months. MCCT and LCCT were significantly decreased in the ACLR&M group (p < 0.001 and p = 0.019, respectively). MCCT, ICCT and LCCT were significantly decreased in the ACLR&MR group (p = 0.017, p = 0.011, and p = 0.004, respectively). No significant change was found in the ACLR group. Cartilage thickness changes were not significantly correlated with the knee muscle strength, IPAQ, TAS and TSKQ scores in all groups (p > 0.05). CONCLUSION The results showed partial meniscectomy and meniscus repair at the time of ACLR as important risk factors for decreased chondral thickness.
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Affiliation(s)
- Ahmet Üşen
- Department of Physical, Medicine and Rehabilitation, Faculty of Medicine, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bagcilar, Istanbul, 34214 Turkey
| | - Sena Tolu
- Department of Physical, Medicine and Rehabilitation, Faculty of Medicine, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bagcilar, Istanbul, 34214 Turkey
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10
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Espregueira-Mendes J, Andrade R, Leal A, Pereira H, Skaf A, Rodrigues-Gomes S, Oliveira JM, Reis RL, Pereira R. Global rotation has high sensitivity in ACL lesions within stress MRI. Knee Surg Sports Traumatol Arthrosc 2017; 25:2993-3003. [PMID: 27530386 DOI: 10.1007/s00167-016-4281-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/05/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE This study aims to objectively compare side-to-side differences of P-A laxity alone and coupled with rotatory laxity within magnetic resonance imaging, in patients with total anterior cruciate ligament (ACL) rupture. METHODS This prospective study enrolled sixty-one patients with signs and symptoms of unilateral total anterior cruciate ligament rupture, which were referred to magnetic resonance evaluation with simultaneous instrumented laxity measurements. Sixteen of those patients were randomly selected to also have the contralateral healthy knee laxity profile tested. Images were acquired for the medial and lateral tibial plateaus without pressure, with postero-anterior translation, and postero-anterior translation coupled with maximum internal and external rotation, respectively. RESULTS All parameters measured were significantly different between healthy and injured knees (P < 0.05), with exception of lateral plateau without stress. The difference between injured and healthy knees for medial and lateral tibial plateaus anterior displacement (P < 0.05) and rotation (P < 0.001) was statistically significant. It was found a significant correlation between the global rotation of the lateral tibial plateau (lateral plateau with internal + external rotation) with pivot-shift, and between the anterior global translation of both tibial plateaus (medial + lateral tibial plateau) with Lachman. The anterior global translation of both tibial plateaus was the most specific test with a cut-off point of 11.1 mm (93.8 %), and the global rotation of the lateral tibial plateau was the most sensitive test with a correspondent cut-off point of 15.1 mm (92.9 %). CONCLUSION Objective laxity quantification of ACL-injured knees showed increased sagittal laxity, and simultaneously in sagittal and transversal planes, when compared to their healthy contralateral knee. Moreover, when measuring instability from anterior cruciate ligament ruptures, the anterior global translation of both tibial plateaus and global rotation of the lateral tibial plateau add diagnostic specificity and sensitivity. This work strengthens the evidence that the anterior cruciate ligament plays an important biomechanical role in controlling the anterior translation, but also both internal and external rotation. The high sensitivity and specificity of this device in objectively identifying and measuring the multiplanar instability clearly guides stability restoration clinical procedures. Level of evidence Cross-sectional study, Level III.
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Affiliation(s)
- João Espregueira-Mendes
- Orthopaedics Department of Minho University, Braga, Portugal. .,Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal. .,Dom Henrique Research Centre, Porto, Portugal. .,3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal. .,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Faculty of Sports, University of Porto, Porto, Portugal
| | - Ana Leal
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,CMEMS Center for MicroElectroMechanical Systems, Mechanical Engineering Department, University of Minho, Guimarães, Portugal
| | - Hélder Pereira
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal
| | - Abdala Skaf
- Hospital do Coração, São Paulo, Brazil.,Musculoskeletal Department, Clínica Alta Excelência Diagnóstica, São Paulo, Brazil
| | - Sérgio Rodrigues-Gomes
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,SMIC Group, Porto, Portugal
| | - J Miguel Oliveira
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rogério Pereira
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Faculty of Health Sciences, University of Fernando Pessoa, Porto, Portugal
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