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Tokgoz MA, Oklaz EB, Ak O, Guler Oklaz EB, Ataoglu MB, Kanatli U. The potential of posterior cruciate ligament buckling phenomenon as a sign for partial anterior cruciate ligament tears. Arch Orthop Trauma Surg 2024; 144:2181-2187. [PMID: 38492061 PMCID: PMC11093845 DOI: 10.1007/s00402-024-05270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Diagnosis of a partial tear of the anterior cruciate ligament (ACL) can be challenging with physical examination and imaging techniques. Although magnetic resonance imaging (MRI) has high sensitivity and specificity for diagnosing complete ACL tears, its effectiveness may be limited when it is used to diagnose for partial tears. The hypothesis of the present study is that the posterior cruciate ligament (PCL) buckling phenomenon, which is a secondary sign of complete ACL tears on MRI, may be a useful method for diagnosing partial ACL tears. MATERIALS AND METHODS The data of 239 patients who underwent knee arthroscopy in a single institution between 2016 and 2022 were analyzed retrospectively. Patients were divided into three groups based on the condition of their ligaments: partial tears, complete tears and intact ligaments. To evaluate the buckling phenomenon on sagittal T2-weighted MRI, measurements of the posterior cruciate ligament angle (PCLA) and the posterior cruciate ligament-posterior cortex angle (PCL-PCA) were conducted in each group. Subsequently, the ability of these two measurement methods to distinguish partial tears from the other groups was assessed. RESULTS Both methods provided significantly different results in all three groups. Partial tears could be distinguished from intact ligaments with 86.8% sensitivity, 89.9% specificity when PCLA < 123.13° and 94.5% sensitivity, 93.2% specificity when PCL-PCA < 23.77°. Partial tears could be distinguished from complete tears with 79.5% sensitivity, 78.4% specificity when PCLA > 113.88° and with 86.1% sensitivity, 85.3% specificity when PCL-PCA > 16.39°. CONCLUSION The main finding of the present study is that the PCLA and PCL-PCA methods are useful on MRI for diagnosing partial ACL tears. PCLA value between 113°-123° and PCL-PCA value between 16°-24° could indicate a partial ACL tear. With these methods, it is possible to distinguish partial tears from healthy knees and reduce missed diagnoses. In addition, the differentiation of partial and complete tears by these methods may prevent unnecessary surgical interventions. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Mehmet Ali Tokgoz
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Mevlana Bulvarı No: 29 Yenimahalle, Ankara, Turkey
| | - Ethem Burak Oklaz
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Mevlana Bulvarı No: 29 Yenimahalle, Ankara, Turkey.
| | - Oguzhan Ak
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Mevlana Bulvarı No: 29 Yenimahalle, Ankara, Turkey
| | | | - Muhammet Baybars Ataoglu
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Mevlana Bulvarı No: 29 Yenimahalle, Ankara, Turkey
| | - Ulunay Kanatli
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Mevlana Bulvarı No: 29 Yenimahalle, Ankara, Turkey
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Schwartz J, Rodriguez AN, Banovetz MT, Braaten JA, Larson CM, Wulf CA, Kennedy NI, LaPrade RF. The Functional Integrity of the Anterior Cruciate Ligament Can Be Objectively Assessed With the Use of Stress Radiographs: A Systematic Review. Orthop J Sports Med 2024; 12:23259671241246197. [PMID: 38680218 PMCID: PMC11047241 DOI: 10.1177/23259671241246197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 05/01/2024] Open
Abstract
Background Stress radiography is a viable imaging modality that can also be used to assess the integrity of the anterior cruciate ligament (ACL) after primary or secondary injury. Because conventional radiography is relatively easy, affordable, and available worldwide, the diagnostic efficacy of ACL standing, lateral decubitus, and supine stress radiography should be evaluated. Purpose To examine the existing literature regarding the application of stress radiography in evaluating the integrity of the ACL. Study Design Systematic review; Level of evidence, 3. Methods Using the PubMed and MEDLINE databases for relevant articles published between 1980 and the present, a systematic review was conducted to identify evidence related to the radiographic diagnosis or assessment of ACL tears. The literature search was conducted in September 2022. Results Of 495 studies, 16 (1823 patients) were included. Four studies examined standing stress radiography, and 12 investigated lateral decubitus or supine stress radiography. Significant heterogeneity in imaging technique and recorded anterior tibial translation was identified. Anterior tibial translation for ACL-injured knees ranged from 1.2 to 10.6 mm for standing stress radiographs and 2.7 to 11.2 mm for supine stress radiographs, with high sensitivities and specificities for both. Conclusion Stress radiography was a dependable diagnostic method for identifying ACL rupture. Further research is necessary to determine the ideal anatomic landmarks, optimal patient positioning, and appropriate applied stresses to establish a standardized protocol for both assessing ACL tears and evaluating the postoperative integrity of ACL reconstruction using stress radiography.
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Deiss V, Bähler P, Kolly P, Schärer A, Henle P, Eichelberger P, Lutz N, Baur H. Test-retest reliability and concurrent validity assessment of a novel high-frequency sensor device for anterior tibial translation measurement in loaded and unloaded condition: an exploratory cross-sectional study. BMC Musculoskelet Disord 2024; 25:218. [PMID: 38491405 PMCID: PMC10943913 DOI: 10.1186/s12891-024-07343-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) and manual tests remain the standard for diagnosing anterior cruciate ligament (ACL) rupture. Furthermore, the passive knee displacement, also described as anterior tibial translation (ATT), is used in order to make decisions about surgery or to assess rehabilitation outcomes. Unfortunately, these manual tests are limited to passive situations, and their application to assess knee stability in loaded, weight-bearing positions are missing. Therefore, a new device with high-performance sensors and a new sensor setting was developed. The aim of this exploratory cross-sectional study was to assess the test-retest reliability of this new device in a first step and the concurrent validity in a second step. METHODS A total of 20 healthy volunteers were measured. Measurement consistency of the new device was assessed on the basis of reliability during Lachman test setting and in loaded position by artificial knee perturbation in a test-retest procedure. In a second step, the concurrent validity was evaluated with the Lachmeter® as a reference instrument. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), the minimal detectable change (MDC) and Bland-Altman analysis were evaluated to assess the quality criteria. RESULTS The measurements with the new device during the Lachman test provided a mean ATT of 5.46±2.22mm. The SEM ranged from 0.60 to 0.69mm resulting in an MDC between 1.67 and 1.93mm for the new device. In the loaded test situation, the mean ATT was 2.11±1.20mm, with test-retest reliability also showing good correlation (r>0.83). The comparison of the two measurement methods with an ICC of (r>0.89) showed good correlation, which also underlines the reasonable agreement of the Bland-Altman analysis. CONCLUSIONS The evaluation of the test-retest reliability of the new device during the knee stability testing in passive situation as well as in a functional, loaded situation presented good reliability. In addition, the new device demonstrated good agreement with the reference device and therefore good validity. Furthermore, the quality criteria demonstrated the ability of the new device to detect the cut-off value (3-5mm) described in the literature for the diagnosis of ACL-deficient knees, which underlines the clinical relevance of this new device as a reliable and valid tool.
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Affiliation(s)
- Valentin Deiss
- Department of Health Professions, Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland.
| | - Philippe Bähler
- Institute for Human Centered Engineering, Bern University of Applied Sciences, Biel, Switzerland
| | - Pascal Kolly
- Institute for Human Centered Engineering, Bern University of Applied Sciences, Biel, Switzerland
| | - Anton Schärer
- Institute for Human Centered Engineering, Bern University of Applied Sciences, Biel, Switzerland
| | - Philippe Henle
- Department of Knee Surgery and Sports Traumatology, Sonnenhof Orthopaedic Center, Bern, Switzerland
| | - Patric Eichelberger
- Department of Health Professions, Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
| | - Nathanael Lutz
- Department of Health Professions, Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
| | - Heiner Baur
- Department of Health Professions, Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
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Wasilczyk C. The Value of Ultrasound Diagnostic Imaging of Anterior Crucial Ligament Tears Verified Using Experimental and Arthroscopic Investigations. Diagnostics (Basel) 2024; 14:305. [PMID: 38337821 PMCID: PMC10855111 DOI: 10.3390/diagnostics14030305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
This study investigates the potential of the ultrasound imaging technique in the assessment of Anterior Cruciate Ligament (ACL) pathologies by standardizing the examination process. We focused on four key ultrasound parameters: the inclination of the ACL; swelling or scarring at the ACL's proximal attachment to the lateral femoral condyle; swelling or scarring of the ACL/posterior cruciate ligament (PCL) compartment complex with accompanying morphological changes in the posterior joint capsule; and dynamic instability, categorized into three ranges-0-2 mm, 3-4 mm, and ≥5 mm. The study group consisted of 25 patients with an ACL injury and 25 controls. All four tested parameters were found more frequently in the study group compared to the control (p < 0.0001). Our findings suggest that this standardized approach significantly augments the diagnostic capabilities of ultrasound, complementing clinical evaluation and magnetic resonance imaging (MRI) findings. The meticulous assessment of these parameters proved crucial in identifying subtle ACL pathologies, which might otherwise be missed in conventional imaging modalities. Notably, the quantification of dynamic instability and the evaluation of morphological changes were instrumental in early detection of ACL injuries, thereby facilitating more precise and effective treatment planning. This study underscores the importance of a standardized ultrasound protocol in the accurate diagnosis and management of ACL injuries, proposing a more comprehensive diagnostic tool for clinicians in the field of sports medicine and orthopedics.
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Affiliation(s)
- Cezary Wasilczyk
- Medical Department, Wasilczyk Medical Clinic, ul. Kosiarzy 37/80, 02-953 Warszawa, Poland
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Mabrouk A, Olson CP, Tagliero AJ, Larson CM, Wulf CA, Kennedy NI, LaPrade RF. Reference standards for stress radiography measurements in knee ligament injury and instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5721-5746. [PMID: 37923947 DOI: 10.1007/s00167-023-07617-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/28/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Stress radiographs are an easily accessible, cost-effective tool in the evaluation of acute and chronic ligament knee injuries. Stress radiographs provide an objective, quantifiable, and functional assessment of the injured ligament and can be a useful adjunct when planning surgical management and to objectively assess postoperative outcomes. This study aimed to review the literature reporting on stress radiographic techniques in evaluating knee ligament injury and instability and propose thresholds for interpreting stress radiography techniques. METHODS The following three databases, OVID MEDLINE, the EMBASE library, and the Cochrane Controlled Trials Register, were systematically searched on January 23, 2023, for studies published from January 1970 to January 2023. The search extended to the reference lists of all relevant studies and orthopedic journals. Included studies were those that described a stress technique for the diagnosis of knee ligament injury; studies that reported a description or comparison of the accuracy and/or reliability of one or several stress radiography techniques, or studies that reported a comparison with alternative diagnostic modalities. RESULTS Sixteen stress radiography techniques were reported for assessing the ACL with stress applied in the anterior plane, 10 techniques for assessing the PCL with stress applied in the posterior plane, 3 techniques for valgus stress, and 4 techniques for varus stress. The Telos device was the most commonly used stress device in the ACL and PCL studies. There was no consensus on the accuracy and reliability of stress radiography techniques for the diagnosis of any knee ligament injury. Stress radiography techniques were compared with alternative diagnostic techniques including instrumented arthrometry, MRI, and physical examination in 18 studies, with variability in the advantages and disadvantages of stress radiography techniques and alternatives. Analysis of results pooled from different studies demonstrated average delta gapping in knees with a completely injured ligament compared to the normal contralateral knee as per the following: for the ACL 4.9 ± 1.4 mm; PCL 8.1 ± 2.5 mm; MCL 2.3 ± 0.05 mm; and the FCL 3.4 ± 0.2 mm. CONCLUSION Despite heterogeneity in the available literature with regard to stress examination techniques and device utilization, the data support that stress radiography techniques were accurate and reliable when compared to numerous alternatives in the diagnosis of acute and chronic knee ligament injuries. The present study also provides average increased ipsilateral compartment gapping/translation for specific knee ligament injuries based on the best available data. These values provide a reference standard for the interpretation of stress radiography techniques, help to guide surgical decision-making, and provide benchmark values for future investigations. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Conner P Olson
- Twin Cities Orthopedics, 4010 W 65th Street, Edina, MN, 55455, USA
| | | | - Chris M Larson
- Twin Cities Orthopedics, 4010 W 65th Street, Edina, MN, 55455, USA
| | - Corey A Wulf
- Twin Cities Orthopedics, 4010 W 65th Street, Edina, MN, 55455, USA
| | | | - Robert F LaPrade
- Twin Cities Orthopedics, 4010 W 65th Street, Edina, MN, 55455, USA.
- University of Virginia, Charlottesville, VA, USA.
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Zhang K, Meng Q, Zhang J, Gao Y, Yang Y, Liu P, Wang C, Ma Y, Shi W. The apex of the deep cartilage is a stable landmark to position the femoral tunnel during remnant-preserving anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:5932-5939. [PMID: 37955676 DOI: 10.1007/s00167-023-07656-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE The aim of this retrospective cohort study was to investigate whether the apex of the deep cartilage (ADC) could help surgeons position the femoral tunnel accurately in remnant-preserving anterior cruciate ligament (ACL) reconstruction (ACLR). METHODS In the current retrospective cohort study, a total of 134 patients who underwent ACLR between 2016 and 2020 were included. The femoral tunnel position was located using ADC as the landmark. The patients were divided into two groups: the remnant-preserving group (RP group, n = 68) underwent remnant-preserving ACLR, and the nonremnant group (NRP group, n = 66) underwent traditional ACLR with remnant removal. Postoperatively, the femoral tunnel position was evaluated on 3D-CT. The length from the ADC to the shallow cartilage margin (L) and to the centre of the femoral tunnel (l) and the length from the centre of the femoral tunnel to a low cartilage ratio in the direction from high to low (H) were measured. RESULTS The l/L values of the RP and NRP groups were both 0.4 ± 0.1 after rounding (n.s.), and the H values were 9.3 ± 1.6 mm and 9.3 ± 1.7 mm, respectively (n.s.). There was no significant difference in l/L or H between the two groups. The estimation plot also showed high consistency of H and l/L of the two groups. The inter- and intraobserver reliability of I, L, l/L, and H were almost perfect. CONCLUSIONS The apex of the deep cartilage is a good landmark for positioning the femoral tunnel in remnant-preserving ACL reconstruction. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Keying Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Qingyang Meng
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jingwei Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yitian Gao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yuping Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Ping Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yong Ma
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
| | - Weili Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
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Cojean T, Batailler C, Robert H, Cheze L. GNRB® laximeter with magnetic resonance imaging in clinical practice for complete and partial anterior cruciate ligament tears detection: A prospective diagnostic study with arthroscopic validation on 214 patients. Knee 2023; 42:373-381. [PMID: 37172464 DOI: 10.1016/j.knee.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/18/2023] [Accepted: 03/28/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Accurate diagnosis of anterior cruciate ligament (ACL) injury is not always obtained with magnetic resonance imaging (MRI). Other tools, such as the GNRB® arthrometer, help to accurately identify the type of ACL tear. The aim of this study was to show that the GNRB® could be a relevant complementary solution to MRI in ACL injuries detection. METHODS A prospective study performed between 2016 and 2020 included 214 patients who had undergone knee surgery. The study compared sensitivity/specificity pairs of MRI and the GNRB® at 134 N to detect healthy ACL, partial and complete ACL tears. Arthroscopies were the 'gold standard'. Forty-six patients had a healthy ACL with associated knee lesions, 168 patients had ACL tears where 107 were complete tears and 61 were partial tears. RESULTS For healthy ACL, MRI scored 100% for sensitivity (SE) and 95% for specificity (SP), and the GNRB® scored SE 95.65% and SP 97.5% at 134 N. For complete ACL tears, MRI scored 80.81% for sensitivity (SE) and 64.49% for specificity (SP), and the GNRB® scored SE 77.78% and SP 85.98% at 134 N. For partial tears, MRI scored SE 29.51% and SP 88.97%, and the GNRB® scored SE 73.77% and SP 85.52% at 134 N. CONCLUSION GNRB® sensitivity and specificity were equivalent to those of MRI for healthy ACL and complete ACL tear detection. However, MRI had some difficulty in detecting partial ACL tears compared with the GNRB® which showed better sensitivity.
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Affiliation(s)
- Théo Cojean
- Université de Lyon, Université Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France.
| | - Cécile Batailler
- Université de Lyon, Université Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France; Hôpital de la Croix-Rousse, Lyon, France
| | - Henri Robert
- Centre Hospitalier du Haut Anjou, Château-Gontier-Sur-Mayenne, France
| | - Laurence Cheze
- Université de Lyon, Université Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
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Moon HS, Choi CH, Kim S, Yoo JH, Jung M, Kwon HJ, Hong YJ, Kim SH. Outpatient-based diagnostic criteria for partial ACL injury: clinical outcomes of non-operative treatment and radiographic predictor. Arch Orthop Trauma Surg 2023; 143:2027-2036. [PMID: 35552802 DOI: 10.1007/s00402-022-04467-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/24/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION This study aimed to (1) evaluate the short-term clinical outcomes of patients who underwent non-operative treatment for partial anterior cruciate ligament (ACL) tears diagnosed using the outpatient-based diagnostic criteria and (2) investigate the radiographic predictors distinguishing patients at risk of non-operative treatment failure. METHODS From 2010 to 2019, patients diagnosed with partial ACL tears and treated with non-operative treatment were reviewed retrospectively. Patients were then classified into two groups: those who successfully responded to non-operative treatment (group S) and those who failed to respond to non-operative treatment and required surgical reconstruction within 6 months after injury (group F). ACL laxity, patient-reported outcomes (PROs), and several radiographic parameters were analyzed. To identify radiographic predictors related to clinical outcomes, radiographic parameters were compared between the groups, which were statistically matched for potential confounders (age and activity level) using inverse probability of treatment weighting. RESULTS A total of 44 patients were analyzed (mean age, 28.7 ± 8.7 years; 31 men), and classified into two groups (group S, 23 patients; group F, 21 patients). There were no significant differences in ACL laxity and PROs between the groups at 1 year after either non-operative treatment or surgical reconstruction. A comparison of radiographic parameters between the groups revealed significant differences in several parameters related to secondary signs of ACL injury. Subsequent regression analyses revealed that anterior tibial translation and extent of bone bruises were radiographic predictors related to clinical outcomes. CONCLUSION Non-operative treatment for partial ACL tears diagnosed using the outpatient-based diagnostic criteria can provide successful short-term clinical outcomes in selective patients. Secondary signs of ACL injuries, particularly the amount of anterior tibial translation and the extent of bone bruises, are radiographic predictors that could differentiate patients at risk of non-operative treatment failure. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Affiliation(s)
- Hyun-Soo Moon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Je-Hyun Yoo
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuk-Jun Kwon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Jae Hong
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Makaram NS, Murray IR, Geeslin AG, Chahla J, Moatshe G, LaPrade RF. Diagnosis and treatment strategies of the multiligament injured knee: a scoping review. Br J Sports Med 2023; 57:543-550. [PMID: 36822842 DOI: 10.1136/bjsports-2022-106425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To map the current literature evaluating the diagnosis and treatment of multiligament knee injuries (MLKIs). DESIGN Scoping review. DATA SOURCES Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and Arksey and O'Malley frameworks were followed. A three-step search strategy identified relevant published literature comprising studies reporting on at least one aspect in the diagnosis or treatment of MLKI in adults. Data were synthesised to form a descriptive analysis and thematic summary. RESULTS Overall, 417 studies were included. There was a substantial chronological increase in the number of studies published per year, with 70% published in the last 12 years. Of included studies, 128 (31%) were narrative reviews, editorials or technical notes with no original data. The majority of studies (n=239, 57%) originated from the USA; only 4 studies (1%) were of level I evidence. Consistent themes of contention included clinical assessment, imaging, operative strategy, timing of surgery and rehabilitation. There was a lack of gender and ethnic diversity reported within patient groups. CONCLUSIONS There remains insufficient high-level evidence to support definitive management strategies for MLKI. There is considerable heterogeneity in outcome reporting in current MLKI literature, precluding robust comparison, interpretation and pooling of data. Further research priorities include the development of expert consensus relating to the investigation, surgical management and rehabilitation of MLKI. There is a need for minimum reporting standards for clinical studies evaluating MLKI.
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Affiliation(s)
- Navnit S Makaram
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,The University of Edinburgh, Edinburgh, UK
| | - Iain R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,The University of Edinburgh, Edinburgh, UK
| | | | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
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Xu J, Lian Y, Sun S, Yang Z, Chen H. Diagnostic Performance of Multi-Direction Adjusted Multi-Planar Reconstruction with Helical CT for Evaluating Continuity of the Anterior Cruciate Ligament. Acad Radiol 2022; 29:e240-e247. [PMID: 35246375 DOI: 10.1016/j.acra.2021.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze the diagnostic performance of MDA-MPR with CT for evaluating ACL structural continuity. METHODS A total of 145 patients with highly suspected ACL injury admitted to our hospital between January 2016 and May 2021 were retrospectively enrolled. All patients had undergone examination with MRI, CT, and arthroscopy. Taking arthroscopy results as the gold standard, the diagnostic accuracy for identifying ACL rupture by MRI and MDA-MPR with CT were compared. RESULTS The receiver operator characteristic curves demonstrated that both MRI and MDA-MPR with CT performed well in the diagnosis of ACL tears. The sensitivities of MRI and MDA-MPR with CT for diagnosing complete ACL tears were 95.16% (59/62) and 90.32% (56/62), respectively. Their specificities in this regard were 77.11% (64/83) and 84.34% (70/83), respectively. MRI had a higher sensitivity but MDA-MPR with CT had a higher specificity for detecting complete ACL tears, and the differences were statistically significant (p <.05). The sensitivities of diagnosing partial ACL tears using MRI and MDA-MPR with CT were 78.79% (26/33) and 75.76% (25/33), respectively, while the specificities were 86.61% (97/112) and 90.18% (101/112), respectively. These differences were non-significant (p >.05). CONCLUSION MDA-MPR with CT has high diagnostic efficiency for ACL injuries, especially in the diagnosis of complete ACL tears.
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Affiliation(s)
- Jun Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Yuanyuan Lian
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Shiqing Sun
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Zhitao Yang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Haisong Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China.
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11
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Howe D, Cone SG, Piedrahita JA, Spang JT, Fisher MB. Age- and Sex-Specific Joint Biomechanics in Response to Partial and Complete Anterior Cruciate Ligament Injury in the Porcine Model. J Athl Train 2022; 57:978-989. [PMID: 34964874 PMCID: PMC9842119 DOI: 10.4085/1062-6050-565-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CONTEXT Pediatric anterior cruciate ligament (ACL) injury rates are increasing and are highest in female adolescents. Complete ACL tears are typically surgically reconstructed, but few guidelines and very limited data exist regarding the need for surgical reconstruction or rehabilitation for partial ACL tears in skeletally immature patients. OBJECTIVE To evaluate the effects of partial (anteromedial bundle) and complete ACL transection on joint laxity and tissue forces under anterior and rotational loads in male and female stifle joints throughout skeletal growth in the porcine model. DESIGN Descriptive laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS We studied 60 male and female Yorkshire crossbreed pigs aged 1.5, 3, 4.5, 6, and 18 months (n = 6 pigs per age per sex). MAIN OUTCOME MEASURE(S) Joint laxity was measured in intact, anteromedial bundle-transected, and ACL-transected joints under applied anterior-posterior drawer and varus-valgus torque using a robotic testing system. Loading of the soft tissues in the stifle joint was measured under each condition. RESULTS Anterior-posterior joint laxity increased by 13% to 50% (P < .05) after anteromedial bundle transection and 75% to 178% (P < .05) after ACL transection. Destabilization after anteromedial bundle transection increased with age (P < .05) and was greater in late female than late male adolescents (P < .05). In anteromedial bundle-transected joints, the posterolateral bundle resisted the anterior load. In ACL-transected joints, the medial collateral ligament (MCL) contribution was largest, followed by the medial meniscus. The MCL contribution was larger and the medial meniscus contribution was smaller in male versus female specimens. CONCLUSIONS Partial ACL transection resulted in moderate increases in joint laxity, with the remaining bundle performing the primary ACL function. Destabilization due to partial ACL transection (anteromedial bundle) was largest in late adolescent joints, indicating that operative treatment should be considered in active, late-adolescent patients with this injury. Increased forces on the MCL and medial meniscus after ACL transection suggested that rehabilitation protocols may need to focus on protecting these tissues.
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Affiliation(s)
- Danielle Howe
- Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, and North Carolina State University, Raleigh
- Comparative Medicine Institute, North Carolina State University, Raleigh
| | - Stephanie G. Cone
- Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, and North Carolina State University, Raleigh
- Comparative Medicine Institute, North Carolina State University, Raleigh
- Department of Mechanical Engineering, University of Wisconsin, Madison
| | - Jorge A. Piedrahita
- Comparative Medicine Institute, North Carolina State University, Raleigh
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh
| | - Jeffrey T. Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina, Chapel Hill
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, and North Carolina State University, Raleigh
- Comparative Medicine Institute, North Carolina State University, Raleigh
- Department of Orthopaedics, School of Medicine, University of North Carolina, Chapel Hill
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12
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Yeo MHX, Seah SJS, Gatot C, Yew A, Lie D. Selective bundle versus complete anterior-cruciate ligament reconstruction: A systematic review and meta-analysis. J Orthop 2022; 33:124-130. [PMID: 35983549 PMCID: PMC9379500 DOI: 10.1016/j.jor.2022.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/10/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Selective bundle reconstruction (SLB) refers to preservation of the intact bundle and reconstruction of the ruptured bundle in a partial tear while complete ACL reconstruction involves the removal of all remnant tissue and reconstruction of one or both bundles. As the evidence for SLB versus complete ACL reconstruction remains unclear, this study aimed to compare the two techniques. This study's hypothesis was that SLB reconstruction allows better function and stability compared to complete ACL reconstruction. Methods A systematic search of PubMed, EMBASE, Scopus and Cochrane Library was conducted, identifying studies that compared SLB ('selective' group) versus complete ('complete' group) ACL reconstruction. Meta-analysis was conducted for post-operative functional scores, stability outcomes and complications as well as pre-operative to post-operative change. Results Eleven studies were included in the meta-analysis, with 1107 patients and a pooled mean follow-up of 29.5 months. Post-operatively, the Selective group had significantly reduced anterior laxity, shown by a lower mean arthrometry side-to-side difference (p<0.01). Analysis of change results showed that the Selective group had a lower mean improvement in arthrometry side-to-side difference as well (p<0.01). No significant difference was shown for all other post-operative outcomes. Conclusion This study provides valuable insight to the management of partial tears. It has demonstrated that the preservation of the intact bundle offers stability and function that is as good as complete reconstruction and that SLB is a potentially viable option in the management of partial tears. Level of evidence Meta-analysis; Level of evidence, 4.
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Affiliation(s)
- Mark HX Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Road, Singapore
| | - Shawn JS Seah
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Road, Singapore
| | - Cheryl Gatot
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore
| | - Andy Yew
- Division of Musculoskeletal Science, Singapore General Hospital, 1 Outram Road, Singapore
| | - Denny Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore
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13
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Cone SG, Barnes RH, Howe D, Fordham LA, Fisher MB, Spang JT. Age- and sex-specific differences in ACL and ACL bundle size during adolescent growth. J Orthop Res 2022; 40:1613-1620. [PMID: 34727387 PMCID: PMC9058042 DOI: 10.1002/jor.25198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are increasingly common in adolescents, and injuries in this age-group are associated with many unique challenges. Recent large animal studies suggest that the size and function of the major bundles of the ACL change differently throughout skeletal growth. To better aid clinical treatment of pediatric partial ACL tears and better predict outcomes from age-specific treatments, there is a need to measure changes in ACL bundle size in humans during growth. As such, the objective of this study was to compare changes in the length and cross-sectional area (CSA) of the ACL and its primary bundles in adolescent human subjects. Magnetic resonance imaging (MRI) scans were analyzed to determine the visibility and integrity of the ACL and its anteromedial and posterolateral bundles. MRI scans were considered from a retrospective database of subjects ranging from 10 to 18 years of age. The ACL and its anteromedial and posterolateral bundles were segmented and reconstructed into 3D models, and length and CSA were calculated. Total ACL length and CSA were greater in males compared with females, with a statistically significant interaction between age and sex for CSA. Sex had a significant effect on the CSA of both bundles. These sex-dependent differences emerge with moderate to large effect sizes (range: d = 0.50 to d = 1.23) beginning around 13 years of age. Along with ACL bundle structure-function relationships previously established in preclinical animal models, these findings may point toward biomechanical changes in the adolescent human ACL.
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Affiliation(s)
- Stephanie G. Cone
- University of Wisconsin – Madison,University of North Carolina – Chapel Hill,North Carolina State University
| | | | - Danielle Howe
- University of North Carolina – Chapel Hill,North Carolina State University
| | | | - Matthew B. Fisher
- University of North Carolina – Chapel Hill,North Carolina State University,Correspondence: Matthew B. Fisher, PhD, Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, 4130 Engineering Building III, CB7115, Raleigh, NC, 27695, ; Jeffrey T. Spang, MD, Department of Orthopaedics, University of North Carolina School of Medicine, 3141 Bioinformatics Building, Chapel Hill, NC, 27599,
| | - Jeffrey T. Spang
- University of North Carolina – Chapel Hill,Correspondence: Matthew B. Fisher, PhD, Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, 4130 Engineering Building III, CB7115, Raleigh, NC, 27695, ; Jeffrey T. Spang, MD, Department of Orthopaedics, University of North Carolina School of Medicine, 3141 Bioinformatics Building, Chapel Hill, NC, 27599,
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14
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Franciozi CE, Minami FK, Ambra LF, Galvão PHSAF, Schumacher FC, Kubota MS. Remnant preserving ACL reconstruction with a functional remnant is related to improved laxity but not to improved clinical outcomes in comparison to a nonfunctional remnant. Knee Surg Sports Traumatol Arthrosc 2022; 30:1543-1551. [PMID: 33893826 DOI: 10.1007/s00167-021-06572-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 04/06/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The Anterior cruciate ligament (ACL) remnant has been pointed out as a ligamentization enhancer. Nonetheless, the remaining tissue can be functional if it still provides some stability or nonfunctional. This study intends to compare the clinical results and knee stability of functional vs. nonfunctional remnant preservation ACL reconstruction (ACLR). METHODS One hundred and seventy-five patients with ACL injuries were included and underwent remnant preservation ACLR. They were divided into two groups accordingly to remnant tissue functionality: functional (Group F) and nonfunctional (Group NF). Primary outcome was defined as patient reported outcomes measured with Lysholm, IKDC and Tegner continuous scales and improvements. Secondary outcomes comprised of Lachman test, anterior drawer test, pivot shift test, extension and flexion deficit, graft coverage by remnant preserved tissue and failure rate (persistent instability or new ACL lesion). Menisci lesions, cartilage lesions and time to surgery were also recorded for each group. RESULTS One hundred and forty-four patients were available at a mean of 30.2 ± 10.1 months: 69 Functional and 75 Nonfunctional. Lysholm, IKDC and Tegner functional outcomes demonstrated no difference between the groups, Functional compared to Nonfunctional: 88.4 ± 10.5 vs. 92.2 ± 4.9, n.s. and 83.2 ± 11.3 vs. 87 ± 5.3, n.s. and 6 (5-10) vs. 6 (5-9), n.s., respectively. Lysholm and IKDC functional outcomes improvements demonstrated differences between the groups: Functional compared to Nonfunctional (39.3 ± 9.4 vs. 42.3 ± 7.4, p = 0.014 and 37.7 ± 10 vs. 41.0 ± 6.6, p = 0.032); however, they were not clinically significant. Functional group showed more stability on physical examination pre- and post-operatively (p < 0.001, p < 0.001). There was no difference regarding extension deficit (n.s.); however, functional group had more flexion deficit (p = 0.02). Nonfunctional group had better graft coverage (p = 0.001). There was no difference regarding failure rate: 4% vs. 9%, (n.s.). CONCLUSION Both remnant preservation ACLR techniques were able to achieve satisfactory functional outcomes. A functional remnant was not related to improved functional outcomes in comparison to a nonfunctional remnant; however, it was related to less laxity pre and postoperatively and inferior graft coverage. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Carlos Eduardo Franciozi
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil.,Knee Institute - Heart Hospital (Hospital do Coração - Hcor), São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Flávio Kazuo Minami
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil.
| | - Luiz Felipe Ambra
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
| | - Pedro Henrique Schmidt Alves Ferreira Galvão
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
| | - Felipe Conrado Schumacher
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
| | - Marcelo Seiji Kubota
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
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15
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Magosch A, Jacquet C, Nührenbörger C, Mouton C, Seil R. Grade III pivot shift as an early sign of knee decompensation in chronic ACL-injured knees with bimeniscal tears. Knee Surg Sports Traumatol Arthrosc 2022; 30:1611-1619. [PMID: 34302192 DOI: 10.1007/s00167-021-06673-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/16/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE To analyse possible associations between the preoperative pivot shift (PS) test and both patient and injury characteristics in anterior cruciate ligament (ACL)-injured knees, considering previously neglected meniscal injuries such as ramp and root tears. The hypothesis was that a preoperative grade III PS was associated with the amount of intra-articular soft-tissue damage and chronicity of the injury. METHODS The cohort involved 376 patients who underwent primary ACL reconstruction (239 males/137 females; median age 26). Patients were examined under anesthesia before surgery, using the PS test. During arthroscopy, intra-articular soft-tissue damage of the injured knee was classified as: (1) partial ACL tear; (2) complete isolated ACL tear; (3) complete ACL tear with one meniscus tear; and (4) complete ACL and bimeniscal tears. Chi-square and Mann-Whitney U tests were used to evaluate whether sex, age, body mass index, sport at injury, mechanism of injury, time from injury and intra-articular damage (structural damage of ACL and menisci) were associated with a grade III PS. Intra-articular damage was further analyzed for two sub-cohorts: acute (time from injury ≤ 6 months) and chronic injuries (> 6 months). RESULTS A grade III PS test was observed in 26% of patients. A significant association with PS grading was shown for age, time from injury and intra-articular soft-tissue damage (p < 0.05). Further analyses showed that grade III PS was associated with intra-articular damage in chronic injuries only (p < 0.01). In complete ACL and bimeniscal tears, grade III PS was more frequent in chronic (53%) than in acute knee injuries (26%; p < 0.01). Patients with chronic complete ACL and bimeniscal tears had a grade III PS 3.3 [1.3-8.2] times more often than patients in the acute sub-cohort. CONCLUSION In ACL-injured patients, a preoperative grade III PS was mainly associated with a higher amount of intra-articular soft-tissue damage and chronicity of the injury. Patients with complete chronic ACL injuries and bimeniscal tears were more likely to have a preoperative grade III PS than their acute counterparts. This suggests that grade III PS may be an early sign of knee decompensation of dynamic rotational knee laxity in chronic ACL-injured knees with bimeniscal lesions. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Amanda Magosch
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg
| | - Christophe Jacquet
- Institute for Movement and Locomotion (IML), Department of Orthopedic Surgery and Traumatology, St. Marguerite Hospital, Marseille, France
| | - Christian Nührenbörger
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg.,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Caroline Mouton
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg.,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Romain Seil
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg. .,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg. .,Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Strassen, Luxembourg.
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16
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Li Z, Li M, Du Y, Zhang M, Jiang H, Zhang R, Ma Y, Zheng Q. Femur-tibia angle and patella-tibia angle: new indicators for diagnosing anterior cruciate ligament tears in magnetic resonance imaging. BMC Sports Sci Med Rehabil 2022; 14:66. [PMID: 35418093 PMCID: PMC9009057 DOI: 10.1186/s13102-022-00462-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022]
Abstract
Background Femur-tibia angle (FTA) and patella-tibia angle (PTA) are two MRI measurements that reflect the rotation of the knee joint. The purposes of this study were to assess whether FTA and PTA are associated with ACL tear and to explore their roles in ACL tear diagnosis. Methods FTA, PTA, ACL angle and anterior tibial subluxation were compared between the two matched groups: ACL tear group and control group (each n = 20). Diagnostic performance was evaluated in a consecutive 120-patient cohort who underwent MR imaging of the knee and subsequently had arthroscopy. Different measurements were assessed by area under the curve (AUC) of receiver operating characteristic (ROC) curve. Results FTA and PTA increased significantly in ACL tears group when compared to the control group (4.79 and 7.36 degrees, respectively, p < 0.05). In distinguishing complete ACL tear, ACL angle had the highest AUC of 0.906 while AUC of PTA and FTA were 0.849 and 0.809. The cutoff of FTA was 80 degrees with a sensitivity of 82% and specificity of 68%, while the cutoff of PTA was 91 degrees with a sensitivity of 82% and specificity of 74%. In distinguishing partial ACL tear, FTA and PTA had the highest AUCs of 0.847 and 0.813, respectively. The calculated cutoff of FTA was 84 degrees with a sensitivity of 90% and specificity of 81%, while the cutoff of PTA was 92 degrees with a sensitivity of 80% and specificity of 77%. Conclusion FTA and PTA increased when ACL tears and they might be valuable in diagnosing ACL tears, especially in distinguishing partial ACL tear from intact ACL.
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Affiliation(s)
- Zeng Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Mengyuan Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yan Du
- Clinical Research Unit, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Mo Zhang
- Clinical Research Unit, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Hai Jiang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Ruiying Zhang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yuanchen Ma
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Qiujian Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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17
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Magosch A, Mouton C, Nührenbörger C, Seil R. Medial meniscus ramp and lateral meniscus posterior root lesions are present in more than a third of primary and revision ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 2021; 29:3059-3067. [PMID: 33165632 DOI: 10.1007/s00167-020-06352-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/26/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this study was (1) to describe the meniscus tear pattern in anterior cruciate ligament (ACL)-injured patients, with a special focus on medial meniscus (MM) ramp lesions and lateral meniscus (LM) root tears and (2) to determine whether patient and injury characteristics were associated with meniscus tear patterns. METHODS Data from 358 cases of ACL primary and revision reconstruction surgeries were extracted from a center-based registry. During arthroscopy, the presence of associated meniscus lesions was documented by systematically inspecting the anterior and posterior tibiofemoral compartments. With a special focus on MM ramp lesions and LM root tears, groups of different injury tear patterns were formed. Chi-square tests were used to determine whether these groups differed with respect to various patient and injury characteristics, including gender, previous ipsilateral ACL injuries, the injury's relation to sport, person contact during injury and the type of ACL tear. Median age at surgery and body mass index were compared between groups using the Kruskal-Wallis test. Significance was set at p < 0.05. RESULTS Two hundred and thirty-nine ACL injuries (67%) showed additional meniscal injuries, of which 125 (52%) involved the MM ramp and/or the LM root. Ramp lesions were more frequent in males (23% vs 12% in females, p < 0.01), in contact injuries (28% vs 16% in non-contact, p < 0.05) and in complete ACL tears (21% vs 5% in partial, p < 0.05). Combined injuries of the MM ramp and the LM root showed a higher percentage of contact injuries compared to non-contact injuries (10% vs 4%, p < 0.05). CONCLUSION Two-thirds of all ACL injuries showed a concomitant meniscus injury, of which half involved the biomechanically relevant, but previously often undiagnosed RLMM or the PRLM. These findings provide evidence that until recently about half of ACL-associated meniscus injuries were not properly identified. Ramp lesions were more frequent in males, contact injuries and in complete ACL tears. These findings stress the need for a systematic assessment and a better understanding of the pathomechanism of these specific injuries which may have an important impact on knee biomechanics and the outcome of ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Amanda Magosch
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg
| | - Caroline Mouton
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Christian Nührenbörger
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Romain Seil
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg.
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg.
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg.
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18
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Seeing Beyond Morphology-Standardized Stress MRI to Assess Human Knee Joint Instability. Diagnostics (Basel) 2021; 11:diagnostics11061035. [PMID: 34199917 PMCID: PMC8226919 DOI: 10.3390/diagnostics11061035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 12/28/2022] Open
Abstract
While providing the reference imaging modality for joint pathologies, MRI is focused on morphology and static configurations, thereby not fully exploiting the modality’s diagnostic capabilities. This study aimed to assess the diagnostic value of stress MRI combining imaging and loading in differentiating partial versus complete anterior cruciate ligament (ACL)-injury. Ten human cadaveric knee joint specimens were subjected to serial imaging using a 3.0T MRI scanner and a custom-made pressure-controlled loading device. Emulating the anterior-drawer test, joints were imaged before and after arthroscopic partial and complete ACL transection in the unloaded and loaded configurations using morphologic sequences. Following manual segmentations and registration of anatomic landmarks, two 3D vectors were computed between anatomic landmarks and registered coordinates. Loading-induced changes were quantified as vector lengths, angles, and projections on the x-, y-, and z-axis, related to the intact unloaded configuration, and referenced to manual measurements. Vector lengths and projections significantly increased with loading and increasing ACL injury and indicated multidimensional changes. Manual measurements confirmed gradually increasing anterior tibial translation. Beyond imaging of ligament structure and functionality, stress MRI techniques can quantify joint stability to differentiate partial and complete ACL injury and, possibly, compare surgical procedures and monitor treatment outcomes.
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19
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Haviv B, Shemesh S, Kittani M, Yassin M, Yaari L. The Reliability of Classifying the Morphology of Anterior Cruciate Ligament Remnants during Surgery. J Knee Surg 2021; 34:712-716. [PMID: 31683349 DOI: 10.1055/s-0039-1700810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Arthroscopic classification of the torn anterior cruciate ligament (ACL) morphology is fundamental for clinical studies on emerging techniques such as repair and preservation. At present, the most acknowledged classification is Crain description of four morphological patterns. The purpose of the study was to analyze the intra- and interobserver reliability of Crain classification in patients undergoing ACL reconstruction surgeries. The study included 101 patients who had ACL reconstruction surgery between the years 2014 and 2017. The morphological pattern of ACL remnant scar formation during surgery was observed and classified according to Crain by three orthopaedic surgeons. Inter- and intraobserver reliabilities were measured using kappa statistics. Intraobserver reliability for the Crain classification ranged from 0.63 to 0.83 (substantial to almost perfect agreement). Interobserver reliability was 0.51 (moderate agreement). In almost a third of the cases, observers reported on additional morphological pattern of scar formation that was not well defined by Crain. A modified classification of four patterns was suggested: (A) without scar tissue, (B) with adhesion to the femoral notch (wall or roof), (C) with adhesion to the notch and posterior cruciate ligament (PCL), and (D) with adhesion to the PCL. Reanalysis of these four morphological configurations resulted in interobserver reliability of 0.82 (almost perfect agreement). In conclusion, the Crain classification of torn ACL remnant morphology has moderate interobserver reliability; however, a suggested classification with modified and additional configurations has almost perfect reliability and may be useful for studies on ACL repair and preservation.
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Affiliation(s)
- Barak Haviv
- Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petch-Tikva, Israel.,Department of Orthopedics, Sackler Faculty of Medicine, Tel-Aviv University, Israel.,Department of Orthopedics, Hasharon Hospital, Rabin Medical Center, Petch-Tikva, Israel
| | - Shai Shemesh
- Department of Orthopedics, Beilinson Hospital, Rabin Medical Center, Petch-Tikva, Israel
| | - Mohamed Kittani
- Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petch-Tikva, Israel.,Department of Orthopedics, Hasharon Hospital, Rabin Medical Center, Petch-Tikva, Israel.,Department of Orthopedics, Beilinson Hospital, Rabin Medical Center, Petch-Tikva, Israel
| | - Mustafa Yassin
- Department of Orthopedics, Sackler Faculty of Medicine, Tel-Aviv University, Israel.,Department of Orthopedics, Hasharon Hospital, Rabin Medical Center, Petch-Tikva, Israel
| | - Lee Yaari
- Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petch-Tikva, Israel.,Department of Orthopedics, Hasharon Hospital, Rabin Medical Center, Petch-Tikva, Israel
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20
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Zhao GL, Lyu JY, Liu CQ, Wu JG, Xia J, Huang GY. A modified anterior drawer test for anterior cruciate ligament ruptures. J Orthop Surg Res 2021; 16:260. [PMID: 33853620 PMCID: PMC8045226 DOI: 10.1186/s13018-021-02381-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/23/2021] [Indexed: 11/12/2022] Open
Abstract
Objective This study was aimed to utilize a modified anterior drawer test (MADT) to detect the anterior cruciate ligament (ACL) ruptures and investigate its accuracy compares with three traditional tests. Methods Four hundred patients were prospectively enrolled between January 2015 and September 2017 preoperatively to undergo knee arthroscopic surgeries. The MADT, anterior drawer test, Lachman test, and pivot shift test were used in the outpatient clinical setting and were compared statistically for their accuracy in terms of ACL ruptures, with arthroscopic findings as the gold standard. Results The prevalence of ACL ruptures in this study was 37.0%. The MADT demonstrated the highest sensitivity (0.89) and accuracy (0.92) among the four tests and had comparable specificity (0.94) and a positive predictive value (0.90) compared with the anterior drawer test, Lachman test, and pivot shift test. The diagnostic odds ratio (DOR) of MADT was 122.92, with other test values of no more than 55.45. The area under the receiver operating characteristic curve (AUC) for the MADT was 0.92 ± 0.01, with a significant difference compared with that for the anterior drawer test (z = 17.00, p < 0.001), Lachman test (z = 9.66, p = 0.002), and pivot shift test (z = 16.39, p < 0.001). The interobserver reproducibility of the MADT was good, with a kappa coefficient of 0.86. When diagnosing partial tears of ACL, the MADT was significantly more sensitive than the anterior drawer test (p < 0.001), Lachman test (p = 0.026), and pivot shift test (p = 0.013). The MADT showed similar sensitivity in detecting anteromedial and posterolateral bundle tears (p = 0.113) and no difference in diagnosing acute and chronic ACL ruptures (χ2 = 1.682, p = 0.195). Conclusions The MADT is also an alternative diagnostic test to detect ACL tear, which is equally superior to the anterior drawer test, Lachman test, and pivot shifting test. It could improve the diagnosis of ACL ruptures combined with other clinical information including injury history, clinical examination, and radiological findings. Levels of evidence Level II/observational diagnostic studies Trial registration Chinese Clinical Trial Registry. ChiCTR1900022945 /retrospectively registered Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02381-x.
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Affiliation(s)
- Guang-Lei Zhao
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China
| | - Jin-Yang Lyu
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China
| | - Chang-Quan Liu
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China
| | - Jian-Guo Wu
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China.,Department of Orthopaedic Surgery, North Branch of Huashan Hospital Fudan University, 518th Jingpohu Road, Bao'shan District, Shanghai, China
| | - Jun Xia
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China
| | - Gang-Yong Huang
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China. .,Department of Orthopaedic Surgery, North Branch of Huashan Hospital Fudan University, 518th Jingpohu Road, Bao'shan District, Shanghai, China.
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21
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Wei Y, Yun X, Liu Y, Wei M. [Effectiveness of partial anterior cruciate ligament suture repair with wide awake local anesthesia no tourniquet technique]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:337-342. [PMID: 33719243 DOI: 10.7507/1002-1892.202008127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of partial anterior cruciate ligament (ACL) suture repair with wide awake local anesthesia no tourniquet (WALANT) technique. Methods Between July 2017 and July 2019, 18 patients with partial ACL injury were admitted. There were 10 males and 8 females, with an average age of 40.5 years (range, 22-57 years). There were 5 cases on the left knee and 13 cases on the right knee. Forteen cases had a clear history of trauma or sports injury, and 4 cases had no obvious cause. The time from injury to operation was 1-6 months (median, 3 months). Partial ligament was sutured using WALANT technique under arthroscopy. The operation time, total hospital stay, and postoperative hospital stay were recorded. Lachman test and anterior drawer test were performed to evaluate the knee joint stability after treatment, and Lysholm and International Knee Documentation Committee (IKDC) scores were used to evaluate the knee function. Five-point Likert scaling were used to evaluate postoperative patient satisfaction. Results The operation time was 30-100 minutes (mean, 64.2 minutes). The total hospital stay was 2-12 days (mean, 4.5 days). Postoperative hospital stay was 1-4 days (mean, 1.8 days). All incisions healed by first intention after operation, and no surgery-related complications occurred. All patients were followed up 12-36 months (mean, 19.1 months). Lachman test and anterior drawer test were negative after operation. Lysholm score and IKDC score at 6 and 12 months after operation were significantly higher than those before operation, and at 12 months after operation were higher than those at 6 months after operation, the differences were significant ( P<0.05). At last follow-up, according to five-point Likert scaling of patient satisfaction, 7 cases were very satisfied, 10 cases were relatively satisfied, and 1 case was general. The total patient satisfaction rate was 94.4% (17/18). MRI scan showed the good ligament tension. Conclusion Using WALANT technique to repair partial ACL injuries under arthroscopy can retain the patient's own ligament tissue to the maximum extent and achieve satisfactory short-term effectiveness.
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Affiliation(s)
- Yu Wei
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | | | - Yang Liu
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Min Wei
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
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Computer-Assisted System in Stress Radiography for Anterior Cruciate Ligament Injury with Correspondent Evaluation of Relevant Diagnostic Factors. Diagnostics (Basel) 2021; 11:diagnostics11030419. [PMID: 33801343 PMCID: PMC7998468 DOI: 10.3390/diagnostics11030419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/20/2021] [Accepted: 02/26/2021] [Indexed: 12/03/2022] Open
Abstract
We sought to design a computer-assisted system measuring the anterior tibial translation in stress radiography, evaluate its diagnostic performance for an anterior cruciate ligament (ACL) tear, and assess factors affecting the diagnostic accuracy. Retrospective research for patients with both knee stress radiography and magnetic resonance imaging (MRI) at our institution was performed. A complete ACL rupture was confirmed on an MRI. The anterior tibial translations with four different methods were measured in 249 patients by the designed algorithm. The diagnostic accuracy of each method in patients with all successful measurements was evaluated. Univariate logistic regression analysis for factors affecting diagnostic accuracy of method four was performed. In the inclusive 249 patients, 177 patients (129 with completely torn ACLs) were available for analysis. Mean anterior tibial translations were significantly increased in the patients with a completely torn ACL by all four methods, with diagnostic accuracies ranging from 66.7% to 75.1%. The diagnostic accuracy of method four was negatively associated with the time interval between stress radiography and MRI as well as force-joint distance on stress view, and not significantly associated with age, gender, flexion angle, intercondylar distance, and force-joint angle. A computer-assisted system measuring the anterior tibial translation in stress radiography showed acceptable diagnostic performance of complete ACL injury. A shorter time interval between stress radiography and MRI as well as shorter force-joint distance were associated with higher diagnostic accuracy.
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23
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Noyes FR, Huser LE, Palmer M. A Biomechanical Study of Pivot-Shift and Lachman Translations in Anterior Cruciate Ligament-Sectioned Knees, Anterior Cruciate Ligament-Reconstructed Knees, and Knees With Partial Anterior Cruciate Ligament Graft Slackening: Instrumented Lachman Tests Statistically Correlate and Supplement Subjective Pivot-Shift Tests. Arthroscopy 2021; 37:672-681. [PMID: 33065214 DOI: 10.1016/j.arthro.2020.09.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the statistical and predictive correlation between instrumented Lachman and pivot-shift tests with progressive loss of anterior cruciate ligament (ACL) function. METHODS The kinematic correlations between pivot-shift and Lachman anterior tibial translations (ATTs) in ACL-deficient and ACL-reconstructed states and in partially lax ACL grafts were determined with precise robotic testing in cadaveric knees. The Lachman test (100-N anteroposterior) and 2 pivot-shift loadings were conducted: anterior tibial loading (100 N), valgus rotation (7 Nm), and internal rotation (5 Nm and 1 Nm). The tibia was digitized to study the resulting medial, central, and lateral tibiofemoral compartment translations. In group 1 knees, 15 bone-patellar tendon-bone reconstructions were first tested, followed by ACL graft loosening with 3- and 5-mm increases in Lachman ATT. In group 2, 43 knees underwent robotic testing before and after ACL sectioning and underwent analysis of the effect of 3- and 5-mm increases in Lachman ATT and complete ACL sectioning on pivot-shift compartment translations. RESULTS In group 1 knees, ACL graft loosening allowing a 3-mm increase in Lachman ATT resulted in increases in pivot-shift lateral compartment translation (lateral compartment ATT) of only 1.6 ± 0.3 mm and 2.2 ± 1.0 mm (internal rotation of 5 Nm and 1 Nm, respectively) that were one-half of those required for a positive pivot-shift test finding. In group 2, for a 3-mm increased Lachman test, there were no positive pivot-shift values. In both groups, a Lachman test with an increase in ATT of 3 mm or less (100 N) had a 100% predictive value for a negative pivot-shift test finding. With ACL graft loosening and a 5-mm increase in the Lachman ATT, group 1 still had no positive pivot-shift values, and in group 2, a positive pivot-shift test finding occurred in 3 of 43 knees (7%, pivot shift 1-Nm internal rotation). After ACL sectioning, a highly predictive correlation was found between abnormal increases in Lachman and pivot-shift translations (P < .001). CONCLUSIONS ACL graft slackening and an instrumented Lachman test with an increase in ATT of 3 mm or less were 100% predictive of a negative pivot-shift subluxation finding and retained ACL stability. Further graft slackening and a 5-mm increase in the Lachman ATT produced pivot-shift lateral compartment ATT increases still less than the values in the ACL-deficient state; however, 7% of the knees (3 of 43) were converted to a positive pivot-shift test finding indicative of ACL graft failure. CLINICAL RELEVANCE Instrumented Lachman tests provide objective data on ACL function and graft failure to supplement subjective pivot-shift tests and are highly recommended for single-center and multicenter ACL studies. In the past decade, a near majority of published ACL studies no longer reported on instrumented Lachman tests, relying solely on highly subjective pivot-shift grading by multiple examiners.
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Affiliation(s)
- Frank R Noyes
- Cincinnati Sportsmedicine and Orthopaedic Center-Mercy Health, Cincinnati, Ohio, U.S.A.; The Noyes Knee Institute, Cincinnati, Ohio, U.S.A..
| | - Lauren E Huser
- Cincinnati Sportsmedicine and Orthopaedic Center-Mercy Health, Cincinnati, Ohio, U.S.A.; The Noyes Knee Institute, Cincinnati, Ohio, U.S.A
| | - Michael Palmer
- Cincinnati Sportsmedicine and Orthopaedic Center-Mercy Health, Cincinnati, Ohio, U.S.A.; The Noyes Knee Institute, Cincinnati, Ohio, U.S.A
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24
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Management of Partial Tears of the Anterior Cruciate Ligament: A Review of the Anatomy, Diagnosis, and Treatment. J Am Acad Orthop Surg 2021; 29:60-70. [PMID: 33394613 DOI: 10.5435/jaaos-d-20-00242] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Partial anterior cruciate ligament (ACL) tears comprise an estimated 10% to 27% of isolated ACL injuries. Partial ACL tears may be challenging to clinically diagnose. We reviewed relevant studies focusing on the anatomy, diagnosis, imaging, and treatment of a partial injury with the goal of providing guidance to clinicians. Although a comprehensive patient history, thorough clinical examination, and imaging studies are helpful in arriving at a diagnosis, the benchmark for diagnosis remains visualization and examination of the ACL at the time of knee arthroscopy. Currently, limited data exist about the long-term outcomes of nonsurgical treatment. Some studies demonstrate that younger, active patients have the risk of progressing to a complete ACL rupture with conservative treatment. The decision to proceed with surgery is based on careful history and physical examination findings that suggest either a "functional" or "nonfunctional" ACL. Surgical treatment consists of augmenting the intact bundle with a selective bundle reconstruction versus a traditional ACL reconstruction. Selective bundle reconstruction has limited data available but is an option. The best evidence supports traditional ACL reconstruction for the surgical management of patients with documented nonfunctional partial tears of the ACL.
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Guenther D, Zhang C, Ferlin F, Vernacchia C, Musahl V, Irrgang JJ, Fu FH. Clinical examination of partial ruptures of the anterior cruciate ligament: A retrospective case-control study. Knee 2020; 27:1866-1873. [PMID: 33202290 DOI: 10.1016/j.knee.2020.07.093] [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: 01/31/2020] [Revised: 07/13/2020] [Accepted: 07/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior drawer test, Lachman test including evaluation of the endpoint, and pivot shift test have been commonly applied clinically in diagnosing anterior cruciate ligament (ACL) injury but how they function in the appraisal of partial ACL tears is less known. The aims of this study were to examine the diagnostic values of the commonly used knee function tests on patients in detecting ACL injury including partial injury patterns, to assess each of the test's predictive values on the specific ACL injury pattern, and to assess if using multiple tests collectively for the diagnosis of the injury could improve diagnostic accuracy. METHODS We evaluated 36 consecutive patients who underwent ACL single bundle augmentation surgery. Those patients were matched by gender and age to 36 patients with a complete rupture of the ACL. Data was obtained from the patients' records. The rupture pattern was confirmed by arthroscopy. An examination under anesthesia was routinely performed by two surgeons who were blinded to the rupture pattern prior to surgery. RESULTS Collectively using both Lachman test and pivot shift test increases ability to distinguish between partial tears and complete ruptures. When comparing partial PL tears and complete ruptures the pivot shift test is more important than the Lachman test. In diagnosing a complete rupture, the evaluation of the endpoint during the Lachman test is more sensitive than the evaluation of the anterior tibial translation during the Lachman test. CONCLUSION Based on the findings of this study, a diagnostic algorithm has been implemented and is presented in this manuscript.
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Affiliation(s)
- Daniel Guenther
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA; Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Caiyan Zhang
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA
| | - Fernando Ferlin
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA
| | - Cara Vernacchia
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA.
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Hiramatsu K, Mae T, Mitsuoka T, Tachibana Y, Nakagawa S, Shino K. Anterior tibial loading on the calf enhances anterior tibial translation in the anterior cruciate ligament deficient knee in the anterior gravity radiographic view. Knee 2020; 27:1764-1771. [PMID: 33197815 DOI: 10.1016/j.knee.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/17/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lateral radiograph in the prone position with the knee flexed at 15° (anterior gravity view (AGV)) is useful as a screening for anterior cruciate ligament (ACL) injuries, while it is sometimes difficult to find the side-to-side difference (SSD) in anterior tibial translation. Thus, we applied a weight (three kilograms) around the lower leg to increase anterior tibial translation. We aimed to determine whether weight load confers an advantage in visualizing anterior knee laxity in ACL injuries. METHODS Fifty-eight patients with confirmed unilateral ACL tears from February 2012 to April 2014 had consented to participate in this study. Lateral radiographs for both knees were taken in AGV and in AGV with a three-kilogram weight load applied to the proximal lower leg. Then, the SSD of tibial position related to the femur was measured in these radiographs. RESULTS The SSD with the weight was significantly greater than that without the weight (5.9 ± 2.1 and 3.5 ± 1.6 mm, respectively, p < 0.01). The ratio of patients with SSD of three millimeters or more in AGV with the weight was also significantly larger than that without the weight (p < 0.01). CONCLUSIONS The anterior laxity in AGV with the three-kilogram weight is larger than that without the weight. Thus, the AGV with the weight could be one of the helpful radiographic technique for auxiliary diagnosis of ACL injury. Level of evidence Cohort study, Level IV.
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Affiliation(s)
- Kunihiko Hiramatsu
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita City, Osaka 565-0871, Japan; Department of Orthopaedic Surgery, Tamai Hospital, Han-nan City, Osaka, Japan.
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita City, Osaka 565-0871, Japan
| | - Tomoki Mitsuoka
- Department of Orthopaedic Surgery, Yao Municipal Hospital, Yao City, Osaka, Japan
| | - Yuta Tachibana
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita City, Osaka 565-0871, Japan
| | - Shigeto Nakagawa
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka City, Osaka, Japan
| | - Konsei Shino
- Sports Orthopaedic Center, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka City, Osaka, Japan
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Adding a modified Lemaire procedure to ACLR in knees with severe rotational knee instability does not compromise isokinetic muscle recovery at the time of return-to-play. J Exp Orthop 2020; 7:84. [PMID: 33128116 PMCID: PMC7599282 DOI: 10.1186/s40634-020-00302-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose To determine whether isokinetic muscle recovery following ACLR using a hamstring tendon (HT) would be equivalent (non-inferior) in knees that had high-grade pivot-shift and adjuvant modified Lemaire procedure versus knees that had minimal pivot-shift and no adjuvant modified Lemaire procedure. Methods We evaluated 96 consecutive patients that underwent primary ACLR. Nine were excluded because of contralateral knee injury, and of the remaining 87, ACLR was performed stand-alone in 52 (Reference group), and with a Lemaire procedure in 35 (Lemaire group) who had high-grade pivot-shift, age < 18, or genu recurvatum > 20°. At 6 months, isokinetic tests were performed at 240°/s and 90°/s to calculate strength deficits of hamstrings (H) and quadriceps (Q). At 8 months, patients were evaluated using IKDC, Lysholm, and Tegner scores. Results Compared to the Reference group, the Lemaire group were younger (23.0 ± 2.5 vs 34.2 ± 10.5, p = 0.021) with a greater proportion of males (80% vs 56%, p < 0.001). The Lemaire group had no complications, but the Reference group had one graft failure and one cyclops syndrome. Strength deficits at 240°/s and at 90°/s were similar in both groups, but mixed H/Q ratios were lower for the Lemaire group (1.02 ± 0.19 vs 1.14 ± 0.24, p = 0.011). IKDC and Lysholm scores were similar in both groups, but Tegner scores were higher in the Lemaire group (median, 6.5 vs 6.0, p = 0.024). Conclusions ACLR with a modified Lemaire procedure for knees with rotational instability grants equivalent isokinetic muscle recovery as stand-alone ACLR in knees with no rotational instability. For ACL-deficient knees with high-grade pivot-shift, a Lemaire procedure restores rotational stability without compromising isokinetic muscle recovery. Study design Level III, comparative study.
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28
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Effect of viscoelastic properties on passive torque variations at different velocities of the knee joint extension and flexion movements. Med Biol Eng Comput 2020; 58:2893-2903. [PMID: 32975707 DOI: 10.1007/s11517-020-02247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
This study aimed to investigate the rate of passive torque variations of human knee joint in the different velocities of knee flexion and extension movements. Ten healthy men were invited to participate in the tests. All passive torque tests were performed for the knee joint extension and flexion on the sagittal plane in three different angular velocities of 15, 45, and 120°/s; in 5 consecutive cycles; and within 0° to 100° range of motion. The electrical activity of knee joint extensor and flexor muscles was recorded until there was no muscle activity signal. A Three-element Solid Model (SLS) was used to obtain the viscose and elastic coefficients. As the velocity increases, the stretch rate in velocity-independent tissues increases, and the stretch rate in velocity-dependent tissues decreases. By increasing the velocity, the resistance of velocity-dependent parts increases, and the velocity-independent parts are not affected by velocity. Since the first torque that resists the joint movement is passive torque, the elastic and viscous torques should be simultaneously used. It is better to perform the movement at a low velocity so that less energy is lost. The viscoelastic resistance of tissues diminishes. Graphical abstract.
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Diaz RMM, Rezende FC, Moscon AC, Franciozi CEDS, Martimbianco ALC, Duarte A. Return to Sports after ACL Reconstruction with Resection or Remnant-Preserving Technique. Rev Bras Ortop 2020; 55:432-437. [PMID: 32904857 PMCID: PMC7458750 DOI: 10.1055/s-0039-3402461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/21/2019] [Indexed: 11/04/2022] Open
Abstract
Objectives
To analyze the results of anterior cruciate ligament (ACL) reconstruction with remnant-preserving versus remnant-resecting technique, concerning the return to pre-lesion activity level.
Methods
The present retrospective cohort study has assessed adults > 18 years old who underwent ACL anatomical reconstruction between 2010 and 2014. The main outcomes assessed were: level of physical activity (4-point scale), sports participation rate, ACL rerupture defined as documented lesion requiring revision surgery and the numeric pain scale rate (NPSR).
Results
A total of 83 individuals were included in the study, with a mean age of 31.8 years old and follow-up mean time of 4.2 years after the surgery. A total of 34 patients underwent ACL reconstruction with remnant-preserving technique, and 49 without remnant preservation. No statistically significant difference was found between groups in all outcomes assessed: level of physical activity before the lesion and after the surgery, ACL rerupture rates and postoperative pain level. Subgroup analysis has shown a statistically significant decrease in the activity level in both groups. The most practiced sport was football; 72% of patients in the remnant group have resumed football activity versus 52.6% of the control group.
Conclusion
Based in these findings, the comparison between ACL reconstruction with remnant preserving technique and remnant resecting technique has shown no differences concerning the return to prelesion activity level.
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Affiliation(s)
| | - Fernando Cury Rezende
- Grupo do Joelho da Ortocity, SP, Brasil.,Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | | | - Ana Luiza Cabrera Martimbianco
- Grupo do Joelho da Ortocity, SP, Brasil.,Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos Santos, SP, Brasil
| | - Aires Duarte
- Grupo do Joelho da Ortocity, SP, Brasil.,Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
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Roger J, Bertani A, Vigouroux F, Mottier F, Gaillard R, Have L, Rongièras F. ACL reconstruction using a quadruple semitendinosus graft with cortical fixations gives suitable isokinetic and clinical outcomes after 2 years. Knee Surg Sports Traumatol Arthrosc 2020; 28:2468-2477. [PMID: 32699919 DOI: 10.1007/s00167-020-06121-2] [Citation(s) in RCA: 10] [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: 12/13/2019] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The objective of this single-center randomized single-blinded trial was to assess the hypothesis that anterior cruciate ligament reconstruction (ACLR) using a four-strand semitendinosus (ST) graft with adjustable femoral and tibial cortical fixation produced good outcomes compared to an ST/gracilis (ST/G) graft with femoral pin transfixation and tibial bioscrew fixation. Follow-up was 2 years. METHODS Patients older than 16 years who underwent primary isolated ACLR included for 1 year until August 2017 were eligible. The primary outcome measures were the subjective International Knee Documentation Committee (IKDC) score, isokinetic muscle strength recovery, and return to work within 2 years. The study was approved by the ethics committee. RESULTS Of 66 eligible patients, 60 completed the study and were included, 33 in the 4ST group and 27 in the ST/G group. Mean age was 30.5 ± 8.9 years in the 4ST group and 30.3 ± 8.5 in the ST/G group (n.s.). No significant between-group differences were found for mean postoperative subjective IKDC (4ST group, 80.2 ± 12.5; ST/G group, 83.6 ± 13.6; n.s.), side-to-side percentage deficits in isokinetic hamstring strength (at 60°/s: ST group, 17% ± 16%; ST/G group, 14% ± 11%; n.s.) or quadriceps strength (at 60°/s: ST group, 14% ± 12%; ST/G group, 19% ± 17%; n.s.), return to work, pain during physical activities, side-to-side differential laxity, balance, loss of flexion/extension, or surgical complications. CONCLUSION This trial demonstrates that functional outcomes after 4ST for ACLR with cortical fixations could be as good, although not better, than those obtained using ST/G. The 4ST technique spares the gracilis tendon, which thus preserves the medial sided muscle and thereby could improve function and limit donor-side morbidity. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Julien Roger
- Division of Orthopaedic Surgery, Department of Surgery, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Antoine Bertani
- Division of Orthopaedic Surgery, Department of Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
| | - Florence Vigouroux
- Division of Orthopaedic Surgery, Department of Surgery, Hôpital d'Instruction des Armées Bégin, Service de Santé des Armées, Saint-Mandé, France
| | - Franck Mottier
- Division of Orthopaedic Surgery, Department of Surgery, Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France
| | - Romain Gaillard
- Division of Orthopaedic Surgery, Department of Surgery, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Laurence Have
- Department of Physical and Medical Rehabilitation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Rongièras
- Division of Orthopaedic Surgery, Department of Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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Bai R, Li X, Li R, He X, Wen Z. Optimization of low-dose scan parameters in dual-energy computed tomography for displaying the anterior cruciate ligament. J Int Med Res 2020; 48:300060520927874. [PMID: 32720539 PMCID: PMC7388117 DOI: 10.1177/0300060520927874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective This study was performed to assess low-dose scan parameters in dual-energy computed
tomography (CT) for displaying the anterior cruciate ligament. Methods Dual-energy CT scans with low and standard dose parameters, respectively, were
performed in nine human knee joint specimens. Eighteen imaging data sets for cruciate
ligament specimens were obtained and processed. Statistical analysis was performed for
signal-to-noise ratios of the CT images and subjective scores. Results Comparable signal-to-noise ratios and subjective image quality scores by evaluators in
dual-energy CT anterior cruciate ligament images between the low and standard-dose
groups were observed. Conclusion Low-dose scan parameters do not compromise the outcomes of anterior cruciate ligament
imaging.
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Affiliation(s)
- Rui Bai
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Radiology, Gosun Medical Imaging Diagnostic Center, Guangzhou, China
| | - Xiangdong Li
- Department of Radiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Rurui Li
- Department of Radiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Xiaohua He
- Department of Radiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Zhibo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Is a Partial Anterior Cruciate Ligament Tear Truly Partial? A Clinical, Arthroscopic, and Histologic Investigation. Arthroscopy 2020; 36:1706-1713. [PMID: 32151662 DOI: 10.1016/j.arthro.2020.02.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/27/2019] [Accepted: 02/26/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To determine whether examination under anesthesia (EUA) and/or magnetic resonance imaging (MRI) is an accurate means for determining patient selection for a selective-bundle reconstruction, (2) to determine whether the preoperative clinical assessment correlates with the arthroscopic examination, and (3) to examine histologically whether a partial anterior cruciate ligament (ACL) tear is truly partial in terms of vascular insult. METHODS This prospective, nonrandomized cohort study included 95 patients who underwent primary ACL reconstruction from January 2013 through May 2014. All patients underwent an EUA, MRI, and arthroscopic evaluation. In patients with partial ACL tears, the intact bundle was resected and underwent histologic examination. The χ2 test was used to compare EUA and MRI in the detection of partial tears. RESULTS Of the 95 patients included, 40 (42%) had EUA findings consistent with a partial ACL tear whereas 22 (23%) had MRI findings interpreted as showing a partial ACL tear. Arthroscopic examination confirmed a partial ACL tear in only 11 patients (12%). The sensitivity of EUA and MRI in the detection of partial ACL tears was 100% and 90.9%, and the specificity was 65% and 85.7%, respectively. The χ2 test suggested statistically significant associations between the method of evaluation and diagnostic outcome [χ2(1) = 7.83, P = .005]. MRI was 1.24 times more likely to correctly identify a partial tear (95% confidence interval, 1.06-1.45). EUA was 2.23 times as likely to incorrectly identify a partial tear (95% confidence interval, 1.24-4.02). The histologic analysis showed increased numbers of lymphocytes, absent polymorphonuclear leukocytes, predominant fibroblasts, neovascularization, and variable collagen orientation. CONCLUSIONS There is a disparity between EUA, MRI, and arthroscopic findings in the evaluation of partial ACL tears. Arthroscopy remains the gold standard for diagnosing the macroscopic integrity of the intact bundle. Microscopic analysis reveals that the integrity of the remaining intact ligament material is altered and may show a histologic response similar to a complete ACL rupture. LEVEL OF EVIDENCE Level III, prospective, nonrandomized cohort study.
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Noh JH, Nam WD, Roh YH. Anterior tibial displacement on preoperative stress radiography of ACL-injured knee depending on knee flexion angle. Knee Surg Relat Res 2019; 31:14. [PMID: 32660620 PMCID: PMC7219608 DOI: 10.1186/s43019-019-0014-2] [Citation(s) in RCA: 4] [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: 06/17/2019] [Accepted: 10/22/2019] [Indexed: 12/31/2022] Open
Abstract
Purpose To compare side-to-side difference (SSD) of anterior tibial translation in instrumented stress radiography for each series of anterior cruciate ligament (ACL)-injured subjects according to knee flexion angle. Methods Forty subjects who were suspected of having significant ACL injury by manual Lachman test and MRI were recruited for this prospective study. These subjects took stress radiographs for both knees with corresponding knee flexion of 10° (series M1) and 30° (series M2) using Telos stress device. Mean SSDs of M1 and M2 were compared. Sensitivities of M1 and M2 were assessed using the SSD ≥ 3 mm or ≥ 5 mm as a cutoff value. Results Mean SSDs in series M1 and M2 were 4.22 ± 3.72 mm and 3.25 ± 3.30 mm, respectively (p < 0.001). When 3 mm of SSD was used as a cutoff value, sensitivities of series M1 and M2 were 47.5% (19/40) and 32.5% (13/40), respectively (p = 0.171). When 5 mm of SSD was used as a cutoff value, sensitivities of series M1 and M2 were 45.0% (18/40) and 22.5% (9/40), respectively (p = 0.033). Conclusions Anterior tibial translation on stress radiographs using a Telos device is more prominent when knee flexion angle is 10° compared to that when knee flexion angle is 30°. However, stress radiography using Telos device, either at 10° or 30° of knee flexion, might not be suitable to make decision on surgical treatment due to relatively low sensitivities.
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Affiliation(s)
- Jung Ho Noh
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon-si, Gangwon-do, 24341, South Korea.
| | - Woo Dong Nam
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon-si, Gangwon-do, 24341, South Korea
| | - Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea
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ACL reconstruction in over-50 year-olds: Comparative study between prospective series of over-50 year-old and under-40 year-old patients. Orthop Traumatol Surg Res 2019; 105:S259-S265. [PMID: 31648996 DOI: 10.1016/j.otsr.2019.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/02/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION ACL reconstruction is increasingly proposed for over-50 year-olds, although surgery had a poor reputation in this age-group, mainly due to postoperative stiffness. ACL reconstruction results were compared between two prospective series of, respectively, over-50 year-old (group 1) and under-40 year-old patients (group 2). The main study hypothesis was that ACL surgery provides the same functional results after 50 as before 40 years of age, and the secondary hypothesis was that the rate of complications does not differ. METHODS A multicenter prospective non-randomized follow-up study included 228 over-50 year-old and 130 under-40 year-old patients in 10 public and private sector centers. Epidemiological data were collected. Clinical laxity, differential laxity, KOOS, IKDC, Tegner and ACL-RSI scores and radiologic aspect were assessed pre- and post-operatively. Early (<3 months) and late (>3 months) complications were collected. Functional scores were compared between groups at last follow-up: 14.2 months (range, 3.5-30.5 months in group 1, and 20.5 months (range, 11.4-29.4 months) in group 2. RESULTS Analysis of epidemiological data showed some inter-group differences: female predominance in group 1 (59% versus 35%), longer trauma-to-surgery time in group 2 (23.6 versus 8.7 weeks), predominance of pivot-contact (team) sports in group 2 (49% versus 6%), and predominance of pivot sports (skiing) in group 1. Tegner scores were lower in group 1 (5.2 versus 7.6). Meniscal lesions were more frequent in group 1 (68% versus 36%), as were cartilage lesions (76% versus 10%). Initial laxity levels were identical (6.5mm in group 1 and 6.7mm in group 2). Type of surgery was identical: 86% hamstring graft in group 1 and 89% in group 2. There were more early complications (hematoma) in group 1; rates of late complications were comparable. Laxity at last follow-up was 2.2mm in both groups, and thus Lachman and pivot-shift test results were identical in terms of firm end-feel and absence of pivot shift. Quality-of-life assessment found higher KOOS scores in group 2, although ACL-RSI scores were identical. Global IKDC scores were slightly better in group 2, due to osteoarthritis in the older patients. CONCLUSION ACL reconstruction after 50 years of age gave good results, correcting laxity as effectively as in under-40 year-olds, with identical technique and identical rates of complications. Time to return to sports and resumed level were comparable. LEVEL AND TYPE OF STUDY III, prospective comparative non-randomized.
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Dejour D, Pungitore M, Valluy J, Nover L, Saffarini M, Demey G. Tibial slope and medial meniscectomy significantly influence short-term knee laxity following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:3481-3489. [PMID: 30809722 DOI: 10.1007/s00167-019-05435-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/20/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE To determine demographic, anatomic, and surgical factors associated with static and dynamic Anterior Tibial Translation (ATT) following ACL reconstruction. The hypothesis was that both static and dynamic ATT would be greater in knees with high tibial slope or that required meniscectomy. METHODS The authors prospectively enrolled 280 consecutive patients that had primary ACL reconstruction using hamstring autografts at one center for which preoperative tear type, meniscal tears, and medial tibial slope were documented. A total of 137 were excluded due to concomitant extra-articular tenodesis or surgical antecedents on either knee, and 18 were lost to follow-up, leaving 125 that were evaluated at a minimum of 6 months including: static ATT on monopodal weight-bearing radiographs, and dynamic ATT on differential stress radiographs using the Telos™ device. RESULTS Both postoperative static and dynamic ATT were strongly associated with preoperative static and dynamic ATT (respectively, β = 0.068 and β = 0.50, p < 0.001). Multivariable regression confirmed that postoperative static ATT increased with tibial slope (β = 0.24; CI 0.01-0.47; p = 0.042) and in knees that had partial medial meniscectomy (β = 2.05; CI 0.25-3.84; p = 0.025), while dynamic ATT decreased with age (β = - 0.11; CI - 0.16 to - 0.05; p < 0.001), and increased with tibial slope (β = 0.27; CI 0.04-0.49; p = 0.019) and in knees that had partial medial meniscectomy (β = 2.20; CI 0.35-4.05; p = 0.019). CONCLUSION Both static and dynamic ATT following ACL reconstruction increased with tibial slope and in knees that had partial medial meniscectomy. These findings could help surgeons tailor their techniques and 'à la carte' rehabilitation protocols, by preserving the menisci and sometimes delaying full weight-bearing and return to sport in patients at risk, and hence improve outcomes and prevent graft failures. STUDY DESIGN Cohort study. LEVEL OF EVIDENCE V.
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Affiliation(s)
- David Dejour
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - Marco Pungitore
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - Jeremy Valluy
- ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland
| | - Luca Nover
- ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland
| | - Mo Saffarini
- ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland.
| | - Guillaume Demey
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
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Park YB, Lee HJ, Ro DH, Lee GY, Kim S, Kim SH. Anterolateral ligament injury has a synergic impact on the anterolateral rotatory laxity in acute anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc 2019; 27:3334-3344. [PMID: 30631908 DOI: 10.1007/s00167-019-05347-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 01/04/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE To investigate the prevalence of the anterolateral ligament (ALL) injuries and its role in rotatory laxity in acute anterior cruciate ligament (ACL)-injured knees. METHODS Two-hundred and ninety-six consecutive patients with acute ACL injuries were evaluated retrospectively, excluding those with other ligament injury and undetectable path of ALL in MRI. Patients were divided into two groups based on the degree of ACL injury in arthroscopy (complete versus partial group). Logistic regression and discriminant analysis were performed to assess the risk of pivot shift test. RESULTS A total of 169 patients were included (128 with complete and 41 with partial ACL rupture). Overall, 106/169 (62.7%) of ALL injuries were characterized, 87/128 (67.9%) in complete group, and 19/41 (46.3%) in partial group. The incidence of pivot shift was 120/128 (93.8%) and 14/41 (34.1%) in the complete and partial groups, respectively. The odds ratio in the pivot shift of combined ALL injury was found as 3.8 (95% CI 1.8-8.4) with the overall ACL injury, but higher as 17.1 (95% CI 3.1-96.4) with partial group. Higher grade of pivot shift showed a greater incidence of injury of ALL. Degree of ACL injury and ALL injury allowed 87.0% of correct classification of subsequent anterolateral rotatory laxity. CONCLUSION Injury to the ALL could have a synergetic effect on anterolateral rotatory laxity in acute ACL-injured knee, however, its effect might be minor in case of complete tear. Careful assessment about combined ALL injury should be considered, especially in knees with high-grade pivot shift in acute ACL-injured knees. LEVEL OF EVIDENCE Retrospective prognostic study, Level IV.
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Affiliation(s)
- Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Du-Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-Gu, Seoul, 03080, South Korea
| | - Geun Young Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Sujin Kim
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea. .,Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France.
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Tibiofemoral bone bruise volume is not associated with meniscal injury and knee laxity in patients with anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 2019; 27:3318-3326. [PMID: 30604253 DOI: 10.1007/s00167-018-5343-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/17/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE This study aimed at evaluating the association between the volume of the bone bruises and the magnitude of knee sagittal laxity and presence of meniscal injury in patients with anterior cruciate ligament (ACL) rupture. It was hypothesized that higher volumes of bone bruises will be associated with increased knee laxity and the presence of meniscal injury. METHODS Patients with clinical diagnosis of ACL injury were referred for magnetic resonance imaging (MRI) and knee sagittal laxity measurement with a mechanical instrumented device (Porto-Knee Testing Device). The femoral and tibial bone bruises were assessed by MRI and the volume measured by manually contouring the bone bruise using a computerized software and computed by a mathematical algorithm combining all measured areas. The ACL rupture type (partial or total), meniscal tear (medial or lateral), and the localization of bone bruise were also analyzed. RESULTS Seventy-six ACL-ruptured participants were included and 34 patients displayed bone bruises. Tibiofemoral sagittal laxity was higher in participants with complete ACL rupture (p < 0.05), but not influenced by the volume of bone bruises and meniscal status (n.s.). The volume of bone bruises was not significantly associated with the meniscal lesion or with the tibiofemoral sagittal laxity, independently of the meniscal injury status (n.s.). CONCLUSIONS The volume of femoral and/or tibial bone bruises was not associated with the type of ACL injury, tibiofemoral sagittal laxity or the status of meniscal injury. Bone bruises must be considered as a radiographic sign of injury and should not be suggestive of injury severity and not overvalued. LEVEL OF EVIDENCE Retrospective cohort study, Level III. IRB NUMBER 0011/0014.
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Fayard JM, Sonnery-Cottet B, Vrgoc G, O'Loughlin P, de Mont Marin GD, Freychet B, Vieira TD, Thaunat M. Incidence and Risk Factors for a Partial Anterior Cruciate Ligament Tear Progressing to a Complete Tear After Nonoperative Treatment in Patients Younger Than 30 Years. Orthop J Sports Med 2019; 7:2325967119856624. [PMID: 31360732 PMCID: PMC6636223 DOI: 10.1177/2325967119856624] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Partial anterior cruciate ligament (ACL) tears are observed in 10% to 27% of isolated ACL tears. There is currently no consensus on diagnosis and treatment protocols, and the outcomes of nonoperative treatment remain undefined. Purpose: To assess the incidence and risk factors for the progression of partial ACL tears to complete ruptures after nonoperative treatment in active patients younger than 30 years. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 41 patients, all younger than 30 years and active in sports, were diagnosed with a partial ACL tear, with no associated meniscal or chondral lesions on magnetic resonance imaging (MRI). All were assigned to a nonoperative treatment program. The Lachman test, ≤4-mm side-to-side difference in laxity by Rolimeter, and MRI were utilized for the diagnosis. Tegner and International Knee Documentation Committee (IKDC) scores were assessed before and after the first lesion, and the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) score was assessed at last follow-up. Postinjury Tegner and IKDC scores were assessed before the second injury for patients progressing to a complete ACL tear and at last follow-up for patients without progression. Results: At a mean of 43 months (range, 24-96 months), the partial ACL injury progressed to a complete ACL tear in 16 (39%) patients. In the remaining 25 patients without progression, the mean Tegner and IKDC scores were 7.0 and 96.0 before the injury and 5.9 and 85.7, respectively, at last follow-up. The mean ACL-RSI score was 69.3. The Tegner and IKDC scores were significantly lower at final follow-up (P = .0002 and P < .0001, respectively). Only 18 (44%) patients returned to their preinjury level of sports activities. A significantly increased risk of progression to a complete ACL tear was seen in patients ≤20 years (odds ratio, 5.19; P = .037) or patients practicing pivoting contact sports (odds ratio, 6.29; P = .026). Meniscal lesions were found in 50% of patients with a partial tear that progressed to a complete ACL tear. Conclusion: A partial ACL injury progressed to a complete ACL tear in 39% of young active patients treated conservatively, with half of the complete tears presenting with a concomitant meniscal lesion at the time of reconstruction. Age ≤20 years and participation in pivoting contact sports were identified as significant risk factors for progression to a complete tear.
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Affiliation(s)
- Jean-Marie Fayard
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Goran Vrgoc
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,Department of Orthopaedic Surgery, University Hospital "Sveti Duh," Zagreb, Croatia
| | - Padhraig O'Loughlin
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,Mater Private Hospital, Cork, Ireland
| | - Geoffroy Dubois de Mont Marin
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,Hôpital Trousseau, CHRU de Tours, Chambray-lès-Tours, France
| | - Benjamin Freychet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Thais D Vieira
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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Lee HJ, Park YB, Kim SH. Diagnostic Value of Stress Radiography and Arthrometer Measurement for Anterior Instability in Anterior Cruciate Ligament Injured Knees at Different Knee Flexion Position. Arthroscopy 2019; 35:1721-1732. [PMID: 31072721 DOI: 10.1016/j.arthro.2019.01.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate diagnostic value of stress radiography and arthrometer measurements for anterior instability at different knee flexion angle positions. METHODS Forty-three patients with complete anterior cruciate ligament (ACL) rupture (group 1) and 37 normal subjects (group 2) were enrolled prospectively. Arthrometer (KT-1000) measurements and stress radiography by Telos were used to evaluate side-to-side differences. Results were recorded according to the knee position (30°, 45°, 60°, and 90°). Areas under the receiver operating characteristic curves (AUCs) were used to evaluate the diagnostic accuracy of each evaluation method. The calculated cutoff values at 30° position were used to evaluate the sensitivity and specificity of combined evaluation with stress radiography and arthrometer measurements. RESULTS The side-to-side differences on stress radiography and arthrometer measurements were significantly different between groups (P < .05), except for the values at the 90° position in arthrometer measurements (P = .844). The amount of anterior translation decreased in both arthrometer measurements and stress radiography between 30° and 45° positions (P < .000); however, no further decrease was observed beyond 45°. The AUC of stress radiography at the 30° position was significantly higher than other values (AUC = 0.955; P = .000). Moreover, the clinical cutoff value of 3 mm showed 86.0% sensitivity and 89.2% specificity in stress radiography at 30°, which were higher than those in arthrometer measurements. Combined use of stress radiography and arthrometer measurements at the 30° position showed 100% sensitivity and 59.5% specificity as a screening test. CONCLUSIONS Evaluation at the 30° knee position was significantly superior to that at other positions for both stress radiography and arthrometer measurements, whereas the 90° knee flexion position was not meaningful for any measurements. Evaluation needs to be performed with a 3-mm cutoff value for stress radiography at the 30° knee position; however, combined use of stress radiography and arthrometer measurements at the 30° knee flexion can have a higher diagnostic value. LEVEL OF EVIDENCE Level I, diagnostic study of established criteria.
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Affiliation(s)
- Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea; Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France.
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Dejour D, Pungitore M, Valluy J, Nover L, Saffarini M, Demey G. Preoperative laxity in ACL-deficient knees increases with posterior tibial slope and medial meniscal tears. Knee Surg Sports Traumatol Arthrosc 2019; 27:564-572. [PMID: 30269166 DOI: 10.1007/s00167-018-5180-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/20/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE The aim of this study was to determine patient and anatomic factors that influence anteroposterior and rotational laxity in knees with ACL tears. Based on the findings of biomechanical studies, we hypothesized that static and dynamic anterior tibial translation (ATT) as well as positive pivot shift would increase with female gender, tibial slope, and meniscal tears. METHODS The authors prospectively collected preoperative data and intraoperative findings of 417 patients that underwent ACL reconstruction. The exclusion criteria were: revision ACL procedures (n = 53), other surgical antecedents (n = 27), prior osteotomies (n = 7) or concomitant ligament tears on the ipsilateral knee (n = 34), and history of ACL tears in the contralateral knee (n = 45), leaving a study cohort of 251 patients. Their preoperative anteroposterior knee laxity was assessed objectively using 'static' monopodal weight-bearing radiographs and 'dynamic' instrumented differential measurements of ATT. Rotational laxity was assessed subjectively using the pivot shift test. RESULTS Multivariable regression showed that static ATT increases only with tibial slope (β = 0.30; p < 0.001), but dynamic ATT increases with tibial slope (β = 0.19; p = 0.041), medial meniscal tears (β = 1.27; p = 0.007), complete ACL tears (β = 2.06; p < 0.001), and to decrease with age (β = - 0.09; p < 0.001). Multivariable regression also indicated that high-grade pivot shift decreases with age (OR 0.94; p < 0.001) and for women (OR 0.25; p < 0.001), and to be higher for knees with complete ACL tears (OR 3.04; p = 0.002) or medial meniscal tears (OR 2.28; p = 0.010). CONCLUSION Contrary to expectations based on biomechanical studies, static ATT was only affected by high posterior tibial slope, while dynamic ATT was affected by both high posterior tibial slopes and medial meniscal tears, but not by gender or lateral meniscal tears. Likewise, pivot shift was affected by gender and medial meniscal tears, but not lateral meniscal tears or posterior tibial slope. These findings are relevant to guide surgeons in optimizing their surgical procedures, such as conserving the menisci when possible, and rehabilitation protocols, by delaying full weight-bearing and return to sports in patients with anatomic and lesional risk factors. LEVEL OF EVIDENCE Cohort study, Level IV.
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Affiliation(s)
- David Dejour
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - Marco Pungitore
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - Jeremy Valluy
- ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland
| | - Luca Nover
- ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland
| | - Mo Saffarini
- ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland.
| | - Guillaume Demey
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
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Ai Z, Feng H, Hu X, Zhen J. Postoperative Therapeutic Effect of ACL Reconstruction at Different Periods. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/ijcm.2019.102005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jaecker V, Zapf T, Naendrup JH, Kanakamedala AC, Pfeiffer T, Shafizadeh S. Differences between traumatic and non-traumatic causes of ACL revision surgery. Arch Orthop Trauma Surg 2018; 138:1265-1272. [PMID: 29779039 DOI: 10.1007/s00402-018-2954-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Indexed: 02/09/2023]
Abstract
PURPOSE The purpose of this study was to evaluate and classify causes for anterior cruciate ligament (ACL) reconstruction failure. It was hypothesized that specific technical and biological reconstruction aspects would differ when comparing traumatic and non-traumatic ACL reconstruction failures. MATERIALS AND METHODS One hundred and forty-seven consecutive patients who experienced ACL reconstruction failure and underwent revision between 2009 and 2014 were analyzed. Based on a systematic failure analysis, including evaluation of technical information on primary ACL reconstruction and radiological assessment of tunnel positions, causes were classified into traumatic and non-traumatic mechanisms of failure; non-traumatic mechanisms were further sub-divided into technical and biologic causes. Spearman's rank correlation coefficient and chi-squared tests were performed to determine differences between groups based on various factors including graft choice, fixation technique, technique of femoral tunnel positioning, tunnel malpositioning, and time to revision. RESULTS Non-traumatic, i.e., technical, and traumatic mechanisms of ACL reconstruction failure were found in 64.5 and 29.1% of patients, respectively. Biological failure was found only in 6.4% of patients. Non-anatomical femoral tunnel positioning was found the most common cause (83.1%) for technical reconstruction failure followed by non-anatomical tibial tunnel positioning (45.1%). There were strong correlations between non-traumatic technical failure and femoral tunnel malpositioning, transtibial femoral tunnel drilling techniques, femoral transfixation techniques as well as earlier graft failure (p < 0.05). CONCLUSIONS Technical causes, particularly tunnel malpositioning, were significantly correlated with increased incidence of non-traumatic ACL reconstruction failure. Transtibial femoral tunnel positioning techniques and femoral transfixation techniques, showed an increased incidence of non-traumatic, earlier graft failure.
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Affiliation(s)
- Vera Jaecker
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Tabea Zapf
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Jan-Hendrik Naendrup
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Ajay C Kanakamedala
- University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA
| | - Thomas Pfeiffer
- Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Sven Shafizadeh
- Department of Sports Traumatology and Trauma Surgery, Witten/Herdecke University, Sana Dreifaltigkeits-Krankenhaus, Aachener Straße 445-449, 50933, Cologne, Germany.
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Ekdahl M, Acevedo M, Dominguez C, Barahona M, Hernandez R, Mujica I. Knee Examination under Anesthesia: Development of a Predictive Score for Partial Anterior Cruciate Ligament Tears. Knee Surg Relat Res 2018; 30:255-260. [PMID: 30157594 PMCID: PMC6122942 DOI: 10.5792/ksrr.18.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 10/29/2022] Open
Abstract
Purpose To determine the accuracy of knee examination under anesthesia (EUA) and develop a prognostic score for partial anterior cruciate ligament (ACL) tears. Materials and Methods A total of 229 patients with an ACL injury were included. Knee EUA was performed using the Lachman test, pivot shift test and arthrometric maximum manual side-to-side difference (AMMD) test. The arthroscopic examination is the gold standard for the diagnosis of partial and complete ACL tears, which was compared with EUA findings. Multivariate logistic regression was estimated, and the significant variables were used to develop a predictive score. Results The relative risk for a complete tear with Lachman 2+ was 8.55 (range, 3.5 to 20.7) and 53.04 (range, 6.7 to 417) with Lachman 3+, compared to Lachman 1+. Negative pivot shift was reported in 23 cases in the partial tear group (76.7%) and in 22 in the complete tear group (11.1%). The AMMD was 3.5 mm in the partial tear group and 5.4 mm in the complete tear group (p<0.05). A prognostic score of less than five suggested the presence of a partial ACL tear. The score showed 81.1% sensitivity and 68.7% specificity. Conclusions Partial ACL tears can be differentiated from complete tears with Lachman test, pivot shift test, and AMMD test.
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Affiliation(s)
- Max Ekdahl
- Department of Orthopedic Surgery, Clinica Indisa, Santigo, Chile.,Department of Orthopedic Surgery, Clinica Las Condes, Santigo, Chile
| | - Marcelo Acevedo
- Department of Orthopedic Surgery, Clinica Indisa, Santigo, Chile
| | | | - Maximiliano Barahona
- Department of Orthopedic Surgery, Clinica Indisa, Santigo, Chile.,Department of Orthopedic Surgery, Hospital Clinico Universidad de Chile, Santigo, Chile
| | | | - Ignacio Mujica
- Department of Orthopedic Surgery, Clinica Indisa, Santigo, Chile
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Seil R, Mouton C, Coquay J, Hoffmann A, Nührenbörger C, Pape D, Theisen D. Ramp lesions associated with ACL injuries are more likely to be present in contact injuries and complete ACL tears. Knee Surg Sports Traumatol Arthrosc 2018. [PMID: 28638970 DOI: 10.1007/s00167-017-4598-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to analyse patient and injury characteristics as well as arthroscopic findings in a prospective cohort of ACL-injured patients with or without an associated ramp lesion. METHODS Two hundred and twenty-four patients undergoing a primary (n = 196) or revision (n = 28) ACL reconstruction were included. The presence of a ramp lesion was determined by a systematic arthroscopic inspection of the posteromedial compartment. Chi-square tests were used to compare the population of ACL-injured patients with and without a ramp lesion regarding sex, age, body mass index, previous ACL injuries, sport before injury, and injury characteristics. Significance was set at p < 0.05. RESULTS Fifty-three out of 224 patients had a ramp lesion (24%). The presence of the latter was not related to any of the analysed patient characteristics. The prevalence of the lesion was higher in contact injuries (n = 19; 41%) compared with non-contact injures (n = 34; 19%; p < 0.001). It was higher in patients with complete ACL ruptures (n = 49; 27%) as opposed to partial ruptures (n = 1; 4%; p = 0.01). A patient was 2.98 [95% CI 1.49-5.98] times more likely to have a ramp lesion if the ACL injury was declared to have been caused by direct contact and 8.71 [95% CI 1.15-66.12] times more likely if the ACL tear was complete. CONCLUSION Ramp lesions may be anticipated in almost one out of four patients undergoing ACL reconstruction, especially if a patient sustained a contact injury and in the presence of a complete ACL tear. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Romain Seil
- Department of Orthopaedic Surgery, Clinique d'Eich - Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg. .,Sports Medicine Research Laboratory, Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg.
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Clinique d'Eich - Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.,Sports Medicine Research Laboratory, Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Julien Coquay
- Department of Orthopaedic Surgery, Clinique St. Pierre Ottignies, Ottignies, Belgium
| | - Alexander Hoffmann
- Department of Orthopaedic Surgery, Clinique d'Eich - Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Christian Nührenbörger
- Department of Orthopaedic Surgery, Clinique d'Eich - Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Dietrich Pape
- Department of Orthopaedic Surgery, Clinique d'Eich - Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.,Sports Medicine Research Laboratory, Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Daniel Theisen
- Sports Medicine Research Laboratory, Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg
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46
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Anterior tibial laxity using the GNRB® device in healthy knees. Knee 2018; 25:34-39. [PMID: 29307479 DOI: 10.1016/j.knee.2017.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 12/29/2016] [Accepted: 03/13/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND GRNB® is a non-radiating power tool that allows the evaluation of the anterior tibial translation. HYPOTHESIS The pressure exerted by the system against the patella and the body mass index (BMI) could affect the anterior tibial translation when we repeat the measurements in healthy knees. MATERIALS AND METHODS We retrospectively evaluated the measurements of anterior knee laxity in healthy knees carried out by the GNRB® in 69 consecutive patients who underwent anterior cruciate ligament (ACL) repair in the contralateral knee. Two measurements were carried out, the initial measurements (M1), and then repeated at a mean of seven months (M2) (4.9 to 13months). RESULTS There were 38 women and 31 men with an average age of 31years. In healthy knees, the Mean average anterior translation was 5.4±4mm with an average patellar force of 35.8 at time M1. The average anterior translation was 4.9±4mm with an average patellar force of 47 at time M2. There was a significant difference between the measurements M1 and M2 (P<0.03). The tightening force was significantly different between the two sets of measurements (P<10-7). There was a negative correlation between the pressure applied on the patella and anterior knee laxity (P<0.01). CONCLUSION The pressure force exerted on the patella during GNRB® affects the measurement of anterior laxity in healthy knees. This raises the problem of the reproducibility of the measurements during repeated examinations at different times.
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47
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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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Combined reconstruction of the anterior cruciate ligament associated with anterolateral tenodesis effectively controls the acceleration of the tibia during the pivot shift. Knee Surg Sports Traumatol Arthrosc 2017; 25:1117-1124. [PMID: 28349161 DOI: 10.1007/s00167-017-4515-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/06/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE The pivot shift test is quantified subjectively during assessment of patients presenting with suspected Anterior Cruciate Ligament (ACL) tears and has a low interobserver reproducibility. The Kinematic Rapid Assessment (KiRA) is a triaxial accelerometer that makes it possible to non-invasively quantify tibial acceleration during the pivot shift test. Abolishing pivot shift is considered to be a key element in surgical reconstruction but is incomplete in 25-38% of patients. METHODS Patients were included prospectively. Inclusion criteria were patients requiring ACL reconstruction associated with at least one of the following factors corresponding to the patient who have a high risk of rupture either by their sports activity, a failure case, or the notion of important rotational laxity: the patient practiced a competitive pivot-contact sport, revision ACL reconstruction (besides STG (semitendinosus-gracilis graft) repair), subjective explosive rotational laxity, Segond fracture, and TELOS value of >10 mm. Standardized pre- and postoperative pivot shift tests were immediately performed under anesthesia in both knees. RESULTS Forty-three patients were included. Mean preoperative variations in tibial acceleration in the healthy and injured knees were 1.2 ± 0.1 and 2.7 ± 0.3 m/s2, respectively, p < 0.01. A statistically significant decrease in immediate postoperative mean variations in acceleration in the injured knee occurred: 1.5 ± 0.3 m/s2, p < 0.01. There was no longer any statistical difference between postoperative contralateral healthy knees and operated knees (n.s). CONCLUSIONS Combined ACL reconstruction associated with anterolateral tenodesis suppress acute pathologic tibial acceleration in the pivot shift. LEVEL OF EVIDENCE III.
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Toanen C, Demey G, Ntagiopoulos PG, Ferrua P, Dejour D. Is There Any Benefit in Anterior Cruciate Ligament Reconstruction in Patients Older Than 60 Years? Am J Sports Med 2017; 45:832-837. [PMID: 28056178 DOI: 10.1177/0363546516678723] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Results of anterior cruciate ligament (ACL) reconstruction are traditionally excellent in younger and nonarthritic patients. During the past few decades, people older than 60 years have become more active than ever, with more demanding physical lifestyles. An increase also has been noted in active patients with diagnosed ACL injuries. More patients are requesting treatment for ACL deficiency in hopes of returning to preinjury levels of activity. PURPOSE The aims of this study were to evaluate the results of ACL reconstruction in patients older than 60 years in terms of functional recovery, return to sports, and postoperative incidence of osteoarthritis and to compare their results with published results of different age groups. STUDY DESIGN Case series; Level of evidence, 4. METHODS Consecutive patients older than 60 years with isolated ACL tear and no established osteoarthritic lesions (Ahlbäck grade 1 or no arthritis) who were treated from 2008 to 2013 were retrospectively included in this study. Primary ACL reconstruction was performed with the same technique in all patients by means of single-bundle autologous hamstring tendon graft. Meniscal injuries were treated with partial debridement when required. No further treatment on cartilage lesions was performed. Postoperative rehabilitation was the same in every case. The International Knee Documentation Committee (IKDC) objective grade, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS) were assessed before and after surgery, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) score was recorded during the final follow-up. Postoperative incidence of osteoarthritis was evaluated on weightbearing radiographs during final follow-up, and anteroposterior laxity was measured pre- and postoperatively with the use of stress radiographs. RESULTS Twelve patients with mean age (±SD) of 61.0 ± 1.4 years at the time of surgery were included. They were followed-up for a mean period of 49.6 ± 24.0 months. Eight patients had associated meniscal tears, and 6 patients had International Cartilage Repair Society stage 1 or 2 chondral lesions. Preoperatively, the objective IKDC grades were B in 4 patients, C in 5, and D in 3. After surgery, the IKDC grades were A in 4 patients, B in 7, and grade C in 1. The mean subjective IKDC and Lysholm scores were a respective 43.4 ± 8.4 and 55.7 ± 12.4 preoperatively and 83.8 ± 9.4 and 93.2 ± 9.0 at the final follow-up ( P < .05). Ten patients (83%) reported recovery of sports activities, with 6 patients (50%) reaching the same level as before injury. The mean ACL-RSI score was 76.2%. Preoperatively, 50% (n = 6) of patients had Ahlbäck stage 1 medial compartment arthritis, versus 58% (n = 7) at the final follow-up ( P = nonsignificant). The side-to-side difference in anterior tibial translation on stress radiographs was 7.2 ± 6.4 mm preoperatively and 1.9 ± 4.3 mm postoperatively ( P < .05). No major complications were reported. CONCLUSION ACL reconstruction in active patients older than 60 years without arthritis restored knee stability in all treated cases. In these patients, as in younger age groups, ACL reconstruction showed good results on functional recovery while not increasing the risk of midterm functional knee deterioration or evolution of knee arthritis. The majority of patients returned to activities at their preinjury level. These data show that older and active patients with nonarthritic ACL-deficient knees need not be excluded from surgical treatment.
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Affiliation(s)
| | | | | | - Paolo Ferrua
- SSD Chirurgia Articolare del Ginnochio, Istituto Ortopedico Gaetano Pini, Milan, Italy
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Shaikh H, Rahnemai-Azar AA, Fu FH. Anterior Cruciate Ligament Augmentation for One-Bundle Tears. ACTA ACUST UNITED AC 2017. [DOI: 10.1053/j.oto.2017.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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