1
|
Bøe B. Nonoperative Anterior Cruciate Ligament Injury Treatment. Clin Sports Med 2024; 43:343-354. [PMID: 38811114 DOI: 10.1016/j.csm.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
This article outlines the key points in the nonoperative treatment of an anterior cruciate ligament (ACL) injury. Initial evaluation and treatment of an acute knee injury, often performed by a physician with limited experience in the treatment of an ACL injury, follow the basic diagnostic workup that lead to the diagnosis. The principles of rehabilitation after ACL injury have changed from time based to criteria based, and the different phases based on physical criteria are described.
Collapse
Affiliation(s)
- Berte Bøe
- Division of Orthopaedics, Oslo University Hospital, Ullevål Sykehus, Postboks 4956, Nydalen, Oslo 0424.
| |
Collapse
|
2
|
Kawashima T, Mutsuzaki H, Watanabe A, Ikeda K, Yamanashi Y, Kinugasa T. Impact of Surgical Timing on Functional Outcomes after Anterior Cruciate Ligament Reconstruction. J Clin Med 2024; 13:2994. [PMID: 38792535 PMCID: PMC11122620 DOI: 10.3390/jcm13102994] [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: 04/16/2024] [Revised: 05/02/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
Objectives: Although acute anterior cruciate ligament reconstruction (ACLR) is often avoided because of postoperative joint stiffness, delayed ACLR can lead to a longer recovery time and can have a negative impact on physical function due to detraining. This study aimed to determine the effects of acute ACLR on postoperative outcomes, including muscle strength, performance, and return to sports. Methods: A total of 110 patients who underwent anatomical ACLR using hamstring autografts were included in this study and were divided into three groups: acute (ACLR performed within 2 weeks after ACL injury), 2-6 weeks (ACLR performed between 2 and 6 weeks after injury), and 6-12 weeks (ACLR performed between 6 and 12 weeks after injury). Several parameters were evaluated, including range of motion, knee joint stability, isokinetic knee strength, performance, and return to sports. Results: No significant differences were found in the range of motion or knee joint stability between the groups. The acute group exhibited significantly greater quadriceps strength at 3 months postoperatively than the other groups (p < 0.05). The single-leg hop test showed that 66.7%, 38.7%, and 33.3% of the patients in the acute, 2-6 weeks, and 6-12 weeks groups, respectively, recovered to an LSI of 90% or greater (p = 0.09, Cramer's V = 0.27). All patients in the acute group were able to return to sports (p = 0.14; Cramer's V = 0.28). Conclusions: Acute ACLR is advantageous for the early recovery of strength and performance without adverse events. Acute ACLR may shorten the time spent away from sports activities.
Collapse
Affiliation(s)
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Japan
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Arata Watanabe
- Department of Orthopedic Surgery, Ichihara Hospital, Tsukuba 300-3295, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Kotaro Ikeda
- Department of Orthopedic Surgery, Ichihara Hospital, Tsukuba 300-3295, Japan
| | - Yuki Yamanashi
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute 480-1195, Japan
| | - Tomonori Kinugasa
- Department of Orthopedic Surgery, Ichihara Hospital, Tsukuba 300-3295, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba 305-8575, Japan
| |
Collapse
|
3
|
de Jonge R, Máté M, Kovács N, Imrei M, Pap K, Agócs G, Váncsa S, Hegyi P, Pánics G. Nonoperative Treatment as an Option for Isolated Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis. Orthop J Sports Med 2024; 12:23259671241239665. [PMID: 38601190 PMCID: PMC11005505 DOI: 10.1177/23259671241239665] [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: 08/29/2023] [Accepted: 09/18/2023] [Indexed: 04/12/2024] Open
Abstract
Background An anterior cruciate ligament (ACL) tear is a risk factor for early osteoarthritis (OA) onset. Generally, ACL reconstruction (ACLR) is associated with better outcomes. However, there is a lack of evidence regarding the effect of operative versus nonoperative treatment for preventing premature knee OA in isolated ACL tears while achieving good functional outcomes. Purpose/Hypothesis The purpose of the study was to compare the outcomes of ACLR to primarily nonoperative management of isolated ACL tears. It was hypothesized that the outcomes between treatment types would be similar. Study Design Systematic review; Level of evidence, 3. Methods This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (registration No. CRD42021285901) and was conducted according to the Cochrane Handbook guidelines. We systematically searched for randomized and nonrandomized studies that compared ACLR with nonoperative treatments in isolated ACL tears in 3 databases until October 25, 2021. The risk of bias and quality of evidence of the included studies was assessed in accordance with the Cochrane guidelines. The primary outcome was radiologic signs of OA, and the secondary outcomes were functional parameters. Using the common effects model, we calculated pooled mean differences (MDs) and odds ratios (ORs) with 95% CIs. Results Five studies-2 randomized controlled trials (RCTs) and 3 retrospective non-RCTs-were included. There was a moderate risk of bias in 2 studies and a serious risk of bias in 1 study. The quality of evidence was rated low because of the higher risk of bias and inconsistency. Nonoperatively treated knees showed a trend toward lower odds of developing radiological signs of OA (OR, 1.84 [95% CI, 0.90 to 3.75]); however, surgically reconstructed knees had significantly better stability (MD, -2.44 [95% CI, -3.21 to -1.66 ]) and a trend toward better but clinically not meaningful Lysholm scores (MD, 2.88 [95% CI, -1.09 to 6.85]). The qualitative synthesis showed that surgical reconstruction was protective against subsequent injuries but not superior when returning to previous activity levels or various functional tests. Conclusion Findings indicated that there is no certain evidence that ACLR for an isolated ACL tear is superior to nonoperative treatment. Clinicians should consider nonoperative treatments with a well-designed rehabilitative program as a primary option. However, these findings must be interpreted with caution because of low study quality and high risk of bias.
Collapse
Affiliation(s)
- Robert de Jonge
- Budapesti Uzsoki Street Hospital, Budapest, Hungary
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Traumatology, Semmelweis University, Budapest, Hungary
| | - Miklós Máté
- Budapesti Uzsoki Street Hospital, Budapest, Hungary
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Traumatology, Semmelweis University, Budapest, Hungary
| | - Norbert Kovács
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Marcell Imrei
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Károly Pap
- Budapesti Uzsoki Street Hospital, Budapest, Hungary
- Department of Traumatology, Semmelweis University, Budapest, Hungary
| | - Gergely Agócs
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Gergely Pánics
- Budapesti Uzsoki Street Hospital, Budapest, Hungary
- Department of Traumatology, Semmelweis University, Budapest, Hungary
- FIFA Medical Centre of Excellence, Budapest, Hungary
| |
Collapse
|
4
|
Zhong J, Lee NJ, Crutchfield C, Mueller J, Ahmad C, Trofa D, Lynch TS. Perioperative outcomes in isolated versus multiligamentous anterior cruciate ligament reconstruction: a retrospective cohort analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1597-1607. [PMID: 38363347 DOI: 10.1007/s00590-024-03848-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE The outcomes of anterior cruciate ligament reconstruction in the setting of multiligamentous knee injury (M-ACLR) have not been well characterized compared to isolated ACLR (I-ACLR). This study aims to characterize and compare short-term outcomes between I-ACLR and M-ACLR. METHODS This is a retrospective cohort analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2017. Current Procedural Terminology codes were used to identify and compare elective I- and M-ACLR patients, excluding patients undergoing concomitant meniscal or chondral procedures. Patient demographics and outcomes after I- and M-ACLR were compared using bivariate analysis. Multiple logistic regression analyzed if multiligamentous ACLR was an independent risk factor for adverse outcomes. RESULTS There was a total of 13,131 ACLR cases, of which 341 were multiligamentous cases. The modified fragility index-5 was higher in multiligamentous ACLR (p < 0.001). Multiligamentous ACLR had worse perioperative outcomes, with higher rate of all complications (3.8%, p = 0.013), operative time > 1.5 h (p < 0.001), length of stay (LOS) ≥ 1 day (p < 0.001), wound complication (2.1%, p = 0.001), and intra- or post-op transfusions (p < 0.001). In multiple logistic regression, multiligamentous ACLR was an independent risk factor for LOS ≥ 1 (odds ratio [OR] 5.8), and intra-/post-op transfusion (OR 215.1) and wound complications (OR 2.4). M-ACLR was not an independent risk factor for any complication, reoperation at 30 days, readmission, urinary tract infection (UTI), or venous thromboembolism (VTE). CONCLUSION M-ACLR generally had worse outcomes than I-ACLR, including longer LOS, need for perioperative transfusions, and wound complications.
Collapse
Affiliation(s)
- Jack Zhong
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA.
- Department of Orthopaedic Surgery, New York University Langone Health, New York, 10010, USA.
| | - Nathan J Lee
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - Connor Crutchfield
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - John Mueller
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - Christopher Ahmad
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - David Trofa
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - T S Lynch
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, 48202, USA
| |
Collapse
|
5
|
Gompels BD, Kanwei OC, McDonnell S. The Segond Fracture as a Vital Diagnostic Tool for Anterior Cruciate Ligament Injury in Acute Settings: A Case Report. Cureus 2024; 16:e58588. [PMID: 38765369 PMCID: PMC11102708 DOI: 10.7759/cureus.58588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
A Segond fracture is a specific type of avulsion fracture involving the lateral aspect of the proximal tibia adjacent to the tibial plateau. Segond fractures are indicative of ligamentous injury in the knee. In this case report, a 29-year-old male delivery driver presented to the ED with acute onset right knee pain after losing control of his motorbike at low speed. Examination revealed significant effusion and medial and lateral joint line tenderness. An anterior-posterior radiograph of the knee showed a Segond fracture. Subsequent MRI confirmed a full-thickness anterior cruciate ligament (ACL) rupture and medial collateral ligament (MCL) tear. Despite surgical reconstruction options, the patient chose conservative management. At eight-week follow-up, he demonstrated satisfactory progress. This case highlights the diagnostic significance of Segond fractures in identifying ligamentous damage in the knee without the availability of MRI. It also highlights the feasibility of non-operative management in some instances.
Collapse
Affiliation(s)
- Benjamin D Gompels
- Department of Surgery, University of Cambridge, Cambridge, GBR
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Ojorhelumi C Kanwei
- Department of Trauma and Orthopaedics, University of Cambridge, Cambridge, GBR
| | - Stephen McDonnell
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| |
Collapse
|
6
|
Murgier J, Duthon V, Deygas A, Ehkirch FP. Does an early post traumatic knee brace reduce the incidence of knee rotational instability? Arch Orthop Trauma Surg 2024; 144:1161-1169. [PMID: 38253710 DOI: 10.1007/s00402-024-05206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE Several anterolateral stabilization procedures have been developed recently to address rotational instability of the knee. Currently, these procedures tend to be systematically used by some practitioners. However, antero-lateral structures of the knee (including the anterolateral ligament, ALL) have a self-healing potential which can reduce the need to perform an antero-lateral procedure. In this study, it was hypothesized that early post-traumatic immobilization of the knee with a knee brace would allow partial healing of antero-lateral structures and also allow control of the pivot shift, thus avoiding antero-lateral extra-articular stabilization. The objective of this study was to compare the severity of pivot shift between two groups of patients who all experienced anterior cruciate ligament (ACL) tear and respectively underwent post-traumatic immobilization of the knee versus no immobilization. METHODS This was a comparative, multicentric (three centers' study) retrospective, consecutive study including 168 patients who underwent ACL reconstruction between May and September 2022. The application or not of post-traumatic immobilization and its duration, the severity of pivot shift observed in the operating room under general anesthesia, the presence of anterolateral lesions as revealed by MRI and the patients' pre-injury sport activity were recorded. RESULTS A grade 3 pivot shift was found in 44 patients (27%). It was more frequently observed in the group without a brace compared to the group with a knee brace (18 patients out of 36: 50% versus 26 patients out of 132: 19.7%; p = 0.0012). Wearing a brace, whether hinged (OR = 0.221, [0.070-0.652]; p = 0.006) or not (OR = 0.232, [0.076-0.667]; p = 0.0064), was protective from the risk of developing a significant pivot shift. CONCLUSION This study demonstrated that the presence of pivot-shift was lower in the patients that had an early post-injury knee brace before their ACL reconstruction. Based on this result, systematic brace placement could be advocated for in patients after knee trauma. LEVEL OF EVIDENCE III, prognostic retrospective case-control study.
Collapse
Affiliation(s)
- Jérôme Murgier
- Orthopedics Department, Aguiléra Clinic, 21 Rue de L'Estagnas, 64200, Biarritz, France.
| | - Victoria Duthon
- Centre de Médecine du Sport et de L'Exercice, Swiss Olympic Medical Center, Hirslanden Clinique La Colline, Geneva, Switzerland
| | - Aymeric Deygas
- Orthopaedic Department, Clinique Maussins-Nollet, Paris, France
| | | |
Collapse
|
7
|
Tseng TH, Chen CL, Chang CH, Wang JH, Young TH. IL-6 induces periostin production in human ACL remnants: a possible mechanism causing post-traumatic osteoarthritis. J Orthop Surg Res 2023; 18:824. [PMID: 37919719 PMCID: PMC10621128 DOI: 10.1186/s13018-023-04308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/22/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE Perostin (POSTN) and IL-6 consistently elevated after ACL injury, and ACL has been proposed as the major source of POSTN. However, there is a lack of evidence whether IL-6 induces ACL remnants to produce POSTN. This study aimed to investigate the effect of IL-6 on POSTN production in ACL fibroblasts, which may help us understand more about the mechanism of PTOA after ACL injury and ACL reconstruction. METHODS ACL remnants were harvested from 27 patients undergoing ACL reconstruction. Quantitative real-time polymerase chain reaction (PCR) was performed to examine the POSTN gene expression of ACL fibroblasts after treatment of different concentrations of IL-6. The POSTN protein production of ACL fibroblasts was determined using western blot analysis. The blockers of possible signaling pathways, including PI3K/Akt, Ras/MAPK, and JAK/STAT pathways, were added to test whether the effect of IL-6 on ACL fibroblast could be attenuated. ACL fibroblast and chondrocyte co-culture was carried out to determine the influence of ACL and IL-6 on chondrocytes. RESULTS Quantitative real-time PCR showed that IL-6 time-dependently and dose-dependently increased POSTN gene expression of ACL fibroblast. Western blot analysis also revealed that IL-6 dose-dependently induced POSTN protein production. Regarding the chronicity of ACL injury, the POSTN protein production was comparable between ACL remnants which were derived within 3 months of injury and at least 6 months after injury. PI3K/Akt blockers could attenuate the effect of IL-6 on ACL remnants, whereas Ras/MAPK and JAK/STAT did not decrease POSTN production. The coexistence of ACL and IL-6 induced more MMP-13 and ADAMTS-4 by chondrocytes. CONCLUSIONS IL-6 induced ACL remnants to produce POSTN. This effect could be attenuated by the PI3K/Akt blocker. Coexistence of IL-6 and ACL remnants may accelerate post-traumatic arthritis.
Collapse
Affiliation(s)
- Tzu-Hao Tseng
- Department of Biomedical Engineering, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei City, 10002, Taiwan
- Department of Orthopaedic Surgery, National Taiwan University Hospital, 7 Chungsan South Road, Taipei City, 10002, Taiwan
| | - Chien-Lin Chen
- Department of Biomedical Engineering, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei City, 10002, Taiwan
| | - Chung-Hsun Chang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, 7 Chungsan South Road, Taipei City, 10002, Taiwan
| | - Jyh-Horng Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, 7 Chungsan South Road, Taipei City, 10002, Taiwan.
| | - Tai-Horng Young
- Department of Biomedical Engineering, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei City, 10002, Taiwan.
| |
Collapse
|
8
|
Ferrero S, Louvois M, Barnetche T, Breuil V, Roux C. Impact of anterior cruciate ligament surgery on the development of knee osteoarthritis: A systematic literature review and meta-analysis comparing non-surgical and surgical treatments. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100366. [PMID: 37252633 PMCID: PMC10209532 DOI: 10.1016/j.ocarto.2023.100366] [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: 11/18/2022] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Context: The development of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is now widely recognized. The impact of surgical or non-surgical management on the development of post-traumatic osteoarthritis is still debated in the medical community.Here, we present a meta-analysis comparing the impact of surgical or non-surgical management of ACL injuries on the development of knee OA. Method A systematic literature review was conducted using data from the PubMed, EMBASE, Medline, and Cochrane libraries from February to May 2019. Only randomized clinical trials published between 2005 and 2019 with a non-surgical group and a surgical group were included to explore the onset or progression of knee OA after ACL injury. Trials had to have at least one radiographic endpoint (Kellgren-Lawrence scoring system). Heterogeneity was assessed using the Cochrane's Q and I2 statistical methods. Results Only three randomized controlled trials met the inclusion criteria and were selected for meta-analysis. Of the 343 injured knees included in the studies, 180 underwent ACL reconstruction and 163 underwent non-surgical treatment. The relative risk of knee osteoarthritis was higher after surgery than after non-surgical treatment (RR 1.72, CI 95% [1.18-2.53], I2 = 0%). Conclusion The results of this meta-analysis suggest a predisposition to knee osteoarthritis after ACL reconstruction surgery compared with non-surgical management. Due to the small number of good quality studies available, further well-conducted randomised studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Stephanie Ferrero
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Nice Sophia Antipolis University, F-06000, Nice, France
| | - Marion Louvois
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Nice Sophia Antipolis University, F-06000, Nice, France
| | - Thomas Barnetche
- Department of Rheumatology, University Hospital of Bordeaux Pellegrin, France
| | - Veronique Breuil
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Nice Sophia Antipolis University, F-06000, Nice, France
| | - Christian Roux
- Department Rheumatology, University of Cote D'Azur, Nice Hospital, Laboratory LAMHESS, EA6312, IBV CNRS IMR 7277 INSERM U1091 UNS, France
| |
Collapse
|
9
|
Celik O, Celik GE, Kilinc BE, Harput G. Knowledge and awareness of anterior cruciate ligament injury among Turkish professional athletes: an online survey. Res Sports Med 2023:1-17. [PMID: 37635390 DOI: 10.1080/15438627.2023.2252128] [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: 10/25/2022] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
The purpose of this study was to assess the awareness and knowledge of professional team sport athletes about ACL injuries, injury prevention programs, and the return to sports after ACL injuries. A total of 419 athletes representing soccer, basketball, volleyball and handball sports were included in the study. We utilized a 15-item self-report survey to assess the awareness of athletes about ACL injury, ACL injury prevention program, and return to sport after ACL injuries. Male and soccer players participated in prevention programs more than female athletes (p = 0.001). Participation in prevention programs was significantly higher in the ≥ 18 years old group than in the < 18 years old group (p = 0.040). Participants who were informed about ACL injuries were 8.4 times more likely to participate in the ACL injuries prevention program than others (OR: 8.38, 95% CI: 3.823-18.376, p < 0.001). The majority of participants believed that return to sport after ACL injury takes 6 months and 81.4% of them thought that it is not possible to do sport without an ACL. This study revealed that the awareness and performance of ACL prevention training programs among professional team sport athletes were insufficient. The athletes' knowledge regarding return to sports after ACL injuries was also inadequate. Improving athletes' knowledge of ACL injuries may lead to increased participation in ACL injury prevention programs. Thus, the provision of tailored educational interventions to athletes could potentially enhance their awareness and understanding of ACL injuries, consequently contributing towards the prevention of such injuries.
Collapse
Affiliation(s)
- Onur Celik
- Institute of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Gizem Ece Celik
- Institute of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Bekir Eray Kilinc
- Department of Orthopaedics and Traumatology, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Gulcan Harput
- Institute of Health Sciences, Hacettepe University, Ankara, Turkey
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| |
Collapse
|
10
|
Dahduli OS, AlHossan AM, Al Rushud MA, Alneghaimshi MM, Alotaibi SF, AlNour MK, Al Otaibi AH, AlAseeri A, AlBatati S. Early Surgical Reconstruction Versus Rehabilitation for Patients With Anterior Cruciate Ligament Rupture: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e43370. [PMID: 37700946 PMCID: PMC10494743 DOI: 10.7759/cureus.43370] [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: 08/12/2023] [Indexed: 09/14/2023] Open
Abstract
Anterior cruciate ligament (ACL) rupture is a common and debilitating knee injury that can significantly impair knee function and stability. The optimal management of ACL injuries remains a topic of ongoing debate, with two primary treatment approaches being surgical reconstruction and adequate rehabilitation. The aim of this study is to compare the knee function and stability outcomes between these two treatment modalities, shedding light on their respective effectiveness. We utilized Scopus, PubMed, Cochrane Database, MEDLINE, and Web of Science from inception until April 20, 2022. We utilized the Cochrane risk of bias tool for quality assessment. The following outcomes were assessed: Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) Subjective Knee score, Lysholm score, the occurrence of the knee giving way, Tegner score, KT1000, Lachman test, pivot shift test, SF-36 score to assess the quality of life, and incidence of reinjury and reoperation. We included a total of six trials with a population sample size of 691 patients, which were divided into surgical versus non-surgical groups, accounting for 348 and 343 patients, respectively. The pooled estimate demonstrated that the surgical reconstruction was associated with a significant increase in the IKDC score (MD = 7.49 [2.04, 12.94], (P = 0.007)), and KOOS score was significant in the reconstruction cohort (MD = 5.87 [1.64, 10.09], (P = 0.007)). The incidences of reoperation (RR = 0.43 [0.20, 0.91], (P = 0.03)), reinjury (RR = 0.49 [0.27, 0.88], (P = 0.02)), and occurrence of the knee giving way (RR = 0.19 [0.08, 0.49], (P = 0.005)) were significantly decreased in the surgical cohort. There is no significant difference between both cohorts regarding the Lysholm score (1.27 [-1.39, 3.93], (P = 0.35)). The findings of this comprehensive analysis indicate that early reconstruction does not demonstrate clear superiority over rehabilitation alone in terms of knee function, Lysholm score, and Tegner score among patients with ACL rupture. However, early reconstruction does exhibit a substantial reduction in the incidence of reinjury, reoperation, and knee giving way, suggesting potential benefits in terms of stability outcomes. These results underscore the importance of considering individual patient characteristics and preferences in treatment decision-making.
Collapse
Affiliation(s)
- Omar S Dahduli
- Department of Orthopedic Surgery, King Fahad Military Medical Complex, Dhahran, SAU
| | - Abdullah M AlHossan
- Department of Orthopedic Surgery, King Fahad Military Medical Complex, Dhahran, SAU
- College of Medicine, Alfaisal University College of Medicine, Riyadh, SAU
| | - Mohammed A Al Rushud
- Department of Orthopedic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Muath M Alneghaimshi
- Department of Orthopedic Surgery, King Fahad Military Medical Complex, Dhahran, SAU
| | - Saad F Alotaibi
- College of Medicine, Shaqra University, Shaqra, SAU
- Department of Orthopedic Surgery, Dammam Medical Complex, Dammam, SAU
| | - Mohammed K AlNour
- College of Medicine, Jouf University, Sakaka, SAU
- Department of Orthopedic Surgery, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Ali AlAseeri
- Department of Orthopedic Surgery, King Fahad Military Medical Complex, Dhahran, SAU
| | - Saud AlBatati
- Department of General Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| |
Collapse
|
11
|
Warathanagasame P, Sakulsriprasert P, Sinsurin K, Richards J, McPhee JS. Comparison of Hip and Knee Biomechanics during Sidestep Cutting in Male Basketball Athletes with and without Anterior Cruciate Ligament Reconstruction. J Hum Kinet 2023; 87:17-27. [PMID: 37559777 PMCID: PMC10407324 DOI: 10.5114/jhk/162965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/06/2023] [Indexed: 08/11/2023] Open
Abstract
This study aimed to compare hip and knee biomechanics during sidestep cutting on the operated and non-operated sides in individuals with anterior cruciate ligament reconstruction (ACLR), and in an uninjured control group. Twenty male basketball athletes, 10 individuals with ACLR and 10 controls, were recruited. Hip and knee joint angles and angular velocities were investigated with a three-dimensional motion analysis system, and ground reaction forces (GRF) along with moments were collected during the deceleration phase of the stance limb during sidestep cutting maneuvers. We found significantly higher peak hip flexion, hip internal rotation angular velocities, and peak thigh angular velocity in the sagittal plane in the ACLR group. In addition, the peak vertical GRF and peak posterior GRF of the ACLR group were significantly higher than those of the control group. Univariate analyses indicated that the posterior GRF of the non-operated side was significantly higher than in the matched operated side in the control group. The operated and non-operated sides in male basketball athletes with ACLR showed alterations in hip and knee biomechanics compared with a control group, especially in the sagittal plane. Therefore, the emphasis of neuromuscular control training for the hip and the knee in basketball players with ACLR is required.
Collapse
Affiliation(s)
- Pinyada Warathanagasame
- Biomechanics and Sports, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Prasert Sakulsriprasert
- Biomechanics and Sports, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Komsak Sinsurin
- Biomechanics and Sports, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Lancashire, United Kingdom
| | - Jamie S. McPhee
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester, United Kingdom
| |
Collapse
|
12
|
Blanke F, Trinnes K, Oehler N, Prall WC, Lutter C, Tischer T, Vogt S. Spontaneous healing of acute ACL ruptures: rate, prognostic factors and short-term outcome. Arch Orthop Trauma Surg 2023; 143:4291-4298. [PMID: 36515708 PMCID: PMC10293391 DOI: 10.1007/s00402-022-04701-0] [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: 05/31/2022] [Accepted: 11/13/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) reconstruction is considered the first line treatment in ACL rupture. However, some patients return to high intensity sport activities and show a normal knee function without ACL reconstruction. Therefore, aim of this study was to evaluate the rate and prognostic factors of spontaneous healing in patients with ACL rupture and the short-term functional outcome. METHODS The rate, prognostic factors and short-term functional results of spontaneous healing in patients with ACL rupture were evaluated in 381 patients. Morphology of ACL rupture and extent of posterior tibial slope (PTS) were classified by MR- and x-ray imaging. In patients with normal knee stability in anesthesia examination and healed ACL during the arthroscopy 6 weeks after trauma ACL reconstruction was canceled. IKDC -, Tegner Activity Score, KT 1000 testing and radiological characteristics were collected 12 months postoperatively in these patients. RESULTS 14.17% of the patients with ACL rupture showed a spontaneous healing after 6 weeks. Femoral ACL-rupture (p < 0.02) with integrity of ligament stump > 50% (p < 0.001), without bundle separation (p < 0.001) and decreased PTS (p < 0.001) was found significantly more often in patients with a spontaneous healed ACL. The average IKDC score was high at 84,63 in patients with healed ACL at 1 year follow-up, but KT 1000 testing was inferior compared to non-injured side. CONCLUSION Spontaneous healing of a ruptured ACL happened in 14% of the patients. Especially in low-demand patients with femoral single bundle lesions without increased posterior tibial slope delayed ACL surgery should be considered to await the possibility for potential spontaneous ACL healing.
Collapse
Affiliation(s)
- F Blanke
- Department of Knee-, Shoulder- and Hip-Surgery and Orthopedic Sports Medicine, Schön Klinik München-Harlaching, Munich, Germany.
- Department of Orthopedic Surgery, University Rostock, Rostock, Germany.
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany.
| | - K Trinnes
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
| | - N Oehler
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
| | - W C Prall
- Department of Knee-, Shoulder- and Hip-Surgery and Orthopedic Sports Medicine, Schön Klinik München-Harlaching, Munich, Germany
- Department of Orthopedic Surgery, University Hospital of Ludwig Maximilian University (LMU), Munich, Germany
| | - C Lutter
- Department of Orthopedic Surgery, University Rostock, Rostock, Germany
| | - T Tischer
- Department of Orthopedic Surgery, University Rostock, Rostock, Germany
| | - S Vogt
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
| |
Collapse
|
13
|
Little C, Lavender AP, Starcevich C, Mesagno C, Mitchell T, Whiteley R, Bakhshayesh H, Beales D. Understanding Fear after an Anterior Cruciate Ligament Injury: A Qualitative Thematic Analysis Using the Common-Sense Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2920. [PMID: 36833617 PMCID: PMC9957354 DOI: 10.3390/ijerph20042920] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
Fear is a significant factor affecting successful return to sport following an anterior cruciate ligament (ACL) injury. However, there is a lack of understanding of the emotional drivers of fear and how fear beliefs are formed. This study qualitatively explored the contextual and emotional underpinnings of fear and how these beliefs were formed, with reference to the Common-Sense Model of Self-Regulation. Face-to-face online interviews were conducted with ACL-injured participants (n = 18, 72% female) with a mean age of 28 years (range 18-50 years). Participants were either 1 year post ACL reconstruction surgery (n = 16) or at least 1 year post injury without surgery (n = 2) and scored above average on a modified Tampa Scale of Kinesiophobia. Four participants were playing state-level sport or higher. Five themes emerged describing factors contributing to fear: 'External messages', 'Difficulty of the ACL rehabilitation journey', 'Threat to identity and independence', 'Socioeconomic factors', and 'Ongoing psychological barriers'. A sixth theme, 'Positive coping strategies', provided insight into influences that could reduce fear and resolve negative behaviors. This study identified a broad range of contextual biopsychosocial factors which contribute to fear, supporting the notion that ACL injuries should not be treated through a purely physical lens. Furthermore, aligning the themes to the common-sense model provided a conceptual framework conveying the inter-related, emergent nature of the identified themes. The framework provides clinicians with a means to understanding fear after an ACL injury. This could guide assessment and patient education.
Collapse
Affiliation(s)
- Cameron Little
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Andrew P. Lavender
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, VIC 3350, Australia
| | - Cobie Starcevich
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Christopher Mesagno
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3011, Australia
| | | | | | - Hanieh Bakhshayesh
- Curtin School of Electrical Engineering, Computing and Mathematical Sciences, Curtin University, Perth, WA 6102, Australia
| | - Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| |
Collapse
|
14
|
Deviandri R, van der Veen HC, Lubis AMT, van den Akker-Scheek I, Postma MJ. "Cost-effectiveness of ACL treatment is dependent on age and activity level: a systematic review". Knee Surg Sports Traumatol Arthrosc 2023; 31:530-541. [PMID: 35997799 PMCID: PMC9898360 DOI: 10.1007/s00167-022-07087-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE To systematically review the literature on health-economic evaluations of anterior cruciate ligament (ACL) injury between reconstruction surgery (ACLR) and non-operative treatment (NO) and suggest the most cost-effective strategy between the two. METHODS All economic studies related to ACLR versus NO post-ACL injury, either trial based or model based, published until April 2022, were identified using PubMed and Embase. The methodology of the health-economic analysis for each included study was categorized according to the four approaches: cost-minimization analysis (CMA), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), and cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list. RESULTS Of the seven included studies, two compared the strategies of early ACLR and NO alone, and five compared early ACLR and NO with optional delayed ACLR. All studies performed a CUA, and one study performed a CBA additionally. The CHEC scores of the included studies can be considered good, ranging from 15 to 18 from a maximum of 19. Applying the common standard threshold of $50,000 per QALY, six studies in young people with high-activity levels or athletes showed that early ACLR would be preferred over either NO alone or delayed ACLR. Of six studies, two even showed early ACLR to be the dominant strategy over either NO alone or delayed ACLR, with per-patient cost savings of $5,164 and $1,803 and incremental per-patient QALY gains of 0.18 and 0.28, respectively. The one study in the middle-aged people with a moderate activity level showed that early ACLR was not more cost-effective than delayed ACLR, with ICER $101,939/QALY using the societal perspective and ICER $63,188/QALY using the healthcare system perspective. CONCLUSION Early ACLR is likely the more cost-effective strategy for ACL injury cases in athletes and young populations with high-activity levels. On the other hand, non-operative treatment with optional delayed ACLR may be the more cost-effective strategy in the middle age population with moderate activity levels. LEVEL OF EVIDENCE Systematic review of level III studies.
Collapse
Affiliation(s)
- R. Deviandri
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands ,grid.444161.20000 0000 8951 2213Department of Physiology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia ,Division of Orthopedics, Arifin Achmad Hospital, Pekanbaru, Indonesia
| | - H. C. van der Veen
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - A. M. T. Lubis
- grid.9581.50000000120191471Department of Orthopedics-Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - I. van den Akker-Scheek
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - M. J. Postma
- grid.4494.d0000 0000 9558 4598Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,grid.4830.f0000 0004 0407 1981Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands ,grid.440745.60000 0001 0152 762XDepartment of Pharmacology & Therapy, Universitas Airlangga, Surabaya, Indonesia ,grid.11553.330000 0004 1796 1481Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| |
Collapse
|
15
|
Migliorini F, Oliva F, Eschweiler J, Torsiello E, Hildebrand F, Maffulli N. Knee osteoarthritis, joint laxity and PROMs following conservative management versus surgical reconstruction for ACL rupture: a meta-analysis. Br Med Bull 2022; 145:72-87. [PMID: 36412118 DOI: 10.1093/bmb/ldac029] [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: 07/17/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Patients whose rupture of the anterior cruciate ligament (ACL) can be managed conservatively or undergo reconstruction surgery. SOURCE OF DATA Current scientific literature published in Web of Science, PubMed and Scopus. AREAS OF AGREEMENT Several studies published by July 2022 compare surgical and conservative management following ACL rupture. The latest evidence suggests that surgical management may expose patients to an increased risk of early-onset knee osteoarthritis (OA). AREAS OF CONTROVERSY The state of art does not recommend a systematic ACL reconstruction to all patients who tore their ACL. After the initial trauma, surgical reconstruction may produce even greater damage to the intra-articular structures compared to conservative management. GROWING POINTS The state of art does not recommend systematic surgical reconstruction to all patients who tore their ACL. The present study compared surgical reconstruction versus conservative management for primary ACL ruptures in terms of joint laxity, patient reported outcome measures (PROMs) and rate of osteoarthritis. AREAS TIMELY FOR DEVELOPING RESEARCH ACL reconstruction provides significant improvement in joint laxity compared to conservative management, but is associated with a significantly greater rate of knee osteoarthritis, despite similar results at PROM assessment.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy
| | - Joerg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany
| | - Ernesto Torsiello
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
| |
Collapse
|
16
|
Little C, Lavender AP, Starcevich C, Mesagno C, Mitchell T, Whiteley R, Bakhshayesh H, Beales D. An Investigation of the Nature of Fear within ACL-Injured Subjects When Exposed to Provocative Videos: A Concurrent Qualitative and Quantitative Study. Sports (Basel) 2022; 10:sports10110183. [PMID: 36422952 PMCID: PMC9692454 DOI: 10.3390/sports10110183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Fear is a factor contributing to poor return to sport after an anterior cruciate (ACL) injury, however the identification and assessment of fear is challenging. To improve understanding of fear, this study qualitatively and quantitatively assessed responses to videos depicting threat to knee stability in people who had experienced an ACL injury. ACL-injured participants who had above average fear on the Tampa Scale of Kinesiophobia and were at least 1-year post-injury/surgery were eligible. Participants were shown four videos depicting sequentially increasing threat to their knee stability (running, cut-and-pivot, feigned knee injury during cut-and-pivot, series of traumatic knee injuries). Qualitative interviews explored participants feeling related to viewing the videos. Participants quantitatively self-rated fear and distress in response to each video. Seventeen participants were included in this study (71% female, with an average time since last ACL injury of 5 ½ years). Five themes were identified: (1) Evoked physiological responses, (2) Deeper contextualisation of the meaning of an ACL injury influencing bodily confidence, (3) Recall of psychological difficulties, (4) Negative implications of a re-injury, and (5) Change to athletic identity. Quantitatively, direct proportionality was noticed between threat level and reported fear and distress. Specifically, participants reported increasing levels of fear and distress as the videos progressed in threat level, with the largest increase seen between a cut-and-pivot movement to a feigned injury during a cut and pivot. The results support the notion that in addition to being a physical injury, an ACL injury has more complex neurophysiological, psychological, and social characteristics which should be considered in management. Using video exposure in the clinic may assist identification of underlying psychological barriers to recovery following an ACL injury, facilitating person-centred care.
Collapse
Affiliation(s)
- Cameron Little
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- Correspondence:
| | - Andrew P. Lavender
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, VIC 3350, Australia
| | - Cobie Starcevich
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Christopher Mesagno
- Institute for Health & Sport, Victoria University, Melbourne, VIC 3011, Australia
| | | | | | - Hanieh Bakhshayesh
- Curtin School of Electrical Engineering, Computing and Mathematical Sciences, Curtin University, Perth, WA 6102, Australia
| | - Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| |
Collapse
|
17
|
Werner DM, Golightly YM, Tao M, Post A, Wellsandt E. Environmental Risk Factors for Osteoarthritis: The Impact on Individuals with Knee Joint Injury. Rheum Dis Clin North Am 2022; 48:907-930. [PMID: 36333003 DOI: 10.1016/j.rdc.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Osteoarthritis is a debilitating chronic condition involving joint degeneration, impacting over 300 million people worldwide. This places a high social and economic burden on society. The knee is the most common joint impacted by osteoarthritis. A common cause of osteoarthritis is traumatic joint injury, specifically injury to the anterior cruciate ligament. The purpose of this review is to detail the non-modifiable and modifiable risk factors for osteoarthritis with particular focus on individuals after anterior cruciate ligament injury. After reading this, health care providers will better comprehend the wide variety of factors linked to osteoarthritis.
Collapse
Affiliation(s)
- David M Werner
- Office of Graduate Studies, Medical Sciences Interdepartmental Area, University of Nebraska Medical Center, 987815 Nebraska Medical Center, Omaha, NE 68198-7815, USA; Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA.
| | - Yvonne M Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, 984035 Nebraska Medical Center Omaha, NE 68198-4035, USA
| | - Matthew Tao
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA; Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Austin Post
- College of Medicine, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA; Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| |
Collapse
|
18
|
Saueressig T, Braun T, Steglich N, Diemer F, Zebisch J, Herbst M, Zinser W, Owen PJ, Belavy DL. Primary surgery versus primary rehabilitation for treating anterior cruciate ligament injuries: a living systematic review and meta-analysis. Br J Sports Med 2022; 56:1241-1251. [PMID: 36038357 DOI: 10.1136/bjsports-2021-105359] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Compare the effectiveness of primarily surgical versus primarily rehabilitative management for anterior cruciate ligament (ACL) rupture. DESIGN Living systematic review and meta-analysis. DATA SOURCES Six databases, six trial registries and prior systematic reviews. Forward and backward citation tracking was employed. ELIGIBILITY CRITERIA Randomised controlled trials that compared primary reconstructive surgery and primary rehabilitative treatment with or without optional reconstructive surgery. DATA SYNTHESIS Bayesian random effects meta-analysis with empirical priors for the OR and standardised mean difference and 95% credible intervals (CrI), Cochrane RoB2, and the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of evidence. RESULTS Of 9514 records, 9 reports of three studies (320 participants in total) were included. No clinically important differences were observed at any follow-up for self-reported knee function (low to very low certainty of evidence). For radiological knee osteoarthritis, we found no effect at very low certainty of evidence in the long term (OR (95% CrI): 1.45 (0.30 to 5.17), two studies). Meniscal damage showed no effect at low certainty of evidence (OR: 0.85 (95% CI 0.45 to 1.62); one study) in the long term. No differences were observed between treatments for any other secondary outcome. Three ongoing randomised controlled trials were identified. CONCLUSIONS There is low to very low certainty of evidence that primary rehabilitation with optional surgical reconstruction results in similar outcome measures as early surgical reconstruction for ACL rupture. The findings challenge a historical paradigm that anatomic instability should be addressed with primary surgical stabilisation to provide optimal outcomes. PROSPERO REGISTRATION NUMBER CRD42021256537.
Collapse
Affiliation(s)
- Tobias Saueressig
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | - Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, Bochum, North Rhine-Westphalia, Germany.,HSD Hochschule Döpfer (University of Applied Sciences), Cologne, North Rhine-Westphalia, Germany
| | - Nora Steglich
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, Bochum, North Rhine-Westphalia, Germany
| | | | - Jochen Zebisch
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | - Maximilian Herbst
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | | | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Daniel L Belavy
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, Bochum, North Rhine-Westphalia, Germany
| |
Collapse
|
19
|
Guo W, Wan T, Tan H, Fan G, Gao X, Liu P, Jiang C. Anterior cruciate ligament deficiency versus intactness for outcomes in patients after unicompartmental knee arthroplasty: a systematic review and meta-analysis. Front Bioeng Biotechnol 2022; 10:890118. [PMID: 36082162 PMCID: PMC9445614 DOI: 10.3389/fbioe.2022.890118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: The unicondylar knee arthroplasty (UKA) procedure is primarily indicated for osteoarthritis of the knee. Anterior cruciate ligament (ACL) defects have long been considered a contraindication to UKA. However, recent clinical studies have found that ACL defects do not affect postoperative outcomes in UKA. To elucidate whether ACL defects affect postoperative outcomes in UKA, we performed a systematic review and Meta-analysis of observational cohort studies comparing the effects of ACL defects and intactness on surgical outcomes in UKA. Methods: In this study, we used “Anterior Cruciate Ligament”, “Anterior Cruciate Ligament Injuries” and “Arthroplasty, Replacement, Knee” as the subject terms according to PICOS principles. These subject terms and the corresponding free texts were used to conduct a systematic search in the three major databases PubMed, Embase and Cochrane on December 9, 2021. The main study variables included age, gender, region, definition of ACL defect and diagnosed diseases. The study used a random effect model to pool the effect of 95% CIs. To explore the sources of heterogeneity and to test the stability of the results, a sensitivity analysis was performed. Results: The systematic review found no significant differences in postoperative clinical outcomes in the elderly population when unicondylar replacement was performed in the setting of multiple factors such as injury, defects, longitudinal tear, and synovial bursa injury defined as ACL deficiency. The primary clinical outcomes included postoperative revision, Tegner activity score, and Oxford Knee Score (OKS). After statistical meta-analysis, postoperative outcomes such as postoperative revision (OR, 1.174; 95% CIs, 0.758–1.817) and Tegner activity score (OR, -0.084; 95% CIs, -0.320–0.151) were not statistically different. Conclusion: There was no difference in postoperative revision rates and functional outcomes such as Tegner activity score between the ACL-deficient group compared with the ACL-intact group. For the present results, it is not advisable to consider ACL deficiency as a contraindication of UKA.
Collapse
Affiliation(s)
- Weiming Guo
- Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Teng Wan
- Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Haifeng Tan
- Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Gang Fan
- Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Xiaoyu Gao
- Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Pan Liu
- Hengyang Medical College, University of South China, Hengyang, Hunan, China
- *Correspondence: Pan Liu, ; Changqing Jiang,
| | - Changqing Jiang
- Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- *Correspondence: Pan Liu, ; Changqing Jiang,
| |
Collapse
|
20
|
Returning Athletes to Sports Following Anterior Cruciate Ligament Tears. Curr Rev Musculoskelet Med 2022; 15:616-628. [PMID: 35881327 PMCID: PMC9789290 DOI: 10.1007/s12178-022-09782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss treatment options, rehabilitation protocols, return-to-play criteria, and expected outcomes after non-operative and operative treatment of anterior cruciate ligament (ACL) tears among an athletic population. RECENT FINDINGS Non-operative treatment may be a viable option for some athletes with an ACL tears but can be difficult to predict "copers," and those that resume to sports return at lower performance level and/or less intense activities. Most studies assessing function after ACL reconstruction demonstrate favorable outcomes using patient-reported outcome studies. However, return-to-play and graft re-rupture rates vary substantially based on patient characteristics and level and type of athletic activity. Grafts used to reconstruct ACL produce similar objective outcomes and favorable patient-reported outcomes but have variable re-rupture rates depending on study and differ largely on morbidity associated with graft harvest. Various treatment methods including non-operative and operative techniques have been demonstrated to be efficacious in returning athletes to athletic activity depending on patient age and level of activity. Adherence to fundamental rehabilitation principles and accepted return-to-play guidelines can optimize outcomes and limit re-injury to the injured or contralateral limb.
Collapse
|
21
|
Culvenor AG, Girdwood MA, Juhl CB, Patterson BE, Haberfield MJ, Holm PM, Bricca A, Whittaker JL, Roos EM, Crossley KM. Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus. Br J Sports Med 2022; 56:1445-1453. [PMID: 35768181 DOI: 10.1136/bjsports-2022-105495] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Synthesise evidence for effectiveness of rehabilitation interventions following ACL and/or meniscal tear on symptomatic, functional, clinical, psychosocial, quality of life and reinjury outcomes. DESIGN Overview of systematic reviews with Grading of Recommendations Assessment, Development and Evaluation certainty of evidence. DATA SOURCES MEDLINE, EMBASE, CINAHL, SPORTDiscus and Cochrane Library. ELIGIBILITY CRITERIA Systematic reviews of randomised controlled trials investigating rehabilitation interventions following ACL and/or meniscal tears in young adults. RESULTS We included 22 systematic reviews (142 trials of mostly men) evaluating ACL-injured individuals and none evaluating isolated meniscal injuries. We synthesised data from 16 reviews evaluating 12 different interventions. Moderate-certainty evidence was observed for: (1) neuromuscular electrical stimulation to improve quadriceps strength; (2) open versus closed kinetic chain exercises to be similarly effective for quadriceps strength and self-reported function; (3) structured home-based versus structured in-person rehabilitation to be similarly effective for quadriceps and hamstring strength and self-reported function; and (4) postoperative knee bracing being ineffective for physical function and laxity. There was low-certainty evidence that: (1) preoperative exercise therapy improves self-reported and physical function postoperatively; (2) cryotherapy reduces pain and analgesic use; (3) psychological interventions improve anxiety/fear; and (4) whole body vibration improves quadriceps strength. There was very low-certainty evidence that: (1) protein-based supplements improve quadriceps size; (2) blood flow restriction training improves quadriceps size; (3) neuromuscular control exercises improve quadriceps and hamstring strength and self-reported function; and (4) continuous passive motion has no effect on range of motion. CONCLUSION The general level of evidence for rehabilitation after ACL or meniscal tear was low. Moderate-certainty evidence indicates that several rehabilitation types can improve quadriceps strength, while brace use has no effect on knee function/laxity.
Collapse
Affiliation(s)
- Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Michael A Girdwood
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Carsten B Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Funen, Denmark.,Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Copenhagen, Denmark
| | - Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Melissa J Haberfield
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Pætur M Holm
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Funen, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessio Bricca
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Funen, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Funen, Denmark
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
22
|
Affiliation(s)
- Vishal Rajput
- University College London Hospitals, London, UK.,The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- University College London Hospitals, London, UK.,The Princess Grace Hospital, London, UK.,The NIHR Biomedical Research Centre at UCLH, London, UK.,The Bone & Joint Journal , London, UK
| |
Collapse
|
23
|
Jenkins SM, Guzman A, Gardner BB, Bryant SA, Del Sol SR, McGahan P, Chen J. Rehabilitation After Anterior Cruciate Ligament Injury: Review of Current Literature and Recommendations. Curr Rev Musculoskelet Med 2022; 15:170-179. [PMID: 35381974 DOI: 10.1007/s12178-022-09752-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament reconstruction (ACLR) is a common surgical procedure with an estimated 120,000 cases performed in the USA each year. Physical therapy plays a critical role in the successful recovery of both surgically and non-surgically managed patients. Interestingly, ACL rehabilitation protocols vary greatly with little consensus among practitioners. Nonetheless, there has been agreement over the last decade to shift from conservative, standardized length protocols to more accelerated, individualized protocols that vary in length and modalities based on patient-specific findings and preferences. This review summarizes the most recent trends, opinions, and modalities in ACL rehabilitation research, with a specific focus on novel methods to treat the specific psychosocial needs of ACL deficient patients. RECENT FINDINGS We found that new protocols emphasize early weight bearing, open kinetic chain (OKC) exercises, and other alternative modalities such as neuromuscular electrical stimulation and blood flow restriction. We also found a recent trend toward the use of clinical milestones to determine when a patient is ready for the next phase of a "step-up" rehabilitation program. One particularly nascent topic of research is the inclusion of methods to treat the psychosocial impacts of ACL injury, recovery, and the anxiety around return to sport. Rehabilitation strategy has become increasingly patient-dependent, and the new modalities being utilized are accelerating patient recovery. Return to sport is a particularly important factor for many ACLR patients, and recovery has an important psychological component that has only recently been addressed in the literature, with positive preliminary findings.
Collapse
Affiliation(s)
- Sarah M Jenkins
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA.
| | - Alvarho Guzman
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Brandon B Gardner
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Stewart A Bryant
- University of Hawaii Orthopaedic Surgery Residency, Honolulu, HI, USA
| | - Shane Rayos Del Sol
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Patrick McGahan
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - James Chen
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| |
Collapse
|
24
|
Webster KE, Hewett TE. Anterior Cruciate Ligament Injury and Knee Osteoarthritis: An Umbrella Systematic Review and Meta-analysis. Clin J Sport Med 2022; 32:145-152. [PMID: 33852440 DOI: 10.1097/jsm.0000000000000894] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/31/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To conduct a systematic review of reviews to summarize the (1) risk for development and (2) prevalence of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury and surgical treatment and (3) compare prevalence rates between surgical and nonsurgical treatment of ACL injury. DATE SOURCES Five electronic databases were searched using medical subject heading and text words up to February 2020 to identify English language reviews. STUDY SELECTION Studies were included if they were a systematic review or meta-analysis. DATA EXTRACTION Thirteen eligible reviews were included, and the main outcome extracted was knee OA prevalence or risk data and any meta-analysis results. DATA SYNTHESIS Results from reviews were combined with a summary meta-analysis based on odds ratios (ORs) or proportions. There was a near 7-fold and 8-fold increase in the odds for the development of knee OA post ACL injury [OR = 6.81 (5.70-8.13)] and ACL reconstruction [OR = 7.7, (6.05-9.79)]. Data were too heterogenous to specify a point estimate prevalence for OA after ACL injury, but OA prevalence was estimated at 36% (19.70-53.01) at near 10 years after reconstruction surgery. A significantly higher prevalence of OA was found for those who received surgical treatment at a minimum 10-year follow-up [OR = 1.40 (1.17-1.68)]. CONCLUSIONS This study combines all data from previous systematic reviews into a single source to show that ACL injury markedly increases the risk for development of knee OA, which is likely to be present in the long term in approximately a third of patients who have reconstruction surgery. Surgical treatment does not reduce OA prevalence in the longer term compared with nonsurgical treatment.
Collapse
Affiliation(s)
- Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne Vic, Australia ; and
| | | |
Collapse
|
25
|
Melbye P, Gundtoft P, Lien-Iversen T, Barklin Morgan D, Pörneki JC, Viberg B. Secondary surgeries 20 years after surgical and non-surgical treatment of ACL rupture: A population-based cohort study. Knee 2022; 35:1-7. [PMID: 35144195 DOI: 10.1016/j.knee.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies with less than 10 years of follow-up have demonstrated no difference between surgical and non-surgical treatment after an anterior cruciate ligament (ACL) rupture; however, long-term effects remain unclear. The aim of this study was to compare the risk of long-term secondary surgical procedures after primary surgical and non-surgical treatment for ACL ruptures. METHODS Patients aged 18-35, registered in the Danish National Patient Registry with an ACL rupture between January 1, 1996 and December 31, 2000 with a minimum of 20 years follow-up were included. The surgically treated group was defined as receiving an ACL reconstruction within 1 year after diagnosis. Major secondary surgical procedures were defined as subsequent ACL surgeries (reconstruction/revision), arthroplasty, deep infection, arthrodesis, or amputation. Minor secondary surgical procedures were defined as meniscal surgery, synovectomy, and manipulation under anesthesia (MUA). Multivariate regression analysis was performed to assess relative risk (RR), adjusted for age and sex. The results are reported with 95% confidence intervals. RESULTS 7,539 patients had an ACL rupture; 1,970 patients were surgically treated. In the surgically treated group, 5.9% of patients underwent major secondary surgeries; this was 6.1% in the non-surgically treated group, yielding an adjusted RR of 1.05 (0.85;1.30). There were 43.9% minor secondary surgeries in the surgically treated group and 49.1% in the non-surgically treated group, yielding an adjusted RR of 1.29 (1.20;1.39). CONCLUSIONS No significant differences in the rate of major secondary surgical procedures between the groups, the non-surgical group was associated with a higher risk of minor secondary surgeries.
Collapse
Affiliation(s)
- Pernille Melbye
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark.
| | - Per Gundtoft
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Teodor Lien-Iversen
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Daniel Barklin Morgan
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Jens Christian Pörneki
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| |
Collapse
|
26
|
Arhos EK, Thoma LM, Grindem H, Logerstedt D, Risberg MA, Snyder-Mackler L. Association of Quadriceps Strength Symmetry and Surgical Status With Clinical Osteoarthritis Five Years After Anterior Cruciate Ligament Rupture. Arthritis Care Res (Hoboken) 2022; 74:386-391. [PMID: 33026698 PMCID: PMC8024414 DOI: 10.1002/acr.24479] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/10/2020] [Accepted: 10/01/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this study was to examine the association of quadriceps strength symmetry and surgical status (anterior cruciate ligament [ACL] reconstruction or nonoperative management) with early clinical knee osteoarthritis (OA) 5 years after ACL injury or reconstruction. METHODS In total, 204 of 300 athletes were analyzed 5 years after ACL injury or reconstruction. Quadriceps strength was measured and reported as a limb symmetry index. We identified participants with early clinical knee OA using the criteria that 2 of 4 Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales score ≤85%. We calculated odds ratios (ORs) and 95% confidence intervals (95% CIs) using logistic regression and adjusted for age, sex, meniscal injury, and body mass index to examine the associations of quadriceps strength and surgical status with clinical knee OA. RESULTS In all, 21% of participants met the KOOS criteria for clinical knee OA. For every 1% increase in quadriceps limb symmetry index, there was a 4% lower odds of clinical OA (adjusted OR [ORadj ] 0.96 [95% CI 0.93-0.99]) at 5 years. Surgical status was not associated with clinical knee OA (ORadj 0.58 [95% CI 0.23-1.50]). CONCLUSION More symmetric quadriceps strength, but not surgical status, 5 years after ACL injury or reconstruction was associated with lower odds of clinical knee OA.
Collapse
Affiliation(s)
- Elanna K. Arhos
- Biomechanics and Movement Science, University of Delaware, Newark, USA
| | - Louise M. Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Hege Grindem
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Oslo, Norway
| | - David Logerstedt
- Department of Physical Therapy, University of the Sciences, Philadelphia, Philadelphia, USA
| | - May Arna Risberg
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | |
Collapse
|
27
|
Otero K, Congiusta D, Galdi B. Is Insurance Status Associated With Likelihood of Operative ACL Injury Treatment Compared With Nonoperative Treatment? Orthop J Sports Med 2022; 10:23259671221084296. [PMID: 35387361 PMCID: PMC8977718 DOI: 10.1177/23259671221084296] [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: 10/22/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background: While many factors inform the choice of operative versus nonoperative
treatment of injuries to the anterior cruciate ligament (ACL) of the knee,
socioeconomic status influences this decision, as has been reported with
other procedures. Purpose: To identify any associations between insurance status and likelihood of
operative treatment of ACL injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The Nationwide Inpatient Sample database was queried using
International Classification of Diseases, 9th Revision
codes for ACL injuries and reconstruction from 2001 to 2013. Chi-square
analysis was performed to determine significant predictors of operative
intervention. Binary logistic regression was used to account for demographic
and significant predictor variables. Results were recorded as odds ratios
(ORs) and 95% CIs. Significance was defined as P <
.05. Results: A total of 32,541 patients with ACL injuries were included in the final
analysis. Overall incidence of surgical reconstruction was 85.4% (n =
27,805). Multivariable regression revealed that nonprivate insurance types
were associated with lower likelihoods of operative reconstruction compared
with private insurance: the lowest likelihood of operation was seen in
uninsured patients (OR, 0.31; P < .01), followed by
Medicare (OR, 0.33; P < .01) and Medicaid (OR, 0.51;
P < .01) patients. There was also a decreased
likelihood of surgery for elderly (OR, 0.0 [for age ≥75 years];
P < .01) and Black patients (OR, 0.65;
P < .01). An increased likelihood of surgery was
seen with female patients (OR, 1.14; P < .01). Patients
in the highest median household income quartile were more likely to undergo
surgery than those in the lowest (OR, 1.36; P <
.01). Conclusion: Compared with privately insured patients, patients with nonprivate insurance
had lower likelihood of surgery. Furthermore, patients in higher income
quartiles were more likely to undergo operative fixation. These findings may
suggest a need for more precise treatment guidelines and studies that
investigate causes of such differences.
Collapse
Affiliation(s)
- Katie Otero
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Dominick Congiusta
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Balazs Galdi
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| |
Collapse
|
28
|
Deviandri R, der Veen HCV, Lubis AM, Postma MJ, van den Akker-Scheek I. Translation and Psychometric Analysis of the Indonesian Versions of the Lysholm and Tegner Scores for Patients With Anterior Cruciate Ligament Injuries. Orthop J Sports Med 2022; 10:23259671211066506. [PMID: 35097144 PMCID: PMC8793459 DOI: 10.1177/23259671211066506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The Lysholm knee score and Tegner activity scale are frequently used patient-reported outcome measures in patients with anterior cruciate ligament (ACL) injuries because of their excellent psychometric properties. These questionnaires were originally developed in the English language. Purpose: To translate and cross-culturally adapt these measures into the Indonesian language and study their validity and reliability so that they can be used in the Indonesian-speaking population with ACL injuries. Study Design: Cohort study (diagnosis/symptom prevalence); Level of evidence, 2. Methods: After a forward-backward translation procedure and cross-cultural adaptation, validity and reliability were investigated. A total of 253 patients with an ACL injury were sent 4 questionnaires (36-Item Short Form Health Survey, Kujala anterior knee pain scale, Indonesian Lysholm knee score [I-LK], and Indonesian Tegner activity scale [I-TS]). The responses of those patients were analyzed. Following COSMIN guidelines, construct validity, test-retest reliability, internal consistency, floor and ceiling effects, and measurement errors were determined. The Bland-Altman method was used to explore absolute agreement. Results: A total of 106 patients (42% response rate) were included in this study. Construct validity was considered to be good, as more than 75% of the predefined hypotheses on correlations between the I-LK, I-TS, and other measures were confirmed. Reliability proved excellent, with a high test-retest correlation for both questionnaires (intraclass correlation coefficient = 0.99). Bland-Altman analysis showed no systematic bias between testing and retesting. The internal consistency of the I-LK was good (Cronbach alpha = 0.73). For the I-LK and I-TS, floor and ceiling effects were less than 15% (floor: 0% and 4.7%, respectively; ceiling: 12.3% and 3.8%, respectively); the standard error of measurement was 1.8 and 0.9, respectively; the minimal detectable change at the individual level was 5.1 and 0.6, respectively; and the minimal detectable change at the group level was 2.4 and 0.5, respectively. Conclusion: Both the I-LK and I-TS appear to be good evaluation tools for Indonesian-speaking patients with an ACL injury.
Collapse
Affiliation(s)
- Romy Deviandri
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Physiology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
- Division of Orthopedics-Sports Injury, Arifin Achmad Hospital, Pekanbaru, Indonesia
| | - Hugo C. van der Veen
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Andri M.T. Lubis
- Department of Orthopedics, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Maarten J. Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, the Netherlands
- Department of Pharmacology and Therapy, Universitas Airlangga, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
29
|
Remnants-preserving ACL reconstruction using direct tendinous graft fixation: a new rat model. J Orthop Surg Res 2022; 17:7. [PMID: 34986843 PMCID: PMC8729105 DOI: 10.1186/s13018-021-02890-9] [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: 10/06/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) repair techniques are new emerging strategies prevailing, in selected cases, over standard reconstruction of the ACL with excision of its remnants. Mid-substance ACL tears represent a challenge for ACL repair techniques, and remnants-preserving ACL reconstruction (rp-ACLR) using an autograft remains the recommended treatment in this situation. However, morbidity associated with the autograft harvesting prompts the need for alternative surgical strategies based on the use of synthetic scaffolds. Relevant small animal models of mid-substance tears with ACL remnants preservation and reconstruction are necessary to establish the preliminary proof of concept of these new strategies. METHODS A rat model of rp-ACLR using a tendinous autograft after complete mid-substance ACL transection was established. Twelve weeks following surgery, clinical outcomes and knee joints were assessed through visual gait analysis, Lachman tests, thigh perimeter measurements, magnetic resonance imaging, micro-computed tomography, and histology, to evaluate the morbidity of the procedure, accuracy of bone tunnel positioning, ACL remnants fate, osteoarthritis, and autograft bony integration. Results were compared with those obtained with isolated ACL transection without reconstruction and to right non-operated knees. RESULTS AND DISCUSSION Most operated animals were weight-bearing the day following surgery, and no adverse inflammatory reaction has been observed for the whole duration of the study. Autograft fixation with cortical screws provided effective graft anchorage until sacrifice. Healing of the transected ACL was not observed in the animals in which no graft reconstruction was performed. rp-ACLR was associated with a reduced degeneration of the ACL remnants (p = 0.004) and cartilages (p = 0.0437). Joint effusion and synovitis were significantly lower in the reconstructed group compared to the transected ACL group (p = 0.004). Most of the bone tunnel apertures were anatomically positioned in the coronal and/or sagittal plane. The most deviated bone tunnel apertures were the tibial ones, located in median less than 1 mm posteriorly to anatomical ACL footprint center. CONCLUSION This study presents a cost-effective, new relevant and objective rat model associated with low morbidity for the preliminary study of bio-implantable materials designed for remnants-preserving ACL surgery after mid-substance ACL tear.
Collapse
|
30
|
Current trends in the anterior cruciate ligament part II: evaluation, surgical technique, prevention, and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2022; 30:34-51. [PMID: 34865182 DOI: 10.1007/s00167-021-06825-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
Clinical evaluation and management of anterior cruciate ligament (ACL) injury is one of the most widely researched topics in orthopedic sports medicine, giving providers ample data on which to base their practices. The ACL is also the most commonly treated knee ligament. This study reports on current topics and research in clinical management of ACL injury, starting with evaluation, operative versus nonoperative management, and considerations in unique populations. Discussion of graft selection and associated procedures follows. Areas of uncertainty, rehabilitation, and prevention are the final topics before a reflection on the current state of ACL research and clinical management of ACL injury. Level of evidence V.
Collapse
|
31
|
Filbay S, Kvist J. Fear of Reinjury Following Surgical and Nonsurgical Management of Anterior Cruciate Ligament Injury: An Exploratory Analysis of the NACOX Multicenter Longitudinal Cohort Study. Phys Ther 2021; 102:6478865. [PMID: 34939109 PMCID: PMC8860188 DOI: 10.1093/ptj/pzab273] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 10/24/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to compare fear and certainty of reinjury between follow-up time points and treatment groups (no anterior cruciate ligament [ACL] reconstruction [no ACLR], pre-ACLR, post-ACLR) and to identify prognostic factors for fear of reinjury at 3 and 12 months following injury or ACLR. METHODS An exploratory analysis of the Natural Corollaries and Recovery After ACL-injury multicenter longitudinal cohort study was conducted. Patients (n = 275) with primary ACL injury and 15 to 40 years of age received usual care (initial physical therapist-supervised rehabilitation, before considering ACLR). Fear of reinjury (as measured with the Anterior Cruciate Ligament Quality of Life instrument [ACL-QOL] item 31 and the Anterior Cruciate Ligament Return to Sport After Injury instrument [ACL-RSI] item 9) and certainty of reinjury (as measured with the Knee Self-Efficacy Scale item D2) were evaluated at baseline and at 3, 6, and 12 months following ACL injury or ACLR. Comparisons were performed with linear mixed models. Linear regression assessed potential prognostic factors (age, sex, preinjury activity, baseline knee function, baseline general self-efficacy, and expected recovery time) for fear of reinjury (ACL-QOL item 31) at the 3- and 12-month follow-up assessments. RESULTS Fear of reinjury was common regardless of ACL treatment. Fear of reinjury decreased between 3 and 6 months and 3 and 12 months (mean difference: ACL-QOL = 9 [95% CI = 2 to 15]; ACL-RSI = 21 [95% CI = 13 to 28]) after injury. This improvement was not observed in patients who later underwent ACLR, who reported worse fear of reinjury at 3 months (ACL-QOL = 10 [95% CI = 3 to 18]) and at 12 months (ACL-RSI = 22 [95% CI = 2 to 42]) postinjury compared with those who did not proceed to ACLR. Following ACLR, fear of reinjury decreased between the 3- and 12-month follow-up assessments (ACL-QOL = 10 [95% CI = 4 to 16]; ACL-RSI = 12 [95% CI = 5 to 19]). Greater baseline general self-efficacy was associated with reduced fear of reinjury at 12 months after injury (adjusted coefficient = 1.7 [95% CI = 0.0 to 3.5]). Female sex was related to more fear of reinjury 3 months after ACLR (-14.5 [95% CI = -25.9 to -3.1]), and better baseline knee function was related to reduced fear of reinjury 12 months after ACLR (0.3 [95% CI = 0.0 to 0.7]). CONCLUSION People who had ACLR reported worse fear of reinjury before surgery than those who did not proceed to ACLR. Different prognostic factors for fear of reinjury were identified in people treated with ACLR and those treated with rehabilitation alone. IMPACT Fear of reinjury is a concern following ACL injury. Clinicians should evaluate and address reinjury fears. These results may assist in identifying individuals at risk of fear of reinjury following surgical and nonsurgical management of ACL injury.
Collapse
Affiliation(s)
- Stephanie Filbay
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Victoria, Australia
| | - Joanna Kvist
- Address all correspondence to Dr Kvist at: ; Follow the author(s): @JoannaKvist
| |
Collapse
|
32
|
Physical prognostic factors predicting outcome following anterior cruciate ligament reconstruction: A systematic review and narrative synthesis. Phys Ther Sport 2021; 53:115-142. [PMID: 34896673 DOI: 10.1016/j.ptsp.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are common. Many patients undergo ACL reconstruction (ACLR), with rehabilitation key to successful outcome. Understanding physical prognostic factors is integral to clinical decision-making, but factors predicting outcome are inadequately defined. The objective was to establish physical prognostic factors predicting outcome following ACLR. METHODS A systematic review following a published protocol (CRD42019127732) searched MEDLINE, CINAHL, EMBASE, key journals and grey literature to November 28, 2020. Prospective cohort studies, participants ≥16 years of age who had undergone ACLR were included, with multi-ligament and/or ACL repair surgery, and studies not published in English excluded. Two independent reviewers conducted searches, extracted data, assessed risk of bias (QUIPS) and overall quality of evidence (GRADE). Meta-analysis was not possible, therefore narrative synthesis was performed. RESULTS 13 studies (16 articles) were included (1 low, 12 high risk of bias). Low-level evidence supports postoperative degenerative changes and poor lower-limb strength predicting poorer outcome long term (KOOS). Very low-level evidence supports greater postoperative quadriceps strength predicting improved functional performance medium term; with lower body mass index predicting improvement of multiple outcome measures. CONCLUSION Limited evidence of low or very low-level indicates multiple prognostic factors predicting outcome following ACLR. A high-quality prognostic study is required.
Collapse
|
33
|
Söderman T, Werner S, Wretling ML, Hänni M, Mikkelsen C, Sundin A, Shalabi A. Knee function 30 years after ACL reconstruction: a case series of 60 patients. Acta Orthop 2021; 92:716-721. [PMID: 34319200 PMCID: PMC8635658 DOI: 10.1080/17453674.2021.1959709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Until now, there have been no studies beyond 30 years after anterior cruciate ligament (ACL) reconstruction. We report knee function a mean 31 years after ACL reconstruction.Patients and methods - This cohort comprised a case series of 60 patients with a mean follow-up of 31 years (28-33) after ACL reconstruction. Patients were evaluated with the International Knee Documentation Committee (IKDC) objective assessment, Knee injury Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale, radiography, and MRI.Results - 30 patients showed an intact ACL graft and 30 a ruptured or missing ACL graft. 40 patients had osteoarthritis in the tibiofemoral compartment and 24 patients in the patellofemoral compartment. Patients with intact ACL grafts scored higher than those with ruptured or missing ACL grafts when it comes to KOOS Sport/Rec. The Hodges Lehmann estimated median difference between groups was 15 (95% CI 0-35). The KOOS scores were lower in the group with ruptured or missing ACL grafts when compared with a healthy-knee reference group of males in terms of Pain, mean difference -8 (CI -15 to -1), Symptoms, mean difference -18 (CI -27 to -9), and Sport/Rec, mean difference -21 (CI -34 to -8). In the group with intact ACL grafts, the KOOS score was lower than a healthy-knee reference group of males in terms of Symptoms, mean difference -12 (CI -21 to -3). Scores for all subgroups of KOOS were higher in patients without osteoarthritis. The IKDC overall clinical assessment outcome was worse in patients with a ruptured or missing ACL graft. The Hodges Lehmann estimated median difference between groups was 1 (CI 0-1).Interpretation - Patients with an intact ACL graft reported higher sports activity and recreation, as measured with KOOS, than patients with a ruptured or missing ACL graft. Patients with severe osteoarthritis reported lower sports activity and recreation, as measured with KOOS.
Collapse
Affiliation(s)
- Thomas Söderman
- Department of Radiology, Institution of Surgical Sciences, Uppsala University, Akademiska Hospital, Uppsala;;,Correspondence:
| | - Suzanne Werner
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | | | - Mari Hänni
- Department of Radiology, Institution of Surgical Sciences, Uppsala University, Akademiska Hospital, Uppsala
| | - Christina Mikkelsen
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Anders Sundin
- Department of Radiology, Institution of Surgical Sciences, Uppsala University, Akademiska Hospital, Uppsala
| | - Adel Shalabi
- Department of Radiology, Institution of Surgical Sciences, Uppsala University, Akademiska Hospital, Uppsala
| |
Collapse
|
34
|
Szymski D, Koch M, Zeman F, Zellner J, Achenbach L, Bloch H, Pfeifer C, Alt V, Krutsch W. Lessons from establishing a football-specific registry of anterior cruciate ligament injuries - data collection and first epidemiological data. SCI MED FOOTBALL 2021; 6:446-451. [DOI: 10.1080/24733938.2021.1991583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Dominik Szymski
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Matthias Koch
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | | | - Leonard Achenbach
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Medical Centre Wuerzburg, Wuerzburg, Germany
| | - Hendrik Bloch
- Department for Sports Injury Prevention, Verwaltungs-Berufsgenossenschaft (VBG), Hamburg, Germany
| | - Christian Pfeifer
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
- SportdocsFranken, Nuremberg, Germany
| |
Collapse
|
35
|
On Measuring Implant Fixation Stability in ACL Reconstruction. SENSORS 2021; 21:s21196632. [PMID: 34640951 PMCID: PMC8513052 DOI: 10.3390/s21196632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/17/2022]
Abstract
Numerous methods and devices are available for implant fixation in anterior cruciate ligament (ACL) reconstruction. Biomechanical data indicate high variability in fixation stability across different devices. This study aims to provide a better insight into measuring the structural characteristics and mechanical behavior of ACL implant fixations. Fourteen human tibial specimens with reconstructed ACLs were subjected to progressively increasing dynamic loading until failure. The motions of the tibia, the proximal and distal graft ends, as well as the testing frame and actuator, were continuously recorded via a motion tracking system. Significantly higher displacements of the machine actuator (1.0 mm at graft slippage onset, and 12.2 mm at ultimate load) were measured compared to the displacements of the proximal (0.8 and 4.3 mm, respectively) and distal graft (0.1 and 3.4 mm, respectively) ends. The displacements measured at different sites showed significant correlations. The provided data suggest significant and systematic inaccuracies in the stiffness and slippage of the fixation when using machine displacement, as commonly reported in the literature. The assessment of the distal graft displacement excludes the artifactual graft elongation, and most accurately reflects the graft slippage onset indicating clinical failure. Considering the high displacement at the ultimate load, the ultimate load could be used as a standardized variable to compare different fixation methods. However, the ultimate load alone is not sufficient to qualitatively describe fixation stability.
Collapse
|
36
|
Deviandri R, van der Veen HC, Lubis AMT, Postma MJ, van den Akker-Scheek I. Translation, Cross-Cultural Adaptation, Validity, and Reliability of the Indonesian Version of the IKDC Subjective Knee Form. Orthop J Sports Med 2021; 9:23259671211038372. [PMID: 34604432 PMCID: PMC8485307 DOI: 10.1177/23259671211038372] [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: 04/01/2021] [Accepted: 05/19/2021] [Indexed: 01/13/2023] Open
Abstract
Background: No questionnaire is currently available for use in patients with anterior cruciate ligament (ACL) injuries in an Indonesian population. The most-used questionnaire in clinical research for these patients is the International Knee Documentation Committee (IKDC) Subjective Knee Form, as its psychometric properties are considered to be excellent. Purpose: To translate the IKDC into Indonesian and assess its validity for use in Indonesian-speaking patients with ACL injuries. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: After a forward-and-backward translation procedure and cross-cultural adaptation, the validity and reliability of the questionnaire were investigated. The responses of ACL injury patients on 3 questionnaires, the Indonesian-IKDC (I-IKDC), 36-Item Short Form Health Survey, and Kujala Anterior Knee Pain Scale, were compared. Following consensus-based standards for the selection of health measurement instruments guidelines, construct validity, test-retest reliability, internal consistency, floor and ceiling effects, and measurement error were determined. The Bland-Altman method was used to explore absolute agreement. Results: Of 253 ACL injury patients, 106 (42%) responded to the invitation. Construct validity was considered good, as all predefined hypotheses on correlations between the I-IKDC and other scores were confirmed. Reliability proved excellent, with a high test-retest correlation (intraclass correlation coefficient = 0.99). Bland-Altman analyses showed no systematic bias between test and retest. Internal consistency was good (Cronbach α = .90). There were no floor or ceiling effects. Standard error of measurement was 2.1, and the minimal detectable change was 5.8 at the individual level and 0.7 at the group level. Conclusion: The I-IKDC, as developed, appeared to be a good evaluation instrument for Indonesian patients with ACL injuries.
Collapse
Affiliation(s)
- Romy Deviandri
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Physiology--Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia.,Division of Orthopaedics--Sports Injury, Arifin Achmad Hospital, Pekanbaru, Indonesia
| | - Hugo C van der Veen
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Andri M T Lubis
- Department of Orthopaedics--Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, the Netherlands.,Department of Economics, Econometrics and Finance, University of Groningen, Faculty of Economics & Business, Groningen, the Netherlands.,Department of Pharmacology and Therapy, Universitas Airlangga, Surabaya, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Inge van den Akker-Scheek
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
37
|
Diemer F, Zebisch J, Saueressig T. [Consequences of anterior cruciate ligament rupture: a systematic umbrella review]. SPORTVERLETZUNG-SPORTSCHADEN 2021; 36:18-37. [PMID: 34544171 DOI: 10.1055/a-1474-8986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The treatment of an anterior cruciate ligament rupture is still controversial. In particular, this applies to the question of conservative versus surgical treatment. The answer to this question is often based on consequential damage such as the development of posttraumatic osteoarthritis, secondary damage to the meniscus or cartilage, and participation in sports. If there are significant differences in these parameters between the individual treatment options, the results will be of great importance for the development of evidence-based treatment pathways. Therefore, the aim of this work was to evaluate the development of knee osteoarthritis after rupture of the anterior cruciate ligament and the corresponding treatment (conservative or surgical). MATERIAL AND METHODS To answer the above question, a systematic literature search was conducted in Medline via Pubmed, the Cochrane Library and in CINAHL. Only systematic reviews with a minimum follow-up period of 10 years were included. The search was conducted in January 2020 and updated in January 2021. Investigated cohorts included patients with a rupture of the anterior cruciate ligament who had undergone either conservative or surgical treatment. Osteoarthritis was diagnosed either radiologically (recognized scores) or clinically (pain and impaired function). Appropriate reviews were qualitatively evaluated using the AMSTAR-2 questionnaire. RESULTS The literature research initially identified n = 42 reviews from which 14 reviews were included. After full-text review and qualitative evaluation, only n = 2 systematic reviews remained for evaluation. The results of both papers show imprecise data with a high variability. However, it can be assumed with high probability that the development of osteoarthritis of the knee is increased after a rupture of the anterior cruciate ligament. There is no evidence that the incidence of joint degeneration may be reduced by reconstruction of the anterior cruciate ligament, nor is there a difference when comparing conservative and surgical treatment directly. CONCLUSION Patients with an anterior cruciate ligament rupture are likely to be at a greater risk of developing progressive joint degeneration. A protective effect of cruciate ligament surgery has not been found in the evaluated studies. A general argument in favour of cruciate ligament surgery aiming to achieve a protective effect on hyaline articular cartilage seems obsolete based on the results and should therefore not be used in patient education in the future.
Collapse
Affiliation(s)
- Frank Diemer
- DIGOTOR GbR, Brackenheim, Germany.,Physio Meets Science GmbH, Leimen, Germany
| | | | | |
Collapse
|
38
|
Stockton DJ, Schmidt AM, Yung A, Desrochers J, Zhang H, Masri BA, Wilson DR. Tibiofemoral contact and alignment in patients with anterior cruciate ligament rupture treated nonoperatively versus reconstruction : an upright, open MRI study. Bone Joint J 2021; 103-B:1505-1513. [PMID: 34465147 DOI: 10.1302/0301-620x.103b9.bjj-2020-1955.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS Anterior cruciate ligament (ACL) rupture commonly leads to post-traumatic osteoarthritis, regardless of surgical reconstruction. This study uses standing MRI to investigate changes in contact area, contact centroid location, and tibiofemoral alignment between ACL-injured knees and healthy controls, to examine the effect of ACL reconstruction on these parameters. METHODS An upright, open MRI was used to directly measure tibiofemoral contact area, centroid location, and alignment in 18 individuals with unilateral ACL rupture within the last five years. Eight participants had been treated nonoperatively and ten had ACL reconstruction performed within one year of injury. All participants were high-functioning and had returned to sport or recreational activities. Healthy contralateral knees served as controls. Participants were imaged in a standing posture with knees fully extended. RESULTS Participants' mean age was 28.4 years (SD 7.3), the mean time since injury was 2.7 years (SD 1.6), and the mean International Knee Documentation Subjective Knee Form score was 84.4 (SD 13.5). ACL injury was associated with a 10% increase (p = 0.001) in contact area, controlling for compartment, sex, posture, age, body mass, and time since injury. ACL injury was associated with a 5.2% more posteriorly translated medial centroid (p = 0.001), equivalent to a 2.6 mm posterior translation on a representative tibia with mean posteroanterior width of 49.4 mm. Relative to the femur, the tibiae of ACL ruptured knees were 2.3 mm more anteriorly translated (p = 0.003) and 2.6° less externally rotated (p = 0.010) than healthy controls. ACL reconstruction was not associated with an improvement in any measure. CONCLUSION ACL rupture was associated with an increased contact area, posteriorly translated medial centroid, anterior tibial translation, and reduced tibial external rotation in full extension. These changes were present 2.7 years post-injury regardless of ACL reconstruction status. Cite this article: Bone Joint J 2021;103-B(9):1505-1513.
Collapse
Affiliation(s)
- David J Stockton
- Centre for Hip Health and Mobility, Vancouver, Canada.,Clinician Investigator Program, University of British Columbia, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | | | - Andrew Yung
- MRI Research Center, University of British Columbia, Vancouver, Canada
| | | | - Honglin Zhang
- Centre for Hip Health and Mobility, Vancouver, Canada
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - David R Wilson
- Centre for Hip Health and Mobility, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| |
Collapse
|
39
|
Pedersen M, Grindem H, Johnson JL, Engebretsen L, Axe MJ, Snyder-Mackler L, Risberg MA. Clinical, Functional, and Physical Activity Outcomes 5 Years Following the Treatment Algorithm of the Delaware-Oslo ACL Cohort Study. J Bone Joint Surg Am 2021; 103:1473-1481. [PMID: 33999877 PMCID: PMC8376754 DOI: 10.2106/jbjs.20.01731] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries can be treated with or without ACL reconstruction (ACLR), and more high-quality studies evaluating outcomes after the different treatment courses are needed. The purpose of the present study was to describe and compare 5-year clinical, functional, and physical activity outcomes for patients who followed our decision-making and treatment algorithm and chose (1) early ACLR with preoperative and postoperative rehabilitation, (2) delayed ACLR with preoperative and postoperative rehabilitation, or (3) progressive rehabilitation alone. Early ACLR was defined as that performed ≤6 months after the preoperative rehabilitation program, and late ACLR was defined as that performed >6 months after the preoperative rehabilitation program. METHODS We included 276 patients from a prospective cohort study. The patients had been active in jumping, pivoting, and cutting sports before the injury and sustained a unilateral ACL injury without substantial concomitant knee injuries. The patients chose their treatment through a shared decision-making process. At 5 years, we assessed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale, sports participation, quadriceps muscle strength, single-legged hop performance, and new ipsilateral and contralateral knee injuries. RESULTS The 5-year follow-up rate was 80%. At 5 years, 64% of the patients had undergone early ACLR, 11% had undergone delayed ACLR, and 25% had had progressive rehabilitation alone. Understandably, the choices that participants made differed by age, concomitant injuries, symptoms, and predominantly level-I versus level-II preinjury activity level. There were no significant differences in any clinical, functional, or physical activity outcomes among the treatment groups. Across treatment groups, 95% to 100% of patients were still active in some kind of sports and 65% to 88% had IKDC-SKF and KOOS scores above the threshold for a patient acceptable symptom state. CONCLUSIONS Patients with ACL injury who were active in jumping, pivoting, and cutting sports prior to injury; who had no substantial concomitant knee injuries; and who followed our decision-making and treatment algorithm had good 5-year knee function and high sport participation rates. Three of 4 patients had undergone ACLR within 5 years. There were no significant differences in any outcomes among patients treated with early ACLR, delayed ACLR, or progressive rehabilitation alone. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Marie Pedersen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hege Grindem
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jessica L. Johnson
- Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Michael J. Axe
- Department of Physical Therapy, University of Delaware, Newark, Delaware
- First State Orthopaedics, Newark, Delaware
| | - Lynn Snyder-Mackler
- Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - May Arna Risberg
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
40
|
Filbay S, Andersson C, Gauffin H, Kvist J. Prognostic Factors for Patient-Reported Outcomes at 32 to 37 Years After Surgical or Nonsurgical Management of Anterior Cruciate Ligament Injury. Orthop J Sports Med 2021; 9:23259671211021592. [PMID: 34395684 PMCID: PMC8361529 DOI: 10.1177/23259671211021592] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/24/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Knowledge to inform the identification of individuals with a poor long-term prognosis after anterior cruciate ligament (ACL) injury is limited. Identifying prognostic factors for long-term outcomes after ACL injury may inform targeted interventions to improve outcomes for those with a poor long-term prognosis. Purpose: To determine whether ACL treatment (early augmented or nonaugmented ACL repair plus rehabilitation, rehabilitation alone, or rehabilitation plus delayed ACL reconstruction [ACLR]) and 4-year measures (quadriceps and hamstrings strength, single-leg hop, knee laxity, flexion and extension deficit, self-reported knee function, activity level) are prognostic factors for patient-reported outcomes at 32 to 37 years after acute ACL injury. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 251 patients aged 15 to 40 years with acute ACL rupture between 1980 and 1985 were allocated to early ACL repair (augmented or nonaugmented) plus rehabilitation or to rehabilitation alone, based on birth year. One hundred ninety of 234 completed 32- to 37-year follow-up questionnaires (response rate, 81%); 18 people were excluded, resulting in 172 patients available for analysis (mean age, 59 ± 6 years; 28% female). Potential prognostic factors assessed 4 years after ACL injury were ACL treatment (early ACL repair, rehabilitation alone, or delayed ACLR), isokinetic quadriceps and hamstrings strength, single-leg hop performance, knee flexion and extension deficit, knee laxity, Tegner activity scale, and Lysholm score. Outcomes included Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and the Anterior Cruciate Ligament Quality of Life (ACL-QOL) measure. Linear regression adjusted for age, sex, baseline meniscal injury, and contralateral ACL injury was used to assess potential prognostic factors for 32- to 37-year outcomes. Multiple imputation accounted for missing data. Results: A fair/poor Lysholm score (vs excellent/good) at 4 years was a prognostic factor for worse KOOS Pain (adjusted regression coefficient, −12 [95% confidence interval (CI), −19 to −4]), KOOS Symptoms (−15 [95% CI, −23 to −7]), KOOS Sport and Recreation (−19 [95% CI, −31 to −8]), and ACL QOL (−9 [95% CI, −18 to −1]) scores. A 4-year single-leg hop limb symmetry index <90% was a prognostic factor for worse KOOS Pain (adjusted regression coefficient, −9 [95% CI, −17 to −1]) and ACL QOL (−13 [95% CI, −22 to −3]) scores at long-term follow-up. A lower activity level, delayed ACLR, and increased knee laxity were prognostic factors in the crude analysis. Rehabilitation alone versus early repair, quadriceps and hamstring strength, and flexion and extension deficit were not related to 32- to 37-year outcomes. Conclusion: Reduced self-reported knee function and single-leg hop performance 4 years after ACL injury were prognostic factors for worse 32- to 37-year outcomes. Estimates exceeded clinically important thresholds, highlighting the importance of assessing these constructs when managing individuals with ACL injuries. Registration: NCT03182647 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Stephanie Filbay
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Victoria, Australia
| | - Christer Andersson
- Division of Surgery, Orthopaedics and Oncology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Håkan Gauffin
- Division of Surgery, Orthopaedics and Oncology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Joanna Kvist
- Unit of Physiotherapy, Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
41
|
Dasgupta A, Sori N, Petrova S, Maghdouri-White Y, Thayer N, Kemper N, Polk S, Leathers D, Coughenour K, Dascoli J, Palikonda R, Donahue C, Bulysheva AA, Francis MP. Comprehensive collagen crosslinking comparison of microfluidic wet-extruded microfibers for bioactive surgical suture development. Acta Biomater 2021; 128:186-200. [PMID: 33878472 DOI: 10.1016/j.actbio.2021.04.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/30/2022]
Abstract
Collagen microfiber-based constructs have garnered considerable attention for ligament, tendon, and other soft tissue repairs, yet with limited clinical translation due to strength, biocompatibility, scalable manufacturing, and other challenges. Crosslinking collagen fibers improves mechanical properties; however, questions remain regarding optimal crosslinking chemistries, biocompatibility, biodegradation, long-term stability, and potential for biotextile assemble at scale, limiting their clinical usefulness. Here, we assessed over 50 different crosslinking chemistries on microfluidic wet-extruded collagen microfibers made with clinically relevant collagen to optimize collagen fibers as a biotextile yarn for suture or other medical device manufacture. The endogenous collagen crosslinker, glyoxal, provides extraordinary fiber ultimate tensile strength near 300MPa, and Young's modulus of over 3GPa while retaining 50% of the initial load-bearing capacity through 6 months as hydrated. Glyoxal crosslinked collagen fibers further proved cytocompatible and biocompatible per ISO 10993-based testing, and further elicits a predominantly M2 macrophage response. Remarkably these strong collagen fibers are amenable to industrial braiding to form strong collagen fiber sutures. Collagen microfluidic wet extrusion with glyoxal crosslinking thus progress bioengineered, strong, and stable collagen microfibers significantly towards clinical use for potentially promoting efficient healing compared to existing suture materials. STATEMENT OF SIGNIFICANCE: Towards improving clinical outcomes for over 1 million ligament and tendon surgeries performed annually, we report an advanced microfluidic extrusion process for type I collagen microfiber manufacturing for biological suture and other biotextile manufacturing. This manuscript reports the most extensive wet-extruded collagen fiber crosslinking compendium published to date, providing a tremendous recourse to the field. Collagen fibers made with clinical-grade collagen and crosslinked with glyoxal, exhibit tensile strength and stability that surpasses all prior reports. This is the first report demonstrating that glyoxal, a native tissue crosslinker, has the extraordinary ability to produce strong, cytocompatible, and biocompatible collagen microfibers. These collagen microfibers are ideal for advanced research and clinical use as surgical suture or other tissue-engineered medical products for sports medicine, orthopedics, and other surgical indications.
Collapse
|
42
|
Low correlation between functional performance and patient reported outcome measures in individuals with non-surgically treated ACL injury. Phys Ther Sport 2021; 47:185-192. [DOI: 10.1016/j.ptsp.2020.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022]
|
43
|
Wellsandt E, Khandha A, Capin J, Buchanan TS, Snyder-Mackler L. Operative and nonoperative management of anterior cruciate ligament injury: Differences in gait biomechanics at 5 years. J Orthop Res 2020; 38:2675-2684. [PMID: 32159239 PMCID: PMC7808330 DOI: 10.1002/jor.24652] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/05/2019] [Accepted: 02/11/2020] [Indexed: 02/04/2023]
Abstract
Gait biomechanics after anterior cruciate ligament (ACL) injury are associated with functional outcomes and the development of posttraumatic knee osteoarthritis. However, biomechanical outcomes between patients treated nonoperatively compared with operatively are not well understood. The primary purpose of this study was to compare knee joint contact forces, angles, and moments during loading response of gait between individuals treated with operative compared with nonoperative management at 5 years after ACL injury. Forty athletes treated operatively and 17 athletes treated nonoperatively completed gait analysis at 5 years after ACL reconstruction or completion of nonoperative rehabilitation. Medial compartment joint contact forces were estimated using a previously validated, patient-specific electromyography-driven musculoskeletal model. Knee joint contact forces, angles, and moments were compared between the operative and nonoperative group using mixed model 2 × 2 analyses of variance. Peak medial compartment contact forces were larger in the involved limb of the nonoperative group (Op: 2.37 ± 0.47 BW, Non-Op: 3.03 ± 0.53 BW; effect size: 1.36). Peak external knee adduction moment was also larger in the involved limb of the nonoperative group (Op: 0.25 ± 0.08 Nm/kg·m, Non-Op: 0.32 ± 0.09 Nm/kg·m; effect size: 0.89). No differences in radiographic tibiofemoral osteoarthritis were present between the operative and nonoperative groups. Overall, participants treated nonoperatively walked with greater measures of medial compartment joint loading than those treated operatively, while sagittal plane group differences were not present. Statement of clinical relevance: The differences in medial knee joint loading at 5 years after operative and nonoperative management of ACL injury may have implications on the development of posttraumatic knee osteoarthritis.
Collapse
Affiliation(s)
- Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, NE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Ashutosh Khandha
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Jacob Capin
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, NE, USA,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA,Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
| | - Thomas S. Buchanan
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Department of Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Department of Physical Therapy, University of Delaware, Newark, DE, USA
| |
Collapse
|
44
|
Hughes JD, Lawton CD, Nawabi DH, Pearle AD, Musahl V. Anterior Cruciate Ligament Repair: The Current Status. J Bone Joint Surg Am 2020; 102:1900-1915. [PMID: 32932291 DOI: 10.2106/jbjs.20.00509] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jonathan D Hughes
- UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cort D Lawton
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY
| | - Danyal H Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY
| | - Andrew D Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
45
|
Konrads C, Döbele S, Ateschrang A, Ahmad SS. Outcome of anterior cruciate ligament reconstruction in children and adolescents: A retrospective study. J Clin Orthop Trauma 2020; 13:46-49. [PMID: 33717873 PMCID: PMC7920141 DOI: 10.1016/j.jcot.2020.08.022] [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: 07/23/2020] [Revised: 08/08/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Indications and outcomes of anterior cruciate ligament (ACL) reconstruction in children and adolescents is still controversial. It was the aim of this study to analyze outcomes of anterior cruciate ligament reconstruction in this special age group. METHODS Retrospectively, we analyzed 62 consecutive cases of ACL reconstruction using a physis crossing technique in six to 16-year-old patients with a mean follow-up of 69 months. RESULTS Cases operated later than six weeks after trauma had significantly more meniscal lesions than patients operated within six weeks of trauma. At last follow-up, we found good or very good subjective and objective results in 71% of the patients. CONCLUSION In active and healthy children with anterior knee instability after ACL tear, ligament reconstruction is a safe and successful procedure and should be considered within six weeks of trauma because instability seems to promote secondary meniscal lesions.
Collapse
Affiliation(s)
- Christian Konrads
- Corresponding author. Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen Schnarrenbergstr. 95 72076, Tübingen, Germany.
| | | | | | | |
Collapse
|
46
|
Rebmann D, Mayr HO, Schmal H, Hernandez Latorre S, Bernstein A. Immunohistochemical analysis of sensory corpuscles in human transplants of the anterior cruciate ligament. J Orthop Surg Res 2020; 15:270. [PMID: 32680550 PMCID: PMC7368668 DOI: 10.1186/s13018-020-01785-5] [Citation(s) in RCA: 4] [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: 03/20/2020] [Accepted: 07/06/2020] [Indexed: 11/12/2022] Open
Abstract
Background Sensory nerve endings in ligaments play an important role for the proprioceptive function. Clinical trials show that the sense of body position does not fully recover in the knee joint after reconstructive surgery of the ruptured anterior cruciate ligament. The aim of this study is to identify sensory corpuscles in autogenous and allogenous transplants of the ligament and to compare their quantity between the used allografts and autografts. Methods Thirty-three patients were included in this study. Three patellar tendon allografts, 14 patellar tendon autografts and 12 semitendinosus autografts were harvested during revision surgery after traumatic rerupture of the graft. The control consisted of 4 healthy anterior cruciate ligaments after fresh rupture. After haematoxylin staining, immunohistochemical analysis was performed using antibodies against S100, p75 and PGP9.5. Microscopical examination was carried out, and the number of mechanoreceptors was counted. Statistical analysis was performed using the Mann-Whitney U test. Results Two types of mechanoreceptors were identified in each graft: Ruffini corpuscles and free nerve endings. The number of Ruffini corpuscles per square centimeter was the highest in the control. Comparing the grafts, the highest number of receptors could be detected in the semitendinosus autograft. The amount of free nerve endings was higher in the semitendinosus and patellar tendon autografts than in the control; the allografts showed the lowest number of receptors. With increasing time after reconstruction, the number of both types of receptors showed a decrease in the semitendinosus graft, whereas it increased in the patellar tendon graft and allograft. The number of mechanoreceptors in the semitendinosus and patellar tendon graft decreased over time after graft-failure, whereas it increased slightly in the allograft. Conclusion This study was the first to identify mechanoreceptors in human transplants of the anterior cruciate ligament. The partial increase in the number of receptors over time after reconstruction could indicate a reinnervation of the grafts.
Collapse
Affiliation(s)
- D Rebmann
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - H O Mayr
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.,Department of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Harlachinger Strasse 51, 81547, Munich, Germany
| | - H Schmal
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - S Hernandez Latorre
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - A Bernstein
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| |
Collapse
|
47
|
Middlebrook A, Bekker S, Middlebrook N, Rushton AB. Physical prognostic factors predicting outcome following anterior cruciate ligament reconstruction: protocol for a systematic review. BMJ Open 2020; 10:e033429. [PMID: 32217559 PMCID: PMC7170562 DOI: 10.1136/bmjopen-2019-033429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 03/01/2020] [Accepted: 03/09/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Injuries of the anterior cruciate ligament (ACL) are a common musculoskeletal complication and can cause significant reduction in patient function and quality of life. Many undergo ACL reconstruction, with high-quality rehabilitation key to successful outcome. Knowledge of physical prognostic factors, such as quadriceps strength, is crucial to inform rehabilitation and has important implications for outcome following ACL reconstruction. However, these factors predicting outcome are poorly defined. Therefore, the aim of this systematic review is to establish physical prognostic factors predictive of outcome in adults following ACL reconstruction. Outcome will be subdivided into two groups of outcome measures, patient-reported and performance-based. Physical prognostic factors of interest will reflect a range of domains and may be modifiable/non-modifiable. Results will help decide most appropriate management and assist in planning and tailoring preoperative and postoperative rehabilitation. METHODS AND ANALYSIS This systematic review protocol is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. MEDLINE, CINAHL and EMBASE databases, key journals and grey literature will be searched from inception to July 2019. Prospective cohort studies including participants aged ≥16 years who have undergone ACL reconstruction will be included, with articles focusing on multi-ligament reconstructions and ACL repair surgery, or not published in English excluded. Two independent reviewers will conduct searches, assess study eligibility, extract data, assess risk of bias (Quality in Prognostic Studies tool) and quantify overall quality of evidence (modified Grading of Recommendations, Assessment, Development and Evaluation guidelines). If possible, a meta-analysis will be conducted, otherwise a narrative synthesis will ensue focusing on prognostic factors, risk of bias of included studies and strength of association with outcomes. ETHICS AND DISSEMINATION Findings will be published in a peer-reviewed journal, presented at conferences and locally to physiotherapy departments. Ethical approval is not required for this systematic review. PROSPERO REGISTRATION NUMBER CRD42019127732.
Collapse
Affiliation(s)
| | | | - Nicola Middlebrook
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK
| | - Alison B Rushton
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK
| |
Collapse
|
48
|
Wang LJ, Zeng N, Yan ZP, Li JT, Ni GX. Post-traumatic osteoarthritis following ACL injury. Arthritis Res Ther 2020; 22:57. [PMID: 32209130 PMCID: PMC7092615 DOI: 10.1186/s13075-020-02156-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/16/2020] [Indexed: 02/08/2023] Open
Abstract
Post-traumatic osteoarthritis (PTOA) develops after joint injury. Specifically, patients with anterior cruciate ligament (ACL) injury have a high risk of developing PTOA. In this review, we outline the incidence of ACL injury that progresses to PTOA, analyze the role of ACL reconstruction in preventing PTOA, suggest possible mechanisms thought to be responsible for PTOA, evaluate current diagnostic methods for detecting early OA, and discuss potential interventions to combat PTOA. We also identify important directions for future research. Although much work has been done, the incidence of PTOA among patients with a history of ACL injury remains high due to the complexity of ACL injury progression to PTOA, the lack of sensitive and easily accessible diagnostic methods to detect OA development, and the limitations of current treatments. A number of factors are thought to be involved in the underlying mechanism, including structural factors, biological factors, mechanical factors, and neuromuscular factor. Since there is a clear "start point" for PTOA, early detection and intervention is of great importance. Currently, imaging modalities and specific biomarkers allow early detection of PTOA. However, none of them is both sensitive and easily accessible. After ACL injury, many patients undergo surgical reconstruction of ACL to restore joint stability and prevent excessive loading. However, convincing evidence is still lacking for the superiority of ACL-R to conservative management in term of the incidence of PTOA. As for non-surgical treatment such as anti-cytokine and chemokine interventions, most of them are investigated in animal studies and have not been applied to humans. A complete understanding of mechanisms to stratify the patients into different subgroups on the basis of risk factors is critical. And the improvement of standardized and quantitative assessment techniques is necessary to guide intervention. Moreover, treatments targeted toward different pathogenic pathways may be crucial to the management of PTOA in the future.
Collapse
Affiliation(s)
- Li-Juan Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Ni Zeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhi-Peng Yan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jie-Ting Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guo-Xin Ni
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China.
| |
Collapse
|
49
|
von Essen C, Eriksson K, Barenius B. Acute ACL reconstruction shows superior clinical results and can be performed safely without an increased risk of developing arthrofibrosis. Knee Surg Sports Traumatol Arthrosc 2020; 28:2036-2043. [PMID: 31559463 PMCID: PMC7347704 DOI: 10.1007/s00167-019-05722-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/11/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To compare acute ACL reconstruction (ACLR) within 8 days of injury with delayed reconstruction after normalized range of motion (ROM), 6-10 weeks after injury. It was hypothesized that acute ACL reconstruction with modern techniques is safe and can be beneficial in terms of patient-reported outcomes and range of motion. METHODS The effect of acute and delayed ACLR was randomized studied on 70 patients with high recreational activity level, Tegner level 6 or more, between 2006 and 2013. Patient-reported outcomes, objective IKDC, KOOS, and manual stability measurements were documented during the 24-month follow-up period. RESULTS The acute ACLR group did not result in increased stiffness and showed superior outcome regarding strength and how the patient felt their knee functioning at 24 months. In addition, the acute group was not inferior to the delayed group in any assessment. Regarding patient-related outcomes in KOOS, both groups showed significant improvements in all subscales, but no difference was found between the groups. Functional return (FR) rate was almost double compared to the Swedish knee ligament register and treatment failure (TF) rate was reduced by half, no significant difference between the groups. No difference regarding cyclops removal, re-injury of ACL or meniscus was found between the two surgical timing groups. CONCLUSION Acute ACLR within 8 days of injury does not appear to adversely affect ROM or result in increased stiffness in the knee joint and was not inferior to the delayed group in any assessment when compared to delayed surgery. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Christoffer von Essen
- Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Karl Eriksson
- Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Björn Barenius
- Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
50
|
Ishibashi Y, Adachi N, Koga H, Kondo E, Kuroda R, Mae T, Uchio Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury - Secondary publication. J Orthop Sci 2020; 25:6-45. [PMID: 31843222 DOI: 10.1016/j.jos.2019.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND This clinical guideline presents recommendations for the management of patients with anterior cruciate ligament (ACL) injury, endorsed by the Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). METHODS The JOA ACL guideline committee revised the previous guideline based on "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which proposed a desirable method for preparing clinical guidelines in Japan. Furthermore, the importance of "the balance of benefit and harm" was also emphasized. This guideline consists of 21 clinical questions (CQ) and 23 background questions (BQ). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS We evaluated the objectives and results of each study in order to make a decision on the level of evidence so as to integrate the results with our recommendations for each CQ. For BQ, the guideline committee proposed recommendations based on the literature. CONCLUSIONS This guideline is intended to be used by physicians, orthopedic surgeons, physical therapists, and athletic trainers managing ACL injuries. We hope that this guideline is useful for appropriate decision-making and improved management of ACL injuries.
Collapse
Affiliation(s)
- Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Japan.
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Japan
| | - Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University School of Medicine, Japan
| |
Collapse
|