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Gabr A, Mancino F, Robinson J, Hage W, O'Leary S, Spalding T, Haddad FS. Satisfactory 5-year functional outcomes following primary ACL reconstructions from the UK National Ligament Registry. Knee Surg Sports Traumatol Arthrosc 2024; 32:798-810. [PMID: 38426562 DOI: 10.1002/ksa.12071] [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: 11/30/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The aim of this study was to describe the 10-year findings from the UK National Ligament Registry (NLR). METHODS A retrospective review was performed for prospectively collected data on the NLR between January 2013 and December 2022. All patients who underwent primary ACL reconstruction (ACLR) on the registry were included. Surgical characteristics were analysed, including surgeon grade and case volume, concomitant knee procedures, venous thromboembolic prophylaxis, graft characteristics, femoral and tibial tunnel drilling, and fixation methods. Clinical outcomes were collected preoperatively and at 6 months, 1 year, 2 years and 5 years following the index procedure. RESULTS During the study period, 17,492 unilateral ACLR procedures were recorded. Autograft was used in 98%, most commonly a combined semitendinosus and gracilis graft (77%) or patella tendon graft (31%). Allograft was used in only 1% of the patients. In 52% of cases, ACLR was associated with an additional procedure, with isolated medial meniscal surgery being the most common (21%). Femoral tunnel drilling was mostly performed through an anteromedial portal (73%) and tibial tunnel drilling using an outside-in technique (92%). The most common method of femoral graft fixation was with an Endobutton fixed loop suspensory device (77%), while interference screws predominated for tibial tunnel fixation (86%). Patients who underwent ACLR surgery showed significant improvement in their functional outcome scores at six months, 1 year, 2 years and 5 years postoperatively. CONCLUSION Data from the NLR shows a detailed description of the current trends and evolution of ACLR in the United Kingdom over the last 10 years. Satisfactory functional outcomes were observed 5 years postoperatively. This study provides useful information on the prevalence of ACL-associated injuries and current surgical techniques with the aim of improving the quality of clinical care and patients' outcomes. Moreover, it provides surgeons with a benchmark against which to compare current practices and functional outcomes following ACLR across the United Kingdom. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ayman Gabr
- West Suffolk Hospital NHS Trust, Bury St Edmunds, UK
- University College London Hospitals NHS Trust, London, UK
| | - Fabio Mancino
- University College London Hospitals NHS Trust, London, UK
| | | | | | - Sean O'Leary
- The Royal Berkshire Hospital NHS Trust, Reading, UK
| | | | - Fares S Haddad
- University College London Hospitals NHS Trust, London, UK
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2
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Froehle AW, Edwards B, Peterson MJ, Meyerson B, Duren DL. Effects of pubertal growth variation on knee mechanics during walking in female and male adolescents. Am J Hum Biol 2023; 35:e23853. [PMID: 36571458 PMCID: PMC10175122 DOI: 10.1002/ajhb.23853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/11/2022] [Accepted: 12/11/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Puberty substantially alters the body's mechanical properties, neuromuscular control, and sex differences therein, likely contributing to increased, sex-biased knee injury risk during adolescence. Female adolescents have higher risk for knee injuries than male adolescents of similar age engaging in similar physical activities, and much research has investigated sex differences in mechanical risk factors. However, few studies address the considerable variation in pubertal growth (timing, pace), knee mechanics, and injury susceptibility within sexes, or the impact of such growth variation on mechanical injury risk. OBJECTIVES The present study tested for effects of variation in pubertal growth on established mechanical knee injury risk factors, examining relationships between and within sexes. METHODS Pubertal growth indices describing variation in the timing and rate of pubertal growth were developed using principal component analysis and auxological data from serial stature measurements. Linear mixed models were applied to evaluate relationships between these indices and knee mechanics during walking in a sample of adolescents. RESULTS Later developing female adolescents with slower pubertal growth had higher extension moments throughout stance, whereas earlier developers had higher valgus knee angles and moments. In male adolescents, faster and later growth were related to higher extension moments throughout gait. In both sexes, faster growers had higher internal rotation moments at foot-strike. CONCLUSIONS Pubertal growth variation has important effects on mechanical knee injury risk in adolescence, affecting females and males differently. Earlier developing females exhibit greater injury risk via frontal plane factors, whereas later/faster developing males have elevated risk via sagittal plane mechanisms.
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Affiliation(s)
- Andrew W Froehle
- Department of Kinesiology and Health, Wright State University, Dayton, Ohio, USA
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Brian Edwards
- Department of Kinesiology and Health, Wright State University, Dayton, Ohio, USA
| | - Matthew J Peterson
- School of Nursing, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Brian Meyerson
- Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Dana L Duren
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
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3
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Kaarre J, Zsidai B, Narup E, Horvath A, Svantesson E, Hamrin Senorski E, Grassi A, Musahl V, Samuelsson K. Scoping Review on ACL Surgery and Registry Data. Curr Rev Musculoskelet Med 2022; 15:385-393. [PMID: 35829892 PMCID: PMC9463418 DOI: 10.1007/s12178-022-09775-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
Purpose of Review To present an overview of registry-based anterior cruciate ligament (ACL) research, as well as provide insight into the future of ACL registries. Recent Findings During the past decades, the ACL registries have had an important role in increasing our understanding of patients with ACL injuries and their treatment. The registry data has deepened our understanding of factors that have been associated with an increased risk of sustaining an ACL injury and for evaluation of treatment factors and their impact on patient-related outcomes. Recently, registry-based ACL research using artificial intelligence (AI) and machine learning (ML) has shown potential to create clinical decision-making tools and analyzing outcomes. Thus, standardization of collected data between the registries is needed to facilitate the further collaboration between registries and to facilitate the interpretation of results and subsequently improve the possibilities for implementation of AI and ML in the registry-based research. Summary Several studies have been based on the current ACL registries providing an insight into the epidemiology of ACL injuries as well as outcomes following ACL reconstruction. However, the current ACL registries are facing future challenges, and thus, new methods and techniques are needed to ensure further good quality and clinical applicability of study findings based on ACL registry data.
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Affiliation(s)
- Janina Kaarre
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden. .,Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Bálint Zsidai
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden.,Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric Narup
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
| | - Alexandra Horvath
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
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Joshi A, Singh N, Basukala B, Bista R, Maharjan B, Pradhan I. Epidemiological profile of anterior cruciate ligament injuries in a tertiary referral trauma center of Nepal. BMC Musculoskelet Disord 2022; 23:595. [PMID: 35725434 PMCID: PMC9210789 DOI: 10.1186/s12891-022-05551-y] [Citation(s) in RCA: 2] [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: 10/16/2021] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Sports related injuries are the leading cause of Anterior Cruciate Ligament (ACL) tear in the Western world. Although professional and recreational sporting activities are increasing in Nepal, they are not as common and prevalent in comparison to western world. In contrast, Road Traffic Accident (RTA) is a very common cause of knee injuries in Nepal. Although there are some studies from Nepal mentioning Road Traffic Accidents (RTAs) as the most common cause of ACL injury, no specific studies have primarily investigated the epidemiological and demographic profile of ACL injured patients from this region. we aimed to understand the epidemiological and demographic profile of ACL injured patients and evaluate the mode of injury in a tertiary referral trauma center of Nepal. Methods This was a retrospective descriptive study of a hospital cohort conducted from February 2018 to January 2020. Electronic details were retrieved, telephone interviews conducted and data analysis was done using descriptive analysis on the patients from the fore mentioned dates to complete demographic and epidemiological information. Results A total of 237 patients were enrolled in this study. Among these, 120 patients (50.6%) fell into the age group of 15–30 years with a male to female ratio of 2.7:1. A RTA was the most common cause of ACL injury (38.8%), followed by sports-related injuries in 33.3% and falls in 16.5% of patients. The most common mode of RTA was a two-wheeler accident, and football was the most common sport causing ACL injuries. Sports injury was more common in patients below 30 years of age (OR = 3.5, 95% CI [2.2, 5.7]), whereas RTA was more common in patients above 30 years of age. Sports was the cause of ACL injury in 55.5% of students and RTAs was the commonest cause of ACL injury in office workers. Conclusion Overall males were more frequently injured than females. Road traffic accidents were the most common cause of ACL injury in our subset of patients. Two-wheeler riders were the most commonly injured patients. Sport was the commonest cause of ACL injury in patients below 30 years, and RTA was common in patients above 30 years of age. Sports were the commonest cause of ACL injury in students, while RTA was the most common cause in office workers. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05551-y.
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Affiliation(s)
- Amit Joshi
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko, Lalitpur, Nepal.
| | - Nagmani Singh
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko, Lalitpur, Nepal
| | - Bibek Basukala
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko, Lalitpur, Nepal
| | - Rohit Bista
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko, Lalitpur, Nepal
| | - Bibek Maharjan
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko, Lalitpur, Nepal
| | - Ishor Pradhan
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko, Lalitpur, Nepal
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Beel W, Mouton C, Tradati D, Nührenbörger C, Seil R. Ramp lesions are six times more likely to be observed in the presence of a posterior medial tibial bone bruise in ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:184-191. [PMID: 33661324 DOI: 10.1007/s00167-021-06520-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to determine whether posterior tibial slope (PTS), meniscal slope (MS), and bone bruise pattern (BBP), as observed on magnetic resonance imaging (MRI), differed between patients with or without medial meniscus ramp lesions at the time of anterior cruciate ligament reconstruction (ACLR). The hypothesis was that patients with a ramp lesion had a higher PTS and MS, with a different BBP than patients without a ramp lesion. METHODS Fifty-six patients undergoing ACLR were selected from an in-house registry and separated into 2 groups: (1) the RAMP group included patients with a primary ACLR and a medial meniscus ramp lesion diagnosed intraoperatively; (2) the CONTROL group included patients with a primary ACLR without ramp lesion after arthroscopic exploration of the posteromedial knee area. The two groups were matched for age, sex and type of concomitant meniscal lesions. The medial/lateral-PTS/MS and BBP were subjected to blinded evaluation on the preoperative MRI of the reconstructed knee. RESULTS Twenty eight patients (21 males; 7 females) were included in each group. No significant difference could be observed between groups in terms of demographical characteristics, PTS, and MS. A posteromedial tibial plateau (PMTP) bone bruise was more often observed in the RAMP group (n = 23/28) compared to the CONTROL group (n = 12/28) (p < 0.01). The RAMP group was 6.1 (95%CI [1.8; 20.8]) times more likely to present a PMTP bone bruise. The likelihood of having a bone bruise in both the medial and lateral compartments was 4.5 (95%CI [1.2; 16.5]) times higher in the RAMP group. However, a BBP only involving the lateral tibiofemoral compartment was more likely to be observed in the CONTROL group (n = 10/28) compared to the RAMP group (n = 3/28, p < 0.05 - odds ratio 4.6 (95%CI [1.1; 19.2]). CONCLUSION Ramp lesions were 6.1 and 4.5 times more likely to be observed in the presence of a posteromedial tibia plateau bone bruise or a combined bone bruise respectively in both the medial and lateral tibiofemoral compartment in patients undergoing ACLR. The tibial and meniscal slopes did not differ between patients with or without ramp lesions undergoing ACLR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Wouter Beel
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg City, Luxembourg
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg City, Luxembourg.,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg City, Luxembourg
| | - Daniele Tradati
- Department of Orthopaedic Surgery, Hospital San Raffaele, Milan, Italy
| | - Christian Nührenbörger
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg City, Luxembourg.,Department of Sports Medicine, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg City, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg City, Luxembourg. .,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg City, Luxembourg. .,Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg City, Luxembourg.
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Wypych M, Lundqvist R, Witoński D, Kęska R, Szmigielska A, Paradowski PT. Prediction of improvement after anterior cruciate ligament reconstruction. Open Med (Wars) 2021; 16:833-842. [PMID: 34124374 PMCID: PMC8165257 DOI: 10.1515/med-2021-0300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 11/15/2022] Open
Abstract
Objective The retrospective investigation was carried out to assess whether subjects who fulfilled our proposed recruitment criteria responded more favorably to anterior cruciate ligament reconstruction (ACLR) than those who did not. Methods We retrospectively analyzed 109 skeletally mature subjects (78 men and 31 women) according to the following proposed criteria of recruitment: (1) pre-injury Tegner activity score ≥7 and a wish to return to a professional sports activity, (2) residual knee instability following injury and/or (3) age <20 years at the operation. The primary outcome was an improvement between assessment A (before operation) and B (mean follow-up of 1.6 years) in the average score for four of the five Knee injury and Osteoarthritis Outcome Score (KOOS) subscales, covering pain, symptoms, difficulty in sports and recreational activities, and quality of life (KOOS4). Results The proposed recruitment criteria for ACLR were met by 58 subjects (53%). There were 49 subjects (45%) who improved between assessment A and B. Subjects who met proposed recruitment criteria were more likely to improve clinically after ACLR (OR 5.7, 95% CI 2.5–13.3). Conclusions Fulfillment of proposed recruitment criteria was a strong predictive factor for outcome improvement in short- to medium-term follow-up after ACLR. Level of evidence Case-control study. Level of evidence 3.
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Affiliation(s)
- Mikołaj Wypych
- Department of Emergency Medicine, Stanisław Rybicki Regional Hospital, Skierniewice, Poland
| | - Robert Lundqvist
- Research and Innovation Unit, Norrbotten County Council, Luleå, Sweden
| | - Dariusz Witoński
- Chair of Clinical Physiotherapy, Institute of Health Sciences, Social Academy of Sciences, Łódź, Poland
| | - Rafał Kęska
- Department of Orthopedics, Poddębice Health Centre, Poddębice, Poland
| | - Anna Szmigielska
- Department of Cardiology, Władysław Biegański Medical University Hospital, Łódź, Poland
| | - Przemysław T Paradowski
- Department of Surgical and Perioperative Sciences, Division of Orthopedics, Sunderby Research Unit, Umeå University, Sunderby Central Hospital of Norrbotten, SE-971 80 Luleå, Sweden.,Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, Jagiellońska 13/15, PL-85-067 Bydgoszcz, Poland.,Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopedics, Lund University, SE-221 85 Lund, Sweden
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Mouton C, Gokeler A, Urhausen A, Nührenbörger C, Seil R. High Incidence of Anterior Cruciate Ligament Injuries Within the First 2 Months of the Season in Amateur Team Ball Sports. Sports Health 2021; 14:183-187. [PMID: 34039120 DOI: 10.1177/19417381211014140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) injuries is commonly reported as an annual incidence rate. There is relatively little information about the seasonal aspects of these injuries. The aim of the current study was to analyze the distribution of ACL injuries during the season in nonprofessional soccer, handball, and basketball based on a retrospective analysis of a hospital-based registry. HYPOTHESIS ACL injuries in soccer, handball, and basketball were more common within the first 2 months of the season in comparison with the rest of the year. STUDY DESIGN Case series. LEVEL OF EVIDENCE Level 4. METHODS Injury occurrence during the calendar year was divided into 6 periods of 2 months, with segment 1 (S1) representing the first 2 months of the season. For soccer, S1 corresponded to September and October. The season started 1 month later for handball and basketball, so S1 represented October and November. Chi-square tests were used to analyze the distribution of ACL injuries among segments according to gender, age, sports, and injury mechanism (contact/noncontact). RESULTS A total of 371 ACL injuries were included (soccer, 258, handball, 56, basketball, 57). Overall, the distribution of ACL injuries was not uniform across the segments (P < 0.01). Almost one-third of the ACL injuries occurred in S1 (n = 104; 28%). Significant differences could be observed according to sports (P < 0.01). There were fewer ACL injuries in S2 for soccer compared with basketball (P < 0.05). In S5, there were significantly more ACL injuries in soccer compared with handball and basketball (P < 0.05). CONCLUSION A high occurrence of ACL injuries was reported immediately within the first 2 months of the season in nonprofessional soccer, handball, and basketball sports. CLINICAL RELEVANCE These findings indicate that ACL injury prevention programs should be started in the preseason period to allow for gradual increases of load.
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Affiliation(s)
- Caroline Mouton
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg.,Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science, Luxembourg
| | - Alli Gokeler
- Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science, Luxembourg.,OCON Center of Orthopaedic Surgery and Sports Medicine, Hengelo, the Netherlands
| | - Anouk Urhausen
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg.,Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg
| | - Christian Nührenbörger
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg.,Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg
| | - Romain Seil
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg.,Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science, Luxembourg.,Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg
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Lateral meniscal slope negatively affects post-operative anterior tibial translation at 1 year after primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:3524-3531. [PMID: 32347343 DOI: 10.1007/s00167-020-06021-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/21/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE The aim of this study was to assess the correlation between posterior tibial slope and meniscal slope over postoperative anterior tibial translation during the first 18 months after primary anterior cruciate ligament (ACL) reconstruction. The main hypothesis was that PTS and MS would be positively correlated with post-operative ATT-SSD after ACL reconstruction. METHODS Patients (28 males and 15 females) with confirmed ACL tears were selected from an in-house registry and included if they were over 16 years old, had primary ACL-reconstruction and healthy contralateral knee. Patients meeting one of the following criteria were excluded: previous knee surgeries, intraarticular fractures, associated ligamentous lesions, previous or concomitant meniscectomy or extraarticular procedures. Lateral posterior tibial slope, medial posterior tibial slope, lateral meniscal slope and medial meniscal slope were measured using preoperative MRIs. The side-to-side-difference in anterior tibial translation was evaluated 9-18 months postoperatively. RESULTS Forty-three patients were included, (28 males/15 females; mean age 25 ± 8 years). Mean postoperative anterior tibial translation was 1.0 ± 1.1 mm at a mean time of 12 ± 1 months. Mean slope values were: lateral posterior tibial slope 4.7° ± 2.2°, medial posterior tibial slope 4.0° ± 2.8°, lateral meniscal slope 3.0° ± 2.2° and medial meniscal slope 2.0° ± 2.8°. The anterior tibial translation was significantly correlated with lateral meniscal slope (r = 0.63; p < 0.01). For each 1° increase in lateral meniscal slope, a 0.3 mm 95% CI [0.2, 0.4] (p < 0.01) increase in anterior tibial translation was observed. A lateral meniscal slope greater or equal to 4.0° was estimated as optimal threshold for increased risk of abnormal side-to-side difference in postoperative anterior tibial translation (≥ 1.2 mm). CONCLUSION The lateral meniscal slope was positively correlated to side-to-side difference in anterior tibial translation after primary ACL reconstruction. A lateral meniscal slope greater or equal to 4.0° was detected as threshold for an increased risk of abnormal side-to-side difference in postoperative anterior tibial translation in patients who underwent primary ACL reconstruction. This confirms that soft tissue slopes have an impact on the outcomes after reconstructive surgery. Level of evidence III.
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Passing return to sports tests after ACL reconstruction is associated with greater likelihood for return to sport but fail to identify second injury risk. Knee 2020; 27:949-957. [PMID: 32247810 DOI: 10.1016/j.knee.2020.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/26/2020] [Accepted: 03/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND A limited number of patients return to sport (RTS) after an anterior cruciate ligament reconstruction (ACLR) and patients who RTS have a relatively high risk for second ACL injury. The purpose of the current study was to compare the results of a test battery between patients who returned to the pre-injury level of sport (RTS group) and patients who did not (NO-RTS group). It was hypothesized that the RTS group showed better test results. METHODS Sixty-four patients (age 27.8 ± 8.8 years) were included. The results of a multicomponent test battery (jump-landing task assessed with the Landing Error Scoring System (LESS), three hop tests, isokinetic strength test for quadriceps and hamstring) were compared between groups with a 2 × 2 ANOVA. RESULTS The RTS group showed a significantly lower LESS score (p = 0.010), significantly higher absolute scores on hop tests with both legs (injured leg: single leg hop test p = 0.013, triple leg hop test p = 0.024, side hop test p = 0.021; non-injured leg: single leg hop test p = 0.011, triple leg hop test p = 0.023, side hop test p = 0.032) and significantly greater hamstring strength in the injured leg (p = 0.009 at 60°/s, p = 0.012 at 180°/s and p = 0.013 at 300°/s). No differences in test results were identified between patients who sustained a second ACL injury and patients who did not. CONCLUSION Patients after ACLR with better jump-landing patterns, hop performance and greater hamstring strength have greater likelihood for RTS. However, our findings show that RTS criteria fail to identify patients who are at risk for a second ACL injury.
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Watanabe H, Majima T, Takahashi K, Iizawa N, Oshima Y, Takai S. Posterior tibial slope angle is associated with flexion-type Salter-Harris II and Watson-Jones type IV fractures of the proximal tibia. Knee Surg Sports Traumatol Arthrosc 2019; 27:2994-3000. [PMID: 30535547 DOI: 10.1007/s00167-018-5319-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 12/04/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Flexion-type Salter-Harris (SH) II fractures of the proximal tibia, also described as Watson-Jones (WJ) IV fractures, are rare injuries reported among adolescent athletes who are close to skeletal maturity and remain elusive. Due to this classification disagreement, the various treatments range from nonoperative to operative types, and no previous studies have explained the mechanisms of injury or the source of the fracture forces. This retrospective matched case-control study aimed to identify radiological factors that are associated with the fracture forces and to elucidate the mechanisms of these injuries. METHODS Sixteen flexion-type SH II/WJ IV fractures of the proximal tibia in 12 adolescents (12 males, mean age of 14.6 years) were retrospectively reviewed, and knee alignment on plain radiographs was assessed to compare the radiological outcomes of the operated knees (n = 7), nonoperated knees (n = 9), and uninjured contralateral knees (n = 8). The results were compared to healthy age- and sex-matched control subjects (n = 24 knees). RESULTS With regard to the radiological outcomes, the posterior tibial slope angle (PTSA) was significantly greater in the nonoperated knees (19.0° ± 1.6°), operated knees (16.8° ± 1.3°), and uninjured knees (13.6° ± 1.3°) than in the healthy knees of the matched control subjects (9.6° ± 0.4°). The anatomical tibiofemoral angle was significantly less in the nonoperated knees (0.7° ± 0.6°) than in the healthy knees of the matched control subjects (3.7° ± 0.4°). CONCLUSIONS These findings suggest a relationship between an increased PTSA and flexion-type SH II/WJ IV fractures of the proximal tibia, considering the deteriorating effects of an increased PTSA on knee kinematics. Adolescent active athletes with an increased PTSA and partially closed epiphysis of the proximal tibia are at risk for suffering from flexion-type SH II/WJ IV fractures of the proximal tibia until the closure of the proximal tibial epiphysis. LEVEL OF EVIDENCE Case-control study, Level III.
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Affiliation(s)
- Hiroshi Watanabe
- Department of Orthopaedic Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamagari, Inzai, Chiba, 270-1694, Japan. .,Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Tokifumi Majima
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kenji Takahashi
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Norishige Iizawa
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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11
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Deckers C, Stephan P, Wever KE, Hooijmans CR, Hannink G. The protective effect of anterior cruciate ligament reconstruction on articular cartilage: a systematic review of animal studies. Osteoarthritis Cartilage 2019; 27:219-229. [PMID: 30317001 DOI: 10.1016/j.joca.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE It is unclear if anterior cruciate ligament (ACL) reconstruction can prevent the onset of degenerative changes in the knee. Previous studies were inconclusive on this subject. The aim of this study was to systematically review all studies on the effect of ACL reconstruction on articular cartilage in animals. DESIGN Pubmed and Embase were searched to identify all original articles concerning the effect of ACL reconstruction on articular cartilage compared with both its positive (ACL transection) and negative (sham and/or non-operated) control in animals. Subsequently a Risk of bias and meta analysis was conducted based on five outcomes (gross macroscopic assessment, medical imaging, histological histochemical grading, histomophometrics and biomechanical characterization) related to articular cartilage. RESULTS From the 19 included studies, 29 independent comparisons could be identified which underwent ACL reconstruction with an average timing of data collection of 23 weeks (range 1-104 weeks). Due to limited data availability meta-analysis could only be conducted for gross macroscopic damage. ACL reconstruction caused significant gross macroscopic damage compared with intact controls (SMD 2.0 [0.88; 3.13]). These findings were supported by individual studies reporting on histomorphometrics, histology and imaging. No significant gross macroscopic damage was found when ACL reconstruction was compared with ACL transection (SMD -0.64 [-1.85; 0.57]). CONCLUSION This systematic review with an average follow up of included studies of 23 weeks (range 1-104 weeks) demonstrates that, in animals, ACL reconstruction does not protect articular cartilage from degenerative changes. The consistency of the direction of effect, provides some reassurance that the direction of effect in humans might be the same.
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Affiliation(s)
- C Deckers
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - P Stephan
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - K E Wever
- Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE), Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - C R Hooijmans
- Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE), Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - G Hannink
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands.
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12
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Editorial Commentary: Medial Meniscal Ramp Lesions: Lessons Learned From the Past in the Pursuit of Evidence. Arthroscopy 2018; 34:1638-1640. [PMID: 29729766 DOI: 10.1016/j.arthro.2018.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 02/02/2023]
Abstract
Thirty-five years after their initial description, ramp lesions of the medial meniscus in anterior cruciate ligament (ACL)-deficient knees are slowly being rediscovered. Routinely repaired in open ACL and peripheral reconstructions before the era of arthroscopic ACL reconstruction, ramp lesions have been largely ignored in the last 2 decades. Following the growing number of studies analyzing the causes of residual laxity after ACL reconstructions over the last decade, ramp lesions are increasingly being implicated, and thus investigated, but remain poorly understood. They are difficult to diagnose, both clinically and with magnetic resonance imaging. Future efforts are needed to close the knowledge gaps on their etiology, biomechanical impact, diagnosis, and repair.
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13
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Seil R, Mouton C, Coquay J, Hoffmann A, Nührenbörger C, Pape D, Theisen D. Ramp lesions associated with ACL injuries are more likely to be present in contact injuries and complete ACL tears. Knee Surg Sports Traumatol Arthrosc 2018. [PMID: 28638970 DOI: 10.1007/s00167-017-4598-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to analyse patient and injury characteristics as well as arthroscopic findings in a prospective cohort of ACL-injured patients with or without an associated ramp lesion. METHODS Two hundred and twenty-four patients undergoing a primary (n = 196) or revision (n = 28) ACL reconstruction were included. The presence of a ramp lesion was determined by a systematic arthroscopic inspection of the posteromedial compartment. Chi-square tests were used to compare the population of ACL-injured patients with and without a ramp lesion regarding sex, age, body mass index, previous ACL injuries, sport before injury, and injury characteristics. Significance was set at p < 0.05. RESULTS Fifty-three out of 224 patients had a ramp lesion (24%). The presence of the latter was not related to any of the analysed patient characteristics. The prevalence of the lesion was higher in contact injuries (n = 19; 41%) compared with non-contact injures (n = 34; 19%; p < 0.001). It was higher in patients with complete ACL ruptures (n = 49; 27%) as opposed to partial ruptures (n = 1; 4%; p = 0.01). A patient was 2.98 [95% CI 1.49-5.98] times more likely to have a ramp lesion if the ACL injury was declared to have been caused by direct contact and 8.71 [95% CI 1.15-66.12] times more likely if the ACL tear was complete. CONCLUSION Ramp lesions may be anticipated in almost one out of four patients undergoing ACL reconstruction, especially if a patient sustained a contact injury and in the presence of a complete ACL tear. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Romain Seil
- Department of Orthopaedic Surgery, Clinique d'Eich - Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg. .,Sports Medicine Research Laboratory, Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg.
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Clinique d'Eich - Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.,Sports Medicine Research Laboratory, Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Julien Coquay
- Department of Orthopaedic Surgery, Clinique St. Pierre Ottignies, Ottignies, Belgium
| | - Alexander Hoffmann
- Department of Orthopaedic Surgery, Clinique d'Eich - Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Christian Nührenbörger
- Department of Orthopaedic Surgery, Clinique d'Eich - Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Dietrich Pape
- Department of Orthopaedic Surgery, Clinique d'Eich - Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.,Sports Medicine Research Laboratory, Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Daniel Theisen
- Sports Medicine Research Laboratory, Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg
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14
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Prentice HA, Lind M, Mouton C, Persson A, Magnusson H, Gabr A, Seil R, Engebretsen L, Samuelsson K, Karlsson J, Forssblad M, Haddad FS, Spalding T, Funahashi TT, Paxton LW, Maletis GB. Patient demographic and surgical characteristics in anterior cruciate ligament reconstruction: a description of registries from six countries. Br J Sports Med 2018; 52:716-722. [PMID: 29574451 DOI: 10.1136/bjsports-2017-098674] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Findings from individual anterior cruciate ligament reconstruction (ACLR) registry studies are impactful, but how various registries from different countries compare with different patient populations and surgical techniques has not been described. We sought to describe six ACLR registry cohorts to understand variation across countries. METHODS Five European registries and one US registry participated. For each registry, all primary ACLR registered between registry establishment through 31December 2014 were identified. Descriptive statistics included frequencies, proportions, medians and IQRs. Revision incidence rates following primary ACLR were computed. RESULTS 101 125 ACLR were included: 21 820 in Denmark, 300 in Luxembourg, 17 556 in Norway, 30 422 in Sweden, 2972 in the UK and 28 055 in the US. In all six cohorts, males (range: 56.8%-72.4%) and soccer injuries (range: 14.1%-42.3%) were most common. European countries mostly used autografts (range: 93.7%-99.7%); allograft was most common in the US (39.9%). Interference screw was the most frequent femoral fixation in Luxembourg and the US (84.8% and 42.9%), and suspensory fixation was more frequent in the other countries (range: 43.9%-75.5%). Interference was the most frequent tibial fixation type in all six cohorts (range: 64.8%-98.2%). Three-year cumulative revision probabilities ranged from 2.8% to 3.7%. CONCLUSIONS Similarities in patient demographics and injury activity were observed between all cohorts of ACLR. However, graft and fixation choices differed. Revision rates were low. This work, including >100 000 ACLR, is the most comprehensive international description of contemporary practice to date.
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Affiliation(s)
- Heather A Prentice
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
| | - Martin Lind
- Division of Sports Surgery, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Clinique d'Eich-Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Andreas Persson
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Norwegian Knee Ligament Registry, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
| | - Henrik Magnusson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ayman Gabr
- Trauma and Orthopaedic Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Romain Seil
- Department of Orthopaedic Surgery, Clinique d'Eich-Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Norwegian Knee Ligament Registry, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
| | - Kristian Samuelsson
- Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jon Karlsson
- Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Magnus Forssblad
- Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Fares S Haddad
- Department of Trauma and Orthopaedics, University College London Hospitals, London, UK
| | - Tim Spalding
- University Hospitals Coventry and Warwickshire (UHCW), Coventry, UK
| | - Tadashi T Funahashi
- Department of Orthopaedics, Southern California Permanente Medical Group, Irvine, California, USA
| | - Liz W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
| | - Gregory B Maletis
- Department of Orthopaedics, Southern California Permanente Medical Group, Baldwin Park, California, USA
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15
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Lion A, Gette P, Meyer C, Seil R, Theisen D. Effect of cognitive challenge on the postural control of patients with ACL reconstruction under visual and surface perturbations. Gait Posture 2018; 60:251-257. [PMID: 29309971 DOI: 10.1016/j.gaitpost.2017.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 02/02/2023]
Abstract
Our study aimed to evaluate the effect of cognitive challenge on double-leg postural control under visual and surface perturbations of patients with anterior cruciate ligament reconstruction (ACLR) cleared to return to sport. Double-leg stance postural control of 19 rehabilitated patients with ACLR (age: 24.8 ± 6.7 years, time since surgery: 9.2 ± 1.6 months) and 21 controls (age: 24.9 ± 3.7 years) was evaluated in eight randomized situations combining two cognitive (with and without silent backward counting in steps of seven), two visual (eyes open, eyes closed) and two surface (stable support, foam support) conditions. Sway area and sway path of the centre of foot pressure were measured during three 20-s recordings for each situation. Higher values indicated poorer postural control. Generally, postural control of patients with ACLR and controls was similar for sway area and sway path (p > 0.05). The lack of visual anchorage and the disturbance of the plantar input by the foam support increased sway area and sway path (p < 0.001) similarly in both groups. The addition of the cognitive task decreased sway area and sway path (p < 0.001) similarly in both groups. Patients with ACLR who recently completed their rehabilitation have normalized postural control during double-leg stance tests. The use of a dual task paradigm under increased task complexity modified postural control, but in a similar way in patients with ACLR than in healthy controls. Double-leg stance tests, even under challenging conditions, are not sensitive enough to reveal postural control differences between rehabilitated patients with ACLR and controls.
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Affiliation(s)
- Alexis Lion
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg.
| | - Paul Gette
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Christophe Meyer
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Romain Seil
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg; Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxembourg
| | - Daniel Theisen
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
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16
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Gokeler A, Dingenen B, Mouton C, Seil R. Clinical course and recommendations for patients after anterior cruciate ligament injury and subsequent reconstruction: A narrative review. EFORT Open Rev 2017; 2:410-420. [PMID: 29209517 PMCID: PMC5702954 DOI: 10.1302/2058-5241.2.170011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Almost all athletes who have suffered an anterior cruciate ligament (ACL) injury expect a full return to sports at the same pre-injury level after ACL reconstruction (ACLR). Detailed patient information on the reasonable outcomes of the surgery may be essential to improve patient satisfaction. Pre-operative rehabilitation before ACLR should be considered as an addition to the standard of care to maximise functional outcomes after ACLR. We propose an optimised criterion-based rehabilitation programme within a biopsychosocial framework. No benchmark exists for evaluating return-to-sport (RTS) readiness after ACLR. Therefore, the authors propose a multi-factorial RTS test battery. A combination of both physical and psychological elements should be included in the RTS test battery. There is need for shared decision-making regarding RTS.
Cite this article: EFORT Open Rev 2017;2:410-420. DOI: 10.1302/2058-5241.2.170011
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Affiliation(s)
- Alli Gokeler
- University of Groningen, University Medical Center Groningen, Center for Human Movement Science, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Bart Dingenen
- Rehabilitation Research Institute, Biomedical Research Institute, Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
| | - Caroline Mouton
- Département de l'Appareil Locomoteur, Centre Hospitalier de Luxembourg - Clinique d'Eich, 76, rue d'Eich, L-1460 Luxembourg, Luxembourg
| | - Romain Seil
- Département de l'Appareil Locomoteur, Centre Hospitalier de Luxembourg - Clinique d'Eich, 76, rue d'Eich, L-1460 Luxembourg, Luxembourg and Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76, rue d'Eich, L-1460 Luxembourg, Luxembourg
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17
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Gokeler A, Welling W, Benjaminse A, Lemmink K, Seil R, Zaffagnini S. A critical analysis of limb symmetry indices of hop tests in athletes after anterior cruciate ligament reconstruction: A case control study. Orthop Traumatol Surg Res 2017; 103:947-951. [PMID: 28428033 DOI: 10.1016/j.otsr.2017.02.015] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hop tests are frequently used to determine return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). Given that bilateral deficits are present after ACLR, this may result in a falsely high limb symmetry index (LSI), since LSI is calculated as a ratio between the values of the limbs. HYPOTHESIS Athletes after ACLR would achieve LSI>90% for the hop test. Secondly, athletes after ACLR demonstrate decreased jump distance on the single hop for distance (SLH) and triple leg hop for distance (TLH) and decreased number of hops for the side hop (SH) for both involved and uninvolved limbs compared to normative data of sex, age and type of sports matched healthy athletes. MATERIALS AND METHODS Fifty-two patients (38 males mean age 23.9±3.5years; 14 females mean age 21.7±3.5 years) who had undergone an ACLR participated in this study. Patients performed the 3 hop tests at a mean time of 7 months after ACLR. Hop distance, number of side hops and LSI were compared with normative data of 188 healthy athletes. RESULTS The differences between the involved limb and the uninvolved limb were significant in all hop tests (SLH P=0.003, TLH P=0.003, SH P=0.018). For females, only significant between limb differences were found in the SLH (P=0.049). For both the SLH and the TLH, significant differences were found between the involved limb and the normative data (males; SLH P<0.001, TLH P<0.001; females; SLH P<0.001, TLH P=0.006) and between the uninvolved limb and the normative data for both males and females (males; SLH P<0.001, TLH P<0.001; females; SLH P=0.003, TLH P=0.038). For the SH, only significant differences were found between the involved limb and the normative values in males (P=0.033). CONCLUSION Athletes who have undergone an ACLR demonstrate bilateral deficits on hop tests in comparison to age and sex matched normative data of healthy controls. Using the LSI may underestimate performance deficits and should therefore be analyzed with caution when used as a criterion for RTS after ACLR. LEVEL OF EVIDENCE III, case control study.
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Affiliation(s)
- A Gokeler
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - W Welling
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Medisch Centrum Zuid, Groningen, The Netherlands
| | - A Benjaminse
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Hanze University Applied Science, School of Sport Studies, Groningen, The Netherlands
| | - K Lemmink
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Seil
- Département de l'Appareil Locomoteur, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - S Zaffagnini
- Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
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18
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Seil R. CORR Insights ®: What Is the Mid-term Failure Rate of Revision ACL Reconstruction? A Systematic Review. Clin Orthop Relat Res 2017; 475:2500-2502. [PMID: 28822060 PMCID: PMC5599404 DOI: 10.1007/s11999-017-5415-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/07/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Romain Seil
- grid.451012.3Chef du Département de l’Appareil Locomoteur, Centre Hospitalier de Luxembourg - Clinique d’ Eich and Co-Director, Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76 rue d’Eich, 1460 Luxembourg, Luxembourg
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19
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Mouton C. CORR Insights ®: Younger Patients and Men Achieve Higher Outcome Scores Than Older Patients and Women After Anterior Cruciate Ligament Reconstruction. Clin Orthop Relat Res 2017; 475:2481-2483. [PMID: 28786091 PMCID: PMC5599422 DOI: 10.1007/s11999-017-5464-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/31/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Caroline Mouton
- 0000 0004 0578 0421grid.418041.8Department of Orthopedic Surgery, Centre Hospitalier de Luxembourg, 76, rue d’Eich, Luxembourg, 1460 Luxembourg
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20
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Akoto R, Lambert C, Balke M, Bouillon B, Frosch KH, Höher J. Epidemiology of injuries in judo: a cross-sectional survey of severe injuries based on time loss and reduction in sporting level. Br J Sports Med 2017; 52:1109-1115. [PMID: 28446454 DOI: 10.1136/bjsports-2016-096849] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sport injury severity can be detected by duration of time loss and reduction of sporting performance. AIM To detect injury type-specific time loss duration and sporting performance reduction in judo. METHODS An online survey of active and former judo athletes was conducted (exclusion criterion: incomplete questionnaire). Only injuries causing more than 3 weeks' time loss were recorded. Athletes classified themselves into performance classes. Injury type-specific frequencies were recorded according to gender, age and performance level. Injury severity was assessed by time loss duration and performance reduction. RESULTS The study included 4659 athletes (65% male, 38% competitive sports). The most commonly injured body regions were the upper extremity (41%) and the lower extremity (39%). Anterior cruciate ligament (ACL) ruptures were the most severe injury type (time loss: 4% of cases 3-6 weeks, 6% 6-12 weeks, 26% 3-6 months, 32% 6-9 months, 18% 9-12 months, 14%>12 months; performance reduction: 32% same level, 39% slightly reduced, 24% strongly reduced, 5% stopped judo). The second most severe type of injury was a vertebral disc prolapse (time loss: 26% 3-6 weeks, 31% 6-12 weeks, 20% 3-6 months, 7% 6-9 months, 3% 9-12 months 13%>12 months; reduction of sporting performance: 39% same level, 34% slightly reduced, 20% strongly reduced, 8% stopped judo). CONCLUSION Across genders and performance levels, ACL ruptures and vertebral disc prolapses were the most severe injuries with respect to time loss and sporting performance reduction.
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Affiliation(s)
- Ralph Akoto
- Sports Clinic Cologne at Cologne Merheim Medical Center, Cologne, University of Witten/Herdecke, Cologne, Germany.,Department of Trauma and Reconstructive Surgery with Division of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Klinik Sankt Georg, Hamburg, Germany.,Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany
| | - Christophe Lambert
- Sports Clinic Cologne at Cologne Merheim Medical Center, Cologne, University of Witten/Herdecke, Cologne, Germany.,Department of Trauma and Reconstructive Surgery with Division of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Klinik Sankt Georg, Hamburg, Germany
| | - Maurice Balke
- Sports Clinic Cologne at Cologne Merheim Medical Center, Cologne, University of Witten/Herdecke, Cologne, Germany
| | - Bertil Bouillon
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Reconstructive Surgery with Division of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Klinik Sankt Georg, Hamburg, Germany
| | - Jürgen Höher
- Sports Clinic Cologne at Cologne Merheim Medical Center, Cologne, University of Witten/Herdecke, Cologne, Germany
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