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Herbst E, Glasbrenner J, Deichsel A, Briese T, Peez C, Raschke MJ, Kittl C. [Injuries of the medial side of the knee : When and how should they be treated?]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:18-26. [PMID: 37848564 PMCID: PMC10787005 DOI: 10.1007/s00113-023-01368-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/19/2023]
Abstract
Different medial structures are responsible for restraining valgus rotation, external rotation, and anteromedial rotation. When injured this can result in various degrees of isolated and combined instabilities. In contrast to earlier speculation, the posterior oblique ligament (POL) is no longer considered to be the main stabilizer of anteromedial rotatory instability (AMRI). Acute proximal medial ruptures are typically managed conservatively with very good clinical results. Conversely, acute distal ruptures usually require a surgical intervention. Chronic instabilities mostly occur in combination with instabilities of the anterior cruciate ligament (ACL). The clinical examination is a particularly important component in these cases to determine the indications for surgery for an additional medial reconstruction. In cases of severe medial and anteromedial instabilities, surgical treatment should be considered. Biomechanically, a combined medial and anteromedial reconstruction appears to be superior to other reconstruction methods; however, there is currently a lack of clinical studies to confirm this biomechanical advantage.
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Affiliation(s)
- Elmar Herbst
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48147, Münster, Deutschland
| | - Johannes Glasbrenner
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48147, Münster, Deutschland
| | - Adrian Deichsel
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48147, Münster, Deutschland
| | - Thorben Briese
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48147, Münster, Deutschland
| | - Christian Peez
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48147, Münster, Deutschland
| | - Michael J Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48147, Münster, Deutschland
| | - Christoph Kittl
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48147, Münster, Deutschland.
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Jang YH, Kim DS. Atelocollagen Injections Improve Outcomes in the Nonsurgical Treatment of Grade III Medial Collateral Ligament Injuries. Clin Orthop Surg 2023; 15:953-959. [PMID: 38045580 PMCID: PMC10689225 DOI: 10.4055/cios23022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 12/05/2023] Open
Abstract
Background The purpose of this study was to evaluate the clinical outcomes of atelocollagen injections in isolated grade III medial collateral ligament (MCL) injuries of the knee joint. Methods A total of 50 participants were included in this retrospective study. Twenty-six patients underwent conservative treatment with a single atelocollagen injection, while the remaining patients underwent only typical conservative treatment. All participants underwent magnetic resonance imaging to identify and grade MCL injury. Valgus stress radiography was performed on both knees at 6 and 12 months after the injury. The visual analog scale (VAS) score was collected at the first visit and at 2 weeks, 6 weeks, 6 months, and 12 months after injury. The International Knee Documentation Committee (IKDC) formula activity level and Lysholm score were evaluated for patient-reported outcomes at the first visit and at 6 and 12 months after injury. The participant's return to the pre-injury activity level ratio was measured by comparing the IKDC formula activity level at 12 months after the injury with that before the injury. Results The VAS and Lysholm scores improved over time in both groups. The VAS and Lysholm scores were significantly better in the collagen injection group than in the control group. Regarding the activity level, the collagen injection group showed significantly better results at the 6-month follow-up, but there was no significant difference at the 12-month follow-up. The medial gap in the injured knee and the side-to-side difference (SSD) in both groups gradually decreased over time. The SSD in the collagen injection group was significantly smaller than that in the control group. Conclusions Atelocollagen injections resulted in better clinical and radiologic outcomes along with a higher rate of return to the pre-injury activity level, thereby exhibiting a positive effect in the nonsurgical treatment of grade III MCL injuries.
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Affiliation(s)
- Young Hwan Jang
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Korea
| | - Doo Sup Kim
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Korea
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Mowers C, Jackson GR, Condon JJ, Dhillon N, Brusalis CM, Khan ZA, Batra A, Jawanda H, Mameri ES, Kaplan DJ, Knapik DM, Verma NN, Chahla J. Medial Collateral Ligament Reconstruction and Repair Show Similar Improvement in Outcome Scores, But Repair Shows Higher Rates of Knee Stiffness and Failure: A Systematic Review. Arthroscopy 2023; 39:2231-2240. [PMID: 36898592 DOI: 10.1016/j.arthro.2023.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/06/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE To compare patient-reported outcomes and complications in patients with medial collateral ligament (MCL) injuries undergoing repair versus reconstruction with a minimum 2-year follow-up. METHODS A literature search was conducted using the PubMed, Scopus, and Embase-computerized databases from database inception to November 2022, according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating clinical outcomes and complications at a minimum of 2 years following MCL repair versus reconstruction were included. Study quality was assessed using the MINORS criteria. RESULTS A total of 18 studies published from 1997 to 2022, consisting of 503 patients were identified. Twelve studies (n = 308 patients; mean age: 32.6 years) reported outcomes following MCL reconstruction, and 8 studies (n = 195 patients; mean age: 28.5 years) reported results following MCL repair. Postoperative International Knee Documentation Committee, Lysholm, and Tegner scores ranged from 67.6 to 91, 75.8 to 94.8, and 4.4 to 8, respectively, in the MCL reconstruction group, compared to 73 to 91, 75.1 to 98.5, and 5.2 to 10, respectively, in the MCL repair group. Knee stiffness was the most commonly reported complication following MCL repair (range: 0% - 50%) and reconstruction (range: 0% - 26.7%). Failures occurred in 0% to 14.6% of patients following reconstruction versus 0% to 35.1% of patients undergoing MCL repair. Manipulation under anesthesia (MUA) for postoperative arthrofibrosis (range: 0% - 12.2%) and surgical debridement for arthrofibrosis (range: 0% - 20%) were the most commonly reported reoperations in the MCL reconstruction and repair groups, respectively. CONCLUSIONS MCL reconstruction versus repair both demonstrate improved International Knee Documentation Committee, Lysholm, and Tegner scores. MCL repair demonstrates higher rates of postoperative knee stiffness and failure at a minimum 2-year follow-up. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Colton Mowers
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Joshua J Condon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nireet Dhillon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Christopher M Brusalis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Zeeshan A Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anjay Batra
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Harkirat Jawanda
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Instituto Brasil de Tecnologia da Saúde, Rio de Janeiro, Brazil; Department of Orthopedics and Traumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Daniel J Kaplan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, Missouri, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Kittl C, Robinson J, Raschke MJ, Olbrich A, Frank A, Glasbrenner J, Herbst E, Domnick C, Herbort M. Medial collateral ligament reconstruction graft isometry is effected by femoral position more than tibial position. Knee Surg Sports Traumatol Arthrosc 2021; 29:3800-3808. [PMID: 33454831 PMCID: PMC8514388 DOI: 10.1007/s00167-020-06420-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/14/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to examine the length change patterns of the native medial structures of the knee and determine the effect on graft length change patterns for different tibial and femoral attachment points for previously described medial reconstructions. METHODS Eight cadaveric knee specimens were prepared by removing the skin and subcutaneous fat. The sartorius fascia was divided to allow clear identification of the medial ligamentous structures. Knees were then mounted in a custom-made rig and the quadriceps muscle and the iliotibial tract were loaded, using cables and hanging weights. Threads were mounted between tibial and femoral pins positioned in the anterior, middle, and posterior parts of the attachment sites of the native superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL). Pins were also placed at the attachment sites relating to two commonly used medial reconstructions (Bosworth/Lind and LaPrade). Length changes between the tibiofemoral pin combinations were measured using a rotary encoder as the knee was flexed through an arc of 0-120°. RESULTS With knee flexion, the anterior fibres of the sMCL tightened (increased in length 7.4% ± 2.9%) whilst the posterior fibres slackened (decreased in length 8.3% ± 3.1%). All fibre regions of the POL displayed a uniform lengthening of approximately 25% between 0 and 120° knee flexion. The most isometric tibiofemoral combination was between pins placed representing the middle fibres of the sMCL (Length change = 5.4% ± 2.1% with knee flexion). The simulated sMCL reconstruction that produced the least length change was the Lind/Bosworth reconstruction with the tibial attachment at the insertion of the semitendinosus and the femoral attachment in the posterior part of the native sMCL attachment side (5.4 ± 2.2%). This appeared more isometric than using the attachment positions described for the LaPrade reconstruction (10.0 ± 4.8%). CONCLUSION The complex behaviour of the native MCL could not be imitated by a single point-to-point combination and surgeons should be aware that small changes in the femoral MCL graft attachment position will significantly effect graft length change patterns. Reconstructing the sMCL with a semitendinosus autograft, left attached distally to its tibial insertion, would appear to have a minimal effect on length change compared to detaching it and using the native tibial attachment site. A POL graft must always be tensioned near extension to avoid capturing the knee or graft failure.
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Affiliation(s)
- Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany.
| | | | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Arne Olbrich
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Andre Frank
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Christoph Domnick
- Department of Trauma and Hand Surgery, Euregio Klinik Nordhorn, Nordhorn, Deutschland
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Kwee RM, Hafezi-Nejad N, Roemer FW, Zikria BA, Hunter DJ, Guermazi A, Demehri S. Association of Mucoid Degeneration of the Anterior Cruciate Ligament at MR Imaging with Medial Tibiofemoral Osteoarthritis Progression at Radiography: Data from the Osteoarthritis Initiative. Radiology 2018; 287:912-921. [PMID: 29465334 DOI: 10.1148/radiol.2018171565] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose To determine whether anterior cruciate ligament (ACL) mucoid degeneration in participants with or at risk for osteoarthritis is associated with longitudinal risk of radiographic progression of medial tibiofemoral compartment joint space loss (JSL). Materials and Methods Baseline demographic, clinical, radiographic, and Magnetic Resonance (MR) Imaging Osteoarthritis Knee Score (MOAKS) data were evaluated in 600 participants from the Osteoarthritis Initiative database. Two blinded musculoskeletal radiologists independently evaluated baseline MR images for ACL mucoid degeneration. Multiple logistic regression was used to investigate the association between ACL mucoid degeneration at MR imaging and JSL progression at radiography, defined as a minimum joint space width decrease greater than 0.7 mm (48 months; cutoff according to mean and standard deviation of 1-year minimum joint space width changes in 90 knees of reference group). Stratified analysis was performed based on baseline cartilage surface damage. Results Knees with ACL mucoid degeneration showed a greater proportion of JSL progression compared with knees with a normal ACL (64% vs 47%; P = .004). After adjustment for all demographic, clinical, radiographic, and MOAKS variables, ACL mucoid degeneration was not statistically significantly associated with JSL progression in the entire cohort (adjusted odds ratio, 1.66; 95% confidence interval: 1.00, 2.77; P = .051). In subgroup analysis, ACL mucoid degeneration was statistically significantly associated with JSL progression in participants with less baseline cartilage surface damage (maximum cartilage surface loss of ≤75% in all subregions [P = .015] and ≤4 of involved subregions with cartilage surface loss [P = .028]). Conclusion ACL mucoid degeneration in participants with or at risk for osteoarthritis is associated with progression of medial tibiofemoral compartment JSL in knees with less baseline cartilage surface area damage. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Robert M Kwee
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Nima Hafezi-Nejad
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Frank W Roemer
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Bashir A Zikria
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - David J Hunter
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Ali Guermazi
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Shadpour Demehri
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
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Palmieri-Smith RM, Cameron KL, DiStefano LJ, Driban JB, Pietrosimone B, Thomas AC, Tourville TW, Consortium ATO. The Role of Athletic Trainers in Preventing and Managing Posttraumatic Osteoarthritis in Physically Active Populations: a Consensus Statement of the Athletic Trainers' Osteoarthritis Consortium. J Athl Train 2017; 52:610-623. [PMID: 28653866 PMCID: PMC5488853 DOI: 10.4085/1062-6050-52.2.04] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To provide athletic trainers with a fundamental understanding of the pathogenesis and risk factors associated with the development of posttraumatic osteoarthritis (PTOA) as well as the best current recommendations for preventing and managing this condition. BACKGROUND Posttraumatic osteoarthritis, or osteoarthritis that develops secondary to joint injury, accounts for approximately 5.5 million US cases annually. A young athlete with a joint injury is at high risk for PTOA before the age of 40, which could lead to the patient living more than half of his or her life with a painful and disabling disorder. Given our frequent contact with physically active people who often sustain traumatic joint injuries, athletic trainers are in a unique position to help prevent and manage PTOA. We can, therefore, regularly monitor joint health in at-risk patients and implement early therapies as necessary. RECOMMENDATIONS The recommendations for preventing and managing PTOA are based on the best available evidence. Primary injury prevention, self-management strategies, maintenance of a healthy body weight, and an appropriate level of physical activity should be encouraged among those at risk for PTOA after acute traumatic joint injury. Education of athletic trainers and patients regarding PTOA is also critical for effective prevention and management of this disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Athletic Trainers' Osteoarthritis Consortium
- University of Michigan, Ann Arbor
- Keller Army Hospital, West Point, NY
- University of Connecticut, Storrs
- Division of Rheumatology, Tufts Medical Center, Boston, MA
- University of North Carolina at Chapel Hill
- University of North Carolina at Charlotte
- University of Vermont, Burlington
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Branch TP, Stinton SK, Siebold R, Freedberg HI, Jacobs CA, Hutton WC. Assessment of knee laxity using a robotic testing device: a comparison to the manual clinical knee examination. Knee Surg Sports Traumatol Arthrosc 2017; 25:2460-2467. [PMID: 26704793 PMCID: PMC5522506 DOI: 10.1007/s00167-015-3935-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/09/2015] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study was to collect knee laxity data using a robotic testing device. The data collected were then compared to the results obtained from manual clinical examination. METHODS Two human cadavers were studied. A medial collateral ligament (MCL) tear was simulated in the left knee of cadaver 1, and a posterolateral corner (PLC) injury was simulated in the right knee of cadaver 2. Contralateral knees were left intact. Five blinded examiners carried out manual clinical examination on the knees. Laxity grades and a diagnosis were recorded. Using a robotic knee device which can measure knee laxity in three planes of motion: anterior-posterior, internal-external tibia rotation, and varus-valgus, quantitative data were obtained to document tibial motion relative to the femur. RESULTS One of the five examiners correctly diagnosed the MCL injury. Robotic testing showed a 1.7° larger valgus angle, 3° greater tibial internal rotation, and lower endpoint stiffness (11.1 vs. 24.6 Nm/°) in the MCL-injured knee during varus-valgus testing when compared to the intact knee and 4.9 mm greater medial tibial translation during rotational testing. Two of the five examiners correctly diagnosed the PLC injury, while the other examiners diagnosed an MCL tear. The PLC-injured knee demonstrated 4.1 mm more lateral tibial translation and 2.2 mm more posterior tibial translation during varus-valgus testing when compared to the intact knee. CONCLUSIONS The robotic testing device was able to provide objective numerical data that reflected differences between the injured knees and the uninjured knees in both cadavers. The examiners that performed the manual clinical examination on the cadaver knees proved to be poor at diagnosing the injuries. Robotic testing could act as an adjunct to the manual clinical examination by supplying numbers that could improve diagnosis of knee injury. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | | | | | | | | | - W. C. Hutton
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA USA
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Gibson K, Sayers SP, Minor MA. An evidence-based recommendation for the inclusion of specific local intrinsic factors in the study of knee osteoarthritis. Knee 2012; 19:890-5. [PMID: 22608853 DOI: 10.1016/j.knee.2012.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 04/04/2012] [Accepted: 04/09/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Adequate characterization of the mechanical environment of the knee with osteoarthritis (OA) is important. These local intrinsic factors are difficult to measure and there is little evidence to guide their selection. This study makes an evidence-based recommendation for the inclusion of specific factors in the future study of knee OA. METHOD Forty-six subjects with knee OA were examined. Observed function was measured by the Timed Chair Rise (TCR). Self-reported function was measured by the WOMAC Function Scale and pain was measured by the WOMAC Pain Scale. Local intrinsic factors measured included varus/valgus alignment, anterior/posterior (A/P) laxity, proprioception, isometric knee extension (KE) strength, isometric knee flexion (KF) strength, and knee range of motion (ROM). RESULTS Factors were recommended for inclusion in future research if they were significantly correlated with at least one measure of function or pain and if the factor made a significant unique contribution to a regression model when more than one local intrinsic factor was correlated with the same measure of function or pain. Alignment was correlated with pain (r=0.48, p=0.001) and WOMAC function (r=0.38, p=0.009). A/P laxity was correlated with pain (r=0.30, p=0.04) and WOMAC function (r=0.37, p=0.01). Knee ROM was correlated to WOMAC function (r=-0.35, p=0.02). KE strength was correlated with TCR (r=0.32, p=0.03). Alignment made a significant contribution to prediction of pain (p=0.003). A/P laxity (p=0.004) and ROM (p=0.008) made a significant contribution to WOMAC function. CONCLUSION We recommend future knee OA studies include the variables varus/valgus alignment, A/P laxity, ROM, and KE strength.
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Affiliation(s)
- Kyle Gibson
- University of Missouri, Department of Physical Therapy, MO 65201, USA.
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Anoka N, Nyland J, McGinnis M, Lee D, Doral MN, Caborn DNM. Consideration of growth factors and bio-scaffolds for treatment of combined grade II MCL and ACL injury. Knee Surg Sports Traumatol Arthrosc 2012; 20:878-88. [PMID: 21830112 DOI: 10.1007/s00167-011-1641-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 07/26/2011] [Indexed: 01/14/2023]
Abstract
The literature suggests that a Grade II medial collateral ligament (MCL) injury in combination with anterior cruciate ligament (ACL) injury will heal naturally and not compromise patient outcome following ACL reconstruction. Evidence based on bone-patella tendon-bone autograft use is stronger than evidence supporting anatomically placed soft tissue graft use. Current ACL reconstruction practices make greater use of soft tissue grafts, differing fixation methods, and anatomically lower placement on the inner wall of the lateral femoral condyle. Anatomical graft placement aligns the femoral bone tunnel more directly with valgus knee loading forces. Differences in the soft tissue graft-bone tunnel integration and ligamentization timetable following ACL reconstruction also increase concerns regarding residual Grade II MCL laxity and functional deficiency during accelerated functional rehabilitation. MCL dysfunction may increase susceptibility to early ACL graft slippage, elongation, outright failure, and medial femoral condyle lift-off with valgus knee loading. This concept paper discusses the potential role of growth factors and bio-scaffolds for improving Grade II MCL injury healing and mechanical integrity when the injury occurs in combination with an ACL injury that is reconstructed with a soft tissue graft and an anatomical surgical approach.
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Affiliation(s)
- Natasha Anoka
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 210 East Gray St., Suite 1003, Louisville, KY 40202, USA
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11
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Hazle CR. Case report of atypical bilateral posteromedial knee instability in a male recreational runner. Physiother Theory Pract 2010; 27:160-71. [PMID: 20977381 DOI: 10.3109/09593981003796497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The posteromedial corner of the knee has intricate anatomical and biomechanical relationships critical to the function of the tibiofemoral joint. Missed or late diagnosis of pathomechanical disorders of the region, such as anteromedial rotary instability, in individuals with knee pain, may result in long-term decreased functional mobility and predisposition for degenerative disorders. This case report describes the chronological history and experience of a 35-year-old male with late diagnosis of anteromedial rotary instability and the subsequent surgical reconstruction and rehabilitation. Difficulties with clinical recognition of the underlying pathology and the postoperative course of rehabilitation are also discussed.
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Affiliation(s)
- Charles R Hazle
- Division of Physical Therapy, University of Kentucky, Center for Rural Health Excellence, Hazard, Kentucky, USA.
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12
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Papalia R, Osti L, Del Buono A, Denaro V, Maffulli N. Management of combined ACL-MCL tears: a systematic review. Br Med Bull 2010; 93:201-15. [PMID: 20007189 DOI: 10.1093/bmb/ldp044] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The optimal management for combined anterior cruciate ligament-medial collateral ligament (ACL-MCL) injuries is controversial. SOURCES OF DATA We performed a literature search using Medline, Cochrane and Google Scholar using the keywords: 'ACL' and 'MCL' in combination with 'surgery treatment', 'conservative treatment', 'surgery management', 'conservative management', 'surgical treatment' and 'surgical management'. We identified 23 published studies. AREAS OF AGREEMENT Conservative and surgical management for combined ACL-MCL injuries resulted in different functional outcomes. The Coleman Methodology Score showed great heterogeneity in terms of study design, patient characteristics, management methods and outcome assessment and generally low methodological quality. AREAS OF CONTROVERSY Given the heterogeneity in terms of treatment and results, we did not find a univocal trend over the years regarding MCL management (conservative or surgical). The use of several scoring systems did not allow us to compare outcomes in the different studies. GROWING POINTS There is a need for a common validated scale for clinical measurements for ACL-MCL injuries, so as to allow easier and more reliable comparison of outcomes in different studies. To improve diagnostic certainty of combined ACL-MCL injuries, all patients should have imaging assessment (MR and stress-radiography) in addition to clinical examination. AREAS TIMELY FOR DEVELOPING RESEARCH There is a need to perform appropriately powered randomized clinical trials of conservative and surgical treatment of combined ACL-MCL injuries, using standard diagnostic assessment, common and validated scoring system comparing reported outcomes and duration of follow-up more than 2 years.
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Affiliation(s)
- Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
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13
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Abstract
The medial collateral ligament is the most frequently injured ligament of the knee. The anatomy and biomechanical role of this ligament and the associated posteromedial structures of the knee continue to be explored. Prophylactic knee bracing has shown promise in preventing injury to the medial collateral ligament, although perhaps at the cost of functional performance. Most isolated injuries are treated nonsurgically. Recent studies have investigated ligament-healing variables, including modalities such as ultrasound and nonsteroidal anti-inflammatory drugs. Concomitant damage to the anterior or posterior cruciate ligaments is a common indication to surgically address the high-grade medial collateral ligament injury. The optimal treatment of multiligamentous knee injuries continues to evolve, and controversy exists surrounding the role of medial collateral ligament repair/reconstruction, with data supporting both conservative and surgical management.
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14
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Funakoshi Y, Hariu M, Tapper JE, Marchuk LL, Shrive NG, Kanaya F, Rattner JB, Hart DA, Frank CB. Periarticular ligament changes following ACL/MCL transection in an ovine stifle joint model of osteoarthritis. J Orthop Res 2007; 25:997-1006. [PMID: 17436314 DOI: 10.1002/jor.20370] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) injuries often lead to significant functional impairment, and are associated with increased risk for induction of degenerative joint disease. However, few studies have described the effect of ligament transection on the remaining intact knee ligaments. This study sought to determine specifically what impact combined ACL/medial collateral ligament (MCL) transection had on the remaining intact knee ligaments, particularly from the histological, biochemical, and molecular perspectives. Twenty weeks post-ACL/MCL transection, the cut ends of sheep MCLs were bridged by scar, while the posterior cruciate ligaments (PCLs) and lateral collateral ligaments (LCLs) seemed gross morphologically normal. Water content and cell density increased significantly in the MCL scars and the intact PCLs but were unchanged in the LCLs. Collagen fibril diameter distribution was significantly altered in both MCL scar tissue and uninjured PCLs from transected joints. MMP-13 mRNA levels in MCL scars and PCLs from ligament transected joints were increased, while TIMP-1 mRNA levels were significantly decreased in the PCLs only. This study has shown that some intact ligaments in injured joints are impacted by the injury. The joint appears to behave like an integrated organ system, with injury to one component affecting the other components as the "organ" attempts to adapt to the loss of integrity.
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Affiliation(s)
- Yusei Funakoshi
- McCaig Centre for Joint Injury & Arthritis Research, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, Canada T2N 4N1
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15
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Conaghan PG, Felson D, Gold G, Lohmander S, Totterman S, Altman R. MRI and non-cartilaginous structures in knee osteoarthritis. Osteoarthritis Cartilage 2006; 14 Suppl A:A87-94. [PMID: 16713722 DOI: 10.1016/j.joca.2006.02.028] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Accepted: 02/26/2006] [Indexed: 02/07/2023]
Abstract
Magnetic resonance imaging (MRI) provides a sensitive tool for examining all the structures involved in the osteoarthritis (OA) process. While much of the MRI literature previously focussed on cartilage, there is increasing research on whole-organ evaluation and including features such as synovitis, bone marrow edema, and meniscal and ligamentous pathology. The aim of this session at the Outcome Measures in Rheumatology Clinical Trials (OMERACT)-Osteoarthritis Research Society International (OARSI) Workshop for Consensus in Osteoarthritis Imaging was to describe the current MRI methods for identifying and quantifying non-cartilaginous structures and review their associations with both OA symptoms and structural progression. Although there is much experience in measuring synovitis (derived from the rheumatoid arthritis literature), only one study has reported an association of MRI-detected synovitis and effusions with OA pain. Bone marrow edema lesions, which may represent areas of trabecular remodelling, have been associated with pain and compartment-specific structural deterioration. MRI studies have confirmed the frequency and importance of meniscal damage in progressive cartilage loss, but not related such damage to symptoms. Osteophytes have been associated with cartilage loss and malalignment to the side of the osteophyte. Ligament damage, including anterior cruciate ligament tears, has been found more commonly than expected in painful OA knees. Improvements in quantitative and semi-quantitative assessments of non-cartilage features will greatly assist understanding of the OA process and its response to therapy.
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Affiliation(s)
- P G Conaghan
- Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK.
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16
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Abstract
The number of people participating in sports continues to increase. The relationship between sports participation, joint injury, and subsequent osteoarthritis is complex. A history of joint injury and participation in high joint loading sports increases the risk of subsequent osteoarthritis changes in affected joints. The impact of osteoarthritis on sports careers depends on multiple factors including the joint involved, the location within that joint, and the physical demands of the chosen sport.
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Affiliation(s)
- Brian R Wolf
- Department of Orthopaedics and Rehabilitation, University of Iowa Sports Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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17
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Abstract
There appears to be an increased risk of lower limb osteoarthritis in participants of repetitive, high impact sports, and this is strongly associated with joint injury. There seems to be little risk associated with recreational running. Assessment of risk for osteoarthritis should take into account the nature of the sport, intensity of training, presence of previous injury, body mass index, and occupation.
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Affiliation(s)
- P G Conaghan
- Department of Rheumatology, Leeds General Infirmary, UK.
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18
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Järvelä T, Kannus P, Järvinen M. Anterior cruciate ligament reconstruction in patients with or without accompanying injuries: A re-examination of subjects 5 to 9 years after reconstruction. Arthroscopy 2001; 17:818-25. [PMID: 11600978 DOI: 10.1016/s0749-8063(01)90004-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the clinical and radiologic results of an anterior cruciate ligament (ACL) reconstruction in patients with an isolated ACL tear and patients with an ACL tear and accompanying injuries. TYPE OF STUDY A retrospective investigation. METHODS Seventy-two patients who did not have previous knee surgery or surgery of the contralateral knee were re-examined 5 to 9 years after the primary ACL reconstruction. The clinical assessment was made using the International Knee Documentation Committee (IKDC) evaluation system, and the Lysholm and the Marshall knee scores. Also, radiographic evaluation and isokinetic strength testing were performed. There were 34 patients (25 men and 9 women) with an isolated ACL tear (group A), and 38 patients (23 men and 15 women) with an ACL tear and accompanying injuries (group B). The mean age was 29 years (SD 9; range, 15 to 49 years) in group A, and 34 years (SD 12; range, 15 to 61 years) in group B. Bone-patellar tendon-bone autograft with mini-arthrotomy technique and screw fixation was used in all patients. Postoperative rehabilitation was also similar in both groups. In group B, 10 medial and 12 lateral (partial or subtotal) arthroscopic meniscectomies were performed at the same time as the ACL reconstruction. Also, 18 of the 19 medial collateral ligament ruptures, the 2 lateral collateral ligament ruptures, and the 1 posterior cruciate ligament rupture were treated surgically at this operation. RESULTS Subjectively (overall assessment, pain, swelling, and giving way of the knee) and objectively (range of motion, stability, crepitation, isokinetic strength testing, and radiological changes of the knee), the groups did not have any significant differences in the 5- to 9-year results. Also, the final evaluation results using the IKDC and the Lysholm and the Marshall knee scores were similar in both groups. However, there were significantly more subsequent knee surgeries in the injured knee in group B than in group A. CONCLUSIONS Our results show no large differences between patients with an isolated ACL tear and those with an ACL tear with accompanying injuries 5 to 9 years after an ACL reconstruction with a bone-patellar tendon-bone autograft. Tibiofemoral osteoarthritis was quite rare, and this may be partly attributable to the fact that the ACL reconstructions were successful, so that all the knees were stable at the re-examination. However, the future will show the final outcome for the patients.
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Affiliation(s)
- T Järvelä
- Division of Orthopaedics, Department of Surgery, Tampere University Hospital, Tampere, Finland.
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Ambrose HC, Simonian PT, Sims WF. Arthroscopic localization of medial collateral ligament injury: Report of 2 cases in adults. Arthroscopy 2001; 17:E21. [PMID: 11337708 DOI: 10.1053/jars.2001.21257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Injury to the medial collateral ligament has previously been assessed primarily using the clinical examination and magnetic resonance imaging. In this article, we describe an adjunct to these diagnostic tools: an arthroscopic observation to assess the specific location of the medial collateral ligament injury.
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Affiliation(s)
- H C Ambrose
- Department of Orthopaedic Surgery, The University of Washington, Seattle, Washington 98195, U.S.A
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Abstract
In spite of considerable research efforts, knee injuries continue to plague athletes. The rate of occurrence may actually be increasing. Particularly vulnerable to injury because of its anatomic location, the knee sustains a tremendous amount of force during sports. Physicians caring for these patients must be familiar with the mechanism of these injuries. This report aims to familiarize rheumatology physicians with an overview of the anatomy, function, physical examination, and treatment of the various anatomic structures that are commonly injured.
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Affiliation(s)
- P D Fadale
- Department of Orthopaedic Surgery, Brown University School of Medicine, Rhode Island Hospital, Providence 02905, USA
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