Nonoperative Treatment for Partial Ruptures of the Lateral Collateral Ligament Occurring in Combination With Complete Ruptures of the Anterolateral Ligament: A Common Injury Pattern in Brazilian Jiu-Jitsu Athletes With Acute Knee Injury

Isolated ACL Reconstruction Versus Combined ACL and Anterolateral Ligament Reconstruction: Functional Outcomes, Return to Sport, and Survivorship: An Updated Meta-analysis of Comparative Studies

BACKGROUND

Failure, persistent knee instability, and reinjury rates after anterior cruciate ligament (ACL) reconstruction are still concerns. Biomechanical investigations have highlighted the role of the anterolateral ligament (ALL) as a crucial knee stabilizer, and clinical outcomes after combined ACL and ALL reconstruction appear to indicate the success of the procedure.

PURPOSE

To compare the functional outcomes, return-to-sport (RTS) rate, and complications between combined ACL and ALL reconstruction and isolated ACL reconstruction.

STUDY DESIGN

Meta-analysis; Level of evidence, 4.

METHODS

The PubMed/MEDLINE, Scopus, and Cochrane Central databases were used to search keywords, and a total of 16 studies were included. The data extracted for quantitative analysis included the Tegner activity scale score, Lysholm knee score, International Knee Documentation Committee (IKDC) score, laxity measured using the KT-1000 knee arthrometer, number and types of complications, RTS rate, and survival rate. Random- and fixed-effects models were used for the meta-analysis of pooled mean differences and odds ratios.

RESULTS

A total of 2329 patients were identified, 1116 of whom underwent combined ACL and ALL reconstruction and 1213 of whom underwent isolated ACL reconstruction. The mean ages were 25.4 ± 7.2 years and 26.5 ± 7.8 years for the combined ACL and ALL reconstruction and isolated ACL reconstruction groups, respectively. The mean follow-ups were 40.3 ± 21.4 months and 42.5 ± 21.6 months, respectively. Comparable Tegner activity scale (P = .16), Lysholm knee (P = .13), and IKDC (P = .83) scores were found between groups. Significantly greater postoperative knee laxity was found in the isolated ACL reconstruction group (mean difference, -0.44; 95% CI, -0.85 to -0.04; P = .03). The combined ACL and ALL reconstruction group showed a significantly lower rate of graft failure (odds ratio [OR], 0.37; 95% CI, 0.18-0.77; P = .008), a higher RTS rate (OR, 1.41; 95% CI, 1.11-1.80; P = .005), and a higher survival rate (OR, 2.94; 95% CI, 1.97-4.37; P < .001).

CONCLUSION

Compared with isolated ACL reconstruction, combined ACL and ALL reconstruction yielded comparable functional outcomes but significantly less residual knee laxity and a lower graft failure rate. Patients who underwent combined ACL and ALL reconstruction also had higher RTS and survival rates.

Comparison of Anterior Cruciate Ligament Reconstruction With Versus Without Anterolateral Augmentation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background

It is clear that the anterolateral ligament has an important role in rotational knee stability. However, whether patients undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) can benefit from anterolateral augmentation (ALA) is still controversial.

Purpose

To compare the effects of isolated ACLR versus ACLR combined with ALA (ACLR+ALA) on clinical outcomes and knee stability.

Study Design

Systematic review; Level of evidence, 1.

Methods

The methodology followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search of the PubMed, Embase, and Cochrane Library Central Register of Controlled Trials databases was undertaken to identify all randomized controlled trials (RCTs) comparing isolated ACLR with ACLR+ALA for the treatment of ACL injuries in the last 15 years. The Cochrane Collaboration risk-of-bias tool and the revised Jadad scale were utilized by 2 independent reviewers to determine the quality of RCTs. Relevant data were extracted and compared between procedures, and heterogeneity across the RCTs was assessed using the I ² statistic.

Results

The initial search yielded 849 articles. A total of 14 studies (1850 patients; 941 ACLR and 909 ACLR+ALA) satisfied the eligibility criteria for the meta-analysis. There were no significant differences between the procedures in terms of patient-reported outcomes (International Knee Documentation Committee score, Tegner score, Knee injury and Osteoarthritis Outcome Score) or return-to-sport rates. However, patients who underwent ACLR+ALA had better knee stability based on the pivot-shift test (risk ratio [RR], 1.06 [95% CI, 1.02 to 1.10]; P = .0008), Lachman test (RR, 1.03 [95% CI, 1.00 to 1.07]; P = .04), and side-to-side difference in anterior laxity (standardized mean difference, -0.55 [95% CI, -0.98 to -0.12]; P = .01) as well as a lower incidence of graft failure (RR, 0.30 [95% CI, 0.19 to 0.45]; P < .01) compared with patients who underwent isolated ACLR.

Conclusion

ALA can be considered as a reinforcement of ACLR to improve anteroposterior and anterolateral rotational stability of the knee and reduce the risk of failure. The patient-reported outcomes of isolated ACLR were similar to those of ACLR+ALA, and both procedures provided improved knee function.

CLINICAL DIAGNOSIS AND TRAINING OPTIMIZATION ON KNEE SPORTS INJURIES

ABSTRACT Introduction: The knee joint is one of the sites of greatest mechanical stress in the lower limbs. The overload generated by impacts, blows from falls, and torsions in collisions can generate disabling tissue damage that is difficult to recover from. Although lacking clinical diagnosis, some studies have pointed out that implementing functional training in rehabilitation can reduce the period of disability and the harmful effects of immobilization. Objective: Study the clinical diagnosis and the optimization of training for knee sports injuries. Methods: This experiment uses the intra-group comparison method. The method used in the experiment is a rehabilitation training protocol for the knee joint, focusing on quadriceps muscle strength and balance. The training cycle is six times per week for one month. Results: The optimization in exercise training evidenced a good improvement in functional ability and pain condition, reflected in the athletes’ balance ability. After training optimization, 9 out of 12 athletes recovered completely, and three improved significantly. Conclusion: Trainers should follow the physical rehabilitation orders and match them with the athletes’ actual situation, sport types, etc., designing the appropriate sports mode for the athletes to promote training optimization and reduce sports joint injuries. Level of Evidence II; Therapeutic Studies - Outcome Investigation.

Percutaneous Lateral Collateral Ligament Release for Arthroscopic Procedures of the Knee: The "Lateral Pie-Crusting"

Arthroscopy of the knee is among the most frequent procedures worldwide in orthopaedic surgery. To avoid iatrogenic cartilage injury, adequate visualization and working space are mandatory to perform complex procedures. Narrow femorotibial joint space is often encountered, and it is challenging to obtain consistent satisfactory results. Medial collateral ligament release is safe and reliable for facilitating medial joint widening. Current clinical studies support lateral collateral ligament (LCL) healing capacity in isolated injuries. This article describes a simple, safe, and reproducible technique of LCL release through a multiple-puncture method to facilitate lateral compartment visualization and instrumentation, the so-called lateral pie-crusting.

KNEE INJURIES PREVALENCE IN BRAZILIAN JIU-JITSU: EPIDEMIOLOGICAL STUDY

OBJECTIVE

To evaluate the epidemiological and clinical characteristics of knee injuries in Brazilian Jiu-Jitsu (BJJ) practitioners.

METHODS

Cross-sectional study, using a mixed questionnaire, based on the Referred Morbidity Index.

RESULTS

198 amateur and professional BJJ fighters, of both sexes, aged between 18 and 60 years, participated in the study. The majority (88%) of the fighters had only one knee injury (p < 0.001). In total, 29.8% proportion of knee injuries (p < 0.001) was identified, which were mainly from the medial collateral ligament (38%), caused by a sprain mechanism (86%) and conservative treatment (65%).

CONCLUSION

A high prevalence of knee injuries in JJB fighters was found, compared to other sports that also perform rotational movements and have great body contact, such as mixed martial arts (MMA), judo, soccer, basketball and handball. Some JJB strikes, such as the key and the projection, can cause greater knee joint stress, both in the attacking fighter and in the opponent. The knowledge of the epidemiological characteristics of sports injuries is important in the elaboration of prevention and training protocols more specific to the sport and for the understanding of the complex mechanisms involved with this outcome in sport. Level of Evidence IV, Case Series.

Research on the Anterolateral Ligament of the Knee: An Evaluation of PubMed Articles From 2010 to 2019

Background:

The anterolateral ligament (ALL) of the knee remains a topic of interest. All aspects of the ligament, including its anatomy, biomechanics, imaging, and clinical importance, are areas for research among knee surgeons.

Purpose:

To evaluate the trends in research on the ALL of the knee, as indicated by studies indexed in PubMed from 2010 to 2019.

Study Design:

Cross-sectional study.

Methods:

We searched PubMed for article titles from January 1, 2010, to December 31, 2019, that included the term “anterolateral ligament.” The initial search was performed with the terms “anterolateral ligament AND knee” and “anterolateral ligament NOT knee.” Next, we performed a search using “anterolateral complex OR anterolateral reconstruction OR lateral extra-articular tenodesis” to avoid missing any studies. A bibliometric evaluation was performed for the search results, and we noted the characteristics of the most cited articles in PubMed.

Results:

Published studies on the ALL peaked in 2017, with 56 studies, and then declined from 2017 to 2019. The 3 leading journals with articles on the ALL were Arthroscopy; Knee Surgery, Sports Traumatology, Arthroscopy; and The American Journal of Sports Medicine. Cadaveric anatomic, cadaveric biomechanical, and clinical imaging studies of the ALL were the most common types of studies published from 2010 to 2019. Clinical studies on the ALL consisted of 18 articles, with the majority displaying a low level of evidence.

Conclusion:

Cadaveric anatomic/histological, cadaveric biomechanical, and clinical imaging studies of the ALL were the most commonly published studies from 2010 to 2019. More clinical outcome studies with a high level of evidence are needed to increase the supporting data for the future practice of ALL reconstruction.