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Yamasaki S, Hashimoto Y, Iida K, Han C, Kinoshita T, Nishino K, Nishida Y, Takigami J, Nakamura H. Quadriceps Tendon With Bone Autograft Has Better Stability and Magnetic Resonance Imaging Maturation Than Hamstring Tendon Autograft After Anterior Cruciate Ligament Reconstruction in Patients With Knee Hyperextension. Arthroscopy 2024; 40:1234-1244. [PMID: 37597704 DOI: 10.1016/j.arthro.2023.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/22/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To compare the clinical outcomes of anterior cruciate ligament (ACL) reconstruction between methods using quadriceps tendon with bone (QTB) and hamstring tendon (HT) in patients with hyperextension of the knee. METHODS The medical records of patients with knee hyperextension greater than 8° who underwent arthroscopic ACL reconstruction between October 2010 and October 2020 with follow-up for at least 2 years (median, 3 years; interquartile range [IQR], 2.0-4.6 years) were retrospectively reviewed. Side-to-side difference in anterior translation, pivot-shift test grade, Lysholm score, and graft intensity using the Howell grade on magnetic resonance imaging at final follow-up were compared between the QTB and HT groups. RESULTS The HT and QTB groups consisted of 42 patients and 21 patients, respectively. The overall mean age was 21.5 years (range, 14-48 years), and the median Tegner Activity Scale score was 6 (range, 3-9). Postoperatively, the median side-to-side difference in anterior translation was 1.75 mm (IQR, 1-3 mm) in the HT group and 1.0 mm (IQR, 0-1.75 mm) in the QTB group (P = .01). Pivot-shift testing showed grade 0 in 74.7%, grade 1 in 18.7%, and grade 2 in 6.6% of patients in the HT group and grade 0 in 85.7% and grade 1 in 14.3% of those in the QTB group (P = .03). The median postoperative Lysholm score was 99 in both groups. Graft signal intensity showed a significant between-group difference: grade I in 52%, grade II in 36%, and grade III in 12% of patients in the HT group versus grade I in 85.7%, grade II in 9.5%, and grade III in 4.8% of those in the QTB group (P = .03). CONCLUSIONS In patients who underwent ACL reconstruction for hyperextension of the knee, QTB yielded better clinical outcomes than HT with respect to anterior stability, rotational stability, and graft signal intensity on median 2-year follow-up magnetic resonance imaging. LEVEL OF EVIDENCE Level III, retrospective case-control study.
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Affiliation(s)
- Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan.
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ken Iida
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Changhun Han
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takuya Kinoshita
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Wang A, Jiang Y, Su T, Xie X, Jiao C, Hu Y, Zhang Z, Guo Q, Jiang D. Clinical Outcomes and Return to Preinjury Sports After Anatomic Reconstruction With a Gracilis Autograft Versus the Modified Broström Procedure in Patients With Generalized Joint Laxity. Orthop J Sports Med 2024; 12:23259671241229443. [PMID: 38455150 PMCID: PMC10919140 DOI: 10.1177/23259671241229443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/21/2023] [Indexed: 03/09/2024] Open
Abstract
Background Generalized joint laxity (GJL) is a risk factor for inferior outcomes after the modified Broström procedure for chronic lateral ankle instability, while anatomic reconstruction with tendons is more inclined to be recommended. However, whether anatomic reconstruction could achieve better results than the modified Broström procedure in patients with GJL is unknown. Purpose To compare clinical outcomes and return to sports between anatomic reconstruction and the modified Broström procedure in patients with GJL. Study Design Cohort study; Level of evidence, 3. Methods Patients with GJL (Beighton score ≥4) who underwent either the modified Broström procedure or anatomic reconstruction with gracilis autografts between 2017 and 2020 were reviewed. Included were 19 patients who underwent anatomic reconstruction (reconstruction group) and 49 patients who underwent the modified Broström procedure (MBP group). Clinical outcomes were compared using the Foot and Ankle Outcome Score (FAOS) and the Karlsson score. The rates of return to preinjury level in high-demand sports, sprain recurrence, and range of motion between the 2 groups were also compared. Results The mean follow-up duration was 38.3 months in the reconstruction group and 43.7 months in the MBP group. The FAOS and Karlsson scores improved significantly after surgery in both groups (P < .001 for all), with the reconstruction group having significantly higher postoperative FAOS-Sports scores (87.9 ± 8.9 vs 80.5 ± 11.6; P = .015) and Karlsson scores (86.9 ± 6.1 vs 82 ± 8.4; P = .025) than the MBP group. The rate of return to preinjury high-demand sports was higher in the reconstruction group than in the MBP group (73.3% vs 38.9%; P = .034). The MBP group had a significantly higher rate of sprain recurrence (22.4% vs 0%; P = .027). More patients reported dorsiflexion restriction in the reconstruction group (n = 4; 21.1%) than in the MBP group (n = 1; 2%) (P = .019); nonetheless, there was no noticeable effect on daily life and sports. Conclusion Better clinical outcomes, less sprain recurrence, and a higher rate of return to preinjury high-demand sports were found after anatomic reconstruction with free tendons compared with the modified Broström procedure in patients with GJL. Anatomic tendon reconstruction can be recommended for such patients, especially those participating in high-demand sports.
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Affiliation(s)
- Anhong Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yanfang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Xing Xie
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yuelin Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Zhu Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Qinwei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
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Lindskog J, Piussi R, Simonson R, Högberg J, Samuelsson K, Thomeé R, Sundemo D, Hamrin Senorski E. Lower rates of return to sport in patients with generalised joint hypermobility two years after ACL reconstruction: a prospective cohort study. BMC Sports Sci Med Rehabil 2023; 15:100. [PMID: 37573382 PMCID: PMC10422717 DOI: 10.1186/s13102-023-00707-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/24/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Generalised joint hypermobility (GJH) has been associated with an increased risk of suffering an anterior cruciate ligament (ACL) injury. Patients with GJH exhibit lower muscle strength and poorer scores for patient-reported outcomes after ACL reconstruction, compared with patients without GJH. The aim of this study was to examine differences in the percentages of patients who return to sport (RTS) or pre-injury level of activity (RTP), muscle function and patient-reported outcomes at the time of RTS or RTP, as well as the time of RTS or RTP in patients with GJH compared with patients without GJH in the first two years after ACL reconstruction. METHODS This prospective study used data from an ACL- and rehabilitation-specific register located in Gothenburg, Sweden. Patients aged between 16 and 50, who had a primary ACL injury treated with reconstruction, were included. Data up to two years after ACL reconstruction were used and consisted of achieving RTS and RTP, results from isokinetic muscle function tests for knee extension and flexion and patient-reported outcomes (Knee Self-Efficacy Scale, Knee injury and Osteoarthritis Outcome Score and ACL-Return to Sport after Injury scale) at the time of RTS, as well as the time of RTP. A Beighton Score of ≥ 5/9 was used to define GJH. A Tegner Activity Scale of ≥ 6 was used to define RTS, while a Tegner equal to or above pre-injury level was used to define RTP. RESULTS A total of 1,198 patients (54.7% women) with a mean age of 28.5 ± 8.6 years were included. A smaller proportion of patients with GJH achieved RTS compared with patients without GJH (49.2% vs. 57.3%, Odds ratio: 0.720, p = 0.041). Furthermore, patients with GJH were marginally less symmetrical on the knee extension strength test, expressed as a Limb Symmetry Index, at the time of RTP compared with patients without GJH (87.3 ± 13.5 vs. 91.7 ± 14.3, Cohen's d = 0.142, p = 0.022). No further differences were found between groups regarding any muscle function tests or patient-reported outcomes. CONCLUSION A smaller proportion of patients with GJH achieved RTS compared with patients without GJH. Patients with GJH displayed less symmetrical knee extension strength at the time of RTP compared with patients without GJH.
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Affiliation(s)
- Jakob Lindskog
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
| | - Rebecca Simonson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden
| | - David Sundemo
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
- Närhälsan Lerum Primary Health Care Center, Lerum, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden.
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden.
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden.
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Zsidai B, Piussi R, Thomeé R, Sundemo D, Musahl V, Samuelsson K, Hamrin Senorski E. Generalised joint hypermobility leads to increased odds of sustaining a second ACL injury within 12 months of return to sport after ACL reconstruction. Br J Sports Med 2023; 57:972-978. [PMID: 37192830 PMCID: PMC10423474 DOI: 10.1136/bjsports-2022-106183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To determine the 12-month risk of a second anterior cruciate ligament (ACL) injury in a population of patients with and without generalised joint hypermobility (GJH) who return to sports (RTS) at competition level after ACL reconstruction (ACL-R). METHODS Data were extracted from a rehabilitation-specific registry for 16-50-year-old patients treated with ACL-R between 2014 and 2019. Demographics, outcome data and the incidence of a second ACL injury within 12 months of RTS, defined as a new ipsilateral or contralateral ACL, were compared between patients with and without GJH. Univariable logistic regression and Cox proportional hazards regression were performed to determine the influence of GJH and time of RTS on the odds of a second ACL injury, and ACL-R survival without a second ACL injury after RTS. RESULTS A total of 153 patients, 50 (22.2%) with GJH and 175 (77.8%) without GJH, were included. Within 12 months of RTS, 7 (14.0%) patients with GJH and 5 (2.9%) without GJH had a second ACL injury (p=0.012). The odds of sustaining a second ipsilateral or contralateral ACL injury were 5.53 (95% CI 1.67 to 18.29) higher in patients with GJH compared with patients without GJH (p=0.014). The lifetime HR of a second ACL injury after RTS was 4.24 (95% CI 2.05 to 8.80; p=0.0001) in patients with GJH. No between-group differences were observed in patient-reported outcome measures. CONCLUSION Patients with GJH undergoing ACL-R have over five times greater odds of sustaining a second ACL injury after RTS. The importance of joint laxity assessment should be emphasised in patients who aim to return to high-intensity sports following ACL-R.
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Affiliation(s)
- Bálint Zsidai
- Department of Orthopaedics, Göteborgs universitet Institutionen för kliniska vetenskaper, Goteborg, Sweden
| | - Ramana Piussi
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Roland Thomeé
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, University of Gothenburg, Gothenburg, Sweden
| | - David Sundemo
- Institute of Clinical Sciences, Department of Orthopeadics, University of Gothenburg, Gothenburg, Europe, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Gothenburg, Sweden
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Roach MH, Aderman MJ, Gee SM, Peck KY, Roach SP, Goss DL, Posner MA, Haley CA, Svoboda SJ, Cameron KL. Influence of Graft Type on Lower Extremity Functional Test Performance and Failure Rate After Anterior Cruciate Ligament Reconstruction. Sports Health 2023; 15:606-614. [PMID: 36154541 PMCID: PMC10293572 DOI: 10.1177/19417381221119420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Both autografts and allografts are used to reconstruct the anterior cruciate ligament (ACL) after injury; however, it is unclear whether graft source affects lower extremity functional test performance or failure rate in an active military population. OBJECTIVE To compare lower extremity functional test performance and graft failure rates between ACL grafts [allograft, hamstring, bone-patellar tendon-bone (BTB)]. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 2. METHODS Ninety-eight cadets entering a US Service Academy with a history of unilateral ACL reconstruction (ACLR) agreed to participate. Before basic training, participants completed 4 lower extremity functional tests. Active injury surveillance was conducted within the study cohort to identify all subsequent graft failures. RESULTS Cadets with hamstring autografts outperformed the BTB and allograft groups on the Lower Quarter Y-Balance Test-Posteromedial direction and single-leg hop test, respectively. No differences were detected by graft type for the other functional tests. The incidence of subsequent ipsilateral graft failures in patients with autograft was 8.11%. No failures were observed in the allograft group during the follow-up period. After controlling for sex, joint hypermobility, and time since injury and surgery, the risk of graft failure was 9.8 times higher for patients with a hamstring autograft than with a BTB (P = 0.045). CONCLUSION After ACLR, graft type appears to influence some single-limb measures of lower extremity function and the risk of subsequent failure. Hamstring autografts demonstrated better functional performance but increased risk of graft failure. CLINICAL RELEVANCE Surgeons need to weigh the pros and cons of all graft options in relation to the patient's lifestyle. Regardless of graft type, individuals with an ACLR may require additional rehabilitation to regain neuromuscular control during dynamic single-limb tasks and mitigate graft failure.
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Affiliation(s)
- Megan H. Roach
- Megan H. Roach, PhD, ATC, 2817 Reilly Road, Fort Bragg, NC 28310 () (Twitter: @houston_mn & @WPOrthoResearch)
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Chung K, Choi CH, Jung M, Choi J, Kim SJ, Kim SH. Factors Influencing the Initial Constraint Level of the Knee Joint and Its Effect on Clinical Outcomes After ACL Reconstruction With Hamstring Graft. Orthop J Sports Med 2023; 11:23259671221148451. [PMID: 36874051 PMCID: PMC9974630 DOI: 10.1177/23259671221148451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/21/2022] [Indexed: 03/07/2023] Open
Abstract
Background A force-based tension protocol that uses a certain amount of tension at graft fixation could still give rise to variations in initial constraint levels of the knee joint in terms of side-to-side difference (SSD) in anterior translation. Purpose To investigate the factors influencing the initial constraint level in anterior cruciate ligament (ACL)-reconstructed knees and compare outcomes according to the level of constraint in terms of anterior translation SSD. Study Design Cohort study; Level of evidence, 3. Methods Included were 113 patients who underwent ipsilateral ACL reconstruction using an autologous hamstring graft and had minimum 2-year follow-up outcomes. All grafts were tensioned and fixed at 80 N using a tensioner at the time of graft fixation. The patients were classified into the following 2 groups according to the initial anterior translation SSD, measured using the KT-2000 arthrometer: a physiologic constraint group with restored anterior laxity ≤2 mm (group P; n = 66) and a high-constraint group with restored anterior laxity >2 mm (group H; n = 47). Clinical outcomes were compared between the groups, and preoperative and intraoperative variables were evaluated to identify factors affecting the initial constraint level. Results Between group P and group H, generalized joint laxity (P = .005), posterior tibial slope (P = .022), and anterior translation measured in the contralateral knee (P < .001) were found to differ significantly. Measured anterior translation in the contralateral knee was the only significant predictor of high initial graft tension (P = .001). No significant differences were found between the groups regarding clinical outcomes and subsequent surgery. Conclusion Greater anterior translation measured in the contralateral knee was an independent predictor of a more constrained knee after ACL reconstruction. The short-term clinical outcomes after ACL reconstruction were comparable, regardless of the initial constraint level in terms of anterior translation SSD.
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Affiliation(s)
- Kwangho Chung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Gyeonggi, Republic of Korea
| | - Chong Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeehoon Choi
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jae Kim
- Arthroscopy and Joint Research Institute, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei Sarang Hospital, Seoul, Republic of Korea.,Arthroscopy and Joint Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Cohen D, Jean PO, Patel M, Aravinthan N, Simunovic N, Duong A, Safran MR, Khanduja V, Ayeni OR. Hip microinstability diagnosis and management: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:16-32. [PMID: 35441843 DOI: 10.1007/s00167-022-06976-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/29/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this systematic review is to present the most common causes, diagnostic features, treatment options and outcomes of patients with hip micro-instability. METHODS Three online databases (MEDLINE, Embase, and PubMed) were searched from database inception March 2022, for literature addressing the diagnosis and management of patients with hip micro-instability. Given the lack of consistent reporting of patient outcomes across studies, the results are presented in a descriptive summary fashion. RESULTS Overall, there were a total of 9 studies including 189 patients (193 hips) included in this review of which 89% were female. All studies were level IV evidence with a mean MINORS score of 12 (range: 10-13). The most commonly used features for diagnosis of micro-instability on history were anterior pain in 146 (78%) patients and a subjective feeling of instability with gait in 143 (81%) patients, while the most common feature on physical examination was the presence of anterior apprehension with combined hip extension and external rotation in 123 (65%) patients. The most common causes of micro-instability were iatrogenic instability secondary to either capsular insufficiency or cam over-resection in 76 (62%) patients and soft tissue laxity in 38 (31%) patients. CONCLUSION The most common symptom of micro-instability on history was anterior hip pain and on physical exam was pain with hip extension and external rotation. There are many treatment options and when managed appropriately based on the precise cause of micro-instability, patients may demonstrate improved outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Pierre-Olivier Jean
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Milin Patel
- Faculty of Science, McMaster University, Hamilton, ON, Canada
| | | | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Andrew Duong
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Marc R Safran
- Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Vikas Khanduja
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8N 3Z5, Canada.
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Hosseinzadeh N, Mohammadpour M, Moghtadaei M, Farahini H, Khazanchin A, Nasiri S, Khazanchin A. Evaluation of the short-term outcomes of anatomic ACL reconstruction with hamstring autograft in patients with generalized joint laxity: A retrospective case-control study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03390-0. [PMID: 36125587 DOI: 10.1007/s00590-022-03390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The outcomes of anterior cruciate ligament reconstruction (ACLR) in patients with generalized joint laxity (GJL) are not clearly understood. In this study, we compared the outcomes of ACLR with quadruple hamstring autograft between GJL and non-GJL patients. METHODS In a retrospective case-control study, 36 patients with GJL, according to the Beighton and Horan Joint Mobility Index, who underwent ACLR surgery, were included. Forty-four group-matched non-GJL patients were included in the control group. The mean follow-up of the patients was 20.65 ± 6.93 months. The outcomes of ACLR were evaluated by the Lachman test, pivot shift test, anterior tibial translation and KT-1000 side-to-side difference, and International Knee Documentation Committee (IKDC) scale. RESULTS The results of the Lachman and pivot shift test were not significantly different between the GJL and non-GJL patients (P = 0.67 and P = 0.27, respectively). The mean anterior tibial translation was 7.06 ± 1.41 mm in the GJL group and 6.11 ± 1.53 mm in the non-GJL group (P = 0.006). The mean KT-1000 side-to-side difference was 2.25 ± 1.31 mm in the case and 2.5 ± 1.44 mm in the control group (P = 0.42). The mean IKDC score of the patients was not significantly different between the GJL and non-GJL groups (66.1 ± 20.6 vs. 69.9 ± 16.1, P = 0.35). ACLR failure occurred in 2 (5.5%) patients of the GJL group and no patients of the control group (P = 0.21). CONCLUSION The present findings suggest ACLR with quadruple hamstring autograft as an adequate treatment for GJL patients, at least in short-term follow-up.
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Affiliation(s)
- Nima Hosseinzadeh
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran
| | - Mehdi Mohammadpour
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran
| | - Mehdi Moghtadaei
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran
| | - Hossein Farahini
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran
| | - Ahmad Khazanchin
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran
| | - Shirin Nasiri
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran
| | - Amir Khazanchin
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, 1157637131, Iran.
- Shafa Orthopedic Hospital, Baharestan Square, Mojahedin-e-Islam St, Shafa Yahyaian Educational and Medical Center, Iran University of Medical Science, Tehran, 1157637131, Iran.
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9
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Generalized joint hypermobility does not influence 1-year patient satisfaction or functional outcome after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:4173-4180. [PMID: 35676596 PMCID: PMC9668803 DOI: 10.1007/s00167-022-07008-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE The purpose of this study was to evaluate whether generalized joint hypermobility (GJH) influences postoperative results, including return to sport, patientreported outcomes, functional performance (hop tests), muscular strength, and the occurrence of ACL re-injury, in patients 1 year after anterior cruciate ligament (ACL) reconstruction. METHODS Data was extracted from a regional rehabilitation-specific registry containing information on patients with ACL injury. Patients between the ages of 16-50 years previously undergoing ACL reconstruction with available 1 year follow-up data were eligible for inclusion. Generalized joint hypermobility was assessed using the Beighton score (BS). Patients were examined one year postoperatively in terms of return to sport, patient-reported outcome, hop tests, muscular strength and the occurrence of reinjury. For purpose of analysis, patients were allocated into two groups, depending on the existence of GJH. The KOOS subscale of sports and recreation was considered the primary outcome. Analyses were performed both dichotomously and by using adjusted logistic regression, to consider potential confounders. RESULTS A total of 356 patients (41% males) were included, of which 76 (24% male) were categorized as having GJH. Patients with GJH had an inferior limb symmetry index preoperatively in terms of knee extension (mean 81.6 [SD 16.4] vs. 91.4 [SD 15.9], p = 0.02) and flexion strength (mean 91.9 vs. 99.1, p = 0.047) compared to patients without GJH. There was no difference between the groups in terms of the primary outcome, nor in any of the other postoperative outcomes. Nine patients (11.8%) in the group with GJH suffered ACL re-injury, compared with 13 patients (4.6%) in the control group (n.s.). CONCLUSION One year after ACL reconstruction the existence of GJH did not affect postoperative patient satisfaction, strength or functional outcome. No conclusive statements can be made regarding the influence of GJH on the risk of ACL re-injury in this particular study. LEVEL OF EVIDENCE Level II.
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Katagiri H, Nakagawa Y, Miyatake K, Ozeki N, Kohno Y, Amemiya M, Sekiya I, Koga H. Comparison of Clinical Outcomes after Revision Anterior Cruciate Ligament Reconstruction using a Bone-patellar Tendon-bone Autograft and that Using a Double-Bundle Hamstring Tendon Autograft. J Knee Surg 2021; 36:613-621. [PMID: 34952548 DOI: 10.1055/s-0041-1740927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to compare clinical outcomes between revision anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone (BPTB) autograft and that using a double-bundle hamstring tendon (HT) autograft. METHODS Consecutive cases of revision ACLRs were reviewed. The Lysholm knee scale and Knee Osteoarthritis Outcome Score (KOOS) were recorded at the final follow-up. The pivot shift test, Lachman test, and anterior knee laxity measurement using an arthrometer were evaluated before revision ACLR and at final follow-up. Contralateral knee laxity was also evaluated, and side-to-side differences noted. The Lysholm knee scale, KOOS, the pivot shift test, Lachman test, and anterior knee laxity were compared between HT versus BPTB autograft recipient groups using the Mann-Whitney test or the t-test. RESULTS Forty-one patients who underwent revision ACLR and followed up for at least 2 years were included. The graft source was a BPTB autograft in 23 patients (BPTB group) and a double-bundle HT autograft in 18 patients (HT group). The mean postoperative follow-up period was 44 ± 28 months in the BPTB group and 36 ± 18 in the HT group (p = 0.38). The HT group had significantly higher KOOS in the pain subscale (less pain) than the BPTB group at the final follow-up (BPTB group 84.2 vs. HT group 94.4; p = 0.02). The BPTB group showed significantly smaller side-to-side difference in anterior knee laxity (superior stability) than the HT group (0.3 vs. 2.6 mm; p < 0.01). The percentage of patients with residual anterior knee laxity in the BPTB group was significantly lower than that in the HT group (9.5% vs. 46.7%; odds ratio, 8.3; p = 0.02). STUDY DESIGN This was a level 3 retrospective study. CONCLUSION Revision ACLR with a BPTB autograft was associated with superior results regarding restoration of knee joint stability as compared with that with a double-bundle HT autograft, whereas double-bundle HT autograft was superior to BPTB autograft in terms of patient-reported outcomes of pain. The rest of the patient-reported outcomes were equal between the two groups.
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Affiliation(s)
- Hiroki Katagiri
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Orthopedic Surgery, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Saitama, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazumasa Miyatake
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobutake Ozeki
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Yuji Kohno
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Masaki Amemiya
- Department of Orthopedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Ichiro Sekiya
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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11
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Lim JR, Lee HM, Yoon TH, Lee HM, Chun YM. Association Between Excessive Joint Laxity and a Wider Hill-Sachs Lesion in Anterior Shoulder Instability. Am J Sports Med 2021; 49:3981-3987. [PMID: 34694163 DOI: 10.1177/03635465211049221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Excessive general joint laxity, a negative prognostic factor in joint instability, has not been studied to determine its relationship with bipolar bone loss in anterior shoulder instability. PURPOSE/HYPOTHESIS This study aimed to investigate the characteristics of bipolar bone defects in the presence of excessive joint laxity and the clinical outcomes based on the on-track/off-track theory. We hypothesized that (1) patients with excessive joint laxity might have less significant bipolar bone defects compared with those without excessive joint laxity and (2) no significant difference would be found in the clinical outcomes, including recurrence rate. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study included 81 patients who had undergone arthroscopic Bankart repair, with (group L; n = 33) or without (group N; n = 48) excessive joint laxity. The presence of excessive joint laxity was defined as a score of ≥4 using Beighton and Horan criteria preoperatively. Bipolar bone lesions were assessed using preoperative 3-dimensional computed tomography. Additional remplissage was performed for cases with off-track or positive engagement test in borderline on-track lesions. The functional outcomes at the 2-year follow-up were assessed using the recurrence rate, Subjective Shoulder Value, Rowe score, University of California Los Angeles shoulder score, active range of motion, and the sports/recreation activity level. RESULTS No significant difference was found in the glenoid bone defect between groups (14.1%, group L; 14.4%, group N). Off-track lesions were identified in 39.4% (13/33) of group L and 14.6% (7/48) of group N (P = .011). The mean Hill-Sachs interval to glenoid track ratio was 83.1% in group L and 75.2% in group N (P = .021). Additional remplissage procedures were more frequently performed in group L (48.5%; 16/33) than in group N (16.7%; 8/48) (P = .002). However, no significant difference was observed in the shoulder functional scores and recurrence rates between the groups. CONCLUSION Patients with anterior shoulder instability and excessive joint laxity had significantly wider Hill-Sachs lesions and more off-track lesions than did those with normal joint laxity despite the lack of a significant difference in the glenoid bone defect. However, these differences in the Hill-Sachs lesion were not related to differences in the functional outcomes between the groups.
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Affiliation(s)
- Joon-Ryul Lim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Hyung-Min Lee
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Hwan-Mo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
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12
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Krebs NM, Barber-Westin S, Noyes FR. Generalized Joint Laxity Is Associated With Increased Failure Rates of Primary Anterior Cruciate Ligament Reconstructions: A Systematic Review. Arthroscopy 2021; 37:2337-2347. [PMID: 33621648 DOI: 10.1016/j.arthro.2021.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate patients with generalized joint laxity (GJL) after primary anterior cruciate ligament reconstruction (ACLR) as to the risk of ACLR failure, graft selection success rates, and overall clinical outcomes. METHODS A systematic review of the PubMed and EMBASE databases was performed to identify studies published from the inception of the databases through February 4, 2020. The inclusion criteria were original studies written in English involving outcomes of patients with GJL who had undergone primary ACLR. RESULTS Nine studies met the inclusion criteria, which included 1,869 patients. Most underwent isolated bone-patellar tendon-bone (BPTB; n = 1062) or hamstring autograft (n = 696) ACLR. Overall, higher graft failure rates tended to occur in patients with GJL compared with patients without GJL (range per study: 6%-30% vs 0%-12.3%). Inferior results were also found patients with GJL in patient-reported outcome measures and postoperative knee stability determined by KT, Lachman, and pivot-shift tests. BPTB autografts tended to have lower failure rates than hamstring autografts in patients with GJL (range per study: 6%-21% vs 17.6%-30%). Only 1 study determined outcomes of a combined ACLR and extra-articular augmentation in patients with GJL. CONCLUSIONS Patients with GJL are at an increased risk of inferior outcomes and graft failure after primary ACLR. BPTB autografts may have more favorable stability outcomes compared with hamstring autografts in patients with GJL. However, the reported stability parameters and KT results, even with a BPTB autograft, remain inferior to non-GJL published results, and the added benefit of an extra-articular procedure to supplement the primary ACLR deserves consideration. LEVEL OF EVIDENCE Level III, systematic review of Level II and III investigations.
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Affiliation(s)
- Nathan M Krebs
- Cincinnati SportsMedicine & Orthopaedic Center, Cincinnati, Ohio, U.S.A
| | | | - Frank R Noyes
- Cincinnati SportsMedicine & Orthopaedic Center, Cincinnati, Ohio, U.S.A.; Noyes Knee Institute, Cincinnati, Ohio, U.S.A.; Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A
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13
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Maldonado DR, Chen JW, Yelton MJ, Rosinsky PJ, Shapira J, Brayboy C, Lall AC, Domb BG. Achieving Successful Outcomes of Hip Arthroscopy in the Setting of Generalized Ligamentous Laxity With Labral Preservation and Appropriate Capsular Management: A Propensity Matched Controlled Study. Am J Sports Med 2020; 48:1625-1635. [PMID: 32374634 DOI: 10.1177/0363546520914604] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Association among generalized ligamentous laxity (GLL), hip microinstability, and patient-reported outcomes (PROs) after hip arthroscopy has yet to be completely established. PURPOSES (1) To report minimum 2-year PROs in patients with GLL who underwent hip arthroscopy in the setting of symptomatic labral tears and femoroacetabular impingement syndrome and (2) to compare clinical results with a matched-pair control group without GLL. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data from a prospectively collected database were retrospectively reviewed between August 2014 and December 2016. Patients were considered eligible if they received primary arthroscopic treatment for symptomatic labral tears and femoroacetabular impingement. Inclusion criteria included preoperative and minimum 2-year follow-up scores for the following PROs: modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale for pain (VAS). From the sample population, 2 groups were created: the GLL group (Beighton score ≥4) and the control group (Beighton score <4). Patients were matched in a 1:2 ratio via propensity score matching according to age, sex, body mass index, Tönnis grade, and preoperative lateral center-edge angle. Patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) for mHHS, Hip Outcome Score-Sports Specific Scale (HOS-SSS), and International Hip Outcome Tool-12 (iHOT-12) were calculated. RESULTS A total of 57 patients with GLL were matched to 88 control patients. Age, sex, body mass index, and follow-up times were not different between groups (P > .05). Preoperative radiographic measurements demonstrated no difference between groups. Intraoperative findings and procedures between groups were similar except for capsular treatment, with the GLL group receiving a greater percentage of capsular plications (P = .04). At minimum 2-year follow-up, both groups showed significant improvement in PROs and VAS (P < .001). Furthermore, the postoperative PROs at minimum 2-year follow-up and the magnitude of improvement (delta value) were similar between groups for mHHS, NAHS, HOS-SSS, and VAS (P > .05). Moreover, groups reached comparable rates of MCID and PASS for mHHS, HOS-SSS, and iHOT-12. CONCLUSION Patients with GLL after hip arthroscopy for symptomatic femoroacetabular impingement and labral tears may expect favorable outcomes with appropriate labral and capsular management at minimum 2-year follow-up. When compared with a pair-matched control group without GLL, results were comparable for mHHS, NAHS, HOS-SSS, and VAS and reached PASS and/or MCID for mHHS, HOS-SSS, and iHOT-12.
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Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Jeffery W Chen
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Mitchell J Yelton
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Philip J Rosinsky
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Jacob Shapira
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Ciaran Brayboy
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
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14
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Sundemo D, Hamrin Senorski E, Karlsson L, Horvath A, Juul-Kristensen B, Karlsson J, Ayeni OR, Samuelsson K. Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: a systematic review. BMJ Open Sport Exerc Med 2019; 5:e000620. [PMID: 31798951 PMCID: PMC6863654 DOI: 10.1136/bmjsem-2019-000620] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2019] [Indexed: 01/02/2023] Open
Abstract
Objectives To investigate the association between generalised joint hypermobility (GJH) and ACL injury risk. Secondary aims involved evaluating associations between GJH and postoperative outcome (including graft-failure risk, knee laxity and patient-reported outcome). Furthermore, we aimed to compare the performance of different grafts in patients with GJH. Methods Databases MEDLINE/PubMed, EMBASE and the Cochrane Library were searched, including 2760 studies. Two reviewers independently screened studies for eligibility. A modified version of the MINORS score was applied for quality appraisal. Studies assessing GJH while reporting the risk of ACL injury and/or postoperative outcome were included. Results Twenty studies were included, using several different methods to determine GJH. There was consistent evidence showing that GJH is a risk factor for unilateral ACL injury in males, while in females, the results were conflicting. There was limited evidence associating GJH with increased knee laxity 5 years postoperatively. There was consistent evidence of inferior postoperative patient-reported outcome in patients with GJH. Moreover, there was limited yet consistent evidence indicating that patellar-tendon autografts are superior to hamstring-tendon autografts in patients with GJH in terms of knee laxity and patient-reported outcome. There was insufficient evidence to draw conclusions regarding the outcomes of bilateral ACL injury and graft failure. Conclusions In men, GJH was associated with an increased risk of unilateral ACL injury. Moreover, GJH was associated with greater postoperative knee laxity and inferior patient-reported outcome. Based on the available evidence, a patellar-tendon autograft appears to be superior to a hamstring-tendon autograft in patients with GJH. However, the included studies were heterogeneous and there is a need for consensus in the assessment of GJH within sports medicine.
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Affiliation(s)
- David Sundemo
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabiltation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Karlsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alexandra Horvath
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, Syddansk Universitet Det Sundhedsvidenskabelige Fakultet, Odense, Denmark
| | - Jon Karlsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olufemi R Ayeni
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kristian Samuelsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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15
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Sundemo D, Mikkelsen C, Cristiani R, Forssblad M, Senorski EH, Svantesson E, Samuelsson K, Stålman A. Contralateral knee hyperextension is associated with increased anterior tibial translation and fewer meniscal injuries in the anterior cruciate ligament-injured knee. Knee Surg Sports Traumatol Arthrosc 2018; 26:3020-3028. [PMID: 29974175 PMCID: PMC6154035 DOI: 10.1007/s00167-018-5047-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/27/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the influence of hyperextension of the contralateral healthy knee on anterior tibial translation (ATT) and the presence of associated injuries in the anterior cruciate ligament (ACL)-injured knee. METHODS A local patient data register containing the surgical and clinical data of patients undergoing ACL reconstruction was analyzed. Patients were divided into groups according to the degree of hyperextension of the contralateral knee: normal (Group A ≤ 0°), mild (Group B 1°-5°), moderate (Group C 6°-10°), and severe (Group D > 10°). The ATT was measured in both knees preoperatively and 6 months postoperatively using the KT-1000 arthrometer. The presence of associated meniscal and cartilage injuries was noted. Using multivariate analysis, Groups B, C, and D were compared with Group A, using this group as a reference. RESULTS A total of 10,957 patients were available in the register and 8502 (Group A n = 4335, Group B n = 3331, Group C n = 771, Group D n = 65) were included in the final analysis. Groups B (10.3 mm; 95% CI 0.06-0.042, p < 0.0001) and C (10.6 mm; 95% CI 0.23-0.89, p = 0.006) showed significantly greater preoperative ATT in the injured knee compared with the control group (10.1 mm). Moreover, at the 6-month follow-up, greater ATT was observed for Groups B (8.5 mm; 95% CI 0.13-0.45, p < 0.0001), C (8.5 mm; 95% CI 0.02-0.60, p = 0.035), and D (9.1 mm; 95% CI - 0.08-1.77, p = 0.082) compared with Group A (8.2 mm). Meniscal injuries were less frequent in patients with contralateral hyperextension [Group B 903 (27.1%) p < 0.0001, Group C 208 (27.0%) p = 0.0003, and Group D 12 (18.5%), 0.012] compared with the control group [Group A 1479 (34.1%)]. CONCLUSION Contralateral knee hyperextension is associated with greater pre- and postoperative ATT in the ACL-injured knee. In patients with contralateral knee hyperextension, concomitant injuries to the menisci are less frequent. Surgeons should consider grafts with superior properties regarding postoperative anteroposterior laxity to patients with contralateral knee hyperextension. LEVEL OF EVIDENCE Retrospective cohort study, Level IV.
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Affiliation(s)
- David Sundemo
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Christina Mikkelsen
- Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Riccardo Cristiani
- Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Forssblad
- 0000 0004 1937 0626grid.4714.6Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Eric Hamrin Senorski
- 0000 0000 9919 9582grid.8761.8Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eleonor Svantesson
- 0000 0000 9919 9582grid.8761.8Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- 0000 0000 9919 9582grid.8761.8Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,000000009445082Xgrid.1649.aDepartment of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Anders Stålman
- Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
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