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Ishida T, Koshino Y, Yamanaka M, Ueno R, Taniguchi S, Ino T, Kasahara S, Samukawa M, Tohyama H. Larger hip external rotation motion is associated with larger knee abduction and internal rotation motions during a drop vertical jump. Sports Biomech 2024; 23:640-654. [PMID: 33663352 DOI: 10.1080/14763141.2021.1881151] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 01/21/2021] [Indexed: 01/14/2023]
Abstract
Associations among hip motions, knee abduction and internal rotation motion during a drop vertical jump (DVJ), which increases the risk of anterior cruciate ligament injury, remain unclear. The purpose of this study was to examine associations among knee abduction, internal rotation and hip joint motions during a DVJ. Fifty-seven young female participants performed a DVJ from a 30-cm height. Hip and knee kinematics and kinetics were analysed using a three-dimensional motion analysis system and force plates. Multiple regression analysis showed that peak knee abduction angle was negatively associated with knee internal rotation and hip internal rotation excursions from initial contact (IC) to peak knee flexion, and positively associated with peak knee abduction moment (R2 = 0.465, P< 0.001). Peak knee internal rotation angle was negatively associated with the hip flexion excursion from IC to peak knee flexion and peak hip adduction moment (R2 = 0.194, P= 0.001). In addition, hip internal rotation excursion was negatively associated with knee abduction and internal rotation excursion from IC to 50 ms after IC. To avoid a large knee abduction and internal rotation motion during jump-landing training, it might be beneficial to provide landing instructions to avoid a large hip external rotation motion.
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Affiliation(s)
- Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Masanori Yamanaka
- Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Ryo Ueno
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | | | - Takumi Ino
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Japan
| | | | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Low CA, Teo SH. Higher Rates of Anatomical Insertion of Medial Hamstring Tendon Regeneration Post-Anterior Cruciate Ligament Reconstruction with Stump Preservation Graft Harvesting Technique: A Prospective, Randomized, Double-Blinded Clinical Trial with Magnetic Resonance Imaging Evaluation. J ISAKOS 2024:S2059-7754(24)00083-X. [PMID: 38677365 DOI: 10.1016/j.jisako.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE (s): The purpose of this study was to compare the regeneration of semitendinosus and gracilis tendons from two different graft harvesting techniques which are the stump preservation and conventional graft harvesting technique. We hypothesised that the stump preservation graft harvesting technique which preserved the distal attachment of tendons at their insertion would facilitate anatomical regeneration to the pes anserinus. METHODS This is a prospective, randomised double-blinded study whereby thirty consecutive patients who underwent single bundle anterior cruciate ligament reconstruction with ipsilateral semitendinosus and gracilis autografts were recruited. The patients were randomly assigned to the stump preservation group (14 patients) or conventional group (16 patients). magnetic resonance imaging (MRI) evaluation was performed preoperatively and at 6-months postoperatively. RESULTS At 6-months follow-up, MRI evaluations showed a higher percentage of insertion of regenerated semitendinosus and gracilis at the pes anserinus in the stump preservation group (75.0%) than that in the conventional group (68.8%). There was significantly higher proximal shift of musculotendinous junction of semitendinosus (5.70 cm versus 3.36 cm, p = 0.029) and gracilis (5.28 cm versus 3.16 cm, p = 0.045) in the conventional group postoperatively. CONCLUSION The stump preservation technique yields higher percentage of anatomical insertion of regenerated tendons and lesser amount of proximal shift of musculotendinous junction. LEVEL OF EVIDENCE III - Prospective study with up to two negative criteria.
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Affiliation(s)
- Chin Aun Low
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Seow Hui Teo
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia.
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Ong MTY, Lu X, Choi BCY, Wan SW, Wang Q, Man GCW, Lui PPY, Fong DTP, Mok DKW, Yung PSH. Vitamin D as an intervention for improving quadriceps muscle strength in patients after anterior cruciate ligament reconstruction: study protocol for a randomized double-blinded, placebo-controlled clinical trial. Trials 2024; 25:251. [PMID: 38605374 PMCID: PMC11008016 DOI: 10.1186/s13063-024-08094-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The goal of anterior cruciate ligament reconstruction (ACLR) is to restore the preinjury level of knee function to return to play (RTP). However, even after completing the rehabilitation programme, some patients may have persistent quadriceps muscle weakness affecting knee function which ultimately leads to a failure in returning to play. Vitamin D has been long recognized for its musculoskeletal effects. Vitamin D deficiency may impair muscle strength recovery after ACLR. Correcting vitamin D levels may improve muscle strength. METHODS This is a double-blinded, randomized controlled trial to investigate the effects of vitamin D supplementation during the post-operative period on quadriceps muscle strength in anterior cruciate ligament (ACL)-injured patients. Patients aged 18-50 with serum vitamin D < 20 ng/ml, unilateral ACL injury, > 90% deficit in total quadriceps muscle volume on the involved leg compared with uninvolved leg, Tegner score 7 + , and no previous knee injury/surgery will be recruited. To assess patient improvement, we will perform isokinetic and isometric muscle assessments, ultrasound imaging for quadriceps thickness, self-reported outcomes, KT-1000 for knee laxity, biomechanical analysis, and Xtreme CT for bone mineral density. To investigate the effect of vitamin D status on quadriceps strength, blood serum samples will be taken before and after intervention. DISCUSSION Patients with low vitamin D levels had greater quadriceps fibre cross-sectional area loss and impaired muscle strength recovery after ACL. The proposed study will provide scientific support for using vitamin D supplementation to improve quadriceps strength recovery after ACLR. TRIAL REGISTRATION ClinicalTrials.gov NCT05174611. Registered on 28 November 2021.
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Affiliation(s)
- Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
| | - Xiaomin Lu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Ben Chi-Yin Choi
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Siu-Wai Wan
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, TU314, Block U, Hung Hom, Hong Kong SAR, China
| | - Qianwen Wang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Gene Chi-Wai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Pauline Po-Yee Lui
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Daniel Tik-Pui Fong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Daniel Kam-Wah Mok
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, TU314, Block U, Hung Hom, Hong Kong SAR, China.
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Homan MD, Braaten JA, Banovetz MT, Monson JK, Kennedy NI, LaPrade RF. Principles for optimizing anterior cruciate ligament reconstruction outcomes in elite athletes: a review of current techniques. Ann Jt 2024; 9:19. [PMID: 38694814 PMCID: PMC11061659 DOI: 10.21037/aoj-22-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/29/2023] [Indexed: 05/04/2024]
Abstract
Anterior cruciate ligament (ACL) tears are one of the most common sport-related injuries and occur in greater than 3% of athletes in a four-year window of sports participation. Non-contact injuries are the most common mechanism for ACL injury in elite-level athletes, especially with increased valgus and external rotation of the knee when loading eccentrically in flexion. Because of the immense toll these injuries and their recovery take on athletes especially, optimal treatment has been a subject of great interest for some time. Many ACL reconstruction (ACLR) and repair techniques have been implemented and improved in the last two decades, leading to many surgical options for this type of injury. The surgical approach to high-level athletes in particular requires additional attention that may not be necessary in the general population. Important considerations for optimizing ACL treatment in high-level athletes include choosing repair vs. reconstruction, surgical techniques, choice of auto- or allograft, and associated concomitant procedures including other injuries or reinforcing techniques as well as attention to rehabilitation. Here, we discuss a range of surgical techniques from repair to reconstruction, and compare and contrast various reconstructive and reinforcing techniques as well as associated surgical pearls and pitfalls. Good outcomes for athletes suffering from ACL injury are attainable with proper treatment including the principles discussed herein.
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Nukuto K, Gale T, Yamamoto T, Musahl V, Anderst W. Bone morphology features associated with knee kinematics may not be predictive of ACL elongation during high-demand activities. Knee Surg Sports Traumatol Arthrosc 2023; 31:5096-5103. [PMID: 37728761 DOI: 10.1007/s00167-023-07560-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Bony morphology has been proposed as a potential risk factor for anterior cruciate ligament (ACL) injury. The relationship between bony morphology, knee kinematics, and ACL elongation during high-demand activities remains unclear. The purpose of this study was to determine if bone morphology features that have been associated with ACL injury risk and knee kinematics are also predictive of ACL elongation during fast running and double-legged drop jump. METHODS Nineteen healthy athletes performed fast running and double-legged drop jump within a biplane radiography imaging system. Knee kinematics and ACL elongation were measured bilaterally after using a validated registration process to track bone motion in the radiographs and after identifying ACL attachment sites on magnetic resonance imaging (MRI). Bony morphological features of lateral posterior tibial slope (LPTS), medial tibial plateau (MTP) depth, and lateral femoral condyle anteroposterior width (LCAP)/lateral tibial plateau anteroposterior width (TPAP) were measured on MRI. Relationships between bony morphology and knee kinematics or ACL elongation were identified using multiple linear regression analysis. RESULTS No associations between bony morphology and knee kinematics or ACL elongation were observed during fast running. During double-legged drop jump, a greater range of tibiofemoral rotation was associated with a steeper LPTS (β = 0.382, p = 0.012) and a deeper MTP depth (β = 0.331, p = 0.028), and a greater range of anterior tibial translation was associated with a shallower MTP depth (β = - 0.352, p = 0.018) and a larger LCAP/ TPAP (β = 0.441, p = 0.005); however, greater ACL elongation was only associated with a deeper MTP depth (β = 0.456, p = 0.006) at toe-off. CONCLUSION These findings indicate that observed relationships between bony morphology and kinematics should not be extrapolated to imply a relationship also exists between those bone morphology features and ACL elongation during high-demand activities. These new findings deepen our understanding of the relationship between bony morphology and ACL elongation during high-demand activities. This knowledge can help identify high-risk patients for whom additional procedures during ACL reconstruction are most appropriate.
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Affiliation(s)
- Koji Nukuto
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
- Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex 3820 South Water Street, Pittsburgh, PA, 15203, USA
| | - Tom Gale
- Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex 3820 South Water Street, Pittsburgh, PA, 15203, USA
| | - Tetsuya Yamamoto
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
- Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex 3820 South Water Street, Pittsburgh, PA, 15203, USA
| | - Volker Musahl
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - William Anderst
- Biodynamics Laboratory, University of Pittsburgh, Rivertech Building Complex 3820 South Water Street, Pittsburgh, PA, 15203, USA.
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Shrestha P, Singh Thapa S, Mahara DP, Paudel S, Lamichhane A, Saud T. Prediction of Hamstring Autograft sizes for Anterior Cruciate Ligament Reconstruction using Preoperative Magnetic Resonance Imaging. J Nepal Health Res Counc 2023; 21:34-39. [PMID: 37742146 DOI: 10.33314/jnhrc.v21i1.4339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/08/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND The purpose of this study is to determine whether preoperative magnetic resonance image measurements can predict the hamstring tendon autograft diameter during anterior cruciate ligament reconstruction. METHODS We prospectively evaluated Forty-two patients with anterior cruciate ligament injury who underwent reconstruction using hamstring tendon autograft. Preoperative diameters and cross-sectional areas of the hamstring tendons were estimated using magnetic resonance imaging of the knee. Intraoperative diameters of the hamstring tendon graft were measured using a cylindrical graft sizer. We used Pearson's correlation test to compare the Preoperative and intraoperative graft size measurements. A possible cutoff value for the hamstring graft size was determined using Receiver operating characteristic analysis. RESULTS The mean age of the patient in the study was 27.5 ± 8.5 years. There were statistically significant correlations between preoperative and intraoperative hamstring tendon graft measurements (P < 0.001). Our study found 13.3 mm² cross-sectional area as the cutoff for predicting 7mm of quadrupled hamstring graft size with both sensitivity and specificity of 85.7 %, respectively. CONCLUSIONS We can conclude that preoperative magnetic resonance imaging measurements can predict the intraoperative graft size. This study can help in preoperatively planning for the graft choice.
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Affiliation(s)
- Prakash Shrestha
- Department of Orthopedic Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sunil Singh Thapa
- Department of Orthopedic Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Deepak Prakash Mahara
- Department of Orthopedic Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sharma Paudel
- Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Arjun Lamichhane
- Department of Orthopedic Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Tejendra Saud
- Department of Orthopedic Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Nukuto K, Hoshino Y, Kataoka K, Kuroda R. Current development in surgical techniques, graft selection and additional procedures for anterior cruciate ligament injury: a path towards anatomic restoration and improved clinical outcomes-a narrative review. Ann Jt 2023; 8:39. [PMID: 38529242 PMCID: PMC10929350 DOI: 10.21037/aoj-23-39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/30/2023] [Indexed: 03/27/2024]
Abstract
Background and Objective Anterior cruciate ligament (ACL) reconstruction has been widely used for ACL injury for a long time. However, residual rotational instability and osteoarthritic changes after ACL reconstruction have been identified as problems. Thus, anatomic reconstruction techniques, various types of grafts and additional procedures have been desired to improve the clinical outcomes and knee instability. Although clinical outcomes and knee stability are better than in the past, ipsilateral graft failures still occur in 4-17% and osteoarthritic changes are seen in about 20% of patients after ACL reconstruction. To remedy these problems, it is necessary to improve the understanding of various surgical techniques and grafts and to pursue further improvement of surgical techniques. Therefore, the objective of this review is to summarize the advantages and disadvantages of various surgical techniques and graft selection, and additional procedures for ACL injury. Methods A literature review was conducted on the surgical procedures for ACL injury. Recent trends in surgical techniques, graft selection, and additional procedures for ACL injury were described. We performed a literature search in PubMed for studies published from origin to May 8, 2023. Studies were required to be English-language articles. Key Content and Findings Although many reports indicate that double-bundle ACL reconstruction is comparable to anatomic single-bundle (SB) reconstruction, intraoperative complications such as tunnel coalition exist in double-bundle reconstruction, and the technique needs to be improved. ACL repair has shown good short-term results, but long-term results need to be examined in the future. Quadriceps tendon autograft is being used more frequently, but hamstrings tendon autograft and bone-patellar tendon-bone autograft also have good results. In addition, in higher-risk cases, lateral extra-articular tenodesis (LET) and anterolateral ligament (ALL) reconstruction can be performed with good results. Conclusions To further improve clinical outcomes, more anatomical reconstructions should be pursued. Autografts are better than allografts and synthetic grafts, but further study is needed to determine which graft is better. Additional procedures should be performed in highly unstable cases and in revision cases.
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Affiliation(s)
- Koji Nukuto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kiminari Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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D’Ambrosi R, Meena A, Arora ES, Attri M, Schäfer L, Migliorini F. Reconstruction of the anterior cruciate ligament: a historical view. Ann Transl Med 2023; 11:364. [PMID: 37675316 PMCID: PMC10477645 DOI: 10.21037/atm-23-87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/17/2023] [Indexed: 09/08/2023]
Abstract
Management of anterior cruciate ligament (ACL) tears has continuously evolved since its first description in approximately 170 A.D. by Claudius Galenus of Pergamum and Rome. The initial immobilization using casts was replaced by a variety of surgical and conservative approaches over the past centuries. The first successful case of ACL repair was conducted by Mayo Robson in 1885, suturing cruciate at the femoral site. In the nineteenth century, surgical techniques were focused on restoring knee kinematics and published the first ACL repair. The use of grafts for ACL reconstruction was introduced in 1917 but gained popularity in the late 1900s. The introduction of arthroscopy in the 1980s represented the greatest milestones in the development of ACL surgery, along with the refinements of indications, development of modern strategies, and improvement in rehabilitation methods. Despite the rapid development and multitude of new treatment approaches for ACL injuries in the last 20 years, autografting has remained the treatment of choice. Compared to the initial methods, arthroscopic procedures are mainly performed, and more resistant and safer fixation devices are available. This results in significantly less trauma from the surgery and more satisfactory long-term results. The most commonly used procedures are still patellar tendon or hamstring autograft. Additionally, popular, but less common, is the use of quadriceps tendon (QT) grafts and allografts. In parallel with surgical developments, biological reconstruction focusing on the preservation of ACL remnants through the use of cell culture techniques, partial reconstruction, tissue engineering, and gene therapy has gained popularity. In 2013, Claes reported the discovery of a new ligament [anterolateral ligament (ALL)] in the knee that could completely change the treatment of knee injuries. The intent of these modifications is to significantly improve the primary restriction of rotational laxity of the knee after ACL injury. Kinematic studies have demonstrated that anatomic ACL reconstruction and anterolateral reconstruction are synergistic in controlling pivot displacement. Recently, there has been an increased focus on the application of artificial intelligence and machine learning to improve predictive capability within numerous sectors of medicine, including orthopedic surgery.
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Affiliation(s)
- Riccardo D’Ambrosi
- CASCO Department, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Amit Meena
- Department Orthopaedic Sports Medicine, Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada
| | - Ekjot Singh Arora
- Department of Orthopedic, Fortis Escorts Heart Institute, New Delhi, India
| | - Manish Attri
- Department of Orthopedic, Central Institute of Orthopedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Luise Schäfer
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany
- Department of Orthopedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
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Nyland J, Pyle B, Richards J, Yoshida K, Brey J, Carter S. A clinical practice review of therapeutic movement-based anterior cruciate ligament reconstruction return to sports bridge program: the biological, biomechanical and behavioral rationale. Ann Jt 2023; 8:23. [PMID: 38529232 PMCID: PMC10929313 DOI: 10.21037/aoj-23-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/12/2023] [Indexed: 03/27/2024]
Abstract
This clinical practice review describes the biological, biomechanical and behavioral rationale behind a return to sport bridge program used predominantly with non-elite, youth and adolescent high school and college athletes following anterior cruciate ligament (ACL) reconstruction. Post-physiotherapy, this program has produced outcomes that meet or exceed previous reports. With consideration for athletic identity and the Specific Adaptations to Imposed Demands (SAID) principle, the early program focus was on restoring non-impaired bilateral lower extremity joint mobility and bi-articular musculotendinous extensibility. Building on this foundation, movement training education, fundamental bilateral lower extremity strength and power, and motor learning was emphasized with use of external focus cues and ecological dynamics-social cognition considerations. Plyometric and agility tasks were integrated to enhance fast twitch muscle fiber recruitment, anaerobic metabolic energy system function, and fatigue resistance. The ultimate goal was to achieve the lower extremity neuromuscular control and activation responsiveness needed for bilateral dynamic knee joint stability. The rationale and conceptual basis of selected movement tasks and general philosophy of care concepts are described and discussed in detail. Based on the previously reported efficacy of this movement-based therapeutic exercise program we recommend that supplemental programs such as this become standard practice following release from post-surgical physiotherapy and before return to sports decision-making.
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Affiliation(s)
- John Nyland
- Norton Orthopedic Institute, Louisville, KY, USA
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
| | - Brandon Pyle
- MSAT Program, Spalding University, Louisville, KY, USA
| | - Jarod Richards
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
| | - Kei Yoshida
- MSAT Program, Spalding University, Louisville, KY, USA
| | - Jennifer Brey
- Norton Orthopedic Institute, Louisville, KY, USA
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
| | - Sam Carter
- Norton Orthopedic Institute, Louisville, KY, USA
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
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Hughes JD, Gabrielli AS, Dalton JF, Raines BT, Dewald D, Musahl V, Lesniak BP. More anterior placement of femoral tunnel position in ACL-R is associated with postoperative meniscus tears. J Exp Orthop 2023; 10:66. [PMID: 37389669 DOI: 10.1186/s40634-023-00630-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE The purpose of this study was to investigate the relationship between tunnel position in ACL reconstruction (ACL-R) and postoperative meniscus tears. METHODS This was a single institution, case-control study of 170 patients status-post ACL-R (2010-2019) separated into two matched groups (sex, age, BMI, graft type). Group 1-symptomatic, operative meniscus tears (both de novo and recurrent) after ACL-R. Group 2-no postoperative meniscus tears. Femoral and tibial tunnel positions were measured by 2 authors via lateral knee radiographs that were used to measure two ratios (a/t and b/h). Ratio a/t was defined as distance from the tunnel center to dorsal most subchondral contour of the lateral femoral condyle (a) divided by total sagittal diameter of the lateral condyle along Blumensaat's line (t). The ratio b/h was defined as distance between the tunnel and Blumensaat's line (b) divided by maximum intercondylar notch height (h). Wilcoxon sign-ranks paired test was used to compare measurements between groups (alpha set at p < 0.05). RESULTS Group 1 had average follow up of 45 months and Group 2 had average follow up of 22 months. There were no significant demographic differences between Groups 1 and 2. Group 1-a/t was 32.0% (± 10.2), which was significantly more anterior than group 2, 29.3% (± 7.3; p < 0.05). There was no difference in average femoral tunnel ratio b/h or tibial tunnel placement between groups. CONCLUSIONS A relationship exists between more anterior/less anatomic femoral tunnel position and the presence of recurrent or de novo, operative meniscus tears after ACL-R. Surgeons performing ACL-R should strive for recreation of native anatomy via proper tunnel placement to maximize postoperative outcomes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jonathan D Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Freddie Fu Sports Medicine Center, 3200 S. Water St, Pittsburgh, PA, 15203, USA.
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Alexandra S Gabrielli
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Freddie Fu Sports Medicine Center, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Jonathan F Dalton
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Freddie Fu Sports Medicine Center, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Benjamin T Raines
- The Hughston Clinic, Fort Walton Beach, FL, USA
- The Hughston Foundation, Inc, Columbus, GA, USA
| | | | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Freddie Fu Sports Medicine Center, 3200 S. Water St, Pittsburgh, PA, 15203, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Freddie Fu Sports Medicine Center, 3200 S. Water St, Pittsburgh, PA, 15203, USA
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Cojean T, Batailler C, Robert H, Cheze L. GNRB® laximeter with magnetic resonance imaging in clinical practice for complete and partial anterior cruciate ligament tears detection: A prospective diagnostic study with arthroscopic validation on 214 patients. Knee 2023; 42:373-381. [PMID: 37172464 DOI: 10.1016/j.knee.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/18/2023] [Accepted: 03/28/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Accurate diagnosis of anterior cruciate ligament (ACL) injury is not always obtained with magnetic resonance imaging (MRI). Other tools, such as the GNRB® arthrometer, help to accurately identify the type of ACL tear. The aim of this study was to show that the GNRB® could be a relevant complementary solution to MRI in ACL injuries detection. METHODS A prospective study performed between 2016 and 2020 included 214 patients who had undergone knee surgery. The study compared sensitivity/specificity pairs of MRI and the GNRB® at 134 N to detect healthy ACL, partial and complete ACL tears. Arthroscopies were the 'gold standard'. Forty-six patients had a healthy ACL with associated knee lesions, 168 patients had ACL tears where 107 were complete tears and 61 were partial tears. RESULTS For healthy ACL, MRI scored 100% for sensitivity (SE) and 95% for specificity (SP), and the GNRB® scored SE 95.65% and SP 97.5% at 134 N. For complete ACL tears, MRI scored 80.81% for sensitivity (SE) and 64.49% for specificity (SP), and the GNRB® scored SE 77.78% and SP 85.98% at 134 N. For partial tears, MRI scored SE 29.51% and SP 88.97%, and the GNRB® scored SE 73.77% and SP 85.52% at 134 N. CONCLUSION GNRB® sensitivity and specificity were equivalent to those of MRI for healthy ACL and complete ACL tear detection. However, MRI had some difficulty in detecting partial ACL tears compared with the GNRB® which showed better sensitivity.
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Affiliation(s)
- Théo Cojean
- Université de Lyon, Université Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France.
| | - Cécile Batailler
- Université de Lyon, Université Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France; Hôpital de la Croix-Rousse, Lyon, France
| | - Henri Robert
- Centre Hospitalier du Haut Anjou, Château-Gontier-Sur-Mayenne, France
| | - Laurence Cheze
- Université de Lyon, Université Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
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12
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Raja BS, Arora M, Gowda AKS, Maheshwari VK, Regmi A. Augmentation with Fibertape Leads to Biomechanically Superior but Similar Clinical Outcomes in ACL Surgeries: Systematic Review and Meta-analysis. Indian J Orthop 2023; 57:722-747. [PMID: 37128558 PMCID: PMC10147891 DOI: 10.1007/s43465-022-00805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023]
Abstract
Purpose The current generation has witnessed significant progress in the field of knee arthroscopy. Suture tapes have gained immense popularity due to perceived improved biomechanical support to the graft while it heals. The purpose of the present systematic review is to analyze the biomechanical construct of suture tapes in ACL repairs and reconstructions along with clinical outcomes. Methods Cochrane Library, PubMed, and Embase were searched until December 2021. All Biomechanical Studies on animal or cadaver knees that compared construct characteristics of suture tape in ACL repair or reconstruction and clinical studies in English focusing on outcomes following suture tape augmentation in ACL repair or reconstruction were included. The quality of clinical studies using the Modified Coleman Methodology Score (MCMS). Results A total of 16 studies biomechanical and 23 clinical studies were included in qualitative synthesis, leaving nine biomechanical studies for final quantitative analyses. Suture tape revealed biomechanical superiority in terms of ultimate strength, stiffness, cyclic displacement, and elongation of graft, while comparing ACLR with internal brace to standard ACLR. No significant difference in retear rates was seen in clinical studies. Clinical score(IKDC score) was found similar in both augmented and non-augmented construct. Similar results were obtained in biomechanical studies. Conclusion The use of suture tape as a ligament augmentation in both ACL reconstruction and ACL repair offers more strength, less elongation or displacement, and is biomechanically stable and sound. There is a lack of data to comprehensively comment upon the clinical superiority of the use of internal augmentation. However, a meta-analysis of the retear rates and clinical outcome score revealed similar outcomes between suture tape augmented and nonaugmented groups.
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Affiliation(s)
- Balgovind S. Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Manit Arora
- Department of Orthopaedics, Fortis Hospital, Mohali, Punjab India
| | - Aditya K. S. Gowda
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Vikas K. Maheshwari
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Anil Regmi
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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McDermott E, DeFoor MT, Blaber OK, Aman ZS, DePhillipo NN, Dekker TJ. Biomechanical comparison of anterior cruciate ligament reconstruction fixation methods and implications on clinical outcomes. Ann Jt 2023; 8:15. [PMID: 38529220 PMCID: PMC10929290 DOI: 10.21037/aoj-22-52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/13/2023] [Indexed: 03/27/2024]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is one of the more common surgeries encountered by orthopaedic surgeons, which has its inherent challenges due to the complex anatomy and biomechanical properties required to reproduce the function and stability of the native ACL. Multiple biomechanical factors from graft choice and tunnel placement to graft tensioning and fixation methods are vital in achieving a successful clinical outcome. Common methods of ACLR graft fixation in both the primary and revision setting are classified into compression/interference, suspensory, or hybrid fixation strategies with multiple adjunct methods of fixation. The individual biomechanical properties of these implants are crucial in facilitating early post-operative rehabilitation, while also withstanding the shear and tensile forces to avoid displacement and early graft failure during graft osseointegration. Implants within these categories include the use of interference screws (IFSs), as well as suspensory fixation with a button, posts, surgical staples, or suture anchors. Outcomes of comparative studies across the various fixation types demonstrate that compression fixation can decrease graft-tunnel motion, tunnel widening, and graft creep, at the risk of damage to the graft by IFSs and graft slippage. Suspensory fixation allows for a minimally invasive approach while allowing similar cortical apposition and biomechanical strength when compared to compression fixation. However, suspensory fixation is criticized for the risk of tunnel widening and increased graft-tunnel motion. Several adjunct fixation methods, including the use of posts, suture-anchors, and staples, offer biomechanical advantages over compression or suspensory fixation methods alone, through a second form of fixation in a second plane of motion. Regardless of the method or implant chosen for fixation, technically secure fixation is paramount to avoid displacement of the graft and allow for appropriate integration of the graft into the bone tunnel. While no single fixation technique has been established as the gold standard, a thorough understanding of the biomechanical advantages and disadvantages of each fixation method can be used to determine the optimal ACLR fixation method through an individualized patient approach.
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Affiliation(s)
- Emily McDermott
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Mikalyn T. DeFoor
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Olivia K. Blaber
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Zachary S. Aman
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Travis J. Dekker
- Department of Orthopaedic Surgery, 10th Medical Group, US Air Force Academy, CO, USA
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Banovetz MT, Kennedy NI, LaPrade RF, Engebretsen L, Moatshe G. Biomechanical considerations for graft choice in anterior cruciate ligament reconstruction. Ann Jt 2023; 8:17. [PMID: 38529237 PMCID: PMC10929340 DOI: 10.21037/aoj-22-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/30/2023] [Indexed: 03/27/2024]
Abstract
Injury to the anterior cruciate ligament (ACL) of the knee is common and often requires surgical reconstruction. There are numerous graft options available to the operating surgeon, to each of which a growing body of dedicated literature exists. Each of these potential choices of ACL graft specimen has a distinctive set of biomechanical properties, clinical outcome profiles, and other special considerations (e.g., autograft versus allograft, harvest site factors, and operating time). The purpose of this review is to discuss the biomechanical characteristics of the native ACL alongside those of several of the most commonly used ACL graft specimens based on a current review of the biomechanical literature. In doing so, this review will also briefly discuss the biomechanical implications for allograft versus autograft usage and single-bundle versus double-bundle repair techniques. This review lists and discusses the stress, strain, stiffness, Young's modulus, and ultimate load to failure of the native ACL, several common autografts [patellar bone-tendon-bone (BTB), hamstring tendon (HT), and quadriceps tendon (QT)], and several common allografts. Given the important biomechanical role of the ACL in stabilizing the knee to translational and rotational forces, it is crucial that the operating surgeon make a decision on graft choice that is informed in the biomechanical implications of ACL graft selection.
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Affiliation(s)
| | | | | | - Lars Engebretsen
- Department of Orthopedic Surgery, University of Oslo Hospital, Oslo, Norway
| | - Gilbert Moatshe
- Department of Orthopedic Surgery, University of Oslo Hospital, Oslo, Norway
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15
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Lind DRG, Patil RS, Amunategui MA, DePhillipo NN. Evolution of anterior cruciate ligament reconstruction & graft choice: a review. Ann Jt 2023; 8:19. [PMID: 38529255 PMCID: PMC10929403 DOI: 10.21037/aoj-22-39] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/21/2023] [Indexed: 03/27/2024]
Abstract
The surgical treatment of anterior cruciate ligament (ACL) injuries dates back over 100 years from the present day [2022]. While open repair of the torn ACL was popularized in the early 1900s, the first ACL reconstructions utilized the fascia lata as a graft and other extra-articular stabilizing techniques. The first free tendon graft reported for ACL reconstructions was the quadriceps tendon (QT) in the 1930s, followed by the hamstrings tendon (HT), and then the patellar tendon. With improved understanding of the ACL anatomy and biomechanics and the invention of the arthroscope, ACL reconstruction evolved from open procedures to arthroscopic. Similarly, with the help of many surgeon-scientists who reported patient outcomes following ACL reconstruction with various techniques, graft choice evolved with the hamstrings and patellar tendon grafts becoming the dominant and preferred choice of both surgeons and patients. In present day, we see a resurgence of one of the original grafts reported, the QT, as well as primary ACL repair. Future research will result in continued advancements of ACL surgical techniques and graft harvesting, which will allow the orthopedic community (including patients and surgeons) to benefit from such innovations and advanced technologies.
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Affiliation(s)
- Dane R G Lind
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Rohan S Patil
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew A Amunategui
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Ghasemi M, Sigurðsson HB, Sveinsson Þ, Briem K. Boys demonstrate greater knee frontal moments than girls during the impact phase of cutting maneuvers, despite age-related increases in girls. Knee Surg Sports Traumatol Arthrosc 2023; 31:1833-1839. [PMID: 36810949 PMCID: PMC10090008 DOI: 10.1007/s00167-023-07340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injury rate is low among children, but increases during adolescence, especially in girls. Increases in the knee valgus moment within 70 ms of contact with the ground (KFM0-70) may explain the sex-specific increase in the risk of ACL injury. The purpose of the study was to investigate sex-dependent changes in the KFM0-70 from pre-adolescence to adolescence during a cutting maneuver (CM). METHODS Kinematic and kinetic data during the CM task, performed before and after physical exertion, were recorded using a motion capture system and a force plate. A total of 293 team handball and soccer players, aged 9-12 years, were recruited. A number of those who continued sports participation (n = 103) returned five years later to repeat the test procedure. Three mixed-model analysis of variance (ANOVA) for repeated measures tests were used to determine the effects of sex and age period on the KFM0-70 (1: with no adjustment, 2: adjusted for repeated measurements, and 3: additionally adjusted with hip and knee joint frontal plane kinematics). RESULTS Boys had significantly higher KFM0-70 than girls at both age periods (p < 0.01 for all models). Girls, not boys, demonstrated significantly increased KFM0-70 from pre-adolescence to adolescence. Importantly, this was fully explained by kinematic variables. CONCLUSION Although the marked increase in KFM0-70 seen in girls may play a role in their risk of ACL rupture, the higher values demonstrated by boys during CM reflect the complexity of multifactorial biomechanical risk factor analysis. The role of kinematics in mediating the KFM0-70 provides means for modification of this risk factor, but as boys had higher joint moments, continued investigation into sex-dependent biomechanical risk factors is warranted. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - Haraldur Björn Sigurðsson
- Department of Physical Therapy, University of Iceland, Reykjavík, Iceland
- Research Centre of Movement Science, University of Iceland, Reykjavík, Iceland
| | - Þórarinn Sveinsson
- Department of Physical Therapy, University of Iceland, Reykjavík, Iceland
- Research Centre of Movement Science, University of Iceland, Reykjavík, Iceland
| | - Kristín Briem
- Department of Physical Therapy, University of Iceland, Reykjavík, Iceland.
- Research Centre of Movement Science, University of Iceland, Reykjavík, Iceland.
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Eliya Y, Qureshi AR, Kay J, Nagai K, Hoshino Y, de Sa D. Anatomical double-bundle anterior cruciate ligament reconstruction moderately improved tegner scores over the long-term: a systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 2023; 31:436-448. [PMID: 35838793 DOI: 10.1007/s00167-022-07046-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/09/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the effects of anatomical double-bundle (DB) versus single-bundle (SB) for anterior cruciate ligament (ACL) reconstruction in skeletally mature patients with ACL injuries. METHODS MEDLINE, EMBASE, and CENTRAL were searched from inception to February 7, 2022 were screened for randomized controlled trials. The Anatomic Anterior Cruciate Ligament Reconstruction Checklist was used to categorize studies as anatomic. A random-effects meta-analysis was conducted, with pooled results being summarized using mean difference (MD). Risk of Bias (RoB) was assessed using the RoB 2.0 tool. Certainty of evidence was rated using GRADE. RESULTS A search of 1371 unique articles yielded eight eligible trials, representing 735 patients (360 DB, 375 SB) with mean (SD) age of 28.5 (2.86) years and follow-up of 52.1 (36.2) months. Most trials had moderate to low RoB. Overall, DB was not significantly better than SB on Lysholm scores (MD = 0.52, 95% CI, - 1.80-2.85, p = 0.66; moderate certainty) or subjective International Knee Documentation Committee (IKDC) scores (MD = - 0.40, 95% CI, - 4.35-3.55, p = 0.84; moderate certainty). Tegner scores were significantly higher in SB than DB in the intermediate term (MD = - 0.72, 95% CI, - 1.10 to - 0.34, p = 0.0002; high certainty), while significantly higher in DB relative to SB in the long-term (MD = 0.52, 95% CI, 0.02-1.03, p = 0.04; high certainty). CONCLUSION DB ACL reconstruction significantly improves Tegner scores relative to SB ACL reconstruction over the long-term (t ≥ 5 years). Intermediate term Tegner scores favour SB reconstruction. In both durations, there was no clinically significant difference based on the pre-specified minimal clinically important difference of 1.0 point. There were also no significant differences in IKDC or Lysholm scores. Surgeons should consider anatomical DB ACL reconstruction as a result of long-term improvement in patient-reported outcomes. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Yousif Eliya
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Abdul-Rehman Qureshi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Kay
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Darren de Sa
- Department of Surgery, Division of Pediatric Orthopaedic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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18
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Wang R, Li B, Hou B. Reconstruction of chronic anterior cruciate ligament rupture using the ligament advanced reinforcement system artificial ligament-comparisons between patients over 50 years and under 50 years. Ann Transl Med 2023; 11:112. [PMID: 36819588 PMCID: PMC9929750 DOI: 10.21037/atm-22-6330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/10/2023] [Indexed: 01/31/2023]
Abstract
Background With the increasing physical activity level in elderly population, anterior cruciate ligament (ACL) injuries are becoming more frequent. Due to the possible surgery complications, treatment for ACL rupture in patients with advanced age is still controversial. The purpose of this study was to compare the therapeutic effects of reconstruction using the ligament advanced reinforcement system (LARS) artificial ligament in patients older than 50 and patients younger than 50 with chronic ACL rupture. Methods Indications included: (I) concurrent history of subjective symptomatic anterior knee instability despite nonoperative rehabilitation for least 3 months, (II) positive preoperative Lachman and pivot shift tests, (III) ACL stump still connecting the femur with the tibia as demonstrated by Magnetic Resonance Imaging (MRI), and (IV) some residual ligament fibers still connecting the femur with the tibia as demonstrated by arthroscopy. Participants were divided into groups based on their age. Participants were divided into groups based on their age. A total of 37 patients who underwent reconstruction of chronic ACL rupture using the LARS artificial ligament were divided into group A (≥50 years, n=16) and group B (<50 years, n=21). Results The outcome measures were compared between the 2 groups. These included the baseline clinical data, the International Knee Documentation Committee (IKDC) scoring system, Pivot shift test, Lachman test, Kneelax arthrometer measurements, Tegner activity scale, Lysholm knee scoring scale, and Kellgren-Lawrence radiographic classification of arthritis and complications. Postoperative knee laxity and the functional examination were significantly improved compared to preoperative measurements for both groups (all P<0.01). No significant differences were found in postoperative knee laxity and functional examination between the 2 groups (all P>0.05). The level of osteoarthritis did not statistically increase in either group during follow-up (all P>0.05). No complications associated with the arthroscopic surgery were found in either group. Conclusions The reconstruction of chronic ACL rupture using the LARS artificial ligament showed similar therapeutic effects in patients over the age of 50 and those under the age of 50.
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Affiliation(s)
- Ronghao Wang
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Bin Li
- Department of Joint Surgery and Sports Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bingzong Hou
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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Kazemi K, Ebrahimi Takamjani I, Salehi R, Sanjari MA, Torkaman A. Coordination of the Lower Limbs of Soccer Players after Anterior Cruciate Ligament Reconstruction with Allograft and Autograft during Landing. Arch Bone Jt Surg 2023; 11:770-776. [PMID: 38146524 PMCID: PMC10748814 DOI: 10.22038/abjs.2023.74186.3433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/30/2023] [Indexed: 12/27/2023]
Abstract
Objectives Quantitative biomechanical tests, along with physical assessment, may be useful to understand kinematics associated with graft types in anterior cruciate ligament surgery, particularly in individuals aiming for a safe return to sport. Methods Sixty male soccer players in three groups participated in this study. Three equal groups of healthy, auto transplanted and allotransplanted participants, matched for age, gender, activity level and functional status, landed with one foot on a force plate. Their kinematic information was recorded by the motion analyzer and used to describe coordination the variability by measuring coupling angles using vector coding. Results The coordination variability of the allograft group in the surgical limb was significantly greater than that of the healthy group at least 9 months after the reconstructive surgery of the ACL and at the stage of return to sports, (F (6, 35) = 2.79, p = 0.025; Wilk's Λ = 0.676, partial η2 = 0.32). The coordination pattern in the surgical and healthy limbs of the surgical groups also differed from that of the healthy people, which was more pronounced in the allograft group, (F (6, 35) = 2.61, p = 0.034; Wilk's Λ = 0.690, partial η2 = 0.31). Conclusion These results show that the allograft group has a different coordination variability at return to sport than the healthy group, so they may need more time for excessive training and competition.
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Affiliation(s)
- Kasra Kazemi
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ismaeil Ebrahimi Takamjani
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, and Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
- Geriatric Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sanjari
- Biomechanics Lab., Rehabilitation Research Center, and Department of Basic Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Torkaman
- Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Shi W, Zhang J, Meng Q, Chen N, Shen Q, Li S, Cao Z, Ao Y, Ma Y. The apex of the deep cartilage is a stable landmark to evaluate the femoral tunnel position in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:256-263. [PMID: 35962841 DOI: 10.1007/s00167-022-07090-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 07/25/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To develop a simple and effective method for evaluating the femoral tunnel position using the apex of the deep cartilage (ADC) as the landmark. METHODS A total of 52 patients who underwent arthroscopic ACL reconstruction were recruited between June and September 2021. The femoral tunnel was placed on the central point of the anteromedial footprint with an accessory anteromedial and a high anterolateral portal. Then, the length from the ADC to the shallow cartilage margin (L1) and to the center of the femoral tunnel (l1), as well as the center to the low cartilage margin (H1, intraoperative height), was measured under arthroscopy and on postoperative CT scans (L2, l2 and H2). Moreover, intraoperative and postoperative cartilage ratios were equivalent to l1/L1 and l2/L2, respectively. Linear regression, Pearson correlation and Bland-Altman analysis were performed to evaluate the consistency between these two measurements of cartilage ratio (l/L) and height (H). RESULTS The mean age at the time of surgery was 28.7 years; 42 patients were male, and 17 patients were hurt in the left knee among 52 patients. The intraoperative cartilage ratio was 0.37 ± 0.04, and the height was 8.1 ± 1.1 mm with almost perfect inter-observer reproducibility. After the surgery, the cartilage ratio and height were measured as 0.39 ± 0.04 and 8.2 ± 1.3 mm on 3D-CT, respectively, with almost perfect intra- and inter-observer reproducibility. Significant positive correlations and linear regression were detected in the cartilage ratio (r = 0.844, p < 0.001), and height (r = 0.926, p < 0.001) intraoperatively and postoperatively. The Bland-Altman plot also showed excellent consistency between arthroscopy and 3D-CT. CONCLUSIONS The ADC is a good landmark in the assessment of femoral tunnel position, with excellent consistency between intraoperative arthroscopic measurements and postoperative 3D-CT. CLINICALTRIALS gov Identifier: NCT04937517. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Weili Shi
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital. Institute of Sports Medicine of Peking University, Beijing, 100191, China
| | - Jingwei Zhang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital. Institute of Sports Medicine of Peking University, Beijing, 100191, China
| | - Qingyang Meng
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital. Institute of Sports Medicine of Peking University, Beijing, 100191, China
| | - Nayun Chen
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital. Institute of Sports Medicine of Peking University, Beijing, 100191, China
| | - Qixian Shen
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital. Institute of Sports Medicine of Peking University, Beijing, 100191, China
| | - Shucan Li
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital. Institute of Sports Medicine of Peking University, Beijing, 100191, China
| | - Zhuohan Cao
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital. Institute of Sports Medicine of Peking University, Beijing, 100191, China
| | - Yingfang Ao
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital. Institute of Sports Medicine of Peking University, Beijing, 100191, China.
| | - Yong Ma
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital. Institute of Sports Medicine of Peking University, Beijing, 100191, China.
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Arhos EK, Di Stasi S, Hartigan EH, Snyder-Mackler L. Males and females have different muscle activity patterns during gait after ACL injury and reconstruction. J Electromyogr Kinesiol 2022; 66:102694. [PMID: 35988533 PMCID: PMC9588796 DOI: 10.1016/j.jelekin.2022.102694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/28/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022] Open
Abstract
Kinematic and kinetic changes following anterior cruciate ligament (ACL) rupture and reconstruction (ACLR) have been fundamental to the understanding of mechanical disrupted load as it contributes to the development of posttraumatic osteoarthritis. These analyses overlook the potential contribution of muscle activity as it relates to the joint loading environment. Males and females classified as non-copers present with unique knee kinematics and kinetics after ACL injury. The purpose of this study was to perform sex-specific analyses in these individuals to explore muscle activity timing during gait after ACL rupture. Thirty-nine participants (12 females, 27 males) were enrolled. Muscle activity during gait was evaluated before and after pre-operative physical therapy, and six months after ACLR. Surface electromyography data were evaluated to determine timing (e.g., the time the muscle activity begins ('On') and ends ('Off')) for seven muscles: vastus lateralis and medialis (VL, VM), lateral and medial hamstrings (LH, MH), lateral and medial gastrocnemius (LG, MG), and soleus (SOL). General linear models with generalized estimating equations detected the effects of limb and time for muscle activity timing. Males presented with more limb asymmetries before and after pre-operative PT in the VL On (p < 0.001) and Off (p = 0.007), VM On and Off (p < 0.001), and MH off (p < 0.001), but all limb differences resolved by six months post ACLR. Changes in muscle activity in males were pervasive over time in both limbs. Females presented with no interlimb differences pre-operatively, and only involved limb VL off (p = 0.027) and VM off (p = 0.003) and the LH off in both limbs (p < 0.038) changed over time. Our data indicate that inter-limb differences in muscle activity across time points and changes in muscle activity timing over the course of physical therapy were sex specific. Males presented with more inter-limb differences in muscle activity across time points, and females presented with fewer asymmetries before and after pre-operative physical therapy. These data support that sex-specific adaptations should be taken into consideration when assessing biomechanical changes after ACLR.
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Affiliation(s)
- Elanna K Arhos
- Department of Physical Therapy, University of Delaware, Newark, DE, USA; Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA.
| | - Stephanie Di Stasi
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erin H Hartigan
- Department of Physical Therapy, University of New England, Portland, ME, USA
| | - Lynn Snyder-Mackler
- Department of Physical Therapy, University of Delaware, Newark, DE, USA; Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
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22
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Ng FDJ, Lie DTT, Yew A. Relooking at double-bundle versus single-bundle anterior cruciate ligament reconstruction: A biomechanical model to evaluate which can confer better rotatory stability. Clin Biomech (Bristol, Avon) 2022; 99:105758. [PMID: 36113193 DOI: 10.1016/j.clinbiomech.2022.105758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 05/04/2022] [Accepted: 08/30/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND To treat anterior cruciate ligament (ACL) injuries, double-bundle ACL reconstruction has been proposed as a more anatomical approach relative to single-bundle reconstruction. However, controversy remains over which technique is superior in addressing knee instability, particularly rotational laxity. We hypothesize that double-bundle reconstruction better restores rotational knee laxity, while both methods are similar in restoring anterior knee laxity, to intact knee levels. METHODS A controlled laboratory study. Eight cadaveric knees were tested accordingly: (1) static anterior laxity testing under 150 N-anterior tibial loading at 20°, 60° and 90° knee flexion using a material testing machine, followed by (2) dynamic simulated pivot-shift with knee-specific loading involving iliotibial band forces, valgus and internal rotation torques, while the knee was brought from extension to 90° flexion on a 6°-of-freedom custom-designed rig. Tibiofemoral kinematics were recorded using an electromagnetic tracking system for the ACL-intact, ACL-deficient, single-bundle and double-bundle ACL-reconstructed knee conditions. FINDINGS Double-bundle reconstruction reduced internal rotation under pivot-shift to levels not significantly different from ACL-intact conditions (P > .173), unlike single-bundle that remained significantly higher at 10-40° flexion (P < .05). For anterior laxity, there was no significant difference between double-bundle, single-bundle, and ACL-intact conditions under static testing (P > .175) or pivot-shift (P = .219). The maximum extent of knee envelope laxity was significantly reduced for double-bundle relative to single-bundle, particularly for the rotatory component (P = .012). INTERPRETATION Double-bundle was biomechanically superior to single-bundle in addressing envelope of rotation, while both techniques restored anterior knee laxity to ACL-intact levels.
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Affiliation(s)
| | - Denny Tjiauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore.
| | - Andy Yew
- Division of Musculoskeletal Sciences, Singapore General Hospital, Outram Road, 169608, Singapore.
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23
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Moon HS, Song SY, Oh JU, Seo YJ. Effects of modified trans-tibial versus trans-portal technique on stress patterns around the femoral tunnel in anatomical single-bundle ACL reconstruction with different knee flexion angles using finite element analysis. BMC Musculoskelet Disord 2022; 23:759. [PMID: 35941643 PMCID: PMC9361554 DOI: 10.1186/s12891-022-05713-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/27/2022] [Indexed: 12/20/2022] Open
Abstract
Background It is unclear whether different anterior cruciate ligament (ACL) graft trajectories in the distal femur would have different effects on stress generated within the distal femur around the femoral tunnel during knee motion. Thus, the purpose of this study was to determine differences in stress patterns around the femoral tunnel created by trans-portal (TP) vs. modified trans-tibial (TT) technique in anatomical ACL reconstruction at different knee flexion angles. Methods Twelve male subjects’ right knees were scanned with a high-resolution computed tomography (CT) scanner (slice thickness: 1 mm) at four different knee flexion angles (0°, 45°, 90°, and 135°). Three-dimensional (3D) models of these four different flexion angles were created and manipulated with several modelling programs. For the TP group, the virtual femoral tunnelling procedure was performed in a 135° flexion model from the low far anteromedial (AM) portal. For the modified TT group, the same knee models were drilled through the modified TT technique at 90° of flexion separately. Virtual grafts under tension of 40 N were put into corresponding bone tunnel and fixed at the outer aperture of femoral tunnels to simulate the suspensory fixation, followed by fixation of the grafts at the middle of tibial tunnels in the 0° knee flexion models. Finally, the models were exported to a finite element analysis package and analysed using ABAQUS/Explicit code (ABAQUS, USA) to monitor the stress occurring at the node where stress distribution occurred most significantly in the femoral bone around the bone tunnel. Results In general, both groups showed a high stress distribution in bony structures around inner and outer orifices of the femoral tunnel. Mean maximal stresses occurring at the lateral femoral condyle around the inner orifice of the femoral tunnel in the TP group were found to be significantly greater than those in the modified TT group at all flexion angles except 90° of flexion. Mean maximal stresses monitored around the outer orifice of the femoral tunnel in the TP group were also significantly greater than those in the modified TT group at all flexion angles. Conclusions Different tunnelling technologies could yield different stress patterns in the lateral femoral condyle around the femoral tunnel. During knee motion, higher stresses were noticed in the TP group than in the modified TT group, especially around inner and outer orifices of the tunnel. Position of the tunnel after reconstruction with the TP technique can have a greater effect on the stress increase in the femur compared to that with the modified TT technique.
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Affiliation(s)
- Hyun-Soo Moon
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Republic of Korea
| | - Si Young Song
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Ji Ung Oh
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Young-Jin Seo
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong, Gyeonggi-do, Republic of Korea.
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Kim Y, Kubota M, Sato T, Inui T, Ohno R, Ishijima M. A bone bruise at the lateral and medial tibial plateau with an anterior cruciate ligament injury is associated with a meniscus tear. Knee Surg Sports Traumatol Arthrosc 2022; 30:2298-306. [PMID: 34806125 DOI: 10.1007/s00167-021-06786-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Bone bruises with anterior cruciate ligament (ACL) injury are well studied, but the association between bone bruises and multiple factors is unclear. The main objective of this study was to investigate the association between bone bruising and ACL injury and concomitant injury as well as clinical and functional scores. The second objective was to investigate the presence and distribution patterns of bone bruises. METHOD A total of 176 patients who underwent ACL reconstruction for primary ACL injury were included. The demographic characteristics and responses to clinical and functional assessments (the Visual Analog Scale for activities of daily living and sports, the Cincinnati Knee Rating System, the Lysholm score, the Knee Osteoarthritis Outcome Score and side-to-side difference in anterior laxity) were recorded at the initial visit. Concomitant injuries were evaluated by intraoperative assessment. RESULTS Bone bruises were detected in 141 patients (80.1%). The lateral femoral condyle (LFC) was the most common site in 116 patients (65.9%), followed by the lateral tibial plateau (LTP) in 82 patients (46.6%), medial tibial plateau (MTP) in 47 patients (26.7%) and medial femoral condyle (MFC) in 29 patients (16.5%). Regarding the distribution patterns, bone bruising at only the LFC, which was the most common pattern, was detected in 38 patients (27.0%). Bone bruising at the LTP or MTP was significantly associated with lateral (LM) and medial meniscus (MM) tears (odds ratios 4.0, 3.0, 4.3 and 40.5, 95% confidence intervals 1.5-11.6, 1.2-15.1, 1.2-17.3 and 8.6-283.0, respectively). No marked differences in the functional or clinical scores were noted. The severity of bone bruising at the MTP was significantly associated with MM tears and that at the LTP was significantly associated with LM tears. (p < 0.01). CONCLUSION This study showed association between bone bruising at LTP and LM tears or at MTP and MM tears. Additionally, it provided detailed information on the presence and distribution patterns of bone bruises at each anatomic site. These findings are clinically relevant and will aid in preoperatively diagnosing meniscus tears in cases of ACL injury. LEVEL OF EVIDENCE Level III.
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25
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Albertson B, Beynnon B, Endres N, Johnson R. Incidence of anterior tibial spine fracture among skiers does not differ with age. Knee Surg Sports Traumatol Arthrosc 2022; 30:2291-2297. [PMID: 34800136 PMCID: PMC9310445 DOI: 10.1007/s00167-021-06782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Injury to the anterior cruciate ligament (ACL) is common in alpine skiing in the form of either an intra-substance ACL tear or anterior tibial spine fracture (ATSF). Anterior tibial spine fractures are typically reported in children. However, several case reports describe these injuries in adults while skiing. The purpose of this study is to describe the sport specific incidence of ATSF in alpine skiing. METHODS The study was conducted over a 22-year period. Skiers who suffered an ATSF were identified and radiographs were reviewed to confirm the diagnosis. Additionally, control data from intra-substance ACL injury groups were collected. The incidence of these injuries in children, adolescents, and adults (grouped as ages 0-10, 11-16, and 17 + years old, respectively) was evaluated and the risk factors for ATSF versus ACL tear were determined. RESULTS There were 1688 intra-substance ACL and 51 ATSF injuries. The incidence of intra-substance ACL injury was greater in adults (40.0 per 100,000 skier days) compared to the adolescent (15.4 per 100,000) and child (1.1 per 100,000) age groups. In contrast, the incidence of ATSF was similar in the adult (0.9 per 100,000), adolescent (1.9 per 100,000), and child (1.9 per 100,000) age groups. Loose ski boot fit was identified as a risk factor for ATSF. CONCLUSION The incidence of ATSF in alpine skiers is similar among all age groups. However, the incidence of intra-substance ACL injuries is far greater in adult skiers compared to adolescents and children. Risk factors for ATSF relate to compliance between the foot/ankle and the ski boot. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Benjamin Albertson
- Department of Orthopaedics and Rehabilitation, University of New Mexico Health Sciences Center, MSC10 5600, 1, Albuquerque, NM, 87131-0001, USA.
| | - Bruce Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT, USA
| | - Nathan Endres
- Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT, USA
| | - Robert Johnson
- Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT, USA
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26
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Nakamae A, Sumen Y, Tsukisaka K, Deie M, Fujimoto E, Ishikawa M, Omoto T, Adachi N. A larger side-to-side difference in anterior knee laxity increases the prevalence of medial and lateral meniscal injuries in patients with ACL injuries. Knee Surg Sports Traumatol Arthrosc 2022; 30:1560-1567. [PMID: 33970292 DOI: 10.1007/s00167-021-06601-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective of this study was to investigate factors that influence the prevalence of medial and lateral meniscal injuries at the time of anterior cruciate ligament (ACL) reconstruction in patients with ACL injuries. METHODS Patients with ACL injuries at 9 institutions were enrolled in this multicentre study. Age, sex, duration between injury and surgery, pivot shift test grade, anterior knee laxity determined using the Kneelax 3 arthrometer, and other variables were assessed by logistic regression analysis. Meniscal conditions were evaluated via arthroscopy. RESULTS In all, 830 patients were enrolled. The prevalence of medial and lateral meniscal tears was 32.0% (266 knees) and 26.5% (220 knees), respectively. Significant factors that influenced the prevalence of medial meniscal injuries were age [odds ratio (OR) 1.03; P = 0.000], side-to-side differences in instrumented anterior knee laxity before surgery (OR 1.12; P = 0.002), duration between injury and surgery (≥ 12 months) (OR 1.86; P = 0.023), and pivot shift test grade (OR 1.36; P = 0.014). Significant factors of lateral meniscal injury were side-to-side differences in anterior knee laxity before surgery (OR 1.12; P = 0.003) and the male sex (OR 1.50; P = 0.027). CONCLUSION Greater anterior knee laxity, age, a longer duration between injury and surgery, and a higher pivot shift test grade predicted medial meniscal injury. Greater anterior knee laxity and the male sex predicted lateral meniscal injury. In patients with ACL injuries, the importance of side-to-side differences in anterior knee laxity should be rediscovered from the viewpoint of meniscal conditions. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Atsuo Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Yoshio Sumen
- Department of Orthopaedic Surgery, JA Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, Japan
| | - Kazuhiro Tsukisaka
- Department of Orthopaedic Surgery, Mazda Hospital, 2-15, Aosakiminami, Huchu-cho, Aki-gun, Hiroshima, 735-8585, Japan
| | - Masataka Deie
- Department of Orthopedic Surgery, Aichi Medical University, 21 Karimata, Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Eisaku Fujimoto
- Department of Orthopedic Surgery, Chugoku Rosai Hospital, 1-5-1, Hiro-Tagaya, Kure, Hiroshima, 737-0193, Japan
| | - Masakazu Ishikawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takenori Omoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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27
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Abstract
Anterior cruciate ligament injuries are a prominent issue in the field of sports medicine, especially for the female athlete. Extensive research has been performed that acknowledges the disparity in anterior cruciate ligament injury rates between male and female athletes and the high prevalence of risk factors specific to females. The underlying causes of anterior cruciate ligament injuries are widespread and are important to consider when approaching injury prevention. For example, prevention techniques aim to correct neuromuscular imbalances and improve biomechanical deficits, which are some of the most significant risk factors leading to these injuries. While there is a lack of opportunity for intervention related to anatomical and hormonal risks, awareness of their influence on injury mechanisms remains an important factor in clinical decision-making. In pursuit of addressing the risks of this injury, several prevention programs have been established that have been shown to successfully reduce anterior cruciate ligament injury rates when properly executed. The most effective programs include early intervention with continuous training and are multicomponent programs including various targeted exercises to modify associated risk factors. Unfortunately, despite the development of these readily available programs, anterior cruciate ligament injury rates remain high due to insufficient implementation of these methods. Recognizing the efficacy and feasibility of utilizing prevention strategies and continuing to develop effective techniques remain of utmost importance to reduce the incidence of this substantial injury among athletes.
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Affiliation(s)
- Hannah Bradsell
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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28
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Nakamae A, Miyamoto A, Kamei G, Eguchi A, Shimizu R, Akao M, Ishikawa M, Adachi N. An older age, a longer duration between injury and surgery, and positive pivot shift test results increase the prevalence of articular cartilage injury during ACL reconstruction in all three compartments of the knee in patients with ACL injuries. Knee Surg Sports Traumatol Arthrosc 2022; 30:219-30. [PMID: 33543356 DOI: 10.1007/s00167-021-06461-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate factors that influence the prevalence of articular cartilage injury in patients with anterior cruciate ligament (ACL) injury. METHODS This multicentre study included patients with ACL injury. Logistic regression analysis was conducted to identify factors that influence the prevalence of cartilage injury during ACL reconstruction. RESULTS A total of 811 patients were enrolled. The factors that significantly influenced the prevalence of cartilage injury were age (odds ratio [OR], 1.04; P = 0.000), a positive pivot shift test result (OR, 1.43; P = 0.021), medial meniscal injury (OR, 2.55; P = 0.000), and delayed surgery (≥ 12 months) (OR, 2.52; P = 0.028) in the medial compartment of the knee; age (OR, 1.05; P = 0.000), subjective grades of apprehension during the pivot shift test (OR, 1.46; P = 0.010), lateral meniscal injury (OR, 1.98; P = 0.003), femoro-tibial angle (FTA) (OR, 0.92; P = 0.006), and delayed surgery (≥ 12 months) (OR, 2.63; P = 0.001) in the lateral compartment; and age (OR, 1.06; P = 0.000), body mass index (OR, 1.07; P = 0.028), a positive pivot shift test result (OR, 1.60; P = 0.018), FTA (OR, 0.90; P = 0.006), and delayed surgery (≥ 12 months) (OR, 3.17; P = 0.008) in the patellofemoral compartment. CONCLUSION An older age, a longer duration between injury and surgery, and a positive pivot shift test result were positively associated with the prevalence of cartilage injury in three compartments in patients with ACL injuries. Early ACL reconstruction is recommended to prevent cartilage injury. LEVEL OF EVIDENCE Level III.
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29
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Klon W, Domżalski M, Malinowski K, Sadlik B. Translation and rotation analysis based on stress MRI for the diagnosis of anterior cruciate ligament tears. Quant Imaging Med Surg 2022; 12:257-268. [PMID: 34993076 DOI: 10.21037/qims-21-153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Due to the increasing need for a detailed biomechanical analysis of anterior cruciate ligament (ACL) lesions, the aim of the study was to develop a method of direct measurement of the three-dimensional tibial translation and rotation based on stress MRI. METHODS For the purpose of the study, thirty patients with acute ACL rupture and 17 healthy control subjects were selected. Based on clinical examination, they were qualified for MRI examination using the Arthroholder Device prototype to perform anterior tibial translation. Each examination was performed at 30° of knee flexion, initially without tibia translation and then using the force applied to the calf of 80 N. The femur and tibia were separately registered using rigid local SimpleITK landmark refinement; translation and rotation parameters were then calculated using the 3D transformation algorithms. The significance level was set at 0.05. RESULTS Initially, the device and method for obtaining the parameters of the 3D translation and rotation were validated. The pooled Standard Deviation for translation parameters was 0.81 mm and for rotation parameters 0.87°. Compared to the control group, statistically significant differences were found in parameters such as Anterior Shift [(median ± interquartile range) 3.89 mm ±6.55 vs. 0.90 mm ±2.78, P=0.002238] and External Rotation (-0.55° ±3.88 vs. -2.87° ±2.40, P=0.005074). Statistically significant correlations were observed in combined groups between Anterior Shift and parameters such as External Rotation (P=0.001611), PCL Tibial Attachment Point (pPCL) Anterior Shift (<0.000001), Rolimeter Measurement (P=0.000016), and Side-to-Side Difference (SSD) (P=0.000383). A significant statistical correlation was also observed between External Rotation and parameters such as Rolimeter (P=0.02261) and SSD (P=0.03458). CONCLUSIONS The analysis of the anterior tibia translation using stress MRI and the proposed three-dimensional calculation method allows for a detailed analysis of the tibial translation and rotation parameters. The correlations showed the importance of external rotation during anterior tibial translation.
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Affiliation(s)
- Wojciech Klon
- St Luke's Hospital, Bielsko-Biała, Poland.,Department of Orthopedics and Trauma, Veteran's Memorial Hospital, Medical University of Lodz, Łódź, Poland
| | - Marcin Domżalski
- Department of Orthopedics and Trauma, Veteran's Memorial Hospital, Medical University of Lodz, Łódź, Poland.,SPORTO Clinic, Łódź, Poland
| | | | - Bogusław Sadlik
- Clinic of Orthopedics and Trauma, Medical University of Wroclaw, Wroclaw, Poland
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30
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Teng PSP, Leong KF, Kong PW. Regression model for predicting knee flexion angles using ankle plantar flexion angles, body mass index and generalised joint laxity. Sports Biomech 2021:1-16. [PMID: 34738493 DOI: 10.1080/14763141.2021.1989480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/30/2021] [Indexed: 10/19/2022]
Abstract
Increased knee flexion angles are associated with reduced non-contact anterior cruciate ligament (ACL) injury risks. Ankle plantar flexion angles and internal risk factors could influence knee flexion angles, but their correlations are unknown. This study aimed to establish and validate a regression model to predict knee flexion angles using ankle plantar flexion angles, body mass index (BMI) and generalised joint laxity (GJL) at initial contact of single-leg drop landings. Thirty-two participants performed single-leg drop landings from a 30-cm-high platform. Kinematics and vertical ground reaction forces were measured using a motion capture system and force plate. A multiple regression was performed, and it was validated using a separate data set. The prediction model explained 38% (adjusted R2) of the change in knee flexion angles at initial contact (p = 0.001, large effect size). However, only the ankle plantar flexion angle (p < 0.001) was found to be a significant predictor of knee flexion angles. External validation further showed that the model explained 26% of knee flexion angles (large effect size). The inverse relationship between ankle plantar flexion and knee flexion angles suggests that foot landing strategies could be used to increase knee flexion angles, thereby reducing non-contact ACL injury risks.
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Affiliation(s)
- P S P Teng
- Institute for Sports Research, Nanyang Technological University, Singapore, Singapore
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - K F Leong
- Institute for Sports Research, Nanyang Technological University, Singapore, Singapore
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - P W Kong
- Institute for Sports Research, Nanyang Technological University, Singapore, Singapore
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
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31
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Li H, Jiang F, Ge Y, Wan F, Li H, Chen S. Differences in artificial ligament graft osseointegration of the anterior cruciate ligament in a sheep model: a comparison between interference screw and cortical suspensory fixation. Ann Transl Med 2021; 9:1370. [PMID: 34733922 PMCID: PMC8506542 DOI: 10.21037/atm-21-1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
Background Interference screws are the most common femoral fixation for anterior cruciate ligament (ACL) reconstruction with polyethylene terephthalate (PET) artificial ligaments. However, interference screws have several disadvantages, such as the risk of one tunnel blowout and damage to the graft. Suspensory fixations have the advantages of high tensile strength and promotion of graft bone contact. The purpose of this study was to compare PET artificial ligament graft osseointegration between interference screw fixation (ISF) and cortical suspensory fixation (CSF) for ACL reconstruction. Methods Forty sheep underwent ACL reconstruction of the right knee with PET artificial ligament. The graft was fixed with ISF or CSF for femoral fixation. Animals were randomly assigned to the ISF (n=20) or the CSF (n=20) groups. The sheep were sacrificed at 3 or 12 months postoperatively for biomechanical tests, micro computed tomography (micro-CT) scans, and histological assessments. Results The mean load-to-failure between the CSF group (836±355 N) appeared higher than that of the ISF group (604±277 N) at 3 months, but no significant difference was detected between the groups (P=0.24). At 12 months, there was also no significant difference in load-to-failure between the CSF and ISF groups (1,194±350 vs. 1,097±764 N; P=0.78). According to the micro-CT scan results, the femoral bone tunnel diameter of the ISF group appeared larger than that of the CSF group at 3 months (12±1 vs. 10±1 mm; P=0.02) and similar to that of the CSF group at 12 months (12±1 vs. 11±2 mm; P=0.38). Furthermore, histological results showed that at the graft-tunnel interface of the femoral tunnel aperture, disoriented fibers formed in the ISF group while oriented and dense fibers formed in the CSF group. Conclusions ACLR with synthetic ligament by cortical suspension devices with adjustable loops demonstrated a better graft-bone healing capacity at the femoral tunnel aperture compared with that from titanium interference screws over 12 months postoperatively. No significant difference was found in biomechanical strength between the two fixation methods during the early healing stage.
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Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Fangyi Jiang
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yunsheng Ge
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Fang Wan
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
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Heinert B, Rutherford D, Cleereman J, Lee M, Kernozek TW. Changes in landing mechanics using augmented feedback: 4-Week training and retention study. Phys Ther Sport 2021; 52:97-102. [PMID: 34450562 DOI: 10.1016/j.ptsp.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/23/2022]
Abstract
CONTEXT Non-contact ACL injuries are common in female athletes during landing tasks. Post-trial performance-based feedback may be an effective method to reduce landing forces and knee valgus during landing. Information regarding the retention of these changes based on such training is generally lacking for weekly and monthly retention. OBJECTIVE To determine the effectiveness of post-trial feedback training to promote and retain changes in vertical ground reaction force (vGRF) and knee to ankle (K:A) ratio during a dual task drop landing in female collegiate athletes. DESIGN Repeated measures; SETTING: University campus. PARTICIPANTS 22 female collegiate athletes. MATERIALS AND METHODS Dual task drop landings were performed over 4 successive weeks with immediate post trial feedback on peak vGRF, symmetry, and K:A ratio. K:A ratio was a surrogate measure for knee valgus in drop landing. RESULTS Significant decreases in vGRF and increases in K:A ratio were found within training sessions (p = .000). Both variables were retained each week over the 4 weeks. CONCLUSION Using a custom portable clinical feedback system may be an effective tool in reducing peak vGRFs and knee abduction angles during a drop landing over a 4-week period in female collegiate athletes.
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Affiliation(s)
- Becky Heinert
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, 54601, USA; Gundersen Health System, La Crosse, WI, 54601, USA
| | - Drew Rutherford
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, 54601, USA
| | - Jacqueline Cleereman
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, 54601, USA
| | - Maria Lee
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, 54601, USA
| | - Thomas W Kernozek
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI, 54601, USA.
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Bouguennec N, Robinson J, Douiri A, Graveleau N, Colombet PD. Two-year postoperative MRI appearances of anterior cruciate ligament hamstrings autografts are not correlated with functional outcomes, anterior laxity, or patient age. Bone Jt Open 2021; 2:569-575. [PMID: 34325524 PMCID: PMC8384440 DOI: 10.1302/2633-1462.28.bjo-2021-0104.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aims MRI has been suggested as an objective method of assessing anterior crucate ligament (ACL) graft “ligamentization” after reconstruction. It has been proposed that the MRI appearances could be used as an indicator of graft maturity and used as part of a return-to-sport assessment. The aim of this study was to evaluate the correlation between MRI graft signal and postoperative functional scores, anterior knee laxity, and patient age at operation. Methods A consecutive cohort of 149 patients who had undergone semitendinosus autograft ACL reconstruction, using femoral and tibial adjustable loop fixations, were evaluated retrospectively postoperatively at two years. All underwent MRI analysis of the ACL graft, performed using signal-to-noise quotient (SNQ) and the Howell score. Functional outcome scores (Lysholm, Tegner, International Knee Documentation Committee (IKDC) subjective, and IKDC objective) were obtained and all patients underwent instrumented side-to-side anterior laxity differential laxity testing. Results Two-year postoperative mean outcome scores were: Tegner 6.5 (2 to 10); Lysholm 89.8 (SD 10.4; 52 to 100); and IKDC subjective 86.8 (SD 11.8; 51 to 100). The objective IKDC score was 86% A (128 patients), 13% B (19 patients), and 1% C (two patients). Mean side-to-side anterior laxity difference (134 N force) was 0.6 mm (SD 1.8; -4.1 to 5.6). Mean graft SNQ was 2.0 (SD 3.5; -14 to 17). Graft Howell scores were I (61%, 91 patients), II (25%, 37 patients), III (13%, 19 patients), and IV (1%, two patients). There was no correlation between either Howell score or SNQ with instrumented anterior or Lysholm, Tegner, and IKDC scores, nor was any correlation found between patient age and ACL graft SNQ or Howell score. Conclusion The two-year postoperative MRI appearances of four-strand, semitendinosus ACL autografts (as measured by SNQ and Howell score) do not appear to have a relationship with postoperative functional scores, instrumented anterior laxity, or patient age at surgery. Other tools for analysis of graft maturity should be developed. Cite this article: Bone Jt Open 2021;2(8):569–575.
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Affiliation(s)
| | - James Robinson
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Adil Douiri
- Clinique du Sport de Bordeaux-Mérignac, Bordeaux, France
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Yamasaki S, Hashimoto Y, Han C, Nishino K, Hidaka N, Nakamura H. Patients with a quadriceps tendon shorter than 60 mm require a patellar bone plug autograft in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2021; 29:1927-1935. [PMID: 32909058 DOI: 10.1007/s00167-020-06261-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the length and thickness of the quadriceps tendon (QT) and anterior cruciate ligament (ACL) to predict the required QT length for individual ACL reconstruction. METHODS Thirty patients (9 females, 21 males; mean age 24.5 years; mean height 169.3 cm) who underwent ACL reconstruction using the QT with a bone plug autograft were enrolled. The length and thickness of the QT on preoperative magnetic resonance imaging (MRI) were compared with those measured under direct visualization. The ACL length was measured on preoperative MRI and three-dimensional computed tomography after ACL reconstruction. The QT length on MRI was compared with the required graft length, and the factors related to an adequate QT length were assessed. RESULTS The mean QT length on MRI was 60.8 ± 1.3 mm and was significantly positively correlated with the QT length under direct visualization (P < 0.01). On MRI, the mean ACL length was 30.8 ± 1.2 mm and the mean QT thickness was 6.3 ± 0.2 mm. Although the mean QT was 0.1 mm longer than the mean required graft length, the QT on MRI was shorter than the required graft length in 37% of patients (11/30). Adequate QT length was related to a QT length of more than 60 mm, but not to age, sex, height, or ACL length. CONCLUSION Although preoperative MRI predicted the required QT length for ACL reconstruction, 37% of patients lacked an adequate QT length, and a QT shorter than 60 mm required the addition of patellar bone. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Shinya Yamasaki
- Department of Orthopaedics Surgery, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan. .,Department of Orthopaedics Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Yusuke Hashimoto
- Department of Orthopaedics Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Changhun Han
- Department of Orthopaedics Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Nishino
- Department of Orthopaedics Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Noriaki Hidaka
- Department of Orthopaedics Surgery, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedics Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Carter HM, Webster KE, Smith BE. Current preoperative physiotherapy management strategies for patients awaiting Anterior Cruciate Ligament Reconstruction (ACLR): A worldwide survey of physiotherapy practice. Knee 2021; 28:300-310. [PMID: 33482621 DOI: 10.1016/j.knee.2020.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/23/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior cruciate ligament ruptures are the most common ligament injury to the knee with surgical reconstruction considered standard treatment. This study aimed to explore the current physiotherapy management strategies used during the preoperative phase of rehabilitation for patients awaiting anterior cruciate ligament reconstruction (ACLR). METHODS An anonymous survey was disseminated online via Twitter and the 'interactive Chartered Society of Physiotherapy' message board. Practising physiotherapists who treated at least one patient prior to ACLR in the past year were invited to take part. Responses were collected over a 4-week period in March 2020. Data were analysed using descriptive statistics. RESULTS In total, 183 respondents replied; 122 completed the full survey. Responses were collected from 20 countries across 3 settings, NHS/public health services, private and sports. Most respondents reported prescribing exercises, advice and education to patients during prehabilitation. Up to 40% also utilised passive treatments including manual therapy, taping/bracing and electrotherapy. The frequency of recommended exercise completion and length of treatment varied. Most respondents (n = 103/84.4%) felt that many patients waiting for ACLR did not receive prehabilitation. Many physiotherapists reported that patients expressed concerns regarding their readiness for surgery (n = 61/50%) and return to preinjury levels of physical activity (n = 112/91.8%). Almost all respondents would discuss non-operative management with patients (n = 112/91.8%) if they had returned to their preinjury level of physical activity before their ACLR. CONCLUSION Overall, this survey provides some insight as to how physiotherapists manage patients awaiting ACLR. Areas of uncertainty in physiotherapy practice have also been highlighted that require further high-quality research.
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Affiliation(s)
- Hayley M Carter
- University Hospitals of Derby and Burton NHS Foundation Trust, Department of Physiotherapy, London Road Community Hospital, Derby, UK.
| | - Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Benjamin E Smith
- University Hospitals of Derby and Burton NHS Foundation Trust, Department of Physiotherapy, London Road Community Hospital, Derby, UK; Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
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Tang X, Marshall B, Wang JH, Zhu J, Li J, Linde MA, Smolinski P, Fu FH. Partial meniscectomy does not affect the biomechanics of anterior cruciate ligament reconstructed knee with a lateral posterior meniscal root tear. Knee Surg Sports Traumatol Arthrosc 2020; 28:3481-3487. [PMID: 32889558 DOI: 10.1007/s00167-020-06209-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/03/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to determine the effects of a lateral meniscus posterior root tear, partial meniscectomy, and total meniscectomy on knee biomechanics in the setting of anterior cruciate ligament (ACL) reconstruction. METHODS Thirteen fresh-frozen cadaver knees were tested with a robotic testing system under an 89.0-N anterior tibial load at full extension (FE), 15°, 30°, 60° and 90° of knee flexion and a simulated pivot-shift loading (7.0 Nm valgus and 5.0 Nm internal tibial rotation) at FE, 15° and 30° of knee flexion. Anterior tibial translation (ATT) and the in-situ force of ACL graft under the different loadings were measured in four knee states: (1) ACL reconstruction with intact lateral meniscus (Intact meniscus), (2) ACL reconstruction with lateral meniscal posterior root tear (Root tear), (3) ACL reconstruction with lateral posterior partial meniscectomy (Partial meniscectomy) and (4) ACL reconstruction with total lateral meniscectomy (Total meniscectomy). RESULTS Under anterior tibial loading, compared with an intact meniscus, root tear significantly increased ATT at 15° and 30° of knee flexion (p < 0.05) and partial meniscectomy had almost same increased ATT as with root tear at any knee flexion between FE and 90°. Under simulated pivot-shift loading, total meniscectomy increased ATT compared with intact meniscus, root tear, partial meniscectomy at FE (p < 0.05). CONCLUSION Under anterior tibial and simulated pivot-shift loading, partial meniscectomy has no significant effect on the stability of ACL-reconstructed knee with lateral meniscal posterior root tear, while total meniscectomy increased laxity at less than 30° of knee flexion. Clinically, in cases of irreparable meniscal root tears or persistent pain a partial meniscectomy can be considered in the setting of ACL reconstruction.
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Affiliation(s)
- Xin Tang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Brandon Marshall
- Department of Mechanical Engineering and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Junjun Zhu
- Department of Mechanical Engineering and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jian Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Monica A Linde
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Patrick Smolinski
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
- Department of Mechanical Engineering and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA.
- Department of Mechanical Engineering and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
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Carter HM, Littlewood C, Webster KE, Smith BE. The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review. BMC Musculoskelet Disord 2020; 21:647. [PMID: 33010802 PMCID: PMC7533034 DOI: 10.1186/s12891-020-03676-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/24/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament reconstruction (ACLR). METHOD A systematic search was conducted from inception to November 2019. Randomised controlled trials (RCTs) published in English were included. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence. RESULTS The search identified 739 potentially eligible studies, three met the inclusion criteria. All included RCTs scored 'high' risk of bias. PreHab in all three RCTs was an exercise programme, each varied in content (strength, control, balance and perturbation training), frequency (10 to 24 sessions) and length (3.1- to 6-weeks). Statistically significant differences (p < 0.05) were reported for quadriceps strength (one RCT) and single leg hop scores (two RCTs) in favour of PreHab three months after ACLR, compared to no PreHab. One RCT reported no statistically significant between-group difference for pain and function. No RCT evaluated post-operative psychological outcomes. CONCLUSION Very low quality evidence suggests that PreHab that includes muscular strength, balance and perturbation training offers a small benefit to quadriceps strength and single leg hop scores three months after ACLR compared with no PreHab. There is no consensus on the optimum PreHab programme content, frequency and length. Further research is needed to develop PreHab programmes that consider psychosocial factors and the measurement of relevant post-operative outcomes such as psychological readiness and return to sport. TRIAL REGISTRATION PROSPERO trial registration number. CRD42020162754 .
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Affiliation(s)
- Hayley M Carter
- Department of Physiotherapy, London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, London Road Community Hospital, Derby, DE1 2QY, UK.
| | - Chris Littlewood
- Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Benjamin E Smith
- Department of Physiotherapy, London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, London Road Community Hospital, Derby, DE1 2QY, UK
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
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Butt U, Khan ZA, Zahir N, Khan Z, Vuletic F, Shah I, Shah JA, Siddiqui AM, Hudetz D. Histological and cellular evaluation of anterior cruciate ligament. Knee 2020; 27:1510-1518. [PMID: 33010768 DOI: 10.1016/j.knee.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/11/2020] [Accepted: 08/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND We hypothesized that the torn anterior cruciate ligament (ACL) demonstrates a great healing response after initial trauma and has competent cells leading to the healing but differs in its response based on the type of tear and duration of injury. This study aimed to evaluate the histological and cellular responses to the injured ACL. METHODS Fifty-two tissue samples from the ACL were harvested from patients undergoing arthroscopy. Detailed histological and cellular examinations were performed for ligament angiogenesis, fibrocytes, and synovial tissue infiltration. We compared the cellular response to injury in partially and completely ruptured ACLs. The duration of ACL injury and its response to cellular characteristics were also examined. Immunohistochemical studies using cluster of differentiation 34 (CD34) staining was used to evaluate endothelial cells and fibrocytes. RESULTS We found a significantly higher density of synovial and ligament angiogenesis and fibrocytes at the torn end of ACL (Mann-Whitney, P < 0.050). Numerous fibrocytes were identified in complete ACL tears versus partial tears (Mann-Whitney = 0.020). Increased cellular proliferation was identified at the ruptured end of ACL remnant (Kruskal-Wallis, P < 0.050). The cellular proliferation of ruptured ACL decreased after 12 months. CONCLUSIONS Based on our findings of the time-dependent decrease in the cellular response at the torn ends of the ACL, we recommend early intervention, preservation of the ACL remnant, and primary ACL repair or augmented reconstruction.
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Affiliation(s)
- Umer Butt
- AO Hospital, Karachi, Pakistan; Circle Bath Hospital, Bath, UK.
| | | | - Naila Zahir
- Department of Histopathology and Cytology, Dr. Essa Laboratory and Diagnostic Centre, Karachi, Pakistan
| | - Zeeshan Khan
- AO Hospital, Karachi, Pakistan; Hayatabad Medical Complex, Peshawar, Pakistan
| | - Filip Vuletic
- Department of Trauma and Orthopaedics, University Hospital Sveti Duh, Zagreb, Croatia
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Hexter AT, Shahbazi S, Thangarajah T, Kalaskar D, Haddad FS, Blunn G. Characterisation of the tensile properties of Demineralised Cortical Bone when used as an anterior cruciate ligament allograft. J Mech Behav Biomed Mater 2020; 110:103981. [PMID: 32823143 DOI: 10.1016/j.jmbbm.2020.103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/21/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Graft choice in anterior cruciate ligament (ACL) reconstruction remains controversial and some grafts fail due to inadequate osteointegration. Demineralised cortical bone (DCB) is an osteoinductive collagen-based scaffold. The aim of this study was to measure the tensile properties of DCB from different locations and from different ages, and determine its compatibility with current ACL fixation systems. METHODS The tensile properties of DCB manufactured from femur and tibia of young (9 month) and old (2-3 years) sheep was measured to determine the most appropriate graft choice. The ultimate load and stiffness of DCB allograft using two fixation systems, interference screws and sutures tied around screw posts, was measured ex vivo in an ovine ACL reconstruction model. Comparison was made with superficial digital flexor tendon (SDFT) and ovine ACL. RESULTS DCB derived from young tibia had the highest ultimate load and stiffness of 67.7 ± 10.6 N and 130.2 ± 64.3 N/mm respectively. No DCB fixation system reached the published peak in vivo force through the ovine ACL of 150 N. SDFT fixation with interference screws (308.2 ± 87.3 N) did reach the in vivo threshold but was significantly weaker than ovine ACL (871.0 ± 64.2 N). CONCLUSION The tensile properties of DCB were influenced by the donor age and bone. Owing to inferior tensile properties and incompatibility with suspensory fixation devices, this study indicates DCB is inferior to current tendon grafts options for ACL reconstruction.
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Affiliation(s)
- Adam T Hexter
- Institute of Orthopaedics and Musculoskelatal Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - Shirin Shahbazi
- Institute of Orthopaedics and Musculoskelatal Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Tanujan Thangarajah
- Institute of Orthopaedics and Musculoskelatal Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Deepak Kalaskar
- Institute of Orthopaedics and Musculoskelatal Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Fares S Haddad
- University College Hospital, 235 Euston Rd, Bloomsbury, London, NW1 2BU, UK
| | - Gordon Blunn
- University of Portsmouth, School of Pharmacy and Biomedical Sciences, Portsmouth, PO1 2DT, UK
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Diermeier T, Tisherman R, Hughes J, Tulman M, Baum Coffey E, Fink C, Lynch A, Fu FH, Musahl V. Quadriceps tendon anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:2644-2656. [PMID: 32072203 DOI: 10.1007/s00167-020-05902-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/03/2020] [Indexed: 12/17/2022]
Abstract
Quadriceps tendon is a promising alternative graft option for anterior cruciate ligament (ACL) reconstruction, which can be harvested with or without a bone block as well as a full or partial thickness graft. Therefore, quadriceps tendon graft could be used in primary and revision ACL reconstruction based on the requirements (tunnel size, tunnel position, etc.). The all soft tissue, partial thickness quadriceps tendon graft in detail and pitfalls of the harvest are described in the present review. After quadriceps tendon harvest, especially in soccer players, who need a strong quadriceps to strike a ball with power, the postoperative rehabilitation may need to be adapted. LEVEL OF EVIDENCE: V.
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Affiliation(s)
- Theresa Diermeier
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA.,Department of Orthopaedic Sport Medicine, Technical University Munich, Munich, Germany
| | - Rob Tisherman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA.,Department of Orthopaedic Sport Medicine, Technical University Munich, Munich, Germany
| | - Jonathan Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Michael Tulman
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria.,Research Unit for Orthopedic Sports Medicine and Injury Prevention, UMIT Hall, Hall, Austria
| | - Andrew Lynch
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.,UPMC Centers for Rehab Services, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA.
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Damavandi M, Mahendrarajah L, Dixon PC, DeMont R. Knee joint kinematics and neuromuscular responses in female athletes during and after multi-directional perturbations. Hum Mov Sci 2020; 70:102596. [PMID: 32217214 DOI: 10.1016/j.humov.2020.102596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/07/2020] [Accepted: 02/19/2020] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to investigate weight-bearing knee joint kinematic and neuromuscular responses during lateral, posterior, rotational, and combination (simultaneous lateral, posterior, and rotational motions) perturbations and post-perturbations phases in 30° flexed-knee and straight-knee conditions. Thirteen healthy female athletes participated. Knee joint angles and muscle activity of vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), semitendinosus (ST), lateral gastrocnemius (LG), and medial gastrocnemius (MD) muscles were computed. Knee abducted during lateral perturbations, whereas it adducted during the other perturbations. It was internally rotated during flexed-knee and externally rotated during straight-knee perturbations and post-perturbations. VL and VM's mean and maximum activities during flexed-knee perturbations were greater than those of straight-knee condition. BF's mean activities were greater during flexed-knee perturbations compared with straight-knee condition, while its maximum activities observed during combination perturbations. ST's maximum activities during combination perturbations were greatest compared with the other perturbations. LG and MG's activities were greater during straight-knee conditions. Compared with the perturbation phase, the mean and maximum muscles' activities were significantly greater during post-perturbations. The time of onset of maximum muscle activity showed a distinctive pattern among the perturbations and phases. The perturbation direction is an important variable which induces individualized knee kinematic and neuromuscular response.
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Affiliation(s)
- Mohsen Damavandi
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada; Faculty of Sport Sciences, Hakim Sabzevari University, Sabzevar, Iran.
| | - Lishani Mahendrarajah
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Philippe C Dixon
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Richard DeMont
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada
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Li F, Qin L, Gong X, Huang Z, Wang T, Liu Z, Sandiford S, Yang J, Zhu S, Liang X, Huang W, Hu N. The Chinese ACL injury population has a higher proportion of small ACL tibial insertion sizes than Western patients. Knee Surg Sports Traumatol Arthrosc 2020; 28:888-896. [PMID: 31111185 PMCID: PMC7035219 DOI: 10.1007/s00167-019-05541-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 05/14/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The study purpose is to characterize the sizes of the anterior cruciate ligament (ACL) insertion site and intercondylar notch in Chinese patients undergoing ACL surgery. The findings will provide a reference for individualized clinical treatment of ACL rupture. METHODS For this study, 137 patients (102 males, 35 females) with an average age of 30.3 ± 9.5 years (range 14-52 years) undergoing ACL reconstruction were included. The tibial ACL insertion site length and width and the intercondylar notch width were measured on MRI and arthroscopically using a ruler. Descriptive statistics of the patients, the distribution of the measurements and the differences between males and females were calculated. RESULTS The ACL tibial insertion size and intercondylar notch width in Chinese patients with ACL injuries, as obtained by MRI and intra-operatively, exhibited significant individual variability. The tibial ACL insertion site had a mean length of 13.5 ± 2.1 mm and width of 10.9 ± 1.5 mm as measured on MRI and a mean length of 13.3 ± 2.1 mm and width of 11.0 ± 1.6 mm as measured intra-operatively. The mean intercondylar notch width was 15.2 ± 2.4 mm on MRI and the mean length was 15.0 ± 2.5 mm intra-operatively. The inter-rater reliability between MRI and intra-operative measurements confirmed that the two methods were consistent. In 65.7% of individuals, the ACL tibial insertion length was < 14 mm. CONCLUSION The distribution of tibial footprint size in Chinese patients is different from that in Western populations. There is a higher proportion of subjects with a tibial footprint size < 14 mm among Chinese patients with ACL injury. Therefore, great care should be taken when treating this population with the double-bundle technique or larger graft options. Level of evidence IV.
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Affiliation(s)
- Feilong Li
- Department of Orthopedics, The Dazu District People'S Hospital, Chongqing, 402360, China.,Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Leilei Qin
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xuan Gong
- Department of Outpatient, Chongqing General Hospital, Chongqing, 400013, China
| | - Zhenggu Huang
- Department of Orthopedics, The Dazu District People'S Hospital, Chongqing, 402360, China
| | - Ting Wang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ziming Liu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Steve Sandiford
- Department of Orthopedics, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Jianye Yang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Sizheng Zhu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xi Liang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wei Huang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ning Hu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Galea-O'Neill RJ, Bruder AM, Goulis J, Shields N. Modifiable factors and their association with self-reported knee function and activity after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Physiother Theory Pract 2019; 37:881-894. [PMID: 31526063 DOI: 10.1080/09593985.2019.1655821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine if body mass index (BMI), smoking status, prehabilitation or time to reconstruction are associated with recovery of self-reported knee function and activity after ACL reconstruction (ACLR). DATA SOURCES Four electronic databases were systematically searched. STUDY SELECTION English language articles were included if: (1) participants aged 16-70 years had primary or first revision ACLR with autograft, following complete rupture; and (2) the association between one of four modifiable factors: (1) BMI; (2) smoking; (3) prehabilitation; or (4) time to reconstruction with self-reported knee function and activity, ACL graft rupture or return to sport was evaluated. RESULTS Twelve articles (representing 11 studies) were included. Meta-analyses found low-quality evidence of no difference in self-reported knee function (d = -0.07, 95% CI -0.37 to 0.23, I2 = 0%) or activity levels (d = 0.11, 95% CI -0.2 to 0.41, I2 = 0%) between acute and subacute ACLR. There was no difference in the relative risk of ACL graft rupture with the timing of ACLR (one study). Meta-analysis demonstrated very low-quality evidence that smokers had worse self-reported functional outcomes after ACLR compared to non-smokers (d = -0.58, 95% CI -0.788 to -0.28, I2 = 59%). One study suggested an inverse relationship between BMI and knee-related quality of life after ACLR. One RCT suggested prehabilitation may reduce time to return to sport. CONCLUSION Low-quality evidence suggests there is no difference in delaying ACLR and very low-quality evidence suggests smokers have worse self-reported functional outcome after ACLR compared to non-smokers. High-quality RCTs are needed to confirm the relationship between the four modifiable factors studied and ACLR outcome.
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Affiliation(s)
- Rebecca Joan Galea-O'Neill
- Department of Physiotherapy, Northern Hospital, Epping, Australia.,Department of Physiotherapy, Epworth Rehabilitation Camberwell, Camberwell, Australia
| | - Andrea Maree Bruder
- School of Allied Health, Human Services and Sport, Sports and Exercise Medicine Research Centre, La Trobe University, Victoria, Australia
| | - Jimmy Goulis
- Department of Physiotherapy, Northern Hospital, Epping, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, Sports and Exercise Medicine Research Centre, La Trobe University, Victoria, Australia
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Fukuda T, Wengler K, Tank D, Korbin S, Paci JM, Komatsu DE, Paulus M, Huang M, Gould E, Schweitzer ME, He X. Abbreviated quantitative UTE imaging in anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2019; 20:426. [PMID: 31521135 DOI: 10.1186/s12891-019-2811-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/30/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Existing ultrashort echo time magnetic resonance imaging (UTE MRI) methods require prohibitively long acquisition times (~ 20-40 min) to quantitatively assess the clinically relevant fast decay T2* component in ligaments and tendons. The purpose of this study was to evaluate the feasibility and clinical translatability of a novel abbreviated quantitative UTE MRI paradigm for monitoring graft remodeling after anterior cruciate ligament (ACL) reconstruction. METHODS Eight patients who had Graftlink™ hamstring autograft reconstruction were recruited for this prospective study. A 3D double-echo UTE sequence at 3.0 Tesla was performed at 3- and 6-months post-surgery. An abbreviated UTE MRI paradigm was established based on numerical simulations and in vivo validation from healthy knees. This proposed approach was used to assess the T2* for fast decay component ([Formula: see text]) and bound water signal fraction (fbw) of ACL graft in regions of interest drawn by a radiologist. RESULTS Compared to the conventional bi-exponential model, the abbreviated UTE MRI paradigm achieved low relative estimation bias for [Formula: see text] and fbw over a range of clinically relevant values for ACL grafts. A decrease in [Formula: see text] of the intra-articular graft was observed in 7 of the 8 ACL reconstruction patients from 3- to 6-months (- 0.11 ± 0.16 ms, P = 0.10). Increases in [Formula: see text] and fbw from 3- to 6-months were observed in the tibial intra-bone graft ([Formula: see text]: 0.19 ± 0.18 ms, P < 0.05; Δfbw: 4% ± 4%, P < 0.05). Lower [Formula: see text] (- 0.09 ± 0.11 ms, P < 0.05) was observed at 3-months when comparing the intra-bone graft to the graft/bone interface in the femoral tunnel. The same comparisons at the 6-months also yielded relatively lower [Formula: see text] (- 0.09 ± 0.12 ms, P < 0.05). CONCLUSION The proposed abbreviated 3D UTE MRI paradigm is capable of assessing the ACL graft remodeling process in a clinically translatable acquisition time. Longitudinal changes in [Formula: see text] and fbw of the ACL graft were observed.
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Huang H, Nagao M, Arita H, Shiozawa J, Nishio H, Kobayashi Y, Kaneko H, Nagayama M, Saita Y, Ishijima M, Takazawa Y, Ikeda H, Kaneko K. Reproducibility, responsiveness and validation of the Tampa Scale for Kinesiophobia in patients with ACL injuries. Health Qual Life Outcomes 2019; 17:150. [PMID: 31506078 PMCID: PMC6737637 DOI: 10.1186/s12955-019-1217-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 08/23/2019] [Indexed: 11/30/2022] Open
Abstract
Background and purpose Psychological factors including fear of pain, re-injury during movement (kinesiophbia) affect return-to-sport rates after anterior cruciate ligament (ACL) reconstructive surgery. Clinicians often encounter in the daily practice that athletes explain lack of self-confidence or psychological readiness during the sports activity. The Tampa Scale for Kinesiophobia (TSK) has been used to evaluate psychological outcomes in patients with ACL injuries in many countries and translated into Japanese version in 2013. However, no researchers validated its reliability, validity, and responsiveness of TSK for patients with ACL injury up to now. The purpose of this study was to evaluate the measurement properties of the Japanese version of the TSK (TSK-J) in patients with ACL injuries. Study design Cohort study (Diagnostic); Level of evidence, 2. Methods This prospective study was performed in the department of orthopaedic surgery at the university hospital of Juntendo from Sep 2016 and Apr 2017. Patients who diagnosed with ACL injury with or without reconstruction surgery completed several patient-reported outcome measures (PROMs) were included in this study. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines were used to evaluate reliability, validity, responsiveness, and interpretability of the TSK-J. Results 222 patients were included in this study. The TSK-J for ACL injured patients showed good internal consistency (Cronbach’s alpha = 0.79) and excellent test-retest reliability (intra-class correlation coefficient, ICC2,1 = 0.90, 95% CI = 0.81 to 0.95). In addtion, the TSK-J was significantly but moderately correlated with the IKDC-SKF (r = − 0.49, P <0.001), VAS-Sports (r = − 0.48, P <0.001), and JACL-25 (r = 0.48, P <0.001). The effect size (ES) was small with the Cohen’s d = − 0.2. The minimal important difference (MID) was − 1.3 points. No significant TSK-J score change was observed over 1-year after ACL reconstruction (r = − 0.12, P <0.001). There were no floor or ceiling effects. Conclusions Our study demonstrated that the Japanese version of TSK has good reliability. However, its low validity and responsiveness indicate that it may not the best way to assess psychological factors for patients with ACL injury.
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Affiliation(s)
- Hui Huang
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masashi Nagao
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan. .,Medical Technology Innovation Center, Juntendo University, Tokyo, Japan. .,Clinical Research & Trial Center, Juntendo University, Tokyo, Japan.
| | - Hitoshi Arita
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Jun Shiozawa
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hirofumi Nishio
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yohei Kobayashi
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Haruka Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masataka Nagayama
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Emergency and Critical Care Medicine, Juntendo University Hospital, Tokyo, Japan
| | - Yoshitomo Saita
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuji Takazawa
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Sports Medicine, School of Health & Sports Science, Juntendo University, Chiba, Japan
| | - Hiroshi Ikeda
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
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Wang H, Kang H, Yao J, Cheng CK, Woo SLY. Evaluation of a magnesium ring device for mechanical augmentation of a ruptured ACL: Finite element analysis. Clin Biomech (Bristol, Avon) 2019; 68:122-127. [PMID: 31200296 DOI: 10.1016/j.clinbiomech.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 05/04/2019] [Accepted: 06/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recently, a ring device was used for mechanical augmentation to aid the healing of ACL. In-vivo study using goat showed improved joint stability after ring repair in comparison to using biological augmentation alone. Objective of this study was to quantify the load and stress levels in the ACL and its femoral insertion site following ring repair. METHODS A three dimensional finite element model of a goat stifle joint was developed to find the load and stress level in the ACL and at its femoral insertion site following ring repair. FINDINGS Ring repair led to approximately a 50% reduction in anterior-posterior tibial translation over the model with a deficient ACL: 5.2 mm vs 10.6 mm, 4.4 mm vs 9.0 mm, and 2.9 mm vs 5.2 mm at joint flexion angles of 37°, 60° and 90° respectively. After ring repair, the in situ force in the ACL was restored to be nearly 60% of the intact ACL. The maximum Von Mises stress at the femoral insertion site was up to 71% of those for the intact ACL. INTERPRETATION This study offers new knowledge on the function of a ring device to mechanically augment ACL repair in order to improve its healing. Quantitative data on loading levels in the repaired ACL and its insertion site that led to its healing could be used as basis for developing novel devices to mechanically augment the healing of ACL in humans.
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Affiliation(s)
- Huizhi Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China; Musculoskeletal Research Center, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Huijun Kang
- Musculoskeletal Research Center, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Jie Yao
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| | - Cheng-Kung Cheng
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China; Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China.
| | - Savio L-Y Woo
- Musculoskeletal Research Center, University of Pittsburgh, Pittsburgh, PA 15219, USA.
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Brockmeyer M, Orth P, Höfer D, Seil R, Paulsen F, Menger MD, Kohn D, Tschernig T. The anatomy of the anterolateral structures of the knee - A histologic and macroscopic approach. Knee 2019; 26:636-646. [PMID: 30910626 DOI: 10.1016/j.knee.2019.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The anatomy of the anterolateral structures of the knee is complex and still controversial. The aim of our study was to analyze this anatomy by histologic and macroscopic evaluation, with a particular emphasis on the anterolateral ligament (ALL). MATERIAL AND METHODS Twenty-three cadaveric knee joints were dissected followed by a qualitative and quantitative anatomic analysis of the anterolateral knee structures. Histology and comparison of different anterolateral structures was performed in addition. RESULTS The ALL was identified in all of the dissected cadaveric knee specimens. It runs in an oblique course from its proximo-dorsal insertion at the distal femur into a ventro-distal direction to the anterolateral tibia. The femoral insertion site was found to be posterior and slightly proximal to the lateral femoral epicondyle and the femoral attachment of the lateral collateral ligament (LCL). The femoral insertion of the ALL overlapped the LCL in all dissected knees. The tibial insertion site was midway between Gerdy's tubercle (GT) and the tip of the fibular head (FH). In 15 of the dissected 23 knee joints, thin attachments to the lateral meniscus were observed. Histology confirmed differences in the composition of the anterolateral knee joint capsule, the ALL and the iliotibial band (ITB). CONCLUSIONS The ALL occurs as a regular separate anterolateral ligamentous structure. It is distinguishable from the ITB and the anterolateral joint capsule in both embalmed and non-embalmed specimens. Histology of the ALL indicates typical ligamentous tissue which clearly differs from the anterolateral knee joint capsule and the thicker ITB. LEVEL OF EVIDENCE Level II, descriptive anatomic study.
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Affiliation(s)
- Matthias Brockmeyer
- Saarland University Medical Center, Department of Orthopaedics and Orthopaedic Surgery, Kirrberger Straße, Geb. 37, 66421 Homburg, Saar, Germany.
| | - Patrick Orth
- Saarland University Medical Center, Department of Orthopaedics and Orthopaedic Surgery, Kirrberger Straße, Geb. 37, 66421 Homburg, Saar, Germany; Saarland University Medical Center, Center of Experimental Orthopaedics, Kirrberger Straße, Geb. 37, 66421 Homburg, Saar, Germany
| | - Denis Höfer
- Saarland University Medical Center, Institute of Anatomy and Cell Biology, Kirrberger Straße, Geb. 61, 66421 Homburg, Saar, Germany
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg; Sports medicine Research Laboratory, Luxembourg Institute of Health, 78 Rue d'Eich, 1460 Luxembourg, Luxembourg
| | - Friedrich Paulsen
- Friedrich Alexander University Erlangen-Nürnberg, Department of Functional and Clinical Anatomy, Universitätsstr. 19, 91054 Erlangen, Germany
| | - Michael D Menger
- Saarland University Medical Center, Institute for Clinical & Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - Dieter Kohn
- Saarland University Medical Center, Department of Orthopaedics and Orthopaedic Surgery, Kirrberger Straße, Geb. 37, 66421 Homburg, Saar, Germany
| | - Thomas Tschernig
- Saarland University Medical Center, Institute of Anatomy and Cell Biology, Kirrberger Straße, Geb. 61, 66421 Homburg, Saar, Germany
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Mohr M, von Tscharner V, Emery CA, Nigg BM. Classification of gait muscle activation patterns according to knee injury history using a support vector machine approach. Hum Mov Sci 2019; 66:335-346. [PMID: 31146192 DOI: 10.1016/j.humov.2019.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 11/26/2022]
Abstract
Abnormal muscle activation patterns during gait following knee injury that persist past the acute injury and rehabilitation phase (>three years) are not well characterized but may be related to post-traumatic knee osteoarthritis. The aim was to characterize the abnormal muscle activity from electromyograms of five leg muscles that were recorded during treadmill walking for young adults with and without a previous knee injury 3-12 years prior. The wavelet transformed and amplitude normalized electromyograms yielded intensity patterns that reflect the muscle activity of these muscles resolved in time and frequency. Patterns belonging to the affected or unaffected leg in previously injured participants and patterns belonging to a previously injured vs. uninjured participant were grouped and then classified using a principal component analysis followed by a support vector machine. A leave-one-out cross-validation was used to test the model significance and generalization. The results showed that trained classifiers could successfully recognize whether muscle activation patterns belonged to the affected or unaffected leg of previously injured individuals. Classification rates of 83% were obtained for all subjects, 100% for females only, indicating sex-specific knee injury effects. In contrast, it was not possible to discriminate between patterns belonging to the previously injured legs or dominant legs of control subjects. For females, the injured leg showed a stronger muscle activity for hamstring muscles and a lower activity for the vastus lateralis. In conclusion, systematic knee injury effects on the neuromuscular control of the knee during gait were present 3-12 years later.
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Affiliation(s)
- Maurice Mohr
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada.
| | - Vinzenz von Tscharner
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - Carolyn A Emery
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada; The Alberta Children's Hospital Research Institute and McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Benno M Nigg
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Alberta, Canada
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Georgiev GP, Kotov G, Iliev A, Slavchev S, Ovtscharoff W, Landzhov B. A comparative study of the epiligament of the medial collateral and the anterior cruciate ligament in the human knee. Immunohistochemical analysis of collagen type I and V and procollagen type III. Ann Anat 2019; 224:88-96. [PMID: 31022516 DOI: 10.1016/j.aanat.2019.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/21/2019] [Accepted: 04/04/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recent reports in rat models have shown that fibroblasts in the epiligament, an enveloping tissue of the ligament, are not static cells and play an important role during the early ligament healing of isolated grade III injury of the collateral ligaments of the knee. Fibroblasts produce collagen types I, III and V and infiltrate within the ligament body via the endoligament. In addition, similarities have been reported between the structure of the epiligament of the medial collateral ligament and anterior cruciate ligament of the knee in rat and in human. In line with the ascribed role of the epiligament tissue and the synthesis of these collagens and their role in ligament healing, the aim of this study was to determine their presence in the normal epiligament of the aforementioned ligaments in humans, to compare their differential expression and to present a novel hypothesis about the failure of healing of the anterior cruciate ligament in contrast to the medial collateral ligament. MATERIALS AND METHODS We used samples from the mid-substance of the medial collateral and the anterior cruciate ligament of the knee joint, acquired from 12 fresh knee joints. Routine histological analysis was performed through hematoxylin and eosin stain, Mallory's trichrome stain and Van Gieson's stain. The immunohistochemical analysis was conducted using monoclonal antibodies against collagen type I and V and procollagen type III. The number of cells in the epiligament, endoligament and the ligament tissue was assessed quantitatively through a computerized system for image analysis NIS-Elements Advanced Research and Statistica software. RESULTS Our observations revealed certain differences in the morphology of the epiligament, as well as variations in the expression of the investigated molecules. Expression of collagen type I was mostly low-positive (1+) in the epiligament and positive (2+) in the ligament tissue of both ligaments. Expression of procollagen type III was mostly positive (2+) in the epiligament and ligament tissue of the medial collateral ligament, low-positive (1+) in the epiligament and negative (0) in ligament tissue of the anterior cruciate ligament. Expression of collagen type V was predominantly low-positive (1+) in the epiligament and negative (0) in the ligament tissue of both ligaments. The immunoreactivity for all three molecules was always higher in the epiligament of the medial collateral ligament than that of the anterior cruciate ligament. CONCLUSIONS The results of our study illustrate for the first time that fibroblasts in the human epiligament are indeed responsible for the synthesis of the main types of collagen participating in the early ligament healing, thus corresponding to previous data of the medial collateral ligament healing in animal models. The differences between the epiligament of the investigated ligaments could add a novel explanation for the failed anterior cruciate ligament healing.
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Affiliation(s)
- Georgi P Georgiev
- Department of Orthopedics and Traumatology, University Hospital 'Queen Giovanna - ISUL', Medical University of Sofia, Bulgaria
| | - Georgi Kotov
- Department of Anatomy, Histology and Embryology, Medical University of Sofia, Bulgaria
| | - Alexandar Iliev
- Department of Anatomy, Histology and Embryology, Medical University of Sofia, Bulgaria.
| | - Svetoslav Slavchev
- Department of Orthopedics and Traumatology, University Hospital of Orthopedics 'Prof. B. Boychev', Medical University of Sofia, Bulgaria
| | - Wladimir Ovtscharoff
- Department of Anatomy, Histology and Embryology, Medical University of Sofia, Bulgaria
| | - Boycho Landzhov
- Department of Anatomy, Histology and Embryology, Medical University of Sofia, Bulgaria
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Svantesson E, Hamrin Senorski E, Alentorn-Geli E, Westin O, Sundemo D, Grassi A, Čustović S, Samuelsson K. Increased risk of ACL revision with non-surgical treatment of a concomitant medial collateral ligament injury: a study on 19,457 patients from the Swedish National Knee Ligament Registry. Knee Surg Sports Traumatol Arthrosc 2019; 27:2450-9. [PMID: 30374568 DOI: 10.1007/s00167-018-5237-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/17/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine how concomitant medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries affect outcome after anterior cruciate ligament (ACL) reconstruction. METHODS Patients aged > 15 years who were registered in the Swedish National Knee Ligament Registry for primary ACL reconstruction between 2005 and 2016 were eligible for inclusion. Patients with a concomitant MCL or LCL injury were stratified according to collateral ligament treatment (non-surgical, repair or reconstruction), and one isolated ACL reconstruction group was created. The outcomes were ACL revision and the 2-year Knee Injury and Osteoarthritis Outcome Score (KOOS), which were analyzed using univariable and multivariable Cox regression and an analysis of covariance, respectively. RESULTS A total of 19,457 patients (mean age 27.9 years, 59.4% males) met the inclusion criteria. An isolated ACL reconstruction implied a lower risk of ACL revision compared with presence of a non-surgically treated MCL injury (HR = 0.61 [95% CI 0.41-0.89], p = 0.0097) but not compared with MCL repair or reconstruction. A concomitant LCL injury did not impact the risk of ACL revision. Patients with a concomitant MCL or LCL injury reported inferior 2-year KOOS compared with isolated ACL reconstruction. The largest difference was found in the sports and recreation subscale across all groups, with MCL reconstruction resulting in the maximum difference (14.1 points [95% CI 4.3-23.9], p = 0.005). CONCLUSION Non-surgical treatment of a concomitant MCL injury in the setting of an ACL reconstruction may increase the risk of ACL revision. However, surgical treatment of the MCL injury was associated with a worse two-year patient-reported knee function. A concomitant LCL injury does not impact the risk of ACL revision compared with an isolated ACL reconstruction. LEVEL OF EVIDENCE Cohort study, Level III.
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