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Kaya S, Unal YC, Guven N, Ozcan C, Dundar A, Turkozu T, Ozkan S, Adanas C, Gokalp MA. The impact of early weight-bearing on results following anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2024; 25:395. [PMID: 38773398 DOI: 10.1186/s12891-024-07525-8] [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: 11/05/2023] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) ruptures are common injuries that typically affect young, physically active individuals and may require surgical reconstruction. Studies have shown that the long time success of ACL reconstruction depends on the surgical technique and the postoperative rehabilitation strategy. However, there is still no consensus on the content of rehabilitation programs. Hence, additional research is required to elucidate the significance of early weight-bearing in the rehabilitation process following ACL reconstruction. The aim of this article is to examine the impact of weight-bearing on the clinical results of ACL reconstruction. MATERIALS AND METHODS We retrospectively reviewed patient records who had undergone arthroscopic reconstruction using a semitendinosus-gracilis tendon graft for anterior cruciate ligament rupture between January 2018 and December 2020. The study included the data of 110 patients. The patients were split into two groups: Group 1 underwent early weight-bearing, while Group 2 followed a non-weight-bearing regimen for three weeks. We assessed the patients using the anterior drawer test, Lachman test, range of motion, Lysholm knee scale, Cincinnati scale, Tegner scale, International Knee Documentation Committee (IKDC) form and clinical records. Analytical tests were conducted to compare the results. RESULTS The complication rates did not show a significant difference between the groups. Group 1 had higher frequencies of positive anterior drawer and Lachman tests. The Lysholm and Cincinnati knee scores of patients in Group 1 were notably lower than those of patients in Group 2. Additionally, the Tegner activity scores and IKDC scores of patients in Group 1 were also meaningfully lower than those of patients in Group 2. In Group 1 patients, there was no notable relationship observed between body mass index (BMI) and the results of the anterior drawer test (ADT) or Lachman test. However, patients with a BMI of 25 or higher in Group 1 showed a decrease in postoperative IKDC scores. In Group 2 patients, no significant relationship was identified between BMI and either the ADT or the Lachman test outcome. CONCLUSION Based on current literature and current rehabilitation guidelines following ACL reconstruction, the decision to initiate early weight-bearing is based on a limited number of studies with low levels of evidence. In our study, we found that patients who followed a non-weight-bearing regimen for 3 weeks after surgery had better mid-term results than those who were allowed to bear weight early. It appears that further prospective studies on this topic are needed to update rehabilitation guidelines in the next.
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Affiliation(s)
- Sehmuz Kaya
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey.
| | - Yunus Can Unal
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey
| | - Necip Guven
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey
| | - Can Ozcan
- Department of Orthopaedics and Traumatology, Orhaneli State Hospital, Bursa, Turkey
| | - Abdulrahim Dundar
- Department of Orthopaedics and Traumatology, Hitit University, Corum, Turkey
| | - Tulin Turkozu
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey
| | - Sezai Ozkan
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey
| | - Cihan Adanas
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey
| | - Mehmet Ata Gokalp
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey
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Li X, Li H, Su J, Ding R. Anterior cruciate ligament femoral side retained stump technique reduces enlargement of the femoral bone tunnel after anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2024; 25:380. [PMID: 38745214 PMCID: PMC11092199 DOI: 10.1186/s12891-024-07464-4] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Enlargement of the bone tunnel has become an unavoidable early complication after anterior cruciate ligament (ACL) reconstruction, whether it is a single or double-bundle ACL reconstruction. Preservation of the ACL stump in ACL reconstruction reduces enlargement of the bone tunnel. The purpose of this study was to investigate the question of whether single-bundle ACL reconstruction using the ACL femoral side retained stump technique reduces enlargement of the femoral tunnel. METHODS Forty patients who underwent single-bundle reconstruction of the ACL were included in this study. The patients were categorized into a Remnant preservation group (Group R) and the Non-remnant preservation group (Group N). In the Remnant preservation group, a high-flexion femoral side retained stump technique was used intraoperatively for the establishment of the femoral side bone tunnel, and in the Non-remnant preservation group, the conventional femoral positioning method was used (we used a femoral positioning drill for localization and drilling of the femoral bone tunnel), and MRI of the operated knee joints was performed at 6 months postoperatively. We measured the internal diameter of the femoral bone tunnel at 5 mm from the intra-articular outlet of the femoral bone tunnel on an MRI scan image perpendicular to the femoral bone tunnel. The size of the tunnel was compared between the intraoperative drilling of the bone tunnel and the size of the bone tunnel at 6 months postoperatively. Postoperative clinical assessment was Lysholm score. RESULTS After a 6-month follow-up of 40 patients, the diameter of the femoral tunnel at a distance of 5 mm from the inner opening of the femoral tunnel was 10.96 ± 0.67 mm and 10.11 ± 0.62 mm in patients of group N and group R, respectively, and the difference was statistically significant (P < 0.05).The diameter of the femoral tunnel at 6 months postoperatively in group N and group R compared to the intraoperative bone tunnel increased by 2.58 ± 0.24 mm and 1.94 ± 0.31 mm, and the difference was statistically significant (P < 0.05).The femoral tunnel enlargement rates of group N and group R were 30.94 ± 3.00% and 24.02 ± 5.10%, respectively, and the differences were significant (P < 0.05). CONCLUSION ACL femoral side retained stump technique does not sacrifice the ideal location of the femoral tunnel and is able to preserve the possible benefits of the ACL stump: reduced femoral tunnel enlargement.
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Affiliation(s)
- Xiaobo Li
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Hanlin Li
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- Clinical Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Jixian Su
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- Clinical Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Ran Ding
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China.
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Schneider JG, Ormseth B, DiBartola AC, Magnussen RA, Duerr RA, Stoodley P, Flanigan DC. Incidence, Common Pathogens, and Risk Factors for Infection after Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review. J Knee Surg 2024; 37:470-481. [PMID: 37734405 DOI: 10.1055/a-2179-3678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
We sought to assess the current literature to present a comprehensive summary of the incidence, common pathogens, and risk factors for infection after anterior cruciate ligament (ACL) reconstruction. PubMed, CINAHL, EMBASE, and Scopus databases were searched for relevant studies reporting on infection after ACL reconstruction. Two reviewers independently screened the extracted studies for adherence to inclusion and exclusion criteria. Studies were selected if they reported on the incidence of infection, pathogens cultured from infected knees, or risk factors for infection after primary ACL reconstruction. Exclusion criteria consisted of studies with fewer than 100 patients or studies that included revision ACL reconstruction. Fifty studies met the inclusion and exclusion criteria, reporting on a total of 316,214 ACL reconstructions. Included studies evaluated between 123 and 104,255 patients. The overall incidence of infection was 0.60% (0.15-2.44%). The most common pathogens were Staphylococcus aureus, S. epidermidis, and coagulase-negative Staphylococci. Five studies reported that the use of hamstring autograft was a statistically significant risk factor for infection after ACL reconstruction, thus making hamstring autograft the most commonly reported risk factor. Other reported risk factors included male sex, use of immuno-suppressive medications or intraarticular steroid injections, prior knee surgery, and diabetes. Systematic review of the literature revealed that infection after ACL reconstruction remains an infrequent event with an incidence of 0.60% (0.15-2.44%). Furthermore, the most common pathogens are from the Staphylococcus genus of bacteria, comprising 84% of all culture-positive infections. Multiple risk factors have been reported for ACL reconstruction; however, statistical significance varied across studies. Together, these findings may help guide physicians in the prevention and treatment of infection after ACL reconstruction.
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Affiliation(s)
| | | | - Alex C DiBartola
- Sports Medicine and the Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert A Magnussen
- Sports Medicine and the Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert A Duerr
- Sports Medicine and the Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paul Stoodley
- Department of Microbial Infection and Immunity and the Department of Orthopaedics, The Ohio State University School of Medicine, The Ohio State University, Columbus, Ohio
| | - David C Flanigan
- Sports Medicine and the Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Hopper H, Adsit M, Reiter CR, Satalich JR, Schmidt RC, Peri MI, Cyrus JW, Vap AR. Female Sex, Older Age, Earlier Surgery, Anticoagulant Use, and Meniscal Repair Are Associated With Increased Risk of Manipulation Under Anesthesia or Lysis of Adhesions for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2024; 40:1687-1699. [PMID: 38000486 DOI: 10.1016/j.arthro.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE To determine what patient or surgical factors are associated with an increased risk of arthrofibrosis requiring manipulation under anesthesia (MUA) or lysis of adhesions (LOA) after anterior cruciate ligament reconstruction (ACLR). METHODS A systematic review was performed in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Cochrane, Embase, and Medline databases were searched for studies published through February 2023. Inclusion criteria were studies that identified risk factors for MUA and/or LOA after ACLR. Studies investigating arthrofibrosis after multiligamentous knee injuries or ACL repair were excluded. RESULTS Eleven studies including a total of 333,876 ACLRs with 4,842 subsequent MUA or LOA (1.45%) were analyzed. Increasing age was associated with an increased risk in 3 studies (P < .001, P < .05, P < .01) but was found to have no association another two. Other factors that were identified by multiple studies as risk factors for MUA/LOA were female sex (4 studies), earlier surgery (5 studies), use of anticoagulants other than aspirin (2 studies), and concomitant meniscal repair (4 studies). CONCLUSIONS In total, 1.45% of the patients who underwent ACLR and were included in this systematic review had to undergo a subsequent MUA/LOA to treat arthrofibrosis. Female sex, older age, earlier surgery, use of anticoagulants other than aspirin, and concomitant meniscal repair were associated with increased risk of MUA/LOA. The modifiable risks, including use of anticoagulants and time between injury and surgery, can be considered when making treatment decisions. LEVEL OF EVIDENCE Level IV, systematic review of Level III-IV studies.
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Affiliation(s)
- Haleigh Hopper
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A..
| | - Matthew Adsit
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - Charles R Reiter
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, U.S.A
| | - James R Satalich
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - R Cole Schmidt
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - Maria I Peri
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - John W Cyrus
- Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Alexander R Vap
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
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Garra S, Moore MR, Li ZI, Eskenazi J, Jazrawi T, Bi AS, Campbell KA, Alaia MJ, Strauss EJ. Segond fracture: an indicator for increased risk of lateral meniscus injury in patients with acute anterior cruciate ligament ruptures. Eur J Orthop Surg Traumatol 2024; 34:1883-1891. [PMID: 38448565 DOI: 10.1007/s00590-024-03857-2] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE The purpose of this study was to investigate the incidence and anatomic distribution of meniscus injury in patients who have sustained acute ACL injuries with and without concomitant Segond fracture. We hypothesized that patients who have sustained a torn ACL with a concomitant Segond fracture would have a higher incidence of lateral meniscal injuries than patients with an isolated ACL injury. METHODS Patients who underwent ACL reconstruction from 2012 to 2022 were retrospectively reviewed. Segond fractures were identified on knee radiographs. Inclusion criteria were age 18-40, injury during sports activity, and reconstruction within 90 days of injury. Sports activity, anatomic location of meniscus injury, and meniscus treatment were documented. Multivariable regression was used to identify predictors of meniscus injury/treatment. RESULTS There were 25 of 603 (4.1%) patients who had an ACL tear with concomitant Segond fracture. The incidence of lateral meniscus injury in the Segond group (72%) was significantly higher than in the non-Segond cohort (49%; p = 0.024). A significantly smaller proportion of medial meniscus injuries among patients with Segond fractures were repaired (23.1%) compared to the non-Segond group (54.2%; p = 0.043). Multivariate analysis found patients with Segond fractures to have increased odds of lateral meniscus injury (OR 2.68; [1.09, 6.60], p = 0.032) and were less likely to have medial meniscus injuries repaired (OR 0.35; [0.15, 0.81], p = 0.014). Additionally, males had increased odds of lateral meniscus injury (OR 1.54; [1.08 - 2.91], p = 0.017), which were more likely to require repair (OR 1.48; [1.02, 2.14], p = 0.038). CONCLUSIONS Among acute ACL injuries, the incidence of lateral meniscus injury is greater among patients with Segond fractures. Patients with Segond fracture were less likely to undergo repair of medial meniscal injuries.
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Affiliation(s)
- Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA.
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Tel-Aviv University, Ramat Gan, Israel.
| | - Michael R Moore
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Jordan Eskenazi
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Taylor Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Andrew S Bi
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, New York, NY, 10016, USA
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Zhou W, Liu X, Hong Q, Wang J, Luo X. Association between passing return-to-sport testing and re-injury risk in patients after anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis. PeerJ 2024; 12:e17279. [PMID: 38699196 PMCID: PMC11064852 DOI: 10.7717/peerj.17279] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Background Inconsistent results have been obtained regarding the association between return-to-sport (RTS) testing and the risk of subsequent re-injury following anterior cruciate ligament reconstruction (ACLR). We therefore conducted a systematic review and meta-analysis to assess the potential association between passing of RTS and the risk of re-injury for patients after ACLR. Methods This meta-analysis was registered in INPLASY with the registration number INPLASY202360027. The electronic databases MedLine, EmBase, and the Cochrane library were systematically searched to identify eligible studies from their inception up to September 2023. The investigated outcomes included knee injury, secondary ACL, contralateral ACL injury, and graft rupture. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the random-effects model. Results A total number of nine studies involving 1410 individuals were selected for the final quantitative analysis. We noted that passing RTS test was not associated with the risk of subsequent knee injury (OR: 0.95; 95% CI: 0.28-3.21; P = 0.929), secondary ACL injury (OR: 0.98; 95% CI: 0.55-1.75; P = 0.945), and contralateral ACL injury (OR: 1.53; 95% CI: 0.63-3.71; P = 0.347). However, the risk of graft rupture was significantly reduced (OR: 0.49; 95% CI: 0.33-0.75; P = 0.001). Conclusions This study found that passing RTS test was not associated with the risk of subsequent knee injury, secondary ACL injury, and contralateral ACL injury, while it was associated with a lower risk of graft rupture. Thus, it is recommended that patients after ACLR pass an RTS test in clinical settings.
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Affiliation(s)
- Wenqi Zhou
- Department of Sport Medicine, Sichuan Orthopedic Hospital, Chengdu, Sichuan, China
| | - Xihui Liu
- Department of Sport Medicine, Sichuan Orthopedic Hospital, Chengdu, Sichuan, China
| | - Qiaomei Hong
- Department of Sport Medicine, Sichuan Orthopedic Hospital, Chengdu, Sichuan, China
| | - Jingping Wang
- Department of Sport Medicine, Sichuan Orthopedic Hospital, Chengdu, Sichuan, China
| | - Xiaobing Luo
- Department of Sport Medicine, Sichuan Orthopedic Hospital, Chengdu, Sichuan, China
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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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Adhitya IPGS, Yu WY, Kurniawati I, Lin MR. Risk factors of knee reinjury after anterior cruciate ligament reconstruction. Int Orthop 2024; 48:983-990. [PMID: 38195945 DOI: 10.1007/s00264-023-06084-2] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE This study aimed to investigate whether the return to level I sports, concomitant injuries, foot-related problems, and other factors would increase the risk of knee reinjury after anterior cruciate ligament reconstruction (ACLR). METHODS This study used a prospective cohort study design. Online enrolment from August 2018 to January 2019 in ACL Community Indonesia recruited 148 patients who had undergone ACLR less than one month prior to injury. Knee injury occurrence after ACLR was diagnosed through a physical examination and positive MRI or arthroscopic findings. RESULTS During the study, 55 knee reinjuries occurred. The proportional hazards model analysis revealed that the risk of knee reinjury at 12 and 24 months for patients who returned to level I sports (hazards ratio (HR)=3.17 and HR=3.90, respectively) was significantly higher than that of the patients who did not return to sports and that the risk for those who returned to level II/III sports did not significantly increase at 12 or 24 months. Patients with concomitant meniscus injury had a significantly higher risk of knee reinjury at 12 and 24 months (HR=3.33 and HR=2.25, respectively) than those without, and the risk of knee reinjury for patients with concomitant posterior cruciate ligament injury was significantly higher at 12 months (HR=3.05) but not at 24 months. Fewer knee symptoms after ACLR were significantly associated with a lower risk of knee reinjury (HR=0.98) at 12 and 24 months. CONCLUSIONS The return to level I sports, concomitant meniscus and posterior cruciate ligament injury, and knee symptoms after ACLR may increase the risk of knee reinjury for post-ACLR patients.
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Affiliation(s)
- I Putu Gde Surya Adhitya
- Department of Physical Therapy, College of Medicine, Universitas Udayana, P.B Sudirman Street, Denpasar, Bali, 80232, Indonesia
| | - Wen-Yu Yu
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan, Republic of China
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China
| | - Ida Kurniawati
- Department of Histology, Faculty of Medicine and Health Sciences, Universitas Warmadewa, Denpasar, Bali, Indonesia
| | - Mau-Roung Lin
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan, Republic of China.
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Danieli MV, Fernandes Guerreiro JP. Extraarticular infection 9 years after anterior cruciate ligament reconstruction. Case report. J ISAKOS 2024; 9:211-214. [PMID: 38081388 DOI: 10.1016/j.jisako.2023.12.004] [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] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/29/2023]
Abstract
Extraarticular infection after anterior cruciate ligament reconstruction (ACLr) is a rare condition with challenging diagnosis because the symptoms are milder and more insidious when compared to septic arthritis. When late (>2 months after surgery), it tends to be associated with osteomyelitis, requiring more extensive surgical debridement and hardware removal. We report a case of extraarticular infection after ACLr, in the acute phase affecting the tibial site and 9 years after index surgery affecting around the femur site. There was no progression to osteomyelitis at any of the sites. The infection developed a large posterolateral encapsulated abscess, with the endobutton plate loose inside it with its loop intact. In addition to the absence of osteomyelitis progression, there was no sinus tract formation, graft or joint involvement. With open debridement and antibiotic therapy, the patient returned to his activities without limitations. The reported case highlights that extraarticular infection after ACLr, while rare, can be challenging to diagnose and treat. However, with appropriate treatment, it can lead to good results with no functional limitations.
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Affiliation(s)
- Marcus Vinicius Danieli
- Unort.E Hospital de Ortopedia, Av. Higienópolis nº 2600, Londrina, PR CEP 86050-000, Brazil; Pontifícia Universidade Católica PUC, Paraná - Campus de Londrina, Av. Jockey Club, 485, Hípica, Londrina, PR CEP 86067-000, Brazil.
| | - João Paulo Fernandes Guerreiro
- Unort.E Hospital de Ortopedia, Av. Higienópolis nº 2600, Londrina, PR CEP 86050-000, Brazil; Pontifícia Universidade Católica PUC, Paraná - Campus de Londrina, Av. Jockey Club, 485, Hípica, Londrina, PR CEP 86067-000, Brazil.
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10
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Wen D, Guo D. Tibial interference-screw extrusion at the early stage after anterior cruciate ligament reconstruction: A case report. Asian J Surg 2024; 47:1800-1802. [PMID: 38158314 DOI: 10.1016/j.asjsur.2023.12.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Dan Wen
- Northern Jiangsu People's Hospital (NJPH), Yangzhou, Jiangsu, 225001, China
| | - Dan Guo
- Northern Jiangsu People's Hospital (NJPH), Yangzhou, Jiangsu, 225001, China.
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11
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Zhong J, Lee NJ, Crutchfield C, Mueller J, Ahmad C, Trofa D, Lynch TS. Perioperative outcomes in isolated versus multiligamentous anterior cruciate ligament reconstruction: a retrospective cohort analysis. Eur J Orthop Surg Traumatol 2024; 34:1597-1607. [PMID: 38363347 DOI: 10.1007/s00590-024-03848-3] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE The outcomes of anterior cruciate ligament reconstruction in the setting of multiligamentous knee injury (M-ACLR) have not been well characterized compared to isolated ACLR (I-ACLR). This study aims to characterize and compare short-term outcomes between I-ACLR and M-ACLR. METHODS This is a retrospective cohort analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2017. Current Procedural Terminology codes were used to identify and compare elective I- and M-ACLR patients, excluding patients undergoing concomitant meniscal or chondral procedures. Patient demographics and outcomes after I- and M-ACLR were compared using bivariate analysis. Multiple logistic regression analyzed if multiligamentous ACLR was an independent risk factor for adverse outcomes. RESULTS There was a total of 13,131 ACLR cases, of which 341 were multiligamentous cases. The modified fragility index-5 was higher in multiligamentous ACLR (p < 0.001). Multiligamentous ACLR had worse perioperative outcomes, with higher rate of all complications (3.8%, p = 0.013), operative time > 1.5 h (p < 0.001), length of stay (LOS) ≥ 1 day (p < 0.001), wound complication (2.1%, p = 0.001), and intra- or post-op transfusions (p < 0.001). In multiple logistic regression, multiligamentous ACLR was an independent risk factor for LOS ≥ 1 (odds ratio [OR] 5.8), and intra-/post-op transfusion (OR 215.1) and wound complications (OR 2.4). M-ACLR was not an independent risk factor for any complication, reoperation at 30 days, readmission, urinary tract infection (UTI), or venous thromboembolism (VTE). CONCLUSION M-ACLR generally had worse outcomes than I-ACLR, including longer LOS, need for perioperative transfusions, and wound complications.
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Affiliation(s)
- Jack Zhong
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA.
- Department of Orthopaedic Surgery, New York University Langone Health, New York, 10010, USA.
| | - Nathan J Lee
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - Connor Crutchfield
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - John Mueller
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - Christopher Ahmad
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - David Trofa
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
| | - T S Lynch
- Department of Orthopedic Surgery, Columbia University, 301 E 17th St, 14th Floor, New York, NY, 10010, USA
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, 48202, USA
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12
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He Y, Fan Y, Zhai L, Zhu W. Comparative efficacy and safety of different surgical approaches for the treatment of anterior cruciate ligament injury: a Bayesian network meta-analysis protocol. BMJ Open 2024; 14:e077242. [PMID: 38553073 PMCID: PMC10982744 DOI: 10.1136/bmjopen-2023-077242] [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: 06/29/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) rupture can be treated surgically or non-surgically, with several surgical interventions available at present. However, the comparatively effective surgical intervention with relatively fewer side effects remains unknown. This study aims to fill in this gap by conducting a Bayesian network meta-analysis (NMA) and provide a theoretical basis for the clinical application. METHOD AND ANALYSIS We will perform a Bayesian NMA and will include randomised controlled trials (RCTs) published in English or Chinese that compare surgical intervention (ie, standard ACL reconstruction, ACL remnant-preserving reconstruction and ACL repair with suture augmentation to conservative therapy or studies that compare one surgical intervention to another for the symptom relief and function recovery of patients with ACL rupture. Primary outcome will be the proportion of patients with symptomatic and functional improvement measured by the Knee Injury and Osteoarthritis Outcome Score before and 6 months after treatment, with scores ranging from 0 (worst) to 100 (best). Secondary outcomes will be knee-specific quality of life (ACL QoL), return to activity and level of sport participation (Tegner or modified Tegner score), health-related QoL (EuroQol Group 5-Dimension 5-Level, EQ-5D-5L), resource use, intervention-related complications and patient satisfaction. We have developed search strategies for PubMed, Embase, the Cochrane Library and Web of Science, retrieving RCTs that meet the inclusion criteria from database inception to 1 December 2023. The methodological quality of the included RCTs will be assessed based on the Cochrane risk of bias table. The relative ranking probability of the best intervention will be estimated using the surface under the cumulative ranking curve. The Bayesian NMA will be conducted by using WinBUGS V.1.4.3. The Grading of Recommendations Assessment, Development and Evaluation approach will be applied to determine our confidence in an overall treatment ranking from the NMA. ETHICS AND DISSEMINATION Ethical approval for this study is not required because no private or confidential patient data will be used in this study. Findings of this study would be disseminated through the publication in a peer-reviewed medical journal. PROSPERO REGISTRATION NUMBER CRD42023437115.
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Affiliation(s)
- Yuchen He
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yishu Fan
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Central South University, Changsha, Hunan, China
| | - Longxiang Zhai
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Weihong Zhu
- Department of Orthopadics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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13
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Grassi A, Olivieri Huerta RA, Lucidi GA, Agostinone P, Dal Fabbro G, Pagano A, Tischer T, Zaffagnini S. A Lateral Extra-articular Procedure Reduces the Failure Rate of Revision Anterior Cruciate Ligament Reconstruction Surgery Without Increasing Complications: A Systematic Review and Meta-analysis. Am J Sports Med 2024; 52:1098-1108. [PMID: 38294248 PMCID: PMC10943615 DOI: 10.1177/03635465231173698] [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: 11/26/2022] [Accepted: 03/17/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Lateral extra-articular procedures are becoming increasingly popular in association with anterior cruciate ligament (ACL) reconstruction, especially in patients with persistent rotatory instability and in a high-risk population. However, few studies have investigated the outcomes of the lateral extra-articular procedure as an associated procedure in an ACL revision (R-ACLR) setting and its benefit with respect to isolated intra-articular reconstruction. HYPOTHESIS Lateral extra-articular procedures reduce the failure rate of revision ACL reconstruction (R-ACLR). PURPOSE To compare subjective outcomes, knee stability, and failure and complication rates between patients who underwent ACL revision with and without an associated lateral extra-articular procedure. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 3. METHODS A systematic search of the PubMed, Cochrane, and OVID databases was performed on September 2022 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Eligible studies were trials directly comparing patients who had isolated ACL revision with patients who had ACL revision associated with lateral extra-articular procedures at a minimum follow-up of 2 years. A meta-analysis was performed, and bias and the quality of the evidence were rated according to the Newcastle-Ottawa Scale. The meta-analysis was conducted according to the PRISMA guidelines. RESULTS Eight studies were included: a total of 334 patients were treated with isolated revision (isolated (R-ACLR)) and 342 treated with combined revision and a lateral extra-articular procedure (combined (R-ACLR)). For the failure rate, the meta-analysis showed a significantly decreased relative risk reduction of 54% (P = .004) in patients with combined (R-ACLR) with respect to isolated R-ACL, whereas no difference in complication rate was observed. The combined (R-ACLR) group demonstrated a decreased risk ratio of 50% (P = .002) for having a positive pivot-shift test result and a relative risk reduction of 68% (P = .003) for having a grade 2-3 pivot shift when compared with the isolated (R-ACLR) group. Finally, no significant differences were observed among the lateral extra-articular procedures. CONCLUSION The addition of a lateral extra-articular procedure to revision ACL significantly reduced the failure rate and postoperative pivot shift without increasing the complication rate. Anterolateral ligament reconstruction and a lateral extra-articular procedure with iliotibial band were effective in improving the outcomes of revision ACL reconstruction. Further high-level studies could help to clarify which subgroup of patients could particularly benefit from an anterolateral procedure in the context of ACL revision.
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Affiliation(s)
- Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Gian Andrea Lucidi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Agostinone
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Dal Fabbro
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Anna Pagano
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Thomas Tischer
- Department of Orthopaedic and Trauma Surgery, Klinik Für Orthopädie und Unfallchirurgie, Malteser Waldkrankenhaus St Marien, Erlangen, Germany
- Department of Orthopaedic Surgery, University Medicine Rostock, Rostock, Germany
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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14
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Kaur J, Pham NS, Cahan E, Halvorsen KC, Langner JL, Bryson XM, Chan CM, Vorhies JS. Use of Peripheral Nerve Blocks Is Not Associated With Decreased Postoperative Opioid Prescription After ACL Reconstruction in Adolescents. Orthopedics 2024; 47:83-88. [PMID: 37341565 DOI: 10.3928/01477447-20230616-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
The rate of anterior cruciate ligament (ACL) injuries and reconstruction in pediatric patients is increasing. Perioperative peripheral nerve blocks (PNBs) are widely used for pain management in this population. We used a multi-state administrative claims database to describe the effect of PNB after ACL reconstruction on postoperative opioid consumption. We identified patients 10 to 18 years old undergoing primary ACL reconstruction between 2014 and 2016 in an administrative claims database. Patients filling an outpatient perioperative prescription for opioids with at least 1 year of follow-up were included. We stratified patients based on PNB. Our primary outcome was opioid prescription patterns (in morphine milligram equivalents [MMEs]) and incidence of opioid represcription. Of the 4459 cases, 2432 (54.5%) of the patients were given a PNB during ACL reconstruction while 2027 (45.5%) were not. Patients with PNB were prescribed more MMEs per day (76.1±41.7 vs 62.7±35.7 MMEs, P<.001), more pills (63.6±53.1 vs 54.4±40.6 pills, P<.001), higher MMEs per pill (10.0±9.5 vs 8.3±5.0 MMEs, P<.001), and more total MMEs (460.6±259.4 vs 355.7±215.1 MMEs, P<.001) than patients without PNB. Adjusting for prescription patterns and demographic variables with logistic regression, PNBs were associated with a 60% increase in the odds of opioid represcription within 30 days and a 32% increase in the odds of opioid represcription within 90 days. We demonstrated an increase in postoperative opioid prescription rates with PNB after ACL reconstruction. [Orthopedics. 2024;47(2):83-88.].
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15
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Lawrence KW, Okewunmi JO, Chakrani Z, Cordero JK, Li X, Parisien RL. Randomized Controlled Trials Comparing Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autografts in Anterior Cruciate Ligament Reconstruction Surgery Are Statistically Fragile: A Systematic Review. Arthroscopy 2024; 40:998-1005. [PMID: 37543146 DOI: 10.1016/j.arthro.2023.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/07/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To assess the statistical fragility of recently published randomized controlled trials (RCTs) comparing the use of hamstring tendon autograft with bone-patellar tendon-bone autograft for anterior cruciate ligament (ACL) reconstruction. METHODS The PubMed, Embase, and MEDLINE databases were queried for RCTs published since 2010 comparing autograft type (bone-patellar tendon-bone vs hamstring tendon) in ACL reconstruction surgery. The fragility index (FI) and reverse FI (rFI) were determined for significant and nonsignificant outcomes, respectively, as the number of outcome reversals required to change statistical significance. The fragility quotient (FQ) and reverse FQ, representing fragility as a proportion of the study population, were calculated by dividing the FI and rFI, respectively, by the sample size. RESULTS We identified 19 RCTs reporting 55 total dichotomous outcomes. The median FI of the 55 total outcomes was 5 (interquartile range [IQR], 4-7), meaning a median of 5 outcome event reversals would alter the outcomes' significance. Five outcomes were reported as statistically significant with a median FI of 4 (IQR, 2-6), meaning a median of 4 outcome event reversals would change outcomes to be nonsignificant. Fifty outcomes were reported as nonsignificant with a median rFI of 5 (IQR, 4-7), meaning a median of 5 outcome event reversals would change outcomes to be significant. The FQ and reverse FQ for significant and nonsignificant outcomes were 0.025 (IQR, 0.018-0.045) and 0.082 (IQR, 0.041-0.106), respectively. For 61.8% of outcomes, patients lost to follow-up exceeded the corresponding FI or rFI. CONCLUSIONS There is substantial statistical fragility in recent RCTs on autograft choice in ACL reconstruction surgery given that altering a few outcome events is sufficient to reverse study findings. For over half of outcomes, maintaining patients lost to follow-up may have been sufficient to reverse study conclusions. CLINICAL RELEVANCE We recommend co-reporting FIs and P values to provide a more comprehensive representation of a study's conclusions when conducting an RCT.
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Affiliation(s)
- Kyle W Lawrence
- Boston University School of Medicine, Boston, Massachusetts, U.S.A..
| | | | - Zakaria Chakrani
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - John K Cordero
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Xinning Li
- Boston University School of Medicine, Boston, Massachusetts, U.S.A
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16
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Yazdi H, Eslami A, Torkaman A, Elahifar O, Kasaeian A, Alimoghadam S, Alimoghadam R, Abolghasemian M. Aspirin is as effective as low molecular weight heparins in preventing symptomatic venous thromboembolism following arthroscopic anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2024; 25:154. [PMID: 38373950 PMCID: PMC10875785 DOI: 10.1186/s12891-024-07282-8] [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: 08/23/2023] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE The optimal agent for thromboprophylaxis following arthroscopic anterior cruciate ligament reconstruction (ACLR) remains unclear, particularly in patients with a low baseline risk for venous thromboembolism (VTE). This retrospective cohort study aims to compare the effectiveness and safety of aspirin versus low molecular weight heparins (LMWHs) in this specific patient population. METHODS We analyzed data from patients who underwent ACLR between March 2016 and March 2021, focusing on those with a low risk for VTE. High-risk individuals, identified by factors such as cardiac disease, pulmonary disease, diabetes mellitus, previous VTE, inflammatory bowel disease, active cancer, and a BMI > 40, were excluded (n = 33). Our approach included a thorough review of medical charts, surgical reports, and pre-operative assessments, complemented by telephone follow-up conducted over a 3-month period by a single investigator. We assessed the incidence of symptomatic VTE, including deep vein thrombosis and pulmonary thromboembolism, as the primary outcome. The secondary outcomes included to complications related to the surgery and thromboprophylaxis. Statistical analysis included descriptive statistics, univariate logistic regression models, and calculations of incidence rates. RESULT In our study, 761 patients (761 knees) were included, with 458 (60.18%) receiving aspirin and 303 (39.82%) receiving LMWH. The two groups showed no significant differences in demographic factors except for age. The incidence of VTE was reported at 1.31% (10 individuals). Specifically, five patients in the aspirin group (1.09%) and five patients in the LMWH group (1.65%) developed a symptomatic VTE event (p = 0.53). Additionally, the two groups did not significantly differ in terms of other complications, such as hemarthrosis or surgical site infection (p > 0.05). Logistic regression analysis revealed no statistically significant difference in VTE risk between the two groups. CONCLUSION This study, focusing on isolated ACLR in patients with a low baseline risk for venous thromboembolism, demonstrated that aspirin is equally effective as low molecular weight heparins for VTE prophylaxis following this surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hamidreza Yazdi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Arvin Eslami
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran.
| | - Ali Torkaman
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Omid Elahifar
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Digestive Diseases Research Center, Digestive Diseases Research Institute; Research Center for Chronic Inflammatory Diseases; Clinical Research Development Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaya Alimoghadam
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Rojina Alimoghadam
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Abolghasemian
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran.
- University of Alberta, Alberta, Canada.
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Horii M, Akagi R, Watanabe S, Enomoto T, Hosokawa H, Ohtori S, Sasho T. Number of intra-operative cyclic knee motion required to achieve stable graft tension in anterior cruciate ligament reconstruction; a prospective clinical study. BMC Musculoskelet Disord 2024; 25:113. [PMID: 38317088 PMCID: PMC10845653 DOI: 10.1186/s12891-024-07239-x] [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: 07/25/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Applying pretension by cyclic knee motion immediately before graft fixation in anterior cruciate ligament (ACL) reconstruction surgery decreases graft elongation during the postoperative course. However, the expected change in graft tension caused by cyclic knee motion remains unclear. We measured graft tension changes caused by cyclic knee motion during double-bundle ACL reconstruction. METHODS We included 39 patients undergoing primary anatomical double-bundle ACL reconstruction with autologous hamstrings as graft sources, at multiple centers between February 2021 and August 2022. After securing the anteromedial (AM) and posterolateral (PL) bundle grafts to the femoral cortex, they were initially tensioned to 40 N per bundle. After 10 cycles of knee extension and flexion motion, ranging from 0 to 90-110°, tension was re-measured and re-tensioned to 40 N if the graft tension had decreased. This was repeated thrice for 10 cycles on each graft. Every 10 cycles, we recorded graft tension changes (ΔGT) and compared the mean ΔGT in the AM and PL bundles. Furthermore, we assessed relationships between total ΔGT in each bundle, age, sex, and graft diameter. RESULTS Twenty-five women and 14 men with a mean age of 27.4 ± 12.4 years were included. The mean ΔGT in AM and PL bundles after every 10 cycles were 6.6 ± 3.7 N, 3.0 ± 2.3 N, 1.4 ± 1.5 N, and 9.9 ± 3.8 N, 4.9 ± 2.6 N, and 2.5 ± 1.9 N, respectively. There were significant differences in ΔGT in both bundles after every 10 cycles (p < 0.01). ΔGT in the AM bundle was significantly lower than in the PM bundle at the same number of cycles (p < 0.01). No correlation was observed between ΔGT in either bundle and age, sex, or graft diameter. CONCLUSIONS The initially applied graft tension decreased by intra-operative cyclic knee movement, and the changes in graft tension decreased after retention and repeated cycles. Three sets of 10 cycles knee motion may avoid initial tension loss of the hamstring autograft in the early phase after double-bundle ACL reconstruction.
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Affiliation(s)
- Manato Horii
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
| | - Ryuichiro Akagi
- Oyumino Central Hospital, Knee Surgery and Sports Medicine Center, 6-49-9 Oyumino-Minami, Midori-Ku, Chiba, Chiba, 266-0033, Japan
| | - Shotaro Watanabe
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Takahiro Enomoto
- Oyumino Central Hospital, Knee Surgery and Sports Medicine Center, 6-49-9 Oyumino-Minami, Midori-Ku, Chiba, Chiba, 266-0033, Japan
| | - Hiroaki Hosokawa
- Department of Orthopedics, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Takahisa Sasho
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
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Lucidi GA, Roberti di Sarsina T, Zaffagnini S. Editorial Commentary: The Number One Cause of Anterior Cruciate Ligament Reconstruction Graft Failure Is a Misplaced Femoral Tunnel: Over-the-Top Technique Plus Lateral Extra-Articular Tenodesis Is Recommended. Arthroscopy 2024; 40:435-437. [PMID: 38296446 DOI: 10.1016/j.arthro.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 02/15/2024]
Abstract
Patient factors (notably high tibial slope and narrow femoral intercondylar notch width) and surgical factors (including meniscus treatment and anterior cruciate ligament [ACL] tunnel position) contribute to ACL reconstruction failure. The number one cause of failure is a misplaced ACL femoral tunnel. Tunnel malposition leads to a higher incidence of postoperative meniscal lesions, inferior clinical outcomes, and higher revision rates.
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Affiliation(s)
- Gian Andrea Lucidi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tommaso Roberti di Sarsina
- Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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19
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Sonnery-Cottet B, Ripoll T, Cavaignac E. Prevention of knee stiffness following ligament reconstruction: Understanding the role of Arthrogenic Muscle Inhibition (AMI). Orthop Traumatol Surg Res 2024; 110:103784. [PMID: 38056774 DOI: 10.1016/j.otsr.2023.103784] [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: 10/24/2022] [Accepted: 06/06/2023] [Indexed: 12/08/2023]
Abstract
The knee is a joint that is often injured in sport, with a large and increasing number of ligament tears and repairs; postoperative complications can lead to poor outcome, such as stiffness. Beyond the well-known and well-described intra- and extra-articular causes of postoperative stiffness, the present study introduces the concept of a central reflex motor inhibition mechanism called arthrogenic muscle inhibition (AMI). AMI occurs after trauma and can be defined as active knee extension deficit due to central impairment of Vastus Medialis Obliquus (VMO) contraction, often associated with spinal reflex hamstring contracture. This explains the post-traumatic flexion contracture that is so common after knee sprain. The clinical presentation of AMI is easy to detect in consultation, in 4 grades from simple VMO inhibition to fixed flexion contracture by posterior capsule retraction in chronic cases. After recent anterior cruciate ligament (ACL) tear, more than 55% of patients show AMI, reducible in 80% of cases by simple targeted exercises initiated in consultation. Practically, in patients who have sustained knee sprain, it is essential to screen for this reflex mechanism and assess reducibility, as AMI greatly aggravates the risk of postoperative stiffness. In case of hemarthrosis, we recommend joint aspiration, which provides immediate benefit in terms of pain and motor inhibition. In case of persistent AMI, classical electrostimulation and "cushion crush", as used by all physiotherapists, are ineffective. To reduce the risk of postoperative stiffness, no surgery should be considered until AMI has resolved. LEVEL OF EVIDENCE: expert opinion.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Groupe Ramsay-Santé, centre orthopédique Santy, FIFA Medical Center of Excellence, hôpital privé Jean-Mermoz, Lyon, France.
| | - Thomas Ripoll
- Service de chirurgie orthopédique, CHU de Toulouse, hôpital Pierre-Paul-Riquet, rue Jean-Dausset, Toulouse, France
| | - Etienne Cavaignac
- Service de chirurgie orthopédique, CHU de Toulouse, hôpital Pierre-Paul-Riquet, rue Jean-Dausset, Toulouse, France
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Hellberg C, Kostogiannis I, Stylianides A, Neuman P. Outcomes >30 Years After Initial Nonoperative Treatment of Anterior Cruciate Ligament Injuries. Am J Sports Med 2024; 52:320-329. [PMID: 38193189 PMCID: PMC10838478 DOI: 10.1177/03635465231214423] [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: 01/12/2023] [Accepted: 09/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND It is unclear how anterior cruciate ligament (ACL) reconstruction (ACLR) affects the development of osteoarthritis (OA). This uncertainty is partly caused by the lack of long-term studies on ACL injuries treated primarily without reconstruction and the underreporting of symptomatic OA. PURPOSE To determine (1) the knee function, symptoms, and activity level, as well as the presence of radiographic and symptomatic OA; (2) how these clinical outcomes have changed over time; and (3) the frequency of subsequent knee surgeries after the index ACL injury in a cohort of patients with ACL injuries treated primarily without reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 100 patients underwent initial nonoperative treatment >30 years ago (mean, 33.2 ± 1.4 years). Of these, 81 patients (mean age, 59 ± 8 years) completed the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Scoring Scale, and Tegner Activity Scale. Seventy-three patients underwent radiography to evaluate tibiofemoral and patellofemoral OA in the ACL-injured knee. Patients only underwent late ACLR if they experienced insufficient knee stability. RESULTS At 33 years after the ACL injury, the KOOS Activities of Daily Living subscore was better than population-based reference values, but scores were similar for the remaining KOOS subscales. Furthermore, 65% of patients had a good or excellent Lysholm score (≥84 points). The Tegner score decreased 4 points from before the injury to 33-year follow-up (P < .001). Most patients (75%) had evidence of radiographic tibiofemoral and/or patellofemoral OA, but only 38% were classified as having symptomatic OA (defined as radiographic OA in combination with a symptomatic knee according to cutoffs on the KOOS). Approximately 50% underwent meniscal surgery, and 29% subsequently underwent ACLR for recurrent instability. There were 2 patients who underwent total knee replacement. CONCLUSION Despite a high prevalence of radiographic OA, patients achieved acceptable subjective knee function and had a relatively low prevalence of symptomatic OA at >30 years after an ACL injury when an initial nonoperative treatment strategy was employed.
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Affiliation(s)
- Clara Hellberg
- Clinical Epidemiology Unit, Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ioannis Kostogiannis
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alexandros Stylianides
- Musculoskeletal Radiology Section, Skåne University Hospital, Lund University, Lund, Sweden
| | - Paul Neuman
- Department of Orthopaedics, Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Gonnachon A, Labattut L, Abdoul Carime N, Orta C, Baulot E, Martz P. Does combined anterior cruciate ligament and anterolateral ligament reconstruction improve return to sport? Eur J Orthop Surg Traumatol 2024; 34:981-987. [PMID: 37803219 DOI: 10.1007/s00590-023-03744-2] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE Only 50-65% of patients return to their previous sporting level after ACL rupture. The literature reports a reduced rate of graft rupture when an anterolateral ligament reconstruction (ALLR) is associated with ACL reconstruction. ACL reconstruction combined with ALL allows a higher return to sport at pre-injury level than isolated reconstruction in patients playing pivot-contact sports. METHODS A retrospective, single-centre study between 2012 and 2020 comparing reconstruction by hamstring tendon technique, isolated ACLR vs ACL with ALLR. An isokinetic test was performed at 6 months post-operatively and patients were re-contacted at a minimum 2-year follow-up to assess their level and delay to return to sport, graft rupture rate and functional evaluation. RESULTS 83 patients were included, 42 in ACLR group and 41 in ACL + ALLR group. Four patients were lost to follow-up and 79 patients were analysed. No significant difference was found on the level of return to sport (28.2% vs. 42.5%; p = 0.18), return to competition (43% vs. 60%; p = 0.18), delay to sports return, isokinetic assessment, functional scores, but a significant difference was found on graft rupture rate in favour of ALLR (12.8% vs. 0%; p = 0.02). CONCLUSION In our study, the addition of an ALL to ACL reconstruction did not improve pre-injury sports recovery or return to competition. STUDY DESIGN Cohort study, level of evidence 4.
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Affiliation(s)
- Arnaud Gonnachon
- Orthopedics Department, CHU F.Mitterrand Dijon-Bourgogne, 12 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France.
| | - Ludovic Labattut
- Orthopedics Department, CHU F.Mitterrand Dijon-Bourgogne, 12 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Nafiz Abdoul Carime
- Public Health Department, CHU F.Mitterrand Dijon-Bourgogne, 12 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Cyril Orta
- Convalescence and Rehabilitation Centre, CHU F.Mitterrand Dijon-Bourgogne, 23a Chem. de Cromois, 21000, Dijon, France
| | - Emmanuel Baulot
- Orthopedics Department, CHU F.Mitterrand Dijon-Bourgogne, 12 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
- INSERM CAPS 1093, Faculty of Sports Sciences (UFR Staps), University of Burgundy, 3 Allée Des Stades Universitaires, BP 27877, Dijon, France
| | - Pierre Martz
- Orthopedics Department, CHU F.Mitterrand Dijon-Bourgogne, 12 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
- INSERM CAPS 1093, Faculty of Sports Sciences (UFR Staps), University of Burgundy, 3 Allée Des Stades Universitaires, BP 27877, Dijon, France
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Cai Q, Wang, D, Yan L, Kuang H, Tang W, Min Z, Wang, X. Abnormal femoral trochlea morphology is a risk factor for secondary injury of anterior cruciate ligament after reconstruction. Medicine (Baltimore) 2024; 103:e36786. [PMID: 38181284 PMCID: PMC10766302 DOI: 10.1097/md.0000000000036786] [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: 10/26/2023] [Accepted: 12/05/2023] [Indexed: 01/07/2024] Open
Abstract
Secondary injury of the anterior cruciate ligament (ACL) is a common concern after anterior cruciate ligament (ACL) reconstruction, and identification of morphological risk factors is essential to prevent these injuries. We hypothesized that abnormal femoral trochlea morphology is associated with secondary ACL injuries after reconstruction. This study aimed to investigate the relationship between femoral trochlear morphology and secondary ACL injuries after reconstruction. A retrospective analysis was conducted on 20 patients who experienced secondary ACL injuries after reconstruction in our hospital between 2017 and 2022 (experimental group), and 40 patients were included in the control group. The following femoral trochlear characteristics were compared between the 2 groups: medial condylar height (MCH), trochlear sulcus height (TSH), lateral condylar height (LCH), trochlear sulcus depth (TSD), trochlear sulcus angle (TSA), medial trochlear inclination (MTI), and lateral trochlear inclination (LTI). The study found that patients in the secondary ACL injury after reconstruction group exhibited the following differences when compared to the control group: decreased MCH (56.33 ± 3.52 vs 59.93 ± 3.24, P value = .015), decreased TSD (4.89 ± 1.56 vs 6.98 ± 1.23, P value ˂ .001), decreased MTI (12.54 ± 6.57 vs 19.45 ± 6.35, P value ˂ .001), and increased TSA (145.23 ± 9.76 vs 139.25 ± 8.42, P value ˂ .001). This study demonstrated a significant correlation between abnormal femoral trochlear morphological characteristics and secondary ACL injuries after reconstruction. Decreased MCH, TSD, and MTI along with increased TSA are associated with a higher risk of secondary ACL injury. These data could thus help identify individuals susceptible to secondary ACL injuries after reconstruction.
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Affiliation(s)
- Qiangqiang Cai
- The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Dongqin Wang,
- The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Liang Yan
- The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Hailin Kuang
- The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Wubing Tang
- The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Zhihai Min
- The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Xin Wang,
- Hebei Medical University Third Hospital, Shijiazhuang, Hebei, People’s Republic of China
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Torkaman A, Hosseinzadeh M, Mohammadyahya E, Torkaman P, Bahaeddini MR, Aminian A, Tayyebi H. All-inside anterior cruciate ligament reconstruction with and without anterolateral ligament reconstruction: a prospective study. BMC Musculoskelet Disord 2024; 25:16. [PMID: 38166782 PMCID: PMC10759739 DOI: 10.1186/s12891-023-07128-9] [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: 09/07/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND There is no clear consensus regarding the superiority of a combined anterior cruciate ligament reconstruction (ACLR) with anterolateral ligament reconstruction (ALLR) versus an isolated ACLR. In this study, we compared the postoperative stability profile, complications, and patient-reported outcomes of these procedures. METHODS Twenty-one patients with an anterior cruciate ligament (ACL) tear who were either treated by an isolated all-inside ACLR (n = 21) or a combined all-inside ACLR and ALLR (n = 20) were included. The outcomes were evaluated in the last follow-up and included the postoperative stability profile evaluated by the Lachman test, pivot shift test, and KT-1000 side-to-side difference, postoperative complications, and patient-reported outcomes evaluated by the International Knee Documentation Committee (IKDC) score and Lysholm knee scale. RESULTS The baseline characteristics of the two groups were not significantly different. The residual Lachman and pivot shift were not significantly different between the two groups (P = 0.41 and P = 0.18, respectively). The mean KT-1000 side-to-side difference was 1.93 ± 1.9 mm in the isolated and 1.635 ± 0.91 mm in the combined group (P = 0.01). The mean improvement of the IKDC score was not significantly different between the isolated and combined groups (24.7 vs. 25.2, P = 0.28). The mean improvement of the Lysholm scale was not significantly different between the isolated and combined groups (33.5 vs. 34.1, P = 0.19). ACL re-rupture occurred in three patients of the isolated group and no patient of the combined group. CONCLUSION The outcomes of patients in the present study support performing a combined ALL and ACL reconstruction.
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Affiliation(s)
- Ali Torkaman
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Hosseinzadeh
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Mohammadyahya
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parsa Torkaman
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Bahaeddini
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Aminian
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Tayyebi
- Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Shafa Yahyaian Educational and Medical Center, Iran University of Medical Science, Baharestan Square, Mojahedin-e-Islam St, Tehran, 1157637131, Iran.
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24
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Zhong J, Lee NJ, Padaki A, Crutchfield C, Ahmad CS, Trofa D, Sean Lynch T. Increased age and modified fragility index increases risk of short-term complications after anterior cruciate ligament reconstruction surgery. Knee 2024; 46:8-18. [PMID: 37972422 DOI: 10.1016/j.knee.2023.10.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/12/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Large data analysis of anterior cruciate ligament reconstruction (ACLR) short-term complications on age will help surgeons stratify and counsel at-risk patients. The purpose of this study is to assess if older patients are at greater risk for short-term complications after ACLR. METHODS This retrospective cohort study included patients who underwent elective ACLR with or without concomitant meniscal procedures in the National Surgical Quality Improvement Program from 2005 to 2017. Patients were divided into age groups 16-30, 31-45, and > 45. Modified fragility index-5 (mFI-5), demographics and short-term outcomes were examined with bivariate and multivariate analysis to determine if age was a risk factor for complications. RESULTS A total of 23,581 patients (35.4% female) were included in this analysis. Mean age was 32.1 ± 10.8 years. Older patients had higher mFI-5 scores (p < 0.001), shorter operative times (p < 0.001), lower use of only general anesthesia (p < 0.001). The oldest patients had similar rates of complications as the two younger groups. Older age was an independent risk factor for VTE, but decreased risk of prolonged operations. A mFI-5 > 0 increased risk factors for readmission (Odds ratio 2.2, P = 0.006). Infection was the most common cause 30-day readmissions (40/135, 29.6%). CONCLUSION In the early postoperative period, older age is an independent risk factor for VTE and younger age is a significant factor for prolonged surgeries. Having an mFI-5 > 0 increased risk factors for readmission.
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Affiliation(s)
- Jack Zhong
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States; New York University Langone Health Dept. of Orthopaedic Surgery, 301 E 17th St, New York, NY 10010, United States.
| | - Nathan J Lee
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - Ajay Padaki
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - Connor Crutchfield
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - Christopher S Ahmad
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - David Trofa
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - T Sean Lynch
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States; Henry Ford Health Dept. of Orthopaedic Surgery, 40777 Ann Arbor Rd, Plymouth, MI 48170, United States
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Kim A, Goodloe JB, Garcia-Lopez E, Klott JD, Dopke KM, Feeley B, Miller MD, Azar FM, Gallo RA. How to Recognize, Correct, and Avoid Intraoperative Complications During Anterior Cruciate Ligament Reconstructions. Instr Course Lect 2024; 73:765-777. [PMID: 38090939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Technical complications are a leading cause of graft failure following anterior cruciate ligament reconstructions. Complications can occur during any phase of the procedure, from graft harvesting to tunnel preparation to graft fixation. Predicting potential causes of technical difficulty and developing strategies to avoid potential pitfalls can limit the number of intraoperative complications. If adverse events do occur intraoperatively, prompt recognition and treatment can lead to favorable outcomes. It is important to discuss strategies to understand potential complications and develop tactics to avoid and correct adverse events that can occur during anterior cruciate ligament reconstruction.
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Fares A, Hardy A, Bohu Y, Meyer A, Karam K, Lefevre N. The impact of bone graft type used to fill bone defects in patients undergoing ACL reconstruction with bone-patellar tendon-bone (BPTB) autograft on kneeling, anterior knee pain and knee functional outcomes. Eur J Orthop Surg Traumatol 2024; 34:181-190. [PMID: 37392257 PMCID: PMC10771375 DOI: 10.1007/s00590-023-03624-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Multiple different materials are used for filling bone defects following bone-patellar tendon-bone (BPTB) graft ACL reconstruction surgery. The theoretical objective being to minimize kneeling pain, improve clinical outcomes and reduce anterior knee pain following surgery. The impact of these materials is assessed in this study. METHODS A prospective monocentric cohort study was conducted from January 2018 to March 2020. There were 128 skeletally mature athletic patients who underwent ACL reconstruction using the same arthroscopic-assisted BPTB technique, with a minimum follow-up of two years identified in our database. After obtaining approval from the local ethics committee, 102 patients were included in the study. Patients were divided into three groups based on type of bone substitute. The Bioactive glass 45S5 ceramic Glassbone™ (GB), collagen and hydroxyapatite bone void filler in sponge form Collapat® II (CP), and treated human bone graft Osteopure®(OP) bone substitutes were used according to availability. Clinical evaluation of patients at follow-up was performed using the WebSurvey software. A questionnaire completed in the 2nd post-operative year included three items: The ability to kneel, the presence of donor site pain, and the palpation of a defect. Another assessment tool included the IKDC subjective score and Lysholm score. These two tools were completed by patients preoperatively, and postoperatively on three occasions (6 months, 1 year, and 2 years). RESULTS A total of 102 patients were included in this study. In terms of Kneeling pain, the percentage of GB and CP patients' who kneel with ease were much higher than that of OP patients (77.78%, 76.5% vs 65.6%, respectively). All three groups experienced an important increase in IKDC and Lysholm scores. There was no difference in anterior knee pain between the groups. CONCLUSION The use of Glassbone® and Collapat II® bone substitutes reduced the incidence of kneeling pain compared to Osteopure®. There was no influence of the bone substitute type on the functional outcome of the knee or on the anterior knee pain at two years of follow.
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Affiliation(s)
- Ali Fares
- Chirurgie du Sport, Clinique du Sport Paris V, Ramsay-Générale de Santé, Paris, France.
| | - Alexandre Hardy
- Chirurgie du Sport, Clinique du Sport Paris V, Ramsay-Générale de Santé, Paris, France
| | - Yoann Bohu
- Chirurgie du Sport, Clinique du Sport Paris V, Ramsay-Générale de Santé, Paris, France
| | - Alain Meyer
- Chirurgie du Sport, Clinique du Sport Paris V, Ramsay-Générale de Santé, Paris, France
| | - Karam Karam
- Chirurgie du Sport, Clinique du Sport Paris V, Ramsay-Générale de Santé, Paris, France
| | - Nicolas Lefevre
- Chirurgie du Sport, Clinique du Sport Paris V, Ramsay-Générale de Santé, Paris, France
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Lu W, Liu D, Cai Z, Pan L, Xie W, Jin H, Liu X, Li Y, Xiao W. Internal brace augmentation reconstruction versus standard anterior cruciate ligament reconstruction: a randomised controlled clinical trial study protocol. BMJ Open 2023; 13:e065254. [PMID: 38114287 DOI: 10.1136/bmjopen-2022-065254] [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] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) rupture is one of the most common knee injuries in sports, and the gold standard for treating ACL rupture is tendon graft reconstruction. Internal brace technology is being used nowadays for ligament repair; however, more relevant in vivo clinical evidence is required for using internal brace technology in ACL reconstruction (ACLR). We conducted a randomised controlled trial to investigate the clinical efficacy of internal brace technology in ACLR. METHODS AND ANALYSIS This randomised, parallel-controlled trial included patients with ACL rupture who underwent inpatient surgery at the Department of Orthopaedics, Xiangya Hospital, Central South University. Random number table method was used to assign the participants to either the test or the control group. The test group underwent ACLR using the internal brace technique, whereas the control group underwent standard ACLR. Uniform postoperative rehabilitation protocol was used for both the groups. Patient-reported outcomes included preoperative baseline and postoperative recovery at 1, 3, 6, 12 and 24 months. The primary outcome was International Knee Documentation Committee function from baseline (ACL rupture) to 6 months postoperatively. Secondary outcomes included (1) other patient outcome reporting metrics, Lysholm knee score, Knee Injury and Osteoarthritis Outcome Score and Visual Analog Scale; (2) the use of Kneelax3 knee stabiliser to assess knee stability; (3) occurrence of adverse events, such as graft refraction or symptomatic instability, postoperative infection and contralateral injury and (4) magnetic resonance images at 12 and 24 months after ACLR. ETHICS AND DISSEMINATION This trial was approved by the Medical Ethics Committee of the Xiangya Hospital of Central South University on 26 October 2021. Data will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2200057526.
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Affiliation(s)
- Wenhao Lu
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Di Liu
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Zijun Cai
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Linyuan Pan
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Wenqing Xie
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Hongfu Jin
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Xu Liu
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Yusheng Li
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
- Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, Changsha, Hunan, China
| | - Wenfeng Xiao
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
- Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, Changsha, Hunan, China
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Hantouly AT, Ahmed AF, Fermin TM, Macchiarola L, Sideris V, Papakostas E, Hooghe PD, Al-Khelaifi K, Olory B, Zikria B. Short-term outcomes of anterior cruciate ligament reconstruction with or without lateral tenodesis or anterolateral ligament reconstruction: a retrospective cohort. Int Orthop 2023; 47:2991-2999. [PMID: 37632528 PMCID: PMC10673961 DOI: 10.1007/s00264-023-05931-6] [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] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/06/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE This study aimed to compare the short-term outcomes of ACL reconstruction (ACLR) alone, ACLR with lateral tenodesis, and ACL and ALL reconstruction. METHODS A retrospective cohort of prospectively collected data on all ACL procedures was performed at Aspetar Specialized Orthopaedic and Sports Medicine Hospital between January 2020 and January 2021. Patients were treated with ACLR alone, ACLR with lateral tenodesis, or ACLR with ALL reconstruction. The primary outcome was the subjective International Knee Documentation Committee (sIKDC) score. The secondary outcomes were the ACL Return to Sport after Injury (ACL-RSI) scores, pivot shift grade, subjective knee stability, and subjective pain on activity. RESULTS A total of 100 cases were included. The most common technique was ACLR with lateral tenodesis (42%), followed by ACLR alone (38%) and ACL with ALL reconstruction (20%). The mean age was 28.15 years (15-60), and 94% of the patients were males. Meniscal procedures were more frequent in the ACLR alone group (65.8%). There was no association between subjective stability, sIKDC, ACL-RSI, and pivot shift grade and the three ACLR techniques while adjusting for age, sex, and concomitant meniscus procedures at six weeks, 12 weeks, six months, and nine months. However, there was a significant decrease in postoperative flexion in the ACL and ALL reconstruction group by a mean of 22° (95% CI - 40.7 - 3.4; P = 0.02) at 6 weeks compared to ACLR alone, which was not evident on later follow-ups. CONCLUSION ACLR with/without lateral augmentation procedures yields similar subjective IKDC, ACL-RSI, pivot shift grade, and subjective knee instability at short-term follow-up. Therefore, lateral extra-articular augmentation procedures are safe to be performed.
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Affiliation(s)
- Ashraf T Hantouly
- Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar.
| | - Abdulaziz F Ahmed
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Luca Macchiarola
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, BO, Italy
| | | | | | | | | | - Bruno Olory
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Bashir Zikria
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Williams AA, Koltsov JCB, Brett A, He J, Chu CR. Using 3D MRI Bone Shape to Predict Pre-Osteoarthritis of the Knee 2 Years After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2023; 51:3677-3686. [PMID: 37936374 DOI: 10.1177/03635465231207615] [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] [Indexed: 11/09/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury increases risks for osteoarthritis (OA), a poorly modifiable and disabling condition. Joint changes of potentially reversible pre-OA have been described just 2 years after ACL reconstruction (ACLR) when early bone shape changes have also been reported. PURPOSE This study evaluates relationships between interlimb differences in tibiofemoral bone shape derived from statistical shape modeling (SSM) of magnetic resonance imaging (MRI) and participant factors on patient-reported outcomes 2 years after unilateral ACLR. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS SSM-derived tibiofemoral bone shape and subchondral bone area were assessed from bilateral knee MRI scans of 72 participants with unilateral ACLR (mean age, 34 ± 11 years; 32 women) and compared with a reference cohort of 398 older individuals without OA (mean age, 50 ± 3 years; 213 women). Multivariable logistic regression models examined relationships between participant and surgical factors with interlimb differences in bone shapes or subchondral bone areas. Relationships between patient-reported outcomes and the interlimb differences in bone shape and subchondral area were examined using similar models. RESULTS Bone shape scores and subchondral bone areas were greater (more OA-like) in ACLR knees than uninjured contralateral knees in every bone metric tested (P≤ .001). Interlimb differences in femur shape scores of participants with ACLR were 65% greater (P < .001) than those of the significantly older reference cohort. Taller height, medial meniscal tears, and decreasing age were associated with larger interlimb differences in shape scores and subchondral areas (P < .05). Bone-patellar tendon-bone (BPTB) autograft recipients demonstrated greater interlimb subchondral area differences compared with allograft recipients (P < .05). Interlimb differences for hamstring autograft recipients did not differ from those with BPTB or allograft. Greater interlimb differences in medial femur subchondral areas were associated with worse patient-reported Knee injury and Osteoarthritis Outcome Score Symptoms (R = 0.27; P = .040). CONCLUSION Even in the absence of radiographic OA, just 2 years after unilateral ACLR patients showed greater bone shape scores and subchondral areas consistent with pre-OA in their ACLR knees. Furthermore, greater medial femur bone areas were weakly associated with worse symptoms. Patients who are younger, are taller, have meniscal tears, or have BPTB grafts may be at increased risk for bony asymmetries 2 years after ACLR.
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Affiliation(s)
- Ashley A Williams
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- Department of Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Jayme C B Koltsov
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | | | - Jade He
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- Department of Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- Department of Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Inoue J, Dadoo S, Nukuto K, Özbek EA, Lesniak BP, Sprague AL, Irrgang JJ, Musahl V. Near complete quadriceps tendon healing 2 years following harvest in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:5747-5754. [PMID: 37930438 DOI: 10.1007/s00167-023-07638-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Despite the recent increase in the use of quadriceps tendon (QT) autograft in anterior cruciate ligament reconstruction (ACLR); however, there remains a paucity of literature evaluating the postoperative morphology of the QT. The present study aimed to determine the postoperative morphologic change of the QT at a minimum of 2 years following harvesting during ACLR. METHODS Patients who underwent ACLR with QT autograft and underwent magnetic resonance imaging (MRI) at a minimum of 2 years following harvesting were retrospectively included in the study. The anterior-to-posterior (A-P) thickness, medial-to-lateral (M-L) width, cross-sectional area (CSA), and signal/noise quotient (SNQ) of the QT were assessed at 5 mm, 15 mm, and 30 mm proximal to the superior pole of the patella on MRI. The CSA was adjusted by the angle between the QT and the plane of the axial cut based on a cosine function (adjusted CSA). The A-P thickness, M-L width, adjusted CSA, and SNQ were compared pre- and postoperatively. In addition, defects or scar tissue formation in the harvest site were investigated on postoperative MRI. RESULTS Thirty patients were recruited for the study. The mean duration between postoperative MRI and surgery was 2.8 ± 1.1 years. The mean A-P thickness was 10.3% and 11.9% larger postoperatively at 5 mm and 15 mm, respectively. The mean M-L width was 7.3% and 6.5% smaller postoperatively at 5 mm and 15 mm, respectively. There were no significant differences in the adjusted CSA between pre- and post-operative states (275.7 ± 71.6 mm2 vs. 286.7 ± 91.8 mm2, n.s.). There was no significant difference in the postoperative change in the SNQ of the QT at all assessment locations. Defect or scar tissue formation at the harvest site was observed in 4 cases (13.3%), and 5 cases (16.6%), respectively. CONCLUSION At a minimum of 2 years following QT harvest during ACLR, the QT became slightly thicker and narrower (approximately 11% and 7%, respectively). While the current study demonstrates that QT re-harvesting can be considered due to nearly normalized tendon morphology, future histological and biomechanical studies are required to determine the re-harvesting potential of the QT. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jumpei Inoue
- Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA.
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan.
| | - Sahil Dadoo
- Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA
| | - Koji Nukuto
- Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Emre Anil Özbek
- Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA
- Department of Orthopaedic Surgery, Ankara University, Ankara, Turkey
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA
| | - Andrew L Sprague
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - James J Irrgang
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA, 15203, USA
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Cantrell WA, Cox CL, Johnson C, Obuchowski N, Strnad G, Swinehart D, Yalcin S, Spindler KP. The Effect of Aspiration and Corticosteroid Injection After ACL Injury on Postoperative Infection Rate. Am J Sports Med 2023; 51:3665-3669. [PMID: 37975540 DOI: 10.1177/03635465231211606] [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] [Indexed: 11/19/2023]
Abstract
BACKGROUND Injecting bioactive substances into the knee is common in orthopaedic practice, and recently it has been shown to mitigate risk factors for posttraumatic osteoarthritis. Therefore, understanding the influence of these injections on postoperative infection rate is imperative. HYPOTHESIS Postinjury aspiration and corticosteroid injection (CSI) of the knee before anterior cruciate ligament (ACL) reconstruction (ACLR) would not increase the risk of postoperative infection. STUDY DESIGN Cohort Study; Level of evidence, 3. METHODS All patients between the ages of 10 and 65 years who underwent primary bone-patellar tendon-bone ACLR by 1 fellowship-trained sports medicine orthopaedic surgeon between January 1, 2011, and September 8, 2020, at 1 of 2 major academic centers were evaluated for inclusion. A total of 693 patients were included, with 273 patients receiving postinjury and preoperative aspiration and CSI. A postoperative infection was defined as a patient returning to the operating room for an intra-articular washout. The intervals-measured in days-between the CSI and ACLR and between ACLR and the final follow-up were recorded. To further evaluate the infection risk in each cohort (total cohort; aspiration and injection cohort; no aspiration and injection cohort), the upper 95% confidence bound for the infection risk was calculated for each cohort. RESULTS There were no postoperative infections in the 693 patients included in this study. The upper 95% confidence bounds were 0.4%, 1.1%, and 0.7% for the total cohort, the cohort that underwent aspiration and injection, and the cohort that did not, respectively. The median number of days between the surgical date and that of the aspiration and injection was 34 days, and the mean follow-up for the entire cohort was 337.4 days (95% CI, 307.6-367.3). CONCLUSION Postinjury and preoperative aspiration and CSI is a safe intervention that can be used before ACLR. Future studies with larger sample sizes, longer patient follow-ups, and multiple surgeons would be helpful to both better understand infection risk and better identify the influence of CSI on preventing posttraumatic osteoarthritis.
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Affiliation(s)
| | | | | | | | | | | | | | - Kurt P Spindler
- Cleveland Clinic Florida, Sports Medicine, Weston, Florida, USA
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Murakami R, Taketomi S, Yamagami R, Kono K, Kawaguchi K, Kage T, Arakawa T, Inui H, Tanaka S. Postoperative quadriceps weakness and male sex are risk factors for patellofemoral articular cartilage lesions after anatomical anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:5681-5689. [PMID: 37884728 PMCID: PMC10719126 DOI: 10.1007/s00167-023-07633-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Patellofemoral (PF) compartment cartilage lesions are a frequent problem after anterior cruciate ligament (ACL) reconstruction. This study aimed to determine the factors that influence PF cartilage lesions after anatomical ACL reconstruction. METHODS This study enrolled a total of 114 patients who did not manifest PF compartment cartilage lesions during anatomical ACL reconstruction and underwent second-look arthroscopy 18 months postoperatively. Arthroscopy using the International Cartilage Repair Society (ICRS) classification was used to assess cartilage lesions. The correlation between surgical findings, radiographic factors, and clinical factors and change of ICRS grade was analysed. Multivariate regression analysis was conducted to reveal the independent risk factors for PF cartilage lesions among patients' demographic data and parameters that correlated with the change of ICRS grade in the correlation analyses. RESULTS ICRS grade changes in PF cartilage were significantly correlated with age, sex, quadriceps strength at 1 year postoperatively, hamstrings strength at pre- and 1 year postoperatively, and single leg hop test at 1 year postoperatively. However, no significant correlation was found between the time between injury and surgery, posterior tibial slope angle, pre- and postoperative Tegner activity scale, graft type, initial graft tension, meniscus injury, meniscus injury treatment, pre- and postoperative range of motion, anteroposterior laxity and preoperative quadriceps strength, and the change in ICRS grade. Multivariate regression analysis revealed male (P = 0.019) and quadriceps strength weakness at 1 year postoperatively (P = 0.009) as independent risk factors for PF cartilage lesions. CONCLUSIONS Quadriceps strength weakness 1 year after ACL reconstruction and males were correlated with a new PF cartilage lesion after anatomical ACL reconstruction, with no significant correlation between bone-patellar tendon-bone autograft, initial graft tension, or extension deficit and new PF cartilage lesion. Rehabilitation that focuses on quadriceps strength after ACL reconstruction is recommended to prevent new PF cartilage lesions. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ryo Murakami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takahiro Arakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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Kingery MT, Halbrecht J. Long-Term Outcomes of Primary Anterior Cruciate Ligament Reconstruction Using Achilles Tendon Allograft. Bull Hosp Jt Dis (2013) 2023; 81:227-231. [PMID: 37979139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE This study sought to assess the long-term structural integrity of primary anterior cruciate ligament (ACL) reconstructions using Achilles tendon allografts by measuring the side-to-side difference in anterior-posterior tibial translation between the operative knee and the contralateral, asymptomatic knee. METHODS This study was a retrospective case series consisting of patients who underwent primary ACL reconstruction with Achilles tendon allograft. Allografts were chemically processed using the AlloWash or AlloTrue methods and then received either gamma radiation or electron beam radiation (range: 0.95 to 1.4 Mrad dose). At the time of follow-up, anterior-posterior tibial translation of both the operative and contralateral knees was measured using the Lachmeter® device. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) questionnaire and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. RESULTS The analysis included 20 patients (mean age: 41.38 ± 14.27 years) with a mean follow-up time of 7.01 ± 5.24 years. There were no graft failures requiring revision during the study period. The mean side-to-side difference in laxity between operative and contralateral knees was 1.10 ± 2.02 mm. Two patients (10%) met the criteria for complete ACL injury at the time of follow-up, while the remaining 18 patients (90%) met the criteria for no ACL injury. The mean IKDC score was 83.5 ± 13.8, and mean KOOS score was 88.4 ± 10.7. CONCLUSIONS Primary ACL reconstruction using an Achilles tendon allograft in skeletally mature patients resulted in maintained knee stability and good functional outcomes over the long-term postoperative period.
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Sproul D, Agarwal A, Malyavko A, Mathur A, Kreulen RT, Thakkar SC, Best MJ. Graft failure within 2 years of isolated anterior cruciate ligament reconstruction is associated with increased risk of secondary meniscus tears. Knee Surg Sports Traumatol Arthrosc 2023; 31:5823-5829. [PMID: 37938327 DOI: 10.1007/s00167-023-07653-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE A debilitating complication following anterior cruciate ligament reconstruction is a secondary meniscus tear. Currently, the literature is mixed regarding the risk factors associated with the incidence of secondary meniscus tears. The aim of this study was to investigate risk factors associated with meniscus tears following an isolated primary anterior cruciate ligament reconstruction. ACL graft failure was hypothesized to be the strongest risk factor for secondary meniscal injury occurrence. METHODS A retrospective cohort analysis was performed using the PearlDiver Database. Patients with a primary anterior cruciate ligament reconstruction were identified in the database. Patients with concomitant knee ligament injury or meniscus injury present at the time the index procedure were excluded. Patients were grouped to those who had a secondary meniscus tear within 2 years following anterior cruciate ligament reconstruction and those who did not. Univariate analysis and multivariable regression analysis was conducted to identify significant risk factors for a secondary meniscus tear. RESULTS There were 25,622 patients meeting criteria for inclusion in this study. Within 2 years from the primary anterior cruciate ligament reconstruction, there were 1,781 patients (7.0%) that experienced a meniscus tear. Graft failure had the highest odds of having a postoperative meniscus tear within 2 years (OR: 4.1; CI 3.5-4.8; p < 0.002). Additional significant risk factors included tobacco use (OR: 2.0; CI 1.0-3.1; p < 0.001), increased Charlson Comorbidity Index (OR: 1.2; CI 1.1-1.4), male gender (OR: 1.1; CI 1.1-1.2; p < 0.001), obesity (OR: 1.1; CI 1.1-1.2; p < 0.001), delayed surgery (OR:1.1; CI 1.1-1.2; p < 0.002), and patients age 30 and older (OR: 1.0; CI 1.0-1.0; p < 0.001). CONCLUSIONS This study found that anterior cruciate ligament graft failure is the strongest predictor of post-operative meniscus tears. Other risk factors, including tobacco use, increased CCI, male gender, obesity, delayed surgery, and age 30 and older, were established, with several being modifiable. Therefore, targeted preoperative optimization of modifiable risk factors and postoperative protocols may reduce the risk of secondary meniscus tears. LEVEL OF EVIDENCE Level III, prognostic trial.
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Affiliation(s)
- David Sproul
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA.
| | - Amil Agarwal
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA
| | - Alisa Malyavko
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA
| | - Abhay Mathur
- The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA
| | - R Timothy Kreulen
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
| | - Savyasachi C Thakkar
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
| | - Matthew J Best
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA
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Sappey-Marinier ET, Howell SM, Nedopil AJ, Hull ML. A Torn or Reconstructed Anterior Cruciate Ligament Does Not Adversely Affect Clinical Outcome Scores and the Incidence of Reoperation After Unrestricted Kinematically Aligned Total Knee Arthroplasty. J Arthroplasty 2023; 38:2612-2617. [PMID: 37321516 DOI: 10.1016/j.arth.2023.06.018] [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: 12/29/2022] [Revised: 05/29/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND There are no reports as to whether the condition of the anterior cruciate ligament (ACL) adversely affects the 2 to 3 year function and reoperation risk of a kinematically aligned (KA) total knee arthroplasty (TKA) performed with posterior cruciate ligament (PCL) retention and an intermediate medial conforming (MC) insert. METHODS A single surgeon's prospective database query identified 418 consecutive primary TKAs performed between January 2019 and December 2019. The surgeon recorded the ACL condition in the operative note. Patients filled out the Forgotten Joint Score (FJS), Oxford knee score (OKS), and Knee Injury and Osteoarthritis Outcome Scores for Joint Replacement at the final follow-up. There were 299 patients with an intact ACL, 99 with a torn ACL, and 20 with a reconstructed ACL. The mean follow-up was 31 months (range, 20 to 45). RESULTS The median FJS, OKS, and Knee Injury and Osteoarthritis Outcome Score (KOOS) of the reconstructed/torn/intact KA TKAs were 90/79/67, 47/44/43, and 92/88/80 points, respectively. The median OKS and KOOS of the reconstructed ACL cohort were 4 and 11 points higher than in the intact ACL cohort (P = .003, .04). One patient who had a reconstructed ACL underwent manipulation under anesthesia (MUA) for stiffness. The 5 reoperations in the intact ACL cohort were for instability (n = 2), revision after failed MUA for stiffness (n = 2), and infection (n = 1). CONCLUSION These results suggest that patients who have a torn and reconstructed ACL can expect high function and a low risk of reoperation comparable to patients who have an intact ACL when treated with unrestricted, caliper-verified KA, PCL retention, and an intermediate MC insert.
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Affiliation(s)
- Elliot T Sappey-Marinier
- Department of Orthopaedic Surgery, University of California, San Francisco, California; Department of Orthopaedic Surgery, Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, California
| | - Alexander J Nedopil
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, Würzburg, Germany
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, California; Department of Orthopedic Surgery, Davis Medical Center, University of California, Sacramento, California; Department of Mechanical Engineering, University of California, Davis, California
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Abouheif M, Sharaby MMF. Revision anterior cruciate ligament reconstruction using the ipsilateral Quadriceps tendon autograft: a modular reconstructive option. Int Orthop 2023; 47:2967-2976. [PMID: 37540275 DOI: 10.1007/s00264-023-05878-8] [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] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/24/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Failed ACL reconstruction is a common occurrence nowadays due to the increased incidence of ACL surgeries and return to full activities following the surgery. Several challenges might stand in the face of this revision surgery particularly the graft harvest and its suitability to the situation with possible widening of the tunnel and the avoidance of additional morbidity at the contralateral side or anterior knee pain as in patellar tendon harvest. The aim of this study is to evaluate the ipsilateral quadriceps tendon as a source of autograft in revision ACL surgery which constitutes a viable option that can potentially decrease the morbidity of the procedure, and meanwhile provide a graft substitute that can be tailored to suit the dilated tunnels commonly encountered in revision surgery, thus giving the patients a good potential for better functional outcome. METHODS Revision anterior cruciate ligament reconstruction was done in 30 patients using the ipsilateral quad tendon as a pure soft tissue or with a bony fragment. RESULTS The mean subjective international Knee Documentation Committee score (IKDC score) at two years follow-up was 65.83 ± 7.20. There is statistically significant improvement of the objective as well as the subjective IKDC scores at the end of follow-up when compared to the preoperative as well as the 6-month evaluation figures. The KT1000 arthrometer recorded a mean of 4.50 ± 1.07. Significant improvement of the limb symmetry index was at two years duration. CONCLUSIONS The quadriceps tendon can be a solution for several challenges that might appear during the revision ACL surgery with comparable results to other tendons and with minimal morbidity on the function of the harvested muscle tendon.
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Affiliation(s)
| | - Mohamed M F Sharaby
- Department of Orthopedics and Traumatology, Mansoura University, Al-Gomhoria Street 35516, Mansoura, Egypt
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Wang Z, Wang F, Li Y, Xing Y, Jiang X, Li C, Ding Z, Tang L. Analgesic effect of nitrous oxide during manual therapy after anterior cruciate ligament reconstruction: a study protocol for a randomized controlled trial. Trials 2023; 24:764. [PMID: 38012761 PMCID: PMC10683199 DOI: 10.1186/s13063-023-07732-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Many patients during manual therapy after anterior ligament reconstruction will experience severe pain, which has a negative impact on their rehabilitation. However, there is rarely an analgesic method for these patients during rehabilitation. Nitrous oxide with rapid analgesic and sedative effects is often used to relieve pain in minor procedures. The purpose of this study is to determine whether or not nitrous oxide analgesia decreases pain compared to oxygen during manual therapy after anterior ligament reconstruction. METHODS/DESIGN This single-center, randomized, double-blind and controlled trial will recruit 120 patients. Patients ≥ 18 years old undergoing manual therapy after anterior ligament reconstruction (1 month post-operative) with acute pain (VAS ≥ 4) are included. The main exclusion criteria included the following: pulmonary embolism, intestinal obstruction, pneumothorax. Patients will be randomly allocated to the intervention group (A) and the control group (B) in a ratio of 1:1. Doctors, therapists, patients, and data collectors are all blind to the study. The manual therapy will be performed by therapists. Nurses who implemented the intervention handed the doctors envelopes containing the patients' codes and allocation of A or B. Group A will receive a pre-prepared nitrous oxide/oxygen mixture plus conventional treatment (no analgesic) given as 30-min treatment sessions, once daily, and group B will receive oxygen plus conventional treatment (no analgesic) under the same conditions. Assessments will be taken 2 min before the intervention (T0), 5 min after the beginning of the intervention (T1), and 5 min after the intervention finished (T2). The primary outcome is pain score. Secondary outcomes include vital signs, side effects, joint range of motion, adjuvant analgesia need, therapist and patient satisfaction, and whether willing to receive the same gas again. EXPECTED OUTCOMES We expect nitrous oxide inhalation to have a beneficial effect on the pain of patients who receive manual therapy after anterior ligament reconstruction. DISCUSSION If this treatment appears beneficial, it could improve patients' satisfaction and quality of life potentially and even be implemented widely in hospital and rehabilitation settings. TRIAL REGISTRATION ClinicalTrials.gov identifier, ChiCTR2200061175 (Version 2.0 June 15, 2022), https://www.chictr.org.cn .
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Affiliation(s)
- Ziyang Wang
- Department of Stomatology, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Fei Wang
- Department of Anesthesiology, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
| | - Yuxiang Li
- School of Nursing, Ningxia Medical University, Ningxia, Yinchuan, China
| | - Yihui Xing
- Department of Stomatology, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Xiaochen Jiang
- Department of Stomatology, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Cui Li
- Department of Rehabilitation Medicine, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
| | - Zhiguo Ding
- Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Lu Tang
- School of Nursing, Weifang Medical University, Weifang, Shandong, China.
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Zhang Y, Xiao X, Deng W, Wang J, Gao H, Han J. Is remnant preservation in anterior cruciate ligament reconstruction superior to the standard technique? An overview of systematic reviews. BMC Musculoskelet Disord 2023; 24:910. [PMID: 38001516 PMCID: PMC10668441 DOI: 10.1186/s12891-023-07030-4] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament injury is a common knee joint injury. Anterior cruciate ligament reconstruction is a common surgical treatment to treat anterior cruciate ligament injury. It may have certain advantages to retain the ligament stump during the operation, but the results of systematic evaluation on whether to retain the ligament stump are different. The conclusion is still controversial, and the quality needs to be strictly evaluated. OBJECTIVE To evaluate the methodological quality, risk of bias, reporting quality and evidence quality of the systematic review of remnant preservation in anterior cruciate ligament reconstruction, and to provide reference for clinical work. METHODS We systematically searched the system evaluations in 8 electronic databases, the languages were limited to Chinese and English, and the time limit was from the establishment of the database to June 2023. Two reviewers independently screened literature and extracted data. The methodological quality, risk of bias, reporting quality and quality of evidence were evaluated by AMSTAR-2, ROBIS, PRISMA and GRADE tools. RESULTS A total of 14 systematic reviews were included. The evaluation of results showed that the methodological quality of the included systematic reviews was relatively low, of which 5 were low quality and 9 were critically low quality. A small number of systematic reviews were low risk of bias. The system evaluation reports are relatively complete, but the lack of program registration is a common problem. A total of 111 pieces of clinical evidence were extracted from the included 14 systematic reviews. The quality of evidence was generally low, with only 7 pieces of high-quality evidence, 45 pieces of medium-quality evidence, and the rest were low and very low-quality evidence. Among the reasons for relegation, imprecision is the most common, followed by inconsistency and indirectness. The existing evidence shows that patients after anterior cruciate ligament reconstruction with remnant preservation have certain advantages in knee joint function, joint stability and proprioception recovery, which may be a more effective surgical method. However, it may also increase the incidence of postoperative complications and adverse reactions. CONCLUSION Compared with Standard Technique, Remnant Preservation in Anterior Cruciate Ligament Reconstruction has more advantages in restoring joint function and stability and proprioception. But the potential risks should also be considered by surgeons. At present, the quality of evidence is generally low, and the reliability of the conclusion is insufficient. It still needs to be verified and further in-depth research is needed.
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Affiliation(s)
- Yunsong Zhang
- Changchun University of Traditional Chinese Medicine, 1035 Boshuo Road, Nanguan District, Changchun City, Jilin Province, China
| | - Xiangyu Xiao
- Shandong University of Traditional Chinese Medicine, No.4655, Changqing University Science and Technology Park, Changqing District, Jinan City, Shandong Province, China
| | - Wei Deng
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, No.1478 Gongnong Road, Chaoyang District, Changchun City, Jilin Province, China
| | - Jianyu Wang
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, No.1478 Gongnong Road, Chaoyang District, Changchun City, Jilin Province, China
| | - Hongwei Gao
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, No.1478 Gongnong Road, Chaoyang District, Changchun City, Jilin Province, China
| | - Jicheng Han
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, No.1478 Gongnong Road, Chaoyang District, Changchun City, Jilin Province, China.
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Xiaojun Z, Ming M, Jianye G, Wudong S, Yi Q, Jun C, Ningqinq H, Panpan F. Effects of proprioceptive training on gait and plantar pressure after anterior cruciate ligament reconstruction: study protocol for a randomized controlled trial. Trials 2023; 24:714. [PMID: 37946263 PMCID: PMC10634122 DOI: 10.1186/s13063-023-07759-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND People who have undergone anterior cruciate ligament reconstruction have an increased risk of osteoarthritis. Abnormality of lower limb kinematics will occur after the operation. This may be related to lower limb muscle strength, the co-excitation of hamstrings and quadriceps femoris, and the weakness of proprioception. Proprioceptive training can improve the proprioception of lower limbs and promote the recovery of lower limb kinematics. Our research objective is to observe whether proprioceptive training can improve the proprioception of lower limbs within 3 months after surgery and whether the recovery of proprioception can correct the abnormal lower limb kinematics. The secondary objective is to explore the underlying mechanism of postoperative lower limb gait abnormalities. METHODS/DESIGN This study is a prospective single-center randomized clinical trial to be conducted in the Sports Medicine and Orthopedics of Zhongda Hospital Southeast University. Forty participants aged 18-50, preparing to undergo anterior cruciate ligament reconstruction, and initial anterior cruciate ligament reconstruction using hamstring tendons as grafts will be randomly assigned to the intervention or comparator group. People in the intervention group will add proprioceptive training three times a week, 20 min each time. The intervention will be conducted on the first day after surgery. The researcher mainly collects the data of joint of sense, gait, and plantar pressure. The assessment will be divided into three stages: after signing the informed consent form (within 2 weeks before surgery), 6 weeks after surgery, and 12 weeks after surgery. DISCUSSION The main purpose of our study is to explore whether the proprioception of patients after anterior cruciate ligament reconstruction is weakened, whether the lower limb kinematics is abnormal and whether the lower limb kinematics can be corrected through proprioceptive training. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200065808. Registered on 15 November 2022; Version 1.
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Affiliation(s)
| | - Ma Ming
- Zhongda Hospital Southeast University, Nanjing, China.
| | - Guo Jianye
- Zhongda Hospital Southeast University, Nanjing, China
| | - Sun Wudong
- Zhongda Hospital Southeast University, Nanjing, China
| | - Qu Yi
- Zhongda Hospital Southeast University, Nanjing, China
| | - Cui Jun
- Nanjing Sport Institute, Nanjing, China
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Yokoe T, Tajima T, Yamaguchi N, Morita Y, Chosa E. Risk Factors of Loss of Knee Range of Motion after Primary Anterior Cruciate Ligament Reconstruction following Preoperative Recovery of Knee Range of Motion. J Knee Surg 2023; 36:1365-1373. [PMID: 36044919 DOI: 10.1055/a-1934-0776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The loss of knee range of motion (ROM) is not an uncommon complication after anterior cruciate ligament reconstruction (ACLR). However, the risk factors of loss of knee ROM remain debatable. The purpose of this study was to evaluate the incidence and risk factors of loss of knee ROM at 12 months after primary ACLR performed after regaining full knee ROM preoperatively. Consecutive patients who underwent primary ACLR after regaining full ROM between January 2014 and January 2020 were retrospectively reviewed. Patients who received a surgical arthrolysis within 12 months after ACLR or those who had a loss of knee ROM at 12 months postoperatively were defined as the loss of ROM group. Possible risk factors of loss of knee ROM, including patient demographic, preoperative, surgical, and postoperative factors, were assessed. The notch wide index and radiographic parameters of the tibial spines; medial tibial spine height/tibial length (TL), lateral tibial spine height (LTSH)/TL, and tibial spine width (TSW)/TL, were also assessed. A total of 141 patients (141 knees) were included (mean age, 25.8 ± 11.4 years; male/female, 56/85). Of the 141 patients, three received surgical arthrolysis within 12 months, and 23 had a loss of knee ROM at 12 months after ACLR. On comparing patients with and without loss of knee ROM, significant differences were found in the age (p = 0.04), LTSH/TL (p = 0.02), and TSW/TL (p = 0.02). A multivariate regression analysis showed that the age (odds ratio [OR]; 1.05, 95% confidence interval [CI]: 1.01-1.09, p = 0.02), LTSH/TL (OR: 1.44, 95% CI: 1.01-2.1, p = 0.04), and TSW/TL (OR: 0.79, 95% CI: 0.65-0.97, p = 0.02) were identified as significant independent risk predictors of loss of knee ROM. This study showed that the incidence of loss of knee ROM at 12 months after primary ACLR was 18.4% (26/141). An older age, a higher LTSH/TL, and a smaller TSW/TL may be associated with loss of knee ROM at 12 months after ACLR.
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Affiliation(s)
- Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Nami Yamaguchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Yudai Morita
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
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Liukkonen R, Vaajala M, Mattila VM, Reito A. Prevalence of post-traumatic osteoarthritis after anterior cruciate ligament injury remains high despite advances in surgical techniques. Bone Joint J 2023; 105-B:1140-1148. [PMID: 37907079 DOI: 10.1302/0301-620x.105b11.bjj-2023-0058.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims The aim of this study was to report the pooled prevalence of post-traumatic osteoarthritis (PTOA) and examine whether the risk of developing PTOA after anterior cruciate ligament (ACL) injury has decreased in recent decades. Methods The PubMed and Web of Science databases were searched from 1 January 1980 to 11 May 2022. Patient series, observational studies, and clinical trials having reported the prevalence of radiologically confirmed PTOA after ACL injury, with at least a ten-year follow-up, were included. All studies were analyzed simultaneously, and separate analyses of the operative and nonoperative knees were performed. The prevalence of PTOA was calculated separately for each study, and pooled prevalence was reported with 95% confidence intervals (CIs) using either a fixed or random effects model. To examine the effect of the year of injury on the prevalence, a logit transformed meta-regression analysis was used with a maximum-likelihood estimator. Results from meta-regression analyses were reported with the unstandardized coefficient (β). Results The pooled prevalence of PTOA was 37.9% (95% CI 32.1 to 44) for operatively treated ACL injuries with a median follow-up of 14.6 years (interquartile range (IQR) 10.6 to 16.7). For nonoperatively treated ACL injuries, the prevalence was 40.5% (95% CI 28.9 to 53.3), with a median of follow-up of 15 years (IQR 11.7 to 20.0). The association between the year of operation and the prevalence of PTOA was weak and imprecise and not related to the choice of treatment (operative β -0.038 (95% CI -0.076 to 0.000) and nonoperative β -0.011 (95% CI -0.101 to 0.079)). Conclusion The initial injury, irrespective of management, has, by the balance of probability, resulted in PTOA within 20 years. In addition, the prevalence of PTOA has only slightly decreased during past decades. Therefore, further research is warranted to develop strategies to prevent the development of PTOA after ACL injuries.
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Affiliation(s)
- Rasmus Liukkonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Matias Vaajala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Aleksi Reito
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Nagashima M, Sasaki R, Tanaka K, Takeshima K. The use of tourniquet is useful in terms of blood loss and soft tissue damage in arthroscopic anterior cruciate ligament reconstruction: a retrospective study. Sci Rep 2023; 13:17798. [PMID: 37853067 PMCID: PMC10584916 DOI: 10.1038/s41598-023-45159-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 10/17/2023] [Indexed: 10/20/2023] Open
Abstract
Whether a tourniquet should be used for anterior cruciate ligament reconstruction (ACLR) when the operative field is secured remains controversial. Little is known about the influence of not using a tourniquet on total perioperative blood loss and soft tissue damage. The aim of this study was to compare total perioperative blood loss and soft tissue damage with and without tourniquet use during ACLR. Seventy-seven consecutive ACLRs in 76 patients were performed without tourniquet use at our hospital and enrolled in this study (T- group) between November 2018 and September 2021. The control group (T + group) comprised 55 historical ACLRs in 55 patients performed with tourniquet use at our hospital between April 2017 and September 2018. Total perioperative blood loss, calculated from the change in hemoglobin between that preoperatively and on postoperative day (POD) 1, and indicators of soft tissue damage including serum white blood cell (WBC) counts, creatine phosphokinase (CPK), and C-reactive protein (CRP) values measured on POD 1 and POD 7 were compared between groups. Total blood loss was significantly higher in the T- group (339 ± 216 mL) than in the T + group (258 ± 199 mL; P = 0.030). On POD 1, WBC counts were significantly higher in the T- group (9.7 ± 2.4 × 103 cells/µL) than in the T + group (9.1 ± 2.5 × 103 cells/µL; P = 0.043), CPK levels were significantly higher in the T- group (294 ± 417 U/L) than in the T + group (255 ± 88 U/L; P = 0.046), and CRP levels were also significantly higher in the T- group (1.40 ± 1.12 mg/dL) than in the T + group (0.91 ± 0.76 mg/dL; P = 0.016). No significant differences in WBC counts or CPK or CRP levels were seen between groups on POD 7. Total blood loss and soft tissue damage were significantly increased without tourniquet use during ACLR. No advantage was found for not using a tourniquet in terms of blood loss or soft tissue damage.
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Affiliation(s)
- Masaki Nagashima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan.
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-Ku, Tokyo, 108-8329, Japan.
| | - Ryo Sasaki
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-Ku, Tokyo, 108-8329, Japan
| | - Kentaro Tanaka
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-Ku, Tokyo, 108-8329, Japan
| | - Kenichiro Takeshima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita City, Chiba, 286-8520, Japan
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Sherman DA, Rush J, Stock MS, D. Ingersoll C, E. Norte G. Neural drive and motor unit characteristics after anterior cruciate ligament reconstruction: implications for quadriceps weakness. PeerJ 2023; 11:e16261. [PMID: 37818333 PMCID: PMC10561646 DOI: 10.7717/peerj.16261] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/18/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose The purpose of this investigation was to compare the quality of neural drive and recruited quadriceps motor units' (MU) action potential amplitude (MUAPAMP) and discharge rate (mean firing rate (MFR)) relative to recruitment threshold (RT) between individuals with anterior cruciate ligament reconstruction (ACLR) and controls. Methods Fourteen individuals with ACLR and 13 matched controls performed trapezoidal knee extensor contractions at 30%, 50%, 70%, and 100% of their maximal voluntary isometric contraction (MVIC). Decomposition electromyography (dEMG) and torque were recorded concurrently. The Hoffmann reflex (H-reflex) and central activation ratio (CAR) were acquired bilaterally to detail the proportion of MU pool available and volitionally activated. We examined MUAPAMP-RT and MFR-RT relationships with linear regression and extracted the regression line slope, y-intercept, and RT range for each contraction. Linear mixed effect modelling used to analyze the effect of group and limb on regression line slope and RT range. Results Individuals with ACLR demonstrated lower MVIC torque in the involved limb compared to uninvolved limb. There were no differences in H-reflex or CAR between groups or limbs. The ACLR involved limb demonstrated smaller mass-normalized RT range and slower MU firing rates at high contraction intensities (70% and 100% MVIC) compared to uninvolved and control limbs. The ACLR involved limb also demonstrated larger MU action potentials in the VM compared to the contralateral limb. These differences were largely attenuated with relative RT normalization. Conclusions These results suggest that persistent strength deficits following ACLR may be attributable to a diminished quadriceps motor neuron pool and inability to upregulate the firing rate of recruited MUs.
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Affiliation(s)
- David A. Sherman
- Live4 Physical Therapy and Wellness, Acton, Massachusetts, United States of America
- Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States of America
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, United States of America
| | - Justin Rush
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, Ohio, United States of America
| | - Matt S. Stock
- Cognition, Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, United States of America
| | - Christopher D. Ingersoll
- College of Health Professions and Sciences, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, Florida, United States of America
| | - Grant E. Norte
- Cognition, Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, United States of America
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Aier S, Kalra S, Varma M, Pandey V. Atypical mycobacterium infection following anterior cruciate ligament reconstruction. BMJ Case Rep 2023; 16:e253440. [PMID: 37802587 PMCID: PMC10565175 DOI: 10.1136/bcr-2022-253440] [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] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
A man in his 20s presented with instability of the right knee following an incident of fall from a height. He was clinicoradiologically diagnosed to have an anterior cruciate ligament (ACL) tear for which he underwent ACL reconstruction. Postoperatively, he was started on an accelerated ACL rehabilitation protocol. Six weeks postoperatively, he developed features of subclinical septic arthritis for which he underwent arthroscopic debridement. Intraoperative samples cultured Mycobacterium abscessus complex on MGIT 960 system. The patient subsequently had to undergo another debridement after 1 month as there were clinical signs of persisting infection. The graft was intact even on the second debridement and after removing the implants. This case reports a rare complication of ACL reconstruction with infection by atypical mycobacterium and the clinical outcome. It also emphasises that prompt surgical intervention can save the graft.
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Affiliation(s)
- Sashitemjen Aier
- Orthopaedics, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | - Saher Kalra
- Orthopaedics, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | - Muralidhar Varma
- Infectious Diseases, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | - Vivek Pandey
- Orthopaedics, Kasturba Medical College Manipal, Manipal, Karnataka, India
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Bolzinger M, Thevenin Lemoine C, Flumian C, Nicolaou N, Sales de Gauzy J, Accadbled F. Analysis of Growth After Transphyseal Anterior Cruciate Ligament Reconstruction in Children. J Pediatr Orthop 2023; 43:537-542. [PMID: 37522467 DOI: 10.1097/bpo.0000000000002484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Pediatric transphyseal anterior cruciate ligament reconstruction (ACLR) bears several advantages and is widely used. The main concern is the risk of growth disturbance. Our purpose was to investigate the incidence and risk factors of growth disturbance in skeletally immature patients who underwent transphyseal ACLR. We hypothesized that this procedure would generate neither clinically relevant limb length discrepancy (LLD) nor axis deviation. METHODS This prospective, consecutive, single-center series included skeletally immature patients who underwent primary transphyseal ACLR using semitendinosus tendon autograft, with a 2-year follow-up bone length standing radiograph of both lower limbs from pelvis to ankle in anterior posterior view. Lower limb length, mechanical axis deviation (MAD), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA) were measured. The definition of postoperative growth disturbance was defined as ≥10 mm for LLD or ≥3 degrees for axis deviation in comparison to the contralateral lower limb. Predictive variables included age at surgery, gender, side, and diameter of bone tunnels. Student or Mann-Whitney test was used for numerical variables, and Chi-square test or Fisher exact test was used for categorical variables. P values <0.05 were considered statistically significant. RESULTS Fifty consecutively treated patients were included. Forty-seven patients (31 boys, 16 girls) with a mean age of 13.2 years (range, 9 to 16) at the time of surgery were available for analysis. Six patients had an LLD of at least 10 mm. Twenty-five patients had a difference in MPTA of a least 3 degrees (range, 5 to 8). Sixteen patients had a difference in LDFA of a least 3 degrees (range, 4 to 9). No patients presented with a clinical deformity or related symptoms. Regarding coronal alignment, there was no statistical difference in mechanical axis deviation, LDFA, or MPTA. Gender, side, age, and bone tunnel diameter did not influence growth disturbance. CONCLUSIONS Transphyseal pediatric ACLR generated a high rate of growth disturbances (leg length discrepancy and axis deviation) although none clinically relevant. Mild proximal tibial axis deviation in patients operated on near skeletal maturity should be further investigated. LEVEL OF EVIDENCE Level III. STUDY DESIGN Case-control study.
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Affiliation(s)
- Manon Bolzinger
- Orthopédie Traumatologie, Hôpital des Enfants, CHU de Toulouse, France
| | | | - Clara Flumian
- Orthopédie Traumatologie, Hôpital des Enfants, CHU de Toulouse, France
| | - Nicolas Nicolaou
- Department of Paediatric Orthopaedics and Spinal Surgery, Sheffield Children's Hospital, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | - Franck Accadbled
- Orthopédie Traumatologie, Hôpital des Enfants, CHU de Toulouse, France
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Liu AF, Guo TC, Feng HC, Yu WJ, Chen JX, Zhai JB. Efficacy and safety of early versus delayed reconstruction for anterior cruciate ligament injuries: A systematic review and meta-analysis. Knee 2023; 44:43-58. [PMID: 37517167 DOI: 10.1016/j.knee.2023.07.008] [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: 04/06/2023] [Revised: 07/02/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To critically evaluate the efficacy and safety of early versus delayed anterior cruciate ligament reconstruction (ACLR) for anterior cruciate ligament (ACL) injuries based on the different cut-off values of the timing of operation. METHODS PubMed, Medline, Embase, Cochrane library, China National Knowledge Infrastructure, Chinese Biomedical Literature, and Wanfang Digital Periodical database were searched from inception to November 2022 without language restrictions. Randomized controlled trials (RCTs) and cohort studies (CSs) comparing early ACLR with delayed ACLR for ACL injuries were included. RESULTS Twenty-four studies (10 RCTs and 14 CSs) were included. According to the information from included studies, 3 weeks, 4 weeks, 6 weeks, 6 months, and 12 months after ACL injuries were considered as the cut-off values of early and delayed ACLR. When 4 weeks were considered as the cut-off value, early ACLR could significantly improve Lysholm score, IKDC score and VAS score at 6 and 12 months postoperatively and decrease the incidence of adverse events compared with delayed ACLR (P < 0.05). However, no statistically significant difference in positive rate of Lachman test and incidence of meniscus injuries and chondral lesions between the two groups when 3 weeks, 6 weeks, 6 months or 12 months after ACL injuries were considered as the cut-off values of early and delayed ACLR (P > 0.05). CONCLUSION The present study suggests that early ACLR, especially conducted within 3-4 weeks after ACL injuries, may be more effective for improving knee function and relieving pain compared with delayed ACLR. More high-quality RCTs are warranted.
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Affiliation(s)
- Ai-Feng Liu
- Department of Orthopedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Tian-Ci Guo
- Department of Orthopedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Hui-Chuan Feng
- Department of Orthopedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Wei-Jie Yu
- Department of Orthopedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Ji-Xin Chen
- Department of Orthopedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jing-Bo Zhai
- School of Public Health, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
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Schmitz JK, Omar O, Nordkvist A, Hedevik H, Janarv PM, Stålman A. Poorer patient-reported outcome and increased risk of revision at a 5-year follow-up among patients with septic arthritis following anterior cruciate ligament reconstruction: a register-based cohort study of 23,075 primary anterior cruciate ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 2023; 31:4090-4098. [PMID: 37395807 PMCID: PMC10471654 DOI: 10.1007/s00167-023-07498-6] [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: 02/25/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE The primary aim of this study is to analyse the patient-reported outcomes after ACLR complicated by septic arthritis. The secondary aim is to examine the 5-year risk of revision surgery after primary ACLR complicated by septic arthritis. The hypothesis was that patients with septic arthritis after ACLR are more likely to have lower PROMs scores and an increased risk of revision, compared with patients without septic arthritis. MATERIALS AND METHODS All primary ACLRs, with a hamstring or patellar tendon autograft (n = 23,075), in the Swedish Knee Ligament Register (SKLR) between 2006 and 2013 were linked with data from the Swedish National Board of Health and Welfare to identify patients with postoperative septic arthritis. These patients were verified in a nationwide medical records analysis and compared with patients without infection in the SKLR. The patient-reported outcome was measured using the Knee injury and Osteoarthritis Index Score (KOOS) and the European Quality of Life Five Dimensions Index (EQ-5D) at 1, 2 and 5 years postoperatively and the 5-year risk of revision surgery was calculated. RESULTS There were 268 events of septic arthritis (1.2%). The mean scores on the KOOS and EQ-5D index were significantly lower for patients with septic arthritis on all subscales on all follow-up occasions compared with patients without septic arthritis. Patients with septic arthritis had a revision rate of 8.2% compared with 4.2% in patients without septic arthritis (adjusted hazard ratio 2.04; confidence interval 1.34-3.12). CONCLUSION Patients suffering from septic arthritis following ACLR are associated with poorer patient-reported outcomes at 1-, 2- and 5-year follow-ups compared with patients without septic arthritis. The risk of revision ACL reconstruction within 5 years of the primary operation for patients with septic arthritis following ACLR is almost twice as high, compared with patients without septic arthritis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jesper Kraus Schmitz
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Osama Omar
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Vo Ortopedi, Södersjukhuset, Sjukhusbacken 10, 11883, Stockholm, Sweden.
| | - Adam Nordkvist
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Hedevik
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Per-Mats Janarv
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Stålman
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Lee ASY, Shu-Hang Yung P, Ong MTY, Lonsdale C, Wong TWL, Siu PM, Hagger MS, Chan DKC. Effectiveness of a theory-driven mHealth intervention in promoting post-surgery rehabilitation adherence in patients who had anterior cruciate ligament reconstruction: A randomized clinical trial. Soc Sci Med 2023; 335:116219. [PMID: 37716185 DOI: 10.1016/j.socscimed.2023.116219] [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] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 05/12/2023] [Accepted: 09/01/2023] [Indexed: 09/18/2023]
Abstract
RATIONALE Patients with anterior cruciate ligament (ACL) reconstruction often have poor adherence to post-surgery rehabilitation. OBJECTIVE This study applied the integrated model of self-determination theory and the theory of planned behavior to examine the effects of a smartphone-delivered intervention on the recovery outcomes of patients with an ACL rupture during post-surgery rehabilitation period. Additionally, we explored the effects of the intervention on participants with different beliefs toward rehabilitation at baseline. METHODS The randomized control trial recruited 96 eligible participants (M age = 27.82 years, SD = 8.73; female = 39%) who underwent ACL reconstruction surgery. Participants were randomly assigned to an intervention group (n = 41), which received standard post-surgical treatment (usual-care) and smartphone application ("ACL-Well"), or a usual-care control group (n = 55). The primary outcomes were recovery outcomes from ACL surgery measured by knee muscle strength and laxity, and subjective knee evaluation completed 4-month post-intervention. Secondary outcomes were the psychological and behavioral outcomes measured at baseline, at 2- and 4-month post-intervention. RESULTS ANCOVA indicated no significant between-group differences in primary outcomes: knee muscle strength, knee laxity and subjective knee evaluation, Fs(1, 27 to 55) = 0.01 to 1.36, p = .25 to .99, η2 = 0.01 to 0.03. For the secondary outcomes, growth mixture modelling revealed self-determined treatment motivation declined significantly over the intervention period in the control group (M slope = -0.39 to -0.12, p = .01 to .04), but not in the intervention group (M slope = -0.19 to -0.08, p = .06 to .38). CONCLUSIONS The smartphone application fell short in promoting orthopedic outpatients' recovery outcomes. Yet, it shows some promises as a mean to maintain patients' motivation and adherence to treatment.
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Affiliation(s)
- Alfred S Y Lee
- Centre for Child and Family Science, The Education University of Hong Kong, Hong Kong, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Chris Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, Australia
| | - Thomson W L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Parco M Siu
- Division of Kinesiology, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Martin S Hagger
- SHARPP Lab, Psychological Sciences, University of California, Merced, USA; Health Sciences Research Institute, University of California, Merced, USA; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; School of Applied Psychology, Griffith University, Mt. Gravatt, Australia
| | - Derwin K C Chan
- Faculty of Education and Human Development, The Education University of Hong Kong, Hong Kong, China.
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Pérez-Prieto D, Totlis T, Madjarevic T, Becker R, Ravn C, Monllau JC, Renz N. ESSKA and EBJIS recommendations for the management of infections after anterior cruciate ligament reconstruction (ACL-R): prevention, surgical treatment and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2023; 31:4204-4212. [PMID: 37243789 PMCID: PMC10471731 DOI: 10.1007/s00167-023-07463-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/17/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Infection after anterior cruciate ligament reconstruction (ACL-R) is a rare but severe complication. Despite an increase in articles published on this topic over the last decade, solid data to optimized diagnostic and therapeutic measures are scarce. For this reason, the European Bone and Joint Infection Society (EBJIS) and the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) collaborated in order to develop recommendations for the diagnosis and management of infections after ACL-R. The aim of the workgroup was to perform a review of the literature and provide practical guidance to healthcare professionals involved in the management of infections after ACL-R. METHODS An international workgroup was recruited to provide recommendations for predefined clinical dilemmas regarding the management of infections after ACL-R. MEDLINE, EMBASE, Cochrane Library and Scopus databases were searched for evidence to support the recommended answers to each dilemma. RESULTS The recommendations were divided into two articles. The first covers etiology, prevention, diagnosis and antimicrobial treatment of septic arthritis following ACL-R and is primarily aimed at infectious disease specialists. This article includes the second part of the recommendations and covers prevention of infections after ACL-R, surgical treatment of septic arthritis following ACL-R and subsequent postoperative rehabilitation. It is aimed not only at orthopedic surgeons, but at all healthcare professionals dealing with patients suffering from infections after ACL-R. CONCLUSION These recommendations guide clinicians in achieving timely and accurate diagnosis as well as providing optimal management, both of which are paramount to prevent loss of function and other devastating sequelae of infection in the knee joint. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Daniel Pérez-Prieto
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar, Barcelona, Spain
- IcatKNEE, Hospital Universitari Dexeus - Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Trifon Totlis
- Thessaloniki Minimally Invasive Surgery (The-MIS) Orthopaedic Centre, St. Luke's Hospital, Thessaloniki, Greece.
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Tomislav Madjarevic
- University Hospital for Orthopaedic Surgery Lovran, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Roland Becker
- Centre of Orthopaedics and Traumatology, University of Brandenburg Theodor Fontane, Brandenburg, Germany
| | - Christen Ravn
- Department of Orthopaedic Surgery and Traumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Juan C Monllau
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar, Barcelona, Spain
- IcatKNEE, Hospital Universitari Dexeus - Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Nora Renz
- Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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50
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Mousavi SH, Radi M, Kazemi D, Izadpanah F, Shahrouzian A. Evaluation the results of anterior cruciate ligament reconstruction with or without using antibiotic solution during graft preparation. Eur J Orthop Surg Traumatol 2023; 33:3033-3036. [PMID: 36988698 DOI: 10.1007/s00590-023-03522-0] [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] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Joint infection after Anterior Cruciate Ligament (ACL) reconstruction is an uncommon infection which can affect joint movement and function. In this study, the impact of using antibiotic during graft preparation on the results of ACL reconstruction was investigated to examine the negative effects of antibiotic solution on graft and clinical symptoms after the surgery. METHODS In this randomized clinical trial study, 80 patients were enrolled. In one group, the graft was placed in vancomycin solution (500 mg of vancomycin powder in 100 ml of normal saline) for 10-15 min during the surgery. In other group, the surgery was performed routinely and the graft was not placed in antibiotic solution. Intravenous antibiotic was given to both groups and they underwent ACL reconstruction surgery through arthroscopic transportal technique using their hamstring tendon. Symptoms and examinations of patients were evaluated for one year after the surgery. RESULTS There was no difference between two groups in terms of knee dislocation, knee lock, pain, fever, positivity of Lachman test, Anterior drawer test and pivot-shift test, knee swelling, and movement restriction in flection and extension (P > 0.05). No infection was seen in patients. CONCLUSIONS Placing grafts in vancomycin solution does not have negative effects on graft quality and results of ACL surgery.
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Affiliation(s)
- Seyed Hamid Mousavi
- Orthopedics Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehran Radi
- Orthopedics Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davoud Kazemi
- Orthopedics Department, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Fatemeh Izadpanah
- Food and Drug Laboratory Research Center and Food and Drug Reference Control Laboratories Center, Food and Drug Administration of Iran, MOH & ME, Tehran, Iran
| | - Abbas Shahrouzian
- Orthopedics Department, Isfahan University of Medical Sciences, Isfahan, Iran
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