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Frey CS, Pierre KJ, Pham NS, Abrams GD, Sherman SL, Spalding T, Safran MR. Management of Isolated Partial ACL Tears: A Survey of International ACL Surgeons. Orthop J Sports Med 2025; 13:23259671241311603. [PMID: 39931635 PMCID: PMC11808748 DOI: 10.1177/23259671241311603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 08/30/2024] [Indexed: 02/13/2025] Open
Abstract
Background Partial anterior cruciate ligament (ACL) tears, particularly injuries detected with magnetic resonance imaging (MRI) but stable on ligamentous examination, appear to be recognized more frequently; however, there remains no consensus management for this complex pathology. Purpose To present the results of a survey of a group of international ACL experts on the management of partial ACL injuries. Study Design Survey study; Level of evidence, 5. Methods The ACL Study Group is an international group of orthopaedic surgeons with a special interest in the ACL. There are 169 members overall, with 135 clinically active surgeons. A branching logic survey was developed and circulated to members of the ACL Study Group via electronic mail. Categories included member demographics as well as recommended management strategies of partial ACL injuries, including recommendations on return to play. Results Of the 135 clinically active surgeon members, 113 responded to the survey (84%). Nonoperative management of partial ACL injuries was selected by 92% of respondents. Of those who managed nonoperatively, 75% indicated they would not restrict weightbearing and 59% would not recommend a knee brace. When those who managed the patient nonoperatively determined criteria for return to sports (RTS), 33% would use differential knee laxity, 87% would assess functional testing, 26% would utilize imaging, and 40% selected time from injury. When using time as a guide for RTS, 13% chose RTS between 7 and 11 weeks postinjury, 56% selected no sport before 3 months, and 22% favored waiting 4 to 6 months before allowing an athlete with a partial ACL injury to RTS. With regard to function as a tool to determine RTS, painless Lachman, strength, swelling, and functional performance tests were all chosen by a majority of respondents. Conclusion This study presented the results of a survey on partial ACL injury management administered to ACL Study Group active surgical members. The majority favored nonoperative management for partial ACL injuries (stable ligament examination but MRI changes in the ligament). Nonoperative treatment and RTS protocols varied and must be customized to the patient.
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Affiliation(s)
- Christopher S. Frey
- Department of Orthopaedic Surgery and Sports Medicine, Stanford Medicine, Redwood City, California, USA
| | - Kinsley J. Pierre
- Department of Orthopaedic Surgery and Sports Medicine, Stanford Medicine, Redwood City, California, USA
| | - Nicole S. Pham
- Department of Orthopaedic Surgery and Sports Medicine, Stanford Medicine, Redwood City, California, USA
| | - Geoffrey D. Abrams
- Department of Orthopaedic Surgery and Sports Medicine, Stanford Medicine, Redwood City, California, USA
| | - Seth L. Sherman
- Department of Orthopaedic Surgery and Sports Medicine, Stanford Medicine, Redwood City, California, USA
| | - Tim Spalding
- Department of Orthopaedic Surgery, Cleveland Clinic London Hospital, London, England, UK
| | - Marc R. Safran
- Department of Orthopaedic Surgery and Sports Medicine, Stanford Medicine, Redwood City, California, USA
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Yang Y, Zheng B, Zhang M, Lin X, Zhang W, Han D, Chen H, Zhou X. The angle of the lower portion of the posterior cruciate ligament assists in the diagnosis of partial anterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc 2024; 32:3015-3022. [PMID: 38989785 DOI: 10.1002/ksa.12346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/03/2024] [Accepted: 06/17/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE To compare the difference of angle of the lower portion of the posterior cruciate ligament (PCL) measured via magnetic resonance imaging (MRI) in patients with and without partial anterior cruciate ligament (ACL) tears and to investigate the effectiveness of the angle of the lower portion of the PCL in diagnosing partial ACL tears. METHODS From January 2022 to December 2022, a cohort of consecutive patients presenting with ACL tears who underwent ACL reconstruction and patients with isolated meniscus tears undergoing arthroscopic surgery were enroled for this study. The angle of the inferior portion of the PCL comprises α and β angles, and the posterior offset of the lateral condyle were measured on the MRI and compared between the partial ACL tear and control groups. Receiver operating characteristic curves, the areas under the curve (AUCs) and the 95% confidence intervals (CIs) were calculated to identify cutoff values for diagnosing partial ACL injuries. RESULTS Following an assessment of cohort eligibility and matching for age and sex, 100 patients were included in this study. The mean age of the cohort was 46.1 ± 10.3 years. The AUC for the α angle was 0.88 (95% CI, 0.82-0.94), with a sensitivity of 0.74 and specificity of 0.84 for predicting partial ACL ruptures; the α angle cutoff value was 73.6° (diagnostic odds ratio (OR), 14.10; 95% CI, 5.33-37.28). The AUC for the β angle was 0.86 (95% CI, 0.79-0.93), with a sensitivity of 0.64 and a specificity of 0.92 for predicting partial ACL ruptures; the β angle cutoff value was 73.3° (diagnostic OR, 14.54; 95% CI, 5.76-36.68). CONCLUSIONS A small α angle and a large β angle were associated with partial ACL tears. The angle of the distal portion of the PCL was simple to measure and reproducible, enhancing the diagnosis of partial ACL tears. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yang Yang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
- Department of Medical Education, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Binbin Zheng
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Mengqin Zhang
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Xiaofang Lin
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Wei Zhang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Dawei Han
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Haixiao Chen
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Xiaobo Zhou
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
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Lo HL, Lin SY, Ho CJ, Ming-Kung Y, Lu CC. Effect of lyophilized exosomes derived from umbilical cord stem cells on chronic anterior cruciate ligament cell injury. J Orthop Surg Res 2024; 19:554. [PMID: 39252098 PMCID: PMC11382386 DOI: 10.1186/s13018-024-05029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 08/23/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Facilitating the healing process of injured anterior cruciate ligament (ACL) tissue is crucial for patients to safely return to sports. Stem cell derived exosomes have shown positive effects on enhancing the regeneration of injured tendons/ligaments. However, clinical application of exosomes in terms of storage and pre-assembly is challenging. We hypothesized that lyophilized exosomes derived from human umbilical cord stem cells (hUSC-EX) could enhance the cell activity of chronically injured ACL cells. MATERIALS AND METHODS We harvested the 8 weeks injured ACL cells from rabbit under IACUC (No. 110232) approval. The studied exosomes were purified from the culture medium of human umbilical cord stem cells (IRB approval No. A202205014), lyophilized to store, and hydrated for use. We compared exosome treated cells with non-exosome treated cells (control group) from the same rabbits. We examined the cell viability, proliferation, migration capability and gene expression of type I and III collagen, TGFβ, VEGF, and tenogenesis in the 8 weeks injured ACL cells after hUSC-EX treatment. RESULTS After hydration, the average size of hUSC-EX was 84.5 ± 70.6 nm, and the cells tested positive for the Alix, TSG101, CD9, CD63, and CD81 proteins but negative for the α-Tubulin protein. After 24 h of treatment, hUSC-EX significantly improved the cell viability, proliferation and migration capability of 8 weeks injured ACL cells compared to that of no exosome treatment group. In addition, the expression of collagen synthesis, TGFβ, VEGF, and tenogenesis gene were all significantly increased in the 8 weeks injured ACL cells after 24 h hUSC-EX delivery. DISCUSSION Lyophilized exosomes are easily stored and readily usable after hydration, thereby preserving their characteristic properties. Treatment with lyophilized hUSC-EX improved the activity and gene expression of 8 weeks injured ACL cells. CONCLUSION Lyophilized hUSC-EX preserve the characteristics of exosomes and can improve chronically injured (8 weeks) ACL cells. Lyophilized hUSC-EX could serve as effective and safe biomaterials that are ready to use at room temperature to enhance cell activity in patients with partial ACL tears and after remnant preservation ACL reconstruction.
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Affiliation(s)
- Hon Lok Lo
- Department of Orthopedics, Kaohsiung Medical University Hospital, No.482, Shanming Rd., Siaogang Dist., Kaohsiung City, 812, Taiwan
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sung-Yen Lin
- Department of Orthopedics, Kaohsiung Medical University Hospital, No.482, Shanming Rd., Siaogang Dist., Kaohsiung City, 812, Taiwan
- Department of Orthopedics, School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Jung Ho
- Department of Orthopedics, Kaohsiung Medical University Hospital, No.482, Shanming Rd., Siaogang Dist., Kaohsiung City, 812, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yeh Ming-Kung
- School of Pharmacy, Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Chang Lu
- Department of Orthopedics, Kaohsiung Medical University Hospital, No.482, Shanming Rd., Siaogang Dist., Kaohsiung City, 812, Taiwan.
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Orthopedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Turati M, Anghilieri FM, Gatti SD, Courvoisier A, Rigamonti L, Zatti G, Nicolaou N, Bigoni M. Arthroscopic repair of proximal anterior cruciate ligament tears in children and adolescents: A systematic review. J Child Orthop 2024; 18:249-257. [PMID: 38831852 PMCID: PMC11144375 DOI: 10.1177/18632521241244626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/17/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Anterior cruciate ligament repair techniques are of growing interest because they allow for minimally invasive surgery that avoids harvesting of the transplant, without risking growth deficiencies in young patients. The aim of this study is to summarize the published evidence about arthroscopic repair of anterior cruciate ligament proximal tears in skeletally immature patients. Methods In total, four studies were included and processed for data extraction after screening for eligibility for this systematic review: one retrospective cohort study and three retrospective case series. Altogether, the four studies included in this review included 61 skeletally immature patients with a mean age of 12.1 years diagnosed with proximal anterior cruciate ligament tear who underwent arthroscopic repair with preservation of the native ligament. The mean follow-up period was 2.8 years. Results The most relevant and objective outcome that we considered was re-rupture rate. One study reports a cumulative incidence of graft failure in the first 3 years after surgery of 48.8% while the others report a 0%, 0% and 21.5% re-rupture rate. No growth disturbances were reported in the included studies. Conclusion Despite growing interest surrounding anterior cruciate ligament repair techniques, the presence of limited quality studies in the literature means repair cannot be strongly supported at present. Some encouraging data regarding the absence of growth disturbance and functional outcomes does exist, but studies with larger samples are required. Level of evidence level IV.
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Affiliation(s)
- Marco Turati
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfants, Grenoble Alpes University, Grenoble, France
| | | | - Simone Daniel Gatti
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Aurelien Courvoisier
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfants, Grenoble Alpes University, Grenoble, France
| | - Luca Rigamonti
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Giovanni Zatti
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nicolas Nicolaou
- Sheffield Children’s Hospital and Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
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Kopka M, Heard SM, Buchko GM, Hiemstra LA, Lafave MR, Kerslake S. Remnant-Sparing Anterior Cruciate Ligament Reconstruction Results in Similar Clinical, Functional, and Quality-of-Life Outcomes to Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2024; 6:100898. [PMID: 38405580 PMCID: PMC10883819 DOI: 10.1016/j.asmr.2024.100898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/12/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose To compare a large cohort of patients who underwent remnant-sparing anterior cruciate ligament reconstruction (rACLR) with a matched group of patients who underwent anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) with respect to clinical laxity, patient-reported outcomes, and functional testing. Methods Patients who underwent rACLR between January 2010 and December 2015 were matched according to age, sex, body mass index, and graft type to patients who underwent ACLR. The primary outcome measure was the ACL Quality of Life (ACL-QOL) score at final follow-up of 24 months. Secondary outcomes included functional tests and clinical laxity measurements at 6, 12, and 24 months postoperatively. Concurrent intra-articular pathology at the time of surgery and postoperative complications were also recorded. Statistical analyses included the dependent t test and the Wilcoxon signed rank test. Results A total of 210 rACLR patients were successfully matched to a corresponding cohort of 210 ACLR patients. There were no statistically significant differences in ACL Quality of Life (ACL-QOL) or functional testing results between the groups; however, scores in both groups showed a steady and statistically significant improvement over time. A statistically significant difference was noted with respect to the Lachman test findings, favoring the rACLR cohort (Z = -2.79, P = .005); no between-group difference was seen for the pivot-shift test (Z = -0.36, P = .72). The rACLR group had a significantly lower rate of concurrent meniscal and chondral injury. There was no difference in complications between the groups (Z = -0.49, P = .63). Conclusions There was no difference in patient-reported or functional testing outcomes in patients undergoing remnant-sparing compared with anatomic single-bundle ACLR. There was, however, a significantly lower rate of positive Lachman test findings after rACLR. Furthermore, the rate of concurrent meniscal and chondral pathology was lower in the rACLR group. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Michaela Kopka
- Banff Sport Medicine, Banff, Canada
- Department of Surgery, University of Calgary, Calgary, Canada
| | - S. Mark Heard
- Banff Sport Medicine, Banff, Canada
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Gregory M. Buchko
- Banff Sport Medicine, Banff, Canada
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Laurie A. Hiemstra
- Banff Sport Medicine, Banff, Canada
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Mark R. Lafave
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
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Moon HS, Choi CH, Kim S, Yoo JH, Jung M, Kwon HJ, Hong YJ, Kim SH. Outpatient-based diagnostic criteria for partial ACL injury: clinical outcomes of non-operative treatment and radiographic predictor. Arch Orthop Trauma Surg 2023; 143:2027-2036. [PMID: 35552802 DOI: 10.1007/s00402-022-04467-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/24/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION This study aimed to (1) evaluate the short-term clinical outcomes of patients who underwent non-operative treatment for partial anterior cruciate ligament (ACL) tears diagnosed using the outpatient-based diagnostic criteria and (2) investigate the radiographic predictors distinguishing patients at risk of non-operative treatment failure. METHODS From 2010 to 2019, patients diagnosed with partial ACL tears and treated with non-operative treatment were reviewed retrospectively. Patients were then classified into two groups: those who successfully responded to non-operative treatment (group S) and those who failed to respond to non-operative treatment and required surgical reconstruction within 6 months after injury (group F). ACL laxity, patient-reported outcomes (PROs), and several radiographic parameters were analyzed. To identify radiographic predictors related to clinical outcomes, radiographic parameters were compared between the groups, which were statistically matched for potential confounders (age and activity level) using inverse probability of treatment weighting. RESULTS A total of 44 patients were analyzed (mean age, 28.7 ± 8.7 years; 31 men), and classified into two groups (group S, 23 patients; group F, 21 patients). There were no significant differences in ACL laxity and PROs between the groups at 1 year after either non-operative treatment or surgical reconstruction. A comparison of radiographic parameters between the groups revealed significant differences in several parameters related to secondary signs of ACL injury. Subsequent regression analyses revealed that anterior tibial translation and extent of bone bruises were radiographic predictors related to clinical outcomes. CONCLUSION Non-operative treatment for partial ACL tears diagnosed using the outpatient-based diagnostic criteria can provide successful short-term clinical outcomes in selective patients. Secondary signs of ACL injuries, particularly the amount of anterior tibial translation and the extent of bone bruises, are radiographic predictors that could differentiate patients at risk of non-operative treatment failure. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Affiliation(s)
- Hyun-Soo Moon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Je-Hyun Yoo
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuk-Jun Kwon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Jae Hong
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Beaulieu ML, Ashton-Miller JA, Wojtys EM. Loading mechanisms of the anterior cruciate ligament. Sports Biomech 2023; 22:1-29. [PMID: 33957846 PMCID: PMC9097243 DOI: 10.1080/14763141.2021.1916578] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/08/2021] [Indexed: 01/26/2023]
Abstract
This review identifies the three-dimensional knee loads that have the highest risk of injuring the anterior cruciate ligament (ACL) in the athlete. It is the combination of the muscular resistance to a large knee flexion moment, an external reaction force generating knee compression, an internal tibial torque, and a knee abduction moment during a single-leg athletic manoeuvre such as landing from a jump, abruptly changing direction, or rapidly decelerating that results in the greatest ACL loads. While there is consensus that an anterior tibial shear force is the primary ACL loading mechanism, controversy exists regarding the secondary order of importance of transverse-plane and frontal-plane loading in ACL injury scenarios. Large knee compression forces combined with a posteriorly and inferiorly sloped tibial plateau, especially the lateral plateau-an important ACL injury risk factor-causes anterior tibial translation and internal tibial rotation, which increases ACL loading. Furthermore, while the ACL can fail under a single supramaximal loading cycle, recent evidence shows that it can also fail following repeated submaximal loading cycles due to microdamage accumulating in the ligament with each cycle. This challenges the existing dogma that non-contact ACL injuries are predominantly due to a single manoeuvre that catastrophically overloads the ACL.
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Affiliation(s)
- Mélanie L. Beaulieu
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James A. Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Edward M. Wojtys
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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van Keulen LZ, Hoogeslag RAG, Brouwer RW, Huis In 't Veld R, Verdonschot N. The importance of continuous remnant preservation in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:1818-1827. [PMID: 34596694 DOI: 10.1007/s00167-021-06746-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Selective anteromedial or posterolateral bundle reconstruction is recognized as a treatment modality in partial anterior cruciate ligament (ACL) reconstruction (ACLR) with a biomechanically sufficient ACL remnant. However, there is paucity in literature investigating clinical outcomes of standard ACLR with preservation of residual continuous but biomechanically insufficient ACL tissue. The aim of this study was to investigate the influence of preservation of residual continuous but biomechanical insufficient ACL tissue in standard ACLR on complication and repeat surgery rate, and patient reported and clinical outcome. METHODS The retrospective cohort comprised 134 patients (age 23 ± 7 years; Tegner 6 ± 3) with an isolated acute ACL tear. In 67 patients, residual continuous but biomechanically insufficient ACL tissue was present and preserved based on visual inspection, probing of the ACL tissue and Lachman test under arthroscopic view (standard reconstruction with tissue preservation; SRTP). These patients were matched to 67 patients that underwent ACLR where no residual ACL tissue could be preserved (standard reconstruction; SR) based on gender, age and chondral and/or meniscal status. Clinical failure (recurrent instability, pathological ACL graft laxity and/or ACL graft discontinuity), other complication and repeat-surgery rate within index surgery and 1-year and within index surgery and 2-year follow-up, and patient reported and clinical outcomes at 1-year and at 2-year follow-up were compared. RESULTS A statistically significant lower clinical failure rate within index surgery and 1-year (SRTP, 3%; SR, 13%; P = 0.028) and within index surgery and 2-year follow-up (SRTP, 3%; SR, 23%; P = 0.001), and revision ACL surgery rate within index surgery and 1-year (SRTP, 2%; ST, 10%; P = 0.029) and within index surgery and 2-year follow-up (SRTP, 2%; SR, 18%; P = 0.001) was found in the SRTP group. No statistically significant differences were found for other investigated outcomes in patients that were without clinical failure. CONCLUSION This study shows that in ACLR surgery, preservation of residual continuous but biomechanical insufficient ACL tissue might lead to lower clinical failure rate and ACL revision surgery rate within index surgery and 1-year, and within index surgery and 2-year follow-up compared to standard ACLR where no residual continuous ACL tissue could be preserved. LEVEL OF EVIDENCE III.
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Affiliation(s)
- L Z van Keulen
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Geerdinksweg 141, 7555 DL, Hengelo, The Netherlands
| | - R A G Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Geerdinksweg 141, 7555 DL, Hengelo, The Netherlands.
| | - R W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - R Huis In 't Veld
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Geerdinksweg 141, 7555 DL, Hengelo, The Netherlands.,Strategic Business Development, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - N Verdonschot
- Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, Enschede, The Netherlands.,Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Radboud University Medical Centre, Nijmegen, The Netherlands
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Li Z, Li M, Du Y, Zhang M, Jiang H, Zhang R, Ma Y, Zheng Q. Femur-tibia angle and patella-tibia angle: new indicators for diagnosing anterior cruciate ligament tears in magnetic resonance imaging. BMC Sports Sci Med Rehabil 2022; 14:66. [PMID: 35418093 PMCID: PMC9009057 DOI: 10.1186/s13102-022-00462-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022]
Abstract
Background Femur-tibia angle (FTA) and patella-tibia angle (PTA) are two MRI measurements that reflect the rotation of the knee joint. The purposes of this study were to assess whether FTA and PTA are associated with ACL tear and to explore their roles in ACL tear diagnosis. Methods FTA, PTA, ACL angle and anterior tibial subluxation were compared between the two matched groups: ACL tear group and control group (each n = 20). Diagnostic performance was evaluated in a consecutive 120-patient cohort who underwent MR imaging of the knee and subsequently had arthroscopy. Different measurements were assessed by area under the curve (AUC) of receiver operating characteristic (ROC) curve. Results FTA and PTA increased significantly in ACL tears group when compared to the control group (4.79 and 7.36 degrees, respectively, p < 0.05). In distinguishing complete ACL tear, ACL angle had the highest AUC of 0.906 while AUC of PTA and FTA were 0.849 and 0.809. The cutoff of FTA was 80 degrees with a sensitivity of 82% and specificity of 68%, while the cutoff of PTA was 91 degrees with a sensitivity of 82% and specificity of 74%. In distinguishing partial ACL tear, FTA and PTA had the highest AUCs of 0.847 and 0.813, respectively. The calculated cutoff of FTA was 84 degrees with a sensitivity of 90% and specificity of 81%, while the cutoff of PTA was 92 degrees with a sensitivity of 80% and specificity of 77%. Conclusion FTA and PTA increased when ACL tears and they might be valuable in diagnosing ACL tears, especially in distinguishing partial ACL tear from intact ACL.
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Affiliation(s)
- Zeng Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Mengyuan Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yan Du
- Clinical Research Unit, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Mo Zhang
- Clinical Research Unit, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Hai Jiang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Ruiying Zhang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yuanchen Ma
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Qiujian Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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10
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Giummarra M, Vocale L, King M. Efficacy of non-surgical management and functional outcomes of partial ACL tears. A systematic review of randomised trials. BMC Musculoskelet Disord 2022; 23:332. [PMID: 35395764 PMCID: PMC8991495 DOI: 10.1186/s12891-022-05278-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/22/2022] [Indexed: 01/13/2023] Open
Abstract
Background The incidence of anterior cruciate ligament (ACL) injuries represents a large burden of knee injuries in both the general and sporting populations, often requiring surgical intervention. Although there is much research on complete ACL tears including outcomes and indications for surgery, little is known about the short- and long-term outcomes of non-operative, physiotherapy led intervention in partial ACL tears. The primary aim of this study was to evaluate studies looking at the effectiveness of physiotherapy led interventions in improving pain and function in young and middle-aged adults with partial ACL tears. Additionally, the secondary aim was to evaluate the completeness of exercise prescription in randomised trials for physiotherapy led interventions in the management in partial ACL tears. Methods A comprehensive and systematic search was performed on six databases (Medline, CINAHL, EMBASE, PEDro, Scopus, SPORTDiscus and Cochrane). The search strategy consisted of two main concepts: (i) partial ACL tears, and (ii) non-operative management. 7,587 papers were identified by the search. After screening of eligible articles by two independent reviewers, 2 randomised studies were included for analysis. The same two reviewers assessed the completeness of reporting using the Toigio and Boutellier mechanobiological exercise descriptions and Template for Intervention Description and Replication (TIDieR) checklist. Group mean standard deviations (SD) for the main outcomes was extracted from both papers for analysis. Prospero Registration Number: CRD42020179892. Results The search strategy identified two studies; one looking at Tai Chi and the other Pilates. The analysis indicated that Tai Chi was significant in reducing pain scores and both Tai Chi and Pilates were found to increase Muscle Peak Torque Strength (MPTS) at 180 degrees. Furthermore, Tai Chi showed a significant increase in proprioception. Conclusions Physiotherapy led interventions such as Pilates, and Tai Chi may improve pain, proprioception and strength in young and middle-aged adults with partial ACL tears, however full scale, high-quality randomised studies are required with long term outcomes recorded. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05278-w.
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Affiliation(s)
- Michael Giummarra
- Australasian College of Sport and Exercise Physicians, Melbourne, Australia
| | - Loretta Vocale
- School of Health and Biomedical Sciences, RMIT University, 124 Latrobe Street, Melbourne, VIC, 3000, Australia.
| | - Matthew King
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
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11
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Kon E, Di Matteo B, Altomare D, Iacono F, Kurpyakov A, Lychagin A, Timashev P, Kalinsky E, Lipina M. Biologic agents to optimize outcomes following ACL repair and reconstruction: A systematic review of clinical evidence. J Orthop Res 2022; 40:10-28. [PMID: 33586785 DOI: 10.1002/jor.25011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 02/04/2023]
Abstract
Treatment options for anterior cruciate ligament (ACL) injuries have greatly developed over the past decades. Although reconstruction surgery is a concrete reality, stimulation of ACL healing through biological techniques could represent a revolutionary conservative approach. The use of biologic products, such as platelet-rich plasma (PRP) or mesenchymal stem cells (MSCs), to treat partial ruptures or to enhance ligamentization after reconstruction, could thoroughly improve clinical outcomes. The aim of the present paper is to systematically review the available literature on this topic, to (i) describe the current state of the art in available biologic techniques; (ii) clarify the outcomes of their application; (iii) identify areas needing further investigation and possible future development. A systematic review of the literature on the use of biologically active agents (PRP and MSCs) to enhance outcomes of ACL surgery was performed: 31 studies were included. Based on the ACL injury pattern, 6 papers investigated biologic agents in ACL partial tears whereas 25 papers in ACL reconstruction. Sixteen of twenty-five studies dealing with ACL reconstruction were randomized controlled trials, whereas only case series are available for partial ACL tears. Current evidence is still lacking sound data to support the use of biological agents: no clinical superiority has been described when using PRP in ACL reconstruction. Concerning ACL healing in partial tears, the application of PRP has led to encouraging outcomes, but these findings should be confirmed by appropriately designed RCTs.
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Affiliation(s)
- Elizaveta Kon
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Berardo Di Matteo
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Daniele Altomare
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesco Iacono
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Anton Kurpyakov
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Aleksey Lychagin
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Peter Timashev
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Department of Polymers and Composites, N.N. Semenov Institute of Chemical Physics, Moscow, Russia.,Chemistry Department, Lomonosov Moscow State University, Moscow, Russia.,World-Class Research Center "Digital Biodesign and Personalized Healthcare," Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Eugene Kalinsky
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Marina Lipina
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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12
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Gunaydin B, Kurtoglu Ozcaglayan TI, Cetin MU, Sari A, Dincel YM, Tekin C. Does anterolateral ligament injury change the treatment option in patients with partial ACL tears? Acta Orthop Belg 2021. [DOI: 10.52628/87.2.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients with ACL tears with ALL injury have more clinical complaints (instability, feeling of the pop on the knee or knee sliding). patients have ALL injury with partial ACL tears, It is unclear whether the choice of treatment will be conservative or surgical.
This study aimed to determine the effect of anterolateral ligament (ALL) status, whether intact or ruptured, on the choice of conservative or surgical treatment in patients with partial anterior cruciate ligament (ACL) tears.
Between 2015 and 2019, patients with suspected partial ACL tears were identified on both physical examination and MR imaging. 122 patients who had partial ACL tears and also status of patient’s ALL could be evaluated by radiologist were included in the study, retrospectively.
Sixty-two patients who underwent ACL reconstruction were determined as group 1, and 60 patients who did not undergo ACL reconstruction were defined as group 2. In patients with partial ACL rupture with or without ACL reconstruction, it was evaluated whether a ruptured or non- ruptured ALL was effective in this decision of conservative or surgically.
The MRIs of patients with partial ACL tears were evaluated by a radiologist and it was concluded that the ALLs of 50 patients were ruptured, and 72 were intact. The ALLs of 36 patients in group 1 were ruptured, and 26 patients were intact. Fourteen patients in group 2 had ruptured ALLs, 46 patient’s ALLs were intact. Seventy-two percent of the patients with partial ACL tears who had ruptured ALLs in MRI underwent ACL reconstruction.
It was found that ACL reconstruction was performed more frequently in patients with partial ACL tears with ALL rupture. Therefore, we believe that preoperative evaluations of ALLs using MRI in patients with partial ACL tears are essential for surgical planning.
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13
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Zicaro JP, Garcia-Mansilla I, Zuain A, Yacuzzi C, Costa-Paz M. Has platelet-rich plasma any role in partial tears of the anterior cruciate ligament? Prospective comparative study. World J Orthop 2021; 12:423-432. [PMID: 34189080 PMCID: PMC8223727 DOI: 10.5312/wjo.v12.i6.423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/18/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Partial tears of the anterior cruciate ligament (ACL) are frequent, and there is still considerable controversy surrounding their diagnosis, natural history and treatment.
AIM To examine patient-reported outcomes, physical examination and magnetic resonance imaging (MRI) findings of partial ACL tears treated with an intraarticular injection of platelet-rich plasma (PRP) compared to a control group.
METHODS From January 2015 to November 2017, consecutive patients from a single institution with partial ACL tears treated nonoperatively were prospectively evaluated. Partial tears were defined as a positive Lachman test with a clear end-point, a negative pivot-shift and less than 3 mm of side-to-side difference using the KT1000 arthrometer. Patients in group 1 were treated with one intraarticular injection of PRP and specific physical therapy protocol. Control group consisted of patients treated only with physical therapy. Prospective analyzed data included physical examination, Tegner activity level and Lysholm and International Knee Documentation Committee scores. Baseline MRI findings and at 6 mo follow-up were reviewed. Failure was defined as those patients with clinical instability at follow-up that required a subsequent ACL reconstruction.
RESULTS A total of 40 patients where included, 21 treated with PRP injection with a mean follow-up of 25 mo [standard deviation (SD): 3.6] and 19 in the control group with a mean follow-up of 25 mo (SD: 5.68). Overall failure rate was 32.0% (n = 13). No significant differences were observed between groups regarding subjective outcomes, return to sport and failure rate. MRI findings revealed an improvement in the ACL signal in half of the patients of both groups. However, we did not find a significant relationship between MRI findings and clinical outcomes.
CONCLUSION Overall, 95.0% of patients returned to sports at a mean follow-up of 25 mo. Mean time to return to sports was 4 mo. Out of these patients, almost 30.0% in each group had a new episode of instability and required surgery at a median time of 5 mo in group 1 and 8 mo in group 2. The addition of PRP alone was not sufficient to enhance any of the outcome measures evaluated, including MRI images, clinical evaluation and failure rate.
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Affiliation(s)
- Juan Pablo Zicaro
- Knee Division, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
| | | | - Andres Zuain
- Knee Division, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
| | - Carlos Yacuzzi
- Knee Division, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
| | - Matias Costa-Paz
- Knee Division, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
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14
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Seeing Beyond Morphology-Standardized Stress MRI to Assess Human Knee Joint Instability. Diagnostics (Basel) 2021; 11:diagnostics11061035. [PMID: 34199917 PMCID: PMC8226919 DOI: 10.3390/diagnostics11061035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 12/28/2022] Open
Abstract
While providing the reference imaging modality for joint pathologies, MRI is focused on morphology and static configurations, thereby not fully exploiting the modality’s diagnostic capabilities. This study aimed to assess the diagnostic value of stress MRI combining imaging and loading in differentiating partial versus complete anterior cruciate ligament (ACL)-injury. Ten human cadaveric knee joint specimens were subjected to serial imaging using a 3.0T MRI scanner and a custom-made pressure-controlled loading device. Emulating the anterior-drawer test, joints were imaged before and after arthroscopic partial and complete ACL transection in the unloaded and loaded configurations using morphologic sequences. Following manual segmentations and registration of anatomic landmarks, two 3D vectors were computed between anatomic landmarks and registered coordinates. Loading-induced changes were quantified as vector lengths, angles, and projections on the x-, y-, and z-axis, related to the intact unloaded configuration, and referenced to manual measurements. Vector lengths and projections significantly increased with loading and increasing ACL injury and indicated multidimensional changes. Manual measurements confirmed gradually increasing anterior tibial translation. Beyond imaging of ligament structure and functionality, stress MRI techniques can quantify joint stability to differentiate partial and complete ACL injury and, possibly, compare surgical procedures and monitor treatment outcomes.
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15
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Barton KI, Heard BJ, Kroker A, Sevick JL, Raymond DA, Chung M, Achari Y, Martin CR, Frank CB, Boyd SK, Shrive NG, Hart DA. Structural Consequences of a Partial Anterior Cruciate Ligament Injury on Remaining Joint Integrity: Evidence for Ligament and Bone Changes Over Time in an Ovine Model. Am J Sports Med 2021; 49:637-648. [PMID: 33523721 DOI: 10.1177/0363546520985279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Severe injury to the knee joint often results in accelerated posttraumatic osteoarthritis (PTOA). In an ovine knee injury model, altered kinematics and degradation of the cartilage have been observed at 20 and 40 weeks after partial anterior cruciate ligament (ACL) transection (p-ACL Tx) surgery. However, changes to the integrity of the remaining intact intra-articular ligaments (posterolateral [PL] band and posterior cruciate ligament [PCL]) as well as the subchondral bone after anteromedial (AM) band Tx remain to be characterized. PURPOSE (1) To investigate histological alterations to the remaining intact intra-articular ligaments, the synovium, and the infrapatellar fat pad (IPFP) and (2) to quantify subchondral bone changes at the contact surfaces of the proximal tibia at 20 and 40 weeks after AM band Tx. STUDY DESIGN Descriptive laboratory study. METHODS Mature female Suffolk cross sheep were allocated into 3 groups: nonoperative controls (n = 6), 20 weeks after partial ACL transection (p-ACL Tx; n = 5), and 40 weeks after p-ACL Tx (n = 6). Ligament, synovium, and IPFP sections were stained and graded. Tibial subchondral bone microarchitecture was assessed using high-resolution peripheral quantitative computed tomography. RESULTS p-ACL Tx of the AM band led to significant change in histological scores of the PL band and the PCL at 20 weeks after p-ACL Tx (P = .031 and P = .033, respectively) and 40 weeks after p-ACL Tx (P = .011 and P = .029) as compared with nonoperative controls. Alterations in inflammatory cells and collagen fiber orientation contributed to the greatest extent of the combined histological score in the PL band and PCL. p-ACL Tx did not lead to chronic activation of the synovium or IPFP. Trabecular bone mineral density was strongly inversely correlated with combined gross morphological damage in the top and middle layers of the subchondral bone in the lateral tibial plateau for animals at 40 weeks after p-ACL Tx. CONCLUSION p-ACL Tx influences the integrity (biology and structure) of remaining intact intra-articular ligaments and bone microarchitecture in a partial knee injury ovine model. CLINICAL RELEVANCE p-ACL Tx leads to alterations in structural integrity of the remaining intact ligaments and degenerative changes in the trabecular bone mineral density, which may be detrimental to the injured athlete's knee joint in the long term.
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Affiliation(s)
- Kristen I Barton
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Bryan J Heard
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Andres Kroker
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Schulich School of Engineering, University of Calgary, Calgary, Canada
| | - Johnathan L Sevick
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Schulich School of Engineering, University of Calgary, Calgary, Canada
| | - Duncan A Raymond
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - May Chung
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yamini Achari
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - C Ryan Martin
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Section of Orthopaedics, Foothills Hospital, Calgary, Canada
| | | | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Schulich School of Engineering, University of Calgary, Calgary, Canada
| | - Nigel G Shrive
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Schulich School of Engineering, University of Calgary, Calgary, Canada
| | - David A Hart
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Canada.,Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
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16
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Management of Partial Tears of the Anterior Cruciate Ligament: A Review of the Anatomy, Diagnosis, and Treatment. J Am Acad Orthop Surg 2021; 29:60-70. [PMID: 33394613 DOI: 10.5435/jaaos-d-20-00242] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Partial anterior cruciate ligament (ACL) tears comprise an estimated 10% to 27% of isolated ACL injuries. Partial ACL tears may be challenging to clinically diagnose. We reviewed relevant studies focusing on the anatomy, diagnosis, imaging, and treatment of a partial injury with the goal of providing guidance to clinicians. Although a comprehensive patient history, thorough clinical examination, and imaging studies are helpful in arriving at a diagnosis, the benchmark for diagnosis remains visualization and examination of the ACL at the time of knee arthroscopy. Currently, limited data exist about the long-term outcomes of nonsurgical treatment. Some studies demonstrate that younger, active patients have the risk of progressing to a complete ACL rupture with conservative treatment. The decision to proceed with surgery is based on careful history and physical examination findings that suggest either a "functional" or "nonfunctional" ACL. Surgical treatment consists of augmenting the intact bundle with a selective bundle reconstruction versus a traditional ACL reconstruction. Selective bundle reconstruction has limited data available but is an option. The best evidence supports traditional ACL reconstruction for the surgical management of patients with documented nonfunctional partial tears of the ACL.
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17
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Ahn GY, Lee TH, Lee KJ, Woo S. Comparison of clinical outcomes and second-look arthroscopic evaluations between anterior cruciate ligament anteromedial bundle augmentation and single-bundle anterior cruciate ligament reconstruction. Knee Surg Relat Res 2020; 32:45. [PMID: 32867827 PMCID: PMC7457806 DOI: 10.1186/s43019-020-00058-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 07/07/2020] [Indexed: 11/16/2022] Open
Abstract
Subject This study compared clinical outcomes and second-look arthroscopic evaluations between anterior cruciate ligament (ACL) anteromedial (AM) bundle augmentation and single-bundle ACL reconstruction. Purpose We compared the clinical results and the second-look arthroscopic findings between (1) single-bundle ACL reconstruction in complete rupture and (2) ACL AM bundle augmentation in isolated AM bundle rupture. Materials and methods Two groups of patients underwent ACL surgery from January 2013 to December 2018. Group 1, who had 64 cases of single-bundle ACL reconstruction with second-look arthroscopy, and Group 2, who had 21 cases of AM bundle augmentation of ACL with second-look arthroscopy, were targeted. We evaluated and compared the clinical results (Lysholm score, Tegner activity score, Lachman test, and pivot-shift test) and synovialization at second-look arthroscopy before the operation and in the final follow-up period, between Group 1 and Group 2. Results The Lysholm score (p = 0.96) and Tegner activity score (p = 0.351) at final follow-up (mean 27.1 months) were 78.3 and 7.2 in Group 1 and 89.1 and 8.1 in Group 2, respectively. The Lachman test (p = 0.074) and pivot-shift test (p = 0.031) results at final follow-up were improved; however, there was no statistical significance. Second-look arthroscopy showed that percentages of synovialization area of grafted tendon at mean 15.6 months follow-up were 61.4% and 93.1% in Group 1 and Group 2, respectively (p = 0.008). The synovial coverage in Group 2 was higher than in Group 1. Conclusion The AM bundle augmentation for ACL injury in which the posterolateral bundle was preserved showed better clinical scores and synovial coverage than single-bundle ACL reconstruction for complete ACL rupture. Level of evidence The level of evidence is Level III, retrospective with case series.
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Affiliation(s)
- Gil Yeong Ahn
- Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Daejamdong-gil 17, Nam-Gu, Pohang, Kyung-Buk, 37661, South Korea
| | - Tae Hun Lee
- Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Daejamdong-gil 17, Nam-Gu, Pohang, Kyung-Buk, 37661, South Korea.
| | - Kyung Jin Lee
- Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Daejamdong-gil 17, Nam-Gu, Pohang, Kyung-Buk, 37661, South Korea
| | - Sangwon Woo
- Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Daejamdong-gil 17, Nam-Gu, Pohang, Kyung-Buk, 37661, South Korea
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18
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CORR Insights®: Is Primary Arthroscopic Repair Using the Pulley Technique an Effective Treatment for Partial Proximal ACL Tears? Clin Orthop Relat Res 2020; 478:1046-1048. [PMID: 32287109 PMCID: PMC7170700 DOI: 10.1097/corr.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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19
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Carulli C, Innocenti M, Roselli G, Sirleo L, Matassi F, Innocenti M. Partial rupture of anterior cruciate ligament: preliminary experience of selective reconstruction. J Orthop Traumatol 2020; 21:5. [PMID: 32222861 PMCID: PMC7103020 DOI: 10.1186/s10195-020-0544-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/28/2020] [Indexed: 01/13/2023] Open
Abstract
Background Partial lesions of the anterior cruciate ligament (ACL) are more common than is generally thought, accounting for about 10–12% of ACL injuries. Selective reconstruction may be considered as an option in isolated bundle rupture. The purpose of this study is to evaluate both subjective and objective clinical results, as well as functional recovery time, after selective arthroscopic single-bundle reconstruction in a consecutive series of patients affected by partial ACL rupture. Materials and methods Thirty-six patients undergoing selective reconstruction of a single ACL bundle were retrospectively evaluated from a series of 354 ACL reconstructions performed over a 3-year period. Although the suspicion of partial lesions was present at clinical and magnetic resonance imaging (MRI) evaluation, final diagnosis was obtained during arthroscopy. All patients were operated using the same technique and type of fixation, and undergoing the same functional recovery protocol. Results Mean follow-up was 64 months (48–84 months). All patients but one achieved good functional recovery and returned to their sports within a mean period of 6.1 months. A single patient complained of postoperative instability 1 year after the index operation and needed further surgery. No complications were recorded. Conclusions Selective reconstruction of partial ACL injury is a method to bear in mind because it offers quick functional recovery. Specific technical and diagnostic steps should be performed and discussed with patients preoperatively. Level of evidence Level 4, retrospective study.
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Affiliation(s)
- Christian Carulli
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Matteo Innocenti
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy.
| | - Giuliana Roselli
- Department of Radiology at Orthopaedic Clinic CTO, University of Florence, Florence, Italy
| | - Luigi Sirleo
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Fabrizio Matassi
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Massimo Innocenti
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
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20
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Shekarforoush M, Vakiel P, Scott M, Muench G, Hart DA, Shrive NG. Relative Surface Velocity of the Tibiofemoral Joint and Its Relation to the Development of Osteoarthritis After Joint Injury. Ann Biomed Eng 2019; 48:695-708. [PMID: 31677123 DOI: 10.1007/s10439-019-02392-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
The relative velocity of the tibiofemoral surfaces during gait before and after partial-ACL and full MCL transection (p-ACL/MCL Tx) was examined in an ovine model (N = 5) and the relation between the variation in the relative sliding velocity component and gross morphological damage was investigated. We defined the in vivo kinematics of the tibiofemoral joints by using an instrumented spatial linkage and then determining the relative velocity components on the reconstructed femoral condyle surfaces. One major finding was that the magnitude of the relative velocity components was relatively high during the initial stance period of the gait and oscillated with a decaying envelope. Interestingly, for most subjects, the highest value of relative sliding velocity occurred during the stance phase, and not swing. The magnitude of the relative velocity components was increased in 3/5 subjects during stance after an injury. For the lateral compartment, there was a significant correlation (p value = 0.005) between the joint gross morphological damage and the increase in the maximum relative sliding velocity during stance. For the medial compartment, there was a trend (p value < 0.1) between the joint gross morphological score and the increase in the maximum relative sliding velocity during stance, 20 weeks after injury. In conclusion, a connection between an increase in the relative surface velocity and gross morphological damage might be due to an increase in the normal stress and the plowing friction between the surfaces.
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Affiliation(s)
- Mehdi Shekarforoush
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Schulich School of Engineering, University of Calgary, Calgary, AB, Canada. .,Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada. .,Cumming School of Medicine, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Paris Vakiel
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Schulich School of Engineering, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Michael Scott
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Gregory Muench
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - David A Hart
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada.,Section of Orthopaedics, Department of Surgery, Foothills Hospital, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Nigel G Shrive
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Schulich School of Engineering, University of Calgary, Calgary, AB, Canada.,Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
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21
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Haviv B, Kittani M, Yaari L, Rath E, Heller S, Shemesh S, Yassin M. The detached stump of the torn anterior cruciate ligament adheres to the femoral notch wall and then to the posterior cruciate ligament within 6 months from injury. Knee Surg Sports Traumatol Arthrosc 2019; 27:2653-2658. [PMID: 30430220 DOI: 10.1007/s00167-018-5293-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 11/09/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the progressive changes in the morphology of traumatic ruptures of the anterior cruciate ligament (ACL) over time. A secondary objective was evaluating their correlation with meniscal tears or chondral lesions. METHODS The study included one hundred and one patients who underwent ACL reconstruction surgery of the knee after a definite date of injury. The torn ACL remnant morphological pattern was assessed and classified during arthroscopy. A correlation analysis was performed between the pathological features of the remnant and the time length from injury. In addition, correlation between ACL remnant subtypes and meniscal tears or chondral lesions was evaluated. RESULTS At surgery there were four distinct ACL tear morphological patterns that were correlated to the time span from injury (r = 0.61, p < 0.001) and ended with scarring of the femoral remnant to the posterior cruciate ligament. The early pattern was noticed within median time of 2.6 months from injury and appeared as a separate stump with no scar tissue. The following two patterns appeared within 6 months from injury and were characterized by adhesion of scar tissue to different locations in the femoral notch. The last morphological pattern appeared as adherence of the ACL stump to the posterior cruciate ligament. This pattern was seen in some patients within 6 months from injury but was the dominant pattern later on and was also correlated with meniscal tears. CONCLUSIONS During the first 3 months from injury the gross morphological features of the torn ACL remnant showed no scar. This phase was followed by scarring of the femoral remnant at first to the femoral notch, and eventually to the posterior cruciate ligament within 6 months from injury and later on. Therefore, further research on the healing potential of the human ACL stump and its biological environment should be focused on the first 3 months from injury. STUDY DESIGN Case series; Level of evidence, 4.
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Affiliation(s)
- Barak Haviv
- Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, 7 Keren Kayemet St, 49372, Petah-Tikva, Israel. .,Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petah-Tikva, Israel.
| | - Mohamed Kittani
- Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, 7 Keren Kayemet St, 49372, Petah-Tikva, Israel.,Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Lee Yaari
- Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, 7 Keren Kayemet St, 49372, Petah-Tikva, Israel.,Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Ehud Rath
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Orthopedic Devision, Sourasky Medical Center, Tel-Aviv, Israel
| | - Snir Heller
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Shai Shemesh
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mustafa Yassin
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petah-Tikva, Israel
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22
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Fayard JM, Sonnery-Cottet B, Vrgoc G, O'Loughlin P, de Mont Marin GD, Freychet B, Vieira TD, Thaunat M. Incidence and Risk Factors for a Partial Anterior Cruciate Ligament Tear Progressing to a Complete Tear After Nonoperative Treatment in Patients Younger Than 30 Years. Orthop J Sports Med 2019; 7:2325967119856624. [PMID: 31360732 PMCID: PMC6636223 DOI: 10.1177/2325967119856624] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Partial anterior cruciate ligament (ACL) tears are observed in 10% to 27% of isolated ACL tears. There is currently no consensus on diagnosis and treatment protocols, and the outcomes of nonoperative treatment remain undefined. Purpose: To assess the incidence and risk factors for the progression of partial ACL tears to complete ruptures after nonoperative treatment in active patients younger than 30 years. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 41 patients, all younger than 30 years and active in sports, were diagnosed with a partial ACL tear, with no associated meniscal or chondral lesions on magnetic resonance imaging (MRI). All were assigned to a nonoperative treatment program. The Lachman test, ≤4-mm side-to-side difference in laxity by Rolimeter, and MRI were utilized for the diagnosis. Tegner and International Knee Documentation Committee (IKDC) scores were assessed before and after the first lesion, and the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) score was assessed at last follow-up. Postinjury Tegner and IKDC scores were assessed before the second injury for patients progressing to a complete ACL tear and at last follow-up for patients without progression. Results: At a mean of 43 months (range, 24-96 months), the partial ACL injury progressed to a complete ACL tear in 16 (39%) patients. In the remaining 25 patients without progression, the mean Tegner and IKDC scores were 7.0 and 96.0 before the injury and 5.9 and 85.7, respectively, at last follow-up. The mean ACL-RSI score was 69.3. The Tegner and IKDC scores were significantly lower at final follow-up (P = .0002 and P < .0001, respectively). Only 18 (44%) patients returned to their preinjury level of sports activities. A significantly increased risk of progression to a complete ACL tear was seen in patients ≤20 years (odds ratio, 5.19; P = .037) or patients practicing pivoting contact sports (odds ratio, 6.29; P = .026). Meniscal lesions were found in 50% of patients with a partial tear that progressed to a complete ACL tear. Conclusion: A partial ACL injury progressed to a complete ACL tear in 39% of young active patients treated conservatively, with half of the complete tears presenting with a concomitant meniscal lesion at the time of reconstruction. Age ≤20 years and participation in pivoting contact sports were identified as significant risk factors for progression to a complete tear.
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Affiliation(s)
- Jean-Marie Fayard
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Goran Vrgoc
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,Department of Orthopaedic Surgery, University Hospital "Sveti Duh," Zagreb, Croatia
| | - Padhraig O'Loughlin
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,Mater Private Hospital, Cork, Ireland
| | - Geoffroy Dubois de Mont Marin
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,Hôpital Trousseau, CHRU de Tours, Chambray-lès-Tours, France
| | - Benjamin Freychet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Thais D Vieira
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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23
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A new method for diagnosis of anterior cruciate ligament tear: MRI with maximum flexion of knee in the prone position: A case control study. Int J Surg 2019; 68:142-147. [PMID: 31276834 DOI: 10.1016/j.ijsu.2019.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/13/2019] [Accepted: 06/24/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The diagnosis of anterior cruciate ligament tear can be made by physical examination and magnetic resonance imaging (MRI) in the supine position. In cases where the tear is partially evaluated on MRI, the choice of treatment may vary. The purpose of the study was to investigate the efficiency of MRI at maximum knee flexion in the prone position and to compare the images with findings of the ACL detected during surgery. MATERIALS AND METHODS Sixty-one patients with partial ACL tears with meniscal and cartilage lesions requiring arthroscopic knee surgery were included in the study between 2017 and 2019. MRI of these patients was prescribed at maximum knee flexion in the prone position. Then, an arthroscopic operation was performed on 61 patients and the findings (intact, partial or total tear of ACL) were recorded. The ACL was evaluated as being intact and partial or total tear. The statistical significance of the efficacy of MRI in the supine position with the knee at maximum flexion in the prone position was compared. RESULTS It was found that, of 61 patients with suspected partial ACL tears, 25 patients had intact ACLs, 22 patients had partial tears and 14 patients had total ACL tears, through the interpretation of MRIs of the prone position by the radiologist. In the arthroscopic surgery of 61 patients, 20 patients had intact ACLs, 27 patients had a partial tear and 14 patients had a total tear. The MRI results with maximum knee flexion in the prone position were more compatible with the findings of the arthroscopic surgery. CONCLUSIONS It could be considered that MRI with maximum knee flexion in the prone position may also be guiding in the diagnosis and treatment of patients with partial anterior cruciate ligament rupture.
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24
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Barton KI, Shekarforoush M, Heard BJ, Sevick JL, Martin CR, Frank CB, Hart DA, Shrive NG. Three-dimensional in vivo kinematics and finite helical axis variables of the ovine stifle joint following partial anterior cruciate ligament transection. J Biomech 2019; 88:78-87. [PMID: 30955851 DOI: 10.1016/j.jbiomech.2019.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 03/10/2019] [Accepted: 03/13/2019] [Indexed: 11/18/2022]
Abstract
Partial anterior cruciate ligament (p-ACL) rupture is a common injury, but the impact of a p-ACL injury on in vivo joint kinematics has yet to be determined in an animal model. The in vivo kinematics of the ovine stifle joint were assessed during 'normal' gait, and at 20 and 40 weeks after p-ACL transection (Tx). Gross morphological scoring of the knee was conducted. p-ACL Tx creates significant progressive post-traumatic osteoarthritis (PTOA)-like damage by 40 weeks. Statistically significant increases for flexion angles at hoof-strike (HS) and mid-stance (MST) were seen at 20 weeks post p-ACL Tx and the HS and hoof-off (HO) points at 40 weeks post p-ACL-Tx, therefore increased flexion angles occurred during stance phase. Statistically significant increases in posterior tibial shift at the mid-flexion (MF) and mid-extension (ME) points were seen during the swing phase of the gait cycle at 40 weeks post p-ACL Tx. Correlation analysis showed a strong and significant correlation between kinematic changes (instabilities) and gross morphological score in the inferior-superior direction at 40 weeks post p-ACL Tx at MST, HO, and MF. Further, there was a significant correlation between change in gross morphological combined score (ΔGCS) and the change in location of the helical axis in the anterior direction (ΔsAP) after p-ACL Tx for all points analyzed through the gait cycle. This study quantified in vivo joint kinematics before and after p-ACL Tx knee injury during gait, and demonstrated that a p-ACL knee injury leads to both PTOA-like damage and kinematic changes.
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Affiliation(s)
- Kristen I Barton
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mehdi Shekarforoush
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Bryan J Heard
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Johnathan L Sevick
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - C Ryan Martin
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Section of Orthopaedics, Department of Surgery, Foothills Hospital, Calgary, Alberta, Canada
| | | | - David A Hart
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Section of Orthopaedics, Department of Surgery, Foothills Hospital, Calgary, Alberta, Canada; Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Bone & Joint Strategic Clinical Network, Alberta Health Services, AB, Canada
| | - Nigel G Shrive
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Schulich School of Engineering, University of Calgary, Calgary, AB, Canada.
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25
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Hamstring tendons or bone-patellar tendon-bone graft for anterior cruciate ligament reconstruction? Orthop Traumatol Surg Res 2019; 105:S89-S94. [PMID: 30130660 DOI: 10.1016/j.otsr.2018.05.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/27/2018] [Accepted: 05/04/2018] [Indexed: 02/02/2023]
Abstract
In anterior cruciate ligament (ACL) reconstruction, success depends on several factors: patient selection; surgical technique, taking account of associated meniscal and ligamentous lesions; and postoperative rehabilitation. Improved hamstring-tendon graft preparation and fixation techniques now provide results in terms of laxity and retear comparable to patellar tendon graft, which has long been the gold-standard for patients with strong functional demand, despite its higher risk of extension stiffness and anterior pain. Apart from a few exceptional preferential indications, such as hamstring tendon in growing children and patients whose lifestyle or occupation involves frequent kneeling and patellar tendon in case of severe medial laxity associated with ACL tear, either graft may be used for ACL reconstruction. The keypoints in the procedure are good tunnel positioning and hence good mastery of the surgical technique, and treatment of all associated lesions, and especially of occult meniscal lesions and rotational laxity due to anterolateral ligament deficiency, which requires associated extra-articular plasty. Graft choice is secondary and not a key to success.
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26
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Kim BH, Kim JI, Lee O, Lee KW, Lee MC, Han HS. Preservation of remnant with poor synovial coverage has no beneficial effect over remnant sacrifice in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:2345-2352. [PMID: 28822999 DOI: 10.1007/s00167-017-4683-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/16/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the influence of synovial coverage of the remnant on clinical outcomes and graft healing in anterior cruciate ligament (ACL) reconstruction. METHODS Seventy-five patients who underwent second-look arthroscopy after a single-bundle ACL reconstruction using autologous quadriceps tendon graft were included. The patients were divided into two groups according to whether the remnant was preserved (group P, n = 42) or sacrificed (group S, n = 33). Group P was further classified according to the degree of synovial coverage of the remnant on initial arthroscopic findings: group A (remnant fully covered with synovium, n = 15), group B (synovial coverage >50%, n = 15), and group C (coverage <50%, n = 12). Clinical outcomes including manual laxity tests, KT-2000 side-to-side difference, modified Lysholm score, Tegner activity score, and International Knee Documentation Committee score were evaluated pre-operatively and prior to the second-look arthroscopy. Graft tension, degrees of synovialization, and gross integrity were evaluated on second-look arthroscopic examination. RESULTS There were no statistical differences in manual laxity tests, KT-2000 side-to-side difference, and clinical scores between groups P and S. In second-look arthroscopic examination, graft tension showed no difference between the two groups, but gross integrity and synovialization were significantly higher in group P (P = 0.032 and P = 0.008, respectively). In subgroup analysis, only group A showed higher grade regarding gross integrity and synovialization in comparison with group S (P = 0.007 and P < 0.001, respectively). CONCLUSIONS Preservation of remnant in ACL reconstruction showed no superiority concerning knee stability and clinical outcomes over remnant sacrificing at post-operative 1-year second-look arthroscopy. Preservation of remnant with good synovial coverage had a positive effect on graft synovialization and maintenance of graft integrity, but this effect was not observed in cases of a remnant with poor synovial coverage. When deciding whether to preserve the remnant or not, the degree of synovial coverage should be considered. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Bo Hyun Kim
- Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Joong Il Kim
- Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea
| | - Osung Lee
- Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
| | - Ki Woung Lee
- Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Myung Chul Lee
- Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyuk Soo Han
- Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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27
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Partial Anterior Cruciate Ligament Ruptures: Advantages by Intraligament Autologous Conditioned Plasma Injection and Healing Response Technique-Midterm Outcome Evaluation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3204869. [PMID: 30148163 PMCID: PMC6083554 DOI: 10.1155/2018/3204869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/02/2018] [Indexed: 02/06/2023]
Abstract
The historical treatment options for partial anterior cruciate ligament (ACL) ruptures were conservative therapy or ACL reconstruction by injured bundle or entire ACL replacement. In awareness of the regenerative potential of biologic agents such as mesenchymal stem cells or platelet rich plasma (PRP), the healing response technique was developed to preserve the injured ACL with better outcomes than the conservative therapy. Further improvement of this technique seems to be obtained by the additional application of PRP products. Thus, the aim of this study was to evaluate the midterm outcome after intraligament autologous conditioned plasma (ACP) by a clinical, scoring, and functional performance assessment. 42 patients were evaluated in this study. The failure rate was 9.5%. Outcome evaluation showed good to excellent results. The scores were IKDC subjective 83.2 (SD 14.5), Lysholm 85.5 (SD 15.5), Tegner 4.7 (SD 1.7), and Cincinnati 85.4 (SD 15.5) after a mean follow-up of 33 months. Clinical examination showed stable Lachman test, negative pivot shift phenomenon, and a significant reduction in AP-laxity compared to preoperative status (rolimeter preoperative: 1.9 (SD1.4); postoperative 0.6 (SD1.8), p=0.001) in all patients. Functional performance testing showed no significant differences between the injured and healthy side. Return to sport was achieved after a mean of 5.8 months (SD 3.6) in 71.1% of the included patients. In summary, this new treatment option revealed in midterm follow-up promising results to treat partial ACL lesions with a reduced need for conversion to ACL reconstruction and with a high percentage of return to preinjury sport activity.
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"Over the Top" Augmentation for Partial Anterior Cruciate Ligament Tears Using Suspension Device for Tibial Fixation. Arthrosc Tech 2018; 7:e731-e737. [PMID: 30094144 PMCID: PMC6074007 DOI: 10.1016/j.eats.2018.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/12/2018] [Indexed: 02/03/2023] Open
Abstract
A technique for augmentation of the partial anterior cruciate ligament is presented. The patient is positioned supine with the knee flexed 90°. After addressing intra-articular injuries, the autologous semitendinosus tendon is harvested and measured in a doubled manner; after that, the tibial tunnel is performed in the outside-in direction, of the same diameter of the doubled graft. Both ends of the graft are sutured together, after inserting it through the loop of a suspension device, which is attached in its augmentation piece. A lateral femoral incision is made, to approach the joint through the "over the top" position. A looped thread is introduced inside the joint with the aid of a hook. This thread pulls the graft's sutures through the "over the top" position. A femoral tunnel is then drilled in the lateromedial and caudocranial direction. The suspension device is attached to the anterior tibial cortex and the graft is pulled in the caudocranial direction to the femoral tunnel, where an interference screw is used for fixation.
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29
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Barton KI, Heard BJ, Sevick JL, Martin CR, Shekarforoush SMM, Chung M, Achari Y, Frank CB, Shrive NG, Hart DA. Posttraumatic Osteoarthritis Development and Progression in an Ovine Model of Partial Anterior Cruciate Ligament Transection and Effect of Repeated Intra-articular Methylprednisolone Acetate Injections on Early Disease. Am J Sports Med 2018; 46:1596-1605. [PMID: 29668309 DOI: 10.1177/0363546518765098] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Partial anterior cruciate ligament (p-ACL) ruptures are a common injury of athletes. However, few preclinical models have investigated the natural history and treatment of p-ACL injuries. PURPOSE To (1) demonstrate whether a controlled p-ACL injury model (anteromedial band transection) develops progressive gross morphological and histological posttraumatic osteoarthritis (PTOA)-like changes at 20 and 40 weeks after the injury and (2) investigate the efficacy of repeated (0, 5, 10, and 15 weeks) intra-articular injections of methylprednisolone acetate (MPA; 80 mg/mL) in the mitigation of potential PTOA-like changes after p-ACL transection. STUDY DESIGN Controlled laboratory study. METHODS Twenty-one 3- to 5-year-old female Suffolk-cross sheep were allocated to 4 groups: (1) nonoperative controls (n = 5), (2) 20 weeks after p-ACL transection (n = 5), (3) 40 weeks after p-ACL transection (n = 6), and (4) 20 weeks after p-ACL transection + MPA (n = 5). Gross morphological grading and histological analyses were conducted. mRNA expression levels for inflammatory, degradative, and structural molecules were assessed. RESULTS p-ACL transection led to significantly more combined gross damage ( P = .008) and significant aggregate histological damage ( P = .009) at 40 weeks after p-ACL transection than the nonoperative controls, and damage was progressive over time. Macroscopically, MPA appeared to slightly mitigate gross damage at 20 weeks after p-ACL transection in some animals. However, microscopic analysis revealed that repeated MPA injections after p-ACL transection led to significant loss in proteoglycan content compared with the nonoperative controls and 20 weeks after p-ACL transection ( P = .008 and P = .008, respectively). CONCLUSION p-ACL transection led to significant gross and histological damage by 40 weeks, which was progressive over time. Multiple repeated MPA injections were not appropriate to mitigate injury-related damage in a p-ACL transection ovine model as significant proteoglycan loss was observed in MPA-treated knees. CLINICAL RELEVANCE A p-ACL injury leads to slow and progressive PTOA-like joint damage, and multiple repeated injections of glucocorticoids may be detrimental to the knee joint in the long term.
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Affiliation(s)
- Kristen I Barton
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bryan J Heard
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Johnathan L Sevick
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - C Ryan Martin
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S M Mehdi Shekarforoush
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - May Chung
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yamini Achari
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Nigel G Shrive
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - David A Hart
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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30
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Koch M, Matteo BD, Eichhorn J, Zellner J, Mayr F, Krutsch W, Achenbach L, Woehl R, Nerlich M, Angele P. Intra-ligamentary autologous conditioned plasma and healing response to treat partial ACL ruptures. Arch Orthop Trauma Surg 2018; 138:675-683. [PMID: 29383441 DOI: 10.1007/s00402-018-2885-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Conservative treatment of partial ACL ruptures is associated with a high failure rate, and often patients undergo ACL reconstruction. ACL preservation by trephination of the ACL origin and application of Autologous Conditioned Plasma (ACP) seems to be an intriguing new treatment option to favour ACL tissue healing and avoid traditional reconstruction. The aim of this study was to describe the mid-term outcomes of this new ACL preserving technique. MATERIALS AND METHODS Twenty-four patients (mean age 41.8 years) affected by partial rupture of one or both ACL bundles were included in the present trial. The partial ACL tears were arthroscopically assessed and classified according to a new five step grading system. All patients were treated by trephination of the femoral ACL stump and intra-ligamentary application of ACP. The postoperative outcome was evaluated by both subjective scores and stability testing up to a mean of 25.1 months' follow-up. Adverse events and failure rate were also documented. RESULTS Clinical outcome was good to excellent with IKDC subjective 82.7 (SD 11.8), Lysholm 87.6 (SD 8.1), Tegner 5.3 (SD 2.1), Cincinnati 88.7 (SD 14.8). The failure rate (i.e. persisting knee instability assessed clinically or by rolimeter) was 12.5%. At objective measurements, knee joints showed a firm endpoint in Lachman test, negative pivot shift phenomenon and a significant reduction in AP-laxity compared to pre-operative status by rolimeter testing (p = 0.002). Return to sport practice was achieved after mean 4.8 months (SD 4.1). CONCLUSIONS ACL stump trephination and concomitant intra-ligamentary application of ACP revealed promising results at mid-term follow-up to treat partial ACL lesions.
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Affiliation(s)
- Matthias Koch
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Berardo Di Matteo
- Center for Biological and Functional Reconstruction of the Knee, Humanitas Research and University Hospital, Rozzano, Italy
| | - Jürgen Eichhorn
- Sporthopaedicum Straubing, Regensburg, Hildegard von Bingen Strasse 1, 93053, Regensburg, Germany
| | - Johannes Zellner
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Felix Mayr
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Leonard Achenbach
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Rebecca Woehl
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
| | - Peter Angele
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany. .,Sporthopaedicum Straubing, Regensburg, Hildegard von Bingen Strasse 1, 93053, Regensburg, Germany.
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Nakamae A, Adachi N, Deie M, Ishikawa M, Nakasa T, Ikuta Y, Ochi M. Risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament reconstruction. Bone Joint J 2018; 100-B:285-293. [DOI: 10.1302/0301-620x.100b3.bjj-2017-0837.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims To investigate the risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament (ACL) reconstruction. Patients and Methods A total of 174 patients who underwent second-look arthroscopic evaluation after anatomical ACL reconstruction were enrolled in this study. The graded condition of the articular cartilage at the time of ACL reconstruction was compared with that at second-look arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction technique, meniscal conditions, and other variables were assessed by regression analysis as risk factors for progression of damage to the articular cartilage. Results In the medial compartment, multivariable logistic regression analysis indicated that partial medial meniscectomy (odds ratio (OR) 6.82, 95% confidence interval (CI) 2.11 to 22.04, p = 0.001), pivot-shift test grade at the final follow-up (OR 3.53, CI 1.39 to 8.96, p = 0.008), BMI (OR 1.15, CI 1.03 to 1.28, p = 0.015) and medial meniscal repair (OR 3.19, CI 1.24 to 8.21, p = 0.016) were significant risk factors for progression of cartilage damage. In the lateral compartment, partial lateral meniscectomy (OR 10.94, CI 4.14 to 28.92, p < 0.001) and side-to-side differences in anterior knee laxity at follow-up (OR 0.63, p = 0.001) were significant risk factors. Conclusion Partial meniscectomy was found to be strongly associated with the progression of articular cartilage damage despite r anatomical ACL reconstruction. Cite this article: Bone Joint J 2018;100-B:285–93.
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Affiliation(s)
- A. Nakamae
- Department of Orthopaedic Surgery, Division
of Medicine, Biomedical Sciences Major, Graduate School of Biomedical
Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - N. Adachi
- Department of Orthopaedic Surgery, Division
of Medicine, Biomedical Sciences Major, Graduate School of Biomedical
Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - M. Deie
- Department of Orthopaedic Surgery, Aichi
Medical University, 21 Karimata, Yazako, Nagakute
City, Aichi 480-1195, Japan
| | - M. Ishikawa
- Department of Orthopaedic Surgery, Division
of Medicine, Biomedical Sciences Major, Graduate School of Biomedical
Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - T. Nakasa
- Department of Orthopaedic Surgery, Division
of Medicine, Biomedical Sciences Major, Graduate School of Biomedical
Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - Y. Ikuta
- Department of Orthopaedic Surgery, Division
of Medicine, Biomedical Sciences Major, Graduate School of Biomedical
Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - M. Ochi
- Hiroshima University, 1-3-2
Kagamiyama Higashi-Hiroshima 739-8511, Japan
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Barton KI, Shekarforoush M, Heard BJ, Sevick JL, Vakil P, Atarod M, Martin R, Achari Y, Hart DA, Frank CB, Shrive NG. Use of pre-clinical surgically induced models to understand biomechanical and biological consequences of PTOA development. J Orthop Res 2017; 35:454-465. [PMID: 27256202 DOI: 10.1002/jor.23322] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/27/2016] [Indexed: 02/04/2023]
Abstract
Post-traumatic osteoarthritis (PTOA) development is often observed following traumatic knee injuries involving key stabilising structures such as the cruciate ligaments or the menisci. Both biomechanical and biological alterations that follow knee injuries have been implicated in PTOA development, although it has not been possible to differentiate clearly between the two causal factors. This review critically examines the outcomes from pre-clinical lapine and ovine injury models arising in the authors' laboratories and differing in severity of PTOA development and progression. Specifically, we focus on how varying severity of knee injuries influence the subsequent alterations in kinematics, kinetics, and biological outcomes. The immediate impact of injury on the lubrication capacity of the joint is examined in the context of its influence on biomechanical alterations, thus linking the biological changes to abnormal kinematics, leading to a focus on the potential areas for interventions to inhibit or prevent development of the disease. We believe that PTOA results from altered cartilage surface interactions where biological and biomechanical factors intersect, and mitigating acute joint inflammation may be critical to prolonging PTOA development. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:454-465, 2017.
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Affiliation(s)
- Kristen I Barton
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mehdi Shekarforoush
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Bryan J Heard
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - John L Sevick
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Paria Vakil
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Mohammad Atarod
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Ryan Martin
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Section of Orthopaedics, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - Yamini Achari
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David A Hart
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cyril B Frank
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nigel G Shrive
- McCaig Institute for Bone & Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
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Dallo I, Chahla J, Mitchell JJ, Pascual-Garrido C, Feagin JA, LaPrade RF. Biologic Approaches for the Treatment of Partial Tears of the Anterior Cruciate Ligament: A Current Concepts Review. Orthop J Sports Med 2017; 5:2325967116681724. [PMID: 28210653 PMCID: PMC5298533 DOI: 10.1177/2325967116681724] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) has been established as the gold standard for treatment of complete ruptures of the anterior cruciate ligament (ACL) in active, symptomatic individuals. In contrast, treatment of partial tears of the ACL remains controversial. Biologically augmented ACL-repair techniques are expanding in an attempt to regenerate and improve healing and outcomes of both the native ACL and the reconstructed graft tissue. PURPOSE To review the biologic treatment options for partial tears of the ACL. STUDY DESIGN Review. METHODS A literature review was performed that included searches of PubMed, Medline, and Cochrane databases using the following keywords: partial tear of the ACL, ACL repair, bone marrow concentrate, growth factors/healing enhancement, platelet-rich plasma (PRP), stem cell therapy. RESULTS The use of novel biologic ACL repair techniques, including growth factors, PRP, stem cells, and bioscaffolds, have been reported to result in promising preclinical and short-term clinical outcomes. CONCLUSION The potential benefits of these biological augmentation approaches for partial ACL tears are improved healing, better proprioception, and a faster return to sport and activities of daily living when compared with standard reconstruction procedures. However, long-term studies with larger cohorts of patients and with technique validation are necessary to assess the real effect of these approaches.
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Affiliation(s)
| | - Jorge Chahla
- The Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - John A Feagin
- The Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Robert F LaPrade
- The Steadman Philippon Research Institute, Vail, Colorado, USA.; The Steadman Clinic, Vail, CO, USA
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Di Matteo B, Loibl M, Andriolo L, Filardo G, Zellner J, Koch M, Angele P. Biologic agents for anterior cruciate ligament healing: A systematic review. World J Orthop 2016; 7:592-603. [PMID: 27672573 PMCID: PMC5027015 DOI: 10.5312/wjo.v7.i9.592] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/22/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To systematically review the currently available literature concerning the application of biologic agents such as platelet-rich plasma (PRP) and stem cells to promote anterior cruciate ligament (ACL) healing.
METHODS A systematic review of the literature was performed on the use of biologic agents (i.e., PRP or stem cells) to favor ACL healing during reconstruction or repair. The following inclusion criteria for relevant articles were used: Clinical reports of any level of evidence, written in English language, on the use of PRP or stem cells during ACL reconstruction/repair. Exclusion criteria were articles written in other languages, reviews, or studies analyzing other applications of PRP/stem cells in knee surgery not related to promoting ACL healing.
RESULTS The database search identified 394 records that were screened. A total of 23 studies were included in the final analysis: In one paper stem cells were applied for ACL healing, in one paper there was a concomitant application of PRP and stem cells, whereas in the remaining 21 papers PRP was used. Based on the ACL injury pattern, two papers investigated biologic agents in ACL partial tears whereas 21 papers in ACL reconstruction. Looking at the quality of the available literature, 17 out of 21 studies dealing with ACL reconstruction were randomized controlled trials. Both studies on ACL repair were case series.
CONCLUSION There is a paucity of clinical trials investigating the role of stem cells in promoting ACL healing both in case of partial and complete tears. The role of PRP is still controversial and the only advantage emerging from the literature is related to a better graft maturation over time, without documenting beneficial effects in terms of clinical outcome, bone-graft integration and prevention of bony tunnel enlargement.
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