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Murrell-Smith ZN, Alabdullah MM, Zhang F, Jennings LM, Astill SL, Liu A. Knee biomechanics during rehabilitation exercise in individuals with and without anterior cruciate ligament reconstruction: A systematic review. Clin Biomech (Bristol, Avon) 2025; 126:106559. [PMID: 40393328 DOI: 10.1016/j.clinbiomech.2025.106559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Revised: 05/09/2025] [Accepted: 05/09/2025] [Indexed: 05/22/2025]
Abstract
BACKGROUND Post-traumatic osteoarthritis rates are similar in individuals with anterior cruciate ligament injury who receive surgical reconstruction and those who opt for non-surgical management, indicating continuing changes in knee biomechanics post-surgery. There is no gold standard rehabilitation strategy for the post-reconstruction patient, however investigating the biomechanics of the knee during rehabilitation exercises will drive the development of more efficacious rehabilitation paradigms. This systematic review aimed to synthesise biomechanical data from healthy participants and participants with anterior cruciate ligament reconstruction during rehabilitation exercises to provide insights into knee biomechanical changes induced by injury and surgery. METHODS A systematic literature search was conducted in Web of Science, MEDLINE, EMBASE, PubMed, CINAHL and Scopus, using key terms relating to anterior cruciate ligament reconstruction, lower limb rehabilitation exercises, and knee biomechanics. 34 articles matching the inclusion criteria were identified following abstract and full text screening. FINDINGS The included studies reported data on 607 healthy participants and 175 participants with an anterior cruciate ligament reconstruction across five different exercises. Peak knee flexion angle was the most reported variable, whereas tibial anterior translation and adduction biomechanics were reported infrequently, despite their relevance to the ligament injury status. INTERPRETATION There is limited biomechanical data of rehabilitation exercise in the knee, with the exception of knee flexion angles. Furthermore, variations in data collection and reporting methods across studies cause difficulties in systematic analysis of results and demonstrate inconsistent kinematic results between articles.
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Affiliation(s)
- Zhané N Murrell-Smith
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK; Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Meernah Mohammed Alabdullah
- School of Electronic and Electrical Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK; Biomedical Engineering, Imam Abdurahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fengtao Zhang
- Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Louise M Jennings
- Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Sarah L Astill
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Aiqin Liu
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK.
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deMille P, Lewis CL, Nguyen JT, Brown AM, Hannafin JA, Chiaia T. Quality of Movement for Athletes 6 Months After ACL Reconstruction. Orthop J Sports Med 2025; 13:23259671251324525. [PMID: 40342355 PMCID: PMC12056337 DOI: 10.1177/23259671251324525] [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: 09/23/2024] [Accepted: 11/25/2024] [Indexed: 05/11/2025] Open
Abstract
Background Anterior cruciate ligament (ACL) injury prevention programs address quality of movement to identify and correct high-risk movement patterns. However, return-to-play decisions after ACL reconstruction (ACLR) are often based on non-sport related quantitative measures such as isokinetic tests, jump testing, and/or time from surgery, with 6 to 9 months a common expectation for progressing to sport-specific training and return to play. Purpose To identify the presence in each limb of movement patterns associated with ACL injury in athletes 6 months post-ACLR using a quality-of-movement assessment. Study Design Cross-sectional study; Level of evidence: 3. Methods A quality-of-movement assessment including 10 dynamic tasks progressing from double- to single-limb and vertical to horizontal movements was administered to 148 athletes at 6 months after ACLR. Tasks were viewed live from the frontal and sagittal planes by a physical therapist and certified strength and conditioning specialist. Movements were evaluated for strategy, depth, alignment, symmetry, and control. The proportion of patients exhibiting faulty movement patterns for each task was assessed in the involved and uninvolved leg and between sex, meniscal injury status, and age. To examine the differences in age, patients were divided into age groups based on their age at the time of surgery (<14 years, 14-18, 19-25, 26-34, and ≥35 years). Results Mean time of testing was 6.4 months after ACLR. All patients exhibited faulty movement patterns for ≥1 task on the involved leg. On the involved leg, the proportion of patients demonstrating faulty movement patterns for a task ranged from 52% to 95%. Forward stepdown (P < .001), single-leg squat (P = .03), side-to-side jump (P = .03), and hop to opposite (P = .04) demonstrated higher frequency of faulty movement patterns in the involved versus the uninvolved leg. Rates of faulty movement patterns were not different between sex or meniscal injury status. Single-leg stance on the involved leg (P = .05) and single-leg bridge (uninvolved leg) (P = .02) differed between age groups. Conclusion Athletes demonstrated multiple faulty movement patterns that have been associated with both initial and second noncontact ACL injury. Faulty movement patterns were evident in tasks as simple as single-leg stance. The rates of faulty movement were similar in both male and female patients, as well as in the involved and uninvolved limb.
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Affiliation(s)
- Polly deMille
- Hospital for Special Surgery, New York, New York, USA
| | - Cara L. Lewis
- Physical Therapy, Rehabilitation Sciences and Medicine, Boston University, Boston, Massachusetts, USA
| | | | - Allison M. Brown
- Rehabilitation and Movement Sciences, Rutgers University, Brunswick, New Jersey, USA
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Pandy MG, Gray HA, Ganapam PN, Culvenor AG, Crossley KM, Guan S. A High-Riding Patella Is a Feature of Knee Joint Motion During Gait After ACL Reconstruction. J Orthop Res 2025; 43:1024-1034. [PMID: 40103486 PMCID: PMC11982598 DOI: 10.1002/jor.26062] [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: 10/03/2024] [Revised: 01/08/2025] [Accepted: 02/17/2025] [Indexed: 03/20/2025]
Abstract
Accurate measurements of knee joint motion during gait after anterior cruciate ligament reconstruction (ACLR), especially for the patellofemoral joint, are sparse. The aim of this study was to measure six-degree-of-freedom (6-DOF) patellofemoral and tibiofemoral motion in ACLR and uninjured contralateral knees during gait, and to compare these results to healthy (control) knees. Biplane fluoroscopy was used to measure 6-DOF patellofemoral and tibiofemoral motion in 15 ACLR participants (26.3 ± 3.9 years) for complete cycles of level walking and downhill walking, and the results were compared to data for 10 healthy individuals (29.8 ± 6.1 years). Mean patellar superior translation, anterior translation, and flexion over the gait cycle were respectively 4.4-5.6 mm greater, 5.4-6.3 mm greater, and 3.7°-7.0° less in the ACLR and contralateral knees compared to controls across both activities (p < 0.021). Articular contact was 7.6 mm higher on the femoral trochlea in the ACLR and contralateral knees compared to controls. The patellar tendon was 8.9 mm longer (p < 0.001) in the ACLR and contralateral knees compared to controls. Among ACLR participants, 14 out of 30 knees (47%) had an Insall-Salvati ratio ≥ 1.20, indicating patella alta. Mean tibial external rotation and anterior translation over the gait cycle were respectively 3.4°-3.8° greater and 2.6-3.0 mm greater in the ACLR knee compared to controls across both activities (p < 0.025). A high-riding patella in both knees of the ACLR participants was due to a longer patellar tendon. A change in the load-bearing areas of the femoral trochlea may contribute to the high rate of patellofemoral osteoarthritis seen after ACLR.
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Affiliation(s)
- Marcus G. Pandy
- Department of Mechanical EngineeringUniversity of MelbourneMelbourneVictoriaAustralia
| | - Hans A. Gray
- Department of Biomedical EngineeringUniversity of MelbourneMelbourneVictoriaAustralia
| | - Padma N. Ganapam
- Department of Mechanical EngineeringUniversity of MelbourneMelbourneVictoriaAustralia
| | - Adam G. Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
| | - Kay M. Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
| | - Shanyuanye Guan
- Department of Mechanical EngineeringUniversity of MelbourneMelbourneVictoriaAustralia
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Kage T, Taketomi S, Tomita T, Yamazaki T, Yamagami R, Kono K, Kawaguchi K, Murakami R, Arakawa T, Kobayashi T, Inui H, Tanaka S. In vivo kinematic analysis of failure cases after nonanatomical anterior cruciate ligament reconstruction: a preliminary study. Knee Surg Relat Res 2024; 36:48. [PMID: 39736711 DOI: 10.1186/s43019-024-00254-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 12/08/2024] [Indexed: 01/01/2025] Open
Abstract
BACKGROUND Nonanatomical anterior cruciate ligament (ACL) reconstruction occasionally induces ACL failure without an evident injury episode, necessitating revision surgery. Although the in vivo kinematics of ACL deficiency before primary ACL reconstruction are well documented, the kinematics of ACL failure after nonanatomical reconstruction remain unexplored. The aim of this study is to investigate ACL failure kinematics following nonanatomical reconstruction. PATIENTS AND METHODS This study enrolled three patients with ACL failure after nonanatomical reconstruction, 20 normal and 16 ACL-deficient knees. The anteroposterior (AP) translation of the medial and lateral femoral condyles and center of the femur and femoral rotation relative to the tibia during squatting were evaluated using a two- to three-dimensional registration technique under fluoroscopy. RESULTS Medial AP translation of the nonanatomically reconstructed knee in one patient showed posterior location and abnormal kinematics compared with the ACL-deficient knees. In contrast, the lateral AP position of the nonanatomically reconstructed knees in two patients were more posteriorly located and showed more abnormal kinematics than the ACL-deficient knees. Central AP translation of the nonanatomically reconstructed knees in two patients was located more posteriorly throughout the range of midflexion. Femoral rotation of the nonanatomically reconstructed knees showed abnormal kinematics compared with that of the normal and ACL-deficient knees. CONCLUSIONS By independently assessing the medial and lateral aspects of the femur, the medial or lateral condyle of the femur of nonanatomically reconstructed knees exhibited a more pronounced abnormality compared with ACL-deficient knees. The femur of the nonanatomically reconstructed knees showed abnormal rotational kinematics. Considering the kinematic aspect, nonanatomical ACL reconstruction should be avoided.
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Affiliation(s)
- Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tetsuya Tomita
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, 1-26-16 Nankokita, Suminoe-ku, Osaka, 559-8611, Japan
| | - Takaharu Yamazaki
- Department of Information Systems, Faculty of Engineering, Saitama Institute of Technology, 1690 Fusaiji, Fukaya, Saitama, 369-0293, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryo Murakami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takahiro Arakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takashi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8500, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Cruz CA, Pruneski JA, McAllister RN, Riopelle D, Bottoni CR. Fifteen-Year Radiographic Follow-up Comparison of Early Versus Delayed ACL Reconstruction: A Retrospective Review of a Previous Prospective Randomized Clinical Trial. Orthop J Sports Med 2024; 12:23259671241298753. [PMID: 39669710 PMCID: PMC11635895 DOI: 10.1177/23259671241298753] [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: 09/27/2024] [Accepted: 10/10/2024] [Indexed: 12/14/2024] Open
Abstract
Background Posttraumatic osteoarthritis (PTOA) after anterior cruciate ligament injury and reconstruction (ACLR) is a prevalent cause of long-term disability. Few studies have compared the effect of ACLR timing on the development of PTOA. Purpose/Hypothesis The purpose of this study was to compare the rate of PTOA at a long-term follow-up between patients who underwent early ACLR (<21 days after injury) versus delayed ACLR (>6 weeks after injury). The authors hypothesized that patients who underwent early ACLR would have lower rates of PTOA compared with the delayed ACLR cohort. Study Design Cohort study; Level of evidence, 2. Methods The authors contacted patients from a previous prospective randomized controlled trial who were randomized to undergo either early (<21 days) or delayed (>6 weeks) ACLR with hamstring tendon autografts. Weightbearing radiographs were obtained at a minimum 15-year follow-up, and radiographic PTOA was evaluated using the Kellgren-Lawrence (K-L) classification system. The prevalence of pathologies was compared between the early and delayed groups using appropriate testing, and logistic regression was used to evaluate for associations with failure-a K-L grade of ≥2 or conversion to total knee arthroplasty (TKA). Results At a mean follow-up of 15.6 years, radiographs were obtained for 58 (28 early, 30 delayed) of the original 69 (84.1%) patients. High rates of PTOA (K-L grade ≥2) were observed in the early (82.1%) and delayed (86.7%) cohorts (P = .634). Two (7.1%) patients in the early cohort converted to TKA compared with 4 (13.3%) patients in the delayed cohort (P = .44). Surgical timing did not affect arthritis severity (P≥ .4), and no factors predicted developing radiographic PTOA in either cohort (P > .2). Increased time from injury decreased the odds of failure in the early ACLR cohort (odds ratio, 0.79; P = .041). Conclusion In this study, >80% of patients who underwent ACLR with hamstring tendon autografts had radiographic evidence of PTOA at a mean 15.6-year follow-up, with no difference in the prevalence or severity of PTOA between the early and delayed groups. In addition, 11% of patients had converted to TKA by the time of the final follow-up, and the conversion rate did not differ according to the timing of ACLR.
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Affiliation(s)
| | - James A. Pruneski
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Rebecca N. McAllister
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - David Riopelle
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA. Presented at the AOSSM Annual Meeting, Washington, District of Columbia, July 2023
| | - Craig R. Bottoni
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
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Ashour AA, Elhafez SM, ElMeligie MM, Hanafy AF. Crossover effect of knee and ankle joint training on knee mechanics after ACL reconstruction: A randomized controlled trial. Gait Posture 2024; 113:512-518. [PMID: 39173441 DOI: 10.1016/j.gaitpost.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rehabilitation is a common intervention after ACL reconstruction. Since different types of exercise can influence muscle and kinematic parameters in diverse ways, the training order between the knee and ankle joints may also change gait parameters. PURPOSE This study aimed to investigate whether the training sequence of the knee and ankle joints (knee followed by ankle training or vice-versa) in an ACL reconstruction (ACLR) rehabilitation program has any effects on knee extension and flexion torques. METHODS Forty-two men (aged 20-30 years) with ACLR participated in this study. They were randomly allocated to receive one of two interventions: (A) knee joint training followed by ankle training or (B) ankle joint training followed by knee training. After five weeks (four weeks of intervention and one-week washout), participants crossed from one group to another for an additional four weeks. Knee extension and flexion torques were assessed during the stance phase of the gait cycle before and after the intervention program. RESULTS Two-way Mixed-design MANOVA showed that knee extension torque improved significantly in both groups after training (p = 0.001, Cohen's D = 0.65), while the knee flexion torque increased significantly only in group B (p= 0.001, Cohen's D = 0.97). When comparing both groups, patients of group B presented significant improvements in the post-training mean values of all tested variables compared with group A. CONCLUSION Starting a post-ACLR rehabilitation program with ankle training followed by knee training is better to improve knee flexion and extension torques during the stance phase of the gait cycle than starting the program by training the knee first, followed by the ankle. Future studies using a mixed-gender sample and different types of ACLR operations are necessary to examine whether similar improvements will happen as well as to test their effects on many sports activities.
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Affiliation(s)
- Ahmed Atteya Ashour
- Department of Biomechanics, Faculty of Physical Therapy, October 6 University, Egypt.
| | | | | | - Abeer Farag Hanafy
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt
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Kim KC, Wakeman B, Wissman R. Functional Imaging of the Knee-A Comprehensive Review. J Knee Surg 2023. [PMID: 37992754 DOI: 10.1055/a-2216-5186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Knee pain is a common presenting problem in the general population. Radiographs and magnetic resonance imaging (MRI) are the cornerstones of imaging in current clinical practice. With advancements in technology, there has been increasing utilization of other modalities to evaluate knee disorders. Dynamic assessment utilizing computed tomography and portable ultrasounds have demonstrated the capacity to accurately assess and reproducibly quantify kinematics of knee disorders. Cartilage physiology can be evaluated with MRI. Emerging research has even demonstrated novel musculoskeletal applications of positron emission tomography to evaluate anterior cruciate ligament graft metabolic activity following reconstruction. As technology continues to evolve and traditional ways are improved upon, future comparative studies will elucidate the distinct advantages of the various modalities. Although radiology is still primarily an anatomic specialty, there is immense potential for functional imaging to be the standard of care. This review focuses on the most common musculoskeletal applications of functional imaging as well as future utilization.
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Affiliation(s)
- Kenneth C Kim
- Department of Radiology, University of Missouri Health Care, Columbia, Missouri
| | - Brooke Wakeman
- Department of Radiology, University of Missouri Health Care, Columbia, Missouri
| | - Rob Wissman
- Musculoskeletal Imaging Division, Department of Radiology, Faculty of Clinical Radiology, University of Missouri System, Columbia, Missouri
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Karatekin YS, Altınayak H, Kehribar L, Yılmaz AK, Korkmaz E, Anıl B. Does Rotation and Anterior Translation Persist as Residual Instability in the Knee after Anterior Cruciate Ligament Reconstruction? (Evaluation of Coronal Lateral Collateral Ligament Sign, Tibial Rotation, and Translation Measurements in Postoperative MRI). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1930. [PMID: 38003979 PMCID: PMC10672908 DOI: 10.3390/medicina59111930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023]
Abstract
Purpose: The aim of this study was to evaluate the presence of residual instability in the knee after ACL reconstruction through the analysis of MRI findings. Methods: This study included patients who underwent isolated ACL reconstruction between December 2019 and December 2021, and had preoperative and postoperative MRI, clinical scores, and postoperative isokinetic measurements. The anterior tibial translation (ATT) distance, coronal lateral collateral ligament (LCL) sign, and femorotibial rotation (FTR) angle were compared preoperatively and postoperatively. The correlation between the changes in preoperative-postoperative measurements and postoperative measurements with clinical scores and isokinetic measurements was examined. The clinical outcomes were compared based on the presence of a postoperative coronal LCL sign. Inclusion criteria were set as follows: the time between the ACL rupture and surgery being 6 months, availability of preoperative and postoperative clinical scores, and objective determination of muscle strength using isokinetic dynamometer device measurements. Patients with a history of previous knee surgery, additional ligament injuries other than the ACL, evidence of osteoarthritis on direct radiographs, cartilage injuries lower limb deformities, and contralateral knee injuries were excluded from this study. Results: This study included 32 patients. After ACL reconstruction, there were no significant changes in the ATT distance (preoperatively: 6.5 ± 3.9 mm, postoperatively: 5.7 ± 3.2 mm) and FTR angle (preoperatively: 5.4° ± 2.9, postoperatively: 5.2° ± 3.5) compared to the preoperative measurements (p > 0.05). The clinical measurements were compared based on the presence of a postoperative coronal LCL sign (observed in 17 patients, not observed in 15 patients), and no significant differences were found for all parameters (p > 0.05). There were no observed correlations between postoperative FTR angle, postoperative ATT distance, FTR angle change, and ATT distance change values with postoperative clinical scores (p > 0.05). Significant correlations were observed between the high strength ratios generated at an angular velocity of 60° and a parameters FTR angle and ATT distance (p-values: 0.028, 0.019, and r-values: -0.389, -0.413, respectively). Conclusions: Despite undergoing ACL reconstruction, no significant changes were observed in the indirect MRI findings (ATT distance, coronal LCL sign, and FTR angle). These results suggest that postoperative residual tibiofemoral rotation and tibial anterior translation may persist; however, they do not seem to have a direct impact on clinical scores. Furthermore, the increase in tibial translation and rotation could potentially negatively affect the flexion torque compared to the extension torque in movements requiring high torque at low angular velocities.
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Affiliation(s)
- Yavuz Selim Karatekin
- Department of Orthopaedics and Traumatology, Samsun Education and Research Hospital, 55090 Samsun, Turkey;
| | - Harun Altınayak
- Department of Orthopaedics and Traumatology, Samsun Education and Research Hospital, 55090 Samsun, Turkey;
| | - Lokman Kehribar
- Medical Faculty, Department of Orthopaedics and Traumatology, Samsun University, 55090 Samsun, Turkey;
| | - Ali Kerim Yılmaz
- Faculty of Yasar Doğu Sport Sciences, Ondokuz Mayıs University, 55090 Samsun, Turkey; (A.K.Y.); (E.K.); (B.A.)
| | - Esra Korkmaz
- Faculty of Yasar Doğu Sport Sciences, Ondokuz Mayıs University, 55090 Samsun, Turkey; (A.K.Y.); (E.K.); (B.A.)
| | - Berna Anıl
- Faculty of Yasar Doğu Sport Sciences, Ondokuz Mayıs University, 55090 Samsun, Turkey; (A.K.Y.); (E.K.); (B.A.)
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Runer A, Keeling L, Wagala N, Nugraha H, Özbek EA, Hughes JD, Musahl V. Current trends in graft choice for primary anterior cruciate ligament reconstruction - part II: In-vivo kinematics, patient reported outcomes, re-rupture rates, strength recovery, return to sports and complications. J Exp Orthop 2023; 10:40. [PMID: 37014518 PMCID: PMC10073382 DOI: 10.1186/s40634-023-00601-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
Postoperative patient satisfaction after anterior cruciate ligament reconstruction (ACL-R) is influenced mainly by the degree of pain, the need for reoperation, and functional performance in daily activities and sports. Graft choice has shown to have an influence on postoperative outcomes after ACL-R. While patient reported outcomes measurements do not differ between graft options, evidence shows that normal knee kinematics is not fully restored after ACL-R with an increase in postoperative anterior tibial translation (ATT). Postoperative graft rupture rates seem to favor bone-patella-tendon-bone (BPTB) and quadriceps tendon (QT) autografts over HT or allografts. While return to sports rates seem comparable between different graft types, postoperative extensor strength is reduced in patients with BPTB and QT whereas flexion strength is weakened in patients with HT. Postoperative donor site morbidity is highest in BPTB but comparable between HT and QT. With all graft options having advantages and drawbacks, graft choice must be individualized and chosen in accordance with the patient.
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Affiliation(s)
- Armin Runer
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA.
- Department for Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Laura Keeling
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nyaluma Wagala
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hans Nugraha
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Udayana, / Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Emre Anil Özbek
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cui H, Cao Z, Wang S, Zhang H, Chen Z, Wu X, Zhao Y, Qie S, Li W. Surface electromyography characteristics of patients with anterior cruciate ligament injury in different rehabilitation phases. Front Physiol 2023; 14:1116452. [PMID: 37051018 PMCID: PMC10083235 DOI: 10.3389/fphys.2023.1116452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Anterior cruciate ligament reconstruction (ACLR) is a common treatment for anterior cruciate ligament (ACL) injury. However, after ACLR, a significant proportion of patients do not return to pre-injury levels. Research on muscle function during movement has important implications in rehabilitation. Methods: Sixty patients with unilateral ACL injury were recruited for this study and assigned into three groups: group A, individuals with an ACL injury before 6 months; group B, individuals with ACLR from 6 months to 1 year; and group C, individuals with ACLR 1 year later. Surface electromyography (SEMG) signals were collected from the bilateral rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL), biceps femoris (BF), and semitendinosus (ST). The tasks performed during the experiment included straight leg raising (SLR) training at 30°, SLR training at 60°, ankle dorsiflexion, walking, and fast walking. Results: In the maximum muscle strength test, the affected side of the BF in group A (199.4 ± 177.12) was significantly larger than in group B (53.91 ± 36.61, p = 0.02) and group C (75.08 ± 59.7, p = 0.023). In the walking test, the contralateral side of the RF in group B (347.53 ± 518.88) was significantly greater than that in group C (139.28 ± 173.78, p = 0.029). In the SLR training (60°) test, the contralateral side of the RF in group C (165.37 ± 183.06) was significantly larger than that in group A (115.09 ± 62.47, p = 0.023) and smaller than that in group B (226.21 ± 237.17, p = 0.046); In the ankle dorsiflexion training test, the contralateral side of the RF in group B (80.37 ± 87.9) was significantly larger than that in group C (45.61 ± 37.93, p = 0.046). Conclusion: This study showed the EMG characteristics of patients with ACL injury helped to determine which muscle requires more training and which exercise model would be best suited for intervention.
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Affiliation(s)
- Hongxing Cui
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Zhijie Cao
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Shanshan Wang
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Hao Zhang
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Ze Chen
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Xipeng Wu
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Yixuan Zhao
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Shuyan Qie
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China
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11
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Li Z, Zhang W, Ren S, Zhou R, Zhang X, You T, Bai L. Relationship Between Number of Lateral Intercondylar Ridges and Area of Denser Bone on the Lateral Intercondylar Wall. Orthop J Sports Med 2022; 10:23259671221091332. [PMID: 35571965 PMCID: PMC9096202 DOI: 10.1177/23259671221091332] [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: 12/17/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background: A deeper understanding of the anatomy of the intercondylar notch of the femur may help reduce technical errors during anatomic anterior cruciate ligament (ACL) reconstruction. Purposes: To classify the number of ridges on the lateral intercondylar wall, identify factors influencing the number of ridges, and define the relationship between the area of denser bone on the lateral intercondylar wall and the lateral intercondylar ridge. Study Design: Descriptive laboratory study. Methods: Included were 89 patients with computed tomography (CT) images of the knee joint. On full lateral view of the lateral femoral condyle, the authors evaluated for the presence of a lateral intercondylar ridge. The height and area of the lateral intercondylar wall (notch height and lateral notch area) and the length of Blumensaat line were calculated. Notch outlet length, axial notch area, notch width index, and transepicondylar length were also calculated using 3-dimensional CT. Maximum intensity projection was used to identify the area of denser bone on the femoral lateral intercondylar wall, and the relationship between this area and the lateral intercondylar ridge was investigated. Results: The lateral intercondylar ridge exhibited 3 types of morphological variations. The invisible type (no ridge) was observed in 20 knees (22.5%); the ridge type (1 ridge), in 23 knees (25.8%); and the plateau type (2 ridges), in 46 knees (51.7%). There were significant differences in notch height, lateral notch area, Blumensaat line length, and denser bone area among the ridge types (P ≤ .031 for all). The locations of the anterior ridge of the plateau type and of all 23 ridges of the ridge type corresponded to the anterior margin line of the area of denser bone. Conclusion: Significant differences were seen in the 3 types of lateral intercondylar ridges. The anterior margin line of the denser bone area on the lateral intercondylar wall was found to correspond to the anterior border of the plateau type and the ridge type. Clinical Relevance: The variations in the lateral intercondylar ridge may affect measurement accuracy during evaluation of ACL tunnel position while using the ridge as a landmark. The plateau-type ridge and the area of denser bone on the lateral intercondylar wall may provide a new way for surgeons to determine the femoral tunnel.
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Affiliation(s)
- Zijian Li
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wentao Zhang
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen, China
| | - Shiyou Ren
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen, China
| | - Ri Zhou
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xintao Zhang
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen, China
| | - Tian You
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lu Bai
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen, China
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12
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Kokkotis C, Moustakidis S, Tsatalas T, Ntakolia C, Chalatsis G, Konstadakos S, Hantes ME, Giakas G, Tsaopoulos D. Leveraging explainable machine learning to identify gait biomechanical parameters associated with anterior cruciate ligament injury. Sci Rep 2022; 12:6647. [PMID: 35459787 PMCID: PMC9026057 DOI: 10.1038/s41598-022-10666-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/11/2022] [Indexed: 11/09/2022] Open
Abstract
Anterior cruciate ligament (ACL) deficient and reconstructed knees display altered biomechanics during gait. Identifying significant gait changes is important for understanding normal and ACL function and is typically performed by statistical approaches. This paper focuses on the development of an explainable machine learning (ML) empowered methodology to: (i) identify important gait kinematic, kinetic parameters and quantify their contribution in the diagnosis of ACL injury and (ii) investigate the differences in sagittal plane kinematics and kinetics of the gait cycle between ACL deficient, ACL reconstructed and healthy individuals. For this aim, an extensive experimental setup was designed in which three-dimensional ground reaction forces and sagittal plane kinematic as well as kinetic parameters were collected from 151 subjects. The effectiveness of the proposed methodology was evaluated using a comparative analysis with eight well-known classifiers. Support Vector Machines were proved to be the best performing model (accuracy of 94.95%) on a group of 21 selected biomechanical parameters. Neural Networks accomplished the second best performance (92.89%). A state-of-the-art explainability analysis based on SHapley Additive exPlanations (SHAP) and conventional statistical analysis were then employed to quantify the contribution of the input biomechanical parameters in the diagnosis of ACL injury. Features, that would have been neglected by the traditional statistical analysis, were identified as contributing parameters having significant impact on the ML model’s output for ACL injury during gait.
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Affiliation(s)
- Christos Kokkotis
- Institute for Bio-Economy & Agri-Technology, Center for Research and Technology Hellas, 38333, Vólos, Greece. .,TEFAA, Department of Physical Education & Sport Science, University of Thessaly, 42100, Trikala, Greece.
| | | | - Themistoklis Tsatalas
- TEFAA, Department of Physical Education & Sport Science, University of Thessaly, 42100, Trikala, Greece
| | - Charis Ntakolia
- Hellenic National Center of COVID-19 Impact on Youth, University Mental Health Research Institute, 11527, Athens, Greece.,School of Naval Architecture and Marine Engineering, National Technical University of Athens, 15772, Athens, Greece
| | - Georgios Chalatsis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University General Hospital of Larissa, 41110, Larissa, Greece
| | | | - Michael E Hantes
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University General Hospital of Larissa, 41110, Larissa, Greece
| | - Giannis Giakas
- TEFAA, Department of Physical Education & Sport Science, University of Thessaly, 42100, Trikala, Greece
| | - Dimitrios Tsaopoulos
- Institute for Bio-Economy & Agri-Technology, Center for Research and Technology Hellas, 38333, Vólos, Greece
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13
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Adouni M, Faisal TR, Dhaher YY. Sensitivity analysis of the knee ligament forces to the surgical design variation during anterior cruciate ligament reconstruction: a finite element analysis. Comput Methods Biomech Biomed Engin 2021; 25:1063-1071. [PMID: 34821520 DOI: 10.1080/10255842.2021.2006647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to understand the effect of essential surgical design parameters on collateral and cruciate ligaments behavior for a Bone-Patellar-Tendon-Bone (BPTB) anterior cruciate ligament reconstruction (ACL-R) surgery. A parametric finite element model of biomechanical experiments depicting the ACL-R surgery associated with a global sensitivity analysis was adopted in this work. The model parameters were six intraoperative variables, two-quadrant coordinates of femoral tunnel placement, femoral tunnel sagittal and coronal angles, graft pretension, and the joint angle at which the BPTB graft is tensioned (fixation angle). Our results indicated that cruciate ligaments (posterior cruciate ligament (PCL) and graft) were mainly sensitive to graft pretension (23%), femoral tunnel sites (56%), and the angle at which the surgeon decided to fix the graft (14%). The collateral ligaments (medial and lateral) were also affected by the same set of surgical parameters as the cruciate ligaments except for graft pretension. The output data of this study may help to identify a better role for the ACL-R intraoperative variables in optimizing the knee joint ligaments' postsurgical functionality.
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Affiliation(s)
- Malek Adouni
- Physical Medicine and Rehabilitation Department, Northwestern University, Chicago, IL, USA.,Mechanical Engineering department, Australian College of Kuwait, Kuwait City, Kuwait
| | - Tanvir R Faisal
- Department of Mechanical Engineering, University of Louisiana at Lafayette, Lafayette, LA, USA
| | - Yasin Y Dhaher
- Physical Medicine and Rehabilitation Department, Northwestern University, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, University of Texas Southwest, Dallas, TX, USA.,Department of Orthopedic Surgery, University of Texas Southwest, Dallas, TX, USA.,Bioengineering, University of Texas Southwest, Dallas, TX, USA
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14
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Kim-Wang SY, Holt AG, McGowan AM, Danyluk ST, Goode AP, Lau BC, Toth AP, Wittstein JR, DeFrate LE, Yi JS, McNulty AL. Immune cell profiles in synovial fluid after anterior cruciate ligament and meniscus injuries. Arthritis Res Ther 2021; 23:280. [PMID: 34736523 PMCID: PMC8567695 DOI: 10.1186/s13075-021-02661-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/17/2021] [Indexed: 01/18/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) and meniscus tears are common knee injuries. Despite the high rate of post-traumatic osteoarthritis (PTOA) following these injuries, the contributing factors remain unclear. In this study, we characterized the immune cell profiles of normal and injured joints at the time of ACL and meniscal surgeries. Methods Twenty-nine patients (14 meniscus-injured and 15 ACL-injured) undergoing ACL and/or meniscus surgery but with a normal contralateral knee were recruited. During surgery, synovial fluid was aspirated from both normal and injured knees. Synovial fluid cells were pelleted, washed, and stained with an antibody cocktail consisting of fluorescent antibodies for cell surface proteins. Analysis of immune cells in the synovial fluid was performed by polychromatic flow cytometry. A broad spectrum immune cell panel was used in the first 10 subjects. Based on these results, a T cell-specific panel was used in the subsequent 19 subjects. Results Using the broad spectrum immune cell panel, we detected significantly more total viable cells and CD3 T cells in the injured compared to the paired normal knees. In addition, there were significantly more injured knees with T cells above a 500-cell threshold. Within the injured knees, CD4 and CD8 T cells were able to be differentiated into subsets. The frequency of total CD4 T cells was significantly different among injury types, but no statistical differences were detected among CD4 and CD8 T cell subsets by injury type. Conclusions Our findings provide foundational data showing that ACL and meniscus injuries induce an immune cell-rich microenvironment that consists primarily of T cells with multiple T helper phenotypes. Future studies investigating the relationship between immune cells and joint degeneration may provide an enhanced understanding of the pathophysiology of PTOA following joint injury.
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Affiliation(s)
- Sophia Y Kim-Wang
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.,Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Abigail G Holt
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Alyssa M McGowan
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Stephanie T Danyluk
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Adam P Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Alison P Toth
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Louis E DeFrate
- Department of Biomedical Engineering, Duke University, Durham, NC, USA. .,Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA. .,Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
| | - John S Yi
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Amy L McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.,Department of Pathology, Duke University School of Medicine, Durham, NC, USA
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15
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Stockton DJ, Schmidt AM, Yung A, Desrochers J, Zhang H, Masri BA, Wilson DR. Tibiofemoral contact and alignment in patients with anterior cruciate ligament rupture treated nonoperatively versus reconstruction : an upright, open MRI study. Bone Joint J 2021; 103-B:1505-1513. [PMID: 34465147 DOI: 10.1302/0301-620x.103b9.bjj-2020-1955.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS Anterior cruciate ligament (ACL) rupture commonly leads to post-traumatic osteoarthritis, regardless of surgical reconstruction. This study uses standing MRI to investigate changes in contact area, contact centroid location, and tibiofemoral alignment between ACL-injured knees and healthy controls, to examine the effect of ACL reconstruction on these parameters. METHODS An upright, open MRI was used to directly measure tibiofemoral contact area, centroid location, and alignment in 18 individuals with unilateral ACL rupture within the last five years. Eight participants had been treated nonoperatively and ten had ACL reconstruction performed within one year of injury. All participants were high-functioning and had returned to sport or recreational activities. Healthy contralateral knees served as controls. Participants were imaged in a standing posture with knees fully extended. RESULTS Participants' mean age was 28.4 years (SD 7.3), the mean time since injury was 2.7 years (SD 1.6), and the mean International Knee Documentation Subjective Knee Form score was 84.4 (SD 13.5). ACL injury was associated with a 10% increase (p = 0.001) in contact area, controlling for compartment, sex, posture, age, body mass, and time since injury. ACL injury was associated with a 5.2% more posteriorly translated medial centroid (p = 0.001), equivalent to a 2.6 mm posterior translation on a representative tibia with mean posteroanterior width of 49.4 mm. Relative to the femur, the tibiae of ACL ruptured knees were 2.3 mm more anteriorly translated (p = 0.003) and 2.6° less externally rotated (p = 0.010) than healthy controls. ACL reconstruction was not associated with an improvement in any measure. CONCLUSION ACL rupture was associated with an increased contact area, posteriorly translated medial centroid, anterior tibial translation, and reduced tibial external rotation in full extension. These changes were present 2.7 years post-injury regardless of ACL reconstruction status. Cite this article: Bone Joint J 2021;103-B(9):1505-1513.
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Affiliation(s)
- David J Stockton
- Centre for Hip Health and Mobility, Vancouver, Canada.,Clinician Investigator Program, University of British Columbia, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | | | - Andrew Yung
- MRI Research Center, University of British Columbia, Vancouver, Canada
| | | | - Honglin Zhang
- Centre for Hip Health and Mobility, Vancouver, Canada
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - David R Wilson
- Centre for Hip Health and Mobility, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
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16
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Chen J, Wang C, Xu C, Qiu J, Xu J, Tsai TY, Zhao J. Effects of Anterolateral Structure Augmentation on the In Vivo Kinematics of Anterior Cruciate Ligament-Reconstructed Knees. Am J Sports Med 2021; 49:656-666. [PMID: 33464924 DOI: 10.1177/0363546520981743] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Double-bundle anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-known treatment that restores the stability of ACL-deficient knees. However, some isolated ACL-reconstructed knees ultimately show rotatory laxity and develop osteoarthritis. Whether combined ACLR with anterolateral structure (ALS) augmentation (ALSA) can provide better improvement in the in vivo knee rotational kinematics remains unknown. HYPOTHESIS When compared with isolated double-bundle ACLR, combined double-bundle ACLR with ALSA can improve knee in vivo rotational kinematics and provide better restoration of knee kinematics. STUDY DESIGN Controlled laboratory study. METHODS Sixteen patients with unilateral ACL injury were randomly divided into 2 groups to receive either combined double-bundle ACLR and ALSA (ALSA group) or isolated double-bundle ACLR (ACLR group). All patients performed a single-leg lunge using the operative and nonoperative/contralateral legs under dual-fluoroscopic imaging system surveillance during a hospital visit at a minimum 1 year (12-13 months) of follow-up to assess the 6 degrees of freedom knee kinematics. Functional evaluation using the Lysholm and Marx rating scales and clinical examinations were also performed. RESULTS From full extension to approximately 90° of knee flexion at 5° intervals, the mean ± SD internal rotation of the reconstructed knees in the ALSA group (1.5°± 0.9°) was significantly smaller than that of the contralateral knees (8.2°± 1.9°; P = .008). The ALSA group knees also showed significantly (P = .045) more medial translation than the contralateral knees. In the ACLR group, the mean internal rotation of the reconstructed knee (6.0°± 2.1°) was significantly smaller than that of the contralateral knees (8.9°± 0.6°; P < .001). At full extension, the tibia was significantly more externally rotated than that of the contralateral legs (0.5°± 7.4° vs 7.6°± 3.4°, P = .049). CONCLUSION When compared with isolated double-bundle ACLR, double-bundle ACLR augmented with ALS reconstruction resulted in anterolateral rotatory overconstraint during the lunge motion. CLINICAL RELEVANCE Additional ALSA of double-bundle ACL-reconstructed knees overconstrained rotatory stability. Therefore, the use of ALSA for ACL-reconstructed knees should be considered with caution for patients with ACL deficiency and anterolateral rotatory instability. Longer-term follow-up to evaluate long-term outcomes and altered kinematics over time is recommended.
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Affiliation(s)
- Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Cong Wang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiayu Qiu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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17
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Tashman S, Zandiyeh P, Irrgang JJ, Musahl V, West RV, Shah N, Fu FH. Anatomic single- and double-bundle ACL reconstruction both restore dynamic knee function: a randomized clinical trial-part II: knee kinematics. Knee Surg Sports Traumatol Arthrosc 2021; 29:2676-2683. [PMID: 33615404 PMCID: PMC8298343 DOI: 10.1007/s00167-021-06479-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/25/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Compare side-to-side differences for knee kinematics between anatomic single-bundle (SB) and anatomic double-bundle (DB) ACLR during downhill running at 6 and 24 months post ACLR using high-accuracy dynamic stereo X-ray imaging. It was hypothesized that anatomic DB ACLR would better restore tibio-femoral kinematics compared to SB ACLR, based on comparison to the contralateral, uninjured knee. METHODS Active individuals between 14 and 50 years of age that presented within 12 months of injury were eligible to participate. Individuals with prior injury or surgery of either knee, greater than a grade 1 concomitant knee ligament injury, or ACL insertion sites less than 14 mm or greater than 18 mm were excluded. Subjects were randomized to undergo SB or DB ACLR with a 10 mm-wide quadriceps tendon autograft harvested with a patellar bone block and were followed for 24 months. Dynamic knee function was assessed during treadmill downhill running using a dynamic stereo X-ray tracking system at 6 and 24 months after surgery. Three-dimensional tibio-femoral kinematics were calculated and compared between limbs (ACLR and uninjured contralateral) at each time point. RESULTS Fifty-seven subjects were randomized (29 DB) and 2-year follow-up was attained from 51 (89.5%). No significant differences were found between SB and DB anatomic ACLR for any of the primary kinematic variables. CONCLUSIONS Contrary to the study hypothesis, double-bundle reconstruction did not show superior kinematic outcomes compared to the single-bundle ACLR. While neither procedure fully restored normal knee kinematics, both anatomic reconstructions were similarly effective for restoring near-normal dynamic knee function. The findings of this study indicate both SB and DB techniques can be used for patients with average size ACL insertion sites. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
| | | | - James J. Irrgang
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA USA ,Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213 USA
| | | | | | - Neha Shah
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213 USA
| | - Freddie H. Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213 USA
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18
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Crook BS, Collins AT, Lad NK, Spritzer CE, Wittstein JR, DeFrate LE. Effect of walking on in vivo tibiofemoral cartilage strain in ACL-deficient versus intact knees. J Biomech 2020; 116:110210. [PMID: 33444927 DOI: 10.1016/j.jbiomech.2020.110210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 02/08/2023]
Abstract
Anterior cruciate ligament (ACL) rupture alters knee kinematics and contributes to premature development of osteoarthritis. However, there is limited data regarding the in vivo biomechanical response of tibiofemoral cartilage to activities of daily living (ADLs) in ACL-deficient knees. In this study, eight otherwise healthy participants with chronic unilateral ACL deficiency completed a stress test to assess the effect of 20 min of level treadmill walking at a speed of 2.5 mph on tibiofemoral cartilage in their ACL-deficient and contralateral ACL-intact knees. Three-dimensional surface models developed from pre- and post-activity magnetic resonance (MR) images of the injured and uninjured knees were used to determine compressive strain across multiple regions of tibiofemoral cartilage (medial and lateral tibial plateaus, medial and lateral femoral condyles, medial aspect of femoral condyle adjacent to intercondylar notch of the femur). In the ACL-deficient knees, we observed significantly increased cartilage strain in the region of the medial femoral condyle adjacent to the intercondylar notch (6% in deficient vs. 2% in contralateral, p = 0.01) as well as across the medial and lateral tibial plateaus (4% vs. 3%, p = 0.01) relative to the contralateral ACL-intact knees. Increased compressive strain at the medial intercondylar notch and tibial plateau suggests alterations in mechanical loading or the response to load in these regions, presumably related to altered knee kinematics. These changes may disrupt cartilage homeostasis and contribute to subsequent development of osteoarthritis.
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Affiliation(s)
- Bryan S Crook
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Amber T Collins
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Nimit K Lad
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, Durham, NC, United States
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States; Department of Biomedical Engineering, Duke University, Durham, NC, United States; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, United States.
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19
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Englander ZA, Wittstein J, Goode AP, Garrett WE, DeFrate LE. Reconsidering Reciprocal Length Patterns of the Anteromedial and Posterolateral Bundles of the Anterior Cruciate Ligament During In Vivo Gait. Am J Sports Med 2020; 48:1893-1899. [PMID: 32515986 PMCID: PMC7693121 DOI: 10.1177/0363546520924168] [Citation(s) in RCA: 4] [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 Some cadaveric studies have indicated that the anterior cruciate ligament (ACL) consists of anteromedial and posterolateral bundles that display reciprocal function with regard to knee flexion. However, several in vivo imaging studies have suggested that these bundles elongate in parallel with regard to flexion. Furthermore, the most appropriate description of the functional anatomy of the ACL is still debated, with the ACL being described as consisting of 2 or 3 bundles or as a continuum of fibers. HYPOTHESIS As long as their origination and termination locations are defined within the ACL attachment site footprints, ACL bundles elongate in parallel with knee extension during gait. STUDY DESIGN Descriptive laboratory study. METHODS High-speed biplanar radiographs of the right knee joint were obtained during gait in 6 healthy male participants (mean ± SD: body mass index, 25.5 ± 1.2 kg/m2; age, 29.2 ± 3.8 years) with no history of lower extremity injury or surgery. Three-dimensional models of the right femur, tibia, and ACL attachment sites were created from magnetic resonance images. The bone models were registered to the biplanar radiographs, thereby reproducing the in vivo positions of the knee joint. For each knee position, the distances between the centroids of the ACL attachment sites were used to represent ACL length. The lengths of 1000 virtual bundles were measured for each participant by randomly sampling locations on the attachment site surfaces and measuring the distances between each pair of locations. Spearman rho rank correlations were performed between the virtual bundle lengths and ACL length. RESULTS The virtual bundle lengths were highly correlated with the length of the ACL, defined as the distance between the centroids of the attachment sites (rho = 0.91 ± 0.1, across participants; P < 5 × 10-5). The lengths of the bundles that originated and terminated in the anterior and medial aspects of the ACL were positively correlated (rho = 0.81 ± 0.1; P < 5 × 10-5) with the lengths of the bundles that originated and terminated in the posterior and lateral aspects of the ACL. CONCLUSION As long as their origination and termination points are specified within the footprint of the attachment sites, ACL bundles elongate in parallel as the knee is extended. CLINICAL RELEVANCE These data elucidate ACL functional anatomy and may help guide ACL reconstruction techniques.
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Affiliation(s)
- Zoë A. Englander
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Jocelyn Wittstein
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Adam P. Goode
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - William E. Garrett
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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Selective bundle tensioning in double-bundle MPFL reconstruction to improve restoration of dynamic patellofemoral contact pressure. Knee Surg Sports Traumatol Arthrosc 2020; 28:1144-1153. [PMID: 31740983 DOI: 10.1007/s00167-019-05789-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the optimal graft tension angles in a medial patellofemoral ligament (MPFL) reconstruction with selective bundle tensioning in order to restore patellofemoral contact pressure distributions closest to the native state. METHODS Twelve human cadaveric knee specimens were mounted with the femur on a custom-made fixation device allowing free range of motion in the knee joint for testing. Using a sensitive pressure film (Tekscan) patellofemoral contact pressure was measured in 15° intervals during a dynamic flexion movement from 0°-90° in the native state, in cut MPFL and after MPFL-reconstruction with a gracilis tendon. The graft was separated in two bundles and was fixed independently on the patella using two knotless anchors. Two groups were made with either the proximal or distal bundle fixed at the femur at a knee flexion angle of 30° and the corresponding other bundle subsequently fixed at the femur at 15°, 45°, 60°, 75° and 90° of knee flexion using extra-cortical fixation and controlled tension of 2N in both groups. The sequence of the flexion angles at the graft fixation was alternated. Pressure measurements were repeated after every fixation of the graft. RESULTS Cutting the MPFL resulted in significantly reduced patellofemoral contact pressure at all flexion angles. After MPFL reconstruction the patellofemoral contact pressure remained significantly reduced during dynamic knee flexion in all tested double-bundle combinations (p < 0.05) except for fixation of the proximal bundle in 30° and the distal bundle in 75°. Selective evaluation of lateral patellofemoral contact pressure, however, showed significant reduction in all tested double-bundle combinations (p < 0.05) from 15° to 90°. Evaluation of isolated medial patellofemoral pressure changes showed no significant difference in all tested combinations compared to the intact knee. Furthermore, evaluation of the isolated proximal and distal patellofemoral contact pressure also revealed a significantly reduced contact pressure in all tested double-bundle combinations (p < 0.05) except for fixation of the proximal bundle in 30° and the distal bundle in 75°. CONCLUSION According to this study, selective bundle tensioning in anatomic MPFL-reconstruction should be considered as an easy and more anatomic alternative to current popular techniques to restore patella kinematics and give clear recommendation about knee flexion angle and tension during fixation. Although tensioning two bundles separately may further improve clinical results. If performed, fixation of the graft is recommended under low tension (2N) with the proximal bundle at 30° and the distal bundle at 75° of knee flexion.
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21
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Chen AJ, Tatarski RL, Perry J, Quatman CE, Hewett TE, Di Stasi S. Single-leg hop mechanics are correlated with self-reported knee function early after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2020; 73:35-45. [PMID: 31931397 DOI: 10.1016/j.clinbiomech.2019.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/23/2019] [Accepted: 12/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Biomechanical changes that persist after anterior cruciate ligament (ACL) injury may impact short- and long-term outcomes. Understanding the relationship of biomechanics during a dynamic task and patient reported function can better identify patients who are most vulnerable to sub-optimal long-term outcomes, such as osteoarthritis (OA). The purpose of this study was to determine whether hip and knee biomechanics during single-leg hop landing were significantly correlated with the Knee injury and Osteoarthritis Outcome Score (KOOS), and whether symptomatic knees displayed altered biomechanics relative to asymptomatic knees. METHODS Hip and knee biomechanics during the landing phase of a single-leg hop of thirty subjects with ACLR were analyzed. Subjects were also classified as symptomatic or asymptomatic based on their KOOS results. Correlation analyses and group comparisons between symptomatic and asymptomatic subjects were conducted. FINDINGS KOOS Symptoms, Pain, and Sport subscales were significantly correlated with frontal and sagittal plane hip and knee biomechanics. Furthermore, those with symptomatic knees demonstrated greater hip and knee flexion angles, and greater hip flexion moments. INTERPRETATION These results indicate that biomechanics associated with ACLR during a single-leg hop are correlated with worse KOOS outcomes. However, these correlations may be due to symptoms of the recovery from ACLR rather than those of OA. The results of this study may help to identify rehabilitation opportunities for patients at risk for worse long-term outcomes after ACLR.
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Affiliation(s)
- Albert J Chen
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States.
| | - Rachel L Tatarski
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States; School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States
| | - Jennifer Perry
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Carmen E Quatman
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Timothy E Hewett
- Orthopedic Biomechanics Laboratories and Sports Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Division of Physical Therapy, The Ohio State University, Columbus, OH, United States
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22
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Lansdown DA, Ma CB. Clinical Utility of Advanced Imaging of the Knee. J Orthop Res 2020; 38:473-482. [PMID: 31498473 DOI: 10.1002/jor.24462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
Advanced imaging modalities, including computed tomography, magnetic resonance imaging (MRI), and dynamic fluoroscopic imaging, allow for a comprehensive evaluation of the knee joint. Compositional sequences for MRI can allow for an evaluation of the biochemical properties of cartilage, meniscus, and ligament that offer further insight into pathology that may not be apparent on conventional clinical imaging. Advances in image processing, shape modeling, and dynamic studies also offer a novel way to evaluate common conditions and to monitor patients after treatment. The purpose of this article is to review advanced imaging modalities of the knee and their current and anticipated future applications to clinical practice. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:473-482, 2020.
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Affiliation(s)
- Drew A Lansdown
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, San Francisco, California
| | - C Benjamin Ma
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, San Francisco, California
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23
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Yan W, Xu X, Xu Q, Sun Z, Chen D, Xu Z, Jiang Q, Shi D. In vivo gait kinematics of the knee after anatomical and non-anatomical single-bundle anterior cruciate ligament reconstruction-a prospective study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:799. [PMID: 32042815 DOI: 10.21037/atm.2019.12.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background The factors that influence functions of knees after anterior cruciate ligament reconstruction (ACLR) still remains uncertain. The functional restoration of knees after ACLR can be reflected on gait kinematics restoration. The purpose of this study was to evaluate the gait kinematics and clinical outcomes of knees after anatomical and non-anatomical single-bundle ACLR during level walking. Methods Thirty-four patients with unilateral primary single-bundle ACLR and 18 healthy people were recruited. Patients were divided into anatomical reconstruction group (AR group; n=13) and non-anatomical reconstruction group (Non-AR group; n=21) according to Bernard Quadrant method. The ACL graft orientations on coronal and sagittal planes were measured on 3D models from medical images. The 6 degrees of freedom (DOF) kinematics of knees and range of motion (ROM) of 6 DOF kinematics were measured with a portable optical tracking system. The comparison of 6 DOF kinematics and ROM of 6 DOF kinematics were performed between the ACLR knees and contralateral knees. The following assessments were also performed including clinical examination, KT-2000 arthrometer measurement, International Knee Documentation Committee (IKDC) and Lysholm scores. Results All patients reached a minimum follow-up of 6 months (10±4 months). For AR group and Non-AR group, no statistically significant differences were observed in gait kinematics between the ACLR knees and contralateral knees. No statistically significant differences between the ACLR knees and contralateral knees were observed in terms of ROM of 6 DOF kinematics in AR group. However, in Non-AR group, the ACLR knees exhibited significant ROM of anterior-posterior translation by approximately 0.5 cm than contralateral knees (P=0.0080). No statistically significant differences between the two groups were observed regarding IKDC subjective score, Lysholm score and KT-2000 arthrometer test. Conclusions The anatomical ACLR can restore close to normal gait kinematics and ROM of 6 DOF kinematics compared with non-anatomical ACLR. The ACL graft after anatomical ACLR simulated native ACL fibers to function in terms of graft orientation.
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Affiliation(s)
- Wenqiang Yan
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Xingquan Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Qian Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.,Laboratory for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Nanjing 210093, China
| | - Ziying Sun
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Dongyang Chen
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Zhihong Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.,Laboratory for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Nanjing 210093, China
| | - Dongquan Shi
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
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Tachibana Y, Mae T, Shino K, Matsuo T, Sugamoto K, Yoshikawa H, Nakata K. Sequential analysis of three-dimensional tibiofemoral relationship through anatomic anterior cruciate ligament reconstruction with gravity-assisted radiographic technique in prone position. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2019; 18:11-17. [PMID: 31641617 PMCID: PMC6796590 DOI: 10.1016/j.asmart.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/10/2019] [Accepted: 08/28/2019] [Indexed: 12/02/2022]
Abstract
Background/objectives It is important to restore the tibiofemoral relationship as well as the anterior knee laxity for more successful anterior cruciate ligament (ACL) reconstruction, since a residual abnormality in the tibiofemoral relationship would lead an abnormal stress on the articular cartilages/menisci and consequently increase the risk of osteoarthritis in the future. This study aimed to sequentially clarify the three-dimensional tibiofemoral relationship before and after anatomic anterior cruciate ligament (ACL) reconstruction under an anterior tibial load with a gravity-assisted radiographic technique in the prone position. Methods Fifteen patients with unilateral ACL injury participated in the study. Anatomic triple-bundle ACL reconstruction was performed using semitendinosus tendon autografts. During the computed tomography scans that were performed preoperatively, and those performed at 3 weeks and at 6 months postoperatively, the patients lay in the prone position with the knee flexed at 15°, wherein the calf weight could exert an anterior drawer force on the tibia due to gravity. Three-dimensional the tibial position relative to the femur were evaluated for each time point, followed by calculation of side-to-side differences in the parameters between the ACL-deficient/ACL-reconstructed knees and the contralateral intact knees. Seven healthy volunteers were enrolled in the control group and the side-to-side differences (right minus left) in these parameters were calculated. Results The tibia in the ACL-deficient knee was located anteriorly by 3.5 ± 1.1 mm and rotated internally by 2.4° ± 2.3°; these values were significantly larger than the corresponding values of −0.2 ± 1.5 mm and 0.1° ± 2.2° in the control group. However, at 3 weeks postoperatively, the tibia in the ACL-reconstructed knee was over-constrained as compared to that in the control group; it was located posteriorly by 2.5 ± 1.4 mm and rotated externally by 3.4° ± 3.4°. At 6 months postoperatively, no significant difference was observed in the tibial displacements/rotations between the patient and control groups. The side-to-side difference in the anterior knee laxity at the manual maximum anterior load was 0.1 ± 1.2 mm at 6 months postoperatively, with a significant improvement over the preoperative value of 7.4 ± 2.5 mm. Conclusions Anatomic ACL reconstruction could restore not only the normal anterior knee laxity, but also the normal tibiofemoral relationship even under an anterior tibial load.
Tibiofemoral relationship was analyzed before and after anatomic ACL reconstruction. Tibial anterior shift and internal rotation was observed in ACL-injuried knees. Anatomic ACL reconstruction could restore the normal tibiofemoral relationship.
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Affiliation(s)
- Yuta Tachibana
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Konsei Shino
- Sports Orthopaedic Center, Osaka Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Tomohiko Matsuo
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Kazuomi Sugamoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Ken Nakata
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
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Wada O, Gamada K, Aoyama N, Mizuno K, Iwasaki Y. A difference in rotational alignment of the tibio-femoral joint after anterior cruciate ligament reconstruction between the bone-patellar tendon-bone and semitendinosus-gracilis grafts. Clin Biomech (Bristol, Avon) 2019; 65:45-50. [PMID: 30965227 DOI: 10.1016/j.clinbiomech.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/22/2018] [Accepted: 03/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A question as to the effect of the graft choice on rotational kinematics after anterior cruciate ligament reconstruction remains unclear. The purpose of this study was to determine if there were any differences in rotational alignment of the knee after anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BTB) graft compared to that using semitendinosus-gracilis (STG) graft. METHODS Ten patients with BTB graft and 10 patients with STG graft were assessed at 3 months after ACL reconstruction. We compared the 6 degrees-of-freedom alignment of the tibiofemoral joint in the fully extended position between knees reconstructed with BTB graft and STG graft using the uninvolved knee as a control. FINDINGS The BTB graft group showed no difference in knee alignment between the ACL reconstructed knee and uninvolved knee, whereas the STG graft group showed greater external rotation in the ACL reconstructed knee than in the uninvolved knee (median values, 8.4° vs 5.8°; p = 0.022). INTERPRETATION ACL reconstruction with the STG graft leads to increased external tibial rotation. Our findings suggest that clinicians should make an effort to prevent increased external tibial rotation during the rehabilitation process in patients with STG graft.
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Affiliation(s)
- Osamu Wada
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Kazuyoshi Gamada
- Department of Rehabilitation, Hiroshima International University, 555-36, Kurosegakuendai, Higashihiroshima City, Hiroshima, Japan.
| | - Naoki Aoyama
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Kiyonori Mizuno
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Yasunobu Iwasaki
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
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Kim BK, Kim TW, Hwang CH, Park HK, Hwang KH, Sim JA, Lee YS, Lee BK. Analysis of Mechanical Loading after Anatomic Anterior Cruciate Ligament Reconstruction Using Combined Single-Photon Emission Computerized Tomography and Conventional Computerized Tomography. Knee Surg Relat Res 2019; 31:37-43. [PMID: 30871291 PMCID: PMC6425891 DOI: 10.5792/ksrr.18.012] [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: 01/28/2018] [Revised: 09/24/2018] [Accepted: 10/22/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose This study was to evaluate changes of the mechanical loading pattern after anatomic anterior cruciate ligament (ACL) reconstruction by analyzing uptake patterns using combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT). Materials and Methods On SPECT/CT, high signal intensity of the articular surface which shows biological activity and mean increase of mechanical loading was compared with that of the tibiofemoral shaft as a comparative signal. The proportion of positive signals was evaluated in all compartments of the operated knee. Analysis was performed according to combined injury. Results A relatively high proportion of positive signals was detected in the posterior zone of the lateral tibial plateau (23.5%) and trochlear groove (23.5%) although increased signal intensity was detected in all compartments. There was no statistical difference depending on the presence of combined injury and between single-bundle and double-bundle ACL reconstruction. Conclusions Following anatomic ACL reconstruction, higher signal intensity was detected, particularly in the posterior part of the lateral tibial plateau and trochlear groove. Close observation for further signal changes or osteoarthritic changes would be required even if there was no combined injury and anatomic reconstruction was performed.
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Affiliation(s)
- Byung Kag Kim
- Department of Orthopedic Surgery, Joint Center, Sungmin Hospital, Incheon
| | - Tae Won Kim
- Department of Orthopedic Surgery, Gil Medical Center, Incheon
| | - Chul Ho Hwang
- Department of Orthopedic Surgery, Gil Medical Center, Incheon
| | - Hong Ki Park
- Department of Orthopedic Surgery, Gil Medical Center, Incheon
| | | | - Jae Ang Sim
- Department of Orthopedic Surgery, Gil Medical Center, Incheon
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam
| | - Beom Koo Lee
- Department of Orthopedic Surgery, The Armed Forces Capital Hospital, Incheon, Korea
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Gagliardi AG, Carry PM, Parikh HB, Traver JL, Howell DR, Albright JC. ACL Repair With Suture Ligament Augmentation Is Associated With a High Failure Rate Among Adolescent Patients. Am J Sports Med 2019; 47:560-566. [PMID: 30730755 DOI: 10.1177/0363546518825255] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The anterior cruciate ligament (ACL) repair technique avoids graft harvest and therefore the risk of donor site morbidity. However, early failure rates after ACL repair with suture ligament augmentation (SLA) remain high. PURPOSE To compare surgical failure, functional outcomes, return to sport, and joint laxity between adolescents who underwent ACL repair with SLA and those who underwent ACL reconstruction with quadriceps tendon-patellar bone autograft (QPA). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Adolescent patients (7-18 years old) underwent ACL repair with SLA or ACL reconstruction with QPA. The authors collected data from those who had postoperative information pertaining to repaired ligament or graft failure, range of motion, complications, and return to sport at a minimum of 6 months after surgery. Participants were contacted after surgery to complete study questionnaires. RESULTS The cohort included 22 consecutive patients in the SLA group and 157 in the QPA group. The median duration of follow-up was 2.7 years (interquartile range, 2.0-3.6 years) in the QPA group and 3.2 years (2.2-3.4 years) in the SLA group. After adjustment for sex, age, body mass index, and time from injury to surgery, the hazard of graft failure in the SLA group was 10.66 times (95% CI, 3.41-32.92; P < .0001) that of the QPA group. The cumulative incidence of graft failure in the first 3 years after surgery was 48.8% (95% CI, 28.9%-73.1%) in the SLA group, as opposed to 4.7% (2.1%-10.3%) in the QPA group. There was no difference in return to sport between the groups. Among individuals who did not rerupture their ACL, International Knee Documentation Committee and Lysholm scores were comparable between the groups, as well as range of motion. CONCLUSION The risk of failure was significantly increased in the SLA group relative to the QPA group. The high risk of failure for the SLA group in this short-term follow-up should be considered when selecting the treatment for adolescent patients with an ACL injury.
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Affiliation(s)
| | | | - Harin B Parikh
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - David R Howell
- Children's Hospital Colorado, Aurora, Colorado, USA.,School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jay C Albright
- Children's Hospital Colorado, Aurora, Colorado, USA.,School of Medicine, University of Colorado, Aurora, Colorado, USA
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Somthavil S. Altered kinematics after anterior cruciate ligament reconstruction, and their role in the prevention of osteoarthritis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.10.529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Anterior cruciate ligament injury is common, and anterior cruciate ligament reconstruction has become the standard of care that aims to restore knee stability, return to activity, and prevent secondary injury. Methods: A literature review was carried out using PubMed and Science Direct databases from 1998 through 2017. Search terms included: anterior cruciate ligament reconstruction and knee osteoarthritis; kinematics after anterior cruciate ligament reconstruction; and prevention of knee osteoarthritis. A total of 356 studies matched the search terms. After removing duplicates and any studies that were not relevant, 73 studies remained. Findings: Individuals usually have impaired neuromuscular control after reconstruction, and abnormal biomechanical patterns may lead to loading of cartilage areas that are not commonly loaded and that, longitudinally, can lead to osteoarthritis. The knee adduction moment indicates loading of the knee joint and has been associated with the development of osteoarthritis and altered gait mechanics have also been implicated in the increased rate of osteoarthritis after anterior cruciate ligament reconstruction, including differences in tibial rotation during walking. Furthermore, altered ankle joint mechanics may be the result of deviations in ankle joint alignment secondary to the structural changes at the knee. It is clear that abnormal mechanical stimulation may cause dysfunction of articular chondrocytes and breakdown of cartilage extracellular matrix, leading to articular cartilage degradation and chondrocyte death. The affected joint will progress to post-traumatic osteoarthritis. Conclusions: The restoration of normal knee anatomy and mechanics, such as returning the joint to normal function, improving muscle strength, functional movement prevention programmes, restoring gait symmetry and weight management are recommended.
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Affiliation(s)
- Sompiya Somthavil
- Lecturer Faculty of Sports Science, Kasetsart University, Nakhon Pathom, Thailand
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Macri EM, Culvenor AG, Morris HG, Whitehead TS, Russell TG, Khan KM, Crossley KM. Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:2622-2629. [PMID: 28488001 DOI: 10.1007/s00167-017-4571-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/03/2017] [Indexed: 01/25/2023]
Abstract
PURPOSE Patellofemoral osteoarthritis (PFOA) occurs in approximately half of anterior cruciate ligament (ACL)-injured knees within 10-15 years of trauma. Risk factors for post-traumatic PFOA are poorly understood. Patellofemoral alignment and trochlear morphology may be associated with PFOA following ACL reconstruction (ACLR), and understanding these relationships, particularly early in the post-surgical time period, may guide effective early intervention strategies. In this study, patellofemoral alignment and trochlear morphology were investigated in relation to radiographic features of early PFOA 1-year post-ACLR. METHODS Participants (aged 18-50 years) had undergone ACLR approximately 1 year prior to being assessed. Early PFOA was defined as presence of a definite patellofemoral osteophyte on lateral or skyline radiograph. Sagittal and axial plane alignment and trochlear morphology were estimated using MRI. Using logistic regression, the relationship between alignment or morphology and presence of osteophytes was evaluated. RESULTS Of 111 participants [age 30 ± 8.5; 41 (37%) women], 19 (17%) had definite osteophytes, only two of whom had had patellofemoral chondral lesions noted intra-operatively. One measure of patellar alignment (bisect offset OR 1.1 [95% confidence interval 1.0, 1.2]) and two measures of trochlear morphology (sulcus angle OR 1.1 [1.0, 1.2], trochlear angle OR 1.2 [1.0, 1.5]) were associated with patellofemoral osteophytes. CONCLUSIONS Patellofemoral malalignment and/or altered trochlear morphology were associated with PFOA 1 year following ACLR compared to individuals post-ACLR without these features. Clarifying the role of alignment and morphology in post-traumatic PFOA may contribute to improving early intervention strategies aimed at secondary prevention. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Erin M Macri
- Department of Family Practice, Centre for Hip Health and Mobility, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Adam G Culvenor
- Institute of Anatomy, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria.,School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Hayden G Morris
- Park Clinic Orthopaedics, St. Vincent's Private Hospital, 166 Gipps Street, East Melbourne, VIC, 3002, Australia
| | - Timothy S Whitehead
- OrthoSport Victoria, Epworth Healthcare, Level 5, 89 Bridge Road, Richmond, VIC, 3121, Australia
| | - Trevor G Russell
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Karim M Khan
- Department of Family Practice, Centre for Hip Health and Mobility, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Kay M Crossley
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, 3086, Australia.
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Kroker A, Bhatla JL, Emery CA, Manske SL, Boyd SK. Subchondral bone microarchitecture in ACL reconstructed knees of young women: A comparison with contralateral and uninjured control knees. Bone 2018. [PMID: 29526780 DOI: 10.1016/j.bone.2018.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Anterior cruciate ligament (ACL) tears are a common sports-related knee injury that increases the risk of developing post-traumatic osteoarthritis (OA). During OA progression bone microarchitecture changes in the affected knee, however, little is known about bone microarchitecture in knees with early stage OA. The purpose of this study is to investigate in a cohort of females predisposed to develop OA how bone microarchitecture in ACL reconstructed knees differs from uninjured contralateral knees as well as healthy control knees and how this relates to early changes in OA. Bone microarchitecture was directly assessed in ACL reconstructed knees of injured female participants (n=15) with a median age of 25.4years (age range: 22.5-28.5) and compared to their uninjured contralateral knees, as well as to a healthy age-matched female control sample (n=14) with a median age of 25.2years (age range: 22.2-27.1). ACL reconstructed knees had lower trabecular bone mineral density (compared to contralateral: -7.7% to -10.4%, p<0.05; control knees: -7.1% to -13.9%, p<0.05) and altered trabecular bone microarchitecture in the medial femur compared to contralateral and control knees. The subchondral bone plate in the lateral femur was thicker in ACL reconstructed knees compared to contralateral (29.6%, p=0.009) and control knees (47.9% to 53.7%, p<0.05). Contralateral knees did not differ from control knees. Loss of trabecular bone and increased subchondral bone plate thickness in the ACL-reconstructed knees are consistent with changes associated with OA progression. Most differences in bone microarchitecture were found in the femur, with few differences in the tibia. The bone microarchitecture of contralateral knees did not differ from control knees in our participants, suggesting the potential to use them as control references in future longitudinal studies.
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Affiliation(s)
- Andres Kroker
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Jennifer L Bhatla
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
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31
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Erhart-Hledik JC, Chu CR, Asay JL, Andriacchi TP. Longitudinal changes in knee gait mechanics between 2 and 8 years after anterior cruciate ligament reconstruction. J Orthop Res 2018; 36:1478-1486. [PMID: 28984381 PMCID: PMC5889359 DOI: 10.1002/jor.23770] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/04/2017] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to longitudinally investigate changes in knee joint kinematics and kinetics from 2 to 8 years post-ACLR. Seventeen subjects with primary unilateral transtibial ACLR performed bilateral gait analysis approximately 2 years and 8 years post-ACLR. Seventeen matched healthy control subjects were also analyzed. Kinematic and kinetic comparisons between the ACLR and contralateral limbs over time were completed using a 2 × 2 (time, limb) repeated-measures ANOVA. Unpaired Student's t-tests were used to compare the ACLR and contralateral kinematics and kinetics to the control group. The ACLR and contralateral limbs had similar gait changes over time. Kinetic changes over time included a reduction in first (p = 0.048) and second (p < 0.001) peak extension moments, internal rotation moment (p < 0.001), adduction moment (first peak: p = 0.002, second peak: p = 0.009, impulse: p = 0.004) and an increase in peak knee flexion moment (p = 0.002). Kinematic changes over time included increases in peak knee flexion angle in the first half of stance (p = 0.026), minimum knee flexion angle in the second half of stance (p < 0.001), and average external rotation angle during stance (p = 0.007), and a reduction in average anterior femoral displacement during stance (p = 0.006). Comparison to healthy controls demonstrated improvement in some gait metrics over time. The results demonstrated longitudinal changes from 2 to 8 years after ACLR in knee joint kinetics and kinematics that have been related to clinical outcome after ACLR and the progression of knee OA, and support future larger and comprehensive investigations into long-term changes in joint mechanics in the ACLR population. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1478-1486, 2018.
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Affiliation(s)
| | - Constance R. Chu
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jessica L. Asay
- Department of Mechanical Engineering, Stanford University, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Thomas P. Andriacchi
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA,Department of Mechanical Engineering, Stanford University, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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Medial Patellofemoral Ligament Reconstruction: Impact of Knee Flexion Angle During Graft Fixation on Dynamic Patellofemoral Contact Pressure-A Biomechanical Study. Arthroscopy 2018; 34:1072-1082. [PMID: 29305291 DOI: 10.1016/j.arthro.2017.09.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 09/17/2017] [Accepted: 09/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Objective evaluation of the optimal graft tension angle to fully restore patellofemoral contact pressure in reconstruction of the medial patellofemoral ligament (MPFL) in comparison to the native knee. METHODS Twelve cadaveric knee specimens were fixed in a custom-made fixation device. A sensitive pressure film (Tekscan) was fixed in the patellofemoral joint, and patellofemoral contact pressure was assessed during a dynamic flexion movement from 0° to 90°. The MPFL was cut and measurements were repeated. Reconstruction of the MPFL was performed with the gracilis tendon subsequently fixed in the femur at 15°, 30°, 45°, 60°, 75°, and 90° of knee flexion under controlled tension (2 N). The sequence of the flexion angles was alternated. Pressure measurements were repeated after every fixation of the graft. RESULTS No significant differences were seen in the overall patellofemoral contact pressure compared to the native knee (P > .05). However, medial patellofemoral pressure showed a significant increased patellofemoral contact pressure after MPFL reconstruction at a knee flexion angle during graft fixation of 15° (P = .027), 45° (P = .050, P = .044), and 75° (P = .039). Moreover, proximal/distal patellofemoral contact pressure revealed a significantly reduced contact pressure at 15° (P = .003), 30° (P = .009), 45° (P = .025), 75° (P = .021), and 90° (P = .022) of flexion distal after MPFL reconstruction compared with the intact knee. Lateral patellofemoral contact pressure was significantly reduced in all performed reconstructions (P < .05). CONCLUSIONS The flexion angle during graft fixation for MPFL reconstruction did not have a significant impact on the overall patellofemoral contact pressure. However, selective medial, proximal, distal, and lateral patellofemoral contact pressure was significantly altered for all reconstructions. Fixation of the MPFL graft at 60° of flexion was able to most closely restore patellofemoral contact pressure compared with the intact knee. CLINICAL RELEVANCE Based on the findings of the present study, fixation of the graft in anatomic reconstruction of the MPFL should be considered in 60° of flexion under low tension (2 N) to most closely restore patellofemoral contact pressure compared with the native knee.
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Bregenhof B, Jørgensen U, Aagaard P, Nissen N, Creaby MW, Thorlund JB, Jensen C, Torfing T, Holsgaard-Larsen A. The effect of targeted exercise on knee-muscle function in patients with persistent hamstring deficiency following ACL reconstruction - study protocol for a randomized controlled trial. Trials 2018; 19:75. [PMID: 29373984 PMCID: PMC5787267 DOI: 10.1186/s13063-018-2448-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/03/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction, using hamstring auto-graft is a common surgical procedure, which often leads to persistent hamstring muscle-strength deficiency and reduced function. The purpose of this randomized controlled trial (RCT) is to investigate the effect of a combined, progressive, strength and neuromuscular exercise intervention on knee muscle strength, functional capacity and hamstring muscle-tendon morphology in ACL-reconstructed patients with persistent hamstring muscle-strength deficiency compared with controls. METHODS/DESIGN The study is designed as a multicenter, parallel-group RCT with balanced randomization (1:1) and blinded outcome assessments (level of evidence: II) and will be reported in accordance with the CONSORT Statement. Fifty ACL-reconstructed patients (hamstring auto-graft) with persistent limb-to-limb knee-flexor muscle-strength asymmetry at 12-24 months' post surgery, will be recruited through outpatient clinics and advertisements. Patients will be randomized to a 12-week progressive, strength and neuromuscular exercise group (SNG) with supervised training twice weekly or a control intervention (CON) consisting of a home-based, low-intensity exercise program. Outcome measures include between-group change in maximal isometric knee-flexor strength (primary outcome) and knee-extensor muscle strength, hamstring-to-quadriceps strength ratios of the leg that has been operated on and Knee injury and Osteoarthritis Outcome Score (KOOS) (secondary outcomes). In addition, several explorative outcomes will be investigated: The International Knee Documentation Committee Subjective Knee Form (IKDC), the Tegner Activity Score, rate of force development (RFD) for the knee flexors and extensors, tendon regeneration and potential muscle hypertrophy at graft harvest site evaluated by magnetic resonance imaging (MRI), postural control, kinetic/kinematic gait characteristics and knee-related functional capacity. DISCUSSION This RCT is designed to investigate the effect of combined, progressive-resistance and neuromuscular exercises on knee-flexor/extensor strength, in the late rehabilitation phase following ACL reconstruction. Reduced hamstring strength represents a potential risk factor for secondary ACL rupture and accelerated progression of osteoarthritis. If deemed effective, the intervention paradigm introduced in this study may help to improve current treatment strategies in ACL-reconstructed patients. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02939677 (recruiting). Registered on 20 October 2016.
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Affiliation(s)
- Bo Bregenhof
- Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark
- Department of Orthopaedics, Lillebaelt Hospital, Kolding, Skovvangen 2-8, 6000 Kolding, Denmark
| | - Uffe Jørgensen
- Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Nis Nissen
- Department of Orthopaedics, Lillebaelt Hospital, Kolding, Skovvangen 2-8, 6000 Kolding, Denmark
| | - Mark W. Creaby
- School of Exercise Science, Australian Catholic University, PO Box 456, Virginia, Queensland 4014 Australia
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Carsten Jensen
- Department of Orthopaedics, Lillebaelt Hospital, Kolding, Skovvangen 2-8, 6000 Kolding, Denmark
| | - Trine Torfing
- Department of Radiology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Anders Holsgaard-Larsen
- Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark
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Azus A, Teng HL, Tufts L, Wu D, Ma CB, Souza RB, Li X. Biomechanical Factors Associated With Pain and Symptoms Following Anterior Cruciate Ligament Injury and Reconstruction. PM R 2018; 10:56-63. [PMID: 28602934 DOI: 10.1016/j.pmrj.2017.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/08/2017] [Accepted: 05/20/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Few studies have investigated the associations between patient-reported outcome and gait in patients with anterior cruciate ligament (ACL) injury and reconstruction over time. Because there is an association between ACL rupture and the presence of osteoarthritis later in life, a better understanding of these relationships will help to elucidate how patients' gait pattern may affect pain and symptoms, potentially leading to better treatment for or preventing the development of knee OA. OBJECTIVE To evaluate the associations between gait characteristics and self-reported pain and symptoms before, 6 months after, and 1 year after anterior cruciate ligament reconstruction. DESIGN Prospective cohort study. SETTING The Human Performance Center at the Orthopedic Institute at the University of California, San Francisco. PATIENTS Patients with full unilateral ACL tears were enrolled. A total of 43 patients were included at 12 months postsurgery. METHODS The independent variable in this study comprised specific gait variables in patients who had undergone ACL reconstruction. At each time point, 3-dimensional motion analysis was performed. Participants also completed the Knee Osteoarthritis Outcome Score (KOOS) questionnaire. MAIN OUTCOMES MEASUREMENTS The primary study outcome measurement was the KOOS and was planned before data collection began. Partial correlations were used to examine cross-sectional associations between gait characteristics and KOOS pain and symptom scores at all time points. In addition, partial correlations were performed to examine the associations between change in postoperative KOOS from 6 months to 1 year and gait characteristics at baseline and 6 months. RESULTS Significant associations between KOOS and gait characteristics were found at all time points, including an association between peak medial ground reaction force and pain (r = -0.344, P = .02) and symptoms (r = -0.407, P = .007) at baseline. CONCLUSIONS Specific gait variables may be predictive of greater pain and symptoms and less improvement over time postreconstruction. This could help to inform rehabilitation exercises post injury and pre reconstruction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Aisia Azus
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107
| | - Hsiang-Ling Teng
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Lauren Tufts
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Daniel Wu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - C Benjamin Ma
- Department of Radiology and Biomedical Imaging and Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA
| | - Richard B Souza
- Department of Radiology and Biomedical Imaging and Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
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35
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A review of extra-articular prosthetic stabilization of the cranial cruciate ligament-deficient stifle. Vet Comp Orthop Traumatol 2017; 24:167-77. [DOI: 10.3415/vcot-10-06-0084] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 12/22/2010] [Indexed: 11/17/2022]
Abstract
SummaryExtra-articular prosthetic stabilization techniques have been used as a method of stabilization of the cranial cruciate ligament (CrCL)-deficient stifle for decades. During extra-articular prosthetic stabilization, the prosthesis is anchored to the femur and tibia, and tensioned in the attempt to resolve femorotibial instability. The position of the anchor points of the prosthesis is crucial for restoring a normal range of joint motion and mitigating alterations in prosthesis tension during motion. Recently developed techniques offer several innovations with potential advantages such as bone-to-bone fixation, prosthetic materials with better mechanical properties, and improved isometry of the anchor points. Whether these innovations provide clinically superior results to the traditional techniques such as lateral circumfabellar-tibial suture techniques has yet to be determined.
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36
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Jang KM, Park JH, Chang M, Kim Y, Lee D, Park S, Wang JH. Three-Dimensional Evaluation of Similarity of Right and Left Knee Joints. Knee Surg Relat Res 2017; 29:307-315. [PMID: 29046046 PMCID: PMC5718788 DOI: 10.5792/ksrr.16.076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 12/05/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the anatomical similarity of three-dimensional (3D) morphometric parameters between right and left knees. Materials and Methods Ten fresh-frozen paired cadaveric knees were tested. Following dissection, footprint areas of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were measured. Surface scanning was performed using a 3D scanner. Scanned data were reproduced and morphometric parameters were measured on specialized software. After making mirror models, we compared footprint center positions of the ACL and PCL of both sides and calculated the average deviation of 3D alignment between the right- and left-side models. Results No significant side-to-side differences were found in any morphometric parameters. Bony shapes displayed a side-to-side difference of <1 mm. Distal femoral and proximal tibial volumes did not present side-to-side differences, either; the average 3D deviations of alignment between the right and left sides were 0.8±0.4/1.1±0.6 mm (distal femur/proximal tibia). Center-to-center distances between the right and left ACL footprints were 2.6/2.7 mm (femur/tibia) for the anteromedial bundle and 2.4/2.8 mm for the posterolateral bundle. They were 1.9/1.5 mm for the anterolateral bundle and 2.2/1.8 mm for the posteromedial bundle of the PCL. Conclusions There was a remarkable 3D morphometric similarity between right and left knees. Our results might support the concept of obtaining morphologic reference data from the uninvolved contralateral knee.
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Affiliation(s)
- Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Koea
| | - Jong-Hoon Park
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Koea
| | - Minho Chang
- School of Mechanical Engineering, Korea University, Seoul, Koea
| | - Youngjun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Koea
| | - Deukhee Lee
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Koea
| | - Sehyung Park
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Koea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Koea
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Kiapour AM, Fleming BC, Murray MM. Structural and Anatomic Restoration of the Anterior Cruciate Ligament Is Associated With Less Cartilage Damage 1 Year After Surgery: Healing Ligament Properties Affect Cartilage Damage. Orthop J Sports Med 2017; 5:2325967117723886. [PMID: 28875154 PMCID: PMC5576541 DOI: 10.1177/2325967117723886] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Abnormal joint motion has been linked to joint arthrosis after anterior cruciate ligament (ACL) reconstruction. However, the relationships between the graft properties (ie, structural and anatomic) and extent of posttraumatic osteoarthritis are not well defined. HYPOTHESES (1) The structural (tensile) and anatomic (area and alignment) properties of the reconstructed graft or repaired ACL correlate with the total cartilage lesion area 1 year after ACL surgery, and (2) side-to-side differences in anterior-posterior (AP) knee laxity correlate with the total cartilage lesion area 1 year postoperatively. STUDY DESIGN Controlled laboratory study. METHODS Sixteen minipigs underwent unilateral ACL transection and were randomly treated with ACL reconstruction or bridge-enhanced ACL repair. The tensile properties, cross-sectional area, and multiplanar alignment of the healing ACL or graft, AP knee laxity, and cartilage lesion areas were assessed 1 year after surgery. RESULTS In the reconstructed group, the normalized graft yield and maximum failure loads, cross-sectional area, sagittal and coronal elevation angles, and side-to-side differences in AP knee laxity at 60° of flexion were associated with the total cartilage lesion area 1 year after surgery (R2 > 0.5, P < .04). In the repaired group, normalized ACL yield load, linear stiffness, cross-sectional area, and the sagittal and coronal elevation angles were associated with the total cartilage lesion area (R2 > 0.5, P < .05). Smaller cartilage lesion areas were observed in the surgically treated knees when the structural and anatomic properties of the ligament or graft and AP laxity values were closer to those of the contralateral ACL-intact knee. Reconstructed grafts had a significantly larger normalized cross-sectional area and sagittal elevation angle (more vertical) when compared with repaired ACLs (P < .02). CONCLUSION The tensile properties, cross-sectional area, and multiplanar alignment of the healing ACLs or grafts and AP knee laxity in reconstructed knees were associated with the extent of tibiofemoral cartilage damage after ACL surgery. CLINICAL RELEVANCE These data highlight the need for novel ACL injury treatments that can restore the structural and anatomic properties of the torn ACL to those of the native ACL in an effort to minimize the risk of early-onset posttraumatic osteoarthritis.
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Affiliation(s)
- Ata M Kiapour
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Braden C Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, USA
| | - Martha M Murray
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Lorbach O, Haupert A, Efe T, Pizanis A, Weyers I, Kohn D, Kieb M. Biomechanical evaluation of MPFL reconstructions: differences in dynamic contact pressure between gracilis and fascia lata graft. Knee Surg Sports Traumatol Arthrosc 2017; 25:2502-2510. [PMID: 26820966 DOI: 10.1007/s00167-016-4005-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 01/18/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the knee kinematics of the intact, MPFL-ruptured and MPFL-reconstructed knee and, moreover, to compare dynamic patellofemoral contact pressure of the gracilis tendon and the fascia lata as an alternative graft option for reconstruction of the MPFL. METHODS Eight paired human cadaveric knees were fixed in a custom-made fixation device. Patellofemoral contact pressure was assessed during a dynamic flexion movement at 15°-30°-45°-60°-75° and 90° using a pressure-sensitive film (Tekscan). The medial patellofemoral ligament was cut, and measurements were repeated. Finally, reconstruction of the MPFL was performed using the gracilis tendon (group I) or a fascia lata graft (group II). Tunnel localization was performed under fluoroscopic control. Grafts were fixed at 30° of flexion, and pressure measurements were repeated. RESULTS Incision of the medial patellofemoral ligament significantly reduced patellofemoral contact pressure at 15°, 30° and 45° of knee flexion compared to the intact knee (p < 0.05), whereas reconstruction of the MPFL using either gracilis tendon of the fascia lata was able to restore pressure distributions at 15° and 30° of knee flexion. However, in the hamstring group, reconstruction of the MPFL revealed a significantly reduced contact pressure at 45° of flexion (p = 0.038) compared to the intact knee. In the fascia lata group, a significant reduction in patellofemoral contact pressure was observed after MPFL reconstruction at 45°, 60°, 75° and 90° of knee flexion (p < 0.05). CONCLUSIONS Anatomic reconstruction of the MPFL with either a gracilis or a fascia lata graft showed comparable patellofemoral pressure distributions which were closely restored compared to the native knee. Therefore, the fascia lata has shown to be a viable alternative to the gracilis tendon for reconstruction of the MPFL. However, anatomic reconstruction of the MPFL may lead to persistently altered patellofemoral contact pressure during knee flexion compared to the native knee independent of the tested graft.
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Affiliation(s)
- Olaf Lorbach
- Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany.
| | - Alexander Haupert
- Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany
| | - Turgay Efe
- Department of Orthopaedic Surgery, Marburg University, Marburg, Germany
| | - Antonius Pizanis
- Department of Trauma-Hand and Reconstructive Surgery, Saarland University, Homburg (Saar), Germany
| | - Imke Weyers
- Institute of Anatomy, Lübeck University, Lübeck, Germany
| | - Dieter Kohn
- Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany
| | - Matthias Kieb
- Department of Orthopaedic and Trauma Surgery, Klinikum Ernst von Bergmann, Potsdam/Bad Belzig, Germany
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DeFrate LE. Effects of ACL graft placement on in vivo knee function and cartilage thickness distributions. J Orthop Res 2017; 35:1160-1170. [PMID: 28213953 PMCID: PMC5466493 DOI: 10.1002/jor.23541] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/23/2017] [Indexed: 02/04/2023]
Abstract
Injuries to the anterior cruciate ligament (ACL) frequently lead to early-onset osteoarthritis. Despite advancement in surgical techniques, ACL reconstruction has a limited ability to prevent these degenerative changes. While previous studies have investigated knee function after ACL reconstruction, in vivo investigations of the effects of graft placement on in vivo joint function and cartilage health are limited. This review presents a series of studies that used novel imaging and 3D modeling techniques to determine the in vivo placement of the ACL graft on the femur using two different ACL reconstruction techniques. These techniques resulted in two distinct graft placement groups: one where the ACL was placed anatomically near the center of the native ACL footprint and another where the graft was placed anteroproximally on the femur, centered outside the ACL footprint. We quantified the effects of graft placement on graft deformation during in vivo loading and how these variables affected knee motion. Finally, we quantified whether femoral placement of the graft affected cartilage thickness. Our results demonstrate that achieving anatomic graft placement on the femur is critical to restoring native ACL function and normal knee kinematics. Knees with grafts that more closely restored normal ACL function, and thus knee motion, experienced less focal cartilage thinning than did those that experienced abnormal knee motion. These results suggest that achieving anatomic graft placement is a critical factor in restoring normal knee motion and potentially slowing the development of degenerative changes after ACL reconstruction. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1160-1170, 2017.
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Affiliation(s)
- Louis E. DeFrate
- Department of Orthopaedic Surgery, Mechanical Engineering and Materials Science, and Biomedical Engineering, Duke University, Durham, NC USA
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Pedoia V, Su F, Amano K, Li Q, McCulloch CE, Souza RB, Link TM, Ma BC, Li X. Analysis of the articular cartilage T 1ρ and T 2 relaxation times changes after ACL reconstruction in injured and contralateral knees and relationships with bone shape. J Orthop Res 2017; 35:707-717. [PMID: 27557479 PMCID: PMC6863081 DOI: 10.1002/jor.23398] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 08/19/2016] [Indexed: 02/04/2023]
Abstract
The objectives of this study were twofold: (1) to evaluate the longitudinal change in cartilage T1ρ and T2 6- and 12-months after ACL reconstruction (ACLR) in both reconstructed and intact contralateral knees with the aim of validating the role of the contralateral knee as an internal control in longitudinal studies; (2) to explore relationships between bone shape at the time of injury and the progression of T1ρ and T2 over 12-months after ACLR. T1ρ and T2 cartilage relaxation times and 3D MRI-based statistical shape modeling (SSM) of tibia and femur were computed for both knees of forty ACL-injured patients and 15 healthy controls. ACL subjects were scanned 8.4 ± 6.4 weeks after injury (2.4 ± 3.7 weeks prior to ACLR), 6- and 12-months after ACLR. Longitudinal changes in T1ρ and T2 values were assessed using linear mixed model, and partial correlation coefficients were calculated between bone shape and longitudinal changes in T1ρ and T2 values. Significant longitudinal increases in T1ρ and T2 values were observed in reconstructed and contralateral knees 6-months after ACLR. Tibial bone shape features, associated with the medial plateau height and width, were observed to be correlated with cartilage T1ρ and T2 progression in reconstructed knees. Our results suggest that caution should be used in considering contralateral knee as internal controls in longitudinal ACL studies and 3D MRI-based-SSM might serve as an imaging biomarker for the early stratification of patients at risk for developing post-traumatic accelerated cartilage degeneration and potentially osteoarthritis after ACL tear. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:707-717, 2017.
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Affiliation(s)
- Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, California 94107
| | - Favian Su
- Department of Radiology and Biomedical Imaging, University of California, 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, California 94107
| | - Keiko Amano
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Qi Li
- Department of Radiology and Biomedical Imaging, University of California, 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, California 94107
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Richard B. Souza
- Department of Radiology and Biomedical Imaging, University of California, 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, California 94107,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California, 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, California 94107
| | - Benjamin C. Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California, 1700 Fourth Street, Suite 201, QB3 Building, San Francisco, California 94107
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Functional Bracing After Anterior Cruciate Ligament Reconstruction: A Systematic Review. J Am Acad Orthop Surg 2017; 25:239-249. [PMID: 28195986 DOI: 10.5435/jaaos-d-15-00710] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate the current literature on the use of functional knee braces after anterior cruciate ligament (ACL) reconstruction with respect to clinical and in vivo biomechanical data. METHODS A systematic search of both the PubMed and Embase databases was performed to identify all studies that reported clinical and/or in vivo biomechanical results of functional bracing versus nonbracing after ACL reconstruction. Extracted data included study design, surgical reconstruction techniques, postoperative rehabilitation protocols, objective outcomes, and subjective outcomes scores. The in vivo biomechanical data collected included kinematics, strength, function, and proprioception. Subjective clinical outcomes scores were collected when available. Quality appraisal analyses were performed using the Cochrane Collaboration tools for randomized and nonrandomized trials to aid in data interpretation. RESULTS Fifteen studies met the selection criteria (including 3 randomized trials [level II], 11 nonrandomized trials [level II], and 1 retrospective comparative study [level III]), with follow-up intervals ranging from 3 to 48 months. Most studies were designed to compare the effects of functional bracing versus nonbracing on subjective and objective results in patients who underwent previous primary ACL reconstruction. Functional bracing significantly improved kinematics of the knee joint and improved gait kinetics, although functional bracing may decrease quadriceps activation without affecting functional tests, range of motion, and proprioception. Four studies reported no differences in subjective outcomes scores with brace use; however, one study reported increased patient confidence with brace use, whereas another study reported decreased pain and quicker return to work when the brace was not used. CONCLUSIONS The effectiveness of postoperative functional bracing following ACL reconstruction remains elusive. Some data suggest that functional bracing may have some benefit with regard to in vivo knee kinematics and may offer increased protection of the implanted graft after ACL reconstruction without sacrificing function, range of motion, or proprioception. However, limited evidence exists supporting the use of routine functional bracing to decrease the rate of reinjury after ACL reconstruction.
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Erhart-Hledik JC, Chu CR, Asay JL, Andriacchi TP. Gait mechanics 2 years after anterior cruciate ligament reconstruction are associated with longer-term changes in patient-reported outcomes. J Orthop Res 2017; 35:634-640. [PMID: 27238273 PMCID: PMC5823008 DOI: 10.1002/jor.23317] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/25/2016] [Indexed: 02/04/2023]
Abstract
This study tested the hypothesis that side-to-side differences in knee gait mechanics 2 years after anterior cruciate ligament (ACL) reconstruction are associated with long-term (∼8 years post-reconstruction) changes in patient-reported outcome scores. Sixteen subjects (5 males; age: 29.1 ± 7.1 years) with primary unilateral ACL reconstruction were gait tested at baseline (2.2 ± 0.3 years post-ACL reconstruction) and filled out KOOS and Lysholm surveys. At long-term follow-up (7.7 ± 0.7 years post-ACL reconstruction), the same subjects completed KOOS and Lysholm surveys. Pearson correlation coefficients assessed relationships between side-to-side differences in kinematics and kinetics at baseline and changes in Lysholm and KOOS Pain/QOL scores from 2 to 8 years post-ACL reconstruction. Significant associations were seen between greater average varus rotation (Lysholm: R = -0.654, p = 0.006) and less anterior femoral displacement (Lysholm: R = 0.578, p = 0.019) during stance of the ACL reconstructed knee versus the contralateral knee at baseline and worse follow-up outcome scores. Significant associations were seen between greater peak knee flexion moment (KOOS Pain: R = -0.572, p = 0.026; KOOS QOL: R = -0.636, p = 0.011), peak knee adduction moment (Lysholm: R = -0.582, p = 0.018; KOOS Pain: R = -0.742, p = 0.002; KOOS QOL: R = -0.551, p = 0.033), and peak internal rotation moment (Lysholm: R = 0.525, p = 0.037; KOOS Pain: R = 0.815, p < 0.001; KOOS QOL: R = 0.777, p = 0.001) in the ACL reconstructed knee at baseline with worse follow-up outcomes. The results of this study support the hypotheses that early changes in gait mechanics following ACL reconstruction are associated with longer-term clinical changes in patient-reported outcomes, suggesting that biomechanical markers obtained as early as 2 years after ACL reconstruction may be useful to understand clinical outcomes in this population. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:634-640, 2017.
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Affiliation(s)
- Jennifer C. Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Department of Mechanical Engineering, Stanford University, Stanford, California
| | - Constance R. Chu
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jessica L. Asay
- Department of Mechanical Engineering, Stanford University, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Thomas P. Andriacchi
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Department of Mechanical Engineering, Stanford University, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Miao X, Huang H, Hu X, Li D, Yu Y, Ao Y. The characteristics of EEG power spectra changes after ACL rupture. PLoS One 2017; 12:e0170455. [PMID: 28182627 PMCID: PMC5300146 DOI: 10.1371/journal.pone.0170455] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 01/05/2017] [Indexed: 11/25/2022] Open
Abstract
Background Reestablishing knee stability is the core of the treatment of ACL (Anterior Cruciate Ligament) injury. Some patients still have a feeling of instability of the knee after ACL injury treatment. This unstable feeling may be caused by central nervous system changes after ACL rupture. Methods To identify the central changes after ACL rupture, EEG spectra were recorded to compare ACL patients and healthy controls when they were walking, jogging, and landing. Results There was a significant increase in delta, theta, alpha and beta band power during walking, jogging and landing in ACL patients. We also found an asymmetry phenomenon of EEG only in the ACL patients, mainly in the frontal area and central-parietal area. The asymmetry of beta band power extended to the frontal and the central area during jogging and landing task. Conclusions There were significant differences in EEG power spectra between the ACL patients and healthy people. ACL patients showed high EEG band power activities and an asymmetry phenomenon. EEG power changes were affected by movements, the asymmetry extended when performing more complicated movements.
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Affiliation(s)
- Xin Miao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Hongshi Huang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Dai Li
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yuanyuan Yu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yingfang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
- * E-mail:
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Branch TP, Stinton SK, Siebold R, Freedberg HI, Jacobs CA, Hutton WC. Assessment of knee laxity using a robotic testing device: a comparison to the manual clinical knee examination. Knee Surg Sports Traumatol Arthrosc 2017; 25:2460-2467. [PMID: 26704793 PMCID: PMC5522506 DOI: 10.1007/s00167-015-3935-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/09/2015] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study was to collect knee laxity data using a robotic testing device. The data collected were then compared to the results obtained from manual clinical examination. METHODS Two human cadavers were studied. A medial collateral ligament (MCL) tear was simulated in the left knee of cadaver 1, and a posterolateral corner (PLC) injury was simulated in the right knee of cadaver 2. Contralateral knees were left intact. Five blinded examiners carried out manual clinical examination on the knees. Laxity grades and a diagnosis were recorded. Using a robotic knee device which can measure knee laxity in three planes of motion: anterior-posterior, internal-external tibia rotation, and varus-valgus, quantitative data were obtained to document tibial motion relative to the femur. RESULTS One of the five examiners correctly diagnosed the MCL injury. Robotic testing showed a 1.7° larger valgus angle, 3° greater tibial internal rotation, and lower endpoint stiffness (11.1 vs. 24.6 Nm/°) in the MCL-injured knee during varus-valgus testing when compared to the intact knee and 4.9 mm greater medial tibial translation during rotational testing. Two of the five examiners correctly diagnosed the PLC injury, while the other examiners diagnosed an MCL tear. The PLC-injured knee demonstrated 4.1 mm more lateral tibial translation and 2.2 mm more posterior tibial translation during varus-valgus testing when compared to the intact knee. CONCLUSIONS The robotic testing device was able to provide objective numerical data that reflected differences between the injured knees and the uninjured knees in both cadavers. The examiners that performed the manual clinical examination on the cadaver knees proved to be poor at diagnosing the injuries. Robotic testing could act as an adjunct to the manual clinical examination by supplying numbers that could improve diagnosis of knee injury. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | | | | | | | | | - W. C. Hutton
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA USA
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Corpus KT, Camp CL, Dines DM, Altchek DW, Dines JS. Evaluation and treatment of internal impingement of the shoulder in overhead athletes. World J Orthop 2016; 7:776-784. [PMID: 28032029 PMCID: PMC5155252 DOI: 10.5312/wjo.v7.i12.776] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
One of the most common pathologic processes seen in overhead throwing athletes is posterior shoulder pain resulting from internal impingement. “Internal impingement” is a term used to describe a constellation of symptoms which result from the greater tuberosity of the humerus and the articular surface of the rotator cuff abutting the posterosuperior glenoid when the shoulder is in an abducted and externally rotated position. The pathophysiology in symptomatic internal impingement is multifactorial, involving physiologic shoulder remodeling, posterior capsular contracture, and scapular dyskinesis. Throwers with internal impingement may complain of shoulder stiffness or the need for a prolonged warm-up, decline in performance, or posterior shoulder pain. On physical examination, patients will demonstrate limited internal rotation and posterior shoulder pain with a posterior impingement test. Common imaging findings include the classic “Bennett lesion” on radiographs, as well as articular-sided partial rotator cuff tears and concomitant SLAP lesions. Mainstays of treatment include intense non-operative management focusing on rest and stretching protocols focusing on the posterior capsule. Operative management is variable depending on the exact pathology, but largely consists of rotator cuff debridement. Outcomes of operative treatment have been mixed, therefore intense non-operative treatment should remain the focus of treatment.
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Relationship between increased in vivo meniscal loads and abnormal tibiofemoral surface alignment in ACL deficient sheep is varied. J Biomech 2016; 49:3824-3832. [DOI: 10.1016/j.jbiomech.2016.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 10/01/2016] [Accepted: 10/11/2016] [Indexed: 01/14/2023]
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SAXBY DAVIDJOHN, BRYANT ADAML, MODENESE LUCA, GERUS PAULINE, KILLEN BRYCEA, KONRATH JASON, FORTIN KARINE, WRIGLEY TIMV, BENNELL KIML, CICUTTINI FLAVIAM, VERTULLO CHRISTOPHER, FELLER JULIANA, WHITEHEAD TIM, GALLIE PRICE, LLOYD DAVIDG. Tibiofemoral Contact Forces in the Anterior Cruciate Ligament–Reconstructed Knee. Med Sci Sports Exerc 2016; 48:2195-2206. [DOI: 10.1249/mss.0000000000001021] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Postoperative time dependent tibiofemoral articular cartilage contact kinematics during step-up after ACL reconstruction. J Biomech 2016; 49:3509-3515. [PMID: 27720228 DOI: 10.1016/j.jbiomech.2016.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 11/23/2022]
Abstract
This study was to investigate the in vivo tibiofemoral cartilage contact locations before and after anterior cruciate ligament (ACL) reconstruction at 6 and 36 months. Ten patients with unilateral ACL injury were included. A step-up motion was analyzed using a combined magnetic resonance modeling and dual fluoroscopic imaging techniques. The preoperative (i.e. ACL deficient and healthy contralateral) and postoperative cartilage contact locations at 6 and 36 months were analyzed. Similar patterns of the cartilage contact locations during the step-up motion were found for the preoperative and postoperative knee states as compared to the preoperative healthy contralateral side. At the end of step-up motion, the medial contact locations at postoperative 36 months were more anterior when compared to the preoperative healthy contralateral (p=0.02) and 6 months postoperative knee states (p=0.01). The changes of the cartilage contact locations at 36 months after ACL reconstruction compared to the healthy contralateral side were strongly correlated with the changes at 6 months postoperatively. This study showed that the tibiofemoral cartilage contact locations of the knee changes with time after ACL reconstruction, implying an ongoing recovery process within the 36 months after the surgery. There could be an association between the short-term (6 months) and longer-term (36 months) contact kinematics after ACL reconstruction. Future studies need to investigate the intrinsic relationship between knee kinematics at different times after ACL reconstruction.
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49
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Halonen KS, Mononen ME, Jurvelin JS, Töyräs J, Kłodowski A, Kulmala JP, Korhonen RK. Importance of Patella, Quadriceps Forces, and Depthwise Cartilage Structure on Knee Joint Motion and Cartilage Response During Gait. J Biomech Eng 2016; 138:2520868. [DOI: 10.1115/1.4033516] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Indexed: 11/08/2022]
Abstract
In finite-element (FE) models of the knee joint, patella is often omitted. We investigated the importance of patella and quadriceps forces on the knee joint motion by creating an FE model of the subject's knee. In addition, depthwise strains and stresses in patellar cartilage with different tissue properties were determined. An FE model was created from subject's magnetic resonance images. Knee rotations, moments, and translational forces during gait were recorded in a motion laboratory and used as an input for the model. Three material models were implemented into the patellar cartilage: (1) homogeneous model, (2) inhomogeneous (arcadelike fibrils), and (3) random fibrils at the superficial zone, mimicking early stages of osteoarthritis (OA). Implementation of patella and quadriceps forces into the model substantially reduced the internal–external femoral rotations (versus without patella). The simulated rotations in the model with the patella matched the measured rotations at its best. In the inhomogeneous model, maximum principal stresses increased substantially in the middle zone of the cartilage. The early OA model showed increased compressive strains in the superficial and middle zones of the cartilage and decreased stresses and fibril strains especially in the middle zone. The results suggest that patella and quadriceps forces should be included in moment- and force-driven FE knee joint models. The results indicate that the middle zone has a major role in resisting shear forces in the patellar cartilage. Also, early degenerative changes in the collagen network substantially affect the cartilage depthwise response in the patella during walking.
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Affiliation(s)
- K. S. Halonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, Kuopio FI-70211, Finland e-mail:
| | - M. E. Mononen
- Department of Applied Physics, University of Eastern Finland, POB 1627, Kuopio FI-70211, Finland
| | - J. S. Jurvelin
- Department of Applied Physics, University of Eastern Finland, POB 1627, Kuopio FI-70211, Finland
- Diagnostic Imaging Centre, Kuopio University Hospital, POB 100, Kuopio FI-70029, Finland
| | - J. Töyräs
- Department of Applied Physics, University of Eastern Finland, POB 1627, Kuopio FI-70211, Finland
- Diagnostic Imaging Centre, Kuopio University Hospital, POB 100, Kuopio FI-70029, Finland
| | - A. Kłodowski
- Laboratory of Machine Design, Lappeenranta University of Technology, Lappeenranta 53850, Finland
| | - J.-P. Kulmala
- Department of Biology of Physical Activity, University of Jyväskylä, Jyväskylä 40014, Finland
| | - R. K. Korhonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, Kuopio FI-70211, Finland
- Diagnostic Imaging Centre, Kuopio University Hospital, POB 100, Kuopio FI-70029, Finland
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50
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Chen WL, Chen YT, Huang SY, Yang CY, Wu CD, Chang CW. Landing strategies focusing on the control of tibial rotation in the initial contact period of one-leg forward hops. Scand J Med Sci Sports 2016; 27:832-841. [PMID: 27185513 DOI: 10.1111/sms.12696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 01/10/2023]
Abstract
Anterior cruciate ligament (ACL) reconstruction (ACLR) surgeries successfully restore anterior tibial translation but not tibial rotation. This study aimed to explore landing strategies focusing on the control of tibial rotation at landing when the ACL is most vulnerable. Three groups of male subjects (50 ACLRs, 26 basketball players, and 31 controls) participated in one-leg forward hop tests for determining the tibial rotatory landing strategies adopted during the initial landing phase. The differences in knee kinematics and muscle activities between internal and external tibial rotatory (ITR, ETR) landing strategies were examined. A higher proportion of basketball players (34.6%) were found to adopt ITR strategies (controls: 6.5%), exhibiting significantly greater hopping distance and knee strength. After adjusting for hopping distance, subjects adopting ITR strategies were found to hop faster with straighter knees at foot contact and with greater ITR and less knee adduction angular displacement during the initial landing phase. However, significantly greater angular displacement in knee flexion, greater medial hamstring activities, and greater co-contraction index of hamstrings and medial knee muscles were also found during initial landing. Our results support the importance of the recruitments of medial hamstrings or the local co-contraction in assisting the rotatory control of the knee during initial landing for avoiding ACL injuries.
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Affiliation(s)
- W-L Chen
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan
| | - Y-T Chen
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan
| | - S-Y Huang
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan
| | - C-Y Yang
- Department of Orthopaedics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - C-D Wu
- Department of Orthopedics, Chi-Mei Medical Center, Tainan, Taiwan
| | - C-W Chang
- Department of Orthopaedics, National Cheng Kung University Hospital, Tainan, Taiwan
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