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PURPOSE: The purpose of this study was to investigate the impact of sex on knee function, activity and quality of life following meniscus surgery using data from the German Arthroscopy Registry. METHODS: This is a retrospective cohort study with data collected between 2017 and 2022. Patient-reported outcome measures (PROMs), namely Knee Injury and Osteoarthritis Outcome Score (KOOS), EuroQol Visual Analogue Scale (EQ Scale), and Marx Activity Rating Scale (MARS), were collected preoperatively and at 6, 12 and 24 months postoperatively. Data were analysed to examine differences between male and female patients regarding PROMs, pre-existing conditions, meniscus lesion types and surgical treatments. RESULTS: A total of 1106 female (36.6%) and 1945 male patients (63.7%) were included. Males were significantly younger than females and had a higher body mass index. Overall, there were four times more medial meniscus lesions (MMLs) (77.5%) than lateral meniscus lesions (LMLs) (27.9%). Degenerative LMLs were more frequent in females, while traumatic LMLs were more common in males. Frequencies of traumatic and degenerative MMLs were similar among males and females. Males had higher absolute KOOS irrespective of treatment or meniscus lesion type. Meniscus repair resulted in similar improvements in ΔKOOS for both sexes, while meniscus resection exhibited higher absolute KOOS for males at each time point. Males generally had higher EQ Scale and MARS than females. CONCLUSION: Greater improvements in knee function, activity and quality of life were observed in males. While MMLs appear to be comparable among sexes, the nature of LML differed significantly. These results may help surgeons to refine patient selection for specific treatments to improve overall clinical outcomes. LEVEL OF EVIDENCE: Level III.
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PURPOSE: In recent years, anterior cruciate ligament (ACL) injuries have been frequently observed in ski jumping. However, available data in this discipline are very scarce. Therefore, the purpose of this study was to investigate whether an ACL injury in elite-level ski jumping limits the performance level after ACL reconstruction (ACLR). METHODS: Both male and female elite-level ski jumpers from five national A-teams who suffered an ACL injury were identified retrospectively by searching available media reports and Fédération Internationale de Ski (FIS) database. World Cup (WC) results and time-out-of-competition before ACL injury and after ACLR were compared. Only athletes who suffered the injury during or after the 2009-2010 season and who participated in at least one WC competition before the injury were included in this study. The level of athletes' performance from two full seasons before until three seasons after the injury was compared. RESULTS: Eighteen elite-level ski jumpers (11 males/seven females) were eligible for the study. All male and four female athletes returned to professional competition after ACLR. One female athlete ended her career due to prolonged recovery and two have not yet recovered due to a recent injury. The mean return-to-competition (RTC) time was 14.6 months in males and 13.5 months in females. The mean WC placement decreased after the ACL injury: two seasons before injury the mean position was 17.9 ± 11.0 (n = 12), one season before it was 22.4 ± 12.8 (n = 15). After recovery, the mean placement in seasons 1-3 was: 26.4 ± 8.9 (n = 7), 25.7 ± 10.3 (n = 13), 33.6 ± 12.2 (n = 10) (p = 0.008). Among the athletes returning to competition, only six males and three females reached their preinjury level and only one male and one female (compared to seven males and three females preinjury) reached an individual top-3 placement after ACLR, accounting for less than 10% of podiums compared to preinjury. CONCLUSION: Only 60% of the professional ski jumpers reached the preinjury level and less than 15% reached a top-3 placement after the ACL injury. These results support the fact that ACL tear during a ski jumping career may be a significant factor limiting high-level performance. In terms of clinical relevance, the findings implicate the need to analyse the reasons of these very low rates of return to elite-level performance, to analyse ACL injury and RTC rates at lower levels of performance and to develop specific prevention strategies in order to reduce the number of ACL injuries in this sport. LEVEL OF EVIDENCE: Level IV.
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Lesões do Ligamento Cruzado Anterior , Desempenho Atlético , Humanos , Masculino , Feminino , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos Retrospectivos , Volta ao Esporte , AtletasRESUMO
PURPOSE: Social media has become the new information acquisition platform for all content producers. In the current literature, there are no studies examining the content quality and the strengths and weaknesses of videos on Instagram that explain anterior cruciate ligament (ACL) injuries, which is the most discussed topic of sports surgery. The aim of this study was to evaluate the quality, strengths and weaknesses of information pertaining to ACL surgery that is disseminated on Instagram. METHOD: An Instagram search was conducted from 30 May 2023 to 30 January 2024. The search encompassed six languages (English, Spanish, German, French, Italian and Turkish) and was performed by six different observers. The investigation focused on eight subheadings derived from current literature on the ACL. These subheadings were addressed in Instagram videos, covering ACL biology or biomechanics, injury mechanism, injury prevention, injury evaluation, surgical technique, injury or surgery complications, injury rehabilitation process and return to sport or work. RESULT: The content was assessed of 127 videos from 127 Instagram accounts, spanning six different languages. Across the review of eight subheadings, the average number covered for the entire group was 3 (range, 0-8). Further analysis revealed that surgical technique was the most frequently mentioned subheading for the whole group (68.5%), followed by injury evaluation (54.3%). Prevention (10.2%) and complications (19.6%) were the least mentioned subheadings. The number of followers showed a correlation with video content quality. CONCLUSION: Although the video quality scores were found to be moderate, the content often focused on surgery and evaluation subheadings. The prevalence of incomplete information underscores the importance of developing strategies to ensure more comprehensive and accurate dissemination of medical knowledge. LEVEL OF EVIDENCE: Level V.
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Lesões do Ligamento Cruzado Anterior , Mídias Sociais , Gravação em Vídeo , Humanos , Lesões do Ligamento Cruzado Anterior/cirurgia , Ortopedia , Reconstrução do Ligamento Cruzado Anterior , Cirurgiões Ortopédicos , Disseminação de Informação/métodosRESUMO
BACKGROUND: Mechanical alignment after total knee arthroplasty (TKA) is still widely used in the surgical community, but the alignment finally obtained by conventional techniques remains uncertain. The recent Coronal Plane Alignment of the Knee (CPAK) classification distinguishes 9 knee phenotypes according to constitutional alignment and joint line obliquity (JLO). The aim of this study was to assess the phenotypes of osteoarthritic patients before and after TKA using mechanical alignment and to analyze the influence of CPAK restoration on functional outcomes. METHODS: This retrospective multicenter study included 178 TKAs with a minimum follow-up of 2 years. Patients were operated on using a conventional technique with the goal of neutral mechanical alignment. The CPAK grade (1 to 9), considering the arithmetic Hip-Knee-Ankle angle (aHKA) and the JLO, was determined before and after TKA. Functional results were assessed using the following patient-reported outcome measures: Knee Injury and Osteoarthritis Outcome Score, the Simple Knee Value, and the Forgotten Joint Score. RESULTS: A true neutral mechanical alignment was obtained in only 37.1%. Isolated restoration of JLO was found in 31.4%, and isolated restoration of the aHKA in 44.9%. Exact restoration of the CPAK phenotype was found in 14.6%. Restoration of the CPAK grade was associated with an improvement in the "daily living": 79.2 ± 5.3 versus 62.5 ± 2.3 (R2 = 0.05, P < .05) and "Quality of life" Knee Injury and Osteoarthritis Outcome Score subscales: 73.8 ± 5.0 versus 62.9 ± 2.2 (R2 = 0.02, P < .05). CONCLUSIONS: This study shows that few neutral mechanical alignments are finally obtained after TKA by conventional technique. A major number of patients present a postoperative modification of their constitutional phenotype. Functional results at 2 years of follow-up appear to be improved by the restoration of the CPAK phenotype, JLO, and aHKA. LEVEL OF CLINICAL ART EVIDENCE: III, Retrospective Cohort Study.
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PURPOSE: The aim was to validate a new MRI method to measure the buckling phenomenon of the PCL, representative of anterior tibial translation, by comparing its reliability and accuracy to identify anterior cruciate ligament (ACL)-deficient knees with existing methods. METHODS: Patients were selected retrospectively and separated into a group of primary ACL injuries and ACL-intact knees. Exclusion criteria were: skeletal immaturity, PCL or a concomitant collateral ligament injury, signs of osteoarthritis (> 1 Kellgren and Lawrence score), tibial plateau fracture, previous ACL reconstruction or displaced meniscal bucket handle tear. The assessment of the curvature of the anterolateral bundle of the PCL was performed on T2 sagittal MRI slices according to 3 methods: (1) the PCL angle (PCLA), (2) the PCL inclination angle (PCLIA) and (3) a new method: the PCL-posterior cortex angle (PCL-PCA), representing the angle between the vertical part of the PCL-ALB and the posterior diaphyseal cortex of the femur. For each method, the inter- and intra-observer reliability was measured. The ability to discriminate both ACL-deficient and ACL-intact knees was evaluated using ROC curves. RESULTS: Twenty-four patients were included in each group. Intra-observer reliability was excellent for all 3 methods (ICCs > 0.90). Inter-observer reliability was excellent for the PCL-PCA (ICC > 0.90) and good for the PCLA and the PCLIA (ICCs between 0.75 and 0.90). The PCL-PCA had the highest precision (lowest standard error of measurement: 2.7°). It yielded an excellent discrimination between the ACL and CTL groups (AUC 0.80 [0.67-0.93]) with the highest sensitivity (71% [52.8-89.2]) and specificity (88% [75-100]) for a positive threshold when the angle was ≤ 22.7°. The PCLA and PCLIA methods led to acceptable discrimination and lower sensitivities and specificities (PCLA: AUC 0.71, sensitivity 63%, specificity 79%, threshold ≤ 117.9°; PCLIA: AUC 0.62, sensitivity 50%, specificity 83%, threshold ≤ 21.4°). CONCLUSION: In comparison with previously described methods, the PCL-PCA was the most reliable and accurate method to measure the PCL buckling phenomenon on MRI in anterior cruciate ligament (ACL)-deficient knees. It offers an easy and objective method for the follow-up of ACL-injured patients and can therefore be recommended for routine use. LEVEL OF EVIDENCE: IV.
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Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Ligamento Cruzado Posterior , Humanos , Ligamento Cruzado Anterior/cirurgia , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/cirurgia , Articulação do Joelho/cirurgia , Estudos Retrospectivos , Reprodutibilidade dos Testes , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Fêmur/diagnóstico por imagem , Tíbia/cirurgia , Imageamento por Ressonância MagnéticaRESUMO
PURPOSE: To develop a tool allowing to classify the magnitude of structural tissue damage occurring in ACL injured knees. The proposed ACL Injury Severity Scale (ACLISS) would provide an easy description and categorization of the wide spectrum of injuries in patients undergoing primary ACL reconstruction, reaching from isolated ACL tears to ACL injuries with a complex association of combined structural damage. METHODS: A stepwise approach was used to develop the ACLISS. The eligibility of each item was based on a literature search and a consensus between the authors after considering the diagnostic modalities and clinical importance of associated injuries to the menisci, subchondral bone, articular cartilage or collateral ligaments. Then, a retrospective analysis of associated injuries was performed in 100 patients who underwent a primary ACL reconstruction (ACLR) by a single surgeon. This was based on acute preoperative MRI (within 8 weeks after injury) as well as intraoperative arthroscopic findings. Depending on their prevalence, the number of selected items was reduced. Finally, an analysis of the overall scale distribution was performed to classify the patients according to different injury profiles. RESULTS: A final scoring system of 12 points was developed (12 = highest severity). Six points were attributed to the medial and lateral tibiofemoral compartment respectively. The amount of associated injuries increased with ACLISS grading. The median scale value was 4.5 (lower quartile 3.0; higher quartile 7.0). Based on these quartiles, a score < 4 was considered to be an injury of mild severity (grade I), a score between ≥ 4 and ≤ 7 was defined as moderately severe (grade II) and a score > 7 displayed the most severe cases of ACL injuries (grade III). The knees were graded ACLISS I in 35%, ACLISS II in 49% and ACLISS III in 16% of patients. Overall, damage to the lateral tibiofemoral compartment was predominant (p < 0.01), but a proportional increase of tissue damage could be observed in the medial tibiofemoral compartment with the severity of ACLISS grading (p < 0.01). CONCLUSIONS: The ACLISS allowed to easily and rapidly identify different injury severity profiles in patients who underwent primary ACLR. Injury severity was associated with an increased involvement of the medial tibiofemoral compartment. The ACLISS is convenient to use in daily clinical practice and represents a feasible grading and documentation tool for a reproducible comparison of clinical data in ACL injured patients. LEVEL OF EVIDENCE: Level III.
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Lesões do Ligamento Cruzado Anterior , Cartilagem Articular , Traumatismos do Joelho , Humanos , Lesões do Ligamento Cruzado Anterior/complicações , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos Retrospectivos , Ligamento Cruzado Anterior/cirurgia , Traumatismos do Joelho/complicações , Traumatismos do Joelho/cirurgia , Cartilagem Articular/cirurgia , Meniscos Tibiais/cirurgiaRESUMO
PURPOSE: There is growing interest in tibial tubercle fractures in pediatric and adolescent population within the last decade. However, there is limited evidence in the existing literature. Therefore, the purpose of this systematic review was to analyze and provide up-to-date data that may prove valuable in decision making and management of these injuries in the general as well as the athletic population. METHODS: A systematic review of the literature in PubMed, Cochrane library and Virtual Health Library was conducted using the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" (PRISMA) guidelines. Articles published in English or Spanish, during the past 20 years, reporting outcomes of tibial tubercle fracture management in patients younger than 18 years old, with a mean follow-up of at least 6 months reporting outcomes, type of management and classification were included. RESULTS: A total of 919 patients with 956 fractures in 25 retrospective cohort studies were included. The mean age was 14.4 ± 0.6 years while 766 [83%] were males and 740 [81%] of the injuries were sports-related. Associated injuries were reported in 91[10%] cases, most common being patellar tendon avulsion. Surgical management was chosen for 845[88%] of the cases, the vast majority being open reduction internal fixation (ORIF) with screws. Union was achieved in 954 [99.8%] cases. Complications and re-operations rate stood at 172[18%] and 161 [19% of the operations], respectively. Return to play (RTP) was reported in 11 [44%] of the studies standing at an average of 98.9% ± 3.6. CONCLUSION: Essentially, this is an adolescent sports knee injury that needs careful planning before decision making because it may affect both RTP and joint preservation. Although union was achieved in almost all patients, there is a high risk of associated injuries, complications and reoperations. The surgeon should be confident to perform fracture fixation as well as addressing associated knee soft tissue injuries to achieve optimal outcomes. LEVEL OF EVIDENCE: Level IV.
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Traumatismos em Atletas , Fraturas da Tíbia , Humanos , Masculino , Adolescente , Criança , Feminino , Traumatismos em Atletas/cirurgia , Traumatismos em Atletas/complicações , Estudos Retrospectivos , Fixação Interna de Fraturas/efeitos adversos , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/cirurgia , Fixação de FraturaRESUMO
PURPOSE: Double-level knee osteotomy (DLO) is a challenging procedure that requires precision in preoperative planning and intraoperative execution to achieve the desired correction. It is indicated in cases of severe varus or valgus deformities where a single-level osteotomy would yield significantly tilted joint line obliquity (JLO). This study aimed to evaluate the effectiveness of DLO in achieving accurate correction without compromising JLO, using patient-specific cutting guides (PSCGs), in cases of bifocal valgus maligned knees. METHODS: A single-centre, retrospective analysis of prospectively collected data for a total of 26 patients, who underwent DLO by PSCGs for valgus malaligned knees, between 2015 and 2020. Post-operative alignment was evaluated and the delta for different lower limb0.05, not statistically significant (ns)). All KOOS subs alignment parameters was calculated; the hip-knee-ankle angle (ΔHKA), medial proximal tibial angle (ΔMPTA), and lateral distal femoral angle (ΔLDFA). At the two-year follow-up, changes in the KOOS sub-scores, UCLA scores, lower limb discrepancy (LLD), and mean time to return to work and sport were recorded. All intraoperative and postoperative complications were recorded. The Mann-Whitney U test with a 95% confidence interval (95% CI) was used to evaluate the differences between two variables; one-way ANOVA between more than two variables and the paired Student's t-test was used to estimate the evolution of functional outcomes. RESULTS: The postoperative mean ΔHKA was 0.9 ± 0.9°, the mean ΔMPTA was 0.7 ± 0.7°, and the mean ΔLDFA was 0.7 ± 0.8° (all values with p > 0.05, not statistically significant (ns)). All KOOS subscore's mean values were improved to an extent two-fold superior to the reported minimal clinically important difference (MCID) (all with p < 0.0001). There was a significant increase in the UCLA score at the final follow-up (5.4 ± 1.5 preoperatively versus 7.7 ± 1.4, p < 0.01). The mean time to return to sport and work was 4.7 ± 1.1 and 4.3 ± 2.1 months, respectively. There was an improvement in Lower-limb discrepancy preoperative (LLD = 1.3 ± 2 cm) to postoperative measures (LLD = 0.3 ± 0.4 cm), ns. Complications were 2 femoral hinge fractures, 2 deep vein thromboses, 1 delayed tibial healing, and 1 hardware removal for hamstring irritation syndrome. CONCLUSION: DLO is effective and safe in achieving accurate correction in bifocal valgus malaligned knees with maintained lower limb length and low complication rate with no compromise of JLO. LEVEL OF EVIDENCE: III.
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Fraturas do Fêmur , Osteoartrite do Joelho , Humanos , Tíbia/cirurgia , Estudos Retrospectivos , Osteoartrite do Joelho/cirurgia , Articulação do Joelho/cirurgia , Fêmur/cirurgia , Extremidade Inferior/cirurgia , Osteotomia/métodosRESUMO
PURPOSE: The posterior cruciate ligament-posterior cortex angle (angle between the most vertical part of the anterolateral PCL bundle and the posterior diaphyseal cortex of the femur; PCL-PCA) is the most accurate approach to describe the PCL buckling phenomenon observed in anterior cruciate ligament (ACL)-deficient knees. The aim of this study was to determine whether the PCL-PCA is associated with chronicity of the ACL rupture, the meniscal status, preoperative knee laxity or imaging signs such as the lateral collateral ligament (LCL) sign or the posterior tibial slope (PTS) in ACL-injured knees. METHODS: Patients with a primary ACL reconstruction (ACLR) after physeal closure were selected retrospectively from a hospital-based ACL registry from 2015 to 2021. Exclusion criteria were: previous ipsilateral/contralateral knee surgery, previous ipsilateral ACL or meniscal tear, ipsilateral PCL and/or collateral ligament injuries or tibial plateau fracture. The ACL deficiency was defined as chronic if time from injury to MRI was > 6 months. The meniscal status was assessed during ACLR, separately for the medial and lateral meniscus, and classified into no tear, minor or major unstable tear. The MRI analyses included the assessment of the PCL-PCA and the LCL sign. PTS was assessed from the lateral plain radiographs of the injured knee. The side-to-side difference in anterior tibial translation (ATT) at 200N was obtained with the GNRB. RESULTS: Eighty-two patients (forty-eight males/thirty-four females) were included in this study. The median PCL-PCA was 16.2° (Q1-Q3: 10.6-24.7) and differed between acute (18.4°) and chronic (10.7°) injuries (p < 0.01). The median PCL-PCA was significantly lower (- 4.6°) in patients with a positive LCL sign (p = 0.03) No significant association could be found between PCL-PCA and meniscal status, PTS or preoperative anterior knee laxity (Lachman, pivot shift and ATT in millimetres). CONCLUSION: The PCL-PCA was significantly lower in chronic ACL injuries and in patients with a positive LCL sign, indicating a higher buckling phenomenon of the PCL in these patients. These results support the fact that PCL-PCA and the LCL sign may be useful parameters to indicate the progression of knee decompensation over time after an ACL injury, and therefore may constitute a helpful tool to optimise treatment choice and timing of ACL reconstruction if necessary. LEVEL OF EVIDENCE: III.
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Lesões do Ligamento Cruzado Anterior , Instabilidade Articular , Ligamentos Laterais do Tornozelo , Ligamento Cruzado Posterior , Masculino , Feminino , Humanos , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/cirurgia , Estudos Retrospectivos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Tíbia/cirurgiaRESUMO
PURPOSE: To investigate whether knee morphological features, patient characteristics, and intraoperative findings are associated with a lateral meniscus (LM) posterior root tear (LMPRT) in anterior cruciate ligament (ACL) injuries with the integrated data from two academic centres. METHODS: This retrospective study used registry data acquired prospectively at two academic centres. Patients with ACL reconstruction (ACLR) with LMPRT and no other LM injury were selected (LMPRT group) from each database. The control group included patients who underwent ACLR without LM tears. Patients were matched to the LMPRT group according to age and gender (1:1). Morphological factors evaluated on preoperative magnetic resonance image scans included lateral femoral condyle (LFC) anterior-posterior diameter, height, and depth; lateral tibial plateau (LTP) articular surface (AS) depth and sagittal plane depth; and lateral and medial posterior tibial slopes (PTSs). LFC height and depth ratios, LTP AS depth and sagittal plane depth ratios, and lateral-to-medial slope asymmetry were computed from previous measurements. Patient characteristics and intraoperative findings were extracted and compared between both groups. RESULTS: The study included 252 patients (126 in each group). The lateral-medial asymmetry of PTS was greater in the LMPRT group (1.2° vs 0.3°, p < 0.05), and the LTP AS depth was smaller in the LMPRT group (31.4 mm vs 33.2 mm, p < 0.01). There were no differences in LFC morphology between the control and LMPRT groups. Pivot shift grade (p < 0.05), percentage of complete ACL tears (p < 0.05), and medial meniscus ramp lesions (p < 0.05) were significantly higher in the LMPRT group. CONCLUSION: LMPRT was associated with significantly increased lateral-medial asymmetry of PTS and significantly smaller LTP AS depth. LMPRT was also associated with an increase in the preoperative pivot shift grade and the presence of a medial meniscus ramp lesion. These morphological characteristics are rather simple to measure and would serve as helpful indicators to preoperatively detect LMPRT, which is frequently challenging to diagnose preoperatively. LEVEL OF EVIDENCE: Level III.
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Lesões do Ligamento Cruzado Anterior , Lesões do Menisco Tibial , Humanos , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Meniscos Tibiais/patologia , Estudos Retrospectivos , Lesões do Menisco Tibial/complicações , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia , Articulação do Joelho/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Lesões do Ligamento Cruzado Anterior/complicações , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Imageamento por Ressonância MagnéticaRESUMO
PURPOSE: Evaluate the current state of sports injury prevention perception, knowledge and practice among sports medicine professionals located in Western Europe and involved in injury prevention. METHODS: Members of two different sports medicine organizations (GOTS and ReFORM) were invited to complete a web-based questionnaire (in German and in French, respectively) addressing perception, knowledge and implementation of sports injury prevention through 22 questions. RESULTS: 766 participants from a dozen of countries completed the survey. Among them, 43% were surgeons, 23% sport physicians and 18% physiotherapists working mainly in France (38%), Germany (23%) and Belgium (10%). The sample rated the importance of injury prevention as "high" or "very high" in a majority of cases (91%), but only 54% reported to be aware of specific injury prevention programmes. The French-speaking world was characterized by lower levels of reported knowledge, unfamiliarity with existing prevention programmes and less weekly time spent on prevention as compared to their German-speaking counterparts. Injury prevention barriers reported by the respondents included mainly insufficient expertise, absence of staff support from sports organizations and lack of time. CONCLUSION: There is a lack of awareness regarding injury prevention concepts among sports medicine professionals of the European French- and German-speaking world. This gap varied according to the professional occupation and working country. Relevant future paths for improvement include specific efforts to build awareness around sports injury prevention. LEVEL OF EVIDENCE: Level IV.
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Traumatismos em Atletas , Medicina Esportiva , Esportes , Humanos , Traumatismos em Atletas/prevenção & controle , Europa (Continente) , FrançaRESUMO
PURPOSE: The aim of this ESSKA consensus is to give recommendations based on evidence and expert opinion to improve diagnosis, preoperative planning, indication and surgical strategy in ACL revision. METHODS: The European expert surgeons and scientists were divided into four groups to participate in this consensus. A "literature group" (four surgeons); "steering group" (14 surgeons and scientists); "rating group" (19 surgeons) and finally "peer review group" (51 representatives of the ESSKA-affiliated national societies from 27 countries). The steering group prepared eighteen question-answer sets. The quality of the answers received grades of recommendation ranging from A (high-level scientific support), to B (scientific presumption), C (low level scientific support) or D (expert opinion). These question-answer sets were then evaluated by the rating group. All answers were scored from 1 to 9. The comments of the rating group were incorporated by the steering group and the consensus was submitted to the rating group a second time. Once a general consensus was reached between the steering and rating groups, the question-answer sets were submitted to the peer review group. A final combined meeting of all the members of the consensus was held to ratify the document. RESULTS: The literature review for the diagnosis and preoperative planning of ACL revision revealed a rather low scientific quality. None of the 18 questions was graded A and six received a grade B. The mean rating of all the questions by the rating group was 8.4 ± 0.3. The questions and recommendations are listed below. CONCLUSION: ACL revision surgery is a widely debated subject with many different opinions and techniques. The literature reveals a poor level of standardisation. Therefore, this international consensus project is of great importance. LEVEL OF EVIDENCE: II.
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PURPOSE: The aim of this ESSKA consensus is to give recommendations based on scientific evidence and expert opinion to improve the diagnosis, preoperative planning, indication and surgical strategy in Anterior Cruciate Ligament revision. METHODS: Part 2, presented herein, followed exactly the same methodology as Part 1: the so-called ESSKA formal consensus derived from the Delphi method. Eighteen questions were ultimately asked. The quality of the answers received the following grades of recommendation: Grade A (high level scientific support), Grade B (scientific presumption), Grade C (low level scientific support) or Grade D (expert opinion). All answers were scored from 1 to 9 by the raters. Once a general consensus had been reached between the steering and rating groups, the question-answer sets were submitted to the peer-review group. A final combined meeting of all the members of the consensus was then held to ratify the document. RESULTS: The review of the literature revealed a rather low scientific quality of studies examining the surgical strategy in cases of ACL reconstruction failure. Of the 18 questions, only 1 received a Grade A rating; 5, a Grade B rating; and 9, grades of C or D. The three remaining complex questions received further evaluations for each portion of the question and were looked at in more detail for the following grades: B and D; A, C and D; or A, B, C and D. The mean rating of all questions by the rating group was 8.0 + - 1.1. The questions and recommendations are listed in the article. CONCLUSION: ACL revision surgery, especially the surgical strategy, is a widely debated subject with many different opinions and techniques. The literature reveals a poor level of standardization. Therefore, this international European consensus project is of great importance and clinical relevance for guiding the management of ACL revision in adults. LEVEL OF EVIDENCE: Level II.
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Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Humanos , Adulto , Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Reoperação , ConsensoRESUMO
OBJECTIVE: To identify, summarise and critically assess economic evaluation studies on sports injury prevention strategies. DESIGN: Systematic review. DATA SOURCES: PubMed, SportDiscuss. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The current literature was searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Economic analyses published since 2010 were checked for inclusion. The methodological quality of the studies was assessed using the Oxford Level of Evidence for economic and decision analysis; underlying randomised controlled trials (RCTs) were rated according to the Physiotherapy Evidence Database (PEDro) Scale, and risk of bias was assessed using the Revised Cochrane risk-of-bias tool. RESULTS: Ten studies fulfilled the inclusion criteria. The quality assessment revealed limited data quality. For trial-based analysis, underlying RCTs were of good quality and had a low risk of bias. Prevention concepts for general injury reduction showed effectiveness and cost savings. Regarding specific injury types, the analysis of the studies showed that the best data are available for ankle, hamstring and anterior cruciate ligament injuries. Measures using specific training interventions were the predominant form of prevention concepts; studies investigating these concepts showed cost-effectiveness with total cost savings between 24.82 and 462 per athlete. CONCLUSION: Injury prevention strategies that were studied are cost-effective. However, estimates and outcomes vary throughout the included studies, and precluded pooling of existing data. Knowledge about the cost-effectiveness of evaluated prevention measures will help improve the acceptance and application of prevention initiatives.
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Traumatismos em Atletas , Traumatismos em Atletas/prevenção & controle , Viés , Análise Custo-Benefício , HumanosRESUMO
PURPOSE: Different graft options are available for the reconstruction of lateral ankle ligaments to treat chronic ankle instability (CAI), which fall in two categories: allografts and autografts. This study aims to provide an updated comparison of the clinical outcomes after stabilisation procedures using allografts and autografts, to correctly advise the clinician during the choice of the best material to be used for the reconstruction of the lateral ligamentous complex of the ankle. METHODS: A systematic review was performed to analyse the use of autografts and allografts for anatomic reconstruction of the lateral ligamentous complex of the ankle in CAI patients. The presence of a postoperative assessment through outcome measures with proofs of validation in the CAI population or patient's subjective evaluation on the treatment were necessary for inclusion. The quality of the included studies was assessed through the modified Coleman Methodology Score (mCMS). Relevant clinical outcome data were pooled to provide a synthetic description of the results in different groups or after different procedures. RESULTS: Twenty-nine studies (autograft: 19; allograft: 9; both procedures: 1) accounting for 930 procedures (autograft: 616; allograft: 314) were included. The average mCMS was 55.9 ± 10.5 points. The Karlsson-Peterson scale was the most frequently reported outcome scale, showing a cumulative average post- to preoperative difference of 31.9 points in the autograft group (n = 379, 33.8 months follow-up) and of 35.7 points in the allograft group (n = 227, 25.8 months follow-up). Patient satisfaction was good or excellent in 92.8% of autograft (n = 333, 65.2 months follow-up) and in 92.3% of allograft procedures (n = 153, 25.0 months follow-up). Return to activity after surgery and recurrence of instability were variably reported across the studies with no clear differences between allograft and autograft highlighted by these outcomes. CONCLUSIONS: The systematic analysis of validated CAI outcome measures and the patient's subjective satisfaction does not support a specific choice between autograft and allograft for the reconstruction of the ankle lateral ligamentous complex in CAI patients. Both types of grafts were associated to a postoperative Karlsson-Peterson score superior to 80 points and to a similar rate of patient's subjective satisfaction. LEVEL OF EVIDENCE: Level IV.
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Instabilidade Articular , Ligamentos Laterais do Tornozelo , Humanos , Tornozelo , Aloenxertos , Ligamentos Laterais do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Articulação do Tornozelo/cirurgia , AutoenxertosRESUMO
PURPOSE: To evaluate the influence of time from injury and meniscus tears on the side-to-side difference in anterior tibial translation (SSD-ATT) as measured on lateral monopodal weightbearing radiographs in both primary and secondary ACL deficiencies. METHODS: Data from 69 patients (43 males/26 females, median age 27-percentile 25-75: 20-37), were retrospectively extracted from their medical records. All had a primary or secondary ACL deficiency as confirmed by MRI and clinical examination, with a bilateral weightbearing radiograph of the knees at 15°-20° flexion available. Meniscal status was assessed on MRI images by a radiologist and an independent orthopaedic surgeon. ATT and posterior tibial slope (PTS) were measured on the lateral monopodal weightbearing radiographs for both the affected and the contralateral healthy side. A paired t-test was used to compare affected/healthy knees. Independent t-tests were used to compare primary/secondary ACL deficiencies, time from injury (TFI) (≤ 4 years/ > 4 years) and meniscal versus no meniscal tear. RESULTS: ATT of the affected side was significantly greater than the contralateral side (6.2 ± 4.4 mm vs 3.5 ± 2.8 mm; p < 0.01). There was moderate correlation between ATT and PTS in both the affected and healthy knees (r = 0.43, p < 0.01 and r = 0.41, p < 0.01). SSD-ATT was greater in secondary ACL deficiencies (4.7 ± 3.8 vs 1.9 ± 3.2 mm; p < 0.01), patients with a TFI greater than 4 years (4.2 ± 3.8 vs 2.0 ± 3.0 mm; p < 0.01) and with at least one meniscal tear (3.9 ± 3.8 vs 0.7 ± 2.2 mm; p < 0.01). Linear regression showed that, in primary ACL deficiencies, SSD-ATT was expected to increase (+ 2.7 mm) only if both a meniscal tear and a TFI > 4 years were present. In secondary ACL deficiencies, SSD-ATT was mainly influenced by the presence of meniscal tears regardless of the TFI. CONCLUSION: SSD-ATT was significantly greater in secondary ACL deficiencies, patients with a TFI greater than 4 years and with at least one meniscal tear. These results confirm that SSD-ATT is a time- and meniscal-dependent parameter, supporting the concept of gradual sagittal decompensation in ACL-deficient knees, and point out the importance of the menisci as secondary restraints of the anterior knee laxity. Monopodal weightbearing radiographs may offer an easy and objective method for the follow-up of ACL-injured patients to identify early signs of soft tissue decompensation under loading conditions. LEVEL OF EVIDENCE: Level III.
Assuntos
Lesões do Ligamento Cruzado Anterior , Doenças das Cartilagens , Traumatismos do Joelho , Adulto , Lesões do Ligamento Cruzado Anterior/complicações , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Doenças das Cartilagens/complicações , Feminino , Humanos , Traumatismos do Joelho/complicações , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Meniscos Tibiais/cirurgia , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Suporte de CargaRESUMO
PURPOSE: The aim of this study was to determine whether posterior tibial slope (PTS), meniscal slope (MS), and bone bruise pattern (BBP), as observed on magnetic resonance imaging (MRI), differed between patients with or without medial meniscus ramp lesions at the time of anterior cruciate ligament reconstruction (ACLR). The hypothesis was that patients with a ramp lesion had a higher PTS and MS, with a different BBP than patients without a ramp lesion. METHODS: Fifty-six patients undergoing ACLR were selected from an in-house registry and separated into 2 groups: (1) the RAMP group included patients with a primary ACLR and a medial meniscus ramp lesion diagnosed intraoperatively; (2) the CONTROL group included patients with a primary ACLR without ramp lesion after arthroscopic exploration of the posteromedial knee area. The two groups were matched for age, sex and type of concomitant meniscal lesions. The medial/lateral-PTS/MS and BBP were subjected to blinded evaluation on the preoperative MRI of the reconstructed knee. RESULTS: Twenty eight patients (21 males; 7 females) were included in each group. No significant difference could be observed between groups in terms of demographical characteristics, PTS, and MS. A posteromedial tibial plateau (PMTP) bone bruise was more often observed in the RAMP group (n = 23/28) compared to the CONTROL group (n = 12/28) (p < 0.01). The RAMP group was 6.1 (95%CI [1.8; 20.8]) times more likely to present a PMTP bone bruise. The likelihood of having a bone bruise in both the medial and lateral compartments was 4.5 (95%CI [1.2; 16.5]) times higher in the RAMP group. However, a BBP only involving the lateral tibiofemoral compartment was more likely to be observed in the CONTROL group (n = 10/28) compared to the RAMP group (n = 3/28, p < 0.05 - odds ratio 4.6 (95%CI [1.1; 19.2]). CONCLUSION: Ramp lesions were 6.1 and 4.5 times more likely to be observed in the presence of a posteromedial tibia plateau bone bruise or a combined bone bruise respectively in both the medial and lateral tibiofemoral compartment in patients undergoing ACLR. The tibial and meniscal slopes did not differ between patients with or without ramp lesions undergoing ACLR. LEVEL OF EVIDENCE: Level III.
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Contusões , Lesões do Menisco Tibial , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Meniscos Tibiais/cirurgia , Lesões do Menisco Tibial/cirurgiaRESUMO
The application of artificial intelligence (AI) and machine learning to the field of orthopaedic surgery is rapidly increasing. While this represents an important step in the advancement of our specialty, the concept of AI is rich with statistical jargon and techniques unfamiliar to many clinicians. This knowledge gap may limit the impact and potential of these novel techniques. We aim to narrow this gap in a way that is accessible for all orthopaedic surgeons. With this manuscript, we introduce the concept of AI and machine learning and give examples of how it can impact clinical practice and patient care.Level of evidence VI.
Assuntos
Cirurgiões Ortopédicos , Ortopedia , Inteligência Artificial , Humanos , Aprendizado de MáquinaRESUMO
PURPOSE: To analyse possible associations between the preoperative pivot shift (PS) test and both patient and injury characteristics in anterior cruciate ligament (ACL)-injured knees, considering previously neglected meniscal injuries such as ramp and root tears. The hypothesis was that a preoperative grade III PS was associated with the amount of intra-articular soft-tissue damage and chronicity of the injury. METHODS: The cohort involved 376 patients who underwent primary ACL reconstruction (239 males/137 females; median age 26). Patients were examined under anesthesia before surgery, using the PS test. During arthroscopy, intra-articular soft-tissue damage of the injured knee was classified as: (1) partial ACL tear; (2) complete isolated ACL tear; (3) complete ACL tear with one meniscus tear; and (4) complete ACL and bimeniscal tears. Chi-square and Mann-Whitney U tests were used to evaluate whether sex, age, body mass index, sport at injury, mechanism of injury, time from injury and intra-articular damage (structural damage of ACL and menisci) were associated with a grade III PS. Intra-articular damage was further analyzed for two sub-cohorts: acute (time from injury ≤ 6 months) and chronic injuries (> 6 months). RESULTS: A grade III PS test was observed in 26% of patients. A significant association with PS grading was shown for age, time from injury and intra-articular soft-tissue damage (p < 0.05). Further analyses showed that grade III PS was associated with intra-articular damage in chronic injuries only (p < 0.01). In complete ACL and bimeniscal tears, grade III PS was more frequent in chronic (53%) than in acute knee injuries (26%; p < 0.01). Patients with chronic complete ACL and bimeniscal tears had a grade III PS 3.3 [1.3-8.2] times more often than patients in the acute sub-cohort. CONCLUSION: In ACL-injured patients, a preoperative grade III PS was mainly associated with a higher amount of intra-articular soft-tissue damage and chronicity of the injury. Patients with complete chronic ACL injuries and bimeniscal tears were more likely to have a preoperative grade III PS than their acute counterparts. This suggests that grade III PS may be an early sign of knee decompensation of dynamic rotational knee laxity in chronic ACL-injured knees with bimeniscal lesions. LEVEL OF EVIDENCE: Level III.
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/complicações , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Feminino , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , MasculinoRESUMO
The application of machine learning (ML) to the field of orthopaedic surgery is rapidly increasing, but many surgeons remain unfamiliar with the nuances of this novel technique. With this editorial, we address a fundamental topic-the differences between ML techniques and traditional statistics. By doing so, we aim to further familiarize the reader with the new opportunities available thanks to the ML approach.