Analysis of the Swedish Knee Ligament Register: Concomitant injuries, revision surgery and smoking render worse results.

PURPOSE: To analyse the 52,199 patients in the Swedish Knee Ligament Register (SKLR) preoperatively, and the patients reaching 5- and 10-year follow-ups who underwent anterior cruciate ligament reconstruction (ACLR), revision ACLR and ACLR on the contralateral side (CACLR). The main hypothesis was that patients undergoing revision ACLR would have worse patient-reported outcome measurements (PROMs) than the primary ACLR group at 10 years and that smoking and concomitant injuries would result in poorer outcomes for all groups. METHODS: Data from 2005 to 2021 were extracted from the SKLR. Only patients whose ACLR surgery was registered in the SKLR were included for revision ACLR and CACLR. The PROMs consist of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the knee-specific PROM (EQ-5D-3L). PROMs were analysed as a whole and in subgroups based on sex, smoking, graft choice and concomitant injuries. RESULTS: Poorer KOOS were seen for revisions compared with primary ACLRs at both the 5- and 10-year follow-ups (p = 0.003). Smokers had significantly poorer KOOS than nonsmokers (p < 0.001) preoperatively in all groups, however only in the primary ACLR group at 5 and 10 years. At 10 years, patients who had undergone CACLR had lower KOOS than primary ACLRs (p = 0.03). Concomitant injuries resulted in statistically, significantly poorer KOOS for both primary ACLRs and CACLRs preoperatively and at the follow-ups. CONCLUSION: The PROMs for revision ACLRs have worse KOOS scores at 10 years compared with the primary ACLRs. The presence of concomitant meniscal or cartilage injuries at the time of ACLR or CACLR were associated with worse PROMs. LEVEL OF EVIDENCE: Level III.

Different femoral tunnel placement in posterior cruciate ligament reconstruction: a finite element analysis.

BACKGROUND: At present, there is no consensus on the optimal biomechanical method for Posterior cruciate ligament (PCL) reconstruction, and the "critical corner" that is produced by the femoral tunnel is currently considered to be one of the main reasons for PCL failure. Thus, the purpose of this study was to identify one or several different tunnels of the femur, thereby reducing the influence of the "critical corner" without reducing the posterior stability of the knee. METHODS: CT and MRI data of the knee joint of a healthy adult man were collected, and computer-related software was used to reconstruct the finite element model of the knee joint, to provide different properties to different materials and to allow for the performance of a finite element analysis of the reconstructed model. The position of the femoral tunnel was positioned and partitioned according to anatomical posture, and three areas were divided (the antero-proximal region, the antero-distal region and the posterior region). In addition, we applied a posterior tibial load of 134 N to the reconstructed model, recorded and compared different tunnels of the femur, conducted peak stress at the flexion of the knee joint of 0°, 30°, 60° and 90°, and elicited the displacement of the proximal tibia. RESULTS: Among the 20 different femoral tunnels, the graft peak stress was lower in tunnels 4, 12 and 18 than in the PCL anatomical footpath tunnel 13, especially at high flexion angles (60° and 90°). These three tunnels did not increase the posterior displacement of the proximal tibia compared with the anatomical footpath tunnel 13. CONCLUSION: In summary, among the options for PCL reconstruction of the femoral tunnel, the tunnels located 5 mm distal to the footprint and 5 mm anterior to the footprint could reduce the peak stress of the graft; additionally, it may reduce the "critical corner" and was shown to not reduce the posterior stability of the knee joint.

[Application of Static Characteristics of Plantar Pressure Distribution in the Assessment of Knee Joint Injury].

OBJECTIVE: This paper used plantar pressure analysis equipment to discuss the plantar pressure distribution pattern and balance ability of patients with the knee joint injury under static standing. METHODS: Zebris FDM-S plantar pressure analysis equipment was used to collect plantar pressure data from subjects with the knee joint injury and healthy control subjects. We compared the pressure values in each region of pelma, and then assessing the balance ability of the subjects based on the trajectory of the overall pressure center movement. RESULTS: Compared with the healthy control group, patients with knee joint injury have a significantly lower pressure in the heel areas and a significantly higher pressure in the middle foot area. And the total pressure of the injured limb foot in the patient group is lower than that in the contralateral foot. In addition, there is a significant increase in the parameters of the balance ability index in the patient group. CONCLUSIONS: The plantar pressure distribution pattern of patients with knee joint injury is different from that of normal people in static standing, and the balance ability is poor. Therefore, this method has a positive guiding significance in the evaluation and application of knee joint injury.

Benefits of using transcranial magnetic stimulation as a tool to facilitate the chronic knee injury rehabilitation.

[Purpose] While primary motor cortex activation has been implicated as a key factor in the arthrogenic muscle inhibition after knee joint injury, no viable rehabilitation protocol has been developed to accommodate this factor. In this study, transcranial magnetic stimulation was applied as a means of dissipating arthrogenic muscle inhibition by introducing temporary motor cortex excitation prior to the rehabilitation. [Subjects and Methods] Twenty-four subjects who have underwent the surgery due to knee injury were recruited, and randomly assigned to the control or the simulation groups. The levels of electromyography signals during the maximum voluntary contraction of the quadriceps muscle before, during, and after training designed for the quadriceps strength rehabilitation were measured. [Results] When compared to controls, subjects who received the transcranial magnetic stimulations showed significantly increased levels of voluntary muscle contraction after the training. Moreover, the beneficial effect of the stimulation increased as the rehabilitation progressed. [Conclusion] Transcranial magnetic stimulation itself does not directly improve the symptoms related to knee injuries. However, the use of this technique can provide a time window for effective intervention by dissipating the unwanted effect of the arthrogenic muscle inhibition during rehabilitation.

Comparison of Insall-Salvati ratios in children with an acute anterior cruciate ligament tear and a matched control population.

OBJECTIVE: An anterior cruciate ligament (ACL) injury is an increasingly recognized cause of knee pain in young patients and in athletes in particular and can be detected non-invasively with MRI. Anecdotal information suggests that patella alta may be more common in the setting of this injury, but no study has documented this phenomenon. This study sought to test whether an ACL tear is associated with an increased Insall-Salvati ratio suggestive of patella alta. MATERIALS AND METHODS: Measurements of patellar height, patellar tendon length, and the Insall-Salvati ratio obtained from MRI of the knee were compared for 34 children with an arthroscopically proven ACL tear (mean age ± SD, 12.4 ± 1.4 years) and 36 control subjects with normal knee examinations (12.8 ± 2.1 years); these measurements were performed independently by two observers. RESULTS: Patellar tendon length (47.6 ± 6.6 mm vs 40.4 ± 5.7 mm) and patellar position calculated as the Insall-Salvati ratio (1.16 ± 0.16 vs 0.99 ± 0.14) were significantly greater in the knees with an ACL injury than in those without an internal injury, respectively, on MRI (p < 0.001). Patella length was not significantly different between the two groups (patients vs control subjects, 41.1 ± 4.2 mm vs 40.6 ± 2.7 mm, respectively; p = 0.523). There was good to excellent interobserver and intraobserver correlation for all measurements. CONCLUSION: There is a significant association between an ACL tear and increased patellar tendon length with a greater Insall-Salvati ratio. The mechanism for this finding is unclear, but this association provides support to suggest relative patella alta may be a risk factor for ACL injuries in pediatric patients.

Effect of sodium hyaluronate combined with rehabilitation training on knee joint injury caused by golf.

BACKGROUND: In high-intensity sports like golf, knee joints are prone to injury, leading to pain, limited mobility, and decreased quality of life. Traditional treatment methods typically involve rehabilitation exercises, but their effectiveness may be limited. In recent years, sodium hyaluronate has emerged as a widely used biomedical material in the treatment of joint diseases. AIM: To explore the effect of sodium hyaluronate combined with rehabilitation training on pain degree, flexion range of motion and motor function of knee joint injured by golf. METHODS: Eighty patients with knee joint injury caused by golf were randomly divided into control (group B) and observation group (group A). The group B was treated with rehabilitation training, and the group A was treated with sodium hyaluronate combined with rehabilitation training. The clinical efficacy, range of motion and function of knee joint, quality of life and inflammatory factors were compared. RESULTS: The excellent and good rate of rehabilitation in the group A was raised than group B. At 6 weeks and 3 months after treatment, the range of motion of the two groups was raised than that before treatment, and that of the group A was raised than group B. After treatment, the scores of Lysholm and International Knee Documentation Committee (IKDC) in the group A were raised, and those in the group A were raised than group B. The VAS score of the two groups was reduced than that of the group B, and the SF-36 score of the group A was reduced than group B. The interleukin (IL)-1 ß, IL-8 and tumor necrosis factor-α in the two groups were reduced, and those in the group A were reduced than group B. CONCLUSION: Sodium hyaluronate combined with rehabilitation training has a good clinical effect in the treatment of patients with knee joint injury caused by golf, which relieve pain, maintain knee joint function and improve patients' life quality.

Analysis of Knee Joint Injury Caused by Physical Training of Freshmen Students Based on 3T MRI and Automatic Cartilage Segmentation Technology: A Prospective Study.

Background: The differential effects of various exercises on knee joint injury have not been well documented. Improper physical training can cause irreversible damage to the knee joint. MRI is generally used to precisely analyze morphological and biochemical changes in the knee cartilage. We compared the effects of long-walking and regular daily physical training on acute and chronic knee joint injuries as well as cartilage structure in freshmen students. Methods: A total of 23 young male college freshmen were recruited to participate in an 8-day 240 km long distance walk and a one-year daily training. 3D-DESSwe, 2D T2 mapping, DIXON, and T1WI of the right knee joint were performed using the MAGNETOM Spectra 3T MR scanner. The injury of meniscus, bone marrow edema, ligaments and joint effusion is graded. Cartilage volume, thickness and T2 values of 21 sub-regions of the knee cartilage were estimated using automatic cartilage segmentation prototype software. Friedman's test and Wilcoxon paired rank-sum test were used to compare quantitative indices of knee cartilage in three groups. Results: The injury to the medial meniscus and anterior cruciate ligament of the knee joint, joint effusion, and bone marrow edema was significantly higher in the long-walking group compared to the baseline and daily groups. Furthermore, injury to the lateral meniscus was significantly worse in the long-walking group compared to the baseline group but was significantly better in the daily group compared to the baseline group. No significant changes to the posterior cruciate ligament were observed among the three groups. Knee cartilage volume was significantly increased, mainly in the stress surface of the femur, patella, and the lateral area of the tibial plateau. Regular daily training did not significantly change the thickness of the knee cartilage. Conversely, knee cartilage thickness decreased in the long-walking group, especially in the medial and lateral areas of the femur and tibial plateau. Moreover, no significant changes were observed in the knee cartilage volume of the long-walking group. Both long-walking and daily groups showed reduced T2 values of the knee joint compared to the baseline. Conclusion: Among freshmen students and the training of this experimental intensity, our results show that regular daily training does not cause high-level injury to the knee joint, but improve the knee joint function adaptability by increasing cartilage volume. Moreover, knee injury caused by short-term long walking can be reversible.

Anterior Cruciate Ligament Reconstruction and Internal Bracing of Medial Structures in Knee Dislocation. Case Study.

This paper presents an alternative method of surgical treatment in patients with late-diagnosed knee dislocation. The treatment involves anterior cruciate ligament reconstruction with an autogenic graft and the use of synthetic Fibertape bracing to ensure normal medial structure healing. The paper includes case presentation, indications for use, a description of the surgical technique and conclusions.