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1.
Artigo em Inglês | MEDLINE | ID: mdl-36121766

RESUMO

The sagittal anatomy of the proximal tibia has a bearing on the forces exerted on the cruciate ligaments. A high posterior tibial slope is now a well-known risk factor causing failure of anterior cruciate ligament (ACL) reconstructions. The posterior slope can be calculated on short or full-length radiographs, MRI scans, or three-dimensional CT scans. Reducing the slope surgically by a sagittal tibial osteotomy is biomechanically protective for the ACL graft. An anterior closing wedge osteotomy may be contemplated when the lateral tibial slope is greater than 12°, in the setting of ACL reconstruction failure(s). Careful surgical planning to calculate the correction, taking into account knee hyperextension and patella height, is critical to avoid complications. It can be done above, at, or below the tibial tuberosity level. A transtuberosity correction can be done with or without a tibial tubercle osteotomy. This complex surgery can be conducted safely by meticulous execution to protect the posterior hinge and neurovascular structures and achieving stable fixation with staples. The limited literature available justifies the usage of anterior closing wedge osteotomy in appropriately selected patients.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteotomia/métodos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(9): 1047-1055, 2022 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-36111464

RESUMO

Objective: Anterior cruciate ligament (ACL) reconstruction using a new generation of artificial ligaments (NGAL) gained popularity in China owing to its good effectiveness and early functional recovery, but iatrogenic surgical failures and preconceived misconceptions have seriously affected its standardized clinical application. A specialist consensus is now developed to provide guidance and reference for orthopaedic sports medicine doctors when adopting or considering the NGAL for ACL reconstruction. Methods: The consensus on the core techniques and adverse events in ACL reconstruction using the NGAL was developed by a modified Delphi method, referring exclusively to the NGAL for ACL reconstruction approved by the National Medical Products Administration (NMPA). Consensus specialists were selected from the members of the Chinese Association of Orthopaedic Surgeons (CAOS) and the Chinese Society of Sports Medicine (CSSM). The drafting team summarized the draft consensus terms based on medical evidence and organized rounds of investigation: two rounds of online questionnaire investigation and the final round of face-to-face meeting. After discussion, revision, and voting, a consensus on the draft consensus term was reached when the agreement rate exceeded 85%. The consensus terms were categorized as "strong" (agreement rate: 95.0%-100%), "moderate" (agreement rate: 90.0%-94.9%), and "basic" (agreement rate: 85.0%-89.9%). Results: Thirty-one specialists completed the questionnaire investigation. They all practiced in university teaching hospitals (Grade-A tertiary hospitals) from 16 provinces, autonomous regions, and municipalities in China. Among them, 28 were chief physicians and 3 were associate chief physicians; 22 were professors and 7 were associate professors; the average seniority in orthopedic sports medicine was 25.2 years (range, 12-40 years); the average seniority in performing ACL reconstruction procedures was 13.2 years (range, 7-23 years); in terms of the number of ACL reconstruction using the NGAL, 18 completed more than 100 cases, of which 6 had more than 300 cases; in terms of research, 28 had published more than 1 related paper in the past 5 years, of which 13 had published more than 3 related papers. Twenty-six specialists attended the face-to-face meeting and reached a consensus on 9 terms, including 8 strong terms and 1 moderate term. Conclusion: ACL reconstruction using the NGAL must deploy "isometric" or "near-isometric" reconstruction and should preserve the natural ACL remnants as much as possible. Bone tunnel positioning can be performed using intraoperative radiographic measurements or the lateral femoral intercondylar ridge as reference marks. Incorrect positioning of the bone tunnel is the main reason of surgical failure, and there is a lack of consensus on handling interference screws during revision. Bone tunnel enlargement exists after reconstruction but rarely causes related symptoms. Synovitis and infection are uncommon complications. The aging effect of polyethylene terephthalate fiber on the long-term clinical outcomes is unknown and deserves attention.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Polietilenotereftalatos , Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Consenso , Técnica Delfos , Humanos , Lipocalina-2
3.
Medicine (Baltimore) ; 101(35): e30107, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36107515

RESUMO

Aggressive rehabilitation after anterior cruciate ligament (ACL) reconstruction may result in better clinical outcomes and fewer complications such as knee stiffness and weakness. We explored the effect of the Chinese knotting technique (CKT) for aggressive rehabilitation after ACL reconstruction. Ninety-one anatomical ACL reconstruction cases from 2016 to 2020 were retrospectively reviewed. All patients were operated by the same senior physician and his team. According to the reconstruction with or without CKT, the patients were divided into 2 groups. Both groups received aggressive rehabilitation. The follow-up time of 91 patients was more than 2 years. In total, 43 out of the 91 patients were in the CKT group, and 48 were in the routine group. The knee joint kinematics recorded by Opti_Knee revealed no significant difference among the CKT group, the routine group, and healthy adults at 3, 6, 12, and 24 months after the operation, respectively. The internal and external rotation angle and the anteroposterior displacement at 3 and 6 months after the operation in the CKT group were smaller than in the routine group and were similar to that of the healthy adults. There was no significant difference in flexion and extension angle, varus or valgus angle, proximal-distal displacement, or the internal or external displacement between the 2 groups. In addition, there was no significant difference in 6 degrees of freedom of the knee between the 2 groups at 12 and 24 months after the operation, respectively, which was similar to healthy adults. Compared to the routine group, the International Knee Documentation Committee scores were significantly higher in the CKT group at the 3, 6, and 12 months, respectively, but no difference was observed at 24 months (P = .749). The Lysholm score was significantly higher in the CKT group at the 3 and 6 months postoperatively, while there was no difference at 12 and 24 months, respectively. In short-term observation, the ACL reconstruction with CKT, which can sustain aggressive rehabilitation and prevent the loosening of ACL graft, can lead to better clinical outcomes and kinematics recovery of the knee compared to routine technique.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Adulto , Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , China , Humanos , Estudos Retrospectivos , Tíbia/cirurgia
4.
Medicine (Baltimore) ; 101(35): e30321, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36107596

RESUMO

RATIONALE: The anterior cruciate ligament (ACL) is relatively rarely injured in children and adolescents, accounting for just 0.5% of all ACL rips that occur. Avulsion fractures are more common in youngsters because their ligamentous structures are known to be stronger than their physical insertion sites. Tibial eminences have been reported to be the sites of most ACL avulsions, and both cartilaginous and osteochondral avulsion fractures have been observed, whereas the latter occurs more commonly. On the other hand, femoral osteochondral avulsion fractures of the ACL in children are uncommon, as only a few studies describe their occurrence in immature patients. PATIENT CONCERNS: In this case report, we present an 11-year-old girl who suffered an ACL femoral attachment avulsion fracture after pivoting her knee during riding. A comprehensive formal evaluation of the knee was impractical due to the persistence of pain and tight haemarthrosis. DIAGNOSES: Femoral anterior cruciate ligament osteochondral avulsion fracture. INTERVENTIONS: We used Two No.2Ethibond sutures to pick up the osteochondral fragment and passed across the lateral femoral condyle to come out laterally and fixed with a tie proximally, and we recommended the patient perform reasonable functional exercises postoperatively. OUTCOMES: The patient had no pain, instability, or activity limitations after 24 months of surgery. Physical examination of the patient revealed full and symmetric ROM, and normal Lachman and pivot shift test performance. LESSONS: ACL avulsion fractures can be accurately treated with arthroscopic reduction and sutures via an inside-out technique, which can reduce the risk of persistent ligamentous laxity and reduce open surgery-related morbidity.


Assuntos
Lesões do Ligamento Cruzado Anterior , Fraturas do Fêmur , Fratura Avulsão , Fraturas Intra-Articulares , Adolescente , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/complicações , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia/métodos , Criança , Feminino , Fraturas do Fêmur/diagnóstico , Fratura Avulsão/diagnóstico por imagem , Fratura Avulsão/cirurgia , Humanos
5.
J Musculoskelet Neuronal Interact ; 22(3): 346-351, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36046990

RESUMO

OBJECTIVES: This study aimed to determine if differences exist in tibial subchondral bone and muscle imbalances between individuals with and without an Anterior Cruciate Ligament (ACL) repair within the past 1 to 5 years (median 3 years). METHODS: Fifteen individuals (ages 18-23 years) that had a unilateral ACL repair with no contralateral knee injuries and 15 age- and sex-matched controls (no prior knee injuries) were recruited to participate. Subchondral bone was measured using peripheral quantitative computed tomography (pQCT) distal to the tibial plateau. Muscle force, power, and force efficiency were measured using single leg jumps performed on a force platform. RESULTS: Within subject analysis showed a greater subchondral vBMD in the injured versus uninjured legs of cases (278±11 mg/cm3 and 258±6 mg/cm3, respectively, mean±SD, p=0.01). Subchondral vBMD was greater on the injured leg of cases than controls (267±8 mg/cm3 and 237±8 mg/cm3, respectively, marginal mean±SE, p=0.01). No differences were observed between cases and controls for muscle force, power, or force efficiency. CONCLUSIONS: Greater subchondral bone mineral density was observed in participants between 1- and 5-years post-op. Given the results of this study and the known long-term effects of ACL injuries, future research must continue to focus on the prevention of these injuries.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Articulação do Joelho , Tíbia/diagnóstico por imagem , Adulto Jovem
6.
JBJS Case Connect ; 12(3)2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-36049034

RESUMO

CASE: A 32-year-old patient was diagnosed with a vertical patella fracture nonunion after a bone-patellar tendon-bone (BTB) anterior cruciate ligament reconstruction. In addition, a 1 × 2 × 1 cm patellar bone defect was noticed at the graft harvesting site. The patient was treated surgically with open reduction and internal fixation and iliac crest bone autograft which resulted in fracture union. CONCLUSION: Many intraoperative and postoperative risk factors for iatrogenic patella fracture when harvesting BTB autograft were identified. Surgeons should be aware of technical skills needed to prevent this complication and should treat the fracture appropriately to avoid nonunion and optimize the outcome.


Assuntos
Fraturas Ósseas , Fraturas não Consolidadas , Traumatismos do Joelho , Ligamento Patelar , Adulto , Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Fraturas Ósseas/etiologia , Fraturas Ósseas/cirurgia , Fraturas não Consolidadas/complicações , Fraturas não Consolidadas/cirurgia , Humanos , Traumatismos do Joelho/cirurgia , Patela/cirurgia , Ligamento Patelar/transplante
7.
Arthroscopy ; 38(9): 2600-2601, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36064274

RESUMO

The anterolateral complex (ALC) of the knee has received renewed research interest because of the potential role of this anatomic region in anterior cruciate ligament (ACL) tear biomechanics and surgical treatment outcomes. The primary structures of the ALC include the iliotibial band deep (Kaplan) fibers, the anterolateral ligament (ALL), and the capsulo-osseous layer (COL) of the iliotibial band, although there remains disagreement on the precise anatomic locations and biomechanical relevance of these structures. Sectioning studies in the ACL-deficient knee have revealed a contribution of the ALC in restraining tibial internal rotation and anterior translation. Biomechanical studies have revealed a potential role for lateral extra-articular reconstruction as an augmentation to ACL reconstruction in knees with combined ACL and ALC sectioning. Clinical studies have reported a reduced ACL reconstruction failure rate with both ALL reconstruction and lateral extra-articular tenodesis procedures.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Tenodese , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular , Tenodese/métodos
8.
Acta Orthop Belg ; 88(2): 355-358, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36001843

RESUMO

Partial running whipstitches are commonly used in DT4 SAMBBA (Single Anteromedial Bundle Biological Augmentation) transplant preparation. We wanted to determine whether or not running whipstitches all over the graft affected the risk of iterative rupture and the overall outcome of the procedure. Two groups of 32 patients comparable in terms of sex, age, sport level and type of sport practiced were recruited in this prospective cohort study. DT4 SAMBBA was performed for all patients by a single surgeon. One cohort was treated with a full length running whipstitches during SAMBBA DT4 transplant preparation (F), the other had a classical SAMBBA DT4 graft preparation (NO F). The ACL RSI, subjective IKDC and KOOS scores were established preoperatively and with a 4 years follow-up. Complication rates (iterative rupture, cyclops syndrome) as well as pre and postoperative score variations were calculated. No statistically significant difference in terms of frequency of iterative rupture or complications could be demonstrated (NO F 9.3% vs F 3.1%, p = 0.61). There was no difference either on score variations compared pre and post operatively. Full running whipstitches of the DT4 SAMBBA transplant does not seem to influence the ligamentoplasty outcomes with a 4 years follow-up.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Humanos , Articulação do Joelho/cirurgia , Estudos Prospectivos , Ruptura
9.
Med Sci Monit ; 28: e937118, 2022 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-35996336

RESUMO

BACKGROUND Previous studies have shown that primary repair (PR) and anterior cruciate ligament reconstruction (ACLR) can effectively treat ACL injuries. Our study aimed to compare different treatments of ACL tears, including autograft, allograft, hybrid graft ACLR, and PR, by assessing clinical outcomes and adverse events. MATERIAL AND METHODS PubMed, Cochrane Library, Embase, and CNKI databases were searched and a frequentist-framework network meta-analysis was used. RESULTS Overall, PR with augmentation was superior to ACLR only for activity recovery (WMD 0.28 95%CI [0.07 to 0.49]), and there was no significant difference shown between PR without augmentation and ACLR. ACLR with irradiated allograft was a poor option for the treatment of ACL rupture, showing the weakest subjective evaluations and functional outcomes and worst safety profile. PR with or without augmentation provided fairly good postoperative efficacy results and produced less postoperative knee laxity than irradiated allograft ACLR (PR: standardized mean difference [SMD] -1.27 [-1.80 to -0.74]; ACLR: SMD -1.36 [-1.88 to -0.83]). However, PR without augmentation showed a high failure rate compared with autograft ACLR (autograft vs PR without augmentation: risk ratio 0.29 [0.10 to 0.85]). CONCLUSIONS For surgical treatment of ACL rupture, irradiated allograft ACLR had the worst efficacy and safety and is not recommended. PR may be an ideal treatment method in terms of efficacy but it is related to a significantly higher revision risk if without augmentation. Autograft ACLR may be the preferred method currently available for most patients requiring surgical treatment of ACL rupture.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Autoenxertos , Humanos , Articulação do Joelho/cirurgia , Metanálise em Rede , Ruptura/cirurgia
10.
Biomater Adv ; 140: 213079, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35985068

RESUMO

Development of an artificial ligament possessing osteogenic activity to enhance ligament-bone healing for reconstruction of anterior cruciate ligament (ACL) is a great challenge. Herein, polyetheretherketone fibers (PKF) were coated with phytic acid (PA)/magnesium (Mg) ions complex (PKPM), which were woven into fabrics as an artificial ligament. The results demonstrated that PKPM with PA/Mg complex coating exhibited optimized surface properties with improved hydrophilicity and surface energy, and slow release of Mg ions. PKPM significantly enhanced responses of rat bone marrow stem cells in vitro. Moreover, PKPM remarkably promoted M2 macrophage polarization that upregulated production of anti-inflammatory cytokine while inhibited M1 macrophage polarization that downregulated production of pro-inflammatory cytokine in vitro. Further, PKPM inhibited fibrous encapsulation by preventing M1 macrophage polarization while promoted osteogenesis for ligament-bone healing by triggering M2 macrophage polarization in vivo. The results suggested that the downregulation of M1 macrophage polarization for inhibiting fibrogenesis and upregulation of M2 macrophage polarization for improving osteogenesis of PKPM were attributed to synergistic effects of PA and sustained release of Mg ions. In summary, PKPM with PA/Mg complex coating upregulated pro-osteogenic macrophage polarization that supplied a profitable anti-inflammatory environments for osteogenesis and ligament-bone healing, thereby possessing tremendous potential for reconstruction of ACL.


Assuntos
Magnésio , Osteogênese , Animais , Ligamento Cruzado Anterior/cirurgia , Benzofenonas , Citocinas/farmacologia , Íons/farmacologia , Magnésio/farmacologia , Ácido Fítico/farmacologia , Polímeros , Ratos
11.
Am J Sports Med ; 50(11): 2953-2960, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35914183

RESUMO

BACKGROUND: The optimal graft choice between the bone-patellar tendon-bone (BPTB) and the quadriceps tendon remains controversial. Studies evaluating the microscopic anatomy of the quadriceps tendon-patellar bone (QTB) and BPTB grafts for anterior cruciate ligament (ACL) reconstruction are currently lacking. HYPOTHESIS: The relationship between post-ACL reconstruction graft bending angle (GBA) and the angle corresponding to the GBA (cGBA) would indicate that the BPTB can bend more than the QTB at the femoral tunnel aperture. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty paired human cadaveric knees fixed at <10° of knee joint flexion (mean age, 82.5 years) underwent histological sectioning and staining with Masson trichrome and toluidine blue. The femoral ACL insertion, QTB graft, and BPTB graft were microscopically analyzed. The width of the direct insertion, thickness of the uncalcified fibrocartilage and calcified fibrocartilage, ligament attachment angle, and cGBA for each group were measured. Eighteen patients who underwent ACL reconstruction with QTB or BPTB autograft were included for the evaluation of GBA using computed tomography images at 1 week postoperatively. RESULTS: The mean insertion widths of the femoral ACL, QTB, and BPTB were 7.81, 9.07, and 6.54 mm, respectively. The QTB was 16% wider than the ACL, while the BPTB was 16% narrower than the ACL. The mean insertion thicknesses of the femoral ACL, QTB, and BPTB were 0.53, 0.94, and 0.38 mm, respectively. The QTB was 77% thicker than the ACL (P < .001), while the BPTB was 28% thinner than the ACL (P = .017). The mean ligament attachment angles of the femoral ACL, QTB, and BPTB were 20.3°, 30.2°, and 33.3°, respectively, and the QTB and the BPTB were 49% and 64% larger, respectively, than the ACL. The mean cGBAs of the femoral ACL, QTB, and BPTB were 33.9°, 35.1°, and 12.3°, respectively. The BPTB was 64% smaller than the ACL, while there was no significant difference between the QTB and the ACL. The mean GBA was 57.7°. CONCLUSION: The insertion width and thickness were significantly greater and smaller in the QTB and BPTB grafts, respectively, than in the ACL. The relationship between GBA after ACL reconstruction and cGBA in knee extension indicates that at the femoral tunnel aperture, the BPTB can bend more than the QTB. CLINICAL RELEVANCE: QTB graft may allow more anatomic ACL reconstruction to be performed.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Patelar , Idoso de 80 Anos ou mais , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Cadáver , Humanos , Ligamento Patelar/cirurgia
12.
Sci Rep ; 12(1): 14071, 2022 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-35982105

RESUMO

Posterior tibial slope (PTS) has been known to contribute to anterior-posterior knee stability and play an essential biomechanical role in knee kinematics. This study aimed to investigate the effect of PTS on single-leg standing sagittal knee alignment of the intact knee. This study included 100 patients with unilateral ACL injury knee (ACL injury group, 53 patients) or with the normal knee (control group, 47 patients). The single-leg standing sagittal alignment of the unaffected knees of the ACL injury group and normal knees of the control group were assessed radiographically with the following parameters: knee extension angle (EXT), PTS, PTS to the horizontal line (PTS-H), femoral shaft anterior tilt to the vertical axis (FAT), and tibial shaft anterior tilt to the vertical axis (TAT). PTS was negatively correlated with EXT and positively correlated with TAT. EXT was significantly larger in the ACL injury group, whereas TAT was smaller in the ACL injury group. Patients with larger PTS tend to stand with a higher knee flexion angle by tilting the tibia anteriorly, possibly reducing tibial shear force. Patients with ACL injury tend to stand with larger EXT, i.e., there is less preventive alignment to minimize the tibial shear force.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/diagnóstico por imagem , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
13.
BMC Musculoskelet Disord ; 23(1): 793, 2022 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-35982445

RESUMO

BACKGROUND: The number of studies with a large cohort of patients that primarily focus on patient-reported outcomes after ACL reconstruction in children and adolescents is limited. The purpose of the present study was to determine whether patient age affects the proportion of patients that achieve a patient-acceptable symptom state (PASS) on the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales one, two, five and 10 years after an ACL reconstruction. METHODS: The patient data in the present study were extracted from the Swedish National Knee Ligament Register (SNKLR). Patients aged between five and 35 years that underwent a primary ACL reconstruction between 1 January 2005 and 31 December 2017 and had completed the KOOS questionnaire at the one-, two-, five- or 10-year follow-up were included. A total of 2,848 patients met the inclusion criteria and were included in the study; 47 paediatric patients (females 5-13, males 5-15 years), 522 adolescents (females 14-19, males 16-19 years) and 2,279 young adults (females 20-35, males 20-35 years). The results from the KOOS were presented as the mean and 95% confidence interval (CI) for the mean. For comparisons between groups, the chi-square test was used for non-ordered categorical variables. For pairwise comparisons between groups, Fisher's exact test (2-sided) was used for dichotomous variables. All the statistical analyses was set at 5%. RESULTS: Adolescents reported a significantly lower score than young adults on the KOOS4 at the two- (68.4 vs. 72.1; P < 0.05), five- (69.8 vs. 76.0; P < 0.05) and 10-year follow-ups (69.8 vs. 78.2; P < 0.05). Moreover, a significantly smaller proportion of adolescents achieved a PASS on each of the KOOS subscales when compared with young adults at the five-year follow-up (Symptoms: 83.3% vs. 91.6%; Pain: 42.9% vs. 55.3%; Function in daily living: 31.4% vs. 41.1%; Function in sports and recreational activities: 42.3% vs. 55.7%; Knee-related quality of life: 50.0% vs. 65.0%; P < 0.05). CONCLUSIONS: A significantly smaller proportion of adolescents achieved a PASS on each of the KOOS subscales when compared with young adults five years after ACL reconstruction. The results of the present study provide important information for physicians and physiotherapists treating young patients after an ACL injury and they can aid in providing realistic expectations in terms of the mid- and long-term outcomes. LEVEL OF EVIDENCE: Prospective Observational Register/Cohort Study, Level II.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Osteoartrite do Joelho , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Osteoartrite do Joelho/cirurgia , Qualidade de Vida , Suécia/epidemiologia , Adulto Jovem
14.
BMC Musculoskelet Disord ; 23(1): 759, 2022 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941643

RESUMO

BACKGROUND: It is unclear whether different anterior cruciate ligament (ACL) graft trajectories in the distal femur would have different effects on stress generated within the distal femur around the femoral tunnel during knee motion. Thus, the purpose of this study was to determine differences in stress patterns around the femoral tunnel created by trans-portal (TP) vs. modified trans-tibial (TT) technique in anatomical ACL reconstruction at different knee flexion angles. METHODS: Twelve male subjects' right knees were scanned with a high-resolution computed tomography (CT) scanner (slice thickness: 1 mm) at four different knee flexion angles (0°, 45°, 90°, and 135°). Three-dimensional (3D) models of these four different flexion angles were created and manipulated with several modelling programs. For the TP group, the virtual femoral tunnelling procedure was performed in a 135° flexion model from the low far anteromedial (AM) portal. For the modified TT group, the same knee models were drilled through the modified TT technique at 90° of flexion separately. Virtual grafts under tension of 40 N were put into corresponding bone tunnel and fixed at the outer aperture of femoral tunnels to simulate the suspensory fixation, followed by fixation of the grafts at the middle of tibial tunnels in the 0° knee flexion models. Finally, the models were exported to a finite element analysis package and analysed using ABAQUS/Explicit code (ABAQUS, USA) to monitor the stress occurring at the node where stress distribution occurred most significantly in the femoral bone around the bone tunnel. RESULTS: In general, both groups showed a high stress distribution in bony structures around inner and outer orifices of the femoral tunnel. Mean maximal stresses occurring at the lateral femoral condyle around the inner orifice of the femoral tunnel in the TP group were found to be significantly greater than those in the modified TT group at all flexion angles except 90° of flexion. Mean maximal stresses monitored around the outer orifice of the femoral tunnel in the TP group were also significantly greater than those in the modified TT group at all flexion angles. CONCLUSIONS: Different tunnelling technologies could yield different stress patterns in the lateral femoral condyle around the femoral tunnel. During knee motion, higher stresses were noticed in the TP group than in the modified TT group, especially around inner and outer orifices of the tunnel. Position of the tunnel after reconstruction with the TP technique can have a greater effect on the stress increase in the femur compared to that with the modified TT technique.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/diagnóstico por imagem , Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Análise de Elementos Finitos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
15.
Arthroscopy ; 38(8): 2368-2369, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35940736

RESUMO

Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed knee operations. An "all-inside" technique creates bone sockets for ACL graft passage, as opposed to more traditional full bone tunnels, and typically incorporates suspensory fixation instead of screw fixation to secure the graft. This technique may be indicated for any ACL reconstruction surgery, where adequate bone stock exists to drill sockets and to use cortical fixation. The technique may be used with all soft tissue, as well as bone plug ACL grafts and autograft hamstring or quadriceps tendon; most allograft tendon options may be performed with an all-inside technique. Advantages include anatomic tunnel/socket placement, decreased postoperative pain and swelling, minimal hardware, appropriate graft tensioning and retensioning, and circumferential graft to bone healing. Tips for successful all-inside surgery include matching graft diameter to socket diameter, drilling appropriate length sockets based on individual graft length, so as not to "bottom out" the graft and confirming cortical button fixation intraoperatively. Potential complications include graft-socket mismatch, full-tunnel reaming, and loss of cortical fixation. Multiple studies have shown the all-inside technique to have similar or superior biomechanical properties and clinical outcomes compared to the more traditional full-tunnel ACL reconstruction techniques.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Parafusos Ósseos , Humanos , Tendões/transplante , Transplante Autólogo
16.
Arthroscopy ; 38(8): 2491-2492, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35940743

RESUMO

Recovery after anterior cruciate ligament reconstruction is optimal about 85% of the time. Revision surgery, psychiatric history, preoperative chronic knee pain, and subsequent knee injury are associated with suboptimal recovery patterns. Sophisticated growth models can analyze patient recovery trajectories. Growth mixture models (GMM) treat a whole cohort as a single group and characterize that group over time, for example, over the course of knee injury and subsequent recovery after surgical reconstruction. Latent class growth analysis is a subcategory of GMM that sorts the cohort into subgroups and allows analysis regarding groups having, for example, standard, delayed, and suboptimal recoveries. This theoretically allows a physician to anticipate which patients are likely to follow a suboptimal trajectory of recovery, to track that recovery based on the model, and to form a treatment plan accordingly.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Reoperação
17.
Medicine (Baltimore) ; 101(32): e29990, 2022 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-35960065

RESUMO

BACKGROUND: This study was a systematic review comparing the clinical outcomes of using the nonirradiated and irradiated allograft for anterior cruciate ligament (ACL) reconstruction. METHODS: A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane. All databases were searched from the earliest records through August 2019 using the following Boolean operators: irradiated AND nonirradiated AND ACL AND allograft. All prospective and retrospective controlled trials were retrieved that directly compared physical examination and knee function scores and patient-rated outcomes between the nonirradiated and irradiated allograft for ACL reconstruction. RESULTS: Three prospective and 2 retrospective articles were identified by the search, and the findings suggested that the nonirradiated allografts were superior to the irradiated allografts based on improved knee joint functional scores and decreased failure rate, even though there was no significantly difference with respect to overall IKDC, range of motion, vertical jump test, and one-leg hop test. CONCLUSIONS: Irradiated allograft should be limited to be used in ACL surgery and further research into new alternative sterilization techniques are needed to avoiding the disease transmission without interference with the biomechanical properties of the grafts.


Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Aloenxertos , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Articulação do Joelho/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
18.
JBJS Case Connect ; 12(3)2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-36040070

RESUMO

CASE: A 29-year-old man presented 2 years after anterior cruciate ligament (ACL) reconstruction by autologous semitendinosus graft and suspensory fixation on both tibial and femoral sides for chronic drainage of clear fluid from an anteromedial wound at the site of the tibial tunnel with a visible sinus tract. Magnetic resonance imaging showed a transtibial articulocutaneous fistula. The patient was treated by tunnel debridement, impaction bone grafting, bioresorbable interference screw, and cement to fully seal the tunnel. The surgery was successful with good clinical outcomes for recurrence and knee stability. CONCLUSION: Communicating transtibial articulocutaneous fistulas are rare complications after ACL reconstruction. Tunnel debridement and filling with graft material affected by an interference screw seem to be an effective method for dealing with such a clinical scenario.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Fístula , Adulto , Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Fístula/cirurgia , Humanos , Articulação do Joelho/cirurgia , Masculino , Tíbia/cirurgia
19.
Apunts, Med. esport (Internet) ; 57(215): 100386, July - September 2022. tab, graf
Artigo em Inglês | IBECS | ID: ibc-207610

RESUMO

Introduction: Bone-patellar tendon-bone (BPTB) autograft is the main treatment choice on complete anterior cruciate ligament (ACL) ruptures. However, high donor-site morbidity has been related to this procedure. A better understanding of the donor-site healing process could help us to decrease donor-site problems. The aim of this study is to describe the evolution of the patellar tendon size during the first year after BPTB procedure.Materials and methods42 consecutive patients underwent ACL reconstruction using BPTB technique in our facilities. We measured the tendon length, width and thickness through musculoskeletal ultrasound before and at 1, 2, 4, 6, 9 and 12 months after the operation. Tendon measurements from the contralateral unaffected tendon were used as a control group. We compared the values between injured and uninjured legs and between pre-op and post-op values.ResultsTendon length decreased significantly in both legs, without any difference between legs at 12 months post-op. Tendon width and thickness of the unaffected limbs showed a tendency to stabilization, while the injured limb showed a significant increase in both values during the first 1-2 months. At 12-months post-op, patellar tendon of the injured limb was significantly wider and thicker than the unaffected contralateral limb.ConclusionHarvesting the central third of the patellar tendon during the BPTB procedure after an ACL injury leads to significant changes in the patellar tendon that can last for up to 12 months after the surgery. Further research must focus on the translation of these findings into clinical signs with longest follow-up periods. (AU)


Assuntos
Humanos , Ligamento Cruzado Anterior/cirurgia , Ligamento Patelar/crescimento & desenvolvimento , Enxertos Osso-Tendão Patelar-Osso/crescimento & desenvolvimento , Sítio Doador de Transplante/cirurgia , Ultrassom/métodos
20.
Knee ; 37: 153-161, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35779433

RESUMO

BACKGROUND: The decision regarding graft choice and fixation in anterior cruciate ligament (ACL) reconstruction remains controversial. Free cylindrical bone plugs have been used successfully as graft fixation method. However, some concerns continue to exist regarding how well these plugs integrate with the bony walls of the tunnel. The aim of this study was to assess osteo-integration of free cylindrical bone plugs and to evaluate its effect on the clinical outcomes of the procedure. METHODS: From January 2015 to December 2017, 30 patients (21-40 years old) with torn ACL were operated on and followed up for 24 months after surgery. All patients were assessed clinically (International Knee Documentation Committee score (IKDC) and Tegner-Lysholm knee scoring system), instrumentally (KT 1000 and Rolimeter), and radiologically (X-ray, computed tomography and magnetic resonance imaging). Young active patients with torn ACL were included while those with previous ligamentous injury and/or surgery were excluded. RESULTS: All bone grafts showed solid bone healing after 6 months of surgery; incorporation was 'good to excellent' (tibial side: 66.6%; femoral side: 86.6%). There was no correlation between age or time interval and graft incorporation. Positive correlation was shown between tibial and femoral graft incorporation within the same patient. Only one patient was abnormal in our final objective IKDC scores (graded C). The mean side-to-side difference with KT 1000 and Rolimeter was 1.9 and 1.8, respectively. CONCLUSION: Free cylindrical bone plugs could be used safely for hamstring tendon graft fixation; it enhances graft tunnel integration within the first 6 months and yields comparable clinical outcomes whilst avoiding the potential hazards of foreign hardware implants.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Adulto , Ligamento Cruzado Anterior/diagnóstico por imagem , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Fêmur/cirurgia , Humanos , Escore de Lysholm para Joelho , Resultado do Tratamento , Adulto Jovem
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