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OBJECTIVE: People who sustain joint injuries such as anterior cruciate ligament (ACL) rupture often develop post-traumatic osteoarthritis (PTOA). In human patients, ACL injuries are often treated with ACL reconstruction. However, it is still unclear how effective joint restabilization is for reducing the progression of PTOA. The goal of this study was to determine how surgical restabilization of a mouse knee joint following non-invasive ACL injury affects PTOA progression. DESIGN: In this study, 187 mice were subjected to non-invasive ACL injury or no injury. After injury, mice underwent restabilization surgery, sham surgery, or no surgery. Mice were then euthanized on day 14 or day 49 after injury/surgery. Functional analyses were performed at multiple time points to assess voluntary movement, gait, and pain. Knees were analyzed ex vivo with micro-computed tomography, RT-PCR, and whole-joint histology to assess articular cartilage degeneration, synovitis, and osteophyte formation. RESULTS: Both ACL injury and surgery resulted in loss of epiphyseal trabecular bone (-27-32%) and reduced voluntary movement at early time points. Joint restabilization successfully lowered OA score (-78% relative to injured at day 14, p < 0.0001), and synovitis scores (-37% relative to injured at day 14, p = 0.042), and diminished the formation of chondrophytes/osteophytes (-97% relative to injured at day 14, p < 0.001, -78% at day 49, p < 0.001). CONCLUSIONS: This study confirmed that surgical knee restabilization was effective at reducing articular cartilage degeneration and diminishing chondrophyte/osteophyte formation after ACL injury in mice, suggesting that these processes are largely driven by joint instability in this mouse model. However, restabilization was not able to mitigate the early inflammatory response and the loss of epiphyseal trabecular bone, indicating that these processes are independent of joint instability.
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Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Progressão da Doença , Osteoartrite do Joelho , Animais , Lesões do Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/complicações , Camundongos , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/cirurgia , Osteoartrite do Joelho/fisiopatologia , Reconstrução do Ligamento Cruzado Anterior/métodos , Cartilagem Articular/patologia , Microtomografia por Raio-X , Modelos Animais de Doenças , Camundongos Endogâmicos C57BL , Masculino , Sinovite/etiologia , Sinovite/cirurgia , Osteófito/etiologiaRESUMO
PURPOSE: To identify MRI-detected anatomical risk factors for non-contact anterior cruciate ligament (ACL) injuries across genders. METHODS: A retrospective analysis was performed on 141 ACL-reconstructed patients (35 females, 106 males) and 142 controls (37 females, 105 males) from January 2020 to April 2022. Inclusion criteria were primary non-contact ACL injuries. The tibial plateau slope, lateral femoral condyle index, Insall-Salvati index, and patellar tendon angle were measured, using binary logistic regression for gender-specific risk evaluation. RESULTS: Increased lateral tibial plateau slope, reduced intercondylar notch width index, lateral femoral condyle index, and patellar tendon angle correlated with ACL injuries in both genders. The Insall-Salvati index was a significant risk factor in females but not in males. CONCLUSION: This study identifies the lateral tibial plateau slope, notch width index, lateral femoral condyle index, and patellar tendon angle at near-extension as risk factors for ACL injuries in both genders, with the Insall-Salvati index also implicated in females.
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Lesões do Ligamento Cruzado Anterior , Humanos , Masculino , Feminino , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/etiologia , Estudos Retrospectivos , Fatores Sexuais , Articulação do Joelho/diagnóstico por imagem , Tíbia , Imageamento por Ressonância Magnética/efeitos adversos , Fatores de Risco , Espectroscopia de Ressonância MagnéticaRESUMO
BACKGROUND: Magnetic resonance imaging (MRI) and manual tests remain the standard for diagnosing anterior cruciate ligament (ACL) rupture. Furthermore, the passive knee displacement, also described as anterior tibial translation (ATT), is used in order to make decisions about surgery or to assess rehabilitation outcomes. Unfortunately, these manual tests are limited to passive situations, and their application to assess knee stability in loaded, weight-bearing positions are missing. Therefore, a new device with high-performance sensors and a new sensor setting was developed. The aim of this exploratory cross-sectional study was to assess the test-retest reliability of this new device in a first step and the concurrent validity in a second step. METHODS: A total of 20 healthy volunteers were measured. Measurement consistency of the new device was assessed on the basis of reliability during Lachman test setting and in loaded position by artificial knee perturbation in a test-retest procedure. In a second step, the concurrent validity was evaluated with the Lachmeter® as a reference instrument. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), the minimal detectable change (MDC) and Bland-Altman analysis were evaluated to assess the quality criteria. RESULTS: The measurements with the new device during the Lachman test provided a mean ATT of 5.46±2.22mm. The SEM ranged from 0.60 to 0.69mm resulting in an MDC between 1.67 and 1.93mm for the new device. In the loaded test situation, the mean ATT was 2.11±1.20mm, with test-retest reliability also showing good correlation (r>0.83). The comparison of the two measurement methods with an ICC of (r>0.89) showed good correlation, which also underlines the reasonable agreement of the Bland-Altman analysis. CONCLUSIONS: The evaluation of the test-retest reliability of the new device during the knee stability testing in passive situation as well as in a functional, loaded situation presented good reliability. In addition, the new device demonstrated good agreement with the reference device and therefore good validity. Furthermore, the quality criteria demonstrated the ability of the new device to detect the cut-off value (3-5mm) described in the literature for the diagnosis of ACL-deficient knees, which underlines the clinical relevance of this new device as a reliable and valid tool.
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Lesões do Ligamento Cruzado Anterior , Articulação do Joelho , Humanos , Estudos Transversais , Reprodutibilidade dos Testes , Articulação do Joelho/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Exame FísicoRESUMO
PURPOSE: The study aimed to evaluate the impact of neurocognitive reliance on jump distance and lower extremity kinematics in individuals who had undergone anterior cruciate ligament reconstruction (ACLR). This was achieved by comparing hop performance under standard and neurocognitive conditions. METHODS: Thirty-two patients after ACLR and 32 healthy controls (CTRL) participated. Both groups performed a single-leg hop for distance (SLHD) and two neurocognitive hop tests, each designed to evaluate distinct aspects of neurocognition. The neurocognitive tests included the reaction SLHD (R-SLHD), measuring reaction to a central stimulus and working memory SLHD (WM-SLHD) assessing response to a memorized stimulus amidst distractor stimuli. Distances were assessed for the three-hop tests. In addition, joint kinematics were collected to calculate lower extremity coordination of the lower extremity. SLHD performance was defined as the mean hop distance per condition per leg for each participant and was analyzed using a mixed ANOVA with condition and leg as the within-subjects factors and the group (ACLR or CTRL) as the between-subjects factor. Differences in joint coordination variability were analyzed using two-sample t-test statistical parametric mapping (SPM) with linear regression. RESULTS: The WM-SLHD resulted in a significantly decreased jump distance compared with the standard hop test both for ACLR and CTRL. Furthermore, the leg difference within the ACLR group increased under higher cognitive load as tested with the WM-SLHD, indicating leg-specific adaptations in lower extremity coordination. CONCLUSIONS: Neurocognitive single-leg hop tests resulted in reduced jump distance in CTRL and ACLR. The neurocognitive hop test revealed changes in coordination variability for the CTRL and the uninjured leg of ACLR individuals, whereas the injured leg's coordination variability remained unaltered, suggesting persistent cognitive control of movements post-ACLR. LEVEL OF EVIDENCE: Level III.
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PURPOSE: The purpose of this study was to develop a neural network model for predicting second anterior cruciate ligament (ACL) injury risk following ACL reconstruction using patient features from medical records. METHODS: Of 486 consecutive patients who underwent primary unilateral ACL reconstruction, 386 patients (198 women, 188 men) with a mean age of 25.1 ± 11.6 years were included in this study. Fifty-eight features, including demographic data, surgical, preoperative and postoperative data, were retrospectively collected from medical records, and features with an incidence of less than 5% were excluded. Finally, 14 features were used for the analysis. The multilayer perceptron was composed of four hidden layers with a rectified linear unit as activation and was trained to maximise the area under the receiver-operating characteristic curve (auROC). Subsequently, validation was carried out through a rigorous threefold cross-validation process. To ascertain the most efficacious combination of features with the highest auROC, a single feature with the least impact on auROC maximisation was systematically eliminated from the comprehensive variable set, ultimately resulting in the retention of a mere two variables. RESULTS: The median follow-up period was 50.5 (24-142) months. Fifty-seven knees had a second ACL injury, with a graft rupture rate of 7.7% and a contralateral injury rate of 6.9%. The maximum auROC for predicting graft rupture was 0.81 with two features: young age and hamstring graft. Meanwhile, the maximum auROC for predicting contralateral ACL injury was 0.74 with seven features, including young age, presence of medial meniscus tear, small body mass index, hamstring graft, female sex and medial meniscus repair or treatment. CONCLUSION: A neural network model with patient features from medical records detected graft ruptures and contralateral ACL injuries with acceptable accuracy. This model can serve as a new, useful tool in clinical practice to inform decisions about ACL reconstruction and retuning to sports postoperatively. LEVEL OF EVIDENCE: Level IV.
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Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Esportes , Masculino , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos Retrospectivos , Ruptura/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodosRESUMO
PURPOSE: To report how many badminton players return to badminton after an anterior cruciate ligament (ACL) injury and to which level. METHODS: Patients in Denmark from 2000 to 2018, registered in the Danish National Patient Register with a diagnosis of ACL rupture and badminton as a primary sport were asked about a return to sport (RTS) and return to performance (RTP) after ACL injury. RTP was defined as the return to full participation in the same sport, same level and same preinjury performance. To investigate the likelihood of RTS and return to preinjury level, a binominal logistic regression was used. RESULTS: Badminton was the primary sport for 900 participants. Only 435 players were injured during badminton, and 626 participants intended to RTP. RTS was achieved by 396 (63%) and 117 (19%) returned to the same performance as their preinjury level. However, 273 (44%) returned to full participation at the same level as the preinjury level but did not perform as well. Males had a significantly higher RTS than females, and RTP was also higher among males [221 (68%) vs. 175 (58%), odds ratio, OR: 1.67, p = 0.003 and 74 (23%) vs. 43 (14%), OR: 1.58, p = 0.05]. CONCLUSION: Return to badminton was achieved by 396 (63%), but only 117 (19%) returned to the same performance as their preinjury level after ACL injury. Females are less successful in RTS and RTP. Future research on improving RTS and the RTP rates in badminton, in general, and specifically for females is needed. LEVEL OF EVIDENCE: Level II.
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Lesões do Ligamento Cruzado Anterior , Esportes com Raquete , Volta ao Esporte , Humanos , Lesões do Ligamento Cruzado Anterior/cirurgia , Esportes com Raquete/lesões , Masculino , Feminino , Dinamarca , Adulto , Adulto Jovem , Adolescente , Sistema de RegistrosRESUMO
PURPOSE: The capacity to explosively contract quadriceps within the critical timeframe associated with anterior cruciate ligament (ACL) injury, quantified by the rate of torque development, is potentially essential for safe landing mechanics. This study aimed to investigate the influence of explosive quadriceps strength on ACL-related sagittal-plane landing mechanics in females with and without ACL reconstruction (ACLR). METHODS: Quadriceps explosive strength and landing mechanics were assessed in 19 ACLR and 19 control females during isometric contractions and double- and single-leg jump landings. A stepwise multiple linear regression model determined the variance in each of the landing biomechanics variables for the ACLR limb and nondominant limb of controls that could be explained by the group, rate of torque development and/or their interaction. If peak kinetic variables could be predicted by the rate of torque development or interaction, additional analyses were conducted, accounting for knee flexion as a covariate in the regression model. RESULTS: During single-leg landings, ACLR females exhibited greater knee flexion at initial contact than controls (p = 0.04). Greater quadriceps rate of torque development predicted higher peak posterior ground reaction force and anterior tibial shear force in both groups (p = 0.04). However, after controlling for knee flexion angle at those peak forces, quadriceps rate of torque development was not predictive. In double-leg landings, greater explosive quadriceps strength was associated with quicker attainment of peak knee extension moment and posterior ground reaction force in the ACLR limb (p = 0.03). CONCLUSION: Regardless of ACL injury status, females with greater explosive quadriceps strength adopted safer single-leg landings through increased knee flexion, potentially mitigating ACL loading despite encountering higher peak forces. During double-leg landings, a greater explosive quadriceps strength of the ACLR limb is associated with faster achievement of peak force upon landing. Incorporating explosive quadriceps strengthening into post-ACLR rehabilitation and injury prevention programmes may enhance landing mechanics for reducing primary and subsequent ACL injury risks. LEVEL OF EVIDENCE: Level II.
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Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Força Muscular , Músculo Quadríceps , Torque , Humanos , Feminino , Músculo Quadríceps/fisiologia , Fenômenos Biomecânicos , Adulto Jovem , Força Muscular/fisiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Adulto , Contração Isométrica/fisiologia , Estudos de Casos e Controles , Articulação do Joelho/fisiopatologia , Articulação do Joelho/fisiologiaRESUMO
PURPOSE: The aim of this consensus project was to give recommendations regarding surgical treatment of the anterior cruciate ligament (ACL) injured patient. METHODS: For this consensus process, an expert, steering and rating group was formed. In an initial online meeting, the steering group, together with the expert group, formed various key topic complexes for which multiple questions were formulated. For each key topic, a structured literature search was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Sufficient consensus was defined as 80% agreement. RESULTS: During this consensus process, 30 topics regarding the surgical management and technique of ACL reconstruction were identified. The literature search for each key question resulted in 30 final statements. Of these 30 final statements, all achieved consensus. CONCLUSIONS: This consensus process has shown that surgical treatment of ACL injury is a complex process. Various surgical factors influence patient outcomes. The proposed treatment algorithm can be used as a decision aid for the surgeon. LEVEL OF EVIDENCE: Level V.
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Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Humanos , Algoritmos , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , ConsensoRESUMO
PURPOSE: To investigate the landing strategies used after discontinuing and continuing the use of a functional knee brace (FKB) while performing a drop jump. METHODS: Following published methodology and power analysis, 23 uninjured male athletes, mean age of 19.4 ± 3.0 years, performed seven tests, during three test conditions (nonbraced, braced and removed brace or continued brace use), over 6 days of 12 testing sessions (S) for a total of 38.5 h. Each subject was provided with a custom-fitted FKB. This study focuses on the single leg drop jump kinetics during S12 when subjects were randomly selected to remove the FKB after 17.5 h or continued use of FKB. The time to peak vertical ground reaction forces (PVGRF) and PVGRF were recorded on landing in eight trials. RESULTS: After brace removal, a significantly shorter mean time to PVGRF was recorded (9.4 ± 22.9 msec (3.9%), p = 0.005, 95% confidence interval (95% CI): -168.1, 36.1), while continued brace use required a nonsignificant (n.s.) longer mean duration to achieve PVGRF (19.4 ± 53.6 msec (8.9%), n.s., 95% CI: -49.7, 73.4). No significant mean PVGRF difference was found in brace removal (25.3 ± 65.8 N) and continued brace use (25.1 ± 23.0 N). CONCLUSION: Removal of FKB after 17.5 h of use led to a significantly shorter time to achieve PVGRF, while continued brace use for 21 h required a longer duration to achieve PVGRF, suggesting faster and slower knee joint loading, respectively. Understanding the concerns associated with the use of FKB and the kinetics of the knee joint will assist clinicians in counselling athletes about the risks and benefits of using an FKB. LEVEL OF EVIDENCE: Level II.
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Braquetes , Articulação do Joelho , Humanos , Masculino , Articulação do Joelho/fisiologia , Adulto Jovem , Fenômenos Biomecânicos , Fatores de Tempo , Suporte de Carga , Adolescente , Adulto , Remoção de DispositivoRESUMO
PURPOSE: The aim of this study was to investigate whether the whole tibial spine volume and femoral intercondylar notch volume are risk factors for anterior cruciate ligament (ACL) injury. The hypothesis was that the whole tibial spine volume and femoral notch volume would be smaller in athletes who sustained ACL injury than in athletes with no history of ACL injury. METHODS: Computed tomography scans of both knees were acquired and three-dimensional bone models were created using Mimics to measure whole tibial spine volume and femoral notch volume. Tibial spine volume, femoral notch volume and each of these volumes normalised by tibial plateau area were compared between the ACL-injured and the ACL-intact group. RESULTS: Fifty-one athletes undergoing unilateral anatomical ACL reconstruction (17 female, 34 male: average age 22.0 ± 7.5) and 19 healthy collegiate athletes with no previous knee injury (eight female, 11 male: average age 20.1 ± 1.3) were included in this study. The whole tibial spine volume in the ACL-injured group (2.1 ± 0.5 cm3) was 20.7% smaller than in the ACL-intact group (2.7 ± 0.7 cm3) (p = 0.005). No differences were observed between the femoral notch volume in the ACL-injured group (9.5 ± 2.1 cm3) and the ACL-intact group (8.7 ± 2.7 cm3) (n.s.). CONCLUSIONS: The main finding of this study was that the whole tibial spine volume of the ACL-injured group was smaller than the ACL-intact group. A small tibial spine volume can be added to the list of anatomical risk factors that may predispose athletes to ACL injury. LEVEL OF EVIDENCE: Level â ¢.
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Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Tíbia , Tomografia Computadorizada por Raios X , Humanos , Masculino , Feminino , Lesões do Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Adulto Jovem , Tíbia/diagnóstico por imagem , Tíbia/anatomia & histologia , Adulto , Atletas , Fêmur/diagnóstico por imagem , Fêmur/anatomia & histologia , Adolescente , Fatores de Risco , Estudos de Casos e Controles , Traumatismos em Atletas/diagnóstico por imagemRESUMO
Traditional motion analysis systems are impractical for widespread screening of non-contact anterior cruciate ligament (ACL) injury risk. The Kinect V2 has been identified as a portable and reliable alternative but was replaced by the Azure Kinect. We hypothesize that the Azure Kinect will assess drop vertical jump (DVJ) parameters associated with ACL injury risk with similar accuracy to its predecessor, the Kinect V2. Sixty-nine participants performed DVJs while being recorded by both the Azure Kinect and the Kinect V2 simultaneously. Our software analyzed the data to identify initial coronal, peak coronal, and peak sagittal knee angles. Agreement between the two systems was evaluated using the intraclass correlation coefficient (ICC). There was poor agreement between the Azure Kinect and the Kinect V2 for initial and peak coronal angles (ICC values ranging from 0.135 to 0.446), and moderate agreement for peak sagittal angles (ICC = 0.608, 0.655 for left and right knees, respectively). At this point in time, the Azure Kinect system is not a reliable successor to the Kinect V2 system for assessment of initial coronal, peak coronal, and peak sagittal angles during a DVJ, despite demonstrating superior tracking of continuous knee angles. Alternative motion analysis systems should be explored.
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Lesões do Ligamento Cruzado Anterior , Humanos , Masculino , Feminino , Adulto , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Fenômenos Biomecânicos/fisiologia , Adulto Jovem , Movimento/fisiologia , Articulação do Joelho/fisiologia , Amplitude de Movimento Articular/fisiologia , SoftwareRESUMO
PURPOSE: Oral contraceptives (OCs) are commonly used by female athletes raising concerns regarding the possible adverse effects of OCs on physical performance, musculoskeletal injuries, and bone density. We aimed to review all current studies on the physiological effects of OCs in physically active women. MATERIALS AND METHODS: A review of literature in electronic search in PubMed and Google Scholar databases from December 2002 to December 2022 using relevant keywords. The reference lists of the articles found eligible were also reviewed. RESULTS: Out of 344 articles in the initial database, 54 clinical studies were eligible for inclusion in our literature review. OCs are used by about two-thirds of female athletes. Current research suggests that OCs' effects on endurance performance and muscle strength are mostly reassuring. OCs do not seem to have a major negative impact on bone health or sports injuries. In fact, new data suggests that they may even significantly reduce the risk of anterior cruciate ligament (ACL) injury. CONCLUSIONS: OCs can be safely used by young female athletes, who may also benefit from better menstrual cycle control. OCs offer newly realised protection from ACL injuries. The use of OCs must be carefully individualised according to their preferences, expectations, and experience.
Hormonal contraception can be safely prescribed to active women. The International Olympic Committee advocates a new and wider definition for the 'athlete triad', where low energy availability presents a special challenge for these athletes. New data suggests that the use of oral contraceptives may protect against ACL injury.
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Lesões do Ligamento Cruzado Anterior , Traumatismos em Atletas , Humanos , Feminino , Contracepção Hormonal , Anticoncepcionais Orais , Ciclo Menstrual , Atletas , Traumatismos em Atletas/prevenção & controle , Lesões do Ligamento Cruzado Anterior/prevenção & controleRESUMO
CONTEXT: The best current evidence supports the effectiveness of neuromuscular training in reducing the risk of injury; however, the rate of anterior cruciate ligament (ACL) injuries is still high. Neurocognitive training (NT) has successfully improved biomechanical risk factors, but they have been considered in only a few studies. OBJECTIVE: To review the literature to determine the effect of NT on biomechanical risk factors related to ACL injury in athletes. EVIDENCE ACQUISITION: We searched PubMed, Google Scholar, Scopus, Science Direct, and the Physiotherapy Evidence Database from inception to August 2011. We included randomized controlled trials that used motor learning approaches and injury prevention programs to investigate kinematic and kinetic risk factors related to ACL injury. The quality of each clinical trial study was evaluated by the Physiotherapy Evidence Database scale. The eligibility criteria were checked based on the PICOS (population, intervention, comparison, outcome, and study type) framework. EVIDENCE SYNTHESIS: A total of 9 studies were included in the final analysis. Motor learning approaches include internal and external focus of attention, dual tasks, visual motor training, self-control feedback, differential learning, and linear and nonlinear pedagogy, combined with exercise programs. In most of the studies that used NT, a significant decrease in knee valgus; tibial abduction and external rotation; ground reaction force; and an increase in knee-, trunk-, hip-, and knee-flexion moment was observed. CONCLUSION: In classical NT, deviation from the ideal movement pattern especially emphasizing variability and self-discovery processes is functional in injury prevention and may mitigate biomechanical risk factors of ACL injuries in athletes. Practitioners are advised to use sport-specific cognitive tasks in combination with neuromuscular training to simulate loads of the competitive environment. This may improve ACL injury risk reduction and rehabilitation programs.
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Lesões do Ligamento Cruzado Anterior , Traumatismos em Atletas , Humanos , Lesões do Ligamento Cruzado Anterior/prevenção & controle , Fenômenos Biomecânicos , Fatores de Risco , Traumatismos em Atletas/prevenção & controle , AtletasRESUMO
PURPOSE OF REVIEW: To provide a comprehensive overview of the inflammatory response following anterior cruciate ligament (ACL) injury and to highlight the relationship between specialized pro-resolving mediators (SPMs) and inflammatory joint conditions, emphasizing the therapeutic potential of modulating the post-injury resolution of inflammation to prevent posttraumatic osteoarthritis (PTOA). RECENT FINDINGS: The inflammatory response triggered after joint injuries such as ACL tear plays a critical role in posttraumatic osteoarthritis development. Inflammation is a necessary process for tissue healing, but unresolved or overactivated inflammation can lead to chronic diseases. SPMs, a family of lipid molecules derived from essential fatty acids, have emerged as active players in the resolution of inflammation and tissue repair. While their role in other inflammatory conditions has been studied, their relationship with PTOA remains underexplored. Proinflammatory mediators contribute to cartilage degradation and PTOA pathogenesis, while anti-inflammatory and pro-resolving mediators may have chondroprotective effects. Therapies aimed at suppressing inflammation in PTOA have limitations, as inflammation is crucial for tissue healing. SPMs offer a pro-resolving response without causing immunosuppression, making them a promising therapeutic option. The known onset date of PTOA makes it amenable to early interventions, and activating pro-resolving pathways may provide new possibilities for preventing PTOA progression. Harnessing the pro-resolving potential of SPMs may hold promise for preventing PTOA and restoring tissue homeostasis and function after joint injuries.
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Lesões do Ligamento Cruzado Anterior , Osteoartrite , Humanos , Osteoartrite/tratamento farmacológico , Osteoartrite/etiologia , Inflamação/metabolismo , Lesões do Ligamento Cruzado Anterior/complicações , Mediadores da Inflamação/metabolismo , Mediadores da Inflamação/uso terapêuticoRESUMO
BACKGROUND: To develop a fully automated CNN detection system based on magnetic resonance imaging (MRI) for ACL injury, and to explore the feasibility of CNN for ACL injury detection on MRI images. METHODS: Including 313 patients aged 16 - 65 years old, the raw data are 368 pieces with injured ACL and 100 pieces with intact ACL. By adding flipping, rotation, scaling and other methods to expand the data, the final data set is 630 pieces including 355 pieces of injured ACL and 275 pieces of intact ACL. Using the proposed CNN model with two attention mechanism modules, data sets are trained and tested with fivefold cross-validation. RESULTS: The performance is evaluated using accuracy, precision, sensitivity, specificity and F1 score of our proposed CNN model, with results of 0.8063, 0.7741, 0.9268, 0.6509 and 0.8436. The average accuracy in the fivefold cross-validation is 0.8064. For our model, the average area under curves (AUC) for detecting injured ACL has results of 0.8886. CONCLUSION: We propose an effective and automatic CNN model to detect ACL injury from MRI of human knees. This model can effectively help clinicians diagnose ACL injury, improving diagnostic efficiency and reducing misdiagnosis and missed diagnosis.
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Lesões do Ligamento Cruzado Anterior , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Área Sob a Curva , Redes Neurais de Computação , Projetos de PesquisaRESUMO
PURPOSE: Identifying predictive factors for all-cause reoperation after anterior cruciate ligament reconstruction could inform clinical decision making and improve risk mitigation. The primary purposes of this study are to (1) determine the incidence of all-cause reoperation after anterior cruciate ligament reconstruction, (2) identify predictors of reoperation after anterior cruciate ligament reconstruction using machine learning methodology, and (3) compare the predictive capacity of the machine learning methods to that of traditional logistic regression. METHODS: A longitudinal geographical database was utilized to identify patients with a diagnosis of new anterior cruciate ligament injury. Eight machine learning models were appraised on their ability to predict all-cause reoperation after anterior cruciate ligament reconstruction. Model performance was evaluated via area under the receiver operating characteristics curve. To explore modeling interpretability and radiomic feature influence on the predictions, we utilized a game-theory-based method through SHapley Additive exPlanations. RESULTS: A total of 1400 patients underwent anterior cruciate ligament reconstruction with a mean postoperative follow-up of 9 years. Two-hundred and eighteen (16%) patients experienced a reoperation after anterior cruciate ligament reconstruction, of which 6% of these were revision ACL reconstruction. SHapley Additive exPlanations plots identified the following risk factors as predictive for all-cause reoperation: diagnosis of systemic inflammatory disease, distal tear location, concomitant medial collateral ligament repair, higher visual analog scale pain score prior to surgery, hamstring autograft, tibial fixation via radial expansion device, younger age at initial injury, and concomitant meniscal repair. Pertinent negatives, when compared to previous studies, included sex and timing of surgery. XGBoost was the best-performing model (area under the receiver operating characteristics curve of 0.77) and outperformed logistic regression in this regard. CONCLUSIONS: All-cause reoperation after anterior cruciate ligament reconstruction occurred at a rate of 16%. Machine learning models outperformed traditional statistics and identified diagnosis of systemic inflammatory disease, distal tear location, concomitant medial collateral ligament repair, higher visual analog scale pain score prior to surgery, hamstring autograft, tibial fixation via radial expansion device, younger age at initial injury, and concomitant meniscal repair as predictive risk factors for reoperation. Pertinent negatives, when compared to previous studies, included sex and timing of surgery. These models will allow surgeons to tabulate individualized risk for future reoperation for patients undergoing anterior cruciate ligament reconstruction. LEVEL OF EVIDENCE: III.
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Lesões do Ligamento Cruzado Anterior , Humanos , Reoperação , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Fatores de Risco , Ruptura/cirurgia , Aconselhamento , Dor/cirurgiaRESUMO
PURPOSE: This study sought to develop and internally validate a machine learning model to identify risk factors and quantify overall risk of secondary meniscus injury in a longitudinal cohort after primary ACL reconstruction (ACLR). METHODS: Patients with new ACL injury between 1990 and 2016 with minimum 2-year follow-up were identified. Records were extensively reviewed to extract demographic, treatment, and diagnosis of new meniscus injury following ACLR. Four candidate machine learning algorithms were evaluated to predict secondary meniscus tears. Performance was assessed through discrimination using area under the receiver operating characteristics curve (AUROC), calibration, and decision curve analysis; interpretability was enhanced utilizing global variable importance plots and partial dependence curves. RESULTS: A total of 1187 patients underwent ACLR; 139 (11.7%) experienced a secondary meniscus tear at a mean time of 65 months post-op. The best performing model for predicting secondary meniscus tear was the random forest (AUROC = 0.790, 95% CI: 0.785-0.795; calibration intercept = 0.006, 95% CI: 0.005-0.007, calibration slope = 0.961 95% CI: 0.956-0.965, Brier's score = 0.10 95% CI: 0.09-0.12), and all four machine learning algorithms outperformed traditional logistic regression. The following risk factors were identified: shorter time to return to sport (RTS), lower VAS at injury, increased time from injury to surgery, older age at injury, and proximal ACL tear. CONCLUSION: Machine learning models outperformed traditional prediction models and identified multiple risk factors for secondary meniscus tears after ACLR. Following careful external validation, these models can be deployed to provide real-time quantifiable risk for counseling and timely intervention to help guide patient expectations and possibly improve clinical outcomes. LEVEL OF EVIDENCE: III.
Assuntos
Lesões do Ligamento Cruzado Anterior , Menisco , Humanos , Educação de Pacientes como Assunto , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/complicações , Ligamento Cruzado Anterior , Fatores de Risco , Estudos RetrospectivosRESUMO
PURPOSE: To investigate if patient-reported outcome measures (PROMs), functional tests and clinical measures correlate well in children after reconstruction of the anterior cruciate ligament (ACL). It was hypothesized that these outcomes correlate, so it is sufficient to report only one of them. METHODS: A consecutive group of children (< 16 years old) who had an ACL reconstruction, were prospectively followed and assessed after 1-year with Pedi-IKDC and KOOS-Child, instrumented laxity measurement, range of motion, extension strength and four performance tests. Relations between the different outcomes were calculated by partial correlation coefficient analysis, controlling for gender, age, height, and weight. RESULTS: Outcomes were available for 141 of 163 children. There were only few positive and weak correlations between performance tests and PROM scores and between clinical measurements and PROM scores. There were weak to strong correlations between the scores from Pedi-IKDC and the scores from each of the five domains of KOOS-Child and a weak to moderate correlation between the different domains of KOOS-Child. Similar correlations were found between the different performance tests. CONCLUSION: For children who had their ACL reconstructed there was no clinically important correlation between scores obtained by PROMs, a battery of functional performance tests and instrumented laxity of the knee at 1-year follow-up. This is an argument for always to include and report all three types of outcomes. LEVEL OF EVIDENCE: Level II.
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Humanos , Adolescente , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Ligamento Cruzado Anterior/cirurgia , Articulação do Joelho/cirurgia , Medidas de Resultados Relatados pelo PacienteRESUMO
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.
Assuntos
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 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.