scholarly journals “I don't opt out of things because I think I will get a sore knee, but I don't expose myself to stupid risks either”: patients’ experiences of a second ACL injury—an interview study

2021 ◽  
Author(s):  
Annette Heijne ◽  
Karin Grävare Silbernagel ◽  
Mari Lundberg
Keyword(s):  
Qualitative Content Analysis ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Acl Rupture ◽  
Common Denominator ◽  
Activity Levels ◽  
Level Of Evidence ◽  
Major Life ◽  
Life Goal ◽  
Coping Process

Abstract Purpose The purpose of this qualitative study was to describe women’s experiences with anterior cruciate ligament reconstruction (ACLR) and a subsequent ACL rupture, and to identify potential facilitators and barriers for coping with rehabilitation after the second injury. Methods Eight women between 17 and 36 years (mean 26, SD 6.5) who had experienced ACLR, followed by another ACL rupture, participated in the study. Semi-structured interviews were conducted, and data were analyzed using qualitative content analysis. Results One overarching theme, “Rehabilitation after a second ACL injury—A lifelong adaptive coping process”, emerged from analyses. Undergoing a second rehabilitation is described as a process of adaptation, beginning with the first injury and still ongoing, more than 5 years later. Participants applied different coping strategies to adapt to these life-altering injuries, but the common denominator was of major life adjustments with no return to previous activity levels. Initially, after the reinjury, it was about coping with the catastrophe of the dreaded second injury. Over time, they accepted their “new” life and reset their recovery/rehabilitation goal not just as “return to sport” but rather as a “personal life goal”. Conclusion Undergoing a second ACL injury is a long process that challenges the patient’s coping skills. Given these results, rehabilitation programs need to be more person centred according to the patients-adjusted life goals. Level of evidence 3.

scholarly journals Increased Total Cost and Lack of Diagnostic Utility for Emergency Department Visits After ACL Injury

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110067
Author(s):  
Lambert T. Li ◽  
Carlin Chuck ◽  
Steven L. Bokshan ◽  
Brett D. Owens
Keyword(s):  
Emergency Department ◽  
Socioeconomic Status ◽  
Low Socioeconomic Status ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Emergency Department Visits ◽  
Level Of Evidence ◽  
Total Cost ◽  
Acl Tear ◽  
Chi Square Analysis

Background: Patients are commonly evaluated at the emergency department (ED) with acute anterior cruciate ligament (ACL) tears, but providers without orthopaedics training may struggle to correctly diagnose these injuries. Hypothesis: It was hypothesized that few patients would be diagnosed with an ACL tear while in the ED and that these patients would be of lower socioeconomic status and more likely to have public insurance. Study Design: Cohort study; Level of evidence, 3. Methods: The 2017 State Ambulatory Surgery and Services Database (SASD) and State Emergency Department Database (SEDD) from the state of Florida were utilized in this study. Cases with Current Procedural Terminology code 29888 (arthroscopically aided ACL reconstruction [ACLR]) were selected from the SASD, and data from the SEDD were matched to patients who had an ED visit for a knee injury within 120 days before ACLR. Chi-square analysis was used to test for differences in patient and surgical variables between the ED visit and nonvisit patient groups. A generalized linear model was created to model the effect of ED visit on total cost for an ACL injury. Results: While controlling for differences in patient characteristics and concomitant procedure usage, a visit to the ED added $4587 in total cost ( P < .001). The ED visit cohort contained a greater proportion of patients with Medicaid (20.2% vs 9.1%), patients who were Black (18.4% vs 10.3%), and patients in the lowest income quartile (34.4% vs 25.0%) ( P < .001 for all). In the ED visit cohort, 14.4% of patients received an allograft versus 10.1% in the non-ED visit cohort ( P = .001) despite having a similar mean age. An ACL sprain was diagnosed in only 29 of the 645 (4.5%) patients who visited the ED. Conclusion: Utilizing the ED for care after an ACL injury was expensive, averaging a $4587 increase in total cost associated with ACLR. However, patients rarely left with a definitive diagnosis, with only 4.5% of patients who underwent ACLR being correctly diagnosed with an ACL tear in the ED. This additional cost was levied disproportionately on patients of low socioeconomic status and patients with Medicaid.

scholarly journals No Association Between Risk of Anterior Cruciate Ligament Rupture and Selected Candidate Collagen Gene Variants in Female Elite Athletes From High-Risk Team Sports

2018 ◽  
Vol 47 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Einar Andreas Sivertsen ◽  
Kari Bente Foss Haug ◽  
Eirik Klami Kristianslund ◽  
Anne-Marie Siebke Trøseid ◽  
Jari Parkkari ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Elite Athletes ◽  
Cruciate Ligament ◽  
Team Sports ◽  
Acl Injury ◽  
Acl Rupture ◽  
Acl Injuries ◽  
Genes Encoding ◽  
Anterior Cruciate

Background: Several single-nucleotide variants (SNVs) in collagen genes have been reported as predisposing factors for anterior cruciate ligament (ACL) tears. However, the evidence is conflicting and does not support a clear association between genetic variants and risk of ACL ruptures. Purpose: To assess the association of previously identified candidate SNVs in genes encoding for collagen and the risk of ACL injury in a population of elite female athletes from high-risk team sports. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 851 female Norwegian and Finnish elite athletes from team sports were included from 2007 to 2011. ACL injuries acquired before inclusion in the cohort were registered by interview. The participants were followed prospectively through 2015 to record new complete ACL injuries. Six selected SNVs were genotyped ( COL1A1: rs1800012, rs1107946; COL3A1: rs1800255; COL5A1: rs12722, rs13946; COL12A1: rs970547). Results: No associations were found between ACL rupture and the SNVs tested. Conclusion: The study does not support a role of the 6 selected SNVs in genes encoding for collagen proteins as risk factors for ACL injury. Clinical Relevance: Genetic profiling to identify athletes at high risk for ACL rupture is not yet feasible.

Psychological Readiness to Return to Sport Is Associated With Second Anterior Cruciate Ligament Injuries

2019 ◽  
Vol 47 (4) ◽  
pp. 857-862 ◽  
Author(s):  
April L. McPherson ◽  
Julian A. Feller ◽  
Timothy E. Hewett ◽  
Kate E. Webster
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Characteristic Curve ◽  
Return To Sport ◽  
Acl Injury ◽  
Short Version ◽  
Cutoff Score ◽  
Level Of Evidence ◽  
Younger Patients ◽  
Anterior Cruciate

Background: Psychological responses after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) have been identified as predictors of return to sport but have not been investigated in relation to further injury. Purpose/Hypothesis: To determine whether psychological readiness to return to sport is associated with second ACL injury. It was hypothesized a priori that at both preoperative and 12-month postoperative time points, patients who sustained a second ACL injury would have lower psychological readiness than patients who did not have a second injury. Study Design: Cohort study; Level of evidence, 2. Methods: Patients who had a primary ACLR procedure between June 2014 and June 2016 completed the ACL–Return to Sport after Injury (ACL-RSI) (short version) scale before their ACLR and repeated the scale at 12 months after surgery to assess psychological readiness to return to sport. Patients were followed for a minimum of 2 years (range, 2-4 years) after surgery to determine further injury. The primary outcome was the relationship between ACL-RSI scores and the incidence of second ACL injury. Results: In 329 patients who returned to sport after ACLR, 52 (16%) sustained a second ACL injury. No difference in psychological readiness was observed at the preoperative time point, but patients who sustained a second injury trended toward lower psychological readiness at 12 months compared with noninjured patients (60.9 vs 67.2 points; P = .11). Younger (≤20 years) patients with injury had significantly lower psychological readiness to return to sport than young noninjured patients (60.8 vs 71.5 points; P = .02), but no difference was found in older patients (60.9 vs 64.6 points; P = .58). In younger patients, receiver operating characteristic curve analysis revealed a cutoff score of 76.7 points with 90% sensitivity to identify younger patients who sustained a second ACL injury. Conclusion: Younger patients with lower psychological readiness are at higher risk for a second ACL injury after return to sport.

scholarly journals DO TIBIAL EMINENCE FRACTURES AND ANTERIOR CRUCIATE LIGAMENT TEARS HAVE SIMILAR OUTCOMES?

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0011
Author(s):  
Heath P. Melugin ◽  
Vishal S. Desai ◽  
Christopher Camp ◽  
Timothy E. Hewett ◽  
Todd A. Milbrandt ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Activity Levels ◽  
Injury Rates ◽  
Tibial Eminence ◽  
Anterior Laxity ◽  
Surgical Fixation ◽  
Anterior Cruciate

Background: Avulsion fractures involving the tibial eminence are considered equivalent in etiology to anterior cruciate ligament tears, however there is limited data comparing outcomes of adolescent patients undergoing surgical fixation of tibial eminence fractures to those undergoing anterior cruciate ligament (ACL) reconstruction. Purpose: The purpose of this study was to compare clinical outcomes, subsequent ACL injury rates, and activity levels between adolescent patients who underwent tibial eminence fracture fixation to patients with mid-substance ACL tears who required acute ligament reconstruction. Methods: This study included a group of patients with tibial eminence fractures treated with surgical fixation matched to a group of similar patients with ACL tears treated with reconstruction between the years of 2001 and 2015. Data regarding initial injury, surgical intervention, ACL/ACL graft injury rates, and physical examination findings were recorded. Clinical and functional outcomes were obtained using physical examination, IKDC subjective scores, Lysholm scores, and Tegner Activity levels. Results: Sixty patients with a mean follow-up of 57.7 (24-206) months were included. 20 patients (11 M:9 F) who underwent surgical fixation for tibial eminence fractures (TEF) with a mean age of 11.9 (7-15) years were matched to a group of 40 patients (23 M:17 F) who underwent ACL reconstruction for ACL tears with a mean age of 12.5 (8-15) years. The TEF group demonstrated significantly lower postoperative IKDC (TEF group: 94.0, ACL group: 97.2 (p=0.04)) and Lysholm scores (TEF group: 92.4, ACL group: 96.9 (p=0.02)). The TEF group returned to sport 121 days sooner (p<0.01), but there was no difference in postoperative Tegner scores (TEF group: 7.3, ACL group: 7.6 (p=0.16)). The TEF group demonstrated increased postoperative anterior laxity (p=0.02) and a higher rate of postoperative arthrofibrosis (p=0.04). There was no difference in subsequent ACL injury (p=0.41). Conclusion: Patients with tibial eminence fractures demonstrated lower mean clinical outcome scores compared to patients with ACL tears at minimum 2-year follow up. Additionally, they experienced more postoperative anterior laxity and had a higher rate of postoperative arthrofibrosis. There was no difference in subsequent ACL injury rate. The TEF group returned to sport sooner than the ACL group, but the postoperative activity level was similar.

Loss of patellofemoral cartilage thickness over 5 years following ACL injury depends on the initial treatment strategy: results from the KANON trial

2019 ◽  
Vol 53 (18) ◽  
pp. 1168-1173 ◽  
Author(s):  
Adam G Culvenor ◽  
Felix Eckstein ◽  
Wolfgang Wirth ◽  
L Stefan Lohmander ◽  
Richard Frobell
Keyword(s):  
Treatment Strategy ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Cartilage Thickness ◽  
Acl Rupture ◽  
Thickness Loss ◽  
Patellar Cartilage ◽  
Randomised Controlled ◽  
The Impact

ObjectivesTo evaluate changes in patellofemoral cartilage thickness over 5 years after anterior cruciate ligament (ACL) injury and to determine the impact of treatment strategy.Methods121 adults (ages 18–35 years, 26% women) had an ACL injury and participated in the KANON randomised controlled trial. Of those, 117 had available MRIs at baseline (<4 weeks post-ACL rupture) and at least one follow-up measurement (2, 5 years). Patellofemoral cartilage thickness was analysed by manual segmentation (blinded to acquisition order). Patellar, trochlear and total patellofemoral cartilage thickness changes were compared between as-randomised (rehabilitation+early ACL reconstruction (ACLR) (n=59) vs rehabilitation+optional delayed ACLR (n=58)) and as-treated groups (rehabilitation+early ACLR (n=59) vs rehabilitation +delayed ACLR (n=29) vs rehabilitation alone (n=29)).ResultsPatellofemoral cartilage thickness decreased −58 µm (95% CI −104 to –11 µm) over 5 years post-ACL rupture, with the greatest loss observed in trochlea during the first 2 years. Participants randomised to rehabilitation+early ACLR had significantly greater loss of patellar cartilage thickness compared with participants randomised to rehabilitation+optional delayed ACLR over the first 2 years (−25 µm (−52, 1 µm) vs +14 µm (−6 to 34 µm), p=0.02) as well as over 5 years (−36 µm (−78 to 5 µm) vs +18 µm (−7, 42 µm), p=0.02). There were no statistically significant differences in patellofemoral cartilage thickness changes between as-treated groups.ConclusionPatellofemoral (particularly trochlear) cartilage thickness loss was observed in young adults following acute ACL rupture. Early ACLR was associated with greater patellofemoral (particularly patellar) cartilage thickness loss over 5 years compared with optional delayed ACLR, indicating that early surgical intervention may be associated with greater short-term structural patellofemoral cartilage deterioration compared with optional delayed surgery.Trial registration numberISRCTN84752559; Post-results.

scholarly journals Anterior Cruciate Ligament, Acute Tears. Spontaneus Healing, is True or False

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0020
Author(s):  
Lucas Marangoni ◽  
Bernardo Murillo ◽  
Damián Bustos ◽  
Pablo Bertiche ◽  
Iván Bitar ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Subjective Evaluation ◽  
Specific Treatment ◽  
Acl Rupture ◽  
Post Injury ◽  
Level Of Evidence ◽  
Size Limitation ◽  
Resting Time ◽  
Anterior Cruciate

Objectives: To identify patients with a diagnosis of acute and complete ACL rupture that healed spontaneously, and to determine whether such healing is related to age, sex, type of rupture, resting time, and trauma mechanisms. Materials and Methods: 30 patients with complete acute ACL rupture were evaluated by clinical diagnosis and Magnetic Resonance Image (MRI). Both Lysholm test and IKDC 2000 were used for subjective evaluation. Results: All patients improved from the first to the second consult, with the following results: Lachman (p <0.0406), pivot shift (p = 0.071), and anterior drawer (p <0.001). During the follow-up MRI, all patients showed signs of healing in ACL. With an average follow-up of 12 months for men (95% CI 6-17) and 13 months for women (95% CI 31 max.), a nearly complete clinical recovery could be inferred, as well as healing occurring independently of variables such as age, sex, or specific treatment (p = 0.795 and p = 0.841). Discussion: Despite this study size limitation, the objectives were achieved. There would be spontaneous ACL healing associated with a 3-month post-injury resting time, but it is unrelated to age, sex, specific physiotherapy treatments, or the use of immobilizers. Level of evidence: level of evidence IV

scholarly journals Hip Angle Behavior in Landing After Drop Jump in Children; and their Implicance in Prevention Programs

2019 ◽  
Vol 1 (1) ◽  
pp. 11-21
Author(s):  
Jair Burboa G ◽  
Matias Bahamondes F ◽  
Mauricio Inostroza M ◽  
Paloma Lillo U ◽  
Jaime Hinzpeter
Keyword(s):  
Risk Factors ◽  
Cruciate Ligament ◽  
Training Session ◽  
Acl Injury ◽  
Physical Load ◽  
Drop Jump ◽  
Protective Capacity ◽  
Level Of Evidence ◽  
Before And After ◽  
Hip Flexion

Background The Anterior Cruciate Ligament (ACL) injury is uncommon, but constitutes an important percentage of the lesions requiring more than 8 weeks of recovery in sports. Most ACL injuries do not require external contact and are associated with biomechanical risk factors that stress this ligament ACL: like an increase in knee valgus angle (KV) and hip flexion (HF) and a decreased in knee flexion (KF). The ACL requires muscle cooperation to resist the load; however, when there is fatigue, the protective capacity of the musculature would decrease. The objective of the study is to analyze the angular behavior before and after a physical load for HF in children of 14-15 years old. Hypothesis The physical load applied in a single training session is enough to change some biomechanical risk factors of ACL injury. Study Design Experimental study Level of Evidence 2b Methods The sample consisted of 50 students from different soccer schools between 14-15 years old. We analyzed the hip angular behavior of hip flexion before and after a training session. The angles where obtained from inertioal sensor while the students performed a Drop Jump test from a 30 centimeters drawer. Results Statistically significant differences were found in the differences between pre physical load HF / post-load HF (p = 0.00053), right pre physical load HF / right post- load HF (p = 0.0086) and left post- load (p = 0.0248206). Conclusions It was concluded that the angular behavior of HF increases significantly in both post-training limbs, after performing a physical load. Clinical Relevance This study analyzed the importance of using prevention injury programs since early stages, and give importance to the eccentric role of hamstring, gluteus and core exercises.

scholarly journals Dynamic Trunk Control Influence on Run-to-Cut Maneuver: A Risk Factor for ACL Rupture

2011 ◽  
Author(s):  
Steve T. Jamison ◽  
Xueliang Pan ◽  
Ajit M. W. Chaudhari
Keyword(s):  
Cruciate Ligament ◽  
Knee Injuries ◽  
Acl Rupture ◽  
Activity Levels ◽  
Trunk Control ◽  
Increased Risk ◽  
Knee Abduction ◽  
Short And Long Term ◽  
Anterior Cruciate

Anterior Cruciate Ligament (ACL) rupture is one of the most common serious knee injuries in field and court sports, with an estimated 70% of these injuries being non-contact in nature, often from sudden changes in direction or pivoting [3]. ACL injury results in both short- and long-term consequences for the athlete, which may include surgery, decreased activity levels, elevated pain levels during activities and increased risk of osteoarthritis. Previous studies have shown that knee abduction and tibial internal rotation moments independently strain the ACL, and that these moments have an interaction effect at physiologic load levels, creating strains approaching the reported range of ACL rupture [2, 6–8].

Four Risk Factors for Arthrofibrosis in Tibial Spine Fractures: A National 10-Site Multicenter Study

2020 ◽  
Vol 48 (12) ◽  
pp. 2986-2993
Author(s):  
Joshua T. Bram ◽  
Julien T. Aoyama ◽  
R. Justin Mistovich ◽  
Henry B. Ellis ◽  
Gregory A. Schmale ◽  
...  
Keyword(s):  
Risk Factors ◽  
Operating Room ◽  
Multicenter Study ◽  
Cruciate Ligament ◽  
Traumatic Injury ◽  
Acl Injury ◽  
Spine Fractures ◽  
Cast Immobilization ◽  
Level Of Evidence ◽  
Tibial Spine

Background: Tibial spine fractures (TSFs) are relatively rare pediatric injuries. Postoperative arthrofibrosis remains the most common complication, with few studies having examined factors associated with its development. Purpose: To identify risk factors for arthrofibrosis and required MUA or lysis of adhesions in the largest known cohort of patients with TSFs. Study Design: Case-control study; Level of evidence, 3. Methods: This was a multicenter study of 249 patients ≤18 years old who had a TSF between January 2000 and February 2019. Patients were separated into cohorts based on whether they developed arthrofibrosis, defined as a 10° deficit in extension and/or 25° deficit in flexion at postoperative 3 months or a return to the operating room for manipulation under anesthesia (MUA) and/or lysis of adhesions. Results: A total of 58 (23.3%) patients developed postoperative arthrofibrosis, with 19 (7.6%) requiring a return to the operating room for MUA. Patients with arthrofibrosis were younger (mean ± SD, 11.3 ± 2.7 vs 12.3 ± 2.8 years; P = .029). They were more likely to have a nonsport, trauma-related injury (65.4% vs 32.1%; P < .001) and a concomitant ACL injury (10.3% vs 1.1%; P = .003). Those with arthrofibrosis had longer operative times (135.0 vs 114.8 minutes; P = .006) and were more likely to have been immobilized in a cast postoperatively (30.4% vs 16.6%; P = .043). In multivariate regression, concomitant anterior cruciate ligament (ACL) injury (odds ratio [OR], 20.0; P = .001), traumatic injury (OR, 3.8; P < .001), age <10 years (OR, 2.2; P = .049), and cast immobilization (OR, 2.4; P = .047) remained significant predictors of arthrofibrosis. Concomitant ACL injury (OR, 7.5; P = .030) was additionally predictive of a required return to the operating room for MUA. Conclusion: Surgeons should be cognizant of arthrofibrosis risk in younger patients with concomitant ACL tears and traumatic injuries not resulting from athletics. Furthermore, postoperative immobilization in a cast should be avoided given the high risk of arthrofibrosis. Concomitant ACL injury is associated with a higher return to the operating room for MUA.

Tibiofemoral contact and alignment in patients with anterior cruciate ligament rupture treated nonoperatively versus reconstruction

2021 ◽  
Vol 103-B (9) ◽  
pp. 1505-1513
Author(s):  
David J. Stockton ◽  
Andrew M. Schmidt ◽  
Andrew Yung ◽  
Jane Desrochers ◽  
Honglin Zhang ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Contact Area ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Acl Rupture ◽  
Healthy Controls ◽  
The Mean ◽  
Anterior Cruciate ◽  
Time Since Injury ◽  
Centroid Location

Aims Anterior cruciate ligament (ACL) rupture commonly leads to post-traumatic osteoarthritis, regardless of surgical reconstruction. This study uses standing MRI to investigate changes in contact area, contact centroid location, and tibiofemoral alignment between ACL-injured knees and healthy controls, to examine the effect of ACL reconstruction on these parameters. Methods An upright, open MRI was used to directly measure tibiofemoral contact area, centroid location, and alignment in 18 individuals with unilateral ACL rupture within the last five years. Eight participants had been treated nonoperatively and ten had ACL reconstruction performed within one year of injury. All participants were high-functioning and had returned to sport or recreational activities. Healthy contralateral knees served as controls. Participants were imaged in a standing posture with knees fully extended. Results Participants’ mean age was 28.4 years (SD 7.3), the mean time since injury was 2.7 years (SD 1.6), and the mean International Knee Documentation Subjective Knee Form score was 84.4 (SD 13.5). ACL injury was associated with a 10% increase (p = 0.001) in contact area, controlling for compartment, sex, posture, age, body mass, and time since injury. ACL injury was associated with a 5.2% more posteriorly translated medial centroid (p = 0.001), equivalent to a 2.6 mm posterior translation on a representative tibia with mean posteroanterior width of 49.4 mm. Relative to the femur, the tibiae of ACL ruptured knees were 2.3 mm more anteriorly translated (p = 0.003) and 2.6° less externally rotated (p = 0.010) than healthy controls. ACL reconstruction was not associated with an improvement in any measure. Conclusion ACL rupture was associated with an increased contact area, posteriorly translated medial centroid, anterior tibial translation, and reduced tibial external rotation in full extension. These changes were present 2.7 years post-injury regardless of ACL reconstruction status. Cite this article: Bone Joint J 2021;103-B(9):1505–1513.

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