scholarly journals Effect of an Anterior Cruciate Ligament Rupture on Knee Proprioception Within 2 Years After Conservative and Operative Treatment: A Systematic Review with Meta-Analysis

2021 ◽  
Author(s):  
John Dick Fleming ◽  
Ramona Ritzmann ◽  
Christoph Centner

Abstract Background The anterior cruciate ligament (ACL) plays a major role in knee proprioception and is thus responsible for maintaining knee joint stability and functionality. The available evidence suggests that ACL reconstruction diminishes somatosensory feedback and proprioceptive functioning, which are vital for adequate joint positioning and movement control. Objective The aim of this systematic review and meta-analysis was to investigate the effect of an ACL rupture on knee proprioception after arthroscopic ACL repair surgery or conservative treatment. Methods A systematic review with meta-analysis was conducted according to the Preferred Reporting Guidelines for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was performed in the following databases from inception to 10th October 2020: PubMed, Web of Science, SPORTDiscus, Cochrane Library and Scopus. Randomized and non-randomized studies that evaluated proprioception using the joint position sense (JPS) and threshold to detection of passive motion (TTDPM) techniques at 15°–30° knee flexion with an external healthy control group in a time period between 6 and 24 months post injury or operation were included in the analysis. Results In total, 4857 studies were identified, from which 11 were included in the final quantitative analysis. The results demonstrated that proprioception after arthroscopic ACL repair surgery was significantly lower than in the healthy control group (JPS: standardized mean difference [SMD] 0.57, 95% confidence interval [CI] 0.27–0.87, p < 0.01, n = 6 studies; TTDPM: SMD 0.77, 95% CI 0.20–1.34, p < 0.01, n = 4 studies). There were no significant differences in proprioception between the conservative treatment group and the healthy control group (JPS: SMD 0.57, 95% CI − 0.69 to 1.84, p = 0.37, n = 4 studies; TTDPM: SMD 0.82, 95% CI − 0.02 to 1.65, p = 0.05, n = 2 studies), although measures for TTDPM were close to statistical significance. Conclusion The findings of the present systematic review and meta-analysis revealed that knee proprioception is persistently compromised 6–24 months following surgical treatment of ACL tears compared with healthy controls. The reduced kinesthetic awareness after ACL surgery is of high relevance for optimizing individual treatment plans in these patients. As the current literature is still scarce about the exact underlying mechanisms, further research is needed. Trial Registration The present systematic review was registered in PROSPERO (CRD42021198617).

2021 ◽  
Author(s):  
Wenfan Gan ◽  
Zheng Xu ◽  
Chunmei Wu ◽  
Junzhi He

Abstract Background: Recently, a number of randomized controlled trials (RCTs) have researched the efficacy of anterior cruciate ligament reconstruction (ACLR) combined with platelet-rich plasma (PRP) in the treatment of anterior cruciate ligament (ACL) injuries. Therefore, we updated a systematic review based on these RCTs to evaluate the effects of PRP on knee function and pain with different time.Methods: We searched in PubMed, Embase, Cochrane, Web of Science(WOS), China National Knowledge Infrastructure(CNKI), and WANFANG DATABASE, for human RCTs comparing the efficacy of intraarticular injection with no injection of PRP. Descriptive summaries and quality assessments were performed for all studies included in this meta-analysis. The outcomes of the stydy included the International Knee Documentation Committee (IKDC), Visual Analogue Scale (VAS), and Lysholm score.Results: Finally, we included 6 RCTs stydies, involving 315 patients. The control group consisted of blank group or placebo group. Follow-up periods ranged from 3 to 18 months. The results of bias risk assessment showed that all the 6 stuydies are unclear risk of bias. Compared with the control group, PRP group significantly improved IKDC score at 3, 6 and 12 months after operation (P = 0.00, 0.01, respectively). Lysholm score and VAS score also has significant differences at 3 months after operation (both P = 0.00).Conclusion: Our study has proved that PRP was more effective in the recovery of knee function and early pain relief after the ACLR than the ACLR alone. Review registration: PROSPERO CRD42021224182. Registered 6 April 2021. Keywords:anterior cruciate ligament injury; anterior cruciate ligament reconstruction; platelet rich plasma; system review; META analysisReview registration: PROSPERO CRD42021224182. Registered 6 April 2021.


2021 ◽  
pp. 155633162110116
Author(s):  
Francisco Figueroa ◽  
David Figueroa ◽  
Rafael Calvo ◽  
Alex Vaisman ◽  
Marilaura Nuñez ◽  
...  

Background: Vancomycin presoaking of the graft has been shown to decrease infection rates in some case series of anterior cruciate ligament (ACL) reconstruction. Purpose: We sought to substantiate the efficacy of vancomycin presoaked grafts for the prevention of infection after ACL reconstruction. Methods: We performed a systematic review of Medline and OVID to assess the incidence of postoperative infection in studies comparing patients undergoing ACL reconstruction with the use of vancomycin presoaked ACL grafts and a control group of patients undergoing ACL reconstruction without the use of presoaked grafts. The efficacy of vancomycin presoaking was calculated using the Agresti-Coull confidence interval. Relative risk (RR) was calculated for every study and the total sample. Results: The 11 studies that met inclusion criteria comprised 24,298 patients. In patients with vancomycin presoaking of the graft, 1 infection was reported in 8764 cases (0.01% rate). In the studies with control groups that did not have vancomycin presoaked grafts, there were 125 infections in 15,534 ACL reconstructions (0.8% rate). The efficacy of vancomycin presoaking in preventing infection after ACL reconstruction was 99.9% (0.999%–1.000% CI). The overall RR obtained was 0.07 (0.03–0.16 CI). All included studies were retrospective cohort studies (level III). Conclusions: Vancomycin presoaking of the graft has been shown to decrease infection rates after ACL reconstruction in studies of low evidence level. This suggests the need for prospective randomized controlled trials addressing this issue so that recommendations on the routine use of vancomycin presoaking of ACL grafts can be made with confidence.


2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Wen-Tzu Tang ◽  
Miao-Ju Hsu ◽  
Yi-Ming Huang ◽  
Yu-Ting Hsu ◽  
Li-Ling Chuang ◽  
...  

Purpose. This study is aimed at investigating the effect of low-intensity electrical stimulation on the voluntary activation level (VA) and the cortical facilitation/inhibition of quadriceps in people with chronic anterior cruciate ligament lesion. Methods. Twenty former athletes with unilateral ACL deficiencies (ACL group) and 20 healthy subjects (healthy control group) participated in the study. The quadriceps VA level, motor-evoked potential (MEP), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) elicited by transcranial magnetic stimulation were tested before and after 30 minutes of low-intensity electrical stimulation (ES). Results. Before ES, the quadriceps VA in the ACL lesion legs of the ACL group was lower compared to the legs of the healthy control group (P<0.05). The MEP sizes in the ACL lesion legs and the healthy control were not significantly different. The ACL lesion legs showed lower SICI and higher ICF compared to the healthy control group (P<0.05). After ES, the quadriceps VA level increased and the SICI-ICF was modulated only in the ACL lesion legs (P<0.05) but not in the healthy controls. Conclusions. Low-intensity ES can normalize the modulation of intracortical inhibition and facilitation, thereby ameliorating the activation failure in individuals with ACL lesion.


PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 561A-561A
Author(s):  
Alex L. Gornitzky ◽  
Ariana Lott ◽  
Joseph L. Yellin ◽  
Peter D. Fabricant ◽  
Theodore J. Ganley

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