scholarly journals Underloading, not overloading, of the patellofemoral joint increases the risk of early osteoarthritis after ACL reconstruction

2021 ◽  
Vol 24 ◽  
pp. S11
Author(s):  
A. Bryant ◽  
K. Crossley ◽  
A. Culvenor ◽  
A. Guermazi ◽  
B. Patterson ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patellofemoral Joint ◽  
Early Osteoarthritis

scholarly journals Poor functional performance 1 year after ACL reconstruction increases the risk of early osteoarthritis progression

2020 ◽  
Vol 54 (9) ◽  
pp. 546-555 ◽  
Author(s):  
Brooke Patterson ◽  
Adam Geoffrey Culvenor ◽  
Christian J Barton ◽  
Ali Guermazi ◽  
Joshua Stefanik ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Performance Test ◽  
Functional Performance ◽  
International Knee Documentation Committee ◽  
Test Battery ◽  
Performance Criteria ◽  
Early Osteoarthritis ◽  
Increased Risk ◽  
Osteoarthritis Progression

BackgroundNot meeting functional performance criteria increases reinjury risk after ACL reconstruction (ACLR), but the implications for osteoarthritis are not well known.ObjectiveTo determine if poor functional performance post-ACLR is associated with risk of worsening early osteoarthritis features, knee symptoms, function and quality of life (QoL).MethodsSeventy-eight participants (48 men) aged 28±15 years completed a functional performance test battery (three hop tests, one-leg-rise) 1 year post-ACLR. Poor functional performance was defined as <90% limb symmetry index (LSI) on each test. At 1 and 5 years, MRI, Knee injury Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) subjective form were completed. Primary outcomes were: (i) worsening patellofemoral and tibiofemoral MRI-osteoarthritis features (cartilage, bone marrow lesions (BMLs) and meniscus) and (ii) change in KOOS and IKDC scores, between 1 and 5 years.ResultsOnly 14 (18%) passed (≥90% LSI on all tests) the functional test battery. Poor functional performance on the battery (all four tests <90% LSI) 1 year post-ACLR was associated with 3.66 times (95% CI 1.12 to 12.01) greater risk of worsening patellofemoral BMLs. A triple-crossover hop <90% LSI was associated with 2.09 (95% CI 1.15 to 3.81) times greater risk of worsening patellofemoral cartilage. There was generally no association between functional performance and tibiofemoral MRI-osteoarthritis features, or KOOS/IKDC scores.ConclusionOnly one in five participants met common functional performance criteria (≥90% LSI all four tests) 1 year post-ACLR. Poor function on all four tests was associated with a 3.66 times increased risk of worsening patellofemoral BMLs, and generally not associated with decline in self-reported outcomes.

Early osteoarthritis of the patellofemoral joint

2016 ◽  
Vol 24 (6) ◽  
pp. 1836-1844 ◽  
Author(s):  
Elizabeth A. Arendt ◽  
Massimo Berruto ◽  
Giuseppe Filardo ◽  
Mario Ronga ◽  
Stefano Zaffagnini ◽  
...  
Keyword(s):  
Patellofemoral Joint ◽  
Early Osteoarthritis

The Effects of the ACL Reconstruction Tunnel(s) on Patellofemoral Contact

2010 ◽  
Vol 34-35 ◽  
pp. 260-264
Author(s):  
Rong Ying Huang ◽  
Qiang Xu ◽  
Yong Gang Xu
Keyword(s):  
Acl Reconstruction ◽  
Patellofemoral Joint ◽  
Double Bundle ◽  
Single Bundle ◽  
Technical Data ◽  
Femoral Cartilage ◽  
Tunnel Contact ◽  
Reconstruction Quality ◽  
Contact Models ◽  
Position And Orientation

No quantitative data were reported in the literature regarding the effects of the ACL reconstruction tunnel(s) on patellofemoral contact .In this study the patellofemoral joint was built from MRI data of a normal knee. Based on this, the patellofemoral contact models in which there were ACL reconstruction tunnel(s) were also built. Then different contact statues of patellofemoral joint were simulated by orthogonal test and finite element method to analyze the effects of the ACL reconstruction tunnel(s) on patellofemoral contact. Results show that: 1. Stress on the cartilages is not sensitive to the parameters of position and orientation relatively, but the single-bundle and double-bundle reconstruction tunnel(s) significantly change the extent of the sensitivity to the motion parameters, especially the stress on the femoral cartilage. 2. The stress on the surface of cartilages also will be obviously changed by single-bundle/double-bundle tunnel(s) and they will significantly increase under some contact status, but for the contact pressure, it is inconspicuous. 3. For single-bundle tunnel, contact areas between cartilages change little while only about one-fifth of the total contact locations have changed by 20%. Besides, the effects of double-bundle are smaller than single-bundle tunnel. This study not only provides technical data to improve the reconstruction quality, but also supplys a method for the assessment of ACL reconstruction.

Posterior Tibial Loading Results in Significant Increase of Peak Contact Pressure in the Patellofemoral Joint During Anterior Cruciate Ligament Reconstruction: A Cadaveric Study

2021 ◽  
Vol 49 (5) ◽  
pp. 1286-1295
Author(s):  
Wenhan Huang ◽  
Michael Tim-Yun Ong ◽  
Gene Chi-Wai Man ◽  
Yang Liu ◽  
Lawrence Chun-Man Lau ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Contact Pressure ◽  
Knee Flexion ◽  
Patellofemoral Joint ◽  
Cruciate Ligament ◽  
Graft Tension ◽  
Posterior Tibial ◽  
Intact Condition ◽  
Peak Contact Pressure ◽  
Anterior Cruciate

Background: Inappropriate posterior tibial loading and initial graft tension during anterior cruciate ligament (ACL) reconstruction may cause altered patellofemoral joint (PFJ) contact mechanics, potentially resulting in pain and joint degeneration. Hypothesis: PFJ contact pressure would increase with the increases in posterior tibial loading and graft tension during ACL reconstruction. Study Design: Controlled laboratory study. Methods: Nine fresh-frozen, nonpaired human cadaveric knees were tested in a customized jig from 0° to 120° of knee flexion. First, the knee was tested in the ACL-intact state. Second, reconstruction of the ACLs using different posterior tibial loadings and graft tensions were performed. The posterior tibial loading was evaluated at 2 levels: 33.5 and 67 N. Graft tension was assessed at 3 levels: low tension (20 N), medium tension (60 N), and high tension (80 N). Maximum values of peak contact pressure in the medial and lateral patellar facets were compared between ACL-intact and ACL-reconstructed knees. The PFJ kinematics between ACL-intact knees and ACL-reconstructed knees were compared during knee flexion at 30°, 60°, 90°, and 120°. Results: Reconstruction of ACLs with both low and high posterior tibial loading resulted in significant increases of peak contact pressure in the medial (range of differences, 0.46-0.92 MPa; P < .05) and lateral (range of differences, 0.51-0.83 MPa; P < .05) PFJ compared with the ACL-intact condition. However, no significant differences in PFJ kinematics were identified between ACL-reconstructed knees and ACL-intact knees. In ACL-reconstructed knees, it was found that a high posterior tibial loading resulted in high peak contact pressure on the medial patellar side (range of differences, 0.37-0.46 MPa; P < .05). No significant difference in peak contact pressure was observed among the differing graft tensions. Conclusion: In this cadaveric model, ACL reconstruction resulted in significant increases of peak contact pressure in the PFJ facet when compared with the ACL-intact condition. A high posterior tibial loading can lead to high medial PFJ peak contact pressure. Graft tension was found to not significantly affect PFJ contact pressure during ACL reconstruction. Clinical Relevance: An excessive posterior tibial loading during ACL reconstruction resulted in increased PFJ contact pressures at time of surgery. These data suggest that a low posterior tibial loading might be preferred during ACL reconstruction surgery to reduce the PFJ contact pressure close to that of the ACL-intact condition.

scholarly journals Morphometric analysis of patella and patellar ligament: a cadaveric study to aid patellar tendon grafts

2021 ◽  
Author(s):  
Ashwini Aithal Padur ◽  
Naveen Kumar ◽  
Melissa Glenda Lewis ◽  
Varalakshmi Chandra Sekaran
Keyword(s):  
Acl Reconstruction ◽  
Morphometric Analysis ◽  
Patellofemoral Joint ◽  
Lower Limbs ◽  
Patellar Ligament ◽  
South Indian Population ◽  
Morphometric Data ◽  
Positive Correlation ◽  
Left Limb ◽  
The Right

Abstract Purpose Morphometric analysis of the patella and the patellar ligament is crucial in diagnosing and surgical corrections of knee injuries and patellofemoral joint disorders. Dimensions of the patella and the patellar ligament are frequently used in implant design and ACL reconstruction. This study aims to obtain detailed morphometric data on the patellar ligament and its localization based on gross anatomical dissections in the adult cadavers. Methods The present study consisted of 50 lower limbs from formalin-fixed male adult cadavers aged about 70 years (45–85) belonging to the South Indian population. Total length of the quadriceps tendon, patellar height, patellar ligament height, proximal width, distal width and thickness of the patellar ligament were measured meticulously. Mean, standard deviation, median scores of each parameter were computed for groups using SPSS 16.0. Level of significance was considered as p < 0.05. Wilcoxon signed-rank test was used to compare the various parameters on the right and left limbs. The relationships between all parameters were analyzed using Spearman’s rank correlation test. Results There was no statistically significant difference in the various measurements of the patella and patellar ligament between the right and left lower limbs. Patellar ligament length showed positive correlation with ligament thickness (r = 0.36; p = 0.078 for right limb and r = 0.33; p = 0.104 for left limb). Proximal width of ligament showed significant positive correlation with distal width (r = 0.41; p = 0.041 for right limb and r = 0.54; p = 0.006 for left limb). Conclusion This morphometric data and analysis might be fundamental in understanding various knee conditions in situ and necessary to orthopedic surgeons for successful planning and execution for ACL reconstruction using patellar ligament graft and other patellofemoral joint disorders. Level of evidence I

scholarly journals Radiographic Osteoarthritis Prevalence Over Ten Years After Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 40 (11) ◽  
pp. 683-695
Author(s):  
Tianwu Chen ◽  
Shuang Wang ◽  
Yunxia Li ◽  
Chengchong Ai ◽  
Fangyi Jiang ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patellofemoral Joint ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Contralateral Side ◽  
Ipsilateral Side ◽  
Knee Oa ◽  
Radiographic Osteoarthritis ◽  
Anterior Cruciate

AbstractThe purpose of this study was to conduct an up-to-date systematic review and meta-analysis of radiographic knee osteoarthritis (OA) over minimal ten years after ACL reconstruction. The database of Pubmed and the Ovid was adopted. The radiographic knee OA over minimal ten years after ACL reconstruction was systematically reviewed. Both the ipsilateral and contralateral knees were evaluated referring to the tibiofemoral joint (TFJ), the patellofemoral joint (PFJ), and the overall knee OA prevalence. Nineteen studies were included for review, with nine screened for the meta-analysis. The overall knee OA rate ranged from 8.3–79.2%, meanly 51.6% on the ipsilateral side; ranged from 3.6–35.7%, meanly 15.5% on the contralateral side. Compared to the contralateral side, the RR of developing radiographic OA was 3.73 (P<0.01) for the overall knee, 2.88 (P<0.01) for TFJ, and 2.42 (P<0.01) for PFJ. Ipsilaterally, the RR of developing TFJ radiographic OA was 1.15 (P<0.01) compared to that of the PFJ. Over a minimum of 10 years after surgery, more than half the cases developed overall radiographic OA on the ipsilateral knee, which was nearly four times higher than the contralateral side. On the ipsilateral knee, the TFJ was most affected.

scholarly journals Gender differences in knee kinematics during weight-bearing knee flexion for patients with arthrofibrosis after anterior cruciate ligament reconstruction

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ling Zhang ◽  
Shuai Fan ◽  
Jiling Ye ◽  
Xin Jiang ◽  
Bin Cai
Keyword(s):  
Gender Differences ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Patellofemoral Joint ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Knee Kinematics ◽  
Tibial Rotation ◽  
Anterior Cruciate ◽  
Tibiofemoral Kinematics

Abstract Background Knowledge of tibiofemoral and patellofemoral joint kinematics is important for understanding gender-related dimorphism in developing knee arthrofibrosis and advancement of related treatments. The objective of our study was to investigate gender differences existing in tibiofemoral kinematics and patellar tracking in patients with arthrofibrosis after anterior cruciate ligament (ACL) reconstruction during weight-bearing knee flexion. Methods The tibiofemoral and patellofemoral joint kinematics were measured in 30 patients (15 male and 15 female) with arthrofibrosis after ACL reconstruction during a lunge task, using computed tomography and dual fluoroscopic imaging system. These data were analyzed for gender differences. Results The range of tibial rotation, patellar inferior shift, tilt, and flexion were significantly decreased in the affected knee compared to the contralateral knee from 15° to 75° of knee flexion (P ≤ 0.04). Statistically significant difference was detected for medial tibial translation between male and female patients at 60° (P = 0.04) and 75° of knee flexion (P = 0.02). The tibial rotation was significantly decreased at 60° (P = 0.03) and 75° of knee flexion (P < 0.01) in females. The inferior patellar shift in females was significantly lower than that in males at 15° (P = 0.04) and 30° of knee flexion (P = 0.01). The patellar tilt was significantly lower at 60° (P = 0.02) and 75° of knee flexion (P < 0.01) in females compared to males. Conclusions The results indicated a significant effect of gender on knee kinematics in patients with arthrofibrosis after ACL reconstruction during weight-bearing knee flexion. These gender differences in tibiofemoral kinematics and patellar tracking may warrant further investigations to determine implications for making gender-specific surgical treatments and rehabilitation programs.

scholarly journals Association of Fibrosis in the Infrapatellar Fat Pad and Degenerative Cartilage Change of Patellofemoral Joint After Anterior Cruciate Ligament Reconstruction

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0009
Author(s):  
Sang Hak Lee ◽  
Kyung Ho Yoon ◽  
Chan Il Bae
Keyword(s):  
Acl Reconstruction ◽  
Patellofemoral Joint ◽  
Cartilage Degeneration ◽  
Infrapatellar Fat Pad ◽  
Procedure Time ◽  
Fat Pad ◽  
Short Term ◽  
Second Look ◽  
Time From Injury

Purpose: The purpose of this study was to evaluate the prevalence and risk factor of cartilage degeneration of patellofemoral joint (PFJ) that was diagnosed by second look arthroscopy in the short term follow-up period. Methods: One hundred seven patients who underwent ACL reconstruction were evaluated by preoperative MRI, postoperative MRI and second-look arthroscopy. Severity of infrapatellar fat pad (IPFP) fibrosis was evaluated by MRI at average of 26 months after ACL reconstruction. Cartilage degeneration was assessed by second look arthroscopy at 29 months. Results: Twenty-five patients (24.0%) showed cartilage degeneration of PFJ in second look arthroscopy. Patients were divided into 3 groups according to severity of IPFP fibrosis tissue i.e. Group A: focal and incomplete band fibrosis, n=69, Group B: complete band fibrosis, n=31, and Group C: diffuse and infiltrated fibrosis, n=7. Cartilage degeneration of PFJ was significantly worsened with more fibrosis formation of IPFP (p<0.001). Other factors for instabilities, BMI, age, concomitant meniscal procedure, time from injury to reconstruction, severity of IPFP fibrosis of preoperative MRI and clinical scores were not correlated with cartilage degeneration of PFJ. The multivariate logistic regression analysis of degeneration of PFJ after ACL reconstruction identified more severe fibrosis tissue formation of IPFP and initial cartilage defect as significant predictors. Conclusions: More extensive fibrosis tissue of IPFP and initial cartilage defect related to further degenerative change of PFJ. Age, BMI, concomitant meniscal procedure, time from injury to reconstruction, clinical scores and instability did not affect cartilage degeneration of PFJ in the short term follow-up period. [Figure: see text]

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