scholarly journals Intra-Articular Cytokine Levels in Adolescent Patients after Anterior Cruciate Ligament Tear

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Marco Bigoni ◽  
Marco Turati ◽  
Giovanni Zatti ◽  
Marta Gandolla ◽  
Paola Sacerdote ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Skeletally Immature ◽  
Growth Plates ◽  
Acl Injuries ◽  
Acl Tear ◽  
Adolescent Patients ◽  
Open Growth Plates ◽  
Anterior Cruciate

The treatment of anterior cruciate ligament (ACL) injuries in children and adolescents is challenging. Preclinical and clinical studies investigated ACL repairing techniques in skeletally immature subjects. However, intra-articular bioenvironment following ACL tear has not yet been defined in skeletally immature patients. The aim of this study was to measure cytokine concentrations in the synovial fluid in adolescent population. Synovial levels of IL-1β, IL-1ra, IL-6, IL-8, IL-10, and TNF-α were measured in 17 adolescent patients (15 boys) with ACL tears who underwent ACL reconstruction including acute (5), subacute (7), and chronic (5) phases. Femoral growth plates were classified as “open” in three patients, “closing” in eight, and “closed” in six. Eleven patients presented an ACL tear associated with a meniscal tear. The mean Tegner and Lysholm scores (mean±SD) of all patients were 8 ± 1 and 50.76 ± 26, respectively. IL-8, TNF-α, and IL-1β levels were significantly greater in patients with “open” physes. IL-1ra and IL-1β levels were significantly higher in patients with ACL tear associated with a meniscal tear. Poor Lysholm scores were associated with elevated IL-6 and IL-10 levels. IL-10 levels positively correlated with IL-6 and IL-8 levels, whereas TNF-α concentration negatively correlated with IL-6 levels. Skeletally immature patients with meniscal tears and open growth plates have a characteristic cytokine profile with particularly elevated levels of proinflammatory cytokines including IL-8, TNF-α, and IL-1β. This picture suggests that the ACL tear could promote an intra-articular catabolic response in adolescent patients greater than that generally reported for adult subjects. The study lacks the comparison with synovial samples from healthy skeletally immature knees due to ethical reasons. Overall, these data contribute to a better knowledge of adolescent intra-articular bioenvironment following ACL injuries.

scholarly journals Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: Early Results Using a Hybrid Physeal-Sparing Technique

2018 ◽  
Vol 6 (2) ◽  
pp. 232596711875533 ◽  
Author(s):  
Robert G. Willson ◽  
Regina O. Kostyun ◽  
Matthew D. Milewski ◽  
Carl W. Nissen
Keyword(s):  
Anterior Cruciate Ligament ◽  
Skeletal Maturity ◽  
Cruciate Ligament ◽  
Return To Play ◽  
Hybrid Technique ◽  
Skeletally Immature ◽  
Acl Injuries ◽  
Outcome Scores ◽  
Anterior Cruciate ◽  
Physeal Sparing

Background: Reconstruction of the anterior cruciate ligament (ACL) in the skeletally immature patient is frequently performed in hopes of preventing new or additional chondral damage and meniscal injuries. Patients within a few years of skeletal maturity are more at risk for ACL injuries than prepubescent patients, about whom several physeal-sparing techniques have been described. Reconstruction techniques in the former higher risk group need to be better understood. Purpose: To review a series of adolescent patients with ACL injuries surgically treated with the hybrid physeal-sparing technique. Study Design: Case series; Level of evidence, 4. Methods: Surgical logs of ACL reconstructions (ACLRs) performed at a single pediatric/adolescent sports medicine center over a 6-year period were reviewed. Patients with open physes who had undergone ACLR with a femoral physeal-sparing tunnel and transphyseal tibial tunnel were identified. Their demographics, operative reports, rehabilitative course, time to return to play, outcome scores, and postoperative radiographs were collected and analyzed. Results: Twenty-three patients with a mean chronological age and bone age of 13.0 and 13.6 years, respectively, were identified. Examination and subjective outcome scores were obtained at a mean of 19 months and overall demonstrated positive results, with a mean Pediatric International Knee Documentation Committee (Pedi-IKDC) score of 96.0 and a mean Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) score of 89.1. Full-length mechanical axis films obtained at a mean 21 months postoperatively demonstrated no leg-length discrepancies or angular deformities in 21 of 23 patients. Two patients had an identified growth disturbance in the form of femoral and tibial growth acceleration on the ACL-reconstructed limb. Conclusion: The femoral physeal-sparing with transphyseal tibial drilling “hybrid” technique in skeletally maturing patients appears to have a high rate of success with low morbidity. However, the possibility of physeal abnormalities does exist, which demonstrates the importance of a close postoperative follow-up and evaluation until skeletal maturity is achieved. ACLR in skeletally immature patients is performed on an increasingly regular basis. Establishing the best and safest technique to do so is therefore important.

Secondary Meniscal Tears in Patients With Anterior Cruciate Ligament Injury: Relationship Among Operative Management, Osteoarthritis, and Arthroplasty at 18-Year Mean Follow-up

2019 ◽  
Vol 47 (7) ◽  
pp. 1583-1590 ◽  
Author(s):  
Michella H. Hagmeijer ◽  
Mario Hevesi ◽  
Vishal S. Desai ◽  
Thomas L. Sanders ◽  
Christopher L. Camp ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Acl Injury ◽  
Nonoperative Treatment ◽  
Meniscal Tears ◽  
Acl Injuries ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injury is one of the most frequent orthopaedic injuries and reasons for time loss in sports and carries significant implications, including posttraumatic osteoarthritis (OA). Instability associated with ACL injury has been linked to the development of secondary meniscal tears (defined as tears that develop after the initial ACL injury). To date, no study has examined secondary meniscal tears after ACL injury and their effect on OA and arthroplasty risk. Purpose: To describe the rates and natural history of secondary meniscal tears after ACL injury and to determine the effect of meniscal tear treatment on the development of OA and conversion to total knee arthroplasty (TKA). Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database of >500,000 patients was reviewed to identify patients with primary ACL injuries between January 1, 1990, and December 31, 2005. Information was collected with regard to ACL injury treatment, rates/characteristics of the secondary meniscal tears, and outcomes, including development of OA and conversion to TKA. Kaplan-Meier and adjusted multivariate survival analyses were performed to test for the effect of meniscal treatment on survivorship free of OA and TKA. Results: Of 1398 primary ACL injuries, the overall rate of secondary meniscal tears was 16%. Significantly lower rates of secondary meniscal tears were noted among patients undergoing acute ACL reconstruction within 6 months (7%) as compared with patients with delayed ACL reconstruction (33%, P < .01) and nonoperative ACL management (19%, P < .01). Of the 235 secondary meniscal tears identified (196 patients), 11.5% underwent repair, 73% partial meniscectomy, and 16% were treated nonoperatively. Tears were most often medial in location (77%) and complex in morphology (56% of medial tears, 54% of lateral tears). At the time of final follow-up, no patient undergoing repair of a secondary meniscal tear (0%) underwent TKA, as opposed to 10.9% undergoing meniscectomy and 6.1% receiving nonoperative treatment ( P = .28). Conclusion: Secondary meniscal tears after ACL injury are most common among patients undergoing delayed surgical or nonoperative treatment of their primary ACL injuries. Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy.

scholarly journals Incidence of Second Anterior Cruciate Ligament Tears (1990-2000) and Associated Factors in a Specific Geographic Locale

2017 ◽  
Vol 45 (7) ◽  
pp. 1567-1573 ◽  
Author(s):  
Nathan D. Schilaty ◽  
Nathaniel A. Bates ◽  
Thomas L. Sanders ◽  
Aaron J. Krych ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Population Based ◽  
Contralateral Side ◽  
Activity Level ◽  
Acl Injuries ◽  
Acl Tear ◽  
Anterior Cruciate

Background: Second anterior cruciate ligament (ACL) tears after reconstruction occur at a reported rate of 20% to 30%. This high frequency indicates that there may be factors that predispose an athlete to graft failure and ACL tears of the contralateral knee. Purpose: To determine the incidence of second ACL injuries in a geographic population-based cohort over a 10-year observation period. Study Design: Descriptive epidemiological study. Methods: International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACL reconstruction were searched across the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 1990 and 2000. This cohort of patients was tracked for subsequent ACL injuries through December 31, 2015. The authors identified 1041 patients with acute, isolated ACL tears. These patients were stratified by primary and secondary tears, sex, age, activity level, side of injury, sex by side of injury, and graft type. Results: Of the 1041 unique patients with a diagnosed ACL tear in Olmsted County, Minnesota, from 1990 to 2000, there were 66 (6.0%) second ACL tears; 66.7% of these tears occurred on the contralateral side. A second ACL injury was influenced by graft type ( P < .0001), election of ACL reconstruction ( P = .0060), and sex by side of injury ( P = .0072). Nonparametric analysis of graft disruption by graft type demonstrated a higher prevalence of second ACL tears with allografts compared with hamstring ( P = .0499) or patellar tendon autografts ( P = .0012). Conclusion: The incidence of second ACL tears in this population-based cohort was 6.0%, with 66.7% of these tears occurring on the contralateral side from the original injury. There was a high population incidence of second ACL injuries in female patients younger than age 20 years. The utilization of patellar tendon autografts significantly reduced the risk of second ACL injuries compared with allografts or hamstring autografts in this cohort.

scholarly journals Resolvin E1 and Cytokines Environment in Skeletally Immature and Adult ACL Tears

2021 ◽  
Vol 8 ◽  
Author(s):  
Marco Turati ◽  
Silvia Franchi ◽  
Giulio Leone ◽  
Massimiliano Piatti ◽  
Nicolò Zanchi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Synovial Fluid ◽  
Growth Plate ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Adult Patients ◽  
Skeletally Immature ◽  
Plate Group ◽  
Anti Inflammatory ◽  
Anterior Cruciate

The intra-articular synovial fluid environment in skeletally immature patients following an ACL tear is complex and remains undefined. Levels of inflammatory and anti-inflammatory cytokines change significantly in response to trauma and collectively define the inflammatory environment. Of these factors the resolvins, with their inherent anti-inflammatory, reparative, and analgesic properties, have become prominent. This study examined the levels of resolvins and other cytokines after ACL tears in skeletally immature and adult patients in order to determine if skeletal maturity affects the inflammatory pattern. Skeletally immature and adult patients with an anterior cruciate ligament injury and meniscal tears were prospectively enrolled over a 5-month period. Synovial fluid samples were obtained before surgery quantifying Resolvin E1, IL-1β, TNF-α, and IL-10 by ELISA. Comparisons between skeletally immature patients and adults, the influence of meniscal tear, growth plate maturity and time from trauma were analyzed. Skeletally immature patients had significantly greater levels of Resolvin E1 and IL-10 compared with adults with an isolated anterior cruciate ligament lesion. Among the injured skeletally immature patients Resolvin E1 levels were greater in the open growth plate group compared with those with closing growth plates. Moreover, levels of Resolvin E1 and IL-10 appeared to decrease with time. Our results suggest that skeletally immature patients have a stronger activation of the Resolvin pattern compared to adult patients and that synovial fluid Resolvins could play an antinflammatory role in the knee after anterior cruciate ligament lesion and that its activity may be synergistic with that of IL-10.

scholarly journals RE-TEAR AND RE-OPERATION RATES FOR PEDIATRIC AND ADOLESCENT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0018
Author(s):  
Nirav K. Pandya
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Acl Injuries ◽  
Radiographic Findings ◽  
Operation Rate ◽  
Adolescent Patients ◽  
Anterior Cruciate ◽  
Poor Outcomes ◽  
Operative Notes

BACKGROUND Anterior cruciate ligament (ACL) injuries have become increasingly common in pediatric and adolescent patients over the last several decades, as this population has become more involved in athletic competition. ACL injuries in skeletally immature patients had historically been treated conservatively with bracing and activity modification; however, poor outcomes including extensive chondral and meniscal damage, increased recurrent instability, and increased sports drop out rates have been observed. Recognition of these poor outcomes has led to a shift towards early operative treatment, resulting in a significant rise in the number of pediatric ACL reconstructions being performed. Yet, a higher failure rate has been noted in this younger population within larger adult cohort studies. The purpose of this study was to evaluate the re-tear and re-operation rates in pediatric and adolescent ACL reconstruction. METHODS The was a retrospective review of pediatric and adolescent patients treated at a single tertiary children’s hospital for ACL reconstruction from 2011 to 2017 by the same pediatric orthopedic surgeon. Review of the electronic medical record was performed to obtain patient demographics, preoperative clinical and radiographic findings, operative notes, and postoperative outcomes. Re-tear and re-operation rates were calculated. RESULTS A total of 308 patients were identified during the study period of which sixty-six percent were female. The mean age of patients was 15.8 years with a mean follow-up of 1.8 +/- 0.8 years. Two-hundred fifty-three hamstring autografts (mean age 15.7+/- 4.1 years) and 55 bone tendon bone autograft (mean age 16.9 +/- 1.45 years) were performed. Two hundred forty-three patents had adult-style reconstructions performed, 40 had transphyseal reconstructions, 24 had partial transphyseal reconstruction, and 1 patient had an all-epiphyseal reconstruction. Average hamstring graft size was 8.3 mm +/- 0.5 mm and all BTB graft were 9 mm. The overall graft re-tear rate was 8.2%. The overall re-operation rate was 13.2% (17 revisions, 5 medial meniscus repairs, 3 I+D’s, 2 cyclops debridements, 1 removal of hardware, and 1 manipulation under anesthesia). The highest re-tear (12.5%) and re-operation (22.5%) rates were found in patients who underwent a transphyseal reconstruction. No growth disturbances which required surgical intervention were noted. CONCLUSIONS / SIGNIFICANCE Pediatric and adolescent ACL reconstruction can be performed safely without a risk of growth disturbance. Patients had a high re-tear and re-operation rate; particularly in patients who underwent transphyseal reconstruction. Strategies must be developed to decrease the re-tear and re-operation rate in this population.

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