scholarly journals Physeal-Sparing Anterior Cruciate Ligament Reconstruction for Skeletally Immature Patients: All-Epiphyseal Technique Using Quadricep Tendon Autograft

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Hatem B. Afana ◽  
Thomas Nau
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Treatment Strategies ◽  
Acl Injury ◽  
Postoperative Rehabilitation ◽  
Acl Injuries ◽  
True Incidence ◽  
Anterior Cruciate ◽  
Tendon Autograft ◽  
Physeal Sparing

The anterior cruciate ligament (ACL) is a major stabilizing structure of the knee and one of the most common injured structures. The true incidence of ACL injury in children and adolescents is unknown, but recent studies suggest increased ACL injury rates, especially in the sports-participating population. The mechanism of injury, clinical examination, and diagnosis of ACL injury in children is the same as in adults. The main concerns in the management of pediatric ACL injuries are the open physes and the eventual long-term consequences of the ACL deficient knee. The ideal treatment strategy of pediatric ACL injuries is still controversial, because there is still no universal consensus for techniques, graft choices, and postoperative rehabilitation. We present a case of a 12-year-old male patient who underwent ACL reconstruction using an all-inside, physeal-sparing technique with a quadriceps tendon autograft and discuss the current treatment strategies.

Measuring Strain Distributions in the Anterior Cruciate Ligament Using Ultrasound

2010 ◽  
Author(s):  
Amy Cochran ◽  
Yingxin Gao ◽  
Ursula Krotscheck ◽  
Margret Thompson ◽  
James Stouffer ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Treatment Strategies ◽  
Acl Injury ◽  
Physiological Factors ◽  
Detailed Understanding ◽  
Prevention And Treatment ◽  
Anterior Cruciate ◽  
Tissue Motion

Optimal prevention and treatment strategies of anterior cruciate ligament (ACL) injury can be realized with a detailed understanding of how physiological factors impact the ACL. A noninvasive, in vivo method that assesses the ACL’s mechanical integrity is needed to help clarify this multi-factorial pathophysiology. We investigated the use of the noninvasive, in vivo technique, ultrasound strain elastography (USE) (1), to distinguish between normal and injured ACLs. USE is used as a diagnostic tool in oncological (2), hepatic (3), and cardiovascular (4) applications. This technique uses ultrasonic RF data to track tissue motion in order to estimate strain within the tissue.

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.

scholarly journals Anterior Cruciate ligament injuries of the knee:

2018 ◽  
Vol 30 (1) ◽  
pp. 1-6
Author(s):  
G Linde Strauss ◽  
D Janse van Rensburg ◽  
C Grant ◽  
A Jansen van Rensburg ◽  
M Velleman ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Mechanism Of Injury ◽  
Mri Scan ◽  
Chi Square ◽  
Valgus Stress ◽  
Acl Injuries ◽  
Anterior Cruciate Ligament Injuries ◽  
Anterior Cruciate

Abstract Background and problem statement Anterior cruciate ligament injuries are common among athletes and the general public. These injuries may lead to significant absence from activity with an associated financial and social burden. No definitive association has been described between mechanism of injury and pathology to enable us to put preventative measures in place in order to limit these injuries. Aim To determine whether there is an association between the mechanism of injury and the pathology seen on a magnetic resonance imaging (MRI) scan in anterior cruciate ligament (ACL) injuries. Methods This was a cross-sectional analytical study. Eighty seven male patients with an ACL injury, who had an MRI scan of the knee within the last two years participated in this study. Participants were contacted to give consent that their information be used in this study. The mechanism of injury and the pathology seen on the MRI scan was noted and categorised into different mechanism of injury groups and associated pathology groups. Statistical analyses included summaries of the data and a test for association between mechanism of injury and pathology. Since there were multiple pathology responses to each mechanism, a modified version of the chi-square test for independence was used. A 5% level of significance was specified. Results MRI scans of ACL injuries indicated that the mechanism of a solid foot plant with rotation of the knee has a greater tendency to be associated with medial meniscal injuries (77%), and also a 54% possibility to be associated with lateral meniscal injuries. A solid foot plant with a valgus stress on the knee showed a higher incidence of associated medial collateral ligaments (MCL) injuries (41%) and femoral bone bruising (62 %). These two mechanisms of injury are the most common in ACL injuries and contribute to the clinical significance found in this study. The p-value was however not statistically significant (p=0.44, chi-square value=20.27, df=45) for any association between pathology and mechanism of injury. Conclusion Some injury mechanisms causing ACL injury were more common than others and also had more associated pathology. The most common mechanism of injury noted is a solid foot plant with either rotation of the knee or valgus stress on the knee. Strengthening tissue structures involved in those movement patterns that cause these mechanisms can possibly limit ACL injuries in athletes and the general public.  Key words Anterior cruciate ligament injury, mechanism, association, pathology, MRI scan, prevention.

scholarly journals Anterior cruciate ligament injuries in Australian football: should women and girls be playing? You’re asking the wrong question

2020 ◽  
Vol 6 (1) ◽  
pp. e000778 ◽  
Author(s):  
Aaron Fox ◽  
Jason Bonacci ◽  
Samantha Hoffmann ◽  
Sophia Nimphius ◽  
Natalie Saunders
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Early Years ◽  
High Rate ◽  
Acl Injuries ◽  
Sports Science ◽  
Australian Football ◽  
Women And Girls ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) injuries have been a rising concern in the early years of the women’s Australian Football League (AFLW), eliciting headlines of a ‘knee crisis’ surrounding the league. There has been a focus on female biology as the primary factor driving the high rate of ACL injuries in the AFLW. Emphasising Australian football (AF) as being dangerous predominantly due to female biology may be misrepresenting a root cause of the ACL injury problem, perpetuating gender stereotypes that can restrict physical development and participation of women and girls in the sport. We propose that an approach addressing environmental and sociocultural factors, along with biological determinants, is required to truly challenge the ACL injury problem in the AFLW. Sports science and medicine must therefore strive to understand the whole system of women in AF, and question how to address inequities for the benefit of the athletes.

scholarly journals The Landing Error Scoring System as a Screening Tool for an Anterior Cruciate Ligament Injury–Prevention Program in Elite-Youth Soccer Athletes

2015 ◽  
Vol 50 (6) ◽  
pp. 589-595 ◽  
Author(s):  
Darin A. Padua ◽  
Lindsay J. DiStefano ◽  
Anthony I. Beutler ◽  
Sarah J. de la Motte ◽  
Michael J. DiStefano ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Screening Tool ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Receiver Operator Characteristic ◽  
Acl Injuries ◽  
Youth Soccer ◽  
Jump Landing ◽  
Anterior Cruciate

Context Identifying neuromuscular screening factors for anterior cruciate ligament (ACL) injury is a critical step toward large-scale deployment of effective ACL injury-prevention programs. The Landing Error Scoring System (LESS) is a valid and reliable clinical assessment of jump-landing biomechanics. Objective To investigate the ability of the LESS to identify individuals at risk for ACL injury in an elite-youth soccer population. Design Cohort study. Setting Field-based functional movement screening performed at soccer practice facilities. Patients or Other Participants A total of 829 elite-youth soccer athletes (348 boys, 481 girls; age = 13.9 ± 1.8 years, age range = 11 to 18 years), of whom 25% (n = 207) were less than 13 years of age. Intervention(s) Baseline preseason testing for all participants consisted of a jump-landing task (3 trials). Participants were followed prospectively throughout their soccer seasons for diagnosis of ACL injuries (1217 athlete-seasons of follow-up). Main Outcome Measure(s) Landings were scored for “errors” in technique using the LESS. We used receiver operator characteristic curves to determine a cutpoint on the LESS. Sensitivity and specificity of the LESS in predicting ACL injury were assessed. Results Seven participants sustained ACL injuries during the follow-up period; the mechanism of injury was noncontact or indirect contact for all injuries. Uninjured participants had lower LESS scores (4.43 ± 1.71) than injured participants (6.24 ± 1.75; t1215 = −2.784, P = .005). The receiver operator characteristic curve analyses suggested that 5 was the optimal cutpoint for the LESS, generating a sensitivity of 86% and a specificity of 64%. Conclusions Despite sample-size limitations, the LESS showed potential as a screening tool to determine ACL injury risk in elite-youth soccer athletes.

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.

scholarly journals Epidemiology of Anterior Cruciate Ligament Injury in Italian First Division Soccer Players

2019 ◽  
Vol 12 (3) ◽  
pp. 279-288 ◽  
Author(s):  
Alberto Grassi ◽  
Luca Macchiarola ◽  
Matteo Filippini ◽  
Gian Andrea Lucidi ◽  
Francesco Della Villa ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Incidence Rate ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Soccer Players ◽  
Injury Incidence ◽  
Acl Injuries ◽  
Professional Soccer ◽  
Incidence Proportion ◽  
Anterior Cruciate

Background: The burden of anterior cruciate ligament (ACL) injury in professional soccer players is particularly relevant as it represents a potentially career-threatening injury. Hypothesis: Our hypotheses were that (1) injury incidence rate would be similar to that reported in the literature, (2) we would identify a uniform distribution of the injuries along the season, and (3) injury incidence rate would be similar in high-ranked and lower ranked teams, based on final placement in the league. Study Design: Descriptive epidemiological study. Level of Evidence: Level 4. Methods: Professional male soccer players participating in the Serie A championship league in 7 consecutive seasons (2011-2012 to 2017-2018) were screened to identify ACL injuries through the online football archive transfermarkt.com . Exposure in matches and training were calculated. Results: There were 84 ACL injuries found (mean player age, 25.3 ± 4.2 years). Overall, 25% of ACL injuries were reruptures (15%) or contralateral injuries (10%). ACL incidence rate was 0.4215 per 1000 hours of play during Serie A matches, 0.0305 per 1000 hours of training (rate ratio [RR], 13.8; 95% CI, 8.4-22.7; P < 0.0001), and 0.0618 per 1000 hours of total play. Injury distribution had a bimodal peak, with the highest number of events in October and March. Alternatively, training injuries peaked in June and July. A significantly higher incidence rate was found for the teams ranked from 1st to 4th place compared with those ranked 5th to 20th (0.1256 vs 0.0559 per 1000 hours of play; RR, 2.2; 95% CI, 1.4-3.6; P = 0.0003). A similar finding was found for injury incidence proportion (3.76% vs 1.64%; P = 0.0003). Conclusion: The overall incidence rate of ACL injuries in Italian Serie A was 0.062 per 1000 hours, with a 14-fold risk in matches compared with training. Relevantly, 25% were second injuries. Most injuries occurred in October and March, and an almost 2-fold incidence rate and incidence proportion were noted in those teams ranked in the first 4 positions of the championship league. Clinical Relevance: Knowing the precise epidemiology of ACL injury in one of the most competitive professional football championship leagues could help delineate fields of research aimed to investigate its risk factors.

scholarly journals The Effect Of Playing Surface On Anterior Cruciate Ligament Injury In NCAA Soccer

2020 ◽  
Vol 8 (3_suppl2) ◽  
pp. 2325967120S0012
Author(s):  
Mark Howard ◽  
Hyunwoo Paco Kang ◽  
Samantha Solaru ◽  
Alexander E. Weber ◽  
Mark F. Rick C
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Soccer Players ◽  
Injury Incidence ◽  
Artificial Turf ◽  
Acl Injuries ◽  
Natural Grass ◽  
Significant Difference ◽  
Anterior Cruciate

Objectives: Previous orthopaedic literature has examined the effect of synthetic playing surfaces on the risk of anterior cruciate ligament (ACL) injury in athletes and produced varying and inconclusive results. The objective of this study was to examine the role of playing surface on the incidence and risk of ACL injury in collegiate soccer athletes. Methods: The NCAA Injury Surveillance Program (ISP) database was queried for ACL injuries for male and female soccer players from the 2004-05 through the 2013-14 seasons at all levels of competition. The number of athlete exposures (AEs), defined as 1 athlete participating in 1 practice or competition in which they were exposed to the possibility of athletic injury, were recorded for grass and synthetic playing surfaces. Both the reported injuries and exposures provided were weighted in order to represent the entire NCAA collegiate soccer population. Normalized ACL incidence rates were calculated as well as 95% confidence intervals (95%CI). Rate ratios comparing competition type amongst both competition and practice were calculated. Results: ACL injuries were more common on grass surfaces (1.16 per 10,000 AEs, 95%CI 1.12-1.20) than artificial turf (0.92 per 10,000 AEs, 95%CI 0.84-1.04). This difference was statistically significant (IRR 1.26, p<0.0001), and driven primarily by the difference in injury incidence during practice. The injury incidence during practice on natural grass (1.18 per 10,000 AEs, 95% CI 1.11-1.26) was significantly greater than the injury incidence rate during practice on artificial turf (0.067 per 10,000 AEs, 95%CI 0.043-0.096). Players were 17.7 times more likely (95%CI 10.6678-27.2187, p<0.0001) to sustain an ACL injury during practice on natural grass when compared to practice on artificial turf. However, there was no significant difference in injury incidence during matches (IRR 0.96, p=0.44), with matches on natural grass (3.35 per 10,000 AEs, 95% CI 3.21-3.51) equivalent to matches on artificial surfaces (3.49 per 10,000 AEs, 95%CI 3.18-3.81). When comparing exposure type, the injury rate was significantly greater during matches (3.38 per 10,000 AEs, 95% CI 3.25-3.52) compared to practices (0.82 per 10,000 AEs, 95%CI 0.77-0.88), with a 4.10-fold increase in ACL injury incidence during matches compared to practice (p<0.0001). Conclusion: Between 2004 and 2014, NCAA soccer players experienced a greater number of ACL injuries on natural grass playing surfaces compared with artificial turf playing surfaces. This difference is driven by injuries during practice, where athletes were nearly 18 times more likely to suffer an ACL injury on grass versus artificial turf. While ACL injuries were more likely during matches compared to practices, no difference in incidence was noted between playing surfaces. Additional study is warranted investigating potential causes for this observed increased risk with soccer practice on grass fields.

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 Tendency of Driving to the Basket Is Associated With Increased Risk of Anterior Cruciate Ligament Tears in National Basketball Association Players: A Cohort Study

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110529
Author(s):  
Blake J. Schultz ◽  
Kevin A. Thomas ◽  
Mark Cinque ◽  
Joshua D. Harris ◽  
William J. Maloney ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Standard Deviation ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
National Basketball Association ◽  
Acl Injuries ◽  
Increased Risk ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Level Performance

Background: Driving to the basket in basketball involves acceleration, deceleration, and lateral movements, which may expose players to increased anterior cruciate ligament (ACL) injury risk. It is unknown whether players who heavily rely on driving have decreased performance on returning to play after ACL reconstruction (ACLR). Hypothesis: Players with a greater tendency to drive to the basket would be more likely to tear their ACL versus noninjured controls and would experience decreased performance when returning to play after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: Season-level performance statistics and ACL injuries were aggregated for National Basketball Association (NBA) seasons between 1980 and 2017 from publicly available sources. Players’ tendency to drive was calculated using 49 common season-level performance metrics. Each ACL-injured player was matched with 2 noninjured control players by age, league experience, and style of play metrics. Points, playing minutes, driving, and 3-point shooting tendencies were compared between players with ACL injuries and matched controls. Independent-samples t test was utilized for comparisons. Results: Of 86 players with a total of 96 ACL tears identified in the NBA, 50 players were included in the final analysis. Players who experienced an ACL tear had a higher career-average drive tendency than controls ( P = .047). Players with career-average drive tendency ≥1 standard deviation above the mean were more likely to tear their ACL than players with drive tendency <1 standard deviation (5.2% vs 2.7%; P = .026). There was no significant difference in total postinjury career points ( P = .164) or career minutes ( P = .237) between cases and controls. There was also no significant change in drive tendency ( P = .152) or 3-point shooting tendency ( P = .508) after return to sport compared with controls. Conclusion: NBA players with increased drive tendency were more likely to tear their ACL. However, players who were able to return after ACLR did not underperform compared with controls and did not alter their style of play compared with the normal changes seen with age. This information can be used to target players with certain playing styles for ACL injury prevention programs.

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