A Systematic Review of the Outcomes of Posterolateral Corner Knee Injuries, Part 2

2015 ◽  
Vol 44 (6) ◽  
pp. 1616-1623 ◽  
Author(s):  
Samuel G. Moulton ◽  
Andrew G. Geeslin ◽  
Robert F. LaPrade
Keyword(s):  
Systematic Review ◽  
Knee Injuries ◽  
Posterolateral Corner

scholarly journals Weightbearing Protocols After Posterolateral Corner Reconstruction: A Systematic Review

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098827
Author(s):  
Brandon L. Morris ◽  
Tanner Poppe ◽  
Kenneth Kim ◽  
Brandon Barnds ◽  
Paul Schroeppel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Knee Injuries ◽  
Return To Sport ◽  
Posterolateral Corner ◽  
Complication Rates ◽  
Knee Reconstruction ◽  
Rehabilitation Programs ◽  
Significant Difference ◽  
Outcome Scores ◽  
Posterolateral Corner Injury

Background: Multiligamentous knee injuries with a posterolateral corner injury represent a devastating insult to the knee. Purpose: To evaluate multiligamentous knee reconstruction rehabilitation programs and recommend a rehabilitation program based on a review of published outcomes studies. Study Design: Systematic review; Level of evidence, 4. Methods: A MEDLINE (PubMed), OVID, and Embase database search was conducted using the terms “posterolateral corner” and “rehabilitation.” All articles obtained were examined to confirm their rehabilitation programs for multiligamentous knee injuries. These injuries included a posterolateral corner injury plus an isolated anterior or posterior cruciate ligament injury or a combined cruciate injury. Results: Ten publications representing 245 patients with multiligamentous knee reconstruction were analyzed. Rehabilitation protocols were divided by weightbearing (WB) status: in 2 studies, patients were non-WB until postoperative 4 weeks (delayed WB; n = 61); 5 studies permitted progressive WB until postoperative 6 weeks (progressive WB; n = 123); and 3 studies allowed WB immediately after surgery (immediate WB; n = 61). No significant difference in outcome scores among the 3 WB groups was found. Arthrofibrosis requiring manipulation under anesthesia was the most common complication (11%) in the delayed WB group, followed by the immediate WB group (3%) and the progressive WB group (0%; P < .01). Overall complication rates were highest in the delayed WB group (44%), followed by the immediate and progressive WB groups (25% and 3%, respectively; P < .00001). The delayed WB group was permitted to return to sport at a mean of 10.5 months from the index procedure; the progressive WB group, at 6.0 months; and the immediate WB group, at 9.0 months ( P < .05). Conclusion: This review revealed no significant difference in outcome scores when comparing immediate, progressive, and delayed WB protocols. Time to permitted return to sport was not significantly different among the groups, but there existed a trend toward earlier return in the progressive WB group. Patients in the delayed and immediate WB groups experienced a higher overall complication rate. Progressive WB postoperative protocols may decrease the risk of complications without compromising outcomes; however, more research is needed to identify the optimal postoperative rehabilitation protocol, given the significant data heterogeneity currently available in the literature.

A Systematic Review of the Outcomes of Posterolateral Corner Knee Injuries, Part 1

2015 ◽  
Vol 44 (5) ◽  
pp. 1336-1342 ◽  
Author(s):  
Andrew G. Geeslin ◽  
Samuel G. Moulton ◽  
Robert F. LaPrade
Keyword(s):  
Systematic Review ◽  
Knee Injuries ◽  
Posterolateral Corner

scholarly journals Low-Energy Multiligament Knee Injuries Are Associated With Higher Postoperative Activity Scores Compared With High-Energy Multiligament Knee Injuries: A Systematic Review and Meta-analysis of the Literature

2020 ◽  
pp. 036354652096208
Author(s):  
Robert S. Dean ◽  
Nicholas N. DePhillipo ◽  
David H. Kahat ◽  
Nathan R. Graden ◽  
Christopher M. Larson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Motor Vehicle ◽  
Meta Analysis ◽  
Knee Injuries ◽  
High Energy ◽  
Low Energy ◽  
Vehicle Accidents ◽  
Injury Mechanisms ◽  
Outcome Scores ◽  
Multiligament Knee Injuries

Background: Multiligament knee injuries (MLKIs) can result from high-energy injury mechanisms such as motor vehicle accidents or low-energy injury mechanisms such as activities of daily living or sports. Purpose/Hypothesis: The purpose was to conduct a systematic review on postoperative patient-reported outcomes after MLKIs and to conduct a meta-analysis of comparable outcome variables based upon high- versus low-energy injury mechanisms. It was hypothesized that MLKIs with low-energy injury mechanisms would demonstrate significantly improved subjective clinical outcome scores compared with high-energy injuries. Study design: Meta-analysis and systematic review. Methods: A systematic review was performed with the inclusion criteria of postoperative MLKI outcomes based upon high-versus low-energy mechanisms of injury with a minimum 2-year follow-up. Outcome scores included were the Lysholm knee scoring scale, Tegner activity scale, and the International Knee Documentation Committee (IKDC) score. High-energy mechanisms included motor vehicle accidents or falls from a height >5 feet; low-energy mechanisms included sports-related injuries, activities of daily living, or falls from <5 feet. A meta-analysis was performed comparing the outcome scores of high- versus low-energy mechanisms of MLKIs. Results: Overall, 1214 studies were identified, 15 of which were included in the systematic review and meta-analysis. Thirteen studies included surgical reconstructions of all injured ligaments. A total of 641 patients with 275 high-energy and 366 low-energy injuries were grouped for comparison in the meta-analysis. No significant differences in Lysholm scale (78.6 vs 78.0) or IKDC scores (69.0 vs 68.4) were found between high- and low-energy groups at a minimum of 2 years (range, 2-10 years) postoperatively ( P > .05). The low-energy injury group demonstrated significantly higher Tegner activity scale scores (5.0 vs 3.9; P = .03). There was no significant difference in failure rates between groups (3.5% vs 2.0%; P = .23). Conclusion: We found in this systematic review and meta-analysis that patients with low-energy mechanisms of MLKI surgery had improved postoperative Tegner activity scores compared with those patients with high-energy mechanisms after MLKI surgery. However, there were no differences in Lysholm score, IKDC score, or failure rates between high- and low-energy MLKI patients at an average of 5.3 years postoperatively.

scholarly journals Epidemiology of sports injuries in basketball: integrative systematic review

2018 ◽  
Vol 4 (1) ◽  
pp. e000468 ◽  
Author(s):  
Carlos Vicente Andreoli ◽  
Bárbara Camargo Chiaramonti ◽  
Elisabeth Biruel ◽  
Alberto de Castro Pochini ◽  
Benno Ejnisman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sports Injuries ◽  
Knee Injuries ◽  
Musculoskeletal Injuries ◽  
The Body ◽  
Lower Limbs ◽  
Integrative Review ◽  
Ankle Injuries ◽  
Upper Limbs ◽  
Sources Of Information

IntroductionBasketball is a contact sport with complex movements that include jumps, turns and changes in direction, which cause frequent musculoskeletal injuries in all regions of the body.ObjectiveThis is an integrative systematic review of the epidemiology of musculoskeletal injuries in basketball.MethodsThis is an integrative review based on the following sources of information: PubMed/MEDLINE, Embase, LILACS, BBO-Biblioteca Brasileira de Odontologia, IBECS-Índice Bibliográfico Espanhol em Ciências da Saúde, nursing journals, dental journals and core clinical journals in the last 10 years with studies addressing the general epidemiology of sports injuries in basketball.ResultsIn total, 268 articles were selected, of which 11 were eligible for the integrative review. A total of 12 960 injuries were observed, most of which occurred in the lower limbs (63.7%), with 2832 (21.9%) ankle injuries and 2305 (17.8%) knee injuries. Injuries in the upper limbs represented 12%–14% of the total injuries. Children and adolescents received head injuries more often compared with the other age and skill categories. In the adult category, there was an increased prevalence of injuries in the trunk and spine. In the upper limbs, hands, fingers and wrists were affected more frequently than the shoulders, arms and forearms. In the masters’ category, there was an increase in the incidence of thigh injuries.ConclusionThe lower limbs were the most affected, with the ankle and knee joints having the highest prevalence of injuries regardless of gender and category. Further randomised studies, increased surveillance and epidemiological data collection are necessary to improve knowledge on sports injuries in basketball and to validate the effectiveness of preventive interventions.

scholarly journals Neuromuscular Function of the Knee Joint Following Knee Injuries: Does It Ever Get Back to Normal? A Systematic Review with Meta-Analyses

2020 ◽  
Author(s):  
Beyza Tayfur ◽  
Chedsada Charuphongsa ◽  
Dylan Morrissey ◽  
Stuart Charles Miller
Keyword(s):  
Systematic Review ◽  
Knee Joint ◽  
Strong Evidence ◽  
Knee Injuries ◽  
Neuromuscular Function ◽  
Spinal Reflex ◽  
Voluntary Activation ◽  
Moderate Evidence ◽  
Reflex Excitability ◽  
Meta Analyses

Abstract Background Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction. Objective To identify how peri-articular neuromuscular function changes over time after knee injury and surgery. Design Systematic review with meta-analyses. Data Sources PubMed, Web of Science, Embase, Scopus, CENTRAL (Trials). Eligibility Criteria for Selecting Studies Moderate and high-quality studies comparing neuromuscular function of muscles crossing the knee joint between a knee-injured population (ligamentous, meniscal, osteochondral lesions) and healthy controls. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and other torque related outcomes. Results A total of 46 studies of anterior cruciate ligament (ACL) and five of meniscal injury were included. For ACL injury, strength and voluntary activation deficits were evident (moderate to strong evidence). Cortical excitability was not affected at < 6 months (moderate evidence) but decreased at 24+ months (moderate evidence). Spinal-reflex excitability did not change at < 6 months (moderate evidence) but increased at 24+ months (strong evidence). We also found deficits in torque variability, rate of torque development, and electromechanical delay (very limited to moderate evidence). For meniscus injury, strength deficits were evident only in the short-term. No studies reported gastrocnemius, soleus or popliteus muscle outcomes for either injury. No studies were found for other ligamentous or chondral injuries. Conclusions Neuromuscular deficits persist for years post-injury/surgery, though the majority of evidence is from ACL injured populations. Muscle strength deficits are accompanied by neural alterations and changes in control and timing of muscle force, but more studies are needed to fill the evidence gaps we have identified. Better characterisation and therapeutic strategies addressing these deficits could improve rehabilitation outcomes, and potentially prevent PTOA. Trial Registration Number PROSPERO CRD42019141850.

scholarly journals Diagnostic Accuracy of Dual-energy CT for Bone Marrow Edema in Patients with Acute Knee Injuries: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Xuelong Chen ◽  
Zhizhuo Li ◽  
Hui Fang ◽  
Xiangyang Yin ◽  
Chengxin Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Marrow ◽  
Knee Injury ◽  
Bone Marrow Edema ◽  
Meta Analysis ◽  
Knee Injuries ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Acute Knee ◽  
Marrow Edema

Abstract Background: The prevalence of knee injury is high and early diagnosis is significant to guide clinical treatment. MRI is recognized as the gold standard for detecting bone marrow edema (BME) in patients with acute knee injury, but limitations still exist. Dual-energy CT (DECT) is investigated as a promising alternative.Methods: We systematically retrieved studies from EMBASE, Scopus, PUBMED, and the Cochrane Library and collected gray literatures. According to PRISMA-DTA guidelines, a systematic review was performed from inception to July 31, 2021, assessing the diagnostic accuracy of DECT for detecting BME in at least 10 adult patients with acute knee injuries and with an MRI reference standard. Study details were independently extracted by two reviewers. Meta-analysis was performed using a bivariate mixed-effects regression model with subgroup analysis performed to evaluate for sources of variability. Results: Nine studies evaluating 290 patients between the ages of 23–53 with acute knee injuries undergoing DECT and MRI were included in analysis. Summary sensitivity, specificity, and AUC values for BME were 85% (95% confidence interval (CI) 77–90%), 96% (95% CI 93–97%), and 0.97 (95% CI 0.95–0.98), respectively. There were no statistically significant differences in specificity and sensitivity amongst comparative subgroups to account for presumed variability amongst studies.Conclusion: DECT is accurate for detecting BME in patients with acute knee injuries and can be used as an alternative to MRI, particularly when MRI is contraindicated or unavailable.

scholarly journals Acute Versus Delayed Surgical Intervention in Multiligament Knee Injuries: A Systematic Review

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110278
Author(s):  
Ryan S. Marder ◽  
Husain Poonawala ◽  
Jorge I. Pincay ◽  
Frank Nguyen ◽  
Patrick F. Cleary ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Surgical Intervention ◽  
Intervention Group ◽  
Knee Injuries ◽  
Cochrane Library ◽  
The Mean ◽  
Multiligament Knee Injuries ◽  
Level 2

Background: The optimal timing of surgical intervention for multiligament knee injuries remains controversial. Purpose: To review the clinical and functional outcomes after acute and delayed surgical intervention for multiligament knee injuries. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a search of the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to September 2020. Eligible studies reported on knee dislocations, multiligament knee injuries, or bicruciate ligament injuries in adult patients (age, ≥18 years). In addition to comparing outcomes between acute and delayed surgical intervention groups, we conducted 3 subgroup analyses for outcomes within isolated knee injuries, knee injuries with concomitant polytrauma/fractures, and high-level (level 2) studies. Results: Included in the analysis were 31 studies, designated as evidence level 2 (n = 3), level 3 (n = 8), and level 4 (n = 20). These studies reported on 2594 multiligament knee injuries sustained by 2585 patients (mean age, 25.1-65.3 years; mean follow-up, 12-157.2 months). At the latest follow-up timepoint, the mean Lysholm (n = 375), International Knee Documentation Committee (IKDC) (n = 286), and Tegner (n = 129) scores for the acute surgical intervention group were 73.60, 67.61, and 5.06, respectively. For the delayed surgical intervention group, the mean Lysholm (n = 196), IKDC (n = 172), and Tegner (n = 74) scores were 85.23, 72.32, and 4.85, respectively. The mean Lysholm (n = 323), IKDC (n = 236), and Tegner (n = 143) scores for our isolated subgroup were 83.7, 74.8, and 5.0, respectively. By comparison, the mean Lysholm (n = 270), IKDC (n = 236), and Tegner (n = 206) scores for the polytrauma/fractures subgroup were 83.3, 64.5, and 5.0, respectively. Conclusion: The results of our systematic review did not elucidate whether acute or delayed surgical intervention produced superior clinical and functional outcomes. Although previous evidence has supported acute surgical intervention, future prospective randomized controlled trials and matched cohort studies must be completed to confirm these findings.

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