A Systematic Review of Basic Science and Animal Studies on the Use of Doxycycline to Reduce the Risk of Posttraumatic Osteoarthritis After Anterior Cruciate Ligament Rupture/Transection

2020 ◽  
pp. 036354652096597
Author(s):  
Matthew J. Kraeutler ◽  
Gianna M. Aliberti ◽  
Anthony J. Scillia ◽  
Eric C. McCarty ◽  
Mary K. Mulcahey
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Basic Science ◽  
Animal Studies ◽  
Cruciate Ligament ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Posttraumatic Osteoarthritis ◽  
Doxycycline Treatment ◽  
Anterior Cruciate

Background: Posttraumatic osteoarthritis (PTOA) after injury to the anterior cruciate ligament (ACL) is common. Purpose: To perform a systematic review of basic science and animal studies to determine the effect of doxycycline treatment on the prevention of PTOA after ACL rupture/transection. Study Design: Systematic review. Methods: A systematic review was performed by searching the PubMed, Cochrane Library, and Embase databases to identify basic science and animal studies evaluating the effect of doxycycline treatment on the prevention of PTOA of the knee joint after ACL/cranial cruciate ligament (CCL) injury. The search phrase used was “doxycycline cruciate ligament.” Inclusion criteria were basic science and animal studies evaluating the effect of oral administration of doxycycline in ACL/CCL-deficient animals with or without a control group. Results: Seven studies met inclusion criteria and were included in this systematic review. Five studies were performed in dogs, 1 in rabbits, and 1 in mice. Overall, the effects of doxycycline treatment on the prevention of PTOA after ACL/CCL rupture/transection were mixed. In dogs, no significant effects of doxycycline treatment were found in terms of matrix metalloproteinase (MMP) activity, while a mouse study found significantly lower MMP-13 expression on the tibia in doxycycline-treated animals, suggesting that doxycycline may protect against proteoglycan loss and decrease osteoarthritis progression. Cartilage nitric oxide concentrations were lower in doxycycline-treated dogs compared with untreated dogs, suggesting decreased cartilage degradation among doxycycline-treated dogs, although there were no significant effects on cartilage stromelysin levels with no significant effects in terms of physiological remodeling or catabolism of cartilage. Bone formation or resorption was not found to be affected by doxycycline treatment. One study demonstrated a substantial beneficial effect of doxycycline on gross morphology of the medial femoral condyle. Doxycycline was found to conserve bone strain energy density and appeared to limit subchondral bone loss in 1 study. Conclusion: Based on the limited available animal studies, doxycycline appears to demonstrate some benefits in the prevention of PTOA after ACL/CCL rupture/transection. Additional studies are needed to further characterize the potential benefits, side effects, dosage, and duration of this treatment after ACL injury in human patients.

Anterior Cruciate Ligament Mechanoreceptors and their Potential Importance in Remnant-Preserving Reconstruction: A Review of Basic Science and Clinical Findings

2017 ◽  
Vol 31 (08) ◽  
pp. 736-746 ◽  
Author(s):  
Jonathan Kosy ◽  
Vipul Mandalia
Keyword(s):  
Anterior Cruciate Ligament ◽  
Posterior Cruciate Ligament ◽  
Clinical Studies ◽  
Basic Science ◽  
Animal Studies ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Future Research ◽  
Remnant Preservation ◽  
Anterior Cruciate

AbstractMechanoreceptors, within the anterior cruciate ligament (ACL), are believed to have importance in proprioception, contributing to dynamic knee stability. The potential for reinnervation of the ACL graft is one of the proposed advantages of remnant-preserving reconstruction. The aim of this review is to summarize advances in the basic science underpinning this function, alongside recent clinical studies, to define the current role for remnant-preservation.A comprehensive systematic review was performed using PubMed and Medline searches. Studies were analyzed with particular focus placed on the methodology used to either identify mechanoreceptors or test proprioception.Contemporary work, using immunohistological staining, has shown mechanoreceptors primarily within proximity to the bony attachments of the ACL (peripherally in the subsynovial layer). The number of these receptors has been shown to decrease rapidly, following rupture, with adhesion to the posterior cruciate ligament slowing this decline. Recent studies have shown proprioceptive deficits, in both the injured and contralateral knees, with the clinical relevance of findings limited by testing methodology and the small differences found. The advantages of remnant-preservation, seen primarily in animal studies, have not been shown in systematic reviews or meta-analysis of clinical studies.The potential for reinnervation of the graft is likely time-dependent and reliant on continued loading of the remnant. Therefore, current clinical use and future research should focus on preserving remnants within 6 months of injury that remain loaded by adherence to the posterior cruciate ligament. Subsequent testing should account for central neurological changes and focus on clinically relevant outcomes.

scholarly journals A Systematic Review of Factors Associated with both Bilateral and Recurrent Anterior Cruciate Ligament Disruption

2019 ◽  
pp. 1-12
Author(s):  
Jaquelyn Kakalecik ◽  
John M. Reynolds ◽  
Joseph S. Torg
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Positive Family History ◽  
Acl Injury ◽  
Inclusion Criteria ◽  
Factors Associated ◽  
Anterior Cruciate ◽  
Ligament Disruption

Background: Numerous studies have reported factors associated with recurrent or subsequent contralateral anterior cruciate ligament disruption, but a comprehensive review of the literature has not been performed. Purpose: This study attempts to systematically review the literature and provide an overview of the currently reported risk factors for recurrent and subsequent contralateral ACL reconstructions in order to allow for more efficient identification and intervention of high-risk patients. Study Design: Systematic Review. Methods: The Pubmed and Embase databases were searched using a combination of keywords such as “ACL reconstruction” and “bilateral or recurrent” and “risk factors” and medical subject headings. All studies were screened by two independent reviewers, and articles that met inclusion criteria (non-contact ACL injury, study analyzed risk factors for contralateral ACL injury or graft rupture) were downloaded and read. Results: The initial search yielded 129 articles, of which 36 met inclusion criteria. After duplicates were removed, 23 articles remained. The reference lists of included articles were cross-referenced, and an additional 2 articles were included. Conclusion: Graft harvest site, allograft usage, return to sport, younger age, a positive family history, increased posterior tibial slope, and the number of previous ACL reconstructions are well-reported risk factors for second ACL injury. Recent studies suggest a patients who have negative psychological states in the perioperative periods have worse long-term functional outcomes.

scholarly journals Risk of knee replacement after anterior cruciate ligament injury: a systematic review

2020 ◽  
Author(s):  
Milan Duong Nguyen ◽  
Asbjørn Årøen
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Knee Replacement ◽  
Cruciate Ligament ◽  
Activity Level ◽  
Cochrane Library ◽  
Estimated Risk ◽  
Anterior Cruciate ◽  
Injured Patients

Abstract BACKGROUND: It is recognized that patients suffering rupture of the anterior cruciate ligament (ACL) are prone to accelerated osteoarthritis (OA), thus, this patient group is at increased risk of undergoing knee replacement (KR) at a younger age compared to the general population. There are limited data directly determining the risk of KR in ACL-injured patients. The purpose of this study is to estimate the risk of undergoing KR in patients with a history of primary ACL injury (ACLi).STUDY DESIGN: Systematic review.METHODS: A systematic literature search with keywords and MeSH terms was performed using PubMed and Cochrane Library. We identified all studies reporting KR as an outcome in individuals with primary ACLi. Individuals with concomitant and secondary intra-articular injuries were included. A modified version of the Coleman Methodology Score (CMS) was used to evaluate the quality of the included studies. The risk was estimated by using the total number of ACL-injured patients and the total number of KRs within this cohort, consisting of both patients with reconstruction and patients with non-operative treatment.RESULTS: A total of 152 390 ACL-injured patients and a total of 1071 KRs were assembled from 5 prospective and 7 retrospective studies, which revealed a mean modified CMS of 70. Mean follow-up time was 16 years (ranging from 4.6 to 30 years). Mean age among the patients was 29.8 years. Estimated risk of undergoing KR after ACLi was 0.7 % with values between 0.54 % and 9.5 % among the included studies.CONCLUSION: This systematic review suggests an estimated risk of KR among ACL-injured patients to be 0.7 %. Our findings are based on the results from the included studies, which, to some degree, showed divergence. The discrepancy may be due to variability in several factors, both research variables and patient factors, including follow-up time, sample size, subsequent injuries, obesity, sex, age and activity level. No consensus about OA development after ACLi has been established, however, OA is a common topic in the conversation between the doctor and the patient. This data may be helpful for physicians and clinicians when informing patients about the long-term risk of symptomatic OA, eventually requiring KR.

scholarly journals The Effectiveness and Recommendation of Motor Imagery Techniques for Rehabilitation after Anterior Cruciate Ligament Reconstruction: A Systematic Review

2021 ◽  
Vol 10 (3) ◽  
pp. 428
Author(s):  
José Manuel Pastora-Bernal ◽  
María José Estebanez-Pérez ◽  
David Lucena-Anton ◽  
Francisco José García-López ◽  
Antonio Bort-Carballo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Motor Imagery ◽  
Cruciate Ligament ◽  
Small Sample ◽  
Current Evidence ◽  
Cochrane Library ◽  
Positive Effects ◽  
Acl Surgery ◽  
Anterior Cruciate

Motor imagery (MI) reported positive effects in some musculoskeletal rehabilitation processes. The main objective of this study was to analyze the effectiveness of MI interventions after anterior cruciate ligament (ACL) reconstruction. A systematic review was conducted from November 2018 to December 2019 in PubMed, Scopus, Web of Science, The Cochrane Library, and Physiotherapy Evidence Database (PEDro). The methodological quality, degree of recommendation, and levels of evidence were analyzed. A total of six studies were included. Selected studies showed unequal results (positive and negative) regarding pain, anxiety, fear of re-injury, function, and activities of daily living. Regarding the range of motion, anthropometric measurements, and quality of life, the results were not conclusive. Muscle activation, strength, knee laxity, time to remove external support, and neurobiological factors showed some favorable results. Nevertheless, the results were based on a limited number of studies, small sample sizes, and a moderate-weak degree of recommendation. In conclusion, our review showed a broader view of the current evidence, including a qualitative assessment to implement MI after ACL surgery. There was no clear evidence that MI added to physiotherapy was an effective intervention after ACL surgery, although some studies showed positive results in clinical outcomes. More adequately-powered long-term randomized controlled trials are necessary.

scholarly journals Hospital readmission after anterior cruciate ligament reconstruction: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037888
Author(s):  
Long Shao ◽  
Di Wu ◽  
Jia-Ying Li ◽  
Xiang-Dong Wu ◽  
Xi Zhou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Hospital Readmission ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Acl Injury ◽  
Cochrane Library ◽  
Anterior Cruciate ◽  
Causes And Risk Factors

IntroductionAnterior cruciate ligament (ACL) injury is one of the most common injuries of the knee. ACL reconstruction (ACLR) has been widely performed as a safe and effective treatment for ACL injuries. As there is an increasing trend in the incidence of ACL injury, hospital readmission after ACLR has attracted renewed attention for the financial burden to both patients and the healthcare system. However, information about hospital readmission after ACLR remains fragmented. Therefore, we plan to systematically review the literature to investigate the rate of, causes and risk factors for hospital readmission after ACLR, and summarise interventions to reduce hospital readmission. This article is to provide the protocol for an upcoming systematic review and meta-analysis on this important issue.Methods and analysisReporting of this protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. Electronic databases, including PubMed, Embase and the Cochrane Library, will be systematically searched from inception to June 2020. No language restrictions will be applied. Studies will be included if they reported hospital readmission or explored the associated potential causes and risk factors for hospital readmission after ACLR. The primary outcome will be the number and time frame of hospital readmission after ACLR. Secondary outcomes will be reasons for readmission, number and types of complications, risk factors for readmission and preventive measures for readmission after ACLR. Quality assessments will be performed by using the Newcastle-Ottawa Scale (NOS). If possible, study results will be summarised in a forest plot, and heterogeneity will be tested by using the Cochran’s Q and I2 statistics.Ethics and disseminationNo ethical approval is required because our study is not related to patients or animals. The results will be published in a peer-reviewed journal.PROSPERO registration numberCRD42020058624.

scholarly journals Clinical and Radiological Outcomes of Anteromedial Portal Versus Transtibial Technique in ACL Reconstruction: A Systematic Review

2021 ◽  
Vol 9 (7) ◽  
pp. 232596712110245
Author(s):  
Marios Loucas ◽  
Rafael Loucas ◽  
Riccardo D’Ambrosi ◽  
Michael Elias Hantes
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Cochrane Library ◽  
Pivot Shift Test ◽  
Single Bundle ◽  
Transtibial Technique ◽  
Drilling Technique ◽  
Anterior Cruciate

Background: The drilling technique used to make a femoral tunnel is critically important for determining outcomes after anterior cruciate ligament (ACL) reconstruction. The 2 most common methods are the transtibial (TT) and anteromedial (AM) techniques. Purpose: To determine whether graft orientation and placement affect clinical outcomes by comparing clinical and radiological outcomes after single-bundle ACL reconstruction with the AM versus TT technique. Study Design: Systematic review; Level of evidence, 3. Methods: Articles in PubMed, EMBASE, the Cochrane Library, ISI Web of Science, Scopus, and MEDLINE were searched from inception until April 25, 2020, using the following Boolean operators: transtibial OR trans-tibial AND (anteromedial OR trans-portal OR independent OR three portal OR accessory portal) AND anterior cruciate ligament. Results: Of 1270 studies retrieved, 39 studies involving 11,207 patients were included. Of these studies, 14 were clinical, 13 were radiological, and 12 were mixed. Results suggested that compared with the TT technique, the AM technique led to significantly improved anteroposterior and rotational knee stability, International Knee Documentation Committee (IKDC) scores, and recovery time from surgery. A higher proportion of negative Lachman ( P = .0005) and pivot-shift test ( P = .0001) results, lower KT-1000 arthrometer maximum manual displacement ( P = .00001), higher Lysholm score ( P = .001), a higher incidence of IKDC grade A/B ( P = .05), and better visual analog scale score for satisfaction ( P = .00001) were observed with the AM technique compared with the TT technique. The AM drilling technique demonstrated a significantly shorter tunnel length ( P = .00001). Significant differences were seen between the femoral and tibial graft angles in both techniques. Low overall complication and revision rates were observed for ACL reconstruction with the AM drilling technique, similar to the TT drilling technique. Conclusion: In single-bundle ACL reconstruction, the AM drilling technique was superior to the TT drilling technique based on physical examination, scoring systems, and radiographic results. The AM portal technique provided a more reproducible anatomic graft placement compared with the TT technique.

Sport-Specific Yearly Risk and Incidence of Anterior Cruciate Ligament Tears in High School Athletes: A Systematic Review and Meta-Analysis

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
Keyword(s):  
High School ◽  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
High School Athletes ◽  
Anterior Cruciate ◽  
Cruciate Ligament Tears

scholarly journals Comparison of Blood Flow Restriction Training versus Non-Occlusive Training in Patients with Anterior Cruciate Ligament Reconstruction or Knee Osteoarthritis: A Systematic Review

2020 ◽  
Vol 10 (1) ◽  
pp. 68
Author(s):  
Cristina Bobes Álvarez ◽  
Paloma Issa-Khozouz Santamaría ◽  
Rubén Fernández-Matías ◽  
Daniel Pecos-Martín ◽  
Alexander Achalandabaso-Ochoa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Blood Flow ◽  
Anterior Cruciate Ligament ◽  
Knee Osteoarthritis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Flow Restriction ◽  
Anterior Cruciate

Patients undergoing anterior cruciate ligament (ACL) reconstruction and patients suffering from knee osteoarthritis (KOA) have been shown to have quadriceps muscle weakness and/or atrophy in common. The physiological mechanisms of blood flow restriction (BFR) training could facilitate muscle hypertrophy. The purpose of this systematic review is to investigate the effects of BFR training on quadriceps cross-sectional area (CSA), pain perception, function and quality of life on these patients compared to a non-BFR training. A literature research was performed using Web of Science, PEDro, Scopus, MEDLINE, Dialnet, CINAHL and The Cochrane Library databases. The main inclusion criteria were that papers were English or Spanish language reports of randomized controlled trials involving patients with ACL reconstruction or suffering from KOA. The initial research identified 159 publications from all databases; 10 articles were finally included. The search was conducted from April to June 2020. Four of these studies found a significant improvement in strength. A significant increase in CSA was found in two studies. Pain significantly improved in four studies and only one study showed a significant improvement in functionality/quality of life. Low-load training with BFR may be an effective option treatment for increasing quadriceps strength and CSA, but more research is needed.

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