scholarly journals WOMAC Pain Scores at the Time of ACL Injury are Associated with Concentrations of Serum and Urine Biomarkers of Type 2 Collagen Degradation at the Time of ACL Reconstruction

2017 ◽  
Vol 5 (7_suppl6) ◽  
pp. 2325967117S0030
Author(s):  
Steven J. Svoboda ◽  
Jesse R. Trump ◽  
James Reilly ◽  
Kenneth Wikiser ◽  
Kenneth L. Cameron
Keyword(s):  
Acl Reconstruction ◽  
Acl Injury ◽  
Collagen Degradation ◽  
Womac Pain ◽  
Pain Scores ◽  
Urine Biomarkers ◽  
Serum And Urine

scholarly journals Intra-articular Morphine and Ropivacaine Injection Provides Efficacious Analgesia As Compared With Femoral Nerve Block in the First 24 Hours After ACL Reconstruction: Results From a Bone–Patellar Tendon–Bone Graft in an Adolescent Population

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098590
Author(s):  
Brendon C. Mitchell ◽  
Matthew Y. Siow ◽  
Andrew T. Pennock ◽  
Eric W. Edmonds ◽  
Tracey P. Bastrom ◽  
...  
Keyword(s):  
Pain Management ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Single Shot ◽  
Pain Scores ◽  
Peripheral Block ◽  
Bone Patellar Tendon

Background: Opioid consumption and patient satisfaction are influenced by a surgeon’s pain-management protocol as well as the use of adjunctive pain mediators. Two commonly utilized adjunctive pain modifiers for anterior cruciate ligament (ACL) reconstruction are femoral nerve blockade and intra-articular injection; however, debate remains regarding the more efficacious methodology. Hypothesis: We hypothesized that intra-articular injection with ropivacaine and morphine would be found to be as efficacious as a femoral nerve block for postoperative pain management in the first 24 hours after bone–patellar tendon–bone (BTB) ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Charts were retrospectively reviewed for BTB ACL reconstructions performed by a single pediatric orthopaedic surgeon from 2013 to 2019. Overall, 116 patients were identified: 58 received intra-articular injection, and 58 received single-shot femoral nerve block. All patients were admitted for 24 hours. Pain scores were assessed every 4 hours. Morphine milligram equivalents (MMEs) consumed were tabulated for each patient. Results: Opioid use was 24.3 MMEs in patients treated with intra-articular injection versus 28.5 MMEs in those with peripheral block ( P = .108). Consumption of MMEs was greater in the intra-articular group in the 0- to 4-hour period (7.1 vs 4.6 MMEs; P = .008). There was significantly less MME consumption in patients receiving intra-articular injection versus peripheral block at 16 to 20 hours (3.2 vs 5.6 MMEs; P = .01) and 20 to 24 hours (3.8 vs 6.5 MMEs; P < .001). Mean pain scores were not significantly different over the 24-hour period (peripheral block, 2.7; intra-articular injection, 3.0; P = .19). Conclusion: Within the limitations of this study, we could identify no significant difference in MME consumption between the single-shot femoral nerve block group and intra-articular injection group in the first 24 hours postoperatively. While peripheral block is associated with lower opioid consumption in the first 4 hours after surgery, patients receiving intra-articular block require fewer opioids 16 to 24 hours postoperatively. Given these findings, we propose that intra-articular injection is a viable alternative for analgesia in adolescent patients undergoing BTB ACL reconstruction.

scholarly journals High rate of second ACL injury following ACL reconstruction in male professional footballers: an updated longitudinal analysis from 118 players in the UEFA Elite Club Injury Study

2021 ◽  
pp. bjsports-2020-103555
Author(s):  
Francesco Della Villa ◽  
Martin Hägglund ◽  
Stefano Della Villa ◽  
Jan Ekstrand ◽  
Markus Waldén
Keyword(s):  
Acl Reconstruction ◽  
Cox Regression ◽  
Injury Rate ◽  
Acl Injury ◽  
High Rate ◽  
Football Players ◽  
Professional Football ◽  
Cox Regression Analysis ◽  
Career Length ◽  
Increased Risk

BackgroundStudies on subsequent anterior cruciate ligament (ACL) ruptures and career length in male professional football players after ACL reconstruction (ACLR) are scarce.AimTo investigate the second ACL injury rate, potential predictors of second ACL injury and the career length after ACLR.Study designProspective cohort study.SettingMen’s professional football.Methods118 players with index ACL injury were tracked longitudinally for subsequent ACL injury and career length over 16.9 years. Multivariable Cox regression analysis with HR was carried out to study potential predictors for subsequent ACL injury.ResultsMedian follow-up was 4.3 (IQR 4.6) years after ACLR. The second ACL injury rate after return to training (RTT) was 17.8% (n=21), with 9.3% (n=11) to the ipsilateral and 8.5% (n=10) to the contralateral knee. Significant predictors for second ACL injury were a non-contact index ACL injury (HR 7.16, 95% CI 1.63 to 31.22) and an isolated index ACL injury (HR 2.73, 95% CI 1.06 to 7.07). In total, 11 of 26 players (42%) with a non-contact isolated index ACL injury suffered a second ACL injury. RTT time was not an independent predictor of second ACL injury, even though there was a tendency for a risk reduction with longer time to RTT. Median career length after ACLR was 4.1 (IQR 4.0) years and 60% of players were still playing at preinjury level 5 years after ACLR.ConclusionsAlmost one out of five top-level professional male football players sustained a second ACL injury following ACLR and return to football, with a considerably increased risk for players with a non-contact or isolated index injury.

scholarly journals 20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope

2017 ◽  
Vol 46 (3) ◽  
pp. 531-543 ◽  
Author(s):  
Lucy J. Salmon ◽  
Emma Heath ◽  
Hawar Akrawi ◽  
Justin P. Roe ◽  
James Linklater ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Degenerative Change ◽  
Acl Injury ◽  
Hamstring Tendon ◽  
Activity Level ◽  
Acl Graft ◽  
Hamstring Tendon Autograft ◽  
Graft Rupture ◽  
Tendon Autograft

Background: No well-controlled studies have compared the long-term outcome of anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft between adolescents and adults. Increased posterior tibial slopes (PTSs) have been reported in the ACL-injured versus controls, but the effect of PTS on the outcome after reconstruction is relatively unexplored. Purpose: To compare the prospective longitudinal outcome of “isolated” ACL ruptures treated with anatomic endoscopic ACL reconstruction using hamstring tendon autograft over 20 years in adolescent and adult cohorts and to examine factors for repeat ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: A single-surgeon series of 200 consecutive patients undergoing isolated primary ACL reconstruction with hamstring tendon autograft were prospectively studied. Subjects were assessed preoperatively and at 2, 7, 15, and 20 years postoperatively. Outcomes included International Knee Documentation Committee (IKDC) Knee Evaluation, IKDC subjective scores, KT-1000 instrumented laxity testing, and radiological evaluation of degenerative change and medial tibial slope. Twenty-year outcomes were compared between those who underwent surgery at the age of 18 years or younger (adolescent group, n = 39) and those who underwent surgery when older than 18 years (adult group, n = 161). Results: At 20 years, 179 of 200 subjects were reviewed (89.5%). ACL graft rupture occurred in 37 subjects and contralateral ACL injury in 22 subjects. Of those with intact ACL grafts at 20 years, outcomes were not statistically different between adolescents and adults for the variables of IKDC subjective score ( P = .29), return to preinjury activity level ( P = .84), current activity level ( P = .69), or degree of radiological degenerative change at 20 years ( P = .51). The adolescent group had a higher proportion of grade 1 ligamentous laxity testing compared with the adult group ( P = .003). Overall, ACL graft survival at 20 years was 86% for adults and 61% for adolescents (hazard ration, 3.3; P = .001). The hazard for ACL graft rupture was increased by 4.8 in adolescent males and 2.5 in adolescent females compared with adults. At 20 years, the ACL survival for adolescents with a PTS of ≥12° was 22%. The hazard for ACL graft rupture was increased by 11 in adolescents with a PTS of ≥12° ( P = .001) compared with adults with a PTS <12°. Conclusion: Repeat ACL injury after isolated ACL reconstruction is common, occurring in 1 in 3 over 20 years. In the absence of further injury, isolated ACL reconstruction using this technique was associated with good long-term outcomes with respect to patient-reported outcomes and return to sports, regardless of age. However, mild ligament laxity and ACL graft rupture after ACL reconstruction are significantly more common in adolescents, especially adolescent males, compared with adults. PTS of 12° or more is the strongest predictor of repeat ACL injury, and its negative effect is most pronounced in adolescents.

scholarly journals Association between serum and urine biomarkers and lumbar spine individual radiographic features: the Johnston County Osteoarthritis Project

2012 ◽  
Vol 20 (11) ◽  
pp. 1286-1293 ◽  
Author(s):  
A.P. Goode ◽  
S.W. Marshall ◽  
V.B. Kraus ◽  
J.B. Renner ◽  
T. Stürmer ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Radiographic Features ◽  
Urine Biomarkers ◽  
Serum And Urine

scholarly journals A Cam Shaped Femur Might Be A Risk Factor for ACL Injuries

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0013
Author(s):  
Thomas Rudolf Pfeiffer ◽  
Jeremy M. Burnham ◽  
Ajay C. Kanakamedala ◽  
Jonathan Daniel Hughes ◽  
James J. Irrgang ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Injury Risk ◽  
Roc Analysis ◽  
Femoral Condyle ◽  
Academic Medical Center ◽  
Acl Injury ◽  
Control Group ◽  
Acl Injuries ◽  
Increased Risk ◽  
The Mean

Objectives: Bony morphologic characteristics have been demonstrated to increase the risk of anterior cruciate ligament (ACL) injury. While posterior femoral condyle condylar offset is an aspect of distal femoral bony morphology that has been reported to influence range of motion and other aspects of knee joint kinematics, it remains unclear whether this characteristic influences the risk of ACL injury. The purpose of the study was to examine the relationship between distal femoral morphology and risks of ACL injury, reconstruction failure, and contralateral ACL injury. It was hypothesized that increased posterior femoral condylar depth, quantified as the cam ratio, would correlate with increased risk of primary ACL injuries, ACL reconstruction failures, and contralateral ACL injuries. Methods: Consecutive patients undergoing evaluation for knee complaints at an academic medical center from 2012-2016 with minimum 24-month follow-up were retrospectively reviewed. Subjects were stratified into four groups: a control group consisting of patients with no ACL injuries and three groups of patients with a primary ACL injury, failed ACL reconstruction, or previous ACL injury with subsequent contralateral ACL injury. Using lateral radiographs, the ratio of posterior condylar depth over total condylar distance was defined as the cam ratio. Analysis-of-variance (ANOVA) and post-hoc testing were used to test for differences in the mean tomahawk ratio between study groups (p<0.05). Receiver Operating Characteristic (ROC) analysis was performed to determine the optimal cam ratio cut-off for detecting increased risk for ACL injury. Results: One hundred and seventy-five patients met inclusion criteria. The mean cam ratios in the control, primary ACL injury, failed ACL reconstruction, and contralateral ACL injury groups were 61.1% (± 2.1), 64.2% (± 3.8), 64.4% (± 3.6), and 66.9% (± 4.0), respectively. Patients with a primary ACL injury, failed ACL reconstruction, or contralateral ACL injury had a significantly higher cam ratio compared to the control group (p<0.008). ROC analysis demonstrated a cam ratio of 63% or greater to be associated with an increased risk for ACL injury with a sensitivity of83% and a specificity of 71%. Conclusion: The data from this study show that an increased posterior femoral condylar depth, or cam ratio, might be associated with increased risk of ACL injury, including primary ACL injury, failed ACL reconstruction, and contralateral ACL injury. The data from this study may help clinicians identify patients at greater risk of ACL injury and re-injury. Future prospective studies will be helpful in investigating the mechanism by which an increased cam ratio increases ACL injury risk and potential strategies to mitigate the increased risk posed by this bony characteristic.

Impact of Treatment with Salsalate on Pain Scores in Patients with Type 2 Diabetes: Results from TINSAL-2D

2011 ◽  
pp. P3-488-P3-488
Author(s):  
Janet B McGill ◽  
Vivian Fonseca ◽  
Laura Pyle ◽  
Kathleen A Jablonski ◽  
Myrlene A Staten ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Pain Scores

Dynamic Postural Control Two Years Following Anterior Cruciate Ligament Reconstruction in a Female Collegiate Soccer Player

2015 ◽  
Vol 20 (2) ◽  
pp. 24-29 ◽  
Author(s):  
Michael A. Samaan ◽  
Eric K. Greska ◽  
Matthew C. Hoch ◽  
Joshua T. Weinhandl ◽  
Sebastian Y. Bawab ◽  
...  
Keyword(s):  
Knee Joint ◽  
Postural Control ◽  
Acl Reconstruction ◽  
Outcome Measure ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Minimal Detectable Change ◽  
Joint Stability ◽  
Compensatory Mechanisms ◽  
Main Outcome Measure

Context:ACL injury may cause a lack of knee joint proprioception and motor control due to knee joint instability. ACL reconstruction restores knee joint stability, yet dynamic postural control may still be affected while performing dynamic tasks.Objective:To examine the effects of ACL injury and reconstruction on dynamic postural control using the Star Excursion Balance Test (SEBT) and single leg hop (SLH).Participant:One Division I female athlete.Main Outcome Measure:The athlete’s dynamic postural control, both pre- and postreconstruction, was compared with preinjury data using the method of minimal detectable change using reach distances obtained from the SEBT and hop distances from the SLH.Results:ACL injury and reconstruction affected the anterior, posteromedial, and posterolateral reach distances of the SEBT. Despite restoration of joint stability, anterior reach distance in the SEBT did not return to preinjury levels 27 months after ACL reconstruction. SLH distances decreased following injury but returned to preinjury levels 27 months after ACL reconstruction.Conclusion:Dynamic postural control and performance during the SEBT and SLH were affected by ACL injury and for extended periods of time after ACL reconstruction. Quadriceps inhibition and muscle strength of the involved limb may affect dynamic postural control both after ACL injury and reconstruction while performing the SEBT. Compensatory mechanisms at the hip and ankle may aid in performance of the SLH after reconstruction. Using baseline measurements, where possible, may help researchers better understand the effects of ACL injury and reconstruction on dynamic postural control.

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