scholarly journals Risk of Secondary ACL Injury in Adolescents Prescribed Functional Bracing After ACL Reconstruction

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711987988
Author(s):  
Gabriel S. Perrone ◽  
Kate E. Webster ◽  
Chris Imbriaco ◽  
Gabriela M. Portilla ◽  
Amishi Vairagade ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Case Series ◽  
Acl Injury ◽  
High Rate ◽  
Control Group ◽  
Acl Injuries ◽  
Injury Rates ◽  
Increased Risk ◽  
Early Graft ◽  
Retear Rate

Background: There is a high incidence of a secondary anterior cruciate ligament (ACL) injury in unbraced adolescent athletes. Little is known about the effect of functional bracing with regard to the risk of secondary ACL injuries among adolescents. Hypothesis: Our primary hypothesis was that adolescents would have a high rate of secondary ACL injury even with brace use. A secondary hypothesis was that the reinjury rate with brace use would be lower than that of a historical control group of unbraced patients. Study Design: Case series; Level of evidence, 4. Methods: A group of 219 patients (age <20 years at surgery) who underwent ACL reconstruction and were prescribed postoperative functional bracing during cutting and pivoting sports for 2 years after surgery completed a survey regarding reinjury to either knee. Rates of knee injuries following ACL reconstruction were calculated and compared with those reported in a similar unbraced cohort. The effect of demographic and anatomic factors on risk of secondary ACL injuries was also investigated. Results: The overall follow-up rate was 65% (142/219) at a mean 5.6 years after surgery. In the braced cohort, the overall graft retear rate was 10%, with the highest retear rates observed in male patients 17 years of age and younger (18%). The overall contralateral ACL injury and combined (graft or contralateral ACL) secondary injury rates were 13% and 23%, respectively, with female patients younger than 18 years having the highest contralateral and combined injury rates (17% and 26%, respectively). Younger age (odds ratio [OR], 0.70; P = .021), family history of ACL injury (OR, 2.81; P = .015), and higher lateral tibial slope (OR, 1.25; P = .016) were associated with increased risk of secondary knee injury in the braced cohort. Compared with the unbraced cohort, the braced cohort had a lower overall graft retear rate ( P = .028), a lower graft retear rate in patients younger than 18 years ( P = .012), lower early graft retear rate (within the first year after surgery) ( P = .011), and lower early graft retear rate in subjects younger than 18 years ( P = .003). Conclusion: Postoperative use of functional bracing can result in reduced risk of graft retear and no change in contralateral injury rates. Clinicians may want to consider the use of postoperative functional bracing in adolescent patients.

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.

scholarly journals A Tomahawk Shaped Femur is a Risk Factor for Anterior Cruciate Ligament Injury

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0001
Author(s):  
Thomas Pfeiffer ◽  
Jeremy Burnham ◽  
Elmar Herbst ◽  
Sven Shafizadeh ◽  
Volker Musahl
Keyword(s):  
Acl Reconstruction ◽  
Roc Analysis ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Control Group ◽  
Acl Injuries ◽  
Injury Group ◽  
Increased Risk ◽  
The Mean ◽  
Anterior Cruciate

Bony morphologic characteristics have been demonstrated to increase the risk of anterior cruciate ligament (ACL) injury. The purpose of the study was to examine distal femoral morphology relative to ACL injury, reconstruction failure, and contralateral ACL injury. It was hypothesized that an increased posterior femoral condylar depth, quantified as the tomahawk ratio, would correlate with increased risk of primary ACL ruptures, ACL reconstruction failures, and contralateral ACL injuries. Consecutive patients undergoing arthroscopic knee surgery 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 tomahawk 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 tomahawk ratio cut-off for detecting increased risk for ACL injury 175 patients met inclusion criteria. The mean tomahawk ratios in the control group, primary ACL injury group, failed ACL reconstruction group, and contralateral ACL injury group 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 tomahawk ratio compared to the control group (p<0.008). ROC analysis demonstrated a tomahawk ratio of 63% or greater to be associated with an increased risk for ACL injury with a sensitivity of 83% and a specificity of 71%. The data from this study show that an increased posterior femoral condylar depth, or tomahawk ratio, is associated with increased risk of ACL injury, including primary ACL injury, failed ACL reconstruction, and contralateral ACL injury. Readily identifiable risk factors, such as an increased tomahawk ratio, could assist clinicians in identifying at-risk individuals who may experience greater benefit from targeted ACL injury prevention counseling and intervention. The presence of the tomahawk-shaped femur could also be used to guide treatment decisions and identify ACL reconstruction patients who may benefit from additional surgical procedures such as extra articular tenodesis.

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 Second Anterior Cruciate Ligament Injuries After Anterior Cruciate Ligament Reconstruction in Professional Sumo Wrestlers: A Case Series

2020 ◽  
Vol 8 (2) ◽  
pp. 232596712090369
Author(s):  
Sadanori Shimizu ◽  
Tsuyoshi Nagase ◽  
Tomohiko Tateishi ◽  
Teruhiko Nakagawa ◽  
Masamitsu Tsuchiya
Keyword(s):  
Anterior Cruciate Ligament ◽  
Surgical Treatment ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Case Series ◽  
Acl Injury ◽  
Current Status ◽  
Level Of Evidence ◽  
Acl Injuries ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injury is one of the most common traumatic injuries in professional sumo wrestlers. Further, ipsilateral reinjuries or contralateral ACL injuries after ACL reconstruction can occur in sumo wrestlers. The incidence of ipsilateral reinjury and contralateral ACL injury after ACL reconstruction ranges from 3% to 13% in a healthy athletic population. Purpose: To investigate the current status of second ACL injuries after ACL reconstruction in sumo wrestlers. Study Design: Case series; Level of evidence, 4. Methods: Between 1988 and 2015, a total of 139 primary ACL reconstructions were performed in professional sumo wrestlers at our hospital. After exclusion of cases of multiple ligament knee reconstruction and patients in whom the contralateral ACL had been injured previously, 110 cases were included in this study. We investigated the number of second injuries, time from primary reconstruction to second injury, treatment method, and change in official sumo ranking after second injuries. The chi-square test, Student t test, and Fisher exact text were used for statistical analysis. Results: Among 110 wrestlers who underwent ACL reconstruction, second injuries after primary ACL reconstruction occurred in 22 cases (20.0%). Among them, 14 cases (12.7%) entailed ipsilateral reinjury, 11 (10.0%) entailed contralateral injury, and 3 involved combined rerupture and contralateral injury. As for surgical treatment, 5 revision ACL reconstructions were performed for ipsilateral reinjury (35.7%), and 7 ACL reconstructions were performed for contralateral injury (63.6%). Surgical treatment was not performed for the remaining cases. Wrestlers who were treated by revision or contralateral ACL reconstruction after the second injury were demoted in rank for 3 to 4 tournaments but overtook the nonoperative treatment group in ranking by 2 years postoperatively; all athletes initially were demoted in rank after the second injury. Conclusion: This study is the first to investigate instances of ipsilateral reinjuries and contralateral ACL injuries after ACL reconstruction in professional athletes in heavyweight combat sports. The incidences of ipsilateral reinjury and contralateral ACL injury after ACL reconstruction in professional sumo wrestlers were relatively higher than those reported in previous studies.

scholarly journals Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098164
Author(s):  
Steven F. DeFroda ◽  
Devan D. Patel ◽  
John Milner ◽  
Daniel S. Yang ◽  
Brett D. Owens
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Odds Ratio ◽  
Cruciate Ligament ◽  
Case Series ◽  
National Basketball Association ◽  
High Rate ◽  
Return To Play ◽  
Lower Percentage ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injury in National Basketball Association (NBA) players can have a significant impact on player longevity and performance. Current literature reports a high rate of return to play, but there are limited data on performance after ACL reconstruction (ACLR). Purpose/Hypothesis: To determine return to play and player performance in the first and second seasons after ACLR in NBA players. We hypothesized that players would return at a high rate. However, we also hypothesized that performance in the first season after ACLR would be worse as compared with the preinjury performance, with a return to baseline by postoperative year 2. Study Design: Case series; Level of evidence, 4. Methods: An online database of NBA athlete injuries between 2010 and 2019 was queried using the term ACL reconstruction. For the included players, the following data were recorded: name; age at injury; position; height, weight, and body mass index; handedness; NBA experience; dates of injury, surgery, and return; knee affected; and postoperative seasons played. Regular season statistics for 1 preinjury season and 2 postoperative seasons were compiled and included games started and played, minutes played, and player efficiency rating. Kaplan-Meier survivorship plots were computed for athlete return-to-play and retirement endpoints. Results: A total of 26 athletes underwent ACLR; of these, 84% (95% CI, 63.9%-95.5%) returned to play at a mean 372.5 days (95% CI, 323.5-421.5 days) after surgery. Career length after injury was a mean of 3.36 seasons (95% CI, 2.27-4.45 seasons). Factors that contributed to an increased probability of return to play included younger age at injury (odds ratio, 0.71 [95% CI, 0.47-0.92]; P = .0337) and fewer years of experience in the NBA before injury (odds ratio, 0.70 [95% CI, 0.45-0.93]; P = .0335). Postoperatively, athletes played a significantly lower percentage of total games in the first season (48.4%; P = .0004) and second season (62.1%; P = .0067) as compared with the preinjury season (78.5%). Player efficiency rating in the first season was 19.3% less than that in the preinjury season ( P = .0056). Performance in the second postoperative season was not significantly different versus preinjury. Conclusion: NBA players have a high rate of RTP after ACLR. However, it may take longer than a single season for elite NBA athletes to return to their full preinjury performance. Younger players and those with less NBA experience returned at higher rates.

scholarly journals When can total knee arthroplasty be safely performed following prior arthroscopy?

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jin-Ning Ma ◽  
Xiao-Lin Li ◽  
Pan Liang ◽  
Sheng-Li Yu
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Knee Arthroplasty ◽  
Acl Injury ◽  
Control Group ◽  
Optimal Timing ◽  
Complication Rates ◽  
Increased Risk ◽  
Total Knee

Abstract Background The optimal timing to perform a total knee arthroplasty (TKA) after knee arthroscopy (KA) was controversial in the literature. We aimed to 1) explore the effect of prior KA on the subsequent TKA; 2) identify who were not suitable for TKA in patients with prior KA, and 3) determine the timing of TKA following prior KA. Methods We retrospectively reviewed 87 TKAs with prior KA and 174 controls using propensity score matching in our institution. The minimum follow-up was 2 years. Postoperative clinical outcomes were compared between groups. Kaplan-Meier curves were created with reoperation as an endpoint. Multivariate Cox proportional hazards regressions were performed to identify risk factors of severe complications in the KA group. The two-piecewise linear regression analysis was performed to examine the optimal timing of TKA following prior KA. Results The all-cause reoperation, revision, and complication rates of the KA group were significantly higher than those of the control group (p < 0.05). The survivorship of the KA group and control group was 92.0 and 99.4% at the 2-year follow-up (p = 0.002), respectively. Male (Hazards ratio [HR] = 3.2) and prior KA for anterior cruciate ligament (ACL) injury (HR = 4.4) were associated with postoperative complications in the KA group. There was a non-linear relationship between time from prior KA to TKA and postoperative complications with the turning point at 9.4 months. Conclusion Prior KA is associated with worse outcomes following subsequent TKA, especially male patients and those with prior KA for ACL injury. There is an increased risk of postoperative complications when TKA is performed within nine months of KA. Surgeons should keep these findings in mind when treating patients who are scheduled to undergo TKA with prior KA.

scholarly journals Should females play Australian football? You’re asking the wrong question…

2020 ◽  
Author(s):  
Aaron Fox ◽  
Jason Bonacci ◽  
Samantha Hoffmann ◽  
Sophia Nimphius ◽  
Natalie Saunders
Keyword(s):  
Gender Stereotypes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Early Years ◽  
High Rate ◽  
Sociocultural Factors ◽  
Acl Injuries ◽  
Sports Science ◽  
Australian Football League ◽  
Australian Football

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 as being dangerous for females due to their biology may be misrepresenting a root cause of the ACL injury problem, perpetuating gender stereotypes that can restrict physical development and participation of females in the sport. We propose that that a framework 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 female Australian football, and question how to address inequities for the benefit of the athletes.

scholarly journals When can be safely performed total knee arthroplasty following prior arthroscopy?

2020 ◽  
Author(s):  
Jin-Ning Ma ◽  
Xiao-Lin Li ◽  
Pan Liang ◽  
Sheng-Li Yu
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Knee Arthroplasty ◽  
Linear Regression Analysis ◽  
Acl Injury ◽  
Optimal Time ◽  
Control Group ◽  
Complication Rates ◽  
Increased Risk ◽  
Total Knee

Abstract Background The optimal time to perform a total knee arthroplasty (TKA) after knee arthroscopy (KA) was controversial in the literature. We aimed to 1) explore the effect of prior KA on the subsequent TKA; 2) identify who were not suitable for TKA in patients with prior KA; and 3) determine the timing of TKA following prior KA.Methods We retrospectively reviewed 87 TKAs with prior KA and 174 controls using propensity score matching in our institution. The minimum followup was 2 years. Postoperative clinical outcomes were compared between groups. Kaplan-Meier curves were created with reoperation as an end point. Multivariate Cox proportional hazards regressions were performed to identify risk factors of severe complications in the KA group. The two-piecewise linear regression analysis was performed to examine the optimal timing of TKA following prior KA.Results The all-cause reoperation, revision and complication rates of KA group were significantly higher than those of control group (p<0.05). The survivorship of KA group and control group was 92.0% and 99.4% at the 2-year followup (p=0.002), respectively. Male (Hazards ratio [HR]=3.2) and prior KA for anterior cruciate ligament (ACL) injury (HR=4.4) were associated with postoperative complications in the KA group. There was a non-liner relationship between time from prior KA to TKA and postoperative complications with the turning point at 9.4 months.Conclusion Prior KA is associated with worse outcomes following subsequent TKA, especially male patients and those with prior KA for ACL injury. There is an increased risk of postoperative complications when TKA is performed within 9 months of KA. Surgeons should keep these findings in mind when treating patients who are scheduled to undergo TKA with prior KA.

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.

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