scholarly journals Do Pediatric Patients With Anterior Cruciate Ligament Tears Have a Higher Rate of Familial Anterior Cruciate Ligament Injury?

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095966
Author(s):  
Joshua T. Bram ◽  
Nicolas Pascual-Leone ◽  
Neeraj M. Patel ◽  
Christopher J. DeFrancesco ◽  
Nakul S. Talathi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Family History ◽  
Pediatric Patients ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Ligament Injury ◽  
Acl Tear ◽  
First Degree Relatives ◽  
History Of ◽  
Anterior Cruciate

Background: Several studies have examined the anterior cruciate ligament (ACL) injury history among relatives of patients undergoing ACL reconstruction (ACLR), but they have primarily analyzed adults with variable results. Hypothesis: We hypothesized that he rate of familial ACL injuries among pediatric patients with ACL tears would be greater than that among pediatric patients with uninjured knees. Study Design: Cohort study; Level of evidence, 3. Methods: Pediatric patients (≤18 years of age) who underwent ACLR between January 2009 and May 2016 were contacted to complete a questionnaire on subsequent complications and family history of ACL tears. A control cohort was recruited from children with uninjured knees seen in the concussion clinic of our institution. Binary logistic regression was used to determine the factors predictive of having a familial ACL tear history or complications. Results: Overall, 450 pediatric patients with primary ACL tears were included. Age at the time of surgery was 14.9 ± 2.2 years with a follow-up of 4.3 ± 2.1 years. When compared with 267 control patients, those with an ACL tear reported a higher rate of first-degree relatives with an ACL injury history (25.1% vs 12.0%; P < .001). In multivariate analysis, children with ACL injury had nearly 3 times (odds ratio [OR], 2.7) higher odds of having a first-degree relative with an ACL tear (95% CI, 1.7-4.2; P < .001). Patients were stratified by the number of first-degree relatives with ACL tears: no relatives, 1 relative, or ≥2 relatives. Children with ≥2 first-degree relatives were more likely to sustain a postoperative graft failure (OR, 5.1; 95% CI 1.7-15.2; P = .003) or a complication requiring surgical intervention (OR, 7.5; 95% CI, 2.6-22.0; P < .001). Conclusion: A family history of ACL injury is more likely in pediatric patients with ACL tears than in uninjured children. Further, patients undergoing primary ACLR as well as a strong family history of ACL tears are more likely to sustain a postoperative graft rupture or complication requiring surgery.

scholarly journals Bilateral simultaneous anterior cruciate ligament injury: a case report and national survey of orthopedic surgeon management preference

2014 ◽  
Vol 6 (4) ◽  
Author(s):  
Ehsan Saadat ◽  
Emily J. Curry ◽  
Xinning Li ◽  
Elizabeth G. Matzkin
Keyword(s):  
Anterior Cruciate Ligament ◽  
Sports Medicine ◽  
Cruciate Ligament ◽  
Management Strategies ◽  
Acl Injury ◽  
Ligament Injury ◽  
Acl Tear ◽  
Orthopedic Surgeons ◽  
Anterior Cruciate ◽  
Staged Reconstruction

Unilateral anterior cruciate ligament (ACL) tear is a common injury seen by sports medicine orthopedic surgeons. However, a bilateral simultaneous ACL injury is extremely rare and has been reported only three times in the literature. We present a young female skier with simultaneous bilateral ACL tears that were managed with staged ACL reconstruction. We then conducted a nationwide survey (United States) to determine the prevalence of simultaneous bilateral ACL tear and preferred management strategies by sports medicine orthopedic surgeons. Sports medicine fellowship directors were contacted and asked to send an 8-item survey to colleagues (sports medicine fellowship trained surgeons) asking about overall number of ACL reconstructions performed, number of bilateral simultaneous ACL injuries seen and optimal management strategies of such an injury. Out of 43 responses, only 22 (51.2%) surgeons had seen a bilateral simultaneous ACL injury. Of these, 16 (76.2%) preferred staged reconstruction. Graft choice was mixed between autograft and allograft, but a large majority preferred either patellar tendon autograft (58%) or hamstring autograft (41%) were the most common choice. Staged reconstruction is the treatment of choice by surgeons surveyed in our study.

scholarly journals Association of Prior Anterior Cruciate Ligament Tear With Decreased Career Longevity in Women’s National Basketball Association

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110092
Author(s):  
Joseph S. Tramer ◽  
Lafi S. Khalil ◽  
Toufic R. Jildeh ◽  
Mohammad Sattar ◽  
Alexander Ziedas ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
National Basketball Association ◽  
Healthy Controls ◽  
Acl Tear ◽  
History Of ◽  
Anterior Cruciate ◽  
And Performance

Background: The incidence of anterior cruciate ligament (ACL) injuries in women’s basketball exceeds that of men. There is a paucity of data regarding career performance in Women’s National Basketball Association (WNBA) athletes with a history of ACL reconstruction. Purpose: To determine whether WNBA athletes with a history of ACL injury prior to professional play have reduced career game utilization, defined as games played and started and minutes per game (MPG), as well as statistical performance, defined by player efficiency rating (PER). Study Design: Cohort study; Level of evidence, 3. Methods: Included were 42 WNBA players from 1997 to 2018 who had a history of ACL reconstruction before entering professional leagues. Body mass index (BMI), age, and position were collected for each player. Career data and performance statistics were likewise collected for each player’s entire WNBA career. A control group of WNBA players with no history of ACL injury were matched by position, BMI, and age at the time of WNBA debut. Statistics compared game utilization and performance to assess the impact of ACL reconstruction. Results: Athletes who sustained an ACL tear before entering the league played in fewer games per season in their first 3 professional seasons compared with healthy controls (24.2 ± 8.4 vs 28.2 ± 6.1; P = .02). Among athletes with a history of ACL reconstruction, 11 (26.2%) played only a single WNBA season, while no control athletes played in just 1 season. Additionally, athletes who had a previous ACL tear started significantly fewer games per season (9.0 ± 9.4 vs 14.0 ± 9.0; P < .01) and played fewer MPG (15.5 ± 7.2 vs 20.7 ± 5.5; P < .01) during their WNBA career. Athletes with a history of ACL tear had significantly shorter WNBA careers (4.8 ± 4.1 vs 8.1 ± 3.3 seasons; P < .001). Total professional play duration (WNBA + overseas) was significantly reduced in players with an ACL tear compared with controls ( P < .05). PER was not significantly different between cohorts at any time point. Conclusion: WNBA athletes with a history of an ACL tear before professional play had decreased career game utilization and workload throughout their career despite having similar PER compared with healthy controls.

scholarly journals USE CAUTION WHEN ASSESSING PRE-OPERATIVE LEG LENGTH DISCREPANCY IN PEDIATRIC PATIENTS WITH ANTERIOR CRUCIATE LIGAMENT INJURIES

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0028
Author(s):  
Lindsay M. Schlichte ◽  
Peter D. Fabricant ◽  
Christine Goodbody ◽  
Daniel W. Green
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pediatric Patients ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Acl Injury ◽  
Leg Length ◽  
Full Extension ◽  
X Ray ◽  
Length Discrepancy ◽  
Anterior Cruciate

Background: Pre- and post-operative standing hip to ankle radiography is critical for monitoring potential post-operative growth arrest and resultant length and angular deformities after pediatric anterior cruciate ligament (ACL) reconstruction. During acquisition of pre-operative standing alignment radiographs, it is possible that patients are lacking full extension, not weight bearing comfortably, or leaning resulting in inaccurate measurements. Purpose: This study aims to assess both pre- and post-operative radiographic measurements to assess if the standing pre-operative x-ray is a accurate and reliable source for baseline measurements. Methods: We retrospectively reviewed prospectively collected pre-operative and first post-operative full-length hip-to-ankle radiographs in a cohort of skeletally immature athletes who presented with an acute ACL injury and underwent subsequent surgical reconstruction. Initially, leg length discrepancy for 25 patients was measured by 3 orthopedic surgeons (top of femoral head to center of tibial plafond). The intraclass correlation was almost perfect (ICC (2,1) = .996) therefore, 1 surgeon measured the remaining 94 radiographs. Measurements for both the injured and uninjured legs were obtained for comparison and surgeons were blinded to the injured side. Results: A total of 119 pediatric patients (mean age 13.4, range 7-14 years) were included (83 males and 36 females). Patient were categorized as either having ≥5mm, ≥10mm, or ≥15mm LLD on pre-operative standing x-ray. Sixty-two patients (52%) were found to have a pre-operative LLD ≥ 5mm. Forty-one (66%) of these patients tore their ACL on the limb measuring shorter. At 6 month post-operative standing x-ray, 35 patients (56%) resolved to ≤5mm LLD. Eighteen patients had a pre-operative LLD of ≥ 10mm. At 6 month post-operative standing x-ray, 13 (72%) patients resolved to ≤5mm LLD. Five patients had a pre-operative LLD of ≥ 15mm. At 6 month post-operative standing x-ray, 4 (80%) resolved ≤5mm. All patients with a pre-operative LLD of ≥ 13mm had sustained an ACL injury on the limb measuring shorter Conclusion: Of the pediatric ACL patients initially presenting with a pre-operative LLD of ≥ 10mm, 72% demonstrated apparent correction of their LLD on their 6 month standing x-ray. This high rate of LLD pre-operatively but not post operatively calls into question the accuracy of pre-operative standing alignment radiographs for patients after an ACL tear. Surgeons and radiology technicians should be aware of injured patients potentially lacking full extension, leaning, or not weight bearing comfortably, and should consider delaying preoperative radiographic length and alignment analysis until after the patient is able to fully straighten the injured knee and weight bear comfortably.

scholarly journals A Comparison of Knee Abduction Angles Measured by a 3D Anatomic Coordinate System Versus Videographic Analysis: Implications for Anterior Cruciate Ligament Injury

2019 ◽  
Vol 7 (1) ◽  
pp. 232596711881983 ◽  
Author(s):  
Zoë A. Englander ◽  
Hattie C. Cutcliffe ◽  
Gangadhar M. Utturkar ◽  
William E. Garrett ◽  
Charles E. Spritzer ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Coordinate System ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Magnetic Resonance Images ◽  
Coronal Plane ◽  
Ligament Injury ◽  
Abduction Angle ◽  
Knee Abduction ◽  
Anterior Cruciate

Background: Knee positions involved in noncontact anterior cruciate ligament (ACL) injury have been studied via analysis of injury videos. Positions of high ACL strain have been identified in vivo. These methods have supported different hypotheses regarding the role of knee abduction in ACL injury. Purpose/Hypothesis: The purpose of this study was to compare knee abduction angles measured by 2 methods: using a 3-dimensional (3D) coordinate system based on anatomic features of the bones versus simulated 2-dimensional (2D) videographic analysis. We hypothesized that knee abduction angles measured in a 2D videographic analysis would differ from those measured from 3D bone anatomic features and that videographic knee abduction angles would depend on flexion angle and on the position of the camera relative to the patient. Study Design: Descriptive laboratory study. Methods: Models of the femur and tibia were created from magnetic resonance images of 8 healthy male participants. The models were positioned to match biplanar fluoroscopic images obtained as participants posed in lunges of varying flexion angles (FLAs). Knee abduction angle was calculated from the positioned models in 2 ways: (1) varus-valgus angle (VVA), defined as the angle between the long axis of the tibia and the femoral transepicondylar axis by use of a 3D anatomic coordinate system; and (2) coronal plane angle (CPA), defined as the angle between the long axis of the tibia and the long axis of the femur projected onto the tibial coronal plane to simulate a 2D videographic analysis. We then simulated how changing the position of the camera relative to the participant would affect knee abduction angles. Results: During flexion, when CPA was calculated from a purely anterior or posterior view of the joint—an ideal scenario for measuring knee abduction from 2D videographic analysis—CPA was significantly different from VVA ( P < .0001). CPA also varied substantially with the position of the camera relative to the participant. Conclusion: How closely CPA (derived from 2D videographic analysis) relates to VVA (derived from a 3D anatomic coordinate system) depends on FLA and camera orientation. Clinical Relevance: This study provides a novel comparison of knee abduction angles measured from 2D videographic analysis and those measured within a 3D anatomic coordinate system. Consideration of these findings is important when interpreting 2D videographic data regarding knee abduction angle in ACL injury.

scholarly journals Protracted Cardiovascular Impairments After Anterior Cruciate Ligament Injury: A Critically Appraised Topic

2020 ◽  
Vol 29 (5) ◽  
pp. 680-683
Author(s):  
Cody R. Butler ◽  
Kirsten Allen ◽  
Lindsay J. DiStefano ◽  
Lindsey K. Lepley
Keyword(s):  
Physical Activity ◽  
Anterior Cruciate Ligament ◽  
National Football League ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Cross Sectional ◽  
History Of ◽  
Cross Sectional Studies ◽  
Anterior Cruciate ◽  
Cv Disease

Clinical Scenario: Anterior cruciate ligament (ACL) tear is a devastating knee injury with negative long-term consequences, such as early-onset knee osteoarthritis, biomechanical compensations, and reduced physical activity. Significant reduction in physical activity is a powerful indicator of cardiovascular (CV) disease; therefore, those with a history of ACL injury may be at increased risk for CV disease compared with noninjured individuals. Focused Clinical Question: Do individuals with a history of ACL injury demonstrate negative CV changes compared with those without a history of ACL injury? Summary of Key Findings: Three articles met the inclusion criteria and investigated CV changes after ACL injury. Both cross-sectional studies compared participants with ACL injury with matched controls. Bell et al compared time spent in moderate to vigorous physical activity and step count, whereas Almeida et al compared maximum rate of oxygen consumption, ventilatory thresholds, isokinetic quadriceps strength, and body composition. Collectively, both quantitative studies found that individuals with a history of ACL injury had less efficient CV systems compared with matched controls and/or preoperative data. Finally, a qualitative study of 3506 retired National Football League athletes showed an increased rate of arthritis and knee replacement surgery after an ACL injury when compared with other retired National Football League members, in addition to a >50% increased rate of myocardial infarction. Clinical Bottom Line: A history of ACL injury is a source of impaired physical activity. Preliminary data indicate that these physical activity limitations negatively impair the CV system, and individuals with a history of ACL injury demonstrate lower maximum oxygen consumption, self-reported disability, and daily step count compared with noninjured peers. These complications support the need for greater emphasis on CV wellness. Strength of Recommendation: Consistent findings from 2 cross-sectional studies and 1 survey study suggest level IIB evidence to support that ACL injury is associated with negative CV health.

scholarly journals Evidence too weak to guide surgical treatment decisions for anterior cruciate ligament injury: a systematic review of the risk of new meniscal tears after anterior cruciate ligament injury

2020 ◽  
Vol 54 (9) ◽  
pp. 520-527 ◽  
Author(s):  
Guri Ranum Ekås ◽  
Clare L Ardern ◽  
Hege Grindem ◽  
Lars Engebretsen
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Surgical Treatment ◽  
Anterior Cruciate Ligament Injury ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Ligament Injury ◽  
Meniscal Tears ◽  
Anterior Cruciate

ObjectiveTo investigate the risk of new meniscal tears after treatment for anterior cruciate ligament (ACL) injury, in children and adults with and without ACL reconstruction.DesignPrognosis systematic review (PROSPERO registration number CRD42016036788).MethodsWe searched Embase, Ovid Medline, Cochrane, CINAHL, SPORTDiscus, PEDro and Google Scholar from inception to 3rd May 2018. Eligible articles included patients with ACL injury (diagnosis confirmed by MRI and/or diagnostic arthroscopy), reported the number of meniscal tears at the time of ACL injury diagnosis/start of treatment and reported the number of new meniscal tears that subsequently occurred. Articles with fewer than 20 patients at follow-up, and articles limited to ACL revision surgery or multi-ligament knee injuries were excluded. Two independent reviewers screened articles, assessed eligibility, assessed risk of bias and extracted data. We judged the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group methodology.ResultsOf 75 studies included in the systematic review, 54 studies with 9624 patients and 501 new meniscal tears were appropriate for quantitative analysis. Heterogeneity precluded data pooling. The risk of new meniscal tears was 0%–21% when follow-up was <2 years, 0%–29% when follow-up was 2 to 5 years, 5%–52% when follow-up was 5 to 10 years and 4%–31% when follow-up was longer than 10 years. The proportion of studies with high risk of selection, misclassification and detection bias was 84%, 69% and 68%, respectively. Certainty of evidence was very low.ConclusionNew meniscal tears occurred in 0%–52% of patients between 4 months and 20 years (mean 4.9±4.4 years) following treatment for ACL injury. The certainty of evidence was too low to guide surgical treatment decisions. This review cannot conclude that the incidence of new meniscal tears is lower if ACL injury is treated with surgery compared with treatment with rehabilitation only.

scholarly journals Brain Activation for Knee Movement Measured Days Before Second Anterior Cruciate Ligament Injury: Neuroimaging in Musculoskeletal Medicine

2015 ◽  
Vol 50 (10) ◽  
pp. 1005-1010 ◽  
Author(s):  
Dustin R. Grooms ◽  
Stephen J. Page ◽  
James A. Onate
Keyword(s):  
Anterior Cruciate Ligament ◽  
Matched Control ◽  
Cruciate Ligament ◽  
Neuromuscular Control ◽  
Brain Activation ◽  
Acl Injury ◽  
Ligament Injury ◽  
Control Participant ◽  
Visual Motor ◽  
Anterior Cruciate

Background Anterior cruciate ligament (ACL) injury has multifactorial causes encompassing mechanical, hormonal, exposure, and anatomical factors. Alterations in the central nervous system also play a role, but their influence after injury, recovery, and recurrent injury remain unknown. Modern neuroimaging techniques can be used to elucidate the underlying functional and structural alterations of the brain that predicate the neuromuscular control adaptations associated with ACL injury. This knowledge will further our understanding of the neural adaptations after ACL injury and rehabilitation and in relation to injury risk. In this paper, we describe the measurement of brain activation during knee extension-flexion after ACL injury and reconstruction and 26 days before a contralateral ACL injury. Methods Brain functional magnetic resonance imaging data for an ACL-injured participant and a matched control participant were collected and contrasted. Results Relative to the matched control participant, the ACL-injured participant exhibited increased activation of motor-planning, sensory-processing, and visual-motor control areas. A similar activation pattern was present for the contralateral knee that sustained a subsequent injury. Conclusions Bilateral neuroplasticity after ACL injury may contribute to the risk of second injury, or aspects of neurophysiology may be predisposing factors to primary injury. Clinical Implications Sensory-visual-motor function and motor-learning adaptations may provide targets for rehabilitation.

scholarly journals Effect of Muscle-Specific Fatigue on the Risk of Anterior Cruciate Ligament Injury in Females

2021 ◽  
Vol 11 (11) ◽  
pp. 4969
Author(s):  
Jeheon Moon ◽  
Jinseok Lee ◽  
Keehyun Kim ◽  
Dohoon Koo ◽  
Jusung Lee ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Musculoskeletal Modeling ◽  
Ligament Injury ◽  
Treatment Conditions ◽  
Valgus Angle ◽  
Anterior Cruciate ◽  
And Control ◽  
Biomechanical Factors

The aim of our study was to investigate the effect of muscle-specific fatigue of the quadriceps and hamstring muscles on the biomechanical factors of anterior cruciate ligament (ACL) injury using musculoskeletal modeling techniques during directional diversion maneuver. Fifteen female subjects performed a directional diversion maneuver under three treatment conditions (quadriceps fatigue, hamstring fatigue, and control gait). Data from the 3D motion capture system and force platform were used to extract anterior/posterior ACL forces using the two-bundle ACL musculoskeletal modeling approach. A decrease in maximum extension (51.3%) and flexion (50.7%) torque after fatigue was observed. After quadriceps fatigue, the extension (p = 0.041) and adduction moments (p = 0.046) of the knee joint and the mean anterior bundle of ACL force (p = 0.021) decreased significantly. The knee flexion angle (p = 0.003), knee valgus angle (p = 0.013), and shear force (p = 0.043) decreased significantly after hamstring fatigue. The decrease in ACL force after quadriceps fatigue confirms its significant role in causing an ACL injury. However, no significant differences in ACL load after hamstring fatigue leads us to speculate that the antagonist muscle group, i.e., the hamstring, might not have a preventive mechanism against ACL injury.

scholarly journals Epidemiology of Anterior Cruciate Ligament (ACL) Injury among Collegiate male athletes in Football and volleyball

2019 ◽  
Vol 4 (2) ◽  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Injury ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Ligament Injury ◽  
Ligament Injuries ◽  
Anterior Cruciate Ligament Injuries ◽  
Male College ◽  
Volleyball Players ◽  
Anterior Cruciate

In this study tried to investigate the prevalence of incidence of anterior cruciate ligament (ACL) injury in collegiate male soccer and volleyball. Because it seems the injury in ACL is more common in soccer and volleyball players. The anterior cruciate ligament (ACL) is one of the most commonly disrupted ligaments in the knee. Male college athletes have higher rates of anterior cruciate ligament injury. Rates of anterior cruciate ligament injuries for men in collegiate in two sports activity have not been examined. Understanding anterior cruciate ligament injury incidence in soccer and volleyball, a contact and non-contact sport for men, could further injury prevention efforts. Data were collected from Sports Cultural Olympiad male students 2012-2014 and analyzed to compare anterior cruciate ligament injuries in male college soccer and volleyball athletes from the questionnaire (n=447) and through interviews with injured players. Our results indicate volleyball players are a high-risk sport for anterior cruciate ligament injury although this sport is among non-contact activity. Our study indicated that soccer has the greatest number of ACL injuries (α =1%) rather than volleyball. Our finding may be explained by the fact that soccer involves more contact than volleyball. Factors such as age, sex, chronicity of injury, associated pathology, activity level, attitude, range of motion and motivation must all be considered to compare of ACL injury. It was suggested that these data would be helpful for the reduction of injury risks and the costs besides with proper onsite precautions.

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