scholarly journals DELAY IN DIAGNOSIS AND MANAGEMENT OF ADOLESCENT ANTERIOR CRUCIATE LIGAMENT INJURIES IN A PUBLICLY FUNDED HEALTHCARE SYSTEM

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0022
Author(s):  
Lise A. Leveille ◽  
Tessa V. Ladner ◽  
Pardeep Sidhu ◽  
Christopher W. Reilly
Keyword(s):  
Articular Cartilage ◽  
Acl Reconstruction ◽  
Household Income ◽  
Cruciate Ligament ◽  
Cartilage Damage ◽  
Wait Time ◽  
Publicly Funded ◽  
History Of ◽  
Anterior Cruciate ◽  
Time From Injury

Background: Delay to surgical anterior cruciate ligament (ACL) reconstruction after injury has been associated with increased frequency and severity of meniscal and articular cartilage pathology. Patient factors that contribute to delayed ACL reconstruction are not well understood. Hypothesis/Purpose: Identify patient factors contributing to delayed ACL reconstruction in a publicly funded healthcare system. Methods: A retrospective review of all patients who had a primary ACL reconstruction at a single institution between 2014 and 2018 was completed. Patient demographic data, side, history of physical therapy, and intraoperative status of the meniscus and articular cartilage were collected. Household income was determined based on federal census data of mean household income by postal code. Time from injury to orthopedic referral (W0), consult (W1), and ACL reconstruction (W2) was calculated. A logistic regression model was constructed to determine the impact of household income, age, and sex on W0, W1, and W2. Results: Eighty-three patients were identified with a mean age of 14 years (range, 9-17). Twenty-eight patients were male (33.7%). Mean time from injury to orthopedic consult was 124 days (range, 0-1096). Mean time from injury to reconstruction was 286 days (range, 51-1623). Eleven patients (13%) had ligament reconstruction within 90 days of injury. Fifty-three patients (63.8%) had meniscal or articular cartilage damage at the time of ACL reconstruction. There was no significant effect of patient sex, age, or history of physical therapy on time to ACL reconstruction. Household income was found to have a significant effect on time to ACL reconstruction. For every $10,000.00 increase in household income, time to reconstruction was reduced by 19%. Using median time to reconstruction (223 days), this represents a decrease of 42 days. Household income only had an effect on W0 with a decrease of 38.4% for every $10,000.00 incremental increase in household income. No association was found between time to ACL reconstruction and odds of meniscal or articular cartilage damage. Conclusion: At a pediatric tertiary care hospital in a public health care system, most adolescent patients are having their ACL reconstructed in a delayed fashion contributing to an increased frequency of intra-articular pathology. Increase in household income was associated with a significant decrease in time to orthopaedic referral. There was no difference in wait time for consultation (W1) or wait time for surgery (W2). Further research is needed to determine specific factors causing this discrepancy in access to healthcare within a publicly funded system.

Risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament reconstruction

2018 ◽  
Vol 100-B (3) ◽  
pp. 285-293 ◽  
Author(s):  
A. Nakamae ◽  
N. Adachi ◽  
M. Deie ◽  
M. Ishikawa ◽  
T. Nakasa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Articular Cartilage ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Cartilage Damage ◽  
Significant Risk ◽  
Articular Cartilage Damage ◽  
Anterior Cruciate

Aims To investigate the risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament (ACL) reconstruction. Patients and Methods A total of 174 patients who underwent second-look arthroscopic evaluation after anatomical ACL reconstruction were enrolled in this study. The graded condition of the articular cartilage at the time of ACL reconstruction was compared with that at second-look arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction technique, meniscal conditions, and other variables were assessed by regression analysis as risk factors for progression of damage to the articular cartilage. Results In the medial compartment, multivariable logistic regression analysis indicated that partial medial meniscectomy (odds ratio (OR) 6.82, 95% confidence interval (CI) 2.11 to 22.04, p = 0.001), pivot-shift test grade at the final follow-up (OR 3.53, CI 1.39 to 8.96, p = 0.008), BMI (OR 1.15, CI 1.03 to 1.28, p = 0.015) and medial meniscal repair (OR 3.19, CI 1.24 to 8.21, p = 0.016) were significant risk factors for progression of cartilage damage. In the lateral compartment, partial lateral meniscectomy (OR 10.94, CI 4.14 to 28.92, p < 0.001) and side-to-side differences in anterior knee laxity at follow-up (OR 0.63, p = 0.001) were significant risk factors. Conclusion Partial meniscectomy was found to be strongly associated with the progression of articular cartilage damage despite r anatomical ACL reconstruction. Cite this article: Bone Joint J 2018;100-B:285–93.

Effect of Remnant-Preserving Reconstruction of Acute Anterior Cruciate Ligament Injuries in a Rabbit Model: Histological and Biomechanical Analysis

2022 ◽  
Vol 12 (5) ◽  
pp. 897-906
Author(s):  
XiaoChen Ju ◽  
Hao Chai ◽  
Sasirekha Krishnan ◽  
Abinaya Jaisankar ◽  
Murugan Ramalingam ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Articular Cartilage ◽  
Acl Reconstruction ◽  
Bone Healing ◽  
Cruciate Ligament ◽  
Cartilage Degeneration ◽  
Remnant Preservation ◽  
Model Animal ◽  
Anterior Cruciate ◽  
Articular Cartilage Degeneration

Acute anterior cruciate ligament (ACL) is a key structure that stabilizes knee joints. The objective of this research is to investigate the influence of ligament remnants preserved on the tendon-bone healing following ACL reconstruction and to examine postoperative articular cartilage degeneration in rabbit as a model animal. Sixty New Zealand rabbits are randomly divided into an ACL reconstruction without remnant preservation group (Group A; n = 30) or ACL reconstruction with remnant preservation group (Group B; n = 30). The expression of HIF-1α, VEGF, and micro vessel density (MVD) in the transplanted tendon was detected by immunohistochemical staining at week 6 and 12 after the operation. The signal intensity of the transplanted tendon was observed by MRI scanning, and the width of the bone tunnel was measured by CT scanning at week 6 and 12 after the operation. The graft biomechanics was tested 12 weeks after the operation. The JNK and MMP-13 expression levels were compared to analyze the cartilage degeneration of the knee at week 12 after the operation. The experimental results were analyzed and showed that the remnant-preserving ACL reconstruction is beneficial for bone healing of the tendon in rabbits, but ACL reconstruction with or without ligament remnants preserved will not affect knee articular cartilage degeneration post-surgery.

scholarly journals Meniscal and Articular Cartilage Predictors of Clinical Outcome After Revision Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 44 (7) ◽  
pp. 1671-1679 ◽  
Author(s):  
◽  
Rick W. Wright ◽  
Laura J. Huston ◽  
Sam K. Nwosu ◽  
Amanda K. Haas ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Cartilage Damage ◽  
Functional Limitation ◽  
Sports Participation ◽  
Activity Level ◽  
Activity Levels ◽  
Revision Acl Reconstruction

Background: Revision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes compared with primary ACL reconstructions. Purpose/Hypothesis: The purpose of this study was to determine if the prevalence, location, and/or degree of meniscal and chondral damage noted at the time of revision ACL reconstruction predicts activity level, sports function, and osteoarthritis symptoms at 2-year follow-up. The hypothesis was that meniscal loss and high-grade chondral damage noted at the time of revision ACL reconstruction will result in lower activity levels, decreased sports participation, more pain, more stiffness, and more functional limitation at 2 years after revision surgery. Study Design: Cohort study; Level of evidence, 2. Methods: Between 2006 and 2011, a total of 1205 patients who underwent revision ACL reconstruction by 83 surgeons at 52 hospitals were accumulated for study of the relationship of meniscal and articular cartilage damage to outcome. Baseline demographic and intraoperative data, including the International Knee Documentation Committee (IKDC) subjective knee evaluation, Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx activity score, were collected initially and at 2-year follow-up to test the hypothesis. Regression analysis was used to control for age, sex, body mass index, smoking status, activity level, baseline outcome scores, revision number, time since last ACL reconstruction, incidence of having a previous ACL reconstruction on the contralateral knee, previous and current meniscal and articular cartilage injury, graft choice, and surgeon years of experience to assess the meniscal and articular cartilage risk factors for clinical outcomes 2 years after revision ACL reconstruction. Results: At 2-year follow-up, 82% (989/1205) of the patients returned their questionnaires. It was found that previous meniscal injury and current articular cartilage damage were associated with the poorest outcomes, with prior lateral meniscectomy and current grade 3 to 4 trochlear articular cartilage changes having the worst outcome scores. Activity levels at 2 years were not affected by meniscal or articular cartilage pathologic changes. Conclusion: Prior lateral meniscectomy and current grade 3 to 4 changes of the trochlea were associated with worse outcomes in terms of decreased sports participation, more pain, more stiffness, and more functional limitation at 2 years after revision surgery, but they had no effect on activity levels. Registration: NCT00625885

A Single Cycle Study of Screw Fixation in Anterior Cruciate Ligament Reconstruction

2008 ◽  
Author(s):  
M. Chizari ◽  
B. Wang ◽  
M. Snow
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Screw Fixation ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Anatomical Reconstruction ◽  
Initial Stability ◽  
History Of ◽  
Post Traumatic ◽  
Anterior Cruciate

The natural history of Anterior Cruciate rupture is one of progressive deterioration of knee function, with the development of instability, meniscal tears and post traumatic osteoarthritis. The current surgical approach is for anatomical reconstruction using a biological tissue autograft. It is well understood that the initial stability is dependent on the strength of the fixation rather than the strength of the graft, until the graft becomes biologically incorporated in the bone tunnel. A study was carried out to better understand postoperative internal bone stresses in anterior cruciate ligament (ACL) reconstruction surgery. The mechanical aspects of an interface screw fixation were examined both experimentally and numerically, with the aim to minimize deleterious effects in ACL reconstruction. The tibial cortical/cancellous bony tunnel and the stress pattern resulting from the screw fixation in the tunnel are investigated.

scholarly journals Conscious performance and arthroscopic findings in athletes with anterior cruciate ligament injuries treated via conservative therapy during the competitive season

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668475
Author(s):  
Yasushi Takata ◽  
Junsuke Nakase ◽  
Tatsuhiro Toratani ◽  
Hitoaki Numata ◽  
Takeshi Oshima ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Acl Reconstruction ◽  
Conservative Therapy ◽  
Cruciate Ligament ◽  
Cartilage Damage ◽  
Acl Injuries ◽  
Arthroscopic Findings ◽  
The Mean ◽  
Anterior Cruciate ◽  
Return To Competition

Purpose: Athletes often receive conservative treatment for injured anterior cruciate ligaments (ACLs) so that they can continue to play to the end of their season. The purpose of this study was to examine the conscious performance and arthroscopic findings of athletes who received conservative therapy for ACL injuries. Methods: Forty-two patients with ACL injuries underwent conservative treatment. After the season ended, ACL reconstruction was performed. We examined the following parameters: (1) time required for return to competition after injury, (2) conscious performance after return to competition, (3) whether the injured knee gave way during conservative therapy or after return to competition, and (4) cause of performance deterioration if applicable. To determine conscious performance, patients were asked to rate their performance after therapy relative to their performance before injury. Results: Thirty-eight of the 42 patients (90.5%) returned to competition after conservative treatment. The mean time to return was 13.8 ± 7.6 weeks, and the mean conscious performance score was 58.4 ± 16.5%. Thirty-eight patients (90.5%) experienced their knee giving way, of whom 36 (94.9%) stated that fear of their knee giving way hampered their performance. At the time of ACL reconstruction, 9 patients had chondral injuries and 22 patients had meniscus injuries. Conclusion: Most athletes with damaged ACLs returned to the field within the same season after conservative treatment. However, conscious performance was only about 60%. It is possible that knees giving way caused secondary meniscus and joint cartilage damage. Therefore, conservative treatment of individuals with ACL injuries should be considered carefully.

High Rates of Osteoarthritis Develop After Anterior Cruciate Ligament Surgery: An Analysis of 4108 Patients

2017 ◽  
Vol 46 (8) ◽  
pp. 2011-2019 ◽  
Author(s):  
Mark E. Cinque ◽  
Grant J. Dornan ◽  
Jorge Chahla ◽  
Gilbert Moatshe ◽  
Robert F. LaPrade
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Patient Age ◽  
Time Of Surgery ◽  
Patient Âgé ◽  
Anterior Cruciate ◽  
Time From Injury

Background: Posttraumatic osteoarthritis (PTOA) after anterior cruciate ligament (ACL) reconstruction ultimately translates into a large economic effect on the health care system owing to the young ages of this population. Purpose/Hypothesis: The purposes were to perform a meta-analysis to determine the prevalence of osteoarthritis after an ACL reconstruction, examining the effects of length of time after surgery, preoperative time interval from injury to surgery, and patient age at the time of surgery. It was hypothesized that the prevalence of PTOA increased with time from surgery and that increased time from injury to surgery and age were also risk factors for the development of PTOA. Study Design: Meta-analysis. Methods: A meta-analysis of the prevalence of radiographic PTOA after ACL reconstruction was performed of studies with a minimum of 5 years’ follow-up, with a level of evidence of 1, 2, or 3. The presence of osteoarthritis was defined according to knee radiographs evaluated with classification based on Kellgren and Lawrence, Ahlbäck, International Knee Documentation Committee, or the Osteoarthritis Research Society International. Metaregression models quantified the relationship between radiographic PTOA prevalence and the mean time from injury to surgery, mean patient age at time of surgery, and mean postoperative follow-up time. Results: Thirty-eight studies (4108 patients) were included. Longer postsurgical follow-up time was significantly positively associated with a higher proportion of PTOA development. The model-estimated proportion of PTOA (95% CI) at 5, 10, and 20 years after surgery was 11.3% (6.4%-19.1%), 20.6% (14.9%-27.7%), and 51.6% (29.1%-73.5%), respectively. Increased chronicity of the ACL tear before surgery and increased patient age were also associated with a higher likelihood of PTOA development. Conclusion: The prevalence of osteoarthritis after an ACL reconstruction significantly increased with time. Longer chronicity of ACL tear and older age at the time of surgery were significantly positively correlated with the development of osteoarthritis. A timely referral and treatment of symptomatic patients are vital to diminish the occurrence of PTOA.

Plyometrics Did Not Improve Jump-Landing Biomechanics in Individuals With a History of Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

2021 ◽  
pp. 1-8
Author(s):  
Hyunjae Jeon ◽  
Sean Krysak ◽  
Steven J. Pfeiffer ◽  
Abbey C. Thomas
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Body Mass ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Jump Landing ◽  
History Of ◽  
Anterior Cruciate

Second anterior cruciate ligament (ACL) injury has similar biomechanical risk factors as primary injury. Standard of care rehabilitation does not adequately mitigate these biomechanical risks. This study examined the effectiveness of a 4-week plyometric intervention on biomechanical risk factors of second ACL injury versus no intervention in patients with a history of ACL reconstruction. Thirty adults post-ACL reconstruction received 12 sessions of plyometric (age: 19.9 ± 1.62 years; body mass index: 23.9 ± 2.6 kg/m2; months postoperative: 35.7 ± 24.2) or no (age: 21.3 ± 3.5 years; body mass index: 27.7 ± 4.8 kg/m2; months postoperative: 45.3 ± 25.4) exercise intervention. Hip and knee biomechanics were quantified during a jump-landing task before and after the intervention. Individual response to the intervention was evaluated via minimal detectable change. Hip flexion angle had the greatest response to plyometric training. Overall, focused plyometric intervention did not adequately mitigate biomechanical risk factors of second ACL injury; thus, development of interventions capable of modifying biomechanics known to contribute to ACL injury risk remains necessary.

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