scholarly journals The Effect of Osseous Valgus Alignment and Posteromedial Ligament Complex Deficiency on ACL Graft Forces: Risk Factors for Failure of ACL Reconstruction

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0029
Author(s):  
Julian Mehl ◽  
Alexander Otto ◽  
Cameron Kia ◽  
Elifho Obopilwe ◽  
Mark Cote ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acl Reconstruction ◽  
Motion Tracking ◽  
Weight Bearing ◽  
High Grade ◽  
Acl Graft ◽  
Leg Axis ◽  
Alignment Correction ◽  
Valgus Alignment ◽  
Dynamic Valgus

Aims and Objectives: Dynamic valgus moments are known risk factors for ACL (re-)injuries. However, the association between osseous valgus alignment and ACL stress is not fully understood. The aim of the present study was to biomechanically investigate the influence of osseous valgus alignment, with and without deficiency of the medial collateral ligament and posterior oblique ligament (= posteromedial ligament complex; PMC), on ACL-graft forces under axial load. Additionally, it was investigated whether PMC reconstruction alone, correction osteotomy alone or a combination of both procedures were capable to decrease ACL-graft forces. Materials and Methods: The native ACL was dissected and ACL reconstruction was performed on ten cadaveric knee joints. A lateral distal femur osteotomy was done to adjust for three different alignment conditions according to the position where the axial weight bearing line (WBL) dissected the tibial plateau (% from medial to lateral): straight leg (50%), medium valgus (85%) and high-grade valgus (115%). Each alignment condition was tested with the PMC intact, deficient and reconstructed. The specimens were placed in a testing rig in 15° of knee flexion with the tibia fixed and the femur mobile on an X-Y-table. Axial loads of 400 N were applied and changes of ACL-graft forces (via an attached load-cell) and dynamic valgus angle (DVA) (via 3D motion tracking) were recorded. Results: In the PMC intact state, lateralization of the WBL to 85% and to 115% led to significantly increased ACL graft forces (85% vs. 50%: 96.1 ± 25.0 N vs. 63.7 ± 22.0 N, p=0.010; 115% vs. 50%: 109.9 ± 24.5 N vs. 63.7 ± 22.0 N; p<0.001) and DVA (85% vs. 50%: 2.0 ± 1.2° vs. 0.0 ± 0.8°, p=0.027; 115% vs. 50%: 2.1 ± 1.3° vs. 0.0 ± 0.8°; p=0.027). Dissection of the PMC led to a significant increase of ACL graft forces and DVAs at 85% and 115% valgus alignment (p<0.001), but not at 50% alignment. In valgus aligned knees (85%) with additional PMC deficiency, reconstruction of the PMC alone was able to significantly decrease ACL graft forces (85% deficient vs. 85% reconstructed: 158.0 ± 47.3 N vs. 112.1 ± 28.8 N; p<0.001) and DVA (85% deficient vs. 85% reconstructed: 7.4 ± 4.0° vs. 3.0 ± 2.0°; p<0.001). However, alignment correction alone was significantly more effective in reducing ACL graft forces (85% reconstructed vs. 50% deficient: 112.1 ± 28.8 N vs. 81.5 ± 23.8 N, p<0.001) and DVA (85% reconstructed vs. 50% deficient: 3.0 ± 2.0° vs. 0.81.0°; p=0.010). These relations were similar for high grade valgus alignment (115%). Conclusion: Osseous valgus alignment led to significantly increased ACL graft forces and DVA under axial joint compression, which was even further enhanced, when the PMC was deficient. In the valgus aligned and PMC deficient knee, correction to a straight leg axis was significantly more effective in decreasing forces on the ACL graft than reconstruction of the PMC.

scholarly journals Extra articular lateral tenodesis in patients with revision anterior cruciate ligament (ACL) reconstruction and high-grade anterior instability

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0030
Author(s):  
Lena Alm ◽  
Karl-Heinz Frosch ◽  
Ralph Akoto
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Revision Surgery ◽  
Cruciate Ligament ◽  
High Grade ◽  
Anterior Instability ◽  
Lateral Tenodesis ◽  
Male Sex ◽  
Anterior Cruciate

Aims and Objectives: While patients following primary anterior cruciate ligament (ACL) surgery show satisfying results, the outcome after revision ACL reconstruction (ACLR) seems to be less favourable. Failure rates of 14 to 33% have been reported for revision ACLR. The purpose of this study was to evaluate the outcome of patients after revision ACLR. We hypothesize that peripheral knee instabilities are risk factors for failure of revision ACLR. Furthermore, we hypothesize that peripheral stabilisation will reduce the risk of failure. Materials and Methods: Between 2013 and 2016, 150 patients were operated with revision ACLR (revision surgery after primary ACL reconstruction). Out of these patients, 73 patients preoperative had a high-grade anterior instability and were included in the retrospective study. High-grade knee anterior instability was defined as high-grade pivot-shift and/or side- to- side difference of more than 5mm in Rolimeter®-testing. An additional extra articular tenodesis was performed in 59 patients during revision ACLR. Patients were clinically examined with a minimum of 2 years after revision surgery (mean 35±6 months) and identified as “failed revision ACLR” and “stable revision ACLR”. Results: Failure of the revision ACLR occurred in 8.2% (n=6) of the cases. Extra articular lateral tenodesis leads to significant lower failure rates in patients with high-grade anterior instability in comparison to patients without further peripheral stabilization (5% vs. 21%, p=0.045). Also, higher postoperative functional scores were shown in the group of additional extra articular lateral tenodesis (Lysholm 89.5±17 vs. 69.5±12, p=0.041; Tegner 6.6±1.4 vs. 4.5±1.4, p=0.009; Cincinnati Rating Scale 91.2±14 vs. 68.5±17, p=0.006). Failure was associated with male sex (n=6 male failures, p=0.017) and obesity (n=4 obese failures with a BMI >30 kg/m2, p<0.001). Conclusion: Additional extra articular tenodesis in patients with revision ACL instability and accompanying high-grade anterior instability significantly reduces the risk of failure of revision ACLR. General risk factors of failure of the revision ACLR are obesity and male sex.

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

scholarly journals TELD with limited foraminoplasty has potential biomechanical advantages over TELD with large annuloplasty: an in-silico study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jingchi Li ◽  
Chen Xu ◽  
Xiaoyu Zhang ◽  
Zhipeng Xi ◽  
Mengnan Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Poor Prognosis ◽  
Adjacent Segment Degeneration ◽  
Iatrogenic Injury ◽  
Adjacent Segment ◽  
Fe Model ◽  
High Grade ◽  
Endoscopic Lumbar Discectomy ◽  
Adjacent Segments

Abstract Background Facetectomy, an important procedure in the in–out and out–in techniques of transforaminal endoscopic lumbar discectomy (TELD), is related to the deterioration of the postoperative biomechanical environment and poor prognosis. Facetectomy may be avoided in TELD with large annuloplasty, but iatrogenic injury of the annulus and a high grade of nucleotomy have been reported as risk factors influencing poor prognosis. These risk factors may be alleviated in TELD with limited foraminoplasty, and the grade of facetectomy in this surgery can be reduced by using an endoscopic dynamic drill. Methods An intact lumbo-sacral finite element (FE) model and the corresponding model with adjacent segment degeneration were constructed and validated to evaluate the risk of biomechanical deterioration and related postoperative complications of TELD with large annuloplasty and TELD with limited foraminoplasty. Changes in various biomechanical indicators were then computed to evaluate the risk of postoperative complications in the surgical segment. Results Compared with the intact FE models, the model of TELD with limited foraminoplasty demonstrated slight biomechanical deterioration, whereas the model of TELD with large annuloplasty revealed obvious biomechanical deterioration. Degenerative changes in adjacent segments magnified, rather than altered, the overall trends of biomechanical change. Conclusions TELD with limited foraminoplasty presents potential biomechanical advantages over TELD with large annuloplasty. Iatrogenic injury of the annulus and a high grade of nucleotomy are risk factors for postoperative biomechanical deterioration and complications of the surgical segment.

scholarly journals Intraventricular haemorrhage in a Ugandan cohort of low birth weight neonates: the IVHU study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
R. MacLeod ◽  
J. N. Paulson ◽  
N. Okalany ◽  
F. Okello ◽  
L. Acom ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Intraventricular Haemorrhage ◽  
Sub Saharan Africa ◽  
Cranial Ultrasound ◽  
High Grade ◽  
Odds Ratios ◽  
Antenatal Steroids ◽  
Eastern Uganda

Abstract Background Globally, 15 million neonates are born prematurely every year, over half in low income countries (LICs). Premature and low birth weight neonates have a higher risk of intraventricular haemorrhage (IVH). There are minimal data regarding IVH in sub-Saharan Africa. This study aimed to examine the incidence, severity and timing of and modifiable risk factors for IVH amongst low-birth-weight neonates in Uganda. Methods This is a prospective cohort study of neonates with birthweights of ≤2000 g admitted to a neonatal unit (NU) in a regional referral hospital in eastern Uganda. Maternal data were collected from interviews and medical records. Neonates had cranial ultrasound (cUS) scans on the day of recruitment and days 3, 7 and 28 after birth. Risk factors were tabulated and are presented alongside odds ratios (ORs) and adjusted odds ratios (aORs) for IVH incidence. Outcomes included incidence, timing and severity of IVH and 28-day survival. Results Overall, 120 neonates were recruited. IVH was reported in 34.2% of neonates; 19.2% had low grade (Papile grades 1–2) and 15% had high grade (Papile grades 3–4). Almost all IVH (90.2%) occurred by day 7, including 88.9% of high grade IVH. Of those with known outcomes, 70.4% (81/115) were alive on day 28 and survival was not associated with IVH. We found that vaginal delivery, gestational age (GA) < 32 weeks and resuscitation in the NU increased the odds of IVH. Of the 6 neonates who received 2 doses of antenatal steroids, none had IVH. Conclusion In this resource limited NU in eastern Uganda, more than a third of neonates born weighing ≤2000 g had an IVH and the majority of these occurred by day 7. We found that vaginal birth, earlier gestation and need for resuscitation after admission to the NU increased the risk of IVH. This study had a high rate of SGA neonates and the risk factors and relationship of these factors with IVH in this setting needs further investigation. The role of antenatal steroids in the prevention of IVH in LICs also needs urgent exploration.

scholarly journals Cumulative incidence and risk factors for radiation induced leukoencephalopathy in high grade glioma long term survivors

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Robert Terziev ◽  
Dimitri Psimaras ◽  
Yannick Marie ◽  
Loic Feuvret ◽  
Giulia Berzero ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
High Grade Glioma ◽  
High Grade ◽  
Nucleotide Polymorphisms ◽  
Increased Risk ◽  
Radiation Induced ◽  
Long Term Survivors

AbstractThe incidence and risk factors associated with radiation-induced leukoencephalopathy (RIL) in long-term survivors of high-grade glioma (HGG) are still poorly investigated. We performed a retrospective research in our institutional database for patients with supratentorial HGG treated with focal radiotherapy, having a progression-free overall survival > 30 months and available germline DNA. We reviewed MRI scans for signs of leukoencephalopathy on T2/FLAIR sequences, and medical records for information on cerebrovascular risk factors and neurological symptoms. We investigated a panel of candidate single nucleotide polymorphisms (SNPs) to assess genetic risk. Eighty-one HGG patients (18 grade IV and 63 grade III, 50M/31F) were included in the study. The median age at the time of radiotherapy was 48 years old (range 18–69). The median follow-up after the completion of radiotherapy was 79 months. A total of 44 patients (44/81, 54.3%) developed RIL during follow-up. Twenty-nine of the 44 patients developed consistent symptoms such as subcortical dementia (n = 28), gait disturbances (n = 12), and urinary incontinence (n = 9). The cumulative incidence of RIL was 21% at 12 months, 42% at 36 months, and 48% at 60 months. Age > 60 years, smoking, and the germline SNP rs2120825 (PPARg locus) were associated with an increased risk of RIL. Our study identified potential risk factors for the development of RIL (age, smoking, and the germline SNP rs2120825) and established the rationale for testing PPARg agonists in the prevention and management of late-delayed radiation-induced neurotoxicity.

scholarly journals Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing

2021 ◽  
Author(s):  
Franziska Leiss ◽  
Julia Sabrina Götz ◽  
Matthias Meyer ◽  
Günther Maderbacher ◽  
Jan Reinhard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Enhanced Recovery ◽  
Weight Bearing ◽  
Femoral Stem ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Fill Ratio ◽  
Stem Subsidence ◽  
Partial Weight

Abstract Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

scholarly journals One year change of knee cartilage morphology in the first release of participants from the Osteoarthritis Initiative progression subcohort: association with sex, body mass index, symptoms and radiographic osteoarthritis status

2008 ◽  
Vol 68 (5) ◽  
pp. 674-679 ◽  
Author(s):  
F Eckstein ◽  
S Maschek ◽  
W Wirth ◽  
M Hudelmaier ◽  
W Hitzl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Body Mass ◽  
Statistical Significance ◽  
Weight Bearing ◽  
Rate Of Change ◽  
Cartilage Loss ◽  
Knee Oa ◽  
Symptomatic Knee ◽  
Osteoarthritis Initiative

Objective:The Osteoarthritis Initiative (OAI) is a multicentre study targeted at identifying biomarkers for evaluating the progression and risk factors of symptomatic knee OA. Here cartilage loss using 3 Tesla (3 T) MRI is analysed over 1 year in a subset of the OAI, together with its association with various risk factors.Methods:An age- and gender-stratified subsample of the OAI progression subcohort (79 women and 77 men, mean (SD) age 60.9 (9.9) years, body mass index (BMI) 30.3 (4.7)) with both frequent symptoms and radiographic OA in at least one knee was studied. Coronal FLASHwe (fast low angle shot with water excitation) MRIs of the right knee were acquired at 3 T. Seven readers segmented tibial and femoral cartilages blinded to order of acquisition. Segmentations were quality controlled by one expert.Results:The reduction in mean cartilage thickness (ThC) was greater (p = 0.004) in the medial than in the lateral compartment, greater (p = 0.001) in the medial femur (−1.9%) than in the medial tibia (−0.5%) and greater (p = 0.011) in the lateral tibia (−0.7%) than in the lateral femur (0.1%). Multifactorial analysis of variance did not reveal significant differences in the rate of change in ThC by sex, BMI, symptoms and radiographic knee OA status. Knees with Kellgren–Lawrence grade 2 or 3 and with a BMI >30 tended to display greater changes.Conclusions:In this sample of the OAI progression subcohort, the greatest, but overall very modest, rate of cartilage loss was observed in the weight-bearing medial femoral condyle. Knees with radiographic OA in obese participants showed trends towards higher rates of change than those of other participants, but these trends did not reach statistical significance.

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.

Necessity for subsequent surgery in women of child-bearing age with positive margins after cold knife conization: A retrospective cohort study

2021 ◽  
Author(s):  
Xinmei Wang ◽  
Juan Xu ◽  
Yang Gao ◽  
Pengpeng Qu
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
High Grade ◽  
Transformation Zone ◽  
Positive Margins ◽  
Child Bearing ◽  
Significant Difference ◽  
Cold Knife ◽  
Cold Knife Conization ◽  
Residual Lesions

Abstract Background: Risk factors for positive margins and residual lesions after cold knife conization (CKC) for high-grade cervical intraepithelial neoplasias (CIN) were assessed in women of child-bearing age. A design for postoperative management and avoiding these situations is offered.Methods: This was a retrospective study on 1,309 premenopausal women with high-grade CIN (including CIN3 and CIN2) based on a cervical biopsy under colposcopy used to diagnose a positive or negative margin. Age, gravidity, parity, HPV species, cytology, transformation zone type, results of endocervical curettage (ECC), quadrant involvement, glandular involvement, and CIN grade were analyzed. Among those with positive margins, 245 underwent surgery within three months, including CKC, a loop electrosurgical excision procedure, and total hysterectomy. Residual lesions were also assessed.Results: There was no significant difference in age, gravidity, parity, glandular involvement, and CIN grade between the two groups (P>0.3). There was a significant difference in HPV species, cytology, ECC results, and quadrant involvement (P<0.002). Multivariate analysis showed a major cytology abnormality, high-risk HPV infection, type III transformation zone, positive ECC result, and multiple quadrant involvement were independent risk factors for positive margins and residual lesions (P<0.02). Age >35 years was also a risk factor (P<0.03).Conclusion: High-risk women should be treated appropriately considering fertility. Patients with positive margins should be managed uniquely. Surgery for women without fertility may be appropriate. Close follow-up is necessary for women who have fertility requirements or are unwilling to undergo subsequent surgery if they have no risk factors, especially for women <35 years.

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