scholarly journals The influence of anesthesia- body mass index and chronicity of the injury on the reliability of diagnostic tests for anterior cruciate ligament rupture

2021 ◽  
Vol 17 (6) ◽  
pp. 428-434
Author(s):  
Emre Bilgin ◽  
Ali Turgut ◽  
Sertan Hancıoğlu ◽  
Emre Sarıekiz ◽  
Melikşah Uzakgider ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Anterior Cruciate Ligament ◽  
Body Mass ◽  
Diagnostic Tests ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Acl Rupture ◽  
Anterior Drawer ◽  
Anterior Cruciate ◽  
Awake Condition

This study aimed to analyze the accuracy and interobserver reliability of the four common diagnostic tests for anterior cruciate ligament (ACL) rupture. The effect of anesthesia, chronicity of the injury and patient’s body mass index (BMI) on the reliabilities was also assessed. Patients who underwent arthroscopic knee surgery were examined before the surgery and under anesthesia by three observers categorized based on their experience levels. One hundred two patients were evaluated to determine the accuracy of these tests. Sixty-two patients with ACL rupture were further examined to assess the effect of BMI (≤ 25 kg/m2, or > 25 kg/m2) and chronicity (≤ 4 or > 4 weeks) of the injury on reliabilities with using the Fleiss kappa method. The Lachman test performed under anesthesia had the highest sensitivity (100%, 100%, and 96.7%). In contrast, pivot shift and lever sign tests had the lowest sensitivity both in awake (24.2%, 17.7%, 8.1% and 37.1%, 33.8%, 29%) and anesthetized condition (75.8%, 75.8%, 67.7% and 41.9%, 43.5%, 40.3%). Specificities of the tests except pivot shift were negatively affected when performed under anesthesia. The reliability of the anterior drawer test was perfect under anesthesia. The lever sign test had the highest reliability in the awake condition in patients with a BMI of > 25 kg/m2. Furthermore, the reliabilities of the anterior drawer, Lachman, and pivot-shift tests in awake condition were found to be increased in patients with a chronic injury. Finally, the examiner’s experience is not important for the physical diagnosis of ACL rupture.

scholarly journals The Combined Effect of Body Mass Index and Tibial Slope Angles on Anterior Cruciate Ligament Injury Risk in Male Knees: A Case-Control Study

2019 ◽  
Vol 12 ◽  
pp. 117954411986792
Author(s):  
Volkan Kızılgöz ◽  
Ali Kemal Sivrioğlu ◽  
Hasan Aydın ◽  
Gökhan Ragıp Ulusoy ◽  
Türkhun Çetin ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Anterior Cruciate Ligament ◽  
Body Mass ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Receiver Operating Characteristics ◽  
Operating Characteristics ◽  
Anterior Cruciate

Introduction: Tibial slope angles (TSAs) have been identified as potential risk factors of anterior cruciate ligament (ACL) injury in the literature. A higher body mass index (BMI) might increase the risk of ACL tear because of greater axial compressive force. The aim of this study was to determine the relationship of these factors and the combined effect of BMI and TSA in determination of risk potential for ACL injury. Methods: The preoperative magnetic resonance (MR) images of 81 ACL-injured male knees and of 68 male individuals with no ACL injuries were evaluated by 2 radiologists to measure the TSA. The Mann-Whitney U-test was performed to indicate the significant difference in height, weight, and BMI values. The independent samples t-test was used to determine the differences between ACL-injured and non-injured groups regarding TSA values. Odds ratios were calculated by logistic regression tests, and receiver operating characteristics (ROC) curves revealed the area under the receiver operating characteristics curve (AUC) values to compare the relationships of these parameters with ACL injury. Results: Body mass index, lateral tibial slope (LTS), and medial tibial slope (MTS) were predictive of ACL risk injury. Body mass index alone had the greatest effect among these parameters, and there were no statistically significant differences in coronal tibial slope values between the ACL-ruptured and control groups. The greatest AUC was observed for the combination of BMI, MTS, and LTS. Conclusions: Body mass index, LTS, and MTS angles were associated with ACL injury risk and BMI + MTS + LTS together revealed the greatest effect on ACL injury.

scholarly journals Predictors of Radiographic Osteoarthritis 2 to 3 Years After Anterior Cruciate Ligament Reconstruction: Data From the MOON On-site Nested Cohort

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986708 ◽  
Author(s):  
◽  
Morgan H. Jones ◽  
Sameer R. Oak ◽  
Jack T. Andrish ◽  
Robert H. Brophy ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Anterior Cruciate Ligament ◽  
Body Mass ◽  
Cruciate Ligament ◽  
Meniscal Repair ◽  
Medial Compartment ◽  
Acl Tear ◽  
Increased Risk ◽  
Anterior Cruciate ◽  
And Cartilage

Background: Multiple studies have shown that patients are susceptible to posttraumatic osteoarthritis (PTOA) after an anterior cruciate ligament (ACL) injury, even with ACL reconstruction (ACLR). Prospective studies using multivariable analysis to identify risk factors for PTOA are lacking. Purpose/Hypothesis: This study aimed to identify baseline predictors of radiographic PTOA after ACLR at an early time point. We hypothesized that meniscal injuries and cartilage lesions would be associated with worse radiographic PTOA using the Osteoarthritis Research Society International (OARSI) atlas criteria. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 421 patients who underwent ACLR returned on-site for standardized posteroanterior semiflexed knee radiography at a minimum of 2 years after surgery. The mean age was 19.8 years, with 51.3% female patients. At baseline, data on demographics, graft type, meniscal status/treatment, and cartilage status were collected. OARSI atlas criteria were used to grade all knee radiographs. Multivariable ordinal regression models identified baseline predictors of radiographic OARSI grades at follow-up. Results: Older age (odds ratio [OR], 1.06) and higher body mass index (OR, 1.05) were statistically significantly associated with a higher OARSI grade in the medial compartment. Patients who underwent meniscal repair and partial meniscectomy had statistically significantly higher OARSI grades in the medial compartment (meniscal repair OR, 1.92; meniscectomy OR, 2.11) and in the lateral compartment (meniscal repair OR, 1.96; meniscectomy OR, 2.97). Graft type, cartilage lesions, sex, and Marx activity rating scale score had no significant association with the OARSI grade. Conclusion: Older patients with a higher body mass index who have an ACL tear with a concurrent meniscal tear requiring partial meniscectomy or meniscal repair should be advised of their increased risk of developing radiographic PTOA. Alternatively, patients with an ACL tear with an articular cartilage lesion can be reassured that they are not at an increased risk of developing early radiographic knee PTOA at 2 to 3 years after ACLR.

Longitudinal Changes of Patellar Alignment Before and After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft

2021 ◽  
pp. 036354652110289
Author(s):  
Tzu-Chieh Liao ◽  
Valentina Pedoia ◽  
Sharmila Majumdar ◽  
Richard B. Souza
Keyword(s):  
Body Mass Index ◽  
Anterior Cruciate Ligament ◽  
Body Mass ◽  
Cruciate Ligament ◽  
Control Group ◽  
Hamstring Autograft ◽  
Longitudinal Changes ◽  
Before And After ◽  
Anterior Cruciate ◽  
Acl Deficient

Background: Evidence has suggested that after anterior cruciate ligament (ACL) reconstruction (ACLR), individuals exhibit patellar malalignment; however, it is unknown if patellar alignment changes over time. Purpose: To examine the longitudinal changes in patellar alignment before, 6 months after, and 3 years after ACLR and to compare these variations, if present, with patellar alignment in controls. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 35 patients who had ACLR using hamstring autograft (19 male; age, 29.9 ± 7.7 years; body mass index, 23.8 ± 2.5) and 20 controls (13 male; age, 30.4 ± 4.8 years; body mass index, 24.3 ± 2.7) participated. All patients underwent bilateral knee magnetic resonance imaging with the knee in extension and 30° of flexion using sagittal T2-weighted, fat-saturated fast spin-echo images to assess patellar alignment in 6 degrees of freedom: anterior-posterior, medial-lateral, and superior-inferior translations; flexion; tilt; and spin. Patients who had ACLR were assessed before (ACL-deficient state) and 6 months and 3 years after ACLR, while control participants were only assessed once. One-way repeated-measures analysis of variance was used to examine patellar alignment across time in the ACLR group. If changes were present, the independent t test was carried out to examine the differences between ACLR knees and control knees. Results: In the knee-extended condition, greater patellar lateral displacement was observed at the ACL-deficient state and 6 months after ACLR compared with 3 years after ACLR within the ACLR group ( P < .001 and P = .043, respectively) and compared with the control group ( P = .001 and P = .039, respectively). Greater patellar lateral tilt was observed at the ACL-deficient state compared with 3 years after ACLR ( P = .003) and compared with the control group ( P = .018). In the knee-flexed condition, greater anterior displacement was observed at the ACL-deficient state compared with 3 years after ACLR ( P = .001) and compared with the control group ( P = .011), and it was also observed at 6 months after ACLR compared with the control group ( P = .019). Less lateral spin was observed at the ACL-deficient state ( P = .042) and 6 months after ACLR ( P = .004) compared with 3 years after ACLR and compared with the control group ( P = .004 for both). No patellar alignment measures in the ACLR knees at 3 years were significantly different from those of the controls. Conclusion: Patellar malalignment in individuals before and after ACLR subjected to longitudinal changes, and the differences in alignment between ACLR and controls diminished over 3 years.

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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