scholarly journals Patellar Tendon Quality and Knee Symptoms in Male Athletes Before the Anterior Cruciate Ligament Reconstruction

2020 ◽  
Author(s):  
Carla Soncino Pereira ◽  
Jasenko Klauznicer ◽  
Sean McAuliffe ◽  
Rodney Whiteley ◽  
Taija Juutinen Finni
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Knee Pain ◽  
Tissue Characterization ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Ultrasound Tissue Characterization ◽  
Anterior Cruciate ◽  
The Impact

Abstract Background: It is unknown if the quality of the patellar tendon is affected by an anterior cruciate ligament (ACL) injury. ACL deficient patients (ACL-D) have shown to have knee pain, quadriceps weakness and reduced knee function. Ultrasound tissue characterization (UTC) has been used to assess the quality of tendons by quantifying the proportion of echo-types using a numerical grading system from best to worst (I-IV). The primary aims of this cross-sectional study were to investigate the patellar tendon quality in athletes with unilateral ACL injuries, and to compare them to asymptomatic control tendons. The secondary aims were to assess the impact of anterior knee pain (AKP) in the patellar tendons of ACL-D, and to explore possible correlations between tendon quality and knee pain, knee extensor strength and time from ACL injury. Methods: UTC was used to scan both patellar tendons of 81 ACL-D athletes and 20 control tendons. Echo-types distribution was calculated to compare the quality between limbs of ACL-D and control tendons; and to compare ACL-D with AKP, other knee pain, and without pain. Associations between the variables of tendon quality and knee symptoms were explored. Results: No difference in tendon quality was found between limbs of ACL-D. Both tendons of ACL-D displayed more echo-type II at the patellar apex, and same or less echo-types III and IV than controls. The proximal half of the control tendons displayed better quality than the distal half. ACL-D knees with pain displayed less extensor strength, however, in addition to the lack of difference in tendon quality regardless of the presence and location of pain, there was no meaningful association between pain, extensor strength and tendon quality. Nevertheless, there were weak to moderate associations between tendon quality and time from ACL injury. Conclusion: Despite the ACL injury, there is no difference in tendon quality between ACL-D limbs, or when subgrouping ACL-D tendons by presence and location of knee pain. Different areas of the patellar tendon may present different characteristics that might be related to training. Tendon quality is better if a person has longer time from injury.

Factors Influencing Return to Play and Second Anterior Cruciate Ligament Injury Rates in Level 1 Athletes After Primary Anterior Cruciate Ligament Reconstruction: 2-Year Follow-up on 1432 Reconstructions at a Single Center

2020 ◽  
Vol 48 (4) ◽  
pp. 812-824 ◽  
Author(s):  
Enda King ◽  
Chris Richter ◽  
Mark Jackson ◽  
Andy Franklyn-Miller ◽  
Eanna Falvey ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Predictive Ability ◽  
Acl Injury ◽  
Return To Play ◽  
Injury Rates ◽  
Level 1 ◽  
Anterior Cruciate

Background: Despite the importance of return-to-play (RTP) rates, second anterior cruciate ligament (ACL) injury rates, and patient-reported outcomes of athletes returning to sports after ACL reconstruction (ACLR), these outcomes have not been evaluated together across a single cohort nor the pre- and intraoperative factors influencing outcomes explored. Purpose: To prospectively report outcomes after ACLR relating to RTP, second ACL injury, and International Knee Document Committee (IKDC) scores in a large cohort of athletes at a single center to examine the influence of pre- and intraoperative variables on these outcomes. Design: Cohort study; Level of evidence, 3. Methods: A consecutive cohort of 1432 athletes undergoing primary ACLR by 2 orthopaedic surgeons was followed up prospectively more than 2 years after surgery. Pre- and intraoperative findings were reported with outcomes at follow-up relating to RTP, second ACL injury, and IKDC. Between-group differences for each outcome were reported and the predictive ability of pre- and intraoperative variables relating to each outcome assessed with logistic regression. Results: There was >95% follow-up 2 years after surgery. The RTP rate was 81%, and of those who returned, 1.3% of those with patellar tendon grafts and 8.3% of those with hamstring grafts experienced ipsilateral rerupture (hazard ratio, 0.17). The contralateral ACL injury rate was 6.6%, and the IKDC score at follow-up was 86.8, with a greater proportion of patients with patellar tendon grafts scoring <80 on the IKDC (odds ratio, 1.56; 95% CI, 1.15-3.12). There was no relationship between time to RTP and second ACL injury, and there was a moderate correlation between ACL–Return to Sport After Injury score and RTP at follow-up ( P < .001, rho = 0.46). There were a number of differences in pre- and intraoperative variables between groups for each outcome, but they demonstrated a poor ability to predict outcomes in level 1 athletes at 2-year follow-up. Conclusion: Findings demonstrated high overall RTP rates, lower reinjury rates with patellar tendon graft after 2-year follow-up in level 1 athletes, and no influence of time to RTP on second ACL injury. Despite differences between groups, there was poor predictive ability of pre- and intraoperative variables. Results suggest pre- and intraoperative variables for consideration to optimize outcomes in level 1 athletes after ACLR, but future research exploring other factors, such as physical and psychological recovery, may be needed to improve outcome prediction after ACLR. Registration: NCT02771548 (ClinicalTrials.gov identifier).

scholarly journals Knee Frontal-Plane Biomechanics in Adults With or Without Bone Marrow Edema-Like Lesions After Anterior Cruciate Ligament Injury

2017 ◽  
Vol 52 (6) ◽  
pp. 581-586 ◽  
Author(s):  
Abbey C. Thomas ◽  
Riann M. Palmieri-Smith
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Pain ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Frontal Plane ◽  
Acl Injury ◽  
Knee Adduction Moment ◽  
Control Group ◽  
Group Frequency ◽  
Anterior Cruciate

Context:  Lateral subchondral bone bruises (BBs) occur frequently with anterior cruciate ligament (ACL) injuries. These BBs are associated with pain during weight bearing, leading individuals to increase medial tibiofemoral loading to alleviate pain laterally. Increased medial tibiofemoral loading may precipitate the development or progression of posttraumatic osteoarthritis; however, no in vivo biomechanical data exist to confirm that lateral BBs increase medial tibiofemoral loading as measured by the external knee-adduction moment (KAM). Objective:  To determine whether lateral BBs after ACL injury increase the external KAM during walking. Design:  Descriptive laboratory study. Setting:  University research laboratory. Patients or Other Participants:  Eleven volunteers with an ACL injury (age = 20.36 ± 4.03 years, height = 177.60 ± 8.59 cm, mass = 79.70 ± 16.33 kg), 12 with an ACL injury and a lateral BB (ACL + BB; age = 19.25 ± 5.58 years, height = 170.71 ± 9.40 cm, mass = 66.79 ± 11.91 kg), and 12 healthy controls (age = 19.67 ± 5.19 years, height = 173.29 ± 11.58 cm, mass = 67.07 ± 11.25 kg) participated. Intervention(s):  We recorded peak KAM during 3 walking trials (1.1 ± 0.6 m/s) in which participants walked over a force platform located in the field of view of a motion-capture system. Main Outcome Measure(s):  Peak KAM was calculated during the first half of stance using standard inverse-dynamics analysis, averaged across trials, and examined via 1-way analysis of variance. Knee pain and function were determined from the International Knee Documentation Committee Subjective Knee Evaluation Form and compared among groups via the Kruskal-Wallis test. Results:  Peak KAM did not differ among groups (ACL injury = 0.14 ± 0.07 Nm·kg−1·m−1, ACL + BB = 0.21 ± 0.08 Nm·kg−1·m−1, control = 0.20 ± 0.08 Nm·kg−1·m−1; F2,35 = 3.243, P = .052). Knee-pain frequency and severity were greater in the ACL-injury (frequency = 2.55 ± 1.81, severity = 3.36 ± 1.75; both P &lt; .001) and ACL + BB (frequency = 3.58 ± 2.81, severity = 4.08 ± 3.20; both P &lt; .001) groups than in the control group (frequency = 0.00 ± 0.00, severity = 0.00 ± 0.00). Knee function was greater in the control group (100.00 ± 0.00) than in the ACL-injury (59.35 ± 17.31; P &lt; .001) and ACL + BB (46.46 ± 25.85; P &lt; .001) groups. Conclusions:  The ACL + BB groups did not walk with a greater external KAM than the ACL-injury or control groups. Thus, lateral tibiofemoral BB did not influence knee frontal-plane loading after ACL injury.

scholarly journals Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

2017 ◽  
Vol 52 (6) ◽  
pp. 575-580 ◽  
Author(s):  
Jeffrey B. Driban ◽  
Stefan Lohmander ◽  
Richard B. Frobell
Keyword(s):  
Bone Marrow ◽  
Anterior Cruciate Ligament ◽  
Knee Pain ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Magnetic Resonance Images ◽  
Bone Marrow Lesion ◽  
Bone Bruise ◽  
Cross Sectional ◽  
Anterior Cruciate

Context:  After an anterior cruciate ligament (ACL) injury, a majority of patients have a traumatic bone marrow lesion (BML, or bone bruise). The clinical relevance of posttraumatic lesions remains unclear. Objective:  To explore the cross-sectional associations between traumatic BML volume and self-reported knee pain and symptoms among individuals within 4 weeks of ACL injury. Design:  Cross-sectional exploratory analysis of a randomized clinical trial. Setting:  Orthopaedic departments at 2 hospitals in Sweden. Patients or Other Participants:  As part of a randomized trial (knee anterior cruciate ligament nonoperative versus operative treatment [KANON] study), 121 young active adults (74% men, age = 26 ± 5 years, height = 1.8 ± 0.1 m, weight = 76 ± 13 kg) with an ACL tear were studied. Main Outcome Measure(s):  The BML volume in the proximal tibia and distal femur was segmented using magnetic resonance images obtained within 4 weeks of injury. A radiologist evaluated the presence of depression fractures on the images. Pain and symptoms of the injured knee (Knee Injury and Osteoarthritis Outcome Score [KOOS] pain and symptoms subscales) were obtained the same day as imaging. We used linear regression models to assess the associations. Results:  Most knees had at least 1 BML (96%), and the majority (57%) had a depression fracture. Whole-knee BML volume was not related to knee pain for the entire cohort (β = −0.09, P = .25). Among those without a depression fracture, larger whole-knee BML volume was associated with increased knee pain (β = –0.46, P = .02), whereas no association was found for those with a depression fracture (β = 0.0, P = .96). Larger medial (β = –0.48, P = .02) but not lateral (β = –0.03, P = .77) tibiofemoral BML volume was associated with greater pain. We found no association between BML volume and knee symptoms. Conclusions:  We confirmed the absence of relationships between whole-knee BML volume and pain and symptoms within 4 weeks of ACL injury. Our findings extend previous reports in identifying weak associations between larger BML volume in the medial compartment and greater pain and between BML volume and greater pain among those without a depression fracture.

scholarly journals In Situ Joint Stiffness Increases During Skeletal Growth but Decreases Following Partial and Complete Anterior Cruciate Ligament Injury

2019 ◽  
Vol 141 (12) ◽  
Author(s):  
Stephanie G. Cone ◽  
Jorge A. Piedrahita ◽  
Jeffrey T. Spang ◽  
Matthew B. Fisher
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Joint Stiffness ◽  
Acl Injury ◽  
Ligament Injury ◽  
Joint Function ◽  
Anterior Cruciate ◽  
Slack Length ◽  
The Impact

Abstract Partial and complete anterior cruciate ligament (ACL) injuries occur in both pediatric and adult populations and can result in loss of joint stability and function. The sigmoidal shape of knee joint function (load-translation curve) under applied loads includes a low-load region (described by slack length) followed by a high-load region (described by stiffness). However, the impact of age and injury on these parameters is not fully understood. The current objective was to measure the effects of age and injury on the shape of joint function in a porcine model. In response to an applied anterior–posterior tibial load, in situ slack did not change (p > 0.05), despite sevenfold increases in joint size with increasing age. Joint stiffness increased from an average of 10 N/mm in early youth to 47 N/mm in late adolescence (p < 0.05). In situ ACL stiffness increased similarly, and changes in in situ joint stiffness and ACL stiffness were highly correlated across ages. With complete ACL injury, in situ slack length increased by twofold to fourfold and in situ stiffness decreased threefold to fourfold across ages (p < 0.05). Partial ACL injury resulted in less dramatic, but statistically significant, increases in joint slack and significant decreases in in situ joint stiffness in the adolescent age groups (p < 0.05). This work furthers our understanding of the interaction between joint biomechanics and ACL function throughout growth and the impact of ACL injury in the skeletally immature joint.

scholarly journals Ball heading and subclinical concussion in soccer as a risk factor for anterior cruciate ligament injury

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
George Kakavas ◽  
Nikolaos Malliaropoulos ◽  
Wieslaw Blach ◽  
Georgios Bikos ◽  
Filippo Migliorini ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Neuromuscular Control ◽  
Acl Injury ◽  
Soccer Players ◽  
Ligament Injury ◽  
Neurocognitive Performance ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
The Impact

AbstractSoccer players have a high risk of anterior cruciate ligament (ACL) injury, a potentially career-ending event. ACL rupture has been linked with abnormal neuromuscular control in the lower limb. Additionally, heading the ball with the unprotected head during game play is increasingly recognized as a major source of exposure to concussive and sub-concussive repetitive head impacts. This article provides a hypothesis of potential connection of ACL injury with ball heading in soccer players. The study reviews literature sources regarding the impact of neurocognitive alterations after ball headings in ACL injuries. Poor baseline neurocognitive performance or impairments in neurocognitive performance via sleep deprivation, psychological stress, or concussion can increase the risk for subsequent musculoskeletal injury.

scholarly journals Prospective and Randomized Clinical Evaluation of Hamstring Versus Patellar Tendon Autograft for Anterior Cruciate Ligament Reconstruction in Soccer Players

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110281
Author(s):  
Luiz Gabriel Betoni Guglielmetti ◽  
Victor Eduardo Roman Salas ◽  
Pedro Baches Jorge ◽  
Fabrício Roberto Severino ◽  
Aires Duarte ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Cruciate Ligament ◽  
Soccer Players ◽  
Outcome Score ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: Anterior cruciate ligament (ACL) reconstruction is usually performed with autologous bone–patellar tendon–bone (PT) or hamstring tendon (HT) graft. There has been only 1 randomized clinical trial examining ACL reconstruction with these grafts specifically in soccer players, and more studies comparing these graft types within a homogenous cohort such as soccer athletes may better highlight differences in outcomes. Purpose: To compare the results of ACL reconstruction with PT versus HT autograft in soccer players and to evaluate objective and subjective outcomes. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 62 professional or semiprofessional soccer players (mean age, 25.1 years) with ACL injury were randomized to undergo reconstruction with PT or HT autograft by a single orthopaedic surgeon (n = 31 in each group). Outcome measures were recorded preoperatively and at 2 years postoperatively. The primary outcome was the modified Cincinnati Knee Rating System, and secondary outcomes were the objective and subjective International Knee Documentation Committee scores, Lachman test, pivot-shift test, anterior drawer test, and Lysholm score. The following variables were also evaluated postoperatively: return to soccer, level at return, graft rerupture, postoperative complications, anterior knee pain, patellar tendinitis, difficulty sprinting, and loss of kicking power. Results: The PT and HT groups were homogenous in terms of age, sex distribution, injured side, and time from injury to surgery, and there was no difference between them on any preoperative outcome score. At 2 years postoperatively, there were no differences between the groups on any outcome score; however, there were significantly fewer patients with anterior knee pain in the HT group compared with the PT group (7 [22.6%] vs 15 [48.4%], respectively; P = .03). Two patients from each group (2/31; 6.5%) sustained rerupture. Conclusion: There were no differences between soccer players who underwent different types of ACL reconstruction with the exception of anterior knee pain, which was more frequent in players who underwent reconstruction with PT graft. Registration: NCT02642692 ( ClinicalTrials.gov ).

The Learning Curve in Arthroscopic ACL Reconstruction. The impact on the Surgical Time and Postoperative Clinical Results

2018 ◽  
Vol 69 (10) ◽  
pp. 2874-2876
Author(s):  
Teodor Negru ◽  
Stefan Mogos ◽  
Ioan Cristian Stoica
Keyword(s):  
Anterior Cruciate Ligament ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Positive Impact ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Single Bundle ◽  
Surgical Time ◽  
Anterior Cruciate ◽  
The Impact

Rupture of the anterior cruciate ligament (ACL) is a common injury. The objective of the current study was to evaluate if the learning curve has an impact on surgical time and postoperative clinical outcomes after anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) using an outside-in tunnel drilling hamstrings technique. The learning curve has a positive impact on surgical time but has no influence on postoperative clinical outcomes at short time follow-up.

scholarly journals Electromyographic Assessment of Anterior Cruciate Ligament Injury Risk in Male Tennis Players: Which Role for Visual Input? A Proof-of-Concept Study

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 997
Author(s):  
Alessandro de Sire ◽  
Nicola Marotta ◽  
Andrea Demeco ◽  
Lucrezia Moggio ◽  
Pasquale Paola ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Visual Input ◽  
Proof Of Concept ◽  
Tennis Players ◽  
Concept Study ◽  
Acl Injury Risk ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) injury incidence is often underestimated in tennis players, who are considered as subjects conventionally less prone to knee injuries. However, evaluation of the preactivation of knee stabilizer muscles by surface electromyography (sEMG) showed to be a predictive value in the assessment of the risk of ACL injury. Therefore, this proof-of-concept study aimed at evaluating the role of visual input on the thigh muscle preactivation through sEMG to reduce ACL injury risk in tennis players. We recruited male, adult, semiprofessional tennis players from July to August 2020. They were asked to drop with the dominant lower limb from a step, to evaluate—based on dynamic valgus stress—the preactivation time of the rectus femoris (RF), vastus medialis, biceps femoris, and medial hamstrings (MH), through sEMG. To highlight the influence of visual inputs, the athletes performed the test blindfolded and not blindfolded on both clay and grass surfaces. We included 20 semiprofessional male players, with a mean age 20.3 ± 4.8 years; results showed significant early muscle activation when the subject lacked visual input, but also when faced with a less-safe surface such as clay over grass. Considering the posteromedial–anterolateral relationship (MH/RF ratio), tennis players showed a significant higher MH/RF ratio if blindfolded (22.0 vs. 17.0% not blindfolded; p < 0.01) and percentage of falling on clay (17.0% vs. 14.0% in grass; p < 0.01). This proof-of-principle study suggests that in case of absence of visual input or falling on a surface considered unsafe (clay), neuro-activation would tend to protect the anterior stress of the knee. Thus, the sEMG might play a crucial role in planning adequate athletic preparation for semiprofessional male athletes in terms of reduction of ACL injury risk.

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