scholarly journals Early Knee Osteoarthritis Changes Pre- And Post-Anterior Cruciate Ligament Reconstruction Assessed By the Semi-Quantitative MRI Osteoarthritis Knee Score (MOAKS) Case Series and Case-Control Study

2021 ◽  
Author(s):  
Tsuyoshi Hamada ◽  
Yusuke Sato ◽  
Atsuya Watanabe ◽  
Takayuki Sakai ◽  
Masahiro Inoue ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Analysis ◽  
Cartilage Loss ◽  
Knee Oa ◽  
Osteoarthritis Knee ◽  
Anterior Cruciate ◽  
Injured Knee ◽  
Time From Injury

Abstract Background: Semi-quantitative scoring of knee abnormalities on magnetic resonance imaging (MRI) can aid in the diagnosis of early stage knee osteoarthritis (OA). Injuries to the anterior cruciate ligament (ACL) and medial meniscus (MM) can contribute to the development of knee OA, but their relationship to its time of onset is unknown.Purpose: To analyze the factors contributing to early knee OA changes in ACL injured knees using MRI Osteoarthritis Knee Score (MOAKS). Methods: Thirty-four cases status post unilateral ACL reconstruction (ACLR) were included. Knee OA abnormalities were evaluated using MOAKS scores of MRIs performed pre- and post-ACLR. Using multiple linear regression analysis, the MOAKS scores of medial osteophytes, medial cartilage alteration, and patellofemoral cartilage alteration were determined as dependent variables. Age, the presence of a meniscal abnormality, the time from injury to ACLR, and body mass index (BMI) were determined as explanatory variables. MOAKS differences between knees with and without medial meniscus (MM) abnormality were tested for each variable using a 2-way repeated-measures analysis of variance with the factors of preoperative vs. postoperative status and MM abnormality. Results: In the pre-ACLR multiple linear regression analysis, the waiting period was significantly and positively associated with medial cartilage loss, Lateral femorotibial osteophytes, lateral cartilage loss. and BMI were positively associated with MM abnormalities. BMI and lateral meniscus (LM) abnormality were significantly associated with lateral cartilage loss. Age was significantly associated with medial osteophytes. Age and LM abnormality were significantly associated with lateral osteophytes. Age, BMI, and LM abnormality were significantly associated with patellofemoral osteophytes. Conclusion: We found early knee OA changes in most knees a mean of 28.2 ± 52.0 months after ACL injury. The time from injury to ACLR, BMI, and the presence of MM or LM abnormality in the ACL injured knee were associated with early knee OA changes. In the ACL injured knee with MM involvement, prompt ACLR may forestall the development of OA.

Patterns of cartilage loss and anterior cruciate ligament status in end-stage osteoarthritis of the knee

2020 ◽  
Vol 102-B (6) ◽  
pp. 716-726 ◽  
Author(s):  
Chloe E. H. Scott ◽  
George Holland ◽  
Oliver Krahelski ◽  
Iain R. Murray ◽  
John F. Keating ◽  
...  
Keyword(s):  
Bone Loss ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Cartilage Loss ◽  
Full Thickness ◽  
Knee Oa ◽  
Tibial Bone ◽  
Anterior Cruciate ◽  
End Stage ◽  
Bicompartmental Arthroplasty

Aims This study aims to determine the proportion of patients with end-stage knee osteoarthritis (OA) possibly suitable for partial (PKA) or combined partial knee arthroplasty (CPKA) according to patterns of full-thickness cartilage loss and anterior cruciate ligament (ACL) status. Methods A cross-sectional analysis of 300 consecutive patients (mean age 69 years (SD 9.5, 44 to 91), mean body mass index (BMI) 30.6 (SD 5.5, 20 to 53), 178 female (59.3%)) undergoing total knee arthroplasty (TKA) for Kellgren-Lawrence grade ≥ 3 knee OA was conducted. The point of maximal tibial bone loss on preoperative lateral radiographs was determined as a percentage of the tibial diameter. At surgery, Lachman’s test and ACL status were recorded. The presence of full-thickness cartilage loss within 16 articular surface regions (two patella, eight femoral, six tibial) was recorded. Results According to articular cartilage loss and ACL status, 195/293 (67%) were suitable for PKA or CPKA: medial unicompartmental knee arthroplasty (UKA) 97/293 (33%); lateral UKA 25 (9%); medial bicompartmental arthroplasty 31 (11%); lateral bicompartmental arthroplasty 12 (4%); bicondylar-UKA 23 (8%); and patellofemoral arthroplasty (PFA) seven (2%). The ACL was intact in 166 (55%), frayed in 82 (27%), disrupted in 12 (4%), and absent in 33 (11%). Lachman testing was specific (97%) but poorly sensitive (38%) for disrupted/absent ACLs. The point of maximal tibial bone loss showed good interclass correlation (ICC 0.797, 0.73 to 0.85 95% confidence interval (CI); p < 0.001) and was more posterior when the ACL was absent. Maximum tibial bone loss occurring at > 55% of the anterior to posterior distance predicted ACL absence with 93% sensitivity and 91% specificity (area under the curve 0.97 (0.94 to 0.99 95% CI; p < 0.001). Conclusion ACL status can be reliably determined from a lateral radiograph using the location of maximal tibial bone loss. According to regions of cartilage loss and ACL status, two-thirds of patients with end-stage knee OA could potentially be treated with PKA or CPKA. Cite this article: Bone Joint J 2020;102-B(6):716–726.

scholarly journals TIME FROM INJURY TO SURGERY IMPACT ON RECOVERY RESULTS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

2017 ◽  
Vol 27 (3) ◽  
pp. 32-37
Author(s):  
Rokas Jurkonis ◽  
Rimtautas Gudas
Keyword(s):  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Meniscus Tear ◽  
Meniscal Tears ◽  
Medial Meniscal Tear ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Time From Injury ◽  
Delayed Reconstruction

Lithuanian University of Health Sciences, Department of Orthopaedics and Traumatology, Kaunas, Lithuania 12 months (25 (46.3%)), (P &lt; 0.001). The examination of possible risk factors for medial meniscus tear revealed, that BMI (overweight) (OR=2.04; 95% CI=1.091-3.814) and time from injury to surgery (weeks) (OR=1.026; 95% CI=1.012-1.04) significantly increased possibility of medial meniscus tear. We found no significant laxity difference between postoperative testings’ (3, 6 and 12 months after surgery) and the three groups, created by the time to surgery. Conclusion. The study revealed a significant difference in the incidence of meniscal tears between patients treated in the early group and in those underwent ACL-R after 12 months, which lead to significantly higher chance (every delayed week increase chance by 1.026 times and overweight (BMI ≥ 25 kg/ m2) increase chance by 2.04 times) of a medial meniscal tear occurring in patients undergoing delayed reconstruction.

scholarly journals Ramp lesion of the medial meniscus

2021 ◽  
Vol 6 (5) ◽  
pp. 372-379
Author(s):  
Yusuf Omar Qalib ◽  
Yicun Tang ◽  
Dawei Wang ◽  
Baizhou Xing ◽  
Xingming Xu ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Injury ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Treatment Options ◽  
Ligament Injury ◽  
Ramp Lesion ◽  
Male Sex ◽  
Anterior Cruciate ◽  
Time From Injury

Ramp lesion of the medial meniscus used to be completely disregarded in the past. Ramp lesion has been now put under the spotlight by orthopaedic and sport medicine surgeons and requires attention. It is closely associated with anterior cruciate ligament injury. Major risk factors include chronic laxity, lateral meniscal lesion, anterior cruciate ligament reconstruction revision, anterolateral ligament tear concomitant with anterior cruciate ligament injury, time from injury, pre-operative side-to-side laxity > 6 mm, age < 30 years old, male sex, etc. Radiologists attempt to create diagnostic criteria for ramp lesion using magnetic resonance imaging. However, the only definite method to diagnose ramp lesion is still arthroscopy. Various techniques exist, among which posteromedial approach is the most highly recommended. Various treatment options are available. The success rate of ramp repair is very high. Major complications are uncommon. Cite this article: EFORT Open Rev 2021;6:372-379. DOI: 10.1302/2058-5241.6.200126

Predictive Factors for Hamstring Autograft Diameter in Anterior Cruciate Ligament Reconstruction

2019 ◽  
Author(s):  
Willem M.P. Heijboer ◽  
Mathijs A.M. Suijkerbuijk ◽  
Belle L. van Meer ◽  
Eric W.P. Bakker ◽  
Duncan E. Meuffels
Keyword(s):  
Anterior Cruciate Ligament ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Model ◽  
Gracilis Tendon ◽  
Thigh Circumference ◽  
Anterior Cruciate

AbstractMultiple studies found hamstring tendon (HT) autograft diameter to be a risk factor for anterior cruciate ligament (ACL) reconstruction failure. This study aimed to determine which preoperative measurements are associated with HT autograft diameter in ACL reconstruction by directly comparing patient characteristics and cross-sectional area (CSA) measurement of the semitendinosus and gracilis tendon on magnetic resonance imaging (MRI). Fifty-three patients with a primary ACL reconstruction with a four-stranded HT autograft were included in this study. Preoperatively we recorded length, weight, thigh circumference, gender, age, preinjury Tegner activity score, and CSA of the semitendinosus and gracilis tendon on MRI. Total CSA on MRI, weight, height, gender, and thigh circumference were all significantly correlated with HT autograft diameter (p < 0.05). A multiple linear regression model with CSA measurement of the HTs on MRI, weight, and height showed the most explained variance of HT autograft diameter (adjusted R 2 = 44%). A regression equation was derived for an estimation of the expected intraoperative HT autograft diameter: 1.2508 + 0.0400 × total CSA (mm2) + 0.0100 × weight (kg) + 0.0296 × length (cm). The Bland and Altman analysis indicated a 95% limit of agreement of ± 1.14 mm and an error correlation of r = 0.47. Smaller CSA of the semitendinosus and gracilis tendon on MRI, shorter stature, lower weight, smaller thigh circumference, and female gender are associated with a smaller four-stranded HT autograft diameter in ACL reconstruction. Multiple linear regression analysis indicated that the combination of MRI CSA measurement, weight, and height is the strongest predictor.

scholarly journals EFFECT OF SKELETAL MATURITY ON INCIDENCE OF ASSOCIATED MENISCAL AND CHONDRAL INJURIES IN ANTERIOR CRUCIATE LIGAMENT INJURED KNEES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0010
Author(s):  
Brett Heldt ◽  
Elsayed Attia ◽  
Raymond Guo ◽  
Indranil Kushare ◽  
Theodore Shybut
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Medial Meniscus ◽  
Skeletal Maturity ◽  
Cruciate Ligament ◽  
Demographic Data ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Meniscus Tears ◽  
Anterior Cruciate

Background: Acute anterior cruciate ligament(ACL) rupture is associated with a significant incidence of concomitant meniscal and chondral injuries. However, to our knowledge, the incidence of these concomitant injuries in skeletally immature(SI) versus skeletally mature(SM) patients has not been directly compared. SI patients are a unique subset of ACL patients because surgical considerations are different, and subsequent re-tear rates are high. However, it is unclear if the rates and types of meniscal and chondral injuries differ. Purpose: The purpose of this study is to compare associated meniscal and chondral injury patterns between SI and SM patients under age 21, treated with ACL reconstruction for an acute ACL tear. We hypothesized that no significant differences would be seen. Methods: We performed a single-center retrospective review of primary ACL reconstructions performed from January 2012 to April 2020. Patients were stratified by skeletal maturity status based on a review of records and imaging. Demographic data was recorded, including age, sex, and BMI. Associated intra-articular meniscal injury, including laterality, location, configuration, and treatment were determined. Articular cartilage injury location, grade, and treatments were determined. Revision rates, non-ACL reoperation rates, and time to surgery were also compared between the two groups. Results: 785 SM and 208 SI patients met inclusion criteria. Mean BMI and mean age were significantly different between groups. Meniscal tear rates were significantly greater in SM versus SI patients in medial meniscus tears(P<.001), medial posterior horn tears(P=.001), medial longitudinal tears configuration(P=.007), lateral Radial configuration(P=.002), and lateral complex tears(P=.011). Medial repairs(P<.001) and lateral partial meniscectomies(P=.004) were more likely in the SM group. There was a significantly greater number of chondral injuries in the SM versus SI groups in the Lateral(p=.007) and medial compartments(P<.001). SM patients had a significantly increased number of outerbridge grade 1 and 2 in the Lateral(P<.001) and Medial Compartments(P=.013). ACL revisions(P=.019) and Non-ACL reoperations(P=.002) were significantly greater in the SI patients compared to SM. No other significant differences were noted. Conclusion: SM ACL injured patients have a significantly higher rate of medial meniscus tears and medial longitudinal configurations treated with repair, and a significantly higher rate of radial and/or complex lateral meniscus tears treated with partial meniscectomy compared to the SI group. We also found a significantly higher rate of both medial and lateral compartment chondral injuries, mainly grades 1 and 2, in SM compared to SI patients. Conversely, SI ACL reconstruction patients had higher revision and subsequent non-ACL surgery rates.

scholarly journals Treadmill Exercise after Controlled Abnormal Joint Movement Inhibits Cartilage Degeneration and Synovitis

Life ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 303
Author(s):  
Yuichiro Oka ◽  
Kenij Murata ◽  
Kaichi Ozone ◽  
Takuma Kano ◽  
Yuki Minegishi ◽  
...  
Keyword(s):  
Treadmill Exercise ◽  
Cruciate Ligament ◽  
Cartilage Degeneration ◽  
Research Society ◽  
Therapeutic Effects ◽  
Joint Movement ◽  
Knee Oa ◽  
Anterior Cruciate ◽  
Safranin O ◽  
Walking Group

Cartilage degeneration is the main pathological component of knee osteoarthritis (OA), but no effective treatment for its control exists. Although exercise can inhibit OA, the abnormal joint movement with knee OA must be managed to perform exercise. Our aims were to determine how controlling abnormal joint movement and treadmill exercise can suppress cartilage degeneration, to analyze the tissues surrounding articular cartilage, and to clarify the effect of treatment. Twelve-week-old ICR mice (n = 24) underwent anterior cruciate ligament transection (ACL-T) surgery on their right knees and were divided into three groups as follows: ACL-T, animals in the walking group subjected to ACL-T; controlled abnormal joint movement (CAJM), and CAJM with exercise (CAJM + Ex) (n = 8/group). Walking-group animals were subjected to treadmill exercise 6 weeks after surgery, including walking for 18 m/min, 30 min/day, 3 days/week for 8 weeks. Safranin-O staining, hematoxylin-eosin staining, and immunohistochemical staining were performed. The OARSI (Osteoarthritis research Society international) score was lower in the CAJM group than in the ACL-T group and was even lower in the CAJM + Ex group. The CAJM group had a lower meniscal injury score than the ACL-T group, and the CAJM + Ex group demonstrated a less severe synovitis than the ACL-T and CAJM groups. The observed difference in the perichondrium tissue damage score depending on the intervention method suggests different therapeutic effects, that normalizing joint motion can solve local problems in the knee joint, and that the anti-inflammatory effect of treadmill exercise can suppress cartilage degeneration.

scholarly journals Primary ACL Repair vs Reconstruction: Investigating the Current Conventional Wisdom

2018 ◽  
Vol 6 (6_suppl3) ◽  
pp. 2325967118S0004 ◽  
Author(s):  
Gabriella Bucci ◽  
Michael Begg ◽  
Kevin Pillifant ◽  
Steven B. Singleton
Keyword(s):  
Anterior Cruciate Ligament ◽  
Sports Medicine ◽  
Cruciate Ligament ◽  
Conventional Wisdom ◽  
Acl Repair ◽  
Arthroscopic Technique ◽  
Anterior Cruciate ◽  
Injured Knee

BACKGROUND: “Why try to convert other collagen substitutes into ligament if the original can be preserved?” said Sherman1. Nowadays, reconstruction became the gold standard treatment for ACL injuries. Despite current treatment, secondary knee osteoarthritis has been described in more than 70% of the injured patients after 10 years follow up.2 Recent studies have reported that tears involving the proximal ACL have an intrinsic healing response. This response has been compared to the one observed in MCL injuries.3, 4. OBJECTIVE: The aim of this study is to initiate a scientific analysis of our experience in patients diagnosed with an acute, proximal ACL tear treated with a primary repair arthroscopic technique. We suggest the creation of a symposium that reconsiders the ACL repair as a tool for treatment, on a selected subset of patients. METHODS: We analyzed retrospectively the data of 12 consecutive patients diagnosed clinically and radiologically (MRI) with proximal ACL tears in our clinic. The inclusion criteria were: proximal ACL tear (type 1 tear in Sherman´s classification), good remaining ACL quality tissue and less than 3 months from injury. The mean age at time of surgery was 33 years (16 to 55). Patients included in this study are athletes either at an amateur or professional level. The technique consists of an anatomical reinsertion of native ACL by reinforcing the anteromedial and posterolateral bundles of the ACL with a series of high strength locking Bunnell-type sutures, moving up the ligament from distal to proximal with an arthroscopic suture passer. The normal ACL insertional footprint within the notch is then debrided to provide a bleeding surface for healing. Finally, the torn ligament is opposed to the native footprint using 1-2 absorbable anchors that recreate the anatomic bundle insertional sites of the native ACL. RESULTS: Associated injuries were found in 7 of the 12 patients, these included 4 knees with lateral and 1 with medial meniscal tear which were repaired in the same procedure. Also, one knee had a medial bucket handle tear, partial meniscectomy was performed, and one knee with a combined ACL/MCL injury in which the MCL was simultaneously repaired. In our ongoing series, were excluded patients that had sustained complex knee injuries with multi-ligament damage (except ACL/MCL injuries), those with ACL re-ruptures, and previous knee surgery with cartilage repair procedures. Validated functional outcomes scores were collected after a mean follow up of 20 months (14-26). For the IKDC subjective score 11 of 12 patients rated their knees as normal or nearly normal. Lachman and Pivot Shift was negative in all patients. Lysholm score postoperatively averaged 93.5 ± 7; preoperatively 48 ± 7. Tegner preinjury 7.5 ± 1.2 postinjury: 7 ± 1.4. The KT-1000 knee arthrometer, objectively measured < 3 mm of anterior tibial motion relative to the femur in the injured knee compared to the non-injured knee at all levels of force, including manual max tests, in all patients included in the study. No complications or further surgeries are reported up to date. CONCLUSION: The keys to success include: Proper patient selection, early intervention, all arthroscopic technique, appropriate suture control of the torn ACL fibers, and stable opposition to a bleeding bone surface at the native attachment site within the femoral notch. Long-term data is pending. However, basic science and early clinical studies are promising. REFERENCES Mark F. Sherman, MD, Lawernce Lieber, MD, Joel R. Bonamo, MD, Luga Podesta, MD, Ira Reiter, RPT., The long-term followup of primary anterior cruciate ligament repair, 1991, The American Journal of Sports Medicine, Vol. 19, No 3. Martha M. Murray, MD. Current Status and Potential for Primary ACL Repair. 2009. Clin Ssports Med. Duy Tan Nguyen, Tamara H. Ramwadhdoebe, Cor P. van der Hart, Leendert Blankervoort, Paul Peter Tak, Cornelis Niek van Dijk., Intrinsic Healing Response of the Human Anterior Cruciate Ligament: An Histological Study of Reattached ACL Remnants, 2014, Journal of Orthopaedic Research. Martha M. Murray, MD, Braden C. Fleming, Ph.D., Use of a Bioactive Scaffold to Stimulate ACL Healing Also Minimizes Post-traumatic Osteoarthritis after Surgery, 2014, American Journal of Sports Medicine. Primary ACL Repair vs Reconstruction: Investigating the Current Conventional Wisdom

Sign in / Sign up

Export Citation Format

Share Document