knee ligament
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2022 ◽  
Vol 9 (1) ◽  
Author(s):  
Georgi P. Georgiev ◽  
Manasi Telang ◽  
Boycho Landzhov ◽  
Łukasz Olewnik ◽  
Svetoslav A. Slavchev ◽  
...  

AbstractAccording to current literature, 90% of knee ligament injuries involve the medial collateral ligament or the anterior cruciate ligament. In contrast to the medial collateral ligament, which regenerates relatively well, the anterior cruciate ligament demonstrates compromised healing. In the past, there were numerous studies in animal models that examined the healing process of these ligaments, and different explanations were established. Although the healing of these ligaments has been largely investigated and different theories exist, unanswered questions persist.Therefore, the aim of this article is 1) to review the different historical aspects of healing of the medial collateral ligament and present the theories for healing failure of the anterior cruciate ligament; 2) to examine the novel epiligament theory explaining the medial collateral ligament healing process and failure of anterior cruciate ligament healing; and 3) to discuss why the enveloping tissue microstructure of the aforementioned ligaments needs to be examined in future studies.We believe that knowledge of the novel epiligament theory will lead to a better understanding of the normal healing process for implementing optimal treatments, as well as a more holistic explanation for anterior cruciate ligament healing failure.


Author(s):  
R. Kyle Martin ◽  
Solvejg Wastvedt ◽  
Ayoosh Pareek ◽  
Andreas Persson ◽  
Håvard Visnes ◽  
...  

Abstract Purpose External validation of machine learning predictive models is achieved through evaluation of model performance on different groups of patients than were used for algorithm development. This important step is uncommonly performed, inhibiting clinical translation of newly developed models. Machine learning analysis of the Norwegian Knee Ligament Register (NKLR) recently led to the development of a tool capable of estimating the risk of anterior cruciate ligament (ACL) revision (https://swastvedt.shinyapps.io/calculator_rev/). The purpose of this study was to determine the external validity of the NKLR model by assessing algorithm performance when applied to patients from the Danish Knee Ligament Registry (DKLR). Methods The primary outcome measure of the NKLR model was probability of revision ACL reconstruction within 1, 2, and/or 5 years. For external validation, all DKLR patients with complete data for the five variables required for NKLR prediction were included. The five variables included graft choice, femur fixation device, KOOS QOL score at surgery, years from injury to surgery, and age at surgery. Predicted revision probabilities were calculated for all DKLR patients. The model performance was assessed using the same metrics as the NKLR study: concordance and calibration. Results In total, 10,922 DKLR patients were included for analysis. Average follow-up time or time-to-revision was 8.4 (± 4.3) years and overall revision rate was 6.9%. Surgical technique trends (i.e., graft choice and fixation devices) and injury characteristics (i.e., concomitant meniscus and cartilage pathology) were dissimilar between registries. The model produced similar concordance when applied to the DKLR population compared to the original NKLR test data (DKLR: 0.68; NKLR: 0.68–0.69). Calibration was poorer for the DKLR population at one and five years post primary surgery but similar to the NKLR at two years. Conclusion The NKLR machine learning algorithm demonstrated similar performance when applied to patients from the DKLR, suggesting that it is valid for application outside of the initial patient population. This represents the first machine learning model for predicting revision ACL reconstruction that has been externally validated. Clinicians can use this in-clinic calculator to estimate revision risk at a patient specific level when discussing outcome expectations pre-operatively. While encouraging, it should be noted that the performance of the model on patients undergoing ACL reconstruction outside of Scandinavia remains unknown. Level of evidence III.


2021 ◽  
Vol 7 (1) ◽  
pp. 2
Author(s):  
Ulrike Wittig ◽  
Georg Hauer ◽  
Ines Vielgut ◽  
Patrick Reinbacher ◽  
Andreas Leithner ◽  
...  

Anterior cruciate ligament (ACL) injuries are among the most common knee injuries. The purpose of this study was to compare surgical reconstruction of the ACL between different countries and regions in order to describe differences regarding epidemiological data, reconstruction frequency, and graft choice. A systematic literature search was performed using the ACL study group website in order to identify the relevant knee ligament registers. Four national registries were included, comprising those from Sweden, the UK, New Zealand, and Norway. A large variation was found concerning the total number of primary ACL reconstructions with a reported range from 4.1 to 51.3 per 100,000 inhabitants. The country-specific delay between injury and reconstruction varied between an average of 6.0 months and 17.6 months. The leading sports activities resulting in ACL injury included soccer, alpine skiing, handball, rugby, and netball. Moreover, a strong variability in graft choice for primary reconstruction was found. The comparison of ACL registers revealed large differences, indicating different clinical implications regarding conservative or surgical therapy and choice of the preferable graft. ACL registers offer a real-world clinical perspective with the aim to improve quality and patient safety by investigating factors associated with subsequent surgical outcomes.


2021 ◽  
Vol 0 ◽  
pp. 1-10
Author(s):  
Dinshaw N. Pardiwala ◽  
Kushalappa Subbiah ◽  
Raghavendraswami Thete ◽  
Ravikant Jadhav ◽  
Nandan Rao

Multiple ligament knee injuries involve tears of two or more of the four major knee ligament structures, and are commonly noted following knee dislocations. These devastating injuries are often associated with soft-tissue trauma, neurovascular deficit, and concomitant articular cartilage or meniscus tears. The complexity of presentation, and spectrum of treatment options, makes these injuries unique and extremely challenging to even the most experienced knee surgeons. A high level of suspicion, and a comprehensive clinical and radiological examination, is required to identify all injured structures. The current literature supports surgical management of these injuries, with cruciate reconstructions, and repair/augmented repair/ reconstruction of collateral ligaments. This review article analyses management principle of multiple ligament knee injuries, and formulates clinical practice guidelines with treatment algorithms essential to plan individualized management of these complex heterogeneous injuries.


2021 ◽  
pp. 221-231
Author(s):  
Christopher M. Gibbs ◽  
Jonathan D. Hughes ◽  
Giacomo Dal Fabbro ◽  
Margaret L. Hankins ◽  
Khalid Alkhelaifi ◽  
...  

2021 ◽  
Vol 0 ◽  
pp. 1-16
Author(s):  
Robert F. LaPrade ◽  
Edward R. Floyd ◽  
Gregory B. Carlson ◽  
Gilbert Moatshe ◽  
Jorge Chahla ◽  
...  

Multiple knee ligament injuries are defined as a disruption of any combination of the four main ligament complexes; the cruciate ligaments, posterolateral corner, and posteromedial corner. Evaluation requires consideration of the entire clinical picture, including injury to associated structures, directions and degree of instability, neurovascular compromise and appropriate imaging, and physical examination. Reconstruction is favored over repair and anatomic- based reconstruction techniques have been validated to restore the native biomechanics of the knee and lead to successful patient-reported and objective outcomes. Anatomic-based reconstruction of many knee ligaments simultaneously requires precise knowledge of the relevant anatomical landmarks, careful planning of reconstruction tunnel positions, and orientations to avoid tunnel convergence, and employment of immediate early motion in the post-operative rehabilitation regimen to provide the patient the best chance for relatively normal use of the affected limb.


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