Application and Surgical Technique of ACL Reconstruction Using Worldwide Registry Datasets: What Can We Extract?

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.

Measurement of Medial Tibial Eminence Dimensions for the Clinical Evaluation of ACL-Injured Knees: A Comparison between CT and MRI

Anterior cruciate ligament (ACL) injuries commonly lead to translational and rotational tibiofemoral instability. The morphology of the medial tibial eminence (MTE) has received increased attention regarding its role in tibiofemoral stability in ACL-injured knees. Therefore, quantification of MTE dimensions on clinical imaging may help clinicians predict knee stability after ACL injury. Although magnetic resonance imaging (MRI) is routinely obtained in patients with ACL injuries, whether the dimensions of the MTE can be accurate quantified on MRI is unknown. The purpose of this study was to assess the degree of correlation between measurements of MTE height and width on computed tomography (CT) versus MRI. An institutional picture archiving and communication system imaging database was used to identify patients aged between 15 and 60 years who received concurrent MRI and CT of the same knee within a 1-year interval. Knees with significant arthrosis, deformity, intraarticular fracture, or hardware-related artifact that obscured visualization of the MTE were excluded. Mean differences and interstudy agreement between CT and MRI MTE measurements were compared using concordance correlation coefficient (r c) and Bland–Altman analysis. A total of 41 knees in 38 patients (mean age, 37 years; 82% male) were analyzed. Interrater reliability for CT and MRI measurements was high (intraclass correlation coefficient = 0.740–0.954). On coronal CT and MRI, mean MTE height measurements were 10.4 ± 1.9 and 10.4 ± 1.8 mm, respectively; mean MTE width measurements were 14.6 ± 3.6 and 14.2 ± 3.0 mm, respectively. On sagittal CT and MRI, mean MTE height measurements were 11.6 ± 1.7 and 11.7 ± 1.7 mm, respectively; mean MTE width measurements were 36.5 ± 4.8 and 36.2 ± 5.0 mm, respectively. Good agreement was observed between CT and MRI measurements of MTE height and width on coronal and sagittal planes (r c = 0.947–0.969). Measurements of MTE height and width were similar on MRI relative to CT on both coronal and sagittal planes. MRI may be suitable for characterizing the dimensions of the MTE when clinically evaluating patients with ACL injuries, potentially allowing for individualized patient care.

Overview on Causes, Diagnosis and Management of Knee Injuries in Children and Adolescents: Review Article

This review aimed to summarize the updates in the causes, diagnosis and management of knee injuries in children and adolescents. Knee injuries are common and are often the result of multiple forces: varus, valgus, hyperextension, hyperflexion, internal rotation, external rotation, anterior or posterior translation, and axial loading. Certain combinations of force are known to cause specific patterns of injury. A knee injury can affect any ligaments, tendons, or fluid-filled sacs (bursae) that surround the knee joint, as well fas the bones, cartilage, and ligaments that make up the joint itself. ACL injuries are one of the most common types of knee injuries, including a torn meniscus that is common in sports that require jumping jacks, patellar fractures, and knee bruises. Magnetic resonance imaging (MRI) is often used to more fully evaluate knee injuries. Radiologists can accurately identify individual lesions and combinations of lesions. Surgical and non-surgical treatments are performed depending on the case.

Combined Effects of External Moments and Muscle Activations on ACL Loading during Numerical Simulations of a Female Model in OpenSim

Background: Anterior cruciate ligament (ACL) injuries have been studied using a variety of methods and tools. However, each is hindered by specific limitations with respect to its application. Aim: To assess the combined effects of external moments and muscle activations on ACL loading using serial, forward dynamics (FD) simulations of single leg, hyperextension landings in OpenSim. Methods: The FD tool of OpenSim was iteratively run using different combinations of knee-spanning muscle activation levels, internal rotation and valgus knee moment magnitudes. A regression was conducted on the data in order to predict ACL loading under different conditions. Results: A purely abduction moment leads to greater mean ACL loading than a purely internal rotation moment or any combination of the two. Additionally, the generalized boosted regression model using both external moments and certain knee muscles identified the internal rotation moment as the most important variable in predicting the ACL load (R2 = 0.9; p < 0.0001). Conclusion: This study demonstrated a novel and practical application of an OpenSim musculoskeletal model that supports the ACL injury mechanism of landing with low knee flexion angles, high muscle forces of the Quadriceps muscles and an external knee valgus moment, though further investigation is needed.

The efficiency of proprioceptive training in preventing injuries to team athletes: A systematic review

The aim of this systematic review was to evaluate the effectiveness of proprioceptive training in the prevention of lower extremity injuries, especially the ankle and knee joint, in team athletes. PRISMA recommendations were applied for this research. PubMed, ScienceDirect, and BioMed Central were used to identify relevant studies. The methodological quality of studies was assessed using the Physiotherapy Evidence Database-PEDro scale. Only 7 research met the eligibility criteria, and their outcomes were presented. Proprioceptive training has been shown to be very effective in preventing ankle injuries, especially in recurrent ankle sprains. However, in 3 of 4 studies lacked the effects of proprioceptive training in the prevention of knee and ACL injuries. Based on the results of the analyzed research, I can conclude that proprioceptive training is a very effective training tool in the prevention of ankle sprains in the population of team athletes, but proprioceptive training is not sufficient as the only training component in preventing knee injuries.

Risk Factors of ACL Injury

An anterior cruciate ligament(ACL) is one of the major stabilizers of the knee joint, injury to which can be quite dreadful even ending many sports careers if not properly treated. Knowledge of the risk factors contributing to ACL injury will help in identifying at-risk individuals and develop preventive strategies. The factors contributing to ACL injury are multi-factorial involving biomechanical, anatomical, hormonal, neuromuscular factors etc; and can be broadly classified as Intrinsic and Extrinsic factors. Intrinsic factors are mostly non-modifiable risk factors may be subdivided into anatomical, genetic, gender, previous ACL Injuries etc . Whereas Extrinsic factors are mostly modifiable risk factors include environmental factors, characteristic of surface and shoe, BMI and others. Anatomical risk factors can divided into tibial parameters like posterior tibial slope, medial tibial plateau depth etc ; femoral parameters like notch width, notch index etc.

Sexual Dimorphisms in Anterior Cruciate Ligament Injury: A Current Concepts Review

Background: Although most anterior cruciate ligament (ACL) injuries occur in male athletes, female athletes are consistently observed to be at a higher risk for sports-specific ACL injury. Purpose: To provide a thorough review of what is known about the sexual dimorphisms in ACL injury to guide treatment and prevention strategies and future research. Study Design: Narrative review. Methods: We conducted a comprehensive literature search for ACL-related studies published between January 1982 and September 2017 to identify pertinent studies regarding ACL injury epidemiology, prevention strategies, treatment outcomes, and dimorphisms. By performing a broad ACL injury search, we initially identified 11,453 articles. After applying additional qualifiers, we retained articles if they were published in English after 1980 and focused on sex-specific differences in any of 8 different topics: sex-specific reporting, difference in sports, selective training, hormonal effects, genetics, neuromuscular and kinematic control, anatomic differences, and outcomes. Results: A total of 122 articles met the inclusion criteria. In sum, the literature review indicated that female athletes are at significantly higher risk for ACL injuries than are their male counterparts, but the exact reasons for this were not clear. Initial studies focused on intrinsic differences between the sexes, whereas recent studies have shifted to focus on extrinsic factors to explain the increased risk. It is likely both intrinsic and extrinsic factors contribute to this increased risk, but further study is needed. In addition to female patients having an increased risk for ACL injuries, they are less likely than are male patients to undergo reconstructive surgery, and they experience worse postsurgical outcomes. Despite this, reconstructive surgery remains the gold standard when knee stability, return to sports, and high functional outcome scores are the goal, but further research is needed to determine why there is disparity in surgical rates and what surgical techniques optimize postsurgical outcomes for female patients. Conclusion: Male athletes often predominated the research concerning ACL injury and treatment, and although sex-specific reporting is progressing, it has historically been deficient. ACL injuries, prevention techniques, and ACL reconstruction require further research to maximize the health potential of at-risk female athletes.

Evaluating the Diagnostic Pathway for Acute ACL Injuries in Trauma Centres: A Systematic Review

Objective: This review sought to evaluate the literature on the initial assessment and diagnostic pathway for patients with a suspected Anterior Cruciate Ligament (ACL) tear.Methods: MEDLINE, EMBASE, and CINAHL were systematically searched for eligible studies. Studies were included if they used at least one assessment method to assess for ACL injury and participants were assessed at an acute trauma centre within 6-weeks of injury. Article quality was evaluated using the QUADAS-2 checklist. Results: A total of 353 studies were assessed for eligibility, 347 were excluded for the following reasons: injuries were not assessed in an acute trauma setting, injuries were not acute, participants had previous ACL injuries or chronic joint deformities affecting the knee, participants were under 18, or participants included animals or cadavers. A total of six studies were included in the review. Common assessment methods included: laxity tests, joint effusion, inability to continue activity, and a history of a ‘pop’ and ‘giving way’ at the time of injury. Diagnostic accuracy varied greatly between the assessment method and the assessing clinician. Gold standard diagnostics were MRI and arthroscopy. A weighted meta-mean calculated the time to reach diagnosis to be 68.60 days [CI 23.94, 113.24]. The mean number of appointments to reach diagnosis varied from 2-5. Delay to surgery or surgical consultation ranged from 61 to 328 days. Conclusion: Clinicians in the Emergency Department are not proficient in performing the assessment methods that are used for diagnosis in acute ACL injury. Reliance on specialist assessments or radiological methods inevitably increases the time to reach a diagnosis, which has repercussions on management options. There is an ever-growing demand to improve diagnostic accuracy and efficiency, innovation into new diagnostic methods that require less specialist training would help improve patient care.

Tendency of Driving to the Basket Is Associated With Increased Risk of Anterior Cruciate Ligament Tears in National Basketball Association Players: A Cohort Study

Background: Driving to the basket in basketball involves acceleration, deceleration, and lateral movements, which may expose players to increased anterior cruciate ligament (ACL) injury risk. It is unknown whether players who heavily rely on driving have decreased performance on returning to play after ACL reconstruction (ACLR). Hypothesis: Players with a greater tendency to drive to the basket would be more likely to tear their ACL versus noninjured controls and would experience decreased performance when returning to play after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: Season-level performance statistics and ACL injuries were aggregated for National Basketball Association (NBA) seasons between 1980 and 2017 from publicly available sources. Players’ tendency to drive was calculated using 49 common season-level performance metrics. Each ACL-injured player was matched with 2 noninjured control players by age, league experience, and style of play metrics. Points, playing minutes, driving, and 3-point shooting tendencies were compared between players with ACL injuries and matched controls. Independent-samples t test was utilized for comparisons. Results: Of 86 players with a total of 96 ACL tears identified in the NBA, 50 players were included in the final analysis. Players who experienced an ACL tear had a higher career-average drive tendency than controls ( P = .047). Players with career-average drive tendency ≥1 standard deviation above the mean were more likely to tear their ACL than players with drive tendency <1 standard deviation (5.2% vs 2.7%; P = .026). There was no significant difference in total postinjury career points ( P = .164) or career minutes ( P = .237) between cases and controls. There was also no significant change in drive tendency ( P = .152) or 3-point shooting tendency ( P = .508) after return to sport compared with controls. Conclusion: NBA players with increased drive tendency were more likely to tear their ACL. However, players who were able to return after ACLR did not underperform compared with controls and did not alter their style of play compared with the normal changes seen with age. This information can be used to target players with certain playing styles for ACL injury prevention programs.