A comparative analysis of the efficacy of anterior cruciate ligament reconstruction with autologous ligament grafting at different time points

BackgroundThis study was performed to compare the clinical efficacies of anterior cruciate ligament (ACL) reconstruction with autologous ligament grafting at different time points.MethodsEighty‐five patients with ACL were categorized into two groups: Group A (GA, n = 45), who underwent early‐stage (≤3 weeks) surgery, and Group B (GB, n = 40), who underwent advanced‐stage (>3 weeks) surgery. Perioperative conditions, knee joint functions, activity and stability before and at 6 months postoperatively, changes in quality of life (QOL), good and excellent rates of knee joint functions, and incidence of complications were compared between the two groups.ResultsIn both groups, there was an increase in the International Knee Documentation Committee (IKDC) score, Lysholm score, and QOL and a decrease in the knee joint angle flexion limitation, angle of spread limitation, positive rates in the anterior drawer test (ADT), and Lachman test score (P < .05) after surgery. At 6 months postoperatively, the IKDC score, Lysholm score, and QOL were higher in GA than in GB (P < .05). The good and excellent rates of knee joint functions were higher in GA than in GB (93.33% vs. 77.50%) (P < .05).ConclusionAnterior cruciate ligament reconstruction with autologous ligament grafting can achieve good effects whether performed in the early or advanced stage; however, the improvements in patients'' knee joint functions and QOL are better in the early stage. Therefore, early ACL reconstruction with autologous ligament grafting is suggested.     

DUAL-TASK ASSESSMENT IMPLICATIONS FOR ANTERIOR CRUCIATE LIGAMENT INJURY: A SYSTEMATIC REVIEW

Background:Several systematic reviews have evaluated the role of dual-task assessment in individuals with concussion. However, no systematic reviews to date have investigated dual-task protocols with implications for individuals with anterior cruciate ligament (ACL) injury or ACL reconstruction (ACLR).Purpose:To systematically review the evidence on dual-task assessment practices applicable to those with ACL deficiency/ACLR, specifically with the aim to identify motor-cognitive performance costs.Study Design:Systematic reviewMethods:A systematic literature review was undertaken on those with ACL-deficient or ACL-reconstructed knees performing dual-task activities. The following databases were searched from inception to June 8, 2018 including CINAHL, PsychInfo, PubMed, SPORTDiscus, Web of Science, and gray literature. Three primary search categories (knee, cognition, and motor task) were included. Only one reviewer independently performed the database search, data extraction, and scored each article for quality. All studies were assessed for quality and pertinent data were extracted, examined and synthesized.Results:Ten studies were included for analysis, all of which were published within the prior ten years. Performance deficits were identified in those with either ACL deficiency or ACLR while dual-tasking, such as prioritization of postural control at the expense of cognitive performance, impaired postural control in single limb stance, greater number of cognitive errors, and increased step width coefficient of variation while walking. No studies examined those with prior ACL injury or ACLR during tasks that mimicked ACL injury mechanisms such as jump-landing or single-leg cutting.Conclusion:The results of the current systematic review suggests that postural control, gait, and/or cognitive deficits exist when evaluated under a dual-task paradigm in those with ACL deficiency or ACLR. This systematic review highlights the need for future research on dual-task assessment for individuals who have sustained an ACL injury or undergone ACLR, specifically utilizing more difficult athletic movements.Level of Evidence:Level 3a     

How Important is the Tunnel Position in Outcomes Post-ACL Reconstruction: A 3D CT-Based Study

BackgroundDrilling the femoral and tibial tunnels at their anatomical locations are critical for good outcomes and involve seeing the footprints well. We intended to compare two techniques of drilling the tunnels and the patient-reported outcomes and knee stability of patients undergoing single bundle ACL reconstruction using 3D CT to evaluate if the tunnels were anatomical or not.Materials and MethodsSixty single bundle ACL reconstructions were analyzed, 30 each with Technique A and B. Pre-operative and after a minimum 27 month follow-up Lysholm, IKDC, Tegner score, hop test, and Lachman test were noted. 3D CT was done to classify femoral tunnels positions as being well placed, slightly or grossly misplaced and tibial tunnels as optimal or suboptimal and compared.ResultsSixty ACL reconstructions had full follow-up with a mean follow-up of 34 months. There was no significant difference between tunnel positions between the two techniques. Well-placed femoral tunnel had better Lysholm score (62.2 ± 16.2 v/s 48.5 ± 17.2, p 0.002) and IKDC score (62.5 ± 14.3 v/s 52.7 ± 15.1, p 0.012).). Those who had their surgeries within 3 months of their injury had better hop test (4.4 ± 0.9 v/s 3.9 ± 1, p 0.034) and IKDC scores (62.5 ± 15.8 v/s 33.2 ± 13.8, p 0.026) as compared to those that had surgery done after 3 monthsConclusionTibial tunnel positions were optimal in most cases and did not differ between the two techniques. Well-placed femoral tunnels and surgeries done within 3 months of the injury produced best results.     

A Prospective Observational Study on Short-Term Functional Outcome of Arthroscopic Anterior Cruciate Ligament Repair of Proximal Tears Using Knotless Single Suture Anchor Technique

PurposeTo assess the clinical outcomes in patients with anterior cruciate ligament (ACL) proximal tears undergoing arthroscopic primary repair with knotless single suture anchor technique.MethodsThe first twenty-two consecutive patients with proximal ACL tears (Sherman types I and II and high-grade partial tears) treated with arthroscopic primary repair with single suture anchor technique were evaluated until 6 months post-operatively. Patients were evaluated with validated functional outcome measures (IKDC and Lysholm scores) and clinical tests for ACL stability.ResultsAt 6-month follow-up, 91% of patients (n = 20) achieved excellent outcome measures for IKDC and Lysholm scores and had complete stability of the ACL to clinical testing. Two patients with poor outcomes at six weeks; one with subjective instability and the other underwent revision surgery represented a failure rate of 9%. The median Lysholm score was 96 (IQ range, 96–100) and median IKDC subjective score was 87.40 (IQ range, 78.20–88.50) at 6-month follow-up. The improvement in Lysholm and IKDC scores over a period of six months post-operatively was statistically significant when compared to preoperative scores (p ≪ 0.0001). Maximum improvement in clinical outcomes is achieved in the first 6 weeks post-surgery with a slower increase thereafter, a time interval which may be considered as a figurative yield point for future work in this field.ConclusionArthroscopic ACL primary repair with knotless single suture anchor technique provides excellent short-term clinical outcomes in a carefully selected subset of patients with proximal ACL tears. More powered and longer duration studies are needed to understand longer term outcomes.Level of EvidenceLevel IV, therapeutic case series.     

前交叉韧带损伤后关节腔内后交叉韧带中基质金属蛋白酶-II活性的研究

目的 初步探索前交叉韧带(anterior cruciate ligament,ACL)损伤后后交叉韧带(posterior cruciate ligament,PCL)中基质金属蛋白酶(MMP-2)的表达量变化情况。方法 用本实验室已获专利的大鼠前交叉韧带瞬时扭转损伤装置将大鼠ACL损伤后在ex-vivo水平上用酶谱分析的方法检测PCL组织中所释放MMP-2的情况。结果 ACL损伤后的第1,2,3天后,PCL组织培养上清液中的MMP-2表达量呈时间依赖性递增趋势。结论 ACL急性损伤后, PCL组织释放大量MMP-2至关节液中。     

Is there significant variation in the material properties of four different allografts implanted for ACL reconstruction

The aims of our study were to: (1) determine if there are differences in the material properties of tendon obtained from implanted tibialis anterior, achilles, bone-patella- bone and tibialis posterior allografts; (2) determine the variability in material properties between the implanted specimens. A total of 60 specimens were collected from fresh frozen allografts implanted at ACL reconstruction. Specimens collected included 15 tibialis anterior, 15 tibialis posterior, 15 achilles and 15 bone-patella-bone tendons. Each specimen was mounted in a custom made cryogrip. The mounted specimens were loaded onto a MTS Testline servo-hydraulic testing machine in a uni-axial tensile test configuration. Specimens were subjected to a strain rate of 5% per second until the ultimate tensile stress (UTS), failure strain and high strain modulus was calculated for each specimen after being normalized for specimen dimensions. Individual material properties were tested using one way analysis of variance (ANOVA) and post hoc Tukey’s B test with a P value of <0.05 considered significant. Homogeneity of variance was assessed using the Levene’s test. As a result, no significant difference was found between all four grafts with regards to UTS, failure strain or high strain linear modulus. The UTS was plotted against the modulus demonstrating a linear relationship which is typical of soft tissues. Significant variability in the results were observed. In conclusion, there was no significant statistical difference between the material properties of the four tendon allografts tested. But significant variability in results was observed within groups and between groups, which may provide one explanation for the range of results in allograft ACL reconstruction reported in the literature.     

半腱肌股薄肌腱横杆悬挂固定法重建膝关节前交叉韧带

目的介绍关节镜下横杆悬挂固定法(Arthrex TransFixⅡ法)固定移植的半腱肌腱、股薄肌腱重建膝关节前交叉韧带的方法。方法2003-01~2005-12,采用半腱肌、股薄肌腱横杆悬挂固定法重建膝关节前交叉韧带43例。其中,男性32例,女性11例。年龄19~67岁,平均年龄26.8岁。平均病程8.9个月。移植物股骨端行横杆悬挂法固定,胫骨端齿压钉固定。结果43例患者中,40例获得随访,随访时间6~18个月,平均12.3个月。随访病例术前Lysholm评分为(49.8±2.7)分,随访时Lysholm评分(91.7±1.8)分,两者相比有显著性差异(P<0.05)。结论关节镜下半腱肌、股薄肌腱横杆悬挂固定法重建膝关节前交叉韧带,是一种微创、疗效确切的方法。     

ACL Injury prevention in female athletes: review of the literature and practical considerations in implementing an ACL prevention program

Female athletes are at 3.5 times risk of sustaining a non-contact ACL injury compared with males. Research has shown that this gender discrepancy results from differences in neuromuscular adaptations and biomechanics related to landing techniques. Studies have examined the preventative effect of ACL prevention programs, which have been designed to address these risky neuromuscular and biomechanical patterns. We review the key studies on ACL prevention in female athletes and summarize the critical components of ACL prevention strategies that have been shown to successfully decrease ACL injury risk. We also discuss recommendations and practical considerations in the implementation of ACL prevention programs in various community settings.     

Reactive oxygen species produced in mitochondria are involved in age-dependent changes of hematopoietic and mesenchymal progenitor cells in mice. A study with the novel mitochondria-targeted antioxidant SkQ1

Lifelong treatment of mice with the effective mitochondria-targeted antioxidant SkQ1 [10-(6′-plastoquinonyl) decyltriphenylphosphonium] does not affect hematopoietic stem cells (HSC) and more differentiated hematopoietic progenitors but significantly decelerates age-dependent changes in peripheral blood. During the first 13 months, SkQ1 (0.9 or 28.8 nmol/kg day) prevents age-dependent myeloid shift (increase in the proportion of granulocytes and decrease in the proportion of lymphocytes). During the next year of treatment the effect disappears, and the hemogram of 2-year-old treated mice does not differ from the control. The number of mesenchymal stem cells (MSC) in the bone marrow does not change during 2 years of treatment with SkQ1, but the concentration of MSC progeny fibroblast colony-forming units (CFU-F) increases with dose of SkQ1. The concentration of CFU-F after 1 and 2 years treatment with SkQ1 is twice higher than in young mice. Our data indicate that the stromal environment of hematopoietic cells could be the primary target of age-dependent changes mediated by reactive oxygen species produced in mitochondria. The anti-aging effects of SkQ1 described here are in perfect agreement with the inhibitory effects of this antioxidant on aging observed in the other models.