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Clinics in Sports Medicine Oct 2023Acromioclavicular joint separations are common shoulder injuries that require prompt recognition, diagnosis, and treatment. Deciding on a treatment algorithm relies on a... (Review)
Review
Acromioclavicular joint separations are common shoulder injuries that require prompt recognition, diagnosis, and treatment. Deciding on a treatment algorithm relies on a detailed knowledge of anatomy and a thorough understanding of the specific functional demands of the patient in question. When a repair or reconstruction is indicated, arthroscopic assistance can be a helpful tool to ensure a safe, anatomic reconstruction that minimizes morbidity and maximizes the potential return to high-level function.
Topics: Humans; Acromioclavicular Joint; Ligaments, Articular; Algorithms; Shoulder Injuries
PubMed: 37716724
DOI: 10.1016/j.csm.2023.05.004 -
Journal of ISAKOS : Joint Disorders &... Aug 2023Ligament augmentation techniques (LATs) are surgical procedures, in which an anatomical ligament repair or reconstruction is strengthened with a synthetic material.... (Review)
Review
IMPORTANCE
Ligament augmentation techniques (LATs) are surgical procedures, in which an anatomical ligament repair or reconstruction is strengthened with a synthetic material. During the last decade, LATs have increased in prevalence in clinical practice and academic literature. Observing the trends in LAT publications can be used to identify clusters of strong evidence for clinical practice and to highlight areas of the literature which need further development.
OBJECTIVE
This article aims to define ligament augmentation as a technique category, observe anatomical, procedural, and temporal trends in LAT publication, and report on the state of current research in this field.
EVIDENCE REVIEW
Primary literature in the English language, which describes ligament augmentation and reports on human, cadaveric, or biomechanical models, and published prior to May 24th, 2022, was targeted for analysis. PubMed, Embase, and Cochrane CENTRAL databases were explored using a focused keyword search strategy, and the resulting publications were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were collected and analysed using descriptive statistics.
FINDINGS
Two hundred eighty-three publications reporting ligament augmentation techniques, published from May 1989 to May 2022, were included for final analysis. A wide technical and anatomical variety of procedures are reported. 36.8% of LAT publications describe knee ligaments, among which the anterior cruciate ligamenthas the highest focus in ligament augmentation publications (31.8% of articles). LAT literature has recently expanded in anatomical scope, with many contemporary articles describing the usage of a LAT in the ankle syndesmosis and coracoclavicular ligaments. 60.4% of LAT literature has been published since 2017. There has been an 11% average increase in the rate of LAT publication reports since 2015. Novel fixation devices-suture buttons and suture anchors-have gained wide popularity in the literature.
CONCLUSIONS AND RELEVANCE
In this review, we define LATs and quantitatively describe the expansion of LAT use reported in the literature. This data will provide physicians an overview of the history of these methods, as well as illustrate the broad range of applications available for the use of LATs.
Topics: Humans; Knee Joint; Ankle Joint; Ligaments, Articular; Suture Anchors
PubMed: 37105381
DOI: 10.1016/j.jisako.2023.04.003 -
International Journal of Molecular... Jan 2024Knee osteoarthritis (OA), an age-related degenerative disease characterized by severe pain and disability, is treated using polynucleotides (PNs) and hyaluronic acid...
Knee osteoarthritis (OA), an age-related degenerative disease characterized by severe pain and disability, is treated using polynucleotides (PNs) and hyaluronic acid (HA). The intra-articular (IA) injection of HA has been studied extensively in both animal models and in humans; however, the efficacy and mechanisms of action remain unclear. In addition, there has been a paucity of research regarding the use of PN alone or in combination with HA in OA. To investigate the effect of the combined injection of PN and HA in vivo, pathological and behavioral changes were assessed in an OA model. Anterior cruciate ligament transection and medial meniscectomy were performed in Sprague-Dawley rats to create the OA animal model. The locomotor activity improved following PNHA injection, while the OARSI grade improved in the medial tibia and femur. In mild OA, TNFα levels decreased histologically in the PN, HA, and PNHA groups but only the PNHA group showed behavioral improvement in terms of distance. In conclusion, PNHA exhibited anti-inflammatory effects during OA progression and improved locomotor activity regardless of the OARSI grade.
Topics: Rats; Humans; Animals; Hyaluronic Acid; Polynucleotides; Rats, Sprague-Dawley; Osteoarthritis, Knee; Anterior Cruciate Ligament; Injections, Intra-Articular
PubMed: 38338992
DOI: 10.3390/ijms25031714 -
Foot (Edinburgh, Scotland) Sep 2023AAFD comprises ligamentous failure and tendon overload, mainly focused on the symptomatic posterior tibial tendon and the spring ligament. Increased lateral column (LC)... (Review)
Review
AAFD comprises ligamentous failure and tendon overload, mainly focused on the symptomatic posterior tibial tendon and the spring ligament. Increased lateral column (LC) instability arising in AAFD is not defined or quantified. This study aims to quantify the increased LC motion in unilateral symptomatic planus feet, using the contralateral unaffected asymptomatic foot as an internal control. In this case matched analysis, 15 patients with unilateral stage 2 AAFD foot and an unaffected contralateral foot were included. Lateral foot translation was measured as a guide to spring ligament competency. Medial and LC dorsal sagittal instability were assessed by direct measurement of dorsal 1st and 4th/5th metatarsal head motion and further video analysis. The mean increase in dorsal LC sagittal motion (between affected vs unaffected foot) was 5.6 mm (95% CI [4.63-6.55], p < 0.001). The mean increase in the lateral translation score was 42.8 mm (95% CI [37.48-48.03], p < 0.001). The mean increase in medial column dorsal sagittal motion was 6.8 mm (95% CI [5.7-7.8], p < 0.001). Video analysis also showed a statistically significant increase in LC dorsal sagittal motion between affected and unaffected sides (p < 0.001). This is the first study that quantifies a statistically significant increased LC dorsal motion in feet with AAFD. Understanding its pathogenesis and its link to talonavicular/spring ligament laxity improves foot assessment and may allow the development of future preventative treatment strategies.
Topics: Humans; Adult; Flatfoot; Foot; Ligaments, Articular; Tendons; Tarsal Joints
PubMed: 37271102
DOI: 10.1016/j.foot.2023.102036 -
The Knee Oct 2023Treatment of patellar instability remains up for debate, and a combination of tibial tubercle osteotomy and medial patellofemoral ligament reconstruction (MPFLr) of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Treatment of patellar instability remains up for debate, and a combination of tibial tubercle osteotomy and medial patellofemoral ligament reconstruction (MPFLr) of the medial patellofemoral ligament (MPFL) has become the mainstay treatment for recurrent lateral patellar dislocation. Due to limited small studies, there remains a variety of surgical techniques still being practiced. The use of MPFL reconstruction, in isolation, has demonstrated promise.
PURPOSE
The purpose of this systematic review and meta-analysis is to investigate if isolated medial patellofemoral ligament reconstruction (iMPFLr) can safely and efficaciously restore knee stability and to present the patient demographics, surgical techniques, graft choices, clinical outcomes, and complications after iMPFLr for recurrent patellar dislocation (RPD).
METHODS
A review of the current literature according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, yielded 299 abstracts. Twenty-seven articles met the inclusion/exclusion criteria accounting for 1200 patients. Data was pooled and analyzed focusing on patient demographics, graft type used, Kujala, International Knee Documentation Committee (IKDC), Lysholm, Tegner, and complications.
RESULTS
Across all studies the weighted mean age was found to be an average of 24.5 years, BMI was 24.9 kg/m, follow-up was 47.3 months, as 67% were female, TT-TG distance was 15.3 mm, and Caton Deschamps index 1.11. The pooled effect size difference of pre versus post assessment of Kujala was -2.8, IKDC was -4.5, Lysholm was -6.4, and Tegner was -0.74. The pooled complication rate was found to be 8% across all included studies. A subgroup analysis was also performed, specifically looking at how single bundle, double bundle, gracilis, semitendinosus and knee angle during fixation effect outcome data.
CONCLUSION
This systematic review and meta-analysis demonstrates that isolated MPFL reconstruction is a safe and effective treatment for recurrent patellar dislocations. Given the efficacy of isolated MPFL reconstruction, future investigations should aim to uncover the exact TT-TG distance, trochlear dysplasia, and patella alta grade for selecting patients to undergo this procedure. Furthermore, more primary research needs to be conducted on this topic due to the overall lack of published data from randomized controlled studies and no broad standardization of outcome measurements.
LEVEL OF EVIDENCE
(4) Systematic Review and Meta-Analysis.
Topics: Humans; Female; Young Adult; Adult; Male; Patellar Dislocation; Patellofemoral Joint; Joint Instability; Knee Joint; Joint Dislocations; Ligaments, Articular; Patella
PubMed: 37531844
DOI: 10.1016/j.knee.2023.07.003 -
Journal of Orthopaedic Surgery and... Sep 2023The objective of this study was to investigate the potential of arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor as a treatment...
PURPOSE
The objective of this study was to investigate the potential of arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor as a treatment option for patients experiencing symptomatic acute and subacute (< 3 months) scapholunate instability.
METHODS
From Jan. 2017 to Jan 2020, 19 wrists with acute or subacute tears of the SL ligament with symptomatic instability were treated with arthroscopic SL repair and dorsal capsulodesis with a suture anchor. The average time from injury to operation was 8.8 weeks (range, 4-11 weeks) and the regular follow-up mean duration at our clinic was 26.5 months (range, 24-32 months). The pain score according to the visual analog scale, wrist range of motion, grip strength, radiographic outcomes and functional outcomes according to the Modified Mayo Wrist Score (MMWS) were evaluated preoperatively and postoperatively during the follow-up period.
RESULTS
All 19 patients had rupture and dissociation of the SL ligament in the radiocarpal joint. The total arc of wrist motion in the flexion-extension plane loss averaged 5.1° (P > .01).The Wilcoxon signed-rank test was used to compare the results: grip force improved significantly with 14.7% improvement of that on the normal side (P < .01); the postoperative MMWS was significantly better than the preoperative scores (P < .01). Of 19 patients of the series, 18 patients (94.7%) achieved good or excellent results according to the MMWS and 16 patients (84.2%) resumed their previous activities. Only one patient (5.3%) had residual laxity of the scapholunate ligament joint at 15 months of follow-up.
CONCLUSIONS
At a minimum of two years of follow-up, patients with acute or subacute symptomatic dissociation of scapholunate ligament instability who underwent arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor treatment had satisfactory results.
LEVEL OF EVIDENCE
Level IV, case series.
Topics: Humans; Suture Anchors; Wrist Joint; Wrist; Ligaments, Articular; Ambulatory Care Facilities
PubMed: 37670343
DOI: 10.1186/s13018-023-04148-y -
The Bone & Joint Journal Dec 2023The aim of this study was to establish consensus statements on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy,...
AIMS
The aim of this study was to establish consensus statements on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy, trochleoplasty, and rehabilitation and return to sporting activity in patients with patellar instability, using the modified Delphi process.
METHODS
This was the second part of a study dealing with these aspects of management in these patients. As in part I, a total of 60 surgeons from 11 countries contributed to the development of consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered unanimous.
RESULTS
Of 41 questions and statements on patellar instability, none achieved unanimous consensus, 19 achieved strong consensus, 15 achieved consensus, and seven did not achieve consensus.
CONCLUSION
Most statements reached some degree of consensus, without any achieving unanimous consensus. There was no consensus on the use of anchors in MPFL reconstruction, and the order of fixation of the graft (patella first versus femur first). There was also no consensus on the indications for trochleoplasty or its effect on the viability of the cartilage after elevation of the osteochondral flap. There was also no consensus on postoperative immobilization or weightbearing, or whether paediatric patients should avoid an early return to sport.
Topics: Humans; Child; Joint Instability; Patellar Dislocation; Patellofemoral Joint; Delphi Technique; Knee Joint; Ligaments, Articular
PubMed: 38035602
DOI: 10.1302/0301-620X.105B12.BJJ-2023-0110.R1 -
Knee Surgery, Sports Traumatology,... Oct 2023Variations in femoral and tibial bony morphology have been associated with higher clinical grading and increased quantitative tibial translation, but not tibial...
PURPOSE
Variations in femoral and tibial bony morphology have been associated with higher clinical grading and increased quantitative tibial translation, but not tibial acceleration, during the pivot shift test following anterior cruciate ligament (ACL) injury. The purpose of this study was to determine the impact of femoral and tibial bony morphology, including a measurement influenced by both parameters (the Lateral Tibiofemoral Articular Distance (LTAD)), on the degree of quantitative tibial acceleration during the pivot shift test and rates of future ACL injury.
METHODS
All patients who underwent primary ACL reconstruction from 2014 to 2019 by a senior orthopedic surgeon with available quantitative tibial acceleration data were retrospectively reviewed. All patients underwent a pivot shift examination under anesthesia with a triaxial accelerometer. Measurements of femoral and tibial bony morphology were performed by two fellowship-trained orthopedic surgeons using preoperative magnetic resonance imaging and lateral radiographs.
RESULTS
Fifty-one patients were included at a mean follow-up of 4.4 years. The mean quantitative tibial acceleration during the pivot shift was 13.8 m/s (range: 4.9-52.0 m/s). A larger Posterior Condylar Offset Ratio (r = 0.30, p = 0.045), smaller medial-to-lateral width of the medial tibial plateau (r = - 0.29, p = 0.041), lateral tibial plateau (r = - 0.28, p = 0.042), and lateral femoral condyle (r = - 0.29, p = 0.037), and a decreased LTAD (r = - 0.53, p < 0.001) significantly correlated with increased tibial acceleration during the pivot shift. Linear regression analysis demonstrated an increase in tibial acceleration of 1.24 m/s for every 1 mm decrease in LTAD. Nine patients (17.6%) sustained ipsilateral graft rupture and 10 patients (19.6%) sustained contralateral ACL rupture. No morphologic measurements were associated with rates of future ACL injury.
CONCLUSION
Increased convexity and smaller bony morphology of the lateral femur and tibia were significantly associated with increased tibial acceleration during the pivot shift. Additionally, a measurement, termed the LTAD, was found to have the strongest association with increased tibial acceleration. Based on the results of this study, surgeons can utilize these measurements to preoperatively identify patients at risk of increased rotatory knee instability.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Retrospective Studies; Knee Joint; Tibia; Joint Instability; Epiphyses
PubMed: 37410122
DOI: 10.1007/s00167-023-07472-2 -
Osteoarthritis and Cartilage Nov 2023To explore the significance of BMP signaling in osteoarthritis (OA) etiology, and thereafter propose a disease-modifying therapy for OA.
OBJECTIVE
To explore the significance of BMP signaling in osteoarthritis (OA) etiology, and thereafter propose a disease-modifying therapy for OA.
METHODS
To examine the role of the BMP signaling in pathogenesis of OA, an Anterior Cruciate Ligament Transection (ACLT) surgery was performed to incite OA in C57BL/6J mouse line at postnatal day 120 (P120). Thereafter, to investigate whether activation of BMP signaling is necessary and sufficient to induce OA, we have used conditional gain- and loss-of-function mouse lines in which BMP signaling can be activated or depleted, respectively, upon intraperitoneal injection of tamoxifen. Finally, we locally inhibited BMP signaling through intra-articular injection of LDN-193189 pre- and post-onset surgically induced OA. The majority of the investigation has been conducted using micro-CT, histological staining, and immuno histochemistry to assess the disease etiology.
RESULTS
Upon induction of OA, depletion of SMURF1-an intra-cellular BMP signaling inhibitor in articular cartilage coincided with the activation of BMP signaling, as measured by pSMAD1/5/9 expression. In mouse articular cartilage, the BMP gain-of-function mutation is sufficient to induce OA even without surgery. Further, genetic, or pharmacological BMP signaling suppression also prevented pathogenesis of OA. Interestingly, inflammatory indicators were also significantly reduced upon LDN-193189 intra-articular injection which inhibited BMP signaling and slowed OA progression post onset.
CONCLUSION
Our findings showed that BMP signaling is crucial to the etiology of OA and inhibiting BMP signaling locally can be a potent strategy for alleviating OA.
Topics: Mice; Animals; Osteoarthritis, Knee; Disease Models, Animal; Mice, Inbred C57BL; Anterior Cruciate Ligament; Cartilage, Articular
PubMed: 37392862
DOI: 10.1016/j.joca.2023.05.016 -
Arthroscopy : the Journal of... Dec 2023To compare the clinical, radiographic, and second-look arthroscopic outcomes between double-bundle (DB) anterior cruciate ligament (ACL) reconstruction (DB group) and... (Randomized Controlled Trial)
Randomized Controlled Trial
Single Bundle Anterior Cruciate Ligament With Anterolateral Ligament Reconstruction Yields Similar Clinical and Radiographic Results at Minimum 2-Year Follow-Up Versus Double Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Controlled Trial.
PURPOSE
To compare the clinical, radiographic, and second-look arthroscopic outcomes between double-bundle (DB) anterior cruciate ligament (ACL) reconstruction (DB group) and combined single-bundle (SB) ACL and anterolateral ligament (ALL) reconstruction (SB + ALL group) by a prospective randomized controlled trial.
METHODS
From May 2019 to June 2020, 84 patients were enrolled in this study. Among them, 10 were lost to follow-up. Thirty-six and 38 patients were successfully allocated to the DB (mean follow up 27.3 ± 4.2 months) and SB + ALL groups (27.2 ± 4.5 months), respectively. The preoperative and postoperative Lachman test, pivot shift test, anterior translation on stress radiographs, KT-2000 arthrometer, Lysholm score, International Knee Documentation Committee score, and Tegner activity score were evaluated and compared. Graft continuity was evaluated using postoperative magnetic resonance imaging (MRI) (32 and 36 patients underwent MRI in the DB and SB + ALL groups at 7.4 ± 3.2 and 7.5 ± 2.9 months after surgery, respectively), and second-look examinations (second-look examination and tibial screw removal were performed concomitantly when patients (1) had tibial screw-related irritation or (2) needed the screws removed, 28 and 23 patients underwent examinations in the DB and SB + ALL groups at 24.0 ± 6.8 and 24.9 ± 8.1 months after surgery, respectively). All measurements were compared between the groups.
RESULTS
Postoperative clinical outcomes significantly improved in both groups. (All variables showed P < .001) No statistically different outcomes were found between the 2 groups. Additionally, postoperative graft continuity on MRI and second-look examinations were not different between the 2 groups.
CONCLUSIONS
The DB and SB + ALL groups showed similar postoperative clinical, radiographic, and second-look arthroscopic outcomes. Both groups showed excellent postoperative stability and clinical outcomes compared with the preoperative measurements.
LEVEL OF EVIDENCE
Level II, randomized controlled trial.
Topics: Humans; Anterior Cruciate Ligament; Follow-Up Studies; Prospective Studies; Treatment Outcome; Knee Joint; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction
PubMed: 37207917
DOI: 10.1016/j.arthro.2023.04.022