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Orthopaedic Journal of Sports Medicine May 2024Netball is a popular sport worldwide, particularly for women. However, its nature puts players at high risk for anterior cruciate ligament (ACL) injury.
BACKGROUND
Netball is a popular sport worldwide, particularly for women. However, its nature puts players at high risk for anterior cruciate ligament (ACL) injury.
PURPOSE
To determine (1) the prevalence of ACL graft rupture and contralateral ACL (CACL) rupture in Australian female netballers after ACL reconstruction (ACLR) and (2) the rate of return to sports (RTS) and psychological readiness.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
A patient database identified 332 consecutive female netball players who underwent ACLR with hamstring tendon autografts performed by 2 surgeons between 2007 and 2015. Patients were retrospectively surveyed at a minimum of 7 years postoperatively-including details of a second ACL injury to either knee, RTS, and psychological readiness per the ACL-Return to Sport After Injury (ACL-RSI) score. Multivariate regression assessed the association between selected variables and repeat ACL injury.
RESULTS
A total of 267 patients (80%) were included with a mean follow-up of 8.4 years (range, 7-15 years). ACL graft rupture and CACL rupture occurred in 11 (4%) and 27 (10%) patients, respectively, at 7 years postoperatively. The ACL graft had a survival rate of 99%, 97%, 97%, and 96% at 1, 2, 5, and 7 years after surgery, respectively. The native CACL had a survival rate of 100%, 99%, 94%, and 90% at 1, 2, 5, and 7 years, respectively. Adolescents had a 4.5 times greater hazard for ACL graft rupture (95% CI, 1.4-14.6; = .014) and a 2.5 times greater hazard for CACL rupture (95% CI, 1.2-5.5; = .021) compared with adults. CACL injury was also associated with a return to level 1-including jumping, hard pivoting, and cutting-sports (hazard ratio, 10.3 [95% CI, 1.4-77.1]; = .023). Most (62%) participants returned to netball, with those with higher ACL-RSI scores more likely to RTS.
CONCLUSION
The prevalence of repeat ACL injury was higher in the contralateral knee (10%) than the ACL-reconstructed knee (4%) at 7 years postoperatively. ACLR was a suitable option for female netballers who sustained an ACL rupture with low long-term rates of graft rupture. Repeat ACL injuries to either knee were more common in adolescents and those who returned to cutting and pivoting sports.
PubMed: 38784789
DOI: 10.1177/23259671241247488 -
Orthopaedic Journal of Sports Medicine May 2024Postoperative laxity correlates with negative clinical outcomes after anterior cruciate ligament reconstruction (ACLR). The influence of lateral extra-articular...
BACKGROUND
Postoperative laxity correlates with negative clinical outcomes after anterior cruciate ligament reconstruction (ACLR). The influence of lateral extra-articular tenodesis (LET) on anteroposterior translation is unclear.
PURPOSE/HYPOTHESIS
This study aimed to evaluate the reduction in radiographic static anterior tibial translation (SATT) and dynamic anterior tibial translation (DATT) after LET as an adjunctive procedure to ACLR. It was hypothesized that adding a LET procedure would have no effect on postoperative SATT and DATT.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
Patients who underwent primary ACLR with hamstring tendon autografts between 2020 and 2022 were reviewed, and those who underwent ACLR and LET as an anterolateral associate procedure were paired 1 to 1 with those who underwent isolated ACLR (control) based on age, sex, preoperative SATT, and posterior tibial slope (PTS). The indications for LET were age <18 years and anterolateral rotary instability (grade ≥2 pivot shift). A previously validated technique was used to measure SATT, DATT, and PTS on lateral weightbearing and lateral stress knee radiographs. Preoperative and 9-month postoperative radiographs were compared between the 2 groups.
RESULTS
A total of 72 patients were included in the analysis (n = 36 patients in each group). The inter- and intraobserver reliability of the SATT, DATT, and PTS measurements was excellent (intraclass correlation coefficients, 0.88-0.99). The mean pre- and postoperative SATT in the ACLR+LET group was 2.44 ± 2.90 mm and 2.44 ± 2.38 mm, respectively, compared with 2.60 ± 2.99 mm and 2.12 ± 2.74 mm, respectively, in the control group. The mean pre- and postoperative reduction in side-to-side DATT in the ACLR+LET group was 5.44 ± 4.65 mm and 1.13 ± 2.95 mm, respectively, compared with 5.03 ± 3.66 mm and 2 ± 3.12 mm, respectively, in the control group. There was no pre- to postoperative difference in SATT ( = .51). However, the side-to-side DATT was reduced by 3.66 ± 3.37 mm postoperatively ( < .001), without significant differences between groups ( = .24).
CONCLUSION
Including a LET procedure for patients undergoing ACLR did not reduce SATT; that is, it did not decrease the amount of tibial translation due to physiological axial load.
PubMed: 38774385
DOI: 10.1177/23259671241246111 -
International Journal of Ophthalmology 2024To report a technique used with intermittent sliding-lock-knot (ISLK) fixation for limbal conjunctival autografts in pterygium surgery and compared with those of routine...
AIM
To report a technique used with intermittent sliding-lock-knot (ISLK) fixation for limbal conjunctival autografts in pterygium surgery and compared with those of routine intermittent (RI) fixation.
METHODS
Consecutive patients with primary pterygium who had undergone pterygium excision combined with limbal conjunctival autograft transplantation between March 2021 and March 2022 at our institute were retrospectively analyzed. Primary outcome measures were mean duration of surgery and suture removal, degree of conjunctival hyperemia on postoperative day 1, pain score at suture removal, postoperative symptoms at 6mo, including conjunctival hyperemia, foreign body sensation, and graft stability.
RESULTS
Ninety-eight patients underwent monocular surgery and were divided into ISLK (51 eyes) and RI (47 eyes) groups according to the type of conjunctiva autograft fixation method planned. There was no significant difference in mean duration of surgery between the two groups (18.59±2.39min 18.15±2.20min, =0.417); however, compared to the RI group, shorter suture removal times were observed in the ISLK group [0.58min (0.42-0.87) 3.00min (2.21-4.15), <0.001]. The degree of conjunctival hyperemia on postoperative day 1 was milder in the ISLK group (<0.001). Pain scores at suture removal were lower in the ISLK group than in RI group [1 (0-3) 2 (1-4), <0.001]. Postoperative symptoms at 6mo were comparable between the groups (=0.487), with no recurrence.
CONCLUSION
ISLK is an innovative method for limbal conjunctival autograft fixation after pterygium excision. Compared to RI fixation, ISLK facilitates suture removal and reduces discomfort, with comparable surgery duration and less conjunctival hyperemia.
PubMed: 38766334
DOI: 10.18240/ijo.2024.05.07 -
Archives of Orthopaedic and Trauma... Jun 2024The periosteum is a readily available tissue at the hamstring harvest site that could be utilized to enhance graft healing and prevent tunnel widening without additional...
INTRODUCTION
The periosteum is a readily available tissue at the hamstring harvest site that could be utilized to enhance graft healing and prevent tunnel widening without additional cost or morbidity. This study aimed to compare graft healing using magnetic resonance imaging (MRI) and functional clinical outcome scores in a matched cohort of patients who underwent anterior cruciate ligament (ACL) reconstruction with hamstring autografts with or without periosteal augmentation.
MATERIAL AND METHODS
Forty-eight patients who underwent ACL reconstruction (ACLR) were prospectively enrolled: 25 with standard ACLR (ST-ACLR) and 23 with periosteal augmented grafts (PA-ACLR). The same surgical techniques, fixation methods, and postoperative protocol were used in both groups. Signal-to-noise quotient (SNQ), graft healing at the bone-graft interface, graft signal according to the Howell scale, and femoral tunnel widening were evaluated using MRI after 1 year of follow-up. International knee documentation score (IKDC), Lysholm, Tegner activity scale, and visual analog scale for pain were used for functional evaluation at a minimum of 2 years postoperative.
RESULTS
The mean SNQ of the proximal part of the graft was 9.6 ± 9.2 and 2.9 ± 3.3 for the ST-ACLR and PA-ACLR groups, respectively (P = 0.005). The mean femoral tunnel widening was 30.3% ± 18.3 and 2.3% ± 9.9 for the ST-ACLR, PA-ACLR groups, respectively (P < 0.001). Complete graft tunnel healing was observed in 65% and 28% of cases in the PA-ACLR and ST-ACLR groups, respectively. Both groups showed marked improvements in functional scores, with no statistically significant differences.
CONCLUSION
Periosteal wrapping of hamstring tendon autografts is associated with better graft healing and maturation and lower incidence of femoral tunnel widening based on MRI analysis 1 year after ACL reconstruction. However, patient-reported outcomes and measured laxity were similar between the two groups at 2 years follow up.
TRIAL REGISTRATION
Trail registration number: PACTR202308594339018, date of registration: 1/5/2023, retrospectively registered at the Pan African Clinical Trial Registry (pactr.samrc.ac.za) database.
Topics: Humans; Anterior Cruciate Ligament Reconstruction; Hamstring Tendons; Adult; Male; Female; Periosteum; Autografts; Magnetic Resonance Imaging; Prospective Studies; Young Adult; Wound Healing; Transplantation, Autologous; Anterior Cruciate Ligament Injuries; Adolescent
PubMed: 38748257
DOI: 10.1007/s00402-024-05356-9 -
Journal of Applied Oral Science :... 2024This study aims to develop a compound biomaterial to achieve effective soft tissue regeneration.
OBJECTIVE
This study aims to develop a compound biomaterial to achieve effective soft tissue regeneration.
METHODOLOGY
Compound hyaluronic acid (CHA) and liquid horizontal-platelet-rich fibrin (H-PRF) were mixed at a ratio of 1:1 to form a CHA-PRF gel. Human gingival fibroblasts (HGFs) were used in this study. The effect of CHA, H-PRF, and the CHA-PRF gel on cell viability was evaluated by CCK-8 assays. Then, the effect of CHA, H-PRF, and the CHA-PRF gel on collagen formation and deposition was evaluated by qRT‒PCR and immunofluorescence analysis. Finally, qRT‒PCR, immunofluorescence analysis, Transwell assays, and scratch wound-healing assays were performed to determine how CHA, H-PRF, and the CHA-PRF gel affect the migration of HGFs.
RESULTS
The combination of CHA and H-PRF shortened the coagulation time of liquid H-PRF. Compared to the pure CHA and H-PRF group, the CHA-PRF group exhibited the highest cell proliferation at all time points, as shown by the CCK-8 assay. Col1a and FAK were expressed at the highest levels in the CHA-PRF group, as shown by qRT‒PCR. CHA and PRF could stimulate collagen formation and HGF migration, as observed by fluorescence microscopy analysis of COL1 and F-actin and Transwell and scratch healing assays.
CONCLUSION
The CHA-PRF group exhibited greater potential to promote soft tissue regeneration by inducing cell proliferation, collagen synthesis, and migration in HGFs than the pure CHA or H-PRF group. CHA-PRF can serve as a great candidate for use alone or in combination with autografts in periodontal or peri-implant soft tissue regeneration.
Topics: Hyaluronic Acid; Humans; Platelet-Rich Fibrin; Fibroblasts; Gingiva; Cell Proliferation; Cell Survival; Cells, Cultured; Regeneration; Time Factors; Cell Movement; Reproducibility of Results; Fluorescent Antibody Technique; Real-Time Polymerase Chain Reaction; Collagen; Materials Testing; Wound Healing; Biocompatible Materials; Collagen Type I
PubMed: 38747782
DOI: 10.1590/1678-7757-2023-0294 -
Orthopaedic Journal of Sports Medicine May 2024The timing of return to work (RTW) after anterior cruciate ligament (ACL) reconstruction (ACLR) is a less studied milestone compared with return to sports. (Review)
Review
BACKGROUND
The timing of return to work (RTW) after anterior cruciate ligament (ACL) reconstruction (ACLR) is a less studied milestone compared with return to sports.
PURPOSE
To systematically review the rate and postoperative timing of RTW after ACLR.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
This study was conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A literature search was performed in PubMed, Embase, Cochrane, and Ovid databases for clinical studies reporting RTW after ACLR, and 806 studies were identified in August 2022. A quality assessment was performed using the Methodological Index of Nonrandomized Studies (MINORS) grading system. The following data were extracted from studies: study characteristics, cohort demographics, ACLR technique, concomitant meniscal and/or cartilage procedures, preoperative patient-reported outcomes, rates of RTW, and days required for RTW after ACLR.
RESULTS
A total of 13 studies met inclusion criteria, totaling 1791 patients (86.4% male). Wide variability was observed in the methodological quality of the assessed studies (MINORS score range, 8-17). Hamstring tendon (HT) autograft was used in 76.8% (n = 1377; mean age, 30.5 years old), allograft in 17.1% (n = 308; mean age, 33.1 years old), the ligament advanced reinforcement system in 2.5% (n = 46; mean age, 33.2 years old), bone-patellar tendon-bone autograft in 2% (n = 36; mean age, 28.5 years old), and quadriceps tendon autograft in 1.3% (n = 24; mean age, 24.1 years old). Among the included patients, 99.1% (n = 1781) reported successful RTW after surgery. The mean time to RTW was 84.2 days (range, 31.4-107.1 days) for HT and 69.5 days (range, 49-56.6 days) for allograft.
CONCLUSION
While data regarding work intensity before and after ACL injury were absent, our study results suggested that patients most often RTW within 90 days of surgery. Patients with allograft ACLR may RTW earlier than patients undergoing ACLR with HT autograft.
PubMed: 38745916
DOI: 10.1177/23259671241249086 -
Burns : Journal of the International... Apr 2024Split-thickness skin graft (STSG) integration rates are susceptible to improvement. Infection and/or biofilm should be appropriately addressed prior to grafting to...
BACKGROUND
Split-thickness skin graft (STSG) integration rates are susceptible to improvement. Infection and/or biofilm should be appropriately addressed prior to grafting to improve the likelihood of graft-take. Incorporating technological aids such as fluorescence (FL) imaging (MolecuLight®), which accurately locates areas of bacterial loads above 10 CFU/gr, for graft site assessment and preparation could yield better outcomes.
METHODS
This single-center, prospective observational study included adult burn patients with previously infected wounds that had been deemed clinically and microbiologically clean and were therefore candidates for grafting. Prior to grafting, a FL imaging assessment (blinded to the surgical team) localized areas positive for moderate-high bacterial loads (>10 CFU/gr). Intra-operatively, a standard swab sample from the recipient site was collected by the surgical team. Postoperatively, areas positive/negative for FL and areas of graft take and failure were overlapped and measured (cm) over a 2D schematic. The performance and accuracy of FL imaging and swab sampling in relation to graft outcomes were assessed.
RESULTS
38 patients were enrolled in the study. The mean total body surface area (TBSA) involvement was 14.5 ± 12.4 % [range 0.8 - 40.2 %]. 25/38 of the subjects enrolled had complete graft take while 13 had partial graft losses. There were no total losses. FL-imaging was positive in 100 % of losses versus 31 % (4/13) of the swab microbiology. FL-imaging was found to have a sensitivity of 86 %, specificity of 98 %, PPV of 72 %, NPV of 99 %, and an accuracy of 94 % for predicting any type or range of graft loss in the entire cohort. Meanwhile, the sensitivity of microbiology from swab samples was 30 %, with a specificity of 76 %.
CONCLUSIONS
FL imaging is an accurate method for assessing recipient sites and predicting the outcome of a skin graft among burn patients. These findings suggest that FL imaging can inform better decision-making surrounding grafts that may lead to better outcomes.
LEVEL OF EVIDENCE
Level IIA, Therapeutic study.
PubMed: 38735804
DOI: 10.1016/j.burns.2024.04.003 -
Journal of Periodontal & Implant Science Apr 2024The aims of this study were 1) to investigate the effects of a subepithelial connective tissue graft (SCTG) and a volume-stable collagen matrix (VCMX) on soft-tissue...
Soft-tissue volume augmentation using a connective tissue graft and a volume-stable collagen matrix with polydeoxyribonucleotide for immediate implant placement: a pilot study in a dog model.
PURPOSE
The aims of this study were 1) to investigate the effects of a subepithelial connective tissue graft (SCTG) and a volume-stable collagen matrix (VCMX) on soft-tissue volume gain in the immediate implant placement protocol, and 2) to determine whether polydeoxyribonucleotide (PDRN) can enhance the effects of a VCMX.
METHODS
Dental implants were placed in 4 mongrel dogs immediately after extracting the distal roots of their third and fourth mandibular premolars. The gap between the implant and the buccal bone plate was filled with synthetic bone substitute particles. The following soft-tissue augmentation modalities were applied buccally: 1) control (no augmentation), 2) SCTG, 3) VCMX, and 4) VCMX/PDRN. After 4 months, histomorphometric analysis was performed. Tissue changes were evaluated using superimposed standard tessellation language (STL) files.
RESULTS
Wound dehiscence was found in more than half of the test groups, but secondary wound healing was successfully achieved in all groups. Histomorphometrically, tissue thickness was favored in group SCTG at or above the implant platform level (IP), and group SCTG and the groups with VCMX presented similar tissue thickness below the IP. However, the differences in such thickness among the groups were minor. The keratinized tissue height was greater in group VCMX/PDRN than in groups SCTG and VCMX. Superimposing the STL files revealed a decrease in soft-tissue volume in all groups.
CONCLUSIONS
Wound dehiscence after soft-tissue volume augmentation might be detrimental to obtaining the expected outcomes. PDRN appears not to have a positive effect on the soft-tissue volume gain.
PubMed: 38725426
DOI: 10.5051/jpis.2400240012 -
The Archives of Bone and Joint Surgery 2024Medial patellofemoral ligament reconstruction is a standard treatment option for patients with patellar instability. The main purpose of this study was to determine...
Medial patellofemoral ligament reconstruction is a standard treatment option for patients with patellar instability. The main purpose of this study was to determine whether isolated anatomic medial patellofemoral ligament reconstruction using double folded, four-strand plantaris tendon autograft restores patellar stability in adolescent patients. Plantaris tendon autografts were harvested through proximal approach and used in four adolescent patients. A four-strand autograft was prepared in a double-limbed configuration and fixed on the patella and the femur with suture anchors and interference screws, respectively. The mean Kujala score improved significantly from 44 ± 24 SD (range, 19 to 69) points preoperatively to 94 ± 10 SD (range, 78 to 100) points postoperatively (P< 0.001). All patients reported excellent subjective outcomes and returned to their pre-injury level of sporting activities. The use of a four-strand plantaris tendon autograft in isolated anatomic medial patellofemoral ligament reconstruction can restore patellar stability in adolescents.
PubMed: 38716173
DOI: 10.22038/ABJS.2024.75154.3476 -
JSES International May 2024Arthroscopic superior capsule reconstruction (SCR) was developed to restore superior shoulder stability, muscle balance, and function after irreparable...
BACKGROUND
Arthroscopic superior capsule reconstruction (SCR) was developed to restore superior shoulder stability, muscle balance, and function after irreparable posterior-superior rotator cuff tears. The purpose of this study was to investigate whether favorable clinical outcomes after SCR for irreparable rotator cuff tears would be obtained in patients aged more than 70 years.
METHODS
A total of 173 consecutive shoulders in 162 patients who underwent arthroscopic SCR using autografts of fascia lata for irreparable rotator cuff tears were allocated to 3 groups according to patient age at the time of surgery: Group 1, <55 years old (11 shoulders); Group 2, 55-70 years old (85 shoulders); and Group 3, > 70 years old (77 shoulders). American Shoulder and Elbow Surgeons and Japanese Orthopaedic Association scores, active shoulder range of motion, and visual analog scale were evaluated before surgery and at the final follow-up. Postoperative complications, including graft tears in magnetic resonance imaging and donor-site morbidity, were assessed.
RESULTS
The mean follow-up was 3 years and 9 months. Both American Shoulder and Elbow Surgeons and Japanese Orthopaedic Association scores and active range of motion (elevation, external rotation, and internal rotation) increased significantly after arthroscopic SCR in all 3 groups ( < .001), and visual analog scale decreased significantly. All 3 groups had low graft tear (6%-10%) and donor site morbidity (0%-1%) rates, with no significant difference among the groups.
CONCLUSION
Arthroscopic SCR can lead to functional improvement and pain relief with a low rate of complications regardless of patient age.
PubMed: 38707584
DOI: 10.1016/j.jseint.2024.01.012