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Journal of Orthopaedic Surgery and... Jun 2024We aimed to analyze the outcomes of intraarticular extra virgin olive oil (EVOO) injection on mechanically induced rabbit knee osteoarthritis (OA) by studying the...
BACKGROUND
We aimed to analyze the outcomes of intraarticular extra virgin olive oil (EVOO) injection on mechanically induced rabbit knee osteoarthritis (OA) by studying the morphological, histological, and radiological findings.
METHODS
The study was conducted on 32 New Zealand White rabbits. The randomly numbered subjects were divided into two main groups. The rabbits numbered 1 to 16 were selected to be the group to receive EVOO, and the remaining were selected into a control group. Both groups were separated into two subgroups for short-term (five weeks) and long-term (10 weeks) follow-up. Anterior cruciate ligament transection was applied on the left knees of all the rabbits via medial parapatellar arthrotomy to simulate knee instability. Immediately after the surgical procedure, 0.2 cc of EVOO was injected into the knee joint of rabbits numbered 1-16, and the control group received 0.2 cc of sterile saline. On the 14th day, long-term group subjects were administered another dose of 0.2 cc EVOO intraarticularly.
RESULTS
The gross morphological scores of the control group subjects were significantly different from the EVOO group for both short-term (p = 0,055) and long-term (p = 0,041) scores. In parallel, the MRI results of the EVOO subjects were significantly different from the control group for both short-term and long-term follow-up assessment scores (p = 0.017, p = 0.014, respectively). The Mankin scoring results showed that there were statistically significant differences between the EVOO and control group in the comparison of both total scores (p = 0.001 for short-term and p = 0.004 for long-term) and subgroup scoring, including macroscopic appearance, chondrocyte cell number, staining, and Tidemark integrity in both short-term (p = 0.005, p = 0.028, p = 0.001, p = 0.005, respectively) and long-term assessments (p = 0.002, p = 0.014, p < 0.001, p = 0. 200, respectively).
CONCLUSIONS
We have observed promising outcomes of intra-articular application of extra virgin olive oil in the treatment of acute degenerative osteoarthritis in rabbit knees. Due to its potential cartilage restorative and regenerative effects, EVOO, when administered intra-articularly, may be a promising agent to consider for further research in the treatment of OA.
Topics: Rabbits; Animals; Olive Oil; Injections, Intra-Articular; Osteoarthritis, Knee; Male
PubMed: 38849876
DOI: 10.1186/s13018-024-04818-5 -
PloS One 2024Change of direction, stops, and pivots are among the most common non-contact movements associated with anterior cruciate ligament (ACL) injuries in soccer. By observing...
Change of direction, stops, and pivots are among the most common non-contact movements associated with anterior cruciate ligament (ACL) injuries in soccer. By observing these dynamic movements, clinicians recognize abnormal kinematic patterns that contribute to ACL tears such as increased knee valgus or reduced knee flexion. Different motions and physical demands are observed across playing positions, which may result in varied lower limb kinematic patterns. In the present study, 28 college and sub-elite soccer players performed four dynamic motions (change of direction with and without ball, header, and instep kick) with the goal of examining the effect of on-field positioning, leg dominance, and gender in lower body kinematics. Motion capture software monitored joint angles in the knee, hip, and ankle. A three-way ANOVA showed significant differences in each category. Remarkably, centrally positioned players displayed significantly greater knee adduction (5° difference, p = 0.013), hip flexion (9° difference, p = 0.034), hip adduction (7° difference, p = 0.016), and dorsiflexion (12° difference, p = 0.022) when performing the instep kick in comparison to their laterally positioned counterparts. These findings suggest that central players tend to exhibit a greater range of motion when performing an instep kicking task compared to laterally positioned players. At a competitive level, this discrepancy could potentially lead to differences in lower limb muscle development among on-field positions. Accordingly, it is suggested to implement position-specific prevention programs to address these asymmetries in lower limb kinematics, which can help mitigate dangerous kinematic patterns and consequently reduce the risk of ACL injury in soccer players.
Topics: Humans; Soccer; Biomechanical Phenomena; Male; Female; Young Adult; Lower Extremity; Adult; Anterior Cruciate Ligament Injuries; Range of Motion, Articular; Knee Joint; Adolescent; Athletes; Ankle Joint; Hip Joint
PubMed: 38848409
DOI: 10.1371/journal.pone.0304511 -
Orthopaedic Journal of Sports Medicine Jun 2024Socket-tunnel overlap during meniscal allograft transplantation (MAT) combined with anterior cruciate ligament reconstruction (ACLR) may compromise graft integrity and...
BACKGROUND
Socket-tunnel overlap during meniscal allograft transplantation (MAT) combined with anterior cruciate ligament reconstruction (ACLR) may compromise graft integrity and lead to impaired fixation and treatment failure.
PURPOSE/HYPOTHESIS
The purpose of this study was to determine optimal socket-tunnel drilling parameters for medial and lateral MAT with concurrent ACLR using artificial tibias and computed tomography (CT) scans for 3-dimensional (3D) modeling. It was hypothesized that clinically relevant socket tunnels could be created to allow for concurrent medial or lateral MAT and ACLR without significant risk for overlap at varying tunnel guide angles.
STUDY DESIGN
Descriptive laboratory study.
METHODS
A total of 27 artificial right tibias (3 per subgroup) were allocated to 9 experimental groups based on the inclination of the socket tunnels (55°, 60°, and 65°) created for simulating medial and lateral MAT and ACLR. Five standardized socket tunnels were created for each tibia using arthroscopic guides: one for the ACL tibial insertion and one for each meniscus root insertion. CT scans were performed for all specimens and sequentially processed using computer software to produce 3D models for quantitative assessment of socket-tunnel overlap risk. Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney tests.
RESULTS
No subgroup consistently presented significantly safer distances than other subgroups for all distances measured. Three cases (11%) and 24 cases (~90%) of tunnel overlap occurred between the ACL tunnel and tunnels for medial and lateral MAT, respectively. Most socket-tunnel overlap (25 of 27; 92.6%) occurred between sockets at depths ranging between 6.3 and 10 mm from the articular surface. For ACLR and posterior root of the lateral meniscus setting, the guide set at 65° increased socket-tunnel distances.
CONCLUSION
When combined ACLR and MAT using socket tunnels for graft fixation is performed, the highest risk for tibial socket-tunnel overlap involves the ACLR tibial socket and the lateral meniscus anterior root socket at a depth of 6 to 10 mm from the tibial articular surface.
CLINICAL RELEVANCE
Setting tibial guides at 65° to the tibial articular surface with the tunnel entry point anteromedial and socket aperture location within the designated anatomic "footprint" will minimize the risk for socket-tunnel overlap.
PubMed: 38845611
DOI: 10.1177/23259671241246277 -
Bone & Joint Research Jun 2024Adenosine, lidocaine, and Mg (ALM) therapy exerts differential immuno-inflammatory responses in males and females early after anterior cruciate ligament (ACL)...
AIMS
Adenosine, lidocaine, and Mg (ALM) therapy exerts differential immuno-inflammatory responses in males and females early after anterior cruciate ligament (ACL) reconstruction (ACLR). Our aim was to investigate sex-specific effects of ALM therapy on joint tissue repair and recovery 28 days after surgery.
METHODS
Male (n = 21) and female (n = 21) adult Sprague-Dawley rats were randomly divided into ALM or Saline control treatment groups. Three days after ACL rupture, animals underwent ACLR. An ALM or saline intravenous infusion was commenced prior to skin incision, and continued for one hour. An intra-articular bolus of ALM or saline was also administered prior to skin closure. Animals were monitored to 28 days, and joint function, pain, inflammatory markers, histopathology, and tissue repair markers were assessed.
RESULTS
Despite comparable knee function, ALM-treated males had reduced systemic inflammation, synovial fluid angiogenic and pro-inflammatory mediators, synovitis, and fat pad fibrotic changes, compared to controls. Within the ACL graft, ALM-treated males had increased expression of tissue repair markers, decreased inflammation, increased collagen organization, and improved graft-bone healing. In contrast to males, females had no evidence of persistent systemic inflammation. Compared to controls, ALM-treated females had improved knee extension, gait biomechanics, and elevated synovial macrophage inflammatory protein-1 alpha (MIP-1α). Within the ACL graft, ALM-treated females had decreased inflammation, increased collagen organization, and improved graft-bone healing. In articular cartilage of ALM-treated animals, matrix metalloproteinase (MMP)-13 expression was blunted in males, while in females repair markers were increased.
CONCLUSION
At 28 days, ALM therapy reduces inflammation, augments tissue repair patterns, and improves joint function in a sex-specific manner. The study supports transition to human safety trials.
PubMed: 38843878
DOI: 10.1302/2046-3758.136.BJR-2023-0360.R1 -
Journal of Clinical Imaging Science 2024Knee pathology, including anterior cruciate ligament (ACL) tears, meniscal tears, articular cartilage lesions, and intra-articular masses or cysts are common clinical...
Knee pathology, including anterior cruciate ligament (ACL) tears, meniscal tears, articular cartilage lesions, and intra-articular masses or cysts are common clinical entities treated by orthopedic surgeons with arthroscopic surgery. Preoperatively, magnetic resonance imaging (MRI) is now standard in confirming knee pathology, particularly detecting pathology less evident with history and physical examination alone. The radiologist's MRI interpretation becomes essential in evaluating intra-articular knee structures. Typically, the radiologist that interprets the MRI does not have the opportunity to view the same pathology arthroscopically. Thus, the purpose of this article is to illustratively reconcile what the orthopedic surgeon sees arthroscopically with what the radiologist sees on magnetic resonance imaging when viewing the same pathology. Correlating virtual and actual images can help better understand pathology, resulting in more accurate MRI interpretations. In this article, we present and review a series of MR and correlating arthroscopic images of ACL tears, meniscal tears, chondral lesions, and intra-articular masses and cysts. Short teaching points are included to highlight the importance of radiological signs and pathological MRI appearance with significant clinical and arthroscopic findings.
PubMed: 38841313
DOI: 10.25259/JCIS_98_2023 -
Arthroscopy Techniques May 2024Revision anterior cruciate ligament (ACL) presents many technical challenges that are not commonly seen in primary ACL reconstruction. The purpose of this article is to...
Over-the-Top Double-Bundle Revision Anterior Cruciate Ligament Reconstruction Technique With Hybrid Hamstring Tendon Autograft-Allograft and Associated Lateral Extra-articular Tenodesis.
Revision anterior cruciate ligament (ACL) presents many technical challenges that are not commonly seen in primary ACL reconstruction. The purpose of this article is to describe an alternative technique consisting of over-the-top double-bundle ACL revision combined with lateral extra-articular tenodesis using hybrid hamstring tendon autograft-allograft. This technique provides a valid treatment option in ACL revision surgery.
PubMed: 38835449
DOI: 10.1016/j.eats.2024.102944 -
The American Journal of Sports Medicine Jul 2024New techniques have been proposed to better address anteromedial rotatory instability in a medial collateral ligament (MCL)-injured knee that require an extra graft and...
BACKGROUND
New techniques have been proposed to better address anteromedial rotatory instability in a medial collateral ligament (MCL)-injured knee that require an extra graft and more surgical implants, which might not be feasible in every clinical setting.
PURPOSE
To investigate if improved resistance to anteromedial rotatory instability can be achieved by using a single-graft, double-bundle (DB) MCL reconstruction with a proximal fixation more anteriorly on the tibia, in comparison with the gold standard single-bundle (SB) MCL reconstruction.
STUDY DESIGN
Controlled laboratory study.
METHODS
Eight fresh-frozen human cadaveric knees were tested using a 6 degrees of freedom robotic simulator in intact knee, superficial MCL/deep MCL-deficient, and reconstruction states. Three different reconstructions were tested: DB MCL no proximal tibial fixation and DB and SB MCL reconstruction with proximal tibial fixation. Knee kinematics were recorded at 0°, 30°, 60°, and 90° of knee flexion for the following measurements: 8 N·m of valgus rotation (VR), 5 N·m of external tibial rotation, 5 N·m of internal tibial rotation, combined 89 N of anterior tibial translation and 5 N·m of external rotation for anteromedial rotation (AMR) and anteromedial translation (AMT). The differences between each state for every measurement were analyzed with VR and AMR/AMT as primary outcomes.
RESULTS
Cutting the superficial MCL/deep MCL increased VR and AMR/AMT in all knee positions except at 90° for VR ( < .05). All reconstructions restored VR to the intact state except at 90° of knee flexion ( < .05). The DB MCL no proximal tibial fixation reconstruction could not restore intact AMR/AMT kinematics in any knee position ( < .05). Adding an anterior-based proximal tibial fixation restored intact AMR/AMT kinematics at ≥30° of knee flexion except at 90° for AMT ( < .05). The SB MCL reconstruction could not restore intact AMR/AMT kinematics at 0° and 90° of knee flexion ( < .05).
CONCLUSION
In this in vitro cadaveric study, a DB MCL reconstruction with anteriorly placed proximal tibial fixation was able to control AMR and AMT better than the gold standard SB MCL reconstruction.
CLINICAL RELEVANCE
In patients with anteromedial rotatory instability and valgus instability, a DB MCL reconstruction may be superior to the SB MCL reconstruction, without causing extra surgical morbidity or additional costs.
Topics: Humans; Joint Instability; Medial Collateral Ligament, Knee; Cadaver; Biomechanical Phenomena; Middle Aged; Rotation; Male; Knee Joint; Female; Plastic Surgery Procedures; Aged; Tibia; Range of Motion, Articular
PubMed: 38828624
DOI: 10.1177/03635465241251463 -
Clinics in Orthopedic Surgery Jun 2024The etiology and pathology of mucoid degeneration of the anterior cruciate ligament (MD-ACL) remain poorly understood. MD-ACL may be associated with knee osteoarthritis...
BACKGROUND
The etiology and pathology of mucoid degeneration of the anterior cruciate ligament (MD-ACL) remain poorly understood. MD-ACL may be associated with knee osteoarthritis (OA) or a mechanism other than OA. This study evaluated the radiological differences between knees with MD-ACL and those with a normal ACL and compared the clinical and radiological features of knees with MD-ACL according to the knee OA status.
METHODS
This retrospective study compared the radiological features of the intercondylar notch width index (NWI) and posterior tibial slope (PTS) of 67 MD-ACL patients (MD group) and 67 age-, sex-, and OA grade-matched patients with a normal ACL (control group). During the subgroup analysis, MD-ACL patients were divided into the non-OA subgroup (n = 41) and OA subgroup (n = 26). The pain location and characteristics of the knee, PTS, and NWI were compared between these subgroups.
RESULTS
Compared to the control group, the MD group had a lower NWI (0.26 ± 0.03 vs. 0.28 ± 0.01, < 0.001) and a larger PTS (11.3° ± 3.0° vs. 9.2° ± 2.5°, < 0.001). During the subgroup analysis, the most common pain locations were the posterior and medial aspects of the knee in the non-OA subgroup (43.9%) and OA subgroup (53.8%), respectively. Pain on terminal flexion was the most common pain characteristic in both subgroups (non-OA subgroup, 73.1%; OA subgroup, 53.8%). The PTS was not different between subgroups (11.7° ± 3.2° in the non-OA subgroup vs. 10.6° ± 2.7° in the OA subgroup; = 0.159). However, the non-OA subgroup had a lower NWI than the OA subgroup (0.25 ± 0.03 vs. 0.28 ± 0.02, = 0.001).
CONCLUSIONS
Patients with MD-ACL had a lower NWI and a larger PTS than patients with a normal ACL. Furthermore, the clinical and radiological features of MD-ACL differed according to the knee OA status. A narrow intercondylar notch may be more closely associated with the development of MD-ACL without OA.
Topics: Humans; Osteoarthritis, Knee; Male; Female; Retrospective Studies; Anterior Cruciate Ligament; Middle Aged; Adult; Radiography; Knee Joint; Aged
PubMed: 38827759
DOI: 10.4055/cios23051 -
Journal of Musculoskeletal & Neuronal... Jun 2024The aim of this study was to compare torque-velocity profiles, muscle architecture, tendon dimensions, and bilateral-symmetry between competitive cyclists (CY),...
OBJECTIVES
The aim of this study was to compare torque-velocity profiles, muscle architecture, tendon dimensions, and bilateral-symmetry between competitive cyclists (CY), competitive runners (RN), ice-hockey players (IH), basketball players (BP), and physically-active individuals (CN) (n=10 for each group).
METHODS
Vastus lateralis (VL) muscle and patellar tendon (PT) structures were determined with B-mode ultrasonography, and maximal knee extensor isokinetic torque was assessed at three different velocities.
RESULTS
Optimal torque and velocity were lower in runners than CY, BP and IH (p<0.05). Maximal power was similar between the athlete groups but greater than CN (p<0.05). Furthermore, RN and BP reached their peak-torque at longer muscle lengths compared to IH and CY (p<0.05). RN had the lowest VL muscle thickness and the greatest fascicle length, while CY had the greatest pennation angle (p<0.05). CY had the greatest PT thickness, particularly at the proximal and medial sites, while BP at the distal point (p<0.05), with similar trends observed for PT cross-sectional-area.
CONCLUSIONS
Our findings show that even if power generating capacity is similar between athletic disciplines, there are discipline-specific muscle adaptations, where particularly runners appear to have muscles adapted for speed rather than torque development, while in cyclists, velocity is sacrificed for torque development.
Topics: Humans; Torque; Athletes; Male; Adult; Young Adult; Muscle, Skeletal; Ultrasonography; Patellar Ligament; Running
PubMed: 38825995
DOI: No ID Found -
The American Journal of Sports Medicine Jul 2024There is still debate regarding the association between arthrometric knee laxity measurements and subjective knee outcome and revision surgery after primary anterior...
BACKGROUND
There is still debate regarding the association between arthrometric knee laxity measurements and subjective knee outcome and revision surgery after primary anterior cruciate ligament reconstruction (ACLR).
PURPOSE
To assess whether arthrometric knee laxity (measured with the KT-1000 arthrometer) 6 months after primary ACLR was associated with the 1-, 2-, and 5-year subjective knee outcomes or revision ACLR at a 5-year follow-up.
STUDY DESIGN
Cohort study, Level of evidence 3.
METHODS
Patients who underwent primary ACLR with a hamstring tendon autograft at the authors' institution between January 1, 2005, and December 31, 2017, with no concomitant ligamentous injuries, were identified. Anterior knee laxity (KT-1000 arthrometer, 134 N) was assessed 6 months postoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and 1, 2, and 5 years postoperatively. Patients who underwent revision ACLR at any institution in the country within 5 years of primary surgery were identified through the Swedish National Knee Ligament Registry.
RESULTS
A total of 4697 patients (54.3% male) with available KT-1000 arthrometer measurements were included (normal: side-to-side [STS] ≤2 mm, 3015 [64.2%]; nearly normal: STS 3-5 mm, 1446 [30.8%]; abnormal: STS >5 mm, 236 [5.0%]). The only significant difference in subjective knee outcome between the groups was for the KOOS Symptoms subscale at the 1-year follow-up (STS ≤2 mm, 79.9 ± 16.2; STS 3-5 mm, 82.5 ± 14.8; STS >5 mm, 85.1 ± 14.2; < .001). No other significant differences between the groups were found preoperatively or at 1, 2, or 5 years postoperatively for any of the KOOS subscales. The hazard for revision ACLR within 5 years of the primary surgery was significantly higher for the groups with an STS of 3 to 5 mm (6.6%; 95/1446) (hazard ratio [HR], 1.42; 95% CI, 1.07-1.87; = .01) and an STS >5 mm (11.4%; 27/236) (HR, 2.61; 95% CI, 1.69-4.03; < .001) compared with the group with an STS ≤2 mm (3.8%; 116/3015).
CONCLUSION
A high grade of postoperative knee laxity (STS 3-5 mm and STS >5 mm) 6 months after primary ACLR was associated with an increased hazard of revision ACLR within 5 years, but it was not associated with an inferior subjective knee outcome.
Topics: Humans; Anterior Cruciate Ligament Reconstruction; Female; Joint Instability; Male; Reoperation; Adult; Young Adult; Hamstring Tendons; Postoperative Complications; Anterior Cruciate Ligament Injuries; Knee Joint; Cohort Studies; Adolescent; Arthrometry, Articular; Middle Aged
PubMed: 38819091
DOI: 10.1177/03635465241253840