Editorial

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2 pages, 213 KiB

Open AccessEditorial

Advances in Anterior Cruciate Ligament Injury, Reconstruction and Rehabilitation

by Adrian Todor

Medicina 2024, 60(1), 136; https://doi.org/10.3390/medicina60010136 - 11 Jan 2024

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Abstract

Another Special Issue dedicated to the anterior cruciate ligament (ACL) of the knee joint [...] Full article

(This article belongs to the Special Issue Advances in Anterior Cruciate Ligament Injury, Reconstruction, and Rehabilitation)

Research

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17 pages, 6316 KiB

Open AccessArticle

The Influence of Platelet-Rich Fibrin on the Healing of Bone Defects after Harvesting Bone–Patellar Tendon–Bone Grafts

by Darko Milovanovic, Petar Vukman, Dusica Gavrilovic, Ninoslav Begovic, Lazar Stijak, Svetlana Sreckovic and Marko Kadija

Medicina 2024, 60(1), 154; https://doi.org/10.3390/medicina60010154 - 15 Jan 2024

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Abstract

Background and Objectives: A bone–patellar tendon–bone (BTB) autograft in anterior cruciate ligament reconstruction (ACLR) is still considered the gold standard among many orthopedic surgeons, despite anterior knee pain and kneeling pain being associated with bone defects at the harvest site. Bioregenerative products [...] Read more.

Background and Objectives: A bone–patellar tendon–bone (BTB) autograft in anterior cruciate ligament reconstruction (ACLR) is still considered the gold standard among many orthopedic surgeons, despite anterior knee pain and kneeling pain being associated with bone defects at the harvest site. Bioregenerative products could be used to treat these defects, perhaps improving both the postoperative discomfort and the overall reconstruction. Materials and methods: During a year-long period, 40 patients were enrolled in a pilot study and divided into a study group, in which bone defects were filled with Vivostat^® PRF (platelet-rich fibrin), and a standard group, in which bone defects were not filled. The main outcome was a decrease in the height and width of the bone defects, as determined by magnetic resonance imaging on the control exams during the one-year follow-up. The secondary outcomes included an evaluation of kneeling pain, measured with a visual analog scale (VAS), and an evaluation of the subjective knee scores. Results: The application of Vivostat^® PRF resulted in a more statistically significant reduction in the width of the defect compared with that of the standard group, especially at 8 and 12 months post operation (p < 0.05). Eight months following the surgery, the study group’s anterior knee pain intensity during kneeling was statistically considerably lower than that of the standard group (p < 0.05), and the statistical difference was even more obvious (p < 0.01) at the last follow-up. Each control examination saw a significant decrease in pain intensity in both the groups, with the values at each exam being lower than those from the prior exam (p < 0.01). A comparison of subjective functional test results 12 months post operation with the preoperative ones did not prove a statistically significant difference between the groups. Conclusions: The use of Vivostat^® PRF reduces kneeling pain and accelerates the narrowing of bone defects after ACLR with a BTB graft, but without confirmation of its influence on the subjective knee score. Full article

(This article belongs to the Special Issue Advances in Anterior Cruciate Ligament Injury, Reconstruction, and Rehabilitation)

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10 pages, 860 KiB

Open AccessArticle

Additional Anterolateral Ligament Reconstruction Helps Patients Improve Dynamic Postural Stability in Revision Anterior Cruciate Ligament Reconstruction

by Joon Kyu Lee, Seung-Ik Cho, Dhong-Won Lee, Sang-Jin Yang, Tae-Wook Kim and Jin-Goo Kim

Medicina 2023, 59(7), 1242; https://doi.org/10.3390/medicina59071242 - 03 Jul 2023

Cited by 2 | Viewed by 1006

Abstract

Background and Objectives: The goal in treating anterior cruciate ligament (ACL) injury especially in revision cases is return to sports activity by regaining dynamic postural stability. Among various methods to achieve this goal, additional anterolateral ligament reconstruction (ALLR) is gaining attention. The [...] Read more.

Background and Objectives: The goal in treating anterior cruciate ligament (ACL) injury especially in revision cases is return to sports activity by regaining dynamic postural stability. Among various methods to achieve this goal, additional anterolateral ligament reconstruction (ALLR) is gaining attention. The purpose of this study was to evaluate the effects of additional ALLR in revision ACL reconstruction (RACLR). Materials and Methods: Patients who underwent RACLR between July 2015 and June 2018 were enrolled. The exclusion criteria were less than 1-year follow-up, age older than 45 years, concomitant multiple ligament injuries, contralateral knee injury, subtotal or total meniscectomized state, and articular cartilage lesions worse than Outerbridge grade 3. Thirty-nine patients (20 patients; RACLR only (Group A), 19 patients; RACLR with additional ALLR (Group B)) were included. Clinical scores (Lysholm score, subjective International Knee Documentation Committee (IKDC) score, Tegner activity scale), isokinetic strength test, single-leg-hop for distance test (SLHDT), Y-balance test (YBT) were checked preoperatively and 1-year postoperatively. Results: Limb symmetry index values in YBT showed significantly better result in Group B 1-year postoperatively (Group A: 97.2 ± 4.0, Group B: 100.3 ± 2.9, p = 0.010), although there were no differences preoperatively between groups (Group A: 90.4 ± 6.7, Group B: 89.3 ± 5.5, p = 0.594). Regarding clinical scores, isokinetic strength tests, and SLHDT, there were no differences between groups preoperatively nor 1-year postoperatively. Conclusions: Additional ALLR in RACLR helped patients gain better dynamic postural stability at 1-year postoperative follow-up. Full article

(This article belongs to the Special Issue Advances in Anterior Cruciate Ligament Injury, Reconstruction, and Rehabilitation)

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8 pages, 548 KiB

Open AccessArticle

The Influence of the Q-Angle and Muscle Strength on Idiopathic Anterior Knee Pain in Adolescents

by Darko Milovanović, Ninoslav Begović, Bojan Bukva, Siniša Dučić, Aleksandar Vlahović, Zoran Paunović, Marko Kadija, Nikola Topalović and Lazar Stijak

Medicina 2023, 59(6), 1016; https://doi.org/10.3390/medicina59061016 - 24 May 2023

Cited by 1 | Viewed by 1913

Abstract

Background and Objectives: Idiopathic anterior knee pain is a common condition in adolescents and is mostly of unknown cause. The aim of this study was to examine the influence of the Q-angle and muscle strength on idiopathic anterior knee pain. Materials and [...] Read more.

Background and Objectives: Idiopathic anterior knee pain is a common condition in adolescents and is mostly of unknown cause. The aim of this study was to examine the influence of the Q-angle and muscle strength on idiopathic anterior knee pain. Materials and Methods: Seventy-one adolescents (41 females and 30 males) diagnosed with anterior knee pain were included in this prospective study. The extensor strength in the knee joint and the Q-angle were monitored. The healthy extremity was used as a control. The Student’s paired sample t-test was applied for testing the difference. Statistical significance was set at 0.05. Results: There was no statistically significant difference in the Q-angle value between the idiopathic AKP and the healthy extremity (p > 0.05) within the entire sample. A statistically significant higher Q-angle of the idiopathic AKP knee (p < 0.05) was obtained in the female subgroup. No statistically significant difference (p > 0.05) was found in the male subgroup. Within the male subgroup, the strength of the extensors within the knee joint of the healthy extremity had statistically significant higher values than the strength of these muscles in the affected extremity (p < 0.05). Conclusion: A greater Q-angle is a risk factor linked to anterior knee pain within the female population. Decreased muscle strength of knee joint extensors is a risk factor linked to anterior knee pain in both sex subgroups. Full article

(This article belongs to the Special Issue Advances in Anterior Cruciate Ligament Injury, Reconstruction, and Rehabilitation)

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10 pages, 1414 KiB

Open AccessArticle

Patellofemoral Pain, Q-Angle, and Performance in Female Chinese Collegiate Soccer Players

by Songhui You, Yinhao Shen, Qingguang Liu and Antonio Cicchella

Medicina 2023, 59(3), 589; https://doi.org/10.3390/medicina59030589 - 16 Mar 2023

Cited by 1 | Viewed by 2153

Abstract

Background and objective: Female sports injuries have been neglected by science, and few relevant studies have considered female subjects. Knee pain in female soccer players is more common than in male soccer players. The number of days of absence from training and competition [...] Read more.

Background and objective: Female sports injuries have been neglected by science, and few relevant studies have considered female subjects. Knee pain in female soccer players is more common than in male soccer players. The number of days of absence from training and competition has been shown to be higher in females than males. The reporting of knee pain is common in female soccer players, but whether knee pain is associated with morphological features is unclear. The Q-angle of the knee has been hypothesized to be a causal factor in knee pain. Asian females have shown higher levels of valgus than non-sporting Caucasian populations, but no data exist for female Chinese players. The aim of our study was to investigate whether there are associations between knee pain, the Q-angle of the lower limb, jump performance, play time, and perceived exertion in female Chinese collegiate soccer players. Materials and Methods: We measured the Q-angle, patellofemoral/anterior knee pain (SNAPPS questionnaire), and CMJ and SJ performance of 21 subjects (age: 20.09 ± 1.13 years, weight: 56.9 ± 6.26 kg, height: 164.24 ± 4.48 cm, and >10 years of practice) before and after a match; Borg scale and play time results were also recorded. Results: We found that our studied group had higher Q-angles in comparison to other ethnic groups reported in the literature, as well as an association of the Q-angle with the age, height, and weight of the players; however, contrary to other studies, we did not find any association between the Q-angle and knee pain, jumps, play time, or perceived exertion. Knee pain was not associated with any of the measured variables. Conclusions: Female Chinese soccer players showed higher Q-angles than players of other ethnic groups, a result that was associated with anthropometrics. The Q-angle was not found to be associated with knee pain, for which the sole determinant was body height. Full article

(This article belongs to the Special Issue Advances in Anterior Cruciate Ligament Injury, Reconstruction, and Rehabilitation)

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11 pages, 802 KiB

Open AccessArticle

Patellofemoral Angle, Pelvis Diameter, Foot Posture Index, and Single Leg Hop in Post-Operative ACL Reconstruction

by Ahmet Serhat Genç and Nizamettin Güzel

Medicina 2023, 59(3), 426; https://doi.org/10.3390/medicina59030426 - 22 Feb 2023

Cited by 2 | Viewed by 2271

Abstract

Background and Objectives: Anterior cruciate ligament (ACL) injuries occur as a result of the deterioration of the static and dynamic stability of the knee. One of the structures involved in providing static stability is the patellofemoral angle (Q angle). The aim of this [...] Read more.

Background and Objectives: Anterior cruciate ligament (ACL) injuries occur as a result of the deterioration of the static and dynamic stability of the knee. One of the structures involved in providing static stability is the patellofemoral angle (Q angle). The aim of this study was to investigate the relationships between Q angle, pelvis diameter, lower extremity length, and foot posture index (FPI) in patients who had undergone ACL reconstruction (ACLR) with the semitendinosus/gracilis (ST/G) technique on both the operated and non-operated sides. Materials and Methods: Twenty-five male recreational athletic patients between the ages of 18 and 35 who had undergone semitendinosus/gracilis (ST/G) anterior cruciate ligament reconstruction at least 6 months earlier were included in the study. Femur length, lower extremity length, pelvis diameter, and Q angle measurements, total foot posture index (FPI) scores, and single leg hop (SLH) and triple hop distance (THD) test results were determined on the operated and non-operated sides. Results: When the findings of the patients were evaluated statistically between the operated and non-operated sides, no significant differences were found in Q angle, femur length, and lower extremity length (p > 0.05). In terms of FPI scores, a significant difference was found only in the inversion/eversion of the calcaneus (CALC) parameter (p < 0.05). When the single hop test (SLHT) results were evaluated statistically on the operated and non-operated sides, the results were in favor of the non-operated side (p < 0.05). In the correlation analysis conducted for both the operated and non-operated sides, positive and significant correlations were found only between SLH and THD (p < 0.05). No significant difference was found in the other parameters. Conclusions: The fact that ST/G ACLR 6th month post-operative findings revealed similar results in Q angle, lower extremity length, and total FPI scores between the operated and non-operated sides showed that the 6-month process did not cause a difference in these parameters. However, it was found that the operated sides showed lower findings compared to non-operated sides for SLHTs, although these findings were within normal ranges in terms of the limb symmetry index. Full article

(This article belongs to the Special Issue Advances in Anterior Cruciate Ligament Injury, Reconstruction, and Rehabilitation)

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13 pages, 1370 KiB

Open AccessArticle

Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study

by Yangang Kong, Lifeng Yin, Hua Zhang, Wenlong Yan, Jiaxing Chen, Aiguo Zhou and Jian Zhang

Medicina 2023, 59(2), 390; https://doi.org/10.3390/medicina59020390 - 17 Feb 2023

Cited by 1 | Viewed by 1736

Abstract

Background and Objectives: Tunnel enlargement (TE) is a widely reported phenomenon after anterior cruciate ligament reconstruction (ACLR). Given the paucity of knowledge in the literature, it remains unclear whether screw position in the tunnel affects TE. This retrospective cohort study evaluated differences [...] Read more.

Background and Objectives: Tunnel enlargement (TE) is a widely reported phenomenon after anterior cruciate ligament reconstruction (ACLR). Given the paucity of knowledge in the literature, it remains unclear whether screw position in the tunnel affects TE. This retrospective cohort study evaluated differences in postoperative tunnel enlargement rates (TER) and clinical results between anterior and posterior tibial interference screw insertion during single-bundle ACLR using autologous hamstring grafts. Materials and Methods: A group of consecutive patients that underwent primary arthroscopic single-bundle ACLR in our hospital were screened and divided into two groups based on the position of the tibial interference screw (determined by Computer Tomography within 3 days after surgery): anterior screw position group (A) and posterior screw position group (B). The bone tunnel size was measured using magnetic resonance imaging (MRI) performed 1 year after surgery. International Knee Documentation Committee (IKDC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used for clinical results 1 year postoperatively. Results: 87 patients were included. The TER of Group A is higher than that of Group B (43.17% vs. 33.80%, p = 0.024). Group A showed a significant increase (12.1%) in enlargement rates at the joint line level than group B (43.77% vs. 31.67%, p = 0.004). Moreover, KOOS and IKDC scores improved in both groups. There were no significant differences in clinical outcomes between the two groups. Conclusions: One year after ACLR, patients with posterior screw showed significantly lower TE than patients with anterior screw. However, the position of screw did not lead to differences in clinical results over our follow-up period. Posterior screw position in the tibial tunnel maybe a better choice in terms of reducing TE. Whether the different screw positions affect the long-term TE and long-term clinical outcomes needs to be confirmed by further studies. Full article

(This article belongs to the Special Issue Advances in Anterior Cruciate Ligament Injury, Reconstruction, and Rehabilitation)

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8 pages, 1057 KiB

Open AccessArticle

Outcomes of Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction According to GNRB Arthrometer Measurement

by You-Hung Cheng, Chih-Hao Chiu, Alvin Chao-Yu Chen, Yi-Sheng Chan and Kuo-Yao Hsu

Medicina 2023, 59(2), 366; https://doi.org/10.3390/medicina59020366 - 14 Feb 2023

Cited by 1 | Viewed by 1652

Abstract

Background and Objectives: To investigate the prognosis of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction, we used a GNRB (Genourob, Laval, France) arthrometer to measure surgical outcomes. Materials and Methods: This retrospective study reviewed patients who underwent combined [...] Read more.

Background and Objectives: To investigate the prognosis of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction, we used a GNRB (Genourob, Laval, France) arthrometer to measure surgical outcomes. Materials and Methods: This retrospective study reviewed patients who underwent combined ACL and ALL reconstruction and had a minimum follow-up of 2 years. Subjective outcomes, namely the International Knee Documentation Committee (IKDC) evaluation form scale scores and Lysholm scores, were evaluated preoperatively and postoperatively. We used a GNRB arthrometer to test the side-to-side laxity under pressures of 134 and 200 N, and we calculated the differential of the slope of the curves. We also recorded complications. Results: Our study examined 18 patients (mean age: 30.56 ± 8.9 years, range: 19–53) with a mean follow-up of 27.37 ± 3.4 months (range: 24–36). Both Lysholm and IKDC scores were significantly improved following the operation. The GNRB arthrometer measured mean anteroposterior laxity side-to-side as 0.76 ± 0.78 mm and 0.82 ± 0.8 mm under pressures of 134 and 200 N, respectively. The mean side-to-side differential slope under 200 N was 3.52 ± 2.17 μm/N. These values indicated that patients displayed no graft tear or low functional knee instability. All patients had a grade 3 pivot shift preoperatively; only two patients had a grade 1 pivot shift postoperatively, with the rest having a negative pivot shift. Conclusions: Our study revealed that combined ACL and ALL reconstruction has an excellent prognosis. GNRB measurement demonstrated excellent stability, and most patients had no residual pivot shift. Full article

(This article belongs to the Special Issue Advances in Anterior Cruciate Ligament Injury, Reconstruction, and Rehabilitation)

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