Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology最新文献

Purpose

To analyze the change in rotational alignment caused by double level osteotomy (DLO) based on comparative three-dimensional image analysis of pre- and postoperative CT images.

Methods

Pre- and postoperative CT examination of the lower extremities were performed with informed consent for 39 consecutive knees undergoing DLO for varus knee deformity. The DLO procedure consisted of closed wedge distal femoral osteotomy (CWDFO) and open wedge high tibial osteotomy (OWHTO). Among those cases, 20 knees complicated with hinge fracture at the osteotomy site were excluded from the analysis to eliminate a confounding factor affecting the results. Consequently, data obtained from 19 knees were subjected to the study analysis while osteotomies with hinge fractures complications were excluded from the study. In the three-dimensional CT image analysis of axial plane images, femoral torsion (the angle between midline along the femoral neck axis and the tangent of the posterior edges of the medial/lateral femoral condyles) and tibial torsion (the angle between the tangent of the posterior edges of the medial/lateral tibial condyles and the transmalleolar axis) were measured. The torsion angle was measured in each of the femurs and the tibias on both pre- and postoperative CT axial images, and the change induced by the osteotomy was calculated and statistically(using Wilcoxon signed-rank test) compared.

Results

The mean pre- and postoperative femoral torsion (anteversion) angles were 29.3° and 31.4° with a significant postoperative increase in internal rotation of the bony segment distal to the osteotomy(P = 0.002). On the tibial side, the mean pre- and postoperative torsion angles were 26.5° and 25.7°, indicating no significant postoperative change(P = 0.199)（NS）.

Conclusions

This study showed that the DLO procedure (combining CWDFO and OWHTO) increased torsion (anteversion) of the femur by 2.1° on average while inducing no significant rotational change on the tibial side.

Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure in Orthopaedic sports medicine. With advances in surgical techniques providing better positioning and fixation of the graft, subsequent graft failure to certain extent should be accounted by poor graft healing. Although different biological modulations for enhancement of graft healing have been tried in different clinical and animal studies, complete graft incorporation into bone tunnels and the “ligamentization” of the intra-articular part have not been fully achieved yet. Based on the understanding of graft healing process and its failure mechanism, the purpose of this review is to combine both the known basic science & clinical evidence, to provide a much clearer picture of the obstacle encountered in graft healing, so as to facilitate researchers on subsequent work on the enhancement of ACL graft healing.

Background/objective

Injury-related fear during sport activities are major psychological factors inhibiting a person’s return to sports (RTS) following anterior cruciate ligament reconstruction (ACLR). Currently, there are no studies that quantitatively analyse the open-ended questionnaire for knee injury-related fear in post-ACLR athletes.

The purpose of this study was to identify knee injury-related fear in athletes who return to ball-centric sports via the use of an open-ended questionnaire. We aimed to determine the main concepts of injury-related fear according to sex, type of sport, and participation level.

Methods

In this study, a quantitative analysis of an open-ended questionnaire was used to examine the type of fear athletes experience after returning to ball-centric sports. The RTS and fear questionnaire collected open-ended questionnaire to knee injury-related fear during sport activities; this questionnaire was completed at the outpatient visit post-RTS. Quantitative content analysis was performed to extract frequently occurring words from the responses to the questionnaire to create a co-occurrence network. The resulting co-occurrence network and extracted words were used to create concepts regarding knee injury-related fear. The relationship between each concept and subject demographics (sex, returned sports events, and participation level) were analysed using the chi-squared test.

Results

Fifty-four athletes (30 females and 24 males) aged 16–45 [median age: 21.2; interquartile range (IQR): 11.0] years with an average RTS of 8.0 (IQR: 3.3) months from ACLR participated in the study. A total of 79 responses were included in the analysis. The knee injury-related fear can be summarized as follows: (1) Quick response to the opponent; (2) Ball-related play; (3) Jump-landing; (4) Contact; (5) Loss of balance; and (6) Athletic movement. Chi-squared tests showed that athletes participating in sport events with potential contact with an opponent (soccer, futsal, basketball, handball, lacrosse, and ultimate (frisbee)) were more likely to experience fear in quick response to the opponent (P < 0.01, adjusted residual = 2.943, ϕ = 0.301).

Conclusion

The knee injury-related fear can be summarized into six concepts. Post-ACLR athletes participating in ball-centric sports need to assess fear in situations such as quick responses to the opponent’s movements and ball-related play, in addition to simple movements such as jumping, cutting, and contact.

Background/objective

For early return to sports after a lateral ankle sprain (LAS) and recurrence prevention, effective rehabilitation and gradual return to sports should be initiated while predicting the return time based on the appropriate severity evaluation immediately after injury. However, since severity evaluations performed in previous studies required large space and stairs and involved high-revel activity, their use as a test and index to evaluate severity after LAS was not appropriate considering convenience and risk of re-injury. Therefore, a quick and simple test was developed to evaluate the severity of acute LAS. This study aimed to verify the association between ankle function for severity evaluation and anterior talofibular ligament (ATFL) injury type by ultrasonography and to clarify the usefulness for acute LAS severity evaluation of the single-leg loading (SLL) test.

Methods

In total, 50 patients (34 men, 16 women) out of 58 patients who visited our sports clinic within 3 days after acute LAS and who conformed to the study criteria were included in this study. During the first visit, SLL test and objective/subjective ankle joint evaluation were performed. The SLL test consists of single-leg standing, single-leg heel raising and single-leg hopping, and patients were classified into four levels from 1 to 4 according to results. In addition, ultrasonographic evaluation was performed within 1 week after the first visit to evaluate the type of ATFL injury. Type I was defined as intact ATFL, Type II as swollen ATFL with an almost intact fibrillar pattern and Type III as ATFL appearing swollen with a disrupted fibrillar pattern. The relationship between the SLL test and each evaluation item was investigated using Spearman's correlation coefficient.

Results

As a result of the SLL test, 15 patients had Level 1 (30%), 19 Level 2 (38%), 5 Level 3 (10%) and 11 Level 4 (22%). With regard to correlation coefficients of the SLL test, Japanese Society for Surgery of the Foot ankle/hindfoot scale and sports activity were r_s = 0.71 (p < 0.001) and r_s = 0.66 (p < 0.001), respectively, showing a significant positive correlation. SLL test and the type of ATFL injury also showed a significant negative correlation (r_s = −0.58, p < 0.001).

Conclusions

The SLL test was a simple and useful test that can be used as an index to evaluate the severity of acute LAS.

Purpose

The aim of this study was to verify the effects of a new remnant augmentation technique with anatomical double-bundle anterior cruciate ligament (ACL) reconstruction for postoperative clinical scores, anterior stability and frequency of complications compared to remnant removal and cases with remnant defects.

Methods

The 105 patients who underwent anatomical double-bundle ACL reconstruction were divided into three groups. If the remnant was a Crain I-III type, remnant-preserving bone tunnel creation was attempted. After the creation of the bone tunnel, good continuity was maintained in 34 patients (preserved group). Due to lost continuity, the remnant was resected in 26 patients (resected group). No identifiable remnant continuity remained (Crain IV) in 45 patients (absent group). The Lysholm knee score, Tegner activity scale, International Knee Documentation Committee (IKDC) subjective score, anterior stability measured using the KT-1000 arthrometer at 2 years postoperatively, and frequency of complications were compared among the three groups. Univariate and multiple linear regression analysis were performed to clarify the factors affecting postoperative anterior stability.

Results

The Lysholm knee score, Tegner activity scale, IKDC subjective score, and frequency of complications were not significantly different among the groups. The mean side-to-side difference of anterior stability was significantly better in the preserved group (0.3 ± 1.6 mm) compared to the resected group (1.6 ± 2.3 mm, p = 0.003) and absent group (1.6 mm ± 1.7, p = 0.009). The multiple linear regression analysis showed remnant preservation significantly related to postoperative anterior stability.

Conclusion

Although there were no differences in clinical scores, the ACL reconstruction with new preservation technique showed good anterior stability and no difference in the frequency of complications.

Background

Most patients with anterior cruciate ligament (ACL) injury undergo ACL reconstruction (ACLR) with the expectation of being able to return to sport (RTS) at the same level of the competition as before the injury. The magnitude and asymmetry of landing impact are important post-ACLR functional variables related to increased ACL strain and poor athletic performance. However, the association between the RTS status and landing impact in post-ACLR patients is unknown.

Objective

To investigate the association between RTS status and landing impact during single-leg landing in post-ACLR patients.

Methods

Forty-four patients after primary, unilateral ACLR participated in this study. They had already participated in sports post-ACLR. Questionnaires were used to assess whether the participants achieved the same competitive level of RTS as before the injury. The magnitude and symmetry of the peak vertical ground reaction force (pVGRF) were collected and analysed during single-leg jump landings. Additionally, knee functions (range of motion, laxity, effusion, strength, and single-leg hop distance) were measured.

Results

A total of 28 (64%) patients reported RTS at their pre-injury competition levels. The no-RTS group had a lower pVGRF magnitude on the operated side than the yes-RTS group (P = .019). The no-RTS group had a higher rate of pVGRF asymmetry (50%) than the yes-RTS group (18%) (P = .040). Logistic regression analysis revealed that pVGRF magnitude and asymmetry were significantly associated with the RTS status. Logistic regression analysis adjusted for knee function revealed that the pVGRF magnitude was significantly associated with the RTS status.

Conclusion

In patients who are unable to RTS at their pre-injury competition level after ACLR, the pVGRF is lower and more likely to be asymmetrical than in those able to RTS at their pre-injury competition level.

Injury to distal tibiofibular syndesmosis is commonly associated with ankle fractures. The surgical treatment especially in isolated chronic syndesmosis instability is still debated. This article has reviewed literature identified from PubMed, EMBASE and Cochrane from year 2000 onwards and compared the functional outcomes between syndesmosis fusion and ligament reconstruction based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eighteen studies were included. All the included papers described a good-to-excellent post-operative functional outcome without major complications. No significant difference between the two surgical interventions could be concluded. Further studies of better quality shall be conducted in the future.

Background

The posterior cruciate ligament (PCL) is one of the essential stabilizers of the knee joint and it was demonstrated that its degenerative change related to the knee osteoarthritis (OA). We aimed to evaluate signal of the PCL in OA patients in comparison with healthy young and elderly volunteers using the ultra-short echo timeenhanced (UTE)-T2∗ mapping, and to validate these findings with histology.

Methods

Thirty asymptomatic volunteers, 13 young people (younger group) and 17 elderly people (elder group), and 27 patients who had undergone total knee arthroplasty (OA group) were enrolled in this study. UTE-T2∗ maps of PCL were obtained from all participants. The PCL was divided into proximal, middle, and distal parts and the UTET2∗ values obtained from each part were compared among the groups. In OA group, the sacrificed PCLs were evaluated histologically in each part corresponding to the part of UTE-T2∗ maps and compared.

Results

The UTE-T2∗ values in OA group were significantly higher than those in other groups except in distal part. In elder group, the UTE-T2∗ values were significantly higher than those in younger group only in the proximal part. Moreover, in OA group, the UTE-T2∗ values in proximal and middle parts were significantly higher than those in distal part. There was a moderate correlation between the UTE-T2∗ values and histological scores.

Conclusions

The specific signal intensity pattern of the PCL in patients with OA was demonstrated using UTE-T2∗ mapping, and these findings were related to histological degenerated status of the PCL.

Background

Although the association between femoroacetabular impingement (FAI) syndrome and hip osteoarthritis (OA) is well established, not all hips exhibiting cam or pincer morphologies (i.e. imaging findings of FAI syndrome) are symptomatic or arthritic. It is difficult to detect which subgroup will wear out, or how does the arthritic process start radiographically. Therefore, we measured in a retrospective study based on computed tomography (CT) analysis, the joint space width (JSW) according to a standard protocol and we investigated its variation according to the presence of a cam and/or pincer morphology. We hypothesized that the radiological presence of a cam and/or pincer hip morphologies, even in asymptomatic subjects, would affect JSW.

Methods

Two hundred pelvic CT scans performed for non-orthopedic etiologies in asymptomatic patients were analyzed using a 3D software. After excluding patients with hip OA or previous hip surgery, 194 pelvic CT scans (388 hips) were retained. We measured for each hip the presence of FAI syndrome imaging findings (cam and pincer morphologies) using the classical parameters of coxometry. In addition, we performed a measurement of articular joint space width according to a standard protocol. We then calculated the mean thickness of 3 defined regions along the femoroacetabular joint: anterior-superior, posterior-inferior, and posterior-superior. Lastly, we compared the JSW across 4 groups: hips with (1) no cam or pincer, (2) pincer, (3) cam, and (4) cam and pincer morphologies using a multivariate analysis. Additionally, a topographic heatmap of JSW was plotted allowing quantitative representation of JSW along the joint.

Results

Increased JSW with peak difference of 0.9 mm (25.7%) was found in hips with cam and pincer morphologies when compared to normal ones (p = 0.002) and to hips with pincer or cam morphologies only.

Conclusion

Positive variations in JSW were associated to the presence of cam and pincer morphologies. This significant increase in JSW could be one of the earliest measurable changes preceding later classical alterations.