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

Background

To assess the incidence of anterolateral ligament (ALL) and Kaplan fiber of the iliotibial band (KF) injuries in patients with acute anterior cruciate ligament (ACL) injury on magnetic resonance imaging (MRI), and to investigate the association between these injuries and the magnitude of preoperative pivot-shift test.

Method

One-hundred and five patients with primary ACL injury were retrospectively reviewed. ALL injury and KF injury were assessed by preoperative MRI, and subjects were allocated into four groups: Group A, neither injury; Group B, only ALL injury; Group C, only KF injury; Group D, simultaneous ALL and KF injuries. Before ACL reconstruction, tibial acceleration during the pivot-shift test was measured by an electromagnetic measurement system, and manual grading was recorded according to the International Knee Documentation Committee (IKDC) guideline.

Results

In MRI, the ALL was identified in 104 patients (99.1%) and KF in 99 patients (94.3%). ALL and KF injuries were observed in 43 patients (43.9%) and 23 patients (23.5%), respectively. Patient distribution to each group was as follows; Group A: 43 patients (43.9%), Group B: 32 patients (32.7%), Group C: 12 patients (12.2%), Group D: 11 patients (11.2%). No significant differences were observed in tibial acceleration, and manual grading among the four groups.

Conclusion

Simultaneous injury to both ALL and KF was uncommon, and preoperative pivot-shift phenomenon did not increase even in those patients. The finding suggests that the role of ALL and KF in controlling anterolateral rotatory knee laxity may be less evident in the clinical setting compared to a biomechanical test setting.

Epiphyseal injury, particular on femoral side, is a major concern in pediatric anterior cruciate ligament (ACL) reconstruction. Therefore, the over-the-top route (OTTR) method has frequently been selected in pediatric ACL reconstruction, with good clinical results reported. However, a cadaver study reported the inferior rotational stability of the OTTR method to that of anatomical single bundle reconstruction. In recent years, a new method of reconstruction, which involves the remnant being detached, re-tensioned, and re-attached, achieved good short-term results. We developed a surgical method to restore the remnant to the posterolateral (PL) bundle footprint and obtain rotational stability in patients, thereby preserving the remnant. We hypothesized that repairing the residual remnant to the PL bundle footprint in pediatric ACL reconstruction could achieve rotational stability. This report offers the surgical techniques for PL bundle tensioning repair using remnants in the pediatric ACL OTTR procedure.

Objectives

While there is a consensus against bracing after anterior cruciate ligament (ACL) reconstruction, the question of its potential benefits, especially in cases involving meniscus repair, as well as its routine use by the majority of clinicians, remains a topic of debate. This study aims to assess the effectiveness of bracing in relation to clinical scores after ACL reconstruction, regardless of meniscus surgery.

Methods

This randomised controlled study involved patients aged 15–55 years who underwent arthroscopic ACL reconstruction surgery. All eligible patients were assigned into two groups: one group received an adjustable frame with a four-point fixation knee brace for a four-week period, while the other did not.

A single experienced surgeon performed standard anatomical single-bundle ACL reconstruction. All patients, irrespective of whether they underwent meniscus repair, followed the same rehabilitation protocol. Knee functional questionnaires, including the International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner Activity Scale, Visual Analogue Scale (VAS), and examinations, were collected preoperatively, at six months, one year, and two years postoperatively. The study employed an intention-to-treat analysis and multilevel mixed-effects generalised linear models to compare continuous outcomes between the groups, adjusting for the times of follow-up.

Results

A total of 84 patients (42 patients per group) comprised of 75 males (89 %) and average age of 30 ± 9.4 years old. Patient-reported function, physical examination findings, and surgical characteristics were comparable between the two groups. (P-value >0.05) Both groups demonstrated significant improvement in IKDC and Lysholm scores at the end of the two-year follow-up period. (P-value <0.0001) In multivariate analysis, bracing was significantly associated with lower Tegner activity scale than the non-brace group after adjustment for VAS and time (coefficient −0.49, 95 % confidence interval −0.87, −0.10, P-value = 0.013). None of the graft ruptures were reported, and there was no significant difference of return to sports between the groups at the end of the follow-up.

Conclusion

The study suggests that knee bracing after ACL reconstruction, regardless of any additional meniscus procedures, fails to enhance subjective or objective outcomes and could potentially have a negative impact on the Tegner activity scale, although the difference is not clinically significant. The routine use of a postoperative brace should be discontinued.

Level of evidence

Level I, Randomised controlled trial with no negative criteria.

Objective

Initial tension at graft fixation is one of key factors for good outcomes in anterior cruciate ligament (ACL) reconstruction. Identifying the pre-operative factors that influence postoperative knee laxity under the anterior tibial load is useful in determining the initial tension at graft fixation. Thus, the purpose of this study was to clarify the pre-operative factors affecting the side-to-side difference in anterior laxity immediately after the anatomic double-bundle ACL reconstruction with a constant initial tension.

Methods

Fifty-five patients underwent the anatomic double-bundle ACL reconstruction with hamstring tendon grafts. Anterior tibial displacement (ATD) was measured on both knees using KT-2000 Knee Arthrometer under anterior drawer load of 67 N, 89 N, 134 N and manual maximum load at 30° of flexion before ACL reconstruction under anesthesia, and was also measured on the operated knees under 89 N immediately after ACL reconstruction under anesthesia. Then, side-to-side difference (SSD) before and immediately after ACL reconstruction was calculated. Correlative relation between the SSD immediately after ACL reconstruction and the ATD/the SSD in each condition was analyzed.

Results

The side-to-side difference of ATD immediately after surgery was −3.8 ± 1.7 mm (0 to -8mm) in response of 89 N of anterior load. There was correlation between the SSD immediately after ACL reconstruction and all ATD on both knees except for the ATD under manual maximum load on the injured knee, while little correlation between the SSD immediately after ACL reconstruction and that before ACL reconstruction was found. Especially, ATD under 89 N on the opposite knees and ATD under 134 N on the injured knees showed selective correlation with the SSD immediately after surgery in the step-wise multiple regression analysis.

Conclusion

As the anterior tibial displacements under 89 N on the contra-lateral knee and under 134 N on the injured knee had a significant correlation with the SSD immediately after ACL reconstruction, those values may be helpful in determining the increase or decrease in initial tension at graft fixation.

Background

Arthroscopic rotator cuff repair (ARCR) is a minimally invasive surgical technique. However, it is challenging to control postoperative pain. This study aimed to investigate the difference between a single-shot interscalene block and a combined continuous block for ARCR.

Methods

Ninety-four patients who underwent ARCR were included in this study. In the preceding period, 43 patients received a single-shot interscalene block and continuous postoperative intravenous opioid infusion (Single group). In the posterior period, 51 patients received a single-shot interscalene block preoperatively and a continuous block postoperatively (Continuous group). Their mean age at surgery was 64.9 years (range, 43–83 years). The mean follow-up period was 25.4 months (range, 24–54 months). The numerical rating scale (NRS) of pain was evaluated immediately after the surgery, at rest, and at night for 1–4 days after the surgery. One day postoperatively, the amount of food taken was assessed from 0 % (no food intake) to 100 % (all food taken). The University of California at Los Angeles (UCLA) shoulder score, range of motion (ROM), and isometric shoulder strength were evaluated.

Results

NRS at rest in the Continuous group on the day of surgery was 3.7 ± 2.5. This was significantly lower than in the Single group (5.2 ± 1.8) (P = 0.002). NRS at rest in the Continuous group on the second day after surgery was 3.0 ± 2.1, significantly lower than in the Single group (3.9 ± 1.8) (P = 0.04). The amount of food taken in the morning in the Continuous group was 61 % ± 37 %, which was significantly greater than in the Single group (35 % ± 41 %) (P = 0.004). The ROM of extension at 6 months postoperatively in the Continuous group was 47 ± 7°, which was significantly greater than in the Single group (43 ± 6°) (P = 0.02). The postoperative strength of the external rotator at 6 months in the Continuous group was 95 ± 33 N, significantly greater than in the Single group (78 ± 28 N) (P = 0.01). There was no significant difference in UCLA score at any time.

Conclusion

The continuous interscalene block with ultrasound guidance in ARCR effectively relieved pain. The recovery of ROM for extension and the strength of the external rotator was better in the Continuous group.

Background/Objective

Normal knee kinematics during flexion and extension activities over the whole range of motion remains unknown. This study aimed to clarify in vivo kinematics during knee flexion and extension activities of normal knees by comparing continuous flexion and extension activities up to a high flexion angle.

Methods

Twenty knees of 10 Japanese volunteers were enrolled in this study. Each volunteer performed a continuous squatting motion under fluoroscopy, and a two- or three-dimensional registration technique was used. Rotation and anteroposterior translation of the medial and lateral sides of the femur relative to the tibia at each flexion angle were evaluated.

Results

Femoral external rotation was significantly smaller from 10° to 40° flexion during extension activities than during flexion activities. However, the femoral external rotation was larger from 120° to 130° flexion during extension activities than during flexion activities. From 10° to 60° of flexion, the medial side was significantly more posteriorly located during extension activities than during flexion activities. Furthermore, the lateral side was significantly more posteriorly located at 130° of flexion during extension activities than during flexion activities.

Conclusion

In vivo kinematics of normal knees during extension activities differ from those during flexion activities in early and high flexion.

Background

This study aimed to investigate the effect of high tibial osteotomy (HTO) on medial meniscus extrusion (MME) and the association between the changes in limb alignment and MME under weight-bearing (WB) conditions after HTO.

Methods

We included 17 patients with knee osteoarthritis (OA) who underwent HTO. MME was evaluated using ultrasonography in supine and unipedal standing positions. Knee alignment was evaluated radiographically using WB, whole-leg radiographs with the hip-knee-ankle angle (HKAA), percentage of the mechanical axis (%MA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA). All measurements were performed serially at four time points: preoperative and 3, 6, and 12 months postoperative. Clinical outcomes were assessed by knee injury and osteoarthrosis outcome score (KOOS) and visual analogue scale (VAS) value for pain.

Results

Mean MME in the WB position was significantly greater than that in the supine position in the preoperative condition; however, MME in both supine and WB positions was significantly lowered postoperatively. The ΔMME, difference of MME between supine and WB positions, was significantly lowered postoperatively and maintained for up to 1 year. MME change in the WB position between preop and postoperative conditions was significantly correlated with change in HKAA and %MA at 1 year postoperative. KOOS and VAS score were significantly improved after HTO.

Conclusions

HTO correcting varus alignment can decrease MME in WB position and minimise the change in MME between supine and WB positions. The changes in MME after HTO were correlated with changes in the mechanical alignments.

Background

Failure to fix the fractured fragment can result in bony fragment resorption and consequent glenoid bone loss. Current arthroscopic repair techniques might lead to insecure fixation and refracture. The purpose of this study was to evaluate the effectiveness of the transosseous sling-suture technique for bony Bankart lesions, and to compare the clinical outcomes for acute and chronic bony Bankart lesions treated with this technique.

Methods

A retrospective case series consisting of 46 patients with bony fracture of the glenoid rim following traumatic injury was identified from May 2015 to August 2020. The patients were divided into the acute lesion group and the chronic lesion group according to the time from first injury to surgery. The size of bone fragment was used to group the patients into the small and the medium sized fragment groups. All the patients underwent arthroscopic repairs using the transosseous sling-suture technique. Preoperative and postoperative evaluations including Rowe score, West Ontario Shoulder Instability Index (WOSI), Visual Analogue Scale (VAS) for pain scores, ROMs and number of dislocations were recorded. No significant differences were found in the comparisons of postoperative ROMs ang functional outcomes regarding between the small and the medium sized fragment groups.

Results

No dislocations occurred for both groups postoperatively. At the last follow-up, all the ROMs (including anterior flexion, abduction, external rotation and internal rotation at the side), the Rowe score, the WOSI score and the VAS score for pain in the both groups were significantly improved compared to the preoperative evaluations (all Ps < 0.001). In the comparisons between the acute and the chronic lesion groups, significantly greater anterior flexion (158.9 ± 8.9° vs. 153.0 ± 6.4°, P = 0.037), abduction (167.7 ± 10.1° vs. 161.0 ± 7.0°, P = 0.035) and external rotation at the side (88.3 ± 6.4° vs. 83.5 ± 5.5°, P = 0.024) were found in the acute lesion group. The comparisons of the Rowe score (86.0 ± 7.5 vs. 87.5 ± 10.6, P = 0.319), the WOSI score (223.5 ± 56.3 vs. 185.0 ± 79.9, P = 0.062), the VAS score for pain (0.4 ± 0.2 vs. 0.3 ± 0.2, P = 0.324) and the internal rotation at the side (74.6 ± 13.2° vs. 80.5 ± 11.1°, P = 0.116) between these two groups did not demonstrate significant differences between the two groups.

Conclusion

This arthroscopic transosseous sling-suture repair technique for shoulder anterior instability with acute and chronic bony Bankart lesion can restore joint stability, improve clinical outcomes and range of motion postoperatively. The acute bony Bankart lesion using the current technique can produce better range of motion compared to the chronic lesion.

Study design

Retrospective case series; Level of evidence, 4.