scholarly journals Anterior cruciate ligament injuries in the prepubescent and adolescent. Modern trends and researches

2021 ◽  
Vol 28 (1) ◽  
pp. 89-107
Author(s):  
Yaroslav A. Ivanov ◽  
Alexander G. Yeltsin ◽  
Dmitry S. Mininkov
Keyword(s):  
Cruciate Ligament ◽  
Leisure Activities ◽  
Knee Injuries ◽  
Young Patients ◽  
Surgical Techniques ◽  
Return To Sports ◽  
Extreme Sports ◽  
Children And Adolescent ◽  
Intercondylar Eminence ◽  
Fractures In Children

The article represents a literature review of research on diagnostics and treatment of ACL tears and intercondylar eminence fractures in children and adolescence published between 2015 and 2020. We scrolled the following databases: Google scholar, Pubmed, and eLilbrary. Today knee injury with isolated ACL tears in young patients is growing more frequent due to their enhanced participation in extreme sports and other organized leisure activities where the risk of injury perceives. The injury with isolated ACL tears represents 1/4 of all knee injuries. Apart from extreme activities there is another risk factor that causes ACL tears late surgical involvement. Partial ACL tears and surgical techniques of skeletal immature patients (extraphyseal and all-ephyseal) were analysed in this study too. This work also includes the subject of re-fixation of fresh ACL rupture. Perspectives of return to sports of young athletes were also analysed. The most common predictive factor of returning to sports is a patients age. Young children return to their usual physical activities more promptly. Questions of proprioceptive impact on bio-mechanics and graft re-innervation also raised. The problem of ACL tears in children and adolescent patient are relevant. It needs more researches and improvements of surgery techniques.

scholarly journals Suture Versus Screw Fixation of Tibial Spine Fractures in Children and Adolescents: A Comparative Study

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988196 ◽  
Author(s):  
Mark Callanan ◽  
Judd Allen ◽  
Brett Flutie ◽  
Francis Tepolt ◽  
Patricia E. Miller ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Surgical Outcomes ◽  
Screw Fixation ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Spine Fractures ◽  
Avulsion Fractures ◽  
Tibial Spine ◽  
Intercondylar Eminence ◽  
Fractures In Children

Background: Tibial spine fractures involve an avulsion injury of the anterior cruciate ligament (ACL) at the intercondylar eminence, typically in children and adolescents. Displaced fractures are commonly treated with either suture or screw fixation. Purpose: To investigate differences in various outcomes between patients treated with arthroscopic suture versus screw fixation for tibial spine avulsion fractures in one of the largest patient cohorts in the literature. Study Design: Cohort study; Level of evidence, 3. Methods: A search of medical records was performed with the goal of identifying all type 2 and type 3 tibial spine avulsion fractures surgically treated between 2000 and 2014 at a pediatric hospital. All patients had a minimum of 12 months clinical follow-up, suture or screw fixation only, and no major concomitant injury. Results: There were 68 knees in 67 patients meeting criteria for analysis. There were no differences with regard to postsurgical arthrofibrosis ( P = .59), ACL reconstruction ( P = .44), meniscal procedures ( P = .85), instability ( P = .49), range of motion ( P = .51), return to sport ( P >.999), or time to return to sport ( P = .11). Elevation of the repaired fragment on postoperative imaging was significantly greater in the suture group (5.4 vs 3.5 mm; P = .005). Postoperative fragment elevation did not influence surgical outcomes. The screw fixation group had more reoperations (13 vs 23; P = .03), a larger number of reoperations for implant removal (3 vs 22; P < .001), and nearly 3 times the odds of undergoing reoperation compared with suture patients (odds ratio, 2.9; P = .03). Conclusion: Clinical outcomes between suture and screw fixation were largely equivalent in our patients. Postoperative fragment elevation does not influence surgical outcomes. Consideration should be given for the greater likelihood of needing a second operation, planned or unplanned, after screw fixation.

scholarly journals Arthroscopic Primary Repair of the Posterior Cruciate Ligament

2021 ◽  
Author(s):  
Harmen D. Vermeijden ◽  
Jelle P. van der List ◽  
Gregory S. DiFelice
Keyword(s):  
Posterior Cruciate Ligament ◽  
Primary Repair ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Knee Injuries ◽  
Surgical Techniques ◽  
Treatment Strategies ◽  
Early Mobilization ◽  
Invasive Approach ◽  
Tibial Translation

AbstractThe posterior cruciate ligament (PCL) is one of the four major stabilizers of the knee joint and functions as the primary restraint to posterior tibial translation. PCL tears rarely occur in isolation and most commonly presents in the setting of multiligamentous knee injuries. Several treatment strategies for these injuries have been proposed over the last decades, including ligament reconstruction and primary repair. Arthroscopic primary PCL repair has the potential to preserve native tissue using a more minimally invasive approach, thereby avoiding donor-site morbidity and allowing early mobilization. While arthroscopic PCL repair is certainly not an effective surgical approach for all patients, this procedure may be a reasonable and less morbid alternative to PCL reconstruction in selected patients treated for proximal or distal avulsion tears, with low failure rates, good knee stability, and good to excellent subjective outcomes. The surgical indications, surgical techniques, postoperative management, and outcomes for arthroscopic primary repair of proximal and distal PCL tears will be discussed in this review.

scholarly journals Evaluation of Single-Bundle versus Double-Bundle PCL Reconstructions with More Than 10-Year Follow-Up

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Masataka Deie ◽  
Nobuo Adachi ◽  
Atsuo Nakamae ◽  
Kobun Takazawa ◽  
Mitsuo Ochi
Keyword(s):  
Evaluation Method ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Surgical Techniques ◽  
Double Bundle ◽  
Single Bundle ◽  
Bundle Versus ◽  
Significant Difference ◽  
The Mean

Background. Posterior cruciate ligament (PCL) injuries are not rare in acute knee injuries, and several recent anatomical studies of the PCL and reconstructive surgical techniques have generated improved patient results. Now, we have evaluated PCL reconstructions performed by either the single-bundle or double-bundle technique in a patient group followed up retrospectively for more than 10 years.Methods. PCL reconstructions were conducted using the single-bundle (27 cases) or double-bundle (13 cases) method from 1999 to 2002. The mean age at surgery was 34 years in the single-bundle group and 32 years in the double-bundle group. The mean follow-up period was 12.5 years. Patients were evaluated by Lysholm scoring, the gravity sag view, and knee arthrometry.Results. The Lysholm score after surgery was89.1±5.6points for the single-bundle group and91.9±4.5points for the double-bundle group. There was no significant difference between the methods in the side-to-side differences by gravity sag view or knee arthrometer evaluation, although several cases in both groups showed a side-to-side difference exceeding 5 mm by the latter evaluation method.Conclusions. We found no significant difference between single- and double-bundle PCL reconstructions during more than 10 years of follow-up.

Prevalence and Detection of Meniscal Ramp Lesions in Pediatric Anterior Cruciate Ligament–Deficient Knees

2021 ◽  
pp. 036354652110101
Author(s):  
Isabelle Bernardini ◽  
Daniel N’Dele ◽  
Marie Faruch Bilfeld ◽  
Camille Thevenin-Lemoine ◽  
Julie Vial ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Knee Injuries ◽  
Young Patients ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Ramp Lesion ◽  
Anterior Cruciate ◽  
Low Sensitivity

Background: Anterior cruciate ligament (ACL) tears represent 13% of knee injuries in children. Medial meniscal tears are commonly associated with ACL ruptures. Ramp lesions correspond to posterior meniscocapsular tears of the medial meniscus. Depending on the study, the prevalence of ramp lesions is inconsistent. Purpose: To describe the prevalence of ramp lesions in children and adolescents and to investigate the sensitivity of magnetic resonance imaging (MRI) for diagnosing such lesions. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: We analyzed videos from arthroscopic ACL reconstruction (ACLR) in children. During these procedures, we systematically looked for potential ramp lesions. To do so, an arthroscope was passed through the intercondylar notch to visualize the posteromedial compartment. A needle was introduced at the site of a posteromedial portal to unfold the meniscocapsular junction to reveal any hidden meniscal tear. Surgical procedures were performed by 2 senior surgeons. Videos were blindly analyzed by a third surgeon. Preoperative MRIs were screened by 2 blinded, independent senior radiologists to look specifically for ramp lesions. Results: Videos of 50 consecutive arthroscopic ACLRs concerning 32 boys and 18 girls were analyzed. Mean age at surgery was 14.2 years (range, 8.5-17.6 years). A total of 14 ramp lesions (28%) in 8 boys and 6 girls were identified. In addition, there were 22 tears of the meniscal body in 20 patients (40%). Arthroscopic and MRI findings did not correlate. Among 14 arthroscopically diagnosed ramp lesions, only 8 were detected on the MRI. Conversely, 12 patients had a ramp lesion detected on the MRI, which could not be confirmed intraoperatively. The sensitivity of MRI was 57% and the positive predictive value was 40%. Conclusion: A meniscal ramp lesion was present in 14 of 50 children (28%) undergoing ACLR. MRI has a low sensitivity for diagnosis of ramp lesions in children. Careful exploration of the posteromedial compartment is strongly recommended. Overlooking such lesions during ACLR may contribute to ongoing instability and higher re-rupture rates in these young patients.

scholarly journals Validation and cultural adaptation of the Russian version of the Pedi-IKDC questionnaire

2021 ◽  
Vol 9 (2) ◽  
pp. 143-151
Author(s):  
Iaroslav A. Ivanov ◽  
Alexander G. Eltsin ◽  
Dmitry S. Mininkov
Keyword(s):  
Cultural Adaptation ◽  
Knee Injuries ◽  
Young Patients ◽  
International Knee Documentation Committee ◽  
Process Data ◽  
Good Tool ◽  
Children And Adolescent ◽  
Russian Version ◽  
High Level

BACKGROUND: Questionnaires are standard tools used for examination of patients. Obtained data provide information about knee function disturbance and level of the quality of life. Young patients with various knee injuries also needed examination questionnaires. In worldwide practice, the Pediatric International Knee Documentation Committee (Pedi-IKDC) is more often used by doctors. However, if the doctor wants to use foreign questionnaire in his/her practice, the questionnaire should be validated and culturally adaptable. AIM: This study aimed to enable the validation and cultural adaptation of the Russian version of the Pedi-IKDC questionnaire based on the English version for children and adolescent. MATERIALS AND METHODS: This questionnaire was translated from English by professional medical translator and by orthopedic surgeon. The Lysholm questionnaire was also used to control the adequacy of Pedi-IKDC results. Statistical analysis was performed to process data. RESULTS: Cronbachs alpha was 0.902, which means that questions have high level of consistency. The high correlation of results between the Lysholm and Pedi-IKDC questionnaire also proves the adequateness and objectiveness of the results. CONCLUSIONS: The proposed Russian version of the Pedi-IKDС questionnaire gives effective, objective, and adequate results. It is a good tool for knee assessment in children.

scholarly journals Copers and Noncopers Use Different Landing Techniques to Limit Anterior Tibial Translation After Anterior Cruciate Ligament Reconstruction

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199806
Author(s):  
Michèle N.J. Keizer ◽  
Egbert Otten ◽  
Chantal M.I. Beijersbergen ◽  
Reinoud W. Brouwer ◽  
Juha M. Hijmans
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Return To Sports ◽  
Beighton Score ◽  
Positive Correlation ◽  
Anterior Tibial ◽  
Flexion Moment ◽  
Anterior Cruciate ◽  
Tibial Translation

Background: At 1 year after anterior cruciate ligament reconstruction (ACLR), two-thirds of patients manage to return to sports (copers), whereas one-third of patients do not return to sports (noncopers). Copers and noncopers have different muscle activation patterns, and noncopers may not be able to control dynamic anterior tibial translation (ATTd) as well as copers. Purpose/Hypothesis: To investigate whether (1) there is a positive correlation between passive ATT (ATTp; ie, general joint laxity) and ATTd during jump landing, (2) whether ATTd is moderated by muscle activating patterns, and (3) whether there is a difference in moderating ATTd between copers and noncopers. We hypothesized that patients who have undergone ACLR compensate for ATTd by developing muscle strategies that are more effective in copers compared with noncopers. Study Design: Controlled laboratory study. Methods: A total of 40 patients who underwent unilateral ACLR performed 10 single-leg hops for distance with both legs. Lower body kinematic and kinetic data were measured using a motion-capture system, and ATTd was determined with an embedded method. Muscle activity was measured using electromyographic signals. Bilateral ATTp was measured using a KT-1000 arthrometer. In addition, the Beighton score was obtained. Results: There was no significant correlation between ATTp and ATTd in copers; however, there was a positive correlation between ATTp and ATTd in the operated knee of noncopers. There was a positive correlation between the Beighton score and ATTp as well as between the Beighton score and ATTd in both copers and noncopers in the operated knee. Copers showed a negative correlation between ATTd and gastrocnemius activity in their operated leg during landing. Noncopers showed a positive correlation between ATTd and knee flexion moment in their operated knee during landing. Conclusion: Copers used increased gastrocnemius activity to reduce ATTd, whereas noncopers moderated ATTd by generating a smaller knee flexion moment. Clinical Relevance: This study showed that copers used different landing techniques than noncopers. Patients who returned to sports after ACLR had sufficient plantar flexor activation to limit ATTd.

Isolated meniscus injuries in skeletally immature children and adolescents: state of the art

2021 ◽  
pp. jisakos-2020-000496
Author(s):  
Gustavo Vinagre ◽  
Flávio Cruz ◽  
Khalid Alkhelaifi ◽  
Pieter D'Hooghe
Keyword(s):  
Children And Adolescents ◽  
State Of The Art ◽  
Surgical Techniques ◽  
Meniscal Repair ◽  
Management Plan ◽  
Anatomical Location ◽  
Return To Sports ◽  
Meniscal Tears ◽  
Geographical Differences ◽  
Meniscal Healing

The prevalence of isolated meniscal injuries in children and adolescents is low; however, we see an increase mainly due to intensified sports-related activities at an early age. A meniscal repair should be attempted whenever possible as children present with increased meniscal healing potential. The diagnosis and management of meniscal tears involve both patient factors and tear characteristics: size, anatomical location and associated injuries. Special attention should be given to the feature of discoid menisci and related tears as they require a specific management plan. This state-of-the-art review highlights the most recent studies on clinical evaluation, surgical techniques, tips and tricks, pitfalls, outcomes, return-to-sports, geographical differences and future perspectives related to meniscal injuries in children and adolescents.

scholarly journals An Investigation of Knee Injury Profiles among Iranian Elite Karatekas: Observations from a Cross-Sectional Study

2021 ◽  
Vol 18 (13) ◽  
pp. 6888
Author(s):  
Hamidreza Naserpour ◽  
Julien S. Baker ◽  
Amir Letafatkar ◽  
Giacomo Rossettini ◽  
Frédéric Dutheil
Keyword(s):  
Knee Injury ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Cross Sectional Study ◽  
Lower Extremity Injury ◽  
Sectional Study ◽  
Positive Health ◽  
Sports Activity ◽  
Cross Sectional ◽  
National Team

Karate training, despite the many positive health benefits, carries a risk of injury for participants. The current cross-sectional study aimed to investigate knee injury profiles among Iranian elite karatekas. Participants who attended the national team qualifiers, which included 390 male Kumite karatekas (age 24 ± 3 years old and weight 63 ± 12 kg), participated in this study. Information on knee injuries (injury history, type of injury mechanisms, and effects of knee symptoms on the ability to perform daily activities and recreational activities) were obtained using the Knee Outcome Survey (KOS). Using Pearson’s correlation coefficient, the study examined the relationships between different variables, including KOS subscales and levels of self-reported knee joint function. Our findings indicated that 287 karatekas (73.6%) experienced knee injuries. The anterior cruciate ligament (ACL) rupture (6.9%), articular cartilage (5.4%), and meniscus damage (3.8%) were the main typology of injury. In addition, there were no differences in knee injuries between the non-dominant and dominant legs. Most injuries occurred during the preparatory period (n = 162, 50%), especially during training periods. The KOS subscales scores (Mean ± Sd) for activities of daily living (ADL) and sports activity (SAS) were, respectively, 89 ± 11 and 91 ± 9. The self-reported scores for both the ADL and SAS subscales were, respectively, 89 ± 11 and 90 ± 10. Pearson coefficients of ADL and SAS subscales with their self-reported score were r = 0.761 (p < 0.0001) and r = 0.782 and (p < 0.0001), respectively. The profile of knee injuries in the current investigation is similar to previous surveys that reported lower extremity injury patterns. The findings of this study could be adopted to inform practice aimed at planning interventions for the reduction and prevention of knee injuries among karatekas.

scholarly journals In Situ “Humanization” of Porcine Bioprostheses: Demonstration of Tendon Bioprostheses Conversion into Human ACL and Possible Implications for Heart Valve Bioprostheses

2021 ◽  
Vol 8 (1) ◽  
pp. 10
Author(s):  
Uri Galili ◽  
Kevin R. Stone
Keyword(s):  
Extracellular Matrix ◽  
Heart Valves ◽  
Cruciate Ligament ◽  
Anticoagulation Therapy ◽  
Young Patients ◽  
Collagen Fibers ◽  
Reconstruction Process ◽  
Bioprosthetic Heart Valves ◽  
Porcine Tissue ◽  
Anterior Cruciate

This review describes the first studies on successful conversion of porcine soft-tissue bioprostheses into viable permanently functional tissue in humans. This process includes gradual degradation of the porcine tissue, with concomitant neo-vascularization and reconstruction of the implanted bioprosthesis with human cells and extracellular matrix. Such a reconstruction process is referred to in this review as “humanization”. Humanization was achieved with porcine bone-patellar-tendon-bone (BTB), replacing torn anterior-cruciate-ligament (ACL) in patients. In addition to its possible use in orthopedic surgery, it is suggested that this humanization method should be studied as a possible mechanism for converting implanted porcine bioprosthetic heart-valves (BHV) into viable tissue valves in young patients. Presently, these patients are only implanted with mechanical heart-valves, which require constant anticoagulation therapy. The processing of porcine bioprostheses, which enables humanization, includes elimination of α-gal epitopes and partial (incomplete) crosslinking with glutaraldehyde. Studies on implantation of porcine BTB bioprostheses indicated that enzymatic elimination of α-gal epitopes prevents subsequent accelerated destruction of implanted tissues by the natural anti-Gal antibody, whereas the partial crosslinking by glutaraldehyde molecules results in their function as “speed bumps” that slow the infiltration of macrophages. Anti-non gal antibodies produced against porcine antigens in implanted bioprostheses recruit macrophages, which infiltrate at a pace that enables slow degradation of the porcine tissue, neo-vascularization, and infiltration of fibroblasts. These fibroblasts align with the porcine collagen-fibers scaffold, secrete their collagen-fibers and other extracellular-matrix (ECM) components, and gradually replace porcine tissues degraded by macrophages with autologous functional viable tissue. Porcine BTB implanted in patients completes humanization into autologous ACL within ~2 years. The similarities in cells and ECM comprising heart-valves and tendons, raises the possibility that porcine BHV undergoing a similar processing, may also undergo humanization, resulting in formation of an autologous, viable, permanently functional, non-calcifying heart-valves.

Assessing Physical Activity After ACL Injury: Moving Beyond Return to Sport

2021 ◽  
pp. 194173812110253
Author(s):  
Christopher Kuenze ◽  
Katherine Collins ◽  
Karin Allor Pfeiffer ◽  
Caroline Lisee
Keyword(s):  
Physical Activity ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Young Patients ◽  
Return To Sport ◽  
Acl Injury ◽  
Noncommunicable Diseases ◽  
Successful Recovery ◽  
Patient Reported ◽  
Anterior Cruciate

Context: Return to sport is widely utilized by sports medicine researchers and clinicians as a primary outcome of interest for successful recovery when working with young patients who have undergone anterior cruciate ligament (ACL) reconstruction (ACLR). While return-to-sport outcomes are effective at tracking progress post-ACLR, they are limited because they do not necessarily capture physical activity (PA) engagement, which is important to maintain knee joint health and reduce the risk of noncommunicable diseases. Therefore, there is a critical need (1) to describe current PA participation and measurement recommendations; (2) to appraise common PA measurement approaches, including patient-reported outcomes and device-based methodologies; and (3) to provide clinical recommendations for future evaluation. Evidence Acquisition: Reports of patient-reported or device-based PA in patients with ACL injury were acquired and summarized based on a PubMed search (2000 through July 2020). Search terms included physical activity OR activity AND anterior cruciate ligament OR ACL. Study Design: Clinical review. Level of Evidence: Level 5. Results: We highlight that (1) individuals with ACLR are 2.36 times less likely to meet the US Department of Health and Human Services PA recommendations even when reporting successful return to sport, (2) common patient-reported PA assessments have significant limitations in the data that can be derived, and (3) alternative patient-reported and device-based assessments may provide improved assessment of PA in this patient population. Conclusion: Clinicians and researchers have relied on return to sport status or self-reported PA participation via surveys. These approaches are not consistent with current recommendations for PA assessment and do not allow for comparison with contemporary PA recommendations or guidelines. Return to sport, patient-reported outcome measures, and device-based assessment approaches should be used in complementary manners to comprehensively assess PA participation after ACLR. However, appropriate techniques should be used when assessing PA in adult and adolescent populations.

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