Injured Ligaments Research Articles

Preliminary identification of somatic mutations profile in ACL injury

Anterior cruciate ligament (ACL) injury is a common orthopedic disease with a high incidence, long recovery time, and often requiring surgical treatment. However, the susceptibility factors for ACL injury are currently unclear, and there is a lack of analysis on the differences in the ligament itself. Previous studies have focused on germline mutations, with less research on somatic mutations. To determine the role of somatic mutations in ACL injuries, we recruited seven patients between the ages of 20 and 39 years diagnosed with ACL injuries, collected their peripheral blood, injured ligament ends, and healthy ligament ends tissues, and performed exome sequencing with gene function enrichment analysis. We detected multiple gene mutations and gene deletions, which were only present in some of the samples. Unfortunately, it was not possible to determine whether these somatic mutations are related to ligament structure or function, or are involved in ACL injury. However, this study provides valuable clues for future in-depth research.

Effect of lyophilized exosomes derived from umbilical cord stem cells on chronic anterior cruciate ligament cell injury

BackgroundFacilitating the healing process of injured anterior cruciate ligament (ACL) tissue is crucial for patients to safely return to sports. Stem cell derived exosomes have shown positive effects on enhancing the regeneration of injured tendons/ligaments. However, clinical application of exosomes in terms of storage and pre-assembly is challenging. We hypothesized that lyophilized exosomes derived from human umbilical cord stem cells (hUSC-EX) could enhance the cell activity of chronically injured ACL cells.Materials and methodsWe harvested the 8 weeks injured ACL cells from rabbit under IACUC (No. 110232) approval. The studied exosomes were purified from the culture medium of human umbilical cord stem cells (IRB approval No. A202205014), lyophilized to store, and hydrated for use. We compared exosome treated cells with non-exosome treated cells (control group) from the same rabbits. We examined the cell viability, proliferation, migration capability and gene expression of type I and III collagen, TGFβ, VEGF, and tenogenesis in the 8 weeks injured ACL cells after hUSC-EX treatment.ResultsAfter hydration, the average size of hUSC-EX was 84.5 ± 70.6 nm, and the cells tested positive for the Alix, TSG101, CD9, CD63, and CD81 proteins but negative for the α-Tubulin protein. After 24 h of treatment, hUSC-EX significantly improved the cell viability, proliferation and migration capability of 8 weeks injured ACL cells compared to that of no exosome treatment group. In addition, the expression of collagen synthesis, TGFβ, VEGF, and tenogenesis gene were all significantly increased in the 8 weeks injured ACL cells after 24 h hUSC-EX delivery.DiscussionLyophilized exosomes are easily stored and readily usable after hydration, thereby preserving their characteristic properties. Treatment with lyophilized hUSC-EX improved the activity and gene expression of 8 weeks injured ACL cells.ConclusionLyophilized hUSC-EX preserve the characteristics of exosomes and can improve chronically injured (8 weeks) ACL cells. Lyophilized hUSC-EX could serve as effective and safe biomaterials that are ready to use at room temperature to enhance cell activity in patients with partial ACL tears and after remnant preservation ACL reconstruction.

Relationship Between Ankle Ligamentous Injuries and Osteochondral Lesions in a Saudi Arabian Population: A Retrospective Cohort Study.

Objectives This study aimed to investigate the relationship between ankle ligamentous injuries and osteochondral defects (OCDs) and to determine the incidence of these conditions within the Saudi Arabian population. Methods This retrospective cohort study included 215 patients (110 males and 105 females) who sought medical advice for an ankle injury at our institute from January 2017 to August 2022. The patients were divided according to age, sex, presence and type of ligamentous injury, and status of OCDs. Patients' ages were categorized into three groups: younger than 30 years (48 patients), 30-60 years (145 patients), and older than 60 years (22 patients). The patients were assessed for ligamentous ankle sprains, tears, and OCDs by reviewing their magnetic resonance imaging reports from radiology records. The exclusion criteria included ankle fracture, ankle surgery, osteoarthritis of the ankle joint, inflammatory arthritis, and congenital deformity of the ankle. The data were collected using a simple questionnaire created via Google Forms. Results Of the 24 patients with OCD, 23 had OCD of the talus. Anterior talofibular ligament (ATFL) injury was the most common injury (75 patients), whereas posterior talofibular ligament (PTFL) injury was the least common. The only significant relationship between ligamentous injury and OCD was observed between PTFL injury and OCD of the talus (P = 0.041). Conclusions In patients with an ankle injury, the most common OCDs occur at the talus, whereas the most injured ligament is the ATFL. Nevertheless, a significant relationship was observed between PTFL injury and OCD of the talus. The findings underscore the importance of considering specific ligament injuries when diagnosing and managing OCDs, especially in patients with chronic ankle pain.

Anterior cruciate ligament (ACL) injury management: current treatment options and future prospects

The knee provides the body with mobility and stability needed to perform everyday functions. In addition, the knee joint plays a role in our proprioception and muscle coordination through the ligaments. These knee ligaments are involved in stabilizing the joint. The anterior cruciate ligament (ACL) is a ligament that protects the tibia from forward translation. It is one of the most injured ligaments in the knee, with almost 400,000 patients undergoing ACL reconstruction surgery each year in the United States. This review aims to present a concise overview of previous and current management options available to treat ACL injuries.

Timing of Surgery & Rehabilitation After Multiligamentous Knee Reconstruction.

To provide an overview of the current evidence of the timing of surgery and rehabilitation after multiligamentous knee injuries (MLKIs) and offer insights into the ongoing multi-center randomized controlled study, the 'STaR trial'. Due to the complexity of the MKLIs, they are usually treated surgically with the goal of either repairing or reconstructing the injured ligaments. Although the current literature on MLKIs is relatively extensive, the consensus on the timing of surgery or rehabilitation following surgery for MLKIs is still lacking. While current literature mostly suggests early treatment, there is also evidence preferring delayed treatment. Furthermore, evidence on the timing of postoperative rehabilitation is limited. Thus, the current multi-center randomized controlled study, the 'STaR trial', is expected to respond to these questions by adding new high-level evidence. The MLKIs are often associated with knee dislocation and constitute a highly complex entity, including concomitant injuries, such as neurovascular, meniscal, and cartilaginous injuries. The treatment of MLKIs usually aims to either repair or reconstruct the injured ligaments, however, there is no general consensus on the timing of surgery or rehabilitation following an MLKI surgery. This current review stresses the need for more high-level research to address the paucity of evidence-based treatment guidelines for the treatment of complex MLKIs.

Effects of combining rehabilitation training on the recovery of athletic ability after reconstruction of injured ligament

This paper aims to investigate the impact of conventional rehabilitation training and neuromuscular electrical stimulation (NMES) on the recovery of motor abilities in patients following ligament injury reconstruction. Forty postoperative patients who underwent surgery for anterior cruciate ligament reconstruction (ACLR) were randomly allocated to either the conventional rehabilitation group or the NMES group. The NMES group received NMES treatment in addition to the conventional rehabilitation program starting from eight weeks postoperatively. Various parameters, including knee joint function, stability, and balance, were compared between the two groups at eight weeks and 12 weeks postoperatively. Compared to the data at eight weeks postoperatively, both groups exhibited significant improvements in all measured indicators at 12 weeks postoperatively (p < 0.05). In the 12th week after the surgery, the NMES group demonstrated a Lysholm score of 93.18 ± 3.67 points, an IKDC score of 84.65 ± 2.33 points, a KT-2000 measurement of 0.88 ± 0.45 mm, a thigh circumference difference of −1.33 ± 0.55 cm, a knee flexion angle of 130.12 ± 4.21°, a single-leg standing time of 60.12 ± 9.33 s, a YBT score of 70.26 ± 2.68 points, and a Bulgarian split squat 1RM size of 58.07 ± 6.85 kg; all of these results were significantly superior to those observed in the conventional group (p < 0.05). NMES significantly enhances the recovery of athletic ability in patients following postoperative ACLR and can be effectively applied in clinical practice.

Comparative study of the early functional outcome of anatomic reconstruction of chronic lateral ankle instability with polyester tape reinforcement versus anchor repair

Purpose This study aims to compare the early functional outcome of anatomic reconstruction of chronic lateral ankle instability with polyester tape reinforcement versus suture anchor repair. Patients and Methods Sixty patients suffering from chronic lateral ankle instability were included. Thirty patients were treated by anatomic reconstruction of the injured ligaments and reinforcement with polyester tape and the other half was treated by suture anchors in our institution with a minimum period of 6 months follow-up. The postoperative results were assessed according to the American Orthopedic Foot and Ankle Surgery (AOFAS) scoring system for hind-foot. Results AOFAS score is improved postoperatively in both techniques without statistically significant difference (P=0.084). The results of the two techniques were comparable without statistically significant difference regarding pain, walking distance, hindfoot motion, foot alignment, activity limitation and support requirement (P=0.602, 0.067, 0.582, 0.448, 0.606, respectively). All the studied cases returned to their original activity level.

TGF-Β Isoforms: TGF-β1, TGF-β2 and TGF-β3 in Ligament and Tendon Healing

Abstract Introduction. Tendon and ligament injuries affect people of all ages, including professional athletes. Tumor Growth Factor β (TGF- β) isoforms play a significant role in the regeneration of tendons and ligaments, such as through the recruitment of macrophages and fibroblasts or the regulation of the formation of extracellular matrix (ECM). Although the TGF- β family regulates signalling pathways related to the healing process, excessive TGF- β activation can lead to fibrosis and the formation of scars and adhesions. This article recapped the significance of TGF- β isoforms TGF- β1, TGF- β2, and TGF- β3 in the physiological healing of injured tendons and ligaments. Material and Methods. A total of 1434 articles were identified using the PubMed search string (TGF-β isoforms or TGF-β1 or tgfb1 or TGF-β2 or tgfb2 or TGF-β3 or tgfb3) and (tendon or ligament). Human studies, animal models and in vitro cultures were included in the search. Forty-nine published articles were included. Results. Histologic evidence demonstrated greater ligament and tendon regeneration and collagen type I expression when using TGF-β1, often leading to fibrosis. TGF-β3 inhibits the TGF-β1 and TGF-β2 by switching Smad2/3 signaling to Smad7 and CREB-1 transcription factor. There was a delay in TGF-β3 level peak compared to other isoforms. Conclusions. All 3 TGF-β isoforms seem to play a significant role in the subsequent stages of healing. We state a hypothesis that during the initial phase of tendon and ligament healing, TGF-β1 levels need to be elevated. Further, TGF-β3 may inhibit the action of TGF-β1 and TGF-β2, which leads to the inhibition of inflammation and changes in ECM production, and consequently to a reduction in the level of scarring.

Do Age and Timing Influence the Outcomes of Single-stage Reconstruction of Multiple Ligament Knee Injuries? 5-10 Years Follow Up.

Multiple ligament knee injuries (MLKIs) are disruptive injuries, however, there are controversies in the results of acute and delayed reconstruction. Also, clinical outcomes between patients older or younger than 40 have not been compared in MLKIs. This study was designed to investigate the influence of age and timing of reconstruction on the outcomes of single-stage reconstruction of MLKIs. The patients who underwent reconstruction of multiple injured ligaments because of MLKIs between May 2013 and July 2019 were added to the cohort. The postoperative complications, knee range of motion (ROM), Lysholm score, International Knee Documentation Committee (IKDC) 2000 score, Tegner activity level, patient satisfaction, and SF-36 score were compared between young (≤ 40 years old, n = 41) and old patients (n = 61); acute (≤ 3 weeks after injury, n = 75) and delayed reconstruction (n = 27), using Mann-Whitney U test or χ2 test. A total of 102 MLKI patients managed by single-stage multi-ligament reconstruction were retrospectively reviewed. Patients were followed up after surgery for a mean of 7.3 years (5.2-10.7 years). At the last follow-up, no significant difference was found in knee ROM, functional scores, and patient-reported outcomes between patients older or younger than 40; acute and delayed reconstruction (p > 0.05). The rate of complications in the delayed reconstruction group was higher than that of the acute reconstruction group (22.2% vs 5.3%, p < 0.05). The IKDC objective scores reached grade A in 63.7%-80.4% of patients, and grade B in 11.8%-23.5% patients. The single-stage reconstruction of MLKIs can obtain comparative long-term functional and objective outcomes regardless of patients older or younger than 40; acute and delayed reconstruction, however, delayed reconstruction is related to a high rate of postoperative complications.

432 Ligament Engagement and In-Situ Force During Multiplanar Loading of the Medial Knee Ligaments

OBJECTIVES/GOALS: Load sharing across the arc of knee flexion of the medial knee ligaments (MKLs) is not well understood. The goal of this research is to characterize ligament engagement and in-situ force within the deep and superficial medial collateral ligament (dMCL, sMCL) and the posterior oblique ligament (POL) in response to externally applied multiplanar loads. METHODS/STUDY POPULATION: Ten human cadaveric knees, 5 male and 5 female, age 32±7 (25-42) [mean±SD (range min-max)] years, were mounted to a force sensor and a 6-degree-of-freedom robotic arm. Knee kinematics, before and after serial dissection of the sMCL, dMCL, and POL, were recorded from 0-30 degrees during applied isolated external rotation, valgus angulation, and anterior tibial moments, and the force (Newtons, N) borne by each structure was measured via the principle of superposition. Loads in the dMCL, sMCL, and POL will be compared across each knee and at each flexion angle with paired t-tests and repeated-measures analysis of variance with Tukey post hoc testing. Ten knees will provide &gt;99% power to detect differences of 5N ± 3% at p=0.05, which is considered the threshold for clinically meaningful force differences. RESULTS/ANTICIPATED RESULTS: Our anticipated results include characterization of the means and standard deviations of the in-situ forces within the dMCL, sMCL, and POL in response to externally applied valgus angulation, tibial external rotation, and anterior-directed tibial loading at 0, 15, and 30 degrees of knee flexion. Our statistical analysis will determine if there are clinically meaningful differences (5N ± 3%) in the loads within each ligament at different knee flexion angles and will also provide data regarding differential relative ligament engagement for each applied force scenario, which is an indication of the percentage of contribution that each structure contributes to knee stability during application of forces and torques to the knee. DISCUSSION/SIGNIFICANCE: Data on ligament engagement and in-situ forces will help clinicians better diagnose potentially injured ligaments when they observe pathological knee laxity in an injured patient. Our results will also inform future computer modeling studies on injury mechanisms, individual anatomical variability, and surgical planning.

Traumatic elbow dislocations

Elbow dislocations occur mostly in the young adult population and nearly 50% occur during sporting activities. Diagnosis and assessment of concentric reduction following manipulation are performed using plain radiography and fluoroscopy. Computed Tomography (CT) enable identifying subtle fractures that can otherwise lead to chronic instability. Simple dislocations by definition have no associated fractures and complex dislocations are associated with a variety of fractures, with the terrible triad injury and trans-humeral dislocations leading to surgical challenges. Assessment of the direction and the mechanics of elbow dislocation enable identify the structures that have been injured. Posterior and posterolateral dislocations are the most common patterns, where the lateral ligament complex is often compromised. Most simple dislocations are amenable to reduction, immobilization, and gradual rehabilitation resulting in good functional outcome. Ongoing instability can occur in 10% of the patients. Complex dislocations pose a surgical challenge and lead to joint stiffness, pain and ongoing instability if not managed properly. Identifying the individual component of a complex dislocation such as radial head fractures, coronoid fractures, proximal ulnar fractures, and ligament injures is important for satisfactory outcome.

Full-field strain distribution in hierarchical electrospun nanofibrous poly-L(lactic) acid/collagen scaffolds for tendon and ligament regeneration: A multiscale study

Regeneration of injured tendons and ligaments (T/L) is a worldwide need. In this study electrospun hierarchical scaffolds made of a poly-L (lactic) acid/collagen blend were developed reproducing all the multiscale levels of aggregation of these tissues. Scanning electron microscopy, microCT and tensile mechanical tests were carried out, including a multiscale digital volume correlation analysis to measure the full-field strain distribution of electrospun structures. The principal strains (εp1 and εp3) described the pattern of strains caused by the nanofibers rearrangement, while the deviatoric strains (εD) revealed the related internal sliding of nanofibers and bundles. The results of this study confirmed the biomimicry of such electrospun hierarchical scaffolds, paving the way to further tissue engineering and clinical applications.

Optimal assessment for anterior talofibular ligament injury utilizing stress ultrasound entails internal rotation during plantarflexion

ObjectivesAn optimal load and ankle position for stress ultrasound of the injured anterior talofibular ligament (ATFL) are unknown. The objectives of this study were to compare stress ultrasound and ankle kinematics from a 6 degree-of-freedom (6-DOF) robotic testing system as a reference standard for the evaluation of injured ATFL and suggest cut-off values for ultrasound diagnosis. MethodsTen fresh-frozen human cadaveric ankles were used. Loads and ankle positions examined by the 6-DOF robotic testing system were: 40 N anterior load, 1.7 Nm inversion, and 1.7 Nm internal rotation torques at 30° plantarflexion, 15° plantarflexion, and 0° plantarflexion. Bony translations were measured by ultrasound and a robotic testing system under the above conditions. After measuring the intact ankle, ATFL was transected at its fibular attachment under arthroscopy. Correlations between ultrasound and robotic testing systems were calculated with Pearson correlation coefficients. Paired t-tests were performed for comparison of ultrasound measurements of translation between intact and transected ATFL and unloaded and loaded conditions in transected ATFL. ResultsGood agreement between ultrasound measurement and that of the robotic testing system was found only in internal rotation at 30° plantarflexion (ICC ​= ​0.77; 95% confidence interval 0.27–0.94). At 30° plantarflexion, significant differences in ultrasound measurements of translation between intact and transected ATFL (p ​< ​0.01) were found in response to 1.7 Nm internal rotation torque and nonstress and stress with internal rotation (p ​< ​0.01) with mean differences of 2.4 ​mm and 1.9 ​mm, respectively. ConclusionBased on the data of this study, moderate internal rotation and plantarflexion are optimal to evaluate the effects of ATFL injury when clinicians utilize stress ultrasound in patients. Level of evidenceIII.

Left peroneal paresis in a young female basketball player after anterior cruciate ligament reconstruction of the right knee

There are various reasons for the injury to the peroneal nerve but the most common cause is compression anywhere along its route, from the origin to the distal branches, usually at the knee level. At the knee level, compression on the fibular level within the course of the peroneal nerve and anatomical and pathological is the site where the peroneal nerve is usually affected. Iatrogenic injuries after surgical interventions to the knee, metabolic, or toxic causes are also common. We present the case of a young female basketball player who underwent a surgical procedure for the injured anterior cruciate ligament of the right knee and during the rehabilitation process, peroneal paresis of a left leg occurred.

The Risk Factors Affected Upon Non-Contact ACL Injury in Gymnastics, Swimming and Basketball Collegiate Student Female Players

The purpose of the present study was to determine of the risk factors affected upon non-contact ACL injury in Gymnastics, Swimming and basketball collegiate student female players. If an athlete injured anterior cruciate ligament the most important thing is to identify factors that affect the injury. However, growing research implicates hormonal, anatomical, environmental and neuromuscular factors that may predispose athletes to these injuries. For this research selected 510 athletes for assess ACL injury factors by two different methods (A) Questionnaire and (B) Interview that information collected among athletes who were play Gymnastics, Swimming and basketball. Our results indicate 61.4% of ACL injury occurred in practice time and 38.6% of ACL injury was during competition. Also, our finding showed that 69% mechanism of injury was non-contact, 4.7% via accident and 26.3% with unknown reason. Furthermore, dynamic alignment at the time of the injury included: Knee-in &amp; Toe- out 44%, Knee-out &amp; Toe-in 22.5 and Hyperextension 11.1%. The ACL prevents the femur from moving forward during weight bearing. It also helps to prevent rotation of the joint. Injury of the ACL most often occurs when an athlete is pivoting, decelerating suddenly or landing from a jump. The injury can also be caused by another player falling across the knee. ACL injuries are, probably, the most common devastating knee ligament injuries amongst sports persons. Usually these injuries are isolated, mainly in non-contact sports, but many often are a part of more complex ligamentous injuries. They occur more often in contact sports, such as basketball. In conclusion, our study produced strong evidence in support of a significant some factors influencing of ACL injury in Gymnastics, Swimming and basketball collegiate student female players.

Immunohistochemical Investigation of Mechanoreceptors Within the Injured Scapholunate Ligament

Scapholunate ligaments (SLLs) play a well-established role in maintaining carpal alignment and kinematics, and are innervated with sensory mechanoreceptors located within the ligaments. They are involved in the afferent arc of dynamic wrist stability. The aim of this study was to describe the changes in these mechanoreceptor populations in injured SLLs. Injured SLLs were collected from human wrists at the time of SLL reconstruction or limited wrist fusion, where the ligament remnants would otherwise be discarded. These specimens were formalin-fixed and paraffin-embedded for immunohistochemical analysis to identify mechanoreceptors, which were then classified by type and location within the ligament. A total of 15 ligaments were collected, with the interval from injury ranging from 39 days-20 years. Eleven ligaments were collected less than one year after injury, and four ligaments were collected two years or more after injury. A total of 66 mechanoreceptors were identified, with 50 mechanoreceptors identified in nine of the 11 specimens collected less than one year after injury. In this group, 54% of the mechanoreceptors resided in the volar subunit, 20% in the dorsal subunit, and 26% in the proximal subunit. Two of the four specimens collected two years or later after injury contained mechanoreceptors, all of which were located in the dorsal subunit. Increasing time from injury demonstrated a decline in mechanoreceptor numbers within the volar subunit. Mechanoreceptors were consistently located in the SLL, particularly in the volar subunit of specimens collected less than one year after injury. Ligament reconstruction techniques aim to primarily reconstitute the biomechanical function of the disrupted SLL; however, re-establishing the afferent proprioceptive capacity of the SLL may be a secondary objective. This suggests the need to consider the reconstruction of its volar subunit particularly in those managed within one year of injury.

The Boyd approach: a valuable alternative to treating simple to complex elbow fractures and dislocations.

The Boyd approach is a single-incision posterior approach to the proximal radius and ulna based on a lateral anconeus muscle reflection and release of the lateral collateral ligamentous complex. This approach remains a lesser-used technique following early reports of proximal radioulnar synostosis and postoperative elbow instability. Although limited by small case series, recent literature does not support these early reported complications. This study presents a single surgeon's outcomes using the Boyd approach for the treatment of simple to complex elbow injuries. Following institutional review board approval, a retrospective review of all patients with simple to complex elbow injuries treated consecutively using a Boyd approach by a shoulder and elbow surgeon was conducted from 2016 to 2020. All patients with at least 1 postoperative clinic visit were included. Data collected included patient demographics, injury description, postoperative complications, elbow range of motion, and radiographic findings including heterotopic ossification and proximal radioulnar synostosis. Categorical and continuous variables were reported using descriptive statistics. A total of 44 patients were included with an average age of 49 years (range 13-82 years). The most commonly treated injuries were Monteggia fracture-dislocations (32%) and terrible triad injuries (18%). Average follow-up was 8 months (range 1-24 months). Final average elbow active arc of motion was from 20° (range 0°-70°) of extension to 124° (range 75°-150°) of flexion. Final supination and pronation were 53° (range 0°-80°) and 66° (range 0°-90°), respectively. There were no cases of proximal radioulnar synostosis. Heterotopic ossification contributing to less than functional elbow range of motion occurred in 2 (5%) patients who elected conservative management. There was 1 (2%) case of early postoperative posterolateral instability due to repair failure of injured ligaments that required revision using a ligament augmentation procedure. Five (11%) patients experienced postoperative neuropathy, including 4 (9%) with ulnar neuropathy. Of these, 1 underwent ulnar nerve transposition, 2 were improving, and 1 had persistent symptoms at final follow-up. This is the largest case series available demonstrating the safe utilization of the Boyd approach for the treatment of simple to complex elbow injuries. Postoperative complications including synostosis and elbow instability may not be as common as previously understood.

Reference standards for stress radiography measurements in knee ligament injury and instability: a systematic review

AbstractPurposeStress radiographs are an easily accessible, cost‐effective tool in the evaluation of acute and chronic ligament knee injuries. Stress radiographs provide an objective, quantifiable, and functional assessment of the injured ligament and can be a useful adjunct when planning surgical management and to objectively assess postoperative outcomes. This study aimed to review the literature reporting on stress radiographic techniques in evaluating knee ligament injury and instability and propose thresholds for interpreting stress radiography techniques.MethodsThe following three databases, OVID MEDLINE, the EMBASE library, and the Cochrane Controlled Trials Register, were systematically searched on January 23, 2023, for studies published from January 1970 to January 2023. The search extended to the reference lists of all relevant studies and orthopedic journals. Included studies were those that described a stress technique for the diagnosis of knee ligament injury; studies that reported a description or comparison of the accuracy and/or reliability of one or several stress radiography techniques, or studies that reported a comparison with alternative diagnostic modalities.ResultsSixteen stress radiography techniques were reported for assessing the ACL with stress applied in the anterior plane, 10 techniques for assessing the PCL with stress applied in the posterior plane, 3 techniques for valgus stress, and 4 techniques for varus stress. The Telos device was the most commonly used stress device in the ACL and PCL studies. There was no consensus on the accuracy and reliability of stress radiography techniques for the diagnosis of any knee ligament injury. Stress radiography techniques were compared with alternative diagnostic techniques including instrumented arthrometry, MRI, and physical examination in 18 studies, with variability in the advantages and disadvantages of stress radiography techniques and alternatives. Analysis of results pooled from different studies demonstrated average delta gapping in knees with a completely injured ligament compared to the normal contralateral knee as per the following: for the ACL 4.9 ± 1.4 mm; PCL 8.1 ± 2.5 mm; MCL 2.3 ± 0.05 mm; and the FCL 3.4 ± 0.2 mm.ConclusionDespite heterogeneity in the available literature with regard to stress examination techniques and device utilization, the data support that stress radiography techniques were accurate and reliable when compared to numerous alternatives in the diagnosis of acute and chronic knee ligament injuries. The present study also provides average increased ipsilateral compartment gapping/translation for specific knee ligament injuries based on the best available data. These values provide a reference standard for the interpretation of stress radiography techniques, help to guide surgical decision‐making, and provide benchmark values for future investigations.Level of evidenceIII.

Is Prehabilitation Effective on Modified Broström Procedure for Chronic Lateral Ankle Instability?

Category: Sports; Ankle Introduction/Purpose: The clinical features of chronic lateral ankle instability (CLAI) consist of mechanical and functional instability. Mechanical instability can be identified by physical examination of the injured anterior talofibular ligament laxity and can be treated with surgical ligament repair. Functional instability is more related to the patient's subjective symptoms due to decreased muscle strength, range of motion (ROM), coordination, and proprioception. In a previous report, ankle instability recurred in 16% after the modified Broström procedure (MBP) despite postoperative rehabilitation. Functional instability should be treated along with mechanical instability. We hypothesized that applying preoperative physiotherapy (prehabilitation) to patients with CLAI would improve postoperative functional recovery. We designed and performed a structured prehabilitation protocol for CLAI patients scheduled for MBP and investigated postoperative effects. Methods: Between March 2021 and December 2022, 28 patients were prospectively enrolled. Patients were randomly assigned to prehabilitation group (P) or non-prehabilitation group (N). Fourteen patients were enrolled in group P, and they started a 4-week prehabilitation protocol that continued the physiotherapy until 6 weeks postoperatively. Group N included 14 patients who received the same protocol of physiotherapy only for 6 weeks after surgery. The physiotherapy protocol consisted of peroneal muscle strengthening using Thera-band, gastro-soleus stretching, bipedal calf raises, single limb stance, step down with single limb, and box hop/quadrant hop. Outcome measurement was performed 1 day before MBP, 4 weeks and 6 weeks after surgery. The visual analogue scale, AOFAS ankle hindfoot scale, Karlsson scale, Foot and Ankle Ability Measure (FAAM-activities of daily living: ADL and FAAM-sports), Lower Extremity Functional Scale (LEFS), and ankle ROM were investigated. All data were statistically analyzed. Results: The mean ages were 27.0 ± 8.46(P), 29.7 ± 7.54(N), and there were 4 (28.6%, P) and 6 (42.9%, N) males. There were no statistical differences between the two groups in age and gender distribution. As shown in the attached table comparing clinical outcomes between the two groups, AOFAS ankle hindfoot scale, Karlsson scale, FAAM-ADL, and LEFS 1 day before MBP were statistically significantly higher in group P than in group N. Compared to group N, group P improved ankle inversion and eversion 1 day before MBP (p &lt; 0.05 each). Although there was no statistical significance, the mean of Karlsson scale, FAAM-ADL subscale, FAAM-sports subscale, and LEFS were all maintained higher in group P than in group N from before MBP to 6 weeks after surgery. Conclusion: Our findings demonstrated the importance of functional recovery along with mechanical stability in the treatment of CLAI. Functional scores tended to be maintained higher in group P than in group N from preoperative to postoperative follow-up period. However, the number of participants included in our study was relatively small at 28. Larger studies with long-time follow- up will be needed. In conclusion, a structured prehabilitation may improve functional recovery when performing MBP for CLAI.

Current State of Platelet-rich Plasma in the Treatment of Rheumatic Disease: A Retrospective Review of the Literature.

Rheumatic diseases are a spectrum of autoimmune or inflammatory diseases that cause damage to the musculoskeletal system as well as vital organs, such as the heart, lungs, kidneys, and central nervous system. The study of rheumatic disease has made great progress in the understanding and management of these conditions in the last few decades using disease-modifying antirheumatic drugs and synthesized biological immunomodulating therapies. However, one potential treatment that has not been well investigated in rheumatic disease is platelet-rich plasma (PRP). PRP is proposed to facilitate the healing of injured tendons and ligaments through a variety of mechanisms, including mitogenesis, angiogenesis and macrophage activation via cytokine release, although its exact mechanism is unclear. There has been a great deal of work in determining the exact preparation method and composition of PRP for regenerative purposes in orthopedic surgery, sports medicine, dentistry, cardiac surgery, pediatric surgery, gynecology, urology, plastic surgery, ophthalmology, and dermatology. Despite this, there is a paucity of research on the impact of PRP on rheumatic disease. This study aims to summarize and evaluate the current research concerning the use of PRP in rheumatic disease.