Knee Anterior Cruciate Ligament Research Articles

Effect of Rehabilitation Training Based on Automatic Extraction Algorithm on Knee Anterior Cruciate Ligament Injury Caused by Exercise.

Objective In order to explore the effect of rehabilitation training based on automatic extraction algorithm on knee anterior cruciate ligament reconstruction under arthroscopy.Methods 81 patients with anterior cruciate ligament injury were randomly divided into observation group (42 cases) and control group (39 cases). The control group was given routine nursing, while the observation group was given rehabilitation training guidance based on automatic extraction algorithm. Lysholm score, HSS score, and range of motion of knee joint extension and flexion were used to evaluate the knee joint function before and after operation in the two groups. The quality of life of the two groups was evaluated by the concise health survey scale. The results showed that 50% of deep venous thrombosis occurred on the first day and 30% on the second day after operation. There was no significant difference in preoperative Lysholm score, HSS score, and knee flexion activity between the observation group and the control group (P > 0.01). After 1-month, 5-month, and 1-year follow-up, the effective rate of knee function recovery in the observation group was significantly better than that in the control group. Lysholm score, HSS score, and knee extension and flexion activity were significantly different from those in the control group (P < 0.01). The postoperative SF-36 quality of life score of the observation group was significantly higher than that of the control group, indicating that the quality of life of the observation group was significantly better than that of the control group. Therefore, early postoperative rehabilitation training guidance based on automatic extraction algorithm can improve local blood circulation and improve knee function and reduce pain, so as to promote the early recovery of patients.

Determining the Substantial Clinical Benefit Values for Patient-Reported Outcome Scores After Primary ACL Reconstruction.

Background:Little is known about the threshold of patient-reported outcomes (PROs) at which patients perceive to have attained a substantial clinical benefit (SCB) after anterior cruciate ligament reconstruction (ACLR).Purpose:To determine the SCB value of PROs 1 year after ACLR in the general population and to determine factors that predict SCB attainment.Study Design:Case series; Level of evidence, 4.Methods:The Lysholm, International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF), Tegner, and Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scores were examined postoperatively in 88 patients who underwent ACLR. At the 12-month follow-up visit, the patients answered 2 independent anchor questions about daily discomfort and functional recovery. Receiver operating characteristic (ROC) curve analysis was used to differentiate PRO scores between patients who responded as having no difficulty versus some difficulty with daily knee discomfort (anchor question 1) and between patients with substantial recovery versus nonsubstantial recovery of knee function (anchor question 2). The area under the ROC curve (AUC) was calculated to assess reliability, and the differences between the AUC values were compared. Multivariate logistic regression analyses were performed to determine predictors affecting SCB attainment.Results:There were 76 patients enrolled in this study. The 12-month Lysholm, IKDC-SKF, Tegner, and ACL-RSI scores that corresponded to the SCB were 88.0, 85.1, 6.5, and 64.2 for anchor question 1 and 84.5, 77.7, 5.5, and 57.1 for anchor question 2, respectively. The AUC values obtained from the ROC curve analyses showed acceptable to excellent reliability (anchor question 1: Lysholm, 0.90; IKDC-SKF, 0.86; Tegner, 0.71; ACL-RSI, 0.92; anchor question 2: Lysholm, 0.80; IKDC-SKF, 0.90; Tegner, 0.82; ACL-RSI, 0.82) and were all statistically significant (P < .001 to P = .028). For all PROs, younger age (Odds Ratio (OR), 0.88-0.94; P < .001 to P = .027) and greater muscle strength (OR, 1.03-1.07; P < .001 to P = .023) were predictive factors of SCB attainment.Conclusion:The postoperative Lysholm, IKDC-SKF, Tegner, and ACL-RSI scores showed acceptable to excellent reliability in predicting the SCB after ACLR in the general population. Age at surgery and thigh muscle strength influenced SCB attainment for all PROs.

Time-series biological responses toward decellularized bovine tendon graft and autograft for 52 consecutive weeks after rat anterior cruciate ligament reconstruction

There is an essential demand for developing biocompatible grafts for knee anterior cruciate ligament reconstruction (ACLR). This study investigated cell infiltration into decellularized bovine tendon xenografts using a rat knee ACLR model. Twelve-week-old Sprague–Dawley rats were used. At weeks 1, 2, 4, 8, 16, 26, and 52 (each period, n = 6) after ACLR, rats receiving decellularized bovine tendon (group D, n = 42) or autologous tendon (group A, n = 42) as grafts underwent peritibial bone tunnel bone mineral density (BMD), histological, and immunohistological assessments. BMD increased over time in both the groups until week 16 and then remained unchanged without exhibiting significant differences between the groups. Initially, cellularity in group D was lower than that in group A; however, by weeks 4–8, both the groups were comparable to the native anterior cruciate ligament group and cellularity remained unchanged until week 52. Initially, group A had more M1 macrophages, indicating inflammation, whereas group D had more M2 macrophages, indicating tissue regeneration. Nonetheless, the M1 and M2 macrophage counts of both the groups were comparable at most times. This study revealed the excellent recellularization and tendon–bone integration abilities of decellularized tendons using a cross-species model.

MODELING OF PATELLA HEIGHT WITH DISTAL FEMUR AND PROXIMAL TIBIA REFERENCE POINTS WITH ARTIFICIAL NEURAL NETWORK

The patellofemoral joint is one of the parts of the knee extension mechanism that plays a role in the stability of the knee by enlarging the force arm of the quadriceps muscle and changing the direction of the muscle strength. For the entire knee joint to perform its task painlessly and functionally, the positions and strength of the muscles, the strength of the ligaments, and their reaction to movement must be compatible. The Insall–Salvati (Ins-Sal) index is useful for showing changes in patellar height produced by repositioning the tibial plateau, in other words, showing changes in patellar tendon length. Patella height is an important value to be taken into account in knee prosthesis surgery, tibial osteotomy, and anterior cruciate ligament reconstruction. The morphometric relationship between the reference measurements of the distal femur and proximal tibia and the position of the patella will be useful in determining the natural anatomy. In this study, we aimed to determine the relationship between patella height and distal femur and proximal tibia reference areas by using the artificial neural network method as an alternative approach method. In order to assess the performance of the estimation of the Ins-Sal index, the four ANN model with six input combinations which included age, gender and the reference measurements for the right and left sides have been constructed and tested. The MSE and [Formula: see text] values are calculated for every four models for the training and test phase. The results show that the proposed approach for modeling of relation between reference measurements and the Ins-Sal index is a powerful approach.

Knee Injury Detection Using Deep Learning on MRI Studies: A Systematic Review.

The improved treatment of knee injuries critically relies on having an accurate and cost-effective detection. In recent years, deep-learning-based approaches have monopolized knee injury detection in MRI studies. The aim of this paper is to present the findings of a systematic literature review of knee (anterior cruciate ligament, meniscus, and cartilage) injury detection papers using deep learning. The systematic review was carried out following the PRISMA guidelines on several databases, including PubMed, Cochrane Library, EMBASE, and Google Scholar. Appropriate metrics were chosen to interpret the results. The prediction accuracy of the deep-learning models for the identification of knee injuries ranged from 72.5–100%. Deep learning has the potential to act at par with human-level performance in decision-making tasks related to the MRI-based diagnosis of knee injuries. The limitations of the present deep-learning approaches include data imbalance, model generalizability across different centers, verification bias, lack of related classification studies with more than two classes, and ground-truth subjectivity. There are several possible avenues of further exploration of deep learning for improving MRI-based knee injury diagnosis. Explainability and lightweightness of the deployed deep-learning systems are expected to become crucial enablers for their widespread use in clinical practice.

Automated Knee MR Images Segmentation of Anterior Cruciate Ligament Tears.

The anterior cruciate ligament (ACL) is one of the main stabilizer parts of the knee. ACL injury leads to causes of osteoarthritis risk. ACL rupture is common in the young athletic population. Accurate segmentation at an early stage can improve the analysis and classification of anterior cruciate ligaments tears. This study automatically segmented the anterior cruciate ligament (ACL) tears from magnetic resonance imaging through deep learning. The knee mask was generated on the original Magnetic Resonance (MR) images to apply a semantic segmentation technique with convolutional neural network architecture U-Net. The proposed segmentation method was measured by accuracy, intersection over union (IoU), dice similarity coefficient (DSC), precision, recall and F1-score of 98.4%, 99.0%, 99.4%, 99.6%, 99.6% and 99.6% on 11451 training images, whereas on the validation images of 3817 was, respectively, 97.7%, 93.8%,96.8%, 96.5%, 97.3% and 96.9%. We also provide dice loss of training and test datasets that have remained 0.005 and 0.031, respectively. The experimental results show that the ACL segmentation on JPEG MRI images with U-Nets achieves accuracy that outperforms the human segmentation. The strategy has promising potential applications in medical image analytics for the segmentation of knee ACL tears for MR images.

Biomechanics of the anterior cruciate ligament under simulated molecular degradation.

Injuries to the knee anterior cruciate ligament (ACL) are common, with a known but poorly understood association with intrinsic and extrinsic risk factors. Some of these factors are enzymatically or mechanically mediated, creating acute focal injuries that may cause significant ligament damage. Understanding the relationship between the basic molecular structure and external loading of the ACL requires a hierarchical connection between the two levels. In the present study, a multi-domain frame was developed connecting the molecular dynamics of the collagen networks to the continuum mechanics of the ACL. The model was used to elucidate the effect of the two possible collagen degradation mechanisms on the aggregate ACL behaviour. Results indicated that collagen content and ACL stiffness were reduced significantly, regardless of the degradation mechanism. Furthermore, the volumetric degradation at the molecular level had a devastating effect on the mechanical behaviour of the ACL when it was compared with the superficial degradation. ACL damage initiation and propagation were clearly influenced by collagen degradation. To summarise, the new insights provided by the predicted results revealed the significance of the collagen network structural integrity to the aggregate mechanical response of the ACL and, hence, underlined the biomechanical factors that may help develop an engineering-based approach towards improving the therapeutic intervention for ACL pathologies.

MiR-18a-3p improves cartilage matrix remodeling and inhibits inflammation in osteoarthritis by suppressing PDP1

Osteoarthritis (OA) is a degenerative disease characterized by synovial inflammation. MiR-18a-3p was reported to be downregulated in knee anterior cruciate ligament of OA patients. In the present study, the specific functions and mechanism of miR-18a-3p in OA were explored. An in vitro model of OA was established using 10 ng/ml IL-1β to treat ATDC5 cells, and medial meniscus instability surgery was performed on Wistar rats to establish in vivo rat model of OA. RT-qPCR revealed that miR-18a-3p was downregulated in IL-1β-stimulated ATDC5 cells. MiR-18a-3p overexpression inhibited secretion of inflammatory cytokines and concentration of matrix metalloproteinases, as shown by ELISA and western blotting. The binding relation between miR-18a-3p and pyruvate dehydrogenase phosphatase catalytic subunit 1 (PDP1) was detected by luciferase reporter assays. MiR-18a-3p targeted PDP1 and negatively regulated PDP1 expression. Results of rescue assays revealed that PDP1 upregulation reserved the suppressive effect of miR-18a-3p overexpression on levels of inflammatory cytokines and matrix metalloproteinases in IL-1β-stimulated ATDC5 cells. H&E staining was used to observe pathological changes of synovial tissues in the knee joint of Wistar rats. Safranin O-fast green/hematoxylin was used to stain cartilage samples of knee joints. MiR-18a-3p overexpression suppressed OA progression in vivo. Overall, miR-18a-3p improves cartilage matrix remodeling and suppresses inflammation in OA by targeting PDP1.

Early and Delayed Surgery for Isolated ACL and Multiligamentous Knee Injuries Have Equivalent Results: A Systematic Review and Meta-analysis

Background: Early surgery for acute ligamentous injuries has recently shown good clinical and functional outcomes. Purpose: To assess the advantages of early vs delayed surgery in patients undergoing isolated anterior cruciate ligament (ACL) or multiligament-injured knee (MLIK) surgery. Study Design: Meta-analyses of Level 1, 2, and 3 studies; Level of evidence, 4. Methods: A systematic search was performed via PubMed, EMBASE, and Cochrane for studies reporting outcomes of timing of surgery after isolated ACL injury or in the MLIK setting using accelerated rehabilitation protocols. Two analyses were conducted to differentiate early and delayed treatment (3- and 6-week cutoffs). Collected outcomes included meniscal or chondral lesions, failure and reoperation rates, range of motion (ROM) deficits, other complications, muscle strength, instrumented laxity, and functional outcomes. Outcomes were reported in risk ratios (RR) or mean differences with 95% CIs. Results: For timing of isolated ACL surgery, 16 studies were included with 2093 patients. High-grade evidence indicated that there were no differences in meniscal or chondral lesions, failure and reoperation rates, stiffness, ROM deficits, complications, muscle strength, instrumented laxity, and functional outcomes between patients treated early and late (all P > .05). When including only studies that set no preoperative criteria for early surgery, the findings were similar. Regarding MLIK surgery, 14 studies were included with 1172 patients. Low evidence was noted for the following: patients treated early had significantly fewer meniscal injuries (RR, 0.7; P = .04) and chondral injuries (RR, 0.5; P < .001), while no differences were found in reoperation rates, complications, stiffness, ROM deficits, muscle strength, instrumented laxity, and functional outcomes between the groups. Other than higher Lysholm scores in the early group for the 3-week analysis (mean difference, 6.8; P = .01), there were no differences between cutoff analyses. Conclusion: This systematic review with meta-analysis found no differences in clinical and functional outcomes between early and delayed surgery for isolated ACL injuries. For MLIK injuries, there were also no differences in surgical outcomes between early and delayed surgery.

Steadiness training improves the quadriceps strength and self-reported outcomes in persistent quadriceps weakness following nine months of anterior cruciate ligament reconstruction and failed conventional physiotherapy

BackgroundPersistent quadriceps weakness may occur after anterior cruciate ligament reconstruction, limiting the strength gain. However, steadiness strengthening might change the inability to gain strength. Hence, we determined whether strength training with force steadiness and visual biofeedback can improve knee quadriceps torque, self-reported pain and knee stability in patients with persistent quadriceps weakness after knee anterior cruciate ligament reconstruction.MethodsTwenty-five patients (aged 43.7 ± 12.2 years) with persistent quadriceps weakness following knee anterior cruciate ligament reconstruction and 34-weeks of physiotherapy performed unilateral strength training for both lower limbs. Four-weeks of conventional physiotherapy at week-30 were given, confirming the inability to gain torque. Then, steadiness training (isometric knee extension with visual biofeedback) was given for 7-weeks. Knee quadriceps peak torque, strength improvement, determination of responders to the intervention, coherence of strength gain between limbs, and self-reported outcomes (pain and knee stability) were obtained. Descriptive statistics and data inference using mixed-ANOVA, McNemar test, and χ2 test were described.FindingsQuadriceps torque in the reconstructed knee improved (98.2 ± 47.2–155.2 ± 78.9 Nm; p = 0.031) for most patients (84%). Nevertheless, the torque was lower than the healthy side maintaining asymmetry (155.2 ± 78.9 vs. 209.5 ± 101.8 Nm; p = 0.026). There was high (20%) and medium coherence (80%) between limbs. Knee stability and pain improved in 72% of the patients (p < 0.001).InterpretationsSteadiness training after anterior cruciate ligament reconstruction followed 9 months of surgery and failed conventional physiotherapy, improves the persistent weakness and self-reported outcomes, but gain strength was dissimilar between limbs.

CORRELATION OF FUNCTIONAL STATUS OF ARTHROSCOPIC ACL RECONSTRUCTION FOR PREVENTION OF TITANIUM INTERFERENCE SCREW

INTRODUCTION: Due to an increase in traffic accidents and more common people participating in sports-related activities, knee injuries are more frequent today. The knee's anterior cruciate ligament is the ligament that gets injured the most frequently. The principal stabiliser that prevents the anterior translation of the tibia over the femur is the anterior cruciate ligament, which plays a pivotal role in the stability and function of the knee joint. The gold standard for treating these injuries is arthroscopic anterior cruciate ligament reconstruction. Methods: This study is a retrospective and prospective analysis of 60 patients who underwent arthroscopic reconstruction of the anterior cruciate ligament using a quadrupled hamstring graft with an endobutton as the femoral fixation device and a titanium interference screw (no=30) or a bioabsorbable interference screw (no=30) as the tibial fixation device. Results: This study is a retrospective and prospective analysis of 60 patients who underwent arthroscopic reconstruction of the anterior cruciate ligament using a quadrupled hamstring graft with an endobutton as the femoral fixation device and a titanium interference screw (no=30) or a bioabsorbable interference screw (no=30) as the tibial fixation device. CONCLUSION: Clinical outcomes for interference screws made of titanium and bioabsorbable material are statistically comparable. The two screws' complication rates were comparable as well. This comparison analysis's findings are consistent with the claim that titanium screws and bioabsorbable screws both produce comparable results when used for ACL restoration.

Computed Tomography Imaging under Artificial Intelligence Reconstruction Algorithm Used in Recovery of Sports Injury of the Knee Anterior Cruciate Ligament.

This study aimed to analyze the influence of artificial intelligence (AI) reconstruction algorithm on computed tomography (CT) images and the application of CT image analysis in the recovery of knee anterior cruciate ligament (ACL) sports injuries. A total of 90 patients with knee trauma were selected for enhanced CT scanning and randomly divided into three groups. Group A used the filtered back projection (FBP) reconstruction algorithm, and the tube voltage was set to 120 kV during CT scanning. Group B used the iDose4 reconstruction algorithm, and the tube voltage was set to 120 kV during CT scanning. In group C, the iDose4 reconstruction algorithm was used, and the tube voltage was set to 100 kV during CT scanning. The noise, signal-to-noise ratio (SNR), carrier-to-noise ratio (CNR), CT dose index volume (CTDI), dose length product (DLP), and effective radiation dose (ED) of the three groups of CT images were compared. The results showed that the noise of groups B and C was smaller than that of group A (P < 0.05), and the SNR and CNR of groups B and C were higher than those of group A. The images of patients in group A with the FBP reconstruction algorithm were noisy, and the boundaries were not clear. The noise of the images obtained by the iDose4 reconstruction algorithm in groups B and C was improved, and the image resolution was also higher. The agreement between arthroscopy and CT scan results was 96%. Therefore, the iterative reconstruction algorithm of iDose4 can improve the image quality. It was of important value in the diagnosis of knee ACL sports injury.

K-Space Data Reconstruction Algorithm-Based MRI Diagnosis and Influencing Factors of Knee Anterior Cruciate Ligament Injury.

This study was aimed at investigating the diagnostic value of MRI based on K-space data reconstruction algorithm for anterior cruciate ligament (ACL) injury of knee joint and the influencing factors of ligament injury. 96 patients with ACL injury of knee joint were selected, and they were randomly divided into two groups: group A (arthroscopy) and group B (MRI examination), and another 96 healthy volunteers in the same period were selected as the control group. The test results of each indicator were compared. The results showed that the signal-to-noise ratio (SNR) of SMASH algorithm was higher than that of sum of squares (SOS) algorithm. In group A, there were 66 positive and 30 negative tests, and in group B, there were 56 positive and 40 negative tests (P < 0.05). The intercondylar fossa width, the intercondylar fossa width index, and the ratio of tibial intercondylar eminence width to intercondylar fossa width in group B were lower than those in the control group (P < 0.05). Compared with the traditional SOS algorithm, SMASH algorithm can improve the image quality, reduce the impact of damage data on the final synthesis image, and improve the image SNR. In clinical work, the ratio of the width of tibial intercondylar eminence to the width of femoral intercondylar fossa can be measured by imaging data to evaluate the matching between tibial intercondylar eminence and femoral intercondylar fossa, so as to evaluate the risk of ACL rupture.

Psychological barriers negotiated by athletes returning to soccer (football) after anterior cruciate ligament reconstructive surgery

ABSTRACT The aim of this qualitative study was to understand the psychological barriers that athletes returning to soccer (football) following anterior cruciate ligament knee reconstruction surgery faced and how they negotiated these barriers. Thematic analysis was used analyse online, open-ended survey data within the framework of self-determination theory. Two themes of ‘Fear of Re-injury' and ‘Self-Help’ respectively represented what barriers athletes faced when returning to soccer and how they were reportedly managed. Novel findings included identifying connections between athlete demographics, individual circumstances, perceived psychological barriers and needs, and their self-derived mental strategy. It also highlighted the need for athletes, coaches, and sports personnel to be educated and trained on the benefits of sports psychology during the return to sport phase, particularly when injuries occur at the local, recreational, non-professional levels of soccer.

Morphometric Analysis of Anatomy of Anterior Cruciate Ligament of Knee and its Attachments - a Cadaveric Study in Indian Population.

Introduction:The Anterior Cruciate Ligament tends to stabilise the knee in various range of extension and flexion. Precise study of anatomy, attachments and position of bundles is important for successful ACL reconstruction. In our study, we attempt to assess general anatomy of ACL, determine and compare its morphometric data pertaining to length and width and its tibio-femoral foot prints in different gender and secondarily determine changes in the same during ACL dynamics witnessed during knee flexion changes.Materials and methods:A total of 19 knees from 10 cadavers were used in the research with mean age of 61±7 years. After dissecting the skin, muscles, patellar and articular capsule were removed and bundle attachments were studied. Thereafter the relative length, width and stiffness of ACL bundles at 0, 90, 140 (maximum) angles of knee flexion were measured along with maximum horizontal and vertical bundle footprints at tibio-femoral attachments were recorded.Results:Mean length and width of insertion of anteromedial (AM) bundle on the tibial surface was 8.8mm and 9.0mm in males and 8.1mm and 8.8mm in females. Furthermore, that of PL bundle was 9.1mm and 7.8mm in males and 8.9mm and 7.1mm in females.Conclusion:The anteromedial (AM) bundle and posterolateral (PL) bundle of ACL were found to be most relaxed at full extension and were most taut at maximum flexion of 140°. AM bundle underwent greater stretching and change of length in comparison to the PL bundle, indicating that it is comparatively a more dominant bundle.

Effect of Rearfoot Strikes on the Hip and Knee Rotational Kinetic Chain During the Early Phase of Cutting in Female Athletes

BackgroundBiomechanical factors affecting horizontal-plane hip and knee kinetic chain and anterior cruciate ligament (ACL) injury risk during cutting maneuvers remain unclear. This study aimed to examine whether different foot strike patterns alter horizontal-plane hip and knee kinetics and kinematics during a cutting maneuver in female athletes and clarify the individual force contribution for producing high-risk hip and knee loadings. Twenty-five healthy female athletes performed a 60° cutting task with forefoot and rearfoot first strike conditions. Horizontal-plane hip and knee moment components, angles, and angular velocities were calculated using synchronized data of the marker positions on the body landmarks and ground reaction forces (GRFs) during the task. The one-dimensional statistical parametric mapping paired t test was used to identify the significant difference in kinetic and kinematic time-series data between foot strike conditions.ResultsIn the rearfoot strike condition, large hip and knee internal rotation loadings were produced during the first 5% of stance due to the application of GRFs, causing a significantly larger hip internal rotation excursion than that of the forefoot strike condition. Dissimilarly, neither initial hip internal rotation displacement nor knee internal rotation GRF loadings were observed in the forefoot strike condition.ConclusionsRearfoot strike during cutting appears to increase noncontact ACL injury risk as the GRF tends to produce combined hip and knee internal rotation moments and the high-risk lower limb configuration. Conversely, forefoot strike during cutting appears to be an ACL-protective strategy that does not tend to produce the ACL-harmful joint loadings and lower extremity configurations. Thus, improving foot strike patterns during cutting should be incorporated in ACL injury prevention programs.

Limiting the Risk of Osteoarthritis After Anterior Cruciate Ligament Injury: Are Health Care Providers Missing the Opportunity to Intervene?

To understand what sports orthopedic surgeons (OS), primary care physicians (PCPs) with sports medicine training, and physical therapists (PTs) managing nonelite athletes with anterior cruciate ligament (ACL) injury tell their patients about their osteoarthritis (OA) risk. An electronic survey was distributed by the Canadian Academy of Sport and Exercise Medicine (PCPs, OS), the Sports and Orthopedic Divisions of the Canadian Physiotherapy Association (PTs), and to OS identified through the Royal College of Physicians and Surgeons and the Canadian Orthopaedic Association. The survey included 4 sections: demographics, factors discussed, timing of discussions, and discussion of risk factors and their management. Proportions or means with 95% confidence intervals were calculated. A total of 501 health care professionals (HCPs) responded (98 PCPs, 263 PTs, and 140 OS). Of those responding, 70-77% of physicians reported always discussing OA risk, but only 35% of PTs did. All HCPs reported that patient activities perceived as detrimental to knee health, ACL reinjury, and simultaneous injury to other structures in the knee were most often the reason for discussing OA risk. OA risk was discussed at initial management post-injury (65-94%), with few discussing risk subsequently. Eighty percent of physicians and 99% of PTs indicated that PTs were suited to provide OA risk and management information. HCPs routinely managing people with ACL injury do not consistently discuss OA risk post-injury with them. Educational strategies for HCPs are urgently needed to develop care pathways inclusive of support for OA risk management following ACL injury.

Outcomes of Combined Unicompartmental Knee Replacement and Anterior Cruciate Ligament Reconstruction: A Systematic Review

Abstract Background The incidence of osteoarthritis of the medial compartment after ACL injury has been quoted to range from 33% to 70%. Medial osteoarthritis in ACL deficient knee is a challenge. Patients are mainly young and active. First reports highlighted a higher incidence of complications, in terms of tibial loosening and higher revision rate, when UKA were performed in ACL-deficient knees. They defined ACL deficiency is a contraindication to UKA. Objectives A systematic review and meta-analysis of literature to assess functional outcomes of combined unicompartmental knee arthroplasty with ACL reconstruction and revision rate. Data Sources The following electronic databases were searched up to 2019: PubMed, Google Scholar search engine, JBJS {Journal of bone and joint Surgery}, Cochrane database of systematic reviews, EMBASE and Science Direct. Results A total of 10 studies met the inclusion criteria encompassing 218 patients who were treated with simultaneous ACL reconstruction and unicompartmental knee arthroplasty. The mean age was 49.5 years (range from 36 to 71) with a mean follow-up of 49.3 months (range from 9 to 258). There was an improvement in mean Oxford Score from 29 to 42.5. The mean knee society score improved from 88.3 to 159. Complications reported included tibial inlay dislocation (n = 3), conversion to a total knee arthroplasty (n = 2), infection requiring two-stage revision (n = 2), stiffness requiring manipulation under anaesthesia (n = 1). Average revision rate was 1.8%. Conclusion Literature has strong evidence to support that combined UKA and ACL reconstruction show good functional outcomes and less revision rate. It is a valid treatment option for MOA more in young age group in whom MOA secondary to ACL tear and intact other knee compartments. there is no clinical trial or study suggest that UKA and ACL reconstruction is superior to UKA with tibial slope change or using fixed bearing prosthesis for MOA in ACL deficient knee with instability.

HOW MANY PAIN PILLS DO WE PRESCRIBE: A SURVEY OF PARTICIPANTS IN SCORE: A QUALITY IMPROVEMENT INITIATIVE (204)

Objectives:The public health opioid abuse epidemic has led to nationwide interest in judicious use and close monitoring of opioid pain medication. Knee arthroscopy(KA) and anterior cruciate ligament reconstruction(ACLR) are common procedures in adolescent patients for which narcotics have been historically utilized for post-operative pain management. The purpose of this study is to investigate pain management strategies following basic KA or ACLR by pediatric sports surgeons who contribute to a multi-center quality improvement initiative(SCORE).Methods:Surgeon participants in SCORE represent fifteen U.S. institutions from primarily academic teaching hospitals who specialize in pediatric sports medicine. Surgeons contribute all ACLR and other KA-related cases. A RedCap survey was distributed to all SCORE surgeon participants in December 2019. A KA (defined as a knee arthroscopy that does not include a ligament reconstruction or a cartilage procedure other than chondroplasty) represented a less invasive procedure, while the ACLR represented a more invasive procedure. Survey results were collected and analyzed for both practice patterns of regional anesthesia utilization and post-operative narcotic prescribing volumes.Results:Twenty-eight SCORE surgeon participants completed the survey, a 100% response rate. A planned prescription of a mean of 16.4 pain pills (range 0-40 pills) were reported for pain management following a KA, only 32.1% of surgeons reported adjunctive regional anesthesia techniques for this procedure in addition to general anesthesia. Following an ACLR, surgeons reported a planned prescription of a mean 23.8 pain pills (range 0-40 pills) and most (92.3%) reported utilization of regional anesthesia for their peri-operative analgesia strategy. Of those using adjunctive regional anesthesia, significant variability was reported: 30.7% reported indwelling catheter placement for peripheral nerve block following ACLR as opposed to a single shot injection method, and several block locations were reported to be utilized of which adductor canal (67.9%) block was the most common (see Figure 1). For both procedure types, variability in multi-modal pain management was noted, with incomplete adoption of the use of additional non-narcotic medication (acetaminophen, 64.2%; and NSAIDS, 75%). Cryotherapy devices were applied/prescribed in 75.0% of knee arthroscopy procedures and 92.8% of ACLR.Conclusions:Despite evidence for effective adjunctive pain management strategies, incomplete adoption of multi-modal techniques and reliance on narcotic medication remains a significant component of pediatric sports surgical practice; with on average > 15 pills prescribed following these procedures. Opportunities for reducing practice variability, adoption of multi-modal analgesia strategies, and decreasing post-operative narcotic use following common adolescent knee procedures exist for this subset of pediatric sports medicine specialists

Optimizing Whole-Body Kinematics During Single-Leg Jump Landing to Reduce Peak Abduction/Adduction and Internal Rotation Knee Moments: Implications for Anterior Cruciate Ligament Injury Risk.

Knee abduction/adduction moment and knee internal rotation moment are known surrogate measures of anterior cruciate ligament (ACL) load during tasks like sidestepping and single-leg landing. Previous experimental literature has shown that a variety of kinematic strategies are associated or correlated with ACL injury risk; however, the optimal kinematic strategies needed to reduce peak knee moments and ACL injury are not well understood. To understand the complex, multifaceted kinematic factors underpinning ACL injury risk and to optimize kinematics to prevent the ACL injury, a musculoskeletal modeling and simulation experimental design was used. A 14-segment, 37-degree-of-freedom, dynamically consistent skeletal model driven by force/torque actuators was used to simulate whole-body single-leg jump landing kinematics. Using the residual reduction algorithm in OpenSim, whole-body kinematics were optimized to reduce the peak knee abduction/adduction and internal/external rotation moments simultaneously. This optimization was repeated across 30 single-leg jump landing trials from 10 participants. The general optimal kinematic strategy was to bring the knee to a more neutral alignment in the transverse plane and frontal plane (featured by reduced hip adduction angle and increased knee adduction angle). This optimized whole-body kinematic strategy significantly reduced the peak knee abduction/adduction and internal rotation moments, transferring most of the knee load to the hip.