Ligament Tears Research Articles

A mechanical study of the influence of ankle joint angle on translational traction of soccer boots

The shoe–surface interaction for soccer players has both safety and performance implications. This interaction has been widely researched in terms of outsole configuration and surface type. However, these investigations, particularly those involving translational traction, often neglect the approach angle of the foot in terms of a real-world setting. This investigation considers the foot position prior to injuries such as anterior cruciate ligament tears, and observes how the translational traction alters with various angles for simulated plantarflexion, dorsiflexion, calcaneal inversion and calcaneal eversion. It was hypothesised that, as these angles increased, the translational traction would decrease as there would be less contact area between the boot and the surface compared to the neutral, flat footform. A custom-built testing apparatus recorded the translational traction of a soccer boot moving in four different directions at different loading angles on both a natural grass and artificial grass playing surface. A one-way ANOVA was performed, with a post-hoc Tukey Test to determine the significant differences between the translational traction between each angle. It was found that the geometry of the outsole configuration, more specifically, the apparent contact area between the shoe and surface played a significant role in the level of traction obtained. These results highlight the importance of stud geometry, particularly with respect to movements when the foot is angled as it would be in a potential injury scenario. Manufacturers should consider the profile of studs relative to the expected movements to not induce excessive traction, which could lead to potential foot fixation and injury.

Clinical Outcomes Following Treatment of Ramp Lesion during Anterior Cruciate Ligament Reconstruction (Systematic Review and Meta-Analysis)

Abstract Background Ramp lesion is defined as a vertical longitudinal detatchment of PHMM due to meniscocapsular ligament tears that is not greater than 2 cm in medio-lateral length resulting in separation of meniscocapsular or meniscotibial ligament. Aim of the Work The study aims to perform a systemic review and meta analysis concerning outcomes of ramp lesion repair during ACL reconstruction. Methodology Systematic review and Meta-analysis on Patients with ramp lesion undergoing ACL reconstruction and ramp lesion treatment with total of 387 studies matched our search terms. After exclusion of duplicates, 37 studies were initially included based on their Abstract. 27 studies were finally included. The average MINORS score of all non-randomised studies was 8.7/16 for non- comparative studies and 16.9/24 for comparative studies, respectively. Results Our results suggest that medial meniscus repair associated with ACL reconstruction may restore meniscal function by adjusting the anteroposterior length of the torn medial meniscus. Our data demonstrate that more than 75% of medial meniscal tears in the ACL-deficient knee occur in the peripheral posterior horn. If we assume that the anatomy as described by Hughston and Eilers is correct, then care should be taken when addressing these tears, because a strong repair is needed to preserve the stability of the knee. Conclusion MRI demonstrated moderate sensitivity and excellent specificity in the diagnosis of ramp lesion in patients with ACL tear. According to the current systematic review, ramp lesions are common in ACL-deficient knees and are often missed through standard anterior portals. Exploration of the meniscocapsular complex via an additional posteromedial portal is recommended, if MRI suggests a lesion in this area or if instability is present at probing. If the posteromedial view still does not reveal any lesion despite significant instability, soft-tissue debridement might uncover hidden lesions (meniscotibial ligament disruptions). Ramp lesion repair leads to a significant improvement of subjective knee scores, regardless of the specific fixation technique. For stable ramp lesions, trephination and abrasion might be equivalent to ramp lesion repair in terms of postoperative stability.

Anterior cruciate ligament tear detection using gated recurrent unit and flexible fitness dependent optimizer

Anterior Cruciate Ligament (ACL) tear is a common knee injury that can be diagnosed using Magnetic Resonance Imaging (MRI). In this study, a novel approach has been proposed for improving the accuracy of ACL tear detection using an optimized Gated Recurrent Unit (GRU) model. The GRU model is a type of Recurrent Neural Network (RNN) that can capture the temporal features of MRI images. The optimization of the GRU model is based on a modified metaheuristic technique, called the Flexible Fitness Dependent Optimizer (FFDO). The FFDO is a flexible and problem-dependent algorithm that can find the best solutions to optimize problems by generating and evaluating a set of candidate solutions based on a fitness function. The proposed approach is applied to the MRNet dataset, and the results are compared with 17 state-of-the-art methods. The results show that the proposed approach can achieve a high accuracy of97.95%for ACL tear detection, which is higher than the existing deep learning and machine learning methods. The proposed approach can also achieve high values for other performance metrics, such as specificity, sensitivity, precision, MCC, F1-score, and AUC. The proposed approach can effectively extract the essential features of knee MRI images that are indicative of ACL tears with high diagnostic accuracy.

Magnetic Resonance Imaging Evaluation of Anterolateral Ligament Tear in Association with Anterior Cruciate Ligament Tear: A Review

Abstract Anterolateral ligament evaluation on magnetic resonance imaging (MRI) is a relatively recent topic, which has come into the limelight in the last decade. The objective of this review article is to study the association of anterolateral ligament tear in anterior cruciate ligament tear on 1.5 T MRI, which can aid in planning the reconstruction procedure.

The Effect of Sportsmetrics Training on Landing Technique in Female Volleyball Players With Dynamic Knee Valgus

Background and Aims The most serious and severe injuries among female volleyball players is the knee injury, especially the anterior cruciate ligament (ACL) tear. Its key risk factors are dynamic knee valgus (DKV) and abnormal alignment during jump landing. One of the successful protocols regarding the prevention of knee injuries in female volleyball players is professional sportsmetrics volleyball training. In the present study, the effect of this protocol on DKV correction and landing error scoring system (LESS) was investigated. Methods The current research is quasi-experimental with a pre-test-post-test design. The statistical sample included 30 female volleyball players (Mean±SD age: 20.83±2.22 years, Mean±SD height: 168.16±6.47 cm, Mean±SD weight: 59.13±7.4 kg, Mean±SD body mass index (BMI): 20.83±1.52 kg/m2, and Mean±SD sports experience: 5.46±1.8 years) who were randomly divided into the training (15 people) and control (15 people) groups. Double leg squat and LESS tests were used to evaluate DKV and landing error. The exercise group participated in the present protocol for 6 weeks, three sessions per week. Each session was approximately 90 minutes, including warm-up exercises, sportsmetrics volleyball training, and cool-down. The analyses of covariance were used to evaluate the data at a significant level of P=0.05. Results The results of covariance analysis showed that performing these exercises significantly reduced (P=0.01) DKV (from 23.13 to 7.86) and landing error (from 17.46 to 7.6). In other words, the training group experienced a 66% decrease in DKV and a 56% decrease in landing error after performing six weeks of sportsmetrics volleyball training. Conclusion Sportsmetrics volleyball training has successfully improved performance and prevented ACL injury in female volleyball players. According to the present study results, performing these exercises leads to correct DKV and improves lower extremity alignment and landing technique. Therefore, performing sportsmetrics volleyball training is strongly recommended for female volleyball players with DKV.

Poster 353: Impact of Meniscus and Cartilage Treatment on Return to Sport Following Anterior Cruciate Ligament (ACL) Reconstruction

Background: Anterior cruciate ligament (ACL) tears are a common injury in athletes. ACL tears often occur with other injuries, including cartilaginous injuries. There is a lack of research regarding cartilage treatment on return to sport (RTS) following ACL reconstruction. Purpose: To evaluate the impact of meniscus and/or cartilage (meniscus-cartilage) treatment on return to sport (RTS) rates and time to return to sport following ACL reconstruction with hamstring tendon (HT), patellar tendon (BPTB), and quadriceps tendon (QT) grafts. Methods: Competitive and recreational athletes between the ages of 13-24 who had an ACL reconstruction between 2010-2022 were included. Activity level, sport, graft type, cartilage treatment, RTS testing result data, and time to RTS were collected. Chi-square statistics and Wilcoxon rank sum tests were used, and statistical significance was set to p<0.05. Results: There were 855 total patients with 354 HT, 361 BPTB, and 140 QT grafts of which 275 did not have meniscus-cartilage treatment and 580 received meniscus-cartilage treatment. Females comprised 52% of ACL reconstructions without meniscus-cartilage treatment and 42% of ACL reconstructions with meniscus-cartilage treatment. The median age was 18 and 17 for those receiving meniscus-cartilage treatment and those without treatment, respectively. Median time to RTS was 27.86 weeks for 151 patients without meniscus-cartilage treatment and 30.49 weeks for 299 patients receiving meniscus cartilage-treatment (p=0.0253). The median 6-meter timed hop ratio was 1.01 for 21 athletes with meniscus-cartilage treatment and 0.965 for 12 athletes without meniscus-cartilage treatment (p=0.0492). Median isokinetic quadriceps testing at 300 degrees per second was 85% of the contralateral leg for 170 athletes with meniscus-cartilage treatment and 85% for 67 athletes without meniscus-cartilage treatment (p=0.7181). Return to previous level of play occurred in 91/104 (87.5%) of those without meniscus-cartilage treatment and 196/220 (89%) of those with meniscus-cartilage treatment (p=0.6742). ACL and non-ACL reinjuries occurred in 18% (49/272) of those without and 20% (118/577) of those with meniscus-cartilage treatment (p=0.4047). Conclusions: Time to clearance to return to sport occurred more quickly in those without meniscus-cartilage treatment. Six-meter timed hop testing results were superior in those receiving meniscus-cartilage treatment. This study will aid orthopaedic surgeons and their athletes while addressing common concomitant injuries during ACL reconstruction.

Poster 341: Nonoperative Treatment of MCL Tears in ACL/MCL Injuries Does Not Increase ACL Retear Rates

Objectives: There continues to be controversy regarding the treatment of medial collateral ligament (MCL) tears when torn in conjunction with the anterior cruciate ligament (ACL). There is a push to acutely repair or reconstruct the MCL in this setting due to lower revision rates following the ACL reconstruction (ACLR). However, most nonoperative treatment philosophies are focused on immobilization through bracing instead of the more rigid casting approach. The purpose of this study was to determine if there was a difference in ACL retear rates or postoperative stability between those with ACL/MCL injuries and isolated ACL injuries when the MCL was treated nonoperatively, including rigid casting prior to the ACLR. Methods: Between 1982 and 2022, 6047 patients planning to have an ACLR were enrolled into the study. The population was determined with inclusion criteria of a primary ACLR using a patellar tendon graft with minimum 1-year follow up. Patients were excluded with revision ACLR, lateral side or posterior cruciate ligament involvement, or lacking postoperative KT data. Patients were divided into two groups, isolated ACLR (N = 5670) and ACL/MCL (N = 377). All MCL tears were treated nonoperatively and when indicated, they were casted in 30° of flexion and changed weekly until a solid end point was achieved and patients had the ability to bear full weight on the involved side. Once medial side stability was attained, preoperative rehabilitation commenced and range of motion was normalized before the ACLR. Postoperatively, all patients followed the same accelerated rehabilitation program. The KT manual maximum (MM) difference between knees, in millimeters, was used for analysis. Graft retear rate was determined through subjective surveys sent yearly to each patient after surgery. To reduce confounding bias in the analysis, the ACL/MCL patients were control matched 1:1 to the isolated ACL injury patients based on sex, age, postoperative activity rating, and surgery timing, which led to 304 patients in each group. Results: Prior to matching, both groups had similar mean ages and rates of having postoperative activity levels ≥7, however, the ACL/MCL group showed higher rates of males (69.0%) and subacute surgery (71.9%) compared to the isolated ACLR group (59.7% males and 56.6% subacute surgery). After matching, the mean age for both groups was similar (ACL/MCL: 24.6 years, isolated ACLR: 24.9 years) and they showed identical rates of males, postoperative activity rating ≥7, and subacute surgery at 66.4%, 90.4%, and 73.0%, respectively. The KT MM difference for the ACL/MCL group was not statistically significantly different when compared to the isolated ACLR group (1.8mm vs 1.6mm; p=0.196). The ACL retear rate for the ACL/MCL group was 7.9% compared to 6.6% for the isolated ACLR group, which was not statistically significantly different, p = 0.531. Conclusions: When the MCL is treated nonoperatively, including the use of a cast, before an ACLR, postoperative stability and rates of ACL retears are similar to those with an isolated ACL tear. Due to similar outcomes for both groups, surgeries to the MCL, and thus potential complications that can come with it, can be avoided. We postulate that the lack of differences in laxity and retear rates for the ACL/MCL group may be due to more rigid cast immobilization for the MCL, as opposed to bracing. Further study is needed to evaluate this hypothesis.

Poster 336: Reliability of Preoperative MRI in the Prediction of ACL Tear Type

Objectives: Anterior cruciate ligament (ACL) tears are among the most frequent ligament injuries in the United States. Most of these injuries are treated surgically, depending on patient-specific factors. Management of these injuries includes nonoperative management with stepwise rehabilitation or surgical treatment with ACL repair or reconstruction. Patient goals, a clinical evaluation, and preoperative MRI imaging are generally assessed to inform the choice of treatment. Classification of ACL tear-type based on stump morphology is critical to preoperative planning, as it can determine a patient’s eligibility for ACL preservation techniques. We aim to determine the efficacy of preoperative magnetic resonance imaging (MRI) in predicting ruptured ACL stump morphology and thus assist in preoperative planning and decision-making. Methods: This retrospective observational study utilized chart review from the case log of a single surgeon at an urban tertiary institution. The review identified patients who underwent the Bridge Enhanced ACL Repair (BEAR) procedure between January 1, 2022 and August 31, 2023. The inclusion criteria included patients who underwent a primary ACL repair with the BEAR technique and had adequate intraoperative and MRI images available for review. Patients excluded were those with inadequate intraoperative imaging or MRI imaging that was unavailable for review. For each patient included, the two senior authors assessed the morphology of the ACL stump on MRI (sagittal T2, coronal T2) and intraoperative arthroscopy images in a blinded manner and assigned a classification grade to each. The MRI-based morphology and the intraoperative image morphology of the tears were classified based on a system validated by DeFelice et al, which includes types 1 to 5 based on the location of the tear from most proximal to most distal. The correlation between the preoperative MRI assessment and the intraoperative arthroscopic assessment was interrogated using simple linear regression quantified with the Pearson correlation coefficient. Results: A total of 35 patients that underwent the BEAR procedure were identified. One patient was excluded due to inadequate intraoperative images. Of the remaining patients, 13 (38.2%) were male and 21 (61.8%) were female. The average patient age was 31, with a median age of 28. Most patients were injured while skiing (32.4%), while the second and third most prevalent mechanisms of injury were nonsports-related (23.4%) and soccer injuries (17.6%), respectively. Of the MRI tears that were analyzed, 9 (26.5%) were classified as type 1, 19 (55.9%) were type 2, and 5 (14.7%) were type 3. There were no tears identified as types 4 or 5 tears. Of the arthroscopic images that were analyzed, 21 (61.8%) were classified as type 1, 10 (29.4%) were type 2, 3 (8.8%) were type 3. Similarly, there were no tears identified as types 4 or 5. MRI accurately predicted the ACL tear type seen arthroscopically 55.9% (19/34) of the time. Of the (15) cases in which MRI did not correlate with the arthroscopic tear type, the MRI classification grade was within 1 grade of the arthroscopic grade 93.3% of the time (14/15). In the cases in which MRI was not correct in its grading, 93.3% of them (14/15) were classified as too high of a grade (MRI perceiving the tear to be more distal than it was in actuality). The Pearson correlation coefficient assessing the correlation between MRI identified tear type and arthroscopy identified tear type was 0.56. Conclusions: MRI accurately predicted the ACL tear type seen arthroscopically in only 55.9% of patients. In >90% of incorrect predictions, arthroscopy determined the ACL tear to be one classification more proximal than predicted by MRI. Our results demonstrate that while preoperative MRI can be useful in identifying approximate ACL tear location, it is essential to examine the ACL at time of arthroscopy for final determination of ACL stump size and viability for ACL restoration procedures. Moreover, a greater percentage of patients may be eligible for an ACL restoration procedure than predicted by preoperative MRI, highlighting the importance of discussing both ACL repair and ACL reconstruction with patients preoperatively. [Figure: see text]

A Review on Rehabilitation and Return to Sport Criteria Post ACL Reconstruction in Athletes

Background: Anterior Cruciate Ligament (ACL) injuries are most often found in young active athletes. They range from mild (small tears or sprain) to severe (complete tear of ligament) and are mostly seen in sports like football, basketball, cricket, gymnastics, skiing, etc ACL reconstruction is a surgical knee procedure that requires intensive postoperative rehabilitation by the athlete to be able to return to sport. Methods: A systematic review was conducted considering the data sources PubMed (MEDLINE), Cochrane Library, PEDro, Google Scholar, EBSCO, Medscape, and Scopus databases using the keywords ACL reconstruction, rehabilitation, and return to sport criteria. The time frame ranged between 2017-2022 Results: The study selection process is presented according to PRISMA guidelines. After title and abstract screening, 50 full-text articles were assessed for eligibility 20 were excluded; the remaining 30 articles were deemed to meet the inclusion criteria and were included. The total number of RCTs included was thirty Conclusion: The thirty included RCTs offer convincing results on post-operative outcomes of muscular strength, function, patient reported symptoms and determination of return to sport criteria. There is limitation in holistic evidence that looks into the psychological as well as physical components of rehabilitation of an athlete that will also accelerate the return to sport duration. Keywords: ACL reconstruction, rehabilitation, return to sport criteria

Tenodesis Anchors: A Convenient Technique for Collateral Ligament Reconstructions

Collateral injuries are usually found in association with cruciate ligament tears. There are multiple techniques to reconstruct the collateral ligaments using autografts and allografts. Conventionally, interference screws are used to fix the graft on the femur, tibia, and fibula. We describe a technique that does not require extensive graft preparation and is simple, reproducible, and less time-consuming using tenodesis anchors that give both compression and stability at the graft insertion sites. In this article, we describe posterolateral corner and medial collateral ligament reconstructions using this technique.

Management of Abhighatajanya janu sandhigata vata with special reference to anterior cruciate ligament tear through Ayurvedic management: A case report

Individuals like dancers can suffer from knee difficulties and there is no upper age limit for such knee joint-related disorders. During standing, walking, jogging, etc., the complex structure of the knee joint absorbs a lot of stress. Acute injuries to the joint may cause discomfort, swelling, and difficulty moving, which could be signs of a ruptured or broken ligament. The severity of the condition depends on the source of injury and the involved structures. Despite being less severe, some of them will still be uncomfortable and functionally restrictive. The symptoms of Janu sandhigata vata as described in Ayurveda may be correlated with signs and symptoms related to damage to the knee joint. A case where the patient was diagnosed as Abhighatajanya janu sandhigata vata with special reference to anterior cruciate ligament tear was managed by Ayurveda approaches that are presented here. The Ayurveda treatment protocol comprises Tikta ksheera basti (~therapeutic enema), Janu seka (~therapeutic streaming over the knee), Dashanga lepa (~anointment), and Sandhaniya upanaha (~poultice application). The treatment has resulted in significant improvement in the functioning of the affected knee joint. This case has demonstrated the role of Ayurveda treatment protocols and management strategies in such ligament and meniscal injuries, without any surgical intervention.

Pigmented villonodular synovitis of knee with concomitant partial tear of anterior cruciate ligament in skeletally immature patient: A case report

Pigmented villonodular synovitis (PVNS) is benign but locally aggressive proliferative disorder that affects synovial joint, tendon sheaths, and bursae. PVNS is rare in child, while concurrent Anterior Cruciate Ligament (ACL) tear in PVNS is uncommon finding. Previous study reported ACL tear might be a risk factor in adult PVNS but lack of record for pediatric PVNS. We report a case of uncommon concomitant ACL partial tear in an already rare pediatric PVNS. A nine-year old female with pain and swelling on left knee, occurred intermittent every 2 months for 1 year prior to surgery. There was moderate knee movement restriction with history of fall from bicycle 1 year before surgery. No history of knee instability was reported. X-ray only denote joint swelling, while MRI shows intraarticular bodies suspected synovial chondromatosis with hyperintense signal sign of partial ACL tear. The patient underwent arthroscopic evaluation which exhibit intraarticular hyperemic and hypertrophic synovium with loosening anteromedial ACL bundle. Arthroscopic synovectomy was then performed followed by range of motion training and muscle strengthening rehabilitation program. Post-operative histopathological result confirms PVNS assessment. 1 year follow up post-surgery shows no recurrence of pain or swelling with free movement of left knee joint and no disturbance or instability while walking. In this case, partial ACL tear may contribute as risk factor of PVNS in child. Arthroscopic synovectomy with physical rehabilitation program shows good functional result with no recurrence at 1-year follow up.

Simultaneous multi-slice technique for reducing acquisition times in diffusion tensor imaging of the knee: a feasibility study.

To explore the feasibility of simultaneous multi-slice (SMS) technique for reducing acquisition times in readout-segmented echo planar imaging (RESOLVE) for diffusion tensor imaging (DTI) of the knee. A total of 30 healthy volunteers and 23 patients with knee acute injury (12 cases with anterior ligament (ACL) tears and 16 cases with patellar cartilage (PC) injury) were enrolled in this prospective study. Three DTI protocols were used: conventional RESOLVE-DTI with 12 directions (protocol 1), SMS-RESOLVE-DTI with 12 directions (protocol 2) and 20 directions (protocol 3). DTI parameters of gastrocnemius, ACL and posterior cruciate ligament (PCL), and PC from three protocols were quantitatively assessed. For volunteers, protocol 2 significantly reduced acquisition time by 38.6% and 34.2% compared to protocols 1 and 3 while maintaining similar high-quality images and similar diffusive parameters, except for the fractional anisotropy (FA) and axial diffusivity (AD) of the PC between protocols 2 and 1 (P < 0.05). For injured ACL and PC, protocols 1 and 2 showed similar accurate diffusive parameters (except for AD, P = 0.025) and similar diagnostic efficacy, which demonstrated significantly lower FA and higher radial diffusivity (RD) in protocols 1 and 2 compared to volunteers (P < 0.05). The 12-direction SMS-RESOLVE-DTI demonstrated a favorable balance between acquisition time and image quality, making it a promising alternative to conventional DTI for evaluating ligament and cartilage injuries. The SMS technique greatly reduces acquisition time while maintaining image quality, which signified the possibility of DTI's clinical application.

Perspective on Clinical and Functional Outcomes of Arthroscopic All-Inside Meniscal Repair: Insights From a Lower Middle-Income Country.

Background Meniscal tears are a common injury in the adult population. With the advent of newer devices, the adoption of the all-inside repair technique has been expanding substantially because of its feasibility and reduced risk to surrounding neurovascular structures. This study was conducted in a lower middle-income country to assess the functional outcome of the arthroscopic all-inside technique and to identify the potential factors that may affect the functional outcome that will eventually influence the future management of these patients. Method This study is a retrospective case series conducted at the Department of Orthopedic Surgery, Aga Khan University Hospital, Karachi, Pakistan. Patients presenting to the outpatient clinics with meniscal tears who underwent arthroscopic all-inside repair from January 2015 to December 2021 were included in this study. The exclusion criteria included patients who had associated fractures and patients with meniscal tears greater than six months ago. Results A total of 29 patients underwent all-inside meniscal repair for meniscus tears. The mean age of our patients was 26.31 years (SD = 7.11 years), ranging from 17 years to 48 years. Of these patients, 26 were males and three were females, accounting for 89.7% and 10.3%, respectively. The most frequent mechanism of injury was twisting while playing sports, accounting for 51.7%, followed by falling while playing sports and road traffic accidents (RTAs), accounting for 13.8% and 20.7%, respectively. Of the 29 patients, 16 (55.2%) had lateral meniscal injuries, 10 (34.5%) were diagnosed with medial meniscus injuries, and three (10.3%) had injuries to both menisci. The most common type of tear that was observed in our sample size was bucket handle tears, which were found in 14 patients, accounting for a total of 48.3%, followed by complex tears in seven patients (24.1%). The majority of the patients, i.e., 19 out of 29 patients (65.5%), had an acute course of injury, i.e., less than six weeks. For the functional outcome, the Lysholm score was calculated at 12 months and was found to be excellent in 17 patients, good in six patients, and fair in six patients, accounting for 58.6%, 20.7%, and 20.7%, respectively. The mean Lysholm score was 90.03 ± 8.85 points. Of the 29 patients, 27 (93.2%) had no complaints at the regular 12-month follow-up, whereas one patient (3.4%) experienced rotatory instability and one patient (3.4%) experienced stiffness at the knee joint. None of the patients had to undergo a reoperation. The mean Lysholm score in the 25 patients who had an associated anterior cruciate ligament tear was 89.64 ± 9.442 points, whereas the four patients who had an isolated meniscal tear had a mean score of 92.50 ± 2.887 points, which was not significantly different (p-value = 0.831). Conclusion All-inside meniscal repair for treating meniscal tears has become the new treatment paradigm as it not only renders excellent functional outcomes with minimal complications but also prevents damage to the surrounding neurovasculature and the soft tissue envelope as it is a minimally invasive technique.

ASSOCIATION BETWEEN WEIGHTBEARING CT AND MRI FINDINGS IN PROGRESSIVE COLLAPSING FOOT DEFORMITY

BackgroundWeightbearing computed tomography scans allow for better understanding of foot alignment in patients with Progressive Collapsing Foot Deformity. However, soft tissue integrity cannot be assessed via WBCT. As performing both WBCT and magnetic resonance imaging is not cost effective, we aimed to assess whether there is an association between specific WBCT and MRI findings.MethodsA cohort of 24 patients of various stages of PCFD (mean age 51±18 years) underwent WBCT scans and MRI. In addition to signs of sinus tarsi impingement, four three-dimensional measurements (talo-calcaneal overlap, talo-navicular coverage, Meary's angle axial/lateral) were obtained using a post processing software (DISIOR 2.1, Finland) on the WBCT datasets. Sinus tarsi obliteration, spring ligament complex and tibiospring ligament integrity, as well as tibialis posterior tendon degeneration were evaluated with MRI. Statistical analysis was performed for significant (P&lt;0.05) correlation between findings.ResultsNone of the assessed 3D measurements correlated with spring ligament complex or tibiospring ligament tears. Age, body mass index, and TCO were associated with tibialis posterior tendon tears. 75% of patients with sinus tarsi impingement on WBCT also showed signs of sinus tarsi obliteration on MRI. Of the assessed parameters, only age and BMI were associated with sinus tarsi obliteration diagnosed on MRI, while the assessed WBCT based 3D measurements were, with the exception of MA axial, associated with sinus tarsi impingement.ConclusionWhile WBCT reflects foot alignment and indicates signs of osseous impingement in PCFD patients, the association between WBCT based 3D measurements and ligament or tendon tears in MRI is limited. Partial or complete tears of the tibialis posterior tendon were only detectable in comparably older and overweight PCFD patients with an increased TCO. WBCT does not replace MRI in diagnostic value. Both imaging options add important information and may impact decision-making in the treatment of PCFD patients.

Return to Soccer After Acute Anterior Cruciate Ligament Primary Repair: A 2-Year Minimum Follow-up Study of 50 Amateur Players.

Return to sport (RTS) after treatment of an anterior cruciate ligament (ACL) tear is a critical parameter to assess the outcome of a surgical procedure. However, few studies have investigated RTS after ACL repair. To evaluate RTS of a group of amateur soccer players at a minimum follow-up of 2 years after ACL repair. Case series; Level of evidence, 4. A retrospective review of all patients treated with acute ACL repair was conducted. A total of 50 amateur soccer players were included in the study. Patients were examined clinically or contacted to complete postoperative patient-reported outcome measures, namely the Knee injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee questionnaire, the ACL-Return to Sport After Injury scale, and the Forgotten Joint Score-12. The patients' mean age was 25.8 ± 7.7 years (range, 14-47 years), and the mean follow-up was 34.3 ± 10.7 months (range, 24-51.3 months). The median Tegner Activity Scale score was 9. The ACL repair failure rate was 16% (8/50). The mean time from repair to failure was 23.1 ± 12.7 months (range, 6-44 months), and the mean age of patients who sustained ACL repair failure was 19.9 ± 3.3 years (range, 14-24 years), significantly lower compared with patients who did not experience ACL repair failure (26.9 ± 7.9 years; range, 16-47 years; P = .017). Multivariate analysis showed that age ≤21 years was the only significant risk factor for ACL repair failure (odds ratio, 5.45; confidence interval, 1.24-27.91; P = .041). Excluding the 8 patients who experienced repair failure, 31 of 42 patients (73.8%) returned to soccer after ACL repair, with 29 of the 31 (93.5%) returning at their preinjury level of play. Moreover, patients who played competitive soccer and returned to their preinjury level of play were significantly younger than those who did not return to their preinjury level of play (mean, 21.1 ± 3.4 vs 29.2 ± 9.5 years, respectively; P = .002) and had significantly better ACL-Return to Sport After Injury scores (mean, 96.6 ± 4 vs 87.8 ± 11, respectively; P = .044). In this study, 73.8% (n = 31) of patients returned to playing soccer, of whom 93.5% (n = 29) returned to their preinjury level after ACL repair. The failure rate was 16% (n = 8) and mainly involved patients ≤21 years old.

REAL-TIME MOTION IMAGE POSE DECOMPOSITION, CLASSIFICATION AND ANALYSIS

Exercise can boost metabolism and make the body healthier. It also increases metabolic rate, helping to consume more calories and burn fat. Regular exercise can stimulate the brain to secrete endorphins, making people feel relaxed and happy, and improves self-confidence, and has been shown to reduce symptoms in people with depression and anxiety. However, incorrect exercise posture may cause harm to the body, such as torn ligaments or muscle strains, so good exercise posture is needed to improve sports performance. This article proposes to use artificial intelligence image analysis method to decompose fitness exercise posture images and establish exercise posture cycle samples to assist in completing fitness exercises.

Post-processing of quantitative 4D-CT for initial evaluation of scapholunate Instability: Assessment of simplified approaches to data analysis

ObjectivesTo evaluate the diagnostic performance of simplified post-processing approaches for quantitative wrist 4D-CT in the assessment of scapholunate instability (SLI). MethodsA prospective monocentric case-control study included 60 patients with suspected post-traumatic scapholunate ligament (SLL) tears and persistent pain. Of these, 40 patients exhibited SLL tears, subdivided into two groups of 20 each: one group with completely torn ligaments and the other with partially torn ligaments. The remaining 20 patients, whose SLLs were intact, served as controls. 4D-CT and CT arthrography were performed, and post-processed by two readers using three approaches: the standard method with full data assessment and dedicated software, partial data assessment with post-processing software (bone locking), and partial data assessment without post-processing software (no bone locking). The scapholunate gap (SLG) parameter was measured in millimeters to evaluate scapholunate diastasis during radioulnar deviation (RUD). The scapholunate ligament status on CT arthrography was considered the gold standard. ResultsThe SLG-derived parameters (range, mean, and maximal values) were significantly increased in patients with both intact and torn scapholunate ligaments across all post-processing approaches (P values ranging from 0.001 to 0.004). SLG range was the best parameter for diagnosing SLL tears, with ROC AUC values ranging from 0.7 to 0.88 across the three post-processing methods. The interobserver reproducibility was better with the alternative approaches (ICC values 0.93–0.96) compared to the standard approach (ICC values 0.65–0.72). Additionally, post-processing time was shorter with the alternative approaches, especially when specific software was not used (reduced from 10 to three minutes). ConclusionSimpler approaches to wrist 4D-CT data analysis yielded acceptable diagnostic performances and improved interobserver reproducibility compared to the standard approach.

From Control to Chaos: Visual-Cognitive Progression During Recovery from ACL Reconstruction.

BACKGROUND: Anterior cruciate ligament tear is a serious knee injury with implications for central nervous system (CNS) plasticity. To perform simple knee movements, people with a history of ACL reconstruction (ACL-R) engage cross-modal brain regions and when challenged with cognitive-motor dual-tasks, physical performance deteriorates. Therefore, people with ACL-R may increase visual-cognitive neural processes for motor control. CLINICAL QUESTION: What components of CNS plasticity should the rehabilitation practitioner target with interventions, and how can practitioners augment rehabilitation exercises to target injury associated plasticity? KEY RESULTS: This clinical commentary (1) describes the neurophysiological foundation for visual-cognitive compensation after ACL-R, (2) provides a theoretical rationale for implementing visual-cognitive challenges throughout the return to sport (RTS) continuum, and (3) presents a framework for implementing visual-cognitive challenges from the acute phases of rehabilitation. The 'Visual-Cognitive Control Chaos Continuum (VC-CCC) framework consists of five training difficulties that progress visual-cognitive challenges from high control to high chaos, to better represent the demands of sport. CLINICAL APPLICATION: The VC-CCC framework augments traditional rehabilitation so that each exercise can progress to increase difficulty and promote sensorimotor and visual-cognitive adaptation after ACL-R.

Establishment of a Posttraumatic Osteoarthritis Model in Mice Induced by Noninvasive Anterior Cruciate Ligament Tear

Background: Animal models that use open surgical transection of the anterior cruciate ligament (ACL) do not accurately simulate the clinical condition regarding the pivot-shift mechanism and the associated inflammatory response that occurs before reconstruction. Purpose/Hypothesis: The purpose was to characterize a reproducible manual, nonsurgical method to mimic an isolated ACL tear in a clinically relevant model and to evaluate the development of progressive posttraumatic osteoarthritis due to ACL injury. It was hypothesized that the ACL could be reproducibly torn with minimal damage to other ligaments and that there would be progressive development of degenerative joint disease after ACL injury. Study Design: Controlled laboratory study. Methods: A total of 37 mice (strain C57BL/6) were used to compare the manual procedure with sham surgery (sham group; n = 10) and with the established surgical ACL transection (ACLT) procedure (surgical group; n = 27). In the sham group, a closed manual procedure was performed on the right knee and sham surgery on the left knee. In the surgical group, the closed manual procedure was performed on the right knee and surgical ACLT on the left knee. Dissection using India ink, histological assessment with safranin O and hematoxylin-eosin staining, radiological evaluation through radiographs and microfocus computed tomography scans, and gait analyses were performed to assess cartilage/ligament status. Osteoarthritis Research Society International (OARSI) and synovitis scores, anterior tibial translation, range of motion, bone microstructure, osteophyte volume, and pain were assessed at 2, 4, and 8 weeks postoperatively. Results: The manual procedure successfully resulted in an ACL rupture and associated meniscal injury. The posterior cruciate, lateral collateral, and medial collateral ligaments were intact in all dissected knees. Two weeks after ACL tear, the surgical group showed a significantly higher synovitis score, whereas 8 weeks after ACL tear, the manual group showed a significantly higher volume of osteophytes. No significant differences were found between the groups in terms of OARSI score, anterior tibial translation, range of motion, bone microstructure computed tomography values, and stride distance/irregularity. Conclusion: This procedure can be used to create an ACL tear model without causing grossly evident injuries to other ligaments and avoiding the risk of cartilage damage from surgical instruments. Clinical Relevance: This procedure offers a more clinically relevant ACL tear model and facilitates simple, inexpensive, and reproducible development of posttraumatic osteoarthritis.