METHODS: The present study consisted of 50 lower limbs from formalin-fixed male adult cadavers aged about 70 years (45-85) belonging to the South Indian population. Total length of the quadriceps tendon, patellar height, patellar ligament height, proximal width, distal width and thickness of the patellar ligament were measured meticulously. Mean, standard deviation, median scores of each parameter were computed for groups using SPSS 16.0. Level of significance was considered as p ligament between the right and left lower limbs. Patellar ligament length showed positive correlation with ligament thickness (r = 0.36; p = 0.078 for right limb and r = 0.33; p = 0.104 for left limb). Proximal width of ligament showed significant positive correlation with distal width (r = 0.41; p = 0.041 for right limb and r = 0.54; p = 0.006 for left limb).
CONCLUSION: This morphometric data and analysis might be fundamental in understanding various knee conditions in situ and necessary to orthopedic surgeons for successful planning and execution for ACL reconstruction using patellar ligament graft and other patellofemoral joint disorders.
LEVEL OF EVIDENCE: I.
METHODS: Thirty rabbits underwent either anterior cruciate ligament transection (ACLT) procedure or injected intraarticularly with monosodium iodoacetate (MIA, 8 mg) at the right knee joint. The subchondral bones were scanned via micro-CT, and articular cartilage was assessed histologically at 4-, 8- and 12-week post-induction.
RESULTS: Based on bone micro-architecture parameters, the surgically induced group revealed bone remodelling processes, indicated by increase bone volume, thickening of trabeculae, reduced trabecular separation and reduced porosity. On the other hand, the chemically induced group showed active bone resorption processes depicted by decrease bone volume, thinning of trabeculae, increased separation of trabecular and increased porosity consistently until week 12. Histologically, the chemically induced group showed more severe articular cartilage damage compared to the surgically induced group.
CONCLUSIONS: It can be concluded that in the ACLT group, subchondral bone remodelling precedes articular cartilage damage and vice versa in the MIA group. The findings revealed distinct pathogenic pathways for both induction methods, providing insight into tailored therapeutic strategies, as well as disease progression and treatment outcomes monitoring.
Material and Methods: Patients with ACL re-injury to either knee after successful primary ACLR were included in Group I and those with no further re-injury were included in Group II. Variables including age, gender, side, body mass index (BMI), thigh atrophy, anterior knee laxity difference between both knees measured by KT-1000 arthrometer, mean time of return to sports (RTS), graft type, type of game, mode of injury, Tegner Activity Score, hormone levels, femoral tunnel length (FTL), posterior tibial slope (PTS) and notch width index (NWI) were studied. Binary logistic regression was used to measure the relative association.
Results: A total of 128 athletes were included with 64 in each group. Mean age in Group I and II were 24.90 and 26.47 years respectively. Mean follow-up of Group I and Group II were 24.5 and 20.11 months respectively. Significant correlation was present between ACL re-injury and following risk factors; PTS of >10º, KT difference of >3.0mm, thigh atrophy of >2.50cm and time to RTS <9.50 months P value <0.05). No correlation was found with age, sex, BMI, type of game, Tegner Activity Score, mode of injury, NWI, size of graft, FTL and hormone levels.
Conclusion: Possible risk factors include PTS of ≥ 10º, KT difference of ≥ 3.0mm at 1 year follow-up, thigh atrophy of ≥ 2.50cm at 1 year follow-up and RTS <9.5 months after primary ACLR.
Design: Anterior cruciate ligament transection (ACLT) was performed to induce OA in thirty-three male New Zealand white rabbits and were randomly divided into three groups: Channa, glucosamine, and control group. The control group received drinking water and the Channa and glucosamine groups were orally administered with 51.4 mg/kg of Channa extract and 77.5 mg/kg of glucosamine sulphate in drinking water, respectively, for eight weeks and then sacrificed. The articular cartilage was evaluated macroscopically and histologically using semiquantitative and quantitative methods. Serum cartilage oligomeric matric protein (COMP), cyclooxygenase 2 (COX-2) enzyme, and prostaglandin E2 (PGE2) were also determined.
Results: Macroscopic analysis revealed that Channa group have a significantly lower severity grade of total macroscopic score compared to the control (p < 0.001) and glucosamine (p < 0.05) groups. Semiquantitative histology scoring showed that both Channa and glucosamine groups had lower severity grading of total histology score compared to the control group (p < 0.001). In comparison with the control, Channa group had lower histopathological changes in three compartments of the joint compared to glucosamine group which had lower histological scoring in two compartments only. The cartilage thickness, area, and roughness of both Channa (p < 0.05) and glucosamine (p < 0.05) groups were superior compared to the control group. However, the Channa group demonstrated significantly less cartilage roughness compared to the glucosamine group (p < 0.05). Serum COMP levels were lower in both Channa (p < 0.05) and glucosamine (p < 0.05) groups compared to the control group.
Conclusion: Both oral administration of Channa extract and glucosamine exhibited chondroprotective action on an ACLT OA-induced rabbit model. However, Channa was superior to glucosamine in maintaining the structure of the cartilage.
METHODS: This prospective comparative study was conducted from 2009 to 2012. Patients with ACL injuries who underwent knee arthroscopy and MRI were included in the study. Two radiologists who were blinded to the clinical history and arthroscopic findings reviewed the pre-arthroscopic MR images. The presence and type of meniscal tears on MRI and arthroscopy were recorded. Arthroscopic findings were used as the reference standard. The accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of MRI in the evaluation of meniscal tears were calculated.
RESULTS: A total of 65 patients (66 knees) were included. The sensitivity, specificity, accuracy, PPV, and NPV for the MRI diagnosis of lateral meniscal tears in our patients were 83, 97, 92, 96, and 90 %, respectively, whereas those for medial meniscus tears were 82, 92, 88, 82, and 88 %, respectively. There were five false-negative diagnoses of medial meniscus tears and four false-negative diagnoses of lateral meniscus tears. The majority of missed meniscus tears on MRI affected the peripheral posterior horns.
CONCLUSION: The sensitivity for diagnosing a meniscal tear was significantly higher when the tear involved more than one-third of the meniscus or the anterior horn. The sensitivity was significantly lower for tears located in the posterior horn and for vertically oriented tears. Therefore, special attention should be given to the peripheral posterior horns of the meniscus, which are common sites of injury that could be easily missed on MRI. The high NPVs obtained in this study suggest that MRI is a valuable tool prior to arthroscopy.
OBJECTIVE: This study investigated the effectiveness of the UDP in the last 6 wk of rehabilitation.
DESIGN: Pre-post study with 2-tailed paired t tests for limited a priori comparisons to examine differences.
SETTING: National Sports Institute of Malaysia.
PARTICIPANTS: 24 Malaysian national athletes.
INTERVENTIONS: 7 sessions/wk of 90 min with 3 sessions allocated for 5 or 6 UDP exercises.
MAIN OUTCOMES: Significant improvements for men and women were noted. Tests included 20-m sprint, 1-repetition-maximum single-leg press, standing long jump, single-leg sway, and a psychological questionnaire.
RESULTS: For men and women, respectively, average strength improvements of 22% (d = 0.96) and 29% (d = 1.05), sprint time of 3% (d = 1.06) and 4% (d = 0.58), and distance jumped of 4% (d = 0.59) and 6% (d = 0.47) were noted. In addition, athletes reported improved perceived confidence in their abilities. All athletes improved in each functional test except for long jump in 2 of the athletes. Mediolateral sway decreased in 18 of the 22 athletes for the injured limb.
CONCLUSION: The prevention training with UDP resulted in improved conditioning and seems to decrease mediolateral sway.
METHODS: From April 2014 to December 2015, a total of 72 knees in 64 patients that underwent OWHTO, second-look arthroscopy, and magnetic resonance imaging (MRI) assessment, were enrolled. Preoperative and postoperative coronal and sagittal translation, joint line orientation angle, the distance between medial femoral notch marginal line and medial tibial spine, and PTS were evaluated. ACL status was arthroscopically graded from grade 1 (best) to 4 (worst). The MRI signal of the graft in three portions (proximal, middle, and distal) was graded from grade 1 (best) to 4 (worst).
RESULTS: High grade (3: partial, and 4: complete rupture) was noted in 28 cases (38.9%) at the second-look arthroscopy compared with 10 cases (13.9%) at index arthroscopy. The MRI signal grade significantly increased at follow up MRI compared with preoperative MRI (P<0.01). An increased signal was commonly noted in the middle and distal portions of the graft.
CONCLUSIONS: Geometric changes after OWHTO were related to ACL deterioration. The ACL was commonly affected at the middle and distal portions and rarely at the proximal portion. There is a possibility of impingement because of the geometric changes.
LEVEL OF EVIDENCE: Level IV.
STATEMENT OF SIGNIFICANCE: In this study, we developed a silk scaffold with increased stiffness and SDF-1 controlled release capacity for ligament repair. This advanced scaffold transplantation combined with intra-articular injection of LSPCs (which was isolated from rabbit ligament for the first time in this study) promoted the regeneration of both the tendinous and bone tunnel portion of ACL. This therapeutic strategy also ameliorated cartilage degeneration and reduced the severity of arthrofibrosis. Hence, combining LSPCs injection with SDF-1-releasing silk scaffold is demonstrated as a therapeutic strategy for ACL regeneration and OA treatment in the clinic.
METHOD: A single, masked, controlled study was designed. This comprised two matched groups of 12 chronically ACLD patients awaiting reconstruction and a group of 12 matched uninjured control subjects. Only one ACLD group received a home-based exercise and educational programme. Assessment before and after the exercise intervention included: knee joint stability (clinical and KT1000 evaluation); muscle strength (Cybex II); standing balance and functional performance (agility, [corrected] and subjective tests).
RESULTS: At the time of initial assessment there were no statistically significant differences in any measures for the two ACLD groups but both ACLD groups were significantly different from the uninjured control group as regards quadriceps strength and function. Measures taken after six weeks showed no significant improvement in the untreated ACLD group or in the uninjured control group. The treated ACLD group showed significant improvement in the following measures: quadriceps strength measured at 60 degrees and 120 degrees per second (p < 0.001); single leg standing balance with eyes closed (p < 0.001); instrumented passive stability at 20 lb (89 N) force (p = 0.003); agility and subjective performance (p < 0.001). The incidence of unstable episodes had decreased in the treated ACLD group, reducing further damage to the joint.
CONCLUSION: This study leaves little doubt that pre-operative physiotherapy had a positive effect on motor function in ACLD subjects and should be prescribed routinely to maximize muscle stabilizing potential prior to reconstruction. Patients report improved stability and, in certain cases, may avoid surgery. The finding that exercise increased the passive stability of the joint was unexpected and requires further investigation.
Method: Twenty-seven patients were included in this study conducted from 1st January to 31st December 2013. All patients were skeletally mature and scheduled to undergo primary anterior cruciate ligament reconstruction using 4S-STG autograft. Ultrasonographic examination of semitendinosus and gracilis tendons to measure the cross sectional area was conducted and anthropometric data (weight, height, leg length and thigh circumference) was measured one day prior to surgery. True autograft diameters were measured intraoperatively using closed-hole sizing block in 0.5 mm incremental size.
Results: There is a statistically significant correlation between the measured combined cross sectional area (semitendinosus and gracilis tendons) and 4S-STG autograft diameter (p = 0.023). An adequate autograft size (at least 7 mm) can be obtained when the combined cross sectional area is at least 15 mm2. There was no correlation with the anthropometric data except for thigh circumference (p = 0.037). Autograft size of at least 7 mm can be obtained when the thigh circumference is at least 41 mm.
Conclusions: Both combined cross sectional area (semitendinosus and gracilis tendons) and thigh circumference can be used to predict an adequate 4S-STG autograft size.