Comprehensive injury-prevention training (plyometric, agility, balance, and core-stability exercises) has been shown to decrease sport-related injury. The relationship between trunk control and ...sport-related injury has been emphasized; however, the isolated effects of core-muscle training are unclear.
To investigate the effect of a simple 8-week core-muscle-training program on the neuromuscular control of the lower limb and trunk during jump landing and single-legged squatting.
Controlled laboratory study.
Laboratory.
Seventeen female collegiate basketball players were randomly divided into training (n = 9; age = 19.7 ± 0.9 years) and control (n = 8; age = 20.3 ± 2.5 years) groups.
The training group completed the core-muscle-training program in addition to daily practice, and the control group performed only daily practice. Kinematic and kinetic data during a drop-jump test and single-legged squat were acquired using a 3-dimensional motion-analysis system.
Three-dimensional hip, knee, and trunk kinematics; knee kinetics; and isokinetic muscle strength were measured at the pretraining and posttraining phases.
For the drop-jump test, the maximal trunk-flexion angle increased (
= .008), and peak knee-valgus moment (
= .008) decreased in the training group. For the single-legged squat, the peak trunk-flexion angle increased (
= .04), and the total amount of trunk lateral-inclination angle (
= .02) and peak knee-valgus moment (
= .008) decreased in the training group. We observed no changes in the control group.
A consecutive 8-week core-muscle-training program improved lower limb and trunk biomechanics. These altered biomechanical patterns could be favorable to preventing sport-related injuries.
Purpose
To elucidate whether sagittal graft tunnel affects the signal intensity in anatomical ACL reconstruction (ACLR) and to clarify the prevalence of intercondylar roof impingement. It was ...hypothesized that if the tunnel apertures are located within the anatomical footprint of ACL, tunnel position would not affect the signal intensity.
Methods
A total of 132 patients who underwent anatomical double-bundle ACLR (DB-ACLR) using hamstring autograft were recruited. Tunnel position was determined by the quadrant method on three-dimensional computed tomography; the femoral tunnel position was defined as “high and low” or “deep and shallow”, while that of the tibial side was defined as “anterior and posterior” or “medial and lateral”. Subjects were divided into three groups according to the tertile of % deep–shallow. The signal intensity was evaluated by the region of interest value of the antero-medial bundle (AMB) and postero-lateral bundle on magnetic resonance imaging at 12 months after reconstruction. Linear regression analysis was conducted to elucidate the relationship between the percentage position of each tunnel and the graft signal intensity.
Results
In the shallow tertile group, AMB signal intensity increased in the anterior position of the tibial tunnel (
β
= − 0.34;
P
= 0.025). In the intermediate and deep tertile groups, the tunnel position did not correlate with the signal intensity.
Conclusions
A more anterior tibial tunnel position increases AMB signal intensity in shallower femoral tunnel. Conversely, this correlation is attenuated for deeper femoral tunnels. Surgeons should pay attention to sagittal femoral tunnel position to create a more anterior tibial tunnel position.
Level of evidence
Level III.
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EMUNI, FSPLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Abstract
We investigated the prevalence of magnetic resonance imaging (MRI) findings and their relationship with knee symptoms in women without radiographic evidence of knee osteoarthritis (KOA). ...This cross-sectional cohort study included 359 Japanese women without radiographic evidence of KOA (Kellgren‒Lawrence grade < 2). All participants underwent T2-weighted fat-suppressed MRI of their knees. Structural abnormalities (cartilage damage, bone marrow lesions BMLs, subchondral cysts, bone attrition, osteophytes, meniscal lesions, and synovitis) were scored according to the whole-organ MRI score method. Knee symptoms were evaluated using the Knee Injury and Osteoarthritis Outcome Score. Participants were divided into early and non-KOA groups based on early KOA classification criteria. Logistic regression analysis was performed to evaluate the relationship between MRI abnormalities and knee symptoms. Cartilage damage was the most common abnormality (43.5%). The prevalences of cartilage damage, BMLs, subchondral cysts, bone attrition, meniscal lesions, and synovitis were higher in patients with early KOA than in those without. Synovitis (odds ratio OR 2.254,
P
= 0.002) and meniscal lesions (OR 1.479,
P
= 0.031) were positively associated with the presence of early KOA. Synovitis was most strongly associated with knee pain and might be a therapeutic target in patients with early KOA.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background:
Remnant-preserved anterior cruciate ligament (ACL) reconstruction was introduced to improve clinical outcomes and biological healing. However, the effects of remnant preservation and the ...influence of the delay from injury until reconstruction on the outcomes of this technique are still uncertain.
Purpose/Hypothesis:
The purposes of this study were to evaluate whether remnant preservation improved the clinical outcomes and graft incorporation of ACL reconstruction and to examine the influence of the delay between ACL injury and reconstruction on the usefulness of remnant preservation. We hypothesized that remnant preservation improves clinical results and accelerates graft incorporation and that its effect is dependent on the delay between ACL injury and reconstruction.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
A total of 151 consecutive patients who underwent double-bundle ACL reconstruction using a semitendinosus graft were enrolled in this study: 74 knees underwent ACL reconstruction without a remnant (or the remnant was <25% of the intra-articular portion of the graft; NR group), while 77 knees underwent ACL reconstruction with remnant preservation (RP group). These were divided into 4 subgroups based on the time from injury to surgery: phase 1 was <3 weeks (n = 24), phase 2 was 3 to less than 8 weeks (n = 70), phase 3 was 8 to 20 weeks (n = 32), and phase 4 was >20 weeks (n = 25). Clinical measurements, including KT-1000 arthrometer side-to-side anterior tibial translation measurements, were assessed at 3, 6, 12, and 24 months after reconstruction. Magnetic resonance imaging evaluations of graft maturation and graft-tunnel integration of the anteromedial and posterolateral bundles were assessed at 3, 6, and 12 months after reconstruction.
Results:
There was no difference in side-to-side anterior tibial translation between the NR and RP groups. There was also no difference in graft maturation between the 2 groups. Furthermore, the time from ACL injury until reconstruction did not affect graft maturation, except in the case of very long delays before reconstruction (phase 4). Graft-tunnel integration was significantly increased in both groups in a time-dependent manner. However, there was no difference between the NR and RP groups.
Conclusion:
Remnant preservation did not improve knee stability at 2 years after ACL reconstruction. Furthermore, remnant preservation did not accelerate graft incorporation, especially during the acute and subacute injury phases.
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FSPLJ, NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Background:
One of the goals of anterior cruciate ligament (ACL) reconstruction is a meniscal protective effect on the knee. Despite the advancement of ACL reconstruction techniques, subsequent ...meniscal tears after ACL reconstruction remain a problem, and the risk factors for recurring lesions are still unclear.
Purpose:
To investigate the incidence of subsequent meniscal surgery after primary ACL reconstruction without revision ACL surgery and to determine the risk factors associated with this reoperation.
Study Design:
Case series; Level of evidence, 4.
Methods:
Overall, 518 patients who underwent primary ACL reconstruction between 2004 and 2012 at one instution participated in this study. Data on body mass index, graft type and femoral tunnel-drilling technique of ACL reconstruction, and location and type of meniscal injury and its treatment at ACL reconstruction were collected from medical records. Clinical outcomes were investigated, including side-to-side difference of anterior laxity, pivot-shift grade, and subsequent meniscal surgery without ACL insufficiency (at minimum 2-year follow-up).
Results:
The prevalence of tears to the medial meniscus (MM) at the primary ACL reconstruction was 43.6% (226/518), 140 of which were repaired; on the contrary, tears of the lateral meniscus (LM) had a prevalence of 55.8% (289/518), 42 of which were repaired. At a mean 30.3 months (range, 8-124 months) after ACL reconstruction, 20 patients (3.9%; 14 MM tears, 3 LM tears, 3 MM + LM tears) required meniscal surgery without ACL reinjury or recurrence of instability. Of these, 14 MMs and 3 LMs had been repaired at primary ACL reconstruction. The failure rates of repaired MM and LM were 10.0% (14/140) and 7.1% (3/42), respectively. The failure rate of MM repair using the all-inside technique (6/36) was significantly higher compared with no treatment, inside-out repair, or partial resection (P = .045). In multiple regression analysis, the presence of MM injury at the time of ACL reconstruction (odds ratio OR, 7.81; P = .003), the side-to-side difference of postoperative anterior tibial translation (OR, 1.91; P = .032), and follow-up period after ACL reconstruction (OR, 1.02; P = .003) were risk factors of subsequent meniscal surgery after ACL reconstruction.
Conclusion:
Incidence of subsequent meniscal surgery after successful ACL reconstruction was <5%. Presence of MM tear at the time of ACL reconsturuction, small amount of increased anterior laxity, and long-term period after ACL reconstruction were predictive of subsequent meniscal surgery.
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FSPLJ, NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
To investigate synovitis' influence on early knee osteoarthritis (EKOA) by serum biomarkers and magnetic resonance imaging (MRI) findings in Japanese women. We enrolled 255 women aged 30-70 without ...radiographic abnormalities (Kellgren-Lawrence grade ≥ 2). Knee injury, OA outcome scores (KOOS), clinical examinations, and standing radiograph were used for classification criteria of EKOA. Participants were classified into normal knee group and EKOA group. All participants underwent MRIs of their right knee. The amount of effusion-synovitis volume was quantified. We compared serum matrix metalloproteinases-3 levels (MMP-3), high-sensitivity C-reactive protein, interleukin-6, and adiponectin between the groups. The relationship between synovitis and EOKA was investigated using multiple linear regression. Fifty-four participants (21%) were classified as EKOA. Serum MMP-3 concentration and effusion-synovitis volume were higher in patients with EKOA (p = 0.025 and p = 0.001, respectively). Effusion-synovitis volume negatively correlated with all KOOS subscales and positively correlated with serum MMP-3 concentration. Serum MMP-3 concentration was associated with effusion-synovitis volume β = 0.60, p < 0.001). There was mildly active but definitive synovitis in EKOA. This was an observational study so that no conclusions can be drawn regarding cause-effect for synovitis and symptoms. Future studies should conduct follow-up of participants with synovitis to assess the progression of knee OA.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Purpose
The concept of medial stabilizing technique total knee arthroplasty (MST-TKA) is to minimize the medial release without the superficial layer of medial collateral ligament (MCL). However, it ...is unclear at what stage the proper medial laxity is obtained during surgery. The purpose of this study was to investigate the implication of deep layer of MCL (dMCL) and osteophyte resection on medial laxity during MST-TKA.
Methods
A total of 103 consecutive patients who underwent cruciate-retaining TKA using the navigation system were included. The intraoperative hip–knee–ankle (HKA) angle was recorded under three conditions (no stress, valgus, and varus stress) at four time points after the resection of the anterior cruciate ligament (ACL) and meniscus (1st evaluation), after the dMCL release (2nd evaluation), and after osteophyte resection on both the femoral and tibial side (3rd evaluation). To assess valgus laxity, the differences in intraoperative HKA angle between 1st and 2nd evaluation (stage 1) and between 2nd and 3rd evaluation (stage 2) were calculated.
Results
Under the valgus stress condition, the intraoperative HKA angle change in stage 2 was significantly larger than that in stage 1 in full extension (stage 1; − 0.5 ± 1.0°, stage 2; − 2.0 ± 1.3°,
p
< 0.001) and 30° flexion (stage 1; − 0.8 ± 1.4°, stage 2; − 1.5 ± 2.0°,
p
= 0.008). There were no significant differences at 60° and 90° of knee flexion. Under the no stress and varus stress conditions, there were no significant differences in knee flexion at all angles.
Conclusion
The medial laxity during MST-TKA increased significantly more after dMCL release and osteophyte resection than after just dMCL release at full extension and 30° flexion, and it was, therefore, considered that osteophyte resection is a key procedure for a successful MST-TKA.
Level of evidence
Level II, therapeutic prospective cohort study.
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EMUNI, FSPLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose To observe the femoral anterior cruciate ligament (ACL) insertion macroscopically, histologically, and immunohistologically. Methods We used 20 embalmed cadaveric knees (mean age, 69.8 ± 5.3 ...years) for this study. The femoral ACL insertion was observed macroscopically, and areas were measured with digital calipers. The morphology of the ACL insertion was subsequently observed, and the areas were measured histologically and immunohistologically (stained for types I and III collagen). Finally, the macroscopic and microscopic measurements were compared. Results Macroscopically, in 16 knees, the proximal ACL fibers spread in a fanlike manner on the medial aspect of the lateral femoral condyle and the femoral insertion was oval. The lengths of the long and short axes of the insertion were 17.7 ± 2.7 mm and 4.6 ± 0.7 mm, respectively. Microscopically, the insertion was located just behind the lateral intercondylar ridge (resident's ridge) and could be divided into the direct and indirect insertions. The direct insertion was 5.3 ± 1.1 mm wide and did not continue to the posterior cartilage. The indirect insertion was located behind the direct insertion, and the posterior ACL fiber stained for type I collagen blended into the posterior cartilage on immunohistologic observations. Another bony ridge was found at the posterior margin of the direct insertion. The widths of the direct insertion were similar between microscopic and macroscopic measurements. Conclusions The femoral ACL insertion observed macroscopically corresponded to the direct insertion observed microscopically. The posterior portion behind the lateral intercondylar posterior ridge was the indirect insertion microscopically and appeared membrane-like macroscopically. Clinical Relevance Findings from observation of the lateral intercondylar posterior ridge during arthroscopy and consideration of the distance from the posterior cartilage border may contribute to surgeons' decisions about femoral tunnel placement during anatomic ACL reconstruction.
Purpose
A few new criteria for early detection and prevention of early knee osteoarthritis (EKOA) have been proposed. However, its prevalence, risk factors, relationship with function and prognosis ...have not been clarified. The purpose of this study was to investigate the prevalence of EKOA and its risk factors in the Japanese general population.
Methods
A total of 1104 volunteers (443 males, 661 females) who participated in the Iwaki cohort study in Japan were enrolled in this cross-sectional study. Their bilateral weight-bearing anterior–posterior knee radiographs were classified by Kellgren–Lawrence (KL) grade. EKOA (KL grade 0/1) was defined according to the following criteria: knee injury and osteoarthritis outcome score < 85%, joint line tenderness, and crepitus and its prevalence among age-sex groups was calculated. Logistic regression analyses were performed to determine the risk factors for EKOA.
Results
Eight hundred and twenty-two participants had KL grade 0/1, and the EKOA prevalence was 9.5% in males and 15.0% in females (
p
= 0.011). The prevalence of EKOA increased with age. The highest prevalence was noted in females aged 50–59 years. Logistic regression analysis showed that the risk factors for EKOA were age (
p
< 0.001, odds ratio (OR) 1.1), female sex (
p
= 0.002, OR 2.5), high body mass index (
p
< 0.001, OR 1.2), and history of knee injury (
p
< 0.001, OR 21.7).
Conclusions
The highest EKOA prevalence was observed in middle adult females (50–59 years old). The risk factors for EKOA were female sex, ageing, obesity and knee injury history, which were extremely similar to those of definitive knee osteoarthritis.
Level of evidence
Level I in diagnostic studies—investigating a diagnostic test.
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EMUNI, FSPLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The current trend in anterior cruciate ligament (ACL) reconstruction has shifted to anatomical double-bundle (DB) reconstruction, which reproduces both the anteromedial bundle (AMB) and the ...posterolateral bundle (PLB) of the ACL. Navigation systems have also been recently introduced to orthopedic surgical procedures, including ACL reconstruction. In DB-ACL reconstruction, the femoral and tibial tunnel positions are very important, but a representation of the ACL footprint under an arthroscopic view has not been established even though navigation systems have been introduced. The purpose of this study was to evaluate the anatomical footprints of both the AMB and the PLB using the representation method for application to arthroscopic DB-ACL reconstruction using a navigation system, and to evaluate the validity of the currently determined footprint position compared with other representation methods.
Thirty-six cadaveric knees were used for an anatomical evaluation of footprints of the AMB and PLB. On the tibial side, the ACL footprints were evaluated using an original method. On the femoral side, the ACL footprints were evaluated using Watanabe's method and three other methods: (1) the quadrant method, (2) Mochizuki's method, and (3) Takahashi's method.
The central points of the ACL footprints were represented almost constantly. The present data is in accordance with previous measurement data.
This study showed that the anatomical data of the ACL femoral and tibial footprints determined with Watanabe's method at the femoral side and our original method at the tibial side were both applicable to arthroscopic surgery with a navigation system.
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FZAB, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, UL, UM, UPUK, VKSCE, ZAGLJ
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