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17 pages, 6838 KiB

Open AccessArticle

The Speed of Pathogen Eradication May Prevent the Early Development of Cartilage Destruction: Case Series of Long-Term Follow-Up of Septic Arthritis (SA) after Anterior Cruciate Ligament Reconstruction (ACL-R) and Literature Review

by Michał Waszczykowski, Anna Fabiś-Strobin, Agnieszka Korczyc-Stępnicka, Krzysztof Małecki, Jerzy Białecki, Paweł Bartosz and Jarosław Fabiś

Appl. Sci. 2022, 12(22), 11679; https://doi.org/10.3390/app122211679 - 17 Nov 2022

Viewed by 1434

Abstract

Late diagnosis and treatment of septic arthritis (SA) after anterior cruciate ligament reconstruction (ACL-R) can lead to graft and cartilage damage. Pathogen eradication time may be the key to preventing the development of osteoarthritis. The purpose of this study was to evaluate the [...] Read more.

Late diagnosis and treatment of septic arthritis (SA) after anterior cruciate ligament reconstruction (ACL-R) can lead to graft and cartilage damage. Pathogen eradication time may be the key to preventing the development of osteoarthritis. The purpose of this study was to evaluate the effect of the proposed management of SA after ACL-R on knee function, pathogen eradication time and knee cartilage status on MRI. Five patients with acute knee SA after ACL-R were included in this study. All five patients underwent knee arthroscopic debridement with lavage and flow drainage with physiological saline with vancomycin. All five patients underwent clinical assessment, isokinetic examinations and MRI quantitative cartilage thickness evaluation at two follow-up points: at a mean of 10.9 years and at a mean of 18.1 years. Slight statistical differences in cartilage thickness on the medial femoral condyle were observed between the SA and control groups (2.077 mm and 2.237 mm, respectively; p = 0.021). There were no significant differences in cartilage thickness between the first and last follow-ups in the SA knees. The proposed treatment could lead to a faster eradication of infection, and thus protect against the early development of osteoarthritis. The quadriceps peak torque deficit may persist afterwards at a mean of 18.1 years follow-up. Full article

(This article belongs to the Special Issue Multicriterial Assessment of Ligament Healing in the Knee Joint)

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17 pages, 7462 KiB

Open AccessArticle

Evaluation of ACL Graft Remodeling and Prediction of Graft Insufficiency in Sequenced MRI—Two-Year Follow-Up

by Urszula Zdanowicz, Beata Ciszkowska-Łysoń, Marcin Paśnik, Michał Drwięga, Karol Ratajczak, Kamil Fulawka, Yoojin C. Lee and Robert Śmigielski

Appl. Sci. 2021, 11(11), 5278; https://doi.org/10.3390/app11115278 - 7 Jun 2021

Cited by 4 | Viewed by 4042

Abstract

Background: Postoperative magnetic resonance imaging (MRI) evaluation of anterior cruciate ligament (ACL) graft maturity is a useful and practical tool that allows for assessment of graft status and remodeling stage. The purpose of this study was to evaluate and compare previously described [...] Read more.

Background: Postoperative magnetic resonance imaging (MRI) evaluation of anterior cruciate ligament (ACL) graft maturity is a useful and practical tool that allows for assessment of graft status and remodeling stage. The purpose of this study was to evaluate and compare previously described methods of graft evaluation in MRI. We identify factors influencing the maturation and correlating graft appearance in MRI with indirect symptoms of graft insufficiency to identify patients at risk. Methods: Retrospective evaluation was performed in 44 patients who received bone patellar tendon bone (BPTB) ACL reconstruction with nine consecutive postoperative MRIs at 2, 6, 12, 18, 24, 36, 48, 72, and 96 weeks. Graft status was evaluated using signal-to-noise quotient (SNQ) methods in both sagittal and axial planes. We also assessed the homogeneity of the graft by standard deviation (SD) of signal intensity. SNQ was correlated with patient’s age, sex, postoperative weight-bearing, as well as indirect signs of graft insufficiency by MRI including graft appearance, posterior cruciate ligament (PCL) buckling, and measurement of anterior tibia subluxation. Results: We observed that the results of modelling SNQs from both sagittal and axial planes were similar. For both SNQs, the change over weeks quotient was nonlinear where the clinical parameter increased at week 36 and subsequently decreased. The SNQ at week 96 does not reach the levels from week 2. We observed that the model incorporating SNQ and relative SD (rSD) in the sagittal plane predicted the tibia anterior subluxation proportions better than the model with clinical parameters measured in the axial plane. Our results demonstrate that greater SD is associated with less graft homogeneity, which could indicate that this model is a good predictor of graft insufficiency. In addition, the proportion of PCL buckling increased over the course of the study. Conclusions: MRI graft evaluation is very useful for assessing graft ligamentization stage and to predict graft insufficiency. Full article

(This article belongs to the Special Issue Multicriterial Assessment of Ligament Healing in the Knee Joint)

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9 pages, 1641 KiB

Open AccessArticle

Platelet-Rich Plasma in Anterior Cruciate Ligament Quadriceps Tendon Bone Reconstruction—Impact of PRP Administration on Pain, Range of Motion Restoration, Knee Stability, Tibial Tunnel Widening and Functional Results

by Konrad Malinowski, Michał Ebisz, Robert F LaPrade and Marcin Mostowy

Appl. Sci. 2021, 11(9), 3993; https://doi.org/10.3390/app11093993 - 28 Apr 2021

Cited by 2 | Viewed by 2262

Abstract

Background: Using Platetet-Rich Plasma (PRP) in anterior cruciate ligament reconstruction (ACLR) has been suggested to improve patient outcomes. The aim of this study was to assess the impact of PRP administration on pain, range of motion (ROM) restoration and the functional results of [...] Read more.

Background: Using Platetet-Rich Plasma (PRP) in anterior cruciate ligament reconstruction (ACLR) has been suggested to improve patient outcomes. The aim of this study was to assess the impact of PRP administration on pain, range of motion (ROM) restoration and the functional results of ACLR performed with quadriceps tendon bone (QTB) autografts. Methods: A total of 106 patients were included in this multicenter study. Fifty-two patients underwent single-bundle QTB ACLR and 54 patients underwent the same procedure with additional PRP administration. Results: Mean time of need for on-demand analgesia was 8 days in the PRP group and 11 days in no-PRP group. Symmetric full extension was restored in a mean of 40 days in the PRP group and 53 days in the no-PRP group. Ninety degrees of flexion was restored at a mean of 21 days in the PRP group and 25 days in the no-PRP group. At 18 months postoperatively, the mean side-to-side difference in anterior tibial translation with the use of an arthrometer (Rolimeter, Aircast Europa) was 1.3 mm in the PRP group vs. 2.7 mm in the no-PRP group. Mean tibial tunnel widening was 1.4 mm in the PRP group vs. 2.1 mm in the no-PRP group. The mean score in the pain section of the KOOS scale was 93 in the PRP group vs. 89 in the no-PRP group. For the IKDC scale, 53 patients in the PRP group graded A or B and 1 patient graded C. In the no-PRP group, 48 patients graded A or B and 4 patients graded C or D. Conclusions: The use of PRP in QTB ACLR may decrease the need for on-demand analgesia and accelerate ROM restoration as well as improve knee stability, lessen the extent of tibial tunnel widening and potentially diminish pain at 18 months postoperatively. Further studies will be needed to confirm all authors’ conclusions. Full article

(This article belongs to the Special Issue Multicriterial Assessment of Ligament Healing in the Knee Joint)

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7 pages, 1935 KiB

Open AccessArticle

The PCL Envelope Lack Sign (PELS) Is a Direct Arthroscopic Sign of Chronic Posterior Cruciate Ligament Insufficiency

by Adrian Góralczyk, Marcin Mostowy, Michał Ebisz, Robert F. LaPrade, Aleksandra Sibilska, Krzysztof Hermanowicz, Marcin E. Domżalski and Konrad Malinowski

Appl. Sci. 2021, 11(8), 3608; https://doi.org/10.3390/app11083608 - 16 Apr 2021

Cited by 1 | Viewed by 3440

Abstract

Purpose: To present the arthroscopic “PCL envelope lack sign” (PELS) and to calculate its diagnostic characteristics in chronic PCL insufficiency. Methods: Recordings of knee arthroscopies performed in a single clinic between April 2015 to March 2020 were retrospectively evaluated, searching for the “PCL [...] Read more.

Purpose: To present the arthroscopic “PCL envelope lack sign” (PELS) and to calculate its diagnostic characteristics in chronic PCL insufficiency. Methods: Recordings of knee arthroscopies performed in a single clinic between April 2015 to March 2020 were retrospectively evaluated, searching for the “PCL envelope”. It was defined as a “soft tissue cuff coursing around the PCL tibial attachment, visible with the arthroscope positioned between the PCL, medial femoral condyle and posterior horn of the medial meniscus at the level of its shiny white fibers”. PELS was defined as “the PCL adhering to the proximal tibia adjacent to the medial meniscal posterior root attachment, inability to observe the normal space between the PCL and posterior tibia and no soft tissue cuff around the PCL tibial attachment”. Inclusion criteria were possibility to evaluate the PELS presence on recordings. Patients who underwent PCL reconstruction were assigned to the study group. The rest of the patients were controls. Criteria to operate on symptomatic PCL patients were at least 5 mm of posterior instability in physical examination and at least 6 months post-injury. Results: Out of 614 available recordings, 592 patients (205 females, 387 males; mean age 45.2 years, SD = 14.36, range 14–81) were included: 38 in the study group and 554 in the control group. In the study group, PELS was positive in 36 of 38 cases (94.7%). In the control group, PELS was negative in 554 PCL-efficient patients (100%). Calculated PELS sensitivity was 94.7%, specificity 100%, positive predictive value 100%, negative predictive value 99.6%. The PELS was present significantly more often in PCL-insufficient patients, p < 0.001. Conclusions: The PCL envelope lack sign was found to be a highly effective tool to arthroscopically confirm chronic PCL insufficiency, and should be considered a direct sign of chronic posterior knee instability. Full article

(This article belongs to the Special Issue Multicriterial Assessment of Ligament Healing in the Knee Joint)

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9 pages, 220 KiB

Open AccessArticle

by Paweł Bąkowski, Kinga Ciemniewska-Gorzela, Kamilla Bąkowska-Żywicka, Łukasz Stołowski and Tomasz Piontek

Appl. Sci. 2021, 11(8), 3494; https://doi.org/10.3390/app11083494 - 13 Apr 2021

Cited by 1 | Viewed by 1774

Abstract

Background: Patients with anterior cruciate ligament (ACL) injuries have poorer proprioception than people without such injuries. The effects of proprioceptive training on knee functionality and proprioceptive improvement after ACL reconstruction is still unclear. Methods: The research material consisted of 40 patients after ACL [...] Read more.

Background: Patients with anterior cruciate ligament (ACL) injuries have poorer proprioception than people without such injuries. The effects of proprioceptive training on knee functionality and proprioceptive improvement after ACL reconstruction is still unclear. Methods: The research material consisted of 40 patients after ACL reconstruction. Of the 40 patients, 20 of them were rehabilitated with a standard program and 20 with additional proprioceptive exercises. The subjective and the objective scores were evaluated. Results: No differences were found between the proprioceptive versus the conservative postoperative rehabilitation in the functional nor in the proprioception outcomes of the operated limbs. Conclusions: There is no advantage to function in doing proprioceptive rehabilitation exercises following the ACL reconstruction, when compared with a traditional strengthening program. Full article

(This article belongs to the Special Issue Multicriterial Assessment of Ligament Healing in the Knee Joint)

15 pages, 1922 KiB

Open AccessArticle

The Influence of Bone Bruises on Bone Tunnel Enlargement Regarding ACL Rupture

by Jolanta Rajca, Marek Gzik and Krzysztof Ficek

Appl. Sci. 2021, 11(6), 2482; https://doi.org/10.3390/app11062482 - 10 Mar 2021

Cited by 3 | Viewed by 2235

Abstract

Purpose: The purpose was to determine the impact of the size of bone bruises (BBs) on bone tunnel enlargement (BTE) occurrence. Materials and methods: Twenty-four (24) patients who underwent anterior cruciate ligament reconstruction (ACLR) were included in this retrospective study. The measurements of [...] Read more.

Purpose: The purpose was to determine the impact of the size of bone bruises (BBs) on bone tunnel enlargement (BTE) occurrence. Materials and methods: Twenty-four (24) patients who underwent anterior cruciate ligament reconstruction (ACLR) were included in this retrospective study. The measurements of BBs based on the initial MRI scan, bone tunnel size based on the control MRI scan, and the spatial determination of BB in relation to the bone tunnel location were evaluated. To analyze the relationship between BBs and BTE in homogeneous groups regarding the time from injury to ACLR (t(I-S)), the largest subgroup B (n = 15), in which t(I-S) was 31 to 60 days, was isolated for further investigation. Results: Based on subgroup B, a weak correlation (r = 0.33) existed between the BB volume and BTE size in the femur and tibia. Considering the relationship between the distance from the BB to the bone tunnel in the femur (f-l) and its enlargement (Δfd), there was a moderate and statistically significant (p < 0.05) negative correlation (r = −0.64). The correlation between those parameters was even stronger (r = −0.77) in subgroup B (time interval between injury and surgery ranged from 31 to 60 days). Conclusions: A retrospective analysis of MRI data in patients after ACL reconstruction surgery showed a relevant association between the distance from the BB to the bone tunnel and BTE in the femur. The relationship was not confirmed in the tibia. Full article

(This article belongs to the Special Issue Multicriterial Assessment of Ligament Healing in the Knee Joint)

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Review

Jump to: Research

14 pages, 428 KiB

Open AccessReview

Why Determining the Native Length Change Pattern of Medial Patellofemoral Ligament Is Still a Challenge: State-of-the-Art Review of Potential Sources of Heterogeneity within Studies Evaluating Isometry of MPFL

by Marcin Mostowy, Katarzyna Kwas, Kacper Ruzik, Magdalena Koźlak, Adam Kwapisz, Eva Brzezinska, Konrad Malinowski and Marcin E. Domżalski

Appl. Sci. 2021, 11(11), 4771; https://doi.org/10.3390/app11114771 - 22 May 2021

Cited by 2 | Viewed by 1755

Abstract

Background: In the literature there are divergent results as to the native MPFL length change pattern. The reason for such divergent results may be the heterogeneity of design of studies analyzing MPFL isometry. The hypothesis of this review was that studies assessing [...] Read more.

Background: In the literature there are divergent results as to the native MPFL length change pattern. The reason for such divergent results may be the heterogeneity of design of studies analyzing MPFL isometry. The hypothesis of this review was that studies assessing MPFL length change pattern are highly heterogenous. The aim was to present a state-of-the-art review of sources of this heterogeneity. Materials and Methods: A total of 816 records were identified through the initial search of MEDLINE and Scopus databases. After eligibility assessment, 10 original articles and five reviews were included. In the included studies, the following 15 potential sources of heterogeneity were assessed: number of patients/cadavers, age, males to females ratio (demographics), identification of measured fibers, measurement method, measurement precision, quadriceps muscle activity, iliotibial band activity, hamstrings activity (study design), patellar height, trochlear or patellar dysplasia, femoral anteversion, mechanical axis of the limb, tibial tubercle–trochlear groove distance, and condylar anteroposterior dimensions (morphology). Each variable was graded in every included article with 1 point if reported precisely and not introducing bias; or with 0 points if reported not precisely, introducing bias, or not reported at all. Results: Within original articles, the highest achieved score was 10 out of 15 possible points with mean score of 6.7, SD = 2.37, and minimum score of just 3 out of 15 points. In the demographics section, mean score was 2.4, SD = 0.8 (80% of maximum possible score of 3); in the study design section it was 3.1, SD = 1.87 (52% of maximum possible score of 6); and in the morphology section it was 1.5, SD = 1.43 (25% of maximum possible score of 6). Conclusions: There is high heterogeneity and incomplete reporting of potential sources of bias in studies assessing native MPFL length change pattern. Future investigators should be aware of the presented factors and their potential impact on MPFL isometry. All methodologic factors should be meticulously reported. Detailed description of demographic data is already a standard; however, authors should more extensively report variables concerning study design and morphology of patients’ patellofemoral joint. Furthermore, future studies should try to meticulously simulate the real-life working environment of MPFL and ensure usage of proper measurement methods. Full article

(This article belongs to the Special Issue Multicriterial Assessment of Ligament Healing in the Knee Joint)

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13 pages, 1888 KiB

Open AccessFeature PaperReview

Maturation of Anterior Cruciate Ligament Graft—Possibilities of Surgical Enhancement: What Do We Know So Far?

by Michał Ebisz, Adrian Góralczyk, Marcin Mostowy, Robert F. LaPrade and Konrad Malinowski

Appl. Sci. 2021, 11(8), 3597; https://doi.org/10.3390/app11083597 - 16 Apr 2021

Cited by 2 | Viewed by 2120

Abstract

The purpose of this study is to review the surgical methods of enhancing anterior cruciate ligament (ACL) graft maturation. Several methods of ACL maturation enhancement were identified through research of the literature available in the PubMed database. ACL remnant preservation was the most [...] Read more.

The purpose of this study is to review the surgical methods of enhancing anterior cruciate ligament (ACL) graft maturation. Several methods of ACL maturation enhancement were identified through research of the literature available in the PubMed database. ACL remnant preservation was the most extensively investigated technique. ACL reconstruction with a pedunculated hamstring graft provides superior revascularization of the graft along with higher mechanical strength. The usage of a graft enveloped with a periosteum was proposed to enhance the tendon-bone unit formation, and consequently, to prevent the bone tunnel widening. The muscle tissue on the graft is a potential source of stem cells. However, an excessive amount may weaken whole graft strength despite its enhanced remodeling. Similarly, amniotic tissue may augment the ACL reconstruction with stem cells and growth factors. Despite the existence of several surgical techniques that utilize amnion, the outcomes of these augmentation methods are lacking. Lastly, the intra-articular transplantation of the synovium on the surface of an ACL was proposed to augment the graft with synovial tissue and blood vessels. In conclusion, diverse approaches are being developed in order to enhance the maturation of an ACL reconstruction graft. Although these approaches have their foundation in on well-established scientific research, their outcomes are still equivocal. Clinical trials of high quality are needed to evaluate their utility in clinical practice. Full article

(This article belongs to the Special Issue Multicriterial Assessment of Ligament Healing in the Knee Joint)

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