Comparison of suture anchor and simple suture for acute injury to lateral ankle ligament: mid-to long-term outcomes / 中华创伤骨科杂志

Objective:To compare the mid-to long-term clinical outcomes between suture anchor and simple suture for acute injury to lateral ankle ligament (cauda equina tear near the insertion).Methods:This retrospective study included 146 patients (professional and semi-professional athletes) who had been treated for acute injury to lateral ankle ligament (cauda equina tear near the insertion) at Department of Sports Medicine, The Third Hospital Affiliated to Peking University from June 2007 to May 2017.They were 101 males and 45 females, with an age of (27.1±10.3) years (from 12 to 62 years). Depending on ligament repair techniques, the patients were divided into a suture anchor group of 81 cases subjected to reconstruction of the torn ligament with a 1.8 mm suture anchor, and a simple suture group of 65 cases subjected to direct suture of the torn ligament with a braided thread. The 2 groups were compared in terms of visual analog scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and Tegner scores at preoperation and the last follow-up, time and level of postoperative motion recovery, proportion of limited joint motion, incidence of re-sprain and patient satisfaction.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). The mean follow-up duration was (46.1±14.1) months (from 36 to 132 months). The VAS pain score, AOFAS ankle-hindfoot score and Tegner score at the last follow-up were significantly improved than those before operation in all the patients ( P<0.05). Postoperatively, there was no significant difference between the 2 groups in VAS pain score, AOFAS ankle-hindfoot score, Tegner score, incidence of re-sprain or proportion of limited joint motion ( P> 0.05). The suture anchor group was significantly better than the simple suture group in the level of postoperative motion recovery (92%±13% versus 89%±13%) and time of postoperative motion recovery [(4.2±1.1) months versus (4.6±1.0) months] ( P<0.05). Conclusions:Ligament repair, either by suture anchor or by simple suture, is a reliable procedure for patients with high sports demands after severe acute injury to the lateral ankle ligament. Compared with simple suture, suture anchor may accelerate postoperative motion recovery to the pre-injury level.

Return to play after anterior cruciate ligament reconstruction / Retorno ao esporte após a reconstrução do ligamento cruzado anterior / Retorno al deporte después de reconstrucción del ligamento cruzado anterior

ABSTRACT The anterior cruciate ligament (ACL) tear represents more than half of all knee injuries in sports that involve body rotations and sudden changes of direction. Discharging the athlete for return to play (RTP) post-ACL reconstruction (ACLR) is a difficult task with multidisciplinary responsibility. For many years, a six-month period post-ACLR was adopted as the only criterion for RTP. However, it is now suggested that RTP should not be exclusively time-based, but to clinical data and systematic assessments. Despite the importance of post-ACLR factors for RTP, pre- and peri-ACLR factors must also be considered. Historically, ACLR is performed with the hamstring or autologous patellar tendons, although the choice of graft is still an open and constantly evolving theme. Anterolateral ligament reconstruction and repair of meniscal ramp tear associated with ACLR have recently been suggested as strategies for improving knee joint stability. Subjective questionnaires are easy to apply, and help identify physical or psychological factors that can hamper RTP. Functional tests, such as hop tests and strength assessment by means of isokinetic dynamometers, are fundamental tools for decision making when associated with clinical evaluation and magnetic resonance imaging. Recently, the capacity to generate force explosively has been incorporated into the muscle strength assessment. This is quantified through the rate of torque development (RTD). Due to characteristics inherent to the practice of sport, there is an extremely short time available for produce strength. Thus, RTD seems to better represent athletic demands than the maximum strength assessment alone. This review investigates the pre-, peri- and post-ACLR factors established in the literature, and shares our clinical practice, which we consider to be best practice for RTP. Level of evidence V; Specialist opinion.

RESUMO A ruptura do ligamento cruzado anterior (LCA) representa mais da metade das lesões do joelho em esportes que envolvem rotações e mudanças repentinas de direção. A liberação do atleta para o retorno ao esporte (RAE) depois da reconstrução do LCA (RLCA) é uma tarefa difícil, de responsabilidade multidisciplinar. Por muitos anos, o período de seis meses pós-RLCA foi utilizado como único critério para RAE. Contudo, atualmente, sugere-se que o RAE não deve estar atrelado exclusivamente ao tempo, mas a dados clínicos e avaliações sistemáticas. Apesar da importância dos fatores pós-RLCA para o RAE, os fatores pré- e peri-RLCA também devem ser contemplados. Historicamente, a RLCA é realizada com tendões isquiotibiais ou patelares autólogos, apesar da escolha do enxerto ainda ser um tema em aberto e em constante evolução. Recentemente, a reconstrução do ligamento anterolateral e o reparo da lesão na rampa meniscal associadas à RLCA têm sido sugeridas como estratégias para melhorar a estabilidade articular do joelho. Questionários subjetivos são de fácil aplicação e ajudam a identificar fatores físicos ou psicológicos que possam dificultar o RAE. Testes funcionais como os hop tests e a avaliação de força com dinamômetros isocinéticos são ferramentas fundamentais na decisão quando aliadas à avaliação clínica e de ressonância magnética. Recentemente, tem-se incorporado ao escopo de avaliação da força muscular a capacidade de gerar força de maneira explosiva, mensurada através da taxa de desenvolvimento de torque (TDT). Devido a características inerentes a prática esportiva os tempos disponíveis para produção de força são demasiadamente pequenos e, sendo assim, a TDT parece representar melhor as demandas esportivas do que a avaliação isolada de força máxima. Nesta revisão, foram reunidos fatores pré, peri e pós-RLCA estabelecidos na literatura, assim como foi compartilhada nossa prática clínica, que consideramos ser a melhor para o RAE. Nível de evidência V; Opinião do especialista.

RESUMEN La ruptura del ligamento cruzado anterior (LCA) representa más de la mitad de las lesiones de rodilla en deportes que involucran rotaciones y cambios repentinos de dirección. La liberación del atleta para el retorno al deporte (RAD) después de la reconstrucción del LCA (RLCA) es una tarea difícil, de responsabilidad multidisciplinaria. Durante muchos años, el período de seis meses post-RLCA fue usado como único criterio para RAD. Sin embargo, actualmente, se sugiere que el RAD no debe estar vinculado exclusivamente al tiempo, sino a datos clínicos y evaluaciones sistemáticas. A pesar de la importancia de los factores post-RLCA para el RAD, también deben ser contemplados los factores pre y peri-RLCA. Históricamente, la RLCA es realizada con tendones isquiotibiales o patelares autólogos, a pesar de que la elección del injerto aún sea un tema abierto y en constante evolución. Recientemente, la reconstrucción del ligamento anterolateral y la reparación de la lesión en la rampa meniscal asociadas a la RLCA han sido sugeridas como estrategias para mejorar la estabilidad articular de la rodilla. Los cuestionarios subjetivos son de fácil aplicación y ayudan a identificar los factores físicos o psicológicos que pueden dificultar el RAD. Los tests funcionales como los hop tests y la evaluación de fuerza con dinamómetros isocinéticos son herramientas fundamentales en la decisión cuando se combinan a la evaluación clínica y de resonancia magnética. Recientemente, se ha incorporado al alcance de evaluación de la fuerza muscular, la capacidad de generar fuerza de manera explosiva, medida a través de la tasa de desarrollo de torque (TDT). Debido a características inherentes a la práctica deportiva, los tiempos disponibles para producción de fuerza son demasiado pequeños y, siendo así, la TDT parece representar mejor las demandas deportivas que la evaluación aislada de fuerza máxima. En esta revisión fueron reunidos factores pre, peri y post-RLCA establecidos en la literatura, así como fue compartida nuestra práctica clínica, que consideramos la mejor para el RAD. Nivel de evidencia V; Opinión del especialista.

Retorno deportivo luego de reconstrucción primaria de ligamento cruzado anterior con injerto hueso-tendón patelar-hueso autólogo: análisis de factores relacionados / Return to play after anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: analysis of related factors

OBJECTIVE: Analyze return to sports and related factors after primary anterior cruciate ligament reconstruction. METHODS: Observational descriptive study. 173 patients operated by the same surgeon and standardized technique (patellar autograft) who answered a questionnaire at least 12 months post procedure were included. Questionnaire included Subjective IKDC, Tegner activity level (Pre and Postoperative) and questions elaborated by the group. RESULTS: Mean age was 30.8 years, 85% were men, 73% practiced soccer and median postoperative IKDC was 71. Follow up until questionnaire response was 28 months. Males had a better return to sports than females (70% vs 48%, p » 0.037). Tegner preinjury level was 5 vs 4.3 postoperative, (p < 0.001). Return to sports was 67% according to Tegner scale and 66% by self-assessment. Return to similar previous activity level was 57% by Tegner scale but 24% by direct questions. Of those patients, 51% have fear of reinjury and 26% by reasons other than knee or surgery. We didn't find association between meniscal injuries and return to sports rate. Patients with chondral injuries had lower rates in return to sports (35% vs 60%, p » 0.002). Subjects that returned to sports had higher IKDC scores (73.5 vs 64.3, p < 0.001). CONCLUSIONS: We found 67% return to sports and 57% to the preinjury level. Positive return to sports factors were male sex, absence of chondral injury and better functional outcome. Psychological factors such as fear of injury is frequent in patients who don't achieve previous levels of activity.

OBJETIVOS: Analizar el retorno deportivo y factores asociados tras la reconstrucción primaria de ligamento cruzado anterior (LCA). MÉTODOS: Estudio observacional descriptivo. Se incluyeron 173 operados entre 2014 y 2017 por el mismo cirujano, los cuales contestaron un cuestionario al menos 12 meses después de la cirugía. El cuestionario incluye IKDC subjetivo, Tegner activity level (pre y post operatorio) y preguntas de elaboración propia. RESULTADOS: La edad promedio es 30,8 años, el 85% son hombres, el 73% practicaba fútbol y la mediana del IKDC fue 71. La media de meses hasta responder el cuestionario fue de 28 meses. Tegner pre-lesión promedio fue de 5 vs 4,3 postoperatorio, p < 0,001. Según la escala Tegner el 57% retorna al mismo nivel previo, sin embargo, de acuerdo con el cuestionario propio solo el 24% lo haría. De ese subgrupo, el 51% tiene temor a lesionarse de nuevo y el 26% reporta razones no relacionadas a la rodilla. No encontramos asociación entre lesiones meniscales y la tasa de retorno. Aquellos que retornan tienen menor prevalencia de lesiones condrales (35% vs 60%, p » 0,002). Los pacientes que retornaron tuvieron un IKDC superior (73,5 vs 64,3, p < 0,001). El sexo masculino tiene una tasa de retorno de 70% vs 48% de su contraparte femenina (p » 0,037). CONCLUSIONES: El 67% retorna al deporte y el 57% lo hace al mismo nivel. Factores positivos relacionados al retorno fueron sexo masculino, ausencia de lesión condral y mejor resultado funcional. Factores psicológicos con el miedo a lesionarse de nuevo son frecuentes en pacientes que no recuperan el nivel previo.

Predictors for Anterior Cruciate Ligament (ACL) Re-injury after Successful Primary ACL Reconstruction (ACLR)

@#Introduction: Few authors have addressed risk factors related to an ipsilateral graft rupture and contralateral anterior cruciate ligament (ACL) injury after return to sports (RTS) following primary ACL reconstruction. 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.

Return to play after anterior cruciate ligament reconstruction among amateur soccer players / Volver a jugar después del ligamento cruzado anterior reconstrucción entre futbolistas aficionados

OBJECTIVE: The aim of the present study is to assess the return to play among amateur soccer league players after anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHOD: The surgical protocols of ACL reconstruction surgeries performed in a sports medicine clinic from July 1st, 2013, to June 30th, 2014, were included in the study. Only the charts of amateur soccer league players who played once or twice a week were selected. The follow-up time was calculated as the number of months between surgery and the telephone survey. At the follow-up, the current status of the soccer playing was recorded. Those patients who were no longer playing in a team were asked what kind of sport they were currently practicing, as well as the main reason for not returning to team playing. RESULTS: A total of 61 (25.6%) patients met the inclusion criteria. The mean follow-up time was of 22.4 3.4 months. At the follow-up, 30 (49.1%) patients were playing in amateur soccer teams. Among the patients who were no longer playing in a team, 19 (61.2%) were playing soccer occasionally, 11 (35.4%) were practicing other sports, and 1 developed a sedentary life style. The reasons for not returning to team playing were: fear of reinjury in 26%; knee symptoms in 26%; lack of confidence in the knee in 23%, family or job commitments in 23%; and not being eligible to participate in competitive sports in 2%. CONCLUSION: After an average of two years of ACL reconstruction, only half of the amateur soccer league players return to play.

Return to Sports Following Rotator Cuff Repair: A Systematic Review and Meta-Analysis / 대한스포츠의학회지

PURPOSE: Given the increasing common use of rotator cuff repair (RCR), return to sport (RTS) remains an important challenge and measure of success for athletes undergoing RCR. To determine the rate of return to the same level of sports after repair of rotator cuff tears.METHODS: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature. The electronic databases of PubMed, Embase, Cochrane Library, and Scopus were used for the literature search. Study quality was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) checklist. Studies evaluating the rate of return to the same level of sports after repair of partial- or full-thickness rotator cuff tears were included.RESULTS: Ten studies were reviewed, including 357 patients who were treated with RCR and who had a mean follow-up of 48.1 months (range, 16–74 months). The overall rate of RTS was 88.6%. Among them, 77.9% (95% confidence interval [CI], 67.1%–86.0%) of patients were able to return to the same level of sports according to the meta-analysis. Subgroup meta-analysis revealed that partial-thickness rotator cuff tear was 77.9% (95% CI, 70.0%–84.1%), and full-thickness was 69.6% (95% CI, 46.3%–85.9%), but there was no statistical significance (p>0.05).CONCLUSION: Most patients (88.6%) were able to return to sports after RCR and 78% of patients return to sports at the same level of play as before their injury.

The Timing of Return to Sports after Anterior Cruciate Ligament Reconstruction in Elite Athletes: A Study Based on Isokinetic Knee Muscle Strength and Multiple Hop Tests / 中国运动医学杂志

Objective To compare the knee function recovery at different times of returning to sport after anterior cruciate ligament reconstruction(ACLR) among elite athletes using knee isokinetic muscle strength test and various hop test.Methods Forty-one elite athletes(14 males,27 females,mean age 22.6 ± 4.1 years) undergoing ACLR between January 2013 and September 2014 were chosen from the database of the National Institute of Sports Medicine and Shanghai Huashan Hospital.Rehabilitation was performed using the same protocol by professional physiotherapists and trainers,who recorded the time of returning to sport of each athlete.One week prior to the scheduled return,bilateral knee isokinetic muscle strength test(test value:peak torque;angle velocity:60°/s,180°/s;motion:flexion,extension) and four hop tests(single hop for distance,side-to-side hop,up-down hop and 8 hop) were applied with the limb symmetry index(LSI) calculated.The athletes were then grouped by their returntime referring to surgery into the premature group(6～8 months),timely return group(9～12 months) and delayed group(over 12 months).The tests results were recorded and compared among the three groups.Results Fourteen athletes were selected into the premature group,with 19 in the timely group and 8 in the delayed group.The average LSI of 60°/s flexion peak torque of the premature group (87.4％ ± 7.5％) was significantly lower than the timely group(95.8％ ± 6.6％) and the delayed group(96.0％ ± 2.4％) (P＜0.01).Significant differences were observed between the premature group and delayed group regarding the 60° extension peak torque(85.8％ ± 9.4％ and 94.8％ ± 4.8％,P＜0.05),180°/s flexion peak torque(90.7％ ± 8.7％ and 101.4％ ± 6.8％,P＜0.05),and 180°/s extension peak torque (90.6％ ± 5.2％ and 97.8％ ± 5.6％,P＜0.05).The average LSL of the premature group at single hop for distance,side-to-side hop and up-down hop(93.A％ ± 8.5％,84.7％ ± 7.3％ and 112.5％ ± 5.7％) was significantly lower than that of the timely group(95.7％ ± 6.0％,104.2％ ± 4.3％ and 105.3％ ± 7.9％) and the delayed group regarding(98.1％ ± 1.9％,104.7％ ± 4.0％ and 106.3％ ± 7.4％) (P＜0.01 for all).The relative peak torque of 60°/s extension of the premature group(2.48 ± 0.58 Nm/kg) was significantly lower than the delayed group(3.21 ± 0.51 Nm/kg) (P＜0.01).Conclusions For elite athletes,returning to sport within 9 months after ACLR results in insufficient restoration of the knee function.Delayed return to sport doesn't improve the outcomes of hop tests,but can enhance the maximum extension torque peak,which needs further study.

Influencia de la reconstrucción del ligamento cruzado anterior sobre la calidad de vida, nivel de confianza y retorno al deporte: un seguimiento de 15 años / Influence of anterior cruciate ligament reconstruction on quality of life, level of confidence and return to sports: a follow-up of 15 years

Antecedentes: la articulación de la rodilla es una de las más afectadas y lesionadas, siendo la lesión del ligamento cruzado anterior (ACL) la más frecuente entre ellas, alcanzando aproximadamente el 79% de todas las lesiones de rodilla. Esta lesión, cuando involucra atletas, causa compromisos físicos, fisiológicos y especialmente psicológicos, considerando la alta tasa de incidencia o lesión contralateral después de regresar al deporte. Este compromiso a veces aleja al atleta del deporte, o disminuye su rendimiento. Toda esta limitación o deterioro afecta directamente la calidad de vida de los atletas. Caso clínico: en el presente estudio se realizó seguimiento de una atleta femenina de balonmano durante 15 años, que fue sometida a 3 reconstrucciones del LCA, para evaluar el deterioro físico, funcional y psicológico que estas cirugías causaron a lo largo de los años. Con-clusión: se comprobó que el paciente se alejó por completo de las actividades posteriores a las cirugías, además de haber desarrollado un severo proceso de artrosis como consecuencia de un importante déficit muscular.

Background information: the knee joint is one of the most affected and injured joints in the body, with the Anterior Cruciate Ligament (ACL) injury being the most common (about 79%). Howe-ver, when this injury involves athletes, not only does it cause physical damage, but physiological and, particularly, psychological as well, as it has a high recurrence rate or provokes a contralateral injury after returning to sports. This damage sometimes steers the athlete away from sports al-together, or performance decreases. Hence, these limitations or impairments directly affect the athletesÍ´ quality of life. Case report: in this study, monitoring or a follow up of a female handball athlete who had to undergo three reconstructions of the ACL was carried for 15 years in order to evaluate the physical, functional and psychological impairment that these surgeries caused over the years. Conclusion: it can be verified that the patient completely steered away from sports activities after the surgeries and developed a severe arthrosis process as a consequence of serious muscular deficit.