Long-Term Examination of Bone Mineral Density in the Calcanei After Anterior Cruciate Ligament Reconstruction in Adolescents and Matched Adult Controls.

PURPOSE: The aims were to evaluate the results 10 to 20 years after anterior cruciate ligament (ACL) reconstruction performed in adolescents in terms of bone mineral density (BMD) in the calcanei using the dual-energy x-ray absorptiometry (DXA) technique, activity level, and quality of life. METHODS: A case-control study of adolescents who underwent ACL reconstruction between 1992 and 2002 was performed. The inclusion criterion was a unilateral ACL injury. The exclusion criteria were bilateral ACL injury, contralateral ACL reconstruction, posterior cruciate ligament injury, and previous or present fractures of either lower extremity. The BMD was measured in both calcanei using the DXA technique and compared with a control group of adult ACL-reconstructed patients and with a DXA reference database. The age of the control group was similar to that of the patient group at the time of BMD assessment, performed 60 months after reconstruction. Activity was measured with the Tegner activity scale. The EQ-5D was used to evaluate quality of life. RESULTS: Thirty-two adolescents (11 boys and 21 girls), aged 12 to 16 years, with a symptomatic unilateral ACL rupture, underwent reconstruction at near skeletally mature age. Of these patients, 29 (91%) took part in the follow-up examination. The BMD values for the male patients were lower on the injured and non-injured sides (-15.2% [P = .02] and -11.8% [P = .05], respectively) compared with the control group. The values for the female patients were -0.8% (P = .84) and -2.2% (P = .69), respectively. Correspondingly, the BMD values for the male patients were lower on the injured and non-injured sides (-8.2% and -4.9%, respectively) compared with the male reference database. The BMD values for the female patients were higher on the injured and non-injured sides (4.1% and 4.3%, respectively) compared with the female reference database. In the control group, female patients had a significantly lower value for the Tegner activity scale preoperatively (median, 2.0; range, 0 to 5) than the female patients in the study group (median, 3.0; range, 2 to 8) (P = .006). In the study group, the Tegner activity scale at follow-up showed a significant correlation with the BMD on the injured side for male patients (ρ = 0.67, P = .03) but not on the non-injured side (ρ = 0.50, P = .14). In the control group, the Tegner activity scale at follow-up showed a significant correlation with the BMD on the non-injured side for female patients (ρ = 0.61, P = .03) but not on the injured side (ρ = 0.34, P = .25). The Tegner activity scale and EQ-5D showed no significant differences between the study groups. CONCLUSIONS: In the long-term, the BMD in the calcanei of patients who were adolescents at the time of ACL reconstruction differed from that of a control group and a reference database. This study indicates that boys with an ACL injury and subsequent ACL reconstruction run a subsequent risk of a significantly lower BMD in their calcanei as adults and, consequently, an increased future fracture risk. LEVEL OF EVIDENCE: Level III, case-control study.

Long-term clinical and radiographic results after delayed anterior cruciate ligament reconstruction in adolescents.

BACKGROUND: The risk of further intra-articular damage associated with nonoperative or delayed anterior cruciate ligament (ACL) reconstruction must be considered against the risk of growth disturbance with early reconstruction and transphyseal drilling. Long-term follow-ups after the surgical treatment of ACL injuries in adolescents are rare. PURPOSE: To evaluate results 10 to 20 years after ACL reconstruction in terms of the radiographic presence of osteoarthritis, clinical assessments, and health-related quality of life in patients who were adolescents at the time of surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-two adolescents (mean age, 15.2 years [range, 12-16 years]; 11 boys, 21 girls), with a symptomatic unilateral ACL rupture, underwent reconstruction using bone-patellar tendon-bone (n=10) or hamstring tendon (n=22) autografts at an almost skeletally mature age according to Tanner stage 4. Twenty-nine patients (91%) underwent clinical, radiographic, and health-related quality of life assessments after 10 to 20 years (mean, 175 months). RESULTS: The mean time between the injury and index surgery was 11.6 months. The reconstructed knee had significantly more osteoarthritic changes compared with the noninvolved contralateral knee (P=.001). Preoperatively, the median Tegner activity level was 4 (range, 2-8), and the median Lysholm knee score was 75 (range, 50-90) points. At follow-up, the respective median values were 4 (range, 1-7) and 84 (range, 34-100) points (P=not significant [preoperatively vs follow-up]). The median finding for the single-legged hop test was 84% (range, 0%-105%) preoperatively and 93% (range, 53%-126%) at follow-up (P=.01). At follow-up, muscle strength measurements displayed more than 90% of the noninvolved leg in both extension and flexion. The manual Lachman test result was significantly improved at follow-up compared with preoperatively (P<.001). The 36-item Short Form Health Survey (SF-36) revealed scores comparable with those of healthy controls. The mean EuroQol (EQ-5D) score was 0.86±0.12. The Knee injury and Osteoarthritis Outcome Score (KOOS) values were lower in all dimensions compared with age-matched healthy controls. CONCLUSION: In the long term, patients who were adolescents at the time of ACL reconstruction revealed significantly more radiographically visible osteoarthritic changes in their operated knee than in their noninvolved contralateral knee. Clinical outcomes and health-related quality of life are comparable with those of healthy controls.

An adaptive alignment algorithm for quality-controlled label-free LC-MS.

Label-free quantification using precursor-based intensities is a versatile workflow for large-scale proteomics studies. The method however requires extensive computational analysis and is therefore in need of robust quality control during the data mining stage. We present a new label-free data analysis workflow integrated into a multiuser software platform. A novel adaptive alignment algorithm has been developed to minimize the possible systematic bias introduced into the analysis. Parameters are estimated on the fly from the data at hand, producing a user-friendly analysis suite. Quality metrics are output in every step of the analysis as well as actively incorporated into the parameter estimation. We furthermore show the improvement of this system by comprehensive comparison to classical label-free analysis methodology as well as current state-of-the-art software.

Health-related quality of life after anterior cruciate ligament reconstruction.

PURPOSE: Recently the patients' own evaluation has become an important complement to post-operative clinical assessments. For many patients, there is a change in life situation after an anterior cruciate ligament reconstruction (ACL), which may affect the health-related quality of life in many ways. The aims of the study were to evaluate the results in terms of health-related quality of life 2-7 years after an ACL reconstruction and to compare the results with a gender- and age-matched control group. Furthermore, to compare the results for males and females using either the bone-patellar tendon-bone autograft (BPTB) or hamstring tendon autograft (HT). METHODS: The SF-36 questionnaire was send by mail to 793 consecutive patients after an ACL reconstruction. Five hundred and forty-four (69%) patients returned the questionnaires leaving 419 patients (161 female, 258 male) who were analysed and matched to a Swedish control group (n = 2,410). RESULTS: The patient group obtained significantly higher scores for General Health (GH), Social Function (SF), Role Emotional (RE) and Mental Health (MH). The control group obtained significantly higher scores for Physical Function (PF) compared with the total ACL group and with the BPTB and HS subgroups. There were no significant differences between males and females. CONCLUSION: After ACL reconstruction, the patients reported good health-related quality of life in comparison with a matched sample of the general population. To incorporate non-disease-specific health assessment measures are important to further refine the disease-specific outcome measurements to evaluate the effect of the treatments and provide cost-effective treatment algorithms.

The proteios software environment: an extensible multiuser platform for management and analysis of proteomics data.

Proteome analysis involves many steps that generate large quantities of data in different formats. This creates a need for automatic data merging and extraction of important features from data. Furthermore, metadata need to be collected and reported to enable critical evaluation of results. Many data analysis tools are developed locally in research laboratories and are nontrivial to adapt for other laboratories, preventing optimal exploitation of generated data. The proteomics field would benefit from user-friendly analysis and data management platforms in which method developers can make their analysis tools available for the community. Here, we describe the Proteios Software Environment (ProSE) that is built around a Web-based local data repository for proteomics experiments. The application features sample tracking, project sharing between multiple users, and automated data merging and analysis. ProSE has built-in support for several quantitative proteomics workflows, and integrates searching in several search engines, automated combination of the search results with predetermined false discovery rates, annotation of proteins and submission of results to public repositories. ProSE also provides a programming interface to enable local extensions, as well as database access using Web services. ProSE provides an analysis platform for proteomics research and is targeted for multiuser projects with needs to share data, sample tracking, and analysis result. ProSE is open source software available at http://www.proteios.org .