ObjectiveTo clarify the intervention guidance of return to sports WeChat applet and evaluate the rehabilitation effectiveness after anterior cruciate ligament (ACL) reconstruction. MethodsBetween September 2020 and September 2022, 80 patients who met the selection criteria and underwent ACL anatomical single bundle reconstruction were selected as the research objects. According to the double-blind random method, they were divided into the applet group and the regular group, with 40 cases in each group. Patients in the applet group were rehabilitated under the guidance of the return to sports WeChat applet, and the patients were asked to perform the test once a month after operation, including patients’ subjective scores [Tegner score, knee injury and osteoarthritis outcome score (KOOS), International Knee Documentation Committee (IKDC) score, American Hospital for Special Surgery (HSS) score], psychological assessment [ACL recovery sports injury scale (ACL-RSI) score], jumping test, balance test, bending angle test. Patients in the regular group were followed up by doctors and nurses regularly by telephone every month. All the patients were reexamined at 3, 6, 9, and 12 months after operation, and the range of motion of the knee joint with 6 degrees of freedom (flexion and extension angle, varus and valgus angle, internal and external rotation angle, anteroposterior displacement, superior and inferior displacement, and internal and external displacement) recorded by Opti_Knee three-dimensional knee joint motion measurement gait analysis system was observed. The anterior tibial translation difference (ATTD) was measured by Ligs knee measuring instrument when a forward thrust of 120 N was applied to the posterior part of the proximal tibia. Tegner score, IKDC score, KOOS score (including KOOS-Pain score, KOOS-Symptoms score, KOOS-Activities of daily living score, KOOS-Sport score, and KOOS-Quality of life score), HSS score, ACL-RSI score, jumping ability, balance ability, patients’ satisfaction with the rehabilitation process, and ACL healing grading according to ACL continuity and signal intensity shown by MRI. Results There were significant differences in various indicators between different time points after operation in the two groups (P<0.05). At 3 months after operation, except that the ACL-RSI score of the applet group was significantly higher than that of the regular group (P<0.05), there was no significant difference in the other indicators between the two groups (P>0.05). At 6 months after operation, the ACL-RSI score, IKDC score, Tegner score, KOOS scores of different items, HSS score, balance and jumping ability of the applet group were significantly higher than those of the regular group (P<0.05), and there was no significant difference in the other indicators between the two groups (P>0.05). At 9 months after operation, there was no significant difference in all indicators between the two groups (P>0.05). At 12 months after operation, 27 cases (67.5%) in the applet group and 21 cases (52.5%) in the regular group returned to sport, with a significant difference of the return to sports incidence between the two groups [RR(95%CI)=1.50 (1.00, 2.25), P=0.049]. In the applet group, 27 cases were very satisfied with the rehabilitation process, 10 cases were satisfied, 2 cases were basically satisfied, and 1 case was not satisfied, while 19, 13, 5, and 3 cases in the regular group, respectively. The satisfaction degree of the applet group was significantly better than that of the regular group (P=0.049). MRI examination of the two groups showed that the ACL was continuous without secondary rupture or necrosis. The ACL healing grade of the applet group was 31 cases of grade 1 and 9 cases of grade 2, and that of the regular group was 28 cases of grade 1 and 12 cases of grade 2, there was no significant difference in ACL healing grade between the two groups (P=0.449). ConclusionThe application of return to sports WeChat applet in the rehabilitation of patients after ACL reconstruction can significantly reduce the fear of return to sports and improve the rate of return to sports. The return to sports WeChat applet is convenient to operate, with high utilization rate and high patient compliance, which significantly improves the satisfaction.
Objective To summarize the evaluation methods of return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR) in recent years, in order to provide reference for clinical practice. Methods The literature related to the RTS after ACLR was searched from CNKI, Wanfang, PubMed, and Foreign Medical Information Resources Retrieval Platform (FMRS) databases. The retrieval range was from 2010 to 2023, and 66 papers were finally included for review. The relevant literature was summarized and analyzed from the aspects of RTS time, objective evaluation indicators, and psychological evaluation. Results RTS is the common desire of patients with ACL injury and doctors, as well as the initial intention of selecting surgery. A reasonable and perfect evaluation method of RTS can not only help patients recover to preoperative exercise level, but also protect patients from re-injury. At present, the main criterion for clinical judgement of RTS is time. It is basically agreed that RTS after 9 months can reduce the re-injury. In addition to time, it is also necessary to test the lower limb muscle strength, jumping, balance, and other aspects of the patient, comprehensively assess the degree of functional recovery and determine the different time of RTS according to the type of exercise. Psychological assessment plays an important role in RTS and has a good clinical predictive effect. ConclusionRTS is one of the research hotspots after ACLR. At present, there are many related evaluation methods, which need to be further optimized by more research to build a comprehensive and standardized evaluation system.
ObjectiveTo observe the effect of preserving tibial residual fibers on the expressions of ligament remodeling related genes in rabbit anterior cruciate ligament (ACL) reconstruction model. MethodsSixty healthy adult New Zealand white rabbits were randomly divided into 4 groups:normal control group (group A, n=6) , sham-operation group (group B, n=18) , non tibial remnant preserved group (group C, n=18) , and tibial remnant preserved group (group D, n=18) . At 2, 6, and 12 weeks after operation, the ligament tissue was harvested to detect the mRNA expressions of collagen type 1A1(COL1A1) , collagen type 3A1(COL3A1) , transforming growth factor β1(TGF-β1), vascular endothelial growth factor (VEGF), growth-associated protein 43(GAP-43) , and neurotrophin 3(NT-3) by real-time fluorescent quantitative PCR. ResultsAt each time point, there was no significant difference in the mRNA expressions of COL1A1, COL3A1, VEGF, and NT-3 between group A and group B (P>0.05) . In group D, the mRNA expressions of COL1A1, COL3A1, TGF-β1, and GAP-43 significantly increased when compared with those of group C at 6 weeks after operation (P＜0.05) ; an increased level of VEGF mRNA was also detected in the group D at 12 weeks after operation (P＜0.05) ; and an increased level of NT-3 mRNA was also observed in group D at 2 and 12 weeks after operation (P＜0.05) . ConclusionThere is a time-dependent manner of angiogenesis-promoting, repair-related, and nerve-related gene expressions after ACL reconstruction with preserving tibial residual fibers during the process of ligamentization. Furthermore, the remnant preservation in ACL reconstruction can promote the expressions of related genes in some time points.
ObjectiveTo compare the effectiveness of the arthroscopic anterior cruciate ligament (ACL) reconstruction with the transtibial technique and through anteromedial approach. MethodsBetween April 2008 and May 2012, 86 patients (86 knees) with ACL rupture underwent single bundle reconstruction with autogeneic hamstring tendons with the transtibial technique in 44 cases (group A) and through anteromedial approach in 42 cases (group B). There was no significant difference in age, gender, injury causes, injury to admission time, preoperative International Knee Documentation Committee (IKDC) score, and Lysholm score between 2 groups (P>0.05). The femoral and tibia tunnels were measured by X-ray films and CT. The knee stability and function were evaluated by Lachman test, pivot shift test, IKDC score, and Lysholm score. ResultsThe patients were followed up 1-2 years (mean, 1.5 years) in group A and 1 year-1 year and 6 months (mean, 1.2 years) in group B. No limitation of knee motion was observed. The Lysholm score and IKDC score were significantly increased at 1 year after operation when compared with preoperative scores in 2 groups (P<0.05), but no significant difference was found between 2 groups (P>0.05). At 1 year after operation, the stability of the knee in group B was significantly better than that in group A, and the results of Lachman test and pivot shift test showed significant differences between 2 groups (P<0.05). The femoral tunnel in group A was significantly longer in length and bigger in coronal angles and sagittal location than that in group B (P<0.05). ConclusionACL reconstruction through anteromedial approach is a surgical technique to be closer to anatomy reconstruction, which can obtain better rotation function and stability of the knee than the transtibial technique.
ObjectiveTo investigate the effect of the femoral tunnel angle on the femoral tunnel after anterior cruciate ligament (ACL) reconstruction in rabbits. MethodsFifty-four healthy 4-5 months old rabbits (weighing, 1.8-2.3 kg, male or female) were randomly divided into 3 groups (n=18). The ACL reconstruction models of the right knee were established in 3 experimental groups using its Achilles tendons, and the left knee served as the control group. On the coronal position, the angle between the femoral tunnel and the femoral shaft axis was 30°, 45°, and 60°. The level of tumor necrosis factor α (TNF-α) in the synovial fluid at 1, 2, and 4 weeks, the maximum load of the ligament and the rate of bone tunnel enlargement at 4, 8, and 12 weeks were detected. ResultsThe level of TNF-α significantly increased, and the maximum load of the ligament significantly decreased in the 3 experimental groups when compared with ones in the control group (P<0.05), but no significant difference was found among 3 experimental groups (P>0.05). The bone tunnel enlargement was observed in 3 experimental groups at each time point and reached the peak at 4 weeks, but no significant difference was shown among 3 groups (P>0.05). ConclusionThe 30-60° angle between the femoral tunnel and the femoral shaft axis in the coronal position has no significant effect on the femoral tunnel enlargement after ACL reconstruction in rabbits.
Objective To compare early graft healing between over-the-top (OTT) and anatomic single-bundle (SB) anterior cruciate ligament (ACL) reconstruction. Methods A clinical data of 40 patients underwent ACL reconstruction, who admitted between June 2021 and October 2022 and met the selective criteria, was retrospectively analyzed. Among them, 20 patients were treated with OTT reconstruction (OTT group) and 20 with SB reconstruction (SB group). There was no significant difference between groups (P>0.05) in the gender, age, affected side, disease duration, degree of meniscus injury, body mass index, and preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, pain visual analogue scale (VAS) score, and KT-2000 measurement. At 3, 6, and 12 months, MRI was performed to measure the signal noise quotient (SNQ) of the proximal end, middle, and distal end of the graft in the two groups, as well as at the corner of the graft with lateral femoral condyle and 1 cm around the femoral fixation point in the OTT group, to observe the degree of graft healing. Before operation and at 3, 6, and 12 months, the knee function and pain were evaluated by IKDC score, Lysholm score, and VAS score. Before operation and at 12 months after operation, the KT-2000 measurement was taken to evaluation the knee joint stability. Results All operations were successfully completed in both groups and the incisions healed by first intention. All patients were followed up 12-15 months (mean, 12.9 months), with no significant difference in the follow-up time between groups (P>0.05). After operation, the IKDC score, VAS score, and Lysholm score improved gradually over time in both groups, with significant differences between different time points (P<0.05). The differences between groups at 3, 6, and 12 months after operation were not significant (P>0.05). The anterior and posterior stability of the knee joint improved significantly in both groups at 12 months after operation, and the difference in KT-2000 measurements was significant when compared with the preoperative value (P<0.05), but the difference of pre- and post-operation between groups was not significant (P>0.05). At 3, 6, and 12 months after operation, MRI showed that the differences in the SNQ of the proximal end and middle of the grafts between the two groups were not significant (P>0.05), and the SNQ of distal end was significantly higher in the SB group than in the OTT group (P<0.05). At each time point, grafts in the OTT group had the highest SNQ at the corner and the lowest at the fixation point, and the differences were significant compared to the other sites (P<0.05). In the two groups, except for the fixation point, the SNQ of the remaining sites were highest at 6 months and lowest at 12 months (P<0.05). In addition, there were significant differences in SNQ between the different sites of grafts (P<0.05), and the SNQ was lowest at proximal end and highest at distal end. At last follow-up, the knee grafts in both groups were in good shape and no graft necrosis or loosening of the internal fixation was observed. Conclusion The knee joint function and graft healing after OTT reconstruction of ACL are similar to those of SB reconstruction, but it should be noted that the healing at the corner of the graft is slower.
ObjectivesTo systematically review the efficacy of exercise therapy on functional and activity recovery after anterior cruciate ligament reconstruction (ACL).MethodsPubMed, EMbase, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of exercise therapy on functional and activity recovery after ACL from inception to May 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 602 patients were included. The results of meta-analysis showed that: 1 week (MD=3.07, 95%CI 1.37 to 4.77, P=0.000 4) and 3 weeks (MD=4.53, 95%CI 2.34 to 6.71, P<0.000 1) conventional exercise training rehabilitation effects were better than natural recovery under orthopedic routine care in promoting knee joint function recovery. The recovery effects of over 6 months neuromuscular training was significantly increased compared with conventional rehabilitation (MD=11.48, 95%CI 8.25 to 14.71, P<0.000 01). In addition, there was significant difference between open and closed chain exercise rehabilitation after more than 6 months rehabilitation training (MD=6.77, 95%CI 0.86 to 12.68, P=0.02).ConclusionsThe current evidence shows that over 6 months neuromuscular training significantly enhance the recovery of motor function after anterior cruciate ligament reconstruction. According to different reconstruction methods, individualized rehabilitation program is developed to maximize the recovery of knee joint function. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusions.
ObjectiveTo investigate the feasibility and effectiveness of a novel remnant-preserving anterior cruciate ligament (ACL) reconstruction with bidirectional barbed suture.MethodsBetween February 2014 and January 2016, 96 patients (96 knees) with ACL injury who met the inclusion criteria were recruited and randomly divided into 2 groups (n=48). All patients underwent ACL reconstruction with autologous tendon. The tibial remnant was fixed with PDS-Ⅱ suture (control group) and bidirectional barbed suture (trial group). There was no significant difference in age, gender, injury side, the interval from injury to operation, and preoperative knee stability (KT-1000 test), International Knee Documentation Committee (IKDC) score, and Lysholm score (P>0.05). The knee stability (KT-1000 test), IKDC score, Lysholm score, proprioception, and Cyclops lesion after operation were recorded.ResultsAll incisions healed by first intention in both groups. Forty-four patients in control group were followed up 26-47 months (mean, 36.6 months), and 45 patients in trial group were followed up 26-48 months (mean, 35.6 months). At last follow-up, the IKDC score, Lysholm score, and KT-1000 test were significantly improved when compared with preoperative ones in both groups (P<0.05); but no significant difference was found between 2 groups (P>0.05). There was no significant difference in proprioception between 2 groups at 1 and 2 years after operation, and between 1 year after operation and 2 years after operation (P>0.05) in the same group. The incidences of Cyclops lesion at 6 months, 1 year and 2 years after operation were 0, 4.44% (2/45), and 4.44% (2/45) in trial group, and 13.6% (6/44), 13.6% (6/44), 20.5% (9/44) in control group, showing significant differences between 2 groups at 6 months and at 2 years after operation (P=0.012; P=0.022) and no significant difference at 1 year after operation (P=0.157).ConclusionThe remnant-preserving ACL reconstruction with bidirectional barbed suture can decrease the incidence of Cyclops lesions. However, this technique can not improve the effectiveness in terms of the clinical function and stability compared with the traditional technique.
Objective To evaluate the tendon regeneration after anterior cruciate ligament (ACL) reconstruction with semitendinosus tendon and gracilis tendon autografts by MRI. Methods Between September 2007 and September 2009, 52 patients undergoing ACL reconstructions with semitendinosus tendon and gracilis tendon autografts were enrolled. There were 29 males and 23 females with an average age of 31.6 years (range, 19-42 years). The left knees were involved in 34 cases and the right knees in 18 cases. The injury was caused by traffic accident in 11 cases, by sports in 38 cases, by heavy pound injury in 2 cases, and by other in 1 case. The time between injury and operation was 6 days to 31 months (median, 11.4 months). Joint pain occurred in 19 cases, joint instability in 28 cases, and joint swelling in 5 cases. The physical examination on admission showed thigh amyotrophy in 7 cases (thigh circumference side-to-side difference gt; 1 cm) and limitation of joint motion in 2 cases. The results of floating patella test, Lachman test, pivot shift test, and anterior drawer test were positive in 5, 51, 49, and 52 cases, respectively. The range of motion of knee was (127.77 ± 5.73)°, International Knee Documentation Committee (IKDC) score was 49.50 ± 4.08, and Lysholm score was 52.40 ± 3.45. Of the patients, 23 were accompanied with medial meniscus tear, 6 with lateral meniscus tear, 2 with plica synovialis, and 1 with loose body. Results All incisions healed by first intention. All the patients were followed up 12-18 months (mean, 14.9 months). At 12 months postoperatively, the results of Lachman test and pivot shift test were positive in 1 case, respectively; the results of anterior drawer test were negative in 52 cases. The range of motion of knee was (131.91 ± 1.81)°, Lysholm score was 94.98 ± 2.77, IKDC score was 93.65 ± 2.42; and there were significant differences when compared with the preoperative ones (P lt; 0.05). At 12 months postoperatively, at 90° resisted flexion of the knee, a very distinct fibrous band could be identified on the posteromedial aspect of the knee in 39 cases. MRI showed that both semitendinosus tendon and gracilis tendon regeneration in 10 cases, only semitendinosus tendon regeneration in 29 cases, only gracilis tendon regeneration in 2 cases, and no tendon regeneration in 11 cases. The regeneration rate of the semitendinosus tendon was 75.0% (39/52); the regeneration rate of the gracilis tendon was 23.1% (12/52); and the regeneration rate of the semitendinosus tendon and gracilis tendon was 78.8% (41/52). Conclusion MRI results suggest that some of the semitendinosus tendon and gracilis tendon could regenerate after harvested for ACL reconstruction.
ObjectiveTo systematically review the progress of different methods for femoral tunnel positioning in anterior cruciate ligament (ACL) reconstruction and provide a clinical reference for treatment of ACL rupture.MethodsThe literature about the femoral tunnel positioning in ACL reconstruction was widely reviewed. The advantages and disadvantages and the clinical results of each method were summarized.ResultsCurrently in ACL reconstruction, methods for femoral tunnel positioning include transtibial technique (TT), anteromedial technique (AM), outside-in (OI), modified TT (mTT), and computer assisted surgery. There is no significant difference in the postoperative effectiveness between TT technique and AM technique. Compared with the TT technique, the OI technique has higher rotational stability of knee, but there is no significant difference in clinical results. The femoral tunnel located by mTT technique is closer to the anatomical placement than that of TT technique, but mTT technique is not effective for systematically anatomic femoral tunnel positioning, and further research is needed to prove its advantages.ConclusionDifferent femoral tunnel positioning methods have their own advantages and disadvantages, and there is no definite evidence that one is superior than the rest.