Anterior Cruciate Ligament Reconstruction Reinitiates an Inflammatory and Chondrodegenerative Process in the Knee Joint.
- 作者列表："Hunt ER","Conley CE","Jacobs CA","Ireland ML","Johnson DL","Lattermann C
:Anterior cruciate ligament(ACL) injury leads to a sustained increase in synovial fluid concentrations of inflammatory cytokines and biomarkers of cartilage breakdown. While this has been documented post-injury, it remains unclear whether ACL reconstruction surgery contributes to the inflammatory process and/or cartilage breakdown.This study is a secondary analysis of 14 patients (9 males/5 females, mean age=19, mean BMI=28) enrolled in an IRB-approved randomized clinical trial. Arthrocentesis was performed at initial presentation (mean=6 days post-injury), immediately prior to surgery (mean=23 days post-injury), one-week post-surgery, and one-month post-surgery. ELISA kits were used to determine concentrations of CTXII, IL-6 and IL-1β in the synovial fluid. The log transformed IL-1β was not normally distributed; therefore, changes between time points were evaluatedusing a non-parametric Kruskal-Wallis one-way ANOVA. IL-1β concentrations significantly increased from the day of surgery to the first postoperative time point (p<.001) and significantly decreased at the 4-week postoperative visit (p=.03). IL-1β concentrations at the 4-week postoperative visit remained significantly greater than both preoperative time points (p >.05).IL-6 concentrations at 1 week post-surgery were significantly higher than at initial presentation (p=0.013), the day of surgery (p<0.001), and 4 weeks after surgery (p=0.002). CTX-II concentrations did not differ between the first three time points (p>.99) but significantly increased at 4 weeks post-surgery (p<.01). ACL reconstruction appears to reinitiate an inflammatory response followed byan increase in markers for cartilage degradation. ACL reconstruction appears to initiate a second "inflammatory hit" resulting in increased chondral breakdown suggesting that post-operative chondroprotection may be needed. This article is protected by copyright. All rights reserved.
: 前交叉韧带 (ACL) 损伤导致关节滑液中炎症细胞因子和软骨分解生物标志物浓度的持续增加。虽然损伤后已有文献记载，但 ACL 重建手术是否有助于炎症过程和/或软骨破裂仍不清楚。本研究是对参加 IRB 批准的随机临床试验的 14 例患者 (9 例男性/5 例女性，平均年龄 = 19，平均 BMI = 28) 的二次分析。在初次就诊 (平均 = 伤后 6 天) 、手术前 (平均 = 伤后 23 天) 、手术后一周进行关节穿刺术,手术后一个月。ELISA 试剂盒测定关节液中 CTXII 、 IL-6 和 il-1 β 的浓度。Log 转化的 il-1 β 不呈正态分布; 因此，使用非参数 Kruskal-Wallis 单因素方差分析评价时间点之间的变化。Il-1 β 浓度从手术当天到术后第一个时间点显著升高 (p<.001)，在术后 4 周访视时显著降低 (p =.03)。术后 4 周访视时 il-1 β 浓度仍显著高于术前两个时间点 (p >.05)。术后 1 周的 IL-6 浓度显著高于初次就诊 (p = 0.013) 、手术当天 (p<0.001) 、和术后 4 周 (p = 0.002)。CTX-II 浓度在前三个时间点之间没有差异 (p>.99)，但在术后 4 周时显著升高 (p<.01)。ACL 重建似乎在软骨降解标志物增加后重新启动炎症反应。ACL 重建似乎启动了第二次 “炎症打击”，导致软骨破裂增加，提示可能需要术后软骨保护。本文受版权保护。保留所有权利。
METHODS:Purpose To determine outcomes of transphyseal ACL reconstruction using a living parental hamstring tendon allograft in a consecutive series of 100 children. Methods One hundred consecutive juveniles undergoing ACL reconstruction with a living parental hamstring allograft were recruited prospectively and reviewed 2 years after ACL reconstruction with IKDC Knee Ligament Evaluation, and KT1000 instrumented laxity testing. Skeletally immature participants obtained annual radiographs until skeletal maturity, and long leg alignment radiographs at 2 years. Radiographic Posterior tibial slope was recorded. Results Of 100 juveniles, the median age was 14 years (range 8–16) and 68% male. At surgery, 30 juveniles were graded Tanner 1 or 2, 21 were Tanner 3 and 49 were Tanner 4 or 5. There were no cases of iatrogenic physeal injury or leg length discrepancy on long leg radiographs at 2 years, despite a median increase in height of 8 cm. Twelve patients had an ACL graft rupture and 9 had a contralateral ACL injury. Of those without further ACL injury, 82% returned to competitive sports, IKDC ligament evaluation was normal in 52% and nearly normal in 48%. The median side to side difference on manual maximum testing with the KT1000 was 2 mm (range − 1 to 5). A radiographic PTS of 12° or more was observed in 49%. Conclusions ACL reconstruction in the juvenile with living parental hamstring tendon allograft is a viable procedure associated with excellent clinical stability, patient-reported outcomes and return to sport over 2 years. Further ACL injury to the reconstructed and the contralateral knee remains a significant risk, with identical prevalence observed between the reconstructed and contralateral ACL between 12 and 24 months after surgery. Level of evidence III (Cohort Study).
METHODS:Purpose The purpose of the study was to investigate the biomechanics of walking and of the knee joint in the acute phase of ACL injury. Methods We examined 18 patients with acute ACL injuries and 20 healthy adults as controls. The biomechanics of the knee joint and of walking was assessed by 5 inertial sensors fixed with special cuffs to the lower back, the lower third of the thigh, and the lower third of the shank of the right and left legs. The movements and temporal characteristics were recorded while the subject was walking 10 m at a comfortable pace. Based on the results of examination, the patients were divided into two groups: with severe function impairment (6 patients) and with moderate function impairment (12 patients). Results It was found that in the first days post-trauma, not only the knee function was reduced, but the function of the entire lower limb as well. This led to a functional asymmetry. The kinematics of movements in the joints changed in accordance with slower walking. The walking became not only slower, but it was also associated with a decreased impact load in the weight acceptance phase. At later dates, the functional impairments were less pronounced. The total range of flexion motion did not exceed 20 degrees in the first group and 55 degrees in the second one. The injured joint developed functional immobilization within the first days post-injury. This was a guarding response by additional muscle strain to prevent unusual and limit physiological movements in the knee joint. The movements in the knee joint while walking were of small amplitude, rocking, and occurred only under load. The amplitude of the main flexion in the swing phase was reduced. Conclusion The stage of an ACL injury should be assessed not only based on the time post-trauma, but also taking account of the functional parameter—the knee range of flexion while walking. According to our findings, the only factor that had influenced the functional condition of the KJ was the duration of joint immobilization after trauma.
METHODS:Purpose Numerous techniques have been described for the tibial-sided graft preparation in anterior cruciate ligament (ACL) reconstruction. The use of less suture material for graft preparation is thought to improve ingrowth and to reduce the risk for infection. At the same time, the suture construct should be strong enough to resist the surgeon’s pull during tensioning of the transplant. Methods In total, 39 fresh-frozen procine deep flexor tendons were used and prepared as four-strand grafts. In the three-suture group ( n = 19), graft preparation was performed using three tibial-sided sutures, with each tendon end sutured separately. In the one-suture group ( n = 20), a modified graft preparation using only one tibial-sided suture was applied. Each sample underwent load-to-failure testing ( N _max) after cyclic pre-loading. To estimate intraoperative tension forces acting on the tibial-sided suture constructs, the maximal tension force of 26 volunteers on such a construct was measured using a load cell. Results The biomechanical testing of the two different suture constructs showed a significantly higher load-to-failure for the three-suture group (711 N ± 91 N) compared to the one-suture group (347 N ± 24 N) ( p = 0.0001). In both groups, the mode of failure was a tear of the suture in all samples. A failure of the suture–tendon interface was not observed in any case. The median maximal tension force on the construct applied by the 26 volunteers was 134 N (range 73–182 N). Conclusion The presented single-suture tendon graft preparation resisted to smaller failure loads than the conventional three-suture technique. However, no failures in the suture–tendon interface were seen and the failure loads observed were far beyond the tension forces that can be expected intraoperatively. Hence, the single-suture graft preparation technique may be a valuable alternative to the conventional technique.