Alteration of Knee Kinematics After Anatomic Anterior Cruciate Ligament Reconstruction Is Dependent on Associated Meniscal Injury
Akpinar, B.; Thorhauer, E.; Irrgang, J.J.; Tashman, S.; Fu, F.H.; Anderst, W.J.
American Journal of Sports Medicine 46(5): 1158-1165
2018
ISSN/ISBN: 0042-773X PMID: 29498872 Document Number: 696476
Ventricular assist devices are an important therapeutic modality in advanced surgical therapy of end-stage heart failure. Previously most frequently used devices generated mainly non-pulsatile blood flow. Despite indisputable clinical success of this therapy, we encounter complications specific to the devices generating continuous flow. Complications are mainly attributed to changes in shear stress and subsequent changes of the blood vessel characteristics, mainly of endothelium. Effect of continuous flow on the vasculature and blood elements, therefore, became a subject of intense recent research. Effect of continuous flow on the vascular bed is subject of intensive research. Widespread methods used in angiology measuring the state of vasculature are based mainly on imaging modalities and on the presence of pulsatile flow; therefore, under circumstances of non-pulsatile flow their use is limited and the attention is shifted also to laboratory methods, namely to detection of circulating indicators of vascular damage. Therefore, in our recent studies of the effect of mechanical ventricular assist devices on the blood flow we exploit combination of imaging and laboratory methods, including measurements of circulating microparticles and endothelial progenitor cells. Based on these studies interesting data were obtained studying the effect of implantation of mechanical cardiac support on the dynamics of vascular changes taking into account also response to changes of blood flow characteristics. In this paper we summarize our observations.Key words: continuous flow - endothelial progenitor cells - mechanical circulatory support - microparticles - vascular damage. Limited in vivo kinematic information exists on managing meniscal injury during anterior cruciate ligament reconstruction (ACLR). Isolated anatomic ACLR restores knee kinematics, whereas ACLR in the presence of medial meniscal injury is associated with altered long-term knee kinematics. Cohort study; Level of evidence, 3. From March 2011 to December 2012, 49 of 57 participants in a clinical trial underwent anatomic ACLR with successful kinematic testing at 24 months after ACLR. Twenty-five patients had associated meniscal tears: medial (n = 11), lateral (n = 9), or bilateral (n = 5). With a dynamic stereo radiography system with superimposed high-resolution computed tomography scans of patient knees, kinematics were measured during downhill running. The initial single-support phase of the gait cycle (0%-10%) was analyzed. Anterior tibial translation (ATT) was the only kinematic outcome between patients' ACLR and contralateral knees that had significant interactions among meniscal groups ( P = .007). There was significant difference in ATT between patients with intact menisci and medial tears ( P = .036) and with medial tears and lateral tears ( P = .025). Patients with intact menisci had no difference in ATT, with a negligible effect size between the ACLR and contralateral knees (mean ± SEM: 13.1 ± 0.7 mm vs 12.6 ± 0.5 mm, P = .24, Cohen d = 0.15, n = 24), while patients with medial meniscal tears had an increase in ATT, with a medium effect size between the ACLR and contralateral knees (15.4 ± 1.0 mm vs 13.2 ± 1.0 mm, P = .024, Cohen d = 0.66, n = 11). Associated medial meniscal injury in the setting of ACLR leads to increased ATT at 24-month follow-up. Furthermore, isolated anatomic ACLR in the absence of meniscal injury demonstrated no significant difference from native knee kinematics at 24-month follow-up during rigorous "high demand" knee activity with the current sample size. Patients undergoing anatomic ACLR in the presence of medial meniscal injury remained at a higher likelihood of sustaining altered long-term knee kinematics.