Name: early weight-bearing rehabilitation protocol after anterior cruciate ligament reconstruction
Uploaded: 2024-03-01T13:30:00.000+00:00
Duration: 5 min 7 s
Description: Read this Scientific Article Protocol about Author Spotlight: Implementing Enhanced Recovery After Surgery Concepts in Rehabilitation Following Anterior Cruciate Ligament Reconstruction at JoVE.com

This research was supported by two grants from the research project grant from Shanghai First People&#39;s Hospital (grant number: SYYG20221007) and the Medical Innovation Research Special Project in the Science and Technology Innovation Action Plan of the Shanghai Science and Technology Committee (grant number: 22Y11912100).

This protocol has been approved by the Ethics Committee of Shanghai First People&#39;s Hospital (project number: 2022SQ470).
1. Study design
<ol>
	<li>Ensure that the study is single-blind: researchers will be aware of group assignments but they will not inform participants of their allocation.</li>
	<li>Random grouping: Ensure that the researchers use a random number table and randomly divide the participants into two groups at a 1:1 ratio. The control group (CG) will receive early non-weight-bearing rehabilitation while the experimental group (EG) will receive EWB.</li>
	<li>Power calculation
	<ol>
		<li>Use analysis software to conduct power analysis to obtain the minimum sample size required for statistical results, refer to existing research, and consider study design to define the assumed drop-out rate. 
		NOTE: The power analysis of this study was based on an independent t-test assuming equal variance. The two-sided significance level was set at an alpha level of 0.05 and a power of 0.8. The results of the power calculation revealed that a total of 34 participants were needed. Considering a drop-out rate of ~10%, we planned to recruit 38 participants.</li>
	</ol>
	</li>
</ol>
2. Participant recruitment (see Figure 1)
NOTE: The research team selected 38 patients who underwent ACLR at Shanghai First People&#39;s Hospital from July 2022 to November 2022 based on the inclusion and exclusion criteria. They were divided into experimental and control groups with 19 participants. General demographic information and clinical indicators, including gender, age, graft type, degree of meniscal repair, pain intensity, and wound healing status, were collected.
<ol>
	<li>Set the inclusion criteria to patients who had undergone ACLR surgery, patients between the ages of 16 and 55, and those who show good compliance and signed the informed consent form.</li>
	<li>Set the exclusion criteria to be concomitant other bone and joint injuries affecting normal activity; concomitant radioactive or complicated or other unstable meniscal tears; and patients with severe complications such as postoperative fever, poor wound healing, and lower extremity deep vein thrombosis.</li>
</ol>
3. Rehabilitation treatment plan
<ol>
	<li>Give patients in both groups the same preoperative and postoperative health education programs.
	<ol>
		<li>Inform the patients about the rehabilitation process, the preparation and use of assistive devices, reasonable expectations, and rehabilitation precautions.</li>
		<li>Perform postoperative assessments, such as pain intensity, edema, and range of motion; formulate personalized rehabilitation plans; and implement rehabilitation programs with the help of the therapist on the day of surgery after the patients regain consciousness.</li>
		<li>Give the same basic bedside rehabilitation programs to the patients in both groups.
		<ol>
			<li>Elevate the affected lower limb as long as possible so that it is at an angle of 30&#176; from the horizontal line.</li>
			<li>Place a cold pack on the affected knee (20 min x 3 times daily, once post rehabilitation).</li>
			<li>Do ankle pump exercises (5 min hourly when the patient is awake).</li>
			<li>Loosen patellar and the surrounding soft tissue. Have the therapist push the patella in four directions, up and down, left and right, and massage the quadriceps and hamstrings.</li>
			<li>Do isometric contraction training of quadriceps (10 sets x 10 repetitions daily).</li>
			<li>Extend and flex the knee joint.</li>
			<li>Perform the activities of daily living training such as dressing, getting in and out of a bed or a chair, and using the toilet under the guidance of the rehabilitation therapist.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Give EWB training to the EG patients but ensure that CG patients are aware that weight-bearing training is prohibited for 2 weeks after surgery. 
	NOTE: EWB in this article refers to full weight-bearing training within 2 days after surgery.
	<ol>
		<li>EWB-standing training (Figure 2).
		<ol>
			<li>Have a chair, a movable mirror, and an electronic body weightometer in the room. Have the patients wear the knee hinge brace. Set the brace at 0&#176;-30&#176;extension for 2 days after surgery.</li>
			<li>Instruct the patient to stand with or without a walker.</li>
			<li>Ask the patients to stand with their feet shoulder-width apart. Have the therapist stand on the affected side of the patients and give them verbal instructions (Figure 2A).</li>
			<li>Observe the body posture in a mirror and adjust the posture independently or under the guidance of the therapist (Figure 2B).</li>
			<li>Put the affected leg on the electronic body weightometer while the weight-bearing intensity of the affected leg gradually increases to 25%, 50%, 75%, and 100% of the body weight (Figure 2C,D).</li>
		</ol>
		</li>
		<li>EWB-balance training (Figure 3).
		<ol>
			<li>Stand on their tiptoes and hold for 5-10 s. Repeat 10x (Figure 3A).</li>
			<li>Stand on one leg with the affected lower limb for 3-5 s and repeat 10x (Figure 3B).</li>
			<li>Ask the patient to stand in a neutral position while pulling on the elastic band with both hands. Have the therapist and the patient pull on the elastic band in opposite directions for 3-5 s and repeat 10x (Figure 3C).</li>
			<li>Ask the patient to stand in a neutral position. Have the therapist move the elastic band around the back of the affected knee and forcefully pull on it. At the same time, ask the patient to try to stay still for 5-10 s; repeat this 10x (Figure 3D).</li>
		</ol>
		</li>
		<li>EWB-gait training (Figure 4).
		<ol>
			<li>Ask the patient to face the mirror and stand in a neutral position.</li>
			<li>Without moving the affected foot, ask the patient to move the healthy foot backward by one small step, then move it forward by one small step, and repeat 50x (Figure 4A).</li>
			<li>Without moving the healthy foot, ask the patient to move the affected foot backward by one small step, then move it forward by one small step, and repeat 50x (Figure 4B).</li>
			<li>Walk in a straight line for 10 m with small feet and low speed. 
			NOTE: If the patient can independently do a straight-leg raise without quadriceps lag, the knee hinge brace is adjusted to 0-30&#176; for training with a slight knee bend allowed during gait.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Discharge the patients in both groups 1-3 days after surgery. After discharge, ensure that they receive remote home rehabilitation and supervision, with rehabilitation therapists maintaining contact with the patients through messaging and telephone.
	<ol>
		<li>Continue self non-weight-bearing rehabilitation programs during the home phase for the patients in CG. 
		NOTE: The home-based rehabilitation programs include quadriceps femoris isotonic contraction, knee flexion and extension training, lower limb non-weight-bearing transfer training, and cardiopulmonary function training.</li>
		<li>Continue self weight-bearing rehabilitation programs during the home phase for the patients in EG but instruct them to avoid excessive weight-bearing standing and walking during home rehabilitation. 
		NOTE: If the pain and edema increase during self weight-bearing rehabilitation, ask the patients to stop weight-bearing immediately, rest with limb elevation and ice application, and connect with the rehabilitation therapist for remote advice.</li>
	</ol>
	</li>
</ol>
4. Outcome assessments
NOTE: The evaluations are completed by rehabilitation therapists on the 2nd, 7th, and 14th day after surgery. The primary outcome measures include wound healing, stability of knee joint, pain, and edema of the knee.
<ol>
	<li>To assess the safety and feasibility, assess and record the wound healing, anterior drawer test of the knee joint, and sudden knee flexion.
	<ol>
		<li>Observe the progress of wound healing and inflammatory reaction. 
		NOTE: Neat and dry wound closure without exudate indicates good wound healing; otherwise, it is considered poor wound healing.</li>
		<li>Ask the patient to lie on the bed and put the affected feet on the bed. Have the physician perform the anterior drawer test for the knee to observe the stability of the knee joint.</li>
		<li>Ask the patient if sudden knee flexion occurs in the affected lower limb during weight-bearing rehabilitation and record the number of sudden knee flexion.</li>
	</ol>
	</li>
	<li>Pain intensity
	<ol>
		<li>Use the numerical rating scale (NRS)10 from 0 to 10 integers, with higher numbers indicating greater pain intensity.</li>
		<li>Tell patients the method of assessment of pain intensity.</li>
		<li>Ask them to choose an integer to represent their pain intensity. 
		NOTE: 0 means no pain, 10 means worst pain.</li>
	</ol>
	</li>
	<li>Degree of knee edema (DKE)
	<ol>
		<li>Ask the patient to lie on the bed.</li>
		<li>Measure 3x with a tape measure around the patella central point for knee circumference and take the average. 
		NOTE: The difference in circumference between the affected and unaffected sides is considered DKE. This study stipulates that a difference of 0-2 cm is mild swelling, 2-4 cm is moderate swelling, and over 4 cm is severe swelling.</li>
	</ol>
	</li>
	<li>Active knee flexion range of motion (AKROM)
	<ol>
		<li>Ask the patient to lie on the bed and bend the knee to the maximum angle.</li>
		<li>Use a goniometer to measure AKROM 3x and take the average. 
		NOTE: The knee joint center is the axis of rotation, the femoral shaft is the fixed arm, and the tibial shaft is the moving arm.</li>
	</ol>
	</li>
	<li>Activities of daily living ability (ADL)
	<ol>
		<li>Ask the patients about their activities of daily living with the Barthel Index11 scale at hospital discharge. 
		NOTE: The total score is 100 points. Higher scores indicate better ADL: 60 points or more indicate basic self-care ability for daily living.</li>
	</ol>
	</li>
</ol>

Rehabilitation Treatment Plan for ACLR Patients

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The authors declare no conflicts of interest.

This study protocol contains details of the EWB rehabilitation after ACLR. Its process is clear and not complicated, and because only simple rehabilitation equipment is needed for the implementation of the EWB rehabilitation program, it is clinically feasible and convenient. In addition, safety is an important consideration in this study protocol. The EWB rehabilitation program not only adds protective measures to prevent iatrogenic sports injury but also follows the step-by-step principle. Therefore, the results of this...

Enhanced Recovery after Surgery (ERAS) is a concept that promotes the early initiation of postsurgery rehabilitation care units, particularly after orthopedic operations, when conditions are appropriate1. This approach seeks to shift the clinical focus from treating the disease to functional rehabilitation promptly with the goal of reducing hospital stays, minimizing postoperative complications, improving patient prognosis and satisfaction, and enhancing overall rehabilitation outcomes. Since the introduction of ERAS, Chinese orthopedic rehabilitation specialist, Zhou Mouwang, has advocated for the active application of accelerated recovery protocols to further progress perioperative rehabilitation practices within the realm of Chinese orthopedics2. Internationally recognized consensus guidelines have also been established to facilitate enhanced surgical recovery for orthopedic conditions such as joint replacement and spine surgery3. Nonetheless, while considerable advancements have been made in implementing ERAS in recent years, the primary application has been in major operations, such as joint replacement surgeries4. As a result, there is a pressing need to further investigate and expand the application of ERAS within the rehabilitation of other orthopedic conditions.
The anterior cruciate ligament (ACL) plays a pivotal role in maintaining knee joint stability. ACL injuries are among the most prevalent sports-related injuries, with approximately 2 million cases occurring worldwide annually5. Anterior cruciate ligament reconstruction (ACLR) is the mainstream treatment approach, aiming to restore normal knee anatomy and stability, prevent secondary injuries, and enable patients' return to sport. Rehabilitation following ACL injury has been an active research area. It is widely accepted that post ACLR rehabilitation is integral for optimizing surgical outcomes and facilitating patients' recovery of sports-related function6,7. However, early weight-bearing (EWB) rehabilitation protocols after ACLR remain understudied, leading to a lack of consensus among clinicians.
The latest research in 2021 supports allowing immediate weight-bearing and full knee range of motion within tolerance after ACL autograft reconstruction surgery7. However, a consensus has not yet been reached in clinical practice. The authoritative British Journal of Sports Medicine published in 2016 also advocates for immediate weight-bearing post ACLR, finding it does not increase knee joint laxity. If gait is proper without increased pain or effusion during/after walking, immediate weight-bearing is considered acceptable6. In contrast, a review in 2022 summarizes that accelerated weight-bearing rehabilitation following ACLR may increase risks of knee joint laxity and bone tunnel widening compared to delayed weight-bearing protocols, advising cautious selection of postoperative regimens8. Additional concerns with EWB include knee pain, swelling, effusion, wound healing, and fall risks after ACLR. Although substantial literature endorses EWB after ACLR, clinical practices still vary. A study in 20209 found that surgeon experience influences post ACLR weight-bearing timelines in France; more experienced surgeons were more likely to favor EWB rehabilitation.
Under the guidance of the ERAS concept, EWB is an important factor affecting patient function and quality of life. However, whether the EWB program could impair wound healing, increase pain and swelling, or impact knee stability remains a key concern for orthopedic and rehabilitation clinicians. In view of the current dilemma of clinicians and inconsistent research results, this study aims to explore the safety and feasibility of EWB after ACLR.

<table><tbody><tr><td>Elastic band</td><td>JOINFIT</td><td>10722038422</td><td></td></tr><tr><td>Electronic body weightometer</td><td>China&#039;s Xiaomi Technology (W0LONOW)</td><td>100021480693</td><td></td></tr><tr><td>Movable mirror</td><td>Guangzhou Compaq Medical Equipment Co. LTD</td><td>10073735389717</td><td></td></tr><tr><td>SPSS 21.0&amp;nbsp;</td><td></td><td></td><td>statistical analysis</td></tr></tbody></table>

early weight-bearing rehabilitation protocol after anterior cruciate ligament reconstruction

Anterior cruciate ligament (ACL) injury is one of the common sports injuries. Anterior cruciate ligament reconstruction (ACLR) is the mainstream treatment for ACL injury, aiming to regain normal anatomical structure and stability of the knee joint and promote the patient's return to sports. Under the guidance of the concept of enhanced recovery after surgery, early weight-bearing rehabilitation (EWB) is an important factor affecting patient function and quality of life. However, there is no consensus on whether EWB rehabilitation can be performed after ACL surgery. 
This study aims to explore the safety and feasibility of EWB after ACL surgery. The study implemented a gradual EWB rehabilitation program in the experimental group, including weight-shifting training, balance training, and gait training on the affected lower limb, and assessed wound healing and stability of the knee joint. The study found that EWB after ACLR is safe and feasible. EWB rehabilitation not only does not pose a negative effect on the patient's knee pain, swelling, wound healing, and stability, but also helps to improve knee active flexion and quality of life faster and better. The EWB program in this study is simple, safe, and effective, and it provides strong theoretical guidance and practical demonstration for accelerated rehabilitation after ACLR.

This study included 38 patients, all of whom completed the 2-week study (CG = 19, PG = 19). There were no significant differences in sex, age, surgical site, graft type, or degree of meniscus repair between the two groups (P &#62; 0.05; see Table 1).
The intensity of pain of patients in EG on postoperative days 2, 7, and 14 was (2.2 &#177; 1.3), (1.1 &#177; 0.6), and (0.6 &#177; 0.5), respectively, indicating a gradual decrease in the intensity of pain. The intensity ...

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Author Spotlight: Implementing the Enhanced Recovery After Surgery Concept in Rehabilitation Following Anterior Cruciate Ligament Reconstruction

Based on the safety and feasibility, this article presents an early weight-bearing rehabilitation protocol after anterior cruciate ligament reconstruction. The protocol is clear and easy to operate, which is helpful to promote its use in clinical practice and accelerate the functional recovery of patients.

Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) injury is one of the common sports injuries. Anterior cruciate ligament reconstruction (ACLR) is the mainstream treatment ...

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Video: Auteur in de schijnwerpers: implementatie van het concept van verbeterd herstel na een operatie bij revalidatie na een reconstructie van de voorste kruisband

Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients 

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, and persistent nerve and muscle impairments after hospital discharge.1-6 Using an explicit protocol with a structured approach to training and quality assurance of research staff, manual muscle testing (MMT) is a highly reliable method for assessing strength, using a standardized clinical examination, for patients following ARDS, and can be completed with mechanically ventilated patients who can tolerate sitting upright in bed and are able to follow two-step commands. 7, 8 
This video demonstrates a protocol for MMT, which has been taught to &ge;43 research staff who have performed &gt;800 assessments on &gt;280 ARDS survivors. Modifications for the bedridden patient are included. Each muscle is tested with specific techniques for positioning, stabilization, resistance, and palpation for each score of the 6-point ordinal Medical Research Council scale.7,9-11 Three upper and three lower extremity muscles are graded in this protocol: shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and ankle dorsiflexion. These muscles were chosen based on the standard approach for evaluating patients for ICU-acquired weakness used in prior publications. 1,2.

Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients

Survivors of acute respiratory distress syndrome (ARDS) and critical illness frequently develop long-lasting muscle weakness. Manual muscle testing (MMT) is a standardized clinical examination commonly used to measure strength of peripheral skeletal muscle groups. This video demonstrates MMT using the 6-point Medical Research Council scale.

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, ...

Surgical Retrieval, Isolation and In vitro Expansion of Human Anterior Cruciate Ligament-derived Cells for Tissue Engineering Applications

Injury to the ACL is a commonly encountered problem in active individuals. Even partial tears of this intra-articular knee ligament lead to biomechanical deficiencies that impair function and stability. Current options for the treatment of partial ACL tears range from nonoperative, conservative management to multiple surgical options, such as: thermal modification, single-bundle repair, complete reconstruction, and reconstruction of the damaged portion of the native ligament. Few studies, if any, have demonstrated any single method for management to be consistently superior, and in many cases patients continue to demonstrate persistent instability and other comorbidities.
The goal of this study is to identify a potential cell source for utilization in the development of a tissue engineered patch that could be implemented in the repair of a partially torn ACL. A novel protocol was developed for the expansion of cells derived from patients undergoing ACL reconstruction. To isolate the cells, minced hACL tissue obtained during ACL reconstruction was digested in a Collagenase solution. Expansion was performed using DMEM/F12 medium supplemented with 10% fetal bovine serum (FBS) and 1% penicillin/streptomycin (P/S). The cells were then stored at -80 &#186;C or in liquid nitrogen in a freezing medium consisting of DMSO, FBS and the expansion medium. After thawing, the hACL derived cells were then seeded onto a tissue engineered scaffold, PLAGA (Poly lactic-co-glycolic acid) and control Tissue culture polystyrene (TCPS). After 7 days, SEM was performed to compare cellular adhesion to the PLAGA versus the control TCPS. Cellular morphology was evaluated using immunofluorescence staining. SEM (Scanning Electron Microscope) micrographs demonstrated that cells grew and adhered on both PLAGA and TCPS surfaces and were confluent over the entire surfaces by day 7. Immunofluorescence staining showed normal, non-stressed morphological patterns on both surfaces. This technique is promising for applications in ACL regeneration and reconstruction.

Surgical Retrieval, Isolation and In vitro Expansion of Human Anterior Cruciate Ligament-derived Cells for Tissue Engineering Applications

For future applications as a patch to repair partial tears of the Anterior Cruciate Ligament (ACL), human ACL derived cells were isolated from tissue obtained during reconstructive procedures, expanded in vitro and grown on tissue engineered scaffolds. Cellular adhesion and morphology was then performed to confirm biocompatibility on scaffold surface.

Injury to the ACL is a commonly encountered problem in active individuals. Even partial tears of this intra-articular knee ligament lead to biomechanical ...

Bioengineering

Athymic Rat Model for Evaluation of Engineered Anterior Cruciate Ligament Grafts

Anterior cruciate ligament (ACL) rupture is a common ligamentous injury that often requires surgery because the ACL does not heal well without intervention. Current treatment strategies include ligament reconstruction with either autograft or allograft, which each have their associated limitations. Thus, there is interest in designing a tissue-engineered graft for use in ACL reconstruction. We describe the fabrication of an electrospun polymer graft for use in ACL tissue engineering. This polycaprolactone graft is biocompatible, biodegradable, porous, and is comprised of aligned fibers. Because an animal model is necessary to evaluate such a graft, this paper describes an intra-articular athymic rat model of ACL reconstruction that can be used to evaluate engineered grafts, including those seeded with xenogeneic cells. Representative histology and biomechanical testing results at 16 weeks postoperatively are presented, with grafts tested immediately post-implantation and contralateral native ACLs serving as controls. The present study provides a reproducible animal model with which to evaluate tissue engineered ACL grafts, and demonstrates the potential of a regenerative medicine approach to treatment of ACL rupture.

Animal models are important tools for the evaluation of tissue-engineered grafts. This paper presents the protocol for preparing an electrospun biodegradable polymer graft for use in anterior cruciate ligament tissue engineering, as well as a surgical protocol for implantation in a rat model.

Anterior cruciate ligament (ACL) rupture is a common ligamentous injury that often requires surgery because the ACL does not heal well without ...

Modified Single-Loop Reconstruction for Pancreaticoduodenectomy

Modified single-loop reconstruction in pancreaticoduodenectomy separates pancreatic secretion from bile. It is performed in cases of high-risk pancreatic remnants to reduce the severity of postoperative pancreatic fistulas and moreover the overall postoperative morbidity. This reconstruction technique is characterized by an extra-long jejunal loop for the construction of the pancreaticojejunostomy and hepaticojejunostomy. The longer distance between these anastomoses and an additional jejuno-jejunostomy between the afferent and efferent limb of the hepaticojejunostomy separate the fluids and prevent backflow of bile towards the pancreaticojejunostomy. Thus, the secretions cannot activate each other and aggravate an existing anastomotic leakage. We observed a reduced rate of severe postoperative pancreatic fistulas after modified single-loop reconstruction compared to conventional single loop reconstruction. The technique is easy to perform, safe, and less time-consuming than a traditional double-loop reconstruction.

The technique of modified single-loop reconstruction following pancreaticoduodenectomy separates pancreatic secretion from bile, thus reducing the severity of POPF without prolonging the duration of surgery.

Modified single-loop reconstruction in pancreaticoduodenectomy separates pancreatic secretion from bile. It is performed in cases of high-risk pancreatic ...

Structured Motor Rehabilitation After Selective Nerve Transfers

After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on the successful re-innervation of the targets in the periphery and on the motor re-learning process entailing cortical plasticity. While there is an increasing number of methods to improve rehabilitation, their routine implementation in a clinical setting remains a challenge due to their complexity and long duration. Therefore, recommendations for rehabilitation strategies are presented with the aim of guiding medical doctors and therapists through the long-lasting rehabilitation process and providing step-by-step instructions for supporting motor re-learning.
Directly after nerve transfer surgery, no motor function is present, and therapy should focus on promoting activity in the sensory-motor cortex areas of the paralyzed body part. After about two to six months (depending on the severity and modality of injury, the distance of nerve regeneration and many other factors), the first motor activity can be detected via electromyography (EMG). Within this phase of rehabilitation, multimodal feedback is used to re-learn the motor function. This is especially critical after nerve transfers, as muscle activation patterns change due to the altered neural connection. Finally, muscle strength should be sufficient to overcome gravity/resistance of antagonistic muscles and joint stiffness, and more functional tasks can be implemented in rehabilitation.

Here, we present a protocol for the motor rehabilitation of patients with severe nerve injuries and selective nerve transfer surgery. It aims at restoring the motor function proposing several stages in patient education, early-stage therapy after surgery and interventions for rehabilitation after successful re-innervation of the nerve&#8217;s target.

After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on ...

Impact of Non-Invasive ACL Injury and Surgery on Protease Activity in Mice

Non-Invasive Compression-Induced Anterior Cruciate Ligament (ACL) Injury and In Vivo Imaging of Protease Activity in Mice

Traumatic joint injuries such as anterior cruciate ligament (ACL) rupture or meniscus tears commonly lead to post-traumatic osteoarthritis (PTOA) within 10-20 years following injury. Understanding the early biological processes initiated by joint injuries (e.g., inflammation, matrix metalloproteinases (MMPs), cathepsin proteases, bone resorption) is crucial for understanding the etiology of PTOA. However, there are few options for in vivo measurement of these biological processes, and the early biological responses may be confounded if invasive surgical techniques or injections are used to initiate OA. In our studies of PTOA, we have used commercially available near-infrared protease activatable probes combined with fluorescence reflectance imaging (FRI) to quantify protease activity in vivo following non-invasive compression-induced ACL injury in mice. This non-invasive ACL injury method closely recapitulates clinically relevant injury conditions and is completely aseptic since it does not involve disrupting the skin or the joint capsule. The combination of these injury and imaging methods allows us to study the time course of protease activity at multiple time points following a traumatic joint injury.

Author Spotlight: Investigating Early Events and Long-Term Effects of ACL Injuries for Osteoarthritis Progression

Non-invasive ACL injury is a reliable and clinically relevant method for initiating post-traumatic osteoarthritis (PTOA) in mice. This injury method also allows for in vivo quantification of protease activity in the joint at early time points post-injury using protease-activatable near infrared probes and fluorescence reflectance imaging.

Traumatic joint injuries such as anterior cruciate ligament (ACL) rupture or meniscus tears commonly lead to post-traumatic osteoarthritis (PTOA) within ...

Arthroscopic Double Posteromedial Approach for PCL Cyst Excision

Arthroscopic Excision of Posterior Cruciate Ligament Cysts Using a Double Posteromedial Approach

Cruciate ligament cysts of the knee are a rare condition. Posterior cruciate ligament cysts of the knee are less common than anterior cruciate ligament cysts. In patients with asymptomatic isolated cruciate ligament cysts of the knee, conservative treatment is recommended. Symptomatic cruciate ligament cysts of the knee are mostly manifested as knee hyperflexion pain, straightening pain, knee discomfort after standing for a long time or walking for a long time, etc., which seriously affects the quality of life, surgical treatment can be performed. The surgical treatments can be divided into ultrasound-guided cyst puncture and fluid extraction procedure and arthroscopic cystectomy. Cysts are mostly lobulated with a multi-layer cyst wall, cyst fluid extraction does not remove the cyst wall completely but simply extracts cyst fluid, leading to a high recurrence rate. Arthroscopic surgery can completely remove the cyst wall with little trauma, a low recurrence rate, and fast postoperative recovery, so arthroscopic resection is the most common and preferred method of treatment. Since posterior cruciate ligament cysts mostly occur posterior to the ligament, we remove the cyst wall by adding a double posteromedial approach to the knee joint, and the cyst wall is removed under direct vision, which is simple to operate, the cyst wall is completely cleared, the trauma is small, the postoperative recovery is fast, and there is no recurrence. Here, 8 posterior cruciate ligament cysts were removed with complete postoperative symptom relief, no surgical complications, and no recurrence at 1-year follow-up.

Author Spotlight: Double Posteromedial Approach for Treating Posterior Cruciate Ligament Cysts

We present a surgical approach to treat posterior cruciate ligament cysts by an arthroscopic double posteromedial approach.

Cruciate ligament cysts of the knee are a rare condition. Posterior cruciate ligament cysts of the knee are less common than anterior cruciate ligament ...

Arthroscopic Repair of Medial Meniscus Posterior Root Tear with Adjustable Titanium Plate Fixation

Medial meniscus injury is one of the most prevalent knee disorders, with posterior root tears occurring in approximately 10% to 21% of affected individuals. A posterior root tear disrupts the meniscus's continuous annular structure, compromising its ability to absorb pressure and protect the knee's articular cartilage. If left untreated, this can result in increased stress on the cartilage, leading to conditions such as varus deformity and accelerated joint degeneration. Partial removal (resection) of the medial meniscus further exacerbates these issues, often leading to quicker joint deterioration. Repairing medial meniscus posterior root tears (MMPRTs) plays a crucial role in restoring the meniscus's structural integrity and improving knee biomechanics. Studies have shown that compared to partial medial meniscectomy or conservative treatments, repairing MMPRTs enhances clinical outcomes and significantly delays the onset of arthritis. This article details a surgical procedure that uses a single-suture, double-loop, adjustable titanium plate fixation technique under arthroscopy for effective MMPRT repair.

This article describes a surgical approach to repairing a medial meniscus posterior root tear (MMPRT) using a single-suture, double-loop, adjustable titanium plate internal fixation under arthroscopy.

Medial meniscus injury is one of the most prevalent knee disorders, with posterior root tears occurring in approximately 10% to 21% of affected ...

Visualization of Knee Joint Degeneration after Non-invasive ACL Injury in Rats

Source: Lindsey K. Lepley1,2, Steven M. Davi1, Timothy A. Butterfield3,4 and Sina Shahbazmohamadi5,
1Department of Kinesiology, University of Connecticut, Storrs, CT; 2Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT; 3Department of Rehabilitation Sciences, University of Kentucky, Lexington, KY; 4Center for Muscle Biology, Department of Physiology, University of Kentucky, Lexington, KY; 5Biomedical Engineering Department, University of Connecticut, Storrs, CT
Anterior cruciate ligament (ACL) injury to the knee dramatically increases the risk of post-traumatic osteoarthritis (PTOA), as approximately one-third of individuals will demonstrate radiographic PTOA within the first decade following ACL injury. Though ACL reconstruction (ACLR) successfully restores knee joint stability, ACLR and current rehabilitation techniques do not prevent the onset of PTOA. Therefore, ACL injury represents the ideal model to study the development of PTOA after traumatic joint injury.
Rat models have been used extensively to study the onset and effect of ACL injury on PTOA. The most widely used model of ACL injury is ACL transection, which is an acute model that surgically destabilizes the joint. Though practical, this model does not faithfully mimic human ACL injury due to the invasive and non-physiological injury procedures that mask the native biological response to injury. To improve the clinical translation of our results, we have recently developed a novel non-invasive model of ACL injury where the ACL is ruptured through a single load of tibial compression. This injury closely replicates injury conditions relevant to humans and is highly reproducible.
Visualization of joint degeneration through micro-computed tomography (&#181;CT) provides several major advancements over traditional OA staining techniques, including rapid, high-resolution, non-destructive 3D imaging of whole joint degeneration. The goal of this demonstration is to introduce the state of the art non-invasive ACL injury in a rodent model and use &#181;CT to quantify knee joint degeneration.

Knee Joint Degeneration after Non-invasive Anterior Cruciate Ligament Injury

Source: Lindsey K. Lepley1,2, Steven M. Davi1, Timothy A. Butterfield3,4 and Sina Shahbazmohamadi5,
1Department of Kinesiology, University of Connecticut, ...

Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction

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