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Patholaxity (Ligamentous) Issues

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Cartilage Restoration

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Abstract

Pathology can be significantly affected by the approach and choice of treatment of ligamentous knee injuries. Non-operative treatment has recently been shown to greatly increase the rates of osteoarthritis of the knee, with a focus of anatomic restoration as the suggested means for surgical approaches, as this more accurately restores the kinematics of the knee. Subsequently, the timing for surgical intervention is key as acute injuries show far fewer incidences of osteoarthritis relative to chronic. Altered articular cartilage contact stress of the tibiofemoral joint occurs following graft placement that does not mimic its native anatomic positioning, but also occurs from the lack of restoring the structural integrity of the knee through each ligamentous stabilizer because of the residual ligamentous laxity that results. Patterns of incidence for concomitant knee injuries are important to understand for properly diagnosing and, furthermore, treating ligamentous injuries of the knee, due to the extreme complexity with both stages of patient care. Failure to reconstruct concomitant injuries adequately can lead to increased force load on the encompassing muscles, tendons, and/or ligaments and furthermore the articulation of the knee. Currently, the topic of greatest interest has been upon the usage of biologics to supplement or even supplant surgical procedures. Three treatment options are currently viewed as the future in biologics, and these include platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and bone marrow aspirate concentrate (BMAC). With the addition of growth factors, promotion of cellular proliferation, migration, survival, and differentiation stands at the forefront for more effective regeneration of damaged ligaments and also for the preservation and healing of articular cartilage.

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References

  1. Geeslin AG, Geeslin MG, LaPrade RF. Ligamentous reconstruction of the knee: what orthopaedic surgeons want radiologists to know. Semin Musculoskelet Radiol. 2017;21(2):75–88.

    Article  PubMed  Google Scholar 

  2. Kennedy NI, LaPrade CM, LaPrade RF. Surgical management and treatment of the anterior cruciate ligament/posterolateral corner injured knee. Clin Sports Med. 2017;36(1):105–17.

    Article  PubMed  Google Scholar 

  3. LaPrade RF, Wentorf FA, Fritts H, Gundry C, Hightower CD. A prospective magnetic resonance imaging study of the incidence of posterolateral and multiple ligament injuries in acute knee injuries presenting with a hemarthrosis. Arthroscopy. 2007;23(12):1341–7.

    Article  PubMed  Google Scholar 

  4. Junkin D, Johnston D, Fu F. Knee ligament injuries. Am Acad Orthop Surg. 2009:135–54.

    Google Scholar 

  5. Salmon LJ, Russell VJ, Refshauge K, Kader D, Connolly C, Linklater J, et al. Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: minimum 13-year review. Am J Sports Med. 2006;34(5):721–32.

    Article  PubMed  Google Scholar 

  6. DeFrate LE. Effects of ACL graft placement on in vivo knee function and cartilage thickness distributions. J Orthop Res. 2017;35(6):1160–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Claes S, Hermie L, Verdonk R, Bellemans J, Verdonk P. Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21(9):1967–76.

    Article  PubMed  Google Scholar 

  8. Geeslin AG, LaPrade RF. Location of bone bruises and other osseous injuries associated with acute grade III isolated and combined posterolateral knee injuries. Am J Sports Med. 2010;38(12):2502–8.

    Article  PubMed  Google Scholar 

  9. LaPrade CM, Civitarese DM, Rasmussen MT, LaPrade RF. Emerging updates on the posterior cruciate ligament: a review of the current literature. Am J Sports Med. 2015;43(12):3077–92.

    Article  PubMed  Google Scholar 

  10. Laprade RF, Griffith CJ, Coobs BR, Geeslin AG, Johansen S, Engebretsen L. Improving outcomes for posterolateral knee injuries. J Orthop Res. 2014;32(4):485–91.

    Article  PubMed  Google Scholar 

  11. LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A. An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med. 2004;32(6):1405–14.

    Article  PubMed  Google Scholar 

  12. LaPrade RF, Tso A, Wentorf FA. Force measurements on the fibular collateral ligament, popliteofibular ligament, and popliteus tendon to applied loads. Am J Sports Med. 2004;32(7):1695–701.

    Article  PubMed  Google Scholar 

  13. Kannus P. Nonoperative treatment of grade II and III sprains of the lateral ligament compartment of the knee. Am J Sports Med. 1989;17(1):83–8.

    Article  CAS  PubMed  Google Scholar 

  14. LaPrade RF, Resig S, Wentorf F, Lewis JL. The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. A biomechanical analysis. Am J Sports Med. 1999;27(4):469–75.

    Article  CAS  PubMed  Google Scholar 

  15. Li G, Moses JM, Papannagari R, Pathare NP, DeFrate LE, Gill TJ. Anterior cruciate ligament deficiency alters the in vivo motion of the tibiofemoral cartilage contact points in both the anteroposterior and mediolateral directions. J Bone Joint Surg Am. 2006;88(8):1826–34.

    Article  PubMed  Google Scholar 

  16. Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med. 2002;30(5):660–6.

    Article  PubMed  Google Scholar 

  17. Robertson A, Nutton RW, Keating JF. Dislocation of the knee. J Bone Joint Surg Br. 2006;88(6):706–11.

    Article  CAS  PubMed  Google Scholar 

  18. Shino K, Mae T, Tachibana Y, Anatomic ACL. Reconstruction: rectangular tunnel/bone-patellar tendon-bone or triple-bundle/semitendinosus tendon grafting. J Orthop Sci. 2015;20(3):457–68.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ, et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy. 2009;25(4):430–8.

    Article  PubMed  Google Scholar 

  20. Moatshe G, Dornan GJ, Loken S, Ludvigsen TC, LaPrade RF, Engebretsen L. Demographics and injuries associated with knee dislocation: a prospective review of 303 patients. Orthop J Sports Med. 2017;5(5):2325967117706521.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Moatshe G, Chahla J, LaPrade RF, Engebretsen L. Diagnosis and treatment of multiligament knee injury: state of the art. J ISAKOS: Joint Disord Orthop Sports Med. 2017;2(3):152–61.

    Article  Google Scholar 

  22. Becker EH, Watson JD, Dreese JC. Investigation of multiligamentous knee injury patterns with associated injuries presenting at a level I trauma center. J Orthop Trauma. 2013;27(4):226–31.

    Article  PubMed  Google Scholar 

  23. Moatshe G, Dornan GJ, Ludvigsen T, Loken S, LaPrade RF, Engebretsen L. High prevalence of knee osteoarthritis at a minimum 10-year follow-up after knee dislocation surgery. Knee Surg Sports Traumatol Arthrosc. 2017;25:3914–22.

    Article  PubMed  Google Scholar 

  24. Øiestad BE, Engebretsen L, Storheim K, Risberg MA. Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med. 2009;37(7):1434–43.

    Article  PubMed  Google Scholar 

  25. Krych AJ, Sousa PL, King AH, Engasser WM, Stuart MJ, Levy BA. Meniscal tears and articular cartilage damage in the dislocated knee. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):3019–25.

    Article  PubMed  Google Scholar 

  26. Richter M, Bosch U, Wippermann B, Hofmann A, Krettek C. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med. 2002;30(5):718–27.

    Article  PubMed  Google Scholar 

  27. Fanelli GC, Edson CJ. Posterior cruciate ligament injuries in trauma patients: Part II. Arthroscopy. 1995;11(5):526–9.

    Article  CAS  PubMed  Google Scholar 

  28. Kennedy NI, Wijdicks CA, Goldsmith MT, Michalski MP, Devitt BM, Aroen A, et al. Kinematic analysis of the posterior cruciate ligament, Part 1: the individual and collective function of the anterolateral and posteromedial bundles. Am J Sports Med. 2013;41(12):2828–38.

    Article  PubMed  Google Scholar 

  29. Skyhar MJ, Warren RF, Ortiz GJ, Schwartz E, Otis JC. The effects of sectioning of the posterior cruciate ligament and the posterolateral complex on the articular contact pressures within the knee. J Bone Joint Surg Am. 1993;75(5):694–9.

    Article  CAS  PubMed  Google Scholar 

  30. Spiridonov SI, Slinkard NJ, LaPrade RF. Isolated and combined grade-III posterior cruciate ligament tears treated with double-bundle reconstruction with use of endoscopically placed femoral tunnels and grafts: operative technique and clinical outcomes. J Bone Joint Surg Am. 2011;93(19):1773–80.

    Article  PubMed  Google Scholar 

  31. Hermans S, Corten K, Bellemans J. Long-term results of isolated anterolateral bundle reconstructions of the posterior cruciate ligament: a 6- to 12-year follow-up study. Am J Sports Med. 2009;37(8):1499–507.

    Article  PubMed  Google Scholar 

  32. Chahla J, Nitri M, Civitarese D, Dean CS, Moulton SG, LaPrade RF. Anatomic double-bundle posterior cruciate ligament reconstruction. Arthrosc Tech. 2016;5(1):e149–56.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Shelbourne KD, Clark M, Gray T. Minimum 10-year follow-up of patients after an acute, isolated posterior cruciate ligament injury treated nonoperatively. Am J Sports Med. 2013;41(7):1526–33.

    Article  PubMed  Google Scholar 

  34. Kim SJ, Kim SH, Jung M, Kim JM, Lee SW. Does sequence of graft tensioning affect outcomes in combined anterior and posterior cruciate ligament reconstructions? Clin Orthop Relat Res. 2015;473(1):235–43.

    Article  PubMed  Google Scholar 

  35. LaPrade RF, Geeslin AG, Murray IR, Musahl V, Zlotnicki JP, Petrigliano F, et al. Biologic treatments for sports injuries II think tank-current concepts, future research, and barriers to advancement, Part 1: biologics overview, ligament injury, Tendinopathy. Am J Sports Med. 2016;44(12):3270–83.

    Article  PubMed  Google Scholar 

  36. Chahla J, Dean CS, Moatshe G, Pascual-Garrido C, Serra Cruz R, LaPrade RF. Concentrated bone marrow aspirate for the treatment of chondral injuries and osteoarthritis of the knee: a systematic review of outcomes. Orthop J Sports Med. 2016;4(1):2325967115625481.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Anderson K, Seneviratne AM, Izawa K, Atkinson BL, Potter HG, Rodeo SA. Augmentation of tendon healing in an intraarticular bone tunnel with use of a bone growth factor. Am J Sports Med. 2001;29(6):689–98.

    Article  CAS  PubMed  Google Scholar 

  38. Caplan AI. Mesenchymal stem cells. J Orthop Res. 1991;9(5):641–50.

    Article  CAS  PubMed  Google Scholar 

  39. Smith RK, Werling NJ, Dakin SG, Alam R, Goodship AE, Dudhia J. Beneficial effects of autologous bone marrow-derived mesenchymal stem cells in naturally occurring tendinopathy. PLoS One. 2013;8(9):e75697.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Gobbi A, Whyte GP. One-stage cartilage repair using a hyaluronic acid-based scaffold with activated bone marrow-derived mesenchymal stem cells compared with microfracture: five-year follow-up. Am J Sports Med. 2016;44(11):2846–54.

    Article  PubMed  Google Scholar 

  41. Coobs BR, Wijdicks CA, Armitage BM, Spiridonov SI, Westerhaus BD, Johansen S, Engebretsen L, LaPrade RF. An in vitro analysis of an anatomic medial knee reconstruction. Am J Sports Med. 2010;38:339–47.

    Article  PubMed  Google Scholar 

  42. Wijdicks CA, et al. Kinematic analysis of the posterior cruciate ligament, Part 2: a comparison of anatomic single- versus double-bundle reconstruction. Am J Sports Med. 2013;41(12):2839–48.

    Article  PubMed  Google Scholar 

  43. Chahla J, Mannava S, Cinque ME, et al. Bone Marrow aspirate concentrate harvesting and processing technique. J Arthrosc Relat Surg. 2017;6(2):e441–5.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Clinical Outcomes-Based Orthopedic Research, Steadman Philippon Research Institute, Vail, CO, USA

    Mitchell Iung Kennedy

  2. Department of BioMedical Engineering, Steadman-Philippon Research Institute, Vail, CO, USA

    Zachary S. Aman

  3. The Steadman Clinic, Vail, CO, USA

    Robert F. LaPrade

Authors
  1. Mitchell Iung Kennedy
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  2. Zachary S. Aman
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  3. Robert F. LaPrade
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Corresponding author

Correspondence to Robert F. LaPrade .

Editor information

Editors and Affiliations

  1. OrthoIndy Knee Preservation and Cartilage Restoration Center of Indiana, Indianapolis, Indiana, USA

    Jack Farr

  2. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA

    Andreas H. Gomoll

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Kennedy, M.I., Aman, Z.S., LaPrade, R.F. (2018). Patholaxity (Ligamentous) Issues. In: Farr, J., Gomoll, A. (eds) Cartilage Restoration. Springer, Cham. https://doi.org/10.1007/978-3-319-77152-6_8

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  • DOI: https://doi.org/10.1007/978-3-319-77152-6_8

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-77152-6

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