Optimal Joint Loading Strategies to Lessen Cartilage Changes after ACLR...

Описание: Optimal Joint Loading Strategies to Lessen Cartilage Changes after ACLR
now Staying within the Envelope of Function: Both Joint Overloading and Underloading can be Detrimental to Cartilage Health Early after ACLR

Mary Lloyd Ireland, M.D.
Professor
University of Kentucky
Dept. of Orthopaedic
Surgery & Sports Medicine, Lexington, KY
www.MaryLloydIreland.com

Staying within the envelope of function: both joint overloading and under-loading can be detrimental to cartilage health early after ACL reconstruction
Thank you to my coauthors
Dalton House, BS1 Sawyer Blair, BS1, Caitlin Conley1, PhD, Darren
Johnson, MD1, Brian Noehren, PhD3, Mary L Ireland, MD1, Cale
Jacobs, PhD

Purpose: Determine whether relative under or overloading is associated with imaging and/or biochemical biomarkers of cartilage degradation after ACLR and whether these association differ over time.

Overloading vs. Underloading
Results S/P ACLR
Find and Maintain Knee Homeostasis
-Use Terms Patients Understand

Envelope of Function Sweet Spot
Find and Maintain Knee Homeostasis

Post OP Protocols
• Should be to restore ROM including extension and strength
• Normalize Gait
• Does WB in Locked post op knee brace cause the articular cartilage problem early
• Normalize Gait Underwater Treadmill
• PWB with Crutches
• Later Return to Impact Cutting Sports

OPTIKNEE Consensus Meta-analysis
66 studies 81 Unique potential risk factors were identified
Sports Scientists & Physical Therapists:
Jackie L Whittaker, Justin M Losciale, Carsten B Juhl, Jonas Bloch Thorlund, Matilde Lundberg, Linda K Truong, Maxi Miciak, Belle
Lore van Meer, Adam G Culvenor, Kay M Crossley, Ewa M Roos, Stefan Lohmander, Marienke van Middelkoop

Participants / Authors from the following countries:
• Canada 5 • Denmark 4 • Netherlands 2 • Sweden 2 • Australia 1
Whittaker JL, Losciale JM, Juhl CB, et al Risk factors for knee osteoarthritis after traumatic knee injury: a systematic review and meta-analysis of randomized controlled trials and cohort studies for the OPTIKNEE Consensus British Journal of Sports Medicine 2022;56:1406-1421.

OPTIKNEE Consensus Clinical Implications
• ACLR does not reduce risk for PTOA
• Perceived value of early ACLR cited as Protective or Harmful for PTOA.
• How is PTOA effected by: • Delayed ACLR
• Not returning to pivoting sports • Rehab and Non Op
No Definitive Answer
Need Evidence Based Studies
Whittaker JL, Losciale JM, Juhl CB, et al Risk factors for knee osteoarthritis after traumatic knee injury: a systematic review and meta-analysis of randomised controlled trials and cohort studies for the OPTIKNEE Consensus British Journal of Sports Medicine 2022;56:1406-1421.

OPTIKNEE Consensus
Manage expectation about risk after ACLR
No clear treatment targets for preventing OA after injury or surgery
Implement evidence-based injury prevention programs
Weight Loss
Quadriceps Strengthening
Whittaker JL, Losciale JM, Juhl CB, et al Risk factors for knee osteoarthritis after traumatic knee injury: a systematic review and meta-analysis of randomised controlled trials and cohort studies for the OPTIKNEE Consensus British Journal of Sports Medicine 2022;56:1406-1421.

ACLSG Beaver Creek 1998
Dye SF. The knee as a biologic transmission with an envelope of function: a theory. Clin Orthop Relat Res. 1996 Apr;(325):10-8. doi: 10.1097/00003086-199604000-00003. PMID: 8998861.
Dye SF, Wojtys EM, Fu FH, Fithian DC, Gillquist I. Factors contributing to function of the knee joint after injury or reconstruction of the anterior cruciate ligament, J.boe Joint Surg 80-A (9) pp1380-1393, 1998.

ISAKOS Lyon, France 2015 Scott Dye, M.D.

“The Knee as a Biologic Transmission with an Envelope of Function”
Scott Dye. Clin Orthop Rel Res 1996;325:(April): 10-18
Zones of Loading
• Disuse
• Homeostasis
• Overuse/Overload • Structural Failure
Goal of Treatment of Knee Disorders
• Maximize the Envelope of Function as Safely and Predictable as Possible
• Inform patients of “lowered threshold” of function

10 Months R ACLR
Forward Trunk & Pelvic Tilt + Trendelenberg – Less knee flexion by 8°
– Less hip adduction by 11°

36YO Female
Professional basketball athlete
RT Knee Allograft ACL reconstruction
Prior left PF Arthrosis

2 Years Post ACL recon
3.5 years postop increasing knee pain

Knee “pack-years” as in smoking: Additive effects of years of participation in basketball. . .
• Pack-yearsofsmokingonlungs • Pack-yearsofactivityonknees
¿Too many Pack Years of Basketball?

Orthopaedic Surgeons Can Stabilize the Knee, but not restore it to Pre-Injury state.
We must communicate honestly with our patients about risks of PTOA
Yearly Follow Up

Thank you
Mary Lloyd Ireland, M.D.
Orthopaedic
Professor
University of Kentucky
-
Surgery & Sports Medicine, Lexington, KY
Dept. of
www.MaryLloydIreland.com